22, No. After adjustment for BMLs, prevalent full-thickness cartilage loss showed a significant but much less important association with incident SCs in the same subregion (odds ratio, 1.4; 95% CI: 1.0, 2.0). Differential diagnoses of OA related BMLs include traumatic bone contusions and fractures with or without disruption of the articular surface. The tibiofemoral and patellofemoral joints were subdivided into 14 subregions. The fracture can be seen as irregular linear or curvilinear subchondral low signal intensity structure near the subchondral bone plate of low signal intensity in T1-weighted images and also sometimes, but not always in T2-weighted images 1,2,4-8. ScienceDirect ® is a registered trademark of Elsevier B.V. ScienceDirect ® is a registered trademark of Elsevier B.V. Open Archive in partnership with OsteoArthritis Society International, MRI-detected subchondral bone marrow signal alterations of the knee joint: terminology, imaging appearance, relevance and radiological differential diagnosis. Structural abnormalities (osteophytes, cartilage loss, bone marrow lesions (BMLs), subchondral cysts, meniscal abnormalities, effusion, Baker's cyst) at 9 patellofemoral and tibiofemoral locations were scored following the knee OA scoring system. Enhancement of subchondral cysts was evaluated on contrast-enhanced MRI as grade 0 (absent), grade 1 (partial enhancement), or grade 2 (full enhancement). These knees were previously selected for one or more of three substudies of the MOST study: (a) a cohort study of risk factors for radiographic progression of OA consisting of randomly selected knees with either patellofemoral or tibiofemoral OA; (b) a case-control study of risk factors for incident radiographically depicted OA; and (c) a case-control study of risk factors for onset of consistent frequent knee pain (15). Figure 1: Axial, sagittal, and coronal MR images show subregional division in the WORMS system. subchondral tibial cysts in patients with knee OA and to explore relationships between proximal tibial subchondral cyst parameters and subchondral bone density as well as clinical characteristics of OA (alignment, joint space narrowing (JSN), OA severity, pain) in patients with knee OA. The MRI evaluation in JOG included the joint features of subchondral BMLs, subchondral cysts, cartilage, meniscus, effusion and synovitis using the Whole Organ Magnetic Resonance Imaging Score (WORMS) method . the presence of pain in chondral pathology of the knee.1 Therefore, subchondral pathology, visible as sclerosis and/ or cysts (plain radiographs) and hyperintensity (on mag-netic resonance imaging [MRI]), has been targeted as a viable entity to treat in a therapeutic strategy to relieve pain.2 Inhibition of subchondral lesions has been shown Examinations were performed at the University of Alabama at Birmingham and at the University of Iowa at Iowa City with the same MR unit. 2, 19 January 2011 | RadioGraphics, Vol. 9, No. 32, Osteoarthritis and Cartilage, Vol. Cyst not associated with OA. Methods. 1, 20 August 2011 | Current Osteoporosis Reports, Vol. (A) Chronic lateral knee pain in 23-year-old man. 38, No. Two-dimensional MRI analyses of tibiofemoral subregions have demonstrated that subchondral BMLs predict cartilage loss and subchondral bone attrition at the same subregion [49, 50]. According to the synovial fluid intrusion theory (3,6), SCs should develop only in subregions with full-thickness cartilage loss, where breaches of the articular surface could allow synovial fluid and/or synovial tissue to intrude into the subchondral bone. The Multicenter Osteoarthritis study is a longitudinal study of individuals who have or are at risk for knee osteoarthritis. No statistically significant differences were found for age (P = .97) and sex (P = .68) when considering subregions with incident SCs. Retrospective cohort of 32 patients with two sequential knee MRI. The presence and size of subchondral cysts and bone marrow edema-like lesions (BMLs) were scored semiquantitatively in each subregion on non-contrast enhanced MRI from 0 to 3. A P value less than .05 was considered to indicate a significant difference. Dr. Nwachukwu will often be able to see acetabular paralabral cysts or subchondral cysts on an MRI scan. Figure 4b: (a) Sagittal proton density–weighted fat-suppressed MR image at baseline shows a grade 1 BML at the anterior (trochlear) subregion of the lateral femur (arrowheads). bone marrow edema-like lesions and subchondral cysts. Two musculoskeletal radiologists (F.W.R. A geode is one of the common differential diagnoses of an epiphyseal lesion (lytic). MRI of bone marrow edema-like signal in the pathogenesis of subchondral cysts. Clinical quantitative computed tomography (QCT) has the potential to characterize cysts in vivo but it is unclear which specific cyst parameters (e.g., number, size) are associated with clinical signs of OA, such as disease severity or pain. The association did not change materially after adjusting for full-thickness cartilage loss, with an odds ratio of 12.9 (95% CI: 8.9, 18.6; P < .0001). Cyst … Eleven tibiofemoral subregions are defined: the central (C) and posterior (P) femur medially and laterally, the anterior (A), central, and posterior tibia medially and laterally, and the subspinous (S) region. 05, No. 2, Journal of the American Veterinary Medical Association, Vol. At baseline examination, all subjects underwent weight-bearing posteroanterior fixed-flexion knee radiography by using the protocol of Peterfy et al (16) and a Plexiglas positioning frame (SynaFlexer; Synarc, San Francisco, Calif). 2, Journal of Orthopaedic Translation, Vol. However, that was a cross-sectional study, and no temporal relationship between these two features could be assessed. Design. The detailed effect of multiple cysts on the knee joint is lacking in the literature. 45, No. Subchondral bone cyst formation is often encountered in osteoarthritis (OA) of the knee, particularly in advanced OA [].Visualised by using magnetic resonance imaging (MRI), subchondral bone cysts occur where the overlying cartilage has largely been eroded [].Two main theories are proposed about cyst formation: the synovial breach theory [3, 4] and the bony contusion theory [1, 5]. A total of 1283 knees were included. Introduction. https://doi.org/10.1016/j.joca.2009.03.012. Grade 2.5 cartilage morphology, which indicates a small (<1 cm) focal area of full-thickness cartilage loss, showed no such association. 1, Arthritis Research & Therapy, Vol. A subchondral cyst (Fig. However, the association of baseline BMLs and full-thickness cartilage loss with incident SCs was not assessed in that cohort. Supportive of this theory is the fact that cysts are often observed in areas of the knee exhibiting concomitant bone marrow edema–like lesions (BMLs) that show histologic features of bone trauma, including areas of necrosis. However, we did find a weak but significant association when all grades were combined after adjusting for prevalent BMLs. The most likely cause is either synovial fluid intrusion or bone contusions. Recently, there has been increasing interest in the role of subchondral bone cysts in OA progression; in particular how subchondral bone cysts may influence pain [1,2,3], or how subchondral bone cysts influence subchondral bone mechanical behaviour []. Subchondral bone cysts commonly occur adjacent to a treated focal cartilage defect and are possibly connected to the joint cavity. Because BMLs are highly associated with cartilage damage in the same subregion of the knee (20,21), we adjusted for full-thickness cartilage loss when testing prevalent BML (bone contusion theory) as the predictor. 19, No. Knee pain was assessed by using the Western Ontario and McMaster University pain subscale. The subchondral cyst was determined as the source of the excess synovial fluid filling up the Baker’s cyst. We assessed the longitudinal association of prevalent BMLs (score ≥ 1) and full-thickness cartilage loss (grades 2.5, 5, and 6) with incident SCs (score ≥ 1) on a per-subregion basis by using logistic regression with generalized estimating equations to account for correlations among the subregions within a knee (using one knee per person). In the knee, cyst-like degenerations may occur resulting from changes in the conjunctive matrix of some articular structures. According to the bone contusion theory (4,7), a subchondral cyst forms independently of the condition of adjacent cartilage. 3-4, 17 August 2018 | RadioGraphics, Vol. Surgical Technique. 6, 30 November 2015 | The American Journal of Sports Medicine, Vol. Patients with acute trauma, infection, neoplasm, or osteonecrosis were excluded. Table 2 Longitudinal Association between Prevalent Full-Thickness Cartilage Loss and Incident SCs in the Same Subregion of the Knee. A.G. is president of BICL. 50, No. †Statistically significant differences were defined as having P <.05. 38, No. Overall, 87% (20/23) of subchondral cysts were subjacent to an MRI visible cartilage abnormality (any grade). The IW fs sequence should be used for determination of lesion extent whenever the size of subchondral bone marrow edema-like lesions is the focus of attention. 4, Cytokine & Growth Factor Reviews, Vol. A longitudinal subanalysis of the individual BML and cartilage morphology grades was performed. For interval developed subchondral cysts, the follow-up images showed 83% (10/12) cartilage lesions. Subchondral cysts are of variable size from a few millimeters to over a centimeter. The presence and size of subchondral cysts and bone marrow edema-like lesions (BMLs) were scored semiquantitatively in each subregion on non-contrast-enhanced MRI from 0 to 3. Subregions without BMLs (score = 0) and without full-thickness cartilage loss (scores 0, 1, 2, 3, and 4) were considered the reference group. We found a high incidence of concomitant occurrence of subchondral cysts with a ruptured anterior cruciate ligament (ACL) in all of these cases. 1, 2 January 2013 | BMC Musculoskeletal Disorders, Vol. WORMS is a validated research tool for semiquantitative assessment of knee OA. Different entities of subchondral BMLs that are of relevance in the context of OA research may be distinguished by specific imaging findings, patient characteristics, symptoms, and history and are discussed in this review. The subspinous region was not considered in this study because it is not covered by articular cartilage. Subjects were participants in the Multicenter Osteoarthritis (MOST) study, a prospective epidemiologic study with the goal of identifying risk factors for incident and progressive knee OA in 3026 people aged 50–79 years either with or at high risk of developing OA. (b) Coronal STIR MR image at 30-month follow-up demonstrates an incident SC developed in the same location (arrow). kDepartment of Radiology, New York University, Hospital for Joint Diseases, New York, NY, USA Summary Objective: To determine if a relationship exists between bone marrow edema-like signal and subchondral cysts on magnetic resonance imaging (MRI). Mean subject age was 62.3 years ± 7.9 (standard deviation), and mean subject body mass index was 30.1 kg/m2 ± 4.9 (range, 18.0–55.8 kg/m2). Dr. Nwachukwu will often be able to see acetabular paralabral cysts or subchondral cysts on an MRI scan. (B) Sagittal PD FS image shows well-defined subchondral cyst (arrow) with surrounding BML (arrowheads). 11, Osteoarthritis and Cartilage, Vol. MR imaging depicted 171 osteophytes and 51 subchondral cysts. Given the fact that magnetic resonance imaging (MRI) is being performed more frequently for assessment of the knee joint (e.g. (b) Coronal STIR MR image at 30-month follow-up demonstrates an incident SC developed in the same location (arrow). post-traumatic, in sport injuries, in rheumatological disorders, in oncological imaging), the number of incidental cystic and “cyst-like” lesions in and around the knee joint found on routine knee MRI scans has also increased [1–4]. (b) Sagittal proton density–weighted fat-suppressed MR image at 30-month follow-up shows an incident SC (arrow) in the middle of the BML depicted at baseline. 1, © 2020 Radiological Society of North America, Bone marrow edema pattern in osteoarthritic knees: correlation between MR imaging and histologic findings, Prevalence and MRI-anatomic correlation of bone cysts in osteoarthritic knees, The cysts of osteoarthritis of the hip: a radiological and pathological study, Subchondral cysts (geodes) in arthritic disorders: pathologic and radiographic appearance of the hip joint, The pathological significance of intra-articular pressure, The pathological changes in degenerative arthritis of the hip and treatment by rotational osteotomy, Osteoarthritis of the knee: correlation of subchondral MR signal abnormalities with histopathologic and radiographic features, Magnetic resonance imaging (MRI) of the knee: a pattern approach for evaluating bone marrow edema, MRI-based semiquantitative assessment of subchondral bone marrow lesions in osteoarthritis research, Bone marrow edema pattern in advanced hip osteoarthritis: quantitative assessment with magnetic resonance imaging and correlation with clinical examination, radiographic findings, and histopathology, MRI-detected bone marrow edema-like lesions are strongly associated with subchondral cysts in patients with or at risk for knee osteoarthritis: the MOST study [abstr], MRI of bone marrow edema-like signal in the pathogenesis of subchondral cysts, A connective tissue disease screening questionnaire for population studies, Correlation of the development of knee pain with enlarging bone marrow lesions on magnetic resonance imaging, Non-fluoroscopic method for flexed radiography of the knee that allows reproducible joint-space width measurement [abstr], Radiological assessment of osteo-arthrosis, Whole-Organ Magnetic Resonance Imaging Score (WORMS) of the knee in osteoarthritis, A comparison of dedicated 1.0 T extremity MRI vs large-bore 1.5 T MRI for semiquantitative whole organ assessment of osteoarthritis: the MOST study, Change in MRI-detected subchondral bone marrow lesions is associated with cartilage loss: the MOST Study—a longitudinal multicentre study of knee osteoarthritis, A study of the prevalence and associations of subchondral bone marrow lesions in the knees of healthy, middle-aged women, Accuracy of T2-weighted fast spin-echo MR imaging with fat saturation in detecting cartilage defects in the knee: comparison with arthroscopy in 130 patients, Grading articular cartilage of the knee using fast spin-echo proton density-weighted MR imaging without fat suppression, Cartilaginous defects of the femorotibial joint: accuracy of coronal short inversion time inversion-recovery MR sequence, Open in Image Can Signal Abnormalities Detected with MR Imaging in Knee Articular Cartilage Be Used to Predict Development of Morphologic Cartilage Defects? subchondral cysts (geodes) altered shape of the femoral condyles and tibial plateau; Plain radiographs are the workhorse of imaging including follow-up, although there is a poor correlation between radiographic findings and clinical symptoms 1,2. Prevalent BMLs strongly predicted incident SCs in the same subregion longitudinally, even after adjustment for full-thickness cartilage loss, which supports the bone contusion theory of SC formation. 23, No. 9, No. WORMS (whole-organ MR imaging score) , KOSS (knee osteoarthritis scoring system) , and BLOKS (Boston-Leeds osteoarthritis knee score) are such semiquantitative measurements in which the cartilage damage is assessed concomitant with other structures of the knee (e.g., menisci, subchondral bone, osteophytes, and synovial membrane) . Bone marrow lesions (BMLs) around the knee are a common magnetic resonance imaging (MRI) finding. 19, No. Subjects considered at high risk for knee OA included those who were overweight or obese; those with knee pain, aching or stiffness on most of the past 30 days, a history of knee injury that made it difficult to walk for at least 1 week; or those who underwent previous knee surgery. Subjects were not eligible to participate in the MOST study if they had rheumatoid arthritis (14), ankylosing spondylitis, psoriatic arthritis, Reiter syndrome, renal insufficiency that required hemodialysis or peritoneal dialysis, or a history of cancer (except for nonmelanoma skin cancer); had undergone or planned to undergo bilateral knee replacement surgery; were unable to walk without assistance; or were planning to move out of the area in the next 3 years. Four patellofemoral subregions are defined: the medial (M) and lateral (L) patella and the anterior subregions of the femur (trochlea) medially and laterally. 12, Current Opinion in Rheumatology, Vol. Subchondral cyst–like lesions (SCs) are a common finding in patients with knee osteoarthritis (OA). Subchondral insufficiency fractures are non-traumatic fractures that occur immediately below the cartilage of a joint. These lesions have a characteristic appearance on magnetic resonance (MR) images, demonstrating well-defined rounded areas of fluidlike signal intensity on unenhanced images (1,2).No evidence of epithelial lining has been detected in prior histologic studies (2–5). An MRI allows him to see both the bony structures of the hip as well as the soft tissues. Prevalent BMLs were found in 1843 subregions (11.3%), prevalent full-thickness cartilage loss was found in 1624 subregions (9.9%), and incident SCs were found in 216 subregions (1.3%). No statistically significant differences were found for age (P = .53) and sex (P = .87) when considering included versus excluded subregions. 2011; 12 (1):198. Patients with acute trauma, infection, neoplasm, or osteonecrosis were excluded. Of 19 153 subregions analyzed initially, 663 (3.5%) exhibited SCs at baseline and were excluded. The Baker’s cyst was easily palpated and grossly seen with the patient in the prone position. (A) Chronic lateral knee pain in 23-year-old man. 1, Clinics in Sports Medicine, Vol. Thus, grades 2.5, 5, and 6 include full-thickness cartilage loss, but the other grades do not. Some limitations to the current study need mentioning. The synovial fluid intrusion theory posits that elevated intraarticular pressure leads to the intrusion of joint fluid into the subchondral bone through fissured or ulcerated cartilage (3,6), with subsequent development of cystic cavities. 6, 18 March 2011 | Rheumatology, Vol. Viewer, Osteochondral Lesions of the Knee: Differentiating the Most Common Entities at MRI, Injectable nanohydroxyapatite-chitosan-gelatin micro-scaffolds induce regeneration of knee subchondral bone lesions, Osteoarthritis: More than Cartilage Degeneration, Concurrent or sequential tibial subchondral cystic lesions in 4 horses with medial femoral condyle subchondral cystic lesions, Giant Intraosseous Cyst in an Osteoarthritic Knee, Changes in the osteochondral unit during osteoarthritis: structure, function and cartilage–bone crosstalk, Bone marrow lesions and subchondral bone pathology of the knee, Longitudinal assessment of MRI in hip osteoarthritis using SHOMRI and correlation with clinical progression, Aetiology and pathogenesis of bone marrow lesions and osteonecrosis of the knee. 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