The Evaluation Of The Diagnosis And Clinical Application Of Knee Joint Cartilage, Meniscus And Ligament Injures With MRI

The Evaluation of the Diagnosis and Clinical Application of Knee Joint Cartilage, Meniscus and Ligament Injures with MRIAs the largest, most complex joint of the human body, the knee is easily injured by the inappropriate exercise, car crashes and other accidents. The traditional method of imaging studies (X-ray, CT) can only show the fracture and other simple injuries clearly, but it is difficult for it to judgment the bone contusion of the knee, articular cartilage damage, meniscus,ligaments and other soft tissue injuries. CT arthrography have improved the accuracy of the diagnosis of knee cartilage and soft tissue injury, however, it is invasive and limited by CT scanning angle,the radiation dose and other factors, so it’s rarely used in clinical practice. Arthroscopy has been proved to be the gold standard for diagnosis of knee injury, but it’s difficult for arthroscopy to be widely used in the preliminary diagnosis of clinical practice because of its invasion, blind spots and other shortcomings. By virtue of no damage, no radiation, multi-faceted, multi-parameter, multi-sequence imaging, high soft tissue contrast, high spatial resolution and other advantages, MRI has been the best screening method for evaluation of knee injury, and has been widely used for diagnosis of knee injury in foreign countries.Objective:Comparing with arthroscopy, to evaluate the classification diagnosis of the meniscus, ligament and cartilage damage by conventional MRI sequences.Materials and Methods:Collect152cases, a total of173knee joints, who were confirmed to have knee injury from January2009to February2012in the Orthopedics of Jilin University China-Japan union Hospital; male93,106knee joints, female59,67knee joints, age16-74, average age45years old. Method:Use1.5T MR scanner, knee joints exterior loop and chose five MRI series (sagittal FSE-T1WI、FSE-T2WI、FS-PDWI; coronal FSE-T1WI、 FS-PDWI). Two physicians in our department evaluate the knee MRI images based on the diagnostic criteria by double blind method, and record the diagnostic conclusions. When two views are not uniform, the third physicians evaluate again, whichever is consistent as the final diagnosis. Take arthroscopic exploratory surgery within2weeks after MRI, evaluate knee injury and record the diagnostic conclusions. Results of MRI classification diagnosis compared with the results of arthroscopic, processing data and draw conclusions.Results:1. The sensitivity, specificity and accuracy of the lateral meniscus were90.2%,95.1%,92.8%by conventional sequences of MRI. Kappa value=0.726, indicating that the MRI findings and arthroscopic have excellent consistency, the Kappa value was statistically significant (p<0.5).2. Application of χ2test to assess differences of the internal and lateral meniscus diagnosis by MRI, There was no significant difference in the the sensitivity of the two groups (χ2=0.046, P>0.75), specificity (χ2=0.015, P>0.75) and accuracy (χ2=0.015, P>0.75).3. The sensitivity, specificity and accuracy of ACL were87.0%,94.1%,91.9%by conventional sequence of MRI. MRI findings and arthroscopic have excellent consistency (Kappa value=0.719, p<0.5).4. The sensitivity, specificity and accuracy of PCL were91.3%,96.8%,95.3%by conventional sequences of MRI. MRI findings and arthroscopic have good consistency (Kappa value=0.657), the Kappa value was statistically significant (p<0.5).5. The sensitivity, specificity and accuracy of collateral ligament were90.9%,97.1%,95.9%by MRI. MRI findings and arthroscopic have excellent consistency (Kappa value=0.845. p<0.5). 6. The sensitivity, specificity and accuracy of cartilage were39.1%,98.8%,67.1%by MRI. MRI findings and arthroscopic have poor consistency (Kappa value=0.343, p<0.5).Conclusion:1.1.5T MRI knee conventional scanning sequences have different diagnostic capabilities to articular cartilage, meniscus and ligament injury, the sensitivity and accuracy of meniscus and ligament injury are higher than these of articular cartilage, and specificity of all three are higher (>90%).2.1.5T MRI classification diagnostic results of meniscus and ligament injury have good consistency with arthroscopic result; however, MRI results of articular cartilage injury have poor consistency with arthroscopic result.3. Using MRI, the sensitivity (χ2=1.346, P>0.75), specificity (χ2=0.076, P>0.75), accuracy (χ2=0.472, P>0.50) of ACL and PCL have no significant difference, effectiveness of ACL and PCL diagnosis don’t have significant difference by MRI.4. Injury classification diagnosis of knee cartilage, meniscus, and ligament injury is of great significance to clinical diagnosis, treatment options and prognosis.