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Journal of Radiological Review 2020 January-February;7(1):12-20

DOI: 10.23736/S2723-9284.19.00236-5

Copyright © 2019 EDIZIONI MINERVA MEDICA

language: English, Italian

Magnetic resonance study of femorotibial chondropathy with T2* Map sequences

Francesca CORSINI 1 , Giovanni MARCHETTO 1, Filippo CANDEO 2, Susi OSTI 3, Massimo FAVAT 1

1 ULSS 5 Polesana, Rovigo, Italy; 2 Orthopedic Trauma Center APSS, Pozza di Fassa, Trento, Italy; 3 Istat, Venice, Italy


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BACKGROUND: The early identification of cartilage degeneration in symptomatic patients undergoing articular magnetic resonance (MRI) of the knee is clinically important to establish an adequate and equally early therapeutic intervention to alleviate symptoms and slow down or even stop the rate of joint degeneration. MR imaging for the identification of cartilage inhomogeneities generally uses, in the standard protocols, Fast Gradient Echo T2* sequences (FGRE T2*), which, however, have a low sensitivity in the detection of early-stage alterations. Quantitative techniques such as T2* Map sequences can be used to better highlight changes in articular cartilage, diagnose disease in the early phase and perform post-treatment follow-up. Currently there are few studies concerning the potential of T2* Map sequences in early detecting chondropathy in symptomatic patients. Therefore, this study was performed to determine whether the addition of a T2* Map sequence to the standard 1.5T knee magnetic resonance (MRI) protocol could improve diagnostic performance in the detection of early-stage cartilage lesions, to compare the discriminative ability of the Fast Gradient Echo T2* (FGRE T2*) and T2* Map sequences in the quantification of femoral-tibial chondropathy and to examine the agreement between the two techniques in assessing the clinical stage of disease and the extent of the damage. The possibility of inserting the sequence within a standardized study protocol was evaluated for selected patients (young, with lesions in the initial stage), also in anticipation of loco-regional treatment with stem cells.
METHODS: Over a period of 6 months, 21 articulations of 19 symptomatic subjects (11 F and 8 M; average age 53) were examined with clinical suspicion of chondropathy, of which the medical and clinical characteristics were recorded. MR imaging was performed at 1.5 T using a routine protocol with the addition of a T2* Map sequence in the sagittal plane. The images were double-blinded by a radiologist expert in musculoskeletal radiology who determined the presence or absence of cartilage lesions on each articular surface, first using the routine MR protocol alone then using the routine MR protocol with T2 maps.
RESULTS: The T2* Map sequence showed greater diagnostic sensitivity for the early alterations compared to FGRE T2*: with the latter, most of the lesions found were classified as mild-intermediate, while with the former, most of the lesions were classified in the most advanced degree (P value <0.05). The outcome of the MRI examination also confirmed signs of joint inflammation in patients sent with clinical suspicion of chondropathy.
CONCLUSIONS: The T2* MAP sequence proved to be a valid, reproducible and more reliable tool than the FGRE T2* in the early diagnosis of patients with femorotibial chondropathy. The clinical-radiological concordance has proved to be very high, allowing the specialist to be better oriented in the formulation of a diagnostic and therapeutic conclusion.


KEY WORDS: Magnetic resonance imaging; Cartilage diseases; Knee

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