MR imaging of the anterior cruciate ligament: value of thin slice direct oblique coronal technique.

PURPOSE: The value of the thin slice direct oblique coronal technique, which is parallel to the anterior cruciate ligament (ACL), was assessed in the evaluation of ACL injury in comparison with conventional oblique sagittal and coronal images.

MATERIAL AND METHODS: A thin slice direct oblique coronal technique was developed and applied clinically to 62 patients after conventional oblique sagittal and coronal images had been obtained. MR images of these 62 patients (24 with tears and 38 without tears) with an arthroscopic correlation were evaluated by three radiologists who were unaware of the arthroscopic results. The diagnostic accuracy of these new images was compared with that of oblique sagittal and coronal images by ROC analysis.

RESULTS: Conventional oblique sagittal and coronal images for the diagnosis of ACL tears revealed accuracies of 82%, 84%, and 84%, sensitivities of 92%, 92%, and 96% and specificities of 76%, 79%, and 76% for the three reviewers, respectively. On thin slice direct oblique coronal images, specificities of 97%, 97%, and 97%, sensitivities of 96%, 96%, and 96%, and accuracies of 97%, 97%, and 97% were obtained, respectively. Diagnostic ability was significantly better with direct oblique coronal images (mean area under the ROC curve [Az]=0.99) than with conventional oblique sagittal and coronal images (Az=0.91) (p<0.05).

CONCLUSION: The addition of thin slice direct oblique coronal images significantly improved specificity and accuracy in the diagnosis of ACL tears.