Hilary Michele Hochberg MD, Presenter: Nothing to Disclose

Diane Bergin MD, Abstract Co-Author: Nothing to Disclose

Adam C. Zoga MD, Abstract Co-Author: Nothing to Disclose

Laurence Parker PhD, Abstract Co-Author: Nothing to Disclose

Michael Cicotti, Abstract Co-Author: Nothing to Disclose

William Brian Morrison MD, Abstract Co-Author: Nothing to Disclose

To evaluate utility of soft tissue and osseous findings associated with meniscal tear on MRI (“secondary signs”), using arthroscopy as the reference standard.

Two musculoskeletal radiologists retrospectively reviewed 33 1.5 T MR knee exams (66 menisci) of 33 patients (24 M: 9F; age range 19-45, mean 32) without recent trauma who underwent subsequent arthroscopy within two months. MR images were evaluated for: focal medial or lateral compartmental cartilage loss or focal cartilage loss directly adjacent to the meniscus; meniscal extrusion greater than 3mm; parameniscal cyst; parameniscal soft tissue edema; subchondral bone marrow edema, its proximity to the meniscus, and its configuration; and perivascular marrow edema. Findings were correlated with presence of meniscal tear at arthroscopy. Sensitivity, specificity and positive and negative predictive values of each sign for meniscal tear were calculated.

There were 26 medial and 12 lateral meniscal tears at arthroscopy. Sensitivity / specificity / PPV / NPV of the individual findings were as follows: focal compartmental cartilage loss, 0.03 / 0.96 / 0.50 / 0.42; focal cartilage loss directly adjacent to the meniscus, 0.53 / 1.00 / 1.00 / 0.61; meniscal extrusion greater than 3mm, 0.42 / 0.96 / 0.94 / 0.55; parameniscal cyst, 0.05 / 1.00 / 1.00 / 0.44; parameniscal soft tissue edema, 0.76 / 0.86 / 0.88 / 0.73; subchondral bone marrow edema, 0.89 / 0.18 / 0.60 / 0.56; subchondral bone marrow edema adjacent to the meniscus, 0.66 / 0.96 / 0.96 / 0.68; linear subchondral bone marrow edema, 0.24 / 0.96 / 0.90 / 0.48; perivascular bone marrow edema, 0.12 / 0.93 / 0.86 / 0.22. These represent preliminary results; the study is ongoing.

High specificity and positive predictive value for meniscal tear was observed with subchondral bone marrow edema directly adjacent to the meniscus, linear subchondral marrow edema, parameniscal cyst, meniscal extrusion greater than 3mm, and focal cartilage loss directly adjacent to the meniscus. These findings may be useful as secondary signs for meniscal tear when application of the standard criteria yields a borderline interpretation.

Hochberg, H, Bergin, D, Zoga, A, Parker, L, Cicotti, M, Morrison, W, Meniscal Tears on MRI of the Knee: Utility of Secondary Signs.  Radiological Society of North America 2005 Scientific Assembly and Annual Meeting, November 27 - December 2, 2005 ,Chicago IL. http://archive.rsna.org/2005/4418647.html