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„Delayed Gadolinium Enhanced MRI of Cartilage“ (dGEMRIC)

Molekulare MRT-Bildgebung des Hüftgelenkknorpels

Delayed Gadolinium Enhanced MRI of Cartilage (dGEMRIC)

Molecular MRI of hip joint cartilage

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Zusammenfassung

Am Hüftgelenk führen präarthrotische Zustände wie Instabilität und Impingement zu pathologischen Belastungen des Gelenkknorpels und sind Risikofaktoren für die Entwicklung einer vorzeitigen Arthrose. Neben weiteren Faktoren ist die Indikation zur chirurgischen Intervention entscheidend von der präoperativen Einschätzung der Knorpelqualität abhängig.

Zur intravitalen Knorpelbeurteilung werden zunehmend molekulare MRT-Verfahren eingesetzt, die bei breiter klinischer Anwendung zukünftig zu einem Paradigmenwechsel in der Beurteilung und Behandlung von Knorpelschäden und Früharthrose führen könnten. Anstatt auf Spätschäden mit palliativen Therapieansätzen zu reagieren, könnten degenerative Schädigungen des Gelenkknorpels bereits früher erkannt und dem Krankheitsstadium angemessen behandelt werden. Außerdem könnte die Effizienz verschiedener operativer und konservativer Therapieverfahren im Verlauf beurteilt werden.

Die vorliegende Arbeit gibt eine Übersicht über die Technik und Anwendung des molekularen MRT-Verfahrens „delayed Gadolinium Enhanced MRI of Cartilage“ (dGEMRIC) am Hüftgelenk. Es wird deutlich, dass dGEMRIC qualitativ eine höhere Sensitivität gegenüber früharthrotischen Veränderungen als nativröntgenologische Aufnahmen besitzt und ein sinnvolles Verfahren zur In-vivo-Beurteilung der Knorpelqualität am Hüftgelenk ist.

Nach aktueller Datenlage besteht begründete Hoffnung, dGEMRIC klinisch zur Diagnostik von degenerativen Gelenkschäden sowie zur Verlaufsbeurteilung nach gelenkerhaltenden Therapieverfahren einzusetzen. Weitere klinische Studien müssen die Eignung dieses Verfahrens als zusätzliche Entscheidungshilfe und zur Planung osteo- und chondroplastischer Eingriffe evaluieren.

Abstract

Factors such as instability and impingement lead to early cartilage damage and osteoarthritis of the hip joint. The surgical outcome of joint-preserving surgery about the hip joint depends on the preoperative quality of joint cartilage.

For in vivo evaluation of cartilage quality, different biochemically sensitive magnetic resonance imaging (MRI) procedures have been tested, some of which have the potential of inducing a paradigm shift in the evaluation and treatment of cartilage damage and early osteoarthritis.

Instead of reacting to late sequelae in a palliative way, physicians could assess cartilage damage early on, and the treatment intensity could be adequate and based on the disease stage. Furthermore, the efficiency of different therapeutic interventions could be evaluated and monitored.

This article reviews the recent application of delayed gadolinium-enhanced MRI of cartilage (dGEMRIC) and discusses its use for assessing cartilage quality in the hip joint. dGEMRIC is more sensitive to early cartilage changes in osteoarthritis than are radiographic measures and might be a helpful tool for assessing cartilage quality.

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Authors and Affiliations

  1. Chirurgische Klinik und Poliklinik, BG-Universitätsklinikum Bergmannsheil, Bochum, Deutschland

    C. Zilkens, M. Dudda, G. Muhr & T.C. Mamisch

  2. Orthopädische Klinik, Children’s Hospital, Harvard Medical School, Boston, USA

    C. Zilkens, M. Jäger, M. Dudda, M.B. Millis, Y.-J. Kim & T.C. Mamisch

  3. Orthopädische Klinik, Universitätsklinikum Düsseldorf, Moorenstraße 5, 40225, Düsseldorf, Deutschland

    C. Zilkens, M. Jäger, B. Bittersohl & R. Krauspe

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  1. C. Zilkens
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  2. M. Jäger
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  3. B. Bittersohl
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  4. M. Dudda
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  5. M.B. Millis
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  6. Y.-J. Kim
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  9. T.C. Mamisch
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Correspondence to C. Zilkens.

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Zilkens, C., Jäger, M., Bittersohl, B. et al. „Delayed Gadolinium Enhanced MRI of Cartilage“ (dGEMRIC). Orthopäde 38, 591–599 (2009). https://doi.org/10.1007/s00132-009-1441-7

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