title: Diagnostic Value of Elastography in the Diagnosis of Intermetatarsal Neuroma.
abstract: The objective of the present study was to characterize the ultrasound and elastographic properties of intermetatarsal neuroma (interdigital neuroma) and their contribution to diagnosis. Eighteen patients with metatarsalgia, who had presented to an orthopedic clinic from April 2013 to February 2015, were diagnosed with 25 intermetatarsal neuromas (11 unilateral [61.11%], 7 bilateral [38.89%]). These patients underwent evaluation with ultrasonography and simultaneous ultrasound strain elastography to assess the elastographic properties of the tissues in the intermetatarsal space. The intermetatarsal neuroma diagnosis was confirmed by histopathologic inspection. The lesion contours, localization, dimensions, and vascularization were evaluated before surgical excision. The elasticity and strain ratio values were compared between the neuroma and adjacent healthy intermetatarsal space. Of the 25 intermetatarsal neuromas, 1 (4%) was not detected by ultrasonography (incidence of detection of 96%). The mean neuroma width was 6.35 (range 3.7 to 13) mm in the coronal plane, and the mean elasticity and strain ratio values were 3.44 (range 1.1 to 5.1) and 9.47 (range 2.3 to 19.3), respectively. The elasticity and strain ratio values were significantly greater in the presence of an interdigital neuroma than in the adjacent healthy intermetatarsal spaces (Z = -3.964, p = .0001 and Z = -3.927, p = .0001, respectively). The diagnostic cutoff values were calculated as 2.52 for elasticity and 6.1 for the strain ratio. Four neuromas (16%) were not demarcated, and the elasticity and strain ratio values for these were lower than those for neuromas with demarcated contours but were greater than those for healthy intermetatarsal spaces (p < .006 and p < .005, respectively). Patients with clinically suspected intermetatarsal neuromas that do not show demarcation and with smaller lesions might benefit from the use of ultrasound elastography for diagnosis.
authors.affiliation: Assistant Professor, Department of Radiology, Medipol University, Faculty of Medicine, Istanbul, Turkey. Electronic address: tug_ormeci@yahoo.co.uk.
authors.forename: Tugrul
authors.initials: T
authors.lastname: Ormeci
authors.affiliation: Assistant Professor, Department of Orthopaedics and Traumatology, Medipol University, Faculty of Medicine, Istanbul, Turkey.
authors.forename: Olcay
authors.initials: O
authors.lastname: Güler
authors.affiliation: Assistant Professor, Department of Orthopaedics and Traumatology, Medipol University, Faculty of Medicine, Istanbul, Turkey.
authors.forename: Melih
authors.initials: M
authors.lastname: Malkoc
authors.affiliation: Assistant Professor, Department of Orthopaedics and Traumatology, Medipol University, Faculty of Medicine, Istanbul, Turkey.
authors.forename: Mert
authors.initials: M
authors.lastname: Keskinbora
authors.affiliation: Resident, Department of Radiology, Medipol University, Faculty of Medicine, Istanbul, Turkey.
authors.forename: Fatma Zeynep
authors.initials: FZ
authors.lastname: Güngören
authors.affiliation: Professor and Chairman, Department of Orthopaedics and Traumatology, Medipol University, Faculty of Medicine, Istanbul, Turkey.
authors.forename: Mahir
authors.initials: M
authors.lastname: Mahirogulları
mesh_terms: D000328:Adult; D000368:Aged; D054459:Elasticity Imaging Techniques; D005260:Female; D006801:Humans; D008279:Magnetic Resonance Imaging; D008297:Male; D037061:Metatarsalgia / Q000209:etiology; D008875:Middle Aged; D000070607:Morton Neuroma / Q000000981:diagnostic imaging*; D012680:Sensitivity and Specificity; D055815:Young Adult
keywords: Morton's neuroma; elasticity; intermetatarsal space; strain ratio; ultrasound