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MRI of meniscal lesions: soft-copy (PACS) and hard-copy evaluation versus reviewer experience
Justus E Roos1, Bianca Chilla, Marco Zanetti
1Department of Radiology, Orthopedic University Hospital Balgrist, Zurich, Switzerland. justus.roos@stanford.edu
Objective:
The purpose of our study was to compare diagnostic performance, reviewer confidence, and time requirements in the MRI diagnosis of meniscal tears for three types of reviewers and two types of image documentations (PACS vs hard copies).
Materials And Methods:
An experienced musculoskeletal radiologist (reviewer 1), a fellow in musculoskeletal radiology (reviewer 2), and a junior staff member in orthopedic surgery (reviewer 3) evaluated MR images displayed on PACS monitors and hard copies independently and in a blinded fashion with regard to the presence or absence of meniscal tears. Seventy-one patients (mean age, 45.4 years; range, 16-80 years) were consecutively included if they had undergone both MRI of the knee and arthroscopy within 4 months. Arthroscopy was the standard of reference. Evaluation time and the reviewer's confidence in his or her diagnosis (Visual Analogue Scale, possible values of 0-100) were determined.
Results:
Accuracies, sensitivities, and specificities in diagnosing meniscal tears were 80-87%, 63-85%, and 87-93% for soft copies and 82-85%, 64-76%, and 87-94.0%, respectively, for hard copies. Intrareviewer differences between PACS and hard copies were not significant for any of the three reviewers (McNemar tests). Reviewer 3 was less sensitive but more specific in the diagnosis of meniscal tears than reviewers 1 and 2. This difference was significant for both the PACS and hard copies. The reviewers' confidence in their diagnoses and evaluation times were not significantly different for PACS and hard copies (analysis of variance with Bonferroni post hoc analysis).
Conclusion:
Differences in the diagnostic performance of suspected meniscal tears depend on reviewer experience rather than on the type of documentation.
Insights
Reviewer experience, not image format (PACS or hard copy), impacts MRI accuracy for meniscal tears. Expertise is key for reliable knee MRI diagnosis.
Area of Science:
- Radiology
- Orthopedic Surgery
- Medical Imaging
Background:
- Magnetic Resonance Imaging (MRI) is crucial for diagnosing knee meniscal tears.
- The display method of MRI images (Picture Archiving and Communication System - PACS vs. hard copies) may influence diagnostic accuracy.
- Varying levels of reviewer experience could affect diagnostic performance.
Purpose of the Study:
- To compare the diagnostic performance of MRI for meniscal tears across different reviewer experience levels.
- To evaluate the impact of image documentation type (PACS vs. hard copies) on diagnostic accuracy, reviewer confidence, and evaluation time.
- To determine if reviewer expertise or image format is more critical for accurate meniscal tear diagnosis.
Main Methods:
- Three reviewers with distinct experience levels (musculoskeletal radiologist, fellow, orthopedic surgery staff) evaluated knee MRIs.
- Images were presented on both PACS monitors and as hard copies in a blinded manner.
- Diagnostic accuracy, reviewer confidence (Visual Analogue Scale), and evaluation time were recorded; arthroscopy served as the reference standard.
Main Results:
- Diagnostic accuracies for meniscal tears ranged from 80-87% for soft copies and 82-85% for hard copies.
- No significant intrareviewer differences were found between PACS and hard copies for any reviewer.
- Reviewer experience significantly impacted sensitivity and specificity, with junior staff being less sensitive but more specific.
Conclusions:
- Reviewer experience is a more significant factor than image documentation type (PACS vs. hard copy) in the diagnostic performance of meniscal tears.
- The findings suggest that focusing on reviewer training and expertise may be more beneficial than solely optimizing image display methods for improving diagnostic accuracy.
