Assessment of peroneal tendon lesions using 2-dimensional and 3-dimensional isotropic magnetic resonance imaging with surgical correlation

Abstract

Accurate diagnoses of peroneal pathologies remains a challenge due to limitations of conventional 2D (dimensional) imaging, which can impact long-term patient outcomes. This study evaluates MRI accuracy and inter-reader reliability of peroneal compartment pathology for 2D and 3D MRI. A consecutive series of patients who underwent peroneal compartment surgery with preoperative 1.5- or 3.0-Tesla ankle MRIs from 2009 to 2024 included 32 scans (22 with 2D, 10 with 2D+3D) from 31 patients (ages 17–74 years, all genders). Three musculoskeletal readers blinded to surgical findings independently analyzed MRI scans for common peroneal tenosynovitis, peroneus brevis and peroneus longus tenosynovitis, tendinopathy, and tears. Inter-reader reliability and diagnostic performance measures were calculated. Using majority vote, overall accuracy, sensitivity, and specificity for peroneal tendons using 2D MRI were 80%, 81%, and 79%, respectively. Using 3D MRI sequences, whether in isolation or combination with 2D MRI, accuracy, sensitivity, and specificity increased to 85%, 88%, and 83%, respectively. The inter-reader reliability for peroneus brevis lesions was 0.45-0.75 for 2D, 0.25-0.35 for 3D, and 0.31-0.54 for combined 2D+3D, while for peroneus longus lesions, it was 0.45-0.90 for 2D, 0.20-0.71 for 3D, and 0.64-0.81 for combined 2D+3D scans. The inter-reader reliability for tenosynovitis ranged from 0.62-0.64 for 2D, 0.25-0.37 for 3D, and 0.57-0.66 for combined 2D+3D scans. The addition of 3D MRI to 2D high-resolution ankle MRI protocol or 3D MRI alone increases accuracy of peroneal compartment lesion detection with minor decrease in inter-reader reliability for peroneal brevis tendon assessment. Larger studies may help validate our findings.