Is T2 mapping reliable in evaluation of native and repair cartilage tissue of the knee?

Hasan Banitalebi, Christian Owesen, Asbjørn Årøen, Hang Thi Tran, Tor Åge Myklebust, Per-Henrik Randsborg, Hasan Banitalebi, Christian Owesen, Asbjørn Årøen, Hang Thi Tran, Tor Åge Myklebust, Per-Henrik Randsborg

Abstract

Purpose: To evaluate the effect of imaging plane and experience of observers on the reliability of T2 mapping of native and repair cartilage tissue of the knee.

Methods: Fifteen consecutive patients from two randomised controlled trials (RCTs) were included in this cross-sectional study. Patients with an isolated knee cartilage lesion were randomised to receive either debridement or microfracture (RCT 1) or debridement or autologous chondrocyte implantation (RCT 2). T2 mapping was performed in coronal and sagittal planes two years postoperatively. A musculoskeletal radiologist, a resident of radiology and two orthopaedic surgeons measured the T2 values independently. Intraclass Correlation Coefficient (ICC) with 95% Confidence Intervals was used to calculate the inter- and intraobserver agreement.

Results: Mean age for the patients was 36.8 ± 11 years, 8 (53%) were men. The overall interobserver agreement varied from poor to good with ICCs in the range of 0.27- 0.76 for native cartilage and 0.00 - 0.90 for repair tissue. The lowest agreement was achieved for evaluations of repair cartilage tissue. The estimated ICCs suggested higher inter- and intraobserver agreement for radiologists. On medial femoral condyles, T2 values were higher for native cartilage on coronal images (p < 0.001) and for repair tissue on sagittal images (p < 0.001).

Conclusions: The reliability of T2 mapping of articular cartilage is influenced by the imaging plane and the experience of the observers. This influence may be more profound for repair cartilage tissue. This is important to consider when using T2 mapping to measure outcomes after cartilage repair surgery.

Trial registration: ClinicalTrials.gov, NCT02637505 and NCT02636881 , registered December 2015.

Level of evidence: II, based on prospective data from two RCTs.

Keywords: Articular cartilage; Autologous chondrocyte implantation; Cartilage repair; MRI; Reliability; T2 mapping.

Conflict of interest statement

The authors declare that there is no conflict of interest.

Figures

Fig. 1
Fig. 1
Flow diagram for the inclusion of the patients in the current reliability study from the two ongoing Randomised Controlled Trials of the Norwegian Cartilage Project. ACI: Autologous Chondrocyte Implantation. *Ongoing inclusion
Fig. 2
Fig. 2
T2 maps of pre-defined ROIs (Regions of Interest) of native cartilage. a: (ROI 2) T2 map of the lateral femoral condyle on sagittal plane, between the margins of the posterior and the anterior horns of the meniscus. b: (ROI 4) T2 map of the medial femoral condyle on coronal plane at the level with the highest peak of the intercondylar eminence. The arrows indicate the boundaries of the ROIs. The sub-regions a, b and c are automatically generated for each ROI
Fig. 3
Fig. 3
T2 measurements of a treated lesion on medial femoral condyle (images from the same patient). a and d: Fat suppressed PD VISTA (Proton Density Volume Isotropic Turbo spin echo Acquisition) in sagittal and coronal planes, respectively. Arrows indicate the boundaries of the lesion. b and e: The same lesion on the first echo of multi-echo sequences as marked by arrows on sagittal and coronal images, respectively. c and f: Colour maps of the same lesion on sagittal and coronal planes, respectively
Fig. 4
Fig. 4
Box plots demonstrating variability of the measured T2 values by the observers in coronal and sagittal planes, for native and repair cartilage tissue

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