Diagnosis Of Meniscal Tears Research Articles

SPECT Imaging in the Diagnosis of Meniscal Tears

Sixty patients scheduled for arthroscopy of a knee because of suspected meniscal tears had preoperative planar and single photon emission computed tomography (SPECT) radionuclide scans. A crescentic pattern of uptake on the SPECT transaxial view was used as a criterion for diagnosing a tear of a meniscus. The sensitivity of the investigation was 77%, specificity 74%, negative predictive value (NPV) 65%, positive predictive value (PPV) 83%, and accuracy 76%. Tears of the posterior horn of the cartilage were also associated with intense focal uptake on the transaxial view as well as increased equilibrium activity in the adjacent femoral condyle. When these appearances were included as additional criteria the sensitivity rose to 90%, NPV 81%, and accuracy 84%. This study confirms the usefulness of SPECT imaging in identifying meniscal tears.

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MR diagnosis of meniscal tears of the knee: value of axial three-dimensional Fourier transformation GRASS images.

Axial MR images of 40 knees in 37 patients with clinically suspected meniscal tears were obtained by using a three-dimensional (3-D) Fourier transform, gradient-refocused acquisition in the steady state (GRASS) pulse sequence. All knees also were examined in both coronal and sagittal planes with a two-dimensional (2-D) Fourier transform, spin-echo pulse sequence for T1-weighted images and a multiplanar GRASS pulse sequence for T2*-weighted images (conventional 2-D pulse sequences). Arthroscopic confirmation was available in all cases and was used as the gold standard. In these 40 knees, 32 of 33 meniscal tears and 45 of 47 normal menisci were correctly identified with axial 3-D imaging, yielding a sensitivity of 97% and specificity of 96%. Conversely, the sensitivity was 82% and the specificity was 100% for the 2-D technique in the diagnosis of meniscal tears. A combination of both techniques yielded 100% sensitivity, 100% specificity, and 100% accuracy in the evaluation of the menisci. Seven discrepancies between the findings of the two techniques were found in the evaluation of 33 arthroscopically proved torn menisci; six of the seven represented false-negative 2-D images and one was a false-negative axial 3-D image. Of 47 normal menisci, only two false-positives occurred with axial 3-D imaging and none with 2-D imaging. Despite the lack of a statistically significant difference, these preliminary findings suggest that the sensitivity in the diagnosis of meniscal tears can be improved by adding thin-sliced axial images with the 3-D GRASS pulse sequence to conventional 2-D imaging.

Diagnosis of meniscal tears using high-resolution computed tomography. Correlation with arthroscopy.

Four hundred and fifty patients (840 knees) underwent axial computed tomography of the knee in a prospective study to evaluate the ability of this technique to identify and characterize meniscal tears. One hundred and thirty-three of the knees subsequently had diagnostic arthroscopy. When compared with the findings at arthroscopy, the sensitivity of computed tomography was 96.5 per cent, the specificity was 81.3 per cent, and the accuracy was 91.0 per cent. The precise protocol for the method of computed tomographic scanning that was employed and the criteria that were used to interpret the images are presented. We found computed tomography to be a valuable non-invasive method for the detection and characterization of meniscal tears.

Computed tomography of the knee with reference to meniscal tears. A prospective blind investigation.

Computed tomography (CT) with a high resolution CT scanner and--on a special occasion--double contrast arthrography of the knee with reference to meniscal tears were performed in 50 patients. Operation or arthroscopy was performed in 28 patients and 15 were found to have meniscal tears. A correct diagnosis of the tears was achieved at CT in 13 of these patients. Three false positive and two false negative CT findings were recorded, resulting in a 91 per cent accuracy for CT, a diagnostic specificity of 84 per cent, and a sensitivity of 95 per cent. The diagnostic value of CT thus compared with that of double contrast arthrography. This should indicate that CT may be used as an alternative non-invasive diagnostic procedure in the diagnosis of meniscal tears of the knee joint.

Meniscectomies in Women

During the past years a number of arthrotomies in women have been done with the presumptive diagnosis of a tear of the meniscus. In a disproportionately large number, the preoperative diagnosis was not confirmed and no tear of the meniscus could be identified. Even in the hands of experienced, responsible orthopedic surgeons, the diagnosis of meniscal tear in a woman is often incorrect. There are several reasons for this and many other pathologic factors that might give rise to the symptoms simulating meniscal tear are involved.