Galea Arthur, Giuffre Bruno, Dimmick Simon, Coolican Myles R J, Parker David A
Royal Free Hampstead National Health Service Trust, Hampstead, London, United Kingdom.
Arthroscopy. 2009 May;25(5):473-80. doi: 10.1016/j.arthro.2008.10.020.
The purpose of our study was to evaluate the impact of preoperative magnetic resonance imaging (MRI) assessment of articular knee pathology on the clinical management of patients presenting with joint line pain.
A preliminary study on 100 patients was performed to assess the accuracy of specific MRI sequences, using arthroscopy as a gold standard. Six hundred and eighteen consecutive patients with knee symptoms presenting to 2 specialist knee surgeons were then recruited. A clinical diagnosis of an arthroscopically treatable lesion was made in all cases. Clinical assessment data were correlated to subsequent MRI findings, recording any discrepancy and in particular whether or not MRI findings influenced management decisions.
In the preliminary study, MRI sequences had an overall sensitivity of 83.2% and a specificity of 94.3% for the detection of chondral lesions. However, when considering arthroscopic grade III and IV lesions, MRI sensitivity and specificity were improved to 84.5% and 97.1%. In the second phase of the study, 141 (22.8%) of the 618 patients presenting with knee symptoms had an altered clinical management subsequent to MRI. The presence of unexpected chondral lesions was found in 77 of these patients. Conversely, 22 patients with clinical symptoms suspicious for simple chondral degeneration had unstable meniscal tears.
We suggest that preoperative MRI scanning identifies a group of patients who have more advanced degenerative joint disease than the clinical assessment and the plain radiographs suggest. This would expedite definitive surgery in patients with advanced osteoarthritis on MRI scans.
Level II, development of diagnostic criteria on basis of consecutive patients with universally applied gold standard.
我们研究的目的是评估术前膝关节关节病理的磁共振成像（MRI）评估对出现关节线疼痛患者临床管理的影响。
以关节镜检查作为金标准，对100例患者进行了初步研究，以评估特定MRI序列的准确性。然后招募了618例连续向2位专业膝关节外科医生就诊的膝关节症状患者。所有病例均做出了关节镜可治疗病变的临床诊断。将临床评估数据与后续MRI结果相关联，记录任何差异，特别是MRI结果是否影响管理决策。
在初步研究中，MRI序列检测软骨损伤的总体敏感性为83.2%，特异性为94.3%。然而，在考虑关节镜III级和IV级病变时，MRI的敏感性和特异性分别提高到84.5%和97.1%。在研究的第二阶段，618例出现膝关节症状的患者中有141例（22.8%）在MRI检查后改变了临床管理。其中77例患者发现存在意外的软骨损伤。相反，22例临床症状怀疑为单纯软骨退变的患者存在不稳定的半月板撕裂。
我们认为术前MRI扫描可识别出一组退行性关节疾病比临床评估和平片显示的更为严重的患者。这将加快MRI扫描显示为晚期骨关节炎患者的确定性手术。
II级，基于连续患者和普遍应用的金标准制定诊断标准。
