title: Validity of gradient-echo three-dimensional delayed gadolinium-enhanced magnetic resonance imaging of hip joint cartilage: a histologically controlled study.
abstract: OBJECTIVE
  To validate gradient-echo three-dimensional (3D) delayed gadolinium-enhanced magnetic resonance imaging of cartilage (dGEMRIC) by means of histological analyses in the assessment of hip joint cartilage.
  
  
  METHODS
  Twenty-one femoral head specimens collected from 21 patients (7 males, 14 females, mean age: 60.9 ± 9.6 years; range: 37.6-77.3 years), who underwent total hip replacement for symptomatic hip joint osteoarthritis, underwent MRI and histological assessment. A region of 2 cm(2) at the weight-bearing area was marked with four pins to enable multi-planar MRI reformatting to be matched with histological sections. MRI was performed at 3T with a 3D double-echo steady-state (DESS) sequence for morphological cartilage assessment and 3D Volumetric Interpolated Breathhold Examination (VIBE) for T1(Gd) mapping. Histological sections were evaluated according to the Mankin score system. Total Mankin score, grade of toluidine staining (sensitive for glycosaminoglycan content) and a modified Mankin score classification system with four sub-groups of cartilage damage were correlated with MRI data.
  
  
  RESULTS
  Spearman's rho correlation analyses revealed a statistically significant correlation between T1(Gd) mapping and histological analyses in all categories including total Mankin score (r=-0.658, p-value ≤ 0.001), toluidine staining (r=-0.802, p-value<0.001) and modified Mankin score (r=-0.716, p-value<0.001). The correlation between morphological MRI and histological cartilage assessment was statistically significant but inferior to the biochemical cartilage MRI (r-values ranging from -0.411 to 0.525, p-values<0.001).
  
  
  CONCLUSIONS
  Gradient-echo dGEMRIC is reliable while offering the unique features of high image resolution and 3D biochemically sensitive MRI for the assessment of early cartilage degeneration.
authors.affiliation: Univ Dusseldorf, Medical Faculty, Department of Orthopaedic Surgery, Moorenstrasse 5, D-40225 Dusseldorf, Germany. christoph.zilkens@med.uni-duesseldorf.de
authors.forename: Christoph
authors.initials: C
authors.lastname: Zilkens
authors.forename: Falk
authors.initials: F
authors.lastname: Miese
authors.forename: Monika
authors.initials: M
authors.lastname: Herten
authors.forename: Sabine
authors.initials: S
authors.lastname: Kurzidem
authors.forename: Marcus
authors.initials: M
authors.lastname: Jäger
authors.forename: Dietmar
authors.initials: D
authors.lastname: König
authors.forename: Gerald
authors.initials: G
authors.lastname: Antoch
authors.forename: Rüdiger
authors.initials: R
authors.lastname: Krauspe
authors.forename: Bernd
authors.initials: B
authors.lastname: Bittersohl
mesh_terms: D000328:Adult; D000368:Aged; D002358:Cartilage, Articular / Q000473:pathology*; D016022:Case-Control Studies; D003287:Contrast Media / Q000008:administration & dosage; D005260:Female; D006571:Heterocyclic Compounds / Q000008:administration & dosage*; D006621:Hip Joint / Q000473:pathology*; D006801:Humans; D021621:Imaging, Three-Dimensional / Q000379:methods*; D008279:Magnetic Resonance Imaging / Q000379:methods*; D008297:Male; D008875:Middle Aged; D009942:Organometallic Compounds / Q000008:administration & dosage*; D015207:Osteoarthritis, Hip / Q000473:pathology*; D015203:Reproducibility of Results; D012680:Sensitivity and Specificity
chemical_list: D003287:Contrast Media; D006571:Heterocyclic Compounds; D009942:Organometallic Compounds; C050823:gadolinium 1,4,7,10-tetraazacyclododecane-N,N',N'',N'''-tetraacetate