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Evaluation of recurring meniscal tears with gadolinium-enhanced magnetic resonance imaging: a randomized, prospective
Michael J Vives1, David Homesley, Michael G Ciccotti
1Department of Orthopaedic Surgery. Department of Radiology, Jefferson Medical College of Thomas Jefferson University, Philadelphia, Pennsylvania, USA.
Background:
Magnetic resonance imaging has been shown to be of questionable accuracy in detecting recurrent meniscal tears after previous resection or repair.
Purpose:
To compare the accuracy of nonenhanced magnetic resonance imaging with that of intraarticular contrast-enhanced direct magnetic resonance arthrography and intravenous contrast-enhanced indirect magnetic resonance arthrography for detection of recurrent meniscal tears.
Study Design:
Prospective cohort study.
Methods:
Forty-one patients who had previous meniscal tears treated by resection or repair but who were experiencing recurrent knee symptoms were prospectively randomized into one of three groups: conventional magnetic resonance imaging, indirect arthrography, and direct arthrography. The interpretations of two musculoskeletal radiologists were compared with the findings of an arthroscopic procedure performed 2 to 14 weeks later.
Results:
Conventional imaging had a sensitivity of 57.9%, specificity of 80%, and overall accuracy of 62.5%. Intravenous contrast improved the sensitivity to 90.9%, specificity to 100%, and overall accuracy to 93.8%; intraarticular contrast had a sensitivity of 91.7%, specificity of 100%, and an overall accuracy of 92.9%.
Conclusions:
We demonstrated an increased accuracy of intravenous or intraarticular contrast-enhanced magnetic resonance arthrography in detecting recurrent meniscal tears. Both contrast routes demonstrated similar accuracy, a finding not previously reported.