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Kim, Jeong, Lee, Choi, Kim, and Park: The Value of MRI in Idiopathic Tarsal Tunnel Syndrome by Measuring the Cross-Sectional Area of Tarsal Tunnel
Musculoskeletal Radiology

Journal of the Korean Society of Radiology 2015; 72(3): 164-170.

Published online: 6 March 2015

DOI: https://doi.org/10.3348/jksr.2015.72.3.164

The Value of MRI in Idiopathic Tarsal Tunnel Syndrome by Measuring the Cross-Sectional Area of Tarsal Tunnel

Min Jung Kim, MD1, Yu Mi Jeong, MD1, Sheen-Woo Lee, MD1, Seung Joon Choi, MD1, Jeong Ho Kim, MD1, Hong Gi Park, MD2

1Department of Radiology, Gachon University, Gil Hospital, Incheon, Korea.

2Department of Orthopedic Surgery, Gachon University, Gil Hospital, Incheon, Korea.

Corresponding author: Yu Mi Jeong, MD. Department of Radiology, Gachon University, Gil Hospital, 21 Namdong-daero 774beon-gil, Namdong-gu, Incheon 405-760, Korea. Tel. 82-32-460-3060, Fax. 82-32-460-3065, youme34@gilhospital.com

Received 8 July 2014       Accepted 29 October 2014

Copyright © 2015 The Korean Society of Radiology

(open-access):

This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/3.0/) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

Abstract

Purpose

The purpose of this study was to evaluate the use of MRI as a diagnostic test in tarsal tunnel syndrome. There are no published reports with this aim and no diagnostic standard for idiopathic tarsal tunnel syndrome (TTS) using imaging modalities.

Materials and Methods

We retrospectively searched our Picture Archiving and Communication System data and medical records to identify patients who were clinically and electomyographically diagnosed with idiopathic TTS without space-occupying lesion on MRI. Twenty five patients were included in the patient group. Another twenty-five patients who underwent ankle MRI for Achilles tendon disease were selected and included in the control group. Cross-sectional areas (CSA) of tarsal tunnel were manually measured independently by two radiologists who were blinded to clinical and surgical results, using three-dimensional reconstruction software in our hospital. Measurements were done on axial images at three levels (level 1, tibiotalar joint level; level 2, medial malleolar tip level; level 3, sustentaculum tali level). Patient and control group data were statistically analyzed by the Mann-Whitney test.

Results

The mean values of CSA at levels 1, 2, and 3 of the tarsal tunnel were 87.8 mm2, 98.2 mm2, and 105.2 mm2, respectively in the patient group; and 100.0 mm2, 113.8 mm2, and 127.9 mm2 in the control group, respectively, in reader 1; and 86.2 mm2, 97.6 mm2, 105.2 mm2, respectively in the patient group; and 99.7 mm2, 112.3 mm2, 124.4 mm2, respectively, in the control group, in reader 2. The mean CSA in the patient group was significantly less than that of the control group at all three levels (p < 0.05). Intra-class correlation coefficient value between reader 1 and reader 2 were 0.98 in group 1, and 0.97 in group 2, respectively.

Conclusion

MRI can be helpful in the assessment of idiopathic tarsal tunnel syndrome. CSA measurements of tarsal tunnel at each level may predict TTS even though there are no space occupying lesions in the tarsal tunnel on MRI.

Keywords: Idiopathic Tarsal Tunnel Syndrome, Cross-Sectional Areas, MRI

Figures and Tables

Fig. 1

The three axial levels of the tarsal tunnel at which the cross-sectional area were measured.

A. Cross section of ankle at level of tibiotalar joint.
B. Cross section of ankle at level of medial malleolar tip.
C. Cross section of ankle at level of sustentaculum tali.
jksr-72-164-g001
Fig. 2

MR axial image of 59/M with idiopathic tarsal tunnel syndrome, right ankle. Some of the patient group showed flattened appearance of fibro-osseous tunnel on the transverse images.

jksr-72-164-g002
Fig. 3

MR axial image of 31/M. Right ankle MRI for postoperative follow-up 2 years after Achilles tendon repair.

jksr-72-164-g003
Table 1

The Comparison of Mean CSA of Tarsal Tunnel

jksr-72-164-i001
CSA (Group 1, mm2) CSA (Group 2, mm2) Asymp. Sig. (2-Tailed)
Reader 1 Level 1* 87.8 100.0 p = 0.035
Level 2* 98.2 113.8 p = 0.026
Level 3* 105.2 127.9 p = 0.013
Reader 2 Level 1 86.2 99.7 p = 0.023
Level 2 97.6 112.3 p = 0.025
Level 3 105.2 124.4 p = 0.024

Note.-*Level 1: tibiotalar joint level, Level 2: medial malleolar tip level, Level 3: sustentaculum tali level.

CSA = cross-sectional area

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