title: MR-imaging of anterior tibiotalar impingement syndrome: agreement, sensitivity and specificity of MR-imaging and indirect MR-arthrography.
abstract: OBJECTIVE
  To clarify the role of MR-imaging in the diagnosis of anterior ankle impingement syndromes.
  
  
  METHODS
  We prospectively examined 51 consecutive patients with chronic ankle pain by MR-imaging. Arthroscopy was performed in 29 patients who previously underwent non-enhanced MR-imaging; in 11 patients, indirect MR-arthrography additionally was performed. MR-examinations were correlated with clinical findings; MR and arthroscopy scores were statistically compared, agreement was measured.
  
  
  RESULTS
  Arthroscopy demonstrated granulation tissue in the lateral gutter (38%) and anterior recess (31%), lesions of the anterior tibiofibular (31%) and the anterior talofibular ligament (21%) as well as intraarticular bodies (10%). Stenosing tenosynovitis and a ganglionic cyst were revealed as extraarticular causes for chronic ankle pain by MR-examination (17%). Agreement of MR-imaging and arthroscopy was fair for the anterior talofibular ligament and the anterior joint cavity (kappa 0.40). Major discrepancy was found for non-enhanced MR scans (kappa 0.49) when compared with indirect MR-arthrography (kappa 0.03) in the anterior cavity. The sensitivity for lesions of the anterior talofibular and calcaneofibular ligament and the anterior cavity (0.91-0.87) detected by MR-imaging was superior in comparison to lesions of the anterior tibiofibular ligament and anteromedial cavity (0.50-0.24).
  
  
  CONCLUSIONS
  MR-imaging provides additional information about the mechanics of chronic ankle impingement rather than an accurate diagnosis of this clinical entity. The method is helpful in differentiating extra- from intra-articular causes of ankle impingement. Indirect MR-arthrography has little or no additional value in patients with ankle impingement syndrome.
authors.affiliation: Department of Radiology, Hanusch Hospital, Heinrich Collin-Strasse 30, A-1140 Vienna, Austria.
authors.forename: Jörg
authors.initials: J
authors.lastname: Haller
authors.forename: Reinhard
authors.initials: R
authors.lastname: Bernt
authors.forename: Thomas
authors.initials: T
authors.lastname: Seeger
authors.forename: Alexander
authors.initials: A
authors.lastname: Weissenbäck
authors.forename: Heinrich
authors.initials: H
authors.lastname: Tüchler
authors.forename: Donald
authors.initials: D
authors.lastname: Resnick
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000843:Ankle Joint / Q000473:pathology*; D001182:Arthroscopy / Q000379:methods*; D005260:Female; D006801:Humans; D007592:Joint Diseases / Q000175:diagnosis*; D008023:Ligaments, Articular / Q000473:pathology; D008279:Magnetic Resonance Imaging / Q000379:methods*; D008297:Male; D008875:Middle Aged; D015588:Observer Variation; D011446:Prospective Studies; D015203:Reproducibility of Results; D012680:Sensitivity and Specificity; D013577:Syndrome; D013628:Talus / Q000473:pathology*; D013710:Tendons / Q000473:pathology; D013977:Tibia / Q000473:pathology*