Comprehensive Assessment of Ankle Syndesmosis Injury Using 3D Isotropic Turbo Spin-Echo Sequences: Diagnostic Performance Compared With That of Conventional and Oblique 3-T MRI

OBJECTIVE. The objective of this study is to evaluate the diagnostic performance of 3D sampling perfection with application-optimized contrasts using different flip angle evolution (SPACE) sequences in the evaluation of ankle syndesmosis injuries, compared with that of conventional orthogonal MRI and oblique proton density-weighted turbo spin-echo (TSE) sequences performed with 3-T MRI. MATERIALS AND METHODS. This retrospective study included 98 patients with suspected ankle syndesmosis injuries who underwent both MRI and surgery. Fifty patients (mean [+/- SD] age, 34.5 +/- 15.3 years) had acute injuries, and 48 patients (mean age, 28.5 +/- 9.6 years) had chronic injuries. For both groups, the diagnostic performance of each MRI sequence with regard to syndesmosis injuries was evaluated. Arthroscopy findings were used as a reference standard to confirm diagnosis. RESULTS. No statistically significant differences in the sensitivity, specificity, accuracy, and AUC values were noted between images of the syndesmosis obtained using proton density-weighted TSE sequences and images of the syndesmosis obtained using 3D SPACE sequences (p > 0.05). Interobserver agreement regarding the diagnosis of both acute and chronic syndesmosis injuries was almost perfect for proton density-weighted TSE images (kappa > 0.80) and was substantial for 3D SPACE images (kappa > 0.75). Both methods of obtaining images of the syndesmosis had a diagnostic performance superior to that of conventional orthogonal MRI. CONCLUSION. The performance of 3D SPACE sequences is comparable to that of 2D proton density-weighted MR images for the diagnosis of acute and chronic syndesmosis injuries.