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Logo of nihpaAbout Author manuscriptsSubmit a manuscriptNIH Public Access; Author Manuscript; Accepted for publication in peer reviewed journal;
Osteoarthritis Cartilage. Author manuscript; available in PMC May 14, 2008.
Published in final edited form as:
PMCID: PMC2384147
NIHMSID: NIHMS46944

delayed Gadolinium Enhanced MRI of Cartilage (dGEMRIC) of the First Carpometacarpal (1CMC) Joint: A Feasibility Study

Ashley Williams, M.S., Sanjay K. Shetty, M.D., Deborah Burstein, Ph.D.,* Charles Day, M.D., and Charles McKenzie, Ph.D.*

Introduction and Summary

The first carpometacarpal (1CMC) joint, at the base of the thumb, is a common site for symptomatic and radiographic osteoarthritis (OA) among the elderly 14. OA in the 1CMC joint can be particularly debilitating because it is associated with a decrease in pincer grip strength and limits activities such as writing and handling small objects 4. Currently, the diagnosis and staging of 1CMC OA is based on physical signs and symptoms and radiographic evidence of reactive bone changes 5. A deeper appreciation of OA etiology and progression in the 1CMC joint is currently limited by a lack of markers sensitive to early intraarticular degenerative changes, particularly those that are radiographically occult, that can be used to quantitatively assess disease status and therapeutic efficacy. The dGEMRIC (delayed Gadolinium Enhanced MRI of Cartilage) technique has previously been used in the knee and hip as a non-invasive method to evaluate one aspect of cartilage biochemical status, that of the spatial distribution of cartilage glycosaminoglycan (GAG) concentration 610, but has never been applied to the thin cartilage in the hand. This study found dGEMRIC evaluation of the 1CMC joint is technically feasible and demonstrates differences between cartilage in asymptomatic and OA joints, potentially providing an objective measure of disease progression and a means for better understanding biochemical changes which might precede cartilage destruction.

Methods, Results and Discussion

9 subjects (5 asymptomatic and 4 1CMC OA,) were examined. Asymptomatic subjects (3 women, 2 men; mean age = 28±6 yrs) reported no current or prior joint pain. OA subjects (3 women, 1 man; mean age = 54±6 yrs) were diagnosed based on joint pain on palpation and/or radiographic evidence of narrowed joint space or osteophytes including the following: radiographically normal Eaton Stage I OA (n= 1), Eaton Stage I OA with deQuervain’s tenosynovitis (n=1); bilateral early radiographic OA, Eaton stage II (n=1); radiographic Eaton stage III OA (n=1) 11. The right hands of asymptomatic subjects and the more severely affected hands of OA subjects were imaged, except in one case where both hands of an OA subject (bilateral Eaton stage II) were imaged. All studies were approved by the institutional review board, and all subjects gave their informed consent.

dGEMRIC examinations were performed on all subjects 12. Volunteers received an IV injection of 0.2 mM/kg Magnevist (Berlex Imaging, Wayne, NJ, USA). Immediately following injection, subjects exercised the study hand by repetitively squeezing and releasing a ball for 5 minutes. Volunteers were imaged with a 1.5T GE Signa TwinSpeed MR imager (GE Healthcare, Waukesha, WI, USA) using a body coil for transmit and a commercially available receive only one-inch surface coil (eCoil, Medrad, Indianola, PA, USA) placed on the dorsal surface of the thumb in receive mode. dGEMRIC images were acquired 60 minutes following injection.

At each dGEMRIC acquisition, a single sagittal slice (oriented to the thumb) was placed roughly in the center of the carpometacarpal joint, and a series of Inversion Recovery - Fast Spin Echo (IR-FSE) images with a 6 cm field of view and 235 μm in-plane × 1.5 mm thick resolution were acquired. In order to achieve the high in plane resolution, the “Zoom” gradient (40 mT/m max gradient strength, 150 mT/m/ms slew rate) of the TwinSpeed MRI was used for all imaging. Prior to reconstruction, images were interpolated in k-space to a 512 matrix. The inversion recovery image series was acquired with parameters: 5 inversion times (Ti) ranging 50–1650ms, 1767ms repetition time (TR, time between inversion pulses), ± 20kHz receiver bandwidth, Echo Train Length of 5, and 2 signal averages. The T1 measurement time was 15 min.

Proton density FSE images of the same geometry were acquired to provide visual guidance for manual segmentation of cartilage in the analysis of the images. Regions of interest (ROIs) were drawn on the trapezial and metacarpal surfaces of the 1CMC joint, and sub-regions were drawn on the volar and dorsal aspects of the metacarpal surface. Volar aspect ROIs were defined as full-thickness cartilage comprising the volar ¼–⅓ of the metacarpal surface based on visual inspection; more dorsal regions were defined as all metacarpal cartilage dorsal to the volar aspect ROI. T1 maps of the cartilage regions were generated using custom coded software (MRIMapper, MIT and Beth Israel Deaconess Medical Center, 2006) for Matlab (TheMathWorks, Natick, MA). Two-tailed t-tests were used to evaluate dGEMRIC differences between the cohorts and regions of cartilage (Excel, Microsoft, Seattle, WA).

Examples of 1CMC dGEMRIC images from 3 individuals acquired 60 minutes after injection are shown in Figure 1. The asymptomatic subject demonstrates higher and more homogeneous dGEMRIC indices than are seen in the Eaton stage I or Eaton stage II subjects.

Figure 1
Examples of 1CMC dGEMRIC acquired 60 minutes after injection: (a) 28 yr-old asymptomatic woman; (b) 50 yr-old woman with painful OA, Eaton Stage I; (c) 50 yr-old professional drummer with radiographic OA, Eaton Stage II. Both OA subjects have lower dGEMRIC ...

Asymptomatic subjects demonstrated generally higher metacarpal dGEMRIC indices (371±54 ms, n=5) than the OA cohort (284±48 ms, n=5 hands from 4 OA subjects). Trapezial surface dGEMRIC indices were also higher for the asymptomatic group compared to OA subjects (405±82 ms v 308±69 ms).

Volar cartilage was absent in 2 of OA joints examined and, therefore, was not included in a regional analysis. A trend for lower dGEMRIC indices in the volar aspect of the metacarpal surface than in more dorsal regions was observed in both asymptomatics (n=5, 329±83 ms v 399±45 ms, volar v dorsal) and in OA subjects (n=3, 272±30 ms v 308±99 ms, volar v dorsal).

The results of the present study demonstrate the feasibility of dGEMRIC evaluation of 1CMC joint cartilage using commonly available hardware and imaging sequences. dGEMRIC indices measured here were shown to be in the same general range as dGEMRIC values previously measured in the hip and knee 7,8. Moreover, dGEMRIC indices of subjects with 1CMC OA were shown to be generally lower than asymptomatics, suggesting that the technique may be sensitive to OA induced biochemical changes in 1CMC cartilage. While cartilage thickness was not measured in the current study, dGEMRIC may provide a complementary tool to quantitative MRI measures for metacarpophalangeal cartilage volume 13 and interphalangeal cartilage T2 mapping 14.

The choice of imaging sequence and parameters in this work was constrained by the need to achieve 100μm in-plane resolution in order to image the thin cartilage with adequate SNR for T1 quantification while using a one-inch receive surface coil. Consequently, dGEMRIC measurement of a single 2D section 1.5mm thick required 15 min of acquisition-time. In the future, scan-time may be reduced by employing a coil with better SNR, thus eliminating the need for averaging (i.e. 2 averages). Higher SNR may also permit the use of 3D techniques capable of probing the entire 1CMC joint in a single imaging session.

The 60-minute delay between injection and dGEMRIC acquisition used here for comparisons of groups of subjects and in regional analyses differs from the 90–120 minute delay commonly used in the knee8,9, although 30–60 minutes post-contrast has been shown to yield higher sensitivity to differences between control and OA subjects in studies of the hip7,10. Further work is needed to determine the optimal window for imaging the 1CMC joint.

Due to the difference in age between the control group and OA subjects examined in this study (mean age 28±6 yrs v 54±6 yrs, respectively), and in light of the high frequency of asymptomatic radiographic degeneration of the 1CMC joint in the general population over 50 years of age1,3,4, it has yet to be determined if the dGEMRIC difference noted between the groups here is due to disease or the result of the aging process. Bilateral dGEMRIC evaluations of subjects with unilateral symptomatic 1CMC OA may help to shed light on this issue.

A prior report of articular cartilage wear patterns of the 1CMC joint in cadaveric specimens noted a trend for cartilage degeneration starting in the volar/radial quadrant of the metacarpal surface with subsequent dorsal and ulnar aspect involvement in more advanced OA 15 In the present pilot study, dGEMRIC variations consistent with this trend were observed. The volar aspect of the metacarpal surface demonstrated lower dGEMRIC values than more dorsal regions. In this work, dGEMRIC evaluation was limited to a single 1.5mm section from the center of the joint, thus only a small portion of each metacarpal surface was sampled. However, given that volar regions sampled here tended to show relatively low dGEMRIC indices and that volar cartilage was altogether absent in 2 of the OA joints examined, these data are compatible with prior reports and suggest that that low dGEMRIC index reflects tissue in a degenerate biochemical state that may also be more vulnerable to tissue thinning.

Acknowledgments

This study was supported in part by Grant AR42773 from the National Institutes of Health.

Footnotes

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References

1. Haara MM, Heliovaara M, Kroger H, Arokoski JP, Manninen P, Karkkainen A, et al. Osteoarthritis in the carpometacarpal joint of the thumb. Prevalence and associations with disability and mortality. J Bone Joint Surg Am. 2004;86-A(7):1452–7. [PubMed]
2. Sodha S, Ring D, Zurakowski D, Jupiter JB. Prevalence of osteoarthrosis of the trapeziometacarpal joint. J Bone Joint Surg Am. 2005;87(12):2614–8. [PubMed]
3. Wilder FV, Barrett JP, Farina EJ. Joint-specific prevalence of osteoarthritis of the hand. Osteoarthritis Cartilage. 2006;14(9):953–7. [PubMed]
4. Zhang Y, Niu J, Kelly-Hayes M, Chaisson CE, Aliabadi P, Felson DT. Prevalence of symptomatic hand osteoarthritis and its impact on functional status among the elderly: The Framingham Study. Am J Epidemiol. 2002;156(11):1021–7. [PubMed]
5. Barron OA, Glickel SZ, Eaton RG. Basal joint arthritis of the thumb. J Am Acad Orthop Surg. 2000;8(5):314–23. [PubMed]
6. Bashir A, Gray ML, Hartke J, Burstein D. Nondestructive imaging of human cartilage glycosaminoglycan concentration by MRI. Magn Reson Med. 1999;41(5):857–865. [PubMed]
7. 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(10):1987–92. [PubMed]
8. Williams A, Gillis A, McKenzie C, Po B, Sharma L, Micheli L, et al. Glycosaminoglycan distribution in cartilage as determined by delayed gadolinium-enhanced MRI of cartilage (dGEMRIC): potential clinical applications. AJR Am J Roentgenol. 2004;182(1):167–72. [PubMed]
9. 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(3):488–92. [PubMed]
10. Tiderius CJ, Jessel R, Kim YJ, Burstein D. Hip dGEMRIC in asymptomatic volunteers and patients with early osteoarthritis: the influence of timing after contrast injection. Magn Reson Med. 2007;57(4):803–805. [PubMed]
11. Eaton RG, Glickel SZ. Trapeziometacarpal osteoarthritis. Staging as a rationale for treatment. Hand Clin. 1987;3(4):455–71. [PubMed]
12. 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(1):36–41. [PubMed]
13. Peterfy CG, van Dijke CF, Lu Y, Nguyen A, Connick TJ, Kneeland JB, et al. Quantification of the volume of articular cartilage in the metacarpophalangeal joints of the hand: accuracy and precision of three-dimensional MR imaging. AJR Am J Roentgenol. 1995;165(2):371–5. [PubMed]
14. Lazovic-Stojkovic J, Mosher TJ, Smith HE, Yang QX, Dardzinski BJ, Smith MB. Interphalangeal joint cartilage: high-spatial-resolution in vivo MR T2 mapping--a feasibility study. Radiol. 2004;233(1):292–6. [PubMed]
15. Koff MF, Ugwonali OF, Strauch RJ, Rosenwasser MP, Ateshian GA, Mow VC. Sequential wear patterns of the articular cartilage of the thumb carpometacarpal joint in osteoarthritis. J Hand Surg [Am] 2003;28(4):597–604. [PubMed]
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