Ultrasound versus magnetic resonance imaging for Morton neuroma: systematic review and meta-analysis

TObjectives: To compare ultrasound (US) and magnetic resonance imaging (MRI) in the diagnosis of Morton’s neuroma. Methods: Studies that assessed the diagnostic accuracy of US and MRI for Morton’s neuroma were retrieved from major medical libraries independently by two reviewers up to 1 April 2014. Predefined inclusion and exclusion criteria were adopted. Results: 277 studies were initially found, and the meta-analysis was conducted on 14 studies. US sensitivity was studied in five studies, MRI sensitivity in three studies, and bothin six studies. All studies used surgery as the reference standard. A high sensitivity (SE) of diagnostic testing was observed for both US (SE (95 % CI) = 0.91 (0.83–0.96)) and MRI (SE (95 % CI) = 0.90 (0.82–0.96)) with no significant differences between the two modalities in diagnosis (Q test p = 0.88). For MRI, specificity of test was 1.00 with a pooled estimation of 1.00 (0.73–1.00), while the pooled specificity was 0.854 (95 % CI: 0.41–1.00) for US. No differences were observed between US and MRI in study design (p = 0.76). Conclusion: This meta-analysis shows that the SE of US (0.91) is equal to (p = 0.88) that of MRI (0.90) for identification of Morton’s neuroma. Key points: • For Morton’s neuroma, US sensitivity is equal to MRI. • US is as accurate as MRI in diagnosing Morton’s neuroma. • US may be the most cost-effective imaging method for Morton’s neuroma