The Characteristic Findings to Assess Meniscal Healing Status After Meniscal Repair on MRI-T2 Mapping

Transcription

1 The Characteristic Findings to Assess Meniscal Healing Status After Meniscal Repair on MRI-T2 Mapping Shinya Yamasaki, MD, PhD 1,2, Yusuke Hashimoto, MD, PhD 2, Takuya Kinoshita, MD 2, Kazuya Nishino, MD 2, Yohei Nishida, MD 2, Shozaburo Terai, MD, PhD 2, Junsei Takigami, MD, PhD 3, Hiroaki Nakamura, Prof 2 1, Dpt. of Orthopaedics Surgery, Osaka City General Hospital 2, Dpt. of Orthopaedics Surgery, Osaka City General Hospital 3, Dpt. Of Orthopaedics Surgery, Shimada Hospital

2 Shinya Yamasaki, MD, PhD. I have no financial conflicts to disclose.

3 Introduction MRI characteristics after meniscal repair A linear increased signal intensity extending to the surface can persist at the site of surgery for many years following successful meniscal repair in conventional MRI. 1,2 Recently, MRI T2 mapping has developed to evaluate the qualitative condition of cartilage and meniscus to assess the degeneration. 3,4,5,6,7 However, there is no report to assess the accuracy of T2 mapping for meniscal healing after arthroscopic repair.

4 Purpose To examine the effectiveness of MRI T2 mapping for the assessment of meniscal healing after repair as confirmed by arthroscopy in comparison with conventional MRI.

5 Methods Enrolled patients Meniscal repair 2 nd look arthroscopy T2 both 1 st surgery and 2 nd look arthroscopy Total 26 menisci of 24 patients Mean age 23.3 years (14-43 years) 9 males/ 15 females

6 Methods MRI T2 mapping Achieva; Philips, Netherlands Analysis: VirtualPlace (AZE Ltd., Japan) TR 2100 msec, TE 10, 20, 30, 40, 50, 60 msec field of view 16 cm, slice thickness 3 mm matrix Scan time 14 min

7 Methods Accuracy assessment 2 nd look 8 Complete Healed 16menisci Incomplete/Unhealed 10menisci 2nd look Conventional Crues 3-stage classification 9 T2 mapping 1. change of T2 value (ΔT2) 2. existence of the red colored line with the highest T2 value (65ms) in the primary injury

8 Results conventional MRI Crues classification healed Incompletely/ unhealed improved 8 3 no change 8 7 P=0.43 T2 mapping- ΔT2 ΔT2(msec) msec P= msec Healed Incompletely/unhealed

9 Sensitivity Results msec T2 mapping - ΔT2 ROC Specificity T2 ΔT2 sensitivity of 81.2 % specificity of 80 % odds ratio of 17.3 P=0.001 T2 mapping - red colored line healed incompletely/unhealed remained 5 9 disappeared 11 1 sensitivity of 81.3 % specificity of 90 % odds ratio of 39.0 P=0.001

10 Discussion Accuracy of assessment of repaired meniscal healing Conventional stricter criterion for the fluid level intensity 10 High specificity (88-92%), but low sensitivity (41-69%) Arthrography 11,12 High sensitivity and specificity (88-89%, 78%) But invasive and risk of allergy to the contrast agent T2 mapping - current study High sensitivity and specificity (81%, 80-90%) No invasive examination

11 Limitation No consensus in the setting of T2 mapping Small sample size Age variation of patients

12 Conclusion MRI T2 mapping differentiated the healing status after meniscal repair using the ΔT2 value and visual color mapping. A cutoff value of 5.2 msec decrease at the repaired area and disappearance of a colored line with a high T2 value were significant findings for arthroscopic meniscal healing assessment.

13 References 1. Hoffelner T, Resch H, Forstner R,Michael M, Minnich B, Tauber M. Arthroscopic all-inside meniscal repair- Does the meniscus heal? A clinical and radiological follow-up examination to verify meniscal healing using a 3-T MRI. Skeletal Radiol 2011;40: Pujol N, Tardy N, Boisrenoult P, Beaufils P. Magnetic Resonance Imaging not suitable for interpretation of meniscal status ten years after arthroscopic repair. Int Orthop 2013;37: Baum T, Joseph GB, Karampinos DC, Jungmann PM, Link TM, Bauer JS (2013) Cartilage and meniscal T2 ralaxation time as non-invasive biomarker for knee osteoarthritis and cartilage repair procedure. Osteoarthritis cartilage 21: Rauscher I, Stahl R, Cheng J et al (2008) Meniscal measurements of T1r and T2 at MR imaging in healthy subjects and patients with osteoarthritis. Radiology 249: Takao S, Nguyen TB, Yu HJ et al (2017) T1rho and T2 relaxation times of the normal adult knee meniscus at 3T: analysis of zonal differences. BMC Musculoskeletal Disorders 18: Tsai PH, Chou MC, Lee HS et al (2009) MR T2 values of the knee menisci in the healthy young population: zonal and sex differences. Osteoarthritis Cartilage 17: Zarins ZA, Bolbos RI, Pialat JB, Link TM, Li X, Souza RB, Majumdar S (2010) Cartilage and meniscus assessment using T1rho and T2 measurements in healthy subjects and patients with osteoarthritis. Osteoarthritis Cartilage 18: Cannon WD Jr. Arthroscopic meniscal repair. Inside-out technique and results. Am J Knee Surg 1996;9: Stoller DW. Magnetic resonance imaging in orthopaedics and sports medicine. 3rd eds. Philadelphia: Lippincott Williams & Wilkins, McCauley TR. MR Imaging Evaluation of the Postoperative Knee. Radiology 2005;234: Applegate GR, Flannigan BD, Tolin BS, Fox JM, Del Pizzo W. MR diagnosis of recurrent tears in the knee: value of intraarticular contrast material. Am J Roentgenol 1993;161: White LM, Schweitzer ME, Weishaupt D, Kramer J, Davis A, Marks PH. Diagnosis of recurrent meniscal tears: prospective evaluation of conventional MR imaging, indirect MR arthrography, and direct MR arthrography. Radiology 2002;222: