Magnetic Resonance Imaging Assessment of Subchondral Bone and Soft Tissues in Knee Osteoarthritis
Section snippets
Bone Marrow Edema-like Lesions
Bone marrow edema-like lesions (BMLs) are defined on MRI as noncystic subchondral areas of ill-defined hyperintensity on proton density-weighted, intermediate-weighted, T2-weighted or short tau inversion recovery (STIR) sequences and hypointensity on T1-weighted spin echo images (Fig. 1).6, 7, 8, 9 MRI assessment of BMLs should be performed only on such sequences, as gradient recalled echo (GRE)-type sequences such as spoiled gradient echo at a steady state (SPGR), fast low angle shot (FLASH),
Synovitis
Although synovitis in OA is thought to be a secondary phenomenon related to cartilage deterioration, its importance in the OA process is recognized.44, 45, 46, 47, 48, 49 Degenerative joints usually demonstrate signs of synovitis, even in the early phase of disease.50, 51, 52
Several methods for detecting and quantifying synovitis with nonenhanced and contrast-enhanced MRI are available. In a pathologic study conducted by Fernandez-Madrid and colleagues51 signal alterations in the Hoffa's fat
Effusion
Joint effusion is detected commonly in patients with moderate-to-advanced knee OA,45, 63 and it reflects synovial activation secondary to ligament injury, loose bodies, hyaline cartilage deterioration, and meniscal damage.64 Joint effusion ideally is assessed and quantified on proton density-weighted, T2-weighted and STIR MRI sequences.12, 13 Synovial thickening as seen in synovitis, however, increases the total synovial volume in such sequences, and differentiating synovium and effusion on
Cruciate and collateral ligaments
It is recognized that traumatic complete anterior cruciate ligament (ACL) tears may lead to premature degeneration of the knee joint.65, 66, 67, 68 The role of traumatic incomplete ACL tears in predicting knee OA, however, is unclear.69 ACL disruption inevitably will cause alterations in knee kinematics, as the ACL is the primary restraint against anterior tibial translation.70 Furthermore, ACL failure increases the external adduction moment and consequently medial loading, increasing the risk
Periarticular cysts and bursae
A wide spectrum of periarticular cystic lesions may be encountered in knee OA.85 Most cystic lesions around the knee are encapsulated fluid collections exhibiting low signal intensity on T1-weighted images and high signal intensity on T2-weighted images.85, 86
Popliteal (Baker's) cysts are not true cysts, but fluid in the semimembranosus-medial gastrocnemius bursa (Fig. 11), mainly caused by the extravasation of joint fluid through the posteromedial capsule, which seems to occur because of
Loose bodies
Loose bodies are seen regularly in conjunction with knee OA, especially in severe cases. Chondral fragments, detached osteophytes, and meniscal fragments, for example, may originate loose bodies in knee OA. Synovial osteochondromatosis has to be considered also.99 The presence of loose bodies is related to internal knee derangement in patients with OA.100, 101 They may trigger synovial inflammation as demonstrated by a recent study using contrast-enhanced MRI,49 and they are a common indication
Summary
Knee OA is considered a disease of the whole joint. MRI has added much to the understanding of all the joint tissues involved in the disease process such as the subchondral bone, synovium, ligaments, and periarticular soft tissues and their significance in explaining pain and structural progression. The use of appropriate MRI pulse sequences is crucial, allowing accurate semiquantitative assessment of these alterations. Reliable semiquantitative scoring systems are available to assess the
References (101)
An update on the pathogenesis and epidemiology of osteoarthritis
Radiol Clin North Am
(2004)- et al.
Joint space narrowing and Kellgren-Lawrence progression in knee osteoarthritis: an analytic literature synthesis
Osteoarthritis Cartilage
(2008) - et al.
MRI-based semiquantitative assessment of subchondral bone marrow lesions in osteoarthritis research
Osteoarthritis Cartilage
(2009) - et al.
Whole-Organ Magnetic Resonance Imaging Score (WORMS) of the knee in osteoarthritis
Osteoarthritis Cartilage
(2004) - et al.
MRI-detected subchondral bone marrow signal alterations of the knee joint: terminology, imaging appearance, relevance, and radiological differential diagnosis
Osteoarthritis Cartilage
(2009) - et al.
Association of bone marrow lesions with knee structures and risk factors for bone marrow lesions in the knees of clinically healthy, community-based adults
Semin Arthritis Rheum
(2007) - et al.
A study of the prevalence and associations of subchondral bone marrow lesions in the knees of healthy, middle-aged women
Osteoarthritis Cartilage
(2007) - et al.
Reversible MRI features and knee pain fluctuation: the MOST study
Osteoarthritis Cartilage
(2007) - et al.
Magnetic resonance-detected subchondral bone marrow and cartilage defect characteristics associated with pain and X-ray defined knee osteoarthritis
Osteoarthritis Cartilage
(2003) - et al.
MRI-detected bone marrow edema-like lesions are strongly associated with subchondral cysts in patients with or at risk for knee osteoarthritis: the MOST study
Osteoarthritis Cartilage
(2008)
MRI of bone marrow edema-like signal in the pathogenesis of subchondral cysts
Osteoarthritis Cartilage
The relationship between specific tissue lesions and pain severity in persons with knee osteoarthritis
Osteoarthritis Cartilage
Prevalence of bone attrition on knee radiographs and MRI in a community-based cohort
Osteoarthritis Cartilage
Tibiofemoral bone marrow lesions and their association with prevalent and incident subchondral bone attrition: the MOST study
Osteoarthritis Cartilage
Cartilage loss occurs in the same subregions as subchondral bone attrition: the MOST study
Osteoarthritis Cartilage
Synovitis: a potential predictive factor of structural progression of medial tibiofemoral knee osteoarthritis—results of a 1-year longitudinal arthroscopic study in 422 patients
Osteoarthritis Cartilage
Peripatellar synovitis in osteoarthritis: comparison of non-enhanced and enhanced magnetic resonance imaging (MRI) and its association with peripatellar knee pain: the MOST study
Osteoarthritis Cartilage
Synovial thickening detected by MR imaging in osteoarthritis of the knee confirmed by biopsy as synovitis
Magn Reson Imaging
Semiquantitative assessment of synovitis in osteoarthritis on non contrast-enhanced MRI
Osteoarthritis Cartilage
Arthroscopic evaluation of synovitis in the knee joints
Arthroscopy
MR features of osteoarthritis of the knee
Magn Reson Imaging
Thirty-five years of follow-up of anterior cruciate ligament-deficient knees in high-level athletes
Arthroscopy
A quantitative histologic comparison: ACL degeneration in the osteoarthritic knee
J Arthroplasty
Evaluation of the anterior cruciate ligament integrity and degenerative arthritic patterns in patients undergoing total knee arthroplasty
J Arthroplasty
Cruciate ligaments in arthritic knees: a histologic study with radiologic correlation
J Arthroplasty
Complete anterior cruciate ligament tear and the risk for cartilage loss and progression of symptoms in men and women with knee osteoarthritis
Osteoarthritis Cartilage
MRI features of cystic lesions around the knee
Knee
Periarticular cysts and their relation to symptoms in osteoarthritis: the MOST study
Osteoarthritis Cartilage
MR imaging of meniscal cysts: evaluation of location and extension using a three-layer approach
Eur J Radiol
Osteochondromatosis of the popliteal bursa
Joint Bone Spine
An arthroscopic treatment regimen for osteoarthritis of the knee
Arthroscopy
Radiological assessment of osteoarthrosis
Ann Rheum Dis
Conscious neurosensory mapping of the internal structures of the human knee without intra-articular anesthesia
Am J Sports Med
Periarticular lesions detected on magnetic resonance imaging: prevalence in knees with and without symptoms
Arthritis Rheum
Bone marrow edema pattern in osteoarthritic knees: correlation between MR imaging and histologic findings
Radiology
Osteoarthritis of the knee: correlation of subchondral MR signal abnormalities with histopathologic and radiographic features
Skeletal Radiol
Magnetic resonance imaging (MRI) of the knee: a pattern approach for evaluating bone marrow edema
Crit Rev Diagn Imaging
MRI protocols for whole-organ assessment of the knee in osteoarthritis
Osteoarthritis Cartilage
Magnetic resonance imaging of articular cartilage of the knee: comparison between fat-suppressed three-dimensional SPGR imaging, fat-suppressed FSE imaging, and fat-suppressed three-dimensional DEFT imaging, and correlation with arthroscopy
J Magn Reson Imaging
The reliability of a new scoring system for knee osteoarthritis MRI and the validity of bone marrow lesion assessment: BLOKS (Boston Leeds Osteoarthritis Knee Score)
Ann Rheum Dis
The association of bone marrow lesions with pain in knee osteoarthritis
Ann Intern Med
Correlation of the development of knee pain with enlarging bone marrow lesions on magnetic resonance imaging
Arthritis Rheum
Change in MRI-detected subchondral bone marrow lesions is associated with cartilage loss—the MOST study. A longitudinal multicenter study of knee osteoarthritis
Ann Rheum Dis
Increase in bone marrow lesions associated with cartilage loss: a longitudinal magnetic resonance imaging study of knee osteoarthritis
Arthritis Rheum
Bone marrow edema and its relation to progression of knee osteoarthritis
Ann Intern Med
Bone marrow edema pattern in advanced hip osteoarthritis: quantitative assessment with magnetic resonance imaging and correlation with clinical examination, radiographic findings, and histopathology
Skeletal Radiol
Bone marrow edema-like lesions change in volume in the majority of patients with osteoarthritis; associations with clinical features
Eur Radiol
Bone marrow lesions in the knee are associated with increased local bone density
Arthritis Rheum
Central bone marrow lesions in symptomatic knee osteoarthritis and their relationship to anterior cruciate ligament tears and cartilage loss
Arthritis Rheum
Prevalence and MRI-anatomic correlation of bone cysts in osteoarthritic knees
AJR Am J Roentgenol
Cited by (11)
Structural changes in the knee during weight loss maintenance after a significant weight loss in obese patients with osteoarthritis: A report of secondary outcome analyses from a randomized controlled trial
2014, Osteoarthritis and CartilageCitation Excerpt :The coronal T1 and STIR images were used for BML size scoring. BMLs appear as ill-defined signal intensity changes in the subchondral bone that are hypointense on T1 images and hyperintense on STIR images17, and evidence support that combining the two is highly effective for the evaluation of BML18,19, even though some data suggests that T2w FS sequences might be more sensitive18. Due to time restraints in the MRI scanner and the use of a coronal STIR sequence the imaging protocol did not allow for the assessment of BMLs in patella.
Weight loss is effective for symptomatic relief in obese subjects with knee osteoarthritis independently of joint damage severity assessed by high-field MRI and radiography
2012, Osteoarthritis and CartilageCitation Excerpt :Cartilage assessments were performed using the 3D FLASH sequence28–30. BMLs appear as ill-defined signal intensity changes in the subchondral bone that are hypointense on T1w images and hyperintense on STIR images31. Evidence support that combining the two is highly effective for the evaluation of BML32,33, even though some data suggests that T2w FS sequences might be more sensitive33.
Greater medial proximal tibial slope is associated with bone marrow lesions in middle-aged women with early knee osteoarthritis
2023, Journal of Orthopaedics and TraumatologyAtlas of Pain Management Injection Techniques, Fourth Edition
2016, Atlas of Pain Management Injection Techniques, Fourth Edition
A version of this article originally appeared in the 47:4 issue of Radiologic Clinics of North America.