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European Radiology
Published in: European Radiology 6/2020

Open Access 01-06-2020 | Knee Osteoarthritis | Musculoskeletal

Quantitative DCE-MRI demonstrates increased blood perfusion in Hoffa’s fat pad signal abnormalities in knee osteoarthritis, but not in patellofemoral pain

Authors: Bas A. de Vries, Rianne A. van der Heijden, Dirk H. J. Poot, Marienke van Middelkoop, Duncan E. Meuffels, Gabriel P. Krestin, Edwin H. G. Oei

Published in: European Radiology | Issue 6/2020

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Abstract

Objective

Infrapatellar fat pad (IPFP) fat-suppressed T2 (T2FS) hyperintense regions on MRI are an important imaging feature of knee osteoarthritis (OA) and are thought to represent inflammation. These regions are also common in non-OA subjects, and may not always be linked to inflammation. Our aim was to evaluate quantitative blood perfusion parameters, as surrogate measure of inflammation, within T2FS-hyperintense regions in patients with OA, with patellofemoral pain (PFP) (supposed OA precursor), and control subjects.

Methods

Twenty-two knee OA patients, 35 PFP patients and 43 healthy controls were included and underwent MRI, comprising T2 and DCE-MRI sequences. T2FS-hyperintense IPFP regions were delineated and a reference region was drawn in adjacent IPFP tissue with normal signal intensity. After fitting the extended Tofts pharmacokinetic model, quantitative DCE-MRI perfusion parameters were compared between the two regions within subjects in each subgroup, using a paired Wilcoxon signed-rank test.

Results

T2FS-hyperintense IPFP regions were present in 16 of 22 (73%) OA patients, 13 of 35 (37%) PFP patients, and 14 of 43 (33%) controls. DCE-MRI perfusion parameters were significantly different between regions with and without a T2FS-hyperintense signal in OA patients, demonstrating higher Ktrans compared to normal IFPF tissue (0.039 min−1 versus 0.025 min−1, p = 0.017) and higher Ve (0.157 versus 0.119, p = 0.010). For PFP patients and controls no significant differences were found.

Conclusions

IPFP T2FS-hyperintense regions are associated with higher perfusion in knee OA patients in contrast to identically appearing regions in PFP patients and controls, pointing towards an inflammatory pathogenesis in OA only.

Key Points

• Morphologically identical appearing T2FS-hyperintense infrapatellar fat pad regions show different perfusion in healthy subjects, subjects with patellofemoral pain, and subjects with knee osteoarthritis.
• Elevated DCE-MRI perfusion parameters within T2FS-hyperintense infrapatellar fat pad regions in patients with osteoarthritis suggest an inflammatory pathogenesis in osteoarthritis, but not in patellofemoral pain and healthy subjects.
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Metadata
Title
Quantitative DCE-MRI demonstrates increased blood perfusion in Hoffa’s fat pad signal abnormalities in knee osteoarthritis, but not in patellofemoral pain
Authors
Bas A. de Vries
Rianne A. van der Heijden
Dirk H. J. Poot
Marienke van Middelkoop
Duncan E. Meuffels
Gabriel P. Krestin
Edwin H. G. Oei
Publication date
01-06-2020
Publisher
Springer Berlin Heidelberg
Published in
European Radiology / Issue 6/2020
Print ISSN: 0938-7994
Electronic ISSN: 1432-1084
DOI
https://doi.org/10.1007/s00330-020-06671-6

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