MRI-软骨损伤.ppt

MRI Imaging of Cartilage injury Zhi-jieXi,M.D.TheDepartmentoftraumaandHandSurgeryTheFirstAffiliatedHospitalofuniversityofGuangxiTraditionalChineseMedicine.Zone of cartilage.Zone of cartilage.normal gray-scale stratification of the remaining medial femoral condyle and tibial plateaugray-scale stratification.Laysofcartilage.Rechtcclassificationgrade 0,normal;grade 1,focal low signal in cartilage,the surface of cartilage is smooth;grade 2,the focal defect has a depth of less than 50%of the total cartilage thickness;grade 3,the focal defect has a depth of more than 50%of the total cartilage thickness;grade 4,the full cartilage were damaged,and the bone surface under cartilage is exposed.Thecartilageblacklinesign:anunexpectedMRIappearanceofdeepcartilagefissuring.Thecartilageblacklinesign:anunexpectedMRIappearanceofdeepcartilagefissuring.Thecartilageblacklinesign:anunexpectedMRIappearanceofdeepcartilagefissuring.Sagittal(A)and coronal(B)fast spin-echo MR images of the knee in a 24-year-old professional football player.There is hyperintensity in the radial zone,indicating deep surface delamination(arrow),adjacent to the tidemark with no flap formation.There is also associated sclerosis of the subchondral plate.The patient underwent microfracture with a good clinical outcomehyperintensity in the radial zone.SodiumMRIfindsearlysignsofarthritis.displaced osteochondral fragment.AT1-weightedsagittalexamdemonstratesanosteochondralinjury(arrow)alongtheanteriorweight-bearingsurfaceofthemedialfemoralcondyle.thefat-suppressedfastspin-echoprotondensityweightedcoronalview,twodiscretecartilagedefects(arrows)areapparentbeneaththesiteofosseousinjury.Notethatthesedefectsarenotvisibleon(E),asT1-weightedimagesarerelativelyinsensitiveforcartilagelesionscartilagedefects.aprotondensityweighedfastspin-echoaxialimagewithfat-suppression,afluidfilledcrater(arrow)isapparentwithinthelateralcompartmentposteriorlythecorrespondingcoronalimage,thecartilagedefectwithinthelateralfemoralcondyle(arrow)isconfirmed,thoughitislessconspicuouscartilagedefects.Afat-suppressedfastspin-echoprotondensityweightedcoronalimagerevealsanill-definedcartilagedefect(arrow)alongtheweight-bearingsurfaceofthelateralfemoralcondyleThesizeandcurvilinearmorphologyofthedefect(arrow)aremoreclearlydelineatedontheaxialimagedemonstratingthecratersigncartilagedefects.Displacedchondralfragment.lateralpatellarmaltrackinganditseffectsonchondralwear(A)Radiograph with lateral patella maltracking,and(B)arthroscopic view showing chondral injury in a patient with lateral patella maltracking and the“kissing lesion”associated.narrowingofjointspace A 53-year-old male underwent high tibial osteotomy:(A)Preoperative XR showing narrowing of medial compartment;and(B)Postoperative view at 7 months showing re-appearance of the medial compartment.Follow-upPreoperative(Pre-op)MRI(STIR)showing bone on bone over the medial compartment of the right knee(red arrow).White arrow showing regenerated articular cartilage at 18 months over the anterior half of both the medial femoral condyle and medial tibial plateau.Follow-upPreoperative(Pre-op)merchant view showing lateral patellar maltracking with absence of the lateral patellofemoral articulation.(B)XR at 18 months showed improvement of the lateral patellofemoral articulation.Follow-upA 49-year-old man underwent high tibial osteotomy,lateral patellar release and tri-compartmental chondral drilling.Osteochondritis Dissecans.Unstable Osteochondritis Dissecans of the Medial femoral CondyleAnosteochondrallesionisseenattheposteriorweightbearingsurfaceofthemedialfemoralcondyle.Afluid-filledbreakinthearticularsurface(arrowhead)ispresent,andthereisfluidattheanteriorinterfaceofthefragment(arrow).Edemaispresentinthebedofthedefect(asterisk).Aprotondensity-weightedfat-suppressedcoronalimagedemonstratesafluidsignal-intensityline(arrows)atthebaseoftheosteochondrallesionofthemedialfemoralcondyle,compatiblewithunstableOCD.Afat-suppressedprotondensity-weightedcoronalimageoftheankleshowsfluidextendingthroughthechondralandcorticalsurface(arrowhead)ofanosteochondrallesionofthelateraltalardome.STIRcoronalandsagittalT2imagesofthemedialfemoralcondylerevealafocalarticulardefect(arrows).Afat-suppressedT2-weightedsagittalimageoftheankleshowsaninvertedosteochondralfragment(arrow).Thearticularsurfaceisfacinginferiorly(dottedline)inthisclearlyunstablelesionTalar Dome.6weeksand20monthsafterautologouschondrocyteimplantation.Sagittal fat-suppressed(A)and fast spin-echo(B)MR images of the knee in a 57-year-old man with extensive osteonecrosis and subchondral collapse of the posterior margin of the lateral femoral condyle.Note the secondary delamination of the overlying cartilage with fluid imbibition between subchondral bone and cartilagesecondary delamination.Sagittal inversion recovery(A)and axial fast spin-echo(B)MR images of the knee in a 31-year-old patient obtained 7 weeks following microfracture over the trochlea.Note the hyperintense reparative fibrocartilage over the defect(arrows).Sagittal fast spin-echo MR image(C)also demonstrates basilar delamination of cartilage without flap formation(arrowhead)adjacent to the area of microfracture,over the lateral margin of the trochleaFollow-up.Sagittal MR image of the knee in a 37-year-old patient obtained 12 months following autologous osteochondral transfer to the trochlea demonstrates that although the osseous components of the plugs are proud relative to subchondral bone,the repair cartilage is flush with that of the native cartilage,with restoration of the radius of curvature of the joint surface.Note the high signal intensity at the repairnative cartilage interface(arrowheads）Follow-up.Sagittal(A)and coronal(B)fast spin-echo MR images of the knee in a 41-year-old patient obtained 3 months following autologous osteochondral transfer using multiple plugs.There is overall good bony incorporation of the osteochondral plugs,but with focal cystic change and collapse of subchondral bone centrally(arrowhead in A and B).Note that the donor site(B)over the lateral aspect of the intercondylar notch is filled with hyperintense material,likely representing reparative Follow-up.Follow-up.Axial fast spin-echo MR image of the knee performed 3 months following autologous osteochondral transfer using multiple plugs to restore a large osteochondral defect of the medial femoral condyle.Note consolidation of trabeculae(linear low signal intensity)around the plugs(arrowheads)as a result of the“press fit”fixation.Donor sites are seen in the lateral femoral condyle,close to the notchFollow-up.Coronal fast spin-echo MR image of the knee in a 61-year-old patient obtained 3 months following placement of a synthetic scaffold bone graft substitute.Note the intermediate signal intensity characteristics of the synthetic plugFollow-up.Coronal fast spin-echo MR images of the knee in a 15-year-old boy obtained following ACI for osteochondritis dissecans of the medial femoral condyle.(A)At the 3-month follow-up,the repair cartilage is proud and hyperintense relative to native cartilage,consistent with graft hypertrophy(arrowheads).Coronal fast spin-echo MR images of the knee in a 31-year-old man obtained following ACI.(A)Six weeks following surgery the graft is hyperintense relative to the intact,hypointense overlying periosteal cover(arrow).(B)Twenty months following surgery there is incorporation of periosteum to what is now isointense reparative cartilage,such that periosteal cover is no longer distinct(arrow).Follow-up.Summarycartilage injury?Bone contusion VS cartilage injuryOsteochondritis Dissecans VS cartilage injurysuccess and failure of surgery .