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Assessment of peroneal tendon lesions using 2-dimensional and 3-dimensional isotropic magnetic resonance imaging with
Flavio Duarte Silva1, Rubeel Akram1, Atul Kumar Taneja1
1Department of Radiology, University of Texas at Southwestern Medical Center, Dallas, USA.
Abstract:
Accurate diagnoses of peroneal pathologies remains a challenge due to limitations of conventional 2D (dimensional) imaging, which can impact long-term patient outcomes. This study evaluates MRI accuracy and inter-reader reliability of peroneal compartment pathology for 2D and 3D MRI. A consecutive series of patients who underwent peroneal compartment surgery with preoperative 1.5- or 3.0-Tesla ankle MRIs from 2009 to 2024 included 32 scans (22 with 2D, 10 with 2D+3D) from 31 patients (ages 17-74 years, all genders). Three musculoskeletal readers blinded to surgical findings independently analyzed MRI scans for common peroneal tenosynovitis, peroneus brevis and peroneus longus tenosynovitis, tendinopathy, and tears. Inter-reader reliability and diagnostic performance measures were calculated. Using majority vote, overall accuracy, sensitivity, and specificity for peroneal tendons using 2D MRI were 80%, 81%, and 79%, respectively. Using 3D MRI sequences, whether in isolation or combination with 2D MRI, accuracy, sensitivity, and specificity increased to 85%, 88%, and 83%, respectively. The inter-reader reliability for peroneus brevis lesions was 0.45-0.75 for 2D, 0.25-0.35 for 3D, and 0.31-0.54 for combined 2D+3D, while for peroneus longus lesions, it was 0.45-0.90 for 2D, 0.20-0.71 for 3D, and 0.64-0.81 for combined 2D+3D scans. The inter-reader reliability for tenosynovitis ranged from 0.62-0.64 for 2D, 0.25-0.37 for 3D, and 0.57-0.66 for combined 2D+3D scans. The addition of 3D MRI to 2D high-resolution ankle MRI protocol or 3D MRI alone increases accuracy of peroneal compartment lesion detection with minor decrease in inter-reader reliability for peroneal brevis tendon assessment. Larger studies may help validate our findings.
Insights
Three-dimensional (3D) MRI enhances diagnostic accuracy for peroneal pathologies compared to conventional 2D MRI, improving detection of tendon injuries and tenosynovitis. While 3D MRI shows promise, further research is needed to validate its impact on inter-reader reliability.
Area of Science:
- Radiology
- Orthopedic Imaging
- Musculoskeletal MRI
Background:
- Diagnosing peroneal pathologies accurately is challenging with conventional 2D MRI, potentially affecting patient outcomes.
- Peroneal tendon injuries and tenosynovitis require precise imaging for effective treatment.
Purpose of the Study:
- To evaluate the diagnostic accuracy and inter-reader reliability of 2D and 3D MRI for peroneal compartment pathologies.
- To compare the performance of 2D MRI, 3D MRI, and combined 2D+3D MRI in detecting peroneal tendon abnormalities.
Main Methods:
- Retrospective analysis of 32 ankle MRIs (2D and 3D) from 31 patients who underwent peroneal compartment surgery.
- Three musculoskeletal radiologists independently assessed scans for tenosynovitis, tendinopathy, and tears in peroneal tendons.
- Diagnostic performance metrics (accuracy, sensitivity, specificity) and inter-reader reliability (using kappa statistics) were calculated.
Main Results:
- 2D MRI achieved 80% accuracy, 81% sensitivity, and 79% specificity for peroneal tendons.
- Incorporating 3D MRI sequences (alone or with 2D) improved accuracy to 85%, sensitivity to 88%, and specificity to 83%.
- Inter-reader reliability varied, with a minor decrease observed for peroneal brevis lesions when using 3D sequences.
Conclusions:
- The addition of 3D MRI sequences to standard ankle MRI protocols significantly increases the accuracy of detecting peroneal compartment lesions.
- While 3D MRI offers improved diagnostic performance, its impact on inter-reader reliability, particularly for peroneal brevis assessment, warrants further investigation.
- Larger studies are recommended to validate these findings and establish optimal MRI protocols for peroneal pathologies.
