The accuracy of three-dimensional magnetic resonance imaging in the diagnosis of ruptures of the lateral ligaments of the ankle

Abstract

In a prospective study, the diagnostic accuracy of three-dimensional magnetic resonance imaging in the evaluation of ruptures of the lateral ligaments of the ankle was determined by comparing three-dimensional magnetic resonance findings with operative findings. In a series of 18 consecutive cases of acute significant inversion trauma to the ankle, a three-dimensional fast imaging with steady-state precession pulse sequence (3D FISP) was performed. The study included only those cases in which views showed a difference in talar tilt of 15 degrees or more, and a difference in anteroposterior drawer of 10 mm or more between the imaged and the normal ankle. All ankles were scheduled for surgical exploration. Compared with operative findings, the sensitivity, specificity, and accuracy of 3D FISP imaging were, respectively, 100%, 50%, and 94.4% for ruptures of the anterior talofibular ligament and 91.7%, 100%, and 94.4% for ruptures of the calcaneofibular ligament. We believe that 3D FISP magnetic resonance imaging is a noninvasive, fast, and very accurate diagnostic aid to operative planning for double ligament tears in younger competitive athletes.

Magnetic resonance imaging in the evaluation of ligament injuries

“…In one series, MR arthrography was 100% sensitive in diagnosing ATFL tears, and 90% sensitive in detecting CFL tears [94]. In this study, conventional MRI yielded a sensitivity of only 50% in detecting ATFL and CFL tears which, by the authors' own admission, is substantially less that that reported by others [95].…”

“…The sensitivity, specificity, and accuracy of MRI as compared with the operative findings have been shown to be 91.7±100%, 50±100%, and 94.4% respectively, depending on the ligament evaluated [83].…”

Is MRI Adequate to Detect Lesions in Patients with Ankle Instability?

“…Because MRI detects subchondral changes, more superficial lesions are less likely to be imaged [25]. Other MRI factors that may affect accuracy include the type of sequence [5,16,17,27], power of the magnet [11,12,26], and positioning [21]. The articular cartilage in the ankle is thinner than in the knee [23], there is close tibiotalar apposition, and the bony anatomy is more complex, all of which could complicate accurate observation of chondral lesions by MRI in the ankle as compared with the knee.…”

National Athletic Trainers' Association Position Statement: Conservative Management and Prevention of Ankle Sprains in Athletes

“…Magnetic resonance imaging (MRI) is a reliable technique to detect acute tears of the anterior talofibular ligament and calcaneofibular ligament after acute injury. [11][12][13] Evidence Category: B 10. Osteochondral lesions of the talus can be accurately detected by both MRI and computed tomography (CT).…”

“…Breitenseher et al 11 found 74% sensitivity and 100% specificity of MRI to detect lateral collateral ligament disruption after acute ankle injury. Conversely, Verhaven et al 12 showed 100% sensitivity and 50% specificity for MRI to detect tears of the ATFL and 92% sensitivity and 100% specificity to detect tears of the CFL. In patients with CAI, MRI specificity was 100% for the diagnosis of ATFL and CFL tears, and accuracy was 91.7% for ATFL and 87.5% for CFL tears.…”