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Grading Articular Cartilage of the Knee Using Fast Spin-Echo Proton Density-Weighted MR Imaging Without Fat Suppression

Andrew H. Sonin1,2,3, Raymond A. Pensy1, Michael E. Mulligan1 and Stephen Hatem1,4

1 Department of Radiology, University of Maryland, 22 S. Greene St., Baltimore, MD 21201-1595.
2 Present address: Radiology Imaging Associates, 8200 E. Belleview Ave., Ste. 124, Greenwood Village, CO 80111.
3 Department of Radiology, University of Colorado School of Medicine, 4200 E. Ninth St., Denver, CO 80262.
4 Present address: Department of Radiology (A-21), Cleveland Clinic Foundation, 9500 Euclid Ave., Cleveland, OH 44195-5021.



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  		Fig. 1. —Proven normal patellofemoral cartilage in 20-year-old woman college basketball player with knee pain after fall who was found at surgery to have tear of anterior cruciate ligament. Axial fast spin-echo proton density-weighted MR image shows anterior cruciate ligament tear, seen as absence of anterior cruciate ligament fibers at its site of attachment on lateral femoral condyle (straight black arrow). Cartilage surfaces were normal. Signal intensity of hyaline cartilage (short white arrows) is intermediate between that of joint fluid (curved arrow) and that of cortical bone (long white arrows).

 


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  		Fig. 2A. —Proven full-thickness defect in patella and normal femoral and tibial cartilages in 24-year-old man, a professional football player with knee pain. Coronal fast spin-echo proton density—weighted MR image shows intact hyaline cartilage (small arrows) as intermediate signal intensity. Note clear visualization of anterior cruciate ligament (short thick arrow) and menisci (long thin arrow).

 


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  		Fig. 2B. —Proven full-thickness defect in patella and normal femoral and tibial cartilages in 24-year-old man, a professional football player with knee pain. Axial fast spin-echo proton density—weighted MR image shows well-defined full-thickness defect in patellar apex (large arrow). Small cartilage fragments are seen in defect and free in joint (small arrows).

 


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  		Fig. 2C. —Proven full-thickness defect in patella and normal femoral and tibial cartilages in 24-year-old man, a professional football player with knee pain. Arthroscopic image corresponding to B shows patellar defect (small arrow). Arthroscopic probe (large arrow) is seen extending into defect.

 


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  		Fig. 3A. —Proven partial-thickness defect of lateral femoral condyle and full-thickness defects in medial femoral condyle and lateral tibial plateau in 40-year-old woman. Coronal fast spin-echo proton density—weighted MR image shows focal full-thickness loss of articular cartilage (short black arrows) in medial femoral condyle and lateral tibial plateau. Areas of more normal medial femoral condylar cartilage were seen on other slices (not shown). Note focal partial-thickness defect (long black arrow) in lateral femoral condyle. Tear (white arrow) of lateral meniscus is also identified but is better seen on adjacent images (not shown).

 


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  		Fig. 3B. —Proven partial-thickness defect of lateral femoral condyle and full-thickness defects in medial femoral condyle and lateral tibial plateau in 40-year-old woman. Corresponding arthroscopic image of lateral compartment shows partial-thickness cartilage loss (straight black arrow) in femoral condyle and high-grade cartilage loss (curved arrow) in lateral tibial plateau that was full thickness in some areas (not seen). Note tear (white arrow) of lateral meniscus.

 


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  		Fig. 3C. —Proven partial-thickness defect of lateral femoral condyle and full-thickness defects in medial femoral condyle and lateral tibial plateau in 40-year-old woman. Arthroscopic image of medial condylar defect (large straight arrow) shows its full-thickness nature. Small radial tear (small straight arrow) of medial meniscus is also present. Curved arrow indicates medial tibial plateau.

 


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  		Fig. 4A. —False-negative trochlear lesion in 30-year-old man with knee pain. Arthroscopically proven full-thickness defect in trochlea was considered normal by all three reviewers. Axial fast spin-echo proton density—weighted MR image shows subchondral sclerosis (large arrow) in lateral trochlea. Overlying cartilage shows no full-thickness defect but in retrospect has irregular outline (small arrow).

 


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  		Fig. 4B. —False-negative trochlear lesion in 30-year-old man with knee pain. Arthroscopically proven full-thickness defect in trochlea was considered normal by all three reviewers. Corresponding arthroscopic image shows fibrillated cartilage (arrow) at site of defect.

 


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  		Fig. 5. —Diffusely thin patellar cartilage that received mixed scores in 24-year-old man with knee pain. Axial fast spin-echo proton density—weighted MR image shows no focal defect but shows overall chondral depth (arrow) of about 3 mm (normal, 5-6 mm). One reviewer scored this surface as normal, one as partial thickness defect, and one as full thickness defect. At arthroscopy, patella was considered normal.

 


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  		Fig. 6. —False-positive medial femoral condylar lesion in 33-year-old woman with knee pain. Coronal fast spin-echo proton density—weighted MR image shows apparent focal defect or blister (arrow) in condylar surface. All three reviewers scored this as partial-thickness defect. At arthroscopy, no defect was found.

 

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