Magnetic resonance imaging of superficial cartilage lesions: Role of contrast in lesion detection

Abstract

Excised patellar cartilage phantoms with artificial surface lesions were imaged in a 2 g/dl albumin solution to determine the effect of cartilage/fluid contrast on detection of early degenerative change. Surface lesions consisted of full-thickness holes, superficial grooves, and coarse abrasion. Phantoms were imaged with a T1-weighted fast lowangle shot (FLASH) and T2*-weighted dual-echo in the steady state (DESS) sequence. Although both sequences were able to identify full-thickness holes, they underestimated the presence of superficial grooves and extent of fibrillation. Despite greater bulk tissue contrast between cartilage and fluid for the FLASH sequence, detection of fibrillation was poorer compared with the DESS images. The results of this study suggest that surface properties of fibrillated cartilage contribute significantly to the insensitivity of magnetic resonance imaging in detecting superficial lesions. In contrast to previous papers suggesting that T1-weighted spoiled gradient-echo imaging provides the greatest accuracy for lesion detection, our results indicate that, in the presence of joint fluid, T2*-weighted imaging increases detection of superficial lesions.

The Clinical Utility and Diagnostic Performance of Magnetic Resonance Imaging for Identification of Early and Advanced Knee Osteoarthritis

“…The relatively poor performance of some MRI studies in detecting early articular cartilage degeneration may be attributable to suboptimal spatial resolution, signal-to-noise ratio, artifacts, and tissue contrast as well as difficulty in capture and integration of cartilage in multiple planes. 7, 24, 61, 76, 77 Approximately 0.3 mm in-plane spatial resolution is necessary to identify superficial articular cartilage changes, consistent with grade 1 articular cartilage degeneration, which is beyond the capabilities and time constraints of most MRI protocols utilized in clinical practice. 77 …”

“…18 As the imaging technology has improved in terms of magnet strength, sequence utilization, and spatial resolution, so has the diagnostic performance. 34, 39, 41, 42, 61, 85, 87, 90 To date, no systematic reviews on MRI diagnosis and grading of osteoarthritis thoroughly summarize the literature as it relates to the sensitivity, specificity, accuracy, and reliability of MRI compared to arthroscopy. Without a comprehensive understanding of the diagnostic utility of MRI to characterize the severity of structural articular cartilage changes by articular cartilage degeneration grades, insight into its use as a non-invasive and evidence based tool to guide diagnostic and treatment practices remains limited.…”

MR imaging of osteochondral grafts and autologous chondrocyte implantation

“…Caution should be exercised as a flare phenomenon in the double-echo steady-state sequence has been shown to sometimes cause a spurious wavy appearance of a normal graft or cartilage surface [41, 42]. Furthermore, there are limitations in the sensitivity of the fast low angle shot (FLASH) and double-echo steady-state sequences for depicting cartilage abnormalities and opinions vary regarding which sequence is superior for cartilage imaging [42–44]. …”

Cartilage morphology at 3.0T: Assessment of three‐dimensional magnetic resonance imaging techniques

“…3D-SPGR (9) has a relatively long imaging time of 5–10 minutes and relative T1-weighting with dark synovial fluid that has traditionally been favored for cartilage thickness measurements. However, sequences that also have successfully evaluated cartilage morphology, such as dual-echo steady state (DESS) (10,11), have bright synovial fluid that highlights cartilaginous fissures and surface defects (12). The main challenge of bSSFP and its variants has been preventing banding artifact in areas of main field inhomogeneity (13).…”