Cook James L, Cook Cristi R, Stannard James P, Vaughn Gavin, Wilson Nichole, Roller Brandon L, Stoker Aaron M, Jayabalan Prakash, Hdeib Moses, Kuroki Keiichi
Comparative Orthopaedic Laboratory, University of Missouri, Columbia, Missouri.
Missouri Orthopaedic Institute, Department of Orthopaedic Surgery, University of Missouri, Columbia, Missouri.
J Knee Surg. 2014 Aug;27(4):319-24. doi: 10.1055/s-0034-1367731. Epub 2014 Jan 28.
While magnetic resonance imaging (MRI) is often considered the "gold standard" diagnostic imaging modality for detection of meniscal abnormalities, it is associated with misdiagnosis in as high as 47% of cases, is costly, and is not readily available to a large number of patients. Ultrasonographic examination of the knee has been reported to be an effective diagnostic tool for this purpose with the potential to overcome many of the shortcomings of MRI. The purpose of this study is to determine the clinical usefulness of ultrasonography for diagnosis of meniscal pathology in patients with acute knee pain and compare its diagnostic accuracy to MRI in a clinical setting. With Institutional Review Board approval, patients (n = 71) with acute knee pain were prospectively enrolled with informed consent. Preoperative MRI (1.5 T) was performed on each affected knee using the hospital's standard equipment and protocols and read by faculty radiologists trained in musculoskeletal MRI. Ultrasonographic assessments of each affected knee were performed by one of two faculty members trained in musculoskeletal ultrasonography using a 10 to 14 MHz linear transducer. Arthroscopic evaluation of affected knees was performed by one of three faculty orthopedic surgeons to assess and record all joint pathology, which served as the reference standard for determining presence, type, and severity of meniscal pathology. All evaluators for each diagnostic modality were blinded to all other data. Data were collected and compared by a separate investigator to determine sensitivity (Sn), specificity (Sp), positive predictive value (PPV), negative predictive value (NPV), correct classification rate (CCR), likelihood ratios (LR[+] and LR[-]), and odds ratios. Preoperative ultrasonographic assessment of meniscal pathology was associated with Sn = 91.2%, Sp = 84.2%, PPV = 94.5%, NPV = 76.2%, CCR = 89.5%, LR(+) = 5.78, and LR(-) = 0.10. Preoperative MRI assessment of meniscal pathology was associated with Sn = 91.7%, Sp = 66.7%, PPV = 84.6%, NPV = 80.0%, CCR = 81.1%, LR(+) = 2.75, and LR(-) = 0.13. Ultrasonography was two times more likely than MRI to correctly determine presence or absence of meniscal pathology seen arthroscopically in this study. Ultrasonography is a useful tool for diagnosis of meniscal pathology with potential advantages over MRI. Based on these data and available portable equipment, ultrasonography could be considered for use as a point-of-injury diagnostic modality for meniscal injuries.
虽然磁共振成像（MRI）通常被认为是检测半月板异常的“金标准”诊断成像方式，但在高达47%的病例中它与误诊相关，成本高昂，并且大量患者无法轻易获得。据报道，膝关节超声检查是用于此目的的一种有效诊断工具，有可能克服MRI的许多缺点。本研究的目的是确定超声检查在诊断急性膝关节疼痛患者半月板病变中的临床实用性，并在临床环境中将其诊断准确性与MRI进行比较。经机构审查委员会批准，前瞻性纳入了71例急性膝关节疼痛患者并获得知情同意。使用医院的标准设备和方案对每个患膝进行术前MRI（1.5T）检查，并由接受过肌肉骨骼MRI培训的放射科教员解读。由两名接受过肌肉骨骼超声检查培训的教员之一使用10至14MHz线性换能器对每个患膝进行超声评估。由三名骨科教员之一对患膝进行关节镜评估，以评估和记录所有关节病变，这作为确定半月板病变的存在、类型和严重程度的参考标准。每种诊断方式的所有评估人员对所有其他数据均不知情。由一名独立研究人员收集和比较数据，以确定敏感性（Sn）、特异性（Sp）、阳性预测值（PPV）、阴性预测值（NPV）、正确分类率（CCR）、似然比（LR[+]和LR[-]）以及比值比。术前半月板病变的超声评估的Sn为91.2%，Sp为84.2%，PPV为94.5%，NPV为76.2%，CCR为89.5%，LR(+)为5.78，LR(-)为0.10。术前半月板病变的MRI评估的Sn为91.7%，Sp为66.7%，PPV为84.6%，NPV为80.0%，CCR为81.1%，LR(+)为2.75，LR(-)为0.13。在本研究中，超声检查正确确定关节镜下所见半月板病变有无的可能性是MRI的两倍。超声检查是诊断半月板病变的一种有用工具，相对于MRI具有潜在优势。基于这些数据和现有的便携式设备，超声检查可被考虑用作半月板损伤的即时诊断方式。
