Stamford Health, Foot & Ankle Surgery, Stamford, CT, USA.
The Dartmouth Institute, Dartmouth College, Hanover, NH, USA.
Eur J Radiol. 2022 Jul;152:110315. doi: 10.1016/j.ejrad.2022.110315. Epub 2022 Apr 30.
Previous literature has suggested both MRI and ultrasound can accurately diagnose plantar plate tears. There is a significant cost difference between these two modalities, sparking interest for which should be the preferred method for diagnosis.
The purpose of this study was to examine the diagnostic accuracy of MRI and dynamic, musculoskeletal ultrasound for lesser metatarsal plantar plate injuries using a systematic review and meta-analysis.
MEDLINE, CINAHL, and Clinicaltrials.gov were searched thru May 2020. We included studies evaluating the diagnostic accuracy of MRI or ultrasound for detecting plantar plate tears, using intraoperative confirmation as the gold standard comparison. Sensitivity and specificity were obtained and pooled from included studies. Summary receiver operating curves were formed for each diagnostic test to compare accuracy. Study quality was assessed using the QUADAS-2 scoring system.
Eleven studies met our inclusion criteria, representing 227 plantar plates for MRI and 238 plantar plates for ultrasound. MRI displayed a pooled sensitivity of 89% (95% CI 0.84, 0.93) and specificity of 83% (95% CI 0.64, 0.94). Ultrasound displayed a sensitivity and specificity of 95% (95% CI 0.91, 0.98) and 52% (95% CI 0.37, 0.68), respectively.
MRI was superior to ultrasound in diagnosing plantar plate injuries overall, however, ultrasound was more sensitive than MRI, suggesting a negative ultrasound would likely rule out a plantar plate injury in the presence of an equivocal physical exam. Determining the grade of the injury is best served with MRI which can provide added insight into the joint's supporting structures (e.g. collateral ligaments) and integrity.
先前的文献表明，MRI 和超声都能准确诊断足底板撕裂。这两种方法的成本差异显著，这激发了人们的兴趣，即哪种方法应作为首选诊断方法。
本研究旨在通过系统评价和荟萃分析，检查 MRI 和动态肌肉骨骼超声在诊断较小跖骨足底板损伤方面的诊断准确性。
通过 MEDLINE、CINAHL 和 Clinicaltrials.gov 检索至 2020 年 5 月的文献。我们纳入了评估 MRI 或超声诊断足底板撕裂准确性的研究，以术中证实作为金标准比较。从纳入的研究中获得并汇总了敏感性和特异性。为比较每种诊断测试的准确性，形成了汇总受试者工作特征曲线。使用 QUADAS-2 评分系统评估研究质量。
11 项研究符合我们的纳入标准，代表了 227 例 MRI 足底板和 238 例超声足底板。MRI 的汇总敏感性为 89%（95%CI 0.84，0.93），特异性为 83%（95%CI 0.64，0.94）。超声的敏感性和特异性分别为 95%（95%CI 0.91，0.98）和 52%（95%CI 0.37，0.68）。
总体而言，MRI 在诊断足底板损伤方面优于超声，但超声的敏感性高于 MRI，这表明在体格检查结果不确定的情况下，阴性超声检查很可能排除足底板损伤。确定损伤程度最好使用 MRI，它可以提供有关关节支撑结构（如侧副韧带）和完整性的附加信息。
