RESUMO
Aim: To understand the relative diagnostic sensitivity,specificity and accuracy of each modality.Introduction: Internal de-arrangement of knee requires utmostdiagnostic accuracy especially in professional sportspersonnel’s. MRI is the most advanced modality to date forsuch injuries and there is a trend among most of the patientsand treating young doctors to order for an MRI, in almost all theinjuries, obvious and occult, with the result that there is a heavyrush of workload on MRI and it is difficult to cope with the workload, resulting in a long waiting list.Method: In view of the above situation and conflicting reports,regarding the efficiency of ultrasound and total neglect ofclinical diagnosis this comparative study of clinicalexamination, ultrasonic diagnosis and MRI was conducted inour tertiary care centre, from March 2017 to March 2018, as aprospective double blind study.Results: Among the 104 patients who participated in this study106 lesions were diagnosed clinically, where in 10 lesions werefalse positives as confirmed by MRI, in only 96 cases. Resultsof ultrasound analysis were quite encouraging as it coulddiagnose IDK in 95 cases meaning only one case as falsenegative. Lateral meniscus (LM) was diagnosed clinically in 16cases, sonographically in 17 cases and by MRI in 18 cases.Medial Meniscus (MM) was diagnosed as torn clinically in 38cases, ultrasonographically and MRI in 36 cases. ACL wasdetected as torn clinically in 32 cases while 28 and 27 by USGand MRI while as PCL was detected as torn clinically in 1 andin 2 cases by USG and MRI. Medial collateral (MC) wasdetected as torn clinically in 7 cases and by USG and MRI In10 cases while as Lateral Collateral (LC) was detected as tornclinically in 2 cases while 3 by USG and MRI.Overall, sensitivity, specificity and accuracy (SSA) of clinicalexamination was 75.7%, 79.6% and 78.1%. Mean SSA ofultrasound was 96.8%, 98.4% and 97.4%. The study provesthat ultrasound is a reasonably sensitive, specific and accuratein expensive diagnostic tool and is underutilized, as in experthands its results match that of MRI.
RESUMO
We selected one hundred magnetic resonance imaging(MRI) in knees of patients with internal derangement of the knee, in all of those cases, arthroscopic operations were performed. Twenty medical doctors, who didnt know the arthroscopic findings, reviewed these MRI; 5 radiology specialists, 5 radiology residents, 5 orthopedic surgeons and 5 orthopedic residents. The radiologists were not informed about the medical history and physical examination of the patients when they read the MRI, but the orthopedic surgeons had the information about those of the patients. The accuracy of reading of MRI was compared between radiologists and orthopedic surgeons, and between specialists and residents. The check-list of the reading were medial and lateral meniscus, ACL and PCL, medial synovial plica and osteochondral lesion. Overall results of accuracy of MRI reading were as follows; radiology specialist-86%-, radiology resident-77%-, orthopedic surgeon-90%- and orthopedic resident-84%-. So accuracy was superior in orthopedic group and specialist group. The medical history and the physical examination of the patients were very helpful to improve accuracy of MRI reading. Reading skill was also important for accurate reading of MRI.