629 - Posterior Tibial Tendon Dysfunction evaluation on MRI: inter-reader analysis and correlation with Johnson and Strom staging.

Friday, February 23, 2024

5:00 PM – 6:30 PM EDT

Co-Author(s)

MR

Mahad Rahman, B.S

Medical Student
UT Southwestern Medical School
Dallas, Texas, United States

Presenting Author(s)

NV

Nikit Venishetty, BA

Medical Student
Paul L. Foster School of Medicine, Texas Tech Health Sciences Center, El Paso
Allen, Texas, United States

Co-Author(s)

FD

Flavio Duarte Silva, M.D

Assistant Professor
UT Southwestern Medical School
Dallas, Texas, United States
AT

Atul K. Taneja, M.D

Radiologist
UT Southwestern Medical School
Dallas, Texas, United States
AE

Alireza Eajazi, MD

Radiologist
UT Southwestern Medical School
Dallas, Texas, United States
YX

Yin Xi, PhD

Associate Professor - Radiology
UT Southwestern Medical School
Dallas, Texas, United States

Corresponding Author(s)

AC

Avneesh Chhabra, MD, MBA

Section Chief, Musculoskeletal Radiology
UCSF School of Medicine
Dallas, Texas, United States

Objectives: To evaluate the inter-reader reliability on MRI in identifying Posterior Tibial Tendon Dysfunction (PTTD) and lesions of related structures and correlate these findings to the clinical staging of PTTD.

Design: 128 consecutive patients with 3-Tesla ankle MRIs, radiographs and clinical findings documented were included. 101 patients had clinical and MRI-based evidence of PTTD, while the remaining were controls. Two musculoskeletal radiologists reviewed the MRI-images to assess for abnormalities of the PTT (tenosynovitis, tendinosis, and tear) and lesions of supporting structures of the medial longitudinal arch (spring ligament, deltoid ligament, and sinus tarsi). Two podiatrists determined the clinical staging of PTTD based on the Johnson and Strom criteria using clinical information and radiographs. Reader agreements were obtained using interclass correlation coefficients (ICCs). Pairwise Spearman correlation coefficients were calculated to evaluate the correlations between MRI findings and clinical staging.

Results: There was substantial inter-reader agreement for PTT tendinopathy/tear (ICC=0.83), superficial deltoid lesions (ICC=0.77), deep deltoid lesions (ICC=0.78), and spring ligament abnormality (ICC=0.79). Moderate agreement was noted for sinus tarsi lesions except ganglion (ICC=0.66) and tarsal coalition (ICC=0.66), while lower agreement was observed for PTT tenosynovitis (ICC=0.34), navicular bone edema (ICC=0.50), and sinus tarsi ganglion (ICC=0.34). Reader 1 showed significant correlations with clinical stages with respect to PTT tendinopathy/tear (r=0.41, p=0.001), tenosynovitis (r=0.34, p=0.004), and spring ligament (r=0.30, p = 0.012). Reader 2 exhibited stronger significant correlations for the same findings respectively (r=0.52 and r=0.70, p=< 0.001, r=0.33, p< 0.005).

Conclusions: Our study revealed substantial inter-reader agreements for PTT tendinopathy/tear, and abnormalities of superficial and deep deltoid, and spring ligaments. Worsening PTT disease and spring ligament pathology on MRI correlate with worse clinical staging, providing new insights into pathophysiology of PTTD and relationships to nearby structures. Our study shows that MRI evaluation of this disease is reliable and holds significant clinical implications for understanding disease progression.