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📌 Subchondral Hypointense Area
✅ Definition

A subchondral hypointense area refers to a low signal intensity region on T1-weighted and fluid-sensitive MR images, located immediately below the subchondral bone plate, causing an apparent thickening of the plate. This is different from a subchondral fracture which runs parallel to the bone plate.
✅ Associated Conditions

1️⃣ Insufficiency Fracture
Represents a combination of a subchondral fracture line and granulation tissue, often leading to secondary osteonecrosis. Early stages show intact subchondral bone plate and articular cartilage.

2️⃣ Subchondral Bone Plate Fracture
Seen in acute trauma or atraumatic collapse, showing impacted trabeculae, fracture callus, reactive cartilage, granulation tissue, and osteonecrosis. Typically presents with bone plate deformity.

3️⃣ Osteoarthritis
Subchondral sclerosis or eburnation from new bone deposition, trabecular microfractures with callus formation, or secondary osteonecrosis. Overlying cartilage denudation is commonly present.

✅ Recommendation

Subchondral hypointense areas often indicate a fracture and secondary osteonecrosis. Use dedicated MRI with a small FOV to differentiate conditions, noting fracture line, collapse, and cartilage loss. The extent of these areas is prognostic in insufficiency fractures.

References

AJR 2019; 213:963–982
"Visualizing MSK Radiology: A Practical Guide to Radiology Mastery"
© 2022 MSK MRI Jee Eun Lee All Rights Reserved.
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#SubchondralHypointenseArea, #MRI, #T1Weighted, #FluidSensitive, #InsufficiencyFracture, #Osteoarthritis, #SubchondralFracture, #BonePlateFracture, #Osteonecrosis, #RadiologyResearch

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