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Novakofski KD, Pownder SL, Koff MF, Williams RM, Potter HG, Fortier LA. High-Resolution Methods for Diagnosing Cartilage Damage In Vivo. Cartilage 2016; 7:39-51. [PMID: 26958316 PMCID: PMC4749750 DOI: 10.1177/1947603515602307] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/23/2022] Open
Abstract
Advances in current clinical modalities, including magnetic resonance imaging and computed tomography, allow for earlier diagnoses of cartilage damage that could mitigate progression to osteoarthritis. However, current imaging modalities do not detect submicrometer damage. Developments in in vivo or arthroscopic techniques, including optical coherence tomography, ultrasonography, bioelectricity including streaming potential measurement, noninvasive electroarthrography, and multiphoton microscopy can detect damage at an earlier time point, but they are limited by a lack of penetration and the ability to assess an entire joint. This article reviews current advancements in clinical and developing modalities that can aid in the early diagnosis of cartilage injury and facilitate studies of interventional therapeutics.
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Affiliation(s)
| | | | - Matthew F. Koff
- MRI Laboratory, Hospital for Special Surgery, New York, NY, USA
| | | | | | - Lisa A. Fortier
- Department of Clinical Sciences, Cornell University, Ithaca, NY, USA,Lisa A. Fortier, Department of Clinical Sciences, Cornell University, VMC C3-181, Ithaca, NY 14853, USA. Email
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Liu F, Choi KW, Samsonov A, Spencer RG, Wilson JJ, Block WF, Kijowski R. Articular Cartilage of the Human Knee Joint: In Vivo Multicomponent T2 Analysis at 3.0 T. Radiology 2015; 277:477-88. [PMID: 26024307 DOI: 10.1148/radiol.2015142201] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
PURPOSE To compare multicomponent T2 parameters of the articular cartilage of the knee joint measured by using multicomponent driven equilibrium single-shot observation of T1 and T2 (mcDESPOT) in asymptomatic volunteers and patients with osteoarthritis. MATERIALS AND METHODS This prospective study was performed with institutional review board approval and with written informed consent from all subjects. The mcDESPOT sequence was performed in the knee joint of 13 asymptomatic volunteers and 14 patients with osteoarthritis of the knee. Single-component T2 (T2(Single)), T2 of the fast-relaxing water component (T2F) and of the slow-relaxing water component (T2S), and the fraction of the fast-relaxing water component (F(F)) of cartilage were measured. Wilcoxon rank-sum tests and multivariate linear regression models were used to compare mcDESPOT parameters between volunteers and patients with osteoarthritis. Receiver operating characteristic analysis was used to assess diagnostic performance with mcDESPOT parameters for distinguishing morphologically normal cartilage from morphologically degenerative cartilage identified at magnetic resonance imaging in eight cartilage subsections of the knee joint. RESULTS Higher cartilage T2(Single) (P < .001), lower cartilage F(F) (P < .001), and similar cartilage T2F (P = .079) and T2S (P = .124) values were seen in patients with osteoarthritis compared with those in asymptomatic volunteers. Differences in T2(Single) and F(F) remained significant (P < .05) after consideration of age differences between groups of subjects. Diagnostic performance was higher with F(F) than with T2(Single) for distinguishing between normal and degenerative cartilage (P < .05), with greater areas under the curve at receiver operating characteristic analysis. CONCLUSION Patients with osteoarthritis of the knee had significantly higher cartilage T2(Single) and significantly lower cartilage F(F) than did asymptomatic volunteers, and receiver operating characteristic analysis results suggested that F(F) may allow greater diagnostic performance than that with T2(Single) for distinguishing between normal and degenerative cartilage.
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Affiliation(s)
- Fang Liu
- From the Departments of Medical Physics (F.L., A.S., W.F.B.), Biomechanical Engineering (K.W.C.), Radiology (A.S., R.K.), and Orthopedics (J.J.W.), University of Wisconsin School of Medicine and Public Health, Madison, Wis; and Magnetic Resonance Imaging and Spectroscopy Section, National Institute on Aging, National Institutes of Health, Baltimore, Md (R.G.S.)
| | - Kwang Won Choi
- From the Departments of Medical Physics (F.L., A.S., W.F.B.), Biomechanical Engineering (K.W.C.), Radiology (A.S., R.K.), and Orthopedics (J.J.W.), University of Wisconsin School of Medicine and Public Health, Madison, Wis; and Magnetic Resonance Imaging and Spectroscopy Section, National Institute on Aging, National Institutes of Health, Baltimore, Md (R.G.S.)
| | - Alexey Samsonov
- From the Departments of Medical Physics (F.L., A.S., W.F.B.), Biomechanical Engineering (K.W.C.), Radiology (A.S., R.K.), and Orthopedics (J.J.W.), University of Wisconsin School of Medicine and Public Health, Madison, Wis; and Magnetic Resonance Imaging and Spectroscopy Section, National Institute on Aging, National Institutes of Health, Baltimore, Md (R.G.S.)
| | - Richard G Spencer
- From the Departments of Medical Physics (F.L., A.S., W.F.B.), Biomechanical Engineering (K.W.C.), Radiology (A.S., R.K.), and Orthopedics (J.J.W.), University of Wisconsin School of Medicine and Public Health, Madison, Wis; and Magnetic Resonance Imaging and Spectroscopy Section, National Institute on Aging, National Institutes of Health, Baltimore, Md (R.G.S.)
| | - John J Wilson
- From the Departments of Medical Physics (F.L., A.S., W.F.B.), Biomechanical Engineering (K.W.C.), Radiology (A.S., R.K.), and Orthopedics (J.J.W.), University of Wisconsin School of Medicine and Public Health, Madison, Wis; and Magnetic Resonance Imaging and Spectroscopy Section, National Institute on Aging, National Institutes of Health, Baltimore, Md (R.G.S.)
| | - Walter F Block
- From the Departments of Medical Physics (F.L., A.S., W.F.B.), Biomechanical Engineering (K.W.C.), Radiology (A.S., R.K.), and Orthopedics (J.J.W.), University of Wisconsin School of Medicine and Public Health, Madison, Wis; and Magnetic Resonance Imaging and Spectroscopy Section, National Institute on Aging, National Institutes of Health, Baltimore, Md (R.G.S.)
| | - Richard Kijowski
- From the Departments of Medical Physics (F.L., A.S., W.F.B.), Biomechanical Engineering (K.W.C.), Radiology (A.S., R.K.), and Orthopedics (J.J.W.), University of Wisconsin School of Medicine and Public Health, Madison, Wis; and Magnetic Resonance Imaging and Spectroscopy Section, National Institute on Aging, National Institutes of Health, Baltimore, Md (R.G.S.)
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Wei B, Zong M, Yan C, Mao F, Guo Y, Yao Q, Xu Y, Wang L. Use of quantitative MRI for the detection of progressive cartilage degeneration in a mini-pig model of osteoarthritis caused by anterior cruciate ligament transection. J Magn Reson Imaging 2015; 42:1032-8. [PMID: 25656460 DOI: 10.1002/jmri.24862] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2014] [Accepted: 01/16/2015] [Indexed: 11/05/2022] Open
Abstract
BACKGROUND To investigate the progression of cartilage degeneration using delayed gadolinium-enhanced MRI of cartilage (dGEMRIC) and T2 mapping in a mini-pig model of osteoarthritis (OA) caused by anterior cruciate ligament transection (ACLT). METHODS Twelve mini-pigs underwent ACLT in the left knee and were monitored by dGEMRIC (T1, gadolinium [Gd]) and T2 mapping after 2, 4, or 6 weeks (n = 4 each). No ACLT surgery was performed in four healthy control mini-pigs, which were also monitored by dGEMRIC and T2 mapping. Cartilage samples from the weight-bearing regions of the left medial femoral condyles were collected for macroscopic, histological, immunohistochemical, and biochemical analysis. Correlations between biochemical contents and T1,Gd and T2 values were evaluated using Pearson correlation analysis. RESULTS T1,Gd values were gradually reduced and T2 values increased over time. Cartilage surfaces showed roughness at 4 weeks and additional defects at 6 weeks. Glycosaminoglycan (GAG) distribution and content gradually reduced over time (P < 0.05), and collagen distribution and anisotropy were obviously changed at 6 weeks. However, collagen content did not differ significantly among postoperative timepoints. GAG content was positively related to T1,Gd values (r = 0.888; P < 0.001) and negatively related to T2 values (r = -0.865; P < 0.001). Collagen content had no discernible correlation with T1,Gd or T2 values. CONCLUSION dGEMRIC and T2 mapping can monitor the progression of cartilage degeneration in a mini-pig model of ACLT-induced OA, permitting early detection of OA.
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Affiliation(s)
- Bo Wei
- Department of Orthopaedic Surgery, Nanjing First Hospital, Nanjing Medical University, Nanjing, People's Republic of China.,Cartilage Regeneration Center, Nanjing First Hospital, Nanjing Medical University, Nanjing, People's Republic of China
| | - Min Zong
- Department of Radiology, the First Affiliated Hospital, Nanjing Medical University, Nanjing, 210006, People's Republic of China
| | - Chao Yan
- Department of Orthopaedic Surgery, Nanjing First Hospital, Nanjing Medical University, Nanjing, People's Republic of China.,Cartilage Regeneration Center, Nanjing First Hospital, Nanjing Medical University, Nanjing, People's Republic of China
| | - Fengyong Mao
- Department of Orthopaedic Surgery, Nanjing First Hospital, Nanjing Medical University, Nanjing, People's Republic of China.,Cartilage Regeneration Center, Nanjing First Hospital, Nanjing Medical University, Nanjing, People's Republic of China
| | - Yang Guo
- Department of Orthopaedic Surgery, Nanjing First Hospital, Nanjing Medical University, Nanjing, People's Republic of China.,Cartilage Regeneration Center, Nanjing First Hospital, Nanjing Medical University, Nanjing, People's Republic of China
| | - Qingqiang Yao
- Department of Orthopaedic Surgery, Nanjing First Hospital, Nanjing Medical University, Nanjing, People's Republic of China.,Cartilage Regeneration Center, Nanjing First Hospital, Nanjing Medical University, Nanjing, People's Republic of China
| | - Yan Xu
- Department of Orthopaedic Surgery, Nanjing First Hospital, Nanjing Medical University, Nanjing, People's Republic of China.,Cartilage Regeneration Center, Nanjing First Hospital, Nanjing Medical University, Nanjing, People's Republic of China
| | - Liming Wang
- Department of Orthopaedic Surgery, Nanjing First Hospital, Nanjing Medical University, Nanjing, People's Republic of China.,Cartilage Regeneration Center, Nanjing First Hospital, Nanjing Medical University, Nanjing, People's Republic of China
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Hesper T, Miese FR, Hosalkar HS, Behringer M, Zilkens C, Antoch G, Krauspe R, Bittersohl B. Quantitative T2* assessment of knee joint cartilage after running a marathon. Eur J Radiol 2015; 84:284-9. [DOI: 10.1016/j.ejrad.2014.11.021] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2014] [Revised: 10/27/2014] [Accepted: 11/17/2014] [Indexed: 11/16/2022]
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Bengtsson Moström E, Lammentausta E, Finnbogason T, Weidenhielm L, Janarv PM, Tiderius CJ. Pre- and postcontrast T1 and T2 mapping of patellar cartilage in young adults with recurrent patellar dislocation. Magn Reson Med 2014; 74:1363-9. [PMID: 25421491 DOI: 10.1002/mrm.25511] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2014] [Revised: 10/11/2014] [Accepted: 10/13/2014] [Indexed: 02/05/2023]
Abstract
PURPOSE To examine the cartilage quality in young adults with recurrent patellar dislocation in childhood using different magnetic resonance imaging parameters. METHODS Sixteen young adults with unilateral recurrent patellar dislocation were investigated ≥5 y (mean, 8.5 y) after the first dislocation. Pre- and postcontrast T1 and precontrast T2 relaxation times were analyzed in four superficial and four deep patellar cartilage regions of both knees. Two hours after intravenous injection of 0.2 mM/kg Gd-DTPA(2-), postcontrast T1 [T1(Gd)] and ΔR1 [1/T1 (precontrast) - 1/T1 (postcontrast)] were analyzed in the regions. Muscle performance and patient-reported outcome were evaluated. RESULTS When comparing the injured side with the noninjured side, differences were seen in the superficial half but not the deep half of the cartilage. T1(Gd) was shorter in the central part, whereas T2 was shorter in the periphery of the patellar cartilage (P < 0.05). ΔR1 demonstrated similar differences between healthy and diseased cartilage as T1(Gd) alone. The knee function was not correlated to the degenerative changes. CONCLUSION The short T1(Gd) centrally indicates degenerative cartilage changes consistent with loss of glycosaminoglycans. Precontrast and ΔR1 calculations may be excluded in clinical dGEMRIC, which simplifies the procedure. A decrease in T2 may be a very early sign of joint pathology but warrants further investigation.
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Affiliation(s)
| | - Eveliina Lammentausta
- Department of Diagnostic Radiology, Oulu University Hospital, Oulu, Finland.,Medical Research Center Oulu, Oulu University Hospital and University of Oulu, Oulu, Finland
| | - Thröstur Finnbogason
- Department of Paediatric Radiology, Karolinska University Hospital, Stockholm, Sweden
| | - Lars Weidenhielm
- Stockholm Sports Trauma Research Center, Department of Molecular Medicine and Surgery, Karolinska Institutet, Stockholm, Sweden
| | - Per-Mats Janarv
- Department of Womens and Childrens Health, Karolinska Institutet, Stockholm, Sweden
| | - Carl Johan Tiderius
- Department of Orthopaedics, Skane University Hospital, Lund University, Lund, Sweden
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Kijowski R, Chaudhary R. Quantitative magnetic resonance imaging of the articular cartilage of the knee joint. Magn Reson Imaging Clin N Am 2014; 22:649-69. [PMID: 25442027 DOI: 10.1016/j.mric.2014.07.005] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
Osteoarthritis is characterized by a decrease in the proteoglycan content and disruption of the highly organized collagen fiber network of articular cartilage. Various quantitative magnetic resonance imaging techniques have been developed for noninvasive assessment of the proteoglycan and collagen components of cartilage. These techniques have been extensively used in clinical practice to detect early cartilage degeneration and in osteoarthritis research studies to monitor disease-related and treatment-related changes in cartilage over time. This article reviews the role of quantitative magnetic resonance imaging in evaluating the composition and ultrastructure of the articular cartilage of the knee joint.
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Affiliation(s)
- Richard Kijowski
- Department of Radiology, University of Wisconsin School of Medicine and Public Health, 600 Highland Avenue, Madison, WI 53792-3252, USA.
| | - Rajeev Chaudhary
- Department of Radiology, University of Wisconsin School of Medicine and Public Health, 600 Highland Avenue, Madison, WI 53792-3252, USA
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Golditz T, Steib S, Pfeifer K, Uder M, Gelse K, Janka R, Hennig FF, Welsch GH. Functional ankle instability as a risk factor for osteoarthritis: using T2-mapping to analyze early cartilage degeneration in the ankle joint of young athletes. Osteoarthritis Cartilage 2014; 22:1377-85. [PMID: 24814687 DOI: 10.1016/j.joca.2014.04.029] [Citation(s) in RCA: 123] [Impact Index Per Article: 12.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/14/2014] [Revised: 04/12/2014] [Accepted: 04/27/2014] [Indexed: 02/02/2023]
Abstract
OBJECTIVE The aim of this study was to investigate, using T2-mapping, the impact of functional instability in the ankle joint on the development of early cartilage damage. METHODS Ethical approval for this study was provided. Thirty-six volunteers from the university sports program were divided into three groups according to their ankle status: functional ankle instability (FAI, initial ankle sprain with residual instability); ankle sprain Copers (initial sprain, without residual instability); and controls (without a history of ankle injuries). Quantitative T2-mapping magnetic resonance imaging (MRI) was performed at the beginning ('early-unloading') and at the end ('late-unloading') of the MR-examination, with a mean time span of 27 min. Zonal region-of-interest T2-mapping was performed on the talar and tibial cartilage in the deep and superficial layers. The inter-group comparisons of T2-values were analyzed using paired and unpaired t-tests. Statistical analysis of variance was performed. RESULTS T2-values showed significant to highly significant differences in 11 of 12 regions throughout the groups. In early-unloading, the FAI-group showed a significant increase in quantitative T2-values in the medial, talar regions (P = 0.008, P = 0.027), whereas the Coper-group showed this enhancement in the central-lateral regions (P = 0.05). Especially the comparison of early-loading to late-unloading values revealed significantly decreasing T2-values over time laterally and significantly increasing T2-values medially in the FAI-group, which were not present in the Coper- or control-group. CONCLUSION Functional instability causes unbalanced loading in the ankle joint, resulting in cartilage alterations as assessed by quantitative T2-mapping. This approach can visualize and localize early cartilage abnormalities, possibly enabling specific treatment options to prevent osteoarthritis in young athletes.
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Affiliation(s)
- T Golditz
- Department of Trauma Surgery, University of Erlangen-Nuremberg, Erlangen, Germany
| | - S Steib
- Institute of Sport Science and Sport, University of Erlangen-Nuremberg, Erlangen, Germany
| | - K Pfeifer
- Institute of Sport Science and Sport, University of Erlangen-Nuremberg, Erlangen, Germany
| | - M Uder
- Department of Radiology, University of Erlangen-Nuremberg, Erlangen, Germany
| | - K Gelse
- Department of Trauma Surgery, University of Erlangen-Nuremberg, Erlangen, Germany
| | - R Janka
- Department of Radiology, University of Erlangen-Nuremberg, Erlangen, Germany
| | - F F Hennig
- Department of Trauma Surgery, University of Erlangen-Nuremberg, Erlangen, Germany
| | - G H Welsch
- Department of Trauma Surgery, University of Erlangen-Nuremberg, Erlangen, Germany; MR Center of Excellence, Department of Radiology, Medical University of Vienna, Vienna, Austria.
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Kijowski R, Roemer F, Englund M, Tiderius CJ, Swärd P, Frobell RB. Imaging following acute knee trauma. Osteoarthritis Cartilage 2014; 22:1429-43. [PMID: 25278054 DOI: 10.1016/j.joca.2014.06.024] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/06/2014] [Revised: 04/21/2014] [Accepted: 06/03/2014] [Indexed: 02/02/2023]
Abstract
Joint injury has been recognized as a potent risk factor for the onset of osteoarthritis. The vast majority of studies using imaging technology for longitudinal assessment of patients following joint injury have focused on the injured knee joint, specifically in patients with anterior cruciate ligament injury and meniscus tears where a high risk for rapid onset of post-traumatic osteoarthritis is well known. Although there are many imaging modalities under constant development, magnetic resonance (MR) imaging is the most important instrument for longitudinal monitoring after joint injury. MR imaging is sensitive for detecting early cartilage degeneration and can evaluate other joint structures including the menisci, bone marrow, tendons, and ligaments which can be sources of pain following acute injury. In this review, focusing on imaging following acute knee trauma, several studies were identified with promising short-term results of osseous and soft tissue changes after joint injury. However, studies connecting these promising short-term results to the development of osteoarthritis were limited which is likely due to the long follow-up periods needed to document the radiographic and clinical onset of the disease. Thus, it is recommended that additional high quality longitudinal studies with extended follow-up periods be performed to further investigate the long-term consequences of the early osseous and soft tissue changes identified on MR imaging after acute knee trauma.
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Affiliation(s)
- R Kijowski
- Department of Radiology, University of Wisconsin, Madison, WI, USA.
| | - F Roemer
- Department of Radiology, University of Erlangen-Nuremberg, Erlangen, Germany; Department of Radiology, Boston University, Boston, MA, USA
| | - M Englund
- Department of Orthopedics, Clinical Sciences Lund, Lund, Sweden; Clinical Epidemiology Research and Training Unit, Boston University, Boston, MA, USA
| | - C J Tiderius
- Department of Orthopedics, Clinical Sciences Lund, Lund, Sweden
| | - P Swärd
- Department of Orthopedics, Clinical Sciences Lund, Lund, Sweden
| | - R B Frobell
- Department of Orthopedics, Clinical Sciences Lund, Lund, Sweden
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Zuo H, Yao W, Qu N, Yang S, Wang J, Cui X. Quantitative evaluation in combination with nonquantitative evaluation in early patellar cartilage osteoarthritis at 3.0 T. Clin Interv Aging 2014; 9:1133-43. [PMID: 25075182 PMCID: PMC4106963 DOI: 10.2147/cia.s65871] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/04/2022] Open
Abstract
Purpose To evaluate quantitative T1 and T2 relaxation times and magnetization transfer ratios (MTRs) in the early diagnosis of patellar cartilage osteoarthritis (OA) and to quantify and possibly refine the current Kellgren-Lawrence score criteria. Materials and methods A total of 92 cases of knee joints with 40 normal volunteers and 30 patients with OA were prospectively evaluated. The knee joints with OA were divided into mild and moderate groups according to the Kellgren-Lawrence score criteria. The discriminative analysis method was used to analyze the accuracy of the original grouped cases correctly classified by age, sex, T1 relaxation times, T2 relaxation times, and MTR values. Linear regression analysis was used between T1 relaxation time, T2 relaxation time, and MTR values. Results The mean T1 relaxation times decreased with the severity of OA, and a significant difference was only found between the normal and moderate OA groups (P<0.05). The mean T2 relaxation times increased, and significant differences were found between the normal and mild OA groups and the normal and moderate OA groups (P<0.001). The MTR values were 35.8%±4.2%, 36.1%±3.2%, and 35.4%±3.8%, respectively. There were no significant differences between the normal and OA groups. In addition, T1 relaxation times were positively correlated with MTR values (P<0.01). A discriminative analysis using a synthesis of all the influential factors indicated a high accuracy rate (93.9%) for the correct classification of the original grouped cases. Conclusion Quantitative T1 and T2 relaxation times were useful in the diagnosis of early OA; T2 relaxation times were more relatively sensitive. The functional usefulness of MTR values may be limited. T1 relaxation times positively correlated with MTR values. Multiple quantitative parameters, combined with some relative nonquantitative clinical parameters and Kellgren-Lawrence scores, may be useful in the early stage of OA and provide better information for clinical treatment and follow-up.
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Affiliation(s)
- Houdong Zuo
- Department of Radiology, Shanghai Jiao Tong University Affiliated Sixth People's Hospital, Shanghai, People's Republic of China
| | - Weiwu Yao
- Department of Radiology, Shanghai Jiao Tong University Affiliated Sixth People's Hospital, Shanghai, People's Republic of China
| | - Nan Qu
- Department of Radiology, Shanghai Jiao Tong University Affiliated Sixth People's Hospital, Shanghai, People's Republic of China
| | - Shixun Yang
- Department of Radiology, Shanghai Jiao Tong University Affiliated Sixth People's Hospital, Shanghai, People's Republic of China
| | - Jianhua Wang
- Department of Orthopedics, Xin Hua Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai, People's Republic of China
| | - Xiaojiang Cui
- Department of Surgery, Department of Obstetrics and Gynecology, Samuel Oschin Comprehensive Cancer Institute, Cedars-Sinai Medical Center, Los Angeles, CA, USA
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An in vitro comparative study of T2 and T2* mappings of human articular cartilage at 3-Tesla MRI using histology as the standard of reference. Skeletal Radiol 2014; 43:947-54. [PMID: 24715200 DOI: 10.1007/s00256-014-1872-z] [Citation(s) in RCA: 37] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/25/2013] [Revised: 03/14/2014] [Accepted: 03/16/2014] [Indexed: 02/02/2023]
Abstract
OBJECTIVE The aim of this study was to evaluate the correlations between T2 value, T2* value, and histological grades of degenerated human articular cartilage. MATERIALS AND METHODS T2 mapping and T2* mapping of nine tibial osteochondral specimens were obtained using a 3-T MRI after total knee arthroplasty. A total of 94 ROIs were analyzed. Histological grades were assessed using the David-Vaudey scale. Spearman's rho correlation analysis and Pearson's correlation analysis were performed. RESULTS The mean relaxation values in T2 map with different histological grades (0, 1, 2) of the cartilage were 51.9 ± 9.2 ms, 55.8 ± 12.8 ms, and 59.6 ± 10.2 ms, respectively. The mean relaxation values in T2* map with different histological grades (0, 1, 2) of the cartilage were 20.3 ± 10.3 ms, 21.1 ± 12.4 ms, and 15.4 ± 8.5 ms, respectively. Spearman's rho correlation analysis confirmed a positive correlation between T2 value and histological grade (ρ = 0.313, p < 0.05). Pearson's correlation analysis revealed a significant negative correlation between T2 and T2* (r = -0.322, p < 0.05). Although T2* values showed a decreasing trend with an increase in cartilage degeneration, this correlation was not statistically significant in this study (ρ = -0.192, p = 0.129). CONCLUSIONS T2 mapping was correlated with histological degeneration, and it may be a good biomarker for osteoarthritis in human articular cartilage. However, the strength of the correlation was weak (ρ = 0.313). Although T2* values showed a decreasing trend with an increase in cartilage degeneration, the correlation was not statistically significant. Therefore, T2 mapping may be more appropriate for the initial diagnosis of articular cartilage degeneration in the knee joint. Further studies on T2* mapping are needed to confirm its reliability and mechanism in cartilage degeneration.
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Ho CP, Surowiec RK, Ferro FP, Lucas EP, Saroki AJ, Dornan GJ, Fitzcharles EK, Anz AW, Smith WS, Wilson KJ, Philippon MJ. Subregional Anatomical Distribution of T2 Values of Articular Cartilage in Asymptomatic Hips. Cartilage 2014; 5:154-64. [PMID: 26069695 PMCID: PMC4297181 DOI: 10.1177/1947603514529587] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/20/2023] Open
Abstract
OBJECTIVE A standardized definition of normative T2 values across the articular surface of the hip must be defined in order to fully understand T2 values for detecting early degeneration. Therefore, in this article, we seek to lay foundational methodology for reproducible quantitative evaluation of hip cartilage damage using T2 mapping to determine the normative T2 values in asymptomatic individuals. DESIGN Nineteen prospectively enrolled asymptomatic volunteers (age 18-35 years, males 10, females 9, alpha angle 49.3º ± 7.2º) were evaluated with a sagittal T2 mapping sequence at 3.0 T magnetic resonance imaging. Acetabular and femoral cartilage was manually segmented directly on the second echo of the T2 mapping sequence by 3 raters, twice. Segmentations were divided into 12 subregions modified from the geographic zone method. Median T2 values within each subregion were compiled for further analysis and interrater and intrarater reliability was assessed. RESULTS In the femur, the posterior-superior subregion was significantly higher (P ≤ 0.05) than those in the posterior-inferior and anterior-inferior subregions. In the acetabulum, the anterior-inferior subregion was significantly higher (P ≤ 0.001) than in the anterior-superior, middle, and posterior-inferior subregions. T2 values of the posterior-superior subregion were significantly higher (P ≤ 0.05) than the anterior-superior, middle, and posterior-inferior subregions. Interrater agreement was generally fair to good.
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Affiliation(s)
- Charles P. Ho
- Steadman Philippon Research Institute, Vail, CO, USA
| | | | | | - Erin P. Lucas
- Steadman Philippon Research Institute, Vail, CO, USA
| | | | | | | | | | - W. Sean Smith
- Steadman Philippon Research Institute, Vail, CO, USA
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Pachowsky ML, Trattnig S, Wondrasch B, Apprich S, Marlovits S, Mauerer A, Welsch GH, Blanke M. In vivo evaluation of biomechanical properties in the patellofemoral joint after matrix-associated autologous chondrocyte transplantation by means of quantitative T2 MRI. Knee Surg Sports Traumatol Arthrosc 2014; 22:1360-9. [PMID: 23689961 DOI: 10.1007/s00167-013-2527-7] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/26/2012] [Accepted: 05/06/2013] [Indexed: 02/02/2023]
Abstract
PURPOSE To determine in vivo biomechanical properties of articular cartilage and cartilage repair tissue of the patella, using biochemical MRI by means of quantitative T2 mapping. METHODS Twenty MR scans were achieved at 3T MRI, using a new 8-channel multi-function coil allowing controlled bending of the knee. Multi-echo spin-echo T2 mapping was prepared in healthy volunteers and in age- and sex-matched patients after matrix-associated autologous chondrocyte transplantation (MACT) of the patella. MRI was performed at 0° and 45° of flexion of the knee after 0 min and after 1 h. A semi-automatic region-of-interest analysis was performed for the whole patella cartilage. To allow stratification with regard to the anatomical (collagen) structure, further subregional analysis was carried out (deep-middle-superficial cartilage layer). Statistical analysis of variance was performed. RESULTS During 0° flexion (decompression), full-thickness T2 values showed no significant difference between volunteers (43 ms) and patients (41 ms). Stratification was more pronounced for healthy cartilage compared to cartilage repair tissue. During 45° flexion (compression), full-thickness T2 values within volunteers were significantly increased (54 ms) compared to patients (44 ms) (p < 0.001). Again, stratification was more pronounced in volunteers compared to patients. The volunteer group showed no significant increase in T2 values measured in straight position and in bended position. There was no significant difference between the 0- and the 60-min MRI examination. T2 values in the patient group increased between the 0- and the 60-min examination. However, the increase was only significant in the superior cartilage layer of the straight position (p = 0.021). CONCLUSION During compression (at 45° flexion), healthy patellar cartilage showed a significant increase in T2-values, indicating adaptations of water content and collagen fibril orientation to mechanical load. This could not be observed within the patella cartilage after cartilage repair (MACT) of the patella, most obvious due to a lack of biomechanical adjustment. LEVEL OF EVIDENCE III.
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Affiliation(s)
- M L Pachowsky
- Department of Trauma and Orthopaedic Surgery, University of Erlangen, Krankenhausstr. 12, 91054, Erlangen, Germany
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Surowiec RK, Lucas EP, Ho CP. Quantitative MRI in the evaluation of articular cartilage health: reproducibility and variability with a focus on T2 mapping. Knee Surg Sports Traumatol Arthrosc 2014; 22:1385-95. [PMID: 24170187 DOI: 10.1007/s00167-013-2714-6] [Citation(s) in RCA: 43] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/17/2013] [Accepted: 10/08/2013] [Indexed: 01/14/2023]
Abstract
PURPOSE Early diagnosis of cartilage degeneration and longitudinal tracking of cartilage health including repair following surgical intervention would benefit from the ability to detect and monitor changes of the articular cartilage non-invasively and before gross morphological alterations appear. METHODS Quantitative MR imaging has shown promising results with various imaging biomarkers such as T2 mapping, T1 rho and dGEMRIC demonstrating sensitivity in the detection of biochemical alterations within tissues of interest. However, acquiring accurate and clinically valuable quantitative data has proven challenging, and the reproducibility of the quantitative mapping technique and its values are essential. Although T2 mapping has been the focus in this discussion, all quantitative mapping techniques are subject to the same issues including variability in the imaging protocol, unloading and exercise, analysis, scanner and coil, calculation methods, and segmentation and registration concerns. RESULTS The causes for variability between time points longitudinally in a patient, among patients, and among centres need to be understood further and the issues addressed. CONCLUSIONS The potential clinical applications of quantitative mapping are vast, but, before the clinical community can take full advantage of this tool, it must be automated, standardized, validated, and have proven reproducibility prior to its implementation into the standard clinical care routine.
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Affiliation(s)
- Rachel K Surowiec
- Steadman Philippon Research Institute, 181 W Meadow Dr, Suite 1000, Vail, CO, 81657, USA,
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T2 values of articular cartilage in clinically relevant subregions of the asymptomatic knee. Knee Surg Sports Traumatol Arthrosc 2014; 22:1404-14. [PMID: 24271329 DOI: 10.1007/s00167-013-2779-2] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/06/2013] [Accepted: 11/10/2013] [Indexed: 10/26/2022]
Abstract
PURPOSE In order for T2 mapping to become more clinically applicable, reproducible subregions and standardized T2 parameters must be defined. This study sought to: (1) define clinically relevant subregions of knee cartilage using bone landmarks identifiable on both MR images and during arthroscopy and (2) determine healthy T2 values and T2 texture parameters within these subregions. METHODS Twenty-five asymptomatic volunteers (age 18-35) were evaluated with a sagittal T2 mapping sequence. Manual segmentation was performed by three raters, and cartilage was divided into twenty-one subregions modified from the International Cartilage Repair Society Articular Cartilage Mapping System. Mean T2 values and texture parameters (entropy, variance, contrast, homogeneity) were recorded for each subregion, and inter-rater and intra-rater reliability was assessed. RESULTS The central regions of the condyles had significantly higher T2 values than the posterior regions (P < 0.05) and higher variance than the posterior region on the medial side (P < 0.001). The central trochlea had significantly greater T2 values than the anterior and posterior condyles. The central lateral plateau had lower T2 values, lower variance, higher homogeneity, and lower contrast than nearly all subregions in the tibia. The central patellar regions had higher entropy than the superior and inferior regions (each P ≤ 0.001). Repeatability was good to excellent for all subregions. CONCLUSION Significant differences in mean T2 values and texture parameters were found between subregions in this carefully selected asymptomatic population, which suggest that there is normal variation of T2 values within the knee joint. The clinically relevant subregions were found to be robust as demonstrated by the overall high repeatability.
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Astur DC, Arliani GG, Binz M, Astur N, Kaleka CC, Amaro JT, Pochini A, Cohen M. Autologous osteochondral transplantation for treating patellar chondral injuries: evaluation, treatment, and outcomes of a two-year follow-up study. J Bone Joint Surg Am 2014; 96:816-23. [PMID: 24875022 DOI: 10.2106/jbjs.m.00312] [Citation(s) in RCA: 43] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
BACKGROUND The patella is the largest human sesamoid bone and often sustains chondral injury. There is no consensus on how to treat a full-thickness, symptomatic articular cartilage injury of the patella. We analyzed the clinical and functional outcomes of patients with symptomatic full-thickness patellar chondral lesions treated with autologous osteochondral transplantation and evaluated osteochondral autograft bone-plug integration through magnetic resonance imaging. METHODS In this prospective study, thirty-three patients with a symptomatic full-thickness patellar chondral injury surgically treated with autologous osteochondral transplantation were evaluated before and after surgical treatment with a minimum two-year follow-up using the Lysholm, Kujala, and Fulkerson questionnaires and the Short Form-36 health survey score. Magnetic resonance images were made at six and twelve months postoperatively and studies were performed to analyze the osteochondral autograft bone-plug integration. RESULTS All thirty-three patients showed a significant improvement in functional scores two years after surgery. The average Lysholm scores were 57.27 points preoperatively and 80.76 points at two years postoperatively, the average Kujala scores were 54.76 points preoperatively and 75.18 points at two years postoperatively, and the Fulkerson average scores were 54.24 points preoperatively and 80.42 points at two years postoperatively. The Short Form-36 life quality score improved significantly. Two years after surgery, all magnetic resonance images showed full bone-plug integration into the patella. CONCLUSIONS Autologous osteochondral transplantation is a successful technique to surgically treat symptomatic full-thickness patellar articular cartilage injuries smaller than 2.5 cm in diameter. Patients had a significant improvement in clinical scores. Bone-plug integration and surface alignment were demonstrated in all patients two years after surgery. LEVEL OF EVIDENCE Therapeutic Level IV. See Instructions for Authors for a complete description of levels of evidence.
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Affiliation(s)
- Diego Costa Astur
- Universidade Federal de São Paulo, Rua Borges Lagoa 783, 5° andar, São Paulo, Brazil 03840-032. E-mail address for D.C. Astur:
| | - Gustavo Gonçalves Arliani
- Universidade Federal de São Paulo, Rua Borges Lagoa 783, 5° andar, São Paulo, Brazil 03840-032. E-mail address for D.C. Astur:
| | - Mario Binz
- Universidade Federal de São Paulo, Rua Borges Lagoa 783, 5° andar, São Paulo, Brazil 03840-032. E-mail address for D.C. Astur:
| | - Nelson Astur
- Universidade Federal de São Paulo, Rua Borges Lagoa 783, 5° andar, São Paulo, Brazil 03840-032. E-mail address for D.C. Astur:
| | - Camila Cohen Kaleka
- Universidade Federal de São Paulo, Rua Borges Lagoa 783, 5° andar, São Paulo, Brazil 03840-032. E-mail address for D.C. Astur:
| | - Joicemar Tarouco Amaro
- Universidade Federal de São Paulo, Rua Borges Lagoa 783, 5° andar, São Paulo, Brazil 03840-032. E-mail address for D.C. Astur:
| | - Alberto Pochini
- Universidade Federal de São Paulo, Rua Borges Lagoa 783, 5° andar, São Paulo, Brazil 03840-032. E-mail address for D.C. Astur:
| | - Moises Cohen
- Universidade Federal de São Paulo, Rua Borges Lagoa 783, 5° andar, São Paulo, Brazil 03840-032. E-mail address for D.C. Astur:
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Patellofemoral friction syndrome: magnetic resonance imaging correlation of morphologic and T2 cartilage imaging. J Comput Assist Tomogr 2014; 38:308-12. [PMID: 24448504 DOI: 10.1097/rct.0b013e3182aab187] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/17/2023]
Abstract
OBJECTIVE This study aimed to investigate whether patellofemoral T2 cartilage changes are associated with lateral patellofemoral friction syndrome (PFS), as indicated by an edema-like signal within the superolateral infrapatellar (Hoffa) fat pad. METHODS In this institutional review board-approved retrospective study of 510 consecutive patients, 49 patients with 50 knee magnetic resonance imaging examinations demonstrating normal or low-grade patellofemoral cartilage abnormalities (whole-organ magnetic resonance imaging score [WORMS] score, ≤2) were included. Twenty-two examinations with PFS (cases) were compared with an age- and sex-matched cohort of 28 examinations without PFS (controls). A 3-T magnetic resonance imaging was performed with multi-echo, spin-echo T2 mapping. Two readers measured in consensus malalignment parameters, including patellar height index, tibial tuberosity to trochlear groove distance, and sulcus angle. Bulk T2 cartilage values in the lateral and medial patellofemoral compartment, central weight-bearing medial and lateral femoral condyles were measured independently. Interobserver agreement was quantified using concordance correlation coefficients. Demographics, anatomic measurements, whole-organ magnetic resonance imaging scores, and cartilage T2 values were compared between cases and controls using Fisher exact test, Wilcoxon rank sum test, and mixed-effects models. RESULTS Cases demonstrated higher patellar height index (P = 0.002) and tibial tuberosity to trochlear groove distance (P = 0.02). Interobserver agreement for T2 values was good overall (concordance correlation coefficient range, 0.65-0.93). Cases demonstrated higher medial facet patellar bulk T2 (38.1 [7.5] ms) versus controls (33.6 [7.3] ms) (P = 0.02); otherwise, there were no significant differences in regional T2 values. CONCLUSIONS T2 mapping in patients with PFS demonstrates increased cartilage T2 in the medial patellar facet, possibly reflecting collagen alteration from early chondromalacia (softening) or increased water content related to altered contact pressures.
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Age and Sex Dependency of Cartilage T2 Relaxation Time Mapping in MRI of Children and Adolescents. AJR Am J Roentgenol 2014; 202:626-32. [DOI: 10.2214/ajr.13.11327] [Citation(s) in RCA: 35] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
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Koller U, Apprich S, Domayer S, Windhager R, Trattnig S. Magnetic resonance mapping of the rim of articular cartilage defects of the patella. INTERNATIONAL ORTHOPAEDICS 2013; 38:67-72. [PMID: 24013438 DOI: 10.1007/s00264-013-2096-x] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/24/2013] [Accepted: 08/21/2013] [Indexed: 11/30/2022]
Abstract
PURPOSE Elevated T2-values of articular cartilage are associated with an increase in cartilage water that results from a damaged collagen matrix, and provide a marker for cartilage damage. We used T2 mapping to analyse the rim of cartilage defects that appeared to be intact on the morphological sequences, to determine whether there are early biochemical changes already present. METHOD We calculated T2 values for the rim of cartilage defects in 25 patients and compared these values to another area of control cartilage in these patients. RESULTS A highly significant increase in T2 values of the deep, superficial, and global layer of the rim versus the control cartilage was measured. ANOVA showed a significant correlation of the defect levels with the T2 values of the deep and global zone of the adjacent cartilage tissue, but not with the superficial zone. CONCLUSION Although cartilage appears to be intact on morphological sequences, T2 mapping can show a loss of structural anisotropy of collagen and the associated increase in cartilage water that indicates the destruction of the adjacent cartilage. Preoperative information about the degree of damage of the collagen matrix will support decision making for cartilage repair.
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Affiliation(s)
- Ulrich Koller
- Department of Orthopaedic Surgery, Medical University of Vienna, Waehringer Gürtel 18-20, 1090, Vienna, Austria,
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Acute cartilage loading responses after an in vivo squatting exercise in people with doubtful to mild knee osteoarthritis: a case-control study. Phys Ther 2013; 93:1049-60. [PMID: 23580627 DOI: 10.2522/ptj.20120491] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
BACKGROUND The effects of exercise on osteoarthritic cartilage remain elusive. OBJECTIVE The objective of this study was to investigate the effect of dynamic in vivo squatting exercise on the magnitude and spatial pattern of acute cartilage responses in people with tibiofemoral osteoarthritis (ie, Kellgren-Lawrence grades 1 and 2). DESIGN This investigation was a case-control study. METHODS Eighteen people with radiographic signs of doubtful to mild medial tibiofemoral osteoarthritis were compared with 18 people who were middle-aged and healthy (controls). Three-dimensional magnetic resonance imaging was used to monitor deformation and recovery on the basis of 3-dimensional cartilage volume calculations (ie, total volume and volumes in anterior, central, and posterior subregions) before and after a 30-repetition squatting exercise. Three-dimensional volumes were estimated after semiautomatic segmentation and were calculated at 4 time points (1 before and 3 after scans). Scans obtained after the exercise were separated by 15-minute intervals. RESULTS In both groups, significant deformation was noted in the medial compartment (-3.4% for the femur and -3.2% for the tibia in people with osteoarthritis versus -2.8% for the femur and -3.8% for the tibia in people in the control group). People with osteoarthritis had significant deformation in the lateral femur (-3.9%) and a tendency toward significant deformation in the lateral tibia (-3.1%). From 15 minutes after exercise cessation onward, volume changes were no longer significantly different from the baseline. At all time points, no significant between-group differences were revealed for volume changes. People with osteoarthritis showed a tendency toward slower recovery preceded by larger deformations in entire cartilage plates and subregions. Spatial subregional deformation patterns were similar between groups. LIMITATIONS Generalizability is limited to people with doubtful to mild osteoarthritis and low levels of pain. CONCLUSIONS Tibiofemoral cartilage deformation appeared similar in magnitude and spatial pattern in people who were middle-aged and either had or did not have tibiofemoral osteoarthritis (ie, Kellgren-Lawrence grades 1 and 2). Restoration of volumes required a 15-minute recovery, especially in the presence of osteoarthritic cartilage degeneration.
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Thuillier DU, Souza RB, Wu S, Luke A, Li X, Feeley BT. T1ρ imaging demonstrates early changes in the lateral patella in patients with patellofemoral pain and maltracking. Am J Sports Med 2013; 41:1813-8. [PMID: 23845401 DOI: 10.1177/0363546513495167] [Citation(s) in RCA: 36] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
BACKGROUND Patellofemoral pain (PFP) is a common condition and often presents without evidence of arthritis on radiographs. Magnetic resonance imaging (MRI) has shown good correlation between T1ρ and T2 relaxation times and changes in the cartilage matrix, but as of yet, there are limited data in the literature utilizing these modalities to evaluate the patellofemoral joint. HYPOTHESIS Patients with PFP and patellar tilt will show longer T1ρ relaxation times in the lateral facets of their patella but no difference in T2 values. STUDY DESIGN Cross-sectional study; Level of evidence, 3. METHODS A total of 20 patients aged 18 to 45 years with anterior knee pain, patellar tilt, and no evidence of osteoarthritis were identified and consented to undergo MRI including axial T1ρ and T2 relaxation time mapping sequences. Knee cartilage was segmented on spoiled gradient recalled acquisition in steady state (SPGR) images using a spline-based algorithm. These results were then compared with those of 10 age-matched controls. RESULTS The mean T1ρ values of the lateral facets were significantly elevated in patients with PFP compared with controls (46.33 ± 4.92 ms vs. 42.32 ± 3.67 ms, respectively; P = .031), while no significant difference was observed in the medial facets (42.20 ± 5.55 ms vs. 41.42 ± 4.09 ms, respectively; P = .69). Significantly higher mean T1ρ values were noted in the lateral facets of the patients with PFP (46.33 ms) compared with the medial facets (42.20 ms) (P = .0001), while no significant differences in T1ρ values were observed between the medial and lateral facets of the controls (P = .502). No significant differences were noted in T2 relaxation times. A high correlation was noted between the mean T1ρ values of the whole patella of patients with PFP and the degree of patellar tilt (r = 0.72). CONCLUSION There were significantly higher T1ρ values in the lateral facets of patients with PFP and patellar tilt that were not seen in control patients. These higher values approach the numbers seen in patients with early osteoarthritis.
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Affiliation(s)
- Daniel U Thuillier
- Department of Orthopaedic Surgery, University of California, San Francisco, 500 Parnassus Avenue, MUW 3rd Floor, Box 0728, San Francisco, CA 94143, USA.
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Kijowski R, Blankenbaker DG, Munoz Del Rio A, Baer GS, Graf BK. Evaluation of the Articular Cartilage of the Knee Joint: Value of Adding a T2 Mapping Sequence to a Routine MR Imaging Protocol. Radiology 2013; 267:503-13. [PMID: 23297335 DOI: 10.1148/radiol.12121413] [Citation(s) in RCA: 127] [Impact Index Per Article: 11.5] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Affiliation(s)
- Richard Kijowski
- Department of Radiology, University of Wisconsin School of Medicine and Public Health, 600 Highland Ave, Clinical Science Center-E3/311, Madison, WI 53792-3252, USA.
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Takayama Y, Hatakenaka M, Tsushima H, Okazaki K, Yoshiura T, Yonezawa M, Nishikawa K, Iwamoto Y, Honda H. T1ρ is superior to T2 mapping for the evaluation of articular cartilage denaturalization with osteoarthritis: Radiological–pathological correlation after total knee arthroplasty. Eur J Radiol 2013; 82:e192-8. [DOI: 10.1016/j.ejrad.2012.11.031] [Citation(s) in RCA: 34] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2012] [Revised: 10/13/2012] [Accepted: 11/20/2012] [Indexed: 12/22/2022]
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Kim SD, Jessel R, Zurakowski D, Millis MB, Kim YJ. Anterior delayed gadolinium-enhanced MRI of cartilage values predict joint failure after periacetabular osteotomy. Clin Orthop Relat Res 2012; 470:3332-41. [PMID: 22907475 PMCID: PMC3492640 DOI: 10.1007/s11999-012-2519-9] [Citation(s) in RCA: 42] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
BACKGROUND Several available compositional MRIs seem to detect early osteoarthritis before radiographic appearance. Delayed gadolinium-enhanced MRI of cartilage (dGEMRIC) has been most frequently used in clinical studies and reportedly predicts premature joint failure in patients undergoing Bernese periacetabular osteotomies (PAOs). QUESTIONS/PURPOSES We asked, given regional variations in biochemical composition in dysplastic hips, whether the dGEMRIC index of the anterior joint would better predict premature joint failure after PAOs than the coronal dGEMRIC index as previously reported. METHODS We retrospectively reviewed 43 hips in 41 patients who underwent Bernese PAO for hip dysplasia. Thirty-seven hips had preserved joints after PAOs and six were deemed premature failures based on pain, joint space narrowing, or subsequent THA. We used dGEMRIC to determine regional variations in biochemical composition. Preoperative demographic and clinical outcome score, radiographic measures of osteoarthritis and severity of dysplasia, and dGEMRIC indexes from different hip regions were analyzed in a multivariable regression analysis to determine the best predictor of premature joint failure. Minimum followup was 24 months (mean, 32 months; range, 24-46 months). RESULTS The two cohorts were similar in age and sex distribution. Severity of dysplasia was similar as measured by lateral center-edge, anterior center-edge, and Tönnis angles. Preoperative pain, joint space width, Tönnis grade, and coronal and sagittal dGEMRIC indexes differed between groups. The dGEMRIC index in the anterior weightbearing region of the hip was lower in the prematurely failed group and was the best predictor. CONCLUSIONS Success of PAO depends on the amount of preoperative osteoarthritis. These degenerative changes are seen most commonly in the anterior joint. The dGEMRIC index of the anterior joint may better predict premature joint failure than radiographic measures of hip osteoarthritis and coronal dGEMRIC index. LEVEL OF EVIDENCE Level II, prognostic study. See Instructions for Authors for a complete description of levels of evidence.
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Affiliation(s)
- Sang Do Kim
- Department of Orthopaedic Surgery, Children’s Hospital Boston, 300 Longwood Avenue, Boston, MA 02115 USA
| | - Rebecca Jessel
- Department of Orthopaedic Surgery, Children’s Hospital Boston, 300 Longwood Avenue, Boston, MA 02115 USA
| | - David Zurakowski
- Department of Orthopaedic Surgery, Children’s Hospital Boston, 300 Longwood Avenue, Boston, MA 02115 USA
| | - Michael B. Millis
- Department of Orthopaedic Surgery, Children’s Hospital Boston, 300 Longwood Avenue, Boston, MA 02115 USA
| | - Young-Jo Kim
- Department of Orthopaedic Surgery, Children’s Hospital Boston, 300 Longwood Avenue, Boston, MA 02115 USA
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Abstract
Hip deformity such as acetabular dysplasia and cam and pincer deformities are thought to be a major cause of hip osteoarthritis. Currently, clinically effective surgical procedures such as pelvic osteotomies and femoral and acetabular osteoplasties are available to correct the underlying deformity. These procedures are most effective in the presence of minimal chondral damage in the joint. Currently, and more so in the future, high-resolution morphologic imaging and biochemical imaging techniques such as Delayed gadolinium-enhanced MR imaging of cartilage, T2, and T1rho will have a clinically important role in diagnosing and staging chondral damage in the hip.
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Abstract
Hip disorders in the young adult manifest along a continuum that ranges from an excessively constrained, impinging joint, to an overly shallow, unstable hip. Knowledge of simple measures on plain radiographs can aid in efficient and accurate identification of mechanically compromised hips that may be at risk for premature OA. Improvements in joint-preserving surgery have shown promise in delaying or preventing progression of articular degeneration; thus, timely diagnosis is important. Once a diagnosis is established, specialized imaging can be individualized to supplement surgical planning, assess the degree of cartilage damage, and facilitate discussion regarding the prognosis of hip-preserving procedures.
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Affiliation(s)
- Cara Beth Lee
- Center for Hip Preservation, Department of Orthopedics, Virginia Mason Medical Center, Seattle, WA 98111, USA.
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