Prestructural cartilage assessment using MRI

Abstract

Cartilage loss is irreversible, and to date, no effective pharmacotherapies are available to protect or regenerate cartilage. Quantitative prestructural/compositional MR imaging techniques have been developed to characterize the cartilage matrix quality at a stage where abnormal findings are early and potentially reversible, allowing intervention to halt disease progression. The goal of this article is to critically review currently available technologies, present the basic concept behind these techniques, but also to investigate their suitability as imaging biomarkers including their validity, reproducibility, risk prediction and monitoring of therapy. Moreover, we highlighted important clinical applications. This review article focuses on the currently most relevant and clinically applicable technologies, such as T2 mapping, T2*, T1ρ, delayed gadolinium enhanced MRI of cartilage (dGEMRIC), sodium imaging and glycosaminoglycan chemical exchange saturation transfer (gagCEST). To date, most information is available for T2 and T1ρ mapping. dGEMRIC has also been used in multiple clinical studies, although it requires Gd contrast administration. Sodium imaging and gagCEST are promising technologies but are dependent on high field strength and sophisticated software and hardware. Level of Evidence: 5 J. Magn. Reson. Imaging 2017;45:949–965

Isotropic three‐dimensional T2 mapping of knee cartilage: Development and validation

“…To date, no effective cure exists to slow down or stop the progression of osteoarthritis (OA), a condition characterized by progressive cartilage degeneration . Because cartilage has limited repair capacity, the early detection of any local damage that precedes permanent cartilage tissue loss is an important target for research.…”

“…Because cartilage has limited repair capacity, the early detection of any local damage that precedes permanent cartilage tissue loss is an important target for research. Compositional magnetic resonance imaging (MRI) techniques have the potential to reflect the biochemical and ultrastructural composition of cartilage and provide quantitative information at the early stages of OA . Among these compositional MRI sequences, T 2 mapping is used most in the clinic …”

A unique anisotropic R2 of collagen degeneration (ARCADE) mapping as an efficient alternative to composite relaxation metric (R2‐R1ρ) in human knee cartilage study

“…More importantly, the relaxation parameters with higher orientation anisotropies were found to be more sensitive to cartilage degenerative changes secondary to osteoarthritis (OA). In other words, the anisotropic component of (i.e., ) has the potential to be a more sensitive MRI biomarker for early cartilage changes in OA and a valuable imaging tool to follow OA progression after anterior cruciate ligament (ACL) reconstruction surgery …”

dGEMRIC and CECT Comparison of Cationic and Anionic Contrast Agents in Cadaveric Human Metacarpal Cartilage

“…MRI possesses several advantages including the absence of ionizing radiation and the capacity to examine the entire joint: articular cartilage, menisci, subchondral bone marrow, synovium, and ligaments . Several MRI‐based techniques (T1 mapping, delayed gadolinium‐enhanced MRI of cartilage [dGEMRIC], T2 mapping, T1ρ, and 23 Na + mapping) provide images that reflect the GAG and collagen content of articular cartilage .…”