Cilengir Atilla Hikmet, Akkus Onur Kaan, Baysan Caner, Uluc Engin, Cilengir Nevin, Tosun Ozgur
Faculty of Medicine, Department of Radiology, Izmir Democracy University, Izmir, Turkey.
Department of Radiology, Izmir Katip Celebi University Ataturk Training and Research Hospital, Izmir, Turkey.
Acta Radiol. 2023 Feb;64(2):648-657. doi: 10.1177/02841851221090623. Epub 2022 Apr 28.
Imaging findings of both anterior cruciate ligament (ACL) sprain and mucoid degeneration overlap in some cases, which may cause errors in magnetic resonance imaging (MRI) evaluation.
To determine the ancillary findings on MRI in distinguishing between ACL sprain and mucoid degeneration, and also to obtain a diagnostic scheme.
MRI scans of 77 patients with ACL mucoid degeneration and 77 cases with ACL sprain were retrospectively evaluated to compare with regard to parameters of age, sex, side, the status of posterior cruciate ligament - medial collateral ligament - lateral collateral ligament, bone marrow edema, intraosseous cyst, subchondral sclerosis, chondromalacia, meniscus tear, effusion, and osteochondral body. A decision tree algorithm was created to predict pathology in ACL, whether it was a sprain or mucoid degeneration.
The prevalence of female sex, femoral intraosseous cyst, tibial intraosseous cyst, subchondral sclerosis, femoral chondromalacia, tibial chondromalacia, medial meniscus tear, and lateral meniscus tear were significantly higher in the ACL mucoid degeneration group ( < 0.001, = 0.016, < 0.001, = 0.003, < 0.001, < 0.001, < 0.001, and < 0.001, respectively). The probability of being mucoid degeneration increased 41.2 times (95% confidence interval [CI] = 5.296-321.132) in cases with tibial intraosseous cyst and increased 1.05 times (95% CI = 1.010-1.080) with each one-year increase in age ( < 0.001 and = 0.011, respectively). The decision tree algorithm had an overall accuracy of 79.2%.
Ancillary findings are helpful in the diagnosis of suspicious cases for ACL mucoid degeneration and ACL sprain. The decision tree algorithm offers a practical and successful approach to this issue.
前交叉韧带（ACL）扭伤和黏液样变性的影像学表现有时会重叠，这可能导致磁共振成像（MRI）评估出现错误。
确定MRI上有助于区分ACL扭伤和黏液样变性的辅助表现，并得出诊断方案。
回顾性评估77例ACL黏液样变性患者和77例ACL扭伤患者的MRI扫描结果，比较年龄、性别、患侧、后交叉韧带-内侧副韧带-外侧副韧带状况、骨髓水肿、骨内囊肿、软骨下硬化、软骨软化、半月板撕裂、积液和骨软骨体等参数。创建决策树算法以预测ACL的病变情况，判断是扭伤还是黏液样变性。
ACL黏液样变性组女性、股骨骨内囊肿、胫骨骨内囊肿、软骨下硬化、股骨软骨软化、胫骨软骨软化、内侧半月板撕裂和外侧半月板撕裂的发生率显著更高（分别为<0.001、=0.016、<0.001、=0.003、<0.001、<0.001、<0.001和<0.001）。胫骨骨内囊肿患者黏液样变性的概率增加41.2倍（95%置信区间[CI]=5.296-321.132），年龄每增加一岁概率增加1.05倍（95%CI=1.010-1.080）（分别为<0.001和=0.011）。决策树算法的总体准确率为79.2%。
辅助表现在诊断ACL黏液样变性和ACL扭伤的可疑病例中很有帮助。决策树算法为解决这个问题提供了一种实用且成功的方法。
