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Three Dimensional Assessment of Knee Cartilage in Cadavers with High Resolution MR-Arthrography and MSCT-Arthrography

Posted Aug 31, 2009 Updated Apr 7, 2023
By Jie Li MD , Zhuo-zhao Zheng MD , Xuan Li MD , Jia-kuo Yu MD
8 min read

Rationale and Objectives

The aim of this study was to compare high-resolution magnetic resonance (MR) arthrography and multislice computed tomographic (MSCT) arthrography in the evaluation of the entire knee cartilage obtained from cadavers.

Materials and Methods

MR arthrography and MSCT arthrography were performed on 16 cadaver knees, and their findings were compared to those found during macroscopic assessment. The sensitivity and specificity of MR arthrography and MSCT arthrography for detecting cartilage lesions of grade ≥ 2 and Spearman’s correlation coefficients between arthrographic and macroscopic grades were determined. In addition, cartilage surface conspicuity of the two techniques was measured using a subjective ranking system.

Results

The sensitivity and specificity, respectively, for the detection of cartilage disorder (grade ≥ 2) were 87% and 97% on MR arthrography and 84% and 99% on MSCT arthrography. There was no statistically significant difference between the two techniques in sensitivity ( P = 1.000) or specificity ( P = .625). Spearman’s correlation coefficients between MR arthrography or MSCT arthrography and macroscopic grading were 0.783 and 0.800, respectively, with no statistically difference ( P = .492). Both MR arthrography and MSCT arthrography enabled the accurate depiction of cartilage surface.

Conclusions

High-resolution MR arthrography and MSCT arthrography were comparably accurate for the assessment of cartilage lesions of the entire knee.

Articular cartilage lesions are commonly seen in athletes and the elderly, but imaging the cartilage remains one of the most difficult and controversial areas in musculoskeletal imaging. Although conventional magnetic resonance (MR) has been regarded as the imaging modality of choice for the noninvasive assessment of articular cartilage, its efficiency had a strong dependence on the selected sequences, and limited performance in depicting cartilage lesions caused by relatively low resolution has been reported . Traditional computed tomographic (CT) arthrography and MR arthrography enable the relatively accurate depiction of cartilage lesions , but most of the reported trials studied the patellar cartilage , not the hyaline cartilage of the entire joint.

With the advent of multislice CT (MSCT) imaging, there have been remarkable advances in musculoskeletal imaging . MSCT imaging can be used to acquire isotropic or near isotropic data sets from which high–spatial resolution multiplanar reformatted images can be generated, so it is possible to evaluate the entire cartilage in a single MSCT arthrographic examination with three-dimensional high resolution. MSCT arthrography had been used in the evaluation of the entire hyaline cartilage in cadaver knees as well as the measurement of cartilage thickness in cadaver ankles . The findings of these previous studies showed that MSCT arthrography depicted cartilage more accurately than MR imaging.

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Materials and methods

Specimen Preparation

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High-Resolution Three-Dimensional MR Arthrography

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MSCT Arthrography

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Macroscopic Analysis

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Table 1

International Cartilage Repair Society Classification of Cartilage Injuries

Grade Macroscopic Findings 0 Normal 1 Superficial lesions, fissures, cracks, indentations 2 Cartilage defects extending down to <50% of cartilage depth 3 Cartilage defects extending down to >50% of cartilage depth 4 Complete loss of cartilage thickness, bone only

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Image Analysis

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Table 2

Grading System for Interpretation of Magnetic Resonance Arthrographic or Multislice Computed Tomographic Arthrographic Images

Grade Findings 0 Smooth articular surface 1 Loss of smooth contour without contrast within cartilage 2 Penetration of contrast in cartilage, <50% of cartilage depth 3 Penetration of contrast material, >50% of cartilage depth 4 Penetration of contrast material, down to subchondral bone

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Statistical Analysis

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Results

Macroscopic Analysis

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Figure 1, (a) Photograph of the patella. The medial facet area was considered to be grade 2 on macroscopic examination (arrow) . (b) Transverse reformation with 2-mm slice thickness on magnetic resonance arthrography showed surface irregularity in medial facet (arrow) , with penetration of contrast in cartilage to less than half of cartilage thickness, consistent with grade 2. (c) Transverse reformation with 2-mm slice thickness on multislice computed tomographic arthrography showed surface irregularity in the medial facet (arrow) identical to that in (b) .

Figure 2, (a) Photograph of the lateral tibial plateau. The anteromedial part of this area was considered to be grade 3 on macroscopic examination (arrow) . (b) Sagittal reformation with 2-mm slice thickness on magnetic resonance arthrography showed surface irregularity in the anteromedial part of the lateral tibial plateau (arrow) , with penetration of contrast material more than half of cartilage thickness but not down to bone, consistent with grade 3. (c) Sagittal reformation with 2-mm slice thickness on multislice computed tomographic arthrography showed surface irregularity in the anteromedial part of the lateral tibial plateau (arrow) identical to that in (b) .

Figure 3, (a) Photograph of the patella. The lateral facet area was considered to be grade 4 on macroscopic examination (arrow) . (b) Transverse reformation with 2-mm slice thickness on magnetic resonance arthrography showed complete loss of cartilage thickness in lateral facet (arrow) as well as subchondral bony hyperostosis (arrow) . (c) Transverse reformation with 2-mm slice-thickness on multislice computed tomographic arthrography showed surface irregularity in the lateral facet and subchondral bony hyperostosis (arrow) identical to that in (b) .

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Detection of Cartilage Lesions of Grade ≥ 2

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Grading of Articular Cartilage

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Cartilage Surface Conspicuity

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Table 3

Rating Scores for Cartilage Surface Conspicuity

MR Arthrography MSCT Arthrography_P_ Femoropatellar joint 5.00 ± 0.00 5.00 ± 0.00 1.000 Femorotibial joint 4.50 ± 0.52 4.44 ± 0.81 .763 Posterior surface of femoral condyles 4.63 ± 0.50 4.94 ± 0.25 .025 ∗

MR, magnetic resonance; MSCT, multislice computed tomographic.

Data are expressed as mean ± standard deviation. P values are based on nonparametric paired-data Wilcoxon’s signed rank test.

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Figure 4, (a) Sagittal reformation with 2-mm slice-thickness on magnetic resonance arthrography. High signal of contrast material on the posterior surface of lateral femoral condyle was unapparent, rating a score of 4 (good). (b) Sagittal reformation with 2-mm slice-thickness on multislice computed tomographic arthrography showed linear high density of contrast material coating the posterior surface of lateral femoral condyle, rating a score of 5 (excellent).

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Discussion

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Academic Radiology, Volume 16, Issue 9
Journals General Radiology
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