Yılmaz Kıroğlu1, Nurzat Elmalı2, Metin Doğan1, İrfan Esenkaya2, Ahmet Harma2, M Şükrü Şahin2

1Muş Devlet Hastanesi Radyoloji Kliniği, Muş
2İnönü Üniversitesi Tıp Fakültesi Ortopedi ve Travmatoloji Anabilim Dalı, Malatya

Keywords: Cartilage, articular/pathology; knee joint/pathology/ radiography; magnetic resonance imaging/methods; osteoarthritis, knee/diagnosis.


Objectives: We investigated the effectiveness of different sequences of magnetic resonance imaging (MRI) in the evaluation of cartilage lesions of traumatic or knee osteoarthritis.
Patients and methods: A total of 27 patients (16 males, 11 females; mean age 44 years; range 23 to 67 years) with traumatic cartilage lesions or knee osteoarthritis were evaluated with MRI using proton turbo spin echo (proton TSE), T2 turbo spin echo (T2 TSE), magnetization transfer contrast (MTC), and three-dimensional selective pulse and inversion recovery fast field echo (3D SPIR) sequences. With these four sequences and for each patient, eight cartilage localizations were separately assessed by two radiologists, making up a total of 216 localizations. Arthroscopy was performed within three weeks after MRI examinations. Cartilage lesions were graded according to the Outerbridge system.
Results: Arthroscopy showed 109 lesions, the most frequent localization being the medial femoral condyle. The highest sensitivity rate was found for grade 4 lesions with each MRI technique. The overall sensitivity and specificity rates were 91.7% and 89.7% for proton TSE, 66.9% and 91.5% for T2 TSE, 75.2% and 93.5% for 3D SPIR, and 62.4% and 94.3% for MTC sequences, respectively. Compared to arthroscopic detection and grading, all the sequences but proton TSE exhibited significantly different findings. A good interobserver agreement (kappa=0.68) was seen only for proton TSE.
Conclusion: Leaving the proton TSE sequence apart, the effectiveness of each sequence per se is low in the detection and grading of cartilage lesions. Incorporation of the proton TSE and T2 TSE sequences into the MRI protocols may result in both higher detection of cartilage lesions and identification of associated knee pathologies.