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MR Arthrography of the Hip: Diagnostic Performance of a Dedicated Water-Excitation 3D Double-Echo Steady-State Sequence to Detect Cartilage Lesions

Patrick R. Knuesel1,2, Christian W. A. Pfirrmann1, Hubert P. Noetzli3,4, Claudio Dora3, Marco Zanetti1, Juerg Hodler1, Bernd Kuehn5 and Marius R. Schmid1

1 Department of Radiology, University Hospital Balgrist, Forchstrasse 340, Zurich CH-8008, Switzerland.
2 Present address: Department of Radiology, Kantonsspital Baden, Daettwil CH-5405, Switzerland.
3 Department of Orthopedics, University Hospital Balgrist, Zurich CH-8008, Switzerland.
4 Present address: Department of Orthopedic Surgery, Zieglerspital Bern, Morillonstrasse, Bern 3001, Switzerland.
5 MR Application Development, Siemens AG Medical Solutions, Karl Schall Strasse 4, Erlangen D-91050, Germany.



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  		Fig. 1. —Schematic drawing illustrates 3D double-echo steady-state sequence. Double-echo steady-state sequence simultaneously acquires signals of two sequences. First one is signal of fast imaging with steady-state precession (FISP) sequence, also known as coherent steady-state signal. Second one is signal of PSIF sequence (time reversal of FISP). RF = radiofrequency, GS = slice-selection gradient, GP = phase-encoding gradient, GR = readout gradient, ADC = analog-to-digital converter.

 


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  		Fig. 2A. —Subchondral bone irregularity may influence detection of acetabular cartilage defect on T1-weighted spin-echo image, as shown in 21-year-old man with acetabular cartilage lesion. Sagittal T1-weighted MR image (TR/TE, 350/14) reveals hypointensity of subchondral bone marrow (arrowheads) adjacent to small area of increased cartilage signal (arrow).

 


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  		Fig. 2B. —Subchondral bone irregularity may influence detection of acetabular cartilage defect on T1-weighted spin-echo image, as shown in 21-year-old man with acetabular cartilage lesion. Sagittal 3D double-echo steady-state image (24/6.5; flip angle, 25°) that corresponds to A shows cartilage defect (arrow) is more conspicuous but subchondral bone marrow abnormalities are not well seen.

 


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  		Fig. 3A. —Extensive cartilage defect seen in both sequence types, as shown in 51-year-old man with cartilage lesion in acetabulum. Sagittal T1-weighted image (TR/TE, 350/14) shows well-defined cartilage loss in anterior acetabulum (between arrows). Obvious adjacent bone marrow abnormality (arrowheads) is visible.

 


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  		Fig. 3B. —Extensive cartilage defect seen in both sequence types, as shown in 51-year-old man with cartilage lesion in acetabulum. Sagittal 3D double-echo steady-state image (24/6.5; flip angle, 25°) that corresponds to A shows size of cartilage lesion (between arrows) is identical to that shown in A. Subchondral bone marrow appears nearly normal.

 


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  		Fig. 4A. —Extensive cartilage defects seen on both 3D double-echo steady-state and T1-weighted spin-echo images, as shown in 33-year-old woman with acetabular and femoral articular cartilage damage. Sagittal T1-weighted image (TR/TE, 350/14) shows signal irregularities within acetabular (curved black arrow), posterior femoral (straight white arrows), and anterior femoral (straight black arrow) cartilage. Subchondral bone cysts (curved white arrows) and sclerosis (arrowheads) are visible on acetabular side.

 


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  		Fig. 4B. —Extensive cartilage defects seen on both 3D double-echo steady-state and T1-weighted spin-echo images, as shown in 33-year-old woman with acetabular and femoral articular cartilage damage. Sagittal 3D double-echo steady-state image (24/6.5; flip angle, 25°) that corresponds to A renders posterior acetabular (curved black arrows), anterior femoral (straight black arrows), and posterior femoral (straight white arrows) cartilage defects more conspicuous than A. In this patient, subchondral cysts (curved white arrows) and adjacent cartilage defects are better seen on 3D double-echo steady-state image than on T1-weighted image.

 

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