Differences in diagnostic power of STIR and T1W sequence in MR findings of bone bruise of acutely traumatized knee

Đorđe R Jelić; Dragan Mašulović; Miroslav Milankov; Branko  Ristić; Vladimir Jakovljević; Radiša Vojinović

doi:10.5937/mckg57-49347

Đorđe R Jelić College of Health Sciences, Academy of Applied Studies Belgrade, Serbia
Dragan Mašulović University of Belgrade, Medical Faculty, Department of Radiology, Belgrade, Serbia
Miroslav Milankov University of Novi Sad, Medical Faculty, Novi Sad, Serbia
Branko Ristić University of Kragujevac, Faculty of Medical Sciences, Kragujevac, Serbia. University Clinical Center Kragujevac, Clinic for Orthopedics and Traumatology, Kragujevac, Serbia
Vladimir Jakovljević University of Kragujevac, Faculty of Medical Sciences, Kragujevac, Serbia
Radiša Vojinović University of Kragujevac, Faculty of Medical Sciences, Kragujevac, Serbia. University Clinical Center Kragujevac, Department of Radiology, Kragujevac, Serbia

DOI: https://doi.org/10.5937/mckg57-49347

Keywords: Keywords: knee; sports; magnetic resonance; bone bruise; STIR; T1W.

Abstract

Introduction: Increasing use of magnetic resonance imaging (MRI) in acute knee trauma has led to increased awareness of bone bruises (BB). Posttraumatic BB is the only predictor of early osteoarthritis. The aim of our research is to determine the way in which it is possible to observe and precisely determine the localization, size, and number of BB, by the correct selection of MR imaging sequences.

Material and methods: MR examinations of the knees performed during 2012-2013 in 100 subjects with an acute knee injury sustained during sports were retrospectively analyzed from the personal archive. All examinations were done in the first month after the trauma. Examinations were performed on an open-type MRI with a power of 0.3T. A standard protocol was used with sequences of spin echo T1-weighted in the sagittal plane, fat suppression T2-weighted in the sagittal, coronal, and axial planes, and Short Tau Inversion Recovery (STIR) in the coronal plane. The presence and arrangement of BB were analyzed. The difference in the frequency of BB findings in STIR compared to the T1W sequence and the assessment of the visibility of BB in both sequences were analyzed.

Results: BB findings were observed in 51% of respondents. BB is the second, after effusion, the most frequent pathological finding on MR examination in acute knee trauma. A significant statistical difference was determined by the Wilcoxon test (Z=-5.067, p=0.000) between the T1W and STIR sequence, which indicates that the STIR sequence is convincingly more sensitive than the T1W sequence for the diagnosis of BB.

Conclusion: It was concluded that better visibility of BB is given by STIR sequence compared to T1W sequence.

Author Biography

Đorđe R Jelić, College of Health Sciences, Academy of Applied Studies Belgrade, Serbia

Doc dr sc Radiologije na Stomatološkom fakultetu Pnačevo.

Doc dr sc Radiologije na katedri Medicine sporta i Radiologije Fakulteta medicinskih nauka u Kragujevcu.

Prof radiologije na Akademiji strukovnih studija Beograd, Viša medicinska škola.

References

REFERENCES
1. Ryu KN, Jin W, Ko YT, Yoon Y, Oh JH, Park YK, et al. Bone bruises: MR characteristics and histological correlation in the young pig. Clin Imaging 2000; 24: 371-80.
2. Ward P, Chang P, Radtke L, Brophy RH. Clinical implications of bone bruise patterns accompanying anterior cruciate ligament tears. Sports Health 2022; 14(4): 585-91.
3. Filardo G, Andriolo L, di Laura Frattura G, Napoli F, Zaffagnini S, Candrian C. Bone bruise in anterior cruciate ligament rupture entails a more severe joint damage affecting joint degenerative progression. Knee Surg Sports Traumatol Arthrosc 2019; 27(1): 44-59.
4. Driban JB, Lohmander S, Frobell RB. Posttraumatic bone marrow lesion volume and knee pain within 4 weeks after anterior cruciate ligament injury. J Athl Train 2017; 52: 575-80.
5. Arndt 3rd WF, Truax AL, Barnett FM, Simmons GE, Brown DC. MR diagnosis of bone contusions of the knee: comparison of coronal T2-weighted fast spin-echo with fat saturation and fast spin-echo STIR images with conventional STIR images. AJR Am J Roentgenol 1996; 166: 119–24.
6. Moran J, Katz LD, Schneble CA, Li DT, Kahan JB, Wang A, et al. A novel MRI mapping technique for evaluating bone bruising patterns associated with noncontact ACL ruptures. Orthop J Sports Med 2022; 10:23259671221088936.
7. Allen GM. Dark T1 bone marrow. Semin Musculoskelet Radiol 2011; 15: 247-56.
8. Vincken PW, Ter Braak BP, van Erkel AR, Coerkamp EG, Mallens WM, Bloem JL. Clinical consequences of bone bruise around the knee. Eur Radiol 2006: 16: 97–107.
9. Marot V, Corin B, Reina N, Murgier J, Berard E, Cavaignac E. Femoral and tibial bone bruise volume is not correlated with ALL injury or rotational instability in patients with ACL-deficient knee. Knee Surg Sports Traumatol Arthrosc 2021; 29: 900-6. Erratum in: Knee Surg Sports Traumatol Arthrosc 2021; 29: 907.
10. Flury A, Hodel S, Andronic O, Kaiser D, Fritz B, Imhoff FB, et al. Extent of posterolateral tibial plateau impaction fracture correlates with anterolateral complex injury and has an impact on functional outcome after ACL reconstruction. Knee Surg Sports Traumatol Arthrosc 2023; 31: 2266-73.
11. Mirowitz SA, Apicella P, Reinus WR, Hammerman AM. MR imaging of bone marrow lesions: relative conspicuousness on T1-weighted, fat-suppressed T2-weighted, and STIR images. AJR Am J Roentgenol 1994; 162(1): 215-21.
12. Lynch TC, Crues 3rd JV, Morgan FW, Sheehan WE, Harter LP, Ryu R. Bone abnormalities of the knee: prevalence and significance at MR imaging. Radiology 1989; 171: 761-6.
13. Terzidis IP, Christodoulou AG, Ploumis AL, Metsovitis SR, Koimtzis M, Givissis P. The appearance of kissing contusion in the acutely injured knee in the athletes. Br J Sports Med 2004; 38: 592-6.
14. Atkinson PJ, Cooper TG, Anseth S, Walter NE, Kargus R, Haut RC. Association of knee bone bruise frequency with time postinjury and type of soft tissue injury. Orthopedics 2008; 31: 440.
15. Bordoni V, di Laura Frattura G, Previtali D, Tamborini S, Candrian C, Cristallo Lacalamita M, et al. Bone bruise and anterior cruciate ligament tears: presence, distribution pattern, and associated lesions in the pediatric population. Am J Sports Med 2019; 47: 3181-6.
16. Jelić D, Masulović D. Bone bruise of the knee associated with the lesions of anterior cruciate ligament and menisci on magnetic resonance imaging. Vojnosanit Pregl 2011; 68: 762-6.