Abstract：
OBJECTIVE: Haglund\'s deformity, an abnormality at the postero-superior corner of the calcaneus is a common cause of posterior heel pain. To date numerous measurements of radiological angles related to the calcaneus have been proposed to differentiate between symptomatic and asymptomatic patients with the deformity. Traditionally, these measurements have been assessed on plain radiographs. The aim of this study was to identify measurements which can be applied to Magnetic Resonance Imaging (MRI) studies of the ankle.
METHODS: A retrospective cohort analysis of 30 MRI ankle studies from patients with symptomatic Haglund\'s deformity and 32 normal studies as controls was undertaken. The angle of BRINK, the Achilles angle, Calcaneal pitch, Achilles-plantar fascia angle and soleus calcaneal distance were measured on optimal T2 fat-saturated sagittal slices.
RESULTS: There was a statistically significant difference (p < 0.0001) in the angle of BRINK between the Haglund\'s and control group. The Area-Under-the-Curve (AUC) was 0.7783 in keeping with good discrimination between the two groups. The angle of BRINK measurement is reproducible, with an intra-observer ICC of 0.837 and an inter-observer ICC of 0.824. There was no statistically significant difference between the two groups for the other measurements. In the Haglund\'s group the Achilles tendon was more likely to attach to the mid 1/3 of the posterior calcaneus as opposed to the superior 1/3 (p = 0.02), calcaneal oedema was more likely to be present (p < 0.001) and non-insertional tendinopathy was more likely to be present (p < 0.001). The presence of a retrocalcaneal bursa is non-specific (p = 0.602).
CONCLUSIONS: The angle of BRINK demonstrates good discrimination between normal and Haglund\'s cases on MRI studies and may improve patient management by supporting surgical decision-making. Future work should correlate the angle of BRINK to long-term outcomes.
METHODS: A retrospective cohort analysis of 30 MRI ankle studies from patients with symptomatic Haglund\'s deformity and 32 normal studies as controls was undertaken. The angle of BRINK, the Achilles angle, Calcaneal pitch, Achilles-plantar fascia angle and soleus calcaneal distance were measured on optimal T2 fat-saturated sagittal slices.
RESULTS: There was a statistically significant difference (p < 0.0001) in the angle of BRINK between the Haglund\'s and control group. The Area-Under-the-Curve (AUC) was 0.7783 in keeping with good discrimination between the two groups. The angle of BRINK measurement is reproducible, with an intra-observer ICC of 0.837 and an inter-observer ICC of 0.824. There was no statistically significant difference between the two groups for the other measurements. In the Haglund\'s group the Achilles tendon was more likely to attach to the mid 1/3 of the posterior calcaneus as opposed to the superior 1/3 (p = 0.02), calcaneal oedema was more likely to be present (p < 0.001) and non-insertional tendinopathy was more likely to be present (p < 0.001). The presence of a retrocalcaneal bursa is non-specific (p = 0.602).
CONCLUSIONS: The angle of BRINK demonstrates good discrimination between normal and Haglund\'s cases on MRI studies and may improve patient management by supporting surgical decision-making. Future work should correlate the angle of BRINK to long-term outcomes.
摘要：
目的：Haglund\的畸形，跟骨后上角的异常是后跟痛的常见原因。迄今为止，已经提出了许多与跟骨相关的放射学角度测量，以区分有症状和无症状的畸形患者。传统上,这些测量已在平片上进行了评估。这项研究的目的是确定可应用于踝关节磁共振成像（MRI）研究的测量值。
方法：对30例症状性Haglund畸形患者的MRI踝关节研究和32例正常对照研究进行回顾性队列分析。BRINK的角度,跟腱角,跟骨音高,在最佳T2脂肪饱和矢状切片上测量跟腱-足底筋膜角和比目鱼跟骨距离。
结果：Haglund与对照组之间的BRINK角度有统计学上的显着差异（p<0.0001）。曲线下面积（AUC）为0.7783，与两组之间的良好区分保持一致。BRINK测量的角度是可重复的，观察者内ICC为0.837，观察者间ICC为0.824。对于其他测量，两组之间没有统计学上的显着差异。在Haglund组中，跟腱更有可能附着在后跟骨的中部1/3，而不是上部1/3（p=0.02），跟骨水肿更可能出现（p<0.001），非插入性肌腱病更可能出现（p<0.001）。跟骨后囊的存在是非特异性的（p=0.602）。
结论：在MRI研究中，BRINK的角度显示出正常和Haglund病例之间的良好区分，并可能通过支持手术决策来改善患者管理。未来的工作应该将BRINK的角度与长期结果相关联。
方法：对30例症状性Haglund畸形患者的MRI踝关节研究和32例正常对照研究进行回顾性队列分析。BRINK的角度,跟腱角,跟骨音高,在最佳T2脂肪饱和矢状切片上测量跟腱-足底筋膜角和比目鱼跟骨距离。
结果：Haglund与对照组之间的BRINK角度有统计学上的显着差异（p<0.0001）。曲线下面积（AUC）为0.7783，与两组之间的良好区分保持一致。BRINK测量的角度是可重复的，观察者内ICC为0.837，观察者间ICC为0.824。对于其他测量，两组之间没有统计学上的显着差异。在Haglund组中，跟腱更有可能附着在后跟骨的中部1/3，而不是上部1/3（p=0.02），跟骨水肿更可能出现（p<0.001），非插入性肌腱病更可能出现（p<0.001）。跟骨后囊的存在是非特异性的（p=0.602）。
结论：在MRI研究中，BRINK的角度显示出正常和Haglund病例之间的良好区分，并可能通过支持手术决策来改善患者管理。未来的工作应该将BRINK的角度与长期结果相关联。
