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Accuracy of cartilage-specific 3-Tesla 3D-DESS magnetic resonance imaging in the diagnosis of chondral lesions: comparison with knee arthroscopy.

Kohl S, Meier S, Ahmad SS, Bonel H, Exadaktylos AK, Krismer A, Evangelopoulos DS - J Orthop Surg Res (2015)

Bottom Line: Lesions were classified using the modified Outerbridge classification.For grade III and IV lesions, 3-T MRI combined with 3D-DESS cartilage-specific sequences represents an accurate diagnostic tool.For grade II lesions, the technique demonstrates moderate sensitivity, while for grade I lesions, the sensitivity is limited to provide reliable diagnosis compared to knee arthroscopy.

View Article: PubMed Central - PubMed

Affiliation: Department of Orthopaedic Surgery, Inselspital, University of Bern, Freiburgstrasse, CH-3010, Bern, Switzerland. sandro.kohl@gmail.com.

ABSTRACT

Background: Arthroscopy is considered as "the gold standard" for the diagnosis of traumatic intraarticular knee lesions. However, recent developments in magnetic resonance imaging (MRI) now offer good opportunities for the indirect assessment of the integrity and structural changes of the knee articular cartilage. The study was to investigate whether cartilage-specific sequences on a 3-Tesla MRI provide accurate assessment for the detection of cartilage defects.

Methods: A 3-Tesla (3-T) MRI combined with three-dimensional double-echo steady-state (3D-DESS) cartilage specific sequences was performed on 210 patients with knee pain prior to knee arthroscopy. Sensitivity, specificity, and positive and negative predictive values of magnetic resonance imaging were calculated and correlated to the arthroscopic findings of cartilaginous lesions. Lesions were classified using the modified Outerbridge classification.

Results: For the 210 patients (1260 cartilage surfaces: patella, trochlea, medial femoral condyle, medial tibia, lateral femoral condyle, lateral tibia) evaluated, the sensitivities, specificities, positive predictive values, and negative predictive values of 3-T MRI were 83.3, 99.8, 84.4, and 99.8 %, respectively, for the detection of grade IV lesions; 74.1, 99.6, 85.2, and 99.3 %, respectively, for grade III lesions; 67.9, 99.2, 76.6, and 98.2 %, respectively, for grade II lesions; and 8.8, 99.5, 80, and 92 %, respectively, for grade I lesions.

Conclusions: For grade III and IV lesions, 3-T MRI combined with 3D-DESS cartilage-specific sequences represents an accurate diagnostic tool. For grade II lesions, the technique demonstrates moderate sensitivity, while for grade I lesions, the sensitivity is limited to provide reliable diagnosis compared to knee arthroscopy.

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MRI and arthroscopic image of a grade IV lesion in a 42-year-old patient completely depleted of cartilage in the weight bearing area
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Fig4: MRI and arthroscopic image of a grade IV lesion in a 42-year-old patient completely depleted of cartilage in the weight bearing area

Mentions: MRI detected a total of 202 lesions. Of those, 38 (18.8 %) were grade I, 90 (44.5 %) grade II, 45 (22.3 %) grade III, and 29 (14.4 %) grade IV. The area most commonly affected was the patellar compartment with 61 (30.1 %) lesions, followed by the medial femoral condyle with 41 (20.3 %), the medial tibial condyle with 38 (18.8 %), the lateral femoral condyle with 24 (11.9 %), the trochlea with 20 (9.9 %), and the lateral tibial condyle with 18 (8.9 %) lesions (Figs. 1, 2, 3, and 4). ICC for each grade of lesions identified on MRI evaluations was 0.34 (p = 0.03) for grade I, 0.67 (p < 0.001) for grade II, 0.89 (p < 0.001) for grade III, and 0.99 (p < 0.001) for grade IV lesions, showing consistency between the two independent reviewers for grades II–IV lesions.Fig. 1


Accuracy of cartilage-specific 3-Tesla 3D-DESS magnetic resonance imaging in the diagnosis of chondral lesions: comparison with knee arthroscopy.

Kohl S, Meier S, Ahmad SS, Bonel H, Exadaktylos AK, Krismer A, Evangelopoulos DS - J Orthop Surg Res (2015)

MRI and arthroscopic image of a grade IV lesion in a 42-year-old patient completely depleted of cartilage in the weight bearing area
© Copyright Policy - OpenAccess
Related In: Results  -  Collection

License 1 - License 2
Show All Figures
getmorefigures.php?uid=PMC4696275&req=5

Fig4: MRI and arthroscopic image of a grade IV lesion in a 42-year-old patient completely depleted of cartilage in the weight bearing area
Mentions: MRI detected a total of 202 lesions. Of those, 38 (18.8 %) were grade I, 90 (44.5 %) grade II, 45 (22.3 %) grade III, and 29 (14.4 %) grade IV. The area most commonly affected was the patellar compartment with 61 (30.1 %) lesions, followed by the medial femoral condyle with 41 (20.3 %), the medial tibial condyle with 38 (18.8 %), the lateral femoral condyle with 24 (11.9 %), the trochlea with 20 (9.9 %), and the lateral tibial condyle with 18 (8.9 %) lesions (Figs. 1, 2, 3, and 4). ICC for each grade of lesions identified on MRI evaluations was 0.34 (p = 0.03) for grade I, 0.67 (p < 0.001) for grade II, 0.89 (p < 0.001) for grade III, and 0.99 (p < 0.001) for grade IV lesions, showing consistency between the two independent reviewers for grades II–IV lesions.Fig. 1

Bottom Line: Lesions were classified using the modified Outerbridge classification.For grade III and IV lesions, 3-T MRI combined with 3D-DESS cartilage-specific sequences represents an accurate diagnostic tool.For grade II lesions, the technique demonstrates moderate sensitivity, while for grade I lesions, the sensitivity is limited to provide reliable diagnosis compared to knee arthroscopy.

View Article: PubMed Central - PubMed

Affiliation: Department of Orthopaedic Surgery, Inselspital, University of Bern, Freiburgstrasse, CH-3010, Bern, Switzerland. sandro.kohl@gmail.com.

ABSTRACT

Background: Arthroscopy is considered as "the gold standard" for the diagnosis of traumatic intraarticular knee lesions. However, recent developments in magnetic resonance imaging (MRI) now offer good opportunities for the indirect assessment of the integrity and structural changes of the knee articular cartilage. The study was to investigate whether cartilage-specific sequences on a 3-Tesla MRI provide accurate assessment for the detection of cartilage defects.

Methods: A 3-Tesla (3-T) MRI combined with three-dimensional double-echo steady-state (3D-DESS) cartilage specific sequences was performed on 210 patients with knee pain prior to knee arthroscopy. Sensitivity, specificity, and positive and negative predictive values of magnetic resonance imaging were calculated and correlated to the arthroscopic findings of cartilaginous lesions. Lesions were classified using the modified Outerbridge classification.

Results: For the 210 patients (1260 cartilage surfaces: patella, trochlea, medial femoral condyle, medial tibia, lateral femoral condyle, lateral tibia) evaluated, the sensitivities, specificities, positive predictive values, and negative predictive values of 3-T MRI were 83.3, 99.8, 84.4, and 99.8 %, respectively, for the detection of grade IV lesions; 74.1, 99.6, 85.2, and 99.3 %, respectively, for grade III lesions; 67.9, 99.2, 76.6, and 98.2 %, respectively, for grade II lesions; and 8.8, 99.5, 80, and 92 %, respectively, for grade I lesions.

Conclusions: For grade III and IV lesions, 3-T MRI combined with 3D-DESS cartilage-specific sequences represents an accurate diagnostic tool. For grade II lesions, the technique demonstrates moderate sensitivity, while for grade I lesions, the sensitivity is limited to provide reliable diagnosis compared to knee arthroscopy.

Show MeSH
Related in: MedlinePlus