Drews Björn Holger, Merz Cornelia, Huth Jochen, Gulkin Daniel, Guelke Joachim, Gebhard Florian, Mauch Frieder
Center of Surgery, Department for Orthopedic Trauma, Hand and Reconstructive Surgery, University of Ulm, Albert-Einstein-Allee 23, 89081, Ulm, Germany.
Sportklinik Stuttgart GmbH, Taubenheimstraße 8, 70734, Stuttgart, Germany.
Skeletal Radiol. 2017 Oct;46(10):1361-1366. doi: 10.1007/s00256-017-2704-8. Epub 2017 Jun 27.
Revision ACL reconstruction is becoming more frequent because of a 10% rate of re-ruptures and insufficiencies. Currently, computed tomography (CT) represents the gold standard in detecting and measuring the tunnels of the initial ACL reconstruction. The purpose of this study was to compare measurement results of CT and thin-sliced MRI sequences, which were modified to a high soft tissue-bone contrast.
Prior to an ACL revision surgery, 16 consecutive patients had an MRI in addition to the standard CT scan. A dedicated 0.25-T Esaote G-Scan (Esaote Biomedica, Cologne, Germany) with a Turbo 3D T1 sequence was used for MRI. Tunnel diameters were measured at 11 defined points of interest. For the statistical evaluation, the Mann-Whitney U test for connected samples was used. Inter- and intraobserver reliability was additionally calculated.
All measured diameters showed significant to highly significant correlations between both diagnostic tools (r = 0.7-0.98). In addition, there was no significant difference (p > 0.5) between the two techniques. Almost all diameters showed nearly perfect intraobserver reliability (ICC 0.8-0.97). Interobserver reliability showed an ICC of 0.91/0.92 for only one diameter in MRI and CT.
Prior to ACL revision surgery, bone tunnel measurements can be done using a 3D T1-MRI sequence in low-field MRI. MRI measurements show the same accuracy as CT scans. Preoperative radiation exposure in mainly young patients could be reduced. Also the costs of an additional CT scan could be saved.
由于再次断裂和功能不全的发生率为10%，前交叉韧带（ACL）翻修重建越来越常见。目前，计算机断层扫描（CT）是检测和测量初次ACL重建隧道的金标准。本研究的目的是比较CT和经改良以获得高软组织-骨对比度的薄层MRI序列的测量结果。
在进行ACL翻修手术前，16例连续患者除了接受标准CT扫描外还进行了MRI检查。使用配备Turbo 3D T1序列的专用0.25-T Esaote G-Scan（德国科隆的Esaote Biomedica公司）进行MRI检查。在11个定义的感兴趣点测量隧道直径。对于统计评估，使用配对样本的曼-惠特尼U检验。此外，还计算了观察者间和观察者内的可靠性。
两种诊断工具测得的所有直径均显示出显著至极显著的相关性（r = 0.7 - 0.98）。此外，两种技术之间无显著差异（p > 0.5）。几乎所有直径的观察者内可靠性都近乎完美（组内相关系数ICC为0.8 - 0.97）。观察者间可靠性方面，MRI和CT中仅一个直径的ICC为0.91/0.92。
在ACL翻修手术前，可在低场MRI中使用3D T1-MRI序列进行骨隧道测量。MRI测量结果与CT扫描具有相同的准确性。可减少主要为年轻患者的术前辐射暴露。此外，还可节省额外CT扫描的费用。
