LONGITUDINAL STUDY ON CARTILAGE T2 AND THICKNESS CHANGE AFTER ACL INJURY – THE DOUBLE BENEFIT OF QDESS MRI
Published on March 10, 2026 by Chondrometrics-admin
Cartilage composition, or cartilage morphology; cartilage relaxometry or morphometry? What is the “better” endpoint, or do we need both? And if we do, isn’t acquisition and segmentation of two sets of MRI sequences in a study or trial not simply prohibitive, too time consuming, and too expensive for the funder?
The current work by Simor Herger et al. published in Osteoarthritis and Cartilage Open
→ https://pubmed.ncbi.nlm.nih.gov/41767838/
uses a novel quantitative double echo steady state (qDESS) sequence “to kill two birds with one stone”, i.e. to cover both tasks with just one acquisition and one set of segmentation.
His work stands on two (previously published) stable shoulders:
1) Herger et al. previously published the baseline analysis of cartilage T2 and thickness in the same cohort, about 2-10 years after ACL injury, using manual segmentation and analysis by Chondrometrics, in the journal of Osteoarthritis and Cartilage:
https://pubmed.ncbi.nlm.nih.gov/38950877/
They found that the T2 of the deep zone in the lateral compartment was longer in the ACL-injured than in the contralateral uninjured knees, and than in healthy control knees. Differences in cartilage thickness, in contrast, were only subtle. The authors resumed that the longitudinal change in deep zone T2 precedes morphological cartilage loss, and that measuring laminar T2 after ACL injury is useful in diagnosing and monitoring early cartilage change.
2) These results were confirmed by his colleague Wolfgang Wirth, and were published in MAGMA:
https://pubmed.ncbi.nlm.nih.gov/39992574/
Using a fully automated AI-based segmentation and analysis technique for qDESS they again observed a significantly longer T2 in the deep layer of the ACL-injured knees than in contralateral and healthy control knees, and with similar effect sizes for automated vs. manual segmentations. Again, no significant differences were observed in superficial T2 or cartilage thickness. Use of automated technology permits scaling of these analysis to larger cohorts, with the current analysis representing an important step in the clinical validation.
The current paper in Osteoarthr Cartil Open by Herger et al. now describes the longitudinal analysis of the two-year change in knee cartilage T2 and thickness and is the first longitudinal analysis using qDESS: https://pubmed.ncbi.nlm.nih.gov/41767838/
Cartilage thickness decreased in at least 50 % of the subregions whereas significant T2 changes were rare. Cartilage thinning was strongest in the lateral tibia, with location independent measures of cartilage thickness change (cartilage thinning score) yielding the strongest longitudinal differences between ACL vs. contralateral uninjured or healthy knees.
Key Points:
- qDESS can be used to applycartilage morphometry and relaxometry to the same MR images.
- Structural and compositional cartilage properties can be extracted simultaneously from the same segmentation.
- The location-independent framework and analysis technology separates observed change from its spatial location. It thus increases the sensitivity to localized changes and supports a reliable longitudinal comparison across participant groups.
- The data show distinct structural and compositional trajectories of femorotibial cartilage in ACL-injured knees over 24 months, with significant changes detected in cartilage thickness
- The findings underline the importance of integrating morphometry and relaxation metrics when studying early cartilage pathology.
Many thanks to Simon Herger, Wolfgang Wirth, Corina Nüesch, Oliver Bieri, Christian Egloff, and Annegret Mündermann for the continued, highly productive cooperation — and to all study participants who made this research possible.
4 Comments
Felix Eckstein
•Thanks for the great collaboration to the group in Basel. I really like this set of articles, because:
– In a clinical study setting, qDESS detects differences in cartilage T2 (cross-sectionally) in early OA (ACL deficiency), both with manual and automated (AI-based) segmentation
– Longitudinally, it detects early changes in cartilage thickness, provided a location-independent analysis method is used that looks at the entire joint
– Hence, with only a 10min 3D acquisitions (qDESS), we can assess cartilage composition & morphology from a single scan with a single set of segmentations, manual or AI-based
– Hopefully the vendors will soon make this sequence publicly available rather than keeping it as a research sequence only
Neal Bangerter
•Really interesting, and great to see further use and validation of the qDESS sequence! This kind of validation work is so important, and very much needed and appreciated by those of us working on the musculoskeletal imaging sequence development side.
Simon Herger
•The MechSens project has been a highly collaborative effort, and I am thrilled with the progress we’ve made so far. The partnership with Wolfgang Wirth and Felix Eckstein, whose technical and clinical expertise in qMRI has been invaluable, has been key to the success of this initiative. Their dedication to research and willingness to invest time into publishing our findings in an academic context has been absolutely crucial.
From the perspective of the MechSens project, the first study’s results have shown that participants with ACL injuries exhibit early signs of compositional changes in the injured knee, despite not reporting joint pain yet. The analysis comparing ACL-injured knees with the contralateral uninjured and healthy control knees has allowed us to better differentiate between normal healthy variability and trauma-induced changes in thickness and T2 values.
Our third study on longitudinal changes further highlighted the variability in our cohort. Interestingly, the ordered value approach revealed the greatest location-independent changes in thickness, while location-dependent changes were smaller in magnitude.
I want to thank everyone involved in this collaboration and look forward to our continued work together on future projects.
Felix Eckstein
•Dear Simon, thanks for your very kind and moving words. It has been a true pleasure both on a professional and on a personal side. And I feel this is how research (should) work(s), and this is why I enjoy so much to being in this area. All the best for starting at the new working location, and for all the happy personal changes 🙂
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