Quantifying knee cartilage development trajectories in children aged 6-12 years via diffusion tensor imaging

This study aims to establish normative diffusion tensor imaging (DTI) biomarkers of pediatric knee cartilage development trajectories and sex-specific differences by quantifying microstructural changes in children aged 6-12 years.

Eighty-four healthy children (43 boys and 41 girls; mean age 9.01 ± 1.84 years) underwent 3.0T MRI of the left knee, including DTI sequences (b-values: 0 and 600 s/mm²). Regions of interest included the growth plate, patellar, medial condylar, and lateral condylar cartilage. Fractional anisotropy (FA) (collagen integrity) and apparent diffusion coefficient (ADC) (proteoglycan/water content) were measured. Bone age was assessed via left-hand radiography according to the Chinese Wrist Bone Development Standard. The signal-to-noise ratio (SNR) of the DTI images was measured. Statistical analyses included Spearman correlation coefficients to assess age/bone age associations, intraclass correlation coefficients (ICCs) to evaluate reproducibility, and t-tests to compare sex/age group differences.

FA values increased significantly with age and bone age (p < 0.001), showing stronger correlations with bone age (boys: r = 0.843; girls: r = 0.789) than with chronological age. Girls exhibited higher FA values than boys across all age groups (p < 0.05), particularly within the growth plate cartilage. ADC values in the growth plate decreased with increasing bone age (girls: r = -0.702; boys: r = -0.511; p < 0.001), with a steeper decline observed in girls. No significant correlations between ADC and age were found in other regions. SNR correlated positively with age and bone age, with ICC confirming excellent reproducibility (FA/ADC ICC > 0.94).

DTI biomarkers (FA/ADC) sensitively reflect pediatric knee cartilage maturation, correlate best with bone age, and enhance quantitative monitoring of cartilage development and pathology in children.