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T2 black lesions on routine knee MRI: differential considerations

  • Musculoskeletal
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Abstract

The majority of abnormal findings or lesions on T2-weighted fast spin-echo (FSE) magnetic resonance imaging (MRI) are hyperintense due to increased perfusion or fluid content, such as infections, tumours or synovitis. Hypointense lesions on T2-weighted images (both fat-suppressed and non-fat-suppressed) are less common and can sometimes be overlooked. Such lesions have limited differential diagnostic possibilities, and include vacuum phenomenon, loose body, tenosynovial giant cell tumour, rheumatoid arthritis, haemochromatosis, gout, amyloid, chondrocalcinosis, hydroxyapetite deposition disease, lipoma arborescens, arthrofibrosis and iatrogenic lesions. These lesions often show characteristic appearances and predilections in the knee. In this article, the authors describe the MRI features of hypointense T2 lesions on routine knee MRI and outline a systematic diagnostic approach towards their evaluation.

Key Points

• Hypointense lesions on T2 images (T2 Dark Lesions) encompass limited diagnostic possibilities.

• T2 Dark lesions often show characteristic appearances and predilections in the knee.

• A systematic diagnostic approach will help radiologists make the correct diagnosis.

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Abbreviations

ACL:

Anterior cruciate ligament

CC:

Chondrocalcinosis

CPPD:

Calcium pyrophosphate dehydrate

fsPDW:

Fat-suppressed proton density

GRE:

Gradient recalled echo

LA:

Lipoma arborescens

LBs:

Loose bodies

MM:

Meniscomeniscal

MRI:

Magnetic resonance imaging

PVNS:

Pigmented villonodular synovitis

RA:

Rheumatoid arthritis

STIR:

Short tau inversion recovery

TGCT:

Tenosynovial giant cell tumour

VP:

Vacuum phenomenon

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Acknowledgments

The authors would like to thank Ms. Pam Curry for creating the beautiful illustrations. The scientific guarantor of this publication is Avneesh Chhabra. The authors of this manuscript declare a relationships with the following company: Dr. Avneesh Chhabra serves as research consultant with Siemens CAD group. The authors state that this work has not received any funding. No complex statistical methods were necessary for this paper. Institutional Review Board approval was not required because it is a review article. Written informed consent was not required for this study because it is a review article. No study subjects or cohorts have been previously reported. Methodology: performed at one institution.

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Authors and Affiliations

  1. Department of Radiology, University of Arkansas for Medical Sciences, Little Rock, AR, USA

    Vibhor Wadhwa

  2. Musculoskeletal Radiology, UT Southwestern Medical Center, Dallas, TX, USA

    Gina Cho, Daniel Moore, Parham Pezeshk & Avneesh Chhabra

  3. Orthopaedic Surgery, UT Southwestern Medical Center, Dallas, TX, USA

    Katherine Coyner & Avneesh Chhabra

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  1. Vibhor Wadhwa
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Correspondence to Avneesh Chhabra.

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Wadhwa, V., Cho, G., Moore, D. et al. T2 black lesions on routine knee MRI: differential considerations. Eur Radiol 26, 2387–2399 (2016). https://doi.org/10.1007/s00330-015-4027-2

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