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. 2010 May;18(5):662-7.
doi: 10.1016/j.joca.2010.01.009. Epub 2010 Feb 11.

Delayed Gadolinium-Enhanced MR Imaging of Cartilage (dGEMRIC) following ACL injury

B C Fleming  1 , H L Oksendahl, W A Mehan, R Portnoy, P D Fadale, M J Hulstyn, M E Bowers, J T Machan, G A Tung
Affiliations

Delayed Gadolinium-Enhanced MR Imaging of Cartilage (dGEMRIC) following ACL injury

B C Fleming et al. Osteoarthritis Cartilage. 2010 May.

Abstract

Objective: Early detection of glycosaminoglycan (GAG) loss may provide insight into mechanisms of cartilage damage in the anterior cruciate ligament (ACL)-injured patient. We hypothesized that tibial and femoral Delayed Gadolinium-Enhanced MR Imaging of Cartilage (dGEMRIC) indices would be lower in the medial compartment of the ACL-injured knee than in the contralateral, uninjured knee, and that scan order (i.e., whether the injured or the uninjured knee was imaged first) would not affect the indices.

Methods: 15 subjects with unilateral ACL injuries received a double dose of gadolinium [Gd(DTPA)(2-)] intravenously. After 90 min, both knees were sequentially imaged. The injured knee was scanned first in the odd-numbered subjects and second in the even-numbered subjects. The dGEMRIC indices of the median slice of the medial compartment were determined using the MRIMapper software. Index comparisons were made between knee status (ACL-injured vs uninjured), scan order (ACL-injured first vs uninjured first), and cartilage location (tibia vs femur) using a mixed model.

Results: There was a significant difference in the mean dGEMRIC indices of the medial compartment between injured and uninjured knees (P<0.007). On average, there was a 13% decrease in the dGEMRIC index of the injured knee compared to the uninjured knee. There were no significant effects due to test order (P=0.800) or cartilage location (P=0.439).

Conclusions: The results demonstrate lower GAG concentrations in the medial compartment of the femoral and tibial articular cartilage of the ACL-injured knee when compared to the contralateral uninjured knee. The dGEMRIC indices were not sensitive to scan order; thus, sequential imaging of both knees is possible in this patient population.

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Figures

Figure 1
Figure 1
The median slice through the medial femoral condyle was selected for dGEMRIC analysis. Both the tibial and femoral cartilage segments were then evaluated within this slice.
Figure 2
Figure 2
T1 maps were generated of the medial compartment of the tibia and the femur using the MRIMapper software package, and the mean dGEMRIC indices were calculated. The blue and red regions denote high and low GAG concentrations, respectively.
Figure 3
Figure 3
Mean dGEMRIC indices from the mid-sagittal slice of the medial compartment of the tibia and femur. The dGEMRIC indices of the ACL-injured knees were significantly less than those of the contralateral uninjured knees (p=0.007). The indices between the tibia and femur were not significantly different (p=0.800). There was no significant difference due to imaging order (p=0.439). The dotted line represents the upper threshold from patients with radiographic evidence of OA.
Figure 4
Figure 4
The medial compartment dGEMRIC indices for the ACL-injured (closed circles) and the contralateral control knee (open circles) are shown for all subjects who were imaged within one year of injury. For each pair, the dGEMRIC index for the injured knee is less than that of the uninjured knee. The regression line and the associated 95% confidence intervals for the injured knees are also shown. The lower dGEMRIC index remains relatively constant over time.
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