Department of Orthopaedic Surgery, University of Arizona, Tucson, Arizona.
Sports Health. 2012 May;4(3):222-31. doi: 10.1177/1941738111434396.
Magnetic resonance imaging (MRI) is routinely used in the diagnosis of sports-related knee injuries.
To determine the accuracy, sensitivity, and specificity of MRI compared with clinical evaluation in the diagnosis of meniscal pathology when the MRI facility and the radiologist are not preselected.
A total of 288 knee arthroscopies were retrospectively compared. Patients were divided into 3 groups: those who had MRI performed and interpreted at a single institution, MRI performed and interpreted at community facilities, or a clinical evaluation by a senior orthopaedic surgeon.
The sensitivity, specificity, and accuracy of the diagnosis of medial meniscal pathology at a single institution were 90%, 59%, 76%; in community facilities, 73%, 68%, 70%; and by a clinical evaluation, 93%, 55%, 73%, respectively. For lateral meniscal pathology, the results were as follows: single institution, 75%, 76%, 81%; community facilities, 60%, 88%, 79%; and clinical evaluation, 45%, 90%, 79%, respectively. Sensitivity for medial meniscus was greater than for lateral meniscus, but specificity of diagnosis was better for lateral meniscus by MRI and clinical evaluation. While not statistically significant, there was increased sensitivity in the diagnosis of medial meniscus and lateral meniscus at SIs, but they have less specificity than at community facilities. The number of false-positive diagnoses (ie, no intra-articular pathology) that resulted in surgery was 4 of 288 (1.39%). The overall accuracy for medial meniscus by MRI was 73% vs 73% for clinical evaluation. The overall accuracy for MRI for lateral meniscus was 78% vs 79% for clinical evaluation.
Routine MRI may not be more beneficial than clinical evaluation when there is no preselection of MRI facility and interpreting radiologist.
The use of MRI for diagnosing meniscal pathology should be reserved for those cases where the orthopaedic clinical examination is ambiguous.
磁共振成像（MRI）常用于运动相关膝关节损伤的诊断。
在未预选 MRI 设备和放射科医生的情况下，比较 MRI 与临床评估对半月板病变诊断的准确性、敏感性和特异性。
回顾性比较了 288 例膝关节镜检查。患者分为 3 组：在单一机构进行 MRI 检查和解读、在社区机构进行 MRI 检查和解读、或由资深骨科医生进行临床评估。
在单一机构中，内侧半月板病变的诊断的敏感性、特异性和准确性分别为 90%、59%、76%；在社区机构中，分别为 73%、68%、70%；而临床评估分别为 93%、55%、73%。对于外侧半月板病变，结果如下：单一机构为 75%、76%、81%；社区机构为 60%、88%、79%；临床评估为 45%、90%、79%。内侧半月板的敏感性大于外侧半月板，但 MRI 和临床评估对外侧半月板的诊断特异性更好。虽然没有统计学意义，但在 SIs 中，内侧和外侧半月板的诊断敏感性增加，但特异性低于社区机构。导致手术的假阳性诊断（即无关节内病变）有 4 例（288 例的 1.39%）。MRI 对内侧半月板的总体准确率为 73%，与临床评估的 73%相当。MRI 对外侧半月板的总体准确率为 78%，与临床评估的 79%相当。
在没有预选 MRI 设备和解读放射科医生的情况下，常规 MRI 可能不如临床评估有益。
对于骨科临床检查不明确的半月板病变，应保留 MRI 用于诊断。
