MRI of the knee: how do field strength and radiologist’s experience influence diagnostic accuracy and interobserver correlation in assessing chondral and meniscal lesions and the integrity of the anterior cruciate ligament?

Abstract

Accuracy of MRI reports is taken for granted. In this paper the inter-observer reliability in the interpretation of meniscal lesions, degree of chondropathy, and integrity of the ACL was analyzed while taking the radiologist's experience and field strength into account. Fifty-two MRI studies of knees were interpreted by 11 radiologists independently. Twenty-two were acquired on 1.0-T, 20 on 1.5-T, and 10 on 3.0-T systems. Four of the radiologists had more than 5 years and seven had 3 to 5 years of experience in interpreting MRI studies. The findings were compared with the intra-operative findings. Inter-observer variance, specificity, and sensitivity were evaluated for each field strength. Inter-observer correlation ranged between 0.370 for cartilage lesions and 0.597 for meniscal tears. Correlation values did not increase with experience or field strength. The number of false reports was dependent on the observer, but not on field strength. The rate of false interpretations was significantly higher for most criteria in the less experienced group. In conclusion, inter-observer correlation was low, although the diagnostic criteria were defined. The use of the classification scheme should be standardized by uniform training. Radiologist experience seems to be more important than field strength.

Interobserver Reliability among Radiologists and Orthopaedists in Evaluation of Chondral Lesions of the Knee by MRI

“…However, the lack of standardised interpretations of chondral lesions by MRI may result in disagreements between physicians from different specialties, leading to conflicting diagnoses and treatment strategies. Musculoskeletal MR exams are interpreted by both radiologists and orthopaedic surgeons in several institutions worldwide [8, 9]. Our hypothesis is that sole radiologists would have a higher interreader agreement than orthopaedic surgeons on the evaluation of chondral lesions by MRI, when orthopaedic surgeons do not have access to patient histories and physical examination results.…”

Magnetic resonance tomography of the knee joint

“…They also recommend the performance of a STIR sequence to further improve the system's diagnostic capabilities. The importance of the radiologist's qualification was shown in an Austrian study [20]: In MRI examinations of knee pathologies, the n=number of cases; *results from the studies included in Smith et al [9], all other results refer to the studies included in the meta-analysis of Oei et al [2] Forest plots can be obtained from the corresponding author upon request The results of the separate pooled weighted analyses for various categories of magnetic field strengths (not tabulated) suggested a modest trend toward better diagnostic performance for higher field strength categories. None of the differences were found to approach statistical significance, however, and the confidence intervals were all wide No differences between low-and highfield MR imaging in the detection of ACL tears number of false reports was dependent on the radiologist rather than on the MRI field strength, and the rate of false interpretations was significantly higher in the less experienced group of radiologists.…”

Diagnostic Accuracy of 0.2 Tesla Open MR Imaging Unit in Detecting Meniscal Tears: Correlation with Arthroscopy

“…The findings were compared with intra-operative findings. Inter-observer correlation was low and radiologist experience was found to be more important than field strength (12).…”

“…The experience of (12,6) arthroscopists and radiologists may also reveal different results (11). Krampla et al reviewed fifty-two MRI studies and analysed inter-observer reliability in the interpretation of meniscal lesions, degree of chondropathy and integrity of the ACL.…”