Knee MRI Underestimates the Grade of Cartilage Lesions (original) (raw)
Related papers
European Radiology, 2020
Objective To assess the performance of a morphological evaluation, based on a clinically relevant magnetic resonance imaging (MRI) protocol, in scoring the severity of knee cartilage damage. Specifically, to evaluate the reproducibility, repeatability, and agreement of MRI evaluation with the gross pathology examination (GPE) of the tissue. Methods MRI of the knee was performed the day before surgery in 23 patients undergoing total knee arthroplasty. Osteochondral tissue resections were collected and chondral defects were scored by GPE according to a semi-quantitative scale. MR images were independently scored by four radiologists, who assessed the severity of chondral damage according to equivalent criteria. Inter-and intra-rater agreements of MRI evaluations were assessed. Correlation, precision, and accuracy metrics between MRI and GPE scores were calculated. Results Moderate to substantial inter-rater agreement in scoring cartilage damage by MRI was found among radiologists. Intrarater agreement was higher than 96%. A significant positive monotonic correlation between GPE and MRI scores was observed for all radiologists, although higher correlation values were obtained by radiologists with expertise in musculoskeletal radiology and/or longer experience. The accuracy of MRI scores displayed a spatial pattern, characterized by lesion overestimation in the lateral condyle and underestimation in the medial condyle with respect to GPE. Conclusions Evaluation of knee cartilage morphology by MRI is a reproducible and repeatable technique, which positively correlates with GPE. Clinical expertise in musculoskeletal radiology positively impacts the evaluation reliability. These findings may help to address limitations in MRI evaluation of knee chondral lesions, thus improving MRI assessment of knee cartilage. Key Points • MRI evaluation of knee cartilage shows moderate to strong correlation with gross pathology examination. • MRI evaluation overestimates cartilage damage in the lateral condyle and underestimates it in the medial condyle. • Education and experience of the radiologist play a role in MRI evaluation of knee chondral lesions.
Arthroscopy: The Journal of Arthroscopic & Related Surgery, 2007
To determine the incidence and morphologic characteristics of knee chondral lesions found at arthroscopy and their correlation with magnetic resonance imaging (MRI). Methods: This is a prospective study on 190 consecutive knee arthroscopic procedures performed between March 2003 and February 2004 by the same surgical team. The study group's age average was 34.8 years (14 to 77 years). The indication for surgery included anterior cruciate ligament tears, meniscal tears, and anterior knee pain. Patients without a preoperative MRI study were excluded. MRI reports were performed by qualified radiologists in all the cases. Chondral lesions were classified according to the International Cartilage Repair Society (ICRS) classification and were included in a database along with the MRI reports. The results were analyzed statistically with analysis of variance, Pearson, kappa, and -square tests. Results: One hundred fifteen chondral lesions in 82 patients were found during the arthroscopic procedure. Most of them were single lesions (72%) located on the medial femoral condyle (32.2%) or medial patellae (22.6%); 62.6% of the lesions were classified as ICRS type 2 or 3-A, with an average surface of 1.99 cm 2 . We found a significant direct correlation between the patient's age and the size of the lesion (P ϭ .001). MRI sensitivity was 45% with a specificity of 100%. The sensitivity increased with deeper lesions (direct relation with the ICRS classification). Our results showed a statistical power of 100%. Conclusions: Although unenhanced MRI using a 1.5-Tesla magnet with conventional sequences (proton density-weighted, T1-weighted, and T2weighted) is most accurate at revealing deeper lesions and defects at the patellae, our study shows that a considerable number of lesions will remain undetected until arthroscopy, which remains the gold standard. Level of Evidence: Level III, diagnostic study of nonconsecutive patients.
3.0-Tesla MRI and Arthroscopy for Assessment of Knee Articular Cartilage Lesions
Orthopedics, 2013
The purpose of this study was to evaluate the ability of 3.0-Tesla magnetic resonance imaging (MRI) to accurately assess knee articular cartilage lesions. Sixteen patients who had knee 3.0-T MRI and underwent knee arthroscopy for partial meniscectomy were included. Three fellowship-trained sports medicine orthopedic surgeons reviewed all images. Articular lesions on MRI were graded from I to IV and compared with arthroscopic grading using the Outerbridge and the International Cartilage Repair Society (ICRS) classifications. The articular surface was divided into 6 regions. Based on MRI findings, of the 288 articular surface evaluations, 113 (39%) surface evaluations were classified as disease-positive (grade 2 to 4). Kappa interrater reliability scores for MRI evaluation, Outerbridge classification, and ICRS classification were 0.13, 0.54, and 0.41, respectively. Using the Outerbridge classification as a reference standard, the sensitivity, specificity, and accuracy were 57%, 71%, and 63%, respectively. Using the ICRS classification, sensitivity, specificity, and accuracy were 59%, 71%, and 69%, respectively. When isolating the articular grading to the senior author on MRI evaluation vs Outerbridge classification, the sensitivity, specificity, and accuracy were 54%, 92%, and 75%, respectively. Based on the current findings, 3.0-T MRI is as an invaluable noninvasive tool with good diagnostic value for assessing articular cartilage lesions of the knee, although it may not be as sensitive and accurate as previously reported.
Radiološke tehnologije, 2021
Introduction: The knee joint has a unique anatomical structure in the human body. The localization between the two longest bones in the human body – femur, and tibia – makes it prone to injuries, trauma, and other pathologies. Clinical examination of the joint is still the primary method in evaluating the condition of the patient's knee. The study aims to determine the diagnostic accuracy of clinical examination and magnetic resonance (MR) in assessing chondral lesions of knee joint using arthroscopy as a reference standard.Patients and methods: The examination was conducted on 94 patients (58 males and 36 females) with knee injuries. Clinical examination indicated a primary chondral lesion of knee cartilage in eight patients (five men and three women), with an average age of 45.75. Besides the clinical examination, the diagnostics were performed using MR imaging by Siemens of 0.5 Tesla, and arthroscopy was performed using Storz arthroscope.Results: Our research has generated th...
Istanbul Medical Journal
Recent progresses in new surgical methods and drugs enable to help delay chondral degeneration and possibly heal post-traumatic chondral changes (5). Therefore, detailed high-resolution diagnostic methods are becoming an obligation to grade and differentiate cartilage pathologies of the knee joint in early and advanced stages. Efficiency of Magnetic Resonance Imaging in Regional Diagnosis and Classification of Advanced Chondropathies of Knee Joint Objective: Today, magnetic resonance imaging (MRI) procedures used to detect and measure articular hyaline cartilaginous defects are being increasingly investigated. In this study, we evaluated the sensitivity and diagnostic efficiency of MRI in the detection of particularly advanced cartilage pathologies compared to the arthroscopic results. Methods: In this study, we enrolled 16 male (%38.1) 26 female (%61.9) patients who applied to Şişli Hamidiye Etfal Education and Research Hospital with complaints of throbbing knee pain after long walks and uneasiness during climbing stairs and whose arthroscopies were already scheduled. Forty-two knee joints were evaluated using routine fat-saturated T2-weighted fast spin echo (FSE), sagittal T1, sagittal fat-suppressed proton density (PD) FSE, and coronal short inversion time inversion recovery (STIR) sequences. The MRI results were retrospectively analyzed and compared with the arthroscopic outcomes. Results: The comparison of advanced cartilage lesions at the specified six regions of the knee joint detected using sagittal fat saturated T2-and axial T2-weighted sequences with arthoscopic results revealed that 199 out of 252 regions results showed concordance. At a total number of 38 regions, MRI results failed to detect cartilage lesions, and at 15 regions, the MRI evaluated pathologic results, while arthroscopy revealed normal results. The success of MRI in grading cartilage defects and its concordance with arthroscopy were higher at the medial condyl of the femur and patellar facets. Conclusion: Although MRI is the leading imaging modality due to its high sensitivity and diagnostic efficiency, particularly in detecting advanced cartilage pathologies, the magnetic power of the device and the sequences used are important to obtain optimal images. Although the success rates of different sequences in different planes in detecting and grading chondropathy vary in studies, MRI reaches high accuracies in detecting and grading advanced cartilage lesions with the use of appropriate sequences.
Journal of orthopaedic surgery and research, 2015
Arthroscopy is considered as "the gold standard" for the diagnosis of traumatic intraarticular knee lesions. However, recent developments in magnetic resonance imaging (MRI) now offer good opportunities for the indirect assessment of the integrity and structural changes of the knee articular cartilage. The study was to investigate whether cartilage-specific sequences on a 3-Tesla MRI provide accurate assessment for the detection of cartilage defects. A 3-Tesla (3-T) MRI combined with three-dimensional double-echo steady-state (3D-DESS) cartilage specific sequences was performed on 210 patients with knee pain prior to knee arthroscopy. Sensitivity, specificity, and positive and negative predictive values of magnetic resonance imaging were calculated and correlated to the arthroscopic findings of cartilaginous lesions. Lesions were classified using the modified Outerbridge classification. For the 210 patients (1260 cartilage surfaces: patella, trochlea, medial femoral condyl...
Association between quantitative MRI and ICRS arthroscopic grading of articular cartilage
Knee surgery, sports traumatology, arthroscopy : official journal of the ESSKA, 2014
To investigate the association of quantitative magnetic resonance imaging (qMRI) parameters with arthroscopic grading of cartilage degeneration. Arthroscopy of the knee is considered to be the gold standard of osteoarthritis diagnostics; however, it is operator-dependent and limited to the evaluation of the articular surface. qMRI provides information on the quality of articular cartilage and its changes even at early stages of a disease. qMRI techniques included T 1 relaxation time, T 2 relaxation time, and delayed gadolinium-enhanced MRI of cartilage mapping at 3 T in ten patients. Due to a lack of generally accepted semiquantitative scoring systems for evaluating severity of cartilage degeneration during arthroscopy, the International Cartilage Repair Society (ICRS) classification system was used to grade the severity of cartilage lesions. qMRI parameters were statistically compared to arthroscopic grading conducted with the ICRS classification system. qMRI parameters were not li...
Cartilage, 2013
Objective. To evaluate the accuracy of arthroscopic measurement of full-thickness (International Cartilage Repair Society grades 3-4) cartilage lesions of the knee. Design. In 33 consecutive arthroscopically evaluated cartilage lesion knees the lesion size was routinely estimated. At the final treatment, a knee arthrotomy was performed, and the lesion was reestimated. The 2 estimates were then compared by paired t test and the area estimated by knee arthrotomy was used as the gold standard. Results. The mean area of the cartilage lesion estimated by arthroscopic surgery was 3.5 cm 2 (standard deviation [SD] = 1.7) whereas in the open surgery the mean area was 3.2 cm 2 (SD = 1.5). The mean difference was 0.3 cm 2 , indicating a tendency toward overestimation by the arthroscopic evaluation, but the difference was not significant (P = 0.09). Additional MRI assessment of the area demonstrated a mean area of 2.3 cm 2 (SD = 1.6). This underestimated the size of the lesion by 1.2 cm 2 (SD = 0.8; P = 0.015). Conclusion. Knee arthroscopic examination estimated a cartilage fullthickness lesion with an error of less than 25 % in the majority of the patients.
Knee MR-arthrography in assessment of meniscal and chondral lesions
Orthopaedics & Traumatology: Surgery & Research, 2009
Introduction. -No study, so far in France, has investigated the diagnosis value of knee MRarthrography since the recent approval of intra-articular gadolinium use, by this country's healthcare authorities. This study objective is to verify the MR-arthrography superiority on conventional knee MRI, in meniscus and cartilage knee lesions diagnosing accuracy both in regard to sensitivity and specificity. Hypothesis. -MR-arthrography, represents in some pathologic situations, a more accurate source of information than conventional MRI. Materials and methods. -Over a 27 months period, 25 patients, scheduled to undergo a knee arthroscopy volunteered, after having been fully informed of the possible interest and risk of the MR-arthrography examination, to participate in this study. Twenty-one of them were finally included since in four cases the surgical indication was not confirmed. The group consisted of 15 males and six females with an average age of 35.7 years. All of them consecutively underwent conventional MRI, MR-arthrography finally followed by arthroscopy. The MRI and MR-arthrograms results were compared to the arthroscopy findings using the nonparametric Kappa test.