Three-dimensional delayed gadolinium-enhanced magnetic resonance imaging of hip joint cartilage at 3 T: A prospective controlled study

doi:10.1016/j.ejrad.2012.04.008

European Journal of Radiology

Volume 81, Issue 11, November 2012, Pages 3420-3425

https://doi.org/10.1016/j.ejrad.2012.04.008 Get rights and content

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 T1_Gd assessment was performed in seven regions in the hip joint, including anterior to superior and posterior regions.

Results

T1_Gd mapping demonstrated the typical pattern of acetabular cartilage consistent with a higher glycosaminoglycan (GAG) content in the main weight-bearing area. T1_Gd values were significantly higher in the control group than in the patient group whereas significant differences in T1_Gd 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.

Introduction

Anatomical variations of the hip joint are recognized precursors of premature osteoarthritis (OA): acetabular dysplasia may cause instability and cam or pincer deformities may cause femoroacetabular impingement (FAI). Both, instability and impingement can be treated surgically with interventions including pelvic osteotomies for dysplasia or hip arthroscopy or osteochondroplasty via surgical hip dislocation for FAI. These procedures are reported to be successful in early stages of cartilage degeneration but not in advanced OA. For this reason, surgical treatment according to the disease severity implies adequate and early cartilage diagnosis.

While radiography is the only validated method to assess disease progression in OA so far, its potential to evaluate treatment success in the short term is low. Delayed gadolinium-enhanced magnetic resonance imaging of cartilage (dGEMRIC) is an established modality to depict cartilage quality in vivo: before structural cartilage changes take place, the loss of cartilage glycosaminoglycans (GAG) is a known early and potentially reversible effect in the development of OA [1]. The GAG loss causes a reduction of negative cartilage fixed charge and permits negatively charged contrast agents to penetrate into the cartilage, thus focally reducing the parameter T1_Gd. Previous studies have demonstrated the feasibility and reliability of hip joint cartilage evaluation by dGEMRIC. The dGEMRIC technique has been subject to constant improvements and recent publications use a three-dimensional (3D) approach enabeling the reconstruction of radial images of the joint in an effort to precisely describe the cartilage damage pattern in focally damaged hip joints [2], [3], [4], [5]. In these studies at 1.5 T, the differentiation between acetabular and femoral cartilage was not possible. However, the separation between acetabular and femoral cartilage during region of interest (ROI) analysis might be important in order not to erroneously measure joint effusion and/or contrast agent thus leading to incorrect T1_Gd values.

The purpose of the present study was to compare acetabular and femoral hip joint cartilage with 3D dGEMRIC in patients with suspected degeneration of hip joint cartilage and asymptomatic controls with suspected normal cartilage. The study was conducted using a 3 T MRI scanner for optimal image resolution and cartilage distinction.

Section snippets

Materials and methods

The study met the regulations of the local ethic committee and all subjects provided written informed consent prior to the study.

Results

A total of 1988 ROIs in 71 individuals were assessed. These included 1120 ROIs in 40 symptomatic patients and 868 ROIs in 31 healthy volunteers. Of these, 159 ROIs in the patient group and 6 ROIs from the volunteer group were excluded due to cartilage loss and/or MR artifacts that severely compromised the T1_Gd assessment. Therefore 961 ROIs from the study group and 862 ROIs from the control group were analyzed. The mean size of the ROIs was 0.09 ± 0.03 cm² (range: 0.03–0.27 cm²).

Within the study

Discussion

Osteoarthritis (OA) of the hip joint is a common and burdensome disease that may cause disability and pain. Childhood diseases like hip dysplasia, Legg–Calve–Perthes disease (LCPD) or slipped capital femoral epiphysis (SCFE) are major etiologic contributors to the development of early hip OA.

In order to be able to treat patients according to the disease severity, the valid assessment of any grade of cartilage damage is warranted. In the past few years, our knowledge of early hip joint cartilage

Acknowledgement

The study was supported by a research grant of the “German Osteoarthritis Aid” (“Deutsche Arthrose-Hilfe e.V.”).

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T1Gd is reduced in bone marrow lesions overlying cartilage in the hip
2023, Osteoarthritis and Cartilage
Bone Marrow Lesions (BMLs) are areas in bone with high fluid signal on MRI associated with painful and progressive OA. While cartilage near BMLs in the knee has been shown to be degenerated, this relationship has not been investigated in the hip. Research question: is T1Gd lower in areas of cartilage overlying BMLs in the hip?
128 participants were recruited from a population-based study of hip pain in 20–49-year-olds. Proton-density weighted fat-suppressed and delayed Gadolinium Enhanced MR Imaging of Cartilage (dGEMRIC) images were acquired to locate BMLs and quantify hip cartilage health. BML and cartilage images were registered and cartilage was separated into BML overlying and surrounding regions. Mean T1Gd was measured in 32 participants with BMLs in both cartilage regions and in matched regions in 32 age- and sex-matched controls. Mean T1Gd in the overlying cartilage was compared using linear mixed-effects models between BML and control groups for acetabular and femoral BMLs, and between cystic and non-cystic BML groups.
Mean T1Gd of overlying cartilage was lower in the BML group compared to the control group (acetabular: −105 ms; 95% CI: −175, −35; femoral: −8 ms; 95% CI: −141, 124). Mean T1Gd in overlying cartilage was lower in cystic compared to non-cystic BML subjects, but the confidence interval is too large to provide certainty in this difference (−3 [95% CI: −126, 121]).
T1Gd is reduced in overlying cartilage in hips from a population-based sample of adults aged 20–49, which suggests BMLs are associated with local cartilage degeneration in hips.
Predictive Value of 3-T Magnetic Resonance Imaging in Diagnosing Grade 3 and 4 Chondral Lesions in the Hip
2016, Arthroscopy - Journal of Arthroscopic and Related Surgery
Citation Excerpt :
Developments in analyzing the molecular composition of articular cartilage with biochemical MRI techniques using T1, T2, T2*, or T1ρ relaxation times are showing promising results for their ability to assess, both visually and quantitatively, chondral lesions in the hip joint.24-27 Delayed gadolinium-enhanced MRI and sodium MRI have also been shown to be useful techniques for quantitative analysis of the physiological features of articular cartilage.28,29 MRI has the ability to assess water, proteoglycan, collagen, and glycosaminoglycan content within cartilage, which can help detect the earliest stages of cartilage damage.
To assess the diagnostic capability and predictive value of 3-T magnetic resonance imaging (MRI) in detecting grade 3 and 4 cartilage lesions in the hip.
From August 2010 to April 2015, patients who underwent 3-T MRI and hip arthroscopy were included in the study. Data were prospectively collected and retrospectively reviewed. A radiologist prospectively documented MRI findings, and the surgeon documented cartilage damage at arthroscopy using the Outerbridge grading system. Arthroscopy was considered the diagnostic gold standard. This study was approved by the institutional review board.
The study group comprised 606 patients, with 354 men (58%) and 252 women (42%). The mean patient age was 34 years (range, 18 to 71 years). For femoral head defects, the sensitivity was 61% (95% confidence interval [CI], 53% to 68%), specificity was 58% (95% CI, 55% to 62%), positive predictive value was 29% (95% CI, 25% to 33%), and negative predictive value was 84% (95% CI, 81% to 87%). For chondral defects of the acetabulum, the sensitivity was 80% (95% CI, 75% to 84%), specificity was 41% (95% CI, 38% to 44%), positive predictive value was 42% (95% CI, 39% to 45%), and negative predictive value was 79% (95% CI, 74% to 84%).
The results of this study showed that 3-T MRI had sensitivity, as well as specificity, for identifying chondral defects that is similar to what has been previously reported. MRI showed increased sensitivity when identifying acetabular defects compared with femoral head defects. With a low positive predictive value, MRI may be most useful in ruling out cartilage lesions.
Level III, diagnostic study.
T2* mapping and delayed gadolinium-enhanced magnetic resonance imaging in cartilage (dGEMRIC) of humeral articular cartilage-a histologically controlled study
2015, Journal of Shoulder and Elbow Surgery
Citation Excerpt :
However, another explanation for this variation is that physiologic variations exist in GAG content owing to differences in cumulative cartilage loading. This explanation is supported by superior T1Gd values in the weight-bearing superior regions of hip joint cartilage,8,48,49 which correlates with the GAG increase in this particular region.39 We recognize the need for reliable information about structure and composition of both native cartilage tissue and repair cartilage tissue in the glenohumeral joint.
Cartilage biochemical imaging modalities that include the magnetic resonance imaging (MRI) techniques of T2* mapping (sensitive to water content and collagen fiber network) and delayed gadolinium-enhanced MRI of cartilage (dGEMRIC, sensitive to the glycosaminoglycan content) can be effective instruments for early diagnosis and reliable follow-up of cartilage damage. The purpose of this study was to provide T2* mapping and dGEMRIC values in various histologic grades of cartilage degeneration in humeral articular cartilage.
A histologically controlled in vitro study was conducted that included human humeral head cartilage specimens with various histologic grades of cartilage degeneration. High-resolution, 3-dimensional (3D) T2* mapping and dGEMRIC were performed that enabled the correlation of MRI and histology data. Cartilage degeneration was graded according to the Mankin score, which evaluates surface morphology, cellularity, toluidine blue staining, and tidemark integrity. SPSS software was used for statistical analyses.
Both MRI mapping values decreased significantly (P < .001) with increasing cartilage degeneration. Spearman rank analysis revealed a significant correlation (correlation coefficients ranging from −0.315 to 0.784; P < .001) between the various histologic parameters and the T2* and T1_Gd mapping values.
This study demonstrates the feasibility of 3D T2* and dGEMRIC to identify various histologic grades of cartilage damage of humeral articular cartilage. With regard to the advantages of these mapping techniques with high image resolution and the ability to accomplish a 3D biochemically sensitive imaging, we consider that these imaging techniques can make a positive contribution to the currently evolving science and practice of cartilage biochemical imaging.
Prevalence of femoroacetabular impingement imaging findings in asymptomatic volunteers: A systematic review
2015, Arthroscopy - Journal of Arthroscopic and Related Surgery
The aim of this study was to determine the prevalence of radiographic findings suggestive of femoroacetabular impingement (FAI) in asymptomatic individuals.
A systematic review was performed using Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. Studies reporting radiographic, computed tomographic, or magnetic resonance imaging (MRI) findings that were suggestive of FAI in asymptomatic volunteers were included. Cam, pincer, and combined pathologic conditions were investigated.
We identified 26 studies for inclusion, comprising 2,114 asymptomatic hips (57.2% men; 42.8% women). The mean participant age was 25.3 ± 1.5 years. The mean alpha angle in asymptomatic hips was 54.1° ± 5.1°. The prevalence of an asymptomatic cam deformity was 37% (range, 7% to 100% between studies)—54.8% in athletes versus 23.1% in the general population. Of the 17 studies that measured alpha angles, 9 used MRI and 9 used radiography (1 study used both). The mean lateral and anterior center edge angles (CEAs) were 31.2° and 30°, respectively. The prevalence of asymptomatic hips with pincer deformity was 67% (range 61% to 76% between studies). Pincer deformity was poorly defined (4 studies [15%]; focal anterior overcoverage, acetabular retroversion, abnormal CEA or acetabular index, coxa profunda, acetabular protrusio, ischial spine sign, crossover sign, and posterior wall sign). Only 7 studies reported on labral injury, which was found on MRI without intra-articular contrast in 68.1% of hips.
FAI morphologic features and labral injuries are common in asymptomatic patients. Clinical decision making should carefully analyze the association of patient history and physical examination with radiographic imaging.
Level IV, systematic review if Level II-IV studies.
OARSI Clinical Trials Recommendations: Hip imaging in clinical trials in osteoarthritis
2015, Osteoarthritis and Cartilage
Citation Excerpt :
The Hip Inflammation MRI Scoring System (HIMRISS) has also been described but was designed only for active lesions (BML, synovitis/effusion)84,85. Cartilage biochemical composition of the hip has been quantified with T220,33,86 and T2* relaxation time measurements87, dGEMRIC31,32,66,88–96 and T1rho relaxation time measurements35. An initial study95 found high reproducibility using dGEMRIC (ICC range, 0.667–0.915) in young healthy subjects.
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.
Functional imaging in OA: Role of imaging in the evaluation of tissue biomechanics
2014, Osteoarthritis and Cartilage
Functional imaging refers broadly to the visualization of organ or tissue physiology using medical image modalities. In load-bearing tissues of the body, including articular cartilage lining the bony ends of joints, changes in strain, stress, and material properties occur in osteoarthritis (OA), providing an opportunity to probe tissue function through the progression of the disease. Here, biomechanical measures in cartilage and related joint tissues are discussed as key imaging biomarkers in the evaluation of OA. Emphasis will be placed on the (1) potential of radiography, ultrasound, and magnetic resonance imaging to assess early tissue pathomechanics in OA, (2) relative utility of kinematic, structural, morphological, and biomechanical measures as functional imaging biomarkers, and (3) improved diagnostic specificity through the combination of multiple imaging biomarkers with unique contrasts, including elastography and quantitative assessments of tissue biochemistry. In comparison to other modalities, magnetic resonance imaging provides an extensive range of functional measures at the tissue level, with conventional and emerging techniques available to potentially to assess the spectrum of preclinical to advance OA.

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Three-dimensional delayed gadolinium-enhanced magnetic resonance imaging of hip joint cartilage at 3 T: A prospective controlled study

Abstract

Purpose

Methods and materials

Results

Conclusions

Introduction

Section snippets

Materials and methods

Results

Discussion

Acknowledgement

Osteoarthritis and Cartilage

Osteoarthritis and Cartilage

MRI techniques in early stages of cartilage disease

Investigative Radiology

Delayed gadolinium-enhanced magnetic resonance imaging of cartilage (dGEMRIC) in femoacetabular impingement

Journal of Orthopaedic Research

Delayed gadolinium-enhanced magnetic resonance imaging (dGEMRIC) of hip joint cartilage in femoroacetabular impingement (FAI): are pre- and postcontrast imaging both necessary?

Magnetic Resonance in Medicine

Optimization of a dual echo in the steady state (DESS) free-precession sequence for imaging cartilage

Journal of Magnetic Resonance Imaging

Delayed gadolinium-enhanced MR imaging of articular cartilage: three-dimensional T1 mapping with variable flip angles and B1 correction

Radiology

Effects of B(1) inhomogeneity correction for three-dimensional variable flip angle T(1) measurements in hip dGEMRIC at 3 T and 1.5 T

Magnetic Resonance in Medicine

A B(1)-insensitive high resolution 2D T(1) mapping pulse sequence for dGEMRIC of the HIP at 3 Tesla

Magnetic Resonance in Medicine

Comparison of delayed gadolinium enhanced MRI of cartilage (dGEMRIC) using inversion recovery and fast T1 mapping sequences

Magnetic Resonance in Medicine

Three-dimensional delayed gadolinium-enhanced MRI of cartilage (dGEMRIC) for in vivo evaluation of reparative cartilage after matrix-associated autologous chondrocyte transplantation at 3.0 T: preliminary results

Journal of Magnetic Resonance Imaging