MR Imaging–based Diagnosis and Classification of Meniscal Tears

Abstract

Magnetic resonance (MR) imaging is currently the modality of choice for detecting meniscal injuries and planning subsequent treatment. A thorough understanding of the imaging protocols, normal meniscal anatomy, surrounding anatomic structures, and anatomic variants and pitfalls is critical to ensure diagnostic accuracy and prevent unnecessary surgery. High-spatial-resolution imaging of the meniscus can be performed using fast spin-echo and three-dimensional MR imaging sequences. Normal anatomic structures that can mimic a tear include the meniscal ligament, meniscofemoral ligaments, popliteomeniscal fascicles, and meniscomeniscal ligament. Anatomic variants and pitfalls that can mimic a tear include discoid meniscus, meniscal flounce, a meniscal ossicle, and chondrocalcinosis. When a meniscal tear is identified, accurate description and classification of the tear pattern can guide the referring clinician in patient education and surgical planning. For example, longitudinal tears are often amenable to repair, whereas horizontal and radial tears may require partial meniscectomy. Tear patterns include horizontal, longitudinal, radial, root, complex, displaced, and bucket-handle tears. Occasionally, meniscal tears can be difficult to detect at imaging; however, secondary indirect signs, such as a parameniscal cyst, meniscal extrusion, or linear subchondral bone marrow edema, should increase the radiologist's suspicion for an underlying tear. Awareness of common diagnostic errors can ensure accurate diagnosis of meniscal tears. Online supplemental material is available for this article.

Diagnostic Accuracy of an MRI Protocol of the Knee Accelerated Through Parallel Imaging in Correlation to Arthroscopy

“…The menisci were evaluated on the basis of the diagnostic criteria according to Nguyen [15] and De Smet [16]. A tear was diagnosed according to the following criteria: Distortion of the meniscus or a signal increase reaching the joint surface on at least two images with a slice thickness of 3 mm.…”

Diz Eklemi: Meniskus ve Baglar

“…Uzaysal çözünürlük diz için yapılmış sargı kullanımı, büyük matriks, küçük FOV ve ince kesit kalınlığı ile iyileştirilebilir. Kullanılabilecek tipik parametreler; <16 cm FOV, en az 192 × 256 matriks (faz kodlama x frekans kodlama) ve 3-4 mm kesit kalınlığı olmalıdır [1]. Konvansiyonel spin eko (SE) ve hızlı spin eko sekanslar (FSE) (kısa ETL (<5) ve uzun bant aralığında) karşı-laştırıldığında, bu ikisinin meniskal yırtıkları saptama oranında farklılık olmadığı ifade edilir.…”

“…Konvansiyonel spin eko (SE) ve hızlı spin eko sekanslar (FSE) (kısa ETL (<5) ve uzun bant aralığında) karşı-laştırıldığında, bu ikisinin meniskal yırtıkları saptama oranında farklılık olmadığı ifade edilir. 2B ve 3B FSE teknikleri yırtıkları hemen hemen benzer doğrulukta saptamakla birlikte özellik-le kökü ilgilendiren lateral menisküs yırtıkları söz konusu olduğunda 3B FSE görüntülemenin düşük duyarlılığından bahsedilir [1]. Klasik olarak meniskal yırtık tanısında PD sekansının kullanılmasının T2-a görüntülere tercih edilmesi gerekliliği salık verilir [1].…”

Comparison of the Thesslay Test and McMurray Test: A Systematic Review of Comparative Diagnostic Studies

“…Furthermore meniscal injuries impose undue load and stress on the adjacent articular cartilage, predisposing the articular cartilage to damage and thus increasing the risk of early onset of osteoarthritis [2]. Research has demonstrated that injuries which occur within avascular regions of the menisci do not heal spontaneously [3].…”

“…Arthroscopy is widely considered the gold standard in the assessment of meniscal injuries, with evidence suggesting magnetic resonance imaging (MRI) is the most accurate non-invasive tool for detecting meniscal injuries [2]. The diagnostic value of MRI has however been questioned, particularly when used in isolation [6].…”