title: Acute knee trauma: value of a short dedicated extremity MR imaging examination for prediction of subsequent treatment.
abstract: OBJECTIVE
  To assess the predictive value of a short magnetic resonance (MR) imaging examination, in addition to or instead of radiography, performed in patients with acute knee trauma to identify those who require additional treatment versus those who do not and can be discharged without further follow-up.
  
  
  METHODS
  The randomized controlled trial and use of collected data for prediction modeling were approved by the institutional review board; informed consent was obtained. Patients with recent knee injury were included in the trial if radiography was ordered. They were randomized into a group undergoing only radiography and a group undergoing radiography plus immediate MR imaging. A 0.2-T dedicated extremity MR imager and four short pulse sequences were used. Univariable and multivariable logistic regression analysis was used to evaluate patient characteristics, trauma mechanism, and findings at radiography and MR imaging for their value in prediction of need for subsequent treatment within the 6-month follow-up.
  
  
  RESULTS
  Data in 189 patients (123 male patients, 66 female patients; mean age, 33.4 years), 109 of whom underwent treatment after their initial visit, were analyzed. Age of 30 years or older, indirect trauma mechanism, radiographic results, and MR imaging results were significant predictors of need for treatment in univariable and multivariable analyses (P < .05). In the multivariable analysis, only abnormal MR imaging results were significantly predictive of need for treatment, and only when MR imaging replaced radiography (odds ratio, 2.61; 95% confidence interval: 1.12, 6.06).
  
  
  CONCLUSIONS
  Implementation of a dedicated extremity MR imaging examination, in addition to or instead of radiography, performed in patients with traumatic knee injury improves prediction of the need for additional treatment but does not significantly aid in identification of patients who can be discharged without further follow-up. Value of a short MR imaging examination in the initial stage after knee trauma is limited.
authors.affiliation: Program for the Assessment of Radiological Technology, Erasmus MC, University Medical Center Rotterdam, Dr Molewaterplein 40, 3015 GD Rotterdam, The Netherlands.
authors.forename: Edwin H G
authors.initials: EH
authors.lastname: Oei
authors.forename: Jeroen J
authors.initials: JJ
authors.lastname: Nikken
authors.forename: Abida Z
authors.initials: AZ
authors.lastname: Ginai
authors.forename: Gabriel P
authors.initials: GP
authors.lastname: Krestin
authors.forename: Jan A N
authors.initials: JA
authors.lastname: Verhaar
authors.forename: Arie B
authors.initials: AB
authors.lastname: van Vugt
authors.forename: M G Myriam
authors.initials: MG
authors.lastname: Hunink
mesh_terms: D000328:Adult; D000368:Aged; D016009:Chi-Square Distribution; D005260:Female; D006801:Humans; D007718:Knee Injuries / Q000175:diagnosis* / Q000000981:diagnostic imaging; D016015:Logistic Models; D008279:Magnetic Resonance Imaging / Q000379:methods*; D008297:Male; D008875:Middle Aged; D011237:Predictive Value of Tests; D011446:Prospective Studies; D011859:Radiography