Detection of Traumatic Bone Marrow Lesions after Knee Trauma: Comparison of ADC Maps Derived from Diffusion-weighted Imaging with Standard Fat-saturated Proton Density-weighted Turbo Spin-Echo Sequences.

Purpose To compare single-shot echo-planar diffusion-weighted imaging-derived apparent diffusion coefficient (ADC) maps with fat-saturated (FS) proton density (PD)-weighted turbo spin-echo (TSE) imaging in the detection of bone marrow lesions (BMLs) after knee trauma. Materials and Methods Institutional review board approval was obtained from Leipzig University. Written informed consent was waived. Three radiologists retrospectively re-examined 97 consecutive patients with reported knee trauma who underwent 1.5-T magnetic resonance (MR) imaging within 90 days of knee trauma. The following sequences were used: (a) sagittal T1-weighted TSE and FS PD-weighted TSE and (b) sagittal T1-weighted TSE and single-shot echo-planar diffusion-weighted imaging-derived ADC mapping. BMLs on the lateral and medial femoral condyle, lateral and medial aspect of the tibial plateau, and patella were documented. Volumetry was performed on BMLs with a thickness of at least 15 mm (major BMLs). ADC values were measured in intact bone marrow and major BMLs. A McNemar test and t tests were used as appropriate to test for significant differences between BML number and volume at an α level of .05. Results Significantly more patients showed at least one BML on ADC maps (98%, 95 of 97 patients) than on FS PD-weighted TSE images (86%, 84 of 97 patients) (P < .001). Of the affected regions detected on FS PD-weighted TSE images, 97% (170 of 175 regions) were identified consistently on ADC maps. Only 58% of the affected regions detected on ADC maps (170 of 293 regions) were identified on FS PD-weighted TSE images (P < .001). Median volume of concordant major BML was approximately two times larger on ADC maps (81 cm) than on FS PD-weighted TSE images (39 cm) (P < .001). The ADC values of intact bone marrow and BMLs did not overlap. Conclusion ADC maps are more sensitive than corresponding FS PD-weighted TSE images for detection of BML after knee trauma and allow detection of significantly more and larger BMLs. ADC map evaluation improves diagnostic performance in regions with insufficient spectral fat saturation, such as the patella. RSNA, 2016 Online supplemental material is available for this article.