Dynamic ultrasound (DUS) versus magnetic resonance imaging (MRI) for the diagnosis of Morton's neuroma: A prospective comparative study.

INTRODUCTION: Morton's neuroma (MN) is primarily diagnosed clinically, with imaging commonly used for confirmation and differential diagnosis, particularly from intermetatarsal bursitis (IMB). Dynamic ultrasonography (DUS) and magnetic resonance imaging (MRI) performance in detecting MN remains debated. The aim of this study was to compare DUS and MRI using concordant imaging findings, histopathologic confirmation, and clinical follow-up. METHODS: Prospective single-centre comparative study, patients with suspect MN underwent DUS and MRI examinations, interpreted independently by blinded radiologists. Surgical excision with histopathologic confirmation was the reference standard for MN, whereas symptoms resolution after conservative treatment at 12-month follow-up confirmed intermetatarsal bursitis (IMB). Diagnostic performance metrics and receiver operating characteristic (ROC) curves were calculated. RESULTS: Seventy-six lesions were evaluated (53 MN and 23 IMB). DUS and MRI demonstrated a diagnostic accuracy of 98.68% and 89.47%. The area under the ROC curve was significantly higher for DUS (P = .0147). CONCLUSION: DUS demonstrated superior diagnostic performance, representing a reliable and cost-effective first-line imaging modality. LEVEL OF EVIDENCE: Level II, prospective comparative diagnostic study.