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Omoumi P, Mourad C, Ledoux JB, Hilbert T. Morphological assessment of cartilage and osteoarthritis in clinical practice and research: Intermediate-weighted fat-suppressed sequences and beyond. Skeletal Radiol 2023; 52:2185-2198. [PMID: 37154871 PMCID: PMC10509097 DOI: 10.1007/s00256-023-04343-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/15/2022] [Revised: 03/28/2023] [Accepted: 04/10/2023] [Indexed: 05/10/2023]
Abstract
Magnetic resonance imaging (MRI) is widely regarded as the primary modality for the morphological assessment of cartilage and all other joint tissues involved in osteoarthritis. 2D fast spin echo fat-suppressed intermediate-weighted (FSE FS IW) sequences with a TE between 30 and 40ms have stood the test of time and are considered the cornerstone of MRI protocols for clinical practice and trials. These sequences offer a good balance between sensitivity and specificity and provide appropriate contrast and signal within the cartilage as well as between cartilage, articular fluid, and subchondral bone. Additionally, FS IW sequences enable the evaluation of menisci, ligaments, synovitis/effusion, and bone marrow edema-like signal changes. This review article provides a rationale for the use of FSE FS IW sequences in the morphological assessment of cartilage and osteoarthritis, along with a brief overview of other clinically available sequences for this indication. Additionally, the article highlights ongoing research efforts aimed at improving FSE FS IW sequences through 3D acquisitions with enhanced resolution, shortened examination times, and exploring the potential benefits of different magnetic field strengths. While most of the literature on cartilage imaging focuses on the knee, the concepts presented here are applicable to all joints. KEY POINTS: 1. MRI is currently considered the modality of reference for a "whole-joint" morphological assessment of osteoarthritis. 2. Fat-suppressed intermediate-weighted sequences remain the keystone of MRI protocols for the assessment of cartilage morphology, as well as other structures involved in osteoarthritis. 3. Trends for further development in the field of cartilage and joint imaging include 3D FSE imaging, faster acquisition including AI-based acceleration, and synthetic imaging providing multi-contrast sequences.
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Affiliation(s)
- Patrick Omoumi
- Department of Radiology, Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland.
| | - Charbel Mourad
- Department of Radiology, Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland
- Department of Diagnostic and Interventional Radiology, Hôpital Libanais Geitaoui CHU, Achrafieh, Beyrouth, Lebanon
| | - Jean-Baptiste Ledoux
- Department of Radiology, Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland
| | - Tom Hilbert
- Department of Radiology, Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland
- Advanced Clinical Imaging Technology, Siemens Healthineers International AG, Lausanne, Switzerland
- LTS5, École Polytechnique FÉdÉrale de Lausanne (EPFL), Lausanne, Switzerland
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Knoth JC, Long JR, Stensby JD. Dark Cartilage Lesions in the Knee: MRI Appearance and Clinical Significance. J Knee Surg 2022; 35:470-474. [PMID: 34781397 DOI: 10.1055/s-0041-1739259] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
Early investigations into the magnetic resonance imaging (MRI) appearance of articular cartilage imaging relied on assessment of the morphology, with subsequent investigators reporting identifying increased T2 signal intensity, bright signal, in degenerated cartilage. The cartilage "black line sign" is a finding that has recently been described in the radiology literature to characterize cartilage pathology. This sign refers to a focal linear hypointense signal within articular cartilage that is oriented perpendicular to the subchondral bone on T2-weighted MRI. The diagnostic significance and clinical relevance of this sign is debated. Since its first description, several papers have further delineated the etiology, prevalence, and clinical relevance of these and other dark cartilage abnormalities. The intent of this article is to summarize these findings, with hopes of bringing to light the importance of dark cartilage lesions and their clinical implication in the world of knee surgery. We will briefly discuss the most probable etiologies of dark cartilage abnormalities and the major factors determining the unique signal intensity. The described anatomical patterns of this finding, the clinical importance, potential mimics, and current treatment recommendations will be reviewed.
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Affiliation(s)
| | - Jeremiah R Long
- Department of Radiology, Mayo Clinic Arizona, Scottsdale, Arizona
| | - James Derek Stensby
- Department of Radiology, 1 Hospital Dr, University of Missouri, Columbia, Missouri
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Cheng KY, Lombardi AF, Chang EY, Chung CB. Knee Cartilage Imaging. Clin Sports Med 2021; 40:677-692. [PMID: 34509205 DOI: 10.1016/j.csm.2021.05.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
Articular cartilage injury and degeneration represent common causes of knee pain, which can be evaluated accurately and noninvasively using MRI. This review describes the structure of cartilage focusing on its histologic appearance to emphasize that structure will dictate patterns of tissue failure as well as MR appearance. In addition to identifying cartilage loss, MRI can demonstrate signal changes that correspond to intrinsic structural abnormalities which place the cartilage at risk for subsequent more serious injury or premature degeneration, allowing for earlier intervention and treatment of important causes of pain and morbidity.
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Affiliation(s)
- Karen Y Cheng
- Department of Radiology, UC San Diego Health, 200 W. Arbor Drive MC 8226, San Diego, CA 92103, USA
| | - Alecio F Lombardi
- Department of Radiology, UC San Diego Health, 200 W. Arbor Drive MC 8226, San Diego, CA 92103, USA; VA San Diego Healthcare System, Radiology Service, 3350 La Jolla Village Drive, MC 114, San Diego, CA 92161, USA
| | - Eric Y Chang
- Department of Radiology, UC San Diego Health, 200 W. Arbor Drive MC 8226, San Diego, CA 92103, USA; VA San Diego Healthcare System, Radiology Service, 3350 La Jolla Village Drive, MC 114, San Diego, CA 92161, USA
| | - Christine B Chung
- Department of Radiology, UC San Diego Health, 200 W. Arbor Drive MC 8226, San Diego, CA 92103, USA; VA San Diego Healthcare System, Radiology Service, 3350 La Jolla Village Drive, MC 114, San Diego, CA 92161, USA.
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Schwaiger BJ, Gersing AS, Mbapte Wamba J, Nevitt MC, McCulloch CE, Link TM. Can Signal Abnormalities Detected with MR Imaging in Knee Articular Cartilage Be Used to Predict Development of Morphologic Cartilage Defects? 48-Month Data from the Osteoarthritis Initiative. Radiology 2016; 281:158-67. [PMID: 27135833 DOI: 10.1148/radiol.2016152308] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
Purpose To determine the incidence with which morphologic articular cartilage defects develop over 48 months in cartilage with signal abnormalities at baseline magnetic resonance (MR) imaging in comparison with the incidence in articular cartilage without signal abnormalities at baseline. Materials and Methods The institutional review boards of all participating centers approved this HIPAA-compliant study. Right knees of 90 subjects from the Osteoarthritis Initiative (mean age, 55 years ± 8 [standard deviation]; 51% women) with cartilage signal abnormalities but without morphologic cartilage defects at 3.0-T MR imaging and without radiographic osteoarthritis (Kellgren-Lawrence score, 0-1) were frequency matched for age, sex, Kellgren-Lawrence score, and body mass index with right knees in 90 subjects without any signal abnormalities or morphologic defects in the articular cartilage (mean age, 54 years ± 5; 51% women). Individual signal abnormalities (n = 126) on intermediate-weighted fast spin-echo MR images were categorized into four subgrades: subgrade A, hypointense; subgrade B, inhomogeneous; subgrade C, hyperintense; and subgrade D, hyperintense with swelling. The development of morphologic articular cartilage defects (Whole-Organ MR Imaging Score ≥2) at 48 months was analyzed on a compartment level and was compared between groups by using generalized estimating equation logistic regression models. Results Cartilage signal abnormalities were more frequent in the patellofemoral joint than in the tibiofemoral joint (59.5% vs 39.5%). Subgrade A was seen more frequently than were subgrades C and D (36% vs 22%). Incidence of morphologic cartilage defects at 48 months was 57% in cartilage with baseline signal abnormalities, while only 4% of compartments without baseline signal abnormalities developed morphologic defects at 48 months (all compartments combined and each compartment separately, P < .01). The development of morphologic defects was not significantly more likely in any of the subgrades (P = .98) and was significantly associated with progression of bone marrow abnormalities (P = .002). Conclusion Knee cartilage signal abnormalities detected with MR imaging are precursors of morphologic defects with osteoarthritis and may serve as imaging biomarkers with which to assess risk for cartilage degeneration. (©) RSNA, 2016.
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Affiliation(s)
- Benedikt J Schwaiger
- From the Departments of Radiology and Biomedical Imaging (B.J.S., A.S.G., J.M.W., T.M.L.) and Epidemiology and Biostatistics (M.C.N., C.E.M.), University of California, San Francisco, 185 Berry St, Suite 350, San Francisco, CA 94107
| | - Alexandra S Gersing
- From the Departments of Radiology and Biomedical Imaging (B.J.S., A.S.G., J.M.W., T.M.L.) and Epidemiology and Biostatistics (M.C.N., C.E.M.), University of California, San Francisco, 185 Berry St, Suite 350, San Francisco, CA 94107
| | - John Mbapte Wamba
- From the Departments of Radiology and Biomedical Imaging (B.J.S., A.S.G., J.M.W., T.M.L.) and Epidemiology and Biostatistics (M.C.N., C.E.M.), University of California, San Francisco, 185 Berry St, Suite 350, San Francisco, CA 94107
| | - Michael C Nevitt
- From the Departments of Radiology and Biomedical Imaging (B.J.S., A.S.G., J.M.W., T.M.L.) and Epidemiology and Biostatistics (M.C.N., C.E.M.), University of California, San Francisco, 185 Berry St, Suite 350, San Francisco, CA 94107
| | - Charles E McCulloch
- From the Departments of Radiology and Biomedical Imaging (B.J.S., A.S.G., J.M.W., T.M.L.) and Epidemiology and Biostatistics (M.C.N., C.E.M.), University of California, San Francisco, 185 Berry St, Suite 350, San Francisco, CA 94107
| | - Thomas M Link
- From the Departments of Radiology and Biomedical Imaging (B.J.S., A.S.G., J.M.W., T.M.L.) and Epidemiology and Biostatistics (M.C.N., C.E.M.), University of California, San Francisco, 185 Berry St, Suite 350, San Francisco, CA 94107
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Abstract
The patellofemoral (PF) joint is a complex articulation, with interplay between the osseous and soft tissue structures to maintain the balance between knee mobility and stability. Disorders of the PF joint can be a source of anterior knee pain (AKP). In this article, radiographic and magnetic resonance imaging of the PF joint are reviewed, including normal anatomy, imaging techniques, and imaging-based measurements. Common imaging findings associated with AKP are reviewed, including symptomatic normal variants, tendinopathy, apophysitis, osteoarthritis, chondromalacia patella, trochlear dysplasia, excessive lateralization of tibial tuberosity, patellar maltracking, patellar dislocation and fractures, anterior bursitis, Morel-Lavallée effusions, and fat pad edema.
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Affiliation(s)
- Stephen Thomas
- Department of Radiology, University of Chicago, 5841 South Maryland Avenue, MC 2026, Chicago, IL 60637, USA
| | - David Rupiper
- Department of Radiology, University of Chicago, 5841 South Maryland Avenue, MC 2026, Chicago, IL 60637, USA
| | - G Scott Stacy
- Department of Radiology, University of Chicago, 5841 South Maryland Avenue, MC 2026, Chicago, IL 60637, USA.
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Markhardt BK, Chang EY. Hypointense signal lesions of the articular cartilage: a review of current concepts. Clin Imaging 2014; 38:785-91. [PMID: 24928821 DOI: 10.1016/j.clinimag.2014.05.002] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2014] [Accepted: 05/04/2014] [Indexed: 11/28/2022]
Abstract
Discussion of articular cartilage disease detection by MRI usually focuses on the presence of bright signal on T2-weighted sequences, such as in Grade 1 chondromalacia and cartilage fissures containing fluid. Less emphasis has been placed on how cartilage disease may be manifested by dark signal on T2-weighted sequences. The appearance of the recently described "cartilage black line sign" of the femoral trochlea highlights these lesions and further raises the question of their etiology. We illustrate various hypointense signal lesions that are not restricted to the femoral trochlea of the knee joint and discuss the possible etiologies for these lesions.
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Affiliation(s)
- B Keegan Markhardt
- Department of Radiology, Community Division, University of Wisconsin, Madison, WI.
| | - Eric Y Chang
- Department of Radiology, VA San Diego Healthcare System, San Diego, CA; Department of Radiology, University of California, San Diego Medical Center, San Diego, CA.
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