Abstract
BackgroundChoice of appropriate MR pulse sequence is important for any research studies using imaging-derived data. The aim of this study was to compare semiquantitative assessment of subchondral bone marrow edema-like lesions and subchondral cysts using intermediate-weighted (IW) fat-suppressed (fs) spin echo and Dual Echo Steady State (DESS) sequences on 3 T MRI.MethodsIncluded were 201 subjects aged 35-65 with frequent knee pain. 3T MRI was performed with the same sequence protocol as in the Osteoarthritis Initiative (OAI). In a primary reading subchondral bone marrow edema-like lesions were assessed according to the WORMS system. Two hundred subregions with such lesions were randomly chosen. The extent of subchondral bone marrow edema-like lesions was re-evaluated separately using sagittal IW fs and DESS sequences according to WORMS. Lesion size and confidence of the differentiation between subchondral bone marrow edema-like lesions and subchondral cysts located within or adjacent to them was rated from 0 to 3. Wilcoxon signed-rank tests and chi-square statistics were used to examine differences between the two sequences.ResultsOf 200 subchondral bone marrow edema-like lesions detected by IW fs sequence, 93 lesions (46.5%) were not depicted by the DESS sequence. The IW fs sequence depicted subchondral bone marrow edema-like lesions to a larger extent than DESS (p < 0.0001), and the opposite was true for subchondral cysts. Confidence scores for differentiation of the two types of lesions were not significantly different between the two sequences.ConclusionsIn direct comparison the IW fs sequence depicts more subchondral bone marrow edema-like lesions and better demonstrate the extent of their maximum size. The DESS sequence helps in the differentiation of subchondral bone marrow edema-like lesions and subchondral cysts. The IW fs sequence should be used for determination of lesion extent whenever the size of subchondral bone marrow edema-like lesions is the focus of attention.
Highlights
Choice of appropriate MR pulse sequence is important for any research studies using imagingderived data
bone marrow edema-like lesions (BML) have been assessed on gradient recalled echo (GRE)-type sequences such as Fast Low Angle Shot (FLASH) or Spoiled Gradient Recalled (SPGR) [7] that are commonly used for quantitative assessment of cartilage volume and thickness due to their high contrast of cartilage to subchondral bone [8]
We focused on subchondral BMLs that are of degenerative origin only, they can represent a variety of pathologies [23]
Summary
Choice of appropriate MR pulse sequence is important for any research studies using imagingderived data. The aim of this study was to compare semiquantitative assessment of subchondral bone marrow edema-like lesions and subchondral cysts using intermediate-weighted (IW) fat-suppressed (fs) spin echo and Dual Echo Steady State (DESS) sequences on 3 T MRI. Subchondral bone marrow edema-like lesions (BML) are defined as non-cystic areas of ill-delineated hyperintensity on fluid-sensitive fast spin echo (FSE) fat suppressed (fs) pulse sequences and of hypointensity on T1-weighted (T1W) spin echo (SE) images [1]. They are one of the features of osteoarthritis (OA) detected on MRI and are observed regularly in conjunction with structural alterations of adjacent cartilage. The Osteoarthritis Initiative (OAI) MRI protocol with sagittal IW fs and DESS (Dual Echo Steady State, which is a T2-weighted gradient echo sequence) sequences acquired at 3 T MRI allows such a comparison
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