subchondral cyst mri knee December 24, 2020 – Posted in: Uncategorized

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). In 121 subregions (46.5%) having cysts, no adjacent full thickness cartilage loss was detected. In vivo observations of pressurized cyst fluid, dead osteocytes, and different appearances of cysts similar to our simulation results support the idea that both mechanisms can simultaneously play a role in the development and growth of subchondral bone cysts. Figure 8a. The subjects underwent imaging at 1.5 T before, immediately after, and 42-60 minutes after intravenous administration of gadopentetate dimeglumine. BMLs, osteophytes and bone shape were independently associated with structural progression or joint replacement. The location of the abnormality is dictated by the mechanism of injury. Seventy-eight lesions (90%) were within one grade using MR imaging and arthroscopy, and 84 lesions (97%) were within two grades using MR imaging and arthroscopy. (a) Radiograph shows a localized ossification defect of the medial femoral condyle containing linear calcifications (white arrow) and surrounded by sclerosis (black arrow). There was no association between knee pain and total subchondral BML volume (b = 0.3 WOMAC units, 95% CI -0.3 to 1.0) or total ligament-based BML volume (b = 1.9, 95% CI -1.6 to 5.3). Note the macerated and extruded medial meniscus (black arrow in b). (b, c) Coronal T1-weighted (b) and proton-density–weighted fat-suppressed (c) MR images show a progeny (P) fragment separated from the parent bone, with signal intensity equal to that of fluid (white arrow in c) and an additional outer rim of sclerosis (black arrow in c). Crema MD, Cibere J, Sayre EC, et al. 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. This is indicative that BMLs do not represent simple edema, but are vascularized due to ongoing repair activity within the lesions 4 . Enlarging or new BMLs occurred mostly in malaligned limbs, on the side of the malalignment (e.g., new medial BMLs in varus-aligned knees). Conclusions The IW fs sequence should be used for determination of lesion extent whenever the size of subchondral bone marrow edema-like lesions is the focus of attention. Four hundred knees were included (1 knee per person, 5600 subregions). Figure 16b. Its unique anatomical structure is well suited to support the articular cartilage, even providing nutrition for its basal layers. Shoulder, elbow, wrist, hip, knee, and ankle joints of 10 volunteers were imaged with optimized parameters. This article was corrected on August 23, 2018. This study reports findings on joint fluid enhancement after intravenous administration of gadopentetate dimeglumine. Groups were divided between mild (grade 0-I) and moderate to severe (grade II-IV) patellofemoral arthritis. Several typical patterns of osteochondral injuries have been described in association with certain types of internal derangement and instability (11–13). They can develop in … The aim of this study was to determine the associations between four radiographic features (joint space narrowing, osteophyte formation, sclerosis and cysts) across and within the three knee compartments (medial tibiofemoral, lateral tibiofemoral and patellofemoral compartment) in knee OA. An osteochondral defect of the femoral condyle (✩) may be the result of several acute and chronic conditions that produce a surface deformity with a localized defect of the articular cartilage and subchondral bone. Figure 8b. Eight rodents underwent anterior cruciate ligament transection and partial medial meniscectomy (ACLX) of the right knee. Patient-reported pain quality improved significantly more following PFA in the grade II-IV group (P = .04). SIF involves a physiologic force applied to weakened trabeculae, often in association with osteopenia and diminished protective function of the articular cartilage and meniscus, which leads to a fracture along the subchondral area of the bone. Pain was not associated with any cyst parameters at any region. Subchondral bone plate disruptions are evident (arrowheads in c and d) and are best depicted on the CT image (d). The sac is usually primarily filled with hyaluronic acid. There was no significant difference at 2 years follow-up between the vitamin D and placebo groups in the mean change from baseline for STV (93.9 mm³, 95% CI -1605.0 to 1792.7) and subchondral BML volume (− 313.5 mm³, 95% CI -4244.7 to 3617.7). There is an overlap in patterns of signal intensity alterations and morphologic abnormalities among these conditions at MRI, while the clinical significance of each lesion and the treatment implications are different. Illustration shows the hypothesized pathogenesis of juvenile OCD as a growth disturbance of the secondary physis that causes a localized delay of ossification and subchondral bone formation, followed by either healing or failure of the overlying cartilage and localized articular surface fragmentation and separation. In this scenario an irregularly shaped cavity developed which became rounded and obtained a rim of sclerotic bone after removal of the pressurized fluid. These two patterns may coexist. 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). Morphological analysis can be semiquantitative or quantitative. Contrast-enhanced MRI can accurately assess the true extent of synovial inflammation. Bone marrow lesions and subchondral bone pathology of the knee Kon, Elizaveta; Ronga, Mario; Filardo, Giuseppe; Farr, Jack; Madry, Henning; Milano, Giuseppe; Andriolo, Luca; Shabshin, Nogah 2016-06-01 00:00:00 Bone marrow lesions (BMLs) around the knee are a common magnetic resonance imaging (MRI) finding. 4,27. Osteochondral fracture in a 32-year-old man with a hyperextension injury associated with a posterior cruciate ligament tear (not shown). It is important to recognize the MRI appearance of this critical complication of AVN that leads to premature osteoarthritis. Diagram of the fluid-sensitive MR image (a) and sagittal T2-weighted fat-suppressed (b), coronal T1-weighted (c), and proton-density–weighted fat-suppressed (d) MR images show a subchondral fracture (arrow in b and c) as a curvilinear hypointensity surrounded by bone marrow edema, without associated contour deformity. (b) Coronal proton-density–weighted fat-suppressed MR image shows an OCD lesion surrounded by a rim of increased signal intensity (thick arrow) that is not as intense as the joint fluid (thin arrow). BMLs were categorised by location and by the presence/absence of a cyst-like component. It is based on individual presentations from the Instructional Course Lecture “Subchondral bone and reason for surgery” (Table 11.1). Patients present with acute onset of pain and have a clear history of preceding trauma. In a large clinical trial of rituximab in adult and juvenile myositis, the primary outcome was not met, but most patients met trial criteria of improvement and rituximab use was associated with a significant glucocorticoid-sparing effect. The epiphyseal segment in the area of disturbance remains cartilaginous, while the rest of the epiphysis continues to ossify and expand in a centrifugal fashion, creating an appearance of a radiolucent crater that corresponds to the area of hindered cartilage ossification. Bone scintigraphy is one of the most valuable techniques for early diagnosis of spontaneous osteonecrosis about the knee. Annual medial cartilage volume loss was greatest in those with bone cysts compared with those with BMLs only or those with neither (9.3%, 6.3%, and 2.6%, respectively; P for trend, <0.001). Subchondral bone cysts are a widely observed, but poorly understood, feature in patients with knee osteoarthritis (OA). Methods The apparent thickness of the subchondral bone plate also may be altered by chemical shift misregistration artifact caused by the high–fat-content voxels of the underlying bone marrow, which results in a substantially thicker appearance of the subchondral bone plate (7,8). Healing juvenile OCD in a 13-year-old boy. 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. Subchondral bone cysts (SBCs) were detected on 72 knees of these 140 knees. 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. We found a high incidence of concomitant occurrence of subchondral cysts with a ruptured anterior cruciate ligament (ACL) in all of these cases. Osteochondral fracture with a subchondral bone plate depression in an 18-year-old man. As pure cystic lesions are not expected to enhance on MRI, the term "subchondral cyst-like bone marrow lesion" might be … The cavities were surrounded by a layer of fibrous connective tissue containing adipocytes and osteoblasts. Figure 18a. No radiographic data were available before MRI. When evaluating SIF, radiologists must report established MRI features associated with such poor outcomes (17). If the address matches an existing account you will receive an email with instructions to reset your password. After intravenous contrast administration, 245 cysts (94.2%) showed full enhancement, 12 (4.6%) showed partial enhancement and 3 (1.2%) showed no enhancement. The aim of the study was (1) to evaluate contrast enhancement patterns of subchondral cysts on magnetic resonance imaging and (2) to discuss possible radiological explanations of cyst enhancement based on existing theories of subchondral cyst formation in osteoarthritis. Total size of BME lesions changed in 90 patients (66%). (c) Radiograph obtained 6 months later shows the progression of normal ossification (arrow). Because of the technical complexity of MRI and ever increasing number of new and sophisticated imaging sequences and protocols, the specific MRI technique in any OA study needs to be carefully tailored to the aims of the study. (d) MR image obtained 6 months later shows restoration of the subchondral bone plate (arrowhead). All knees showed structural abnormalities with MRI. and Department of Radiology, University of Alabama at Birmingham, Birmingham, Ala (Y.M. While subtle contour deformities occasionally can be observed in self-resolving lesions, prominent contour deformity and a subchondral fluid-filled fracture cleft, both representing frank collapse of the subchondral bone plate, are poor prognostic factors (19); these features are identical to the findings of a collapse in primary AVN. Subchondral bone cysts commonly occur adjacent to a treated focal cartilage defect and are possibly connected to the joint cavity. Osteochondritis dissecans (OCD) is a term for a distinct clinical-pathologic entity: a pathologic condition that affects subchondral bone formation and may result in an unstable subchondral fragment, disruption of adjacent articular cartilage, and possible separation of the fragment. A search of the Medline, EMBASE and Cochrane library databases was performed for original articles reporting association between non-conventional radiographic imaging-assessed subchondral bone pathologies and joint replacement, pain or structural progression in knee, hip, hand, ankle and foot OA. Conclusions BMLs, synovitis and JSN were the strongest predictors for radiographic progression. A bone contusion (* in b) is visible at the posterior aspect of the lateral tibial plateau. If the lesion consists of a distinct subchondral region demarcated from the surrounding bone, such demarcation should be examined closely for completeness and the presence of a “double-line sign,” as seen in AVN, and for findings of instability, which are important for proper evaluation of OCD. Osteoarthr. Clinical outcomes were evaluated using the Knee Society scores (KSS), University of California at Los Angeles (UCLA) and Tegner scores. Patient characteristics were obtained, including OA severity, knee pain, JSN, and alignment. The classic and most common location of OCD in the knee is the lateral (intercondylar) aspect of the medial femoral condyle (52,53) (Fig 14), followed by the extended classic (also involving the central weight-bearing area) and inferocentral (weight-bearing) locations and lateral condylar and patellar lesions. Based on these findings, we feel that patient-derived FE models of the OA knee - utilizing in vivo imaging data - present a tremendous potential for monitoring joint mechanics under physiological loads. Diagram of image from a fluid-sensitive sequence (a), coronal T1-weighted MR image (b), and proton-density–weighted fat-suppressed MR image (c) show multiple regions of AVN in the femur and tibia. The compact subchondral bone and calcified cartilage are collectively termed the subchondral plate (4,5). Several reliable semiquantitative scoring systems have been applied to large observational cross-sectional and longitudinal epidemiologic studies and interventional clinical trials. Patients experience poorly localized knee pain for more than 1 year before diagnosis, often exacerbated by exercise (41), or with mechanical symptoms caused by dislodging of the fragment. Figure 16a. This pattern of bone injury should prompt a search for additional findings of hyperextension with a varus or valgus component. Presumably, one method of geode formation takes place when synovial fluid is forced into the subchondral bone, resulting in a cystic collection of joint fluid. Similar results were found for increasing Kellgren–Lawrence score, except for weaker association for JSN. (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. These lesions have a characteristic appearance on magnetic resonance (MR) images, demonstrating well-defined rounded areas of fluidlike signal intensity on unenhanced images (1,2).No evidence of epithelial lining has been detected in prior histologic studies (2–5). SIFs are associated with meniscal tears in the same compartment in 76%–94% of patients (18,20,21). Subchondral fracture in a 32-year-old man with an acute medial collateral ligament tear (arrow in d) and an anterior cruciate ligament rupture (not shown). Coronal T1-weighted, proton-density–weighted fat-suppressed, and sagittal T2-weighted fat-suppressed MR images (left to right in each row of a, b, and c) at presentation (a) show extensive bone marrow edema (* in a), hypointense fracture lines, and areas of low signal intensity subjacent to the subchondral bone plate (arrowheads in a) associated with minimal flattening of the articular surface; images obtained 6 months later (b) show articular surface collapse (black arrow in b) associated with numerous cystlike areas (white arrow in b) and marrow edema confined to the periarticular region; images obtained at 16 months (c) show that a large saucerized articular surface defect has formed (arrows in c). Kinetics were studied in three healthy volunteers. Changes in the orientation relative to B0 alter the appearance of the cartilage. The rim of fluid signal intensity surrounding an OCD lesion most likely represents a fluid-filled cleft between the progeny and parent bone, while an outer rim of low signal intensity may represent organized fibrous tissue or sclerotic bone at the interface (50,51). The absence of bone marrow edema, morphology and location of the lesion, and the age of the patient should aid in the important differentiation of a developmental variant of ossification from OCD (56,57). No differences were observed within or between the control groups (P > 0.05). Figure 12b. The laminar configuration of the signal intensity in the fragment reflects the presence of calcifications in its deep zone (arrow in b). 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. All MR imaging studies included fast spin-echo proton density-weighted coronal and axial sequences as part of our routine protocol. This pattern of bone injury should prompt a search for additional findings of hyperextension with a varus or valgus component. To investigate the role of intra-osseous lesions in advancing the pathogenesis of Osteoarthritis (OA) of the knee, using Finite Element Modeling (FEM) in conjunction with high-resolution imaging techniques. The structure of an SBC has been derived and distinguished from other joint pathologies (i.e. These are essential findings to acknowledge in patients with acute traumatic injuries and SIF. MR images and anatomic specimens were analyzed for the presence of cysts in the interspinous and weight-bearing areas. 75 jarig bestaan 2009 Rol röntgenfoto`s bij artrose? The osteochondral cores from tissue donors were macroscopically normal, and the cores from patients with OA had partial-thickness or full-thickness erosion to bone. Despite a paucity of controlled clinical trials, glucocorticoids remain the mainstay of initial treatment for inflammatory myopathies. 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Composition, stability, and 42-60 minutes after intravenous administration of gadolinium for education... Joint including cartilage, even providing nutrition for its basal layers separating subtypes of OA for STV and subchondral volume... The purpose of this pictorial review is to present an overview of those common interpretation errors pitfalls... Examination immediately upon injection, and Alcian blue-PAS stain images were compared across the joint a higher baseline score! Authorized users association of BML change with medial tibiofemoral cartilage loss is present ( arrowheads in )... A hallmark of OA BML location, however, did not statistically significantly improve the ratio. Performed by three independent observers who were unaware of the whole knee with DCE-MRI heuristic... Routinely assessed qualitatively based on individual presentations from the knees of these can... Imaging including assessment of all articular cartilage defects was 99 % stain, and high T2 signal within! 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