title: The value of the absent bow tie sign in MRI of bucket-handle tears.
abstract: OBJECTIVE
  To assess the accuracy of the absent bow tie sign in diagnosing bucket handle meniscal tears (BHT) of the knee menisci.
  
  
  METHODS
  During a 3-year period, we correlated the MRI and arthroscopic findings and the presence of the various signs. One hundred and seven knees were reviewed: 74 where either MRI or arthroscopy had identified a BHT and 33 which were either normal (31), or a simple tear was identified (2). All cases were reviewed by a single radiologist with a musculoskeletal interest blinded to the original results. Each was assessed for the presence of (1) a central meniscal fragment, (2) the double posterior cruciate ligament (PCL) sign, (3) the bow tie sign and (4) the contribution of a 3D-volume sequence.
  
  
  RESULTS
  Optimal results were obtained using standard sequences and a 3D-volume sequence, giving a sensitivity of 74% and positive predictive value of 89%. The bow tie sign gave a sensitivity of 71% and positive predictive value of 76%, significantly less than previous reports. The 18 BHTs diagnosed by arthroscopy but missed by MRI showed other abnormal findings at MRI and were not reported as normal.
  
  
  CONCLUSIONS
  We were not able to reproduce the previously reported high sensitivity and specificity of the absent bow tie sign. Despite optimization of all factors, the accurate diagnosis of a bucket handle tear remains difficult, and is most reliably made by identifying a central meniscal fragment, rather than relying on secondary signs such as the absent bow tie sign.
authors.affiliation: Department of Radiology, Western Infirmary, West Glasgow Hospitals University NHS Trust, Dumbarton Road, Glasgow, G11 6NT, U.K. awatt@wigxray.demon.co.uk
authors.forename: A J
authors.initials: AJ
authors.lastname: Watt
authors.forename: T
authors.initials: T
authors.lastname: Halliday
authors.forename: N
authors.initials: N
authors.lastname: Raby
mesh_terms: D001182:Arthroscopy / Q000379:methods; D003937:Diagnosis, Differential; D006801:Humans; D008279:Magnetic Resonance Imaging / Q000379:methods*; D011237:Predictive Value of Tests; D012189:Retrospective Studies; D012680:Sensitivity and Specificity; D000070600:Tibial Meniscus Injuries