Abstract
We performed this meta-analysis to examine the diagnostic accuracy of MRI for the diagnosis of anterior cruciate ligament (ACL) injury in comparison to arthroscopy. We also compared the diagnostic accuracy of MRI with magnetic field intensities (MFI) greater than or equal to 1.5T with those below 1.5T, in addition to different MRI sequences. Studies relevant to the diagnosis of ACL injury by MRI and arthroscopy were analyzed. Computer and manual retrieval were carried out on studies published between January 1, 2006 and May 31, 2016. Twenty-one papers were included. Neither threshold nor non-threshold effects were present (p = 0.40, p = 0.06). The pooled sensitivity (SE), specificity (SP), positive likelihood ratio (LR+), negative likelihood ratio (LR−) and diagnostic odds ratio (DOR) with 95% confidence interval (CI) were 87% (84–90%), 90% (88–92%), 6.78 (4.87–9.44), 0.16 (0.13–0.20) and 44.70 (32.34–61.79), respectively. The area under the curve (AUC) was 0.93. The risk of publication bias was negligible (p = 0.75). In conclusion, examination by MRI is able to provide appreciable diagnostic performance. However, the principle, which states that the higher the MFI, the better the diagnostic accuracy, could not be verified. Additionally, conventional sequences (CSs) associated with proton density-weighted imaging (PDWI) are only slightly better than CSs alone, but not statistically different.
Highlights
We performed this meta-analysis to examine the diagnostic accuracy of Magnetic resonance imaging (MRI) for the diagnosis of anterior cruciate ligament (ACL) injury in comparison to arthroscopy
Associated injuries of the ACL and other structures are caused by a variety of events: (i) ACL injury associated with medial collateral ligament and medial meniscus injury is caused by forced flexion-external rotation stress; (ii) damage associated with lateral compartment injury is caused by forced flexion-internal rotation stress; (iii) when associated with lateral and medial compartment injury it is caused by different associations of varus-valgus and rotatory stress; (iv) when
It is likely that overuse of the MRI technique in the diagnosis of ACL injury leads to misdiagnosis, especially in a chronic incomplete tear which might be due to the special sensitivity to the hydrogen atom and could be associated with volume effects and synovial hyperplasia[18]
Summary
21 articles[9, 14,15,16,17,18,19,20,21,22,23,24,25,26,27,28,29,30,31,32,33] were chosen and marked with 3 stars, articles for which true positive (TP), false positive (FP), true negative (TN) and false negative (FN) results could be extracted or accurately calculated through 2 × 2 contingency tables (16 from PubMed and 5 from EMBASE) These articles consisted of 16 prospective studies and 5 retrospective studies, for a total of 1722 cases. The number of low and unclear risk of bias was 39 and 45, respectively, for the four domains (patient selection, index test, reference standard, and flow and timing).
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