Comparative analysis of ultrasound and magnetic resonance imaging in diagnosing pain in the posterolateral region of the ankle

Mocanu, Dan; Bokwa-Dąbrowska, Katarzyna; Helander, Katarina Nilsson; Szaro, Pawel

doi:10.15557/jou.2025.0002

Abstract

Aim

The purpose of this study was to evaluate the diagnostic value of ultrasound compared to magnetic resonance imaging (MRI) as a reference in detecting peroneus brevis split ruptures.

Material and methods

We re-reviewed 112 ultrasound examinations performed between 2020 and 2021 by three musculoskeletal radiologists with 8–10 years of experience. Patients were referred due to pain lasting at least 8 months in the posterolateral ankle. Ultrasound was performed using a LOGIQ E9 General Electric device with a 6–15 MHz or 18 MHz probe. Sixty-three patients who underwent MRI within 8 months and were included in the study. Ultrasound and MRI findings were categorized as: a) no peroneus split, b) presence of peroneus split, or c) unspecific findings. MRI served as the reference standard. Sensitivity, specificity, positive predictive value, negative predictive value, and accuracy were calculated.

Results

Seven cases (11.1%) were false positives (diagnosed on ultrasound but not MRI) and 9 (14.3%) were false negatives (missed by ultrasound but detected on MRI). Six cases (9.5%) were true positives (identified on both ultrasound and MRI), and 41 patients (65.1%) were true negatives (negative on both modalities). Ultrasound showed a sensitivity of 40.0% and specificity of 85.4%. The positive predictive value (PPV) was 46.2%, while the negative predictive value (NPV) was 82.0%.

Conclusions

Ultrasound demonstrated limited sensitivity but high specificity in detecting peroneus brevis split ruptures.

References

Reijnierse M, Griffith JF: High-resolution ultrasound and MRI in the evaluation of the forefoot and midfoot. J Ultrason 2023; 23: e251–e271. doi: 10.15557/jou.2023.0033.
Open DOI Search in Google Scholar Back to article
Posadzy M, Ostrowska M, Michalski E, Gietka P, Mańczak M, Lanckoroński M et al.: Ultrasound and MRI of the foot in children and adolescents newly diagnosed with juvenile idiopathic arthritis. J Ultrason 2023; 23: e106–e113. doi: 10.15557/jou.2023.0019.
Open DOI Search in Google Scholar Back to article
Sobel M, Bohne WH, Levy ME: Longitudinal attrition of the peroneus brevis tendon in the fibular groove: an anatomic study. Foot Ankle 1990; 11: 124–128. doi: 10.1177/107110079001100302.
Open DOI Search in Google Scholar Back to article
Giza E, Mak W, Wong SE, Roper G, Campanelli V, Hunter JC: A clinical and radiological study of peroneal tendon pathology. Foot Ankle Spec 2013; 6: 417–421. doi: 10.1177/1938640013501544.
Open DOI Search in Google Scholar Back to article
Franson J, Baravarian B: Lateral ankle triad: the triple injury of ankle synovitis, lateral ankle instability, and peroneal tendon tear. Clin Podiatr Med Surg 2011; 28: 105–115. doi: 10.1016/j.cpm.2010.09.007.
Open DOI Search in Google Scholar Back to article
Pellegrini MJ, Sevillano J, Ortiz C, Giza E, Carcuro G: Knotless Modified Arthroscopic-Broström Technique for Ankle Instability. Foot Ankle Int 2019; 40: 475–483. doi: 10.1177/1071100718820341.
Open DOI Search in Google Scholar Back to article
Drakonaki EE, Gataa KG, Solidakis N, Szaro P: Anatomical variations and interconnections of the superior peroneal retinaculum to adjacent lateral ankle structures: a preliminary imaging anatomy study. J Ultrason 2021; 21: 12–21. doi: 10.15557/JoU.2021.0003.
Open DOI Search in Google Scholar Back to article
Safran MR, Benedetti RS, Bartolozzi AR 3rd, Mandelbaum BR: Lateral ankle sprains: a comprehensive review: part 1: etiology, pathoanatomy, histopathogenesis, and diagnosis. Med Sci Sports Exerc 1999; 31(7 Suppl): S429–437. doi: 10.1097/00005768-199907001-00004.
Open DOI Search in Google Scholar Back to article
Bokwa-Dąbrowska K, Mocanu D, Alexiev A, Helander KN, Szaro P: Peroneus brevis split rupture is underreported on magnetic resonance imaging of the ankle in patients with chronic lateral ankle pain. Eur J Radiol Open 2024; 13: 100591. doi: 10.1016/j.ejro.2024.100591.
Open DOI Search in Google Scholar Back to article
Dombek MF, Lamm BM, Saltrick K, Mendicino RW, Catanzariti AR: Peroneal tendon tears: a retrospective review. J Foot Ankle Surg 2003; 42: 250–258. doi: 10.1016/s1067-2516(03)00314-4.
Open DOI Search in Google Scholar Back to article
Sammarco GJ, DiRaimondo CV: Chronic peroneus brevis tendon lesions. Foot Ankle. 1989; 9: 163–170. doi: 10.1177/107110078900900403.
Open DOI Search in Google Scholar Back to article
Huuskonen M, Borkmann S, Bengtsson A, Sobecki P, Józwiak R, Solidakis N, Szaro P: Radiological features accompanying peroneus brevis split rupture revealed on magnetic resonance imaging - a cohort study. J Foot Ankle Res 2023; 16: 10. doi: 10.1186/s13047-023-00604-4.
Open DOI Search in Google Scholar Back to article
Park HJ, Lee SY, Park NH, Rho MH, Chung EC, Kwag HJ: Accuracy of MR findings in characterizing peroneal tendons disorders in comparison with surgery. Acta Radiol 2012; 53: 795–801. doi: 10.1258/ar.2012.120184.
Open DOI Search in Google Scholar Back to article
Miura K, Ishibashi Y, Tsuda E, Kusumi T, Toh S: Split lesions of the peroneus brevis tendon in the Japanese population: an anatomic and histologic study of 112 cadaveric ankles. J Orthop Sci 2004; 9: 291–295. doi: 10.1007/s00776-004-0784-5.
Open DOI Search in Google Scholar Back to article
Davda K, Malhotra K, O’Donnell P, Singh D, Cullen N: Peroneal tendon disorders. EFORT Open Rev 2017; 2: 281–292. doi: 10.1302/2058-5241.2.160047.
Open DOI Search in Google Scholar Back to article
Bonnin M, Tavernier T, Bouysset M: Split lesions of the peroneus brevis tendon in chronic ankle laxity. Am J Sports Med 1997; 25: 699–703. doi: 10.1177/036354659702500520.
Open DOI Search in Google Scholar Back to article
Taljanovic MS, Alcala JN, Gimber LH, Rieke JD, Chilvers MM, Latt LD: High-resolution US and MR imaging of peroneal tendon injuries. Radiographics. 2015; 35: 179–199. doi: 10.1148/rg.351130062. Erratum in: Radiographics 2015; 35: 651. doi: 10.1148/rg.352154005.
Open DOI Search in Google Scholar Back to article
Lamm BM, Myers DT, Dombek M, Mendicino RW, Catanzariti AR, Saltrick K: Magnetic resonance imaging and surgical correlation of peroneus brevis tears. J Foot Ankle Surg 2004; 43: 30–36. doi: 10.1053/j.jfas.2003.11.002.
Open DOI Search in Google Scholar Back to article
Melville DM, Taljanovic MS, Gimber LH, Miller M, Ahmad A, Sepich D, Latt LD: Comparison of Ultrasound and MRI with Intraoperative Findings in the Diagnosis of Peroneal Tendinopathy, Tears, and Subluxation. J Clin Med 2024; 13: 740. doi: 10.3390/jcm13030740.
Open DOI Search in Google Scholar Back to article
Galli MM, Protzman NM, Mandelker EM, Malhotra AD, Schwartz E, Brigido SA: An examination of anatomic variants and incidental peroneal tendon pathologic features: a comprehensive MRI review of asymptomatic lateral ankles. J Foot Ankle Surg 2015; 54: 164–172. doi: 10.1053/j.jfas.2014.11.005.
Open DOI Search in Google Scholar Back to article
Grant TH, Kelikian AS, Jereb SE, McCarthy RJ: Ultrasound diagnosis of peroneal tendon tears. A surgical correlation. J Bone Joint Surg Am 2005; 87: 1788–1794. doi: 10.2106/JBJS.D.02450.
Open DOI Search in Google Scholar Back to article
Rockett MS, Waitches G, Sudakoff G, Brage M: Use of ultrasonography versus magnetic resonance imaging for tendon abnormalities around the ankle. Foot Ankle Int 1998; 19: 604–612. doi: 10.1177/107110079801900907.
Open DOI Search in Google Scholar Back to article
Sobel M, Geppert MJ, Warren RF: Chronic ankle instability as a cause of peroneal tendon injury. Clin Orthop Relat Res 1993; 296: 187–191.
Search in Google Scholar Back to article
Davis WH, Sobel M, Deland J, Bohne WH, Patel MB: The superior peroneal retinaculum: an anatomic study. Foot Ankle Int 1994; 15: 271–725. doi: 10.1177/107110079401500507.
Open DOI Search in Google Scholar Back to article
Patil P, Dasgupta B: Role of diagnostic ultrasound in the assessment of musculoskeletal diseases. Ther Adv Musculoskelet Dis. 2012; 4: 341–355. doi: 10.1177/1759720X12442112.
Open DOI Search in Google Scholar Back to article
Logan RL, Scott PJ: Uncertainty in clinical practice: implications for quality and costs of health care. Lancet 1996; 347: 595–598. doi: 10.1016/s0140-6736(96)91284-2.
Open DOI Search in Google Scholar Back to article

Comparative analysis of ultrasound and magnetic resonance imaging in diagnosing pain in the posterolateral region of the ankle

Abstract

Aim

Material and methods

Results

Conclusions

Paradigm

My account