Diagnostic accuracy of proton density versus proton density fat-saturated magnetic resonance imaging (MRI) sequences in meniscal tear evaluation: a multireader ROC analysis.

AIM: Compare the diagnostic performance of proton density (PD) and PD fat-saturated magnetic resonance imaging (MRI) sequences in detecting meniscal tears using receiver operating characteristic curve analysis with multiple independent readers.

MATERIALS AND

METHODS

This retrospective, institutional review board approved study included 98 patients who underwent knee arthroscopy for suspected meniscal tears between July 1, 2020, and January 31, 2021. Sagittal PD and PD fat-saturated MRI sequences were independently reviewed by 3 musculoskeletal radiologists on separate days. Readers rated diagnostic confidence on a 5-point scale. Diagnostic accuracy was assessed using area under the curve (AUC), DeLong tests, sensitivity, specificity, positive predictive value, and negative predictive value, with arthroscopy as the reference standard. Binary classification was based on reader scores of 4 or 5 and agreement from at least 2 of three 3 was required.

RESULTS

For medial meniscal tears, PD sequences yielded an AUC of 0.9302, sensitivity of 93.2%, and specificity of 87.5%. PD fat-saturated sequences yielded an AUC of 0.9229, sensitivity of 95.9%, and specificity of 79.2% (DeLong p = 0.575). For lateral meniscal tears, AUC was 0.8329 for PD and 0.8088 for PD fat-saturated sequences (DeLong P = 0.339).

CONCLUSION

Both sequences demonstrated high diagnostic performance for meniscal tear detection. Fat-saturated sequences showed slightly higher sensitivity but lower specificity. No significant difference in diagnostic accuracy was observed between sequences.