Sharp R J, Wade C M, Hennessy M S, Saxby T S
The Brisbane Foot and Ankle Centre, Queensland, Australia.
J Bone Joint Surg Br. 2003 Sep;85(7):999-1005. doi: 10.1302/0301-620x.85b7.12633.
We investigated 29 cases, diagnosed clinically as having Morton's neuroma, who had undergone MRI and ultrasound before a neurectomy. The accuracy with which pre-operative clinical assessment, ultrasound and MRI had correctly diagnosed the presence of a neuroma were compared with one another based on the histology and the clinical outcome. Clinical assessment was the most sensitive and specific modality. The accuracy of the ultrasound and MRI was similar and dependent on size. Ultrasound was especially inaccurate for small lesions. There was no correlation between the size of the lesion and either the pre-operative pain score or the change in pain score following surgery. Reliance on single modality imaging would have led to inaccurate diagnosis in 18 cases and would have only benefited one patient. Even imaging with both modalities failed to meet the predictive values attained by clinical assessment. There is no requirement for ultrasound or MRI in patients who are thought to have a Morton's neuroma. Small lesions, < 6 mm in size, are equally able to cause symptoms as larger lesions. Neurectomy provides an excellent clinical outcome in most cases.
我们调查了29例临床诊断为莫顿神经瘤的患者，这些患者在进行神经切除术之前接受了MRI和超声检查。根据组织学和临床结果，比较术前临床评估、超声和MRI正确诊断神经瘤存在的准确性。临床评估是最敏感和特异的方式。超声和MRI的准确性相似，且取决于大小。超声对小病变尤其不准确。病变大小与术前疼痛评分或术后疼痛评分变化之间无相关性。仅依靠单一模式成像会导致18例诊断不准确，且仅对1例患者有益。即使两种模式成像也未能达到临床评估所获得的预测价值。对于疑似患有莫顿神经瘤的患者，无需进行超声或MRI检查。小于6mm的小病变与较大病变一样容易引起症状。在大多数情况下，神经切除术可提供良好的临床结果。
