Department of Orthopedic Surgery, Inje University Busan Paik Hospital, Busan, Republic of Korea.
Department of Orthopedic Surgery, SNU Seoul Hospital, Seoul, Republic of Korea.
Arch Orthop Trauma Surg. 2023 Sep;143(9):5631-5639. doi: 10.1007/s00402-023-04871-5. Epub 2023 Apr 17.
Osteochondral lesions of the talus (OLT) usually have non-specific clinical symptoms, and radiographs have a low sensitivity for detecting OLT. The purpose of this study is to compare the diagnostic value of CT arthrography (CTa) with that of MRI using arthroscopy as the reference standard for grading OLT.
We retrospectively reviewed patients who had OLT between 2015 and 2020. Patients with symptomatic OLT as a surgical indication, who were treated arthroscopically, and underwent both CTa and MRI before surgery were included. OLT was evaluated by both CTa and MRI using arthroscopy as the standard. We graded CTa, MRI, arthroscopic findings using Mintz classification.
Thirty-five patients were included. Accuracy rates of MRI and CTa for grading OLT, compared to those of arthroscopy, were 57.1% and 88.6%, respectively. Among 15 mismatched cases in MRI, 12 lesions (80%) were matched in CTa and arthroscopy. CTa had significantly higher diagnostic performance than MRI for the detection of grade III lesions (p = 0.041). Using the receiver operating characteristics curves, the area under the curve values for lesion grading were 0.893 for CTa and 0.762 for MRI.
CTa was statistically significantly better in detecting chondral flapping or subchondral exposure lesions for OLT than MRI on using arthroscopy as the reference standard. Because the stability of the OLT is essential in determining the treatment method, if an OLT is observed on MRI and is suspected to cause ankle pain, we recommend additional CTa examination to determine the more correct treatment strategies for OLT.
Diagnostic Level III.
距骨骨软骨损伤（OLT）通常具有非特异性的临床症状，且 X 线平片对 OLT 的检出率较低。本研究旨在比较 CT 关节造影（CTa）与 MRI 的诊断价值，以关节镜为 OLT 分级的参考标准。
我们回顾性分析了 2015 年至 2020 年间患有 OLT 的患者。将有症状的 OLT 作为手术指征、接受关节镜治疗且在术前同时行 CTa 和 MRI 检查的患者纳入研究。OLT 通过 CTa 和 MRI 进行评估，以关节镜为标准。我们使用 Mintz 分级法对 CTa、MRI 和关节镜检查结果进行分级。
共纳入 35 例患者。与关节镜相比，MRI 和 CTa 对 OLT 分级的准确率分别为 57.1%和 88.6%。在 MRI 中，15 个不匹配的病例中，12 个病变（80%）在 CTa 和关节镜检查中是匹配的。与 MRI 相比，CTa 对 III 级病变的检测具有更高的诊断性能（p=0.041）。使用受试者工作特征曲线，CTa 对病变分级的曲线下面积值为 0.893，MRI 为 0.762。
以关节镜为参考标准，与 MRI 相比，CTa 在检测 OLT 的软骨瓣状或软骨下暴露性病变方面具有统计学意义上的优势。由于 OLT 的稳定性对于确定治疗方法至关重要，如果 MRI 观察到 OLT 并怀疑其引起踝关节疼痛，我们建议进行额外的 CTa 检查，以确定更正确的 OLT 治疗策略。
诊断性 III 级。
