Thesis (M.Sc.) - Cairo University - Faculty of Medicine - Department of Radio-Diagnosis

Background: the purpose of this study was to test and compare the additive value of the oblique sagittal and the oblique coronal MRI techniques to the routine knee MRI technique in evaluation and grading ACL graft injury using knee arthroscopy as a reference gold standard to validate the MRI results. Material and methods: this is a cross sectional analytic study including (36) patients with history of anterior cruciate ligament reconstruction surgery, complaining of any of these symptoms, raising the possibility of complications: (pain, swelling, limitation of movement). All patients were referred to the Radiology department from the outpatient clinic of the Orthopedics department, Kasr el-ainy Hospital, Faculty of Medicine, Cairo University. The radiologist evaluated the status of the ACL grafts with using the routine knee MRI and then with adding the oblique sagittal and oblique coronal T2W imaging. The severity of ACL graft injury was graded using a 3-point system from MR images as intact, partial tear or complete tear, and the results were compared with the arthroscopic results as a reference gold standard. Weighted kappa statistics were used to assess the diagnostic agreement between the MRI diagnoses and the arthroscopic results. The strength of Interobserver agreement was interpreted according to the guidelines described by Landis and Koch ,(91) 0: poor, 0.01-0.20: slight, 0.21-0.40: fair, 0.41-0.60: moderate, 0.61-0.80: substantial and 0.81-1.00: almost perfect.The sensitivity, specificity and accuracy for detecting graft tear were calculated by grouping the grade 1 and 2 injuries. P.value and weighted kappa statistics were used to analyze the diagnostic sensitivities, specificities and accuracies of the knee MRI with and without the additional oblique sagittal and oblique coronal imaging. Results: The diagnostic agreements between the MR grade and the arthroscopic grade for imaging with protocol A were considered 2fair 3 with weighted kappa values of 0.399 (reader 1) and 0.357 (reader 2)

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