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High-resolution MR neurography: evaluation before repeat tarsal tunnel surgery.
Avneesh Chhabra1, Ty K Subhawong, Eric H Williams
1Russell H. Morgan Department of Radiology and Radiological Science, Johns Hopkins University School of Medicine, Johns Hopkins Hospital, Baltimore, MD 21287, USA.
AJR. American Journal of Roentgenology
|June 25, 2011
Summary
High-resolution MR neurography (MRN) accurately identifies nerve reentrapment after failed tarsal tunnel surgery. This imaging technique aids in presurgical diagnosis for persistent symptoms, improving surgical planning.
Area of Science:
- Orthopedics
- Radiology
- Neurology
Background:
- Persistent symptoms after tarsal tunnel release often necessitate repeat surgery.
- Accurate presurgical evaluation is crucial for successful outcomes in revision surgeries.
Purpose of the Study:
- To determine the accuracy of high-resolution MR neurography (MRN) in the presurgical evaluation of patients undergoing repeat tarsal tunnel surgery.
- To assess MRN's ability to detect specific abnormalities like fibrosis, neuroma, and denervation.
Main Methods:
- Retrospective review of 10 MRN studies from 9 patients with persistent symptoms post-tarsal tunnel release.
- Analysis of MRN findings including focal fibrosis, nerve abnormalities, neuroma, and muscle denervation.
- Calculation of diagnostic accuracy using clinical and intraoperative findings as reference standards.
Main Results:
- MRN detected nerve reentrapment due to focal fibrosis in 90% of cases.
- High sensitivity for detecting injury to the medial (100%) and lateral plantar nerves (100%), with overall accuracy of 86%.
- MRN showed 91% sensitivity for focal fibrosis and 67% for neuroma detection; superior evaluation of muscle denervation compared to surgery.
Conclusions:
- High-resolution MR neurography provides accurate morphologic information for presurgical diagnosis of nerve injury after failed tarsal tunnel release.
- MRN effectively guides surgical planning by detailing the location and extent of nerve pathology.
