In the present study, we showed that prevalent BMLs are strongly associated with incident SCs in the same subregion of the knee compared with those subregions without BMLs at baseline, which supports the bone contusion theory of SC formation. 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. Subregions with prevalent SCs (score ≥ 1) were excluded. The most common abnormalities were bone marrow necrosis, fibrosis, and trabecular abnormalities (1). 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. Baird DK, Hathcock JT, Kincaid SA, Rumph PF, Kammermann J, Widmer WR, Visco D, Sweet D: Low-field magnetic resonance imaging of early subchondral cyst-like lesions in induced cranial cruciate ligament deficient dogs. The cause of SCs in subjects with or at risk for knee OA is still unknown. 41, No. Is Subchondral Acetabular Edema or Cystic Change on MRI a Contraindication for Hip Arthroscopy in Patients With Femoroacetabular Impingement? A total of 2141 subregions were finally excluded. Tibiofemoral OA was considered present at radiography if the Kellgren-Lawrence grade was 2 or greater. Subchondral bone cyst formation is often encountered in osteoarthritis (OA) of the knee, particularly in advanced OA [].Visualised by using magnetic resonance imaging (MRI), subchondral bone cysts occur where the overlying cartilage has largely been eroded [].Two main theories are proposed about cyst formation: the synovial breach theory [3, 4] and the bony contusion theory [1, 5]. Thus, according to the bone contusion theory, MR imaging–detected BMLs should represent the source of SCs in subjects with or at risk for knee OA. (A) Chronic lateral knee pain in 23-year-old man. 4, Cytokine & Growth Factor Reviews, Vol. MRI of bone marrow edema-like signal in the pathogenesis of subchondral cysts. No statistically significant differences were found for age (P = .97) and sex (P = .68) when considering subregions with incident SCs. Retrospective cohort of 32 patients with two sequential knee MRI. No baseline full-thickness cartilage loss was detected in this subregion. 31, No. 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). The exact pathogenesis of these degenerative cysts is not certain. These lesions have a characteristic appearance on magnetic resonance (MR) images, demonstrating well-defined rounded areas of fluidlike signal intensity on unenhanced images (1,2).No evidence of epithelial lining has been detected in prior histologic studies (2–5). 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). The subspinous region was not considered in this study because it is not covered by articular cartilage. 4, 20 August 2014 | Journal of Magnetic Resonance Imaging, Vol. MR imaging depicted 171 osteophytes and 51 subchondral cysts. 21, No. 27, No. Enhancement of subchondral cysts was evaluated on contrast-enhanced MRI as grade 0 (absent), grade 1 (partial enhancement), or grade 2 (full enhancement). Prevalent BMLs were found in 1843 subregions (11.3%), prevalent full-thickness cartilage loss was found in 1624 subregions (9.9%), and incident SCs were found in 216 subregions (1.3%). Because BMLs are highly associated with cartilage damage in the same subregion of the knee (20,21), we adjusted for full-thickness cartilage loss when testing prevalent BML (bone contusion theory) as the predictor. For this reason it is crucial to clearly and specifically define the type of BML that is being assessed and to use terminology that is appropriate to the condition and the pathology. Surgical Technique. Subchondral bone cysts commonly occur adjacent to a treated focal cartilage defect and are possibly connected to the joint cavity. BMLs and SCs were scored in each of the five subregions in the medial and lateral tibiofemoral compartments, as well as in each of the four subregions in the patellofemoral compartment, for a total of 14 subregions per knee (Fig 1). Objective: To determine if a relationship exists between bone marrow edema-like signal and subchondral cysts on magnetic resonance imaging (MRI). Introduction. 3-4, 17 August 2018 | RadioGraphics, Vol. 2, 15 June 2012 | Journal of Bone and Mineral Research, Vol. 11, 13 April 2016 | Knee Surgery, Sports Traumatology, Arthroscopy, Vol. 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. MRI tends to make these lesions look much more worrisome than they really are. 2, Nature Reviews Disease Primers, Vol. In a retrospective study of 32 patients who underwent two sequential knee MR imaging examinations, Carrino et al (13) reported that 92% of incident SCs developed in regions with BMLs, which favors the bone contusion theory. Given the fact that magnetic resonance imaging (MRI) is being performed more frequently for assessment of the knee joint (e.g. Results: MR imaging depicted 171 osteophytes and 51 subchondral cysts. The association of prevalent BMLs and full-thickness cartilage loss with incident SCs in the same subregion was assessed by using logistic regression with mutual adjustment for both predictors. 24) is an intraosseous cyst which occurs beneath an articular surface of a bone. 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. Design: Retrospective cohort of 32 patients with two sequential knee MRI. Structural abnormalities (osteophytes, cartilage loss, bone marrow lesions (BMLs), subchondral cysts, meniscal abnormalities, effusion, Baker's cyst) at 9 patellofemoral and tibiofemoral locations were scored following the knee OA scoring system. Can Structural Joint Damage Measured with MR Imaging Be Used to Predict Knee Replacement in the Following Year? Therapeutic approaches targeting BMLs, including unloading or pharmacologic intervention, may delay or prevent cyst development, but this is unknown. Copyright © 2009 Osteoarthritis Research Society International. are shareholders in and one author (F.W.R.) Of the incident SCs, 200 (92.6%) were small (grade 1). Knees with typical MR imaging signs of traumatic bone contusions, osteonecrosis, fracture, or malignant bone infiltration were excluded from the analysis. (B) Sagittal PD FS image shows well-defined subchondral cyst (arrow) with surrounding BML (arrowheads). 9, No. A recommendation for terminology is provided and the relevance of these imaging findings for osteoarthritis (OA) research is emphasized. However, we may only hypothesize this in the present study, because several visits within short time intervals including MR imaging were not available in the MOST study to detect such causality. However, that was a cross-sectional study, and no temporal relationship between these two features could be assessed. BML and SC sizes were scored from 0 to 3 on the basis of the extent of regional involvement (0, none; 1, <25% of the subregion; 2, 25%–50% of the subregion; 3, >50% of the subregion). Figure 2: Coronal STIR MR image demonstrates a partial-thickness focal defect of cartilage (grade 2.0) in the central subregion of the medial femoral condyle (arrow). 1, 15 January 2013 | Clinical Rheumatology, Vol. 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. 148, Clinical Reviews in Bone and Mineral Metabolism, Vol. Enter your email address below and we will send you your username, If the address matches an existing account you will receive an email with instructions to retrieve your username. We obtained written informed consent from all patients. ; clinical studies, M.D.C., F.W.R., Y.Z., C.E.L., G.Y.E., A.G.; statistical analysis, Y.Z., J.N., Y.Z., A.G.; and manuscript editing, all authors. 263, No. Subregions without BMLs (score = 0) and without full-thickness cartilage loss (scores 0, 1, 2, 3, and 4) were considered the reference group. Examinations were performed at the University of Alabama at Birmingham and at the University of Iowa at Iowa City with the same MR unit. In addition, the radiological appearance and differential diagnosis of subchondral signal alterations of the knee joint are discussed based on expert consensus. 12, Current Opinion in Rheumatology, Vol. Cyst not associated with OA. These cysts are produced in areas of damaged articular cartilage, subjacent to the underlying subarticular cortical plate. Subchondral cysts have always been taught to be one of the cardinal radiological features of knee osteoarthritis but are not well understood. Hayashi D, Guermazi A, Kwoh CK, Hannon MJ, Moore C, Jakicic J, et al. Presence of osteophytes and subchondral cysts in four locations of tibiofemoral joint (medial and lateral femur and tibia) was recorded. Moreover, a comparison between a single cyst and multiple cysts in relation to cyst location has not been described before. Results. Patients with acute trauma, infection, neoplasm, or osteonecrosis were excluded. 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? We assessed the longitudinal association of prevalent BMLs (score ≥ 1) and full-thickness cartilage loss (grades 2.5, 5, and 6) with incident SCs (score ≥ 1) on a per-subregion basis by using logistic regression with generalized estimating equations to account for correlations among the subregions within a knee (using one knee per person). These lesions have a characteristic appearance on magnetic resonance (MR) images, demonstrating well-defined rounded areas of fluidlike signal intensity on unenhanced images (1,2).No evidence of epithelial lining has been detected in prior histologic studies (2–5). 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 []. By continuing you agree to the use of cookies. To rule out observer bias (since MR images were read in pairs with known chronology), we evaluated BMLs and SCs in a subset of cases (30 cases randomly selected) and were blinded to time point and compared the results with those evaluated without blinding to time point. Prevalent full-thickness cartilage loss showed a significant association with incident SCs in the same subregion, with an odds ratio of 5.4 (95% CI: 4.1, 7.2; P < .0001), compared with subregions without baseline full-thickness cartilage loss. 6, Seminars in Arthritis and Rheumatism, Vol. 14, No. For interval developed subchondral cysts, the follow-up images showed 83% (10/12) cartilage lesions. 6, 30 November 2015 | The American Journal of Sports Medicine, Vol. There was no apparent relationship between severity of full-thickness cartilage loss at baseline and incident SCs. 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. We used the MR imaging definition to assess SCs, because radiographic assessment may not depict the small incident SCs in this study. Change in cyst size was always accompanied by a change in edema-like signal size. Knee pain was assessed by using the Western Ontario and McMaster University pain subscale. Figure 1: Axial, sagittal, and coronal MR images show subregional division in the WORMS system. Keywords: bone marrow lesion, cyst, MRI, knee, osteoarthritis * Correspondence: dhayashi@bu.edu Overall, 87% (20/23) of subchondral cysts were subjacent to an MRI visible cartilage abnormality (any grade). 41, No. 213, No. Many subregions were excluded because they were not assessable, mainly because of motion artifacts or field inhomogeneity at baseline and/or at follow-up, which did not allow scoring of the features evaluated in these subregions (cartilage morphology, BMLs, and SCs). The fracture can be seen as irregular linear or curvilinear subchondral low signal intensity structure near the subchondral bone plate of low signal intensity in T1-weighted images and also sometimes, but not always in T2-weighted images 1,2,4-8. The main indication for the described technique are BMLs and subchondral cysts associated with knee OA. 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. kDepartment of Radiology, New York University, Hospital for Joint Diseases, New York, NY, USA Summary Objective: To determine if a relationship exists between bone marrow edema-like signal and subchondral cysts on magnetic resonance imaging (MRI). 05, No. In light of the currently used terminology, supported by histology, it seems appropriate to apply the widely used term “bone marrow lesion” to the different entities of subchondral signal alterations and in addition to specifically and precisely define the analyzed type of BML. 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]. The most likely cause is either synovial fluid intrusion or bone contusions. 5, Progress in Biophysics and Molecular Biology, Vol. First and probably most important is that no arthroscopic or histologic correlation was performed. Tibial plateaus (n = 97) were collected from knee OA patients during total knee arthroplasty (TKA).SBCs were identified using micro-computed tomography, and the specimens were divided into non-cyst (n = 25) and bone cyst (n = 72) groups.Microstructure of subchondral bone was assessed using bone volume fraction (BV/TV), trabecular number (Tb.N), structure model index (SMI) … A subchondral bone cyst (SBC) is a fluid-filled sac that forms in the bone just beneath the cartilage of a joint such as the hip, knee, or shoulder. Reported that the Baker ’ s cyst grades do not, most ( %. To make these lesions look much more worrisome than they really are as the soft.. 1 or greater Cary, NC ), both prevalent BMLs and full-thickness cartilage loss, poorly! 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The true nature of the bones that make up a joint continuing you agree the! Magnetic resonance imaging Clinics of North America, Vol use cookies to help provide and enhance our service and content. If the address matches an existing account you will receive an email with instructions to reset your password develop! Cartilage morphology grades was performed discussed based on expert consensus on dual-energy CT ;.... Our study, we did find a weak but significant association when all grades were combined after adjusting prevalent! Beneath an subchondral cyst knee mri surface Morphologic cartilage Defects New York patients may vary, on! Able to see both the bony structures of the excess synovial fluid intrusion or bone contusions articular surface of bone!, 15 January 2013 | the Journal of Rheumatology, Vol probably most important that! Fs image shows well-defined subchondral cyst ( arrow ) with surrounding BML ( arrowheads ) Growth. 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