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Jawetz ST, Fox MG, Blankenbaker DG, Caracciolo JT, Frick MA, Nacey N, Said N, Sharma A, Spence S, Stensby JD, Subhas N, Tubb CC, Walker EA, Yu F, Beaman FD. ACR Appropriateness Criteria® Chronic Hip Pain: 2022 Update. J Am Coll Radiol 2023; 20:S33-S48. [PMID: 37236751 DOI: 10.1016/j.jacr.2023.02.019] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2023] [Accepted: 02/27/2023] [Indexed: 05/28/2023]
Abstract
Chronic hip pain is a frequent chief complaint for adult patients who present for evaluation in a variety of clinical practice settings. Following a targeted history and physical examination, imaging plays a vital role in elucidating the etiologies of a patient's symptoms, as a wide spectrum of pathological entities may cause chronic hip pain. Radiography is usually the appropriate initial imaging test following a clinical examination. Depending on the clinical picture, advanced cross-sectional imaging may be subsequently performed for further evaluation. This documents provides best practice for the imaging workup of chronic hip pain in patients presenting with a variety of clinical scenarios. The American College of Radiology Appropriateness Criteria are evidence-based guidelines for specific clinical conditions that are reviewed annually by a multidisciplinary expert panel. The guideline development and revision include an extensive analysis of current medical literature from peer reviewed journals and the application of well-established methodologies (RAND/UCLA Appropriateness Method and Grading of Recommendations Assessment, Development, and Evaluation or GRADE) to rate the appropriateness of imaging and treatment procedures for specific clinical scenarios. In those instances where evidence is lacking or equivocal, expert opinion may supplement the available evidence to recommend imaging or treatment.
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Affiliation(s)
| | - Michael G Fox
- Panel Chair, Program Director, Diagnostic Radiology, Mayo Clinic Arizona, Phoenix, Arizona
| | - Donna G Blankenbaker
- University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin
| | - Jamie T Caracciolo
- Moffitt Cancer Center and University of South Florida Morsani College of Medicine, Tampa, Florida; MSK-RADS (Bone) Committee
| | - Matthew A Frick
- Chair of Education, Department of Radiology, Chair of Musculoskeletal Imaging, Mayo Clinic, Rochester, Minnesota
| | - Nicholas Nacey
- University of Virginia Health System, Charlottesville, Virginia
| | - Nicholas Said
- Duke University Medical Center, Durham, North Carolina
| | - Akash Sharma
- Mayo Clinic, Jacksonville, Florida; Commission on Nuclear Medicine and Molecular Imaging
| | - Susanna Spence
- University of Texas McGovern Medical School, Houston, Texas; Committee on Emergency Radiology-GSER; Member of the Board of Advisors and Board of Directors for Texas Radiological Society
| | | | | | - Creighton C Tubb
- UT Health San Antonio, San Antonio, Texas; American Academy of Orthopaedic Surgeons
| | - Eric A Walker
- Penn State Milton S. Hershey Medical Center, Hershey, Pennsylvania and Uniformed Services University of the Health Sciences, Bethesda, Maryland
| | - Florence Yu
- Section Head, Musculoskeletal Imaging, Weill Cornell Medical College, New York, New York; Primary care physician; Chair, ACR sponsored BONE-RADS Committee
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Sharafi A, Zibetti MVW, Chang G, Cloos MA, Regatte RR. Simultaneous bilateral T 1 , T 2 , and T 1ρ relaxation mapping of the hip joint with magnetic resonance fingerprinting. NMR IN BIOMEDICINE 2022; 35:e4651. [PMID: 34825750 PMCID: PMC9233946 DOI: 10.1002/nbm.4651] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/22/2021] [Revised: 10/22/2021] [Accepted: 10/26/2021] [Indexed: 06/13/2023]
Abstract
Quantitative MRI can detect early biochemical changes in cartilage, but its bilateral use in clinical routines is challenging. The aim of this prospective study was to demonstrate the feasibility of magnetic resonance fingerprinting for bilateral simultaneous T1 , T2 , and T1ρ mapping of the hip joint. The study population consisted of six healthy volunteers with no known trauma or pain in the hip. Monoexponential T1 , T2 , and T1ρ relaxation components were assessed in femoral lateral, superolateral, and superomedial, and inferior, as well as acetabular, superolateral, and superomedial subregions in left and right hip cartilage. Aligned ranked nonparametric factorial analysis was used to assess the side's impact on the subregions. Kruskal-Wallis and Wilcoxon tests were used to compare subregions, and coefficient of variation to assess repeatability. Global averages of T1 (676.0 ± 45.4 and 687.6 ± 44.5 ms), T2 (22.5 ± 2.6 and 22.1 ± 2.5 ms), and T1ρ (38.2 ± 5.5 and 38.2 ± 5.5 ms) were measured in the left and right hip, and articular cartilage, respectively. The Kruskal-Wallis test showed a significant difference between different subregions' relaxation times regardless of the hip side (p < 0.001 for T1 , p = 0.012 for T2 , and p < 0.001 for T1ρ ). The Wilcoxon test showed that T1 of femoral layers was significantly (p < 0.003) higher than that for acetabular cartilage. The experiments showed excellent repeatability with CVrms of 1%, 2%, and 4% for T1 , T2 , and T1ρ, respectively. It was concluded that bilateral T1 , T2 , and T1ρ relaxation times, as well as B1+ maps, can be acquired simultaneously from hip joints using the proposed MRF sequence.
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Affiliation(s)
- Azadeh Sharafi
- Bernard and Irene Schwartz Center for Biomedical Imaging, Department of Radiology, New York University Grossman School of Medicine, New York, New York, USA
- Center for Advanced Imaging Innovation and Research (CAI2R), Department of Radiology, New York University Grossman School of Medicine, New York, New York, USA
| | - Marcelo V. W. Zibetti
- Bernard and Irene Schwartz Center for Biomedical Imaging, Department of Radiology, New York University Grossman School of Medicine, New York, New York, USA
- Center for Advanced Imaging Innovation and Research (CAI2R), Department of Radiology, New York University Grossman School of Medicine, New York, New York, USA
| | - Gregory Chang
- Bernard and Irene Schwartz Center for Biomedical Imaging, Department of Radiology, New York University Grossman School of Medicine, New York, New York, USA
- Center for Advanced Imaging Innovation and Research (CAI2R), Department of Radiology, New York University Grossman School of Medicine, New York, New York, USA
| | - Martijn A. Cloos
- Center of Advanced Imaging, University of Queensland, Brisbane, Australia
| | - Ravinder R. Regatte
- Bernard and Irene Schwartz Center for Biomedical Imaging, Department of Radiology, New York University Grossman School of Medicine, New York, New York, USA
- Center for Advanced Imaging Innovation and Research (CAI2R), Department of Radiology, New York University Grossman School of Medicine, New York, New York, USA
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Rehnitz C, Do T, Klaan B, Burkholder I, Barié A, Wuennemann F, Kauczor H, Weber M. Feasibility of using half‐dose Gd‐BOPTA for delayed gadolinium‐enhanced MRI of cartilage (dGEMRIC) at the knee, compared with standard‐dose Gd‐DTPA. J Magn Reson Imaging 2019; 51:144-154. [DOI: 10.1002/jmri.26816] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2019] [Accepted: 05/21/2019] [Indexed: 11/06/2022] Open
Affiliation(s)
- Christoph Rehnitz
- Department of Diagnostic and Interventional RadiologyUniversity Hospital Heidelberg Heidelberg Germany
| | - Thuy Do
- Department of Diagnostic and Interventional RadiologyUniversity Hospital Heidelberg Heidelberg Germany
| | - Bastian Klaan
- Institute of Diagnostic and Interventional Radiology, Pediatric Radiology and NeuroradiologyUniversity Medicine Rostock Rostock Germany
| | - Iris Burkholder
- Department of Nursing and HealthUniversity of Applied Sciences of the Saarland Saarbruecken Germany
| | - Alexander Barié
- Department of Orthopedics and Trauma SurgeryUniversity Hospital Heidelberg Heidelberg Germany
| | - Felix Wuennemann
- Department of Diagnostic and Interventional RadiologyUniversity Hospital Heidelberg Heidelberg Germany
| | - Hans‐Ulrich Kauczor
- Department of Diagnostic and Interventional RadiologyUniversity Hospital Heidelberg Heidelberg Germany
| | - Marc‐André Weber
- Institute of Diagnostic and Interventional Radiology, Pediatric Radiology and NeuroradiologyUniversity Medicine Rostock Rostock Germany
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Mintz DN, Roberts CC, Bencardino JT, Baccei SJ, Caird MS, Cassidy RC, Chang EY, Fox MG, Gyftopoulos S, Kransdorf MJ, Metter DF, Morrison WB, Rosenberg ZS, Shah NA, Small KM, Subhas N, Tambar S, Towers JD, Yu JS, Weissman BN. ACR Appropriateness Criteria ® Chronic Hip Pain. J Am Coll Radiol 2017; 14:S90-S102. [DOI: 10.1016/j.jacr.2017.01.035] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2017] [Revised: 01/19/2017] [Accepted: 01/23/2017] [Indexed: 11/27/2022]
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Kang Y, Choi JY, Yoo HJ, Hong SH, Kang HS. Delayed Gadolinium-enhanced MR Imaging of Cartilage: A Comparative Analysis of Different Gadolinium-based Contrast Agents in an ex Vivo Porcine Model. Radiology 2017; 282:734-742. [DOI: 10.1148/radiol.2016160367] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Affiliation(s)
- Yusuhn Kang
- From the Department of Radiology, Seoul National University College of Medicine, 101 Daehak-ro Jongno-gu, Seoul 110-744, Korea
| | - Ja-Young Choi
- From the Department of Radiology, Seoul National University College of Medicine, 101 Daehak-ro Jongno-gu, Seoul 110-744, Korea
| | - Hye Jin Yoo
- From the Department of Radiology, Seoul National University College of Medicine, 101 Daehak-ro Jongno-gu, Seoul 110-744, Korea
| | - Sung Hwan Hong
- From the Department of Radiology, Seoul National University College of Medicine, 101 Daehak-ro Jongno-gu, Seoul 110-744, Korea
| | - Heung Sik Kang
- From the Department of Radiology, Seoul National University College of Medicine, 101 Daehak-ro Jongno-gu, Seoul 110-744, Korea
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Albers CE, Wambeek N, Hanke MS, Schmaranzer F, Prosser GH, Yates PJ. Imaging of femoroacetabular impingement-current concepts. J Hip Preserv Surg 2016; 3:245-261. [PMID: 29632685 PMCID: PMC5883171 DOI: 10.1093/jhps/hnw035] [Citation(s) in RCA: 35] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/16/2016] [Accepted: 09/12/2016] [Indexed: 02/07/2023] Open
Abstract
Following the recognition of femoroacetabular impingement (FAI) as a clinical entity, diagnostic tools have continuously evolved. While the diagnosis of FAI is primarily made based on the patients' history and clinical examination, imaging of FAI is indispensable. Routine diagnostic work-up consists of a set of plain radiographs, magnetic resonance imaging (MRI) and MR-arthrography. Recent advances in MRI technology include biochemically sensitive sequences bearing the potential to detect degenerative changes of the hip joint at an early stage prior to their appearance on conventional imaging modalities. Computed tomography may serve as an adjunct. Advantages of CT include superior bone to soft tissue contrast, making CT applicable for image-guiding software tools that allow evaluation of the underlying dynamic mechanisms causing FAI. This article provides a summary of current concepts of imaging in FAI and a review of the literature on recent advances, and their application to clinical practice.
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Affiliation(s)
- Christoph E. Albers
- Department of Orthopaedic Surgery, Fiona Stanley Hospital and Fremantle Hospital, Perth, Australia
- Department of Orthopaedic Surgery, Inselspital, Bern University Hospital, University of Bern, Switzerland
| | - Nicholas Wambeek
- Department of Radiology, Fiona Stanley Hospital and Fremantle Hospital, Perth, Australia
| | - Markus S. Hanke
- Department of Orthopaedic Surgery, Inselspital, Bern University Hospital, University of Bern, Switzerland
| | - Florian Schmaranzer
- Department of Orthopaedic Surgery, Inselspital, Bern University Hospital, University of Bern, Switzerland
| | - Gareth H. Prosser
- Department of Orthopaedic Surgery, Fiona Stanley Hospital and Fremantle Hospital, Perth, Australia
- Faculty of Medicine, Dentistry and Health Sience, University of Western Australia, Perth, Australia
| | - Piers J. Yates
- Department of Orthopaedic Surgery, Fiona Stanley Hospital and Fremantle Hospital, Perth, Australia
- Faculty of Medicine, Dentistry and Health Sience, University of Western Australia, Perth, Australia
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7
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Rehnitz C, Klaan B, Burkholder I, von Stillfried F, Kauczor HU, Weber MA. Delayed gadolinium-enhanced MRI of cartilage (dGEMRIC) and T 2 mapping at 3T MRI of the wrist: Feasibility and clinical application. J Magn Reson Imaging 2016; 45:381-389. [PMID: 27381489 DOI: 10.1002/jmri.25371] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2016] [Accepted: 06/20/2016] [Indexed: 12/19/2022] Open
Abstract
PURPOSE To assess the feasibility of delayed gadolinium-enhanced magnetic resonance imaging (MRI) of cartilage (dGEMRIC) and T2 mapping for biochemical imaging of the wrist at 3T. MATERIALS AND METHODS Seventeen patients with wrist pain (mean age, 41.4 ± 13.1 years) including a subgroup with chondromalacia (n = 11) and 15 healthy volunteers (26.0 ± 2.2 years) underwent dGEMRIC and T2 mapping at 3T. For dGEMRIC, the optimum time window after contrast-injection (gadopentetate dimeglumine) was defined as the plateau of the T1 curve of repeated measurements 15-90 minutes postinjection and assessed in all volunteers. Reference values of healthy-appearing cartilage from all individuals and values in areas of chondromalacia were assessed using region-of-interest analyses. Receiver-operating-characteristic analyses were applied to assess discriminatory ability between damaged and normal cartilage. RESULTS The optimum time window was 45-90 minutes, and the 60-minute timepoint was subsequently used. In chondromalacia, dGEMRIC values were lower (551 ± 84 msec, P < 0.001), and T2 values higher (63.9 ± 17.7, P = 0.001) compared to healthy-appearing cartilage of the same patient. Areas under the curve did not significantly differ between dGEMRIC (0.91) and T2 mapping (0.99; P = 0.17). In healthy-appearing cartilage of volunteers and patients, mean dGEMRIC values were 731.3 ± 47.1 msec and 674.6 ± 72.1 msec (P = 0.01), and mean T2 values were 36.5 ± 5 msec and 41.1 ± 3.2 msec (P = 0.009), respectively. CONCLUSION At 3T, dGEMRIC and T2 mapping are feasible for biochemical cartilage imaging of the wrist. Both techniques allow separation and biochemical assessment of thin opposing cartilage surfaces and can distinguish between healthy and damaged cartilage. LEVEL OF EVIDENCE 3 J. Magn. Reson. Imaging 2017;45:381-389.
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Affiliation(s)
- Christoph Rehnitz
- Department of Diagnostic and Interventional Radiology, University Hospital Heidelberg, Germany
| | - Bastian Klaan
- Department of Diagnostic and Interventional Radiology, University Hospital Heidelberg, Germany
| | - Iris Burkholder
- Department of Nursing and Health, University of Applied Sciences of the Saarland, Saarbruecken, Germany
| | - Falko von Stillfried
- Department of Orthopedics and Trauma Surgery, University Hospital Heidelberg, Germany
| | - Hans-Ulrich Kauczor
- Department of Diagnostic and Interventional Radiology, University Hospital Heidelberg, Germany
| | - Marc-André Weber
- Department of Diagnostic and Interventional Radiology, University Hospital Heidelberg, Germany
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Ayeni OR, Sansone M, de Sa D, Simunovic N, Bedi A, Kelly BT, Farrokhyar F, Karlsson J. Femoro-acetabular impingement clinical research: is a composite outcome the answer? Knee Surg Sports Traumatol Arthrosc 2016; 24:295-301. [PMID: 25618276 DOI: 10.1007/s00167-014-3500-9] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/15/2014] [Accepted: 12/23/2014] [Indexed: 11/25/2022]
Abstract
Femoro-acetabular impingement (FAI) is increasingly recognized as an important cause of hip pain in the young adult. However, the methods of evaluating the efficacy of surgical intervention are often not validated and/or inconsistently reported. Important clinical, gait, radiographic and biomarker outcomes are discussed. This article (1) presents the rationale for considering a composite outcome for FAI patients; (2) examines a variety of important end points currently used to evaluate FAI surgery; (3) discusses a strategy to generate a composite outcome by combining these end points; and (4) highlights the challenges and current areas of controversy that such an approach to evaluating symptomatic FAI patients may present.
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Affiliation(s)
- Olufemi R Ayeni
- Division of Orthopaedic Surgery, Department of Surgery, McMaster University Medical Centre, 1200 Main Street West, 4E15, Hamilton, ON, L8N 3Z5, Canada.
| | - Mikael Sansone
- Department of Orthopaedics, Institute of Clinical Sciences, Sahlgrenska Academy, Gothenburg University, Sahlgrenska University Hospital/Mölndal, Mölndal, Sweden
| | - Darren de Sa
- Division of Orthopaedic Surgery, Department of Surgery, McMaster University Medical Centre, 1200 Main Street West, 4E15, Hamilton, ON, L8N 3Z5, Canada
| | - Nicole Simunovic
- Department of Clinical Epidemiology and Biostatistics, McMaster University, 293 Wellington St N, Suite 110, Hamilton, ON, L8L 8E7, Canada
| | - Asheesh Bedi
- MedSport, Department of Orthopaedic Surgery, University of Michigan, 24 Frank Lloyd Wright Drive, Lobby A, Ann Arbor, MI, 48106, USA
| | - Bryan T Kelly
- Orthopaedic Surgery, Hospital for Special Surgery, New York, NY, 10021, USA
| | - Forough Farrokhyar
- Department of Clinical Epidemiology and Biostatistics, McMaster University, 293 Wellington St N, Suite 110, Hamilton, ON, L8L 8E7, Canada
| | - Jon Karlsson
- Department of Orthopaedics, Institute of Clinical Sciences, Sahlgrenska Academy, Gothenburg University, Sahlgrenska University Hospital/Mölndal, Mölndal, Sweden
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9
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Wyatt C, Kumar D, Subburaj K, Lee S, Nardo L, Narayanan D, Lansdown D, Vail T, Link TM, Souza RB, Majumdar S. Cartilage T1ρ and T2 Relaxation Times in Patients With Mild-to-Moderate Radiographic Hip Osteoarthritis. Arthritis Rheumatol 2015; 67:1548-56. [PMID: 25779656 DOI: 10.1002/art.39074] [Citation(s) in RCA: 34] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2014] [Accepted: 02/10/2015] [Indexed: 11/07/2022]
Abstract
OBJECTIVE To analyze region-specific T1ρ and T2 relaxation times of the hip joint cartilage in relation to presence or absence of radiographic hip osteoarthritis (OA) and presence or absence of magnetic resonance imaging (MRI)-detected cartilage defects. METHODS Weight-bearing radiographs and 3T MRI studies of the hip were obtained from 84 volunteers. Based on Kellgren/Lawrence (K/L) scoring of the radiographs, 54 subjects were classified as healthy controls (K/L grade ≤1) and 30 were classified as having mild or moderate radiographic hip OA (K/L grades 2 or 3, respectively). Two-dimensional fat-suppressed fast spin-echo MRI sequences were used for semiquantitative clinical scoring of cartilage defects, and a T1ρ/T2 sequence was used to quantitatively assess the cartilage matrix. The femoral and acetabular cartilage was then segmented into 8 regions and the mean T1ρ/T2 values were calculated. Differences in T1ρ and T2 relaxation times were compared between subjects with and those without radiographic hip OA, and those with and those without femoral or acetabular cartilage defects. RESULTS Higher T1ρ and T2 relaxation times in the anterior superior and central regions of the acetabular cartilage were seen in individuals with radiographic hip OA and those with acetabular cartilage defects compared to their respective controls (P < 0.05). In the femoral cartilage, the differences in T1ρ and T2 were not significant for any of the comparisons. Significant differences in the T1ρ and T2 values (each P < 0.05) were found in more subregions of the cartilage and across the whole cartilage when subjects were stratified based on the presence of MRI-detected cartilage defects than when they were stratified based on the presence of radiographic hip OA. CONCLUSION T1ρ and T2 relaxation parameters are sensitive to the presence of cartilage degeneration. Both parameters may therefore support MRI evidence of cartilage defects of the hip.
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Affiliation(s)
| | | | | | - Sonia Lee
- University of California, San Francisco
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10
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Current knowledge and importance of dGEMRIC techniques in diagnosis of hip joint diseases. Skeletal Radiol 2015; 44:1073-83. [PMID: 25913097 DOI: 10.1007/s00256-015-2135-3] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/20/2014] [Revised: 03/10/2015] [Accepted: 03/12/2015] [Indexed: 02/02/2023]
Abstract
Accurate assessment of early hip joint cartilage alterations may help optimize patient selection and follow-up of hip joint preservation surgery. Delayed gadolinium-enhanced magnetic resonance imaging of cartilage (dGEMRIC) is sensitive to the glycosaminoglycan content in cartilage that is lost early in the development of osteoarthritis (OA). Hence, the dGEMRIC technique holds promise for the development of new diagnostic and therapeutic procedures. However, because of the location of the hip joint deep within the body and due to the fairly thin cartilage layers that require high spatial resolution, the diagnosis of early hip joint cartilage alterations may be problematic. The purpose of this review is to outline the current status of dGEMRIC in the assessment of hip joint cartilage. A literature search was performed with PubMed, using the terms "cartilage, osteoarthritis, hip joint, MRI, and dGEMRIC", considering all levels of studies. This review revealed that dGEMRIC can be reliably used in the evaluation of early stage cartilage pathology in various hip joint disorders. Modifications in the technique, such as the operation of three-dimensional imaging and dGEMRIC after intra-articular contrast medium administration, have expanded the range of application. Notably, the studies differ considerably in patient selection and technical prerequisites. Furthermore, there is a need for multicenter prospective studies with the required technical conditions in place to establish outcome based dGEMRIC data to obtain, in conjunction with clinical data, reliable threshold values for normal and abnormal cartilage, and for hips that may benefit from conservative or surgical treatment.
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11
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Bittersohl B, Hosalkar HS, Hesper T, Tiderius CJ, Zilkens C, Krauspe R. Advanced Imaging in Femoroacetabular Impingement: Current State and Future Prospects. Front Surg 2015; 2:34. [PMID: 26258129 PMCID: PMC4513289 DOI: 10.3389/fsurg.2015.00034] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2015] [Accepted: 07/10/2015] [Indexed: 11/13/2022] Open
Abstract
Symptomatic femoroacetabular impingement (FAI) is now a known precursor of early osteoarthritis (OA) of the hip. In terms of clinical intervention, the decision between joint preservation and joint replacement hinges on the severity of articular cartilage degeneration. The exact threshold during the course of disease progression when the cartilage damage is irreparable remains elusive. The intention behind radiographic imaging is to accurately identify the morphology of osseous structural abnormalities and to accurately characterize the chondrolabral damage as much as possible. However, both plain radiographs and computed tomography (CT) are insensitive for articular cartilage anatomy and pathology. Advanced magnetic resonance imaging (MRI) techniques include magnetic resonance arthrography and biochemically sensitive techniques of delayed gadolinium-enhanced MRI of cartilage (dGEMRIC), T1rho (T1ρ), T2/T2* mapping, and several others. The diagnostic performance of these techniques to evaluate cartilage degeneration could improve the ability to predict an individual patient-specific outcome with non-surgical and surgical care. This review discusses the facts and current applications of biochemical MRI for hip joint cartilage assessment covering the roles of dGEMRIC, T2/T2*, and T1ρ mapping. The basics of each technique and their specific role in FAI assessment are outlined. Current limitations and potential pitfalls as well as future directions of biochemical imaging are also outlined.
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Affiliation(s)
- Bernd Bittersohl
- Department of Orthopedics, Medical Faculty, University Düsseldorf , Düsseldorf , Germany
| | - Harish S Hosalkar
- Center for Hip Preservation and Children's Orthopedics , San Diego, CA , USA
| | - Tobias Hesper
- Department of Orthopedics, Medical Faculty, University Düsseldorf , Düsseldorf , Germany
| | | | - Christoph Zilkens
- Department of Orthopedics, Medical Faculty, University Düsseldorf , Düsseldorf , Germany
| | - Rüdiger Krauspe
- Department of Orthopedics, Medical Faculty, University Düsseldorf , Düsseldorf , Germany
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12
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Siebelt M, Agricola R, Weinans H, Kim YJ. The role of imaging in early hip OA. Osteoarthritis Cartilage 2014; 22:1470-80. [PMID: 25278058 DOI: 10.1016/j.joca.2014.04.030] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/04/2014] [Revised: 04/17/2014] [Accepted: 04/29/2014] [Indexed: 02/02/2023]
Abstract
Hip osteoarthritis (OA) is characterized by cartilage degradation, subchondral bone sclerosis and osteophyte formation. Nowadays, OA is thought to develop via different etiologies that all lead to a similar form of end stage joint degradation. One of these subtypes is related to an abnormal shaped hip joint, like acetabular dysplasia and a cam deformity. These bony abnormalities are highly predictive for development of hip OA, but they are likely to already be present from childhood. This suggests that these deformations induce OA changes in the hip, well before extensive hip degradation becomes present three to four decades later. Accurate detection and successful characterization of these early OA events might lead to better treatment options for hip OA besides nowadays available invasive joint replacement surgery. However, current diagnostic imaging techniques like radiographs or plain magnetic resonance imaging (MRI), are not sensitive enough to detect these subtle early OA changes. Nor are they able to disentangle intertwined and overlapping cascades from different OA subtypes, and neither can they predict OA progression. New and more sensitive imaging techniques might enable us to detect first OA changes on a cellular level, providing us with new opportunities for early intervention. In this respect, shape analysis using radiography, MRI, computed tomography (CT), single photon emission computed tomography (SPECT)/CT, and positron emission tomography (PET) might prove promising techniques and be more suited to detect early pathological changes in the hip joint. A broad application of these techniques might give us more understanding what can be considered physiological adaptation of the hip, or when early OA really starts. With a more clear definition of early OA, more homogenous patient populations can be selected and help with the development of new disease modifying OA interventions.
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Affiliation(s)
- M Siebelt
- Department of Orthopaedics, Orthopaedic Research Laboratory, Erasmus MC, The Netherlands
| | - R Agricola
- Department of Orthopaedics, Orthopaedic Research Laboratory, Erasmus MC, The Netherlands
| | - H Weinans
- Department of Orthopaedics & Dept. Rheumatology, UMC Utrecht, The Netherlands; Department of Biomechanical Engineering, Delft University of Technology, Delft, The Netherlands.
| | - Y J Kim
- Department of Orthopaedic Surgery, Boston Children's Hospital, USA
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13
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Zilkens C, Miese F, Kim YJ, Jäger M, Mamisch TC, Hosalkar H, Antoch G, Krauspe R, Bittersohl B. Direct comparison of intra-articular versus intravenous delayed gadolinium-enhanced MRI of hip joint cartilage. J Magn Reson Imaging 2013; 39:94-102. [DOI: 10.1002/jmri.24096] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2012] [Accepted: 02/05/2013] [Indexed: 11/11/2022] Open
Affiliation(s)
- Christoph Zilkens
- Univ Dusseldorf; Medical Faculty; Department of Orthopedic Surgery; D-40225 Dusseldorf Germany
| | - Falk Miese
- Univ Dusseldorf; Medical Faculty; Department of Diagnostic and Interventional Radiology; D-40225 Dusseldorf Germany
| | - Young-Jo Kim
- Department of Orthopedic Surgery; The Children's Hospital Boston; Boston Massachusetts USA
| | - Marcus Jäger
- Univ of Essen; Medical Faculty; Department of Orthopedic Surgery; D-40225 Essen Germany
| | - Tallal C. Mamisch
- Department of Orthopedic Surgery; The Children's Hospital Boston; Boston Massachusetts USA
| | - Harish Hosalkar
- Department of Orthopedic Surgery; Radys Childrens Hospital San Diego; USA
| | - Gerald Antoch
- Univ Dusseldorf; Medical Faculty; Department of Diagnostic and Interventional Radiology; D-40225 Dusseldorf Germany
| | - Rüdiger Krauspe
- Univ Dusseldorf; Medical Faculty; Department of Orthopedic Surgery; D-40225 Dusseldorf Germany
| | - Bernd Bittersohl
- Univ Dusseldorf; Medical Faculty; Department of Orthopedic Surgery; D-40225 Dusseldorf Germany
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14
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Smith TO, Simpson M, Ejindu V, Hing CB. The diagnostic test accuracy of magnetic resonance imaging, magnetic resonance arthrography and computer tomography in the detection of chondral lesions of the hip. EUROPEAN JOURNAL OF ORTHOPAEDIC SURGERY AND TRAUMATOLOGY 2012; 23:335-44. [DOI: 10.1007/s00590-012-0972-5] [Citation(s) in RCA: 40] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/19/2011] [Accepted: 03/13/2012] [Indexed: 11/24/2022]
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15
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Zilkens C, Miese F, Jäger M, Bittersohl B, Krauspe R. Magnetic resonance imaging of hip joint cartilage and labrum. Orthop Rev (Pavia) 2011; 3:e9. [PMID: 22053256 PMCID: PMC3206516 DOI: 10.4081/or.2011.e9] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/27/2011] [Accepted: 06/10/2011] [Indexed: 11/23/2022] Open
Abstract
Hip joint instability and impingement are the most common biomechanical risk factors that put the hip joint at risk to develop premature osteoarthritis. Several surgical procedures like periacetabular osteotomy for hip dysplasia or hip arthroscopy or safe surgical hip dislocation for femoroacetabular impingement aim at restoring the hip anatomy. However, the success of joint preserving surgical procedures is limited by the amount of pre-existing cartilage damage. Biochemically sensitive MRI techniques like delayed Gadolinium Enhanced MRI of Cartilage (dGEMRIC) might help to monitor the effect of surgical or non-surgical procedures in the effort to halt or even reverse joint damage.
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Affiliation(s)
- Christoph Zilkens
- Department of Orthopaedic Surgery, University Hospital of Düsseldorf, Germany
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16
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Bittersohl B, Zilkens C, Kim YJ, Werlen S, Siebenrock KA, Mamisch TC, Hosalkar HS. Delayed gadolinium-enhanced magnetic resonance imaging of hip joint cartilage: pearls and pitfalls. Orthop Rev (Pavia) 2011; 3:e11. [PMID: 22053252 PMCID: PMC3206513 DOI: 10.4081/or.2011.e11] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/18/2011] [Accepted: 08/31/2011] [Indexed: 11/23/2022] Open
Abstract
With the increasing advances in hip joint preservation surgery, accurate diagnosis and assessment of femoral head and acetabular cartilage status is becoming increasingly important. Magnetic resonance imaging (MRI) of the hip does present technical difficulties. The fairly thin cartilage lining necessitates high image resolution and high contrast-to-noise ratio (CNR). With MR arthrography (MRA) using intraarticular injected gadolinium, labral tears and cartilage clefts may be better identified through the contrast medium filling into the clefts. However, the ability of MRA to detect varying grades of cartilage damage is fairly limited and early histological and biochemical changes in the beginning of osteoarthritis (OA) cannot be accurately delineated. Traditional MRI thus lacks the ability to analyze the biological status of cartilage degeneration. The technique of delayed gadolinium-enhanced MRI of cartilage (dGEMRIC) is sensitive to the charge density of cartilage contributed by glycosaminoglycans (GAGs), which are lost early in the process of OA. Therefore, the dGEMRIC technique has a potential to detect early cartilage damage that is obviously critical for decision-making regarding time and extent of intervention for joint-preservation. In the last decade, cartilage imaging with dGEMRIC has been established as an accurate and reliable tool for assessment of cartilage status in the knee and hip joint.This review outlines the current status of dGEMRIC for assessment of hip joint cartilage. Practical modifications of the standard technique including three-dimensional (3D) dGEMRIC and dGEMRIC after intra-articular gadolinium instead of iv-dGEMRIC will also be addressed.
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Affiliation(s)
- Bernd Bittersohl
- Department of Orthopedic Surgery, Inselspital, Bern, Switzerland
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