Bencardino J, Rosenberg Z S, Beltran J, Liu X, Marty-Delfaut E
Department of Radiology, Massachusetts General Hospital, 15 Parkman St., Ste. 515, Boston, MA 02114, USA.
AJR Am J Roentgenol. 2000 Sep;175(3):649-53. doi: 10.2214/ajr.175.3.1750649.
We determined the prevalence of clinically silent Morton's neuroma and searched for distinguishing MR imaging features of Morton's neuroma in patients with clinical complaints related to this entity and in patients with clinically silent lesions.
One radiologist who was unaware of clinical findings retrospectively reviewed 85 consecutive foot MR examinations. MR imaging criteria for Morton's neuroma included a low- to intermediate-signal-intensity soft-tissue mass in the intermetatarsal space. The size, location, and signal intensity of each neuroma and the presence of intermetatarsal bursae were recorded. The patients were subdivided into symptomatic or asymptomatic groups on the basis of the patients' answers on a questionnaire documenting the locations and characteristics of symptoms and discussions with each referring physician about clinical findings. Surgical confirmation was available in eight of 25 symptomatic patients.
The prevalence of Morton's neuroma in patients with no clinical evidence of this condition was 33% (19/57). Twenty-five patients had symptomatic Morton's neuroma, 19 had Morton's neuroma based on MR imaging findings with no clinical manifestations, and 41 did not have Morton's neuroma. Slightly larger lesions were observed in the symptomatic group, although significant overlap was noted between the two groups. The mean transverse diameter of symptomatic neuromas was 5.3 mm (standard deviation, 2.14) compared with 4.1 mm (standard deviation, 1.75) for asymptomatic neuromas; this difference was marginally significant (p = 0.05).
The MR imaging diagnosis of Morton's neuroma does not imply symptomatology. Careful correlation between clinical and MR imaging findings is mandatory before Morton's neuroma is considered clinically relevant.
我们确定了临床无症状的莫顿神经瘤的患病率，并寻找与该疾病相关临床症状患者及临床无症状病变患者中莫顿神经瘤的鉴别性磁共振成像（MR）特征。
一名对临床检查结果不知情的放射科医生对85例连续的足部MR检查进行了回顾性分析。莫顿神经瘤的MR成像标准包括跖骨间隙内低至中等信号强度的软组织肿块。记录每个神经瘤的大小、位置、信号强度以及跖骨间滑囊的存在情况。根据患者对记录症状位置和特征的问卷回答以及与每位转诊医生关于临床检查结果的讨论，将患者分为有症状组或无症状组。25例有症状的患者中有8例获得了手术证实。
无该疾病临床证据的患者中莫顿神经瘤的患病率为33%（19/57）。25例患者有症状性莫顿神经瘤，19例基于MR成像结果诊断为莫顿神经瘤但无临床表现，41例没有莫顿神经瘤。有症状组的病变略大，尽管两组之间有明显重叠。有症状神经瘤的平均横径为5.3毫米（标准差，2.14），无症状神经瘤为4.1毫米（标准差，1.75）；这种差异具有边缘显著性（p = 0.05）。
莫顿神经瘤的MR成像诊断并不意味着有症状。在认为莫顿神经瘤具有临床相关性之前，必须仔细对比临床和MR成像结果。
