Skeletal Radiology

, Volume 40, Issue 5, pp 553–561 | Cite as

Comparison of pre-operative dGEMRIC imaging with intra-operative findings in femoroacetabular impingement: preliminary findings

  • Bernd Bittersohl
  • Harish S. Hosalkar
  • Sebastian Apprich
  • Stefan A. Werlen
  • Klaus A. Siebenrock
  • Tallal Charles MamischEmail author
Scientific Article



To study standard MRI and dGEMRIC in patients with symptomatic FAI undergoing surgical intervention and compare them with intra-operative findings to see if they were corroborative.


Sixteen patients with symptomatic FAI that warranted surgical intervention were prospectively studied. All patients underwent plain radiographic series for FAI assessment followed by standard MRI and dGEMRIC. Subsequently, patients were surgically treated with safe dislocation and the joint was evaluated for any macroscopic signs of damaged cartilage. Data were statistically analyzed.


A total of 224 zones in 16 patients were evaluated. One hundred and sixteen zones were intra-operatively rated as normal with mean T1 values of 510.1 ms ± 141.2 ms. Eighty zones had evidence of damage with mean T1 values of 453.1 ms ± 113.6 ms. The difference in these T1 values was significant (p = 0.003). Correlation between standard MRI and intra-operative findings was moderate (r = 0.535, p < 0.001). Intra-operative findings revealed more damage than standard MRI. On standard MRI, 68.6% zones were graded normal while 31.4% had evidence of damage. On intra-operative visualization, 56.4% zones were graded normal and 43.6% had evidence of damage. Correlation between dGEMRIC and intra-operative findings turned out to be weak (r = 0.114, p < 0.126). On T1 assessment 31.4% of zones were graded as normal and 68.6% as damaged.


dGEMRIC was significantly different between normal and affected cartilage based on intra-operative assessment. The correlation for morphological findings was limited, underestimating defects. By combining morphological with biochemical assessment dGEMRIC may play some role in the future to prognosticate outcomes and facilitate surgical planning and intervention.


MRI Hip Cartilage FAI dGEMRIC Surgery 


Conflict of interest

The authors declare that there is no conflict of interest.


  1. 1.
    Ganz R, Parvizi J, Beck M, Leunig M, Notzli H, Siebenrock KA. Femoroacetabular impingement: a cause for osteoarthritis of the hip. Clin Orthop Relat Res. 2003;(417):112–20.Google Scholar
  2. 2.
    Murphy S, Tannast M, Kim YJ, Buly R, Millis MB. Debridement of the adult hip for femoroacetabular impingement: indications and preliminary clinical results. Clin Orthop Relat Res. 2004;(429):178–81.Google Scholar
  3. 3.
    Wagner S, Hofstetter W, Chiquet M, Mainil-Varlet P, Stauffer E, Ganz R, et al. Early osteoarthritic changes of human femoral head cartilage subsequent to femoro-acetabular impingement. Osteoarthritis Cartilage. 2003;11:508–18.PubMedCrossRefGoogle Scholar
  4. 4.
    Beck M, Leunig M, Parvizi J, Boutier V, Wyss D, Ganz R. Anterior femoroacetabular impingement. II. Midterm results of surgical treatment. Clin Orthop Relat Res. 2004;(418):67–73.Google Scholar
  5. 5.
    Spencer S, Millis MB, Kim YJ. Early results of treatment of hip impingement syndrome in slipped capital femoral epiphysis and pistol grip deformity of the femoral head-neck junction using the surgical dislocation technique. J Pediatr Orthop. 2006;26:281–5.PubMedGoogle Scholar
  6. 6.
    Pfirrmann CW, Mengiardi B, Dora C, Kalberer F, Zanetti M, Hodler J. Cam and pincer femoroacetabular impingement: characteristic MR arthrographic findings in 50 patients. Radiology. 2006;240:778–85.PubMedCrossRefGoogle Scholar
  7. 7.
    Czerny C, Hofmann S, Neuhold A, Tschauner C, Engel A, Recht MP, et al. Lesions of the acetabular labrum: accuracy of MR imaging and MR arthrography in detection and staging. Radiology. 1996;200:225–30.PubMedGoogle Scholar
  8. 8.
    Locher S, Werlen S, Leunig M, Ganz R. MR-Arthrography with radial sequences for visualization of early hip pathology not visible on plain radiographs. Z Orthop Ihre Grenzgeb. 2002;140:52–7.PubMedCrossRefGoogle Scholar
  9. 9.
    Petersilge CA. MR arthrography for evaluation of the acetabular labrum. Skeletal Radiol. 2001;30:423–30.PubMedCrossRefGoogle Scholar
  10. 10.
    Petersilge CA, Haque MA, Petersilge WJ, Lewin JS, Lieberman JM, Buly R. Acetabular labral tears: evaluation with MR arthrography. Radiology. 1996;200:231–5.PubMedGoogle Scholar
  11. 11.
    Bashir A, Gray ML, Hartke J, Burstein D. Nondestructive imaging of human cartilage glycosaminoglycan concentration by MRI. Magn Reson Med. 1999;41:857–65.PubMedCrossRefGoogle Scholar
  12. 12.
    Nieminen MT, Rieppo J, Silvennoinen J, Toyras J, Hakumaki JM, Hyttinen MM, et al. Spatial assessment of articular cartilage proteoglycans with Gd-DTPA-enhanced T1 imaging. Magn Reson Med. 2002;48:640–8.PubMedCrossRefGoogle Scholar
  13. 13.
    Bashir A, Gray ML, Boutin RD, Burstein D. Glycosaminoglycan in articular cartilage: in vivo assessment with delayed Gd(DTPA)(2-)-enhanced MR imaging. Radiology. 1997;205:551–8.PubMedGoogle Scholar
  14. 14.
    Burstein D, Velyvis J, Scott KT, Stock KW, Kim YJ, Jaramillo D, et al. Protocol issues for delayed Gd(DTPA)(2-)-enhanced MRI (dGEMRIC) for clinical evaluation of articular cartilage. Magn Reson Med. 2001;45:36–41.PubMedCrossRefGoogle Scholar
  15. 15.
    Cunningham T, Jessel R, Zurakowski D, Millis MB, Kim YJ. Delayed gadolinium-enhanced magnetic resonance imaging of cartilage to predict early failure of Bernese periacetabular osteotomy for hip dysplasia. J Bone Joint Surg Am. 2006;88:1540–8.PubMedCrossRefGoogle Scholar
  16. 16.
    Gillis A, Bashir A, McKeon B, Scheller A, Gray ML, Burstein D. Magnetic resonance imaging of relative glycosaminoglycan distribution in patients with autologous chondrocyte transplants. Invest Radiol. 2001;36:743–8.PubMedCrossRefGoogle Scholar
  17. 17.
    Kim YJ, Jaramillo D, Millis MB, Gray ML, Burstein D. Assessment of early osteoarthritis in hip dysplasia with delayed gadolinium-enhanced magnetic resonance imaging of cartilage. J Bone Joint Surg Am. 2003;85-A:1987–92.PubMedGoogle Scholar
  18. 18.
    Kurkijarvi JE, Mattila L, Ojala RO, Vasara AI, Jurvelin JS, Kiviranta I, et al. Evaluation of cartilage repair in the distal femur after autologous chondrocyte transplantation using T2 relaxation time and dGEMRIC. Osteoarthritis Cartilage. 2007;15:372–8.PubMedCrossRefGoogle Scholar
  19. 19.
    Tiderius CJ, Olsson LE, de Verdier H, Leander P, Ekberg O, Dahlberg L. Gd-DTPA2)-enhanced MRI of femoral knee cartilage: a dose-response study in healthy volunteers. Magn Reson Med. 2001;46:1067–71.PubMedCrossRefGoogle Scholar
  20. 20.
    Tiderius CJ, Olsson LE, Leander P, Ekberg O, Dahlberg L. Delayed gadolinium-enhanced MRI of cartilage (dGEMRIC) in early knee osteoarthritis. Magn Reson Med. 2003;49:488–92.PubMedCrossRefGoogle Scholar
  21. 21.
    Tiderius CJ, Svensson J, Leander P, Ola T, Dahlberg L. dGEMRIC (delayed gadolinium-enhanced MRI of cartilage) indicates adaptive capacity of human knee cartilage. Magn Reson Med. 2004;51:286–90.PubMedCrossRefGoogle Scholar
  22. 22.
    Trattnig S, Mamisch TC, Pinker K, Domayer S, Szomolanyi P, Marlovits S, et al. Differentiating normal hyaline cartilage from post-surgical repair tissue using fast gradient echo imaging in delayed gadolinium-enhanced MRI (dGEMRIC) at 3 Tesla. Eur Radiol. 2008;18:1251–9.PubMedCrossRefGoogle Scholar
  23. 23.
    Vasara AI, Nieminen MT, Jurvelin JS, Peterson L, Lindahl A, Kiviranta I. Indentation stiffness of repair tissue after autologous chondrocyte transplantation. Clin Orthop Relat Res. 2005;(433):233–42.Google Scholar
  24. 24.
    Williams A, Sharma L, McKenzie CA, Prasad PV, Burstein D. Delayed gadolinium-enhanced magnetic resonance imaging of cartilage in knee osteoarthritis: findings at different radiographic stages of disease and relationship to malalignment. Arthritis Rheum. 2005;52:3528–35.PubMedCrossRefGoogle Scholar
  25. 25.
    Cova M, Toffanin R. MR microscopy of hyaline cartilage: current status. Eur Radiol. 2002;12:814–23.PubMedCrossRefGoogle Scholar
  26. 26.
    Poole AR, Kojima T, Yasuda T, Mwale F, Kobayashi M, Laverty S. Composition and structure of articular cartilage: a template for tissue repair. Clin Orthop Relat Res. 2001;(391 Suppl):S26–33.Google Scholar
  27. 27.
    Buckwalter JA, Roughley PJ, Rosenberg LC. Age-related changes in cartilage proteoglycans: quantitative electron microscopic studies. Microsc Res Tech. 1994;28:398–408.PubMedCrossRefGoogle Scholar
  28. 28.
    Venn M, Maroudas A. Chemical composition and swelling of normal and osteoarthrotic femoral head cartilage. I. Chemical composition. Ann Rheum Dis. 1977;36:121–9.PubMedCrossRefGoogle Scholar
  29. 29.
    Bittersohl B, Hosalkar HS, Haamberg T, Kim YJ, Werlen S, Siebenrock KA, et al. Reproducibility of dGEMRIC in assessment of hip joint cartilage: a prospective study. J Magn Reson Imaging. 2009;30:224–8.PubMedCrossRefGoogle Scholar
  30. 30.
    Bittersohl B, Hosalkar HS, Hughes T, Kim YJ, Werlen S, Siebenrock KA, et al. Feasibility of T(2) (*) mapping for the evaluation of hip joint cartilage at 1.5T using a three-dimensional (3D), gradient-echo (GRE) sequence: a prospective study. Magn Reson Med. 2009;62:896–901.PubMedCrossRefGoogle Scholar
  31. 31.
    Bittersohl B, Steppacher S, Haamberg T, Kim YJ, Werlen S, Beck M, et al. Cartilage damage in femoroacetabular impingement (FAI): preliminary results on comparison of standard diagnostic vs delayed gadolinium-enhanced magnetic resonance imaging of cartilage (dGEMRIC). Osteoarthritis Cartilage. 2009;17:1297–306.PubMedCrossRefGoogle Scholar
  32. 32.
    Ganz R, Gill TJ, Gautier E, Ganz K, Krugel N, Berlemann U. Surgical dislocation of the adult hip: a technique with full access to the femoral head and acetabulum without the risk of avascular necrosis. J Bone Joint Surg Br. 2001;83:1119–24.PubMedCrossRefGoogle Scholar
  33. 33.
    Lavigne M, Parvizi J, Beck M, Siebenrock KA, Ganz R, Leunig M. Anterior femoroacetabular impingement. I. Techniques of joint preserving surgery. Clin Orthop Relat Res. 2004;(418):61–6.Google Scholar
  34. 34.
    Beck M, Kalhor M, Leunig M, Ganz R. Hip morphology influences the pattern of damage to the acetabular cartilage: femoroacetabular impingement as a cause of early osteoarthritis of the hip. J Bone Joint Surg Br. 2005;87:1012–8.PubMedCrossRefGoogle Scholar
  35. 35.
    Bowalekar SK. Statistics in medical research. IV. Sampling distribution, statistical testing of hypothesis and student's t-test. J Postgrad Med. 1994;40:46–51.PubMedGoogle Scholar
  36. 36.
    Myers JL, Well A. Research design and statistical analysis. In: Mahwah, NJ: Erlbaum; 2003.Google Scholar
  37. 37.
    Landis JR, Koch GG. An application of hierarchical kappa-type statistics in the assessment of majority agreement among multiple observers. Biometrics. 1977;33:363–74.PubMedCrossRefGoogle Scholar
  38. 38.
    Knuesel PR, Pfirrmann CW, Noetzli HP, Dora C, Zanetti M, Hodler J, et al. MR arthrography of the hip: diagnostic performance of a dedicated water-excitation 3D double-echo steady-state sequence to detect cartilage lesions. AJR Am J Roentgenol. 2004;183:1729–35.PubMedGoogle Scholar
  39. 39.
    Schmid MR, Notzli HP, Zanetti M, Wyss TF, Hodler J. Cartilage lesions in the hip: diagnostic effectiveness of MR arthrography. Radiology. 2003;226:382–6.PubMedCrossRefGoogle Scholar

Copyright information

© ISS 2010

Authors and Affiliations

  • Bernd Bittersohl
    • 1
  • Harish S. Hosalkar
    • 2
  • Sebastian Apprich
    • 1
  • Stefan A. Werlen
    • 3
  • Klaus A. Siebenrock
    • 1
  • Tallal Charles Mamisch
    • 1
    Email author
  1. 1.Department of Orthopedic SurgeryUniversity of Bern, InselspitalBernSwitzerland
  2. 2.Department of Orthopedic SurgeryChildren’s HospitalSan DiegoUSA
  3. 3.Department of RadiologySonnenhof HospitalBernSwitzerland

Personalised recommendations