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      T2 mapping of the acetabular cartilage in infants and children with developmental dysplasia of the hip

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          Abstract

          Background

          T2 mapping is useful for evaluating the cartilage matrix.

          Purpose

          To determine the variations in the acetabular cartilage T2 relaxation values between healthy individuals and those with developmental dysplasia of the hip (DDH).

          Material and Methods

          Thirty-three patients with unilateral DDH underwent 3-T magnetic resonance imaging (MRI) between January 2018 and February 2019. Fifteen volunteers (30 hips) were enrolled as controls. T2 values were measured with the T2 mapping sequence in all layers and were equally divided into three layers (deep, middle, and superficial) with equal thickness. We calculated the mean T2 relaxation values for the full thickness, deep, middle, and superficial layers and compared the values between the different groups. In addition, the inter- and intra-observer agreements were calculated.

          Results

          The T2 relaxation values in the DDH arm were significantly lower in the middle, superficial, and full thickness layers compared with those of the volunteers and contralateral hips. The T2 relaxation values of the deep layers showed no significant difference between the different groups. The acetabular cartilage T2 relaxation values increased from the deep layer to the superficial layer in the control and contralateral groups. Both inter- and intra-observer agreements were good.

          Conclusion

          MRI T2 mapping may help to diagnose developmental disorders of the acetabular cartilage matrix in infants and children with DDH. Abnormal acetabular cartilage T2 relaxation values may be due to the extraordinary stress load of the femoral head.

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          Most cited references28

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          Morphology of the acetabulum in congenital dislocation of the hip. Gross, histological and roentgenographic studies.

          At autopsy, the hips of six infants who died soon after birth and had unilateral congenital hip dysplasia were found to have a cartilaginous ridge in the acetabulum which separated the hip socket into two sections. In two of the hips with a moderate degree of dysplasia and in one completely dislocated hip the ridge was formed exclusively by a bulge of acetabular cartilage. In three completely dislocated hips the ridge was formed by a bulge of acetabular cartilage covered by the inverted labrum. The acetabular cartilage showed signs of degeneration whereas the triradiate cartilage was normal. Examination of many newborn infants indicated that hip "clicks" are common and are not diagnostic of hip dysplasia. This diagnosis should be made only when the femoral head slides with a jolt over the acetabular ridge, causing a true positive Ortolani sign. Scattered ossification centers in the acetabular cartilage were seen on the roentgenograms of nearly half of fifty-nine hips with congenital dislocation reduced after the child was two years old, but less frequently in hips reduced at an earlier age.
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            Growth and development of the acetabulum in the normal child. Anatomical, histological, and roentgenographic studies.

            I PONSETI (1978)
            Postmortem studies of ten normal full-term infants and of three children, seven, nine, and fourteen years old, showed that the acetabular cartilage complex is a unit that is triradiate medially and cup-shaped laterally and is interposed between the ilium, ischium, and pubis. This complex is composed of epiphyseal growth-plate cartilage adjacent to these bones, of articular cartilage adjacent to these bones, of articular cartilage around the acetabular cavity, and, for the most part, of hyaline carilage. Interstitial growth within the triradiate part of the cartilage complex causes the hip socket to expand during growth. The concavity of the acetabulum develops in response to the presence of the spherical femoral head. The depth of the acetabulum increased during development as the result of interstitial growth in the acetabular cartilage, of appositional growth at the periphery of this cartilage, and of periosteal new-bone formation at the acetabular margin. At puberty, three secondary centers of ossification appear in the hyaline cartilage surrounding the acetabular cavity. These centers are homologous with other epiphyses in the skeleton. The os acetabuli, which is the epiphysis of the os pubis, forms the anterior wall of the acetabulum. The epiphysis of the ilium, which has been called the acetabular epiphysis, forms a good part of the superior wall of the acetabulum. A small epiphysis of the ischium was seen in the oldest patient, who was fourteen years old. The bone in these epiphyses expands toward the periphery of the acetabulum and thus contributes to its increase in depth.
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              Changes in spatial collagen content and collagen network architecture in porcine articular cartilage during growth and maturation.

              The present study was designed to reveal changes in the collagen network architecture and collagen content in cartilage during growth and maturation of pigs. Femoral groove articular cartilage specimens were collected from 4-, 11- and 21-month-old domestic pigs (n=12 in each group). The animal care conditions were kept constant throughout the study. Polarized light microscopy was used to determine the collagen fibril network birefringence, fibril orientation and parallelism. Infrared spectroscopy was used to monitor changes in the spatial collagen content in cartilage tissue. During growth, gradual alterations were recorded in the collagen network properties. At 4 months of age, a major part of the collagen fibrils was oriented parallel to the cartilage surface throughout the tissue. However, the fibril orientation changed considerably as skeletal maturation progressed. At 21 months of age, the fibrils of the deep zone cartilage ran predominantly at right angles to the cartilage surface. The collagen content increased and its depthwise distribution changed during growth and maturation. A significant increase of the collagen network birefringence was observed in the deep tissue at the age of 21 months. The present study revealed dynamic changes of the collagen network during growth and maturation of the pigs. The structure of the collagen network of young pigs gradually approached a network with the classical Benninghoff architecture. The probable explanation for the alterations is growth of the bone epiphysis with simultaneous adaptation of the cartilage to increased joint loading. The maturation of articular cartilage advances gradually with age and offers, in principle, the possibility to influence the quality of the tissue, especially by habitual joint loading. These observations in porcine cartilage may be of significance with respect to the maturation of human articular cartilage.
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                Author and article information

                Contributors
                Journal
                Acta Radiologica
                Acta Radiol
                SAGE Publications
                0284-1851
                1600-0455
                October 2021
                October 27 2020
                October 2021
                : 62
                : 10
                : 1418-1425
                Affiliations
                [1 ]Department of Radiology, Shengjing Hospital of China Medical University, Shenyang, Liaoning Province, PR China
                [2 ]Philips Healthcare, Shenyang, Liaoning Province, PR China
                [3 ]Department of Pediatric Orthopaedics, Shengjing Hospital of China Medical University, Shenyang, Liaoning Province, PR China
                Article
                10.1177/0284185120966684
                5f7cdd0b-46c4-4cdb-b6ad-0e3b0437ba7e
                © 2021

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