Korean J Radiol.  2008 Oct;9(5):409-415. 10.3348/kjr.2008.9.5.409.

Ankle MRI for Anterolateral Soft Tissue Impingement: Increased Accuracy with the Use of Contrast-Enhanced Fat-Suppressed 3D-FSPGR MRI

• Choo HJ
• Suh JS
• Kim SJ
• Huh YM
• Kim MI
• Lee JW

• KMID: 1385398
• DOI: http://doi.org/10.3348/kjr.2008.9.5.409

Abstract

OBJECTIVE
To validate the use of contrast-enhanced (CE) fat-suppressed three-dimensional (3D) fast gradient-recalled acquisition in the steady state with radiofrequency spoiling (FSPGR) magnetic resonance imaging (MRI) for the diagnosis of anterolateral soft tissue impingement of the ankle, as compared to the use of routine ankle MRI. MATERIALS AND METHODS: Contrast-enhanced fat-suppressed 3D-FSPGR MRI and routine MRI scans were retrospectively reviewed for 45 patients with arthroscopically proven anterolateral impingement. In addition, scans were reviewed in 45 control subjects with diagnoses other than impingement. Two radiologists independently reviewed the two sets of images in random order. Using areas (Az) under the receiver operating characteristic curve (ROC), we compared the depiction of anterolateral soft tissue impingement in the two sets of images. RESULTS: The overall accuracy for lesion characterization was significantly higher (p < 0.05) using the CE fat-suppressed 3D-FSPGR MR images (Az = 0.892 and 0.881 for reader 1 and 2, respectively) than using the routine MR images (Az = 0.763 and 0.745). The use of CE fat-suppressed 3D-FSPGR MRI enhanced impingement depiction in most cases. However, in cases with a thickened non-enhancing scar or joint effusion, the routine images better depicted a soft tissue mass that intruded into anterolateral gutter than the CE images. CONCLUSION: The use of CE fat-suppressed 3D-FSPGR MRI of the ankle allows a more accurate assessment of anterolateral soft tissue impingement of the ankle, as compared to the use of routine MRI.

Keyword

Ankle, abnormalities; Ankle, injuries; Ankle, MR

MeSH Terms

Adolescent
Adult
Aged
Ankle Joint/*pathology
Contrast Media
Female
Gadolinium DTPA/diagnostic use
Humans
Image Interpretation, Computer-Assisted
Imaging, Three-Dimensional
Joint Diseases/*diagnosis
Magnetic Resonance Imaging/*methods
Male
Middle Aged
ROC Curve
Retrospective Studies
Sensitivity and Specificity
Statistics, Nonparametric

Figure

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  Fig. 1 Imaging findings of normal anterolateral recess of ankle and soft tissue impingement at anterolateral recess of ankle as depicted by use of routine MR. Images are transverse T2-weighted (TR/TE of 2000/20/70, 256 × 256 matrix, 1 NEX [number of excitatid], FOV [field of view] of 12 cm) spin echo MRI, taken approximately at level of malleolar fossa. A. Normal anterolateral recesses were defined as clear anterolateral recesses of ankle without thickened anterior talofibular ligament (arrow). B, C. Anterolateral soft tissue impingement of ankle was defined as filling of anterolateral gutter with soft tissue (B), fuzzy and marked thickening of anterior talofibular ligament (C).

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  Fig. 2 Imaging findings of normal anterolateral recess of ankle and soft tissue impingement at anterolateral recess of ankle by use of 3D-FSPGR MR. Images are reformatted-axial contrast-enhanced fat-suppressed 3D-FSPGR images (TR/TE of 20.9/2.2 msec, flip angle of 15°, 256 × 192 matrix, 1 number of excitatid, field of view of 12 cm) using coronal contrast enhanced 3D-FSPGR imaging. A. Normal image shows no enhancing lesion at anterolateral recess of ankle. B. Anterolateral soft tissue impingement of ankle was defined as a nodular thick enhancement with internal intrusion (arrow).

• 

  Fig. 3 56-year old woman with chronic ankle pain. This was true positive case diagnosed by both routine MRI and contrast enhanced fat-suppressed 3D-FSPGR MRI. A, B. Axial intermediate (A) and T2 (B) weighted spin echo (2000/20/70) MRI showing soft tissue fullness in anterolateral recess (arrow). C. Reformatted-axial contrast enhanced fat-suppressed 3D FSPGR images also show enhancing soft tissue fullness in anterolateral recess (arrow).

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  Fig. 4 30-year-old man with chronic ankle pain. This case was correctly diagnosed by CE fat-suppressed 3D-FSPGR MRI and was missed by use of routine MRI. A, B. Axial T2 (A) weighted spin echo (2000/70) MRI shows mild fuzzy anterior talofibular ligament (arrow). However, reformatted axial CE fat-suppressed 3D-FSPGR (B) MRI shows irregular thick enhancement in anterolateral recess (arrow) of ankle. C. Arthroscopic findings confirm presence of anterolateral impinged soft tissue (*).

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  Fig. 5 33-year-old man with chronic ankle pain. This was contrast enhanced 3D-FSPGR MRI false negative case but routine MRI true positive case. A. Axial T2-weighted spin echo (2000/70) MRI shows focal soft tissue mass. B. Reformatted axial contrast enhanced fat-suppressed 3D-FSPGR MRI shows no enhancing lesion in anterolateral recess of ankle. C. Arthroscopic findings confirm presence of anterolateral impinged soft tissue (*).

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