史蒂夫·比科学术医院磁共振成像诊断非骨性膝关节损伤的准确性。
The accuracy of magnetic resonance imaging diagnosis of non-osseous knee injury at Steve Biko Academic Hospital.
作者信息
Singh Nashil, Hanekom Heleen, Suleman Farhana E
机构信息
Department of Radiology, University of Pretoria, Steve Biko Academic Hospital, Pretoria, South Africa.
出版信息
SA J Radiol. 2019 Sep 25;23(1):1754. doi: 10.4102/sajr.v23i1.1754. eCollection 2019.
BACKGROUND
Preoperative magnetic resonance imaging (MRI) has internationally been proven to reduce unnecessary knee arthroscopies and assist with surgical planning. This has the advantage of avoiding unnecessary surgery and the associated anaesthetic risk, as well as reducing costs. No data were found in the recently published literature assessing the accuracy of MRI interpretation of knee ligament injury in the public sector locally.
OBJECTIVES
This pilot study aimed to determine the accuracy of MRI in detecting non-osseous knee injury in a resource-limited tertiary-level academic hospital in Pretoria, South Africa, compared to the gold standard arthroscopy findings.
METHOD
This was an exploratory retrospective analysis of 39 patients who had MRI and arthroscopy at Steve Biko Academic Hospital (SBAH). True positive, true negative, false positive and false negative results were extrapolated from findings in both modalities and translated into sensitivity, specificity, positive predictive value (PPV) and negative predictive value (NPV) for each structure.
RESULTS
Negative predictive values were recorded as 97%, 81%, 90% and 100% (anterior cruciate ligament [ACL], medial meniscus [MM], lateral meniscus [LM] and posterior cruciate ligament [PCL], respectively), which were comparative to recently published international literature. The PPV results were lower than those previously evaluated at 55%, 58%, 55% and not applicable. The sensitivities and specificities of the ligaments were 83%, 58%, 83% and not applicable; and 87%, 81%, 70% and not applicable, respectively.
CONCLUSION
Magnetic resonance imaging was found to be sensitive and specific, with a high NPV noted in all structures evaluated. Negative results can therefore be used to avoid unnecessary surgery to the benefit of the patient and state. The study reiterates that high accuracy can be obtained from MRI on a 1.5-tesla non-dedicated scanner, with interpretation by generalist radiologists.
背景
术前磁共振成像（MRI）已在国际上被证明可减少不必要的膝关节镜检查，并有助于手术规划。这具有避免不必要手术及相关麻醉风险以及降低成本的优势。在当地公共部门最近发表的文献中，未发现评估MRI对膝关节韧带损伤解读准确性的数据。
目的
本试点研究旨在确定在南非比勒陀利亚一家资源有限的三级学术医院中，与金标准关节镜检查结果相比，MRI检测非骨性膝关节损伤的准确性。
方法
这是一项对在史蒂夫·比科学术医院（SBAH）接受MRI和关节镜检查的39例患者进行的探索性回顾性分析。从两种检查方式的结果中推断出真阳性、真阴性、假阳性和假阴性结果，并转化为每个结构的灵敏度、特异度、阳性预测值（PPV）和阴性预测值（NPV）。
结果
阴性预测值分别记录为97%、81%、90%和100%（分别针对前交叉韧带[ACL]、内侧半月板[MM]、外侧半月板[LM]和后交叉韧带[PCL]），与最近发表的国际文献相当。PPV结果低于先前评估的结果，分别为55%、58%、55%，后交叉韧带的PPV不适用。韧带的灵敏度和特异度分别为83%、58%、83%，后交叉韧带的灵敏度不适用；以及87%、81%、70%，后交叉韧带的特异度不适用。
结论
发现磁共振成像具有敏感性和特异性，在所评估的所有结构中NPV都很高。因此，阴性结果可用于避免不必要的手术，对患者和国家都有益。该研究重申，通过普通放射科医生对1.5特斯拉非专用扫描仪进行MRI检查可获得较高的准确性。
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