MR imaging of the menisci and cruciate ligaments: a systematic review.
OBJECTIVE
To systematically review and synthesize published data on the diagnostic performance of magnetic resonance (MR) imaging of the menisci and cruciate ligaments and to assess the effect of study design characteristics and magnetic field strength on diagnostic performance.


METHODS
Articles published between 1991 and 2000 were included if at least 30 patients were studied, arthroscopy was the reference standard, the magnetic field strength was reported, positivity criteria were defined, and the absolute numbers of true-positive, false-negative, true-negative, and false-positive results were available or derivable. Pooled weighted and summary receiver operating characteristic (ROC) analyses were performed for tears of both menisci and both cruciate ligaments separately and for the four lesions combined, by using random effects models. Differences were assessed according to lesion type.


RESULTS
Twenty-nine of 120 retrieved articles were included. Pooled weighted sensitivity was higher for medial meniscal tears than that for lateral meniscal tears. However, pooled weighted specificity for the medial meniscus was lower than that for the lateral meniscus. In summary ROC analyses performed per lesion, various study design characteristics were found to influence diagnostic performance. Higher magnetic field strength significantly improved discriminatory power only for anterior cruciate ligament tears. When all lesions were combined in one overall summary ROC analysis, magnetic field strength was a significant but modest predictor of diagnostic performance.


CONCLUSIONS
Diagnostic performance of MR imaging of the knee is different according to lesion type and is influenced by various study design characteristics. Higher magnetic field strength modestly improves diagnostic performance, but a significant effect was demonstrated only for anterior cruciate ligament tears.
Oei
Edwin H G
EH
Program for the Assessment of Radiological Technology, Department of Radiology, Erasmus University Medical Center Rotterdam, Dr Molewaterplein 50, Rm EE21-40a, 3015 GE Rotterdam, the Netherlands.
Nikken
Jeroen J
JJ
Verstijnen
Antonia C M
AC
Ginai
Abida Z
AZ
Myriam Hunink
M G
MG
D000070598:Anterior Cruciate Ligament Injuries; D005189:False Positive Reactions; D006801:Humans; D007718:Knee Injuries / Q000175:diagnosis*; D012372:ROC Curve; D012680:Sensitivity and Specificity; D000070600:Tibial Meniscus Injuries