Anterior cruciate ligament injury: Fast spin-echo MR imaging with arthroscopic correlation in 217 examinations

Department of Radiology, Stanford University School of Medicine, CA 94305, USA.
American Journal of Roentgenology (Impact Factor: 2.73). 06/1998; 170(5):1215-9. DOI: 10.2214/ajr.170.5.9574587
Source: PubMed


Our objective was to evaluate the accuracy of MR imaging strategy that uses primarily fast spin-echo sequences for the diagnosis of anterior cruciate ligament tears.
The original clinical interpretations of MR images of 217 examinations of the knee joint were correlated with subsequent arthroscopic results. Each MR examination included a double-echo fast spin-echo sequence as the only imaging sequence in the sagittal plane. Subsequent discordant MR and arthroscopic examinations were then subjected to reanalysis by two observers who were unaware of arthroscopic results to determine if misinterpretations were observer or image dependent. Two hundred sixteen patients who underwent MR imaging for suspected internal derangement of the knee subsequently underwent arthroscopic surgery. Two patients had both knees evaluated. One patient was excluded because he was referred for evaluation for osteomyelitis, not internal derangement. This yielded a total number of 217 MR examinations for suspected internal derangement of the knee.
For 56 arthroscopically proven tears, the sensitivity of MR imaging was 96%. The specificity was 98%, yielding an overall accuracy rate of 98%. The positive and negative predictive values were 95% and 99%, respectively. These values are within the ranges of previously reported MR imaging strategies using conventional spin-echo sequences.
Fast spin-echo MR imaging of the knee can be an alternative to conventional spin-echo imaging for the detection of anterior cruciate ligament tears.

17 Reads
  • Source
    • "We shoved that both additional MR techniques reveal partial rupture of ACL from the “grey zone” of indirect signs such as course angulations of ACL, hyperintense MR signal, unclear contours of the ligament with the characteristics of fluid, bleeding and/or fibrosis (depending on the time between trauma and MRI examination).7,11,21,26–29,34 "
    [Show abstract] [Hide abstract]
    ABSTRACT: Complete rupture of the anterior cruciate ligament (ACL) does not represent a diagnostic problem for the standard magnetic resonance (MR) protocol of the knee. Lower accuracy of the standard MR protocol for partial rupture of the ACL can be improved by using additional, dedicated MR techniques. The study goal was to draw a comparison between sagittal-oblique MR technique of ACL imaging flexion MR technique of ACL imaging and, ACL imaging obtained with standard MR protocol of the knee. In this prospective study we included 149 patients who were referred to magnetic resonance imaging (MRI) examination due to knee soft tissues trauma during 12 months period. MRI signs of ACL trauma, especially detection of partial tears, number of slices per technique showing the whole ACL, duration of applied additional protocols, and reproducibility of examination were analysed. Accuracy of standard MRI protocol of the knee comparing to both additional techniques is identical in detection of a complete ACL rupture. Presentations of the partial ruptures of ACL using flexion technique and sagittal-oblique technique were more sensitive (p<0.001) than presentation using standard MR protocol. There was no statistically significant difference between MRI detection of the ruptured ACL between additional techniques (p> 0.65). Sagittal-oblique technique provides a higher number of MRI slices showing the whole course of the ACL and requires a shorter scan time compared to flexion technique (p<0.001). Both additional techniques (flexion and sagittal-oblique) are just as precise as the standard MR protocol for the evaluation of a complete rupture of the ACL, so they should be used in cases of suspicion of partial rupture of the ACL. Our study showed sagittal-oblique technique was superior, because it did not depend on patient's ability to exactly repeat the same external rotation if standard MR protocol was used or to repeat exactly the same flexion in flexion MR technique in further MR examinations. Sagittal-oblique technique does not require the patient's knee to be repositioned, which makes this technique faster. We propose this technique in addition to the standard MR protocol for detection of partial ACL tears.
    Radiology and Oncology 03/2013; 47(1):19-25. DOI:10.2478/raon-2013-0006 · 1.91 Impact Factor
  • Source
    • "In order to evaluate the need for an arthroscopic operation, MRI examination of the knee joint is often performed. According to previous research, MRI offers good sensitivity and specificity for examining menisci and ligament injuries of the knee [1] [2] [3] [4] [5] [6] [7]. With the 1.5 Tesla MRI sequences chondral lesions can also be detected reliably [8-12]. "
    [Show abstract] [Hide abstract]
    ABSTRACT: This prospective study aimed to evaluate if chondral and meniscal lesions in symptomatic knees of osteoarthritis patients can be reliably identified using only one sagittal dual-echo MRI (Magnetic Resonance Imaging) sequence. MRI was performed on 13 patients after knee arthroscopy due to knee pain and clinically suspected osteoarthritis using a 1.5-Tesla scanner with knee coil and a sagittal dual-echo turbo spin-echo PD (Proton Density)- and T2-weighted sequence. The MRI and arthroscopic findings were then compared. Of 65 articular surfaces, 47 were damaged. For articular cartilage lesions, the overall sensitivity of MRI was 46.8%, specificity 72.2%, and diagnostic accuracy 53.9%, and for meniscal ruptures 81.2%, 66.7%, and 73.1%, respectively. The present study showed that the reliability of screening MRI of knees using only one sagittal dual-echo sequence does not suffice for diagnosis of chondral or meniscal lesions, and should therefore not replace routine knee MRI or diagnostic arthroscopy.
    The Open Orthopaedics Journal 02/2008; 2(1):19-22. DOI:10.2174/1874325000802010019
  • Source
    [Show abstract] [Hide abstract]
    ABSTRACT: Acute knee injury is a common event throughout life, and it is usually the result of a traffic accident, simple fall, or twisting injury. Over 90% of patients with acute knee injury undergo radiography. An overlooked fracture or delayed diagnosis can lead to poor patient outcome. The major aim of this thesis was retrospectively to study imaging of knee injury with a special focus on tibial plateau fractures in patients referred to a level-one trauma center. Multi-detector computed tomography (MDCT) findings of acute knee trauma were studied and compared to radiography, as well as whether non-contrast MDCT can detect cruciate ligaments with reasonable accuracy. The prevalence, type, and location of meniscal injuries in magnetic resonance imaging (MRI) were evaluated, particularly in order to assess the prevalence of unstable meniscal tears in acute knee trauma with tibial plateau fractures. The possibility to analyze with conventional MRI the signal appearance of menisci repaired with bioabsorbable arrows was also studied. The postoperative use of MDCT was studied in surgically treated tibial plateau fractures: to establish the frequency and indications of MDCT and to assess the common findings and their clinical impact in a level-one trauma hospital. This thesis focused on MDCT and MRI of knee injuries, and radiographs were analyzed when applica-ble. Radiography constitutes the basis for imaging acute knee injury, but MDCT can yield information beyond the capabilities of radiography. Especially in severely injured patients , sufficient radiographs are often difficult to obtain, and in those patients, radiography is unreliable to rule out fractures. MDCT detected intact cruciate ligaments with good specificity, accuracy, and negative predictive value, but the assessment of torn ligaments was unreliable. A total of 36% (14/39) patients with tibial plateau fracture had an unstable meniscal tear in MRI. When a meniscal tear is properly detected preoperatively, treatment can be combined with primary fracture fixation, thus avoiding another operation. The number of meniscal contusions was high. Awareness of the imaging features of this meniscal abnormality can help radiologists increase specificity by avoiding false-positive findings in meniscal tears. Postoperative menisci treated with bioabsorbable arrows showed no difference, among different signal intensities in MRI, among menisci between patients with operated or intact ACL. The highest incidence of menisci with an increased signal intensity extending to the meniscal surface was in patients whose surgery was within the previous 18 months. The results may indicate that a rather long time is necessary for menisci to heal completely after arrow repair. Whether the menisci with an increased signal intensity extending to the meniscal surface represent improper healing or re-tear, or whether this is just the earlier healing feature in the natural process remains unclear, and further prospective studies are needed to clarify this. Postoperative use of MDCT in tibial plateau fractures was rather infrequent even in this large trauma center, but when performed, it revealed clinically significant information, thus benefitting patients in regard to treatment. Akuutti polvivamma on yleinen tapaturma aikuisväestössä. Se on useimmiten seurausta liikenneonnettomuudesta, kaatumisesta tai vääntövammasta. Polven röntgenkuvaus onkin yleisin radiologinen kuvaus tapaturma-asemilla ja yli 90% tapaturma-asemille hakeutuvista polvivammapotilaista otetaan polven röntgenkuvat. Näistä potilaista 6-12% on todella polvimurtuma. Polvimurtuman viivästynyt diagnoosi voi johtaa huonoon hoitotulokseen. Väitöskirjassa tutkittiin polvivammoja; erityisesti sääriluun nivelpinnan käsittävien murtumien löydöksiä. Tutkimusaineisto koostui suuren traumasairaalan potilaista. Tutkimuksen pääpaino oli monileiketietokonetomografia- ja magneettitutkimuksissa ja perinteisten röntgenkuvien löydöksiä ei analysoitu kaikissa osatöissä. Akuutin polvivamman löydöksiä tutkittiin monileiketietokonetomografian avulla ja verrattiin perinteiseen röntgenkuvaukseen, lisäksi selvitettiin monileiketietokonetomografian mahdollisuuksia pehmytkudosten vammojen diagnostiikassa. Polven nivelpinnan murtumiin liittyvien polven nivelkierukoiden vammojen yleisyyttä, erilaisia vammatyyppejä ja erityisesti hoidettavien vammojen esiintyvyyttä selvitettiin. Väitöskirjassa selvitettiin biohajoavilla nuolilla kirurgisesti hoidettujen nivelkierukoiden magneettikuvauslöydöksiä, sekä tutkittiin monileiketietokonetomografian käyttöä kirurgisesti hoidettujen polvien nivelpinnan murtumien seurannassa. Röntgenkuvat olivat riittävät ensisijaisena tutkimuksena akuutin polvivamman kuvantamisessa suurimmalle osalle potilaista, mutta vakavasti loukkaantuneilla potilailla röntgenkuvaus ei välttämättä riittänyt poissulkemaan murtumaa ja heille suositellaan jatkotutkimuksena monileiketietokonetomografian käyttöä. Polven ristisiteiden kuvantamisessa monileiketietokonetomografian avulla ehjät ristisiteet erottuivat luotettavasti, mutta revenneiden ristisiteiden osalta kuvantaminen oli epäluotettavaa. Sääriluun nivelpinnan käsittävien murtumien yhteydessä löytyi paljon polven nivelkierukoiden epästabiileja re-peämiä, jotka yleensä vaativat kirurgista hoitoa. Näiden murtumien yhteydessä magneettikuvaus onkin suositeltavaa. Biohajoavin nuolin korjattujen polven nivelkierukoiden kuvantaminen perinteisellä magneettikuvauksella osoittautui epävarmaksi potilaiden seurannassa ja erityistä nivelensisäistä kontras-tiainetta suositellaan käytettäväksi ainakin niille potilaille, joilla toimenpiteestä on kulunut alle 18kk. Kirurgisesti hoidettujen sääriluun nivelpinnan käsittävien murtumien jatkoseuranta toteutetaan nykyisin pääosin perinteisellä röntgenkuvauksella ja jopa tässä suuressa traumasairaalassa vain 9% hoidetuista potilaista tehtiin jatkotutkimuksena monileiketietokonetomografia tutkimus. Näissä tapauksissa monileiketietokonetomografian avulla saatiin kuitenkin potilaiden hoitoa hyödyttävää lisätietoa.
Show more


17 Reads
Available from