Advantages of cone beam computed tomography for evaluation of subchondral insufficiency fractures of the knee compared to MRI

• Published in: Scientific reports 2024-07, Vol.14 (1), p.15278-9, Article 15278
• Main Authors: Delsmann, Maximilian M., Delsmann, Julian, Jandl, Nico Maximilian, Maas, Kai-Jonathan, Beil, Frank Timo, Amling, Michael, Henes, Frank Oliver, Rolvien, Tim, Spink, Clemens
• Format: Article
• Language: English
• Subjects: 692/308; 692/699/578; Aged; Ahlbäck; Body mass index; Bone imaging; Bone lesions; Cancellous bone; Collapse; Computed tomography; Cone-Beam Computed Tomography - methods; Correlation coefficient; Female; Femur; Fractures; Fractures, Stress - diagnostic imaging; Humanities and Social Sciences; Humans; Insufficiency fracture; Knee; Knee Joint - diagnostic imaging; Knee Joint - pathology; Lesions; Magnetic resonance imaging; Magnetic Resonance Imaging - methods; Male; Middle Aged; multidisciplinary; Osteonecrosis; Reproducibility of Results; Science; Science (multidisciplinary); SPONK; Subchondral bone; Subchondral bone plate; Tomography
• ISSN: 2045-2322; 2045-2322
• DOI: 10.1038/s41598-024-64591-7

To determine the diagnostic yield of cone beam computed tomography (CBCT) compared with 3 T magnetic resonance imaging (MRI) for the evaluation of subchondral insufficiency fractures of the knee. Consecutive patients with subchondral insufficiency fractures of the knee examined by 3 T MRI and CBCT of the femoral condyles were reviewed. Two experienced raters graded the lesion severity on 3 T MRI and CBCT images: grade 1: no signs of a subchondral bone lesion; grade 2: subchondral trabecular fracture or cystic changes, but without infraction of the subchondral bone plate; grade 3: collapse of the subchondral bone plate. Ratings were repeated after six weeks to determine reliability. In addition, the bone lesion size was measured as elliptical area (mm 2 ) and compared between CBCT and T1-weighted MRI sequences. Among 30 patients included (43.3% women; mean age: 60.9 ± 12.8 years; body mass index (BMI) 29.0 ± 12.8 kg/m 2 ), the medial femoral condyle was affected in 21/30 patients (70%). The grading of subchondral lesions between MRI and CBCT did not match in 12 cases (40%). Based on MRI images, an underestimation (i.e., undergrading) compared with CBCT was observed in nine cases (30%), whereas overgrading occurred in three cases (10%). Compared to CBCT, routine T1-weighted 3 T sequences significantly overestimated osseus defect zones in sagittal (84.7 ± 68.9 mm 2 vs. 35.9 ± 38.2 mm 2 , p