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10-Min 3D Turbo Spin Echo MRI of the Knee in Children: Arthroscopy-Validated Accuracy for the Diagnosis of Internal Derangement


Fritz, Jan; Ahlawat, Shivani; Fritz, Benjamin; Thawait, Gaurav K; Stern, Steven E; Raithel, Esther; Klyce, Walter; Lee, Rushyuan J (2019). 10-Min 3D Turbo Spin Echo MRI of the Knee in Children: Arthroscopy-Validated Accuracy for the Diagnosis of Internal Derangement. Journal of Magnetic Resonance Imaging (JMRI), 49(7):e139-e151.

Abstract

BACKGROUND Ten-minute MRI of the pediatric knee can add value through increased cost-effectiveness and decreased sedation needs but requires validation of its clinical efficacy. PURPOSE To determine the arthroscopy-based diagnostic accuracy and interreader reliability of 10-min 3D Controlled Aliasing In Parallel Imaging Results In Higher Acceleration (CAIPIRINHA) turbo spin echo (TSE) MRI with two isotropic pulse sequences for the diagnosis of internal derangement in children with painful knee conditions. STUDY TYPE Prospective. SUBJECTS Sixty children. FIELD STRENGTH/SEQUENCE 3T, gradient echo-based scout with automatic anatomical landmark recognition and plane prescription, 3D CAIPIRINHA SPACE TSE. ASSESSMENT Three fellowship-trained musculoskeletal radiologists evaluated the MRI studies independently and resolved discrepancies through consensus. Outcome variables included image quality, motion artifacts, meniscal abnormalities, anterior and posterior cruciate ligament tears, and cartilage lesions. Arthroscopic surgery served as the standard of reference, which was performed after 37 (range, 1-143) days post-MRI. STATISTICAL TESTS Diagnostic accuracy analysis of MRI with arthroscopic surgery as the standard of reference. Reliability analysis through calculation of interreader agreements with kappa statistics. RESULTS All studies were suitable for diagnostic interpretation with good-to-very-good image quality ratings and little-to-no motion degradation ratings in the majority of cases. The sensitivities/specificities/accuracies of 3D CAIPIRINHA TSE MRI were 0.93/0.96/0.94 for 15/60 (25%) medial meniscal tears, 0.95/0.92/0.94 for 21/60 (35%) lateral meniscal tears, 0.83/1.00/0.92 for 6/60 (17%) discoid menisci, 1.00/0.98/0.99 for 16/60 (27%) anterior cruciate ligament tears, 1.0/1.0/1.0 for 2/60 (3%) posterior cruciate ligament tears, 1.00/1.00/1.00 for 5/60 (8%) osteochondritis dissecans lesions, 0.71/0.96/0.84 for 48 (13%) defects in 360 cartilage segments, and 0.85/0.97/0.91 overall. The interreader agreements were overall good-to-very-good (kappa, 0.72-1.00). DATA CONCLUSION The clinical use of 10-min 3D CAIPIRINHA TSE MRI of the knee in children with painful knee conditions yields an overall high arthroscopy-validated diagnostic accuracy of 91% and good-to-very good interreader reliability for the diagnosis of internal knee derangements. LEVEL OF EVIDENCE 1 Technical Efficacy: Stage 6 J. MAGN. RESON. IMAGING 2018.

Abstract

BACKGROUND Ten-minute MRI of the pediatric knee can add value through increased cost-effectiveness and decreased sedation needs but requires validation of its clinical efficacy. PURPOSE To determine the arthroscopy-based diagnostic accuracy and interreader reliability of 10-min 3D Controlled Aliasing In Parallel Imaging Results In Higher Acceleration (CAIPIRINHA) turbo spin echo (TSE) MRI with two isotropic pulse sequences for the diagnosis of internal derangement in children with painful knee conditions. STUDY TYPE Prospective. SUBJECTS Sixty children. FIELD STRENGTH/SEQUENCE 3T, gradient echo-based scout with automatic anatomical landmark recognition and plane prescription, 3D CAIPIRINHA SPACE TSE. ASSESSMENT Three fellowship-trained musculoskeletal radiologists evaluated the MRI studies independently and resolved discrepancies through consensus. Outcome variables included image quality, motion artifacts, meniscal abnormalities, anterior and posterior cruciate ligament tears, and cartilage lesions. Arthroscopic surgery served as the standard of reference, which was performed after 37 (range, 1-143) days post-MRI. STATISTICAL TESTS Diagnostic accuracy analysis of MRI with arthroscopic surgery as the standard of reference. Reliability analysis through calculation of interreader agreements with kappa statistics. RESULTS All studies were suitable for diagnostic interpretation with good-to-very-good image quality ratings and little-to-no motion degradation ratings in the majority of cases. The sensitivities/specificities/accuracies of 3D CAIPIRINHA TSE MRI were 0.93/0.96/0.94 for 15/60 (25%) medial meniscal tears, 0.95/0.92/0.94 for 21/60 (35%) lateral meniscal tears, 0.83/1.00/0.92 for 6/60 (17%) discoid menisci, 1.00/0.98/0.99 for 16/60 (27%) anterior cruciate ligament tears, 1.0/1.0/1.0 for 2/60 (3%) posterior cruciate ligament tears, 1.00/1.00/1.00 for 5/60 (8%) osteochondritis dissecans lesions, 0.71/0.96/0.84 for 48 (13%) defects in 360 cartilage segments, and 0.85/0.97/0.91 overall. The interreader agreements were overall good-to-very-good (kappa, 0.72-1.00). DATA CONCLUSION The clinical use of 10-min 3D CAIPIRINHA TSE MRI of the knee in children with painful knee conditions yields an overall high arthroscopy-validated diagnostic accuracy of 91% and good-to-very good interreader reliability for the diagnosis of internal knee derangements. LEVEL OF EVIDENCE 1 Technical Efficacy: Stage 6 J. MAGN. RESON. IMAGING 2018.

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Item Type:Journal Article, refereed, original work
Communities & Collections:04 Faculty of Medicine > Balgrist University Hospital, Swiss Spinal Cord Injury Center
Dewey Decimal Classification:610 Medicine & health
Language:English
Date:June 2019
Deposited On:18 Sep 2018 14:48
Last Modified:24 Sep 2019 23:36
Publisher:Wiley-Blackwell Publishing, Inc.
ISSN:1053-1807
OA Status:Closed
Free access at:Publisher DOI. An embargo period may apply.
Publisher DOI:https://doi.org/10.1002/jmri.26241
PubMed ID:30142235

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