Imaging of non-osteochondral tissues in osteoarthritis

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Presentation transcript:

Imaging of non-osteochondral tissues in osteoarthritis A. Guermazi, F.W. Roemer, M.D. Crema, M. Englund, D. Hayashi Osteoarthritis and Cartilage Volume 22, Issue 10, Pages 1590-1605 (October 2014) DOI: 10.1016/j.joca.2014.05.001 Copyright © 2014 Osteoarthritis Research Society International Terms and Conditions

Fig. 1 Synovitis assessed on non-enhanced and contrast-enhanced sequences. (A) Axial PD-weighted fat-suppressed MRI shows severe patellofemoral OA of the knee with cartilage loss, subchondral bone marrow alterations and diffuse hyperintensity in the joint cavity representing a composite of joint effusion and synovial thickening. (B) Axial CE T1-weighted fat-suppressed MRI of the same knee clearly shows that most of this represents synovial thickening (arrowheads). There is only a little joint fluid seen in the left peripatellar recess (arrow), which is visualized as linear hypointensity. Osteoarthritis and Cartilage 2014 22, 1590-1605DOI: (10.1016/j.joca.2014.05.001) Copyright © 2014 Osteoarthritis Research Society International Terms and Conditions

Fig. 2 Meniscal damage preceding cartilage loss. (A) Baseline sagittal intermediate-weighted fat-suppressed MRI shows a horizontal oblique degenerative meniscal tear of the medial-posterior horn (arrows). (B) Twelve months later, focal cartilage damage is seen at the central part of the medial femur directly adjacent to the meniscal lesion (arrowhead). (C) At 24-month follow-up increasing cartilage loss is observed locally, directly adjacent to the meniscus. This example illustrates how the meniscal function is paramount for physiological load transmission and protection of the articular surface integrity. Osteoarthritis and Cartilage 2014 22, 1590-1605DOI: (10.1016/j.joca.2014.05.001) Copyright © 2014 Osteoarthritis Research Society International Terms and Conditions

Fig. 3 Meniscal instability as a cause of incident OA. The upper row shows coronal intermediate-weighted non-fat-suppressed MRIs over 2 years; the lower row shows corresponding sagittal intermediate-weighted fat-suppressed MRIs of the medial compartment. The left column depicts normal meniscal and cartilage integrity. The middle column (12-month follow-up images) shows an incident root tear of the medial-posterior horn (small arrow). The corresponding sagittal image shows superficial cartilage thinning adjacent to the meniscus (thick arrows). The upper right image (24-month follow-up) shows widening of the meniscal tear (small arrow) and increasing medial meniscal subluxation (arrowhead). The corresponding sagittal image shows perimeniscal cartilage thinning. Radiographic OA was diagnosed at month 24. Osteoarthritis and Cartilage 2014 22, 1590-1605DOI: (10.1016/j.joca.2014.05.001) Copyright © 2014 Osteoarthritis Research Society International Terms and Conditions

Fig. 4 ACL degeneration as part of the involvement of the entire joint in OA. The upper left image depicts a hypointense ACL of normal thickness (arrows) The lower left image shows the same knee and emphasizes the bi-fasciculated structure of the ligament (arrowhead), which commonly exhibits a striated appearance on sagittal images. The upper right image shows the same knee after 24 months. The ACL is now markedly hyperintense and thickened. The lower right sagittal intermediate-weighted fat-saturated image shows the same knee and confirms the hyperintense signal alterations and volume increase. This example represents mucoid degeneration of the ACL, which is difficult to distinguish from partial rupture based on imaging alone. Osteoarthritis and Cartilage 2014 22, 1590-1605DOI: (10.1016/j.joca.2014.05.001) Copyright © 2014 Osteoarthritis Research Society International Terms and Conditions

Fig. 5 Example of a labral lesion in early hip OA. Sagittal proton-density fat-saturated MRI exhibits a subtle anterior labral tear (arrow). Note diffuse superficial cartilage loss at the posterior circumference (arrowhead). Acetabular cartilage cannot be distinguished from the femoral cartilage surface, which is commonly the case whenever there is no joint fluid distending the two opposing surfaces. Osteoarthritis and Cartilage 2014 22, 1590-1605DOI: (10.1016/j.joca.2014.05.001) Copyright © 2014 Osteoarthritis Research Society International Terms and Conditions