Staging of osteochondral lesions of the talus: comparison of Cone Beam CT - Arthrography with Magnetic Resonance Imaging

Julie Desimpel, Filip M. Vanhoenacker

Abstract


Purpose: To evaluate the value of Cone Beam Computed Tomography (CBCT)-Arthrography (CBCT-A) versus Magnetic Resonance Imaging (MRI) for staging of osteochondral lesions of the talus.

Material and Methods: 35 consecutive patients with chronic ankle pain and an osteochondral lesion on MRI were included and subsequently underwent CBCT-A. The following parameters were analysed by two reviewers: size of lesion, depth of lesion, degree of detachment, presence of bone marrow oedema on 1.5 Tesla MRI or sclerosis on CBCT-A, presence of subchondral cysts and additional lesions in the tibia.

Results: Analysis of CBCT-Arthrography resulted in an upstaging in 17 patients with a statistically significant difference (p<0.05) for the degree of detachment between MRI and CBCT-Arthrography.

Conclusions: CBCT-A allows a more precise staging of osteochondral lesion of the talus than 1.5 T MRI. However, because of its exposure to radiation and more invasive nature, MRI is recommended as the initial screening method for evaluation of osteochondral lesions of the ankle. Additional CBCT-A is reserved for selected cases in which surgical treatment is considered.


Keywords


MR; CBCT-arthrography; osteochondral lesion; ankle

Full Text:

PDF

References


Durur-Subasi I, Duru-Karakaya A, Yildirim O. Osteochondral lesions of major joints. Eurasian J Med 2015; 47(2): 138-144.

Van Dijk N, Reilingh M, Zengerink M, et al. The natural history of osteochondral lesions in the ankle. Instr Course Lect 2010; 59: 375-386.

Van Bergen C, Gerards RM, Opdam K, et al. Diagnosing, planning and evaluating osteochondral ankle defects with imaging modalities. WJO 2015; 6(11): 944-953.

Pirimoglu B, Ogul H, Polat G, et al. The comparison of direct magnetic resonance arthrography with volumetric interpolated breath-hold examination sequence and multidetector computed tomography arthrography techniques in detection of talar osteochondral lesions. Acta Orthop Traumatol Turc 2019; 53(3): 209-214.

Kirschke JS, Braun S, Baum, T et al. Diagnostic value of CT arthrography for evaluation of osteochondral lesions at the ankle. BioMed Research International 2016 doi: 10.1155/2016/3594253.

Schmid MR, Pfirrmann CW, Hodler J, et al. Cartilage lesions in the ankle joint: comparison of MR arthrography and CT arthrography. Skeletal Radiology 2003; 32: 259-265.

Cerezal L, Llopis E, Caga A, et al. MR arthrography of the ankle: indications and technique. Radiol Clin North Am 2008; 46(6): 973-974.

De Smet E, De Praeter G, Verstraete KL, et al. Direct comparison of conventional radiography and cone-beam CT in small bone and joint trauma. Skelet Radiol 44(8): 1111–1117.

Anderson IF, Crichton KJ, Grattan-Smith T, et al. Osteochondral fractures of the dome of the talus. J Bone Joint Surg Am 1989; 71(8): 1143-1152.

Outerbridge R. The etiology of chondromalacia patellae. J Bone Joint Surg Br 1961; 43: 752-757.

Posadzy M, Desimpel J, Vanhoenacker FM. Staging of osteochondral lesions of the talus: MRI and Cone Beam CT. J Belg Soc Radiol 2017; 101(S2): 1.

Steele JR, Dekker TJ, Federen AE, et al. Osteochondral lesions of the talus: Current concepts in diagnosis and treatment. Foot & Ankle Orthopaedics 2018; 1-9.

Berndt L, Harty M. Transchondral fractures (osteochondritis dissecans of the talus). J Bone Joint Surg 1959; 41: 988-1020.

Hepple S, Winson IG, Glew D. Osteochondral lesions of the talus: a revised classification. Foot Ankle Int 1999; 20(12): 789-793.

Anderson IF, Crichton KJ, Grattan-Smith T, et al. Osteochondral fractures of the dome of the talus. J Bone Joint Surg Am 1989; 71(8): 1143-1152.

Badekas T, Takvorian M, Souras N. Treatment principles for osteochondral lesions in foot and anke. Int Orthop 2013; 37(9): 1697-1706.

Zengerink M, Struijs PA, Tol JL, et al. Treatment of osteochondral lesions of the talus: a systematic review. Knee Surg Sports Traumatol Arthrosc 2010; 18: 238–246.

Emre TY, Ege T, Cift HT, et al. Open mosaicplasty in osteochondral lesions of the talus: a prospective study. J Foot Ankle Surg 2012; 51(5): 556–560.

Verhagen RA, Struijs PA, Bossuyt PM, et al. Systematic review of treatment strategies for osteochondral defects of the talar dome. Foot Ankle Clin 2003; 8(2): 233–242.

Hannon CP, Ross KA, Murawski CD, et al. Arthroscopic bone marrow stimulation and concentrated bone marrow aspirate for osteochondral lesions of the talus: a case-control study of functional and magnetic resonance observation of cartilage repair tissue outcomes. Arthroscopy 2016; 32(2): 348-349.

Rico JV, Dalmau A, Chaqués FJ, et al. Treatment of Osteochondral lesions of the talus with bone marrow stimulation and Chitosan-Glycerol phosphate/blood implants. Arthrosc Tech 2015; 4(6): 663-667.

Van Bergen CJA, De Leeuw PAJ, Van Dijk CN. Treatment of osteochondral defects of the talus. Rev Chir Orthop Reparatrice Appar Mot 2008; 94(8): 398-408.

Kirschke JS, Braun S, Baum T, et al. Diagnostic value of CT Arthrography for evaluation of osteochondral Lesions at the ankle. Biomed Res Int 2016; 2016:3594253.

Posadzy M, Desimpel J, Vanhoenacker F. Cone beam CT of the musculoskeletal system: clinical applications. Insights Imaging 2019; 9 (1): 35-45.

Rungprai C, Tennant JN, Gentry RD, et al. Management of osteochondral lesions of the talar dome. Open Orthop J 2017; 11: 743-761.

Morvan G, Busson J,Wybier M. Tomodensitométrie du pied et de la cheville. Paris, Masson, 2003; 87-127.

Prado MP, Kennedy JG, Raduan F, et al. Diagnosis and treatment of osteochondral lesions of the ankle: current concepts. Rev Bras Ortop 2016; 51(5): 489-500.

Easley ME, Latt DL, Santangelo JR, et al. Osteochondral lesions of the talus. J Am Acad Orthop Surg 2010; 18(10): 616-630.

Deng E, Gao L, Shi W, et al. Both Magnetic Resonance Imaging and Computed Tomography are reliable and valid in evaluating cystic osteochondral lesions of the talus. Orthop J Sports Med 2020; 8(9): 1-6.

Barr C, Bauer JS, Malfair D, et al. MR Imaging of the ankle at 3 Tesla and 1.5 Tesla: Protocol optimization and application to cartilage, ligament and tendon pathology in cadaver specimens. Eur Radiol 2007; 17(6): 1518–1528.




DOI: http://dx.doi.org/10.36162/hjr.v6i2.429

Refbacks

  • There are currently no refbacks.