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首页> 外文期刊>Orthopaedic Journal of Sports Medicine >MRI Characterization and Diagnosis of Individual Syndesmotic Structures in Asymptomatic and Injured Cohorts
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MRI Characterization and Diagnosis of Individual Syndesmotic Structures in Asymptomatic and Injured Cohorts

机译：无症状和受伤人群的单个下突结构的MRI表征和诊断

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Objectives: The purpose of this study was to characterize the MRI presentation of the distal tibiofibular syndesmosis in both asymptomatic volunteers and injured patients to define the optimal MRI sequencing image(s) for each structure and further improve clinical diagnostic sensitivity and reliability of common syndesmotic injuries. Additionally, we correlated the presentation of individual structures on MRI with anatomic investigations to assess the ability of MRI to reproducibly identify the individual syndesmotic structures and common pathology. Methods: This study was IRB approved. Age-matched volunteers deemed asymptomatic by self-reported subjective measures, objective physical exam, and morphological MRI exam were analyzed to refine syndesmosis imaging and define the optimal MRI sequence(s) for the characterization of the individual articular structures. Twenty patients from the practice of one foot and ankle fellowship trained orthopaedic surgeon (initial blinded for review) between December 2009 through September 2013 were included. Preoperative 3.0 T ankle MR images (Magnetom Verio, Siemens Medical Solutions, Erlangen, Germany) from patients with suspected syndesmotic injuries and subsequent arthroscopic evaluation were retrospectively reviewed and analyzed. Patient MRI findings were correlated with arthroscopic surgery to calculate the sensitivity, specificity, positive predictive value (PPV) and negative predictive value (NPV). To further the understanding of the distal tibiofibular syndesmosis and concomitant pathology, concurrent injuries to other structures of the ankle were recorded and reported. Results: Analysis of asymptomatic volunteers allowed for the successful identification of optimal MRI sequences for the visualization of individual syndesmotic structures (Table 1). In the patient cohort, sequence-optimized MRI diagnosed pathology correlated strongly with arthroscopic surgery reports demonstrating excellent diagnostic sensitivity and specificity in the diagnoses of common clinically observed syndesmotic injuries (Table 1)(Figure 1). Rarely (20%), were isolated injuries to the syndesmosis reported either preoperatively on MRI or intraoperatively during arthroscopy. Concurrent fractures (medial/lateral/bi/tri malleolar, proximal/distal/maisonneuve fibular fractures, and attachment avulsions), additional ligamentous injury (deltoid sprains/tears), tendon tears (peroneus brevis), osteochondral lesions (distal tibia, dorsal/medial/lateral talus), and synovitis were frequently observed. Conclusion: Accurate diagnosis and subsequent treatment are paramount when dealing with syndesmotic injuries due to the chronic pain and instability that can result from misdiagnoses and inappropriate treatment. In this MRI characterization of syndesmotic structures and retrospective analysis of diagnostic accuracy, we demonstrate the capability of MRI to consistently visualize relevant individual syndesmotic structures and to diagnose frequently observed syndesmotic injuries with a high degree of sensitivity and specificity. We propose that the optimal MRI sequences/planes defined in this study be clinically implemented to aid in future pre-operative planning, to facilitate anatomic repair of the syndesmosis, and to assist in post-operative assessment of the ankle syndesmosis.
机译：目的：本研究的目的是在无症状志愿者和受伤患者中表征胫骨腓骨远端的MRI表现，以针对每种结构定义最佳的MRI测序图像，并进一步提高临床诊断敏感性和常见的胫骨联合损伤。此外，我们将MRI上单个结构的呈现与解剖学研究相关联，以评估MRI可再现地识别单个结缔组织结构和常见病理的能力。方法：本研究获得IRB批准。通过自我报告的主观测量，客观体格检查和形态学MRI检查被视为无症状的年龄匹配的志愿者进行了分析，以完善下颌联合成像并定义用于表征单个关节结构的最佳MRI序列。在2009年12月至2013年9月之间，有20名来自接受一脚和脚踝助教训练的骨科医生的患者（最初不知情）。回顾性分析了可疑下颌联合损伤患者的术前3.0 T踝MR图像（Magnetom Verio，西门子医疗解决方案，德国埃尔兰根）和随后的关节镜评估。将患者的MRI检查结果与关节镜手术相关联，以计算敏感性，特异性，阳性预测值（PPV）和阴性预测值（NPV）。为了进一步了解远端胫腓联合症和伴随的病理学，记录并报告了踝关节其他结构的并发损伤。结果：无症状志愿者的分析可以成功鉴定出最佳的MRI序列，以可视化单个下突结构（表1）。在患者队列中，经序列优化的MRI诊断的病理学与关节镜手术报告密切相关，显示出在临床上常见的皮下注射损伤的诊断中具有出色的诊断敏感性和特异性（表1）（图1）。很少（20％）因MRI术前或关节镜检查时术中报告的孤立性损伤。并发性骨折（内侧/外侧/双/三踝，近端/远端/黄韧带骨折和附着撕脱），附加韧带损伤（三角肌扭伤/撕裂），腱撕裂（腓骨短肌），骨软骨病变（远端胫骨，背侧/经常观察到内侧/外侧距骨和滑膜炎。结论：由于误诊和不适当的治疗可能会导致慢性疼痛和不稳定，因此，正确的诊断和后续治疗对于治疗下颌联合损伤至关重要。在MRI对结膜结构的表征以及对诊断准确性的回顾性分析中，我们证明了MRI能够始终如一地可视化相关的单个结膜结构并以高度的敏感性和特异性来诊断经常观察到的结膜损伤的能力。我们建议在临床上实施本研究中定义的最佳MRI序列/平面，以帮助将来进行术前计划，促进对下颌骨的解剖修复，并有助于对踝下颌骨的术后评估。

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