title: Comparison of spin echo T1-weighted sequences versus fast spin-echo proton density-weighted sequences for evaluation of meniscal tears at 1.5 T.
abstract: OBJECTIVE
  At our institution, fast spin-echo (FSE) proton density (PD) imaging is used to evaluate articular cartilage, while conventional spin-echo (CSE) T1-weighted sequences have been traditionally used to characterize meniscal pathology. We sought to determine if FSE PD-weighted sequences are equivalent to CSE T1-weighted sequences in the detection of meniscal tears, obviating the need to perform both sequences.
  
  
  METHODS
  We retrospectively reviewed the records of knee arthroscopies performed by two arthroscopy-focused surgeons from an academic medical center over a 2-year period. The preoperative MRI images were interpreted independently by two fellowship-trained musculoskeletal radiologists who graded the sagittal CSE T1 and FSE PD sequences at different sittings with grades 1-5, where 1 = normal meniscus, 2 = probable normal meniscus, 3 = indeterminate, 4 = probable torn meniscus, and 5 = torn meniscus. Each meniscus was divided into an anterior and posterior half, and these halves were graded separately. Operative findings provided the gold standard. Receiver operating characteristic (ROC) analysis was performed to compare the two sequences.
  
  
  RESULTS
  There were 131 tears in 504 meniscal halves. Using ROC analysis, the reader 1 area under curve for FSE PD was significantly better than CSE T1 (0.939 vs. 0.902, >95% confidence). For reader 2, the difference met good criteria for statistical non-inferiority but not superiority (0.913 for FSE PD and 0.908 for CSE T1; >95% non-inferiority for difference at most of -0.027).
  
  
  CONCLUSIONS
  FSE PD-weighted sequences, using our institutional protocol, are not inferior to CSE T1-weighted sequences for the detection of meniscal tears and may be superior.
authors.affiliation: Department of Diagnostic Radiology, Yale University School of Medicine, P.O. Box 208042, Tompkins East 2, New Haven, CT, 06520-8042, USA.
authors.forename: Andrew B
authors.initials: AB
authors.lastname: Wolff
authors.forename: Lorenzo L
authors.initials: LL
authors.lastname: Pesce
authors.forename: Jim S
authors.initials: JS
authors.lastname: Wu
authors.forename: L Ryan
authors.initials: LR
authors.lastname: Smart
authors.forename: Michael J
authors.initials: MJ
authors.lastname: Medvecky
authors.forename: Andrew H
authors.initials: AH
authors.lastname: Haims
mesh_terms: D000293:Adolescent; D000328:Adult; D001182:Arthroscopy; D002648:Child; D005260:Female; D049671:History, 18th Century; D006801:Humans; D007090:Image Interpretation, Computer-Assisted; D007718:Knee Injuries / Q000175:diagnosis* / Q000473:pathology; D008279:Magnetic Resonance Imaging / Q000379:methods*; D008297:Male; D008592:Menisci, Tibial / Q000473:pathology*; D008875:Middle Aged; D011237:Predictive Value of Tests; D012372:ROC Curve; D012189:Retrospective Studies