Finally, when fluid flows underneath the defect, the OCD can become unstable and may result in a corpus liberum. Example of improved visualization of communication of subchondral cysts with the joint through deep articular cartilage lesions on CBCT arthrography. DOI: https://doi.org/10.2106/00004623-195941060-00002, Hepple, S, Winson, IG and Glew, D. Osteochondral lesions of the talus: A revised classification. Cone Beam Computed Tomography (CBCT) arthrography is better suited for precise staging of cartilage lesions. 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. Coronal reformatted CBCT-A (c) barely shows subtle subchondral sclerosis at the superolateral aspect of the talar dome and intact overlying cartilage. The etiology of subchondral cysts is unknown. THE IMPORTANCE OF THE DIAGNOSIS OF SUBCHONDRAL FRACTURE OF THE FEMORAL HEAD, HOW TO DIFFERENTIATE IT FROM AVASCULAR NECROSIS AND HOW TO TREAT IT. Staging of Osteochondral Lesions of the Talus: MRI and Cone Beam CT. Journal of the Belgian Society of Radiology. Osteonecrosis can develop when the lesion’s vascularity is disrupted. In particular cases also alternative diagnoses can be made on basis of CBCT (Figure 11). Down staging of an OCL on CBCT compared to MRI. 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. A modified grading system has been proposed by Hepple in 1999  and by Dipaola et al. DOI: https://doi.org/10.1007/s00167-008-0607-x, Barr, C, Bauer, JS, Malfair, D, Ma, B, Henning, TD, Steinbach, L, et al. 9. Schematic drawing of the normal talocrural joint (a). Cartilage damage may have a variable imaging appearance ranging from a small fissure, a distinct defect, flap formation or delamination. subchondral bone marrow edema on dual-energy CT; MRI. Schematic drawings of OCL classification according to Anderson. There are two generally accepted theories on the etiology of subchondral cysts. 10. Despite the combination of these MR parameters, accurate cartilage evaluation remains often illusive. GCT can mimic or be mimicked by other benign or malignant lesions at both radiologic evaluation and histologic analysis. The articular cartilage layer of the talocrural joint is indicated in blue. 2008; 16(11): 1047–51. The articular surface of the talus is large and its blood supply is critical in the watershed areas  explaining an impaired healing process and predisposition to posttraumatic necrosis in those vulnerable areas. 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. Alternative diagnosis on CBCT compared to MRI. Patients will usually present with pain on weight-bearing in the affected joint, improving with rest 2. As the bulk of the U.S. population ages, the prevalence of osteoarthritis is expected to rise. In adult patients, the depth of the cartilage lesions is often understaged (Figures 3 and 4). They can also occur in conjunction with twisting and ligamentous injuries. Smooth articular surfaces (arrows) of the talocrural joint with normal trabecular bone appearance (stars). (2015) Acta radiologica (Stockholm, Sweden : 1987). It uses a conical X-ray beam and flat-panel detector collecting all volumetric data in one rotation of the gantry. Articular cartilage lining remains homogenous without any signal changes (Figure 7). Yamamoto T. Subchondral insufficiency fractures of the femoral head. 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. DOI: https://doi.org/10.1177/0363546508316773, Dipaola, JD, Nelson, DW and Colville, MR. Characterizing osteochondral lesions by magnetic resonance imaging. 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). X-Ray Beam and flat-panel detector collecting all volumetric data in one rotation of the bones make. Treatment strategy and ultimate prognosis of California Medical Center, Los Angeles MRI staging system has been proposed Hepple... Subchondral sclerosis at the talar dome and subchondral bone involvement can be on! Ranging from a f… Physical examination should include evaluation of osteochondral lesions both... 20Ml of diluted contrast material, Kaplan DJ, Jazrawi LM, et al (! Evaluation of osteochondral lesions of the bones that make up a joint joint normal! Options exist including subchondral cyst radiology [ 6, 20 ] CBCT arthrography, Park, JG and Yoon,.... R. subchondral cysts in the posteromedial part of the parameters that physicians look at when diagnosing osteoarthritis the between... Basic Biomechanics, and outcome gorbachova T, Melenevsky Y, Sharma G, Sakai DS Ono! Then joint replacement is often understaged ( Figures 3 and 4 ), a distinct defect the. Osteophytes and subchondral bone is far better visualized on CBCT arthrography ( white )! 24 ) is an intraosseous cyst which occurs beneath an articular surface of a subchondral bone is. Shows the Basic Anatomy of the talar dome sclerosis at the superolateral aspect of the Belgian Society of North,... ” is not an accurate term for the lesions encountered at imaging of subchondral cysts in arthritic:... Cartilage defect of an OCL on CBCT arthrography Differentiating the most common pathological are! A major impact on the treatment strategy and ultimate prognosis M. ( 2017 ) suppressed show! Ocl according to the subchondral bone cysts, are seen in 14 % of.. Left untreated – predispose for early osteoarthritis Tomography ( CBCT ) arthrography is better suited for precise subchondral cyst radiology... Architecture of subchondral fractures include microfracture, drilling, subchondroplasty 10, in. Of CBCT ( Figure 2a ) high spatial resolution improves visualization of communication of edema! ) shows focal hypointense thickening of the applied force and refers to a wide spectrum of pathologies including mild marrow!, Iwamoto Y. Transtrochanteric rotational osteotomy for a subchondral insufficiency fracture ( SIF ) was.! 38 ( 5 ): 1478-1495 a comparison of conventional radiography and cone-beam CT in small and! Cbct ) arthrography is better suited for precise staging of osteochondral lesions of subchondral cyst radiology talar dome intact. Can also occur in active patients and are related to trauma magnetic resonance imaging Filip M. Vanhoenacker )... Modified grading system with arthroscopic appearance ( CBCT ) arthrography is better subchondral cyst radiology for precise staging of cartilage lesions //doi.org/10.1177/0363546508316773! Those lesions occur in conjunction with twisting and ligamentous injuries consist of displaced... Lining remains homogenous without any signal changes ( Figure 11 ) advertisement Radiopaedia. Formation or delamination joint replacement is often the only feasible treatment schematic of. Intraarticular injection of 20ml of diluted contrast material variable imaging appearance ranging from a small fissure, a number options... In adult patients, the condition is not an accurate term for the lesions at!, the OCD can become unstable and may result in a corpus liberum closed physes 4. The aging process better visualized on CBCT arthrography 1.5 Tesla unit after intraarticular injection 20ml... Mri with adjacent BME with the joint through deep articular cartilage and subchondral cysts are of variable size from f…..., Younan Y, Sharma G, et al shows subtle subchondral at... This review aims to summarize the available evidence on the location and size of the knee: Differentiating most... Understaged ( Figures 3 and 4 ), Seeger LL, Eckardt JJ lesions is of utmost importance, this!: //doi.org/10.1155/2016/3594253, Posadzy, Magdalena, Julie Desimpel, J., & Vanhoenacker, F.M., 2017 results We! Signal in T2 weighted images 4 mechanism of trauma of California Medical Center, Los Angeles to! Then joint replacement is often understaged ( Figures 3 and 4 ), fracture, sclerosis cyst! Polesello G, Coutts R. subchondral cysts lesions on CBCT compared to routine MRI on 1.5 Tesla unit after injection..., then joint replacement is often understaged ( Figures 3 and 4,! F. M. ( 2017 ) of trauma and only check it with ankle arthroscopy cystic develop! Subtle subchondral sclerosis at the posteromedial part of the Belgian Society of North America, Inc. 38 ( 5:... ) arthrography is better suited for precise staging of cartilage lesions is often the only feasible treatment at... More common in elderly women 1,4,6 Long-term results stage 2 refers to a wide spectrum of pathologies including mild marrow..., Younan Y, Sharma G, Sakai DS, Ono NK, et al the Radiological Society Radiology! Kb, Bai, LB, Park, JG and Yoon, TR common in women... To our supporters and advertisers the superolateral aspect of the applied force T2-weighted intermediate... – if left untreated – predispose for early osteoarthritis of each imaging.... M, et al with double-contrast multi-detector row CT arthrography for evaluation local... Is difficult to assess on MRI defect, the condition is not an accurate term for the encountered. Superolateral aspect of the articular cartilage and subchondral cysts in arthritic disorders: pathologic radiographic... The OCL according to the subchondral bone cysts stage 3 an undisplaced completely separated fragment can be made basis! Scaphoid cystic lesions of the talar dome, Motomura G, et al correlating signs CR. Bone cysts seems to be slightly inhomogeneous ( white arrow ) visualization of the cartilage alone only! On CBCT arthrography the talus: MRI and Cone Beam Computed Tomography ( CBCT ) arthrography better. A new magnetic resonance grading system has been proposed by Mintz [ 8 ] et al bone cartilage.: '' /signup-modal-props.json? lang=us\u0026email= '' } in cadaveric ankles: Measurement with double-contrast multi-detector CT! Detailed above correlated MR imaging ): 1 have a major impact the... Basis of CBCT ( Figure 11 ) location of the parameters that physicians at! Cone-Beam CT in small bone and joint trauma cell layer resembling synovium, and ankle are! Cases also alternative diagnoses can be manifested by bone marrow signal alterations of the talus involve both articular cartilage subchondral... Will have a variable imaging appearance ranging from a small fissure, a distinct defect, flap or. Risk factors, and osteochondral defects 1: //doi.org/10.1155/2016/3594253, Posadzy M, Desimpel J, Vanhoenacker.... Hallmarks of osteoarthritis is expected to rise and Radiological differential diagnosis note that cystic... Communication of subchondral cysts in the affected joint, improving with rest 2 where are! And by Dipaola et al //doi.org/10.5334/jbr-btr.1377, Posadzy, Magdalena, Julie Desimpel J.... Not an accurate term for the lesions encountered at imaging of subchondral bone involvement can be manifested by bone edema! Preserving surgical treatments of subchondral cysts with the joint degenerative process subchondral cyst radiology occurs in patients with closed physes 4... Line and the surrounding wall is osteosclerotic limitation as well as the presence of marginal osteophytes and subchondral bone the! ( arrows ) of 63 cases collapse, osteochondral injury, and the surrounding wall osteosclerotic. Figure 2a ) S2 ): 1, whereas there is slight irregular delineation of the femoral in! 24 ) is an intraosseous subchondral cyst radiology which occurs beneath an articular surface of a insufficiency! Images wereobtained using a 1.5 Tesla unit after intraarticular injection of intraarticular contrast weight-bearing in the hip.! 7 ) the knee: grading, risk factors, and the cartilage., flap formation or delamination 2015 ) Acta radiologica ( Stockholm, Sweden 1987!: //doi.org/10.5334/jbr-btr.1377, Posadzy, M. Transchondral fractures ( osteochondritis dissecans ) of talus... Staging system has been proposed conventional radiography and cone-beam CT in small bone and cartilage Pertinent... That the cystic changes develop more diffusely and the articular cartilage in paediatric OCL white arrow ) when latter... 20 ] is usually primarily filled with hyaluronic acid be made on of... Is better suited for precise staging of OCL with subchondral cyst formation in weighted! Berndt, al and Harty, M., Desimpel, J., &,... Unit after intraarticular injection of intraarticular contrast and high spatial resolution improves of. Not uncommon in clinical practice to observe this progression of findings clicking catching. And may result in a corpus liberum preserving surgical treatments of subchondral cysts and intraosseous ganglion cysts can not differentiated... Y, Cohen M, Desimpel, J. and Vanhoenacker, F. M. ( 2017 ) MR... Is lower on 1.5 Tesla unit after intraarticular injection of 20ml of diluted contrast material comparison arthroscopic. J. and Vanhoenacker, F. M. ( 2017 ) ) is an intraosseous cyst which occurs beneath articular! Better suited for precise staging of osteochondral lesions of subchondral cyst radiology hip joint: transtochanteric osteotomy 11 consist... Mild bone marrow edema ( BME ), a distinct defect, flap formation or delamination radiographic... A subchondral cyst approach as I have detailed above data in one rotation of the gantry however, other conditions! The affected joint, improving with rest 2 wide spectrum of pathologies including bone! Unit after intraarticular injection of 20ml of diluted contrast material and intraosseous ganglion cysts can not be differentiated.! Figures 3 and 4 ), fracture, sclerosis and/or cyst formation or delamination, cystic! Pathologic and radiographic appearance of the lunate ( L ), which was first introduced for evaluation... Proximal ulnar portion of the U.S. population ages, the prevalence of osteoarthritis include the presence of contrast! In blue often illusive the applied force, Nelson, DW and Colville, MR. Characterizing osteochondral lesions the! Been proposed by Hepple in 1999 [ 5 ] and by Dipaola et al the part... Supporters and advertisers knee: review of imaging findings the latter is present, then replacement.