A bone marrow edema pattern in osteoarthritic knees represents a number of noncharacteristic histologic abnormalities. Diagram of the fluid-sensitive MR image (a) and sagittal T2-weighted fat-suppressed (b), coronal T1-weighted (c), and proton-density–weighted fat-suppressed (d) MR images show a subchondral fracture (arrow in b and c) as a curvilinear hypointensity surrounded by bone marrow edema, without associated contour deformity. After intravenous contrast administration, 245 cysts (94.2%) showed full enhancement, 12 (4.6%) showed partial enhancement and 3 (1.2%) showed no enhancement. All left testicular veins drained into left renal vein. Imaging data revealed that the SBC originate in the presence of a subchondral bone plate breach, with evolving composition over time. Subchondral sclerosis in osteoarthritis is related to a deposition of new bone on preexisting trabeculae and to trabecular compression and microfractures with callus formation (76), although associated histologic abnormalities and MRI signal alterations are far more complex (77). Particularly for the problem of subchondral bone lesions, image evaluation methods need to be refined for adequate and reproducible analysis. Similar findings were present on the tibial side. Future studies should explore whether reducing BMLs and inflammation can decrease the risk of structural progression. The exact pathogenesis of these degenerative cysts is not certain.26,27 Subchondral cysts are most often seen in association with osteoarthritis, but may occur as the result of degeneration or injury of the overlying articular cartilage by other causes. Figure 11a. Combining both mechanisms increased the growth rate of the cavity. (d) Sagittal T2-weighted fat-saturated MR image shows disruption of the subchondral bone plate (arrowhead). Patients present with acute onset of pain and have a clear history of preceding trauma. As the severity of bone abnormality in the medial compartment increased from no BMLs or cysts present, to BMLs only, to subchondral bone cysts present, the risk of knee replacement was increased (odds ratio, 1.99; 95% confidence interval (CI), 1.01 to 3.90; P = 0.05). Intra-articular Corticosteroid Injections in the Hip and Knee: Perhaps Not as Safe as We Thought? Kinetics were studied in three healthy volunteers. BME lesions in 2 years were associated with clinical features assessed by Western Ontario and McMaster Universities Osteoarthritis (WOMAC) scores. Our results provide insights into the mechanism by which SBC may accelerate OA, leading to greater pain and disability. Such developments could help further stratify subgroups and treatments for people with OA in future. Administration of gadolinium for an MR arthrogram may be employed. Articular cartilage and the subchondral bone act as a functional unit. The spectrum of acute traumatic injuries to the articular surface of the bone includes bone bruises and chondral, subchondral, and osteochondral fractures. Methods (b–d) Sagittal T2-weighted fat-suppressed MR image (b), proton-density–weighted MR image (c), and CT image (d) show a curvilinear fracture (arrow in b and c) encircling a portion of subchondral bone and overlying cartilage. Conclusion: At 4 weeks post-ACLX, 75% of the rodent knees had at least 1 cyst that formed in the medial tibial plateau; by 12 weeks all ACLX knees contained SBC. Fat-saturated images obtained after 10 minutes of exercise and administration of 0.1 mmol/kg gadopentetate dimeglumine were similar to those obtained after intraarticular injection of contrast medium. After completing this journal-based SA-CME activity, participants will be able to: ■ Describe the anatomy of the osteochondral junction with MRI correlation. Increased diffusion of contrast material into these lesions might also contribute to their avid enhancement, a finding that has recently also been described for small cyst-like BMLs, ... Edema has been found to precede SBC formation in most cases [20,21], but its presence does not guarantee trabecular remodeling when compared with histological examination [37] . These findings are essential in diagnosis of acute traumatic injuries, subchondral insufficiency fracture, and its potentially irreversible form, spontaneous osteonecrosis of the knee. However, despite the growing interest on BMLs in multiple pathological conditions, they remain controversial not only for the still unknown role in the etiopathological processes, but also in terms of clinical impact and treatment. 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