Park Sungchul, Han Seo-Goo, Kim Koeun, Lee Heungwoo, Bang Yun-Sic, Kang Keum Nae, Lee Jonghyuk, Kim Young Uk
Department of Anesthesiology and Pain Medicine, CHA Bundang Medical Center, CHA University, Seongnam 13496, Korea.
Department of Internal Medicine, Catholic Kwandong University, College of Medicine, International St. Mary's Hospital, Incheon 22711, Korea.
Quant Imaging Med Surg. 2021 Feb;11(2):533-539. doi: 10.21037/qims-20-764.
An injured calcaneofibular ligament (CFL) is a major cause of ankle instability (AI). Previous research has demonstrated that the thickness of the calcaneofibular ligament (CFLT) is correlated with higher-grade sprains and ankle instability. However, inflammatory hypertrophy is distinct from ligament thickness; accordingly, we considered that the calcaneofibular ligament cross-sectional area (CFLCSA) as a potential morphological parameter to analyze inflammatory CFL. We hypothesized that the CFLCSA was a key morphologic parameter in AI diagnosis.
We gathered the CFL data of 26 AI patients and 25 control subjects who had undergone ankle magnetic resonance imaging (A-MRI), and it had revealed no evidence of AI. Ankle level T1-weighted coronal A-MRI images were acquired. Using our image analysis program (INFINITT PACS), we analyzed the CFLT and CFLCSA at the CFL on the A-MRI. The CFLCSA was measured as the whole ligament cross-sectional area of the CFL that was most hypertrophied in the transverse A-MR images. The CFLT was measured at the thickest level of CFL.
The mean CFLT was 3.49±0.82 mm in the control group, and 4.82±0.76 mm in the AI group. The mean CFLCSA was 33.31±7.02 mm in the control group, and 65.33±20.91 mm in the AI group. The AI patients had significantly greater CFLT (P<0.001) and CFLCSA (P<0.001) than the control group participants. A receiver operating characteristic (ROC) curve analysis in the evaluation of the diagnostic tests showed that the optimal cut-off score of the CFLT was 4.06 mm, with 76.9% sensitivity, 76.0% specificity, and an area under the curve (AUC) of 0.89 (95% CI, 0.79-0.99). The optimal cut-off threshold of the CFLCSA was 43.85 mm, with 92.3% sensitivity, 92.0% specificity, and AUC of 0.94 (95% CI, 0.86-1.00).
Even though the CFLT and CFLCSA were both significantly associated with AI, the CFLCSA was a more sensitive diagnostic test.
跟腓韧带（CFL）损伤是踝关节不稳（AI）的主要原因。先前的研究表明，跟腓韧带厚度（CFLT）与较高级别的扭伤和踝关节不稳相关。然而，炎症性肥大与韧带厚度不同；因此，我们认为跟腓韧带横截面积（CFLCSA）作为分析炎症性CFL的潜在形态学参数。我们假设CFLCSA是AI诊断中的关键形态学参数。
我们收集了26例AI患者和25例接受踝关节磁共振成像（A-MRI）且未显示AI证据的对照受试者的CFL数据。获取踝关节水平的T1加权冠状位A-MRI图像。使用我们的图像分析程序（INFINITT PACS），我们在A-MRI上分析CFL处的CFLT和CFLCSA。CFLCSA测量为横向A-MR图像中最肥厚的CFL的整个韧带横截面积。CFLT在CFL最厚的水平处测量。
对照组的平均CFLT为3.49±0.82mm，AI组为4.82±0.76mm。对照组的平均CFLCSA为33.31±7.02mm，AI组为65.33±20.91mm。AI患者的CFLT（P<0.001）和CFLCSA（P<0.001）明显大于对照组参与者。诊断试验评估中的受试者工作特征（ROC）曲线分析表明，CFLT的最佳截断值为4.06mm，灵敏度为76.9%，特异性为76.0%，曲线下面积（AUC）为0.89（95%CI，0.79-0.99）。CFLCSA的最佳截断阈值为43.85mm,灵敏度为92.3%，特异性为92.0%，AUC为0.94（95%CI，0.86-1.00）。
尽管CFLT和CFLCSA均与AI显著相关，但CFLCSA是更敏感的诊断试验。
