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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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Rogers MJ, Adeyemi TF, Kim J, Maak TG. Understanding Preoperative Demographics and Risk Factors for Early Revision Surgery in Patients Undergoing Hip Arthroscopic Surgery: A Large Database Study. Orthop J Sports Med 2019; 7:2325967119849579. [PMID: 31263723 PMCID: PMC6595673 DOI: 10.1177/2325967119849579] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
BACKGROUND Hip arthroscopic surgery has become an increasingly common surgical technique to diagnose and treat various hip abnormalities. While increased efficacy has been reported, debate remains regarding appropriate surgical indications. Multiple factors including patient demographics, surgical procedure, and underlying disease have been associated with poor surgical outcomes. Preoperative diagnostic and treatment interventions including physical therapy and injections may affect surgical indications and outcomes. PURPOSE To identify patient characteristics and preoperative factors associated with an increased risk of early revision surgery and/or extended postoperative medical care after index hip arthroscopic surgery. STUDY DESIGN Case-control study; Level of evidence, 3. METHODS Utah's All Payer Claims Database, a state-mandated registry containing data from all payers, including private insurance, Medicare Advantage, and Medicaid, was queried to identify patients who underwent hip arthroscopic surgery during a 3-year period (January 1, 2013, to December 31, 2015). Demographics, comorbidities, nonoperative care modalities, pain medications, and revision procedures were collected using claims data at 6 months preoperatively and 12 months postoperatively. RESULTS A total of 1283 patients who underwent primary hip arthroscopic surgery were analyzed, of whom 57.6% (n = 739) were female. Within 1 year of index surgery, 7.8% and 2.1% of patients underwent revision hip arthroscopic surgery and conversion to total hip arthroplasty (THA), respectively. Patients older than 60 years and male patients were more likely to undergo revision arthroscopic surgery (odds ratio [OR], 0.89; P < .001 and OR, 1.59; P = .04, respectively) and convert to THA (OR, 1.03; P = .01 and OR, 2.25; P = .05, respectively). Preoperative opioid use was significantly associated with increased odds of revision surgery (OR, 1.64; P = .05) and THA (OR, 2.70; P = .03). No significant relationship existed between preoperative physical therapy or intra-articular hip injections and revision hip arthroscopic surgery (OR, 1.20; P = .45 and OR, 1.18; P = .52, respectively) or conversion to THA (OR, 0.89; P = .79 and OR, 0.71; P = .46, respectively). CONCLUSION This study showed that predictable patient factors can effectively guide preoperative decision making and may improve prognosis. Certain patient pools require optimization preoperatively, and a subset of patients appears to require additional surgical indications.
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Affiliation(s)
- Miranda J. Rogers
- Department of Orthopaedic Surgery, University Orthopaedic Center, University of Utah, Salt Lake City, Utah, USA
| | - Temitope F. Adeyemi
- Department of Orthopaedic Surgery, University Orthopaedic Center, University of Utah, Salt Lake City, Utah, USA
| | - Jaewhan Kim
- Department of Physical Therapy and Athletic Training, University of Utah, Salt Lake City, Utah, USA
| | - Travis G. Maak
- Department of Orthopaedic Surgery, University Orthopaedic Center, University of Utah, Salt Lake City, Utah, USA
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Leopold SS. Editorial Comment: The Bernese Hip Symposium and CORR®-Sharing the Latest and Best in Hip Surgery Research. Clin Orthop Relat Res 2019; 477:960-961. [PMID: 30998627 PMCID: PMC6494327 DOI: 10.1097/corr.0000000000000759] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
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Abstract
BACKGROUND The management of asymptomatic individuals with cam femoral morphology that predisposes their hips to femoroacetabular impingement has received little attention. Such hips may have subclinical articular damage; however, whether this cartilage damage will progress is unknown as is whether any particular bone morphologies are associated with this progression. Such knowledge could help determine the natural history and guide management of such individuals. QUESTIONS/PURPOSES The purpose of this study was to determine whether (1) asymptomatic hips with cam morphology are at risk of further cartilage degeneration (as evaluated by T1ρ); (2) T1ρ changes are predictive of symptom onset; and (3) bony morphologic parameters are associated with T1ρ signal changes. METHODS In a prospective, longitudinal study, 17 asymptomatic volunteers/hips (16 men; 33 ± 6 years) with cam morphology underwent two T1ρ MRI scans and functional assessment (WOMAC) at recruitment and at 4 years (range, 2-6 years). Volunteers were recruited from a previous study, which reported on the prevalence of cam morphology among asymptomatic individuals using hip MRI; cam morphology was defined as an α angle ≥ 60° anterolaterally and/or ≥ 50.5° anteriorly relative to the neck axis. The differences in T1ρ values (ΔT1ρ) and relative differences (%ΔT1ρ) were calculated as: ΔT1ρ = T1ρFollowup - T1ρInitial and %ΔT1ρ = ΔT1ρ/T1ρInitial. A %ΔT1ρ > 17.6% was considered clinically important. Using CT data, femoral, acetabular, and spinopelvic parameters were measured. Whether ΔT1ρ and/or %ΔT1ρ was associated with any of the bone morphologic parameters was tested using Spearman's correlation coefficient. RESULTS The global T1ρ in these asymptomatic hips with cam morphology remained unchanged between initial (mean, 35 ± 5 ms) and followup scans (mean, 34 ± 3 ms; p = 0.518). No differences with the numbers available in T1ρ values were seen initially between the anterolateral and posterolateral (34 ± 6 ms versus 33 ± 4 ms; p = 0.734) regions; at followup, T1 values were higher posterolaterally (36 ± 5 ms versus 32 ± 5 ms; p = 0.031). The mean global ΔT1ρ was 1 ± 5 ms (95% confidence interval, -1 to +3 ms) and the mean global %ΔT1ρ was 2% ± 13%. Two volunteers reported lower WOMAC scores; one patient exhibited a clinically important increase in %ΔT1ρ (-26%). The degree of acetabular coverage correlated with %ΔT1ρ (rho = 0.59-0.61, p = 0.002); the lesser the acetabular coverage anterolaterally, the greater the corresponding area's T1ρ at followup. CONCLUSIONS Although signs of posterolateral joint degeneration were detected, these were not generally associated with symptoms, and only one of the two volunteers with the onset of symptoms had a clinically important increase in %ΔT1ρ. We found that reduced acetabular coverage may increase the likelihood that preclinical cartilage degeneration will arise within 2 to 6 years; thereby reduced acetabular coverage should be considered when stratifying asymptomatic hips at risk of degeneration. Future studies should be performed with a larger cohort and include femoral version among the parameters studied. LEVEL OF EVIDENCE Level II, diagnostic study.
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Beaulé PE, Speirs AD, Anwander H, Melkus G, Rakhra K, Frei H, Lamontagne M. Surgical Correction of Cam Deformity in Association with Femoroacetabular Impingement and Its Impact on the Degenerative Process within the Hip Joint. J Bone Joint Surg Am 2017; 99:1373-1381. [PMID: 28816897 DOI: 10.2106/jbjs.16.00415] [Citation(s) in RCA: 40] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
BACKGROUND Cam morphology in association with femoroacetabular impingement (FAI) is a recognized cause of hip pain and cartilage damage and proposed as a leading cause of arthritis. The purpose of this study was to analyze the functional and biomechanical effects of the surgical correction of the cam deformity on the degenerative process associated with FAI. METHODS Ten male patients with a mean age of 34.3 years (range, 23.1 to 46.5 years) and a mean body mass index (and standard deviation) of 26.66 ± 4.79 kg/m underwent corrective surgery for cam deformity in association with FAI. Each patient underwent a computed tomography (CT) scan to assess acetabular bone mineral density (BMD), high-resolution T1ρ magnetic resonance imaging (MRI) of the hips to assess proteoglycan content, and squatting motion analysis as well as completed self-administered functional questionnaires (Hip disability and Osteoarthritis Outcome Score [HOOS]) both preoperatively and 2 years postoperatively. RESULTS At a mean follow-up of 24.5 months, improvements in functional scores and squat performance were seen. Regarding the zone of impingement in the anterosuperior quadrant of the acetabular rim, the mean change in BMD at the time of follow-up was -31.8 mg/cc (95% confidence interval [CI], -11 to -53 mg/cc) (p = 0.008), representing a 5% decrease in BMD. The anterosuperior quadrant also demonstrated a significant decrease in T1ρ values, reflecting a stabilization of the cartilage degeneration. Significant correlations were noted between changes in clinical functional scores and changes in T1ρ values (r = -0.86; p = 0.003) as well as between the BMD and maximum vertical force (r = 0.878; p = 0.021). CONCLUSIONS Surgical correction of a cam deformity in patients with symptomatic FAI not only improved clinical function but was also associated with decreases in T1ρ values and BMD. These findings are the first, to our knowledge, to show that alteration of the hip biomechanics through surgical intervention improves the overall health of the hip joint. LEVEL OF EVIDENCE Therapeutic Level IV. See Instructions for Authors for a complete description of levels of evidence.
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Affiliation(s)
- Paul E Beaulé
- 1Division of Orthopaedic Surgery (P.E.B. and H.A.) and Department of Medical Imaging (G.M. and K.R.), The Ottawa Hospital, Ottawa, Ontario, Canada 2Department of Mechanical and Aerospace Engineering, Carleton University, Ottawa, Ontario, Canada 3School of Human Kinetics and Department of Mechanical Engineering, University of Ottawa, Ottawa, Ontario, Canada
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Nemeth A, Marco L, Boutitie F, Sdika M, Grenier D, Rabilloud M, Beuf O, Pialat J. Reproducibility of in vivo magnetic resonance imaging T
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rho and T
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relaxation time measurements of hip cartilage at 3.0T in healthy volunteers. J Magn Reson Imaging 2017. [DOI: 10.1002/jmri.25799] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022] Open
Affiliation(s)
- Angeline Nemeth
- Univ Lyon, INSA‐Lyon, Université Claude Bernard Lyon 1, UJM‐Saint Etienne, CNRS, Inserm, CREATIS, UMR 5220, U1206, F‐69616Villeurbanne France
| | - Lucy Marco
- Univ Lyon, INSA‐Lyon, Université Claude Bernard Lyon 1, UJM‐Saint Etienne, CNRS, Inserm, CREATIS, UMR 5220, U1206, F‐69616Villeurbanne France
- Radiologie et Imagerie médicale diagnostique et thérapeutique, Hôpital François MitterrandDijon France
| | - Florent Boutitie
- Hospices Civils de Lyon, Service de Biostatistique et Bioinformatique, Lyon, France; Université de Lyon, Lyon, France; Université Lyon 1, Villeurbanne, France; CNRS, UMR 5558, Laboratoire de Biométrie et Biologie Evolutive, Equipe Biostatistique‐SantéVilleurbanne France
| | - Michael Sdika
- Univ Lyon, INSA‐Lyon, Université Claude Bernard Lyon 1, UJM‐Saint Etienne, CNRS, Inserm, CREATIS, UMR 5220, U1206, F‐69616Villeurbanne France
| | - Denis Grenier
- Univ Lyon, INSA‐Lyon, Université Claude Bernard Lyon 1, UJM‐Saint Etienne, CNRS, Inserm, CREATIS, UMR 5220, U1206, F‐69616Villeurbanne France
| | - Muriel Rabilloud
- Hospices Civils de Lyon, Service de Biostatistique et Bioinformatique, Lyon, France; Université de Lyon, Lyon, France; Université Lyon 1, Villeurbanne, France; CNRS, UMR 5558, Laboratoire de Biométrie et Biologie Evolutive, Equipe Biostatistique‐SantéVilleurbanne France
| | - Olivier Beuf
- Univ Lyon, INSA‐Lyon, Université Claude Bernard Lyon 1, UJM‐Saint Etienne, CNRS, Inserm, CREATIS, UMR 5220, U1206, F‐69616Villeurbanne France
| | - Jean‐Baptiste Pialat
- Service de Radiologie, Centre Hospitalier Lyon‐Sud, Hospices Civils de Lyon, INSERM U1033 et Université Lyon 1Lyon France
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T1ρ Hip Cartilage Mapping in Assessing Patients With Cam Morphology: How Can We Optimize the Regions of Interest? Clin Orthop Relat Res 2017; 475:1066-1075. [PMID: 27506970 PMCID: PMC5339114 DOI: 10.1007/s11999-016-5011-0] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
BACKGROUND T1ρ MRI has been shown feasible to detect the biochemical status of hip cartilage, but various region-of-interest strategies have been used, compromising the reproducibility and comparability between different institutions and studies. QUESTIONS/PURPOSES The purposes of this study were (1) to determine representative regions of interest (ROIs) for cartilage T1ρ mapping in hips with a cam deformity; and (2) to assess intra- and interobserver reliability for cartilage T1ρ mapping in hips with a cam deformity. METHODS The local ethics committee approved this prospective study with written informed consent obtained. Between 2010 and 2013, in 54 hips (54 patients), T1ρ 1.5-T MRI was performed. Thirty-eight hips (38 patients; 89% male) with an average age of 35 ± 7.5 years (range, 23-51 tears) were diagnosed with a cam deformity; 16 hips (16 patients; 87% male) with an average age of 34 ± 7 years (range, 23-47 years) were included in the control group. Of the 38 patients with a cam deformity, 20 were pain-free and 18 symptomatic patients underwent surgery after 6 months of failed nonsurgical management of antiinflammatories and physical therapy. Exclusion criteria were radiologic sings of osteoarthritis with Tönnis Grade 2 or higher as well as previous hip surgery. Three region-of-interest (ROI) selections were analyzed: Method 1: as a whole; Method 2: as 36 to 54 small ROIs (sections of 30° in the sagittal plane and 3 mm in the transverse plane); Method 3a: as six ROIs (sections of 90° in the sagittal plane and one-third of the acetabular depth in the transverse plane: the anterosuperior and posterosuperior quadrants, divided into lateral, intermediate, and medial thirds); and Method 3b: as the ratio (anterosuperior over posterosuperior quadrant). ROIs in Method 3 represent the region of macroscopic cartilage damage, described in intraoperative findings. To asses interobserver reliability, 10 patients were analyzed by two observers (HA, GM). For intraobserver reliability, 20 hip MRIs were analyzed twice by one observer (HA). To assess interscan reliability, three patients underwent two scans within a time period of 2 weeks and were analyzed twice by one observer (HA). T1ρ values were compared using Student's t test. Interclass correlation coefficient (ICC) and root mean square coefficient of variation (RMS-CV) were used to analyze intraobserver, interobserver, and interscan reliability. RESULTS Patients with a cam deformity showed increased T1ρ values in the whole hip cartilage (mean: 34.0 ± 3.8 ms versus 31.4 ± 3.0 ms; mean difference: 2.5; 95% confidence interval [CI], 4.7-0.4; p = 0.019; Method 1), mainly anterolateral (2), in the lateral and medial thirds of the anterosuperior quadrant (mean: 32.3 ± 4.9 ms versus 29.4 ± 4.1 ms; mean difference: 3.0; 95% CI, 5.8-0.2; p = 0.039 and mean 36.5 ± 5.6 ms versus 32.6 ± 3.8 ms; mean difference: 3.8; 95% CI, 6.9-0.8; p = 0.014), and in the medial third of the posterosuperior quadrant (mean: 34.4 ± 5.5 ms versus 31.1 ± 3.9 ms; mean difference: 3.1; 95% CI, 6.2-0.1; p = 0.039) (3a). The ratio was increased in the lateral third (mean: 1.00 ± 0.12 versus 0.90 ± 0.15; mean difference: 0.10; 95% CI, 0.18-0.2; p = 0.018) (3b). ICC and RMS-CV were 0.965 and 4% (intraobserver), 0.953 and 4% (interobserver), and 0.988 (all p < 0.001) and 9% (inter-MR scan), respectively. CONCLUSIONS Cartilage T1ρ MRI mapping in hips is feasible at 1.5 T with strong inter-, intraobserver, and inter-MR scan reliability. The six ROIs (Method 3) showed a difference of T1ρ values anterolateral quadrant, consistent with the dominant area of cartilage injury in cam femoroacetabular impingement, and antero- and posteromedial, indicating involvement of the entire hip cartilage health. The six ROIs (Method 3) have been shown feasible to assess cartilage damage in hips with a cam deformity using T1ρ MRI. We suggest applying this ROI selection for further studies using quantitative MRI for assessment of cartilage damage in hips with a cam deformity to achieve better comparability and reproducibility between different studies. The application of this ROI selection on hips with other deformities (eg, pincer deformity, developmental dysplasia of the hip, and acetabular retroversion) has to be analyzed and potentially adapted. LEVEL OF EVIDENCE Level III, diagnostic study.
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Pascual-Garrido C, Hao J, Schrock J, Mei-Dan O, Chahla J. Arthroscopic Juvenile Allograft Cartilage Implantation for Cartilage Lesions of the Hip. Arthrosc Tech 2016; 5:e929-e933. [PMID: 27709060 PMCID: PMC5040603 DOI: 10.1016/j.eats.2016.04.018] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/09/2016] [Accepted: 04/20/2016] [Indexed: 02/03/2023] Open
Abstract
Cartilage lesions in the hip are of high prevalence. Most of these lesions are treated with microfracture. Microfracture has relatively good subjective outcomes for smaller lesions; however, it is limited by the ability to reproduce hyaline cartilage, especially in older patients. For larger chondral defects, we present a technique using juvenile allograft cartilage implantation implanted arthroscopically to treat cartilage lesions in the hip. The purpose of this technical note is to describe the arthroscopic technique for treating chondral lesions in the hip with allograft juvenile cartilage.
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Affiliation(s)
- Cecilia Pascual-Garrido
- Department of Orthopedics, University of Colorado, Aurora, Colorado, U.S.A.,Address correspondence to Cecilia Pascual-Garrido, M.D., Assistant Professor, Department of Orthopedics, University of Colorado, University of Colorado Hospital–Anschutz Outpatient Pavilion, 1635 N. Aurora Court, Aurora, CO 80045, U.S.A.Department of OrthopedicsUniversity of ColoradoUniversity of Colorado Hospital–Anschutz Outpatient Pavilion1635 N. Aurora CourtAuroraCO80045U.S.A.
| | - Jiandong Hao
- Department of Orthopedics, University of Colorado, Aurora, Colorado, U.S.A
| | - John Schrock
- Department of Orthopedics, University of Colorado, Aurora, Colorado, U.S.A
| | - Omer Mei-Dan
- Department of Orthopedics, University of Colorado, Aurora, Colorado, U.S.A
| | - Jorge Chahla
- Steadman Philippon Research Institute, Vail, Colorado, U.S.A
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Anwander H, Melkus G, Rakhra KS, Beaulé PE. T1ρ MRI detects cartilage damage in asymptomatic individuals with a cam deformity. J Orthop Res 2016; 34:1004-9. [PMID: 26573964 DOI: 10.1002/jor.23101] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/10/2015] [Accepted: 11/03/2015] [Indexed: 02/04/2023]
Abstract
Hips with a cam deformity are at risk for early cartilage degeneration, mainly in the anterolateral region of the joint. T1ρ MRI is a described technique for assessment of proteoglycan content in hyaline cartilage and subsequently early cartilage damage. In this study, 1.5 Tesla T1ρ MRI was performed on 20 asymptomatic hips with a cam deformity and compared to 16 healthy control hips. Cam deformity was defined as an alpha angle at 1:30 o'clock position over 60° and/or at 3:00 o'clock position over 50.5°. Hip cartilage was segmented and divided into four regions of interest (ROIs): anterolateral, anteromedial, posterolateral, and posteromedial quadrants. Mean T1ρ value of the entire weight bearing cartilage in hips with a cam deformity (34.0 ± 4.6 ms) was significantly higher compared to control hips (31.3 ± 3.2 ms, p = 0.050). This difference reached significance in the anterolateral (p = 0.042) and posteromedial quadrants (p = 0.041). No significant correlation between the alpha angle and T1ρ values was detected. The results indicate cartilage damage occurs in hips with a cam deformity before symptoms occur. A significant difference in T1ρ values was found in the anterolateral quadrant, the area of direct engagement of the deformity, and in the posteromedial quadrant. To conclude, T1ρ MRI can detect early chondral damage in asymptomatic hips with a cam deformity. © 2015 Orthopaedic Research Society. Published by Wiley Periodicals, Inc. J Orthop Res 34:1004-1009, 2016.
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Affiliation(s)
- Helen Anwander
- Division of Orthopaedic Surgery, The Ottawa Hospital, Ottawa, Canada
| | - Gerd Melkus
- Department of Medical Imaging, The Ottawa Hospital, Ottawa, Canada.,Department of Radiology, Faculty of Medicine, University of Ottawa, Ottawa, Canada
| | - Kawan S Rakhra
- Department of Medical Imaging, The Ottawa Hospital, Ottawa, Canada.,Department of Radiology, Faculty of Medicine, University of Ottawa, Ottawa, Canada
| | - Paul E Beaulé
- Division of Orthopaedic Surgery, The Ottawa Hospital, Ottawa, Canada.,Faculty of Medicine, University of Ottawa, Ottawa, Canada
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Schleich C, Bittersohl B, Miese F, Schmitt B, Müller-Lutz A, Sondern M, Antoch G, Krauspe R, Zilkens C. Glycosaminoglycan chemical exchange saturation transfer at 3T MRI in asymptomatic knee joints. Acta Radiol 2016; 57:627-32. [PMID: 26253931 DOI: 10.1177/0284185115598811] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2015] [Accepted: 07/12/2015] [Indexed: 12/27/2022]
Abstract
BACKGROUND Biochemical alterations such as glycosaminoglycan (GAG) depletion occur early in the course of osteoarthritis, but cannot be detected with standard magnetic resonance techniques. With glycosaminoglycan chemical exchange saturation transfer (gagCEST), a biochemical imaging technique, it is feasible to detect biochemical components in knee joint cartilage. PURPOSE To establish baseline values for gagCEST magnetic resonance imaging (MRI) in knee joint cartilage at 3 Tesla (T). MATERIAL AND METHODS Twenty volunteers (8 women, 12 men; mean age, 24.55 ± 2.35 years;age range, 21-29 years) with no history or clinical findings indicative of knee joint pathologies underwent MRI at 3T. The imaging protocol included three-dimensional (3D) double-echo steady-state sequence for morphological cartilage assessment and a prototype 3D CEST pulse sequence to evaluate the CEST effects in six cartilage regions of the knee joint: (i) lateral femoral condyle; (ii) medial femoral condyle; (iii) lateral tibial plateau; (iv) medial tibial plateau; (v) patella; and (vi) trochlea. We used the asymmetry of the magnetization transfer ratio (MTRasym) parameter to quantify the gagCEST effects in these regions. RESULTS Regional differences revealed high MTRasym values in the patellar (1.62% ± 1.19%) and the trochlear (1.17% ± 1.29%) cartilages, and low MTRasym values in the medial femoral condyle (0.41% ± 0.58%) and the lateral tibial plateau (0.52% ± 0.53%) cartilages. CONCLUSION Regional differences in the gagCEST values must be considered when conducting gagCEST imaging of knee joint cartilage. In the future gagCEST imaging may be an additional feature in the evaluation of the biochemical composition of knee joint cartilage.
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Affiliation(s)
- Christoph Schleich
- University Düsseldorf, Medical Faculty, Department of Diagnostic and Interventional Radiology, Düsseldorf, Germany
| | - Bernd Bittersohl
- University Düsseldorf, Medical Faculty, Department of Orthopedics, Düsseldorf, Germany
| | - Falk Miese
- University Düsseldorf, Medical Faculty, Department of Diagnostic and Interventional Radiology, Düsseldorf, Germany
| | - Benjamin Schmitt
- Siemens Ltd. Australia, Healthcare Sector, Macquarie Park, NSW, Australia
| | - Anja Müller-Lutz
- University Düsseldorf, Medical Faculty, Department of Diagnostic and Interventional Radiology, Düsseldorf, Germany
| | - Malte Sondern
- University Düsseldorf, Medical Faculty, Department of Orthopedics, Düsseldorf, Germany
| | - Gerald Antoch
- University Düsseldorf, Medical Faculty, Department of Diagnostic and Interventional Radiology, Düsseldorf, Germany
| | - Rüdiger Krauspe
- University Düsseldorf, Medical Faculty, Department of Orthopedics, Düsseldorf, Germany
| | - Christoph Zilkens
- University Düsseldorf, Medical Faculty, Department of Orthopedics, Düsseldorf, Germany
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Abstract
OBJECTIVE Imaging of hip cartilage is challenging because of its limited thickness and complex geometry and therefore requires advanced MRI techniques. However, cartilage abnormalities are found in a number of disease entities, and their diagnosis may impact patient management. This article will provide pertinent information about the motivation to image hip cartilage, which imaging techniques to use, and how to analyze cartilage; finally, we will discuss disease entities with regional cartilage lesions, including the typical MRI findings. CONCLUSION Because the detection and quantification of regional cartilage abnormalities are critical for guidance of operative and nonoperative management of hip disorders, radiologists should be familiar with imaging and analysis techniques for assessing hip cartilage.
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12
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Abstract
Hip pain is common in all age groups, and osteoarthritis of this joint is an increasingly recognized problem particularly in aging populations. One of the primary goals in the diagnostic evaluation in patients with hip pain is to identify and correct pathologies that could progress to osteoarthritis. Magnetic resonance imaging (MRI) has become an important noninvasive method for characterizing hip anatomy and pathology in these patients. Improvements in MRI hardware and techniques have allowed high spatial and contrast resolution imaging to detect subtle abnormalities, such as acetabular labral and articular cartilage injuries, which often contribute to patient symptoms. Newer MRI techniques, such as delayed gadolinium-enhanced MRI of cartilage and T2 mapping, can give insight into the biochemical structure of tissues such as the articular cartilage. In turn, these can allow quantitative assessment and enable imagers to more directly compare the findings of patients at earlier stages of disease. It is important to understand the fundamental principles of various MRI techniques and their limitations to know when these techniques can best be applied. In addition, understanding of normal hip anatomy and common anatomic variants is useful for being able to accurately detect and localize areas of pathology and to prevent misinterpreting normal structures as diseased. The aims of this work were to briefly review normal hip anatomy and common anatomic variants seen on routine MRI examination, to discuss principles often used in high-resolution hip MRI and newer techniques for biochemical evaluation, and to examine several intra-articular pathologic conditions of the hip joint that are of current clinical interest.
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Affiliation(s)
- Imran M Omar
- From the Department of Radiology, Northwestern University Feinberg School of Medicine, Chicago, IL
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Is the contralateral hip at risk in patients with unilateral symptomatic cam femoroacetabular impingement? A quantitative T1ρ MRI study. Osteoarthritis Cartilage 2015; 23:1337-42. [PMID: 25819578 DOI: 10.1016/j.joca.2015.03.018] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/12/2014] [Revised: 02/11/2015] [Accepted: 03/15/2015] [Indexed: 02/02/2023]
Abstract
OBJECTIVES To assess the profile of weight-bearing cartilage of hips with a cam deformity using T1ρ magnetic resonance imaging (MRI) and evaluate for a side-to-side difference in the T1ρ profile of patients with bilateral cam morphology but only unilateral hip pain. METHODS 19 patients with bilateral cam morphology undergoing osteochondroplasty for unilateral hip pain were prospectively recruited. Anterior and anterosuperior alpha angles were measured using computer tomography. All patients underwent bilateral 1.5T T1ρ MRI. The cartilage bilayer of the hip joint was evaluated and the mean T1ρ relaxation time calculated for each quadrant of the weight-bearing surface. RESULTS Mean T1ρ relaxation times were not significantly different when each quadrant was compared to the rest of the weight-bearing surface of the symptomatic (P = 0.068) and asymptomatic hips (P = 0.102). There was also no significant side-to-side difference between the same quadrants of symptomatic and asymptomatic hips. No correlation was detected between alpha angle and the mean T1ρ relaxation time in each quadrant. There was no significant difference in mean alpha angles between the symptomatic and asymptomatic sides at the anterior (54.2 vs 56.0°; P = 0.382) and anterosuperior positions (65.1 vs 65.2°; P = 0.971). CONCLUSION We conclude that previously observed regional variation in T1ρ values of normal hips is altered in hips with cam morphology. No difference in T1ρ values between symptomatic and asymptomatic cam hips was demonstrated. Therefore, regardless of the presence of hip pain, a cam deformity may predispose to hip joint cartilage degradation and increase the risk of hip osteoarthritis.
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