Abstract
To evaluate the diagnostic performance and reader agreement of a novel MRI image fusion method enabling the reconstruction of oblique images for the assessment of the tibiofibular syndesmosis. We evaluated 40 magnetic resonance imaging examinations of patients with ankle sprains (16 with ruptures and 24 without) for the presence of anteroinferior tibiofibular ligament rupture. For all patients, we performed a fusion of standard two-dimensional transversal and coronal 3 mm PDw TSE images into an oblique-fusion reconstruction (OFR) and compared these against conventionally scanned oblique sequence for the evaluation of the tibiofibular syndesmosis. To evaluate diagnostic performance, two expert readers independently read the OFR images twice. We analyzed sensitivity, specificity, negative and positive predictive values, accuracy, and agreement. Reader 1 misinterpreted one OFR as a false negative, demonstrating a sensitivity of 0.94 and specificity of 1.00, reader 2 demonstrated perfect accuracy. Intrareader agreement was almost perfect for reader 1 (α = 0.95) and was perfect for reader 2 (α = 1.00). Additionally, interreader agreement between all fusion sequence reads was almost perfect (α = 0.97). The proposed OFR enables reliable detection of anteroinferior tibiofibular ligament rupture with excellent inter- and intrareader agreement, making conventional scanning of oblique images redundant and supplies a method to retroactively create oblique images, e.g., from external examinations.
Highlights
Ankle sprains are the most common injury from athletic activity [1,2]
Based on the consensus read, 16 patients presented with rupture of the anteroinferior tibiofibular ligament (AITFL)
All 16 patients diagnosed with AITFL rupture underwent surgery, confirming a proven complete rupture of the AITFL
Summary
Ankle sprains are the most common injury from athletic activity [1,2]. even more ankle joint injuries (50.7%) occur in everyday life, with an incidence of 2.15 per1000 person/years [3], often leading to chronic symptoms including pain, weakness, and instability [4]. Ankle sprains are the most common injury from athletic activity [1,2]. Even more ankle joint injuries (50.7%) occur in everyday life, with an incidence of 2.15 per. 1000 person/years [3], often leading to chronic symptoms including pain, weakness, and instability [4]. -called high-ankle sprains that may include injury to the tibiofibular syndesmosis occur in up to one-quarter of all ankle sprains [5]. The syndesmosis is injured in roughly 10% of cases without an injury of the lateral ankle ligaments [6]. Associated ankle injuries, for example, to the calcaneofibular ligament, are displayed more often in case of AITFL injury [9], potentially resulting in peroneal muscle atrophy [10] and ankle instability [11]
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