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Nielsen FK, Sørensen FB, Egund N, Boel LW, Holm C, Jurik AG. Bone marrow lesions in knee osteoarthritis assessed by dynamic contrast-enhanced MRI with histopathological correlations. Acta Radiol 2024:2841851241251639. [PMID: 38766869 DOI: 10.1177/02841851241251639] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/22/2024]
Abstract
BACKGROUND Bone marrow lesions (BMLs) in knee osteoarthritis (OA) have been assessed histopathologically and by dynamic contrast-enhanced magnetic resonance imaging (DCE-MRI); however, a direct comparison of the results has not been reported. PURPOSE To evaluate and compare the findings by DCE-MRI and histopathology of subchondral BMLs in knee OA. MATERIAL AND METHODS In total, 19 patients with medial tibiofemoral knee OA undergoing total knee arthroplasty were analyzed. Preoperative MRI, including a DCE sequence, was performed, and bone biopsies were obtained from the resected specimens corresponding to BML areas. The contrast enhancement by DCE-MRI was analyzed using semi-quantitative (area under the curve [AUC]), peak enhancement [PE]), and quantitative (Ktrans, Kep) methods. Enhancement in the medial OA compartment was compared with similar areas in a normal lateral compartment, and the DCE characteristics of BMLs were correlated with semi-quantitatively graded histopathological features. RESULTS AUC and PE were significantly higher in medial tibial and femoral BMLs compared with the values in the lateral condyles; Ktrans and Kep were only significantly higher in the tibial plateau. In the tibia, AUC and PE were significantly correlated with the grade of vascular proliferation, and PE also with the degree of marrow fibrosis. There was no significant correlation between AUC/PE and histopathological findings in the femur and no correlation between quantitative DCE parameters and histopathological findings. CONCLUSION BML characteristics by semi-quantitative DCE in the form of AUC and PE may be used as parameters for the degree of histopathological vascularization in the bone marrow whereas quantitative DCE data were less conclusive.
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Affiliation(s)
| | | | - Niels Egund
- Department of Radiology, Aarhus University Hospital, Aarhus, Denmark
| | - Lene Warner Boel
- Department of Forensic Medicine, Aarhus University, Aarhus, Denmark
| | - Carsten Holm
- Department of Orthopaedic Surgery, Silkeborg Regional Hospital, Silkeborg, Denmark
| | - Anne Grethe Jurik
- Department of Radiology, Aarhus University Hospital, Aarhus, Denmark
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Mostert JM, Dur NB, Li X, Ellermann JM, Hemke R, Hales L, Mazzoli V, Kogan F, Griffith JF, Oei EH, van der Heijden RA. Advanced Magnetic Resonance Imaging and Molecular Imaging of the Painful Knee. Semin Musculoskelet Radiol 2023; 27:618-631. [PMID: 37935208 PMCID: PMC10629992 DOI: 10.1055/s-0043-1775741] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2023]
Abstract
Chronic knee pain is a common condition. Causes of knee pain include trauma, inflammation, and degeneration, but in many patients the pathophysiology remains unknown. Recent developments in advanced magnetic resonance imaging (MRI) techniques and molecular imaging facilitate more in-depth research focused on the pathophysiology of chronic musculoskeletal pain and more specifically inflammation. The forthcoming new insights can help develop better targeted treatment, and some imaging techniques may even serve as imaging biomarkers for predicting and assessing treatment response in the future. This review highlights the latest developments in perfusion MRI, diffusion MRI, and molecular imaging with positron emission tomography/MRI and their application in the painful knee. The primary focus is synovial inflammation, also known as synovitis. Bone perfusion and bone metabolism are also addressed.
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Affiliation(s)
- Jacob M. Mostert
- Department of Radiology and Nuclear Medicine, Erasmus University Medical Center, Rotterdam, The Netherlands
| | - Niels B.J. Dur
- Department of Radiology and Nuclear Medicine, Erasmus University Medical Center, Rotterdam, The Netherlands
- Department of Orthopedics and Sports Medicine, Erasmus University Medical Center, Rotterdam, The Netherlands
| | - Xiufeng Li
- Department of Radiology, Center for Magnetic Resonance Research (CMRR), University of Minnesota, Minneapolis, Minnesota
| | - Jutta M. Ellermann
- Department of Radiology, Center for Magnetic Resonance Research (CMRR), University of Minnesota, Minneapolis, Minnesota
| | - Robert Hemke
- Department of Radiology and Nuclear Medicine, Amsterdam University Medical Center, Amsterdam, The Netherlands
| | - Laurel Hales
- Department of Radiology, Stanford University, Stanford, California
| | | | - Feliks Kogan
- Department of Radiology, Stanford University, Stanford, California
| | - James F. Griffith
- Department of Imaging and Interventional Radiology Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong
| | - Edwin H.G. Oei
- Department of Radiology and Nuclear Medicine, Erasmus University Medical Center, Rotterdam, The Netherlands
| | - Rianne A. van der Heijden
- Department of Radiology and Nuclear Medicine, Erasmus University Medical Center, Rotterdam, The Netherlands
- Department of Radiology, University of Wisconsin-Madison, Madison, Wisconsin
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3
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Starck L, Skeie BS, Bartsch H, Grüner R. Arterial input functions in dynamic susceptibility contrast MRI (DSC-MRI) in longitudinal evaluation of brain metastases. Acta Radiol 2023; 64:1166-1174. [PMID: 35786055 DOI: 10.1177/02841851221109702] [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] [Indexed: 11/15/2022]
Abstract
BACKGROUND Dynamic susceptibility contrast magnetic resonance imaging (DSC-MRI) could be helpful to separate true disease progression from pseudo-progression in brain metastases when assessing the need for retreatment. However, the selection of arterial input functions (AIFs) is not standardized for analysis, limiting its use for this application. PURPOSE To compare population-based AIFs, AIFs specific to each patient, and AIFs specific to every visit in the longitudinal follow-up of brain metastases. MATERIAL AND METHODS Longitudinal data were collected from eight patients before treatment (6 of 8 patients) and after treatment (6-17 visits). Imaging was performed using a 1.5-T MRI system. Lesions were segmented by subtracting precontrast images from postcontrast images. Cerebral blood volume (rCBV) and cerebral blood flow (rCBF) were computed, and Pearson's product moment correlation coefficients were calculated to evaluate similarity of DSC parameters dependent on various AIF choices across time. AIF shape characteristics were compared. Parameter differences between white matter (WM) and gray matter (GM) were obtained to determine which AIF choice maximizes tissue differentiation. RESULTS Although DSC parameters follow similar patterns in time, the various AIF selections cause large parameter variations with relative standard deviations of up to ±60%. AIFs sampled in one patient across sessions more similar in shape than AIFs sampled across patients. Estimates of rCBV based on scan-specific AIFs differentiated better between perfusion in WM and GM than patient-specific or population-based AIFs (P ≤ 0.02). CONCLUSION Results indicate that scan-specific AIFs are the best choice for DSC-MRI parameter estimations in the longitudinal follow-up of brain metastases.
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Affiliation(s)
- Lea Starck
- Department of Physics and Technology, 1658University of Bergen, Bergen, Norway
- Mohn Medical Imaging and Visualization Centre, Bergen, Norway
| | - Bente Sandvei Skeie
- Department of Neurosurgery, 60498Haukeland University Hospital, Bergen, Norway
| | - Hauke Bartsch
- Mohn Medical Imaging and Visualization Centre, Bergen, Norway
- Department of Radiology, 60498Haukeland University Hospital, Bergen, Norway
| | - Renate Grüner
- Department of Physics and Technology, 1658University of Bergen, Bergen, Norway
- Mohn Medical Imaging and Visualization Centre, Bergen, Norway
- Department of Radiology, 60498Haukeland University Hospital, Bergen, Norway
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4
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Bone marrow MR perfusion imaging and potential for tumor evaluation. Skeletal Radiol 2023; 52:477-491. [PMID: 36271181 DOI: 10.1007/s00256-022-04202-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/26/2022] [Revised: 09/19/2022] [Accepted: 10/04/2022] [Indexed: 02/02/2023]
Abstract
The physiology of bone perfusion is reviewed outlining how it can be measured with dynamic contrast-enhanced MRI as well as intravoxel incoherent imaging. Evaluation of bone perfusion provides a potential means of assessing tumor activity and treatment response beyond that possible with standard MR imaging.
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Tang Y, Gitajn IL, Cao X, Han X, Elliott JT, Yu X, Bateman LM, Malskis BS, Fisher LA, Sin JM, Henderson ER, Pogue BW, Jiang S. Automated motion artifact correction for dynamic contrast-enhanced fluorescence imaging during open orthopedic surgery. PROCEEDINGS OF SPIE--THE INTERNATIONAL SOCIETY FOR OPTICAL ENGINEERING 2023; 12361:1236104. [PMID: 37034556 PMCID: PMC10078951 DOI: 10.1117/12.2650028] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 03/15/2023]
Abstract
Indocyanine green (ICG)-based dynamic contrast-enhanced fluorescence imaging (DCE-FI) can objectively assess bone perfusion intraoperatively. However, it is susceptible to motion artifacts due to patient's involuntary respiration during the 4.5-minute DCE-FI data acquisition. An automated motion correction approach based on mutual information (MI) frameby-frame was developed to overcome this problem. In this approach, MIs were calculated between the reference and the adjacent frame translated and the maximal MI corresponded to the optimal translation. The images obtained from eighteen amputation cases were utilized to validate the approach and the results show that this correction can significantly reduce the motion artifacts and can improve the accuracy of bone perfusion assessment.
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Affiliation(s)
- Yue Tang
- Thayer school of Engineering, Dartmouth College, Hanover, NH, USA 03755
| | - I Leah Gitajn
- Department of Orthopaedics, Dartmouth-Hitchcock Medical Center, Lebanon, NH, USA 03756
| | - Xu Cao
- Thayer school of Engineering, Dartmouth College, Hanover, NH, USA 03755
| | - Xinyue Han
- Thayer school of Engineering, Dartmouth College, Hanover, NH, USA 03755
| | - Jonathan T Elliott
- Department of Orthopaedics, Dartmouth-Hitchcock Medical Center, Lebanon, NH, USA 03756
| | - Xiaohan Yu
- Thayer school of Engineering, Dartmouth College, Hanover, NH, USA 03755
| | - Logan M Bateman
- Department of Orthopaedics, Dartmouth-Hitchcock Medical Center, Lebanon, NH, USA 03756
| | - Bethany S Malskis
- Department of Orthopaedics, Dartmouth-Hitchcock Medical Center, Lebanon, NH, USA 03756
| | - Lillian A Fisher
- Department of Orthopaedics, Dartmouth-Hitchcock Medical Center, Lebanon, NH, USA 03756
| | - Jessica M Sin
- Department of Radiology, Dartmouth-Hitchcock Medical Center, Lebanon, NH, USA 03756
| | - Eric R Henderson
- Department of Orthopaedics, Dartmouth-Hitchcock Medical Center, Lebanon, NH, USA 03756
| | - Brian W Pogue
- Thayer school of Engineering, Dartmouth College, Hanover, NH, USA 03755
| | - Shudong Jiang
- Thayer school of Engineering, Dartmouth College, Hanover, NH, USA 03755
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Lazaro LE, Dyke JP, Cady A, Banffy MB. Femoral Head Vascularity After Arthroscopic Femoral Osteochondroplasty: An In Vivo Dynamic Contrast-Enhanced MRI Study. Orthop J Sports Med 2022; 10:23259671221139355. [PMID: 36582928 PMCID: PMC9793043 DOI: 10.1177/23259671221139355] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/17/2022] [Accepted: 07/06/2022] [Indexed: 12/24/2022] Open
Abstract
Background A serious concern with surgical procedures around the hip joint is iatrogenic injury of the arterial supply to the femoral head (FH) and consequent development of FH osteonecrosis. Cam-type morphology can extend to the posterosuperior area. Understanding the limit of the posterior superior extension of the femoral osteochondroplasty is paramount to avoid underresection and residual impingement while maintaining FH vascularity. Purpose/Hypothesis The aim of this study was to quantify the impact of arthroscopic femoral osteochondroplasty on the FH vascular supply. It was hypothesized that keeping the superior extension of the resection zone anterior to the 12-o'clock position would maintain FH vascularity. Study Design Case series; Level of evidence, 4. Methods Ten adult patients undergoing arthroscopic femoroacetabular impingement (FAI) surgery were included in the study. Computed tomography (CT) scans were obtained before and after arthroscopic osteochondroplasty to define the extension of resection margins. To quantify FH vascularity, postoperative dynamic contrast-enhanced magnetic resonance imaging (DCE-MRI) was obtained at 2 time points: immediately after surgery and at the 3-month follow-up. Custom MRI analysis software was used to quantify perfusion. Results CT scan analysis demonstrated that the superior resection margin was maintained anterior to the 12-o'clock position in half of the patients. The remining 5 patients had a mean posterior extension of 11.4° ± 7.5°. The immediate postoperative DCE-MRI revealed diminished venous outflow in the operative side but no difference in overall FH perfusion. At the 3-month follow-up DCE-MRI, there was no perfusion difference between the operative and nonoperative FHs. Conclusion This study provides previously unreported quantitative MRI data on in vivo perfusion of the FH after the commonly performed arthroscopic femoral osteochondroplasty for the treatment of cam-type FAI. Maintaining resection margins anterior to the 12-o'clock position, or even 10° posteriorly, was not observed to impair perfusion to the FH.
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Affiliation(s)
- Lionel E. Lazaro
- Doctors’ Center Hospital, San Juan and Dorado, Puerto Rico.,Lionel E. Lazaro, MD, Doctors’ Center Hospital, San Juan and
Dorado, 00909, Puerto Rico (
)
| | - Jonathan P. Dyke
- Citigroup Biomedical Imaging Center, Weill Cornell Medicine, New
York, New York, USA
| | - Adam Cady
- Cedar-Sinai Kerlan-Jobe Institute, Los Angeles, California,
USA
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Jiang S, Elliott JT, Xing J, Cao X, Yu X, Han X, Dabrowski RE, Christian ML, Henderson ER, Pogue BW, Gitajn IL. ICG-based dynamic contrast-enhanced fluorescence imaging guided open orthopaedic surgery: pilot patient study. PROCEEDINGS OF SPIE--THE INTERNATIONAL SOCIETY FOR OPTICAL ENGINEERING 2021; 11625:116250W. [PMID: 36082047 PMCID: PMC9451047] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Subscribe] [Scholar Register] [Indexed: 06/15/2023]
Abstract
Forty two patients with high energy open fractures were involved into the study to investigate whether an indocyanine green (ICG)-based dynamic contrast-enhanced fluorescence imaging (DCE-FI) can be used to objectively assess bone perfusion and guide surgical debridement. For each patient, fluorescence images were recorded after 0.1 mg/kg of ICG was administered intravenously. By utilizing a bone-specific kinetic model to the video sequences, the perfusion-related metrics were calculated. The results of this study shown that the quantitative ICG-based DEC-FI can accurately assess the human bone perfusion during the orthopedic surgery.
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Affiliation(s)
- Shudong Jiang
- Thayer school of Engineering, Dartmouth College, Hanover, NH
| | - Jonathan T Elliott
- Department of Orthopaedics, Dartmouth-Hitchcock Medical Center, Lebanon, NH
| | - Jin Xing
- Thayer school of Engineering, Dartmouth College, Hanover, NH
| | - Xu Cao
- Thayer school of Engineering, Dartmouth College, Hanover, NH
| | - Xiaohan Yu
- Thayer school of Engineering, Dartmouth College, Hanover, NH
| | - Xinyue Han
- Thayer school of Engineering, Dartmouth College, Hanover, NH
| | | | | | - Eric R Henderson
- Department of Orthopaedics, Dartmouth-Hitchcock Medical Center, Lebanon, NH
| | - Brian W Pogue
- Thayer school of Engineering, Dartmouth College, Hanover, NH
| | - I Leah Gitajn
- Department of Orthopaedics, Dartmouth-Hitchcock Medical Center, Lebanon, NH
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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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de Vries BA, van der Heijden RA, Verschueren J, Bos PK, Poot DH, van Tiel J, Kotek G, Krestin GP, Oei EH. Quantitative subchondral bone perfusion imaging in knee osteoarthritis using dynamic contrast enhanced MRI. Semin Arthritis Rheum 2020; 50:177-182. [DOI: 10.1016/j.semarthrit.2019.07.013] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2019] [Revised: 07/30/2019] [Accepted: 07/31/2019] [Indexed: 01/12/2023]
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Eijkenboom JFA, van der Heijden RA, de Kanter JLM, Oei EH, Bierma-Zeinstra SMA, van Middelkoop M. Patellofemoral alignment and geometry and early signs of osteoarthritis are associated in patellofemoral pain population. Scand J Med Sci Sports 2020; 30:885-893. [PMID: 32096249 PMCID: PMC7187437 DOI: 10.1111/sms.13641] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2019] [Revised: 02/03/2020] [Accepted: 02/06/2020] [Indexed: 12/20/2022]
Abstract
Background Patellofemoral pain (PFP) patients show increased prevalence of patellar malalignment. Structural and alignment abnormalities of the patellofemoral joint (PFJ) may play a role in development of PFP and patellofemoral osteoarthritis (PFOA). Objectives Evaluating associations of patellofemoral alignment and femoral geometry with bony and cartilaginous abnormalities in PFP patients and healthy control subjects. Methods Data from a case‐control study were used (64 PFP subjects, 70 control subjects, 57% female, age 23.2 (6.4)). Alignment and femoral geometry measures in the PFJ were determined using MRI. Structural abnormalities in the PFJ associated with OA (bone marrow lesions, osteophytes, minor cartilage defects and Hoffa‐synovitis), quantified cartilage composition (T1ρ relaxation times) in the PFJ and perfusion within the patellar bone were examined using different MRI techniques. Associations were analyzed using regression analyses, adjusted for potential confounders. Results Lateral patellar tilt was negatively associated with presence of osteophytes on both patella (OR 0.91; 95% CI 0.84 to 0.98), anterior femur (OR 0.92; 95% CI 0.84 to 0.99) and minor cartilage defects on patella (OR 0.91; 95% CI 0.84 to 0.99). Patella alta was positively associated with the presence of bone marrow lesions in the patella and minor cartilage defects (OR 48.33; 95% CI 4.27 to 547.30 and OR 17.51; 95% CI 1.17 to 262.57, respectively). Patella alta and medial patellar translation were positively associated with T1ρ relaxation times within trochlear cartilage (β 5.2; 95% CI 0.77 to 9.58, and 0.36; 95% CI 0.08 to 0.64, respectively). None of the alignment and geometry measures were associated with bone perfusion. Conclusion Our study implies that associations between patellofemoral alignment and geometry and structural joint abnormalities linked to OA are already present in both PFP patients and healthy control subjects.
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Affiliation(s)
- Joost F A Eijkenboom
- Department of General Practice, Erasmus MC University Medical Center, Rotterdam, The Netherlands
| | - Rianne A van der Heijden
- Department of Radiology & Nuclear Medicine, Erasmus MC University Medical Center, Rotterdam, The Netherlands
| | - Janneke L M de Kanter
- Department of Radiology & Nuclear Medicine, Erasmus MC University Medical Center, Rotterdam, The Netherlands
| | - Edwin H Oei
- Department of Radiology & Nuclear Medicine, Erasmus MC University Medical Center, Rotterdam, The Netherlands
| | - Sita M A Bierma-Zeinstra
- Department of General Practice, Erasmus MC University Medical Center, Rotterdam, The Netherlands
| | - Marienke van Middelkoop
- Department of General Practice, Erasmus MC University Medical Center, Rotterdam, The Netherlands
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11
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de Vries BA, van der Heijden RA, Poot DHJ, van Middelkoop M, Meuffels DE, Krestin GP, Oei EHG. Quantitative DCE-MRI demonstrates increased blood perfusion in Hoffa's fat pad signal abnormalities in knee osteoarthritis, but not in patellofemoral pain. Eur Radiol 2020; 30:3401-3408. [PMID: 32064564 PMCID: PMC7248045 DOI: 10.1007/s00330-020-06671-6] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2019] [Revised: 12/19/2019] [Accepted: 01/23/2020] [Indexed: 12/13/2022]
Abstract
Objective Infrapatellar fat pad (IPFP) fat-suppressed T2 (T2FS) hyperintense regions on MRI are an important imaging feature of knee osteoarthritis (OA) and are thought to represent inflammation. These regions are also common in non-OA subjects, and may not always be linked to inflammation. Our aim was to evaluate quantitative blood perfusion parameters, as surrogate measure of inflammation, within T2FS-hyperintense regions in patients with OA, with patellofemoral pain (PFP) (supposed OA precursor), and control subjects. Methods Twenty-two knee OA patients, 35 PFP patients and 43 healthy controls were included and underwent MRI, comprising T2 and DCE-MRI sequences. T2FS-hyperintense IPFP regions were delineated and a reference region was drawn in adjacent IPFP tissue with normal signal intensity. After fitting the extended Tofts pharmacokinetic model, quantitative DCE-MRI perfusion parameters were compared between the two regions within subjects in each subgroup, using a paired Wilcoxon signed-rank test. Results T2FS-hyperintense IPFP regions were present in 16 of 22 (73%) OA patients, 13 of 35 (37%) PFP patients, and 14 of 43 (33%) controls. DCE-MRI perfusion parameters were significantly different between regions with and without a T2FS-hyperintense signal in OA patients, demonstrating higher Ktrans compared to normal IFPF tissue (0.039 min−1 versus 0.025 min−1, p = 0.017) and higher Ve (0.157 versus 0.119, p = 0.010). For PFP patients and controls no significant differences were found. Conclusions IPFP T2FS-hyperintense regions are associated with higher perfusion in knee OA patients in contrast to identically appearing regions in PFP patients and controls, pointing towards an inflammatory pathogenesis in OA only. Key Points • Morphologically identical appearing T2FS-hyperintense infrapatellar fat pad regions show different perfusion in healthy subjects, subjects with patellofemoral pain, and subjects with knee osteoarthritis. • Elevated DCE-MRI perfusion parameters within T2FS-hyperintense infrapatellar fat pad regions in patients with osteoarthritis suggest an inflammatory pathogenesis in osteoarthritis, but not in patellofemoral pain and healthy subjects.
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Affiliation(s)
- Bas A de Vries
- Department of Radiology & Nuclear Medicine, Erasmus University Medical Center Rotterdam, Rotterdam, The Netherlands
| | - Rianne A van der Heijden
- Department of Radiology & Nuclear Medicine, Erasmus University Medical Center Rotterdam, Rotterdam, The Netherlands
| | - Dirk H J Poot
- Department of Radiology & Nuclear Medicine, Erasmus University Medical Center Rotterdam, Rotterdam, The Netherlands.,Department of Medical Informatics, Erasmus University Medical Center Rotterdam, Rotterdam, The Netherlands
| | - Marienke van Middelkoop
- Department of General Practice, Erasmus University Medical Center Rotterdam, Rotterdam, The Netherlands
| | - Duncan E Meuffels
- Department of Orthopedic Surgery, Erasmus University Medical Center Rotterdam, Rotterdam, The Netherlands
| | - Gabriel P Krestin
- Department of Radiology & Nuclear Medicine, Erasmus University Medical Center Rotterdam, Rotterdam, The Netherlands
| | - Edwin H G Oei
- Department of Radiology & Nuclear Medicine, Erasmus University Medical Center Rotterdam, Rotterdam, The Netherlands.
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Best practices for MRI systematic reviews and meta‐analyses. J Magn Reson Imaging 2018; 49:e51-e64. [DOI: 10.1002/jmri.26198] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2018] [Accepted: 05/01/2018] [Indexed: 12/12/2022] Open
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13
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van der Heijden RA, Poot DHJ, Ekinci M, Kotek G, van Veldhoven PLJ, Klein S, Verhaar JAN, Krestin GP, Bierma-Zeinstra SMA, van Middelkoop M, Oei EHG. Blood perfusion of patellar bone measured by dynamic contrast-enhanced MRI in patients with patellofemoral pain: A case-control study. J Magn Reson Imaging 2018; 48:1344-1350. [PMID: 29734499 PMCID: PMC6221059 DOI: 10.1002/jmri.26174] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2018] [Accepted: 04/16/2018] [Indexed: 01/04/2023] Open
Abstract
BACKGROUND Altered perfusion might play an important role in the pathophysiology of patellofemoral pain (PFP), a common knee complaint with unclear pathophysiology. PURPOSE To investigate differences in dynamic contrast-enhanced (DCE)-MRI perfusion parameters between patients with PFP and healthy control subjects. POPULATION/SUBJECTS/PHANTOM/SPECIMEN/ANIMAL MODEL Thirty-five adult patients with PFP and 44 healthy adult control subjects. FIELD STRENGTH/SEQUENCE 3T DCE-MRI consisting of a sagittal, anterior-posterior, frequency-encoded, fat-suppressed 3D spoiled gradient-echo sequence with intravenous contrast administration. ASSESSMENT Patellar bone volumes of interest (VOIs) were delineated by a blinded observer. Quantitative perfusion parameters (kep and ktrans ) were calculated from motion-compensated DCE-MRI data by fitting Tofts' model. Weighted mean and unweighted median values of kep and ktrans were computed within the patellar bone VOIs. STATISTICAL TESTS Differences in patellar bone perfusion parameters were compared between groups by linear regression analyses, adjusted for confounders. RESULTS Mean differences of weighted mean and unweighted median were 0.0039 (95% confidence interval [CI] -0.0013; 0.0091) and 0.0052 (95% CI -0.0078; 0.018) for ktrans , and 0.046 (95% CI -0.021; 0.11) and 0.069 (95% CI -0.017; 0.15) for kep , respectively. All perfusion parameters were not significantly different between groups (P-values: 0.32; 0.47 for ktrans , and 0.24; 0.15) for kep . However, a significant difference in variance between populations was observed for ktrans (P-value 0.007). DATA CONCLUSION Higher patellar bone perfusion parameters were found in patients with PFP when compared to healthy control subjects, but these differences were not statistically significant. This result, and the observed significant difference in ktrans variance, warrant further research. LEVEL OF EVIDENCE 1 Technical Efficacy: Stage 3 J. Magn. Reson. Imaging 2018;47:1344-1350.
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Affiliation(s)
- Rianne A van der Heijden
- Department of General Practice, Erasmus MC, University Medical Center, Rotterdam, The Netherlands.,Department of Radiology & Nuclear Medicine, Erasmus MC, University Medical Center, Rotterdam, The Netherlands
| | - Dirk H J Poot
- Biomedical Imaging Group Rotterdam, Departments of Medical Informatics & Radiology, Erasmus MC, Rotterdam, The Netherlands.,Quantitative Imaging, Department of Imaging Physics, TU Delft, Delft, The Netherlands
| | - Melek Ekinci
- Department of General Practice, Erasmus MC, University Medical Center, Rotterdam, The Netherlands
| | - Gyula Kotek
- Department of Radiology & Nuclear Medicine, Erasmus MC, University Medical Center, Rotterdam, The Netherlands
| | | | - Stefan Klein
- Biomedical Imaging Group Rotterdam, Departments of Medical Informatics & Radiology, Erasmus MC, Rotterdam, The Netherlands
| | - Jan A N Verhaar
- Department of Orthopedics Erasmus MC, University Medical Center, Rotterdam, The Netherlands
| | - Gabriel P Krestin
- Department of Radiology & Nuclear Medicine, Erasmus MC, University Medical Center, Rotterdam, The Netherlands
| | - Sita M A Bierma-Zeinstra
- Department of General Practice, Erasmus MC, University Medical Center, Rotterdam, The Netherlands.,Department of Orthopedics Erasmus MC, University Medical Center, Rotterdam, The Netherlands
| | - Marienke van Middelkoop
- Department of General Practice, Erasmus MC, University Medical Center, Rotterdam, The Netherlands
| | - Edwin H G Oei
- Department of Radiology & Nuclear Medicine, Erasmus MC, University Medical Center, Rotterdam, The Netherlands
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