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Musculoskeletal Imaging |
1 From the Dept of Medical Imaging, Mount Sinai Hosp and Univ Health Network (L.M.W.), Dept of Public Health Sciences, Clinical Epidemiology and Health Services Research (A.D.), and Dept of Orthopedic Surgery, Orthopedic and Arthritic Hosp (P.H.M.), Univ of Toronto, 600 University Ave, Toronto, Ontario, Canada M5G 1X5; Dept of Radiology, Thomas Jefferson Univ Hosp, Philadelphia, Pa (M.E.S.); Institute of Diagnostic Imaging, Univ Hosp Zurich, Switzerland (D.W.); and Institute for CT and MR Imaging at Schiller Park, Linz, Austria (J.K.). From the 2000 RSNA scientific assembly. Received Jan 31, 2001; revision requested Mar 1; revision received Jun 13; accepted Jul 5. L.M.W. supported by RSNA Research and Education Foundation. A.D. supported by Health Career Award, Canadian Institutes of Health Research, SSHCR/NHRDP. Address correspondence to L.M.W. (e-mail: lwhite@mtsinai.on.ca).
PURPOSE: To prospectively investigate the accuracy of conventional magnetic resonance (MR) imaging, direct MR arthrography, and indirect MR arthrography in assessment of possible recurrent or residual meniscal tears.
MATERIALS AND METHODS: Three hundred sixty-four patients who had previously undergone meniscal preservation surgery were prospectively examined with conventional MR imaging, indirect MR arthrography, and direct MR arthrography. Ninety-four patients (104 postoperative menisci) underwent subsequent second-look arthroscopic surgery. Each case was evaluated for (a) surfacing intrameniscal intermediate- or T1-weighted signal intensity, (b) surfacing intrameniscal T2-weighted signal intensity, (c) morphologic changes beyond those expected postoperatively, (d) joint effusion on conventional MR or indirect MR arthrographic studies, and (e) overall presence or absence of recurrent meniscal tear.
RESULTS: Seventy-one arthroscopically proved recurrent meniscal tears were found. In the diagnosis of recurrent meniscal tears, sensitivity, specificity, positive predictive value, negative predictive value, and accuracy were 86%, 67%, 83%, 71%, and 80%, respectively, for conventional MR imaging; 83%, 78%, 90%, 64%, and 81%, respectively, for indirect MR arthrography; and 90%, 78%, 90%, 78%, and 85%, respectively, for direct MR arthrography. No significant difference in the diagnostic accuracy of one method relative to another was observed (P > .54). Surfacing intrameniscal T2-weighted signal intensity was the most specific sign, with the highest positive predictive value of a recurrent tear.
CONCLUSION: Although a small incremental increase in accuracy is associated with the use of direct MR arthrography over conventional MR imaging and indirect MR arthrography, no significant difference in diagnostic accuracy among the three techniques was demonstrated for detection of recurrent or residual meniscal tear.
Index terms: Knee, arthrography, 452.121411, 452.121412, 452.121415, 452.121416, 452.12143 • Knee, ligaments, menisci and cartilage, 452.4852 • Knee, MR, 452.121411, 452.121412, 452.121415, 452.121416, 452.12143
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