Background: Osteoarthritis (OA) is the most common joint disorder globally and a major cause of disabiltiy with
the knee joint responsible for 80% of the disease burden. Progressive degenerative changes in cartilage tissue
result in deterioration and loss of articular cartilage. Cartilage has poor capacity of healing and the detection of
degeneration usually occurs at a stage of progression where changes are irreversible.
To improve the understanding of the degenerative process and to monitor early stage cartilage disease, new
methods are needed. Delayed gadolinium enhanced magnetic resonance imaging of cartilage (dGEMRIC) is a
technique to evaluate cartilage quality by estimation of glycosaminoglycan (GAG) content, a low dGEMRIC index
indicates low cartilage quality. The characteristic resistance to compressive forces of healthy cartilage relies on
high GAG content. Decreasing GAG content is regarded as one of the first alterations in progression to cartilage
Aims and cohorts: 1) To validate the dGEMRIC measurement technique. 2) To monitor changes in cartilage
quality in two cohorts of knee-injured patients: a) traumatic cartilage injury and b) ACL injury. To investigate the
capacity of dGEMRIC to predict clinical and radiographic OA in both these cohorts.
Results: For 6 investigators, the inter- and intra-observer reproducibility of dGEMRIC measurements with manual
definition of different regions of interest was good with CV% of <3% at repeated measures. No difference was
found related to investigator experience.
A traumatic cartilage injury was associated with a high prevalence of OA after 17 years. The dGEMRIC index in
the repair tissue was low already 2 years postoperatively, indicating fibrocartilage of low quality. A negative
correlation between the dGEMRIC index in the adjacent cartilage and future OA suggests that the quality of the
surrounding cartilage influences outcome after cartilage repair surgery.
29 patients with ACL rupture were investigated with dGEMRIC 3 weeks and 2 years after injury. dGEMRIC
index was lower compared to non-injured controls. Patient that had sustained meniscectomy, or had BMI ≥25, had
lower cartilage quality at 2 years.
Long-term follow-up was performed in 16 patients with cartilage repair surgery and 31 patients with ACL
rupture. In the cartilage repair group, the 12 knees that had developed radiographic OA had lower dGEMRIC
index (p=0.07), and in the ACL group low medial dGEMRIC index was associated with both medial ROA and OA
symptoms (p<0.05) after 14 years.
Conclusion: Non-invasive assessment of cartilage quality with dGEMRIC is feasible and measures relevant
differences in a clinical context. Cartilage quality assessed with dGEMRIC has a prognostic capacity relative knee
- Department of Clinical Sciences, Lund
- Tiderius, Carl Johan, Supervisor
- Dahlberg, Leif, Assistant supervisor
|Award date||2019 Nov 29|
|Place of Publication||Lund|
|Publication status||Published - 2019|
Place: Föreläsningssal 5, Centralblocket, Entrégatan 7, Skånes Universitetssjukhus i Lund
Name: Stark, André
Affiliation: Karolinska institutet, Stockholm