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3-Tesla-MRT vs. Arthroskopie bei der Diagnostik degenerativer Knorpelschäden des Kniegelenkes

Erste klinische Ergebnisse

3-Tesla MRI vs. arthroscopy for diagnostics of degenerative knee cartilage diseases

Preliminary clinical results

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Zusammenfassung

Hintergrund

In der Literatur finden sich nur wenige Arbeiten, die sich mit der MRT-Diagnostik degenerativer Knorpelschäden befassen. Untersuchungen über die MRT-Diagnostik des Gelenkknorpels bei Feldstärken von 3 Tesla demonstrieren viel versprechende Ergebnisse. Um den Nutzen des 3-Tesla-MRT zur Entscheidungsfindung konservativer oder operativer Behandlungspfade zu evaluieren, ist diese Studie auf Patienten mit degenerativen Knorpelschäden gerichtet.

Methoden

Es wurden 32 Patienten mit chronischen Knieschmerzen, einem Alter von ≥40 Jahren, unauffälliger Traumanamnese und zumindest zweitgradigen degenerativen Knorpelschäden einbezogen. Die im präoperativen 3-Tesla-MRT (axial/koronar/sagittal PD-TSE-SPAIR, axial/sagittal 3D-T1-FFE, axial T2-FFE, Philips Medical Systems, Intera-3.0T™) festgestellten Knorpelveränderungen wurden klassifiziert (Grad I–IV) und mit den arthroskopischen Befunden verglichen.

Ergebnisse

Bei 36% (70/192) der untersuchten Knorpelflächen zeigte sich keine Übereinstimmung zwischen dem MRT- und Arthroskopiegrading. Am häufigsten wurden hierbei zweit- und drittgradige Knorpelschäden miteinander verwechselt. Entsprechend der positiven Vorhersagewerte liegt die Wahrscheinlichkeit, dass sich bei einem auffälligen MRT-Befund auch arthroskopisch ein entsprechender Schaden findet, zwischen 39 und 72%. Hingegen zeigten die Spezifitäten und negativen Vorhersagewerte bei den unterschiedlichen Schädigungsgraden Werte zwischen 85 und 95%.

Schlussfolgerung

Hinsichtlich der hohen Spezifitäten und negativen Vorhersagewerte ist das 3-Tesla-MRT als Ausschlussmethode sogar geringfügiger Knorpeldegenerationen von Bedeutung. Zusammenfassend ist das 3-Tesla-MRT bei der Diagnostik degenerativer Knorpelschäden eine unterstützende, nicht-invasive Methode zur Entscheidung konservativer oder operativer Behandlungsmöglichkeiten. Dennoch kann das 3-Tesla-MRT den Nutzen einer diagnostischen Arthroskopie für eine dezidierte Beurteilung der Gelenkflächen und eine entsprechende Therapieplanung nicht ersetzten. Dies gilt insbesondere für Therapieansätze, bei denen die Differenzierung zweit- und drittgradiger Knorpelschäden von Interesse ist.

Abstract

Background

The literature contains only a few studies investigating the magnetic resonance imaging (MRI) diagnostics of degenerative cartilage diseases. Studies on MRI diagnostics of the cartilage using field strengths of 3-Tesla demonstrate promising results. To assess the value of 3-Tesla MRI for decision making regarding conservative or operative treatment possibilities, this study focused on patients with degenerative cartilage diseases.

Methods

Thirty-two patients with chronic knee pain, a minimum age of 40 years, a negative history of trauma, and at least grade II degenerative cartilage disease were included. Cartilage abnormalities detected at preoperative 3-Tesla MRI (axial/koronar/sagittal PD-TSE-SPAIR, axial/sagittal 3D-T1-FFE, axial T2-FFE; Intera 3.0T, Philips Medical Systems) were classified (grades I–IV) and compared with arthroscopic findings.

Results

Thirty-six percent (70/192) of the examined cartilage surfaces demonstrated no agreement between MRI and arthroscopic grading. In most of these cases, grades II and III cartilage lesions were confounded with each other. Regarding the positive predictive values, the probability that a positive finding in MRI would be exactly confirmed by arthroscopy was 39–72%. In contrast, specificities and negative predictive values of different grades of cartilage diseases were 85–95%.

Conclusions

Regarding the high specificities and negative predictive values, 3-Tesla MRI is a reliable method for excluding even slight cartilage degeneration. In summary, in degenerative cartilage diseases, 3-Tesla MRI is a supportive, noninvasive method for clinical decision making regarding conservative or operative treatment possibilities. However, the value of diagnostic arthroscopy for a definitive assessment of the articular surfaces and for therapeutic planning currently cannot be replaced by 3-Tesla MRI. This applies especially to treatment options in which a differentiation between grade II and III cartilage lesions is of interest.

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Authors and Affiliations

  1. Zentrum für Unfallchirurgie und Orthopädische Chirurgie, Helios-Klinikum Wuppertal, Universitätsklinikum der privaten Universität Witten-Herdecke, Heusnerstraße 40, 42117, Wuppertal, Deutschland

    L.V. von Engelhardt

  2. Klinik für Orthopädie und Unfallchirugie, Universitätsklinikum Bonn, Rheinische Friedrich-Wilhelms-Universität, Bonn, Deutschland

    A. Schmitz, B. Burian & P.H. Pennekamp

  3. Radiologische Klinik, Universitätsklinikum, Rheinische Friedrich-Wilhelms-Universität, Bonn, Deutschland

    H.H. Schild & M. von Falkenhausen

  4. Klinik für Orthopädie, Unfall- und Handchirurgie, Helios-Klinikum, Krefeld, Deutschland

    C.N. Kraft

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  1. L.V. von Engelhardt
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  2. A. Schmitz
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  3. B. Burian
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  7. M. von Falkenhausen
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Correspondence to L.V. von Engelhardt.

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von Engelhardt, L., Schmitz, A., Burian, B. et al. 3-Tesla-MRT vs. Arthroskopie bei der Diagnostik degenerativer Knorpelschäden des Kniegelenkes. Orthopäde 37, 914–922 (2008). https://doi.org/10.1007/s00132-008-1313-6

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