Lim P S, Schweitzer M E, Deely D M, Wapner K L, Hecht P J, Treadwell J R, Ross M S, Kahn M D
Department of Radiology, Thomas Jefferson University Hospital, Philadelphia, Pennsylvania 19107, USA.
Foot Ankle Int. 1997 Oct;18(10):658-63. doi: 10.1177/107110079701801011.
We evaluated four potential secondary magnetic resonance imaging signs to aid in clinical diagnosis of posterior tibial tendon (PTT) tears. Seventy-one ankles (25 PTT tears and 46 controls) were evaluated for the following secondary signs: (1) PTT sheath fluid, (2) a distal tibial spur located just anterior to the PTT, (3) unroofing of the talus, and (4) "bone bruise"--like medullary lesions. Two musculoskeletal radiologists rated their confidence using a scale and were compared for level of agreement. The presence of PTT sheath fluid had modest specificity and fair to moderate sensitivity. Tibial spurring and unroofing of the talus had excellent specificity and fair sensitivity. Bone bruise-like lesions were commonly seen in cases and controls. Examination of divergence of opinion between the two radiologists revealed pitfalls in interpretation of PTT sheath fluid and bone bruise-like lesions, which were commonly the result of adjacent vessels and inhomogeneous fat saturation, respectively. We conclude that secondary signs of PTT tears with high specificities include unroofing of the talus, tibial spurring, and PTT sheath fluid.
我们评估了四种潜在的磁共振成像间接征象，以辅助胫后肌腱（PTT）撕裂的临床诊断。对71个踝关节（25例PTT撕裂和46例对照）进行了以下间接征象评估：（1）PTT腱鞘积液；（2）位于PTT正前方的胫骨远端骨刺；（3）距骨剥脱；（4）“骨挫伤”样骨髓病变。两名肌肉骨骼放射科医生使用量表对其信心程度进行评分，并比较了他们的一致程度。PTT腱鞘积液具有中等特异性和一般至中等的敏感性。胫骨骨刺和距骨剥脱具有极佳的特异性和一般的敏感性。骨挫伤样病变在病例组和对照组中均常见。对两位放射科医生之间意见分歧的检查发现，PTT腱鞘积液和骨挫伤样病变的解读存在陷阱，分别常见于相邻血管和脂肪饱和不均匀的情况。我们得出结论，具有高特异性的PTT撕裂间接征象包括距骨剥脱、胫骨骨刺和PTT腱鞘积液。
