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Lattanzi R. Methods for the Clinical Translation of Quantitative MRI for the Evaluation of Patients With Femoroacetabular Impingement. HSS J 2023; 19:442-446. [PMID: 37937089 PMCID: PMC10626928 DOI: 10.1177/15563316231193404] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/21/2023] [Accepted: 07/17/2023] [Indexed: 11/09/2023]
Affiliation(s)
- Riccardo Lattanzi
- Center for Advanced Imaging Innovation and Research (CAIR) and Bernard and Irene Schwartz Center for Biomedical Imaging, Department of Radiology, New York University Grossman School of Medicine, New York, NY, USA
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Atkins PR, Morris A, Elhabian SY, Anderson AE. A Correspondence-Based Network Approach for Groupwise Analysis of Patient-Specific Spatiotemporal Data. Ann Biomed Eng 2023; 51:2289-2300. [PMID: 37357248 PMCID: PMC11047278 DOI: 10.1007/s10439-023-03270-6] [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] [Received: 02/17/2023] [Accepted: 06/01/2023] [Indexed: 06/27/2023]
Abstract
Methods for statistically analyzing patient-specific data that vary both spatially and over time are currently either limited to summary statistics or require elaborate surface registration. We propose a new method, called correspondence-based network analysis, which leverages particle-based shape modeling to establish correspondence across a population and preserve patient-specific measurements and predictions through statistical analysis. Herein, we evaluated this method using three published datasets of the hip describing cortical bone thickness of the proximal femur, cartilage contact stress, and dynamic joint space between control and patient cohorts to evaluate activity- and group-based differences, as applicable, using traditional statistical parametric mapping (SPM) and our proposed spatially considerate correspondence-based network analysis approach. The network approach was insensitive to correspondence density, while the traditional application of SPM showed decreasing area of the region of significance with increasing correspondence density. In comparison to SPM, the network approach identified broader and more connected regions of significance for all three datasets. The correspondence-based network analysis approach identified differences between groups and activities without loss of subject and spatial specificity which could improve clinical interpretation of results.
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Affiliation(s)
- Penny R Atkins
- Scientific Computing and Imaging Institute, University of Utah, Salt Lake City, UT, USA
- Department of Orthopaedics, University of Utah, Salt Lake City, UT, USA
| | - Alan Morris
- Scientific Computing and Imaging Institute, University of Utah, Salt Lake City, UT, USA
| | - Shireen Y Elhabian
- Scientific Computing and Imaging Institute, University of Utah, Salt Lake City, UT, USA
- School of Computing, University of Utah, Salt Lake City, UT, USA
| | - Andrew E Anderson
- Scientific Computing and Imaging Institute, University of Utah, Salt Lake City, UT, USA.
- Department of Orthopaedics, University of Utah, Salt Lake City, UT, USA.
- Department of Biomedical Engineering, University of Utah, Salt Lake City, UT, USA.
- Department of Physical Therapy, University of Utah, Salt Lake City, UT, USA.
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Mills ES, Becerra JA, Yensen K, Bolia IK, Shontz EC, Kebaish KJ, Dobitsch A, Hasan LK, Haratian A, Ong CD, Gross J, Petrigliano FA, Weber AE. Current and Future Advanced Imaging Modalities for the Diagnosis of Early Osteoarthritis of the Hip. Orthop Res Rev 2022; 14:327-338. [PMID: 36131944 PMCID: PMC9482955 DOI: 10.2147/orr.s357498] [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: 01/13/2022] [Accepted: 08/16/2022] [Indexed: 12/04/2022] Open
Abstract
Hip osteoarthritis (OA) can be idiopathic or develop secondary to structural joint abnormalities of the hip joint (alteration of normal anatomy) and/or due to a systemic condition with joint involvement. Early osteoarthritic changes to the hip can be completely asymptomatic or may cause the development hip symptomatology without evidence of OA on radiographs. Delaying the progression of hip OA is critical due to the significant impact of this condition on the patient’s quality of life. Pre-OA of the hip is a newly established term that is often described as the development of signs and symptoms of degenerative hip disease but no radiographic evidence of OA. Advanced imaging methods can help to diagnose pre-OA of the hip in patients with hip pain and normal radiographs or aid in the surveillance of asymptomatic patients with an underlying hip diagnosis that is known to increase the risk of early OA of the hip. These methods include the delayed gadolinium-enhanced magnetic resonance imaging (MRI) of cartilage (dGEMRIC), quantitative magnetic resonance imaging (qMRI- T1rho, T2, and T2* relaxation time mapping), 7-Tesla MRI, computed tomography (CT), and optical coherence tomography (OCT). dGEMRIC proved to be a reliable and accurate modality though it is limited by the significant time necessary for contrast washout between scans. This disadvantage is potentially overcome by T2 weighted MRIs, which do not require contrast. 7-Tesla MRI is a promising development for enhanced imaging resolution compared to 1.5 and 3T MRIs. This technique does require additional optimization and development prior to widespread clinical use. The purpose of this review was to summarize the results of translational and clinical studies investigating the utilization of the above-mentioned imaging modalities to diagnose hip pre-OA, with special focus on recent research evaluating their implementation into clinical practice.
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Affiliation(s)
- Emily S Mills
- Department of Orthopaedic Surgery, Keck School of Medicine, University of Southern California, Los Angeles, CA, USA
| | - Jacob A Becerra
- Department of Orthopaedic Surgery, Keck School of Medicine, University of Southern California, Los Angeles, CA, USA
| | - Katie Yensen
- Department of Orthopaedic Surgery, Keck School of Medicine, University of Southern California, Los Angeles, CA, USA
| | - Ioanna K Bolia
- Department of Orthopaedic Surgery, Keck School of Medicine, University of Southern California, Los Angeles, CA, USA
- Correspondence: Ioanna K Bolia, USC Epstein Family Center for Sports Medicine at Keck Medicine of USC, 1520 San Pablo st #2000, Los Angeles, CA, 90033, USA, Tel +1 9703432813, Fax +8181 658 5920, Email
| | - Edward C Shontz
- Department of Orthopaedic Surgery, Keck School of Medicine, University of Southern California, Los Angeles, CA, USA
| | - Kareem J Kebaish
- Department of Orthopaedic Surgery, Keck School of Medicine, University of Southern California, Los Angeles, CA, USA
| | - Andrew Dobitsch
- Department of Orthopaedic Surgery, Keck School of Medicine, University of Southern California, Los Angeles, CA, USA
| | - Laith K Hasan
- Department of Orthopaedic Surgery, Keck School of Medicine, University of Southern California, Los Angeles, CA, USA
| | - Aryan Haratian
- Department of Orthopaedic Surgery, Keck School of Medicine, University of Southern California, Los Angeles, CA, USA
| | - Charlton D Ong
- Department of Radiology, Keck School of Medicine, University of Southern California, Los Angeles, CA, USA
| | - Jordan Gross
- Department of Radiology, Keck School of Medicine, University of Southern California, Los Angeles, CA, USA
| | - Frank A Petrigliano
- Department of Orthopaedic Surgery, Keck School of Medicine, University of Southern California, Los Angeles, CA, USA
| | - Alexander E Weber
- Department of Orthopaedic Surgery, Keck School of Medicine, University of Southern California, Los Angeles, CA, USA
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Gao G, Dong H, Wang J, Ao Y, Xu Y. Accuracy of Magnetic Resonance Imaging in the Diagnosis of Acetabular Chondral Delamination in Femoroacetabular Impingement. Orthop J Sports Med 2022; 10:23259671221119225. [PMID: 36051975 PMCID: PMC9424888 DOI: 10.1177/23259671221119225] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/10/2022] [Accepted: 06/06/2022] [Indexed: 11/15/2022] Open
Abstract
Background Currently, there is no consensus regarding the accuracy of magnetic resonance imaging (MRI) in the detection of acetabular chondral delamination (ACD) in patients with femoroacetabular impingement (FAI), and, correspondingly, the preoperative diagnosis of ACD remains challenging. Hypothesis It was hypothesized that MRI would have relatively high accuracy in detecting ACD in patients with FAI. Study Design Cohort study (diagnosis); Level of evidence, 2. Methods We retrospectively evaluated patients who attended the sports medicine clinic of our department and underwent arthroscopic surgery for the diagnosis of FAI between January 2018 and December 2020. All patients underwent preoperative 3.0-T MRI. ACD was evaluated by 2 raters on 3.0-T MRI scans, and interrater and intrarater reliability was assessed. Sensitivity, specificity, accuracy, positive predictive value (PPV), and negative predictive value (NPV) of MRI for diagnosis of ACD were calculated, using arthroscopic surgery as the standard. Results A total of 233 patients (mean age, 37.4 years; 99 male and 134 female) were included in this study. The presence of ACD in 101 (43.3%) patients was confirmed during hip arthroscopy. The intraobserver reliability of both of the observers in detecting ACD using 3.0-T MRI scans was almost perfect (observer 1, kappa coefficient [κ] = 0.909 [95% CI, 0.854-0.964]; observer 2, κ = 0.937 [95% CI, 0.890-0.984]), and the interobserver reliability between the observers (κ = 0.801 [95% CI, 0.723-0.879]) was substantial. The overall sensitivity, specificity, PPV, and NPV of preoperative MRI to detect ACD were 83.7%, 82%, 74.2%, and 89.1%, respectively. Conclusion It was found that 3.0-T MRI had a relatively high sensitivity, specificity, PPV, and NPV for diagnosis of ACD in patients with FAI and could be a reliable method of diagnosing ACD preoperatively.
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Affiliation(s)
- Guanying Gao
- Institute of Sports Medicine, Beijing Key Laboratory of Sports Injuries, Peking University Third Hospital, Beijing, China
| | - Hanmei Dong
- Institute of Sports Medicine, Beijing Key Laboratory of Sports Injuries, Peking University Third Hospital, Beijing, China
| | - Jianquan Wang
- Institute of Sports Medicine, Beijing Key Laboratory of Sports Injuries, Peking University Third Hospital, Beijing, China
| | - Yingfang Ao
- Institute of Sports Medicine, Beijing Key Laboratory of Sports Injuries, Peking University Third Hospital, Beijing, China
| | - Yan Xu
- Institute of Sports Medicine, Beijing Key Laboratory of Sports Injuries, Peking University Third Hospital, Beijing, China
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Häller TV, Schenk P, Jud L, Hoch A, Götschi T, Zingg PO. Consistency of 3D femoral torsion measurement from MRI compared to CT gold standard. BMC Musculoskelet Disord 2021; 22:739. [PMID: 34454445 PMCID: PMC8403345 DOI: 10.1186/s12891-021-04633-7] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/21/2021] [Accepted: 08/16/2021] [Indexed: 01/17/2023] Open
Abstract
Background Several hip and knee pathologies are associated with aberrant femoral torsion. Diagnostic workup includes computed tomography (CT) and magnetic resonance imaging (MRI). For three-dimensional (3D) analysis of complex deformities it would be desirable to measure femoral torsion from MRI data to avoid ionizing radiation of CT in a young patient population. 3D measurement of femoral torsion from MRI has not yet been compared to measurements from CT images. We hypothesize that agreement will exist between MRI and CT 3D measurements of femoral torsion. Methods CT and MRI data from 29 hips of 15 patients with routine diagnostic workup for suspected femoroacetabular impingement (FAI) were used to generate 3D bone models. 3D measurement of femoral torsion was performed by two independent readers using the method of Kim et al. which is validated for CT. Inter-modalitiy and inter-reader intraclass correlation coefficients (ICC) were calculated. Results Between MRI and CT 3D measurements an ICC of 0.950 (0.898; 0.976) (reader 1) respectively 0.950 (0.897; 0.976) (Reader 2) was found. The ICC (95% CI) expressing the inter-reader reliability for both modalities was 0.945 (0.886; 0.973) for MRI and 0.957 (0.910; 0.979) for CT, respectively. Mean difference between CT and MRI measurement was 0.42° (MRI – CT, SD: 2.77°, p = 0.253). Conclusions There was consistency between 3D measurements of femoral torsion between computer rendered MRI images compared to measurements with the “gold standard” of CT images. ICC for inter-modality and inter-reader consistency indicate excellent reliability. Accurate, reliable and reproducible 3D measurement of femoral torsion is possible from MRI images.
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Affiliation(s)
- Thomas Vincent Häller
- Department of Orthopedics, Balgrist University Hospital, University of Zurich, Forchstrasse 340, 8008, Zurich, Switzerland.
| | - Pascal Schenk
- Department of Orthopedics, Balgrist University Hospital, University of Zurich, Forchstrasse 340, 8008, Zurich, Switzerland
| | - Lukas Jud
- Department of Orthopedics, Balgrist University Hospital, University of Zurich, Forchstrasse 340, 8008, Zurich, Switzerland
| | - Armando Hoch
- Department of Orthopedics, Balgrist University Hospital, University of Zurich, Forchstrasse 340, 8008, Zurich, Switzerland
| | - Tobias Götschi
- Computer Assisted Research and Development Group, Balgrist University Hospital, University of Zurich, Forchstrasse 340, 8008, Zurich, Switzerland
| | - Patrick Oliver Zingg
- Department of Orthopedics, Balgrist University Hospital, University of Zurich, Forchstrasse 340, 8008, Zurich, Switzerland
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Onggo JD, Onggo JR, Nambiar M, Duong A, Ayeni OR, O'Donnell J, Singh PJ. The 'wave sign' in hip arthroscopy: a systematic review of epidemiological factors, current diagnostic methods and treatment options. J Hip Preserv Surg 2020; 7:410-422. [PMID: 33948197 PMCID: PMC8081434 DOI: 10.1093/jhps/hnaa058] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/07/2020] [Revised: 10/28/2020] [Accepted: 11/17/2020] [Indexed: 12/22/2022] Open
Abstract
This study aims to present a systematic review and synthesized evidence on the epidemiological factors, diagnostic methods and treatment options available for this phenomenon. A multi-database search (OVID Medline, EMBASE and PubMed) was performed according to PRISMA guidelines on 18 June 2019. All studies of any study design discussing on the epidemiological factors, diagnostic methods, classification systems and treatment options of the wave sign were included. The Newcastle–Ottawa quality assessment tool was used to appraise articles. No quantitative analysis could be performed due to heterogeneous data reported; 11 studies with a total of 501 patients with the wave sign were included. Three studies examined risk factors for wave sign and concluded that cam lesions were most common. Other risk factors include alpha angle >65° (OR=4.00, 95% CI: 1.26–12.71, P=0.02), male gender (OR 2.24, 95% CI: 1.09–4.62, P=0.03) and older age (OR=1.04, 95% CI: 1.01–1.07, P=0.03). Increased acetabular coverage in setting of concurrent cam lesions may be a protective factor. Wave signs most commonly occur at the anterior, superior and anterosuperior acetabulum. In terms of staging accuracy, the Haddad classification had the highest coefficients in intraclass correlation (k=0.81, 95% CI: 0.23–0.95, P=0.011), inter-observer reliability (k=0.88, 95% CI: 0.72–0.97, P<0.001) and internal validity (k=0.89). One study investigated the utility of quantitative magnetic imaging for wave sign, concluding that significant heterogeneity in T1ρ and T2 values (P<0.05) of acetabular cartilage is indicative of acetabular debonding. Four studies reported treatment techniques, including bridging suture repair, reverse microfracture with bubble decompression and microfracture with fibrin adhesive glue, with the latter reporting statistically significant improvements in modified Harris hip scores at 6-months (MD=19.2, P<0.05), 12-months (MD=22.0, P<0.05) and 28-months (MD=17.5, P<0.001). No clinical studies were available for other treatment options. There is a scarcity of literature on the wave sign. Identifying at risk symptomatic patients is important to provide prompt diagnosis and treatment. Diagnostic techniques and operative options are still in early developmental stages. More research is needed to understand the natural history of wave sign lesions after arthroscopic surgery and whether intervention can improve long-term outcomes. Level IV, Systematic review of non-homogeneous studies.
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Affiliation(s)
- Jason Derry Onggo
- Department of Orthopaedic Surgery, Tan Tock Seng Hospital, Singapore
| | - James Randolph Onggo
- Department of Orthopaedic Surgery, Box Hill Hospital, Box Hill, Victoria, Australia.,Faculty of Medicine, Nursing and Health Sciences, Monash University, Clayton, Victoria, Australia
| | - Mithun Nambiar
- Faculty of Medicine, Nursing and Health Sciences, Monash University, Clayton, Victoria, Australia.,Department of Orthopaedic Surgery, Maroondah Hospital, Ringwood, Victoria, Australia
| | - Andrew Duong
- Department of Surgery, Division of Orthopaedic Surgery, McMaster University Medical Centre, McMaster University, Ontario, Canada
| | - Olufemi R Ayeni
- Department of Surgery, Division of Orthopaedic Surgery, McMaster University Medical Centre, McMaster University, Ontario, Canada
| | - John O'Donnell
- Department of Surgery, Swinburne University of Technology, Hawthorn, Victoria, Australia.,Hip Arthroscopy Australia, Richmond, Victoria, Australia
| | - Parminder J Singh
- Department of Orthopaedic Surgery, Maroondah Hospital, Ringwood, Victoria, Australia.,Hip Arthroscopy Australia, Richmond, Victoria, Australia
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Samaan MA, Grace T, Zhang AL, Majumdar S, Souza RB. Short term outcomes of hip arthroscopy on hip joint mechanics and cartilage health in patients with femoroacetabular impingement syndrome. Clin Biomech (Bristol, Avon) 2020; 71:214-220. [PMID: 31794897 PMCID: PMC7039761 DOI: 10.1016/j.clinbiomech.2019.11.014] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/11/2019] [Revised: 10/02/2019] [Accepted: 11/23/2019] [Indexed: 02/07/2023]
Abstract
BACKGROUND Femoroacetabular acetabular impingement syndrome consists of abnormal hip joint morphology resulting in painful hip joint impingement. Hip arthroscopy corrects the abnormal morphology and reduces clinical symptoms associated with femoroacetabular impingement syndrome yet the effects of hip arthroscopy on gait mechanics and cartilage health are not well understood. METHODS Ten femoroacetabular impingement syndrome patients and 10 matched asymptomatic controls underwent gait analysis consisting of three-dimensional hip joint kinematics and kinetics. Femoroacetabular impingement syndrome patients underwent gait analysis and quantitative magnetic resonance imaging of the surgical hip joint before and seven months post-surgery. Patient reported outcomes were obtained from all study participants and were used to quantify hip joint pain, function and quality of life. FINDINGS Prior to surgery, femoroacetabular impingement syndrome patients demonstrated hip joint kinematics or kinetics as the control group. After surgery, femoroacetabular impingement syndrome patients exhibited improved patient reported outcomes, similar hip joint kinematic patterns, increased hip flexion and decreased hip extension moment impulses within the surgical limb. The femoroacetabular impingement syndrome patients that ambulated with increased HFMI post-surgery demonstrated a decrease in femoral cartilage T1ρ and T2 values. INTERPRETATION Femoroacetabular impingement syndrome patients exhibited improved clinical symptoms yet ambulated with altered sagittal plane hip joint loading after hip arthroscopy. Increased hip flexion moment impulse post-surgery was associated with improved cartilage health within the surgical limb. These study findings suggest that sagittal plane hip joint loading at short-term follow-up after hip arthroscopy is associated with cartilage health and may be an important biomechanical parameter in post-operative rehabilitation programs.
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Affiliation(s)
- Michael A Samaan
- Department of Kinesiology and Health Promotion, University of Kentucky, 1200 University Drive, Lexington, KY, 40506, USA
| | - Trevor Grace
- Department of Orthopaedic Surgery, University of California-San Francisco, 1500 Owens Street, San Francisco, CA, 94158, USA
| | - Alan L Zhang
- Department of Orthopaedic Surgery, University of California-San Francisco, 1500 Owens Street, San Francisco, CA, 94158, USA
| | - Sharmila Majumdar
- Department of Radiology and Biomedical Imaging, University of California-San Francisco, 185 Berry Street, San Francisco, CA, 94107, USA
| | - Richard B Souza
- Department of Radiology and Biomedical Imaging, University of California-San Francisco, 185 Berry Street, San Francisco, CA, 94107, USA,Department of Physical Therapy and Rehabilitation Science, University of California-San Francisco, 1500 Owens Street, San Francisco, CA, 94158, USA
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Postoperative MRI Findings and Associated Pain Changes After Arthroscopic Surgery for Femoroacetabular Impingement. AJR Am J Roentgenol 2019; 214:177-184. [PMID: 31691612 DOI: 10.2214/ajr.19.21421] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
OBJECTIVE. The purpose of this study is to describe postoperative MRI findings after femoroacetabular impingement surgery in correlation with pain changes and surgical findings. SUBJECTS AND METHODS. We prospectively enrolled 42 patients (43 hips) who were scheduled for FAI surgery. Pre- and postoperative MR images were obtained using a 3-T MRI system. Changes in pain scores were assessed using the hip dysfunction and osteoarthritis outcome score. MR images were evaluated for the presence of acetabuloplasty or femoroplasty, presence of chondral and labral repair surgery, bone marrow edema, subchondral cysts, chondral defects, labral tears, capsular defects, and effusion. The optimal orientation to detect these changes was noted. Imaging findings were compared with pain score changes using linear regression analysis. Sensitivity and specificity were assessed using surgical correlation as the reference standard. RESULTS. Increased acetabular bony débridement length was associated with decreased improvement in pain scores (coefficient, -2.07; 95% CI, -3.53 to -0.62; p = 0.008), whereas other imaging findings were not significantly different. Femoroplasty and capsular alterations were best detected on oblique axial sequences; acetabuloplasty and cartilage and labral repair were best seen on sagittal sequences. MRI showed excellent sensitivity (100%) and specificity (100%) for detecting labral repair and excellent sensitivity for detecting femoroplasty (98%). Sensitivity and specificity were lower for detecting acetabuloplasty (83% and 80%, respectively) and chondral repair (75% and 54%, respectively). CONCLUSION. Arthroscopic acetabuloplasty showed a greater association with postoperative pain than did other aspects of surgical correction for femoroacetabular impingement. Femoroplasty and labral repair were reliably diagnosed on 3-T MRI; however, limitations were found in the evaluation of acetabular chondral repair.
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Pedoia V, Majumdar S. Translation of morphological and functional musculoskeletal imaging. J Orthop Res 2019; 37:23-34. [PMID: 30273968 DOI: 10.1002/jor.24151] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/07/2018] [Accepted: 09/24/2018] [Indexed: 02/04/2023]
Abstract
In an effort to develop quantitative biomarkers for degenerative joint disease and fill the void that exists for diagnosing, monitoring, and assessing the extent of whole joint degeneration, the past decade has been marked by a greatly increased role of noninvasive imaging. This coupled with recent advances in image processing and deep learning opens new possibilities for promising quantitative techniques. The clinical translation of quantitative imaging was previously hampered by tedious non-scalable and subjective image analysis. Osteoarthritis (OA) diagnosis using X-rays can be automated by the use of deep learning models and pilot studies showed feasibility of using similar techniques to reliably segment multiple musculoskeletal tissues and detect and stage the severity of morphological abnormalities in magnetic resonance imaging (MRI). Automation and more advanced feature extraction techniques have applications on larger more heterogeneous samples. Analyses based on voxel based relaxometry have shown local patterns in relaxation time elevations and local correlations with outcome variables. Bone cartilage interactions are also enhanced by the analysis of three-dimensional bone morphology and the potential for the assessment of metabolic activity with simultaneous Positron Emission Tomography (PET)/MR systems. Novel techniques in image processing and deep learning are augmenting imaging to be a source of quantitative and reliable data and new multidimensional analytics allow us to exploit the interactions of data from various sources. In this review, we aim to summarize recent advances in quantitative imaging, the application of image processing and deep learning techniques to study knee and hip OA. ©2018 Orthopaedic Research Society. Published by Wiley Periodicals, Inc. J Orthop Res XX:XX-XX, 2018.
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Grants
- GE Healthcare
- P50 AR060752 National Institute of Arthritis and Musculoskeletal and Skin Diseases, National Institutes of Health, (NIH-NIAMS)
- R01AR046905 National Institute of Arthritis and Musculoskeletal and Skin Diseases, National Institutes of Health, (NIH-NIAMS)
- K99AR070902 National Institute of Arthritis and Musculoskeletal and Skin Diseases, National Institutes of Health, (NIH-NIAMS)
- R00AR070902 National Institute of Arthritis and Musculoskeletal and Skin Diseases, National Institutes of Health, (NIH-NIAMS)
- R61AR073552 National Institute of Arthritis and Musculoskeletal and Skin Diseases, National Institutes of Health, (NIH-NIAMS)
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Affiliation(s)
- Valentina Pedoia
- Department of Radiology and Biomedical Imaging, QB3 Building, 2nd Floor, Suite 203, 1700 - 4th Street, University of California, San Francisco, California, 94158
| | - Sharmila Majumdar
- Department of Radiology and Biomedical Imaging, QB3 Building, 2nd Floor, Suite 203, 1700 - 4th Street, University of California, San Francisco, California, 94158
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10
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Samaan MA, Zhang AL, Popovic T, Pedoia V, Majumdar S, Souza RB. Hip joint muscle forces during gait in patients with femoroacetabular impingement syndrome are associated with patient reported outcomes and cartilage composition. J Biomech 2018; 84:138-146. [PMID: 30600097 DOI: 10.1016/j.jbiomech.2018.12.026] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2018] [Revised: 11/29/2018] [Accepted: 12/17/2018] [Indexed: 10/27/2022]
Abstract
Femoroacetabular impingement syndrome (FAIS) consists of abnormal hip joint morphology and pain during activities of daily living. Abnormal gait mechanics and potentially abnormal muscle forces within FAI patients leads to articular cartilage damage. Therefore, there is a necessity to understand the effects of FAI on hip joint muscle forces during gait and the link between muscle forces, patient reported outcomes (PRO) and articular cartilage health. The purposes of this study were to assess: (1) hip muscle forces between FAI patients and healthy controls and (2) the associations between hip muscle forces with PRO and cartilage composition (T1ρ/T2 mapping) within FAI patients. Musculoskeletal simulations were used to estimate peak muscle forces during the stance phase of gait in 24 FAI patients and 24 healthy controls. Compared to controls, FAI patients ambulated with lower vasti (30% body-weight, p = 0.01) and higher sartorius (4.0% body-weight, p < 0.01) forces. Within FAI patients, lower peak gluteus medius, gluteus minimus, sartorius and iliopsoas forces were associated with worse hip joint pain and function (R = 0.43-0.70, p = 0-0.04), while lower muscle forces were associated with increased T1ρ and T2 values (i.e. altered cartilage composition) within the hip joint cartilage (R = -0.44 to -0.58, p = 0.006-0.05). Although FAI patients demonstrate abnormal muscle forces, it is unknown whether or not these altered muscle force patterns are associated with pain avoidance or weak musculature. Further investigation is required in order to better understand the effects of FAI on hip joint muscle forces and the associations with hip joint cartilage degeneration.
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Affiliation(s)
- Michael A Samaan
- Musculoskeletal Quantitative Imaging Research Group, Department of Radiology and Biomedical Imaging, University of California - San Francisco, San Francisco, CA, USA; Department of Kinesiology & Health Promotion, University of Kentucky, Lexington, KY, USA.
| | - Alan L Zhang
- Department of Orthopaedic Surgery, University of California - San Francisco School of Medicine, San Francisco, CA, USA
| | - Tijana Popovic
- Musculoskeletal Quantitative Imaging Research Group, Department of Radiology and Biomedical Imaging, University of California - San Francisco, San Francisco, CA, USA
| | - Valentina Pedoia
- Musculoskeletal Quantitative Imaging Research Group, Department of Radiology and Biomedical Imaging, University of California - San Francisco, San Francisco, CA, USA
| | - Sharmila Majumdar
- Musculoskeletal Quantitative Imaging Research Group, Department of Radiology and Biomedical Imaging, University of California - San Francisco, San Francisco, CA, USA
| | - Richard B Souza
- Musculoskeletal Quantitative Imaging Research Group, Department of Radiology and Biomedical Imaging, University of California - San Francisco, San Francisco, CA, USA; Department of Physical Therapy and Rehabilitation Science, University of California - San Francisco, San Francisco, CA, USA
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11
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Affiliation(s)
| | | | - O Kenechi Nwawka
- Department of Radiology and Imaging, Hospital for Special Surgery, New York, NY, USA
| | - Hollis G Potter
- Sports Health Associate Editor for Imaging, Department of Radiology and Imaging, Hospital for Special Surgery, New York, NY, USA
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12
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Rossi-deVries J, Pedoia V, Samaan MA, Ferguson AR, Souza RB, Majumdar S. Using multidimensional topological data analysis to identify traits of hip osteoarthritis. J Magn Reson Imaging 2018; 48:1046-1058. [PMID: 29734501 DOI: 10.1002/jmri.26029] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2018] [Accepted: 03/01/2018] [Indexed: 11/11/2022] Open
Abstract
BACKGROUND Osteoarthritis (OA) is a multifaceted disease with many variables affecting diagnosis and progression. Topological data analysis (TDA) is a state-of-the-art big data analytics tool that can combine all variables into multidimensional space. TDA is used to simultaneously analyze imaging and gait analysis techniques. PURPOSE To identify biochemical and biomechanical biomarkers able to classify different disease progression phenotypes in subjects with and without radiographic signs of hip OA. STUDY TYPE Longitudinal study for comparison of progressive and nonprogressive subjects. POPULATION In all, 102 subjects with and without radiographic signs of hip osteoarthritis. FIELD STRENGTH/SEQUENCE 3T, SPGR 3D MAPSS T1ρ /T2 , intermediate-weighted fat-suppressed fast spin-echo (FSE). ASSESSMENT Multidimensional data analysis including cartilage composition, bone shape, Kellgren-Lawrence (KL) classification of osteoarthritis, scoring hip osteoarthritis with MRI (SHOMRI), hip disability and osteoarthritis outcome score (HOOS). STATISTICAL TESTS Analysis done using TDA, Kolmogorov-Smirnov (KS) testing, and Benjamini-Hochberg to rank P-value results to correct for multiple comparisons. RESULTS Subjects in the later stages of the disease had an increased SHOMRI score (P < 0.0001), increased KL (P = 0.0012), and older age (P < 0.0001). Subjects in the healthier group showed intact cartilage and less pain. Subjects found between these two groups had a range of symptoms. Analysis of this subgroup identified knee biomechanics (P < 0.0001) as an initial marker of the disease that is noticeable before the morphological progression and degeneration. Further analysis of an OA subgroup with femoroacetabular impingement (FAI) showed anterior labral tears to be the most significant marker (P = 0.0017) between those FAI subjects with and without OA symptoms. DATA CONCLUSION The data-driven analysis obtained with TDA proposes new phenotypes of these subjects that partially overlap with the radiographic-based classical disease status classification and also shows the potential for further examination of an early onset biomechanical intervention. LEVEL OF EVIDENCE 2 Technical Efficacy: Stage 2 J. Magn. Reson. Imaging 2018;48:1046-1058.
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Affiliation(s)
- Jasmine Rossi-deVries
- Department of Radiology and Biomedical Imaging, University of California, San Francisco, California, USA
| | - Valentina Pedoia
- Department of Radiology and Biomedical Imaging, University of California, San Francisco, California, USA
| | - Michael A Samaan
- Department of Radiology and Biomedical Imaging, University of California, San Francisco, California, USA.,Department of Physical Therapy and Rehabilitation Science, University of California, San Francisco, California, USA
| | - Adam R Ferguson
- Weill Institute for Neurosciences, Department of Neurological Surgery, Brain and Spinal Injury Center, University of California, San Francisco, California, USA.,San Francisco Veterans Affairs Medical Center, San Francisco, California, USA
| | - Richard B Souza
- Department of Radiology and Biomedical Imaging, University of California, San Francisco, California, USA.,Department of Physical Therapy and Rehabilitation Science, University of California, San Francisco, California, USA
| | - Sharmila Majumdar
- Department of Radiology and Biomedical Imaging, University of California, San Francisco, California, USA
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