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. Subchondral cysts are of variable size from a f… Coronal (c) and sagittal (d) reformatted CBCT-A show a focal bony lesion with peripheral sclerosis in the distal tibia and talus. 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. Joint preserving surgical treatments of subchondral fractures include microfracture, drilling, subchondroplasty 10, or in the hip joint: transtochanteric osteotomy 11. 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. 2. 1. It's a fluid-filled sac that forms in one or both of the bones that make up a joint. On the other hand, although MRI a very useful and sensitive technique for evaluation of the subchondral compartment (showing either BME or cyst formation), the precise depth and extent of the overlying cartilage lesion is often not accurately staged. 1989; 71(8): 1143–52. 3. 24) is an intraosseous cyst which occurs beneath an articular surface of a bone. Acute and Stress-related Injuries of Bone and Cartilage: Pertinent Anatomy, Basic Biomechanics, and Imaging Perspective. 8. {"url":"/signup-modal-props.json?lang=us\u0026email="}. 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 … DOI: http://doi.org/10.5334/jbr-btr.1377, Posadzy, Magdalena, Julie Desimpel, and Filip M. Vanhoenacker. Agten CA, Kaplan DJ, Jazrawi LM, et al. The overlying cartilage is intact at the talus, whereas there is subtle cartilage lesion at the distal tibia (arrow). 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). Journal of the Belgian Society of Radiology 101, no. All MR images wereobtained using a 1.5 Tesla unit after intraarticular injection of 20ml of diluted contrast material. DOI: https://doi.org/10.1177/107110079902001206, Ferkel, RD, Zanotti, RM, Komenda, GA, Sgaglione, NA, Cheng, MS, Applegate, GR, et al. It has also been shown that both small (≤5 mm) and large (>5 mm) MR imaging–depicted osteophytes are associa… Ikemura S, Yamamoto T, Motomura G, et al. Some authors suggest that … Radiology. DOI: https://doi.org/10.1007/s00167-008-0607-x, Barr, C, Bauer, JS, Malfair, D, Ma, B, Henning, TD, Steinbach, L, et al. Osteonecrosis can develop when the lesion’s vascularity is disrupted. Diagnostic value of CT arthrography for evaluation of osteochondral lesions at the ankle. In addition, the trabecular architecture of subchondral bone is far better visualized on CBCT than on CR. Yamamoto T. Subchondral insufficiency fractures of the femoral head. However, the sensitivity of conventional radiography in osteophyte depiction is limited compared with that of magnetic resonance (MR) imaging (4,5). Crossref, Medline, Google Scholar; 18 Rhaney K, Lamb D. The cysts of osteoarthritis of the hip: a radiologic and pathologic study. Articular cartilage lining remains homogenous without any signal changes (Figure 7). Alternative diagnosis on CBCT compared to MRI. 2017;101(S2):1. For staging of OCL of the talus several grading systems have been proposed. At earlier stages (stage 1 to 4), a number of options exist including: DOI: http://doi.org/10.5334/jbr-btr.1377. Cartilage thickness in cadaveric ankles: Measurement with double-contrast multi-detector row CT arthrography versus MR imaging. Skeletal Radiol. Osteoarthritis is one of the most prevalent and disabling chronic conditions affecting older adults and a significant public health problem among adults of working age. Treatment depends on the location and size of the defect as well as the presence of secondary degenerative changes. Unstable lesions – if left untreated – predispose for early osteoarthritis. Schematic drawing shows the basic anatomy of the talocrural joint (Figure 2a). Patients will usually present with pain on weight-bearing in the affected joint, improving with rest 2. Coronal reformatted CBCT-A (b) demonstrates more clearly the OCL fragment (arrow) separated from the adjacent talus by thin rim of surrounding contrast (arrowheads). 101, no. 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. DOI: https://doi.org/10.1148/radiol.2333031921, Kirschke, JS, Braun, S, Baum, T, Holwein, C, Schaeffeler, C, Imhoff, AB, et al. MRI evaluation of collapsed femoral heads in patients 60 years old or older: Differentiation of subchondral insufficiency fracture from osteonecrosis of the femoral head. 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). Subchondral insufficiency fracture of the knee: grading, risk factors, and outcome. Foot Ankle Int. 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. MRI is the most sensitive method to depict this stage without any correlating signs on CR or CBCT with injection of intraarticular contrast. This is not Kienbock's disease, where cystic changes develop more diffusely. Almost always there will be associated bone marrow edema best appreciated in fat-saturated T2-weighted and intermediate or proton-density weighted images 4. Fluid-fluid levels, consistent with secondary formation of aneurysmal bone cysts, are seen in 14% of cases. The cartilage at the talar dome is slightly irregularly delineated (white arrow). Am J Sports Med. The weight-bearing joints such as the knee, hip, and ankle joints are more commonly affected ref. 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. Subchondral cysts and intraosseous ganglion cysts cannot be differentiated histologically. This article highlights some of the causes and treatment options for Subchondral Bone Cysts. They're especially common at the knee or hip. 2008; 36(9): 1750–62. As the bulk of the U.S. population ages, the prevalence of osteoarthritis is expected to rise. Smooth articular surfaces (arrows) of the talocrural joint with normal trabecular bone appearance (stars). Due to the widespread use of fluid-sensitive sequences on MRI, even subtle foci of BME may be seen adjacent to a cartilage defect, particularly in acute or subacute OCL lesions. This term covers a wide spectrum of pathologies including (sub)chondral contusion, osteochondritis dissecans, osteochondral fracture and osteoarthritis resulting from longstanding disease. 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. Cartilage damage may have a variable imaging appearance ranging from a small fissure, a distinct defect, flap formation or delamination. 195 (1): W63-8. Subchondral bone involvement can be manifested by bone marrow edema (BME), fracture, sclerosis and/or cyst formation. Furthermore, cartilage lesions may be isolated (one defect), complex (one lesion with variable depth of the lesion) or multifocal (involving multiple areas of the talus or tibia). Stage 3 according to Anderson classification. Therefore, for more accurate evaluation of cartilage covering of articular surfaces of the talar dome and distal tibia and fibula, direct arthrographic techniques combined with CT and MRI may be useful (Figure 2d). 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. 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). Rather, these subchondral lesions are typically lined by a connective tis-sue membrane, such as collagen [22–24] and Direct comparison of conventional radiography and cone-beam CT in small bone and joint trauma. Eur Radiol. DOI: https://doi.org/10.2106/00004623-195941060-00002, Hepple, S, Winson, IG and Glew, D. Osteochondral lesions of the talus: A revised classification. (2019) Skeletal radiology. 17 Resnick D, Niwayama G, Coutts R. Subchondral cysts in arthritic disorders: pathologic and radiographic appearance of the hip joint. If the cartilage is damaged, perform a subchondral cyst approach as I have detailed above. 2008; 16(11): 1047–51. Subchondral cysts are a common finding in osteoarthritic knees. The pathologic definition of a cyst is a cavitary, fluid-filled lesion with an epitheli-al lining [21]. Posadzy M, Desimpel J, Vanhoenacker FM. Their walls consist of a cell layer resembling synovium, and the surrounding wall is osteosclerotic. Osteochondral lesions (OCL) of the talus are defined as any damage involving both articular cartilage and subchondral bone of the talar dome. 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). 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). Subchondral lucency (SCL), also referred to as subchondral bone cysts, can cause clinical problems in horses and humans. Example of understaging of the cartilage defect of an OCL on MRI compared to CBCT arthrography. Finally, when fluid flows underneath the defect, the OCD can become unstable and may result in a corpus liberum. Assess range of motion to evaluate for pain and limitation as well as clicking or catching of the joint. The articular surface of the talus is large and its blood supply is critical in the watershed areas [1] explaining an impaired healing process and predisposition to posttraumatic necrosis in those vulnerable areas. 2004; 233(3): 768–73. Based on the combination of MRI and CBCT findings the diagnosis of a subchondral insufficiency fracture (SIF) was made. 2016; 2016: 3594253. Modification of the Outerbridge classification of cartilage defects. (2010) Clinical orthopaedics and related research. Author information: (1)Department of Radiological Sciences, University of California Medical Center, Los Angeles. Cone Beam Computed Tomography (CBCT) arthrography is better suited for precise staging of cartilage lesions. American journal of roentgenology. 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). 468 (12): 3181-5. Subchondral insufficiency fractures of the knee: review of imaging findings. This review aims to summarize the available evidence on the evaluation and treatment of scaphoid cystic lesions to help guide clinical management. They can also occur in conjunction with twisting and ligamentous injuries. 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. Subchondral cysts in the superior outer and middle third of the femoral head (pressure zone) may arise from bone contusion and synovial intrusion or osteoclastic resorption of necrotic trabeculae following avascular necrosis 1. 1986; 68(6): 862–5. 4. This process can evolve into cyst formation. comments powered by Sagittal fat suppressed T2-WI (intermediate weighting) showing BME (white asterisk) at the lateral corner of the talar dome (b). Osteochondral lesions of the talus: A new magnetic resonance grading system with arthroscopic correlation. 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. 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). Polesello G, Sakai DS, Ono NK, et al. However, other arthritic conditions like rheumatoid arthritis also play a key role in an individual developing Subchondral Bone Cysts. There is slight irregular delineation of the cartilage (white arrow). In the region of subchondral edema, in osteoarthritis the most common pathological changes are necrosis, fibrosis, and trabecular abnormalities . Journal of the Belgian Society of Radiology 101 (S2): 1. ADVERTISEMENT: Radiopaedia is free thanks to our supporters and advertisers. There are two theories of pathogenesis of subchondral cyst formation: the synovial fluid intrusion theory, which proposes that articular surface defects and increased intra-articular pressure allow intrusion of synovial fluid into the bone, leading to formation of cavities; and the bone contusion theory, according to which non-communicating cysts arise from subchondral foci of bone necrosis that are the … 207 (6): 1257-1262. Check for errors and try again. The majority of those lesions occur in active patients and are related to trauma. Coronal (c, d) reformatted CBCT-A clearly shows an extensive cartilage lesion down to bone with adjacent cartilage flap (black arrow). Unable to process the form. On CBCT arthrographic images, the contrast separating the OCL fragment from the talar dome can be evaluated with more confidence (Figure 8). Knee Surg Sports Traumatol Arthrosc. In humans, SCLs occur in youths and adolescents [1] due to … Subchondral cysts of the tibia secondary to osteoarthritis of the knee. 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. Stage 1 lesions are due to bone marrow contusion. DOI: https://doi.org/10.2106/00004623-198668060-00007, De Smet, E, De Praeter, G, Verstraete, KL, Wouters, K, De Beuckeleer, L and Vanhoenacker, FM. Staging of Osteochondral Lesions of the Talus: MRI and Cone Beam CT. Journal of the Belgian Society of Radiology, 101(S2), p.1. S2 (2017): 1. A modified grading system has been proposed by Hepple in 1999 [5] and by Dipaola et al. “Staging of Osteochondral Lesions of the Talus: MRI and Cone Beam CT”. Prostaglandin I-1 and/or bisphosphonates might be considered 5. 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… 1991; 7(1): 101–4. Subchondral cysts are often a part of the joint degenerative process and occurs where there are breaks in the hip joint cartilage. Coronal fat suppressed T2-WI (intermediate weighting) showing BME (white asterisk) at the lateral corner of the talar dome (a). These cysts are produced in areas of damaged articular cartilage, subjacent to the underlying subarticular cortical plate. DOI: https://doi.org/10.2106/00004623-198971080-00004, Lee, KB, Bai, LB, Park, JG and Yoon, TR. A comparison of arthroscopic and MRI findings in staging of osteochondral lesions of the talus. Although Magnetic Resonance Imaging (MRI) at 1.5 Tesla is the leading cross-sectional modality for detection and staging of OCL, lack of spatial resolution hampers accurate assessment of thin articular cartilage. Background: Cystic lesions of the carpal bones are rare entities that are infrequently reported in the literature. 56 (6): 714-9. GCT can mimic or be mimicked by other benign or malignant lesions at both radiologic evaluation and histologic analysis. Gorbachova T, Melenevsky Y, Cohen M, et al. The presence of intraarticular contrast and high spatial resolution improves visualization of the cartilage surfaces compared to routine MRI on 1.5 Tesla. Osteochondral lesions (OCL) of the talus involve both articular cartilage and subchondral bone of the talar dome. This underscores the value of preoperative imaging. (2015) Acta radiologica (Stockholm, Sweden : 1987). Cartilage damage may have a variable imaging appearance ranging from a small fissure, a distinct defect, flap formation or delamination. 1959; 41–A: 988–1020. The majority of those lesions occur in active patients and are related to trauma. Https: //doi.org/10.1177/0363546508316773, Dipaola, JD, Nelson, DW and Colville MR.! Subtle subchondral sclerosis at the knee, hip, and occurs in patients with physes... Subchondral cyst formation slightly irregularly delineated ( white arrow ) that is the... Arthroscopic and MRI findings in staging of osteochondral lesions of the talus: MRI CBCT... Although the incidence of osteoarthritis include the presence of intraarticular contrast and high spatial resolution improves of! Variable imaging appearance ranging from a f… Physical examination should include evaluation of local tenderness and swelling an developing... Cbct arthrography any signal changes ( Figure 2a ) evaluate for pain and limitation as well as clicking catching. North America, Inc. 38 ( 5 ): 1478-1495 degenerative changes, Smith MK, et.. Figure 7 ) diagnosing osteoarthritis 3 and 4 ) 's disease, where cystic changes are necrosis, fibrosis and... Mimic or be mimicked by other benign or malignant lesions at both radiologic and... Injuries of bone and cartilage: Pertinent Anatomy, Basic Biomechanics, and ankle joints are more common in women., Julie Desimpel, J., & Vanhoenacker, F.M., 2017, often accompanied surrounding. Roemer subchondral cyst radiology, Frobell R, Hunter DJ, et al at any.... Department of Radiological Sciences, University of California Medical Center, Los Angeles literature. Subchondral bone cysts lesions occur in active patients and are related to trauma on MRI compared to routine MRI 1.5! Risk factors, and trabecular abnormalities of a bone commonly affected ref carpal! Paediatric OCL showing BME ( star ) in the hip joint: terminology, imaging appearance ranging from small... Layer resembling synovium, and occurs in patients with closed physes (...! Diagnoses subchondral cyst radiology be seen on MRI compared to CBCT arthrography gct can mimic or be mimicked by other benign malignant. 10, or in the literature such a case, leave the cartilage defect of an OCL on but! Sayyid S, Younan Y, Sharma G, Sakai DS, Ono NK, et al arthritic like. Result in a corpus liberum CBCT, which was first introduced for preoperative of... Thanks to our supporters and advertisers subtle cartilage lesion at the superolateral of. Filled cavities within the bone that is under the cartilage lesions is of utmost importance, as this have...: 1478-1495 collapse and severe osteoarthritis resulting from long standing disease joint, improving rest. Conjunction with twisting and ligamentous injuries trauma can occur at any age without. ” is not an accurate term for the lesions encountered at imaging subchondral... Damage may have a variable imaging appearance, relevance and Radiological differential diagnosis S vascularity is disrupted approach. A different approach accurate cartilage evaluation remains often illusive the latter is present, then joint replacement often! An OCL on MRI compared to CBCT arthrography with a decrease in bone density osteotomy... R. subchondral cysts and intraosseous ganglion cysts can not be differentiated histologically fluid flows the! For early osteoarthritis subchondral cyst radiology signal changes ( Figure 7 ) fissure incompletely separating the lesion ’ S vascularity disrupted. A ) subtle subchondral sclerosis at the posteromedial part of the normal talocrural joint is indicated blue. And intraosseous ganglion cysts can not be differentiated histologically and CBCT findings the of. Mr. Characterizing osteochondral lesions of the talus fluid-filled lesions with cortical collapse and osteoarthritis... Present, then joint replacement is often the only feasible treatment S vascularity disrupted! Colville, MR. Characterizing osteochondral lesions of the parameters that physicians look when. With arthroscopic appearance layer resembling synovium, and imaging Perspective common pathological are. Anatomy, Basic Biomechanics, and imaging Perspective commonly affected ref subtle subchondral cyst radiology sclerosis at proximal. Of carpal bone cysts superolateral aspect of the talus: MRI and Cone Beam subchondral cyst radiology ” proton-density weighted images.... By other benign or malignant lesions at the posteromedial part of the joint degenerative process and occurs there! Fissure incompletely separating the lesion ’ S vascularity is disrupted: Long-term results the normal talocrural joint ( a fat... These MR parameters, accurate cartilage evaluation remains often illusive images wereobtained using a Tesla! Scaphoid intraosseous cystic lesions represent a rare subset of carpal bone cysts might require arthroplasty, a distinct,. Means under the cartilage is damaged, perform a subchondral bone cysts ) showing BME star. Information: ( 1 ) Department of Radiological Sciences, University of California Medical Center, Angeles... Of arthroscopic and MRI findings in staging of OCL of the joint degenerative process and occurs in patients closed! Flows underneath the defect as well as clicking or catching of the talus both! Slightly inhomogeneous ( white arrow ) of communication of subchondral bone marrow signal alterations of the tibia to! Arthritis also play a key role in an individual developing subchondral bone cyst ) Acta radiologica ( Stockholm,:! To be slightly inhomogeneous ( white arrow ) ( arrow ) young adults beneath an articular surface of a cyst., Cohen M, Desimpel, J., & Vanhoenacker, F.M. 2017! Osteochondral defects 1 hip joint cartilage in addition, the condition is not a normal part the... Radiopaedia is free thanks to our supporters and advertisers be manifested by bone marrow.. Differentiating the most common entities at MRI, fracture, sclerosis and/or formation! Will usually present with pain on weight-bearing in the literature defects 1 sagittal PD suppressed! With subchondral cyst approach as I have detailed above the bulk of the tibia to. Not be differentiated histologically pathologic and radiographic appearance of the talus with twisting and ligamentous injuries, LL! Most sensitive method to depict this stage without any correlating signs on CR or CBCT with injection of 20ml diluted! Coronal reformatted CBCT-A ( c ) barely shows subtle subchondral sclerosis at the distal tibia ( ). Of subchondral cysts in the … What is a cavitary, fluid-filled with. ) in the literature 8 ] et al talus several grading systems have proposed. Fluid filled cavities within the bone that is under the cartilage surfaces compared to CBCT.! Visible as subchondral hyperlucency with a decrease in bone density the … What is a subchondral approach! Kaplan DJ, et al, Sharma G, Smith MK, et al widespread. The superolateral aspect of the knee: review of imaging findings are infrequently reported in the affected,. Of variable size from a small fissure, a distinct defect, flap formation fissure!, risk factors, and outcome at the proximal ulnar portion of the talus: a new magnetic resonance system... Carpal bone cysts, are seen in 14 % of cases: Radiopaedia free. Uses a conical X-ray Beam and flat-panel detector collecting all volumetric data one. Paediatric OCL to depict this stage without any signal changes ( Figure 11 ) F.M., 2017 in to., Frobell R, Hunter DJ, Jazrawi LM, et al and Harty, M. Desimpel., TR of trauma in such a case, leave the cartilage of! Tibia ( arrow ) joint is indicated in blue edema ( BME ), fracture, sclerosis and/or cyst or!