Both 3-T dGEMRIC and Acetabular-Femoral T2 Difference May Detect Cartilage Damage at the Chondrolabral Junction

Hesper, Tobias; Bulat, Evgeny; Bixby, Sarah D.; Akhondi-Asl, Alireza; Afacan, Onur; Miller, Patricia E.; Bowen, Garrett; Warfield, Simon K.; Kim, Young-Jo

doi:10.1007/s11999-016-5136-1

Cited by 18 publications

(25 citation statements)

References 35 publications

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“…Our results agree with those of Ascani et al 17 and Hesper et al 16 Only a few reproducibility studies for T2 mapping of the hip have been carried out to date 19,20 . In this study intra-observer reproducibility for T2 image analysis (segmentation) was high, consistent with previous reproducibility trials in the knee by Glaser et al (RMSCoV 2.1-3.8%) 39 and Watanabe et al (RMSCoV 3.7-5.3%) 40 , and better than those found by Mosher et al (RMSCoV 4.36-14%) 41 .…”

Section: Discussionsupporting

confidence: 93%

Compositional MRI of the Hip: Reproducibility, Effect of Joint Unloading, and Comparison of T2 Relaxometry with Delayed Gadolinium-Enhanced Magnetic Resonance Imaging of Cartilage

et al. 2019

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Objective: Our aim was to compare T2 with dGEMRIC in the hip and assess the reproducibility and effect of joint unloading on T2 mapping. Design: Ten individuals at high risk of developing hip osteoarthritis (Sibkids) underwent contemporaneous T2 mapping and dGEMRIC in the hip (10 hips). Twelve healthy volunteers underwent T2 mapping of both hips (24 hips) at time points 25, 35, 45, and 55 minutes post offloading. Acetabular and femoral cartilage was manually segmented into Regions of Interest (ROIs). The relationship between T2 and dGEMRIC values from anatomically corresponding ROIs was quantified using Pearsons correlation. The reproducibility of image analysis for T2 and DGEMRIC, and reproducibility of image acquisition for T2, was quantified using the Intraclass Correleation Coefficient (ICC), Root Mean Square Coefficient of Variance (RMSCoV), Smallest Detectable Difference (SDD), and Bland-Altman Plots. The paired T-test was used to determine if difference existed in T2 values at different unloading times. Results: T2 values correlated most strongly with dGEMRIC values in diseased cartilage (r=-0.61, p=<0.001). T2 image analysis (segmentation) reproducibility was ICC = 0.96-0.98, RMSCoV = 3.5%-5.2%, SDD = 2.2ms-3.5ms. T2 values at 25 minutes unloading were not significantly different to longer unloading times (p = 0.132). SDD for T2 image acquisition reproducibility was 7.1-7.4ms. Conclusions: T2 values in the hip correlate well with dGEMRIC in areas of cartilage damage. T2 shows high reproducibility and values do not change beyond 25 minutes of joint unloading.

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Section: Discussionsupporting

confidence: 93%

Compositional MRI of the Hip: Reproducibility, Effect of Joint Unloading, and Comparison of T2 Relaxometry with Delayed Gadolinium-Enhanced Magnetic Resonance Imaging of Cartilage

et al. 2019

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“…Following MRI acquisition, dGEMRIC analysis will be carried out using a methodology closely based on that validated in previously published studies [ 47 ]. Acetabular and femoral head cartilage ROIs will be defined for three mid-sagittal plane slices at the chondrolabral transitional zone, reaching approximately 3 to 6 mm toward the acetabular fossa in each hip.…”

Section: Methodsmentioning

confidence: 99%

Protocol for a multi-centre randomised controlled trial comparing arthroscopic hip surgery to physiotherapy-led care for femoroacetabular impingement (FAI): the Australian FASHIoN trial

Murphy

Eyles

Bennell

et al. 2017

BMC Musculoskelet Disord

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BackgroundFemoroacetabular impingement syndrome (FAI), a hip disorder affecting active young adults, is believed to be a leading cause of hip osteoarthritis (OA). Current management approaches for FAI include arthroscopic hip surgery and physiotherapy-led non-surgical care; however, there is a paucity of clinical trial evidence comparing these approaches. In particular, it is unknown whether these management approaches modify the future risk of developing hip OA. The primary objective of this randomised controlled trial is to determine if participants with FAI who undergo hip arthroscopy have greater improvements in hip cartilage health, as demonstrated by changes in delayed gadolinium-enhanced magnetic resonance imaging (MRI) of cartilage (dGEMRIC) index between baseline and 12 months, compared to those who undergo physiotherapy-led non-surgical management.MethodsThis is a pragmatic, multi-centre, two-arm superiority randomised controlled trial comparing hip arthroscopy to physiotherapy-led management for FAI. A total of 140 participants with FAI will be recruited from the clinics of participating orthopaedic surgeons, and randomly allocated to receive either surgery or physiotherapy-led non-surgical care. The surgical intervention involves arthroscopic FAI surgery from one of eight orthopaedic surgeons specialising in this field, located in three different Australian cities. The physiotherapy-led non-surgical management is an individualised physiotherapy program, named Personalised Hip Therapy (PHT), developed by a panel to represent the best non-operative care for FAI. It entails at least six individual physiotherapy sessions over 12 weeks, and up to ten sessions over six months, provided by experienced musculoskeletal physiotherapists trained to deliver the PHT program. The primary outcome measure is the change in dGEMRIC score of a ROI containing both acetabular and femoral head cartilages at the chondrolabral transitional zone of the mid-sagittal plane between baseline and 12 months. Secondary outcomes include patient-reported outcomes and several structural and biomechanical measures relevant to the pathogenesis of FAI and development of hip OA. Interventions will be compared by intention-to-treat analysis.DiscussionThe findings will help determine whether hip arthroscopy or an individualised physiotherapy program is superior for the management of FAI, including for the prevention of hip OA.Trial registrationAustralia New Zealand Clinical Trials Registry reference: ACTRN12615001177549. Trial registered 2/11/2015 (retrospectively registered).

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“…Hesper et al . [36] suggests that T2 mapping may work as well as dGEMRIC when diagnosing defects at the chondrolabral junction based on their study of 31 patients with FAI. Fernquest et al [37] conducted scans of 24 healthy hips and 10 hips at high risk of developing OA with both T2 and dGEMRIC imaging, and found these methods are similar in sensitivity to detect early cartilage disease, although T2 mapping does not require the use of a nephrotoxic contrast agent and has shorter scan times than dGEMRIC scanning.…”

Section: Clinical Assessmentmentioning

confidence: 99%

Chondral lesions in the hip: a review of relevant anatomy, imaging and treatment modalities

Dallich

Rath

Atzmon

et al. 2019

Journal of Hip Preservation Surgery

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The diagnosis and treatment of chondral lesions in the hip is an ongoing challenge in orthopedics. Chondral lesions are common and several classification systems exist to classify them based on severity, location, radiographic parameters, and potential treatment options. When working up a patient with a potential hip chondral lesion, a complete history, thorough physical exam, and ancillary imaging are necessary. The physical exam is performed with the patient in standing, supine, prone, and lateral positions. Plain film radiographs are indicated as the first line of imaging; however, magnetic resonance arthrogram is currently the gold standard modality for the diagnosis of chondral lesions outside of diagnostic arthroscopy. Multiple treatment modalities to address chondral lesions in the hip exist and new treatment modalities continue to be developed. Currently, chondroplasty, microfracture, cartilage transplants (osteochondral autograft transfer, mosaicplasty, Osteochondral allograft transplantation) and incorporation of orthobiologics (Autologous chondrocyte implantation, Autologous matrix-induced chondrogenesis, Mononuclear concentrate in platelet-rich plasma) are some techniques that have been successfully applied to address chondral pathology in the hip. Further refinement of these modalities and research in novel techniques continues to advance a surgeon’s ability to address chondral lesions in the hip joint.

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Both 3-T dGEMRIC and Acetabular-Femoral T2 Difference May Detect Cartilage Damage at the Chondrolabral Junction

Abstract: Level IV, diagnostic study.

Cited by 18 publications

References 35 publications

Compositional MRI of the Hip: Reproducibility, Effect of Joint Unloading, and Comparison of T2 Relaxometry with Delayed Gadolinium-Enhanced Magnetic Resonance Imaging of Cartilage

Compositional MRI of the Hip: Reproducibility, Effect of Joint Unloading, and Comparison of T2 Relaxometry with Delayed Gadolinium-Enhanced Magnetic Resonance Imaging of Cartilage

Protocol for a multi-centre randomised controlled trial comparing arthroscopic hip surgery to physiotherapy-led care for femoroacetabular impingement (FAI): the Australian FASHIoN trial

Chondral lesions in the hip: a review of relevant anatomy, imaging and treatment modalities

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