Skip to main content

Advertisement

Log in

MRI of the knee joint with a 3-D gradient echo sequence

Equivalent to diagnostic arthroscopy?

  • Original Articles
  • Published:
Archives of Orthopaedic and Trauma Surgery Aims and scope Submit manuscript

Summary

Three-dimensional (3-D) gradient echo sequences offer the advantage of volume imaging within a few minutes scanning time and creating thin contiguous slices. An optimized sequence (FISP 3D 40) was evaluated for its potential to detect lesions of the menisci, cruciate ligaments, and articular cartilage in 80 patients compared to arthroscopy as the standard. Magnetic resonance imaging showed a sensitivity of 97.9%, a specificity of 97.3%, and an accuracy of 97.5% for meniscal lesions, and a sensitivity of 100% , a specificity of 97.1%, and an accuracy of 97.5% for lesions of the cruciate ligaments. Based upon morphological criteria normal cartilage was identified in 91.5%, but fibrillation of different depths (grades 1–3) was poorly recognized. All full-thickness depths (grade 4) were recognized. Measurement of mean signal intensity (95% confidence intervals) was more useful to discriminate normal from abnormal cartilage (grades 1–3). This method promises the capability to detect early stages of oestoarthritis in future. The present results show MRI of the knee joint with a 3-D fast imaging technique to be a noninvasive alternative to diagnostic arthroscopy.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Similar content being viewed by others

References

  1. Adam G, Bohndorf K, Prescher A, Krasny R, Günther RW (1988) Der hyaline Gelenkknorpel in der MR-Tomographie des Kniegelenkes bei 1.5T. RÖFO 148:648–651

    Google Scholar 

  2. Adam G, Bohndorf K, Prescher A, Drobnitzky M, Gunther RW (1989) Kernspintomographie der Knorpelstrukturen des Kniegelenkes mit 3D-Volumen-Imaging in Verbindung mit einem schnellen Bildrechner. RÖFO 150:44–48

    Google Scholar 

  3. Allgayer B, Gewalt Y, Flock K, Heuck A, Lehner K, Gradinger R, Luttke G (1991) Diagnostische Treffsicherheit der MRT bei Kreuzbandverletzungen. RÖFO 155:159–164

    Google Scholar 

  4. Barronian AD, Zoltan JD, Bucon KA (1989) Magnetic resonance imaging of the knee: correlation with arthroscopy. Arthroscopy 5:197–191

    Google Scholar 

  5. Beltran J, Noto AM, Mosure JC, Bools JC, Zuelzer W, Christoforidis AJ (1986) Meniscal tears: MR demonstration of experimentally produced injuries. Radiology 158:691–693

    Google Scholar 

  6. Beltran J, Noto AM, Mosure JC, Weiss KL, Zuelzer W, Christoforidis AJ (1986) The knee: surface coil MR imaging at 1.5T. Radiology 159:741–751

    Google Scholar 

  7. Boden SD, Davis OD, Stoller DW, Brown S, Vallas JC, Labropoulos PA (1991) The incidence of abnormal MRI scans of the knee in asymptomatic subjects: a prospective and blinded investigation. Trans Orthop Res Soc 16:579

    Google Scholar 

  8. Brandt KD, Braunstein EM, Visco DM, O'Connor B, Heck D, Albrecht M (1991) Anterior (cranial) cruciate ligament transection in the dog: a bona fide model of osteoarthritis, not merely of cartilage injury and repair. Trans Orthop Res Soc 16:331

    Google Scholar 

  9. Burk DL, Kanal E, Brunberg JA, Johnstone GF, Swenson HE, Wolf GL (1986) 1.5-T surface-coil MRI of the knee. AJR 147:203–300

    Google Scholar 

  10. Burk DL, Dalinka MK, Kanal E, Schiebler ML, Cohen EK, Prorok RJ, Gefter WB, Kressel HY (1988) Meniscal and ganglion cysts of the knee: MR evaluation. AJR 150:331–338

    Google Scholar 

  11. Chandnani VP, Ho C, Chu P, Trudell D, Resnick D (1991) Knee hyaline cartilage evaluated with MR imaging: a cadaveric study involving multiple imaging sequences and intraarticular injection of gadolinium and saline solution. Radiology 178:557–561

    Google Scholar 

  12. Crues JV, Mink J, Levy TL, Lotysch M, Stoller DW (1987) Meniscal tears of the knee: accuracy of MR imaging. Radiology 164:445–448

    Google Scholar 

  13. Crues JV, Ryu R, Morgan FW (1990) Meniscal pathology: the expanding role of magnetic resonance imaging. Clin Orthop 252:80–87

    Google Scholar 

  14. Deimling M, Heudes P, Weber H (1987) Rapid three dimensional MR-imaging. Proceedings of the International Symposium Comput Assist Radiol, pp 74–80

  15. Donohue MJ, Buss D, Oegema TR, Thompson RC (1983) The effect of indirect blunt trauma an adult canine articular cartilage. J Bone Joint Surg [Am] 65:948–957

    Google Scholar 

  16. Engel A (1990) Magnetic resonance knee arthrography. Enhanced contrast by gadolinium complex in the rabbit and in humans. Acta Orthop Scand [Suppl] 240:1–57

    Google Scholar 

  17. Farley TE, Howell SM, Love KF, Wolfe RD, Neumann CH (1991) Meniscal tears: MR and arthrography findings after arthroscopic repair. Radiology 180:517–522

    Google Scholar 

  18. Fischer SP, Fox JM, Del Pizzo W, Friedmann MJ, Snyder SJ, Ferkel RD (1991) Accuracy of diagnoses from magnetic resonance imaging of the knee. A multi-center analysis of one thousand and fourteen patients. J Bone Joint Surg [Am] 73:2–10

    Google Scholar 

  19. Frahm J, Haase A, Matthaei D (1986) Rapid three-dimensional MR imaging using the FLASH technique. J Comput Assist Tomogr 10:363–368

    Google Scholar 

  20. Gallimore GW, Harms SE (1986) Knee injuries: high resolution MR imaging. Radiology 160:457–461

    Google Scholar 

  21. Glashow JL, Katz R, Schneider M, Scott WM (1989) Double-blind assessment of the value of magnetic resonance imaging in the diagnosis of anterior cruciate and meniscal lesions. J Bone Joint Surg [Am] 71:113–119

    Google Scholar 

  22. Glückert K, Kladny B (1989) Magnetresonanztomographie des Bewegungsapparates mit schnellen Bildsequenzen. Orthopade 18:53–65

    Google Scholar 

  23. Glückert K, Blank-Schal A, Hofmann G, Kladny B, Willauschus W, Wirtz P (1990) Möglichkeiten der Früherfassung von Athrosen durch bildgebende Verfahren. Orthopäde 19:50–57

    Google Scholar 

  24. Glückert K, Kladny B, Hofmann G, Willauschus W, Blank-chäl A, Wirtz P (1990) MRI evaluation of early degenerative cartilage disease by a three-dimensional gradient echo sequence. In: Higer HP, Bielke G (eds) Tissue characterization in MR imaging. Springer, Berlin Heidelberg New York, pp 185–192

    Google Scholar 

  25. Gradinger R, Lehner K, Träger J, Rupp N, Hipp E (1990) Wertigkeit von Computertomographie (CT) und Magnetresonanztomographie (MRT) bei degenerativen Kniegelenksveranderungen. Orthop Praxis 11:703–70

    Google Scholar 

  26. Grover JS, Bassett LW, Gross ML, Seeger LL, Finerman GAM (1990) Posterior cruciate ligament: MR imaging. Radiology 174:527–530

    Google Scholar 

  27. Gylys-Morin VM, Hajek PC, Sartoris DJ, Resnick D (1987) Articular cartilage defects: detectability in cadaver knees with MR. AJR 148:1153–1157

    Google Scholar 

  28. Haase A, Frahm J, Matthaei K, Merboldt D, Hänicke W (1985) Rapid images and NMR movies. Society of Magnetic Resonance in Medicine (SMRM), Abstracts, p 980

  29. Haggar AM, Froelich JW, Hearshen DO, Sadasivan K (1988) Meniscal abnormalities of the knee: 3DFT fast-scan GRASS MR imaging. AJR 150:1341–1344

    Google Scholar 

  30. Hajek PC, Baker LL, Sartoris DJ, Neumann C, Resnick D (1987) MR arthrography: anatomic-pathologic investigation. Radiology 163:141–147

    Google Scholar 

  31. Hajek PC, Sartoris DJ, Neumann C, Resnick D (1987) Potential contrast agents for MR arthrography: in vitro evaluation and practical observations. AJR 149:97–104

    Google Scholar 

  32. Handelberg F, Shahabpour M, Casteleyn PP (1990) Chondral lesions of the patella evaluated with computed tomography, magnetic resonance imaging, and arthroscopy. Arthroscopy 6:24–29

    Google Scholar 

  33. Harms SE, Muschler G (1986) Three-dimensional MR imaging of the knee using surface coils. J Comput Assist Tomogr 10:773–777

    Google Scholar 

  34. Harms SE, Flaming DP, Fisher CF, Fulmer JM (1989) New method for fast MR imaging of the knee. Radiology 173:743–750

    Google Scholar 

  35. Hartzman S, Reicher MA, Bassett LW, Duckwiler GR, Mandelbaum B, Gold RH (1987) MR imaging of the knee. Part II. Chronic disorders. Radiology 162:553–557

    Google Scholar 

  36. Hayes CW, Sawyer RW, Conway WIT (1990) Patellar cartilage lesions: in vitro detection and staging with MR imaging and pathologic correlation. Radiology 176:479–483

    Google Scholar 

  37. Herrmann J, Hofmann G, Kladny B, Willauschus W, Arnold H (1990) Klinische Aspekte zur Erfassung der frühen Arthrose. Orthopade 19:36–42

    Google Scholar 

  38. Jackson DW, Jennings LD, Maywood RM, Berger PIT (1988) Magnetic resonance imaging of the knee. Am J Sports Med 16:29–37

    Google Scholar 

  39. Jerosch J, Lahm A, Castro WHM, Assheuer J (1991) Kann die Kernspintomographie die diagnostische Arthroskopie bei Meniskus- oder Bandverletzungen des Kniegelenks ersetzen? Arthroskopie 4:78–83

    Google Scholar 

  40. Jung T, Rodriguez M, Augusting N, Friedrich N, Schulthess von G (1988) 1.5-T-MRT, Arthrographie und Arthroskopie in der Evaluation von Knieläsionen. RÖFO 148:390–393

    Google Scholar 

  41. Karvonen RL, Negendank WG, Fraser SM, Mayes MD, An T, Fernandez-Madrid F (1990) Articular cartilage defects of the knee: correlation between magnetic resonance imaging and gross pathology. Ann Rheum Dis 49:672–675

    Google Scholar 

  42. Kelly MA, Flock TJ, Kimmel JA, Kiernan HA, Singson RS, Starron RB, Feldman F (1991) MR imaging of the knee: clarification of its role. Arthroscopy 7:78–85

    Google Scholar 

  43. König H, Deimling M (1988) Bedeutung schneller Gradientenechosequenzen für die kernspintomographische Gelenkdiagnostik. RÖFO 145:307–310

    Google Scholar 

  44. König H, Sauter R, Deimling M, Vogt M (1987) Cartilage disorders: comparison of SPIN-ECHO, CHESS, and FLASH sequence MR images. Radiology 164:753–758

    Google Scholar 

  45. König H, Küper K, Feine U (1988) Nicht-invasive Meniskusdiagnostik: Möglichkeiten der Kernspintomographie und der Emissionscomputertomographie. Röntgenpraxis 41:92–97

    Google Scholar 

  46. König H, Skalej M, Höntzsch D, Aicher K (1988) Kernspintomographie von Knochen-Knorpel-Transplantaten im Kniegelenk: Transplantat-Morphologie und Versuch einer quantitativen Beurteilung der Knorpelveränderungen. RÖFO 148:176–182

    Google Scholar 

  47. König H, Aicher K, Klose U, Saal J (1990) Die quantitative Beurteilung von Veränderungen des hyalinen Gelenkknorpels unter Anwendung der FLASH-Sequenz. Eletromedica 58:14–22

    Google Scholar 

  48. Krestin GP, Friedman G, Bunke J, Stembrich W (1987) Experimentelle Untersuchungen und erste klinische Erfahrungen mit der Fast-Field-Echo (FEE) Sequenz. RÖFO 147:179–185

    Google Scholar 

  49. Lee JK, Lawrence Y, Phelps CT, Wirth CR, Czajka J, Lozman J (1968) Anterior cruciate ligament tears: MR imaging compared with arthroscopy and clinical tears. Radiology 166:861–864

    Google Scholar 

  50. Lehner KB, Rechl HP, Gmeinwieser JK, Heuck AF, Lukas HP, Kohl HP (1989) Structure, function and degeneration of bovine hyaline cartilage: assessment with MR imaging in vitro. Radiology 170:495–499

    Google Scholar 

  51. Lotysch M (1986) Scrutinizing knee joints: MRI offers new insight. Diagn Imaging 90–94

  52. Lotysch M, Mink J, Crues JV, Schwartz SA (1986) Magnetic imaging in the detection of meniscal injuries. Magn Reson Imaging 4:94

    Google Scholar 

  53. Lynch TCP, Crues JV, Morgan FW, Sheehan WE, Harter LP, Ryu R (1989) Bone abnormalities of the knee: prevalence and significance at MR imaging. Radiology 171:761–766

    Google Scholar 

  54. Manco LG, Berlow ME (1989) Meniscal tears-comparison of arthrography, CT and MRI. Critical review in Diagnostic Imaging 29:151–179

    Google Scholar 

  55. Manco LG, Lozman J, Coleman ND, Kavanaugh JH, Bilfield BS, Dougherty J (1987) Noninvasive evaluation of knee meniscal tears: preliminary comparison of MR imaging and CT. Radiology 163:727–730

    Google Scholar 

  56. Mandelbaum BR, Finerman GAM, Reicher MA, Hartzman S, Bassett L, Gold RH, Rauschning W, Dorey F (1986) Magnetic resonance imaging as a tool for evaluation of traumatic knee injuries. Am J Sports Med 143:361–370

    Google Scholar 

  57. Mesgarzadeh M, Schneck CD, Bonakdarpour A (1988) Magnetic resonance imaging of the knee and correlation with normal anatomy. Radiographics 8:707–733

    Google Scholar 

  58. Meulen P van der, Green JP, Cuppen JIM (1985) MR-imaging by field echos and small angle excitation. Magn Res Imaging 3:297–299

    Google Scholar 

  59. Mink JH, Deutsch AL (1989) Occult cartilage and bone injuries of the knee: detection, classification and assessment with MR imaging. Radiology 170:823–829

    Google Scholar 

  60. Mink JH, Reicher MA, Crues JV, Fox JM (1987) Magnetic resonance imaging of the knee. Raven Press, New York

    Google Scholar 

  61. Mink JH, Levy T, Crues JV (1988) Tears of the anterior cruciate ligament and menisci of the knee: MR imaging evaluation. Radiology 167:769–774

    Google Scholar 

  62. 62.Noyes FR, Stabler CL (1989) A system for grading articular cartilage lesions for arthroscopy. Am J Sports Med 17:505–513

    Google Scholar 

  63. Oppelt A, Graumann H, Barfuss H, Fischer H, Bartl W, Schajor W (1986) FISP: eine neue schnelle Pulssequenz für die Kernspintomographie. Electromedica 54:5–18

    Google Scholar 

  64. Polly DW, Callaghan JJ, Sikes RA, McCabe JM, MaMahon K, Savory CG (1988) The accuracy of selective magnetic resonance imaging compared with the findings of arthoscopy of the knee. J Bone Joint Surg [Am] 70:192–198

    Google Scholar 

  65. Raunest J, Oberle K, Loehnert J, Hoetzinger H (1991) The clinical value of magnetic resonance imaging in the evaluation of meniscal disorders. J Bone Joint Surg [Am] 73:11–16

    Google Scholar 

  66. Reicher MA, Bassett LW, Gold RH (1986) High-resolution magnetic resonance imaging of the knee joint: pathologic correlations. AJR 145:903–909

    Google Scholar 

  67. Reicher MA, Hartzman S, Duckwiler GR, Bassett LW, Anderson LJ, Gold RH (1986) Meniscal injuries: detection using MR imaging. Radiology 159:753–757

    Google Scholar 

  68. Reicher MA, Hartzman S, Bassett LW, Mandelbaum B, Duckwiler G, Gold RH (1987) MR imaging of the knee. Part I. Traumatic disorders. Radiology 162:547–551

    Google Scholar 

  69. Reiser M, Rupp N, Pfändner K, Schepp S, Lukas P (1986) Die Darstellung von Kreuzbandläsionen durch die MR-Tomographie. RÖFO 145:193–198

    Google Scholar 

  70. Reiser MF, Bongartz G, Erlemann R, Strobel M, Pauly T, Gaebert K, Stoeber U, Peters PE (1988) Magnetic resonance in cartilaginous lesions of the knee joint with three-dimensional gradient-echo imaging. Skeletal Radiol 17:465–471

    Google Scholar 

  71. Rodammer G, Lehner K, Rechl H, Gradinger R (1989) MR imaging of hyaline cartilage in chondromalacia patellae and osteochondritis dissecans: a comparison with CT-arthography and arthroscopy. Trans Orthop Res Soc 14:445

    Google Scholar 

  72. Rosen MA, Jackson DW, Berger PE (1991) Occult osseus lesions documented by magnetic resonance imaging associated with anterior cruciate ligament ruptures. Arthroscopy 7:45–51

    Google Scholar 

  73. Schuler M, Naegele M, Lienemann A, Münch O, Siuda S, Hahn D, Lissner J (1987) Die Wertigkeit der hochauflösenden CT und der Kernspintomographie im Vergleich zu den Standardverfahren bei der Diagnostik von Meniskusläsionen. RÖFO 146:391–397

    Google Scholar 

  74. Schultz E, Felix R (1988) Schnelle MRT-Sequenzen-Theoretische Grundlagen und klinische Abbildungseigenschaften. Digitale Bilddiagn 8:50–58

    Google Scholar 

  75. Silva I, Silver DM (1988) Tears of the meniscus as revealed by magnetic resonance imaging. J Bone Joint Surg [Am] 70:199–202

    Google Scholar 

  76. Skalej M, Bongers H (1990) Schnelle und hochauflösende 3D-Bildgebung für die kernspintomographische Diagnostik von Erkrankungen des Kniegelenks. RÖFO 153:528–534

    Google Scholar 

  77. Skalej M, Kose U, Küper M (1988) Optimierte Untersuchungstechnik von Meniskopathien durch kernspintomographisches 3D-Imaging bei 1,5 Tesla. RÖFO 148:183–189

    Google Scholar 

  78. Solomon SL, Totty WG, Lee JKT (1989) MR imaging of the knee: comparison of three dimensional FISP and two dimensional spin-echo pulse sequence. Radiology 173:739–742

    Google Scholar 

  79. Spritzer CE, Vogler JB, Martinez S, Garrett WE, Johnson GA, McNamara MJ, Lohnes J, Herfkens RJ (1988) MR imaging of the knee: preliminary results with a 3DFT GRASS pulse sequence. AJR 150:597–603

    Google Scholar 

  80. Stoller DW, Martin C, Crues JV, Kaplan L, Mink JH (1987) Meniscal tears: pathologic correlation with MR imaging. Radiology 163:731–735

    Google Scholar 

  81. Turner DA, Prodromos CC, Petasnick JP, Clark JW (1985) Acute injury of the ligaments of the knee: magnetic resonance evaluation. Radiology 154:717–722

    Google Scholar 

  82. Tyrrell RL, Glückert K, Pathria M, Modic MT (1988) Fast three-dimensional MR imaging of the knee: comparison with arthroscopy. Radiology 166:865–872

    Google Scholar 

  83. Vellet AD, Marks P, Fowler P, Munro T (1989) Accuracy of nonorthogonal magnetic resonance imaging in acute disruption of the anterior cruciate ligament. Arthroscopy 5:287–293

    Google Scholar 

  84. Vellet AD, Marks PH, Fowler PJ, Munro TG (1991) Occult posttraumatic osteochondral lesions of the knee: prevalence, classification, and short-term sequelae evaluated with MR imaging. Radiology 178:271–276

    Google Scholar 

  85. Weber H, Purdy D, Deimling M, Oppelt A (1986) Contrast behaviour of the fast imaging sequences FLASH and FISP: results from synthetic images. Society of Magnetic Resonance in Medicine (SMRM), pp 957–958

  86. Wojtys E, Wilson M, Buckwalter K, Braunstein E, Martel W (1987) Magnetic resonance imaging of knee hyaline cartilage and intraarticular pathology. Am J Sports Med 15:455–463

    Google Scholar 

  87. Yulish BS, Montanez J, Goodfollow DB, Bryan PJ, Mulopulos GP, Modic MT (1987) Chondromalacia patellae: assessment with MR imaging. Radiology 164:763–766

    Google Scholar 

Download references

Author information

Authors and Affiliations

Authors

Additional information

Dedicated to Prof. Dr. D. Hohmann on the occasion of his 60th birthday

Rights and permissions

Reprints and permissions

About this article

Cite this article

Glückert, K., Kladny, B., Blank-Schäl, A. et al. MRI of the knee joint with a 3-D gradient echo sequence. Arch Orthop Trauma Surg 112, 5–14 (1992). https://doi.org/10.1007/BF00431036

Download citation

  • Received:

  • Issue Date:

  • DOI: https://doi.org/10.1007/BF00431036

Keywords

Navigation