Knee
MRI, with its high soft tissue
contrast is one of the main imaging tools to depict knee
joint pathology.
MRI allows accurate imaging of intra-articular structures such as ligaments, cartilage, menisci, bone marrow, synovium, and adjacent soft tissue.
Knee exams require a dedicated
extremity coil, providing a homogenous imaging volume and high
SNR to ensure best signal coverage.
A complete knee MR examination includes for example
sagittal and
coronal T1 weighted, and
proton density weighted pulse sequences +/-
fat saturation, or
STIR sequences. For high
spatial resolution, maximal 4 mm
thick slices with at least an in plane
resolution of 0.75 mm and small
gap are recommended. To depict the
anterior cruciate ligament clearly, the
sagittal plane has to be rotated 10 - 20° externally (parallel to the medial border of the femoral condyle). Retropatellar cartilage can bee seen for example in
axial T2 weighted gradient echo sequences with
Fatsat. However, the choice of the
pulse sequences is depended of the diagnostic question, the used scanner, and preference of the operator.
Diagnostic quality in knee imaging is possible with
field strengths ranging from 0.2 to
3T. With
low field strengths more signal averages must be measured, resulting in increased scan times to provide equivalent quality as
high field strengths.
More diagnostic information of meniscal tears and chondral defects can be obtained by direct
magnetic resonance arthrography, which is done by introducing a dilute solution of
gadolinium in saline (1:1000) into the
joint capsule. The knee is then scanned in all three planes using T1W
sequences with
fat suppression. For indirect arthrography, the
contrast is given i.v. and similar scans are started 20 min. after injection and exercise of the knee.
Frequent indications of MRI scans in musculoskeletal knee diseases are: e.g., meniscal degeneration and tears, ligament injuries, osteochondral fractures, osteochondritis dissecans, avascular bone necrosis and rheumatoid arthritis.
See also
Imaging of the Extremities and
STIR.