Three-tesla magnetic resonance imaging of the meniscus of the knee: What about equivocal errors?

Background: The significance of borderline magnetic resonance (MR) findings that are equivocal for a tear of the knee meniscus remains uncertain. Given their higher signal-to-noise ratio (SNR) and greater spatial resolution, these equivocal meniscal tears could be expected to be less frequent using a 3.0T MR system. Purpose: To investigate the prevalence of equivocal meniscal tears using 3.0T MR, and to study their impact on MR accuracy compared with arthroscopy in the detection of meniscal tears. Material and Methods: The medical records of 100 patients who underwent 3.0T MR imaging and subsequent arthroscopy of the knee were retrospectively reviewed. Two observers interpreted MR images in consensus, and menisci were diagnosed as torn (abnormality on two or more images), equivocal for a tear (abnormality on one image), or intact, using arthroscopy as the standard of reference. The prevalence of equivocal meniscal tears was assessed, and MR accuracy was calculated as follows: first, considering both torn menisci and equivocal diagnoses as positive for a tear; and second, considering only torn menisci as positive for a tear. Results: Evidence of meniscal tears on MR images was equivocal in 12 medial (12%) and three lateral (3%) menisci. Of these equivocal MR diagnoses, tears were found at arthroscopy in eight medial and one lateral meniscus. In our study, the specificity and positive predictive value increased for both the medial and lateral meniscus when only menisci with two or more abnormal images were considered to be torn: from 80% and 89% to 91% and 94% for the medial meniscus, and from 91% and 73% to 93% and 78% for the lateral meniscus, respectively. Conclusion: Subtle findings that are equivocal for a tear of the knee meniscus still make MR diagnosis difficult, even at 3.0T. We recommend that radiologists should rather be descriptive in reporting subtle or equivocal MR findings, alerting the clinician of possible meniscal tear.

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Magnetic resonance imaging for detection of late meniscal tears in dogs following tibial tuberosity advancement for treatment of cranial cruciate ligament injury

Veterinary and Comparative Orthopaedics and Traumatology ◽

10.3415/vcot-13-08-0107 ◽

2014 ◽

Vol 27 (02) ◽

pp. 141-146 ◽

Cited By ~ 3

Author(s):

C. R. Lamb ◽

M. S. Tivers ◽

A. Li ◽

F. Taylor-Brown

Keyword(s):

Magnetic Resonance Imaging ◽

Magnetic Resonance ◽

Mr Imaging ◽

Cruciate Ligament ◽

Meniscal Tear ◽

Ligament Injury ◽

Meniscal Tears ◽

Resonance Imaging ◽

Mr Images ◽

Cranial Cruciate Ligament

SummaryTo document the use of and to estimate the accuracy of magnetic resonance (MR) imaging for detection of late meniscal tears in dogs with cranial cruciate ligament injury treated with tibial tuberosity advancement (TTA).Medical records of dogs that had TTA followed by stifle MR imaging for suspected meniscal tear and subsequent arthrotomy were reviewed retrospectively. Magnetic resonance images were reviewed independently by an observer blinded to clinical information who classified menisci as torn, abnormal but intact, or normal. Magnetic resonance and surgical findings were compared.Eight stifles from large breed dogs were included. Six stifles had a medial meniscal tear identified in MR images and later confirmed surgically. In the remaining two stifles, the menisci appeared intact in MR images and no tear was identified at subsequent arthrotomy. Lateral menisci in all stifles appeared intact in MR images and were considered normal at surgery. Susceptibility artefacts associated with TTA implants were present in all images but did not adversely affect interpretation of intra-articular structures.Magnetic resonance imaging appears to be accurate for diagnosis of late meniscal tears. Artefacts associated with TTA implants did not prevent evaluation of critical intra-articular structures. Further investigation with MR imaging should be considered when late meniscal tear is suspected following TTA.

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Diagnostic Accuracy of Magnetic Resonance Imaging in the Detection of Type and Location of Meniscus Tears: Comparison with Arthroscopic Findings

Journal of Clinical Medicine ◽

10.3390/jcm10040606 ◽

2021 ◽

Vol 10 (4) ◽

pp. 606

Author(s):

Seong Hwan Kim ◽

Han-Jun Lee ◽

Ye-Hoon Jang ◽

Kwang-Jin Chun ◽

Yong-Beom Park

Keyword(s):

Magnetic Resonance Imaging ◽

Magnetic Resonance ◽

Diagnostic Accuracy ◽

Medial Meniscus ◽

Cruciate Ligament ◽

Lateral Meniscus ◽

Meniscal Tears ◽

Resonance Imaging ◽

Arthroscopic Findings ◽

Meniscus Tears

Magnetic resonance imaging (MRI) has been widely used for the diagnosis of meniscal tears, but its diagnostic accuracy, depending on the type and location, has not been well investigated. We aimed to evaluate the diagnostic accuracy of MRI by comparing MRI and arthroscopic findings. Preoperative 3.0-T MRI and arthroscopic findings from 2005 to 2018 were reviewed to determine the presence, type, and location of meniscus tears. In addition, subgroup analysis was performed according to anterior cruciate ligament (ACL) injury. The exclusion criteria were as follows: (1) Inflammatory arthritis, (2) other ligament injuries, (3) inability to classify meniscal tears due to degenerative arthritis, (4) over 90 days from MRI to surgery, and (5) incomplete data. Of the 2998 eligible patients, 544 were finally included. The sensitivity and specificity of MRI in determining medial and lateral meniscus tears were 91.8% and 79.9%, and 80.8% and 85.4%, respectively. The accuracy of MRI in the ACL-injured group was lower than that in the ACL-intact group (medial meniscus: 81.7% vs. 88.1%, p = 0.041; 72.9% vs. lateral meniscus: 88.0%, p < 0.001). MRI accuracy was low for the longitudinal tears of the posterior horn of the medial meniscus in the ACL-injured group. MRI could be a diagnostic tool for meniscus tears, but has limited accuracy in their classification of the type and location. Hence, care should be taken during arthroscopic assessment of ACL-injured patients due to low diagnostic accuracy of preoperative MRI.

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Dynamics of the meniscus underweight-loading conditions: an investigation using upright magnetic resonance imaging

Orthopaedic Journal of Sports Medicine ◽

10.1177/2325967120s00453 ◽

2020 ◽

Vol 8 (7_suppl6) ◽

pp. 2325967120S0045

Author(s):

Junsuke Nakase ◽

Kengo Shimozaki ◽

Rikuto Yoshimizu ◽

Hiroyuki Tsuchiya ◽

Kazuki Asai

Keyword(s):

Magnetic Resonance Imaging ◽

Magnetic Resonance ◽

Supine Position ◽

Medial Meniscus ◽

Lateral Meniscus ◽

Loading Conditions ◽

Resonance Imaging ◽

Significant Difference ◽

Posterior Shift ◽

Weight Loading

Objectives: Meniscal morphology underweight-loading conditions remains unknown, because weight loading is rarely performed during magnetic resonance imaging (MRI). We focused on the weight-loading condition and developed an upright MRI. This study aimed to investigate the shift of the medial and lateral meniscus in healthy adults under both fully weight loaded and unloaded conditions, using both supine and upright MRI. Methods: Eighteen volunteers (13 men and 5 women) without previous knee complaints underwent an MRI of the right knee. The mean age of the subjects was 21.8±3.1 years. The examination was performed in three positions: supine, double-leg upright (DLU), and single-leg upright (SLU). The knees were fully extended in each position. For both the supine and upright examinations, we used a special MRI apparatus (Gravity MRI, Hitachi, Japan) that is capable of imaging in any position with a static magnetic field strength of 0.4 T (Figure). T1-weighted images were obtained in both coronal and sagittal planes with a slice thickness of 2 mm. The medial or lateral, anterior and posterior shifts of both the medial and lateral meniscus were measured, against the tibial wedge. The medial and lateral meniscal shift rates were measured as assessment items under each condition. The shift rate was defined as the proportion of the measured meniscal shift compared to the overall width of the medial and lateral meniscus. The MRI reference section on the sagittal plane was the midpoint of the medial or lateral femoral condyle. On the coronal plane, the reference point was the midpoint of the medial and lateral tibial condyle. The measurement items were compared in all three imaging positions using analysis of variance and multiple comparison tests, with statistical significance set at P < 0.05. Results: We show the results from the analysis of the dynamics of the medial and lateral meniscus in Table. The difference among the three conditions for the medial shift rate of the medial meniscus was significant. The medial shift rate was significantly greater in the DLU and SLU positions than in the supine position (supine: 7.3±5.8% vs. DLU: 20.0±8.8 % (P<0.01), supine vs. SLU: 21.5±7.6% (P<0.01), DLU vs. SLU (P=0.7)). No significant differences were observed for the anterior and posterior shift rates of the medial meniscus (anterior: P=0.6, posterior: P=0.4). In the lateral meniscus, the lateral shift rate was significantly greater in the SLU position than in the supine position, but no significant difference was observed in the DLU position (supine: -1.2±11.8% vs. DLU: 2.7±11.1 % (P=0.2), supine vs. SLU: 4.5±10.8% (P=0.04), DLU vs. SLU: P=0.7). Both anterior and posterior shift rates in the lateral meniscus were significantly greater in DLU and SLU positions than in the supine position (anterior/ supine: -20.6±14.3% vs. DLU: -14.7±12.2% (P<0.01), supine vs. SLU: -8.9±14.9% (P<0.01), DLU vs. SLU: P=0.3, posterior/ supine: -78.0±19.6% vs. DLU: -63.7±18.7 % (P<0.01), supine vs. SLU: -57.8±19.2% (P<0.01), DLU vs. SLU: P=0.4). Conclusions: Under upright weight-loading conditions, the medial meniscus showed only medial shift, whilst the lateral meniscus was seen to shift in lateral, anterior, and posterior directions. No significant difference was observed between the DLU and SLU shift rates in both the medial and lateral meniscus in healthy adults. We believe that this result will be useful when considering loading and rehabilitation following meniscal repair. [Table: see text]

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Clinical Diagnostic Value of Magnetic Resonance Imaging in Knee Joint Sports Injury

Journal of Medical Imaging and Health Informatics ◽

10.1166/jmihi.2021.3301 ◽

2021 ◽

Vol 11 (2) ◽

pp. 453-461

Author(s):

Bing Wang ◽

Li Wang ◽

Yingyi Wang ◽

Fen Qin

Keyword(s):

Magnetic Resonance Imaging ◽

Magnetic Resonance ◽

Knee Joint ◽

Clinical Judgment ◽

Lateral Meniscus ◽

Clinical Effects ◽

Resonance Imaging ◽

Knee Meniscus ◽

Meniscus Injury ◽

Sensitivity Specificity

This article mainly analyzes the clinical effects of magnetic resonance diagnosis in knee meniscus injury. Patients with knee meniscus injury were taken as the research object. All patients used magnetic resonance examination and surgery and arthroscopy examination, and surgery and arthroscopy examination as the control parameters. The analysis used magnetic resonance diagnosis results and the classification of meniscus injury diagnosed by magnetic resonance and surgery and arthroscopy. The results showed that the sensitivity, specificity, and accuracy of conventional MR1 sequence diagnosis of medial meniscus injury were 86.3%, 95.6%, and 92.4%, respectively. The sensitivity, specificity and accuracy of conventional MRI in diagnosing lateral meniscus injury of the knee joint were 91.3%, 94.5%, and 92.5% respectively. The sensitivity of MRI to medial and lateral meniscus injury was (χ2 = 0.07, P > 0.77), There were no significant differences in specificity χ2 = 0.01, P > 0.77) and accuracy χ2 = 0.01, P > 0.77). The knee meniscus injury has a greater impact on patients. The diagnostic effect of magnetic resonance imaging is better and the diagnostic accuracy is higher. It can help clinical judgment and treatment. The effect is obvious and worthy of clinical promotion.

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Correlation of Meniscal Tear with Timing of Anterior Cruciate Ligament Reconstruction in Patients without Initially Concurrent Meniscal Tear

The Journal of Knee Surgery ◽

10.1055/s-0038-1675783 ◽

2018 ◽

Vol 32 (11) ◽

pp. 1128-1132

Author(s):

Kun-Hui Chen ◽

En-Rung Chiang ◽

Hsin-Yi Wang ◽

Hsiao-Li Ma

Keyword(s):

Medial Meniscus ◽

Cruciate Ligament ◽

Meniscal Tear ◽

Lateral Meniscus ◽

Acl Injury ◽

Meniscus Tear ◽

Meniscal Tears ◽

Anterior Cruciate ◽

Late Group ◽

Acl Deficient

AbstractThe incidence of meniscal tear was reported to increase with the delay of anterior cruciate ligament reconstruction (ACLR). The tear may occur concurrently with the ACL injury or after the ACL injury. Few studies had focused on the patients whose meniscus is intact during ACL injury. We determined the correlation between timing of surgery and incidence of meniscal tears in ACL-deficient knees with initially intact meniscus. We retrospectively reviewed 387 patients who had undergone primary ACLR. Time of initial ACL injury, magnetic resonance imaging (MRI) examination, and surgery was recorded. The MRI was reviewed by experienced radiologic and orthopaedic doctors. Intraoperative arthroscopic images were also obtained and reviewed. The type of tear noted during surgery was classified according to the modification of International Society of Arthroscopy, Knee Surgery and Orthopaedic Sports Medicine classification of meniscal tears. Patients were divided into early (surgery within 12 months from injury) and late surgery group (surgery at more than 12 months from injury). There were 216 patients with intact medial meniscus and 257 patients with intact lateral meniscus on the postinjury MRI study. The incidence of medial meniscus tear (MMT) was significantly higher than lateral meniscus tear (LMT) during the ACLR (33.8 vs. 19.8%, p < 0.001). The incidence of MMT is higher in late group than in early group (53.7 vs. 29.1%, p = 0.004, odds ratio= 2.815). The incidence of LMT is mildly higher in late group but without statistics significance (23.8 vs. 18.6%, p = 0.364). In both MMT and LMT, the most common injury pattern observed was a longitudinal tear. The incidence of each type is not different between early and late group. For patients without concurrent meniscal injuries with the ACL tear, the incidence of MMT significantly increased if ACLR was performed more than 12 months after injury. The medial meniscus was more prone to injury than the lateral meniscus in chronic ACL-deficient knee. ACLR should be performed earlier to reduce the risk of meniscal tears for patients without initially concurrent meniscal tear.

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Magnetic Resonance Image Characterization of Knee Meniscus Signal Intensity using Crue’s Approach: Results from a Multi-centre Evidence

Advances in Bioscience and Clinical Medicine ◽

10.7575/aiac.abcmed.v.9n.3p.15 ◽

2021 ◽

Vol 9 (3) ◽

pp. 15

Author(s):

Akwa E. Erim ◽

Benjamin E. Udoh ◽

Pius Agweye ◽

Ofonime Ukweh ◽

Anthony C. Ugwu

Keyword(s):

Magnetic Resonance ◽

Signal Intensity ◽

Resonance Imaging ◽

Mr Images ◽

Meniscal Lesion ◽

Knee Meniscus ◽

Meniscal Lesions ◽

Grade 3 ◽

And Gender

This study aimed to characterize knee meniscus signal-intensity using magnetic resonance imaging. Our research included knee MR images of 138 subjects from multi-centres in Nigeria, between September 2016 and December 2017. Knee images were retrieved from patients' folder of MRI scanners and transfered to a DICOM workstation (Onis 2.6) for image analysis. Knee meniscus was characterized into 0, 1, 2 & 3 grades using Crue’s grading approach. Our research revealed 58% incidence of meniscal lesion. Study yielded a significant relationship between meniscal lesion and gender (p <.005) with a greater proportion of these lesions in women than in men. Meniscal lesions showed significant association with osteoarthritis (OA) (p < 0.05). Grade 3 lesions (actual tears) were largely of horizontal configuration.

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Magnetic resonance imaging in the evaluation of meniscal tear

Asian Biomedicine ◽

10.2478/abm-2010-0029 ◽

2010 ◽

Vol 4 (2) ◽

pp. 215-222

Author(s):

Numphung Numkarunarunrote ◽

Anoma Sanpatchayapong ◽

Pongsak Yuktanandana ◽

Somsak Kuptniratsaikul

Keyword(s):

Magnetic Resonance Imaging ◽

Magnetic Resonance ◽

Predictive Value ◽

Meniscal Tear ◽

Posterior Horn ◽

Anterior Horn ◽

Meniscal Tears ◽

Resonance Imaging ◽

Sensitivity Specificity ◽

Knee Pathology

Abstract Background: Magnetic resonance imaging (MRI) has been recognized as the imaging method for non-invasive evaluation of knee pathology, particular meniscus and ligaments. Objective: Compare the sensitivity, specificity, and accuracy of MRI in the detection of meniscal tears with arthroscopy. Material and methods: Twenty-seven patients who were diagnosed as meniscal tear on arthroscopy with preoperative MRI were included in this study between January 2003 and June 2008. MRI was performed with a 1.5 Tesla Signa Horizon Echospeed MRI for eight patients between January 2003 and June 2005 and a 1.5 Tesla Signa Excited HD MRI for nineteen patients between July 2005 and June 2008. The location of meniscal tear was evaluated by studying three areas: anterior horn, body and posterior horn. Sensitivity, specificity, accuracy, positive predictive value (PPV), and negative predictive value (NPV) of the anterior horn, body, posterior horn and overall meniscus were calculated. Results: The sensitivity of MRI for detecting meniscal tears at the anterior horn, body, posterior horn, and overall medial meniscus was 42.9%, 87.5%, 94.1%, and 81.3%, respectively. The specificity was 95.0%, 84.2%, 81.8%, and 88.0%, respectively. The accuracy was 81.5%, 85.2%, 89.3%, and 85.4%, respectively. The PPV was 75.0%, 70.0%, 88.9%, and 81.2%, respectively. The NPV was 82.6%, 94.1%, 90.0%, and 88.0%, respectively. The sensitivity of MRI for detecting meniscal tears at the anterior horn, body, posterior horn and overall lateral meniscus was 0%, 100%, 85.7%, and 80.0%, respectively. The specificity was 100%, 100%, 90.5% and 97.2%, respectively. The accuracy was 96.0%, 100%, 90.5%, and 97.2%, respectively. The PPV was 100%, 75% and 80%, respectively. The NPV was 96.3%, 100%, 95.0%, and 97.2%, respectively. Conclusion: MRI is a helpful technique to detect meniscal tear with different sensitivity and accuracy on the meniscal location.

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DIAGNOSTIC ACCURACY OF ULTRASOUND IN DETECTING MENISCAL TEARS TAKING MAGNETIC RESONANCE IMAGING AS GOLD STANDARD

Journal of Humanities, Social and Management Sciences (JHSMS) ◽

10.54112/bcsrj.v2020i1.40 ◽

2020 ◽

Vol 2020 (1) ◽

Author(s):

MA Omer ◽

SS Malik ◽

MN Anjum ◽

Az Riaz ◽

R Ali

Keyword(s):

Magnetic Resonance Imaging ◽

Magnetic Resonance ◽

Diagnostic Accuracy ◽

Gold Standard ◽

Lateral Meniscus ◽

Meniscus Tear ◽

Meniscal Tears ◽

Resonance Imaging ◽

Non Invasive ◽

Sensitivity Specificity

Meniscal tears are mostly seen worldwide. Multiple imaging modalities are currently used to evaluate pathologic conditions of the knee. MRI can be referred as the non-invasive gold standard investigation to help establishing diagnosis of meniscal tears, but it economically unaffordable to most of patients and needs long examination times. Ultrasound is a possible alternative to MRI. It is simple, convenient and an inexpensive and non-invasive method. The use of ultrasound in identifying meniscal tears has been proposed, but its diagnostic accuracy remains controversial. The objective of the research is to define the diagnostic accurateness of ultrasound scan in detecting meniscal tears taking magnetic resonance imaging as gold standard. It was a diagnostic cross-sectional study in which 78 patients visiting Department of Diagnostic Radiology, Doctors Hospital, Lahore were included. Convenient sampling technique was used. Written informed consent was taken from all the patients. Patients were investigated with the help of ultrasound and results were noted on the designed proforma, subsequently the results were compared to the MRI scan of the knee joint. Data was entered and statistically analyzed using SPSS 21.0. Frequency tables were generated for all variables. For quantitative data like age mean and standard deviation were calculated and for qualitative data like sex and meniscal tears percentages were calculated. Sensitivity, Specificity, Positive Predictive Value, Negative Predictive Value was given. Bar and pie charts were used to present categorical data. Kappa analysis was utilized. The mean age of the patients was 38.18+12.818 years, 82.1% were males and 47.4% had sports trauma. Out of 48 medial meniscus tear on USG, 38(48.7%) were true positive and 10(12.8%) were false positive on MRI. Out of 10 lateral meniscus tear on USG, 9(11.5%) were true positive and 1(1.3%) was false positive on MRI. The sensitivity, specificity, PPV, NPV and diagnostic accuracy of ultrasound for medial meniscus tears were 95.00%, 73.68%, 79.16%, 93.33% and 84.61% while for lateral meniscus tears were 75.00%, 98.48%, 90.00%, 95.58% and 94.87%, respectively. Study concluded that ultrasound has good diagnostic accuracy when compared with magnetic resonance imaging in detecting meniscal tears.

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Should We Prefer Magnetic Resonance Imaging to Physical Examination in Meniscal Tears

The Journal of Knee Surgery ◽

10.1055/s-0039-1693449 ◽

2019 ◽

Vol 33 (12) ◽

pp. 1251-1255 ◽

Cited By ~ 1

Author(s):

Gökhun Arıcan ◽

Ahmet Özmeriç ◽

Özgür Şahin ◽

Serkan İltar ◽

Kadir Bahadır Alemdaroğlu

Keyword(s):

Magnetic Resonance Imaging ◽

Magnetic Resonance ◽

Physical Examination ◽

Lateral Meniscus ◽

Meniscal Tears ◽

Resonance Imaging ◽

Predictive Values ◽

Arthroscopic Findings ◽

Meniscus Tears ◽

Joint Line Tenderness

AbstractThe aim of this study was to compare the sensitivity, specificity, accuracy, positive and negative predictive values of magnetic resonance imaging (MRI), and clinical examination in the diagnosis of meniscus tears with the findings obtained from the knee joint arthroscopy. A retrospective study was made of 452 patients who underwent knee arthroscopy due to meniscus tears between 2012 and 2017. Physical examination was performed using the Thessaly's, McMurray's, and Joint line tenderness tests (JLTT). On preoperative MRI, medial meniscal tears were observed in 292 patients, lateral meniscal tears in 96 patients, and medial and lateral meniscal tears in 64 patients. According to the arthroscopy results, 284 patients had medial meniscal tears, 108 patients had lateral meniscal tears, and 60 patients had medial and lateral meniscal tears. Sensitivity and specificity of the JLTT was determined as 93 and 86% respectively for medial meniscal tears and 94 and 89% for lateral meniscal tears. The McMurray's test was 60% sensitive, 68% specific for medial meniscal tears (MMT), and 73% sensitive and 68% specific for lateral meniscus tears (LMT). The Thessaly's test was 93% sensitive and 87% specific for medial meniscal tears; and 94% sensitive and 88% specific for LMT. Compared with the arthroscopic findings, MRI was observed to have sensitivity of 94% for MMT and 84% for LMT. For specificity, the values were 89% for MMT and 91% for LMT. Accuracy was 89% for MMT and 86% for LMT. In comparison with the arthroscopic findings, the triple test was determined to have sensitivity of 92% for MMT and 89% for LMT. The specificity was 88% for MMT and 91% for LMT. The results of this study showed that a combination of selected physical examination methods is as sensitive as MRI in the diagnosis of meniscus tears.

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