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.
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References
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
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
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
Barronian AD, Zoltan JD, Bucon KA (1989) Magnetic resonance imaging of the knee: correlation with arthroscopy. Arthroscopy 5:197–191
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
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
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
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
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
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
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
Crues JV, Mink J, Levy TL, Lotysch M, Stoller DW (1987) Meniscal tears of the knee: accuracy of MR imaging. Radiology 164:445–448
Crues JV, Ryu R, Morgan FW (1990) Meniscal pathology: the expanding role of magnetic resonance imaging. Clin Orthop 252:80–87
Deimling M, Heudes P, Weber H (1987) Rapid three dimensional MR-imaging. Proceedings of the International Symposium Comput Assist Radiol, pp 74–80
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
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
Farley TE, Howell SM, Love KF, Wolfe RD, Neumann CH (1991) Meniscal tears: MR and arthrography findings after arthroscopic repair. Radiology 180:517–522
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
Frahm J, Haase A, Matthaei D (1986) Rapid three-dimensional MR imaging using the FLASH technique. J Comput Assist Tomogr 10:363–368
Gallimore GW, Harms SE (1986) Knee injuries: high resolution MR imaging. Radiology 160:457–461
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
Glückert K, Kladny B (1989) Magnetresonanztomographie des Bewegungsapparates mit schnellen Bildsequenzen. Orthopade 18:53–65
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
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
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
Grover JS, Bassett LW, Gross ML, Seeger LL, Finerman GAM (1990) Posterior cruciate ligament: MR imaging. Radiology 174:527–530
Gylys-Morin VM, Hajek PC, Sartoris DJ, Resnick D (1987) Articular cartilage defects: detectability in cadaver knees with MR. AJR 148:1153–1157
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
Haggar AM, Froelich JW, Hearshen DO, Sadasivan K (1988) Meniscal abnormalities of the knee: 3DFT fast-scan GRASS MR imaging. AJR 150:1341–1344
Hajek PC, Baker LL, Sartoris DJ, Neumann C, Resnick D (1987) MR arthrography: anatomic-pathologic investigation. Radiology 163:141–147
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
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
Harms SE, Muschler G (1986) Three-dimensional MR imaging of the knee using surface coils. J Comput Assist Tomogr 10:773–777
Harms SE, Flaming DP, Fisher CF, Fulmer JM (1989) New method for fast MR imaging of the knee. Radiology 173:743–750
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
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
Herrmann J, Hofmann G, Kladny B, Willauschus W, Arnold H (1990) Klinische Aspekte zur Erfassung der frühen Arthrose. Orthopade 19:36–42
Jackson DW, Jennings LD, Maywood RM, Berger PIT (1988) Magnetic resonance imaging of the knee. Am J Sports Med 16:29–37
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
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
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
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
König H, Deimling M (1988) Bedeutung schneller Gradientenechosequenzen für die kernspintomographische Gelenkdiagnostik. RÖFO 145:307–310
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
König H, Küper K, Feine U (1988) Nicht-invasive Meniskusdiagnostik: Möglichkeiten der Kernspintomographie und der Emissionscomputertomographie. Röntgenpraxis 41:92–97
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
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
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
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
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
Lotysch M (1986) Scrutinizing knee joints: MRI offers new insight. Diagn Imaging 90–94
Lotysch M, Mink J, Crues JV, Schwartz SA (1986) Magnetic imaging in the detection of meniscal injuries. Magn Reson Imaging 4:94
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
Manco LG, Berlow ME (1989) Meniscal tears-comparison of arthrography, CT and MRI. Critical review in Diagnostic Imaging 29:151–179
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
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
Mesgarzadeh M, Schneck CD, Bonakdarpour A (1988) Magnetic resonance imaging of the knee and correlation with normal anatomy. Radiographics 8:707–733
Meulen P van der, Green JP, Cuppen JIM (1985) MR-imaging by field echos and small angle excitation. Magn Res Imaging 3:297–299
Mink JH, Deutsch AL (1989) Occult cartilage and bone injuries of the knee: detection, classification and assessment with MR imaging. Radiology 170:823–829
Mink JH, Reicher MA, Crues JV, Fox JM (1987) Magnetic resonance imaging of the knee. Raven Press, New York
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
62.Noyes FR, Stabler CL (1989) A system for grading articular cartilage lesions for arthroscopy. Am J Sports Med 17:505–513
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
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
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
Reicher MA, Bassett LW, Gold RH (1986) High-resolution magnetic resonance imaging of the knee joint: pathologic correlations. AJR 145:903–909
Reicher MA, Hartzman S, Duckwiler GR, Bassett LW, Anderson LJ, Gold RH (1986) Meniscal injuries: detection using MR imaging. Radiology 159:753–757
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
Reiser M, Rupp N, Pfändner K, Schepp S, Lukas P (1986) Die Darstellung von Kreuzbandläsionen durch die MR-Tomographie. RÖFO 145:193–198
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
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
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
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
Schultz E, Felix R (1988) Schnelle MRT-Sequenzen-Theoretische Grundlagen und klinische Abbildungseigenschaften. Digitale Bilddiagn 8:50–58
Silva I, Silver DM (1988) Tears of the meniscus as revealed by magnetic resonance imaging. J Bone Joint Surg [Am] 70:199–202
Skalej M, Bongers H (1990) Schnelle und hochauflösende 3D-Bildgebung für die kernspintomographische Diagnostik von Erkrankungen des Kniegelenks. RÖFO 153:528–534
Skalej M, Kose U, Küper M (1988) Optimierte Untersuchungstechnik von Meniskopathien durch kernspintomographisches 3D-Imaging bei 1,5 Tesla. RÖFO 148:183–189
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
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
Stoller DW, Martin C, Crues JV, Kaplan L, Mink JH (1987) Meniscal tears: pathologic correlation with MR imaging. Radiology 163:731–735
Turner DA, Prodromos CC, Petasnick JP, Clark JW (1985) Acute injury of the ligaments of the knee: magnetic resonance evaluation. Radiology 154:717–722
Tyrrell RL, Glückert K, Pathria M, Modic MT (1988) Fast three-dimensional MR imaging of the knee: comparison with arthroscopy. Radiology 166:865–872
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
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
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
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
Yulish BS, Montanez J, Goodfollow DB, Bryan PJ, Mulopulos GP, Modic MT (1987) Chondromalacia patellae: assessment with MR imaging. Radiology 164:763–766
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Dedicated to Prof. Dr. D. Hohmann on the occasion of his 60th birthday
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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
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DOI: https://doi.org/10.1007/BF00431036