Delayed gadolinium‐enhanced magnetic resonance imaging of cartilage (dGEMRIC) in Femoacetabular impingement

Abstract

Femoroacetabular impingement is a well-described pre-arthritic condition with two main types; cam and pincer. Studies using the open treatment for impingement have described patterns of articular cartilage wear specific to cam and pincer impingement. Assessing articular damage in the hip joint is an important component of treatment. Intravenous gadolidium allows radiologists to perform an indirect assessment of articular cartilage glycosaminoglycan (GAG) content by using a technique called dGEMRIC. Using this indirect assessment of articular cartilage, we compared the dGEMRIC indices in a group of six cam and seven pincer patients to a control group (n = 12) of asymptomatic controls that had no plain MRI findings of osteoarthritis. The superior portion of the hip joint was divided into seven regions from 9 to 3 o'clock. These regions were then subdivided into peripheral and central regions. The cam and pincer groups both had statistically lower dGEMRIC values compared to the control group. The cam group demonstrated not only peripheral but also central involvement of the joint and this was concentrated in the anterior portion of the joint. The pincer group exhibited more global hip involvement with all areas of the hip averaging a dGEMRIC index 28% less than controls. With the use of dGEMRIC more specific patterns of cartilage wear can be elicited in patients with impingement, which may improve patient selection and help better understand the progression of osteoarthithis throughout the hip joint.