A systematic review and meta-analysis of the diagnostic accuracy of MRI for suspected ACL and meniscal tears of the knee
Purpose To determine the diagnostic accuracy of magnetic resonance imaging (MRI) and ultrasound (US) in the diagnosis of anterior cruciate ligament (ACL), medial meniscus and lateral meniscus tears in people with suspected ACL and/or meniscal tears. Methods MEDLINE, Web of Science and the Cochrane l...
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| Veröffentlicht in: | Knee surgery, sports traumatology, arthroscopy : official journal of the ESSKA sports traumatology, arthroscopy : official journal of the ESSKA, 2016-05, Vol.24 (5), p.1525-1539 |
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| container_title | Knee surgery, sports traumatology, arthroscopy : official journal of the ESSKA |
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| creator | Phelan, Nigel Rowland, Patrick Galvin, Rose O’Byrne, John M. |
| description | Purpose
To determine the diagnostic accuracy of magnetic resonance imaging (MRI) and ultrasound (US) in the diagnosis of anterior cruciate ligament (ACL), medial meniscus and lateral meniscus tears in people with suspected ACL and/or meniscal tears.
Methods
MEDLINE, Web of Science and the Cochrane library were searched from inception to March 2014. All prospective studies of the diagnostic accuracy of MRI or US against arthroscopy as the reference standard were included in the systematic review. Studies with a retrospective design and those with evidence of verification bias were excluded. Methodological quality of included studies was assessed using the QUADAS-2 tool. A meta-analysis of studies evaluating MRI to calculate the pooled sensitivity and specificity for each target condition was performed using a bivariate model with random effects. Sub-group and sensitivity analysis were used to examine the effect of methodological and other study variables.
Results
There were 14 studies included in the meta-analysis of the accuracy of MRI for ACL tears, 19 studies included for medial meniscal tears and 19 studies for lateral meniscal tears. The summary estimates of sensitivity and specificity of MRI were 87 % (95 % CI 77–94 %) and 93 % (95 % CI 91–96 %), respectively, for ACL tears; 89 % (95 % CI 83–94 %) and 88 % (95 % CI 82–93 %), respectively, for medial meniscal tears; and 78 % (95 % CI 66–87 %) and 95 % (95 % CI 91–97 %), respectively, for lateral meniscal tears. Magnetic field strength had no significant effect on accuracy. Most studies had a high or unclear risk of bias. There were an insufficient number of studies that evaluated US to perform a meta-analysis.
Conclusion
This study provides a systematic review and meta-analysis of diagnostic accuracy studies of MRI and applies strict exclusion criteria in relation to the risk of verification bias. The risk of bias in most studies is high or unclear in relation to the reference standard. Concerns regarding the applicability of patient selection are also present in most studies.
Level of evidence
III. |
| doi_str_mv | 10.1007/s00167-015-3861-8 |
| format | Article |
| fullrecord | <record><control><sourceid>proquest_cross</sourceid><recordid>TN_cdi_proquest_miscellaneous_1790966224</recordid><sourceformat>XML</sourceformat><sourcesystem>PC</sourcesystem><sourcerecordid>1787091348</sourcerecordid><originalsourceid>FETCH-LOGICAL-c471t-ce3ae0b63a01a791e850bb5a75bbcf99d209c4f76093f3c3bc61bc048e0785c43</originalsourceid><addsrcrecordid>eNqNkU1v1DAQhi0EokvhB_SCLPXCxTCOHTs-rlYFKm2FhOBsTZxJm5KPrZ207L8nYZcKIVXiNJbmmWdGfhk7k_BeAtgPCUAaK0DmQhVGiuIZW0mtlLBK2-dsBU5nIoPcnLBXKd0CzE_tXrKTzBipdZav2M81T_s0UodjE3ik-4YeOPYV72hEgT22-9QkPtR8vCFeNXjdD2lBMYQpYtgvrauvl7weIk9T2lEYqeLrzfZo6ZsUsOUjYXzU_OiJXrMXNbaJ3hzrKfv-8eLb5rPYfvl0uVlvRdBWjiKQQoLSKASJ1kkqcijLHG1elqF2rsrABV1bA07VKqgyGFkG0AWBLfKg1Sl7d_Du4nA3URp9N19EbYs9DVPy0jpwxmTZ_6CFBSeVLmb0_B_0dpji_Fu_qdxpB7BQ8kCFOKQUqfa72HQY916CXxL0hwT9nKBfEvTLzNujeSo7qh4n_kQ2A9kBSHOrv6b41-onrb8ARGSlSA</addsrcrecordid><sourcetype>Aggregation Database</sourcetype><iscdi>true</iscdi><recordtype>article</recordtype><pqid>1785949008</pqid></control><display><type>article</type><title>A systematic review and meta-analysis of the diagnostic accuracy of MRI for suspected ACL and meniscal tears of the knee</title><source>MEDLINE</source><source>Wiley Online Library Journals Frontfile Complete</source><source>SpringerLink Journals - AutoHoldings</source><creator>Phelan, Nigel ; Rowland, Patrick ; Galvin, Rose ; O’Byrne, John M.</creator><creatorcontrib>Phelan, Nigel ; Rowland, Patrick ; Galvin, Rose ; O’Byrne, John M.</creatorcontrib><description>Purpose
To determine the diagnostic accuracy of magnetic resonance imaging (MRI) and ultrasound (US) in the diagnosis of anterior cruciate ligament (ACL), medial meniscus and lateral meniscus tears in people with suspected ACL and/or meniscal tears.
Methods
MEDLINE, Web of Science and the Cochrane library were searched from inception to March 2014. All prospective studies of the diagnostic accuracy of MRI or US against arthroscopy as the reference standard were included in the systematic review. Studies with a retrospective design and those with evidence of verification bias were excluded. Methodological quality of included studies was assessed using the QUADAS-2 tool. A meta-analysis of studies evaluating MRI to calculate the pooled sensitivity and specificity for each target condition was performed using a bivariate model with random effects. Sub-group and sensitivity analysis were used to examine the effect of methodological and other study variables.
Results
There were 14 studies included in the meta-analysis of the accuracy of MRI for ACL tears, 19 studies included for medial meniscal tears and 19 studies for lateral meniscal tears. The summary estimates of sensitivity and specificity of MRI were 87 % (95 % CI 77–94 %) and 93 % (95 % CI 91–96 %), respectively, for ACL tears; 89 % (95 % CI 83–94 %) and 88 % (95 % CI 82–93 %), respectively, for medial meniscal tears; and 78 % (95 % CI 66–87 %) and 95 % (95 % CI 91–97 %), respectively, for lateral meniscal tears. Magnetic field strength had no significant effect on accuracy. Most studies had a high or unclear risk of bias. There were an insufficient number of studies that evaluated US to perform a meta-analysis.
Conclusion
This study provides a systematic review and meta-analysis of diagnostic accuracy studies of MRI and applies strict exclusion criteria in relation to the risk of verification bias. The risk of bias in most studies is high or unclear in relation to the reference standard. Concerns regarding the applicability of patient selection are also present in most studies.
Level of evidence
III.</description><identifier>ISSN: 0942-2056</identifier><identifier>EISSN: 1433-7347</identifier><identifier>DOI: 10.1007/s00167-015-3861-8</identifier><identifier>PMID: 26614425</identifier><language>eng</language><publisher>Berlin/Heidelberg: Springer Berlin Heidelberg</publisher><subject>Accuracy ; Adolescent ; Adult ; Anterior Cruciate Ligament Injuries - diagnosis ; Arthroscopy ; Bias ; Diagnostic tests ; Female ; Humans ; Knee ; Knee Joint ; Ligaments ; Magnetic resonance imaging ; Magnetic Resonance Imaging - standards ; Male ; Medicine ; Medicine & Public Health ; Menisci, Tibial - pathology ; Meta-analysis ; Middle Aged ; Orthopedics ; Patients ; Pediatrics ; Search strategies ; Systematic review ; Tibial Meniscus Injuries - diagnosis ; Ultrasonic imaging ; Young Adult</subject><ispartof>Knee surgery, sports traumatology, arthroscopy : official journal of the ESSKA, 2016-05, Vol.24 (5), p.1525-1539</ispartof><rights>European Society of Sports Traumatology, Knee Surgery, Arthroscopy (ESSKA) 2015</rights><rights>European Society of Sports Traumatology, Knee Surgery, Arthroscopy (ESSKA) 2016</rights><lds50>peer_reviewed</lds50><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c471t-ce3ae0b63a01a791e850bb5a75bbcf99d209c4f76093f3c3bc61bc048e0785c43</citedby><cites>FETCH-LOGICAL-c471t-ce3ae0b63a01a791e850bb5a75bbcf99d209c4f76093f3c3bc61bc048e0785c43</cites></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><linktopdf>$$Uhttps://link.springer.com/content/pdf/10.1007/s00167-015-3861-8$$EPDF$$P50$$Gspringer$$H</linktopdf><linktohtml>$$Uhttps://link.springer.com/10.1007/s00167-015-3861-8$$EHTML$$P50$$Gspringer$$H</linktohtml><link.rule.ids>314,776,780,27901,27902,41464,42533,51294</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/26614425$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Phelan, Nigel</creatorcontrib><creatorcontrib>Rowland, Patrick</creatorcontrib><creatorcontrib>Galvin, Rose</creatorcontrib><creatorcontrib>O’Byrne, John M.</creatorcontrib><title>A systematic review and meta-analysis of the diagnostic accuracy of MRI for suspected ACL and meniscal tears of the knee</title><title>Knee surgery, sports traumatology, arthroscopy : official journal of the ESSKA</title><addtitle>Knee Surg Sports Traumatol Arthrosc</addtitle><addtitle>Knee Surg Sports Traumatol Arthrosc</addtitle><description>Purpose
To determine the diagnostic accuracy of magnetic resonance imaging (MRI) and ultrasound (US) in the diagnosis of anterior cruciate ligament (ACL), medial meniscus and lateral meniscus tears in people with suspected ACL and/or meniscal tears.
Methods
MEDLINE, Web of Science and the Cochrane library were searched from inception to March 2014. All prospective studies of the diagnostic accuracy of MRI or US against arthroscopy as the reference standard were included in the systematic review. Studies with a retrospective design and those with evidence of verification bias were excluded. Methodological quality of included studies was assessed using the QUADAS-2 tool. A meta-analysis of studies evaluating MRI to calculate the pooled sensitivity and specificity for each target condition was performed using a bivariate model with random effects. Sub-group and sensitivity analysis were used to examine the effect of methodological and other study variables.
Results
There were 14 studies included in the meta-analysis of the accuracy of MRI for ACL tears, 19 studies included for medial meniscal tears and 19 studies for lateral meniscal tears. The summary estimates of sensitivity and specificity of MRI were 87 % (95 % CI 77–94 %) and 93 % (95 % CI 91–96 %), respectively, for ACL tears; 89 % (95 % CI 83–94 %) and 88 % (95 % CI 82–93 %), respectively, for medial meniscal tears; and 78 % (95 % CI 66–87 %) and 95 % (95 % CI 91–97 %), respectively, for lateral meniscal tears. Magnetic field strength had no significant effect on accuracy. Most studies had a high or unclear risk of bias. There were an insufficient number of studies that evaluated US to perform a meta-analysis.
Conclusion
This study provides a systematic review and meta-analysis of diagnostic accuracy studies of MRI and applies strict exclusion criteria in relation to the risk of verification bias. The risk of bias in most studies is high or unclear in relation to the reference standard. Concerns regarding the applicability of patient selection are also present in most studies.
Level of evidence
III.</description><subject>Accuracy</subject><subject>Adolescent</subject><subject>Adult</subject><subject>Anterior Cruciate Ligament Injuries - diagnosis</subject><subject>Arthroscopy</subject><subject>Bias</subject><subject>Diagnostic tests</subject><subject>Female</subject><subject>Humans</subject><subject>Knee</subject><subject>Knee Joint</subject><subject>Ligaments</subject><subject>Magnetic resonance imaging</subject><subject>Magnetic Resonance Imaging - standards</subject><subject>Male</subject><subject>Medicine</subject><subject>Medicine & Public Health</subject><subject>Menisci, Tibial - pathology</subject><subject>Meta-analysis</subject><subject>Middle Aged</subject><subject>Orthopedics</subject><subject>Patients</subject><subject>Pediatrics</subject><subject>Search strategies</subject><subject>Systematic review</subject><subject>Tibial Meniscus Injuries - diagnosis</subject><subject>Ultrasonic imaging</subject><subject>Young Adult</subject><issn>0942-2056</issn><issn>1433-7347</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2016</creationdate><recordtype>article</recordtype><sourceid>EIF</sourceid><sourceid>BENPR</sourceid><recordid>eNqNkU1v1DAQhi0EokvhB_SCLPXCxTCOHTs-rlYFKm2FhOBsTZxJm5KPrZ207L8nYZcKIVXiNJbmmWdGfhk7k_BeAtgPCUAaK0DmQhVGiuIZW0mtlLBK2-dsBU5nIoPcnLBXKd0CzE_tXrKTzBipdZav2M81T_s0UodjE3ik-4YeOPYV72hEgT22-9QkPtR8vCFeNXjdD2lBMYQpYtgvrauvl7weIk9T2lEYqeLrzfZo6ZsUsOUjYXzU_OiJXrMXNbaJ3hzrKfv-8eLb5rPYfvl0uVlvRdBWjiKQQoLSKASJ1kkqcijLHG1elqF2rsrABV1bA07VKqgyGFkG0AWBLfKg1Sl7d_Du4nA3URp9N19EbYs9DVPy0jpwxmTZ_6CFBSeVLmb0_B_0dpji_Fu_qdxpB7BQ8kCFOKQUqfa72HQY916CXxL0hwT9nKBfEvTLzNujeSo7qh4n_kQ2A9kBSHOrv6b41-onrb8ARGSlSA</recordid><startdate>20160501</startdate><enddate>20160501</enddate><creator>Phelan, Nigel</creator><creator>Rowland, Patrick</creator><creator>Galvin, Rose</creator><creator>O’Byrne, John M.</creator><general>Springer Berlin Heidelberg</general><general>Springer Nature B.V</general><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>3V.</scope><scope>7QO</scope><scope>7RV</scope><scope>7TS</scope><scope>7X7</scope><scope>7XB</scope><scope>88E</scope><scope>8AO</scope><scope>8FD</scope><scope>8FI</scope><scope>8FJ</scope><scope>8FK</scope><scope>ABUWG</scope><scope>AFKRA</scope><scope>BENPR</scope><scope>CCPQU</scope><scope>FR3</scope><scope>FYUFA</scope><scope>GHDGH</scope><scope>K9.</scope><scope>KB0</scope><scope>M0S</scope><scope>M1P</scope><scope>NAPCQ</scope><scope>P64</scope><scope>PQEST</scope><scope>PQQKQ</scope><scope>PQUKI</scope><scope>PRINS</scope><scope>7X8</scope></search><sort><creationdate>20160501</creationdate><title>A systematic review and meta-analysis of the diagnostic accuracy of MRI for suspected ACL and meniscal tears of the knee</title><author>Phelan, Nigel ; Rowland, Patrick ; Galvin, Rose ; O’Byrne, John M.</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c471t-ce3ae0b63a01a791e850bb5a75bbcf99d209c4f76093f3c3bc61bc048e0785c43</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2016</creationdate><topic>Accuracy</topic><topic>Adolescent</topic><topic>Adult</topic><topic>Anterior Cruciate Ligament Injuries - diagnosis</topic><topic>Arthroscopy</topic><topic>Bias</topic><topic>Diagnostic tests</topic><topic>Female</topic><topic>Humans</topic><topic>Knee</topic><topic>Knee Joint</topic><topic>Ligaments</topic><topic>Magnetic resonance imaging</topic><topic>Magnetic Resonance Imaging - standards</topic><topic>Male</topic><topic>Medicine</topic><topic>Medicine & Public Health</topic><topic>Menisci, Tibial - pathology</topic><topic>Meta-analysis</topic><topic>Middle Aged</topic><topic>Orthopedics</topic><topic>Patients</topic><topic>Pediatrics</topic><topic>Search strategies</topic><topic>Systematic review</topic><topic>Tibial Meniscus Injuries - diagnosis</topic><topic>Ultrasonic imaging</topic><topic>Young Adult</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Phelan, Nigel</creatorcontrib><creatorcontrib>Rowland, Patrick</creatorcontrib><creatorcontrib>Galvin, Rose</creatorcontrib><creatorcontrib>O’Byrne, John M.</creatorcontrib><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>ProQuest Central (Corporate)</collection><collection>Biotechnology Research Abstracts</collection><collection>Nursing & Allied Health Database</collection><collection>Physical Education Index</collection><collection>Health & Medical Collection</collection><collection>ProQuest Central (purchase pre-March 2016)</collection><collection>Medical Database (Alumni Edition)</collection><collection>ProQuest Pharma Collection</collection><collection>Technology Research Database</collection><collection>Hospital Premium Collection</collection><collection>Hospital Premium Collection (Alumni Edition)</collection><collection>ProQuest Central (Alumni) (purchase pre-March 2016)</collection><collection>ProQuest Central (Alumni Edition)</collection><collection>ProQuest Central UK/Ireland</collection><collection>ProQuest Central</collection><collection>ProQuest One Community College</collection><collection>Engineering Research Database</collection><collection>Health Research Premium Collection</collection><collection>Health Research Premium Collection (Alumni)</collection><collection>ProQuest Health & Medical Complete (Alumni)</collection><collection>Nursing & Allied Health Database (Alumni Edition)</collection><collection>Health & Medical Collection (Alumni Edition)</collection><collection>Medical Database</collection><collection>Nursing & Allied Health Premium</collection><collection>Biotechnology and BioEngineering Abstracts</collection><collection>ProQuest One Academic Eastern Edition (DO NOT USE)</collection><collection>ProQuest One Academic</collection><collection>ProQuest One Academic UKI Edition</collection><collection>ProQuest Central China</collection><collection>MEDLINE - Academic</collection><jtitle>Knee surgery, sports traumatology, arthroscopy : official journal of the ESSKA</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Phelan, Nigel</au><au>Rowland, Patrick</au><au>Galvin, Rose</au><au>O’Byrne, John M.</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>A systematic review and meta-analysis of the diagnostic accuracy of MRI for suspected ACL and meniscal tears of the knee</atitle><jtitle>Knee surgery, sports traumatology, arthroscopy : official journal of the ESSKA</jtitle><stitle>Knee Surg Sports Traumatol Arthrosc</stitle><addtitle>Knee Surg Sports Traumatol Arthrosc</addtitle><date>2016-05-01</date><risdate>2016</risdate><volume>24</volume><issue>5</issue><spage>1525</spage><epage>1539</epage><pages>1525-1539</pages><issn>0942-2056</issn><eissn>1433-7347</eissn><abstract>Purpose
To determine the diagnostic accuracy of magnetic resonance imaging (MRI) and ultrasound (US) in the diagnosis of anterior cruciate ligament (ACL), medial meniscus and lateral meniscus tears in people with suspected ACL and/or meniscal tears.
Methods
MEDLINE, Web of Science and the Cochrane library were searched from inception to March 2014. All prospective studies of the diagnostic accuracy of MRI or US against arthroscopy as the reference standard were included in the systematic review. Studies with a retrospective design and those with evidence of verification bias were excluded. Methodological quality of included studies was assessed using the QUADAS-2 tool. A meta-analysis of studies evaluating MRI to calculate the pooled sensitivity and specificity for each target condition was performed using a bivariate model with random effects. Sub-group and sensitivity analysis were used to examine the effect of methodological and other study variables.
Results
There were 14 studies included in the meta-analysis of the accuracy of MRI for ACL tears, 19 studies included for medial meniscal tears and 19 studies for lateral meniscal tears. The summary estimates of sensitivity and specificity of MRI were 87 % (95 % CI 77–94 %) and 93 % (95 % CI 91–96 %), respectively, for ACL tears; 89 % (95 % CI 83–94 %) and 88 % (95 % CI 82–93 %), respectively, for medial meniscal tears; and 78 % (95 % CI 66–87 %) and 95 % (95 % CI 91–97 %), respectively, for lateral meniscal tears. Magnetic field strength had no significant effect on accuracy. Most studies had a high or unclear risk of bias. There were an insufficient number of studies that evaluated US to perform a meta-analysis.
Conclusion
This study provides a systematic review and meta-analysis of diagnostic accuracy studies of MRI and applies strict exclusion criteria in relation to the risk of verification bias. The risk of bias in most studies is high or unclear in relation to the reference standard. Concerns regarding the applicability of patient selection are also present in most studies.
Level of evidence
III.</abstract><cop>Berlin/Heidelberg</cop><pub>Springer Berlin Heidelberg</pub><pmid>26614425</pmid><doi>10.1007/s00167-015-3861-8</doi><tpages>15</tpages></addata></record> |
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| identifier | ISSN: 0942-2056 |
| ispartof | Knee surgery, sports traumatology, arthroscopy : official journal of the ESSKA, 2016-05, Vol.24 (5), p.1525-1539 |
| issn | 0942-2056 1433-7347 |
| language | eng |
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| source | MEDLINE; Wiley Online Library Journals Frontfile Complete; SpringerLink Journals - AutoHoldings |
| subjects | Accuracy Adolescent Adult Anterior Cruciate Ligament Injuries - diagnosis Arthroscopy Bias Diagnostic tests Female Humans Knee Knee Joint Ligaments Magnetic resonance imaging Magnetic Resonance Imaging - standards Male Medicine Medicine & Public Health Menisci, Tibial - pathology Meta-analysis Middle Aged Orthopedics Patients Pediatrics Search strategies Systematic review Tibial Meniscus Injuries - diagnosis Ultrasonic imaging Young Adult |
| title | A systematic review and meta-analysis of the diagnostic accuracy of MRI for suspected ACL and meniscal tears of the knee |
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