title: Multimodal approach in the use of clinical scoring, morphological MRI and biochemical T2-mapping and diffusion-weighted imaging in their ability to assess differences between cartilage repair tissue after microfracture therapy and matrix-associated autologous chondrocyte transplantation: a pilot study.
abstract: OBJECTIVE
  The aim of the present pilot study is to show initial results of a multimodal approach using clinical scoring, morphological magnetic resonance imaging (MRI) and biochemical T2-relaxation and diffusion-weighted imaging (DWI) in their ability to assess differences between cartilage repair tissue after microfracture therapy (MFX) and matrix-associated autologous chondrocyte transplantation (MACT).
  
  
  METHODS
  Twenty patients were cross-sectionally evaluated at different post-operative intervals from 12 to 63 months after MFX and 12-59 months after MACT. The two groups were matched by age (MFX: 36.0+/-10.4 years; MACT: 35.1+/-7.7 years) and post-operative interval (MFX: 32.6+/-16.7 months; MACT: 31.7+/-18.3 months). After clinical evaluation using the Lysholm score, 3T-MRI was performed obtaining the MR observation of cartilage repair tissue (MOCART) score as well as T2-mapping and DWI for multi-parametric MRI. Quantitative T2-relaxation was achieved using a multi-echo spin-echo sequence; semi-quantitative diffusion-quotient (signal intensity without diffusion-weighting divided by signal intensity with diffusion weighting) was prepared by a partially balanced, steady-state gradient-echo pulse sequence.
  
  
  RESULTS
  No differences in Lysholm (P=0.420) or MOCART (P=0.209) score were observed between MFX and MACT. T2-mapping showed lower T2 values after MFX compared to MACT (P=0.039). DWI distinguished between healthy cartilage and cartilage repair tissue in both procedures (MFX: P=0.001; MACT: P=0.007). Correlations were found between the Lysholm and the MOCART score (Pearson: 0.484; P=0.031), between the Lysholm score and DWI (Pearson:-0.557; P=0.011) and a trend between the Lysholm score and T2 (Person: 0.304; P=0.193).
  
  
  CONCLUSIONS
  Using T2-mapping and DWI, additional information could be gained compared to clinical scoring or morphological MRI. In combination clinical, MR-morphological and MR-biochemical parameters can be seen as a promising multimodal tool in the follow-up of cartilage repair.
authors.affiliation: MR Center, Department of Radiology, Medical University of Vienna, Vienna, Austria.
authors.forename: G H
authors.initials: GH
authors.lastname: Welsch
authors.forename: S
authors.initials: S
authors.lastname: Trattnig
authors.forename: S
authors.initials: S
authors.lastname: Domayer
authors.forename: S
authors.initials: S
authors.lastname: Marlovits
authors.forename: L M
authors.initials: LM
authors.lastname: White
authors.forename: T C
authors.initials: TC
authors.lastname: Mamisch
mesh_terms: D000328:Adult; D000704:Analysis of Variance; D054544:Arthroplasty, Subchondral; D002358:Cartilage, Articular / Q000293:injuries* / Q000473:pathology* / Q000601:surgery; D019902:Chondrocytes / Q000637:transplantation; D003430:Cross-Sectional Studies; D038524:Diffusion Magnetic Resonance Imaging / Q000379:methods; D005260:Female; D006801:Humans; D007719:Knee Joint / Q000473:pathology; D008297:Male; D008875:Middle Aged; D010865:Pilot Projects; D014182:Transplantation, Autologous / Q000379:methods; D014945:Wound Healing / Q000502:physiology