Diagnostic accuracy of 3D color volume-rendered CT images for peroneal tendon dislocation in patients with acute calcaneal fractures

Background: Use of three-dimensional (3D) color volume-rendered (VR) images has been reported to be more timeefficient compared to that of cross-sectional computed tomography (CT) images for the diagnosis of peroneal tendon dislocation. However, the diagnostic performance of this technique has not been studied. Purpose: To test diagnostic accuracy of 3D color VR CT images of ankle for peroneal tendon dislocation in patients with acute calcaneal fractures. Material and Methods: The study consisted of 121 ankle CT studies from 105 consecutive patients (85 men, 20 women; mean age, 42 years; age range, 16-75 years) with acute calcaneal fractures. Peroneal tendon dislocation was diagnosed on multiplanar CT images by consensus of two experienced musculoskeletal radiologists, which served as the reference standard. Three other musculoskeletal radiologists independently reviewed 3D images alone on a workstation. The readers determined whether or not there was peroneal tendon dislocation using three degrees of certainty (definite, probable, and possible). Diagnostic performance of 3D images for peroneal tendon dislocation was evaluated by calculating the sensitivities, specificities, and area under the receiver-operating characteristic (ROC) curves. Results: Forty-eight (40%) out of 121 studies showed peroneal tendon dislocation based on the expert readings using multiplanar reformatted images. Sensitivities/specificities of 3D images measured 0.92/0.81, 0.88/0.90, and 0.81/0.92 for three readers, respectively. The area under the proper binormal ROC curve based on all three readers (0.93, 0.94, and 0.92) measured 0.93 with a 95% confidence interval of 0.89-0.98. Conclusion: Diagnostic accuracy of 3D images is comparable to, but not as good as that of MPR images for the diagnosis of peroneal tendon dislocation in patients with acute calcaneal fractures.