ArticlePolish journal of radiology2026
Reliability of anterior cruciate ligament (ACL) graft signal intensity measurement on MRI: a novel method with intra- and interrater analysis over a 1-week interval.
Article in Polish journal of radiology, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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Abstract
Purpose: To determine the intra- and interrater reliability of the anterior cruciate ligament (ACL) graft signal-to-noise quotient (SNQ) assessed on magnetic resonance imaging (MRI) using a standardized coronal-oblique plane and region-of-interest (ROI) measurement protocol. Material and methods: Twelve adults following ACL reconstruction underwent MRI graft assessment. Five ROIs were placed along the intra-articular portion of the ACL graft. Posterior cruciate ligament (PCL) and background ROIs were used for SNQ normalization (SNQ = [ACL signal - PCL signal]/background signal). Two radiologists independently performed two blinded measurement sessions, 1 week apart. Reliability included intraclass correlation coefficients (ICCs), 95% confidence intervals (CIs), standard error of measurement (SEM), and smallest detectable difference (SDD). Results: Intrarater ICCs for individual ROIs ranged from 0.67 to 0.90, with the highest reliability at R2 (ICC = 0.90; 95% CI: 0.70-0.97) and the lowest at R5 (ICC = 0.67; 95% CI: 0.20-0.89). Corresponding SEM values ranged from 0.31 to 1.01 and SDD from 0.87 to 2.79. Interrater ICCs ranged from 0.52 to 0.83, again highest at R2 (ICC = 0.83; 95% CI: 0.65-0.92) and lowest at R5 (ICC = 0.52; 95% CI: 0.15-0.76). Interrater SEM values ranged from 0.51 to 1.23 and SDD from 1.43 to 3.43. Averaging SNQ across all five ROIs improved reliability, yielding excellent intrarater agreement (ICC = 0.90; 95% CI: 0.67-0.97; SEM = 0.28; SDD = 0.76) and good interrater agreement (ICC = 0.85; 95% CI: 0.67-0.93; SEM = 0.34; SDD = 0.96). Conclusions: The proposed MRI-based SNQ protocol demonstrates excellent intrarater and good interrater reliability over a 1-week interval. ROI averaging meaningfully enhances reproducibility and provides actionable SDD thresholds for detecting ACL graft signal change.
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