Purpose: To prospectively compare the accuracy of three-dimensional (3D) water-excitation (WE) true fast imaging with steady-state precession (FISP) in the diagnosis of articular cartilage defects with that of sequences commonly used to image the knee, with arthroscopy or surgery as the reference standard. Materials and Methods: This study protocol was institutional review board approved. Written informed consent was obtained from all patients. Thirty knees in 29 patients (mean age, 56 years; range, 18-86 years) were prospectively evaluated by using sagittal 3D WE true FISP with two section thicknesses (1.7 mm [true FISPthin] and 3.0 mm [true FISPthick]), two-dimensional (2D) intermediate-weighted spin-echo with fat saturation, 2D fast short inversion time inversion-recovery, 3D WE double-echo steady-state, and 3D fat-saturated fast low-angle shot sequences. Cartilage defects were graded on magnetic resonance images and during surgery with a modified Noyes scoring system. Contrast-to-noise ratio (CNR) and CNR efficiency were calculated. Sensitivity, specificity, and accuracy were assessed. Inter-observer agreement was determined with kappa statistics, and quantitative results were evaluated with the Wilcoxon signed rank test. Results: The performance of 3D WE true FISPthick (sensitivity, specificity, and accuracy, respectively, were 52%, 93%, and 71% for reader 1 and 65%, 88%, and 76% for reader 2) and 3D WE true FISPthin (sensitivity, specificity, and accuracy, respectively, were 58%, 94%, and 75% for reader 1 and 63%, 80%, and 71% for reader 2) sequences was no different than that of other sequences in the detection of circumscribed defects. Three-dimensional WE true FISP sequences had a significantly (P < .0033) higher CNR and CNR efficiency between cartilage and fluid than the corresponding sequences with the same section thickness. Conclusion: Three-dimensional WE true FISP enables high contrast between joint fluid and articular cartilage and a diagnostic performance that is comparable with that of standard sequences.
