Cruciate ligament injuries of the knee: A meta‐analysis of the diagnostic performance of 3D MRI

Abstract

Background Despite the advantages of 3D MRI in evaluation of cruciate ligament injuries, its use in clinical practice is still a matter of debate due to controversy regarding its diagnostic performance. Purpose To evaluate the diagnostic performance of 3D MRI for detecting cruciate ligament injuries, using surgery or arthroscopy as the reference standard. Study Type Meta‐analysis. Population Patients with knee pain. Field Strength/Sequence 3D and 2D MRI. Assessment Four databases were reviewed according to PRISMA guidelines. Statistical Tests Pooled values of sensitivity, specificity, and diagnostic odds ratio (DOR) were calculated using a random‐effects model. To investigate the effect of relevant covariates on the diagnostic performance of 3D MRI, sensitivity analysis was performed using meta‐regression to calculate relative DOR. Results Of 731 initially identified reports, 22 (1298 3D MRI examinations) met our criteria and were included. Pooled estimates of sensitivity and specificity for 3D sequences were 91.4% (95% confidence interval [CI]: 87.4–94.2%) and 96.1% (95% CI: 93.8–97.6%), respectively. Fourteen studies also reported the results of 2D MRI, with pooled sensitivity of 90.6% (95% CI: 84.1–94.6%) and specificity of 97.1% (95% CI: 94.7–98.4%), which were not significantly different from 3D sequences. 3D MRI sequences performed using 3T scanners had significantly higher DOR compared with 3D sequences performed on 1.5T or lower scanners (relative DOR: 6.04, P = 0.01). Data Conclusion 3D MRI is equivalent to 2D MRI in the diagnosis of cruciate ligament injuries. The use of 3T scanners improves the performance of 3D MRI for detecting cruciate ligament injuries. Level of Evidence: 2 Technical Efficacy: Stage 2 J. Magn. Reson. Imaging 2019;50:1545–1560.

Standard MRI May Not Predict Specific Acute Anterior Cruciate Ligament Rupture Characteristics

“…24 Additional oblique scans in the coronal and axial planes improve visualization of the ACL, and a 3-dimensional MRI sequence might provide more information on the ACL rupture characteristics. 1,12,20,22,25,26 Furthermore, it has been reported that MRI performed with the knee in flexion instead of extension improves accuracy in the diagnosis of partial and complete ACL ruptures in general. Although not investigated, this might improve the accuracy of MRI for classifying the characteristics of complete ACL rupture that were investigated in the present study.…”

Osteoarthritis year in review 2020: imaging

“…A meta-analysis of 22 reports evaluating the diagnostic performance of MRI in detecting cruciate ligament injuries identified 3D MRI to be equivalent to 2D MRI, and 3D MRI at 3 Tesla (T) to be more accurate than at 1.5 T, with surgery or arthroscopy being the reference standard 6 . A study on a fully automated approach for detecting Anterior cruciate ligament (ACL) tears 7 is summarized in the chapter on DL below.…”

3D MRI: Technical Considerations and Practical Integration

“…The 2D and 3D FSE and TSE pulse sequences have similar diagnostic performance for the detection of articular cartilage defects, meniscus tears, and intercrucial ligament tears in the knee. [22][23][24] 3D Gradient-echo Acquisitions Unlike TSE sequences, GRE sequences use an RF excitation pulse angle α < 90 degrees (►Fig. 2b).…”