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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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2
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Scholes MJ, Kemp JL, Mentiplay BF, Heerey JJ, Agricola R, Semciw AI, Souza RB, Link TM, Majumdar S, King MG, Lawrenson PR, Crossley KM. Does Femoroacetabular Impingement Syndrome Affect Self-Reported Burden in Football Players With Hip and Groin Pain? Sports Health 2022; 14:920-931. [PMID: 35321607 PMCID: PMC9631050 DOI: 10.1177/19417381221076141] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
BACKGROUND It is unknown if football players with femoroacetabular impingement (FAI) syndrome report worse burden than those with other causes of hip/groin pain, and to what extent this is mediated by cartilage defects and labral tears. HYPOTHESIS Football players with FAI syndrome would report worse burden than other symptomatic players, with the effect partially mediated by cartilage defects and/or labral tears. STUDY DESIGN Cross-sectional study. LEVEL OF EVIDENCE Level 4. METHODS Football (soccer and Australian football) players (n = 165; 35 women) with hip/groin pain (≥6 months and positive flexion-adduction-internal rotation test) were recruited. Participants completed 2 patient-reported outcome measures (PROMs; the International Hip Outcome Tool-33 [iHOT-33] and Copenhagen Hip and Groin Outcome Score [HAGOS]) and underwent hip radiographs and magnetic resonance imaging (MRI). FAI syndrome was determined to be present when cam and/or pincer morphology were present. Cartilage defects and labral tears were graded as present or absent using MRI. Linear regression models investigated relationships between FAI syndrome (dichotomous independent variable) and PROM scores (dependent variables). Mediation analyses investigated the effect of cartilage defects and labral tears on these relationships. RESULTS FAI syndrome was not related to PROM scores (unadjusted b values ranged from -4.693 (P = 0.23) to 0.337 (P = 0.93)) and cartilage defects and/or labral tears did not mediate its effect (P = 0.22-0.97). CONCLUSION Football players with FAI syndrome did not report worse burden than those with other causes of hip/groin pain. Cartilage defects and/or labral tears did not explain the effect of FAI syndrome on reported burden. CLINICAL RELEVANCE FAI syndrome, cartilage defects, and labral tears were prevalent but unrelated to reported burden in symptomatic football players.
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Affiliation(s)
| | | | | | | | | | | | | | | | | | | | | | - Kay M. Crossley
- Kay M. Crossley, PT, PhD,
La Trobe Sport and Exercise Medicine Research Centre, School of Allied Health,
Human Services and Sport, La Trobe University, Bundoora, Victoria 3806,
Australia ()
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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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Automated 3D Analysis of Clinical Magnetic Resonance Images Demonstrates Significant Reductions in Cam Morphology Following Arthroscopic Intervention in Contrast to Physiotherapy. Arthrosc Sports Med Rehabil 2022; 4:e1353-e1362. [PMID: 36033193 PMCID: PMC9402425 DOI: 10.1016/j.asmr.2022.04.020] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/27/2021] [Accepted: 04/19/2022] [Indexed: 11/25/2022] Open
Abstract
Purpose To obtain automated measurements of cam volume, surface area, and height from baseline (preintervention) and 12-month magnetic resonance (MR) images acquired from male and female patients allocated to physiotherapy (PT) or arthroscopic surgery (AS) management for femoroacetabular impingement (FAI) in the Australian FASHIoN trial. Methods An automated segmentation pipeline (CamMorph) was used to obtain cam morphology data from three-dimensional (3D) MR hip examinations in FAI patients classified with mild, moderate, or major cam volumes. Pairwise comparisons between baseline and 12-month cam volume, surface area, and height data were performed within the PT and AS patient groups using paired t-tests or Wilcoxon signed-rank tests. Results A total of 43 patients were included with 15 PT patients (9 males, 6 females) and 28 AS patients (18 males, 10 females) for premanagement and postmanagement cam morphology assessments. Within the PT male and female patient groups, there were no significant differences between baseline and 12-month mean cam volume (male: 1269 vs 1288 mm3, t[16] = −0.39; female: 545 vs 550 mm,3t[10] = −0.78), surface area (male: 1525 vs 1491 mm2, t[16] = 0.92; female: 885 vs 925 mm,2t[10] = −0.78), maximum height (male: 4.36 vs 4.32 mm, t[16] = 0.34; female: 3.05 vs 2.96 mm, t[10] = 1.05) and average height (male: 2.18 vs 2.18 mm, t[16] = 0.22; female: 1.4 vs 1.43 mm, t[10] = −0.38). In contrast, within the AS male and female patient groups, there were significant differences between baseline and 12-month cam volume (male: 1343 vs 718 mm3, W = 0.0; female: 499 vs 240 mm3, t[18] = 2.89), surface area (male: 1520 vs 1031 mm2, t(34) = 6.48; female: 782 vs 483 mm2, t(18) = 3.02), maximum-height (male: 4.3 vs 3.42 mm, W = 13.5; female: 2.85 vs 2.24 mm, t(18) = 3.04) and average height (male: 2.17 vs 1.52 mm, W = 3.0; female: 1.4 vs 0.94 mm, W = 3.0). In AS patients, 3D bone models provided good visualization of cam bone mass removal postostectomy. Conclusions Automated measurement of cam morphology from baseline (preintervention) and 12-month MR images demonstrated that the cam volume, surface area, maximum-height, and average height were significantly smaller in AS patients following ostectomy, whereas there were no significant differences in these cam measures in PT patients from the Australian FASHIoN study. Level of Evidence Level II, cohort study.
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5
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Mahmoud SSS, Takla A, Meyer D, Griffin D, O’Donnell J. Arthroscopic hip surgery offers better early patient-reported outcome measures than targeted physiotherapy programs for the treatment of femoroacetabular impingement syndrome: a systematic review and meta-analysis of randomized controlled trials. J Hip Preserv Surg 2022; 9:107-118. [PMID: 35854801 PMCID: PMC9291355 DOI: 10.1093/jhps/hnac012] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/29/2022] [Revised: 03/01/2021] [Accepted: 02/10/2022] [Indexed: 02/04/2023] Open
Abstract
Targeted physiotherapy programs (TPP), and surgery, using either open surgical hip dislocation or hip arthroscopy (HA), are the treatment modalities available for femoroacetabular impingement syndrome (FAIS). Randomized controlled trials have recently been performed to compare these treatment options. This review was performed to provide a focused synthesis of the available evidence regarding the relative value of treatment options. A systematic search was performed of Medline, Embase, Cochrane Library and ClinicalTrials.gov databases. Inclusion criteria were randomized controlled trials comparing treatment methods. The Cochrane Risk of Bias assessment tool (RoB2) was used to assess the selected studies. A meta-analysis was performed between homogenous studies. Four trials were identified including 749 patients (392 males). The mean ages of the cohorts ranged between 30.1 and 36.2 years old. Three hundred thirty-five patients underwent HA by 46 surgeons among all trials. Fifty-two patients crossed over from the TPP to the HA group. One of the trials was found to have a high risk of bias, while the other three were between low risk and some concerns. The iHOT-33 was the most commonly used patient-reported outcome measure followed by the HOS ADL and EQ-5D-5L. Others scores were also identified. Scores from two trials could be pooled together for meta-analysis. Apart from SF-12 and GRC, all other scores have shown significantly better outcomes with HA in comparison to TPP at 8- and 12-months follow-up points. HA offers better patient-reported outcomes than TPP for management of FAIS at 8- and 12-months follow-up.
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Affiliation(s)
- Samer S S Mahmoud
- Hip Arthroscopy Australia, 21 Erin Street, Richmond, VIC 3121, Australia
| | - Amir Takla
- Department of Health Professions, Faculty of Health, Arts and Design, Sports & Musculoskeletal Physiotherapist, Australian Sports Physiotherapy, Swinburne University of Technology, Hip Arthroscopy Australia, 21 Erin Street, Richmond, VIC 3121, Australia
| | - Denny Meyer
- Department of Health Sciences and Biostatistics, School of Health, Swinburne University of Technology, PO Box 218, Hawthorn, VIC 3122, Australia
| | - Damian Griffin
- Department of Orthopaedic Surgery, University of Warwick, University Hospitals of Coventry and Warwickshire NHS Trust, Clifford Bridge Road, Coventry CV2 2DX, UK
| | - John O’Donnell
- Department of Orthopaedics, Swinburne University of Technology, PO Box 218, Hawthorn, VIC 3122, Australia
- Hip Arthroscopy Australia, 21 Erin Street, Richmond, VIC 3121, Australia
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6
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Bergiers S, Hothi H, Henckel J, Di Laura A, Belzunce M, Skinner J, Hart A. The in vivo location of edge-wear in hip arthroplasties : combining pre-revision 3D CT imaging with retrieval analysis. Bone Joint Res 2021; 10:639-649. [PMID: 34605661 PMCID: PMC8559968 DOI: 10.1302/2046-3758.1010.bjr-2021-0132.r1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Aims Acetabular edge-loading was a cause of increased wear rates in metal-on-metal hip arthroplasties, ultimately contributing to their failure. Although such wear patterns have been regularly reported in retrieval analyses, this study aimed to determine their in vivo location and investigate their relationship with acetabular component positioning. Methods 3D CT imaging was combined with a recently validated method of mapping bearing surface wear in retrieved hip implants. The asymmetrical stabilizing fins of Birmingham hip replacements (BHRs) allowed the co-registration of their acetabular wear maps and their computational models, segmented from CT scans. The in vivo location of edge-wear was measured within a standardized coordinate system, defined using the anterior pelvic plane. Results Edge-wear was found predominantly along the superior acetabular edge in all cases, while its median location was 8° (interquartile range (IQR) -59° to 25°) within the anterosuperior quadrant. The deepest point of these scars had a median location of 16° (IQR -58° to 26°), which was statistically comparable to their centres (p = 0.496). Edge-wear was in closer proximity to the superior apex of the cups with greater angles of acetabular inclination, while a greater degree of anteversion influenced a more anteriorly centred scar. Conclusion The anterosuperior location of edge-wear was comparable to the degradation patterns observed in acetabular cartilage, supporting previous findings that hip joint forces are directed anteriorly during a greater portion of walking gait. The further application of this novel method could improve the current definition of optimal and safe acetabular component positioning. Cite this article: Bone Joint Res 2021;10(10):639–649.
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Affiliation(s)
- Sean Bergiers
- Institute of Orthopaedics and Musculoskeletal Science, University College London, London, UK
| | - Harry Hothi
- Institute of Orthopaedics and Musculoskeletal Science, University College London, London, UK.,Royal National Orthopaedic Hospital NHS Trust, Stanmore, UK
| | - Johann Henckel
- Royal National Orthopaedic Hospital NHS Trust, Stanmore, UK
| | - Anna Di Laura
- Institute of Orthopaedics and Musculoskeletal Science, University College London, London, UK.,Royal National Orthopaedic Hospital NHS Trust, Stanmore, UK
| | | | - John Skinner
- Institute of Orthopaedics and Musculoskeletal Science, University College London, London, UK.,Royal National Orthopaedic Hospital NHS Trust, Stanmore, UK
| | - Alister Hart
- Institute of Orthopaedics and Musculoskeletal Science, University College London, London, UK.,Royal National Orthopaedic Hospital NHS Trust, Stanmore, UK
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7
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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: 25] [Impact Index Per Article: 8.3] [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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8
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Affiliation(s)
- Nancy A Chauvin
- Department of Pediatric Radiology, Penn State Health Milton S. Hershey Medical Center, Penn State College of Medicine, Hershey, PA.
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9
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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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10
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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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11
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Nebelung S, Rath B, Tingart M, Kuhl C, Schrading S. [Chondral and osteochondral defects : Representation by imaging methods]. DER ORTHOPADE 2017; 46:894-906. [PMID: 28936540 DOI: 10.1007/s00132-017-3472-9] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
Morphological imaging of cartilage at high resolution allows the differentiation of chondral and osteochondral lesions. Nowadays, magnetic resonance imaging is the principal diagnostic tool in the assessment of cartilage structure and composition. Conventional radiography, computed tomography, ultrasound or optical coherence tomography are adjunct diagnostic modalities in the assessment of cartilage pathologies. The present article discusses the up-to-date diagnostic practice of cartilage imaging in terms of its scientific basis and current clinical status, requirements, techniques and image interpretation. Innovations in the field such as functional MRI are discussed as well due to their mid- to long-term clinical perspective.
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Affiliation(s)
- S Nebelung
- Klinik für Diagnostische und Interventionelle Radiologie, Universitätsklinikum Aachen, Pauwelsstraße 30, 52074, Aachen, Deutschland
| | - B Rath
- Klinik für Orthopädie, Universitätsklinikum Aachen, Pauwelsstraße 30, 52074, Aachen, Deutschland
| | - M Tingart
- Klinik für Orthopädie, Universitätsklinikum Aachen, Pauwelsstraße 30, 52074, Aachen, Deutschland
| | - C Kuhl
- Klinik für Diagnostische und Interventionelle Radiologie, Universitätsklinikum Aachen, Pauwelsstraße 30, 52074, Aachen, Deutschland
| | - S Schrading
- Klinik für Diagnostische und Interventionelle Radiologie, Universitätsklinikum Aachen, Pauwelsstraße 30, 52074, Aachen, Deutschland.
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12
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Palmer A, Fernquest S, Rombach I, Park D, Pollard T, Broomfield J, Bangerter N, Carr A, Glyn-Jones S. Diagnostic and prognostic value of delayed Gadolinium Enhanced Magnetic Resonance Imaging of Cartilage (dGEMRIC) in early osteoarthritis of the hip. Osteoarthritis Cartilage 2017; 25:1468-1477. [PMID: 28506842 DOI: 10.1016/j.joca.2017.05.004] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/10/2016] [Revised: 04/15/2017] [Accepted: 05/04/2017] [Indexed: 02/02/2023]
Abstract
BACKGROUND Delayed Gadolinium Enhanced Magnetic Resonance Imaging of Cartilage (dGEMRIC) can detect glycosaminoglycan loss in the acetabular cartilage of asymptomatic individuals with cam morphology. The aims of this study were to explore the relationship between cam morphology and dGEMRIC values, and to explore whether baseline dGEMRIC can predict the development of radiographic hip osteoarthritis. METHODS Prospective cohort (SibKids) study with clinical, radiographic, and MRI assessment at baseline and five-year follow-up (n = 34). The dGEMRIC values of cartilage regions were correlated with measures of cam morphology. Receiver operating characteristic (ROC) analysis was applied to baseline variables to predict radiographic loss of joint space width. RESULTS Superolateral acetabular cartilage dGEMRIC values were significantly lower in participants with cam morphology (P < 0.001), defined as an alpha angle greater than 60°. There was a negative correlation between alpha angle and the dGEMRIC value of adjacent acetabular cartilage. This relationship was strongest superoanteriorly (r = -0.697 P < 0.001). There was a positive correlation between baseline dGEMRIC and the magnitude of joint space width narrowing (r = 0.398 P = 0.030). ROC analysis of combined baseline variables (positive impingement test, alpha angle, dGEMRIC ratio) gave an Area Under the Curve (AUC) of 0.75 for predicting joint space width narrowing greater than 0.5 mm within 5 years. CONCLUSIONS The size and position of cam morphology determines the severity and location of progressive cartilage damage, supporting the biomechanical aetiology of femoroacetabular impingement. Baseline dGEMRIC is able to predict the development of radiographic osteoarthritis. Compositional MRI offers the potential to identify patients who may benefit from early intervention to prevent the development of osteoarthritis.
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Affiliation(s)
- A Palmer
- Nuffield Department of Orthopaedics, Rheumatology, and Musculoskeletal Sciences, University of Oxford, United Kingdom.
| | - S Fernquest
- Nuffield Department of Orthopaedics, Rheumatology, and Musculoskeletal Sciences, University of Oxford, United Kingdom
| | - I Rombach
- Nuffield Department of Orthopaedics, Rheumatology, and Musculoskeletal Sciences, University of Oxford, United Kingdom
| | - D Park
- Nuffield Department of Orthopaedics, Rheumatology, and Musculoskeletal Sciences, University of Oxford, United Kingdom
| | - T Pollard
- Nuffield Department of Orthopaedics, Rheumatology, and Musculoskeletal Sciences, University of Oxford, United Kingdom
| | - J Broomfield
- Nuffield Department of Orthopaedics, Rheumatology, and Musculoskeletal Sciences, University of Oxford, United Kingdom
| | - N Bangerter
- Electrical and Computer Engineering Department, Brigham Young University, USA
| | - A Carr
- Nuffield Department of Orthopaedics, Rheumatology, and Musculoskeletal Sciences, University of Oxford, United Kingdom
| | - S Glyn-Jones
- Nuffield Department of Orthopaedics, Rheumatology, and Musculoskeletal Sciences, University of Oxford, United Kingdom
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Schmaranzer F, Haefeli PC, Hanke MS, Liechti EF, Werlen SF, Siebenrock KA, Tannast M. How Does the dGEMRIC Index Change After Surgical Treatment for FAI? A Prospective Controlled Study: Preliminary Results. Clin Orthop Relat Res 2017; 475:1080-1099. [PMID: 27709422 PMCID: PMC5339130 DOI: 10.1007/s11999-016-5098-3] [Citation(s) in RCA: 35] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
BACKGROUND Delayed gadolinium-enhanced MRI of cartilage (dGEMRIC) allows an objective, noninvasive, and longitudinal quantification of biochemical cartilage properties. Although dGEMRIC has been used to monitor the course of cartilage degeneration after periacetabular osteotomy (PAO) for correction of hip dysplasia, such longitudinal data are currently lacking for femoroacetabular impingement (FAI). QUESTIONS/PURPOSES (1) How does the mean acetabular and femoral dGEMRIC index change after surgery for FAI at 1-year followup compared with a similar group of patients with FAI treated without surgery? (2) Does the regional distribution of the acetabular and femoral dGEMRIC index change for the two groups over time? (3) Is there a correlation between the baseline dGEMRIC index and the change of patient-reported outcome measures (PROMs) at 1-year followup? (4) Among those treated surgically, can dGEMRIC indices distinguish between intact and degenerated cartilage? METHODS We performed a prospective, comparative, nonrandomized, longitudinal study. At the time of enrollment, the patients' decision whether to undergo surgery or choose nonoperative treatment was not made yet. Thirty-nine patients (40 hips) who underwent either joint-preserving surgery for FAI (20 hips) or nonoperative treatment (20 hips) were included. The two groups did not differ regarding Tönnis osteoarthritis score, preoperative PROMs, or baseline dGEMRIC indices. There were more women (60% versus 30%, p = 0.003) in the nonoperative group and patients were older (36 ± 8 years versus 30 ± 8 years, p = 0.026) and had lower alpha angles (65° ± 10° versus 73° ± 12°, p = 0.022) compared with the operative group. We used a 3.0-T scanner and a three-dimensional dual flip-angle gradient-echo technique for the dGEMRIC technique for the baseline and the 1-year followup measurements. dGEMRIC indices of femoral and acetabular cartilage were measured separately on the initial and followup radial dGEMRIC reformats in direct comparison with morphologic radial images. Regions of interest were placed manually peripherally and centrally within the cartilage based on anatomic landmarks at the clockface positions. The WOMAC, the Hip disability and Osteoarthritis Outcome Score, and the modified Harris hip score were used as PROMs. Among those treated surgically, the intraoperative damage according to the Beck grading was recorded and compared with the baseline dGEMRIC indices. RESULTS Although both the operative and the nonoperative groups experienced decreased dGEMRIC indices, the declines were more pronounced in the operative group (-96 ± 112 ms versus -16 ± 101 ms on the acetabular side and -96 ± 123 ms versus -21 ± 83 ms on the femoral side in the operative and nonoperative groups, respectively; p < 0.001 for both). Patients undergoing hip arthroscopy and surgical hip dislocation experienced decreased dGEMRIC indices; the decline in femoral dGEMRIC indices was more pronounced in hips after surgical hip dislocation (-120 ± 137 ms versus -61 ± 89 ms, p = 0.002). In the operative group a decline in dGEMRIC indices was observed in 43 of 44 regions over time. In the nonoperative group a decline in dGEMRIC indices was observed in four of 44 regions over time. The strongest correlation among patients treated surgically was found between the change in WOMAC and baseline dGEMRIC indices for the entire joint (R = 0.788, p < 0.001). Among those treated nonoperatively, no correlation between baseline dGEMRIC indices and change in PROMs was found. In the posterosuperior quadrant, the dGEMRIC index was higher for patients with intact cartilage compared with hips with chondral lesions (592 ± 203 ms versus 444 ± 205 ms, p < 0.001). CONCLUSIONS We found a decline in acetabular, femoral, and regional dGEMRIC indices for the surgically treated group at 1-year followup despite an improvement in all PROMs. We observed a similar but less pronounced decrease in the dGEMRIC index in symptomatic patients without surgical treatment indicating continuous cartilage degeneration. Although treatment of FAI is intended to alter the forces acting across the hip by eliminating impingement, its effects on cartilage biology are not clear. dGEMRIC provides a noninvasive method of assessing these effects. Longer term studies will be needed to determine whether the matrix changes of the bradytrophic cartilage seen here are permanent or clinically important. LEVEL OF EVIDENCE Level II, therapeutic study.
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Affiliation(s)
- Florian Schmaranzer
- Department of Orthopaedic Surgery, Inselspital, University of Bern, Freiburgstrasse, Bern, 3010 Switzerland
| | - Pascal C. Haefeli
- Department of Orthopaedic Surgery, Inselspital, University of Bern, Freiburgstrasse, Bern, 3010 Switzerland
| | - Markus S. Hanke
- Department of Orthopaedic Surgery, Inselspital, University of Bern, Freiburgstrasse, Bern, 3010 Switzerland
| | - Emanuel F. Liechti
- Department of Orthopaedic Surgery, Inselspital, University of Bern, Freiburgstrasse, Bern, 3010 Switzerland
| | | | - Klaus A. Siebenrock
- Department of Orthopaedic Surgery, Inselspital, University of Bern, Freiburgstrasse, Bern, 3010 Switzerland
| | - Moritz Tannast
- Department of Orthopaedic Surgery, Inselspital, University of Bern, Freiburgstrasse, Bern, 3010 Switzerland
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14
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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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15
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Henn LL, Hughes J, Iisakka E, Ellermann J, Mortazavi S, Ziegler C, Nissi MJ, Morgan P. Disease severity classification using quantitative magnetic resonance imaging data of cartilage in femoroacetabular impingement. Stat Med 2017; 36:1491-1505. [DOI: 10.1002/sim.7213] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2016] [Revised: 10/12/2016] [Accepted: 12/07/2016] [Indexed: 01/16/2023]
Affiliation(s)
- Lisa L. Henn
- Arbor Research Collaborative for Health; Ann Arbor MI USA
| | - John Hughes
- Department of Biostatistics and Informatics; University of Colorado; Denver Denver CO USA
| | | | - Jutta Ellermann
- Center for Magnetic Resonance Research, Department of Radiology; University of Minnesota; Minneapolis MN USA
| | - Shabnam Mortazavi
- Center for Magnetic Resonance Research, Department of Radiology; University of Minnesota; Minneapolis MN USA
| | - Connor Ziegler
- Department of Orthopedic Surgery; University of Connecticut Health Center; Farmington MN USA
| | - Mikko J. Nissi
- Department of Applied Physics; University of Eastern Finland; Kuopio Finland
| | - Patrick Morgan
- Department of Orthopaedic Surgery; University of Minnesota; Minneapolis MN USA
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16
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Link TM, Neumann J, Li X. Prestructural cartilage assessment using MRI. J Magn Reson Imaging 2016; 45:949-965. [PMID: 28019053 DOI: 10.1002/jmri.25554] [Citation(s) in RCA: 72] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2016] [Accepted: 10/25/2016] [Indexed: 12/20/2022] Open
Abstract
Cartilage loss is irreversible, and to date, no effective pharmacotherapies are available to protect or regenerate cartilage. Quantitative prestructural/compositional MR imaging techniques have been developed to characterize the cartilage matrix quality at a stage where abnormal findings are early and potentially reversible, allowing intervention to halt disease progression. The goal of this article is to critically review currently available technologies, present the basic concept behind these techniques, but also to investigate their suitability as imaging biomarkers including their validity, reproducibility, risk prediction and monitoring of therapy. Moreover, we highlighted important clinical applications. This review article focuses on the currently most relevant and clinically applicable technologies, such as T2 mapping, T2*, T1ρ, delayed gadolinium enhanced MRI of cartilage (dGEMRIC), sodium imaging and glycosaminoglycan chemical exchange saturation transfer (gagCEST). To date, most information is available for T2 and T1ρ mapping. dGEMRIC has also been used in multiple clinical studies, although it requires Gd contrast administration. Sodium imaging and gagCEST are promising technologies but are dependent on high field strength and sophisticated software and hardware. LEVEL OF EVIDENCE 5 J. Magn. Reson. Imaging 2017;45:949-965.
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Affiliation(s)
- Thomas M Link
- Department of Radiology and Biomedical Imaging, University of California at San Francisco, San Francisco, California, USA
| | - Jan Neumann
- Department of Radiology and Biomedical Imaging, University of California at San Francisco, San Francisco, California, USA
| | - Xiaojuan Li
- Department of Radiology and Biomedical Imaging, University of California at San Francisco, San Francisco, California, USA
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17
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Murphy NJ, Eyles JP, Hunter DJ. Hip Osteoarthritis: Etiopathogenesis and Implications for Management. Adv Ther 2016; 33:1921-1946. [PMID: 27671326 PMCID: PMC5083776 DOI: 10.1007/s12325-016-0409-3] [Citation(s) in RCA: 130] [Impact Index Per Article: 16.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2016] [Indexed: 01/05/2023]
Abstract
Highly prevalent among the elderly, hip osteoarthritis (OA) carries a heavy burden of disease. Guidelines for the management of hip OA are often extrapolated from knee OA research, despite clear differences in the etiopathogenesis and response to treatments of OA at these sites. We propose that hip OA requires specific attention separate from other OA phenotypes. Our understanding of the etiopathogenesis of hip OA has seen significant advance over the last 15 years, since Ganz and colleagues proposed femoroacetabular impingement (FAI) as an important etiological factor. This narrative review summarizes the current understanding of the etiopathogenesis of hip OA and identifies areas requiring further research. Therapeutic approaches for hip OA are considered in light of the condition’s etiopathogenesis. The evidence for currently adopted management strategies is considered, especially those approaches that may have disease-modifying potential. We propose that shifting the focus of hip OA research and public health intervention to primary prevention and early detection may greatly improve the current management paradigm.
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Affiliation(s)
- Nicholas J Murphy
- Department of Rheumatology, Royal North Shore Hospital and Northern Clinical School, University of Sydney, Reserve Road, St Leonards, Sydney, NSW, 2065, Australia
| | - Jillian P Eyles
- Department of Rheumatology, Royal North Shore Hospital and Northern Clinical School, University of Sydney, Reserve Road, St Leonards, Sydney, NSW, 2065, Australia
| | - David J Hunter
- Department of Rheumatology, Royal North Shore Hospital and Northern Clinical School, University of Sydney, Reserve Road, St Leonards, Sydney, NSW, 2065, Australia.
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18
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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: 30] [Impact Index Per Article: 3.8] [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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Rehnitz C, Klaan B, Burkholder I, von Stillfried F, Kauczor HU, Weber MA. Delayed gadolinium-enhanced MRI of cartilage (dGEMRIC) and T 2 mapping at 3T MRI of the wrist: Feasibility and clinical application. J Magn Reson Imaging 2016; 45:381-389. [PMID: 27381489 DOI: 10.1002/jmri.25371] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2016] [Accepted: 06/20/2016] [Indexed: 12/19/2022] Open
Abstract
PURPOSE To assess the feasibility of delayed gadolinium-enhanced magnetic resonance imaging (MRI) of cartilage (dGEMRIC) and T2 mapping for biochemical imaging of the wrist at 3T. MATERIALS AND METHODS Seventeen patients with wrist pain (mean age, 41.4 ± 13.1 years) including a subgroup with chondromalacia (n = 11) and 15 healthy volunteers (26.0 ± 2.2 years) underwent dGEMRIC and T2 mapping at 3T. For dGEMRIC, the optimum time window after contrast-injection (gadopentetate dimeglumine) was defined as the plateau of the T1 curve of repeated measurements 15-90 minutes postinjection and assessed in all volunteers. Reference values of healthy-appearing cartilage from all individuals and values in areas of chondromalacia were assessed using region-of-interest analyses. Receiver-operating-characteristic analyses were applied to assess discriminatory ability between damaged and normal cartilage. RESULTS The optimum time window was 45-90 minutes, and the 60-minute timepoint was subsequently used. In chondromalacia, dGEMRIC values were lower (551 ± 84 msec, P < 0.001), and T2 values higher (63.9 ± 17.7, P = 0.001) compared to healthy-appearing cartilage of the same patient. Areas under the curve did not significantly differ between dGEMRIC (0.91) and T2 mapping (0.99; P = 0.17). In healthy-appearing cartilage of volunteers and patients, mean dGEMRIC values were 731.3 ± 47.1 msec and 674.6 ± 72.1 msec (P = 0.01), and mean T2 values were 36.5 ± 5 msec and 41.1 ± 3.2 msec (P = 0.009), respectively. CONCLUSION At 3T, dGEMRIC and T2 mapping are feasible for biochemical cartilage imaging of the wrist. Both techniques allow separation and biochemical assessment of thin opposing cartilage surfaces and can distinguish between healthy and damaged cartilage. LEVEL OF EVIDENCE 3 J. Magn. Reson. Imaging 2017;45:381-389.
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Affiliation(s)
- Christoph Rehnitz
- Department of Diagnostic and Interventional Radiology, University Hospital Heidelberg, Germany
| | - Bastian Klaan
- Department of Diagnostic and Interventional Radiology, University Hospital Heidelberg, Germany
| | - Iris Burkholder
- Department of Nursing and Health, University of Applied Sciences of the Saarland, Saarbruecken, Germany
| | - Falko von Stillfried
- Department of Orthopedics and Trauma Surgery, University Hospital Heidelberg, Germany
| | - Hans-Ulrich Kauczor
- Department of Diagnostic and Interventional Radiology, University Hospital Heidelberg, Germany
| | - Marc-André Weber
- Department of Diagnostic and Interventional Radiology, University Hospital Heidelberg, Germany
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Abstract
Hip arthroscopy has experienced unprecedented growth in recent years and remains an area of booming technology and interest in orthopedic surgery. As understanding of the pathologic state of femoroacetabular impingement (FAI) has grown, imaging modalities have increased. Careful consideration of all bony and soft tissue structures in concert with physical examination findings in nonarthritic patients is necessary before any surgical intervention. This article summarizes the authors' approach to imaging in patients suspected of FAI, which facilitates careful patient selection and preoperative planning.
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Feasibility of Dual Flip Angle-Based Fast 3-Dimensional T1 Mapping for Delayed Gadolinium-Enhanced Magnetic Resonance Imaging of Cartilage of the Knee: A Histologically Controlled Study. J Comput Assist Tomogr 2016; 40:442-6. [PMID: 26938692 DOI: 10.1097/rct.0000000000000378] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
OBJECTIVE The aim of the study was to validate dual-flip angle-based fast 3-dimensional (3D) T1 mapping for delayed gadolinium-enhanced magnetic resonance imaging (MRI) of cartilage (dGEMRIC) by means of histological analyses in the assessment of the cartilage of the knee in a porcine model. METHODS A total of 15 mini pigs were included in this study. The left knee anterior cruciate ligaments of all mini pigs were transected. The mini pigs were divided into 3 groups postoperatively, with 5 pigs randomly assigned to 1 group. Dual-flip angle-based fast T1 mapping for dGEMRIC was obtained in the sagittal planes at 0 week (group 1), 3 weeks (group 2), and 6 weeks (group 3) after operation, using an 8-channel knee coil. Magnetic resonance imaging was performed at 3T with dual-flip angle-based fast 3D T1 mapping sequence for morphological cartilage assessment of dGEMRIC T1 values. After MRI analysis, histological and biochemical composition (water, collagen, and glycosaminoglycan [GAG]) of the knee cartilage in the medial femoral condyle was quantified ex vivo. RESULTS The T1 values obtained by the dual-flip angle-based fast 3D T1 mapping were positively correlated with the glycosaminoglycan content (r = 0.85; P < 0.05). The values had no significant correlation with the collagen content. The dGEMRIC-T1 values obtained by this method showed the medial femoral condyle cartilage in the anterior cruciate ligament-transected knee after transection decreased with time (P < 0.05). Histological sections of cartilage damage were correlated with MRI data. CONCLUSIONS This study demonstrated the reliability of using dual-flip angle-based fast T1 mapping for dGEMRIC for the biochemical assessment of early cartilage degeneration. This technique is a powerful tool for researchers and clinicians to acquire sufficient resolution data within a reasonable scan time.
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Wyatt C, Kumar D, Subburaj K, Lee S, Nardo L, Narayanan D, Lansdown D, Vail T, Link TM, Souza RB, Majumdar S. Cartilage T1ρ and T2 Relaxation Times in Patients With Mild-to-Moderate Radiographic Hip Osteoarthritis. Arthritis Rheumatol 2015; 67:1548-56. [PMID: 25779656 DOI: 10.1002/art.39074] [Citation(s) in RCA: 34] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2014] [Accepted: 02/10/2015] [Indexed: 11/07/2022]
Abstract
OBJECTIVE To analyze region-specific T1ρ and T2 relaxation times of the hip joint cartilage in relation to presence or absence of radiographic hip osteoarthritis (OA) and presence or absence of magnetic resonance imaging (MRI)-detected cartilage defects. METHODS Weight-bearing radiographs and 3T MRI studies of the hip were obtained from 84 volunteers. Based on Kellgren/Lawrence (K/L) scoring of the radiographs, 54 subjects were classified as healthy controls (K/L grade ≤1) and 30 were classified as having mild or moderate radiographic hip OA (K/L grades 2 or 3, respectively). Two-dimensional fat-suppressed fast spin-echo MRI sequences were used for semiquantitative clinical scoring of cartilage defects, and a T1ρ/T2 sequence was used to quantitatively assess the cartilage matrix. The femoral and acetabular cartilage was then segmented into 8 regions and the mean T1ρ/T2 values were calculated. Differences in T1ρ and T2 relaxation times were compared between subjects with and those without radiographic hip OA, and those with and those without femoral or acetabular cartilage defects. RESULTS Higher T1ρ and T2 relaxation times in the anterior superior and central regions of the acetabular cartilage were seen in individuals with radiographic hip OA and those with acetabular cartilage defects compared to their respective controls (P < 0.05). In the femoral cartilage, the differences in T1ρ and T2 were not significant for any of the comparisons. Significant differences in the T1ρ and T2 values (each P < 0.05) were found in more subregions of the cartilage and across the whole cartilage when subjects were stratified based on the presence of MRI-detected cartilage defects than when they were stratified based on the presence of radiographic hip OA. CONCLUSION T1ρ and T2 relaxation parameters are sensitive to the presence of cartilage degeneration. Both parameters may therefore support MRI evidence of cartilage defects of the hip.
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Affiliation(s)
| | | | | | - Sonia Lee
- University of California, San Francisco
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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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Is the contralateral hip at risk in patients with unilateral symptomatic cam femoroacetabular impingement? A quantitative T1ρ MRI study. Osteoarthritis Cartilage 2015; 23:1337-42. [PMID: 25819578 DOI: 10.1016/j.joca.2015.03.018] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/12/2014] [Revised: 02/11/2015] [Accepted: 03/15/2015] [Indexed: 02/02/2023]
Abstract
OBJECTIVES To assess the profile of weight-bearing cartilage of hips with a cam deformity using T1ρ magnetic resonance imaging (MRI) and evaluate for a side-to-side difference in the T1ρ profile of patients with bilateral cam morphology but only unilateral hip pain. METHODS 19 patients with bilateral cam morphology undergoing osteochondroplasty for unilateral hip pain were prospectively recruited. Anterior and anterosuperior alpha angles were measured using computer tomography. All patients underwent bilateral 1.5T T1ρ MRI. The cartilage bilayer of the hip joint was evaluated and the mean T1ρ relaxation time calculated for each quadrant of the weight-bearing surface. RESULTS Mean T1ρ relaxation times were not significantly different when each quadrant was compared to the rest of the weight-bearing surface of the symptomatic (P = 0.068) and asymptomatic hips (P = 0.102). There was also no significant side-to-side difference between the same quadrants of symptomatic and asymptomatic hips. No correlation was detected between alpha angle and the mean T1ρ relaxation time in each quadrant. There was no significant difference in mean alpha angles between the symptomatic and asymptomatic sides at the anterior (54.2 vs 56.0°; P = 0.382) and anterosuperior positions (65.1 vs 65.2°; P = 0.971). CONCLUSION We conclude that previously observed regional variation in T1ρ values of normal hips is altered in hips with cam morphology. No difference in T1ρ values between symptomatic and asymptomatic cam hips was demonstrated. Therefore, regardless of the presence of hip pain, a cam deformity may predispose to hip joint cartilage degradation and increase the risk of hip osteoarthritis.
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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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Frank JM, Harris JD, Erickson BJ, Slikker W, Bush-Joseph CA, Salata MJ, Nho SJ. Prevalence of Femoroacetabular Impingement Imaging Findings in Asymptomatic Volunteers: A Systematic Review. Arthroscopy 2015; 31:1199-204. [PMID: 25636988 DOI: 10.1016/j.arthro.2014.11.042] [Citation(s) in RCA: 282] [Impact Index Per Article: 31.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/02/2014] [Revised: 11/09/2014] [Accepted: 11/26/2014] [Indexed: 02/02/2023]
Abstract
PURPOSE The aim of this study was to determine the prevalence of radiographic findings suggestive of femoroacetabular impingement (FAI) in asymptomatic individuals. METHODS 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. RESULTS 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. CONCLUSIONS 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 OF EVIDENCE Level IV, systematic review if Level II-IV studies.
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Affiliation(s)
- Jonathan M Frank
- Hip Preservation Center, Division of Sports Medicine, Department of Orthopedic Surgery, Rush University Medical Center, Rush Medical College of Rush University, Chicago, Illinois, U.S.A..
| | - Joshua D Harris
- Hip Preservation Center, Division of Sports Medicine, Department of Orthopedic Surgery, Rush University Medical Center, Rush Medical College of Rush University, Chicago, Illinois, U.S.A
| | - Brandon J Erickson
- Hip Preservation Center, Division of Sports Medicine, Department of Orthopedic Surgery, Rush University Medical Center, Rush Medical College of Rush University, Chicago, Illinois, U.S.A
| | - William Slikker
- Hip Preservation Center, Division of Sports Medicine, Department of Orthopedic Surgery, Rush University Medical Center, Rush Medical College of Rush University, Chicago, Illinois, U.S.A
| | - Charles A Bush-Joseph
- Hip Preservation Center, Division of Sports Medicine, Department of Orthopedic Surgery, Rush University Medical Center, Rush Medical College of Rush University, Chicago, Illinois, U.S.A
| | - Michael J Salata
- Hip Preservation Center, Division of Sports Medicine, Department of Orthopedic Surgery, Rush University Medical Center, Rush Medical College of Rush University, Chicago, Illinois, U.S.A
| | - Shane J Nho
- Hip Preservation Center, Division of Sports Medicine, Department of Orthopedic Surgery, Rush University Medical Center, Rush Medical College of Rush University, Chicago, Illinois, U.S.A
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Matzat SJ, Kogan F, Fong GW, Gold GE. Imaging strategies for assessing cartilage composition in osteoarthritis. Curr Rheumatol Rep 2015; 16:462. [PMID: 25218737 DOI: 10.1007/s11926-014-0462-3] [Citation(s) in RCA: 32] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023]
Abstract
Efforts to reduce the ever-increasing rates of osteoarthritis (OA) in the developed world require the ability to non-invasively detect the degradation of joint tissues before advanced damage has occurred. This is particularly relevant for damage to articular cartilage because this soft tissue lacks the capacity to repair itself following major damage and is essential to proper joint function. While conventional magnetic resonance imaging (MRI) provides sufficient contrast to visualize articular cartilage morphology, more advanced imaging strategies are necessary for understanding the underlying biochemical composition of cartilage that begins to break down in the earliest stages of OA. This review discusses the biochemical basis and the advantages and disadvantages associated with each of these techniques. Recent implementations for these techniques are touched upon, and future considerations for improving the research and clinical power of these imaging technologies are also discussed.
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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: 40] [Impact Index Per Article: 4.4] [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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Abstract
Excellent morphological imaging of cartilage is now possible and allows the detection of subtle cartilage pathologies. Besides the standard 2D sequences, a multitude of 3D sequences are available for high-resolution cartilage imaging. The first part therefore deals with modern possibilities of morphological imaging. The second part deals with functional cartilage imaging with which it is possible to detect changes in cartilage composition and thus early osteoarthritis as well as to monitor biochemical changes after therapeutic interventions. Validated techniques such as delayed gadolinium-enhanced magnetic resonance imaging of cartilage (dGEMRIC) and T2 mapping as well the latest techniques, such as the glycosaminoglycan chemical exchange-dependent saturation transfer (gagCEST) technique will be discussed.
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Pun S, Kumar D, Lane NE. Femoroacetabular impingement. Arthritis Rheumatol 2015; 67:17-27. [PMID: 25308887 DOI: 10.1002/art.38887] [Citation(s) in RCA: 54] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2014] [Accepted: 09/16/2014] [Indexed: 11/06/2022]
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Lazik A, Körsmeier K, Claßen T, Jäger M, Kamminga M, Kraff O, Lauenstein TC, Theysohn JM, Landgraeber S. 3 Tesla high-resolution and delayed gadolinium enhanced MR imaging of cartilage (dGEMRIC) after autologous chondrocyte transplantation in the hip. J Magn Reson Imaging 2014; 42:624-33. [PMID: 25522716 DOI: 10.1002/jmri.24821] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2014] [Accepted: 11/18/2014] [Indexed: 11/08/2022] Open
Abstract
BACKGROUND To evaluate the feasibility of 3 Tesla (T) high-resolution and gadolinium enhanced MRI of cartilage (dGEMRIC) in the thin and rounded hip cartilage of patients after acetabular matrix-based autologous chondrocyte transplantation (MACT). METHODS Under general ethics approval, 24 patients were prospectively examined 6-31 months after acetabular MACT at 3T using high-resolution proton-density weighted (PDw) images (bilateral PD SPACE, 0.8 mm isotropic; unilateral PD-TSE coronal/sagittal, 0.8 × 0.8 resp. 0.5 × 0.5 × 2.5 mm) as well as T1 mapping (3D-FLASH, 0.78 mm isotropic) in dGEMRIC technique, and clinically scored. The cartilage transplant was evaluated using an adapted MOCART score (maximum 85 points). T1 relaxation times were measured independently by two radiologists. Here, regions of interest were placed manually in automatically calculated relaxation-maps, both in the transplant and adjacent healthy cartilage regions. Interobserver reliability was estimated by means of intraclass-correlation (ICC). RESULTS The transplant was morphologically definable in the PDw images of 23 patients with a mean MOCART score of 69 points (60-80 points, SD 6.5). T1 maps showed a clear differentiation between acetabular and femoral cartilage, but correlation with PDw images was necessary to identify the transplant. Mean T1 relaxation times of the transplant were 616.3 ms (observer 1) resp. 610.1 ms (observer 2), and of adjacent healthy acetabular cartilage 574.5 ms (observer 1) resp. 604.9 ms (observer 2). Interobserver reliability of the relaxation times in the transplant was excellent (ICC-coefficient 0.88) and in adjacent healthy regions good (0.77). CONCLUSION High-resolution PDw imaging with adapted MOCART scoring and dGEMRIC is feasible after MACT in the thin and rounded hip cartilage.
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Affiliation(s)
- Andrea Lazik
- Department of Diagnostic and Interventional Radiology and Neuroradiology, University Hospital Essen, Essen, Germany
| | | | - Tim Claßen
- Department of Orthopaedics, University Hospital Essen, Germany
| | - Marcus Jäger
- Department of Orthopaedics, University Hospital Essen, Germany
| | | | - Oliver Kraff
- Erwin L. Hahn Institute for Magnetic Resonance Imaging, University of Duisburg-Essen, Germany
| | - Thomas C Lauenstein
- Department of Diagnostic and Interventional Radiology and Neuroradiology, University Hospital Essen, Essen, Germany
| | - Jens M Theysohn
- Department of Diagnostic and Interventional Radiology and Neuroradiology, University Hospital Essen, Essen, Germany
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Morgan P, Spiridonov S, Goebel R, Nissi M, Frei R, Ellermann J. MR Imaging with T2*- mapping for improved acetabular cartilage assessment in FAI-a case report with arthroscopic correlation. Orthop Traumatol Surg Res 2014; 100:971-3. [PMID: 25459458 DOI: 10.1016/j.otsr.2014.09.014] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/17/2012] [Revised: 08/30/2014] [Accepted: 09/12/2014] [Indexed: 02/02/2023]
Abstract
UNLABELLED Articular cartilage assessment in femoroacetabular impingement (FAI) is challenging. Recent studies on T2* relaxation time mapping suggest the technique may be useful in diagnosing cartilage damage. The purpose of this case report is to describe how quantitative T2*-mapping may improve cartilage assessment of the acetabulum in patients with FAI. MR arthrography was performed at 3 Tesla (T) using intra-articular Gadolinium and a T2* mapping protocol. Data from the acetabular cartilage was separated from femoral head cartilage data and then superimposed on a flattened, map projection representation of the patient's acetabulum. The areas of unhealthy cartilage observed at the time of arthroscopy - including debonding and delamination - were seen preoperatively at the same anatomic locations as areas of decreased T2* values. T2* mapping values provided a non-invasive assessment of the acetabular articular cartilage. A flattened acetabular map projection allowed for anatomic visualization of areas of unhealthy cartilage. LEVEL OF EVIDENCE Level IV.
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Affiliation(s)
- P Morgan
- Department of Orthopaedic Surgery, University of Minnesota, 2512 South 7th Street, Minneapolis, MN, 55454, USA
| | - S Spiridonov
- Department of Radiology, University of Minnesota, 2021, Sixth Street SE, Minneapolis, MN 55455, USA
| | - R Goebel
- Department of Psychology and Neuroscience, Maastricht University, P.O. Box 616 6200 MD Maastricht, The Netherlands
| | - M Nissi
- Department of Radiology, University of Minnesota, 2021, Sixth Street SE, Minneapolis, MN 55455, USA
| | - R Frei
- Department of Orthopedic Surgery, Charles University, Budínova 2, Praha 8, 180 81, Czech Republic
| | - J Ellermann
- Department of Radiology, University of Minnesota, 2021, Sixth Street SE, Minneapolis, MN 55455, USA.
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Xia Y, Chandra SS, Engstrom C, Strudwick MW, Crozier S, Fripp J. Automatic hip cartilage segmentation from 3D MR images using arc-weighted graph searching. Phys Med Biol 2014; 59:7245-66. [DOI: 10.1088/0031-9155/59/23/7245] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
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34
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Oei EHG, van Tiel J, Robinson WH, Gold GE. Quantitative radiologic imaging techniques for articular cartilage composition: toward early diagnosis and development of disease-modifying therapeutics for osteoarthritis. Arthritis Care Res (Hoboken) 2014; 66:1129-41. [PMID: 24578345 DOI: 10.1002/acr.22316] [Citation(s) in RCA: 53] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2013] [Accepted: 02/18/2014] [Indexed: 12/19/2022]
Affiliation(s)
- Edwin H G Oei
- Stanford University, Stanford, California; Erasmus MC, University Medical Center, Rotterdam, The Netherlands
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36
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Ellermann J, Ziegler C, Nissi MJ, Goebel R, Hughes J, Benson M, Holmberg P, Morgan P. Acetabular Cartilage Assessment in Patients with Femoroacetabular Impingement by Using T2* Mapping with Arthroscopic Verification. Radiology 2014; 271:512-23. [DOI: 10.1148/radiol.13131837] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
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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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Li X, Majumdar S. Quantitative MRI of articular cartilage and its clinical applications. J Magn Reson Imaging 2013; 38:991-1008. [PMID: 24115571 DOI: 10.1002/jmri.24313] [Citation(s) in RCA: 83] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2012] [Accepted: 06/21/2013] [Indexed: 12/27/2022] Open
Abstract
Cartilage is one of the most essential tissues for healthy joint function and is compromised in degenerative and traumatic joint diseases. There have been tremendous advances during the past decade using quantitative MRI techniques as a noninvasive tool for evaluating cartilage, with a focus on assessing cartilage degeneration during osteoarthritis (OA). In this review, after a brief overview of cartilage composition and degeneration, we discuss techniques that grade and quantify morphologic changes as well as the techniques that quantify changes in the extracellular matrix. The basic principles, in vivo applications, advantages, and challenges for each technique are discussed. Recent studies using the OA Initiative (OAI) data are also summarized. Quantitative MRI provides noninvasive measures of cartilage degeneration at the earliest stages of joint degeneration, which is essential for efforts toward prevention and early intervention in OA.
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Affiliation(s)
- Xiaojuan Li
- Musculoskeletal Quantitative Imaging Research Group, Department of Radiology and Biomedical Imaging, University of California, San Francisco, California, USA
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Palmer AJR, Brown CP, McNally EG, Price AJ, Tracey I, Jezzard P, Carr AJ, Glyn-Jones S. Non-invasive imaging of cartilage in early osteoarthritis. Bone Joint J 2013; 95-B:738-46. [PMID: 23723266 DOI: 10.1302/0301-620x.95b6.31414] [Citation(s) in RCA: 80] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
Treatment for osteoarthritis (OA) has traditionally focused on joint replacement for end-stage disease. An increasing number of surgical and pharmaceutical strategies for disease prevention have now been proposed. However, these require the ability to identify OA at a stage when it is potentially reversible, and detect small changes in cartilage structure and function to enable treatment efficacy to be evaluated within an acceptable timeframe. This has not been possible using conventional imaging techniques but recent advances in musculoskeletal imaging have been significant. In this review we discuss the role of different imaging modalities in the diagnosis of the earliest changes of OA. The increasing number of MRI sequences that are able to non-invasively detect biochemical changes in cartilage that precede structural damage may offer a great advance in the diagnosis and treatment of this debilitating condition.
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Affiliation(s)
- A J R Palmer
- Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford, Windmill Road, Headington OX3 7LD, UK
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Matzat SJ, van Tiel J, Gold GE, Oei EHG. Quantitative MRI techniques of cartilage composition. Quant Imaging Med Surg 2013; 3:162-74. [PMID: 23833729 DOI: 10.3978/j.issn.2223-4292.2013.06.04] [Citation(s) in RCA: 43] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2013] [Accepted: 06/24/2013] [Indexed: 12/15/2022]
Abstract
Due to aging populations and increasing rates of obesity in the developed world, the prevalence of osteoarthritis (OA) is continually increasing. Decreasing the societal and patient burden of this disease motivates research in prevention, early detection of OA, and novel treatment strategies against OA. One key facet of this effort is the need to track the degradation of tissues within joints, especially cartilage. Currently, conventional imaging techniques provide accurate means to detect morphological deterioration of cartilage in the later stages of OA, but these methods are not sensitive to the subtle biochemical changes during early disease stages. Novel quantitative techniques with magnetic resonance imaging (MRI) provide direct and indirect assessments of cartilage composition, and thus allow for earlier detection and tracking of OA. This review describes the most prominent quantitative MRI techniques to date-dGEMRIC, T2 mapping, T1rho mapping, and sodium imaging. Other, less-validated methods for quantifying cartilage composition are also described-Ultrashort echo time (UTE), gagCEST, and diffusion-weighted imaging (DWI). For each technique, this article discusses the proposed biochemical correlates, as well its advantages and limitations for clinical and research use. The article concludes with a detailed discussion of how the field of quantitative MRI has progressed to provide information regarding two specific patient populations through clinical research-patients with anterior cruciate ligament rupture and patients with impingement in the hip. While quantitative imaging techniques continue to rapidly evolve, specific challenges for each technique as well as challenges to clinical applications remain.
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Abstract
Femoroacetabular impingement (FAI) is a common cause of early-onset osteoarthritis of the hip. It can be caused by morphologic abnormalities involving the proximal femur or acetabulum, leading to abnormal abutment of the femoral head-neck against the acetabular rim. This repetitive trauma causes mechanical wear of the labrum and articular cartilage, leading to osteoarthritis of the hip. Magnetic resonance imaging is an accurate noninvasive imaging modality that can detect acetabular labral lesions and adjacent cartilage damage, and is able to detect underlying subtle anatomic variations of the femoral head-neck junction and acetabulum associated with FAI.
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Aprato A, Massè A, Faletti C, Valente A, Atzori F, Stratta M, Jayasekera N. Magnetic resonance arthrography for femoroacetabular impingement surgery: is it reliable? J Orthop Traumatol 2013; 14:201-6. [PMID: 23397418 PMCID: PMC3751278 DOI: 10.1007/s10195-013-0227-1] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/01/2011] [Accepted: 01/12/2013] [Indexed: 10/27/2022] Open
Abstract
BACKGROUND Magnetic resonance arthrography (MRA) is commonly used to demonstrate injury to the labrum and hyaline cartilage in patients with femoroacetabular impingement (FAI). The purpose of this study was to assess the diagnostic correlation between MRA and findings at arthroscopic and open surgery. MATERIALS AND METHODS MRA reports of 41 hips with symptomatic FAI were reviewed and compared with subsequent intraoperative findings (n = 21 surgical dislocations and n = 20 therapeutic hip arthroscopies). Each case was assessed for the presence of a cam deformity, a cartilage lesion of the femoral head, an os acetabuli, an injury to the labrum and injury to the acetabular cartilage. Results were collected prospectively in a cross-table and analysed retrospectively for sensitivity, specificity, positive predictive value (PPV) and negative predictive value (NPV). RESULTS The sensitivity, specificity, PPV and NPV in the presence of reported cam-type deformity or an os acetabuli were 100%. In the presence of cartilage lesions of the femoral head, the values were 46, 81, 55 and 73%, respectively. For labral tears, the values were 91, 86, 97 and 67%. In the presence of acetabular cartilage injuries, the values were 69, 88, 78 and 81%, respectively. CONCLUSIONS MRA appears to be an efficacious imaging modality in the evaluation of labral tears, cam-type impingement lesions and os acetabuli of the hip. MRA is less efficacious in the diagnosis of cartilage abnormalities in the hip, both femoral and acetabular. Researchers should focus on further improvements in imaging techniques in order to give reliable preoperative information to the surgeon.
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Affiliation(s)
- Alessandro Aprato
- Pelvic Unit, Orthopaedic Department, II Faculty of Medicine, San Luigi Hospital of Orbassano, University of Turin, Regione Gonzole n.10, 10043, Turin, Orbassano, Italy.
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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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Abstract
The technical advances in arthroscopic surgery of the hip, including the improved ability to manage the capsule and gain extensile exposure, have been paralleled by a growth in the number of conditions that can be addressed. This expanding list includes symptomatic labral tears, chondral lesions, injuries of the ligamentum teres, femoroacetabular impingement (FAI), capsular laxity and instability, and various extra-articular disorders, including snapping hip syndromes. With a careful diagnostic evaluation and technical execution of well-indicated procedures, arthroscopic surgery of the hip can achieve successful clinical outcomes, with predictable improvements in function and pre-injury levels of physical activity for many patients. This paper reviews the current position in relation to the use of arthroscopy in the treatment of disorders of the hip. Cite this article: Bone Joint J 2013;95-B:10–19.
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Affiliation(s)
- A. Bedi
- University of Michigan, MedSport, Department
of Orthopaedic Surgery, Lobby A, 24
Frank Lloyd Wright Drive, Ann Arbor, Michigan
48106, USA
| | - B. T. Kelly
- Hospital for Special Surgery, 535
East 70th Street, New York, New York
10021, USA
| | - V. Khanduja
- Addenbrooke’s – Cambridge University Hospitals
NHS Foundation Trust, Box 37, Hills
Road, Cambridge CB2 0QQ, UK
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Kim SD, Jessel R, Zurakowski D, Millis MB, Kim YJ. Anterior delayed gadolinium-enhanced MRI of cartilage values predict joint failure after periacetabular osteotomy. Clin Orthop Relat Res 2012; 470:3332-41. [PMID: 22907475 PMCID: PMC3492640 DOI: 10.1007/s11999-012-2519-9] [Citation(s) in RCA: 42] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
BACKGROUND Several available compositional MRIs seem to detect early osteoarthritis before radiographic appearance. Delayed gadolinium-enhanced MRI of cartilage (dGEMRIC) has been most frequently used in clinical studies and reportedly predicts premature joint failure in patients undergoing Bernese periacetabular osteotomies (PAOs). QUESTIONS/PURPOSES We asked, given regional variations in biochemical composition in dysplastic hips, whether the dGEMRIC index of the anterior joint would better predict premature joint failure after PAOs than the coronal dGEMRIC index as previously reported. METHODS We retrospectively reviewed 43 hips in 41 patients who underwent Bernese PAO for hip dysplasia. Thirty-seven hips had preserved joints after PAOs and six were deemed premature failures based on pain, joint space narrowing, or subsequent THA. We used dGEMRIC to determine regional variations in biochemical composition. Preoperative demographic and clinical outcome score, radiographic measures of osteoarthritis and severity of dysplasia, and dGEMRIC indexes from different hip regions were analyzed in a multivariable regression analysis to determine the best predictor of premature joint failure. Minimum followup was 24 months (mean, 32 months; range, 24-46 months). RESULTS The two cohorts were similar in age and sex distribution. Severity of dysplasia was similar as measured by lateral center-edge, anterior center-edge, and Tönnis angles. Preoperative pain, joint space width, Tönnis grade, and coronal and sagittal dGEMRIC indexes differed between groups. The dGEMRIC index in the anterior weightbearing region of the hip was lower in the prematurely failed group and was the best predictor. CONCLUSIONS Success of PAO depends on the amount of preoperative osteoarthritis. These degenerative changes are seen most commonly in the anterior joint. The dGEMRIC index of the anterior joint may better predict premature joint failure than radiographic measures of hip osteoarthritis and coronal dGEMRIC index. LEVEL OF EVIDENCE Level II, prognostic study. See Instructions for Authors for a complete description of levels of evidence.
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Affiliation(s)
- Sang Do Kim
- Department of Orthopaedic Surgery, Children’s Hospital Boston, 300 Longwood Avenue, Boston, MA 02115 USA
| | - Rebecca Jessel
- Department of Orthopaedic Surgery, Children’s Hospital Boston, 300 Longwood Avenue, Boston, MA 02115 USA
| | - David Zurakowski
- Department of Orthopaedic Surgery, Children’s Hospital Boston, 300 Longwood Avenue, Boston, MA 02115 USA
| | - Michael B. Millis
- Department of Orthopaedic Surgery, Children’s Hospital Boston, 300 Longwood Avenue, Boston, MA 02115 USA
| | - Young-Jo Kim
- Department of Orthopaedic Surgery, Children’s Hospital Boston, 300 Longwood Avenue, Boston, MA 02115 USA
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Abstract
Hip deformity such as acetabular dysplasia and cam and pincer deformities are thought to be a major cause of hip osteoarthritis. Currently, clinically effective surgical procedures such as pelvic osteotomies and femoral and acetabular osteoplasties are available to correct the underlying deformity. These procedures are most effective in the presence of minimal chondral damage in the joint. Currently, and more so in the future, high-resolution morphologic imaging and biochemical imaging techniques such as Delayed gadolinium-enhanced MR imaging of cartilage, T2, and T1rho will have a clinically important role in diagnosing and staging chondral damage in the hip.
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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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Abstract
Hip disorders in the young adult manifest along a continuum that ranges from an excessively constrained, impinging joint, to an overly shallow, unstable hip. Knowledge of simple measures on plain radiographs can aid in efficient and accurate identification of mechanically compromised hips that may be at risk for premature OA. Improvements in joint-preserving surgery have shown promise in delaying or preventing progression of articular degeneration; thus, timely diagnosis is important. Once a diagnosis is established, specialized imaging can be individualized to supplement surgical planning, assess the degree of cartilage damage, and facilitate discussion regarding the prognosis of hip-preserving procedures.
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Affiliation(s)
- Cara Beth Lee
- Center for Hip Preservation, Department of Orthopedics, Virginia Mason Medical Center, Seattle, WA 98111, USA.
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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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