Perini L, Del Borrello M, Cipriano R, Cavallo A, Volpe A
Diagnostica per immagini di Euganea Medica, Via Colombo 13, I-35020 Albignasego (PD), Italy.
Radiol Med. 2006 Oct;111(7):897-905. doi: 10.1007/s11547-006-0088-2. Epub 2006 Oct 11.
The aim of this paper is to demonstrate the efficacy of the dynamic study of the forefoot during lateral compression of the metatarsal heads (Mulder's manoeuvre) in the visualisation of Morton's neuroma. The data were compared with clinical signs, conventional ultrasound (US), magnetic resonance (MR) and surgical findings.
Forty forefeet in 38 patients were investigated with conventional and dynamic US using a 10-MHz linear probe (Esaote Technos). MR was performed in 26 forefeet with a 0.2-T scanner (Esaote Artoscan). Twenty intermetatarsal spaces in 18 forefeet were explored surgically.
Thirty-seven intermetatarsal masses were identified through dynamic US in the 40 forefeet investigated (two double localisations). This method was clearly more effective than conventional US, which could only locate 25. In those forefeet investigated with MR, it was possible to confirm dynamic US findings in 16 out of 22. In one of the six cases unconfirmed by MR, a neuroma was removed following surgery. Twenty masses (19 neuromas and one synovial ganglion) were found in the 18 forefeet treated by surgery.
Clinical evaluation, which is fundamental for accurate diagnosis, can make use of dynamic US in the first instance in order to confirm clinical signs and identify the correct site and number of masses. In our opinion, MR maintains a primary role in differential diagnosis with other diseases (mainly stress fractures, bursitis, ganglion cysts or tendon tumour sheaths).
本文旨在证明在跖骨头外侧挤压（穆德手法）过程中对前足进行动态研究在可视化莫顿神经瘤方面的有效性。将数据与临床体征、传统超声（US）、磁共振（MR）及手术结果进行比较。
使用10MHz线性探头（百胜Technos）对38例患者的40只前足进行传统及动态超声检查。使用0.2T扫描仪（百胜Artoscan）对26只前足进行磁共振成像检查。对18只前足的二十个跖间隙进行手术探查。
在接受检查的40只前足中，通过动态超声发现了37个跖间隙肿物（2例为双重定位）。该方法明显比传统超声更有效，传统超声仅能定位25个。在接受磁共振成像检查的前足中，22例中有16例能够证实动态超声检查结果。在磁共振成像未证实的6例病例中，有1例在手术后切除了神经瘤。在接受手术治疗的18只前足中发现了20个肿物（19个神经瘤和1个滑膜囊肿）。
临床评估对于准确诊断至关重要，首先可利用动态超声来确认临床体征并确定肿物的正确位置和数量。我们认为，磁共振成像在与其他疾病（主要是应力性骨折、滑囊炎、腱鞘囊肿或肌腱鞘瘤）的鉴别诊断中仍起主要作用。
