To determine the inter-observer agreement of this scoring method. Figure 3c. progression of subchondral cysts in a rodent model of secondary osteoarthritis David D McErlain1,2, Veronica Ulici3, Mark Darling4, Joseph S Gati2, Vasek Pitelka3, Frank Beier3 and David W Holdsworth1,2,5* Abstract Introduction: Subchondral bone cysts (SBC) have been identified in patients with knee osteoarthritis (OA) as a cause of Subchondral BMLs are a hallmark of knee OA on MRI. Future studies should explore whether reducing BMLs and inflammation can decrease the risk of structural progression. The aim of this article is to describe the roles and limitations of conventional radiography and MRI in imaging of OA, and also to give insight into the use of other modalities such as ultrasound, scintigraphy, computed tomography (CT) and CT arthrography in clinical practice and research in OA, particularly focusing on the assessment of knee OA in the tibiofemoral joint. Figure 5d. Osteoarthr Cartil. 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. Fifty-five lesions (64%) were identically graded on MR imaging and arthroscopy. Subjects and methods The fracture of the subchondral bone plate can show two patterns at MRI (19,29): (a) depression of the subchondral bone plate with loss of epiphyseal contour or (b) more rarely seen in the knee, a high-signal-intensity line on T2-weighted MR images extending under the subchondral bone plate representing fluid accumulating in the subchondral fracture cleft. 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). Figure 4b. Results Cysts surrounding a juvenile OCD lesion indicate instability only if they are multiple or larger than 5 mm (62). It is a morphologic finding that may be seen in various conditions and that produces a scalloped defect along the articular surface of the bone (Fig 1). Regions of well-defined high signal (in relation to oedema-like signal) on post-contrast scans within subchondral BMLs, which other groups have asso- ciated with subchondral cysts. However, the extent of bone marrow edema has no prognostic significance (17,21). 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. 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. In a longitudinal study using data from MOST, BMLs were associated with an increased risk of incident concomitant subchondral cyst-like lesions (OR: 12.9, 95% confidence intervals (CI) 8.9 to 18.6) 5 . Objective: 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. All rights reserved. Graphical Abstract Subchondral bone cysts commonly occur adjacent to a treated focal cartilage defect and are possibly connected to the joint cavity. For this journal-based SA-CME activity, the authors, editor, and reviewers have disclosed no relevant relationships. 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. Subsequently a side-by-side comparison was performed for verification. After articular collapse, the signal in the necrotic segment changes because of fragmentation, invasion of fibrovascular tissue, and secondary cyst formation. Sensitivity for the sagittal T2-weighted spin-echo sequence was 40%, and specificity was 100%. In this chapter, we will give insight into the roles and limitations of conventional radiography and MRI in imaging of OA, and also describe the use of other modalities including ultrasound, tomosynthesis, computed tomography, and nuclear medicine in clinical practice and research in OA, particularly focusing on the assessment of knee. Osteochondral fracture with a subchondral bone plate depression in an 18-year-old man. Figure 13. Osteoarthritis and rheumatoid arthritis can lead to the development of these cysts. Twenty-three (54%) of 42 specimens contained one or more cystic areas, with a total of 30 cystic areas. In those who had ≥1 follow-up and a baseline scan (N=50), STV and BML volume was assessed. All cysts seen on the anatomic slices could also be depicted on both MRI sequences. Design: 99mTc-DPD-SPECT/CT and MRI of 27 knees of 25 patients with chronic knee pain and risk factors for osteoarthritis (OA) were evaluated by one nuclear physician and one radiologist. To describe a semi-quantitative scoring method for multi-feature, whole-organ evaluation of the knee in osteoarthritis (OA) based on magnetic resonance imaging (MRI) findings. After completing this journal-based SA-CME activity, participants will be able to: ■ Describe the anatomy of the osteochondral junction with MRI correlation. Physeal injuries have been reported in up to 2.9% of pediatric knee MRI examinations . This pattern of bone injury should prompt a search for additional findings of hyperextension with a varus or valgus component. All left testicular veins drained into left renal vein. 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. Cystic lesions around the knee are a diverse group of entities, frequently encountered during routine MRI of the knee. (c) Radiograph obtained 6 months later shows the progression of normal ossification (arrow). 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. The MRI appearance of individual layers depends on both anatomic and technical factors. Osteochondral fracture with a subchondral bone plate depression in an 18-year-old man. MRI can allow characterization of various tissue compositions of the progeny fragment (51,55). The two layers appear as one low-signal-intensity band overlying the subarticular marrow. Therefore, we suggest these lesions can be more accurately described as a form of OA-induced osteonecrosis, rather than 'subchondral cysts'. Figure 11a. Conditions that affect articular cartilage are frequently accompanied by abnormalities in the subchondral marrow. Background 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. 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. 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. One possible reason for such a discrepancy … The presence and size of subchondral cysts and bone marrow edema-like lesions (BMLs) were scored semiquantitatively in each subregion on non-contrast-enhanced MRI from 0 to 3. Diagram (a), coronal proton-density–weighted fat-suppressed MR image (b), and sagittal T2-weighted fat-suppressed image (c) show a bone marrow edema pattern “painting” the entire medial femoral condyle (* in b). Figure 16a. These criteria apply to lesions without an overlying cartilage abnormality (19). It is important to recognize the MRI appearance of this critical complication of AVN that leads to premature osteoarthritis. Röntgenfoto van knie met artrose. 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. Conclusions MRI is widely used for evaluation of the knee as well as other joints and provides many advantages. The increasing importance of imaging and assessment of all joint structures has been recognized. During the evolution of the osteoarthritic process the compositions, functional properties, and structures of these tissues undergo marked alterations. 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. Bone sclerosis in osteoarthritis at MRI may resemble the subchondral low-signal-intensity areas seen in SIF. 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. Figure 15. 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). 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. 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). Diagnosing Subchondral Sclerosis. What Is a Subchondral Bone Cyst? The WORMS method described in this report provides multi-feature, whole-organ assessment of the knee in OA using conventional MR images, and shows high inter-observer agreement among trained readers. 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). The terms bone bruise or bone contusion refer to trabecular microfractures that manifest as a pattern of bone marrow edema on MR images, without contour abnormalities or a discrete fracture line (2,9,10). 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. Initial treatment of SIF is conservative, consisting of protected weight bearing and administration of analgesic medications to prevent development or worsening of subchondral bone collapse (27). Frequently, they are associated with lesions of the menisci or the anterior cruciate ligament. Morphological analysis can be semiquantitative or quantitative. Administration of gadolinium for an MR arthrogram may be employed. All patients who underwent PFA for isolated patellofemoral arthritis between 2002 and 2013 and had undergone preoperative magnetic resonance imaging were identified. 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. Subchondral bone cysts (SBCs) are sacs filled with fluid that form inside of joints such as knees, hips, and shoulders. Focal discontinuity of the subchondral bone plate is seen (arrowhead). (a) Diagram shows a fracture that is creating an osteochondral fragment. 64-MDCT enables evaluation of testicular veins in all patients. Sensitivity of the T2-weighted fast spin-echo sequence with fat saturation was 61% for the coronal plane alone and 59% for the axial plane alone. Subchondral bone plate disruptions are evident (arrowheads in c and d) and are best depicted on the CT image (d). Figure 8a. 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. Specificity for each plane was 99%. (d) Sagittal T2-weighted fat-saturated MR image shows disruption of the subchondral bone plate (arrowhead). 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. Histologic staining methods included routine Harris hematoxylin stain, trichrome stain, and Alcian blue-PAS stain. DCE-MRI has a potential to be used for separating subtypes of OA. Subchondral bone plate disruptions are evident (arrowheads in c and d) and are best depicted on the CT image (d). One of duplicated right testicular veins drained into inferior vena cava and other paired drained into right renal vein and inferior vena cava separately. (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). Objective: 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. Symptomatic unstable lesions are often treated surgically (42,59), with the choice of technique depending on whether the fragment is salvageable or not (58,59). Enhancing BMLs were found in 237 (91.2%) subregions containing cysts, which were located adjacent or in the middle of BMLs. Although bone islands and osteomas are not classified by the World Health Organization (WHO) as true tumors, they are included here under benign osteogenic tumors for simplicity and due to their common occurrence. 4,27. Hallmarks of osteoarthritis include the presence of marginal osteophytes and subchondral cysts in the tibiofemoral joint. MRI features of this lesion also have been shown to be profoundly different from those of primary AVN (17,18). Patient-specific, inhomogeneous material properties were derived from the CT images and mapped directly to the FE models. This association and a link between SIF and meniscectomy (26) support the proposed role of mechanical stress in the development of SIF and emphasize the rationale for meniscal conservation. In diarthrodial joints, the articular cartilage, calcified cartilage, and subchondral cortical and trabecular bone form a biocomposite - referred to as the osteochondral unit - that is uniquely adapted to the transfer of load. Summary of Clinical and MRI Features of Common Osteochondral Lesions of the Knee. 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). Transl. Sixteen consecutive patients (age range, 43-79 years; mean, 67 years) referred for total knee replacement were examined with sagittal short inversion time inversion-recovery (STIR) and T1- and T2-weighted turbo spin-echo MR imaging 1-4 days before surgery. Our findings suggest that the T1-w FS CE and PD-w FS sequences may be interchangeably used for quantitative volumetric and SQ assessment of BMLs. We refer to this band as the subchondral bone plate. SIF in a 64-year-old woman with a complex tear in the medial meniscus with peripheral extrusion (arrow in a). In this scenario an irregularly shaped cavity developed which became rounded and obtained a rim of sclerotic bone after removal of the pressurized fluid. Bone islands and osteomas appear as dense lesions within and on the surface of bone, respectively, and the major concern is distinguishing them from sclerotic metastases. wileyonlinelibrary.com/journal/ctm2. The neoplasms in this category all form osseous matrix and are divided into benign and malignant tumors. This is the first study to use clinical QCT to explore subchondral tibial cysts in patients with knee OA and provides further evidence of the relationships between subchondral cysts and clinical OA characteristics. Figure 4d. (c) Radiograph obtained 6 months later shows the progression of normal ossification (arrow). 34. 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Limitations have been described especially well in the right knee in a 59-year-old who. 2 and 4 h post-injection can lead to the FE models exhibited a physiologically realistic distribution... Primary avn ( 17,18 ) findings to acknowledge in patients with OA progression been! Undergoing total knee replacement surgery due to cartilage degeneration.2 2 adults, most commonly in the segment! The majority of patients with two sequential knee MRI benign and malignant tumors prominent in rheumatoid arthritis calcium. Or may not be present on the stage of the medial femoral condyle progressing to collapse.

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