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Aim and objectives: In forensic age estimation e.g. for judicial proceedings surpassed age thresholds can be legally relevant. To examine age related differences in skeletal development the recommendations by the Study Group on Forensic Age Diagnostics (AGFAD) are based on ionizing radiation (among others orthopantomograms, plain x-rays of the hand). Vieth et al. and Ottow et al. proposed MRI-classifications for the epiphyseal-diaphyseal fusion of the knee joint to define different age groups in healthy volunteers. The aim of the present study was to directly compare these two classifications in a large German patient population. Materials and methods: MRI of the knee joint of 900 patients (405 female, 495 male) from 10 to 28 years of age were retrospectively analyzed. Acquired T1-weighted turbo spin-echo sequence (TSE) and T2-weighted sequence with fat suppression by turbo inversion recovery magnitude (TIRM) were analyzed for the two classifications. The different bony fusion stages of the two classifications were determined and the corresponding chronological ages assigned. Differences between the sexes were analyzed. Intra- and inter-observer agreements were determined using Cohen's kappa. Results: With the classification of Ottow et al. it was possible to determine completion of the 18th and 21st year of life in both sexes. With the classification of Vieth et al. completion of the 18th year of life for female patients and the 14th and 21st year of life in both sexes could be determined. The intra- and inter-observer agreement levels were very good (κ > 0.82). Conclusion: In the large German patient cohort of this study it was possible to determine the 18th year of life with for both sexes with the classification of Ottow et al. and for female patients with the classification of Vieth et al. It was also possible to determine the 21st year of life for all bones with the classification of Ottow et al. and for the distal femur with the classification of Vieth et al. [ABSTRACT FROM AUTHOR]

A disk-shaped meniscus is a commonly known alternative to the C-shaped meniscus, which is defined by a larger-than-normal meniscus body. However, the enlarged meniscus has a severe disadvantage, which is the increase in shearing forces exerted on it, which can lead to a tear in its body. The Wrisberg form of discoid lateral meniscus is a rare abnormality. The absence of the posterior meniscotibial ligament results in an excessive range of movement and instability of the meniscus, with only its meniscofemoral ligament (Wrisberg's ligament) remaining intact and attached to the posterior horn of the meniscus. Additionally, a Wrisberg variant can exhibit a significant disorder in its microstructure due to an abnormal collagen network, mucosal disintegration, and a lack of vascularity. This study includes 32 skeletally immature patients who came to our institution with symptomatic discoid lateral meniscus. The initial evaluation of every knee included magnetic resonance imaging (MRI), followed by arthroscopy. MRI enables the classification of discoid meniscus based on meniscal morphology, stability or instability, meniscal intrasubstance degradation, and the occurrence of meniscal rupture. The discoid meniscus was reshaped, excising the hypertrophied central portion of the meniscus. The International Knee Documentation Committee (IKDC) system, which is an online system for the evaluation of knee function, was utilized. Twenty-four discoid menisci were assessed as being stable and having a tear in their body. Eight discoid menisci were determined to be unstable (Wrisberg variant) with degeneration within their substance but no meniscus tear. At surgery, the mean age of the patients was 11.81+/−2.62 years (range 5–14 years). The average follow-up was 3.71+/−0.92 years (range, 3–6). The mean preoperative IKDC score was 44.71+/−14.42 (range, 21–57) points. Postoperatively, the mean IKDC score was 81.56+/−1.70 (range, 79–84) points. The two-tailed p -value was < 0.0001. The assumption that MRI assessment is essential not only for detecting the Wrisberg alternate but also for uncovering possible meniscal disintegration and intra-substance alterations that are not usually observed through arthroscopy is supported by our data. [ABSTRACT FROM AUTHOR]

Background and purpose: Trauma to the knee is one of the most common injuries in people, especially young people, and delay in the diagnosis of knee fractures and soft tissue injuries in the knee causes limitation of movement, instability, and constant knee pain. In this research can show the correlation between the initial symptoms of the patients and the need for further procedures. To be able to identify traumatic knee injuries that are not clear in the simple knee radiography and to evaluate the findings of the patients for further procedure. Materials and methods: This research is an observational study in which all patients who presented with knee trauma during the course of the study were included in the study. All the information of these patients in a form including age, age group and sex, admission and discharge information such as visit date, discharge date, duration of hospitalization, mechanism of trauma, underlying disease, knee pain, limitation of range of motion, hemarthrosis, associate injury, skin abrasion, Inability to walk, history of knee trauma, radiography findings, knee CT findings, MRI findings, arthroscopy findings, Lysholm and Tegner knee score, probable diagnosis in the emergency room, type of treatment the emergency room, duration of hospitalization in the emergency room, discharge from the emergency room, in The hospitalization form of the performed procedures, the time of hospitalization in the ward and the definitive diagnosis were collected, and then 4 weeks after discharge, they were followed up by phone call with referral to the orthopedic clinic, and other diagnostic and therapeutic measures were reviewed in these patients. The information was provided by the project manager without interfering in the patient care process. Quantitative data were expressed as mean and standard deviation and qualitative data were expressed as frequency and percentage. Independent student t-tests were used to evaluate quantitative variables in two groups, and the Chi-Square test and Fisher's exact test were used to evaluate qualitative variables. Results: During the study period, 177 people were studied. The average age of the patients was 24.21±13.08, of which 138 (76.7%) were men. Most of the injury was caused by traffic accidents. The initial diagnosis in the emergency department had a significant relationship with the definite diagnosis. A statistically significant relationship was seen between MRI findings with knee movement limitation and non-weight bearing. There was a statistically significant relationship between the existence of definitive injury in the knee, limitation of knee movement, lacerations and scratches on the knee, and non-weight bearing. The mechanism of knee injury and laceration, the inability to weight bearing, and the positive findings of X-ray and MRI in the patients who underwent invasive procedures were significantly different from those who received conservative treatment. Conclusion: Injury mechanisms in patients and clinical symptoms such as knee range of motion limitation and non-weigh bearing and abrasion or laceration of the skin on the knee, despite the lack of findings in the initial investigations in the emergency department, is a high chance of injury to the knee joint and they need further evaluation and follow-up.

Objective: Chondromalacia patella (CP) describes the softening of the patellar cartilage, and magnetic resonance imaging (MRI) is more useful in diagnosis than other imaging methods. The aim of study is to determine the frequency of other knee MRI fndings and their relationship with chondromalacia stages in patients evaluated for reasons other than trauma and found to have patellar chondromalacia. Methods: This retrospective study included patients who underwent knee MRI examination in the radiology departments of Cukurova University Faculty of Medicine and Health Sciences University Adana Faculty of Medicine for reasons other than trauma between January 2016 and January 2022. Magnetic resonance imaging was used to evaluate the presence and stage of CP, and the outerbridge system was used for staging. As additional fndings, the presence of osteoarthritis, cruciate ligament, meniscus, collateral ligament, and patellar tendon pathologies were evaluated. Results: A total of 278 patients, 168 women and 110 men, with an average age of 59.4 ± 9.8 years, were included in our study. Forty-six patients had stage 1, 64 had stage 2, 66 had stage 3, and 102 had stage 4 CP. A statistically signifcant correlation was found between increasing chondromalacia stage and the presence and stage of osteoarthritis (P < .001), the incidence of anterior cruciate ligament pathology (P < .001), the incidence of tears of the medial meniscus (anterior horn P < .002, posterior horn P < .039), and advanced age (P < .001). Conclusion: It has been determined that there is a relationship between the stage of CP and some additional knee pathologies and advanced age. [ABSTRACT FROM AUTHOR]

Manual anatomical landmarking for morphometric knee bone characterization in orthopedics is highly time-consuming and shows high operator variability. Therefore, automation could be a substantial improvement for diagnostics and personalized treatments relying on landmark-based methods. Applications include implant sizing and planning, meniscal allograft sizing, and morphological risk factor assessment. For twenty MRI-based 3D bone and cartilage models, anatomical landmarks were manually applied by three experts, and morphometric measurements for 3D characterization of the distal femur and proximal tibia were calculated from all observations. One expert performed the landmark annotations three times. Intra- and inter-observer variations were assessed for landmark position and measurements. The mean of the three expert annotations served as the ground truth. Next, automated landmark annotation was performed by elastic deformation of a template shape, followed by landmark optimization at extreme positions (highest/lowest/most medial/lateral point). The results of our automated annotation method were compared with ground truth, and percentages of landmarks and measurements adhering to different tolerances were calculated. Reliability was evaluated by the intraclass correlation coefficient (ICC). For the manual annotations, the inter-observer absolute difference was 1.53 ± 1.22 mm (mean ± SD) for the landmark positions and 0.56 ± 0.55 mm (mean ± SD) for the morphometric measurements. Automated versus manual landmark extraction differed by an average of 2.05 mm. The automated measurements demonstrated an absolute difference of 0.78 ± 0.60 mm (mean ± SD) from their manual counterparts. Overall, 92% of the automated landmarks were within 4 mm of the expert mean position, and 95% of all morphometric measurements were within 2 mm of the expert mean measurements. The ICC (manual versus automated) for automated morphometric measurements was between 0.926 and 1. Manual annotations required on average 18 min of operator interaction time, while automated annotations only needed 7 min of operator-independent computing time. Considering the time consumption and variability among observers, there is a clear need for a more efficient, standardized, and operator-independent algorithm. Our automated method demonstrated excellent accuracy and reliability for landmark positioning and morphometric measurements. Above all, this automated method will lead to a faster, scalable, and operator-independent morphometric analysis of the knee. [ABSTRACT FROM AUTHOR]

Objective: Peripatellar fat pads are extrasynovial intracapsular fat tissues. Suprapatellar, perifemoral, and infrapatellar (Hoffa fat pad) fat pads are included in the peripatellar fat pad. This study aimed to describe the magnetic resonance imaging (MRI) signs of suprapatellar fat pad impingement syndrome, describe their prevalence and pattern, and look into the relationship between their MRI and clinical signs. Methods: Two radiologists retrospectively analyzed 5,700 patients’ knee MRI data between December 2010 and December 2015. We documented the MRI findings that were associated with suprapatellar fad pad impingement syndrome. The correlations between age, osteoarthritis, chondromalacia, and the patellofemoral joint were evaluated using Pearson’s correlations. Results: In our study group, the prevalence of suprapatellar fat pad impingement was 5.3%. Of the patients 52% were men and 48% were women. Patients who were admitted to the clinic complained of non-specific pain in 80.3% of patients. Twenty-seven patients (8.9%) presented with isolated suprapatellar impingement syndrome; 185 (60.9%) showed an increase in intra-articular fluid; 4 (1.3%) had synovitis findings; 17 (5.6%) had medial collateral ligament tears; 107 (35.2%) had quadriceps femoris tendinitis; 8 (2.6%) had patellar tendinitis; 80 (26.3%) had a medial meniscus tear; 23 (7.6%) had Baker’s cyst; and 30 (9.9%) had soft-tissue edema. Medial meniscus degeneration was observed in 51 (16.8%) patients, Hoffa edema was observed in 31 (10.2%) patients, and anterior cruciate ligament tears in 3 (1%) patients. There were positive correlations between age and osteoarthritis (r=0.4660, p

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Introduction: The Wrisberg variant of the discoid lateral meniscus is a very rare disorder and is characterized by the hypermobility and instability of the meniscus caused by the absence of its posterior tibial attachment, with only its meniscofemoral junction (Wrisberg's ligament) maintained, and inserted in the posterior horn of the meniscus. As a result, the posterior horn of the lateral meniscus is mobile; often subluxing into the joint. Materials and methods: A total of eight skeletally immature patients with symptomatic Wrisberg variant of the discoid lateral meniscus were included in this study. Each knee was evaluated with MRI and arthroscopy. We graded unstable discoid menisci according to their discoid morphology (complete vs. incomplete), meniscal intra-substance degeneration, and the presence or absence of meniscal tears. All eight menisci were evaluated as degenerated with no meniscal tears. Five of them were evaluated as complete. Due to the severely degenerated meniscus, we considered it unnecessary to repair the detached posterior tibial ligament, so we performed a reshaping of the discoid meniscus, restoring a C-shape, excising the hypertrophied central part of the meniscus, and creating a posterior horn with a remaining rim of 6–8 mm. For evaluation of the knee function preoperatively and postoperatively we used the online International Knee Documentation Committee (IKDC) system. The purpose of this study is to emphasize the importance of MRI in identifying and revealing the unstable (Wrisberg variant) type of discoid meniscus in children. Results: The mean patient age at the time of surgery was 8.25 ± 2.91 years (range 5–13 years). The average follow-up was 3.75 ± 0.46 years (range 3–4) years. The mean preoperative IKDC score was 22.37 ± 1.50 (range 21–25) points. The mean postoperative IKDC score was 80.50 ± 1.77 (range 79–84) points. Conclusions: MRI is a valuable tool in the evaluation of the shape, stability, and consistency of symptomatic discoid menisci. It is helpful for the detection of the unstable Wrisberg variant. [ABSTRACT FROM AUTHOR]

Manual anatomical landmarking for morphometric knee bone characterization in orthopedics is highly time-consuming and shows high operator variability. Therefore, automation could be a substantial improvement for diagnostics and personalized treatments relying on landmark-based methods. Applications include implant sizing and planning, meniscal allograft sizing, and morphological risk factor assessment. For twenty MRI-based 3D bone and cartilage models, anatomical landmarks were manually applied by three experts, and morphometric measurements for 3D characterization of the distal femur and proximal tibia were calculated from all observations. One expert performed the landmark annotations three times. Intra- and inter-observer variations were assessed for landmark position and measurements. The mean of the three expert annotations served as the ground truth. Next, automated landmark annotation was performed by elastic deformation of a template shape, followed by landmark optimization at extreme positions (highest/lowest/most medial/lateral point). The results of our automated annotation method were compared with ground truth, and percentages of landmarks and measurements adhering to different tolerances were calculated. Reliability was evaluated by the intraclass correlation coefficient (ICC). For the manual annotations, the inter-observer absolute difference was 1.53 ± 1.22 mm (mean ± SD) for the landmark positions and 0.56 ± 0.55 mm (mean ± SD) for the morphometric measurements. Automated versus manual landmark extraction differed by an average of 2.05 mm. The automated measurements demonstrated an absolute difference of 0.78 ± 0.60 mm (mean ± SD) from their manual counterparts. Overall, 92% of the automated landmarks were within 4 mm of the expert mean position, and 95% of all morphometric measurements were within 2 mm of the expert mean measurements. The ICC (manual versus automated) for automated morphometric measurements was between 0.926 and 1. Manual annotations required on average 18 min of operator interaction time, while automated annotations only needed 7 min of operator-independent computing time. Considering the time consumption and variability among observers, there is a clear need for a more efficient, standardized, and operator-independent algorithm. Our automated method demonstrated excellent accuracy and reliability for landmark positioning and morphometric measurements. Above all, this automated method will lead to a faster, scalable, and operator-independent morphometric analysis of the knee.

The UNet has become the golden standard method for the segmentation of 2D medical images that any new method must be validated against. In recent years, a number of variations to the seminal UNet have been proposed with promising results in the papers introducing them. However, there is no clear consensus if any of these architectures generalize as well and the UNet currently remains the methodological golden standard. For the segmentation of 3D scans, UNet‐inspired methods are also dominant, but there is a larger variety across applications. By evaluating the architectures in a different dimensionality, embedded in a different method, and for a different task, we aimed to evaluate if any of these UNet alternatives are promising as a new golden standard that generalizes even better than the UNet. The purpose of this study was to compare UNet inspired models for generalized 3D segmentation. To efficiently segment the 3D scans, we employed each UNet variant architecture as the central 2D segmentation core in the multi‐planar UNet 3D segmentation method that previously demonstrated excellent generalization in the MICCAI Segmentation Decathlon. It would strongly support a claim of generalizability, if a promising UNet‐variant consistently outperforms the UNet in this quite different setting. The experimental results show that the multi‐planar‐based UNet2+ (MPUNet2+) method outperforms other variants including the original multi‐planar UNet (MPUNet). [ABSTRACT FROM AUTHOR]

Purpose: The outcome of a tibial plateau fracture (TPF) depends on the fracture reduction achieved and the extent of soft-tissue lesions, including lesions in the ligaments, cartilage, and menisci. Sub-optimal treatment can result in poor knee function and osteoarthritis. Preoperative planning is primarily based on conventional X-ray and computed tomography (CT), which are unsuitable for diagnosing soft-tissue lesions. Magnetic resonance imaging (MRI) is not routinely performed. To date, no literature exists that clearly states the indications for preoperative MRI. This systematic review aimed to determine the frequency of soft-tissue lesions in TPFs, the association between fracture type and soft-tissue lesions, and the types of cases for which MRI is indicated. Methods: A systematic review of the literature was based on articles located in PubMed/MEDLINE and the Cochrane Central Register of Controlled Trials (CENTRAL), supplemented by searching the included articles' reference lists and the ePublication lists of leading orthopedic and trauma journals. Results: A total of 1138 studies were retrieved. Of these, 18 met the eligibility criteria and included a total of 877 patients. The proportion of total soft-tissue lesions was 93.0%. The proportions of soft-tissue lesions were as follows: medial collateral ligament 20.7%, lateral collateral ligament 22.9%, anterior cruciate ligament 36.8%, posterior cruciate ligament 14.8%, lateral meniscus 48.9%, and medial meniscus 24.5%. A weak association was found between increasing frequency of LCL and ACL lesions and an increase in fracture type according to Schatzker's classification. No standard algorithm for MRI scans of TPFs was found. Conclusion: At least one ligament or meniscal lesion is present in 93.0% of TPF cases. More studies with higher levels of evidence are needed to find out in which particular cases MRI adds value. However, MRI is recommended, at least in young patients and cases of high-energy trauma. [ABSTRACT FROM AUTHOR]

Segmenting anterior and posterior cruciate ligaments (ACL/PCL) presents challenges in medical imaging due to diverse characteristics, including size, shape, and intensity. Our study uses superpixel-based spectral clustering for knee cruciate ligament segmentation in 2D DICOM slices, renowned for generating high-quality clusters. The proposed method addresses the challenges by (i) identifying the ligamentous region (ROI) through superpixel-based computation, (ii) extracting features (intensity-based, shape-based, geometric complexity, and Scale-Invariant Feature Transform) from the ROI, and (iii) segmenting knee ligament tissues using spectral clustering on the extracted features. Superpixel-based spectral clustering addresses the challenge of constructing a dense similarity matrix and significantly reduces the computational burden. Furthermore, 3D visualization of ligament structures is performed using the Visualization Toolkit (VTK). We evaluated our proposed approach on a dataset of knee MRI slices, assessing the results via the dice score, average surface distance (ASD), and root mean squared error (RMSE) metrics. Our method achieved an average dice score of 0.912 for ACL segmentation and 0.896 for PCL segmentation, outperforming other clustering methods. These scores showed an enhancement of 10.7% and 14.9% in segmentation accuracy for the ACL and PCL, respectively. Furthermore, reduced error margins were demonstrated with the mean ASD values of 1.60 and 1.78 and the mean RMSE values of 1.76 and 1.86 for ACL and PCL, respectively. These results show the effectiveness of the proposed method for cruciate ligament segmentation and its potential for increasing the segmentation accuracy and speed, offering significant advantages over manual segmentation by reducing time and expertise. [ABSTRACT FROM AUTHOR]

He Sui,1,&ast; Jin Li,2,3,&ast; Lin Liu,1 Zhongwen Lv,1 Yunfei Zhang,4 Yongming Dai,4 Zhanhao Mo1 1China-Japan Union Hospital of Jilin University, Changchun, People’s Republic of China; 2Jilin Province People’s Hospital, Changchun, People’s Republic of China; 3The Department of Trauma Surgery, Shanghai Oriental Hospital, Shanghai, People’s Republic of China; 4Central Research Institute, United Imaging Healthcare, Shanghai, 201800, People’s Republic of China&ast;These authors contributed equally to this workCorrespondence: Zhanhao Mo, China-Japan Union Hospital of Jilin University, No. 126 Xiantai Street, Erdao District, Changchun, People’s Republic of China, Email mozhanhao@jlu.edu.cnPurpose: The three-dimensional (3D) sequence of magnetic resonance imaging (MRI) plays a critical role in the imaging of musculoskeletal joints; however, its long acquisition time limits its clinical application. In such conditions, compressed sensing (CS) is introduced to accelerate MRI in clinical practice. We aimed to investigate the feasibility of an isotropic 3D variable-flip-angle fast spin echo (FSE) sequence with CS technique (CS-MATRIX) compared to conventional 2D sequences in knee imaging.Methods: Images from different sequences of both the accelerated CS-MATRIX and the corresponding conventional acquisitions were prospectively analyzed and compared. The signal-to-noise ratio (SNR) and contrast-to-noise ratio (CNR) of the structures within the knees were measured for quantitative analysis. The subjective image quality and diagnostic agreement were compared between CS-MATRIX and conventional 2D sequences. Quantitative and subjective image quality scores were statistically analyzed with the paired t-test and Wilcoxon signed-rank test, respectively. Diagnostic agreements of knee substructure were assessed using Cohen’s weighted kappa statistic.Results: For quantitative analysis, images from the CS-MATRIX sequence showed a significantly higher SNR than T2-fs 2D sequences for visualizing cartilage, menisci, and ligaments, as well as a higher SNR than proton density (pd) 2D sequences for visualizing menisci and ligaments. There was no significant difference between CS-MATRIX and 2D T2-fs sequences in subjective image quality assessment. The diagnostic agreement was rated as moderate to very good between CS-MATRIX and 2D sequences.Conclusion: This study demonstrates the feasibility and clinical potential of the CS-MATRIX sequence technique for detecting knee lesions The CS-MATRIX sequence allows for faster knee imaging than conventional 2D sequences, yielding similar image quality to 2D sequences.Keywords: knee MRI, compressed sensing, 3D variable-flip-angle fast spin echo

This paper focuses on different types of backbone networks for machine learning architectures which perform classification of knee Magnetic Resonance Imaging (MRI) images. This paper aims to compare different types of feature extraction networks for the same classification task, in terms of accuracy and performance. Multiple variations of machine learning models were trained based on the MRNet architecture, choosing AlexNet, ResNet, VGG-11, VGG-16, and Efficientnet as the backbone. The models were evaluated on the MRNet validation dataset, computing Area Under the Receiver Operating Characteristics Curve (ROC-AUC), accuracy, f1 score, and Cohen's Kappa as evaluation metrics. The MRNet-VGG16 model variant shows the best results for Anterior Cruciate Ligament (ACL) tear detection. For general abnormality detection, MRNet-VGG16 is dominated by MRNet-Resnet in confidence between 0.5 and 0.75 and by MRNet-VGG11 for confidence more than 0.8. Due to the non-uniform nature of backbone network performance on different MRI planes, it is advisable to use an LR ensemble of: VGG16 on a coronal plane for all classification tasks; on an axial plane for abnormality and ACL tear detection; Alexnet on a sagittal plane for abnormality detection, and an axial plane for meniscal tear detection; and VGG11 on a sagittal plane for ACL tear detection. The results also indicate that the Cohen's Kappa metric is valuable in model evaluation for the MRNet dataset, as it provides deeper insights on classification decisions. [ABSTRACT FROM AUTHOR]

Purpose: Many children who undergo MR of the knee to evaluate traumatic injury may not undergo a separate dedicated evaluation of their skeletal maturity, and we wished to investigate how accurately skeletal maturity could be automatically inferred from knee MRI using deep learning to offer this additional information to clinicians.Materials and Methods: Retrospective data from 894 studies from 783 patients were obtained (mean age 13.1 years, 47% female). Coronal and sagittal sequences that were T1/PD-weighted were included and resized to 224 × 224 pixels. Data were divided into train (n = 673), tune (n = 48), and test (n = 173) sets, and children were separated across sets. The chronologic age was predicted using deep learning approaches based on a long short-term memory (LSTM) model, which took as input DenseNet-121-extracted features from all T1/PD coronal and sagittal slices. Each test case was manually assigned a bone age by two radiology residents using a reference atlas provided by Pennock and Bomar. The patient's age served as ground truth.Results: The error of the model's predictions for chronological age was not significantly different from that of radiology residents (model M.S.E. 1.30 vs. resident 0.99, paired t-test = 1.47, p = 0.14). Pearson correlation between model and resident prediction of chronologic age was 0.96 (p < 0.001).Conclusion: A deep learning-based approach demonstrated ability to infer skeletal maturity from knee MR sequences that was not significantly different from resident performance and did so in less than 2% of the time required by a human expert. This may offer a method for automatically evaluating lower extremity skeletal maturity automatically as part of every MR examination. [ABSTRACT FROM AUTHOR]

Background and Aim Meniscal tears are one of the most frequent disorders affecting the knee joint in athletes and normal people. MRI the first choice of imaging of knee joint but in recent days, ultrasound (US) has made strides in imaging of musculoskeletal disorders due to improvement of imaging qualities. This study aimed to investigate the role of US in diagnosis of meniscus tears as compared to MRI. Patients and Methods A total of 100 patients examined by high definition US and under go to MRI examination of the knee joint. Results Regarding the diagnostic performance of US compared to MRI, the sensitivity reached (89.1%), specificity (∼72.2%), positive predictive value (∼90.1%), negative predictive value (70.1%), and accuracy (84.7%). Conclusion Ultrasonography may be used as a screening tool before arthroscopy in selected cases where MRI was a contraindication or is not available or if the patient was not affording. Ultrasonography showed a dynamic image of the meniscus and thus may prove useful if studied in conjunction with correct clinical examination.

Objective: To assess the accuracy of routine knee MRI in detecting acute popliteal artery and/or common peroneal nerve (CPN) dysfunction following multiligamentous knee injury (MLKI), with correlation of MRI findings to clinical outcome. Materials and methods: Routine MRI knee examinations in 115 MLKI patients (54/115 with acute neurovascular injury, 61/115 without neurovascular injury) were retrospectively reviewed. Cases were classified by injury mechanism and ligamentous injuries sustained. MRI examinations were reviewed by two readers for vascular (arterial flow void, arterial calibre, intimal flap, perivascular hematoma) and CPN (intraneural T2-hyperintensity, calibre, discontinuity, perineural hematoma) injuries. Accuracy of routine knee MRI in the diagnosis of acute neurovascular injury and correlation of MRI findings to clinical outcome were evaluated. Results: Patients included 86/115 males, mean age 33 years. The accuracy of MRI in diagnosis of acute CPN injury was 80.6%, 83.6% (readers 1 and 2): sensitivity (78%, 79.7%), specificity (80%, 86.7%), PPV (78%, 82.5%), and NPV (82.7%, 84.4%). Increased intraneural T2 signal showed a significant correlation to acute CPN dysfunction (p < 0.05). MRI was 75%, 69.8% (readers 1 and 2) accurate in detecting acute vascular injury: sensitivity (73.3%, 86.7%), specificity (75.2%, 67.3%), PPV (30.5%, 36.1%), and NPV (95%, 97.1%). No MRI features of vascular injury showed a statistical correlation with clinical outcome. Neurovascular complications were more common in ultra-low-energy injuries and KD-V3L pattern of ligament disruption. Conclusion: Routine MRI is of limited accuracy in assessing vascular complication, but higher accuracy in assessing CPN injury following MLKI. Increased intraneural T2 signal on conventional knee MR imaging shows statistically significant association with clinically documented acute CPN dysfunction following MLKI. [ABSTRACT FROM AUTHOR]

Aim: This study has the primary objective of studying the effect of Wharton jelly mesenchymal stem cells (WJMSCs) in the treatment of knee osteoarthritis. As a secondary end point, we report on the efficacy of such therapy. Patients and methods: 16 patients with advanced Kellgren stage were treated using two doses of expanded WJMSCs given 1 month apart. Patients were followed for 48 months using the Knee Injury and Osteoarthritis Outcome Score (KOOS) and 12 months using magnetic resonance imaging (MRI). Results: Treatment was well tolerated. One patient developed moderate effusion and one superficial phlebitis. We observed functional and pain improvement at 12 and 48 months (p < 0.0001), with statistically significant improvement on MRI scans at 12 months in cartilage loss, osteophytes, bone marrow lesions, effusion and synovitis (p < 0.01), and highly significant improvement in subchondral sclerosis (p < 0.0001). Conclusion: WJMSCs are safe and potentially effective in producing significant improvement in KOOS and MRI scores when administered intra-articularly in knee osteoarthritis cases under ultrasound guidance. [ABSTRACT FROM AUTHOR]

Purpose: The medical examination ("medical") is an important procedure in professional soccer since it has high economic relevance. In addition to clinical tests, magnetic resonance imaging (MRI) is used to assess joint health. In the present study, the reliability of semiquantitative knee MRI during the "medical" in professional soccer was tested, and its relationship with clinical data and days missed due to knee injury was observed. Methods: In this cross-sectional study, between 2012 and 2019, 69 newly assigned players (age 18–35 years) from a professional soccer club underwent MRI (3.0 T) of both knee joints during their "medical". Reported knee injuries and previously missed days due to injury were obtained from player anamnesis and the "transfermarkt.com" database. Based on the established "Whole-Organ Magnetic Resonance Imaging Score" (WORMS), two independent radiologists graded the MRI results. Further evaluation was based on the mean score of both knees. Results: The mean WORMS for all subjects was 13.9 (median 10.5, range 0–61). Players with previous injuries had significantly higher scores than players without reported injuries (22.1 ± 17.7 vs. 8.9 ± 4.4, p < 0.002). Three outliers (previously undetected injuries) in the group of players without reported injuries were observed (6.7%). The WORMS was significantly correlated with a prior knee injury (r: 0.424, p < 0.0001) and days missed due to injury (r: 0.489, p < 0.001). Age was correlated with the WORMS (r: 0.386, p < 0.001). In a linear regression model, prior injury was the only significant predictor of a high WORMS (p = 0.001). The WORMS was a significant predictor of days missed due to injury (p < 0.0002) and prior injury (sensitivity: 78%, specificity: 91%, p = 0.006). The intraclass correlation coefficient was excellent (0.89). Conclusion: Semiquantitative knee MRI for WORMS determination during the soccer "medical" is a robust and reliable method. Prior injury, even in players without documented trauma, was detected by the WORMS, and previously missed days due to injury were correlated with the semiquantitative MR knee score. Level of evidence: Level III. [ABSTRACT FROM AUTHOR]

Rationale and Objectives: Train and apply natural language processing (NLP) algorithms for automated radiology-arthroscopy correlation of meniscal tears.Materials and Methods: In this retrospective single-institution study, we trained supervised machine learning models (logistic regression, support vector machine, and random forest) to detect medial or lateral meniscus tears on free-text MRI reports. We trained and evaluated model performances with cross-validation using 3593 manually annotated knee MRI reports. To assess radiology-arthroscopy correlation, we then randomly partitioned this dataset 80:20 for training and testing, where 108 test set MRIs were followed by knee arthroscopy within 1 year. These free-text arthroscopy reports were also manually annotated. The NLP algorithms trained on the knee MRI training dataset were then evaluated on the MRI and arthroscopy report test datasets. We assessed radiology-arthroscopy agreement using the ensembled NLP-extracted findings versus manually annotated findings.Results: The NLP models showed high cross-validation performance for meniscal tear detection on knee MRI reports (medial meniscus F1 scores 0.93-0.94, lateral meniscus F1 scores 0.86-0.88). When these algorithms were evaluated on arthroscopy reports, despite never training on arthroscopy reports, performance was similar, though higher with model ensembling (medial meniscus F1 score 0.97, lateral meniscus F1 score 0.99). However, ensembling did not improve performance on knee MRI reports. In the radiology-arthroscopy test set, the ensembled NLP models were able to detect mismatches between MRI and arthroscopy reports with sensitivity 79% and specificity 87%.Conclusion: Radiology-arthroscopy correlation can be automated for knee meniscal tears using NLP algorithms, which shows promise for education and quality improvement. [ABSTRACT FROM AUTHOR]

Abstract Background This work was conducted to assess the diagnostic efficiency of isotropic three-dimensional VISTA-fast spin echo versus standard two-dimensional fast spin echo at 1.5 T MRI, in the assessment of internal knee derangement in symptomatic patients, aiming to obtain similar diagnostic accuracy in a shorter time span, with reduction of partial volume artifacts by thin continuous sections. Results This was a non-randomized control study including 39 patients (32 male and 7 females, mean age 37 years old). A correlative study was done utilizing MRI standard 2D FSE (protocol A) versus 3D-VISTA-FSE (protocol B) for medial meniscus (MM) and lateral meniscus (LM), as well as anterior cruciate ligament ACL lesions, comparing the MRI results with the findings of arthroscopy as the gold standard. Both protocols depicted medial meniscus lesions with accuracy, specificity, and sensitivity (97.44%, 96.30%, and 100% respectively), lateral meniscus lesions with accuracy, specificity, and sensitivity (97.44%, 100%, and 50% respectively), and ACL lesions with accuracy, specificity, and sensitivity (100%, 100%, and 100% respectively), while there were no PCL lesions depicted through the study population. Comparing the time factor between both protocols revealed protocol A to consume 13.7 min, while protocol B consumed 6.6 min. Conclusion Three-dimensional isotropic VISTA-FSE sequence, although having similar accuracy in diagnosing cruciate and meniscal lesions as the standard sequences, facilitates thin-section data acquisition and multi-planar image reformation in standard and non-standard planes, without intersection gaps that are crucial for the detection and dissection of compound structures; also, it allows a shorter time span, which is more advantageous for patients, particularly the traumatized and emergency patients.

Introduction: A meniscal tear is the most common injury to the knee, and commonly occurring from both athletic events and activities of daily living. The diagnosis of a meniscal tear may require Magnetic Resonance Imaging (MRI), which is costly. In remote and rural parts of our country, MRI is not available so ultrasonographic examination of knee can be used as diagnostic tool to overcome financial burden to such population groups. Aim: To correlate the accuracy of Ultrasonography (USG) and MRI for diagnosing meniscal tears and also to correlate the specificity, sensitivity, and predictive values of USG for meniscal tears in comparison with MRI. Materials and Methods: It was an observational study. It included 50 patients who presented to our institute with complain of acute or chronic knee pain and restriction of movement with clinical signs and symptoms of meniscal tear with history of trauma. All patients underwent ultrasonographic examination of knee along with MRI and arthroscopy. The statistical analysis was done by using Statistical Package for Social Sciences (SPSS) 22.0 software. Accuracy, sensitivity, specificity, Positive Predictive Value (PPV) and Negative Predictive Value (NPV) were calculated based on detection of meniscal tear. Results: This study comprised of 50 patients: 45 were males and 5 were females whose median age was 29 years. Upon combining both medial and lateral menisci, USG showed mean accuracy of 72%, mean sensitivity of 48.6% and mean specificity of 85.7%. MRI showed mean accuracy of 76%, mean sensitivity of 50% and the mean specificity of 90.6%. Conclusion: According to this study, USG has shown reasonable accuracy, sensitivity, specificity, PPV and NPV in comparison to MRI in detecting meniscal lesions.This study has proved that USG can be a good negative test for meniscal tear as we can exclude normal meniscus from abnormal, thus patient with normal meniscus could be prevented from undergoing costly MRI as their initial investigation. So, it can be used as an effective diagnostic screening tool.

Background One of the important factors affecting the biomechanics of the knee joint is the posterior tibial slope which is the tibial plateau's anatomical inclination toward the posterior of the sagittal plane. This inclination, which affects anterior-posterior stability, is important for the kinematics of the knee joint. Changes in the tibial slope may cause a deficit in the stability and function of the knee joint. We aimed to examine the inclination of the posterior horn of the meniscus and posterior tibial slope in healthy individuals and investigate the effect of body mass index on these measurements. Methodology A total of 34 magnetic resonance images and lateral knee radiographs were evaluated in this study. The study included individuals aged 15 to 78 without a history of previous injury or surgery of their knee. Results In the measurements made on magnetic resonance images, a statistically significant difference was found between 25% lateral meniscus slope (mean ± SD = 28.08 ± 1.88) and 25% medial meniscus slope (mean ± SD = 27.31 ± 1.41) (p = 0.05). At the same time, a statistically significant difference (p = 0.011) was found between 25% medial combined slope (mean ± SD = 29.05 ± 3.80) and 25% lateral combined slope (mean ± SD = 30.62 ± 2.99). There was no statistically significant difference between tibial and meniscus slopes, body mass index, gender, and age. Conclusions Our study results have shown that the 25% lateral meniscus and combined slopes are greater than the 25% medial meniscus slope., Competing Interests: Human subjects: Consent for treatment and open access publication was obtained or waived by all participants in this study. Near East University Scientific Research Ethics Board issued approval YDU/2021-901314. Animal subjects: All authors have confirmed that this study did not involve animal subjects or tissue. Conflicts of interest: In compliance with the ICMJE uniform disclosure form, all authors declare the following: Payment/services info: All authors have declared that no financial support was received from any organization for the submitted work. Financial relationships: All authors have declared that they have no financial relationships at present or within the previous three years with any organizations that might have an interest in the submitted work. Other relationships: All authors have declared that there are no other relationships or activities that could appear to have influenced the submitted work., (Copyright © 2024, Yilmaz et al.)

Background & Objectives: Knee is the largest synovial joint in the body. Although FSE PD (fast spin echo proton density) imaging technique for the diagnosis of meniscal tear has replaced CSE PD (conventional spin echo proton density) technique in many MRI centers, several studies have questioned the effectiveness of FSE PD technique in diagnosis of meniscal tear. In this study, the diagnostic values of CSE PD and FSE PD techniques in evaluation of meniscus tear are compared. Materials: In this study, using CSE PD and FSE PD techniques, MRI was performed on 67 knees of patients with suspected meniscal tear referring to the MRI Center of Imam Reza Hospital (Kermanshah, Iran). Diagnostic arthroscopy was also performed for all patients. The data were entered SPSS version 20, and finally the results of MRI reports of the two techniques were compared in evaluation of meniscal tear taking into account the arthroscopic findings as the gold standard. Results: According to the results of this study, no significant difference was found in specificity and positive predictive value of the two techniques. However, the sensitivity and negative predictive values were significantly different, in such a way that the related values were 97% and 97% in the CSE PD technique and 69% and 73% in the FSE PD technique, respectively. Conclusion: Due to low sensitivity and high false negative results, MRI using FSE PD technique is not recommended as an alternative for CSE PD technique in evaluation of meniscal tear. [ABSTRACT FROM AUTHOR]

• The morphological images obtained by 3D MIXTURE have a contrast comparable to that of standard 2D TSE and have equivalent diagnostic performance. • The T2 map obtained by 3D MIXTURE is equivalent to the conventional multi-echo spin-echo (MESE) technique and shows no systematic bias. • The T2 map obtained by 3D MIXTURE correlates well with the location of the lesion on morphological images, allowing quantitative evaluation of the knee cartilage (T2 values of the lesion are consistent with those reported in the literature). Quantitative MRI techniques such as T2 mapping are useful in comprehensive evaluation of various pathologies of the knee joint yet require separate scans to conventional morphological measurements and long acquisition times. The recently introduced 3D MIXTURE (Multi-Interleaved X-prepared Turbo-Spin Echo with Intuitive Relaxometry) technique can obtain simultaneous morphologic and quantitative information of the knee joint. To compare MIXTURE with conventional methods and to identify differences in morphological and quantitative information. Phantom studies were conducted, and in vivo human scans were performed (20 patients) presented with knee arthralgia. MIXTURE is based on 3D TSE without and with T2 preparation modules in an interleaved manner for both morphology with PDW and fat suppressed T2W imaging as well as quantitative T2 mapping within one single scan. Image quality and lesion depiction were visually assessed and compared between MIXTURE and conventional 2D TSE by two experienced radiologists. Contrast-to-noise ratio was used to assess the adjacent tissue contrast in a quantitative way for both obtained PDW and fat suppressed T2W images. Quantitative T2 values were measured in phantom and from in vivo knee cartilage. The overall diagnostic confidence and contrast-to-noise ratio were deemed comparable between MIXTURE and 2D TSE. While the chosen T2 preparation modules for MIXTURE rendered consistent T2 values comparing to the current standard, measured cartilage T2 values ranged from 26.1 to 50.7 ms, with significant difference between the lesion and normal areas (p < 0.05). MIXTURE can help to provide high-resolution information for both anatomical and pathological assessment. [ABSTRACT FROM AUTHOR]

• Despite high demand, long MRI acquisition times lead to extended patient wait times. • CS-SuperRes reconstructions for low-resolution matches image quality of standard CS. • Using CS-SuperRes resulted in a 57% reduction in scan time. • 2D knee MRI protocol within 5 min while maintaining excellent image quality. • Enabling new ways for patients' logistics and workflow-management. To investigate the potential of combining Compressed Sensing (CS) and a newly developed AI-based super resolution reconstruction prototype consisting of a series of convolutional neural networks (CNN) for a complete five-minute 2D knee MRI protocol. In this prospective study, 20 volunteers were examined using a 3T-MRI-scanner (Ingenia Elition X, Philips). Similar to clinical practice, the protocol consists of a fat-saturated 2D-proton-density-sequence in coronal, sagittal and transversal orientation as well as a sagittal T1-weighted sequence. The sequences were acquired with two different resolutions (standard and low resolution) and the raw data reconstructed with two different reconstruction algorithms: a conventional Compressed SENSE (CS) and a new CNN-based algorithm for denoising and subsequently to interpolate and therewith increase the sharpness of the image (CS-SuperRes). Subjective image quality was evaluated by two blinded radiologists reviewing 8 criteria on a 5-point Likert scale and signal-to-noise ratio calculated as an objective parameter. The protocol reconstructed with CS-SuperRes received higher ratings than the time-equivalent CS reconstructions, statistically significant especially for low resolution acquisitions (e.g., overall image impression: 4.3 ± 0.4 vs. 3.4 ± 0.4, p < 0.05). CS-SuperRes reconstructions for the low resolution acquisition were comparable to traditional CS reconstructions with standard resolution for all parameters, achieving a scan time reduction from 11:01 min to 4:46 min (57 %) for the complete protocol (e.g. overall image impression: 4.3 ± 0.4 vs. 4.0 ± 0.5, p < 0.05). The newly-developed AI-based reconstruction algorithm CS-SuperRes allows to reduce scan time by 57% while maintaining unchanged image quality compared to the conventional CS reconstruction. [ABSTRACT FROM AUTHOR]

This paper focuses on different types of backbone networks for machine learning architectures which perform classification of knee Magnetic Resonance Imaging (MRI) images. This paper aims to compare different types of feature extraction networks for the same classification task, in terms of accuracy and performance. Multiple variations of machine learning models were trained based on the MRNet architecture, choosing AlexNet, ResNet, VGG-11, VGG-16, and Efficientnet as the backbone. The models were evaluated on the MRNet validation dataset, computing Area Under the Receiver Operating Characteristics Curve (ROC-AUC), accuracy, f1 score, and Cohen’s Kappa as evaluation metrics. The MRNet-VGG16 model variant shows the best results for Anterior Cruciate Ligament (ACL) tear detection. For general abnormality detection, MRNet-VGG16 is dominated by MRNet-Resnet in confidence between 0.5 and 0.75 and by MRNet-VGG11 for confidence more than 0.8. Due to the non-uniform nature of backbone network performance on different MRI planes, it is advisable to use an LR ensemble of: VGG16 on a coronal plane for all classification tasks; on an axial plane for abnormality and ACL tear detection; Alexnet on a sagittal plane for abnormality detection, and an axial plane for meniscal tear detection; and VGG11 on a sagittal plane for ACL tear detection. The results also indicate that the Cohen’s Kappa metric is valuable in model evaluation for the MRNet dataset, as it provides deeper insights on classification decisions.

Background Simultaneous injury of two or more knee ligaments with concurrent tears involving the anterior cruciate and medial collateral ligaments is considered to be associated with femorotibial knee dislocations (KD). The purpose of this study is to characterize multiligamentous knee injury patterns associated with dislocations on MRI and to describe the incidence of their sequelae such as tibial plateau fractures, peroneal nerve injuries, and posterolateral corner (PLC) injuries. Participants and methods After obtaining institutional ethical committee approval, we retrospectively identified 108 multiligamentous knee injuries in 100 patients who met with trauma and were treated at our tertiary care center between April 2014 and December 2018. Descriptive statistics were reported using numbers and percentages for categorical variables in cases of multiligamentous injuries, ipsilateral tibial plateau fractures, ipsilateral femoral fractures, peroneal nerve injury, arterial injury, compartment syndrome, and PLC injuries. Results The most common (39.8%) injury pattern was a combined disruption of the anterior cruciate ligament, posterior cruciate ligament, and PLC. Schenck KD III-M was the most common injury type in KD, constituting 16.7%. Medial-sided injuries were the most common injury patterns seen with KD. There was a significant risk of peroneal nerve injury with lateral-sided injuries. Conclusion KD, though rare, may have devastating clinical sequelae such as compartment syndrome if not recognized and treated. Therefore, it is necessary to recognize imaging findings of femorotibial joint dislocations and associated injuries to the adjacent neurovascular bundles.

Background: This work was conducted to assess the diagnostic efficiency of isotropic three-dimensional VISTA-fast spin echo versus standard two-dimensional fast spin echo at 1.5 T MRI, in the assessment of internal knee derangement in symptomatic patients, aiming to obtain similar diagnostic accuracy in a shorter time span, with reduction of partial volume artifacts by thin continuous sections. Results: This was a non-randomized control study including 39 patients (32 male and 7 females, mean age 37 years old). A correlative study was done utilizing MRI standard 2D FSE (protocol A) versus 3D-VISTA-FSE (protocol B) for medial meniscus (MM) and lateral meniscus (LM), as well as anterior cruciate ligament ACL lesions, comparing the MRI results with the findings of arthroscopy as the gold standard. Both protocols depicted medial meniscus lesions with accuracy, specificity, and sensitivity (97.44%, 96.30%, and 100% respectively), lateral meniscus lesions with accuracy, specificity, and sensitivity (97.44%, 100%, and 50% respectively), and ACL lesions with accuracy, specificity, and sensitivity (100%, 100%, and 100% respectively), while there were no PCL lesions depicted through the study population. Comparing the time factor between both protocols revealed protocol A to consume 13.7 min, while protocol B consumed 6.6 min. Conclusion: Three-dimensional isotropic VISTA-FSE sequence, although having similar accuracy in diagnosing cruciate and meniscal lesions as the standard sequences, facilitates thin-section data acquisition and multi-planar image reformation in standard and non-standard planes, without intersection gaps that are crucial for the detection and dissection of compound structures; also, it allows a shorter time span, which is more advantageous for patients, particularly the traumatized and emergency patients. [ABSTRACT FROM AUTHOR]

Abstract Background Majority of musculoskeletal cross-sectional imaging requests have a non-revealing and non-specific clinical history of pain. However, the location of pain is very relevant towards arriving at a specific orthopedic diagnosis. The purpose of this research was to study the impact of skin marker placement and training of technologists prior to knee MRI in detection of clinically important findings. Methods Total 200 consecutive left knee MRIs were evaluated before and after technologist training with regards to marker placement at the site of clinical symptoms or palpable finding. Marker location in relation to the knee was recorded and important findings were classified as correlated important finding, non-correlated important finding, other compartment important finding in non-correlated cases, and diffuse abnormality, i.e. tri-compartmental cartilage defects in both correlated and non-correlated cases. Differences among scans before and after technologist training were analyzed. Results The marker placement was observed in higher proportion of patients in post-training scans (78% vs 60%, p = 0.00). The most common location of the marker was in anterior or anterolateral knee (32% and 34% cases, respectively). The marker-important finding correlation was also higher post training, but not statistically significant (53% versus 38%, p = 0.57). Important findings correlated with the marker in more than 50% of the scans in the post-training set. Conclusion Marker placement can aid in detection of clinically important imaging finding and technologist training aids in increased rates of marker placement and improved correlation.

Background Over time, there has been a noticeable increase in anterior cruciate ligament (ACL) injuries. The current imperative is to anticipate predisposing factors and proactively prevent ACL injuries. The occurrence of ACL injuries has been linked to diverse factors associated with the morphology of the distal femur. Objectives Through this study, we aim to compare the anatomic variables of distal femur morphology such as notch width (NW), bicondylar width (BW), notch entrance width (NEW), and notch width index (NWI) between patients with ACL injuries and non-injured patients using MRI. We also aim to make a comparison of these factors between male and female genders to assess the gender variability. Material and methods A retrospective case-control study was conducted amongst patients who underwent MRI Knee scan for clinical suspicion of internal derangement during the study period. We selected the first 125 individuals who were found to have ACL injury in the MRI scans and selected another 125 individuals who had an intact ACL in the scans, to serve as controls in the study. Demographic information was retrieved from the hospital's electronic records, and the assessment of NW, NWI, BW, and NEW was conducted through a review of MRI sequences. They were then compared between the cases and control groups, as well as between male and female genders. Results The ACL-injured group exhibited statistically significant reductions in NW and NWI. While 17.39 mm was the mean NW among cases, 17.86 was the mean value among controls. Similarly, the mean NWI was 0.25 among patients with ACL injuries and 0.27 among controls. Gender-based comparisons also revealed statistically significant differences in NW and NWI measurements, where females were reported to have comparatively lower measurements. The mean NW for males and females in the injured group were 18.26 mm and 15.40 mm, respectively, while it was 18.71 mm and 16.90 mm, respectively, in the control group. In the case of NEW, males in the injured group had a slightly higher value (21.33 mm) than the controls (20.65). Females on the other hand exhibited a lower mean value of NEW in ACL-injured group (18.51 mm) in comparison to the non-injured (18.79 mm). BW did not seem to show a significant difference between the two groups. Conclusions In the studied population, ACL injuries demonstrated a higher occurrence in individuals with a narrow femoral intercondylar NWI. If any of these characteristics are identified in an MRI, it may be helpful to identify individuals who are at a higher risk of developing ACL injuries and may thereby help in planning preventative strategies., Competing Interests: The authors have declared that no competing interests exist., (Copyright © 2024, Maheshwari et al.)

Objective: To assess the accuracy of routine knee MRI in detecting acute popliteal artery and/or common peroneal nerve (CPN) dysfunction following multiligamentous knee injury (MLKI), with correlation of MRI findings to clinical outcome. Materials and methods: Routine MRI knee examinations in 115 MLKI patients (54/115 with acute neurovascular injury, 61/115 without neurovascular injury) were retrospectively reviewed. Cases were classified by injury mechanism and ligamentous injuries sustained. MRI examinations were reviewed by two readers for vascular (arterial flow void, arterial calibre, intimal flap, perivascular hematoma) and CPN (intraneural T2-hyperintensity, calibre, discontinuity, perineural hematoma) injuries. Accuracy of routine knee MRI in the diagnosis of acute neurovascular injury and correlation of MRI findings to clinical outcome were evaluated. Results: Patients included 86/115 males, mean age 33 years. The accuracy of MRI in diagnosis of acute CPN injury was 80.6%, 83.6% (readers 1 and 2): sensitivity (78%, 79.7%), specificity (80%, 86.7%), PPV (78%, 82.5%), and NPV (82.7%, 84.4%). Increased intraneural T2 signal showed a significant correlation to acute CPN dysfunction (p < 0.05). MRI was 75%, 69.8% (readers 1 and 2) accurate in detecting acute vascular injury: sensitivity (73.3%, 86.7%), specificity (75.2%, 67.3%), PPV (30.5%, 36.1%), and NPV (95%, 97.1%). No MRI features of vascular injury showed a statistical correlation with clinical outcome. Neurovascular complications were more common in ultra-low-energy injuries and KD-V3L pattern of ligament disruption. Conclusion: Routine MRI is of limited accuracy in assessing vascular complication, but higher accuracy in assessing CPN injury following MLKI. Increased intraneural T2 signal on conventional knee MR imaging shows statistically significant association with clinically documented acute CPN dysfunction following MLKI. [ABSTRACT FROM AUTHOR]

Background: Clinical knee MRI protocols require upwards of 15 minutes of scan time. Purpose/Hypothesis: To compare the imaging appearance of knee abnormalities depicted with a 5‐minute 3D double‐echo in steady‐state (DESS) sequence with separate echo images, with that of a routine clinical knee MRI protocol. A secondary goal was to compare the imaging appearance of knee abnormalities depicted with 5‐minute DESS paired with a 2‐minute coronal proton‐density fat‐saturated (PDFS) sequence. Study Type: Prospective. Subjects: Thirty‐six consecutive patients (19 male) referred for a routine knee MRI. Field Strength/Sequences: DESS and PDFS at 3T. Assessment: Five musculoskeletal radiologists evaluated all images for the presence of internal knee derangement using DESS, DESS+PDFS, and the conventional imaging protocol, and their associated diagnostic confidence of the reading. Statistical Tests: Differences in positive and negative percent agreement (PPA and NPA, respectively) and 95% confidence intervals (CIs) for DESS and DESS+PDFS compared with the conventional protocol were calculated and tested using exact McNemar tests. The percentage of observations where DESS or DESS+PDFS had equivalent confidence ratings to DESS+Conv were tested with exact symmetry tests. Interreader agreement was calculated using Krippendorff's alpha. Results: DESS had a PPA of 90% (88–92% CI) and NPA of 99% (99–99% CI). DESS+PDFS had increased PPA of 99% (95–99% CI) and NPA of 100% (99–100% CI) compared with DESS (both P < 0.001). DESS had equivalent diagnostic confidence to DESS+Conv in 94% of findings, whereas DESS+PDFS had equivalent diagnostic confidence in 99% of findings (both P < 0.001). All readers had moderate concordance for all three protocols (Krippendorff's alpha 47–48%). Data Conclusion: Both 1) 5‐minute 3D‐DESS with separated echoes and 2) 5‐minute 3D‐DESS paired with a 2‐minute coronal PDFS sequence depicted knee abnormalities similarly to a routine clinical knee MRI protocol, which may be a promising technique for abbreviated knee MRI. Level of Evidence: 2 Technical Efficacy: Stage 2 J. Magn. Reson. Imaging 2018. [ABSTRACT FROM AUTHOR]

Background: Deep learning (DL) can improve image quality by removing noise from accelerated MRI., Objective: To compare the quality of various accelerated imaging applications in knee MRI with and without DL., Method: We analyzed 44 knee MRI scans from 38 adult patients using the DL-reconstructed parallel acquisition technique (PAT) between May 2021 and April 2022. The participants underwent sagittal fat-saturated T2-weighted turbo-spin-echo accelerated imaging without DL (PAT-2 [2-fold parallel accelerated imaging], PAT-3, and PAT-4) and with DL (DL with PAT-3 [PAT-3DL] and PAT-4 [PAT-4DL]). Two readers independently evaluated subjective image quality (diagnostic confidence of knee joint abnormalities, subjective noise and sharpness, and overall image quality) using a 4-point grading system (1-4, 4=best). Objective image quality was assessed based on noise (noise power) and sharpness (edge rise distance)., Results: The mean acquisition times for PAT-2, PAT-3, PAT-4, PAT-3DL, and PAT-4DL sequences were 2:55, 2:04, 1:33, 2:04, and 1:33 min, respectively. Regarding subjective image quality, PAT-3DL and PAT-4DL scored higher than PAT-2. Objectively, DL-reconstructed imaging had significantly lower noise than PAT-3 and PAT-4 (P <0.001), but the results were not significantly different from those for PAT-2 (P >0.988). Objective image sharpness did not differ significantly among the imaging combinations (P =0.470). The inter-reader reliability ranged from good to excellent (κ = 0.761–0.832)., Conclusion: PAT-4DL imaging in knee MRI exhibits similar subjective image quality, objective noise, and sharpness levels compared with conventional PAT-2 imaging, with an acquisition time reduction of 47%., (Copyright© Bentham Science Publishers; For any queries, please email at epub@benthamscience.net.)

Abstract Maintaining anterolateral rotational stability of the knee requires a complex set of structures, most notably the anterior cruciate ligament. However, lateral knee structures such as the anterolateral ligament (ALL) also play an important role. There has been controversy over the role the ALL plays in an ACL deficient knee to maintain rotational stability. In this study, we examined ACL deficient knees with and without intact ALLs, for rotatory laxity using a pivot shift examination. This was graded using International Knee Document Committee (IKDC) criteria. MRI was used to view the ALL and its status. We found no statistically significant difference in rotational stability of ACL deficient knees, with or without intact ALLs. We did however find a statistically significant association between injury to the ALL and other concomitant lateral structures such as the lateral collateral ligament, biceps femoris tendon, and iliotibial band. This supports that the ALL works in concert with the other lateral structures in the knee and the ACL, to provide rotational stability. This suggests that as an isolated structure, the ALL's contribution to clinical rotational stability is not significant, even in the presence of an ACL tear. [ABSTRACT FROM AUTHOR]

Purpose: To demonstrate and evaluate the scan time and quantitative accuracy of simultaneous bilateral‐knee imaging compared with single‐knee acquisitions. Methods: Hardware modifications and safety testing was performed to enable MR imaging with two 16‐channel flexible coil arrays. Noise covariance and sensitivity‐encoding g‐factor maps for the dual‐coil‐array configuration were computed to evaluate coil cross‐talk and noise amplification. Ten healthy volunteers were imaged on a 3T MRI scanner with both dual‐coil‐array bilateral‐knee and single‐coil‐array single‐knee configurations. Two experienced musculoskeletal radiologists compared the relative image quality between blinded image pairs acquired with each configuration. Differences in T2 relaxation time measurements between dual‐coil‐array and single‐coil‐array acquisitions were compared with the standard repeatability of single‐coil‐array measurements using a Bland‐Altman analysis. Results: The mean g‐factors for the dual‐coil‐array configuration were low for accelerations up to 6 in the right–left direction, and minimal cross‐talk was observed between the two coil arrays. Image quality ratings of various joint tissues showed no difference in 89% (95% confidence interval: 85–93%) of rated image pairs, with only small differences (“slightly better” or “slightly worse”) in image quality observed. The T2 relaxation time measurements between the dual‐coil‐array configuration and the single‐coil configuration showed similar limits of agreement and concordance correlation coefficients (limits of agreement: −0.93 to 1.99 ms; CCC: 0.97 (95% confidence interval: 0.96–0.98)), to the repeatability of single‐coil‐array measurements (limits of agreement: −2.07 to 1.96 ms; CCC: 0.97 (95% confidence interval: 0.95–0.98)). Conclusion: A bilateral coil‐array setup can image both knees simultaneously in similar scan times as conventional unilateral knee scans, with comparable image quality and quantitative accuracy. This has the potential to improve the value of MRI knee evaluations. Magn Reson Med 80:529–537, 2018. © 2017 International Society for Magnetic Resonance in Medicine. [ABSTRACT FROM AUTHOR]

A fully automated knee magnetic resonance imaging (MRI) segmentation method to study osteoarthritis (OA) was developed using a novel hierarchical set of random forests (RF) classifiers to learn the appearance of cartilage regions and their boundaries. A neighborhood approximation forest is used first to provide contextual feature to the second-level RF classifier that also considers local features and produces location-specific costs for the layered optimal graph image segmentation of multiple objects and surfaces (LOGISMOS) framework. Double-echo steady state MRIs used in this paper originated from the OA Initiative study. Trained on 34 MRIs with varying degrees of OA, the performance of the learning-based method tested on 108 MRIs showed significant reduction in segmentation errors ( p<\textsf 0.05 ) compared with the conventional gradient-based and single-stage RF-learned costs. The 3-D LOGISMOS was extended to longitudinal-3-D (4-D) to simultaneously segment multiple follow-up visits of the same patient. As such, data from all time-points of the temporal sequence contribute information to a single optimal solution that utilizes both spatial 3-D and temporal contexts. 4-D LOGISMOS validation on 108 MRIs from baseline, and 12 month follow-up scans of 54 patients showed significant reduction in segmentation errors ( p<\textsf 0.01 ) compared with 3-D. Finally, the potential of 4-D LOGISMOS was further explored on the same 54 patients using five annual follow-up scans demonstrating a significant improvement of measuring cartilage thickness ( p<\textsf 0.01 ) compared with the sequential 3-D approach. [ABSTRACT FROM PUBLISHER]

Objective: To present a novel method for automated segmentation of knee menisci from MRIs. To evaluate quantitative meniscal biomarkers for osteoarthritis (OA) estimated thereof.Method: A segmentation method employing convolutional neural networks in combination with statistical shape models was developed. Accuracy was evaluated on 88 manual segmentations. Meniscal volume, tibial coverage, and meniscal extrusion were computed and tested for differences between groups of OA, joint space narrowing (JSN), and WOMAC pain. Correlation between computed meniscal extrusion and MRI Osteoarthritis Knee Score (MOAKS) experts' readings was evaluated for 600 subjects. Suitability of biomarkers for predicting incident radiographic OA from baseline to 24 months was tested on a group of 552 patients (184 incident OA, 386 controls) by performing conditional logistic regression.Results: Segmentation accuracy measured as dice similarity coefficient was 83.8% for medial menisci (MM) and 88.9% for lateral menisci (LM) at baseline, and 83.1% and 88.3% at 12-month follow-up. Medial tibial coverage was significantly lower for arthritic cases compared to non-arthritic ones. Medial meniscal extrusion was significantly higher for arthritic knees. A moderate correlation between automatically computed medial meniscal extrusion and experts' readings was found (ρ = 0.44). Mean medial meniscal extrusion was significantly greater for incident OA cases compared to controls (1.16 ± 0.93 mm vs 0.83 ± 0.92 mm; P < 0.05).Conclusion: Especially for medial menisci an excellent segmentation accuracy was achieved. Our meniscal biomarkers were validated by comparison to experts' readings as well as analysis of differences w.r.t groups of OA, JSN, and WOMAC pain. It was confirmed that medial meniscal extrusion is a predictor for incident OA. [ABSTRACT FROM AUTHOR]

The use of Cartesian and Blade techniques also affects image quality. The Cartesian technique is more commonly used in Knee MRI examinations. Cartesian technique is vulnerable to movement, giving rise to motion artifacts. This motion artifact is often caused by too long scanning time, so ETL settings are important. An alternative to reducing this risk is to use the Blade technique and by setting the appropriate ETL. The research objective was to determine the differences image quality and anatomical information and to determine the technique that produced quality images and MRI anatomical information on the sagittal knee section between the Cartesian ETL and Blade T2 Weighted TSE combination. This is experiment research. Samples of 10 volunteers, carried out scanning with Cartesian and Blade techniques with variations ETL 14, 16, 18. Focus of assessment on ACL, PCL, meniscus, fluid, and fat. Image quality includes SNR and CNR. The assessment of the anatomical information by a radiologist. Data analyzed with Anova, Friedman, and Wilcoxon test. The results study showed that overall, there are significant differences in image quality between Cartesian and Blade techniques with p-value 0.005. There are differences in anatomical information with p-value

Purpose: To investigate the accuracy of MRI in assessment of sports related knee injuries. Materials and methods: From August 2012 to March 2013 thirty patients referred for sports related knee pain have been included in this study. Patients were subjected to a dedicated MR knee study and correlated knee arthroscopy and surgery. Results: The study included thirty patients complaining of sports related knee pain, only 5 patients (16.6%) were with normal MRI findings and 25 patients (83.4%) were with abnormal MRI findings. Among the 25 patients who had injuries of their knees, 15 patients (60%) had ACL injuries, 2 patients (8%) had PCL injuries, 10 patients (40%) had meniscal injuries, 8 patients (32%) had collateral ligament injuries, 5 patients (20%) had bone injuries and 2 patients (8%) had muscular injuries. Only 7 patients (28%) were represented with isolated injury and 18 patients (72%) were represented with combined injuries. In correlation with arthroscopies and surgeries, morphological analysis was true-positive in 23 (92%) patients of the 25 injured patients, and true-negative in 3 (60%) patients of the 5 normal patients. Morphological analysis revealed overall 92% sensitivity and 60% specificity. Regarding the 15 patients who had ACL injuries, 13 patients (86.6%) were true-positive and 8 patients (80%) of the 10 patients who had meniscal injuries were true-positive. Conclusion: MRI represents the optimal imaging tool in the evaluation of the sports related knee injuries, which has been shown to be an accurate and non invasive method of diagnosing ligament, meniscal, cartilage and muscular knee injuries.

Background: Majority of musculoskeletal cross-sectional imaging requests have a non-revealing and non-specific clinical history of pain. However, the location of pain is very relevant towards arriving at a specific orthopedic diagnosis. The purpose of this research was to study the impact of skin marker placement and training of technologists prior to knee MRI in detection of clinically important findings.Methods: Total 200 consecutive left knee MRIs were evaluated before and after technologist training with regards to marker placement at the site of clinical symptoms or palpable finding. Marker location in relation to the knee was recorded and important findings were classified as correlated important finding, non-correlated important finding, other compartment important finding in non-correlated cases, and diffuse abnormality, i.e. tri-compartmental cartilage defects in both correlated and non-correlated cases. Differences among scans before and after technologist training were analyzed.Results: The marker placement was observed in higher proportion of patients in post-training scans (78% vs 60%, p = 0.00). The most common location of the marker was in anterior or anterolateral knee (32% and 34% cases, respectively). The marker-important finding correlation was also higher post training, but not statistically significant (53% versus 38%, p = 0.57). Important findings correlated with the marker in more than 50% of the scans in the post-training set.Conclusion: Marker placement can aid in detection of clinically important imaging finding and technologist training aids in increased rates of marker placement and improved correlation. [ABSTRACT FROM AUTHOR]

Purpose To introduce a method for obtaining fat-suppressed images in real-time MRI of moving joints at 3 Tesla (T) using a bSSFP sequence with phase detection to enhance visualization of soft tissue structures during motion. Methods The wrist and knee of nine volunteers were imaged with a real-time bSSFP sequence while performing dynamic tasks. For appropriate choice of sequence timing parameters, water and fat pixels showed an out-of-phase behavior, which was exploited to reconstruct water and fat images. Additionally, a 2-point Dixon sequence was used for dynamic imaging of the joints, and resulting water and fat images were compared with our proposed method. Results The joints could be visualized with good water-fat separation and signal-to-noise ratio (SNR), while maintaining a relatively high temporal resolution (5 fps in knee imaging and 10 fps in wrist imaging). The proposed method produced images of moving joints with higher SNR and higher image quality when compared with the Dixon method. Conclusions Water-fat separation is feasible in real-time MRI of moving knee and wrist at 3 T. PS-bSSFP offers movies with higher SNR and higher diagnostic quality when compared with Dixon scans. Magn Reson Med 78:58-68, 2017. © 2016 International Society for Magnetic Resonance in Medicine [ABSTRACT FROM AUTHOR]

Purpose: To develop and clinically evaluate a pediatric knee magnetic resonance imaging (MRI) technique based on volumetric fast spin-echo (3DFSE) and compare its diagnostic performance, image quality, and imaging time to that of a conventional 2D protocol.Materials and Methods: A 3DFSE sequence was modified and combined with a compressed sensing-based reconstruction resolving multiple image contrasts, a technique termed T2 Shuffling (T2 Sh). With Institutional Review Board (IRB) approval, 28 consecutive children referred for 3T knee MRI prospectively underwent a standard clinical knee protocol followed by T2 Sh. T2 Sh performance was assessed by two readers blinded to diagnostic reports. Interpretive discrepancies were resolved by medical record chart review and consensus between the readers and an orthopedic surgeon. Image quality was evaluated by rating anatomic delineation, with 95% confidence interval. A Wilcoxon rank-sum test assessed the null hypothesis that T2 Sh structure delineation compared to conventional 2D is unchanged. Intraclass correlation coefficients were calculated for interobserver agreement. Imaging time of the conventional protocol and T2 Sh was compared.Results: There was 81% and 87% concordance between T2 Sh reports and diagnostic reports, respectively, for each reader. Upon consensus review, T2 Sh had 93% sensitivity and 100% specificity compared to clinical reports for detection of clinically relevant findings. The 95% confidence interval of diagnostic or better rating was 95-100%, with 34-80% interobserver agreement. There was no significant difference in structure delineation between T2 Sh and 2D, except for the retinaculum (P < 0.05), where 2D was preferred. Typical imaging time for T2 Sh and the conventional exam was 7 and 13 minutes, respectively.Conclusion: A single-sequence pediatric knee exam is feasible with T2 Sh, providing multiplanar, reformattable 4D images.Level Of Evidence: 2 J. MAGN. RESON. IMAGING 2017;45:1700-1711. [ABSTRACT FROM AUTHOR]

Anterior cruciate and posterior cruciate injuries rarely occur in isolation and are often associated with injuries to the secondary or supporting structures that provide stability against rotational forces. These structures include the posterolateral and posteromedial corner ligaments and tendons, as well as the anterolateral ligament. If injuries to these secondary structures are not appreciated at the time of cruciate ligament reconstruction, an isolated cruciate ligament reconstruction may be predisposed to early failure. Thus it is crucial for radiologists interpreting knee magnetic resonance imaging to understand and report on injury to these ligaments and tendons at the time of initial injury to help the orthopaedic surgeon plan a comprehensive approach to ligament reconstruction. This strategy will ultimately result in improved patient outcomes. [ABSTRACT FROM AUTHOR]

Knee osteoarthritis (OA), a prevalent joint disease in the U.S., poses challenges in terms of predicting of its early progression. Although high-resolution knee magnetic resonance imaging (MRI) facilitates more precise OA diagnosis, the heterogeneous and multifactorial aspects of OA pathology remain significant obstacles for prognosis. MRI-based scoring systems, while standardizing OA assessment, are both time-consuming and labor-intensive. Current AI technologies facilitate knee OA risk scoring and progression prediction, but these often focus on the symptomatic phase of OA, bypassing initial-stage OA prediction. Moreover, their reliance on complex algorithms can hinder clinical interpretation. To this end, we make this effort to construct a computationally efficient, easily-interpretable, and state-of-the-art approach aiding in the radiographic OA (rOA) auto-classification and prediction of the incidence and progression, by contrasting an individual's cartilage thickness with a similar demographic in the rOA-free cohort. To better visualize, we have developed the toolset for both prediction and local visualization. A movie demonstrating different subtypes of dynamic changes in local centile scores during rOA progression is available at https://tli3.github.io/KneeOA/. Specifically, we constructed age-BMI-dependent reference charts for knee OA cartilage thickness, based on MRI scans from 957 radiographic OA (rOA)-free individuals from the Osteoarthritis Initiative cohort. Then we extracted local and global centiles by contrasting an individual's cartilage thickness to the rOA-free cohort with a similar age and BMI. Using traditional boosting approaches with our centile-based features, we obtain rOA classification of KLG ≤ 1 versus KLG = 2 (AUC = 0.95 , F1 = 0.89 ), KLG ≤ 1 versus KLG ≥ 2 (AUC = 0.90 , F1 = 0.82 ) and prediction of KLG2 progression (AUC = 0.98 , F1 = 0.94 ), rOA incidence (KLG increasing from < 2 to ≥ 2 ; AUC = 0.81 , F1 = 0.69 ) and rOA initial transition (KLG from 0 to 1; AUC = 0.64 , F1 = 0.65 ) within a future 48-month period. Such performance in classifying KLG ≥ 2 matches that of deep learning methods in recent literature. Furthermore, its clinical interpretation suggests that cartilage changes, such as thickening in lateral femoral and anterior femoral regions and thinning in lateral tibial regions, may serve as indicators for prediction of rOA incidence and early progression. Meanwhile, cartilage thickening in the posterior medial and posterior lateral femoral regions, coupled with a reduction in the central medial femoral region, may signify initial phases of rOA transition., Competing Interests: Conflict of Interests The authors declare no conflict of financial interests.