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Glycosaminoglycan Content of Knee Cartilage Following Posterior Cruciate Ligament Rupture Demonstrated by Delayed Gadolinium-Enhanced Magnetic Resonance Imaging of Cartilage (dGEMRIC)A Case Report
Allan A. Young, MBBS, MSpMed1; Peter Stanwell, Dip App Sc(MRT), Grad Dip MRI2; Ashley Williams, MS3; James A. Rohrsheim, MBBS1; David A. Parker, FRACS1; Bruno Giuffre, FRANZCR2; Andrew M. Ellis, FRACS1
1 Raymond Purves Research Laboratory, Institute of Bone and Joint Research (A.A.Y.) and Department of Orthopaedic and Traumatic Surgery (J.A.R., D.A.P., and A.M.E.), Royal North Shore Hospital, University of Sydney, Pacific Highway, St. Leonards N.S.W. 2065, Australia. E-mail address for A.A. Young: al_young@bigpond.com
2 Institute for Magnetic Resonance Research, Royal North Shore Hospital, University of Sydney, Level 3, Block 3, Pacific Highway, St. Leonards N.S.W. 2065, Australia
3 Department of Radiology, Beth Israel Deaconess Medical Center, 330 Brookline Avenue, Boston, MA 02215
View Disclosures and Other Information
In support of their research or preparation of this manuscript, one or more of the authors received grants or outside funding from the Australian Orthopaedic Association Research Foundation and Schering AM Australia. None of the authors received payments or other benefits or a commitment or agreement to provide such benefits from a commercial entity. No commercial entity paid or directed, or agreed to pay or direct, any benefits to any research fund, foundation, educational institution, or other charitable or nonprofit organization with which the authors are affiliated or associated.
Investigation performed at the Raymond Purves Research Laboratory, Department of Orthopaedic and Traumatic Surgery, and Institute for Magnetic Resonance Research, Royal North Shore Hospital, Sydney, Australia

The Journal of Bone and Joint Surgery, Incorporated
J Bone Joint Surg Am, 2005 Dec 01;87(12):2763-2767. doi: 10.2106/JBJS.D.02923
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Following joint trauma and during the early stages of cartilage degeneration, typical changes become apparent in tissue structure and composition, including the loss of glycosaminoglycan1,2. These changes often are not apparent on conventional magnetic resonance imaging or visible at arthroscopy, thereby precluding diagnosis. Delayed gadolinium-enhanced magnetic resonance imaging of cartilage, or dGEMRIC, is an emerging in vivo method for the assessment of the biochemical composition of articular cartilage and provides a surrogate measure of glycosaminoglycan content3,4. When injected intravenously, the anionic contrast agent gadolinium diethylene triamine penta-acetic acid (Gd-DTPA2—) penetrates cartilage both from the synovial surface and from the subchondral bone3,5. Given sufficient time, the anionic contrast agent distributes inversely to the fixed negative charge associated with the cartilage glycosaminoglycan content in accordance with the Donnan principle of equilibrium. Gd-DTPA2-therefore distributes in relatively higher concentrations in regions of low glycosaminoglycan, and vice versa. Gd-DTPA2-has a concentration-dependent effect on the magnetic resonance imaging parameter T1; therefore, T1 imaging in the presence of Gd-DTPA2— (T1Gd) reflects the cartilage Gd-DTPA2—concentration and, hence, glycosaminoglycan concentration.
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