Quantitative T2 Mapping of Articular Cartilage of the Glenohumeral Joint at 3.0T in Rotator Cuff Disease Patients: the Evaluation of Degenerative Change of Cartilage

Kyung Ryeol Lee; Su Yeon Ko; Guk Myung Choi

doi:10.13104/imri.2019.23.3.228

Journal List > Investig Magn Reson Imaging > v.23(3) > 1135552

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Lee, Ko, and Choi: Quantitative T2 Mapping of Articular Cartilage of the Glenohumeral Joint at 3.0T in Rotator Cuff Disease Patients: the Evaluation of Degenerative Change of Cartilage

Original Article

iMRI 2019;23(3):228-240.

Published online: 12 January 2019

DOI: https://doi.org/10.13104/imri.2019.23.3.228

Quantitative T2 Mapping of Articular Cartilage of the Glenohumeral Joint at 3.0T in Rotator Cuff Disease Patients: the Evaluation of Degenerative Change of Cartilage

Kyung Ryeol Lee, Su Yeon Ko, Guk Myung Choi

^¹Department of Radiology, Jeju National University Hospital, Jeju-si, Korea

Correspondence to: Kyung Ryeol Lee, M.D. Department of Radiology, Jeju National University Hospital 15 Aran 13-gil, Jeju-si, Jeju-do 63241, Korea. Tel. +82-64-717-1373 Fax. +82-64-717-1377 E-mail: we1977@naver.com

Received 13 May 2019 Revised 21 June 2019 Accepted 25 June 2019

This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/3.0) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

Abstract

Purpose

The aim of this study is to evaluate the T2 value of the articular cartilage of the glenohumeral joint in rotator cuff disease displayed on 3.0T MRI and to apply it in clinical practice.

Materials and Methods

This study involved sixty-two patients who underwent shoulder MRI containing T2 mapping. The mean T2 value was measured by placing a free hand ROI over the glenoid or humeral cartilage from the bone-cartilage interface to the articular surface on three consecutive, oblique coronal images. The drawn ROI was subsequently divided into superior and inferior segments. The assessed mean T2 values of the articular cartilage of the glenohumeral joint were compared and evaluated based on the degree of rotator cuff tear, the degree of fatty atrophy of the rotator cuff, and the acromiohumeral distance.

Results

ICC values between two readers indicated moderate or good reproducibility. The mean T2 value for the articular cartilage of the glenoid and humeral head cartilage failed to show any significant difference based on the degree of rotator cuff tear. However, the mean T2 values of articular cartilage, based on fatty atrophy, tended to be higher in fatty atrophy 3 or fatty atrophy 4 groups while some subregions displayed significantly higher mean T2 values. There was no correlation between the acromiohumeral distance and the mean T2 values of the articular cartilage of the glenoid and humeral head.

Conclusion

T2 mapping of the glenohumeral joint failed to show any significant difference in quantitative analysis of the degenerative change of the articular cartilage based on the degree of rotator cuff tear. However, it also offers quantitative information on the degenerative change of cartilage of the glenohumeral joint in patients with rotator cuff tear and severe fatty atrophy of the rotator cuff.

Keywords: Shoulder, Glenohumeral, Cartilage, Rotator cuff, T2 mapping

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Fig. 1.

T2 value measurement (a, b). Three consecutive oblique coronal sections comprising large areas of humeral and glenoid cartilage were selected from the images. (c, d) On color-coded T2 maps comparing the T2-weighted image. ROI was drawn on targeted cartilage of the glenoid and humeral head respectively. The drawn ROI was subsequently divided into superior and inferior segments.

Fig. 2.

(a) 46-year-old man with tendinopathy of rotator cuff and Goutallier grade 2. (b) The T2 map of the glenohumeral joint indicates slightly lower T2 value compared to the reported normal range. (The mean T2 value of reader 1; glenoid [41.88 ms], humeral head [41.95 ms], the mean T2 value of reader 2; glenoid [38.60 ms], humeral head [43.30 ms].)

Fig. 3.

(a, b) 76-year-old woman with full thickness tear of rotator cuff and Goutallier grade 3. (c) The T2 map of the glenohumeral joint showing higher T2 value compared to the reported normal range. The mean T2 value of glenoid according to reader 2 was similar with the reported normal range. (The mean T2 value of reader 1; glenoid [99.15 ms], humeral head [59.43 ms], the mean T2 value of reader 2; glenoid [47.57 ms], humeral head [56.40 ms])

Fig. 4.

(a, b) 72-year-old man with full thickness tear of rotator cuff and decreased acromiohumeral distance (AHD; 6.90 cm). (c) The T2 map of the glenohumeral joint indicates similar or slightly lower T2 value compared to the reported normal range. (The mean T2 value of reader 1; glenoid [45.35 ms], humeral head [48.91 ms], the mean T2 value of reader 2; glenoid [47.70 ms], humeral head [41.90 ms])

Table 1.

Intraclass Correlation Coefficient (ICC) for Interobserver Reproducibility between Reader 1 and Reader 2

	T2 mapping	P value
ICC of two readers (glenoid)	0.501 (0.175–0.698)	< 0.05
ICC of two readers (humeral hea	d) 0.721 (0.538–0.831)	< 0.05

Table 2.

The Mean T2 Values (ms) of Articular Cartilage of All Sub-regions of the Glenoid and Humeral Head According to the Degree of Rotator Cuff Tear for Reader 1 and Reader 2

			All sub-regions		F ratio	P value
			Mean	Sd	F ratio	P value
Reader 1	Glenoid	Grade 1 (n = 20)	45.82	9.80	0.526	0.594
		Grade 2 (n = 21)	44.02	13.32
		Grade 3 (n = 22)	48.38	17.50
	Humeral head	Grade 1 (n = 20)	56.32	18.05	2.217	0.118
		Grade 2 (n = 21)	47.67	6.72
		Grade 3 (n = 22)	55.27	16.17
Reader 2	Glenoid	Grade 1 (n = 20)	45.80	17.36	0.038	0.963
		Grade 2 (n = 21)	45.37	15.34
		Grade 3 (n = 22)	44.56	11.38
	Humeral head	Grade 1 (n = 20)	49.68	9.51	1.416	0.251
		Grade 2 (n = 21)	45.42	5.85
		Grade 3 (n = 22)	48.84	9.95

Table 3.

The Mean T2 Values (ms) of Articular Cartilage of All Sub-regions of the Glenoid and Humeral Head According to the Degree of Fatty Atrophy of Supraspinatus for Reader 1 and Reader 2

			All sub-regions		F ratio	P value
			Mean	Sd	F ratio	P value
Reader 1	Glenoid	Goutallier grade 1 (n = 8)	46.85	13.25
		Goutallier grade 2 (n = 48)	44.17	11.09
		Goutallier grade 3 (n = 3)	68.15	29.71	3.364	0.024
		Goutallier grade 4 (n = 4)	51.43	22.25
	Humeral head	Goutallier grade 1 (n = 8)	57.13	21.98
		Goutallier grade 2 (n = 48)	50.75	10.99	2.072	0.114
		Goutallier grade 3 (n = 3)	64.66	18.43
		Goutallier grade 4 (n = 4)	64.19	28.82
Reader 2	Glenoid	Goutallier grade 1 (n = 8)	42.30	11.28
		Goutallier grade 2 (n = 48)	45.40	15.64	0.503	0.682
		Goutallier grade 3 (n = 3)	53.92	13.25
		Goutallier grade 4 (n = 4)	42.41	5.77
	Humeral head	Goutallier grade 1 (n = 8)	47.68	7.00
		Goutallier grade 2 (n = 48)	47.46	8.25
		Goutallier grade 3 (n = 3)	60.97	15.83	2.645	0.057
		Goutallier grade 4 (n = 4)	44.98	5.51

Table 4.

The Acromiohumeral Distance and the Mean T2 Values (ms) of the Articular Cartilage of All Sub-regions of the Glenoid and Humeral Head

			Unstandardized coefficients		t	Significance	F	R²
			B	Std. error	t	Significance	F	R²
All sub-regions'	Reader 1	Glenoid	–1.384	1.433	–0.966	0.338	0.933	0.015
	Reader 1	Humeral head	0.482	1.531	0.315	0.754	0.099	0.002
	Reader 2	Glenoid	–0.339	1.512	–0.224	0.823	0.050	0.001
	Reader 2	Humeral head	0.991	0.861	1.151	0.254	1.325	0.022

*B: unstandardized beta **t: t-test statistic ***F: F value ****R²: R-squared

Table 5.

The Mean T2 Values (ms) of Articular Cartilage of Sub-regions of the Glenoid and Humeral Head According to the Degree of Rotator Cuff Tear for Reader 1 and Reader 2

			Grade 1 (n = 20)	Grade 2 (n = 21)	Grade 3 (n = 22)	F ratio	P value
Reader 1	Glenoid	AS	53.11 ± 18.75	50.11 ± 23.56	48.03 ± 17.63	0.336	0.716
		AI	38.04 ± 11.91	39.73 ± 13.82	41.17 ± 14.55	0.282	0.756
		MS	51.88 ± 18.68	43.42 ± 6.66	52.31 ± 23.59	1.651	0.200
		MI	41.90 ± 13.50	46.32 ± 34.87	41.91 ± 14.15	0.256	0.775
		PS	50.97 ± 17.17	45.13 ± 8.23	65.53 ± 61.86	1.634	0.204
		PI	39.00 ± 9.95	39.41 ± 10.35	41.35 ± 16.53	0.206	0.814
	Humeral head	AS	66.74 ± 31.01	53.61 ± 11.70	56.90 ± 14.17	2.263	0.113
		AI	48.23 ± 11.61	44.15 ± 11.59	53.76 ± 18.84	2.366	0.103
		MS	59.98 ± 16.33	51.98 ± 8.68	52.88 ± 10.76	2.616	0.081
		MI	49.72 ± 21.34	42.77 ± 10.01	61.27 ± 52.16	1.666	0.198
		PS	53.07 ± 16.29	49.76 ± 6.35	52.88 ± 16.36	0.379	0.686
		PI	60.21 ± 48.23	43.76 ± 12.11	53.95 ± 25.45	1.402	0.254
Reader 2	Glenoid	AS	46.03 ± 12.66	48.31 ± 22.92	48.95 ± 16.22	0.154	0.858
		AI	39.98 ± 10.85	37.62 ± 8.96	40.72 ± 15.71	0.371	0.692
		MS	66.51 ± 88.34	45.36 ± 17.98	48.39 ± 24.42	0.958	0.389
		MI	40.51 ± 11.82	41.34 ± 15.10	42.44 ± 20.96	0.072	0.931
		PS	41.48 ± 6.34	60.26 ± 80.46	46.93 ± 12.05	0.870	0.424
		PI	40.32 ± 13.22	39.32 ± 6.81	39.95 ± 10.17	0.049	0.952
	Humeral head	AS	57.31 ± 14.75	52.74 ± 14.97	53.01 ± 11.68	0.702	0.500
		AI	52.53 ± 17.89	42.04 ± 6.07	47.20 ± 9.69	3.844	0.027
		MS	50.85 ± 8.02	48.94 ± 8.84	49.86 ± 7.16	0.291	0.749
		MI	46.71 ± 17.29	42.26 ± 8.91	48.72 ± 16.63	1.070	0.349
		PS	46.85 ± 6.86	47.89 ± 6.78	45.79 ± 7.78	0.459	0.634
		PI	43.87 ± 16.55	38.69 ± 4.14	48.47 ± 22.88	1.864	0.164

AI = anteroinferior; AS = anterosuperior; MI = middle-inferior; MS = middle-superior; PI = posteroinferior; PS = posterosuperior

Table 6.

The Mean T2 Values (ms) of Articular Cartilage of Sub-regions of the Glenoid and Humeral Head According to the Degree of Fatty Atrophy of Supraspinatus for Reader 1 and Reader 2

			Goutallier grade 1 (n = 8)	Goutallier grade 2 (n = 48)	Goutallier grade 3 (n = 3)	Goutallier grade 4 (n = 4)	F ratio	P value
Reader 1	Glenoid	AS	48.26 ± 15.10	49.85 ± 21.21	62.53 ± 10.75	48.26 ± 15.10	0.404	0.751
		AI	36.50 ± 7.60	39.34 ± 13.67	42.33 ± 7.50	40.04 ± 15.41	0.760	0.521
		MS	56.71 ± 27.06	45.81 ± 11.48	66.70 ± 32.47	61.85 ± 37.75	2.845	0.045
		MI	42.33 ± 14.42	43.97 ± 25.43	42.93 ± 9.71	38.68 ± 5.72	0.070	0.976
		PS	57.24 ± 23.86	46.38 ± 10.32	145.87 ± 145.43	71.73 ± 61.47	9.246	0.000
		PI	40.04 ± 15.41	39.67 ± 12.55	48.53 ± 13.06	36.80 ± 7.41	0.544	0.654
	Humeral head	AS	66.11 ± 17.03	56.73 ± 21.76	83.37 ± 7.98	66.11 ± 17.03	2.084	0.112
		AI	46.43 ± 16.59	46.79 ± 10.41	56.13 ± 18.67	65.69 ± 66.22	4.540	0.006
		MS	64.53 ± 20.42	52.87 ± 9.77	68.70 ± 18.08	48.65 ± 4.24	4.039	0.011
		MI	49.31 ± 26.70	47.98 ± 19.50	43.90 ± 4.61	102.78 ± 111.56	3.696	0.017
		PS	50.71 ± 16.85	50.69 ± 10.03	59.50 ± 12.68	63.08 ± 35.67	1.366	0.262
		PI	65.69 ± 66.22	49.41 ± 21.63	76.33 ± 59.27	46.00 ± 6.70	1.223	0.309
Reader 2	Glenoid	AS	46.20 ± 14.44	46.82 ± 17.85	64.90 ± 11.50	46.20 ± 14.44	1.043	0.380
		AI	40.58 ± 14.98	38.64 ± 11.40	39.53 ± 7.53	35.54 ± 6.72	0.581	0.630
		MS	55.39 ± 30.62	52.36 ± 58.08	75.03 ± 51.25	41.45 ± 7.57	0.237	0.870
		MI	37.53 ± 8.02	42.19 ± 18.16	43.83 ± 10.98	38.73 ± 5.47	0.237	0.870
		PS	38.60 ± 6.48	51.98 ± 53.60	54.83 ± 6.90	39.83 ± 3.45	0.247	0.863
		PI	35.54 ± 6.72	40.43 ± 10.89	45.37 ± 8.17	37.48 ± 6.52	0.891	0.451
	Humeral head	AS	56.04 ± 9.65	53.61 ± 14.65	66.80 ± 11.70	56.04 ± 9.65	1.075	0.367
		AI	51.25 ± 20.03	46.15 ± 11.80	53.20 ± 5.98	38.93 ± 5.10	0.599	0.618
		MS	50.54 ± 6.54	49.47 ± 8.07	59.60 ± 7.45	46.00 ± 4.90	1.971	0.128
		MI	42.98 ± 10.84	45.72 ± 15.74	58.77 ± 14.75	44.68 ± 4.68	0.868	0.463
		PS	46.33 ± 6.11	46.86 ± 6.57	55.80 ± 10.10	40.70 ± 9.05	2.828	0.046
		PI	38.93 ± 5.10	42.94 ± 13.73	71.67 ± 53.74	42.23 ± 7.76	3.363	0.025

AI = anteroinferior; AS = anterosuperior; MI = middle-inferior; MS = middle-superior; PI = posteroinferior; PS = posterosuperior

Table 7.

The Acromiohumeral Distance and the Mean T2 Values (ms) of the Articular Cartilage of Sub-regions of the Glenoid and Humeral Head

			Unstandardized coefficients		t	Significance	F	R²
			B	Std. error	t	Significance	F	R²
AS	Reader 1	Glenoid	0.391	2.030	0.193	0.848	0.037	0.001
	Reader 1	Humeral head	0.558	2.169	0.257	0.798	0.066	0.001
	Reader 2	Glenoid	–0.171	1.821	–0.094	0.925	0.009	0.000
	Reader 2	Humeral head	0.863	1.420	0.608	0.546	0.369	0.006
AI	Reader 1	Glenoid	–0.910	1.380	–0.660	0.512	0.435	0.007
	Reader 1	Humeral head	0.721	1.540	0.468	0.641	0.219	0.004
	Reader 2	Glenoid	–0.139	1.257	–0.111	0.912	0.012	0.000
	Reader 2	Humeral head	1.820	1.106	1.646	0.105	2.711	0.043
MS	Reader 1	Glenoid	–1.659	1.864	–0.890	0.377	0.792	0.013
	Reader 1	Humeral head	1.173	1.295	0.906	0.368	0.821	0.014
	Reader 2	Glenoid	–3.897	5.449	–0.715	0.477	0.511	0.008
	Reader 2	Humeral head	0.130	0.816	0.159	0.874	0.025	0.000
MI	Reader 1	Glenoid	0.252	2.366	0.106	0.916	0.011	0.000
	Reader 1	Humeral head	–1.681	3.514	–0.478	0.634	0.229	0.004
	Reader 2	Glenoid	0.059	1.691	0.035	0.972	0.001	0.000
	Reader 2	Humeral head	0.510	1.531	0.333	0.740	0.111	0.002
PS	Reader 1	Glenoid	–6.480	3.910	–1.657	0.103	2.746	0.044
	Reader 1	Humeral head	–0.654	1.410	–0.464	0.644	0.215	0.004
	Reader 2	Glenoid	1.788	4.875	0.367	0.715	0.135	0.002
	Reader 2	Humeral head	0.879	0.716	1.229	0.224	1.510	0.025
PI	Reader 1	Glenoid	0.102	1.306	0.078	0.938	0.006	0.000
	Reader 1	Humeral head	2.776	3.297	0.842	0.403	0.709	0.012
	Reader 2	Glenoid	0.326	0.942	0.346	0.730	0.120	0.002
	Reader 2	Humeral head	1.742	1.661	1.049	0.298	1.101	0.018

*B: unstandardized beta **t: t-test statistic ***F: F value ****R²: R-squared AI = anteroinferior; AS = anterosuperior; MI = middle-inferior; MS = middle-superior; PI = posteroinferior; PS = posterosuperior

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