Sungchul Park1, Seo-Goo Han2, Koeun Kim1, Heungwoo Lee1, Yun-Sic Bang1, Keum Nae Kang3, Jonghyuk Lee3, Young Uk Kim4. 1. Department of Anesthesiology and Pain Medicine, CHA Bundang Medical Center, CHA University, Seongnam 13496, Korea. 2. Department of Internal Medicine, Catholic Kwandong University, College of Medicine, International St. Mary's Hospital, Incheon 22711, Korea. 3. Department of Anesthesiology and Pain Medicine, National Police Hospital, Seoul 05715, Korea. 4. Department of Anesthesiology and Pain Medicine, Catholic Kwandong University, College of Medicine, International St. Mary's Hospital, Incheon 22711, Korea.
Abstract
BACKGROUND: An injured calcaneofibular ligament (CFL) is a major cause of ankle instability (AI). Previous research has demonstrated that the thickness of the calcaneofibular ligament (CFLT) is correlated with higher-grade sprains and ankle instability. However, inflammatory hypertrophy is distinct from ligament thickness; accordingly, we considered that the calcaneofibular ligament cross-sectional area (CFLCSA) as a potential morphological parameter to analyze inflammatory CFL. We hypothesized that the CFLCSA was a key morphologic parameter in AI diagnosis. METHODS: We gathered the CFL data of 26 AI patients and 25 control subjects who had undergone ankle magnetic resonance imaging (A-MRI), and it had revealed no evidence of AI. Ankle level T1-weighted coronal A-MRI images were acquired. Using our image analysis program (INFINITT PACS), we analyzed the CFLT and CFLCSA at the CFL on the A-MRI. The CFLCSA was measured as the whole ligament cross-sectional area of the CFL that was most hypertrophied in the transverse A-MR images. The CFLT was measured at the thickest level of CFL. RESULTS: The mean CFLT was 3.49±0.82 mm in the control group, and 4.82±0.76 mm in the AI group. The mean CFLCSA was 33.31±7.02 mm2 in the control group, and 65.33±20.91 mm2 in the AI group. The AI patients had significantly greater CFLT (P<0.001) and CFLCSA (P<0.001) than the control group participants. A receiver operating characteristic (ROC) curve analysis in the evaluation of the diagnostic tests showed that the optimal cut-off score of the CFLT was 4.06 mm, with 76.9% sensitivity, 76.0% specificity, and an area under the curve (AUC) of 0.89 (95% CI, 0.79-0.99). The optimal cut-off threshold of the CFLCSA was 43.85 mm2, with 92.3% sensitivity, 92.0% specificity, and AUC of 0.94 (95% CI, 0.86-1.00). CONCLUSIONS: Even though the CFLT and CFLCSA were both significantly associated with AI, the CFLCSA was a more sensitive diagnostic test. 2021 Quantitative Imaging in Medicine and Surgery. All rights reserved.
BACKGROUND: An injured calcaneofibular ligament (CFL) is a major cause of ankle instability (AI). Previous research has demonstrated that the thickness of the calcaneofibular ligament (CFLT) is correlated with higher-grade sprains and ankle instability. However, inflammatory hypertrophy is distinct from ligament thickness; accordingly, we considered that the calcaneofibular ligament cross-sectional area (CFLCSA) as a potential morphological parameter to analyze inflammatory CFL. We hypothesized that the CFLCSA was a key morphologic parameter in AI diagnosis. METHODS: We gathered the CFL data of 26 AI patients and 25 control subjects who had undergone ankle magnetic resonance imaging (A-MRI), and it had revealed no evidence of AI. Ankle level T1-weighted coronal A-MRI images were acquired. Using our image analysis program (INFINITT PACS), we analyzed the CFLT and CFLCSA at the CFL on the A-MRI. The CFLCSA was measured as the whole ligament cross-sectional area of the CFL that was most hypertrophied in the transverse A-MR images. The CFLT was measured at the thickest level of CFL. RESULTS: The mean CFLT was 3.49±0.82 mm in the control group, and 4.82±0.76 mm in the AI group. The mean CFLCSA was 33.31±7.02 mm2 in the control group, and 65.33±20.91 mm2 in the AI group. The AI patients had significantly greater CFLT (P<0.001) and CFLCSA (P<0.001) than the control group participants. A receiver operating characteristic (ROC) curve analysis in the evaluation of the diagnostic tests showed that the optimal cut-off score of the CFLT was 4.06 mm, with 76.9% sensitivity, 76.0% specificity, and an area under the curve (AUC) of 0.89 (95% CI, 0.79-0.99). The optimal cut-off threshold of the CFLCSA was 43.85 mm2, with 92.3% sensitivity, 92.0% specificity, and AUC of 0.94 (95% CI, 0.86-1.00). CONCLUSIONS: Even though the CFLT and CFLCSA were both significantly associated with AI, the CFLCSA was a more sensitive diagnostic test. 2021 Quantitative Imaging in Medicine and Surgery. All rights reserved.
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