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Van Dyck P, Vandenrijt J, Vande Vyvere T, Snoeckx A, Heusdens CHW. Analysis of Discordant Findings between 3T Magnetic Resonance Imaging and Arthroscopic Evaluation of the Knee Meniscus. J Clin Med 2023; 12:5667. [PMID: 37685734 PMCID: PMC10489133 DOI: 10.3390/jcm12175667] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2023] [Revised: 08/23/2023] [Accepted: 08/29/2023] [Indexed: 09/10/2023] Open
Abstract
Numerous studies have assessed the performance of magnetic resonance imaging (MRI) in detecting tears of the knee menisci using arthroscopy results as the gold standard, but few have concentrated on the nature of discordant findings. The purpose of this study was to analyze the discordances between 3T MRI and arthroscopic evaluation of the knee meniscus. Medical records of 112 patients who underwent 3T MRI and subsequent arthroscopy of the knee were retrospectively analyzed to determine the accuracy of diagnoses of meniscal tear. Compared with arthroscopy, there were 22 false-negative and 14 false-positive MR interpretations of meniscal tear occurring in 32 patients. Images with errors in diagnosis were retrospectively reviewed by two musculoskeletal radiologists in consensus and all errors were categorized as either unavoidable, equivocal or as interpretation error. Of 36 MR diagnostic errors, there were 16 (44%) unavoidable, 5 (14%) interpretation errors and 15 (42%) equivocal for meniscal tear. The largest categories of errors were unavoidable false-positive MRI diagnoses (71%) and equivocal false-negative MRI diagnoses (50%). All meniscal tears missed by MRI were treated with partial meniscectomy (n = 14) or meniscal repair (n = 8). Discordant findings between 3T MRI and arthroscopic evaluation of the knee meniscus remain a concern and primarily occur due to unavoidable and equivocal errors. Clinicians involved in the diagnosis and treatment of patients with meniscal tears should understand why and how the findings seen on knee MRI and arthroscopy may sometimes differ.
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Affiliation(s)
- Pieter Van Dyck
- Department of Radiology, Antwerp University Hospital, Drie Eikenstraat 655, 2650 Edegem, Belgium; (T.V.V.); (A.S.)
- Faculty of Medicine and Health Sciences, University of Antwerp, Universiteitsplein 1, 2610 Wilrijk, Belgium;
| | - Jasper Vandenrijt
- Department of Orthopedics, Antwerp University Hospital, Drie Eikenstraat 655, 2650 Edegem, Belgium;
| | - Thijs Vande Vyvere
- Department of Radiology, Antwerp University Hospital, Drie Eikenstraat 655, 2650 Edegem, Belgium; (T.V.V.); (A.S.)
- Faculty of Medicine and Health Sciences, University of Antwerp, Universiteitsplein 1, 2610 Wilrijk, Belgium;
| | - Annemiek Snoeckx
- Department of Radiology, Antwerp University Hospital, Drie Eikenstraat 655, 2650 Edegem, Belgium; (T.V.V.); (A.S.)
- Faculty of Medicine and Health Sciences, University of Antwerp, Universiteitsplein 1, 2610 Wilrijk, Belgium;
| | - Christiaan H. W. Heusdens
- Faculty of Medicine and Health Sciences, University of Antwerp, Universiteitsplein 1, 2610 Wilrijk, Belgium;
- Department of Orthopedics, Antwerp University Hospital, Drie Eikenstraat 655, 2650 Edegem, Belgium;
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Ahmad R. Intra-substance meniscal changes and their clinical significance: a meta-analysis. Sci Rep 2021; 11:3642. [PMID: 33574469 PMCID: PMC7878874 DOI: 10.1038/s41598-021-83181-5] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2020] [Accepted: 01/29/2021] [Indexed: 11/23/2022] Open
Abstract
The degeneration of radial tie fibres of the central meniscal layer, and thinning of its lamellar layer results in increased intensity signals on magnetic resonance imaging, making it difficult to differentiate from true meniscal tear. This study aimed to assess the rate of encountered MRI grades 1 and 2 intrasubstance meniscal changes, and to set guidelines to report these changes based on predicted clinical outcome. A systematic review approach was employed using search engines, libraries, and databases (Google Scholar, ERIC, PubMed, and Medline) to search for scholarly sources on meniscal lesions and their significance in MRI published between 1 January 2000 and 30 June 2019. It retrieved 2750 abstracts, out of which 2738 were excluded and 13 studies meeting inclusion criteria were meta-analysed. It found an association between intrasubstances meniscal changes and outcomes. It resulted that intrasubstance meniscal changes were preservable through the protective functioning of the meniscus. Other than weight gain, no other significant risk factor of developing true meniscal tears later in life was found. It is important to examine intrasubstance meniscal change when patients suffer from mechanical meniscal symptoms especially in old age.
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Affiliation(s)
- Rani Ahmad
- King Abdulaziz University, Jeddah, Saudi Arabia.
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Shin D, Youn K, Lee E, Lee M, Chung H, Kim D. Risk factors for lesions of the knee menisci among workers in South Korea's national parks. Ann Occup Environ Med 2016; 28:56. [PMID: 27766160 PMCID: PMC5057211 DOI: 10.1186/s40557-016-0143-y] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2016] [Accepted: 09/28/2016] [Indexed: 11/10/2022] Open
Abstract
Background This study was designed to investigate the prevalence of the menisci lesions in national park workers and work factors affecting this prevalence. Methods The study subjects were 698 workers who worked in 20 Korean national parks in 2014. An orthopedist visited each national park and performed physical examinations. Knee MRI was performed if the McMurray test or Apley test was positive and there was a complaint of pain in knee area. An orthopedist and a radiologist respectively read these images of the menisci using a grading system based on the MRI signals. To calculate the cumulative intensity of trekking of the workers, the mean trail distance, the difficulty of the trail, the tenure at each national parks, and the number of treks per month for each worker from the start of work until the present were investigated. Chi-square tests was performed to see if there were differences in the menisci lesions grade according to the variables. The variables used in the Chi-square test were evaluated using simple logistic regression analysis to get crude odds ratios, and adjusted odds ratios and 95 % confidence intervals were calculated using multivariate logistic regression analysis after establishing three different models according to the adjusted variables. Results According to the MRI signal grades of menisci, 29 % were grade 0, 11.3 % were grade 1, 46.0 % were grade 2, and 13.7 % were grade 3. The differences in the MRI signal grades of menisci according to age and the intensity of trekking as calculated by the three different methods were statistically significant. Multiple logistic regression analysis was performed for three models. In model 1, there was no statistically significant factor affecting the menisci lesions. In model 2, among the factors affecting the menisci lesions, the OR of a high cumulative intensity of trekking was 4.08 (95 % CI 1.00–16.61), and in model 3, the OR of a high cumulative intensity of trekking was 5.84 (95 % CI 1.09–31.26). Conclusion The factor that most affected the menisci lesions among the workers in Korean national park was a high cumulative intensity of trekking.
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Affiliation(s)
- Donghee Shin
- Department of Occupational and Environmental Medicine, Wonjin Green Hospital, 568-1 Sagajeong-ro 49-gil 53, Jungrang-gu, Seoul South Korea
| | - Kanwoo Youn
- Department of Occupational and Environmental Medicine, Wonjin Green Hospital, 568-1 Sagajeong-ro 49-gil 53, Jungrang-gu, Seoul South Korea
| | - Eunja Lee
- Department of Radiology, Wonjin Green Hospital, 568-1 Sagajeong-ro 49-gil 53, Jungrang-gu, Seoul South Korea
| | - Myeongjun Lee
- Department of Occupational and Environmental Medicine, Wonjin Green Hospital, 568-1 Sagajeong-ro 49-gil 53, Jungrang-gu, Seoul South Korea
| | - Hweemin Chung
- Department of Occupational and Environmental Medicine, Wonjin Green Hospital, 568-1 Sagajeong-ro 49-gil 53, Jungrang-gu, Seoul South Korea
| | - Deokweon Kim
- Department of Orthopedics, Wonjin Green Hospital, 568-1 Sagajeong-ro 49-gil 53, Jungrang-gu, Seoul South Korea
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Roemer FW, Kwoh CK, Hannon MJ, Hunter DJ, Eckstein F, Fujii T, Boudreau RM, Guermazi A. What comes first? Multitissue involvement leading to radiographic osteoarthritis: magnetic resonance imaging-based trajectory analysis over four years in the osteoarthritis initiative. Arthritis Rheumatol 2015; 67:2085-96. [PMID: 25940308 DOI: 10.1002/art.39176] [Citation(s) in RCA: 129] [Impact Index Per Article: 14.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2014] [Accepted: 04/23/2015] [Indexed: 11/10/2022]
Abstract
OBJECTIVE To assess whether the presence of structural osteoarthritis (OA) features over as many as 4 years prior to incident radiographic OA increases the risk of radiographic OA in a nested, case-control design. METHODS We studied 355 knees from the Osteoarthritis Initiative cohort that developed radiographic OA before the 48-month visit. They were matched one-to-one by sex, age, and contralateral knee radiographic status with a control knee. Magnetic resonance images (MRIs) were read for bone marrow lesions (BMLs), cartilage damage, meniscal damage (including tears and extrusion), Hoffa synovitis, and effusion synovitis. Conditional logistic regression was applied to assess the risk of radiographic OA with regard to the presence of BMLs (score ≥2), cartilage lesions (score ≥1.1), meniscal damage (any) and extrusion of ≥3 mm ± (score ≥2), and Hoffa and effusion synovitis (any). Time points were defined as incident radiographic OA visit (P0), 1 year prior to the detection of radiographic OA (P -1), 2 years prior to the detection of radiographic OA (P -2), etc. RESULTS The presence of Hoffa synovitis (hazard ratio [HR] 1.76 [95% confidence interval (95% CI) 1.18-2.64]), effusion synovitis (HR 1.81 [95% CI 1.18-2.78]), and medial meniscal damage (HR 1.83 [95% CI 1.17-2.89]) at P -2 predicted radiographic OA incidence. At P -1, all features but meniscal extrusion predicted radiographic OA, with highest odds for medial BMLs (HR 6.50 [95% CI 2.27-18.62]) and effusion synovitis (HR 2.50 [95% CI 1.76-3.54]). The findings at P -3 and P -4 did not reach statistical significance. CONCLUSION Our findings indicate that the presence of specific structural features of MRI-detected joint damage 2 years prior to incident radiographic OA increases the risk of incident radiographic OA. However, 1 year prior to radiographic OA, the presence of almost any abnormal morphologic feature increases the risk of radiographic OA in the subsequent year.
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Affiliation(s)
- Frank W Roemer
- Boston University School of Medicine, Boston, Massachusetts, and University of Erlangen-Nuremberg, Erlangen, Germany
| | - C Kent Kwoh
- University of Arizona College of Medicine, Tucson, and University of Pittsburgh Graduate School of Public Health, Pittsburgh, Pennsylvania
| | - Michael J Hannon
- University of Pittsburgh Graduate School of Public Health, Pittsburgh, Pennsylvania
| | - David J Hunter
- Royal North Shore Hospital, Institute of Bone and Joint Research, Kolling Institute of Medical Research, and University of Sydney, St. Leonards, New South Wales, Australia
| | - Felix Eckstein
- Paracelsus Medical University, Salzburg, Austria, and Chondrometrics GmbH, Ainring, Germany
| | - Tomoko Fujii
- University of Pittsburgh Graduate School of Public Health, Pittsburgh, Pennsylvania
| | - Robert M Boudreau
- University of Pittsburgh Graduate School of Public Health, Pittsburgh, Pennsylvania
| | - Ali Guermazi
- Boston University School of Medicine, Boston, Massachusetts
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Roßbach BP, Pietschmann MF, Gülecyüz MF, Niethammer TR, Ficklscherer A, Wild S, Jansson V, Müller PE. Indications requiring preoperative magnetic resonance imaging before knee arthroscopy. Arch Med Sci 2014; 10:1147-52. [PMID: 25624852 PMCID: PMC4296071 DOI: 10.5114/aoms.2014.47825] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/29/2013] [Revised: 05/25/2013] [Accepted: 06/15/2013] [Indexed: 11/17/2022] Open
Abstract
INTRODUCTION Knee arthroscopy knee is gold standard in diagnosis and simultaneous treatment of knee disorders. But most patients undergo magnetic resonance imaging (MRI) before arthroscopy, although MRI results are not always consistent with arthroscopic findings. This raises the question in which suspected diagnoses MRI really has influence on diagnosis and consecutive surgical therapy. MATERIAL AND METHODS Preoperative MRI of 330 patients with knee disorders were compared with arthroscopic findings. The MRI were performed by 23 radiologists without specialization in musculoskeletal diagnostics. Specificity, sensitivity, negative/positive predictive value and accuracy of MRI were calculated in comparison to arthroscopic findings. RESULTS We found sensitivity/specificity of 58%/93% for anterior horn, 94%/46% for posterior horn of medial meniscus and 71%/81% for anterior and 62%/82% for posterior horn of lateral meniscus. Related to anterior cruciate ligament injuries we showed sensitivity/specificity of 82%/91% for grade 0 + I and 72%/96% for grade II + III. For Cartilage damage sensitivity/specificity of 98%/7% for grade I-, 89%/29% for grade II-, 96%/38% for grade III- and 96%/69% for grade IV-lesions were revealed. CONCLUSIONS The MRI should not be used as routine diagnostic tool for knee pain. No relevant information for meniscal lesions and anterior cruciate ligament ruptures has been gained with MRI from non-specialized outside imaging centres. The MRI should not be used as routine diagnostic tool for knee pain. No relevant information for meniscal lesions and anterior cruciate ligament ruptures has been gained with MRI from non-specialized outside imaging centres.
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Affiliation(s)
- Björn Peter Roßbach
- Department of Orthopaedic Surgery, University Hospital of Munich (LMU), Munich, Germany
| | | | - Mehmet Fatih Gülecyüz
- Department of Orthopaedic Surgery, University Hospital of Munich (LMU), Munich, Germany
| | | | - Andreas Ficklscherer
- Department of Orthopaedic Surgery, University Hospital of Munich (LMU), Munich, Germany
| | - Stefan Wild
- Department of Trauma, Hand and Reconstructive Surgery, Academic Hospital of Munich, Klinikum Augsburg, Augsburg, Germany
| | - Volkmar Jansson
- Department of Orthopaedic Surgery, University Hospital of Munich (LMU), Munich, Germany
| | - Peter Ernst Müller
- Department of Orthopaedic Surgery, University Hospital of Munich (LMU), Munich, Germany
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Barrett E, Barr F, Owen M, Bradley K. A retrospective study of the MRI findings in 18 dogs with stifle injuries. J Small Anim Pract 2009; 50:448-55. [PMID: 19769665 DOI: 10.1111/j.1748-5827.2009.00822.x] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Affiliation(s)
- E Barrett
- Department of Clinical Veterinary Science, University of Bristol, North Somerset
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Radial tears in the root of the posterior horn of the medial meniscus. Knee Surg Sports Traumatol Arthrosc 2008; 16:849-54. [PMID: 18536902 DOI: 10.1007/s00167-008-0569-z] [Citation(s) in RCA: 170] [Impact Index Per Article: 10.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/07/2008] [Accepted: 05/08/2008] [Indexed: 10/22/2022]
Abstract
The purpose of this study is to define the clinical features and characteristics of radial tears in the root of the posterior horn of the medial meniscus and to report the outcome of arthroscopic treatment. Arthroscopic meniscus surgery was performed on 7,148 knees. Of those, 722 (10.1%) were radial tear in the root of the posterior horn of the medial meniscus. We reviewed the medical records from a random sample of 67 subjects studied (mean age 55.8 years, range 38-72, mean follow-up period 56.7 months, range, 8-123), which included surgical notes and detailed arthroscopic photographs of 70 knees. All patients were treated with arthroscopic partial meniscectomy. The age distribution, preoperative physical signs, results of magnetic resonance imaging , body mass index, and surgical findings of the study subjects were analyzed and the clinical results were graded with the Lysholm knee scoring scale and a questionnaire. Radiologic evaluation consisted of preoperative and at the latest follow-up radiographs. Eighty percent of the patients were older than 50 years, and 80.6% were either obese or morbidly obese. The mean Lysholm score improved from a preoperative value of 53 to a value of 67. The average preoperative Kellgren-Lawrence radiograph grade was 2 (range 0-3 points), a value that increased to 3 (range 2-4) at the latest follow-up, which showed a significant worsening. The preoperative MRI was reevaluated after the arthroscopic confirmation of a medial meniscal root tear. A tear could be demonstrated in only 72.9% of the patients, the rest of whom demonstrated degeneration and/or fluid accumulation at the posterior horn without a visible meniscal tear. Radial tears in the root of the medial meniscal posterior horn, which may not be visible in about one-third of the preoperative MRI scans, are common. That type of meniscal tear is strongly associated with obesity and older age and is morphologically different from the degenerative tears that often occur in the posterior horn. Partial meniscectomy provides symptomatic relief in most cases but does not arrest the progression of radiographically revealed osteoarthritis.
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Low AK, Chia MR, Carmody DJ, Lucas P, Hale D. Clinical significance of intrasubstance meniscal lesions on MRI. J Med Imaging Radiat Oncol 2008; 52:227-30. [PMID: 18477116 DOI: 10.1111/j.1440-1673.2008.01951.x] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
Grade 2 meniscal changes on MRI are linear signals confined within the meniscus thought to represent areas of meniscal degeneration or intrasubstance tears. It has been reported that in only 10% of cases is a meniscal tear detected during subsequent arthroscopy. Usually non-operative management is appropriate, but in some cases, grade 2 meniscal changes are seen on MRI in patients with a typical presentation of a meniscal tear. In this circumstance, an arthroscopic partial meniscectomy may be indicated and an MRI report, which describes the meniscus as being normal, may be confusing. A pilot study of 10 consecutive symptomatic patients (mean age 28.1 years) with a grade 2 meniscal signal on MRI was performed. At arthroscopy, with thorough examination of the meniscus using a probe, an intrasubstance tear was detected in all 10 patients. Partial meniscectomy was performed, with a mean follow-up of 6.7 months. All but one patient (due to other pathology) had marked improvement in pain and function. Thus, the authors believe that grade 2 signal changes should be reported in a manner that raises the possibility that they may cause symptoms and that the presence of any intrasubstance changes should be clearly conveyed in the report.
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Affiliation(s)
- A K Low
- Sydney Adventist Hospital, Sydney, New South Wales, Australia.
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Diagnostics of degenerative meniscal tears at 3-Tesla MRI compared to arthroscopy as reference standard. Arch Orthop Trauma Surg 2008; 128:451-6. [PMID: 17968565 DOI: 10.1007/s00402-007-0485-6] [Citation(s) in RCA: 34] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/17/2006] [Indexed: 12/15/2022]
Abstract
INTRODUCTION The goal of this study was to evaluate the diagnostic performance of 3-Tesla MRI for the assessment of degenerative meniscal tears in clinical practice. MATERIALS AND METHODS In patients with chronic knee pain, a negative history of acute trauma and a mean age of 52 years, 3-Tesla MRI were performed a few days prior to arthroscopy. In 86 menisci, diagnostic values of 3-Tesla MRI for the detection of degenerative tears were evaluated using arthroscopy as reference standard. The MRI classification, for meniscus diagnostics, described by Crues was used. RESULTS At arthroscopy, all tears identified (19 horizontal, 7 complex, 3 radial) were degenerative as confirmed by histological examination. MRI grade II lesions had a prevalence of 24% and a rate of 24% of missed tears, whereas grade I lesions were not associated with a torn meniscus at arthroscopy. For meniscal tears, (grade III) sensitivity and specificity of 3-Telsa MRI was 79 and 95% for both menisci, 86 and 100% for the medial meniscus, and 57 and 92% for the lateral meniscus. The best diagnostic performance was found for complex tears, horizontal tears showed relatively good results, poor results were documented for radial tears. CONCLUSION For the medial meniscus, where horizontal and complex tears were more prevalent, 3-Tesla MRI shows a higher accuracy than for the lateral meniscus. Particularly with regard to the medial meniscus, 3-Tesla MRI could be effectively used when a degenerative tear is suspected. Nevertheless, in regard to a remarkable number of false positive and false negative findings the diagnostic value of a 3-Tesla MRI investigation should not be overestimated.
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Huysse W, Verstraete K. Health technology assessment of magnetic resonance imaging of the knee. Eur J Radiol 2008; 65:190-3. [DOI: 10.1016/j.ejrad.2007.11.011] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2007] [Accepted: 11/07/2007] [Indexed: 12/01/2022]
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Fox MG. MR imaging of the meniscus: review, current trends, and clinical implications. Radiol Clin North Am 2008; 45:1033-53, vii. [PMID: 17981182 DOI: 10.1016/j.rcl.2007.08.009] [Citation(s) in RCA: 58] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
MR imaging is the preferred imaging modality for evaluating the meniscus. Overall, when strict criteria are followed, it is accurate in diagnosing meniscal tears in patients who have not had prior meniscal surgery. However, an accurate interpretation requires a through knowledge of the normal meniscal anatomy, common meniscal variants, and common diagnostic pitfalls. In this article, the author emphasizes the importance of describing meniscal tears properly and discusses treatment options. Diagnosing a recurrent tear is more complicated in patients who have had prior partial meniscal resection or repair, and the use of MR arthrography in this group of patients is discussed. Recent developments in areas such as 3 T and parallel imaging offer promise for accurate meniscal evaluation with even shorter scan times.
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Affiliation(s)
- Michael G Fox
- Division of Musculoskeletal Radiology, Department of Radiology, University of Virginia, Charlottesville, VA 22908, USA.
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Van Dyck P, Gielen J, D'Anvers J, Vanhoenacker F, Dossche L, Van Gestel J, Parizel PM. MR diagnosis of meniscal tears of the knee: analysis of error patterns. Arch Orthop Trauma Surg 2007; 127:849-54. [PMID: 17440743 DOI: 10.1007/s00402-007-0318-7] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/11/2006] [Indexed: 11/29/2022]
Abstract
PURPOSE Despite high accuracy of magnetic resonance imaging (MRI) for diagnosing meniscal tears, MR findings do not always agree with surgical findings. We performed a blinded, retrospective study to analyze the nature and frequency of errors in the MR diagnosis of meniscal tears. MATERIALS AND METHODS Medical records of 100 consecutive patients who underwent MR and arthroscopy of the knee at our institution were reviewed. Twelve patients underwent prior meniscal surgery. Twenty-three patients had 27 discrepancies between MR and surgical findings. These were independently reviewed by two additional musculoskeletal radiologists in a double blinded fashion. Original incorrect diagnoses were categorized as either unavoidable, interpretation error or equivocal for meniscal tear. RESULTS MR accuracy was 88% for the medial and 85% for the lateral meniscus. Of 27 incorrect MR diagnoses, 12 (44%) were unavoidable, 10 (37%) equivocal and 5 (19%) interpretation errors. Of the 67 medial meniscal tears, 12 (18%) were missed. Eight (67%) of these 12 were categorized as equivocal, including three postoperative menisci. Of 30 lateral tears, 12 (40%) were missed, 7 (58%) of which were categorized as unavoidable. Of these 12, 11 (92%) showed fraying of the inner edge, which was shaved at arthroscopy (n = 8) or had stable tear treated conservatively (n = 3). There were three false-positive diagnoses, all occuring in the lateral meniscus, two of which were unavoidable and one interpretation error. CONCLUSION Of all missed lateral meniscal tears, most are unavoidable and related to confusion between what represents fraying and what represents a tear. Unavoidable false-positive diagnoses are infrequent and may be related to incomplete arthroscopic evaluation. Subtle or equivocal findings still make MR diagnosis difficult, even for experienced radiologists.
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Affiliation(s)
- Pieter Van Dyck
- Department of Radiology, University Hospital Antwerp, Edegem, Belgium.
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Fox MG. MR Imaging of the Meniscus: Review, Current Trends, and Clinical Implications. Magn Reson Imaging Clin N Am 2007; 15:103-23. [PMID: 17499184 DOI: 10.1016/j.mric.2007.02.004] [Citation(s) in RCA: 29] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
MR imaging is the preferred imaging modality for evaluating the meniscus. Overall, when strict criteria are followed, it is accurate in diagnosing meniscal tears in patients who have not had prior meniscal surgery. However, an accurate interpretation requires a through knowledge of the normal meniscal anatomy, common meniscal variants, and common diagnostic pitfalls. In this article, the author emphasizes the importance of describing meniscal tears properly and discusses treatment options. Diagnosing a recurrent tear is more complicated in patients who have had prior partial meniscal resection or repair, and the use of MR arthrography in this group of patients is discussed. Recent developments in areas such as 3 T and parallel imaging offer promise for accurate meniscal evaluation with even shorter scan times.
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Affiliation(s)
- Michael G Fox
- Division of Musculoskeletal Radiology, Department of Radiology, University of Virginia, Box 800170, Charlottesville, VA 22908, USA.
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