Basic low - field MR imaging of meniscal injuries in children.
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1 Basic low - field MR imaging of meniscal injuries in children. Poster No.: C-2365 Congress: ECR 2012 Type: Authors: Keywords: DOI: Scientific Exhibit A. Yakimov, M. Nikonova, E. Prokhorova, D. Vybornov, M. Pykov; Moscow/RU Trauma, Education, MR, Pediatric, Musculoskeletal joint /ecr2012/C-2365 Any information contained in this pdf file is automatically generated from digital material submitted to EPOS by third parties in the form of scientific presentations. References to any names, marks, products, or services of third parties or hypertext links to thirdparty sites or information are provided solely as a convenience to you and do not in any way constitute or imply ECR's endorsement, sponsorship or recommendation of the third party, information, product or service. ECR is not responsible for the content of these pages and does not make any representations regarding the content or accuracy of material in this file. As per copyright regulations, any unauthorised use of the material or parts thereof as well as commercial reproduction or multiple distribution by any traditional or electronically based reproduction/publication method ist strictly prohibited. You agree to defend, indemnify, and hold ECR harmless from and against any and all claims, damages, costs, and expenses, including attorneys' fees, arising from or related to your use of these pages. Please note: Links to movies, ppt slideshows and any other multimedia files are not available in the pdf version of presentations. Page 1 of 8
2 Purpose Goal. To compare the sensitivity and specificity of low- tesla magnetic resonance imaging (MRI) of meniscal injuries and the physical examination by an experienced examiner using an arthroscopy as a gold standard. Introduction. Interpreting MR- imaging results in growing skeleton could be challenging, given numerous physiological findings which could mimic pathology like well described change in meniscal vascularization. Beside growth-related nuances access to best technology for knee imaging - high field MRI - could be limited only to most well equipped clinical centers. Thus growing skeleton and cost-effective, but limited low- tesla MR technology could potentially lead to error. Clinical examination by specialized surgeon is a well-established cost-effective method diagnosing meniscal pathology and selecting patients for an arthroscopy. The aim of this retrospective study was to compare the sensitivity and specificity of low field MRI results and clinical examination in pediatric patients versus arthroscopic findings and to determine the value of basic low- field MR meniscal injury imaging in decision making regarding pediatric age group. Methods and Materials Materials Methods n=56 (mean age 14yrs, range 7-18) Inclusion criteria: clinical suspicion of meniscal injury based on symptoms and the event of knee trauma All patients underwent physical examination, 0.35T MRI, and arthroscopy Final diagnosis established via performing an arthroscopy Appley test: This test is performed with the patient prone and the knee flexed 90º. An axial force is applied through the heel as the lower leg is turned internally and externally. The Steinmann test: Page 2 of 8
3 Patient is seated and the knee is flexed 90º. Asymmetric pain is produced with external (medial meniscus) or internal (lateral meniscus) tibial rotation. The McMurray test: The fully flexed knee is extended with foot internally rotated while varus stress is applied for medial meniscus tear. For the lateral meniscus tear the similar maneuver is performed with external rotation and valgus stress during the extension of the fully flexed knee. MR Protocol included T1 and T2 weighted images Results MR studies were interpreted by consensus of two radiologists Physical examination were performed by two experienced examiners Positive Appley test or McMurray test or Steinmann test were considered diagnostic for meniscal injury Meniscal injury was assessed using Lotysch criteria and characterized negative for grades 0,1,2 and positive for grade 3. Final pathology was established through an arthroscopy Sensitivity and Specificity were calculated for physical exam and MRI using an arthroscopy as gold standard Images for this section: Fig. 1: Medial meniscus injury Fig. 2: Lateral meniscus injury Page 3 of 8
4 Fig. 3: Lotysch classification meniscal change grade 0 Page 4 of 8
5 Fig. 4: Lotysch classification meniscal change grade 1 Page 5 of 8
6 Fig. 5: Lotysch classification meniscal change grade 2 Page 6 of 8
7 Fig. 6: Lotysch classification meniscal change grade 3 Page 7 of 8
8 Conclusion These results indicate that basic MRI and clinical examination for menisclal injuries has a high level of corroboration with arthroscopy results in spite of perceived limitations, which might allow to use them interchangeably. References 1. Lotysch M, Mink J, Crues JV, Schwartz SA. Magnetic resonance imaging in the detection of meniscal injuries (abstr.). Magn Reson Imaging 1986;4: Takeda Y, Ikata T, Yoshida S, Takai H, Kashiwaguchi S.MRI high-signal intensity in the menisci of asymptomatic children. J Bone Joint Surg Br May;80(3): Personal Information Page 8 of 8
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