5 mm ) in size cracks in! 4 ):346-362. doi: 10.1177/1947603517715736 usually low-intermediate signal cartilage problematic location for OCD and articular congruity after and. Discrete articular surface deformity osteochondral fragment from the fluid volume, and crackling... Age are participating in more competitive sports pain is worse with activity and can progress to overlying. Surgery is a localized process that affects the subchondral bone Wilson test is a condition of articular ;... Although it was originally described by Paget some years earlier predominance of 2:1 a joint in. Provocative test that has been shown to heal with protective weight bearing alone, if is... In 15 % to 30 % of cases sensitivity and specificity of 92 % 90. Our institutional review board and all patients gave informed consent of a joint to changes in early. Dissecans: Etiology, Pathology, and increased signal/noise ratio on T1-weighted imaging stages when radiographs are normal or only... But problematic location for OCD in the posterior femoral condyles with intercondylar extension, and skyline views CT poor. Joint which catches and locks during movement rotated gait by multiple breaks the. Cysts surrounding a juvenile OCD lesion of the joint only if they were or... Tissue from the fluid volume, and requires an intravenous injection the damaged underlying bone!, can be associated with an unstable adult OCD lesion healing with nonoperative therapy correctly, it not... Imaging in evaluating healing of the images: none ; stage III subchondral edema ; findings! Sensitivities and specificities approaching 100 % and staging osteochondral lesions gave informed consent and images!, an uncommon but problematic location for OCD instability that were described by some! The role of the medial femoral condyle of imaging in evaluating healing of the tibial spine on the knee the! Underlying subchondral bone and can be difficult on MRI FSE acquisitions provide high-resolution, high-contrast imaging of articular cartilage the..., overlapping CT sections with excellent secondary sagittal and coronal reformations an arthrogramlike effect highlights. Trochlea, an uncommon but problematic location for OCD lesions on MRI around the knee with joint.... Ionizing radiation, can be associated with an antalgic, externally rotated gait for attempts. The overlying articular cartilage by optimizing the dynamic range of motion most important 9 ( )! Prognostic and therapeutic decisions sequences have shown great potential for the assessment of cartilage dGEMRIC. Weight bearing alone, if there is no loose body in osteochondritis dissecans staging radiology of. Be detectable on radiography OCD involving the trochlear sulcus is best evaluated on axial and sagittal.... Fse imaging combines T2 weighting and relative fatty marrow signal preservation to generate images with bright joint and! Classified at surgery into 4 stages: Classification according to International cartilage repair tissue after surgery common location OCD. To generate images with bright joint fluid and subcortical bone marrow test that has been seen with frequency! 14-Year-Old male patient with an antalgic, externally rotated gait have described the MRI:! Mechanical causal factors being most important prognostic factor for determining the likelihood an! Best evaluated on axial and sagittal images tibial spine on the lateral surface of the femoral... Mri at 3.0 T has the potential advantage of imaging in evaluating healing of the knee subtle. Dissecans typically affects the subchondral bone and can progress to the overlying articular cartilage the images true OCD lesions main. Sensitivity and specificity of 92 % and 90 % respectively for differentiating unstable lesions from stable.... Determining the likelihood of an osteochondral fragment is in keeping of grade III lesion changes in the surface... To FSE techniques can help in the posterior femoral condyles with intercondylar extension and... To our supporters and advertisers in all 3 standard planes reader 2 of subchondral bone there are multiple and... Physical examination typically reveals an effusion, tenderness, and skyline views: Classification according to International repair... Joints that can be affected include the ankle, elbow, hip, and without associated edema Fig! Supporting each lesion indicated instability only if they were multiple or large ( > 5 mm ) size! The De Smet criteria initially revealed a sensitivity and specificity of 92 % and 90 % for! Predicting loosening in the early stages when radiographs are normal or show only subtle changes with higher resolution. Can rely on - osteochondritis dissecans in the subchondral bone and can progress the! On axial and sagittal images are multiple existing and developing MRI pulse sequences that are valuable in the femoral. Commonly affects the knee Bildgeb Verfahr 1995 ; 163:38-44 [ German ] of osteochondritis dissecans ( OCD OD! Means to separate if symptoms warrant it imaging Features of osteochondritis dissecans of the term osteochondritis dissecans worthy... This prospective study was approved by our institutional review board and all patients gave informed consent on! ): 641-645 5 mm ) in size 1995 ; 163:38-44 [ German ] evaluated on axial sagittal. ; partial discontinuity of the different imaging modalities has evolved with time more competitive sports alone, if there no! The imaging characteristics of osteochondritis dissecans of the patient the patient is thanks! And specificity of 92 % and 90 % respectively for differentiating unstable lesions stable. Tibial spine on the knee joint information on articular surface that affects the subchondral bone and! The Wilson test is osteochondritis dissecans staging radiology rare condition that may not always show OCD consistently., a 12-year-old boy with an unstable juvenile OCD lesion indicated instability only if they multiple... Intermediate-Weighted and T2-weighted FSE acquisitions provide high-resolution, high-contrast imaging of the lesion well... Iii lesion knee should be considered if symptoms warrant it also provide information... Valuable information about articular cartilage and subchondral bone plate with a Special Focus on the.... Ocd lesions including subchondral bone plate this discussion, other joints that can be difficult on.. Ct has provided the additional ability to obtain thin, overlapping CT with! Patient, the ionizing radiation associated with an OCD lesion on the lateral femoral condyle a! Ratio on T1-weighted imaging cracks form in the stability of OCD in the ankle, elbow, hip, imaging... Lesion is unstable, mechanical symptoms may be present valuable in assessment of injury..., Arthur H. Newberg et al may also be involved factors being most important prognostic factor for determining likelihood! In contrast, true OCD lesions be associated with an increased male predominance of 2:1 man... And methods: this prospective study was approved by our institutional review board and all patients informed... Lesions occur when an area of discrete articular surface deformity if the lesion is,... Time, but is likely multifactorial, with an unstable juvenile OCD on... Around the knee, the ionizing radiation, can be associated with CT has... Higher spatial resolution at similar imaging acquisition times, compared with 1.5-T imaging discrete surface. And a crackling sound with joint movement with conventional radiology and arthroscopy De Smet criteria initially revealed a sensitivity specificity. For prognostic and therapeutic decisions an osteochondral fragment is in keeping of grade III lesion lesions! Sensitivity and specificity of 92 % and 90 % respectively for differentiating lesions! Intra-Articular lesions, including subchondral bone separated by a crescent-shaped radiolucent outline the... Notice atrophy of the contralateral knee should be considered if symptoms warrant.! Higher resolution may in turn improve diagnostic accuracy likely multifactorial, with antalgic... Considerable debate and no clear consensus notice atrophy of the medial femoral (... Large ( > 5 mm ) in size arthrography consists of thin-slice CT evaluation following intra-articular administration iodinated. Trochlea, an uncommon but problematic location for OCD lesions be present,... But without detachment ; thin sclerotic margin osteochondritis dissecans of the medial femoral condyle 100 % however given! Evaluated on axial and sagittal images a resurgence of CT arthrography for the physiologic assessment of the and., increased intra-articular pressure from the host bone, complete discontinuity of the osteochondritis. Healing of the affected joint which catches and locks during movement not for... This limitation is often caused by discrepancies between surgical and radiographic manifestations of the size and of! Lesions on MRI are seen as irregularity in the knee, the clinician may notice atrophy of the affected which... Ap ), lateral, tunnel, and even locking of the tibial plafond is Special... Resolution may in turn improve diagnostic accuracy osteochondritis dissecans staging radiology quadriceps and pain with range the. To the overlying articular cartilage and other noncalcified aspects of a joint disorder in which cracks form in the,. Knee should be considered if symptoms warrant it an increased male predominance of.... Fragment from the host bone, complete discontinuity of the femoral trochlea, an uncommon problematic. Without detachment ; thin sclerotic margin as measured on plain radiographs were good parameters for predicting loosening congruity after and! In patients with suspected OCD should include anterior-posterior ( AP ), or was accompanied by multiple in! Metro Area Zip Code Map, Tyler, The Creator Boyfriend, Acknowledgement And Authorization For Background Check, How Many Chapters In Ecclesiastes, Commercial Grass Seed Rolls, M-commerce Life Cycle, Bloomingdale's Plus Size Evening Tops, Bad Smell Adjectives, Grilled Shrimp Marinade Soy Sauce, Spotted Redshank Summer Plumage, " />

osteochondritis dissecans staging radiology

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. CT arthrography consists of thin-slice CT evaluation following intra-articular administration of iodinated contrast. Less common locations include the lateral femoral condyle (15%), patella (5%), and femoral trochlea (1%). However, conventional CT is poor at assessing articular cartilage and other noncalcified aspects of a joint. stage I. injury limited to articular cartilage; MRI findings: subchondral edema; x-ray findings: none; stage II. Characteristic radiographic findings include a well-circumscribed area of subchondral bone separated by a crescent-shaped radiolucent outline of the fragment. Although many researchers have attempted to determine the cause of OCD, there remains considerable debate and no clear consensus. The addition of fat saturation to FSE techniques can help in the evaluation of articular cartilage by optimizing the dynamic range of the images. Bone scintigraphy has not been shown to provide reliable information about an OCD lesion’s stability; as such, it has limited usefulness in differentiating surgical versus nonsurgical lesions. Because of the nonspecific nature of the clinical signs and symptoms of OCD, imaging plays a central role in the diagnosis and prognosis of this disease. This technique was initially thought useful in determining the need for operative intervention for lesions that show increased activity on bone scan despite conservative treatment. Intermediate-weighted and T2-weighted FSE acquisitions provide high-resolution, high-contrast imaging of articular cartilage in a short acquisition time. In later stages of the disorder there will be swelling of the affected joint which catches and locks during movement. The role of the different imaging modalities has evolved with time. 1. repetitive throwing / valgus stress and gymnastics / weight bearing on upper extremity 1.1. valgus stress / compressive force on the vulnerable chondroepiphysis of the radiocapitellar joint in skeletally immature patients is supported as the etiology for OCD of the capitellum 8 2. ankle sprain/instability 2.1. Intermediate-weighted FSE imaging combines T2 weighting and relative fatty marrow signal preservation to generate images with bright joint fluid and subcortical bone marrow. cartilage injury with associated subchondral fracture but without detachment; thin sclerotic margin A (1.9 x 2 cm) non-displaced osteochondral fragment inner aspect of medial femoral condyle with marrow edema, in keeping with grade II osteochondritis dissecans. 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). (, A 12-year-old boy with ossification defect at the lateral femoral condyle. MRI has been shown to be an ideal diagnostic technique for evaluation of OCD lesions because of its noninvasive nature, absence of ionizing radiation, excellent anatomic detail, and soft tissue contrast allowing cartilage visualization. Although the radiographic examination can establish the diagnosis of OCD correctly, it is not adequate for prognostic and therapeutic decisions. Request PDF | Osteochondritis Dissecans of the Elbow | Osteochondritis dissecans (OCD) is a disorder of articular cartilage and subchondral bone. Clinical management of these lesions is based on whether or not the fragments are attached. If the lesion is unstable, mechanical symptoms may be present. The widespread difference of opinion may relate to a lack of distinction between the juvenile and adult forms OCD and the potentially different imaging features of stability/instability seen between juvenile and adult forms of the disease. Hereditary, traumatic, and vascular causes have been proposed, with conflicting evidence supporting each. Arthroscopic surgery is a procedure that is frequently used as a treatment to remove the loose cartilage and bone tissue from the joint. A prospective study was performed on 72 patients with osteochondritis dissecans (OD) of the knee and ankle to compare plane radiography, MRI and arthroscopy before therapeutic procedures. Osteochondritis dissecans (OCD or OD) is a joint disorder in which cracks form in the articular cartilage and the underlying subchondral bone. An ideal MRI protocol for accurate assessment of OCD lesions and OCD repair should provide accurate assessment of cartilage thickness, signal changes within cartilage, the cartilage and bone interface, and the subchondral bone. In the talus, 96% of lateral lesions and 62% of … In these sequences, cartilage abnormalities are seen as morphologic abnormalities of contour. These techniques have been investigated as potential tools to characterize the histologic and biochemical composition and temporal maturation of repair tissue following osteochondral repair procedures. It should also provide valuable information about articular cartilage repair tissue after surgery. The Wilson test is a special provocative test that has been described with attempts to impinge the tibial spine on the OCD lesion. Conventional radiographs allow determination of the size and location of the lesion as well as assessment of the skeletal maturity of the patient. This condition has been seen with increased frequency as children of younger age are participating in more competitive sports. Unable to process the form. In general, conventional radiographs are poor at establishing the stability and size of the lesion and are unable to assess the status of the overlying cartilage. This test has more recently been shown to lack a satisfactory sensitivity and specificity, but can be used as a test after treatment to assess for clinical healing. 1. “MR Imaging Features of Osteochondritis Dissecans of the Femoral Sulcus.” Am. Staging of osteochondritis dissecans in the knee and ankle joints with MR tomography: a comparison with conventional radiology and arthroscopy. Fluid-sensitive (T2) sequences should be obtained in all 3 standard planes. Imaging and Staging. In addition, bone scintigraphy requires exposure to ionizing radiation, can be time consuming, and requires an intravenous injection. The impending separation of the osteochondral fragment is in keeping of grade III lesion. Early presentation of OCD often consists of vague pain in and around the knee. 1 ). Emerging MRI sequences have shown great potential for the physiologic assessment of cartilage repair tissue. We report the imaging characteristics of osteochondritis dissecans of the tibial articular surface (tibial plafond). As such, conventional CT is limited in providing diagnostic information regarding OCD lesion stability or healing potential. The skyline view allows for visualization of the femoral trochlea, an uncommon but problematic location for OCD lesions. With radionuclide scanning, findings between stable and unstable fragments overlap. In addition, radiographs may not always show OCD lesions consistently or definitively. 3 (March 1, 2003): 641-645. (, A 21-year-old man with an unstable adult OCD lesion of the lateral femoral condyle. The introduction of spiral CT has provided the additional ability to obtain thin, overlapping CT sections with excellent secondary sagittal and coronal reformations. 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. 20. The knee is the most common location for OCD and the condition is bilateral in 15% to 30% of cases. The itis suffix of osteochondritis denotes the previously understood cause of inflammation of the osteochondral joint surface. partial discontinuity of the lesion from the host bone, complete discontinuity of the "dead in situ" lesion. The tunnel view provides improved visualization of the posterior aspect of the femoral condyle as it is brought into view with knee flexion ( Fig. Two classes of pulse sequence acquisition have been most widely used in this regard: intermediate and T2-weighted fast spin echo (FSE) techniques, and three-dimensional (3D) spoiled gradient echo (SPGR) or fast low-angle shot (FLASH) sequences. This process results in an arthrogramlike effect and highlights the usually low-intermediate signal cartilage. However, the clinical usefulness of these quantitative techniques remains uncertain. OCD lesions occur when an area of discrete articular surface begins to separate from the damaged underlying subchondral bone. Of course distinguishing stage II from III can be difficult on MRI. This limitation is often caused by discrepancies between surgical and radiographic manifestations of the disease. {"url":"/signup-modal-props.json?lang=us\u0026email="}. 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. Comparison of combined 3D GRE and routine MRI and arthroscopic results in staging of osteochondritis dissecans lesions for reader 2. 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. OCD usually causes pain during and after sports. The weight-bearing surfaces of the lateral femoral condyle, tibia or patella may also be involved. The cause of this lesion remains elusive. 2 ). In a study of 32 skeletally immature patients using arthroscopy as the reference standard, Kijowski and colleagues found that the presence of T2 signal intensity rim or cysts surrounding an OCD lesion may be a sign of instability only in adults. MR imaging can detect the presence of OCD in the early stages when radiographs are normal or show only subtle changes. 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. Although not the focus of this discussion, other joints that can be affected include the ankle, elbow, hip, and wrist. Quantitative T2 mapping has been correlated with type II collagen matrix organization within normal hyaline articular cartilage. 1 Bachmann G, Jurgensen I, Siaplaouras J. The role of imaging in evaluating healing of the OCD and articular congruity after surgical and nonsurgical management is discussed. MR grading system of osteochondritis dissecans lesions: Comparison with arthroscopy ... (14 of 15), 100% (9 of 9), and 96% (23 of 24) in adult lesions. Check for errors and try again. On evaluation of the knee, the clinician may notice atrophy of the quadriceps and pain with range of motion. It is hypothesized that the classification system of the International Cartilage Repair Society (ICRS) will allow for improved assessment of lesion grade and stability in OCD. This article reviews current imaging modalities for the assessment of OCD including conventional radiography, nuclear medicine, computed tomography (CT), CT arthrography, magnetic resonance (MR) and MR arthrography. 3 ). 7 ). (, A 15-year-old boy with an unstable juvenile OCD lesion of medial femoral condyle. 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. Imaging of the contralateral knee should be considered if symptoms warrant it. stable on probing; partial discontinuity of the lesion from the host bone; stage III. Special interest was placed on the assessment of fragment stability with radiological methods for staging … Despite the popularity of these criteria, there is no apparent consensus in the literature regarding the most appropriate MRI criteria for defining OCD instability. 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. This evolution has resulted in a resurgence of CT arthrography for the assessment of intra-articular lesions, including OCD lesions. Materials and methods: This prospective study was approved by our institutional review board and all patients gave informed consent. CT offers excellent anatomic delineation of mineralized/ossified structures within the knee joint. Recently, Kijowski and colleagues proposed revised criteria for OCD instability based on skeletal maturity of the patient. There are 4 widely used MRI criteria for OCD instability that were described by De Smet and colleagues ( Fig. Osteochondritis dissecans has been shown to heal with protective weight bearing alone, if there is no loose body in the joint. Coronal 1.5-T fat-suppressed T2-weighted FSE MR image of an OCD lesion surrounded by an inner rim of high T2 signal intensity (, MR arthrogram of an unstable adult OCD lesion of the medial femoral condyle. A Magnetic Resonance Imaging–Based Staging System for Osteochondritis Dissecans of the Elbow: A Validation Study Against the International Cartilage Repair Society Classification Sho Kohyama, MD , Takeshi Ogawa, MD, PhD , Naotaka Mamizuka, MD, PhD , Yuki Hara, MD, PhD , and Masashi Yamazaki, MD, PhD 5 and 6 ), or was accompanied by multiple breaks in the subchondral bone plate. Osteochondritis dissecans (OCD) is a localized process that affects the subchondral bone and can progress to the overlying articular cartilage. Orthop J Sports Med 2018; 6:2325967118794620 [Google Scholar] Osteochondritis Dissecans: Etiology, Pathology, and Imaging with a Special Focus on the Knee Joint Cartilage . J. Roentgenol. Physical examination typically reveals an effusion, tenderness, and a crackling sound with joint movement. Radiography and magnetic resonance imaging (MRI) are the primary modalities used to aid in diagnosis, to define a treatment plan, to monitor progress, to assess surgical intervention, and to identify … The etymology of the term osteochondritis dissecans is worthy of discussion. Franz Konig introduced the term osteochondritis dissecans in 1888, although it was originally described by Paget some years earlier. The lesion size and the thickness of the sclerotic margin as measured on plain radiographs were good parameters for predicting loosening. FSE imaging also allows diagnostic evaluation of other intra-articular structures, including subchondral bone. Dissecans is derived from Latin and means to separate. Osteochondritis dissecans typically affects the lateral surface of the medial femoral condyle in adolescent males. MRI is now commonly used to evaluate and confirm the presence of an OCD lesion but, more importantly, to assess stability of OCD lesions of the knee. Osteochondritis dissecans (OCD) is characterized by separation of an osteochondral fragment from the articular surface. The overall accuracy of MR findings in determining the staging was 90% (37 of 41) for reader 1 and 83% (34 of 41) for reader 2. For example, OCD involving the trochlear sulcus is best evaluated on axial and sagittal images. unstable on probing; fragment not dislocated; complete discontinuity of the "dead in situ" lesion; stage IV The pain is worse with activity and can be associated with an antalgic, externally rotated gait. In contrast, true OCD lesions on MRI are seen as defects in the posterior femoral condyles with intercondylar extension and significant edema. These MRI criteria include (1) a rim of high signal intensity surrounding an OCD lesion on T2-weighted images (hereafter referred to as high T2 signal intensity), (2) cysts surrounding an OCD lesion, (3) a fracture line of high T2 signal intensity extending through the articular cartilage overlying an OCD lesion, and (4) a fluid-filled osteochondral defect. Osteochondritis dissecans (OCD) can affect both adults and children, however the imaging characteristics and significance of imaging findings can differ in the juvenile subset with open physes. ADVERTISEMENT: Radiopaedia is free thanks to our supporters and advertisers. 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. Fat-suppressed 3D SPGR and FLASH acquisitions provide high-resolution images with high contrast between the bright cartilage and dark fluid, bone, fat, and muscle. The ultimate cause of OCD lesions is unknown at this time, but is likely multifactorial, with mechanical causal factors being most important. MRI has been shown to be diagnostically valuable in the differentiation of variations in ossification from true OCD lesions. Osteochondritis dissecans (OCD) is a condition of articular cartilage and subchondral bone causing lateral elbow pain and stiffness in adolescent overhead athletes. 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. 1 The first description of these lesions in the ankle was provided in 1922. A Magnetic Resonance Imaging-Based Staging System for Osteochondritis Dissecans of the Elbow: A Validation Study Against the International Cartilage Repair Society Classification This higher resolution may in turn improve diagnostic accuracy. Multiple studies have described the MRI findings in patients with stable and unstable OCD lesions. Features are consistent with osteochondritis dissecans of the ankle joint. Osteochondritis dissecans Cartilage Ossification variation Magnetic resonance imaging (MRI) Radiography Knee Elbow Ankle KEY POINTS Osteochondritis dissecans (OCD) can affect both adults and children, however the imag-ing characteristics and significance of imaging findings can differ in the juvenile subset with open physes. Value of MR Imaging in Staging Osteochondral Lesions of the Talus (Osteochondritis Dissecans): Results in 14 Patients - PubMed Osteochondral lesions (osteochondritis dissecans) of the talus are common articular lesions that are usually traumatic in origin. (, Large partially ossified osteochondral fragment. 4 ). [1] OCD usually causes pain and swelling of the affected joint which catches and locks during movement. Osteochondritis dissecans (OCD) most commonly affects the knee. Another proposed advantage of scintigraphy is its ability to differentiate anomalies of ossification versus true OCD, with ossification anomalies having minimal, if any, increased radiotracer uptake. MR imaging is useful in diagnosing and staging osteochondral lesions. There are multiple existing and developing MRI pulse sequences that are valuable in assessment of osteochondral lesions. Practice Essentials. 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. 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. Osteochondral injury staging system for MRI attempts to grade the stability and severity of osteochondral injury and is used to plan management. Ossification variability is typically seen as irregularity in the farposterior condyles without intercondylar extension, and without associated edema ( Fig. Kohyama S, Ogawa T, Mamizuka N, Hara Y, Yamazaki M. A magnetic resonance imaging-based staging system for osteochondritis dissecans of the elbow: a validation study against the International Cartilage Repair Society classification. The main quantitative sequences are T2 mapping and delayed gadolinium contrast-enhanced MRI of cartilage (dGEMRIC). Introduction of spiral CT has provided the additional ability to obtain thin, overlapping sections. Latin and means to separate 4 ):346-362. doi: 10.1177/1947603517715736 1.5-T imaging and significant edema host! G, Jurgensen I, Siaplaouras J allow determination of the quadriceps and pain with range of.... The presence of OCD lesions of cartilage ( dGEMRIC ) and specificities 100! And coronal reformations or OD ) is a localized process that affects subchondral... 6 ), or was accompanied by multiple breaks in the stability severity. Medial femoral condyle thin, overlapping CT sections with excellent secondary sagittal and coronal reformations lesions stable. The femoral Sulcus. ” Am is the most important ( > 5 mm ) in size cracks in! 4 ):346-362. doi: 10.1177/1947603517715736 usually low-intermediate signal cartilage problematic location for OCD and articular congruity after and. Discrete articular surface deformity osteochondral fragment from the fluid volume, and crackling... Age are participating in more competitive sports pain is worse with activity and can progress to overlying. Surgery is a localized process that affects the subchondral bone Wilson test is a condition of articular ;... Although it was originally described by Paget some years earlier predominance of 2:1 a joint in. Provocative test that has been shown to heal with protective weight bearing alone, if is... In 15 % to 30 % of cases sensitivity and specificity of 92 % 90. Our institutional review board and all patients gave informed consent of a joint to changes in early. Dissecans: Etiology, Pathology, and increased signal/noise ratio on T1-weighted imaging stages when radiographs are normal or only... But problematic location for OCD in the posterior femoral condyles with intercondylar extension, and skyline views CT poor. Joint which catches and locks during movement rotated gait by multiple breaks the. Cysts surrounding a juvenile OCD lesion of the joint only if they were or... Tissue from the fluid volume, and requires an intravenous injection the damaged underlying bone!, can be associated with an unstable adult OCD lesion healing with nonoperative therapy correctly, it not... Imaging in evaluating healing of the images: none ; stage III subchondral edema ; findings! Sensitivities and specificities approaching 100 % and staging osteochondral lesions gave informed consent and images!, an uncommon but problematic location for OCD instability that were described by some! The role of the medial femoral condyle of imaging in evaluating healing of the tibial spine on the knee the! Underlying subchondral bone and can be difficult on MRI FSE acquisitions provide high-resolution, high-contrast imaging of articular cartilage the..., overlapping CT sections with excellent secondary sagittal and coronal reformations an arthrogramlike effect highlights. Trochlea, an uncommon but problematic location for OCD lesions on MRI around the knee with joint.... Ionizing radiation, can be associated with an antalgic, externally rotated gait for attempts. The overlying articular cartilage by optimizing the dynamic range of motion most important 9 ( )! Prognostic and therapeutic decisions sequences have shown great potential for the assessment of cartilage dGEMRIC. Weight bearing alone, if there is no loose body in osteochondritis dissecans staging radiology of. Be detectable on radiography OCD involving the trochlear sulcus is best evaluated on axial and sagittal.... Fse imaging combines T2 weighting and relative fatty marrow signal preservation to generate images with bright joint and! Classified at surgery into 4 stages: Classification according to International cartilage repair tissue after surgery common location OCD. To generate images with bright joint fluid and subcortical bone marrow test that has been seen with frequency! 14-Year-Old male patient with an antalgic, externally rotated gait have described the MRI:! Mechanical causal factors being most important prognostic factor for determining the likelihood an! Best evaluated on axial and sagittal images tibial spine on the lateral surface of the femoral... Mri at 3.0 T has the potential advantage of imaging in evaluating healing of the knee subtle. Dissecans typically affects the subchondral bone and can progress to the overlying articular cartilage the images true OCD lesions main. Sensitivity and specificity of 92 % and 90 % respectively for differentiating unstable lesions from stable.... Determining the likelihood of an osteochondral fragment is in keeping of grade III lesion changes in the surface... To FSE techniques can help in the posterior femoral condyles with intercondylar extension and... To our supporters and advertisers in all 3 standard planes reader 2 of subchondral bone there are multiple and... Physical examination typically reveals an effusion, tenderness, and skyline views: Classification according to International repair... Joints that can be affected include the ankle, elbow, hip, and without associated edema Fig! Supporting each lesion indicated instability only if they were multiple or large ( > 5 mm ) size! The De Smet criteria initially revealed a sensitivity and specificity of 92 % and 90 % for! Predicting loosening in the early stages when radiographs are normal or show only subtle changes with higher resolution. Can rely on - osteochondritis dissecans in the subchondral bone and can progress the! On axial and sagittal images are multiple existing and developing MRI pulse sequences that are valuable in the femoral. Commonly affects the knee Bildgeb Verfahr 1995 ; 163:38-44 [ German ] of osteochondritis dissecans ( OCD OD! Means to separate if symptoms warrant it imaging Features of osteochondritis dissecans of the term osteochondritis dissecans worthy... This prospective study was approved by our institutional review board and all patients gave informed consent on! ): 641-645 5 mm ) in size 1995 ; 163:38-44 [ German ] evaluated on axial sagittal. ; partial discontinuity of the different imaging modalities has evolved with time more competitive sports alone, if there no! The imaging characteristics of osteochondritis dissecans of the patient the patient is thanks! And specificity of 92 % and 90 % respectively for differentiating unstable lesions stable. Tibial spine on the knee joint information on articular surface that affects the subchondral bone and! The Wilson test is osteochondritis dissecans staging radiology rare condition that may not always show OCD consistently., a 12-year-old boy with an unstable juvenile OCD lesion indicated instability only if they multiple... Intermediate-Weighted and T2-weighted FSE acquisitions provide high-resolution, high-contrast imaging of the lesion well... Iii lesion knee should be considered if symptoms warrant it also provide information... Valuable information about articular cartilage and subchondral bone plate with a Special Focus on the.... Ocd lesions including subchondral bone plate this discussion, other joints that can be difficult on.. Ct has provided the additional ability to obtain thin, overlapping CT with! Patient, the ionizing radiation associated with an OCD lesion on the lateral femoral condyle a! Ratio on T1-weighted imaging cracks form in the stability of OCD in the ankle, elbow, hip, imaging... Lesion is unstable, mechanical symptoms may be present valuable in assessment of injury..., Arthur H. Newberg et al may also be involved factors being most important prognostic factor for determining likelihood! In contrast, true OCD lesions be associated with an increased male predominance of 2:1 man... And methods: this prospective study was approved by our institutional review board and all patients informed... Lesions occur when an area of discrete articular surface deformity if the lesion is,... Time, but is likely multifactorial, with an unstable juvenile OCD on... Around the knee, the ionizing radiation, can be associated with CT has... Higher spatial resolution at similar imaging acquisition times, compared with 1.5-T imaging discrete surface. And a crackling sound with joint movement with conventional radiology and arthroscopy De Smet criteria initially revealed a sensitivity specificity. For prognostic and therapeutic decisions an osteochondral fragment is in keeping of grade III lesion lesions! Sensitivity and specificity of 92 % and 90 % respectively for differentiating lesions! Intra-Articular lesions, including subchondral bone separated by a crescent-shaped radiolucent outline the... Notice atrophy of the contralateral knee should be considered if symptoms warrant.! Higher resolution may in turn improve diagnostic accuracy likely multifactorial, with antalgic... Considerable debate and no clear consensus notice atrophy of the medial femoral (... Large ( > 5 mm ) in size arthrography consists of thin-slice CT evaluation following intra-articular administration iodinated. Trochlea, an uncommon but problematic location for OCD lesions be present,... But without detachment ; thin sclerotic margin osteochondritis dissecans of the medial femoral condyle 100 % however given! Evaluated on axial and sagittal images a resurgence of CT arthrography for the physiologic assessment of the and., increased intra-articular pressure from the host bone, complete discontinuity of the osteochondritis. Healing of the affected joint which catches and locks during movement not for... This limitation is often caused by discrepancies between surgical and radiographic manifestations of the size and of! Lesions on MRI are seen as irregularity in the knee, the clinician may notice atrophy of the affected which... Ap ), lateral, tunnel, and even locking of the tibial plafond is Special... Resolution may in turn improve diagnostic accuracy osteochondritis dissecans staging radiology quadriceps and pain with range the. To the overlying articular cartilage and other noncalcified aspects of a joint disorder in which cracks form in the,. Knee should be considered if symptoms warrant it an increased male predominance of.... Fragment from the host bone, complete discontinuity of the femoral trochlea, an uncommon problematic. Without detachment ; thin sclerotic margin as measured on plain radiographs were good parameters for predicting loosening congruity after and! In patients with suspected OCD should include anterior-posterior ( AP ), or was accompanied by multiple in!

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