Delayed gadolinium-enhanced MRI of meniscus (dGEMRIM) and cartilage (dGEMRIC) in healthy knees and in knees with different stages of meniscus pathology.
BACKGROUND
Lesions in the meniscus are risk factors for developing knee osteoarthritis (OA), not least because of the role of the meniscus in the pathological progression of OA. Delayed gadolinium enhanced MRI of cartilage (dGEMRIC) has extensively been used to identify pre-radiographic cartilage changes in OA. In contrast, its counterpart with regard to examination of the meniscus, gadolinium enhanced MRI of meniscus (dGEMRIM), has been less utilized. In this study we use 3D dGEMRIM in patients with meniscus lesions and compare them with previous results of healthy individuals.


METHODS
Eighteen subjects with MRI-verified posteromedial meniscus lesions and 12 healthy subjects with non-injured and non-symptomatic knee joints, together 30 volunteers, were examined using 3D Look-Locker sequence after intravenous injection of Gd-DTPA2-(0.2 mmol/kg body weight). Relaxation time (T1) was measured in the posterior meniscus and femoral cartilage before and 60, 90, 120 and 180 min after injection. Relaxation rate (R1 = 1/T1) and change in relaxation rate (ΔR1) were calculated. For statistical analyses, Student's t-test and Analysis of Variance (ANOVA) were used.


RESULTS
The pre-contrast diagnostic MRI identified two sub-cohorts in the 18 patients with regard to meniscus injury: 1) 11 subjects with MRI verified pathological intrameniscal changes (grade 2) in the posteromedial meniscus only and no obvious cartilage changes. The lateral meniscus showed no pathology. 2) 7 subjects with MRI verified pathological rupture (grade 3) of the posteromedial meniscus and pathological changes in the lateral meniscus and/or medial and lateral joint cartilage. Comparisons of pathological and healthy posteromedial meniscus revealed opposite patterns in both T1Gdand ΔR1 values between pathological meniscus grade 2 and grade 3. The concentration of the contrast agent was lower than in healthy meniscus in grade 2 lesions (p = 0.046) but tended to increase in grade 3 lesions (p = 0.110). Maximum concentration of contrast agent was reached after 180 min in both cartilage and menisci (except for grade 3 menisci where the maximum concentration was reached after 90 min).


CONCLUSIONS
dGEMRIM and dGEMRIC may be feasible to combine in vivo, preferably with one examination before and one 2 h after contrast injection. Possible different dGEMRIM patterns at different stages of meniscus lesions must be taken into account when evaluating meniscus pathology.
Department of Orthopaedics, Lund University, Skåne University Hospital, SE-205 02, Malmö, Sweden. ulf.sigurdsson@skane.se.
Ulf
U
Sigurdsson
Institute of Radiology und Scintigraphy, Kantonsspital Lucerne, Spitalstrasse, 6000, Lucerne, Switzerland.
Gunilla
G
Müller
Medical Radiation Physics, Department of Translational Medicine, Lund University, Skåne University Hospital, SE-205 02, Malmö, Sweden.
Carl
C
Siversson
Department of Diagnostic Radiology, Oulu University Hospital, PO Box 50, FI-90029 OYS, Oulu, Finland.
Eveliina
E
Lammentausta
Medical Imaging and Physiology, Skåne University Hospital, SE-221 85, Lund, Sweden.
Jonas
J
Svensson
Department of Orthopaedics, Clinical Sciences Lund, Lund University, Skåne University Hospital, SE-221 85, Lund, Sweden.
Carl-Johan
CJ
Tiderius
Department of Orthopaedics, Clinical Sciences Lund, Lund University, Skåne University Hospital, SE-221 85, Lund, Sweden.
Leif E
LE
Dahlberg
Cartilage; Glycosaminoglycans; Meniscus; dGEMRIC; dGEMRIM
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