Ormeci Tugrul, Güler Olcay, Malkoc Melih, Keskinbora Mert, Güngören Fatma Zeynep, Mahirogulları Mahir
Assistant Professor, Department of Radiology, Medipol University, Faculty of Medicine, Istanbul, Turkey.
Assistant Professor, Department of Orthopaedics and Traumatology, Medipol University, Faculty of Medicine, Istanbul, Turkey.
J Foot Ankle Surg. 2016 Jul-Aug;55(4):720-6. doi: 10.1053/j.jfas.2016.01.025. Epub 2016 Mar 8.
The objective of the present study was to characterize the ultrasound and elastographic properties of intermetatarsal neuroma (interdigital neuroma) and their contribution to diagnosis. Eighteen patients with metatarsalgia, who had presented to an orthopedic clinic from April 2013 to February 2015, were diagnosed with 25 intermetatarsal neuromas (11 unilateral [61.11%], 7 bilateral [38.89%]). These patients underwent evaluation with ultrasonography and simultaneous ultrasound strain elastography to assess the elastographic properties of the tissues in the intermetatarsal space. The intermetatarsal neuroma diagnosis was confirmed by histopathologic inspection. The lesion contours, localization, dimensions, and vascularization were evaluated before surgical excision. The elasticity and strain ratio values were compared between the neuroma and adjacent healthy intermetatarsal space. Of the 25 intermetatarsal neuromas, 1 (4%) was not detected by ultrasonography (incidence of detection of 96%). The mean neuroma width was 6.35 (range 3.7 to 13) mm in the coronal plane, and the mean elasticity and strain ratio values were 3.44 (range 1.1 to 5.1) and 9.47 (range 2.3 to 19.3), respectively. The elasticity and strain ratio values were significantly greater in the presence of an interdigital neuroma than in the adjacent healthy intermetatarsal spaces (Z = -3.964, p = .0001 and Z = -3.927, p = .0001, respectively). The diagnostic cutoff values were calculated as 2.52 for elasticity and 6.1 for the strain ratio. Four neuromas (16%) were not demarcated, and the elasticity and strain ratio values for these were lower than those for neuromas with demarcated contours but were greater than those for healthy intermetatarsal spaces (p < .006 and p < .005, respectively). Patients with clinically suspected intermetatarsal neuromas that do not show demarcation and with smaller lesions might benefit from the use of ultrasound elastography for diagnosis.
本研究的目的是描述跖间神经瘤（趾间神经瘤）的超声和弹性成像特征及其对诊断的贡献。2013年4月至2015年2月在骨科门诊就诊的18例跖痛症患者被诊断为25个跖间神经瘤（11例单侧[61.11%]，7例双侧[38.89%]）。这些患者接受了超声检查及同步超声应变弹性成像，以评估跖间隙组织的弹性成像特征。跖间神经瘤的诊断经组织病理学检查证实。在手术切除前评估病变的轮廓、定位、大小和血管形成情况。比较神经瘤与相邻健康跖间隙的弹性和应变比值。25个跖间神经瘤中，1个（4%）未被超声检测到（检测率为96%）。神经瘤在冠状面的平均宽度为6.35（范围3.7至13）mm，平均弹性和应变比值分别为3.44（范围1.1至5.1）和9.47（范围2.3至19.3）。存在趾间神经瘤时的弹性和应变比值显著高于相邻健康跖间隙（Z = -3.964，p = 0.0001；Z = -3.927，p = 0.0001）。弹性的诊断临界值计算为2.52，应变比值的诊断临界值计算为6.1。4个神经瘤（16%）边界不清，其弹性和应变比值低于边界清晰的神经瘤，但高于健康跖间隙（p分别<0.006和p<0.005）。临床疑似但未显示边界且病变较小的跖间神经瘤患者可能会受益于超声弹性成像用于诊断。
