Value of Low-Field Magnetic Resonance Imaging in Diagnosing Meniscal Tears in the Canine Stifle: A Prospective Study Evaluating Sensitivity and Specificity in Naturally Occurring Cranial Cruciate Ligament Deficiency with Arthroscopy as the Gold Standard

Authors: 
Peter Böttcher, Dr med vet, Diplomate ECVS 1 , Andreas Brühschwein, Dr med vet, Diplomate ECVDI 2 , Philipp Winkels, DVM 1 , Hinnerk Werner, DVM 1 , Eberhard Ludewig, Dr med vet, Diplomate ECVDI 1 , Vera Grevel, Prof Dr med vet, Diplomate ECVS 1 , and Ger
Volume: 
39
Number: 
3
Pages: 
296-305
Journal: 
Veterinary Surgery
Date: 
April 2010

ABSTRACT
Objective: To evaluate the sensitivity and specificity of low-field magnetic resonance imaging (lfMRI) for detection of meniscal tears in the canine stifle.
Study Design: Double-blinded prospective clinical study.
Animals: Forty-two consecutive stifles of dogs (≥20 kg; n=34) with clinical and radiologic signs suspicious for cranial cruciate ligament (CCL) insufficiency.
Methods: Each stifle had 7 predefined lfMRI sequences using a 0.5 T magnet with a human knee coil. After lfMRI, diagnostic arthroscopy was performed by 1 surgeon unaware of the MRI findings. After completion of the study MRI images were read by 1 investigator, unaware of the intraoperative findings.
Results: At arthroscopy, 22 stifles had meniscal tears requiring subtotal meniscectomy. Of these only 14 were identified by lfMRI. Overall sensitivity and specificity of lfMRI for detection of meniscal tears were 0.64 (95% confidence interval [95% CI]=0.43, 0.80) and 0.90 (95% CI=0.70, 0.97), respectively. Positive and negative predictive values were 0.88 (95% CI=0.64, 0.97) and 0.69 (95% CI=0.50, 0.83), respectively. Neither the state of dislocation of vertical longitudinal tears nor the amount of CCL rupture had an influence on lfMRI accuracy (P=1.00).
Conclusion: lfMRI was of low diagnostic accuracy in detecting meniscal tears, when compared with arthroscopy. Especially negative lfMRI findings should be interpreted with caution.
Clinical Relevance: When using lfMRI as a noninvasive preoperative screening tool for the diagnosis of meniscal tears, a high percentage of missed meniscal tears has to be expected.

Small animal: