Comparison of diagnostic performance of X‑ray, CT and MRI in patients with surgically confirmed subtle Lisfranc injuries

Tang,Lubo; Zhou,Wen; Bai,Lu; Wu,Chenxi; Xiong,Changyue; Yan,Yuxin; Chen,Sumeng

doi:10.3892/etm.2024.12462

Comparison of diagnostic performance of X‑ray, CT and MRI in patients with surgically confirmed subtle Lisfranc injuries

Authors:
- Lubo Tang
- Wen Zhou
- Lu Bai
- Chenxi Wu
- Changyue Xiong
- Yuxin Yan
- Sumeng Chen
View Affiliations

Affiliations: Department of Sports Medicine, Shenzhen Hospital of Peking University, Shenzhen, Guangdong 518036, P.R. China, Department of Medical Imaging, Shenzhen Hospital of Peking University, Shenzhen, Guangdong 518036, P.R. China
Published online on: February 29, 2024 https://doi.org/10.3892/etm.2024.12462
Article Number: 174
Copyright: © Tang et al. This is an open access article distributed under the terms of Creative Commons Attribution License.

Metrics: Total Views: 0 (Spandidos Publications: | PMC Statistics: )

Metrics: Total PDF Downloads: 0 (Spandidos Publications: | PMC Statistics: )

Cited By (CrossRef): 0 citations Loading Articles...

Abstract

The present study aimed to compare the diagnostic performance of three imaging tests: X‑ray, computed tomography (CT) and magnetic resonance imaging (MRI), for subtle Lisfranc injuries and three anatomical subtype injuries. The non‑weight‑bearing X‑ray, CT and MRI imaging results of patients with subtle Lisfranc injuries from September 2013 to March 2022 were retrospectively reviewed. Subtle Lisfranc injuries and three anatomical subtypes (first, second and cuneiform rays) were diagnosed based on the surgical reports. The diagnostic performance of X‑ray, CT and MRI was compared. The sensitivity (Sn), specificity (Sp), positive predictive value, negative predictive value, area under the receiver operating characteristic curve (AUC) and κ coefficient were reported. A total of 31 patients were included in the study. The correct diagnosis was made in 48.4% (15/31), 87.1% (27/31) and 96.8% (30/31) of patients by X‑ray, CT and MRI, respectively. A total of 54 different anatomical injuries were found intraoperatively in all patients, with MRI and CT having high agreement (Sn, 72.2 and 87.0%; κ, 0.69 and 0.78, respectively) and X‑ray having a low agreement (Sn, 29.6%; κ, 0.26) with the surgical findings. Regarding the first‑ray injuries, CT had the highest Sn (76.9%), Sp (100%) and AUC (0.885) in diagnosing subtle Lisfranc injuries. MRI showed the best Sn (88.5 and 93.3%, respectively) and AUC (0.942 and 0.904, respectively) in both second and cuneiform rays. In conclusion, non‑weight‑bearing X‑rays had poor diagnostic accuracy for subtle Lisfranc injuries and their subtypes. CT was superior to X‑rays and MRI in diagnosing first‑ray injuries. Although not significantly different from CT in terms of overall diagnosis, MRI was superior to X‑ray and CT in diagnosing second and cuneiform‑ray injuries.

View Figures

View References

1	Smith N, Stone C and Furey A: Does open reduction and internal fixation versus primary arthrodesis improve patient outcomes for lisfranc trauma? A systematic review and meta-analysis. Clin Orthop Relat Res. 474:1445–1452. 2016.PubMed/NCBI View Article : Google Scholar
2	Renninger CH, Cochran G, Tompane T, Bellamy J and Kuhn K: Injury characteristics of low-energy lisfranc injuries compared with high-energy injuries. Foot Ankle Int. 38:964–969. 2017.PubMed/NCBI View Article : Google Scholar
3	Siddiqui NA, Galizia MS, Almusa E and Omar IM: Evaluation of the tarsometatarsal joint using conventional radiography, CT, and MR imaging. Radiographics. 34:514–531. 2014.PubMed/NCBI View Article : Google Scholar
4	Sripanich Y, Weinberg MW, Krähenbühl N, Rungprai C, Saltzman CL and Barg A: Reliability of measurements assessing the Lisfranc joint using weightbearing computed tomography imaging. Arch Orthop Trauma Surg. 141:775–781. 2021.PubMed/NCBI View Article : Google Scholar
5	Nunley JA and Vertullo CJ: Classification, investigation, and management of midfoot sprains: Lisfranc injuries in the athlete. Am J Sports Med. 30:871–878. 2002.PubMed/NCBI View Article : Google Scholar
6	Briceno J, Leucht A, Younger A and Veljkovic A: Subtle Lisfranc injuries: Fix it, fuse it, or bridge it? Foot Ankle Clin. 25:711–726. 2020.PubMed/NCBI View Article : Google Scholar
7	Rosenbaum A, Dellenbaugh S, Dipreta J and Uhl R: Subtle injuries to the lisfranc joint. Orthopedics. 34:882–887. 2011.PubMed/NCBI View Article : Google Scholar
8	Faciszewski T, Burks RT and Manaster BJ: Subtle injuries of the Lisfranc joint. J Bone Joint Surg Am. 72:1519–1522. 1990.PubMed/NCBI
9	Norfray JF, Geline RA, Steinberg RI, Galinski AW and Gilula LA: Subtleties of Lisfranc fracture-dislocations. AJR Am J Roentgenol. 137:1151–1156. 1981.PubMed/NCBI View Article : Google Scholar
10	Weatherford BM, Anderson JG and Bohay DR: Management of tarsometatarsal joint injuries. J Am Acad Orthop Surg. 25:469–479. 2017.PubMed/NCBI View Article : Google Scholar
11	Curtis MJ, Myerson M and Szura B: Tarsometatarsal joint injuries in the athlete. Am J Sports Med. 21:497–502. 1993.PubMed/NCBI View Article : Google Scholar
12	Kaar S, Femino J and Morag Y: Lisfranc joint displacement following sequential ligament sectioning. J Bone Joint Surg Am. 89:2225–2232. 2007.PubMed/NCBI View Article : Google Scholar
13	Seo DK, Lee HS, Lee KW, Lee SK and Kim SB: Nonweightbearing radiographs in patients with a subtle lisfranc injury. Foot Ankle Int. 38:1120–1125. 2017.PubMed/NCBI View Article : Google Scholar
14	Kalia V, Fishman EK, Carrino JA and Fayad LM: Epidemiology, imaging, and treatment of Lisfranc fracture-dislocations revisited. Skeletal Radiol. 41:129–136. 2012.PubMed/NCBI View Article : Google Scholar
15	Hatch RL, Alsobrook JA and Clugston JR: Diagnosis and management of metatarsal fractures. Am Fam Physician. 76:817–826. 2007.PubMed/NCBI
16	Desmond EA and Chou LB: Current concepts review: Lisfranc injuries. Foot Ankle Int. 27:653–660. 2006.PubMed/NCBI View Article : Google Scholar
17	Ly TV and Coetzee JC: Treatment of primarily ligamentous Lisfranc joint injuries: Primary arthrodesis compared with open reduction and internal fixation. A prospective, randomized study. J Bone Joint Surg Am. 88:514–520. 2006.PubMed/NCBI View Article : Google Scholar
18	Sripanich Y, Weinberg MW, Krähenbühl N, Rungprai C, Mills MK, Saltzman CL and Barg A: Imaging in Lisfranc injury: A systematic literature review. Skeletal Radiol. 49:31–53. 2020.PubMed/NCBI View Article : Google Scholar
19	Raikin SM, Elias I, Dheer S, Besser MP, Morrison WB and Zoga AC: Prediction of midfoot instability in the subtle Lisfranc injury. Comparison of magnetic resonance imaging with intraoperative findings. J Bone Joint Surg Am. 91:892–899. 2009.PubMed/NCBI View Article : Google Scholar
20	Haraguchi N, Ota K, Ozeki T and Nishizaka S: Anatomical Pathology of subtle lisfranc injury. Sci Rep. 9(14831)2019.PubMed/NCBI View Article : Google Scholar
21	Yu X, Pang QJ and Yang CC: Functional outcome of tarsometatarsal joint fracture dislocation managed according to Myerson classification. Pak J Med Sci. 30:773–777. 2014.PubMed/NCBI
22	Yeoh J, Muir KR, Dissanayake AM and Tzu-Chieh WY: Lisfranc fracture-dislocation precipitating acute Charcot arthopathy in a neuropathic diabetic foot: A case report. Cases J. 1(290)2008.PubMed/NCBI View Article : Google Scholar
23	Ponkilainen VT, Laine HJ, Mäenpää HM, Mattila VM and Haapasalo HH: Incidence and characteristics of midfoot injuries. Foot Ankle Int. 40:105–112. 2019.PubMed/NCBI View Article : Google Scholar
24	Singh A, Lokikere N, Saraogi A, Unnikrishnan PN and Davenport J: Missed Lisfranc injuries-surgical vs conservative treatment. Ir J Med Sci. 190:653–656. 2021.PubMed/NCBI View Article : Google Scholar
25	Haapamaki V, Kiuru M and Koskinen S: Lisfranc fracture-dislocation in patients with multiple trauma: Diagnosis with multidetector computed tomography. Foot Ankle Int. 25:614–619. 2004.PubMed/NCBI View Article : Google Scholar
26	Preidler KW, Peicha G, Lajtai G, Seibert FJ, Fock C, Szolar DM and Raith H: Conventional radiography, CT, and MR imaging in patients with hyperflexion injuries of the foot: Diagnostic accuracy in the detection of bony and ligamentous changes. AJR Am J Roentgenol. 173:1673–1677. 1999.PubMed/NCBI View Article : Google Scholar
27	Castro M, Melão L, Canella C, Weber M, Negrão P, Trudell D and Resnick D: Lisfranc joint ligamentous complex: MRI with anatomic correlation in cadavers. AJR Am J Roentgenol. 195:W447–W455. 2010.PubMed/NCBI View Article : Google Scholar
28	Sands A and Grose A: Lisfranc injuries. Injury. 35 (Suppl 2):SB71–SB76. 2004.PubMed/NCBI View Article : Google Scholar
29	Arntz CT, Veith RG and Hansen ST Jr: Fractures and fracture-dislocations of the tarsometatarsal joint. J Bone Joint Surg Am. 70:173–181. 1988.PubMed/NCBI
30	Sherief TI, Mucci B and Greiss M: Lisfranc injury: How frequently does it get missed? And how can we improve? Injury. 38:856–860. 2007.PubMed/NCBI View Article : Google Scholar
31	Stein RE: Radiological aspects of the tarsometatarsal joints. Foot Ankle. 3:286–289. 1983.PubMed/NCBI View Article : Google Scholar
32	Llopis E, Carrascoso J, Iriarte I, Serrano Mde P and Cerezal L: Lisfranc injury imaging and surgical management. Semin Musculoskelet Radiol. 20:139–153. 2016.PubMed/NCBI View Article : Google Scholar
33	Ponkilainen VT, Partio N, Salonen EE, Riuttanen A, Luoma EL, Kask G, Laine HJ, Mäenpää H, Päiväniemi O, Mattila VM and Haapasalo HH: Inter- and intraobserver reliability of non-weight-bearing foot radiographs compared with CT in Lisfranc injuries. Arch Orthop Trauma Surg. 140:1423–1429. 2020.PubMed/NCBI View Article : Google Scholar
34	Wong LH, Chrea B, Atwater LC and Meeker JE: The first tarsometatarsal joint in Lisfranc injuries. Foot Ankle Int. 43:1308–1316. 2022.PubMed/NCBI View Article : Google Scholar
35	Kennelly H, Klaassen K, Heitman D, Youngberg R and Platt SR: Utility of weight-bearing radiographs compared to computed tomography scan for the diagnosis of subtle Lisfranc injuries in the emergency setting. Emerg Med Australas. 31:741–744. 2019.PubMed/NCBI View Article : Google Scholar
36	Hatem SF: Imaging of lisfranc injury and midfoot sprain. Radiol Clin North Am. 46:1045–1060, vi. 2008.PubMed/NCBI View Article : Google Scholar
37	Lewis JS Jr and Anderson RB: Lisfranc injuries in the athlete. Foot Ankle Int. 37:1374–1380. 2016.PubMed/NCBI View Article : Google Scholar