磁共振成像的时机影响前交叉韧带损伤膝关节中外侧韧带撕裂检测的准确性和观察者间的一致性。
Timing of magnetic resonance imaging affects the accuracy and interobserver agreement of anterolateral ligament tears detection in anterior cruciate ligament deficient knees.
作者信息
Han Audrey Xinyun, Tan Tien Jin, Nguyen Tiep, Lee Dave Yee Han
机构信息
Department of Orthopedic Surgery, Changi General Hospital, Singapore, Singapore.
Department of Diagnostic Radiology, Changi General Hospital, Singapore, Singapore.
出版信息
Knee Surg Relat Res. 2020 Nov 27;32(1):64. doi: 10.1186/s43019-020-00082-z.
PURPOSE
We aimed to identify the anterolateral ligament (ALL) tears in anterior cruciate ligament (ACL)-deficient knees using standard 1.5-Tesla magnetic resonance imaging (MRI).
METHODS
We included all patients who underwent primary ACL reconstruction at our center between 2012 and 2015. Exclusion criteria included patients with multiple ligament injuries, lateral collateral ligament, posterolateral corner, and infections, and patients who underwent MRI more than 2 months after their injury. All patients (n = 148) had ACL tears that were subsequently arthroscopically reconstructed. The magnetic resonance (MR) images of the injured knees performed within 2 months of injury were reviewed by a musculoskeletal radiologist and an orthopedic surgeon. The patients were divided into two groups. The first group of patients had MRI performed within 1 month of injury. The second group of patients had MRI performed 1-2 months after the index injury. Both assessors were blinded and the MR mages were read separately to assess the presence of ALL, presence of a tear and the location of the tear. Based on their readings, interobserver agreement (kappa statistic (K)), sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV), and accuracy were compared.
RESULTS
The ALL was identified in 100% of the patients. However, there was a discrepancy of up to 15% in the identification of tear of the ALL. In the first group in which MRI scans were performed within 1 month of injury, the ALL tear was identified by the radiologist in 92% of patients and by the surgeon in 90% of patients (Κ = 0.86). In the second group in which MRI scans were performed within 1-2 months of the injury, the ALL tear was identified by the radiologist in 78% of patients and by the surgeon in 93% of patients (K = 0.62).
CONCLUSION
The ALL can be accurately identified on MRI, but the presence and location of ALL tear and its location cannot be reliably identified on MRI. The accuracy in identification and characterization of a tear was affected by the interval between the time of injury and the time when the MRI was performed.
LEVEL OF EVIDENCE
Diagnostic, level IIIb, retrospective.
目的
我们旨在使用标准的1.5特斯拉磁共振成像（MRI）来识别前交叉韧带（ACL）损伤膝关节中的前外侧韧带（ALL）撕裂。
方法
我们纳入了2012年至2015年间在我们中心接受初次ACL重建的所有患者。排除标准包括多发韧带损伤、外侧副韧带、后外侧角损伤及感染患者，以及受伤超过2个月后接受MRI检查的患者。所有患者（n = 148）均有ACL撕裂，随后接受了关节镜下重建。一名肌肉骨骼放射科医生和一名骨科医生对受伤后2个月内进行的受伤膝关节的磁共振（MR）图像进行了评估。患者被分为两组。第一组患者在受伤后1个月内进行了MRI检查。第二组患者在初次受伤后1 - 2个月进行了MRI检查。两位评估者均不知情，分别读取MR图像以评估ALL的存在、撕裂的存在及撕裂的位置。根据他们的读取结果，比较了观察者间的一致性（kappa统计量（K））、敏感性、特异性、阳性预测值（PPV）、阴性预测值（NPV）和准确性。
结果
100%的患者中识别出了ALL。然而，在ALL撕裂的识别上存在高达15%的差异。在受伤后第1组（受伤后1个月内进行MRI扫描）中，放射科医生在92%的患者中识别出ALL撕裂，外科医生在90%的患者中识别出ALL撕裂（Κ = 0.86）。在第2组（受伤后1 - 2个月进行MRI扫描）中，放射科医生在78%的患者中识别出ALL撕裂，外科医生在93%的患者中识别出ALL撕裂（K = 0.62）。
结论
ALL可在MRI上准确识别，但ALL撕裂的存在及其位置在MRI上无法可靠识别。撕裂的识别和特征描述的准确性受受伤时间与进行MRI检查时间间隔的影响。
证据水平
诊断性，IIIb级，回顾性研究。
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