Evaluation of focal cartilage lesions of the knee using MRI T2 mapping and delayed Gadolinium Enhanced MRI of Cartilage (dGEMRIC)

Asbjørn Årøen, Helga Brøgger, Jan Harald Røtterud, Einar Andreas Sivertsen, Lars Engebretsen, May Arna Risberg, Asbjørn Årøen, Helga Brøgger, Jan Harald Røtterud, Einar Andreas Sivertsen, Lars Engebretsen, May Arna Risberg

Abstract

Background: Assessment of degenerative changes of the cartilage is important in knee cartilage repair surgery. Magnetic Resonance Imaging (MRI) T2 mapping and delayed Gadolinium Enhanced MRI of Cartilage (dGEMRIC) are able to detect early degenerative changes. The hypothesis of the study was that cartilage surrounding a focal cartilage lesion in the knee does not possess degenerative changes.

Methods: Twenty-eight consecutive patients included in a randomized controlled trial on cartilage repair were evaluated using MRI T2 mapping and dGEMRIC before cartilage treatment was initiated. Inclusion was based on disabling knee problems (Lysholm score of ≤ 75) due to an arthroscopically verified focal femoral condyle cartilage lesion. Furthermore, no major malalignments or knee ligament injuries were accepted. Mean patient age was 33 ± 9.6 years, and the mean duration of knee symptoms was 49 ± 60 months. The MRI T2 mapping and the dGEMRIC measurements were performed at three standardized regions of interest (ROIs) at the medial and lateral femoral condyle, avoiding the cartilage lesion

Results: The MRI T2 mapping of the cartilage did not demonstrate significant differences between condyles with or without cartilage lesions. The dGEMRIC results did not show significantly lower values of the affected condyle compared with the opposite condyle and the contra-lateral knee in any of the ROIs. The intraclass correlation coefficient (ICC) of the dGEMRIC readings was 0.882.

Conclusion: The MRI T2 mapping and the dGEMRIC confirmed the arthroscopic findings that normal articular cartilage surrounded the cartilage lesion, reflecting normal variation in articular cartilage quality.

Study identifier: NCT00885729 , registered April 17 2009.

Figures

Fig. 1
Fig. 1
Modified standard drawing published by the International Cartilage Repair Society (ICRS) for mapping a cartilage lesion. The red area describes cartilage injury, and the corresponding blue areas describe the reference point of measurements of the injured versus non-injured knee and condyle. Underneath is a corresponding illustration of the ROIs in T1 (left) and T2 (right) of the lateral condyle of the same knee
Fig. 2
Fig. 2
Mean values (ms) of MRI T2 mapping of the medial femoral condyles. The blue bars represent the unaffected medial condyles, and the red bars represent the affected medial condyles. ROI, region of interest; A, anterior; C, central; P, posterior
Fig. 3
Fig. 3
Mean values of the T2 mapping of the lateral femoral condyles. The blue bars represent the unaffected lateral condyles, and the red bars represent the affected lateral condyles. ROI, region of interest; A, anterior; C, central; P, posterior
Fig. 4
Fig. 4
The dGEMRIC readings (mean of three different measurements in the condyle) in the injured condyle in relation to the KOOS pain score values reported by the patients at the dGEMRIC examination. The best fit line shows a significant deviation, p-value = 0.039
Fig. 5
Fig. 5
The dGEMRIC readings (mean of three different measurements in the condyle) in the injured condyle in relation to the duration of symptoms. The best fit line does not show a significant deviation, p-value = 0.08

References

    1. Aroen A, Loken S, Heir S, Alvik E, Ekeland A, Granlund OG, et al. Articular cartilage lesions in 993 consecutive knee arthroscopies. Am J Sports Med. 2004;32:211–5. doi: 10.1177/0363546503259345.
    1. Heir S, Nerhus TK, Rotterud JH, Loken S, Ekeland A, Engebretsen L, et al. Focal cartilage defects in the knee impair quality of life as much as severe osteoarthritis: a comparison of knee injury and osteoarthritis outcome score in 4 patient categories scheduled for knee surgery. Am J Sports Med. 2010;38:231–7. doi: 10.1177/0363546509352157.
    1. Loken S, Heir S, Holme I, Engebretsen L, Aroen A. 6-year follow-up of 84 patients with cartilage defects in the knee. Knee scores improved but recovery was incomplete. Acta Orthop. 2010;81:611–8. doi: 10.3109/17453674.2010.519166.
    1. Wondrasch B, Aroen A, Rotterud JH, Hoysveen T, Bolstad K, Risberg MA. The feasibility of a 3-month active rehabilitation program for patients with knee full-thickness articular cartilage lesions: the Oslo Cartilage Active Rehabilitation and Education Study. J Orthop Sports Phys Ther. 2013;43:310–24. doi: 10.2519/jospt.2013.4354.
    1. Brommer H, Laasanen MS, Brama PA, van Weeren PR, Helminen HJ, Jurvelin JS. In situ and ex vivo evaluation of an arthroscopic indentation instrument to estimate the health status of articular cartilage in the equine metacarpophalangeal joint. Vet Surg. 2006;35:259–66. doi: 10.1111/j.1532-950X.2006.00136.x.
    1. Malicev E, Barlic A, Kregar-Velikonja N, Strazar K, Drobnic M. Cartilage from the edge of a debrided articular defect is inferior to that from a standard donor site when used for autologous chondrocyte cultivation. J Bone Joint Surg. 2011;93:421–6. doi: 10.1302/0301-620X.93B3.25675.
    1. Cunningham T, Jessel R, Zurakowski D, Millis MB, Kim YJ. Delayed gadolinium-enhanced magnetic resonance imaging of cartilage to predict early failure of Bernese periacetabular osteotomy for hip dysplasia. J Bone Joint Surg. 2006;88:1540–8. doi: 10.2106/JBJS.E.00572.
    1. Vasiliadis HS, Danielson B, Ljungberg M, McKeon B, Lindahl A, Peterson L. Autologous chondrocyte implantation in cartilage lesions of the knee: long-term evaluation with magnetic resonance imaging and delayed gadolinium-enhanced magnetic resonance imaging technique. Am J Sports Med. 2010;38:943–9. doi: 10.1177/0363546509358266.
    1. Wei ZM, Du XK, Huo TL, Li XB, Quan GN, Li TR, et al. Quantitative T2 mapping evaluation for articular cartilage lesions in a rabbit model of anterior cruciate ligament transection osteoarthritis. Chin Med J. 2012;125:843–50.
    1. Mamisch TC, Zilkens C, Siebenrock KA, Bittersohl B, Kim YJ, Werlen S. Hip MRI and its implications for surgery in osteoarthritis patients. Rheum Dis Clin N Am. 2009;35:591–604. doi: 10.1016/j.rdc.2009.09.001.
    1. Tiderius CJ, Olsson LE, Nyquist F, Dahlberg L. Cartilage glycosaminoglycan loss in the acute phase after an anterior cruciate ligament injury: delayed gadolinium-enhanced magnetic resonance imaging of cartilage and synovial fluid analysis. Arthritis Rheum. 2005;52:120–7. doi: 10.1002/art.20795.
    1. Kellgren JH, Lawrence JS. Radiological assessment of osteo-arthrosis. Ann Rheum Dis. 1957;16:494–502. doi: 10.1136/ard.16.4.494.
    1. Bashir A, Gray ML, Burstein D. Gd-DTPA2- as a measure of cartilage degradation. Magn Reson Med. 1996;36:665–73. doi: 10.1002/mrm.1910360504.
    1. Burstein D, Velyvis J, Scott KT, Stock KW, Kim YJ, Jaramillo D, et al. Protocol issues for delayed Gd(DTPA)(2-)-enhanced MRI (dGEMRIC) for clinical evaluation of articular cartilage. Magn Reson Med. 2001;45:36–41. doi: 10.1002/1522-2594(200101)45:1<36::AID-MRM1006>;2-W.
    1. Tiderius CJ, Olsson LE, de Verdier H, Leander P, Ekberg O, Dahlberg L. Gd-DTPA2)-enhanced MRI of femoral knee cartilage: a dose–response study in healthy volunteers. Magn Reson Med. 2001;46:1067–71. doi: 10.1002/mrm.1300.
    1. 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. doi: 10.1002/jmri.22750.
    1. Gray ML, Burstein D, Kim YJ, Maroudas A. 2007 Elizabeth Winston Lanier Award Winner. Magnetic resonance imaging of cartilage glycosaminoglycan: basic principles, imaging technique, and clinical applications. J Orthop Res. 2008;26:281–91. doi: 10.1002/jor.20482.
    1. Roos EM, Lohmander LS. The Knee injury and Osteoarthritis Outcome Score (KOOS): from joint injury to osteoarthritis. Health Qual Life Outcomes. 2003;1:64. doi: 10.1186/1477-7525-1-64.
    1. Paradowski PT, Bergman S, Sunden-Lundius A, Lohmander LS, Roos EM. Knee complaints vary with age and gender in the adult population. Population-based reference data for the Knee injury and Osteoarthritis Outcome Score (KOOS) BMC Musculoskelet Disord. 2006;7:38. doi: 10.1186/1471-2474-7-38.
    1. Roos EM, Roos HP, Lohmander LS, Ekdahl C, Beynnon BD. Knee Injury and Osteoarthritis Outcome Score (KOOS)--development of a self-administered outcome measure. J Orthop Sports Phys Ther. 1998;28:88–96. doi: 10.2519/jospt.1998.28.2.88.
    1. Bekkers JE, de Windt TS, Raijmakers NJ, Dhert WJ, Saris DB. Validation of the Knee Injury and Osteoarthritis Outcome Score (KOOS) for the treatment of focal cartilage lesions. Osteoarthr Cartil. 2009;17:1434–9. doi: 10.1016/j.joca.2009.04.019.
    1. Saris DB, Vanlauwe J, Victor J, Almqvist KF, Verdonk R, Bellemans J, et al. Treatment of symptomatic cartilage defects of the knee: characterized chondrocyte implantation results in better clinical outcome at 36 months in a randomized trial compared to microfracture. Am J Sports Med. 2009;37(Suppl 1):10S–9. doi: 10.1177/0363546509350694.
    1. Multanen J, Rauvala E, Lammentausta E, Ojala R, Kiviranta I, Hakkinen A, et al. Reproducibility of imaging human knee cartilage by delayed gadolinium-enhanced MRI of cartilage (dGEMRIC) at 1.5 Tesla. Osteoarthr Cartil. 2009;17:559–64. doi: 10.1016/j.joca.2008.12.001.
    1. Neuman P, Owman H, Muller 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. Osteoarthr Cartil. 2014;22:84–90. doi: 10.1016/j.joca.2013.10.006.
    1. Owman H, Tiderius CJ, Neuman P, Nyquist F, Dahlberg LE. Association between findings on delayed gadolinium-enhanced magnetic resonance imaging of cartilage and future knee osteoarthritis. Arthritis Rheum. 2008;58:1727–30. doi: 10.1002/art.23459.
    1. Harris JD, Siston RA, Brophy RH, Lattermann C, Carey JL, Flanigan DC. Failures, re-operations, and complications after autologous chondrocyte implantation--a systematic review. Osteoarthr Cartil. 2011;19:779–91. doi: 10.1016/j.joca.2011.02.010.
    1. Ericsson YB, Tjornstrand J, Tiderius CJ, Dahlberg LE. Relationship between cartilage glycosaminoglycan content (assessed with dGEMRIC) and OA risk factors in meniscectomized patients. Osteoarthr Cartil. 2009;17:565–70. doi: 10.1016/j.joca.2008.10.009.
    1. 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. Osteoarthr Cartil. 2014;22:928–32. doi: 10.1016/j.joca.2014.04.021.
    1. Engen CN, Engebretsen L, Aroen A. Knee cartilage defect patients enrolled in randomized controlled trials are not representative of patients in orthopedic practice. Cartilage. 2010;1:312–9. doi: 10.1177/1947603510373917.
    1. Nojiri T, Watanabe N, Namura T, Narita W, Ikoma K, Suginoshita T, et al. Utility of delayed gadolinium-enhanced MRI (dGEMRIC) for qualitative evaluation of articular cartilage of patellofemoral joint. Knee Surg Sports Traumatol Arthrosc. 2006;14:718–23. doi: 10.1007/s00167-005-0013-6.
    1. Wayne JS, Kraft KA, Shields KJ, Yin C, Owen JR, Disler DG. MR imaging of normal and matrix-depleted cartilage: correlation with biomechanical function and biochemical composition. Radiology. 2003;228:493–9. doi: 10.1148/radiol.2282012012.
    1. Souza RB, Feeley BT, Zarins ZA, Link TM, Li X, Majumdar S. T1rho MRI relaxation in knee OA subjects with varying sizes of cartilage lesions. Knee. 2013;20:113–9. doi: 10.1016/j.knee.2012.10.018.

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