A COMPARISON OF RADIOGRAPHY, COMPUTED TOMOGRAPHY, AND MAGNETIC RESONANCE IMAGING FOR THE DIAGNOSIS OF PALMAR PROCESS FRACTURES IN FOALS

The relative sensitivity of radiography, computed tomography, and magnetic resonance imaging for detecting palmar process fractures of the distal phalanx in foals was determined and the imaging findings were compared with histomorphologic evaluations of the palmar processes. Compared to radiography, computed tomography and magnetic resonance imaging did not improve the sensitivity for detection of palmar process fractures. Statistical agreement for palmar process fracture diagnosis was excellent among the three imaging modalities. Histomorphologic evaluations were more sensitive for diagnosis of palmar process fracture than any of the imaging modalities. Three-dimensional image reconstructions and volume measurements of distal phalanges and palmar process fracture fragments from computed tomography studies provided more complete anatomical information than radiography. Magnetic resonance imaging confirmed that the deep digital flexor tendon insertion on the distal phalanx is immediately axial to the site where palmar process fractures occur, and differentiated cartilage, bone, and soft tissue structures of the hoof.     

MAGNETIC RESONANCE IMAGING FINDINGS IN HORSES WITH RECENT ONSET NAVICULAR SYNDROME BUT WITHOUT RADIOGRAPHIC ABNORMALITIES

Seventy-two horses with recent onset of navicular syndrome and normal radiographs were assessed. Horses underwent magnetic resonance (MR) imaging of both front feet. All abnormalities were characterized and the most severe abnormality identified, if possible. Abnormal signal intensity in the navicular bone was the most severe abnormality in 24 (33%) horses. Pathologic change in the deep digital flexor tendon was the most severe abnormality in 13 (18%) horses. Pathologic change in the collateral sesamoidean ligament was the most severe abnormality in 11 (15%) horses. Pathologic change in the distal sesamoidean impar ligament was the most severe abnormality in seven (10%) horses. Multiple abnormalities were observed in 13 (18%) horses in which an abnormality that was more severe than the others could not be determined. Abnormalities were not observed in the navicular bone or its supporting soft tissues in four (5%) horses. Fifty-six horses had abnormalities that were most severe in one limb; in 52 (93%) horses, the most severe abnormalities were in the foot of the most lame limb. In 7% (4/56) of horses, the most severe findings were in the opposite limb, and in 16 horses, the findings on both limbs were similar. MR imaging is a useful technique for evaluating horses with navicular syndrome and can differentiate between multiple abnormalities. This provides a more specific diagnosis which affects further treatment of the horse. Pathologic changes in different locations in the foot can cause similar clinical signs that, before MR imaging, were categorized as one syndrome.     

EVALUATION OF THE VARIABLY OSSIFIED COLLATERAL CARTILAGES OF THE DISTAL PHALANX AND ADJACENT ANATOMIC STRUCTURES IN THE FINNHORSE WITH COMPUTED TOMOGRAPHY AND MAGNETIC RESONANCE IMAGING

Six Finnhorse cadaver forefeet were selected to represent radiographically different types and grades of ossification of the collateral cartilages of the distal phalanx. These cartilages and adjacent tissues were evaluated with computed tomography (CT) and high field magnetic resonance imaging (MRI). In CT the internal structure of the cartilages was consistent, but in MRI some differences were noted. The shape of the collateral cartilages and their ligamentous attachments varied. The border between ossified and non-ossified cartilage appeared distinct, with considerable variation in the extent of the ossified area in regard to the cross-sectional area of the cartilage. Ossification originating from the palmar processes and extending in the proximaVpalmaroproximal direction, without separate centers of ossification, generally appeared smooth and inactive. Palmar ossification followed the irregular shape of the cartilage. Separate centers of ossification had a medullary cavity or were sclerotic. Presence ofamedullary cavity or sclerosis were also found at the base of the cartilages. The incomplete fusion lines between separate centres of ossification and the ossified base of the cartilage varied from congruent and inactive to reactive with marked sclerosis, flared margins and parachondral changes. Incomplete fusion may be clinically significant. Local conformational adaptations of the hoof were also documented with extensive ossification of the collateral cartilage.     

MAGNETIC RESONANCE IMAGING AND COMPUTED TOMOGRAPHY CHARACTERISTICS OF INTRACRANIAL INTRA-ARACHNOID CYSTS IN 6 DOGS

Magnetic resonance imaging (MRI) and computed tomographic imaging (CT) characteristics of intracranial intra-arachnoid cysts in six dogs are described.Of the six dogs, three were less than one year of age and 4 were males. Five of the six dogs weighed less than 11 kg. Five cysts were located in the quadrigeminal cistern.On CT images, the intracranial intra-arachnoid cysts had sharply defined margins, contained fluid isodense to CSf and did not enhance following IV administration of contrast. On MRI images, the intracranial intra-arachnoid cysts were extra-axial, contained fluid isointense with CSF and did not enhance following IV contrast. While spinal arachnoid cysts of dogs have been reported in the literature, other than the six dogs contained in this report, intracranial intra-arachnoid cysts have not to our knowledge been described in animals. These six dogs have a similar age, sex, arachnoid cysts.     

COMPARISON OF MAGNETIC RESONANCE IMAGING,COMPUTED TOMOGRAPHY,AND RADIOGRAPHY FOR ASSESSMENT OF NONCARTILAGINOUS CHANGES IN EQUINE METACARPOPHALANGEAL OSTEOARTHRITIS

We compared the ability of 1.5 T magnetic resonance imaging (MRI), computed tomography (CT), and computed radiography (CR) to evaluate noncartilaginous structures of the equine metacarpophalangeal joint (MCP), and the association of imaging changes with gross cartilage damage in the context of osteoarthritis. Four CR projections, helical single‐slice CT, and MRI (T1‐weighted gradient recalled echo [GRE], T2^*‐weighted GRE with fast imaging employing steady‐state acquisition [FIESTA], T2‐weighted fast spin echo with fat saturation, and spoiled gradient recalled echo with fat saturation [SPGR‐FS]) were performed on 20 racehorse cadaver forelimbs. Osteophytosis, synovial effusion, subchondral bone lysis and sclerosis, supracondylar lysis, joint fragments, bone marrow lesions, and collateral desmopathy were assessed with each modality. Interexaminer agreement was inferior to intraexaminer agreement and was generally moderate (i.e., 0.4<κ<0.6). Subchondral bone sclerosis scores using CT or MRI were correlated significantly with the reference quantitative CT technique used to assess bone mineral density (P<0.0001). Scores for subchondral lysis and osteophytosis were higher with MRI or CT vs. CR (P<0.0001). Although differences between modalities were noted, osteophytosis, subchondral sclerosis, and lysis as well as synovial effusion were all associated with the degree of cartilage damage and should be further evaluated as potential criteria to be included in a whole‐organ scoring system. This study highlights the capacity of MRI to evaluate noncartilaginous changes in the osteoarthritic equine MCP joint.     

MAGNETIC RESONANCE IMAGING FOR THE DIAGNOSIS OF STRESS FRACTURES IN A HORSE

In humans, magnetic resonance (MR) imaging is the method of choice for the diagnosis of stress fractures. In this paper, bilateral stress fracture of the lateral condyle of the third metacarpal bone in a French trotter is described. Results of the radiographic, MR imaging, and histologic examinations are presented, with a focus on the MR signal abnormalities found. Based on this patient, the potential use of MR imaging for the diagnosis of stress fractures in horses is discussed.     

COMPUTED TOMOGRAPHY AND MAGNETIC RESONANCE IMAGING OF CAVERNOUS SINUS ENLARGEMENT IN A DOG WITH UNILATERAL EXOPHTHALMOS

Computed tomography (CT), magnetic resonance imaging (MRI) and magnetic resonance angiography (MRA) were performed on a dog with a two year history of unilateral exophthalmos occurring two years following head trauma. On CT images, an expansile enhancing mass was present along the right intracranial cavernous sinus and extended through the orbital fissure into the retrobulbar space. With MRI, the structure appeared as a signal void due to the presence of rapidly flowing blood. Gadolinium enhancement of the adjacent brain was not present. A vascular origin of the lesion was confirmed with MRA. Based on the CT and MRI findings, the enlarged cavernous sinus and associated ophthalmic plexus were believed to represent an arterialized aneurysm, most likely the result of traumatic arteriovenous fistulization. Treatment consisted of surgical enucleation. At the time of this report, 29 mouths later, the dog remains free of clinical signs.     

COMPUTED TOMOGRAPHIC EVALUATION OF FINNHORSE CADAVER FOREFEET WITH RADIOGRAPHICALLY PROBLEMATIC FINDINGS ON THE FLEXOR ASPECT OF THE NAVICULAR BONE

Computed tomography (CT) was performed on 12 Finnhorse cadaver forefeet with known radiographic changes in the navicular bone (poor corticomedullary junction, irregular appearance of the flexor central eminence, uneven or unequal thickness of the flexor cortex, and/or irregular outline of the proximal or distal flexor margin). The purpose was to confirm the radiographic findings and to investigate if further information of the flexor aspect of the bone could be gained with CT. In CT, the midsagittal outline as well as the internal structure of the bones varied greatly. Different combinations of trabecular and compact bone were seen within the flexor central eminence. Lucencies within the compact bone were commonly present in the proximal half of the eminence, but in five bones lucencies were also identified in the distal half. Due to partial overlapping of the bone and varying bony composition of the eminence, accurate radiographic evaluation of the shape and internal structure of the flexor central eminence was often found to be difficult. The flexor cortex usually appeared to be thinner in CT than in conventional radiographs. Medullary sclerosis and poor flexor corticomedullary junction were commonly overinterpreted radiographically. New bone formation on the proximal flexor margin of the navicular bone was generally visualized in radiographs, but CT allowed also the evaluation of the internal structure of the bone. In one navicular bone, an avulsion fragment on the distal flexor margin was seen in CT images; radiographically this fragment could not be visualized. It was concluded that the flexor aspect of the navicular bone may be difficult to assess reliably with conventional radiography.     

EVALUATION OF MAGNETIC RESONANCE IMAGING TECHNIQUES IN THE EQUINE DIGIT

An anatomic study of the equine digit using magnetic resonance imaging (MRI) was performed. Seventeen isolated forelimbs and one hindleg of nine warmblood horses were imaged in transverse, sagittal, and dorsal planes with a 1.5 Tesla magnet using T1-, T2- proton density-weighted spin echo sequences as well as T2 gradient echo sequences. One scan plane in each horse was compared with corresponding anatomic and histologic sections. The best imaging planes to visualize various anatomic structures were determined. Fibrocartilage was visualized in the insertion of the deep digital flexor tendon and the suspensory ligament as well as in the distal sesamoidean ligaments. The correlation of MRI images with anatomic and histologic sections confirmed that all of the anatomic structures in the equine digit could be evaluated in PD and T2 studies.     

MAGNETIC RESONANCE IMAGING FINDINGS IN THE EQUINE DEEP DIGITAL FLEXOR TENDON AND DISTAL SESAMOID BONE IN ADVANCED NAVICULAR DISEASE—AN EX VIVO STUDY

We describe the abnormal magnetic resonance (MR) imaging findings in the deep digital flexor tendon (DDFT) and distal sesamoid bone in horses with radiographic changes compatible with navicular syndrome. Thirteen postmortem specimens were examined using a 1.5-T magnetic field, with spin echo (SE) T1-weighted, turbo SE (TSE) proton density-weighted (with and without fat saturation), and fat saturation TSE T2-weighted sequences. The limbs were then dissected to compare the MR findings with the gross assessment and histologic examination of the DDFT and distal sesamoid bones. Tendonous abnormalities were detected by MR imaging in 12 DDFTs and confirmed at necropsy. Most tendon lesions were located at the level of the distal sesamoid bone and the proximal recess of the podotrochlear bursa. Tendon lesions were classified based on their MR imaging features as core lesions, dorsal lesions, dorsal abrasions, and parasagittal splits. Areas of increased MR signal in the DDFTs were characterized by tendon fiber disturbance and lack of continuity of the collagen fibers, foci of edema, hemorrhages, and formation of lakes containing eosinophilic plasma-like material or amphophilic material of low density. Bone marrow signal alterations in the distal sesamoid bone were seen in all digits. Two main phenomena were responsible for the abnormal signal, respectively, in T1-weighted (decreased signal) and in T2-weighted fat-suppressed images (increased signal): a decrease in the fat marrow content in the trabecular spaces and an increase in the fluid content. Histologic examination revealed foci of bone marrow edema, hemorrhage, necrosis, and fibrosis. Cyst formation and trabecular abnormalities (disorganization, thinning, remodelling) were also observed in areas of abnormal signal intensity. Increased bone density because of trabecular thickening induced a decrease in signal in all sequences.     

COMPARISONS AMONG RADIOGRAPHY,ULTRASONOGRAPHY AND COMPUTED TOMOGRAPHY FOR EX VIVO CHARACTERIZATION OF STIFLE OSTEOARTHRITIS IN THE HORSE

A better understanding of imaging characteristics of equine stifle osteoarthritis (OA) may allow earlier detection and improve prognosis. Objectives of this ex vivo, prospective, methods comparison study were to (1) describe the location and severity of naturally acquired OA lesions in the equine stifle using ultrasound (US), radiography (XR), computed tomography (CT), and macroscopic evaluation (ME); (2) compare the diagnostic performance of each imaging modality with ME; and (3) describe subchondral bone mineral density (BMD) in equine stifle joints with OA using CT. Radiographic, CT, and US evaluations were performed on 23 equine cadaver stifles and compared with ME. Significant associations were found between osteophyte global scores for all imaging modalities (CT, P ? 0.0001; XR, P = 0.005; US, P = 0.04) vs. ME osteophyte global scores. Osteophytes were detected most frequently in the medial femorotibial (MFT) joint. A specific pattern of osteophytes was observed, with a long ridge of new bone at the insertion of the MFT joint capsule cranially on the medial femoral condyle. A novel caudo‐10°proximo‐5°lateral‐cranio‐disto‐medial oblique radiographic projection was helpful for detection of intercondylar osteophytes. Multiplanar CT reformatted images were helpful for characterizing all osteophytes. Osteophyte grades at most sites did not differ among modalities. Low sensitivity/specificity for subchondral bone sclerosis and flattening of femoral condyles suggested that these signs may not be reliable radiographic and CT indicators of equine stifle OA. Equine stifle OA was associated with a decrease in BMD and specific sites of focal subchondral bone resorption/cyst formation were found in some specimens.     

RADIOGRAPHIC, COMPUTED TOMOGRAPHIC AND MAGNETIC RESONANCE IMAGING EVALUATION OF A CHRONIC LONG DIGITAL EXTENSOR TENDON AVULSION IN A DOG

Long digital extensor tendon avulsion is reported in a 5 month old Great Dane. Clinically the dog presented with a unilateral weight-bearing pelvic limb lameness. Joint effusion was present and there was pain and crepitance associated with flexion of the stifle. Orthopedic evaluation and radiographs were suggestive of a long digital extensor tendon injury which was confirmed by computed tomography and magnetic resonance imaging.The injury was surgically repaired with screw and spiked washer fixation.     

MAGNETIC RESONANCE IMAGING OF THE EQUINE FOOT

The purpose of this study was to assess the ability of magnetic resonance imaging to depict abnormalities of the equine foot. MRI was performed on isolated limbs which had lesions of the foot. These images were made in 3 perpendicular planes (sagittal, transverse and frontal) using a T1 weighted sequence and were 5mm thick. Images accurately depicted normal and pathologic structures in the foot and proved to be very precise for documenting degenerative joint disease, navicular disease and laminitis lesions. This preliminary study demonstrates the considerable potential of MRI in the diagnosis of locomotor problems in the horse.     

COMPARISON OF COMPUTED TOMOGRAPHY, TANGENTIAL VIEW RADIOGRAPHY, AND CONVENTIONAL RADIOGRAPHY IN EVALUATION OF CANINE PELVIC TRAUMA

Thirteen dogs with fractures requiring surgical repair were evaluated by standard two-view (i.e., lateral and ventrodorsal) radiography, tangential view (ventro 20 degrees cranial-dorsocaudal [inlet] and ventro 20 degrees caudal-dorsocranial [outlet]) radiography, and computed tomography (CT). Radiographic and CT examinations were reviewed independently by the three authors, and specific anatomic sites were graded for the presence or possibility of lesions. The results of radiographic interpretations were compared to CT scan interpretations. Eighty-one percent of skeletal lesions detected by CT scans were diagnosed definitively radiographically. Differences between the interpretation of CT and radiographic examinations included abnormalities associated with soft-tissue structures (P < 0.0001), the sacroiliac joints (P = 0.02), and the acetabula (P = 0.04). Interpretation of the lateral/ventrodorsal and inlet/outlet radiographic series were not statistically different, although inlet views may be complimentary to the standard radiographic examination. Its use deserves further study. Reader variation was less on evaluation of CT examinations than radiographic examinations. CT multiplaner reformations and three-dimensional reconstructions were useful for surgical planning in seven dogs. CT scanning is superior to survey radiography in assessing skeletal and soft-tissue injuries in dogs with pelvic trauma, although all clinically significant surgical lesions were described accurately radiographically. Based on this small series, the routine CT examination of dogs with pelvic trauma may not be justifiable for diagnosis but may be advantageous for surgical planning, especially if acetabular fractures are suspected on radiographs.     

COMPARISON OF RADIOGRAPHY, MYELOGRAPHY AND COMPUTED TOMOGRAPHY FOR THE EVALUATION OF CANINE VERTEBRAL AND SPINAL CORD TUMORS IN SIXTEEN DOGS

Radiographic, myelographic and computed tomographic (CT) studies from sixteen dogs with histologically diagnosed vertebral or spinal cord neoplasia (seventeen lesions) were retrospectively evaluated. Radiographs were compared with CT images to evaluate vertebral bony changes (bone production, lysis or both). Myelographic and CT images were evaluated to separate lesions into one of three categories, extradural, intradural/extramedullary, or intramedullary. These findings were compared to histologic tumor type from surgical or necropsy samples. Histologically, seven lesions were vertebral tumors and were classified as extradural lesions; ten lesions were spinal cord tumors of which eight were classified as intradural/extramedullary and two as intramedullary. Using CT, the amount of bony change associated with extradural lesions was greater than or equal to the amount of bony change visualized using radiographs. Myelography more correctly differentiated between intradural/ extramedullary and intramedullary lesions than did CT, although three open diagnoses detracted from the CT results. This study suggests that when evaluating extradural lesions, the amount of bony change was better visualized using CT than survey radiographs. Myelography was better when compared to CT for classifying spinal cord lesions, however, standardization of the CT imaging protocol may help determine the specific clinical indications for using CT in dogs with suspected vertebral or spinal cord tumors.     

ANATOMICAL STUDY OF CRANIAL NERVE EMERGENCE AND SKULL FORAMINA IN THE HORSE USING MAGNETIC RESONANCE IMAGING AND COMPUTED TOMOGRAPHY

For accurate interpretation of magnetic resonance (MR) images of the equine brain, knowledge of the normal cross‐sectional anatomy of the brain and associated structures (such as the cranial nerves) is essential. The purpose of this prospective cadaver study was to describe and compare MRI and computed tomography (CT) anatomy of cranial nerves' origins and associated skull foramina in a sample of five horses. All horses were presented for euthanasia for reasons unrelated to the head. Heads were collected posteuthanasia and T2‐weighted MR images were obtained in the transverse, sagittal, and dorsal planes. Thin‐slice MR sequences were also acquired using transverse 3D‐CISS sequences that allowed mutliplanar reformatting. Transverse thin‐slice CT images were acquired and multiplanar reformatting was used to create comparative images. Magnetic resonance imaging consistently allowed visualization of cranial nerves II, V, VII, VIII, and XII in all horses. The cranial nerves III, IV, and VI were identifiable as a group despite difficulties in identification of individual nerves. The group of cranial nerves IX, X, and XI were identified in 4/5 horses although the region where they exited the skull was identified in all cases. The course of nerves II and V could be followed on several slices and the main divisions of cranial nerve V could be distinguished in all cases. In conclusion, CT allowed clear visualization of the skull foramina and occasionally the nerves themselves, facilitating identification of the nerves for comparison with MRI images.     

MAGNETIC RESONANCE IMAGING FEATURES OF PROXIMAL METACARPAL AND METATARSAL INJURIES IN THE HORSE

Magnetic resonance (MR) imaging abnormalities in horses with lameness localized to the proximal metacarpal or metatarsal region have not been described. To accomplish that, the medical records of 45 horses evaluated with MR imaging that had lameness localized to either the proximal metacarpal or metatarsal region were reviewed. Abnormalities observed in the proximal suspensory ligament or the accessory ligament of the deep digital flexor tendon included abnormal high signal, enlargement, or alteration in shape. Twenty-three horses had proximal suspensory ligament desmitis (13 hindlimb, 10 forelimb). Sixteen horses had desmitis of the accessory ligament of the deep digital flexor tendon. One horse had desmitis of the proximal suspensory ligament and the accessory ligament of the deep digital flexor tendon on the same limb and one horse had desmitis of the proximal suspensory ligament on one forelimb and desmitis of the accessory ligament of the deep digital flexor tendon on the other forelimb. Four horses did not have abnormalities in the proximal suspensory ligament or accessory ligament of the deep digital flexor tendon. Eighty percent of horses with forelimb proximal suspensory ligament desmitis and 69% of horses with hindlimb proximal suspensory ligament desmitis returned to their intended use. Sixty-three percent of horses with desmitis of the accessory ligament of the deep digital flexor tendon were able to return to their intended use. MR imaging is a valuable diagnostic modality that allows diagnosis of injury in horses with lameness localized to the proximal metacarpal and metatarsal regions. The ability to accurately diagnose the source of lameness is important in selecting treatment that will maximize the chance to return to performance.     

COMPARISON OF RADIOGRAPHY AND COMPUTED TOMOGRAPHY FOR THE DIAGNOSIS OF CANINE NASAL ASPERGILLOSIS

To compare the radiographic and computed tomographic (CT) findings and to evaluate the sensitivity of radiography and CT for diagnosis of nasal aspergillosis in dogs, the radiographic and CT studies of 48 dogs with chronic nasal disease were reviewed separately. The radiographic and CT findings were recorded, and a diagnosis was made. The results obtained in the dogs with nasal aspergillosis (n = 25) were used. Based on definite aspergillosis as diagnosis, CT had a sensitivity of 88% and radiography of 72%. Considering definite and probable aspergillosis as equivalent, CT had a sensitivity of 92% and radiography of 84%. The sensitivity was higher in dogs with lesions affecting the entire nasal cavity and frontal sinus on at least one side (n = 20) with a sensitivity of 100% for CT and 90-95% for radiography than in dogs with lesions restricted to the nasal cavities (n = 5) where CT had a sensitivity of 60-80% and radiography of 0-40%. CT was superior to radiography for evaluation of the nasal cavities (mucosal thickening along the nasal bones, surrounding bone hyperostosis/lysis), frontal sinuses (mucosal thickening along the frontal bone, fluid/soft tissue, frontal bone hyperostosis/lysis), and differentiation between a cavitated-like or a mass-like process. This study suggests that CT is more sensitive than radiography for diagnosis of nasal aspergillosis in the dog because of a better demonstration of some changes suggestive of nasal aspergillosis. A diagnosis of a nasal aspergillosis restricted to the nasal cavities or associated with an FB is challenging, even with the use of CT.     

ANATOMICAL STUDY OF CRANIAL NERVE EMERGENCE AND SKULL FORAMINA IN THE DOG USING MAGNETIC RESONANCE IMAGING AND COMPUTED TOMOGRAPHY

Twenty-two magnetic resonance imaging (MRI) brain studies of different breeds of dogs were reviewed to assess the anatomy of cranial nerve (CN) origins and associated skull foramina. These included five anatomic studies of normal brains using 2-mm-thick slices and 17 studies using conventional clinical protocols with 3- or 4-mm slices on both normal and abnormal brains. Images were obtained in transverse, sagittal, and dorsal planes to allow a thorough comparison between studies. CNs II, III, V (and its divisions), and VIII were observed consistently on conventional studies. On the thin-slice studies, the origins and proximal portions of CNN IV, VII, and the group of IX, X, and XI could be seen. The origins of CNN VI and XII were not observed with certainty. In parallel, a computed tomography study of an isolated skull was performed with a thin copper wire within each of the skull foramina to determine precisely each CN exit and to facilitate recognition of the course of CNs when exiting the skull on MRI images.     

RADIOGRAPHIC AND MAGNETIC RESONANCE IMAGING OF THE STIFLE JOINT IN EXPERIMENTAL OSTEOARTHRITIS OF DOGS

Radiography and magnetic resonance imaging were used to evaluate osteoarthritis at 2, 6, and 12 weeks following transection of the cranial cruciate ligament of the stifle (femorotibial) joint of 6 dogs. A quantitative radiographic scoring system was used to assess the progression of hard and soft tissue changes of osteoarthritis. Mediolateral (flexed joint) and oblique (extended joint) radiographic projections enabled identification of small osteophytes on the femoral trochlear ridges, which were detected at an earlier stage of development than was previously reported. Magnetic resonance imaging was useful in detecting changes in cartilage thickness, osteophytosis and intraarticular loose bodies. Radiography and magnetic resonance imaging were complementary in the assessment of pathologic changes of osteoarthritis.