Orthopaedics and Traumatology Department, Bégin Military Academic Hospital, 69, avenue de Paris, 94160 Saint-Mandé, France.
Orthop Traumatol Surg Res. 2009 Feb;95(1):40-7. doi: 10.1016/j.otsr.2008.09.005. Epub 2009 Feb 4.
No study, so far in France, has investigated the diagnosis value of knee MR-arthrography since the recent approval of intra-articular gadolinium use, by this country's healthcare authorities. This study objective is to verify the MR-arthrography superiority on conventional knee MRI, in meniscus and cartilage knee lesions diagnosing accuracy both in regard to sensitivity and specificity.
MR-arthrography, represents in some pathologic situations, a more accurate source of information than conventional MRI.
Over a 27 months period, 25 patients, scheduled to undergo a knee arthroscopy volunteered, after having been fully informed of the possible interest and risk of the MR-arthrography examination, to participate in this study. Twenty-one of them were finally included since in four cases the surgical indication was not confirmed. The group consisted of 15 males and six females with an average age of 35.7 years. All of them consecutively underwent conventional MRI, MR-arthrography finally followed by arthroscopy. The MRI and MR-arthrograms results were compared to the arthroscopy findings using the nonparametric Kappa test.
To diagnose meniscal tears, statistical agreement measure for MRI with arthroscopy was good (K=0.69) but not as good as the MR-arthrography/arthroscopy agreement which, by itself was excellent (K=0.84). As a diagnosis tool, the sensitivity and specificity of MR-arthrography (respectively 100 and 89.6%) were much higher than the corresponding values observed in conventional MRI (92.3 and 82.8%, respectively) which nonetheless remain satisfactory. The meniscal tears characterization seemed to be better interpreted using MR-arthrography. As far as the chondral lesions in this series, they were predominantly located on the patellar surface and in the medial femorotibial compartment. For diagnosing the latter, the MRI/arthroscopy agreement was good (K=0.70) but not as good as the MR-arthrography/arthroscopy agreement (K=0.805) which can be rated excellent. The detection sensitivity thus increased by 10% with gadolinium intra-articular injection. However, assessment accuracy of the lesions depth was mediocre, with frequent errors for the intermediary stages.
Intra-articular gadolinium injection improved MRI performances for numerous reasons: filling the joint, reinforcing the synovial fluid signal, and enhancing anatomic structures contrast on the T1-weighted sequences images. In this study, MR-arthrography appeared to be superior to conventional MRI in meniscal and cartilaginous lesions diagnosis, confirming the results previously obtained in other countries. In light of these results and other data from the literature, MR-arthrography can be indicated as an alternative to CT-arthrography in various clinical situations: detection of recurrent tears on operated menisci, search for cartilaginous lesions or foreign bodies in the joint space, and preoperative assessment before chondral repair procedures. However, conventional MRI remains the reference examination for studying cartilage, because the low resolution of MR-arthrography limits its performances in quantitative assessment of lesions depth.
在法国，自从国家医疗保健当局批准关节内钆的使用以来，目前还没有研究调查膝关节磁共振关节造影术的诊断价值。本研究的目的是验证磁共振关节造影术在半月板和软骨膝关节病变的诊断准确性方面优于常规膝关节 MRI，包括敏感性和特异性。
在某些病理情况下，磁共振关节造影术比常规 MRI 提供更准确的信息来源。
在 27 个月的时间内，25 名计划接受膝关节关节镜检查的患者在充分了解磁共振关节造影检查的可能益处和风险后自愿参加了这项研究。由于手术指征未得到证实，最终有 21 名患者入组，其中 4 名患者被排除在外。该组包括 15 名男性和 6 名女性，平均年龄为 35.7 岁。所有患者均连续接受常规 MRI、磁共振关节造影术，最后行关节镜检查。使用非参数 Kappa 检验比较 MRI 和磁共振关节造影术的结果与关节镜检查结果。
为了诊断半月板撕裂，MRI 与关节镜检查的统计一致性测量值良好（Kappa=0.69），但不如磁共振关节造影术与关节镜检查的一致性好（Kappa=0.84），后者本身是极好的。作为一种诊断工具，磁共振关节造影术的敏感性和特异性（分别为 100%和 89.6%）明显高于常规 MRI 的相应值（分别为 92.3%和 82.8%），但仍令人满意。半月板撕裂的特征似乎通过磁共振关节造影术更好地解释。至于本系列中的软骨病变，它们主要位于髌骨表面和内侧股骨胫骨关节间隙。对于诊断后者，MRI 与关节镜检查的一致性良好（Kappa=0.70），但不如磁共振关节造影术与关节镜检查的一致性好（Kappa=0.805），后者可以评为极好。通过关节内注射钆，检测灵敏度提高了 10%。然而，病变深度的评估准确性较差，中间阶段经常出现错误。
关节内注射钆提高了 MRI 的性能，原因有很多：填充关节、增强关节液信号、增强 T1 加权序列图像上的解剖结构对比度。在这项研究中，磁共振关节造影术在半月板和软骨病变的诊断方面似乎优于常规 MRI，证实了其他国家先前获得的结果。根据这些结果和文献中的其他数据，磁共振关节造影术可以在各种临床情况下替代 CT 关节造影术：检测已行半月板手术的半月板的复发性撕裂、寻找关节腔内的软骨病变或异物，以及软骨修复术前评估。然而，常规 MRI 仍然是研究软骨的参考检查，因为磁共振关节造影术的分辨率较低，限制了其在病变深度的定量评估中的性能。
