AG Knorpelbildgebung

Contact Details

 A. Gersing, P. JungmannDr. med. Alexandra S. Gersing

Department of Diagnostic and Interventional Radiology
Klinikum rechts der Isar
Technische Universität München
Klinikum rechts der Isar
Ismaninger Str. 22, 81675 München
phone: +49 (0) 89 4140 2621
email: alexandra.gersing (at) tum. de


Priv-Doz. Dr. med. Pia M. Jungmann
email: pia.jungmann (at) tum. de

Research Background

Osteoarthritis (OA) is the most common musculoskeletal disorder with a continuously increasing prevalence in our aging society. It is a leading cause for disability among the elderly. Apart from analgetic medication and final joint replacement, there is no treatment known so far, that targets and inhibits the progressive degenerative structural changes. This adds weight to the importance of early detection of OA prior to clinical symptoms and before irreversible damage to the joint occurs. During recent years different cartilage repair procedures have been established for surgical treatment of focal cartilage defects, which are usually found in young individuals following traumatic injuries. Cartilage repair procedures are continuously being improved for different joints. Optimization and evaluation of these procedures seems essential, since focal cartilage defects represent a main risk factor for advanced OA.

Qualitative and quantitative magnetic-resonance (MR) imaging represents an important diagnostic tool for detection and monitoring of early OA, of focal cartilage defects, as well as for monitoring of the progressive changes of hyaline articular cartilage in OA and of cartilage repair procedures.

Figure 1

Figure 1: 3T MR images of the knee and of the ankle for evaluation of cartilage. Coronal T1-weighted (w) (A) and coronal intermediate-weighted (IM-w) fat saturated (fs) (B) MR images of a patient with an osteochondral repair procedure at the lateral femoral condyle at the knee. Sagittal T1-w image with a driven equilibrium pulse (C) and a sagittal IM-w fs image (D) of the ankle with axial traction for better morphological evaluation of articular cartilage.

Non-invasive cartilage MR biomarkers such as T2, T2* or T1rho relaxation time measurements are able to detect early biochemical cartilage matrix changes, mainly increases in water content, collagen disruption and loss of proteoglycans. T2 relaxation time measurements have been shown to predict progression to morphological cartilage loss and they may have important impact on describing epidemiology of early OA and for pre- and postoperative outcome evaluation of cartilage repair procedures.

Figure 2

Figure 2: Cartilage T2 relaxation time color maps of the knee (A), ankle (B), hip (C) and shoulder joint (D) overlaid on the sagittal first-echo images of the MSME sequence. Blue color indicates low, red color high T2 values.

In collaborations with the sportsorthopaedics and orthopediaedics department at the Technical University of Munich, these techniques are used for risk factor analyses and outcome evaluation after several different surgical procedures.

Figure 3

Figure 3: Cartilage T2 relaxation time measurements in a longitudinal follow-up of a patient with cartilage repair surgery.

New quantitative cartilage imaging techniques and post-processing procedures are continuously being optimized in our ongoing research studies in collaborations with several physicists and engineers for better morphological and quantitative cartilage evaluation.

Figure 4

Figure 4: Imaging of osteochondral samples in an experimental setup. A: morphological 7T MR image (3D IM-w), B: morphological 3T MR image (2D IM-w) C: T2 mapping at 3T MRI, D: Phase Contrast Imaging.

Further, new metal artifact reducing MR sequences (MARS; slice encoding metal artifact correction (SEMAC) and view angle tilting (VAT)) are being evaluated and optimized to allow improved periprosthetic evaluation after final joint replacement.

Figure 5

Figure 5: Patient with bilateral total hip arthroplasty (Coronal T1-weighted sequences). In contrast to conventional MR image acquisition (A), with metal artifact reducing MR techniques (VAT and SEMAC, B), susceptibility artifacts are reduced significantly for improved evaluation of periprosthetic tissues.


AG Osteoporose

AG Karampinos

AG Noel

Prof. Thomas M. Link, MD (Professor of Radiology, Section Chief Musculoskeletal Radiology, Clinical Director MQIR, Department of Radiology and Biomedical Imaging, University of California San Francisco)

Prof. Franz Pfeiffer, PhD (Physics Department, Chair of Biomedical Physics (E17), Technische Universität München)

Klinik und Poliklinik für Orthopädie, Technical University of Munich

Klinik und Poliklinik für Sportorthopädie, Technical University of Munich

Open Positions

You can contact us directly, if you would like to work with us.

Selected Peer-Reviewed Publications (Pubmed)

Coverpage Arthritis Care and Research

Evaluation of Chondrocalcinosis and Associated Knee Joint Degeneration Using MR Imaging: Data from the Osteoarthritis Initiative. Gersing AS, Schwaiger BJ, Heilmeier U, Joseph GB, Facchetti L, Kretzschmar M, Lynch JA, McCulloch CE, Nevitt MC, Steinbach LS, Link TM. Eur Radiol. 2016 Oct 4. [Epub ahead of print] doi: 10.1007/s00330-016-4608-8

Magnetic Resonance Imaging Score and Classification System (AMADEUS) for Assessment of Preoperative Cartilage Defect Severity. Jungmann PM, Welsch GH, Brittberg M, Trattnig S, Braun S, Imhoff AB, Salzmann GM. Cartilage 2016. First published on August 25, 2016 as doi:10.1177/1947603516665444
Progression of cartilage degeneration and clinical symptoms in obese and overweight individuals is dependent on the amount of weight loss: 48-month data from the Osteoarthritis Initiative. Gersing AS, Solka M, Joseph GB, Schwaiger BJ, Heilmeier U, Feuerriegel G, Nevitt MC, McCulloch CE, Link TM. Osteoarthritis Cartilage. 2016 Jul;24(7):1126-34.

Can Signal Abnormalities Detected with MR Imaging in Knee Articular Cartilage Be Used to Predict Development of Morphologic Cartilage Defects? 48-Month Data from the Osteoarthritis Initiative. Schwaiger BJ, Gersing AS, Mbapte Wamba J, McCulloch CE, Nevitt M, Link TM. Radiology. 2016 Oct;281(1):158-67. doi: 10.1148/radiol.2016152308. Epub 2016 May 2.

Longitudinal Assessment of MRI in Hip Osteoarthritis Using SHOMRI and Correlation with Clinical Progression. Schwaiger BJ, Gersing AS, Lee S, Nardo L, Samaan M, Souza RB, Link TM, Majumdar S. Seminars in Arthritis Rheum. 2016 Jun;45(6):648-55. doi: 10.1016/j.semarthrit.2016.04.001. Epub 2016 Apr 8.

Imaging of Osteoarthritis in Geriatric Patients. Gersing AS, Link TM. Curr Radiol Rep. 2016 Jan;4(1). pii: 4. Epub 2016 Jan 2.
Bilateral cartilage T2 mapping 9 years after Mega-OATS implantation at the knee: a quantitative 3T MRI study. Jungmann PM, Brucker PU, Baum T, Link TM, Foerschner F, Minzlaff P, Banke IJ, Saier T, Imhoff AB, Rummeny EJ, Bauer JS. Osteoarthritis Cartilage. 2015 Dec;23(12):2119-28.
3.0T MR imaging of the ankle: Axial traction for morphological cartilage evaluation, quantitative T2 mapping and cartilage diffusion imaging-A preliminary study. Jungmann PM, Baum T, Schaeffeler C, Sauerschnig M, Brucker PU, Mann A, Ganter C, Bieri O, Rummeny EJ, Woertler K, Bauer JS. Eur J Radiol. 2015 Aug;84(8):1546-54
View-Angle Tilting and Slice-Encoding Metal Artifact Correction for Artifact Reduction in MRI: Experimental Sequence Optimization for Orthopaedic Tumor Endoprostheses and Clinical Application. Jungmann PM, Ganter C, Schaeffeler CJ, Bauer JS, Baum T, Meier R, Nittka M, Pohlig F, Rechl H, von Eisenhart-Rothe R, Rummeny EJ, Woertler K. PLoS One. 2015 Apr 24;10(4):e0124922.
Relationship of unilateral total hip arthroplasty (THA) to contralateral and ipsilateral knee joint degeneration - a longitudinal 3T MRI study from the Osteoarthritis Initiative (OAI). Jungmann PM, Nevitt MC, Baum T, Liebl H, Nardo L, Liu F, Lane NE, McCulloch CE, Link TM. Osteoarthritis Cartilage. 2015 Jul;23(7):1144-53.
Cartilage repair surgery: outcome evaluation by using noninvasive cartilage biomarkers based on quantitative MRI techniques? Jungmann PM, Baum T, Bauer JS, Karampinos DC, Erdle B, Link TM, Li X, Trattnig S, Rummeny EJ, Woertler K, Welsch GH. Biomed Res Int. 2014;2014:840170. Review.
What has imaging contributed to the epidemiological understanding of osteoarthritis? Jungmann PM, Liu F, Link TM. Skeletal Radiol. 2014 Mar;43(3):271-5. Review.

Early T2 changes predict onset of radiographic knee osteoarthritis: data from the osteoarthritis initiative. Liebl H, Joseph G, Nevitt MC, Singh N, Heilmeier U, Karupppasamy S, Jungmann PM, McCulloch CE, Lynch JA, Lane NE, Link TM. Ann Rheum Dis. 2014 Mar 10. doi: 10.1136/annrheumdis-2013-204157. [Epub ahead of print]. PMID: 24615539

Alignment does not influence cartilage T2 in asymptomatic knee joints. Sauerschnig M, Bauer JS, Kohn L, Hinterwimmer S, Landwehr S, Woertler K, Jungmann PM, Koestler W, Niemeyer P, Imhoff AB, Salzmann GM. Knee Surg Sports Traumatol Arthrosc. 2013 Nov 29. [Epub ahead of print]. PMID: 24292942

T(2) relaxation time measurements are limited in monitoring progression, once advanced cartilage defects at the knee occur: longitudinal data from the osteoarthritis initiative. Jungmann PM, Kraus MS, Nardo L, Liebl H, Alizai H, Joseph GB, Liu F, Lynch J, McCulloch CE, Nevitt MC, Link TM. J Magn Reson Imaging. 2013 Dec;38(6):1415-24. doi: 10.1002/jmri.24137. Epub 2013 Sep 13. PMID: 24038491

Association of metabolic risk factors with cartilage degradation assessed by T2 relaxation time at the knee: data from the osteoarthritis initiative. Jungmann PM, Kraus MS, Alizai H, Nardo L, Baum T, Nevitt MC, McCulloch CE, Joseph GB, Lynch JA, Link TM. Arthritis Care Res (Hoboken). 2013 Dec;65(12):1942-50. doi: 10.1002/acr.22093. PMID: 23926027

Cartilage and meniscal T2 relaxation time as non-invasive biomarker for knee osteoarthritis and cartilage repair procedures. Baum T, Joseph GB, Karampinos DC, Jungmann PM, Link TM, Bauer JS. Osteoarthritis Cartilage. 2013 Oct;21(10):1474-84. doi: 10.1016/j.joca.2013.07.012. Epub 2013 Jul 27. Review. PMID: 23896316.

Association of trochlear dysplasia with degenerative abnormalities in the knee: data from the Osteoarthritis Initiative. Jungmann PM, Tham SC, Liebl H, Nevitt MC, McCulloch CE, Lynch J, Link TM. Skeletal Radiol. 2013 Oct;42(10):1383-92. doi: 10.1007/s00256-013-1664-x. Epub 2013 Jun 26. PMID: 23801099

Correlation of magnetic resonance imaging-based knee cartilage T2 measurements and focal knee lesions with body mass index: thirty-six-month followup data from a longitudinal, observational multicenter study. Baum T, Joseph GB, Nardo L, Virayavanich W, Arulanandan A, Alizai H, Carballido-Gamio J, Nevitt MC, Lynch J, McCulloch CE, Link TM. Arthritis Care Res (Hoboken). 2013 Jan;65(1):23-33. doi: 10.1002/acr.21741. PMID: 22623435

Baseline mean and heterogeneity of MR cartilage T2 are associated with morphologic degeneration of cartilage, meniscus, and bone marrow over 3 years--data from the Osteoarthritis Initiative. Joseph GB, Baum T, Alizai H, Carballido-Gamio J, Nardo L, Virayavanich W, Lynch JA, Nevitt MC, McCulloch CE, Majumdar S, Link TM. Osteoarthritis Cartilage. 2012 Jul;20(7):727-35. doi: 10.1016/j.joca.2012.04.003. Epub 2012 Apr 11.
PMID: 22503812

Effects of unloading on knee articular cartilage T1rho and T2 magnetic resonance imaging relaxation times: a case series. Souza RB, Baum T, Wu S, Feeley BT, Kadel N, Li X, Link TM, Majumdar S. J Orthop Sports Phys Ther. 2012 Jun;42(6):511-20. doi: 10.2519/jospt.2012.3975. Epub 2012 Mar 8. PMID: 22402583

Association of magnetic resonance imaging-based knee cartilage T2 measurements and focal knee lesions with knee pain: data from the Osteoarthritis Initiative. Baum T, Joseph GB, Arulanandan A, Nardo L, Virayavanich W, Carballido-Gamio J, Nevitt MC, Lynch J, McCulloch CE, Link TM. Arthritis Care Res (Hoboken). 2012 Feb;64(2):248-55. doi: 10.1002/acr.20672. PMID: 22012846

Changes in knee cartilage T2 values over 24 months in subjects with and without risk factors for knee osteoarthritis and their association with focal knee lesions at baseline: data from the osteoarthritis initiative. Baum T, Stehling C, Joseph GB, Carballido-Gamio J, Schwaiger BJ, Müller-Höcker C, Nevitt MC, Lynch J, McCulloch CE, Link TM. J Magn Reson Imaging. 2012 Feb;35(2):370-8. doi: 10.1002/jmri.22834. Epub 2011 Oct 10. PMID: 21987496

Texture analysis of cartilage T2 maps: individuals with risk factors for OA have higher and more heterogeneous knee cartilage MR T2 compared to normal controls--data from the osteoarthritis initiative. Joseph GB, Baum T, Carballido-Gamio J, Nardo L, Virayavanich W, Alizai H, Lynch JA, McCulloch CE, Majumdar S, Link TM. Arthritis Res Ther. 2011;13(5):R153. doi: 10.1186/ar3469. Epub 2011 Sep 20. PMID: 21933394

Physical activity is associated with magnetic resonance imaging-based knee cartilage T2 measurements in asymptomatic subjects with and those without osteoarthritis risk factors. Hovis KK, Stehling C, Souza RB, Haughom BD, Baum T, Nevitt M, McCulloch C, Lynch JA, Link TM. Arthritis Rheum. 2011 Aug;63(8):2248-56. doi: 10.1002/art.30419. PMID: 21538328

A novel fast knee cartilage segmentation technique for T2 measurements at MR imaging--data from the Osteoarthritis Initiative. Stehling C, Baum T, Mueller-Hoecker C, Liebl H, Carballido-Gamio J, Joseph GB, Majumdar S, Link TM. Osteoarthritis Cartilage. 2011 Aug;19(8):984-9. doi: 10.1016/j.joca.2011.04.002. Epub 2011 Apr 12. PMID:21515391

Articular cartilage in the knee: current MR imaging techniques and applications in clinical practice and research. Crema MD, Roemer FW, Marra MD, Burstein D, Gold GE, Eckstein F, Baum T, Mosher TJ, Carrino JA, Guermazi A. Radiographics. 2011 Jan-Feb;31(1):37-61. doi: 10.1148/rg.311105084. Review. PMID: 21257932

Meniscal T1rho and T2 measured with 3.0T MRI increases directly after running a marathon. Stehling C, Luke A, Stahl R, Baum T, Joseph G, Pan J, Link TM. Skeletal Radiol. 2011 Jun;40(6):725-35. doi: 10.1007/s00256-010-1058-2. Epub 2010 Oct 30. PMID: 21052658

T2 assessment and clinical outcome following autologous matrix-assisted chondrocyte and osteochondral autograft transplantation. Salzmann GM, Paul J, Bauer JS, Woertler K, Sauerschnig M, Landwehr S, Imhoff AB, Schöttle PB. Osteoarthritis Cartilage. 2009 Dec;17(12):1576-82. doi: 10.1016/j.joca.2009.07.010. Epub 2009 Sep 1. PMID: 19737529

Magnetic resonance imaging of the ankle at 3.0 Tesla and 1.5 Tesla in human cadaver specimens with artificially created lesions of cartilage and ligaments. Bauer JS, Barr C, Henning TD, Malfair D, Ma CB, Steinbach L, Link TM. Invest Radiol. 2008 Sep;43(9):604-11. doi: 10.1097/RLI.0b013e31817e9ada. PMID: 18708853

Fast high-spatial-resolution MRI of the ankle with parallel imaging using GRAPPA at 3 T. Bauer JS, Banerjee S, Henning TD, Krug R, Majumdar S, Link TM. AJR Am J Roentgenol. 2007 Jul;189(1):240-5. PMID: 17579177
MR imaging of the ankle at 3 Tesla and 1.5 Tesla: protocol optimization and application to cartilage, ligament and tendon pathology in cadaver specimens. Barr C, Bauer JS, Malfair D, Ma B, Henning TD, Steinbach L, Link TM. Eur Radiol. 2007 Jun;17(6):1518-28. Epub 2006 Oct 24. PMID: 17061070

Quadriceps intramuscular fat fraction rather than muscle size is associated with knee osteoarthritis. Kumar D, Karampinos DC, MacLeod TD, Lin W, Nardo L, Li X, Link TM, Majumdar S, Souza RB. Osteoarthritis Cartilage. 2014 Feb;22(2):226-34. doi: 10.1016/j.joca.2013.12.005. Epub 2013 Dec 20. PMID: 24361743

Quadriceps and hamstrings morphology is related to walking mechanics and knee cartilage MRI relaxation times in young adults. Kumar D, Subburaj K, Lin W, Karampinos DC, McCulloch CE, Li X, Link TM, Souza RB, Majumdar S. J Orthop Sports Phys Ther. 2013 Dec;43(12):881-90. doi: 10.2519/jospt.2013.4486. Epub 2013 Oct 30. PMID: 24175607