• Users Online: 239
  • Home
  • Print this page
  • Email this page
Home About us Editorial board Search Ahead of print Current issue Archives Submit article Instructions Subscribe Contacts Login 

 Table of Contents  
ORIGINAL ARTICLE
Year : 2014  |  Volume : 9  |  Issue : 1  |  Page : 1-4

Knee joint diseases diagnosed by ultrasound and magnetic resonance imaging


1 Department of Anatomy, College of Applied Medical Sciences, King Khalid University, Abha, Saudi Arabia
2 Department of Radiography, Faculty of Radiological Sciences and Nuclear Medicine, Rebat University, Omdurman, Sudan
3 Department of Ultrasound, Faculty of Radiologic Science, Sudan University of Science and Technology, Khartoum, Sudan
4 Department of Radiology, National University, Khartoum, Sudan

Date of Web Publication13-Nov-2014

Correspondence Address:
Elgeili Adam Yousif
College of Applied Medical Sciences, King Khalid University, Abha, Saudi Arabia

Login to access the Email id


DOI: 10.4103/1858-5000.144640

Rights and Permissions
  Abstract 

Introduction: A great number of people all over the world suffer from knee joint problems. The benefits of ultrasound (US) when compared to magnetic resonance imaging (MRI) are that the US is noninvasive, freely available, well-accepted by patients, cheap and that it has the advantage of dynamic evaluation and real-time imaging. In this study, there is a comparison between uUS and MRI in characterization of knee joint diseases using. Materials and Methods: This is an observational cross-sectional study of 200 patients, who attended the Radiological Center, College of Applied Medical Sciences, King Khalid University, Saudi Arabia, from October 2011 to August 2013. The US technique has been carried out according to the protocol of American Institute of Ultrasound in Medicine, using a linear probe transducer with high frequency 7.5-12 MHz. Results: The range of the patients' age was 12-80 years. The most common presenting symptoms were painful swelling of the knee joint and inability to move. In 125 of them US and MRI revealed variable diseases: Effusion (81), loose body (2), synovial cyst (4), quadriceps tendon rupture (1), meniscus tear (6), tumor (1) bursitis (8), arthritis (5), baker cyst (4) deep vein thrombosis (3) diagnosed with both US and MRI, and anterior cruciate ligament tear (6), posterior cruciate ligament tear (4) seen with MRI only. Conclusion and Recommendations: The study suggested that US can evaluate cystic lesions, as well as menisci, ligaments, tendons, and muscles tear. Most of the knee joint disorders were degenerative in origin. Since MRI is not easily available in developing countries and rural areas. US can be used routinely for the diagnoses of most knee joint diseases, shortening the list of MRI indications.Introduction: A great number of people all over the world suffer from knee joint problems. The benefits of ultrasound (US) when compared to magnetic resonance imaging (MRI) are that the US is noninvasive, freely available, well-accepted by patients, cheap and that it has the advantage of dynamic evaluation and real-time imaging. In this study, there is a comparison between uUS and MRI in characterization of knee joint diseases using. Materials and Methods: This is an observational cross-sectional study of 200 patients, who attended the Radiological Center, College of Applied Medical Sciences, King Khalid University, Saudi Arabia, from October 2011 to August 2013. The US technique has been carried out according to the protocol of American Institute of Ultrasound in Medicine, using a linear probe transducer with high frequency 7.5-12 MHz. Results: The range of the patients' age was 12-80 years. The most common presenting symptoms were painful swelling of the knee joint and inability to move. In 125 of them US and MRI revealed variable diseases: Effusion (81), loose body (2), synovial cyst (4), quadriceps tendon rupture (1), meniscus tear (6), tumor (1) bursitis (8), arthritis (5), baker cyst (4) deep vein thrombosis (3) diagnosed with both US and MRI, and anterior cruciate ligament tear (6), posterior cruciate ligament tear (4) seen with MRI only. Conclusion and Recommendations: The study suggested that US can evaluate cystic lesions, as well as menisci, ligaments, tendons, and muscles tear. Most of the knee joint disorders were degenerative in origin. Since MRI is not easily available in developing countries and rural areas. US can be used routinely for the diagnoses of most knee joint diseases, shortening the list of MRI indications.

Keywords: Arthritis, effusion, knee joint, magnetic resonance imaging, ultrasound


How to cite this article:
Yousif EA, Ahmed BH, Abdella AA, Ali QM. Knee joint diseases diagnosed by ultrasound and magnetic resonance imaging. Sudan Med Monit 2014;9:1-4

How to cite this URL:
Yousif EA, Ahmed BH, Abdella AA, Ali QM. Knee joint diseases diagnosed by ultrasound and magnetic resonance imaging. Sudan Med Monit [serial online] 2014 [cited 2019 May 24];9:1-4. Available from: http://www.sudanmedicalmonitor.org/text.asp?2014/9/1/1/144640


  Introduction Top


The use of ultrasound (US) as a clinical investigative tool started in 1950's. US application in imaging remained underutilized until 1980's. It is a noninvasive, freely available, well-accepted by patients, affordable and dynamic evaluation in real time. [1] Recent advances in US system instrumentation and transducer technology allowed better demonstration of musculoskeletal diseases. The most known clinical application is the ability to obtain a clear anatomical overview of the superficial structures around the bones. Soft tissue pathology of the knee represented one of the common uses since the nineties of the last century. [2],[3] The majority of adults, all over the world, complain of knee joint pain, that is routinely investigated by conventional X-ray, US and magnetic resonance imaging (MRI). The latter provides conclusive diagnosis, but the disadvantage of being an expensive option, well beyond the capabilities of most developing countries. The efficiency of US has not been studied in comparison with MRI in knee disorders like anterior cruciate ligament/posterior cruciate ligament (ACL/PCL) ruptures, collateral ligament injuries, quadriceps tendon rupture, cellulitis, soft tissue abscesses, septic arthritis, aneurysm, nerve sheath tumor, meniscal tears, joint effusions and other fluid collections such as bursitis and Baker's cysts. [4] (US) and MRI is the primary modalities currently used for synovium assessment. [5]


  Materials and methods Top


A total of 200 patients with knee joint symptom participated in this study, which has taken place between September 2011 and June 2014, in the Radiology Department, College of Applied Medical Sciences, King Khalid University, Saudi Arabia (Abha, Aseer Region).

Ultrasound examination

The knee joint US examination has performed with GE-USA Medical System Logic 3 Expert 2007, using linear probes with high frequency of 7.5-12 MHz. The technique protocol meet the standard by American Institute of Ultrasound in Medicine.

Magnetic resonance imaging examination

The MRI machine was a GE 1.5 Tesla field of view 14 cm, using 4/0.2 mm thickness/gap and about 20 min total time [without Gradient Echo (GRE)]. 5 or 6 sequences were used: (1) Axial fast spin echo (FSE) T2-weighted Fatsat, (2) Coronal FSE T1-weighted, (3) Coronal FSE proton density-weighted (PDW) Fatsat, (4) Sagittal spin echo PDW, (5) Sagittal FSE T2-weighted Fatsat, (6) ± Sagittal Elective T2 relaxation time (T2*).

Data collection and analysis

Data will be collected in the tabulated database sheet and will be analyzed by Statistical Package for Social Studies (SPSS) Version 22 (SPSS Inc., 233s. Wacker Drive, Chicago, IL, 60606-6412, USA). The data included the age, gender, weight, height, mass index, US findings, MRI findings, US and MRI characterizations.


  Results Top


The age of the patients and subjects ranged from 12 to 80 years. Males were 166 (83%) and females were 34 (17%) as shown in [Table 1]. The symptoms included painful swelling and restriction of movements. 125 patients (102 males [81.4%] and 23 females [18.4%]) had definite disease as revealed by US and MRI. US and MRI revealed the disorders shown in [Table 2]: 81 effusions (64.8%) [Figure 1]a-c, loose body 2 (1.6), synovial cyst 4 (3.2%), quadriceps tendon rupture 1 (0.8), meniscus tear 6 (4.8%) [Figure 2]a and b, tumor 1 (0.8%) and bursitis 8 (6.4%) [Figure 3], arthritis 5 (4%), baker cyst 4 (3.2%) [Figure 4], and deep vein thrombosis 3 (2.4%) also seen in both US and MRI and ACL tear 6 (4.8%), PCL tear 4 (3.2%) seen in MRI only. Knee joint pathological entities diagnosed with US and MRI. US was as good as MRI except for ACL and PCL rupture. [Figure 1], [Figure 2], [Figure 3], [Figure 4] demonstrate some lesions as shown by MRI and US.
Figure 1: Knee joint effusion: (a) Axial T2-weighted magnetic resonance imaging (MRI), (b) sagittal T2-weighted MRI, (c) ultrasound

Click here to view
Figure 2: Medial meniscal tear: (a) Coronal T1-weighted magnetic resonance imaging, (b) ultrasound

Click here to view
Figure 3: Ultrasound prepatellar bursitis (a) and a septal pattern (b)

Click here to view
Figure 4: Baker's cyst, transverse

Click here to view
Table 1: Age group according to the frequent incidence of the diseases


Click here to view
Table 2: Knee joint disorder seen by ultrasound and MRI


Click here to view



  Discussion Top


In this study, out of 200 patients presenting with knee joint symptoms males constituted 83% and female 17%, a finding shared by many previous studies, though higher in this study which has been carried out where males are more active and out. The most common clinical complaints were found to be knee joint pain and swelling, similar to what has been observed by other investigators. Effusion was the commonest finding observed in 81 patients (64.8%). Esen et al., in 2013 [6] found effusion by US to be 55% of consecutive patients presenting with painful knee. Despite inherent limitations, joint US examination identified subclinical abnormalities of HJ in young subjects with severe hemophilia. [7]

Because meniscal injury is associated with sporting activities especially football, a common sport in Saudi Arabia, a 4.8% of cases showed meniscal degeneration and tear. US showed all cases demonstrable with MRI. This was the conclusion of Court-Payen [8] who listed suspected meniscal tears as one of the important indications. This is also in line with the concluding remarks of the recent (2013) meeting of the American Association of Orthopedic Surgeons [9] the US is a useful tool for diagnosis of meniscal pathology, with potential advantages over MRI. The availability, affordability and portability are invaluable at moment-of-injury in athletes. Reports reveal that majority of cases developed knee joint meniscal tears because the meniscus has such important functions in load bearing and stability of the knee, loss of this structure in the young is associated with significant degenerative changes, which may also be depicted with US and MRI. Such justification exactly matches our findings in this study.

Studies done by Teefey Eric [1] and Ward et al[10] had shown that identification of fluid between the semimembranosus and medial gastrocnemius tendons in communication with a posterior knee cyst indicates Baker's cyst with 100% accuracy. These features have been demonstrated in all cases where the Baker's cysts were found. The gender distribution is the same three females (75%) and one male (25%). This has been attributed to the fact that females stand more than male in the kitchen, and they are more obese.

According to Swamy et al., [11] ruptures of the patellar and quadriceps tendon are rare injuries requiring immediate repair to allow extensor movement. US is extensively used as a diagnostic tool before surgery on acute traumatic tears of the patellar tendon and quadriceps tendons. In obese and muscular patients US may not be reliable without confirmation with MRI. In this study, the percentage of tendon rupture is also rare due to the cold nature of the cases presented.

This study confirmed that US offers little or no diagnostic information for deep internal structures such as the cruciate ligaments. If this is suspected, MRI is the technique of choice.


  Conclusion and recommendation Top


Ultrasound can be used to evaluate the knee joint diseases especially cystic lesions, effusions, menisci, ligaments, tendons, and muscles tears. Most of these knee joint disorders were either traumatic or degenerative in etiology. MRI is not wide available and is expensive, for that reason the study recommends the use of US in painful knee joint in routine patient care in developing countries. When ACL or PCL rupture is suspected, MRI is inevitable.


  Acknowledgments Top


The authors would like to express their appreciation to Administrative Manager of College of Applied Medical Sciences, Abha, KSA for giving the opportunity to conduct the study in the Radiological Center. Special thanks for Technical Radiological Staff in the Department for their cooperation.

 
  References Top

1.
Teefey SA, Middleton WD, Yamaguchi K. Shoulder sonography. State of the art. Radiol Clin North Am 1999;37:767-85, ix.  Back to cited text no. 1
    
2.
Iagnocco A. Imaging the joint in osteoarthritis: A place for ultrasound? Best Pract Res Clin Rheumatol 2010;24:27-38.  Back to cited text no. 2
[PUBMED]    
3.
van Holsbeeck MT, Kolowich PA, Eyler WR, Craig JG, Shirazi KK, Habra GK, et al. US depiction of partial-thickness tear of the rotator cuff. Radiology 1995;197:443-6.  Back to cited text no. 3
    
4.
Grassi W, Lamanna G, Farina A, Cervini C. Sonographic imaging of normal and osteoarthritic cartilage. Semin Arthritis Rheum 1999;28:398-403.  Back to cited text no. 4
    
5.
Guermazi A, Burstein D, Conaghan P, Eckstein F, Hellio Le Graverand-Gastineau MP, Keen H, et al. Imaging in osteoarthritis. Rheum Dis Clin North Am 2008;34:645-87.  Back to cited text no. 5
    
6.
Esen S, Akarirmak U, Aydin FY, Unalan H. Clinical evaluation during the acute exacerbation of knee osteoarthritis: The impact of diagnostic ultrasonography. Rheumatol Int 2013;33:711-7.  Back to cited text no. 6
    
7.
Di Minno MN, Iervolino S, Soscia E, Tosetto A, Coppola A, Schiavulli M, et al. Magnetic resonance imaging and ultrasound evaluation of "healthy" joints in young subjects with severe haemophilia A. Haemophilia 2013;19:e167-73.  Back to cited text no. 7
    
8.
Court-Payen M. Sonography of the knee: Intra-articular pathology. J Clin Ultrasound 2004;32:481-90.  Back to cited text no. 8
[PUBMED]    
9.
Leahy M. Ultrasound useful for diagnosing meniscal pathology. Annual Meeting of the American Association of Orthopedic Surgeons, 19-23, February, 2013.  Back to cited text no. 9
    
10.
Ward EE, Jacobson JA, Fessell DP, Hayes CW, van Holsbeeck M. Sonographic detection of Baker's cysts: Comparison with MR imaging. AJR Am J Roentgenol 2001;176:373-80.  Back to cited text no. 10
    
11.
Swamy GN, Nanjayan SK, Yallappa S, Bishnoi A, Pickering SA. Is ultrasound diagnosis reliable in acute extensor tendon injuries of the knee? Acta Orthop Belg 2012;78:764-70.  Back to cited text no. 11
    


    Figures

  [Figure 1], [Figure 2], [Figure 3], [Figure 4]
 
 
    Tables

  [Table 1], [Table 2]



 

Top
 
 
  Search
 
Similar in PUBMED
   Search Pubmed for
   Search in Google Scholar for
 Related articles
Access Statistics
Email Alert *
Add to My List *
* Registration required (free)

 
  In this article
Abstract
Introduction
Materials and me...
Results
Discussion
Conclusion and r...
Acknowledgments
References
Article Figures
Article Tables

 Article Access Statistics
    Viewed2951    
    Printed162    
    Emailed0    
    PDF Downloaded259    
    Comments [Add]    

Recommend this journal


[TAG2]
[TAG3]
[TAG4]