Department of Orthopedic Surgery, Konkuk University Medical Center, Konkuk University School of Medicine, Gwangjin-gu, Seoul, South Korea.
Department of Radiology, Konkuk University Medical Center, Konkuk University School of Medicine, 120-1 Neungdong-ro, Gwangjin-gu, Seoul, 05030, South Korea.
BMC Musculoskelet Disord. 2021 Oct 12;22(1):869. doi: 10.1186/s12891-021-04759-8.
Interosseous ligament vertical segment (IOLV) and calcaneofibular ligament (CFL) have been reported to be important in stabilizing the subtalar joint. Unlike CFL, there is not much information regarding the comparison of MRI results with surgical evaluation of IOLV and the comparison between 2D and 3D MRI on IOLV evaluation. The feasibility of MRI in IOLV evaluation has yet to be reported. The purpose of this study was to evaluate the validity and reliability of MRI in IOLV tear detection via correlation with arthroscopic results. We also compared the diagnostic performance of 2D and 3D MR images.
In this retrospective study, 52 patients who underwent subtalar arthroscopy after ankle MRI were enrolled. Arthroscopic results confirmed IOLV tear in 25 cases and intact IOLV in 27 cases. Two radiologists independently evaluated the IOLV tears using only conventional 2D images, followed by isotropic 3D images, and comparison with arthroscopic results.
Only the 2D sequences interpreted by two readers showed a sensitivity of 64.0-96.0%, a specificity of 29.6-44.4%, a positive predictive value of 51.6-56.4%, and a negative predictive value of 57.1-88.9%. Addition of isotropic 3D sequences changed the sensitivity to 60.0-80.0%, specificity to 63.0-77.8%, positive predictive value to 64.3-76.9%, and negative predictive value to 66.7-80.8%. The overall diagnostic performance of isotropic 3D sequences (AUC values: 0.679-0.816) was higher than that of 2D sequences (AUC values: 0.568-0.647). Inter-observer and intra-observer agreement between the two readers was moderate-to-good for both 2D and 3D sequences. The diagnostic accuracy in 19 patients with tarsal sinus fat obliteration tended to increase from 26.3-42.1% to 57.9-73.7% with isotropic 3D sequences compared with 2D sequences.
Isotropic 3D MRI was feasible for the assessment of IOLV tear prior to subtalar arthroscopy. Additional 3D sequences showed higher diagnostic accuracy compared with conventional 2D sequences in IOLV evaluation. Isotropic 3D sequences may be more valuable in detecting IOLV tear in case of tarsal sinus fat obliteration.
骨间韧带垂直段（IOLV）和跟腓韧带（CFL）已被报道在稳定距下关节中起重要作用。与 CFL 不同，关于 IOLV 的 MRI 结果与手术评估的比较以及 IOLV 评估的 2D 与 3D MRI 的比较，信息并不多。MRI 评估 IOLV 的可行性尚未有报道。本研究的目的是通过与关节镜结果的相关性来评估 MRI 检测 IOLV 撕裂的有效性和可靠性。我们还比较了 2D 和 3D MRI 图像的诊断性能。
在这项回顾性研究中，纳入了 52 例踝关节 MRI 后接受距下关节镜检查的患者。关节镜检查结果证实 25 例 IOLV 撕裂，27 例 IOLV 完整。两位放射科医生仅使用常规 2D 图像、各向同性 3D 图像对 IOLV 撕裂进行评估，并与关节镜结果进行比较。
仅两位读者解读的 2D 序列显示出 64.0-96.0%的敏感性、29.6-44.4%的特异性、51.6-56.4%的阳性预测值和 57.1-88.9%的阴性预测值。添加各向同性 3D 序列后，敏感性变为 60.0-80.0%、特异性变为 63.0-77.8%、阳性预测值变为 64.3-76.9%、阴性预测值变为 66.7-80.8%。各向同性 3D 序列的整体诊断性能（AUC 值：0.679-0.816）高于 2D 序列（AUC 值：0.568-0.647）。两位读者之间的 2D 和 3D 序列的观察者间和观察者内一致性均为中等至良好。与 2D 序列相比，在 19 例跗骨窦脂肪消失的患者中，添加各向同性 3D 序列后，诊断准确性从 26.3-42.1%增加到 57.9-73.7%。
各向同性 3D MRI 可在距下关节镜检查前评估 IOLV 撕裂。与常规 2D 序列相比，附加的 3D 序列在 IOLV 评估中具有更高的诊断准确性。在跗骨窦脂肪消失的情况下，各向同性 3D 序列可能更有助于检测 IOLV 撕裂。
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