Walter William R, Alaia Erin F, Samim Mohammad, Rosenberg Zehava S
Department of Radiology, New York University Langone Health, 301 E. 17th St., 6th Floor, New York, NY, 10003, USA.
Pediatr Radiol. 2021 Oct;51(11):2047-2057. doi: 10.1007/s00247-021-05101-z. Epub 2021 May 19.
There is a paucity of literature describing MRI patterns of high ankle sprains in pediatric patients. Radiologists should understand MRI patterns of these injuries in both adults and children.
To describe normal MRI appearance of pediatric syndesmotic ligaments and compare MRI patterns of high ankle sprains in children versus adults.
We reviewed consecutive ankle MRIs performed over 3 years and divided them into three cohorts: a normal pediatric (≤16 years) cohort, and pediatric and adult cohorts with acute/subacute ankle syndesmosis injuries. Our retrospective review assessed interobserver agreement (Cohen kappa coefficient) and normal pediatric syndesmotic anatomy. We compared patterns of high ankle sprains (Fisher exact test) including ligament tears, periosteal stripping, avulsions and fractures.
Of the 582 ankle MRIs, we included 25 in the normal pediatric cohort, 20 in the pediatric injury cohort and 23 in the adult injury cohort. The anterior and posterior tibiofibular ligaments all attached to cortex or cartilaginous precursor, while the interosseous ligament/membrane complex attached to the fibrous periosteum in 22/25 (88%) normal pediatric cases. Tibial periosteal stripping at the interosseous ligament/membrane complex attachment occurred in 7/20 (35%) pediatric and 1/23 (4%) adult injury cases (P=0.02). No other statistically significant differences were found. Interobserver agreement ranged from kappa=0.46 to kappa=0.82 (ligament tears), 0.38 to 0.45 (avulsions) and 0.69 to 0.77 (periosteal stripping).
The normal interosseous ligament/membrane complex typically attaches to fibrous periosteum rather than bony cortex. Tibial periosteal stripping, usually without tibial fracture, is significantly more common among pediatric high ankle sprains. MRI patterns of high ankle sprains are otherwise not significantly different between children and adults.
描述小儿患者高位踝关节扭伤的MRI表现的文献较少。放射科医生应了解成人和儿童这些损伤的MRI表现。
描述小儿下胫腓韧带的正常MRI表现，并比较儿童与成人高位踝关节扭伤的MRI表现。
我们回顾了连续3年进行的踝关节MRI检查，并将其分为三个队列：正常小儿（≤16岁）队列，以及患有急性/亚急性踝关节下胫腓损伤的小儿和成人队列。我们的回顾性研究评估了观察者间的一致性（Cohen卡方系数）和小儿下胫腓正常解剖结构。我们比较了高位踝关节扭伤的表现（Fisher精确检验），包括韧带撕裂、骨膜剥离、撕脱和骨折。
在582例踝关节MRI检查中，我们纳入了正常小儿队列中的25例，小儿损伤队列中的20例和成人损伤队列中的23例。胫腓前韧带和胫腓后韧带均附着于皮质或软骨前体，而在22/25（88%）的正常小儿病例中，骨间韧带/膜复合体附着于纤维骨膜。在7/20（35%）的小儿损伤病例和1/23（4%）的成人损伤病例中发生了骨间韧带/膜复合体附着处的胫骨骨膜剥离（P=0.02）。未发现其他具有统计学意义的差异。观察者间的一致性范围为卡方=0.46至卡方=0.82（韧带撕裂），0.38至0.45（撕脱）和0.69至0.77（骨膜剥离）。
正常的骨间韧带/膜复合体通常附着于纤维骨膜而非骨皮质。胫骨骨膜剥离，通常无胫骨骨折，在小儿高位踝关节扭伤中明显更常见。儿童和成人高位踝关节扭伤的MRI表现否则无显著差异。
