Upload
dinhbao
View
231
Download
0
Embed Size (px)
Citation preview
MRI EVALUATION OF CARTILAGE
George Koulouris
INTRODUCTION
• Anatomicimagingnotsufficient• Currenttechniquesdetectestablishedcar=lagedefectsandsubchondralchange(BME&cyst)
• Earlyinterven=onofcar=lageimaging&noveltreatments– demandforfunc=onal/biochemicalimaging– needtoimageearlycar=lagebreakdown
RECENTINNOVATIONS
• T2Mapping • T1rhoimaging
• DWI
• DTI
• dGEMRIC(delayedgadoliniumMRIofcar=lage)currentlyonlytechniqueproventobepredic=veforfuturejointdegenera=on
CARTILAGE
• CHONDROCYTES:(1‐2%)
• EXTRACELLULARMATRIX:
• Solid Proteoglycans(5‐10%) Collagens‐TypeII(15‐20%)
• FluidWater(70‐80%)
COLLAGENNETWORK
• Proteoglycan: • draws water &
maintains osmotic pressure
• counteracts swelling pressures
• provides force in tension & shear
• resists compression
• Extensivepolysaccharidechains• Formlargecomplexesofnega=velychargedproteoglycans
• maintain:– osmo=cpressure– fluidwithinthecar=lagematrix
– compressives=ffness
GLYCOSAMINOGLYCANS(GAG)
GLYCOSAMINOGLYCANS(GAG)
• Car=lagebehavesasas=ffelas=cpolymertosuddenimpact
• Slowviscoelas=cdeforma=ontosustainedloading
• GAGlossisaknownearlyeventintheprogressionofOA
• ?earlybreakdownreversible
dGEMRIC
• assessesearlycar=lagedamageasGAGlosspriortodevelopmentofmacroscopiccar=lagedefects
• nega=velychargedMRIcontrast(Gadolinium;Gd),(IVorintra‐ar=cular)isrepelledbynega=velychargedGAG
―=Gadolinium
=GAG
dGEMRIC
• lessGAGincar=lagelessnega=vechargerela,vetonormalcar=lagethemorethenega=velychargedcontrastwillpenetrateGAGdepletecar=lage(1)
• Gdpenetratesnormalcar=lage,high[GAG],inareciprocalmanner
dGEMRIC
• ↑Gd↓T1value(MRIpropertyofGd)• Doublenega=ve:
↓[GAG]=↑Gd=↓T1↑[GAG]=↓Gd=↑T1
• [GAG]isdirectlypropor=onaltoT1value• T1value=T1relaxa=on=me=dGEMRICindex
dGEMRIC
[GAG] = dGEMRIC index
TECHNIQUE
TECHNIQUE
• IVGd–doubledose
• Exercise
• Wait30‐90minforpenetra=on(2)
• IAbeoerthanIV(3,4)
• T1mapsofcar=lagegenerated/manuallyplooed
• Nodifferencebetween1.5T&3T(5)
VALIDATION
• Reproducible(6)
• Excellentinvitrocorrela=on(7)
• HigherdGEMRICindex(lessGd,higher[GAG])=higherresistancetomechanicalcompression(8,9)
INTERPRETATION
MARATHON
BEFORE 1DAY 1WEEK
SHOULDERARTHROGRAM
HUMERALHEADdGEMRICINDEX GLENOIDdGEMRICINDEX
• 9/52PeriacetabularOsteotomy(PAO)failed
• dGEMRICindex:– usefulmeasureofearlyOA– bestpredictoroffailure(P<0.02)– iden=fiedpoorcandidatesforPAO
• PoordGEMRICindex(<400msec)forconserva=vemanagement(injec=on,physio,debridement)
• GooddGEMRICindex(>400msec)PAO• Eliminatedtheneedtorelysolelyonradiographs(changes
occurtoolate)[10]
DYSPLASIA
DYSPLASIA
DYSPLASIA
• N=96dysplas=chipsOAdefinedas2SD<average,i.e.dGEMRIC<390msec
• MeandGEMRIC473cfnormalhipsof570[11]
SUCFE
• 16pa=entsSUCFEfollowedupfor14.5years– T1valueslowerlaterallythancentrally– Goodcorrela=onbetweendGEMRICindex,painandalphaangles(degreeofoffset)[12]
• Perthe’sdisease:– lossofGAGmedially[13]
SUCFE
FAI
• Significantcorrela=onbetween:– dGEMRICindex– pain– alphaangle
• correla=onofdGEMRICwithalphaanglesuggeststhathipswithmorefemoraldeformityshowfeaturesofearlyOA[14]
• CamFAIlowerdGEMRICvaluesanterosuperiorly• PincerFAIgeneralizedcircumferen=alloss[15]
ACLINJUREDKNEE
• dGEMRICevalua=onoftheACLinjuredkneeshows13%lowerdGEMRICindexinthemedialcompartmentwhencomparedwiththenormalcontralateralside[16]
PCLINJURY
[17]
KNEEDISLOCATION
[18]
MedialFacet LateralFacet
BilateralPatellarDisloca=on
411 426
UnilatDisloca=on–nondislocatedside
465 466
Normal 490 510
• HigherGAGinfollowingMACIthanMFX[19]
CARTILAGERx
[19,20,21,22]
• AlllowdGEMRICindexareasshowabnormalityonkneearthroscopy(N=16)[23]
• Kneepaininpa=entswithoutOAbutlowdGEMRICindexaremorelikelytodevelopradiographicallyevidentOAin6yrs[24]
• ValgusmalalignedknesslowerdGEMRICindexlaterallyandvarusknessmedially[25]
KNEEOA
KNEEOA
• dGEMRICindexcorrelatesstronglywithkneeflexorandextensorstrength,sugges=ngthatstrongcoordinatedmusclesmayplayaroleinpreven=ngOA
• overweight&meniscetcomyareRFforOA–dGEMRICindex14%lower374vs437[26]
• ModerateincreaseindGEMRICindexofcar=lageinpa=entswithmoderateOA&whoexercise[27]
OTHERJOINTS
• MatrixAssociatedAutologousChondrocyteImplanta=on(MACI)oftheankle[28]
• 1stCMCofthethumb[29]
AFLAPPLICATIONS
• Knowninjury/congenital/developmentalissueinpoten=aldraycandidatewillFAIstanduptotherigorsofAFL?
• Assistsindiagnosisnocar=lagedefect,butisthatcamlesionsignificant?DoesthelowdGEMRICindexaccountforpain?Pubicsymphysis?
• ExplainsprolongedpaindespitenoapparentcausePostPCLinjury
• Timingofreturntocompe==onPostbonebruising.Iswai=ngforBMEtoresolveinsufficient?
• Informedconsentregardingrisksofplayingvsre=rementArethereearlybutpermanentchangesindGEMRICindexpostmeniscectomy?
• Morerealis=cexpecta=onsfromplayer,club&medicalstafffollowinginjury?Decreasesfutureriskofli=ga=on
• Re=redAFLplayers&incidenceofOA
AFLAPPLICATIONS
CONCLUSION
• dGMERICimagingvalidatedtechniqueinearlyGAGloss
• GAGloss:– precedesOA,?reversible– detectedbyGdpenetra=on&T1WI
• BestimagingpredictorofOA
REFERENCES• (1).XiaY,ZhengS,BidthanapallyA.Depth‐dependentprofilesof
glycosaminoglycansinar=cularcar=lagebymicroMRIandhistochemistry.JMagnResonImaging.2008Jul;28(1):151‐7.
• (2).TideriusCJ,etal.HipdGEMRICinasymptoma=cvolunteersandpa=entswithearlyosteoarthri=s:theinfluenceof=mingayercontrastinjec=on.MagnResonMed.2007Apr;57(4):803‐5.
• (3).KwackKS,etalComparisonstudyofintraar=cularandintravenousgadolinium‐enhancedmagne=cresonanceimagingofcar=lageinacaninemodel.ActaRadiol.2008Feb;49(1):65‐74.
• (4).BoesenM.Delayedgadolinium‐enhancedmagne=cresonanceimaging(dGEMRIC)ofhipjointcar=lage:beoercar=lagedelinea=onayerintra‐ar=cularthanintravenousgadoliniuminjec=on.ActaRadiol.2006May;47(4):391‐6.
• (5).WilliamsA,etal.SuitabilityofT(1Gd)asthedGEMRICindexat1.5Tand3.0T.MagnResonMed.2007Oct;58(4):830‐4
• (6).MultanenJ,etal.Reproducibilityofimaginghumankneecar=lagebydelayedgadolinium‐enhancedMRIofcar=lage(dGEMRIC)at1.5Tesla.Osteoarthri=sCar=lage.2009May;17(5):559‐64.Epub2008Dec10.
• (7).BashirA,etal.Nondestruc=veimagingofhumancar=lageglycosaminoglycanconcentra=onbyMRI.MagnResonMed.1999May;41(5):857‐65.
• (8).BaldassarriM,etal.Rela=onshipbetweencar=lages=ffnessanddGEMRICindex:correla=onandpredic=on.JOrthopRes.2007Jul;25(7):904‐12.
• (9).MayerhoeferME,etal.TheinvivoeffectsofunloadingandcompressiononT1‐Gd(dGEMRIC)relaxa=on=mesinhealthyar=cularkneecar=lageat3.0Tesla.EurRadiol.2010Feb;20(2):443‐9.Epub2009Sep1.
• [10].CunninghamLE,etal.Delayedgadolinium‐enhancedmagne=cresonanceimagingofcar=lagetopredictearlyfailureofBerneseperiacetabularosteotomyforhipdysplasia.JBoneJointSurgAm.2006Jul;88(7):1540‐8.
• [11].JesselRH,etal.Radiographicandpa=entfactorsassociatedwithpre‐radiographicosteoarthri=sinhipdysplasia.JBoneJointSurgAm.2009May;91(5):1120‐9.
• [12].ZilkensC,etal.Delayedgadolinium‐enhancedmagne=cresonanceimagingofcar=lage(dGEMRIC),ayerslippedcapitalfemoralepiphysis.EurJRadiolMay24.[Epubaheadofprint]2010
REFERENCES
• [13].ZilkensC,etal.Delayedgadolinium‐enhancedmagne=cresonanceimagingofcar=lageinthelong‐termfollow‐upayerPerthesdisease.JPediatrOrthop.2010Mar;30(2):147‐53.
• [14].JesselRH,etal.Assessmentofosteoarthri=sinhipswithfemoroacetabularimpingementusingdelayedgadoliniumenhancedMRIofcar=lage.JMagnResonImaging.2009Nov;30(5):1110‐5.
• [15].BioersohlB,etal.Car=lagedamageinfemoroacetabularimpingement(FAI):preliminaryresultsoncomparisonofstandarddiagnos=cvsdelayedgadolinium‐enhancedmagne=cresonanceimagingofcar=lage(dGEMRIC).Osteoarthri=sCar=lage.2009Oct;17(10):1297‐306.Epub2009May3.
• [16].FlemingBC,etal.DelayedGadolinium‐EnhancedMRImagingofCar=lage(dGEMRIC)followingACLinjury.Osteoarthri=sCar=lage.2010May;18(5):662‐7.Epub2010Feb11.
• [17].YoungAA,etal.Glycosaminoglycancontentofkneecar=lagefollowingposteriorcruciateligamentrupturedemonstratedbydelayedgadolinium‐enhancedmagne=cresonanceimagingofcar=lage(dGEMRIC).Acasereport.JBoneJointSurgAm.2005Dec;87(12):2763‐7.
REFERENCES
• [18].WatanabeA,etal.Degenera=onofpatellarcar=lageinpa=entswithrecurrentpatellardisloca=onfollowingconserva=vetreatment:evalua=onwithdelayedgadolinium‐enhancedmagne=cresonanceimagingofcar=lage.Osteoarthri=sCar=lage.2009Dec;17(12):1546‐53.Epub2009May18
• [19].PinkerK,etal.Longitudinalevalua=onofcar=lagecomposi=onofmatrix‐associatedautologouschondrocytetransplantswith3‐Tdelayedgadolinium‐enhancedMRIofcar=lage.AJRAmJRoentgenol.2008Nov;191(5):1391‐6.
• [20].DomaverSE,etal.T2mappinganddGEMRICayerautologouschondrocyteimplanta=onwithafibrin‐basedscaffoldintheknee:preliminaryresults.EurJRadiol.2010Mar;73(3):636‐42.Epub2009Jan20.AJRAmJRoentgenol.2008Nov;191(5):1391‐6
• [21].WatanabeA,etal.AbilityofdGEMRICandT2mappingtoevaluatecar=lagerepairayermicrofracture:agoatstudy.Osteoarthri=sCar=lage.2009Oct;17(10):1341‐9.Epub2009Apr17.
• [22].TraonigS,etal.Differen=a=ngnormalhyalinecar=lagefrompost‐surgicalrepair=ssueusingfastgradientechoimagingindelayedgadolinium‐enhancedMRI(dGEMRIC)at3Tesla.EurRadiol.2008Jun;18(6):1251‐9.Epub2008Feb2.
REFERENCES
• [23].NoiiriT,etal.U=lityofdelayedgadolinium‐enhancedMRI(dGEMRIC)forqualita=veevalua=onofar=cularcar=lageofpatellofemoraljoint.KneeSurgSportsTraumatolArthrosc.2006Aug;14(8):718‐23.Epub2006Jan4.
• [24].OwmanH,etal.Associa=onbetweenfindingsondelayedgadolinium‐enhancedmagne=cresonanceimagingofcar=lageandfuturekneeosteoarthri=s.Arthri=sRheum.2008Jun;58(6):1727‐30.
• [25].WilliamsA,etal.Delayedgadolinium‐enhancedmagne=cresonanceimagingofcar=lageinkneeosteoarthri=s:findingsatdifferentradiographicstagesofdiseaseandrela=onshiptomalalignment.Arthri=sRheum.2005Nov;52(11):3528‐35
• [26].EricssonYB,etal.Rela=onshipbetweencar=lageglycosaminoglycancontent(assessedwithdGEMRIC)andOAriskfactorsinmeniscectomizedpa=ents.Osteoarthri=sCar=lage.2009May;17(5):565‐70.Epub2008Oct29.
• [27].RoosEM,DahlbergL.Posi=veeffectsofmoderateexerciseonglycosaminoglycancontentinkneecar=lage:afour‐month,randomized,controlledtrialinpa=entsatriskofosteoarthri=s.Arthri=sRheum.2005Nov;52(11):3507‐14.
REFERENCES
• [28].DomaverSE,etal.Delayedgadolinium‐enhancedMRIofcar=lageintheankleat3T:feasibilityandpreliminaryresultsayermatrix‐associatedautologouschondrocyteimplanta=on.JMagnResonImaging.2010Mar;31(3):732‐9.
• [29].WilliamsA,etal.DelayedgadoliniumenhancedMRIofcar=lage(dGEMRIC)ofthefirstcarpometacarpal(1CMC)joint:afeasibilitystudy.Osteoarthri=sCar=lage.2008Apr;16(4):530‐2.Epub2008Jan14.
REFERENCES