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Yue S, Zhai G, Zhao S, Liang X, Liu Y, Zheng J, Chen X, Dong Y. The biphasic role of the infrapatellar fat pad in osteoarthritis. Biomed Pharmacother 2024; 179:117364. [PMID: 39226725 DOI: 10.1016/j.biopha.2024.117364] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2024] [Revised: 08/23/2024] [Accepted: 08/26/2024] [Indexed: 09/05/2024] Open
Abstract
Osteoarthritis (OA) is a progressive degenerative disease resulting in joint deterioration. It is a whole organ disease characterized by cartilage degeneration and varying degrees of synovitis, involving pathological changes in all joint tissues, such as cartilage, subchondral bone, ligaments, meniscus, synovium, and infrapatellar fat pad (IPFP). IPFP is the largest adipose tissue structure in the knee joint and is composed of fat cells, immune cells and blood vessels. Moreover, IPFP is located close to the cartilage and bone surface so that it may reduce the impact of loading and absorb forces generated through the knee joint, and may have a protective role in joint health. IPFP has been shown to release various cytokines and adipokines that play pro-inflammatory and pro-catabolic roles in cartilage, promoting OA progression. Intra-articular injections of IPFP-derived mesenchymal stem cells and exosomes have been shown to reduce pain and prevent OA progression in patients with knee OA. Previous studies have shown that IPFP has a biphasic effect on OA progression. This article reviews the latest research progress of IPFP, discusses the role and mechanism of IPFP in OA, provide new intervention strategies for the treatment of OA. This article will also discuss the handling of IPFP during the procedure of total knee arthroplasty.
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Affiliation(s)
- Songkai Yue
- Department of Orthopedics, Henan Provincial People's Hospital, People's Hospital of Zhengzhou University, Henan University People's Hospital, Zhengzhou 450003, China
| | - Ganggang Zhai
- Department of Orthopedics, Henan Provincial People's Hospital, People's Hospital of Zhengzhou University, Henan University People's Hospital, Zhengzhou 450003, China
| | - Siyu Zhao
- Department of Orthopedics, Henan Provincial People's Hospital, People's Hospital of Zhengzhou University, Henan University People's Hospital, Zhengzhou 450003, China
| | - Xiaming Liang
- Department of Orthopedics, Henan Provincial People's Hospital, People's Hospital of Zhengzhou University, Henan University People's Hospital, Zhengzhou 450003, China
| | - Yunke Liu
- Department of Orthopedics, Henan Provincial People's Hospital, People's Hospital of Zhengzhou University, Henan University People's Hospital, Zhengzhou 450003, China
| | - Jia Zheng
- Department of Orthopedics, Henan Provincial People's Hospital, People's Hospital of Zhengzhou University, Henan University People's Hospital, Zhengzhou 450003, China
| | - Xiaoyang Chen
- Department of Orthopedics, Henan Provincial People's Hospital, People's Hospital of Zhengzhou University, Henan University People's Hospital, Zhengzhou 450003, China
| | - Yonghui Dong
- Department of Orthopedics, Henan Provincial People's Hospital, People's Hospital of Zhengzhou University, Henan University People's Hospital, Zhengzhou 450003, China.
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Satake Y, Izumi M, Aso K, Ikeuchi M. Association between infrapatellar fat pad ultrasound elasticity and anterior knee pain in patients with knee osteoarthritis. Sci Rep 2023; 13:20103. [PMID: 37973859 PMCID: PMC10654649 DOI: 10.1038/s41598-023-47459-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/31/2022] [Accepted: 11/14/2023] [Indexed: 11/19/2023] Open
Abstract
This study investigates whether infrapatellar fat pad (IPFP) elasticity is associated with anterior knee pain in patients with knee osteoarthritis (KOA). The IPFP elasticity of 97 patients with KOA (Kellgren and Lawrence [KL] grades of the femorotibial and patellofemoral joints ≥ 2 and ≤ 2, respectively), aged 46-86 years, was evaluated via shear wave speed using ultrasound elastography. The patients were divided into two groups according to the presence or absence of anterior knee pain. Univariate analyses were used to compare patient age, sex, femorotibial KL grade, magnetic resonance imaging findings (Hoffa, effusion synovitis, bone marrow lesion scores, and IPFP size), and IPFP elasticity between the groups. Multivariate logistic regression analyses were subsequently performed using selected explanatory variables. IPFP elasticity was found to be associated with anterior knee pain in the univariate (p = 0.007) and multivariate (odds ratio: 61.12, 95% CI 1.95-1920.66; p = 0.019) analyses. Anterior knee pain is strongly associated with stiffer IPFPs regardless of the femorotibial KL grade, suggesting that ultrasound elastography is useful for the diagnosis of painful IPFP in patients with KOA.
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Affiliation(s)
- Yoshinori Satake
- Department of Orthopaedic Surgery, Kochi Medical School, Kochi University, Kohasu, Okoh-Cho, Nankoku-City, Kochi, 783-8505, Japan.
| | - Masashi Izumi
- Department of Orthopaedic Surgery, Kochi Medical School, Kochi University, Kohasu, Okoh-Cho, Nankoku-City, Kochi, 783-8505, Japan
| | - Koji Aso
- Department of Orthopaedic Surgery, Kochi Medical School, Kochi University, Kohasu, Okoh-Cho, Nankoku-City, Kochi, 783-8505, Japan
| | - Masahiko Ikeuchi
- Department of Orthopaedic Surgery, Kochi Medical School, Kochi University, Kohasu, Okoh-Cho, Nankoku-City, Kochi, 783-8505, Japan
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Cen H, Yan Q, Meng T, Chen Z, Zhu J, Wang Y, Ruan G, Wang T, Han W, Hunter D, Ding C. Quantitative infrapatellar fat pad signal intensity alteration as an imaging biomarker of knee osteoarthritis progression. RMD Open 2023; 9:rmdopen-2022-002565. [PMID: 36697038 PMCID: PMC9884854 DOI: 10.1136/rmdopen-2022-002565] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2022] [Accepted: 01/02/2023] [Indexed: 01/26/2023] Open
Abstract
OBJECTIVE To determine the association of quantitative infrapatellar fat pad (IPFP) signal intensity alteration with knee osteoarthritis (OA) progression. METHOD This study was performed based on the Foundation for the National Institutes of Health OA Biomarkers Consortium study, a nested case-control study consisting of 600 participants. The IPFP signal intensity alterations were quantitatively measured at baseline, 12 months and 24 months. The associations of baseline and time-integrated values over 12 and 24 months of IPFP signal intensity measures with knee OA progression over 48 months were evaluated with adjustment for baseline confounders. RESULTS The baseline level of clustering effect of high signal intensity (Clustering factor (H)) was predictive of clinically relevant progression (both radiographic and pain progression) (OR 1.22). The time-integrated values of all IPFP signal intensity measures, except for mean value of IPFP signal intensity (Mean (IPFP)) over 24 months (ORs ranging from 1.23 to 1.39) as well was all except for Mean (IPFP) and mean value of IPFP high signal intensity (Mean (H)) over 12 months (ORs ranging from 1.20 to 1.31), were positively associated with clinically relevant progression. When the associations of quantitative IPFP signal intensity measures with radiographic and pain progression were examined separately, more IPFP signal intensity measures with stronger effect sizes were associated with radiographic progression compared with pain progression. CONCLUSION The associations of short-term alteration in quantitative IPFP signal intensity measures with long-term knee OA progression suggest that these measures might serve as efficacy of intervention biomarkers of knee OA.
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Affiliation(s)
- Han Cen
- Clinical Research Centre, Zhujiang Hospital, Southern Medical University, Guangzhou, Guangdong, China,Menzies Institute for Medical Research, University of Tasmania, Hobart, Tasmania, Australia
| | - Qingran Yan
- Department of Rheumatology, Renji Hospital, School of Medicine, Shanghai Jiaotong University, Shanghai, China
| | - Tao Meng
- Department of Rheumatology and Immunology, The Second Hospital of Anhui Medical University, Hefei, Anhui, China
| | - Zhongshan Chen
- Menzies Institute for Medical Research, University of Tasmania, Hobart, Tasmania, Australia,School of Mathematics and Information Science, Nanjing Normal University of Special Education, Nanjing, Jiangsu, China
| | - Jimin Zhu
- Menzies Institute for Medical Research, University of Tasmania, Hobart, Tasmania, Australia,Department of Public Health and General Medicine, School of Life Sciences, Anhui University of Chinese Medicine, Hefei, Anhui, China
| | - Yuanyuan Wang
- Menzies Institute for Medical Research, University of Tasmania, Hobart, Tasmania, Australia,Department of Health Management, Nanfang Hospital, Southern Medical University, Guangzhou, Guangdong, China
| | - Guangfeng Ruan
- Menzies Institute for Medical Research, University of Tasmania, Hobart, Tasmania, Australia,Clinical Research Centre, Guangzhou First People's Hospital, School of Medicine, South China University of Technology, Guangzhou, Guangdong, China
| | - Tian Wang
- Menzies Institute for Medical Research, University of Tasmania, Hobart, Tasmania, Australia,Department of Rheumatology and Clinical Immunology, Beijing An Zhen Hospital, Capital Medical University, Beijing, Beijing, China
| | - Weiyu Han
- Clinical Research Centre, Zhujiang Hospital, Southern Medical University, Guangzhou, Guangdong, China
| | - David Hunter
- Clinical Research Centre, Zhujiang Hospital, Southern Medical University, Guangzhou, Guangdong, China,Department of Rheumatology, Royal North Shore Hospital and Institute of Bone and Joint Research, Kolling Institute, University of Sydney, Sydney, New South Wales, Australia
| | - Changhai Ding
- Clinical Research Centre, Zhujiang Hospital, Southern Medical University, Guangzhou, Guangdong, China .,Menzies Institute for Medical Research, University of Tasmania, Hobart, Tasmania, Australia
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Macri EM, Neogi T, Jarraya M, Guermazi A, Roemer F, Lewis CE, Torner JC, Lynch JA, Tolstykh I, Jafarzadeh SR, Stefanik JJ. Magnetic Resonance Imaging-Defined Osteoarthritis Features and Anterior Knee Pain in Individuals With, or at Risk for, Knee Osteoarthritis: A Multicenter Study on Osteoarthritis. Arthritis Care Res (Hoboken) 2022; 74:1533-1540. [PMID: 33768706 PMCID: PMC8463633 DOI: 10.1002/acr.24604] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2020] [Revised: 01/21/2021] [Accepted: 03/23/2021] [Indexed: 11/06/2022]
Abstract
OBJECTIVE The lack of strong association between knee osteoarthritis (OA) structural features and pain continues to perplex researchers and clinicians. Evaluating the patellofemoral joint in addition to the tibiofemoral joint alone has contributed to explaining this structure-pain discordance, hence justifying a more comprehensive evaluation of whole-knee OA and pain. The present study, therefore, was undertaken to evaluate the association between patellofemoral and tibiofemoral OA features with localized anterior knee pain (AKP) using 2 study designs. METHODS Using cross-sectional data from the Multicenter Osteoarthritis Study, our first approach was a within-person, knee-matched design in which we identified participants with unilateral AKP. We then assessed magnetic resonance imaging (MRI)-derived OA features (cartilage damage, bone marrow lesions [BMLs], osteophytes, and inflammation) in both knees and evaluated the association of patellofemoral and tibiofemoral OA features to unilateral AKP. In our second approach, MRIs from 1 knee per person were scored, and we evaluated the association of OA features to AKP in participants with AKP and participants with no frequent knee pain. RESULTS Using the first approach (n = 71, 66% women, mean ± SD age 69 ± 8 years), lateral patellofemoral osteophytes (odds ratio [OR] 5.0 [95% confidence interval (95% CI) 1.7-14.6]), whole-knee joint effusion-synovitis (OR 4.7 [95% CI 1.3-16.2]), and infrapatellar synovitis (OR 2.8 [95% CI 1.0-7.8]) were associated with AKP. Using the second approach (n = 882, 59% women, mean ± SD age 69 ± 7 years), lateral and medial patellofemoral cartilage damage (prevalence ratio [PR] 2.3 [95% CI 1.3-4.0] and PR 1.9 [95% CI 1.1-3.3], respectively) and lateral patellofemoral BMLs (PR 2.6 [95% CI 1.5-4.7]) were associated with AKP. CONCLUSION Patellofemoral but not tibiofemoral joint OA features and inflammation were associated with AKP.
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Affiliation(s)
- Erin M. Macri
- Erasmus MC, Rotterdam, The Netherlands, and University of DelawareNewark
| | - Tuhina Neogi
- Boston University and Boston Imaging Core LabBostonMassachusetts
| | | | - Ali Guermazi
- Boston University and Boston Imaging Core LabBostonMassachusetts
| | - Frank Roemer
- Boston University, Boston, Massachusetts, and Friedrich‐Alexander University Erlangen‐NurembergErlangenGermany
| | | | | | | | | | | | - Joshua J. Stefanik
- University of Delaware, Newark, and Northeastern UniversityBostonMassachusetts
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Zhong L, Li M, Du X, Ding Y, Zhang X, Mei Y, Yi P, Feng Y, Chen Y, Zhang X. Quantitative evaluation of the characteristic of infrapatellar fat pad Fat Content and Unsaturation Index by using hydrogen proton MR spectroscopy. Magn Reson Imaging 2022; 94:18-24. [DOI: 10.1016/j.mri.2022.07.014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/01/2022] [Revised: 07/23/2022] [Accepted: 07/27/2022] [Indexed: 10/16/2022]
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Exploring Anatomo-Morphometric Characteristics of Infrapatellar, Suprapatellar Fat Pad, and Knee Ligaments in Osteoarthritis Compared to Post-Traumatic Lesions. Biomedicines 2022; 10:biomedicines10061369. [PMID: 35740391 PMCID: PMC9220326 DOI: 10.3390/biomedicines10061369] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2022] [Revised: 06/06/2022] [Accepted: 06/07/2022] [Indexed: 11/17/2022] Open
Abstract
Several studies have investigated cartilage degeneration and inflammatory subchondral bone and synovial membrane changes using magnetic resonance (MR) in osteoarthritis (OA) patients. Conversely, there is a paucity of data exploring the role of knee ligaments, infrapatellar fat pad (IFP), and suprapatellar fat pad (SFP) in knee OA compared to post-traumatic cohorts of patients. Therefore, the aim of this study was to analyze the volumetric and morphometric characteristics of the following joint tissues: IFP (volume, surface, depth, femoral and tibial arch lengths), SFP (volume, surface, oblique, antero−posterior, and cranio−caudal lengths), anterior (ACL) and posterior cruciate ligament (PCL) (volume, surface, and length), and patellar ligament (PL) (volume, surface, arc, depth, and length). Eighty-nine MR images were collected in the following three groups: (a) 32 patients with meniscal tears, (b) 29 patients with ACL rupture (ACLR), and (c) 28 patients affected by end-stage OA. Volume, surface, and length of both ACL and PCL were determined in groups a and c. A statistical decrease of IFP volume, surface, depth, femoral and tibial arch lengths was found in end-stage OA compared to patients with meniscal tear (p = 0.002, p = 0.008, p < 0.0001, p = 0.028 and p < 0.001, respectively) and patients with ACLR (p < 0.0001, p < 0.0001, p = 0.008 and p = 0.011, respectively). An increment of volume and surface SFP was observed in group b compared to both groups a and c, while no differences were found in oblique, antero−posterior, and cranio−caudal lengths of SFP among the groups. No statistical differences were highlighted comparing volume, surface, arc, and length of PL between the groups, while PL depth was observed to be decreased in end-OA patients compared with meniscal tear patients (p = 0.023). No statistical differences were observed comparing ACL and PCL lengths between patients undergoing meniscectomy and TKR. Our study confirms that IFP MR morphometric characteristics are different between controls and OA, supporting an important role of IFP in OA pathology and progression in accordance with previously published studies. In addition, PL depth changes seem to be associated with OA pathology. Multivariate analysis confirmed that OA patients had a smaller IFP compared to patients with meniscal tears, confirming its involvement in OA.
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Edama M, Otsuki T, Yokota H, Hirabayashi R, Sekine C, Maruyama S, Kageyama I. Morphological characteristics of the infrapatellar fat pad. Sci Rep 2022; 12:8923. [PMID: 35624138 PMCID: PMC9142527 DOI: 10.1038/s41598-022-12859-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2022] [Accepted: 05/17/2022] [Indexed: 11/09/2022] Open
Abstract
The relationship between the morphological characteristics of the infrapatellar fat pad (IFP) and joint deformity has yet to be fully elucidated. Therefore, the purpose of this study was to clarify the morphological characteristics of the IFP and to identify the relationships between morphological characteristics of the IFP and degenerative grade of the articular surface of the patella. This investigation examined 41 legs from 25 Japanese cadavers. The IFP length, width, and volume were measured. It was categorized into three types: Type I, IFP proximal located on medial and lateral sides of the patella; Type II, the IFP proximal only located medially; and Type III, absence of the IFP proximal. Articular surfaces were graded as macroscopically intact or mildly altered (Grade I), moderately (Grade II), or severely (Grade III). Grade III was significantly more frequent than Grades I or II in Type III. IFP volume was significantly larger in Type I than in Types II or III. A negative correlation was found between the degenerative grade of the articular surface of the patella and IFP volume. It was suggested that a relationship between the degenerative grade of the articular surface of the patella and the IFP volume.
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Affiliation(s)
- Mutsuaki Edama
- Institute for Human Movement and Medical Sciences, Niigata University of Health and Welfare, Shimami-cho 1398, Kita-ku, Niigata, 950-3198, Japan. .,Department of Anatomy, School of Life Dentistry at Niigata, Nippon Dental University, Niigata, Japan.
| | - Tomofumi Otsuki
- Institute for Human Movement and Medical Sciences, Niigata University of Health and Welfare, Shimami-cho 1398, Kita-ku, Niigata, 950-3198, Japan
| | - Hirotake Yokota
- Institute for Human Movement and Medical Sciences, Niigata University of Health and Welfare, Shimami-cho 1398, Kita-ku, Niigata, 950-3198, Japan
| | - Ryo Hirabayashi
- Institute for Human Movement and Medical Sciences, Niigata University of Health and Welfare, Shimami-cho 1398, Kita-ku, Niigata, 950-3198, Japan
| | - Chie Sekine
- Institute for Human Movement and Medical Sciences, Niigata University of Health and Welfare, Shimami-cho 1398, Kita-ku, Niigata, 950-3198, Japan
| | - Sae Maruyama
- Institute for Human Movement and Medical Sciences, Niigata University of Health and Welfare, Shimami-cho 1398, Kita-ku, Niigata, 950-3198, Japan
| | - Ikuo Kageyama
- Department of Anatomy, School of Life Dentistry at Niigata, Nippon Dental University, Niigata, Japan
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He J, Ba H, Feng J, Peng C, Liao Y, Li L, Cao X, Wang Z, Shen M, Wu S. Increased signal intensity, not volume variation of infrapatellar fat pad in knee osteoarthritis: A cross-sectional study based on high-resolution magnetic resonance imaging. J Orthop Surg (Hong Kong) 2022; 30:10225536221092215. [PMID: 35422165 DOI: 10.1177/10225536221092215] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
BACKGROUND Infrapatellar fat pad (IPFP) is regarded as an essential knee tissue involved in osteoarthritis (OA) for its potential structural-related or metabolism-related function. This cross-sectional study aims to identify which part is more related to OA. METHODS Patients with knee OA (n = 53) and healthy controls (n = 54) were prospectively recruited. Based on high-resolution magnetic resonance imaging with a slice thickness of only 0.35 mm, IPFP structural-related parameters (volume and maximal area), metabolism-related parameter (signal), degeneration indicators, and patellar maltracking indicators (patellar translation, patellofemoral angle, and Insall-Salvati ratio) were measured. IPFP volume (maximal area, and signal) was compared between healthy controls and OA patients. The level of significance for all comparisons was set as .05. RESULTS OA patients had higher IPFP signal (672.9 ± 136.9 vs 567.3 ± 63.6, p = .009), but no significant difference in IPFP volume or maximal area compared with healthy controls. In healthy controls, IPFP signal was positively associated with age (β = 1.481; 95% CI: 0.286-2.676; p = .018); IPFP maximal area was positively related to Insall-Salvati ratio (β = 0.001; 95% CI: 0.0003-0.0017; p = .039), but not associated with patellar translation and patellofemoral angle. In OA patients, IPFP signal was positively associated with cartilage loss (β = 0.005; 95% CI: 0.003-0.007; p = .013); no correlation between knee pain and IPFP volume or maximal area was observed. CONCLUSIONS The metabolism-related function of IPFP, which can be reflected by the IPFP signal, might play a more critical role in OA progression than its structural function.
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Affiliation(s)
- Jinshen He
- Department of Orthopaedic Surgery, 504354Third Xiangya Hospital of Central South University, Changsha, China
| | - Hongliang Ba
- Department of Orthopaedic Surgery, 504354Third Xiangya Hospital of Central South University, Changsha, China
| | - Jing Feng
- Department of Orthopaedic Surgery, 504354Third Xiangya Hospital of Central South University, Changsha, China
| | - Cheng Peng
- Department of Burns, 504354Third Xiangya Hospital of Central South University, Changsha, China
| | - Yunjie Liao
- Department of Radiology, 504354Third Xiangya Hospital of Central South University, Changsha, China
| | - Lifeng Li
- Department of Radiology, 504354Third Xiangya Hospital of Central South University, Changsha, China
| | - Xu Cao
- Department of Orthopaedic Surgery, 504354Third Xiangya Hospital of Central South University, Changsha, China
| | - Zili Wang
- Department of Orthopaedic Surgery, 504354Third Xiangya Hospital of Central South University, Changsha, China
| | - Minren Shen
- Department of Orthopaedic Surgery, 504354Third Xiangya Hospital of Central South University, Changsha, China
| | - Song Wu
- Department of Orthopaedic Surgery, 504354Third Xiangya Hospital of Central South University, Changsha, China
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Martel-Pelletier J, Tardif G, Pelletier JP. An Open Debate on the Morphological Measurement Methodologies of the Infrapatellar Fat Pad to Determine Its Association with the Osteoarthritis Process. Curr Rheumatol Rep 2022; 24:76-80. [PMID: 35235164 DOI: 10.1007/s11926-022-01057-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/12/2022] [Indexed: 11/28/2022]
Abstract
INTRODUCTION Knee osteoarthritis (OA) is a disease affecting all the neighboring articular tissues including the infrapatellar fat pad (IPFP). Although not yet as widely studied as other tissues in the knee, the IPFP has been recognized to have important metabolic activities and is a key player in OA. METHODS In this commentary, we will briefly describe the different methodologies employed for the MRI morphological measurement of this tissue and depict the findings in regard to OA. RESULTS The morphology of this tissue, monitored mainly with the use of magnetic resonance imaging (MRI), demonstrates changes during OA. However, studies of the IPFP morphological alterations and their association with the OA process have shown conflicting results, including a detrimental or beneficial role or no role at all. Although many reasons could explain such mixed findings, one might be the different methodologies used for the MRI measurement of area, volume, or signal intensity. In addition, several techniques are also employed for measuring the volume and signal intensity. An additional level of complexity is related to the presence within the IPFP of two different types of signal intensities, hyper-intensity, and hypo-intensity. CONCLUSION A consensus of a procedure to measure the morphology of the IPFP is urgently needed to fully appreciate the role of this tissue in the pathology of OA, as well as its uses for clinical decision-making.
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Affiliation(s)
- Johanne Martel-Pelletier
- Osteoarthritis Research Unit, University of Montreal Hospital Research Centre (CRCHUM), 900 Saint-Denis Street, Pavilion R, Room R11.412, Montreal, Quebec, H2X 0A9, Canada.
| | - Ginette Tardif
- Osteoarthritis Research Unit, University of Montreal Hospital Research Centre (CRCHUM), 900 Saint-Denis Street, Pavilion R, Room R11.412, Montreal, Quebec, H2X 0A9, Canada
| | - Jean-Pierre Pelletier
- Osteoarthritis Research Unit, University of Montreal Hospital Research Centre (CRCHUM), 900 Saint-Denis Street, Pavilion R, Room R11.412, Montreal, Quebec, H2X 0A9, Canada
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Chen Y, Zhang X, Li M, Zhong L, Ding Y, Zhang Y, Du X, Mo X, Chen J, Chen Q, Huang W, Zhong S, Zhang X. Quantitative MR evaluation of the infrapatellar fat pad for knee osteoarthritis: using proton density fat fraction and T2* relaxation based on DIXON. Eur Radiol 2022; 32:4718-4727. [PMID: 35141779 DOI: 10.1007/s00330-022-08561-5] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2021] [Revised: 12/21/2021] [Accepted: 01/03/2022] [Indexed: 11/26/2022]
Abstract
OBJECTIVES To investigate the efficacy of fat fraction (FF) and T2* relaxation based on DIXON in the assessment of infrapatellar fat pad (IFP) for knee osteoarthritis (KOA) progression in older adults. METHODS Ninety volunteers (age range 51-70 years, 65 females) were enrolled in this study. Participants were grouped based on the Kellgren-Lawrence grading (KLG). The FF and T2* values were measured based on the 3D-modified DXION technique. Cartilage defects, bone marrow lesions, and synovitis were assessed based on a modified version of whole-organ magnetic resonance imaging score (WORMS). Knee pain was assessed by self-administered Western Ontario and McMaster Osteoarthritis Index (WOMAC) questionnaire. The differences of FF and T2* measurement and the correlation with WORMS and WOMAC assessments were analyzed. Diagnostic efficiency was analyzed by using receiver operating characteristic (ROC) curves. RESULTS A total of 60 knees were finally included (n = 20 in each group). The values were 82.6 ± 3.7%, 74.7 ± 5.4%, and 60.5 ± 14.1% for FF is the no OA, mild OA, and advanced OA groups, and were 50.7 ± 6.6 ms, 44.1 ± 6.6 ms, and 39.1 ± 4.2 ms for T2*, respectively (all p values < 0.001). The WORMS assessment and WOMAC pain assessment showed negative correlation with FF and T2* values. The ROC showed the area under the curve (AUC), sensitivity, and specificity for diagnosing OA were 0.93, 77.5%, and 100% using FF, and were 0.86, 75.0%, and 90.0% using T2*, respectively. CONCLUSIONS FF and T2* alternations in IFP are associated with knee structural abnormalities and clinical symptoms cross-sectionally and may have the potential to predict the severity of KOA. KEY POINTS • Fat fraction (FF) and T2* relaxation based on DIXON imaging are novel methods to quantitatively assess the infrapatellar fat pad for knee osteoarthritis (KOA) progression in older adults. • The alterations of FF and T2* using mDIXON technique in IFP were associated with knee structural abnormalities and clinical symptoms. • FF and T2* alternations in IFP can serve as the new imaging biomarkers for fast, simple, and noninvasive assessment in KOA.
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Affiliation(s)
- Yanjun Chen
- School of Basic Medical Sciences, Southern Medical University, No.1023, Shatai Road South, Baiyun District, Guangzhou, 510515, Guangdong, China
- The Third Affiliated Hospital of Southern Medical University, No.183, Zhongshan Avenue West, Tianhe District, Guangzhou, 510630, Guangdong, China
| | - Xintao Zhang
- The Third Affiliated Hospital of Southern Medical University, No.183, Zhongshan Avenue West, Tianhe District, Guangzhou, 510630, Guangdong, China
| | - Mianwen Li
- The Third Affiliated Hospital of Southern Medical University, No.183, Zhongshan Avenue West, Tianhe District, Guangzhou, 510630, Guangdong, China
| | - Lijie Zhong
- The Third Affiliated Hospital of Southern Medical University, No.183, Zhongshan Avenue West, Tianhe District, Guangzhou, 510630, Guangdong, China
| | - Yukun Ding
- The Third Affiliated Hospital of Southern Medical University, No.183, Zhongshan Avenue West, Tianhe District, Guangzhou, 510630, Guangdong, China
| | - Yaru Zhang
- School of Basic Medical Sciences, Southern Medical University, No.1023, Shatai Road South, Baiyun District, Guangzhou, 510515, Guangdong, China
| | - Xueting Du
- Department of Radiology, Affiliated Hospital of Guangdong Medical University, Guangzhou, Guangdong, China
| | - Xianfu Mo
- The Third Affiliated Hospital of Southern Medical University, No.183, Zhongshan Avenue West, Tianhe District, Guangzhou, 510630, Guangdong, China
| | - Jialing Chen
- The Third Affiliated Hospital of Southern Medical University, No.183, Zhongshan Avenue West, Tianhe District, Guangzhou, 510630, Guangdong, China
| | - Qianmin Chen
- The Third Affiliated Hospital of Southern Medical University, No.183, Zhongshan Avenue West, Tianhe District, Guangzhou, 510630, Guangdong, China
| | - Wenhua Huang
- School of Basic Medical Sciences, Southern Medical University, No.1023, Shatai Road South, Baiyun District, Guangzhou, 510515, Guangdong, China
| | - Shizhen Zhong
- School of Basic Medical Sciences, Southern Medical University, No.1023, Shatai Road South, Baiyun District, Guangzhou, 510515, Guangdong, China.
| | - Xiaodong Zhang
- The Third Affiliated Hospital of Southern Medical University, No.183, Zhongshan Avenue West, Tianhe District, Guangzhou, 510630, Guangdong, China.
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11
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Hart HF, Culvenor AG, Patterson BE, Doshi A, Vora A, Guermazi A, Birmingham TB, Crossley KM. Infrapatellar fat pad volume and Hoffa-synovitis after ACL reconstruction: Association with early osteoarthritis features and pain over 5 years. J Orthop Res 2022; 40:260-267. [PMID: 33458849 DOI: 10.1002/jor.24987] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/28/2020] [Accepted: 01/11/2021] [Indexed: 02/04/2023]
Abstract
Infrapatellar fat pad (IPFP) morphology and Hoffa-synovitis may be relevant to the development and progression of post-traumatic osteoarthritis (OA). We aimed to compare IPFP volume and Hoffa-synovitis in participants with anterior cruciate ligament reconstruction (ACLR) and uninjured controls, and to determine their association with prevalent and worsening early knee OA features and pain in participants post-ACLR. We assessed IPFP volume and Hoffa-synovitis from magnetic resonance imaging (MRI) in 111 participants 1-year post-ACLR and 20 uninjured controls. Patellofemoral and tibiofemoral cartilage and bone marrow lesions (BMLs) were assessed from MRIs at 1 and 5 years post-ACLR, and worsening defined as any longitudinal increase in lesion size/severity. IPFP volume and Hoffa-synovitis prevalence were compared between groups with analysis of covariance and χ 2 tests, respectively. Generalized linear models assessed the relation of IPFP volume and Hoffa-synovitis to prevalent and worsening features of OA and knee pain (Knee injury and Osteoarthritis Outcome Score-Pain Subscale, Anterior Knee Pain Scale). No significant between-group differences were observed in IPFP volume (ACLR 34.39 ± 7.29cm3 , Control 34.27 ± 7.56cm3 ) and Hoffa-synovitis (ACLR 61%, Control 80%). Greater IPFP volume at 1-year post-ACLR was associated with greater odds of patellofemoral BMLs at 1-year (odds ratio [OR] [95% confidence intervals]: 1.104 [1.016, 1.200]) and worsening tibiofemoral cartilage lesions at 5-year post-ACLR (OR: 1.234 [1.026, 1.483]). Hoffa-synovitis at 1-year post-ACLR was associated with greater odds of worsening patellofemoral BMLs at 5-year post-ACLR (OR: 7.465 [1.291, 43.169]). In conclusion, IPFP volume and Hoffa-synovitis prevalence are similar between individuals 1-year post-ACLR and controls. Greater IPFP volume and Hoffa-synovitis appear to be associated with the presence and worsening of some early OA features in those post-ACLR, but not pain.
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Affiliation(s)
- Harvi F Hart
- Department of Physical Therapy, Western University, London, Ontario, Canada.,La Trobe Sport and Exercise Medicine Research Centre, School of Allied Health, Human Services and Sport, La Trobe University, Bundoora, Victoria, Australia
| | - Adam G Culvenor
- La Trobe Sport and Exercise Medicine Research Centre, School of Allied Health, Human Services and Sport, La Trobe University, Bundoora, Victoria, Australia
| | - Brooke E Patterson
- La Trobe Sport and Exercise Medicine Research Centre, School of Allied Health, Human Services and Sport, La Trobe University, Bundoora, Victoria, Australia
| | - Ankit Doshi
- Master of Clinical Science Program, Western University, London, Ontario, Canada
| | - Ashish Vora
- Master of Clinical Science Program, Western University, London, Ontario, Canada
| | - Ali Guermazi
- School of Medicine, Boston University, Boston, Massachusetts, USA
| | | | - Kay M Crossley
- La Trobe Sport and Exercise Medicine Research Centre, School of Allied Health, Human Services and Sport, La Trobe University, Bundoora, Victoria, Australia
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12
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Shibata K, Wakasa M, Saito A, Kimoto M, Takahashi Y, Sato H, Kamada T, Shinde T, Takahashi H, Kimura Y, Okada K. Hyperechoic and Low Morphological Changes in the Prefemoral Fat Pad in Individuals with Knee Osteoarthritis Based on Ultrasonographic Findings. J Med Ultrasound 2021; 29:105-110. [PMID: 34377641 PMCID: PMC8330681 DOI: 10.4103/jmu.jmu_85_20] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2020] [Revised: 07/17/2020] [Accepted: 08/24/2020] [Indexed: 11/05/2022] Open
Abstract
Background: To clarify the changes in the echo intensity (EI) in the prefemoral fat pad (PFP) and identify the relationship between the PFP and clinical features of knee osteoarthritis (OA). Methods: Twenty-six women with knee OA (mean age: 76 years) and 17 healthy women (mean age: 73 years) were enrolled. The Kellgren and Lawrence grading scale was used for the radiographic evaluation of knee OA. The EI of the PFP was measured as grayscale values. The change ratio of the anteroposterior PFP length during quadriceps contraction was measured. Knee range of motion and pain (100-mm visual analog scale) were evaluated. Results: The EI was significantly higher in the OA group than in the healthy group (P < 0.001). The change ratio of the PFP in the OA group was significantly lower than that in the healthy group (P < 0.001). The ranges of knee flexion and extension were correlated with the EI of the PFP (both P < 0.01) and the change ratio of the PFP (both P < 0.01). There was no significant correlation observed with knee pain. Conclusion: Hyperechoic changes and a decreased change ratio of the PFP were observed in the patients with knee OA. High EI and decreased morphological PFP changes were associated with decreased ranges of motion.
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Affiliation(s)
| | - Masahiko Wakasa
- Department of Physical Therapy, Akita University Graduate School of Health Sciences, Akita, Japan
| | - Akira Saito
- Department of Physical Therapy, Akita University Graduate School of Health Sciences, Akita, Japan
| | - Minoru Kimoto
- Department of Physical Therapy, Akita University Graduate School of Health Sciences, Akita, Japan
| | - Yusuke Takahashi
- Department of Rehabilitation Medicine, Akita University Hospital, Akita, Japan
| | - Hiromichi Sato
- Department of Rehabilitation, Akita Kousei Medical Center, Akita, Japan
| | - Tetsuaki Kamada
- Department of Rehabilitation, Akita Kousei Medical Center, Akita, Japan
| | - Takuto Shinde
- Department of Rehabilitation, Akita City Hospital, Akita, Japan
| | - Hitomi Takahashi
- Department of Physical Therapy, School of Health Sciences, International University of Health and Welfare, Tochigi, Japan
| | - Yoshiaki Kimura
- Department of Orthopedic Surgery, Akita City Hospital, Akita, Japan
| | - Kyoji Okada
- Department of Physical Therapy, Akita University Graduate School of Health Sciences, Akita, Japan
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13
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van der Heijden RA, de Vries BA, Poot DHJ, van Middelkoop M, Bierma-Zeinstra SMA, Krestin GP, Oei EHG. Quantitative volume and dynamic contrast-enhanced MRI derived perfusion of the infrapatellar fat pad in patellofemoral pain. Quant Imaging Med Surg 2021; 11:133-142. [PMID: 33392017 DOI: 10.21037/qims-20-441] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
Background Patellofemoral pain (PFP) is a common knee condition and possible precursor of knee osteoarthritis (OA). Inflammation, leading to an increased perfusion, or increased volume of the infrapatellar fat pad (IPFP) may induce knee pain. The aim of the study was to compare quantitative dynamic contrast-enhanced magnetic resonance imaging (DCE-MRI) parameters, as imaging biomarkers of inflammation, and volume of the IPFP between patients with PFP and controls and between patients with and without IPFP edema or joint effusion. Methods Patients with PFP and healthy controls were included and underwent non-fat suppressed 3D fast-spoiled gradient-echo (FSPGR) and DCE-MRI. Image registration was applied to correct for motion. The IPFP was delineated on FSPGR using Horos software. Volume was calculated and quantitative perfusion parameters were extracted by fitting extended Tofts' pharmacokinetic model. Differences in volume and DCE-MRI parameters between patients and controls were tested by linear regression analyses. IPFP edema and effusion were analyzed identically. Results Forty-three controls and 35 PFP patients were included. Mean IPFP volume was 26.04 (4.18) mL in control subjects and 27.52 (5.37) mL in patients. Median Ktrans was 0.017 (0.016) min-1 in control subjects and 0.016 (0.020) min-1 in patients. None of the differences in volume and perfusion parameters were statistically significant. Knees with effusion showed a higher perfusion of the IPFP compared to knees without effusion in patients only. Conclusions The IPFP has been implicated as source of knee pain, but higher DCE-MR blood perfusion, an imaging biomarker of inflammation, and larger volume are not associated with PFP. Patient's knees with effusion showed a higher perfusion, pointing towards inflammation.
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Affiliation(s)
| | - Bas A de Vries
- Department of Radiology & Nuclear Medicine, Erasmus MC, Rotterdam, The Netherlands
| | - Dirk H J Poot
- Department of Radiology & Nuclear Medicine, Erasmus MC, Rotterdam, The Netherlands
| | | | | | - Gabriel P Krestin
- Department of Radiology & Nuclear Medicine, Erasmus MC, Rotterdam, The Netherlands
| | - Edwin H G Oei
- Department of Radiology & Nuclear Medicine, Erasmus MC, Rotterdam, The Netherlands
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14
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Macri EM, Neogi T, Tolstykh I, Widjajahakim R, Lewis CE, Torner JC, Nevitt MC, Roux M, Stefanik JJ. Relation of Patellofemoral Joint Alignment, Morphology, and Radiographic Osteoarthritis to Frequent Anterior Knee Pain: Data from the Multicenter Osteoarthritis Study. Arthritis Care Res (Hoboken) 2020; 72:1066-1073. [PMID: 31199605 PMCID: PMC6911012 DOI: 10.1002/acr.24004] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/01/2019] [Accepted: 06/11/2019] [Indexed: 01/31/2023]
Abstract
OBJECTIVE Patellofemoral (PF) alignment and trochlear morphology are associated with PF osteoarthritis (OA) and knee pain, but whether they are associated with localized anterior knee pain is unknown, which is believed to be a symptom specific to PF joint pathology. We therefore aimed to evaluate the relation of PF alignment and morphology, as well as PFOA and tibiofemoral OA, to anterior knee pain. METHODS The Multicenter Osteoarthritis Study is a cohort study of individuals with, or at risk for, knee OA. We evaluated cross-sectional associations of PF alignment, trochlear morphology, and PF and tibiofemoral radiographic OA, with localized anterior knee pain (defined with a pain map). We used 2 approaches: a within-person knee-matched evaluation of participants with unilateral anterior knee pain (conditional logistic regression), and a cohort approach comparing those with anterior knee pain to those without (binomial regression). RESULTS With the within-person knee-matched approach (n = 110; 64% women, mean age 70 years, body mass index [BMI] 30.9), PF alignment, morphology, and tibiofemoral OA were not associated with unilateral anterior knee pain. Radiographic PFOA was associated with pain, odds ratio 5.3 (95% confidence interval [95% CI] 1.6-18.3). Using the cohort approach (n = 1,818; 7% of knees with anterior knee pain, 59% women, mean age 68 years, BMI 30.4), results were similar: only PFOA was associated with pain, with a prevalence ratio of 2.2 (95% CI 1.4-3.4). CONCLUSION PF alignment and trochlear morphology were not associated with anterior knee pain in individuals with, or at risk for, knee OA. Radiographic PFOA, however, was associated with pain, suggesting that features of OA, more so than mechanical features, may contribute to localized symptoms.
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Affiliation(s)
- Erin M Macri
- University of Delaware, Newark, and Erasmus MC, Rotterdam, The Netherlands
| | - Tuhina Neogi
- School of Medicine, Boston University, Boston, Massachusetts
| | | | | | | | | | | | - Michael Roux
- Hospital for Special Surgery, New York, New York
| | - Joshua J Stefanik
- University of Delaware, Newark, and School of Medicine, Boston University and Northeastern University, Boston, Massachusetts
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15
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Kijowski R, Demehri S, Roemer F, Guermazi A. Osteoarthritis year in review 2019: imaging. Osteoarthritis Cartilage 2020; 28:285-295. [PMID: 31877380 DOI: 10.1016/j.joca.2019.11.009] [Citation(s) in RCA: 26] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/31/2019] [Revised: 10/17/2019] [Accepted: 11/15/2019] [Indexed: 02/02/2023]
Abstract
OBJECTIVE To provide a narrative review of original articles on osteoarthritis (OA) imaging published between April 1, 2018 and March 30, 2019. METHODS All original research articles on OA imaging published in English between April 1, 2018 and March 30, 2019 were identified using a PubMed database search. The search terms of "Osteoarthritis" or "OA" were combined with the search terms "Radiography", "X-Rays", "Magnetic Resonance Imaging", "MRI", "Ultrasound", "US", "Computed Tomography", "Dual Energy X-Ray Absorptiometry", "DXA", "DEXA", "CT", "Nuclear Medicine", "Scintigraphy", "Single-Photon Emission Computed Tomography", "SPECT", "Positron Emission Tomography", "PET", "PET-CT", or "PET-MRI". Articles were reviewed to determine relevance based upon the following criteria: 1) study involved human subjects with OA or risk factors for OA and 2) study involved imaging to evaluate OA disease status or OA treatment response. Relevant articles were ranked according to scientific merit, with the best publications selected for inclusion in the narrative report. RESULTS The PubMed search revealed a total of 1257 articles, of which 256 (20.4%) were considered relevant to OA imaging. Two-hundred twenty-six (87.1%) articles involved the knee joint, while 195 (76.2%) articles involved the use of magnetic resonance imaging (MRI). The proportion of published studies involving the use of MRI was higher than previous years. An increasing number of articles were also published on imaging of subjects with joint injury and on deep learning application in OA imaging. CONCLUSION MRI and other imaging modalities continue to play an important role in research studies designed to better understand the pathogenesis, progression, and treatment of OA.
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Affiliation(s)
- R Kijowski
- Department of Radiology, University of Wisconsin-Madison, Madison, WI, USA.
| | - S Demehri
- Department of Radiology, Johns Hopkins University, Baltimore, MD, USA.
| | - F Roemer
- Department of Radiology, Boston University, Boston, MA, USA; Department of Radiology, Friedrich-Alexander University Erlangen-Nürnberg (FAU), Universitätsklinikum Erlangen, Erlangen, Germany.
| | - A Guermazi
- Department of Radiology, Boston University, Boston, MA, USA.
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16
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Takahashi I, Matsuzaki T, Kuroki H, Hoso M. Disuse histological changes of an unloading environment on joint components in rat knee joints. OSTEOARTHRITIS AND CARTILAGE OPEN 2019; 1:100008. [DOI: 10.1016/j.ocarto.2019.100008] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2019] [Accepted: 10/30/2019] [Indexed: 01/01/2023] Open
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17
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Masaki T, Takahashi K, Hashimoto S, Ikuta F, Watanabe A, Kiuchi S, Okuaki T, Mochizuki Y, Takai S. Volume change in infrapatellar fat pad is associated not with obesity but with cartilage degeneration. J Orthop Res 2019; 37:593-600. [PMID: 30537040 DOI: 10.1002/jor.24201] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/10/2018] [Accepted: 11/28/2018] [Indexed: 02/04/2023]
Abstract
Infrapatellar fat pad has been implicated in knee osteoarthritis. We examined whether infrapatellar fat pad volume is associated with quantitative cartilage changes using magnetic resonance imaging T1ρ mapping. Fifty-eight knees of knee pain patients (19 men, 39 women, mean age 57.0 [range 29-85] years) who were conservatively managed and had >1 T1ρ mapping images taken over time were evaluated. We used three slices from the medial femoral and tibial cartilage; areas showing T1ρ values <130 ms and >50 ms were designated as having cartilage degeneration. Cases were categorized into three groups: Improvement, No Change, and Deterioration. Fat-suppressed T2-weighted sagittal magnetic resonance images were used for measuring infrapatellar fat pad volume. Percent change in infrapatellar fat pad volume was -5.01 ± 5.66%, -2.06 ± 4.92%, and 0.05 ± 6.09% in the Improvement (n = 22), No Change (n = 22), and Deterioration (n = 14) groups, respectively, demonstrating significantly reduced infrapatellar fat pad volume in the Improvement group (p < 0.05). Multivariate regression analyses revealed that the percent change in infrapatellar fat pad volume significantly affected T1ρ change category independent of age, sex, follow-up period, baseline infrapatellar fat pad volume, and Kellgren-Lawrence grade. Infrapatellar fat pad volume and obesity or body weight change showed no correlation. Infrapatellar fat pad volume was reduced in patients with improved quantitative cartilage assessment on magnetic resonance imaging T1ρ mapping. This is the first study demonstrating associations between quantitative cartilage changes and infrapatellar fat pad morphological changes, suggesting a detrimental role of infrapatellar fat pad volume in articular cartilage degeneration. © 2018 Orthopaedic Research Society. Published by Wiley Periodicals, Inc. J Orthop Res.
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Affiliation(s)
- Tadashi Masaki
- Department of Orthopaedic Surgery, Nippon Medical School, 1-1-5 Sendagi, Bunkyo-ku, Tokyo, 113-8603, Japan.,Department of Orthopaedic Surgery, University of Health and Welfare Hospital, 537-3 Iguchi, Nasu-shiobara, Tochigi, 329-2763, Japan
| | - Kenji Takahashi
- Department of Orthopaedic Surgery, University of Health and Welfare Hospital, 537-3 Iguchi, Nasu-shiobara, Tochigi, 329-2763, Japan.,AIC Yaesu Clinic, 2-1-18 Nihonbashi, Chuo-ku, Tokyo, 103-0027, Japan
| | - Sanshiro Hashimoto
- Minami-Shinjuku Orthopaedic Rehabilitation Clinic, 2-16-7 Yoyogi, Shibuya-ku, Tokyo, 151-0053, Japan
| | - Futoshi Ikuta
- Department of Orthopaedic Surgery, Nippon Medical School, 1-1-5 Sendagi, Bunkyo-ku, Tokyo, 113-8603, Japan
| | - Atsuya Watanabe
- Department of General Medical Services, Graduate School of Medicine, Chiba University, 1-8-1 Inohana, Chuo-ku, Chiba, 260-8670, Japan
| | - Shinji Kiuchi
- AIC Yaesu Clinic, 2-1-18 Nihonbashi, Chuo-ku, Tokyo, 103-0027, Japan
| | - Tomoyuki Okuaki
- Philips Healthcare, MR Clinical Science, 2-13-37 Kounan, Minato-ku, Tokyo, 108-8507, Japan
| | - Yusuke Mochizuki
- Department of Orthopaedic Surgery, Nippon Medical School, 1-1-5 Sendagi, Bunkyo-ku, Tokyo, 113-8603, Japan
| | - Shinro Takai
- Department of Orthopaedic Surgery, Nippon Medical School, 1-1-5 Sendagi, Bunkyo-ku, Tokyo, 113-8603, Japan
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18
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Zhou Z, Zhao G, Kijowski R, Liu F. Deep convolutional neural network for segmentation of knee joint anatomy. Magn Reson Med 2018; 80:2759-2770. [PMID: 29774599 PMCID: PMC6342268 DOI: 10.1002/mrm.27229] [Citation(s) in RCA: 111] [Impact Index Per Article: 18.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2017] [Revised: 03/29/2018] [Accepted: 03/31/2018] [Indexed: 12/21/2022]
Abstract
PURPOSE To describe and evaluate a new segmentation method using deep convolutional neural network (CNN), 3D fully connected conditional random field (CRF), and 3D simplex deformable modeling to improve the efficiency and accuracy of knee joint tissue segmentation. METHODS A segmentation pipeline was built by combining a semantic segmentation CNN, 3D fully connected CRF, and 3D simplex deformable modeling. A convolutional encoder-decoder network was designed as the core of the segmentation method to perform high resolution pixel-wise multi-class tissue classification for 12 different joint structures. The 3D fully connected CRF was applied to regularize contextual relationship among voxels within the same tissue class and between different classes. The 3D simplex deformable modeling refined the output from 3D CRF to preserve the overall shape and maintain a desirable smooth surface for joint structures. The method was evaluated on 3D fast spin-echo (3D-FSE) MR image data sets. Quantitative morphological metrics were used to evaluate the accuracy and robustness of the method in comparison to the ground truth data. RESULTS The proposed segmentation method provided good performance for segmenting all knee joint structures. There were 4 tissue types with high mean Dice coefficient above 0.9 including the femur, tibia, muscle, and other non-specified tissues. There were 7 tissue types with mean Dice coefficient between 0.8 and 0.9 including the femoral cartilage, tibial cartilage, patella, patellar cartilage, meniscus, quadriceps and patellar tendon, and infrapatellar fat pad. There was 1 tissue type with mean Dice coefficient between 0.7 and 0.8 for joint effusion and Baker's cyst. Most musculoskeletal tissues had a mean value of average symmetric surface distance below 1 mm. CONCLUSION The combined CNN, 3D fully connected CRF, and 3D deformable modeling approach was well-suited for performing rapid and accurate comprehensive tissue segmentation of the knee joint. The deep learning-based segmentation method has promising potential applications in musculoskeletal imaging.
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Affiliation(s)
- Zhaoye Zhou
- Department of Biomedical Engineering, University of Minnesota, Minneapolis, Minnesota
| | - Gengyan Zhao
- Departments of Radiology, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin
| | - Richard Kijowski
- Departments of Radiology, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin
| | - Fang Liu
- Departments of Radiology, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin
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19
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Fontanella CG, Belluzzi E, Rossato M, Olivotto E, Trisolino G, Ruggieri P, Rubini A, Porzionato A, Natali A, De Caro R, Vettor R, Ramonda R, Macchi V, Favero M. Quantitative MRI analysis of infrapatellar and suprapatellar fat pads in normal controls, moderate and end-stage osteoarthritis. Ann Anat 2018; 221:108-114. [PMID: 30292837 DOI: 10.1016/j.aanat.2018.09.007] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2018] [Revised: 09/17/2018] [Accepted: 09/18/2018] [Indexed: 12/16/2022]
Abstract
The aim of this study was to analyze the magnetic resonance imaging (MRI) volumetric and morphometric characteristics of the infrapatellar fat pad (IFP) and the suprapatellar fat pad (SFP) in normal controls, moderate and end-stage osteoarthritis (OA) patients. Forty-four MRI images of the three groups were collected: a) 17 patients undergoing meniscectomy with Outerbridge score 0 (control group); b) 15 patients undergoing meniscectomy with Outerbridge score 3/4 (moderate OA group); and c) 12 patients undergoing total knee replacement (end-stage OA group). Volume, depth, femoral and tibial arch lengths of IFP were quantified. The hypointense IFP signals were also scored. The SFP volume, oblique, antero-posterior and cranio-caudal lengths were determined. IFP and SFP characteristics were compared between groups. A decrease of IFP volume, depth, femoral, and tibial arch lengths in moderate and end-stage OA compared to controls were observed. A difference in IFP hypointense signal was found between groups. No differences were found in SFP characteristics between the groups. In controls and moderate OA patients, correlations were found among the different MRI characteristics of both IFP and SFP, while in the end-stage OA group correlations were found only in SFP. We evidenced differences of the IFP MRI morphometric characteristics between the groups analyzed, supporting an important role of IFP in OA pathology and progression. On the contrary, no differences were highlighted in SFP analysis suggesting that this fat pad is not clearly involved in OA, probably due to its peculiar localization and different function.
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Affiliation(s)
- Chiara Giulia Fontanella
- Department of Biomedical Sciences, University of Padova, Via Bassi 58, I-35131 Padova, Italy; Centre for Mechanics of Biological Materials, University of Padova, Via A. Gabelli 65, 35127 Padova, Italy
| | - Elisa Belluzzi
- Rheumatology Unit, Department of Medicine - DIMED, University Padova, 35128 Padova, Italy; Musculoskeletal Pathology and Oncology Laboratory, Department of Orthopedics and Orthopedic Oncology, 35128 University of Padova, Italy
| | - Marco Rossato
- Clinica Medica 3, Department of Medicine - DIMED, University of Padova, 35128 Padova, Italy
| | - Eleonora Olivotto
- RAMSES Laboratory, RIT Department, IRCCS Istituto Ortopedico Rizzoli, Bologna, Italy
| | - Giovanni Trisolino
- Department. of Pediatric Orthopedics and Traumatology, IRCCS Istituto Ortopedico Rizzoli Bologna, Italy
| | - Pietro Ruggieri
- Department of Orthopedics and Orthopedic Oncology, 35128 University of Padova, Italy
| | - Alessandro Rubini
- Department of Biomedical Sciences, University of Padova, Via Bassi 58, I-35131 Padova, Italy; Centre for Mechanics of Biological Materials, University of Padova, Via A. Gabelli 65, 35127 Padova, Italy
| | - Andrea Porzionato
- Institute of Human Anatomy, Department of Neuroscience, University of Padova, Via A. Gabelli 65, 35127 Padova, Italy
| | - Arturo Natali
- Centre for Mechanics of Biological Materials, University of Padova, Via A. Gabelli 65, 35127 Padova, Italy; Department of Industrial Engineering, University of Padova, Via Venezia 1, I-35131 Padova, Italy
| | - Raffaele De Caro
- Institute of Human Anatomy, Department of Neuroscience, University of Padova, Via A. Gabelli 65, 35127 Padova, Italy
| | - Roberto Vettor
- Clinica Medica 3, Department of Medicine - DIMED, University of Padova, 35128 Padova, Italy
| | - Roberta Ramonda
- Rheumatology Unit, Department of Medicine - DIMED, University Padova, 35128 Padova, Italy
| | - Veronica Macchi
- Institute of Human Anatomy, Department of Neuroscience, University of Padova, Via A. Gabelli 65, 35127 Padova, Italy.
| | - Marta Favero
- Rheumatology Unit, Department of Medicine - DIMED, University Padova, 35128 Padova, Italy
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