Prevalent BMLs showed a strong association with incident SCs in the same subregion, with an odds ratio of 15.0 (95% confidence interval [CI]: 10.9, 20.5; P < .0001), compared with subregions without prevalent BMLs (Figs 3 and 4). Design: Retrospective cohort of 32 patients with two sequential knee MRI. Geodes, also known as a subchondral cysts, are well-defined lytic lesions at the periarticular surfaces. 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 []. The most common abnormalities were bone marrow necrosis, fibrosis, and trabecular abnormalities (1). Patients with acute trauma, infection, neoplasm, or osteonecrosis were excluded. 7, No. A recent study (19) showed that WORMS assessment by using a 1.0-T dedicated extremity MR system is possible with a moderate to high degree of agreement and accuracy compared with WORMS assessment by using a 1.5-T large-bore MR imaging unit. In a study comparing MR imaging features with histologic findings in 19 patients after hip replacement, Taljanovic et al (11) found microfractures in different stages of healing and bone marrow necrosis in 100% of patients, and 85% had bone marrow fibrosis. However, the effect of full-thickness cartilage loss was diluted after adjustment for BMLs, and no significant association was found when evaluating different grades separately, which does not support the synovial fluid intrusion theory of SC formation. 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. Furthermore, a larger size of BMLs at baseline was associated with an increased risk for the development of SCs at follow-up, which also favors the bone contusion theory. In 1285 participants (median age 56 years, 55% women, median body mass index (BMI) 30 kg/m 2), MRI of the right knee were obtained. 48-Month Data from the Osteoarthritis Initiative, Search under the Cartilage: A Gamut of Subchondral Lesions, Think Different: Sorting Out Osteochondral Lesions of the Knee, Subchondroplasty: A New Minimally Invasive Procedure for Treatment of Knee Pain Associated with Arthritis. To determine if a relationship exists between bone marrow edema-like signal and subchondral cysts on magnetic resonance imaging (MRI). 1, Arthritis Research & Therapy, Vol. 213, No. However, the association of baseline BMLs and full-thickness cartilage loss with incident SCs was not assessed in that cohort. 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]. If readers disagreed on the presence of OA, readings were adjudicated by a panel of three readers (two nonauthors and D.T.F.). 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. Baseline and follow-up MR readings were performed during a period of 2 years. CAS PubMed Google Scholar Request PDF | Bone marrow lesions and subchondral bone pathology of the knee | Bone marrow lesions (BMLs) around the knee are a common magnetic resonance imaging (MRI) finding. Magnetic resonance imaging (MRI) of the knee joint is one of the most commonly requested in general radiological practise examinations and belongs to the core clinical practice in most MRI units along with spinal and brain MRI. To assess the association of prevalent bone marrow edema–like lesions (BMLs) and full-thickness cartilage loss with incident subchondral cyst–like lesions (SCs) in the knee to evaluate the bone contusion versus synovial fluid intrusion theories of SC formation. Bone marrow lesions and subchondral bone pathology of the knee Kon, Elizaveta; Ronga, Mario; Filardo, Giuseppe; Farr, Jack; Madry, Henning; Milano, Giuseppe; Andriolo, Luca; Shabshin, Nogah 2016-06-01 00:00:00 Bone marrow lesions (BMLs) around the knee are a common magnetic resonance imaging (MRI) finding. 23, No. Enhancement of subchondral cysts was evaluated on contrast-enhanced MRI as grade 0 (absent), grade 1 (partial enhancement), or grade 2 (full enhancement). However, despite the growing interest on BMLs in multiple pathological conditions, they remain controversial not only for the still unknown role in the etiopathological processes, but also in terms of clinical impact and treatment. A musculoskeletal radiologist and a rheumatologist, who were not authors (both with more than 10 years of experience reading study radiographs) and were blinded to clinical data, independently graded the images according to the Kellgren-Lawrence scale (17). Surgical treatment options for New York patients may vary, based on the size, type and symptoms of the hip cyst. 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). 32, No. 3, 27 September 2011 | Rheumatology, Vol. BMLs and SCs were scored from 0 to 3. 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. Readers cannot be blinded to features of relevance because those are depicted on the paired images and are seen simultaneously. 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). 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. 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). The Baker’s cyst was easily palpated and grossly seen with the patient in the prone position. 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. WORMS is a validated research tool for semiquantitative assessment of knee OA. They are cavities that develop in the medial part of the meniscus or in one of its horns and may reach 2 cm . Degenerative cyst-like lesions in meniscus are a classic example. The evidence for local and central pain processing, Semiquantitative assessment of subchondral bone marrow edema-like lesions and subchondral cysts of the knee at 3T MRI: A comparison between intermediate-weighted fat-suppressed spin echo and Dual Echo Steady State sequences, Mechanical Loading: Bone Remodeling and Cartilage Maintenance, Frequency of Bone Marrow Lesions and Association with Pain Severity: Results from a Population-based Symptomatic Knee Cohort, Comment on: Bone marrow lesions in people with knee osteoarthritis predict progression of disease and joint replacement: a longitudinal study, Magnetic Resonance Imaging in Knee Osteoarthritis Research: Semiquantitative and Compositional Assessment, Rapidly Progressive Osteoarthritis: Biomechanical Considerations, Osteoarthritis year 2010 in review: imaging, Crosstalk between cartilage and bone: When bone cytokines matter, Articular Cartilage in the Knee: Current MR Imaging Techniques and Applications in Clinical Practice and Research1, Subchondral Bone Marrow Edema in Patients with Degeneration of the Articular Cartilage of the Knee Joint. Bone Biomarkers Related to Osteoarthritis, Bone turnover and articular cartilage differences localized to subchondral cysts in knees with advanced osteoarthritis, The Longitudinal Reliability and Responsiveness of the OMERACT Hand Osteoarthritis Magnetic Resonance Imaging Scoring System (HOAMRIS), Scoring hip osteoarthritis with MRI (SHOMRI): A whole joint osteoarthritis evaluation system, Subchondral Bone and Its Role in Osteoarthritis, Development and reliability of a multi-modality scoring system for evaluation of disease progression in pre-clinical models of osteoarthritis: celecoxib may possess disease-modifying properties, Three-dimensional analysis of subchondral cysts in hip osteoarthritis: An ex vivo HR-pQCT study, Iterative Development and Reliability of the OMERACT Hand Osteoarthritis MRI Scoring System, A pilot trial of intravenous pamidronate for chronic low back pain, Importance of subchondral bone in the pathogenesis and management of osteoarthritis from bench to bed, Quantification of bone marrow lesion volume and volume change using semi-automated segmentation: data from the osteoarthritis initiative, Bone cysts after osteochondral allograft repair of cartilage defects in goats suggest abnormal interaction between subchondral bone and overlying synovial joint tissues, Animal models of osteoarthritis for the understanding of the bone contribution, Lentiviral Small Hairpin RNA Knockdown of Macrophage Inflammatory Protein-1γ Ameliorates Experimentally Induced Osteoarthritis in Mice, High-resolution ultrasonography and 3.0 T magnetic resonance imaging in erosive and nodal hand osteoarthritis: high frequency of erosions in nodal osteoarthritis, Prevalent cartilage damage and cartilage loss over time are associated with incident bone marrow lesions in the tibiofemoral compartments: the MOST study, Animal models in OA: a means to explore bone, Magnetic Resonance Imaging of Subchondral Bone Marrow Lesions in Association with Osteoarthritis, Relationship between microstructure and degree of mineralization in subchondral bone of osteoarthritis: A synchrotron radiation µCT study, Detection of Osteophytes and Subchondral Cysts in the Knee with Use of Tomosynthesis, Targeting Bone Alleviates Osteoarthritis in Osteopenic Mice and Modulates Cartilage Catabolism, Early diagnosis to enable early treatment of pre-osteoarthritis, What makes osteoarthritis painful? 12, No. 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 . 6, Seminars in Arthritis and Rheumatism, Vol. 50, No. The Health Insurance Portability and Accountability Act–compliant study protocol was approved by the Institutional Review Boards at the University of Iowa, University of Alabama at Birmingham, University of California at San Francisco, and Boston University School of Medicine. An overview of the published literature is presented. Some limitations to the current study need mentioning. Vet Radiol Ultrasound. Subchondral insufficiency fractures are non-traumatic fractures that occur immediately below the cartilage of a joint. 50, No. Semiquantitative assessment of subchondral bone marrow edema-like lesions and subchondral cysts of the knee at 3T MRI: a comparison between intermediate-weighted fat-suppressed spin echo and Dual Echo Steady State sequences. 11, Osteoarthritis and Cartilage, Vol. BMLs were defined as poorly delineated areas of hyperintensity directly adjacent to the subchondral plate on STIR and proton density–weighted fat-suppressed MR images. Funding: This work was supported by National Institute on Aging (grants U01-AG-18947, U01-AG-18832, U01-AG-19069, and U01-AG-18820). In a recent cross-sectional study evaluating the distribution of SCs in subregions of the knee with normal cartilage, partial-thickness loss, or full-thickness loss of cartilage, Crema et al (12) found that 46.5% of MR imaging–detected SCs were present in subregions with no full-thickness cartilage loss, which speaks against the synovial fluid intrusion theory. 6, 30 November 2015 | The American Journal of Sports Medicine, 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). 1, Osteoarthritis and Cartilage, Vol. The clinical relevance of subchondral cysts in regard to pain or structural progression of OA is not well understood as of to date. Subchondral cysts are of variable size from a few millimeters to over a centimeter. She had reported that the Baker’s cyst had been there for many years and periodically aspirated by different doctors. Assessment of subchondral non-cystic ill-defined BMLs on gradient echo-type sequences should be avoided as they will underestimate the size of the lesion. Subchondral cyst. Knee pain was assessed by using the Western Ontario and McMaster University pain subscale. 2, 22 November 2012 | Osteoporosis International, Vol. BMLs, which represent focal bone remodeling due to overloading, are predictors of pain and progression of cartilage damage in OA (15,20) and are potential treatment targets. (b) Coronal STIR MR image at 30-month follow-up demonstrates an incident SC developed in the same location (arrow). Enhancement of subchondral cysts was evaluated on contrast enhanced MRI as grade 0 (absent), grade 1 (partial enhancement), or grade 2 (full enhancement). Introduction. The weighted κ coefficients of interobserver reliability (studies in 30 knees randomly selected and read by both readers) were 0.66 for the readings of BMLs (comparing scores 0–3 in each subregion), 0.57 for SCs (comparing scores 0–3 in each subregion), and 0.78 for cartilage morphology (comparing scores 0–6 in each subregion). These cysts are produced in areas of damaged articular cartilage, subjacent to the underlying subarticular cortical plate. 12, 1 September 2015 | The Journal of Rheumatology, Vol. Design: Retrospective cohort of 32 patients with two sequential knee MRI. 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]. 9, No. Subchondral bone cysts commonly occur adjacent to a treated focal cartilage defect and are possibly connected to the joint cavity. 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. Overall, 87% (20/23) of subchondral cysts were subjacent to an MRI visible cartilage abnormality (any grade). 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. The weighted κ coefficients of intraobserver reliability were 0.85 for the readings of BMLs and 0.96 for those of SCs, comparing scores 0–3 in each subregion. Radiology: Volume 263: Number 1—April 2012 n radiology.rsna.org 207 MusCuloskeletAl IMAgIng: Tomosynthesis of Osteophytes and Subchondral Cysts in the Knee Hayashi et al had a history of Paget disease, rheu-matoid arthritis, gout, systemic lupus erythematosus, other inflammatory joint disease of the knee, or major knee trauma or surgery. We obtained written informed consent from all patients. Enhancement of subchondral cysts was evaluated on contrast-enhanced MRI as grade 0 (absent), grade 1 (partial enhancement), or grade 2 (full enhancement). 12, No. MRI shows a well defined, regular, complex heterogenously altered lobulated completely intraosseous lesion in the subchondral location of the glenoid with no expansion / bleed / labral / cartilage / joint involvement. The underlying BML may have vanished (20). MOST study subjects were recruited and enrolled between June 2003 and March 2005. Is Subchondral Acetabular Edema or Cystic Change on MRI a Contraindication for Hip Arthroscopy in Patients With Femoroacetabular Impingement? For subregions demonstrating incident SCs without prevalent BMLs at baseline, it is still possible that an incident BML developed after the baseline visit that turned into a subchondral cyst, which was then observed at follow-up. For interval developed subchondral cysts, the follow-up images showed 83% (10/12) cartilage lesions. When comparing the MR imaging features of the tibial plateau in 16 patients with severe knee OA with histologic specimens prior to joint replacement, Zanetti et al (1) found that abnormal tissue appeared in only about half of the regions with MR imaging–detected BMLs. 2, 15 June 2012 | Journal of Bone and Mineral Research, Vol. Radiograph shows well-defined radiolucency in the lateral tibia representing a cystic lesion (arrow). 21, No. Of 19 153 subregions analyzed initially, 663 (3.5%) exhibited SCs at baseline and were excluded. Finally, a reading bias toward SC when a BML or an area of full-thickness cartilage loss is present cannot be ruled out completely, although the reading experience of both our experts makes this less likely. An MRI allows him to see both the bony structures of the hip as well as the soft tissues. 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