They're especially common at the knee or hip. Histologic core biopsy specimens obtained in juvenile OCD lesions showed that osteonecrosis is either absent (47,50) or infrequent (48,51). The condition can manifest either in childhood (juvenile OCD) or middle age (adult OCD), but the most frequent age of onset is in preadolescence. 64-MDCT enables evaluation of testicular veins in all patients. 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. 2014;22(4):540-6. doi: 10.1016/j.joca.2014.01.006. 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. Changes in the orientation relative to B0 alter the appearance of the cartilage. Subchondral bone cysts are a widely observed, but poorly understood, feature in patients with knee osteoarthritis (OA). Subchondral sclerosis in osteoarthritis is related to a deposition of new bone on preexisting trabeculae and to trabecular compression and microfractures with callus formation (76), although associated histologic abnormalities and MRI signal alterations are far more complex (77). The structure of an SBC has been derived and distinguished from other joint pathologies (i.e. Osteoarthritis (OA) is a widely prevalent disease of the whole joint including cartilage, bone and soft tissues. MR imaging consisted of axial and coronal T2-weighted fast spin-echo sequences with fat saturation and sagittal T2-weighted spin-echo sequences. 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. 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. Mean age was 51 years (range, 36 to 81), and mean follow-up was 3 years (range, 2 to 10). Adjacent portions were analyzed by 3-dimensional histology for calcified cartilage, subchondral bone, and subchondral bone plate thickness and vascular canal density. In vitro T2-weighted spin-echo MR images of the tibial plateau at 7 T in the same specimen oriented perpendicularly to the main magnetic field (B0, gray arrow, top image) and tilted 55° to B0 (bottom image) show the typical layered appearance of the articular cartilage. 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. Classic SIF in a 64-year-old man. Indirect MR arthrographic findings in 17 patients with joint disorders (eg, rotator-cuff tears, meniscal tears, and osteoarthritis) were compared with arthroscopic findings. 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). Results When the knee is visualized by using magnetic resonance imaging (MRI), SBCs appear more frequently [ 2 ] than on radiographs, and SBCs are … 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. Based on Barrie and Laor et al (43,46). 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). Osteonecrosis is a common condition that is the result of a reduction or complete loss of blood supply to the bone. 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). 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. STV was also associated with knee symptoms. Subchondral cysts (geodes) in arthritic disorders: pathologic and radiographic appearance of the hip joint AJR Am J Roentgenol. Sagittal proton-density–weighted (a) and T2-weighted fat-suppressed (b) MR images of the medial femoral condyle show subchondral cystlike lesions (arrow) and bone marrow edema-like lesions (* in b). 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. This article discusses epidemiologic study designs for osteoarthritis and why traditional designs are outmoded. Bilateral MRI was performed 24 h after the initial injection of papain, and 1 week, 1 month, and 3 months following three papain injections. Following trauma, osteochondritis dissecans, osteonecrosis or osteoarthritis, this intimate connection may become disrupted. The MRI appearance of individual layers depends on both anatomic and technical factors. 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. (a) Coronal proton-density–weighted fat-suppressed image shows an extensive bone marrow edema pattern involving the medial femoral condyle (*), accompanied by a subchondral area of low signal intensity (arrowhead) located immediately subjacent to a subchondral bone plate, producing its apparent thickening. PROSPERO registration number: CRD 42013005009. Clinical quantitative computed tomography (QCT) has the potential to characterize cysts in vivo but it is unclear which specific cyst parameters (e.g., number, size) are associated with clinical signs of OA, such as disease severity or pain. A subchondral bone cyst (SBC) is a fluid-filled sac that forms in the bone just beneath the cartilage of a joint such as the hip, knee, or shoulder. The adjacent articular cartilage was scored in each subregion on non-enhanced MRI as grade 0 (intact), grade 1 (partial thickness loss), or grade 2 (full thickness loss). All patients had grade IV patellofemoral chondromalacia and/or significant subchondral cyst formation and edema on magnetic resonance imaging. The expansion of these lesions is due to stress-induced bone resorption from the incurred mechanical instability. All patients who underwent PFA for isolated patellofemoral arthritis between 2002 and 2013 and had undergone preoperative magnetic resonance imaging were identified. Semiquantitative assessment of subchondral bone marrow edema-like lesions and subchondral cysts of the knee at 3T MRI: A comparison between intermediate-weighted fat-suppressed spin echo and Dual Echo Steady State sequences | springermedizin.de Skip to main content The two layers appear as one low-signal-intensity band overlying the subarticular marrow. These are essential findings to acknowledge in patients with acute traumatic injuries and SIF. (a) Radiograph shows a localized ossification defect of the medial femoral condyle containing linear calcifications (white arrow) and surrounded by sclerosis (black arrow). 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). A total of 47 BMLs were identified and were manually segmented on all three sequences. Ten subjects were studied: two asymptomatic volunteers and eight patients with suspected meniscal tears. Crema MD, Cibere J, Sayre EC, et al. Graphical Abstract Subchondral bone cysts commonly occur adjacent to a treated focal cartilage defect and are possibly connected to the joint cavity. 34. 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). 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 . 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 injury is commonly associated with immediate effusion that represents hemarthrosis or lipohemarthrosis. Alternatively, cysts could be the result of elevated intra-articular pressure due to inflammation, i.e. Bone is an integral part of the osteoarthritis (OA) process. Background: Caution should be used when considering PFA for patients with minimal radiographic evidence of patellofemoral arthritis. Osteochondral defects-the type of defects that extend into the subchondral bone-account for about 5% of all articular cartilage lesions. Figure 4c: A two year follow up demonstrates a fluid filled subchondral fracture (arrowhead), subcortical cysts and new degenerative bony changes at the medial tibial plateau (arrows). In articular fluid samples from four patients 1 hour after intravenous injection, the average intraarticular concentration was 141 mumol +/- 47 (1 standard deviation) at atomic absorption spectrophotometry. Interobserver variability for the presence of disease, which was measured using the kappa statistic, was 0.63. The distal femoral growth plate is open (* in a and b). 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. Subchondral cysts were detected in 260 subregions (4.6%). Figure 5c. ■ Contrast and compare common entities that manifest as osteochondral lesions of the knee: acute traumatic osteochondral injuries, AVN, SIF of the knee, OCD, bone marrow edema-like lesions, and subchondral cystlike lesions in osteoarthritis. Figure 11a. 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). Longitudinal studies are needed to explore the possibility of the development from a compartmental disease to a multicompartmental disease and the impact of contributing factors on the development. Results: The cartilage surfaces were graded using a 3-point system, and results were compared with arthroscopic findings. 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. Vitamin D supplementation does not appear to have an effect on synovitis or BML volume in patients with symptomatic knee OA. 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. Such edema appears speckled and poorly defined. 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 clinical scenario and histologic findings are typical of secondary osteonecrosis. 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. Osteochondral fracture with a subchondral bone plate depression in an 18-year-old man. Enter your email address below and we will send you your username, If the address matches an existing account you will receive an email with instructions to retrieve your username. These lesions range from benign cysts to complications of underlying diseases such as infection, arthritis, and malignancy. The volume of subchondral BMLs with a cyst-like component was not associated with pain (b = 0.8, 95% CI -0.5 to 2.1) however, the volume of the cyst-like component itself was associated with pain (b = 51.8, 95% CI 14.2 to 89.3). Trial registration As cysts can regress, they may also provide therapeutic targets in knee OA. Seventy-five knees in 55 patients met inclusion criteria. Conclusions BMLs, synovitis and JSN were the strongest predictors for radiographic progression. In this study, the frequency of SBCs (74%) in OA patients was higher than that (57%) reported in a previous study using MRI 11. Limitations marrow edema-like lesions and subchondral cysts of the knee at 3T MRI: A comparison between intermediate-weighted fat-suppressed spin echo and Dual Echo Steady State sequences Daichi Hayashi1*, Ali Guermazi1,2, C Kent Kwoh3,4, Michael J Hannon3, Carolyn Moore5, John M Jakicic6, Stephanie M Green3 and Frank W Roemer1 Abstract Background: Choice of appropriate MR pulse … Cystic lesions around the knee are a diverse group of entities, frequently encountered during routine MRI of the knee. 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%. Note the lack of edema in the necrotic segment. (d) Sagittal T2-weighted fat-saturated MR image shows disruption of the subchondral bone plate (arrowhead). BML location, however, did not influence symptoms. 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. Bone marrow edema surrounding the infarct is present on the femoral side (* in c) but not the tibial side. The purpose of this study was to assess the accuracy of routine T2-weighted MR imaging in detecting and grading articular cartilage lesions in the knee compared with arthroscopy. At 4 weeks post-ACLX, 75% of the rodent knees had at least 1 cyst that formed in the medial tibial plateau; by 12 weeks all ACLX knees contained SBC. 10.1016/j.joca.2006.05.011 [Google Scholar] Chan P. M. B., Wen C., Yang W. C., Yan C., Chiu K. (2017). This misnomer was entrenched in the medical lexicon for many years, persisting after recognition of this entity as a SIF (15,16). At the onset of disease, the space between the joint bones will begin to narrow due to cartilage degeneration.2 2. We used fixed-effect panel-regression modelling to examine the association between volume and symptoms. Figure 11b. (b) Subsequently, a frank articular collapse (arrowheads) has developed, followed by loss of fatty signal intensity in the necrotic area (arrows). 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. The protocol for the trial can be accessed at https://www.ctu.mrc.ac.uk/studies/all-studies/v/video/ Results MRI-defined moderate/severe synovitis (OR=3.52, 95% CI 1.29 to 9.59), bone marrow lesions (BML) (OR=2.73, 95% CI 1.29 to 5.78) and JSN (severe JSN: OR=11.05, 95% CI 3.22 to 37.90) at baseline predicted progression of radiographic JSN. Lateral cyst number and volume were also associated with joint alignment, OA severity, JSN and sex. Although cartilage loss is the hallmark of OA, it is clear that OA is a disease of the whole joint. MRI of bone marrow edema-like signal in the pathogenesis of subchondral cysts. (b) Subsequently, a frank articular collapse (arrowheads) has developed, followed by loss of fatty signal intensity in the necrotic area (arrows). 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. BME lesions in 2 years were associated with clinical features assessed by Western Ontario and McMaster Universities Osteoarthritis (WOMAC) scores. Osteoarthritis typically develops in stages: 1. Increased diffusion of contrast material into these lesions might also contribute to their avid enhancement, a finding that has recently also been described for small cyst-like BMLs, ... Edema has been found to precede SBC formation in most cases [20,21], but its presence does not guarantee trabecular remodeling when compared with histological examination [37] . Subchondral hypointense fracture lines tend to resolve with conservative therapy and can be seen in patients with transient reversible SIF and in 78% of those with clinical SONK. Authors D Resnick, G Niwayama, R D Coutts. Data from the Amsterdam OA Cohort were used. Histopathology results verified the staged degeneration of papain-treated articular cartilage. When combined, these secondary MRI findings have 100% sensitivity and 100% specificity for detection of unstable juvenile OCD lesions. Figure 2. Figure 9b. This may be performed with either a direct or indirect technique. It has also been shown that both small (≤5 mm) and large (>5 mm) MR imaging–depicted osteophytes are associa… Symptomatic OA in the imaged knee was defined following the American College of Rheumatology criteria. Histologic staining methods included routine Harris hematoxylin stain, trichrome stain, and Alcian blue-PAS stain. Tibial specimens were sectioned using a high-speed rotating diamond disk into 3-mm-thick slices. Mean fluid enhancement for patients was 137% on initial and 262% on delayed images obtained after exercise. Note.—AVN = avascular necrosis, BML = bone marrow edema-like lesion, LFC = lateral femoral condyle, MFC = medial femoral condyle, OCD = osteochondritis dissecans, SIF = subchondral insufficiency fracture, SONK = spontaneous osteonecrosis of the knee. Objectives To examine whether MRI features predict radiographic progression including erosive evolution in patients from the Oslo hand osteoarthritis (OA) cohort, which is the first longitudinal hand OA study with available MRI. Particularly for the problem of subchondral bone lesions, image evaluation methods need to be refined for adequate and reproducible analysis. Methods It reviews the design of new studies, the Osteoarthritis Initiative and Multicenter Ostroarthritis Study. In calcium pyrophosphate deposition disease, geodes resemble those in osteoarthritis but are larger, more numerous, and more widespread. All subjects with available non-enhanced and contrast-enhanced MRI were included. (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. Subchondral bone plate disruptions are evident (arrowheads in c and d) and are best depicted on the CT image (d). In conclusion, both stress-shielding by pressurized fluid, and osteocyte death may cause cyst growth. These questions were tested using longitudinal magnetic resonance imaging (MRI) data in a natural history study of symptomatic knee osteoarthritis (OA). SIF in a 51-year-old woman with atraumatic sudden onset of knee pain and swelling. 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. Evaluation of the articular surfaces was performed by three independent observers who were unaware of the arthroscopic results. The arthrographic effect may provide a more convenient alternative to intraarticular injection of gadopentetate dimeglumine for MR arthrography. (d) MR image obtained 6 months later shows restoration of the subchondral bone plate (arrowhead). Unstable OCD lesion in a 17-year-old boy. Background 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. Radiographs, coronal T1-weighted images, proton-density–weighted fat-suppressed images, and sagittal proton-density–weighted images (left to right in rows a and b) were obtained at the onset of knee pain (a) and 7 years later (b). 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). This is a proof-of-concept study in an animal model. WOMAC was assessed annually. All left testicular veins drained into left renal vein. 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. Note the macerated and extruded medial meniscus (black arrow in b). The latter conditions have also been associated with intercondylar enthesophytes and third intercondylar tubercle of Parsons (TITP), both of which were observed in the intercondylar regions. Subchondral bone cyst formation is often encountered in osteoarthritis (OA) of the knee, particularly in advanced OA [].Visualised by using magnetic resonance imaging (MRI), subchondral bone cysts occur where the overlying cartilage has largely been eroded [].Two main theories are proposed about cyst formation: the synovial breach theory [3, 4] and the bony contusion theory [1, 5]. The bone marrow edema pattern zone (ill-defined and hyperintense on STIR images and hypointense on T1-weighted MR images) mainly consisted of normal tissue (53% of the area was fatty marrow, 16% was intact trabeculae, and 2% was blood vessels) and a smaller proportion of several abnormalities (bone marrow necrosis [11% of area], abnormal [necrotic or remodeled] trabeculae [8%], bone marrow fibrosis [4%], bone marrow edema [4%], and bone marrow bleeding [2%]). In this scenario an irregularly shaped cavity developed which became rounded and obtained a rim of sclerotic bone after removal of the pressurized fluid. (c) Radiograph obtained 6 months later shows the progression of normal ossification (arrow). A study by Yamamoto and Bullough (15), which was supported by results of a later study (16), showed that the primary event is a SIF, followed by secondary necrosis limited to the area between the fracture line and the subchondral bone plate. 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