Subchondral bone cysts commonly occur adjacent to a treated focal cartilage defect and are possibly connected to the joint cavity. Per the synovial fluid intrusion theory, one would expect those scores to indicate increased risk for incident SCs in the same subregion at follow-up. Radiographs were read in approximately 8 months without interruption. Copyright © 2009 Osteoarthritis Research Society International. SCs were defined as well-delineated areas of hyperintensity directly adjacent to the subchondral plate on STIR and proton density–weighted fat-suppressed MR images. Prevalent BMLs strongly predicted incident SCs in the same subregion longitudinally, even after adjustment for full-thickness cartilage loss, which supports the bone contusion theory of SC formation. The exact pathogenesis of these degenerative cysts is not certain. 6, 18 March 2011 | Rheumatology, Vol. 1, Clinics in Sports Medicine, Vol. (b) Sagittal proton density–weighted fat-suppressed MR image at 30-month follow-up shows an incident SC (arrow) in the middle of the BML depicted at baseline. In a study comparing MR imaging features with histologic findings in 19 patients after hip replacement, Taljanovic et al (11) found microfractures in different stages of healing and bone marrow necrosis in 100% of patients, and 85% had bone marrow fibrosis. 05, No. Because there is a high prevalence of BMLs in subregions exhibiting cartilage damage (20,21), we adjusted these results for the presence of concomitant BMLs when considering full-thickness cartilage loss as the predictor. First and probably most important is that no arthroscopic or histologic correlation was performed. Full-thickness cartilage loss is seen in this subregion at follow-up. 6, 22 September 2016 | Nature Reviews Rheumatology, Vol. There was no apparent relationship between severity of full-thickness cartilage loss at baseline and incident SCs. 42, No. 50, No. WORMS (whole-organ MR imaging score) , KOSS (knee osteoarthritis scoring system) , and BLOKS (Boston-Leeds osteoarthritis knee score) are such semiquantitative measurements in which the cartilage damage is assessed concomitant with other structures of the knee (e.g., menisci, subchondral bone, osteophytes, and synovial membrane) . 27, No. Tibiofemoral OA was considered present at radiography if the Kellgren-Lawrence grade was 2 or greater. Figure 4a: (a) Sagittal proton density–weighted fat-suppressed MR image at baseline shows a grade 1 BML at the anterior (trochlear) subregion of the lateral femur (arrowheads). These cysts are produced in areas of damaged articular cartilage, subjacent to the underlying subarticular cortical plate. 32, No. Keywords: bone marrow lesion, cyst, MRI, knee, osteoarthritis * Correspondence: Radiograph shows well-defined radiolucency in the lateral tibia representing a cystic lesion (arrow). We obtained written informed consent from all patients. A recent cross-sectional study (12) showed SCs to be highly associated with BMLs in the same subregion of the knee in patients with or at risk for knee OA, which favors the bone contusion theory of SC formation. 148, Clinical Reviews in Bone and Mineral Metabolism, Vol. BMLs were defined as poorly delineated areas of hyperintensity directly adjacent to the subchondral plate on STIR and proton density–weighted fat-suppressed MR images. 22, No. Structural abnormalities (osteophytes, cartilage loss, bone marrow lesions (BMLs), subchondral cysts, meniscal abnormalities, effusion, Baker's cyst) at 9 patellofemoral and tibiofemoral locations were scored following the knee OA scoring system. A longitudinal subanalysis of the individual BML and cartilage morphology grades was performed. 6, Seminars in Arthritis and Rheumatism, Vol. For interval developed subchondral cysts, the follow-up images showed 83% (10/12) cartilage lesions. Magnetic resonance imaging (MRI) of the knee joint is one of the most commonly requested in general radiological practise examinations and belongs to the core clinical practice in most MRI units along with spinal and brain MRI. Methods: The preoperative knee of 42 knee arthroplasty patients was scanned using QCT. Enter your email address below and we will send you your username, If the address matches an existing account you will receive an email with instructions to retrieve your username. Larger prevalent BMLs were associated with an increased incidence of SCs (Table 1). 23, No. Objective: To determine if a relationship exists between bone marrow edema-like signal and subchondral cysts on magnetic resonance imaging (MRI). Of 19 153 subregions analyzed initially, 663 (3.5%) exhibited SCs at baseline and were excluded. The presence and size of subchondral cysts and bone marrow edema-like lesions (BMLs) were scored semiquantitatively in each subregion on non-contrast-enhanced MRI from 0 to 3. Bone Biomarkers Related to Osteoarthritis, Bone turnover and articular cartilage differences localized to subchondral cysts in knees with advanced osteoarthritis, The Longitudinal Reliability and Responsiveness of the OMERACT Hand Osteoarthritis Magnetic Resonance Imaging Scoring System (HOAMRIS), Scoring hip osteoarthritis with MRI (SHOMRI): A whole joint osteoarthritis evaluation system, Subchondral Bone and Its Role in Osteoarthritis, Development and reliability of a multi-modality scoring system for evaluation of disease progression in pre-clinical models of osteoarthritis: celecoxib may possess disease-modifying properties, Three-dimensional analysis of subchondral cysts in hip osteoarthritis: An ex vivo HR-pQCT study, Iterative Development and Reliability of the OMERACT Hand Osteoarthritis MRI Scoring System, A pilot trial of intravenous pamidronate for chronic low back pain, Importance of subchondral bone in the pathogenesis and management of osteoarthritis from bench to bed, Quantification of bone marrow lesion volume and volume change using semi-automated segmentation: data from the osteoarthritis initiative, Bone cysts after osteochondral allograft repair of cartilage defects in goats suggest abnormal interaction between subchondral bone and overlying synovial joint tissues, Animal models of osteoarthritis for the understanding of the bone contribution, Lentiviral Small Hairpin RNA Knockdown of Macrophage Inflammatory Protein-1γ Ameliorates Experimentally Induced Osteoarthritis in Mice, High-resolution ultrasonography and 3.0 T magnetic resonance imaging in erosive and nodal hand osteoarthritis: high frequency of erosions in nodal osteoarthritis, Prevalent cartilage damage and cartilage loss over time are associated with incident bone marrow lesions in the tibiofemoral compartments: the MOST study, Animal models in OA: a means to explore bone, Magnetic Resonance Imaging of Subchondral Bone Marrow Lesions in Association with Osteoarthritis, Relationship between microstructure and degree of mineralization in subchondral bone of osteoarthritis: A synchrotron radiation µCT study, Detection of Osteophytes and Subchondral Cysts in the Knee with Use of Tomosynthesis, Targeting Bone Alleviates Osteoarthritis in Osteopenic Mice and Modulates Cartilage Catabolism, Early diagnosis to enable early treatment of pre-osteoarthritis, What makes osteoarthritis painful? 10.1016/j.joca.2006.05.011 [Google Scholar] Chan P. M. B., Wen C., Yang W. C., Yan C., Chiu K. (2017). Knee osteoarthritis (OA) is a painful and debilitating disease characterized by cartilage deterioration and altered subchondral bone. MOST study subjects were recruited and enrolled between June 2003 and March 2005. A geode is one of the common differential diagnoses of an epiphyseal lesion (lytic). No adjacent full-thickness cartilage loss is seen. Prevalent BMLs showed a strong association with incident SCs in the same subregion, with an odds ratio of 15.0 (95% confidence interval [CI]: 10.9, 20.5; P < .0001), compared with subregions without prevalent BMLs (Figs 3 and 4). The HIPAA-compliant protocol was approved by the institutional review boards of all participating centers, and written informed consent was obtained from all participants. She had reported that the Baker’s cyst had been there for many years and periodically aspirated by different doctors. Many subregions were excluded because they were not assessable, mainly because of motion artifacts or field inhomogeneity at baseline and/or at follow-up, which did not allow scoring of the features evaluated in these subregions (cartilage morphology, BMLs, and SCs). 2, 19 January 2011 | RadioGraphics, Vol. No adjacent full-thickness cartilage loss is seen. 41, No. A recent study (12) demonstrated that BMLs are highly associated with SCs in the same subregion of the knee. If readers disagreed on the presence of OA, readings were adjudicated by a panel of three readers (two nonauthors and D.T.F.). As the joint tries to repair itself, the remodeling of bone can often b… 12, No. A recommendation for terminology is provided and the relevance of these imaging findings for osteoarthritis (OA) research is emphasized. Subchondral bone cysts can happen with any type of arthritis, so rheumatoid arthritis can also cause it. The aim of this study was to test the synovial fluid intrusion versus the bone contusion theory of SC formation in subjects with or at risk for knee OA by evaluating the association of prevalent BMLs and full-thickness cartilage loss with incident SCs in the same subregion of the knee by using MR imaging. Med. To assess the association of prevalent bone marrow edema–like lesions (BMLs) and full-thickness cartilage loss with incident subchondral cyst–like lesions (SCs) in the knee to evaluate the bone contusion versus synovial fluid intrusion theories of SC formation. 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. 32, Osteoarthritis and Cartilage, Vol. Figure 3a: (a) Coronal STIR MR image at baseline shows a grade 1 BML at the central subregion of the medial tibia (arrowheads). Subchondral cysts have always been taught to be one of the cardinal radiological features of knee osteoarthritis but are not well understood. Readers cannot be blinded to features of relevance because those are depicted on the paired images and are seen simultaneously. 23, No. They're especially common at the knee or hip. In the present study, we showed that prevalent BMLs are strongly associated with incident SCs in the same subregion of the knee compared with those subregions without BMLs at baseline, which supports the bone contusion theory of SC formation. Finally, a reading bias toward SC when a BML or an area of full-thickness cartilage loss is present cannot be ruled out completely, although the reading experience of both our experts makes this less likely. Is Subchondral Acetabular Edema or Cystic Change on MRI a Contraindication for Hip Arthroscopy in Patients With Femoroacetabular Impingement? Table 1 Longitudinal Association between Prevalent BMLs and Incident SCs in the Same Subregion of the Knee. 1, © 2020 Radiological Society of North America, Bone marrow edema pattern in osteoarthritic knees: correlation between MR imaging and histologic findings, Prevalence and MRI-anatomic correlation of bone cysts in osteoarthritic knees, The cysts of osteoarthritis of the hip: a radiological and pathological study, Subchondral cysts (geodes) in arthritic disorders: pathologic and radiographic appearance of the hip joint, The pathological significance of intra-articular pressure, The pathological changes in degenerative arthritis of the hip and treatment by rotational osteotomy, Osteoarthritis of the knee: correlation of subchondral MR signal abnormalities with histopathologic and radiographic features, Magnetic resonance imaging (MRI) of the knee: a pattern approach for evaluating bone marrow edema, MRI-based semiquantitative assessment of subchondral bone marrow lesions in osteoarthritis research, Bone marrow edema pattern in advanced hip osteoarthritis: quantitative assessment with magnetic resonance imaging and correlation with clinical examination, radiographic findings, and histopathology, MRI-detected bone marrow edema-like lesions are strongly associated with subchondral cysts in patients with or at risk for knee osteoarthritis: the MOST study [abstr], MRI of bone marrow edema-like signal in the pathogenesis of subchondral cysts, A connective tissue disease screening questionnaire for population studies, Correlation of the development of knee pain with enlarging bone marrow lesions on magnetic resonance imaging, Non-fluoroscopic method for flexed radiography of the knee that allows reproducible joint-space width measurement [abstr], Radiological assessment of osteo-arthrosis, Whole-Organ Magnetic Resonance Imaging Score (WORMS) of the knee in osteoarthritis, A comparison of dedicated 1.0 T extremity MRI vs large-bore 1.5 T MRI for semiquantitative whole organ assessment of osteoarthritis: the MOST study, Change in MRI-detected subchondral bone marrow lesions is associated with cartilage loss: the MOST Study—a longitudinal multicentre study of knee osteoarthritis, A study of the prevalence and associations of subchondral bone marrow lesions in the knees of healthy, middle-aged women, Accuracy of T2-weighted fast spin-echo MR imaging with fat saturation in detecting cartilage defects in the knee: comparison with arthroscopy in 130 patients, Grading articular cartilage of the knee using fast spin-echo proton density-weighted MR imaging without fat suppression, Cartilaginous defects of the femorotibial joint: accuracy of coronal short inversion time inversion-recovery MR sequence, Open in Image No statistically significant differences were found for age (P = .97) and sex (P = .68) when considering subregions with incident SCs. 10, 1 December 2013 | The Journal of Rheumatology, Vol. Bone marrow lesions and subchondral bone pathology of the knee Kon, Elizaveta; Ronga, Mario; Filardo, Giuseppe; Farr, Jack; Madry, Henning; Milano, Giuseppe; Andriolo, Luca; Shabshin, Nogah 2016-06-01 00:00:00 Bone marrow lesions (BMLs) around the knee are a common magnetic resonance imaging (MRI) finding. 12, 1 September 2015 | The Journal of Rheumatology, Vol. Vet Radiol Ultrasound. Given the fact that magnetic resonance imaging (MRI) is being performed more frequently for assessment of the knee joint (e.g. Two musculoskeletal radiologists (F.W.R. No baseline full-thickness cartilage loss was detected in this subregion. The most common abnormalities were bone marrow necrosis, fibrosis, and trabecular abnormalities (1). An MRI visible cartilage abnormality was adjacent to 87% (20/23) of cysts. We assessed the longitudinal association of prevalent BMLs (score ≥ 1) and full-thickness cartilage loss (grades 2.5, 5, and 6) with incident SCs (score ≥ 1) on a per-subregion basis by using logistic regression with generalized estimating equations to account for correlations among the subregions within a knee (using one knee per person). are shareholders in and one author (F.W.R.) Degenerative cyst-like lesions in meniscus are a classic example. After HTO, the evolution of cysts was evaluated on MRI performed with a five year follow-up on the 72 knees with pre-operative cysts. Subchondral cyst–like lesions (SCs) are a common finding in patients with knee osteoarthritis (OA). 663 ( 3.5 % ) incident SCs, considered the outcome, were defined as having