Benjamin Alan Tritle MD, Presenter: Nothing to Disclose

Michael C. Forney MD, Abstract Co-Author: Nothing to Disclose

Patricia Botti Delzell MD, Abstract Co-Author: Nothing to Disclose

The foot and ankle are well suited for musculoskeletal ultrasound since many structures are superficial and able to be well seen. Clinicians have often narrowed the possibilities for a patient’s symptoms to a limited differential or a specific anatomic location. In such situations, MRI may be an overly extensive and expensive test. Because of its usefulness and economic advantage, we sought to investigate the frequency with which musculoskeletal ultrasound supports or changes clinical management.

After obtaining IRB approval, a retrospective review of 110 consecutive patients who underwent MSK ultrasound of the foot or ankle was conducted (January 4, 2012-November 26, 2013). 98 of these patients had both a pre- and post-ultrasound clinical impression/plan documented in the medical record. The categories of the pre-ultrasound impressions included: Inflammatory conditions (36); Morton’s Neuroma (16); Traumatic/Mechanical conditions (15); Suspected mass (other than neuroma) (10); Foreign body (8); Degenerative (7); Infectious (2). Note was made if the clinical diagnosis was changed or confirmed by ultrasound, and if treatment decisions were altered.

Ultrasound of the foot or ankle impacted diagnosis and or management for a large number of patients. Diagnosis or management was influenced in 62 of 98 (63%; 95% CI: 53-72%) patients. In the majority of these cases, 68% (95% CI: 55-78%), both the diagnosis and the treatment were altered. In 36 patients whose diagnosis and treatment were not altered, ultrasound confirmed the initial clinical impression 97% of the time (35/36; 95% CI: 85-100%).

Musculoskeletal ultrasound of the foot and ankle can play an important role in clinical decision making for a large group of patients. When musculoskeletal ultrasound did not change the diagnosis or management in this group of patients, it confirmed the initial clinical impression which may also be important to the clinician and the patient. In addition to being significantly lower in cost compared with MRI, ultrasound offers a more readily available test and may be better tolerated by some patients.

Musculoskeletal ultrasound is a cost effective imaging modality which has become more readily available. Our data demonstrate ultrasound of the foot and ankle frequently impact clinical management.

Tritle, B, Forney, M, Delzell, P, Clinical Utility of Musculoskeletal Ultrasound in Foot and Ankle Pathology: How Ultrasound Imaging Changes Diagnosis and Management.  Radiological Society of North America 2014 Scientific Assembly and Annual Meeting, - ,Chicago IL. http://archive.rsna.org/2014/14018256.html