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ABSTRACT: The aim of this study was to assess the glycosaminoglycan (GAG) content in hip joint cartilage in mature hips with a history of slipped capital femoral epiphysis (SCFE) using delayed gadolinium-enhanced MRI of cartilage (dGEMRIC).
28 young-adult subjects (32 hips) with a mean age of 23.8 ± 4.0 years (range: 18.1-30.5 years) who were treated for mild or moderate SCFE in adolescence were included into the study. Hip function and clinical symptoms were evaluated with the Harris hip score (HHS) system at the time of MRI. Plain radiographic evaluation included Tonnis grading, measurement of the minimal joint space width (JSW) and alpha-angle measurement. The alpha-angle values were used to classify three sub-groups: group 1=subjects with normal femoral head-neck offset (alpha-angle <50°), group 2=subjects with mild offset decrease (alpha-angle 50°-60°), and group 3=subjects with severe offset decrease (alpha-angle >60°).
There was statistically significant difference noted for the T1(Gd) values, lateral and central, between group 1 and group 3 (p-values=0.038 and 0.041). The T1(Gd) values measured within the lateral portion were slightly lower compared with the T1(Gd) values measured within the central portion that was at a statistically significance level (p-value <0.001). HHS, Tonnis grades and JSW revealed no statistically significant difference.
By using dGEMRIC in the mid-term follow-up of SCFE we were able to reveal degenerative changes even in the absence of joint space narrowing that seem to be related to the degree of offset pathology. The dGEMRIC technique may be a potential diagnostic modality in the follow-up evaluation of SCFE.
European journal of radiology 09/2011; 79(3):400-6. · 2.65 Impact Factor
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Arne Holstein,
Christoph Zilkens,
Bernd Bittersohl,
Marcus Jäger,
Tanja Haamberg,
Tallal C Mamisch,
Rotem S Lanzman,
Patric Kröpil,
Dirk Blondin,
Rüdiger Krauspe,
Gerald Antoch,
Günther Fürst,
Falk Miese
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ABSTRACT: Introduction: The purpose of the present study was to evaluate the feasibility of delayed gadolinium-enhanced magnetic resonance imaging of cartilage (dGEMRIC) in the detection of cartilage changes versus morphologic imaging in the long-term course of Legg-Calvé-Perthes disease (LCPD). Methods: A total of 31 hips in 26 patients (mean age, 30.0years; range, 18-54years) who were diagnosed with LCPD in childhood were included. Twenty-one radiographically normal contralateral hips served as controls. dGEMRIC indices of femoral and acetabular cartilage in the weight-bearing zone. Cartilage morphology was classified on radial PD-weighted images according to the modified Outerbridge classification. Results: Mean dGEMRIC values of cartilage were significantly lower in hips after LCPD than in the radiographically normal contralateral hips (513±100 ms vs. 579±103 ms; P=0.026). In 24 out of 31 LCPD hips and in 4 out of 21 radiographically normal contralateral hips, morphological cartilage changes were noted. Analysis of variance analysis revealed a significant influence of Outerbridge grading on decreased T1-values (P=0.031). Conclusion: Our results suggest that dGEMRIC at 1.5 T is suitable to assess cartilage quality changes in the long-term follow-up after LCPD. The evaluation of biochemical cartilage quality with dGEMRIC may provide additional information about early cartilage changes occurring without visible alterations of cartilage morphology.
Journal of Medical Imaging and Radiation Oncology 06/2011; 55(3):259-65. · 0.87 Impact Factor
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Falk Roland Miese,
Christoph Zilkens, Arne Holstein,
Bernd Bittersohl,
Patric Kröpil,
Tallal Charles Mamisch,
Rotem Shlomo Lanzman,
Philip Bilk,
Dirk Blondin,
Marcus Jäger,
Rüdiger Krauspe,
Günther Fürst
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ABSTRACT: T2 and T2* mapping are novel tools to assess cartilage quality.
To evaluate hip cartilage quality in the long-term follow-up of patients with slipped capital femoral epiphysis (SCFE) with T2 and T2* mapping.
Thirty-three patients (19 men, 14 women, mean age 24 ± 6.0 years, range 18-51 years) with a history of SCFE in 41 hips and 10 healthy controls (seven men, mean age 22 ± 4 years) were included. Follow-up period was 12 ± 6 (range 4-39 years) years. Coronal T2 and T2* mapping were performed on a 1.5 T scanner. T2 and T2* values of the hip articular cartilage were determined in the medial, central, and lateral portion of the hip within the weight bearing zone. Clinical symptoms including pain were assessed with the Harris hip score. Statistical analysis was performed using Mann-Whitney U test and Spearman rank sum test.
In hips after SCFE T2 (central portion: 25.71 ms ± 4.84 ms vs. 29.71 ms ± 7.04 ms, p<0.05) and T2* (central portion: 20.76 ms ± 3.17 ms vs. 23.06 ms ± 2.68 ms, P<0.01) of cartilage were significantly lower, compared to controls. The differences were most apparent in the lateral portion of the hip articular cartilage. Abnormal cartilage T2 and T2* were not associated with hip pain or impaired hip function. SCFE was unilateral in 23 cases (70%). In the patients' unaffected hips without SCFE, areas of significantly reduced T2 (central portion: 26.07 ms ± 4.27 ms, P<0.05) and T2* (lateral portion: 23.23 ms ± 2.45 vs. 25.11 ms ± 3.01 ms, P<0.05) were noted.
T2 and T2* mapping of the hip in patients after SCFE are significantly different from healthy controls and may offer additional information about cartilage quality.
Acta Radiologica 10/2010; 52(1):106-10. · 1.37 Impact Factor
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ABSTRACT: Aim of this study was to assess the glycosaminoglycan content in hip joint cartilage in mature hips with a history of Legg-Calvé-Perthes (LCPD) disease using delayed gadolinium-enhanced magnetic resonance imaging of cartilage (dGEMRIC).
Thirty one hips in 27 adults (mean age: 30.5+/-10.9 y) with LCPD in childhood were included. Mean follow-up after diagnosis was 24.5+/-11.4 years. Clinical symptoms and standard radiographic parameters were evaluated. dGEMRIC indices were calculated as T1(Gd) mean values in four coronal MRI slices medially, centrally, and laterally. For comparison, the morphologically normal appearing contra-lateral hips (21 hips) were assessed.
The following T1(Gd) values for the LCPD group were noted: medial (507+/-100 ms), central (543+/-104 ms), and lateral (553+/-105 ms). The total T1(Gd) mean value was 534+/-104 ms. The difference between LCPD and normal hips was statistically significant only for the medial compartment (P=0.018).
Hip joint cartilage after LCPD shows a significant glycosaminoglycan loss in the medial compartment while this decrease is less apparent centrally and laterally. dGEMRIC allows direct assessment of cartilage matrix biochemistry and may depict the complex damage pattern of hip joint cartilage after LCPD spatially and qualitatively better than other radiographic methods.
Prognostic study, Level II-1 (retrospective study).
Journal of pediatric orthopedics 03/2010; 30(2):147-53. · 1.23 Impact Factor
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ABSTRACT: To assess rotation deficits, asphericity of the femoral head and localisation of cartilage damage in the follow-up after slipped capital femoral epiphysis (SCFE).
Magnetic resonance imaging studies were obtained in adult patients with a history of SCFE. A total of 35 hips after SCFE in 26 patients (mean age 24.1 +/- 6.5, mean follow-up 11.9 +/- 6.1 years) were evaluated. The control group comprised 20 healthy hips from 10 young adults with an average age of 23.9 +/- 3.7 years. The MR protocol included a T1-weighted sequence with a 3D volumetric interpolated breath-hold sequence and a radial 2D proton density-weighted sequence around the femoral neck. Images were evaluated for alpha angle and cartilage damage in five positions around the femoral head. Hip function was evaluated at the time of MRI and correlated with MRI results. Mann-Whitney U test and Spearman's correlation coefficient were used for statistical analysis.
In the hips after SCFE alpha angles were significantly increased in the anterosuperior (74.1 degrees +/- 18.8 degrees ) and superior (72.5 degrees +/- 21.5 degrees ) positions and decreased in the posterior position (25.0 degrees +/- 7.2 degrees ). Cartilage damage was dominant in the anterosuperior and superior positions. Impaired rotation significantly correlated with increased anterosuperior, superior and posterosuperior alpha angles.
The data support an anterosuperior and superior cam-type deformity of the femoral head-neck junction in the follow-up after SCFE. MRI after SCFE can be used to assess anterosuperior and superior alpha angles, since the anterior alpha angle by itself may underestimate asphericity and is not associated with rotation deficits.
Skeletal Radiology 02/2010; 39(6):533-41. · 1.54 Impact Factor
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ABSTRACT: To evaluate the spatial distribution of cerebral abnormalities in cirrhotic subjects with and without hepatic encephalopathy (HE) found with magnetization transfer imaging (MTI).
Nineteen cirrhotic patients graded from neurologically normal to HE grade 2 and 18 healthy control subjects underwent magnetic resonance imaging. They gave institutional-review-board-approved written consent. Magnetization transfer ratio (MTR) maps were generated from MTI. We tested for significant differences compared to the control group using statistical non-parametric mapping (SnPM) for a voxel-based evaluation.
The MTR of grey and white matter was lower in subjects with more severe HE. Changes were found in patients with cirrhosis without neurological deficits in the basal ganglia and bilateral white matter. The loss in magnetization transfer increased in severity and spatial extent in patients with overt HE. Patients with HE grade 2 showed an MTR decrease in white and grey matter: the maximum loss of magnetization transfer effect was located in the basal ganglia [SnPM (pseudo-)t = 17.98, P = 0.0001].
The distribution of MTR changes in HE points to an early involvement of basal ganglia and white matter in HE.
World Journal of Gastroenterology 11/2009; 15(41):5157-64. · 2.47 Impact Factor
