Degenerative joint disease on MRI and physical activity: a clinical study of the knee joint in 320 patients

We examined 320 patients with MRI and arthroscopy after an acute trauma to evaluate MRI in diagnosis of degenerative joint disease of the knee in relation to sports activity and clinical data. Lesions of cartilage and menisci on MRI were registered by two radiologists in consensus without knowledge of arthroscopy. Arthroscopy demonstrated grade-1 to grade-4 lesions of cartilage on 729 of 1920 joint surfaces of 320 knees, and MRI diagnosed 14 % of grade-1, 32 % of grade-2, 94 % of grade-3, and 100 % of grade-4 lesions. Arthroscopy explored 1280 meniscal areas and showed degenerations in 10 %, tears in 11.4 %, and complex lesions in 9.2 %. Magnetic resonance imaging was in agreement with arthroscopy in 81 % showing more degenerations but less tears of menisci than arthroscopy. Using a global system for grading the total damage of the knee joint into none, mild, moderate, or severe changes, agreement between arthroscopy and MRI was found in 82 %. Magnetic resonance imaging and arthroscopy showed coherently that degree of degenerative joint changes was significantly correlated to patient age or previous knee trauma. Patients over 40 years had moderate to severe changes on MRI in 45 % and patients under 30 years in only 22 %. Knee joints with a history of trauma without complete structural or functional reconstitution showed marked changes on MRI in 57 %, whereas stable joints without such alterations had degenerative changes in only 26 %. There was no correlation of degenerative disease to gender, weight, type, frequency, and intensity of sports activity. Therefore, MRI is an effective non-invasive imaging method for exact localization and quantification of chronic joint changes of cartilage and menisci that recommends MRI for monitoring in sports medicine. Received: 28 July 1997; Revision received: 9 February 1998; Accepted: 20 March 1998     

膝关节骨挫伤的MR诊断与临床分析

 目的探讨膝关节骨挫伤的MR诊断价值.方法回顾分析32例骨挫伤的MR表现,并与临床资料相对照.结果本组32例膝关节骨挫伤MR均表现信号异常,为骨骺或于骺端松质骨内斑片状、地图状或网状信号,自旋回波SE序列及快速自旋回波FSE序列T1W呈低或等信号,T2W呈混杂高信号,境界不清,梯度回波脂肪抑制GE序列及短时反转恢复STIR序列病变T2W呈显著高信号,境界清晰.膝关节骨挫伤扭伤多见,常位于胫骨平台后外侧、股骨外髁和胫骨平台内侧,可合并半月板、前交叉韧带和侧副韧带损伤,14例临床症状消失后复查MR示骨挫伤信号恢复正常.结论MR能揭示膝关节骨挫伤的病理改变,准确判断有无其他结构的损伤,是膝关节骨挫伤的最佳检查手段.     

MRI和关节镜诊断膝半月板损伤的比较研究

目的 :探讨膝关节半月板损伤MRI和关节镜下的不同表现及其对半月板损伤的诊断意义。方法 :回顾性分析 10 2个半月板损伤的MRI表现和关节镜下图像。根据MRI信号改变将半月板损伤分为Ⅰ级、Ⅱ级、Ⅲ级 ,并与关节镜下所见对比 ,分别加以研究。结果 :根据MRI信号强度改变 ,10 2个膝关节中Ⅰ级损伤 3 4个 ,Ⅱ级损伤 2 7个 ,Ⅲ级损伤 41个。与关节镜检结果对比 ,MRI诊断半月板撕裂的敏感度 90 .0 % ,特异度 91.9% ,符合率 91.2 %。结论 :MRI在半月板损伤的诊断中具有极高价值 ,对指导患者的治疗具有重要的临床意义。     

膝关节损伤核磁共振成像诊断分析

目的探讨G-SCAN检查对膝关节损伤的诊断价值。方法 120例膝关节损伤,采用G-SCAN（0.25T可旋转式核磁共振成像仪）膝关节表面线圈检查,分别采用自旋回波序列、梯度回波序列、脂肪抑制序列,做矢状位、冠状位及横断位扫描。结果 G-SCAN可以清楚显示膝关节半月板、韧带及骨挫伤。本组120例病例中,半月板损伤95例,其中单纯外侧半月板损伤63例,单纯内侧半月板损伤8例,内、外侧半月板同时损伤24例;韧带损伤85例,其中前交叉韧带损伤68例,后交叉韧带损伤19例,胫侧副韧带损伤65例,腓侧副韧带损伤5例;骨挫伤35例,其中单纯胫骨挫伤22例,单纯股骨挫伤5例,胫骨及股骨同时挫伤8例。结论 G-SCAN是诊断膝关节结构损伤的最佳检查方法之一,可为临床医生选择合适的治疗方法提供依据,具有重要的临床价值。     

Imaging of the knee joint with emphasis on magnetic resonance imaging

The knee joint is frequently affected by trauma as well as degenerative and inflammatory disorders, involving the internal structures (i.e. ligaments, menisci, cartilage, synovial membrane) and the adjacent bones. Plain radiographs represent an indispensable basis for diagnosis. For further analysis magnetic resonance imaging (MRI) has become the method of choice, and has widely replaced computed tomography, arthrography and stress examinations. Extensive experience has been accumulated in MRI of the knee joint in recent years. In addition, advances in MRI technology have had a major impact on diagnostic accuracy. In this paper, diagnosis of various lesions of the knee joint, such as meniscal and ligamental injuries, aseptic necrosis, lesions of the hyaline cartilage, occult fractures and inflammatory lesions will be discussed. Offprint requests to: M. F. Reiser     

膝关节半月板损伤的MRI诊断及分类

半月板损伤是膝关节紊乱最常见的原因之一。磁共振检查是目前最敏感最准确的检查方法，面且对半月板撕裂的类型能做出较准确的判断。     

Magnetic resonance in cartilaginous lesions of the knee joint with three-dimensional gradient-echo imaging

Diagnosis of chondromalacia of the patellofemoral joint using three-dimensional gradient-echo sequences was investigated in 41 patients, with arthroscopic verification in 25 patients. In vitro examinations in human caderveric patellae were performed in order to determine optimal imaging parameters. FLASH (T_R=40 ms, T_E=10 ms, flip angle=30°) and FISP (T_R=40 ms, T_E=10 ms, flip angle=40°) were used in clinical studies. Advanced stages of chrondromalacia could be visualized with high sensitivity. The therapeutically relevant differentiation of major and minor degrees of chondromalacia seems to be possible. 30° FLASH-images in the axial plane proved to be the most efficacious technique for the diagnosis of chondromalacia.     

Fast magnetic resonance imaging of the knee using a parallel acquisition technique (mSENSE): a prospective performance evaluation

The performance of a magnetic resonance (MR) imaging strategy that uses multiple receiver coil elements and integrated parallel imaging techniques (iPAT) in traumatic and degenerative disorders of the knee and to compare this technique with a standard MR imaging protocol was evaluated. Ninety patients with suspected internal derangements of the knee joint prospectively underwent MR imaging at 1.5 T. For signal detection, a 6-channel array coil was used. All patients were investigated with a standard imaging protocol consisting of different turbo spin-echo sequences proton density (PD), T₂-weighted turbo spin echo (TSE) with and without fat suppression) in three imaging planes. All sequences were repeated with an integrated parallel acquisition technique (iPAT) using the modified sensitivity encoding (mSENSE) algorithm with an acceleration factor of 2. Two radiologists independently evaluated and scored all images with regard to overall image quality, artefacts and pathologic findings. Agreement of the parallel ratings between readers and imaging techniques, respectively, was evaluated by means of pairwise kappa coefficients that were stratified for the area of evaluation. Agreement between the parallel readers for both the iPAT imaging and the conventional technique, respectively, as well as between imaging techniques was found encouraging with inter-observer kappa values ranging between 0.78 and 0.98 for both imaging techniques, and the inter-method kappa values ranging between 0.88 and 1.00 for both clinical readers. All pathological findings (e.g. occult fractures, meniscal and cruciate ligament tears, torn and interpositioned Hoffa’s cleft, cartilage damage) were detected by both techniques with comparable performance. The use of iPAT lead to a 48% reduction of acquisition time compared with standard technique. Parallel imaging using mSENSE proved to be an efficient and economic tool for fast musculoskeletal MR imaging of the knee joint with comparable diagnostic performance to conventional MR imaging.Karl-Friedrich Kreitner and Bernd Romaneehsen contributed equally to this work.     

Giant synovial cyst of knee treated arthroscopically through a cystic portal

Synovial cysts are well-defined fluid filled cysts that can extend for a variable distance outside the joint space. These cysts can sometimes grow to a large size making its treatment challenging especially when associated with intra-articular pathologies.We describe a case of giant synovial cyst arising from the left knee and extending to the medial proximal calf in a 77-year old female who presented with knee joint pain, episodes of locking and calf mass occurring within 2 months of onset. Imaging studies also showed associated medial and lateral meniscal tears with medial compartment and patellofemoral osteoarthritis. The cyst was treated by disrupting the valvular mechanism using a standard posteromedial portal and complete excision of the cyst wall via a posteromedial cystic portal. The meniscal lesions were dealt with through the standard anterior portals. At 25-month follow up there were no signs of recurrence of the cyst clinically or with MRI. The cystic portal technique is effective in treating a giant synovial cyst of the knee even in the presence of meniscal tears and high grade chondral lesions. An erratum to this article can be found at     

膝创伤后滑膜炎的关节镜治疗

目的 探讨关节镜在膝关节创伤后滑膜炎中的治疗作用。方法 1987年9月-2000年8月共收治36例，以膝关节肿胀为主要临床表现16例，以“机械型”疼痛为主者12例，两者均有8例，术前均经体检及X线检查，其中7例行MRI检查排除其他损伤，常规关节镜检查后行滑膜切除术。结果 局限性滑膜炎24例，弥漫性炎症12例，镜下表现分为渗出型7例，增生型23例，纤维型6例，9例发现其他病变，32例经平均3.7年随访，28例疗效评定为优良（87.5%)，临床表现关节肿胀为主和镜下渗出型及增生型者关节镜治疗效果较好。结论 关节镜手术治疗膝创伤后滑膜炎既可发现可能存在其他病变，又有良好的效果。     

Intra-articular ganglion cysts of the knee joint: a report of 85 cases and review of the literature

Intra-articular ganglia and cysts of the knee joint are rare and mostly incidental findings in MRI and arthroscopy. During a period of 15 years, nearly 8,000 knees were arthroscopically examined. In total, 85 intra-articular soft tissue masses were found within the knee cavity. Of these, 76 were incidental and asymptomatic findings in arthroscopy performed for treatment of osteoarthritic symptoms. Several repeated minor knee traumata were reported in this group but no histories of serious traumatic events. Nine ganglion cysts were obviously solely responsible for the intermittent or chronic non-specific knee discomfort, and classified as symptomatic. There were no histories of previous injury to the knees, no clinical signs of instabilities or meniscal and femoropatellar pathologies, and no associated further intra-articular lesions in arthroscopy. Forty-nine cystic masses originated from the ACL, 16 from the PCL, 12 from the anterior (eight medial, four lateral) and three from the posterior horn of the menisci (two medial, one lateral). Three were located in the infrapatellar fat pad, one arose from a medial plica and one from a subchondral bone cyst. All ganglion cysts were successfully resected or excised using arthroscopic technique. A review of the literature is given and compared with the findings and data of this study.     

Internal derangements of the knee associated with patellofemoral joint degeneration

The objective of the present study was to evaluate whether internal derangements of the knee joint are associated with patellofemoral joint (PFJ) degeneration. Data were collected prospectively from 1,000 consecutive knee arthroscopies. Chondral lesions were observed in 854 patients, and these patients were included in this study. Patients details (age, sex, duration of symptoms, injuries, and possible mechanism of injury), operative details (types and number of portals, equipment used), intra-articular findings (articular, meniscal and synovial lesions, and stability characteristics) and procedures performed were recorded. Articular lesions were noted on anatomic articular maps of the different functional zones, using a system which presaged the current ICRS system. Using this zoning system, it was easy for the authors to separate the patients with isolated patellofemoral degeneration and arthritis and to do the statistical analysis. Increased incidence of isolated patellofemoral degeneration was noted in patients with synovial shelves, in comparison with patients without shelves (24.7% vs. 15.5%, respectively; P=0.001). Patients with severe patellofemoral maltracking were found to have increased incidence of isolated patellofemoral degeneration in comparison with patients without patella maltracking (64.7% vs. 18% respectively; P<0.001). In conclusion, patellofemoral maltracking and synovial shelves of the knee are highly associated with PFJ degeneration. On the contrary, meniscal tears and ligamentous injuries are associated mainly with degeneration of other compartments of the knee joint and not the PFJ.     

Reactive synovitis of the knee joint: MR imaging appearance with arthroscopic correlation

Objective. To evaluate the use of routine MR imaging sequences in detecting and characterizing secondary reactive synovitis of the knee joint using arthroscopy as the standard of reference. Design and patients. Fifty consecutive patients with a history of knee pain who were referred for MR imaging and subsequently underwent arthroscopy of the knee comprised the study group. MR images were evaluated for the presence and appearance of synovitis reflected in synovial thickening and irregularity. Synovial thickening was graded on MR imaging as follows: 0=normal, 1=thin line of increased signal intensity, 2=increased signal intensity with frond-like or hair-like projections and a granular appearance of joint fluid. Standard knee imaging protocols were used. Results. The sensitivity, specificity, and accuracy of MR imaging in detecting synovitis compared with arthroscopy were 88%, 97%, and 95%, respectively. Grade 1 synovitis was best seen on proton-density-weighted images, demonstrating increased signal intensity of the synovium against the relatively low signal intensity of the joint fluid. Grade 2 synovitis was best seen on proton-density images and T2-weighted spin echo and fast spin echo images with fat saturation, demonstrating a granular and linear hair-like appearance of joint fluid. Axial and sagittal imaging planes were most helpful in the diagnosis of synovitis. Conclusion. Routine MR pulse sequences are useful in identifying the presence and extent of synovial abnormalities. The detection of different stages of synovial pathology should become an important part of the evaluation of the post-traumatic patient as treatment may be altered as a result. Received: 17 March 2000 Revision requested: 5 May 2000 Revision received: 8 June 2000 Accepted: 8 June 2000     

Three-dimensional delayed gadolinium-enhanced magnetic resonance imaging of hip joint cartilage at 3T: A prospective controlled study

Purpose

To assess acetabular and femoral hip joint cartilage with three-dimensional (3D) delayed gadolinium-enhanced magnetic resonance imaging (dGEMRIC) in patients with degeneration of hip joint cartilage and asymptomatic controls with morphologically normal appearing cartilage.

Methods and materials

A total of 40 symptomatic patients (18 males, 22 females; mean age: 32.8 ± 10.2 years, range: 18–57 years) with different hip joint deformities including femoroacetabular impingement (n = 35), residual hip dysplasia (n = 3) and coxa magna due to Legg–Calve–Perthes disease in childhood (n = 2) underwent high-resolution 3D dGEMRIC for the evaluation of acetabular and femoral hip joint cartilage. Thirty-one asymptomatic healthy volunteers (12 males, 19 females; mean age: 24.5 ± 1.8 years, range: 21–29 years) without underlying hip deformities were included as control. MRI was performed at 3 T using a body matrix phased array coil. Region of interest (ROI) analyses for T1_Gd assessment was performed in seven regions in the hip joint, including anterior to superior and posterior regions.

Results

T1_Gd mapping demonstrated the typical pattern of acetabular cartilage consistent with a higher glycosaminoglycan (GAG) content in the main weight-bearing area. T1_Gd values were significantly higher in the control group than in the patient group whereas significant differences in T1_Gd values corresponding to the amount of cartilage damage were noted both in the patient group and in the control group.

Conclusions

Our study demonstrates the potential of high-resolution 3D dGEMRIC at 3 T for separate acetabular and femoral hip joint cartilage assessment in various forms of hip joint deformities.     

High-resolution magnetic resonance imaging of arthritic pathology in the rat knee

High-resolution magnetic resonance imaging (MRI) has been used to visualise the changes that occur in both soft tissue and bone during antigen-induced, monoarticular arthritis (AIMA) of the rat knee. Extensive optimisation studies were performed in order to minimise the time of the experiments and to maximise both the signal-to-noise ratio and the contrast in the MR images. The study was cross-sectional rather than longitudinal and at each of the 13 time points studied during the progression of the disease, corresponding X-radiographs and histological sections were obtained. Interpretation of the spin echo MR images was aided by the use of chemical shift-selective imaging, magnetisation transfer contrast and relaxation time experiments, as well as by correlation with the histology and X-radiography data. The MR images clearly show invasion of the synovium by an inflammatory pannus which spreads over the articular cartilage and invades the bone, leading to erosion and later remodelling. Two distinct types of bony erosion were observed: focal erosions, especially at the margins of the joint, and subchondral erosions. It is concluded that MRI provides a sensitive, non-invasive method for investigating both early-stage inflammatory changes and late-stage bony changes in the knee joints of the arthritic rat.     

膝关节半月板撕裂的磁共振诊断：附61例关节镜对照分析

目的：比较分析半月板撕裂的ＭＲＩ表现和关节镜所见，明确半月板撕裂ＭＲＩ成像的作用和价值。材料和方法：对一组６１例（６８膝）ＭＲＩ资料的影像学特征与关节镜所见作对照分析，ＭＲＩ半月板内异常高信号影的判断采用Ｌｏｔｙｓｃｈ提出的分级标准。结果：ＭＲＩ对半月板损伤的诊断敏感性为９５％，特异性为８８％，关节镜符合率为９２％。ＭＲ的Ⅲ级信号与关节镜所见半月板撕裂具有高度相关性，其中Ⅲ级信号仅见于一层和见于一层以上者分别与半月板撕裂的对应关系有显著差别。病变信号发生部位及其与半月板特定表面的关系对诊断结果无影响。结论：ＭＲＩ对膝关节半月板撕裂的诊断极有价值，半月板内Ⅲ级信号是诊断半月板撕裂的可靠征象，而当Ⅲ级信号影仅见于一层时，诊断须慎重。     

Magnetic resonance imaging of knee trauma

This article reviews the magnetic resonance (MR) appearance of normal knee anatomy and the role of MRI in the evaluation of knee trauma. Images acquired in the sagittal plane are the most useful. A combination of T₁- and T₂-weighted spin echo pulse sequences is most commonly employed. A meniscal tear is identified by an intrameniscal signal which extends to the joint surface. MR and arthroscopic findings agree in more than 90% of patients. It is important to be familiar with the MRI appearance of normal anatomic variants that may be confused with meniscal tears: the transverse geniculate ligament, the hiatus of the popliteal tendon sheath, and the meniscofemoral ligaments. Tears in the anterior cruciate, posterior cruciate, and collateral ligaments are also depicted.The following article is one in a series of review articles which represent expansions of papers presented at the annual meeting of the International Skeletal Society and were solicited by the editors     

Retears of postoperative knee meniscus: findings on magnetic resonance imaging (MRI) and magnetic resonance arthrography (MRA) by using low and high field magnets

PURPOSE: The purpose of this study was to determine the diagnostic performance of magnetic resonance (MR) obtained with intra-articular contrast medium in the evaluation of recurrent meniscal tears using low-field extremity-only and high-field whole-body magnets. MATERIALS AND METHODS: Postoperative standard MR examinations and MR arthrographies of 95 knees were reviewed. Patients experiencing pain and disability after meniscal repair underwent standard MR and MR arthrography (Gadoterate meglumine 0.0025 mmol/ml) on both a 0.2-T and 1.5-T magnet. In 52 of 95 patients, second-look arthroscopy was performed; in the remaining 43 of 95 patients, clinical follow-up was used as the standard of reference. Sensitivity, specificity, positive and negative predictive values as well as accuracy of MRI/MR arthrographic signs as meniscal morphologic changes and the presence of contrast medium tracking into the tear at T1- and T2-weighted sequences in the detection of recurrent meniscal tears were determined. RESULTS: All MR and MR arthrograpic signs were sensitive in the detection of recurrent tears (range 80-91%). Abnormal meniscal morphology had low specificity [26% (13/50)] for both the 0.2-T and 1.5-T scanner, whereas accuracy was 55% (52/95) and 57% (54/95), respectively. The presence of contrast medium within the meniscus substance on T2-weighted images had higher value of specificity [84% (42/50)] and accuracy [84% (80/95)] by using low field strength magnet than by using high field strength magnet [74% (37/50) and 81% (77/95), respectively]. Whereas, the increased intrameniscal signal intensity extending to the meniscal surface at T1-weighted sequences after intra-articular contrast medium administration had lower specificity and accuracy on 0.2-T images [84% (42/50) and 82% (78/95), respectively] than on 1.5-T images [90% (45/50) and 88% (84/95), respectively]. CONCLUSION: A diagnosis of recurrent meniscal tear in a previously arthroscopically repaired meniscus can be made both on 0.2-T and 1.5-T magnets on the basis of increased signal on T2-weighted and T1-weighted images in the presence of intra-articular contrast material.     

Bilateral lipoma arborescens of the knee in a child: a case report

We report a case of childhood lipoma arborescens of both knee joints who had been erroneously diagnosed to have initially acute rheumatic fever and subsequently oligoarticular juvenile rheumatoid arthritis. She had taken anti-inflammatory medication for 8 years without remission of the effusion. Magnetic resonance imaging (MRI) and synovectomy revealed the diagnosis of lipoma arborescens. Lipoma arborescens should be kept in mind in the differential diagnosis of refractory chronic joint effusion and synovial hypertrophy in the childhood period, and MRI yields the correct diagnosis in this setting.     

膝关节交叉韧带低场强MRI表现及其损伤诊断

目的 :研究膝关节正常交叉韧带MRI特点和交叉韧带损伤的的MRI表现。方法 :对 2 0 0例正常膝关节交叉韧带的MRI进行回顾性分析 ,对 2 5例临床可疑交叉韧带损伤患者的MRI资料和关节镜检查行对比研究。结果 :正常膝关节矢状位MRI上显示交叉韧带最佳 ,冠状位和横断位作为补充 ,交叉韧带损伤的MRI表现为韧带连续性中断、局灶性或弥漫性肿胀、信号强度增高及断端移位 ;以关节镜检查结果为标准 ,MRI诊断交叉韧带损伤的敏感度为 91.3 % ,特异度为 91.6% ,符合率为 91.4%。结论 :MRI多方位扫描是一种准确诊断交叉韧带损伤的方法 ,矢状位显示交叉韧带最佳。