Effect of epidural corticosteroid injection on magnetic resonance imaging findings

The predictive role of the posterior tibial tendon cross-sectional area in early diagnosing posterior tibial tendon dysfunction

A hypertrophied posterior tibial tendon (PTT) has been considered to be an important morphologic parameter of PTT dysfunction (PTTD). Previous research has demonstrated that the PTT thickness (PTTT) is correlated with early signs of PTTD. However, the thickness is different from hypertrophy. Thus, we devised the PTT cross-sectional area (PTTCSA) as a new predictive parameter for diagnosing the PTTD.The PTT data were acquired from 14 patients with PTTD and from 20 normal individuals who underwent ankle magnetic resonance imaging. We measured the PTTT and PTTCSA at the PTT on the ankle magnetic resonance imaging.The mean PTTT was 2.43 ± 0.39 mm in the normal group and 3.40 ± 0.42 mm in the PTTD group. The average PTTCSA was 16.10 ± 4.27 mm in the normal group and 26.93 ± 4.38 mm in the PTTD group. The receiver operator characteristic analysis curve demonstrated that the highest predictive value of the PTTT was 3.07 mm, with 85.7% sensitivity, 85.0% specificity. The highest predictive value of the PTTCSA was 22.54 mm, with 92.9% sensitivity, 90.0% specificity.Our findings suggest that the PTTCSA was a more valid predictor of PTTD, even though the PTTT and PTTCSA were both significantly associated with PTTD.

The role of the anterior talofibular ligament area as a morphological parameter of the chronic ankle sprain

BACKGROUND

Repetitive microtrauma can result in a hypertrophied ATFL. Previous studies have found that the anterior talofibular ligament thickness (ATFLT) is correlated with lateral ankle sprains, ligament injuries and chronic stroke in patients, and thickened anterior talofibular ligament (ATFL) has been considered to be a major morphologic parameter of hypertrophied ATFL. However, hypertrophy is different from thickness. Thus, we devised the anterior talofibular ligament area (ATFLA) as a new morphological parameter to evaluate the hypertrophy of the whole ATFL.

METHODS

ATFL samples were collected from 53 patients with sprain group and from 50 control subjects who underwent magnetic resonance imaging (MRI) of the ankle and revealed no evidence of lateral ankle injury. Axial T1-weighted MRI images were collected at the ankle level from all subjects. We measured the ATFLA and ATFLT at the anterior margin of the fibular malleolus to the talus bone on the MRI using a picture archiving and communications system. The ATFLA was measured as the whole cross-sectional ligament area of the ATFL that was most hypertrophied in the axial MR images. The ATFLT was measured as the thickest point between the lateral malleolus and the talus of the ankle.

RESULTS

The average ATFLA was 25.0 ± 6.0 mm² in the control group and 47.1 ± 10.4 mm² in the sprain group. The average ATFLT was 2.3 ± 0.6 mm in the control group and 3.8 ± 0.6 mm in the hypertrophied group. Patients in sprain group had significantly greater ATFLA (p < 0.001) and ATFLT (p < 0.001) than the control subjects. A Receiver Operator Characteristics curve analysis showed that the best cut-off point of the ATFLA was 34.8 mm², with 94.3% sensitivity, 94.0% specificity, and an AUC of 0.97 (95% CI, 0.94-1.00). The optimal cut-off point of the ATFLT was 3.1 mm, with 86.8% sensitivity, 86.0% specificity, and AUC of 0.95 (95% CI, 0.92-0.99).

CONCLUSION

ATFLA is a new morphological parameter for evaluating chronic ankle sprain, and may even be more sensitive than ATFLT.