DGEMRIC as a tool for measuring changes in cartilage quality following high tibial osteotomy: a feasibility study M. Rutgers, L.W. Bartels, A.I. Tsuchida,

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dGEMRIC as a tool for measuring changes in cartilage quality following high tibial osteotomy: a feasibility study M. Rutgers, L.W. Bartels, A.I. Tsuchida, R.M. Castelein, W.J. Dhert, K.L. Vincken, R.J. van Heerwaarden, D.B.F. Saris Osteoarthritis and Cartilage Volume 20, Issue 10, Pages 1134-1141 (October 2012) DOI: 10.1016/j.joca.2012.07.001 Copyright © 2012 Osteoarthritis Research Society International Terms and Conditions

Fig. 1 Influence of HTO hardware artefacts on dGEMRIC scan result. Left: dGEMRIC scan of a HTO patient with hardware in situ. Gross artefacts are seen influencing T1Gd measurements. Right: dGEMRIC scan in a HTO patient, in which hardware was removed prior to MRI. The right image is representative of all HTO patients, in whom hardware was removed. Osteoarthritis and Cartilage 2012 20, 1134-1141DOI: (10.1016/j.joca.2012.07.001) Copyright © 2012 Osteoarthritis Research Society International Terms and Conditions

Fig. 2 3D ROI's were generated of various sections of the knee and used for T1Gd comparison before and after HTO. (A): Designation of the cartilaginous area on a sagittal slice of the LFC and tibial plateau. Depending on the width of the knee, four or five adjacent sagittal slices were used to create the separate 3D ROI's: the MFC, the LFC, the MTP and the LTP. (B): T1-mapping was performed in each ROI. This section demonstrates T1Gd distribution throughout a sagittal slice, used for creation of the LFC and LTP ROI. Using these sagittal slices, a mean T1Gd could be calculated for each ROI. (C): A sagittal slice, used for creation of the LFC ROI is demonstrated. The MFC and LFC ROI's were divided into three different sub-ROI's, using the anterior and posterior meniscal border as anatomical landmark: Anterior (A), Middle load bearing (M) and Posterior (P) femoral cartilage. Osteoarthritis and Cartilage 2012 20, 1134-1141DOI: (10.1016/j.joca.2012.07.001) Copyright © 2012 Osteoarthritis Research Society International Terms and Conditions

Fig. 3 (a) Mean T1Gd values of all compartments combined, before and after HTO in 10 patients (before vs after, P = 0.11). Bars represent means ± 95% CI. (b) Mean T1Gd values of the ROI's before and after HTO in 10 patients. The decrease in T1Gd was higher in tibial (15% decrease in MTP T1Gd, 16% decrease in LTP T1Gd) than in femoral cartilage (5% decrease in MFC T1Gd, 3% decrease in LFC T1Gd), although the differences were not significant within the separate ROI's. Before and after HTO, medial femoral cartilage had a lower T1Gd than lateral femoral cartilage (before HTO P = 0.007; after HTO P = 0.015). Tibial cartilage had a consistent higher T1Gd than femoral cartilage in the medial as well as lateral compartment (P < 0.001). Bars represent means ± 95% CI. Osteoarthritis and Cartilage 2012 20, 1134-1141DOI: (10.1016/j.joca.2012.07.001) Copyright © 2012 Osteoarthritis Research Society International Terms and Conditions