Knee MRI, with its high soft tissue contrast is one of the main imaging tools to depict knee joint pathology. MRI allows accurate imaging of intra-articular structures such as ligaments, cartilage, menisci, bone marrow, synovium, and adjacent soft tissue.
Knee exams require a dedicated extremity coil, providing a homogenous imaging volume and high SNR to ensure best signal coverage. A complete knee MR examination includes for example sagittal and coronal T1 weighted, and proton density weighted pulse sequences +/- fat saturation, or STIR sequences. For high spatial resolution, maximal 4 mm thick slices with at least an in plane resolution of 0.75 mm and small gap are recommended. To depict the anterior cruciate ligament clearly, the sagittal plane has to be rotated 10 - 20° externally (parallel to the medial border of the femoral condyle). Retropatellar cartilage can bee seen for example in axial T2 weighted gradient echo sequences with Fatsat. However, the choice of the pulse sequences is depended of the diagnostic question, the used scanner, and preference of the operator.
Diagnostic quality in knee imaging is possible with field strengths ranging from 0.2 to 3T. With low field strengths more signal averages must be measured, resulting in increased scan times to provide equivalent quality as high field strengths.
More diagnostic information of meniscal tears and chondral defects can be obtained by direct magnetic resonance arthrography, which is done by introducing a dilute solution of gadolinium in saline (1:1000) into the joint capsule. The knee is then scanned in all three planes using T1W sequences with fat suppression. For indirect arthrography, the contrast is given i.v. and similar scans are started 20 min. after injection and exercise of the knee.
Frequent indications of MRI scans in musculoskeletal knee diseases are:
e.g., meniscal degeneration and tears, ligament injuries, osteochondral fractures, osteochondritis dissecans, avascular bone necrosis and rheumatoid arthritis.

See also Imaging of the Extremities and STIR.

Often used to indicate an image where most of the contrast between tissues or tissue states is due to differences in tissue T2 created typically by using longer TE and TR times.
This term may be misleading in that the potentially important effects of tissue density differences and the range of tissue T2 values are often ignored.
Choosing the machine parameters such that TR greater than T1 (typically greater than 2 000 ms) and TE less than T2 (typically greater than 100 ms) and noting that (1-exp(-TR/T1) = 1 for TR/T1 much greater than 1, will reduce Eq. 1 to the expression
Mxy = Mxy0exp(-TE/T2)
which is dependent on T2 only, hence the term T2 weighting. Therefore T2 weighted image contrast state is approached by imaging with a TR long compared to tissue T1 (to reduce T1 contribution to image contrast) and a TE between the longest and shortest tissue T2s of interest. A TR greater than 3 times the longest T1 is required for the T1 effect to be less than 5%. Due to the wide range of T1 and T2 and tissue density values that can be found in the body, an image that is T2 weighted for some tissues may not be so for others.
See also T2 Time.
Lesions with short T2 are (dark in T2 weighted sequences):
acute haemorrhage (deoxyHb)
haemosiderin
physiologic iron (basal ganglia, etc.)
mucinous lesions.

Signal intensity interpretation in MR imaging has a major problem.
Often there is no intuitive approach to signal behavior as signal intensity is a very complicated function of the contrast-determining tissue parameter, proton density, T1 and T2, and the machine parameters TR and TE. For this reason, the terms T1 weighted image, T2 weighted image and proton density weighted image were introduced into clinical MR imaging.
Air and bone produce low-intensity, weaker signals with darker images. Fat and marrow produce high-intensity signals with brighter images.
The signal intensity measured is related to the square of the xy-magnetization, which in a SE pulse sequence is given by
Mxy = Mxy0(1-exp(-TR/T1)) exp(-TE/T2) (1)
where Mxy0 = Mz0 is proportional to the proton or spin density, and corresponds to the z-magnetization present at zero time of the experiment when it is tilted into the xy-plane.

See also T2 Weighted Image and Ernst Angle.

The basis of T1 weighted imaging is the longitudinal relaxation. A T1 weighted magnetic resonance image is created typically by using short TE and TR times.
The final image is a reflection of more than one of these pulse sequence parameters, weighted according to the type of sequence and its timing. T1 signals determine predominantly the contrast and brightness in this type of images but proton density will always contribute to the image intensity. The T1 dependence is mainly determined by the repetition time or any pre-pulses (such as in an inversion recovery pulse sequence).
Due to the larger longitudinal and transverse magnetization, fat has a higher signal and will appear bright on a T1 contrast MR image. Conversely, water has less longitudinal magnetization prior to a RF pulse, therefore less transverse magnetization after a RF pulse yielding low signal appearing dark on a T1 contrast image. Often, a paramagnetic contrast agent, a gadolinium compound, is administered, and both pre-contrast T1 weighted images and post-contrast T1 weighted images are obtained.