Jeannette wilkins award: Can locally delivered gadolinium be visualized on MRI? a pilot study infection

Morgan B. Giers, Chris S. Estes, Alex C. McLaren, Michael Caplan, Ryan McLemore

Research output: Contribution to journalArticle

6 Citations (Scopus)

Abstract

Background: Management of orthopaedic infections relies on débridement and local delivery of antimicrobials; however, the distribution and concentration of locally delivered antimicrobials in postdébridement surgical sites is unknown. Gadolinium-DTPA (Gd-DTPA) has been proposed as an imaging surrogate for antimicrobials because it is similar in size and diffusion coefficient to gentamicin. Questions/purposes: Is in vivo distribution of locally delivered Gd-DTPA (1) visible on MRI; (2) reliably visualized by different observers; (3) affected by the anatomic delivery site; and (4) affected by the in vitro release rate from the delivery vehicle? Methods: Twenty-four local delivery depots were imaged in nine rabbits using two anatomic sites (intramedullary canal, quadriceps) with Gd-DTPA in intermediate-porosity polymethylmethacrylate (PMMA) or high-porosity PMMA; six of the nine rabbits also had Gd-DTPA delivered in collagen at a third site (hamstring). A total of 45,000 fat-suppressed T1-weighted RARE scans were acquired using a 7-T Bruker Biospec MRI: nine rabbits, 2-mm slices over 10 cm, four TR values, 25 time periods (pre, every 15 minutes for 6 hours). T1 maps were constructed at every time period. Gd-DTPA distribution was observed qualitatively on the T1 maps. Interobserver reliability was determined. Results: Locally delivered Gd-DTPA was visible. Interobserver agreement was excellent. Intramuscular delivery followed intermuscular planes; intramedullary delivery was contained within the canal by bone. Distribution from collagen decreased after 1 hour but from PMMA increased over 6 hours. Conclusions: Locally delivered Gd-DTPA can be visualized on MRI; distribution is affected by anatomical location and delivery vehicle. Clinical Relevance: Contrast-based imaging using locally delivered Gd-DTPA may be useful as an antibiotic surrogate to determine antibiotic distribution in surgical sites.

Original languageEnglish (US)
Pages (from-to)2654-2662
Number of pages9
JournalClinical Orthopaedics and Related Research
Volume470
Issue number10
DOIs
StatePublished - Oct 2012

Fingerprint

Gadolinium DTPA
Gadolinium
Infection
Polymethyl Methacrylate
Porosity
Rabbits
Collagen
Anti-Bacterial Agents
Gentamicins
Orthopedics
Fats
Bone and Bones

ASJC Scopus subject areas

  • Orthopedics and Sports Medicine

Cite this

Jeannette wilkins award : Can locally delivered gadolinium be visualized on MRI? a pilot study infection. / Giers, Morgan B.; Estes, Chris S.; McLaren, Alex C.; Caplan, Michael; McLemore, Ryan.

In: Clinical Orthopaedics and Related Research, Vol. 470, No. 10, 10.2012, p. 2654-2662.

Research output: Contribution to journalArticle

Giers, Morgan B. ; Estes, Chris S. ; McLaren, Alex C. ; Caplan, Michael ; McLemore, Ryan. / Jeannette wilkins award : Can locally delivered gadolinium be visualized on MRI? a pilot study infection. In: Clinical Orthopaedics and Related Research. 2012 ; Vol. 470, No. 10. pp. 2654-2662.
@article{0123e810b8a246f6aac7350e5c4ecabd,
title = "Jeannette wilkins award: Can locally delivered gadolinium be visualized on MRI? a pilot study infection",
abstract = "Background: Management of orthopaedic infections relies on d{\'e}bridement and local delivery of antimicrobials; however, the distribution and concentration of locally delivered antimicrobials in postd{\'e}bridement surgical sites is unknown. Gadolinium-DTPA (Gd-DTPA) has been proposed as an imaging surrogate for antimicrobials because it is similar in size and diffusion coefficient to gentamicin. Questions/purposes: Is in vivo distribution of locally delivered Gd-DTPA (1) visible on MRI; (2) reliably visualized by different observers; (3) affected by the anatomic delivery site; and (4) affected by the in vitro release rate from the delivery vehicle? Methods: Twenty-four local delivery depots were imaged in nine rabbits using two anatomic sites (intramedullary canal, quadriceps) with Gd-DTPA in intermediate-porosity polymethylmethacrylate (PMMA) or high-porosity PMMA; six of the nine rabbits also had Gd-DTPA delivered in collagen at a third site (hamstring). A total of 45,000 fat-suppressed T1-weighted RARE scans were acquired using a 7-T Bruker Biospec MRI: nine rabbits, 2-mm slices over 10 cm, four TR values, 25 time periods (pre, every 15 minutes for 6 hours). T1 maps were constructed at every time period. Gd-DTPA distribution was observed qualitatively on the T1 maps. Interobserver reliability was determined. Results: Locally delivered Gd-DTPA was visible. Interobserver agreement was excellent. Intramuscular delivery followed intermuscular planes; intramedullary delivery was contained within the canal by bone. Distribution from collagen decreased after 1 hour but from PMMA increased over 6 hours. Conclusions: Locally delivered Gd-DTPA can be visualized on MRI; distribution is affected by anatomical location and delivery vehicle. Clinical Relevance: Contrast-based imaging using locally delivered Gd-DTPA may be useful as an antibiotic surrogate to determine antibiotic distribution in surgical sites.",
author = "Giers, {Morgan B.} and Estes, {Chris S.} and McLaren, {Alex C.} and Michael Caplan and Ryan McLemore",
year = "2012",
month = "10",
doi = "10.1007/s11999-012-2315-6",
language = "English (US)",
volume = "470",
pages = "2654--2662",
journal = "Clinical Orthopaedics and Related Research",
issn = "0009-921X",
publisher = "Springer New York",
number = "10",

}

TY - JOUR

T1 - Jeannette wilkins award

T2 - Can locally delivered gadolinium be visualized on MRI? a pilot study infection

AU - Giers, Morgan B.

AU - Estes, Chris S.

AU - McLaren, Alex C.

AU - Caplan, Michael

AU - McLemore, Ryan

PY - 2012/10

Y1 - 2012/10

N2 - Background: Management of orthopaedic infections relies on débridement and local delivery of antimicrobials; however, the distribution and concentration of locally delivered antimicrobials in postdébridement surgical sites is unknown. Gadolinium-DTPA (Gd-DTPA) has been proposed as an imaging surrogate for antimicrobials because it is similar in size and diffusion coefficient to gentamicin. Questions/purposes: Is in vivo distribution of locally delivered Gd-DTPA (1) visible on MRI; (2) reliably visualized by different observers; (3) affected by the anatomic delivery site; and (4) affected by the in vitro release rate from the delivery vehicle? Methods: Twenty-four local delivery depots were imaged in nine rabbits using two anatomic sites (intramedullary canal, quadriceps) with Gd-DTPA in intermediate-porosity polymethylmethacrylate (PMMA) or high-porosity PMMA; six of the nine rabbits also had Gd-DTPA delivered in collagen at a third site (hamstring). A total of 45,000 fat-suppressed T1-weighted RARE scans were acquired using a 7-T Bruker Biospec MRI: nine rabbits, 2-mm slices over 10 cm, four TR values, 25 time periods (pre, every 15 minutes for 6 hours). T1 maps were constructed at every time period. Gd-DTPA distribution was observed qualitatively on the T1 maps. Interobserver reliability was determined. Results: Locally delivered Gd-DTPA was visible. Interobserver agreement was excellent. Intramuscular delivery followed intermuscular planes; intramedullary delivery was contained within the canal by bone. Distribution from collagen decreased after 1 hour but from PMMA increased over 6 hours. Conclusions: Locally delivered Gd-DTPA can be visualized on MRI; distribution is affected by anatomical location and delivery vehicle. Clinical Relevance: Contrast-based imaging using locally delivered Gd-DTPA may be useful as an antibiotic surrogate to determine antibiotic distribution in surgical sites.

AB - Background: Management of orthopaedic infections relies on débridement and local delivery of antimicrobials; however, the distribution and concentration of locally delivered antimicrobials in postdébridement surgical sites is unknown. Gadolinium-DTPA (Gd-DTPA) has been proposed as an imaging surrogate for antimicrobials because it is similar in size and diffusion coefficient to gentamicin. Questions/purposes: Is in vivo distribution of locally delivered Gd-DTPA (1) visible on MRI; (2) reliably visualized by different observers; (3) affected by the anatomic delivery site; and (4) affected by the in vitro release rate from the delivery vehicle? Methods: Twenty-four local delivery depots were imaged in nine rabbits using two anatomic sites (intramedullary canal, quadriceps) with Gd-DTPA in intermediate-porosity polymethylmethacrylate (PMMA) or high-porosity PMMA; six of the nine rabbits also had Gd-DTPA delivered in collagen at a third site (hamstring). A total of 45,000 fat-suppressed T1-weighted RARE scans were acquired using a 7-T Bruker Biospec MRI: nine rabbits, 2-mm slices over 10 cm, four TR values, 25 time periods (pre, every 15 minutes for 6 hours). T1 maps were constructed at every time period. Gd-DTPA distribution was observed qualitatively on the T1 maps. Interobserver reliability was determined. Results: Locally delivered Gd-DTPA was visible. Interobserver agreement was excellent. Intramuscular delivery followed intermuscular planes; intramedullary delivery was contained within the canal by bone. Distribution from collagen decreased after 1 hour but from PMMA increased over 6 hours. Conclusions: Locally delivered Gd-DTPA can be visualized on MRI; distribution is affected by anatomical location and delivery vehicle. Clinical Relevance: Contrast-based imaging using locally delivered Gd-DTPA may be useful as an antibiotic surrogate to determine antibiotic distribution in surgical sites.

UR - http://www.scopus.com/inward/record.url?scp=84866366968&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=84866366968&partnerID=8YFLogxK

U2 - 10.1007/s11999-012-2315-6

DO - 10.1007/s11999-012-2315-6

M3 - Article

C2 - 22441993

AN - SCOPUS:84866366968

VL - 470

SP - 2654

EP - 2662

JO - Clinical Orthopaedics and Related Research

JF - Clinical Orthopaedics and Related Research

SN - 0009-921X

IS - 10

ER -