Diagnostic Value of Oblique Coronal and Oblique Sagittal Magnetic Resonance Imaging (MRI) in Diagnosis of Anterior Cruciate Ligament (ACL) Tears

Abstract

Introduction Tears of the anterior cruciate ligament (ACL) are common among young athletes and diagnosis may be difficult especially in the young population. Therefore, finding a new method to increase the correct diagnosis is necessary. Materials and Methods This double-blind prospective observational study was conducted on 51 patients with suspected ACL rupture. In this study, in addition to the standard protocols, the oblique-sagittal and oblique-coronal MRI were assessed and used in three different methods, including A method (orthogonal MRI protocol), B method (orthogonal MRI protocol and oblique-sagittal MRI), and C method (orthogonal MRI protocol and oblique-coronal MRI). Results In detecting both complete and partial rupture of ACL, B method had highest diagnostic accuracy (kappa = 0.338, P=0.001), and after that, C method had acceptable accuracy (kappa = 0.292, P=0.011). In addition, in detecting a partial rupture of ACL, B method (kappa = 0.5, P<0.001), and C method had acceptable accuracy (kappa = 0.361, P=0.006). Meanwhile, in detecting a complete rupture of ACL, B method had the highest diagnostic accuracy (kappa = 0.898, P<0.001), and subsequently A method had significant accuracy (kappa = 0.812, P<0.001). Conclusions Our results showed that the evaluation of ACL rupture by oblique-sagittal MRI in addition to orthogonal MRI protocol is accurate and with high sensitivity and specificity values. It allows to find abnormal images immediately with higher accuracy in the emergency department and more critically ill patients may benefit from the advantages of this imaging protocol.

A new modified MR dual precision positioning of thin-slice oblique sagittal fat suppression proton density weighted imaging: its diagnostic accuracy in anterior cruciate ligament injury

“…The misdiagnosis rate of anterior cruciate ligament (ACL) tear of the knee joint is as high as 47% due to the confusion of high signal generated by synovial hyperplasia and partial volume effect on the standard MRI sequences 8 . A study revealed the evaluation of ACL tear by standard MRI sequences with additional oblique-sagittal plane showed high sensitivity and specificity 15 , 18 . Furthermore, another study using two additional oblique sequences (sagittal and coronal) to evaluate the ACL tear concluded that the use of oblique coronal and oblique sagittal MRI of the knee improved the diagnostic accuracy of the ACL tear 19 .…”

“…The study using two additional oblique sequences (sagittal and coronal) to evaluate the ACL tear concluded that the usage of oblique coronal and oblique sagittal MRI of the knee improved the diagnostic accuracy of the ACL tear 19 . Furthermore, another study revealed the evaluation of ACL tear by standard MRI sequences with additional oblique-sagittal plane showed high sensitivity and specificity compared to a standard MRI protocol 18 . The results in these studies are similar to ours and we further found that our new modified DPP-TSO-Sag-FS-PDWI sequence can maximize the acquisition of ACL complete and true anatomical images and exclude the influence of anatomical differences between individuals, which is helpful to improve the authenticity and accuracy of ACL scanning images and to improve the diagnostic accuracy of ACL injury with its three grades.…”