Russell H. Morgan Department of Radiology and Radiological Science, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA.
Radiology, Balgrist University Hospital, Zurich, Switzerland.
J Magn Reson Imaging. 2019 Jun;49(7):e139-e151. doi: 10.1002/jmri.26241. Epub 2018 Aug 24.
Ten-minute MRI of the pediatric knee can add value through increased cost-effectiveness and decreased sedation needs but requires validation of its clinical efficacy.
To determine the arthroscopy-based diagnostic accuracy and interreader reliability of 10-min 3D Controlled Aliasing In Parallel Imaging Results In Higher Acceleration (CAIPIRINHA) turbo spin echo (TSE) MRI with two isotropic pulse sequences for the diagnosis of internal derangement in children with painful knee conditions.
Prospective.
Sixty children.
FIELD STRENGTH/SEQUENCE: 3T, gradient echo-based scout with automatic anatomical landmark recognition and plane prescription, 3D CAIPIRINHA SPACE TSE.
Three fellowship-trained musculoskeletal radiologists evaluated the MRI studies independently and resolved discrepancies through consensus. Outcome variables included image quality, motion artifacts, meniscal abnormalities, anterior and posterior cruciate ligament tears, and cartilage lesions. Arthroscopic surgery served as the standard of reference, which was performed after 37 (range, 1-143) days post-MRI.
Diagnostic accuracy analysis of MRI with arthroscopic surgery as the standard of reference. Reliability analysis through calculation of interreader agreements with kappa statistics.
All studies were suitable for diagnostic interpretation with good-to-very-good image quality ratings and little-to-no motion degradation ratings in the majority of cases. The sensitivities/specificities/accuracies of 3D CAIPIRINHA TSE MRI were 0.93/0.96/0.94 for 15/60 (25%) medial meniscal tears, 0.95/0.92/0.94 for 21/60 (35%) lateral meniscal tears, 0.83/1.00/0.92 for 6/60 (17%) discoid menisci, 1.00/0.98/0.99 for 16/60 (27%) anterior cruciate ligament tears, 1.0/1.0/1.0 for 2/60 (3%) posterior cruciate ligament tears, 1.00/1.00/1.00 for 5/60 (8%) osteochondritis dissecans lesions, 0.71/0.96/0.84 for 48 (13%) defects in 360 cartilage segments, and 0.85/0.97/0.91 overall. The interreader agreements were overall good-to-very-good (kappa, 0.72-1.00).
The clinical use of 10-min 3D CAIPIRINHA TSE MRI of the knee in children with painful knee conditions yields an overall high arthroscopy-validated diagnostic accuracy of 91% and good-to-very good interreader reliability for the diagnosis of internal knee derangements.
1 Technical Efficacy: Stage 6 J. Magn. Reson. Imaging 2019;49:e139-e151.
儿科膝关节 10 分钟 MRI 可以通过增加成本效益和减少镇静需求来增加价值，但需要验证其临床疗效。
通过关节镜检查，确定两种各向同性脉冲序列的 10 分钟 3D 控制解混并行成像结果更高加速（CAIPIRINHA）涡轮自旋回波（TSE）MRI 对内翻患儿膝关节疼痛性疾病的诊断准确性和三位读者之间的可靠性。
前瞻性。
60 名儿童。
磁场强度/序列：3T，基于梯度回波的扫描，具有自动解剖标志识别和平面处方功能，3D CAIPIRINHA 空间 TSE。
三位接受过肌肉骨骼放射学专业培训的放射科医生独立评估 MRI 研究，并通过共识解决差异。主要结局变量包括图像质量、运动伪影、半月板异常、前交叉韧带撕裂和软骨损伤。关节镜手术作为金标准，在 MRI 后 37 天（范围 1-143 天）进行。
以关节镜检查为金标准的 MRI 诊断准确性分析。通过计算读者之间的一致性的 kappas 统计来评估可靠性。
所有研究都适合诊断解释，大多数情况下，图像质量评分良好至非常好，运动退化评分很小或没有。3D CAIPIRINHA TSE MRI 的敏感性/特异性/准确性为：内侧半月板撕裂的 15/60（25%）为 0.93/0.96/0.94，外侧半月板撕裂的 21/60（35%）为 0.95/0.92/0.94，盘状半月板撕裂的 6/60（17%）为 0.83/1.00/0.92，前交叉韧带撕裂的 16/60（27%）为 1.00/0.98/0.99，后交叉韧带撕裂的 2/60（3%）为 1.0/1.0/1.0，骨软骨炎病变的 5/60（8%）为 1.00/1.00/1.00，360 个软骨段中的 48 个（13%）缺陷为 0.71/0.96/0.84，整体为 0.85/0.97/0.91。读者之间的一致性总体良好至非常好（kappa，0.72-1.00）。
10 分钟膝关节 3D CAIPIRINHA TSE MRI 在膝关节疼痛患儿中的临床应用，其整体关节镜验证的诊断准确性高达 91%，对于诊断膝关节内部病变具有良好至非常好的读者间可靠性。
1 技术功效：第 6 阶段 J. Magn. Reson. Imaging 2019;49:e139-e151.
