title: Coronal oblique imaging of the knee: can it increase radiologists' confidence in diagnosing posterior root meniscal tears?
abstract: OBJECTIVE
  To investigate the utility of the coronal oblique sequence in the interrogation of posterior root meniscal lesions.
  
  
  METHODS
  Following international review board approval, 62 consecutive knee arthroscopy cases were referred to the musculoskeletal (MSK) radiologists from the same orthopaedic surgeon for imaging/surgical correlation of the posterior meniscal roots. Of 62 cases, 45 lateral and 46 medial menisci met the inclusion criteria. Imaging evaluation was performed with standard magnetic resonance imaging (MRI) sequences, including a coronal oblique proton density sequence. Two blinded fellowship-trained MSK radiologists independently evaluated the menisci on standard sequences indicating whether a tear was identified and then specifying a confidence score using a scale of 1-3 on each study interpreted. Immediately thereafter, the coronal oblique sequence was evaluated using the same method. Statistics were performed on meniscal lesions involving the posterior horn/root junction or isolated root tears comparing confidence scores.
  
  
  RESULTS
  Reader A identified nine posterior horn/root junction tears and 14 isolated root tears. Following the addition of the coronal oblique sequence, confidence scores increased in three of 14 (21.4%) isolated root tears. All three final reads were concordant with arthroscopy. Reader B identified 10 posterior horn/root junction tears and 19 isolated root tears. The confidence score increased in six cases: five of 19 (26.3%) isolated root tears and one of 10 (10%) posterior horn/root junction tears. All six final reads were concordant with arthroscopy. Kappa coefficients indicated near perfect agreement.
  
  
  CONCLUSIONS
  The coronal oblique sequence increased reader confidence in nearly 24% of the posterior root cases identified in this series.
authors: Department of Radiology, Division of Musculoskeletal Imaging, University of Pittsburgh Medical Center, Pittsburgh, PA 15213, USA. casagrandab@upmc.edu
authors: B U
authors: BU
authors: Casagranda
authors: J
authors: J
authors: Leeman
authors: J M
authors: JM
authors: Costello
authors: B
authors: B
authors: Rafiee
authors: C D
authors: CD
authors: Harner
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D001182:Arthroscopy; D005260:Female; D006801:Humans; D007718:Knee Injuries / Q000175:diagnosis* / Q000473:pathology; D007719:Knee Joint / Q000473:pathology*; D008279:Magnetic Resonance Imaging / Q000379:methods*; D008297:Male; D008592:Menisci, Tibial / Q000473:pathology; D008875:Middle Aged; D015588:Observer Variation; D000070600:Tibial Meniscus Injuries; D055815:Young Adult