Spectrum and Patterns of Knee Pathology in Adult Patients Referred for Mri to Kenyatta National Hospital a 3t Mri Kenyan Perspective Principal Investigation

Abstract

Study Background The knee is one of the most common joints to be injured in the human body. This study aims to highlight the various types of injuries in the knee joint with state of the art 3T Magnetic resonance imaging (MRI) in subjects who meet the inclusion criteria. The soft tissue detail provided by MRI is unparalleled. 3T MRI provides the highest signal to noise ratio (SNR) and hence improves identification of structures by improving anatomical detail. 3T magnets provide better spatial and temporal resolution than 1.5T magnets and are far more superior in diagnosis of articular cartilage lesions as evidenced by their greater sensitivity. Furthermore, a 3T magnet overperforms in the detection of medial meniscus horizontal and unstable tears and anterior cruciate ligament (ACL) lesions are picked with greater diagnostic confidence and accuracy. As of now, no such study has been undertaken in Kenya, and this study will help bridge the gap in knowledge and pave the way for more studies. Broad Objective The main objective of this study is to ascertain the spectrum and patterns of pathology affecting structures in the knee joint, in patients undergoing MRI examinations using a 3T MRI scanner at the Radiology Department of Kenyatta National Hospital. Study design and Site Descriptive prospective study at the MRI unit of the Department of Radiology, Kenyatta National Hospital, that serves the population in Nairobi and its environs. Study Participants A total of 53 patients with knee symptoms who were referred for MR imaging of the knee. Materials and methods A descriptive prospective study was done at the MRI unit of the Department of Radiology, Kenyatta National Hospital between April 2021 and June 2021. 53 xii consecutive patients referred to the Department of Radiology for a Knee MRI who fit the inclusion criteria were enrolled into the study. Once enrolled the demographic information of each patient was recorded. The MRI knee examination was then performed after which the images were analyzed on the DICOM viewer on the reporting workstation and findings were recorded in the data collection form. A report was also generated for each patient that was then validated by the consultant radiologist. Statistical analysis of the findings was then done using SPSS version 20 IBM and Microsoft Excel after which it was presented on tables and graphs. No arthroscopic findings were available to correlate with the imaging findings. Results A total of 53 participants were recruited into the study. The mean age of the sample was 38.2 years (SD  12.3) with a range between 19 and 61 years. The median age was 37 years. The male to female ratio was 1:1.3. Most of the participants were in the 19-49 years age range. The right knee was affected more than the left knee. The patients were referred from A&E Casualty. The most common findings encountered were joint effusions, ACL tears, meniscal tears and degenerative joint disease. Of these, joint effusions accounted for 73.6% (n=39), ACL tears accounted for 35.9% (n=19), meniscal tears accounted for 18.9% (n=10) and degenerative joint disease accounted for 24.5% (n=13). ACL tears were more common in women with a male to female ratio of 1:3.8. The predominant meniscus injured was the medial meniscus which accounted for 13.2% (n=7). Patellar contusion was the most common finding in the patella accounting for 13.2% (n=7). 69.8% of patients had symptoms for more than two weeks. Knee pain was the most common presenting symptom (96%). Conclusion Knee pain is more common in females than in males. The right knee is more commonly affected than the left knee. The most common finding was joint effusion secondary to another pathology followed and the most common soft tissue injury was an ACL tear. ACL injuries are more common in females than in males. This finding was not similar to other studies. Most ACL and PCL injuries have concurrent injuries. Degenerative changes seen on MRI increase with age.