Akatsu Yorikazu, Yamaguchi Satoshi, Mukoyama Shunsuke, Morikawa Tsuguo, Yamaguchi Tadashi, Tsuchiya Kan, Iwasaki Junichi, Akagi Ryuichiro, Muramatsu Yuta, Katsuragi Joe, Fukawa Taisuke, Endo Jun, Takahashi Kazuhisa, Sasho Takahisa
Department of Orthopedic Surgery, Chiba University Graduate School of Medicine, 1-8-1 Inohana, Chuo-ku, Chiba, 260-8670, Japan. E-mail address for T. Sasho:
Seikei-kai Chiba Medical Center, 1-11-12 Minamityou, Chuo-ku, Chiba City, Chiba, 260-0842, Japan.
J Bone Joint Surg Am. 2015 May 20;97(10):799-806. doi: 10.2106/JBJS.N.01055.
Imaging is of great importance in diagnosing meniscal tears. The aim of this study was to assess the accuracy of high-resolution ultrasound in the diagnosis of meniscal tears, with arthroscopic examination as the standard reference, after resolution was confirmed with a target-mounted reference phantom. An additional goal was to elucidate the area of the meniscus that could be visualized with the same ultrasound machine after placement of markers into the menisci of cadaveric knees.
Seventy patients were included for the assessment of the accuracy of a high-resolution ultrasound machine with a 14.0 to 6.0-MHz linear transducer. The preoperative ultrasound diagnosis, in terms of the presence and type of tear, was compared with that in the surgical reports. In the cadaveric studies, nine needles were placed in the peripheral zone of the menisci at regular intervals and the number of needles that could be observed with the system was recorded.
The overall sensitivity, specificity, positive predictive value, and negative predictive value of ultrasound examination for meniscal tears were 88%, 85%, 85%, and 88%, respectively. These statistical parameters did not differ significantly between the medial and lateral menisci. The sensitivity for diagnosing horizontal, vertical, radial, flap, bucket-handle, and complex tears and for detecting discoid lateral menisci was 83%, 64%, 0%, 64%, 54%, 90%, and 80%, respectively. Ten percent of the lateral menisci could not be evaluated because of poor images. The cadaveric studies revealed that the ultrasound visualized the entire meniscus except for the anterior horn.
The findings of this study suggest that ultrasound examination may be suitable for screening for meniscal tears. The fact that almost 10% of the lateral menisci could not be evaluated because of poor images appears to be a weakness of ultrasound.
影像学在诊断半月板撕裂中具有重要意义。本研究的目的是在通过目标定位参考模型确认分辨率后，以关节镜检查作为标准参考，评估高分辨率超声诊断半月板撕裂的准确性。另一个目标是阐明在将标记物置于尸体膝关节半月板后，使用同一超声机器可观察到的半月板区域。
纳入70例患者以评估配备14.0至6.0MHz线性换能器的高分辨率超声机器的准确性。将术前超声诊断的撕裂存在情况及类型与手术报告中的诊断进行比较。在尸体研究中，以固定间隔在半月板的周边区域放置9根针，并记录系统能够观察到的针的数量。
超声检查诊断半月板撕裂的总体敏感性、特异性、阳性预测值和阴性预测值分别为88%、85%、85%和88%。这些统计参数在内侧半月板和外侧半月板之间无显著差异。诊断水平撕裂、垂直撕裂、放射状撕裂、瓣状撕裂、桶柄状撕裂、复杂撕裂以及检测盘状外侧半月板的敏感性分别为83%、64%、0%、64%、54%、90%和80%。由于图像质量差，10%的外侧半月板无法评估。尸体研究显示，超声可观察到除前角外的整个半月板。
本研究结果表明超声检查可能适用于半月板撕裂的筛查。由于图像质量差导致近10%的外侧半月板无法评估这一事实似乎是超声的一个弱点。
