DIAGNOSTIC ACCURACY OF ULTRASOUND IN DETECTING MENISCAL TEARS TAKING MAGNETIC RESONANCE IMAGING AS GOLD STANDARD

MA Omer; SS Malik; AA MALIK; MN Anjum; Az Riaz; R Ali

doi:10.54112/bcsrj.v2020i1.40

Authors

MA Omer Department of Diagnostic Radiology, The University of Lahore, Lahore, Pakistan
SS Malik Radiology Research Section, The University of Lahore, Lahore, Pakistan
AA MALIK Consultant Interventional Radiologist, Doctors Hospital and Medical Center, Lahore, Pakistan
MN Anjum Radiology Research Section, The University of Lahore, Lahore, Pakistan
Az Riaz House Officer Radiology, Services Hospital Lahore, Lahore, Pakistan
R Ali Consultant Radiologist DHQ Hospital Sheikupura, Pakistan

DOI:

https://doi.org/10.54112/bcsrj.v2020i1.40

Keywords:

Ultrasound, meniscal tears, magnetic resonance imaging, diagnosis, sensitivity

Abstract

Meniscal tears are mostly seen worldwide. Multiple imaging modalities are currently used to evaluate pathologic conditions of the knee. MRI can be referred as the non-invasive gold standard investigation to help establishing diagnosis of meniscal tears, but it economically unaffordable to most of patients and needs long examination times. Ultrasound is a possible alternative to MRI. It is simple, convenient and an inexpensive and non-invasive method. The use of ultrasound in identifying meniscal tears has been proposed, but its diagnostic accuracy remains controversial. The objective of the research is to define the diagnostic accurateness of ultrasound scan in detecting meniscal tears taking magnetic resonance imaging as gold standard. It was a diagnostic cross-sectional study in which 78 patients visiting Department of Diagnostic Radiology, Doctors Hospital, Lahore were included. Convenient sampling technique was used. Written informed consent was taken from all the patients. Patients were investigated with the help of ultrasound and results were noted on the designed proforma, subsequently the results were compared to the MRI scan of the knee joint. Data was entered and statistically analyzed using SPSS 21.0. Frequency tables were generated for all variables. For quantitative data like age mean and standard deviation were calculated and for qualitative data like sex and meniscal tears percentages were calculated. Sensitivity, Specificity, Positive Predictive Value, Negative Predictive Value was given. Bar and pie charts were used to present categorical data. Kappa analysis was utilized. The mean age of the patients was 38.18+12.818 years, 82.1% were males and 47.4% had sports trauma. Out of 48 medial meniscus tear on USG, 38(48.7%) were true positive and 10(12.8%) were false positive on MRI. Out of 10 lateral meniscus tear on USG, 9(11.5%) were true positive and 1(1.3%) was false positive on MRI. The sensitivity, specificity, PPV, NPV and diagnostic accuracy of ultrasound for medial meniscus tears were 95.00%, 73.68%, 79.16%, 93.33% and 84.61% while for lateral meniscus tears were 75.00%, 98.48%, 90.00%, 95.58% and 94.87%, respectively. Study concluded that ultrasound has good diagnostic accuracy when compared with magnetic resonance imaging in detecting meniscal tears.

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References

Acebes, C., Romero, F. I., Contreras, M. A., Mahillo, I., and Herrero-Beaumont, G. (2013). Dynamic ultrasound assessment of medial meniscal subluxation in knee osteoarthritis. Rheumatology 52, 1443-1447.

Akatsu, Y., Yamaguchi, S., Mukoyama, S., Morikawa, T., Yamaguchi, T., Tsuchiya, K., Iwasaki, J., Akagi, R., Muramatsu, Y., and Katsuragi, J. (2015). Accuracy of high-resolution ultrasound in the detection of meniscal tears and determination of the visible area of menisci. JBJS 97, 799-806.

Alizadeh, A., Jandaghi, A. B., Zirak, A. K., Karimi, A., Mardani-Kivi, M., and Rajabzadeh, A. (2013). Knee sonography as a diagnostic test for medial meniscal tears in young patients. European Journal of Orthopaedic Surgery & Traumatology 23, 927-931.

Arif, U., Shah, Z. A., Khan, M. A., Ijaz, M., and Qayum, H. (2013). Diagnostic accuracy of 1.5 tesla MRI in the diagnosis of meniscal tears of knee joint. Arthroscopy 42, 25.

Attya, M. S. (2015). Evaluation of role of non ionized radiology tools in knee soft tissue injuries. Al-Azhar Assiut Medical Journal 13, 1.

Bien, N., Rajpurkar, P., Ball, R. L., Irvin, J., Park, A., Jones, E., Bereket, M., Patel, B. N., Yeom, K. W., and Shpanskaya, K. (2018). Deep-learning-assisted diagnosis for knee magnetic resonance imaging: development and retrospective validation of MRNet. PLoS medicine 15, e1002699.

Choi, C.-J., Choi, Y.-J., Lee, J.-J., and Choi, C.-H. (2010). Magnetic resonance imaging evidence of meniscal extrusion in medial meniscus posterior root tear. Arthroscopy: The Journal of Arthroscopic & Related Surgery 26, 1602-1606.

Cimino, F., Volk, B. S., and Setter, D. (2010). Anterior cruciate ligament injury: diagnosis, management, and prevention. American family physician 82, 917-922.

Crawford, R., Walley, G., Bridgman, S., and Maffulli, N. (2007). Magnetic resonance imaging versus arthroscopy in the diagnosis of knee pathology, concentrating on meniscal lesions and ACL tears: a systematic review. British medical bulletin 84, 5-23.

Dai, H., Huang, Z.-g., Chen, Z.-j., and Liu, J.-x. (2015). Diagnostic accuracy of ultrasonography in assessing meniscal injury: meta-analysis of prospective studies. Journal of Orthopaedic Science 20, 675-681.

De Smet, A. A., Blankenbaker, D. G., Kijowski, R., Graf, B. K., and Shinki, K. (2009). MR diagnosis of posterior root tears of the lateral meniscus using arthroscopy as the reference standard. American Journal of Roentgenology 192, 480-486.

Dong, F., Zhang, L., Wang, S., Dong, D., Xu, J., Wu, H., Liu, Y., and Li, M. (2018). The diagnostic accuracy of B-mode ultrasound in detecting meniscal tears: a systematic review and pooled meta-analysis. Medical ultrasonography 20, 164-169.

Gadgil, S., Kakade, A., Bagga, R. P., ZM, and Yadav, M. (2018). MR imaging of meniscal tears. International Journal of Research in Medical Sciences. 6, 195-205.

Lee, M. J., and Chow, K. (2007). Ultrasound of the knee. In "Seminars in musculoskeletal radiology", Vol. 11, pp. 137-148. © Thieme Medical Publishers.

Mahdy, N. S., Sakr, H. M., and Allam, A. E. (2018). The Role of Ultrasound in Evaluation of Meniscal Injury. The Egyptian Journal of Hospital Medicine 72, 5490-5494.

Micheo, W., Hernández, L., and Seda, C. (2010). Evaluation, management, rehabilitation, and prevention of anterior cruciate ligament injury: current concepts. PM&R 2, 935-944.

Mostafa, H. A. M., Abou Elfotuh, A. M., and Alsakka, M. M. (2019). MRI Versus Ultrasound In Diagnosis Of Meniscal Tear In Knee Joint. The Egyptian Journal of Hospital Medicine 74, 303-309.

Murmu, C., Tiwari, P., and Agrawal, V. K. (2017). Evaluation of medial meniscal injury and anterior cruciate ligament tear by MRI with arthroscopic correlation. International Surgery Journal 4, 589-592.

Najafi, J., Bagheri, S., and Lahiji, F. A. (2006). The value of sonography with micro convex probes in diagnosing meniscal tears compared with arthroscopy. Journal of ultrasound in medicine 25, 593-597.

Nguyen, J. C., De Smet, A. A., Graf, B. K., and Rosas, H. G. (2014). MR imaging–based diagnosis and classification of meniscal tears. Radiographics 34, 981-999.

Nogueira-Barbosa, M. H., Gregio-Junior, E., Lorenzato, M. M., Guermazi, A., Roemer, F. W., Chagas-Neto, F. A., and Crema, M. D. (2015). Ultrasound assessment of medial meniscal extrusion: a validation study using MRI as reference standard. American Journal of Roentgenology 204, 584-588.

Oei, E. H., Nikken, J. J., Verstijnen, A. C., Ginai, A. Z., and Myriam Hunink, M. (2003). MR imaging of the menisci and cruciate ligaments: a systematic review. Radiology 226, 837-848.

Phelan, N., Rowland, P., Galvin, R., and O’Byrne, J. M. (2016). A systematic review and meta-analysis of the diagnostic accuracy of MRI for suspected ACL and meniscal tears of the knee. Knee Surgery, Sports Traumatology, Arthroscopy 24, 1525-1539.

Razek, A., Fouda, N., Elmetwaley, N., and Elbogdady, E. (2009). Sonography of the knee joint. Journal of ultrasound 12, 53-60.

Sally, M. H., and Ali, A. M. (2019). Role of Ultrasound in Assessment of Menisco-Ligamentous Injuries of Knee Joint in Comparison with Magnetic Resonance Imaging. The Medical Journal of Cairo University 87, 4571-4577.

Sharma, V., and Grewal, S. (2020). Sonographic evaluation of pathologies of knee joint with MRI correlation. International Journal of Medical Research Professionals 6, 26-33.

Shetty, M. (2013). evaluation of internal derangements of knee joint. Mangalore: (Doctoral dissertation).

Snoeker, B. A., Bakker, E. W., Kegel, C. A., and Lucas, C. (2013). Risk factors for meniscal tears: a systematic review including meta-analysis. journal of orthopaedic & sports physical therapy 43, 352-367.

Stewart, T. (2010). Tribology of artificial joints. Orthopaedics and Trauma 24, 435-440.

Wang, W., Li, Z., Peng, H.-M., Bian, Y.-Y., Li, Y., Qian, W.-W., Weng, X.-S., Jin, J., Yang, X.-Y., and Lin, J. (2019). Accuracy of MRI diagnosis of meniscal tears of the knee: a meta-analysis and systematic review. The journal of knee surgery.

Yaseen, M. K., and Gorial, F. I. (2019). Accuracy of Ultrasound in Comparison to Magnatic Resonance Imaging in Diagnosis of Meniscal Tears. Indian Journal of Public Health Research & Development 10, 397-400.

Yousif, E. A., Ahmed, B. H., Abdella, A. A., Ali, Q. M., Abdallah, Y. M., Boshara, M. A., Elhaj, A. M., Alshaikh, A. A., Abuidris, D. O., and Eltayeb, A. A. (2014). Knee joint diseases diagnosed by ultrasound and magnetic resonance imaging. Sudan Medical Monitor 9, 1.