Diagnostic Imaging of Patellofemoral Instability.

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Abstract

[Indexed for MEDLINE] Conflict of interest statement: The authors declare that they have no conflict of interest. 19. Nat Rev Rheumatol. 2026 Apr;22(4):256-271. doi: 10.1038/s41584-026-01353-x. Epub 2026 Feb 3. Advances in cartilage imaging techniques. Guermazi A(1)(2), Eckstein F(3)(4), Gold G(5), Hayashi D(6), Jarraya M(7), Kogan F(5), Li X(8), Link TM(9), Nebelung S(10), Oei EHG(11), Omoumi P(12), Saarakkala S(13)(14), Trattnig S(15), Wirth W(4), Roemer FW(16)(17)(18). Author information: (1)Chobanian and Avedisian School of Medicine, Boston University, Boston, MA, USA. guermazi@bu.edu. (2)Department of Radiology, VA Boston Healthcare System, West Roxbury, MA, USA. guermazi@bu.edu. (3)Research Program for Musculoskeletal Imaging, Center for Anatomy and Cell Biology Paracelsus Medical University (PMU), Salzburg, Austria. (4)Chondrometrics GmbH, Freilassing, Germany. (5)Department of Radiology, Stanford University, Stanford, CA, USA. (6)Department of Radiology, Tufts University School of Medicine, Boston, MA, USA. (7)Department of Radiology, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA. (8)Program of Advanced Musculoskeletal Imaging, Departments of Biomedical Engineering and Diagnostic Radiology, Cleveland Clinic, Cleveland, OH, USA. (9)Department of Radiology, University of California at San Francisco, San Francisco, CA, USA. (10)Department of Diagnostic and Interventional Radiology, University Hospital Aachen, Aachen, Germany. (11)Department of Radiology and Nuclear Medicine, Erasmus MC, University Medical Center, Rotterdam, The Netherlands. (12)Department of Radiology, Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland. (13)Research Unit of Health Sciences and Technology, University of Oulu, Oulu, Finland. (14)Department of Diagnostic Radiology, Oulu University Hospital, Oulu, Finland. (15)Department of Biomedical Imaging and Image Guided Therapy, Medical University of Vienna, Vienna, Austria. (16)Department of Radiology, VA Boston Healthcare System, West Roxbury, MA, USA. (17)Department of Radiology, Universitätsklinikum, Erlangen, Germany. (18)Friedrich-Alexander-Universität Erlangen-Nürnberg (FAU), Erlangen, Germany. Articular cartilage is crucial for joint function; however, it has limited regenerative capacity when damaged, a hallmark of many rheumatic diseases. Non-invasive imaging is essential for early diagnosis, therapeutic monitoring and prognostication. MRI remains the reference standard, offering detailed assessment of both morphological and compositional cartilage changes. Technological advances, including high-resolution and compositional MRI techniques such as T2 mapping, T1ρ, delayed gadolinium-enhanced MRI of cartilage, sodium imaging, diffusion imaging and ultra-short echo-time imaging, enable early detection of matrix alterations that precede structural breakdown. CT arthrography, although it involves radiation, serves as a valuable alternative when MRI is contra-indicated, offering high performance in the detection and evaluation of cartilage surface lesions. Emerging modalities, such as ultrasonography and PET, offer additional functional insights but are currently limited in scope. Artificial intelligence is poised to transform cartilage imaging through accelerated acquisition, automated segmentation, improved interpretation and enhanced efficiency, with growing clinical adoption. Advanced cartilage imaging will probably have an increasingly important role in clinical rheumatology, particularly for the optimization of individualized management of cartilage pathology. © 2026. This is a U.S. Government work and not under copyright protection in the US; foreign copyright protection may apply. DOI: 10.1038/s41584-026-01353-x