Which oblique plane is more helpful in diagnosing an anterior cruciate ligament tear?

GNRB® laximeter with magnetic resonance imaging in clinical practice for complete and partial anterior cruciate ligament tears detection: A prospective diagnostic study with arthroscopic validation on 214 patients

BACKGROUND

Accurate diagnosis of anterior cruciate ligament (ACL) injury is not always obtained with magnetic resonance imaging (MRI). Other tools, such as the GNRB® arthrometer, help to accurately identify the type of ACL tear. The aim of this study was to show that the GNRB® could be a relevant complementary solution to MRI in ACL injuries detection.

METHODS

A prospective study performed between 2016 and 2020 included 214 patients who had undergone knee surgery. The study compared sensitivity/specificity pairs of MRI and the GNRB® at 134 N to detect healthy ACL, partial and complete ACL tears. Arthroscopies were the 'gold standard'. Forty-six patients had a healthy ACL with associated knee lesions, 168 patients had ACL tears where 107 were complete tears and 61 were partial tears.

RESULTS

For healthy ACL, MRI scored 100% for sensitivity (SE) and 95% for specificity (SP), and the GNRB® scored SE 95.65% and SP 97.5% at 134 N. For complete ACL tears, MRI scored 80.81% for sensitivity (SE) and 64.49% for specificity (SP), and the GNRB® scored SE 77.78% and SP 85.98% at 134 N. For partial tears, MRI scored SE 29.51% and SP 88.97%, and the GNRB® scored SE 73.77% and SP 85.52% at 134 N.

CONCLUSION

GNRB® sensitivity and specificity were equivalent to those of MRI for healthy ACL and complete ACL tear detection. However, MRI had some difficulty in detecting partial ACL tears compared with the GNRB® which showed better sensitivity.

Use of oblique sagittal and coronal weighted images for diagnosis and grading of ACL graft injury

Background

This study was done to evaluate the value of adding the oblique sagittal and oblique coronal MRI to the standard MRI knee protocol for evaluation of suspected ACL graft injuries.

Results

This was a cross-sectional analytic study where we reviewed 36 MRI knee examinations of 36 patients (30 males, 6 females, age range: 17–60 years, mean age: 26 years) who were subjected to ACL reconstruction and follow-up arthroscopy. Two experienced radiologists, blinded to the results of each other, evaluated the status and the severity of the ACL graft injury using the routine knee MRI (protocol A) and using the routine MRI after adding the oblique sagittal and coronal imaging (protocol B). Weighted kappa statistics were used to evaluate the diagnostic accuracies of the knee MRI before and after the addition of the oblique sagittal and coronal weighted images (protocol A and protocol B, respectively) and to assess the interobserver agreement. The weighted kappa values according to the routine knee MRI were 0.357 (reader 1) and 0.399 (reader 2). The inclusion of additional oblique coronal imaging increased the weighted kappa values to 0.505 (reader 1) and 0.528 (reader 2). The interobserver agreement weighted kappa value also increased from 0.606 to 0.759 by adding the oblique sagittal and coronal imaging to the routine knee MRI examination.

Conclusion

The additional use of oblique sagittal and coronal MRI of the knee improves the diagnostic accuracy for diagnosing and grading ACL graft injury with the arthroscopy used as a gold standard.

Assessment of the Usefulness of Image Reconstruction in the Oblique and Double-oblique Sagittal Planes for Magnetic Resonance Imaging of the Canine Cranial Cruciate Ligament

Introduction

The aim of the study was to determine the quality and significance of the magnetic resonance image of the canine knee after reconstruction in the oblique and double-oblique sagittal plane. This reconstruction and 3D images are rarely used in common protocols due to the longer study time they require. The study aimed to demonstrate significance for such diagnostic images in specific sequences in order to stimulate consideration of their more frequent use in diagnosis of diseases of the cruciate ligament in dogs.

Material and Methods

All tests were carried out using an open magnetic resonance tomography scanner with magnetic field induction. The images obtained from the 30 canine patients examined were reconstructed and evaluated by independent appraisers. Statistical analysis was performed.

Results

The study showed that MRI of the stifle joint using 3D sequences provides higher quality images of the cranial cruciate ligament in dogs. The results of the statistical analysis showed that multi-faceted reconstruction allows the secondary determination of the oblique imaging planes and obtains images of adequate quality.

Conclusion

It can be concluded that multi-faceted reconstruction facilitates the secondary determination of oblique imaging planes. This reconstruction additionally makes images available of better quality compared to the 2D sequence.

Diagnostic Value of Oblique Coronal and Oblique Sagittal Magnetic Resonance Imaging (MRI) in Diagnosis of Anterior Cruciate Ligament (ACL) Tears

Introduction: Tears of the anterior cruciate ligament (ACL) are common among young athletes and diagnosis may be difficult especially in the young population. Therefore, finding a new method to increase the correct diagnosis is necessary.

Materials and Methods: This double-blind prospective observational study was conducted on 51 patients with suspected ACL rupture. In this study, in addition to the standard protocols, the oblique-sagittal and oblique-coronal MRI were assessed and used in three different methods, including A method (orthogonal MRI protocol), B method (orthogonal MRI protocol and oblique-sagittal MRI), and C method (orthogonal MRI protocol and oblique-coronal MRI).

Results: In detecting both complete and partial rupture of ACL, B method had highest diagnostic accuracy (kappa = 0.338, P=0.001), and after that, C method had acceptable accuracy (kappa = 0.292, P=0.011). In addition, in detecting a partial rupture of ACL, B method (kappa = 0.5, P<0.001), and C method had acceptable accuracy (kappa = 0.361, P=0.006). Meanwhile, in detecting a complete rupture of ACL, B method had the highest diagnostic accuracy (kappa = 0.898, P<0.001), and subsequently A method had significant accuracy (kappa = 0.812, P<0.001).

Conclusions: Our results showed that the evaluation of ACL rupture by oblique-sagittal MRI in addition to orthogonal MRI protocol is accurate and with high sensitivity and specificity values. It allows to find abnormal images immediately with higher accuracy in the emergency department and more critically ill patients may benefit from the advantages of this imaging protocol.

The rotating stretched curved planar reconstruction of 3D-FIESTA MR imaging for evaluating the anterior cruciate ligament of the knee joint

PURPOSE

To determine the feasibility of the rotating stretched curved planar reconstruction (CPR) of three-dimensional fast imaging with steady-state acquisition magnetic resonance imaging (3D-FIESTA MRI) for evaluating the anterior cruciate ligament of the knee joint.

MATERIALS AND METHODS

MRI of 40 knee joints in healthy volunteers was performed on a 3.0-T MR scanner and a phased-array extremity coil. The protocol consisted of oblique sagittal spin echo (SE) T1WI, coronal FS-PDWI, axial FS-FSE-T2WI, and 3D-FIESTA sequences. The rotating stretched curved planar reconstructions (CPR) of the ACL at angles of 0°, 30°, 60°, 90°, 120°, 150°, and 180° were generated from images of 3D-FIESTA sequences. Signal-to-noise ratio (SNR) and contrast-to-noise ratio (CNR) of the 3D-FIESTA were compared with those of the oblique sagittal SE T1WI sequence. The presence of the tibial attachment, midportion, femoral attachment, and double bundles of the ACL on the oblique sagittal SE T1WI and CPR of 3D-FIESTA MR imaging were divided into two categories: visible and not visible.

RESULTS

The ACL SNR efficiency of 3D-FIESTA sequences was significantly higher than that of oblique sagittal SE T1WI sequence (P < 0.05). The 3D-FIESTA sequences produced images with a significantly higher CNR between ACL and synovial fluid than did the oblique sagittal SE T1WI sequence (P < 0.05). CPR of 3D-FIESTA MRI generated an excellent visualization of the ACL. The CPR of 3D-FIESTA MRI was rated superior to oblique sagittal SE T1WI sequence in 60% and 65% of cases with regard to the tibial attachment and midportion of ACL, respectively (P < 0.05). CPR of 3D-FIESTA MR imaging was rated superior to oblique sagittal SE T1WI sequence in 80% and 85% of cases with regard to femoral attachment and double bundles of ACL, respectively (P < 0.05).

CONCLUSION

The rotating stretched curved planar reconstruction of 3D-FIESTA sequences is significantly better than that of conventional 2D-MRI in evaluating the native ACL and its components, AM bundle and PL bundle, in healthy volunteers.

Imaging of Athletic Injuries of Knee Ligaments and Menisci: Sports Imaging Series

Acute knee injuries are a common source of morbidity in athletes and if overlooked may result in chronic functional impairment. Magnetic resonance (MR) imaging of the knee has become the most commonly performed musculoskeletal MR examination and is an indispensable tool in the appropriate management of the injured athlete. Meniscal and ligamentous tearing are the most frequent indications for surgical intervention in sports injuries and an understanding of the anatomy, biomechanics, mechanisms of injury, and patterns of injury are all critical to accurate diagnosis and appropriate management. These will be discussed in reference to meniscal tears and injuries of the cruciate ligaments as well as injuries of the posterolateral and posteromedial corners of the knee. (©) RSNA, 2016.

Acute Proximal Anterior Cruciate Ligament Tears: Outcomes After Arthroscopic Suture Anchor Repair Versus Anatomic Single-Bundle Reconstruction

PURPOSE

To compare clinical and radiologic results of primary anterior cruciate ligament (ACL) suture anchor repair and microfracturing with anatomic ACL single-bundle reconstruction in patients with acute proximal ACL avulsion tears.

METHODS

Between January 2010 and December 2013, 420 patients underwent ACL treatment. Forty-one patients were included in this study. The inclusion criteria were as follows: unilateral acute proximal ACL rupture, concomitant meniscus lesions, no previous knee ligament surgery, and no additional ligament injuries or absence of ligament injury of the contralateral knee. Preoperative magnetic resonance imaging confirming a proximal avulsion tear of the ACL was required. Patients had to undergo surgical treatment within 6 weeks after injury. Follow-up examination included Lachman and pivot-shift testing, KT-1000 measurement, and the International Knee Documentation Committee score.

RESULTS

At a mean follow-up of 28 months (range, 24 to 31 month), 20 patients in each group were available. A mean KT-1000 arthrometer result of less than 3 mm indicated stability in all patients (P = .269). Three patients had a 1+ Lachman test (P = .072) and 4 patients had a 1+ pivot-shift test in the ACL repair group (P = .342). The International Knee Documentation Committee score results did not differ significantly (P > .99), but there was a significant correlation between poor results and failure rate (P = .001) in the refixation group. The failure rate was 15% in the ACL refixation group and 0% in the reconstruction group (P = .231). Magnetic resonance imaging confirmed homogeneous signal and proper ACL position in 100% of patients in the control group and 86% in the ACL repair group.

CONCLUSIONS

Proximal refixation of the ACL using knotless suture anchors and microfracturing restores knee stability and results in comparable functional outcomes to a control group treated with single-bundle ACL reconstruction. The results suggest that refixation of the ACL is a feasible treatment option in selected patients.

LEVEL OF EVIDENCE

Level III, case-control study.

Three-dimensional isotropic T2-weighted fast spin-echo (VISTA) knee MRI at 3.0 T in the evaluation of the anterior cruciate ligament injury with additional views: comparison with two-dimensional fast spin-echo T2-weighted sequences

Background There has been no comparison study to assess the diagnostic efficacy of additional anterior cruciate ligament (ACL) views in three-dimensional (3D) volume isotropic turbo spin-echo acquisition (VISTA) and two-dimensional (2D) fast spin-echo (FSE) T2-weighted (T2W) images for the diagnosis of ACL tear. Purpose To compare the diagnostic performances of additional ACL views on VISTA with those on the 2D FSE T2W images. Material and Methods This retrospective study included 78 patients who were suspected to have ACL injury and underwent both 2D TSE T2W magnetic resonance imaging (MRI) and 3D VISTA MRI of the knee between November 2012 and March 2013. The diagnostic performance of each oblique sagittal and coronal view and the combined images was evaluated for sensitivity, specificity, and accuracy for diagnosing an ACL tear. The arthroscopically and clinically confirmed diagnoses were used as the reference standard. The values were statistically analyzed using the McNemar test. Results The inter-observer agreement between two readers of the additional ACL views on 3D VISTA and 2D FSE T2W images were substantial on 2D FSE images and nearly concurred on the VISTA image. When considering both views of the oblique sagittal and coronal images, the inter-observer agreement between readers nearly concurred. There were no statistically significant differences in the sensitivity, specificity, and accuracy between 2D FSE images and VISTA images. Conclusion The performance of the additional ACL view on 3D VISTA MRI is comparable to that of 2D FSE T2W MRI in the diagnosis of ACL tear though the image quality of the 3D VISTA MRI is not equal to that of 2D FSE MRI.

Usefulness of the oblique view of three-dimensional isotropic T2-weighted fast spin-echo (VISTA) in the evaluation of anterior cruciate ligament reconstruction

BACKGROUND

To compare the diagnostic performance of the oblique sagittal and oblique coronal views of the anterior cruciate ligament (ACL) on three-dimensional (3D) volume isotropic turbo spin-echo acquisition (VISTA) images with two-dimensional (2D) fast spin-echo (FSE) T2-weighted images in the diagnosis of complications in ACL reconstruction.

MATERIALS AND METHODS

This retrospective study included 74 patients. Both sequences were independently interpreted by two radiologists.

RESULT

There were no statistically significant differences in the sensitivity, specificity, or accuracy between the two images.

CONCLUSION

The diagnostic performance of the two oblique views on 3D VISTA imaging was comparable to that of 2D FSE.

Peroneal tendon pathology evaluation using the oblique sagittal plane in ankle MR imaging

BACKGROUND

Because peroneal tendons course from the lateral side of the proximal fibula through the posterior side of the distal fibula, correct diagnosis of the tendon pathology on an orthogonal sagittal plane can be difficult.

PURPOSE

To evaluate the diagnostic usefulness of oblique sagittal imaging (peroneal view) for evaluation of peroneal tendon pathology.

MATERIAL AND METHODS

This retrospective study included 69 patients at our institution who underwent routine ankle magnetic resonance imaging (MRI) using the peroneal view. Twenty-three patients underwent arthroscopy. Anatomic identification of the peroneal tendons on orthogonal sagittal MRI sequences and peroneal views were evaluated. Two radiologists evaluated the peroneal tendons based on an entire length view, an entire width view, and margin sharpness using a 4-point scale. Diagnostic accuracy using orthogonal sagittal and peroneal views was evaluated by calculating sensitivity, specificity, and accuracy. Arthroscopic or clinical findings were used as the reference standard.

RESULTS

Total anatomical scores on the peroneal view were higher than those of the orthogonal sagittal views (P < 0.001). Both readers were able to identify anatomy of the tendon using the full length, full width and sharp margin, and determined that the peroneal view was better when compared with the orthogonal sagittal views (P < 0.001). Although the sensitivity and accuracy of the peroneal view in the diagnosis of peroneal tendon injury were slightly higher than orthogonal view, the values were not statistically significant.

CONCLUSION

Peroneal views provide better anatomic evaluation of the peroneal tendons itself, although cannot show significant superiority in the diagnostic performances.

Usefulness of oblique coronal and sagittal MR images of the knee after double-bundle and selective anterior cruciate ligament reconstructions

BACKGROUND

The use of double-bundle and selective-bundle anterior cruciate ligament (ACL) reconstruction is increasing. Few studies have been conducted to determine the diagnostic efficacy of additional oblique views of knee magnetic resonance imaging (MRI) for grading ACL graft injury for double-bundle and selective-bundle ACL reconstructions.

PURPOSE

To evaluate the diagnostic value of combining oblique coronal and sagittal imaging with orthogonal views for diagnosis of ACL graft failure after double-bundle or selective-bundle ACL reconstruction.

MATERIAL AND METHODS

This retrospective study included 64 patients who underwent double-bundle or selective-bundle ACL reconstruction surgery and received oblique coronal and oblique sagittal MRI of the knee. Subjective scoring of the images was performed by two radiologists who assessed the possibility of ACL graft failure based on full length view, full width view, and margin sharpness according to a 4-point scale. Diagnostic performance for ACL graft failure based on orthogonal views alone, ACL views alone, and orthogonal views with additional ACL views was evaluated by calculating the sensitivity, specificity, and accuracy.

RESULTS

The full length scores and total scores on ACL views were significantly higher than those of orthogonal views. The specificities and accuracies of diagnoses were highest for a combination of orthogonal, ACL sagittal, and ACL coronal views.

CONCLUSION

After double-bundle or selective-bundle ACL reconstruction, oblique sagittal and coronal images of the ACL provide better anatomic evaluation of the ACL than orthogonal views and specificity and accuracy of diagnoses were improved when oblique views were combined.

Usefulness of the oblique coronal plane in ankle MRI of the calcaneofibular ligament

AIM

To evaluate the usefulness and diagnostic accuracy of oblique coronal MRI of the calcaneofibular ligament (CFL) view for diagnosis of CFL injury.

MATERIAL AND METHODS

This retrospective study included 91 patients who were suspected to have CFL injury who underwent CFL view imaging. Anatomical identification of the CFL on orthogonal MRI sequences and CFL views was evaluated. Two radiologists evaluated the CFL based on an entire length view, an entire width view, and margin sharpness using a four-point scale. Diagnostic accuracy using orthogonal and CFL views was evaluated by calculating sensitivity, specificity, and accuracy. Arthroscopic or clinical findings were used as the reference standard.

RESULTS

Both readers found identification of lesions using the entire length, entire width, and sharp margin from CFL view images to be superior to that based on orthogonal images. The sensitivity and accuracy of diagnosing CFL injury were significantly higher when using the CFL view compared to the orthogonal view, although specificity was not significantly different between the CFL view and orthogonal view images.

CONCLUSIONS

CFL view imaging enables better anatomical evaluation and improved sensitivity and accuracy of diagnosis of CFL injury. CFL view images should therefore be used to evaluate potential CFL injuries.

The usefulness of the oblique coronal plane in knee MRI on the evaluation of the posterior cruciate ligament

BACKGROUND

Imaging findings of posterior cruciate ligament (PCL) injury may be equivocal, particularly when the patient has suffered a partial ligament tear. Some PCLs are positioned more horizontally, making it difficult to diagnose injury based on routine imaging planes alone due to partial volume artifact.

PURPOSE

To evaluate the diagnostic accuracy of combining oblique coronal imaging (PCL view) with traditional orthogonal views for PCL evaluation.

MATERIAL AND METHODS

This retrospective study included 20 patients with PCL injury and 43 patients with intact PCL who underwent PCL view imaging. Anatomic identification of PCL pathology on the orthogonal magnetic resonance imaging (MRI) sequences and PCL views was evaluated. Subjective scoring of the PCL was performed by two radiologists who assessed the possibility of a PCL tear based on an entire length view, an entire width view, and margin sharpness according to a 4-point scale. Diagnostic accuracy using these two views was evaluated by calculating the sensitivity, specificity, and accuracy. Arthroscopic and clinical findings were used as the reference standard.

RESULTS

Total scores for the PCL view were higher than those of orthogonal views (P < 0.001). Both readers found that anatomic identification using the full width view and sharp margin to be superior using the PCL view compared with the orthogonal views (P < 0.001). The specificities and accuracies were higher in cases where an additional PCL view was provided, but did not show statistical significance.

CONCLUSION

PCL view provides better anatomic evaluation of the PCL and mild improvement in the specificity and accuracy.

Oblique coronal and oblique sagittal MRI for diagnosis of anterior cruciate ligament tears and evaluation of anterior cruciate ligament remnant tissue

BACKGROUND

The purpose of this study was to investigate the efficacy of additional oblique magnetic resonance imaging (MRI) for the diagnosis of anterior cruciate ligament (ACL) tear and evaluation of ACL remnant tissue.

METHODS

We retrospectively reviewed the records of 54 knees. Three independent readers evaluated the MR images by the use of three methods: orthogonal sagittal images only (method A); orthogonal sagittal and additional oblique sagittal images (method B); and orthogonal sagittal and oblique coronal images (method C). The sensitivity, specificity, and accuracy for the diagnosis of an ACL tear and the detection of the condition of the ACL remnant tissue by the use of each method were calculated in comparison with arthroscopic findings as the reference standard.

RESULTS

The arthroscopic records revealed 27 knees with intact ACLs and 27 with torn ACLs. Among the 27 knees with torn ACLs, 9 did not have continuous remnant tissue and 18 had certain remnant tissue attached to the femur or the posterior cruciate ligament. The specificities and accuracies of methods B and C for diagnosing an ACL tear were higher than those for method A. The sensitivity, specificity, and accuracy of method C for the detection of ACL remnant tissue were higher than those for method A and B.

CONCLUSIONS

Additional use of oblique MRI improved the accuracy of diagnosis of ACL tear and showed a reasonable level of efficacy in detecting ACL remnant tissue.

LEVEL OF EVIDENCE

Level IV (case series).

MRI diagnosis of ACL bundle tears: value of oblique axial imaging

OBJECTIVE

To investigate the diagnostic accuracy of oblique axial intermediate weighting MR imaging in detecting partial thickness anterior cruciate ligament (ACL) bundle tears.

MATERIALS AND METHODS

The study protocol was approved by the institutional ethics committee. Sixty-one subjects (43 male, 18 female; mean age 27.4 years; range 9 to 57 years) with clinically suspected ACL tear or meniscal tear between September 2009 and January 2011 were studied with MRI and arthroscopy. Detection of partial tear for the ACL as a whole and for each ACL bundle by protocol A (standard orthogonal sequences) and protocol B (standard orthogonal sequences plus oblique axial intermediate weighted imaging) was compared in a blinded fashion. Performance characteristics for protocol A and protocol B were compared using sensitivity, specificity, accuracy and ROC curves. A two-tailed p value of <0.05 indicated statistical significance.

RESULTS

Fifteen (24.6%) normal, 15 (24.6%) partial and 31 complete tears were diagnosed by arthroscopy. Sensitivity, specificity and accuracy of protocol A for the diagnosis of partial tear of the ACL was 33%, 87% and 74%, while for protocol B the values were 87%, 87% and 87% respectively. The area under the curve (AUC) for the diagnosis of partial ACL tear and individual bundle tear was higher for protocol B, although this difference did not reach statistical significance (p > 0.05).

CONCLUSION

The addition of oblique axial imaging to standard MR imaging improves diagnostic accuracy for detecting partial tears of the ACL as well as individual bundle tears of the ACL.

MRI appearance of the distal insertion of the anterior cruciate ligament of the knee: an additional criterion for ligament ruptures

OBJECTIVE

Anterior cruciate ligament tears are frequent and if not diagnosed may lead to relevant patient disability. Magnetic resonance imaging is the method of choice for the non-invasive diagnosis of these tears. Despite the high performance of this method some cases are challenging and the criteria described in the literature are not sufficient to reach a diagnosis. We propose a systematic method for the evaluation of anterior cruciate ligament tears based on the aspect of its distal portion.

MATERIALS AND METHODS

Magnetic resonance studies of 132 knees were evaluated in correlation with arthroscopy. The performance of the proposed method was compared with that of classic imaging signs of anterior cruciate ligament tear. The impact of image quality and reader expertise on the proposed method and the classic signs of tear were taken into account.

RESULTS

This method had a sensitivity and specificity of 91.1% and 82.9% for the detection of abnormal ACLs. The interobserver agreement (kappa) of the proposed method was significantly higher than that of the classic signs at all levels of expertise (0.89 vs 0.76). This method was not influenced by image quality. Distal ACL analysis identified more partial tears and synovialization (granulation scar tissue)than the conventional method (71% vs 58.5% for partial tears and 83.5% vs 58.5% for synovialization).

CONCLUSION

The proposed classification has a high performance and reproducibility for the identification of abnormal anterior cruciate ligament. The results were influenced neither by the level of expertise of the readers nor by the image quality.

The contribution of MRI to the diagnosis of traumatic tears of the anterior cruciate ligament

When faced with a clinical suspicion of knee ligament injury, MRI nowadays has a central role in the diagnostic strategy. In particular, it is essential for assessing the cruciate ligaments and any associated meniscal tears. The objective of this review is to present the various direct and indirect MRI signs of tearing of the anterior cruciate ligament (ACL) and then describe the lesions associated with it. The anatomical and clinical aspects are also discussed so that the contribution of MRI to the diagnosis and therapeutic management of an ACL tear can be better understood.