CT Arthrography One study involving anterolateral ankle impingement compared CT arthrography to arthroscopic findings. The study found that CT arthrography had a sensitivity and specificity of 97% and 71%, respectively [77]. Image-guided Anesthetic Injection Fluoroscopic or US-guided injections have been shown as an effective treatment for some ankle impingement syndromes [78,79]. Bone Scan with SPECT or SPECT/CT Recently, SPECT combined with CT has been shown to provide additional information compared with clinical diagnosis and conventional bone scintigraphy for the evaluation of impingement syndromes and soft-tissue pathology [7]. One study found that SPECT/CT provided information not suspected on clinical diagnosis in 56% of cases with impingement syndromes or soft-tissue pathology [7]. CT CT CT may be useful for depiction of osseous causes of impingement, such as chronic abnormalities between the talus and an os trigonum or fractures of the lateral tubercle of the talus or os trigonum [62]. Arthrography Arthrography is not routinely used for the evaluation of ankle impingement syndromes. Radiography Stress views are not routinely used for the evaluation of ankle impingement syndromes. Variant 7: Chronic ankle pain. Ankle radiographs normal, pain of uncertain etiology. Next study. When chronic ankle pain is of unclear etiology, normal ankle radiographs can be followed by other imaging tests, primarily directed by clinical findings. Chronic Ankle Pain MRI If the patient has a focal soft-tissue abnormality, MRI can be considered. Peripheral nerve-related symptoms can be evaluated with US or MRI; however, US has the benefit of higher resolution. If symptoms are believed to originate from osseous structures, MRI can be considered if there is concern for an initially missed fracture [80]. MRI is effective in detecting osseous stress injuries [81]. Overall, MRI is the imaging test that globally evaluates all anatomic structures, including bone marrow [13,82].
Chronic Ankle Pain. CT Arthrography One study involving anterolateral ankle impingement compared CT arthrography to arthroscopic findings. The study found that CT arthrography had a sensitivity and specificity of 97% and 71%, respectively [77]. Image-guided Anesthetic Injection Fluoroscopic or US-guided injections have been shown as an effective treatment for some ankle impingement syndromes [78,79]. Bone Scan with SPECT or SPECT/CT Recently, SPECT combined with CT has been shown to provide additional information compared with clinical diagnosis and conventional bone scintigraphy for the evaluation of impingement syndromes and soft-tissue pathology [7]. One study found that SPECT/CT provided information not suspected on clinical diagnosis in 56% of cases with impingement syndromes or soft-tissue pathology [7]. CT CT CT may be useful for depiction of osseous causes of impingement, such as chronic abnormalities between the talus and an os trigonum or fractures of the lateral tubercle of the talus or os trigonum [62]. Arthrography Arthrography is not routinely used for the evaluation of ankle impingement syndromes. Radiography Stress views are not routinely used for the evaluation of ankle impingement syndromes. Variant 7: Chronic ankle pain. Ankle radiographs normal, pain of uncertain etiology. Next study. When chronic ankle pain is of unclear etiology, normal ankle radiographs can be followed by other imaging tests, primarily directed by clinical findings. Chronic Ankle Pain MRI If the patient has a focal soft-tissue abnormality, MRI can be considered. Peripheral nerve-related symptoms can be evaluated with US or MRI; however, US has the benefit of higher resolution. If symptoms are believed to originate from osseous structures, MRI can be considered if there is concern for an initially missed fracture [80]. MRI is effective in detecting osseous stress injuries [81]. Overall, MRI is the imaging test that globally evaluates all anatomic structures, including bone marrow [13,82].