Accuracy of 3 Tesla magnetic resonance imaging using detection of fiber loss and a visual analog scale for diagnosing partial and complete cranial cruciate ligament ruptures in dogs

Abstract

Canine cranial cruciate ligament rupture is often bilateral and asymmetrical, ranging from partial to complete rupture. The purpose of our diagnostic accuracy study was to assess the accuracy of 3 Tesla magnetic resonance imaging (MRI) detection of fiber loss and use of a visual analog scale in the diagnosis of complete versus partial cranial cruciate ligament rupture in 28 clinical dogs with unilateral complete rupture and contralateral partial rupture. Three Tesla MRI was performed on 56 stifles using sagittal sequences (T2-weighted fast spin echo with fat saturation, proton density fast spin echo, and T2-weighted 3D fast spin echo CUBE). Two MRI observers assessed the cranial cruciate ligament for fiber loss and completed a visual analog scale. The MRI data were compared to arthroscopy and clinical status. Accuracy classifying partial or complete rupture was assessed using receiver operating characteristic analysis. Compared to arthroscopy, for complete cranial cruciate ligament rupture, sensitivity, specificity, and accuracy of MRI detection of fiber loss were 0.78, 0.50-0.60, and 0.68-0.71, respectively, and, for partial tears, specificity was 1.00. An MRI In stifles with clinically unstable complete cranial cruciate ligament rupture, both MRI tests are sensitive though not specific compared to arthroscopy. As a diagnostic imaging method, MRI may help guide treatment in patients with cranial cruciate ligament damage, particularly for stable partial rupture.

Correlation between orthopaedic and radiographic examination findings and arthroscopic ligament fibre damage in dogs with cruciate ligament rupture

“…This could be accomplished by arthroscopic examination of the contralateral stifle in dogs with evidence of contralateral synovial effusion or osteophytosis, but would have required an additional surgical procedure. The easurement of cranial tibial subluxation on weight‐bearing radiographs and the use of ultrasound or MR imaging would also have provided additional useful data for correlation with cruciate ligament fibre damage.…”

“…Arthroscopic stifle examination is the current gold standard for the identification of CrCL and CaCL fibre damage, as it provides a direct magnified view of the surface of the ligaments and enables ligament probing to assess rupture of fibre bundles . Ultrasound and magnetic resonance (MR) imaging can also be used to examine the cruciate ligaments and assess fibre damage. These imaging methods enable the examination of the entire volume of the ligament and not just surface features.…”

“…In a recent study, ultrasonography had a low sensitivity of 50% in the diagnosis of CR . MR imaging using a 3 Tesla scanner with a 3D FSE CUBE sequence can provide excellent images of the cruciate ligaments, menisci, articular cartilage and soft tissue structures of the stifle, but availability for clinical imaging is limited.…”

Ultrasonographic Evaluation of Dogs with Cranial Cruciate Ligament Rupture Undergoing to Arthrotomy

“…Na avaliação ultrassonográfica do LCCr tentamos identificar as fibras do ligamento e parte do [25]. Na ressonância magnética (RM) de alto campo lesões envolvendo mais de 79% das fibras são dificilmente diferenciadas da ruptura completa [13]. Apesar da artrotomia minimamente invasiva, poder limitar a visualização dos ligamentos cruzados [2], estudo anterior não observou diferença na identificação das rupturas parciais e completas entre a artrotomia e a artroscopia [25].…”

“…Ocorre com maior frequência pela degeneração do ligamento que pela lesão traumática [18]. Cães com RLCCr completa ou quase completa [13], apresentam instabilidade articular, que pode ser diagnosticada pelos testes de compressão tibial e movimento de gaveta durante o exame clínico [19]. A ruptura parcial envolvendo menos de 75-79% das fibras, geralmente não causa instabilidade [13,25], sendo de difícil diagnóstico.…”