Elsevier

Clinical Radiology

Volume 70, Issue 4, April 2015, Pages 351-358
Clinical Radiology

Review
The accuracy of ultrasonography and magnetic resonance imaging for the diagnosis of Morton's neuroma: a systematic review

https://doi.org/10.1016/j.crad.2014.10.017Get rights and content

Aim

To determine the accuracy of MRI versus ultrasound for Morton's neuroma.

Materials and methods

A search was undertaken for clinical studies published in any language in PubMed up to the date of December 2013. Studies assessing the accuracy of the ultrasound or MRI for the diagnosis of Morton's neuroma were included. Data were pooled for meta-analysis. Study selection, data collection, and extraction were performed independently by two authors. Meta-disc 1.4 and Revman 5.2 software were applied for statistical analysis.

Results

The study included 12 studies; 217 patients underwent MRI and 241 underwent ultrasound examinations. There appeared greater diagnostic accuracy for ultrasound than MRI for the diagnosis of Morton's neuroma (ultrasound sensitivity 90%, specificity 88%, positive likelihood ratio 2.77, negative likelihood ratio 0.16 versus MRI sensitivity 93%, specificity 68%, positive likelihood ratio 1.89, negative likelihood ratio 0.19).

Conclusions

The available evidence suggests that ultrasound can provide better accuracy for the diagnosis of Morton's neuroma than MRI.

Introduction

Morton's neuroma is a common painful condition that affects the forefoot.1 The exact aetiology of this condition is yet to be found. Some believe that it is mechanically induced neuropathy, and some hold the opinion that it is caused by proliferated fibrous tissue around the plantar nerve causing entrapment rather than a real tumour of the nerve; most think that it is not truly a neuroma but a combination of different pathological conditions including perineural fibrosis, local vascular proliferation, oedema of the endoneurium, and axonal degeneration.2, 3, 4, 5 Middle-aged women are more likely to develop this condition,6 and it is reported women are up to 10 times more likely than men to have this condition.2 The neuroma mainly affects the third web space of the forefoot.4 Patients with Morton's neuroma are in debilitating pain, resulting in many patients being reluctant to walk or even put their foot on the ground.2 This condition comprises a large proportion of the workload of foot and ankle surgeons.2

Diagnosis of Morton's neuroma can be difficult as clinical features could be various. Diagnosis could be made clinically mainly based on history and the patient's symptoms. Masses in the web spaces can occasionally be palpated and Tinel's sign could be present. However, none of these signs are specific and accurate enough for diagnosis and provide little information regarding the nature of the condition or accurate localization of the neuroma.3, 4, 7 With the development of diagnostic technology, MRI and ultrasonography have been widely used in the diagnostic workup of Morton's neuroma. Ultrasound is a relatively cheap and simple test to perform. Many researchers have conducted investigations using ultrasound to diagnose Morton's neuroma.1, 8, 9 However, operator dependency means that ultrasound is not infallible. MRI is another non-invasive imaging method used to diagnose Morton's neuroma.10, 11, 12, 13 MRI can be used to identify surrounding soft tissues and has been frequently prescribed for this condition. Although MRI has its advantages, there are some absolute contraindications such as magnetic metallic implants in the body. In addition, MRI is relatively expensive and time consuming and not every patient is willing to undertake it. Therefore, the decision of whether to use ultrasound or MRI is controversial.

The objective of the present study was to compare the diagnostic accuracy of ultrasound and MRI for diagnosing Morton's neuroma.

Section snippets

Materials and methods

This study followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines.14

An electronic search of PubMed was conducted for relevant studies that had been published to December 2013. The search strategy is presented in Table 1. The search did not restrict languages and only included studies on human subjects. Only the most recent or complete report for those studies published multiple times were included. Studies assessing the diagnostic accuracy

Results

The study inclusion process is shown in the flowchart (Fig 1). Initial database searches identified 72 articles of which the title and abstracts were screened and 37 showed potential eligibility. After full-text investigation, 17 were excluded due to different focus and eight were excluded because of lack of essential data. Twelve studies (including one abstract15) were included in the analysis. Seven1, 4, 9, 15, 16, 17, 18 of the included studies focused on the diagnostic accuracy of US, three3

Discussion

The present study was conducted to compare the diagnostic accuracy of ultrasound and MRI for the detection of Morton's neuroma in the forefoot. Considering pooled sensitivity, both ultrasound (90%) and MRI (93%) were similar and relatively high. MRI (68%) has a relatively lower specificity than ultrasound (88%) in the detection of Morton's neuroma. Comparing the two diagnostic tests, ultrasound had a higher positive likelihood ratio than MRI (2.77 versus 1.89) and lower negative likelihood

Acknowledgements

This work was supported by National Natural Sciences Foundation of China (31370984).

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