Limits...
MRI and ultrasonography in Morton's neuroma: Diagnostic accuracy and correlation.

Torres-Claramunt R, Ginés A, Pidemunt G, Puig L, de Zabala S - Indian J Orthop (2012)

Bottom Line: In all cases, a histopathological examination confirmed the diagnosis.MRI had a higher sensitivity than US and should be considered the technique of choice in those cases.However, a negative result does not exclude the diagnosis (false negative 17%).

View Article: PubMed Central - PubMed

Affiliation: Orthopaedic Department of the Parc de Salut Mar. Passeig Marítim 25-29, 08003 Barcelona, Spain.

ABSTRACT

Background: The diagnosis of Morton's neuroma is based primarily on clinical findings. Ultrasonography (US) and magnetic resonance image (MRI) studies are considered complementary diagnostic techniques. The aim of this study was to establish the correlation and sensitivity of both techniques used to diagnose Morton's neuroma.

Materials and methods: Thirty seven patients (43 intermetatarsal spaces) with Morton's neuroma operated were retrospectively reviewed. In all cases MRI or ultrasound was performed to complement clinical diagnosis of Morton's neuroma. In all cases, a histopathological examination confirmed the diagnosis. Estimates of sensitivity were made and correlation (kappa statistics) was assessed for both techniques.

Results: Twenty seven women and 10 men participated with a mean age of 60 years. Double lesions presented in six patients. The second intermetatarsal space was affected in 10 patients and the third in 33 patients. An MRI was performed in 41 cases and a US in 23 cases. In 21 patients, both an MRI and a US were performed. With regard to the 41 MRIs performed, 34 were positive for Morton's neuroma and 7 were negative. MRI sensitivity was 82.9% [95% confidence interval (CI): 0.679-0.929]. Thirteen out of 23 US performed were positive and 10 US were negative. US sensitivity was 56.5% (95% CI: 0.345-0.768). Relative to the 21 patients on whom both techniques were carried out, the agreement between both techniques was poor (kappa statistics 0.31).

Conclusion: Although ancillary studies may be required to confirm the clinical diagnosis in some cases, they are probably not necessary for the diagnosis of Morton's neuroma. MRI had a higher sensitivity than US and should be considered the technique of choice in those cases. However, a negative result does not exclude the diagnosis (false negative 17%).

No MeSH data available.


Related in: MedlinePlus

Transverse T1-weighted MRI image reveals Morton's neuroma in the third interdigital space. A well demarcated low/intermediate signal intensity mass is shown. The Morton's neuroma is seen circled in red
© Copyright Policy - open-access
Related In: Results  -  Collection

License
getmorefigures.php?uid=PMC3377144&req=5

Figure 1: Transverse T1-weighted MRI image reveals Morton's neuroma in the third interdigital space. A well demarcated low/intermediate signal intensity mass is shown. The Morton's neuroma is seen circled in red

Mentions: Between January 2004 and July 2008, a total of 37 patients with Morton's neuroma underwent surgical treatment at our institution. Data for these patients were retrospectively reviewed. All patients presented with signs and symptoms consistent with Morton's neuroma (i.e., Mulder's sign, numbness, radiation of neuritic pain, metatarsal pain, etc.). Prior to this report and according to our previous protocol, an ancillary test, an MRI or a US, was always ordered as a complement to the clinical diagnosis depending on the physician's criteria. When a discrepancy between the clinical and image diagnoses appeared, a second test was carried out. For the US study, a 7.5- or 9-MHz linear transducer (HDI 5000, Advanced Technology Laboratories, Bothell, WA, USA) was used. The images were obtained along sagittal and long axis planes from the plantar aspect of the foot. The dynamic method of expressing the neuroma on the dorsal aspect was performed. The diagnostic criterion was a focal hypoechoic interdigital nodule of the web space of the forefoot at the level of the metatarsal head beneath the intermetatarsal ligament. MRI was performed using a 1.5-T scanner (Signa; General Electric Medical Systems, Milwaukee, WI, USA) with transverse T1 sequences and transverse T2 sequences perpendicular to the metatarsal bones with the patient in the supine position. A thickening of the intermetatarsal nerve and a well defined ovoid mass at the plantar aspect near the metatarsal head with intermediate signal intensity on T1-weighted images [Figure 1] and low signal intensity on T2-weighted images [Figure 2] was defined as Morton's neuroma.


MRI and ultrasonography in Morton's neuroma: Diagnostic accuracy and correlation.

Torres-Claramunt R, Ginés A, Pidemunt G, Puig L, de Zabala S - Indian J Orthop (2012)

Transverse T1-weighted MRI image reveals Morton's neuroma in the third interdigital space. A well demarcated low/intermediate signal intensity mass is shown. The Morton's neuroma is seen circled in red
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC3377144&req=5

Figure 1: Transverse T1-weighted MRI image reveals Morton's neuroma in the third interdigital space. A well demarcated low/intermediate signal intensity mass is shown. The Morton's neuroma is seen circled in red
Mentions: Between January 2004 and July 2008, a total of 37 patients with Morton's neuroma underwent surgical treatment at our institution. Data for these patients were retrospectively reviewed. All patients presented with signs and symptoms consistent with Morton's neuroma (i.e., Mulder's sign, numbness, radiation of neuritic pain, metatarsal pain, etc.). Prior to this report and according to our previous protocol, an ancillary test, an MRI or a US, was always ordered as a complement to the clinical diagnosis depending on the physician's criteria. When a discrepancy between the clinical and image diagnoses appeared, a second test was carried out. For the US study, a 7.5- or 9-MHz linear transducer (HDI 5000, Advanced Technology Laboratories, Bothell, WA, USA) was used. The images were obtained along sagittal and long axis planes from the plantar aspect of the foot. The dynamic method of expressing the neuroma on the dorsal aspect was performed. The diagnostic criterion was a focal hypoechoic interdigital nodule of the web space of the forefoot at the level of the metatarsal head beneath the intermetatarsal ligament. MRI was performed using a 1.5-T scanner (Signa; General Electric Medical Systems, Milwaukee, WI, USA) with transverse T1 sequences and transverse T2 sequences perpendicular to the metatarsal bones with the patient in the supine position. A thickening of the intermetatarsal nerve and a well defined ovoid mass at the plantar aspect near the metatarsal head with intermediate signal intensity on T1-weighted images [Figure 1] and low signal intensity on T2-weighted images [Figure 2] was defined as Morton's neuroma.

Bottom Line: In all cases, a histopathological examination confirmed the diagnosis.MRI had a higher sensitivity than US and should be considered the technique of choice in those cases.However, a negative result does not exclude the diagnosis (false negative 17%).

View Article: PubMed Central - PubMed

Affiliation: Orthopaedic Department of the Parc de Salut Mar. Passeig Marítim 25-29, 08003 Barcelona, Spain.

ABSTRACT

Background: The diagnosis of Morton's neuroma is based primarily on clinical findings. Ultrasonography (US) and magnetic resonance image (MRI) studies are considered complementary diagnostic techniques. The aim of this study was to establish the correlation and sensitivity of both techniques used to diagnose Morton's neuroma.

Materials and methods: Thirty seven patients (43 intermetatarsal spaces) with Morton's neuroma operated were retrospectively reviewed. In all cases MRI or ultrasound was performed to complement clinical diagnosis of Morton's neuroma. In all cases, a histopathological examination confirmed the diagnosis. Estimates of sensitivity were made and correlation (kappa statistics) was assessed for both techniques.

Results: Twenty seven women and 10 men participated with a mean age of 60 years. Double lesions presented in six patients. The second intermetatarsal space was affected in 10 patients and the third in 33 patients. An MRI was performed in 41 cases and a US in 23 cases. In 21 patients, both an MRI and a US were performed. With regard to the 41 MRIs performed, 34 were positive for Morton's neuroma and 7 were negative. MRI sensitivity was 82.9% [95% confidence interval (CI): 0.679-0.929]. Thirteen out of 23 US performed were positive and 10 US were negative. US sensitivity was 56.5% (95% CI: 0.345-0.768). Relative to the 21 patients on whom both techniques were carried out, the agreement between both techniques was poor (kappa statistics 0.31).

Conclusion: Although ancillary studies may be required to confirm the clinical diagnosis in some cases, they are probably not necessary for the diagnosis of Morton's neuroma. MRI had a higher sensitivity than US and should be considered the technique of choice in those cases. However, a negative result does not exclude the diagnosis (false negative 17%).

No MeSH data available.


Related in: MedlinePlus