Friemert B, Oberländer Y, Danz B, Häberle H J, Bähren W, Gerngross H, Schwarz W
Chirurgische Abteilung, Bundeswehrkrankenhaus Ulm, Germany.
Zentralbl Chir. 2002 Oct;127(10):822-7. doi: 10.1055/s-2002-35125.
The accuracy of magnet resonance imaging in diagnosing cartilage lesions is discussed controversially. The sensitivity of this examination ranges from 15 % to 96 %. Clinical evidence demonstrates that cartilage lesions, diagnosed by MRI, were not confirmed in arthroscopy. The purpose of this prospective study was to analyse the practicability of replacing arthroscopy by MRI in diagnosis of cartilage lesions.
195 patients with acute or chronic knee pain were examined by reason of a pathological clinic result by MRI preoperatively. In group A (n = 86), a standard program was performed in the radiological department of German Army Hospital (sagittal STIR TSE und PD TSE, coronary und transversal T2 FFE [TR = 660 ms, TE = 18 ms, FA = 30 degrees, 512er-Matrix]), in 21 patients (subgroup AK) a cartilage specific sequence (fs T1 W FFE) without gadolinium was added. Patients in group B (n = 88) were examined in a private outpatient clinic (sagittal T1 SE, T2 SE and T2 FLASH [TR = 608 ms, TE = 18 ms, FA = 20 degrees, 256er-Matrix]) with the use of gadolinium. A clear clinical diagnosis had to be performed before MRI examination.
156 lesions of the cartilage were detected arthroscopically. The sensitivity of the examination was in group A 33 %; group B 53 %; group AK 38 %, specificity in group A 99 %; group B 98 % and group AK 98 %. The positive and negative predictive values were in group A 75 %/98 %; group B 48 %/98 % and in group AK 50 %/97 %.
MRI was not able to detect reliable cartilage lesions. Until now, arthroscopy is the golden standard to detect cartilage lesions.
磁共振成像在诊断软骨损伤方面的准确性存在争议。该检查的敏感性范围为15%至96%。临床证据表明，经磁共振成像诊断的软骨损伤在关节镜检查中未得到证实。这项前瞻性研究的目的是分析在软骨损伤诊断中用磁共振成像替代关节镜检查的实用性。
195例急性或慢性膝关节疼痛患者因临床病理结果术前接受磁共振成像检查。A组（n = 86）在德国陆军医院放射科执行标准程序（矢状面短时反转恢复快速自旋回波序列及质子密度加权快速自旋回波序列、冠状面及横断面T2加权快速场回波序列[重复时间 = 660毫秒，回波时间 = 18毫秒，翻转角 = 30度，512矩阵]），21例患者（AK亚组）增加了无钆的软骨特异性序列（脂肪抑制T1加权快速场回波序列）。B组（n = 88）在一家私立门诊诊所接受检查（矢状面T1加权自旋回波序列、T2加权自旋回波序列及T2加权快速小角度激发序列[重复时间 = 608毫秒，回波时间 = 18毫秒，翻转角 = 20度，256矩阵]）并使用钆。在磁共振成像检查前必须做出明确的临床诊断。
关节镜检查发现156处软骨损伤。A组检查的敏感性为33%；B组为53%；AK亚组为38%，A组的特异性为99%；B组为98%，AK亚组为98%。A组的阳性和阴性预测值分别为75%/98%；B组为48%/98%，AK亚组为50%/97%。
磁共振成像无法可靠地检测软骨损伤。到目前为止，关节镜检查仍是检测软骨损伤的金标准。
