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Special Focus Session

What’s New in Cartilage?¹

¹ From the Department of Radiology, Stanford University, Packard EE Bldg, Rm 222, Stanford, CA 94305-9510 (G.E.G.); the Department of Radiology, Yale University, New Haven, Conn (T.R.M.); the Division of Health Sciences and Technology, Harvard University–Massachusetts Institute of Technology, Cambridge, Mass (M.L.G.); and Commonwealth Radiology, Richmond, Va (D.G.D.). From the Plenary Session, Special Focus Session: What’s New in Cartilage? presented at the 2002 RSNA scientific assembly. Received April 17, 2003; revision requested April 23 and received May 21; accepted May 27. Supported by grants AR46904-02 and AR41773-04 from the National Institutes of Health, by the Whitaker Foundation, and by the Arthritis Foundation. Address correspondence to G.E.G. (e-mail: gold@stanford.edu).

View larger version (186K): [in a new window]   Figure 1a.  Sagittal three-dimensional (3D) spoiled GRE images of the knee obtained without (a) and with (b) fat suppression. Use of fat suppression or water-only excitation improves the dynamic range settings and allows demonstration of more detail in the cartilage.

View larger version (164K): [in a new window]   Figure 1b.  Sagittal three-dimensional (3D) spoiled GRE images of the knee obtained without (a) and with (b) fat suppression. Use of fat suppression or water-only excitation improves the dynamic range settings and allows demonstration of more detail in the cartilage.

View larger version (148K): [in a new window]   Figure 2a.  Focal cartilage contusion after tearing of the anterior cruciate ligament. (a) Sagittal proton-density fast SE image shows a tear of the anterior cruciate ligament (arrow). (b) Image from arthroscopy shows cartilage damage in the lateral femoral condyle (arrow). (c) Sagittal 3D spoiled GRE image shows cartilage step-off in the lateral femoral condyle (arrow). (d) Sagittal fast SE image obtained at the same location shows less detail of the cartilage (arrow).

View larger version (78K): [in a new window]   Figure 2b.  Focal cartilage contusion after tearing of the anterior cruciate ligament. (a) Sagittal proton-density fast SE image shows a tear of the anterior cruciate ligament (arrow). (b) Image from arthroscopy shows cartilage damage in the lateral femoral condyle (arrow). (c) Sagittal 3D spoiled GRE image shows cartilage step-off in the lateral femoral condyle (arrow). (d) Sagittal fast SE image obtained at the same location shows less detail of the cartilage (arrow).

View larger version (114K): [in a new window]   Figure 2c.  Focal cartilage contusion after tearing of the anterior cruciate ligament. (a) Sagittal proton-density fast SE image shows a tear of the anterior cruciate ligament (arrow). (b) Image from arthroscopy shows cartilage damage in the lateral femoral condyle (arrow). (c) Sagittal 3D spoiled GRE image shows cartilage step-off in the lateral femoral condyle (arrow). (d) Sagittal fast SE image obtained at the same location shows less detail of the cartilage (arrow).

View larger version (165K): [in a new window]   Figure 2d.  Focal cartilage contusion after tearing of the anterior cruciate ligament. (a) Sagittal proton-density fast SE image shows a tear of the anterior cruciate ligament (arrow). (b) Image from arthroscopy shows cartilage damage in the lateral femoral condyle (arrow). (c) Sagittal 3D spoiled GRE image shows cartilage step-off in the lateral femoral condyle (arrow). (d) Sagittal fast SE image obtained at the same location shows less detail of the cartilage (arrow).

View larger version (158K): [in a new window]   Figure 3a.  Cartilage defect. Sagittal 3D spoiled GRE (a) and T2-weighted fast SE (b) images show a partial-thickness cartilage defect in the medial femoral condyle (solid arrow). Note that fluid (dashed arrow) is dark on the 3D spoiled GRE image (a), whereas it provides an outline of the defect on the T2-weighted fast SE image (b).

View larger version (168K): [in a new window]   Figure 3b.  Cartilage defect. Sagittal 3D spoiled GRE (a) and T2-weighted fast SE (b) images show a partial-thickness cartilage defect in the medial femoral condyle (solid arrow). Note that fluid (dashed arrow) is dark on the 3D spoiled GRE image (a), whereas it provides an outline of the defect on the T2-weighted fast SE image (b).

View larger version (107K): [in a new window]   Figure 4a.  Focal cartilage contusion in a 17-year-old patient after trauma. (a) Sagittal 3D spoiled GRE image shows a contusion of the medial femoral condyle (arrow). (b) Sagittal fast SE image obtained with fat suppression shows the contusion (solid arrow) and adjacent marrow edema (dashed arrow). Marrow edema is an excellent marker for cartilage damage but is not seen with the relatively T1-weighted spoiled GRE technique.

View larger version (167K): [in a new window]   Figure 4b.  Focal cartilage contusion in a 17-year-old patient after trauma. (a) Sagittal 3D spoiled GRE image shows a contusion of the medial femoral condyle (arrow). (b) Sagittal fast SE image obtained with fat suppression shows the contusion (solid arrow) and adjacent marrow edema (dashed arrow). Marrow edema is an excellent marker for cartilage damage but is not seen with the relatively T1-weighted spoiled GRE technique.

View larger version (133K): [in a new window]   Figure 5a.  Cartilage fissure after trauma. Sagittal fast SE image obtained without fat suppression (a) and sagittal 3D spoiled GRE image obtained with fat suppression (b) show a cartilage fissure in the lateral patella (arrow). The fissure is outlined by bright synovial fluid on the fast SE image (a), but the underlying cartilage is better seen on the spoiled GRE image (b).

View larger version (119K): [in a new window]   Figure 5b.  Cartilage fissure after trauma. Sagittal fast SE image obtained without fat suppression (a) and sagittal 3D spoiled GRE image obtained with fat suppression (b) show a cartilage fissure in the lateral patella (arrow). The fissure is outlined by bright synovial fluid on the fast SE image (a), but the underlying cartilage is better seen on the spoiled GRE image (b).

View larger version (150K): [in a new window]   Figure 6a.  Delaminating cartilage injury in a 14-year-old soccer player. (a) Sagittal 3D spoiled GRE image shows delamination of the trochlear cartilage (arrow). (b) Sagittal image obtained adjacent to a shows further delamination (solid arrow). Also seen is a piece of delaminated cartilage in the joint (dashed arrow).

View larger version (130K): [in a new window]   Figure 6b.  Delaminating cartilage injury in a 14-year-old soccer player. (a) Sagittal 3D spoiled GRE image shows delamination of the trochlear cartilage (arrow). (b) Sagittal image obtained adjacent to a shows further delamination (solid arrow). Also seen is a piece of delaminated cartilage in the joint (dashed arrow).

View larger version (73K): [in a new window]   Figure 7a.  Subchondral osteophyte as a sign of cartilage damage. (a) Anterior radiograph shows a small osteophyte of the lateral femoral condyle (arrow). (b) Sagittal 3D spoiled GRE image shows the osteophyte in an area of cartilage damage (arrow). (c) Sagittal T2-weighted fast SE image shows the osteophyte (arrow). The full thickness of the remaining cartilage is difficult to see due to cartilage signal loss. (Reprinted, with permission, from reference 76.)

View larger version (78K): [in a new window]   Figure 7b.  Subchondral osteophyte as a sign of cartilage damage. (a) Anterior radiograph shows a small osteophyte of the lateral femoral condyle (arrow). (b) Sagittal 3D spoiled GRE image shows the osteophyte in an area of cartilage damage (arrow). (c) Sagittal T2-weighted fast SE image shows the osteophyte (arrow). The full thickness of the remaining cartilage is difficult to see due to cartilage signal loss. (Reprinted, with permission, from reference 76.)

View larger version (147K): [in a new window]   Figure 7c.  Subchondral osteophyte as a sign of cartilage damage. (a) Anterior radiograph shows a small osteophyte of the lateral femoral condyle (arrow). (b) Sagittal 3D spoiled GRE image shows the osteophyte in an area of cartilage damage (arrow). (c) Sagittal T2-weighted fast SE image shows the osteophyte (arrow). The full thickness of the remaining cartilage is difficult to see due to cartilage signal loss. (Reprinted, with permission, from reference 76.)

View larger version (174K): [in a new window]   Figure 8a.  DEFT imaging of articular cartilage. (a) Sagittal 3D DEFT image shows a fissure in the patellofemoral cartilage (arrow). (b) Sagittal two-dimensional fast SE image shows the fissure (arrow) with lower cartilage signal. (c) Sagittal 3D DEFT image shows full-thickness cartilage loss in the medial femoral condyle (arrow). (d) Sagittal two-dimensional fast SE image shows the cartilage loss (arrow). DEFT imaging produces bright synovial fluid while maintaining cartilage signal; thus, the remaining cartilage is distinguished from the subchondral bone with DEFT imaging but not with fast SE imaging. (Courtesy of Samuel Fuller, MD, Stanford University, Stanford, Calif.)

View larger version (149K): [in a new window]   Figure 8b.  DEFT imaging of articular cartilage. (a) Sagittal 3D DEFT image shows a fissure in the patellofemoral cartilage (arrow). (b) Sagittal two-dimensional fast SE image shows the fissure (arrow) with lower cartilage signal. (c) Sagittal 3D DEFT image shows full-thickness cartilage loss in the medial femoral condyle (arrow). (d) Sagittal two-dimensional fast SE image shows the cartilage loss (arrow). DEFT imaging produces bright synovial fluid while maintaining cartilage signal; thus, the remaining cartilage is distinguished from the subchondral bone with DEFT imaging but not with fast SE imaging. (Courtesy of Samuel Fuller, MD, Stanford University, Stanford, Calif.)

View larger version (165K): [in a new window]   Figure 8c.  DEFT imaging of articular cartilage. (a) Sagittal 3D DEFT image shows a fissure in the patellofemoral cartilage (arrow). (b) Sagittal two-dimensional fast SE image shows the fissure (arrow) with lower cartilage signal. (c) Sagittal 3D DEFT image shows full-thickness cartilage loss in the medial femoral condyle (arrow). (d) Sagittal two-dimensional fast SE image shows the cartilage loss (arrow). DEFT imaging produces bright synovial fluid while maintaining cartilage signal; thus, the remaining cartilage is distinguished from the subchondral bone with DEFT imaging but not with fast SE imaging. (Courtesy of Samuel Fuller, MD, Stanford University, Stanford, Calif.)

View larger version (152K): [in a new window]   Figure 8d.  DEFT imaging of articular cartilage. (a) Sagittal 3D DEFT image shows a fissure in the patellofemoral cartilage (arrow). (b) Sagittal two-dimensional fast SE image shows the fissure (arrow) with lower cartilage signal. (c) Sagittal 3D DEFT image shows full-thickness cartilage loss in the medial femoral condyle (arrow). (d) Sagittal two-dimensional fast SE image shows the cartilage loss (arrow). DEFT imaging produces bright synovial fluid while maintaining cartilage signal; thus, the remaining cartilage is distinguished from the subchondral bone with DEFT imaging but not with fast SE imaging. (Courtesy of Samuel Fuller, MD, Stanford University, Stanford, Calif.)

View larger version (159K): [in a new window]   Figure 9a.  High-resolution FEMR imaging of cartilage in the knee. Parameters for all images were 512 x 256, 16-cm field of view, and 2-mm-thick sections. (a) Sagittal T2-weighted fast SE image obtained with interleaving (imaging time, 5:30 [minutes:seconds]). (b) Sagittal 3D spoiled GRE image obtained with fat suppression (imaging time, 8:56). (c) Sagittal FEMR water image (imaging time, 2:43). (d) Sagittal FEMR lipid image. The cartilage signal on the spoiled GRE image (b) and FEMR images (c, d) is nearly identical despite the much longer imaging time for spoiled GRE imaging (8:56 vs 2:43). The cartilage signal with fast SE imaging is much lower than with FEMR or spoiled GRE imaging.

View larger version (199K): [in a new window]   Figure 9b.  High-resolution FEMR imaging of cartilage in the knee. Parameters for all images were 512 x 256, 16-cm field of view, and 2-mm-thick sections. (a) Sagittal T2-weighted fast SE image obtained with interleaving (imaging time, 5:30 [minutes:seconds]). (b) Sagittal 3D spoiled GRE image obtained with fat suppression (imaging time, 8:56). (c) Sagittal FEMR water image (imaging time, 2:43). (d) Sagittal FEMR lipid image. The cartilage signal on the spoiled GRE image (b) and FEMR images (c, d) is nearly identical despite the much longer imaging time for spoiled GRE imaging (8:56 vs 2:43). The cartilage signal with fast SE imaging is much lower than with FEMR or spoiled GRE imaging.

View larger version (181K): [in a new window]   Figure 9c.  High-resolution FEMR imaging of cartilage in the knee. Parameters for all images were 512 x 256, 16-cm field of view, and 2-mm-thick sections. (a) Sagittal T2-weighted fast SE image obtained with interleaving (imaging time, 5:30 [minutes:seconds]). (b) Sagittal 3D spoiled GRE image obtained with fat suppression (imaging time, 8:56). (c) Sagittal FEMR water image (imaging time, 2:43). (d) Sagittal FEMR lipid image. The cartilage signal on the spoiled GRE image (b) and FEMR images (c, d) is nearly identical despite the much longer imaging time for spoiled GRE imaging (8:56 vs 2:43). The cartilage signal with fast SE imaging is much lower than with FEMR or spoiled GRE imaging.

View larger version (207K): [in a new window]   Figure 9d.  High-resolution FEMR imaging of cartilage in the knee. Parameters for all images were 512 x 256, 16-cm field of view, and 2-mm-thick sections. (a) Sagittal T2-weighted fast SE image obtained with interleaving (imaging time, 5:30 [minutes:seconds]). (b) Sagittal 3D spoiled GRE image obtained with fat suppression (imaging time, 8:56). (c) Sagittal FEMR water image (imaging time, 2:43). (d) Sagittal FEMR lipid image. The cartilage signal on the spoiled GRE image (b) and FEMR images (c, d) is nearly identical despite the much longer imaging time for spoiled GRE imaging (8:56 vs 2:43). The cartilage signal with fast SE imaging is much lower than with FEMR or spoiled GRE imaging.

View larger version (137K): [in a new window]   Figure 10a.  Sagittal Dixon SSFP imaging of the ankle joint at 3.0 T. Parameters for all images were 256 x 256, 18-cm field of view, and 2-mm-thick sections. (a) Dixon SSFP water image (imaging time, 2:18). (b) Dixon SSFP lipid image. (c) Three-dimensional spoiled GRE image obtained with fat suppression (imaging time, 7:40). Note that the fat suppression is much more homogeneous on the Dixon SSFP image (a) than on the spoiled GRE image obtained with conventional fat suppression (c). (Courtesy of Scott Reeder, MD, PhD, Stanford University, Stanford, Calif.)

View larger version (162K): [in a new window]   Figure 10b.  Sagittal Dixon SSFP imaging of the ankle joint at 3.0 T. Parameters for all images were 256 x 256, 18-cm field of view, and 2-mm-thick sections. (a) Dixon SSFP water image (imaging time, 2:18). (b) Dixon SSFP lipid image. (c) Three-dimensional spoiled GRE image obtained with fat suppression (imaging time, 7:40). Note that the fat suppression is much more homogeneous on the Dixon SSFP image (a) than on the spoiled GRE image obtained with conventional fat suppression (c). (Courtesy of Scott Reeder, MD, PhD, Stanford University, Stanford, Calif.)

View larger version (138K): [in a new window]   Figure 10c.  Sagittal Dixon SSFP imaging of the ankle joint at 3.0 T. Parameters for all images were 256 x 256, 18-cm field of view, and 2-mm-thick sections. (a) Dixon SSFP water image (imaging time, 2:18). (b) Dixon SSFP lipid image. (c) Three-dimensional spoiled GRE image obtained with fat suppression (imaging time, 7:40). Note that the fat suppression is much more homogeneous on the Dixon SSFP image (a) than on the spoiled GRE image obtained with conventional fat suppression (c). (Courtesy of Scott Reeder, MD, PhD, Stanford University, Stanford, Calif.)

View larger version (194K): [in a new window]   Figure 11a.  Sagittal fat-saturated SSFP imaging of the knee at 3.0 T. Parameters for both images were 512 x 384, 16-cm field of view, and 1-mm-thick sections. (a) Fat-saturated SSFP image shows a cartilage SNR of 21 (imaging time, 5:44). (b) Three-dimensional fat-suppressed GRE image shows a cartilage SNR of 7 (imaging time, 5:45). The higher SNR efficiency of steady-state techniques makes them appealing for high-resolution cartilage imaging.

View larger version (216K): [in a new window]   Figure 11b.  Sagittal fat-saturated SSFP imaging of the knee at 3.0 T. Parameters for both images were 512 x 384, 16-cm field of view, and 1-mm-thick sections. (a) Fat-saturated SSFP image shows a cartilage SNR of 21 (imaging time, 5:44). (b) Three-dimensional fat-suppressed GRE image shows a cartilage SNR of 7 (imaging time, 5:45). The higher SNR efficiency of steady-state techniques makes them appealing for high-resolution cartilage imaging.

View larger version (89K): [in a new window]   Figure 12a.  Axial steady-state diffusion-weighted images of the patellofemoral cartilage in a healthy volunteer, obtained with effective b values (beff) of 115 (a), 350 (b), and 630 (c) sec/mm2. Imaging is performed with three levels of diffusion weighting (effective b value), and navigation is performed to minimize the effects of motion. Note the decreasing signal for cartilage as free water is suppressed at higher b values. Diffusion-weighted imaging may allow early demonstration of breakdown of the collagen matrix. (Courtesy of Karla Miller, Stanford University, Stanford, Calif.)

View larger version (87K): [in a new window]   Figure 12b.  Axial steady-state diffusion-weighted images of the patellofemoral cartilage in a healthy volunteer, obtained with effective b values (beff) of 115 (a), 350 (b), and 630 (c) sec/mm2. Imaging is performed with three levels of diffusion weighting (effective b value), and navigation is performed to minimize the effects of motion. Note the decreasing signal for cartilage as free water is suppressed at higher b values. Diffusion-weighted imaging may allow early demonstration of breakdown of the collagen matrix. (Courtesy of Karla Miller, Stanford University, Stanford, Calif.)

View larger version (89K): [in a new window]   Figure 12c.  Axial steady-state diffusion-weighted images of the patellofemoral cartilage in a healthy volunteer, obtained with effective b values (beff) of 115 (a), 350 (b), and 630 (c) sec/mm2. Imaging is performed with three levels of diffusion weighting (effective b value), and navigation is performed to minimize the effects of motion. Note the decreasing signal for cartilage as free water is suppressed at higher b values. Diffusion-weighted imaging may allow early demonstration of breakdown of the collagen matrix. (Courtesy of Karla Miller, Stanford University, Stanford, Calif.)

View larger version (83K): [in a new window]   Figure 13.  Quantitative evaluation of glycosaminoglycan content in cartilage with delayed gadolinium-enhanced imaging. Top: Delayed gadolinium-enhanced image maps T1 to glycosaminoglycan (GAG) content and shows a focal area of low glycosaminoglycan concentration (arrow). Bottom: Photograph of the specimen after staining with toluidine blue shows a focal area of cartilage damage (arrow). (Reprinted, with permission, from reference 73.)

View larger version (77K): [in a new window]   Figure 14a.  Delayed gadolinium-enhanced imaging after autologous chondrocyte implantation. GAG = glycosaminoglycan. (a) Coronal image obtained 2 months after implantation shows decreased glycosaminoglycan content (arrow) in part of the implant. (b) Sagittal image obtained 15 months after implantation shows almost normal levels of glycosaminoglycan (arrow) in part of the implant. This example shows the potential of MR imaging for monitoring the glycosaminoglycan content in a cartilage repair site over time. (Reprinted, with permission, from reference 74.)

View larger version (76K): [in a new window]   Figure 14b.  Delayed gadolinium-enhanced imaging after autologous chondrocyte implantation. GAG = glycosaminoglycan. (a) Coronal image obtained 2 months after implantation shows decreased glycosaminoglycan content (arrow) in part of the implant. (b) Sagittal image obtained 15 months after implantation shows almost normal levels of glycosaminoglycan (arrow) in part of the implant. This example shows the potential of MR imaging for monitoring the glycosaminoglycan content in a cartilage repair site over time. (Reprinted, with permission, from reference 74.)