Gómez Alejandro Lorente, Cuenca Marcela Gómez, Moreno Carmen Victoria Rojas, Cabezas Pablo Palacios, Mariscal Gonzalo, Khalil Ibrahim, Moreno Rafael Lorente, Berdullas Leire Pelaz
Ramón y Cajal University Hospital, Madrid, Spain.
Facultad de Medicina Universidad San Pablo CEU, Madrid, Spain.
Foot Ankle Surg. 2025 Sep 3. doi: 10.1016/j.fas.2025.08.009.
This systematic review and meta-analysis evaluated the diagnostic accuracy of conventional computed tomography (CT) and weight-bearing computed tomography (WBCT) in assessing Lisfranc injuries, comparing their sensitivity, specificity, and reliability for detecting structural abnormalities between injured and uninjured cases.
A systematic search of PubMed, Scopus, WOS, and Medline databases identified 736 articles, of which 16 studies met the inclusion criteria. Seven studies were included in the meta-analysis. The analysis examined measurements such as M1-M2 and M2-C1 base distances, TMT1 and TMT2 dorsal step-offs, axial joint area and volume, and alignment parameters. Subgroup analyses compared conventional CT and WBCT methods.
The injured group showed significantly greater M1-M2 and M2-C1 Base Distances than the uninjured group (M1-M2: MD = 0.88 mm; M2-C1: MD = 2.61 mm; p-value < 0.0001), with no significant differences between imaging modalities. The injured group had greater TMT2 dorsal step-offs (MD = 0.81 mm; p < 0.001), while TMT1 dorsal step-off differences varied between modalities. Injured joints demonstrated significantly larger Axial Joint Area and Volume (MD = 16.26 mm²) and volumes (MD = 189.1 mm³; p < 0.0001). Additionally, WBCT demonstrated high sensitivity and specificity for Lisfranc injuries, particularly for parameters like axial joint volume (AUC = 0.91). Conventional CT showed variable diagnostic performance, with sensitivity and specificity ranging from 69 % to 97.9 % and 39.3-100 %, respectively. The "Mercedes sign" (a three-pointed star appearance on axial CT indicating C1-M2 diastasis) and "Peeking cuneiform sign" (visible medial cuneiform between first and second metatarsals on AP view) showed over 92 % sensitivity and specificity.
Both conventional CT and WBCT effectively identify Lisfranc injuries when comparing injured and uninjured cases, with WBCT demonstrating superior sensitivity, specificity, and diagnostic accuracy in certain parameters. Conventional CT remains reliable but exhibits variability in specific assessments. Future research should focus on standardizing imaging protocols and refining diagnostic thresholds to enhance consistency and accuracy.
本系统评价和荟萃分析评估了传统计算机断层扫描（CT）和负重计算机断层扫描（WBCT）在评估Lisfranc损伤方面的诊断准确性，比较了它们在检测受伤和未受伤病例之间结构异常的敏感性、特异性和可靠性。
对PubMed、Scopus、WOS和Medline数据库进行系统检索，共识别出736篇文章，其中16项研究符合纳入标准。7项研究纳入荟萃分析。分析检测了M1-M2和M2-C1基底部距离、TMT1和TMT2背侧台阶、轴向关节面积和体积以及对线参数等测量值。亚组分析比较了传统CT和WBCT方法。
受伤组的M1-M2和M2-C1基底部距离显著大于未受伤组（M1-M2：MD = 0.88 mm；M2-C1：MD = 2.61 mm；p值<0.0001），不同成像方式之间无显著差异。受伤组的TMT2背侧台阶更大（MD = 0.81 mm；p < 0.001），而TMT1背侧台阶差异在不同成像方式之间有所不同。受伤关节的轴向关节面积和体积（MD = 16.26 mm²）以及体积（MD = 189.1 mm³；p < 0.0001）显著更大。此外，WBCT对Lisfranc损伤显示出高敏感性和特异性，特别是对于轴向关节体积等参数（AUC = 0.91）。传统CT显示出可变的诊断性能，敏感性和特异性分别为69%至97.9%和39.3%至100%。“梅赛德斯征”（轴向CT上的三点星状表现，提示C1-M2分离）和“楔骨窥视征”（前后位视图上第一和第二跖骨之间可见内侧楔骨）的敏感性和特异性均超过92%。
在比较受伤和未受伤病例时，传统CT和WBCT均能有效识别Lisfranc损伤，WBCT在某些参数上显示出更高的敏感性、特异性和诊断准确性。传统CT仍然可靠，但在特定评估中存在变异性。未来的研究应专注于标准化成像方案并完善诊断阈值，以提高一致性和准确性。
