Magnetic Resonance Arthrography And Non-enhanced Magnetic Resonance Imaging In The Diagnosis Of Plica Synovialis Mediopatellaris Of Knee Joint

PurposeTo analysis the ability of MR arthrography(MRA)and regular magnetic resonance imaging(MRI)on finding plica synovialis mediopatellaris(PSM)and it's typing,and to evaluate the value of both in the diagnosis of mediopatellar plica syndrome(MPS)in using1.5 T magnetic resonance.This research includes two parts: The first part,to analysis the ability of MRA on finding PSM and it's typing,and to evaluate the value of MRA in the diagnosis of MPS.The second part,to analysis the ability of regular MRI on finding PSM and it's typing,and to evaluate the value of regular MRI in the diagnosis of MPS.And comparing the value between MRA and regular MRI in the diagnosis of PSM and MPS.Materials and methods1.MRAFrom July 2014 to February 2016,One hundred and six knee joints of one hundred and one patients who underwent MRA in Jinan Military General Hospital were chosen sequentially(Inclusion criteria: first,all patients implemented arthroscopy,and arthroscopy was implemented within two months(1-60 days)after MR arthrography;second,the data of MRA and arthroscopic surgery of the patients can be get;third,patients had clinical signs sunch as: anteromedial knee pain or mechanical symptoms such as locking and snapping).All MRA imaging of knee joints were analyzed.The exist of PSM and the type(if existed)of PSMs were evaluated.Meanwhile,the exist of MPS of patients were evaluated.Taking arthroscopy as the golden standard,sensitivity and specificity of diagnosing PSM,classifications and MPS using MRA were caculated.Consistency was tested by Kappa value between the result of MRA and that of arthroscopy in the diagnosis of PSM,classification and MPS.2.Conventional MRIOne hundred and twelve knee joints of one hundred and three patients who underwent regular MRI in Jinan Military General Hospital from August 2014 to April 2016 were chosen sequentially(Inclusion criteria: first,all patients implemented arthroscopy,and it was implemented within two months(1-60 days)after regular MRI;second,the data of MRI and arthroscopic surgery of the patients can be get;third,patients had clinical symptoms as follow: anteromedial knee pain or mechanical symptoms such as locking and snapping).All cases' MRI were analyzed.The exist of PSM and the type(if existed)of PSMs were evaluated.Meanwhile,the exist of MPS of patients were evaluated.Taking arthroscopy as the golden standard,sensitivity and specificity of diagnosing PSM and MPS using regular MRI were caculated.Consistency was tested by Kappa value between the result of MRI and that of arthroscopy in the diagnosis of PSM,classification and MPS.Results1.MRA resultIn 106 knees of 101 patients,PSMs were found in 70 ones in MRA,and 69 ones were confirmed by arthroscopy.The result of 63 cases was exactly the same with the classification result of arthroscopy(24 type A,19 type B,17 type C,3 type D).The total sensitivity was 95.8%,the total specificity was 97.1%.The sensitivity of each type was88.9% type A,86.4% type B,85.0% type C,100.0% type D;The specificity of each type was 96.2% type A,97.6% type B,98.8% type C,96.7% type D respectively.The classification result of PSM in MRA was compared with that of arthroscopy,consistency is wonderful(Kappa=0.875).Meanwhile,MPSs were found in 16 ones in MRA,the same result with arthroscopy 14 ones.The sensitivity and specificity was 87.5% and 97.8%respectively in MRA diagnosing MPS.The MRA result for diagnosing MPS was compared with that of arthroscopy,consistency is good(Kappa=0.853).2.Conventional MRI resultIn 112 knees of 103 patients,PSMs were found in 51 ones in regular MRI and the same result with arthroscopy 39 ones,and can not be classified.The sensitivity and specificity were 51.3% and 66.7% respectively in MRI diagnosing PSM,the MRI result for diagnosing PSM was compared with that of arthroscopy,consistency is worse(Kappa=0.235).Meanwhile,MPSs were found in 17 ones in regular MRI,the same result with arthroscopy 15 ones,2 cases were diagnosed excessively.The sensitivity and specificity was 83.3% and 97.9% respectively in MRI diagnosing MPS.The MRI result for diagnosing MPS was compared with that of arthroscopy,consistency is excellent(Kappa=0.831).Conclusion1.MRA of knee can accurately find PSM and its exact type,and has higher accuracy in the diagnosis of MPS.2.Conventional MRI can not accurately diagnosis normal PSM,typing it,but has higher accuracy in the diagnosis of MPS.3.When the clinical suspicion of the MPS,Only Conventional MRI can make an accurate diagnosis.However,MRA is better than MRI in the diagnosis of PSM and it's typing.