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Imaging of Patellar Cartilage with a 2D Multiple-Echo Data Image Combination Sequence

¹ Department of Radiology, University Hospital Balgrist, Forchstrasse 340, Zurich CH-8008, Switzerland.
² Department of Orthopedic Surgery, University Hospital Balgrist, Zurich CH-8008, Switzerland.
³ MR Applications Development, Siemens Medical Solutions, Erlangen, Germany.

OBJECTIVE. We sought to evaluate the diagnostic value of a 2D multiple-echo data image combination (MEDIC) MRI sequence in the detection of patellar cartilage defects.

MATERIALS AND METHODS. Our study included 52 consecutive patients who had knee surgery within 4 months of undergoing an MRI examination including an axial 2D MEDIC (TR/TE, 884/26; flip angle, 30°) sequence. Cartilage was surgically graded on a 5-point scale: 0, normal; 1, softening or swelling; 2, partial thickness defect; 3, fissuring to the level of the subchondral bone; or 4, exposed subchondral bone. Cartilage was graded on MRI according to a scale that was almost identical to the surgical scale except that grade 1 lesions were defined as signal alteration or swelling of cartilage. Two blinded reviewers independently analyzed patellar cartilage. Sensitivity, specificity, accuracy, and weighted kappa values for interobserver variability were calculated.

RESULTS. Low-grade cartilage lesions predominated in our study group. When grade 2 or higher was considered the threshold for relevance, the sensitivity, specificity, and accuracy for the MEDIC sequence was as high as 79%, 82%, and 81%, respectively. Increasing the threshold of relevance to grade 3 increased the sensitivity, specificity, and accuracy to as high as 83%, 91%, and 90%, respectively. Interobserver agreement for the MEDIC sequence was good (weighted = 0.68).

CONCLUSION. The 2D MEDIC sequence performs comparably to previously described sequences optimized for cartilage imaging such as the 3D double-echo steady-state or 3D spoiled gradient-recalled sequences with good interobserver agreement, high sensitivity, and excellent specificity for revealing low- to intermediate-degree cartilage defects.

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