Interpretation of Cartilage Damage at Routine Clinical MRI: How to Match Arthroscopic Findings.
Interpretation of Cartilage Damage at Routine Clinical MRI: How to Match Arthroscopic Findings.
复制标题
DOI：
10.1148/rg.220051
复制
发表时间：
2022-08
期刊：
影响因子：
--
通讯作者：
B. Markhardt;Brady K. Huang;Andrea M. Spiker;E. Chang
中科院分区：
文献类型：
--
作者：
B. Markhardt;Brady K. Huang;Andrea M. Spiker;E. Chang
本综述旨在辅助解读常规临床磁共振成像（MRI）中关节软骨的损伤情况，以改善临床治疗。讨论了软骨的组织学和生化特征以及临床治疗的相关方面，同时也探讨了MRI物理学原理。利用MRI对关节软骨损伤进行特征描述需要详细了解不同序列参数下骨软骨单元的正常及损伤表现。了解软骨下骨板的位置是确定软骨病变深度的关键。在MRI上确定骨板具有挑战性，因为关节软骨的纤维组织具有各向异性，在与含脂肪的髓腔交界处容易出现“魔角”现象和化学位移伪影。这些伪影可能导致高估软骨下骨板的厚度，进而高估软骨病变的深度。在软骨形态正常的区域，孤立的高信号和低信号病变在关节镜检查中通常代表软骨退变。MRI上软骨下骨髓的改变也增加了在关节镜检查中观察到软骨损伤的可能性，即使形态学病变无法分辨，而且较大的软骨下病变在关节镜检查中与更高的分级相关。还综述了软骨损伤的其他次要特征的临床意义，包括骨赘、关节内游离体和滑膜炎。本文有在线补充材料。美国政府的工作是在与北美放射学会（RSNA）的独家许可下发表的。
This review is intended to aid in the interpretation of damage to the articular cartilage at routine clinical MRI to improve clinical management. Relevant facets of the histologic and biochemical characteristics and clinical management of cartilage are discussed, as is MRI physics. Characterization of damage to the articular cartilage with MRI demands a detailed understanding of the normal and damaged appearance of the osteochondral unit in the context of different sequence parameters. Understanding the location of the subchondral bone plate is key to determining the depth of the cartilage lesion. Defining the bone plate at MRI is challenging because of the anisotropic fibrous organization of articular cartilage, which is susceptible to the "magic angle" phenomenon and chemical shift artifacts at the interface with the fat-containing medullary cavity. These artifacts may cause overestimation of the thickness of the subchondral bone plate and, therefore, overestimation of the depth of a cartilage lesion. In areas of normal cartilage morphology, isolated hyperintense and hypointense lesions often represent degeneration of cartilage at arthroscopy. Changes in the subchondral bone marrow at MRI also increase the likelihood that cartilage damage will be visualized at arthroscopy, even when a morphologic lesion cannot be resolved, and larger subchondral lesions are associated with higher grades at arthroscopy. The clinical significance of other secondary features of cartilage damage are also reviewed, including osteophytes, intra-articular bodies, and synovitis. Online supplemental material is available for this article. Work of the U.S. Government published under an exclusive license with the RSNA.