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

Stanford University, Stanford, California, United States
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.

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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.
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