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Yiu C, Griffith JF, Xiao F, Shi L, Zhou B, Wu S, Tam LS. Automated quantification of wrist bone marrow oedema, pre- and post-treatment, in early rheumatoid arthritis. Rheumatol Adv Pract 2024; 8:rkae073. [PMID: 38915843 PMCID: PMC11194532 DOI: 10.1093/rap/rkae073] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2024] [Accepted: 05/22/2024] [Indexed: 06/26/2024] Open
Abstract
Objective Bone inflammation (osteitis) in early RA (ERA) manifests as bone marrow oedema (BME) and precedes the development of bone erosion. In this prospective, single-centre study, we developed an automated post-processing pipeline for quantifying the severity of wrist BME on T2-weighted fat-suppressed MRI. Methods A total of 80 ERA patients [mean age 54 years (s.d. 12), 62 females] were enrolled at baseline and 49 (40 females) after 1 year of treatment. For automated bone segmentation, a framework based on a convolutional neural network (nnU-Net) was trained and validated (5-fold cross-validation) for 15 wrist bone areas at baseline in 60 ERA patients. For BME quantification, BME was identified by Gaussian mixture model clustering and thresholding. BME proportion (%) and relative BME intensity within each bone area were compared with visual semi-quantitative assessment of the RA MRI score (RAMRIS). Results For automated wrist bone area segmentation, overall bone Sørensen-Dice similarity coefficient was 0.91 (s.d. 0.02) compared with ground truth manual segmentation. High correlation (Pearson correlation coefficient r = 0.928, P < 0.001) between visual RAMRIS BME and automated BME proportion assessment was found. The automated BME proportion decreased after treatment, correlating highly (r = 0.852, P < 0.001) with reduction in the RAMRIS BME score. Conclusion The automated model developed had an excellent segmentation performance and reliable quantification of both the proportion and relative intensity of wrist BME in ERA patients, providing a more objective and efficient alternative to RAMRIS BME scoring.
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Affiliation(s)
- Chungwun Yiu
- Department of Imaging and Interventional Radiology, Chinese University of Hong Kong, Hong Kong, China
| | - James Francis Griffith
- Department of Imaging and Interventional Radiology, Chinese University of Hong Kong, Hong Kong, China
| | - Fan Xiao
- Department of Imaging and Interventional Radiology, Chinese University of Hong Kong, Hong Kong, China
| | - Lin Shi
- Department of Imaging and Interventional Radiology, Chinese University of Hong Kong, Hong Kong, China
| | - Bingjing Zhou
- Department of Imaging and Interventional Radiology, Chinese University of Hong Kong, Hong Kong, China
| | - Su Wu
- Department of Imaging and Interventional Radiology, Chinese University of Hong Kong, Hong Kong, China
| | - Lai-Shan Tam
- Rheumatology Division, Faculty of Medicine, Chinese University of Hong Kong, Hong Kong, China
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Karimi A, El-Abtah M, Sinkler M, Faraji N, Voos J, Harlow E, Miskovsky S. Asymptomatic Bone Marrow Edema in Weight-bearing Bones in Athletes and Military Trainees: A Systematic Literature Review. Int J Sports Med 2023; 44:683-691. [PMID: 37263276 DOI: 10.1055/a-2013-2226] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
Abstract
Asymptomatic bone marrow edema (aBME) is a non-specific radiographic finding often found in athletes. Although aBME may represent the body's physiological response to training load, the etiology, MRI characteristics, and natural history of aBME remain unknown. To better characterize aBME in the lower extremities of military trainees and athletes. A systematic literature review in accordance with PRISMA guidelines was performed to identify primary research articles reporting on aBME in the lower extremities of athletes and military trainees. We identified 347 unique articles and after applying inclusion and exclusion criteria, 10 articles were included for qualitative synthesis. There were a total of 444 patients with an average age of 28.4±9.6 included. The most commonly used MRI sequences were proton-density with fat-saturation and T1-weighted imaging. The pattern of BME was inconsistently described, with various classification schemas used. The changes in aBME during longitudinal follow-up were dynamic and demonstrated both radiographic progression and regression. aBME is a highly prevalent and radiographically dynamic entity observed in high-level athletes and military trainees. Although follow-up was limited in the included studies, aBME may represent a natural, non-pathologic, reaction in response to specific biomechanical stressors.
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Affiliation(s)
- Amir Karimi
- Medical School, Case Western Reserve University School of Medicine, Cleveland, United States
| | - Mohamed El-Abtah
- Medical School, Case Western Reserve University School of Medicine, Cleveland, United States
| | - Margaret Sinkler
- Department Of Orthopedic Surgery, University Hospitals Cleveland Medical Center, Cleveland, United States
| | - Navid Faraji
- Department of Diagnostic Radiology, Division of Musculoskeletal Radiology, University Hospitals Cleveland Medical Center, Cleveland, United States
| | - James Voos
- Department Of Orthopedic Surgery, University Hospitals Cleveland Medical Center, Cleveland, United States
- University Hospitals Drusinsky Sports Medicine Institute, Cleveland, United States
| | - Ethan Harlow
- Department Of Orthopedic Surgery, University Hospitals Cleveland Medical Center, Cleveland, United States
| | - Shana Miskovsky
- Department Of Orthopedic Surgery, University Hospitals Cleveland Medical Center, Cleveland, United States
- University Hospitals Drusinsky Sports Medicine Institute, Cleveland, United States
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Vladimirov N, Brui E, Levchuk A, Al-Haidri W, Fokin V, Efimtcev A, Bendahan D. CNN-based fully automatic wrist cartilage volume quantification in MR images: A comparative analysis between different CNN architectures. Magn Reson Med 2023; 90:737-751. [PMID: 37094028 DOI: 10.1002/mrm.29671] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2022] [Revised: 03/17/2023] [Accepted: 03/26/2023] [Indexed: 04/26/2023]
Abstract
PURPOSE Automatic measurement of wrist cartilage volume in MR images. METHODS We assessed the performance of four manually optimized variants of the U-Net architecture, nnU-Net and Mask R-CNN frameworks for the segmentation of wrist cartilage. The results were compared to those from a patch-based convolutional neural network (CNN) we previously designed. The segmentation quality was assessed on the basis of a comparative analysis with manual segmentation. The best networks were compared using a cross-validation approach on a dataset of 33 3D VIBE images of mostly healthy volunteers. Influence of some image parameters on the segmentation reproducibility was assessed. RESULTS The U-Net-based networks outperformed the patch-based CNN in terms of segmentation homogeneity and quality, while Mask R-CNN did not show an acceptable performance. The median 3D DSC value computed with the U-Net_AL (0.817) was significantly larger than DSC values computed with the other networks. In addition, the U-Net_AL provided the lowest mean volume error (17%) and the highest Pearson correlation coefficient (0.765) with respect to the ground truth values. Of interest, the reproducibility computed using U-Net_AL was larger than the reproducibility of the manual segmentation. Moreover, the results indicate that the MRI-based wrist cartilage volume is strongly affected by the image resolution. CONCLUSIONS U-Net CNN with attention layers provided the best wrist cartilage segmentation performance. In order to be used in clinical conditions, the trained network can be fine-tuned on a dataset representing a group of specific patients. The error of cartilage volume measurement should be assessed independently using a non-MRI method.
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Affiliation(s)
- Nikita Vladimirov
- School of Physics and Engineering, ITMO University, Saint-Petersburg, Russia
| | - Ekaterina Brui
- School of Physics and Engineering, ITMO University, Saint-Petersburg, Russia
| | - Anatoliy Levchuk
- School of Physics and Engineering, ITMO University, Saint-Petersburg, Russia
- Department of Radiology, Federal Almazov North-West Medical Research Center, Saint-Petersburg, Russia
| | - Walid Al-Haidri
- School of Physics and Engineering, ITMO University, Saint-Petersburg, Russia
| | - Vladimir Fokin
- School of Physics and Engineering, ITMO University, Saint-Petersburg, Russia
- Department of Radiology, Federal Almazov North-West Medical Research Center, Saint-Petersburg, Russia
| | - Aleksandr Efimtcev
- School of Physics and Engineering, ITMO University, Saint-Petersburg, Russia
- Department of Radiology, Federal Almazov North-West Medical Research Center, Saint-Petersburg, Russia
| | - David Bendahan
- Centre de Résonance Magnétique Biologique et Médicale, Aix-Marseille Universite, CNRS, Marseille, France
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Patterns of Vertebral Bone Marrow Edema in the Normal Healing Process of Lumbar Interbody Fusion: Baseline Data for Diagnosis of Pathological Events. Spine (Phila Pa 1976) 2023; 48:358-363. [PMID: 36730742 DOI: 10.1097/brs.0000000000004534] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/16/2022] [Accepted: 10/29/2022] [Indexed: 02/04/2023]
Abstract
STUDY DESIGN Retrospective investigation using a prospectively collected database. OBJECTIVE To examine the appearance and characteristics of vertebral bone marrow edema (BME) in the normal healing of lumbar interbody fusion. SUMMARY OF BACKGROUND DATA Although BME in pathological spinal conditions has been well-documented, the patterns and characteristics of BME in the normal healing process of spinal fusion remains unexplored. MATERIALS AND METHODS We reviewed imaging from 225 patients with normal healing following posterior lumbar interbody fusion or transforaminal lumbar interbody fusion. BME was identified on magnetic resonance imaging at the third postoperative week and categorized with respect to its appearance, including assessment of area and extension within the relevant vertebrae. RESULTS Three hundred eighty-nine of the 450 instrumented vertebrae (86.4%) displayed evidence BME. All instances of BME were associated with the area of contact with the endplate. The average extent of BME was 32.7±1.0%. BME within normal healing following interbody fusion could be categorized into four types: no edema (13.6%), anterior corner (36.6%), around-the-cage focal (48.0%), and diffuse (1.8%). Anterior corner BME was significantly associated with instances of single cage placement than in dual cages (42.6% vs. 24.7%, P =0.0002). Single cages had a significantly higher rate of BME than dual cages (92.0% vs. 75.3%, P <0.0001). The extent of BME was significantly greater in the single cage cohort (36.9% vs. 24.2% in dual cages, P <0.0001). CONCLUSIONS This serves as the first study demonstrating the patterns of BME associated with normal healing following lumbar interbody fusion procedures. Anterior corner BME and around-the-cage focal BME were the most common patterns encountered, with diffuse BME a relatively rare pattern. These findings might contribute to the better differentiation of postoperative pathological events from normal healing following lumbar interbody fusion. LEVEL OF EVIDENCE 4.
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Haj‐Mirzaian A, Kubassova O, Boesen M, Carrino J, Bird P. Computer-Assisted Image Analysis in Assessment of Peripheral Joint MRI in Inflammatory Arthritis: A Systematic Review and Meta-analysis. ACR Open Rheumatol 2022; 4:721-734. [PMID: 35689340 PMCID: PMC9374055 DOI: 10.1002/acr2.11450] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2021] [Revised: 03/29/2022] [Accepted: 04/15/2022] [Indexed: 12/01/2022] Open
Abstract
OBJECTIVE To summarize the feasibility of computer-assisted quantification of joint pathologies on magnetic resonance imaging (MRI) in patients with inflammatory arthritis by evaluating the published data on reliability, validity, and feasibility. METHODS A systematic literature search was performed for original articles published from January 1, 1985, to January 1, 2021. We selected studies in which patients with inflammatory arthritis were enrolled, and arthritis-related structural damage/synovitis in peripheral joints was assessed on non-contrast-enhanced, contrast-enhanced (CE), or dynamic CE (DCE)-MRI using (semi)automated methods. Data were pooled using random-effects model. RESULTS Twenty-eight studies consisting of 1342 MRIs were included (mean age, 54.8 years; 66.7% female; duration of arthritis, 3.6 years). Among clinical/laboratory factors, synovial membrane volume (SV) was moderately correlated with erthrocyte sedimentation rate (ESR) level (P < 0.01). Pooled analysis showed an overall excellent intra- and inter-reader reliability for computer-aided quantification of bone erosion volume (BEV; r = 0.97 [95% CI: 0.92-0.99], 0.93 [0.87-0.97]), SV (r = 0.98 [95% CI: 0.90-0.99], 0.86 [0.78-0.91]), and DCE-MRI perfusion parameters (r = 0.96-0.99). Meta-regression showed that computer-aided and manual methods provide comparable reliability (P > 0.05). Computer-aided measurement of BEV (r = 0.92), SV (r = 0.82), and DCE-MRI biomarkers (r = 0.72 N-total; r = 0.74 N-plateau; r = 0.64 N-washout) were significantly correlated with the Rheumatoid Arthritis Magnetic Resonance Imaging Score (RAMRIS; P < 0.01), allowing for earlier assessment of drug efficacy. On average, (semi)automated analysis of BEV/SV took 17 minutes (vs. 9 minutes for the RAMRIS) and DCE-MRI took 4 minutes (vs. 33 minutes for manual assessment). CONCLUSION Computer-aided image quantification technologies demonstrate excellent reliability and validity when used to quantify MRI pathologies of peripheral joints in patients with inflammatory arthritis. Computer-aided evaluation of inflammatory arthritis is an emerging field and should be considered as a viable complement to conventional observer-based scoring methods for clinical trials application.
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Affiliation(s)
| | | | - Mikael Boesen
- University Hospital Bispebjerg and Frederiksberg; The Parker InstituteCopenhagenDenmark
| | - John Carrino
- Hospital for Special SurgeryHackensackNew Jersey
| | - Paul Bird
- University of New South WalesSydneyNew South WalesAustralia
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Marage L, Lasbleiz J, Fondin M, Lederlin M, Gambarota G, Saint-Jalmes H. Voxel-based mapping of five MR biomarkers in the wrist bone marrow. MAGMA (NEW YORK, N.Y.) 2021; 34:729-740. [PMID: 33709226 DOI: 10.1007/s10334-020-00901-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/08/2020] [Revised: 11/30/2020] [Accepted: 12/02/2020] [Indexed: 06/12/2023]
Abstract
OBJECTIVE MRI is a reliable and accurate technique to characterize rheumatoid arthritis. The aim of this study was to provide voxel-by-voxel 3D maps of the proton density fat fraction (PDFF), the T1 of water (T1W), the T1 of fat (T1F), the T2* of water (T2*W), the T2* of fat (T2*F) in the wrist bone marrow. MATERIALS AND METHODS The experiments were conducted on 14 healthy volunteers (mean age: 24 ± 4). The data were acquired at 1.5 T using two optimized four-echo 3D 1.2 × 1.2 × 1.2 mm3-isotropic spoiled gradient sequences. A repeatability study was carried out. The measurements were done using a homemade parametric viewer software. RESULTS The inter-volunteer results were, on average: PDFF = 86 ± 3%, T1W = 441 ± 113 ms, T1F = 245 ± 19 ms, T2*W = 6 ± 1 ms and T2*F = 16 ± 3 ms. The coefficients of variation were for fat based biomarkers CVPDFF < 5%, CVT1F < 15% and CVT2*F < 10% in the repeatability study. DISCUSSION The protocol and quantification tool proposed in this study provide high-resolution voxel-by-voxel 3D maps of five biomarkers in the wrist in less than 4 min of acquisition.
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Affiliation(s)
- Louis Marage
- CLCC Eugène Marquis, Inserm, LTSI - UMR 1099, Univ Rennes, CHU Rennes, 2 Av. du Professeur Léon Bernard, 35000, Rennes, France.
| | - Jeremy Lasbleiz
- CLCC Eugène Marquis, Inserm, LTSI - UMR 1099, Univ Rennes, CHU Rennes, 2 Av. du Professeur Léon Bernard, 35000, Rennes, France
| | - Maxime Fondin
- CLCC Eugène Marquis, Inserm, LTSI - UMR 1099, Univ Rennes, CHU Rennes, 2 Av. du Professeur Léon Bernard, 35000, Rennes, France
| | - Mathieu Lederlin
- CLCC Eugène Marquis, Inserm, LTSI - UMR 1099, Univ Rennes, CHU Rennes, 2 Av. du Professeur Léon Bernard, 35000, Rennes, France
| | - Giulio Gambarota
- CLCC Eugène Marquis, Inserm, LTSI - UMR 1099, Univ Rennes, CHU Rennes, 2 Av. du Professeur Léon Bernard, 35000, Rennes, France
| | - Hervé Saint-Jalmes
- CLCC Eugène Marquis, Inserm, LTSI - UMR 1099, Univ Rennes, CHU Rennes, 2 Av. du Professeur Léon Bernard, 35000, Rennes, France
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Quantification of bone marrow edema in rheumatoid arthritis by using high-speed T2-corrected multiecho acquisition of 1H magnetic resonance spectroscopy: a feasibility study. Clin Rheumatol 2021; 40:4639-4647. [PMID: 34155572 DOI: 10.1007/s10067-021-05764-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2020] [Revised: 04/06/2021] [Accepted: 05/03/2021] [Indexed: 10/21/2022]
Abstract
OBJECTIVE To determine whether high-speed T2-corrected multiecho (HISTO) sequences can quantify bone marrow edema (BME) in the capitate bone in rheumatoid arthritis (RA), and whether the HISTO fat fraction (FF) reflects therapeutic effectiveness. METHODS In this prospective study, 25 RA patients (19 women; average age, 45.08 ± 13.48 years) underwent 3.0-T MRI with HISTO at the baseline and after 4, 8, and 12 weeks of treatment. Rheumatoid factor (RF), erythrocyte sedimentation rate (ESR), C-reactive protein (CRP), platelet (PLT) count, and 28-joint Disease Activity Score using ESR (DAS28-ESR) were recorded on the day of each MRI examination by a rheumatologist blinded to the MRI findings. In addition, 21 healthy subjects (15 women; age, 49.17 ± 6.56 years) underwent only the HISTO sequence at a single time point. RESULTS HISTO FF values were significantly higher in the control group (74.5% ± 3.1%; range, 68.6-79.3%) than in the patient group (55.8% ± 17.7%; range, 15.6-79.0%) at the baseline (independent-samples t-test: t = 5.257, P = 0.000). The changes in HISTO FF and DAS28-ESR showed moderate negative correlations with each other at 4, 8, and 12 weeks, and all of them were statistically significant (P < 0.05). As the HISTO FF increased, the DAS28-ESR decreased. CONCLUSION The HISTO sequence can measure the bone marrow FF of the wrist joint bones in RA patients. The HISTO FF value increased as the DAS28-ESR decreased. The HISTO sequence may help quantify BME in RA and help monitor the effectiveness of RA treatment. Key Points •The HISTO sequence could measure the bone marrow FF of the wrist joint bones. •FF value increased as the DAS28-ESR decreased in RA patients. •The HISTO sequence can monitor the therapeutic effect of RA.
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Maraghelli D, Brandi ML, Matucci Cerinic M, Peired AJ, Colagrande S. Edema-like marrow signal intensity: a narrative review with a pictorial essay. Skeletal Radiol 2021; 50:645-663. [PMID: 33029648 PMCID: PMC7875957 DOI: 10.1007/s00256-020-03632-4] [Citation(s) in RCA: 20] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/07/2020] [Revised: 09/24/2020] [Accepted: 09/24/2020] [Indexed: 02/02/2023]
Abstract
The term edema-like marrow signal intensity (ELMSI) represents a general term describing an area of abnormal signal intensity at MRI. Its appearance includes absence of clear margins and the possibility of exceeding well-defined anatomical borders (for example, physeal scars). We can define "ELMSI with unknown cause" an entity where the characteristic MR appearance is associated with the absence of specific signs of an underlying condition. However, it is more often an important finding indicating the presence of an underlying disease, and we describe this case as "ELMSI with known cause." It presents a dynamic behavior and its evolution can largely vary. It initially corresponds to an acute inflammatory response with edema, before being variably replaced by more permanent marrow remodeling changes such as fibrosis or myxomatous connective tissue that can occur over time. It is important to study ELMSI variations over time in order to evaluate the activity state and therapeutic response of an inflammatory chronic joint disease, the resolution of a trauma, and the severity of an osteoarthritis. We propose a narrative review of the literature dealing with various subjects about this challenging topic that is imaging, temporal evolution, etiology, differential diagnoses, and possible organization, together with a pictorial essay.
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Affiliation(s)
- Davide Maraghelli
- Department of Experimental and Clinical Biomedical Sciences, Radiodiagnostic Unit n. 2, University of Florence - Azienda Ospedaliero-Universitaria Careggi, Largo Brambilla 3, Florence, 50134, Italy
| | - Maria Luisa Brandi
- Department of Experimental and Clinical Medicine, Unit of Bone and Mineral Diseases, University of Florence - Azienda Ospedaliero- Universitaria Careggi, Largo Brambilla 3, Florence, 50134, Italy
| | - Marco Matucci Cerinic
- Department of Experimental and Clinical Biomedical Sciences Division of Rheumatology, University of Florence - Azienda Ospedaliero-Universitaria Careggi, Largo Brambilla 3, Florence, 50134, Italy
| | - Anna Julie Peired
- Department of Experimental and Clinical Biomedical Sciences, Radiodiagnostic Unit n. 2, University of Florence - Azienda Ospedaliero-Universitaria Careggi, Largo Brambilla 3, Florence, 50134, Italy
| | - Stefano Colagrande
- Department of Experimental and Clinical Biomedical Sciences, Radiodiagnostic Unit n. 2, University of Florence - Azienda Ospedaliero-Universitaria Careggi, Largo Brambilla 3, Florence, 50134, Italy.
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Lim W, Saifuddin A. Review article: the differential diagnosis of bone marrow edema on wrist MRI. Skeletal Radiol 2019; 48:1525-1539. [PMID: 30903260 DOI: 10.1007/s00256-019-03204-1] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/05/2018] [Revised: 02/01/2019] [Accepted: 03/05/2019] [Indexed: 02/02/2023]
Abstract
There is a large variety of conditions that can result in 'bone marrow edema' or 'bone marrow lesions' (BML) in the wrist on magnetic resonance imaging (MRI). The combination of clinical history and the distribution of the BML can serve as a valuable clue to a specific diagnosis. This article illustrates the different patterns of BML in the wrist to serve as a useful guide when reviewing wrist MRI studies. Imaging artefacts will also be briefly covered.
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Affiliation(s)
- WanYin Lim
- Dr Jones and Partners Medical Imaging, 226 Greenhill Road, Eastwood, SA, 5063, Australia. .,Royal Adelaide Hospital, Port Rd, Adelaide, SA, 5000, Australia.
| | - Asif Saifuddin
- Royal National Orthopaedic Hospital, Brockley Hill, Stanmore, HA7 4LP, UK.,Everlight Radiology, Level 6 West, Euston Road, London, NW1 3AX, UK
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Shimizu T, Cruz A, Tanaka M, Mamoto K, Pedoia V, Burghardt AJ, Heilmeier U, Link TM, Graf J, Imboden JB, Li X. Structural Changes over a Short Period Are Associated with Functional Assessments in Rheumatoid Arthritis. J Rheumatol 2019; 46:676-684. [DOI: 10.3899/jrheum.180496] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/24/2018] [Indexed: 11/22/2022]
Abstract
Objective.To investigate the correlation between changes in radiological quantitative assessment with changes in clinical and functional assessment from baseline to 3 months in patients with rheumatoid arthritis (RA).Methods.Twenty-eight patients with RA [methotrexate (MTX) and anti-tumor necrosis factor–α (TNF-α) group with high disease activity (n = 18); and MTX group with low disease activity (n = 10)] underwent assessments at baseline and 3 months: clinical [28-joint count Disease Activity Score (DAS28)], functional [Health Assessment Questionnaire (HAQ) and Michigan Hand Outcome Questionnaire (MHQ)], and imaging-based [3 Tesla magnetic resonance imaging (MRI) and high-resolution peripheral quantitative computed tomography (HR-pQCT)]. MR images were evaluated semiquantitatively [RA MRI scoring (RAMRIS)] and quantitatively for the volume of synovitis and bone marrow edema (BME) lesions. Erosion volumes were measured using HR-pQCT.Results.After 3 months, the anti-TNF-α group demonstrated an improvement in disease activity through DAS28, HAQ, and MHQ. MRI showed significant decreases in synovitis and BME volume for the anti-TNF-α group, and significant increases in the MTX group. HR-pQCT showed significant decreases in bone erosion volume for the anti-TNF-α group, and significant increases in the MTX group. No significance was observed using RAMRIS. Changes in synovitis, BME, and erosion volumes, but not RAMRIS, were significantly correlated with changes in DAS28, HAQ, and MHQ.Conclusion.Quantitative measures were more sensitive than semiquantitative grading when evaluating structural and inflammatory changes with treatment, and were associated with patient clinical and functional outcomes. Multimodality imaging with 3T MRI and HR-pQCT may provide promising biomarkers that help determine disease progression and therapy response.
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Fujimori M, Kamishima T, Kato M, Seno Y, Sutherland K, Sugimori H, Nishida M, Atsumi T. Composite assessment of power Doppler ultrasonography and MRI in rheumatoid arthritis: a pilot study of predictive value in radiographic progression after one year. Br J Radiol 2018; 91:20170748. [PMID: 29565675 DOI: 10.1259/bjr.20170748] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022] Open
Abstract
OBJECTIVE Power Doppler ultrasonography (PDUS) and MRI are independently useful to predict structural damage in patients with rheumatoid arthritis (RA). We hypothesize that there is a complementary relationship between these modalities. The aim of this study is, therefore, to investigate the usefulness of the predictive value of composite assessment of PDUS and contrast-enhanced MRI in radiographic outcomes in patients with RA. METHODS 20 patients (17 females and 3 males) with RA on disease-modifying antirheumatic drugs underwent PDUS and MRI of both hands at baseline. Radiography of the bilateral hands was performed at baseline and at 1 year. Articular synovitis on PDUS was evaluated according to quantitative measurement. Synovitis, bone marrow edema and bone erosion were scored according to the RA MRI scoring method. The changes of joint space narrowing and bone erosion on radiograph were assessed by the Sharp/van der Heijde method. We applied t-statistics to combine the assessment of quantitative PDUS with semiquantitative MRI. RESULTS Structural damage progression for radiography was not correlated with any evaluations for MRI, while it showed significant correlation with synovitis on PDUS (rs = 0.597, p = 0.005). The composite assessment of both modalities (synovitis for PDUS and bone marrow edema for MRI) was correlated with structural damage progression on radiograph (rs = 0.792, p < 0.0001). CONCLUSION Composite assessment of PDUS and MRI may have a stronger predictive value in radiographic progression than PDUS or MRI alone in RA. Advances in knowledge: Composite assessment of PDUS and MRI may be an effective predictor of structural damage in RA.
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Affiliation(s)
- Motoshi Fujimori
- 1 Master Course of Health Sciences, Graduate School of Health Sciences, Hokkaido University, Sapporo , Hokkaido , Japan
| | - Tamotsu Kamishima
- 2 Department of Biomedical Science and Engineering, Faculty of Health Sciences, Hokkaido University , Hokkaido, Sapporo , Japan
| | - Masaru Kato
- 3 Department of Rheumatology, Endocrinology and Nephrology, Faculty of Medicine and Graduate School of Medicine, Hokkaido University , Sapporo , Japan
| | - Yumika Seno
- 4 Department of Health Sciences,Hokkaido University , Sapporo, Hokkaido , Japan
| | - Kenneth Sutherland
- 5 Global Station for Medical Science and Engineering, Global Institution for Collaborative Research and Education (GI-CoRE), Hokkaido University , Sapporo, Hokkaido , Japan.,6 Division of Photonic Bioimaging, Faculty of Medicine Research Center for Cooperative Projects, Hokkaido University , Sapporo , Japan
| | - Hiroyuki Sugimori
- 2 Department of Biomedical Science and Engineering, Faculty of Health Sciences, Hokkaido University , Hokkaido, Sapporo , Japan
| | - Mutsumi Nishida
- 7 Division of Laboratory and Transfusion Medicine/Diagnostic Center for Sonography, Hokkaido University Hospital , Sapporo, Hokkaido , Japan
| | - Tatsuya Atsumi
- 3 Department of Rheumatology, Endocrinology and Nephrology, Faculty of Medicine and Graduate School of Medicine, Hokkaido University , Sapporo , Japan
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Barile A, Arrigoni F, Bruno F, Guglielmi G, Zappia M, Reginelli A, Ruscitti P, Cipriani P, Giacomelli R, Brunese L, Masciocchi C. Computed Tomography and MR Imaging in Rheumatoid Arthritis. Radiol Clin North Am 2017; 55:997-1007. [DOI: 10.1016/j.rcl.2017.04.006] [Citation(s) in RCA: 56] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/14/2023]
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Aizenberg E, Roex EAH, Nieuwenhuis WP, Mangnus L, van der Helm-van Mil AHM, Reijnierse M, Bloem JL, Lelieveldt BPF, Stoel BC. Automatic quantification of bone marrow edema on MRI of the wrist in patients with early arthritis: A feasibility study. Magn Reson Med 2017; 79:1127-1134. [PMID: 28480581 PMCID: PMC5811824 DOI: 10.1002/mrm.26712] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2017] [Revised: 03/23/2017] [Accepted: 03/23/2017] [Indexed: 02/03/2023]
Abstract
Purpose To investigate the feasibility of automatic quantification of bone marrow edema (BME) on MRI of the wrist in patients with early arthritis. Methods For 485 early arthritis patients (clinically confirmed arthritis of one or more joints, symptoms for less than 2 years), MR scans of the wrist were processed in three automatic stages. First, super‐resolution reconstruction was applied to fuse coronal and axial scans into a single high‐resolution 3D image. Next, the carpal bones were located and delineated using atlas‐based segmentation. Finally, the extent of BME within each bone was quantified by identifying image intensity values characteristic of BME by fuzzy clustering and measuring the fraction of voxels with these characteristic intensities within each bone. Correlation with visual BME scores was assessed through Pearson correlation coefficient. Results Pearson correlation between quantitative and visual BME scores across 485 patients was r=0.83, P<0.001. Conclusions Quantitative measurement of BME on MRI of the wrist has the potential to provide a feasible alternative to visual scoring. Complete automation requires automatic detection and compensation of acquisition artifacts. Magn Reson Med 79:1127–1134, 2018. © 2017 The Authors Magnetic Resonance in Medicine published by Wiley Periodicals, Inc. on behalf of International Society for Magnetic Resonance in Medicine. This is an open access article under the terms of the Creative Commons Attribution‐NonCommercial‐NoDerivs License, which permits use and distribution in any medium, provided the original work is properly cited, the use is non‐commercial and no modifications or adaptations are made.
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Affiliation(s)
- Evgeni Aizenberg
- Department of Radiology, Leiden University Medical Center, Leiden, The Netherlands
| | - Edgar A H Roex
- Department of Radiology, Leiden University Medical Center, Leiden, The Netherlands.,Department of Biomechanical Engineering, Delft University of Technology, Delft, The Netherlands
| | - Wouter P Nieuwenhuis
- Department of Rheumatology, Leiden University Medical Center, Leiden, The Netherlands
| | - Lukas Mangnus
- Department of Rheumatology, Leiden University Medical Center, Leiden, The Netherlands
| | | | - Monique Reijnierse
- Department of Radiology, Leiden University Medical Center, Leiden, The Netherlands
| | - Johan L Bloem
- Department of Radiology, Leiden University Medical Center, Leiden, The Netherlands
| | - Boudewijn P F Lelieveldt
- Department of Radiology, Leiden University Medical Center, Leiden, The Netherlands.,Intelligent Systems Department, Delft University of Technology, Delft, The Netherlands
| | - Berend C Stoel
- Department of Radiology, Leiden University Medical Center, Leiden, The Netherlands
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Ho KY, Kulig K. Changes in water content in response to an acute bout of eccentric loading in a patellar tendon with a history of tendinopathy: A case report. Physiother Theory Pract 2016; 32:566-70. [PMID: 27472664 DOI: 10.1080/09593985.2016.1206646] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
OBJECTIVE This case-based report assessed resting water content and exercise-driven water exchange within a tendon with a history of tendinopathy and compared the response to that of a healthy uninvolved tendon. DESIGN Case Report. SETTING University imaging center. PARTICIPANT The participant was a 27-year-old female basketball player 39 months following knee trauma. Patellar tendinopathy developed 12 months after the injury episode and was treated with eccentric exercises. Eighteen months from the beginning of the first eccentric training bout, the participant reported full resolution of symptoms and returned to her pre-injury sport participation without symptoms. INTERVENTION Eccentric decline squat exercise. MAIN OUTCOME MEASURES Tendon water content obtained from magnetic resonance imaging (MRI). RESULTS MRI acquired 39 months post-injury demonstrated increased resting water content of the involved tendon (involved: 91.1% vs. uninvolved: 84.6%). Immediately after the eccentric squat maneuver, water content decreased on both involved and uninvolved tendons (involved: 89.5% vs. uninvolved: 83.3%). CONCLUSIONS Elevated resting water content of the involved tendon found in this report may be indicative of reduced tendon stiffness. A similar amount of water content reduction was observed on both sides following mechanical loading, suggesting that the involved tendon may respond to the eccentric exercise similarly to the uninvolved tendon. Future investigations are needed to study the relationships among tendon water exchanges, mechanical properties, patient symptoms, and tissue injuries.
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Affiliation(s)
- Kai-Yu Ho
- a Department of Physical Therapy , University of Nevada , Las Vegas, Las Vegas , NV , USA
| | - Kornelia Kulig
- b Division of Biokinesiology and Physical Therapy , University of Southern California , Los Angeles , CA , USA
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Pedoia V, Majumdar S, Link TM. Segmentation of joint and musculoskeletal tissue in the study of arthritis. MAGMA (NEW YORK, N.Y.) 2016; 29:207-21. [PMID: 26915082 PMCID: PMC7181410 DOI: 10.1007/s10334-016-0532-9] [Citation(s) in RCA: 38] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/24/2015] [Revised: 02/05/2016] [Accepted: 02/08/2016] [Indexed: 12/26/2022]
Abstract
As the most frequent cause of physical disability, musculoskeletal diseases such as arthritis and osteoporosis have a great social and economical impact. Quantitative magnetic resonance imaging (MRI) biomarkers are important tools that allow clinicians to better characterize, monitor, and even predict musculoskeletal disease progression. Post-processing pipelines often include image segmentation. Manually identifying the border of the region of interest (ROI) is a difficult and time-consuming task. Manual segmentation is also affected by inter- and intrauser variability, thus limiting standardization. Fully automatic or semi-automatic methods that minimize the user interaction are highly desirable. Unfortunately, an ultimate, highly reliable and extensively evaluated solution for joint and musculoskeletal tissue segmentation has not yet been proposed, and many clinical studies still adopt fully manual procedures. Moreover, the clinical translation of several promising quantitative MRI techniques is highly affected by the lack of an established, fast, and accurate segmentation method. The goal of this review is to present some of the techniques proposed in recent literature that have been adopted in clinical studies for joint and musculoskeletal tissue analyses in arthritis patients. The most widely used MRI sequences and image processing algorithms employed to accomplish segmentation challenges will be discussed in this paper.
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Affiliation(s)
- Valentina Pedoia
- Musculoskeletal Quantitative Imaging Research Group, Department of Radiology and Biomedical Imaging, UC San Francisco, 1700 Fourth Street, Suite 201, QB3 Building, San Francisco, CA, 94107, USA.
| | - Sharmila Majumdar
- Musculoskeletal Quantitative Imaging Research Group, Department of Radiology and Biomedical Imaging, UC San Francisco, 1700 Fourth Street, Suite 201, QB3 Building, San Francisco, CA, 94107, USA
| | - Thomas M Link
- Musculoskeletal Quantitative Imaging Research Group, Department of Radiology and Biomedical Imaging, UC San Francisco, 1700 Fourth Street, Suite 201, QB3 Building, San Francisco, CA, 94107, USA
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Liu J, Pedoia V, Heilmeier U, Ku E, Su F, Khanna S, Imboden J, Graf J, Link T, Li X. High-temporospatial-resolution dynamic contrast-enhanced (DCE) wrist MRI with variable-density pseudo-random circular Cartesian undersampling (CIRCUS) acquisition: evaluation of perfusion in rheumatoid arthritis patients. NMR IN BIOMEDICINE 2016; 29:15-23. [PMID: 26608949 PMCID: PMC4724417 DOI: 10.1002/nbm.3443] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/17/2015] [Revised: 09/04/2015] [Accepted: 10/10/2015] [Indexed: 06/05/2023]
Abstract
This study is to evaluate highly accelerated three-dimensional (3D) dynamic contrast-enhanced (DCE) wrist MRI for assessment of perfusion in rheumatoid arthritis (RA) patients. A pseudo-random variable-density undersampling strategy, circular Cartesian undersampling (CIRCUS), was combined with k-t SPARSE-SENSE reconstruction to achieve a highly accelerated 3D DCE wrist MRI. Two healthy volunteers and 10 RA patients were studied. Two patients were on methotrexate (MTX) only (Group I) and the other eight were treated with a combination therapy of MTX and anti-tumor necrosis factor (TNF) therapy (Group II). Patients were scanned at baseline and 3 month follow-up. DCE MR images were used to evaluate perfusion in synovitis and bone marrow edema pattern in the RA wrist joints. A series of perfusion parameters was derived and compared with clinical disease activity scores of 28 joints (DAS28). 3D DCE wrist MR images were obtained with a spatial resolution of 0.3 × 0.3 × 1.5 mm(3) and temporal resolution of 5 s (with an acceleration factor of 20). The derived perfusion parameters, most notably transition time (dT) of synovitis, showed significant negative correlations with DAS28-ESR (r = -0.80, p < 0.05) and DAS28-CRP (r = -0.87, p < 0.05) at baseline and also correlated significantly with treatment responses evaluated by clinical score changes between baseline and 3 month follow-up (with DAS28-ESR r = -0.79, p < 0.05, and DAS28-CRP r = -0.82, p < 0.05). Highly accelerated 3D DCE wrist MRI with improved temporospatial resolution has been achieved in RA patients and provides accurate assessment of neovascularization and perfusion in RA joints, showing promise as a potential tool for evaluating treatment responses.
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Affiliation(s)
- Jing Liu
- Department of Radiology and Biomedical Imaging, University of California San Francisco, San Francisco, California, United States
| | - Valentina Pedoia
- Department of Radiology and Biomedical Imaging, University of California San Francisco, San Francisco, California, United States
| | - Ursula Heilmeier
- Department of Radiology and Biomedical Imaging, University of California San Francisco, San Francisco, California, United States
| | - Eric Ku
- Department of Radiology and Biomedical Imaging, University of California San Francisco, San Francisco, California, United States
| | - Favian Su
- Department of Radiology and Biomedical Imaging, University of California San Francisco, San Francisco, California, United States
| | - Sameer Khanna
- University of California Berkeley, Berkeley, California, United States
| | - John Imboden
- Department of Medicine, University of California San Francisco, San Francisco, California, United States
| | - Jonathan Graf
- Department of Medicine, University of California San Francisco, San Francisco, California, United States
| | - Thomas Link
- Department of Radiology and Biomedical Imaging, University of California San Francisco, San Francisco, California, United States
| | - Xiaojuan Li
- Department of Radiology and Biomedical Imaging, University of California San Francisco, San Francisco, California, United States
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Computer-aided and manual quantifications of MRI synovitis, bone marrow edema-like lesions, erosion and cartilage loss in rheumatoid arthritis of the wrist. Skeletal Radiol 2015; 44:539-47. [PMID: 25488101 DOI: 10.1007/s00256-014-2059-3] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/18/2014] [Revised: 10/08/2014] [Accepted: 11/06/2014] [Indexed: 02/02/2023]
Abstract
PURPOSE To investigate the reliability and validity of computer-aided automated and manual quantification as well as semiquantitative analysis for MRI synovitis, bone marrow edema-like lesions, erosion and cartilage loss of the wrist in rheumatoid arthritis (RA) compared to the OMERACT-RAMRIS. METHODS AND MATERIALS Wrist MRI was performed at 3 T in 16 patients with RA. Synovial volume and perfusion, bone marrow edema-like lesion (BMEL) volume, signal intensity and perfusion, and erosion dimensions were measured manually and using an in-house-developed automated software algorithm; findings were correlated with the OMERAC-RAMRIS gradings. In addition, a semiquantitative MRI cartilage loss score system was developed. Intraclass correlation coefficients (ICCs) were used to test the reproducibility of these quantitative and semiquantitative techniques. Spearman correlation coefficients were calculated between lesion quantifications and RAMRIS and between the MRI cartilage score and radiographic Sharp van der Heijde joint space narrowing scores. RESULTS The intra- and interobserver ICCs were excellent for synovial, BMEL and erosion quantifications and cartilage loss grading (all >0.89). The synovial volume, BMEL volume and signal intensity, and erosion dimensions were significantly correlated with the corresponding RAMRIS (r = 0.727 to 0.900, p < 0.05). Synovial perfusion parameter maximum enhancement (Emax) was significantly correlated with synovitis RAMRIS (r = 0.798). BMEL perfusion parameters were not correlated with the RAMRIS BME score. Cartilage loss gradings from MRI were significantly correlated with the Sharp joint space narrowing scores (r = 0.635, p = 0.008). CONCLUSION The computer-aided, manual and semiquantitative methods presented in this study can be used to evaluate MRI pathologies in RA with excellent reproducibility. Significant correlations with standard RAMRIS were found in the measurements using these methods.
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Shapiro LM, Matzat SJ, Gold GE. Functional magnetic resonance imaging. Rheumatology (Oxford) 2015. [DOI: 10.1016/b978-0-323-09138-1.00041-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022] Open
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Lee CH, Srikhum W, Burghardt AJ, Virayavanich W, Imboden JB, Link TM, Li X. Correlation of structural abnormalities of the wrist and metacarpophalangeal joints evaluated by high-resolution peripheral quantitative computed tomography, 3 Tesla magnetic resonance imaging and conventional radiographs in rheumatoid arthritis. Int J Rheum Dis 2014; 18:628-39. [DOI: 10.1111/1756-185x.12495] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
Affiliation(s)
- Chan Hee Lee
- Department of Radiology and Biomedical Imaging; University of California, San Francisco; San Francisco California USA
- Division of Rheumatology; Department of Internal Medicine; National Health Insurance Service Ilsan Hospital; Goyang-si South Korea
| | - Waraporn Srikhum
- Department of Radiology and Biomedical Imaging; University of California, San Francisco; San Francisco California USA
- Department of Radiology; Thammasat University; Pathumthani Thailand
| | - Andrew J. Burghardt
- Department of Radiology and Biomedical Imaging; University of California, San Francisco; San Francisco California USA
| | - Warapat Virayavanich
- Department of Radiology and Biomedical Imaging; University of California, San Francisco; San Francisco California USA
- Department of Radiology; Ramathibodi Hospital; Mahidol University; Bangkok Thailand
| | - John B. Imboden
- Department of Medicine; University of California; San Francisco California USA
- Division of Rheumatology; San Francisco General Hospital; San Francisco California USA
| | - Thomas M. Link
- Department of Radiology and Biomedical Imaging; University of California, San Francisco; San Francisco California USA
| | - Xiaojuan Li
- Department of Radiology and Biomedical Imaging; University of California, San Francisco; San Francisco California USA
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20
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Teruel JR, Burghardt AJ, Rivoire J, Srikhum W, Noworolski SM, Link TM, Imboden JB, Li X. Bone structure and perfusion quantification of bone marrow edema pattern in the wrist of patients with rheumatoid arthritis: a multimodality study. J Rheumatol 2014; 41:1766-73. [PMID: 25086074 DOI: 10.3899/jrheum.131564] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
OBJECTIVE To quantify bone structure and perfusion parameters in regions of bone marrow edema pattern (BMEP), non-edematous bone marrow (NBM), and pannus tissue areas in the wrists of patients with rheumatoid arthritis (RA) using 3-Tesla (3T) magnetic resonance imaging (MRI), and high resolution peripheral quantitative computed tomography (HR-pQCT). METHODS Sixteen subjects fulfilling American College of Rheumatology classification were imaged using a HR-pQCT system and a 3T MRI scanner with an 8-channel wrist coil. Coronal T2-weighted and dynamic contrast-enhanced (DCE-MRI) images were acquired. BMEP and pannus tissue areas were segmented semiautomatically in T2-weighted images. NBM areas were placed at a similar distance from the joint space as BMEP regions. MR and HR-pQCT images were registered, and bone variables were calculated within the BMEP and NBM regions. Perfusion parameters in BMEP, pannus tissue, and NBM regions were calculated based on the signal-time curve obtained from DCE-MRI. RESULTS Eighteen BMEP areas were segmented, 15 of them presented proximal to pannus-filled erosions. Significant increases in bone density and trabecular thickness and number were observed in all BMEP regions compared to NMB (p < 0.05). Significantly elevated perfusion measures were observed in both BMEP and pannus tissue regions compared to NBM (p < 0.05). CONCLUSION BMEP regions showed significantly increased bone density and structures as well as perfusion measures, suggesting bone remodeling and active inflammation. Combining MRI and HR-pQCT provides a powerful multimodality approach for understanding BMEP and erosions, and for potentially identifying novel imaging markers for disease progression in RA.
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Affiliation(s)
- Jose R Teruel
- From the Musculoskeletal Quantitative Imaging Research Group, Department of Radiology and Biomedical Imaging, University of California, San Francisco; San Francisco, California, USA.J.R. Teruel, MSc, Research Fellow, Department of Radiology and Biomedical Imaging, University of California, San Francisco (UCSF); PhD Candidate, Department of Circulation and Medical Imaging, Norwegian University of Science and Technology (NTNU), Trondheim, Norway; A.J. Burghardt, Researcher, Department of Radiology and Biomedical Imaging, UCSF; J. Rivoire, PhD, Postdoctoral Research Fellow, Department of Radiology and Biomedical Imaging, UCSF; W. Srikhum, MD, Research Fellow, Department of Radiology and Biomedical Imaging, UCSF; Lecturer in Radiology, Department of Radiology, Thammasat University, Pathum Thani, Thailand; S.M. Noworolski, PhD, Associate Professor, Department of Radiology and Biomedical Imaging, UCSF; T.M. Link, MD, PhD, Professor of Radiology, Chief, Musculoskeletal Imaging and Clinical Director, Musculoskeletal and Quantitative Imaging Research Group, Department of Radiology and Biomedical Imaging, UCSF; J.B. Imboden, MD, Professor of Rheumatology, Department of Medicine, UCSF; X. Li, PhD, Associate Professor, Department of Radiology and Biomedical Imaging, UCSF
| | - Andrew J Burghardt
- From the Musculoskeletal Quantitative Imaging Research Group, Department of Radiology and Biomedical Imaging, University of California, San Francisco; San Francisco, California, USA.J.R. Teruel, MSc, Research Fellow, Department of Radiology and Biomedical Imaging, University of California, San Francisco (UCSF); PhD Candidate, Department of Circulation and Medical Imaging, Norwegian University of Science and Technology (NTNU), Trondheim, Norway; A.J. Burghardt, Researcher, Department of Radiology and Biomedical Imaging, UCSF; J. Rivoire, PhD, Postdoctoral Research Fellow, Department of Radiology and Biomedical Imaging, UCSF; W. Srikhum, MD, Research Fellow, Department of Radiology and Biomedical Imaging, UCSF; Lecturer in Radiology, Department of Radiology, Thammasat University, Pathum Thani, Thailand; S.M. Noworolski, PhD, Associate Professor, Department of Radiology and Biomedical Imaging, UCSF; T.M. Link, MD, PhD, Professor of Radiology, Chief, Musculoskeletal Imaging and Clinical Director, Musculoskeletal and Quantitative Imaging Research Group, Department of Radiology and Biomedical Imaging, UCSF; J.B. Imboden, MD, Professor of Rheumatology, Department of Medicine, UCSF; X. Li, PhD, Associate Professor, Department of Radiology and Biomedical Imaging, UCSF
| | - Julien Rivoire
- From the Musculoskeletal Quantitative Imaging Research Group, Department of Radiology and Biomedical Imaging, University of California, San Francisco; San Francisco, California, USA.J.R. Teruel, MSc, Research Fellow, Department of Radiology and Biomedical Imaging, University of California, San Francisco (UCSF); PhD Candidate, Department of Circulation and Medical Imaging, Norwegian University of Science and Technology (NTNU), Trondheim, Norway; A.J. Burghardt, Researcher, Department of Radiology and Biomedical Imaging, UCSF; J. Rivoire, PhD, Postdoctoral Research Fellow, Department of Radiology and Biomedical Imaging, UCSF; W. Srikhum, MD, Research Fellow, Department of Radiology and Biomedical Imaging, UCSF; Lecturer in Radiology, Department of Radiology, Thammasat University, Pathum Thani, Thailand; S.M. Noworolski, PhD, Associate Professor, Department of Radiology and Biomedical Imaging, UCSF; T.M. Link, MD, PhD, Professor of Radiology, Chief, Musculoskeletal Imaging and Clinical Director, Musculoskeletal and Quantitative Imaging Research Group, Department of Radiology and Biomedical Imaging, UCSF; J.B. Imboden, MD, Professor of Rheumatology, Department of Medicine, UCSF; X. Li, PhD, Associate Professor, Department of Radiology and Biomedical Imaging, UCSF
| | - Waraporn Srikhum
- From the Musculoskeletal Quantitative Imaging Research Group, Department of Radiology and Biomedical Imaging, University of California, San Francisco; San Francisco, California, USA.J.R. Teruel, MSc, Research Fellow, Department of Radiology and Biomedical Imaging, University of California, San Francisco (UCSF); PhD Candidate, Department of Circulation and Medical Imaging, Norwegian University of Science and Technology (NTNU), Trondheim, Norway; A.J. Burghardt, Researcher, Department of Radiology and Biomedical Imaging, UCSF; J. Rivoire, PhD, Postdoctoral Research Fellow, Department of Radiology and Biomedical Imaging, UCSF; W. Srikhum, MD, Research Fellow, Department of Radiology and Biomedical Imaging, UCSF; Lecturer in Radiology, Department of Radiology, Thammasat University, Pathum Thani, Thailand; S.M. Noworolski, PhD, Associate Professor, Department of Radiology and Biomedical Imaging, UCSF; T.M. Link, MD, PhD, Professor of Radiology, Chief, Musculoskeletal Imaging and Clinical Director, Musculoskeletal and Quantitative Imaging Research Group, Department of Radiology and Biomedical Imaging, UCSF; J.B. Imboden, MD, Professor of Rheumatology, Department of Medicine, UCSF; X. Li, PhD, Associate Professor, Department of Radiology and Biomedical Imaging, UCSF
| | - Susan M Noworolski
- From the Musculoskeletal Quantitative Imaging Research Group, Department of Radiology and Biomedical Imaging, University of California, San Francisco; San Francisco, California, USA.J.R. Teruel, MSc, Research Fellow, Department of Radiology and Biomedical Imaging, University of California, San Francisco (UCSF); PhD Candidate, Department of Circulation and Medical Imaging, Norwegian University of Science and Technology (NTNU), Trondheim, Norway; A.J. Burghardt, Researcher, Department of Radiology and Biomedical Imaging, UCSF; J. Rivoire, PhD, Postdoctoral Research Fellow, Department of Radiology and Biomedical Imaging, UCSF; W. Srikhum, MD, Research Fellow, Department of Radiology and Biomedical Imaging, UCSF; Lecturer in Radiology, Department of Radiology, Thammasat University, Pathum Thani, Thailand; S.M. Noworolski, PhD, Associate Professor, Department of Radiology and Biomedical Imaging, UCSF; T.M. Link, MD, PhD, Professor of Radiology, Chief, Musculoskeletal Imaging and Clinical Director, Musculoskeletal and Quantitative Imaging Research Group, Department of Radiology and Biomedical Imaging, UCSF; J.B. Imboden, MD, Professor of Rheumatology, Department of Medicine, UCSF; X. Li, PhD, Associate Professor, Department of Radiology and Biomedical Imaging, UCSF
| | - Thomas M Link
- From the Musculoskeletal Quantitative Imaging Research Group, Department of Radiology and Biomedical Imaging, University of California, San Francisco; San Francisco, California, USA.J.R. Teruel, MSc, Research Fellow, Department of Radiology and Biomedical Imaging, University of California, San Francisco (UCSF); PhD Candidate, Department of Circulation and Medical Imaging, Norwegian University of Science and Technology (NTNU), Trondheim, Norway; A.J. Burghardt, Researcher, Department of Radiology and Biomedical Imaging, UCSF; J. Rivoire, PhD, Postdoctoral Research Fellow, Department of Radiology and Biomedical Imaging, UCSF; W. Srikhum, MD, Research Fellow, Department of Radiology and Biomedical Imaging, UCSF; Lecturer in Radiology, Department of Radiology, Thammasat University, Pathum Thani, Thailand; S.M. Noworolski, PhD, Associate Professor, Department of Radiology and Biomedical Imaging, UCSF; T.M. Link, MD, PhD, Professor of Radiology, Chief, Musculoskeletal Imaging and Clinical Director, Musculoskeletal and Quantitative Imaging Research Group, Department of Radiology and Biomedical Imaging, UCSF; J.B. Imboden, MD, Professor of Rheumatology, Department of Medicine, UCSF; X. Li, PhD, Associate Professor, Department of Radiology and Biomedical Imaging, UCSF
| | - John B Imboden
- From the Musculoskeletal Quantitative Imaging Research Group, Department of Radiology and Biomedical Imaging, University of California, San Francisco; San Francisco, California, USA.J.R. Teruel, MSc, Research Fellow, Department of Radiology and Biomedical Imaging, University of California, San Francisco (UCSF); PhD Candidate, Department of Circulation and Medical Imaging, Norwegian University of Science and Technology (NTNU), Trondheim, Norway; A.J. Burghardt, Researcher, Department of Radiology and Biomedical Imaging, UCSF; J. Rivoire, PhD, Postdoctoral Research Fellow, Department of Radiology and Biomedical Imaging, UCSF; W. Srikhum, MD, Research Fellow, Department of Radiology and Biomedical Imaging, UCSF; Lecturer in Radiology, Department of Radiology, Thammasat University, Pathum Thani, Thailand; S.M. Noworolski, PhD, Associate Professor, Department of Radiology and Biomedical Imaging, UCSF; T.M. Link, MD, PhD, Professor of Radiology, Chief, Musculoskeletal Imaging and Clinical Director, Musculoskeletal and Quantitative Imaging Research Group, Department of Radiology and Biomedical Imaging, UCSF; J.B. Imboden, MD, Professor of Rheumatology, Department of Medicine, UCSF; X. Li, PhD, Associate Professor, Department of Radiology and Biomedical Imaging, UCSF
| | - Xiaojuan Li
- From the Musculoskeletal Quantitative Imaging Research Group, Department of Radiology and Biomedical Imaging, University of California, San Francisco; San Francisco, California, USA.J.R. Teruel, MSc, Research Fellow, Department of Radiology and Biomedical Imaging, University of California, San Francisco (UCSF); PhD Candidate, Department of Circulation and Medical Imaging, Norwegian University of Science and Technology (NTNU), Trondheim, Norway; A.J. Burghardt, Researcher, Department of Radiology and Biomedical Imaging, UCSF; J. Rivoire, PhD, Postdoctoral Research Fellow, Department of Radiology and Biomedical Imaging, UCSF; W. Srikhum, MD, Research Fellow, Department of Radiology and Biomedical Imaging, UCSF; Lecturer in Radiology, Department of Radiology, Thammasat University, Pathum Thani, Thailand; S.M. Noworolski, PhD, Associate Professor, Department of Radiology and Biomedical Imaging, UCSF; T.M. Link, MD, PhD, Professor of Radiology, Chief, Musculoskeletal Imaging and Clinical Director, Musculoskeletal and Quantitative Imaging Research Group, Department of Radiology and Biomedical Imaging, UCSF; J.B. Imboden, MD, Professor of Rheumatology, Department of Medicine, UCSF; X. Li, PhD, Associate Professor, Department of Radiology and Biomedical Imaging, UCSF.
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Ho KY, Hu HH, Colletti PM, Powers CM. Recreational runners with patellofemoral pain exhibit elevated patella water content. Magn Reson Imaging 2014; 32:965-8. [PMID: 24906520 DOI: 10.1016/j.mri.2014.04.018] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2013] [Revised: 04/18/2014] [Accepted: 04/20/2014] [Indexed: 10/25/2022]
Abstract
Increased bone water content resulting from repetitive patellofemoral joint overloading has been suggested to be a possible mechanism underlying patellofemoral pain (PFP). To date, it remains unknown whether persons with PFP exhibit elevated bone water content. The purpose of this study was to determine whether recreational runners with PFP exhibit elevated patella water content when compared to pain-free controls. Ten female recreational runners with a diagnosis of PFP (22 to 39years of age) and 10 gender, age, weight, height, and activity matched controls underwent chemical-shift-encoded water-fat magnetic resonance imaging (MRI) to quantify patella water content (i.e., water-signal fraction). Differences in bone water content of the total patella, lateral aspect of the patella, and medial aspect of the patella were compared between groups using independent t tests. Compared with the control group, the PFP group demonstrated significantly greater total patella bone water content (15.4±3.5% vs. 10.3±2.1%; P=0.001), lateral patella water content (17.2±4.2% vs. 11.5±2.5%; P=0.002), and medial patella water content (13.2±2.7% vs. 8.4±2.3%; P<0.001). The higher patella water content observed in female runners with PFP is suggestive of venous engorgement and elevated extracellular fluid. In turn, this may lead to an increase in intraosseous pressure and pain.
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Affiliation(s)
- Kai-Yu Ho
- Department of Physical Therapy, University of Nevada, Las Vegas, Las Vegas, NV, USA
| | - Houchun H Hu
- Ming Hsieh Department of Electrical Engineering, University of Southern California, Los Angeles, CA, USA; Department of Radiology, University of Southern California, Los Angeles, CA, USA
| | - Patrick M Colletti
- Department of Radiology, University of Southern California, Los Angeles, CA, USA
| | - Christopher M Powers
- Division of Biokinesiology and Physical Therapy, University of Southern California, Los Angeles, CA, USA.
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Hötker AM, Schmidtmann I, Oberholzer K, Düber C. Dynamic contrast enhanced-MRI in rectal cancer: Inter- and intraobserver reproducibility and the effect of slice selection on pharmacokinetic analysis. J Magn Reson Imaging 2013; 40:715-22. [DOI: 10.1002/jmri.24385] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2013] [Accepted: 08/07/2013] [Indexed: 12/11/2022] Open
Affiliation(s)
- Andreas M. Hötker
- Department of Diagnostic and Interventional Radiology; Universitätsmedizin Mainz; Germany
| | - Irene Schmidtmann
- Institute of Medical Biostatistics, Epidemiology and Informatics; Universitätsmedizin Mainz; Germany
| | - Katja Oberholzer
- Department of Diagnostic and Interventional Radiology; Universitätsmedizin Mainz; Germany
| | - Christoph Düber
- Department of Diagnostic and Interventional Radiology; Universitätsmedizin Mainz; Germany
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Current World Literature. Curr Opin Rheumatol 2013; 25:398-409. [DOI: 10.1097/bor.0b013e3283604218] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Srikhum W, Virayavanich W, Burghardt AJ, Yu A, Link TM, Imboden JB, Li X. Quantitative and semiquantitative bone erosion assessment on high-resolution peripheral quantitative computed tomography in rheumatoid arthritis. J Rheumatol 2013; 40:408-16. [PMID: 23418386 DOI: 10.3899/jrheum.120780] [Citation(s) in RCA: 38] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
OBJECTIVE To develop novel quantitative and semiquantitative bone erosion measures at metacarpophalangeal (MCP) and wrist joints in patients with rheumatoid arthritis (RA) using high-resolution peripheral quantitative computed tomography (HR-pQCT), and to correlate these measurements with disease duration and bone marrow edema (BME) patterns derived from magnetic resonance imaging (MRI). METHODS Sixteen patients with RA and 7 healthy subjects underwent hand and wrist HR-pQCT and 3-Tesla MRI. Bone erosions of the MCP2, MCP3, and distal radius were evaluated by measuring maximal erosion dimension on axial slices, which is a simple and fast measurement, and then were graded (grades 0-3) based on the maximal dimension. Correlation coefficients were calculated between (1) sum maximal dimensions, highest grades, and sum grades of bone erosions; (2) erosion measures and the clinical evaluation; (3) erosion measures and BME volume in distal radius. RESULTS The inter- and intrareader agreements of maximal erosion dimensions were excellent (intraclass correlation coefficients 0.89, 0.99, and root mean square error 9.4%, 4.7%, respectively). Highest grades and sum grades were significantly correlated to sum maximal dimensions of all erosions. Number of erosions, sum maximal erosion dimensions, highest grades, and sum grades correlated significantly with disease duration. Number of erosions, sum maximal dimensions, and erosion grading of the distal radius correlated significantly with BME volume. CONCLUSION HR-pQCT provides a sensitive method with high reader agreement in assessment of structural bone damage in RA. The good correlation of erosion measures with disease duration as well as BME volume suggests that they could become feasible measures of erosions in RA.
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Affiliation(s)
- Waraporn Srikhum
- Musculoskeletal Quantitative Imaging Research Group, Department of Radiology and Biomedical Imaging, UCSF (University of California, San Francisco), CA, USA
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Dietrich O. Techniques for Diffusion and Perfusion Assessment in Bone-Marrow MRI. MAGNETIC RESONANCE IMAGING OF THE BONE MARROW 2013. [DOI: 10.1007/174_2012_549] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
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Aoki T, Yamashita Y, Oki H, Takahashi H, Hayashida Y, Saito K, Tanaka Y, Korogi Y. Iterative decomposition of water and fat with echo asymmetry and least-squares estimation (IDEAL) of the wrist and finger at 3T: comparison with chemical shift selective fat suppression images. J Magn Reson Imaging 2012; 37:733-8. [PMID: 22911970 DOI: 10.1002/jmri.23795] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2011] [Accepted: 07/31/2012] [Indexed: 11/06/2022] Open
Abstract
PURPOSE To compare fat-suppressed magnetic resonance imaging (MRI) quality using iterative decomposition of water and fat with echo asymmetry and least-squares estimation (IDEAL) with that using chemical shift selective fat-suppressed T1-weighted spin-echo (CHESS) images for evaluating rheumatoid arthritis (RA) lesions of the hand and finger at 3T. MATERIALS AND METHODS MRI was performed in eight healthy volunteers and eight RA patients with a 3.0T MR system (Signa HDxt GE healthcare) using an eight-channel knee coil. FS-CHESS-T1-SE and IDEAL imaging were acquired in the coronal planes covering the entire structure of the bilateral hands with a slice thickness of 2 mm. In the RA patients both images were obtained after intravenous gadolinium administration. Image quality was evaluated on a five-point scale (1 = excellent to 5 = very poor). Synovitis and bone marrow contrast uptake on MR images were reviewed by two musculoskeletal radiologists using the Rheumatoid Arthritis MRI Scoring System (RAMRIS) of the Outcome Measures in Rheumatoid Arthritis Clinical Trials (OMERACT) group. RESULTS IDEAL showed uniform FS unaffected by magnetic field inhomogeneity and challenging geometry of hand and fingers, while CHESS-T1-SE often showed FS failure within the first metacarpal joint, tip of the finger, and ulnar aspect of the wrist joint. Overall image quality was significantly better with IDEAL than CHESS-T1-SE images (4.43 vs. 3.43, P < 0.01). Interobserver agreement (κ value) for synovitis and bone marrow contrast uptake was good to excellent with IDEAL (0.74-0.91, 0.62-0.89, respectively). CONCLUSION IDEAL could compensate for the effects of field inhomogeneities, providing uniform FS of the hand and finger than did the CHESS-T1-SE sequence.
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Affiliation(s)
- Takatoshi Aoki
- Department of Radiology, University of Occupational and Environmental Health, Kitakyushu, Japan.
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Current World Literature. Curr Opin Rheumatol 2012; 24:342-9. [DOI: 10.1097/bor.0b013e328352d26c] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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