Morton 神经瘤：切除术后的 MRI 表现——无症状和有症状的跖间间隙的术后 MRI 和组织学发现。

Morton neuroma: MR imaging after resection--postoperative MR and histologic findings in asymptomatic and symptomatic intermetatarsal spaces.

机构信息

Department of Orthopedics, University Hospital Balgrist, University of Zurich, Forchstrasse 340, CH-8008 Zurich, Switzerland.

出版信息

Radiology. 2010 Jun;255(3):850-6. doi: 10.1148/radiol.10091531.

DOI:10.1148/radiol.10091531

PMID:20501722

Abstract

PURPOSE

To evaluate the prevalence of postoperative magnetic resonance (MR) imaging findings in asymptomatic and symptomatic patients after resection of Morton neuroma.

MATERIALS AND METHODS

This study was approved by the institutional review board. Informed consent was obtained from each participant. Fifty-eight consecutive patients (46 women, 12 men) who had undergone resection of a painful Morton neuroma (90 Morton neuromas were removed in 66 feet), pre- and postoperative MR imaging, and clinical follow-up for a minimum of 2 years after surgery were identified. Two experienced musculoskeletal radiologists evaluated MR images with regard to the presence of presumed recurrent Morton neuroma, scar, or intermetatarsal bursitis. The prevalence of abnormalities in asymptomatic and symptomatic intermetatarsal spaces was determined. The results of the second radiologist were used only to determine interobserver reliability. The kappa statistics were obtained to assess interobserver agreement. Seven patients with presumed recurrent Morton neuroma underwent repeat surgery.

RESULTS

Clinically speaking, 68 intermetatarsal spaces (44 of 58 patients [76%], 47 feet) were asymptomatic at follow-up and 22 (14 of 58 patients [24%], 19 feet) were symptomatic. A presumed Morton neuroma was found in 18 (26%) of the asymptomatic spaces and 11 (50%) of the symptomatic spaces. A presumed scar was found in six (9%) of the asymptomatic spaces and two (9%) of the symptomatic spaces. A presumed intermetatarsal bursitis was found in six (9%) of the asymptomatic spaces and six (27%) of the symptomatic spaces. Interobserver agreement for presumed recurrent Morton neuroma was substantial (kappa = 0.64). Histologic examination of presumed recurrent Morton neuroma revealed fibrous tissue but no sign of peripheral neural tissue.

CONCLUSION

MR imaging after Morton neuroma resection commonly reveals Morton neuroma-like abnormalities in asymptomatic and symptomatic intermetatarsal spaces.

摘要

目的

评估无症状和有症状的莫顿神经瘤切除术后磁共振成像（MR）检查结果的发生率。

材料与方法

本研究经机构审查委员会批准，所有参与者均签署了知情同意书。共确定了 58 例连续患者（46 名女性，12 名男性），这些患者均因疼痛性莫顿神经瘤（66 只脚中有 90 个莫顿神经瘤被切除）而行切除术，术前和术后均行 MR 成像，并在手术后至少 2 年进行临床随访。两位有经验的肌肉骨骼放射科医生评估了 MR 图像中是否存在疑似复发性莫顿神经瘤、疤痕或中间跖骨囊炎。确定无症状和有症状的中间跖骨空间中异常的发生率。第二位放射科医生的结果仅用于确定观察者间的可靠性。获得kappa 统计数据以评估观察者间的一致性。对 7 例疑似复发性莫顿神经瘤的患者进行了重复手术。

结果

从临床角度来看，在随访时，68 个中间跖骨空间（58 例患者中的 44 例[76%]，47 只脚）无症状，22 个中间跖骨空间（58 例患者中的 14 例[24%]，19 只脚）有症状。在 18 个（26%）无症状的空间和 11 个（50%）有症状的空间中发现了疑似莫顿神经瘤。在 6 个（9%）无症状的空间和 2 个（9%）有症状的空间中发现了疑似疤痕。在 6 个（9%）无症状的空间和 6 个（27%）有症状的空间中发现了疑似中间跖骨囊炎。疑似复发性莫顿神经瘤的观察者间一致性为中等（kappa = 0.64）。对疑似复发性莫顿神经瘤的组织学检查显示纤维组织，但无周围神经组织的迹象。