Abstract
Symptomatic femoroacetabular impingement (FAI) is now a known precursor of early osteoarthritis (OA) of the hip. In terms of clinical intervention, the decision between joint preservation and joint replacement hinges on the severity of articular cartilage degeneration. The exact threshold during the course of disease progression when the cartilage damage is irreparable remains elusive. The intention behind radiographic imaging is to accurately identify the morphology of osseous structural abnormalities and to accurately characterize the chondrolabral damage as much as possible. However, both plain radiographs and computed tomography (CT) are insensitive for articular cartilage anatomy and pathology. Advanced magnetic resonance imaging (MRI) techniques include magnetic resonance arthrography and biochemically sensitive techniques of delayed gadolinium-enhanced MRI of cartilage (dGEMRIC), T1rho (T1ρ), T2/T2* mapping, and several others. The diagnostic performance of these techniques to evaluate cartilage degeneration could improve the ability to predict an individual patient-specific outcome with non-surgical and surgical care. This review discusses the facts and current applications of biochemical MRI for hip joint cartilage assessment covering the roles of dGEMRIC, T2/T2*, and T1ρ mapping. The basics of each technique and their specific role in FAI assessment are outlined. Current limitations and potential pitfalls as well as future directions of biochemical imaging are also outlined.
Highlights
First described by Smith-Peterson in 1936 [1] and in more detail by Stulberg et al [2], Harris [3], and Ganz et al [4], femoroacetabular impingement (FAI) refers to a condition in which structural abnormalities of the proximal femur and/or acetabulum lead to mechanical abutment or conflict during hip motion
The present review aims to outline the facts and current applications of biochemical magnetic resonance imaging (MRI) for hip joint cartilage assessment covering the roles of delayed gadolinium-enhanced MRI of cartilage (dGEMRIC), T2/T2*, and T1ρ mapping
Since symptomatic FAI is a pre-arthritic condition, early diagnosis and imaging of the relevant patho-anatomy with treatment is important in changing clinical course of early arthritis
Summary
First described by Smith-Peterson in 1936 [1] and in more detail by Stulberg et al [2], Harris [3], and Ganz et al [4], femoroacetabular impingement (FAI) refers to a condition in which structural abnormalities of the proximal femur and/or acetabulum lead to mechanical abutment or conflict during hip motion. Having identified the classical physical examination findings, radiographic imaging aims [1] to identify the morphology leading to abutment in the individual case and confirm the radiographic diagnosis of FAI, [2] to define the pathological extent of the impingement, [3] to evaluate the extent and severity of chondrolabral damage at the time of presentation, and [4] to differentiate other relevant diagnoses that may occasionally co-exist, including labral tears with hip dysplasia. With superior soft tissue contrast and the capacity for multi-planar image acquisition, MRI and MRA can reveal the degree of chondrolabral damage They provide crucial information on the location and extent of hip deformity and other causes of hip pain (such as avascular necrosis of the femoral head, neoplastic synovitis) can be excluded. Current limitations and potential pitfalls and the present and future aspects of biochemical MRI in FAI are discussed
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