MRI OF KNEE

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MRI OF KNEE

• DR.DEEPAK PATKAR
• MRI CENTRE
• DR.BALABHAI NANAVATI HOSPITAL

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TECHNIQUE

• Surface coil
• Supine
• Knee full extension 10-20 ext rotation

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SEQUENCES

• Sagittal T1WI 3mm, 16 FOV
• Sagittal Gradient
• Coronal STIR
• Axial T2WI

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T1WI T2WI

• Bright
• Dark
• Dark
• intermediate

• Less bright
• Bright
• Dark
• intermediate

FAT
FLUID
Bone,tendon, Lig, fibrocartilage
Hyaline cartilage
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SAGITTAL
Menisci Cruciate ligaments Articular cartilage
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CORONAL
Collateral ligaments Menisci Cruciate ligaments
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AXIAL
Patellofemoral jt ligaments
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menisci
C shaped fibrocartilage Act as shock absorbers
? jt stability
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MENISCI
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MENISCI

• Bow tie appearance in 2 sections
• Post horn of medial meniscus larger than ant horn
• Dark on all sequences

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ACL
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PCL
PCL
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MCL
Superficial deep layers deep layer attached
to medial meniscus
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LCL
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PATELLAR TENDON
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PATELLAR RETINACULUM
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MENISCI

• Grade 1 signal - globular hyperI signal within
  meniscus. asymptomatic
• Grade 2 signal - linear hyperI signal not
  reaching articular surface. May or may not be
  symptomatic
• Grade 3 signal - linear hyperI signal reaching
  articular surface.

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Grade 1 signal
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Grade 2 signal
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LM GR II TEAR
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Grade 3 tear
Post horn of MM most commonly involved as it is
less mobile due to attachment to capsule
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Bucket handle tear
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Bucket handle Tear
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Bucket handle Tear
DOUBLE PCL SIGN
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Meniscal tear with meniscal cyst
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LM TEAR
Note two ant horns
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Complex tear MM
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Discoid meniscus

• Lateral meniscus more common
• Broad disc like meniscus
• Loss of central tapering
• Bow tie on more than 3 sections
• Extends upto intercondylar notch
• Susceptible to tear

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• Discoid
• meniscus

Note bow tie appearance in 4 sections
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• Discoid
• meniscus

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Variations Mimicking Pathology

• Transverse ligament
• Posterior ligaments of Humphry and WrisBerg
• Popliteal tendon sheath
• Diffuse degenerations
• Magic angle phenomenon
• Post operative status

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• Popliteus tendon

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Ligament of Humphrey
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TRANSVERSE LIG
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• Compared with arthroscopy, sensitivity of MRI of
  meniscal tears is b/n 80 to 100 ( 93, Li et al)
• 100 -ve predictive value

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ACL
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ACL TEAR
MN
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ACL TEAR
If hemarthrosis present, 70 have ACL tear
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Avulsion fracture of ACL
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• Accuracy of MRI in diagnosing ACL tear is 95
• 94 sensitivity 100 specificity
• Not accurate in differentiating complete from
  partial tears

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PCL

• Often assoc with other serious knee injury
• due to post displacement of tibia in relation to
  femur or hyperextension
• MRI has 100 sensitivity specificity

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PCL TEAR
PCL
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PCL TEAR WITH AVULSION OF TIBIAL PLATEAU
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MCL TEAR
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LCL contusion
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BONE CONTUSION
STIR images
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Fracture patella with fragment
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QUADRICEPS TENDINOSIS
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Quadriceps tendon tear
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OSTEOARTHRITIS
3D Cartilage Sequence
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OA
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OA
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Loose bodies
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CHONDROMALACIA PATELLAE
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OSTEOCHONDRITIS DISSECANS

• Male, 10-20 yrs
• Lat surface of medial condyle
• H/0 trauma in 50

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OSTEOCHONDRITIS DISSECANS
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TB arthritis
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Brodies abcess
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RA
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Ruptured bakers cyst
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Osteogenic sarcoma
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Parosteal OS
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ABC
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NEWER ADVANCES

• 3D MRI
• high resolution MRI
• patellar tracking
• Limb salvage surgery

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3D MRI
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PATELLAR TRACKING
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PLANNING FOR LIMB SALVAGE SURGERY
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• MRI is non invasive useful imaging modality in
  the evaluation of internal derangements of knee

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THANK YOU