Umans H, Wimpfheimer O, Haramati N, Applbaum Y H, Adler M, Bosco J
Department of Radiology, Albert Einstein College of Medicine, Bronx, New York, NY 10467, USA.
AJR Am J Roentgenol. 1995 Oct;165(4):893-7. doi: 10.2214/ajr.165.4.7676988.
The purpose of our study was to assess the ability of MR imaging to detect partial tears of the anterior cruciate ligament (ACL) as these injuries, if extensive enough, may result in ligamentous insufficiency or predispose to subsequent acquired knee instability.
A review of all arthroscopic reports from two institutions during the periods 1990-1992 and 1992-1993, respectively, revealed 13 patients with partial tears of the ACL. Thirteen cases each of intact and completely ruptured anterior cruciate ligaments on arthroscopy were randomly selected as controls from the same report review. Preoperative MR images for all cases selected were obtained. Criteria for diagnosis included the absence of findings of complete ACL tear in conjunction with abnormal intrasubstance signal, bowing of the ACL, or nonvisualization of the ACL on one MR imaging sequence with visualization of intact fibers on other sequences. Inter- and intraobserver agreement was assessed using the kappa statistic.
The sensitivity of MR imaging for detecting partial ACL tears ranged from 0.40 to 0.75, and the specificity ranged from 0.62 to 0.89. Variability of both inter- and intraobserver interpretations was greater than 0.7 kappa in all but one combination, comparing the diagnostic consistency of each of three readers both with himself, using two readings on separate days, and with each separate interpretation by the other two radiologists.
Our results show that MR evaluation of partial ACL tears is not sufficiently sensitive to establish the diagnosis without arthroscopy. This study was limited, however, by its small size and by the heterogeneity of the MR imaging technique.
我们研究的目的是评估磁共振成像（MR）检测前交叉韧带（ACL）部分撕裂的能力，因为这些损伤如果足够广泛，可能会导致韧带功能不全或易引发随后获得性膝关节不稳定。
分别回顾了两家机构在1990 - 1992年和1992 - 1993年期间的所有关节镜检查报告，发现13例ACL部分撕裂患者。从同一报告回顾中随机选取13例关节镜检查显示ACL完整和完全断裂的病例作为对照。获取所有选定病例的术前MR图像。诊断标准包括在一个MR成像序列上无ACL完全撕裂的表现，同时伴有韧带内异常信号、ACL弓状改变或ACL不可见，而在其他序列上可见完整纤维。使用kappa统计量评估观察者间和观察者内的一致性。
MR成像检测ACL部分撕裂的敏感性范围为0.40至0.75，特异性范围为0.62至0.89。除一种组合外，在所有情况下，观察者间和观察者内解释的变异性均大于0.7 kappa，这是比较三位读者各自在不同日期进行两次阅读时与自身的诊断一致性，以及与其他两位放射科医生各自的单独解释之间的一致性。
我们的结果表明，在没有关节镜检查的情况下，MR对ACL部分撕裂的评估敏感性不足以确立诊断。然而，本研究受样本量小和MR成像技术异质性的限制。
