Cartilage damage in femoroacetabular impingement (FAI): preliminary results on comparison of standard diagnostic vs delayed gadolinium-enhanced magnetic resonance imaging of cartilage (dGEMRIC)

Bittersohl, Bernd; Steppacher, Simon D.; Haamberg, Tanja; Kim, Y.-J.; Werlen, Stefan; Beck, Martín; Siebenrock, Klaus A.; Mamisch, Tallal C.

doi:10.1016/j.joca.2009.04.016

Cited by 99 publications

(86 citation statements)

References 39 publications

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“…Although we were unable to see a statistical difference in any of the individual regions between the cam and pincer impingement groups there seem to be different patterns of articular damage between the two groups. These would be in accordance with recent studies 5,8,33 which demonstrated the majority of the damage in the anterior superior region of the joint in cam hips. Additionally, the damages assessed posteriorly were only about half the damage as seen in the anterior regions, compared to the control group.…”

Section: Discussionsupporting

confidence: 94%

“…Additionally, the majority of impingement patients have mixed findings of pincer and cam, which have shown to give very varied patterns of articular damage. 33 Prior to understanding these mixed patients we sought to identify cases in which a cam or pincer mechanism was clearly predominant making it difficult to obtain However, this may not be a limitation because dGEMRIC uses a method to detect the GAG content of arthritis and it has been shown to be independent of age. 33 It may be that the patients with pincer impingement, present with more advanced disease.…”

Section: Discussionmentioning

confidence: 99%

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Delayed gadolinium‐enhanced magnetic resonance imaging of cartilage (dGEMRIC) in Femoacetabular impingement

Mamisch

Kain

Bittersohl

et al. 2011

Journal Orthopaedic Research

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Femoroacetabular impingement is a well-described pre-arthritic condition with two main types; cam and pincer. Studies using the open treatment for impingement have described patterns of articular cartilage wear specific to cam and pincer impingement. Assessing articular damage in the hip joint is an important component of treatment. Intravenous gadolidium allows radiologists to perform an indirect assessment of articular cartilage glycosaminoglycan (GAG) content by using a technique called dGEMRIC. Using this indirect assessment of articular cartilage, we compared the dGEMRIC indices in a group of six cam and seven pincer patients to a control group (n ¼ 12) of asymptomatic controls that had no plain MRI findings of osteoarthritis. The superior portion of the hip joint was divided into seven regions from 9 to 3 o'clock. These regions were then subdivided into peripheral and central regions. The cam and pincer groups both had statistically lower dGEMRIC values compared to the control group. The cam group demonstrated not only peripheral but also central involvement of the joint and this was concentrated in the anterior portion of the joint. The pincer group exhibited more global hip involvement with all areas of the hip averaging a dGEMRIC index 28% less than controls. With the use of dGEMRIC more specific patterns of cartilage wear can be elicited in patients with impingement, which may improve patient selection and help better understand the progression of osteoarthithis throughout the hip joint. ß

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Section: Discussionsupporting

confidence: 94%

Section: Discussionmentioning

confidence: 99%

Delayed gadolinium‐enhanced magnetic resonance imaging of cartilage (dGEMRIC) in Femoacetabular impingement

Mamisch

Kain

Bittersohl

et al. 2011

Journal Orthopaedic Research

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“…Beck et al [3] first described intraoperative cartilage damage in hips with cam-type FAI mainly in the anterosuperior quadrant, which is consistent with other intraoperative observations [2,14,20] and findings in computer simulation [30]. Although MRI mapping of cartilage in the hip has been shown to be feasible and capable to evaluate the biochemical status of cartilage in dysplasia [19,25,26,29] as well as cam FAI (Table 1) [4,7,9,19,[24][25][26]29], the region-of-interest (ROI) selection used in terms of size and location has varied between studies. Having said that, understanding how to best define and analyze the ROIs is still evolving and is critical to ensure reproducible and comparable results between institutions and studies.…”

Section: Introductionsupporting

confidence: 56%

“…One technique, which is sensitive to the proteoglycan content in cartilage, is delayed gadolinium-enhanced MRI of cartilage (dGEMRIC). It has been shown that dGEMRIC can serve in the evaluation of hips with dysplasia [22] or a cam deformity [4]. However, dGEMRIC requires intravenous injection of an exogenous contrast agent; other quantitative approaches for cartilage imaging that do not use contrast agents now are available, including T1q mapping.…”

Section: Introductionmentioning

confidence: 99%

T1ρ Hip Cartilage Mapping in Assessing Patients With Cam Morphology: How Can We Optimize the Regions of Interest?

Anwander

Rakhra

Melkus

et al. 2017

Clinical Orthopaedics &Amp; Related Research

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Background T1q MRI has been shown feasible to detect the biochemical status of hip cartilage, but various regionof-interest strategies have been used, compromising the reproducibility and comparability between different institutions and studies. Questions/purposes The purposes of this study were (1) to determine representative regions of interest (ROIs) for cartilage T1q mapping in hips with a cam deformity; and (2) to assess intra-and interobserver reliability for cartilage T1q mapping in hips with a cam deformity. MethodsThe local ethics committee approved this prospective study with written informed consent obtained. Between 2010 and 2013, in 54 hips (54 patients), T1q 1.5-T MRI was performed. Thirty-eight hips (38 patients; 89% male) with an average age of 35 ± 7.5 years (range, 23-51 tears) were diagnosed with a cam deformity; 16 hips (16 patients; 87% male) with an average age of 34 ± 7 years (range, 23-47 years) were included in the control group. Of the 38 patients with a cam deformity, 20 were pain-free and 18 symptomatic patients underwent surgery after 6 months of failed nonsurgical management of antiinflammatories and physical therapy. Exclusion criteria were radiologic sings of osteoarthritis with Tönnis Grade 2 or higher as well as previous hip surgery. Three region-of-interest (ROI) selections were analyzed: Method 1: as a whole; Method 2: as 36 to 54 small ROIs (sections of 30°in the sagittal plane and 3 mm in the transverse plane); Method 3a: as six ROIs (sections of 90°in the sagittal plane and one-third of the acetabular depth in the transverse plane: the anterosuperior and posterosuperior quadrants, divided into lateral, intermediate, and medial thirds); and Method 3b: as the ratio (anterosuperior over posterosuperior quadrant). ROIs in Method 3 represent the region of macroscopic cartilage damage, described in intraoperative findings. To asses interobserver reliability, 10 patients were analyzed by two observers (HA, GM). For intraobserver reliability, 20 hip MRIs were analyzed twice by one observer (HA). To assess interscan reliability, three patients underwent two scans within a time period of 2 weeks and were analyzed twice by one observer (HA). T1q values were compared using Student's t test. Interclass correlation coefficient (ICC) and root mean square coefficient of variation (RMS-CV) were used to analyze intraobserver, interobserver, and interscan reliability. Results Patients with a cam deformity showed increased T1q values in the whole hip cartilage (mean: 34.0 ± 3.8 ms versus 31.4 ± 3.0 ms; mean difference: 2.5; 95% confidence interval [CI], 4.7-0.4; p = 0.019; Method 1), mainly anterolateral (2), in the lateral and medial thirds of the anterosuperior quadrant (mean: 32.3 ± 4.9 ms versus 29.4 ± 4.1 ms; mean difference: 3.0; 95% CI, 5.8-0.2; p = 0.039 and mean 36.5 ± 5.6 ms versus 32.6 ± 3.8 ms; mean difference: 3.8; 95% CI, 6.9-0.8; p = 0.014), and in the medial third of the posterosuperior quadrant (mean: 34.4 ± 5.5 ms versus 31.1 ± 3.9 ms; mean difference: 3.1; 95% CI, 6....

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“…Sensitivity for delamination assessed by MRA is only 22% [16]. Potentially more sophisticated MR techniques, such as dGEMRIC [17][18][19][20], T1rho and T2 mapping, will enable more accurate identification of cartilage damage preoperatively. A number of studies have investigated the role of dGEMRIC in FAI.…”

Section: Difficulties With Imagingmentioning

confidence: 99%

A perspective on femoroacetabular impingement

Pollard

2011

Skeletal Radiol

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Although Smith-Petersen described impingement of the native hip in 1936 [1], the success of replacement arthroplasty of the hip dominated the orthopaedic literature until the early contemporary reports of femoroacetabular impingement (FAI) at the turn of the millennium [2]. Subsequently, an exponential increase in interest in the subject has occurred, as demonstrated by the annual number of Pubmed hits for FAI, which reached 168 in 2010 alone. This interest is perhaps not surprising when one considers that FAI represents a new diagnosis for young adults with hip pain, an opportunity for advanced imaging and surgical techniques, and perhaps most tantalisingly, the possibility of altering the natural history of degenerative joint disease and limiting progression to endstage osteoarthritis (OA). With the explosion of recent interest in FAI, there are many controversies and unresolved issues that will be the targets for research over the next decade. Aetiology of FAIFemoroacetabular impingement may occur secondary to paediatric hip disease or trauma, but the vast majority of cases have no underlying known cause and may be considered "primary FAI". A hip with symptomatic FAI is likely to differ from a "normal" hip through a combination of its morphology, durability of its articular cartilage and labrum, and demands placed upon it, with regard to the range of movement and activity level of the patient. Recent evidence suggests a strong genetic component to FAI [3], which is in keeping with the known genetic predisposition to hip OA. Whether abnormal morphology is determined at conception, or is acquired during skeletal development, is not known. It is conceivable that there is a genetic predisposition to subclinical slipped capital femoral epiphysis, for example. However, not all hips with abnormal joint morphology develop symptoms. A cam deformity is a common finding (approximately 20% incidence) in asymptomatic male subjects [4][5][6][7] and patients with FAI often have similar deformities in the contralateral asymptomatic hip [8]. This supports the notion that additional variables, such as the vulnerability of the labrum and articular cartilage to injury, and activity level, are important in modulating whether abnormal morphology results in symptoms. The importance of activity type and intensity needs further investigation. It stands to reason that an activity such as hurdling will potentially damage an at-risk hip by increasing the frequency and severity of impingement episodes. Better ways of grading activity are required in order to classify individuals. With regard to morphology, very little is known regarding the development of the nondysplastic hip through childhood and adolescence, and prospective studies during skeletal development may help to determine whether morphology is dependent on activity or other factors. Longitudinal studies of well-characterised cohorts will improve our understanding of how FAI develops. Difficulties with imagingIt is crucial to appreciate that making a diagnosis of FAI relies on...

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Cartilage damage in femoroacetabular impingement (FAI): preliminary results on comparison of standard diagnostic vs delayed gadolinium-enhanced magnetic resonance imaging of cartilage (dGEMRIC)

Abstract: We conclude that a pattern of zonal T1 variation does seem to exist that is unique for different sub-groups of FAI. The FA GRE approach to perform 3D T1 mapping has a promising role for further studies of standard MRI and dGEMRIC in the hip joint.

Cited by 99 publications

References 39 publications

Delayed gadolinium‐enhanced magnetic resonance imaging of cartilage (dGEMRIC) in Femoacetabular impingement

Delayed gadolinium‐enhanced magnetic resonance imaging of cartilage (dGEMRIC) in Femoacetabular impingement

T1ρ Hip Cartilage Mapping in Assessing Patients With Cam Morphology: How Can We Optimize the Regions of Interest?

A perspective on femoroacetabular impingement

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