Multiple studies have described the MRI findings in patients with stable and unstable OCD lesions. In addition, bone scintigraphy requires exposure to ionizing radiation, can be time consuming, and requires an intravenous injection. Characteristic radiographic findings include a well-circumscribed area of subchondral bone separated by a crescent-shaped radiolucent outline of the fragment. The Wilson test is a special provocative test that has been described with attempts to impinge the tibial spine on the OCD lesion. Initial radiographic evaluation of patients with suspected OCD should include anterior-posterior (AP), lateral, tunnel, and skyline views. 1 The first description of these lesions in the ankle was provided in 1922. 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. Osteochondritis dissecans of the talar articular surface of the ankle joint has been well described. Onset is between childhood and middle age, with the majority of patients being between 10 and 40 years of age, with approximately a 2:1 male to female ratio 3. 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). 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. On evaluation of the knee, the clinician may notice atrophy of the quadriceps and pain with range of motion. Developed by renowned radiologists in each specialty, STATdx provides comprehensive decision support you can rely on - Osteochondritis Dissecans “MR Imaging Features of Osteochondritis Dissecans of the Femoral Sulcus.” Am. Potential limitations of such sequences include their long acquisition times as well as their susceptibility to metal artifacts, which may be an important consideration after surgery. There are multiple existing and developing MRI pulse sequences that are valuable in assessment of osteochondral lesions. Franz Konig introduced the term osteochondritis dissecans in 1888, although it was originally described by Paget some years earlier. 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. The cause of this lesion remains elusive. Osteochondritis dissecans (OCD) is a localized process that affects the subchondral bone and can progress to the overlying articular cartilage. 2 ). However, given the young demographics of the typical OCD patient, the ionizing radiation associated with CT scanning has tempered widespread adoption. In the talus, 96% of lateral lesions and 62% of … Abstract. Discrepancies include underestimation of fragment size, or fragments that appear radiographically separated can be covered by normal cartilage at surgery, and vice versa ( Fig. Osteochondritis dissecans (OCD or OD) is a joint disorder in which cracks form in the articular cartilage and the underlying subchondral bone. Imaging and Staging. 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. Intermediate-weighted FSE imaging combines T2 weighting and relative fatty marrow signal preservation to generate images with bright joint fluid and subcortical bone marrow. This condition has been seen with increased frequency as children of younger age are participating in more competitive sports. Fluid-sensitive (T2) sequences should be obtained in all 3 standard planes. In later stages of the disorder there will be swelling of the affected joint which catches and locks during movement. It should also provide valuable information about articular cartilage repair tissue after surgery. The tunnel view provides improved visualization of the posterior aspect of the femoral condyle as it is brought into view with knee flexion ( Fig. Recently, Kijowski and colleagues proposed revised criteria for OCD instability based on skeletal maturity of the patient. The lesion size and the thickness of the sclerotic margin as measured on plain radiographs were good parameters for predicting loosening. 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. MRI at 3.0 T has the potential advantage of imaging with higher spatial resolution at similar imaging acquisition times, compared with 1.5-T imaging. 3 (March 1, 2003): 641-645. Rofo Fortschr Geb Rontgenstr Neuen Bildgeb Verfahr 1995 ; 163:38-44[German]. CT offers excellent anatomic delineation of mineralized/ossified structures within the knee joint. Osteochondritis dissecans (OCD or OD) is a joint disorder primarily of the subchondral bone in which cracks form in the articular cartilage and the underlying subchondral bone. Osteochondritis dissecans (OCD) most commonly affects the knee. Features are consistent with osteochondritis dissecans of the ankle joint. MR imaging can detect the presence of OCD in the early stages when radiographs are normal or show only subtle changes. The itis suffix of osteochondritis denotes the previously understood cause of inflammation of the osteochondral joint surface. CT arthrography consists of thin-slice CT evaluation following intra-articular administration of iodinated contrast. Orthop J Sports Med 2018; 6:2325967118794620 [Google Scholar] However, the clinical usefulness of these quantitative techniques remains uncertain. Osteochondritis Dissecans: Etiology, Pathology, and Imaging with a Special Focus on the Knee Joint Cartilage . This evolution has resulted in a resurgence of CT arthrography for the assessment of intra-articular lesions, including OCD 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. 1. 2018 Oct;9(4):346-362. doi: 10.1177/1947603517715736. ADVERTISEMENT: Supporters see fewer/no ads, Please Note: You can also scroll through stacks with your mouse wheel or the keyboard arrow keys. 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 can be classified at surgery into 4 stages: Classification according to International Cartilage Repair Society. Practice Essentials. The weight-bearing surfaces of the lateral femoral condyle, tibia or patella may also be involved. Osteochondritis dissecans (OCD) is characterized by separation of an osteochondral fragment from the articular surface. 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. Conventional radiographs allow determination of the size and location of the lesion as well as assessment of the skeletal maturity of the patient. Prevalence of this condition ranges between 15 and 29 per 100,000, with an increased male predominance of 2:1. Osteochondral injury staging system for MRI attempts to grade the stability and severity of osteochondral injury and is used to plan management. 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 … 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. Arthroscopic surgery is a procedure that is frequently used as a treatment to remove the loose cartilage and bone tissue from the joint. {"url":"/signup-modal-props.json?lang=us\u0026email="}. 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. 5 and 6 ), or was accompanied by multiple breaks in the subchondral bone plate. 180, no. 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. 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