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Acute Knee Trauma: Value of a Short Dedicated Extremity MR Imaging Examination for Prediction of Subsequent Treatment¹

¹ From the Program for the Assessment of Radiological Technology (ART Program) (E.H.G.O., J.J.N., M.G.M.H.) and Departments of Radiology (E.H.G.O., J.J.N., A.Z.G., G.P.K., M.G.M.H.), Epidemiology and Biostatistics (E.H.G.O., J.J.N., M.G.M.H.), Orthopaedic Surgery (J.A.N.V.), and Traumatology (A.B.v.V.), Erasmus MC, University Medical Center Rotterdam, Room EE21-40a, Dr Molewaterplein 50, 3015 GE Rotterdam, the Netherlands. Received July 7, 2003; revision requested September 24; revision received April 5, 2004; accepted May 19. Supported in part by the Revolving Fund of the University Hospital Rotterdam and by Esaote, Genoa, Italy. Address correspondence to M.G.M.H. (e-mail: m.hunink@erasmusmc.nl).

PURPOSE: To assess the predictive value of a short magnetic resonance (MR) imaging examination, in addition to or instead of radiography, performed in patients with acute knee trauma to identify those who require additional treatment versus those who do not and can be discharged without further follow-up.

MATERIALS AND METHODS: The randomized controlled trial and use of collected data for prediction modeling were approved by the institutional review board; informed consent was obtained. Patients with recent knee injury were included in the trial if radiography was ordered. They were randomized into a group undergoing only radiography and a group undergoing radiography plus immediate MR imaging. A 0.2-T dedicated extremity MR imager and four short pulse sequences were used. Univariable and multivariable logistic regression analysis was used to evaluate patient characteristics, trauma mechanism, and findings at radiography and MR imaging for their value in prediction of need for subsequent treatment within the 6-month follow-up.

RESULTS: Data in 189 patients (123 male patients, 66 female patients; mean age, 33.4 years), 109 of whom underwent treatment after their initial visit, were analyzed. Age of 30 years or older, indirect trauma mechanism, radiographic results, and MR imaging results were significant predictors of need for treatment in univariable and multivariable analyses (P < .05). In the multivariable analysis, only abnormal MR imaging results were significantly predictive of need for treatment, and only when MR imaging replaced radiography (odds ratio, 2.61; 95% confidence interval: 1.12, 6.06).

CONCLUSION: Implementation of a dedicated extremity MR imaging examination, in addition to or instead of radiography, performed in patients with traumatic knee injury improves prediction of the need for additional treatment but does not significantly aid in identification of patients who can be discharged without further follow-up. Value of a short MR imaging examination in the initial stage after knee trauma is limited.

© RSNA, 2005

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