MRI versus Ultrasonography to Assess Meniscal Abnormalities in Acute Knees

Abstract

While magnetic resonance imaging (MRI) is often considered the "gold standard" diagnostic imaging modality for detection of meniscal abnormalities, it is associated with misdiagnosis in as high as 47% of cases, is costly, and is not readily available to a large number of patients. Ultrasonographic examination of the knee has been reported to be an effective diagnostic tool for this purpose with the potential to overcome many of the shortcomings of MRI. The purpose of this study is to determine the clinical usefulness of ultrasonography for diagnosis of meniscal pathology in patients with acute knee pain and compare its diagnostic accuracy to MRI in a clinical setting. With Institutional Review Board approval, patients (n ¼ 71) with acute knee pain were prospectively enrolled with informed consent. Preoperative MRI (1.5 T) was performed on each affected knee using the hospital's standard equipment and protocols and read by faculty radiologists trained in musculoskeletal MRI. Ultrasonographic assessments of each affected knee were performed by one of two faculty members trained in musculoskeletal ultrasonography using a 10 to 14 MHz linear transducer. Arthroscopic evaluation of affected knees was performed by one of three faculty orthopedic surgeons to assess and record all joint pathology, which served as the reference standard for determining presence, type, and severity of meniscal pathology. All evaluators for each diagnostic modality were blinded to all other data. Data were collected and compared by a separate investigator to determine sensitivity (Sn), specificity (Sp), positive predictive value (PPV), negative predictive value (NPV), correct classification rate (CCR), likelihood ratios (LR [þ] and LR[À]), and odds ratios. Preoperative ultrasonographic assessment of meniscal pathology was associated with Sn ¼ 91.2%, Sp

Knee Ultrasonography to Determine Risk for Noncontact Injuries in Collegiate American Football Players

“…Ultrasonography is as or more effective than MRI for evaluating meniscal pathology, 10,11 and ultrasonography-identified abnormalities correlate with clinical symptoms. 12 While comprehensive ultrasonographic characterization of the cruciate ligaments is limited, 10,13 portions of the ACL and posterior cruciate ligament (PCL) can be imaged, and ultrasonographic findings associated with ACL and PCL pathology can be consistently assessed. 14 The MCL and lateral collateral ligament (LCL) of the knee, patellar tendon, and quadriceps tendon can be effectively imaged ultrasonographically as well.…”

“…MRI requires specialized equipment at a dedicated facility, it is associated with claustrophobia and phonophobia, it may be contraindicated when the patient has implanted medical devices, it is relatively expensive, and it is not readily accessible to the majority of the medical world. 10 In contrast, ultrasonography is a safe, effective, and portable modality for the efficient imaging of the knee that is readily available for use at the point-of-care locations. Ultrasonography is as or more effective than MRI for evaluating meniscal pathology, 10,11 and ultrasonography-identified abnormalities correlate with clinical symptoms.…”

“…10 In contrast, ultrasonography is a safe, effective, and portable modality for the efficient imaging of the knee that is readily available for use at the point-of-care locations. Ultrasonography is as or more effective than MRI for evaluating meniscal pathology, 10,11 and ultrasonography-identified abnormalities correlate with clinical symptoms. 12 While comprehensive ultrasonographic characterization of the cruciate ligaments is limited, 10,13 portions of the ACL and posterior cruciate ligament (PCL) can be imaged, and ultrasonographic findings associated with ACL and PCL pathology can be consistently assessed.…”

Sonographic soft tissue arthritic changes associated with post-stroke hemiplegic knee pain: utility of musculoskeletal ultrasound in a resource-limited setting

“…Although magnetic resonance imaging (MRI) is accurate and reproducible for evaluating bone, articular cartilage, and soft tissues [11][12][13], it is expensive, time consuming, and not widely available for routine use in resource-poor settings. Arthroscopy provides a direct view of the cartilage and synovium and is considered as a gold standard for assessing cartilage lesions [14].…”

Role of Ultrasound in Assessment of Menisco-Ligamentous Injuries of Knee Joint in Comparison with Magnetic Resonance Imaging

“…Clinical examination even by the most experienced staff using the strictest of clinical methods is not always enough to diagnose knee injuries. Arthroscopy has been considered as the gold standard for the diagnosis of knee injuries, but is invasive, expensive and requires day surgery admission [4] .…”