1. Reliability of diffraction enhanced imaging for assessment of cartilage lesions, ex vivo 
Jun Li, M.D., James M. Williams, Ph.D., Zhong Zhong, Ph.D., Klaus E. Kuettner, Ph.D., Matthias Aurich, M.D., Juergen Mollenhauer, Ph.D., Carol Muehleman, Ph.D. 
Osteoarthritis and Cartilage 
Volume 13, Issue 3, Pages (March 2005)
DOI: /j.joca
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2. Fig. 1
(a–c) DEI images taken at −0.8, the peak, and +0.8 of the X-ray intensity curve, or intensity curve, respectively. It can be seen that the cartilage lesions [in the photograph of the specimen in (d)], are best visualized on − and + sides where refraction properties are best elucidated. Only a shadow of the cartilage at the left border of the specimen can be seen in the “conventional” radiograph (e).
Osteoarthritis and Cartilage  , DOI: ( /j.joca )
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3. Fig. 2
Example of the five grades of cartilage integrity. The normal-looking cartilage on the superior surface of the talus in (a) has a homogeneous appearance without contrast heterogeneities in its DEI image in (b). (c) shows a Grade 1 specimen whose focal fibrillation (arrows) on the superior surface of the dome is visualized as a series of contrast heterogeneities (arrows) in its DEI image in (d). The fissure (arrows) surrounded by frayed cartilage in (e) is visualized as such in its DEI image in (f) where the fissure is seen as a sharp line surrounded by contrast heterogeneities at points of cartilage damage (arrows). A Grade 3 lesion, characterized by loss of cartilage in less than 30% of the surface [(g) arrow] is visualized in DEI as cartilage focal cartilage loss, in this case surrounded by damaged cartilage (h). Loss of cartilage over most, or all, of the articular surface (i) is seen as an absence of cartilage in DEI or, cartilage loss with remnants of damaged cartilage remaining (j).
Osteoarthritis and Cartilage  , DOI: ( /j.joca )
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4. Fig. 3
Examples of the appearance of various lesions in DEI images. Frayed, irregular cartilage [(a), arrows] is seen as contrast heterogeneities with a roughened articular surface in its DEI image [(b), arrows]. A crack/fissure [(c), right arrow] and other surface lesions [(c), left arrows] can be seen as a sharp, dark line surrounded by contrast changes (d) and contrast heterogeneities with surface irregularities (d), respectively, in DEI. Deep ulceration and chondral flaps [(e), right arrow] demonstrate as contrast heterogeneities, surface irregularities, and loss of cartilage thickness in DEI [(f), right arrow]. Focal partial-thickness cartilage loss [(e), left arrow] appears as a partial loss of X-ray contrast in DEI. Partial-length tram track lesions [(g) middle three arrows] appear as focal spots of partial loss of contrast, demonstrating that some cartilage has been lost along the surface [(h) middle three arrows]. A full-length tram track lesion [(g), right arrow] appears as an indentation in the cartilage surface in DEI. Other deep, and/or diffuse lesions [(g), left arrows] manifest as cartilage loss, diffuse contrast heterogeneities, and surface irregularities [(h), left arrows].
Osteoarthritis and Cartilage  , DOI: ( /j.joca )
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5. Fig. 4
(a–g) Several views of a trochlear surface displaying several tram track lesions (arrows) in which grooves have been eroded by the bony ridge of the apposing anterior distal tibia during joint motion. (a) DEI image of trochlea in frontal view showing cartilage lesions with associated subchondral bony ridge at arrows. (b) Photograph of trochlear surface from above. (c, d) Stereoscopic view of a 2mm coronal section of the trochlea (4× and 25×). (e–g) Confocal (40×), reflective (50×), and histologic (40×) views, respectively, showing one of the longitudinal lesions with its associated subchondral bony ridge.
Osteoarthritis and Cartilage  , DOI: ( /j.joca )
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6. Fig. 5
(a) DEI image of a talus that was given a grade of 1 (surface fibrillation) due to the slight contrast heterogeneities seen at the arrow. This region of the specimen was thought to be normal and without any surface interruption when visualized grossly (b). However, histological examination indeed revealed early degeneration of the articular cartilage including surface fibrillation and loss of proteoglycan [(c); 40×].
Osteoarthritis and Cartilage  , DOI: ( /j.joca )
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7. Fig. 6
(a, b) DEI image and photograph, respectively, of a talus displaying a Grade 2 lesion (fissure; at arrow) that was not recognized as such by the observers. Rather this talar region was thought to simply show fibrillation. Histological examination supported the gross appearance (c). Upon further analyses the observers realized that it was indeed a Grade 2 lesion but they were unfamiliar with the presentation of such a lesion in DEI. Further experience with the reading of DEI images will improve such recognition.
Osteoarthritis and Cartilage  , DOI: ( /j.joca )
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