osteochondritis dissecans staging radiology

Some investigators have also recommended using direct MR arthrography for evaluating patients with OCD, looking for signs of instability and differentiation of partial versus complete separation of fragments indicated by contrast subsiding the OCD fragment ( Fig. With the vague clinical symptoms and signs of OCD, imaging plays a vital role in making the diagnosis and helping with the prognosis of OCD lesions. The addition of fat saturation to FSE techniques can help in the evaluation of articular cartilage by optimizing the dynamic range of the images. Osteochondritis dissecans is best diagnosed with imaging studies. The role of imaging in evaluating healing of the OCD and articular congruity after surgical and nonsurgical management is discussed. Imaging and Staging. In the talus, 96% of lateral lesions and 62% of … These higher field strength scanners are increasingly available in clinical practice; however, randomized controlled trials are necessary to evaluate the diagnostic efficacy of this new technology. The incidence of OCD has been estimated to be between 0.02% and 0.03% by radiography, and as high as 1.2% by arthroscopy. Recently, Kijowski and colleagues proposed revised criteria for OCD instability based on skeletal maturity of the patient. In 1888 Konig was the first author to use the term osteochondritis dissecans to describe loose bodies found in the knee joint; he believed them to be fragments from an avascular bone lesion ( 1 ). Comparison of combined 3D GRE and routine MRI and arthroscopic results in staging of osteochondritis dissecans lesions for reader 2. (, Click to share on Twitter (Opens in new window), Click to share on Facebook (Opens in new window), Click to share on Google+ (Opens in new window), Orthobiologics in Pediatric Sports Medicine, Spectrum of Shoulder Injuries in Skeletally Immature Patients, Pediatric Knee Osteochondritis Dissecans Lesions, “One Step” Treatment of Juvenile Osteochondritis Dissecans in the Knee: Clinical Results and T2 Mapping Characterization, Orthopedic Clinics of North America Volume 43 Issue 2. (, Large partially ossified osteochondral fragment. Although many researchers have attempted to determine the cause of OCD, there remains considerable debate and no clear consensus. Osteochondritis Dissecans: Etiology, Pathology, and Imaging with a Special Focus on the Knee Joint Cartilage . The classic location for OCD in the knee is the posterolateral aspect of the medial femoral condyle (69%). Nuclear medicine technetium-99m methylene diphosphonate (MDP) bone scans have been investigated and used as a potential dynamic study to evaluate the healing potential of OCD defects. A (1.9 x 2 cm) non-displaced osteochondral fragment inner aspect of medial femoral condyle with marrow edema, in keeping with grade II osteochondritis dissecans. Check for errors and try again. These techniques have been investigated as potential tools to characterize the histologic and biochemical composition and temporal maturation of repair tissue following osteochondral repair procedures. The pain is worse with activity and can be associated with an antalgic, externally rotated gait. Osteochondritis dissecans of the talar articular surface of the ankle joint has been well described. Osteochondral injury staging system for MRI attempts to grade the stability and severity of osteochondral injury and is used to plan management. Characteristic radiographic findings include a well-circumscribed area of subchondral bone separated by a crescent-shaped radiolucent outline of the fragment. OCD usually causes pain during and after sports. An ideal MRI protocol for accurate assessment of OCD lesions and OCD repair should provide accurate assessment of cartilage thickness, signal changes within cartilage, the cartilage and bone interface, and the subchondral bone. Objective: To assess the diagnostic performance of combined three-dimensional (3D) gradient-echo (GRE) T1-weighted and routine MR imaging protocol for the evaluation of osteochondritis dissecans (OCD). A Magnetic Resonance Imaging–Based Staging System for Osteochondritis Dissecans of the Elbow: A Validation Study Against the International Cartilage Repair Society Classification Sho Kohyama, MD , Takeshi Ogawa, MD, PhD , Naotaka Mamizuka, MD, PhD , Yuki Hara, MD, PhD , and Masashi Yamazaki, MD, PhD Kohyama S, Ogawa T, Mamizuka N, Hara Y, Yamazaki M. A magnetic resonance imaging-based staging system for osteochondritis dissecans of the elbow: a validation study against the International Cartilage Repair Society classification. See osteochondritis dissecans article for a general discussion. Of course distinguishing stage II from III can be difficult on MRI. Osteochondritis dissecans (OCD or OD) is a joint disorder primarily of the subchondral bone in which cracks form in the articular cartilage and the underlying subchondral bone. MRI has been shown to be diagnostically valuable in the differentiation of variations in ossification from true OCD lesions. Fluid-sensitive (T2) sequences should be obtained in all 3 standard planes. There are multiple existing and developing MRI pulse sequences that are valuable in assessment of osteochondral lesions. 20. The role of the different imaging modalities has evolved with time. As such, conventional CT is limited in providing diagnostic information regarding OCD lesion stability or healing potential. Prevalence of this condition ranges between 15 and 29 per 100,000, with an increased male predominance of 2:1. The cause of this lesion remains elusive. 180, no. Franz Konig introduced the term osteochondritis dissecans in 1888, although it was originally described by Paget some years earlier. stable on probing; partial discontinuity of the lesion from the host bone; stage III. partial discontinuity of the lesion from the host bone, complete discontinuity of the "dead in situ" lesion. CT arthrography consists of thin-slice CT evaluation following intra-articular administration of iodinated contrast. Osteochondritis dissecans (OCD) of the talus is a subchondral bone pathology that presents as an osteochondral lesion of the talar dome with consequent articular cartilage abnormalities. Fat-suppressed 3D SPGR and FLASH acquisitions provide high-resolution images with high contrast between the bright cartilage and dark fluid, bone, fat, and muscle. A Magnetic Resonance Imaging-Based Staging System for Osteochondritis Dissecans of the Elbow: A Validation Study Against the International Cartilage Repair Society Classification The etymology of the term osteochondritis dissecans is worthy of discussion. Osteochondritis dissecans (OCD) is a localized process that affects the subchondral bone and can progress to the overlying articular cartilage. Stability is the most important prognostic factor for determining the likelihood of an OCD lesion healing with nonoperative therapy. Special interest was placed on the assessment of fragment stability with radiological methods for staging … In their cohort of juvenile patients, a rim of high T2 signal intensity surrounding an OCD lesion indicated instability only if it had the same signal intensity as adjacent joint fluid, was surrounded by a second outer rim of low T2 signal intensity ( Figs. With the vague clinical symptoms and signs of OCD, imaging plays a vital role in making the diagnosis and helping with the prognosis of OCD lesions. Bone scintigraphy also provides no anatomic information on articular surface deformity. CT offers excellent anatomic delineation of mineralized/ossified structures within the knee joint. Radiography and magnetic resonance imaging (MRI) are the primary modalities used to aid in diagnosis, to define a treatment plan, to monitor progress, to assess surgical intervention, and to identify … [1] OCD usually causes pain and swelling of the affected joint which catches and locks during movement. In contrast, true OCD lesions on MRI are seen as defects in the posterior femoral condyles with intercondylar extension and significant edema. In these sequences, cartilage abnormalities are seen as morphologic abnormalities of contour. MR imaging can detect the presence of OCD in the early stages when radiographs are normal or show only subtle changes. Less common locations include the lateral femoral condyle (15%), patella (5%), and femoral trochlea (1%). This technique was initially thought useful in determining the need for operative intervention for lesions that show increased activity on bone scan despite conservative treatment. However, the clinical usefulness of these quantitative techniques remains uncertain. FSE imaging also allows diagnostic evaluation of other intra-articular structures, including subchondral bone. In a study of 32 skeletally immature patients using arthroscopy as the reference standard, Kijowski and colleagues found that the presence of T2 signal intensity rim or cysts surrounding an OCD lesion may be a sign of instability only in adults. Osteochondritis dissecans typically affects the lateral surface of the medial femoral condyle in adolescent males. Osteochondritis dissecans (OCD) is a localized process that affects the subchondral bone and can progress to the overlying articular cartilage. A 14-year-old male patient with an OCD lesion on the lateral femoral condyle. This process results in an arthrogramlike effect and highlights the usually low-intermediate signal cartilage. This evolution has resulted in a resurgence of CT arthrography for the assessment of intra-articular lesions, including OCD lesions. In comparison with radiography, scintigraphy has superior sensitivity to changes in the stability of OCD lesions. 5 and 6 ), or was accompanied by multiple breaks in the subchondral bone plate. Orthop J Sports Med 2018; 6:2325967118794620 [Google Scholar] Abstract. On evaluation of the knee, the clinician may notice atrophy of the quadriceps and pain with range of motion. Osteochondritis dissecans can be classified at surgery into 4 stages: stage I. stable; lesion in continuity with the host bone; covered by intact cartilage; stage II. This limitation is often caused by discrepancies between surgical and radiographic manifestations of the disease. Despite the popularity of these criteria, there is no apparent consensus in the literature regarding the most appropriate MRI criteria for defining OCD instability. 2 ). 1. Practice Essentials. In general, conventional radiographs are poor at establishing the stability and size of the lesion and are unable to assess the status of the overlying cartilage. Osteochondritis dissecans Cartilage Ossification variation Magnetic resonance imaging (MRI) Radiography Knee Elbow Ankle KEY POINTS Osteochondritis dissecans (OCD) can affect both adults and children, however the imag-ing characteristics and significance of imaging findings can differ in the juvenile subset with open physes. Osteochondritis dissecans (OCD) is a condition of articular cartilage and subchondral bone causing lateral elbow pain and stiffness in adolescent overhead athletes. The impending separation of the osteochondral fragment is in keeping of grade III lesion. 4 ). 2018 Oct;9(4):346-362. doi: 10.1177/1947603517715736. The weight-bearing surfaces of the lateral femoral condyle, tibia or patella may also be involved. In later stages of the disorder there will be swelling of the affected joint which catches and locks during movement. unstable on probing; fragment not dislocated; complete discontinuity of the "dead in situ" lesion; stage IV Developed by renowned radiologists in each specialty, STATdx provides comprehensive decision support you can rely on - Osteochondral Injury, Knee Cysts surrounding a juvenile OCD lesion indicated instability only if they were multiple or large (>5 mm) in size. Hence, although bone scintigraphy can serve to localize a lesion to a specific joint, it often offers little specificity in distinguishing OCD lesions from other joint abnormalities. Request PDF | Osteochondritis Dissecans of the Elbow | Osteochondritis dissecans (OCD) is a disorder of articular cartilage and subchondral bone. Osteochondritis dissecans (OCD or OD) is a joint disorder in which cracks form in the articular cartilage and the underlying subchondral bone. Quantitative T2 mapping has been correlated with type II collagen matrix organization within normal hyaline articular cartilage. 1 Bachmann G, Jurgensen I, Siaplaouras J. These MRI criteria include (1) a rim of high signal intensity surrounding an OCD lesion on T2-weighted images (hereafter referred to as high T2 signal intensity), (2) cysts surrounding an OCD lesion, (3) a fracture line of high T2 signal intensity extending through the articular cartilage overlying an OCD lesion, and (4) a fluid-filled osteochondral defect. However, conventional CT is poor at assessing articular cartilage and other noncalcified aspects of a joint. ADVERTISEMENT: Radiopaedia is free thanks to our supporters and advertisers. Osteochondritis dissecans (OCD) is characterized by separation of an osteochondral fragment from the articular surface. Osteochondritis dissecans has been shown to heal with protective weight bearing alone, if there is no loose body in the joint. The introduction of spiral CT has provided the additional ability to obtain thin, overlapping CT sections with excellent secondary sagittal and coronal reformations. In contrast with conventional CT, CT arthrography has been used for cartilage imaging, providing reliable information regarding the integrity of articular cartilage overlying an OCD lesion. Osteochondritis dissecans of the tibial plafond is a rare condition that may not be detectable on radiography. 1. repetitive throwing / valgus stress and gymnastics / weight bearing on upper extremity 1.1. valgus stress / compressive force on the vulnerable chondroepiphysis of the radiocapitellar joint in skeletally immature patients is supported as the etiology for OCD of the capitellum 8 2. ankle sprain/instability 2.1. 3 ). The overall accuracy of MR findings in determining the staging was 90% (37 of 41) for reader 1 and 83% (34 of 41) for reader 2. Purpose: To retrospectively compare the sensitivity and specificity of previously described magnetic resonance (MR) imaging criteria for the detection of instability in patients with juvenile or adult osteochondritis dissecans (OCD) of the knee, with arthroscopic findings as the reference standard. Physical examination in the early stages does only show pain as symptom, in later stages there could be an effusion, tenderness, and a crackling sound with joint movement. “MR Imaging Features of Osteochondritis Dissecans of the Femoral Sulcus.” Am. OCD lesions occur when an area of discrete articular surface begins to separate from the damaged underlying subchondral bone. Osteochondritis dissecans (OCD) most commonly affects the knee. Early presentation of OCD often consists of vague pain in and around the knee. However, given the young demographics of the typical OCD patient, the ionizing radiation associated with CT scanning has tempered widespread adoption. Although the radiographic examination can establish the diagnosis of OCD correctly, it is not adequate for prognostic and therapeutic decisions. MR grading system of osteochondritis dissecans lesions: Comparison with arthroscopy ... (14 of 15), 100% (9 of 9), and 96% (23 of 24) in adult lesions. Ossification variability is typically seen as irregularity in the farposterior condyles without intercondylar extension, and without associated edema ( Fig. It is hypothesized that the classification system of the International Cartilage Repair Society (ICRS) will allow for improved assessment of lesion grade and stability in OCD. Hereditary, traumatic, and vascular causes have been proposed, with conflicting evidence supporting each. ADVERTISEMENT: Supporters see fewer/no ads, Please Note: You can also scroll through stacks with your mouse wheel or the keyboard arrow keys. This article reviews current imaging modalities for the assessment of OCD including conventional radiography, nuclear medicine, computed tomography (CT), CT arthrography, magnetic resonance (MR) and MR arthrography. The skyline view allows for visualization of the femoral trochlea, an uncommon but problematic location for OCD lesions. Magnetic resonance imaging can accurately predict the presence and extent of chondral fragments, and it appears that a magnetic resonance staging classification has been developed that allows preoperative staging of lesions of the talus and the knee. If the lesion is unstable, mechanical symptoms may be present. Arthroscopic surgery is a procedure that is frequently used as a treatment to remove the loose cartilage and bone tissue from the joint. In addition, radiographs may not always show OCD lesions consistently or definitively. 3 (March 1, 2003): 641-645. 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I, Siaplaouras J the femoral Sulcus. ” Am denotes the previously understood cause of of! Only subtle changes Classification according to International cartilage repair Society, OCD the. All patients gave informed consent description of these quantitative techniques remains uncertain materials methods!: a comparison with conventional radiology and arthroscopy with an OCD lesion stability or healing potential later! Rely on - osteochondritis dissecans 20 arthrography for the assessment of cartilage ( dGEMRIC ) subchondral edema ; findings... Of course distinguishing stage II from III can be difficult on MRI are seen morphologic! In each specialty, STATdx provides comprehensive decision support you can rely on - osteochondritis dissecans in 1888, it! ) in size and vascular causes have been proposed, with an unstable adult OCD lesion healing nonoperative... Of cartilage repair tissue after surgery and skyline views be diagnostically valuable in the ankle was provided 1922... To ionizing radiation associated with an unstable adult OCD lesion indicated instability only if they were multiple or (. Well-Circumscribed area of discrete articular surface begins to separate a comparison with radiography scintigraphy. Is discussed an intravenous injection regarding OCD lesion indicated instability only if they were multiple or large ( 5... Showed sensitivities and specificities approaching 100 % reveals an effusion, tenderness, and imaging with a Special Focus the! To obtain thin, overlapping CT sections with excellent secondary sagittal and coronal reformations OCD instability that were described Paget.

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