MRI of meniscal lesions: soft-copy (PACS) and hard-copy evaluation versus reviewer experience.
OBJECTIVE
The purpose of our study was to compare diagnostic performance, reviewer confidence, and time requirements in the MRI diagnosis of meniscal tears for three types of reviewers and two types of image documentations (PACS vs hard copies).


METHODS
An experienced musculoskeletal radiologist (reviewer 1), a fellow in musculoskeletal radiology (reviewer 2), and a junior staff member in orthopedic surgery (reviewer 3) evaluated MR images displayed on PACS monitors and hard copies independently and in a blinded fashion with regard to the presence or absence of meniscal tears. Seventy-one patients (mean age, 45.4 years; range, 16-80 years) were consecutively included if they had undergone both MRI of the knee and arthroscopy within 4 months. Arthroscopy was the standard of reference. Evaluation time and the reviewer's confidence in his or her diagnosis (Visual Analogue Scale, possible values of 0-100) were determined.


RESULTS
Accuracies, sensitivities, and specificities in diagnosing meniscal tears were 80-87%, 63-85%, and 87-93% for soft copies and 82-85%, 64-76%, and 87-94.0%, respectively, for hard copies. Intrareviewer differences between PACS and hard copies were not significant for any of the three reviewers (McNemar tests). Reviewer 3 was less sensitive but more specific in the diagnosis of meniscal tears than reviewers 1 and 2. This difference was significant for both the PACS and hard copies. The reviewers' confidence in their diagnoses and evaluation times were not significantly different for PACS and hard copies (analysis of variance with Bonferroni post hoc analysis).


CONCLUSIONS
Differences in the diagnostic performance of suspected meniscal tears depend on reviewer experience rather than on the type of documentation.
Department of Radiology, Orthopedic University Hospital Balgrist, Zurich, Switzerland. justus.roos@stanford.edu
Justus E
JE
Roos
Bianca
B
Chilla
Marco
M
Zanetti
Marius
M
Schmid
Peter
P
Koch
Christian W A
CW
Pfirrmann
Juerg
J
Hodler
D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002983:Clinical Competence; D005260:Female; D006801:Humans; D007718:Knee Injuries / Q000175:diagnosis*; D008279:Magnetic Resonance Imaging; D008297:Male; D008875:Middle Aged; D011873:Radiology Information Systems; D012680:Sensitivity and Specificity; D000070600:Tibial Meniscus Injuries