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Correlation of benign incidental findings seen on whole-body PET-CT with knee MRI: patterns of 18F-FDG avidity, intra-articular pathology, and bone marrow edema lesions

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Abstract

Objectives

To correlate patterns of 18F-FDG uptake on whole-body PET-CT with MR findings and compare the degree of FDG activity between symptomatic and asymptomatic knees.

Materials and methods

Retrospective database query was performed using codes for knee MRI as well as whole-body PET-CT. Patients with malignant disease involving the knee or hardware were excluded. Patients who had both studies performed within 1 year between 2012 and 2017 were included for analysis. Knee joint osteoarthrosis, meniscal and ligamentous integrity, presence of joint effusion, and synovitis were assessed and recorded. Bone marrow edema lesions (BMELs) were identified, segmented, and analyzed using volumetric analysis. SUVmax was assessed over the suprapatellar joint space, intercondylar notch and Hoffa’s fat pad. Symptomatic and asymptomatic knees were compared in patients with unilateral symptoms.

Results

Twenty-two cases (20 patients) with mean age 63.3 years (range, 36–91 years) were included. Two patients had bilateral pain. The most FDG avid regions in both symptomatic and asymptomatic knees were the intercondylar notch (SUVmax = 1.84 vs. 1.51), followed by suprapatellar pouch (SUVmax = 1.74 vs. 1.29) and Hoffa’s fat pad (SUVmax = 1.01 vs. 0.87). SUVmax was significantly associated with cartilage loss (mean modified Outerbridge score) (r = 0.60, p = 0.003) and degree of synovitis (r = 0.48, p = 0023). Overall, mean SUVmax was significantly higher in the presence of a meniscal tear (1.83 ± 0.67 vs. 1.22 ± 0.40, p = 0.030). Nine patients had BMELs (volume: range = 0.6–27.8, mean = 7.79) however there was no significant association between BMEL volume and SUVmax.

Conclusions

Higher FDG activity correlates with intra-articular derangement and the intercondylar notch represents the most metabolically active region of the knee.

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Author information

Authors and Affiliations

  1. Department of Radiology, NYU Langone Orthopedic Hospital, 301 E 17th St, New York, NY, 10003, USA

    Christopher J. Burke, William R. Walter & Sushma Gaddam

  2. Department of Radiology, NYU Langone Orthopedic Hospital, New York, NY, USA

    Christopher J. Burke

  3. Department of Orthopedic Surgery, NYU Hospital for Joint Diseases, Center for Musculoskeletal Care, 301 E 17th St, New York, NY, 10003, USA

    Hien Pham

  4. Department of Statistics, NYU Langone Medical Center, 660 1st Avenue, New York, NY, 10016, USA

    James S. Babb

  5. Department of Nuclear Medicine, NYU Langone Medical Center, 560 1st Avenue, New York, NY, 10016, USA

    Joseph Sanger & Fabio Ponzo

Authors
  1. Christopher J. Burke
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  2. William R. Walter
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  3. Sushma Gaddam
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  5. James S. Babb
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Correspondence to Christopher J. Burke.

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Additional information

Work was performed at: NYU Langone Orthopedic Hospital, New York, NY

Appendix. Modified Outerbridge grading system [34]

Appendix. Modified Outerbridge grading system [34]

Cartilage loss divided into four grades by MRI, typically using fat-saturated proton-density sequences. This grading system is the modified Outerbridge grading system, which was devised for arthroscopy initially for assessment of chondromalacia patella, but then modified and extended for all chondral surfaces.

  • Grade I

    • focal areas of hyperintensity with normal contour

    • arthroscopically: softening or swelling of cartilage

  • Grade II

    • blister-like swelling/fraying of articular cartilage extending to surface

    • arthroscopically: fragmentation and fissuring within soft areas of articular cartilage

  • Grade III

    • partial thickness cartilage loss with focal ulceration

    • arthroscopically: partial thickness cartilage loss with fibrillation (crab-meat appearance)

  • Grade IV

    • full-thickness cartilage loss with underlying bone reactive changes

    • arthroscopically: cartilage destruction with exposed subchondral bone

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Burke, C.J., Walter, W.R., Gaddam, S. et al. Correlation of benign incidental findings seen on whole-body PET-CT with knee MRI: patterns of 18F-FDG avidity, intra-articular pathology, and bone marrow edema lesions. Skeletal Radiol 47, 1651–1660 (2018). https://doi.org/10.1007/s00256-018-3001-x

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  • DOI: https://doi.org/10.1007/s00256-018-3001-x

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