Department of Emergency Medicine, Sanggye Paik Hospital, Inje University College of Medicine, 1342 Dongil-ro, Nowon-gu, Seoul, 01757, Republic of Korea.
Department of Radiology, Kyung Hee University Hospital at Gangdong, Kyung Hee University School of Medicine, 892 Dongnam-ro, Gangdong-gu, Seoul, 05278, Republic of Korea.
Skeletal Radiol. 2019 Oct;48(10):1599-1610. doi: 10.1007/s00256-019-03225-w. Epub 2019 May 10.
To evaluate the diagnostic performance of knee ultrasound for anterior cruciate ligament (ACL) and posterior cruciate ligament (PCL) injuries.
PubMed and EMBASE databases were searched for diagnostic accuracy studies that used ultrasound for diagnosing ACL and PCL injuries. Bivariate and hierarchical summary receiver operating characteristic modeling was used to evaluate diagnostic performance. Subgroup analysis was performed by assessing studies conducted using the ultrasound technique (functional ultrasound versus conventional ultrasound) for diagnosing ACL injury. We performed meta-regression analyses for a potential source of heterogeneity.
Eleven (938 ultrasound/878 patients) and six articles (281 ultrasound/237 patients) were included for ACL and PCL injuries respectively. The summary sensitivity, summary specificity, and area under the hierarchical summary receiver operating characteristic for ACL and PCL injuries were 0.88 (95% confidence interval [CI], 0.81-0.93) and 0.99 (95% CI, 0.49-1.00), 0.96 (95% CI, 0.91-0.98) and 0.99 (95% CI, 0.73-1.00), and 0.97 (95% CI, 0.96-0.98) and 1.00 (95% CI, 0.99-1.00) respectively. In subgroup analysis, there was no significant difference between sensitivity (p = 0.63) and specificity (p = 0.72) of functional and conventional ultrasound. Among the various potential covariates, patient enrollment, patient position, and ultrasound performer were associated with heterogeneity in terms of sensitivity, and proportion of the ACL injury was associated with heterogeneity in terms of specificity.
Knee ultrasound demonstrates high diagnostic performance for ACL and PCL injuries, particularly when performed by experienced musculoskeletal radiologists. Future prospective studies to compare the cost- and time-effectiveness between ultrasound and magnetic resonance imaging and to determine the optimal ultrasound parameters are warranted.
评估膝关节超声在诊断前交叉韧带（ACL）和后交叉韧带（PCL）损伤中的诊断性能。
在 PubMed 和 EMBASE 数据库中检索了使用超声诊断 ACL 和 PCL 损伤的诊断准确性研究。使用双变量和分层汇总受试者工作特征建模来评估诊断性能。通过评估用于诊断 ACL 损伤的超声技术（功能超声与常规超声）的研究进行了亚组分析。我们对潜在的异质性来源进行了元回归分析。
分别纳入了 11 项（938 例超声/878 例患者）和 6 项研究（281 例超声/237 例患者）用于 ACL 和 PCL 损伤。ACL 和 PCL 损伤的汇总敏感性、特异性和分层汇总受试者工作特征曲线下面积分别为 0.88（95%置信区间[CI]，0.81-0.93）和 0.99（95%CI，0.49-1.00）、0.96（95%CI，0.91-0.98）和 0.99（95%CI，0.73-1.00）以及 0.97（95%CI，0.96-0.98）和 1.00（95%CI，0.99-1.00）。在亚组分析中，功能超声和常规超声的敏感性（p=0.63）和特异性（p=0.72）之间无显著差异。在各种潜在的协变量中，患者入组、患者体位和超声操作者与敏感性的异质性相关，而 ACL 损伤的比例与特异性的异质性相关。
膝关节超声对 ACL 和 PCL 损伤具有较高的诊断性能，尤其是由经验丰富的肌肉骨骼放射科医生进行时。需要进一步开展前瞻性研究，以比较超声和磁共振成像的成本和时间效益，并确定最佳的超声参数。
