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MRI of Meniscal Lesions: Soft-Copy (PACS) and Hard-Copy Evaluation Versus Reviewer Experience

¹ Department of Radiology, Orthopedic University Hospital Balgrist, Zurich, Switzerland.
² Department of Diagnostic Radiology, University Hospital Zurich, CH-8091 Zurich, Switzerland.
³ Present address: Department of Radiology, Stanford University, 300 Pasteur Dr., Room S072B, Stanford, CA 94305-5105.
⁴ Department of Radiology, Waid Hospital, Zurich, Switzerland.
⁵ Department of Orthopedic Surgery, Orthopedic University Hospital Balgrist, Zurich, Switzerland.

OBJECTIVE. The purpose of our study was to compare diagnostic performance, reviewer confidence, and time requirements in the MRI diagnosis of meniscal tears for three types of reviewers and two types of image documentations (PACS vs hard copies).

MATERIALS AND METHODS. An experienced musculoskeletal radiologist (reviewer 1), a fellow in musculoskeletal radiology (reviewer 2), and a junior staff member in orthopedic surgery (reviewer 3) evaluated MR images displayed on PACS monitors and hard copies independently and in a blinded fashion with regard to the presence or absence of meniscal tears. Seventy-one patients (mean age, 45.4 years; range, 16–80 years) were consecutively included if they had undergone both MRI of the knee and arthroscopy within 4 months. Arthroscopy was the standard of reference. Evaluation time and the reviewer's confidence in his or her diagnosis (Visual Analogue Scale, possible values of 0–100) were determined.

RESULTS. Accuracies, sensitivities, and specificities in diagnosing meniscal tears were 80–87%, 63–85%, and 87–93% for soft copies and 82–85%, 64–76%, and 87–94.0%, respectively, for hard copies. Intrareviewer differences between PACS and hard copies were not significant for any of the three reviewers (McNemar tests). Reviewer 3 was less sensitive but more specific in the diagnosis of meniscal tears than reviewers 1 and 2. This difference was significant for both the PACS and hard copies. The reviewers' confidence in their diagnoses and evaluation times were not significantly different for PACS and hard copies (analysis of variance with Bonferroni post hoc analysis).

CONCLUSION. Differences in the diagnostic performance of suspected meniscal tears depend on reviewer experience rather than on the type of documentation.

Keywords: knee • meniscal tears • MRI • musculoskeletal imaging • PACS

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