Glycosaminoglycan Distribution in Cartilage as Determined by Delayed Gadolinium-Enhanced MRI of Cartilage (dGEMRIC): Potential Clinical Applications

Glycosaminoglycan Distribution in Cartilage as Determined by Delayed Gadolinium-Enhanced MRI of Cartilage (dGEMRIC): Potential Clinical Applications

Ashley Williams¹, Amy Gillis¹, Charles McKenzie¹, Bruce Po¹, Leena Sharma², Lyle Micheli³, Brian McKeon⁴ and Deborah Burstein¹

¹ Department of Radiology, Beth Israel Deaconess Medical Center, 4 Blackfan Cir., Rm. 147, Boston, MA 02115.
² Division of Rheumatology, Northwestern University Medical School, 300 E Superior St., Tarry 3-713, Chicago, IL 60611.
³ Division of Sports Medicine, Children's Hospital Boston, 319 Longwood Ave., Sixth Floor, Boston, MA 02115.
⁴ Department of Orthopedic Surgery, New England Baptist Hospital, ProSports Orthopedics, 840 Winter St., Waltham, MA 02451.

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Fig. 1. —Color scale of glycosaminoglycan distribution (T1_Gd) index used in delayed gadolinium-enhanced MRI of cartilage technique. Blue–green end of scale represents high T1_Gd values, meaning high glycosaminoglycan levels. Red end of scale represents low T1_Gd values, meaning low glycosaminoglycan concentrations.

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Fig. 2A. —Global and focal ranges of glycosaminoglycan distribution (T1_Gd) index. Sagittal T1_Gd image of lateral compartment in 26-year-old female professional dancer shows high-range (blue–green areas) T1_Gd values (mean ± SD, 547 ± 121 msec) for tibial plateau and weight-bearing zones of femoral condyle compartments (arrows).

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Fig. 2B. —Global and focal ranges of glycosaminoglycan distribution (T1_Gd) index. Coronal T1_Gd image of 28-year-old asymptomatic female volunteer shows T1_Gd index in mid range (448 ± 89 msec) across all compartments.

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Fig. 2C. —Global and focal ranges of glycosaminoglycan distribution (T1_Gd) index. Sagittal T1_Gd image of 78-year-old woman with moderately severe medial osteoarthritis reveals T1_Gd values in low range (red areas) (285 ± 74 msec) for medial femoral condyle with focal area (arrows) displaying lower values (243 ± 56 msec). Mean T1_Gd index of surrounding cartilage was 312 ± 75 msec.

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Fig. 3A. —Compartmental differences in glycosaminoglycan distribution (T1_Gd) index. Coronal T1_Gd image of 19-year-old woman obtained before surgery to repair anterior cruciate ligament injured 2 months earlier reveals overall mid-range index values. Low-range values (red areas) are seen at superficial boundaries and throughout lateral femoral condyle, with T1_Gd index (mean ± SD) of compartment measured at 340 ± 65 msec. Medial femoral condyle (MFC) and medial tibial plateau (MTP) have higher T1_Gd values (blue–green areas) than are seen in lateral femoral condyle (LFC) and lateral tibial plateau (LTP): MFC/LFC = 1.12, MTP/LTP = 1.25.

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Fig. 4A. —Focal variations in glycosaminoglycan distribution (T1_Gd) images. Axial T1_Gd image obtained in 63-year-old woman with osteoarthritis (diagnosed on basis of radiographic findings of osteophyte and clinical knee symptoms) and evidence of medial patellar subluxation and medial patellofemoral narrowing. Patella shows lateral lesion (red area) with mean index (mean ± SD, 289 ± 47 msec) 30% lower than that of adjacent tissue (423 ± 96 msec). Low T1_Gd levels may be precursor to frank cartilage loss such as that seen in medial patella.

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Fig. 4B. —Focal variations in glycosaminoglycan distribution (T1_Gd) images. Sagittal T1_Gd image of 69-year-old woman with moderately severe medial osteoarthritis reveals that lateral compartment, which appeared unaffected on radiograph (not shown), has numerous focal areas of low T1_Gd values (red areas), with mean value of 281 ± 47 msec. Index of T1_Gd in surrounding cartilage (green areas) was 435 ± 79 msec.

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Fig. 5A. —Medial sagittal glycosaminoglycan distribution (T1_Gd) images of 49-year-old woman recovering from arthroscopic knee surgery. Red areas represent low T1_Gd values and blue–green areas represent high T1_Gd values. Comparison of image obtained before patient began taking nutritional supplements (A) with image obtained 6 months after she began taking glucosamine and chondroitin sulfate supplements (B) (CosaminDS, Nutramax Laboratories, Edgewood, MD) reveals 19% increase in T1_Gd.

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Fig. 6. —Plot of delayed gadolinium-enhanced MRI of cartilage (dGEMRIC) index values for glycosaminoglycan distribution (T1_Gd) in 10 volunteers who were followed for 6 months while taking glucosamine and chondroitin sulfate supplements (CosaminDS, Nutramax Laboratories, Edgewood, MD). Stars denote significant (p < 0.05) changes over 6-month period (two volunteers with increased values, and one with decreased values).

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Fig. 7A. —Lateral sagittal glycosaminoglycan distribution (T1_Gd) images obtained in 30-year-old man who underwent osteoarticular transfer system procedure. Red areas represent low T1_Gd values and blue–green areas represent high T1_Gd values. Comparison of images obtained 7 (A) and 20 (B) months after procedure shows T1_Gd index at implant site (open arrow) increased 20% during interval between imaging examinations. T1_Gd indexes at harvest sites (solid arrows) decreased 20–25%.

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Fig. 7B. —Lateral sagittal glycosaminoglycan distribution (T1_Gd) images obtained in 30-year-old man who underwent osteoarticular transfer system procedure. Red areas represent low T1_Gd values and blue–green areas represent high T1_Gd values. Comparison of images obtained 7 (A) and 20 (B) months after procedure shows T1_Gd index at implant site (open arrow) increased 20% during interval between imaging examinations. T1_Gd indexes at harvest sites (solid arrows) decreased 20–25%.

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Fig. 3B. —Compartmental differences in glycosaminoglycan distribution (T1_Gd) index. Coronal T1_Gd image of 78-year-old man with no reported history of knee injury (although image reveals medial meniscal abnormalities) shows overall T1_Gd index value in mid range. Medial compartment has slightly lower values than does lateral compartment. Both MFC and MTP show lower index values than LFC and LTP: MFC/LFC = 0.81, MTP/LTP = 0.85.

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Fig. 3C. —Compartmental differences in glycosaminoglycan distribution (T1_Gd) index. Sagittal T1_Gd image of 53-year-old man obtained 10 years after medial meniscectomy shows extensive medial degradation. Large region of distinctly lower T1_Gd index values are seen in femoral condyle, with sharp demarcation between that region and surrounding cartilage. T1_Gd index of degraded area (red) is 35% lower (289 ± 63 msec) than index of surrounding tissue (440 ± 74 msec).

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Fig. 5B. —Medial sagittal glycosaminoglycan distribution (T1_Gd) images of 49-year-old woman recovering from arthroscopic knee surgery. Red areas represent low T1_Gd values and blue–green areas represent high T1_Gd values. Comparison of image obtained before patient began taking nutritional supplements (A) with image obtained 6 months after she began taking glucosamine and chondroitin sulfate supplements (B) (CosaminDS, Nutramax Laboratories, Edgewood, MD) reveals 19% increase in T1_Gd.

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