Boeve B F, Davidson R A, Staab E V
Department of Medicine, University of Florida College of Medicine, J. Hillis Miller Health Center, Gainesville 32611.
South Med J. 1991 Sep;84(9):1123-7. doi: 10.1097/00007611-199109000-00016.
To better define the role of magnetic resonance imaging (MRI) in the evaluation of knee injuries, we analyzed 10 recently published articles comparing MRI and arthroscopy in the detection of meniscal and anterior cruciate ligament tears. Sensitivity (SN), specificity (SP), positive predictive value (PPV), and negative predictive value (NPV) for medial meniscus (MM) tears, lateral meniscus (LM) tears, and anterior cruciate ligament (ACL) tears were either obtained or calculated from data contained in each article. The medians of measurements for MM tears were 97% SN, 89% SP, 88% PPV, and 96% NPV. Measurement medians for LM tears were 85% SN, 94% SP, 86% PPV, and 95% NPV. ACL tear measurement medians were 100% SN, 96% SP, 80% PPV, and 98% NPV. High NPVs were found in several studies, many of which were 100%. The high NPV of MR imaging suggests that diagnostic arthroscopic surgery is not necessary in the evaluation of patients with negative MRI studies. The superior sensitivity of MRI in detecting frank posterior horn tears, intrasubstance meniscal tears, and significant incidental findings also suggests that screening MRI scans can facilitate preoperative planning.
为了更好地界定磁共振成像（MRI）在评估膝关节损伤中的作用，我们分析了最近发表的10篇文章，这些文章比较了MRI和关节镜检查在检测半月板和前交叉韧带撕裂方面的情况。通过每篇文章中包含的数据，获取或计算出内侧半月板（MM）撕裂、外侧半月板（LM）撕裂和前交叉韧带（ACL）撕裂的敏感度（SN）、特异度（SP）、阳性预测值（PPV）和阴性预测值（NPV）。MM撕裂测量值的中位数分别为敏感度97%、特异度89%、阳性预测值88%和阴性预测值96%。LM撕裂测量值的中位数分别为敏感度85%、特异度94%、阳性预测值86%和阴性预测值95%。ACL撕裂测量值的中位数分别为敏感度100%、特异度96%、阳性预测值80%和阴性预测值98%。在多项研究中发现了较高的阴性预测值，其中许多为100%。MR成像的高阴性预测值表明，对于MRI检查结果为阴性的患者，在评估时无需进行诊断性关节镜手术。MRI在检测明显的后角撕裂、半月板实质内撕裂和重要的偶然发现方面具有较高的敏感度，这也表明筛查性MRI扫描有助于术前规划。
