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 [5] 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 [1] 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. 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