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Skeletal Radiology
Published in: Skeletal Radiology 11/2023

Open Access 08-05-2023 | Osteoarthrosis | Review Article

Morphological assessment of cartilage and osteoarthritis in clinical practice and research: Intermediate-weighted fat-suppressed sequences and beyond

Authors: Patrick Omoumi, Charbel Mourad, Jean-Baptiste Ledoux, Tom Hilbert

Published in: Skeletal Radiology | Issue 11/2023

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Abstract

Magnetic resonance imaging (MRI) is widely regarded as the primary modality for the morphological assessment of cartilage and all other joint tissues involved in osteoarthritis. 2D fast spin echo fat-suppressed intermediate-weighted (FSE FS IW) sequences with a TE between 30 and 40ms have stood the test of time and are considered the cornerstone of MRI protocols for clinical practice and trials. These sequences offer a good balance between sensitivity and specificity and provide appropriate contrast and signal within the cartilage as well as between cartilage, articular fluid, and subchondral bone. Additionally, FS IW sequences enable the evaluation of menisci, ligaments, synovitis/effusion, and bone marrow edema-like signal changes. This review article provides a rationale for the use of FSE FS IW sequences in the morphological assessment of cartilage and osteoarthritis, along with a brief overview of other clinically available sequences for this indication. Additionally, the article highlights ongoing research efforts aimed at improving FSE FS IW sequences through 3D acquisitions with enhanced resolution, shortened examination times, and exploring the potential benefits of different magnetic field strengths. While most of the literature on cartilage imaging focuses on the knee, the concepts presented here are applicable to all joints.

Key points

1. MRI is currently considered the modality of reference for a “whole-joint” morphological assessment of osteoarthritis.
2. Fat-suppressed intermediate-weighted sequences remain the keystone of MRI protocols for the assessment of cartilage morphology, as well as other structures involved in osteoarthritis.
3. Trends for further development in the field of cartilage and joint imaging include 3D FSE imaging, faster acquisition including AI-based acceleration, and synthetic imaging providing multi-contrast sequences.
Literature
1.
Roemer FW, Demehri S, Omoumi P, et al. State of the art: imaging of osteoarthritis-revisited. Radiology. 2020:2020192498.
2.
Roux M, Hilbert T, Hussami M, Becce F, Kober T, Omoumi P. MRI T2 mapping of the knee providing synthetic morphologic images: comparison to conventional turbo spin-echo MRI. Radiology. 2019;293:620–30.PubMedCrossRef
3.
Colotti R, Omoumi P, Bonanno G, Ledoux JB, van Heeswijk RB. Isotropic three-dimensional T2 mapping of knee cartilage: Development and validation. J Magn Reson Imaging. 2018;47:362–71.PubMedCrossRef
4.
Wirth W, Ladel C, Maschek S, Wisser A, Eckstein F, Roemer F. Quantitative measurement of cartilage morphology in osteoarthritis: current knowledge and future directions. Skeletal Radiol. 2022.
5.
Omoumi P, Mercier GA, Lecouvet F, Simoni P, Vande Berg BC. CT arthrography, MR arthrography, PET, and scintigraphy in osteoarthritis. Radiol Clin North Am. 2009;47:595–615.PubMedCrossRef
6.
Steinbach LS, Palmer WE, Schweitzer ME. Special focus session. MR arthrography. Radiographics. 2002;22:1223–46.PubMedCrossRef
7.
White LM, Kramer J, Recht MP. MR imaging evaluation of the postoperative knee: ligaments, menisci, and articular cartilage. Skeletal Radiol. 2005;34:431–52.PubMedCrossRef
8.
Heuck A, Woertler K. Posttreatment imaging of the knee: cruciate ligaments and menisci. Semin Musculoskelet Radiol. 2022;26:230–41.PubMedCrossRef
9.
Potter HG, Linklater JM, Allen AA, Hannafin JA, Haas SB. Magnetic resonance imaging of articular cartilage in the knee. An evaluation with use of fast-spin-echo imaging. J Bone Joint Surg Am. 1998;80:1276–84.PubMedCrossRef
10.
Bredella MA, Tirman PF, Peterfy CG, et al. 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. AJR Am J Roentgenol. 1999;172:1073–80.PubMedCrossRef
11.
Link TM. MR imaging in osteoarthritis: hardware, coils, and sequences. Radiol Clin North Am. 2009;47:617–32.PubMedCrossRef
12.
Omoumi P, Teixeira P, Delgado G, Chung CB. Imaging of lower limb cartilage. Top Magn Reson Imaging. 2009;20:189–201.PubMedCrossRef
13.
Kijowski R, Davis KW, Woods MA, et al. Knee joint: comprehensive assessment with 3D isotropic resolution fast spin-echo MR imaging--diagnostic performance compared with that of conventional MR imaging at 3.0 T. Radiology. 2009;252:486–95.PubMedCrossRef
14.
Rosas HG, De Smet AA. Magnetic resonance imaging of the meniscus. Top Magn Reson Imaging. 2009;20:151–73.PubMedCrossRef
15.
Nguyen JC, De Smet AA, Graf BK, Rosas HG. MR imaging-based diagnosis and classification of meniscal tears. Radiographics. 2014;34:981–99.PubMedCrossRef
16.
Peh WC, Chan JH. The magic angle phenomenon in tendons: effect of varying the MR echo time. Br J Radiol. 1998;71:31–6.PubMedCrossRef
17.
Bydder M, Rahal A, Fullerton GD, Bydder GM. The magic angle effect: a source of artifact, determinant of image contrast, and technique for imaging. J Magn Reson Imaging. 2007;25:290–300.PubMedCrossRef
18.
19.
Jung JY, Yoon YC, Kim HR, Choe B-K, Wang JH, Jung JY. Knee derangements: comparison of isotropic 3D fast spin-echo, isotropic 3D balanced fast field-echo, and conventional 2D fast spin-echo MR imaging. Radiology. 2013;268:802–13.PubMedCrossRef
20.
21.
Yoshioka H, Stevens K, Genovese M, Dillingham MF, Lang P. Articular cartilage of knee: normal patterns at MR imaging that mimic disease in healthy subjects and patients with osteoarthritis. Radiology. 2004;231:31–8.PubMedCrossRef
22.
Waldschmidt JG, Rilling RJ, Kajdacsy-Balla AA, Boynton MD, Erickson SJ. In vitro and in vivo MR imaging of hyaline cartilage: zonal anatomy, imaging pitfalls, and pathologic conditions. Radiographics. 1997;17:1387–402.PubMedCrossRef
23.
Park HJ, Lee SY, Rho MH, et al. Usefulness of the fast spin-echo three-point Dixon (mDixon) image of the knee joint on 3.0-T MRI: comparison with conventional fast spin-echo T2 weighted image. Br J Radiol. 2016;89:20151074.PubMedPubMedCentralCrossRef
24.
Bastian-Jordan M, Dhupelia S, McMeniman M, Lanham M, Hislop-Jambrich J. A quality audit of MRI knee exams with the implementation of a novel 2-point DIXON sequence. J Med Radiat Sci. 2019;66:163–9.PubMedPubMedCentralCrossRef
25.
Kammen BF, Padua EM, Karakas SP, et al. Clinical experience with two-point mDixon turbo spin echo as an alternative to conventional turbo spin echo for magnetic resonance imaging of the pediatric knee. Pediatr Radiol. 2019;49:791–800.PubMedCrossRef
26.
Hunter DJ, Altman RD, Cicuttini F, et al. OARSI Clinical Trials recommendations: knee imaging in clinical trials in osteoarthritis. Osteoarthritis and Cartilage. 2015;23:698–715.PubMedCrossRef
27.
Eckstein F, Winzheimer M, Hohe J, Englmeier KH, Reiser M. Interindividual variability and correlation among morphological parameters of knee joint cartilage plates: analysis with three-dimensional MR imaging. Osteoarthritis Cartilage. 2001;9:101–11.PubMedCrossRef
28.
Eckstein F, Yang M, Guermazi A, et al. Reference values and Z-scores for subregional femorotibial cartilage thickness - results from a large population-based sample (Framingham) and comparison with the non-exposed Osteoarthritis Initiative reference cohort. Osteoarthr Cartil. 2010;18(10):1275–83.
29.
Omoumi P, Michoux N, Larbi A, et al. Multirater agreement for grading the femoral and tibial cartilage surface lesions at CT arthrography and analysis of causes of disagreement. Eur J Radiol. 2017;88:95–101.PubMedCrossRef
30.
Markhardt BK, Huang BK, Spiker AM, Chang EY. Interpretation of cartilage damage at routine clinical mri: how to match arthroscopic findings. Radiographics:2022220051.
31.
Vande Berg BC, Lecouvet FE, Maldague B, Malghem J. MR appearance of cartilage defects of the knee: preliminary results of a spiral CT arthrography-guided analysis. Eur Radiol. 2004;14:208–14.PubMedCrossRef
32.
Wissman RD, Ingalls J, Nepute J, et al. The trochlear cleft: the “black line” of the trochlear trough. Skeletal Radiol. 2012;41:1121–6.PubMedCrossRef
33.
Markhardt BK, Chang EY. Hypointense signal lesions of the articular cartilage: a review of current concepts. Clin Imaging. 2014;38:785–91.PubMedCrossRef
34.
Noyes FR, Stabler CL. A system for grading articular cartilage lesions at arthroscopy. Am J Sports Med. 1989;17:505–13.PubMedCrossRef
35.
36.
Harris JD, Brophy RH, Jia G, et al. Sensitivity of magnetic resonance imaging for detection of patellofemoral articular cartilage defects. Arthroscopy. 2012;28:1728–37.PubMedCrossRef
37.
Devitt BM, Bell SW, Webster KE, Feller JA, Whitehead TS. Surgical treatments of cartilage defects of the knee: Systematic review of randomised controlled trials. Knee. 2017;24:508–17.PubMedCrossRef
38.
Hayashi D, Roemer FW, Link T, et al. Latest advancements in imaging techniques in OA. Therapeutic Advances in Musculoskeletal Disease. 2022;14:1759720X2211466.CrossRef
39.
Hunter DJ, Guermazi A, Lo GH, et al. Evolution of semi-quantitative whole joint assessment of knee OA: MOAKS (MRI Osteoarthritis Knee Score). Osteoarthritis and Cartilage. 2011;19:990–1002.PubMedPubMedCentralCrossRef
40.
Walter SS, Fritz B, Kijowski R, Fritz J. 2D versus 3D MRI of osteoarthritis in clinical practice and research. Skeletal Radiol. 2023.
41.
Shakoor D, Guermazi A, Kijowski R, et al. Diagnostic Performance of three-dimensional MRI for depicting cartilage defects in the knee: a meta-analysis. Radiology. 2018;289:71–82.PubMedCrossRef
42.
Kijowski R, Blankenbaker DG, Davis KW, Shinki K, Kaplan LD, De Smet AA. Comparison of 1.5- and 3.0-T MR imaging for evaluating the articular cartilage of the knee joint. Radiology. 2009;250:839–48.PubMedCrossRef
43.
Omoumi P, Rubini A, Dubuc J-E, Vande Berg BC, Lecouvet FE. Diagnostic performance of CT-arthrography and 1.5T MR-arthrography for the assessment of glenohumeral joint cartilage: a comparative study with arthroscopic correlation. Eur Radiol. 2014;25:961–9.PubMedCrossRef
44.
Rubenstein JD, Li JG, Majumdar S, Henkelman RM. Image resolution and signal-to-noise ratio requirements for MR imaging of degenerative cartilage. AJR Am J Roentgenol. 1997;169:1089–96.PubMedCrossRef
45.
Link TM, Majumdar S, Peterfy C, et al. High resolution MRI of small joints: impact of spatial resolution on diagnostic performance and SNR. Magn Reson Imaging. 1998;16:147–55.PubMedCrossRef
46.
Pfirrmann CWA, Duc SR, Zanetti M, Dora C, Hodler J. MR arthrography of acetabular cartilage delamination in femoroacetabular cam impingement. Radiology. 2008;249:236–41.PubMedCrossRef
47.
Konstantinidis G, Mitchell M, Boyd G, Coady C, Ghosh S, Wong I. Poor sensitivity of magnetic resonance arthrography to detect hip chondral delamination: a retrospective follow-up of 227 FAI-operated patients. Cartilage. 2021;12:162–8.PubMedCrossRef
48.
Neumann J, Zhang AL, Bucknor M, et al. Acetabular cartilage delamination: performance of MRI using arthroscopy as the standard of reference. Acta Radiol. 2022:2841851221113966.
49.
Schmaranzer F, Lerch TD, Steppacher SD, Siebenrock KA, Schmaranzer E, Tannast M. Femoral cartilage damage occurs at the zone of femoral head necrosis and can be accurately detected on traction MR arthrography of the hip in patients undergoing joint preserving hip surgery. J Hip Preserv Surg. 2021;8:28–39.PubMedPubMedCentralCrossRef
50.
Omoumi P. The Dixon method in musculoskeletal MRI: from fat-sensitive to fat-specific imaging. Skeletal Radiol. 2022;51(7):1365.PubMedCrossRef
51.
Ma J, Singh SK, Kumar AJ, Leeds NE, Zhan J. T2-weighted spine imaging with a fast three-point dixon technique: comparison with chemical shift selective fat suppression. J Magn Reson Imaging. 2004;20:1025–9.PubMedCrossRef
52.
Del Grande F, Santini F, Herzka DA, et al. Fat-suppression techniques for 3-T MR imaging of the musculoskeletal system. Radiographics. 2014;34:217–33.PubMedCrossRef
53.
Kirchgesner T, Perlepe V, Michoux N, Larbi A, Vande BB. Fat suppression at 2D MR imaging of the hands: Dixon method versus CHESS technique and STIR sequence. Eur J Radiol. 2017;89:40–6.PubMedCrossRef
54.
Bacher S, Hajdu SD, Maeder Y, Dunet V, Hilbert T, Omoumi P. Differentiation between benign and malignant vertebral compression fractures using qualitative and quantitative analysis of a single fast spin echo T2-weighted Dixon sequence. Eur Radiol. 2021;31:9418–27.PubMedPubMedCentralCrossRef
55.
Zanchi F, Richard R, Hussami M, Monier A, Knebel JF, Omoumi P. MRI of non-specific low back pain and/or lumbar radiculopathy: do we need T1 when using a sagittal T2-weighted Dixon sequence. Eur Radiol. 2020;30:2583–93.PubMedPubMedCentralCrossRef
56.
Maeder Y, Dunet V, Richard R, Becce F, Omoumi P. Bone marrow metastases: T2-weighted dixon spin-echo fat images can replace T1-weighted spin-echo images. Radiology. 2018;286:948–59.PubMedCrossRef
57.
Chiabai O, Van Nieuwenhove S, Vekemans MC, et al. Whole-body MRI in oncology: can a single anatomic T2 Dixon sequence replace the combination of T1 and STIR sequences to detect skeletal metastasis and myeloma. Eur Radiol. 2022;33(1):244–57.PubMedPubMedCentralCrossRef
58.
Glaser C, D’Anastasi M, Theisen D, et al. Understanding 3D TSE sequences: advantages, disadvantages, and application in MSK imaging. Semin Musculoskelet Radiol. 2015;19:321–7.PubMedCrossRef
59.
Hennig J, Nauerth A, Friedburg H. RARE imaging: a fast imaging method for clinical MR. Magn Reson Med. 1986;3:823–33.PubMedCrossRef
60.
Haase A, Frahm J, Matthaei D, Hänicke W, Merboldt KD. FLASH imaging: rapid NMR imaging using low flip-angle pulses. J Magn Reson. 2011;213:533–41.PubMedCrossRef
61.
62.
Friedrich KM, Reiter G, Kaiser B, et al. High-resolution cartilage imaging of the knee at 3T: basic evaluation of modern isotropic 3D MR-sequences. Eur J Radiol. 2010;78:398–405.PubMedCrossRef
63.
Bach Cuadra M, Favre J, Omoumi P. Quantification in musculoskeletal imaging using computational analysis and machine learning: segmentation and radiomics. Semin Musculoskelet Radiol. 2020;24:50–64.PubMedCrossRef
64.
Fujinaga Y, Yoshioka H, Sakai T, Sakai Y, Souza F, Lang P. Quantitative measurement of femoral condyle cartilage in the knee by MRI: Validation study by multireaders. J Magn Reson Imaging. 2014;39:972–7.PubMedCrossRef
65.
Schaefer FKW, Kurz B, Schaefer PJ, et al. Accuracy and precision in the detection of articular cartilage lesions using magnetic resonance imaging at 1.5 Tesla in an in vitro study with orthopedic and histopathologic correlation. Acta Radiol. 2007;48:1131–7.PubMedCrossRef
66.
Rofsky NM, Lee VS, Laub G, et al. Abdominal MR imaging with a volumetric interpolated breath-hold examination. Radiology. 1999;212:876–84.PubMedCrossRef
67.
Vandevenne JE, Vanhoenacker F, Mahachie John JM, Gelin G, Parizel PM. Fast MR arthrography using VIBE sequences to evaluate the rotator cuff. Skeletal Radiol. 2009;38:669–74.PubMedCrossRef
68.
Bae WC, Dwek JR, Znamirowski R, et al. Ultrashort echo time MR imaging of osteochondral junction of the knee at 3 T: identification of anatomic structures contributing to signal intensity. Radiology. 2010;254:837–45.PubMedPubMedCentralCrossRef
69.
Omoumi P, Bae WC, Du J, et al. Meniscal calcifications: morphologic and quantitative evaluation by using 2D inversion-recovery ultrashort echo time and 3D ultrashort echo time 3.0-T MR imaging techniques--feasibility study. Radiology. 2012;264:260–8.PubMedPubMedCentralCrossRef
70.
Cheng KY, Moazamian D, Ma Y, et al. Clinical application of ultrashort echo time (UTE) and zero echo time (ZTE) magnetic resonance (MR) imaging in the evaluation of osteoarthritis. Skeletal Radiol. 2023.
71.
Yoshioka H, Stevens K, Hargreaves BA, et al. Magnetic resonance imaging of articular cartilage of the knee: comparison between fat-suppressed three-dimensional SPGR imaging, fat-suppressed FSE imaging, and fat-suppressed three-dimensional DEFT imaging, and correlation with arthroscopy. J Magn Reson Imaging. 2004;20:857–64.PubMedCrossRef
72.
Van Dyck P, Smekens C, Roelant E, Vande Vyvere T, Snoeckx A, De Smet E. 3D CAIPIRINHA SPACE versus standard 2D TSE for routine knee MRI: a large-scale interchangeability study. Eur Radiol. 2022;32:6456–67.PubMedCrossRef
73.
Hilbert T, Omoumi P, Raudner M, Kober T. Synthetic contrasts in musculoskeletal MRI: a review. Invest Radiol. 2023;58:111–9.PubMedCrossRef
74.
Hilbert T, Sumpf TJ, Weiland E, et al. Accelerated T2 mapping combining parallel MRI and model-based reconstruction: GRAPPATINI. J Magn Reson Imaging. 2018;48:359–68.PubMedCrossRef
75.
Warntjes JB, Leinhard OD, West J, Lundberg P. Rapid magnetic resonance quantification on the brain: Optimization for clinical usage. Magn Reson Med. 2008;60:320–9.PubMedCrossRef
76.
Omoumi P, Ducarouge A, Tournier A, et al. To buy or not to buy-evaluating commercial AI solutions in radiology (the ECLAIR guidelines). Eur Radiol. 2021;31:3786–96.PubMedPubMedCentralCrossRef
77.
Griswold MA, Jakob PM, Heidemann RM, et al. Generalized autocalibrating partially parallel acquisitions (GRAPPA). Magn Reson Med. 2002;47:1202–10.PubMedCrossRef
78.
Pruessmann KP, Weiger M, Scheidegger MB, Boesiger P. SENSE: sensitivity encoding for fast MRI. Magn Reson Med. 1999;42:952–62.PubMedCrossRef
79.
Garwood ER, Recht MP, White LM. Advanced imaging techniques in the knee: benefits and limitations of new rapid acquisition strategies for routine knee MRI. AJR Am J Roentgenol. 2017;209:552–60.PubMedCrossRef
80.
Barth M, Breuer F, Koopmans PJ, Norris DG, Poser BA. Simultaneous multislice (SMS) imaging techniques. Magn Reson Med. 2016;75:63–81.PubMedCrossRef
81.
Del Grande F, Rashidi A, Luna R, et al. Five-minute five-sequence knee MRI using combined simultaneous multislice and parallel imaging acceleration: comparison with 10-minute parallel imaging knee MRI. Radiology. 2021;299:635–46.PubMedCrossRef
82.
Lustig M, Donoho D, Pauly JM. Sparse MRI: The application of compressed sensing for rapid MR imaging. Magn Reson Med. 2007;58:1182–95.PubMedCrossRef
83.
Knoll F, Murrell T, Sriram A, et al. Advancing machine learning for MR image reconstruction with an open competition: Overview of the 2019 fastMRI challenge. Magn Reson Med. 2020;84:3054–70.PubMedPubMedCentralCrossRef
84.
Subhas N, Li H, Yang M, et al. Diagnostic interchangeability of deep convolutional neural networks reconstructed knee MR images: preliminary experience. Quantitative Imaging in Medicine and Surgery. 2020;10:1748–62.PubMedPubMedCentralCrossRef
85.
Yu T, Hilbert T, Piredda GF et al. Validation and generalizability of self-supervised image reconstruction methods for undersampled MRI. arXiv preprint arXiv:220112535. 2022
86.
87.
Padormo F, Beqiri A, Hajnal JV, Malik SJ. Parallel transmission for ultrahigh-field imaging. NMR Biomed. 2016;29:1145–61.PubMedCrossRef
88.
Khodarahmi I, Keerthivasan MB, Brinkmann IM, Grodzki D, Fritz J. Modern low-field MRI of the musculoskeletal system: practice considerations, opportunities, and challenges. Invest Radiol. 2022;58:76–87.PubMedCrossRef
Metadata
Title
Morphological assessment of cartilage and osteoarthritis in clinical practice and research: Intermediate-weighted fat-suppressed sequences and beyond
Authors
Patrick Omoumi
Charbel Mourad
Jean-Baptiste Ledoux
Tom Hilbert
Publication date
08-05-2023
Publisher
Springer Berlin Heidelberg
Published in
Skeletal Radiology / Issue 11/2023
Print ISSN: 0364-2348
Electronic ISSN: 1432-2161
DOI
https://doi.org/10.1007/s00256-023-04343-2

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