ArticleQuantitative imaging in medicine and surgery2026
Missed diagnosis of knee tuberculosis on X-ray: contributing factors and diagnostic value of CT and MRI.
Article in Quantitative imaging in medicine and surgery, 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
Background: X-ray examinations often fail to detect early-stage knee tuberculosis (KTB), yet reports on the comparative diagnostic performance of advanced imaging modalities remain limited. This study aimed to descriptively investigate the factors contributing to missed diagnoses of KTB using X-ray examinations and characterize the findings detected by multidetector computed tomography (CT) and magnetic resonance imaging (MRI). Methods: A retrospective analysis was conducted on patients diagnosed with KTB based on pathological or etiological confirmation at Kunming Third People's Hospital between January 2022 and March 2025. Specifically, only the cases in which the initial X-ray examination failed to establish the diagnosis were included to analyze the reasons for missed diagnosis. CT and MRI findings were reviewed, and the reasons for missed diagnosis on X-ray were analyzed. Results: A total of 93 patients with KTB were included, of whom 36 cases were not diagnosed by X-ray (26 males, 10 females; mean age 40.2±16.3 years; 35 with pulmonary tuberculosis; 20 right-sided and 16 left-sided). CT imaging demonstrated bone erosions in 25 cases (69.4%), joint effusion in 23 cases (63.9%), and osteoporosis or soft tissue swelling in 22 cases each (61.1%). MRI demonstrated bone marrow edema in all cases (100%), synovial thickening in 33 cases (91.7%), joint effusion in 32 cases (88.9%), soft tissue edema in 31 cases (86.1%), bone erosions in 25 cases (69.4%), and soft tissue abscess in 20 cases (55.6%). Missed diagnoses on X-ray were primarily attributed to lesions with absent or minimal bone destruction and the limited sensitivity of unilateral anteroposterior radiographs in detecting osteoporosis and soft tissue swelling. Among 12 patients who underwent weight-bearing full-length imaging of the lower extremities, osteoporosis was observed in 8 cases, reduced joint space in 4 cases, and soft tissue swelling in 6 cases. Conclusions: Early-stage KTB was frequently underdiagnosed when X-ray examinations were used alone. MRI demonstrated a higher frequency of detection for key early signs such as bone marrow edema and soft tissue pathology compared to CT, and weight-bearing full-length X-ray examinations of bilateral lower extremities may provide additional diagnostic value.
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