Fazio Constance G, Muir Peter, Schaefer Susan L, Waller Kenneth R
Department of Surgical Sciences, University of Wisconsin-Madison School of Veterinary Medicine, Madison, WI, 53706.
Vet Radiol Ultrasound. 2018 Jan;59(1):64-78. doi: 10.1111/vru.12567. Epub 2017 Nov 1.
Canine cranial cruciate ligament rupture is often bilateral and asymmetrical, ranging from partial to complete rupture. The purpose of our diagnostic accuracy study was to assess the accuracy of 3 Tesla magnetic resonance imaging (MRI) detection of fiber loss and use of a visual analog scale in the diagnosis of complete versus partial cranial cruciate ligament rupture in 28 clinical dogs with unilateral complete rupture and contralateral partial rupture. Three Tesla MRI was performed on 56 stifles using sagittal sequences (T2-weighted fast spin echo with fat saturation, proton density fast spin echo, and T2-weighted 3D fast spin echo CUBE). Two MRI observers assessed the cranial cruciate ligament for fiber loss and completed a visual analog scale. The MRI data were compared to arthroscopy and clinical status. Accuracy classifying partial or complete rupture was assessed using receiver operating characteristic analysis. Compared to arthroscopy, for complete cranial cruciate ligament rupture, sensitivity, specificity, and accuracy of MRI detection of fiber loss were 0.78, 0.50-0.60, and 0.68-0.71, respectively, and, for partial tears, specificity was 1.00. An MRI visual analog scale score ≥79 was indicative of complete cranial cruciate ligament rupture (sensitivity 0.72-0.94 and specificity 0.71-0.84). Using a visual analog scale cut-point ≥79, observers achieved good accuracy discriminating clinical status of partial or complete cranial cruciate ligament rupture (area under the curve 0.87-0.93). MRI evaluation for fiber loss and use of a visual analog scale are specific in stifles with clinically stable partial cranial cruciate ligament rupture. In stifles with clinically unstable complete cranial cruciate ligament rupture, both MRI tests are sensitive though not specific compared to arthroscopy. As a diagnostic imaging method, MRI may help guide treatment in patients with cranial cruciate ligament damage, particularly for stable partial rupture.
犬颅交叉韧带断裂常为双侧且不对称，程度从部分断裂到完全断裂不等。我们这项诊断准确性研究的目的是，评估3特斯拉磁共振成像（MRI）检测纤维束缺失的准确性，以及使用视觉模拟评分法诊断28只单侧完全断裂和对侧部分断裂的临床犬的完全性与部分性颅交叉韧带断裂的情况。对56个 stifles（此处可能有误，推测是“膝关节”之类的医学术语，暂保留英文）进行了3特斯拉MRI检查，采用矢状位序列（脂肪抑制T2加权快速自旋回波、质子密度快速自旋回波以及T2加权3D快速自旋回波CUBE）。两名MRI观察者评估颅交叉韧带的纤维束缺失情况并完成视觉模拟评分。将MRI数据与关节镜检查及临床状况进行比较。使用受试者工作特征分析评估对部分或完全断裂进行分类的准确性。与关节镜检查相比，对于完全性颅交叉韧带断裂，MRI检测纤维束缺失的敏感性、特异性和准确性分别为0.78、0.50 - 0.60和0.68 - 0.71，对于部分撕裂，特异性为1.00。MRI视觉模拟评分≥79表明为完全性颅交叉韧带断裂（敏感性0.72 - 0.94，特异性0.71 - 0.84）。使用视觉模拟评分切点≥79时，观察者在区分部分或完全性颅交叉韧带断裂的临床状况方面准确性良好（曲线下面积0.87 - 0.93）。对于临床上稳定的部分性颅交叉韧带断裂的膝关节，MRI评估纤维束缺失及使用视觉模拟评分具有特异性。对于临床上不稳定的完全性颅交叉韧带断裂的膝关节，与关节镜检查相比，两种MRI检查均具有敏感性但不具有特异性。作为一种诊断成像方法，MRI可能有助于指导颅交叉韧带损伤患者的治疗，尤其是对于稳定的部分性断裂。
