Comparison of Three-Dimensional Double-Echo Steady-State Sequence with Routine Two-Dimensional Sequence in the Depiction of Knee Cartilage

Document Type : Original Paper


1 Medical Physics Research Center, Mashhad University of Medical Sciences, Mashhad, Iran

2 Department of Orthopedic ,Faculty of medicine,Mashhad University of Medical Sciences, Mashhad, Iran

3 Department of radiology, faculty of medicine, Mashhad University of Medical Sciences, Mashhad, Iran

4 Department of Epidemiology & Biostatistics School of Health, Mashhad University of Medical Sciences , Mashhad, Iran


Introduction: There are some routine two-dimensional sequences, including short tau inversion recovery (STIR), T2-weighted fast-spin echo (T2W-FSE), and proton-density fast spin-echo for diagnosing osteoarthritis and lesions of the knee cartilage. However, these sequences have some disadvantages, such as long scan time, inadequate spatial resolution, and suboptimal tissue contrast which results in loss of image details, as well as missing the visualization of knee cartilage lesions. Three-dimensional (3D) sequences, such as the double-echo steady-state (DESS) sequence can decrease and overcome these problems to the smallest possible amount.
Material and Methods: A total of 15 volunteers with knee pain were examined by a 1.5 Tesla magnetic resonance imaging.The contrast-to-noise ratio (CNR) and thickness values of the knee articular cartilage were measured. The CNR and thickness values were comparedby the Friedman test and the Wilcoxon signed-rank test.
Results: The obtained results showed significant differences between sequences in CNR and thickness values. The DESS sequence with a flip angle of 40°showed the best CNR values and 3D fast low-angle shot (FLASH) showed the worst results. In addition, the results showed no significant differences between FLASH, 3D DESS 40° and 90° in terms of cartilage thickness. However, thickness values of these sequences were much higher than that of the PD, T2, and STIR sequences.
Conclusion: The 3D DESS sequence with two flip angles of 40°and 90° are the best sequences for visualizing the cartilage and the synovial fluid. Because they provide the best contrast between the cartilage and the synovial fluid, it is recommended to use DESS sequences in the evaluation of cartilage defections.


Main Subjects

  1. References


    1. Brittberg M, Lindahl A, Nilsson A, Ohlsson C, Isaksson O, Peterson L. Treatment of deep cartilage defects in the knee with autologous chondrocyte transplantation. The New England journal of medicine. 1994;331(14):889-95.
    2. Amin S, LaValley MP, Guermazi A, Grigoryan M, Hunter DJ, Clancy M, et al. The relationship between cartilage loss on magnetic resonance imaging and radiographic progression in men and women with knee osteoarthritis. Arthritis and rheumatism. 2005;52(10):3152-9.
    3. Kraus VB, Sprow K, Powell KE, Buchner D, Bloodgood B, Piercy K, et al. Effects of Physical Activity in Knee and Hip Osteoarthritis: A Systematic Umbrella Review. Medicine and science in sports and exercise. 2019;51(6):1324-39.
    4. March LM, Bachmeier CJ. Economics of osteoarthritis: a global perspective. Bailliere's clinical rheumatology. 1997;11(4):817-34.
    5. Wang Y, Wluka AE, Jones G, Ding C, Cicuttini FM. Use magnetic resonance imaging to assess articular cartilage. Therapeutic advances in musculoskeletal disease. 2012;4(2):77-97.
    6. Coumas JM, Palmer WE. Knee arthrography. Evolution and current status. Radiologic clinics of North America. 1998;36(4):703-28.
    7. Crema MD, Roemer FW, Marra MD, Burstein D, Gold GE, Eckstein F, et al. Articular cartilage in the knee: current MR imaging techniques and applications in clinical practice and research. Radiographics : a review publication of the Radiological Society of North America, Inc. 2011;31(1):37-61.
    8. Peterfy CG, Gold G, Eckstein F, Cicuttini F, Dardzinski B, Stevens R. MRI protocols for whole-organ assessment of the knee in osteoarthritis. Osteoarthritis and cartilage. 2006;14 Suppl A:A95-111.
    9. Han CH, Park HJ, Lee SY, Chung EC, Choi SH, Yun JS, et al. IDEAL 3D spoiled gradient echo of the articular cartilage of the knee on 3.0 T MRI: a comparison with conventional 3.0 T fast spin-echo T2 fat saturation image. Acta radiologica (Stockholm, Sweden : 1987). 2015;56(12):1479-86.
    10. Milewski MD, Smitaman E, Moukaddam H, Katz LD, Essig DA, Medvecky MJ, et al. Comparison of 3D vs. 2D fast spin echo imaging for evaluation of articular cartilage in the knee on a 3T system scientific research. European journal of radiology. 2012;81(7):1637-43.
    11. Kijowski R, Gold GE. Routine 3D magnetic resonance imaging of joints. Journal of magnetic resonance imaging : JMRI. 2011;33(4):758-71.
    12. Kijowski R, Blankenbaker DG, Woods M, Del Rio AM, De Smet AA, Reeder SB. Clinical usefulness of adding 3D cartilage imaging sequences to a routine knee MR protocol. AJR American journal of roentgenology. 2011;196(1):159-67.
    13. Crema MD, Nogueira-Barbosa MH, Roemer FW, Marra MD, Niu J, Chagas-Neto FA, et al. Three-dimensional turbo spin-echo magnetic resonance imaging (MRI) and semiquantitative assessment of knee osteoarthritis: comparison with two-dimensional routine MRI. Osteoarthritis and cartilage. 2013;21(3):428-33.
    14. Siepmann DB, McGovern J, Brittain JH, Reeder SB. High-resolution 3D cartilage imaging with IDEAL SPGR at 3 T. AJR American journal of roentgenology. 2007;189(6):1510-5.
    15. Lavdas E, Topalzikis T, Mavroidis P, Kyriakis I, Roka V, Kostopoulos S, et al. Comparison of PD BLADE with fat saturation (FS), PD FS and T2 3D DESS with water excitation (WE) in detecting articular knee cartilage defects. Magnetic resonance imaging. 2013;31(8):1255-62.
    16. Hardy PA, Recht MP, Piraino D, Thomasson D. Optimization of a dual echo in the steady state (DESS) free-precession sequence for imaging cartilage. Journal of magnetic resonance imaging : JMRI. 1996;6(2):329-35.
    17. Eckstein F, Hudelmaier M, Wirth W, Kiefer B, Jackson R, Yu J, et al. Double echo steady state magnetic resonance imaging of knee articular cartilage at 3 Tesla: a pilot study for the Osteoarthritis Initiative. Annals of the rheumatic diseases. 2006;65(4):433-41.
    18. Duc SR, Pfirrmann CW, Schmid MR, Zanetti M, Koch PP, Kalberer F, et al. Articular cartilage defects detected with 3D water-excitation true FISP: prospective comparison with sequences commonly used for knee imaging. Radiology. 2007;245(1):216-23.
    19. Ruehm S, Zanetti M, Romero J, Hodler J. MRI of patellar articular cartilage: evaluation of an optimized gradient echo sequence (3D-DESS). Journal of magnetic resonance imaging : JMRI. 1998;8(6):1246-51.
    20. Schaefer FK, Kurz B, Schaefer PJ, Fuerst M, Hedderich J, Graessner J, et al. Accuracy and precision in the detection of articular cartilage lesions using magnetic resonance imaging at 1.5 Tesla in an in vitro study with orthopedic and histopathologic correlation. Acta radiologica (Stockholm, Sweden : 1987). 2007;48(10):1131-7.
    21. Sharma L. Osteoarthritis year in review 2015: clinical. Osteoarthritis and cartilage. 2016;24(1):36-48.
    22. Van Dyck P, Vanhevel F, Vanhoenacker FM, Wouters K, Grodzki DM, Gielen JL, et al. Morphological MR imaging of the articular cartilage of the knee at 3 T-comparison of standard and novel 3D sequences. Insights into imaging. 2015;6(3):285-93.
    23. Moriya S, Miki Y, Kanagaki M, Yamamoto A, Okudaira S, Nakamura S, et al. Evaluation of cartilage surface injuries using 3D-double echo steady state (3D-DESS): effect of changing flip angle from 40 degrees to 90 degrees. Acta radiologica (Stockholm, Sweden : 1987). 2011;52(10):1138-42.
    24. Moriya S, Miki Y, Kanagaki M, Matsuno Y, Miyati T. 90 degrees -flip-angle three-dimensional double-echo steady-state (3D-DESS) magnetic resonance imaging of the knee: isovoxel cartilage imaging at 3T. European journal of radiology. 2014;83(8):1429-32.