Multidetector computed tomography in acute knee injuries: assessment of cruciate ligaments with magnetic resonance imaging correlation.
OBJECTIVE
To evaluate whether non-contrast multidetector computed tomography (MDCT) for suspected acute knee fractures can also be used to evaluate cruciate ligament pathology.


METHODS
A total of 42 patients (17-65 years) underwent four-section MDCT. The images were independently evaluated at clinical workstations by four radiologists. They assessed the integrity (normal or torn) and the best slice direction (axial, sagittal, or coronal) for visualization of the cruciate ligaments. Magnetic resonance imaging (MRI), performed within 4 weeks (mean 6 days) in relation to MDCT, was considered the gold standard.


RESULTS
Ligament integrity at MDCT: the mean interobserver proportion of agreement for a normal anterior cruciate ligament (ACL) was 0.73, for a torn ACL 0.41, for a normal posterior cruciate ligament (PCL) 0.96, and for a torn PCL 0.54. Interobserver variation for ACL was significant (P = 0.0136-0.0260), but insignificant for PCL (P = 0.3389-0.7212). Intra-observer variation was insignificant. Visualization was best in the axial and sagittal direction for ACL and PCL, respectively. At MRI, 29 normal, one partially, and 12 completely torn ACLs, and 37 normal, four partially and one completely torn PCL were found.


CONCLUSIONS
MDCT can detect an intact ACL and PCL with good specificity, accuracy, and negative predictive value. The assessment of torn ligaments is unreliable.
Mustonen
A O T
AO
Helsinki Medical Imaging Center, Department of Radiology, Helsinki University Central Hospital, Töölö Trauma Center, Topeliuksenkatu 5, FIN-00029 Helsinki, Finland. antti.mustonen@helsinki.fi
Koivikko
M P
MP
Haapamaki
V V
VV
Kiuru
M J
MJ
Lamminen
A E
AE
Koskinen
S K
SK
D000208:Acute Disease; D000293:Adolescent; D000328:Adult; D000368:Aged; D016118:Anterior Cruciate Ligament / Q000000981:diagnostic imaging / Q000473:pathology; D005260:Female; D005387:Finland; D006801:Humans; D007091:Image Processing, Computer-Assisted / Q000379:methods; D007718:Knee Injuries / Q000175:diagnosis*; D007719:Knee Joint / Q000000981:diagnostic imaging / Q000473:pathology; D008023:Ligaments, Articular / Q000000981:diagnostic imaging* / Q000473:pathology*; D008279:Magnetic Resonance Imaging / Q000379:methods*; D008297:Male; D008875:Middle Aged; D015588:Observer Variation; D016119:Posterior Cruciate Ligament / Q000000981:diagnostic imaging / Q000473:pathology; D011237:Predictive Value of Tests; D015203:Reproducibility of Results; D012189:Retrospective Studies; D012680:Sensitivity and Specificity; D014057:Tomography, X-Ray Computed / Q000379:methods*