Validity of Radiograph-Based Infrapatellar Fat Pad Opacity Grading for Assessing Knee Synovitis: Correlation With Contrast-Enhanced MRI.

OBJECTIVE

The purpose of this study was to determine the validity of infrapatellar fat pad (IPFP) opacity grading based on lateral knee radiography for assessing knee synovitis using correlation with contrast-enhanced (CE) MRI.

MATERIALS AND METHODS

Retrospective reviews of radiographs and CE knee MR images from 79 patients were independently performed by two radiologists. They evaluated IPFP opacity alteration (IPFP) and joint effusion grades on lateral knee conventional radiographs, IPFP signal intensity alteration (IPFP) and joint effusion grades on CE MR images, and synovitis (SYN) grade in nine divided regions, three compartments (parapatellar, periligamentous, perimeniscal), and the whole knee on CE MR images. Correlations between radiographic grades and MRI assessments were evaluated using Spearman correlation tests, and the correlation coefficients (ρ) were compared. Interobserver agreement was evaluated using weighted kappa values.

RESULTS

The IPFP grade was very highly correlated with the IPFP grade (ρ = 0.906, p < 0.001) and highly correlated with SYN grades from four regions (suprapatellar, infrapatellar, intercondylar, lateral parapatellar recess), the parapatellar compartment, and the whole knee (ρ = 0.614-0.740, all p < 0.001). The IPFP grade was moderately correlated with the SYN grades of the remaining five regions and two compartments (ρ = 0.457-0.547, all p < 0.001). The differences between correlation coefficients for SYN grades and the IPFP and IPFP grades were not statistically significant (p = 0.290-1.0). Interobserver reliabilities were excellent or good for IPFP, IPFP, and SYN grades (κ = 0.661-1.000).

CONCLUSION

IPFP grade assessment enables valid evaluation and reporting of knee synovitis, especially in the parapatellar compartment and the whole knee.