Published Online:

The multitude of MR imaging techniques available for assessing the structure and composition of articular cartilage in the knee are described, and their current applications in clinical practice and clinical research are discussed.

Magnetic resonance (MR) imaging is the most important imaging modality for the evaluation of traumatic or degenerative cartilaginous lesions in the knee. It is a powerful noninvasive tool for detecting such lesions and monitoring the effects of pharmacologic and surgical therapy. The specific MR imaging techniques used for these purposes can be divided into two broad categories according to their usefulness for morphologic or compositional evaluation. To assess the structure of knee cartilage, standard spin-echo (SE) and gradient-recalled echo (GRE) sequences, fast SE sequences, and three-dimensional SE and GRE sequences are available. These techniques allow the detection of morphologic defects in the articular cartilage of the knee and are commonly used in research for semiquantitative and quantitative assessments of cartilage. To evaluate the collagen network and proteoglycan content in the knee cartilage matrix, compositional assessment techniques such as T2 mapping, delayed gadolinium-enhanced MR imaging of cartilage (or dGEMRIC), T1ρ imaging, sodium imaging, and diffusion-weighted imaging are available. These techniques may be used in various combinations and at various magnetic field strengths in clinical and research settings to improve the characterization of changes in cartilage.

©RSNA, 2011


  • 1 Felson DT. Osteoarthritis of the knee. N Engl J Med 2006;354(8):841–848. Crossref, MedlineGoogle Scholar
  • 2 Gold GE, Chen CA, Koo S, Hargreaves BA, Bangerter NK. Recent advances in MRI of articular cartilage. AJR Am J Roentgenol 2009;193(3):628–638. Crossref, MedlineGoogle Scholar
  • 3 Gold GE, McCauley TR, Gray ML, Disler DG. What's new in cartilage? RadioGraphics 2003;23(5):1227–1242. LinkGoogle Scholar
  • 4 Burstein D, Gray M, Mosher T, Dardzinski B. Measures of molecular composition and structure in osteoarthritis. Radiol Clin North Am 2009;47(4):675–686. Crossref, MedlineGoogle Scholar
  • 5 Trattnig S, Domayer S, Welsch GW, Mosher T, Eckstein F. MR imaging of cartilage and its repair in the knee: a review. Eur Radiol 2009;19(7):1582–1594. Crossref, MedlineGoogle Scholar
  • 6 Choi YS, Potter HG, Chun TJ. MR imaging of cartilage repair in the knee and ankle. RadioGraphics 2008;28(4):1043–1059. LinkGoogle Scholar
  • 7 Link TM, Stahl R, Woertler K. Cartilage imaging: motivation, techniques, current and future significance. Eur Radiol 2007;17(5):1135–1146. Crossref, MedlineGoogle Scholar
  • 8 Black C, Clar C, Henderson R, et al.. The clinical effectiveness of glucosamine and chondroitin sup-plements in slowing or arresting progression of osteoarthritis of the knee: a systematic review and economic evaluation. Health Technol Assess 2009;13(52):1–148. Crossref, MedlineGoogle Scholar
  • 9 Gudas R, Kalesinskas RJ, Kimtys V, et al.. A prospective randomized clinical study of mosaic osteochondral autologous transplantation versus microfracture for the treatment of osteochondral defects in the knee joint in young athletes. Arthroscopy 2005;21(9):1066–1075. Crossref, MedlineGoogle Scholar
  • 10 Knutsen G, Drogset JO, Engebretsen L, et al.. A randomized trial comparing autologous chondrocyte implantation with microfracture: findings at five years. J Bone Joint Surg Am 2007;89(10):2105–2112. Crossref, MedlineGoogle Scholar
  • 11 Jungius KP, Schmid MR, Zanetti M, Hodler J, Koch P, Pfirrmann CW. Cartilaginous defects of the femorotibial joint: accuracy of coronal short inversion time inversion-recovery MR sequence. Radiology 2006;240(2):482–488. LinkGoogle Scholar
  • 12 Kijowski R, Blankenbaker DG, Davis KW, Shinki K, Kaplan LD, De Smet AA. Comparison of 1.5- and 3.0-T MR imaging for evaluating the articular cartilage of the knee joint. Radiology 2009;250(3): 839–848. LinkGoogle Scholar
  • 13 Peterfy CG, Guermazi A, Zaim S, et al.. Whole-Organ Magnetic Resonance Imaging Score (WORMS) of the knee in osteoarthritis. Osteoarthritis Cartilage 2004;12(3):177–190. Crossref, MedlineGoogle Scholar
  • 14 Hunter DJ, Lo GH, Gale D, Grainger AJ, Guermazi A, Conaghan PG. The reliability of a new scoring system for knee osteoarthritis MRI and the validity of bone marrow lesion assessment: BLOKS (Boston Leeds Osteoarthritis Knee Score). Ann Rheum Dis 2008;67(2):206–211. Crossref, MedlineGoogle Scholar
  • 15 Kornaat PR, Ceulemans RY, Kroon HM, et al.. MRI assessment of knee osteoarthritis: Knee Osteoarthritis Scoring System (KOSS)—inter-observer and intra-observer reproducibility of a compartment-based scoring system. Skeletal Radiol 2005;34(2):95–102. Crossref, MedlineGoogle Scholar
  • 16 Disler DG, McCauley TR, Kelman CG, et al.. Fat-suppressed three-dimensional spoiled gradient-echo MR imaging of hyaline cartilage defects in the knee: comparison with standard MR imaging and arthroscopy. AJR Am J Roentgenol 1996;167(1):127–132. Crossref, MedlineGoogle Scholar
  • 17 Gerdes CM, Kijowski R, Reeder SB. IDEAL imaging of the musculoskeletal system: robust water fat separation for uniform fat suppression, marrow evaluation, and cartilage imaging. AJR Am J Roentgenol 2007;189(5):W284–W291. Crossref, MedlineGoogle Scholar
  • 18 Meyer CH, Pauly JM, Macovski A, Nishimura DG. Simultaneous spatial and spectral selective excitation. Magn Reson Med 1990;15(2):287–304. Crossref, MedlineGoogle Scholar
  • 19 Roemer FW, Guermazi A, Lynch JA, et al.. Short tau inversion recovery and proton density-weighted fat suppressed sequences for the evaluation of osteoarthritis of the knee with a 1.0 T dedicated extremity MRI: development of a time-efficient sequence protocol. Eur Radiol 2005;15(5):978–987. Crossref, MedlineGoogle Scholar
  • 20 Mohr A, Priebe M, Taouli B, Grimm J, Heller M, Brossmann J. Selective water excitation for faster MR imaging of articular cartilage defects: initial clinical results. Eur Radiol 2003;13(4):686–689. Crossref, MedlineGoogle Scholar
  • 21 Graichen H, Springer V, Flaman T, et al.. Validation of high-resolution water-excitation magnetic resonance imaging for quantitative assessment of thin cartilage layers. Osteoarthritis Cartilage 2000;8(2):106–114. Crossref, MedlineGoogle Scholar
  • 22 Duc SR, Pfirrmann CW, Schmid MR, 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):216–223. LinkGoogle Scholar
  • 23 Vallotton JA, Meuli RA, Leyvraz PF, Landry M. Comparison between magnetic resonance imaging and arthroscopy in the diagnosis of patellar cartilage lesions: a prospective study. Knee Surg Sports Traumatol Arthrosc 1995;3(3):157–162. Crossref, MedlineGoogle Scholar
  • 24 Freeman DM, Bergman G, Glover G. Short TE MR microscopy: accurate measurement and zonal differentiation of normal hyaline cartilage. Magn Reson Med 1997;38(1):72–81. Crossref, MedlineGoogle Scholar
  • 25 Kijowski R, Davis KW, Woods MA, et al.. Knee joint: comprehensive assessment with 3D isotropic resolution fast spin-echo MR imaging—diagnostic performance compared with that of conventional MR imaging at 3.0 T. Radiology 2009;252(2):486–495. LinkGoogle Scholar
  • 26 Roemer FW, Zhang Y, Niu J, et al.. Tibiofemoral joint osteoarthritis: risk factors for MR-depicted fast cartilage loss over a 30-month period in the multicenter osteoarthritis study. Radiology 2009;252(3):772–780. LinkGoogle Scholar
  • 27 Bobic V. ICRS articular cartilage imaging committee. ICRS MR imaging protocol for knee articular cartilage. Zollikon, Switzerland: International Cartilage Repair Society, 2000;12. Google Scholar
  • 28 Roemer FW, Hunter DJ, Guermazi A. MRI-based semiquantitative assessment of subchondral bone marrow lesions in osteoarthritis research. Osteoarthritis Cartilage 2009;17(3):414–415; author reply 416–417. Crossref, MedlineGoogle Scholar
  • 29 Kijowski R, Blankenbaker DG, Klaers JL, Shinki K, De Smet AA, Block WF. Vastly undersampled isotropic projection steady-state free precession imaging of the knee: diagnostic performance compared with conventional MR. Radiology 2009;251(1):185–194. LinkGoogle Scholar
  • 30 Ristow O, Steinbach L, Sabo G, et al.. Isotropic 3D fast spin-echo imaging versus standard 2D imaging at 3.0 T of the knee: image quality and diagnostic performance. Eur Radiol 2009;19(5):1263–1272. Crossref, MedlineGoogle Scholar
  • 31 Disler DG, McCauley TR, Wirth CR, Fuchs MD. Detection of knee hyaline cartilage defects using fat-suppressed three-dimensional spoiled gradient-echo MR imaging: comparison with standard MR imaging and correlation with arthroscopy. AJR Am J Roentgenol 1995;165(2):377–382. Crossref, MedlineGoogle Scholar
  • 32 Eckstein F, Guermazi A, Roemer FW. Quantitative MR imaging of cartilage and trabecular bone in osteoarthritis. Radiol Clin North Am 2009;47(4):655–673. Crossref, MedlineGoogle Scholar
  • 33 Crema MD, Guermazi A, Li L, et al.. The association of prevalent medial meniscal pathology with cartilage loss in the medial tibiofemoral compartment over a 2-year period. Osteoarthritis Cartilage 2010;18(3):336–343. Crossref, MedlineGoogle Scholar
  • 34 Siepmann DB, McGovern J, Brittain JH, Reeder SB. High-resolution 3D cartilage imaging with IDEAL SPGR at 3 T. AJR Am J Roentgenol 2007;189(6):1510–1515. Crossref, MedlineGoogle Scholar
  • 35 Wirth W, Nevitt M, Hellio Le Graverand MP, et al.. Sensitivity to change of cartilage morphometry using coronal FLASH, sagittal DESS, and coronal MPR DESS protocols: comparative data from the Osteoarthritis Initiative (OAI). Osteoarthritis Cartilage 2010;18(4):547–554. Crossref, MedlineGoogle Scholar
  • 36 Glaser C, Tins BJ, Trumm CG, Richardson JB, Reiser MF, McCall IW. Quantitative 3D MR evaluation of autologous chondrocyte implantation in the knee: feasibility and initial results. Osteoarthritis Cartilage 2007;15(7):798–807. Crossref, MedlineGoogle Scholar
  • 37 Hargreaves BA, Gold GE, Lang PK, et al.. MR imaging of articular cartilage using driven equilibrium. Magn Reson Med 1999;42(4):695–703. Crossref, MedlineGoogle Scholar
  • 38 Gold GE, Fuller SE, Hargreaves BA, Stevens KJ, Beaulieu CF. Driven equilibrium magnetic resonance imaging of articular cartilage: initial clinical experience. J Magn Reson Imaging 2005;21(4): 476–481. Crossref, MedlineGoogle Scholar
  • 39 Radlbauer R, Lomoschitz F, Salomonowitz E, Eberhardt KE, Stadlbauer A. MR imaging of the knee: improvement of signal and contrast efficiency of T1-weighted turbo spin echo sequences by applying a driven equilibrium (DRIVE) pulse. Eur J Radiol 2010;75(2):e82–e87. Crossref, MedlineGoogle Scholar
  • 40 Moriya S, Miki Y, Yokobayashi T, Ishikawa M. Three-dimensional double-echo steady-state (3D-DESS) magnetic resonance imaging of the knee: contrast optimization by adjusting flip angle. Acta Radiol 2009;50(5):507–511. Crossref, MedlineGoogle Scholar
  • 41 Eckstein F, Hudelmaier M, Wirth W, et al.. Double echo steady state magnetic resonance imaging of knee articular cartilage at 3 Tesla: a pilot study for the Osteoarthritis Initiative. Ann Rheum Dis 2006;65(4):433–441. Crossref, MedlineGoogle Scholar
  • 42 Duc SR, Koch P, Schmid MR, Horger W, Hodler J, Pfirrmann CW. Diagnosis of articular cartilage abnormalities of the knee: prospective clinical evaluation of a 3D water-excitation true FISP sequence. Radiology 2007;243(2):475–482. LinkGoogle Scholar
  • 43 Duc SR, Pfirrmann CW, Koch PP, Zanetti M, Hodler J. Internal knee derangement assessed with 3-minute three-dimensional isovoxel true FISP MR sequence: preliminary study. Radiology 2008;246(2):526–535. LinkGoogle Scholar
  • 44 Vasnawala SS, Pauly JM, Nishimura DG, Gold GE. MR imaging of knee cartilage with FEMR. Skeletal Radiol 2002;31(10):574–580. Crossref, MedlineGoogle Scholar
  • 45 Gold GE, Hargreaves BA, Vasanawala SS, et al.. Articular cartilage of the knee: evaluation with fluctuating equilibrium MR imaging—initial experience in healthy volunteers. Radiology 2006;238(2): 712–718. LinkGoogle Scholar
  • 46 Gold GE, Reeder SB, Yu H, et al.. Articular cartilage of the knee: rapid three-dimensional MR imaging at 3.0 T with IDEAL balanced steady-state free precession—initial experience. Radiology 2006;240(2): 546–551. LinkGoogle Scholar
  • 47 Friedrich KM, Reiter G, Kaiser B, et al.. High-resolution cartilage imaging of the knee at 3T: basic evaluation of modern isotropic 3D MR-sequences. Eur J Radiol 2010 Feb 5. [Epub ahead of print] Google Scholar
  • 48 Schaefer FK, Kurz B, Schaefer PJ, 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 Radiol 2007;48(10): 1131–1137. Crossref, MedlineGoogle Scholar
  • 49 Liess C, Lüsse S, Karger N, Heller M, Glüer CC. Detection of changes in cartilage water content using MRI T2-mapping in vivo. Osteoarthritis Cartilage 2002;10(12):907–913. Crossref, MedlineGoogle Scholar
  • 50 Mosher TJ, Smith H, Dardzinski BJ, Schmithorst VJ, Smith MB. MR imaging and T2 mapping of femoral cartilage: in vivo determination of the magic angle effect. AJR Am J Roentgenol 2001;177(3):665–669. Crossref, MedlineGoogle Scholar
  • 51 Dunn TC, Lu Y, Jin H, Ries MD, Majumdar S. T2 relaxation time of cartilage at MR imaging: comparison with severity of knee osteoarthritis. Radiology 2004;232(2):592–598. LinkGoogle Scholar
  • 52 Koff MF, Amrami KK, Kaufman KR. Clinical evaluation of T2 values of patellar cartilage in patients with osteoarthritis. Osteoarthritis Cartilage 2007;15(2):198–204. Crossref, MedlineGoogle Scholar
  • 53 Stehling C, Liebl H, Krug R, et al.. Patellar cartilage: T2 values and morphologic abnormalities at 3.0-T MR imaging in relation to physical activity in asymptomatic subjects from the osteoarthritis initiative. Radiology 2010;254(2):509–520. LinkGoogle Scholar
  • 54 Welsch GH, Mamisch TC, Domayer SE, et al.. Cartilage T2 assessment at 3-T MR imaging: in vivo differentiation of normal hyaline cartilage from reparative tissue after two cartilage repair procedures—initial experience. Radiology 2008;247(1):154–161. LinkGoogle Scholar
  • 55 McKenzie CA, Williams A, Prasad PV, Burstein D. Three-dimensional delayed gadolinium-enhanced MRI of cartilage (dGEMRIC) at 1.5T and 3.0T. J Magn Reson Imaging 2006;24(4):928–933. Crossref, MedlineGoogle Scholar
  • 56 Williams A, Sharma L, McKenzie CA, Prasad PV, Burstein D. Delayed gadolinium-enhanced magnetic resonance imaging of cartilage in knee osteoarthritis: findings at different radiographic stages of disease and relationship to malalignment. Arthritis Rheum 2005;52(11):3528–3535. Crossref, MedlineGoogle Scholar
  • 57 Tiderius CJ, Svensson J, Leander P, Ola T, Dahlberg L. dGEMRIC (delayed gadolinium-enhanced MRI of cartilage) indicates adaptive capacity of human knee cartilage. Magn Reson Med 2004;51(2): 286–290. Crossref, MedlineGoogle Scholar
  • 58 Anandacoomarasamy A, Giuffre BM, Leibman S, et al.. Delayed gadolinium-enhanced magnetic resonance imaging of cartilage: clinical associations in obese adults. J Rheumatol 2009;36(5):1056–1062. Crossref, MedlineGoogle Scholar
  • 59 Bashir A, Gray ML, Hartke J, Burstein D. Nondestructive imaging of human cartilage glycosaminoglycan concentration by MRI. Magn Reson Med 1999;41(5):857–865. Crossref, MedlineGoogle Scholar
  • 60 Watanabe A, Wada Y, Obata T, et al.. Delayed gadolinium-enhanced MR to determine glycosaminoglycan concentration in reparative cartilage after autologous chondrocyte implantation: preliminary results. Radiology 2006;239(1):201–208. LinkGoogle Scholar
  • 61 Owman H, Tiderius CJ, Neuman P, Nyquist F, Dahlberg LE. Association between findings on delayed gadolinium-enhanced magnetic resonance imaging of cartilage and future knee osteoarthritis. Arthritis Rheum 2008;58(6):1727–1730. Crossref, MedlineGoogle Scholar
  • 62 Duvvuri U, Charagundla SR, Kudchodkar SB, et al.. Human knee: in vivo T1(rho)-weighted MR imaging at 1.5 T—preliminary experience. Radiology 2001;220(3):822–826. LinkGoogle Scholar
  • 63 Stahl R, Luke A, Li X, et al.. T1rho, T2 and focal knee cartilage abnormalities in physically active and sedentary healthy subjects versus early OA patients: a 3.0-Tesla MRI study. Eur Radiol 2009;19(1): 132–143. Crossref, MedlineGoogle Scholar
  • 64 Mlynárik V, Trattnig S, Huber M, Zembsch A, Imhof H. The role of relaxation times in monitoring pro-teoglycan depletion in articular cartilage. J Magn Reson Imaging 1999;10(4):497–502. Crossref, MedlineGoogle Scholar
  • 65 Borthakur A, Shapiro EM, Beers J, Kudchodkar S, Kneeland JB, Reddy R. Sensitivity of MRI to proteoglycan depletion in cartilage: comparison of sodium and proton MRI. Osteoarthritis Cartilage 2000;8(4):288–293. Crossref, MedlineGoogle Scholar
  • 66 Wang L, Wu Y, Chang G, et al.. Rapid isotropic 3D-sodium MRI of the knee joint in vivo at 7T. J Magn Reson Imaging 2009;30(3):606–614. Crossref, MedlineGoogle Scholar
  • 67 Wheaton AJ, Borthakur A, Shapiro EM, et al.. Proteoglycan loss in human knee cartilage: quantitation with sodium MR imaging—feasibility study. Radiology 2004;231(3):900–905. LinkGoogle Scholar
  • 68 Burstein D, Gray ML, Hartman AL, Gipe R, Foy BD. Diffusion of small solutes in cartilage as measured by nuclear magnetic resonance (NMR) spectroscopy and imaging. J Orthop Res 1993;11(4): 465–478. Crossref, MedlineGoogle Scholar
  • 69 Mamisch TC, Menzel MI, Welsch GH, et al.. Steady-state diffusion imaging for MR in-vivo evaluation of reparative cartilage after matrix-associated autologous chondrocyte transplantation at 3 tesla: preliminary results. Eur J Radiol 2008;65(1):72–79. Crossref, MedlineGoogle Scholar
  • 70 Kladny B, Glückert K, Swoboda B, Beyer W, Weseloh G. Comparison of low-field (0.2 Tesla) and high-field (1.5 Tesla) magnetic resonance imaging of the knee joint. Arch Orthop Trauma Surg 1995;114(5):281–286. Crossref, MedlineGoogle Scholar
  • 71 Woertler K, Strothmann M, Tombach B, Reimer P. Detection of articular cartilage lesions: experimental evaluation of low- and high-field-strength MR imaging at 0.18 and 1.0 T. J Magn Reson Imaging 2000;11(6):678–685. Crossref, MedlineGoogle Scholar
  • 72 Crema MD, Roemer FW, Zhu Y, et al.. Subchondral cystlike lesions develop longitudinally in areas of bone marrow edema-like lesions in patients with or at risk for knee osteoarthritis: detection with MR imaging—the MOST study. Radiology 2010;256(3): 855–862. LinkGoogle Scholar
  • 73 Roemer FW, Lynch JA, Niu J, et al.. A comparison of dedicated 1.0 T extremity MRI vs large-bore 1.5 T MRI for semiquantitative whole organ assessment of osteoarthritis: the MOST study. Osteoarthritis Cartilage 2010;18(2):168–174. Crossref, MedlineGoogle Scholar
  • 74 Stahl R, Krug R, Kelley DA, et al.. Assessment of cartilage-dedicated sequences at ultra-high-field MRI: comparison of imaging performance and diagnostic confidence between 3.0 and 7.0 T with respect to osteoarthritis-induced changes at the knee joint. Skeletal Radiol 2009;38(8):771–783. Crossref, MedlineGoogle Scholar
  • 75 Krug R, Carballido-Gamio J, Banerjee S, et al.. In vivo bone and cartilage MRI using fully-balanced steady-state free-precession at 7 tesla. Magn Reson Med 2007;58(6):1294–1298. Crossref, MedlineGoogle Scholar

Article History

Received: Apr 7 2010
Revision requested: May 24 2010
Revision received: July 9 2010
Revision received: July 26 2010
Published online: Jan 19 2011
Published in print: Jan 2011