University of Oulu

Sigurdsson et al. BMC Musculoskeletal Disorders (2016) 17:406, DOI 10.1186/s12891-016-1244-z

Delayed gadolinium-enhanced MRI of meniscus (dGEMRIM) and cartilage (dGEMRIC) in healthy knees and in knees with different stages of meniscus pathology

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Author: Sigurdsson, Ulf1; Müller, Gunilla2; Siversson, Carl3;
Organizations: 1Department of Orthopaedics, Lund University, Skåne University Hospital
2Institute of Radiology und Scintigraphy, Kantonsspital Lucerne
3Medical Radiation Physics, Department of Translational Medicine, Lund University, Skåne University Hospital
4Department of Diagnostic Radiology, Oulu University Hospital
5Medical Imaging and Physiology, Skåne University Hospital
6Department of Orthopaedics, Clinical Sciences Lund, Lund University, Skåne University Hospital
Format: article
Version: published version
Access: open
Online Access: PDF Full Text (PDF, 0.4 MB)
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Language: English
Published: Springer Nature, 2016
Publish Date: 2017-04-06


Background: Lesions in the meniscus are risk factors for developing knee osteoarthritis (OA), not least because of the role of the meniscus in the pathological progression of OA. Delayed gadolinium enhanced MRI of cartilage (dGEMRIC) has extensively been used to identify pre-radiographic cartilage changes in OA. In contrast, its counterpart with regard to examination of the meniscus, gadolinium enhanced MRI of meniscus (dGEMRIM), has been less utilized. In this study we use 3D dGEMRIM in patients with meniscus lesions and compare them with previous results of healthy individuals.

Methods: Eighteen subjects with MRI-verified posteromedial meniscus lesions and 12 healthy subjects with non-injured and non-symptomatic knee joints, together 30 volunteers, were examined using 3D Look-Locker sequence after intravenous injection of Gd-DTPA²⁻ (0.2 mmol/kg body weight). Relaxation time (T1) was measured in the posterior meniscus and femoral cartilage before and 60, 90, 120 and 180 min after injection. Relaxation rate (R1 = 1/T1) and change in relaxation rate (ΔR1) were calculated. For statistical analyses, Student’s t-test and Analysis of Variance (ANOVA) were used.

Results: The pre-contrast diagnostic MRI identified two sub-cohorts in the 18 patients with regard to meniscus injury: 1) 11 subjects with MRI verified pathological intrameniscal changes (grade 2) in the posteromedial meniscus only and no obvious cartilage changes. The lateral meniscus showed no pathology. 2) 7 subjects with MRI verified pathological rupture (grade 3) of the posteromedial meniscus and pathological changes in the lateral meniscus and/or medial and lateral joint cartilage.

Comparisons of pathological and healthy posteromedial meniscus revealed opposite patterns in both T1Gd and ΔR1 values between pathological meniscus grade 2 and grade 3. The concentration of the contrast agent was lower than in healthy meniscus in grade 2 lesions (p = 0.046) but tended to increase in grade 3 lesions (p = 0.110). Maximum concentration of contrast agent was reached after 180 min in both cartilage and menisci (except for grade 3 menisci where the maximum concentration was reached after 90 min).

Conclusion: dGEMRIM and dGEMRIC may be feasible to combine in vivo, preferably with one examination before and one 2 h after contrast injection. Possible different dGEMRIM patterns at different stages of meniscus lesions must be taken into account when evaluating meniscus pathology.

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Series: BMC musculoskeletal disorders
ISSN: 1471-2474
ISSN-E: 1471-2474
ISSN-L: 1471-2474
Volume: 17
Article number: 406
DOI: 10.1186/s12891-016-1244-z
Type of Publication: A1 Journal article – refereed
Field of Science: 3121 General medicine, internal medicine and other clinical medicine
Funding: This study was supported by grants from the Swedish Research Council (VR), governmental funding of clinical research within the Swedish National Health Service (ALF), Skåne County Council’s Research and Development Foundation (FoU), the Swedish National Centre for Reasearch in Sports (CIF), The Swedish Rheumatism Association (RF), Skåne University Hospital funds, King Gustaf V’s 80-Year Fund, The Herman Järnhardt Foundation, The Alfred Österlund Foundation and Greta and Johan Kock’s Foundation.
Dataset Reference: The datasets analyzed during the current study are available from the corresponding author on reasonable request.
Copyright information: © The Author(s). 2016. This article is distributed under the terms of the Creative Commons Attribution 4.0 International License (, which permits unrestricted use, distribution, and reproduction in any medium, provided you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made. The Creative Commons Public Domain Dedication waiver ( applies to the data made available in this article, unless otherwise stated.