Keywords:
Normal variants, Diagnostic procedure, Ultrasound, MR, Conventional radiography, Musculoskeletal system, Musculoskeletal bone, Extremities, Education and training
Authors:
J. Desimpel1, M. S. Posadzy2, F. M. H. M. Vanhoenacker3; 1Duffel/Antwerp/BE, 2Poznań/PL, 3Duffel/Antwerp/Ghent/BE
DOI:
10.1594/essr2017/P-0214
Methods and Materials
Patients
Our study is a monocentric,
retrospective cohort study of 23 patients. Inclusion criteria included referral for imaging (either US,
CT or MRI; Table 1) for chronic lateral ankle pain below the lateral malleolus and a width of the tuberculum peroneum ≥ 3 mm .
Patients with underlying fracture were excluded.
Imaging protocols
Conventional radiography was performed on the AXIOM Luminos dRF (Siemens,
Erlangen,
Germany).
AP,
lateral and Mortise view are the three standard images performed of the ankle.
Additional axial image to visualize the hypertrophic tuberculum was also performed. US images using Philips Health Systems EPIQ5G (Bothell,
WA 98021,
USA).
CBCT imaging was performed on a Newtom 5G-system (QR,
Verona,
Italy).
The field of view (8 x 8-cm) was centered on the painful ankle region.
All MR examinations were performed on a 1.5T system (Siemens,Magnetom Aera,
Erlangen,
Germany). Routinely the following sequences were performed: sagittal,
axial and coronal FS T2-WI,
coronal PD and axial T1-WI with a slice thickness of 3 mm. Only seven patients underwent one type of imaging i.e. MR. The other patients had at least a combination of two imaging techniques of which the combination of MR and US was most frequent (6 patients or 26%).
Table 1: Overview of the different examinations
Type of examination |
Number of patients |
X-ray |
10 |
US |
12 |
CBCT |
2 |
MR |
17 |
Analysis of clinical history and imaging parameters
The following parameters were retrospectively reviewed by 2 observers in consensus: history of previous ankle sprain or trauma,
width of the TP on all imaging modalities,
the presence and grade (I-III) of tenosynovitis of peroneus brevis (PB) and/or longus tendon (PL) (table 2),
bone marrow edema (BME) at the os calcaneus.
Table 2: Tenosynovitis grading according to reference 7.
Grade 1 |
Focal thickening of the tendon + effusion |
GRade 2 |
Partial tear |
GRade 3 |
Full tear |