Direct comparison of conventional radiography and cone-beam CT in small bone and joint trauma. 2008; 36(9): 1750–62. 3. It has also been shown that both small (≤5 mm) and large (>5 mm) MR imaging–depicted osteophytes are associa… Finally, when fluid flows underneath the defect, the OCD can become unstable and may result in a corpus liberum. Osteochondral lesions (OCL) of the talus involve both articular cartilage and subchondral bone of the talar dome. The presence of a subchondral edema with an acetabular cyst on MRI is indicative of a full-thickness cartilage lesion at the time of arthroscopy. J Bone Joint Surg Am. There is slight irregular delineation of the cartilage (white arrow). Yamamoto T. Subchondral insufficiency fractures of the femoral head. Note the more subtle subchondral cyst formation in the proximal margin of the hamate (H), related to chronic repetitive abutment with the lunate (type II lunate morphology with an extra facet which articulates with the hamate). With the advent of MRI, this grading system was further revised including evaluation of structures invisible on conventional radiology, such as the integrity of the cartilage and presence of BME. Schematic drawing of the normal talocrural joint (a). DOI: https://doi.org/10.1053/jars.2003.50041, Anderson, IF, Crichton, KJ, Grattan-Smith, T, Cooper, RA and Brazier, D. Osteochondral fractures of the dome of the talus. comments powered by Subchondral insufficiency fracture of the knee: grading, risk factors, and outcome. in 2003. J Bone Joint Surg Am. Additional CBCT-Arthrography is, however, very useful for more accurate cartilage staging and should be considered in those clinical scenarios where arthroscopic treatment of the lesion is considered. On CBCT arthrographic images, the contrast separating the OCL fragment from the talar dome can be evaluated with more confidence (Figure 8). Subchondral cystic lesions are common features that are associated with many arthropathies and synovial-based processes. Down staging of an OCL on CBCT compared to MRI. Although the incidence of osteoarthritis increases with age, the condition is not a normal part of the aging process. A suggested grading system based on MRI findings is 9: Low-grade subchondral fractures in particular, if there is no collapse of the subchondral bone plate, can be treated conservatively with restricted weight-bearing 2,3  and non-steroidal anti-inflammatory drugs. Unable to process the form. Note also partial filling of the subchondral cyst (black arrowhead) with contrast as an indirect sign of joint communication through a cartilage lesion. subchondral bone marrow edema on dual-energy CT; MRI. Sagittal PD fat suppressed MRI image (a) showing BME (star) at the posteromedial part of the talar dome. A comparison of arthroscopic and MRI findings in staging of osteochondral lesions of the talus. Studies on cadavers performed on CT arthrography [12] showed more accurate cartilage thickness measurements in comparison to standard MRI, which is in line with a superior evaluation of OCL with CT arthrographic techniques [13] (Figure 9). (2009) Revista brasileira de ortopedia. Ostlere SJ(1), Seeger LL, Eckardt JJ. Assess range of motion to evaluate for pain and limitation as well as clicking or catching of the joint. Osteochondral Lesions of the Knee: Differentiating the Most Common Entities at MRI. This term refers to a wide spectrum of pathologies including mild bone marrow contusion as well as severe osteoarthritis resulting from long standing disease. They're especially common at the knee or hip. Journal of the Belgian Society of Radiology 101 (S2): 1. 7. Articular cartilage covering the articular surfaces (blue), cortical bone (black), normal bone marrow (yellow) and ligaments (brown). ADVERTISEMENT: Supporters see fewer/no ads, Please Note: You can also scroll through stacks with your mouse wheel or the keyboard arrow keys. (2018) Radiographics : a review publication of the Radiological Society of North America, Inc. 38 (5): 1478-1495. In osteoarthritis, the overloading and the vascular obstruction within the subchondral bone leads to subchondral sclerosis, bone marrow edema and bleeding, and subchondral cysts. Sayyid S, Younan Y, Sharma G, et al. DOI: https://doi.org/10.1177/0363546508316773, Dipaola, JD, Nelson, DW and Colville, MR. Characterizing osteochondral lesions by magnetic resonance imaging. DOI: http://doi.org/10.5334/jbr-btr.1377, Posadzy, M., et al.. “Staging of Osteochondral Lesions of the Talus: MRI and Cone Beam CT”. RESULTS: We identified 58 subchondral cystsin 43(71.7%) of 63 cases. 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. 2017. 10. Despite the combination of these MR parameters, accurate cartilage evaluation remains often illusive. T1 andT2-weighted axial, oblique coronal, and oblique sagittal images were analysed for the presence, location, number,shape, size, and connection to the joint cavity of subchondral cysts. 45, No. 2007; 17(6): 1518–28. Stage 1 lesion according to Anderson classification. 9. 1. Acute and Stress-related Injuries of Bone and Cartilage: Pertinent Anatomy, Basic Biomechanics, and Imaging Perspective. Journal of the Belgian Society of Radiology 101, no. When the latter is present, then joint replacement is often the only feasible treatment. Radiology. 11. DOI: https://doi.org/10.1007/s00330-006-0446-4, El-Khoury, GY, Alliman, KJ, Lundberg, HJ, Rudert, MJ, Brown, TD and Saltzman, CL. Subchondral insufficiency fractures of the knee: review of imaging findings. DOI: https://doi.org/10.1155/2016/3594253, Posadzy, M., Desimpel, J. and Vanhoenacker, F.M., 2017. The fracture can be seen as irregular linear or curvilinear subchondral low signal intensity structure near the subchondral bone plate of low signal intensity in T1-weighted  images and also sometimes, but not always in T2-weighted images 1,2,4-8. Coronal (b) and sagittal (c) reformatted CBCT-A show subtle subchondral sclerosis (black arrow) at the superolateral aspect of the talar dome, but the overlying cartilage is intact. They can progress to subchondral collapse, osteochondral injury, and osteochondral defects 1. In stage 3 an undisplaced completely separated fragment can be seen on MRI with adjacent BME. Usually, subchondral fractures present as linear or curvilinear structures often paralleling the subchondral bone plate, with or without areas of subchondral collapse 2. Coronal (a) and sagittal (b) fat suppressed T2-WI show adjacent kissing areas of bone marrow edema (white arrowheads) at the distal tibia and talar dome. Sagittal (a) fat suppressed T2-WI show a subchondral band-like area of low signal at the subchondral cortex (white arrow) with surrounding BME (white asterisk). 1991; 7(1): 101–4. Their walls consist of a cell layer resembling synovium, and the surrounding wall is osteosclerotic. CBCT following intra-articular injection of Iodine contrast (CBCT-Arthrography) may render exquisite detail of the articular cartilage using very thin slices and multiplanar reformation. Although Conventional Radiography (CR) is still the initial diagnostic modality used for evaluation of ankle pain, later studies showed that 30–43% of talar OCL diagnosed on MRI were invisible on CR [5]. 4 (3): 173-80. Based on the combination of MRI and CBCT findings the diagnosis of a subchondral insufficiency fracture (SIF) was made. Subchondroplasty: What the Radiologist Needs to Know. DOI: https://doi.org/10.1016/j.fas.2013.10.005, https://doi.org/10.2106/00004623-198668060-00007, https://doi.org/10.1007/s00256-015-2127-3, https://doi.org/10.2106/00004623-195941060-00002, https://doi.org/10.1177/107110079902001206, https://doi.org/10.1016/0749-8063(91)90087-E, https://doi.org/10.2106/00004623-198971080-00004, https://doi.org/10.1007/s00167-008-0607-x, https://doi.org/10.1007/s00330-006-0446-4, https://doi.org/10.1148/radiol.2333031921. MRI-detected subchondral bone marrow signal alterations of the knee joint: terminology, imaging appearance, relevance and radiological differential diagnosis. Useful MR scoring parameters include lesion location, lesion size in 3 planes, subchondral bone marrow edema, subchondral cyst formation and/or sclerosis, status of the overlying cartilage, contour depression of the articular bone plate. On a corresponding sagittal reformatted CBCT-A (c), there is almost complete detachment of the cartilage at the superolateral aspect of the talar dome (black arrow). Note that the cystic changes are subchondral at the proximal ulnar portion of the lunate (L). Unstable lesions – if left untreated – predispose for early osteoarthritis. Coronal (c) and sagittal (d) reformatted CBCT-A show a focal bony lesion with peripheral sclerosis in the distal tibia and talus. In this regard, CBCT-Arthrography (CBCT-A) may be very promising technique for precise staging of cartilage lesions of the ankle as an alternative for Multi Detector Computed Tomography (MDCT). Staging of Osteochondral Lesions of the Talus: MRI and Cone Beam CT. Journal of the Belgian Society of Radiology, 101(S2), 1. The red arrow indicates the direction of the applied force. Subchondral bone involvement can be manifested by bone marrow edema (BME), fracture, sclerosis and/or cyst formation. A subchondral cyst (Fig. 1959; 41–A: 988–1020. 2015; 44(8): 1111–7. The symptoms you will likely notice are: Lameness may be acute or hardly noticed unless the horse is working at specific increased speeds or when involved in specific activities - intermittent, especially in older horses but can be noted in horses of any age MRI is the most sensitive method to depict this stage without any correlating signs on CR or CBCT with injection of intraarticular contrast. 6. Although not comprehensive in scope, this article correlated the pathophysiology and imaging features of several of these disorders to better understand the associated subchondral lucencies. An alternative MRI staging system has been proposed by Mintz [8] et al. 4. Arthroscopic evaluation of the cartilage is regarded as the gold standard [2], but due to its invasiveness and the need for anesthesia, it should be reserved for preoperatively well-documented cases and combined with surgical treatment procedures. Frequently, these lesions occur with ligamentous injury and one should thoroughly examine for instability.One may obtain radiographic imaging to evaluate for cystic or chondral changes, but bear in mind that these studies are insufficient for complete diag… 1989; 71(8): 1143–52. Cartilage damage may have a variable imaging appearance ranging from a small fissure, a distinct defect, flap formation or delamination. Coronal (a) fat suppressed T2-WI show adjacent BME (white asterisk) at the superolateral aspect of the talar dome. Hallmarks of osteoarthritis include the presence of marginal osteophytes and subchondral cysts in the tibiofemoral joint. Fluid-fluid levels, consistent with secondary formation of aneurysmal bone cysts, are seen in 14% of cases. This article highlights some of the causes and treatment options for Subchondral Bone Cysts. Coronal PD fat suppressed coronal image (a) showing an OCL fragment completely detached from talar dome without displacement (arrow), bone marrow oedema (star) of adjacent part of the talus. Prostaglandin I-1 and/or bisphosphonates might be considered 5. Example of improved visualization of communication of subchondral cysts with the joint through deep articular cartilage lesions on CBCT arthrography. 17 (9): 1115-31. DOI: http://doi.org/10.5334/jbr-btr.1377. DOI: https://doi.org/10.1016/0749-8063(91)90087-E, Mintz, DN, Tashjian, GS, Connell, DA, Deland, JT, O’Malley, M and Potter, HG. The main reason for that is the fact that we need images with high spatial resolution to detect early changes of articular cartilage of the ankle joint. Patients will usually present with pain on weight-bearing in the affected joint, improving with rest 2. This review aims to summarize the available evidence on the evaluation and treatment of scaphoid cystic lesions to help guide clinical management. Staging of Osteochondral Lesions of the Talus: MRI and Cone Beam CT. Journal of the Belgian Society of Radiology. AJR Am J Roentgenol 1977;128:799–806. Treatment depends on the location and size of the defect as well as the presence of secondary degenerative changes. Subchondral cysts are of variable size from a f… However, the sensitivity of conventional radiography in osteophyte depiction is limited compared with that of magnetic resonance (MR) imaging (4,5). This is not Kienbock's disease, where cystic changes develop more diffusely. Arthroscopy. DOI: https://doi.org/10.2106/00004623-195941060-00002, Hepple, S, Winson, IG and Glew, D. Osteochondral lesions of the talus: A revised classification. high signal subchondral cysts; Treatment and prognosis. DOI: http://doi.org/10.5334/jbr-btr.1377, Posadzy M, Desimpel J, Vanhoenacker FM. 2. “Staging of Osteochondral Lesions of the Talus: MRI and Cone Beam CT”. Lomax, A, Miller, RJ, Fogg, QA, Jane Madeley, N and Senthil Kumar, C. Quantitative assessment of the subchondral vascularity of the talar dome: A cadaveric study. {"url":"/signup-modal-props.json?lang=us\u0026email="}. Cone Beam Computed Tomography (CBCT) arthrography is better suited for precise staging of cartilage lesions. Subchondral bone involvement can be manifested by bone marrow edema (BME), fracture, sclerosis and/or cyst formation. The articular cartilage layer of the talocrural joint is indicated in blue. The majority of those lesions occur in active patients and are related to trauma. Later on, this grading system has been modified to computed tomographic evaluation and correlated with arthroscopy, distinguishing cystic lesion of talar dome seen in primary stages with or without communication to the articular surface and detached fragment in more advanced lesions [6]. GCT can mimic or be mimicked by other benign or malignant lesions at both radiologic evaluation and histologic analysis. This term covers a wide spectrum of pathologies including (sub)chondral contusion, osteochondritis dissecans, osteochondral fracture and osteoarthritis resulting from longstanding disease. Thus, “cyst” is not an accurate term for the lesions encountered at imaging of subchondral bone. Subchondral bone cysts commonly occur adjacent to a treated focal cartilage defect and are possibly connected to the joint cavity. Staging of Osteochondral Lesions of the Talus: MRI and Cone Beam CT. Journal of the Belgian Society of Radiology. 24) is an intraosseous cyst which occurs beneath an articular surface of a bone. DOI: https://doi.org/10.1007/s00256-015-2127-3, Berndt, AL and Harty, M. Transchondral fractures (osteochondritis dissecans) of the talus. Polesello G, Sakai DS, Ono NK, et al. Agten CA, Kaplan DJ, Jazrawi LM, et al. In our patients, from the follow-up X-ray and MRI we observed a satisfied regeneration of the subchondral bone without bone resorption or recurrence of the cyst, indicating that cancellous bone autograft is an effective method for treating subchondral cysts.Furthermore, the successful reconstruction of the subchondral bone significantly relieved the patients' symptoms, as the … The fracture can be seen as irregular linear or curvilinear subchondral low signal intensity structure near the subchondral bone plate of low signal intensity in T1-weighted images and also sometimes, but not always in T2-weighted images 1,2,4-8. In addition, the trabecular architecture of subchondral bone is far better visualized on CBCT than on CR. A modified grading system has been proposed by Hepple in 1999 [5] and by Dipaola et al. 280 (1): 21-38. 2016; 2016: 3594253. In particular cases also alternative diagnoses can be made on basis of CBCT (Figure 11). The overlying cartilage is difficult to assess on MRI but seems to be slightly inhomogeneous (white arrow). ADVERTISEMENT: Radiopaedia is free thanks to our supporters and advertisers. 48 (12): 1961-1974. Alternative diagnosis on CBCT compared to MRI. Stage 1 lesions are due to bone marrow contusion. Osteochondral lesions of the talus: A new magnetic resonance grading system with arthroscopic correlation. The purpose of this pictorial review is to illustrate the strength of each imaging method. (2016) AJR. Coronal reformatted CBCT-A (b) demonstrates more clearly the OCL fragment (arrow) separated from the adjacent talus by thin rim of surrounding contrast (arrowheads). Schematic drawing shows the basic anatomy of the talocrural joint (Figure 2a). DOI: https://doi.org/10.2106/00004623-198971080-00004, Lee, KB, Bai, LB, Park, JG and Yoon, TR. The weight-bearing joints such as the knee, hip, and ankle joints are more commonly affected ref. Subchondral cysts of the tibia secondary to osteoarthritis of the knee. [6, 20]. Rather, these subchondral lesions are typically lined by a connective tis-sue membrane, such as collagen [22–24] and All were located in the … Radiology department of the Onze Lieve Vrouwe Gasthuis, Amsterdam and the Rijnland hospital, Leiderdorp, the Netherlands Publicationdate 2010-04-10 In this article we will discuss a systematic approach to the differential diagnosis of bone tumors and tumor-like lesions. The location of the lesion at the talus is related to the mechanism of the injury and direction of the applied force (Figure 1). Anatomy of the talocrural joint. 44 (2): 102-5. (2010) AJR. Posadzy M, Desimpel J, Vanhoenacker FM. Stage 4 consists of a displaced fragment, often accompanied with surrounding bone marrow edema. The overlying cartilage is difficult to assess on MRI. The cartilage at the talar dome is slightly irregularly delineated (white arrow). Arthroscopic treatment of chronic osteochondral lesions of the talus: Long-term results. MRI coronal PD fat suppressed image (1.5 Tesla equipment) of the talocrural joint (c) with normal appearance of the thin cartilage layer (arrows) of intermediate signal, low signal of subchondral bone and homogenous bone marrow signal (stars). Moreover, despite several modifications of the staging systems on MRI, not all combination of the degree of involvement of the cartilage and subchondral bone are included and therefore these classification systems remain uncomprehensive, complicated and less valuable for use in daily routine. Coronal fat suppressed T2-WI (intermediate weighting) showing BME (white asterisk) at the lateral corner of the talar dome (a). DOI: http://doi.org/10.5334/jbr-btr.1377, Posadzy, Magdalena, Julie Desimpel, and Filip M. Vanhoenacker. Subchondral cysts are typically found within the hip joint. The etiology of subchondral cysts is unknown. Case 2: subchondral insufficiency fracture, subchondral insufficiency fracture of the knee, directly visible subchondral trabecular discontinuity on high resolution, signs of subcortical impaction visible as subchondral hyperdensity, grade 2: bone marrow edema with low signal intensity fracture line, grade 3: fluid-filled fracture line and cysts, grade 4: cortical collapse with a step off, concave, smooth half-moon/crescentic appearing necrotic segment, usually in conjunction with chondral damage. 17 Resnick D, Niwayama G, Coutts R. Subchondral cysts in arthritic disorders: pathologic and radiographic appearance of the hip joint. Physical examination should include evaluation of local tenderness and swelling. A subchondral fracture is a fracture of the trabecular cancellous bone just beneath the subchondral bone plate without disruption of the articular surface 1. Besides the limitations of MRI in this field, it is still considered the most comprehensive imaging modality of the ankle because of its capability to assess soft tissue and bone marrow abnormalities on a single examination. Symptoms of subchondral cystic lesions can be mild to severe and can be of an acute onset. In such a case, leave the cartilage alone and only check it with ankle arthroscopy. MRI allows for distinguishing normal cartilage from subchondral bone as well as evaluating the adjacent bone marrow, ligaments and other surrounding soft tissues (Figure 2c). 56 (6): 714-9. THE IMPORTANCE OF THE DIAGNOSIS OF SUBCHONDRAL FRACTURE OF THE FEMORAL HEAD, HOW TO DIFFERENTIATE IT FROM AVASCULAR NECROSIS AND HOW TO TREAT IT. 8. Ikemura S, Yamamoto T, Motomura G, et al. Because the plasticity of the cartilage in children and adolescents is higher than in adults, OCL lesions in young patients are often characterized by isolated subchondral bony changes without overlying cartilage disruption (Figure 5). CBCT-Arthrography (CBCT-A) of the talocrural joint, coronal reformatted image (d) showing smooth cartilage lining covering the normal subchondral bone of the talus (arrow) and tibia (arrowhead). Similar to the Outerbridge classification widely used in staging of cartilage lesions of the knee, a modified staging system for evaluation of the depth of cartilage defects with correlation to arthroscopy may be used in the ankle (Figure 10). 101, no. In adult patients, the depth of the cartilage lesions is often understaged (Figures 3 and 4). Nowadays MR staging of OCL on MRI is usually done by the Anderson classification [9], which is another modification of the initial staging system based on plain film evaluation by Berndt and Harty (Figure 6). There is slight irregular delineation of the cartilage (white arrow). Coronal (c, d) reformatted CBCT-A clearly shows an extensive cartilage lesion down to bone with adjacent cartilage flap (black arrow). (2019) Skeletal radiology. However, other arthritic conditions like rheumatoid arthritis also play a key role in an individual developing Subchondral Bone Cysts. Coronal reformatted CBCT-A (c) barely shows subtle subchondral sclerosis at the superolateral aspect of the talar dome and intact overlying cartilage. DOI: https://doi.org/10.1007/s00167-008-0607-x, Barr, C, Bauer, JS, Malfair, D, Ma, B, Henning, TD, Steinbach, L, et al. Disqus. MRI sensitivity in detection of OCL of the talus, correlated with arthroscopic correlation, varies according to different studies and has been reported as high as 81% [10]. Check for errors and try again. Osteonecrosis can develop when the lesion’s vascularity is disrupted. Subchondral cysts are a common finding in osteoarthritic knees. Foot Ankle Int. DOI: https://doi.org/10.1177/107110079902001206, Ferkel, RD, Zanotti, RM, Komenda, GA, Sgaglione, NA, Cheng, MS, Applegate, GR, et al. Subchondral bone cysts (SBCs) are sacs filled with fluid that form inside of joints such as knees, hips, and shoulders. Biomed Res Int. The presence of intraarticular contrast and high spatial resolution improves visualization of the cartilage surfaces compared to routine MRI on 1.5 Tesla. American journal of roentgenology. S2 (2017): 1. Cartilage damage may have a variable imaging appearance ranging from a small fissure, a distinct defect, flap formation or delamination. In fact, Subchondral Bone Cyst is one of the parameters that physicians look at when diagnosing osteoarthritis. 2017;101(S2):1. Recently, Cone Beam Computed Tomography (CBCT) of small joints has been introduced as an alternative technique for Multi Detector CT, combining a very high spatial resolution, low radiation dose and low cost [3]. The synovial fluid intrusion theory suggests that elevated intra-articular pressure forces joint fluid into the subchondral bone via fissured or ulcerated cartilage,, creating a cyst. Subchondral fractures are usually a consequence of compressive forces, transmitted from the cartilage to the subchondral bone plate and from there to the trabeculae, which fail to resist that force and break or fracture 3. What Is a Subchondral Bone Cyst? 468 (12): 3181-5. 3. Due to its noninvasiveness, absence of radiation exposure and its ability to visualize associated concomitant soft tissue abnormalities, MRI is the initial technique for exclusion/confirmation of an osteochondral lesion of the ankle. Cartilage thickness in cadaveric ankles: Measurement with double-contrast multi-detector row CT arthrography versus MR imaging. Joint preserving surgical treatments of subchondral fractures include microfracture, drilling, subchondroplasty 10, or in the hip joint: transtochanteric osteotomy 11. With widespread use of MR it is now not uncommon in clinical practice to observe this progression of findings. Subchondral fractures due to trauma can occur at any age. They can also occur in conjunction with twisting and ligamentous injuries. For staging of OCL of the talus several grading systems have been proposed. More severe symptoms tend to occur in the radiographically more advan… Stage 3 according to Anderson classification. Example of accurate staging of the status of the articular cartilage in paediatric OCL. 1986; 68(6): 862–5. (2016) Radiology. These patients have inferior outcomes for arthroscopic treatment of FAI compared with patients with similar age and activity level without MRI subchondral … Coronal PD fat suppressed MRI image (b) revealing BME (star) in the posteromedial part of the talar dome. As the bulk of the U.S. population ages, the prevalence of osteoarthritis is expected to rise. DOI: http://doi.org/10.5334/jbr-btr.1377, Posadzy, M., Desimpel, J., & Vanhoenacker, F. M. (2017). Location of the OCL according to the mechanism of trauma. MRI is an excellent imaging tool, able to detect osteoarthritis indicators such as chondromalacia (with a magnet strength of 1.5 T, it has a sensitivity of 100% for grade III and IV lesions) 20, 21, subchondral edema, and subchondral cysts … Smooth articular surfaces (arrows) of the talocrural joint with normal trabecular bone appearance (stars). Subchondral cysts are often a part of the joint degenerative process and occurs where there are breaks in the hip joint cartilage. 2004; 233(3): 768–73. 207 (6): 1257-1262. (2009) Osteoarthritis and cartilage. Almost always there will be associated bone marrow edema best appreciated in fat-saturated T2-weighted and intermediate or proton-density weighted images 4. At earlier stages (stage 1 to 4), a number of options exist including: When a small defect in the chondral plate is present, the intraarticular fluid will erode the subchondral bone, which will result in bone marrow edema. A subchondral cyst without superficial cartilage damage is rare and requires a different approach. This underscores the value of preoperative imaging. MR imaging of the ankle at 3 Tesla and 1.5 Tesla: Protocol optimization and application to cartilage, ligament and tendon pathology in cadaver specimens. These cysts are produced in areas of damaged articular cartilage, subjacent to the underlying subarticular cortical plate. The exact pathogenesis of these degenerative cysts is not certain.26,27 Subchondral cysts are most often seen in association with osteoarthritis, but may occur as the result of degeneration or injury of the overlying articular cartilage by other causes. As MRI is inaccurate for the evaluation of the articular cartilage compartment, further staging with direct arthrographic techniques are often mandatory if an OCL is detected on MRI and in those scenarios in which arthrosopic treatment is considered. Schematic drawings of OCL classification according to Anderson. Stage 2 refers to partial detachment of OCL with subchondral cyst formation or fissure incompletely separating the lesion from the talar dome. In the region of subchondral edema, in osteoarthritis the most common pathological changes are necrosis, fibrosis, and trabecular abnormalities . ... extends to the subchondral bone, and occurs in patients with closed physes (4 ... Skeletal Radiology, Vol. This process can evolve into cyst formation. Mr parameters, accurate cartilage evaluation remains often illusive intermediate or proton-density weighted images 2,4 in an developing... 1.5 Tesla theories on the evaluation and histologic analysis ) in the hip:. 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