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Su X, Wang Y, Chen J, Liang Z, Wan L, Tang G. A feasibility study of in vivo quantitative ultra-short echo time-MRI for detecting early cartilage degeneration. Insights Imaging 2024; 15:162. [PMID: 38922455 PMCID: PMC11208376 DOI: 10.1186/s13244-024-01734-4] [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: 12/07/2023] [Accepted: 06/02/2024] [Indexed: 06/27/2024] Open
Abstract
OBJECTIVES To explore the feasibility of Ultra-short echo time (UTE) - MRI quantitative imaging in detecting early cartilage degeneration in vivo and underlying pathological and biochemical basis. METHODS Twenty volunteers with osteoarthritis (OA) planning for total knee arthroplasty (TKA) were prospectively recruited. UTE-MRI sequences and conventional sequences were performed preoperatively. Regions of interests (ROIs) were manually drawn on the tibial plateau and lateral femoral condyle images to calculate MRI values. Cartilage samples were collected during TKA according to the preset positions corresponding to MR images. Pathological and biochemical components of the corresponding ROI, including histological grading, glycosaminoglycan (GAG) content, collagen integrity, and water content were obtained. RESULTS 91 ROIs from volunteers of 7 males (age range: 68 to 78 years; 74 ± 3 years) and 13 females (age range: 57 to 79 years; 67 ± 6 years) were evaluated. UTE-MTR (r = -0.619, p < 0.001), UTE-AdiabT1ρ (r = 0.568, p < 0.001), and UTE-T2* values (r = -0.495, p < 0.001) showed higher correlation with Mankin scores than T2 (r = 0.287, p = 0.006) and T1ρ (r = 0.435, p < 0.001) values. Of them, UTE-MTR had the highest diagnostic performance (AUC = 0.824, p < 0.001). UTE-MTR, UTE-AdiabT1ρ and UTE-T2* value was mainly related to collagen structural integrity, PG content and water content, respectively (r = 0.536, -0.652, -0.518, p < 0.001, respectively). CONCLUSION UTE-MRI have shown greater in vivo diagnostic value for early cartilage degeneration compared to conventional T2 and T1ρ values. Of them, UTE-MTR has the highest diagnostic efficiency. UTE-MTR, UTE-AdiabT1ρ, and UTE-T2* value mainly reflect different aspects of cartilage degeneration--integrity of collagen structure, PG content, and water content, respectively. CRITICAL RELEVANCE STATEMENT Ultra-short echo time (UTE)-MRI has the potential to be a novel image biomarkers for detecting early cartilage degeneration in vivo and was correlated with biochemical changes of early cartilage degeneration. KEY POINTS Conventional MR may miss some early cartilage changes due to relatively long echo times. Ultra-short echo time (UTE)-MRI showed the ability in identifying early cartilage degeneration in vivo. UTE-MT, UTE-AdiabT1ρ, and UTE-T2* mapping mainly reflect different aspects of cartilage degeneration.
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Affiliation(s)
- Xiaolian Su
- Department of Radiology, Shanghai Tenth People's Hospital, School of Medicine, Tongji University, Shanghai, 200092, China
| | - Yitong Wang
- Department of Radiology, Shanghai Tenth People's Hospital, School of Medicine, Tongji University, Shanghai, 200092, China
| | - Jieying Chen
- Department of Radiology, Shanghai Tenth People's Hospital, School of Medicine, Tongji University, Shanghai, 200092, China
| | - Zonghui Liang
- Department of Radiology, Shanghai Jing'an District Central Hospital, Shanghai, China
| | - Lidi Wan
- Department of Radiology, Shanghai Tenth People's Hospital, School of Medicine, Tongji University, Shanghai, 200092, China.
- Chongming Branch of Tenth People's Hospital Affiliated to Tongji University, Shanghai, China.
| | - Guangyu Tang
- Department of Radiology, Shanghai Tenth People's Hospital, School of Medicine, Tongji University, Shanghai, 200092, China.
- Department of Radiology, Shanghai Stomatological Hospital & School of Stomatology, Fudan University, Shanghai, China.
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Williams AA, Asay JL, Asare D, Desai AD, Gold GE, Hargreaves BA, Chaudhari AS, Chu CR. Reproducibility of Quantitative Double-Echo Steady-State T 2 Mapping of Knee Cartilage. J Magn Reson Imaging 2024. [PMID: 38703134 DOI: 10.1002/jmri.29431] [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: 02/09/2024] [Revised: 04/18/2024] [Accepted: 04/19/2024] [Indexed: 05/06/2024] Open
Abstract
BACKGROUND Cartilage T2 can detect joints at risk of developing osteoarthritis. The quantitative double-echo steady state (qDESS) sequence is attractive for knee cartilage T2 mapping because of its acquisition time of under 5 minutes. Understanding the reproducibility errors associated with qDESS T2 is essential to profiling the technical performance of this biomarker. PURPOSE To examine the combined acquisition and segmentation reproducibility of knee cartilage qDESS T2 using two different regional analysis schemes: 1) manual segmentation of subregions loaded during common activities and 2) automatic subregional segmentation. STUDY TYPE Prospective. SUBJECTS 11 uninjured participants (age: 28 ± 3 years; 8 (73%) female). FIELD STRENGTH/SEQUENCE 3-T, qDESS. ASSESSMENT Test-retest T2 maps were acquired twice on the same day and with a 1-week interval between scans. For each acquisition, average cartilage T2 was calculated in four manually segmented regions encompassing tibiofemoral contact areas during common activities and 12 automatically segmented regions from the deep-learning open-source framework for musculoskeletal MRI analysis (DOSMA) encompassing medial and lateral anterior, central, and posterior tibiofemoral regions. Test-retest T2 values from matching regions were used to evaluate reproducibility. STATISTICAL TESTS Coefficients of variation (%CV), root-mean-square-average-CV (%RMSA-CV), and intraclass correlation coefficients (ICCs) assessed test-retest T2 reproducibility. The median of test-retest standard deviations was used for T2 precision. Bland-Altman (BA) analyses examined test-retest biases. The smallest detectable difference (SDD) was defined as the BA limit of agreement of largest magnitude. Significance was accepted for P < 0.05. RESULTS All cartilage regions across both segmentation schemes demonstrated intraday and interday qDESS T2 CVs and RMSA-CVs of ≤5%. T2 ICC values >0.75 were observed in the majority of regions but were more variable in interday tibial comparisons. Test-retest T2 precision was <1.3 msec. The T2 SDD was 3.8 msec. DATA CONCLUSION Excellent CV and RMSA-CV reproducibility may suggest that qDESS T2 increases or decreases >5% (3.8 msec) could represent changes to cartilage composition. LEVEL OF EVIDENCE: 2 TECHNICAL EFFICACY Stage 2.
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Affiliation(s)
- Ashley A Williams
- Department of Orthopaedic Surgery, Stanford University, Stanford, California, USA
- VA Palo Alto Health Care System, Palo Alto, California, USA
| | - Jessica L Asay
- Department of Radiology, Stanford University, Stanford, California, USA
| | - Daniella Asare
- VA Palo Alto Health Care System, Palo Alto, California, USA
| | - Arjun D Desai
- Department of Radiology, Stanford University, Stanford, California, USA
- Department of Electrical Engineering, Stanford University, Stanford, California, USA
| | - Garry E Gold
- Department of Radiology, Stanford University, Stanford, California, USA
- Department of Bioengineering, Stanford University, Stanford, California, USA
| | - Brian A Hargreaves
- Department of Radiology, Stanford University, Stanford, California, USA
- Department of Electrical Engineering, Stanford University, Stanford, California, USA
- Department of Bioengineering, Stanford University, Stanford, California, USA
| | - Akshay S Chaudhari
- Department of Radiology, Stanford University, Stanford, California, USA
- Department of Biomedical Data Science, Stanford University, Stanford, California, USA
| | - Constance R Chu
- Department of Orthopaedic Surgery, Stanford University, Stanford, California, USA
- VA Palo Alto Health Care System, Palo Alto, California, USA
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Ramsdell JC, Beynnon BD, Borah AS, Gardner-Morse MG, Zhang J, Krug MI, Tourville TW, Geeslin M, Failla MJ, DeSarno M, Fiorentino NM. Tibial and femoral articular cartilage exhibit opposite outcomes for T1ρ and T2* relaxation times in response to acute compressive loading in healthy knees. J Biomech 2024; 169:112133. [PMID: 38744146 PMCID: PMC11193943 DOI: 10.1016/j.jbiomech.2024.112133] [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: 05/24/2023] [Revised: 03/01/2024] [Accepted: 05/02/2024] [Indexed: 05/16/2024]
Abstract
Abnormal loading is thought to play a key role in the disease progression of cartilage, but our understanding of how cartilage compositional measurements respond to acute compressive loading in-vivo is limited. Ten healthy subjects were scanned at two timepoints (7 ± 3 days apart) with a 3 T magnetic resonance imaging (MRI) scanner. Scanning sessions included T1ρ and T2* acquisitions of each knee in two conditions: unloaded (traditional MRI setup) and loaded in compression at 40 % bodyweight as applied by an MRI-compatible loading device. T1ρ and T2* parameters were quantified for contacting cartilage (tibial and femoral) and non-contacting cartilage (posterior femoral condyle) regions. Significant effects of load were found in contacting regions for both T1ρ and T2*. The effect of load (loaded minus unloaded) in femoral contacting regions ranged from 4.1 to 6.9 ms for T1ρ, and 3.5 to 13.7 ms for T2*, whereas tibial contacting regions ranged from -5.6 to -1.7 ms for T1ρ, and -2.1 to 0.7 ms for T2*. Notably, the responses to load in the femoral and tibial cartilage revealed opposite effects. No significant differences were found in response to load between the two visits. This is the first study that analyzed the effects of acute loading on T1ρ and T2* measurements in human femoral and tibial cartilage separately. The results suggest the effect of acute compressive loading on T1ρ and T2* was: 1) opposite in the femoral and tibial cartilage; 2) larger in contacting regions than in non-contacting regions of the femoral cartilage; and 3) not different visit-to-visit.
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Affiliation(s)
- John C Ramsdell
- Department of Electrical and Biomedical Engineering, University of Vermont, United States
| | - Bruce D Beynnon
- Department of Electrical and Biomedical Engineering, University of Vermont, United States; Department of Orthopaedics and Rehabilitation, University of Vermont, United States
| | - Andrew S Borah
- Department of Orthopaedics and Rehabilitation, University of Vermont, United States
| | - Mack G Gardner-Morse
- Department of Orthopaedics and Rehabilitation, University of Vermont, United States
| | - Jiming Zhang
- Department of Radiology Oncology & Medical Physics, University of Vermont, United States
| | - Mickey I Krug
- Department of Orthopaedics and Rehabilitation, University of Vermont, United States
| | - Timothy W Tourville
- Department of Orthopaedics and Rehabilitation, University of Vermont, United States; Department of Rehabilitation and Movement Sciences, University of Vermont, United States
| | - Matthew Geeslin
- Department of Radiology, University of Vermont, United States
| | - Mathew J Failla
- Department of Orthopaedics and Rehabilitation, University of Vermont, United States; Department of Rehabilitation and Movement Sciences, University of Vermont, United States
| | - Michael DeSarno
- Biomedical Statistics Research Core, University of Vermont, United States
| | - Niccolo M Fiorentino
- Department of Electrical and Biomedical Engineering, University of Vermont, United States; Department of Orthopaedics and Rehabilitation, University of Vermont, United States; Department of Mechanical Engineering, University of Vermont, United States.
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Baran E, Birczyński A, Dorożyński P, Kulinowski P. Spatially resolved polymer mobilization revisited - Three-dimensional, UltraShort Echo Time (3D UTE) magnetic resonance imaging of sodium alginate matrix tablets. J Colloid Interface Sci 2023; 649:626-634. [PMID: 37364462 DOI: 10.1016/j.jcis.2023.06.139] [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: 03/20/2023] [Revised: 05/24/2023] [Accepted: 06/19/2023] [Indexed: 06/28/2023]
Abstract
HYPOTHESIS Three-dimensional 1H UltraShort Echo Time magnetic resonance imaging (1H 3D UTE MRI) of the matrix tablet made of hydrophilic polymer hydrated in heavy water (D2O) will allow investigation of the hydration-induced spatiotemporal evolution of the material originally included in the matrix tablet during manufacturing (i.e., polymer chains and bound water). EXPERIMENTS The oblong-shaped sodium alginate matrix tablets were used to verify the hypothesis. The matrix was measured before and during hydration in D2O for up to 2 h using the 1H 3D UTE MRI. Five echo times (first at 20 μs) were used, resulting in five three-dimensional images (one image for each echo time). In chosen cross-sections, two parametric images, i.e., amplitude and T2* relaxation time maps, were calculated using "pixel-by-pixel" mono-exponential fitting. FINDINGS The regions of the alginate matrix with T2* shorter than 600 μs were analyzed before (air-dry matrix) and during hydration (parametric, spatiotemporal analysis). During the study, only hydrogen nuclei (protons) pre-existing in the air-dry sample (polymer and bound water) were monitored because the hydration medium (D2O) was not visible. As a result, it was found that morphological changes in regions having T2* shorter than 300 μs were the effect of fast initial water ingress into the core of the matrix and subsequent polymer mobilization (early hydration providing additional 5% w/w hydration medium content relating to air-dry matrix). In particular, evolving layers in T2* maps were detected, and a fracture network was formed shortly after the matrix immersion in D2O. The current study presented a coherent picture of polymer mobilization accompanied by local polymer density decrease. We concluded, that the T2* mapping using 3D UTE MRI can effectively be applied as a polymer mobilization marker.
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Affiliation(s)
- Ewelina Baran
- Institute of Technology, The Pedagogical University of Kraków, Podchorążych 2, 30-084 Kraków, Poland.
| | - Artur Birczyński
- Institute of Technology, The Pedagogical University of Kraków, Podchorążych 2, 30-084 Kraków, Poland.
| | - Przemysław Dorożyński
- Department of Drug Technology and Pharmaceutical Biotechnology, Medical University of Warsaw, Banacha 1, 02-097 Warszawa, Poland.
| | - Piotr Kulinowski
- Institute of Technology, The Pedagogical University of Kraków, Podchorążych 2, 30-084 Kraków, Poland.
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Ligamentization of the reconstructed ACL differs between the intraarticular and intraosseous regions: A quantitative assessment using UTE-T2* mapping. PLoS One 2022; 17:e0271935. [PMID: 35867680 PMCID: PMC9307199 DOI: 10.1371/journal.pone.0271935] [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: 02/25/2022] [Accepted: 07/08/2022] [Indexed: 11/20/2022] Open
Abstract
Background The purpose of this study was to prospectively observe the trends of ultrashort echo time (UTE)-T2* values for the intraarticular and intraosseous regions of reconstructed anterior cruciate ligaments from 6 to 12 months after anterior cruciate ligament reconstruction by using UTE-T2* mapping, and to investigate the changes and differences over time in each region. Methods Ten patients underwent UTE-T2* mapping of the operated knee at 6, 9, and 12 months after anterior cruciate ligament reconstruction. The UTE-T2* values of intraarticular and intraosseous regions of reconstructed anterior cruciate ligaments at 6, 9, and 12 months postoperatively were statistically compared. Results The UTE-T2* values of the intraarticular region at 6 months postoperatively were significantly higher than those at 9 and 12 months. There were no significant differences in the UTE-T2* values at 6, 9, and 12 months postoperatively in the intraosseous region. At 6 months postoperatively, the UTE-T2* values of the intraarticular region were significantly higher than those of the intraosseous region. The UTE-T2* values of the intraosseous region at the tibia were significantly lower than those of the other sites at any postoperative time point. Conclusions According to UTE-T2*mapping-based findings, histological maturation of reconstructed ACLs is faster in the intraosseous region than in the intraarticular region. In particular, the intraarticular region is still undergoing rapid histologic changes at 6 months postoperatively, and its tissue structure is less substantial than normal. The findings of this study may provide clues to determine the optimal timing for safe return to sports in terms of ligamentaization of reconstructed ACLs.
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Wu LL, Liu LH, Rao SX, Wu PY, Zhou JJ. Ultrashort time-to-echo T2* and T2* relaxometry for evaluation of lumbar disc degeneration: a comparative study. BMC Musculoskelet Disord 2022; 23:524. [PMID: 35650645 PMCID: PMC9161611 DOI: 10.1186/s12891-022-05481-9] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/19/2022] [Accepted: 05/24/2022] [Indexed: 11/22/2022] Open
Abstract
Background To compare potential of ultrashort time-to-echo (UTE) T2* mapping and T2* values from T2*-weighted imaging for assessing lumbar intervertebral disc degeneration (IVDD),with Pfirrmann grading as a reference standard. Methods UTE-T2* and T2* values of 366 lumbar discs (L1/2-L5/S1) in 76 subjects were measured in 3 segmented regions: anterior annulus fibrosus, nucleus pulposus (NP), and posterior annulus fibrosus. Lumbar intervertebral discs were divided into 3 categories based on 5-level Pfirrmann grading: normal (Pfirrmann grade I),early disc degeneration (Pfirrmann grades II-III), and advanced disc degeneration (Pfirrmann grades IV-V). Regional differences between UTE-T2* and T2* relaxometry and correlation with degeneration were statistically analyzed. Results UTE-T2* and T2*value correlated negatively with Pfirrmann grades (P < 0.001). In NP, correlations with Pfirrmann grade were high with UTE-T2* values (r = − 0.733; P < 0.001) and moderate with T2* values (r = -0.654; P < 0.001). Diagnostic accuracy of detecting early IVDD was better with UTE-T2* mapping than T2* mapping (P < 0.05),with receiver operating characteristic analysis area under the curve of 0.715–0.876. Conclusions UTE-T2* relaxometry provides another promising magnetic resonance imaging sequence for quantitatively evaluate lumbar IVDD and was more accurate than T2*mapping in the earlier stage degenerative process.
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Affiliation(s)
- Li-Lan Wu
- Department of Radiology, Xiamen Branch, Zhongshan Hospital, Fudan University, Xiamen, China
| | - Li-Heng Liu
- Department of Radiology, Zhongshan Hospital, Fudan University, shanghai, China.,Shanghai Institute of Medical Imaging, shanghai, China
| | - Sheng-Xiang Rao
- Department of Radiology, Zhongshan Hospital, Fudan University, shanghai, China.,Shanghai Institute of Medical Imaging, shanghai, China
| | | | - Jian-Jun Zhou
- Department of Radiology, Zhongshan Hospital, Fudan University, shanghai, China. .,Shanghai Institute of Medical Imaging, shanghai, China.
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Chen Y, Li L, Le N, Chang EY, Huang W, Ma YJ. On the fat saturation effect in quantitative ultrashort TE MR imaging. Magn Reson Med 2022; 87:2388-2397. [PMID: 34985141 DOI: 10.1002/mrm.29149] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2021] [Revised: 12/01/2021] [Accepted: 12/20/2021] [Indexed: 12/11/2022]
Abstract
PURPOSE To investigate the effect of fat saturation (FatSat) on quantitative UTE imaging of variable knee tissues on a 3T scanner. METHODS Three quantitative UTE imaging techniques, including the UTE multi-echo sequence for T 2 ∗ measurement, the adiabatic T1ρ prepared UTE sequence for T1ρ measurement, and the magnetization transfer (MT)-prepared UTE sequence for MT ratio (MTR) and macromolecular proton fraction (MMF) measurements were used in this study. Twelve samples of cartilage and twelve samples of meniscus, as well as six whole knee cadaveric specimens, were imaged with the three above-mentioned UTE sequences with and without FatSat. The difference, correlation, and agreement between the UTE measurements with and without FatSat were calculated to investigate the effects of FatSat on quantification. RESULTS Fat was well-suppressed using all three UTE sequences when FatSat was deployed. For the small sample study, the quantification difference ratio (QDR) values of all the measured biomarkers ranged from 0.7% to 12.6%, whereas for the whole knee joint specimen study, the QDR values ranged from 0.2% to 12.0%. Except for T1ρ in muscle and MMF in meniscus (p > 0.05), most of the measurements showed statistical differences for T1ρ , MTR, and MMF (p < 0.05) between FatSat and non-FatSat scans. Most of the measurements for T 2 ∗ showed no significant differences (p > 0.05). Strong correlations were found for all the biomarkers between measurements with and without FatSat. CONCLUSION The UTE biomarkers showed good correlation and agreement with some slight differences between the scans with and without FatSat.
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Affiliation(s)
- Yanjun Chen
- Department of Medical Imaging, The Third Affiliated Hospital of Southern Medical University, Guangzhou, Guangdong, China.,Department of Radiology, University of California, San Diego, California, USA
| | - Liang Li
- Department of Radiology, University of California, San Diego, California, USA.,Department of Radiology, Renmin Hospital of Wuhan University, Wuhan, Hubei, China
| | - Nicole Le
- Department of Radiology, University of California, San Diego, California, USA.,Research Service, Veterans Affairs San Diego Healthcare System, San Diego, California, USA
| | - Eric Y Chang
- Department of Radiology, University of California, San Diego, California, USA.,Research Service, Veterans Affairs San Diego Healthcare System, San Diego, California, USA
| | - Wenhua Huang
- Guangdong Provincial Key Laboratory of Medical Biomechanics, School of Basic Medical Sciences, Southern Medical University, Guangzhou, Guangdong, China
| | - Ya-Jun Ma
- Department of Radiology, University of California, San Diego, California, USA
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Afsahi AM, Sedaghat S, Moazamian D, Afsahi G, Athertya JS, Jang H, Ma YJ. Articular Cartilage Assessment Using Ultrashort Echo Time MRI: A Review. Front Endocrinol (Lausanne) 2022; 13:892961. [PMID: 35692400 PMCID: PMC9178905 DOI: 10.3389/fendo.2022.892961] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/09/2022] [Accepted: 04/14/2022] [Indexed: 01/05/2023] Open
Abstract
Articular cartilage is a major component of the human knee joint which may be affected by a variety of degenerative mechanisms associated with joint pathologies and/or the aging process. Ultrashort echo time (UTE) sequences with a TE less than 100 µs are capable of detecting signals from both fast- and slow-relaxing water protons in cartilage. This allows comprehensive evaluation of all the cartilage layers, especially for the short T2 layers which include the deep and calcified zones. Several ultrashort echo time (UTE) techniques have recently been developed for both morphological imaging and quantitative cartilage assessment. This review article summarizes the current catalog techniques based on UTE Magnetic Resonance Imaging (MRI) that have been utilized for such purposes in the human knee joint, such as T1, T2∗ , T1ρ, magnetization transfer (MT), double echo steady state (DESS), quantitative susceptibility mapping (QSM) and inversion recovery (IR). The contrast mechanisms as well as the advantages and disadvantages of these techniques are discussed.
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Affiliation(s)
- Amir Masoud Afsahi
- Department of Radiology, University of California San Diego, San Diego, CA, United States
- Research Service, Veterans Affairs San Diego Healthcare System, San Diego, CA, United States
| | - Sam Sedaghat
- Department of Radiology, University of California San Diego, San Diego, CA, United States
| | - Dina Moazamian
- Department of Radiology, University of California San Diego, San Diego, CA, United States
- Research Service, Veterans Affairs San Diego Healthcare System, San Diego, CA, United States
| | - Ghazaleh Afsahi
- Department of Biotechnology Research, BioSapien, San Diego, CA, United States
| | - Jiyo S. Athertya
- Department of Radiology, University of California San Diego, San Diego, CA, United States
| | - Hyungseok Jang
- Department of Radiology, University of California San Diego, San Diego, CA, United States
| | - Ya-Jun Ma
- Department of Radiology, University of California San Diego, San Diego, CA, United States
- *Correspondence: Ya-Jun Ma,
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Thomas KA, Krzemiński D, Kidziński Ł, Paul R, Rubin EB, Halilaj E, Black MS, Chaudhari A, Gold GE, Delp SL. Open Source Software for Automatic Subregional Assessment of Knee Cartilage Degradation Using Quantitative T2 Relaxometry and Deep Learning. Cartilage 2021; 13:747S-756S. [PMID: 34496667 PMCID: PMC8808775 DOI: 10.1177/19476035211042406] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/17/2023] Open
Abstract
OBJECTIVE We evaluated a fully automated femoral cartilage segmentation model for measuring T2 relaxation values and longitudinal changes using multi-echo spin-echo (MESE) magnetic resonance imaging (MRI). We open sourced this model and developed a web app available at https://kl.stanford.edu into which users can drag and drop images to segment them automatically. DESIGN We trained a neural network to segment femoral cartilage from MESE MRIs. Cartilage was divided into 12 subregions along medial-lateral, superficial-deep, and anterior-central-posterior boundaries. Subregional T2 values and four-year changes were calculated using a radiologist's segmentations (Reader 1) and the model's segmentations. These were compared using 28 held-out images. A subset of 14 images were also evaluated by a second expert (Reader 2) for comparison. RESULTS Model segmentations agreed with Reader 1 segmentations with a Dice score of 0.85 ± 0.03. The model's estimated T2 values for individual subregions agreed with those of Reader 1 with an average Spearman correlation of 0.89 and average mean absolute error (MAE) of 1.34 ms. The model's estimated four-year change in T2 for individual subregions agreed with Reader 1 with an average correlation of 0.80 and average MAE of 1.72 ms. The model agreed with Reader 1 at least as closely as Reader 2 agreed with Reader 1 in terms of Dice score (0.85 vs. 0.75) and subregional T2 values. CONCLUSIONS Assessments of cartilage health using our fully automated segmentation model agreed with those of an expert as closely as experts agreed with one another. This has the potential to accelerate osteoarthritis research.
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Affiliation(s)
- Kevin A. Thomas
- Department of Biomedical Data Science,
Stanford University, Stanford, CA, USA
| | - Dominik Krzemiński
- Cardiff University Brain Research
Imaging Centre, Cardiff University, Cardiff, Wales, UK
| | - Łukasz Kidziński
- Department of Bioengineering, Stanford
University, Stanford, CA, USA
| | - Rohan Paul
- Department of Biomedical Data Science,
Stanford University, Stanford, CA, USA
| | - Elka B. Rubin
- Department of Radiology, Stanford
University, Stanford, CA, USA
| | - Eni Halilaj
- Department of Mechanical Engineering,
Carnegie Mellon University, Pittsburgh, PA, USA
| | | | - Akshay Chaudhari
- Department of Biomedical Data Science,
Stanford University, Stanford, CA, USA
- Department of Radiology, Stanford
University, Stanford, CA, USA
| | - Garry E. Gold
- Department of Bioengineering, Stanford
University, Stanford, CA, USA
- Department of Radiology, Stanford
University, Stanford, CA, USA
- Department of Orthopaedic Surgery,
Stanford University, Stanford, CA, USA
| | - Scott L. Delp
- Department of Bioengineering, Stanford
University, Stanford, CA, USA
- Department of Orthopaedic Surgery,
Stanford University, Stanford, CA, USA
- Department of Mechanical Engineering,
Stanford University, Stanford, CA, USA
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10
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Chalian M, Li X, Guermazi A, Obuchowski NA, Carrino JA, Oei EH, Link TM. The QIBA Profile for MRI-based Compositional Imaging of Knee Cartilage. Radiology 2021; 301:423-432. [PMID: 34491127 PMCID: PMC8574057 DOI: 10.1148/radiol.2021204587] [Citation(s) in RCA: 36] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2020] [Revised: 06/18/2021] [Accepted: 07/07/2021] [Indexed: 12/16/2022]
Abstract
MRI-based cartilage compositional analysis shows biochemical and microstructural changes at early stages of osteoarthritis before changes become visible with structural MRI sequences and arthroscopy. This could help with early diagnosis, risk assessment, and treatment monitoring of osteoarthritis. Spin-lattice relaxation time constant in rotating frame (T1ρ) and T2 mapping are the MRI techniques best established for assessing cartilage composition. Only T2 mapping is currently commercially available, which is sensitive to water, collagen content, and orientation of collagen fibers, whereas T1ρ is more sensitive to proteoglycan content. Clinical application of cartilage compositional imaging is limited by high variability and suboptimal reproducibility of the biomarkers, which was the motivation for creating the Quantitative Imaging Biomarkers Alliance (QIBA) Profile for cartilage compositional imaging by the Musculoskeletal Biomarkers Committee of the QIBA. The profile aims at providing recommendations to improve reproducibility and to standardize cartilage compositional imaging. The QIBA Profile provides two complementary claims (summary statements of the technical performance of the quantitative imaging biomarkers that are being profiled) regarding the reproducibility of biomarkers. First, cartilage T1ρ and T2 values are measurable at 3.0-T MRI with a within-subject coefficient of variation of 4%-5%. Second, a measured increase or decrease in T1ρ and T2 of 14% or more indicates a minimum detectable change with 95% confidence. If only an increase in T1ρ and T2 values is expected (progressive cartilage degeneration), then an increase of 12% represents a minimum detectable change over time. The QIBA Profile provides recommendations for clinical researchers, clinicians, and industry scientists pertaining to image data acquisition, analysis, and interpretation and assessment procedures for T1ρ and T2 cartilage imaging and test-retest conformance. This special report aims to provide the rationale for the proposed claims, explain the content of the QIBA Profile, and highlight the future needs and developments for MRI-based cartilage compositional imaging for risk prediction, early diagnosis, and treatment monitoring of osteoarthritis.
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Affiliation(s)
- Majid Chalian
- From the Department of Radiology, Division of Musculoskeletal Imaging
and Intervention, University of Washington, UW Radiology–Roosevelt
Clinic, 4245 Roosevelt Way NE, Box 354755, Seattle, WA 98105 (M.C.); Department
of Biomedical Engineering, Program of Advanced Musculoskeletal Imaging (PAMI)
(X.L.), and Department of Biostatistics (N.A.O.), Cleveland Clinic, Cleveland,
Ohio; Department of Radiology, Boston University School of Medicine, Boston,
Mass (A.G.); Department of Radiology and Imaging, Hospital for Special Surgery,
New York, NY (J.A.C.); Department of Radiology & Nuclear Medicine,
Erasmus MC University Medical Center, Rotterdam, the Netherlands (E.H.O.);
European Imaging Biomarkers Alliance (E.H.O.); and Department of Radiology and
Biomedical Imaging, University of California, San Francisco, Calif
(T.M.L.)
| | - Xiaojuan Li
- From the Department of Radiology, Division of Musculoskeletal Imaging
and Intervention, University of Washington, UW Radiology–Roosevelt
Clinic, 4245 Roosevelt Way NE, Box 354755, Seattle, WA 98105 (M.C.); Department
of Biomedical Engineering, Program of Advanced Musculoskeletal Imaging (PAMI)
(X.L.), and Department of Biostatistics (N.A.O.), Cleveland Clinic, Cleveland,
Ohio; Department of Radiology, Boston University School of Medicine, Boston,
Mass (A.G.); Department of Radiology and Imaging, Hospital for Special Surgery,
New York, NY (J.A.C.); Department of Radiology & Nuclear Medicine,
Erasmus MC University Medical Center, Rotterdam, the Netherlands (E.H.O.);
European Imaging Biomarkers Alliance (E.H.O.); and Department of Radiology and
Biomedical Imaging, University of California, San Francisco, Calif
(T.M.L.)
| | - Ali Guermazi
- From the Department of Radiology, Division of Musculoskeletal Imaging
and Intervention, University of Washington, UW Radiology–Roosevelt
Clinic, 4245 Roosevelt Way NE, Box 354755, Seattle, WA 98105 (M.C.); Department
of Biomedical Engineering, Program of Advanced Musculoskeletal Imaging (PAMI)
(X.L.), and Department of Biostatistics (N.A.O.), Cleveland Clinic, Cleveland,
Ohio; Department of Radiology, Boston University School of Medicine, Boston,
Mass (A.G.); Department of Radiology and Imaging, Hospital for Special Surgery,
New York, NY (J.A.C.); Department of Radiology & Nuclear Medicine,
Erasmus MC University Medical Center, Rotterdam, the Netherlands (E.H.O.);
European Imaging Biomarkers Alliance (E.H.O.); and Department of Radiology and
Biomedical Imaging, University of California, San Francisco, Calif
(T.M.L.)
| | - Nancy A. Obuchowski
- From the Department of Radiology, Division of Musculoskeletal Imaging
and Intervention, University of Washington, UW Radiology–Roosevelt
Clinic, 4245 Roosevelt Way NE, Box 354755, Seattle, WA 98105 (M.C.); Department
of Biomedical Engineering, Program of Advanced Musculoskeletal Imaging (PAMI)
(X.L.), and Department of Biostatistics (N.A.O.), Cleveland Clinic, Cleveland,
Ohio; Department of Radiology, Boston University School of Medicine, Boston,
Mass (A.G.); Department of Radiology and Imaging, Hospital for Special Surgery,
New York, NY (J.A.C.); Department of Radiology & Nuclear Medicine,
Erasmus MC University Medical Center, Rotterdam, the Netherlands (E.H.O.);
European Imaging Biomarkers Alliance (E.H.O.); and Department of Radiology and
Biomedical Imaging, University of California, San Francisco, Calif
(T.M.L.)
| | - John A. Carrino
- From the Department of Radiology, Division of Musculoskeletal Imaging
and Intervention, University of Washington, UW Radiology–Roosevelt
Clinic, 4245 Roosevelt Way NE, Box 354755, Seattle, WA 98105 (M.C.); Department
of Biomedical Engineering, Program of Advanced Musculoskeletal Imaging (PAMI)
(X.L.), and Department of Biostatistics (N.A.O.), Cleveland Clinic, Cleveland,
Ohio; Department of Radiology, Boston University School of Medicine, Boston,
Mass (A.G.); Department of Radiology and Imaging, Hospital for Special Surgery,
New York, NY (J.A.C.); Department of Radiology & Nuclear Medicine,
Erasmus MC University Medical Center, Rotterdam, the Netherlands (E.H.O.);
European Imaging Biomarkers Alliance (E.H.O.); and Department of Radiology and
Biomedical Imaging, University of California, San Francisco, Calif
(T.M.L.)
| | - Edwin H. Oei
- From the Department of Radiology, Division of Musculoskeletal Imaging
and Intervention, University of Washington, UW Radiology–Roosevelt
Clinic, 4245 Roosevelt Way NE, Box 354755, Seattle, WA 98105 (M.C.); Department
of Biomedical Engineering, Program of Advanced Musculoskeletal Imaging (PAMI)
(X.L.), and Department of Biostatistics (N.A.O.), Cleveland Clinic, Cleveland,
Ohio; Department of Radiology, Boston University School of Medicine, Boston,
Mass (A.G.); Department of Radiology and Imaging, Hospital for Special Surgery,
New York, NY (J.A.C.); Department of Radiology & Nuclear Medicine,
Erasmus MC University Medical Center, Rotterdam, the Netherlands (E.H.O.);
European Imaging Biomarkers Alliance (E.H.O.); and Department of Radiology and
Biomedical Imaging, University of California, San Francisco, Calif
(T.M.L.)
| | - Thomas M. Link
- From the Department of Radiology, Division of Musculoskeletal Imaging
and Intervention, University of Washington, UW Radiology–Roosevelt
Clinic, 4245 Roosevelt Way NE, Box 354755, Seattle, WA 98105 (M.C.); Department
of Biomedical Engineering, Program of Advanced Musculoskeletal Imaging (PAMI)
(X.L.), and Department of Biostatistics (N.A.O.), Cleveland Clinic, Cleveland,
Ohio; Department of Radiology, Boston University School of Medicine, Boston,
Mass (A.G.); Department of Radiology and Imaging, Hospital for Special Surgery,
New York, NY (J.A.C.); Department of Radiology & Nuclear Medicine,
Erasmus MC University Medical Center, Rotterdam, the Netherlands (E.H.O.);
European Imaging Biomarkers Alliance (E.H.O.); and Department of Radiology and
Biomedical Imaging, University of California, San Francisco, Calif
(T.M.L.)
| | - for the RSNA QIBA MSK Biomarker Committee
- From the Department of Radiology, Division of Musculoskeletal Imaging
and Intervention, University of Washington, UW Radiology–Roosevelt
Clinic, 4245 Roosevelt Way NE, Box 354755, Seattle, WA 98105 (M.C.); Department
of Biomedical Engineering, Program of Advanced Musculoskeletal Imaging (PAMI)
(X.L.), and Department of Biostatistics (N.A.O.), Cleveland Clinic, Cleveland,
Ohio; Department of Radiology, Boston University School of Medicine, Boston,
Mass (A.G.); Department of Radiology and Imaging, Hospital for Special Surgery,
New York, NY (J.A.C.); Department of Radiology & Nuclear Medicine,
Erasmus MC University Medical Center, Rotterdam, the Netherlands (E.H.O.);
European Imaging Biomarkers Alliance (E.H.O.); and Department of Radiology and
Biomedical Imaging, University of California, San Francisco, Calif
(T.M.L.)
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11
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Chu CR, Williams AA, Erhart-Hledik JC, Titchenal MR, Qian Y, Andriacchi TP. Visualizing pre-osteoarthritis: Integrating MRI UTE-T2* with mechanics and biology to combat osteoarthritis-The 2019 Elizabeth Winston Lanier Kappa Delta Award. J Orthop Res 2021; 39:1585-1595. [PMID: 33788306 DOI: 10.1002/jor.25045] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/17/2020] [Revised: 03/03/2021] [Accepted: 03/24/2021] [Indexed: 02/04/2023]
Abstract
Osteoarthritis (OA) is a leading cause of pain and disability for which disease-modifying treatments remain lacking. This is because the symptoms and radiographic changes of OA occur after the onset of likely irreversible changes. Defining and treating earlier disease states are therefore needed to delay or to halt OA progression. Taking this concept a step further, studying OA pathogenesis before disease onset by characterizing potentially reversible markers of increased OA risk to identify a state of "pre-osteoarthritis (pre-OA)" shifts the paradigm towards OA prevention. The purpose of this review is to summarize the 42 studies comprising the 2019 Kappa Delta Elizabeth Lanier Award where conceptualization of a systems-based definition for "pre-osteoarthritis (pre-OA)" was followed by demonstration of potentially reversible markers of heightened OA risk in patients after anterior cruciate ligament (ACL) injury and reconstruction. In the process, these efforts contributed a new magnetic resonance imaging method of ultrashort echo time (UTE) enhanced T2* mapping to visualize joint tissue damage before the development of irreversible changes. The studies presented here support a transformative approach to OA that accounts for interactions between mechanical, biological, and structural markers of OA risk to develop and evaluate new treatment strategies that can delay or prevent the onset of clinical disease. This body of work was inspired by and performed for patients. Shifting the paradigm from attempting to modify symptomatic radiographic OA towards monitoring and reversing markers of "pre-OA" opens the door for transforming the clinical approach to OA from palliation to prevention.
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Affiliation(s)
- Constance R Chu
- Department Orthopaedic Surgery, Stanford University, Stanford, California, USA.,Department of Surgery, Veterans Affairs Palo Alto Healthcare System, Palo Alto, California, USA
| | - Ashley A Williams
- Department Orthopaedic Surgery, Stanford University, Stanford, California, USA.,Department of Surgery, Veterans Affairs Palo Alto Healthcare System, Palo Alto, California, USA
| | - Jennifer C Erhart-Hledik
- Department Orthopaedic Surgery, Stanford University, Stanford, California, USA.,Department of Surgery, Veterans Affairs Palo Alto Healthcare System, Palo Alto, California, USA
| | | | - Yongxian Qian
- Center for Biomedical Imaging, New York University, New York, New York, USA
| | - Thomas P Andriacchi
- Department Orthopaedic Surgery, Stanford University, Stanford, California, USA.,Department of Mechanical Engineering, Stanford University, Stanford, California, USA
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12
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Xue YP, Ma YJ, Wu M, Jerban S, Wei Z, Chang EY, Du J. Quantitative 3D Ultrashort Echo Time Magnetization Transfer Imaging for Evaluation of Knee Cartilage Degeneration In Vivo. J Magn Reson Imaging 2021; 54:1294-1302. [PMID: 33894091 DOI: 10.1002/jmri.27659] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2020] [Revised: 04/08/2021] [Accepted: 04/08/2021] [Indexed: 12/22/2022] Open
Abstract
BACKGROUND Recent studies suggest that macromolecular fraction (MMF) derived from three-dimensional ultrashort echo time magnetization transfer (UTE-MT) imaging is insensitive to the magic angle effect. However, its clinical use in osteoarthritis (OA) remains to be investigated. PURPOSE To investigate the feasibility of 3D UTE-MT-derived MMF in differentiating normal from degenerated cartilage. STUDY TYPE Prospective. SUBJECTS Sixty-two participants (54.8 ± 16.7 years, 30 females) with and without OA, plus two healthy volunteers (mean age 35.0 years) for reproducibility test. FIELD STRENGTH/SEQUENCE 3 T/UTE-MT sequence. ASSESSMENT A 3D UTE-MT sequence was employed to calculate MMF based on a two-pool model. Kellgren-Lawrence (KL) grade and Whole-Organ Magnetic Resonance Imaging Score (WORMS) were evaluated by three experienced musculoskeletal radiologists. KL grade was condensed into three groups: KL0, KL1-2, and KL3-4. WORMS was regrouped based on extent of lesion (extent group) and depth of lesion (depth group), respectively. The performance of MMF at evaluating the degeneration of cartilage was assessed via Spearman's correlation coefficient and the area under the curve (AUC) calculated according to the receiver-operating characteristic curve. STATISTICAL TESTS After normality check, one-way analysis of variance was used to evaluate the performance. Tukey-Kramer test was performed for post hoc testing. RESULTS MMF showed significant negative correlations with KL grade (r = -0.53, P < 0.05) and WORMS (r = -0.49, P < 0.05). Significantly lower MMFs were found in subjects with greater KL grade (11.8 ± 0.8% for KL0; 10.9 ± 0.9% for KL1-2; 10.6 ± 1.1% for KL3-4; P < 0.05) and in cartilage with greater extent (12.1 ± 1.6% for normal cartilage; 10.9 ± 1.6% for regional lesions; 9.6 ± 1.7% for diffuse lesions; P < 0.05) and depth (12.1 ± 1.6% for normal cartilage; 10.6 ± 1.6% for partial-thickness lesions; 8.8 ± 1.7% for full-thickness lesions; P < 0.05) of lesions. AUC values of MMF for doubtful-minimal OA (KL1-2) and mild cartilage degradation (WORMS1-2) were 0.8 and 0.7, respectively. DATA CONCLUSION This study highlights the clinical potential of MMF in the detection of early OA. LEVEL OF EVIDENCE 2 TECHNICAL EFFICACY STAGE: 2.
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Affiliation(s)
- Yan-Ping Xue
- Department of Radiology, Beijing Chao-Yang Hospital, Capital Medical University, Beijing, China.,Department of Radiology, University of California San Diego, La Jolla, California, USA
| | - Ya-Jun Ma
- Department of Radiology, University of California San Diego, La Jolla, California, USA
| | - Mei Wu
- Department of Radiology, University of California San Diego, La Jolla, California, USA
| | - Saeed Jerban
- Department of Radiology, University of California San Diego, La Jolla, California, USA
| | - Zhao Wei
- Department of Radiology, University of California San Diego, La Jolla, California, USA
| | - Eric Y Chang
- Department of Radiology, University of California San Diego, La Jolla, California, USA.,Radiology Service, Veterans Affairs San Diego Healthcare System, San Diego, California, USA
| | - Jiang Du
- Department of Radiology, University of California San Diego, La Jolla, California, USA
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13
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Williams AA, Erhart-Hledik JC, Asay JL, Mahtani GB, Titchenal MR, Lutz AM, Andriacchi TP, Chu CR. Patient-Reported Outcomes and Knee Mechanics Correlate With Patellofemoral Deep Cartilage UTE-T2* 2 Years After Anterior Cruciate Ligament Reconstruction. Am J Sports Med 2021; 49:675-683. [PMID: 33507800 DOI: 10.1177/0363546520982608] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
BACKGROUND Patellofemoral joint degeneration and dysfunction after anterior cruciate ligament reconstruction (ACLR) are increasingly recognized as contributors to poor clinical outcomes. PURPOSE To determine if greater deep cartilage matrix disruption at 2 years after ACLR, as assessed by elevated patellofemoral magnetic resonance imaging (MRI) ultrashort echo time-enhanced T2* (UTE-T2*), is correlated with (1) worse patient-reported knee function and pain and (2) gait metrics related to patellofemoral tracking and loading, such as greater external rotation of the tibia at heel strike, reduced knee flexion moment (as a surrogate of quadriceps function), and greater knee flexion angle at heel strike. STUDY DESIGN Cross-sectional study; Level of evidence, 3. METHODS MRI UTE-T2* relaxation times in patellar and trochlear deep cartilage were compared with patient-reported outcomes and ambulatory gait metrics in 60 patients with ACLR at 2 years after reconstruction. ACLR gait metrics were compared with those of 60 uninjured reference patients matched by age, body mass index, and sex. ACLR UTE-T2* values were compared with those of 20 uninjured reference patients. RESULTS Higher trochlear UTE-T2* values were associated with worse Knee injury and Osteoarthritis Outcome Scores (KOOS) Sport/Recreation subscale scores (rho = -0.32; P = .015), and showed a trend for association with worse KOOS Pain subscale scores (rho = -0.26; P = .045). At 2 years after ACLR, greater external rotation of the tibia at heel strike was associated with higher patellar UTE-T2* values (R = 0.40; P = .002); greater knee flexion angle at heel strike was associated with higher trochlear UTE-T2* values (rho = 0.39; P = .002); and greater knee flexion moment showed a trend for association with higher trochlear UTE-T2* values (rho = 0.30; P = .019). Patellar cartilage UTE-T2* values, knee flexion angle at heel strike, and external rotation of the tibia at heel strike were all elevated in ACLR knees as compared with reference knees (P = .029, .001, and .044, respectively). CONCLUSION Patellofemoral deep cartilage matrix disruption, as assessed by MRI UTE-T2*, was associated with reduced sports and recreational function and with gait metrics reflective of altered patellofemoral loading. As such, the findings provide new mechanistic information important to improving clinical outcomes related to patellofemoral dysfunction after ACLR.
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Affiliation(s)
- Ashley A Williams
- Department of Orthopaedic Surgery, Stanford University, Stanford, California, USA.,Veterans Affairs Palo Alto Healthcare System, Palo Alto, California, USA
| | - Jennifer C Erhart-Hledik
- Department of Orthopaedic Surgery, Stanford University, Stanford, California, USA.,Veterans Affairs Palo Alto Healthcare System, Palo Alto, California, USA
| | - Jessica L Asay
- Veterans Affairs Palo Alto Healthcare System, Palo Alto, California, USA.,Department of Mechanical Engineering, Stanford University, Stanford, California, USA
| | - Gordhan B Mahtani
- Department of Orthopaedic Surgery, Stanford University, Stanford, California, USA.,Veterans Affairs Palo Alto Healthcare System, Palo Alto, California, USA
| | | | - Amelie M Lutz
- Department of Radiology, Stanford University, Stanford, California, USA
| | - Thomas P Andriacchi
- Department of Orthopaedic Surgery, Stanford University, Stanford, California, USA.,Department of Mechanical Engineering, Stanford University, Stanford, California, USA
| | - Constance R Chu
- Department of Orthopaedic Surgery, Stanford University, Stanford, California, USA.,Veterans Affairs Palo Alto Healthcare System, Palo Alto, California, USA
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14
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Osteoarthritis year in review 2020: imaging. Osteoarthritis Cartilage 2021; 29:170-179. [PMID: 33418028 DOI: 10.1016/j.joca.2020.12.019] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/07/2020] [Revised: 11/23/2020] [Accepted: 12/17/2020] [Indexed: 02/02/2023]
Abstract
This narrative "Year in Review" highlights a selection of articles published between January 2019 and April 2020, to be presented at the OARSI World Congress 2020 within the field of osteoarthritis (OA) imaging. Articles were obtained from a PubMed search covering the above period, utilizing a variety of relevant search terms. We then selected original and review studies on OA-related imaging in humans, particularly those with direct clinical relevance, with a focus on the knee. Topics selected encompassed clinically relevant models of early OA, particularly imaging applications on cruciate ligament rupture, as these are of direct clinical interest and provide potential opportunity to evaluate preventive therapy. Further, imaging applications on structural modification of articular tissues in patients with established OA, by non-pharmacological, pharmacological and surgical interventions are summarized. Finally, novel deep learning approaches to imaging are reviewed, as these facilitate implementation and scaling of quantitative imaging application in clinical trials and clinical practice. Methodological or observational studies outside these key focus areas were not included. Studies focused on biology, biomechanics, biomarkers, genetics and epigenetics, and clinical studies that did not contain an imaging component are covered in other articles within the OARSI "Year in Review" series. In conclusion, exciting progress has been made in clinically validating human models of early OA, and the field of automated articular tissue segmentation. Most importantly though, it has been shown that structure modification of articular cartilage is possible, and future research should focus on the translation of these structural findings to clinical benefit.
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15
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16
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Hafner T, Schock J, Post M, Abrar DB, Sewerin P, Linka K, Knobe M, Kuhl C, Truhn D, Nebelung S. A serial multiparametric quantitative magnetic resonance imaging study to assess proteoglycan depletion of human articular cartilage and its effects on functionality. Sci Rep 2020; 10:15106. [PMID: 32934341 PMCID: PMC7492285 DOI: 10.1038/s41598-020-72208-y] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2020] [Accepted: 08/21/2020] [Indexed: 02/06/2023] Open
Abstract
Water, collagen, and proteoglycans determine articular cartilage functionality. If altered, susceptibility to premature degeneration is increased. This study investigated the effects of enzymatic proteoglycan depletion on cartilage functionality as assessed by advanced Magnetic Resonance Imaging (MRI) techniques under standardized loading. Lateral femoral condylar cartilage-bone samples from patients undergoing knee replacement (n = 29) were serially imaged by Proton Density-weighted and T1, T1ρ, T2, and T2* mapping sequences on a clinical 3.0 T MRI scanner (Achieva, Philips). Using pressure-controlled indentation loading, samples were imaged unloaded and quasi-statically loaded to 15.1 N and 28.6 N, and both before and after exposure to low-concentrated (LT, 0.1 mg/mL, n = 10) or high-concentrated trypsin (HT, 1.0 mg/mL, n = 10). Controls were not treated (n = 9). Responses to loading were assessed for the entire sample and regionally, i.e. sub- and peri-pistonally, and zonally, i.e. upper and lower sample halves. Trypsin effects were quantified as relative changes (Δ), analysed using appropriate statistical tests, and referenced histologically. Histological proteoglycan depletion was reflected by significant sub-pistonal decreases in T1 (p = 0.003) and T2 (p = 0.008) after HT exposure. Loading-induced changes in T1ρ and T2* were not related. In conclusion, proteoglycan depletion alters cartilage functionality and may be assessed using serial T1 and T2 mapping under loading.
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Affiliation(s)
- Tobias Hafner
- Department of Diagnostic and Interventional Radiology, Aachen University Hospital, Aachen, Germany
| | - Justus Schock
- Medical Faculty, Department of Diagnostic and Interventional Radiology, University Hospital Düsseldorf, Moorenstraße 5, 40225, Dusseldorf, Germany.,Institute of Computer Vision and Imaging, RWTH University Aachen, Aachen, Germany
| | - Manuel Post
- Department of Diagnostic and Interventional Radiology, Aachen University Hospital, Aachen, Germany
| | - Daniel Benjamin Abrar
- Medical Faculty, Department of Diagnostic and Interventional Radiology, University Hospital Düsseldorf, Moorenstraße 5, 40225, Dusseldorf, Germany
| | - Philipp Sewerin
- Medical Faculty, Department and Hiller-Research-Unit for Rheumatology, University Hospital Düsseldorf, Düsseldorf, Germany
| | - Kevin Linka
- Department of Continuum and Materials Mechanics, Hamburg University of Technology, Hamburg, Germany
| | - Matthias Knobe
- Clinic for Orthopaedic and Trauma Surgery, Cantonal Hospital Luzern, Luzern, Switzerland
| | - Christiane Kuhl
- Department of Diagnostic and Interventional Radiology, Aachen University Hospital, Aachen, Germany
| | - Daniel Truhn
- Department of Diagnostic and Interventional Radiology, Aachen University Hospital, Aachen, Germany
| | - Sven Nebelung
- Medical Faculty, Department of Diagnostic and Interventional Radiology, University Hospital Düsseldorf, Moorenstraße 5, 40225, Dusseldorf, Germany.
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17
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Kajabi AW, Casula V, Ojanen S, Finnilä MA, Herzog W, Saarakkala S, Korhonen RK, Nissi MJ, Nieminen MT. Multiparametric MR imaging reveals early cartilage degeneration at 2 and 8 weeks after ACL transection in a rabbit model. J Orthop Res 2020; 38:1974-1986. [PMID: 32129515 DOI: 10.1002/jor.24644] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/22/2019] [Revised: 01/20/2020] [Accepted: 02/29/2020] [Indexed: 02/04/2023]
Abstract
In this study, the rabbit model with anterior cruciate ligament transection (ACLT) was used to investigate early degenerative changes in cartilage using multiparametric quantitative magnetic resonance imaging (qMRI). ACLT was surgically induced in the knees of skeletally mature New Zealand White rabbits (n = 14). ACL transected and contralateral knee compartments-medial femur, lateral femur, medial tibia, and lateral tibia-were harvested 2 (n = 8) and 8 weeks (n = 6) postsurgery. Twelve age-matched nonoperated rabbits served as control. qMRI was conducted at 9.4 T and included relaxation times T1 , T2 , continuous-wave T1ρ (CWT1ρ ), adiabatic T1ρ (AdT1ρ ), adiabatic T2ρ (AdT2ρ ), and relaxation along a fictitious field (TRAFF ). For reference, quantitative histology and biomechanical measurements were carried out. Posttraumatic changes were primarily noted in the superficial half of the cartilage. Prolonged T1 , T2 , CWT1ρ , and AdT1ρ were observed in the lateral femur 2 and 8 weeks post-ACLT, compared with the corresponding control and contralateral groups (P < .05). Collagen orientation was significantly altered in the lateral femur at 2 weeks post-ACLT compared with the corresponding control group. In the medial femur, all the studied relaxation time parameters, except TRAFF , were increased 8 weeks post-ACLT, as compared with the corresponding contralateral and control groups (P < .05). Similarly, significant proteoglycan loss was observed in the medial femur at 8 weeks following surgery (P < .05). Multiparametric MRI demonstrated early degenerative changes primarily in the superficial cartilage with T1 , T2 , CWT1ρ , and AdT1ρ sensitive to cartilage changes at 2 weeks after surgery.
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Affiliation(s)
- Abdul Wahed Kajabi
- Research Unit of Medical Imaging, Physics and Technology, University of Oulu, Oulu, Finland.,Medical Research Center Oulu, University of Oulu and Oulu University Hospital, Oulu, Finland
| | - Victor Casula
- Research Unit of Medical Imaging, Physics and Technology, University of Oulu, Oulu, Finland.,Medical Research Center Oulu, University of Oulu and Oulu University Hospital, Oulu, Finland
| | - Simo Ojanen
- Research Unit of Medical Imaging, Physics and Technology, University of Oulu, Oulu, Finland.,Department of Applied Physics, University of Eastern Finland, Kuopio, Finland
| | - Mikko A Finnilä
- Research Unit of Medical Imaging, Physics and Technology, University of Oulu, Oulu, Finland.,Department of Applied Physics, University of Eastern Finland, Kuopio, Finland
| | - Walter Herzog
- Human Performance Laboratory, Faculty of Kinesiology, University of Calgary, Calgary, Alberta, Canada
| | - Simo Saarakkala
- Research Unit of Medical Imaging, Physics and Technology, University of Oulu, Oulu, Finland.,Medical Research Center Oulu, University of Oulu and Oulu University Hospital, Oulu, Finland.,Department of Diagnostic Radiology, Oulu University Hospital, Oulu, Finland
| | - Rami K Korhonen
- Department of Applied Physics, University of Eastern Finland, Kuopio, Finland
| | - Mikko J Nissi
- Research Unit of Medical Imaging, Physics and Technology, University of Oulu, Oulu, Finland.,Department of Applied Physics, University of Eastern Finland, Kuopio, Finland
| | - Miika T Nieminen
- Research Unit of Medical Imaging, Physics and Technology, University of Oulu, Oulu, Finland.,Medical Research Center Oulu, University of Oulu and Oulu University Hospital, Oulu, Finland.,Department of Diagnostic Radiology, Oulu University Hospital, Oulu, Finland
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18
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Kia C, Cavanaugh Z, Gillis E, Dwyer C, Chadayammuri V, Muench LN, Berthold DP, Murphy M, Pacheco R, Arciero RA. Size of Initial Bone Bruise Predicts Future Lateral Chondral Degeneration in ACL Injuries: A Radiographic Analysis. Orthop J Sports Med 2020; 8:2325967120916834. [PMID: 32426411 PMCID: PMC7222279 DOI: 10.1177/2325967120916834] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/23/2020] [Accepted: 03/10/2020] [Indexed: 11/16/2022] Open
Abstract
Background: Bone marrow contusions are common after an acute anterior cruciate ligament (ACL) injury. It is unknown whether the severity of this initial bruise can predict the potential of developing chondral changes even after ACL reconstructive surgery (ACLR). Purpose: To investigate whether the initial bone bruise area could be predictive of progressive chondral defects. Study Design: Cohort study; Level of evidence, 3. Methods: A retrospective chart review was performed to capture patients with an acute ACL injury with pre- and post-ACLR magnetic resonance imaging (MRI) between January 2000 and December 2017. Lesion areas were measured on initial MRI, and chondral wear was graded on final imaging by use of the modified Outerbridge classification. An ordinal model was created to determine whether the initial area was a significant predictor for future chondral degeneration. Results: A total of 40 patients with a mean age of 34.5 ± 12.6 years were included for analysis. All patients underwent ACLR at a mean 139 ± 64 days from initial injury. A lateral tibial and femoral bone bruise was most commonly present in patients (77.5% and 62.5%, respectively). A medial femoral bone bruise was found in only 12.5% (5/40) of patients. The initial contusion area significantly correlated with increasing chondral wear over time in the tibia and lateral femoral condyle (P < .001). Patients with a bone bruise encompassing 100% of the lateral femoral compartment on MRI had a 74% chance of having grade 3 or 4 chondral changes at 5 years (P = .001). Absence of a bone bruise on initial MRI was the greatest predictor of no cartilage wear at 5 years in all compartments (P < .001). The presence of a concomitant lateral meniscal injury increased the risk of developing type 3 or 4 chondral wear in the lateral tibial plateau (P = .012) but did not pose increased risk of femoral wear (P = .23). Conclusion: A significant relationship between area of initial bone bruise at the time of injury and progressive posttraumatic chondral disease was found in the tibial and lateral femoral compartments.
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Affiliation(s)
- Cameron Kia
- Department of Orthopaedic Surgery, University of Connecticut Health Center, Farmington, Connecticut, USA
| | - Zachary Cavanaugh
- Department of Orthopaedic Surgery, University of Connecticut Health Center, Farmington, Connecticut, USA
| | - Edward Gillis
- Department of Orthopaedic Surgery, University of Connecticut Health Center, Farmington, Connecticut, USA
| | - Corey Dwyer
- Department of Orthopaedic Surgery, University of Connecticut Health Center, Farmington, Connecticut, USA
| | - Vivek Chadayammuri
- Department of Orthopaedic Surgery, University of Connecticut Health Center, Farmington, Connecticut, USA
| | - Lukas N Muench
- Department of Orthopaedic Surgery, University of Connecticut Health Center, Farmington, Connecticut, USA.,Department of Orthopaedic Sports Medicine, Technical University of Munich, Munich, Germany
| | - Daniel P Berthold
- Department of Orthopaedic Surgery, University of Connecticut Health Center, Farmington, Connecticut, USA.,Department of Orthopaedic Sports Medicine, Technical University of Munich, Munich, Germany
| | - Matthew Murphy
- Department of Orthopaedic Surgery, University of Connecticut Health Center, Farmington, Connecticut, USA
| | - Rafael Pacheco
- Department of Orthopaedic Surgery, University of Connecticut Health Center, Farmington, Connecticut, USA
| | - Robert A Arciero
- Department of Orthopaedic Surgery, University of Connecticut Health Center, Farmington, Connecticut, USA
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19
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Kijowski R, Demehri S, Roemer F, Guermazi A. Osteoarthritis year in review 2019: imaging. Osteoarthritis Cartilage 2020; 28:285-295. [PMID: 31877380 DOI: 10.1016/j.joca.2019.11.009] [Citation(s) in RCA: 26] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/31/2019] [Revised: 10/17/2019] [Accepted: 11/15/2019] [Indexed: 02/02/2023]
Abstract
OBJECTIVE To provide a narrative review of original articles on osteoarthritis (OA) imaging published between April 1, 2018 and March 30, 2019. METHODS All original research articles on OA imaging published in English between April 1, 2018 and March 30, 2019 were identified using a PubMed database search. The search terms of "Osteoarthritis" or "OA" were combined with the search terms "Radiography", "X-Rays", "Magnetic Resonance Imaging", "MRI", "Ultrasound", "US", "Computed Tomography", "Dual Energy X-Ray Absorptiometry", "DXA", "DEXA", "CT", "Nuclear Medicine", "Scintigraphy", "Single-Photon Emission Computed Tomography", "SPECT", "Positron Emission Tomography", "PET", "PET-CT", or "PET-MRI". Articles were reviewed to determine relevance based upon the following criteria: 1) study involved human subjects with OA or risk factors for OA and 2) study involved imaging to evaluate OA disease status or OA treatment response. Relevant articles were ranked according to scientific merit, with the best publications selected for inclusion in the narrative report. RESULTS The PubMed search revealed a total of 1257 articles, of which 256 (20.4%) were considered relevant to OA imaging. Two-hundred twenty-six (87.1%) articles involved the knee joint, while 195 (76.2%) articles involved the use of magnetic resonance imaging (MRI). The proportion of published studies involving the use of MRI was higher than previous years. An increasing number of articles were also published on imaging of subjects with joint injury and on deep learning application in OA imaging. CONCLUSION MRI and other imaging modalities continue to play an important role in research studies designed to better understand the pathogenesis, progression, and treatment of OA.
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Affiliation(s)
- R Kijowski
- Department of Radiology, University of Wisconsin-Madison, Madison, WI, USA.
| | - S Demehri
- Department of Radiology, Johns Hopkins University, Baltimore, MD, USA.
| | - F Roemer
- Department of Radiology, Boston University, Boston, MA, USA; Department of Radiology, Friedrich-Alexander University Erlangen-Nürnberg (FAU), Universitätsklinikum Erlangen, Erlangen, Germany.
| | - A Guermazi
- Department of Radiology, Boston University, Boston, MA, USA.
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20
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Shultz SJ, Schmitz RJ, Cameron KL, Ford KR, Grooms DR, Lepley LK, Myer GD, Pietrosimone B. Anterior Cruciate Ligament Research Retreat VIII Summary Statement: An Update on Injury Risk Identification and Prevention Across the Anterior Cruciate Ligament Injury Continuum, March 14-16, 2019, Greensboro, NC. J Athl Train 2019; 54:970-984. [PMID: 31461312 PMCID: PMC6795093 DOI: 10.4085/1062-6050-54.084] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Affiliation(s)
- Sandra J. Shultz
- Applied Neuromechanics Research Laboratory, University of North Carolina at Greensboro
| | - Randy J. Schmitz
- Applied Neuromechanics Research Laboratory, University of North Carolina at Greensboro
| | - Kenneth L. Cameron
- John A. Feagin Jr Sports Medicine Fellowship, Keller Army Hospital, United States Military Academy, West Point, NY
| | - Kevin R. Ford
- Human Biomechanics and Physiology Laboratory, Department of Physical Therapy, High Point University, NC
| | - Dustin R. Grooms
- Ohio Musculoskeletal & Neurological Institute and Division of Athletic Training, School of Applied Health Sciences and Wellness, College of Health Sciences and Professions, Ohio University, Athens
| | | | - Gregory D. Myer
- The SPORT Center, Division of Sports Medicine, and Departments of Pediatrics and Orthopaedic Surgery, Cincinnati Children's Hospital Medical Center, College of Medicine, University of Cincinnati, OH
| | - Brian Pietrosimone
- MOTION Science Institute, Department of Exercise and Sport Science, University of North Carolina at Chapel Hill
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21
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Chu CR. Concepts Important to Secondary Prevention of Posttraumatic Osteoarthritis. J Athl Train 2019; 54:987-988. [PMID: 31437015 DOI: 10.4085/1062-6050-54.082] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Affiliation(s)
- Constance R Chu
- Department of Orthopaedic Surgery, Stanford University School of Medicine, Redwood City, CA
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22
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von Drygalski A, Barnes RFW, Jang H, Ma Y, Wong JH, Berman Z, Du J, Chang EY. Advanced magnetic resonance imaging of cartilage components in haemophilic joints reveals that cartilage hemosiderin correlates with joint deterioration. Haemophilia 2019; 25:851-858. [PMID: 31199035 DOI: 10.1111/hae.13802] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2019] [Revised: 05/16/2019] [Accepted: 05/17/2019] [Indexed: 12/12/2022]
Abstract
INTRODUCTION Evidence suggests that toxic iron is involved in haemophilic joint destruction. AIM To determine whether joint iron deposition is linked to clinical and imaging outcomes in order to optimize management of haemophilic joint disease. METHODS Adults with haemophilia A or haemophilia B (n = 23, ≥ age 21) of all severities were recruited prospectively to undergo assessment with Hemophilia Joint Health Scores (HJHS), pain scores (visual analogue scale [VAS]) and magnetic resonance imaging (MRI) at 3T using conventional MRI protocols and 4-echo 3D-UTE-Cones sequences for one affected arthropathic joint. MRI was scored blinded by two musculoskeletal radiologists using the International Prophylaxis Study Group (IPSG) MRI scale. Additionally, UTE-T2* values of cartilage were quantified. Correlations between parameters were performed using Spearman rank correlation. Two patients subsequently underwent knee arthroplasty, which permitted linking of histological findings (including Perl's reaction) with MRI results. RESULTS MRI scores did not correlate with pain scores or HJHS. Sixteen joints had sufficient cartilage for UTE-T2* analysis. T2* values for cartilage correlated inversely with HJHS (rs = -0.81, P < 0.001) and MRI scores (rs = -0.52, P = 0.037). This was unexpected since UTE-T2* values decrease with better joint status in patients with osteoarthritis, suggesting that iron was present and responsible for the effects. Histological analysis of cartilage confirmed iron deposition within chondrocytes, associated with low UTE-T2* values. CONCLUSIONS Iron accumulation can occur in cartilage (not only in synovium) and shows a clear association with joint health. Cartilage iron is a novel biomarker which, if quantifiable with innovative joint-specific MRI T2* sequences, may guide treatment optimization.
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Affiliation(s)
- Annette von Drygalski
- Department of Medicine, University of California San Diego, San Diego, California.,Department of Molecular Medicine, The Scripps Research Institute, La Jolla, California
| | - Richard F W Barnes
- Department of Medicine, University of California San Diego, San Diego, California
| | - Hyungseok Jang
- Department of Radiology, University of California San Diego, San Diego, California
| | - Yajun Ma
- Department of Radiology, University of California San Diego, San Diego, California
| | - Jonathan H Wong
- Department of Radiology, University of California San Diego, San Diego, California
| | - Zachary Berman
- Department of Radiology, University of California San Diego, San Diego, California
| | - Jiang Du
- Department of Radiology, University of California San Diego, San Diego, California
| | - Eric Y Chang
- Department of Radiology, University of California San Diego, San Diego, California.,Radiology Service, VA San Diego Healthcare System, San Diego, California
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23
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Abstract
OBJECTIVE. For many years, MRI of the musculoskeletal system has relied mostly on conventional sequences with qualitative analysis. More recently, using quantitative MRI applications to complement qualitative imaging has gained increasing interest in the MRI community, providing more detailed physiologic or anatomic information. CONCLUSION. In this article, we review the current state of quantitative MRI, technical and software advances, and the most relevant clinical and research musculoskeletal applications of quantitative MRI.
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