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Diagnosis of Articular Cartilage Abnormalities of the Knee: Prospective Clinical Evaluation of a 3D Water-Excitation True FISP Sequence¹

¹ From the Departments of Radiology (S.R.D., M.R.S., J.H., C.W.A.P.) and Orthopedic Surgery (P.K.), University Hospital, Balgrist, Forchstrasse 340, CH-8008 Zurich, Switzerland; and Siemens Medical Solutions, Erlangen, Germany (W.H.). Received February 13, 2006; revision requested April 13; revision received May 19; accepted June 8; final version accepted September 12. Address correspondence to S.R.D. (e-mail: Sylvain.Duc{at}hcuge.ch).

Purpose: To prospectively evaluate the accuracy of three-dimensional (3D) water-excitation true fast imaging with steady-state precession (FISP) in the assessment of cartilage abnormalities of the knee, by using surgery as the reference standard.

Materials and Methods: The study was approved by the hospital institutional review board. Written informed consent was obtained from all patients. Twenty-nine patients (30 knees) with a mean age of 56 years (range, 18–86 years) were prospectively evaluated with a sagittal 3D true FISP magnetic resonance (MR) sequence. The mean interval between MR imaging and surgery was 1 day (range, 0–9 days). During surgery, the articular surfaces of the knee were evaluated by using a modified Noyes score. The MR images were evaluated by two blinded readers on two separate occasions. Diagnostic performance was evaluated by setting the cutoff for abnormality between grade 1 (intact cartilage surface) and grade 2 (cartilage defects). Statistical methods used included calculation of sensitivity, specificity, and accuracy, with 95% confidence intervals (Wilson score method) and calculation of values with standard errors.

Results: Overall sensitivity, specificity, and accuracy for the two readers and the two evaluations ranged from 56% to 66%, 78% to 93%, and 71% to 75%, respectively. Interobserver agreement was substantial for both the first ( = 0.73) and the second ( = 0.65) evaluation. Intraobserver agreement was almost perfect ( = 0.84) for reader 1 and moderate ( = 0.60) for reader 2.

Conclusion: The 3D water-excitation true FISP MR sequence allows assessment of the articular cartilage of the knee with moderate-to-high specificity and low-to-moderate sensitivity.

© RSNA, 2007