Sonographic Appearances of Morton's Neuroma: Differences from Other Interdigital Soft Tissue Masses

Abstract

PurposeTo evaluate the ultrasonographic characteristics of Morton's neuroma (MNs) and the usefulness of the ‘ginkgo leaf sign’ for differentiating MNs from other interdigital soft tissue masses.Material & MethodsFourteen histologically proven MNs in ten patients were retrospectively reviewed and compared with other interdigital soft tissue masses (9 ganglion cysts, 7 epidermoid tumors, and one fibroma). Ultrasonographic examinations were performed by a musculoskeletal radiologist using the HDI 5000 (Philips, Bothell, WA, USA) or the Logiq E9 (GE Medical Systems, Milwaukee, WI, USA) equipped with a linear 6-15 MHz probe, and the findings were interpreted in consensus by two musculoskeletal radiologists. The ultrasonographic findings of the MNs were compared with those for other interdigital soft tissue masses. The ginkgo leaf sign was defined as the appearance of a biconcave shape of the mass from compression by adjacent structures.ResultsThe mean size of the MNs was 5.6 mm. There was a significant difference in incidence between males and females (female dominant, p = 0.003). There was no difference in incidence with regard to age (p = 0.259). All lesions were hypoechoic (100%, 14/14) and ten cases exhibited the ginkgo leaf sign (71%, 10/14, p < 0.001). The lesions were either well marginated (43%, 6/14) or poorly marginated (57%, 8/14, p = 0.075). None of the lesions abutted on adjacent bony structures (p < 0.001).ConclusionInterdigital MNs are primarily found in middle-aged women and often demonstrate the ginkgo leaf sign. MNs are hypoechoic and do not abut onto adjacent bony structures. These characteristics can be helpful when differentiating MNs from other interdigital soft tissue masses. PurposeTo evaluate the ultrasonographic characteristics of Morton's neuroma (MNs) and the usefulness of the ‘ginkgo leaf sign’ for differentiating MNs from other interdigital soft tissue masses. To evaluate the ultrasonographic characteristics of Morton's neuroma (MNs) and the usefulness of the ‘ginkgo leaf sign’ for differentiating MNs from other interdigital soft tissue masses. Material & MethodsFourteen histologically proven MNs in ten patients were retrospectively reviewed and compared with other interdigital soft tissue masses (9 ganglion cysts, 7 epidermoid tumors, and one fibroma). Ultrasonographic examinations were performed by a musculoskeletal radiologist using the HDI 5000 (Philips, Bothell, WA, USA) or the Logiq E9 (GE Medical Systems, Milwaukee, WI, USA) equipped with a linear 6-15 MHz probe, and the findings were interpreted in consensus by two musculoskeletal radiologists. The ultrasonographic findings of the MNs were compared with those for other interdigital soft tissue masses. The ginkgo leaf sign was defined as the appearance of a biconcave shape of the mass from compression by adjacent structures. Fourteen histologically proven MNs in ten patients were retrospectively reviewed and compared with other interdigital soft tissue masses (9 ganglion cysts, 7 epidermoid tumors, and one fibroma). Ultrasonographic examinations were performed by a musculoskeletal radiologist using the HDI 5000 (Philips, Bothell, WA, USA) or the Logiq E9 (GE Medical Systems, Milwaukee, WI, USA) equipped with a linear 6-15 MHz probe, and the findings were interpreted in consensus by two musculoskeletal radiologists. The ultrasonographic findings of the MNs were compared with those for other interdigital soft tissue masses. The ginkgo leaf sign was defined as the appearance of a biconcave shape of the mass from compression by adjacent structures. ResultsThe mean size of the MNs was 5.6 mm. There was a significant difference in incidence between males and females (female dominant, p = 0.003). There was no difference in incidence with regard to age (p = 0.259). All lesions were hypoechoic (100%, 14/14) and ten cases exhibited the ginkgo leaf sign (71%, 10/14, p < 0.001). The lesions were either well marginated (43%, 6/14) or poorly marginated (57%, 8/14, p = 0.075). None of the lesions abutted on adjacent bony structures (p < 0.001). The mean size of the MNs was 5.6 mm. There was a significant difference in incidence between males and females (female dominant, p = 0.003). There was no difference in incidence with regard to age (p = 0.259). All lesions were hypoechoic (100%, 14/14) and ten cases exhibited the ginkgo leaf sign (71%, 10/14, p < 0.001). The lesions were either well marginated (43%, 6/14) or poorly marginated (57%, 8/14, p = 0.075). None of the lesions abutted on adjacent bony structures (p < 0.001). ConclusionInterdigital MNs are primarily found in middle-aged women and often demonstrate the ginkgo leaf sign. MNs are hypoechoic and do not abut onto adjacent bony structures. These characteristics can be helpful when differentiating MNs from other interdigital soft tissue masses. Interdigital MNs are primarily found in middle-aged women and often demonstrate the ginkgo leaf sign. MNs are hypoechoic and do not abut onto adjacent bony structures. These characteristics can be helpful when differentiating MNs from other interdigital soft tissue masses.