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Murphy NJ, Eyles J, Spiers L, Davidson EJ, Linklater JM, Kim YJ, Hunter DJ. Combined femoral and acetabular version and synovitis are associated with dGEMRIC scores in people with femoroacetabular impingement (FAI) syndrome. J Orthop Res 2023; 41:2484-2494. [PMID: 37032588 PMCID: PMC10946968 DOI: 10.1002/jor.25568] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/08/2022] [Revised: 03/20/2023] [Accepted: 03/29/2023] [Indexed: 04/11/2023]
Abstract
This study sought to explore, in people with symptoms, signs and imaging findings of femoroacetabular impingement (FAI syndrome): (1) whether more severe labral damage, synovitis, bone marrow lesions, or subchondral cysts assessed on magnetic resonance imaging (MRI) were associated with poorer cartilage health, and (2) whether abnormal femoral, acetabular, and/or combined femoral and acetabular versions were associated with poorer cartilage health. This cross-sectional study used baseline data from the 50 participants with FAI syndrome in the Australian FASHIoN trial (ACTRN12615001177549) with available dGEMRIC scans. Cartilage health was measured using delayed gadolinium-enhanced MRI of cartilage (dGEMRIC) score sampled at the chondrolabral junction on three midsagittal slices, at one acetabular and one femoral head region of interest on each slice, and MRI features were assessed using the Hip Osteoarthritis MRI Score. Analyses were adjusted for alpha angle and body mass index, which are known to affect dGEMRIC score. Linear regression assessed the relationship with the dGEMRIC score of (i) selected MRI features, and (ii) femoral, acetabular, and combined femoral and acetabular versions. Hips with more severe synovitis had worse dGEMRIC scores (partial η2 = 0.167, p = 0.020), whereas other MRI features were not associated. A lower combined femoral and acetabular version was associated with a better dGEMRIC score (partial η2 = 0.164, p = 0.021), whereas isolated measures of femoral and acetabular version were not associated. In conclusion, worse synovitis was associated with poorer cartilage health, suggesting synovium and cartilage may be linked to the pathogenesis of FAI syndrome. A lower combined femoral and acetabular version appears to be protective of cartilage health at the chondrolabral junction.
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Affiliation(s)
- Nicholas J. Murphy
- The University of Sydney, Sydney Musculoskeletal Health and the Kolling InstituteFaculty of Medicine and Health and the Northern Sydney Local Health DistrictSydneyAustralia
- Department of Orthopaedic SurgeryJohn Hunter HospitalNew Lambton HeightsAustralia
| | - Jillian Eyles
- The University of Sydney, Sydney Musculoskeletal Health and the Kolling InstituteFaculty of Medicine and Health and the Northern Sydney Local Health DistrictSydneyAustralia
- Department of RheumatologyRoyal North Shore HospitalSt LeonardsAustralia
| | - Libby Spiers
- Department of Physiotherapy, Centre for Health, Exercise and Sports MedicineUniversity of MelbourneMelbourneAustralia
| | - Emily J. Davidson
- Department of RadiologyRoyal Prince Alfred HospitalSydneyNew South WalesAustralia
| | | | - Young Jo Kim
- Department of Orthopedic SurgeryBoston Children's HospitalBostonMassachusettsUSA
| | - David J. Hunter
- The University of Sydney, Sydney Musculoskeletal Health and the Kolling InstituteFaculty of Medicine and Health and the Northern Sydney Local Health DistrictSydneyAustralia
- Department of RheumatologyRoyal North Shore HospitalSt LeonardsAustralia
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Mills ES, Becerra JA, Yensen K, Bolia IK, Shontz EC, Kebaish KJ, Dobitsch A, Hasan LK, Haratian A, Ong CD, Gross J, Petrigliano FA, Weber AE. Current and Future Advanced Imaging Modalities for the Diagnosis of Early Osteoarthritis of the Hip. Orthop Res Rev 2022; 14:327-338. [PMID: 36131944 PMCID: PMC9482955 DOI: 10.2147/orr.s357498] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2022] [Accepted: 08/16/2022] [Indexed: 12/04/2022] Open
Abstract
Hip osteoarthritis (OA) can be idiopathic or develop secondary to structural joint abnormalities of the hip joint (alteration of normal anatomy) and/or due to a systemic condition with joint involvement. Early osteoarthritic changes to the hip can be completely asymptomatic or may cause the development hip symptomatology without evidence of OA on radiographs. Delaying the progression of hip OA is critical due to the significant impact of this condition on the patient’s quality of life. Pre-OA of the hip is a newly established term that is often described as the development of signs and symptoms of degenerative hip disease but no radiographic evidence of OA. Advanced imaging methods can help to diagnose pre-OA of the hip in patients with hip pain and normal radiographs or aid in the surveillance of asymptomatic patients with an underlying hip diagnosis that is known to increase the risk of early OA of the hip. These methods include the delayed gadolinium-enhanced magnetic resonance imaging (MRI) of cartilage (dGEMRIC), quantitative magnetic resonance imaging (qMRI- T1rho, T2, and T2* relaxation time mapping), 7-Tesla MRI, computed tomography (CT), and optical coherence tomography (OCT). dGEMRIC proved to be a reliable and accurate modality though it is limited by the significant time necessary for contrast washout between scans. This disadvantage is potentially overcome by T2 weighted MRIs, which do not require contrast. 7-Tesla MRI is a promising development for enhanced imaging resolution compared to 1.5 and 3T MRIs. This technique does require additional optimization and development prior to widespread clinical use. The purpose of this review was to summarize the results of translational and clinical studies investigating the utilization of the above-mentioned imaging modalities to diagnose hip pre-OA, with special focus on recent research evaluating their implementation into clinical practice.
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Affiliation(s)
- Emily S Mills
- Department of Orthopaedic Surgery, Keck School of Medicine, University of Southern California, Los Angeles, CA, USA
| | - Jacob A Becerra
- Department of Orthopaedic Surgery, Keck School of Medicine, University of Southern California, Los Angeles, CA, USA
| | - Katie Yensen
- Department of Orthopaedic Surgery, Keck School of Medicine, University of Southern California, Los Angeles, CA, USA
| | - Ioanna K Bolia
- Department of Orthopaedic Surgery, Keck School of Medicine, University of Southern California, Los Angeles, CA, USA
- Correspondence: Ioanna K Bolia, USC Epstein Family Center for Sports Medicine at Keck Medicine of USC, 1520 San Pablo st #2000, Los Angeles, CA, 90033, USA, Tel +1 9703432813, Fax +8181 658 5920, Email
| | - Edward C Shontz
- Department of Orthopaedic Surgery, Keck School of Medicine, University of Southern California, Los Angeles, CA, USA
| | - Kareem J Kebaish
- Department of Orthopaedic Surgery, Keck School of Medicine, University of Southern California, Los Angeles, CA, USA
| | - Andrew Dobitsch
- Department of Orthopaedic Surgery, Keck School of Medicine, University of Southern California, Los Angeles, CA, USA
| | - Laith K Hasan
- Department of Orthopaedic Surgery, Keck School of Medicine, University of Southern California, Los Angeles, CA, USA
| | - Aryan Haratian
- Department of Orthopaedic Surgery, Keck School of Medicine, University of Southern California, Los Angeles, CA, USA
| | - Charlton D Ong
- Department of Radiology, Keck School of Medicine, University of Southern California, Los Angeles, CA, USA
| | - Jordan Gross
- Department of Radiology, Keck School of Medicine, University of Southern California, Los Angeles, CA, USA
| | - Frank A Petrigliano
- Department of Orthopaedic Surgery, Keck School of Medicine, University of Southern California, Los Angeles, CA, USA
| | - Alexander E Weber
- Department of Orthopaedic Surgery, Keck School of Medicine, University of Southern California, Los Angeles, CA, USA
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Ben-Eliezer N, Raya JG, Babb JS, Youm T, Sodickson DK, Lattanzi R. A New Method for Cartilage Evaluation in Femoroacetabular Impingement Using Quantitative T2 Magnetic Resonance Imaging: Preliminary Validation against Arthroscopic Findings. Cartilage 2021; 13:1315S-1323S. [PMID: 31455091 PMCID: PMC8808928 DOI: 10.1177/1947603519870852] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/19/2022] Open
Abstract
OBJECTIVE The outcome of arthroscopic treatment for femoroacetabular impingement (FAI) depends on the preoperative status of the hip cartilage. Quantitative T2 can detect early biochemical cartilage changes, but its routine implementation is challenging. Furthermore, intrinsic T2 variability between patients makes it difficult to define a threshold to identify cartilage lesions. To address this, we propose a normalized T2-index as a new method to evaluate cartilage in FAI. DESIGN We retrospectively analyzed magnetic resonance imaging (MRI) data of 18 FAI patients with arthroscopically confirmed cartilage defects. Cartilage T2 maps were reconstructed from multi-spin-echo 3-T data using the echo-modulation-curve (EMC) model-based technique. The central femoral cartilage, assumed healthy in early-stage FAI, was used as the normalization reference to define a T2-index. We investigated the ability of the T2-index to detect surgically confirmed cartilage lesions. RESULTS The average T2-index was 1.14 ± 0.1 and 1.13 ± 0.1 for 2 separated segmentations. Using T2-index >1 as the threshold for damaged cartilage, accuracy was 88% and 100% for the 2 segmentations. We found moderate intraobserver repeatability, although separate segmentations yielded comparable accuracy. Damaged cartilage could not be identified using nonnormalized average T2 values. CONCLUSIONS This preliminary study confirms the importance of normalizing T2 values to account for interpatient variability and suggests that the T2-index is a promising biomarker for the detection of cartilage lesions in FAI. Future work is needed to confirm that combining T2-index with morphologic MRI and other quantitative biomarkers could improve cartilage assessment in FAI.
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Affiliation(s)
- Noam Ben-Eliezer
- Center for Advanced Imaging Innovation
and Research (CAI2R) and Bernard and Irene Schwartz Center for Biomedical Imaging,
Department of Radiology, New York University School of Medicine, New York, NY,
USA
| | - José G. Raya
- Center for Advanced Imaging Innovation
and Research (CAI2R) and Bernard and Irene Schwartz Center for Biomedical Imaging,
Department of Radiology, New York University School of Medicine, New York, NY,
USA,The Sackler Institute of Graduate
Biomedical Sciences, New York University School of Medicine, New York, NY, USA
| | - James S. Babb
- Center for Advanced Imaging Innovation
and Research (CAI2R) and Bernard and Irene Schwartz Center for Biomedical Imaging,
Department of Radiology, New York University School of Medicine, New York, NY,
USA
| | - Thomas Youm
- Department of Orthopedic Surgery, New
York University Hospital for Joint Diseases, New York, NY, USA
| | - Daniel K. Sodickson
- Center for Advanced Imaging Innovation
and Research (CAI2R) and Bernard and Irene Schwartz Center for Biomedical Imaging,
Department of Radiology, New York University School of Medicine, New York, NY,
USA,The Sackler Institute of Graduate
Biomedical Sciences, New York University School of Medicine, New York, NY, USA
| | - Riccardo Lattanzi
- Center for Advanced Imaging Innovation
and Research (CAI2R) and Bernard and Irene Schwartz Center for Biomedical Imaging,
Department of Radiology, New York University School of Medicine, New York, NY,
USA,The Sackler Institute of Graduate
Biomedical Sciences, New York University School of Medicine, New York, NY, USA,Riccardo Lattanzi, The Bernard and Irene
Schwartz Center for Biomedical Imaging, New York University Langone Health, 660
First Avenue Room 203, New York, NY 10016, USA.
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Lu Z, Pan S, Wang B, Liu J, Gao T, Lyu X. T2 mapping of the acetabular cartilage in infants and children with developmental dysplasia of the hip. Acta Radiol 2021; 62:1418-1425. [PMID: 33108893 DOI: 10.1177/0284185120966684] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND T2 mapping is useful for evaluating the cartilage matrix. PURPOSE To determine the variations in the acetabular cartilage T2 relaxation values between healthy individuals and those with developmental dysplasia of the hip (DDH). MATERIAL AND METHODS Thirty-three patients with unilateral DDH underwent 3-T magnetic resonance imaging (MRI) between January 2018 and February 2019. Fifteen volunteers (30 hips) were enrolled as controls. T2 values were measured with the T2 mapping sequence in all layers and were equally divided into three layers (deep, middle, and superficial) with equal thickness. We calculated the mean T2 relaxation values for the full thickness, deep, middle, and superficial layers and compared the values between the different groups. In addition, the inter- and intra-observer agreements were calculated. RESULTS The T2 relaxation values in the DDH arm were significantly lower in the middle, superficial, and full thickness layers compared with those of the volunteers and contralateral hips. The T2 relaxation values of the deep layers showed no significant difference between the different groups. The acetabular cartilage T2 relaxation values increased from the deep layer to the superficial layer in the control and contralateral groups. Both inter- and intra-observer agreements were good. CONCLUSION MRI T2 mapping may help to diagnose developmental disorders of the acetabular cartilage matrix in infants and children with DDH. Abnormal acetabular cartilage T2 relaxation values may be due to the extraordinary stress load of the femoral head.
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Affiliation(s)
- Zhao Lu
- Department of Radiology, Shengjing Hospital of China Medical University, Shenyang, Liaoning Province, PR China
| | - Shinong Pan
- Department of Radiology, Shengjing Hospital of China Medical University, Shenyang, Liaoning Province, PR China
| | - Baijun Wang
- Philips Healthcare, Shenyang, Liaoning Province, PR China
| | - Jiahui Liu
- Department of Pediatric Orthopaedics, Shengjing Hospital of China Medical University, Shenyang, Liaoning Province, PR China
| | - Tianyang Gao
- Department of Radiology, Shengjing Hospital of China Medical University, Shenyang, Liaoning Province, PR China
| | - Xiaohong Lyu
- Department of Radiology, Shengjing Hospital of China Medical University, Shenyang, Liaoning Province, PR China
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Hunter DJ, Eyles J, Murphy NJ, Spiers L, Burns A, Davidson E, Dickenson E, Fary C, Foster NE, Fripp J, Griffin DR, Hall M, Kim YJ, Linklater JM, Molnar R, Neubert A, O'Connell RL, O'Donnell J, O'Sullivan M, Randhawa S, Reichenbach S, Schmaranzer F, Singh P, Tran P, Wilson D, Zhang H, Bennell KL. Multi-centre randomised controlled trial comparing arthroscopic hip surgery to physiotherapist-led care for femoroacetabular impingement (FAI) syndrome on hip cartilage metabolism: the Australian FASHIoN trial. BMC Musculoskelet Disord 2021; 22:697. [PMID: 34399702 PMCID: PMC8369620 DOI: 10.1186/s12891-021-04576-z] [Citation(s) in RCA: 31] [Impact Index Per Article: 10.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/02/2021] [Accepted: 08/04/2021] [Indexed: 11/29/2022] Open
Abstract
Background Arthroscopic surgery for femoroacetabular impingement syndrome (FAI) is known to lead to self-reported symptom improvement. In the context of surgical interventions with known contextual effects and no true sham comparator trials, it is important to ascertain outcomes that are less susceptible to placebo effects. The primary aim of this trial was to determine if study participants with FAI who have hip arthroscopy demonstrate greater improvements in delayed gadolinium-enhanced magnetic resonance imaging (MRI) of cartilage (dGEMRIC) index between baseline and 12 months, compared to participants who undergo physiotherapist-led management. Methods Multi-centre, pragmatic, two-arm superiority randomised controlled trial comparing physiotherapist-led management to hip arthroscopy for FAI. FAI participants were recruited from participating orthopaedic surgeons clinics, and randomly allocated to receive either physiotherapist-led conservative care or surgery. The surgical intervention was arthroscopic FAI surgery. The physiotherapist-led conservative management was an individualised physiotherapy program, named Personalised Hip Therapy (PHT). The primary outcome measure was change in dGEMRIC score between baseline and 12 months. Secondary outcomes included a range of patient-reported outcomes and structural measures relevant to FAI pathoanatomy and hip osteoarthritis development. Interventions were compared by intention-to-treat analysis. Results Ninety-nine participants were recruited, of mean age 33 years and 58% male. Primary outcome data were available for 53 participants (27 in surgical group, 26 in PHT). The adjusted group difference in change at 12 months in dGEMRIC was -59 ms (95%CI − 137.9 to - 19.6) (p = 0.14) favouring PHT. Hip-related quality of life (iHOT-33) showed improvements in both groups with the adjusted between-group difference at 12 months showing a statistically and clinically important improvement in arthroscopy of 14 units (95% CI 5.6 to 23.9) (p = 0.003). Conclusion The primary outcome of dGEMRIC showed no statistically significant difference between PHT and arthroscopic hip surgery at 12 months of follow-up. Patients treated with surgery reported greater benefits in symptoms at 12 months compared to PHT, but these benefits are not explained by better hip cartilage metabolism. Trial registration details Australia New Zealand Clinical Trials Registry reference: ACTRN12615001177549. Trial registered 2/11/2015. Supplementary Information The online version contains supplementary material available at 10.1186/s12891-021-04576-z.
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Affiliation(s)
- David J Hunter
- Institute of Bone and Joint Research, Kolling Institute of Medical Research, University of Sydney, Camperdown, Australia. .,Department of Rheumatology, Royal North Shore Hospital, Sydney, Australia.
| | - Jillian Eyles
- Institute of Bone and Joint Research, Kolling Institute of Medical Research, University of Sydney, Camperdown, Australia.,Department of Rheumatology, Royal North Shore Hospital, Sydney, Australia
| | - Nicholas J Murphy
- Institute of Bone and Joint Research, Kolling Institute of Medical Research, University of Sydney, Camperdown, Australia.,Department of Orthopaedic Surgery, Gosford and Wyong Hospitals, Gosford, New South Wales, Australia
| | - Libby Spiers
- Department of Physiotherapy, Centre for Health, Exercise and Sports Medicine, University of Melbourne, Parkville, Australia
| | | | - Emily Davidson
- Department of Radiology, Royal Prince Alfred Hospital, Sydney, New South Wales, 2035, Australia
| | - Edward Dickenson
- Warwick Medical School, University of Warwick, Coventry, UK.,University Hospitals of Coventry and Warwickshire NHS Trust, Coventry, UK
| | - Camdon Fary
- Department of Orthopaedic Surgery, Western Health, Melbourne, Australia.,Australian Institute for Musculoskeletal Science (AIMSS), The University of Melbourne and Western Health, St. Albans, VIC, Australia
| | - Nadine E Foster
- STARS Education and Research Alliance, School of Health and Rehabilitation Sciences, University of Queensland, St Lucia, Australia.,Primary Care Centre Versus Arthritis, School of Medicine, Keele University, Newcastle upon Tyne, UK
| | - Jurgen Fripp
- The Australian e-Health Research Centre, CSIRO Health and Biosecurity, Brisbane, Australia
| | | | - Michelle Hall
- Department of Physiotherapy, Centre for Health, Exercise and Sports Medicine, University of Melbourne, Parkville, Australia
| | - Young Jo Kim
- Department of Orthopedic Surgery, Boston Children's Hospital, 300 Longwood Avenue, Boston, MA, 02115, USA
| | - James M Linklater
- Department of Musculoskeletal Imaging, Castlereagh Imaging, St Leonards, New South Wales, Australia
| | - Robert Molnar
- Sydney Orthopaedic Trauma & Reconstructive Surgery, Sydney, New South Wales, Australia
| | - Ales Neubert
- The Australian e-Health Research Centre, CSIRO Health and Biosecurity, Brisbane, Australia
| | - Rachel L O'Connell
- Institute of Bone and Joint Research, Kolling Institute of Medical Research, University of Sydney, Camperdown, Australia.,NHMRC Clinical Trials Centre, University of Sydney, Camperdown, Australia
| | - John O'Donnell
- Hip Arthroscopy Australia, 21 Erin St, Richmond, Victoria, Australia.,St Vincent's Private Hospital, 159 Grey St, East Melbourne, Victoria, Australia
| | - Michael O'Sullivan
- North Sydney Orthopaedic and Sports Medicine Centre, North Sydney, New South Wales, Australia
| | - Sunny Randhawa
- Macquarie University Hospital, 3 Technology Pl, Macquarie University, Macquarie Park, NSW, 2109, Australia
| | - Stephan Reichenbach
- Institute of Social and Preventive Medicine, University of Bern, Bern, Switzerland.,Department of Rheumatology, Immunology and Allergology, University Hospital and University of Bern, Bern, Switzerland.,Department Diagnostic, Interventional and Paediatric Radiology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Florian Schmaranzer
- Department Diagnostic, Interventional and Paediatric Radiology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Parminder Singh
- Hip Arthroscopy Australia, 21 Erin St, Richmond, Victoria, Australia.,Maroondah Hospital, Eastern Health, Davey Drive, Ringwood East, Melbourne, Victoria, 3135, Australia
| | - Phong Tran
- Department of Orthopaedic Surgery, Western Health, Melbourne, Australia.,Australian Institute for Musculoskeletal Science (AIMSS), The University of Melbourne and Western Health, St. Albans, VIC, Australia
| | - David Wilson
- Department of Orthopaedics, Center for Hip Health and Mobility, University of British Columbia, Vancouver, BC, Canada
| | - Honglin Zhang
- Department of Orthopaedics, Center for Hip Health and Mobility, University of British Columbia, Vancouver, BC, Canada
| | - Kim L Bennell
- Department of Physiotherapy, Centre for Health, Exercise and Sports Medicine, University of Melbourne, Parkville, Australia
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Melkus G, Beaulé PE, Wilkin G, Rakhra KS. What Is the Correlation Among dGEMRIC, T1p, and T2* Quantitative MRI Cartilage Mapping Techniques in Developmental Hip Dysplasia? Clin Orthop Relat Res 2021; 479:1016-1024. [PMID: 33355837 PMCID: PMC8083801 DOI: 10.1097/corr.0000000000001600] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/17/2020] [Accepted: 11/10/2020] [Indexed: 01/31/2023]
Abstract
BACKGROUND Delayed gadolinium-enhanced MRI of cartilage (dGEMRIC) is a validated technique for evaluating cartilage health in developmental dysplasia of the hip (DDH), which can be a helpful prognosticator for the response to surgical treatments. dGEMRIC requires intravenous injection of gadolinium contrast, however, which adds time, expense, and possible adverse reactions to the imaging procedure. Newer MRI cartilage mapping techniques such as T1 rho (ρ) and T2* have been performed in the hip without the need for any contrast, although it is unknown whether they are equivalent to dGEMRIC. QUESTION/PURPOSE In this study, our purpose was to determine the correlation between the relaxation values of three cartilage mapping techniques, dGEMRIC, T1ρ, and T2*, in patients with DDH. METHODS Fifteen patients with DDH (three male, 12 female; mean age 29 ± 9 years) scheduled for periacetabular osteotomy underwent preoperative dGEMRIC, T1ρ, and T2* MRI at 3T with quantitative cartilage mapping. The outcomes of dGEMRIC, T1ρ, and T2* mapping were calculated for three regions of interest (ROI) to analyze the weightbearing cartilage of the hip: global ROI, anterior and posterior ROI, and further subdivided into medial, intermediate, and lateral to generate six smaller ROIs. The correlation between the respective relaxation time values was evaluated using the Spearman correlation coefficient (rS) for each ROI, categorized as negligible, weak, moderate, strong, or very strong. The relaxation values within the subdivided ROIs were compared for each of the three cartilage mapping techniques using the Kruskal-Wallis test. RESULTS There was a moderate correlation of T1ρ and T2* relaxation values with dGEMRIC relaxation values. For the global ROI, there was a moderate correlation between dGEMRIC and T2* (moderate; rS = 0.63; p = 0.01). For the anterior ROI, a moderate or strong correlation was found between dGEMRIC and both T1ρ and T2*: dGEMRIC and T1ρ (strong; rS = -0.71; p = 0.003) and dGEMRIC and T2* (moderate; rS = 0.69; p = 0.004). There were no correlations for the posterior ROI. The mean dGEMRIC, T1ρ, and T2* relaxation values were not different between the anterior and posterior ROIs nor between the subdivided six ROIs. CONCLUSION Quantitative T1ρ and T2* cartilage mapping demonstrated a moderate correlation with dGEMRIC, anteriorly and globally, respectively. However, the clinical relevance of such a correlation remains unclear. Further research investigating the correlation of these two noncontrast techniques with clinical function and outcome scores is needed before broad implementation in the preoperative investigation of DDH. LEVEL OF EVIDENCE Level II, diagnostic study.
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Affiliation(s)
- Gerd Melkus
- G. Melkus, K. S. Rakhra, Department of Medical Imaging, The Ottawa Hospital, Ottawa, ON, Canada
- G. Melkus, K. S. Rakhra, Department of Radiology, University of Ottawa, Ottawa, ON, Canada
- P. E. Beaulé, G. Wilkin, Division of Orthopaedic Surgery, The Ottawa Hospital, Ottawa, ON, Canada
- P. E. Beaulé, G. Wilkin, Department of Medicine, University of Ottawa, Ottawa, Canada
| | - Paul E Beaulé
- G. Melkus, K. S. Rakhra, Department of Medical Imaging, The Ottawa Hospital, Ottawa, ON, Canada
- G. Melkus, K. S. Rakhra, Department of Radiology, University of Ottawa, Ottawa, ON, Canada
- P. E. Beaulé, G. Wilkin, Division of Orthopaedic Surgery, The Ottawa Hospital, Ottawa, ON, Canada
- P. E. Beaulé, G. Wilkin, Department of Medicine, University of Ottawa, Ottawa, Canada
| | - Geoffrey Wilkin
- G. Melkus, K. S. Rakhra, Department of Medical Imaging, The Ottawa Hospital, Ottawa, ON, Canada
- G. Melkus, K. S. Rakhra, Department of Radiology, University of Ottawa, Ottawa, ON, Canada
- P. E. Beaulé, G. Wilkin, Division of Orthopaedic Surgery, The Ottawa Hospital, Ottawa, ON, Canada
- P. E. Beaulé, G. Wilkin, Department of Medicine, University of Ottawa, Ottawa, Canada
| | - Kawan S Rakhra
- G. Melkus, K. S. Rakhra, Department of Medical Imaging, The Ottawa Hospital, Ottawa, ON, Canada
- G. Melkus, K. S. Rakhra, Department of Radiology, University of Ottawa, Ottawa, ON, Canada
- P. E. Beaulé, G. Wilkin, Division of Orthopaedic Surgery, The Ottawa Hospital, Ottawa, ON, Canada
- P. E. Beaulé, G. Wilkin, Department of Medicine, University of Ottawa, Ottawa, Canada
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7
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Damopoulos D, Lerch TD, Schmaranzer F, Tannast M, Chênes C, Zheng G, Schmid J. Segmentation of the proximal femur in radial MR scans using a random forest classifier and deformable model registration. Int J Comput Assist Radiol Surg 2019; 14:545-561. [PMID: 30604143 DOI: 10.1007/s11548-018-1899-z] [Citation(s) in RCA: 20] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2018] [Accepted: 12/10/2018] [Indexed: 11/25/2022]
Abstract
BACKGROUND Radial 2D MRI scans of the hip are routinely used for the diagnosis of the cam type of femoroacetabular impingement (FAI) and of avascular necrosis (AVN) of the femoral head, both considered causes of hip joint osteoarthritis in young and active patients. A method for automated and accurate segmentation of the proximal femur from radial MRI scans could be very useful in both clinical routine and biomechanical studies. However, to our knowledge, no such method has been published before. PURPOSE The aims of this study are the development of a system for the segmentation of the proximal femur from radial MRI scans and the reconstruction of its 3D model that can be used for diagnosis and planning of hip-preserving surgery. METHODS The proposed system relies on: (a) a random forest classifier and (b) the registration of a 3D template mesh of the femur to the radial slices based on a physically based deformable model. The input to the system are the radial slices and the manually specified positions of three landmarks. Our dataset consists of the radial MRI scans of 25 patients symptomatic of FAI or AVN and accompanying manual segmentation of the femur, treated as the ground truth. RESULTS The achieved segmentation of the proximal femur has an average Dice similarity coefficient (DSC) of 96.37 ± 1.55%, an average symmetric mean absolute distance (SMAD) of 0.94 ± 0.39 mm and an average Hausdorff distance of 2.37 ± 1.14 mm. In the femoral head subregion, the average SMAD is 0.64 ± 0.18 mm and the average Hausdorff distance is 1.41 ± 0.56 mm. CONCLUSIONS We validated a semiautomated method for the segmentation of the proximal femur from radial MR scans. A 3D model of the proximal femur is also reconstructed, which can be used for the planning of hip-preserving surgery.
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Affiliation(s)
- Dimitrios Damopoulos
- Institute for Surgical Technology and Biomechanics, University of Bern, Stauffacherstrasse 78, 3014, Bern, Switzerland.
| | - Till Dominic Lerch
- Department of Orthopaedic Surgery and Traumatology, Inselspital, University of Bern, Freiburgstrasse, 3010, Bern, Switzerland
| | - Florian Schmaranzer
- Department of Orthopaedic Surgery and Traumatology, Inselspital, University of Bern, Freiburgstrasse, 3010, Bern, Switzerland
| | - Moritz Tannast
- Department of Orthopaedic Surgery and Traumatology, Inselspital, University of Bern, Freiburgstrasse, 3010, Bern, Switzerland
| | - Christophe Chênes
- School of Health Sciences - Geneva, HES-SO University of Applied Sciences and Arts Western Switzerland, Avenue de Champel 47, 1206, Geneva, Switzerland
| | - Guoyan Zheng
- Institute for Surgical Technology and Biomechanics, University of Bern, Stauffacherstrasse 78, 3014, Bern, Switzerland.
| | - Jérôme Schmid
- School of Health Sciences - Geneva, HES-SO University of Applied Sciences and Arts Western Switzerland, Avenue de Champel 47, 1206, Geneva, Switzerland
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8
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Abstract
To review the value of acetabular magnetic resonance imaging (MRI) in children with developmental dysplasia of the hip (DDH) of different ages.Eighty-eight medical records of children with unilateral DDH who were diagnosed and treated in our hospital between January 2010 and December 2015 were retrospectively analyzed. The affected hips were put into the case group, and the normal hips were put into the control group. All cases were further divided into 3 age groups: infant (<1 year), 16 cases; young children (1-3 years), 48 cases; and children (3-13 years), 24 cases. The differences of the acetabular depth (AD), the bony acetabular index (BAI), and the cartilaginous acetabular index (CAI) between each group were measured and compared for a linear correlation analysis. At the same time, the distribution of the acetabular cartilage in the anterosuperior, top, and posterosuperior parts (the three parts) from the two groups was measured, respectively.Measurement results from both the case and control groups were as follows: AD was 5.46 ± 2.62 mm and 9.74 ± 2.33 mm; BAI was 33.26 ± 5.49° and 23.50 ± 5.33°; and CAI was 21.04 ± 6.16° and 12.71 ± 4.83°. Differences from the two groups were statistically significant (t = 11.94, 13.78, 9.16, P < .05); BAI and CAI were linearly correlated (r = 0.86, 0.75, P < .05). The AD in infant, young children, and children groups from the case group were 4.26 ± 0.42 mm, 4.79 ± 1.74 mm, and 7.31 ± 2.74 mm, respectively, which was statically significant as well (F = 11.37, P < .05). Under the same grouping criteria, BAI was recorded as 29.04 ± 5.11°, 34.56 ± 4.27°, and 33.12 ± 5.69°; CAI was recorded as 16.62 ± 5.50°, 21.79 ± 6.33°, and 20.91 ± 6.40° separately. There was a linear correlation (r = 0.78, 0.65, P < .05) between BAI and CAI in young children and children groups. The distribution of acetabular cartilage in the above-mentioned three parts from both young children and children groups was statistically significant (P < .05).MRI is a satisfactory imaging modality to children with DDH of different ages for the assessment of AD, BAI, CAI, and acetabular cartilage in multiple locations. It can provide ample imaging reference to clinical evaluation of the acetabulum development in DDH.
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Guo Y, Zhang H, Qian H, Wilson DR, Wong H, Barber M, Forster BB, Esdaile J, Cibere J. Association of Femoroacetabular Impingement and Delayed Gadolinium-Enhanced Magnetic Resonance Imaging of Cartilage: A Population-Based Study. Arthritis Care Res (Hoboken) 2018; 70:1160-1168. [DOI: 10.1002/acr.23463] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2017] [Accepted: 10/31/2017] [Indexed: 11/08/2022]
Affiliation(s)
- Yimeng Guo
- Arthritis Research Canada; Richmond British Columbia Canada
| | - Honglin Zhang
- University of British Columbia and Vancouver Coastal Health Research Institute; Vancouver British Columbia Canada
| | - Hong Qian
- St. Paul's Hospital; Vancouver British Columbia Canada
| | - David R. Wilson
- University of British Columbia and Vancouver Coastal Health Research Institute; Vancouver British Columbia Canada
| | - Hubert Wong
- University of British Columbia, St. Paul's Hospital, and Canadian HIV Trials Network; Vancouver British Columbia Canada
| | - Morgan Barber
- Arthritis Research Canada; Richmond British Columbia Canada
| | - Bruce B. Forster
- University of British Columbia, Vancouver Coastal Health Research Institute, and Providence Health Care; Vancouver British Columbia Canada
| | - John Esdaile
- Arthritis Research Canada, Richmond; and University of British Columbia, Vancouver, British Columbia; and University of Calgary; Calgary Alberta Canada
| | - Jolanda Cibere
- Arthritis Research Canada, Richmond; and University of British Columbia; Vancouver British Columbia Canada
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Fernquest S, Park D, Marcan M, Palmer A, Voiculescu I, Glyn-Jones S. Segmentation of hip cartilage in compositional magnetic resonance imaging: A fast, accurate, reproducible, and clinically viable semi-automated methodology. J Orthop Res 2018; 36:2280-2287. [PMID: 29469172 DOI: 10.1002/jor.23881] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/19/2017] [Accepted: 02/16/2018] [Indexed: 02/04/2023]
Abstract
Manual segmentation is a significant obstacle in the analysis of compositional MRI for clinical decision-making and research. Our aim was to produce a fast, accurate, reproducible, and clinically viable semi-automated method for segmentation of hip MRI. We produced a semi-automated segmentation method for cartilage segmentation of hip MRI sequences consisting of a two step process: (i) fully automated hierarchical partitioning of the data volume generated using a bespoke segmentation approach applied recursively, followed by (ii) user selection of the regions of interest using a region editor. This was applied to dGEMRIC scans at 3T taken from a prospective longitudinal study of individuals considered at high-risk of developing osteoarthritis (SibKids) which were also manually segmented for comparison. Fourteen hips were segmented both manually and using our semi-automated method. Per hip, processing time for semi-automated and manual segmentation was 10-15, and 60-120 min, respectively. Accuracy and Dice similarity coefficient (DSC) for the comparison of semi-automated and manual segmentations was 0.9886 and 0.8803, respectively. Intra-observer and inter-observer reproducibility of the semi-automated segmentation method gave an accuracy of 0.9997 and 0.9991, and DSC of 0.9726 and 0.9354, respectively. We have proposed a fast, accurate, reproducible, and clinically viable semi-automated method for segmentation of hip MRI sequences. This enables accurate anatomical and biochemical measurements to be obtained quickly and reproducibly. This is the first such method that shows clinical applicability, and could have large ramifications for the use of compositional MRI in research and clinically. © 2018 Orthopaedic Research Society. Published by Wiley Periodicals, Inc. J Orthop Res.
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Affiliation(s)
- Scott Fernquest
- Nuffield Department of Orthopaedics, Rheumatology, and Musculoskeletal Sciences, Botnar Research Centre, University of Oxford, Oxford, OX3 7LD, United Kingdom
| | - Daniel Park
- Nuffield Department of Orthopaedics, Rheumatology, and Musculoskeletal Sciences, Botnar Research Centre, University of Oxford, Oxford, OX3 7LD, United Kingdom
| | - Marija Marcan
- Department of Computer Science, University of Oxford, Oxford, OX1 3QD, United Kingdom
| | - Antony Palmer
- Nuffield Department of Orthopaedics, Rheumatology, and Musculoskeletal Sciences, Botnar Research Centre, University of Oxford, Oxford, OX3 7LD, United Kingdom
| | - Irina Voiculescu
- Department of Computer Science, University of Oxford, Oxford, OX1 3QD, United Kingdom
| | - Sion Glyn-Jones
- Nuffield Department of Orthopaedics, Rheumatology, and Musculoskeletal Sciences, Botnar Research Centre, University of Oxford, Oxford, OX3 7LD, United Kingdom
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11
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Murphy NJ, Eyles J, Bennell KL, Bohensky M, Burns A, Callaghan FM, Dickenson E, Fary C, Grieve SM, Griffin DR, Hall M, Hobson R, Kim YJ, Linklater JM, Lloyd DG, Molnar R, O’Connell RL, O’Donnell J, O’Sullivan M, Randhawa S, Reichenbach S, Saxby DJ, Singh P, Spiers L, Tran P, Wrigley TV, Hunter DJ. Protocol for a multi-centre randomised controlled trial comparing arthroscopic hip surgery to physiotherapy-led care for femoroacetabular impingement (FAI): the Australian FASHIoN trial. BMC Musculoskelet Disord 2017; 18:406. [PMID: 28950859 PMCID: PMC5615805 DOI: 10.1186/s12891-017-1767-y] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/15/2017] [Accepted: 09/21/2017] [Indexed: 03/06/2023] Open
Abstract
BACKGROUND Femoroacetabular impingement syndrome (FAI), a hip disorder affecting active young adults, is believed to be a leading cause of hip osteoarthritis (OA). Current management approaches for FAI include arthroscopic hip surgery and physiotherapy-led non-surgical care; however, there is a paucity of clinical trial evidence comparing these approaches. In particular, it is unknown whether these management approaches modify the future risk of developing hip OA. The primary objective of this randomised controlled trial is to determine if participants with FAI who undergo hip arthroscopy have greater improvements in hip cartilage health, as demonstrated by changes in delayed gadolinium-enhanced magnetic resonance imaging (MRI) of cartilage (dGEMRIC) index between baseline and 12 months, compared to those who undergo physiotherapy-led non-surgical management. METHODS This is a pragmatic, multi-centre, two-arm superiority randomised controlled trial comparing hip arthroscopy to physiotherapy-led management for FAI. A total of 140 participants with FAI will be recruited from the clinics of participating orthopaedic surgeons, and randomly allocated to receive either surgery or physiotherapy-led non-surgical care. The surgical intervention involves arthroscopic FAI surgery from one of eight orthopaedic surgeons specialising in this field, located in three different Australian cities. The physiotherapy-led non-surgical management is an individualised physiotherapy program, named Personalised Hip Therapy (PHT), developed by a panel to represent the best non-operative care for FAI. It entails at least six individual physiotherapy sessions over 12 weeks, and up to ten sessions over six months, provided by experienced musculoskeletal physiotherapists trained to deliver the PHT program. The primary outcome measure is the change in dGEMRIC score of a ROI containing both acetabular and femoral head cartilages at the chondrolabral transitional zone of the mid-sagittal plane between baseline and 12 months. Secondary outcomes include patient-reported outcomes and several structural and biomechanical measures relevant to the pathogenesis of FAI and development of hip OA. Interventions will be compared by intention-to-treat analysis. DISCUSSION The findings will help determine whether hip arthroscopy or an individualised physiotherapy program is superior for the management of FAI, including for the prevention of hip OA. TRIAL REGISTRATION Australia New Zealand Clinical Trials Registry reference: ACTRN12615001177549 . Trial registered 2/11/2015 (retrospectively registered).
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Affiliation(s)
- Nicholas J. Murphy
- Kolling Institute of Medical Research, Institute of Bone and Joint Research, University of Sydney, Camperdown, Australia
- Department of Rheumatology, Royal North Shore Hospital, St Leonards, Australia
| | - Jillian Eyles
- Kolling Institute of Medical Research, Institute of Bone and Joint Research, University of Sydney, Camperdown, Australia
- Department of Rheumatology, Royal North Shore Hospital, St Leonards, Australia
| | - Kim L. Bennell
- Centre for Health, Exercise and Sports Medicine, Department of Physiotherapy, University of Melbourne, Melbourne, Australia
| | - Megan Bohensky
- Melbourne EpiCentre, University of Melbourne, Melbourne, Australia
| | | | - Fraser M. Callaghan
- Sydney Translational Imaging Laboratory, Heart Research Institute, Charles Perkins Centre, University of Sydney, Camperdown, Australia
- Sydney Medical School, University of Sydney, Camperdown, Australia
| | - Edward Dickenson
- Warwick Medical School, University of Warwick, Coventry, UK and University Hospitals of Coventry and Warwickshire NHS Trust, Coventry, UK
| | - Camdon Fary
- Department of Orthopaedic Surgery, Western Health, Melbourne, Australia
- Australian Institute for Musculoskeletal Science (AIMSS), The University of Melbourne and Western Health, St Albans, Melbourne, VIC Australia
| | - Stuart M. Grieve
- Sydney Translational Imaging Laboratory, Heart Research Institute, Charles Perkins Centre, University of Sydney, Camperdown, Australia
- Sydney Medical School, University of Sydney, Camperdown, Australia
| | - Damian R. Griffin
- Warwick Medical School, University of Warwick, Coventry, UK and University Hospitals of Coventry and Warwickshire NHS Trust, Coventry, UK
| | - Michelle Hall
- Centre for Health, Exercise and Sports Medicine, Department of Physiotherapy, University of Melbourne, Melbourne, Australia
| | - Rachel Hobson
- Warwick Medical School, University of Warwick, Coventry, UK and University Hospitals of Coventry and Warwickshire NHS Trust, Coventry, UK
| | - Young Jo Kim
- Department of Orthopedic Surgery, Boston Children’s Hospital, 300 Longwood Avenue, Boston, MA 02115 USA
| | - James M. Linklater
- Department of Musculoskeletal Imaging, Castlereagh Sports Imaging Centre, St Leonards, NSW Australia
| | - David G. Lloyd
- Gold Coast Orthopaedic Research and Education Alliance, Menzies Health Institute Queensland, Griffith University, Nathan, Australia
- School of Allied Health Sciences, Griffith University, Nathan, Australia
| | - Robert Molnar
- Sydney Orthopaedic Trauma & Reconstructive Surgery, Sydney, NSW Australia
| | - Rachel L. O’Connell
- Department of Rheumatology, Royal North Shore Hospital, St Leonards, Australia
- NHMRC Clinical Trials Centre, University of Sydney, Camperdown, Australia
| | - John O’Donnell
- Hip Arthroscopy Australia, 21 Erin St, Richmond, VIC Australia
- St Vincent’s Private Hospital, 159 Grey St, East Melbourne, VIC Australia
| | - Michael O’Sullivan
- North Sydney Orthopaedic and Sports Medicine Centre, North Sydney, NSW Australia
| | - Sunny Randhawa
- Macquarie University Hospital, 3 Technology Pl, Macquarie University, Sydney, NSW 2109 Australia
| | - Stephan Reichenbach
- Institute of Social and Preventive Medicine, University of Bern, Bern, Switzerland
- Department of Rheumatology, Immunology and Allergology, University Hospital and University of Bern, Bern, Switzerland
| | - David J. Saxby
- Gold Coast Orthopaedic Research and Education Alliance, Menzies Health Institute Queensland, Griffith University, Nathan, Australia
- School of Allied Health Sciences, Griffith University, Nathan, Australia
| | - Parminder Singh
- Hip Arthroscopy Australia, 21 Erin St, Richmond, VIC Australia
- Maroondah Hospital, Eastern Health, Davey Drive, Ringwood East, Melbourne, VIC 3135 Australia
| | - Libby Spiers
- Centre for Health, Exercise and Sports Medicine, Department of Physiotherapy, University of Melbourne, Melbourne, Australia
| | - Phong Tran
- Department of Orthopaedic Surgery, Western Health, Melbourne, Australia
- Australian Institute for Musculoskeletal Science (AIMSS), The University of Melbourne and Western Health, St Albans, Melbourne, VIC Australia
| | - Tim V. Wrigley
- Centre for Health, Exercise and Sports Medicine, Department of Physiotherapy, University of Melbourne, Melbourne, Australia
| | - David J. Hunter
- Kolling Institute of Medical Research, Institute of Bone and Joint Research, University of Sydney, Camperdown, Australia
- Department of Rheumatology, Royal North Shore Hospital, St Leonards, Australia
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12
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Hesper T, Bulat E, Bixby S, Akhondi-Asl A, Afacan O, Miller P, Bowen G, Warfield S, Kim YJ. Both 3-T dGEMRIC and Acetabular-Femoral T2 Difference May Detect Cartilage Damage at the Chondrolabral Junction. Clin Orthop Relat Res 2017; 475:1058-1065. [PMID: 27807678 PMCID: PMC5339137 DOI: 10.1007/s11999-016-5136-1] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
BACKGROUND In addition to case reports of gadolinium-related toxicities, there are increasing theoretical concerns about the use of gadolinium for MR imaging. As a result, there is increasing interest in noncontrast imaging techniques for biochemical cartilage assessment. Among them, T2 mapping holds promise because of its simplicity, but its biophysical interpretation has been controversial. QUESTIONS/PURPOSES We sought to determine whether (1) 3-T delayed gadolinium-enhanced MRI of cartilage (dGEMRIC) and T2 mapping are both capable of detecting cartilage damage at the chondrolabral junction in patients with femoroacetabular impingement (FAI); and (2) whether there is a correlation between these two techniques for acetabular and femoral head cartilage assessment. METHODS Thirty-one patients with hip-related symptoms resulting from FAI underwent a preoperative 3-T MRI of their hip that included dGEMRIC and T2 mapping (symptomatic group, 16 women, 15 men; mean age, 27 ± 8 years). Ten volunteers with no symptoms according to the WOMAC served as a control (asymptomatic group, seven women, three men; mean age, 28 ± 3 years). After morphologic cartilage assessment, acetabular and femoral head cartilages were graded according to the modified Outerbridge grading criteria. In the midsagittal plane, single-observer analyses of precontrast T1 values (volunteers), the dGEMRIC index (T1Gd, patients), and T2 mapping values (everyone) were compared in acetabular and corresponding femoral head cartilage at the chondrolabral junction of each hip by region-of-interest analysis. RESULTS In the symptomatic group, T1Gd and T2 values were lower in the acetabular cartilage compared with corresponding femoral head cartilage (T1Gd: 515 ± 165 ms versus 650 ± 191 ms, p < 0.001; T2: 39 ± 8 ms versus 46 ± 10 ms, p < 0.001). In contrast, the asymptomatic group demonstrated no differences in T1 and T2 values for the acetabular and femoral cartilages with the numbers available (T1: 861 ± 130 ms versus 860 ± 182 ms, p = 0.98; T2: 43 ± 7 ms versus 42 ± 6 ms, p = 0.73). No correlation with the numbers available was noted between the modified Outerbridge grade and T1, T1Gd, or T2 as well as between T2 and either T1 or T1Gd. CONCLUSIONS Without the need for contrast media application, T2 mapping may be a viable alternative to dGEMRIC when assessing hip cartilage at the chondrolabral junction. However, acquisition-related phenomena as well as regional variations in the microstructure of hip cartilage necessitate an internal femoral head cartilage control when interpreting these results. LEVEL OF EVIDENCE Level IV, diagnostic study.
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Affiliation(s)
- Tobias Hesper
- grid.2515.30000000403788438Department of Orthopedic Surgery, Boston Children’s Hospital, 300 Longwood Avenue, Boston, MA 02115 USA
| | - Evgeny Bulat
- grid.2515.30000000403788438Department of Orthopedic Surgery, Boston Children’s Hospital, 300 Longwood Avenue, Boston, MA 02115 USA
| | - Sarah Bixby
- grid.2515.30000000403788438Department of Radiology, Boston Children’s Hospital, Boston, MA USA
| | - Alireza Akhondi-Asl
- grid.2515.30000000403788438Division of Critical Care Medicine, Department of Anesthesiology, Perioperative and Pain Medicine, Boston Children’s Hospital, Boston, MA USA ,grid.38142.3c000000041936754XHarvard Medical School, Boston, MA USA
| | - Onur Afacan
- grid.2515.30000000403788438Department of Radiology, Boston Children’s Hospital, Boston, MA USA
| | - Patricia Miller
- grid.2515.30000000403788438Department of Orthopedic Surgery, Boston Children’s Hospital, 300 Longwood Avenue, Boston, MA 02115 USA
| | - Garrett Bowen
- grid.2515.30000000403788438Department of Orthopedic Surgery, Boston Children’s Hospital, 300 Longwood Avenue, Boston, MA 02115 USA
| | - Simon Warfield
- grid.2515.30000000403788438Department of Radiology, Boston Children’s Hospital, Boston, MA USA
| | - Young-Jo Kim
- grid.2515.30000000403788438Department of Orthopedic Surgery, Boston Children’s Hospital, 300 Longwood Avenue, Boston, MA 02115 USA
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13
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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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A narrative overview of the current status of MRI of the hip and its relevance for osteoarthritis research - what we know, what has changed and where are we going? Osteoarthritis Cartilage 2017; 25:1-13. [PMID: 27621214 DOI: 10.1016/j.joca.2016.08.015] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/24/2016] [Revised: 08/24/2016] [Accepted: 08/28/2016] [Indexed: 02/02/2023]
Abstract
OBJECTIVE To review and discuss the role of magnetic resonance imaging (MRI) in the context of hip osteoarthritis (OA) research. DESIGN The content of this narrative review, based on an extensive PubMed database research including English literature only, describes the advances in MRI of the hip joint and its potential usefulness in hip OA research, reviews the relevance of different MRI features in regard to symptomatic and structural progression in hip OA, and gives an outlook regarding future use of MRI in hip OA research endeavors. RESULTS Recent technical advances have helped to overcome many of the past difficulties related to MRI assessment of hip OA. MRI-based morphologic scoring systems allow for detailed assessment of several hip joint tissues and, in combination with the recent advances in MRI, may increase reproducibility and sensitivity to change. Compositional MRI techniques may add to our understanding of disease onset and progression. Knowledge about imaging pitfalls and anatomical variants is crucial to avoid misinterpretation. In comparison to research on knee OA, the associations between MRI features and the incidence and progression of disease as well as with clinical symptoms have been little explored. Anatomic alterations of the hip joint as seen in femoro-acetabular impingement (FAI) seem to play a role in the onset and progression of structural damage. CONCLUSIONS With the technical advances occurring in recent years, MRI may play a major role in investigating the natural history of hip OA and provide an improved method for assessment of the efficacy of new therapeutic approaches.
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15
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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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Residual hip dysplasia at 1 year after treatment for neonatal hip instability is not related to degenerative joint disease in young adulthood: a 21-year follow-up study including dGEMRIC. Osteoarthritis Cartilage 2016; 24:436-42. [PMID: 26521012 DOI: 10.1016/j.joca.2015.10.010] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/15/2015] [Revised: 09/11/2015] [Accepted: 10/21/2015] [Indexed: 02/02/2023]
Abstract
OBJECTIVE Developmental dysplasia of the hip (DDH) is associated with an increased risk of early hip osteoarthritis (OA). We aimed to examine the outcome at the completion of growth in a cohort of children who had residual acetabular dysplasia at age 1 year following early treatment for neonatal instability of the hip (NIH). DESIGN We examined 21 of 30 subjects who had been treated with the von Rosen splint neonatally for NIH and had residual acetabular dysplasia at age 1 year. Mean follow-up time was 21 years (range 17-24). Signs of OA and acetabular dysplasia were assessed by radiography. Cartilage quality was assessed by delayed Gadolinium Enhanced Magnetic Resonance Imaging of Cartilage (dGEMRIC), a tool for molecular imaging of cartilage quality, at 1.5 T. Patient reported outcome (PRO) was assessed by the 12-item WOMAC score. RESULTS No study participant had radiographic OA (defined as Kellgren-Lawrence grade ≥2) or minimum joint space width (JSW) ≤2 mm. The mean dGEMRIC index was 630 ms (95% CI: 600-666, range: 516-825) suggesting good cartilage quality. The mean 12-item WOMAC score was 1.2. Two of three radiographic measurements of DDH correlated positively to the dGEMRIC index. CONCLUSIONS Children treated neonatally for NIH have good hip function and no signs of cartilage degeneration at 21-year follow-up, despite residual dysplasia at age 1 year. Unexpectedly, radiographic signs of dysplasia were associated with better cartilage quality, as assessed with dGEMRIC. This may indicate cartilage adaptation to increased mechanical stress in mild hip dysplasia.
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Bulat E, Bixby SD, Siversson C, Kalish LA, Warfield SK, Kim YJ. Planar dGEMRIC Maps May Aid Imaging Assessment of Cartilage Damage in Femoroacetabular Impingement. Clin Orthop Relat Res 2016; 474:467-78. [PMID: 26304042 PMCID: PMC4709317 DOI: 10.1007/s11999-015-4522-4] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
BACKGROUND Three-dimensional (3-D) delayed gadolinium-enhanced MRI of cartilage (dGEMRIC) helps quantify biochemical changes in articular cartilage that correlate with early-stage osteoarthritis. However, dGEMRIC analysis is performed slice by slice, limiting the potential of 3-D data to give an overall impression of cartilage biochemistry. We previously developed a computational algorithm to produce unfolded, or "planar," dGEMRIC maps of acetabular cartilage, but have neither assessed their application nor determined whether MRI-based grading of cartilage damage or dGEMRIC measurements predict intraoperative findings in hips with symptomatic femoroacetabular impingement (FAI). QUESTIONS/PURPOSES (1) Does imaging-based assessment of acetabular cartilage damage correlate with intraoperative findings in hips with symptomatic FAI? (2) Does the planar dGEMRIC map improve this correlation? (3) Does the planar map improve the correlation between the dGEMRIC index and MRI-based grading of cartilage damage in hips with symptomatic FAI? (4) Does the planar map improve imaging-based evaluation time for hips with symptomatic FAI? METHODS We retrospectively studied 47 hips of 45 patients with symptomatic FAI who underwent hip surgery between 2009 and 2013 and had a 1.5-T 3-D dGEMRIC scan within 6 months preoperatively. Our cohort included 25 males and 20 females with a mean ± SD age at surgery of 29 ± 11 years. Planar dGEMRIC maps were generated from isotropic, sagittal oblique TrueFISP and T1 sequences. A pediatric musculoskeletal radiologist with experience in hip MRI evaluated studies using radially reformatted sequences. For six acetabular subregions (anterior-peripheral [AP]; anterior-central [AC]; superior-peripheral [SP]; superior-central [SC]; posterior-peripheral [PP]; posterior-central [PC]), modified Outerbridge cartilage damage grades were recorded and region-of-interest T1 averages (the dGEMRIC index) were measured. Beck's intraoperative cartilage damage grades were compared with the Outerbridge grades and dGEMRIC indices. For a subset of 26 hips, 13 were reevaluated with the map and 13 without the map, and total evaluation times were recorded. RESULTS There were no meaningful differences in the correlations obtained with versus without referencing the planar maps. Planar map-independent Outerbridge grades had a notable (p < 0.05) Spearman's rank correlation (ρ) with Beck's grades that was moderate in AP, SC, and PC (0.3 < ρ < 0.5) and strong in SP (ρ > 0.5). For map-dependent Outerbridge grades, ρ was moderate in AP, AC, and SC and strong in SP. Map-independent dGEMRIC indices had a ρ with Beck's grades that was moderate in AP and SC (-0.3 > ρ > -0.5) and strong in SP (ρ < -0.5). For map-dependent dGEMRIC indices, ρ was moderate in SC and strong in SP. Similarly, there were no meaningful, map-dependent differences in the correlations. When comparing Outerbridge grades and dGEMRIC indices, there were notable correlations across all subregions. Without the planar map, ρ was moderate in AC and PC and strong in AP, SP, SC, and PP. With the map, ρ was strong in all six subregions. In AC, there was a notable map-dependent improvement in this correlation (p < 0.001). Finally, referencing the planar dGEMRIC map during evaluation was associated with a decrease in mean evaluation time, from 207 ± 32 seconds to 152 ± 33 seconds (p = 0.001). CONCLUSIONS Our work challenges the weak correlation between dGEMRIC and intraoperative findings of cartilage damage that was previously reported in hips with symptomatic FAI, suggesting that dGEMRIC has potential diagnostic use for this patient population. The planar dGEMRIC maps did not meaningfully alter the correlation of imaging-based evaluation of cartilage damage with intraoperative findings; however, they notably improved the correlation of dGEMRIC and MRI-based grading in AC, and their use incurred no additional time cost to imaging-based evaluation. Therefore, the planar maps may improve dGEMRIC's use as a continuous proxy for an otherwise discrete and simplified MRI-based grade of cartilage damage in hips with symptomatic FAI. LEVEL OF EVIDENCE Level III, diagnostic study.
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Affiliation(s)
- Evgeny Bulat
- Department of Orthopedic Surgery, Boston Children's Hospital, 300 Longwood Avenue, Boston, MA, 02115, USA
| | - Sarah D Bixby
- Department of Radiology, Boston Children's Hospital, Boston, MA, USA
| | - Carl Siversson
- Department of Medical Radiation Physics, Lund University, Skåne University Hospital, Malmö, Sweden
| | - Leslie A Kalish
- Clinical Research Center, Boston Children's Hospital, Boston, MA, USA
| | - Simon K Warfield
- Department of Radiology, Boston Children's Hospital, Boston, MA, USA
| | - Young-Jo Kim
- Department of Orthopedic Surgery, Boston Children's Hospital, 300 Longwood Avenue, Boston, MA, 02115, USA.
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Does periacetabular osteotomy have depth-related effects on the articular cartilage of the hip? Clin Orthop Relat Res 2015; 473:3735-43. [PMID: 26329795 PMCID: PMC4626520 DOI: 10.1007/s11999-015-4545-x] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
BACKGROUND Osteoarthritis may result from abnormal mechanics leading to biochemically mediated degradation of cartilage. In a dysplastic hip, the periacetabular osteotomy (PAO) is designed to normalize the mechanics and our initial analysis suggests that it may also alter the cartilage biochemical composition. Articular cartilage structure and biology vary with the depth from the articular surface including the concentration of glycosaminoglycans (GAG), which are the charge macromolecules that are rapidly turned over and are lost in early osteoarthritis. Delayed gadolinium-enhanced magnetic resonance imaging of cartilage (dGEMRIC) enables noninvasive measurement of cartilage GAG content. The dGEMRIC index represents an indirect measure of GAG concentration with lower values indicating less GAG content. GAG content can normally vary with mechanical loading; however, progressive loss of GAG is associated with osteoarthritis. By looking at the changes in amounts of GAG in response to a PAO at different depths of cartilage, we may gain further insights into the types of biologic events that are occurring in the joint after a PAO. QUESTIONS/PURPOSES We (1) measured the GAG content in the superficial and deep zones for the entire joint before and after PAO; and (2) investigated if the changes in the superficial and deep zone GAG content after PAO varied with different locations within the joint. METHODS This prospective study included 37 hips in 37 patients (mean age 26 ± 9 years) who were treated with periacetabular osteotomy for symptomatic acetabular dysplasia and had preoperative and 1-year follow up dGEMRIC scans. Twenty-eight of the 37 also had 2-year scans. Patients were eligible if they had symptomatic acetabular dysplasia with lateral center-edge angle < 20° and no or minimal osteoarthritis. The change in dGEMRIC after surgery was assessed in the superficial and deep cartilage zones at five acetabular radial planes. RESULTS The mean ± SD dGEMRIC index in the superficial zone fell from 480 ± 137 msec preoperatively to 409 ± 119 msec at Year 1 (95% confidence interval [CI], -87 to -54; p < 0.001) and recovered to 451 ± 115 msec at Year 2 (95% CI, 34-65; p < 0.001), suggesting that there is a transient event that causes the biologically sensitive superficial layer to lose GAG. In the deep acetabular cartilage zone, dGEMRIC index fell from 527 ± 148 msec preoperatively to 468 ± 143 msec at Year 1 (95% CI, -66 to -30; p < 0.001) and recovered to 494 ± 125 msec at Year 2 (95% CI, 5-32; p = 0.008). When each acetabular radial plane was looked at separately, the change from before surgery to 1 year after was confined to zones around the superior part of the joint. The only significant change from 1 to 2 years was an increase in the superficial layer of the superior zone (1 year 374 ± 123 msec, 2 year 453 ± 117 msec, p < 0.006). CONCLUSIONS This study suggests that PAO may alter the GAG content of the articular cartilage with a greater effect on the superficial zone compared with the deeper acetabular cartilage zone, especially at the superior aspect of the joint. Some surgeons have observed that surgery itself can be a stressor that can accelerate joint degeneration. Perhaps the decrease in dGEMRIC index seen in the superficial layer may be a catabolic response to postsurgical inflammation given that some recovery was seen at 2 years. The decrease in dGEMRIC index in the deep layer seen mainly near the superior part of the joint is persistent and may represent a response of articular cartilage to normalization of increased mechanical load seen in this region after osteotomy, which may be a normal response to alteration in loading. CLINICAL RELEVANCE This study looks at the biochemical changes in the articular cartilage before and after a PAO for dysplastic hips using MRI in a similar manner to using histological methods to study alterations in articular cartilage with mechanical loading. Although PAO alters alignment and orientation of the acetabulum, its effects on cartilage biology are not clear. dGEMRIC provides a noninvasive method of assessing these effects.
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Jackson KA, Glyn-Jones S, Batt ME, Arden NK, Newton JL. Assessing risk factors for early hip osteoarthritis in activity-related hip pain: a Delphi study. BMJ Open 2015; 5:e007609. [PMID: 26419679 PMCID: PMC4593156 DOI: 10.1136/bmjopen-2015-007609] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
OBJECTIVE Hip pain and injury as a result of activity can lead to the development of early hip osteoarthritis (OA) in susceptible individuals. Our understanding of the factors that increase susceptibility continues to evolve. The ability to clearly identify individuals (and cohorts) with activity-related hip pain who are at risk of early hip OA is currently lacking. The purpose of this study was to gain expert consensus on which key clinical measures might help predict the risk of early hip OA in individuals presenting with activity-related hip pain. The agreed measures would constitute a standardised approach to initial clinical assessment to help identify these individuals. METHODS This Dephi study used online surveys to gain concordance of expert opinion in a structured process of 'rounds'. In this study, we asked 'What outcome measures are useful in predicting hip OA in activity-related hip pain?' The Delphi panel consisted of experts from sport and exercise medicine, orthopaedics, rheumatology, physiotherapy and OA research. RESULTS The study identified key clinical measures in the history, examination and investigations (plain anteroposterior radiograph and femoroacetabular impingement views) that the panel agreed would be useful in predicting future risk of hip OA when assessing activity-related hip pain. The panel also agreed that certain investigations and tests (eg, MR angiography) did not currently have a role in routine assessment. There was a lack of consensus regarding the role of MRI, patient-reported outcome measures (PROMs) and certain biomechanical and functional assessments. CONCLUSIONS We provide a standardised approach to the clinical assessment of patients with activity-related hip pain. Assessment measures rejected by the Delphi panel were newer, more expensive investigations that currently lack evidence. Assessment measures that did not reach consensus include MRI and PROMs. Their role remains ambiguous and would benefit from further research.
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Affiliation(s)
- K A Jackson
- Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, Arthritis Research UK Centre for Sport, Exercise and Osteoarthritis, University of Oxford, Botnar Research Centre, Oxford, UK
| | - S Glyn-Jones
- Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, Arthritis Research UK Centre for Sport, Exercise and Osteoarthritis, University of Oxford, Botnar Research Centre, Oxford, UK
| | - M E Batt
- Arthritis Research UK Centre for Sport, Exercise and Osteoarthritis, Queen's Medical Centre, Nottingham, UK
| | - N K Arden
- Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, Arthritis Research UK Centre for Sport, Exercise and Osteoarthritis, University of Oxford, Botnar Research Centre, Oxford, UK
| | - J L Newton
- Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, Arthritis Research UK Centre for Sport, Exercise and Osteoarthritis, University of Oxford, Botnar Research Centre, Oxford, UK
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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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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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22
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Magnetic resonance imaging findings compared with histological findings of the labrum in hip osteoarthritis. Skeletal Radiol 2015; 44:767-75. [PMID: 25616616 DOI: 10.1007/s00256-015-2096-6] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/31/2014] [Revised: 12/24/2014] [Accepted: 01/05/2015] [Indexed: 02/02/2023]
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OARSI Clinical Trials Recommendations: Hip imaging in clinical trials in osteoarthritis. Osteoarthritis Cartilage 2015; 23:716-31. [PMID: 25952344 PMCID: PMC4430132 DOI: 10.1016/j.joca.2015.03.004] [Citation(s) in RCA: 44] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/25/2014] [Revised: 03/01/2015] [Accepted: 03/09/2015] [Indexed: 02/02/2023]
Abstract
Imaging of hip in osteoarthritis (OA) has seen considerable progress in the past decade, with the introduction of new techniques that may be more sensitive to structural disease changes. The purpose of this expert opinion, consensus driven recommendation is to provide detail on how to apply hip imaging in disease modifying clinical trials. It includes information on acquisition methods/techniques (including guidance on positioning for radiography, sequence/protocol recommendations/hardware for magnetic resonance imaging (MRI)); commonly encountered problems (including positioning, hardware and coil failures, artifacts associated with various MRI sequences); quality assurance/control procedures; measurement methods; measurement performance (reliability, responsiveness, and validity); recommendations for trials; and research recommendations.
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Hingsammer AM, Kalish LA, Stelzeneder D, Bixby S, Mamisch TC, Connell P, Millis MB, Kim YJ. Does periacetabular osteotomy for hip dysplasia modulate cartilage biochemistry? J Bone Joint Surg Am 2015; 97:544-50. [PMID: 25834078 DOI: 10.2106/jbjs.m.01233] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
BACKGROUND The aim of periacetabular osteotomy is to improve joint mechanics in patients with developmental dysplasia of the hip. In our study, we tried to determine whether the proteoglycan content, as measured with delayed gadolinium-enhanced magnetic resonance imaging of cartilage (dGEMRIC), can be modulated with the alteration of the hip joint biomechanics. METHODS In this prospective cohort study, thirty-seven patients (thirty-seven hips) with no or minimal osteoarthritis were treated with periacetabular osteotomy for symptomatic acetabular dysplasia. All patients had preoperative and one-year follow-up dGEMRIC scans. Twenty-eight of the thirty-seven also had two-year scans. The changes in dGEMRIC findings and hip morphology between the preoperative visit and the examinations at one and two years following the periacetabular osteotomy were assessed. RESULTS The mean preoperative dGEMRIC index (and standard deviation) was 561.6 ± 117.6 ms; this decreased to 515.2 ± 118.4 ms at one year after periacetabular osteotomy but subsequently recovered to 529.2 ± 99.1 ms at two years postoperatively. The decrease in the dGEMRIC index of the acetabular cartilage after surgery appears to be most pronounced at the superior aspect of the acetabulum, where the decrease in mechanical loading after periacetabular osteotomy would be most pronounced. All domains of the Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) demonstrated significant improvement from the preoperative to the postoperative visits (all p < 0.001). CONCLUSIONS Periacetabular osteotomy for developmental dysplasia of the hip appears to alter the mechanical loading of articular cartilage in the hip, which in turn alters the cartilage matrix composition, as demonstrated by dGEMRIC.
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Affiliation(s)
- Andreas M Hingsammer
- Department of Orthopaedic Surgery, Child and Adult Hip Program (A.M.H., D.S., P.C., M.B.M., and Y.-J. K.), Clinical Research Program (L.A.K.), and Department of Radiology (S.B.), Boston Children's Hospital, 300 Longwood Avenue, Hunnewell 225, Boston, MA 02115. E-mail address for Y.-J. Kim:
| | - Leslie A Kalish
- Department of Orthopaedic Surgery, Child and Adult Hip Program (A.M.H., D.S., P.C., M.B.M., and Y.-J. K.), Clinical Research Program (L.A.K.), and Department of Radiology (S.B.), Boston Children's Hospital, 300 Longwood Avenue, Hunnewell 225, Boston, MA 02115. E-mail address for Y.-J. Kim:
| | - David Stelzeneder
- Department of Orthopaedic Surgery, Child and Adult Hip Program (A.M.H., D.S., P.C., M.B.M., and Y.-J. K.), Clinical Research Program (L.A.K.), and Department of Radiology (S.B.), Boston Children's Hospital, 300 Longwood Avenue, Hunnewell 225, Boston, MA 02115. E-mail address for Y.-J. Kim:
| | - Sarah Bixby
- Department of Orthopaedic Surgery, Child and Adult Hip Program (A.M.H., D.S., P.C., M.B.M., and Y.-J. K.), Clinical Research Program (L.A.K.), and Department of Radiology (S.B.), Boston Children's Hospital, 300 Longwood Avenue, Hunnewell 225, Boston, MA 02115. E-mail address for Y.-J. Kim:
| | - Tallal Charles Mamisch
- Department of Orthopaedic Surgery, Inselspital Bern, University of Bern, 3010 Bern, Switzerland
| | - Patricia Connell
- Department of Orthopaedic Surgery, Child and Adult Hip Program (A.M.H., D.S., P.C., M.B.M., and Y.-J. K.), Clinical Research Program (L.A.K.), and Department of Radiology (S.B.), Boston Children's Hospital, 300 Longwood Avenue, Hunnewell 225, Boston, MA 02115. E-mail address for Y.-J. Kim:
| | - Michael B Millis
- Department of Orthopaedic Surgery, Child and Adult Hip Program (A.M.H., D.S., P.C., M.B.M., and Y.-J. K.), Clinical Research Program (L.A.K.), and Department of Radiology (S.B.), Boston Children's Hospital, 300 Longwood Avenue, Hunnewell 225, Boston, MA 02115. E-mail address for Y.-J. Kim:
| | - Young-Jo Kim
- Department of Orthopaedic Surgery, Child and Adult Hip Program (A.M.H., D.S., P.C., M.B.M., and Y.-J. K.), Clinical Research Program (L.A.K.), and Department of Radiology (S.B.), Boston Children's Hospital, 300 Longwood Avenue, Hunnewell 225, Boston, MA 02115. E-mail address for Y.-J. Kim:
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Siversson C, Akhondi-Asl A, Bixby S, Kim YJ, Warfield SK. Three-dimensional hip cartilage quality assessment of morphology and dGEMRIC by planar maps and automated segmentation. Osteoarthritis Cartilage 2014; 22:1511-5. [PMID: 25278060 PMCID: PMC4404159 DOI: 10.1016/j.joca.2014.08.012] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/01/2014] [Revised: 08/11/2014] [Accepted: 08/24/2014] [Indexed: 02/02/2023]
Abstract
OBJECTIVE The quantitative interpretation of hip cartilage magnetic resonance imaging (MRI) has been limited by the difficulty of identifying and delineating the cartilage in a three-dimensional (3D) dataset, thereby reducing its routine usage. In this paper a solution is suggested by unfolding the cartilage to planar two-dimensional (2D) maps on which both morphology and biochemical degeneration patterns can be investigated across the entire hip joint. DESIGN Morphological TrueFISP and biochemical delayed gadolinium enhanced MRI of cartilage (dGEMRIC) hip images were acquired isotropically for 15 symptomatic subjects with mild or no radiographic osteoarthritis (OA). A multi-template based label fusion technique was used to automatically segment the cartilage tissue, followed by a geometric projection algorithm to generate the planar maps. The segmentation performance was investigated through a leave-one-out study, for two different fusion methods and as a function of the number of utilized templates. RESULTS For each of the generated planar maps, various patterns could be seen, indicating areas of healthy and degenerated cartilage. Dice coefficients for cartilage segmentation varied from 0.76 with four templates to 0.82 with 14 templates. Regional analysis suggests even higher segmentation performance in the superior half of the cartilage. CONCLUSIONS The proposed technique is the first of its kind to provide planar maps that enable straightforward quantitative assessment of hip cartilage morphology and dGEMRIC values. This technique may have important clinical applications for patient selection for hip preservation surgery, as well as for epidemiological studies of cartilage degeneration patterns. It is also shown that 10-15 templates are sufficient for accurate segmentation in this application.
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Affiliation(s)
- Carl Siversson
- Computational Radiology Laboratory, Boston Children's Hospital, Harvard Medical School, Boston, MA, United States,Department of Medical Radiation Physics, Lund University, Malmö, Sweden
| | - Alireza Akhondi-Asl
- Computational Radiology Laboratory, Boston Children's Hospital, Harvard Medical School, Boston, MA, United States
| | - Sarah Bixby
- Department of Radiology, Boston Children's Hospital, Harvard Medical School, Boston, MA, United States
| | - Young-Jo Kim
- Department of Orthopaedic Surgery, Boston Children's Hospital, Harvard Medical School, Boston, MA, United States
| | - Simon K. Warfield
- Computational Radiology Laboratory, Boston Children's Hospital, Harvard Medical School, Boston, MA, United States
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Riley GM, McWalter EJ, Stevens KJ, Safran MR, Lattanzi R, Gold GE. MRI of the hip for the evaluation of femoroacetabular impingement; past, present, and future. J Magn Reson Imaging 2014; 41:558-72. [PMID: 25155435 DOI: 10.1002/jmri.24725] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2014] [Accepted: 07/21/2014] [Indexed: 11/07/2022] Open
Abstract
The concept of femoroacetabular impingement (FAI) has, in a relatively short time, come to the forefront of orthopedic imaging. In just a few short years MRI findings that were in the past ascribed to degenerative change, normal variation, or other pathologies must now be described and included in radiology reports, as they have been shown, or are suspected to be related to, FAI. Crucial questions have come up in this time, including: what is the relationship of bony morphology to subsequent cartilage and labral damage, and most importantly, how is this morphology related to the development of osteoarthritis? In this review, we attempt to place a historical perspective on the controversy, provide guidelines for interpretation of MRI examinations of patients with suspected FAI, and offer a glimpse into the future of MRI of this complex condition.
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Affiliation(s)
- Geoffrey M Riley
- Department of Radiology, Stanford University, Stanford, California, USA
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27
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Lattanzi R, Petchprapa C, Ascani D, Babb JS, Chu D, Davidovitch RI, Youm T, Meislin RJ, Recht MP. Detection of cartilage damage in femoroacetabular impingement with standardized dGEMRIC at 3 T. Osteoarthritis Cartilage 2014; 22:447-56. [PMID: 24418673 DOI: 10.1016/j.joca.2013.12.022] [Citation(s) in RCA: 35] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/10/2013] [Revised: 12/10/2013] [Accepted: 12/21/2013] [Indexed: 02/02/2023]
Abstract
OBJECTIVE This study aimed at identifying the optimal threshold value to detect cartilage lesions with Standardized delayed Gadolinium-Enhanced MRI of Cartilage (dGEMRIC) at 3 T and evaluate intra- and inter-observer repeatability. DESIGN We retrospectively reviewed 20 hips in 20 patients. dGEMRIC maps were acquired at 3 T along radial imaging planes of the hip and standardized to remove the effects of patient's age, sex and diffusion of gadolinium contrast. Two observers separately evaluated 84 Standardized dGEMRIC maps, both by visual inspection and using an average index for a region of interest (ROI) in the acetabular cartilage. A radiologist evaluated the acetabular cartilage on morphologic MR images at exactly the same locations. Using intra-operative findings as reference, the optimal threshold to detect cartilage lesions with Standardized dGEMRIC was assessed and results were compared with the diagnostic performance of morphologic magnetic resonance imaging (MRI). RESULTS Using z < -2 as threshold and visual inspection of the color-adjusted maps, sensitivity, specificity and accuracy for Observer 1 and Observer 2, were 83%, 60% and 75%, and 69%, 70% and 69%, respectively. Overall performance was 52%, 67% and 58%, when using an average z for the acetabular cartilage, compared to 37%, 90% and 56% for morphologic assessment. The kappa coefficient was 0.76 and 0.68 for intra- and inter-observer repeatability, respectively, indicating substantial agreement. CONCLUSIONS Standardized dGEMRIC at 3 T is accurate in detecting cartilage damage and could improve preoperative assessment in femoroacetabular impingement (FAI). As cartilage lesions in FAI are localized, visual inspection of the Standardized dGEMRIC maps is more accurate than an average z for the acetabular cartilage.
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Affiliation(s)
- R Lattanzi
- The Bernard and Irene Schwartz Center for Biomedical Imaging, Department of Radiology, New York University Langone Medical Center, 660 First Avenue, New York, NY 10016, USA; Department of Radiology, New York University Langone Medical Center, 550 First Avenue, New York, NY 10016, USA.
| | - C Petchprapa
- Department of Radiology, New York University Langone Medical Center, 550 First Avenue, New York, NY 10016, USA
| | - D Ascani
- The Bernard and Irene Schwartz Center for Biomedical Imaging, Department of Radiology, New York University Langone Medical Center, 660 First Avenue, New York, NY 10016, USA
| | - J S Babb
- Department of Radiology, New York University Langone Medical Center, 550 First Avenue, New York, NY 10016, USA
| | - D Chu
- Department of Radiology, New York University Langone Medical Center, 550 First Avenue, New York, NY 10016, USA
| | - R I Davidovitch
- Department of Orthopedic Surgery, New York University Hospital for Joint Diseases, 301 East 17th Street, New York, NY 10003, USA
| | - T Youm
- Department of Orthopedic Surgery, New York University Hospital for Joint Diseases, 301 East 17th Street, New York, NY 10003, USA
| | - R J Meislin
- Department of Orthopedic Surgery, New York University Hospital for Joint Diseases, 301 East 17th Street, New York, NY 10003, USA
| | - M P Recht
- Department of Radiology, New York University Langone Medical Center, 550 First Avenue, New York, NY 10016, USA
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Zilkens C, Miese F, Herten M, Kurzidem S, Jäger M, König D, Antoch G, Krauspe R, Bittersohl B. Validity of gradient-echo three-dimensional delayed gadolinium-enhanced magnetic resonance imaging of hip joint cartilage: A histologically controlled study. Eur J Radiol 2013; 82:e81-6. [DOI: 10.1016/j.ejrad.2012.09.024] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2012] [Revised: 09/13/2012] [Accepted: 09/28/2012] [Indexed: 10/27/2022]
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Is the damage of cartilage a global or localized phenomenon in hip dysplasia, measured by dGEMRIC? Clin Orthop Relat Res 2013; 471:301-7. [PMID: 23079789 PMCID: PMC3528925 DOI: 10.1007/s11999-012-2633-8] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/25/2012] [Accepted: 09/24/2012] [Indexed: 01/31/2023]
Abstract
BACKGROUND The mechanism of damage in osteoarthritis is believed to be multifactorial where mechanical and biological factors are important in its initiation and progression. Hip dysplasia is a classic model of increased mechanical loading on cartilage attributable to insufficient acetabular coverage that leads to osteoarthritis. If the damage is all attributable to direct mechanical damage then one initially would expect only local, not global changes. QUESTIONS/PURPOSES We hypothesize that in hip dysplasia although the elevated cumulative contact stresses are localized, the damage to cartilage is biologically mediated, therefore, biochemical changes will be global. METHODS Thirty-two patients with symptomatic hip dysplasia were scanned using a 1.5-T MRI scanner. We used a high-resolution three-dimensional dGEMRIC technique to characterize the distribution of cartilage damage in dysplastic hips. High-resolution isotropic acquisition was reformatted around the femoral neck axis and the dGEMRIC index was calculated separately for femoral and acetabular cartilages. Joint space widths also were evaluated in each reformatted slice. Each hip was characterized by the presence or absence of joint migration and by Tönnis grade. RESULTS The global dGEMRIC index correlated with the dGEMRIC indices of individual regions with the highest correlations occurring in the anterosuperior to posterosuperior regions. The corresponding correlations for joint space width were uniformly lower, suggesting that tissue loss is a more local phenomenon. Higher Tönnis grades and hips with joint migration were associated with lower dGEMRIC indices. CONCLUSIONS The dGEMRIC index shows a global decrease, whereas tissue loss is more localized. This suggests that hip osteoarthritis in acetabular dysplasia is a biologically mediated event that affects the entire joint.
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Conventional 3-T MRI and 1.5-T MR arthrography of femoroacetabular impingement. AJR Am J Roentgenol 2012; 199:509-15. [PMID: 22915390 DOI: 10.2214/ajr.12.8672] [Citation(s) in RCA: 36] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
OBJECTIVE This article provides a review of femoroacetabular impingement (FAI) and the role MRI is attempting to fulfill in this complex and sometimes controversial condition. A perspective on the current status and on the advantages of 1.5-T MR arthrography is presented, and its usefulness in this setting is compared with the potential of nonarthrographic 3-T MRI. CONCLUSION With its increasing availability, 3-T MRI has the potential to provide routine, less invasive assessment of the hip for FAI.
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Xu L, Su Y, Kienle KP, Hayashi D, Guermazi A, Zhang J, Dai Y, Cheng X. Evaluation of radial distribution of cartilage degeneration and necessity of pre-contrast measurements using radial dGEMRIC in adults with acetabular dysplasia. BMC Musculoskelet Disord 2012; 13:212. [PMID: 23110607 PMCID: PMC3517476 DOI: 10.1186/1471-2474-13-212] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/13/2012] [Accepted: 10/11/2012] [Indexed: 12/04/2022] Open
Abstract
Background The purpose of the present study was to investigate the radial distribution patterns of cartilage degeneration in dysplastic hips at different stages of secondary osteoarthritis (OA) by using radial delayed gadolinium-enhanced magnetic resonance imaging of cartilage (dGEMRIC), and to assess whether pre-contrast measurements are necessary. Methods Thirty-five hips in 21 subjects (mean age ± SD, 27.6 ± 10.8 years) with acetabular dysplasia (lateral CE angle < 25°) were studied. Severity of OA was assessed on radiographs using Tönnis grading. Pre- (T1pre) and post-contrast T1 (T1Gd) values were measured at 7 sub-regions on radial reformatted slices acquired from a 3-dimensional (3D) T1 mapping sequence using a 1.5 T MR scanner. Values of radial T1pre, T1Gd and ΔR1 (1/T1Gd - 1/T1pre) of subgroups with different severity of OA were compared to those of the subgroup without OA using nonparametric tests, and bivariate linear Pearson correlations between radial T1Gd and ΔR1 were analyzed for each subgroup. Results Compared to the subgroup without OA, the subgroup with mild OA was observed with a significant decrease in T1Gd in the anterosuperior to superior sub-regions (mean, 476 ~ 507 ms, p = 0.026 ~ 0.042) and a significant increase in ΔR1 in the anterosuperior to superoposterior and posterior sub-regions (mean, 0.93 ~ 1.37 s-1, p = 0.012 ~ 0.042). The subgroup with moderate to severe OA was observed with a significant overall decrease in T1Gd (mean, 404 ~ 452 ms, p = 0.001 ~ 0.020) and an increase in ΔR1 (mean, 1.17 ~1.69 s-1, p = 0.001 ~ 0.020). High correlations were observed between radial T1Gd and ΔR1 for all subgroups (r = −0.869 ~ −0.944, p < 0.001). Conclusions Radial dGEMRIC without pre-contrast measurements is useful for evaluating different patterns of cartilage degeneration in the entire hip joint of patients with hip dysplasia, particularly for those in early stages of secondary OA.
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Affiliation(s)
- Li Xu
- Department of Radiology, 4th Medical College of Peking University (Beijing Jishuitan Hospital), 31 Xinjiekou East Street, Beijing, 100035, China
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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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Lattanzi R, Petchprapa C, Glaser C, Dunham K, Mikheev AV, Krigel A, Mamisch TC, Kim YJ, Rusinek H, Recht M. A new method to analyze dGEMRIC measurements in femoroacetabular impingement: preliminary validation against arthroscopic findings. Osteoarthritis Cartilage 2012; 20:1127-33. [PMID: 22771774 DOI: 10.1016/j.joca.2012.06.012] [Citation(s) in RCA: 34] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/30/2012] [Revised: 05/02/2012] [Accepted: 06/21/2012] [Indexed: 02/02/2023]
Abstract
OBJECTIVE To validate a new method to analyze delayed gadolinium-enhanced magnetic resonance imaging of cartilage (dGEMRIC) measurements in the hip for early assessment of cartilage defects in femoroacetabular impingement (FAI). METHODS We performed a retrospective review of 10 hips in 10 FAI patients, who underwent hip arthroscopy. T1-weighted images and dGEMRIC T(1) maps were acquired at 1.5 T on coronal planes, including the anterior-superior, superior, posterior-superior hip cartilage. For all slices, a region of interest (ROI) was defined over the central portion of the femoral cartilage, assumed to be healthy, and T1 values (x) were transformed to standard scores (z) using z = (x -μ)/σ, where μ and σ are the average and standard deviation of T1 in the femoral ROI. Diagnostic performance of the resulting standardized dGEMRIC maps was evaluated against intraoperative findings and compared with that of a previously proposed dGEMRIC analysis as well as morphologic assessment. RESULTS Assuming z = -2 or z = -3 as the threshold between normal and degenerated cartilage, sensitivity, specificity and accuracy were 88%, 51% and 62%, and 71%, 63% and 65%, respectively. By using T1 = 500 ms as single threshold for all dGEMRIC T1 maps, these values became 47%, 58% and 55%, whereas they were 47%, 79% and 70% for morphologic evaluation. CONCLUSIONS Standardized dGEMRIC can increase the sensitivity in detecting abnormal cartilage in FAI and has the potential to improve the clinical interpretation of dGEMRIC measurements in FAI, by removing the effect of inter- and intra-patient T1 variability.
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Affiliation(s)
- R Lattanzi
- The Bernard and Irene Schwartz Center for Biomedical Imaging, Department of Radiology, New York University Langone Medical Center, New York, NY 10016, USA.
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Stelzeneder D, Mamisch TC, Kress I, Domayer SE, Werlen S, Bixby SD, Millis MB, Kim YJ. Patterns of joint damage seen on MRI in early hip osteoarthritis due to structural hip deformities. Osteoarthritis Cartilage 2012; 20:661-9. [PMID: 22469848 DOI: 10.1016/j.joca.2012.03.014] [Citation(s) in RCA: 59] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/29/2011] [Revised: 02/24/2012] [Accepted: 03/24/2012] [Indexed: 02/02/2023]
Abstract
OBJECTIVE The aim of this study was to evaluate differences in damage patterns assessed using magnetic resonance imaging (MRI) between hips with femoroacetabular impingement (FAI) and developmental dysplasia of the hip (DDH) as well as to correlate MRI findings with delayed Gadolinium enhanced MRI of cartilage (dGEMRIC) and with patient pain. DESIGN This retrospective study included 40 patients (mean age 28.6 ± 11.2 years) who underwent dGEMRIC and morphological MRI of the hip. Twenty-one hips with FAI and 19 with DDH were investigated. A self-developed morphological grading (MRI score) and dGEMRIC evaluation were done on seven radial reformats obtained from an isotropic 3D True-fast imaging with steady state precession (FISP) sequence and an isotropic T1-mapping sequence. The observed damage patterns were summed up into sub-scores and a total MRI score. RESULTS Labrum damage, paralabral cysts, and acetabular rim bone cysts were more common in DDH patients than in FAI patients. No significant differences were seen in the occurrence of cartilage damage, bone cysts, or osteophytes. In DDH (but not in FAI), the dGEMRIC index demonstrated a tendency for lower values in areas next to cartilage defects. There was no association between labrum damage and dGEMRIC index. A moderate correlation was seen between Western Ontario and McMaster Universities (WOMAC) pain score and cartilage damage, paralabral cysts, and the total MRI score. CONCLUSIONS This study confirms a higher prevalence of labrum damage but not cartilage damage in patients with DDH in comparison to patients with FAI. In addition, our data suggests an association of cartilage damage and paralabral cysts with patient reported pain.
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Affiliation(s)
- D Stelzeneder
- Department of Orthopaedic Surgery, Children's Hospital Boston, Harvard Medical School, Boston, MA 02115, USA
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Zilkens C, Miese F, Kim YJ, Hosalkar H, Antoch G, Krauspe R, Bittersohl B. Three-dimensional delayed gadolinium-enhanced magnetic resonance imaging of hip joint cartilage at 3T: a prospective controlled study. Eur J Radiol 2012; 81:3420-5. [PMID: 22591759 DOI: 10.1016/j.ejrad.2012.04.008] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2012] [Revised: 04/09/2012] [Accepted: 04/10/2012] [Indexed: 10/28/2022]
Abstract
PURPOSE To assess acetabular and femoral hip joint cartilage with three-dimensional (3D) delayed gadolinium-enhanced magnetic resonance imaging (dGEMRIC) in patients with degeneration of hip joint cartilage and asymptomatic controls with morphologically normal appearing cartilage. METHODS AND MATERIALS A total of 40 symptomatic patients (18 males, 22 females; mean age: 32.8±10.2 years, range: 18-57 years) with different hip joint deformities including femoroacetabular impingement (n=35), residual hip dysplasia (n=3) and coxa magna due to Legg-Calve-Perthes disease in childhood (n=2) underwent high-resolution 3D dGEMRIC for the evaluation of acetabular and femoral hip joint cartilage. Thirty-one asymptomatic healthy volunteers (12 males, 19 females; mean age: 24.5±1.8 years, range: 21-29 years) without underlying hip deformities were included as control. MRI was performed at 3 T using a body matrix phased array coil. Region of interest (ROI) analyses for T1Gd assessment was performed in seven regions in the hip joint, including anterior to superior and posterior regions. RESULTS T1Gd mapping demonstrated the typical pattern of acetabular cartilage consistent with a higher glycosaminoglycan (GAG) content in the main weight-bearing area. T1Gd values were significantly higher in the control group than in the patient group whereas significant differences in T1Gd values corresponding to the amount of cartilage damage were noted both in the patient group and in the control group. CONCLUSIONS Our study demonstrates the potential of high-resolution 3D dGEMRIC at 3 T for separate acetabular and femoral hip joint cartilage assessment in various forms of hip joint deformities.
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Affiliation(s)
- Christoph Zilkens
- University Dusseldorf, Medical Faculty, Department of Orthopaedic Surgery, Moorenstraße 5, D-40225 Dusseldorf, Germany.
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Perdikakis E, Karachalios T, Katonis P, Karantanas A. Comparison of MR-arthrography and MDCT-arthrography for detection of labral and articular cartilage hip pathology. Skeletal Radiol 2011; 40:1441-7. [PMID: 21298428 DOI: 10.1007/s00256-011-1111-9] [Citation(s) in RCA: 47] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/08/2010] [Revised: 12/18/2010] [Accepted: 01/19/2011] [Indexed: 02/02/2023]
Abstract
OBJECTIVE To compare the diagnostic ability of MR arthrography (MRa) and MDCT arthrography (CTa) in depicting surgically proven hip labral tears and articular cartilage degradation. MATERIALS AND METHODS Labral pathology and articular cartilage were prospectively evaluated with MRa and CTa in 14 hips of 10 patients. The findings were evaluated by two independent observers (a musculoskeletal fellow and one senior musculoskeletal radiologist). Sensitivity, specificity, accuracy, and positive predictive value were determined using arthroscopic and open surgery findings as the standard of reference. Interobserver agreement was recorded. All images were assessed for the presence of a labral tear (according to Czerny classification) and for cartilage erosion using a 3 point scale for both methods: 1 = complete visualization-sharp edges, 2 = blurred edges fissuring-partial defects, 3 = exposed bone. The same classification was applied surgically. RESULTS Disagreement between the senior observer and the fellow observer was recorded in three cases of labral tearing with MRa and six with CTa. Disagreement was also found in four cases of cartilage erosion with both MRa and CTa. The percent sensitivity, specificity, accuracy, and positive predictive value for correctly assessing the labral tear were as follows for MRa/CTa, respectively: 100/15, 50/13, 90/14, and 90/13 (P < 0.05). The same values for cartilage assessment were 63/66, 33/40, 50/57 and 55/66 (P > 0.05). CONCLUSION Interobserver reproducibility with MRa is very good for labral tearing assessment. MRa is better for assessing labral tears. CTa shows better, but not statistically significant, demonstration of the articular cartilage.
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Affiliation(s)
- Evangelos Perdikakis
- Department of Radiology, University Hospital, University of Crete, Stavrakia, Heraklion, Greece.
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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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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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Lattanzi R, Glaser C, Mikheev AV, Petchprapa C, Mossa DJ, Gyftopoulos S, Rusinek H, Recht M, Kim D. A B1-insensitive high resolution 2D T1 mapping pulse sequence for dGEMRIC of the HIP at 3 Tesla. Magn Reson Med 2011; 66:348-55. [PMID: 21688318 DOI: 10.1002/mrm.23035] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2010] [Revised: 04/07/2011] [Accepted: 05/12/2011] [Indexed: 11/11/2022]
Abstract
Early detection of cartilage degeneration in the hip may help prevent onset and progression of osteoarthritis in young patients with femoroacetabular impingement. Delayed gadolinium-enhanced MRI of cartilage is sensitive to cartilage glycosaminoglycan loss and could serve as a diagnostic tool for early cartilage degeneration. We propose a new high resolution 2D T1 mapping saturation-recovery pulse sequence with fast spin echo readout for delayed gadolinium-enhanced magnetic resonance imaging of cartilage of the hip at 3 T. The proposed sequence was validated in a phantom and in 10 hips, using radial imaging planes, against a rigorous multipoint saturation-recovery pulse sequence with fast spin echo readout. T1 measurements by the two pulse sequences were strongly correlated (R2>0.95) and in excellent agreement (mean difference=-8.7 ms; upper and lower 95% limits of agreement=64.5 and -81.9 ms, respectively). T1 measurements were insensitive to B1+ variation as large as 20%, making the proposed T1 mapping technique suitable for 3 T.
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Affiliation(s)
- Riccardo Lattanzi
- Department of Radiology, Center for Biomedical Imaging, New York University Langone Medical Center, New York, New York 10016, USA.
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Yen YM, Millis MB. Arthroscopy Of the Pediatric and Adolescent Patient. OPER TECHN SPORT MED 2011. [DOI: 10.1053/j.otsm.2010.12.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
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