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. 2022 Feb 20;58(2):321.
doi: 10.3390/medicina58020321.

The Role of Diffusion Weighted MR Imaging in the Diagnosis of Tendon Injuries of the Ankle and Foot

Hasan Aydın  1 , Volkan Kızılgöz  2 , Önder Ersan  3 , Baki Hekimoğlu  4
Affiliations

The Role of Diffusion Weighted MR Imaging in the Diagnosis of Tendon Injuries of the Ankle and Foot

Hasan Aydın et al. Medicina (Kaunas). .

Abstract

Background and objectives: Our aim is to determine the diagnostic performance and utility of Diffusion Weighted MR Imaging (DWI) against the routine Magnetic Resonance Imaging (MRI) for the evaluation of patients with tendon injuries of the ankle and foot. Materials and Method: After institutional review board approval and informed consent taken from all the patients, ankle and foot MR imaging and DWI-Apparent Diffusion Coefficient (ADC) mapping were performed on the 81 injured tendons of 50 patients. All tendon injuries were named as Rupture (R), Partial tear (PT), and Tenosynovitis (T). Diagnostic interpretation was based on the MRI-DWI and ADC mapping, verified by either open surgery, diagnostic arthroscopy, or conservative procedures-splint application. Statistical analysis of this research was assessed by Fischer's exact test, variance analysis test between dependent groups, Receiver Operating Characteristics (ROC) curve, and Pearson chi square statistics. Results: MRI depicted all tendon injuries with 70% sensitivity and 100% specificity, and showed a significant statistical relationship to surgical and arthroscopic references with high agreement (p < 0.05, k: 0.609). DWI had 100% sensitivity and 83-90% specificity for the visualization of tendon injuries with certain agreement and a significant statistical relationship to the gold standard (p < 0.05, k: 0.890-0.899). For all those injured tendons, DWI had 100% sensitivity for the diagnosis of R, and 92-97% sensitivity corresponding to PT and T over routine ankle MR imaging. The specificity of DWI to MRI ranged from 75 to 44% for all the injured tendons. DWI had significant statistical superiority over MRI for the visualization of R, PT, and T of all tendons included in this research (p < 0.05). Conclusions: DWI is a good imaging modality for the visualization of ankles with tendon injuries, possibly further improving the sensitivity of the classical ankle and foot MRI, and supplying more beneficial and diagnostic information than routine MR imaging on the basis of R, PT, and T of tendons at the ankle and foot.

Keywords: MRI; ankle injuries; diffusion MRI; diffusion weighted MRI; tendon injuries.

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Conflict of interest statement

The authors declare no conflict of interest.

Figures

Figure 1
Figure 1
(a,b) Axial and coronal ADC-DWI images show the FHL tendon partial tear.
Figure 2
Figure 2
Study Flow Chart for Readers.
Figure 3
Figure 3
(a–c) Sagittal T2WI, coronal DWI, axial T2WI images. The images depict an FDL tendon partial tear.
Figure 3
Figure 3
(a–c) Sagittal T2WI, coronal DWI, axial T2WI images. The images depict an FDL tendon partial tear.
Figure 4
Figure 4
Axial ADC-DWI presents a TP tendon tear.
Figure 5
Figure 5
(a–d) Axial-Sagittal DWI, axial, and Sagittal T2W images show post-sequela cystic TA tenosynovitis.
Figure 5
Figure 5
(a–d) Axial-Sagittal DWI, axial, and Sagittal T2W images show post-sequela cystic TA tenosynovitis.
Figure 6
Figure 6
ROC curve analysis, presenting DWI.MRI comparison for ruptured tendons.
Figure 7
Figure 7
ROC curve analysis, predicting DWI.MRI comparison for tendons with partial tears.
Figure 8
Figure 8
ROC curve analysis, regarding DWI.MRI comparison for tendons with tenosynovitis.
See this image and copyright information in PMC

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