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This Article Full Text Full Text (PDF) All Versions of this Article: 35/3/427    most recent 0363546506294858v1 Alert me when this article is cited Alert me if a correction is posted Citation Map Services Similar articles in this journal Similar articles in ISI Web of Science Similar articles in PubMed Alert me to new issues of the journal Download to citation manager Reprints and Permissions Citing Articles Citing Articles via HighWire Citing Articles via Google Scholar Google Scholar Articles by Warden, S. J. Articles by Crossley, K. M. Search for Related Content PubMed PubMed Citation Articles by Warden, S. J. Articles by Crossley, K. M. Related Collections Imaging Studies Knee Muscle Patella

Comparative Accuracy of Magnetic Resonance Imaging and Ultrasonography in Confirming Clinically Diagnosed Patellar Tendinopathy

Stuart J. Warden, BPhysio (Hons), PhD^,,*, Zoltan S. Kiss, MBBS, FRANZCR^,, Frank A. Malara, MBBS, FRANZCR^||,¶, Alistair B. T. Ooi, Jill L. Cook, BAppSci (Physio), PhD^# and Kay M. Crossley, BAppSci (Physio), PhD

From the Department of Physical Therapy, School of Health and Rehabilitation Sciences, Indiana University, Indianapolis, Indiana, Centre for Health, Exercise and Sports Medicine, School of Physiotherapy, The University of Melbourne, Melbourne, Victoria, Australia, Department of Radiology, Mercy Private Hospital, Melbourne, Victoria, Australia, ^|| Victoria House Medical Imaging, Prahran, Victoria, Australia, ^¶ Department of Radiology, Austin Health, Heidelberg, Victoria, Australia, and ^# Musculoskeletal Research Centre, School of Physiotherapy, La Trobe University, Bundoora, Victoria, Australia

^* Address correspondence to Stuart J. Warden, BPhysio (Hons), PhD, Department of Physical Therapy, Indiana University, 1140 West Michigan Street, CF-326, Indianapolis, IN 46202 (e-mail: stwarden{at}iupui.edu).

Background: Diagnosis of patellar tendinopathy is based primarily on clinical examination; however, it is commonplace to image the patellar tendon for diagnosis confirmation, with the imaging modalities of choice being magnetic resonance imaging (MRI) and ultrasonography (US). The comparative accuracy of these modalities has not been established.

Hypothesis: Magnetic resonance imaging and US have good (>80%) accuracy and show substantial agreement in confirming clinically diagnosed patellar tendinopathy.

Study Design: Cohort study (diagnosis); Level of evidence, 2.

Methods: Magnetic resonance imaging and US (gray scale [GS-US] and color Doppler [CD-US]) features of 30 participants with clinically diagnosed patellar tendinopathy and 33 activity-matched, asymptomatic participants were prospectively compared. Accuracy, sensitivity, specificity, positive and negative predictive values, and the likelihood of positive and negative test results were determined for each technique.

Results: The accuracy of MRI, GS-US, and CD-US was 70%, 83%, and 83%, respectively (P = .04; MRI vs GS-US). The likelihood of positive MRI, GS-US, and CD-US was 3.1, 4.8, and 11.6, respectively. The MRI and GS-US had equivalent specificity (82% vs 82%; P = 1.00); however, the sensitivity of GS-US was greater than MRI (87% vs 57%; P = .01). Sensitivity (70% vs 87%; P = .06) and specificity (94% vs 82%; P = .10) did not differ between CD-US and GS-US.

Conclusions: Ultrasonography was more accurate than MRI in confirming clinically diagnosed patellar tendinopathy. GS-US and CD-US may represent the best combination for confirming clinically diagnosed patellar tendinopathy because GS-US had the greatest sensitivity, while a positive CD-US test result indicated a strong likelihood an individual was symptomatic.

Key Words: anterior knee pain • jumper’s knee • MRI • tendinitis • ultrasound

This article has been cited by other articles:

				S. J. Warden, B. R. Metcalf, Z. S. Kiss, J. L. Cook, C. R. Purdam, K. L. Bennell, and K. M. Crossley Low-intensity pulsed ultrasound for chronic patellar tendinopathy: a randomized, double-blind, placebo-controlled trial Rheumatology, April 1, 2008; 47(4): 467 - 471. [Abstract] [Full Text] [PDF]