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Prospective Comparison of 1.5 and 3.0-T MRI for Evaluating the Knee Menisci and ACL
Pieter Van Dyck, MD1; Filip M. Vanhoenacker, MD, PhD1; Valérie Lambrecht, MD2; Kristien Wouters, MSc, PhD1; Jan L. Gielen, MD, PhD1; Lieven Dossche, MD1; Paul M. Parizel, MD, PhD1
1 Departments of Radiology (P.V.D., F.M.V., J.L.G., P.M.P.), Biostatistics (K.W.), and Orthopedics (L.D.), Antwerp University Hospital and University of Antwerp, Wilrijkstraat 10, 2650 Antwerp (Edegem), Belgium. E-mail address for P. Van Dyck: pieter.van.dyck@uza.be
2 Department of Radiology, Ghent University Hospital and University of Ghent, De Pintelaan 185, 9000 Ghent, Belgium
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Investigation performed at Antwerp University Hospital and the University of Antwerp, Antwerp (Edegem), Belgium



Disclosure: None of the authors received payments or services, either directly or indirectly (i.e., via his or her institution), from a third party in support of any aspect of this work. None of the authors, or their institution(s), have had any financial relationship, in the thirty-six months prior to submission of this work, with any entity in the biomedical arena that could be perceived to influence or have the potential to influence what is written in this work. Also, no author has had any other relationships, or has engaged in any other activities, that could be perceived to influence or have the potential to influence what is written in this work. The complete Disclosures of Potential Conflicts of Interest submitted by authors are always provided with the online version of the article.

Copyright © 2013 by The Journal of Bone and Joint Surgery, Inc.
J Bone Joint Surg Am, 2013 May 15;95(10):916-924. doi: 10.2106/JBJS.L.01195
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Abstract

Background: 

MRI (magnetic resonance imaging) is widely used to diagnose meniscal pathology and ACL (anterior cruciate ligament) tears. Because of the enhanced signal-to-noise ratio and improved image quality at higher field strength, knee MRI equipment is shifting from 1.5 to 3.0 T. To date, objective evidence of improved diagnostic ability at 3.0 T is lacking. The purpose of this prospective study was to assess the accuracy of 1.5 and 3.0-T MRI of the knee, in the same individuals, for diagnosing meniscal pathology and ACL tears, utilizing arthroscopy as the reference standard.

Methods: 

Two hundred patients underwent MRI of the knee at 1.5 and 3.0 T. All MRI examinations consisted of multiplanar turbo spin-echo sequences. One hundred patients underwent subsequent knee arthroscopy. Two blinded independent radiologists assessed all MRI studies to identify meniscal pathology and ACL tears. In patients with MRI results indicating the need for surgical treatment, the sensitivity and specificity of the 1.5 and 3.0-T protocols for detecting these lesions were determined, utilizing arthroscopy as the reference standard, and compared with use of the McNemar test. The kappa statistic for inter-reader agreement in the 200 patients was calculated.

Results: 

For medial meniscal tears, the mean sensitivity and specificity for the two readers were 93% and 90%, respectively, at 1.5 T and 96% and 88%, respectively, at 3.0 T. For lateral meniscal tears, the mean sensitivity and specificity were 77% and 99%, respectively, at 1.5 T and 82% and 98%, respectively, at 3.0 T. For ACL tears, the mean sensitivity and specificity were 78% and 100%, respectively, at 1.5 T and 80% and 100%, respectively, at 3.0 T. None of the values for either reader differed significantly between the 1.5 and 3.0-T MRI protocols. Inter-reader agreement was almost perfect to perfect (kappa = 0.82 to 1.00).

Conclusions: 

Routine use of a 3.0-T MRI protocol did not significantly improve accuracy for evaluating the knee menisci and ACL compared with a similar 1.5-T protocol.

Level of Evidence: 

Diagnostic Level I. See Instructions for Authors for a complete description of levels of evidence.

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    Accreditation Statement
    These activities have been planned and implemented in accordance with the Essential Areas and policies of the Accreditation Council for Continuing Medical Education (ACCME) through the joint sponsorship of the American Academy of Orthopaedic Surgeons and The Journal of Bone and Joint Surgery, Inc. The American Academy of Orthopaedic Surgeons is accredited by the ACCME to provide continuing medical education for physicians.
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