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📌Subchondral Hypointense Area
✅ Definition
- The term “subchondral hypointense area” refers to the finding on T1-weighted and fluid-sensitive MR images of a subchondral area of low signal intensity immediately subjacent to the subchondral bone plate that produces apparent thickening of the plate.
- This observation differs from the subchondral fracture that runs a short distance from the bone plate.
✅ Conditions Associated with Subchondral Hypointense Area
1️⃣ Insufficiency Fracture
- In patients with an insufficiency fracture, the hypointense crescentic area often represents a combination of a subchondral fracture line and granulation tissue and frequently secondary osteonecrosis interposed between the fracture and the bone plate.
- In early stages, the subchondral bone plate and overlying articular cartilage are intact.
2️⃣ Subchondral Bone Plate Fracture
- An apparent thickening of the bone plate, seen in either acute trauma or atraumatic collapse, represents impacted trabeculae and, depending on chronicity and cause, fracture callus, reactive cartilage, granulation tissue, and osteonecrosis.
- A deformity of the bone plate is typically present.
3️⃣ Osteoarthritis
- Subchondral sclerosis or eburnation may also produce subarticular hypointensity related to deposition of new bone on preexisting trabeculae, trabecular microfractures with callus formation, or secondary (shallow) osteonecrosis.
- Overlying cartilage denudation is invariably present because it represents an origin of these changes.
✅ Recommendation
- Attention should be given to the finding of a subchondral hypointense area because it frequently represents a fracture and secondary osteonecrosis.
- Dedicated MRI with a small FOV is recommended to help differentiate associated conditions, although overlap may be present, particularly in advanced lesions.
- Additional findings, such as fracture line, collapse, and cartilage loss should be sought.
- The extent of a subchondral hypointense area has prognostic significance in insufficiency fractures.
References
- AJR 2019; 213:963–982
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#SubchondralHypointenseArea, #MRI, #T1Weighted, #FluidSensitive, #InsufficiencyFracture, #Osteoarthritis, #SubchondralFracture, #BonePlateFracture, #Osteonecrosis, #RadiologyResearch
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