MAGNETIC RESONANCE IMAGING OF CYSTIC KNEE LESIONS - PowerPoint Presentation

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MAGNETIC RESONANCE IMAGING OF CYSTIC KNEE LESIONS

 M. GONGI, W. HARZALLAH, M. OMRI, R. SALEM, MA. JELLALI, A. ZRIG, W. MNARI, M. MAATOUK, M. GOLLI

THE 5th PAN ARAB CONGRESS OF RADIOLOGY

 

MUSCULOSKELETAL : MK 12

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INTRODUCTION (1) :

- Cystic lesions around the knee are a diverse group of entities, frequently encountered during routine MRI of the knee.

- These lesions may produce overlapping clinical features, rendering the clinical diagnosis difficult.

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INTRODUCTION (2) :

- MRI is the technique of choice in characterizing lesions around the knee: to confirm the cystic nature of the lesion, to evaluate the anatomical relationship to the joint and surrounding tissues, and to identify associated intra-

articular

disorders.

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PURPOSE :

The purpose of this study is to review the MRI aspects of some cystic knee lesions.

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MATERIALS AND METHODS :

- We retrospectively report 11 cases of cystic knee lesions collected in the radiology department of

Fattouma

Bourguiba

Hospital of

Monastir

over a period of 5 years.

- All patients were explored by MRI (1.5 Tesla) for knee pain.

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RESULTS :

The most common lesion was Baker cyst, also termed

popliteal

cyst (5 cases).

Meniscal

cysts were found in 3 cases .

A cyst of the

ilio-tibial

band was found in one case.

-

Mucoid

degeneration of the anterior

cruciate

ligament was diagnosed in 2 cases.

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DISCUSSION :

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1 -

Popliteal

(

Baker’s

)

Cysts

:

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Popliteal

cysts are lined with

synovium

and result from extrusion of joint fluid into the

gastrocnemio-semimembranosus

bursa through a weak portion of the

postermedial

capsule of the knee between the medial head of the

gastrocnemius

muscle and the

semimembrannosus

muscle.

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- Size :

The cyst can vary in size from quite small to very large.

-

Age :

It’s

rare in

chidren

.

-

Presentation

:

-asymptomatic +++ 

-painful 

popliteal

swelling ,

-knee effusion,

-clicking of the knee,

-buckling of the knee ..

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-

Complications :

- break :  table of pseudo-

thrombophlebitis

,

- 

vascular

or nerve compression, 

- synovial 

diseases

:

osteochondromatosis

..

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On

MR images

,

popliteal

cysts usually appear as well-defined fluid collections.

The presence of hemorrhage or debris within the

cyst is not rare.

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:

popliteal

cyst

SM

:

semimembrannosus

muscle

G

:

gastrocnemius

muscle

SM

G

SM

G

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Hemorrhagic

popliteal

cyst

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Large

popliteal

cyst

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A

popliteal

cyst

found

in a child

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2 -

Meniscal

Cysts

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-

Meniscal

cysts characteristically are located

at the joint line on the medial or lateral side of the knee and invariably are associated with an underlying horizontal

meniscal

tear.

They are formed by extrusion of joint fluid, into the adjacent tissues, through this

meniscal

tear which leads directly into the cyst.

Presentation :

They are manifested by knee pain, locking and a mass adjacent to the joint line.

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-On

MR images

, lateral

meniscal

cysts appear as well-defined rounded cysts located adjacent to a

meniscal

tear.

Medial

meniscal

cysts

tend

to be larger and dissect away from the site of the tear .

The

meniscal

tear is usually horizontal

and extensive.

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Lateral

meniscal

cyst

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Meniscal

cyst

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Meniscal

cyst

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3 -

Mucoïd

degeneration of the anterior

cruciate

ligament :

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- The lesion presents with knee pain and restriction of flexion.

The

pathogenesis

is unclear.

It’s suspected in a patient with a physically intact ligament and no obvious trauma history.

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- The lesion may manifest as an elongated cyst

along the long axis of the ACL, or as an enlarged

ACL.

- Discrete

intraosseous

ganglia are observed in

77% of the cases with

mucoid

degeneration of the

ACL.

These ganglia consist of

myxoid

material and

have generally no identifiable communication with

the

articular

surface or joint cavity.-

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The

MR-findings

of

mucoid

degeneration of the ACL include:

- an ill-defined ACL,

- an increased

ligamentous

girth,

- a normal orientation of the ligament,

- and an increased signal intensity on all sequences interspersed among visible intact ACL

fibers

.

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Mucoid

degeneration of the ACL

ACL

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Mucoid

degeneration of the ACL

a

b

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4 - Cyst of the

ilio-tibial

band :

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Iliotibial

band friction syndrome (ITBFS) is a common cause of lateral knee pain that is often related to intense physical activity, as occurs in long-distance runners, cyclists...

Clinical examination :

tenderness over the lateral femoral

epicondyle

and reproducible pain during flexion and extension of the knee.

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On

MRI findings

, there is a cyst located adjacent to

Iliotibial

band.

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: cyst

ITB

:

ilio-tibial

band

ITB

ITB

a

b

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c

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CONCLUSION (1) :

- A wide variety of cystic lesions may be encountered in the soft tissues and bones during routine MR imaging of the knee

.

- The ability of MR to visualize internal derangements of the knee and abnormalities of the surrounding soft tissues makes this technique ideally suited to the evaluation of these cystic lesions.

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CONCLUSION (2) :

- MR diagnosis is also needed to avoid unnecessary arthroscopy and to guide specific therapy.