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Early investigations into the magnetic resonance imaging (MRI) appearance of articular cartilage imaging relied on assessment of the morphology, with subsequent investigators reporting identifying increased T2 signal intensity, bright signal, in degenerated cartilage. The cartilage “black line sign” is a finding that has recently been described in the radiology literature to characterize cartilage pathology. This sign refers to a focal linear hypointense signal within articular cartilage that is oriented perpendicular to the subchondral bone on T2-weighted MRI. The diagnostic significance and clinical relevance of this sign is debated. Since its first description, several papers have further delineated the etiology, prevalence, and clinical relevance of these and other dark cartilage abnormalities. The intent of this article is to summarize these findings, with hopes of bringing to light the importance of dark cartilage lesions and their clinical implication in the world of knee surgery. We will briefly discuss the most probable etiologies of dark cartilage abnormalities and the major factors determining the unique signal intensity. The described anatomical patterns of this finding, the clinical importance, potential mimics, and current treatment recommendations will be reviewed.

The knee is the most commonly examined joint with magnetic resonance imaging (MRI) and, as such, it is the joint that most trainee radiologists start reporting. This article addresses the main pathologies encountered on MRI examination of the knee, outlining the key features to note and report, as well as providing examples of terminology used to describe these findings.

Introduction: The integrity of articular cartilage determines the functional state of the joint. In recent years, the development of MRI sequences of various articular cartilage has become the focus of many research topics. Objective: The accuracy of diagnosis of knee cartilage injury caused by motion injury was studied retrospectively by meta-three-dimensional software. Methods: Forty-six knee joints of 45 patients with sports injuries, multi-sequence MRI was performed before surgery, including conventional knee MRI (SET1WI, FSEPD/T2WI), 3D SPGR, and 3D FIESTA sequences. Results: According to the operation results, the sensitivity, specificity, positive predictive value, and negative predictive value of 3D SPGR combined with conventional MRI sequence evaluation of cartilage damage are the highest, 73%, 98%, 95%, and 90%. Conclusions: 3D SPGR combined with conventional MRI sequences can improve accurate evaluation and diagnosis of cartilage disease over a reasonable scan time. Level of evidence II; Therapeutic studies - investigation of treatment results. RESUMO Introdução: A integridade da cartilagem articular determina o estado funcional da articulação. Nos últimos anos, o desenvolvimento de sequências de ressonância magnética de várias cartilagens articulares se tornou o foco de muitos tópicos de pesquisa. Objetivo: A precisão do diagnóstico de lesão da cartilagem do joelho causada por lesão de movimento foi estudada retrospectivamente por software meta-tridimensional. Métodos: Quarenta e seis articulações de joelho de 45 pacientes com lesões esportivas, várias sequências de ressonância magnética foram realizadas antes da cirurgia, incluindo ressonância magnética de joelho convencional (SET1WI, FSEPD / T2WI), 3D SPGR e sequências 3D FIESTA. Resultados: De acordo com os resultados da operação, a sensibilidade, especificidade, valor preditivo positivo e valor preditivo negativo de 3D SPGR combinado com avaliação de sequência de ressonância magnética convencional de danos na cartilagem são os mais altos, 73%, 98%, 95% e 90%. Conclusões: 3D SPGR combinado com sequências convencionais de ressonância magnética pode melhorar a avaliação precisa e diagnóstico de doença da cartilagem em um tempo de varredura razoável. Nível de evidência II; Estudos terapêuticos- investigação dos resultados do tratamento. RESUMEN Introducción: La integridad del cartílago articular determina el estado funcional de la articulación. En los últimos años, el desarrollo de secuencias de resonancia magnética de varios cartílagos articulares se ha convertido en el foco de muchos temas de investigación. Objetivo: La precisión del diagnóstico de la lesión del cartílago de la rodilla causada por una lesión por movimiento se estudió retrospectivamente mediante un software meta-tridimensional. Métodos: Cuarenta y seis articulaciones de rodilla de 45 pacientes con lesiones deportivas, se realizó una resonancia magnética de secuencia múltiple antes de la cirugía, incluida la resonancia magnética de rodilla convencional (SET1WI, FSEPD/T2WI), secuencias 3D SPGR y 3D FIESTA. Resultados: De acuerdo con los resultados de la operación, la sensibilidad, la especificidad, el valor predictivo positivo y el valor predictivo negativo de 3D SPGR combinados con la evaluación de la secuencia de resonancia magnética convencional del daño del cartílago son los más altos, 73%, 98%, 95% y 90%. Conclusiones: 3D SPGR combinado con secuencias de resonancia magnética convencionales puede mejorar la evaluación y el diagnóstico precisos de la enfermedad del cartílago en un tiempo de exploración razonable. Nivel de evidencia II; Estudios terapéuticos- investigación de los resultados del tratamiento.

PURPOSE: To determine the relationship between femoral–tibial morphometries and anterior cruciate ligament (ACL) pathologies using magnetic resonance imaging (MRI). METHODS: We retrospectively evaluated 455 patients (211 females and 244 males) who underwent knee MRI with suspected ACL pathology. Imaging findings were classified as normal ACL (n = 119), degeneration of the ACL (n = 116), partial ACL tear (n = 103), and complete ACL tear (n = 117). In all groups, the femoral intercondylar notch width (INW), intercondylar distance (CD), notch width index (NWI), and intercondylar notch angle (INA), the angles between the tibial plateau and tibial spines (MPA and LPA), intercondylar eminence peak angle (IEA), and tibial slope angles (MSA and LSA) were measured. RESULTS: Femoral INW and NWI were significantly lower in patients with ACL pathology (p

Objective: While articular cartilage defects are common incidental findings among adult athletes, the effect of running on the cartilage of adolescent athletes have rarely been assessed. This study aims to assess the variations in the articular cartilage of the knees in healthy adolescent basketball players using quantitative T2 MRI (magnetic resonance imaging). Design: Fifteen adolescent basketball players were recruited (13.8 ± 0.5 years old). Girls were excluded to avoid potential gender-related confounding effects. Players underwent a pre-run MRI scan of both knees. All participants performed a 30-minute run on a treadmill. Within 15 minutes after completion of their run, players underwent a second, post-run MRI scan. Quantitative T2 maps were generated using the echo modulation curve (EMC) algorithm. Pre-run scans and post-run scans were compared using paired t test. Results: Participants finished their 30-minute run with a mean running distance of 5.77 ± 0.42 km. Pre-run scans analysis found statistically significant ( P < 0.05) changes in 3 regions of the knee lateral compartment representing the cartilaginous tissue. No differences were found in the knee medial compartment. Post-run analysis showed lower T2 values in the medial compartment compared to the pre-run scans in several weight-bearing regions: femoral condyle central (pre/post mean values of 33.9/32.2 ms, P = 0.020); femoral condyle posterior (38.1/36.8 ms, P = 0.038); and tibial plateau posterior (34.1/31.0 ms, P < 0.001). The lateral regions did not show any significant changes. Conclusions: Running leads to microstructural changes in the articular cartilage in several weight-bearing areas of the medial compartment, both in the femoral and the tibial cartilage.

Comparisons of 5-minute five-sequence knee MRI using simultaneous multislice and parallel imaging acceleration and 10-minute five-sequence knee MRI using parallel imaging acceleration only suggest ...

This study aimed to investigate the morphological variations in the cross-sectional anatomy of the meniscus between similar-sized matched menisci. Knee MRI of 329 patients with intact menisci were retrospectively reviewed, and the meniscal length (ML), meniscal width (MW), and cross-sectional dimensions (meniscal height and width) of the anterior, posterior horns, and the corpus were measured. Patients with similar-sized menisci who had less than 1 mm difference in ML and MW were matched. 330 male-to-male medial menisci (MM), 623 male-to-male lateral menisci (LM), 82 female-to-female MM, 233 female-to-female LM, 176 cross-gender MM, and 265 cross-gender LM unique combination of ideally matched pairs (total: 1709) were generated. The disparity in the cross-sectional dimensions, absolute difference, and the paired percent differences was statistically analyzed. The ML and MW in all groups were statistically similar, with a predefined absolute difference of 1 mm both for ML and MW (paired percent difference

Place: France; International audience; PURPOSE: The purpose of this study was to assess and compare the prevalence of meniscal, ligament and cartilage lesions on knee MRI in a series of age- and sex-matched patients with and without medial meniscal ossicle.MATERIALS AND METHODS: Forty-two knee MRI examinations obtained in 42 patients (36 men, 6 women; mean age, 42.5±22.2 [SD] years; range: 19-65years) on which a medial meniscal ossicle was present were compared to 42 knee MRI examinations obtained in 42 age- and sex-matched patients (36 men, 6 women; mean age, 41.8±20.6 [SD] years; range: 19-65years) on which no medial meniscal ossicles were present. Two radiologists (R1, R2) blinded to the presence of meniscal ossicle by reading only the fat-saturated intermediate-weighted MR images separately assessed the presence of meniscal, ligament and cartilage lesions on these 84 knee MRI examinations. Prevalence of meniscal and ligament lesions and degree of cartilage degradation at MRI were compared between knees with and those without medial meniscal ossicle.RESULTS: In knees with medial meniscal ossicle, R1 and R2 detected 33 (79%) and 38 (90%) medial meniscal lesions, respectively that involved the posterior root (n=25/32 for R1/R2), the posterior horn (n=19/14 for R1/R2) or the body (n=8/10 for R1/R2). The prevalence of posterior root tear (60% [25/42]/76% [32/42] for R1/R2) and that of anterior cruciate ligament (ACL) lesions (48% [20/42]/57% [24/42] for R1/R2) as well as the medial cartilage degradation score (3.35±0.87 [SD] for R1 and 3.92±0.78 [SD] for R2) were significantly greater in knees with than in knees without medial meniscal ossicle (root lesions: P\textless0.01 for both readers; ACL lesions and medial cartilage score: P\textless0.01 for both readers).CONCLUSION: On MRI examination, knees with a medial meniscal ossicle demonstrate a greater frequency of medial posterior root tear and of ACL lesions and a greater degree of medial femoro-tibial cartilage degradation by comparison with knees without medial ossicle.

Background Bone-cartilage mismatch is a variation in which the surface curvature of the articular cartilage is incongruent with the curvature of the underlying subchondral bone. The purpose of this study is to investigate the prevalence of this variant in the medial tibial plateau (MTP) and examine potential association with clinical findings and intra-articular derangements using MRI. Methods A quantitative and qualitative retrospective analysis of 98 knee MRI studies was performed. Bone and cartilage depths of the MTP were measured to assess bone-cartilage morphology and classified into congruent (concave bone-concave cartilage) and incongruent (concave bone-convex cartilage) patterns. Associations between bone-cartilage mismatch and clinical findings and other MRI changes were assessed using Fisher’s exact test. Results By quantitative assessment, four individuals (4%) had MTP incongruent morphology (bone-cartilage mismatch). The mean bone depth ± standard deviation (SD) was 2.3 ± 0.6 mm concave in the congruent group, and 1.4 ± 0.6 mm concave in the incongruent group. The mean cartilage depth ± SD was 0.7 ± 0.7 mm concave in the congruent group, and 0.9 ± 0.5 mm convex in the incongruent group. By qualitative assessment, three individuals (3%) had incongruent morphology. Although not statistically significant, a higher proportion of individuals (3 of 4; 75%) with incongruent cartilage demonstrated chondromalacia patellae compared to those with congruent cartilage (38 of 94; 40%). Conclusion Bone-cartilage mismatch was present in 3–4% of the knees. Individuals with incongruent cartilage demonstrated a trend of a higher proportion of chondromalacia patellae. Larger studies are needed to evaluate this further.

Age estimation is a crucial element of forensic medicine to assess the chronological age of living individuals without or lacking valid legal documentation. Methods used in practice are labor-intensive, subjective, and frequently comprise radiation exposure. Recently, also non-invasive methods using magnetic resonance imaging (MRI) have evaluated and confirmed a correlation between growth plate ossification in long bones and the chronological age of young subjects. However, automated and user-independent approaches are required to perform reliable assessments on large datasets. The aim of this study was to develop a fully automated and computer-based method for age estimation based on 3D knee MRIs using machine learning. The proposed solution is based on three parts: image-preprocessing, bone segmentation, and age estimation. A total of 185 coronal and 404 sagittal MR volumes from Caucasian male subjects in the age range of 13 and 21 years were available. The best result of the fivefold cross-validation was a mean absolute error of 0.67 ± 0.49 years in age regression and an accuracy of 90.9%, a sensitivity of 88.6%, and a specificity of 94.2% in classification (18-year age limit) using a combination of convolutional neural networks and tree-based machine learning algorithms. The potential of deep learning for age estimation is reflected in the results and can be further improved if it is trained on even larger and more diverse datasets.

OBJECTIVE: Deep learning (DL) image reconstruction has the potential to disrupt the current state of MRI by significantly decreasing the time required for MRI examinations. Our goal was to use DL to accelerate MRI to allow a 5-minute comprehensive examination of the knee without compromising image quality or diagnostic accuracy. MATERIALS AND METHODS. A DL model for image reconstruction using a variational network was optimized. The model was trained using dedicated multisequence training, in which a single reconstruction model was trained with data from multiple sequences with different contrast and orientations. After training, data from 108 patients were retrospectively undersampled in a manner that would correspond with a net 3.49-fold acceleration of fully sampled data acquisition and a 1.88-fold acceleration compared with our standard twofold accelerated parallel acquisition. An interchangeability study was performed, in which the ability of six readers to detect internal derangement of the knee was compared for clinical and DL-accelerated images. RESULTS. We found a high degree of interchangeability between standard and DL-accelerated images. In particular, results showed that interchanging the sequences would produce discordant clinical opinions no more than 4% of the time for any feature evaluated. Moreover, the accelerated sequence was judged by all six readers to have better quality than the clinical sequence. CONCLUSION. An optimized DL model allowed acceleration of knee images that performed interchangeably with standard images for detection of internal derangement of the knee. Importantly, readers preferred the quality of accelerated images to that of standard clinical images.

Clinically measured Quadriceps angle (Q-angle) has low reliability. Measurement of angle between femoral shaft and patellar tendon (FSPT angle) on routine knee MRI was described in this study to represent the lateral vector forces of quadriceps mechanism. The cross-sectional study was designed to compare this angle between subjects with objective patellofemoral instability (PFI) versus those without PFI, to assess its reliability, and to assess its validity in terms of its ability to differentiate between PFI and non-PFI subjects using the “Receiver Operating Characteristic” (ROC) curve. MRI scans of 20 subjects with PFI and 20 without PFI were obtained. FSPT angle was measured in each MRI by three different raters. In addition, the clinical Q-angle was also measured in the control group. The FSPT angle was significantly higher in PFI group as compared with the non-PFI group (p

OBJECTIVE. Cartilage loss on preoperative knee MRI is a predictor of poor outcomes after arthroscopic partial meniscectomy. The purpose of this study was to compare the ability to predict outcomes after arthroscopic partial meniscectomy with a clinically used modified Outerbridge system versus a semiquantitative MRI Osteoarthritis Knee Score system for grading cartilage loss. MATERIALS AND METHODS. Patients who underwent preoperative knee MRI within 6 months of arthroscopic partial meniscectomy and who had outcomes available from the time of surgery and 1 year later were eligible for inclusion. Cases were evaluated by two radiologists and one radiology fellow with the use of both grading systems. The accuracy of each system in discriminating between surgical success and failure was estimated using the ROC curve (AUC) with 95% CIs. A Wald test was used to assess noninferiority of the clinical grading system. Interreader agreement regarding the accuracy of the grading systems in predicting outcomes was also compared. RESULTS. A total of 78 patients (38 women and 40 men; mean age, 56.6 years) were included in the study. A prediction model using clinical grading (AUC = 0.695; 95% CI, 0.566-0.824) was noninferior (p = 0.047) to a model using MRI Osteoarthritis Knee Score grading (AUC = 0.683; 95% CI, 0.539-0.827). Both MRI prediction models performed better than a model using demographic characteristics only (AUC = 0.667; 95% CI, 0.522-0.812). Inter-reader agreement with clinical grading (80.8%) was higher than that with MRI Osteoarthritis Knee Score grading (65.0%; p = 0.012). CONCLUSION. A clinically used system to grade cartilage loss on MRI is as effective as a semiquantitative system for predicting outcomes after arthroscopic partial meniscectomy, while also offering improved interreader agreement.

Background: Many prevalent disorders were observed in and around the knee joint. Magnetic resonance imaging (MRI) was a modern and costly diagnostic technology that was progressively applied worldwide. This study was conducted in the Bushehr educational hospitals in 2018 with the purpose of determining the necessity of knee MRI prescriptions. Methods: This paper was a kind of cross-sectional descriptive-analytical study. The statistical population of the study was all patients who were prescribed knee MRI due to the appearance of knee problems and referred to the MRI Center of Bushehr University of Medical Sciences in 2018. The sampling method was convenient sampling. The sample in this study included 274 patients. The indications and data collection form of Vojdani et al.'s study were used to specify the necessity of the mentioned prescriptions. In this study, SPSS 22 software was applied to analyze data. Also, the Chi-Square test was used to for analyzing the data. Results: Among the total studied population in this study, MRI prescription was evaluated inappropriately for approximately 24 % of patients. In this study, the appropriateness of the prescriptions had a significant relationship with age, job, education level, physician prescribing, and requesting MRI (P-value < 0.05). Conclusion: It could be deduced that about a quarter of MRI was not appropriate to clinical prescription. Regarding the high cost of hospital and the necessity of their reduction, induced demand would be prevented by using valid indications. Therefore, reducing unnecessary prescriptions yielded to fewer costs of the health system and patients.

The aim of this study was to propose and validate a new six-item topographical classification of knee bone marrow lesions in coronal MRI images, to provide an easy-to-use aid to describe their location in a more reproducible and accurate way. This study was conducted in four phases. The first was to do a literature search for methods of describing bone marrow lesions in MRI of the knee. The second was creation of a six-area topographic classification of bone marrow lesions in coronal MRI of the knee. The third phase was selection of cases with bone marrow lesions on knee MRI performed in a single hospital between January of 2017 and December of 2018. The fourth phase was categorization of the bone marrow lesions’ location according to the new proposed classification by three independent examiners, two orthopedic surgeons and one radiologist. Patient’s demographic data and associated lesions were collected. The inter-observer and intra-observer reliability of the proposed classification was then calculated. MRI examination of 4000 patients were studied and in 520 patients a total of 666 bone marrow lesions were identified and their location classified using the new system. The inter-observer and intra-observer reliability analysis found a Fleiss’ Kappa value of 0.96 (0.95–0.97) and 0.97 (0.96–0.97), respectively, confirming the high reproducibility of the proposed classification. The proposed six-location classification of bone marrow lesions is highly reproducible and can help researchers develop studies and share information in a more accurate and reliable way. The correct classification of bone marrow lesions can lead to a more accurate description of this pathology and help clinicians to propose appropriate therapies for this group of patients. V.

Background Magnetic resonance imaging (MRI) is a non-invasive highly sensitive tool for diagnosing chondromalacia patellae in the early stages. Many studies have evaluated patellar and trochlear morphology with different radiologic indices. We aimed to assess the discriminative power of tibial, patellar, and femoral indices in MRI for chondromalacia patellae. Patients and methods 100 cases of chondromalacia, as well as 100 age-matched controls among the patients who underwent knee MRI between February 2017 and March 2019, were included. The standard protocol of knee MRI was applied and the diagnosis of chondromalacia was made on MRI findings. Chondromalacia subjects were also classified as grade 1 to 4 according to the Modified Outerbridge’s MRI grading system. We measured 25 MRI parameters in the knee and adjacent structures to determine the relation between chondromalacia patellae and anatomical MRI parameters. Results Tibial slope, trochlear depth, lateral trochlear inclination, and lateral patellar tilt angle had significant correlation with chondromalacia. Any increase in lateral trochlear inclination and lateral patellar tilt angle could increase the probability of the disease (Odds ratio [OR] 1.15, 1.13; 95% CI: 1.03–1.30; 1.02–1.26, respectively), while any increase in medial tibial slope and trochlear depth could decrease the probability of chondromalacia (OR 0.85, 0.06; 95% CI: 0.73–0.98, 0.02–0.17, respectively). We also designed a model for the severity of disease by using the patellar height index (relative odds ratio: 75.9). Conclusions The result of this study showed the novelty role of tibial anatomy in developing chondromalacia and its mechanism. We also concluded that patellar height might be an important factor in defining disease severity.

Background: The utility of magnetic resonance imaging (MRI) in the primary care setting is uncertain, with a perception that there is less likelihood for surgery after MRI ordered by general practitioners (GPs) when compared with orthopaedic surgeons and sports medicine physicians. Additionally, the influence of patient age and sex on subsequent surgical intervention is currently unknown. Purpose/Hypothesis: The purpose of this study was to compare surgical incidence after MRI referrals by orthopaedic surgeons, GPs, and sports medicine physicians, including a subset analysis for GP patients based on type of approval given by the radiologist. The authors also wanted to explore the association of age and sex on subsequent surgical intervention. They hypothesized that surgical incidence after MRI ordered by orthopaedic surgeons and sports medicine physicians would be higher than after MRI ordered by GPs. Study Design: Cohort study; Level of evidence, 3. Methods: Knee MRI referrals by the 3 physician cohorts during May to December 2017 were assessed. For GP patients, the types of approval or recommendation from a radiologist were categorized. Subsequent surgical intervention status was then compared among referral groups up to 2 years after MRI. Associations of age and sex with surgical occurrence were also assessed. Chi-square test, analysis of variance, and univariate/multivariable logistic regression were used for statistical analysis. Results: Overall, 407 referrals were evaluated (GP, n = 173; orthopaedic, n = 176; sports medicine, n = 58). Surgical incidence was not significantly higher for orthopaedic and sports medicine than GP referrals at 3 months (10%, 3%, and 6%, respectively; P = .23), 6 months (20%, 17%, and 15%; P = .49), and 2 years (30%, 35%, and 24%; P = .25). Surgical incidence for GP patients was higher after discussion with a radiologist or when evaluating specific pathology on prior imaging versus less defined reasons (30.4% vs 15.7%, respectively; P = .03). Surgical incidence was lower for older patients (11% vs 31% for >60 years vs all other age groups combined; P = .002), and women were less likely to undergo surgery than men (22% vs 35%, respectively; P = .008). Conclusion: Surgical incidence after MRI was likely appropriately lower for older patients. Lower incidence for female patients is of uncertain cause and warrants further study.

Objectives: In managing pediatric knee conditions, an accurate bone age assessment is often critical for diagnostic, prognostic, and treatment purposes. Historically, the Greulich and Pyle Atlas (hand atlas) has been the gold standard bone age assessment tool. In 2013, a shorthand bone age assessment tool based on this atlas (hand shorthand) was established as a simpler and more efficient alternative. Recently, a knee MRI bone age atlas (MRI atlas) was created potentially to circumvent the need for a left hand radiograph. Our objective is to create a shorthand version of the magnetic resonance imaging atlas. Methods: A shorthand bone age method (Figure 1) was created utilizing the previously published MRI atlas, which utilizes several criteria that are visualized across a series of images. The MRI shorthand draws on the most characteristic criteria for each age that is best observed on a single MR image. For validation, we performed a retrospective assessment of skeletally immature patients that had a knee MRI and left hand radiograph within four weeks. Four readers who were familiar with the hand atlas, hand shorthand, MRI atlas, and MRI shorthand read each of the images in a blinded fashion. Inter- and intra-observer reliability was evaluated using intraclass correlation coefficient (ICC), variability among observers was evaluated using percent agreement. Results: 26 patients with a mean age of 13.6 years (range 9.0-16.9) met the inclusion criteria. The intra- and inter-observer reliability of all four assessment tools was excellent (ICC ≥ 0.8, pConclusions: The MRI shorthand is a simple and efficient means of assessing skeletal maturity of adolescent patients with a knee MRI. This bone age assessment technique has inter-observer and intra-observer reliability equivalent or better than the standard means utilizing a left hand radiograph.

Amaç: Patella tiplerindeki farklılıkların, menisküs üzerindeki yükü değiştirerek ve yürüme mekaniğinde değişikliğe neden olarak menisküs rüptürünün etiyolojisinde rol oynayabileceğini düşünüyoruz. Bu çalışmada patella tiplerinin dağılımı ve menisküs rüptürü ile ilişkisi araştırıldı.Materyal ve Metod: Bu çalışmada, Ocak 2017- Temmuz 2018 tarihleri arasında Fizik Tedavi ve Rehabilitasyon polikliniğine başvuran 510 hastanın diz manyetik rezonans (MR) incelemeleri patella tiplerinin ayırımı ve menisküs rüptürünün dağılımı açısından PACS sisteminde retrospektif olarak tekrar değerlendirildi. Hastaların klinik öyküleri, muayene bulguları, yaşları ve cinsiyetleri hastanenin kayıt sisteminden alındı. On sekiz yaş altındaki hastalar, majör travma öyküsü olan ve ameliyat edilen hastalar çalışma dışı bırakıldı. Diz MR incelemesi 3-Tesla magnet gücüne sahip MR cihazı (MagnetomSkyra, Siemens Healthcare, Erlangen, Almanya) ile standart diz koili kullanılarak gerçekleştirildi. Patella tipi sınıflamasında aksiyel PD görüntüleri kullanılarak, Baumgartl ve arkadaşlarının yaptıkları sınıflama esas alındı. Buna göre; Tip I: İçbükey ve eşit uzunluktaki medial ve lateral fasetler. Tip II: Medial faset düz veya içbükeydir, lateral faset medial fasetten daha belirgindir. Tip III: Daha küçük medial faset mevcut ve dışbükeydir. Tip IV: Medial faset veya merkez kenarı yoktur, jokey şapkası olarak adlandırılır. Elde edilen sayısal veriler, yaş, cinsiyet patella tipi ve menisküs yırtılması açısından SPSS 20.0 (SPSSInc., Chicago IL, USA) versiyonu istatistik paket programı kullanılarak işlendi. Bulgular: Çalışmaya alınan 238 (%46,7) kadın, 272 (%53,3) erkek toplam 510 hasta, patella tipi ve menisküs rüptürü açısından değerlendirildi. Hastaların ortalama yaşları 38.83 ± 0.5 idi (en az 18, en çok 76). Tüm hastalarda Tip I patella 132 (%25,9) Tip II 354 (%69,4) Tip III 24 (%4,7) olarak bulundu. 376 hastada, %73,7 oranında menisküs yırtılması tespit edilmedi ve 134 (%26,3) hastada menisküs yırtılması vardı. Menisküs yırtığı olan hastaların 68'i (%50,7) kadın, 66'sı (%49,3) erkekti. Sonuç: Farklı patella tiplerinde simetrik ve simetrik olmayan yükleme sonucu menisküs üzerindeki orantısız veya simetrik olmayan basınç sonucu menisküs rüptürü eğiliminin artacağını düşündük. Ancak çalışmamızda meniskal rüptür ile patella tipleri arasında istatistiksel olarak anlamlı bir ilişki bulamadık.

To quantify the prevalence of complete tibial insertion of the biceps femoris tendon in patients presenting for knee MRI scans. Knee MRI scans over a 4-year period (2014–2018) were accessed at a tertiary referral centre and community-based private practice. A total of 433 scans were reviewed. 30 scans were excluded from the study due to repeat imaging or incomplete coverage of the biceps femoris tendon insertion. Appearances of the distal biceps tendon bony insertion were scrutinized on the remaining 403 scans. Each biceps femoris tendon insertion was classified into one of the four categories—complete fibular insertion, predominant fibular insertion, predominant tibial insertion and complete tibial insertion. Out of the final 403 scans included in the study, five cases of complete tibial insertion of the biceps femoris tendon were identified (just over 1% of the total population). 42 cases were identified as having predominant tibial insertion (10% of the total population). 113 cases had predominantly fibular insertion and 243 cases had complete fibular insertion. Complete anomalous insertion of the biceps femoris tendon on the anterolateral tibia is an uncommon entity. Such an attachment is found in approximately 1% of patients presenting for MRI evaluation of the knee.

Purpose Knee tibiofemoral osteoarthritis (KOA) is a major health problem, affecting approximately 30% of elderly. Several studies have reported that the loss of patellar cartilage is associated with an increased risk of KOA. However, no study has reported the optimal cut off value of patellar cartilage cross-sectional area (PCA) in KOA. We hypothesize that PCA is a new sensitive morphologic parameter in the diagnosis of KOA. The purpose of this study was to determine whether PCA could be used as an important adjuvant morphological parameter in the diagnosis of KOA. Patients and methods Data regarding PCA were collected from 88 subjects with KOA. A total of 77 subjects in the control group underwent knee MRI as part of nonsymptomatic medical examination. T2-weighted axial images were acquired from both groups. Using a picture archiving communications system, we analyzed the cross-sectional area of the patellar cartilage on MRI. Results The average PCA was 98.66±22.18 mm2 in the control group, which was significantly (p

Purpose We compared two imaging techniques to assess whether 3D VISTA imaging could replace 2D FSE in diagnosing PCL reconstruction complications. Materials and methods This retrospective study included 40 patients who underwent surgery of PCL reconstruction and follow-up knee MRI (3D VISTA and 2D FSE) for evaluation of PCL graft integrity. Each image was interpreted independently by two radiologists without knowledge of radiologic reports or clinical history. The diagnostic performance of the 2D FSE PCL view, 3D VISTA PCL view, orthogonal 2D FSE image, and combined sequences were evaluated in terms of sensitivity, specificity, and accuracy for diagnosing complications of PCL graft. The reference diagnoses were made arthroscopically or clinically. Results The sensitivities of the 3D VISTA PCL view were similar to those of the 2D PCL view. The sensitivities of the combination of the orthogonal view and the 3D VISTA PCL view were also similar to those of the combination of the orthogonal view and the 2D PCL view. The specificities and accuracies of each image exhibited similar results. There was no statistically significant difference in diagnostic performance between the 3D VISTA PCL view and the 2D PCL view (solitary or combined with the orthogonal view). Conclusions The diagnostic performance of the PCL views on 3D VISTA images is comparable to that of 2D FSE images in the diagnosis of PCL graft complications.

To evaluate the appropriateness of MRI ordering practices and their effect on clinical management for nontraumatic knee pain at the primary care clinics of a large public urban hospital.In all, 196 consecutive MRIs for nontraumatic knee pain ordered from primary care clinics in a large public urban hospital over an 18-month period were studied. ACR Appropriateness Criteria (AC) scores for nontraumatic knee pain were retrospectively calculated from medical record reviews. The record was also reviewed to assess whether knee MRI changed clinical management. Knee osteoarthritis grading was performed. Tests were performed for differences in age, body mass index (BMI), gender, and ethnicity among appropriate and inappropriate MRIs.Of the MRIs, 57% (108 knees) had "usually appropriate" (ie, 7-9) and 43% (8 knees) had "usually not appropriate" (ie, 1-3) AC scores (P.1). Clinical management was changed in 26% of knees with "usually appropriate" and 20% of knees with "usually inappropriate" scores (P.05), and 70% of the knees with "usually appropriate" and 61% of the knee with "usually not appropriate" scores had moderate to severe osteoarthritis. Age, BMI, gender, and ethnicity had no significant effect on AC scores.In patients referred from primary care for MRI for nontraumatic knee pain, adherence to AC was low. Additional focus on reducing "appropriate" studies that do not impact clinical management (eg, cases with radiographically evident moderate to severe osteoarthritis) is also warranted.

This article highlights five knee injuries that, in the author's experience, are commonly overlooked by readers inexperienced in knee MRI: ramp lesions, meniscocapsular tears, meniscal root ligament tears, posterior capsular ligament tears, and partial anterior cruciate ligament tears. Although these injuries are readily apparent when the images are assessed for the given abnormality, the author believes they may be overlooked because either the injury is not considered or the affected area is not closely inspected. These injuries may not alter immediate clinical management or require surgical intervention; nevertheless, they may result in patient symptoms and may potentially increase the risk of further knee injury. Moreover, these injuries are difficult to recognize clinically and arthroscopically. This review presents these five injuries, emphasizing relevant anatomy, normal MRI appearances, common injury patterns, and tips to avoid overlooking them. Routine review of these areas when interpreting knee MRI, with additional imaging as necessary, will allow these injuries to be recognized more regularly.

In this paper we evaluate two unsupervised approaches to denoise Magnetic Resonance Images (MRI) in the complex image space using the raw information that k-space holds. The first method is based on Stein’s Unbiased Risk Estimator, while the second approach is based on a blindspot network, which limits the network’s receptive field. Both methods are tested on two different datasets, one containing real knee MRI and the other consists of synthetic brain MRI. These datasets contain information about the complex image space which will be used for denoising purposes. Both networks are compared against a state-of-the-art algorithm, Non-Local Means (NLM) using quantitative and qualitative measures. For most given metrics and qualitative measures, both networks outperformed NLM, and they prove to be reliable denoising methods.

Background and aim: Recently, there has been a growing interest in the use of Dixon sequence for knee MRI in order to save time spent on the scanner, and improving diagnostic utility. Our purpose was to compare the diagnostic performance of Dixon sequence on low-field MRI with the proton-density sequence on high-field MRI. Methods: This prospective study included 40 patients who underwent 0.25T knee MRI, using the routine protocol with the addition of a sagittal 4-point Dixon sequence (SPED), and an additional sequence on 1.5T scanner, consisting in a fat-suppressed proton-density fast-spin-echo (FS PD-FSE). Two radiologists independently examined the images, evaluating the anatomic identification score and diagnostic performances of the two sequences. Interreader agreement was evaluated using an intraclass correlation coefficient (ICC). Results: Final population counted 34 patients (36 knee MR images) with a mean age of 52.9 years (range, 18–75 years). Interreader agreement was very high except for cartilage injuries at medial femoral condyle and medial tibial plateau (ICC SPED: 0.757, ICC FS PD-FSE: 0.746), even if not statistically significant. There were no significant differences in mean signal-to-noise ratio (SNR), artifacts presence and diagnostic confidence between SPED and PD-FS sequence. Conclusions: Dixon sequences on low-field scanner have a comparable diagnostic accuracy to PD-FS sequence obtained on a high field scanner for knee MR imaging. (www.actabiomedica.it)

Purpose: This study was conducted in order to evaluate the clinical utility of MRI in detecting cartilage lesions and its dependence on anatomical location and lesion grade. Methods: A retrospective analysis of MRI reports and arthroscopic findings was performed on 190 consecutive patients treated in one orthopaedic department. MRI protocols were prepared by 18 radiologists from 10 different MRI centers with the use of 1.5 T magnets. The image protocols were selected by reading radiologists. Four hundred and fifty-three chondral lesions in five anatomic locations were identified during this study and graded according to the ICRS classification. Sensitivity, specificity, receiver operating characteristic (ROC), and Bangdiwala’s observer agreement charts were utilized to evaluate the diagnostic performance. Results: Only approximately 30% of MRI showed an adequate cartilage status in all anatomical locations. The sensitivity ranged from 92% in healthy cartilage to 5% in grade I lesions. The specificity differed also grossly depending on the lesion grade, reaching 96.5% in grade four lesions and 38% in healthy cartilage. The medial compartment Bangdiwala’s observer agreement charts show a gross underestimation of cartilage lesions, and the area under the curve (AUC) of ROC surpasses 0.7 only in the medial femoral condyle and patella-femoral joint. Overall, the medial compartment accuracy was significantly higher than the lateral compartment. The MRI showed correspondence of its diagnostic performance with cartilage lesion severity. Conclusion: MRI underestimates the extent of cartilage injury and evaluation of cartilage defects based on MRI should be taken with caution by orthopaedic surgeons in planning surgery. Surgical planning on MRI should take cartilage lesions under consideration, even if no cartilage lesions are reported on the MRI.

Background Osteoarthritis (OA) of the knee joint is a common cause of chronic disability in older adults. During the past 10 years, the infrapatellar fat pad (IPFP) has emerged as a new player in the pathogenesis of knee OA. Its exact role in the pathogenesis of knee OA remains uncertain. While many studies focused on the detrimental effect of the chemical mediators released by IPFP and their role in the accentuation of the development of OA, only few studies elucidated the beneficial effect of IPFP maximal area as a local shock absorber protecting the adjacent articular structures from progressive damage. The aim of this study was to evaluate the relation between the IPFP maximal area and the prevalence of OA manifestations. We also studied the relation between the subcutaneous (SC) fat thicknesses on the medial aspect of the knee as a surrogate marker of body obesity and the IPFP area. Results A total of 216 knee scans for 188 adult patients (64 males and 124 females) who met the inclusion criteria were examined. They were between 45 and 66 years (mean 52.5 years). The mean IPFP area for all patients was 6.9 cm2 (± 1.6 SD) (ranged from 4.5 to 11 cm2). After adjustment for potential confounders, there was a significant negative association between IPFP area and radiographic manifestations of OA (osteophites, joint space narrowing, and grade of OA) (P value P value Conclusion In our study, we found supportive evidence that IPFP maximal area is associated with fewer osteoarthritic knee changes and less cartilage damage, suggesting that it plays a protective role against the development and progression of OA. Further large-scale clinical studies are awaited to confirm the obtained results. Based on our findings, it would be recommended to avoid IPFP resection during surgery in order to maintain its protective effect.

Radiologists tend to possess human error during pathologies scans for any abnormalities; thus, the introduction of automation shall has a great impact on accurately detecting injuries and more musculoskeletal examinations. Magnetic Resonance Imaging (MRI) scans are an effective method to detect injured sections but the process tends to be time-consuming and prone to human error. Therefore, our paper highlights the automation impact on knee MRI for abnormal, anterior cruciate ligament (ACL), meniscal damages using deep learning. Deep learning model such as Convolutional Neural Network (CNN) can infer the representation of images due to its properties: local connection and shared weights. We have explored two deep CNN models (VGG16 and VGG19) with transfer learning approach to predict knee injury on MRNet dataset collected by Stanford University. The classification accuracy obtained for abnormal, ACL tear, and meniscal tear are 83.19%, 84.96%, and 70.80%, respectively, using VGG16, whereas 84.07%, 84.96%, and 74.34%, respectively, using VGG19 model.