CT Knee With negative radiographs, CT may be performed as the next imaging study for the evaluation of suspected radiographically occult knee fractures [12] and bone marrow contusions [16-18]. CT may diagnose or predict ligamentous injuries [14,15,50,51] and predict meniscal [15,50,51] injuries. However, MRI is superior to CT in evaluation of bone marrow lesions [27-29], meniscal [21,26] and ligamentous [21,31-34] injuries, and may be subsequently performed as clinically indicated. MR Arthrography Knee With negative radiographs, MR arthrography is not routinely used as the next imaging study for the evaluation of suspected occult knee fractures or internal derangement. MRA Knee With negative radiographs, MRA is not routinely used as the next imaging study for the evaluation of suspected occult knee fractures or internal derangement. MRI Knee MRI should be the next imaging modality to evaluate for the presence of radiographically occult fractures and/or internal derangements of the acutely injured knee. With its superb contrast resolution and multiplanar imaging capability, MRI is proven to be a highly accurate imaging modality in the evaluation of bone marrow contusions and occult fractures [27-29] as well as meniscal [21,26] and ligamentous injuries [21,31-34]. Bone Scan with SPECT or SPECT/CT Knee Tc-99m bone scan with SPECT/CT would not be the next best imaging study to evaluate for radiographically occult fractures and/or internal derangement. Even-Sapir et al [37] showed promising results of a SPECT study in diagnosis of the ACL and meniscal tears and the associated bone contusions in patients with acute knee trauma with arthroscopic and MRI correlation. However, a more recent SPECT study with arthroscopic correlation by Wertman et al [39] showed a lower sensitivity, specificity, and accuracy than MRI in evaluating meniscal injuries.
Acute Trauma to the Knee. CT Knee With negative radiographs, CT may be performed as the next imaging study for the evaluation of suspected radiographically occult knee fractures [12] and bone marrow contusions [16-18]. CT may diagnose or predict ligamentous injuries [14,15,50,51] and predict meniscal [15,50,51] injuries. However, MRI is superior to CT in evaluation of bone marrow lesions [27-29], meniscal [21,26] and ligamentous [21,31-34] injuries, and may be subsequently performed as clinically indicated. MR Arthrography Knee With negative radiographs, MR arthrography is not routinely used as the next imaging study for the evaluation of suspected occult knee fractures or internal derangement. MRA Knee With negative radiographs, MRA is not routinely used as the next imaging study for the evaluation of suspected occult knee fractures or internal derangement. MRI Knee MRI should be the next imaging modality to evaluate for the presence of radiographically occult fractures and/or internal derangements of the acutely injured knee. With its superb contrast resolution and multiplanar imaging capability, MRI is proven to be a highly accurate imaging modality in the evaluation of bone marrow contusions and occult fractures [27-29] as well as meniscal [21,26] and ligamentous injuries [21,31-34]. Bone Scan with SPECT or SPECT/CT Knee Tc-99m bone scan with SPECT/CT would not be the next best imaging study to evaluate for radiographically occult fractures and/or internal derangement. Even-Sapir et al [37] showed promising results of a SPECT study in diagnosis of the ACL and meniscal tears and the associated bone contusions in patients with acute knee trauma with arthroscopic and MRI correlation. However, a more recent SPECT study with arthroscopic correlation by Wertman et al [39] showed a lower sensitivity, specificity, and accuracy than MRI in evaluating meniscal injuries.