The objective of this article was to analyze the accuracy and precision with which the quantitative distribution of articular cartilage can be determined in the knee joint using MRI. A three-dimensional (3D) technique that accounts for the out-of-plane deviation of the interface normal in strongly curved joint surfaces (3D MR-CCM) has been developed for cartilage thickness measurements. Eight cadaveric knee-joint specimens and six volunteers were imaged using a fat-suppressed gradient-echo sequence at a resolution of 2 x 0.31 x 0.31 mm3. Cartilage volumes and topographical thickness maps were obtained and compared with those derived from anatomical sections by image analysis. The deviation of the MR volumes from those of the sections was 1-12%, the coefficient of variation after repositioning ranged from 2.9% (patella) to 8.2% (lateral tibial plateau). Between 60% and 80% of all image points could be attributed to identical thickness intervals, less than 20% deviating by more than 0.5 mm. The intraobserver and interobserver reproducibilities were very high in both the specimens and the volunteers. In the knee joint, 3D reconstructions of the cartilages, and measurements that take into account the out-of-plane deviation of the interface normals (3D MR-CCM), are required.

The FLASH and fat-suppressed FLASH sequences allowed the most accurate determination of the cartilage volume and thickness. Fat-suppression considerably increased the contrast of the cartilage to the synovial fluid, fat and bone marrow, yielding higher reproducibility of the volumetric measurements. The remaining difference from the anatomical volume and thickness may be because the calcified cartilage is not delineated by magnetic resonance imaging.

A method for the assessment of articular cartilage thickness based on MRI is presented and its accuracy and reproducibility tested. Six specimens of human patellae were imaged, using a fat-suppressed FLASH 3D sequence, and sectioned with a high-precision band saw. The regional distribution of articular cartilage thickness was determined from the MR images and from the anatomical sections (intervals of 0.5 mm). With image analysis 50-90% of the image points were found to lie within exactly the same thickness interval in corresponding patterns, and less than 17% deviated more than 0.5 mm. More than 85% of all pixels were reproducible with MRI after new positioning of the joint. No influence of the read-out direction and no important differences between areas of thin and thick cartilage could be detected. The authors conclude that MR chondro-crassometry can provide accurate and reproducible information on cartilage thickness.