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Prospective study on diagnostic strategies in osteochondral lesions of the talus

IS MRI SUPERIOR TO HELICAL CT?

Department of Orthopaedic and Trauma Surgery, Ziekenhuis Hilversum, PO Box 10016, 1201 DA Hilversum, The Netherlands.

M. Maas, MD, PhD, Radiologist

Department of Radiology

M. G. W. Dijkgraaf, PhD, Epidemiologist

Department of Clinical Epidemiology and Biostatistics

J. L. Tol, MD, PhD, Orthopaedic Resident; R. Krips, MD, PhD, Orthopaedic Resident; and C. Niek van Dijk, MD, PhD, Orthopaedic Surgeon

Department of Orthopaedic Surgery, Academic Medical Centre, PO Box 22660, 1100 DD, Amsterdam, The Netherlands.

Correspondence should be sent to Dr R. A. W. Verhagen.

Our aim in this prospective study was to determine the best diagnostic method for discriminating between patients with and without osteochondral lesions of the talus, with special relevance to the value of MRI compared with the new technique of multidetector helical CT. We compared the diagnostic value of history, physical examination and standard radiography, a 4 cm heel-rise view, helical CT, MRI, and diagnostic arthroscopy for simultaneous detection or exclusion of osteochondral lesions of the talus. A consecutive series of 103 patients (104 ankles) with chronic ankle pain was included in this study. Of these, 29 with 35 osteochondral lesions were identified. Twenty-seven lesions were located in the talus.

Our findings showed that helical CT, MRI and diagnostic arthroscopy were significantly better than history, physical examination and standard radiography for detecting or excluding an osteochondral lesion. Also, MRI and diagnostic arthroscopy performed better than a mortise view with a 4 cm heel-rise. We did not find a statistically significant difference between helical CT and MRI. Diagnostic arthroscopy did not perform better than helical CT and MRI for detecting or excluding an osteochondral lesion.

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