Abs Bilal, Ferreira Branco David, Gamulin Axel, Botti Paul, Buzzi Marcello, Poletti Pierre-Alexandre, Bouredoucen Hicham, Boudabbous Sana
Department of Radiology, Geneva University Hospital, Rue Gabrielle-Perret-Gentil 4, 1205, Geneva, Switzerland.
Department of Orthopedic Surgery, Geneva University Hospital, Rue Gabrielle-Perret-Gentil 4, 1205, Geneva, Switzerland.
Radiol Med. 2024 Dec;129(12):1840-1848. doi: 10.1007/s11547-024-01905-9. Epub 2024 Nov 4.
Midtarsal injuries are often missed at initial presentation which may lead to long-term complications. Nonetheless, radiographs (XR) are used as a primary imaging method. The place of cone beam computer tomography (CBCT) remains unclear in the management of midfoot injuries. The aim of this study was to update imaging findings on traumatic ankle and foot injuries (TAAFI) with CBCT and to assess the sensitivity, specificity and accuracy of XR compared to CBCT for midfoot injuries detections.
All CBCT studies performed due to (TAAFI) that had previous XR were collected for a period of 5 years. They were retrospectively anonymized and analyzed by a radiologist. A second blinded study of XR was made by a second radiologist as a control.
A total of 754 cases were included. Lisfranc and Chopart injuries were detected in 153 (20.2%) and 154 (20.4%) patients, respectively. Lisfranc and Chopart's lesions combined together were seen in 33 cases (10.7%). A blinded retrospective analysis of XR compared to CBCT shows a sensitivity of 64.9% (56.8-72.4%; 95% CI), a specificity of 95.0% (92.9-96.6%; 95% CI) and an accuracy of 88.9% (86.4-91.0%; 95% CI) for Chopart's injuries. Regarding Lisfranc, the sensitivity was 62.1% (53.9-69.8%; 95% CI), specificity 99.0% (97.8-99.6%; 95% CI) and accuracy 91.5% (89.3-93.4%; 95% CI).
This cohort study highlights the missed injuries of Chopart on XR and the low association with Lisfranc avulsions. The use of CBCT helps in detecting and assessing midfoot injury.
中跗骨损伤在初次就诊时常常被漏诊，这可能导致长期并发症。尽管如此，X线片（XR）仍是主要的影像学检查方法。在中足损伤的处理中，锥形束计算机断层扫描（CBCT）的作用仍不明确。本研究的目的是更新CBCT对创伤性踝足部损伤（TAAFI）的影像学表现，并评估与CBCT相比，XR在检测中足损伤时的敏感性、特异性和准确性。
收集5年间因TAAFI进行的所有既往有XR检查的CBCT研究。由一名放射科医生对其进行回顾性匿名分析。另一名放射科医生对XR进行二次盲法研究作为对照。
共纳入754例病例。分别在153例（20.2%）和154例（20.4%）患者中检测到Lisfranc损伤和Chopart损伤。33例（10.7%）患者同时存在Lisfranc和Chopart损伤。与CBCT相比，对XR进行盲法回顾性分析显示，Chopart损伤的敏感性为64.9%（56.8 - 72.4%；95%可信区间），特异性为95.0%（92.9 - 96.6%；95%可信区间），准确性为88.9%（86.4 - 91.0%；95%可信区间）。对于Lisfranc损伤，敏感性为62.1%（53.9 - 69.8%；95%可信区间），特异性为99.0%（97.8 - 99.6%；95%可信区间），准确性为91.5%（89.3 - 93.4%；95%可信区间）。
这项队列研究突出了XR对Chopart损伤的漏诊情况以及与Lisfranc撕脱伤的低关联性。CBCT的应用有助于检测和评估中足损伤。
