Center for Musculoskeletal Surgery, Campus Virchow Klinikum, Charité-Universitätsmedizin Berlin, Augustenburgerplatz 1, 13353 Berlin, Germany.
AJR Am J Roentgenol. 2013 Sep;201(3):496-504. doi: 10.2214/AJR.12.8553.
The purpose of this study was to examine the advantages of MRI-guided ankle stress examinations in the detection of chronic ankle instability.
An MRI-compatible stress device was developed and tested for MRI safety. Bilateral MRI stress examinations were performed on 50 volunteers with and without clinically evident subjective instability of the ankle joints (72 subjective stable ankle joints in 37 subjects, 28 ankles in 15 subjects with chronic ankle instability). Both the inversion test and the anterior drawer test were performed under axial, coronal, 45° paraxial, and sagittal T2-weighted fast spin-echo image control. MR images were assessed for talar tilt, subtalar tilt, anterior talus translation, anterior calcaneus translation, medial talocalcaneal translation, and the diameters of the lateral ankle ligaments (anterior talofibular ligament, calcaneofibular ligament, and posterior talofibular ligament).
The MRI stress device was found suitable and safe for use in the MRI environment. The talocrural and subtalar joints could be assessed simultaneously. Significant differences between groups A and B (p≤0.05) were found in talar tilt, subtalar tilt, anterior talus translation, anterior calcaneus translation, medial talocalcaneal translation, and decrease in diameters of calcaneofibular and posterior talofibular ligaments. Also found were sex differences in talar tilt, subtalar tilt, anterior talus translation, and diameters of the anterior talofibular, calcaneofibular, and posterior talofibular ligaments. Significant relations were found between talar tilt and anterior talus translation, subtalar tilt and anterior calcaneus translation, subtalar tilt and medial talocalcaneal translation, and between anterior calcaneus translation and medial talocalcaneal translation in groups A and B.
Stress examination under MRI control has advantages in the assessment of mechanical ankle instability. Additional diagnostic and clinically relevant information is obtained through direct imaging of the ligaments and assessment of additional parameters of ankle laxity (subtalar tilt, anterior calcaneus translation, medial talocalcaneal translation). The main advantages are objective imaging and measurement of abnormal looseness of the lower ankle joint and its direct simultaneous comparison with the upper ankle joint.
本研究旨在探讨 MRI 引导下踝关节应力检查在慢性踝关节不稳定中的优势。
开发了一种 MRI 兼容的应力装置，并对其进行了 MRI 安全性测试。对 50 名志愿者进行了双侧 MRI 应力检查，这些志愿者的踝关节均有或无临床明显的主观不稳定（37 名受试者的 72 个主观稳定踝关节，15 名慢性踝关节不稳定受试者的 28 个踝关节）。在轴向、冠状、45°旁轴和矢状 T2 加权快速自旋回波图像控制下进行了内翻试验和前抽屉试验。评估距骨倾斜、距下倾斜、距骨前移位、跟骨前移位、内侧距跟骨移位和外侧踝关节韧带（距腓前韧带、跟腓韧带和距腓后韧带）直径。
MRI 应力装置在 MRI 环境中被发现是合适且安全的。可同时评估距小腿关节和距下关节。组 A 和组 B 之间存在显著差异（p≤0.05），包括距骨倾斜、距下倾斜、距骨前移位、跟骨前移位、内侧距跟骨移位和跟腓后韧带、距腓后韧带直径减小。还发现了性别差异，包括距骨倾斜、距下倾斜、距骨前移位和距腓前韧带、跟腓韧带和距腓后韧带的直径。在组 A 和组 B 中，距骨倾斜与距骨前移位、距下倾斜与跟骨前移位、距下倾斜与内侧距跟骨移位以及跟骨前移位与内侧距跟骨移位之间存在显著相关性。
MRI 控制下的应力检查在评估机械性踝关节不稳定方面具有优势。通过直接成像和评估踝关节松弛度的附加参数（距下倾斜、跟骨前移位、内侧距跟骨移位）可获得额外的诊断和临床相关信息。主要优势是客观成像和测量下踝关节的异常松弛，并直接与上踝关节进行比较。
