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Knee mri
1. MR Imaging of the knee
Dr.Ajai Perti MD.
Chief Radiologist & Medical Director
Vita Diagnostics Ltd.
MR & CT Imaging Centers,
Cochin, Thrissur, Vaikom,Calicut
7. Grading of meniscal signal
Grade I : Globular intrasubstance increased
signal intensity, not extending to
articular surface.
Grade II : Linear , may communicate with
capsular margin.
Grade III : Sharp linear, extending to articular
surface
40. MCL injury
Grade I : Edema & hemorrhage superficial to lig.
Grade II : Displacement of lig. fibres from bone
Grade III : Complete lig. discontinuity.
47. Chondromalacia patella
• Softening of articular cartilage
• Common in young adults, can mimic meniscal tear
• Predisposing – Trauma, patellar malalignment,
subluxation , PCL injury etc.
48.
49. • Primarily affects male patients -
10 to 20 yrs
• Typically involves the lateral
surface of med.fem.condyle.
• H/o trauma in 50%
Osteochondritis dissecans
50. Osteochondritis dissecans - Staging
Stage I : lesion 1-3cm ; intact cartilage
Stage II : Cartilage defect ; no loose body
Stage III : Partially detached ost.chond fragment
Stage IV : Complete separation ; loose body +
56. • Grade-2 vs grade 3 signals –
• To distinguish articular surface extension of
the tears.
• Intrasubstance tear –at scopy - may need
probing.
• Effusion- If present – disrupted menisceal
surface.
57. Contd….
• Transverse ligament-
• Anterior horns of medial & lateral
meniscus.
• Antero-lateral to LM - between tibial
attachment of ACL and Infra patellar fat
pad.
• Seen in 40% pts.
• Simulates an oblique tear of LM.
58. contd….
• Fibrillation- Fraying of the free edge.
• Use fat sat images.
• FrayingMacerationImbibes synovial
fluidHigh signal on T2WIMimics a
tear.
59. cont…
• Popliteus tendon-
• Sheath near the Posterior horn of LM
Grade-3 signal Tear.
• After lat. meniscectomy Popliteus
Retained post.horn remnant.
60. contd. …
• Menisco-Femoral Ligaments-Anterior -Lig.
Of Humphrey- ant. to PCL-34%.
• Posterior -Lig. Of Wrisberg- post. to PCL-
60%.
• Fat bet. Post horn of LM and MF ligament
Mimics vertical tear in post.horn of LM.
61. Pseudo bucket-handle tear….
• Separate portions of PHLM-In corona
sections.
• Not seen with Medial meniscus.
• Look at Sagittal images.
62. Lax meniscal sign….
• Lax or redundant meniscus- MM with
asso. EffusionMimics menisceal tear.
• Disappears with joint manipulation.
63. Others…..
• Vaccum Phenomenon-Intra-articular
gas Signal void Mimics tear.
• Pesudo loose body-Intercondylar notch
Low signalMimics a loose body.
• MCL bursa- bet. MM and MCL
Menisco-capsular tear.
64. Final Request….
• What the mind doesn’t know the eyes…….
• Radiologists do make mistakes even after
years of MR interpretation….
• Follow ups are of great help to improve the
diagnostic accuracy…..!!!!