Diagnostic Efficacy of 3-T MRI for Knee Injuries Using Arthroscopy as a Reference Standard: A Meta-Analysis

Smith, Christian; McGarvey, Ciaran; Harb, Ziad; Back, Diane; Houghton, Russell; Davies, Andrew; Ajuied, Adil

doi:10.2214/ajr.15.15795

Cited by 30 publications

(33 citation statements)

References 49 publications

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“…Phelan et al summarized the results of 14 prospective studies and concluded that 2D sequences had a pooled sensitivity and specificity of 87% and 93%, respectively, for detecting ACL injuries . A recent meta‐analysis by Smith et al summarized the results of three studies performed using 3T MRI scanners and reported a pooled sensitivity and specificity for detecting ACL injuries of 92% and 99%, respectively . However, neither prior meta‐analyses found a significant improvement in diagnostic performance with the use of 3T scanners, which is in contrast with our findings.…”

Section: Discussioncontrasting

confidence: 93%

“…Furthermore, the comparison between the diagnostic performance of 3D sequences and simultaneously acquired 2D sequences revealed that both modalities have overall similar performance. Our pooled estimates of sensitivity and specificity of 3D sequences are also within the range of results of prior meta‐analyses, which reported sensitivity and specificity of 2D sequences for detecting ACL injuries . Phelan et al summarized the results of 14 prospective studies and concluded that 2D sequences had a pooled sensitivity and specificity of 87% and 93%, respectively, for detecting ACL injuries .…”

Section: Discussionsupporting

confidence: 79%

“…We observed that 3D sequences acquired on 3T scanners had significantly higher diagnostic performance for detecting ACL injuries than 3D sequences acquired on 1.5T or lower field strength scanners. This could be explained by the relatively small number of studies using 3T scanners included in the prior meta‐analyses …”

Section: Discussionmentioning

confidence: 99%

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

Shakoor

Guermazi

Kijowski

et al. 2019

Magnetic Resonance Imaging

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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.

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Section: Discussioncontrasting

confidence: 93%

Section: Discussionsupporting

confidence: 79%

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

Shakoor

Guermazi

Kijowski

et al. 2019

Magnetic Resonance Imaging

View full text Add to dashboard Cite

show abstract

“…Smith et al . (2016) proved that there is no evidence that 3T scanners had superior diagnostic efficacy for ACL injury when compared with 1.5T machines 11 . Similarly, Phelan et al .…”

Section: Discussionmentioning

confidence: 99%

“…Recent studies have compared the diagnostic accuracy of 1.5T MRI with 3.0T MRI 11 , MRI combined with ultrasonography 12 , and MRI combined with physical examination 8, 13 . However, the exact diagnostic accuracy of MRI for ACL injury is unknown, as are the differences in diagnostic accuracy between MRI with magnetic field intensities (MFI) greater than or equal to 1.5T compared with those below 1.5T, or between different MRI sequences, The objectives of this meta-analysis were to (i) systematically examine the diagnostic accuracy of MRI for the diagnosis of ACL injury; (ii) compare the diagnostic accuracy of MFI greater than or equal to 1.5T with MFI below 1.5T; and (iii) compare the diagnostic accuracy of different MRI sequences.…”

Section: Introductionmentioning

confidence: 99%

The diagnostic accuracy of magnetic resonance imaging for anterior cruciate ligament injury in comparison to arthroscopy: a meta-analysis

Huang

et al. 2017

Sci Rep

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We performed this meta-analysis to examine the diagnostic accuracy of MRI for the diagnosis of anterior cruciate ligament (ACL) injury in comparison to arthroscopy. We also compared the diagnostic accuracy of MRI with magnetic field intensities (MFI) greater than or equal to 1.5T with those below 1.5T, in addition to different MRI sequences. Studies relevant to the diagnosis of ACL injury by MRI and arthroscopy were analyzed. Computer and manual retrieval were carried out on studies published between January 1, 2006 and May 31, 2016. Twenty-one papers were included. Neither threshold nor non-threshold effects were present (p = 0.40, p = 0.06). The pooled sensitivity (SE), specificity (SP), positive likelihood ratio (LR+), negative likelihood ratio (LR−) and diagnostic odds ratio (DOR) with 95% confidence interval (CI) were 87% (84–90%), 90% (88–92%), 6.78 (4.87–9.44), 0.16 (0.13–0.20) and 44.70 (32.34–61.79), respectively. The area under the curve (AUC) was 0.93. The risk of publication bias was negligible (p = 0.75). In conclusion, examination by MRI is able to provide appreciable diagnostic performance. However, the principle, which states that the higher the MFI, the better the diagnostic accuracy, could not be verified. Additionally, conventional sequences (CSs) associated with proton density-weighted imaging (PDWI) are only slightly better than CSs alone, but not statistically different.

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Primary care referral for knee MRI in the United Kingdom: Association with demography and subsequent surgical intervention

Jayaram

Sun

Coombes

et al. 2019

Magnetic Resonance Imaging

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Background Since 2008 primary care physicians (GPs) in our region have been allowed open access to knee MRI scans. There are questions about whether this changes referral practice and if it is an effective use of resources. Purpose To describe the change in demographics of patients referred for knee MRI following implementation of a new referral pathway. Study Type Retrospective observational study. Population All primary care referrals between 2008 and 2015 for knee MRI from a population of 900,000. Field Strength/Sequence Not applicable. Assessment Demographic profile and number of knee MRI referrals and subsequent arthroscopies. Statistical Tests Comparisons between urban and rural populations used the t‐test. Test for normality used Shapiro–Wilks. Comparison between abnormal MRI proportions used a chi‐squared test. Results There were 23,928 knee MRI referrals (10,695 from GPs) between 2000 and 2015. MRI knee referrals rose from 210 in 2008 to 2379 in 2015. The average age of the patient decreased from 46.8 (SD = 14.9) in 2008 to 41.3 (SD = 14.7) in 2015. Conversion to arthroscopy declined from 15.4% to 10.2%, but there was no significant change in abnormal scan proportion. Conversion rates showed no significant difference between rural (9.6%) and urban populations (10.5%). Referral rates were significantly higher in low socioeconomic status areas (47.3% vs. 34.6%). The median referral rate per 1000 patients was 13.8 (interquartile range = 8.4). Referral rates varied widely between practices. Data Conclusion Despite a large rise in knee MRI referrals from primary care, there has been no substantial change in the age profile, suggesting that there has been no increase in inappropriate referral of elderly patients in whom MRI is unlikely to influence management. A modest decrease in the conversion rate to arthroscopy may be reasonably offset against a decrease in secondary care referrals. Socioeconomic status of the target population must be considered when planning primary care knee MRI services. Level of Evidence: 4 Technical Efficacy Stage: 6 J. Magn. Reson. Imaging 2019.

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Diagnostic Efficacy of 3-T MRI for Knee Injuries Using Arthroscopy as a Reference Standard: A Meta-Analysis

Abstract: This study does not provide evidence that 3-T scanners have superior diagnostic efficacy for meniscal damage and ACL integrity when compared with previous studies of 1.5-T machines.

Cited by 30 publications

References 49 publications

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

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

The diagnostic accuracy of magnetic resonance imaging for anterior cruciate ligament injury in comparison to arthroscopy: a meta-analysis

Primary care referral for knee MRI in the United Kingdom: Association with demography and subsequent surgical intervention

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