The Comparative Study Of Multi-position MRI And HFUS In The Diagnosis Of Lateral Collateral Ligament Of Ankle Injury

ObjectiveTo explore the ideal MR imaging position of lateral collateral ligament of the ankle by using different MR imaging positions,including routine position,valgus position and full plantar flexion position.To compare the diagnostic value of multi-position MR imaging and high frequency ultrasound?HFUS?in the diagnosis of lateral collateral ligament in ankle injury through analyzing the consistency between MRI/HFUS diagnosis and surgical results,thus providing ideal imaging technique and important diagnositic information for the clinical treatment of ankle injury.Materials and Methods1.General InformationHealthy volunteer group.Thirty healthy people with normal ankle enrolled in the group,including 13 males and 17 females,aged 16-55 years.All of the subjects in this group were examined with multi-position MR imaging.Ankle injury group.From October 2015 to August 2016,182 patients with clinically-diagnosed ankle injury were consecutively collected in this study,including 118males and 64 females,aged 20-55 years in Linyi People's Hospital.Ankles were unilate-rally injured,including daily work or life activity injuries?118 cases?,traffic injuries?50cases?,and fall accident injuries?14 patients?.The common clinical manifestations were ankle pain and swelling.More serious presentations such as subcutaneous bruising,corresponding obvious tenderness and restriction of ankle joint movement could also be found in part of the patients.All patients were treated either with conservative treatment or surgical treatment?127 cases were treated conservatively,and the other 55 cases received surgical treatment?.These 55 cases who received surgical treatment were enrolled in ankle injury group and accepted routine position MRI,valgus position MRI and high frequency ultrasonography examinations.2.Imaging ProtocolMR Protocol.The subjects were imaged with a 1.5-tesla MR scanner?United Imaging uMR 560,Shanghai?by using a small flexibility coil.The routine position MRI?natural position,or about 20°plantar flexion?,Valgus position MRI and full plantar flexion MRI were performed separately.T₁WI?sagital?,T₂WI?sagital?and PDWI-FS?axial,sagittal and coronal?scanning were performed as routine MR sequences,in order to exclude compound injury.Axial and coronal PDWI-FS scanning were performed in valgus position and full plantar flexion MRI.The routine position MRI,valgus position MRI and full plantar flexion MRI were performed in the healthy volunteer group;The routine position MRI,valgus position MRI and HFUS examination were performed in the ankle joint injury group.The examination were performed after acupuncture treatment if the patients failed to cooperate with the examination because of ankle pain.HFUS Protocols.Ultrasonography of the ankle was performed using GE LOGIQ E9color doppler ultrasonic diagnostic apparatus operating with an 7-13MHz linear array transducer.3.Image Review.The multi-position MR imaging were analyzed by two senior radiologists;All HFUS examinations were performed by two senior ultrosound physician specializd in musculoskeletal US.4.Statistical Analysis.Statistical analysis was performed using SPSS 19.0 software.Healthy volunteer group:Rank Sum Test was used to analyze the measurement data of healthy group because of its non-normal distribution;Experimental group:Kappa test was used to analyzed the consistency of routine position MRI,valgus position MRI,HFUS and the result of operation?gold standard?in the detection of ankle injury respectively,P<0.05was considered to indicate statistical difference.Results1.Multi-position MRI display of LCL in normal ankle1.1.There was significant statistical difference among multi-position MRI examination in ATFL?P<0.05?.The routine position MRI and valgus position MRI are better than plantar flexion position MRI?Z=-3.003,-3.292,P<0.0125?.There was no significant statistical difference between routine position MRI and valgus position MRI?P>0.05?.1.2.There was significant statistical difference among multi-position MRI examinations in PTFL?P<0.05?.The routine position MRI and valgus position MRI are better than plantar flexion position MRI?Z=-2.961,-3.507,P<0.0125?.There was no significant statistical difference between routine position MRI and valgus position MRI?P>0.05?.1.3 There was significant statistical difference among multi-position MRI examinations in CFL?P<0.05?.CFL was better displayed on the Valgus position MRI than plantar flexion MRI and routine position MRI?Z=-5.301,-3.780,-3.144,P<0.0125?2.The diagnositic rusults by routine position MRI and valgus position MRI and HFUS of the ankle injury group2.1 Partially ruptured ligament:Five ligaments were misdiagnosed on the routine position MRI and 3 ligaments by valgus position MRI.Completely ruptured ligament:Four ligaments were misdiagnosed on the routine position MRI,2 ligaments by valgus position MRI,while 5 ligaments by HFUS.2.2 Kappa analysis of the consistency between the three imaging methods and the"gold standard"?Kappa<0.4:poor consistency;0.4<Kappa?0.75:ordinary consistency;Kappa>0.75:preferable consistency?.2.2.1 In the diagnosis of LCL injury,the results of routine position MRI,valgus position MRI and HFUS examination were consistent with the"gold standard"?Kappa=0.880,0.935,0.843?.2.2.2 In the diagnosis of CFL injury,the consistency with the“gold standard”of valgus position MRI and the HFUS were good?Kappa=0.904,0.808?while that of the routine position MRI was less good?Kappa=0.739?.Conclusions1?The routine position MRI showed better for ATFL and PTFL,but poor display for CFL2?The plantar flexion position MRI showed better for CFL,but poor display for ATFL and PTFL3?The valgus position MRI showed better for ATFL,CFL and PTFL4?For the diagnosis of lateral ligament injury of the ankle,the routine position MRI,the valgus position MRI and HFUS were consistent with the operation,but for the diagnosis of CFL,compared with the routine position MRI,the valgus position MRI and HUFS were high-consistency with the operationNot only CFL,but also ATFL and PTFL,can be clearly shown on valgus position MRI;Moreover,valgus position MRI examination has an excellent consistency with the“gold standard”in diagnosing lateral collateral ligament injuries especially in CFL injuries,thus worth to be promoted in clinical practice.