Chou Mei-Chun, Yeh Lee-Ren, Chen Clement Kuen-Huang, Pan Huay-Ban, Chou Yi-Jiun, Liang Huei-Lung
Department of Radiology, Kaohsiung Veterans General Hospital, Kaohsiung, Taiwan, ROC.
J Chin Med Assoc. 2006 Jan;69(1):26-31. doi: 10.1016/s1726-4901(09)70107-8.
The purpose of this study was to determine the efficacy of plain magnetic resonance imaging (MRI) and magnetic resonance (MR) arthrography for detecting collateral ligamentous injury of the ankle joint.
Fifty patients (October 2001 to November 2003) suffering from ankle disability who underwent plain MRI and MR arthrographic studies were enrolled in this study. The diagnostic criteria for ligament disruption on plain MRI included nonvisualization, disruption, waviness of the ligament, or coexistent avulsion fracture. The MR arthrographic findings of ligament disruption were based on leakage of gadolinium contrast medium anterior to the anterior talofibular (ATaF) ligament following ATaF ligament disruption, and the contrast medium filling into the common peroneal tendon sheath after calcaneofibular (CF) ligament disruption. The 2 modalities were interpreted respectively and blindly.
Seventeen patients received surgical intervention. There were 14 patients who had a torn ATaF ligament and 6 patients who suffered from CF ligament disruption proved by surgery. Limited detection of preoperative plain MRI survey, which showed 12 patients had torn ATaF and 2 patients had torn CF ligament, was noted. However, most patients with ligamentous injury were correctly diagnosed by MR arthrography preoperatively (only 1 case of CF injury was missed). The plain MRI alone had a higher incidence of false negative and false positive detection. MR arthrography was also valuable for evaluating the coexisting intra-articular pathologies of the ankle joint.
For evaluating ankle disability, using plain MRI alone is not adequate for correctly detecting lateral collateral ligamentous injury of the ankle joint. MR arthrography improves the sensitivity and the accuracy for ATaF and CF ligament injuries. It also helps in assessing coexisting pathologic lesions of ankle joints, especially impingement syndromes and osteochondral lesions, and provides more information for therapeutic decision making.
本研究的目的是确定普通磁共振成像（MRI）和磁共振（MR）关节造影在检测踝关节侧副韧带损伤方面的疗效。
本研究纳入了50例（2001年10月至2003年11月）因踝关节功能障碍而接受普通MRI和MR关节造影检查的患者。普通MRI上韧带断裂的诊断标准包括韧带未显影、中断、走行迂曲或并存撕脱骨折。MR关节造影中韧带断裂的表现基于钆对比剂在距腓前韧带（ATaF）断裂后于其前方漏出，以及在跟腓韧带（CF）断裂后对比剂充盈至腓总腱鞘内。分别对这两种检查方式进行独立且盲法解读。
17例患者接受了手术干预。手术证实有14例患者存在ATaF韧带撕裂，6例患者存在CF韧带断裂。术前普通MRI检查的检出率有限，显示有12例患者存在ATaF韧带撕裂，2例患者存在CF韧带撕裂。然而，大多数韧带损伤患者术前通过MR关节造影得到了正确诊断（仅漏诊1例CF损伤）。单纯普通MRI的假阴性和假阳性检出率较高。MR关节造影对于评估踝关节并存的关节内病变也很有价值。
对于评估踝关节功能障碍，仅使用普通MRI不足以正确检测踝关节外侧副韧带损伤。MR关节造影提高了对ATaF和CF韧带损伤的敏感性和准确性。它还有助于评估踝关节并存的病理病变，尤其是撞击综合征和骨软骨损伤，并为治疗决策提供更多信息。
