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Almolla RM, Almalki YE, Basha MAA, Mohamed Farag MAEA, Metwally MI, Nada MG, Libda YI, Zaitoun MMA, Abdalla AAEHM, Yousef HY, Abd Elhamed ME, Elsheikh AM, Alduraibi SK, Eldib DB, Khater HM, Mahmoud HF, Elkayal ES, Alshehri SHS, Aldhilan AS, Basha AMA, Hassan HA. MRI-Based Classification for Tibial Spine Fracture: Detection Efficacy, Classification Accuracy, and Reliability. Acad Radiol 2024; 31:1480-1490. [PMID: 37914624 DOI: 10.1016/j.acra.2023.10.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2023] [Revised: 10/02/2023] [Accepted: 10/03/2023] [Indexed: 11/03/2023]
Abstract
RATIONALE AND OBJECTIVES Recently, a new MRI-based classification for evaluating tibial spine fractures (TSFs) was developed to aid in treating these injuries. Our objective was to assess the detection efficacy, classification accuracy, and reliability of this classification in detecting and grading TSFs, as well as its impact on treatment strategy, compared to the Meyers and McKeever (MM) classification. MATERIALS AND METHODS A retrospective study included 68 patients with arthroscopically confirmed TSFs. All patients had plain radiography and conventional MRI of the affected knee before arthroscopy. Three experienced radiologists independently reviewed all plain radiographs and MRI data and graded each patient according to MM and MRI-based classifications. The detection efficacy, classification accuracy, and inter-rater agreement of both classifications were evaluated and compared, using arthroscopic findings as the gold standard. RESULTS The final analysis included 68 affected knees. Compared to the MM classification, the MRI-based classification produced 22.0% upgrade of TSFs and 11.8% downgrade of TSFs. According to the reviewers, the fracture classification accuracy of the MRI-based classification (91.2-95.6%) was significantly higher than that of the MM classification (73.5-76.5%, p = 0.002-0.01). The fracture detection rate of MRI-based classification (94.1-98.5%) was non-significantly higher than that of the MM classification (83.8-89.7%, p = 0.07-0.4). The soft tissue injury detection accuracy for MRI-based classification was 91.2-94.1%. The inter-rater reliability for grading TSFs was substantial for both the MM classification (κ = 0.69) and MRI-based classification (κ = 0.79). CONCLUSION MRI-based classification demonstrates greater accuracy and reliability compared to MM classification for detecting and grading TSFs and associated soft tissue injuries.
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Affiliation(s)
- Rania Mostafa Almolla
- Department of Radio-diagnosis, Faculty of Human Medicine, Zagazig University, Zagazig, Egypt (R.M.A., M.A.A.B., M.I.M., M.G.N., Y.I.L., M.M.A.Z., A.A.E-H.M.A., H.Y.Y., M.E.A.E., A.M.E., H.A.H.)
| | - Yassir Edrees Almalki
- Division of Radiology, Department of Internal Medicine, Medical College, Najran University, Najran, Kingdom of Saudi Arabia (Y.E.A.)
| | - Mohammad Abd Alkhalik Basha
- Department of Radio-diagnosis, Faculty of Human Medicine, Zagazig University, Zagazig, Egypt (R.M.A., M.A.A.B., M.I.M., M.G.N., Y.I.L., M.M.A.Z., A.A.E-H.M.A., H.Y.Y., M.E.A.E., A.M.E., H.A.H.).
| | | | - Maha Ibrahim Metwally
- Department of Radio-diagnosis, Faculty of Human Medicine, Zagazig University, Zagazig, Egypt (R.M.A., M.A.A.B., M.I.M., M.G.N., Y.I.L., M.M.A.Z., A.A.E-H.M.A., H.Y.Y., M.E.A.E., A.M.E., H.A.H.)
| | - Mohamad Gamal Nada
- Department of Radio-diagnosis, Faculty of Human Medicine, Zagazig University, Zagazig, Egypt (R.M.A., M.A.A.B., M.I.M., M.G.N., Y.I.L., M.M.A.Z., A.A.E-H.M.A., H.Y.Y., M.E.A.E., A.M.E., H.A.H.)
| | - Yasmin Ibrahim Libda
- Department of Radio-diagnosis, Faculty of Human Medicine, Zagazig University, Zagazig, Egypt (R.M.A., M.A.A.B., M.I.M., M.G.N., Y.I.L., M.M.A.Z., A.A.E-H.M.A., H.Y.Y., M.E.A.E., A.M.E., H.A.H.)
| | - Mohamed M A Zaitoun
- Department of Radio-diagnosis, Faculty of Human Medicine, Zagazig University, Zagazig, Egypt (R.M.A., M.A.A.B., M.I.M., M.G.N., Y.I.L., M.M.A.Z., A.A.E-H.M.A., H.Y.Y., M.E.A.E., A.M.E., H.A.H.)
| | - Ahmed A El-Hamid M Abdalla
- Department of Radio-diagnosis, Faculty of Human Medicine, Zagazig University, Zagazig, Egypt (R.M.A., M.A.A.B., M.I.M., M.G.N., Y.I.L., M.M.A.Z., A.A.E-H.M.A., H.Y.Y., M.E.A.E., A.M.E., H.A.H.)
| | - Hala Y Yousef
- Department of Radio-diagnosis, Faculty of Human Medicine, Zagazig University, Zagazig, Egypt (R.M.A., M.A.A.B., M.I.M., M.G.N., Y.I.L., M.M.A.Z., A.A.E-H.M.A., H.Y.Y., M.E.A.E., A.M.E., H.A.H.)
| | - Marwa E Abd Elhamed
- Department of Radio-diagnosis, Faculty of Human Medicine, Zagazig University, Zagazig, Egypt (R.M.A., M.A.A.B., M.I.M., M.G.N., Y.I.L., M.M.A.Z., A.A.E-H.M.A., H.Y.Y., M.E.A.E., A.M.E., H.A.H.)
| | - Amgad M Elsheikh
- Department of Radio-diagnosis, Faculty of Human Medicine, Zagazig University, Zagazig, Egypt (R.M.A., M.A.A.B., M.I.M., M.G.N., Y.I.L., M.M.A.Z., A.A.E-H.M.A., H.Y.Y., M.E.A.E., A.M.E., H.A.H.)
| | - Sharifa Khalid Alduraibi
- Department of Radiology, College of Medicine, Qassim University, Buraidah, Kingdom of Saudi Arabia (S.K.A., A.S.A.)
| | - Diaa Bakry Eldib
- Department of Radio-diagnosis, Faculty of Human Medicine, Benha University, Benha, Egypt (D.B.E., H.M.K.)
| | - Hamada M Khater
- Department of Radio-diagnosis, Faculty of Human Medicine, Benha University, Benha, Egypt (D.B.E., H.M.K.)
| | - Hossam Fathi Mahmoud
- Department of Orthopedic Surgery and Traumatology, Faculty of Human Medicine, Zagazig University, Zagazig, Egypt (H.F.M.)
| | - Engy S Elkayal
- Department of Radio-diagnosis, Faculty of Human Medicine, Fayoum University, Fayoum, Egypt (E.S.E.)
| | - Shaker Hassan S Alshehri
- Department of Orthopedic Surgery, College of Medicine, King Khalid University, Abha, Kingdom of Saudi Arabia (S.H.S.A.)
| | - Asim S Aldhilan
- Department of Radiology, College of Medicine, Qassim University, Buraidah, Kingdom of Saudi Arabia (S.K.A., A.S.A.)
| | - Ahmed M A Basha
- Faculty of General Medicine, Tyumen State Medical University, Tyumen, Russian Federation (A.M.A.B.)
| | - Hanan A Hassan
- Department of Radio-diagnosis, Faculty of Human Medicine, Zagazig University, Zagazig, Egypt (R.M.A., M.A.A.B., M.I.M., M.G.N., Y.I.L., M.M.A.Z., A.A.E-H.M.A., H.Y.Y., M.E.A.E., A.M.E., H.A.H.)
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