Kompendium 2020 Forschung & Klinik

TOP-Studien
24
Figure 2:
A 42-year-old male patient with suspected
cartilage lesion at the apex of the patella on
high-resolution axial PD TSE morphological
image at baseline. The corresponding T2 map
shows a diffuse and slight increase of T2 values
in the same area (A). After 4 years (B), morphological
cartilage status seems to have improved,
together with a decrease of T2 values. The
bisected white frames symbolize typical ROI
placement for zonal assessment of deep and
superficial T2 values.
Results & Conclusions
As a result, we found significantly higher global T2 values at baseline in the
progression group (N = 11; 57.4 ± 7.8 ms), compared to patients without
progression of cartilage defect size (N = 17; 40.6 ± 6.9 ms). Furthermore, the
non-progression group showed only a minor increase in global T2 relaxation
times (43.1 ± 7.9 ms; P = 0.07) at follow up, whereas in the progression group
global (68,7 ± 19 ms; P = 0.02) and superficial T2 values (65,8 ± 8.2–79.8 ±
24.4 ms; P = 0.03) increased significantly. T2 values for healthy reference cartilage
remained stable (Figure 1). Surprisingly, in two patients an improvement
in ICRS grading was observed (regression group), with decreasing T2 values.
The ROC analysis showed an area under the curve of 0.92 (95%CI 0.82–1.0).
At a cut-off value of 47.15 ms, we found a sensitivity of 92% (false-positive
rate of 18%) for future progression of cartilage defects.
Dr. Sebastian Apprich
Author:
Since 2019 Sebastian Apprich
has been a consultant for
Orthopedic and Trauma Surgery
and coordinates the research
activities of the Magnetic
resonance Imaging Cluster.
His clinical interests focus on
joint preserving therapy as well
as hand and foot surgery. As a
result of his expanded research
activities, he has (co)authored
36 pubmed-listed articles and
holds an actual h-index of 17
points (scopus.com).
Taken together, our study demonstrated that T2 mapping enables quantification
of patellar cartilage defect progression in untreated defects
over time. Furthermore, elevated cartilage T2 values at baseline were
associated with longitudinal morphologic degeneration. Within this small
patient cohort with early-stage patellar cartilage defects, T2 mapping
seemed to be a potential predictive marker of patellar cartilage degeneration.
Therefore, this axial T2 mapping sequence, in combination with the
unique characteristics of the patella cartilage (thick cartilage, superficial
and parallel position to the body surface) might be well suited for future
prospective studies to evaluate the natural course of cartilage defects and
their treatment in vivo.
In the Future
Furthermore, our future research will focus to overcome current limitations
of 2-dimensional (2D) multi-echo-spin echo T2 mapping techniques in the
quantitative assessment of hyaline cartilage of the whole joint. Therefore,
further development of 3-D imaging techniques with possibility for multiplanar
reconstruction and, even more important, improvements of the timeconsuming
evaluation process of T2 maps by implementing automated segmentation
techniques in combination with Gray-Level Co-Occurrence Matrix
(GLCM) features will hopefully make quantitative T2 mapping more feasible
for clinical OA-research purposes.