MR imaging of articular cartilage in the ankle: comparison of available imaging sequences and methods of measurement in cadavers

Tan, Terence; Wilcox, Dennis M.; Frank, Lawrence R.; Shih, Chunhsi; Trudell, D.; Sartoris, David J.; Resnick, Donald

doi:10.1007/s002560050173

Cited by 61 publications

(33 citation statements)

References 21 publications

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“…Our low detection rate of chondral lesions by MRI support a previous report suggesting these lesions are difficult to observe in the ankle [26] and in the knee using conventional MRI techniques [5,13,14,22]. Although meniscus and ligament injuries are easily imaged, arthroscopy is required to see articular cartilage injuries in the knee [5,14].…”

Section: Discussionsupporting

confidence: 82%

“…Because MRI detects subchondral changes, more superficial lesions are less likely to be imaged [25]. Other MRI factors that may affect accuracy include the type of sequence [5,16,17,27], power of the magnet [11,12,26], and positioning [21]. The articular cartilage in the ankle is thinner than in the knee [23], there is close tibiotalar apposition, and the bony anatomy is more complex, all of which could complicate accurate observation of chondral lesions by MRI in the ankle as compared with the knee.…”

Section: Discussionmentioning

confidence: 99%

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Is MRI Adequate to Detect Lesions in Patients with Ankle Instability?

O’Neill

Aman

Guyton

2010

Clinical Orthopaedics &Amp; Related Research

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Background Chondral lesions, peroneal tendon tears, and other disorders in patients with chronic ankle instability may not be detected by preoperative MRI. Also, MRI often is obtained and interpreted at the referring institution, leading to variability in reading. Questions/PurposesWe assessed the accuracy of the radiologists' and orthopaedic surgeon's reading of preoperative MRI for diagnosing ankle lesions in patients with ankle instability warranting surgery. Patients and Methods We retrospectively reviewed 133 patients who underwent 135 surgeries for lateral ankle ligament reconstruction with concomitant ankle arthroscopy and who had preoperative MRI. Results We found 72 associated lesions in 66 of the 135 surgeries, including 38 chondral injuries, 18 peroneus brevis tears, seven loose bodies, and nine other miscellaneous abnormalities. Eliminating eight lesions for which the decision to operate was not based on operative findings, there were 127 surgeries with 64 associated lesions that required intraoperative confirmation or were detected intraoperatively. In the original reports, the radiologists identified 39% (15) of the chondral injuries, 56% (10) of the peroneal tears, and 57% (four) of the loose bodies. Radiologists' MRI sensitivity for detecting lesions was 45%. The attending surgeon identified 47% (18) of the chondral injuries, 89% (16) of the loose bodies, 71% (five) of the peroneus brevis tears, and the posterior talus process lesion, with a sensitivity of 63%. ConclusionsOur data suggest orthopaedic surgeons should review preoperative MRIs and also suggest the sensitivity of MRI may not be adequate to detect lesions in these patients before surgery.

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Section: Discussionsupporting

confidence: 82%

Section: Discussionmentioning

confidence: 99%

Is MRI Adequate to Detect Lesions in Patients with Ankle Instability?

O’Neill

Aman

Guyton

2010

Clinical Orthopaedics &Amp; Related Research

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“…These new sequences offer the possibility to acquire 3D data sets with isotropic voxels, which provides excellent segmentation possibilities. 56,57 The values for mean and maximum cartilage thickness of the talus, tibia, and fibula measured using this approach are greater than those previously reported using a number of different techniques including A-mode ultrasound, 58 MRI, 17,40 and force-needle probes. 59,60 However, it is important to note that these studies excluded the highly curved regions over the talar shoulders, which have been shown to be the site of maximum cartilage thickness.…”

Section: Discussionmentioning

confidence: 55%

“…We have demonstrated that the mean and maximum thickness of each layer of ankle cartilage exceed the measurements previously reported. 17,40,[58][59][60] We have shown that, by using a dGVF snake segmentation algorithm combined with an anisotropic diffusion denoising algorithm, we can extract the cartilage layer more precisely than previously achieved 17 in the ankle joint. Finally, the 3D thickness distribution maps have shown a characteristic pattern with the thickest cartilage occurring over the anterior-lateral and posterior-medial talar shoulders, where OCD lesions commonly occur.…”

Section: Discussionmentioning

confidence: 99%

“…Unfortunately, the resolution of the sequence for the ankle joint (0.625 Â 0.625 Â 1.5 mm 39 ) is not suitable for precise quantification of cartilage thickness and volume. Similarly, the sequence used by Tan et al 40 lacked sufficient resolution (0.83 Â 0.625 Â 3.0 mm) which combined with the use of a thresholding technique to measure thickness led to errors of AE100% in their measurements. Al-Ali et al 17 and Eckstein et al 41 used a B-spline snake image segmentation program and reconstructed the cartilage layers of the talar dome and tibial plafond after image interpolation.…”

Section: Introductionmentioning

confidence: 99%

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Quantitative and topographical evaluation of ankle articular cartilage using high resolution MRI

Millington

Tang

et al. 2006

Journal Orthopaedic Research

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The objectives of this study were to quantitatively evaluate the articular cartilage layers of the ankle and describe the cartilage topographical distribution across the joint surfaces using high resolution MRI and image segmentation. An anisotropic diffusion noise reduction algorithm and a directional gradient vector flow (dGVF) snake segmentation algorithm were applied to cartilage sensitive MR images. Eight cadaveric ankles were studied. Six repeated data sets were acquired in five of the ankles. Quantitative parameters were calculated for each cartilage layer; coefficients of variation (CV) were calculated from the six repeated data sets; and 3D thickness distribution maps were generated. The noise reduction algorithm produced marked image enhancement. Mean cartilage thickness ranged from 0.91 AE 0.08 mm in the fibula to 1.34 AE 0.14 mm in the talus. Mean cartilage volume was 3.32 AE 0.55 ml, 1.72 AE 0.25 ml, and 0.35 AE 0.06 ml for the talus, tibia, and fibula, respectively. Mean CV ranged 2.82%-5.04% for quantitative parameters in the talus and tibia. The reported noise reduction and segmentation technique allow precise extraction of ankle cartilage and 3D reconstructions show that the thickest cartilage occurs over the talar shoulders, where osteochondritits dissecans (OCD) lesions commonly occur. ß

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Imaging articular cartilage defects in the ankle joint with 3D fat‐suppressed echo planar imaging: Comparison with conventional 3D fat‐suppressed gradient echo imaging

Ba‐Ssalamah

Schibany

Puig

et al. 2002

Magnetic Resonance Imaging

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Purpose: To shorten the examination time for articular cartilage imaging, using a recently developed three-dimensional (3D) multishot echo planar imaging (EPI) sequence with fat saturated (FS), compared to aconventional 3D fatsaturated spoiled gradient echo sequence (3D FS GRE). Material and Methods:There were 32 consecutive patients with ankle joint disorders who underwent magnetic resonance imaging (MRI) in a 1.0-T unit. Hyaline cartilage was imaged with a 3D FS EPI sequence and a 3D FS GRE sequence. Image assessment criteria included lesion conspicuity, contrast between different types of normal tissue, and image artifacts. In addition, contrast-to-noise ratios (CNRs) of cartilage vs. joint fluid and bone marrow were measured. Results:The 3D FS EPI sequence provided a high CNR between cartilage and subchondral bone, similar to that of the 3D FS GRE sequence. The CNR between cartilage and effusion was significantly lower on the 3D EPI sequence due to the higher signal intensity of fluid. Both sequences were equal in lesion detection ability. The image quality of the 3D FS GRE sequence was slightly higher than that of the 3D FS EPI, but the difference was not statistically significant. Conclusion:We conclude that the 3D FS EPI sequence is comparable to the 3D FS GRE sequence in the detection of cartilage lesions, with the additional advantage of reduction in scan time by a factor of 4. TO DATE, MAGNETIC RESONANCE IMAGING (MRI) has been the best method for the noninvasive visualization of articular cartilage. Although spin echo (SE), fast spin echo (FSE), magnetization transfer contrast (MTC), and gradient echo (GRE) sequences are well established for detection of internal derangements of the ankle joint, these MR sequences are sometimes not sensitive enough for the evaluation of abnormalities of the hyaline articular cartilage (1-9). This is due to the lack of thin-section acquisition, which allows accurate volumetric measurements not only of the cartilage layers of the knee joint, but also of smaller joints, such as the ankle joint.Volume acquisition with 3D GRE sequences provides a high signal-to-noise ratio (SNR) and minimal effective slice thickness with consecutive reduction of partial volume artifacts, and the possibility of multiplanar reconstructions (10). The addition of frequency-selective fat saturation (FS) to 3D T1-weighted GRE sequences results in a significant increase in the contrast-to-noise ratios (CNRs) between cartilage and joint fluid and between cartilage and subchondral bone, demonstrating articular cartilage as a band of high signal intensity (11). Thus, the 3D FS T1-weighted GRE sequence has been reported to be one of the most sensitive techniques for the routine evaluation of articular cartilage lesions (4,(12)(13)(14). A disadvantage of this technique, however, is the relatively long examination time, which makes this sequence less attractive for routine clinical application.Echo planar imaging (EPI) with a multishot technique is now available on routine MR scanners and can be used to...

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MR imaging of articular cartilage in the ankle: comparison of available imaging sequences and methods of measurement in cadavers

Abstract: Of the sequences and measurement techniques studied, the FS-SPGR sequence combined with the use of digitized image analysis provides the most accurate method for the assessment of ankle hyaline cartilage.

Cited by 61 publications

References 21 publications

Is MRI Adequate to Detect Lesions in Patients with Ankle Instability?

Is MRI Adequate to Detect Lesions in Patients with Ankle Instability?

Quantitative and topographical evaluation of ankle articular cartilage using high resolution MRI

Imaging articular cartilage defects in the ankle joint with 3D fat‐suppressed echo planar imaging: Comparison with conventional 3D fat‐suppressed gradient echo imaging

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