| BackgroundThe injury of knee,especially the anterior cruciate ligament(ACL)and meniscus tear,is common.The ACL tear,meniscus tear can lead to joint pain,swelling,dysfunction,and even declining in sport function.The accurate diagnosis of ACL injures and meniscus tear and tear type is contribute to the choice of clinical treatment,the formulation of surgical scheme and the evaluation of prognosis.MRI,with high soft tissue resolution and spatial resolution.has become the most commonly used and noninvasive method of knee joint injury.The conventional two-dimension MRI(2D-MRI)is used commonly in the clinical examination.but the thick slice and partial volume effect may miss the small lesions.Three dimensional MRI(3D-MRI)can acquire volumetric data which allow multi-plane reformation(MPR)to the diagnosis of the lesions and to detect the subtle pathology changes.Objectives1.To evaluate the application of 3D-MRI PDWI-SPAIR in the diagnosis of ACL injury and injury classification.2.To evaluate the application of 3D-MRI PDWI-SPAIR in the diagnosis of meniscus tear and tear types.Subjects and methodsA collection and analysis was made in the clinical,arthroscopy and MRI data of 100 patients with 104 knees,who underwent MRI and arthroscopy between Dec.2013 and May.2016 in our hospital.In 3D-MRI PDW-SPAIR(Proton Density-weighted with the fat suppuration of spectral attenuated inversion recovery)sequence,thin MPR of ACL was made in oblique coronal and transverse view,thin MPR of meniscus were made in transverse and coronal view.In this paper,the diagnosis sensitivity,specificity and accuracy will be compared between conventional 2D-MRI sequences and 3D-MRI PDW-SPAIR in the diagnosis of ACL injury and injury classification,and meniscus including discoid meniscus tear and tear types,and then,to evaluate the application of 3D-MRI in above applications.Results1.Comparison 2D-MRI and 3D-MRI with arthroscopy on ACL injuries diagnosis,the total sensitivity,total specificity and total accuracy of 2D-MRI and 3D-MRI were 88%and 93.4%,71.4%and 92.9%,83.6%and 93.3%,respectively.By Kappa test,the ACL injury results of 2D-MRI and arthroscopic diagnosis have a moderate degree of consistency,K=0.591;3D-MRI and arthroscopic diagnosis of ACL injury results have a high degree of consistency,K=0.835.2.Comparison 2D-MRI and 3D-MRI with arthroscopy on the diagnosis of 3 degree ACL injury,the sensitivity,specificity and accuracy of 2D-MRI and 3D-MRI were 81.8%and 94%,94.3%and 97.2%,90.3%and 96.2%,respectively.The sensitivity,specificity accuracy of 2D-MRI and 3D-MRI on the diagnosis of 2 degree ACL injury were 68%and 84%、89.8%and 97.5%、84,6%and 94.2%,respectively;The sensitivity,specificity accuracy of 2D-MRI and 3D-MRI on the diagnosis of 1 degree ACL injury were 66.7%and 88.9%、91.8%and 98.9%、87.5%and 97.1%,respectively.;3.Comparison 2D-MRI and 3D-MRI with arthroscopy on the diagnosis of meniscus tear,the sensitivity,specificity and accuracy of 2D-MRI and 3D-MRI were 77.2%and 91.8%、88%and 96%、79.8%and 92.8%,respectively.By Kappa test,the meniscus tear results of 2D-MRI and arthroscopic diagnosis have a moderate degree of consistency,K=0.541;3D-MRI and arthroscopic diagnosis of meniscus tear results have a high degree of consistency,K=0.817.4.Comparison 2D-MRI and 3D-MRI with arthroscopy on the diagnosis of various types of meniscus tear,the sensitivity are as follows:for complex tears,75.0%、and 89.6%;for horizontal tears,85.0%and 95.0%;for longitudinal tears,83.3%and 90.0%;for oblique tear,82.9%、95.1%;for bunket-handle tears,83.3%and 100%;for radial tears,85.7%and 100%.Conclusions1.Compared with the conventional 2D-MRI,there was higher diagnostic sensitivity,specificity and accuracy of 3D-MRI on ACL tear.It can effectively reduce the false positive and false negative,but for chronic ligament injury,it is easy to be escaped diagnosis.So it is necessary to closely combine the history and clinical physical examination.2.The 4 level(0-3level)was used as the standard for the classification of ACL injury.which was helpful for the clinical diagnosis and treatment.The sensitivity,specificity and accuracy of 3D-MRI were higher than that of 2D-MRI in the diagnosis of grade ACL injury of 1-3.3.The incidence of bone contusion,lateral collateral ligament injury and joint effusion was significantly higher in the acute ACL injury group than in the chronic group.The incidence of medial meniscus tear and cartilage injury in chronic ACL injury was significantly higher than in the acute group.4.Compared with the conventional 2D-MRI,there was higher diagnostic sensitivity,specificity and accuracy of 3D-MRI on meniscus tear.3D-MRI can more accurately evaluate meniscus tear types,and can provide more information for the choice of clinical treatment and the establishment of operation scheme. |
