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Review
. 2011 Jan-Feb;31(1):37-61.
doi: 10.1148/rg.311105084.

Articular cartilage in the knee: current MR imaging techniques and applications in clinical practice and research

Michel D Crema  1 , Frank W Roemer, Monica D Marra, Deborah Burstein, Garry E Gold, Felix Eckstein, Thomas Baum, Timothy J Mosher, John A Carrino, Ali Guermazi
Affiliations
Review

Articular cartilage in the knee: current MR imaging techniques and applications in clinical practice and research

Michel D Crema et al. Radiographics. 2011 Jan-Feb.

Abstract

Magnetic resonance (MR) imaging is the most important imaging modality for the evaluation of traumatic or degenerative cartilaginous lesions in the knee. It is a powerful noninvasive tool for detecting such lesions and monitoring the effects of pharmacologic and surgical therapy. The specific MR imaging techniques used for these purposes can be divided into two broad categories according to their usefulness for morphologic or compositional evaluation. To assess the structure of knee cartilage, standard spin-echo (SE) and gradient-recalled echo (GRE) sequences, fast SE sequences, and three-dimensional SE and GRE sequences are available. These techniques allow the detection of morphologic defects in the articular cartilage of the knee and are commonly used in research for semiquantitative and quantitative assessments of cartilage. To evaluate the collagen network and proteoglycan content in the knee cartilage matrix, compositional assessment techniques such as T2 mapping, delayed gadolinium-enhanced MR imaging of cartilage (or dGEMRIC), T1ρ imaging, sodium imaging, and diffusion-weighted imaging are available. These techniques may be used in various combinations and at various magnetic field strengths in clinical and research settings to improve the characterization of changes in cartilage.

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Figures

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Axial short inversion time inversion recovery image obtained in the knee accurately depicts a focal full-thickness chondral defect (arrows) at the trochlear groove.
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Axial 2D T2-weighted fast SE image provides excellent depiction of a focal region of deep cartilaginous delamination (arrows), with high contrast between the cartilage surfaces and synovial fluid.
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Coronal 3D SPGR image shows intact high-signal-intensity cartilaginous surfaces in the medial and lateral tibiofemoral compartments. Lipid suppression provides excellent contrast between cartilage and subchondral bone.
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Sagittal 3D DEFT image demonstrates a cartilage fissure (arrow) at the medial tibial plateau. The defect is outlined by the high signal intensity of synovial fluid, an appearance that derives from the driven equilibrium acquisition technique.
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Sagittal 3D bSSFP water image obtained with a fluctuating equilibrium technique at 1.5 T (TR/TE = 6.6/1.8, in-plane resolution = 0.3 × 0.6 mm, section thickness = 2 mm, acquisition time = 2 min 43 sec) provides excellent contrast between cartilage and fluid despite areas of imperfect fat-water separation (arrowheads) resulting from field inhomogeneity.
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Sagittal IDEAL-bSSFP water image shows excellent contrast between cartilage and synovial fluid (arrows) and between cartilage and other surrounding tissues.
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Sagittal 3D SPACE water image accurately depicts cartilage thinning at the medial femoral condyle (arrowheads) and tearing at the posterior horn of the medial meniscus (arrow). Note the anterior medial femoral osteophyte.
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Whole-knee sodium MR image obtained with a proton density–weighted SPGR sequence in a healthy 20-year-old volunteer shows high signal intensity in cartilage at the medial compartment. Images were acquired at 3.0 T with a custom quadrature sodium coil and 3D cones readout trajectory, with a spatial resolution of 1.25 × 1.25 × 4 mm and acquisition time of 20 min. Scale is in millimoles.
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Sagittal ADC map obtained with diffusion-weighted MR imaging in the knee of an asymptomatic 28-year-old man shows a region of higher signal intensity at the posterior aspect of the medial femoral condyle, a finding suggestive of increased water proton mobility through a disruption in the cartilage matrix. Imaging was performed at 3.0 T (TR/TE = 2200/73, b = 600 sec/mm2, section thickness = 5 mm, matrix = 192 × 192).
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See this image and copyright information in PMC

Comment in

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