Frank W. Roemer MD, Presenter: Shareholder, Boston Imaging Core Lab, LLC

Kent Chian Kwoh MD, Abstract Co-Author: Nothing to Disclose

Michael Hannon, Abstract Co-Author: Nothing to Disclose

Carolyn E. Moore MD, PhD, Abstract Co-Author: Nothing to Disclose

Stephanie M Green, Abstract Co-Author: Nothing to Disclose

Ali Guermazi MD, Abstract Co-Author: Stockholder, Synarc, Inc President, Boston Imaging Core Lab, LLC Research grant, General Electric Company Research Consultant, Merck KGaA

Modern MRI systems offer a multitude of cartilage-dedicated sequences which are being used clinically and for research purposes using quantitative cartilage morphometry. It is unknown if these dedicated sequences are equally useful for semiquantitative (SQ) scoring of focal cartilage defects. The aim of the study was to compare SQ assessment of focal cartilage damage using the DESS- and IW-sequences at 3 T MRI.  

The Joints On Glucosamine (JOG) Study includes 177 subjects (95 men and 82 women) aged 35-65 with chronic frequent knee pain. 3 T MRI (sagittal IW fat suppressed, triplanar DESS and coronal IW sequences) of both knees was performed at baseline. Cartilage status was scored according to the WORMS-system. A total of 245 superficial or full-thickness defects were detected. In an additional consensus reading by two MSK radiologists (FWR, AG) the lesions were evaluated side-by-side using only the sagittal DESS- and IW-sequences. Lesion conspicuity, signal changes adjacent to the defect and lesion size was recorded for each cartilage defect. Wilcoxon statistics were applied to determine differences between the sequences.  

37 (17.5%) of the scorable lesions were located in the medial tibio-femoral (TF), 47 (22.8%) in the lateral TF and 126 (59.7%) in the patello-femoral compartment. 82.5% were superficial and 17.5%full-thickness defects. Conspicuity was superior for the IW-sequence (P<0.001). The DESS-sequence showed more associated signal changes (p<0.001). In 37 (17.5%) cases, the DESS sequence showed the lesions as being larger (in direct comparison to IW); in 71 cases (33.6%), both sequences depicted lesion with the same size and in 103 (48.8%) cases, the IW showed the lesion as being larger (p<0.001).  

The cartilage-dedicated DESS-sequence was inferior to the IW sequence in depicting the number and size of focal cartilage defects. More intrachondral signal changes were observed with the DESS, but the significance of this finding is unclear.  

Semiquantitative scoring of focal cartilage defects should not only be performed on cartilage-dedicated sequences but also on conventional fat suppressed fast spin echo sequences.  

Roemer, F, Kwoh, K, Hannon, M, Moore, C, Green, S, Guermazi, A, Focal Cartilage Damage of the Knee Joint: A Comparison of Fat-suppressed Intermediate-weighted Fast Spin Echo (IW) and Double Echo Steady State (DESS) Sequences for Semiquantitative Assessment at 3 T MRI.  Radiological Society of North America 2009 Scientific Assembly and Annual Meeting, November 29 - December 4, 2009 ,Chicago IL. http://archive.rsna.org/2009/8009167.html