title: Planar dGEMRIC Maps May Aid Imaging Assessment of Cartilage Damage in Femoroacetabular Impingement.
abstract: BACKGROUND
  Three-dimensional (3-D) delayed gadolinium-enhanced MRI of cartilage (dGEMRIC) helps quantify biochemical changes in articular cartilage that correlate with early-stage osteoarthritis. However, dGEMRIC analysis is performed slice by slice, limiting the potential of 3-D data to give an overall impression of cartilage biochemistry. We previously developed a computational algorithm to produce unfolded, or "planar," dGEMRIC maps of acetabular cartilage, but have neither assessed their application nor determined whether MRI-based grading of cartilage damage or dGEMRIC measurements predict intraoperative findings in hips with symptomatic femoroacetabular impingement (FAI).
  
  
  OBJECTIVE
  (1) Does imaging-based assessment of acetabular cartilage damage correlate with intraoperative findings in hips with symptomatic FAI? (2) Does the planar dGEMRIC map improve this correlation? (3) Does the planar map improve the correlation between the dGEMRIC index and MRI-based grading of cartilage damage in hips with symptomatic FAI? (4) Does the planar map improve imaging-based evaluation time for hips with symptomatic FAI?
  
  
  METHODS
  We retrospectively studied 47 hips of 45 patients with symptomatic FAI who underwent hip surgery between 2009 and 2013 and had a 1.5-T 3-D dGEMRIC scan within 6 months preoperatively. Our cohort included 25 males and 20 females with a mean ± SD age at surgery of 29 ± 11 years. Planar dGEMRIC maps were generated from isotropic, sagittal oblique TrueFISP and T1 sequences. A pediatric musculoskeletal radiologist with experience in hip MRI evaluated studies using radially reformatted sequences. For six acetabular subregions (anterior-peripheral [AP]; anterior-central [AC]; superior-peripheral [SP]; superior-central [SC]; posterior-peripheral [PP]; posterior-central [PC]), modified Outerbridge cartilage damage grades were recorded and region-of-interest T1 averages (the dGEMRIC index) were measured. Beck's intraoperative cartilage damage grades were compared with the Outerbridge grades and dGEMRIC indices. For a subset of 26 hips, 13 were reevaluated with the map and 13 without the map, and total evaluation times were recorded.
  
  
  RESULTS
  There were no meaningful differences in the correlations obtained with versus without referencing the planar maps. Planar map-independent Outerbridge grades had a notable (p < 0.05) Spearman's rank correlation (ρ) with Beck's grades that was moderate in AP, SC, and PC (0.3 < ρ < 0.5) and strong in SP (ρ > 0.5). For map-dependent Outerbridge grades, ρ was moderate in AP, AC, and SC and strong in SP. Map-independent dGEMRIC indices had a ρ with Beck's grades that was moderate in AP and SC (-0.3 > ρ > -0.5) and strong in SP (ρ < -0.5). For map-dependent dGEMRIC indices, ρ was moderate in SC and strong in SP. Similarly, there were no meaningful, map-dependent differences in the correlations. When comparing Outerbridge grades and dGEMRIC indices, there were notable correlations across all subregions. Without the planar map, ρ was moderate in AC and PC and strong in AP, SP, SC, and PP. With the map, ρ was strong in all six subregions. In AC, there was a notable map-dependent improvement in this correlation (p < 0.001). Finally, referencing the planar dGEMRIC map during evaluation was associated with a decrease in mean evaluation time, from 207 ± 32 seconds to 152 ± 33 seconds (p = 0.001).
  
  
  CONCLUSIONS
  Our work challenges the weak correlation between dGEMRIC and intraoperative findings of cartilage damage that was previously reported in hips with symptomatic FAI, suggesting that dGEMRIC has potential diagnostic use for this patient population. The planar dGEMRIC maps did not meaningfully alter the correlation of imaging-based evaluation of cartilage damage with intraoperative findings; however, they notably improved the correlation of dGEMRIC and MRI-based grading in AC, and their use incurred no additional time cost to imaging-based evaluation. Therefore, the planar maps may improve dGEMRIC's use as a continuous proxy for an otherwise discrete and simplified MRI-based grade of cartilage damage in hips with symptomatic FAI.
  
  
  METHODS
  Level III, diagnostic study.
authors: Department of Orthopedic Surgery, Boston Children's Hospital, 300 Longwood Avenue, Boston, MA, 02115, USA.
authors: Evgeny
authors: E
authors: Bulat
authors: Department of Radiology, Boston Children's Hospital, Boston, MA, USA.
authors: Sarah D
authors: SD
authors: Bixby
authors: Department of Medical Radiation Physics, Lund University, Skåne University Hospital, Malmö, Sweden.
authors: Carl
authors: C
authors: Siversson
authors: Clinical Research Center, Boston Children's Hospital, Boston, MA, USA.
authors: Leslie A
authors: LA
authors: Kalish
authors: Department of Radiology, Boston Children's Hospital, Boston, MA, USA.
authors: Simon K
authors: SK
authors: Warfield
authors: Department of Orthopedic Surgery, Boston Children's Hospital, 300 Longwood Avenue, Boston, MA, 02115, USA. Young-Jo.Kim@childrens.harvard.edu.
authors: Young-Jo
authors: YJ
authors: Kim
mesh_terms: D000293:Adolescent; D000328:Adult; D000465:Algorithms; D002358:Cartilage, Articular / Q000473:pathology* / Q000601:surgery; D003287:Contrast Media; D005260:Female; D057925:Femoracetabular Impingement / Q000473:pathology* / Q000601:surgery; D006621:Hip Joint / Q000473:pathology* / Q000601:surgery; D006801:Humans; D021621:Imaging, Three-Dimensional / Q000379:methods*; D008279:Magnetic Resonance Imaging / Q000379:methods*; D008297:Male; D008875:Middle Aged; D011237:Predictive Value of Tests; D011857:Radiographic Image Interpretation, Computer-Assisted / Q000379:methods*; D012189:Retrospective Studies; D057188:Workflow; D055815:Young Adult
chemical_list: D003287:Contrast Media