Ciliz Deniz, Ciliz Asim, Elverici Eda, Sakman Bülent, Yüksel Enis, Akbulut Oya
Departmant of Diagnostic Radiology, Ankara Numune Education and Research Hospital, Ankara, Turkey.
Clin Imaging. 2008 May-Jun;32(3):212-9. doi: 10.1016/j.clinimag.2007.09.008.
The diagnosis of a recurrent tear can be more difficult in the postoperative meniscus. The purpose of our study was to determine the accuracy of conventional magnetic resonance imaging (MRI) and MRI with intraarticular contrast material [magnetic resonance (MR) arthrography] for detecting recurrent meniscal tears after surgery.
Seventy-two patients who had arthroscopic surgery for meniscal tear and still got complaints were selected prospectively for MR arthrography and conventional MRI. Routine knee protocols with appropriate surface coil were used on 0.5 T MRI system. A 1:100 gadolinium-saline solution 30-40 ml was injected intraarticulary for MR arthrography. Of 72 patients, 45 had repeated arthroscopy for comparison of the results. The morphology of the meniscus as seen on MR images was characterized according to meniscal repair an the degree of meniscal resection into three groups. (1) less than 25% of the meniscal resection, (2) more than 25% meniscal resection, (3) meniscal repair. With routine conventional MR images, we grouped patients according to the signal intensity of menisci as Grade 1, Grade 2, Grade 3, and tear.
The prevalence of recurrent meniscal tears in our study group was [68% (37/72 tears)]. In the diagnosis of recurrent meniscal tear, conventional MRI and MR arthrography had sensitivities of 54.0% and 94.5%, respectively; specificities of 75.0% and 87.5%, respectively; and accuracy of 57.7% and 93.4%, respectively. The accuracy of the conventional MRI studies was significantly less than that of the MR arthrography group (P<.05).
Our study results indicate high overall accuracy for MR arthrography in the diagnosis of recurrent or residual meniscal tears. When meniscal resection is minimal, the right diagnosis could be obtained with conventional MRI. MR arthrography is necessary for patients with meniscal resection of more than 25% and who do not have sufficient joint effusion.
术后半月板复发性撕裂的诊断可能更具难度。本研究的目的是确定传统磁共振成像（MRI）及关节内注射造影剂的MRI（磁共振关节造影）检测术后半月板复发性撕裂的准确性。
前瞻性选取72例因半月板撕裂接受关节镜手术但仍有症状的患者，进行磁共振关节造影及传统MRI检查。在0.5T MRI系统上采用配备合适表面线圈的常规膝关节检查方案。关节内注射30 - 40ml 1:100钆 - 盐水溶液进行磁共振关节造影。72例患者中，45例接受了再次关节镜检查以比较结果。根据半月板修复情况及半月板切除程度，将MR图像上半月板的形态分为三组。（1）半月板切除少于25%，（2）半月板切除超过25%，（3）半月板修复。根据常规传统MR图像，将患者按半月板信号强度分为1级、2级、3级及撕裂。
本研究组中半月板复发性撕裂的发生率为[68%（37/72处撕裂）]。在诊断半月板复发性撕裂时，传统MRI和磁共振关节造影的敏感性分别为54.0%和94.5%；特异性分别为75.0%和87.5%；准确性分别为57.7%和93.4%。传统MRI检查的准确性显著低于磁共振关节造影组（P<0.05）。
我们的研究结果表明，磁共振关节造影在诊断复发性或残留半月板撕裂方面总体准确性较高。当半月板切除极少时，传统MRI可获得正确诊断。对于半月板切除超过25%且关节积液不足的患者，磁共振关节造影是必要的。
