Valid MR imaging predictors of prior knee arthroscopy.

PURPOSE: To determine whether fibrosis of the medial patellar reticulum (MPR), lateral patellar reticulum (LPR), deep medial aspect of Hoffa's fat pad (MDH), or deep lateral aspect of Hoffa's fat pad (LDH) is a valid predictor of prior knee arthroscopy. MATERIALS AND METHODS: Institutional review board approval and waiver of informed consent were obtained for this HIPPA-compliant study. Initially, fibrosis of the MPR, LPR, MDH, or LDH in MR imaging studies of 50 patients with prior knee arthroscopy and 100 patients without was recorded. Subsequently, two additional radiologists, blinded to clinical data, retrospectively and independently recorded the presence of fibrosis of the MPR in 50 patients with prior knee arthroscopy and 50 without. Sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV), and accuracy for detecting the presence of fibrosis in the MPR were calculated. κ statistics were used to analyze inter-observer agreement. RESULTS: Fibrosis of each of the regions examined during the first portion of the study showed a significant association with prior knee arthroscopy (p < 0.005 for each). A patient with fibrosis of the MPR, LDH, or LPR was 45.5, 9, or 3.7 times more likely, respectively, to have had a prior knee arthroscopy. Logistic regression analysis indicated that fibrosis of the MPR supplanted the diagnostic utility of identifying fibrosis of the LPR, LDH, or MDH, or combinations of these (p ≥ 0.09 for all combinations). In the second portion of the study, fibrosis of the MPR demonstrated a mean sensitivity of 82%, specificity of 72%, PPV of 75%, NPV of 81%, and accuracy of 77% for predicting prior knee arthroscopy. CONCLUSIONS: Analysis of MR images can be used to determine if a patient has had prior knee arthroscopy by identifying fibrosis of the MPR, LPR, MDH, or LDH. Fibrosis of the MPR was the strongest predictor of prior knee arthroscopy.

Characterization of genitourinary lesions with diffusion-weighted imaging.

Diffusion-weighted imaging has been widely accepted as a powerful imaging technique in neuroradiology. Until recently, the inclusion of diffusion-weighted sequences in body imaging protocols has been hindered by technical limitations. However, with advances in magnetic resonance (MR) imaging technology and technique, these limitations are being overcome. The addition of diffusion-weighted sequences to routine abdominopelvic MR imaging protocols has been found to yield diagnostically useful information with only a minimal increase in imaging time. More specifically, the use of diffusion-weighted imaging in the genitourinary system can facilitate the detection and characterization of genitourinary tract lesions that demonstrate equivocal signal intensity characteristics with routine MR imaging sequences. Diffusion-weighted imaging is not only helpful in differentiating benign from malignant processes, but it can also be used to assess meta-static lesions, possible tumor recurrence, and treatment response. Because it does not require injection of a gadolinium-based contrast agent, diffusion-weighted imaging can be used in patients with renal insufficiency or contrast material allergy. Most of the body diffusion-weighted imaging studies reported in the literature to date have been conducted with 1.5-T magnets. However, the feasibility of body diffusion-weighted imaging at 3.0 T is currently under investigation in an effort to determine the efficacy of the routine inclusion of diffusion-weighted imaging sequences in 3.0-T body MR imaging protocols.