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The Meniscus: Recent Advances in MR Imaging of the Knee

¹ Department of Radiology, Duke University Medical Center, Box 3808, Durham NC 27710.

View larger version (128K): [in a new window]   Fig. 1A. —Conventional spin-echo versus fast spin-echo imaging for meniscal tear in 33-year-old man. Sagittal proton density—weighted MR image (TR/TE, 2000/20) obtained through medial meniscus shows oblique tear (arrow) of posterior horn, which was also seen on two adjacent images.

View larger version (141K): [in a new window]   Fig. 1B. —Conventional spin-echo versus fast spin-echo imaging for meniscal tear in 33-year-old man. Sagittal fast spin-echo MR image (3000/18) obtained through medial meniscus does not show meniscal tear.

View larger version (70K): [in a new window]   Fig. 2A. —Schematic of absent bow-tie sign. A = first sagittal slice, B = next adjacent sagittal slice. Drawing illustrates how two consecutive MR images should traverse body of meniscus, giving bow-tie appearance on sagittal images.

View larger version (73K): [in a new window]   Fig. 2B. —Schematic of absent bow-tie sign. A = first sagittal slice, B = next adjacent sagittal slice. When bucket-handle tear is present and part of free edge of meniscus is displaced, second sagittal image fails to have bow-tie appearance.

View larger version (140K): [in a new window]   Fig. 3A. —Bucket-handle tear in 25-year-old man. Most medial sagittal fast spin-echo T2-weighted MR image (TR/TE, 3000/60) obtained through medial meniscus shows normal-appearing body segment.

View larger version (135K): [in a new window]   Fig. 3B. —Bucket-handle tear in 25-year-old man. Sagittal MR image should show bow-tie appearance but instead shows apparent anterior and posterior horns separated by gap.

View larger version (158K): [in a new window]   Fig. 3C. —Bucket-handle tear in 25-year-old man. Coronal fast spin-echo T2-weighted MR image (3000/60) with fat suppression reveals truncated medial meniscus (straight arrow) with displaced fragment seen in intercondylar notch (curved arrow).

View larger version (162K): [in a new window]   Fig. 3D. —Bucket-handle tear in 25-year-old man. Sagittal fast spin-echo T2-weighted MR image (3000/60) obtained through intercondylar notch shows displaced fragment (arrows) beneath posterior cruciate ligament.

View larger version (144K): [in a new window]   Fig. 4A. —Meniscal cyst in 40-year-old woman. Sagittal proton density—weighted MR image (TR/TE, 2000/20) with fat suppression obtained through medial meniscus shows swollen anterior horn (arrow) with high signal within, indicative of meniscal cyst.

View larger version (164K): [in a new window]   Fig. 4B. —Meniscal cyst in 40-year-old woman. Fast spin-echo T2-weighted MR image (3000/20) with fat suppression shows parameniscal component (arrow), which is similar to joint fluid in signal, whereas intrameniscal signal remains intermediate in intensity.

View larger version (109K): [in a new window]   Fig. 5. —Meniscal cyst with parameniscal component in 27-year-old man. Coronal fast spinecho T2-weighted MR image (TR/TE, 3000/20) with fat suppression shows meniscal cyst (solid arrow) with intermediate signal throughout medial meniscus with adjacent parameniscal component (open arrows), which is similar to joint fluid in signal intensity.

View larger version (148K): [in a new window]   Fig. 6A. —Inferiorly displaced medial meniscus flap tear in 20-year-old man. Most medial sagittal fast spin-echo MR T2-weighted image (TR/TE, 3000/60) obtained through medial meniscus shows low-signal mass (arrow) inferior to normal rectangular body segment.

View larger version (134K): [in a new window]   Fig. 6B. —Inferiorly displaced medial meniscus flap tear in 20-year-old man. Adjacent sagittal MR image shows apparent defect in central portion of bow tie (arrow), caused by inferior flap of meniscus displacing into medial gutter and allowing central portion of body of meniscus to collapse.

View larger version (125K): [in a new window]   Fig. 6C. —Inferiorly displaced medial meniscus flap tear in 20-year-old man. Coronal fast spin-echo T2-weighted MR image (3000/60) shows displaced flap (arrow) of meniscus inferior to medial meniscus in medial gutter.

View larger version (60K): [in a new window]   Fig. 7. —Radial tear in 25-year-old man, with diagram showing ghost meniscus. Sagittal gradient-echo MR image obtained through complete radial tear of posterior horn shows entire posterior horn as intermediate in signal (arrow) compared with that of anterior horn.

View larger version (65K): [in a new window]   Fig. 8. —Radial tear in 32-year-old woman, with diagram showing meniscal cleft. Sagittal T2-weighted MR image with fat suppression obtained through body of meniscus with radial tear shows small gap in expected "bow tie" (arrow).

View larger version (70K): [in a new window]   Fig. 9. —Radial tear in 45-year-old woman, with diagram showing truncated triangle. Coronal T2-weighted MR image with fat suppression obtained through radial tear in mid body shows tip of meniscus as intermediate in signal (arrow) compared with that of remainder of meniscus.

View larger version (82K): [in a new window]   Fig. 10. —Radial tear in 26-year-old man, with diagram showing marching cleft. Sagittal T2-weighted MR images with fat suppression obtained through radial tear that is aligned obliquely to plane of imaging reveal cleft (arrows) in each segment of meniscus that is slightly more posterior than that in each prior image. A, B, and C = sagittal slices through meniscus.

View larger version (109K): [in a new window]   Fig. 11. —Peripheral meniscal tear in 24-year-old man. Sagittal proton density—weighted MR image (TR/TE, 2000/20) with fat suppression shows meniscal tear (arrow) in periphery of posterior horn.

View larger version (121K): [in a new window]   Fig. 12A. —Meniscal contusion in 39-year-old woman. Sagittal proton density—weighted MR image (TR/TE, 2000/20) with fat suppression obtained through medial meniscus in patient with torn anterior cruciate ligament shows increased signal in posterior horn (solid arrow), which abuts articular surface of meniscus but is somewhat illdefined. Adjacent bone contusion is seen in tibia (curved arrow). At surgery no meniscal tear was found.

View larger version (120K): [in a new window]   Fig. 12B. —Meniscal contusion in 39-year-old woman. Adjacent sagittal MR image again shows amorphous high signal in meniscus (arrow).

View larger version (141K): [in a new window]   Fig. 12C. —Meniscal contusion in 39-year-old woman. Sagittal MR image obtained through intercondylar notch shows torn anterior and posterior cruciate ligaments.

View larger version (132K): [in a new window]   Fig. 13A. —Chondrocalcinosis mimicking meniscal tear in 63-year-old man. Radiograph of knee reveals chondrocalcinosis in medial and lateral menisci (arrows).

View larger version (123K): [in a new window]   Fig. 13B. —Chondrocalcinosis mimicking meniscal tear in 63-year-old man. Sagittal proton density—weighted MR image (TR/TE, 2000/20) obtained through lateral meniscus shows marked increased signal throughout meniscus (arrows).

View larger version (112K): [in a new window]   Fig. 14. —Meniscal flounce in 21-year-old man. Sagittal proton density—weighted MR image (TR/TE, 2000/20) obtained through medial meniscus shows wavy appearance. Medial meniscus was otherwise normal.

View larger version (109K): [in a new window]   Fig. 15. —Speckled anterior horn of lateral meniscus in 25-year-old woman. Sagittal proton density—weighted MR image (TR/TE, 2000/20) with fat suppression obtained through lateral meniscus shows speckled appearance of anterior horn (arrow) due to some anterior cruciate ligament fibers interdigitating with meniscus.

View larger version (184K): [in a new window]   Fig. 16A. —Wrisberg's variant of discoid lateral meniscus in 16-year-old boy. Fast spin-echo T2-weighted MR image (TR/TE, 4000/75) with fat suppression obtained through discoid lateral meniscus shows posterior horn unattached to capsule (arrow).

View larger version (157K): [in a new window]   Fig. 16B. —Wrisberg's variant of discoid lateral meniscus in 16-year-old boy. Adjacent sagittal MR image shows no attachment of posterior horn to capsule (arrow). At surgery, posterior horn was found to be unattached to capsule and freely mobile.

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