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

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          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.

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          Most cited references18

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          Measurement of observer agreement.

          Statistical measures are described that are used in diagnostic imaging for expressing observer agreement in regard to categorical data. The measures are used to characterize the reliability of imaging methods and the reproducibility of disease classifications and, occasionally with great care, as the surrogate for accuracy. The review concentrates on the chance-corrected indices, kappa and weighted kappa. Examples from the imaging literature illustrate the method of calculation and the effects of both disease prevalence and the number of rating categories. Other measures of agreement that are used less frequently, including multiple-rater kappa, are referenced and described briefly.
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            Special focus session. MR arthrography.

            Direct magnetic resonance (MR) arthrography with injection of saline solution or diluted gadolinium can be useful for evaluating certain pathologic conditions in the joints. It is most helpful for outlining labral-ligamentous abnormalities in the shoulder and distinguishing partial-thickness from full-thickness tears in the rotator cuff, demonstrating labral tears in the hip, showing partial- and full-thickness tears of the collateral ligament of the elbow and delineating bands in the elbow, identifying residual or recurrent tears in the knee following meniscectomy, increasing the certainty of perforations of the ligaments and triangular fibrocartilage in the wrist, correctly identifying ligament tears in the ankle and increasing the sensitivity for ankle impingement syndromes, assessing the stability of osteochondral lesions in the articular surface of joints, and delineating loose bodies in joints. Indirect MR arthrography with intravenous administration of diluted gadolinium may be performed when direct arthrography is inconvenient or not logistically feasible. Although indirect MR arthrography has some disadvantages vis-à-vis direct MR arthrography, it does not require fluoroscopic guidance or joint injection and it is superior to conventional MR imaging in delineating structures when there is minimal joint fluid. In addition, vascularized or inflamed tissue will enhance with this method. Indirect MR arthrography can be used to rule in or diagnose abnormalities and to exclude abnormalities.
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              MR imaging of ankle impingement syndromes.

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                Author and article information

                Journal
                Korean J Radiol
                KJR
                Korean Journal of Radiology
                The Korean Society of Radiology
                1229-6929
                2005-8330
                Sep-Oct 2008
                30 October 2008
                : 9
                : 5
                : 409-415
                Affiliations
                [1 ]Department of Radiology and Research Institute of Radiological Science, College of Medicine, Yonsei University, Seoul 120-752, Korea.
                [2 ]Department of Radiology, College of Medicine, Inje University, Busan 614-735, Korea.
                [3 ]Department of Orthopedic Surgery, Yonsei University, College of Medicine, Seoul 120-752, Korea.
                Author notes
                Address reprint requests to: Jin-Suck Suh, MD, Department of Radiology, Yonsei University College of Medicine, 134 Sincheon-dong Seodaemun-gu, Seoul 120-752, Korea. Tel. (822) 2228-7400, Fax. (822) 393-3035, jss@ 123456yuhs.ac
                Article
                10.3348/kjr.2008.9.5.409
                2627205
                18838849
                afa44e6e-134d-4081-8c4a-162be6162b6f
                Copyright © 2008 The Korean Society of Radiology

                This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License ( http://creativecommons.org/licenses/by-nc/3.0) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

                History
                : 11 September 2007
                : 15 April 2008
                Categories
                Original Article

                Radiology & Imaging
                ankle, mr,ankle, abnormalities,ankle, injuries
                Radiology & Imaging
                ankle, mr, ankle, abnormalities, ankle, injuries

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