Korean J Radiol.  2011 Feb;12(1):78-88. 10.3348/kjr.2011.12.1.78.

Evaluation of the Chondromalacia Patella Using a Microscopy Coil: Comparison of the Two-Dimensional Fast Spin Echo Techniques and the Three-Dimensional Fast Field Echo Techniques

• Kim HJ
• Lee SH
• Kang CH
• Ryu JA
• Shin MJ
• Cho KJ
• Cho WS

• KMID: 991685
• DOI: http://doi.org/10.3348/kjr.2011.12.1.78

Abstract

OBJECTIVE
We wanted to compare the two-dimensional (2D) fast spin echo (FSE) techniques and the three-dimensional (3D) fast field echo techniques for the evaluation of the chondromalacia patella using a microscopy coil.
MATERIALS AND METHODS
Twenty five patients who underwent total knee arthroplasty were included in this study. Preoperative MRI evaluation of the patella was performed using a microscopy coil (47 mm). The proton density-weighted fast spin echo images (PD), the fat-suppressed PD images (FS-PD), the intermediate weighted-fat suppressed fast spin echo images (iw-FS-FSE), the 3D balanced-fast field echo images (B-FFE), the 3D water selective cartilage scan (WATS-c) and the 3D water selective fluid scan (WATS-f) were obtained on a 1.5T MRI scanner. The patellar cartilage was evaluated in nine areas: the superior, middle and the inferior portions that were subdivided into the medial, central and lateral facets in a total of 215 areas. Employing the Noyes grading system, the MRI grade 0-I, II and III lesions were compared using the gross and microscopic findings. The sensitivity, specificity and accuracy were evaluated for each sequence. The significance of the differences for the individual sequences was calculated using the McNemar test.
RESULTS
The gross and microscopic findings demonstrated 167 grade 0-I lesions, 40 grade II lesions and eight grade III lesions. Iw-FS-FSE had the highest accuracy (sensitivity/specificity/accuracy = 88%/98%/96%), followed by FS-PD (78%/98%/93%, respectively), PD (76%/98%/93%, respectively), B-FFE (71%/100%/93%, respectively), WATS-c (67%/100%/92%, respectively) and WATS-f (58%/99%/89%, respectively). There were statistically significant differences for the iw-FS-FSE and WATS-f and for the PD-FS and WATS-f (p < 0.01).
CONCLUSION
The iw-FS-FSE images obtained with a microscopy coil show best diagnostic performance among the 2D and 3D GRE images for evaluating the chondromalacia patella.

Keyword

Cartilage; Magnetic resonance (MR); Knee; Histopathologic correlation

MeSH Terms

Aged
Chondromalacia Patellae/*diagnosis/pathology
Female
Humans
*Imaging, Three-Dimensional
Magnetic Resonance Imaging/instrumentation/*methods
Male
Middle Aged
Patella/pathology
Sensitivity and Specificity

Figure

• 

  Fig. 1 Division of nine areas of patella.

• 

  Fig. 2 Cutting articular surface of patella (schematic diagram, left) and example of gross pictures of cutting patella (right).

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  Fig. 3 55-year-old woman with knee pain. Proton density-weighted (A), fat-suppressed proton density-weighted (B), intermediate weighted-fat suppressed fast spin echo (C), 3D water selective cartilage scan (D), 3D water selective fluid scan (E) and 3D balanced-fast field echo (F) images show no evidence of chondromalacia in patella except for osteophyte at medial end.

• 

  Fig. 4 72-year-old woman with knee pain. Proton density-weighted (A), fat-suppressed proton density-weighted (B), intermediate weighted-fat suppressed fast spin echo (C), 3D water selective cartilage scan (D), 3D water selective fluid scan (E) and 3D balanced-fast field echo (F) images show blister formation at lateral patellar cartilage and grade I change on all sequences (arrows). Histology (G, × 40) shows blister formation at base of patellar cartilage (arrows), intact surface, hypercellularity and extensive matrix formation at superior portion of blister (arrowheads).

• 

  Fig. 5 66-year-old woman with knee pain. Proton density-weighted (A), fat-suppressed proton density-weighted (B), intermediate weighted-fat suppressed fast spin echo (C), 3D water selective cartilage scan (D), 3D water selective fluid scan (E) and 3D balanced-fast field echo (F) images show focal breakage in cartilage surface of medial patellar facet on fast spin echo sequence images (A-C, arrows), but this is not definite on gradient echo images (D-F). Gross microscopic image (G) shows disruption of articular surface to depth less than 50% (arrow), and this grade IIA.

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  Fig. 6 64-year-old woman with knee pain. Proton density-weighted (A), fat-suppressed proton density-weighted (B), intermediate weighted-fat suppressed fast spin echo (C), 3D water selective cartilage scan (D), 3D water selective fluid scan (E) and 3D balanced-fast field echo (F) images show deep fissuring of articular cartilage of medial patellar facet, and exposed subchondral bone is seen on all sequences and gross microscopic image (G) (arrows), and this grade III.

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