Quantitative magnetic resonance imaging had higher sensitivity in diagnosing chondral lesions of the knee: a systematic review and meta-analysis

Purpose This systematic review aims to investigate the accuracy and reliability of Magnetic Resonance Imaging (MRI) in identifying and grading chondral lesions and explore the optimal imaging technique to image cartilage. Method A comprehensive search was conducted on Medline, Embase, and Cochrane Library. Eligible cohort studies published before August 2022 were included. The study reports used MRI to diagnose and grade cartilage lesions, with intraoperative findings as the reference standard. Summary estimates of diagnostic performance were obtained. The reliability of MRI interpretation was summarized. Subgroup analyses were performed based on assessed imaging techniques, field strength, and joint surface. Results Forty-three trials and 3706 patients were included in the systematic review. The overall area under curve (AUC) for hierarchical summarized receiver operating characteristics (HSROC) was 0.91 (95%CI 0.88 to 0.93). The pooled sensitivity for quantitative MRI, three-dimensional (3D) MRI and two-dimensional (2D) MRI were 0.82 (95%CI 0.64 to 0.92), 0.79 (95%CI 0.74 to 0.83) and 0.63 (95%CI 0.51 to 0.73), respectively. The pooled sensitivity of 3 tesla (3T), 1.5 tesla (1.5T) and <1.5T MRI were 0.79 (95%CI 0.72 to 0.85), 0.67 (95%CI 0.60 to 0.74) and 0.55 (95%CI 0.39 to 0.71), respectively. There were differences in inter-observer consistency across different studies. Conclusion In general, MRI had high specificity in discriminating normal cartilage, but its sensitivity for identifying chondral lesions is less optimal. Further analysis showed that quantitative MRI, 3D MRI, and 3T MRI demonstrate higher sensitivity comparing with 2D MRI, 1.5T MRI and < 1.5T MRI. Level of Evidence III. The range of level of evidence for included studies: II-III. The design of included studies: prospective trials, retrospective trials and bidirectional tirals.