Kuikka Paavo-Ilari, Sillanpää Petri, Mattila Ville M, Niva Maria H, Pihlajamäki Harri K
Centre for Military Medicine, Research Unit, Helsinki, Finland.
Am J Sports Med. 2009 May;37(5):1003-8. doi: 10.1177/0363546508329543. Epub 2009 Feb 13.
No previous research has investigated the diagnostic validity of magnetic resonance imaging for acute versus chronic meniscal tears using comparable materials and methods.
There is no difference in the diagnostic validity of magnetic resonance imaging for acute versus chronic meniscal tears in young adults.
Cohort study (diagnosis); Level of evidence, 2.
A total of 628 young adult military personnel underwent magnetic resonance imaging and arthroscopy of the knee over a 6-year period. Inclusion criteria were met by 82 patients with acute knee trauma (magnetic resonance imaging within 30 days from trauma) and 40 patients with chronic knee symptoms (symptoms lasting over 6 months before magnetic resonance imaging). The original magnetic resonance imaging and arthroscopy records were reviewed twice by a musculoskeletally trained radiologist, blinded to previous magnetic resonance imaging and arthroscopy findings. Interobserver correlations and intraobserver reliability were calculated and reported. Arthroscopy served as the gold standard when calculating the diagnostic values of magnetic resonance imaging for acute and chronic meniscal tears.
The median age of the patients was 20 years (range, 18-25). Magnetic resonance imaging detected acute meniscal tears with sensitivity of 67%, specificity of 93%, and diagnostic accuracy of 88% and chronic meniscal tears with 64%, 91%, and 86%, respectively. There was no statistically significant difference in magnetic resonance imaging results between the 2 groups.
The diagnostic validity of magnetic resonance imaging is similar for meniscal tears in acute knee trauma and in knee symptoms lasting over 6 months in young adults. The results also suggest that effusion or hemarthrosis do not weaken the diagnostic validity of magnetic resonance imaging. The magnetic resonance imaging sensitivity achieved in the present study was relatively poor, but the specificity was good for both acute and chronic meniscal tears. Despite negative magnetic resonance imaging findings at the acute stage of knee trauma, patient monitoring and readiness for arthroscopy should be considered if justified by the patient's symptoms.
以往尚无研究使用可比的材料和方法来调查磁共振成像对急性与慢性半月板撕裂的诊断有效性。
在年轻成年人中，磁共振成像对急性与慢性半月板撕裂的诊断有效性没有差异。
队列研究（诊断）；证据等级，2级。
在6年期间，共有628名年轻成年军事人员接受了膝关节的磁共振成像和关节镜检查。82例急性膝关节创伤患者（创伤后30天内进行磁共振成像）和40例慢性膝关节症状患者（磁共振成像前症状持续超过6个月）符合纳入标准。一名接受过肌肉骨骼系统培训的放射科医生在不知道先前磁共振成像和关节镜检查结果的情况下，对原始磁共振成像和关节镜检查记录进行了两次复查。计算并报告了观察者间的相关性和观察者内的可靠性。在计算磁共振成像对急性和慢性半月板撕裂的诊断价值时，关节镜检查作为金标准。
患者的中位年龄为20岁（范围18 - 25岁）。磁共振成像检测急性半月板撕裂的敏感性为67%，特异性为93%，诊断准确性为88%；检测慢性半月板撕裂的敏感性、特异性和诊断准确性分别为64%、91%和86%。两组之间的磁共振成像结果无统计学显著差异。
磁共振成像对年轻成年人急性膝关节创伤中的半月板撕裂和持续超过6个月的膝关节症状中的半月板撕裂的诊断有效性相似。结果还表明，积液或关节积血不会削弱磁共振成像的诊断有效性。本研究中获得的磁共振成像敏感性相对较差，但对急性和慢性半月板撕裂的特异性都较好。尽管在膝关节创伤急性期磁共振成像结果为阴性，但如果患者症状表明有必要，仍应考虑对患者进行监测并做好关节镜检查的准备。
