[3-dimensional sonography in the diagnosis of meniscal lesions. An experimental and clinical study]

Inter-rater reliability in the classification of supraspinatus tendon tears using 3D ultrasound - a question of experience?

Background

Three-dimensional (3D) ultrasound of the shoulder is characterized by a comparable accuracy to two-dimensional (2D) ultrasound. No studies investigating 2D versus 3D inter-rater reliability in the detection of supraspinatus tendon tears taking into account the level of experience of the raters have been carried out so far.

Objectives

The aim of this study was to determine the inter-rater reliability in the analysis of 3D ultrasound image sets of the supraspinatus tendon between sonographer with different levels of experience.

Patients and methods

Non-interventional, prospective, observational pilot study of 2309 images of 127 adult patients suffering from unilateral shoulder pain. 3D ultrasound image sets were scored by three raters independently. The intra-and interrater reliabilities were calculated.

Results

There was an excellent intra-rater reliability of rater A in the overall classification of supraspinatus tendon tears (2D vs 3D κ = 0.892, pairwise reliability 93.81%, 3D scoring round 1 vs 3D scoring round 2 κ = 0.875, pairwise reliability 92.857%). The inter-rater reliability was only moderate compared to rater B on 3D (κ = 0.497, pairwise reliability 70.95%) and fair compared to rater C (κ = 0.238, pairwise reliability 42.38%).

Conclusions

The reliability of 3D ultrasound of the supraspinatus tendon depends on the level of experience of the sonographer. Experience in 2D ultrasound does not seem to be sufficient for the analysis of 3D ultrasound imaging sets. Therefore, for a 3D ultrasound analysis new diagnostic criteria have to be established and taught even to experienced 2D sonographers to improve reproducibility.

3-Dimensional ultrasound imaging for meniscal lesions

PURPOSE

The aim of this prospective study was to evaluate preoperative three-dimensional ultrasound scans for the detection of meniscal lesions with a special focus on interobserver reliability.

METHODS

Forty one patients with clinical signs of meniscal lesions were preoperatively examined by ultrasound using the 3-D technique (11.7 MHz linear transducer). The 3-D dataset was stored and examined by a second orthopaedic surgeon. The second ultrasound examiner was blinded to the results of the first. Any meniscal pathology was confirmed arthroscopically and documented.

RESULTS

At arthroscopy eight lateral meniscal lesions and 57 medial meniscal lesions were detected at different locations. The sensitivity and specificity of the original ultrasound examination was acceptable whereas the results of the second ultrasound session were not as sensitive.

CONCLUSION

Three-D-ultrasound with a high resolution transducer, in the hands of an experienced operator, provides acceptable results in the detection of meniscal lesions, however, analysis of the volume dataset from the 3-D ultrasound investigation indicates that it does not offer sufficient accuracy for clinical use.

Wertigkeit von 3D-Sonographie und MRT des Meniskusschadens

BACKGROUND

The aim of this prospective study was the evaluation of preoperative three-dimensional ultrasound in detecting meniscal lesions compared to preoperative MRI.

METHODS

A total of 34 patients with clinical signs of meniscal lesions were examined preoperatively (11.7 MHz linear transducer) using the 3-D technique. Before ultrasound, MRI was performed, the results of which were unknown to the ultrasound examiner. The basis of the MRI result was the radiologist's written report. Arthroscopically the meniscal situation was noted and taken as reference.

RESULTS

At arthroscopy there were 10 lateral meniscal lesions at different locations and 47 medial meniscal lesions at different locations. The sensitivity (0.5-0.78) and specificity (0.75-0.95) of both imaging methods were overall comparable.

CONCLUSION

Ultrasound with the three-dimensional technique and high-resolution transducer in the hands of an experienced operator gives results comparable to the MRI interpretation by a general radiologist in detecting meniscal lesions.

The value of sonography with micro convex probes in diagnosing meniscal tears compared with arthroscopy

OBJECTIVE

Meniscal tears are common in knee injuries. Sonography has been used in the knee to evaluate meniscal tears. Linear probes with high resolution have been used, and the overall accuracy of sonography has been more than 70% in many studies. In this study, we used a 6.5-MHz micro convex probe to evaluate meniscal tears, and the results were compared with arthroscopic findings.

METHODS

Four hundred six knee joints with knee pain and a clinical indication for arthroscopy were examined from the popliteal fossa with the 6.5-MHz micro convex probe. Those patients with positive sonographic findings who had an arthroscopic examination (100 patients) were included in our study, and the results were compared. The results were statistically analyzed by the Fisher exact test.

RESULTS

One hundred knees with sonographic examinations underwent arthroscopic evaluation. Three age groups were included in the study (20-30, 30-40, and >40 years). Comparison of the results between the two methods showed sensitivity of 100% and specificity of 95% for sonography in detecting meniscal tears. The positive predictive value for the medial meniscus was 95%, and the negative predictive value was 100%; these values for the lateral meniscus were 93% and 100%, respectively.

CONCLUSIONS

Meniscal tears are common in all age groups. The use of sonography allows rapid, low-cost, and noninvasive exploration of meniscal tears as a first-line diagnostic method. We recommend high-resolution micro convex probes, which better fit the anatomic concavity of the popliteal fossa, as efficient investigation tools.

The three-dimensional ultrasound evaluation of the rotator cuff--an experimental study

OBJECTIVE

An accurate sonographic diagnosis of rotator cuff lesions significantly depends on image quality and on the experience of the operator. The present study was performed to determine whether the use of three dimensional (3D) sonography further increases the diagnostic yield of ultrasound.

METHODS

In an experimental study 22 artificial rotator cuff lesions (seven full thickness and 15 partial thickness tears) of cadaveric shoulder joints were evaluated by ultrasound with two and three dimensional imaging in a water basin.

RESULTS

With 3D ultrasound, rotator cuff lesions were more often correctly diagnosed (sensitivity of 77%) than with conventional 2D sonography (sensitivity of 64%). Specificity was 85 and 69%, respectively. In partial thickness tears in particular, 3D imaging was the superior method reaching a sensitivity and specificity of 73 and 77%, respectively, compared to 53 and 61%, respectively, with 2D ultrasound. With 2D and 3D ultrasound eight and 11 out of 13 tendons, respectively, were correctly diagnosed as intact confirmed by histopathological examination.

CONCLUSION

Although the results of an experimental study may not reflect the clinical situation, 3D ultrasound appears to facilitate diagnosis of partial thickness rotator cuff tears.