Prediction of clinical response to corticosteroid or platelet-rich plasma injection in plantar fasciitis with MRI: A prospective,randomized, double-blinded study |
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| Institution: | 1. Department of Radiology, CHU Montpellier, Montpellier University, 34090 Montpellier, France;2. Department of Medical Information, CHU Montpellier, Montpellier University, 34090 Montpellier, France;3. Department of Physical Medicine and Rehabilitation, CHU Montpellier, Montpellier University, 34090 Montpellier, France;1. Department of Radiology, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, 2-5-1 Shikata-cho kita-ku, Okayama, 700-8558, Japan;2. Department of Radiological Technology, Okayama University Graduate School of Health Sciences, 2-5-1 Shikata-cho kita-ku, Okayama, 700-8558, Japan;1. Department of Hepato-Pancreatic-Biliary and Endocrine Surgery, Hôpital Cochin, Assistance Publique-Hôpitaux de Paris, 75014 Paris, France;2. Université de Paris, Faculté de Médecine, 75006 Paris, France;1. Department of Medical Imaging, CHU de Nîmes, Nîmes Medical Imaging Group, Imagine, Univ. Montpellier, 30029 Nîmes, France;2. Department of Interventional Radiology, Hôpital Avicenne, AP-HP, 93000 Bobigny, France;3. Department of Interventional Radiology, Clinique de l''Orangerie, 67000 Strasbourg, France;4. Department of Radiology, Institut Médico-Chirurgical Arnault Tzanck, 06100 Saint Laurent du Var, France;5. Department of Radiology, Hôpital Nord, CHU de Saint Etienne, 42055 Saint Priest en Jarez, France;6. Department of Radiology, CHU de Rouen Normandie, Inserm U1096, Université de Rouen Normandie, 76000 Rouen, France;1. University of Minnesota, Department of Radiology, Division of Interventional Radiology, Minneapolis, MN, 55455, USA;2. Minneapolis VA Medical Center, Department of Radiology, MN, 55417, USA |
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| Abstract: | PurposeThe purpose of this study was to identify association between magnetic resonance imaging (MRI) features and clinical data at baseline and six months following platelet-rich plasma (PRP) or corticosteroid (CS; cortivazol) injection in patients with plantar fasciitis, and to identify initial MRI criteria associated with a favorable clinical response to treatment.Material and methodsThe study was registered on ClinicalTrials.gov (NCT03857334). MRI examinations of 36 patients with plantar fasciitis lasting more than 3 months who were randomly assigned to receive ultrasound-guided PRP (PRP group, 20 patients) or CS (CS group, 18 patients) injection were quantitatively and qualitatively analyzed with respect to plantar fascia thickness, plantar fascia hyperintensity on T2-weighted STIR (HSTIR) images, calcaneal bone marrow and surrounding soft tissues. Clinical evaluation including visual analytic scale (VAS) assessment and MRI examinations were obtained before and 6 months after treatment. Good clinical response was defined as pain VAS decrease > 50% at 6 months. ROC curves with AUC measurements were used to determine cut-off points.ResultsIn the whole study population, an association was found between MRI features (deep soft tissue and calcaneal bone marrow HSTIR) and pain VAS scores for the first steps of the day (P = 0.028 and P = 0.007, respectively). No significant radioclinical associations on post-treatment MRI examinations were found in either group. Initial coronal thickness of plantar fascia was associated with a good clinical response in the CS group (P < 0.01). ROC curve analysis found that 7-mm or thicker plantar aponeurosis at initial MRI was predictive of good clinical response in patients with CS treatment (Youden index = 0.6). PRP infiltrations were effective regardless of fascia thickness (73% of patients with ≤ 7 mm aponeurosis and 67% for thicker ones).ConclusionInitial facia thickness (> 7 mm) is predictive of good clinical response six months after CS injection, whereas PRP injection shows effectiveness regardless of fascia thickness. |
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