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Knorpelbildgebung

Imaging of cartilage

  • Kniegelenkdiagnostik
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Zusammenfassung

Übergeordnetes Therapieziel bei Knorpelschäden ist die Gewährleistung der optimal möglichen Gelenkfunktionalität durch Erhaltung bzw. Wiederherstellung einer stabilen Kongruenz und einer ausgeglichenen mechanischen Belastungssituation im Gelenk. Aufgabe der Magnetresonanztomographier (MRT) ist es, Zahl, Tiefe und flächenhafte Ausdehnung von Knorpelveränderungen und deren Verteilung über die verschiedenen Gelenkkompartimente zu beschreiben.

Für eine adäquate Knorpeldiagnostik in der MRT ist eine hohe räumliche Auflösung bei gutem Signal-zu-Rausch-Verhältnis (SNR) und gutem Kontrast zum Gelenkbinnenraum und zum subchondralen Knochen nötig. Letzterer ergibt sich bei TSE-Sequenzen für Echozeiten um 30–50 ms. Die Darstellung von Läsionen in mehreren Ebenen erhöht die Treffsicherheit. Kurze Echozeit, hohe Bandbreite und geeignete Wahl der Frequenzkodierrichtung tragen zur Minimierung von Metallartefakten bei.

Moderate T2w-TSE-Sequenzen stellen Binnenveränderungen am Knorpel, subchondrale Knochenmarködem-ähnliche Areale als Hinweis auf etwaige benachbarte Knorpelläsionen und Erguss, der Knorpeldefekte kontrastreich konturiert, sensitiv dar. Die Stärke der T1w-FS/WE-3D-GE-Sequenzen ist ihre hohe räumliche Auflösung, die die graduelle Erfassung von Knorpelerosionen unterstützt.

Kriterien zur Beurteilung der Stabilität bei Osteochondrosis dissecans (OD) sind die Grenzfläche zum umgebenden Knochen, die Integrität der Knorpeloberfläche und assoziierte zystische Veränderungen. Die Treffsicherheit steigt, wenn mehrere Kriterien zusammentreffen, die Prognose ist assoziiert mit der Größe des betroffenen Areals.

Abstract

The motivation for cartilage repair is the preservation of adequate joint motion. Repairing joint surface congruity and providing balanced load bearing are crucial for this. MRI can contribute to this goal by describing number, depth, size, and distribution of cartilage lesions throughout the different joint compartments.

Essential to such a contribution are adequate spatial resolution at a reasonable SNR together with good contrast between both cartilage and the subchondral bone as well as the joint space. For TSE sequences, this is achieved using TEs between 30 and 50 ms. Diagnostic accuracy is optimal when a lesion is depicted in more than one plane. Short TE, high bandwidth, and the appropriate orientation of the frequency encoding direction contribute to minimizing metal artifacts.

Besides internal alterations of the cartilage’s matrix, moderately T2-weighted TSE sequences sensitively depict bone marrow edema such as signal alterations and joint effusion, both contributing to highlight even subtle cartilage lesions. T1-weighted FS/WE 3D GE sequences profit from their high spatial resolution to appreciate gradual erosion of the cartilage.

In OD the interface to the surrounding bone, the integrity of the overlying cartilage, and associated cysts are used to determine stability. The presence of two or more findings increases diagnostic accuracy. Prognosis is associated with the size of the affected area.

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  1. Institut für Klinische Radiologie, Klinikum Großhadern der Ludwig-Maximilians-Universität München

    C. Glaser

  2. Institut für Klinische Radiologie, Klinikum Großhadern der Ludwig-Maximilians-Universität, Marchioninistr. 15, 81377 , München

    C. Glaser

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Glaser, C. Knorpelbildgebung. Radiologe 46, 16–25 (2006). https://doi.org/10.1007/s00117-005-1287-x

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