300 Section - Diagnostic Performance of ultrasound compared with MRI for acute ankle ligament injuries

Acute ankle ligament injury is one of the most common musculoskeletal conditions in sports and daily activities, often leading to functional impairment and instability. Accurate diagnosis is critical for treatment planning and prevention of complications. Magnetic resonance imaging (MRI) is considered the gold standard for evaluating ligamentous injuries; however, its high cost and limited availability restrict its widespread use. Musculoskeletal ultrasound (MSUS) is inexpensive, rapid, and allows dynamic assessment, though its diagnostic value depends on the ligament examined and the operator’s expertise.

Design:

A retrospective study was conducted at Alpha Medical Rehabilitation Center from January 16, 2023, to December 16, 2024. A total of 67 patients who underwent both ankle ultrasound and MRI were included. Diagnostic accuracy, sensitivity, and specificity of ultrasound were calculated using confusion matrix analysis, overall agreement, and Cohen’s kappa coefficient, analyzed with SPSS version 29.

Results:

 The mean age of patients was 28.7±1 years; 64.2% were male and 35.8% female. Agreement between ultrasound and MRI was highest for the calcaneofibular ligament (CFL, 86.6%) and anterior talofibular ligament (ATFL, 83.6%). Moderate agreement was found for the posterior talofibular ligament (PTFL, 58.2%), while the lowest was for the deltoid complex ligament (DCL, 49.3%). Cohen’s kappa indicated good agreement for ATFL (κ=0.72) and CFL (κ=0.78), fair for PTFL (κ=0.39), and slight for DCL (κ=0.20).

Conclusion: Ultrasound showed high diagnostic accuracy comparable to MRI in detecting acute ATFL and CFL injuries, supporting its role as a reliable, cost-effective, and rapid first-line imaging modality. However, its performance was limited in detecting deeper ligament injuries such as PTFL and DCL, confirming the continued role of MRI in comprehensive assessment.