MRI of the popliteofibular ligament: isotropic 3D WE-DESS versus coronal oblique fat-suppressed T2W MRI

Objective The objective was to compare isotropic 3D water excitation double-echo steady state (WE-DESS) MRI with coronal oblique fat-suppressed T2-weighted (FS T2W) images in the identification of the popliteofibular ligament (PFL). Materials and methods A prospective analysis of 122 consecutive knee MRIs was performed in patients referred for knee pain from the orthopaedic clinic. In addition to the standard knee sequences, isotropic WE-DESS volume acquisition through the whole knee and coronal oblique FS T2W fast spin echo sequences through the posterolateral corner were obtained. The presence of the popliteus and biceps femoris tendons, lateral collateral and PFL was documented. Anterior cruciate ligament injury was present in 33 cases and these were excluded from the study because of the risk of associated PFL injury, leaving a total of 89 cases. Of the 42 patients in whom arthroscopic evaluation was subsequently obtained, none were found to have an injury to the PFL. Results The lateral collateral ligament, biceps femoris and popliteus tendon were identified in all cases on all sequences. The PFL was seen in 81 (91.0%; 95% CI 85.1-97.0%) patients using the WE-DESS sequence and 63 (70.8%; 95% CI 61.3-80.2%) patients using the coronal oblique FS T2W sequence, a statistically significant difference (p < 0.00005). Conclusions Isotropic 3D WE-DESS MRI significantly enhances our ability to identify the popliteofibular ligament compared with coronal oblique fat-suppressed T2-weighted images.