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Casula V, Kajabi AW. Quantitative MRI methods for the assessment of structure, composition, and function of musculoskeletal tissues in basic research and preclinical applications. MAGMA (NEW YORK, N.Y.) 2024:10.1007/s10334-024-01174-7. [PMID: 38904746 DOI: 10.1007/s10334-024-01174-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/31/2023] [Revised: 05/04/2024] [Accepted: 05/30/2024] [Indexed: 06/22/2024]
Abstract
Osteoarthritis (OA) is a disabling chronic disease involving the gradual degradation of joint structures causing pain and dysfunction. Magnetic resonance imaging (MRI) has been widely used as a non-invasive tool for assessing OA-related changes. While anatomical MRI is limited to the morphological assessment of the joint structures, quantitative MRI (qMRI) allows for the measurement of biophysical properties of the tissues at the molecular level. Quantitative MRI techniques have been employed to characterize tissues' structural integrity, biochemical content, and mechanical properties. Their applications extend to studying degenerative alterations, early OA detection, and evaluating therapeutic intervention. This article is a review of qMRI techniques for musculoskeletal tissue evaluation, with a particular emphasis on articular cartilage. The goal is to describe the underlying mechanism and primary limitations of the qMRI parameters, their association with the tissue physiological properties and their potential in detecting tissue degeneration leading to the development of OA with a primary focus on basic and preclinical research studies. Additionally, the review highlights some clinical applications of qMRI, discussing the role of texture-based radiomics and machine learning in advancing OA research.
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Affiliation(s)
- Victor Casula
- Research Unit of Health Sciences and Technology, Faculty of Medicine, University of Oulu, Oulu, Finland.
| | - Abdul Wahed Kajabi
- Center for Magnetic Resonance Research, University of Minnesota, Minneapolis, MN, USA
- Department of Radiology, University of Minnesota, Minneapolis, MN, USA
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Martín Noguerol T, Raya JG, Wessell DE, Vilanova JC, Rossi I, Luna A. Functional MRI for evaluation of hyaline cartilage extracelullar matrix, a physiopathological-based approach. Br J Radiol 2019; 92:20190443. [PMID: 31433668 DOI: 10.1259/bjr.20190443] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022] Open
Abstract
MRI of articular cartilage (AC) integrity has potential to become a biomarker for osteoarthritis progression. Traditional MRI sequences evaluate AC morphology, allowing for the measurement of thickness and its change over time. In the last two decades, more advanced, dedicated MRI cartilage sequences have been developed aiming to assess AC matrix composition non-invasively and detect early changes in cartilage not captured on morphological sequences. T2-mapping and T1ρ sequences can be used to estimate the relaxation times of water inside the AC. These sequences have been introduced into clinical protocols and show promising results for cartilage assessment. Extracelullar matrix can also be assessed using diffusion-weighted imaging and diffusion tensor imaging as the movement of water is limited by the presence of extracellular matrix in AC. Specific techniques for glycosaminoglycans (GAG) evaluation, such as delayed gadolinium enhanced MRI of cartilage or Chemical Exchange Saturation Transfer imaging of GAG, as well as sodium imaging have also shown utility in the detection of AC damage. This manuscript provides an educational update on the physical principles behind advanced AC MRI techniques as well as a comprehensive review of the strengths and weaknesses of each approach. Current clinical applications and potential future applications of these techniques are also discussed.
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Affiliation(s)
| | - Jose G Raya
- Department of Radiology, NYU School of Medicine, NY, USA
| | | | - Joan C Vilanova
- Department of Radiology, Clínica Girona. Institute Diagnostic Imaging (IDI), University of Girona, Girona, Spain
| | | | - Antonio Luna
- MRI unit, Radiology department, Health Time, Jaén, Spain
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Rehnitz C, Do T, Klaan B, Burkholder I, Barié A, Wuennemann F, Kauczor H, Weber M. Feasibility of using half‐dose Gd‐BOPTA for delayed gadolinium‐enhanced MRI of cartilage (dGEMRIC) at the knee, compared with standard‐dose Gd‐DTPA. J Magn Reson Imaging 2019; 51:144-154. [DOI: 10.1002/jmri.26816] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2019] [Accepted: 05/21/2019] [Indexed: 11/06/2022] Open
Affiliation(s)
- Christoph Rehnitz
- Department of Diagnostic and Interventional RadiologyUniversity Hospital Heidelberg Heidelberg Germany
| | - Thuy Do
- Department of Diagnostic and Interventional RadiologyUniversity Hospital Heidelberg Heidelberg Germany
| | - Bastian Klaan
- Institute of Diagnostic and Interventional Radiology, Pediatric Radiology and NeuroradiologyUniversity Medicine Rostock Rostock Germany
| | - Iris Burkholder
- Department of Nursing and HealthUniversity of Applied Sciences of the Saarland Saarbruecken Germany
| | - Alexander Barié
- Department of Orthopedics and Trauma SurgeryUniversity Hospital Heidelberg Heidelberg Germany
| | - Felix Wuennemann
- Department of Diagnostic and Interventional RadiologyUniversity Hospital Heidelberg Heidelberg Germany
| | - Hans‐Ulrich Kauczor
- Department of Diagnostic and Interventional RadiologyUniversity Hospital Heidelberg Heidelberg Germany
| | - Marc‐André Weber
- Institute of Diagnostic and Interventional Radiology, Pediatric Radiology and NeuroradiologyUniversity Medicine Rostock Rostock Germany
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MacKay JW, Low SBL, Smith TO, Toms AP, McCaskie AW, Gilbert FJ. Systematic review and meta-analysis of the reliability and discriminative validity of cartilage compositional MRI in knee osteoarthritis. Osteoarthritis Cartilage 2018; 26:1140-1152. [PMID: 29550400 DOI: 10.1016/j.joca.2017.11.018] [Citation(s) in RCA: 70] [Impact Index Per Article: 11.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/03/2017] [Revised: 10/16/2017] [Accepted: 11/14/2017] [Indexed: 02/02/2023]
Abstract
OBJECTIVE To assess reliability and discriminative validity of cartilage compositional magnetic resonance imaging (MRI) in knee osteoarthritis (OA). DESIGN The study was carried out per PRISMA recommendations. We searched MEDLINE and EMBASE (1974 - present) for eligible studies. We performed qualitative synthesis of reliability data. Where data from at least two discrimination studies were available, we estimated pooled standardized mean difference (SMD) between subjects with and without OA. Discrimination analyses compared controls and subjects with mild OA (Kellgren-Lawrence (KL) grade 1-2), severe OA (KL grade 3-4) and OA not otherwise specified (NOS) where not possible to stratify. We assessed quality of the evidence using Quality Appraisal of Diagnostic Reliability (QAREL) and Quality Assessment of Diagnostic Accuracy (QUADAS-2) tools. RESULTS Fifty-eight studies were included in the reliability analysis and 26 studies were included in the discrimination analysis, with data from a total of 2,007 knees. Intra-observer, inter-observer and test-retest reliability of compositional techniques were excellent with most intraclass correlation coefficients >0.8 and coefficients of variation <10%. T1rho and T2 relaxometry were significant discriminators between subjects with mild OA and controls, and between subjects with OA (NOS) and controls (P < 0.001). T1rho showed best discrimination for mild OA (SMD [95% CI] = 0.73 [0.40 to 1.06], P < 0.001) and OA (NOS) (0.60 [0.41 to 0.80], P < 0.001). Quality of evidence was moderate for both parts of the review. CONCLUSIONS Cartilage compositional MRI techniques are reliable and, in the case of T1rho and T2 relaxometry, can discriminate between subjects with OA and controls.
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Affiliation(s)
- J W MacKay
- Department of Radiology, University of Cambridge, Cambridge, UK.
| | - S B L Low
- Department of Radiology, Norfolk & Norwich University Hospital, Norwich, UK.
| | - T O Smith
- School of Health Sciences, University of East Anglia, Norwich, UK.
| | - A P Toms
- Department of Radiology, Norfolk & Norwich University Hospital, Norwich, UK.
| | - A W McCaskie
- Division of Trauma & Orthopaedics, Department of Surgery, University of Cambridge, Cambridge UK.
| | - F J Gilbert
- Department of Radiology, University of Cambridge, Cambridge, UK.
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Rehnitz C, Kuni B, Wuennemann F, Chloridis D, Kirwadi A, Burkholder I, Kauczor HU, Weber MA. Delayed gadolinium-enhanced MRI of cartilage (dGEMRIC) and T
2
mapping of talar osteochondral lesions: Indicators of clinical outcomes. J Magn Reson Imaging 2017; 46:1601-1610. [DOI: 10.1002/jmri.25731] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2017] [Accepted: 03/27/2017] [Indexed: 12/17/2022] Open
Affiliation(s)
- Christoph Rehnitz
- Department of Diagnostic and Interventional Radiology; University Hospital Heidelberg; Germany
| | - Benita Kuni
- Department of Orthopedics and Trauma Surgery; University Hospital Heidelberg; Germany
| | - Felix Wuennemann
- Department of Diagnostic and Interventional Radiology; University Hospital Heidelberg; Germany
| | - Dimitrios Chloridis
- Department of Orthopedics and Trauma Surgery; University Hospital Heidelberg; Germany
| | - Anand Kirwadi
- Department of Radiology; Manchester Royal Infirmary; Manchester UK
| | - Iris Burkholder
- Department of Nursing and Health; University of Applied Sciences of the Saarland; Saarbruecken Germany
| | - Hans-Ulrich Kauczor
- Department of Diagnostic and Interventional Radiology; University Hospital Heidelberg; Germany
| | - Marc-André Weber
- Department of Diagnostic and Interventional Radiology; University Hospital Heidelberg; Germany
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Rehnitz C, Klaan B, Do T, Barié A, Kauczor HU, Weber MA. Feasibility of gadoteric acid for delayed gadolinium-enhanced MRI of cartilage (dGEMRIC) at the wrist and knee and comparison with Gd-DTPA. J Magn Reson Imaging 2017; 46:1433-1440. [DOI: 10.1002/jmri.25688] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2017] [Accepted: 02/10/2017] [Indexed: 12/20/2022] Open
Affiliation(s)
- Christoph Rehnitz
- Department of Diagnostic and Interventional Radiology; University Hospital Heidelberg; Germany
| | - Bastian Klaan
- Department of Diagnostic and Interventional Radiology; University Hospital Heidelberg; Germany
| | - Thuy Do
- Department of Diagnostic and Interventional Radiology; University Hospital Heidelberg; Germany
| | - Alexander Barié
- Department of Orthopedics and Trauma Surgery; University Hospital Heidelberg; Germany
| | - Hans-Ulrich Kauczor
- Department of Diagnostic and Interventional Radiology; University Hospital Heidelberg; Germany
| | - Marc-André Weber
- Department of Diagnostic and Interventional Radiology; University Hospital Heidelberg; Germany
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Kang Y, Choi JY, Yoo HJ, Hong SH, Kang HS. Delayed Gadolinium-enhanced MR Imaging of Cartilage: A Comparative Analysis of Different Gadolinium-based Contrast Agents in an ex Vivo Porcine Model. Radiology 2017; 282:734-742. [DOI: 10.1148/radiol.2016160367] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Affiliation(s)
- Yusuhn Kang
- From the Department of Radiology, Seoul National University College of Medicine, 101 Daehak-ro Jongno-gu, Seoul 110-744, Korea
| | - Ja-Young Choi
- From the Department of Radiology, Seoul National University College of Medicine, 101 Daehak-ro Jongno-gu, Seoul 110-744, Korea
| | - Hye Jin Yoo
- From the Department of Radiology, Seoul National University College of Medicine, 101 Daehak-ro Jongno-gu, Seoul 110-744, Korea
| | - Sung Hwan Hong
- From the Department of Radiology, Seoul National University College of Medicine, 101 Daehak-ro Jongno-gu, Seoul 110-744, Korea
| | - Heung Sik Kang
- From the Department of Radiology, Seoul National University College of Medicine, 101 Daehak-ro Jongno-gu, Seoul 110-744, Korea
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Munukka M, Waller B, Rantalainen T, Häkkinen A, Nieminen MT, Lammentausta E, Kujala UM, Paloneva J, Sipilä S, Peuna A, Kautiainen H, Selänne H, Kiviranta I, Heinonen A. Efficacy of progressive aquatic resistance training for tibiofemoral cartilage in postmenopausal women with mild knee osteoarthritis: a randomised controlled trial. Osteoarthritis Cartilage 2016; 24:1708-1717. [PMID: 27211862 DOI: 10.1016/j.joca.2016.05.007] [Citation(s) in RCA: 46] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/21/2016] [Revised: 04/19/2016] [Accepted: 05/09/2016] [Indexed: 02/02/2023]
Abstract
OBJECTIVE To study the efficacy of aquatic resistance training on biochemical composition of tibiofemoral cartilage in postmenopausal women with mild knee osteoarthritis (OA). DESIGN Eighty seven volunteer postmenopausal women, aged 60-68 years, with mild knee OA (Kellgren-Lawrence grades I/II and knee pain) were recruited and randomly assigned to an intervention (n = 43) and control (n = 44) group. The intervention group participated in 48 supervised aquatic resistance training sessions over 16 weeks while the control group maintained usual level of physical activity. The biochemical composition of the medial and lateral tibiofemoral cartilage was estimated using single-slice transverse relaxation time (T2) mapping and delayed gadolinium-enhanced magnetic resonance imaging of cartilage (dGEMRIC index). Secondary outcomes were cardiorespiratory fitness, isometric knee extension and flexion force and knee injury and OA outcome (KOOS) questionnaire. RESULTS After 4-months aquatic training, there was a significant decrease in both T2 -1.2 ms (95% confidence interval (CI): -2.3 to -0.1, P = 0.021) and dGEMRIC index -23 ms (-43 to -3, P = 0.016) in the training group compared to controls in the full thickness posterior region of interest (ROI) of the medial femoral cartilage. Cardiorespiratory fitness significantly improved in the intervention group by 9.8% (P = 0.010). CONCLUSIONS Our results suggest that, in postmenopausal women with mild knee OA, the integrity of the collagen-interstitial water environment (T2) of the tibiofemoral cartilage may be responsive to low shear and compressive forces during aquatic resistance training. More research is required to understand the exact nature of acute responses in dGEMRIC index to this type of loading. Further, aquatic resistance training improves cardiorespiratory fitness. TRIAL REGISTRATION NUMBER ISRCTN65346593.
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Affiliation(s)
- M Munukka
- Department of Health Sciences, University of Jyväskylä, Jyväskylä, Finland.
| | - B Waller
- Department of Health Sciences, University of Jyväskylä, Jyväskylä, Finland.
| | - T Rantalainen
- Institute for Physical Activity and Nutrition (IPAN), School of Exercise and Nutrition Sciences, Deakin University, Melbourne, Australia.
| | - A Häkkinen
- Department of Health Sciences, University of Jyväskylä, Jyväskylä, Finland; Department of Physical Medicine and Rehabilitation, Central Finland Central Hospital, Jyväskylä, Finland.
| | - M T Nieminen
- Department of Diagnostic Radiology, Oulu University Hospital, Oulu, Finland; Research Unit of Medical Imaging, Physics and Technology, University of Oulu, Oulu, Finland; Medical Research Center, University of Oulu and Oulu University Hospital.
| | - E Lammentausta
- Department of Diagnostic Radiology, Oulu University Hospital, Oulu, Finland.
| | - U M Kujala
- Department of Health Sciences, University of Jyväskylä, Jyväskylä, Finland.
| | - J Paloneva
- Department of Surgery, Central Finland Central Hospital, Jyväskylä, Finland.
| | - S Sipilä
- Department of Health Sciences, University of Jyväskylä, Jyväskylä, Finland; Gerontology Research Center, University of Jyväskylä, Finland.
| | - A Peuna
- Department of Diagnostic Radiology, Oulu University Hospital, Oulu, Finland; Research Unit of Medical Imaging, Physics and Technology, University of Oulu, Oulu, Finland.
| | - H Kautiainen
- Department of General Practice and Primary Health Care, University of Helsinki, Helsinki, Finland; Unit of Primary Health Care, Kuopio University Hospital, Kuopio, Finland.
| | - H Selänne
- Mehiläinen Sports Medical Clinic, Jyväskylä, Finland.
| | - I Kiviranta
- Department of Orthopaedics and Traumatology, University of Helsinki, and Helsinki University Hospital, Helsinki, Finland.
| | - A Heinonen
- Department of Health Sciences, University of Jyväskylä, Jyväskylä, Finland.
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Sigurdsson U, Müller G, Siversson C, Lammentausta E, Svensson J, Tiderius CJ, Dahlberg LE. Delayed gadolinium-enhanced MRI of meniscus (dGEMRIM) and cartilage (dGEMRIC) in healthy knees and in knees with different stages of meniscus pathology. BMC Musculoskelet Disord 2016; 17:406. [PMID: 27682996 PMCID: PMC5041400 DOI: 10.1186/s12891-016-1244-z] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/06/2016] [Accepted: 09/08/2016] [Indexed: 12/23/2022] Open
Abstract
Background Lesions in the meniscus are risk factors for developing knee osteoarthritis (OA), not least because of the role of the meniscus in the pathological progression of OA. Delayed gadolinium enhanced MRI of cartilage (dGEMRIC) has extensively been used to identify pre-radiographic cartilage changes in OA. In contrast, its counterpart with regard to examination of the meniscus, gadolinium enhanced MRI of meniscus (dGEMRIM), has been less utilized. In this study we use 3D dGEMRIM in patients with meniscus lesions and compare them with previous results of healthy individuals. Methods Eighteen subjects with MRI-verified posteromedial meniscus lesions and 12 healthy subjects with non-injured and non-symptomatic knee joints, together 30 volunteers, were examined using 3D Look-Locker sequence after intravenous injection of Gd-DTPA2− (0.2 mmol/kg body weight). Relaxation time (T1) was measured in the posterior meniscus and femoral cartilage before and 60, 90, 120 and 180 min after injection. Relaxation rate (R1 = 1/T1) and change in relaxation rate (ΔR1) were calculated. For statistical analyses, Student’s t-test and Analysis of Variance (ANOVA) were used. Results The pre-contrast diagnostic MRI identified two sub-cohorts in the 18 patients with regard to meniscus injury: 1) 11 subjects with MRI verified pathological intrameniscal changes (grade 2) in the posteromedial meniscus only and no obvious cartilage changes. The lateral meniscus showed no pathology. 2) 7 subjects with MRI verified pathological rupture (grade 3) of the posteromedial meniscus and pathological changes in the lateral meniscus and/or medial and lateral joint cartilage. Comparisons of pathological and healthy posteromedial meniscus revealed opposite patterns in both T1Gd and ΔR1 values between pathological meniscus grade 2 and grade 3. The concentration of the contrast agent was lower than in healthy meniscus in grade 2 lesions (p = 0.046) but tended to increase in grade 3 lesions (p = 0.110). Maximum concentration of contrast agent was reached after 180 min in both cartilage and menisci (except for grade 3 menisci where the maximum concentration was reached after 90 min). Conclusion dGEMRIM and dGEMRIC may be feasible to combine in vivo, preferably with one examination before and one 2 h after contrast injection. Possible different dGEMRIM patterns at different stages of meniscus lesions must be taken into account when evaluating meniscus pathology.
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Affiliation(s)
- Ulf Sigurdsson
- Department of Orthopaedics, Lund University, Skåne University Hospital, SE-205 02, Malmö, Sweden.
| | - Gunilla Müller
- Institute of Radiology und Scintigraphy, Kantonsspital Lucerne, Spitalstrasse, 6000, Lucerne, Switzerland
| | - Carl Siversson
- Medical Radiation Physics, Department of Translational Medicine, Lund University, Skåne University Hospital, SE-205 02, Malmö, Sweden
| | - Eveliina Lammentausta
- Department of Diagnostic Radiology, Oulu University Hospital, PO Box 50, FI-90029 OYS, Oulu, Finland
| | - Jonas Svensson
- Medical Imaging and Physiology, Skåne University Hospital, SE-221 85, Lund, Sweden
| | - Carl-Johan Tiderius
- Department of Orthopaedics, Clinical Sciences Lund, Lund University, Skåne University Hospital, SE-221 85, Lund, Sweden
| | - Leif E Dahlberg
- Department of Orthopaedics, Clinical Sciences Lund, Lund University, Skåne University Hospital, SE-221 85, Lund, Sweden
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Guermazi A, Alizai H, Crema MD, Trattnig S, Regatte RR, Roemer FW. Compositional MRI techniques for evaluation of cartilage degeneration in osteoarthritis. Osteoarthritis Cartilage 2015; 23:1639-53. [PMID: 26050864 DOI: 10.1016/j.joca.2015.05.026] [Citation(s) in RCA: 161] [Impact Index Per Article: 17.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/11/2014] [Revised: 04/26/2015] [Accepted: 05/25/2015] [Indexed: 02/02/2023]
Abstract
Osteoarthritis (OA), a leading cause of disability, affects 27 million people in the United States and its prevalence is rising along with the rise in obesity. So far, biomechanical or behavioral interventions as well as attempts to develop disease-modifying OA drugs have been unsuccessful. This may be partly due to antiquated imaging outcome measures such as radiography, which are still endorsed by regulatory agencies such as the United States Food and Drug Administration (FDA) for use in clinical trials. Morphological magnetic resonance imaging (MRI) allows unparalleled multi-feature assessment of the OA joint. Furthermore, advanced MRI techniques also enable evaluation of the biochemical or ultrastructural composition of articular cartilage relevant to OA research. These compositional MRI techniques have the potential to supplement clinical MRI sequences in identifying cartilage degeneration at an earlier stage than is possible today using morphologic sequences only. The purpose of this narrative review is to describe compositional MRI techniques for cartilage evaluation, which include T2 mapping, T2* Mapping, T1 rho, dGEMRIC, gagCEST, sodium imaging and diffusion weighted imaging (DWI). We also reviewed relevant clinical studies that have utilized these techniques for the study of OA. The different techniques are complementary. Some focus on isotropy or the collagen network (e.g., T2 mapping) and others are more specific in regard to tissue composition, e.g., gagCEST or dGEMRIC that convey information on the GAG concentration. The application and feasibility of these techniques is also discussed, as they will play an important role in implementation in larger clinical trials and eventually clinical practice.
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Affiliation(s)
- A Guermazi
- Department of Radiology, Boston University School of Medicine, Boston, MA, USA; Department of Research, Aspetar Orthopaedic and Sports Medicine Hospital, Doha, Qatar.
| | - H Alizai
- Department of Radiology, University of Texas Health Science Center at San Antonio, San Antonio, TX, USA; Department of Radiology, New York University Langone Medical Center, New York, NY, USA
| | - M D Crema
- Department of Radiology, Boston University School of Medicine, Boston, MA, USA; Department of Research, Aspetar Orthopaedic and Sports Medicine Hospital, Doha, Qatar; Department of Radiology, Hospital do Coração and Teleimagem, São Paulo, Brazil
| | - S Trattnig
- Department of Biomedical Imaging and Image Guided Therapy, Medical University of Vienna, Vienna, Austria
| | - R R Regatte
- Department of Radiology, New York University Langone Medical Center, New York, NY, USA
| | - F W Roemer
- Department of Radiology, Boston University School of Medicine, Boston, MA, USA; Department of Research, Aspetar Orthopaedic and Sports Medicine Hospital, Doha, Qatar; Department of Radiology, University of Erlangen, Erlangen, Germany
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Owman H, Tiderius CJ, Ericsson YB, Dahlberg LE. Long-term effect of removal of knee joint loading on cartilage quality evaluated by delayed gadolinium-enhanced magnetic resonance imaging of cartilage. Osteoarthritis Cartilage 2014; 22:928-32. [PMID: 24795270 DOI: 10.1016/j.joca.2014.04.021] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/11/2013] [Revised: 03/31/2014] [Accepted: 04/22/2014] [Indexed: 02/02/2023]
Abstract
OBJECTIVE Ankle fracture patients were used as a model to study the long-term effect of the removal of joint loading on knee cartilage quality in human subjects. DESIGN The knees of 10 patients with ipsilateral ankle fractures were investigated using delayed gadolinium-enhanced magnetic resonance imaging of cartilage (dGEMRIC) at the time of ankle injury. After 6 weeks' prescribed unloading of the affected leg, but no restrictions regarding knee movement, the cast was removed from the ankle and the patient underwent a second dGEMRIC examination. Physiotherapy was then initiated. A third dGEMRIC examination was performed 4 months after remobilization, and a final examination 1 year after the injury. RESULTS Baseline T1Gd values for the 10 patients were within a narrow range. No significant change in mean T1Gd was observed after 6 weeks' prescribed unloading, but the T1Gd range had increased significantly. Four months after remobilization, the mean T1Gd was significantly lower than in the previous examinations, and the range remained significantly broader than at baseline. At the 1-year follow-up, the mean T1Gd was almost identical to the value after remobilization, and the T1Gd range still showed a significant increase compared to the baseline investigation. CONCLUSIONS Removal of knee cartilage loading for 6 weeks resulted in a measurable effect on the cartilage matrix, as evidenced by a broader T1Gd range. A decrease in mean T1Gd was observed 4 months after remobilization. These differences persisted a year after injury compared to baseline.
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Affiliation(s)
- H Owman
- Department of Orthopaedics, Clinical Sciences, Malmö, Lund University, Sweden.
| | - C J Tiderius
- Department of Orthopaedics, Clinical Sciences, Malmö, Lund University, Sweden
| | - Y B Ericsson
- Department of Orthopaedics, Clinical Sciences, Malmö, Lund University, Sweden
| | - L E Dahlberg
- Department of Orthopaedics, Clinical Sciences, Malmö, Lund University, Sweden
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Delayed gadolinium-enhanced MRI of the meniscus (dGEMRIM) in patients with knee osteoarthritis: relation with meniscal degeneration on conventional MRI, reproducibility, and correlation with dGEMRIC. Eur Radiol 2014; 24:2261-70. [DOI: 10.1007/s00330-014-3204-z] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2014] [Revised: 03/26/2014] [Accepted: 04/24/2014] [Indexed: 12/18/2022]
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Garnov N, Gründer W, Thörmer G, Trampel R, Turner R, Kahn T, Busse H. In vivo MRI analysis of depth-dependent ultrastructure in human knee cartilage at 7 T. NMR IN BIOMEDICINE 2013; 26:1412-1419. [PMID: 23801556 DOI: 10.1002/nbm.2968] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/29/2012] [Revised: 02/26/2013] [Accepted: 04/01/2013] [Indexed: 06/02/2023]
Abstract
Signal intensities of T2-weighted magnetic resonance images depend on the local fiber arrangement in hyaline cartilage. The aims of this study were to determine whether angle-sensitive MRI at 7 T can be used to quantify the cartilage ultrastructure of the knee in vivo and to assess potential differences with age. Ten younger (21-30) and ten older (55-76 years old) healthy volunteers were imaged with a T2-weighted spin-echo sequence in a 7 T whole-body MRI. A "fascicle" model was assumed to describe the depth-dependent fiber arrangement of cartilage. The R/T boundary positions between radial and transitional zones were assessed from intensity profiles in small regions of interest in the femur and tibia, and normalized to cartilage thickness using logistic curve fits. The quality of our highly resolved (0.3 × 0.3 × 1.0 mm(3)) MR cartilage images were high enough for quantitative analysis (goodness of fit R(2) = 0.91 ± 0.09). Between younger and older subjects, normalized positions of the R/T boundary, with value 0 at the bone-cartilage interface and 1 at the cartilage surface, were significantly (p < 0.05) different in femoral (0.51 ± 0.12 versus 0.41 ± 0.10), but not in tibial cartilage (0.65 ± 0.11 versus 0.57 ± 0.09, p = 0.119). Within both age groups, differences between femoral and tibial R/T boundaries were significant. Using a fascicle model and angle-sensitive MRI, the depth-dependent anisotropic fiber arrangement of knee cartilage could be assessed in vivo from a single 7 T MR image. The derived quantitative parameter, thickness of the radial zone, may serve as an indicator of the structural integrity of cartilage. This method may potentially be suitable to detect and monitor early osteoarthritis because the progressive disintegration of the anisotropic network is also indicative of arthritic changes in cartilage.
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Affiliation(s)
- Nikita Garnov
- Department of Diagnostic and Interventional Radiology, Leipzig University Hospital, Liebigstrasse 20, Leipzig, Germany
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Kumahashi N, Tadenuma T, Kuwata S, Fukuba E, Uchio Y. A longitudinal study of the quantitative evaluation of patella cartilage after total knee replacement by delayed gadolinium-enhanced magnetic resonance imaging of cartilage (dGEMRIC) and T2 mapping at 3.0 T: preliminary results. Osteoarthritis Cartilage 2013; 21:126-35. [PMID: 23099213 DOI: 10.1016/j.joca.2012.09.004] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/06/2012] [Revised: 07/23/2012] [Accepted: 09/18/2012] [Indexed: 02/02/2023]
Abstract
OBJECTIVE To characterize the quantitative changes of patella cartilage over time after total knee arthroplasty (TKA) by delayed gadolinium-enhanced magnetic resonance imaging of cartilage (dGEMRIC) and T2 mapping at 3.0 T. METHOD Twenty-six knees of 26 patients (23 women and three men, mean age, 75 years) with primary osteoarthritis and osteonecrosis of the knee underwent TKA with a zirconia ceramic implant in this prospective study. Twelve patients without patella resurfacing (NR group) and 14 patients with patella resurfacing (R group) had TKA with cemented fixation. The implant position was examined by radiograph, computed tomography (CT) and magnetic resonance imaging (MRI). The clinical scores were checked pre-operatively, 1 year post-operatively and at the final follow-up. Patella cartilage and its thickness were evaluated pre-operatively and 1 year after TKA by dGEMRIC and T2 mapping in the NR group only. Patella cartilage was divided into eight regions of interest: the deep and superficial layers of the outer lateral and medial half, and the inner lateral and medial half from the central ridge. RESULTS The implant position was appropriate in all cases and clinical scores were not significantly different between the two groups. The post-operative dGEMRIC value of the outer medial half superficial zone in the NR group was significantly decreased compared with the pre-operation value (P<0.05), whereas T2 mapping was not significantly changed in all zones. The cartilage thickness of the outer zone was significantly thinner post-operatively (P<0.05). CONCLUSIONS These findings indicate that osteoarthritic changes in the outer zone of patella cartilage occurred 1 year after TKA.
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Affiliation(s)
- N Kumahashi
- Department of Orthopaedics, Shimane University, School of Medicine, 89-1 Enya-cho, Izumo-shi, Shimane 693-8501, Japan.
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Chu CR, Williams AA, Coyle CH, Bowers ME. Early diagnosis to enable early treatment of pre-osteoarthritis. Arthritis Res Ther 2012; 14:212. [PMID: 22682469 PMCID: PMC3446496 DOI: 10.1186/ar3845] [Citation(s) in RCA: 153] [Impact Index Per Article: 12.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022] Open
Abstract
Osteoarthritis is a prevalent and disabling disease affecting an increasingly large swathe of the world population. While clinical osteoarthritis is a late-stage condition for which disease-modifying opportunities are limited, osteoarthritis typically develops over decades, offering a long window of time to potentially alter its course. The etiology of osteoarthritis is multifactorial, showing strong associations with highly modifiable risk factors of mechanical overload, obesity and joint injury. As such, characterization of pre-osteoarthritic disease states will be critical to support a paradigm shift from palliation of late disease towards prevention, through early diagnosis and early treatment of joint injury and degeneration to reduce osteoarthritis risk. Joint trauma accelerates development of osteoarthritis from a known point in time. Human joint injury cohorts therefore provide a unique opportunity for evaluation of pre-osteoarthritic conditions and potential interventions from the earliest stages of degeneration. This review focuses on recent advances in imaging and biochemical biomarkers suitable for characterization of the pre-osteoarthritic joint as well as implications for development of effective early treatment strategies.
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Affiliation(s)
- Constance R Chu
- Cartilage Restoration Center, Department of Orthopaedic Surgery, University of Pittsburgh, Biomedical Science Tower E1640, 200 Lothrop Street, PA 15261, USA.
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Laurens E, Schneider E, Winalski CS, Calabro A. A synthetic cartilage extracellular matrix model: hyaluronan and collagen hydrogel relaxivity, impact of macromolecular concentration on dGEMRIC. Skeletal Radiol 2012; 41:209-17. [PMID: 22170182 PMCID: PMC3272489 DOI: 10.1007/s00256-011-1331-z] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/30/2011] [Revised: 11/09/2011] [Accepted: 11/09/2011] [Indexed: 02/02/2023]
Abstract
OBJECTIVE To develop and characterize the MR properties of a synthetic model for cartilage extra-cellular matrix using hydrogels and to determine the concentration dependence of spin-lattice (T1) and spin-spin (T2) relaxation times of hydrogels and their glycosaminoglycan and collagen components in the presence and absence of gadopentetate dimeglumine (Gd-DTPA) for use in dGEMRIC. MATERIALS AND METHODS T1 and T2 measurements were made at 3 Tesla on a range of gelatin (i.e., collagen) and hyaluronan (i.e., glycosaminoglycan) solutions (6.25-100 g/l), alone, together in a composite, and as dityramine-bridged hydrogels. Relaxivity was calculated as a function of macromolecular concentration. RESULTS Even at the highest concentrations, gelatin and hyaluronan solutions had T1 and T2 values significantly larger than those reported for cartilage. Only composite hydrogels with gelatin and hyaluronan concentrations naturally found in cartilage resulted in T1 values, but not T2 values, representative of cartilage. Relaxivities were slightly dependent on both hyaluronan concentration (R1 = 0.0027 l g(-1) s(-1); R2 = 0.025 l g(-1) s(-1)) and gelatin concentration (R1 = 0.0032 l g(-1) s(-1); R2 = 0.020 l g(-1) s(-1)) alone and as a composite (R1 = 0.0068 l g(-1) s(-1); R2 = 0.101 l g(-1) s(-1)). Gd-DTPA relaxivities were dependent upon macromolecular concentration and varied by 14-32% (R1 = 4.24 to 5.55 mM(-1) s(-1); R2 = 4.60 to 6.27 mM(-1) s(-1)) over the range of cartilage biochemistry. CONCLUSIONS Without the contrast agent, hyaluronan and gelatin, alone or in a composite, have a very small impact on the relaxivities of the model system. The impact on R1 was approximately tenfold less than on R2. In contrast, macromolecular concentrations above 50 g/l significantly impacted Gd-DTPA relaxivity and should be accounted for when measuring the glycosaminoglycan content of cartilage in vivo using dGEMRIC.
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Affiliation(s)
- Ediuska Laurens
- Department of Biomedical Engineering, The Cleveland Clinic, Cleveland, OH, USA, Stryker Craniomaxillofacial, Stryker Corporation, Mahwah, NJ, USA
| | - Erika Schneider
- Imaging Institute, The Cleveland Clinic, 9500 Euclid Avenue, HB6, Cleveland, OH 44195, USA
| | - Carl S. Winalski
- Department of Biomedical Engineering, The Cleveland Clinic, Cleveland, OH, USA, Imaging Institute, The Cleveland Clinic, 9500 Euclid Avenue, HB6, Cleveland, OH 44195, USA
| | - Anthony Calabro
- Department of Biomedical Engineering, The Cleveland Clinic, Cleveland, OH, USA
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Salo EN, Nissi MJ, Kulmala KAM, Tiitu V, Töyräs J, Nieminen MT. Diffusion of Gd-DTPA²⁻ into articular cartilage. Osteoarthritis Cartilage 2012; 20:117-26. [PMID: 22179030 DOI: 10.1016/j.joca.2011.11.016] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/04/2011] [Revised: 11/18/2011] [Accepted: 11/24/2011] [Indexed: 02/02/2023]
Abstract
OBJECTIVES The delayed Gadolinium-Enhanced MRI of Cartilage (dGEMRIC) technique is a method proposed for non-invasive measurement of cartilage glycosaminoglycan (GAG) content. In this method, gadopentetate (Gd-DTPA²⁻) is assumed to distribute in cartilage in inverse relation to the GAG distribution, thus allowing quantification of the GAG content. For accurate GAG quantification, the kinetics of Gd-DTPA²⁻ in articular cartilage is of critical importance. However, the diffusion of Gd-DTPA²⁻ has not been systematically studied over long time periods using MRI-feasible gadopentetate concentrations. Thus, the present study aims to investigate the diffusion of gadopentetate into cartilage in vitro in intact and enzymatically degraded cartilage. METHODS The diffusion of gadopentetate into bovine articular cartilage was investigated at 9.4 T over 18-h time period using repeated T(1) measurements in two models, (1) comparing intact and trypsin-treated tissue and (2) assessing the effect of penetration direction. The diffusion process was further assessed by determining the gadopentetate flux and diffusivity. The results were compared with histological and biochemical reference methods. RESULTS AND CONCLUSIONS The results revealed that passive diffusion of Gd-DTPA²⁻ was significantly slower than previously assumed, leading to overestimation of the GAG content at equilibrating times of few hours. Moreover, Gd-DTPA²⁻ distribution was found to depend not only on GAG content, but also on collagen content and diffusion direction. Interestingly, the dGEMRIC technique was found to be most sensitive to cartilage degradation in the early stages of diffusion process, suggesting that full equilibrium between gadopentetate and cartilage may not be required in order to detect cartilage degeneration.
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Affiliation(s)
- E-N Salo
- Department of Applied Physics, University of Eastern Finland, Kuopio, Finland.
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Kokkonen HT, Mäkelä J, Kulmala KAM, Rieppo L, Jurvelin JS, Tiitu V, Karjalainen HM, Korhonen RK, Kovanen V, Töyräs J. Computed tomography detects changes in contrast agent diffusion after collagen cross-linking typical to natural aging of articular cartilage. Osteoarthritis Cartilage 2011; 19:1190-8. [PMID: 21827864 DOI: 10.1016/j.joca.2011.07.008] [Citation(s) in RCA: 40] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/04/2011] [Revised: 07/13/2011] [Accepted: 07/16/2011] [Indexed: 02/02/2023]
Abstract
OBJECTIVE The effect of threose-induced collagen cross-linking on the mechanical and diffusive properties of cartilage was investigated in vitro. In particular, we investigated the potential of Contrast Enhanced Computed Tomography (CECT) to detect changes in articular cartilage after increased collagen cross-linking, which is an age-related phenomenon. METHODS Osteochondral plugs (Ø=6.0 mm, n=28) were prepared from intact bovine patellae (n=7). Two of the four adjacent samples, prepared from each patella, were treated with threose to increase the collagen cross-linking, while the other two specimen served as paired controls. One sample pair was mechanically tested and then mechanically injured using a material testing device. Contrast agent [ioxaglate (Hexabrix™)] diffusion was imaged in the other specimen pair for 25 h using CECT. Water fraction, collagen and proteoglycan content, collagen network architecture and the amount of cross-links [hydroxylysyl pyridinoline (HP), lysyl pyridinoline (LP) and pentosidine (Pent)] of the samples were also determined. RESULTS Cartilage collagen cross-linking, both Pent and LP, were significantly (P<0.001) increased due to threose treatment. CECT could detect the increased cross-links as the contrast agent penetration and the diffusion flux were significantly (P<0.05) lower in the threose treated than in untreated samples. The equilibrium modulus (+164%, P<0.05) and strain dependent dynamic modulus (+47%, P<0.05) were both significantly greater in the threose treated samples than in reference samples, but there was no association between the initial dynamic modulus and the threose treatment. The water fraction, proteoglycan and collagen contents, as well as collagen architecture, were not significantly altered by the threose treatment. CONCLUSIONS To conclude, the CECT technique was found to be sensitive at detecting changes in cartilage tissue due to increased collagen cross-linking. This is important since increased cross-linking has been proposed to be related to the increased injury susceptibility of tissue.
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Affiliation(s)
- H T Kokkonen
- Department of Applied Physics, University of Eastern Finland, Kuopio, Finland.
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Winalski CS, Rajiah P. The evolution of articular cartilage imaging and its impact on clinical practice. Skeletal Radiol 2011; 40:1197-222. [PMID: 21847750 DOI: 10.1007/s00256-011-1226-z] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/20/2011] [Accepted: 06/27/2011] [Indexed: 02/02/2023]
Abstract
Over the past four decades, articular cartilage imaging has developed rapidly. Imaging now plays a critical role not only in clinical practice and therapeutic decisions but also in the basic research probing our understanding of cartilage physiology and biomechanics.
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Affiliation(s)
- Carl S Winalski
- Imaging Institute, Cleveland Clinic, 9500 Euclid Avenue, Cleveland, OH 44195, USA.
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Li W, Edelman RR, Prasad PV. Delayed contrast enhanced MRI of meniscus with ionic and non-ionic agents. J Magn Reson Imaging 2011; 33:731-5. [DOI: 10.1002/jmri.22477] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022] Open
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