Change in regional cartilage morphology and joint space width in osteoarthritis participants versus healthy controls: a multicentre study using 3.0 Tesla MRI and Lyon–Schuss radiography

Objective:

Cartilage morphology displays sensitivity to change in osteoarthritis (OA) with quantitative MRI (qMRI). However, (sub)regional cartilage thickness change at 3.0 Tesla (T) has not been directly compared with radiographic progression of joint space narrowing in OA participants and non-arthritic controls.

Methods:

A total of 145 women were imaged at 7 clinical centres: 86 were non-obese and asymptomatic without radiographic OA and 55 were obese with symptomatic and radiographic OA (27 Kellgren–Lawrence grade (KLG)2 and 28 KLG3). Lyon–Schuss (LS) and fixed flexion (FF) radiographs were obtained at baseline, 12 and 24 months, and coronal spoiled gradient echo MRI sequences at 3.0 T at baseline, 6, 12 and 24 months. (Sub)regional, femorotibial cartilage thickness and minimum joint space width (mJSW) in the medial femorotibial compartment were measured and the standardised response means (SRMs) determined.

Results:

At 6 months, qMRI demonstrated a −3.7% “annualised” change in cartilage thickness (SRM −0.33) in the central medial femorotibial compartment (cMFTC) of KLG3 subjects, but no change in KLG2 subjects. The SRM for mJSW in 12-month LS/FF radiographs of KLG3 participants was −0.68/−0.13 and at 24 months was −0.62/−0.20. The SRM for cMFTC changes measured with qMRI was −0.32 (12 months; −2.0%) and −0.48 (24 months; −2.2%), respectively.

Conclusions:

qMRI and LS radiography detected significant change in KLG3 participants at high risk of progression, but not in KLG2 participants, and only small changes in controls. At 12 and 24 months, LS displayed greater, and FF less, sensitivity to change in KLG3 participants than qMRI.

One year change of knee cartilage morphology in the first release of participants from the Osteoarthritis Initiative progression subcohort: association with sex, body mass index, symptoms and radiographic osteoarthritis status

OBJECTIVE

The Osteoarthritis Initiative (OAI) is a multicentre study targeted at identifying biomarkers for evaluating the progression and risk factors of symptomatic knee OA. Here cartilage loss using 3 Tesla (3 T) MRI is analysed over 1 year in a subset of the OAI, together with its association with various risk factors.

METHODS

An age- and gender-stratified subsample of the OAI progression subcohort (79 women and 77 men, mean (SD) age 60.9 (9.9) years, body mass index (BMI) 30.3 (4.7)) with both frequent symptoms and radiographic OA in at least one knee was studied. Coronal FLASHwe (fast low angle shot with water excitation) MRIs of the right knee were acquired at 3 T. Seven readers segmented tibial and femoral cartilages blinded to order of acquisition. Segmentations were quality controlled by one expert.

RESULTS

The reduction in mean cartilage thickness (ThC) was greater (p = 0.004) in the medial than in the lateral compartment, greater (p = 0.001) in the medial femur (-1.9%) than in the medial tibia (-0.5%) and greater (p = 0.011) in the lateral tibia (-0.7%) than in the lateral femur (0.1%). Multifactorial analysis of variance did not reveal significant differences in the rate of change in ThC by sex, BMI, symptoms and radiographic knee OA status. Knees with Kellgren-Lawrence grade 2 or 3 and with a BMI >30 tended to display greater changes.

CONCLUSIONS

In this sample of the OAI progression subcohort, the greatest, but overall very modest, rate of cartilage loss was observed in the weight-bearing medial femoral condyle. Knees with radiographic OA in obese participants showed trends towards higher rates of change than those of other participants, but these trends did not reach statistical significance.

Double echo steady state magnetic resonance imaging of knee articular cartilage at 3 Tesla: a pilot study for the Osteoarthritis Initiative

BACKGROUND

Quantitative magnetic resonance imaging (qMRI) may provide valuable measures of cartilage morphology in osteoarthritis (OA) but has been confined to sequences with relatively long acquisition times at 1.5 Tesla (T).

OBJECTIVE

To test the accuracy and precision of knee cartilage qMRI with a fast double echo, steady state (DESS) sequence with water excitation (we) at 3 T.

METHODS

As a pilot study for the Osteoarthritis Initiative, test-retest MR images were acquired in the knees of 19 participants with no OA to moderate degrees of clinical OA. Two double oblique coronal fast low angle shot (FLASHwe) sequences (1.5 mm slice thickness) were acquired at 3 T, and two sagittal DESSwe sequences (0.7 mm slice thickness). Double oblique coronal multiplanar reformats (MPR) were performed (1.5 mm slice thickness) from the sagittal DESSwe. Knee joint cartilage plates were quantified unpaired in random order with blinding to subject identification.

RESULTS

In the femorotibial joint, precision errors (root mean square coefficient of variation in % for unpaired analysis) for cartilage volume and thickness were 3.0-6.4% with coronal FLASHwe, 2.4-6.2% with coronal MPR DESSwe, and 2.3-8.2% with sagittal DESSwe. Correlation coefficients between DESSwe and FLASHwe ranged from r = 0.88 to 1.0. In the femoropatellar joint, precision errors (sagittal DESSwe) were 3.4-8.5%.

CONCLUSIONS

DESSwe permits accurate and precise analysis of cartilage morphology in the femorotibial joint at 3 T. Further studies are needed to examine the accuracy of DESSwe in the femoropatellar joint and its ability to characterise sensitivity to longitudinal changes in cartilage morphology.

Use of novel interactive input devices for segmentation of articular cartilage from magnetic resonance images

OBJECTIVE

To study the effect of new interactive computer input devices on cartilage segmentation in terms of time, consistency between input devices, and precision in quantitative magnetic resonance imaging (qMRI).

DESIGN

We compared two new input devices, an interactive digitizing tablet and an interactive touch-sensitive screen, to a traditional mouse. Medial tibial and patellar cartilage of six healthy and six osteoarthritic knees were segmented using each input device. Cartilage volume, surface area and mean thickness were assessed using a validated algorithm and used to determine consistency and precision. Segmentation time was also measured.

RESULTS

Segmenting with an interactive touch-sensitive screen reduced segmentation time by 15% when compared to the traditional mouse but we found no significant difference in segmentation time between the interactive digitizing tablet and the traditional mouse. We found no difference in consistency or precision of cartilage volume, mean thickness or surface area between the three input devices tested.

CONCLUSIONS

We conclude that measurements of cartilage made using articular cartilage segmentation from MR images are independent of the input device chosen for user interaction.

[Primary osteosarcoma of the thyroid gland]

Primary extraosseous osteosarcoma of the thyroid gland is a very rare tumor with a poor prognosis. Only few cases have been reported in the literature. Metastases of osteosarcoma in the thyroid gland were also found but are very seldom. A primary thyroid tumor with osteosarcomatous differentiation in a 82-year-old man is presented and the histopathological classification, biological features and possible mechanisms of the occurrence of such thyroid tumors are briefly discussed.

Dynamics of haemostasis during the oestrous cycle and pregnancy in bitches

The blood coagulation status was studied in 31 bitches of different breeds during 33 oestrous cycles and during nine pregnancies. Two other bitches were ovariohysterectomized and received subcutaneous injections of oestradiol benzoate for 7 consecutive days. Blood samples were taken in early and late follicular phases, at ovulation, at day 1 after the end of oestrus as determined by cytology, at days 30, 60, 90 and 120 of metoestrus and in anoestrus. The samples were analysed for the concentrations of fibrinogen, fibrin(ogen) degradation products, as well as for the prothrombin time, the activated partial thromboplastin time, the antithrombin III activity, the number of platelets and the haematocrit. In other blood plasma samples the concentrations of oestradiol and progesterone were measured. In the two bitches that were ovariohysterectomized and received subcutaneous injections of oestradiol benzoate for 7 consecutive days, the coagulation parameters and hormones were examined in blood samples collected at appropriate terms and time intervals as in intact dogs. The significantly increased concentrations of fibrinogen and fibrin(ogen) degradation products, the large number of platelets and the decreased antithrombin III activity observed during the luteal phase of the nonpregnant and pregnant bitches are attributed to direct or indirect effects of the high peripheral progesterone concentrations. In the mid-luteal phase (day 30) this activation was more distinct during pregnancy than in the nonpregnant dogs presumably owing to additional effects of local processes in the uteroplacental area. Influences of high concentrations of oestradiol were not observed either during the follicular phase of the intact bitches or after oestradiol benzoate administration in the ovariohysterectomized dogs.

[Antithrombin III activity in health cats and its changes in selected disease]

Measurements of the antithrombin III (AT III) activity in feline plasma with a thrombin dependent chromogenic substrate assay using an automatic analyzer showed a high within run precision. The coefficient of variance was 1.82% (normal AT III activity) or 3.19% (decreased AT III activity), respectively. In comparison with the feline pool plasma the AT III activity in canine plasma was similar (93.7%) and in human reference plasma was lower (71.7%). Respecting healthy cats aged more than three months no distinct influence could be demonstrated on the AT III activity neither of age nor of gender (p = 0.2180). Based on the 2.5%- and 97.5%- quantile the reference range was 83.5-122.5% respecting the total number of healthy cats (n = 138) or 82.6-121.5% concerning the 116 European Shorthair cats. AT III activity of cats infected with feline immunodeficiency virus (n = 37) or teline leukemia virus (n = 20) as well as of cats suffering from different solitary tumors (n = 8) was not distinctly different from the control group (p > 0.05). On the contrary, a significant decrease of AT III activity was found in traumatized cats (n = 20; median = 80.8%, p < 0.0001) as well as in animals with chronic renal failure (n = 20; median = 91.7%, p = 0.0228) which can be mainly attributed to a consumption reaction or excessive renal loss, respectively.

[Sonographic appearance of the canine kidney compared with pathologic-histologic morphology]

Aim of the present study was to evaluate the possibility whether the ultrasonographic appearance of the canine kidney can be attached to a specific histopathologic diagnosis. The sonographic examination was performed in 117 dogs that were presented in the Small Animal Clinic of Hannover Veterinary School, Germany, for euthanasia. After the euthanasia the kidneys were exenterated and evaluated pathohistologically in the Department of Pathology of Hannover Veterinary School. According to the sonographic changes the patients were classified into seven different groups and compared with the histopathologic findings. The results of this study demonstrate that it is currently not feasible to relate a gray-scale sonography image of a diffuse renal parenchymal alteration to a specific histopathologic diagnosis. It remains to be seen if it is possible to improve the renal ultrasonography with new diagnostic methods, e.g. color-doppler ultrasonography.

[Candidiasis of the liver following successful chemotherapy of acute myeloid leukemia (Fab type 6) and recovery with oral fluconazole therapy]

The spectrum of disseminated candidiasis includes both an acute and chronic presentation. In contrast to the acute form, chronic disseminated candidiasis (hepatosplenic candidiasis) often occurs late after granulocytopenic episodes in patients undergoing chemotherapy, usually for acute leukemia. We discuss a female patient who underwent extensive successful chemotherapy for acute myelogenous leukemia (FAB type 6) and who developed chronic hepatosplenic candidiasis 19 months later. Therapy with amphotericin B and flucytosine was not successful and a cure was effected only after long-term oral fluconazole treatment. Diagnostic problems, possible reasons for the observed failure of amphotericin B treatment, and the current use of fluconazole in disseminated candidiasis are discussed.

[Double-contrast tomographic arthrography and double-contrast CT arthrography in rotator cuff lesions]

Arthrotomography is a good method for the evaluation of incomplete or complete tears of the supraspinatus tendon, the assessment of the size of tears and the quality of the nonruptured part. CT arthrography is useful in the evaluation of the subscapularis tendon and the labral-capsular components. It depends on the clinical symptoms and the result of primary arthrography whether both methods are performed in one session or not. Based on the experience of 1200 arthro(tomo)graphy and axial CT arthrography examinations, the procedure and results in our institution are reported.

Urethral pressure response to smooth and skeletal muscle relaxants in anesthetized, adult male cats with naturally acquired urethral obstruction

The effects of the skeletal muscle-relaxing drug dantrolene sodium alone, and in combination with the alpha 1-adrenergic antagonist prazosin, on the urethral pressure profile were investigated in male cats with obstructive lower urinary tract disease. Decreases in mean segmental intraurethral pressure induced by dantrolene (n = 3) or dantrolene in combination with prazosin (n = 3) were evaluated statistically, using a paired design. Statistical analysis was applied to absolute (mm of Hg) pressure values. Intravenous administration of dantrolene alone (1 mg/kg of body weight, n = 3) significantly decreased pressure in the postprostatic/penile urethral segment, but did not decrease prostatic urethral pressures. Dantrolene in combination with prazosin (0.03 mg/kg IV) caused a 20% pressure decrease in the prostatic segment (P = 0.060). Preprostatic urethral pressure was not significantly affected by either treatment regimen in the small pool of cats studied. There was no difference in baseline pressures (mm of Hg) in the 3 intraurethral segments of these 6 recently obstructed male cats, compared with historic baseline pressures (mm of Hg) in the 3 intraurethral segments of 28 healthy male cats. These results indicate that dantrolene and prazosin may be effective in relaxing intraurethral skeletal and smooth musculature in male cats clinically afflicted with obstructive lower urinary tract disease. However, it is not certain that administration of muscle relaxants would facilitate urethral catheterization and removal of the obstruction in male cats with blockage of the lower urinary tract. Strikingly, results of this study suggest that urethral muscle spasm had a minor role in these cats.

Effect of succinylcholine, diazepam, and dantrolene on the urethral pressure profile of anesthetized, healthy, sexually intact male cats

Effects of the neuromuscular blocking agent succinylcholine (n = 9), the centrally acting skeletal muscle relaxant diazepam (n = 11), and the directacting skeletal muscle relaxant dantrolene sodium (n = 8) on the urethral pressure profile were evaluated in anesthetized, healthy, sexually intact, adult male cats. Intravenous administration of succinylcholine (0.075 mg/kg of body weight) significantly decreased mean absolute pressure in the prostatic and post-prostatic/penile intraurethral segments by -9.5 and -6.5 mm of Hg, respectively (P = 0.0002 and P = 0.0006, respectively). Dantrolene (1.0 mg/kg, IV) significantly decreased mean prostatic and postprostatic/penile intraurethral segmental pressures by -3.5 and -2.8 mm of Hg, respectively (P = 0.005 and P = 0.0181, respectively). Diazepam (0.8 mg/kg, IV) did not significantly alter mean intraurethral segmental pressures. None of the drugs caused a change in segmental lengths of the urethra. These results indicate that skeletal muscle makes a substantial contribution to intraurethral tone in anesthetized, healthy, sexually intact male cats and that skeletal muscle relaxation may be successful in reducing prostatic and post-prostatic/penile urethral segmental tone in male cats. These results also suggest that dantrolene sodium may be valuable for the pharmacologic management of urethral disorders in male cats.

Renal oncocytoma: a rare renal tumor with typical angiographic features

We report on a case of renal oncocytoma (proximal tubular adenoma) with typical vascular architecture. The vascular supply of the oncocytoma showed a 'spoke-wheel'-like pattern. The typical angiographic features may help to differentiate oncocytomas from hypernephromas and thus diagnose it as such in the preoperative period. By the use of the electron microscope some typical invasions into a small vein could be traced, therefore it seems likely that renal oncocytoma is semi-malignant. Confusion of the renal oncocytoma with a large renal cyst is a classical diagnostic error which can be fatal.

Plasma zinc and magnesium alterations in acute myocardial infarction

In 31 patients suffering from acute myocardial infarction plasma zinc and magnesium concentrations were measured. In acute infarction plasma zinc concentrations were strikingly decreased and plasma magnesium concentration slightly decreased. A close correlation between fall in zinc concentrations and the rise of serum CPK in these patients could be observed. No correlations were found between infarct localisation and sex and alterations in zinc concentrations. In contrast, a close correlation between fall in zinc content and severity of infarction occurred. Thus, the observed alterations in plasma zinc probably can be used as a diagnostic and prognostic indicator. Furthermore it should be considered whether zinc substitution would be of therapeutical benefit in patients suffering from acute myocardial infarction.

[2 cases of multiple myeloma with osteosclerosis]

A report on two patients with osteoclerotic myeloma is presented (myeloma with osteoblastic lesions). In case one, metastatic bone tumor of unknown origin was wrongly diagnosed initially. Because of increasing neurological symptoms laminectomy was performed. Biopsy led to the correct diagnosis of multiple myeloma of IgA-type. Patient also had a very severe peripheral neuropathy. The second patient had pancytopenia and osteosclerotic lesions of the pelvis. Bone marrow aspiration revealed so-called "empty marrow". Based on these findings, myelofibrosis was wrongly diagnosed at another hospital. Bone marrow aspiration, paper- and immunoelectrophoresis subsequently produced the correct diagnosis of multiple myeloma of IgG-type. Multiple myeloma usually is characterized by osteolytic lesions of the bones. However, the literature contains some 50 cases with osteosclerotic multiple myeloma, three different forms of which are described. In a fairly large percentage osteosclerotic multiple myeloma is combined with periphereal polyneuropathy. It would appear that in IgE-myeloma the incidence of sclerotic lesions is higher. Osteosclerotic multiple myeloma is very rare. It should however be considered if the differential diagnosis of osteosclerotic bone lesions is established.

[Age-dependent changes of stress-related immunosuppression]

The present investigations on the influence of physical stress and physical training and on the influence of aging on 19-S-antibody producing spleen cells showed: 1. Physical stress causes a failing of immunity in mice, which had no training. The immune response can be diminished by physical stress before and after sensitization. The immunosuppressive effect of stress is greater, if it was placed after sensitization. There is a strict correlation between the immunosuppressive effect of physical stress and the time of maximum production of 19-S-antibodies. 2. The immunosuppressive effect of physical stress increases with increasing age. The protecting effect of physical training is lower in adult and old animals than in young mice. 3. There is an increase of antibody loaded spleen cells until an age of eight months. In elder mice the number of immunocytes decreases significantly. 4. The mortality rate is greater in stressed and trained young mice than in the adult and old animals. Supposing a better adaptation in young mice it is to be considered that the biologically better developed animals survived by selections.

[Gold treatment of rheumatoid arthritis]

In basic therapy of Rheumatoid Arthritis gold is preferred. Continued as well as discontinued therapy is used. The effect of gold is of complex nature. Gold is localized in cells of the RES and mesenchyme main in the inflammatory area. The passing acceleration of mesenchyme metabolism possibly shortens the duration of the inflammatory process. Gold further shows effects on cellular and subcellular membranes, on collagen, ACTH-production and on immune reactions. Patients with high activity and slow progression of their disease are especially suitable for chrysotherapy. Low maintenance of gold levels is effective and inhibits toxic-allergical reactions may be in a sort of desensitisation.

Characterization of the collagen synthesized by cultured human smooth muscle cells from fetal and adult aorta

Smooth muscle cells were grown from explants of the tunica media of fetal and adult human aorta. Collagen was isolated after incubation with [14C]glycine and was characterized by ion-exchange chromatography. All cells investigated synthesized two types of collagen: Type I (chain composition [alpha1(I)]2alpha2) and type III (chain composition [alpha1(III)]3). The collagen made by cells from adult donors contained approximately 70% type I and 30% type III collagen. This corresponds to the collagen composition in teh original tissue. No age-relate change in the type I/type III ratio was found with cells from donors between 9 and 67 years of age. On the other hand, the type III portion of the collagen made by fetal cells was markedly less (about 15-20% of total collagen).

[Primary extranodal lymphogranulomatosis of the flexura dodenal-jejunalis]

A primary extranodal lymphogranuloma of Hodgkin was found in the small bowel (PS II AE) of a 34-year-old man. Two years after radical surgery followed by local telecobalt therapy, the patient is in good health. The symptomatology, therapy and prognosis of this rare form of Hodgkin's lymphogranuloma are briefly reviewed.

Diffuse lymphangiomyomatosis

A case of diffuse lymphangiomyomatosis with involvement of the large veins of the body is reported. The clinical, pathologoanatomic and especially the roentgenologic findings are described. Interstitial lung thickening, pleural effusions and spontaneous pneumothorax are findings which together with a stasis in the lymphatic system strongly suggest the diagnosis. The extensive involvement of the venous system supports the theory of a hamartomatous nature of the disease.