Comparison of conventional and delayed gadolinium-enhanced MRI in assessing cartilage quality and predicting joint degenerative progression in elderly patients with osteoarthritis

The comparison of magnetic resonance imaging (MRI) and delayed gadolinium-enhanced MRI of cartilage (dGEMRIC) in assessing cartilage quality and predicting joint degeneration progression holds significant clinical relevance. The objective of this study is to observe the effects of standard MRI and dGEMRIC in assessing cartilage quality and predicting joint degeneration progression in elderly osteoarthritis (OA) patients. This prospective cohort study enrolled 250 elderly OA patients (January 2021 to September 2023) who underwent standard MRI and dGEMRIC to measure relaxation time (T2), longitudinal relaxation rate (ΔR1), and glycosaminoglycan (GAG) content. Patients were followed for 2 years to monitor joint degeneration progression, and ROC curve analysis was performed to assess predictive accuracy. Kappa statistics evaluated diagnostic agreement. Of the 250 patients, 76 (30.4 %) experienced joint degeneration progression (progression group), while 174 (69.6 %) did not (non-progression group). The progression group exhibited higher T2 and GAG values (P < 0.05) but lower ΔR1 values (P < 0.05) compared to the non-progression group. Standard MRI T2 and GAG correlated positively (r = 0.310,0.145; P < 0.05), whereas ΔR1 correlated negatively (r = −0.138; P < 0.05) with progression. dGEMRIC T2 and GAG correlated more strongly (r = 0.651,0.555; P < 0.05), with ΔR1 showing a stronger negative correlation (r = −0.222; P < 0.05). Both standard MRI and dGEMRIC assessments had predictive value for joint degeneration progression in elderly OA patients, with dGEMRlC showing higher predictive value. The stronger correlations with dGEMRIC suggest its utility in detecting early cartilage changes not visible on standard MRI. This is clinically significant, as early detection delaying disease progression and improving outcomes. These findings underscore dGEMRIC's role in guiding clinical decisions, especially in early OA when interventions are most effective.