Abstract
Objectives
To compare ultrasound (US) and magnetic resonance imaging (MRI) in the diagnosis of Morton’s neuroma.
Methods
Studies that assessed the diagnostic accuracy of US and MRI for Morton’s neuroma were retrieved from major medical libraries independently by two reviewers up to 1 April 2014. Predefined inclusion and exclusion criteria were adopted.
Results
277 studies were initially found, and the meta-analysis was conducted on 14 studies. US sensitivity was studied in five studies, MRI sensitivity in three studies, and bothin six studies. All studies used surgery as the reference standard. A high sensitivity (SE) of diagnostic testing was observed for both US (SE (95 % CI) = 0.91 (0.83–0.96)) and MRI (SE (95 % CI) = 0.90 (0.82–0.96)) with no significant differences between the two modalities in diagnosis (Q test p = 0.88). For MRI, specificity of test was 1.00 with a pooled estimation of 1.00 (0.73–1.00), while the pooled specificity was 0.854 (95 % CI: 0.41–1.00) for US. No differences were observed between US and MRI in study design (p = 0.76).
Conclusion
This meta-analysis shows that the SE of US (0.91) is equal to (p = 0.88) that of MRI (0.90) for identification of Morton’s neuroma.
Key points
• For Morton’s neuroma, US sensitivity is equal to MRI.
• US is as accurate as MRI in diagnosing Morton’s neuroma.
• US may be the most cost-effective imaging method for Morton’s neuroma.
Similar content being viewed by others
Abbreviations
- PRISMA:
-
preferred reporting items for systematic reviews and meta-analyses
- TP:
-
true positive
- TN:
-
true negative
- FP:
-
false positive
- FN:
-
false negative
References
Abreu E, Aubert S, Wavreille G, Gheno R, Canella C, Cotten A (2013) Peripheral tumor and tumor-like neurogenic lesions. Eur J Radiol 82:38–50
Lee MJ, Kim S, Huh YM, Song HT, Lee SA, Lee JW et al (2007) Morton neuroma: evaluated with ultrasonography and MR imaging. Korean J Radiol 8:148–155
Lee KS (2009) Musculoskeletal ultrasound: how to evaluate for Morton's neuroma. AJR Am J Roentgenol 193:W172
Zanetti M, Ledermann T, Zollinger H, Hodler J (1997) Efficacy of MR imaging in patients suspected of having Morton's neuroma. AJR Am J Roentgenol 168:529–532
Liberati A, Altman DG, Tetzlaff J, Mulrow C, Gøtzsche PC, Ioannidis JP et al (2009) The PRISMA statement for reporting systematic reviews and meta-analyses of studies that evaluate health care interventions: explanation and elaboration. PLoS Med 6(7):e1000100
Newcombe RG (1998) Two-sided confidence intervals for the single proportion: comparison of seven methods. Stat Med 17:857–872
Fazal MA, Khan I, Thomas C (2012) Ultrasonography and magnetic resonance imaging in the diagnosis of Morton's neuroma. J Am Podiatr Med Assoc 102:184–186
Kankanala G, Jain AS (2007) The operational characteristics of ultrasonography for the diagnosis of plantar intermetatarsal neuroma. J Foot Ankle Surg 46:213–217
Oliver TB, Beggs I (1998) Ultrasound in the assessment of metatarsalgia: a surgical and histological correlation. Clin Radiol 53:287–289
Owens R, Gougoulias N, Guthrie H, Sakellariou A (2011) Morton's neuroma: clinical testing and imaging in 76 feet, compared to a control group. Foot Ankle Surg 17:197–200
Pastides P, El-Sallakh S, Charalambides C (2012) Morton's neuroma: a clinical versus radiological diagnosis. Foot Ankle Surg 18:22–24
Perini L, Del Borrello M, Cipriano R, Cavallo A, Volpe A (2006) Dynamic sonography of the forefoot in Morton's syndrome: correlation with magnetic resonance and surgery. Radiol Med 111:897–905
Quinn TJ, Jacobson JA, Craig JG, van Holsbeeck MT (2000) Sonography of Morton's neuromas. AJR Am J Roentgenol 174:1723–1728
Redd RA, Peters VJ, Emery SF, Branch HM, Rifkin MD (1989) Morton neuroma: sonographic evaluation. Radiology 171:415–417
Sharp RJ, Wade CM, Hennessy MS, Saxby TS (2003) The role of MRI and ultrasound imaging in Morton's neuroma and the effect of size of lesion on symptoms. J Bone Joint Surg (Br) 85:999–1005
Sobiesk GA, Wertheimer SJ, Schulz R, Dalfovo M (1997) Sonographic evaluation of interdigital neuromas. J Foot Ankle Surg 36:364–366
Torres-Claramunt R, Ginés A, Pidemunt G, Puig L, de Zabala S (2012) MRI and ultrasonography in Morton's neuroma: diagnostic accuracy and correlation. Indian J Orthop 46:321–325
Zanetti M, Strehle JK, Kundert HP, Zollinger H, Hodler J (1999) Morton neuroma: effect of MR imaging findings on diagnostic thinking and therapeutic decisions. Radiology 213:583–588
Bancroft LW, Peterson JJ, Kransdorf MJ (2008) Imaging of soft tissue lesions of the foot and ankle. Radiol Clin North Am 46:1093–1103
Martinoli C, Court-Payen M, Michaud J, Padua L, Altafini L et al (2010) Imaging of neuropathies about the ankle and foot. Semin Musculoskelet Radiol 14:344–356
Lucchetta M, Briani C, Liotta GA, Martinoli C, Coraci D, Padua L (2010) Ultrasonographic Tinel sign: comment. Muscle Nerve 41:570–571
Chipman JN, Mott RT, Stanton CA, Cartwright MS (2009) Ultrasonographic Tinel sign. Muscle Nerve 40:1033–1035
Tagliafico A, Bodner G, Rosenberg I, Palmieri F, Garello I, Altafini L et al (2010) Peripheral nerves: ultrasound-guided interventional procedures. Semin Musculoskelet Radiol 14:559–566
Zanetti M, Weishaupt D (2005) MR imaging of the forefoot: Morton neuroma and differential diagnoses. Semin Musculoskelet Radiol 9:175–186
Weishaupt D, Treiber K, Kundert HP, Zollinger H, Vienne P, Hodler J et al (2003) Morton neuroma: MR imaging in prone, supine, and upright weight-bearing body positions. Radiology 226:849–856
Acknowledgments
The scientific guarantor of this publication is Alberto Tagliafico, MD. The authors of this manuscript declare no relationships with any companies, whose products or services may be related to the subject matter of the article. The authors state that this work was partially funded by the University of Genoa. The statistical analysis was done entirely by two professional biostatisticians with specific expertise in meta-analysis: Prof. Maria Pia Sormani and Alessio Signori, PhD candidate. Institutional Review Board approval is not required for a meta-analysis. Methodology: Systematic review and meta-analysis.
Author information
Authors and Affiliations
Corresponding author
Electronic supplementary material
Below is the link to the electronic supplementary material.
ESM 1
(DOCX 65 kb)
Rights and permissions
About this article
Cite this article
Bignotti, B., Signori, A., Sormani, M.P. et al. Ultrasound versus magnetic resonance imaging for Morton neuroma: systematic review and meta-analysis. Eur Radiol 25, 2254–2262 (2015). https://doi.org/10.1007/s00330-015-3633-3
Received:
Revised:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s00330-015-3633-3