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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] [What about the content of this article? (0)] [Affiliation(s)] [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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Jones CE, Cibere J, Qian H, Zhang H, Guo Y, Russell D, Forster BB, Wong H, Esdaile JM, Wilson DR. Delayed Gadolinium-Enhanced Magnetic Resonance Imaging of Cartilage Values in Hips With Bone Marrow Lesions. Arthritis Care Res (Hoboken) 2022; 74:1997-2004. [PMID: 34137188 DOI: 10.1002/acr.24733] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2020] [Revised: 04/28/2021] [Accepted: 06/15/2021] [Indexed: 02/05/2023]
Abstract
OBJECTIVE Bone marrow lesions (BMLs) are associated with painful and progressive osteoarthritis (OA). Quantitative magnetic resonance imaging (MRI) has been used to study early cartilage degeneration in knees with BML, but similar work has not been done in hips. The purpose of this study was to compare mean delayed gadolinium-enhanced MRI of cartilage (dGEMRIC) relaxation values (T1Gd) in hips with BML to hips without BML in a population-based study. Reduced T1Gd suggests depleted glycosaminoglycan. Our hypothesis was that mean T1Gd is lower in hips with BML compared to hips without BML. METHODS Study participants (n = 128) were recruited from a cross-sectional population-based study of people ages 20-49 years with and without hip pain. dGEMRIC and proton density (PD)-weighted MRI scans of 1 hip from each participant were used for this analysis. BMLs were identified from PD-weighted fat-suppressed images. We applied a sampling-weighted linear regression model to determine the association of the presence of BMLs with mean cartilage T1Gd (significance: P < 0.05). The model was adjusted for age, sex, body mass index (BMI), hip pain, cam/pincer deformity, and physical activity. RESULTS Thirty-two (25%) of the 128 participants had at least 1 BML. Subjects with at least 1 BML, compared to those without, had similar weighted characteristics of age, BMI, physical activity levels, and frequency of hip pain. Mean T1Gd was 75.25 msec lower (95% confidence interval -149.69, -0.81; P = 0.048) (9%) in the BML compared to the no-BML group. CONCLUSION Our results suggest that hips with BMLs are associated with hip cartilage degeneration early in the OA disease process.
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Affiliation(s)
- Carly E Jones
- Centre for Hip Health and Mobility, University of British Columbia, Vancouver, British Columbia, Canada
| | - Jolanda Cibere
- Arthritis Research Canada, Vancouver, British Columbia, Canada, and University of British Columbia, Vancouver, British Columbia, Canada
| | - Hong Qian
- Centre for Health Evaluation and Outcome Sciences, Vancouver, British Columbia, Canada
| | - Honglin Zhang
- Centre for Hip Health and Mobility, University of British Columbia, Vancouver, British Columbia, Canada
| | - Yimeng Guo
- Arthritis Research Canada, Vancouver, British Columbia, Canada
| | - David Russell
- University of British Columbia, Vancouver, British Columbia, Canada
| | - Bruce B Forster
- University of British Columbia, Vancouver, British Columbia, Canada
| | - Hubert Wong
- Centre for Health Evaluation and Outcome Sciences, Vancouver, British Columbia, Canada
| | - John M Esdaile
- Arthritis Research Canada, Vancouver, British Columbia, Canada
| | - David R Wilson
- Centre for Hip Health and Mobility, Department of Orthopedics, University of British Columbia, Vancouver, British Columbia, Canada
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Lerch TD, Ambühl D, Schmaranzer F, Todorski IAS, Steppacher SD, Hanke MS, Haefeli PC, Liechti EF, Siebenrock KA, Tannast M. Biochemical MRI With dGEMRIC Corresponds to 3D-CT Based Impingement Location for Detection of Acetabular Cartilage Damage in FAI Patients. Orthop J Sports Med 2021; 9:2325967120988175. [PMID: 33816640 PMCID: PMC7988263 DOI: 10.1177/2325967120988175] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/01/2020] [Accepted: 09/30/2020] [Indexed: 01/20/2023] Open
Abstract
Background Anterior femoroacetabular impingement (FAI) is associated with labral tears and acetabular cartilage damage in athletic and young patients. Delayed gadolinium-enhanced magnetic resonance imaging of cartilage (dGEMRIC) is an imaging method for detecting early damage to cartilage. Purpose We evaluated the following questions: (1) What is the sensitivity and specificity of morphological magnetic resonance imaging (MRI) and dGEMRIC for detecting cartilage damage? Do the mean acetabular and femoral dGEMRIC indices differ between (2) superior acetabular clock positions with and without impingement and (3) between cam- and pincer-type FAI? Study Design Cohort study (diagnosis); Level of evidence, 2. Methods This was a retrospective comparative study of 21 hips (20 patients with symptomatic anterior FAI) without osteoarthritis on anteroposterior radiographs. Morphological MRI and dGEMRIC (3.0-T, 3-dimensional [3D] T1 maps, dual-flip angle technique) of the same hip joint were compared. Intraoperative acetabular cartilage damage was assessed in patients who underwent surgical treatment. Computed tomography (CT)-based 3D bone models of the same hip joint were used as the gold standard for the detection of impingement, and dGEMRIC indices and zones of morphologic damage were compared with the CT-based impingement zones. Results Of the 21 hips, 10 had cam-type FAI and 8 had pincer-type FAI according to radiographs. The mean age was 30 ± 9 years (range, 17-48 years), 71% were female, and surgical treatment was performed in 52%. We found a significantly higher sensitivity (69%) for dGEMRIC compared with morphological MRI (42%) in the detection of cartilage damage (P < .001). The specificity of dGEMRIC was 83% and accuracy was 78%. The mean peripheral acetabular and femoral dGEMRIC indices for clock positions with impingement (485 ± 141 and 440 ± 121 ms) were significantly lower compared with clock positions without impingement (596 ± 183 and 534 ± 129 ms) (P < .001). Hips with cam-type FAI had significantly lower acetabular dGEMRIC indices compared with hips with pincer-type FAI on the anterosuperior clock positions (1 to 3 o'clock) (P = .018). Conclusion MRI with dGEMRIC was more sensitive than morphological MRI, and lower dGEMRIC values were found for clock positions with impingement as detected on 3D-CT. This could aid in patient-specific diagnosis of FAI, preoperative patient selection, and surgical decision making to identify patients with cartilage damage who are at risk for inferior outcomes after hip arthroscopy.
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Affiliation(s)
- Till D Lerch
- Department of Orthopaedic Surgery, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland.,Department of Diagnostic, Interventional and Pediatric Radiology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Dimitri Ambühl
- Department of Orthopaedic Surgery, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland.,Department of Diagnostic, Interventional and Pediatric Radiology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Florian Schmaranzer
- Department of Orthopaedic Surgery, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland.,Department of Diagnostic, Interventional and Pediatric Radiology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Inga A S Todorski
- Department of Orthopaedic Surgery, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland.,Department of Diagnostic, Interventional and Pediatric Radiology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Simon D Steppacher
- Department of Orthopaedic Surgery, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Markus S Hanke
- Department of Orthopaedic Surgery, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Pascal C Haefeli
- Department of Orthopaedic Surgery, Lucerne Cantonal Hospital, Lucerne, Switzerland
| | - Emanuel F Liechti
- Department of Orthopaedic Surgery, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Klaus A Siebenrock
- Department of Orthopaedic Surgery, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Moritz Tannast
- Department of Orthopaedic Surgery, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland.,Department of Orthopaedic Surgery, Fribourg Cantonal Hospital, University of Fribourg, Fribourg, Switzerland
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Tiderius CJ, Hawezi ZK, Olsson LE, Dahlberg LE. Pre-contrast T1 and cartilage thickness as confounding factors in dGEMRIC when evaluating human cartilage adaptation to physical activity. BMC Med Imaging 2019; 20:1. [PMID: 31892314 PMCID: PMC6938637 DOI: 10.1186/s12880-019-0399-0] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2018] [Accepted: 12/04/2019] [Indexed: 11/28/2022] Open
Abstract
Background The dGEMRIC (delayed Gadolinium-Enhanced MRI of Cartilage) technique has been used in numerous studies for quantitative in vivo evaluation of the relative glycosaminoglycan (GAG) content in cartilage. The purpose of this study was to determine the influence of pre-contrast T1 and cartilage thickness when assessing knee joint cartilage quality with dGEMRIC. Methods Cartilage thickness and T1 relaxation time were measured in the central part of the femoral condyles before and two hours after intravenous Gd-DTPA2− administration in 17 healthy volunteers from a previous study divided into two groups: 9 sedentary volunteers and 8 exercising elite runners. Results were analyzed in superficial and a deep weight-bearing, as well as in non-weight-bearing regions of interest. Results In the medial compartment, the cartilage was thicker in the exercising group, in weight-bearing and non-weight-bearing segments. In most of the segments, the T1 pre-contrast value was longer in the exercising group compared to the sedentary group. Both groups had a longer pre-contrast T1 in the superficial cartilage than in the deep cartilage. In the superficial cartilage, the gadolinium concentration was independent of cartilage thickness. In contrast, there was a linear correlation between the gadolinium concentration and cartilage thickness in the deep cartilage region. Conclusion Cartilage pre-contrast T1 and thickness are sources of error in dGEMRIC that should be considered when analysing bulk values. Our results indicate that differences in cartilage structure due to exercise and weight-bearing may be less pronounced than previously demonstrated.
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Affiliation(s)
- Carl Johan Tiderius
- Orthopaedics, Department of Clinical Sciences Lund, Lund University, Skåne University Hospital, Lund, Sweden
| | - Zana K Hawezi
- Orthopaedics, Department of Clinical Sciences Lund, Lund University, Skåne University Hospital, Lund, Sweden
| | - Lars E Olsson
- Medical Radiation Physics, Department of Translational Medicine, Lund University, Malmö, Sweden.,Department of Haematology, Oncology and Radiation Physics, Skåne University Hospital, Malmö, Sweden
| | - Leif E Dahlberg
- Orthopaedics, Department of Clinical Sciences Lund, Lund University, Skåne University Hospital, Lund, Sweden.
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Peterson P, Tiderius CJ, Olsson E, Lundin B, Olsson LE, Svensson J. Knee dGEMRIC at 7 T: comparison against 1.5 T and evaluation of T 1-mapping methods. BMC Musculoskelet Disord 2018; 19:149. [PMID: 29769051 PMCID: PMC5956845 DOI: 10.1186/s12891-018-2071-1] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/17/2018] [Accepted: 04/30/2018] [Indexed: 12/28/2022] Open
Abstract
Background dGEMRIC (delayed Gadolinium Enhanced Magnetic Resonance Image of Cartilage) is a well-established technique for cartilage quality assessment in osteoarthritis at clinical field strengths. The method is robust, but requires injection of contrast agent and a cumbersome examination procedure. New non-contrast-agent-based techniques for cartilage quality assessment are currently being developed at 7 T. However, dGEMRIC remains an important reference technique during this development. The aim of this work was to compare T1 mapping for dGEMRIC at 7 T and 1.5 T, and to evaluate three T1-mapping methods at 7 T. Methods The knee of 10 healthy volunteers and 9 patients with early signs of cartilage degradation were examined at 1.5 T and 7 T after a single (one) contrast agent injection (Gd-(DTPA)2−). Inversion recovery (IR) sequences were acquired at both field strengths, and at 7 T variable flip angle (VFA) and Look-Locker (LL) sequences were additionally acquired. T1 maps were calculated and average T1 values were estimated within superficial and deep regions-of-interest (ROIs) in the lateral and medial condyles, respectively. Results T1 values were 1.8 (1.4–2.3) times longer at 7 T. A strong correlation was detected between 1.5 T and 7 T T1 values (r = 0.80). For IR, an additional inversion time was required to avoid underestimation (bias±limits of agreement − 127 ± 234 ms) due to the longer T1 values at 7 T. Out of the two 3D sequences tested, LL resulted in more accurate and precise T1 estimation compared to VFA (average bias±limits of agreement LL: 12 ± 202 ms compared to VFA: 25 ± 622 ms). For both, B1 correction improved agreement to IR. Conclusion With an adapted sampling scheme, dGEMRIC T1 mapping is feasible at 7 T and correlates well to 1.5 T. If 3D is to be used for T1 mapping of the knee at 7 T, LL is preferred and VFA is not recommended. For VFA and LL, B1 correction is necessary for accurate T1 estimation.
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Affiliation(s)
- Pernilla Peterson
- Medical Radiation Physics, Department of Translational Medicine, Lund University, Inga Marie Nilssons gata 49, SE-205 02, Malmö, Sweden. .,Department of Oncology and Radiation Physics, Skåne University Hospital, Inga Marie Nilssons gata 49, SE-205 02, Malmö, Sweden.
| | - Carl Johan Tiderius
- Orthopedics, Department of Clinical Sciences, Lund University, Skåne University Hospital, SE-221 85, Lund, Sweden
| | - Emma Olsson
- Medical Radiation Physics, Department of Translational Medicine, Lund University, Inga Marie Nilssons gata 49, SE-205 02, Malmö, Sweden
| | - Björn Lundin
- Department of Medical Imaging and Physiology, Skåne University Hospital, SE-221 85, Lund, Sweden
| | - Lars E Olsson
- Medical Radiation Physics, Department of Translational Medicine, Lund University, Inga Marie Nilssons gata 49, SE-205 02, Malmö, Sweden.,Department of Oncology and Radiation Physics, Skåne University Hospital, Inga Marie Nilssons gata 49, SE-205 02, Malmö, Sweden
| | - Jonas Svensson
- Medical Radiation Physics, Department of Translational Medicine, Lund University, Inga Marie Nilssons gata 49, SE-205 02, Malmö, Sweden.,Department of Medical Imaging and Physiology, Skåne University Hospital, SE-221 85, Lund, Sweden
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Örtegren J, Peterson P, Svensson J, Tiderius CJ. Persisting CAM deformity is associated with early cartilage degeneration after Slipped Capital Femoral Epiphysis: 11-year follow-up including dGEMRIC. Osteoarthritis Cartilage 2018; 26:557-63. [PMID: 29426010 DOI: 10.1016/j.joca.2018.01.013] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/04/2017] [Revised: 01/03/2018] [Accepted: 01/18/2018] [Indexed: 02/02/2023]
Abstract
OBJECTIVE Slipped capital femoral epiphysis (SCFE) in adolescence is associated with increased risk of future osteoarthritis (OA). The purpose of this study was to study clinical and radiographic risk factors for early cartilage degeneration after SCFE. DESIGN 22 patients (44 hips) (mean age 24 years, range 18-27) treated with in situ fixation (The Hansson hook-pin) for stable SCFE on average 11 years previously were investigated. Cartilage status was assessed with delayed gadolinium-enhanced magnetic resonance imaging of cartilage (dGEMRIC). The alpha angle, reflecting femoroacetabular impingement (FAI), and the original slip angle were measured. Clinical outcome was assessed with the Copenhagen hip and groin outcome score (HAGOS) and clinical examination. RESULTS The dGEMRIC index was lower in SCFE hips than unaffected hips 456 ms (CI 419-493) vs 521 ms (CI 476-567) (P = 0.03). The difference was larger (mean 21 ms) in anterior than posterior regions of the hip (P = 0.038). The alpha angle was higher in SCFE hips, 61.5° (CI 53.9-69.1) vs 45.6° (CI 43.6-47.6), (P < 0.001). The alpha angle, but not the original slip angle, correlated negatively with the dGEMRIC index (R = -0.40, P = 0.046). There was a positive correlation between HAGOS and the dGEMRIC-index (R = 0.41, P = 0.012). CONCLUSIONS Early cartilage degeneration after SCFE seems related to persisting FAI in adulthood, rather than the initial slip severity. The correlation between dGEMRIC and HAGOS indicates a clinical relevance of the MRI findings. Our results suggest that FAI after SCFE should be evaluated already after physeal closure in order to predict and possibly prevent future OA development.
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Hangaard S, Gudbergsen H, Skougaard M, Bliddal H, Nybing JD, Tiderius CJ, Boesen M. Point of no return for improvement of cartilage quality indicated by dGEMRIC before and after weight loss in patients with knee osteoarthritis: a cohort study. Acta Radiol 2018; 59:336-340. [PMID: 28696168 DOI: 10.1177/0284185117720857] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Background It has been demonstrated that weight loss improves symptoms in obese subjects with knee osteoarthritis (KOA). A parallel change in cartilage morphology remains to be demonstrated. Purpose To demonstrate a parallel change in cartilage morphology. Material and Methods Obese patients with KOA were examined before and after weight loss over 16 weeks. Target knee joints were radiographically assessed by the Kellgren/Lawrence grading (KLG) system. Patients with KLG-1 and 2 changes in the lateral compartment were included. Delayed gadolinium-enhanced MRI of cartilage (dGEMRIC) was performed using intra-articular contrast. Results Nine patients with lateral KLG-1 and ten patients with lateral KLG-2 were studied. There were no group differences regarding the lateral compartment baseline dGEMRIC T1 values: median = 497 ms (KLG-1) and 533 ms (KLG-2) ( P = 0.12), or regarding reduction in body mass index (BMI) after 16 weeks: 12.8% versus 11.4% ( P = 0.74). In the KLG-1 group, several cases of increased dGEMRIC T1 values were seen and median value decreased significantly less than in KLG-2 group (15 ms versus 41 ms, P = 0.03) after weight loss. Conclusion Improvement of cartilage quality, assessed with dGEMRIC, after weight loss might be possible in early stage KOA (KLG-1), but not in later stage KOA (KLG-2). The results may suggest a point of no return for improvement of cartilage quality that should be tested in larger trials.
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Affiliation(s)
- Stine Hangaard
- Department of Radiology, Copenhagen University Hospital, Bispebjerg and Frederiksberg Hospital, Denmark
- The Parker Institute, Copenhagen University Hospital, Bispebjerg and Frederiksberg Hospital, Denmark
| | - Henrik Gudbergsen
- The Parker Institute, Copenhagen University Hospital, Bispebjerg and Frederiksberg Hospital, Denmark
| | - Marie Skougaard
- The Parker Institute, Copenhagen University Hospital, Bispebjerg and Frederiksberg Hospital, Denmark
| | - Henning Bliddal
- The Parker Institute, Copenhagen University Hospital, Bispebjerg and Frederiksberg Hospital, Denmark
| | - Janus D Nybing
- Department of Radiology, Copenhagen University Hospital, Bispebjerg and Frederiksberg Hospital, Denmark
| | - Carl Johan Tiderius
- Department of Orthopaedics, Lund University, Skåne University Hospital, Lund, Sweden
| | - Mikael Boesen
- Department of Radiology, Copenhagen University Hospital, Bispebjerg and Frederiksberg Hospital, Denmark
- The Parker Institute, Copenhagen University Hospital, Bispebjerg and Frederiksberg Hospital, Denmark
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Tyagi P, Janicki J, Moon CH, Kaufman J, Chermansky C. Novel contrast mixture achieves contrast resolution of human bladder wall suitable for T1 mapping: applications in interstitial cystitis and beyond. Int Urol Nephrol 2018; 50:401-409. [PMID: 29392488 DOI: 10.1007/s11255-018-1794-0] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2017] [Accepted: 01/13/2018] [Indexed: 11/25/2022]
Abstract
PURPOSE Instillation of novel contrast mixture (NCM) was recently shown to improve the contrast resolution of rat bladder wall with high contrast-to-noise ratio (CNR). Here, the clinical safety and the feasibility of NCM-enhanced MRI to achieve artifact-free visualization of human bladder wall suitable for quantitative measurement of the magnetic resonance (MR) longitudinal relaxation time (T1) was assessed. METHODS Six female subjects [two controls and two with Hunner-type interstitial cystitis IC and two with non-Hunner-type IC] consented for MRI at 3 T before and after instillation of NCM [4 mM gadobutrol and 5 mM ferumoxytol in 50 mL of sterile water for injection]. Single breath-hold fast MR acquisition in large readout bandwidth for 5-mm-thick single slice with variable flip angle was applied to minimize the motion and chemical shift artifacts in measurements of bladder wall thickness (BWT), CNR and T1 from 20 pixels. RESULTS NCM instillation in subjects did not evoke pain or discomfort. Fourfold increase in bladder wall CNR (*p < 0.02) and pixel size of 0.35 mm with minimal influence of artifacts allowed accurate determination of bladder wall thinning ~ 0.46 mm from 50 mL NCM (*p < 0.05). Pre-contrast bladder wall T1 of 1544 ± 34.2 ms was shortened to 860.09 ± 13.95 ms in Hunner-type IC (*p < 0.0001) relative to only 1257.42 ± 20.59 and 1258.16 ± 6.16 ms in non-Hunner-type IC and controls, respectively. CONCLUSION Findings demonstrate the safety and feasibility of NCM-enhanced MRI to achieve artifact-free differential contrast and spatial resolution of human bladder wall, which is suitable for measuring BWT and pixel-wise measurement of T1 in post-contrast setting.
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Affiliation(s)
- Pradeep Tyagi
- Department of Urology, University of Pittsburgh, E313 Montefiore Hospital, 3459 Fifth Ave, Pittsburgh, PA, 15213, USA.
| | | | - Chan-Hong Moon
- Department of Radiology, Magnetic Resonance Research Center, University of Pittsburgh, Pittsburgh, PA, USA
| | | | - Christopher Chermansky
- Department of Urology, University of Pittsburgh, E313 Montefiore Hospital, 3459 Fifth Ave, Pittsburgh, PA, 15213, USA
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Munukka M, Waller B, Häkkinen A, Nieminen MT, Lammentausta E, Kujala UM, Paloneva J, Kautiainen H, Kiviranta I, Heinonen A. Physical Activity Is Related with Cartilage Quality in Women with Knee Osteoarthritis. Med Sci Sports Exerc 2017; 49:1323-1330. [PMID: 28240703 DOI: 10.1249/mss.0000000000001238] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Abstract
PURPOSE To study the relationship between 12-month leisure-time physical activity (LTPA) level and changes in estimated biochemical composition of tibiofemoral cartilage in postmenopausal women with mild knee osteoarthritis (OA). METHODS Originally, 87 volunteer postmenopausal women, age 60 to 68 yr, with mild knee OA (Kellgren Lawrence I/II and knee pain) participated in a randomized controlled, 4-month aquatic training trial (RCT), after which 76 completed the 12-month postintervention follow-up period. Self-reported LTPA was collected along the 12-month period using a diary from which MET task hours per month were calculated. Participants were divided into MET task hour tertiles: 1, lowest (n = 25); 2 = middle (n = 25) and 3 = highest (n = 26). The biochemical composition of the cartilage was estimated using transverse relaxation time (T2) mapping sensitive to the properties of the collagen network and delayed gadolinium-enhanced magnetic resonance imaging of the cartilage (dGEMRIC index) sensitive to the cartilage glycosaminoglycan content. Secondary outcomes were cardiorespiratory fitness, isometric knee extension and flexion force, and the knee injury and OA outcome questionnaire. RESULTS During the 12-month follow-up period, there was a significant linear relationship between higher LTPA level and increased dGEMRIC index changes in the posterior region of interest (ROI) of the lateral (P = 0.003 for linearity) and medial (P = 0.006) femoral cartilage. Furthermore, these changes were seen in the posterior lateral femoral cartilage superficial (P = 0.004) and deep (P = 0.007) ROI and in the posterior medial superficial ROI (P < 0.001). There was no linear relationship between LTPA level and other measured variables. CONCLUSIONS These results suggest that higher LTPA level is related to regional increases in estimated glycosaminoglycan content of tibiofemoral cartilage in postmenopausal women with mild knee OA as measured with dGEMRIC index during a 12-month period.
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Affiliation(s)
- Matti Munukka
- 1Faculty of Sport and Health Sciences, University of Jyväskylä, Jyväskylä, FINLAND; 2Department of Physical Medicine and Rehabilitation, Central Finland Central Hospital, Jyväskylä, FINLAND; 3Research Unit of Medical Imaging, Physics and Technology, University of Oulu, Oulu, FINLAND; 4Department of Diagnostic Radiology, Oulu University Hospital, Oulu, FINLAND; 5Medical Research Center, University of Oulu and Oulu University Hospital, Oulu, FINLAND; 6Department of Surgery, Central Finland Central Hospital, Jyväskylä, FINLAND; 7Department of General Practice and Primary Health Care, University of Helsinki, Helsinki, FINLAND; 8Unit of Primary Health Care, Kuopio University Hospital, Kuopio, FINLAND; and 9Department of Orthopaedics and Traumatology, University of Helsinki, and Helsinki University Hospital, Helsinki, FINLAND
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Moström EB, Lammentausta E, Finnbogason T, Weidenhielm L, Janarv PM, Tiderius CJ. T2 mapping and post-contrast T1 (dGEMRIC) of the patellar cartilage: 12-year follow-up after patellar stabilizing surgery in childhood. Acta Radiol Open 2017; 6:2058460117738808. [PMID: 29123919 PMCID: PMC5661686 DOI: 10.1177/2058460117738808] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2017] [Accepted: 09/18/2017] [Indexed: 12/29/2022] Open
Abstract
Background Cartilage degeneration has been reported after recurrent patellar dislocation. However, effects of surgical stabilization in childhood have not yet been described. Purpose To examine the cartilage quality in very young adults operated with a patellar stabilizing procedure due to recurrent patellar dislocation in childhood, and evaluate if cartilage quality correlates with clinical parameters and patient-reported outcomes. Material and Methods Seventeen patients were investigated ≥ 5 years (mean = 11.6 years) after patellar stabilizing surgery in childhood. Pre-contrast T2 relaxation times were analyzed in four superficial and four deep patellar cartilage regions of both knees. Two hours after 0.2 mM/kg Gd-DTPA2 i.v., post-contrast T1 (T1(Gd)) was analyzed in the same regions. Patient-reported outcomes (KOOS, Kujala, and Tegner scores) and recurrence rates were evaluated. Results Comparing operated to healthy side, neither T2 nor dGEMRIC differed between the operated and the reference knee regarding the superficial half of the cartilage. In the deep half of the cartilage, T1(Gd) was shorter in the central part of the cartilage, whereas T2 was longer medially (P < 0.05). A low score in the KOOS subscales Symptom and Sports & Recreation, was correlated to the degenerative changes detected by T1(Gd) (r = 0.5, P = 0.041). Conclusion In general, our findings demonstrate good cartilage quality 12 years after patellar stabilizing surgery during childhood. The subtle changes in T2 and T1(Gd) in the deep cartilage layer may be a result of altered biomechanics, although very early degenerative changes cannot be excluded. The short T1(Gd) centrally may reflect lower glycosaminoglycan content, whereas the increase in T2 medially indicates increased cartilage hydration.
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Affiliation(s)
- Eva Bengtsson Moström
- Department of Women's and Children's Health, Karolinska Institutet, Stockholm, Sweden
| | - Eveliina Lammentausta
- Department of Diagnostic Radiology, Oulu University Hospital, Finland.,Medical Research Center Oulu, Oulu University Hospital and University of Oulu, Finland
| | | | - Lars Weidenhielm
- Stockholm Sports Trauma Research Center, Department of Molecular Medicine and Surgery, Karolinska Institutet, Stockholm, Sweden
| | - Per-Mats Janarv
- Department of Women's and Children's Health, Karolinska Institutet, Stockholm, Sweden.,Stockholm Sports Trauma Research Center, Department of Molecular Medicine and Surgery, Karolinska Institutet, Stockholm, Sweden
| | - Carl Johan Tiderius
- Department of Orthopaedics, Skane University Hospital, Lund University, Sweden
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11
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Wei W, Lambach B, Jia G, Flanigan D, Chaudhari AM, Wei L, Rogers A, Payne J, Siston RA, Knopp MV. Assessing the effect of football play on knee articular cartilage using delayed gadolinium-enhanced MRI of cartilage (dGEMRIC). Magn Reson Imaging 2017; 39:149-156. [DOI: 10.1016/j.mri.2017.01.008] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2016] [Revised: 01/09/2017] [Accepted: 01/09/2017] [Indexed: 11/28/2022]
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12
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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] [What about the content of this article? (0)] [Affiliation(s)] [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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13
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Multanen J, Rantalainen T, Kautiainen H, Ahola R, Jämsä T, Nieminen MT, Lammentausta E, Häkkinen A, Kiviranta I, Heinonen A. Effect of progressive high-impact exercise on femoral neck structural strength in postmenopausal women with mild knee osteoarthritis: a 12-month RCT. Osteoporos Int 2017; 28:1323-1333. [PMID: 28035445 DOI: 10.1007/s00198-016-3875-1] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/12/2016] [Accepted: 12/07/2016] [Indexed: 11/27/2022]
Abstract
UNLABELLED It is uncertain whether subjects with mild knee osteoarthritis, and who may be at risk of osteoporosis, can exercise safely with the aim of improving hip bone strength. This RCT showed that participating in a high-impact exercise program improved femoral neck strength without any detrimental effects on knee cartilage composition. INTRODUCTION No previous studies have examined whether high-impact exercise can improve bone strength and articular cartilage quality in subjects with mild knee osteoarthritis. In this 12-month RCT, we assessed the effects of progressive high-impact exercise on femoral neck structural strength and biochemical composition of knee cartilage in postmenopausal women. METHODS Eighty postmenopausal women with mild knee radiographic osteoarthritis were randomly assigned into the exercise (n = 40) or control (n = 40) group. Femoral neck structural strength was assessed with dual-energy X-ray absorptiometry. The knee cartilage region exposed to exercise loading was measured by the quantitative MRI techniques of T2 mapping and delayed gadolinium-enhanced MRI of cartilage (dGEMRIC). Also, an accelerometer-based body movement monitor was used to evaluate the total physical activity loading on the changes of femoral neck strength in all participants. Training effects on the outcome variables were estimated by the bootstrap analysis of covariance. RESULTS A significant between-group difference in femoral neck bending strength in favor of the trainees was observed after the 12-month intervention (4.4%, p < 0.01). The change in femoral neck bending strength remained significant after adjusting for baseline value, age, height, and body mass (4.0%, p = 0.020). In all participants, the change in bending strength was associated with the total physical activity loading (r = 0.29, p = 0.012). The exercise participation had no effect on knee cartilage composition. CONCLUSION The high-impact training increased femoral neck strength without having any harmful effect on knee cartilage in women with mild knee osteoarthritis. These findings imply that progressive high-impact exercise is a feasible method in seeking to prevent hip fractures in postmenopausal women whose articular cartilage may also be frail.
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Affiliation(s)
- J Multanen
- Department of Physical Medicine and Rehabilitation, Central Finland Central Hospital, Keskussairaalantie 19, 40620, Jyväskylä, Finland.
- Department of Health Sciences, University of Jyväskylä, Jyväskylä, Finland.
| | - T Rantalainen
- Center for Physical Activity and Nutrition Research, School of Exercise and Nutrition Sciences, Deakin University Melbourne, Melbourne, Australia
| | - H Kautiainen
- Department of General Practice and Primary Health Care, University of Helsinki, Helsinki, Finland
- Unit of Primary Health Care, Kuopio University Hospital, Kuopio, Finland
| | - R Ahola
- Research Unit of Medical Imaging, Physics and Technology, University of Oulu, Oulu, Finland
| | - T Jämsä
- Research Unit of Medical Imaging, Physics and Technology, University of Oulu, Oulu, Finland
- Medical Research Center Oulu, Oulu University Hospital and University of Oulu, Oulu, Finland
- Department of Diagnostic Radiology, Oulu University Hospital, Oulu, Finland
| | - M T Nieminen
- Research Unit of Medical Imaging, Physics and Technology, University of Oulu, Oulu, Finland
- Department of Diagnostic Radiology, Oulu University Hospital, Oulu, Finland
- Department of Radiology, University of Oulu, Oulu, Finland
| | - E Lammentausta
- Department of Diagnostic Radiology, Oulu University Hospital, Oulu, Finland
| | - A Häkkinen
- Department of Physical Medicine and Rehabilitation, Central Finland Central Hospital, Keskussairaalantie 19, 40620, Jyväskylä, Finland
- Department of Health Sciences, University of Jyväskylä, Jyväskylä, Finland
| | - I Kiviranta
- Department of Orthopaedics and Traumatology, University of Helsinki, and Helsinki University Hospital, Helsinki, Finland
| | - A Heinonen
- Department of Physical Medicine and Rehabilitation, Central Finland Central Hospital, Keskussairaalantie 19, 40620, Jyväskylä, Finland
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14
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Abstract
Background and purpose - The natural history of focal cartilage defects (FCDs) is still unresolved, as is the long-term cartilage quality after cartilage surgery. It has been suggested that delayed gadolinium-enhanced magnetic resonance imaging of cartilage (dGEMRIC) is a biomarker of early OA. We aimed to quantitatively evaluate the articular cartilage in knees with FCDs, 12 years after arthroscopic diagnosis. Patients and methods - We included 21 patients from a cohort of patients with knee pain who underwent arthroscopy in 1999. Patients with a full-thickness cartilage defect, stable knees, and at least 50% of both their menisci intact at baseline were eligible. 10 patients had cartilage repair performed at baseline (microfracture or autologous chondrocyte implantation), whereas 11 patients had either no additional surgery or simple debridement performed. Mean follow-up time was 12 (10-13) years. The morphology and biochemical features were evaluated with dGEMRIC and T2 mapping. Standing radiographs for Kellgren and Lawrence (K&L) classification of osteoarthritis (OA) were obtained. Knee function was assessed with VAS, Tegner, Lysholm, and KOOS. Results - The dGEMRIC showed varying results but, overall, no increased degeneration of the injured knees. Degenerative changes (K&L above 0) were, however, evident in 13 of the 21 knees. Interpretation - The natural history of untreated FCDs shows large dGEMRIC variations, as does the knee articular cartilage of surgically treated patients. In this study, radiographic OA changes did not correlate with cartilage quality, as assessed with dGEMRIC.
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Affiliation(s)
- Cathrine Nørstad Engen
- Oslo Sports Trauma Research Center (OSTRC), Norwegian School of Sports Sciences, Oslo,Institute of Clinical Medicine, Faculty of Medicine, University of Oslo, Oslo,Correspondence:
| | - Sverre Løken
- Oslo Sports Trauma Research Center (OSTRC), Norwegian School of Sports Sciences, Oslo,Department of Orthopaedic Surgery, Oslo University Hospital, Oslo
| | - Asbjørn Årøen
- Oslo Sports Trauma Research Center (OSTRC), Norwegian School of Sports Sciences, Oslo,Institute of Clinical Medicine, Campus Ahus, University of Oslo, Lørenskog,Department of Orthopedic Surgery, Akershus University Hospital, Lørenskog, Norway
| | - Charles Ho
- Steadman Philippon Research Institute, Vail, CO, USA
| | - Lars Engebretsen
- Oslo Sports Trauma Research Center (OSTRC), Norwegian School of Sports Sciences, Oslo,Institute of Clinical Medicine, Faculty of Medicine, University of Oslo, Oslo,Department of Orthopaedic Surgery, Oslo University Hospital, Oslo
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15
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Munukka M, Waller B, Rantalainen T, Häkkinen A, Nieminen MT, Lammentausta E, Kujala UM, Paloneva J, Sipilä S, Peuna A, Kautiainen H, Selänne H, Kiviranta I, Heinonen A. Efficacy of progressive aquatic resistance training for tibiofemoral cartilage in postmenopausal women with mild knee osteoarthritis: a randomised controlled trial. Osteoarthritis Cartilage 2016; 24:1708-1717. [PMID: 27211862 DOI: 10.1016/j.joca.2016.05.007] [Citation(s) in RCA: 46] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/21/2016] [Revised: 04/19/2016] [Accepted: 05/09/2016] [Indexed: 02/02/2023]
Abstract
OBJECTIVE To study the efficacy of aquatic resistance training on biochemical composition of tibiofemoral cartilage in postmenopausal women with mild knee osteoarthritis (OA). DESIGN Eighty seven volunteer postmenopausal women, aged 60-68 years, with mild knee OA (Kellgren-Lawrence grades I/II and knee pain) were recruited and randomly assigned to an intervention (n = 43) and control (n = 44) group. The intervention group participated in 48 supervised aquatic resistance training sessions over 16 weeks while the control group maintained usual level of physical activity. The biochemical composition of the medial and lateral tibiofemoral cartilage was estimated using single-slice transverse relaxation time (T2) mapping and delayed gadolinium-enhanced magnetic resonance imaging of cartilage (dGEMRIC index). Secondary outcomes were cardiorespiratory fitness, isometric knee extension and flexion force and knee injury and OA outcome (KOOS) questionnaire. RESULTS After 4-months aquatic training, there was a significant decrease in both T2 -1.2 ms (95% confidence interval (CI): -2.3 to -0.1, P = 0.021) and dGEMRIC index -23 ms (-43 to -3, P = 0.016) in the training group compared to controls in the full thickness posterior region of interest (ROI) of the medial femoral cartilage. Cardiorespiratory fitness significantly improved in the intervention group by 9.8% (P = 0.010). CONCLUSIONS Our results suggest that, in postmenopausal women with mild knee OA, the integrity of the collagen-interstitial water environment (T2) of the tibiofemoral cartilage may be responsive to low shear and compressive forces during aquatic resistance training. More research is required to understand the exact nature of acute responses in dGEMRIC index to this type of loading. Further, aquatic resistance training improves cardiorespiratory fitness. TRIAL REGISTRATION NUMBER ISRCTN65346593.
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Affiliation(s)
- M Munukka
- Department of Health Sciences, University of Jyväskylä, Jyväskylä, Finland.
| | - B Waller
- Department of Health Sciences, University of Jyväskylä, Jyväskylä, Finland.
| | - T Rantalainen
- Institute for Physical Activity and Nutrition (IPAN), School of Exercise and Nutrition Sciences, Deakin University, Melbourne, Australia.
| | - A Häkkinen
- Department of Health Sciences, University of Jyväskylä, Jyväskylä, Finland; Department of Physical Medicine and Rehabilitation, Central Finland Central Hospital, Jyväskylä, Finland.
| | - M T Nieminen
- Department of Diagnostic Radiology, Oulu University Hospital, Oulu, Finland; Research Unit of Medical Imaging, Physics and Technology, University of Oulu, Oulu, Finland; Medical Research Center, University of Oulu and Oulu University Hospital.
| | - E Lammentausta
- Department of Diagnostic Radiology, Oulu University Hospital, Oulu, Finland.
| | - U M Kujala
- Department of Health Sciences, University of Jyväskylä, Jyväskylä, Finland.
| | - J Paloneva
- Department of Surgery, Central Finland Central Hospital, Jyväskylä, Finland.
| | - S Sipilä
- Department of Health Sciences, University of Jyväskylä, Jyväskylä, Finland; Gerontology Research Center, University of Jyväskylä, Finland.
| | - A Peuna
- Department of Diagnostic Radiology, Oulu University Hospital, Oulu, Finland; Research Unit of Medical Imaging, Physics and Technology, University of Oulu, Oulu, Finland.
| | - H Kautiainen
- Department of General Practice and Primary Health Care, University of Helsinki, Helsinki, Finland; Unit of Primary Health Care, Kuopio University Hospital, Kuopio, Finland.
| | - H Selänne
- Mehiläinen Sports Medical Clinic, Jyväskylä, Finland.
| | - I Kiviranta
- Department of Orthopaedics and Traumatology, University of Helsinki, and Helsinki University Hospital, Helsinki, Finland.
| | - A Heinonen
- Department of Health Sciences, University of Jyväskylä, Jyväskylä, Finland.
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Mitra S, Fernandez-Del-Valle M, Hill JE. The role of MRI in understanding the underlying mechanisms in obesity associated diseases. Biochim Biophys Acta Mol Basis Dis 2016; 1863:1115-1131. [PMID: 27639834 DOI: 10.1016/j.bbadis.2016.09.008] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2016] [Revised: 09/08/2016] [Accepted: 09/08/2016] [Indexed: 02/07/2023]
Abstract
Obesity and its possible association with diseases including diabetes and cardiovascular diseases have been studied for decades for its impact on healthcare. Recent studies clearly indicate the need for developing accurate and reproducible methodologies for assessing body fat content and distribution. Body fat distribution plays a significant role in developing an insight in the underlying mechanisms in which adipose tissue is linked with various diseases. Among imaging technologies including computerized axial tomography (CAT or CT), magnetic resonance imaging (MRI), and magnetic resonance spectroscopy (MRS), MRI and MRS seem to be the best emerging techniques and together are being considered as the gold standard for body fat content and distribution. This paper reviews studies up to the present time involving different methodologies of these two emerging technologies and presents the basic concepts of MRI and MRS with required novel image analysis techniques in accurate, quantitative, and direct assessment of body fat content and distribution. This article is part of a Special Issue entitled: Oxidative Stress and Mitochondrial Quality in Diabetes/Obesity and Critical Illness Spectrum of Diseases - edited by P. Hemachandra Reddy.
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Affiliation(s)
| | | | - Jason E Hill
- Texas Tech University, Lubbock, TX, United States
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17
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Trattnig S, Bogner W, Gruber S, Szomolanyi P, Juras V, Robinson S, Zbýň Š, Haneder S. Clinical applications at ultrahigh field (7 T). Where does it make the difference? NMR Biomed 2016; 29:1316-34. [PMID: 25762432 DOI: 10.1002/nbm.3272] [Citation(s) in RCA: 42] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/02/2014] [Revised: 01/20/2015] [Accepted: 01/22/2015] [Indexed: 05/11/2023]
Abstract
Presently, three major MR vendors provide commercial 7-T units for clinical research under ethical permission, with the number of operating 7-T systems having increased to over 50. This rapid increase indicates the growing interest in ultrahigh-field MRI because of improved clinical results with regard to morphological as well as functional and metabolic capabilities. As the signal-to-noise ratio scales linearly with the field strength (B0 ) of the scanner, the most obvious application at 7 T is to obtain higher spatial resolution in the brain, musculoskeletal system and breast. Of specific clinical interest for neuro-applications is the cerebral cortex at 7 T, for the detection of changes in cortical structure as a sign of early dementia, as well as for the visualization of cortical microinfarcts and cortical plaques in multiple sclerosis. In the imaging of the hippocampus, even subfields of the internal hippocampal anatomy and pathology can be visualized with excellent resolution. The dynamic and static blood oxygenation level-dependent contrast increases linearly with the field strength, which significantly improves the pre-surgical evaluation of eloquent areas before tumor removal. Using susceptibility-weighted imaging, the plaque-vessel relationship and iron accumulation in multiple sclerosis can be visualized for the first time. Multi-nuclear clinical applications, such as sodium imaging for the evaluation of repair tissue quality after cartilage transplantation and (31) P spectroscopy for the differentiation between non-alcoholic benign liver disease and potentially progressive steatohepatitis, are only possible at ultrahigh fields. Although neuro- and musculoskeletal imaging have already demonstrated the clinical superiority of ultrahigh fields, whole-body clinical applications at 7 T are still limited, mainly because of the lack of suitable coils. The purpose of this article was therefore to review the clinical studies that have been performed thus far at 7 T, compared with 3 T, as well as those studies performed at 7 T that cannot be routinely performed at 3 T. Copyright © 2015 John Wiley & Sons, Ltd.
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Affiliation(s)
- Siegfried Trattnig
- High Field MR Center, Department of Biomedical Imaging and Image-guided Therapy, Medical University of Vienna, Vienna, Austria
- CD Laboratory for Clinical Molecular MR Imaging
| | - Wolfgang Bogner
- High Field MR Center, Department of Biomedical Imaging and Image-guided Therapy, Medical University of Vienna, Vienna, Austria
| | - Stephan Gruber
- High Field MR Center, Department of Biomedical Imaging and Image-guided Therapy, Medical University of Vienna, Vienna, Austria
| | - Pavol Szomolanyi
- High Field MR Center, Department of Biomedical Imaging and Image-guided Therapy, Medical University of Vienna, Vienna, Austria
- Department of Imaging Methods, Institute of Measurement Sciences, Slovak Academy of Sciences, Bratislava, Slovakia
| | - Vladimir Juras
- High Field MR Center, Department of Biomedical Imaging and Image-guided Therapy, Medical University of Vienna, Vienna, Austria
- Department of Imaging Methods, Institute of Measurement Sciences, Slovak Academy of Sciences, Bratislava, Slovakia
| | - Simon Robinson
- High Field MR Center, Department of Biomedical Imaging and Image-guided Therapy, Medical University of Vienna, Vienna, Austria
| | - Štefan Zbýň
- High Field MR Center, Department of Biomedical Imaging and Image-guided Therapy, Medical University of Vienna, Vienna, Austria
| | - Stefan Haneder
- Vascular and Abdominal Imaging, Institute of Clinical Radiology and Nuclear Medicine, University Medical Center Mannheim, Mannheim, Germany
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Kang CH, Kim HK, Shiraj S, Anton C, Kim DH, Horn PS. Patellofemoral instability in children: T2 relaxation times of the patellar cartilage in patients with and without patellofemoral instability and correlation with morphological grading of cartilage damage. Pediatr Radiol 2016; 46:1134-41. [PMID: 26902297 DOI: 10.1007/s00247-016-3574-2] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/16/2015] [Revised: 12/14/2015] [Accepted: 02/04/2016] [Indexed: 12/17/2022]
Abstract
BACKGROUND Patellofemoral instability is one of the most common causes of cartilage damage in teenagers. OBJECTIVE To quantitatively evaluate the patellar cartilage in patients with patellofemoral instability using T2 relaxation time maps (T2 maps), compare the values to those in patients without patellofemoral instability and correlate them with morphological grades in patients with patellofemoral instability. MATERIALS AND METHODS Fifty-three patients with patellofemoral instability (mean age: 15.9 ± 2.4 years) and 53 age- and gender-matched patients without patellofemoral instability were included. Knee MR with axial T2 map was performed. Mean T2 relaxation times were obtained at the medial, central and lateral zones of the patellar cartilage and compared between the two groups. In the patellofemoral instability group, morphological grading of the patellar cartilage (0-4) was performed and correlated with T2 relaxation times. RESULTS Mean T2 relaxation times were significantly longer in the group with patellofemoral instability as compared to those of the control group across the patellar cartilage (Student's t-test, P<0.05) with the longest time at the central area. Positive correlation was seen between mean T2 relaxation time and morphological grading (Pearson correlation coefficiency, P<0.001). T2 increased with severity of morphological grading from 0 to 3 (mixed model, P<0.001), but no statistical difference was seen between grades 3 and 4. CONCLUSION In patellofemoral instability, patellar cartilage damage occurs across the entire cartilage with the highest T2 values at the apex. T2 relaxation times directly reflect the severity in low-grade cartilage damage, which implies an important role for T2 maps in differentiating between normal and low-grade cartilage damage.
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Affiliation(s)
- Chang Ho Kang
- Department of Radiology, Korea University Anam Hospital, Korea University College of Medicine, Seoul, South Korea
| | - Hee Kyung Kim
- Department of Radiology, Cincinnati Children's Hospital Medical Center, 3333 Burnet Ave., Cincinnati, OH, 45229-3039, USA.
| | - Sahar Shiraj
- Department of Radiology, Cincinnati Children's Hospital Medical Center, 3333 Burnet Ave., Cincinnati, OH, 45229-3039, USA
| | - Christopher Anton
- Department of Radiology, Cincinnati Children's Hospital Medical Center, 3333 Burnet Ave., Cincinnati, OH, 45229-3039, USA
| | - Dong Hoon Kim
- Korea University College of Medicine, Seoul, South Korea
| | - Paul S Horn
- Divisions of Neurology and Biostatistics & Epidemiology, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA
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van der Heijden RA, Oei EHG, Bron EE, van Tiel J, van Veldhoven PLJ, Klein S, Verhaar JAN, Krestin GP, Bierma-Zeinstra SMA, van Middelkoop M. No Difference on Quantitative Magnetic Resonance Imaging in Patellofemoral Cartilage Composition Between Patients With Patellofemoral Pain and Healthy Controls. Am J Sports Med 2016; 44:1172-8. [PMID: 26951075 DOI: 10.1177/0363546516632507] [Citation(s) in RCA: 35] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
BACKGROUND Retropatellar cartilage damage has been suggested as an etiological factor for patellofemoral pain (PFP), a common knee condition among young and physically active individuals. To date, there is no conclusive evidence for an association between cartilage defects and PFP. Nowadays, advanced quantitative magnetic resonance imaging (MRI) techniques enable estimation of cartilage composition. PURPOSE To investigate differences in patellofemoral cartilage composition between patients with PFP and healthy control subjects using quantitative MRI. STUDY DESIGN Cross-sectional study; Level of evidence, 3. METHODS Patients with PFP and healthy control subjects underwent 3.0-T MRI including delayed gadolinium-enhanced MRI of cartilage and T1ρ and T2 mapping. Differences in relaxation times of patellofemoral cartilage were compared between groups by linear regression analyses, adjusted for age, body mass index, sex, sports participation, and time of image acquisition. RESULTS This case-control study included 64 patients and 70 controls. The mean (±SD) age was 23.2 ± 6.4 years and the mean body mass index was 22.9 ± 3.4 kg/m(2); 56.7% were female. For delayed gadolinium-enhanced MRI of cartilage, the mean T1GD relaxation times of patellar (657.8 vs 669.4 ms) and femoral cartilage (661.6 vs 659.8 ms) did not significantly differ between patients and controls. In addition, no significant difference was found in mean T1ρ relaxation times of patellar (46.9 vs 46.0 ms) and femoral cartilage (50.8 vs 50.2 ms) and mean T2 relaxation times of patellar (33.2 vs 32.9 ms) and femoral cartilage (36.7 vs 36.6 ms) between patients and controls. Analysis of prespecified medial and lateral subregions within the patellofemoral cartilage also revealed no significant differences. CONCLUSION There was no difference in composition of the patellofemoral cartilage, estimated with multiple quantitative MRI techniques, between patients with PFP and healthy control subjects. However, clinically relevant differences could not be ruled out for T1ρ in the adolescent population. Retropatellar cartilage damage has long been hypothesized as an important factor in the pathogenesis of PFP, but study findings suggest that diminished patellofemoral cartilage composition is not associated with PFP.
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Affiliation(s)
- Rianne A van der Heijden
- Department of General Practice, Erasmus MC, University Medical Center, Rotterdam, the Netherlands Department of Radiology, Erasmus MC, University Medical Center, Rotterdam, the Netherlands
| | - Edwin H G Oei
- Department of Radiology, Erasmus MC, University Medical Center, Rotterdam, the Netherlands
| | - Esther E Bron
- Biomedical Imaging Group Rotterdam, Departments of Radiology and Medical Informatics, Erasmus MC, University Medical Center, Rotterdam, the Netherlands
| | - Jasper van Tiel
- Department of Radiology, Erasmus MC, University Medical Center, Rotterdam, the Netherlands Department of Orthopedic Surgery, Erasmus MC, University Medical Center, Rotterdam, the Netherlands
| | | | - Stefan Klein
- Biomedical Imaging Group Rotterdam, Departments of Radiology and Medical Informatics, Erasmus MC, University Medical Center, Rotterdam, the Netherlands
| | - Jan A N Verhaar
- Department of Orthopedic Surgery, Erasmus MC, University Medical Center, Rotterdam, the Netherlands
| | - Gabriel P Krestin
- Department of Radiology, Erasmus MC, University Medical Center, Rotterdam, the Netherlands
| | - Sita M A Bierma-Zeinstra
- Department of General Practice, Erasmus MC, University Medical Center, Rotterdam, the Netherlands Department of Orthopedic Surgery, Erasmus MC, University Medical Center, Rotterdam, the Netherlands
| | - Marienke van Middelkoop
- Department of General Practice, Erasmus MC, University Medical Center, Rotterdam, the Netherlands
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Hawezi ZK, Lammentausta E, Svensson J, Roos EM, Dahlberg LE, Tiderius CJ. Regional dGEMRIC analysis in patients at risk of osteoarthritis provides additional information about activity related changes in cartilage structure. Acta Radiol 2016; 57:468-74. [PMID: 26113741 DOI: 10.1177/0284185115591237] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2015] [Accepted: 05/18/2015] [Indexed: 01/30/2023]
Abstract
BACKGROUND Previously, a positive effect of exercise on cartilage structure was indicated with delayed gadolinium-enhanced magnetic resonance imaging (MRI) of cartilage (dGEMRIC). However, in that study only one full-thickness region of interest (ROI) in the medial femoral condyle was analyzed. PURPOSE To improve the knowledge about exercise effects on cartilage structure by re-analyzing previous images with regional dGEMRIC analysis. MATERIAL AND METHODS Thirty patients (age range, 38-50 years) with a previous medial meniscus resection were divided into three groups according to self-reported change in physical activity (PA) level in a 4-month exercise intervention study: Group I (n = 11), increased PA level; Group II (n = 13), no change in PA level; and Group III (n = 6), reduced PA level. dGEMRIC index was analyzed at inclusion and after 4 months. Anterior (less load) and posterior (more load) ROIs of medial and lateral femoral condyles were analyzed, as well as superficial and deep cartilage regions. RESULTS Group I increased the dGEMRIC index in the posterior cartilage (P = 0.004). The increase was larger in the lateral (P = 0.005) than the medial compartment in both superficial and deep cartilage regions. The dGEMRIC index did not change in Group II. In Group III, the dGEMRIC index decreased in the medial posterior cartilage (P = 0.03). CONCLUSION In patients with a previous medial meniscectomy, the beneficial effect of exercise varies between different locations within the joint, the largest improvement being observed in lateral posterior cartilage, i.e. the load-bearing cartilage in the compartment without a meniscus lesion. The effects of exercise do not seem to vary with cartilage depth.
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Affiliation(s)
- ZK Hawezi
- Department of Clinical Sciences, Lund University, Lund, Sweden
| | - E Lammentausta
- Department of Diagnostic Radiology, Oulu University Hospital, Finland
| | - J Svensson
- Department of Radiation Physics, Skåne University Hospital Malmö, Lund University, Sweden
| | - EM Roos
- Institute of Sports Science and Clinical Biomechanics, University of Southern Denmark, Odense, Denmark
| | - LE Dahlberg
- Department of Clinical Sciences, Lund University, Lund, Sweden
| | - CJ Tiderius
- Department of Orthopedics, Skåne University Hospital, Lund University, Sweden
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Widhalm HK, Seemann R, Hamboeck M, Mittlboeck M, Neuhold A, Friedrich K, Hajdu S, Widhalm K. Osteoarthritis in morbidly obese children and adolescents, an age-matched controlled study. Knee Surg Sports Traumatol Arthrosc 2016; 24:644-52. [PMID: 24841943 DOI: 10.1007/s00167-014-3068-4] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/29/2013] [Accepted: 05/05/2014] [Indexed: 02/02/2023]
Abstract
PURPOSE Main objective of this study was to investigate the association of pain and early cartilage lesions in morbidly obese children and adolescents. METHODS A total of 57 subjects were included in the study. Morbidly obese patients (n = 39) were subdivided into two groups: Group A: (11 males and 9 females, 14.2 ± 2.7 years) with permanent knee pain; and Group B: (10 males and 9 females, 14.4 ± 2.2 years) without permanent or without any knee pain. Group C (8 males and 10 females, 15.0 ± 2.9 years) included age-matched children and adolescents of normal weight. MRI examinations were performed in all subjects, and an extensive analysis of the images was conducted according to the condition of the cartilage surface and the meniscus. Patients' subjective health was assessed by means of four well-known knee scores (IKDC, KOOS, Tegner/Lysholm, and VAS). Nonparametric Jonckheere-Terpstra test was used to test the trend of the natural order between the three groups. RESULTS In 38 of 39 morbidly obese children and adolescents, in at least one region of the knee, a marked cartilage lesion could be shown by MRI. Group A showed significantly (p < 0.001) more cartilage lesions (mean 3.7) compared to Group B (mean 2.8) and Group C (mean 0.8). IKDC, and all the KOOS subunits, showed significantly (p < 0.001, p Bonferroni < 0.001) increasing scores from Group A to B to C, in addition to KOOS symptoms. CONCLUSIONS Morbid obesity causes early lesions of the knee cartilage, even in young patients. Significantly, more patients with reported pain show more severe damages.
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Affiliation(s)
- H K Widhalm
- Department of Trauma Surgery, Center for Joints and Cartilage, Medical University of Vienna, Waehringer Guertel 18-20, 1090, Vienna, Austria.
| | - R Seemann
- Department of Maxillofacial Surgery, Medical University of Vienna, Vienna, Austria.
| | - M Hamboeck
- Department of Trauma Surgery, Center for Joints and Cartilage, Medical University of Vienna, Waehringer Guertel 18-20, 1090, Vienna, Austria.
| | - M Mittlboeck
- Department of Medical Statistics, Medical University of Vienna, Vienna, Austria.
| | - A Neuhold
- Department of Radiology, Private Hospital Rudolfinerhaus, Vienna, Austria.
| | - K Friedrich
- Department of Radiology, Medical University of Vienna, Vienna, Austria.
| | - S Hajdu
- Department of Trauma Surgery, Center for Joints and Cartilage, Medical University of Vienna, Waehringer Guertel 18-20, 1090, Vienna, Austria.
| | - K Widhalm
- Department of Pediatrics, Paracelsus Private Medical University, Salzburg, Austria.
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Wenger D, Siversson C, Dahlberg LE, Tiderius CJ. Residual hip dysplasia at 1 year after treatment for neonatal hip instability is not related to degenerative joint disease in young adulthood: a 21-year follow-up study including dGEMRIC. Osteoarthritis Cartilage 2016; 24:436-42. [PMID: 26521012 DOI: 10.1016/j.joca.2015.10.010] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/15/2015] [Revised: 09/11/2015] [Accepted: 10/21/2015] [Indexed: 02/02/2023]
Abstract
OBJECTIVE Developmental dysplasia of the hip (DDH) is associated with an increased risk of early hip osteoarthritis (OA). We aimed to examine the outcome at the completion of growth in a cohort of children who had residual acetabular dysplasia at age 1 year following early treatment for neonatal instability of the hip (NIH). DESIGN We examined 21 of 30 subjects who had been treated with the von Rosen splint neonatally for NIH and had residual acetabular dysplasia at age 1 year. Mean follow-up time was 21 years (range 17-24). Signs of OA and acetabular dysplasia were assessed by radiography. Cartilage quality was assessed by delayed Gadolinium Enhanced Magnetic Resonance Imaging of Cartilage (dGEMRIC), a tool for molecular imaging of cartilage quality, at 1.5 T. Patient reported outcome (PRO) was assessed by the 12-item WOMAC score. RESULTS No study participant had radiographic OA (defined as Kellgren-Lawrence grade ≥2) or minimum joint space width (JSW) ≤2 mm. The mean dGEMRIC index was 630 ms (95% CI: 600-666, range: 516-825) suggesting good cartilage quality. The mean 12-item WOMAC score was 1.2. Two of three radiographic measurements of DDH correlated positively to the dGEMRIC index. CONCLUSIONS Children treated neonatally for NIH have good hip function and no signs of cartilage degeneration at 21-year follow-up, despite residual dysplasia at age 1 year. Unexpectedly, radiographic signs of dysplasia were associated with better cartilage quality, as assessed with dGEMRIC. This may indicate cartilage adaptation to increased mechanical stress in mild hip dysplasia.
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van Tiel J, Kotek G, Reijman M, Bos PK, Bron EE, Klein S, Nasserinejad K, van Osch GJVM, Verhaar JAN, Krestin GP, Weinans H, Oei EHG. Is T1ρ Mapping an Alternative to Delayed Gadolinium-enhanced MR Imaging of Cartilage in the Assessment of Sulphated Glycosaminoglycan Content in Human Osteoarthritic Knees? An in Vivo Validation Study. Radiology 2015; 279:523-31. [PMID: 26588020 DOI: 10.1148/radiol.2015150693] [Citation(s) in RCA: 57] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
Abstract
PURPOSE To determine if T1ρ mapping can be used as an alternative to delayed gadolinium-enhanced magnetic resonance imaging of cartilage (dGEMRIC) in the quantification of cartilage biochemical composition in vivo in human knees with osteoarthritis. MATERIALS AND METHODS This study was approved by the institutional review board. Written informed consent was obtained from all participants. Twelve patients with knee osteoarthritis underwent dGEMRIC and T1ρ mapping at 3.0 T before undergoing total knee replacement. Outcomes of dGEMRIC and T1ρ mapping were calculated in six cartilage regions of interest. Femoral and tibial cartilages were harvested during total knee replacement. Cartilage sulphated glycosaminoglycan (sGAG) and collagen content were assessed with dimethylmethylene blue and hydroxyproline assays, respectively. A four-dimensional multivariate mixed-effects model was used to simultaneously assess the correlation between outcomes of dGEMRIC and T1ρ mapping and the sGAG and collagen content of the articular cartilage. RESULTS T1 relaxation times at dGEMRIC showed strong correlation with cartilage sGAG content (r = 0.73; 95% credibility interval [CI] = 0.60, 0.83) and weak correlation with cartilage collagen content (r = 0.40; 95% CI: 0.18, 0.58). T1ρ relaxation times did not correlate with cartilage sGAG content (r = 0.04; 95% CI: -0.21, 0.28) or collagen content (r = -0.05; 95% CI = -0.31, 0.20). CONCLUSION dGEMRIC can help accurately measure cartilage sGAG content in vivo in patients with knee osteoarthritis, whereas T1ρ mapping does not appear suitable for this purpose. Although the technique is not completely sGAG specific and requires a contrast agent, dGEMRIC is a validated and robust method for quantifying cartilage sGAG content in human osteoarthritis subjects in clinical research.
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Affiliation(s)
- Jasper van Tiel
- From the Departments of Radiology (J.v.T., G.K., E.E.B., S.K., G.P.K., E.H.G.O.), Orthopedic Surgery (J.v.T., M.R., P.K.B., G.J.V.M.v.O., J.A.N.V.), Medical Informatics (E.E.B., S.K.), Biostatistics (K.N.), and Otorhinolaryngology (G.J.V.M.v.O.), Erasmus University Medical Center, PO Box 2040, 3000 CA Rotterdam, the Netherlands; Department of Biomechanical Engineering, Delft University of Technology, Delft, the Netherlands (H.W.); and Department of Orthopedics and Rheumatology, University Medical Center Utrecht, Utrecht, the Netherlands (H.W.)
| | - Gyula Kotek
- From the Departments of Radiology (J.v.T., G.K., E.E.B., S.K., G.P.K., E.H.G.O.), Orthopedic Surgery (J.v.T., M.R., P.K.B., G.J.V.M.v.O., J.A.N.V.), Medical Informatics (E.E.B., S.K.), Biostatistics (K.N.), and Otorhinolaryngology (G.J.V.M.v.O.), Erasmus University Medical Center, PO Box 2040, 3000 CA Rotterdam, the Netherlands; Department of Biomechanical Engineering, Delft University of Technology, Delft, the Netherlands (H.W.); and Department of Orthopedics and Rheumatology, University Medical Center Utrecht, Utrecht, the Netherlands (H.W.)
| | - Max Reijman
- From the Departments of Radiology (J.v.T., G.K., E.E.B., S.K., G.P.K., E.H.G.O.), Orthopedic Surgery (J.v.T., M.R., P.K.B., G.J.V.M.v.O., J.A.N.V.), Medical Informatics (E.E.B., S.K.), Biostatistics (K.N.), and Otorhinolaryngology (G.J.V.M.v.O.), Erasmus University Medical Center, PO Box 2040, 3000 CA Rotterdam, the Netherlands; Department of Biomechanical Engineering, Delft University of Technology, Delft, the Netherlands (H.W.); and Department of Orthopedics and Rheumatology, University Medical Center Utrecht, Utrecht, the Netherlands (H.W.)
| | - Pieter K Bos
- From the Departments of Radiology (J.v.T., G.K., E.E.B., S.K., G.P.K., E.H.G.O.), Orthopedic Surgery (J.v.T., M.R., P.K.B., G.J.V.M.v.O., J.A.N.V.), Medical Informatics (E.E.B., S.K.), Biostatistics (K.N.), and Otorhinolaryngology (G.J.V.M.v.O.), Erasmus University Medical Center, PO Box 2040, 3000 CA Rotterdam, the Netherlands; Department of Biomechanical Engineering, Delft University of Technology, Delft, the Netherlands (H.W.); and Department of Orthopedics and Rheumatology, University Medical Center Utrecht, Utrecht, the Netherlands (H.W.)
| | - Esther E Bron
- From the Departments of Radiology (J.v.T., G.K., E.E.B., S.K., G.P.K., E.H.G.O.), Orthopedic Surgery (J.v.T., M.R., P.K.B., G.J.V.M.v.O., J.A.N.V.), Medical Informatics (E.E.B., S.K.), Biostatistics (K.N.), and Otorhinolaryngology (G.J.V.M.v.O.), Erasmus University Medical Center, PO Box 2040, 3000 CA Rotterdam, the Netherlands; Department of Biomechanical Engineering, Delft University of Technology, Delft, the Netherlands (H.W.); and Department of Orthopedics and Rheumatology, University Medical Center Utrecht, Utrecht, the Netherlands (H.W.)
| | - Stefan Klein
- From the Departments of Radiology (J.v.T., G.K., E.E.B., S.K., G.P.K., E.H.G.O.), Orthopedic Surgery (J.v.T., M.R., P.K.B., G.J.V.M.v.O., J.A.N.V.), Medical Informatics (E.E.B., S.K.), Biostatistics (K.N.), and Otorhinolaryngology (G.J.V.M.v.O.), Erasmus University Medical Center, PO Box 2040, 3000 CA Rotterdam, the Netherlands; Department of Biomechanical Engineering, Delft University of Technology, Delft, the Netherlands (H.W.); and Department of Orthopedics and Rheumatology, University Medical Center Utrecht, Utrecht, the Netherlands (H.W.)
| | - Kazem Nasserinejad
- From the Departments of Radiology (J.v.T., G.K., E.E.B., S.K., G.P.K., E.H.G.O.), Orthopedic Surgery (J.v.T., M.R., P.K.B., G.J.V.M.v.O., J.A.N.V.), Medical Informatics (E.E.B., S.K.), Biostatistics (K.N.), and Otorhinolaryngology (G.J.V.M.v.O.), Erasmus University Medical Center, PO Box 2040, 3000 CA Rotterdam, the Netherlands; Department of Biomechanical Engineering, Delft University of Technology, Delft, the Netherlands (H.W.); and Department of Orthopedics and Rheumatology, University Medical Center Utrecht, Utrecht, the Netherlands (H.W.)
| | - Gerjo J V M van Osch
- From the Departments of Radiology (J.v.T., G.K., E.E.B., S.K., G.P.K., E.H.G.O.), Orthopedic Surgery (J.v.T., M.R., P.K.B., G.J.V.M.v.O., J.A.N.V.), Medical Informatics (E.E.B., S.K.), Biostatistics (K.N.), and Otorhinolaryngology (G.J.V.M.v.O.), Erasmus University Medical Center, PO Box 2040, 3000 CA Rotterdam, the Netherlands; Department of Biomechanical Engineering, Delft University of Technology, Delft, the Netherlands (H.W.); and Department of Orthopedics and Rheumatology, University Medical Center Utrecht, Utrecht, the Netherlands (H.W.)
| | - Jan A N Verhaar
- From the Departments of Radiology (J.v.T., G.K., E.E.B., S.K., G.P.K., E.H.G.O.), Orthopedic Surgery (J.v.T., M.R., P.K.B., G.J.V.M.v.O., J.A.N.V.), Medical Informatics (E.E.B., S.K.), Biostatistics (K.N.), and Otorhinolaryngology (G.J.V.M.v.O.), Erasmus University Medical Center, PO Box 2040, 3000 CA Rotterdam, the Netherlands; Department of Biomechanical Engineering, Delft University of Technology, Delft, the Netherlands (H.W.); and Department of Orthopedics and Rheumatology, University Medical Center Utrecht, Utrecht, the Netherlands (H.W.)
| | - Gabriel P Krestin
- From the Departments of Radiology (J.v.T., G.K., E.E.B., S.K., G.P.K., E.H.G.O.), Orthopedic Surgery (J.v.T., M.R., P.K.B., G.J.V.M.v.O., J.A.N.V.), Medical Informatics (E.E.B., S.K.), Biostatistics (K.N.), and Otorhinolaryngology (G.J.V.M.v.O.), Erasmus University Medical Center, PO Box 2040, 3000 CA Rotterdam, the Netherlands; Department of Biomechanical Engineering, Delft University of Technology, Delft, the Netherlands (H.W.); and Department of Orthopedics and Rheumatology, University Medical Center Utrecht, Utrecht, the Netherlands (H.W.)
| | - Harrie Weinans
- From the Departments of Radiology (J.v.T., G.K., E.E.B., S.K., G.P.K., E.H.G.O.), Orthopedic Surgery (J.v.T., M.R., P.K.B., G.J.V.M.v.O., J.A.N.V.), Medical Informatics (E.E.B., S.K.), Biostatistics (K.N.), and Otorhinolaryngology (G.J.V.M.v.O.), Erasmus University Medical Center, PO Box 2040, 3000 CA Rotterdam, the Netherlands; Department of Biomechanical Engineering, Delft University of Technology, Delft, the Netherlands (H.W.); and Department of Orthopedics and Rheumatology, University Medical Center Utrecht, Utrecht, the Netherlands (H.W.)
| | - Edwin H G Oei
- From the Departments of Radiology (J.v.T., G.K., E.E.B., S.K., G.P.K., E.H.G.O.), Orthopedic Surgery (J.v.T., M.R., P.K.B., G.J.V.M.v.O., J.A.N.V.), Medical Informatics (E.E.B., S.K.), Biostatistics (K.N.), and Otorhinolaryngology (G.J.V.M.v.O.), Erasmus University Medical Center, PO Box 2040, 3000 CA Rotterdam, the Netherlands; Department of Biomechanical Engineering, Delft University of Technology, Delft, the Netherlands (H.W.); and Department of Orthopedics and Rheumatology, University Medical Center Utrecht, Utrecht, the Netherlands (H.W.)
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Zilkens C, Tiderius CJ, Krauspe R, Bittersohl B. 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] [What about the content of this article? (0)] [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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Bengtsson Moström E, Lammentausta E, Finnbogason T, Weidenhielm L, Janarv PM, Tiderius CJ. Pre- and postcontrast T1 and T2 mapping of patellar cartilage in young adults with recurrent patellar dislocation. Magn Reson Med 2014; 74:1363-9. [PMID: 25421491 DOI: 10.1002/mrm.25511] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2014] [Revised: 10/11/2014] [Accepted: 10/13/2014] [Indexed: 02/05/2023]
Abstract
PURPOSE To examine the cartilage quality in young adults with recurrent patellar dislocation in childhood using different magnetic resonance imaging parameters. METHODS Sixteen young adults with unilateral recurrent patellar dislocation were investigated ≥5 y (mean, 8.5 y) after the first dislocation. Pre- and postcontrast T1 and precontrast T2 relaxation times were analyzed in four superficial and four deep patellar cartilage regions of both knees. Two hours after intravenous injection of 0.2 mM/kg Gd-DTPA(2-), postcontrast T1 [T1(Gd)] and ΔR1 [1/T1 (precontrast) - 1/T1 (postcontrast)] were analyzed in the regions. Muscle performance and patient-reported outcome were evaluated. RESULTS When comparing the injured side with the noninjured side, differences were seen in the superficial half but not the deep half of the cartilage. T1(Gd) was shorter in the central part, whereas T2 was shorter in the periphery of the patellar cartilage (P < 0.05). ΔR1 demonstrated similar differences between healthy and diseased cartilage as T1(Gd) alone. The knee function was not correlated to the degenerative changes. CONCLUSION The short T1(Gd) centrally indicates degenerative cartilage changes consistent with loss of glycosaminoglycans. Precontrast and ΔR1 calculations may be excluded in clinical dGEMRIC, which simplifies the procedure. A decrease in T2 may be a very early sign of joint pathology but warrants further investigation.
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Affiliation(s)
| | - Eveliina Lammentausta
- Department of Diagnostic Radiology, Oulu University Hospital, Oulu, Finland.,Medical Research Center Oulu, Oulu University Hospital and University of Oulu, Oulu, Finland
| | - Thröstur Finnbogason
- Department of Paediatric Radiology, Karolinska University Hospital, Stockholm, Sweden
| | - Lars Weidenhielm
- Stockholm Sports Trauma Research Center, Department of Molecular Medicine and Surgery, Karolinska Institutet, Stockholm, Sweden
| | - Per-Mats Janarv
- Department of Womens and Childrens Health, Karolinska Institutet, Stockholm, Sweden
| | - Carl Johan Tiderius
- Department of Orthopaedics, Skane University Hospital, Lund University, Lund, Sweden
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Owman H, Ericsson YB, Englund M, Tiderius CJ, Tjörnstrand J, Roos EM, Dahlberg LE. Association between delayed gadolinium-enhanced MRI of cartilage (dGEMRIC) and joint space narrowing and osteophytes: a cohort study in patients with partial meniscectomy with 11 years of follow-up. Osteoarthritis Cartilage 2014; 22:1537-41. [PMID: 24583348 DOI: 10.1016/j.joca.2014.02.929] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/26/2013] [Revised: 01/22/2014] [Accepted: 02/19/2014] [Indexed: 02/02/2023]
Abstract
OBJECTIVE To examine the association between the relaxation time (T1Gd) of delayed gadolinium-enhanced magnetic resonance imaging of cartilage (dGEMRIC) and grade of tibiofemoral joint space narrowing (JSN) and osteophytosis 11 years later, in a cohort of meniscectomized patients. DESIGN Patients (n = 45) aged 35-50 who had undergone an arthroscopic partial medial meniscectomy 1-6 years earlier, due to degenerative meniscal tear, were examined using dGEMRIC. These patients had no cartilage changes defined as deep clefts or visible bone at the time of arthroscopy. Eleven years later (12-16 years after surgery) 34 of these subjects (76%) were evaluated by weight-bearing knee radiography, and tibiofemoral joint changes were graded according to the Osteoarthritis Research Society International Atlas. RESULTS Lower T1Gd in the medial compartment was associated with higher grade of medial JSN (grade 0, 351 ms; grade 1, 386 ms; grade 2, 342 ms; grade 3, 259 ms [P for trend < 0.001]) and more osteophytosis (score 0, 371 ms; score 1, 389 ms; score 2, 354 ms; score 3, 289 ms; score 4, 265 ms; score 5, 275 ms [P for trend = 0.001]). Lower T1Gd in the lateral compartment was associated with higher grade of lateral JSN (grade 0, 436 ms; grade 1, 346 ms [P for trend = 0.026]). CONCLUSION The current study suggests that lower T1Gd measured with dGEMRIC of medial and lateral femoral cartilage is associated with higher grade of JSN 11 years later, and medially, also with more osteophytosis.
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Affiliation(s)
- H Owman
- Department of Orthopaedics, Clinical Sciences, Lund University, Malmö, Sweden.
| | - Y B Ericsson
- Department of Orthopaedics, Clinical Sciences, Lund University, Malmö, Sweden
| | - M Englund
- Department of Orthopaedics, Clinical Sciences, Lund University, Lund, Sweden; Clinical Epidemiology Research & Training Unit, Boston University School of Medicine, Boston, MA, USA
| | - C J Tiderius
- Department of Orthopaedics, Clinical Sciences, Lund University, Malmö, Sweden
| | - J Tjörnstrand
- Department of Orthopaedics, Clinical Sciences, Lund University, Malmö, Sweden
| | - E M Roos
- Research Unit for Musculoskeletal Function and Physiotherapy, Department of Sports Science and Clinical Biomechanics, University of Southern Denmark, Odense, Denmark
| | - L E Dahlberg
- Department of Orthopaedics, Clinical Sciences, Lund University, Malmö, Sweden; Department of Orthopaedics, Clinical Sciences, Lund University, Lund, Sweden
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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] [What about the content of this article? (0)] [Affiliation(s)] [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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Sigurdsson U, Siversson C, Lammentausta E, Svensson J, Tiderius CJ, Dahlberg LE. In vivo transport of Gd-DTPA2- into human meniscus and cartilage assessed with delayed gadolinium-enhanced MRI of cartilage (dGEMRIC). BMC Musculoskelet Disord 2014; 15:226. [PMID: 25005036 PMCID: PMC4125346 DOI: 10.1186/1471-2474-15-226] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/11/2013] [Accepted: 07/01/2014] [Indexed: 11/11/2022] Open
Abstract
Background Impaired stability is a risk factor in knee osteoarthritis (OA), where the whole joint and not only the joint cartilage is affected. The meniscus provides joint stability and is involved in the early pathological progress of OA. Delayed gadolinium-enhanced MRI of cartilage (dGEMRIC) has been used to identify pre-radiographic changes in the cartilage in OA, but has been used less commonly to examine the meniscus, and then using only a double dose of the contrast agent. The purpose of this study was to enable improved early OA diagnosis by investigate the temporal contrast agent distribution in the meniscus and femoral cartilage simultaneously, in healthy volunteers, using 3D dGEMRIC at two different doses of the contrast agent Gd-DTPA2-. Methods The right knee in 12 asymptomatic volunteers was examined using a 3D Look-Locker sequence on two occasions after an intravenous injection of a double or triple dose of Gd-DTPA2- (0.2 or 0.3 mmol/kg body weight). The relaxation time (T1) and relaxation rate (R1 = 1/T1) were measured in the meniscus and femoral cartilage before, and 60, 90, 120 and 180 minutes after injection, and the change in relaxation rate (ΔR1) was calculated. Paired t-test and Analysis of Variance (ANOVA) were used for statistical evaluation. Results The triple dose yielded higher concentrations of Gd-DTPA2- in the meniscus and cartilage than the double dose, but provided no additional information. The observed patterns of ΔR1 were similar for double and triple doses of the contrast agent. ΔR1 was higher in the meniscus than in femoral cartilage in the corresponding compartments at all time points after injection. ΔR1 increased until 90-180 minutes in both the cartilage and the meniscus (p < 0.05), and was lower in the medial than in the lateral meniscus at all time points (p < 0.05). A faster increase in ΔR1 was observed in the vascularized peripheral region of the posterior medial meniscus, than in the avascular central part of the posterior medial meniscus during the first 60 minutes (p < 0.05). Conclusion It is feasible to examine undamaged meniscus and cartilage simultaneously using dGEMRIC, preferably 90 minutes after the injection of a double dose of Gd-DTPA2- (0.2 mmol/kg body weight).
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Affiliation(s)
- Ulf Sigurdsson
- Department of Orthopaedics, Lund University, Skåne University Hospital, SE-205 02 Malmö, Sweden.
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Owman H, Tiderius CJ, Ericsson YB, Dahlberg LE. Long-term effect of removal of knee joint loading on cartilage quality evaluated by delayed gadolinium-enhanced magnetic resonance imaging of cartilage. Osteoarthritis Cartilage 2014; 22:928-32. [PMID: 24795270 DOI: 10.1016/j.joca.2014.04.021] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/11/2013] [Revised: 03/31/2014] [Accepted: 04/22/2014] [Indexed: 02/02/2023]
Abstract
OBJECTIVE Ankle fracture patients were used as a model to study the long-term effect of the removal of joint loading on knee cartilage quality in human subjects. DESIGN The knees of 10 patients with ipsilateral ankle fractures were investigated using delayed gadolinium-enhanced magnetic resonance imaging of cartilage (dGEMRIC) at the time of ankle injury. After 6 weeks' prescribed unloading of the affected leg, but no restrictions regarding knee movement, the cast was removed from the ankle and the patient underwent a second dGEMRIC examination. Physiotherapy was then initiated. A third dGEMRIC examination was performed 4 months after remobilization, and a final examination 1 year after the injury. RESULTS Baseline T1Gd values for the 10 patients were within a narrow range. No significant change in mean T1Gd was observed after 6 weeks' prescribed unloading, but the T1Gd range had increased significantly. Four months after remobilization, the mean T1Gd was significantly lower than in the previous examinations, and the range remained significantly broader than at baseline. At the 1-year follow-up, the mean T1Gd was almost identical to the value after remobilization, and the T1Gd range still showed a significant increase compared to the baseline investigation. CONCLUSIONS Removal of knee cartilage loading for 6 weeks resulted in a measurable effect on the cartilage matrix, as evidenced by a broader T1Gd range. A decrease in mean T1Gd was observed 4 months after remobilization. These differences persisted a year after injury compared to baseline.
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Affiliation(s)
- H Owman
- Department of Orthopaedics, Clinical Sciences, Malmö, Lund University, Sweden.
| | - C J Tiderius
- Department of Orthopaedics, Clinical Sciences, Malmö, Lund University, Sweden
| | - Y B Ericsson
- Department of Orthopaedics, Clinical Sciences, Malmö, Lund University, Sweden
| | - L E Dahlberg
- Department of Orthopaedics, Clinical Sciences, Malmö, Lund University, Sweden
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van Tiel J, Kotek G, Reijman M, Bos PK, Bron EE, Klein S, Verhaar JAN, Krestin GP, Weinans H, Oei EHG. Delayed gadolinium-enhanced MRI of the meniscus (dGEMRIM) in patients with knee osteoarthritis: relation with meniscal degeneration on conventional MRI, reproducibility, and correlation with dGEMRIC. Eur Radiol 2014; 24:2261-70. [DOI: 10.1007/s00330-014-3204-z] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2014] [Revised: 03/26/2014] [Accepted: 04/24/2014] [Indexed: 12/18/2022]
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Wang L, Regatte RR. Quantitative mapping of human cartilage at 3.0T: parallel changes in T₂, T₁ρ, and dGEMRIC. Acad Radiol 2014; 21:463-71. [PMID: 24594416 DOI: 10.1016/j.acra.2013.12.010] [Citation(s) in RCA: 33] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2013] [Revised: 12/14/2013] [Accepted: 12/15/2013] [Indexed: 10/25/2022]
Abstract
RATIONALE AND OBJECTIVES The objectives of this study were to measure the parallel changes of transverse relaxation times (T₂), spin-lattice relaxation time in the rotating frame (T₁ρ), and the delayed gadolinium-enhanced magnetic resonance imaging of cartilage (dGEMRIC)-T1 mapping of human knee cartilage in detecting cartilage degeneration at 3.0T. MATERIALS AND METHODS Healthy volunteers (n = 10, mean age 35.6 years) and patients (n = 10, mean age 65 years) with early knee osteoarthritis (OA) were scanned at 3.0T MR using an 8-channel phased array knee coil (transmit-receive). Quantitative assessment of T₂, T₁ρ, and dGEMRIC-T₁ values (global and regional) were correlated between asymptomatic subjects and patients with OA. RESULTS The average T₂ (39 ± 2 milliseconds [mean ± standard deviation] vs. 47 ± 6 milliseconds, P < .0007) and T₁ρ (48 ± 3 vs. 62 ± 8 milliseconds, P < .0002) values were all markedly increased in all patients with OA when compared to healthy volunteers. The average dGEMRIC-T₁ (1244 ± 134 vs. 643 ± 227 milliseconds, P < .000002) value was sharply decreased after intravenous administration of gadolinium contrast agent in all patients with OA. CONCLUSIONS The research results showed that all the T₂, T₁ρ, and dGEMRIC-T₁ relaxation times varied with the cartilage degeneration. The dGEMRIC-T₁ and T₁ρ relaxation times seem to be more sensitive than T₂ in detecting early cartilage degeneration. The preliminary study demonstrated that the early biochemical changes in knee osteoarthritic patients could be detected noninvasively in in vivo using T₁ρ and dGEMRIC-T₁ mapping.
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Widmyer MR, Utturkar GM, Leddy HA, Coleman JL, Spritzer CE, Moorman CT, DeFrate LE, Guilak F. High body mass index is associated with increased diurnal strains in the articular cartilage of the knee. ACTA ACUST UNITED AC 2014; 65:2615-22. [PMID: 23818303 DOI: 10.1002/art.38062] [Citation(s) in RCA: 41] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2013] [Accepted: 06/10/2013] [Indexed: 11/10/2022]
Abstract
OBJECTIVE Obesity is an important risk factor for osteoarthritis (OA) and is associated with changes in both the biomechanical and inflammatory environments within the joint. However, the relationship between obesity and cartilage deformation is not fully understood. The goal of this study was to determine the effects of body mass index (BMI) on the magnitude of diurnal cartilage strain in the knee. METHODS Three-dimensional maps of knee cartilage thickness were developed from 3T magnetic resonance images of the knees of asymptomatic age- and sex-matched subjects with normal BMI (18.5-24.9 kg/m2) or high BMI (25-31 kg/m2). Site-specific magnitudes of diurnal cartilage strain were determined using aligned images recorded at 8:00 AM and 4:00 PM on the same day. RESULTS Subjects with high BMI had significantly thicker cartilage on both the patella and femoral groove, as compared to subjects with normal BMI. Diurnal cartilage strains were dependent on location in the knee joint, as well as BMI. Subjects with high BMI, compared to those with normal BMI, exhibited significantly higher compressive strains in the tibial cartilage. Cartilage thickness on both femoral condyles decreased significantly from the AM to the PM time point; however, there was no significant effect of BMI on diurnal cartilage strain in the femur. CONCLUSION Increased BMI is associated with increased diurnal strains in articular cartilage of both the medial and lateral compartments of the knee. The increased cartilage strains observed in individuals with high BMI may, in part, explain the elevated risk of OA associated with obesity or may reflect alterations in the cartilage mechanical properties in subjects with high BMI.
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Affiliation(s)
- Margaret R Widmyer
- Duke University and Duke University Medical Center, Durham, North Carolina
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Multanen J, Nieminen MT, Häkkinen A, Kujala UM, Jämsä T, Kautiainen H, Lammentausta E, Ahola R, Selänne H, Ojala R, Kiviranta I, Heinonen A. Effects of high-impact training on bone and articular cartilage: 12-month randomized controlled quantitative MRI study. J Bone Miner Res 2014; 29:192-201. [PMID: 23775755 DOI: 10.1002/jbmr.2015] [Citation(s) in RCA: 47] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/15/2013] [Revised: 05/17/2013] [Accepted: 06/03/2013] [Indexed: 01/03/2023]
Abstract
Osteoarthritis and osteoporosis often coexist in postmenopausal women. The simultaneous effect of bone-favorable high-impact training on these diseases is not well understood and is a topic of controversy. We evaluated the effects of high-impact exercise on bone mineral content (BMC) and the estimated biochemical composition of knee cartilage in postmenopausal women with mild knee osteoarthritis. Eighty women aged 50 to 66 years with mild knee osteoarthritis were randomly assigned to undergo supervised progressive exercise three times a week for 12 months (n = 40) or to a nonintervention control group (n = 40). BMC of the femoral neck, trochanter, and lumbar spine was measured by dual-energy X-ray absorptiometry (DXA). The biochemical composition of cartilage was estimated using delayed gadolinium-enhanced magnetic resonance imaging (MRI) cartilage (dGEMRIC), sensitive to cartilage glycosaminoglycan content, and transverse relaxation time (T2) mapping that is sensitive to the properties of the collagen network. In addition, we evaluated clinically important symptoms and physical performance-related risk factors of falling: cardiorespiratory fitness, dynamic balance, maximal isometric knee extension and flexion forces, and leg power. Thirty-six trainees and 40 controls completed the study. The mean gain in femoral neck BMC in the exercise group was 0.6% (95% CI, -0.2% to 1.4%) and the mean loss in the control group was -1.2% (95% CI, -2.1% to -0.4%). The change in baseline, body mass, and adjusted body mass change in BMC between the groups was significant (p = 0.005), whereas no changes occurred in the biochemical composition of the cartilage, as investigated by MRI. Balance, muscle force, and cardiorespiratory fitness improved significantly more (3% to 11%) in the exercise group than in the control group. Progressively implemented high-impact training, which increased bone mass, did not affect the biochemical composition of cartilage and may be feasible in the prevention of osteoporosis and physical performance-related risk factors of falling in postmenopausal women.
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Affiliation(s)
- Juhani Multanen
- Department of Health Sciences, University of Jyväskylä, Jyväskylä, Finland
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Neuman P, Owman H, Müller G, Englund M, Tiderius CJ, Dahlberg LE. Knee cartilage assessment with MRI (dGEMRIC) and subjective knee function in ACL injured copers: a cohort study with a 20 year follow-up. Osteoarthritis Cartilage 2014; 22:84-90. [PMID: 24185106 DOI: 10.1016/j.joca.2013.10.006] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/27/2013] [Revised: 08/31/2013] [Accepted: 10/22/2013] [Indexed: 02/02/2023]
Abstract
OBJECTIVE To assess knee cartilage quality and subjective knee function, 20 years after injury in anterior cruciate ligament (ACL) injured copers. METHOD We examined 32 knees using delayed gadolinium-enhanced magnetic resonance imaging (MRI) of cartilage (dGEMRIC), 20 years after a complete ACL tear. Only subjects who had coped with the ACL injury without ACL reconstruction (ACLR), and who presented without radiographic signs of osteoarthritis (OA) at an earlier 16-year follow-up, were included in this study. The quality of the central weight-bearing parts of the medial and lateral femoral cartilage was estimated with dGEMRIC (T1Gd). These results were compared with corresponding results in 24 healthy individuals, and with the subjects' self-reported subjective knee function using the Knee Injury and Osteoarthritis Outcome Score (KOOS) questionnaire. RESULTS The values of T1Gd in the medial and lateral femoral cartilage of the study group (mean (95% CI)), were 404 (385-423) and 427 (399-455) ms, not statistically different from those of the healthy reference group (P = 0.065 and 0.31). The subjective knee function 20 years after the injury, according to the five domains of the KOOS score, was good, with a mean score of 90 ± 11. Values of T1Gd for the medial femoral cartilage were correlated with the KOOS subgroup QOL (P = 0.021, Pearson correlation). CONCLUSIONS Subjects who have managed to cope with their ACL injury for 20 years with sustained good subjective knee function also seem to have knee cartilage of good quality, with T1Gd values not very different from a healthy reference group.
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Affiliation(s)
- P Neuman
- Department of Orthopaedics, Clinical Sciences, Malmö, Lund University, Sweden.
| | - H Owman
- Department of Orthopaedics, Clinical Sciences, Malmö, Lund University, Sweden
| | - G Müller
- Department of Radiology, Clinical Sciences, Malmö, Lund University, Sweden
| | - M Englund
- Department of Orthopaedics, Clinical Sciences, Malmö, Lund University, Sweden; Clinical Epidemiology Research & Training Unit, Boston University School of Medicine, Boston, MA, USA
| | - C J Tiderius
- Department of Orthopaedics, Clinical Sciences, Malmö, Lund University, Sweden
| | - L E Dahlberg
- Department of Orthopaedics, Clinical Sciences, Malmö, Lund University, Sweden
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van Tiel J, Reijman M, Bos PK, Hermans J, van Buul GM, Bron EE, Klein S, Verhaar JAN, Krestin GP, Bierma-Zeinstra SMA, Weinans H, Kotek G, Oei EHG. Delayed gadolinium-enhanced MRI of cartilage (dGEMRIC) shows no change in cartilage structural composition after viscosupplementation in patients with early-stage knee osteoarthritis. PLoS One 2013; 8:e79785. [PMID: 24223194 PMCID: PMC3819245 DOI: 10.1371/journal.pone.0079785] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2013] [Accepted: 09/25/2013] [Indexed: 12/11/2022] Open
Abstract
Introduction Viscosupplementation with hyaluronic acid (HA) of osteoarthritic (OA) knee joints has a well-established positive effect on clinical symptoms. This effect, however, is only temporary and the working mechanism of HA injections is not clear. It was suggested that HA might have disease modifying properties because of its beneficial effect on cartilage sulphated glycosaminoglycan (sGAG) content. Delayed gadolinium-enhanced MRI of cartilage (dGEMRIC) is a highly reproducible, non-invasive surrogate measure for sGAG content and hence composition of cartilage. The aim of this study was to assess whether improvement in cartilage structural composition is detected using dGEMRIC 14 weeks after 3 weekly injections with HA in patients with early-stage knee OA. Methods In 20 early-stage knee OA patients (KLG I-II), 3D dGEMRIC at 3T was acquired before and 14 weeks after 3 weekly injections with HA. To evaluate patient symptoms, the knee injury and osteoarthritis outcome score (KOOS) and a numeric rating scale (NRS) for pain were recorded. To evaluate cartilage composition, six cartilage regions in the knee were analyzed on dGEMRIC. Outcomes of dGEMRIC, KOOS and NRS before and after HA were compared using paired t-testing. Since we performed multiple t-tests, we applied a Bonferroni-Holm correction to determine statistical significance for these analyses. Results All KOOS subscales (‘pain’, ‘symptoms’, ‘daily activities’, ‘sports’ and ’quality of life’) and the NRS pain improved significantly 14 weeks after Viscosupplementation with HA. Outcomes of dGEMRIC did not change significantly after HA compared to baseline in any of the cartilage regions analyzed in the knee. Conclusions Our results confirm previous findings reported in the literature, showing persisting improvement in symptomatic outcome measures in early-stage knee OA patients 14 weeks after Viscosupplementation. Outcomes of dGEMRIC, however, did not change after Viscosupplementation, indicating no change in cartilage structural composition as an explanation for the improvement of clinical symptoms.
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Affiliation(s)
- Jasper van Tiel
- Department of Orthopedic Surgery, Erasmus MC, University Medical Center, Rotterdam, The Netherlands
- Department of Radiology, Erasmus MC, University Medical Center, Rotterdam, The Netherlands
| | - Max Reijman
- Department of Orthopedic Surgery, Erasmus MC, University Medical Center, Rotterdam, The Netherlands
| | - Pieter K. Bos
- Department of Orthopedic Surgery, Erasmus MC, University Medical Center, Rotterdam, The Netherlands
| | - Job Hermans
- Department of Orthopedic Surgery, Erasmus MC, University Medical Center, Rotterdam, The Netherlands
| | - Gerben M. van Buul
- Department of Orthopedic Surgery, Erasmus MC, University Medical Center, Rotterdam, The Netherlands
- Department of Radiology, Erasmus MC, University Medical Center, Rotterdam, The Netherlands
| | - Esther E. Bron
- Department of Radiology, Erasmus MC, University Medical Center, Rotterdam, The Netherlands
- Department of Medical Informatics, Erasmus MC, University Medical Center, Rotterdam, The Netherlands
| | - Stefan Klein
- Department of Radiology, Erasmus MC, University Medical Center, Rotterdam, The Netherlands
- Department of Medical Informatics, Erasmus MC, University Medical Center, Rotterdam, The Netherlands
| | - Jan A. N. Verhaar
- Department of Orthopedic Surgery, Erasmus MC, University Medical Center, Rotterdam, The Netherlands
| | - Gabriel P. Krestin
- Department of Radiology, Erasmus MC, University Medical Center, Rotterdam, The Netherlands
| | - Sita M. A. Bierma-Zeinstra
- Department of Orthopedic Surgery, Erasmus MC, University Medical Center, Rotterdam, The Netherlands
- Department of General Practice, Erasmus MC, University Medical Center, Rotterdam, The Netherlands
| | - Harrie Weinans
- Department of Orthopedic Surgery, Erasmus MC, University Medical Center, Rotterdam, The Netherlands
- Department of Biomechanical Engineering, Delft University of Technology, Delft, The Netherlands
| | - Gyula Kotek
- Department of Radiology, Erasmus MC, University Medical Center, Rotterdam, The Netherlands
| | - Edwin H. G. Oei
- Department of Radiology, Erasmus MC, University Medical Center, Rotterdam, The Netherlands
- * E-mail:
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Zilkens C, Miese FR, Crumbiegel C, Kim YJ, Herten M, Antoch G, Krauspe R, Bittersohl B. Magnetic resonance imaging and histology of ovine hip joint cartilage in two age populations: a sheep model with assumed healthy cartilage. Skeletal Radiol 2013; 42:699-705. [PMID: 23275026 DOI: 10.1007/s00256-012-1554-7] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/14/2012] [Revised: 10/08/2012] [Accepted: 11/18/2012] [Indexed: 02/02/2023]
Abstract
OBJECTIVE To compare morphologically normal appearing cartilage in two age groups with delayed gadolinium-enhanced magnetic resonance imaging of cartilage (dGEMRIC) and correlate magnetic resonance imaging (MRI) findings with histology. MATERIALS AND METHODS Twenty femoral head specimens collected from ten lambs (group I) and ten young adult sheep (group II) underwent dGEMRIC and histological assessment. A region of 2 cm(2) with morphologically normal-appearing cartilage was marked with a surgical suture for subsequent matching of MRI and histological sections. The MRI protocol included a three-dimensional (3D) double-echo steady-state sequence for morphological cartilage assessment, a B1 pre-scan with various flip angles for B1 field heterogeneity correction, and 3D volumetric interpolated breathhold examination for T1(Gd) mapping (dGEMRIC). Histological analysis was performed according to the Mankin scoring system. RESULTS A total of 303 regions of interest (ROI; 101 MRI reformats matching 101 histological sections) was assessed. Twenty-six ROIs were excluded owing to morphologically apparent cartilage damage or insufficient MR image quality. Therefore, 277 ROIs were analyzed. Histological analyses revealed distinct degenerative changes in various cartilage samples of group II (young adult sheep). Corresponding T1(Gd) values were significantly lower in the group of sheep (mean T1(Gd) = 540.4 ms) compared with the group of lambs (mean T1(Gd) = 623.6 ms; p < 0.001). CONCLUSIONS Although morphologically normal, distinct cartilage degeneration may be present in young adult sheep cartilage. dGEMRIC can reveal these changes and may be a tool for the assessment of early cartilage degeneration.
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Affiliation(s)
- Christoph Zilkens
- Department of Orthopedic Surgery, Medical Faculty, University of Düsseldorf, Moorenstrasse 5, 40225, Düsseldorf, Germany.
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Baum T, Joseph GB, Nardo L, Virayavanich W, Arulanandan A, Alizai H, Carballido-Gamio J, Nevitt MC, Lynch J, McCulloch CE, Link TM. Correlation of magnetic resonance imaging-based knee cartilage T2 measurements and focal knee lesions with body mass index: thirty-six-month followup data from a longitudinal, observational multicenter study. Arthritis Care Res (Hoboken) 2013; 65:23-33. [PMID: 22623435 DOI: 10.1002/acr.21741] [Citation(s) in RCA: 43] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2011] [Accepted: 05/07/2012] [Indexed: 12/15/2022]
Abstract
OBJECTIVE To compare magnetic resonance imaging (MRI)-based knee cartilage T2 measurements and focal knee lesions and 36-month changes in these parameters among knees of normal controls and knees of normal weight, overweight, and obese subjects with risk factors for knee osteoarthritis (OA). METHODS A total of 267 subjects ages 45-55 years from the Osteoarthritis Initiative database were analyzed in this study. Two hundred thirty-one subjects had risk factors for knee OA, but no radiographic OA (Kellgren/Lawrence score ≤1) at baseline. Thirty-six subjects were normal controls. Subjects with OA risk factors were stratified in 3 groups: normal weight (n = 78), overweight (n = 84), and obese (n = 69). All subjects underwent 3T MRI of the right knee at baseline and after 36 months. Focal knee lesions were assessed and cartilage T2 measurements (mean T2 and T2 texture analysis) were performed. RESULTS The baseline prevalence and severity of meniscal and cartilage lesions were highest in obese subjects and lowest in normal controls (P < 0.05). Obese subjects had the highest mean T2 values and the most heterogeneous cartilage (as assessed by T2 texture analysis), while normal controls had the lowest mean T2 values and the most homogeneous cartilage at baseline (P < 0.05). Increased body mass index (BMI) was significantly (P < 0.05) associated with greater progression of cartilage lesions and constantly elevated cartilage T2 entropy over 36 months. CONCLUSION In preclinical OA, increased BMI is associated with more severe cartilage degeneration as assessed by both morphologic and quantitative MRI measurements.
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Affiliation(s)
- Thomas Baum
- University of California, San Francisco, San Francisco, CA 94107, USA.
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Kumahashi N, Tadenuma T, Kuwata S, Fukuba E, Uchio Y. A longitudinal study of the quantitative evaluation of patella cartilage after total knee replacement by delayed gadolinium-enhanced magnetic resonance imaging of cartilage (dGEMRIC) and T2 mapping at 3.0 T: preliminary results. Osteoarthritis Cartilage 2013; 21:126-35. [PMID: 23099213 DOI: 10.1016/j.joca.2012.09.004] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/06/2012] [Revised: 07/23/2012] [Accepted: 09/18/2012] [Indexed: 02/02/2023]
Abstract
OBJECTIVE To characterize the quantitative changes of patella cartilage over time after total knee arthroplasty (TKA) by delayed gadolinium-enhanced magnetic resonance imaging of cartilage (dGEMRIC) and T2 mapping at 3.0 T. METHOD Twenty-six knees of 26 patients (23 women and three men, mean age, 75 years) with primary osteoarthritis and osteonecrosis of the knee underwent TKA with a zirconia ceramic implant in this prospective study. Twelve patients without patella resurfacing (NR group) and 14 patients with patella resurfacing (R group) had TKA with cemented fixation. The implant position was examined by radiograph, computed tomography (CT) and magnetic resonance imaging (MRI). The clinical scores were checked pre-operatively, 1 year post-operatively and at the final follow-up. Patella cartilage and its thickness were evaluated pre-operatively and 1 year after TKA by dGEMRIC and T2 mapping in the NR group only. Patella cartilage was divided into eight regions of interest: the deep and superficial layers of the outer lateral and medial half, and the inner lateral and medial half from the central ridge. RESULTS The implant position was appropriate in all cases and clinical scores were not significantly different between the two groups. The post-operative dGEMRIC value of the outer medial half superficial zone in the NR group was significantly decreased compared with the pre-operation value (P<0.05), whereas T2 mapping was not significantly changed in all zones. The cartilage thickness of the outer zone was significantly thinner post-operatively (P<0.05). CONCLUSIONS These findings indicate that osteoarthritic changes in the outer zone of patella cartilage occurred 1 year after TKA.
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Affiliation(s)
- N Kumahashi
- Department of Orthopaedics, Shimane University, School of Medicine, 89-1 Enya-cho, Izumo-shi, Shimane 693-8501, Japan.
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Abstract
OBJECTIVE We investigated the feasibility of delayed computed tomography (CT) arthrography for evaluation of human knee cartilage in vivo. Especially, the diffusion of contrast agent out of the joint space and the optimal time points for imaging were determined. DESIGN Two patients were imaged using delayed CT arthrography and delayed gadolinium-enhanced magnetic resonance imaging of cartilage (dGEMRIC) techniques. RESULTS Two hours after injection, the concentration of contrast agent in the joint space was still high enough (20% to 24.5% of the initial concentration at 0 minutes) to allow delayed CT arthrography. The half-life of the contrast agent in the joint space varied from 30 to 60 minutes. The contrast agent concentration in patellar and femoral cartilage reached the maximum after 30 and 60 minutes, respectively. According to dGEMRIC, there were no differences between patients. However, in delayed CT arthrography, the penetration of the contrast agent was higher in the osteoarthritic knee cartilage. CONCLUSIONS Contrast agent remained in the joint space long enough to enable delayed CT arthrography of cartilage. After 30 minutes, the normalized contrast agent concentration was higher in the cartilage of the osteoarthritic knee in comparison with the healthy knee. To conclude, delayed CT arthrography exhibited potential for use in the clinical evaluation of cartilage integrity.
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Affiliation(s)
- Harri T. Kokkonen
- Department of Applied Physics, University of Eastern Finland, Kuopio, Finland,Department of Clinical Neurophysiology, Kuopio University Hospital, Kuopio, Finland
| | - Antti S. Aula
- Department of Medical Physics, Imaging Centre, Tampere University Hospital, Tampere, Finland
| | - Heikki Kröger
- Department of Orthopaedics, Traumatology and Hand Surgery, Kuopio University Hospital, Kuopio, Finland
| | | | | | - Esa Mervaala
- Department of Clinical Neurophysiology, Kuopio University Hospital, Kuopio, Finland,Institute of Clinical Medicine, Clinical Neurophysiology, University of Eastern Finland, Kuopio, Finland
| | - Jukka S. Jurvelin
- Department of Applied Physics, University of Eastern Finland, Kuopio, Finland
| | - Juha Töyräs
- Department of Applied Physics, University of Eastern Finland, Kuopio, Finland,Department of Clinical Neurophysiology, Kuopio University Hospital, Kuopio, Finland
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Griffin TM, Huebner JL, Kraus VB, Yan Z, Guilak F. Induction of osteoarthritis and metabolic inflammation by a very high-fat diet in mice: effects of short-term exercise. ACTA ACUST UNITED AC 2012; 64:443-53. [PMID: 21953366 DOI: 10.1002/art.33332] [Citation(s) in RCA: 171] [Impact Index Per Article: 14.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
OBJECTIVE To test the hypotheses that obesity due to a very high-fat diet induces knee osteoarthritis (OA), and that short-term wheel-running exercise protects against obesity-induced knee OA by reducing systemic inflammation and metabolic dysregulation. METHODS Male C57BL/6J mice were fed either a control diet (13.5% kcal from fat) or a very high-fat diet (60% kcal from fat) from age 12 weeks to age 24 weeks. From 20 to 24 weeks of age, half of the mice were housed with running wheels. The severity of knee OA was determined by assessing histopathologic features, and serum cytokines were measured using a multiplex bead immunoassay and enzyme-linked immunosorbent assays. Body composition was quantified by dual-energy x-ray absorptiometry, and insulin resistance was assessed by glucose tolerance testing. RESULTS Feeding mice with a very high-fat diet increased knee OA scores and levels of serum leptin, adiponectin, KC (mouse analog of interleukin-8 [IL-8]), monokine induced by interferon-γ (CXCL9), and IL-1 receptor antagonist to an extent in proportion to the gain in body fat (3-fold increase in percent body fat compared to controls). Wheel-running exercise reduced progression of OA in the medial femur of obese mice. In addition, exercise disrupted the clustering of cytokine expression and improved glucose tolerance, without reducing body fat or cytokine levels. CONCLUSION Obesity induced by a very high-fat diet in mice causes OA and systemic inflammation in proportion to body fat. Increased joint loading is not sufficient to explain the increased incidence of knee OA with obesity, as wheel running is protective rather than damaging. Exercise improves glucose tolerance and disrupts the coexpression of proinflammatory cytokines, suggesting that increased aerobic exercise may act independently of weight loss in promoting joint health.
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Stubendorff JJ, Lammentausta E, Struglics A, Lindberg L, Heinegård D, Dahlberg LE. Is cartilage sGAG content related to early changes in cartilage disease? Implications for interpretation of dGEMRIC. Osteoarthritis Cartilage 2012; 20:396-404. [PMID: 22334095 DOI: 10.1016/j.joca.2012.01.015] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/07/2011] [Revised: 01/06/2012] [Accepted: 01/17/2012] [Indexed: 02/02/2023]
Abstract
OBJECTIVE This study investigates sulphated glycosaminoglycans (sGAG) content changes in early osteoarthritis (OA), and whether contrast-enhanced magnetic resonance imaging (MRI) of cartilage in vitro may identify early event of OA pathology. METHOD Osteochondral plugs from patients with hip OA or femoral neck fracture (reference group) were collected and analysed by 1.5 T MRI with ΔR1 as a measure of cartilage contrast concentration. Cartilage hydration, contents of sGAG, cartilage oligomeric matrix protein (COMP), hydroxyproline, denatured collagen, and aggrecan TEGE(392) neoepitope were determined and histological grading was performed. RESULTS sGAG content correlated to ΔR1, although no difference in either of these parameters was detectable between OA and reference cartilage at 4 h of contrast equilibration. In contrast, biochemical analysis of other cartilage matrix constituents showed distinct alterations typical for early cartilage degradation in OA cartilage and with clear evidence for increased aggrecan turnover. CONCLUSION In the present in vitro study, cartilage sGAG content could not distinguish between early OA cartilage and reference cartilage. Given, that delayed gadolinium enhanced MRI of cartilage (dGEMRIC) indicates early events in the pathogenesis of OA in vivo, our results from the in vitro studies imply other, additional factors than cartilage sGAG content, e.g., alterations in diffusion or increased supply of contrast agent in the diseased joint. Alternatively, an altered dGEMRIC reflects later stages of OA, when sGAG content decreases. Further investigations are warranted, to understand variations in sGAG content in pathology, an essential background for interpreting dGEMRIC measurements.
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Affiliation(s)
- J J Stubendorff
- Joint and Soft Tissue Unit, Department of Clinical Sciences Malmö, Lund University, Department of Orthopaedics, Skåne University Hospital, Malmö, SE-20502 Malmö, Sweden.
| | - E Lammentausta
- Joint and Soft Tissue Unit, Department of Clinical Sciences Malmö, Lund University, Department of Orthopaedics, Skåne University Hospital, Malmö, SE-20502 Malmö, Sweden; Department of Diagnostic Radiology, Oulu University Hospital, POB 50, FI-90029 OYS, Oulu, Finland
| | - A Struglics
- Department of Orthopaedics, Clinical Sciences Lund, Lund University, Lund 221 84, Sweden
| | - L Lindberg
- Joint and Soft Tissue Unit, Department of Clinical Sciences Malmö, Lund University, Department of Orthopaedics, Skåne University Hospital, Malmö, SE-20502 Malmö, Sweden
| | - D Heinegård
- Department of Clinical Sciences Lund, BMC C12 Lund University, SE-22184 Lund, Sweden
| | - L E Dahlberg
- Joint and Soft Tissue Unit, Department of Clinical Sciences Malmö, Lund University, Department of Orthopaedics, Skåne University Hospital, Malmö, SE-20502 Malmö, Sweden
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Hawezi ZK, Lammentausta E, Svensson J, Dahlberg LE, Tiderius CJ. In vivo transport of Gd-DTPA(2-) in human knee cartilage assessed by depth-wise dGEMRIC analysis. J Magn Reson Imaging 2011; 34:1352-8. [PMID: 21954084 DOI: 10.1002/jmri.22750] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022] Open
Abstract
PURPOSE To investigate the transport of Gd-DTPA(2-) in different layers of femoral knee cartilage in vivo. MATERIALS AND METHODS T(1) measurements (1.5 Tesla) were performed in femoral knee cartilage of 23 healthy volunteers. The weight-bearing central cartilage was analyzed before contrast and at eight time points after an intravenous injection of Gd-DTPA(2-) : 12-60 min (4 volunteers) and 1-4 h (19 volunteers). Three regions of interest were segmented manually: deep, middle, and superficial. RESULTS Before contrast injection, a depth-wise variation of T(1) was observed with 50% higher values in the superficial region compared with the deep region. In the deep region, the uptake of Gd-DTPA(2-) was not detected until 36 min and the concentration increased until 240 min, whereas in the superficial region, the uptake was seen already at 12 min and the concentration decreased after 180 min (P < 0.01). There was a difference between medial and lateral compartment regarding bulk, but not superficial Gd-DTPA(2-) concentration. The bulk gadolinium concentration was negatively related to the cartilage thickness (r = -0.68; P < 0.01). CONCLUSION The depth-wise and thickness dependent variations in Gd-DTPA(2) transport influence the interpretation of bulk dGEMRIC analysis in vivo. In thick cartilage, incomplete penetration of Gd-DTPA(2) will yield a falsely too long T(1) .
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Affiliation(s)
- Zana K Hawezi
- Joint and Soft Tissue Unit, Department of Clinical Sciences, Lund University, Malmö, Sweden
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Neuman P, Tjörnstrand J, Svensson J, Ragnarsson C, Roos H, Englund M, Tiderius CJ, Dahlberg LE. Longitudinal assessment of femoral knee cartilage quality using contrast enhanced MRI (dGEMRIC) in patients with anterior cruciate ligament injury--comparison with asymptomatic volunteers. Osteoarthritis Cartilage 2011; 19:977-83. [PMID: 21621622 DOI: 10.1016/j.joca.2011.05.002] [Citation(s) in RCA: 40] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/22/2010] [Revised: 04/08/2011] [Accepted: 05/05/2011] [Indexed: 02/02/2023]
Abstract
OBJECTIVE In this observational longitudinal study we estimate knee joint cartilage glycosaminoglycan (GAG) content, in patients with an acute anterior cruciate ligament (ACL) injury, with or without a concomitant meniscus injury. METHODS 29 knees (19 men/10 women) were prospectively examined by repeat delayed gadolinium-enhanced magnetic resonance imaging of cartilage (dGEMRIC), approximately 3 weeks and 2.3±1.3 (range 4.5) years after the injury. We estimated the GAG content (T1Gd) in the central weight-bearing parts of the medial and lateral femoral cartilage and compared results with a reference cohort (n=24) with normal knees and no history of injury examined by dGEMRIC at one occasion previously. RESULTS The healthy reference group had longer T1Gd values compared with the ACL-injured patients at follow-up both medially: 428±38 vs 363±61ms (P<0.0001) and laterally: 445±41 vs 396±48ms (P=0.0002). At follow-up T1Gd was lower in meniscectomized patients compared to those without a meniscectomy, both medially (-84ms, P=0.002) and laterally (-38ms, P=0.05). In the injured group, the medial femoral cartilage showed similar T1Gd at the two dGEMRIC investigations: 357±50 vs 363±61ms (P=0.57), whereas the lateral femoral cartilage T1Gd increased: 374±48 vs 396±48ms (P=0.04). CONCLUSIONS The general decrease in cartilage T1Gd in ACL-injured patients compared with references provide evidence for structural matrix GAG changes that seem more pronounced if a concomitant meniscal injury is present. The fact that post-traumatic OA commonly develops in ACL-injured patients, in particularly those with meniscectomy, suggests that shorter T1Gd may be an early biomarker for OA.
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Affiliation(s)
- P Neuman
- Department of Orthopedics, Clinical Sciences, Malmö, Lund University, Sweden.
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Bittersohl B, Hosalkar HS, Werlen S, Trattnig S, Siebenrock KA, Mamisch TC. dGEMRIC and subsequent T1 mapping of the hip at 1.5 Tesla: Normative data on zonal and radial distribution in asymptomatic volunteers. J Magn Reson Imaging 2011; 34:101-6. [DOI: 10.1002/jmri.22528] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
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Abstract
Osteoarthritis is thought to be the most prevalent chronic joint disease. The incidence of osteoarthritis is rising because of the ageing population and the epidemic of obesity. Pain and loss of function are the main clinical features that lead to treatment, including non-pharmacological, pharmacological, and surgical approaches. Clinicians recognise that the diagnosis of osteoarthritis is established late in the disease process, maybe too late to expect much help from disease-modifying drugs. Despite efforts over the past decades to develop markers of disease, still-imaging procedures and biochemical marker analyses need to be improved and possibly extended with more specific and sensitive methods to reliably describe disease processes, to diagnose the disease at an early stage, to classify patients according to their prognosis, and to follow the course of disease and treatment effectiveness. In the coming years, a better definition of osteoarthritis is expected by delineating different phenotypes of the disease. Treatment targeted more specifically at these phenotypes might lead to improved outcomes.
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Affiliation(s)
- Johannes W J Bijlsma
- Department of Rheumatology and Clinical Immunology, University Medical Centre Utrecht, Utrecht, Netherlands.
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McAlindon TE, Nuite M, Krishnan N, Ruthazer R, Price LL, Burstein D, Griffith J, Flechsenhar K. Change in knee osteoarthritis cartilage detected by delayed gadolinium enhanced magnetic resonance imaging following treatment with collagen hydrolysate: a pilot randomized controlled trial. Osteoarthritis Cartilage 2011; 19:399-405. [PMID: 21251991 DOI: 10.1016/j.joca.2011.01.001] [Citation(s) in RCA: 94] [Impact Index Per Article: 7.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/17/2010] [Revised: 12/23/2010] [Accepted: 01/03/2011] [Indexed: 02/02/2023]
Abstract
OBJECTIVE To determine whether either of two magnetic resonance imaging approaches - delayed gadolinium enhanced magnetic resonance imaging of cartilage (dGEMRIC), or T2 mapping - can detect short-term changes in knee hyaline cartilage among individuals taking a formulation of collagen hydrolysate. DESIGN Single center, prospective, randomized, placebo-controlled, double-blind, pilot trial of collagen hydrolysate for mild knee osteoarthritis (OA). Participants were allowed to continue the prior analgesic use. The primary outcome was change in dGEMRIC T1 relaxation time in the cartilage regions of interest at the 24-week timepoint. Secondary endpoints included the change in dGEMRIC T1 relaxation time between baseline and 48 weeks, the change in T2 relaxation time at 0, 24 and 48 weeks, the symptom and functional measures obtained at each of the visits, and overall analgesic use. RESULTS Among a sample of 30 randomized subjects the dGEMRIC score increased in the medial and lateral tibial regions of interest (median increase of 29 and 41 ms respectively) in participants assigned to collagen hydrolysate but decreased (median decline 37 and 36 ms respectively) in the placebo arm with the changes between the two groups at 24 weeks reaching significance. No other significant changes between the two groups were seen in the other four regions, or in any of the T2 values or in the clinical outcomes. CONCLUSIONS These preliminary results suggest that the dGEMRIC technique may be able to detect change in proteoglycan content in knee cartilage among individuals taking collagen hydrolysate after 24 weeks.
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Affiliation(s)
- T E McAlindon
- Division of Rheumatology, Tufts Medical Center, Box 406, 800 Washington Street, Boston, MA 02111, USA.
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Van Ginckel A, Baelde N, Almqvist KF, Roosen P, McNair P, Witvrouw E. Functional adaptation of knee cartilage in asymptomatic female novice runners compared to sedentary controls. A longitudinal analysis using delayed Gadolinium Enhanced Magnetic Resonance Imaging of Cartilage (dGEMRIC). Osteoarthritis Cartilage 2010; 18:1564-9. [PMID: 20950697 DOI: 10.1016/j.joca.2010.10.007] [Citation(s) in RCA: 58] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/05/2010] [Revised: 09/15/2010] [Accepted: 10/04/2010] [Indexed: 02/02/2023]
Abstract
OBJECTIVE To longitudinally estimate the change in glycosaminoglycan content of knee cartilage in asymptomatic untrained female novice runners participating in a Start To Run program (STR) compared to sedentary controls. METHOD Nine females enrolling in a 10-week STR and 10 sedentary controls participated voluntarily. Prior to and after the 10-week period, both groups were subjected to dGEMRIC imaging. dGEMRIC indices of knee cartilage were determined at baseline and for the change after the 10-week period in both groups. Based on a self-reported weekly log, physical activity change during the study was depicted as decreased, unchanged or increased. The Mann-Whitney U and Kruskal-Wallis tests were applied to test the hypotheses that dGEMRIC changes occurred between groups and according to physical activity changes respectively. RESULTS No significant differences were established between groups for dGEMRIC indices at baseline (P=0.541). A significant positive change of the median dGEMRIC index in the runners group was demonstrated when compared to the controls [+11.66ms (95% CI: -25.29, 44.43) vs -9.56ms (95% CI: -29.55, 5.83), P=0.006]. The change in dGEMRIC index differed significantly according to physical activity change (P=0.014), showing an increase in dGEMRIC index with increasing physical activity. CONCLUSION Since cartilage appears to positively respond to moderate running when compared to a sedentary lifestyle, this running scheme might be considered a valuable tool in osteoarthritis prevention strategies. Caution is warranted when applying these results to a wider population and to longer training periods.
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Li W, Scheidegger R, Wu Y, Edelman RR, Farley M, Krishnan N, Burstein D, Prasad PV. Delayed contrast-enhanced MRI of cartilage: Comparison of nonionic and ionic contrast agents. Magn Reson Med 2010; 64:1267-73. [DOI: 10.1002/mrm.22555] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
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Studler U, White LM, Andreisek G, Luu S, Cheng HLM, Sussman MS. Impact of motion on T1 mapping acquired with inversion recovery fast spin echo and rapid spoiled gradient recalled-echo pulse sequences for delayed gadolinium-enhanced MRI of cartilage (dGEMRIC) in volunteers. J Magn Reson Imaging 2010; 32:394-8. [DOI: 10.1002/jmri.22249] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022] Open
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Watanabe A, Obata T, Ikehira H, Ueda T, Moriya H, Wada Y. Degeneration of patellar cartilage in patients with recurrent patellar dislocation following conservative treatment: evaluation with delayed gadolinium-enhanced magnetic resonance imaging of cartilage. Osteoarthritis Cartilage 2009; 17:1546-53. [PMID: 19481191 DOI: 10.1016/j.joca.2009.05.001] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/29/2008] [Revised: 04/16/2009] [Accepted: 05/04/2009] [Indexed: 02/02/2023]
Abstract
OBJECTIVE To examine the characteristics of cartilage degeneration in patients with recurrent patellar dislocation (RPD) following conservative treatment using delayed gadolinium-enhanced magnetic resonance imaging (MRI) of cartilage (dGEMRIC). DESIGN This study evaluated three groups of knees: group I, 35 knees from both knees of patients with bilateral RPD and dislocated side knees of patients with unilateral RPD; group II, 15 non-dislocated side knees of patients with unilateral RPD; and group III, 20 knees from both knees of healthy volunteers. Differences in post-contrast T1 [T1(Gd)] of cartilage at both medial and lateral facets between groups I, II and III were analyzed. For group I, possible relationships were evaluated between T1(Gd) of cartilage and patient age, length of time between the initial dislocation and MRI and the total number of dislocations between the initial dislocation and MRI for both medial and lateral facets. RESULTS The mean T1(Gd) of cartilage at medial facets for groups I, II and III were 411+/-46ms, 465+/-38ms and 490+/-29ms, respectively; there were significant differences between these means (P<0.05). The mean T1(Gd) of cartilage at lateral facets for groups I, II and III were 426+/-53ms, 466+/-45ms and 510+/-36ms, respectively; there were also significant differences between these means (P<0.05). Significant correlations were observed between T1(Gd) of cartilage for both medial and lateral facets and length of time between the initial dislocation and MRI (P<0.05). No other correlations were significant. CONCLUSION dGEMRIC may be a useful method to monitor glycosaminoglycan concentration in patients with RPD following conservative treatment.
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Affiliation(s)
- A Watanabe
- Department of Radiology, Teikyo University Chiba Medical Center, Chiba, Japan.
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