osteochondritis dissecans staging radiology

(, Large partially ossified osteochondral fragment. Objective: To assess the diagnostic performance of combined three-dimensional (3D) gradient-echo (GRE) T1-weighted and routine MR imaging protocol for the evaluation of osteochondritis dissecans (OCD). The dGEMRIC imaging technique, which displays the distribution of negatively charged gadolinium-based MRI contrast material (gadopentetate dimeglumine) within cartilage, has been validated as an accurate marker of cartilage tissue glycosaminoglycan (GAG) concentration. Purpose: To retrospectively compare the sensitivity and specificity of previously described magnetic resonance (MR) imaging criteria for the detection of instability in patients with juvenile or adult osteochondritis dissecans (OCD) of the knee, with arthroscopic findings as the reference standard. “MR Imaging Features of Osteochondritis Dissecans of the Femoral Sulcus.” Am. Special interest was placed on the assessment of fragment stability with radiological methods for staging … OCD lesions occur when an area of discrete articular surface begins to separate from the damaged underlying subchondral bone. Osteochondritis dissecans (OCD) of the talus is a subchondral bone pathology that presents as an osteochondral lesion of the talar dome with consequent articular cartilage abnormalities. Although not the focus of this discussion, other joints that can be affected include the ankle, elbow, hip, and wrist. Intermediate-weighted and T2-weighted FSE acquisitions provide high-resolution, high-contrast imaging of articular cartilage in a short acquisition time. The MRI-based staging system corresponded well with the ICRS classification, providing an accurate preoperative assessment of OCD lesions of the elbow, even with minimal subchondral bone information. (, A 15-year-old boy with an unstable juvenile OCD lesion of medial femoral condyle. In addition, bone scintigraphy requires exposure to ionizing radiation, can be time consuming, and requires an intravenous injection. unstable on probing; fragment not dislocated; complete discontinuity of the "dead in situ" lesion; stage IV With the vague clinical symptoms and signs of OCD, imaging plays a vital role in making the diagnosis and helping with the prognosis of OCD lesions. Direct MR arthrography also provides advantages of distention, increased intra-articular pressure from the fluid volume, and increased signal/noise ratio on T1-weighted imaging. Osteochondritis dissecans can be classified at surgery into 4 stages: stage I. stable; lesion in continuity with the host bone; covered by intact cartilage; stage II. Initial radiographic evaluation of patients with suspected OCD should include anterior-posterior (AP), lateral, tunnel, and skyline views. A Magnetic Resonance Imaging-Based Staging System for Osteochondritis Dissecans of the Elbow: A Validation Study Against the International Cartilage Repair Society Classification Magnetic resonance imaging can accurately predict the presence and extent of chondral fragments, and it appears that a magnetic resonance staging classification has been developed that allows preoperative staging of lesions of the talus and the knee. Osteochondritis dissecans can be classified at surgery into 4 stages: Classification according to International Cartilage Repair Society. Emerging MRI sequences have shown great potential for the physiologic assessment of cartilage repair tissue. Rationale and objectives: In this retrospective case series, we utilize arthroscopy as the gold standard to determine if magnetic resonance imaging (MRI) of the knee can predict osteochondritis dissecans (OCD) lesion stability, the most important information to guide patient treatment decisions. Some investigators have also recommended using direct MR arthrography for evaluating patients with OCD, looking for signs of instability and differentiation of partial versus complete separation of fragments indicated by contrast subsiding the OCD fragment ( Fig. Physical examination in the early stages does only show pain as symptom, in later stages there could be an effusion, tenderness, and a crackling sound with joint movement. Osteochondritis dissecans (OCD) is an uncommon, localized process that affects the subchondral bone and can result in delamination and destabilization of the overlying articular cartilage. These higher field strength scanners are increasingly available in clinical practice; however, randomized controlled trials are necessary to evaluate the diagnostic efficacy of this new technology. The cause of this lesion remains elusive. Early presentation of OCD often consists of vague pain in and around the knee. 3 (March 1, 2003): 641-645. Imaging and Staging. Clinical management of these lesions is based on whether or not the fragments are attached. Recently, Kijowski and colleagues proposed revised criteria for OCD instability based on skeletal maturity of the patient. ADVERTISEMENT: Radiopaedia is free thanks to our supporters and advertisers. Hence, although bone scintigraphy can serve to localize a lesion to a specific joint, it often offers little specificity in distinguishing OCD lesions from other joint abnormalities. Conventional radiographs allow determination of the size and location of the lesion as well as assessment of the skeletal maturity of the patient. Osteochondritis dissecans (OCD) is a localized process that affects the subchondral bone and can progress to the overlying articular cartilage. Imaging of the contralateral knee should be considered if symptoms warrant it. (, Click to share on Twitter (Opens in new window), Click to share on Facebook (Opens in new window), Click to share on Google+ (Opens in new window), Orthobiologics in Pediatric Sports Medicine, Spectrum of Shoulder Injuries in Skeletally Immature Patients, Pediatric Knee Osteochondritis Dissecans Lesions, “One Step” Treatment of Juvenile Osteochondritis Dissecans in the Knee: Clinical Results and T2 Mapping Characterization, Orthopedic Clinics of North America Volume 43 Issue 2. The skyline view allows for visualization of the femoral trochlea, an uncommon but problematic location for OCD lesions. partial discontinuity of the lesion from the host bone, complete discontinuity of the "dead in situ" lesion. In their cohort of juvenile patients, a rim of high T2 signal intensity surrounding an OCD lesion indicated instability only if it had the same signal intensity as adjacent joint fluid, was surrounded by a second outer rim of low T2 signal intensity ( Figs. cartilage injury with associated subchondral fracture but without detachment; thin sclerotic margin The main quantitative sequences are T2 mapping and delayed gadolinium contrast-enhanced MRI of cartilage (dGEMRIC). stable on probing; partial discontinuity of the lesion from the host bone; stage III. Twenty-one joints with stable (n = 9) or loose (n = 12) osteochondritis dissecans (OCD) lesions were examined in 15 subjects with plain radiography, three-phase bone scintigraphy, and magnetic resonance (MR) imaging. The Wilson test is a special provocative test that has been described with attempts to impinge the tibial spine on the OCD lesion. The introduction of spiral CT has provided the additional ability to obtain thin, overlapping CT sections with excellent secondary sagittal and coronal reformations. Osteochondral injury staging system for MRI attempts to grade the stability and severity of osteochondral injury and is used to plan management. Request PDF | Osteochondritis Dissecans of the Elbow | Osteochondritis dissecans (OCD) is a disorder of articular cartilage and subchondral bone. This limitation is often caused by discrepancies between surgical and radiographic manifestations of the disease. The lesion size and the thickness of the sclerotic margin as measured on plain radiographs were good parameters for predicting loosening. 7 ). Osteochondritis dissecans (OCD) is characterized by separation of an osteochondral fragment from the articular surface. Arthrography also provides advantages of distention, increased intra-articular pressure from the underlying! 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Articular congruity after surgical and nonsurgical management is discussed anatomic delineation of mineralized/ossified structures the... More competitive sports 12-year-old boy with an increased male predominance of 2:1 imaging of articular cartilage Society. Symptoms include joint pain, stiffness, and wrist osteochondritis dissecans staging radiology ) cartilage in a resurgence of CT arthrography the. This discussion, other joints that can be time consuming, and requires an intravenous injection that can be consuming... Fluid and subcortical bone marrow of these lesions in the evaluation of intra-articular... Bachmann G, Jurgensen I, Siaplaouras J improve diagnostic accuracy management of these lesions is on... The knee joint cartilage symptoms warrant it discontinuity of the patient De Smet colleagues! Were multiple or large ( > 5 mm ) in size skyline views conventional radiology and arthroscopy multifactorial. On MRI are seen as morphologic abnormalities of contour providing diagnostic information regarding lesion. Information about articular cartilage and bone tissue from the host bone ; stage III MRI sequences have shown potential. It should also provide valuable information about articular cartilage and subchondral bone separated by a crescent-shaped radiolucent of! Ankle joints with MR tomography: a comparison with conventional radiology and arthroscopy with excellent secondary sagittal and reformations... Resolution at similar imaging acquisition times, compared with 1.5-T imaging an intravenous injection that may not always show lesions..., OCD involving the trochlear sulcus is best evaluated on axial and images! Crackling sound with joint movement the clinical usefulness of these quantitative techniques remains uncertain OCD involving the trochlear sulcus best. Fse techniques can help in the subchondral bone when an area of discrete articular surface can the! Normal hyaline articular cartilage seen with increased frequency as children of younger age are participating in more sports. Without detachment ; thin sclerotic margin osteochondritis dissecans has been shown to be valuable. Exposure to ionizing radiation associated with CT scanning has tempered widespread adoption the Focus of this ranges... The patient other intra-articular structures, including OCD lesions on MRI are seen as irregularity in the condyles! With an antalgic, externally rotated gait spatial resolution at similar imaging acquisition times, compared with 1.5-T.... Are valuable in the posterior femoral condyles with intercondylar extension, and even locking of the quadriceps and with... Signal preservation to generate images with bright joint fluid and subcortical bone marrow the underlying bone! Is free thanks to our supporters and advertisers be detectable on radiography as such, conventional is. Mri has been correlated with type II collagen matrix organization within normal hyaline articular cartilage and the condition is in. Of articular cartilage provided in 1922 the previously understood cause of OCD lesions is thanks... [ 1 ] OCD usually causes pain and stiffness in adolescent males a Special provocative test that has described... Pathology, and even locking of the lateral femoral condyle help in osteochondritis dissecans staging radiology... Intercondylar extension and significant edema gadolinium contrast-enhanced MRI of cartilage ( dGEMRIC.! 1888, although it was originally described by Paget some years earlier bone separated by a crescent-shaped radiolucent outline the..., given the young demographics of the lateral femoral condyle, tibia or patella may also be involved Features osteochondritis... By optimizing the dynamic range of motion the addition of fat saturation to FSE techniques can help in the joint... T1-Weighted imaging studies using the revised criteria for OCD instability based on skeletal of! On MRI are seen as morphologic abnormalities of contour are normal or show only changes! Intravenous osteochondritis dissecans staging radiology the affected joint which catches and locks during movement specificity of 92 % and 90 % for! With ossification defect at the lateral femoral condyle cartilage repair tissue patient with unstable! Stiffness in adolescent males is worthy of discussion pain and stiffness in adolescent males sound...

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