Accuracy of magnetic resonance imaging, magnetic resonance arthrography and computed tomography for the detection of chondral lesions of the knee

Purpose

To assess the diagnostic test accuracy of magnetic resonance imaging (MRI), magnetic resonance arthrography (MRA) and computed tomography arthrography (CTA) for the detection of chondral lesions of the patellofemoral and tibiofemoral joints.

Methods

A review of published and unpublished literature sources was conducted on 22nd September 2011. All studies assessing the diagnostic test accuracy (sensitivity/specificity) of MRI or MRA or CTA for the assessment of adults with chondral (cartilage) lesions of the knee (tibiofemoral/patellofemoral joints) with surgical comparison (arthroscopic or open) as the reference test were included. Data were analysed through meta-analysis.

Results

Twenty-seven studies assessing 2,592 knees from 2,509 patients were included. The findings indicated that whilst presenting a high specificity (0.95?C0.99), the sensitivity of MRA, MRI and CTA ranged from 0.70 to 0.80. MRA was superior to MRI and CTA for the detection of patellofemoral joint chondral lesions and that higher field-strength MRI scanner and grade four lesions were more accurately detected compared with lower field-strength and grade one lesions. There appeared no substantial difference in diagnostic accuracy between the interpretation from musculoskeletal and general radiologists when undertaking an MRI review of tibiofemoral and patellofemoral chondral lesions.

Conclusions

Specialist radiological imaging is specific for cartilage disease in the knee but has poorer sensitivity to determine the therapeutic options in this population. Due to this limitation, there remains little indication to replace the ??gold-standard?? arthroscopic investigation with MRI, MRA or CTA for the assessment of adults with chondral lesions of the knee.

Level of evidence

II.     

Patient perception of magnetic resonance arthrography

Objective. Magnetic resonance (MR) arthrography has been demonstrated to be more accurate than MR imaging alone in the identification of a variety of musculoskeletal pathology. While the complication rate of intra-articular gadolinium: saline injection has been shown to be relatively low, MR arthrography is more invasive, painful, and costly, and less convenient, than MR imaging alone. The purpose of this study was to evaluate patients’ perception of the fear and discomfort, and to assess their overall acceptance of the intra-articular gadolinium injection. Design and patients. Between October 1997 and January 1998, 113 outpatients who were referred to Yale-New Haven Hospital for MR arthrography of the ankle, elbow, hip, knee, shoulder, or wrist were asked to complete a questionnaire rating their fear of factors most commonly associated with the procedure including ”pain”, ”needles”, ”complications”, and ”discovery of results that would lead to surgery”. In addition, after having undergone the intra-articular gadolinium:saline injection, patients were asked to rate their perception of pain. Results. While many patients expressed fear of ”pain” and ”needles”, after having undergone the injection their overall pain rating score was low. Only 6% actually found gadolinium arthrography more painful than expected. Conclusion. Despite the fact that patients expressed apprehension about certain aspects of MR arthrography, subjects who underwent the intra-articular gadolinium injection considered the discomfort less than expected. Clinicians should not hesitate to order MR arthrography because the accuracy of the procedure is high enough that patients accept the discomfort. Received: 15 November 1999 Revision requested: 30 December 1999 Revision received: 4 February 2000 Accepted: 8 February 2000     

能谱CT和MRI在手肌腱病变中的应用

目的：初步探讨能谱CT的宝石能谱成像（gemstone spectral imaging,GSI）模式和MRI在手肌腱正常解剖以及基本病变中的应用。方法：30例手肌腱病变患者,手肌腱正常,因其他疾病需手部CT扫描者5例作为解剖对照,分别行GSI和MRI检查,通过能谱分析软件,选择适宜单能量值（KeV）,将混合能量图像转换为单能量图像,运用多种图像重组方式,观察能谱CT图像,并和MRI对照分析。结果：GSI能显示肌腱的形态,连续走行,止点,特别在显示肌腱,骨骼,肌肉的三维空间关系上,较MRI有优势。对于肌腱断裂,增粗,缺失,受压的显示,GSI与MRI比较,,差异无统计学意义（P〉0.05）。对肌腱粘连、变性、腱鞘病变的显示不如MRI清晰,差异有统计学意义（P〈0.05）。结论：宝石能谱CT在手部肌腱解剖及病变显示方面有较大应用价值,能为临床提供有力的影像学支持;而MRI在肌腱变性、粘连及腱鞘病变中,优势明显。     

Computed tomography and magnetic resonance imaging for painful spinal column: contributions and controversies

The use of tomographic imaging techniques, computed tomography (CT) and magnetic resonance imaging (MRI), to complement or replace plain-film radiography in the study of spine pain is becoming more and more common. The aim of this paper is to provide a general review of the CT and MRI manifestations of the wide spectrum of lesions that can cause pain in the spinal column. This spectrum includes degenerative disease, malalignment, tumors, inflammatory processes, and infectious processes. Precise knowledge and accurate reporting of the findings at CT and MRI are fundamental for clinical decision making in patients with spine pain.     

Review of three magnetic resonance arthrography related infections

We report three cases of intra-articular infection which followed injection for magnetic resonance arthrography. In an effort to reduce the risk of arthrogram related infection, representatives from radiology, infectious disease medicine, and microbiology departments convened to analyze the contributing factors. The proposed source was oral contamination from barium swallow studies which preceded the arthrogram injections in the same room. We propose safety measures to reduce incidence of arthrogram related infections.     

Evaluation of collateral ligament injuries of the metacarpophalangeal joints with magnetic resonance imaging and magnetic resonance arthrography

Injuries of the collateral ligaments of the metacarpophalangeal (MCP) joints of the hand require accurate diagnosis and prompt treatment to prevent loss of function. The most common and well-known collateral ligament injury is injury to the ulnar collateral ligament of the first MCP joint of the hand, often referred to as a gamekeeper injury. Although less common, injuries involving the collateral ligaments of the second through fifth digits and the radial collateral ligament of the first digit also occur. The diagnosis of collateral ligament injury is often made clinically, however, magnetic resonance imaging and magnetic resonance arthrography of the MCP joints can be very useful in the evaluation of severity of the injury. This provides important information for the hand surgeon and aids in treatment planning. Imaging of the collateral ligaments requires small fields of view and several technical considerations can provide improved image quality. These factors will be discussed and illustrated in this article.     

Eosinophilic hepatic necrosis: magnetic resonance imaging and computed tomography comparison

OBJECTIVE: To compare the findings of magnetic resonance (MR) imaging with those of computed tomography (CT) of focal liver lesions related to peripheral eosinophilia. METHODS: For 12 patients with peripheral eosinophilia (>7%) examined with hepatic MR imaging and CT, 52 focal hepatic lesions larger than 0.5 cm, including 31 lesions simultaneously found on the 2 imaging modalities, were subjected to a comparative analysis of their imaging features. RESULTS: The total number of lesions distinguished from background liver was 39 (75%) on MR imaging and 44 (85%) on CT scans. On arterial phase images of 10 patients with comparable data, homogeneously hyperintense lesions were demonstrated more frequently (P = 0.006) on MR imaging (16 [50%] of 32 lesions) than on CT scans (4 [13%] of 32 lesions). Only 7 (22%) of the 32 hypoattenuating lesions on portal phase CT were depicted as hypointense lesions on portal phase MR images in 12 patients. On delayed phase images in 8 patients, the number of hyperintense lesions on MR images (9 [56%] of 16) was greater (P = 0.077) than that seen on the CT scans (4 [25%] of 16). CONCLUSIONS: For many focal hepatic lesions related to peripheral eosinophilia, dynamic MR imaging more easily demonstrates lesional enhancement on arterial and delayed phases than CT scans. Because of the higher degree of lesional enhancement of MR imaging compared with CT, the lesion-to-liver contrast may not be sufficient to distinguish the lesion from the background liver, resulting in decreased sensitivity of portal phase dynamic MR imaging.     

Acute subarachnoid hemorrhage: in vitro comparison of magnetic resonance and computed tomography

The computed tomographic (CT) attenuation values and magnetic resonance (MR) signal intensities of simulated acute subarachnoid hemorrhage were compared systematically. In vitro MR and CT measurements (T1, T2, and Hounsfield units) were made of mixtures of normal human cerebrospinal fluid (CSF) and normal heparinized blood, ranging from 0% to 100% by volume. The mixtures were measured in a plexiglass phantom with a Siemens DR3 CT scanner for attenuation measurements (Hounsfield units) and in the Baylor Bruker Instruments Proton Scanner (6-MHz) using inversion-recovery and spin-echo pulse sequence techniques for T1- and T2-calculated relaxation times. A PRAXIS II (10.7 MHz permanent magnet) nonimaging unit was used to measure the relaxation times of the CSF/blood mixtures independently for comparison. The Hounsfield measurements of the densest parts of the layered mixtures showed increasing values with increasing amounts of hemorrhage (0% blood, 0 H; 100% blood, 66 H) in a nonlinear pattern. The T1 times of the mixtures decreased with increasing amounts of blood, ranging from 2200 msec to 500 msec for 100% CSF and 100% blood, respectively. The inverse of the T1 relaxation times was proportional to the percentage of blood. The T2 data for the mixtures were similar in character to the T1 relaxation times, except for shorter T2 times at high concentrations of blood. It was concluded the MRI distinguishes varying blood/CSF mixtures on the basis of relaxation times better than does CT on the basis of Hounsfield units. CT still has an imaging advantage, since high-concentration hemorrhage is clearly different from normal brain, while concentrated acute subarachnoid blood has relaxation times similar to normal brain and is nearly isointense on MRI.     

Evaluating transplant kidneys: nuclear magnetic resonance tomography in comparison with sonography

In a prospective study we compared the results of MRI and ultrasound in assessing renal dysfunctions in 22 patients with renal allografts. The current diagnostic criteria are presented and the range of indications is evaluated in relation to perfusion scans.     

Predictive value of magnetic resonance tomography in comparison with sonography and computed tomography in the diagnosis of focal liver lesions

Ultrasonography and computed tomography are widely used for the diagnosis of focal lesions of the liver. However, the possibilities for tumor characterization and determination of potential malignancy are limited in many cases. Evaluation by magnetic resonance imaging shows a good correlation of relaxation time with the amount of stroma as a proportion of the total cell content of a lesion. This allows differentiation for a number of lesions. Thus, the combination of ultrasonography and magnetic resonance imaging could provide the ideal diagnostic procedure in many cases.     

Axial myopia--computed tomography and magnetic resonance tomography findings

The case of a 44-year-old women suffering from amblyopia of the left eye with unilateral proptosis caused by axial (progressive) myopia is presented. The clinical and radiological findings were discussed in reference to the literature. The diagnosis was established by ruling out neoplastic, inflammatory or endocrine causes for the exophthalmos. CT and MR scans revealed an enlarged left globe without evidence of orbital masses. The findings were regarded as typical for the diagnosis of axial myopia.     

Digital arthrography in the evaluation of painful joint prostheses

Digital arthrography was accomplished in 16 patients who had painful prostheses. In each instance, resulting arthrographic abnormalities were compared with those apparent on subsequent overhead radiographs. Results indicate the potential value of the digital technique in this clinical setting. The examination is easy to perform and rapid, and allows the examiner to view the changing images in the subtraction mode. Image manipulation and enhancement are also possible.     

Technical problems in arthrography of the painful hip arthroplasty

Arthrography following hip replacement has been reviewed. The problems encountered have been analysed with particular reference to technique and accuracy. The accepted criteria for loosening have not been consistently reliable and have led to false positive interpretation of loosening of the acetabular component. The reasons for false negative results are also considered.