MRI of Articular Cartilage: Revisiting Current Status and Future Directions
Michael P. Recht1,
Douglas W. Goodwin2,
Carl S. Winalski3 and
Lawrence M. White4
1 Cleveland Clinic Foundation, 9500 Euclid Ave., A21, Cleveland, OH 44195.
2 Dartmouth-Hitchcock Medical Center, One Medical Center Dr., Lebanon, NH
03756.
3 Cartilage Repair Center and Department of Radiology, Brigham and Women's
Hospital, 75 Francis St., Boston, MA 02115.
4 Mount Sinai Hospital, 600 University Ave., #563, Toronto, ON M5G 1X5,
Canada.
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Fig. 1A —In 65-year-old woman, spin-echo images (TR/TE, 1,000/20) of
femoral condyle fragment imaged at 7 T with articular surface perpendicular to
(A) and parallel with (B) main magnetic field. (Reprinted with
permission from [21])
Higher-signal-intensity transition layer (arrow) separates
lower-signal-intensity radial layer from low-signal-intensity surface.
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Fig. 1B —In 65-year-old woman, spin-echo images (TR/TE, 1,000/20) of
femoral condyle fragment imaged at 7 T with articular surface perpendicular to
(A) and parallel with (B) main magnetic field. (Reprinted with
permission from [21]) When
imaged after rotation of sample by 90°, pattern of layering changes shows
influence of magic-angle effect. Orientation effect is evident at all levels
of sample, including transitional layer (arrow).
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Fig. 2A —Osteochondral fragment from 56-year-old man. (Reprinted with
permission from [32])
Spin-echo image (TR/TE, 1,000/20) of femoral condyle fragment imaged at 7 T
shows low signal intensity (arrows) in regions where cartilage matrix
is aligned with main magnetic field (B0).
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Fig. 2B —Osteochondral fragment from 56-year-old man. (Reprinted with
permission from [32]) Sample
photographed after fracture sectioning. In regions where cartilage matrix is
aligned with B0, signal intensity is low (long arrow).
Striations on MR image appear to reflect fibrous-appearing structure revealed
in fractured sample (short arrows).
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Fig. 3A —MR images of 61-year-old man with knee pain. Fat-saturated 3D
spoiled gradient-recalled echo image (TR/TE, 50/11; flip angle, 30°)
(A) and fast spin-echo T2-weighted image (TR/TE, 5,334/91; echo-train
length, 4) (B) show chondral flap (arrows) involving medial
femoral condyle.
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Fig. 3B —MR images of 61-year-old man with knee pain. Fat-saturated 3D
spoiled gradient-recalled echo image (TR/TE, 50/11; flip angle, 30°)
(A) and fast spin-echo T2-weighted image (TR/TE, 5,334/91; echo-train
length, 4) (B) show chondral flap (arrows) involving medial
femoral condyle.
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Fig. 4A —40-year-old woman with acute knee injury. Sagittal
fat-saturated 3D spoiled gradient-recalled echo image (TR/TE, 22/9; flip
angle, 45°) (A) and transaxial fast spin-echo image (TR/TE,
3,000/87; echo-train length, 5) (B) show chondral fracture
(arrows) with mild displacement of chondral fragment.
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Fig. 4B —40-year-old woman with acute knee injury. Sagittal
fat-saturated 3D spoiled gradient-recalled echo image (TR/TE, 22/9; flip
angle, 45°) (A) and transaxial fast spin-echo image (TR/TE,
3,000/87; echo-train length, 5) (B) show chondral fracture
(arrows) with mild displacement of chondral fragment.
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Fig. 5A —MR images after microfracture in 32-year-old male
professional basketball player. Fat-saturated T2-weighted fast spin-echo
coronal image (TR/TE, 3,250/90; echo-train length, 5) 2 months after
microfracture (A) and fat-saturated T2-weighted fast spin-echo image
(3,000/85; echo-train length, 5) 7 months after microfracture (B) show
that repair tissue (arrows) is greater at 7 months than at 2 months,
with congruent articular surface.
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Fig. 5B —MR images after microfracture in 32-year-old male
professional basketball player. Fat-saturated T2-weighted fast spin-echo
coronal image (TR/TE, 3,250/90; echo-train length, 5) 2 months after
microfracture (A) and fat-saturated T2-weighted fast spin-echo image
(3,000/85; echo-train length, 5) 7 months after microfracture (B) show
that repair tissue (arrows) is greater at 7 months than at 2 months,
with congruent articular surface.
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Fig. 6 —37-year-old man 2 years after autologous osteochondral
transplantation of medial femoral condyle. T2-weighted fast spin-echo coronal
image (TR/TE, 6,192/132; echo-train length, 7) shows relatively congruent
cartilage surface (arrows).
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Fig. 7 —17-year-old boy 3 months after autologous osteochondral
transplantation. Fat-saturated 3D spoiled gradient-recalled echo sagittal
image (TR/TE, 50/11; flip angle, 40°) shows subsidence of osteochondral
plugs (arrows), with resultant incongruent articular surface.
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Fig. 8A —52-year-old man with failed abrasion arthroplasty of medial
trochlea who was treated by autologous chondrocyte implantation (ACI). Six
years after surgery, he was asymptomatic and underwent imaging with IV
(indirect) MRI arthrography. Photograph obtained near end of surgery shows
anterior margin of intercondylar notch (arrow) and 25-mm-long x
22-mm-wide ACI site (arrowheads) covering nearly entire medial
trochlear facet.
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Fig. 8B —52-year-old man with failed abrasion arthroplasty of medial
trochlea who was treated by autologous chondrocyte implantation (ACI). Six
years after surgery, he was asymptomatic and underwent imaging with IV
(indirect) MRI arthrography. Sagittal proton density-weighted fast spin-echo
image (TR/TE, 2,400/37; echo-train length, 8) of knee shows complete fill of
trochlear ACI site (arrowheads) by repair tissue, which appears
slightly darker than native articular cartilage. Levels of articular surface
and subchondral bone plate are slightly above those of adjacent, nonoperated
regions.
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Fig. 8C —52-year-old man with failed abrasion arthroplasty of medial
trochlea who was treated by autologous chondrocyte implantation (ACI). Six
years after surgery, he was asymptomatic and underwent imaging with IV
(indirect) MRI arthrography. Sagittal proton density-weighted fast spin-echo
fat-saturated image (2,900/25; echo-train length, 8) of knee shows normal
signal in bone marrow subjacent to ACI site (arrowheads).
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Fig. 8D —52-year-old man with failed abrasion arthroplasty of medial
trochlea who was treated by autologous chondrocyte implantation (ACI). Six
years after surgery, he was asymptomatic and underwent imaging with IV
(indirect) MRI arthrography. Transaxial proton density-weighted fast spin-echo
image (3,625/30; echo-train length, 12) of knee shows ACI site
(arrowheads) on medial trochlear facet filled with
low-signal-intensity repair tissue.
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Fig. 8E —52-year-old man with failed abrasion arthroplasty of medial
trochlea who was treated by autologous chondrocyte implantation (ACI). Six
years after surgery, he was asymptomatic and underwent imaging with IV
(indirect) MRI arthrography. Oblique coronal T1-weighted spin-echo
fat-saturated image (650/12) of knee obtained in plane orthogonal to trochlear
ACI site shows area of native articular cartilage thinning (arrow)
medial to ACI repair site (arrowheads). Region of native cartilage
thinning is poorly shown on transaxial image (D) because of
partial-volume artifact.
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Fig. 9A —22-year-old woman with catching sensation in knee 6 months
after autologous chondrocyte implantation (ACI) surgery for 24-mm-long x
19-mm-wide osteochondral defect of medial femoral condyle. Sagittal proton
density-weighted fast spin-echo image (TR/TE, 2,900/38; echo-train length, 8)
of knee from IV (indirect) MR arthrogram shows prominent periosteal
hypertrophy. Surface of ACI site (arrowheads) is above level of
native articular cartilage, best seen at junction between ACI and native
cartilage (arrow).
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Fig. 9B —22-year-old woman with catching sensation in knee 6 months
after autologous chondrocyte implantation (ACI) surgery for 24-mm-long x
19-mm-wide osteochondral defect of medial femoral condyle. Sagittal proton
density-weighted fast spin-echo fat-saturated image (2,900/25; echo-train
length, 8) of knee from same examination as A shows mild edemalike
signal in marrow beneath ACI site (arrowheads).
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Fig. 9C —22-year-old woman with catching sensation in knee 6 months
after autologous chondrocyte implantation (ACI) surgery for 24-mm-long x
19-mm-wide osteochondral defect of medial femoral condyle. Image of ACI site
from knee arthroscopic surgery performed 19 days after A shows
prominent mound of fibrous, periosteal overgrowth (arrow) and
junction between ACI and native articular cartilage (arrowheads).
Fibrous periosteal tissue was débrided, revealing firm, intact repair
tissue underneath.
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Fig. 10A —Transaxial MR images of patellofemoral joint of patient with
knee pain. (Reprinted with permission from
[90]) Driven equilibrium
Fourier transform (DEFT) image with fat saturation (TR/TE, 400/15) clearly
shows deep cartilage fissure with surface irregularity (arrow).
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Fig. 10B —Transaxial MR images of patellofemoral joint of patient with
knee pain. (Reprinted with permission from
[90]) On spoiled
gradient-recalled echo fat-saturated image (50/15; flip angle, 30°)
obtained at same location, abnormality is more difficult to visualize
(arrow).
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Fig. 11A —MR images from delayed gadolinium-enhanced MR imaging of
cartilage study of knee of 41-year-old man after treatment of cartilage defect
of medial femoral condyle with autologous chondrocyte implantation (ACI).
Coronal STIR fast spin-echo MR image (TR/TE, 1,800/14; inversion time, 1,650
msec; echo-train length, 7) of knee obtained 2 hr after IV injection of 0.2
mmol of gadopentetate dimeglumine per kilogram of body weight shows complete
fill of ACI site (arrowheads) on medial femoral condyle. Surface of
repair site is slightly irregular. Signal intensity of superficial layer of
articular cartilage of medial tibial plateau appears mildly frayed.
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Fig. 11B —MR images from delayed gadolinium-enhanced MR imaging of
cartilage study of knee of 41-year-old man after treatment of cartilage defect
of medial femoral condyle with autologous chondrocyte implantation (ACI).
Color-encoded T1 map of cartilage obtained from set of 7 STIR images with
inversion times ranging from 50 to 1,650 msec is superimposed on gray-scale
image of knee. T1 value of repair tissue (arrowheads) in ACI site is
83% of that of adjacent, native articular cartilage of medial femoral condyle,
indicating slightly lower concentration of glycosaminoglycans within repair
tissue. Lower T1 values within superficial articular cartilage of medial
femoral condyle and tibial plateaus indicate loss of glycosaminoglycans.
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Copyright © 2005 by the American Roentgen Ray Society.
