Radiology
HOME HELP FEEDBACK SUBSCRIPTIONS ARCHIVE SEARCH TABLE OF CONTENTS
QUICK SEARCH:   [advanced]


     

Published online before print February 20, 2007, 10.1148/radiol.2431060294
This Article
Right arrow Abstract Freely available
Right arrow Figures Only
Right arrow Full Text (PDF)
Right arrow All Versions of this Article:
2431060294v1
243/1/180    most recent
Right arrow Submit a response
Right arrow Alert me when this article is cited
Right arrow Alert me when eLetters are posted
Right arrow Alert me if a correction is posted
Right arrow Citation Map
Services
Right arrow Email this article to a friend
Right arrow Similar articles in this journal
Right arrow Similar articles in PubMed
Right arrow Alert me to new issues of the journal
Right arrow Download to citation manager
Right arrow reprints & permissions
Citing Articles
Right arrow Citing Articles via HighWire
Right arrow Citing Articles via Google Scholar
Google Scholar
Right arrow Articles by Saupe, N.
Right arrow Articles by Weishaupt, D.
Right arrow Search for Related Content
PubMed
Right arrow PubMed Citation
Right arrow Articles by Saupe, N.
Right arrow Articles by Weishaupt, D.
(Radiology 2007;243:180-187.)
© RSNA, 2007

Musculoskeletal Imaging

MR Imaging of Cartilage in Cadaveric Wrists: Comparison between Imaging at 1.5 and 3.0 T and Gross Pathologic Inspection1

Nadja Saupe, MD, Christian W. A. Pfirrmann, MD, Marius R. Schmid, MD, Thomas Schertler, MD, Mirjana Manestar, MD and Dominik Weishaupt, MD

1 From the Department of Diagnostic Radiology, University Hospital Zurich, Raemistrasse 100, CH-8091 Zurich, Switzerland (N.S., T.S., D.W.); the Department of Radiology, Orthopedic University Hospital Balgrist, Zurich (C.W.A.P., M.R.S.); and the Institute of Anatomy, University of Zurich (M.M.). Received February 15, 2006; revision requested April 20; revision received June 8; final version accepted August 1. Address correspondence to N.S. (e-mail: nadja.saupe{at}balgrist.ch).


   ABSTRACT
TOP
 ABSTRACT
MATERIALS AND METHODS
 RESULTS
 DISCUSSION
 ADVANCES IN KNOWLEDGE
 References
 
Purpose: To evaluate prospectively the diagnostic accuracy of magnetic resonance (MR) imaging in the identification of cartilage abnormalities at 3.0 and 1.5 T in cadaveric wrists, with gross pathologic findings as the standard of reference.

Materials and Methods: The study was approved by the hospital review board, and informed consent for scientific use of body parts had been provided by the subjects. Ten cadaveric wrists from nine subjects were evaluated (seven left wrists, three right; five women, four men; age range, 46–99 years; mean age, 80 years). All wrists were examined with MR imaging in a 1.5-T unit and a 3.0-T unit, with the same imaging protocol used with both systems. Imaging protocol included intermediate-weighted fast spin-echo sequences and three-dimensional gradient-recalled-echo sequences. Cartilage surfaces of the proximal and distal carpal row, including the scaphotrapeziotrapezoidal joint, were analyzed in blinded fashion by two musculoskeletal radiologists working independently and then in consensus. Open inspection of the wrists was used as the standard of reference. Sensitivity, specificity, accuracy, and positive and negative predictive values were calculated. The McNemar test was used to assess differences in diagnostic assessment. Weighted {kappa} values were calculated for interobserver agreement.

Results: One hundred seventy cartilage surfaces were graded. The sensitivity and specificity for cartilage lesions were 43%–52% and 82%–89%, respectively, at 1.5 T and 48%–52% and 82% at 3.0 T. Differences in assessment did not reach statistical significance (P > .99). Highest sensitivities were found in the proximal carpal row (67%–71%); lowest sensitivities were found in the distal carpal row (14%–24%). Interobserver agreement was higher for imaging at 3.0 T ({kappa} = 0.634) than at 1.5 T ({kappa} = 0.267).

Conclusion: The performance of MR imaging for the detection of articular cartilage abnormalities in the wrist depends on anatomic location. Interobserver agreement is higher for imaging at 3.0 than at 1.5 T, but diagnostic performances were not significantly different (P > .99) at either field strength.

© RSNA, 2007

Magnetic resonance (MR) imaging has become an important diagnostic tool for evaluation of wrist pain. MR imaging has been shown to be accurate in the evaluation of tears of the central disk of the triangular fibrocartilage complex (1–5), tears of the scapholunate and lunotriquetral ligaments (6–10), and tendon abnormalities (11).

Despite the clinical importance of cartilage lesions of the radiocarpal and intercarpal joints, the role of MR imaging in this regard has not been well investigated. To the best of our knowledge, there are only sparse data regarding the diagnostic performance of MR imaging in the assessment of wrist cartilage (6,12,13). The paucity of data might be due to the fact that the hyaline articular cartilage layers of the radiocarpal and intercarpal joints are relatively thin (14), making assessment of cartilage lesions difficult. Optimization of cartilage imaging with MR imaging has evolved in two directions: quantitative techniques (15–17) and morphologic techniques based on new imaging sequences performed at up to 1.5 T or with higher magnetic field strengths (18–20). Early data showed promising visualization of wrist cartilage with 3.0-T imaging (21).

To the best of our knowledge, there have not been any published articles comparing MR imaging of the cartilage at 3.0 with that at 1.5 T in cadaveric wrists. Thus, the purpose of our study was to evaluate prospectively the diagnostic accuracy of MR imaging in the identification of cartilage abnormalities in cadaveric wrists at 3.0 and 1.5 T, with gross pathologic findings as the standard of reference.


   MATERIALS AND METHODS
TOP
 ABSTRACT
 MATERIALS AND METHODS
RESULTS
 DISCUSSION
 ADVANCES IN KNOWLEDGE
 References
 
Specimens
Ten cadaveric wrists from nine subjects (seven left wrists, three right; five women, four men; age range, 46–99 years; mean age, 80 years) were evaluated between March and April 2004. All cadavers were randomly selected by an anatomist (M.M.), who used a table of random numbers to do so. Clinical history, including reports of prior trauma, was not available for any of the subjects. The specimens were exarticulated at the elbow joint and consisted of a whole forearm, including the hand. For fixation, all specimens were perfused with a mixture of the following substances: formalin; chloral hydrate; calcium chloride; a mixture of formalin, glyoxal, and glutaraldehyde (Almudor; Isspest Control, Dietikon, Switzerland); and water. This mixture contains an overall formalin concentration of 2.8%. All specimens were from persons who had donated their bodies to the anatomic institute of our university (University Hospital Zurich, Zurich, Switzerland) and had provided informed consent for scientific use of their body parts. Our hospital's review board approved our study and allows such studies to be performed with a general permit issued by the responsible state agency; our study was conducted in accordance with institutional policies.

Imaging
All cadavers were examined with (a) a 1.5-T MR unit (Signa Excite HD; GE Medical Systems, Milwaukee, Wis) with a quadrature four-channel phased-array wrist coil and (b) a 3.0-T unit (Gyroscan Intera; Philips Medical Systems, Best, the Netherlands) with a rectangular surface coil design (loop size, 10 x 20 cm).

The same sequences were performed and the same parameters used with both MR systems (1.5 and 3.0 T): a coronal fat-suppressed intermediate weighted fast spin-echo (SE) sequence (repetition time msec/echo time msec, 1800/24; field of view [FOV], 8 x 8 cm; section thickness, 2 mm; intersection gap, 0.5 mm; image matrix, 512 x 256; number of signals acquired [NSA], four; echo train length, four; receiver bandwidth, 25 kHz at 1.5 T and 56 kHz at 3.0 T), a coronal fat-suppressed three-dimensional gradient-recalled-echo (GRE) sequence (3.0-T system, three-dimensional fast field echo; 1.5-T system, three-dimensional GRE) (40–45/12–15; flip angle, 25°; matrix, 512 x 256; FOV, 8 x 8 cm; NSA, three; section thickness, 1 mm; no intersection gap), and a coronal intermediate-weighted fast SE sequence without fat suppression (3000/42; FOV, 8 x 8 cm; section thickness, 2 mm; intersection gap, 0.5 mm; image matrix, 512 x 256; NSA, four; echo train length, five; receiver bandwidth, 25 kHz at 1.5 T and 56 kHz at 3.0 T).

Image Analysis
Two radiologists (C.W.A.P., D.W.) with 7 and 9 years of professional experience in musculoskeletal radiology, respectively, interpreted the imaging data (first independently, then in consensus) for both imaging modalities and for all 10 specimens. Neither radiologist was involved in image acquisition or gross anatomic inspection. Images obtained at 1.5 and 3.0 T were interpreted separately, with an interval of 6 weeks between reading sessions. The studies were presented to the readers in a different order during the first and second reading sessions to avoid a bias from memorizing. All MR images were interpreted at a workstation (Advantage Windowing Workstation; GE Medical Systems Europe, Buc, France).

For study purposes, the assessable cartilage surfaces were divided into the following anatomic regions: the proximal carpal row, the distal carpal row, and the scaphotrapeziotrapezoidal (STT) joint (Fig 1). The cartilage surfaces of the proximal carpal row included all surfaces of the radiocarpal joint (ie, cartilage between the radius and lunate and radius and scaphoid bones), the lunotriquetral joint (ie, cartilage between the lunate bone and triquetrum), and the scapholunate joint (ie, cartilage between the lunate and scaphoid bones). The cartilage surfaces were evaluated separately on each side of the joint. Accordingly, in the proximal carpal row, 70 cartilage surfaces were theoretically assessable.


Figure 1
View larger version (154K):
[in this window]
[in a new window]
[Download PPT slide]
  		Figure 1: Drawing over coronal radiograph shows assessed cartilage surfaces by anatomic region. 1, In proximal carpal row (dashed lines), cartilage surfaces of the radiocarpal, lunotriquetral, and scapholunate joints were assessed. 2, In distal carpal row (dotted line), cartilage surfaces of the hamatotriquetral, lunocapitate, and scaphocapitate joints were assessed. 3, In STT joint 3 (solid lines), cartilage surfaces of the scaphotrapezial and scaphotrapezoidal joints were assessed.

 
The cartilage surfaces of the distal carpal row included all surfaces of the hamatotriquetral joint (ie, cartilage between the hamate bone and triquetrum), the lunocapitate joint (ie, cartilage between the capitate and lunate bones), and the scaphocapitate joint (ie, cartilage between the scaphoid and capitate bones). The cartilage surfaces were evaluated separately on each side of the joint. Accordingly, in the distal carpal row, 60 cartilage surfaces were theoretically assessable.

The cartilage surface of the STT joint included all cartilage between the scaphoid and trapezium and between the scaphoid and the trapezoid. The cartilage surfaces were evaluated separately on each side of the joint. Accordingly, at the STT joint, 40 cartilage surfaces were theoretically assessable. In addition, if a hamatolunate facet was present, the cartilage between the hamate and lunate bones was evaluated. Hence, a total of 178 cartilage surfaces were analyzed in the study.

Each cartilage surface was described as normal or abnormal on the basis of increased signal intensity on the intermediate-weighted images, visualized articular defects, or subchondral marrow changes suggestive of overlying articular defects (6). The macroscopic grading of cartilage defects was based on a modified Outerbridge classification, as follows: a grade of 0 indicated normal cartilage (corresponding to modified Outerbridge classification grade 0) (Fig 2); a grade of 1, cartilage softening and swelling, as well as mild surface fibrillation and/or less than 50% loss of cartilage thickness (corresponding to modified Outerbridge grades 1 and 2) (Fig 3); a grade of 2, severe surface fibrillation and/or loss of more than 50% of cartilage thickness but without exposure of subchondral bone (corresponding to modified Outerbridge classification grade 3); and a grade of 3, complete loss of cartilage with subchondral bone exposure (corresponding to modified Outerbridge classification grade 4) (Fig 4) (22,23).


Figure 2
View larger version (115K):
[in this window]
[in a new window]
[Download PPT slide]
  		Figure 2: Coronal intermediate-weighted fat-suppressed 3.0-T MR image (FOV, 8 x 8 cm; section thickness, 2 mm; intersection gap, 0.5 mm; echo train length, five; 3000/42; matrix, 512 x 256; NSA, four) shows normal homogeneous compact cartilage between lunate and hamate bones. No morphologic alterations or signal intensity abnormalities are seen in distal carpal row in lunocapitate joint. There is no defect of lunate and hamate cartilage in lunocapitate joint (arrows). The cartilage was given a grade of 0 by both readers.

 

Figure 3
View larger version (139K):
[in this window]
[in a new window]
[Download PPT slide]
  		Figure 3: Coronal intermediate-weighted fat-suppressed 1.5-T MR image (FOV, 8 x 8 cm; section thickness, 2 mm; intersection gap, 0.5 mm; echo train length, five; 3000/42; matrix, 512 x 256; NSA, four) shows grade 1 lesion with subtle superficial cartilage contour abnormalities. In radiolunate joint, slight irregularities and superficial cartilage fibrillations are seen (arrows). Adjacent normal regular cartilage with smooth surface (arrowheads) is also seen in proximal carpal row, without a cartilage defect. Lunate cartilage in radiolunate joint shows a grade 1 lesion.

 

Figure 4
View larger version (127K):
[in this window]
[in a new window]
[Download PPT slide]
  		Figure 4: Coronal intermediate-weighted fat-suppressed 3.0-T MR image (FOV, 8 x 8 cm; image percentage, 100%; section thickness, 2 mm; intersection gap, 0.5 mm; echo train length, four; 1800/24; matrix, 512 x 256; NSA, four) shows grade 2 and 3 cartilage defects. Grade 2 cartilage defect is present in scapholunate joint. Cartilage contour appears inhomogeneous and deranged, with fissuring to level of bone but without exposed bone (long arrow). Additionally, a grade 3 lesion is noted in lunate cartilage surface, with severe alteration of cartilage, loss of substance, full-thickness injury (short arrow), and exposed lunate bone (arrowheads).

 
Gross Pathologic Inspection
Within 1 month after MR imaging, all cadaveric wrists were inspected jointly by an anatomist (M.M.) with 27 years of experience and a radiologist (M.R.S.) with 6 years of experience in musculoskeletal radiology. During the interval between imaging and anatomic analysis, the specimens were again fixed in the formalin mixture described above. Each observer graded the degree of cartilage defects by using the same grading system and anatomic map used for MR image analysis. Both readers were blinded to the imaging findings. The results of this gross pathologic inspection served as the standard of reference.

Statistical Analysis
A power analysis was performed before we started our study. An {alpha} error level or confidence level of 5% and a ß error level or statistical power (1 – ß) of 80% was used. A sample size of 10 enabled confidence within the required confidence ranges.

Sensitivity, specificity, positive predictive value, negative predictive value, and accuracy with a 95% confidence interval were calculated, with cadavers used as the primary sampling units to address the correlation of ratings within the same cadaver. A survey data analysis was performed by using software (Intercooled Stata, version 9.2; Stata, College Station, Tex). For statistical analysis, cartilage lesion grades 0 and 1 were analyzed together, as were grades 2 and 3.

Statistical significance was calculated with the Wilcoxon signed rank test; differences with P values less than .05 were considered significant. Weighted {kappa} values for interobserver agreement were calculated at both field strengths with software (SPSS, version 11.0; SPSS, Chicago, Ill). According to Landis and Koch (24), {kappa} values of 0.20 or less indicate poor agreement; {kappa} values of 0.21–0.40, fair agreement; {kappa} values of 0.41–0.60, moderate agreement; {kappa} values of 0.61–0.80, good agreement; and {kappa} values of 0.81–1.00, very good agreement.


   RESULTS
TOP
 ABSTRACT
 MATERIALS AND METHODS
 RESULTS
DISCUSSION
 ADVANCES IN KNOWLEDGE
 References
 
All randomly selected cadaveric wrists satisfied the criteria for inclusion and underwent the index test and the reference standard evaluation. The flow diagram in Figure 5 shows the design of the study.


Figure 5
View larger version (16K):
[in this window]
[in a new window]
[Download PPT slide]
  		Figure 5: Flow diagram of study on diagnostic accuracy shows abnormal and normal results and presence or absence of the target condition for consensus readings at 3.0 and 1.5 T.

 
At gross pathologic inspection, 64 grade 0 lesions (36%), 25 grade 1 lesions (14%), 20 grade 2 lesions (11%), and 69 grade 3 lesions (39%) were found (Figs 6, 7). The highest proportion of grade 2 and 3 lesions (Table 1) was found in the STT joint (82%) (Fig 8), followed by the second (hamatolunate) facet (75%). In the proximal carpal row, grade 0 and 1 lesions were most frequent (70%). A hamatolunate facet was found in four of 10 (40%) cadaveric wrists at gross pathologic and radiologic assessment.


Figure 6A
View larger version (121K):
[in this window]
[in a new window]
[Download PPT slide]
  		Figure 6a: Cornonal intermediate-weighted fat-suppressed MR images (FOV, 8 x 8 cm; image percentage, 100%; section thickness, 2 mm; intersection gap, 0.5 mm; echo train length, four; 1800/24; matrix, 512 x 256; NSA, four) obtained at (a) 3.0 T and (b) 1.5 T show grade 3 cartilage defect (thick arrow) with severe alteration and inhomogeneity of cartilage in distal carpal row between the hamate and lunate bones. Subchondral marrow changes in hamate bone are also demonstrated (arrowheads). Image quality is better at 3.0 T; subchondral marrow changes are better visualized, and interface between cartilage of hamate bone and that of capitate bone (thin arrows) is visible as hypointense small band. Despite these findings, the grade 3 cartilage defect is clearly shown on both images.

 

Figure 6B
View larger version (120K):
[in this window]
[in a new window]
[Download PPT slide]
  		Figure 6b: Cornonal intermediate-weighted fat-suppressed MR images (FOV, 8 x 8 cm; image percentage, 100%; section thickness, 2 mm; intersection gap, 0.5 mm; echo train length, four; 1800/24; matrix, 512 x 256; NSA, four) obtained at (a) 3.0 T and (b) 1.5 T show grade 3 cartilage defect (thick arrow) with severe alteration and inhomogeneity of cartilage in distal carpal row between the hamate and lunate bones. Subchondral marrow changes in hamate bone are also demonstrated (arrowheads). Image quality is better at 3.0 T; subchondral marrow changes are better visualized, and interface between cartilage of hamate bone and that of capitate bone (thin arrows) is visible as hypointense small band. Despite these findings, the grade 3 cartilage defect is clearly shown on both images.

 

Figure 7A
View larger version (126K):
[in this window]
[in a new window]
[Download PPT slide]
  		Figure 7a: (a) Proximal gross anatomic specimen obtained in 96-year-old woman with grade 3 cartilage defect in lunate and scaphoid cartilage surface (arrows). Cartilage is in central areas of lunate bone (L), and a scaphoid bone (S) is completely absent. (b) Corresponding coronal intermediate-weighted fat-suppressed 1.5-T MR image (FOV, 8 x 8 cm; image percentage, 100%; section thickness, 2 mm; intersection gap, 0.5 mm; echo train length, four; 1800/24; matrix, 512 x 256; NSA, four) also shows grade 3 defect with loss of cartilage and a full-thickness tear of both cartilage surfaces (arrow); the exposed bone is also detectable, with increased signal intensity in subchondral lunate bone ((L) arrowheads). S = scaphoid bone.

 

Figure 7B
View larger version (142K):
[in this window]
[in a new window]
[Download PPT slide]
  		Figure 7b: (a) Proximal gross anatomic specimen obtained in 96-year-old woman with grade 3 cartilage defect in lunate and scaphoid cartilage surface (arrows). Cartilage is in central areas of lunate bone (L), and a scaphoid bone (S) is completely absent. (b) Corresponding coronal intermediate-weighted fat-suppressed 1.5-T MR image (FOV, 8 x 8 cm; image percentage, 100%; section thickness, 2 mm; intersection gap, 0.5 mm; echo train length, four; 1800/24; matrix, 512 x 256; NSA, four) also shows grade 3 defect with loss of cartilage and a full-thickness tear of both cartilage surfaces (arrow); the exposed bone is also detectable, with increased signal intensity in subchondral lunate bone ((L) arrowheads). S = scaphoid bone.

 

View this table:
[in this window]
[in a new window]

  		Table 1. Cartilage Lesion Grades at Gross Pathologic Inspection

 

Figure 8
View larger version (158K):
[in this window]
[in a new window]
[Download PPT slide]
  		Figure 8: Coronal intermediate-weighted fat-suppressed 1.5-T MR image (FOV, 8 x 8 cm; image percentage, 100%; section thickness, 2 mm; intersection gap, 0.5 mm; echo train length, four; 1800/24; matrix, 512 x 256; NSA, four) shows grade 3 cartilage defect in scaphotrapezoidal joint. Full-thickness cartilage loss (arrow) of scaphoidal cartilage surface is depicted. Additionally, the trapezoid bone is exposed, with only slightly increased signal intensity of subchondral trapezoid bone (arrowheads). S = scaphoid bone, T = trapezium.

 
In the STT joint, sensitivity, specificity, and accuracy were 64%, 57%, and 63% for both MR field strengths. Sensitivity, specificity, and accuracy, respectively, in the detection of grade 2 and 3 cartilage abnormalities of the hamatolunate facet were 17%, 100%, and 88% at 1.5 T and 83%, 100%, and 88% at 3.0 T.

Considering all 178 cartilage surfaces, interobserver agreement for detection of cartilage lesion detection was fair ({kappa} = 0.27) at 1.5 T and good ({kappa} = 0.63) at 3.0 T. Considering the 170 surfaces without the hamatolunate facet, there were no significant differences in detection between field strengths (1.5 and 3.0 T) for reader 1 (P = .480), reader 2 (P > .99), or the consensus reading (P > .99). There were also no significant differences in the detection of grade 2 and 3 lesions between readers 1 and 2 for either field strength (1.5 T: P = .606; 3.0 T: P > .99) (Table 2). Tables 3 and 4 show results for the proximal and distal carpal rows, respectively.


View this table:
[in this window]
[in a new window]

  		Table 2. Detection of Grade 2 and 3 Cartilage Defects at 1.5 and 3.0 T

 

View this table:
[in this window]
[in a new window]

  		Table 3. Detection of Grade 2 and 3 Cartilage Defects in Proximal Carpal Row at 1.5 and 3.0 T

 

View this table:
[in this window]
[in a new window]

  		Table 4. Detection of Grade 2 and 3 Cartilage Defects in Distal Carpal Row at 1.5 and 3.0 T

 

   DISCUSSION
TOP
 ABSTRACT
 MATERIALS AND METHODS
 RESULTS
 DISCUSSION
ADVANCES IN KNOWLEDGE
 References
 
Accurate, and preferably noninvasive, diagnostic tools for assessing cartilage are desirable. MR imaging is currently the most-used imaging technique for assessment of cartilage. In addition to improved MR sequences such as intermediate-weighted fast SE sequences, spoiled GRE sequences, and steady-state free precession (25), advanced techniques such as T2 mapping are increasingly used to evaluate cartilage (26).

MR imaging has been demonstrated to be effective for depicting chondral lesions in large joints, such as the knee, with relatively thick cartilage surfaces, up to 7 mm (27–30). Currently, with an optimized technique and magnetic field strengths up to 1.5 T, 79% of in vivo focal cartilage lesions in the knee joint have been detected, without use of intraarticular or intravenous contrast media (31). The diagnostic performance of MR imaging for cartilage lesions in large joints can likely be improved with the availability of 3.0-T imagers. Results of early studies in sheep cadaver limbs (32) have shown that the use of three-dimensional GRE fat-suppressed sequences can result in an area under the receiver operating characteristic curve of 0.88 at 3.0 T (compared with 0.85 at 1.5 T). The application of steady-state free precession–based techniques has demonstrated the highest increase in signal-to-noise ratio and contrast-to-noise ratio in the knee cartilage of volunteers (20,32). In a recently published study by Masi et al (31) that involved use of a porcine knee cartilage model and fat-saturated intermediate-weighted fast SE sequences, 90% of focal cartilage lesions in knee cartilage were detected at 3.0 T.

The role of MR imaging in the assessment of cartilage in small joints, such as the wrist, has not been extensively investigated (33–35). In small joints, the thickness of the cartilage is 1.5 mm on average (0.4–2.1 mm for hyaline cartilage in the superior tibial and inferior talar portion of the ankle joint and 1.23 mm in humeral head articular cartilage [34,35], compared with the average cartilage thickness of 7 mm in the knee joint) (27–30). The difference in cartilage thickness between large and small joints probably explains the weak diagnostic performance of MR imaging for cartilage defects in joints such as the wrist.

In a retrospective study, Haims et al (6) evaluated the diagnostic performance of MR imaging for cartilage lesions in the distal radius, scaphoid, lunate, and triquetrum in patients with wrist pain by using T1-weighted SE and fat-suppressed T2 and two-dimensional spoiled GRE sequences with a 1.5-T imager. The authors found sensitivities of 18%–41% and specificities of 75%–93% for focal cartilage defects of the proximal carpal row. Compared with the results of that study (6), our results show increased sensitivities for the detection of cartilage defects, varying between 44% and 54%. The higher diagnostic performance observed in our study may be explained by the fact that we used cadavers, in which the possibility of degradation by artifacts is less likely than with in vivo imaging.

Although the overall sensitivities and specificities for the detection of grade 2 and 3 cartilage defects were higher at 3.0 than at 1.5 T, there was no significant difference between these two field strengths in our study. This is in contradiction to the findings of Masi et al (31), who demonstrated a significantly higher performance of 3.0-T MR imaging compared with 1.5-T imaging in the detection of cartilage defects in a porcine knee cartilage model. Nevertheless, we found better interobserver agreement for detection of grade 2 and 3 cartilage lesions at 3.0 than at 1.5 T.

One probable explanation for our finding of no significant difference between field strengths is that we did not use an optimized or dedicated wrist coil with the 3.0-T MR system. At the time of our study, no dedicated wrist coil was available for that system. Preliminary work by Bauer et al (36) has shown that with an optimized coil design, up to a threefold increase in signal-to-noise ratio may be obtained with 3.0- versus 1.5-T imaging. Another explanation could be the imaging protocol, in that we did not use sequences optimized for 3.0-T systems. Our study results have shown that the sensitivities and specificities of MR imaging for the detection of cartilage defects vary depending on anatomic location for both 1.5- and 3.0-T field strengths. In comparison with Haims et al (6), who reported sensitivities of only 18%–41% for focal cartilage lesion detection in the proximal carpal row (lunate cartilage, 41%; distal radius, 27%; triquetrum, 18%; scaphoid, 31%), we recorded the highest sensitivities (67%–71%) in the proximal carpal row at 1.5 and 3.0 T, with coronal intermediate-weighted fat-suppressed fast SE sequences.

In our study, the lowest sensitivities were found in the distal carpal row, for cartilage abnormalities of the hamatotriquetral, lunocapitate, and scaphocapitate joints. These sensitivities, for both field strengths, ranged from only 14% to 24%. Possible explanations for these results include the strong volar extrinsic and collateral ligaments of the wrist, which restrict the visibility of intercarpal cartilage owing to volume averaging.

We acknowledge the following limitations in our study. As already noted, we did not use an optimized or dedicated wrist coil with the 3.0-T MR system; none was available at the time of our study for our 3.0-T system. We did not use sequences optimized for 3.0-T systems but rather used the same sequences employed at 1.5 T. The current availability of optimized 3.0-T sequences, such as those involving the variable-flip-angle strategy (37,38), may help transition the potential benefits of 3.0-T MR systems into clinical practice. We also did not use intraarticular contrast material, which results of several studies (39–41) have shown might increase the diagnostic performance of MR imaging for cartilage lesions. Another limitation of our study was the fact that no histologic analysis was performed. A histologic analysis of the cartilage surfaces would have been of particular interest in the cases of false-positive findings at MR imaging. Finally, we studied cadaveric specimens and not patients, so no clinical data were available about the presence or duration of wrist pain.

In conclusion, the results of our study have shown that the performance of MR imaging in demonstrating articular cartilage abnormalities of the wrist depends on the location of these abnormalities. Interobserver agreement was better for imaging at 3.0 than at 1.5 T. No difference in diagnostic performance was found between 3.0 and 1.5 T.


   ADVANCES IN KNOWLEDGE
TOP
 ABSTRACT
 MATERIALS AND METHODS
 RESULTS
 DISCUSSION
 ADVANCES IN KNOWLEDGE
References
 


   FOOTNOTES
 

Abbreviations: FOV = field of view • GRE = gradient-recalled echo • NSA = number of signals acquired • SE = spin echo • STT = scaphotrapeziotrapezoidal

Authors stated no financial relationship to disclose.

Author contributions: Guarantors of integrity of entire study, N.S., D.W.; study concepts/study design or data acquisition or data analysis/interpretation, all authors; manuscript drafting or manuscript revision for important intellectual content, all authors; approval of final version of submitted manuscript, all authors; literature research, N.S., T.S., M.M.; clinical studies, all authors; statistical analysis, C.W.A.P.; and manuscript editing, N.S., C.W.A.P., M.R.S., D.W.


   References
TOP
 ABSTRACT
 MATERIALS AND METHODS
 RESULTS
 DISCUSSION
 ADVANCES IN KNOWLEDGE
 References
 

  1. Golimbu CN, Firooznia H, Melone CP Jr, Rafii M, Weinreb J, Leber C. Tears of the triangular fibrocartilage of the wrist: MR imaging. Radiology 1989; 173:731–733.[Abstract/Free Full Text]
  2. Oneson SR, Timins ME, Scales LM, Erickson SJ, Chamoy L. MR imaging diagnosis of triangular fibrocartilage pathology with arthroscopic correlation. AJR Am J Roentgenol 1997; 168:1513–1518.[Abstract/Free Full Text]
  3. Schweitzer ME, Brahme SK, Hodler J, et al. Chronic wrist pain: spin-echo and short tau inversion recovery MR imaging and conventional and MR arthrography. Radiology 1992; 182:205–211.[Abstract/Free Full Text]
  4. Totterman SM, Miller RJ, McCance SE, Meyers SP. Lesions of the triangular fibrocartilage complex: MR findings with a three-dimensional gradient-recalled-echo sequence. Radiology 1996; 199:227–232.[Abstract/Free Full Text]
  5. Zlatkin MB, Chao PC, Osterman AL, Schnall MD, Dalinka MK, Kressel HY. Chronic wrist pain: evaluation with high-resolution MR imaging. Radiology 1989; 173:723–729.[Abstract/Free Full Text]
  6. Haims AH, Moore AE, Schweitzer ME, et al. MRI in the diagnosis of cartilage injury in the wrist. AJR Am J Roentgenol 2004; 182:1267–1270.[Abstract/Free Full Text]
  7. Manton GL, Schweitzer ME, Weishaupt D, et al. Partial interosseous ligament tears of the wrist: difficulty in utilizing either primary or secondary MRI signs. J Comput Assist Tomogr 2001; 25:671–676.[CrossRef][Medline]
  8. Scheck RJ, Romagnolo A, Hierner R, Pfluger T, Wilhelm K, Hahn K. The carpal ligaments in MR arthrography of the wrist: correlation with standard MRI and wrist arthroscopy. J Magn Reson Imaging 1999; 9:468–474.[CrossRef][Medline]
  9. Schweitzer ME, Natale P, Winalski CS, Culp R. Indirect wrist MR arthrography: the effects of passive motion versus active exercise. Skeletal Radiol 2000; 29:10–14.[CrossRef][Medline]
  10. Zanetti M, Bram J, Hodler J. Triangular fibrocartilage and intercarpal ligaments of the wrist: does MR arthrography improve standard MRI? J Magn Reson Imaging 1997; 7:590–594.[Medline]
  11. Bencardino JT. MR imaging of tendon lesions of the hand and wrist. Magn Reson Imaging Clin N Am 2004; 12:333–347.[CrossRef][Medline]
  12. Pfirrmann CW, Theumann NH, Chung CB, Trudell DJ, Resnick D. The hamatolunate facet: characterization and association with cartilage lesions—magnetic resonance arthrography and anatomic correlation in cadaveric wrists. Skeletal Radiol 2002; 31:451–456.[CrossRef][Medline]
  13. Bordalo-Rodrigues M, Schweitzer M, Bergin D, Culp R, Barakat MS. Lunate chondromalacia: evaluation of routine MRI sequences. AJR Am J Roentgenol 2005; 184:1464–1469.[Abstract/Free Full Text]
  14. Peterfy CG, van Dijke CF, Lu Y, et al. Quantification of the volume of articular cartilage in the metacarpophalangeal joints of the hand: accuracy and precision of three-dimensional MR imaging. AJR Am J Roentgenol 1995; 165:371–375.[Abstract/Free Full Text]
  15. Burstein D, Bashir A, Gray ML. MRI techniques in early stages of cartilage disease. Invest Radiol 2000; 35:622–638.[CrossRef][Medline]
  16. Dunn TC, Lu Y, Jin H, Ries MD, Majumdar S. T2 relaxation time of cartilage at MR imaging: comparison with severity of knee osteoarthritis. Radiology 2004; 232:592–598.[Abstract/Free Full Text]
  17. Regatte RR, Akella SV, Wheaton AJ, et al. 3D-T1rho-relaxation mapping of articular cartilage: in vivo assessment of early degenerative changes in symptomatic osteoarthritic subjects. Acad Radiol 2004; 11:741–749.[Medline]
  18. Gold GE, Fuller SE, Hargreaves BA, Stevens KJ, Beaulieu CF. Driven equilibrium magnetic resonance imaging of articular cartilage: initial clinical experience. J Magn Reson Imaging 2005; 21:476–481.[CrossRef][Medline]
  19. Hargreaves BA, Gold GE, Beaulieu CF, Vasanawala SS, Nishimura DG, Pauly JM. Comparison of new sequences for high-resolution cartilage imaging. Magn Reson Med 2003; 49:700–709.[CrossRef][Medline]
  20. Kornaat PR, Reeder SB, Koo S, et al. MR imaging of articular cartilage at 1.5T and 3.0T: comparison of SPGR and SSFP sequences. Osteoarthritis Cartilage 2005; 13:338–344.[CrossRef][Medline]
  21. Saupe N, Prussmann KP, Luechinger R, Bosiger P, Marincek B, Weishaupt D. MR imaging of the wrist: comparison between 1.5- and 3-T MR imaging—preliminary experience. Radiology 2005; 234:256–264.[Abstract/Free Full Text]
  22. Recht MP, Kramer J, Marcelis S, et al. Abnormalities of articular cartilage in the knee: analysis of available MR techniques. Radiology 1993; 187:473–478.[Abstract/Free Full Text]
  23. Uhl M, Allmann KH, Tauer U, et al. Comparison of MR sequences in quantifying in vitro cartilage degeneration in osteoarthritis of the knee. Br J Radiol 1998; 71:291–296.[Abstract]
  24. Landis JR, Koch GG. The measurement of observer agreement for categorical data. Biometrics 1977; 33:159–174.[CrossRef][Medline]
  25. Gold GE, McCauley TR, Gray ML, Disler DG. What's new in cartilage? RadioGraphics 2003; 23:1227–1242.[Abstract/Free Full Text]
  26. Van Breuseghem I, Bosmans HT, Elst LV, et al. T2 mapping of human femorotibial cartilage with turbo mixed MR imaging at 1.5 T: feasibility. Radiology 2004; 233:609–614.[Abstract/Free Full Text]
  27. Bredella MA, Tirman PF, Peterfy CG, et al. 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. AJR Am J Roentgenol 1999; 172:1073–1080.[Abstract/Free Full Text]
  28. Disler DG, McCauley TR, Kelman CG, et al. Fat-suppressed three-dimensional spoiled gradient-echo MR imaging of hyaline cartilage defects in the knee: comparison with standard MR imaging and arthroscopy. AJR Am J Roentgenol 1996; 167:127–132.[Abstract/Free Full Text]
  29. Hall FM, Wyshak G. Thickness of articular cartilage in the normal knee. J Bone Joint Surg Am 1980; 62:408–413.[Free Full Text]
  30. Murphy BJ. Evaluation of grades 3 and 4 chondromalacia of the knee using T2*-weighted 3D gradient-echo articular cartilage imaging. Skeletal Radiol 2001; 30:305–311.[CrossRef][Medline]
  31. Masi JN, Sell CA, Phan C, et al. Cartilage MR imaging at 3.0 versus that at 1.5 T: preliminary results in a porcine model. Radiology 2005; 236:140–150.[Abstract/Free Full Text]
  32. Fischbach F, Bruhn H, Unterhauser F, et al. Magnetic resonance imaging of hyaline cartilage defects at 1.5T and 3.0T: comparison of medium T2-weighted fast spin echo, T1-weighted two-dimensional and three-dimensional gradient echo pulse sequences. Acta Radiol 2005; 46:67–73.[CrossRef][Medline]
  33. Cole PR, Jasani MK, Wood B, Freemont AJ, Morris GA. High resolution, high field magnetic resonance imaging of joints: unexpected features in proton images of cartilage. Br J Radiol 1990; 63:907–909.[Abstract/Free Full Text]
  34. Hodler J, Loredo RA, Longo C, Trudell D, Yu JS, Resnick D. Assessment of articular cartilage thickness of the humeral head: MR-anatomic correlation in cadavers. AJR Am J Roentgenol 1995; 165:615–620.[Abstract/Free Full Text]
  35. Tan TC, Wilcox DM, Frank L, et al. MR imaging of articular cartilage in the ankle: comparison of available imaging sequences and methods of measurement in cadavers. Skeletal Radiol 1996; 25:749–755.[CrossRef][Medline]
  36. Bauer J, Ross C, Li X, Carballido-Gamio J, Banerjee S, Krug R. Optimization and reproducibility evaluation of volumetric cartilage measurements of the knee at 1.5T and 3T [abstr]. In: Proceedings of the Thirteenth Meeting of the International Society for Magnetic Resonance in Medicine. Berkeley, Calif: International Society for Magnetic Resonance in Medicine, 2005.
  37. Busse RF. Reduced RF power without blurring: correcting for modulation of refocusing flip angle in FSE sequences. Magn Reson Med 2004; 51:1031–1037.[CrossRef][Medline]
  38. Hennig J, Weigel M, Scheffler K. Multiecho sequences with variable refocusing flip angles: optimization of signal behavior using smooth transitions between pseudo steady states (TRAPS). Magn Reson Med 2003; 49:527–535.[CrossRef][Medline]
  39. Gagliardi JA, Chung EM, Chandnani VP, et al. Detection and staging of chondromalacia patellae: relative efficacies of conventional MR imaging, MR arthrography, and CT arthrography. AJR Am J Roentgenol 1994; 163:629–636.[Abstract/Free Full Text]
  40. Kramer J, Recht MP, Imhof H, Stiglbauer R, Engel A. Postcontrast MR arthrography in assessment of cartilage lesions. J Comput Assist Tomogr 1994; 18:218–224.[Medline]
  41. Rand T, Brossmann J, Pedowitz R, Ahn JM, Haghigi P, Resnick D. Analysis of patellar cartilage: comparison of conventional MR imaging and MR and CT arthrography in cadavers. Acta Radiol 2000; 41:492–497.[CrossRef][Medline]



This article has been cited by other articles:


Home page
 Am. J. Roentgenol.Home page
J. Zhao, R. Krug, D. Xu, Y. Lu, and T. M. Link
MRI of the Spine: Image Quality and Normal-Neoplastic Bone Marrow Contrast at 3 T Versus 1.5 T
Am. J. Roentgenol., April 1, 2009; 192(4): 873 - 880.
[Abstract] [Full Text] [PDF]

This Article
Right arrow Abstract Freely available
Right arrow Figures Only
Right arrow Full Text (PDF)
Right arrow All Versions of this Article:
2431060294v1
243/1/180    most recent
Right arrow Submit a response
Right arrow Alert me when this article is cited
Right arrow Alert me when eLetters are posted
Right arrow Alert me if a correction is posted
Right arrow Citation Map
Services
Right arrow Email this article to a friend
Right arrow Similar articles in this journal
Right arrow Similar articles in PubMed
Right arrow Alert me to new issues of the journal
Right arrow Download to citation manager
Right arrow reprints & permissions
Citing Articles
Right arrow Citing Articles via HighWire
Right arrow Citing Articles via Google Scholar
Google Scholar
Right arrow Articles by Saupe, N.
Right arrow Articles by Weishaupt, D.
Right arrow Search for Related Content
PubMed
Right arrow PubMed Citation
Right arrow Articles by Saupe, N.
Right arrow Articles by Weishaupt, D.

HOME HELP FEEDBACK SUBSCRIPTIONS ARCHIVE SEARCH TABLE OF CONTENTS
RADIOLOGY RADIOGRAPHICS RSNA JOURNALS ONLINE