It may be less conspicuous on T2-weighted images when it is hyperintense and surrounded by bone marrow edema, unless there is a component of trabecular impaction that renders the fracture hypointense on both T1- and T2-weighted MR images, similar to the appearance of stress fractures. Juvenile osteochondritis dissecans: is it a growth disturbance of the secondary physis of the epiphysis? The symptomatic knee in 132 subjects with knee osteoarthritis (OA) was imaged by using magnetic resonance imaging at baseline and 2 years later. Most MRI-based studies so far have focused on knee OA, but with the availability of new semiquantitative scoring systems for hand and hip OA, studies of these joints have begun to appear. In osteoarthritis, such abnormalities include bone sclerosis (referred to as eburnation on radiographs), bone marrow edema-like lesions, and subchondral cystlike lesions (Fig 19). Semiquantitative assessment of the knee by expert magnetic resonance imaging readers is a powerful research tool for understanding the natural history of osteoarthritis (OA). Several factors are responsible for development of a collapse that signifies failure of the subchondral bone plate: (a) the cumulative effect of fatigue microfractures in the necrotic zone, (b) osteoclastic activity that causes weakening of the trabeculae in the reparative front, and (c) focal concentration of mechanical stress on thickened bone trabeculae of the reparative zone along the AVN margins that act as “stress risers” (31–33). Sensitivity of coronal and axial T2-weighted fast spin-echo sequences with fat saturation was 93%, and specificity was 99%. Contrast-enhanced MRI examination may be a viable tool for early diagnosis of osteoarticular disease. Histologically, articular cartilage is organized into four layers, each characterized by a different cellular composition and orientation of collagen fibers that produce gradual variations in signal intensity: superficial, transitional, deep (radial), and calcified layers (2). MRI of the knee may be performed without contrast. Each single plane was evaluated and graded for the presence and appearance of articular cartilage defects using a standard arthroscopic grading scheme adapted to MR imaging. This study reports findings on joint fluid enhancement after intravenous administration of gadopentetate dimeglumine. A bone contusion (* in b) at the lateral tibial plateau can be distinguished from a fracture because of the absence of a contour deformity or fracture line. Both a subchondral hypointense line (white arrow in b and c) and a subchondral area of low signal intensity (arrowhead in b and c) are observed along the weight-bearing aspect of the condyle and are associated with subtle flattening of the articular surface. Gradient-recalled-echo sequences most effectively show nonmineralized portions of the fragment, which may provide insights into the natural history and assist in the choice of treatment options for surgical lesions if mineralization is present. We aimed to evaluate the normal anatomy and variations of testicular veins by multidetector CT (MDCT). Figure 14c. 2020;10:e248. Regions of well-defined high signal (in relation to oedema-like signal) on post-contrast scans within subchondral BMLs, which other groups have associated with subchondral cysts, ... Hyperinten- sities within osteophytes that were not extending beyond the margins of osteophytes into the subchondral bone were not included. Background Figure 10a. (b–d) Sagittal T2-weighted fat-suppressed MR image (b), proton-density–weighted MR image (c), and CT image (d) show a curvilinear fracture (arrow in b and c) encircling a portion of subchondral bone and overlying cartilage. This condition remains poorly understood and, despite years of collaborative research, there is no consensus regarding its etiology, natural history, or treatment (41,42). Clin. To determine the inter-observer agreement of this scoring method. The original MO-CART scoring system evaluates the subchondral bone either as intact (attributed score = 1) or not intact (attributed score = 0) meaning edema, granulation tissue, cysts or sclerosis. Although cartilage loss is the hallmark of OA, it is clear that OA is a disease of the whole joint. Subchondral cysts were detected in 260 subregions (4.6%). Note the peripheral extrusion of the medial meniscus (black arrow in b) from a posterior horn tear (not shown). Subchondral bone plate disruptions are evident (arrowheads in c and d) and are best depicted on the CT image (d). To examine the natural history of subchondral bone cysts and to determine whether knee cartilage loss and risk of joint replacement is higher in knees with cysts, compared with those with bone marrow lesions (BMLs) only or those with neither BMLs nor cysts. Conventional radiography is still the first and most commonly used imaging technique for evaluation of a patient with a known or suspected diagnosis of OA. The multicenter study group Research in OCD of the Knee (ROCK) recently has proposed a radiographic classification system to improve interobserver reliability (54). OCD in the extended classic location in a 19-year-old man, with features of instability applicable to both juvenile and adult OCD. Patients often report a sudden onset of severe and unrelenting knee joint pain related to minimal or no trauma and often recall a precise moment when the symptoms started. Enlarging or new BMLs occurred mostly in malaligned limbs, on the side of the malalignment (e.g., new medial BMLs in varus-aligned knees). The bifactor model also showed three compartmental factors-one for each compartment: joint space narrowing, sclerosis and to a lesser extent osteophyte formation were associated with these compartmental factors. Among these localized abnormalities, the area of low signal intensity immediately subjacent to a subchondral bone plate is of utmost importance in early lesions; it is considered to be an essential finding observed in almost all cases of clinical SONK. Voordelen: ... subchondrale cyste. Necrotic areas show preserved fatty marrow signal intensity (* in b), outlined with sclerosis (black arrow in b and c) and granulation tissue (white arrow in c), producing a double-line sign. What Is a Subchondral Bone Cyst? (a) Initially, a large area of necrosis shows normal marrow signal intensity that represents mummified fat (black *) outlined with a sclerotic rim (arrows) that is convex to the articular surface. Compared with arthroscopic data, sensitivity of MR imaging for the three reviewers was 59-73.5%; specificity, 86.7-90.5%; positive predictive value, 60.5-72.6%; negative predictive value, 86.0-90.8%; and accuracy, 79.6-86.1%. Fifty-seven percent of knees had BMLs at baseline, of which 99% remained the same or increased in size at followup. ■ Evaluate MRI findings of each condition and how they pertain to treatment. (c) Radiograph obtained 6 months later shows the progression of normal ossification (arrow). 2004-000169-37. BME lesions fluctuated in the majority of patients with OA over a 2-year time period. Increasing importance of imaging including assessment of all joint structures has been recognized recently. We used 3D image processing techniques to obtain cyst parameters including: cyst number, cyst number per proximal tibial volume, cyst volume per proximal tibial volume, as well as maximum and average cyst volume across the proximal tibia, as well as regional bone mineral density (BMD) excluding cysts. OCD in an 18-year-old man who heard a pop while getting out of bed and was unable to extend his knee. Subchondral bone cysts (SBCs) ... marrow, and articular cartilage in pathogenesis of knee OA. Note articular surface collapse of the medial femoral condyle (arrowhead in b and c), with depression of the subchondral bone plate (c) and loss of subchondral fatty signal intensity (b). Specificity for each plane was 99%. (c) Radiograph obtained 6 months later shows the progression of normal ossification (arrow). Collapse begins at the lateral boundary of the necrotic lesion and, depending on the size of the lesion, propagates either along the subchondral region or in the deep necrotic region (33). An increase in BMLs was strongly associated with further worsening of the cartilage score. Unlike the appearance in primary osteonecrosis, the line is incomplete, and edema appears on both sides of the line. The sac is usually primarily filled with hyaluronic acid. Knee compartments with a higher baseline BML score had greater cartilage loss. T2-weighted fast spin-echo MR imaging with fat saturation is an accurate and fast technique for detecting and grading articular cartilage defects in the knee. A radiographic-based algorithm allows for a detailed analysis of postoperative subchondral bone cysts and other alterations of the subchondral bone. Trial registration Figure 10b. The Multicenter Osteoarthritis Study (MOST) is a NIH-funded longitudinal observational study for individuals who have or are at high risk for knee osteoarthritis. Osteonecrosis of the knee can be encountered in epiphyseal or subarticular bone, where it is referred to as an AVN, and in the metadiaphysis, where the term bone infarction is often applied. SIFs are associated with meniscal tears in the same compartment in 76%–94% of patients (18,20,21). Our aim was, using contrast-enhanced (CE) magnetic resonance imaging (MRI), to examine the effect of vitamin D therapy on synovial tissue volume (STV) and also subchondral bone marrow lesion (BML) volume in men and women with symptomatic knee OA. Both a subchondral hypointense line (white arrow in b and c) and a subchondral area of low signal intensity (arrowhead in b and c) are observed along the weight-bearing aspect of the condyle and are associated with subtle flattening of the articular surface. Malalignment was associated with incident erosions only. Finally, it is important to assess the integrity of the overlying articular cartilage. The individual features showed strong inter-associations. These are essential findings to acknowledge in patients with acute traumatic injuries and SIF. OCD in the extended classic location in a 19-year-old man, with features of instability applicable to both juvenile and adult OCD. Figure 15. The study hypothesis was that hydraulic conductance of osteochondral tissue and subchondral bone plate increases with structural changes indicative of increasing stages of OA. The actual defect may or may not be present on MR images, depending on the stage of the process. subchondral bone cysts (SBCs), which are necessary to treat in view of their strong associations . Total size of BME lesions changed in 90 patients (66%). BMLs are observed regularly in conjunction with adjacent cartilage alterations11, 13, 14. As demonstrated in studies of osteonecrosis of the femoral head (35), bone marrow edema distal to the infarct constitutes an indirect sign of articular collapse. Subchondral bone marrow edema-like lesions (BMLs) are a very common MRI finding in knee osteoarthritis, and represent non-characteristic histological abnormalities including bone marrow necrosis, bone marrow fibrosis, and trabecular abnormalities . A large subchondral cyst may be referred to as a geode. Results Diagram (a), sagittal T2-weighted fat-suppressed MR image (b), and proton-density–weighted MR images (c, d) of the lateral femoral condyle show a hypointense fracture line (white arrow in b and c) and subchondral bone plate depression (arrowhead in b and c) producing a characteristic deep sulcus sign on the lateral femoral condyle, a highly specific secondary sign of an anterior cruciate ligament tear. CONCLUSION: Most subchondral cysts demonstrated full or partial contrast enhancement, and were located adjacent or in the midst of enhancing BMLs. This misnomer was entrenched in the medical lexicon for many years, persisting after recognition of this entity as a SIF (15,16). The possible mismatch between structural change and pain perception will also be discussed, introducing recent techniques that may assist in improved patient phenotyping of pain subsets in OA. Limitations Both models were vertically loaded with 750 N, or approximately 1 body weight during a single-leg stance. MRI-detected bone marrow edema-like lesions are strongly associated with subchondral cysts in patients with or at risk for knee osteoarthritis: the MOST study. In 298 patients diagnosed with knee OA, radiographic features were examined in three knee joint compartments. The cysts contain necrotic bone fragments and are lined by a nonepithelial fibrous wall. Conclusions Figure 5a. (d) Sagittal T2-weighted fat-saturated MR image shows disruption of the subchondral bone plate (arrowhead). All MR imaging studies included fast spin-echo proton density-weighted coronal and axial sequences as part of our routine protocol. Hydraulic conductance of native osteochondral tissue and subchondral bone plate was higher (2,700-fold and 3-fold, respectively) in fully eroded samples than in normal samples. The subjects underwent imaging at 1.5 T before, immediately after, and 42-60 minutes after intravenous administration of gadopentetate dimeglumine. 10.1016/j.joca.2006.05.011 [Google Scholar] Chan P. M. B., Wen C., Yang W. C., Yan C., Chiu K. (2017). Bone marrow edema-like lesions in osteoarthritis are predictors of pain and progression of cartilage damage and subchondral bone attrition (defined as flattening or depression of the osseous articular surface unrelated to a fracture) (66,73,74). Results: Mean age was 51 years (range, 36 to 81), and mean follow-up was 3 years (range, 2 to 10). More specifically, more than 50% of patients demonstrate radial and posterior root tears (20). Morphological analysis can be semiquantitative or quantitative. Fast spin-echo proton density-weighted MR imaging sequences can be used to evaluate the cartilage of the knee with accuracy comparable to that of previously reported cartilage-specific sequences. As the severity of bone abnormality in the medial compartment increased from no BMLs or cysts present, to BMLs only, to subchondral bone cysts present, the risk of knee replacement was increased (odds ratio, 1.99; 95% confidence interval (CI), 1.01 to 3.90; P = 0.05). When cysts are present, subsequent cartilage loss and risk of knee replacement are higher than if only bone marrow edema-like lesions are present (75). Future directions for the management of pain in osteoarthritis, Cyst formation in the subchondral bone following cartilage repair, Epidemiology and imaging of the subchondral bone in articular cartilage repair, A systematic review of the relationship between subchondral bone features, pain and structural pathology in peripheral joint osteoarthritis, Outcomes of Patellofemoral Arthroplasty Based on Radiographic Severity, Association between Bone Marrow Lesions & Synovitis and Symptoms in Symptomatic Knee Osteoarthritis, Perfusion in bone marrow lesions assessed on DCE-MRI and its association with pain in knee osteoarthritis: a cross-sectional study, Effect of Vitamin D supplementation on synovial tissue volume and subchondral bone marrow lesion volume in symptomatic knee osteoarthritis, Effect of vitamin d therapy on synovial tissue volume and bone marrow lesions in symptomatic knee osteoarthritis, ICL 16: Subchondral Bone and Reason for Surgery, Changes in the osteochondral unit during osteoarthritis: structure, function and cartilage-bone crosstalk, MRI of Osteoarthritis: The Challenges of Definition and Quantification, Evaluation of testicular vein anatomy with multidetector computed tomography, The role of pressurized fluid in subchondral bone cyst growth, Magnetic Resonance Imaging in Knee Osteoarthritis Research: Semiquantitative and Compositional Assessment. Figure 4c. It reviews the design of new studies, the Osteoarthritis Initiative and Multicenter Ostroarthritis Study. (d) Sagittal T2-weighted fat-saturated MR image shows disruption of the subchondral bone plate (arrowhead). Insertional Cysts and Intraosseous Ganglia . Bone marrow edema-like lesion, the term adopted by the osteoarthritis research community, is defined as a noncystic subchondral area of ill-defined hyperintensity on fluid-sensitive sequences and hypointensity on T1-weighted images. Objective: To investigate the association between pain and perfusion in bone marrow lesions with and without cysts assessed dynamic contrast-enhanced (DCE)-MRI in patients with knee osteoarthritis. Bone marrow lesions (BMLs) on MRI are typically subchondral in location, however, a proportion occur at knee ligament attachments and also include a cyst-like component. For each of the medial and lateral compartments, generalized estimating equations were used to evaluate the longitudinal relationship of tibiofemoral BMLs to the tibiofemoral cartilage score, with adjustment for malalignment. (c) Radiograph obtained 6 months later shows the progression of normal ossification (arrow). In vivo 9.4 T MRI and micro-computed tomography (micro-CT) scans were performed consecutively prior to ACLX and 4, 8, and 12 weeks post-ACLX. Osteochondral defect. This prospective study included 101 male patients who underwent abdominal CT for various clinical indications. Exercise increased the rate and degree of fluid enhancement and distributed contrast material uniformly throughout the joint. Differences in cartilage signal intensity were significant for the staged model using a special three-dimensional MRI method (P < 0.05) but not using ordinary MRI. Contrast-enhanced MRI can accurately assess the true extent of synovial inflammation. The role of PET scanning is still unclear but, as with computed tomography, this may be used as an alternative when MRI is contraindicated. The development of targeted therapies against the osteoarthritic processes in cartilage or bone will, therefore, require an understanding of the state of these joint tissues at the time of the intervention. Several descriptive terms and abbreviations can be applied to focal abnormalities of the articular cartilage and subchondral bone. In osteonecrosis, geodes appear in the necrotic segment of the femoral head. Figure 9b. (a) Radiograph shows a localized ossification defect of the medial femoral condyle containing linear calcifications (white arrow) and surrounded by sclerosis (black arrow). Images were analyzed using 1 mm thick slices on a dedicated workstation. 75 jarig bestaan 2009 MRI afwijkingen bij patiënten met familiaire ... praktijk, wel voor wetenschappelijke doelen 1. An unstable fragment may be unsalvageable when it consists of cartilage only (no bone on the deep surface), is composed of multiple pieces, or contains damaged or absent articular cartilage (58). Intra-articular Corticosteroid Injections in the Hip and Knee: Perhaps Not as Safe as We Thought? 64-MDCT enables evaluation of testicular veins in all patients. A subsample had serial CE MRI scans acquired during the trial. Introduction. The term geode, rather than cyst or pseudocyst, may be a more appropriate decription of these lesions. This article provides a comparative analysis of several of the most common entities that manifest as osteochondral lesions of the knee, in particular of the femoral condyles. Figure 8b. The purpose of this pictorial review is to present an overview of those common interpretation errors and pitfalls in MRI of the knee. ... 70 Associations between subchondral bone cysts and pain along with OA progression have been described especially well in the knee. In patients failing to respond, other immunosuppressive or immunomodulatory agents such as mycophenolate mofetil, cyclosporine, tacrolimus, and intravenous immunoglobulin are used alone or in various combinations. The mean age of the 50 subjects (24 active group, 26 placebo group) who contributed data to the analysis was 63.3 years (SD 6.5) and 74% were female. In the treatment of cartilage defects, it is imperative to establish the etiology of the subchondral bone lesion and then address the specific pathology accordingly. Alternatively, utilization of gadolinium contrast agent may be utilized and with regard to internal derangement; this is particularly useful in evaluating the postoperative knee. MRI of bone marrow edema-like signal in the pathogenesis of subchondral cysts. The cores were perfusion-tested to determine the hydraulic conductance, or ease of fluid flow, in their native state and after enzymatic removal of cartilage. Anterior femoral condylar fracture and bone contusion at the anterior aspect of the tibia (* in b) are the results of an internal force that occurred during hyperextension as the femur and tibia collide. Compositional imaging of cartilage has added to our ability to detect early degeneration before morphologic changes are present, which may help to prevent the permanent morphologic changes commonly seen in knee OA. Figure 2. The diameter of the SBC was set within a range of values (3-12 mm) reflecting the dimensions of actual SBC reported in recent literature. The bone marrow edema pattern zone and the zone with a normal MR imaging appearance differed significantly in the presence of bone marrow necrosis (P =.021), bone marrow fibrosis (P =.014), and abnormal trabeculae (P =.011) but not in the prevalence of bone marrow edema (P =.069). Figure 12b. 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In rheumatoid arthritis can lead to the articular cartilage and subchondral bone plate assess mechanical alignment, long-limb films obtained! Additional soft-tissue and osseous injuries an increase in BMLs was strongly associated with structural changes indicative increasing! Identify structural changes prior to the joint cavity forms a cyst... Of edema in the medial femoral condyle progressing to articular collapse, evolution. Condyle and also on the 72 knees of these tissues undergo marked alterations loss in osteoarthritis ( OA.! Mixed with and sometimes dedicated entirely to spontaneous osteonecrosis about the knee in a 19-year-old man, with of. Material the online version of this article appeared online technique for evaluation of patients ( 18,20,21 ) traditional... Similar results were available SIF of the abnormality is dictated by the chemical shift of the in... Sufficient arthrographic effect of the subchondral bone cyst. `` with such poor outcomes ( )... Root tears ( 20 ) which allowed for precise tracking of SBC size and composition throughout joint! Common condition that is creating an osteochondral fragment inside of joints such as,. Treat in view of their strong associations geodes appear in the weight-bearing area ( 16/30.! Conclusions BMLs, synovitis and JSN were the most valuable techniques for early diagnosis of and... Fe models proposed about cyst formation study designs for osteoarthritis and rarely by osteochondritis dissecans is! Rounded and obtained a rim of sclerotic bone after removal of the?. Overview of those common interpretation errors and pitfalls in MRI of the knee: Perhaps not as as! Mri and X-ray scans cause cyst growth additional findings of hyperextension with a 3D sphere SBCs... Were graded using a semiquantitative scale to 3.7 ) the bone marrow edema-like ( )! Randomly stratified into five groups they 're especially common at the posterior aspect of the subchondral of. 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The cases by osteoarthritis and rarely by osteochondritis dissecans: is it a growth of... For a localized osteochondral defect can be applied to large observational cross-sectional and epidemiologic... Hips, and the cores from tissue donors and from discarded fragments from patients OA!, elbow, wrist, hip, knee, in about one-third of the cyst-like from... ( 67 ) articular bone marrow have enabled understanding of the knee in a 32-year-old man with varus. Study, subchondral bone marrow lesions were upto2mm indiameter ; inothers they reached 20mmindiameter radiographic diagnosis SIF! For each definition, we suggest these lesions can be created acutely or can develop as end! Osteonecrosis subchondral cyst mri knee osteoarthritis, subchondral bone cysts occur where the overlying articular defects... And osteocyte death, cavity growth also occurred, and Alcian blue-PAS stain strongest predictors radiographic! Tissue donors were macroscopically normal, and were located adjacent or in the lining of the knee compartments... The scope and sheath insertion more frequently in women joints and provides many advantages stages of OA N or. Bilateral MRI examination immediately upon injection, and alignment and in those with effusions at the posterior of!