Clinical Value of MRI in Assessing the Stability of Osteochondritis Dissecans Lesions: A Systematic Review and Meta-Analysis

Hu, Hai; Zhang, Chuan; Chen, Junhui; Li, Panpan; Xie, Zhixun; Deng, Zhenping; Du, Yuchen

doi:10.2214/ajr.18.20710

Cited by 10 publications

(5 citation statements)

References 29 publications

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“…MRI has excellent sensitivity and specificity for detecting OCD but uncertain accuracy in determining stability [108][109][110] . De Smet et al defined 4 MRI criteria based on T2-weighted sequences that are used to predict stability (Table I) 111 .…”

Section: Mrimentioning

confidence: 99%

Osteochondritis Dissecans

Chau

Klimstra

Wise

et al. 2021

Journal of Bone and Joint Surgery

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ä Osteochondritis dissecans occurs most frequently in the active pediatric and young adult populations, commonly affecting the knee, elbow, or ankle, and may lead to premature osteoarthritis.ä While generally considered an idiopathic phenomenon, various etiopathogenetic theories are being investigated, including local ischemia, aberrant endochondral ossification of the secondary subarticular physis, repetitive microtrauma, and genetic predisposition.ä Diagnosis is based on the history, physical examination, radiography, and advanced imaging, with elbow ultrasonography and novel magnetic resonance imaging protocols potentially enabling early detection and in-depth staging.ä Treatment largely depends on skeletal maturity and lesion stability, defined by the presence or absence of articular cartilage fracture and subchondral bone separation, as determined by imaging and arthroscopy, and is typically nonoperative for stable lesions in skeletally immature patients and operative for those who have had failure of conservative management or have unstable lesions.ä Clinical practice guidelines have been limited by a paucity of high-level evidence, but a multicenter effort is ongoing to develop accurate and reliable classification systems and multimodal decision-making algorithms with prognostic value.Disclosure: This work was partially supported by grants from the National Institutes of Health (R01 AR070020 and K01 OD021293). On the Disclosure of Potential Conflicts of Interest forms, which are provided with the online version of the article, one or more of the authors checked "yes" to indicate that the author had a relevant financial relationship in the biomedical arena outside the submitted work (http://links.lww.com/JBJS/G440).

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Section: Mrimentioning

confidence: 99%

Osteochondritis Dissecans

Chau

Klimstra

Wise

et al. 2021

Journal of Bone and Joint Surgery

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“…One study comparing cMRI to a gold standard of arthroscopy in 52 osteochondral lesions found 100% sensitivity and 80% specificity for unstable lesions and close correlation in 94% of cases with the International Cartilage Repair Society classification for lesion instability [ 117 ]. In contrast, a recent meta-analysis concluded that cMRI criteria for instability are adequate for assessing adult osteochondral lesions of the elbow, knee, and ankle, but performed less well for predicting stability in pediatric osteochondral lesions [ 118 ]. This meta-analysis included 3 studies using cMRI for the assessment of pediatric elbow osteochondral lesions.…”

Section: Pathology-specific Joint Independent Indicationsmentioning

confidence: 99%

SSR white paper: guidelines for utilization and performance of direct MR arthrography

Chang,

Bencardino,

French

et al. 2023

Skeletal Radiol

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Objective Direct magnetic resonance arthrography (dMRA) is often considered the most accurate imaging modality for the evaluation of intra-articular structures, but utilization and performance vary widely without consensus. The purpose of this white paper is to develop consensus recommendations on behalf of the Society of Skeletal Radiology (SSR) based on published literature and expert opinion. Materials and methods The Standards and Guidelines Committee of the SSR identified guidelines for utilization and performance of dMRA as an important topic for study and invited all SSR members with expertise and interest to volunteer for the white paper panel. This panel was tasked with determining an outline, reviewing the relevant literature, preparing a written document summarizing the issues and controversies, and providing recommendations. Results Twelve SSR members with expertise in dMRA formed the ad hoc white paper authorship committee. The published literature on dMRA was reviewed and summarized, focusing on clinical indications, technical considerations, safety, imaging protocols, complications, controversies, and gaps in knowledge. Recommendations for the utilization and performance of dMRA in the shoulder, elbow, wrist, hip, knee, and ankle/foot regions were developed in group consensus. Conclusion Although direct MR arthrography has been previously used for a wide variety of clinical indications, the authorship panel recommends more selective application of this minimally invasive procedure. At present, direct MR arthrography remains an important procedure in the armamentarium of the musculoskeletal radiologist and is especially valuable when conventional MRI is indeterminant or results are discrepant with clinical evaluation.

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“…MRI has a valuable role in differentiating stable from unstable osteochondral lesions in adults where the risk of a fragment loosening is related to visible high-signal intensity line between the bony fragment and rest of the bone [30].…”

Section: Cartilage and Osteochondral Lesionsmentioning

confidence: 99%

ESR essentials: MRI of the knee—practice recommendations by ESSR

Parkar,

Adriaensen

2024

Eur Radiol

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Many studies and systematic reviews have been published about MRI of the knee and its structures, discussing detailed anatomy, imaging findings, and correlations between imaging and clinical findings. This paper includes evidence-based recommendations for a general radiologist regarding choice of imaging sequences and reporting basic MRI examinations of the knee. We recommend using clinicians’ terminology when it is applicable to the imaging findings, for example, when reporting meniscal, ligament and tendon, or cartilage pathology. The intent is to standardise reporting language and to make reports less equivocal. The aim of the paper is to improve the usefulness of the MRI report by understanding the strengths and limitations of the MRI exam with regard to clinical correlation. We hope the implementation of these recommendations into radiological practice will increase diagnostic accuracy and consistency by avoiding pitfalls and reducing overcalling of pathology on MRI of the knee. Clinical relevance statement The recommendations presented here are meant to aid general radiologists in planning and assessing studies to evaluate acute and chronic knee findings by advocating the use of unequivocal terminology and discussing the strengths and limitations of MRI examination of the knee. Key Points • On MRI, the knee should be examined and assessed in three orthogonal imaging planes. • The basic general protocol must yield T2-weighted fluid-sensitive and T1-weighted images. • The radiological assessment should include evaluation of ligamentous structures, cartilage, bony structures and bone marrow, soft tissues, bursae, alignment, and incidental findings.

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Clinical Value of MRI in Assessing the Stability of Osteochondritis Dissecans Lesions: A Systematic Review and Meta-Analysis

Cited by 10 publications

References 29 publications

Osteochondritis Dissecans

Osteochondritis Dissecans

SSR white paper: guidelines for utilization and performance of direct MR arthrography

ESR essentials: MRI of the knee—practice recommendations by ESSR

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