Quantitative Imaging Biomarkers of PRP-Induced Tendon Remodeling in Chronic Tendinopathy: Review and Single-Center Experience with Ultrasound Radiomics and MRI T2 Profiling

This review discusses the use of platelet-rich plasma (PRP) as a treatment for chronic tendinopathy and the integration of quantitative imaging techniques to monitor tendon response. The study highlights the use of ultrasound shear-wave elastography, radiomics, and MRI T2/T2* mapping as potential biomarkers for tendon structure and inflammation. At the authors' center, leukocyte-rich PRP is administered under ultrasound guidance, and follow-up includes questionnaires and texture analysis of ultrasound and MRI data. A pilot study showed short-term clinical improvement and significant changes in texture features, with some correlating with symptom relief. A prospective cohort demonstrated significant six-month clinical gains, particularly in tendinosis cases, suggesting that these imaging biomarkers can effectively capture PRP-induced tendon remodeling and may help tailor PRP protocols to specific tendon phenotypes.