SIFs are associated with meniscal tears in the same compartment in 76%–94% of patients (18,20,21). All subjects exhibited enhancement of joint fluid. Dr. Aruna Mani answered 18 years experience Medical Oncology Changes in the orientation relative to B0 alter the appearance of the cartilage. Once a characteristic pattern of osseous injury is recognized on MR images, the radiologist must seek specific additional soft-tissue and osseous injuries. A total of 47 BMLs were identified and were manually segmented on all three sequences. These osseous injuries are the result of impaction of the lateral femoral condyle against the posterolateral tibial plateau during internal rotation and anterior translation of the tibia accompanying an anterior cruciate ligament rupture (arrow in d). with progression of osteoarthritis 9. (a) Diagram shows a fracture that is creating an osteochondral fragment. In total 2456 abstracts were screened and 139 papers were included (70 cross-sectional, 71 longitudinal analyses; 116 knee, 15 hip, six hand, two ankle and involved 113 MRI, eight DXA, four CT, eight scintigraphic and eight 2D shape analyses). The original MOCART 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. Data was acquired from participants who took part in a randomised placebo-controlled trial (UK VIDEO) investigating the effect of vitamin D therapy (800 IU cholecalciferol daily) on radiographic joint space narrowing. The purpose of this pictorial review is to present an overview of those common interpretation errors and pitfalls in MRI of the knee. Our findings do not support the use of the term "herniation cyst.". 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. This condition remains poorly understood and, despite years of collaborative research, there is no consensus regarding its etiology, natural history, or treatment (41,42). Such developments could help further stratify subgroups and treatments for people with OA in future. Several typical patterns of osteochondral injuries have been described in association with certain types of internal derangement and instability (11–13). The laminar configuration of the signal intensity in the fragment reflects the presence of calcifications in its deep zone (arrow in b). (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. The laminar configuration of the signal intensity in the fragment reflects the presence of calcifications in its deep zone (arrow in b). Importantly, these interventions will not be successful unless they are applied at the early stages of disease before considerable structural and functional alterations occur in the osteochondral unit. VIDEO was registered with EudraCT: ref. Note the macerated and extruded medial meniscus (black arrow in b). 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). Current treatments are largely based on the modulation of pain, including NSAIDs, opiates and, more recently, centrally acting pharmacotherapies to avert pain. Patients present with acute onset of pain and have a clear history of preceding trauma. A bone contusion (* in b) is visible at the posterior aspect of the lateral tibial plateau. These cysts will appear as round, homogenous, intermediate-low T1, and high T2 signal foci within the articular bone marrow. Fig. Osteochondral fracture with a subchondral bone plate depression in an 18-year-old man. Figure 15. In this scenario an irregularly shaped cavity developed which became rounded and obtained a rim of sclerotic bone after removal of the pressurized fluid. subchondral tibial cysts in patients with knee OA and to explore relationships between proximal tibial subchondral cyst parameters and subchondral bone density as well as clinical characteristics of OA (alignment, joint space narrowing (JSN), OA severity, pain) in patients with knee OA. SBCs, bone marrow lesion (BML), and hip-knee-ankle (HKA) axis were measured by using validated methods. In calcium pyrophosphate deposition disease, geodes resemble those in osteoarthritis but are larger, more numerous, and more widespread. The inferior lytic defects may be physical evidence of bone marrow lesions (BML), a clinical OA indicator visible via MRI. Cysts may be seen accompanying AVN and SIF (19). A bone contusion (* in b) is visible at the posterior aspect of the lateral tibial plateau. They're especially common at the knee or hip. The volume of the cyst-like component from subchondral BMLs with a cyst-like component was associated with knee pain. Morphological analysis can be semiquantitative or quantitative. Following trauma, osteochondritis dissecans, osteonecrosis or osteoarthritis, this intimate connection may become disrupted. Subchondral cyst, bone marrow edema-like signal, cartilage abnormalities and overall osteoarthritis severity were initially independently assessed on the baseline and follow-up MRI examinations. The most common histologic findings in bone marrow edema-like lesions include bone necrosis, fibrosis, hemorrhage, and trabecular abnormalities, while edema is infrequent (64–66). Cysts surrounding a juvenile OCD lesion indicate instability only if they are multiple or larger than 5 mm (62). A radiographic-based algorithm allows for a detailed analysis of postoperative subchondral bone cysts and other alterations of the subchondral bone. OCD in the extended classic location in a 19-year-old man, with features of instability applicable to both juvenile and adult OCD. Subjects with serial images were assessed (N = 50) for STV and subchondral BML volume. In conclusion, both stress-shielding by pressurized fluid, and osteocyte death may cause cyst growth. Alternatively, cysts could be the result of elevated intra-articular pressure due to inflammation, i.e. Subchondral bone cysts (SBCs) are sacs filled with fluid that form inside of joints such as knees, hips, and shoulders. Additional secondary criteria are employed for a juvenile OCD lesion to increase specificity. Think Different: Sorting Out Osteochondral Lesions of the Knee, Subchondral Bone Marrow Edema in Patients with Degeneration of the Articular Cartilage of the Knee Joint, Search under the Cartilage: A Gamut of Subchondral Lesions, 3.0-T Evaluation of Knee Cartilage by Using Three-Dimensional IDEAL GRASS Imaging: Comparison with Fast Spin-Echo Imaging, Cartilage Disease of the Knee with Direct Arthroscopic Correlation. 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. (b) Subsequently, a frank articular collapse (arrowheads) has developed, followed by loss of fatty signal intensity in the necrotic area (arrows). 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). (d) Sagittal T2-weighted fat-saturated MR image shows disruption of the subchondral bone plate (arrowhead). The unique feature of this condition is that separation and detachment of the osteochondral fragment culminate the process that originally starts deep underneath the articular surface (43) and subsequently involves the articular cartilage at the peripheral border of the lesion: an “inside-out” mechanism. Two misconceptions contributed to a long evolution of the understanding of this disorder: (a) a pre–MRI-era hypothesis that attributed it to a primary AVN, resulting in the misnomer, and (b) an effort to distinguish it fundamentally from SIF, largely impelled by differences in prognosis. Healing juvenile OCD in a 13-year-old boy. What Is a Subchondral Bone Cyst? Results Subchondral bone cysts are a widely observed, but poorly understood, feature in patients with knee osteoarthritis (OA). Osteochondral defects are predominantly located on the medial femoral condyle and also on the patella. Such a fracture can either stabilize or progress to a frank collapse of the articular surface that is associated with pain and progressive osteoarthritis and eventually necessitates knee replacement. At both the medial and lateral compartments of the proximal tibia, greater cyst number and volume were associated with higher BMD. A spherical shell extending 1mm radially around the SBC served as the sample volume for measurements of von Mises equivalent stress. However, subsequent evidence supports the bony contusion theory, in which violent impact between opposing surfaces of the joint results in areas of bone necrosis, particularly when the overlying cartilage has been eroded, and that synovial breach is a secondary event [1,5, ... A small retrospective study of 32 patients with knee OA found that 11 (92%) of 12 of cysts developed within BMLs over ~18 months [13]. Note the lack of edema in the necrotic segment. (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). To date, MRI is the only imaging modality which can depict the concomitant occurrence of a subchondral cyst and a ruptured anterior cruciate ligament at the knee joint. Although interpretation of knee MRI seems straightforward in most scenarios, there are a number of pitfalls that may cause common mistakes. If the lesion consists of a subchondral region demarcated from the surrounding bone, the demarcation should be examined for completeness and the presence of a “double-line sign” that is seen in avascular necrosis or findings of instability, which are important for proper evaluation of osteochondritis dissecans. These criteria apply to lesions without an overlying cartilage abnormality (19). Interspinous and weight-bearing tibial cysts are common in severe knee osteoarthritis. (MR images courtesy of Douglas W. Goodwin, MD, Dartmouth Geisel School of Medicine.). In osteonecrosis, geodes appear in the necrotic segment of the femoral head. Radiographic severity of patellofemoral arthritis was classified according to the Iwano classification system. Increased fluid exudation from overlying and opposing cartilage, increased fluid depressurization, and increased cartilage tissue strains could lead to chondrocyte death and cartilage damage. Data were available from 107 participants. The tibiofemoral and patellofemoral joints were divided in 14 subregions. 75 jarig bestaan 2009 Rol röntgenfoto`s bij artrose? (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. It reviews the design of new studies, the Osteoarthritis Initiative and Multicenter Ostroarthritis Study. Coronal proton-density–weighted fat-suppressed MR image (a) sagittal proton-density–weighted MR image (b), and T2-weighted fat-suppressed MR image (c) show an OCD lesion in a classic location at the lateral aspect of the medial femoral condyle with cysts (curved arrow in a and c) and a high-signal-intensity rim (straight arrow in b) at the interface between the fragment and parent bone associated with breaks in the subchondral bone plate and articular cartilage along the periphery of the lesion (arrowhead in b and c). Glucocorticoid-sparing agents, either methotrexate or azathioprine, are often begun concomitantly with glucocorticoid therapy. (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. (c) Radiograph obtained 6 months later shows the progression of normal ossification (arrow). We used Spearman’s correlation coefficients to explore associations between patient characteristics and cyst parameters. Osteoarthritis Cartilage. The individual features showed strong inter-associations. Healing juvenile OCD in a 13-year-old boy. Figure 18d. Figure 11b. SUBCHONDRAL CYSTS INARTHRITIS 801 lesions were upto2mm indiameter; inothers they reached 20mmindiameter. The increasing importance of imaging and assessment of all joint structures has been recognized. Osteochondral defect. Osteochondral lesion is a general term that encompasses a variety of acute or chronic localized abnormalities of the articular cartilage and subchondral bone. The rate of fluid enhancement was assessed in three subjects, and the effects of exercise were studied. For example, radiography is still the golden standard for imaging features of osteoarthritis. Bone is an integral part of the osteoarthritis (OA) process. Osteoarthritis is a widely prevalent disease of the whole joint including cartilage, bone, and soft tissues. Duplicate 3D models were also created with a 3D sphere mimicking SBCs in medial tibia. SIF in a 64-year-old woman with a complex tear in the medial meniscus with peripheral extrusion (arrow in a). All cysts seen on the anatomic slices could also be depicted on both MRI sequences. Subchondral bone cysts (SBCs) ... marrow, and articular cartilage in pathogenesis of knee OA. We adjusted for age, sex, Body Mass Index, follow-up time and other erosive joints (the latter for analyses on incident erosions only). When analyzing osteochondral lesions on MR images of the knee, the radiologist must first consider patient demographics, clinical presentation, and history of trauma. After HTO, the evolution of cysts was evaluated on MRI performed with a five year follow-up on the 72 knees with pre-operative cysts. It is based on individual presentations from the Instructional Course Lecture “Subchondral bone and reason for surgery” (Table 11.1). No evidence of epithelial components was found in the lining of the cavities. Subchondral cyst–like lesions (SCs) are a common finding in patients with knee osteoarthritis (OA). Radiologically BMLs in OA are understood as non-cystic subchondral areas of ill-defined hyperintensity in T2w, PDw, STIR or IW images and of hypointensity on T1w images6, 22, 57 . Patellofemoral arthroplasty (PFA) is increasingly performed for symptomatic patellofemoral arthritis. 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%. 64-MDCT enables evaluation of testicular veins in all patients. 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