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Diagnosis and classification of chondral knee injuries: comparison between magnetic resonance imaging and arthroscopy
Marcus Vinicius Danieli1,2, João Paulo Fernandes Guerreiro3, Alexandre deOliveira Queiroz3
1Uniorte - Hospital de Ortopedia, Antonio Pisicchio, 155, apto 1402, Londrina, PR, CEP 86040-482, Brazil. mvdanieli@hotmail.com.
Purpose:
To compare the magnetic resonance imaging (MRI) findings of patients undergoing knee arthroscopy for chondral lesions. The hypothesis was that MRI displays low sensitivity in the diagnosis and classification of chondral injuries.
Methods:
A total of 83 knees were evaluated. The MRIs were performed using the same machine (GE SIGNA HDX 1.45 T). The MRI results were compared with the arthroscopy findings, and an agreement analysis was performed. Thirty-eight of the 83 MRI exams were evaluated by another radiologist for inter-observer agreement analysis. These analyses were performed using the kappa (κ) coefficient.
Results:
The highest incidence of chondral injury was in the patella (14.4 %). The κ coefficient was 0.31 for the patellar surface; 0.38 for the trochlea; 0.46 for the medial femoral condyle; 0.51 for the lateral femoral condyle; and 0.19 for the lateral plateau. After dividing the injuries into two groups (ICRS Grades 0-II and Grades III and IV), the following κ coefficients were obtained as follows: 0.49 (patella); 0.53 (trochlea); 0.46 (medial femoral condyle); 0.43 (medial plateau); 0.67 (lateral femoral condyle); and 0.51 (lateral plateau). The MRI sensitivity was 76.4 % (patella), 88.2 % (trochlea), 69.7 % (medial femoral condyle), 85.7 % (medial plateau), 81.8 % (lateral femoral condyle) and 75 % (lateral plateau). Comparing the radiologists' evaluations, the following κ coefficients were obtained as follows: 0.73 (patella); 0.63 (trochlea); 0.84 (medial femoral condyle); 0.72 (medial plateau); 0.77 (lateral femoral condyle); and 0.91 (lateral plateau).
Conclusion:
Compared with arthroscopy, MRI displays moderate sensitivity for detecting and classifying chondral knee injuries. It is an important image method, but we must be careful in the assessment of patients with suspected chondral lesions.
Level Of Evidence:
III.
Insights
Magnetic resonance imaging (MRI) shows moderate sensitivity for diagnosing knee chondral lesions. While valuable, careful interpretation is needed when assessing suspected cartilage injuries.
Area of Science:
- Orthopedic Surgery
- Radiology
- Medical Imaging
Background:
- Chondral lesions are common knee injuries.
- Accurate diagnosis is crucial for effective treatment planning.
- Magnetic resonance imaging (MRI) is a non-invasive tool used to evaluate knee structures.
Purpose of the Study:
- To compare magnetic resonance imaging (MRI) findings with arthroscopic results for chondral knee lesions.
- To evaluate the sensitivity of MRI in diagnosing and classifying chondral injuries.
- To assess inter-observer agreement among radiologists for MRI interpretation.
Main Methods:
- 83 knee arthroscopies were performed.
- MRI scans were conducted using a GE SIGNA HDX 1.45 T scanner.
- MRI results were compared to arthroscopy findings using kappa (κ) coefficient for agreement analysis.
Main Results:
- The highest incidence of chondral injury was observed in the patella (14.4%).
- MRI sensitivity for detecting chondral lesions varied by knee region, ranging from 69.7% to 88.2%.
- Inter-observer agreement for MRI interpretation was generally good to excellent (κ coefficients ranging from 0.63 to 0.91).
Conclusions:
- MRI demonstrates moderate sensitivity in detecting and classifying chondral knee injuries.
- MRI is a valuable imaging modality for evaluating suspected chondral lesions.
- Radiologists should exercise caution when interpreting MRI findings for chondral injuries.
