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

Objectives 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.