MSCT diagnosis of foot and ankle tendon injury / 中国骨伤

<p><b>OBJECTIVE</b>To study the MSCT features and diagnosis of foot and ankle tendon injury and improve the recognition to avoid the missed.</p><p><b>METHODS</b>From January 2009 to December 2010, 32 patients suspected of foot and ankle tendon injury were enrolled and included 24 males and 8 females with an average age of 43 years ranging from 23 to 68 years. All patients had pain, tenderness, swelling or disfunction in the diseased foot and were finally confirmed with surgery, MRI, contralateral contrast and followed-up. The MSCT was performed with a multi-detector CT scanner (Emotion 6; Siemens) within 7 days after injury. Two experienced radiologists evaluated the tendon abnormalities before told the outcome.</p><p><b>RESULTS</b>With 5 patients lost, the final study included 27 patients. Thirty-one tendon injuries were finally confirmed in 23 cases. Thirty-five tendon abnormalities were diagnosed on CT images among all 243 tendons but 4 of them were misdiagnoses. The CT overall diagnostic sensitivity, specificity, and accuracy was 88.8% (31/35), 98.1% (208/212), and 98.4% (239/243). Eleven tendon dislocations showed as the tendon partially or completely off the tendon groove. Thirteen tendon entrapment showed no less than half section of the tendon embedded the fracture in the axial images, and 7 tendons located in the fracture gap or 6 tendons closely related with widened fracture in VR images (2 misdiagnosis). Four bone chip insertion showed the chip inserted in the tendons both in the axial images and VR images (1 misdiagnosis). Four tendon ruptures showed discontinuity and shortening of the tendon (1 misdiagnosis). Three tendon injuries showed thickening, density reduction and blurring of tendons, and misty surrounding fat space.</p><p><b>CONCLUSION</b>With comprehensive MSCT examination (thin-slice scanning and volume rendering) of foot and ankle, the tendon dislocation, tendon entrapment, bone chip intercalation, and tendon rupture/injury could be confidently diagnose.</p>

Value of spiral CT examination for diagnosis of occult fracture of ankle and foot / 中国骨伤

<p><b>OBJECTIVE</b>To investigate the value of spiral CT examination for diagnosis occult fracture of the patients with negative result of X-ray examination and with high suspicion of fractures,so as to reduce misdiagnosis.</p><p><b>METHODS</b>From January 2007 to June 2010, 31 patients with ankle trauma performed spiral CT examination, including 18 males and 13 females, ranging in age from 21 to 67 years, with a mean of 35 years. The main symptoms of the patients included ankle pain, local swelling, obvious tenderness and activity limitation. All the patients had negative results of X-ray examination.</p><p><b>RESULTS</b>The spiral CT examination revealed 11 patients with fractures, involving a total of 17 points. Single fracture were found in 6 cases,and multiple fractures were found in 5 cases. Among single fractures, the lateral malleolus fracture was found in 1 case, talus fracture was found in 1 case, scaphoid fracture was found in 1 case, the fracture of the base of 5th metatarsal base was found in 1 case and calcaneal fractures were found in 2 cases. Within multiple fractures,internal and lateral malleolus fracture were found in 1 case; medial malleolus, calcaneus and talus fractures were found in 1 case; talus and scaphoid fractures were found in 1 case; the fractures of 1st and 2nd cuneiform bone were found in 1 case; the 2nd and 3rd metatarsal base fracture was found in 1 case.</p><p><b>CONCLUSION</b>For the patients with negative X-ray examination and high suspicion of fractures,the spiral CT examination is needed, which could significantly improve the detection rate of occult fractures, and provide imaging basis for clinical treatment and judicial identify.</p>