How should you approach this 24-year-old’s knee case?

This 24-year-old reports for a knee MRI. She reports no injury, but her knee is misaligned and pain is worse with activity.

Q1 – What do you call the type of image shown on image 1?

Q2 – What parameter on MRI is varied to achieve such a map?

Q3 – What is the name of the cardinal feature of cartilage organization that is appreciated on such a map?

Q4 – What does the blue arrow indicate on image 1?

Q5 – What adjectives might you use to describe the abnormality highlighted by the green arrows on image 2?

Sagittal T2

Axial BASG 3D

 

A1 – T2 cartilage map

A2 – The echo time or TE

A3 – Stratification. In other words, the deeper portions of cartilage are normally darker on water-weighted images and get lighter as one proceeds more superficially and this translates into a change in color from darker colors and hues to lighter colors and hues. This should remain organized throughout the young knee.

A4 – Alteration in glycosaminoglycans substance, arrangement, and altered proteogylcan milieu.

A5 – Intrasubstance delamination and intrasubstance separation of the middle layer of lateral patellar facet cartilage.

 

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