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Mills ES, Becerra JA, Yensen K, Bolia IK, Shontz EC, Kebaish KJ, Dobitsch A, Hasan LK, Haratian A, Ong CD, Gross J, Petrigliano FA, Weber AE. Current and Future Advanced Imaging Modalities for the Diagnosis of Early Osteoarthritis of the Hip. Orthop Res Rev 2022; 14:327-338. [PMID: 36131944 PMCID: PMC9482955 DOI: 10.2147/orr.s357498] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2022] [Accepted: 08/16/2022] [Indexed: 12/04/2022] Open
Abstract
Hip osteoarthritis (OA) can be idiopathic or develop secondary to structural joint abnormalities of the hip joint (alteration of normal anatomy) and/or due to a systemic condition with joint involvement. Early osteoarthritic changes to the hip can be completely asymptomatic or may cause the development hip symptomatology without evidence of OA on radiographs. Delaying the progression of hip OA is critical due to the significant impact of this condition on the patient’s quality of life. Pre-OA of the hip is a newly established term that is often described as the development of signs and symptoms of degenerative hip disease but no radiographic evidence of OA. Advanced imaging methods can help to diagnose pre-OA of the hip in patients with hip pain and normal radiographs or aid in the surveillance of asymptomatic patients with an underlying hip diagnosis that is known to increase the risk of early OA of the hip. These methods include the delayed gadolinium-enhanced magnetic resonance imaging (MRI) of cartilage (dGEMRIC), quantitative magnetic resonance imaging (qMRI- T1rho, T2, and T2* relaxation time mapping), 7-Tesla MRI, computed tomography (CT), and optical coherence tomography (OCT). dGEMRIC proved to be a reliable and accurate modality though it is limited by the significant time necessary for contrast washout between scans. This disadvantage is potentially overcome by T2 weighted MRIs, which do not require contrast. 7-Tesla MRI is a promising development for enhanced imaging resolution compared to 1.5 and 3T MRIs. This technique does require additional optimization and development prior to widespread clinical use. The purpose of this review was to summarize the results of translational and clinical studies investigating the utilization of the above-mentioned imaging modalities to diagnose hip pre-OA, with special focus on recent research evaluating their implementation into clinical practice.
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Affiliation(s)
- Emily S Mills
- Department of Orthopaedic Surgery, Keck School of Medicine, University of Southern California, Los Angeles, CA, USA
| | - Jacob A Becerra
- Department of Orthopaedic Surgery, Keck School of Medicine, University of Southern California, Los Angeles, CA, USA
| | - Katie Yensen
- Department of Orthopaedic Surgery, Keck School of Medicine, University of Southern California, Los Angeles, CA, USA
| | - Ioanna K Bolia
- Department of Orthopaedic Surgery, Keck School of Medicine, University of Southern California, Los Angeles, CA, USA
- Correspondence: Ioanna K Bolia, USC Epstein Family Center for Sports Medicine at Keck Medicine of USC, 1520 San Pablo st #2000, Los Angeles, CA, 90033, USA, Tel +1 9703432813, Fax +8181 658 5920, Email
| | - Edward C Shontz
- Department of Orthopaedic Surgery, Keck School of Medicine, University of Southern California, Los Angeles, CA, USA
| | - Kareem J Kebaish
- Department of Orthopaedic Surgery, Keck School of Medicine, University of Southern California, Los Angeles, CA, USA
| | - Andrew Dobitsch
- Department of Orthopaedic Surgery, Keck School of Medicine, University of Southern California, Los Angeles, CA, USA
| | - Laith K Hasan
- Department of Orthopaedic Surgery, Keck School of Medicine, University of Southern California, Los Angeles, CA, USA
| | - Aryan Haratian
- Department of Orthopaedic Surgery, Keck School of Medicine, University of Southern California, Los Angeles, CA, USA
| | - Charlton D Ong
- Department of Radiology, Keck School of Medicine, University of Southern California, Los Angeles, CA, USA
| | - Jordan Gross
- Department of Radiology, Keck School of Medicine, University of Southern California, Los Angeles, CA, USA
| | - Frank A Petrigliano
- Department of Orthopaedic Surgery, Keck School of Medicine, University of Southern California, Los Angeles, CA, USA
| | - Alexander E Weber
- Department of Orthopaedic Surgery, Keck School of Medicine, University of Southern California, Los Angeles, CA, USA
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Ruckli AC, Schmaranzer F, Meier MK, Lerch TD, Steppacher SD, Tannast M, Zeng G, Burger J, Siebenrock KA, Gerber N, Gerber K. Automated quantification of cartilage quality for hip treatment decision support. Int J Comput Assist Radiol Surg 2022; 17:2011-2021. [PMID: 35976596 PMCID: PMC9515031 DOI: 10.1007/s11548-022-02714-z] [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] [Subscribe] [Scholar Register] [Received: 01/11/2022] [Accepted: 06/30/2022] [Indexed: 11/30/2022]
Abstract
Purpose Preservation surgery can halt the progress of joint degradation, preserving the life of the hip; however, outcome depends on the existing cartilage quality. Biochemical analysis of the hip cartilage utilizing MRI sequences such as delayed gadolinium-enhanced MRI of cartilage (dGEMRIC), in addition to morphological analysis, can be used to detect early signs of cartilage degradation. However, a complete, accurate 3D analysis of the cartilage regions and layers is currently not possible due to a lack of diagnostic tools. Methods A system for the efficient automatic parametrization of the 3D hip cartilage was developed. 2D U-nets were trained on manually annotated dual-flip angle (DFA) dGEMRIC for femoral head localization and cartilage segmentation. A fully automated cartilage sectioning pipeline for analysis of central and peripheral regions, femoral-acetabular layers, and a variable number of section slices, was developed along with functionality for the automatic calculation of dGEMRIC index, thickness, surface area, and volume. Results The trained networks locate the femoral head and segment the cartilage with a Dice similarity coefficient of 88 ± 3 and 83 ± 4% on DFA and magnetization-prepared 2 rapid gradient-echo (MP2RAGE) dGEMRIC, respectively. A completely automatic cartilage analysis was performed in 18s, and no significant difference for average dGEMRIC index, volume, surface area, and thickness calculated on manual and automatic segmentation was observed. Conclusion An application for the 3D analysis of hip cartilage was developed for the automated detection of subtle morphological and biochemical signs of cartilage degradation in prognostic studies and clinical diagnosis. The segmentation network achieved a 4-time increase in processing speed without loss of segmentation accuracy on both normal and deformed anatomy, enabling accurate parametrization. Retraining of the networks with the promising MP2RAGE protocol would enable analysis without the need for B1 inhomogeneity correction in the future.
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Affiliation(s)
- Adrian C Ruckli
- sitem Center for Translational Medicine and Biomedical Entrepreneurship, Personalised Medicine, University of Bern, Bern, Switzerland
| | - Florian Schmaranzer
- Department of Diagnostic-, Interventional- and Pediatric Radiology, Inselspital, University Hospital of Bern, Bern, Switzerland
| | - Malin K Meier
- Department of Orthopaedic Surgery and Traumatology, Inselspital, University Hospital of Bern, Bern, Switzerland
| | - Till D Lerch
- Department of Diagnostic-, Interventional- and Pediatric Radiology, Inselspital, University Hospital of Bern, Bern, Switzerland
| | - Simon D Steppacher
- Department of Orthopaedic Surgery and Traumatology, Inselspital, University Hospital of Bern, Bern, Switzerland
| | - Moritz Tannast
- Department of Orthopaedic Surgery and Traumatology, Fribourg Cantonal Hospital, University of Fribourg, Fribourg, Switzerland
| | - Guodong Zeng
- sitem Center for Translational Medicine and Biomedical Entrepreneurship, Personalised Medicine, University of Bern, Bern, Switzerland.,Department of Orthopaedic Surgery and Traumatology, Fribourg Cantonal Hospital, University of Fribourg, Fribourg, Switzerland
| | - Jürgen Burger
- sitem Center for Translational Medicine and Biomedical Entrepreneurship, Personalised Medicine, University of Bern, Bern, Switzerland
| | - Klaus A Siebenrock
- Department of Orthopaedic Surgery and Traumatology, Inselspital, University Hospital of Bern, Bern, Switzerland
| | - Nicolas Gerber
- sitem Center for Translational Medicine and Biomedical Entrepreneurship, Personalised Medicine, University of Bern, Bern, Switzerland.
| | - Kate Gerber
- sitem Center for Translational Medicine and Biomedical Entrepreneurship, Personalised Medicine, University of Bern, Bern, Switzerland
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Schmaranzer F, Haefeli PC, Liechti EF, Hanke MS, Tannast M, Büchler L. Improved Cartilage Quality on Delayed Gadolinium-Enhanced MRI of Hip Cartilage after Subchondral Drilling of Acetabular Cartilage Flaps in Femoroacetabular Impingement Surgery at Minimum 5-Year Follow-Up. Cartilage 2021; 13:617S-629S. [PMID: 32686503 PMCID: PMC8808901 DOI: 10.1177/1947603520941241] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/18/2022] Open
Abstract
OBJECTIVE To assess whether subchondral drilling of acetabular cartilage flaps during femoroacetabular impingement (FAI) surgery improves (1) acetabular dGEMRIC indices and (2) morphologic magnetic resonance imaging (MRI) scores, compared with hips in which no additional treatment of cartilage lesions had been performed; and (3) whether global dGEMRIC indices and MRI scores correlate. DESIGN Prospective cohort study of consecutive patients with symptomatic FAI treated with open surgery between 2000 and 2007. Patients with subchondral drilling of acetabular cartilage flaps were allocated to the study group, those without drilling to the control group. All patients underwent indirect 3-T MR arthrography to assess cartilage quality by dGEMRIC indices and a semiquantitative morphologic MRI score at minimum 5 years after surgery. dGEMRIC indices and morphologic MRI scores were compared between and among groups using analysis of covariance/paired t tests. RESULTS No significant difference was found between the global dGEMRIC indices of the study group (449 ± 147 ms, 95% CI 432-466 ms) and the control group (428 ± 143 ms, 95% CI 416-442 ms; P = 0.235). In regions with cartilage flaps, the study group showed higher dGEMRIC indices (472 ± 160 ms, 95% CI 433-510 ms) compared with the control group (390 ± 122 ms, 95% CI 367-413 ms; P < 0.001). No significant differences were found for the morphologic MRI scores. A strong inversely linear correlation between the dGEMRIC indices and the morphologic MRI scores (r = -0.727, P < 0.001) was observed. CONCLUSIONS Treatment of acetabular cartilage flaps with subchondral drilling leads to better cartilage quality in regions with cartilage flaps at minimum 5 years of follow-up.
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Affiliation(s)
- Florian Schmaranzer
- Department of Diagnostic, Interventional
and Pediatric Radiology, Inselspital Bern, University of Bern, Bern,
Switzerland,Department of Orthopaedic Surgery and
traumatology, inselspital Bern, University of Bern, Bern, Switzerland,Florian Schmaranzer, University of Bern,
Freiburgstraße, Bern, 3010, Switzerland.
| | - Pascal C. Haefeli
- Department of Orthopaedic Surgery,
Kantonsspital Luzern, Luzern, Switzerland
| | - Emanuel F. Liechti
- Department of Orthopaedic Surgery and
traumatology, inselspital Bern, University of Bern, Bern, Switzerland
| | - Markus S. Hanke
- Department of Orthopaedic Surgery and
traumatology, inselspital Bern, University of Bern, Bern, Switzerland
| | - Moritz Tannast
- Department of Orthopaedic Surgery and
Traumatology, Kantonsspital Fribourg, University of Fribourg Faculty of Science and
Medicine, Fribourg, Switzerland
| | - Lorenz Büchler
- Department of Orthopaedic Surgery and
Traumatology, Kantonsspital Aarau AG, Aarau, Switzerland
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Schmaranzer F, Afacan O, Lerch TD, Kim YJ, Siebenrock KA, Ith M, Cullmann JL, Kober T, Klarhoefer M, Tannast M, Bixby SD, Novais EN, Jung B. Magnetization-prepared 2 Rapid Gradient-Echo MRI for B 1 Insensitive 3D T1 Mapping of Hip Cartilage: An Experimental and Clinical Validation. Radiology 2021; 299:150-158. [PMID: 33620288 DOI: 10.1148/radiol.2021200085] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
Background Often used for T1 mapping of hip cartilage, three-dimensional (3D) dual-flip-angle (DFA) techniques are highly sensitive to flip angle variations related to B1 inhomogeneities. The authors hypothesized that 3D magnetization-prepared 2 rapid gradient-echo (MP2RAGE) MRI would help provide more accurate T1 mapping of hip cartilage at 3.0 T than would 3D DFA techniques. Purpose To compare 3D MP2RAGE MRI with 3D DFA techniques using two-dimensional (2D) inversion recovery T1 mapping as a standard of reference for hip cartilage T1 mapping in phantoms, healthy volunteers, and participants with hip pain. Materials and Methods T1 mapping at 3.0 T was performed in phantoms and in healthy volunteers using 3D MP2RAGE MRI and 3D DFA techniques with B1 field mapping for flip angle correction. Participants with hip pain prospectively (July 2019-January 2020) underwent indirect MR arthrography (with intravenous administration of 0.2 mmol/kg of gadoterate meglumine), including 3D MP2RAGE MRI. A 2D inversion recovery-based sequence served as a T1 reference in phantoms and in participants with hip pain. In healthy volunteers, cartilage T1 was compared between 3D MP2RAGE MRI and 3D DFA techniques. Paired t tests and Bland-Altman analysis were performed. Results Eleven phantoms, 10 healthy volunteers (median age, 27 years; range, 26-30 years; five men), and 20 participants with hip pain (mean age, 34 years ± 10 [standard deviation]; 17 women) were evaluated. In phantoms, T1 bias from 2D inversion recovery was lower for 3D MP2RAGE MRI than for 3D DFA techniques (mean, 3 msec ± 11 vs 253 msec ± 85; P < .001), and, unlike 3D DFA techniques, the deviation found with MP2RAGE MRI did not correlate with increasing B1 deviation. In healthy volunteers, regional cartilage T1 difference (109 msec ± 163; P = .008) was observed only for the 3D DFA technique. In participants with hip pain, the mean T1 bias of 3D MP2RAGE MRI from 2D inversion recovery was -23 msec ± 31 (P < .001). Conclusion Compared with three-dimensional (3D) dual-flip-angle techniques, 3D magnetization-prepared 2 rapid gradient-echo MRI enabled more accurate T1 mapping of hip cartilage, was less affected by B1 inhomogeneities, and showed high accuracy against a T1 reference in participants with hip pain. © RSNA, 2021.
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Affiliation(s)
- Florian Schmaranzer
- From the Department of Diagnostic, Interventional and Pediatric Radiology (F.S., T.D.L., M.I., J.L.C., B.J.) and Department of Orthopaedic Surgery (K.A.S., M.T.), Inselspital, University Hospital Bern, University of Bern, Freiburgstrasse, 3010 Bern, Switzerland; Departments of Orthopaedic Surgery (F.S., Y.J.K., E.N.N.) and Radiology (O.A., S.D.B.), Boston Children's Hospital, Harvard Medical School, Boston, Mass; Advanced Clinical Imaging Technology, Siemens Healthcare, Lausanne, Switzerland (T.K.); Department of Radiology, Lausanne University Hospital, University of Lausanne, Lausanne, Switzerland (T.K.); LTS5, École Polytechnique Fédérale de Lausanne (EPFL), Lausanne, Switzerland (T.K.); Siemens Healthcare, Zürich, Switzerland (M.K.); and Department of Orthopaedic Surgery, Cantonal Hospital, University of Fribourg, Fribourg, Switzerland (M.T.)
| | - Onur Afacan
- From the Department of Diagnostic, Interventional and Pediatric Radiology (F.S., T.D.L., M.I., J.L.C., B.J.) and Department of Orthopaedic Surgery (K.A.S., M.T.), Inselspital, University Hospital Bern, University of Bern, Freiburgstrasse, 3010 Bern, Switzerland; Departments of Orthopaedic Surgery (F.S., Y.J.K., E.N.N.) and Radiology (O.A., S.D.B.), Boston Children's Hospital, Harvard Medical School, Boston, Mass; Advanced Clinical Imaging Technology, Siemens Healthcare, Lausanne, Switzerland (T.K.); Department of Radiology, Lausanne University Hospital, University of Lausanne, Lausanne, Switzerland (T.K.); LTS5, École Polytechnique Fédérale de Lausanne (EPFL), Lausanne, Switzerland (T.K.); Siemens Healthcare, Zürich, Switzerland (M.K.); and Department of Orthopaedic Surgery, Cantonal Hospital, University of Fribourg, Fribourg, Switzerland (M.T.)
| | - Till D Lerch
- From the Department of Diagnostic, Interventional and Pediatric Radiology (F.S., T.D.L., M.I., J.L.C., B.J.) and Department of Orthopaedic Surgery (K.A.S., M.T.), Inselspital, University Hospital Bern, University of Bern, Freiburgstrasse, 3010 Bern, Switzerland; Departments of Orthopaedic Surgery (F.S., Y.J.K., E.N.N.) and Radiology (O.A., S.D.B.), Boston Children's Hospital, Harvard Medical School, Boston, Mass; Advanced Clinical Imaging Technology, Siemens Healthcare, Lausanne, Switzerland (T.K.); Department of Radiology, Lausanne University Hospital, University of Lausanne, Lausanne, Switzerland (T.K.); LTS5, École Polytechnique Fédérale de Lausanne (EPFL), Lausanne, Switzerland (T.K.); Siemens Healthcare, Zürich, Switzerland (M.K.); and Department of Orthopaedic Surgery, Cantonal Hospital, University of Fribourg, Fribourg, Switzerland (M.T.)
| | - Young-Jo Kim
- From the Department of Diagnostic, Interventional and Pediatric Radiology (F.S., T.D.L., M.I., J.L.C., B.J.) and Department of Orthopaedic Surgery (K.A.S., M.T.), Inselspital, University Hospital Bern, University of Bern, Freiburgstrasse, 3010 Bern, Switzerland; Departments of Orthopaedic Surgery (F.S., Y.J.K., E.N.N.) and Radiology (O.A., S.D.B.), Boston Children's Hospital, Harvard Medical School, Boston, Mass; Advanced Clinical Imaging Technology, Siemens Healthcare, Lausanne, Switzerland (T.K.); Department of Radiology, Lausanne University Hospital, University of Lausanne, Lausanne, Switzerland (T.K.); LTS5, École Polytechnique Fédérale de Lausanne (EPFL), Lausanne, Switzerland (T.K.); Siemens Healthcare, Zürich, Switzerland (M.K.); and Department of Orthopaedic Surgery, Cantonal Hospital, University of Fribourg, Fribourg, Switzerland (M.T.)
| | - Klaus A Siebenrock
- From the Department of Diagnostic, Interventional and Pediatric Radiology (F.S., T.D.L., M.I., J.L.C., B.J.) and Department of Orthopaedic Surgery (K.A.S., M.T.), Inselspital, University Hospital Bern, University of Bern, Freiburgstrasse, 3010 Bern, Switzerland; Departments of Orthopaedic Surgery (F.S., Y.J.K., E.N.N.) and Radiology (O.A., S.D.B.), Boston Children's Hospital, Harvard Medical School, Boston, Mass; Advanced Clinical Imaging Technology, Siemens Healthcare, Lausanne, Switzerland (T.K.); Department of Radiology, Lausanne University Hospital, University of Lausanne, Lausanne, Switzerland (T.K.); LTS5, École Polytechnique Fédérale de Lausanne (EPFL), Lausanne, Switzerland (T.K.); Siemens Healthcare, Zürich, Switzerland (M.K.); and Department of Orthopaedic Surgery, Cantonal Hospital, University of Fribourg, Fribourg, Switzerland (M.T.)
| | - Michael Ith
- From the Department of Diagnostic, Interventional and Pediatric Radiology (F.S., T.D.L., M.I., J.L.C., B.J.) and Department of Orthopaedic Surgery (K.A.S., M.T.), Inselspital, University Hospital Bern, University of Bern, Freiburgstrasse, 3010 Bern, Switzerland; Departments of Orthopaedic Surgery (F.S., Y.J.K., E.N.N.) and Radiology (O.A., S.D.B.), Boston Children's Hospital, Harvard Medical School, Boston, Mass; Advanced Clinical Imaging Technology, Siemens Healthcare, Lausanne, Switzerland (T.K.); Department of Radiology, Lausanne University Hospital, University of Lausanne, Lausanne, Switzerland (T.K.); LTS5, École Polytechnique Fédérale de Lausanne (EPFL), Lausanne, Switzerland (T.K.); Siemens Healthcare, Zürich, Switzerland (M.K.); and Department of Orthopaedic Surgery, Cantonal Hospital, University of Fribourg, Fribourg, Switzerland (M.T.)
| | - Jennifer L Cullmann
- From the Department of Diagnostic, Interventional and Pediatric Radiology (F.S., T.D.L., M.I., J.L.C., B.J.) and Department of Orthopaedic Surgery (K.A.S., M.T.), Inselspital, University Hospital Bern, University of Bern, Freiburgstrasse, 3010 Bern, Switzerland; Departments of Orthopaedic Surgery (F.S., Y.J.K., E.N.N.) and Radiology (O.A., S.D.B.), Boston Children's Hospital, Harvard Medical School, Boston, Mass; Advanced Clinical Imaging Technology, Siemens Healthcare, Lausanne, Switzerland (T.K.); Department of Radiology, Lausanne University Hospital, University of Lausanne, Lausanne, Switzerland (T.K.); LTS5, École Polytechnique Fédérale de Lausanne (EPFL), Lausanne, Switzerland (T.K.); Siemens Healthcare, Zürich, Switzerland (M.K.); and Department of Orthopaedic Surgery, Cantonal Hospital, University of Fribourg, Fribourg, Switzerland (M.T.)
| | - Tobias Kober
- From the Department of Diagnostic, Interventional and Pediatric Radiology (F.S., T.D.L., M.I., J.L.C., B.J.) and Department of Orthopaedic Surgery (K.A.S., M.T.), Inselspital, University Hospital Bern, University of Bern, Freiburgstrasse, 3010 Bern, Switzerland; Departments of Orthopaedic Surgery (F.S., Y.J.K., E.N.N.) and Radiology (O.A., S.D.B.), Boston Children's Hospital, Harvard Medical School, Boston, Mass; Advanced Clinical Imaging Technology, Siemens Healthcare, Lausanne, Switzerland (T.K.); Department of Radiology, Lausanne University Hospital, University of Lausanne, Lausanne, Switzerland (T.K.); LTS5, École Polytechnique Fédérale de Lausanne (EPFL), Lausanne, Switzerland (T.K.); Siemens Healthcare, Zürich, Switzerland (M.K.); and Department of Orthopaedic Surgery, Cantonal Hospital, University of Fribourg, Fribourg, Switzerland (M.T.)
| | - Markus Klarhoefer
- From the Department of Diagnostic, Interventional and Pediatric Radiology (F.S., T.D.L., M.I., J.L.C., B.J.) and Department of Orthopaedic Surgery (K.A.S., M.T.), Inselspital, University Hospital Bern, University of Bern, Freiburgstrasse, 3010 Bern, Switzerland; Departments of Orthopaedic Surgery (F.S., Y.J.K., E.N.N.) and Radiology (O.A., S.D.B.), Boston Children's Hospital, Harvard Medical School, Boston, Mass; Advanced Clinical Imaging Technology, Siemens Healthcare, Lausanne, Switzerland (T.K.); Department of Radiology, Lausanne University Hospital, University of Lausanne, Lausanne, Switzerland (T.K.); LTS5, École Polytechnique Fédérale de Lausanne (EPFL), Lausanne, Switzerland (T.K.); Siemens Healthcare, Zürich, Switzerland (M.K.); and Department of Orthopaedic Surgery, Cantonal Hospital, University of Fribourg, Fribourg, Switzerland (M.T.)
| | - Moritz Tannast
- From the Department of Diagnostic, Interventional and Pediatric Radiology (F.S., T.D.L., M.I., J.L.C., B.J.) and Department of Orthopaedic Surgery (K.A.S., M.T.), Inselspital, University Hospital Bern, University of Bern, Freiburgstrasse, 3010 Bern, Switzerland; Departments of Orthopaedic Surgery (F.S., Y.J.K., E.N.N.) and Radiology (O.A., S.D.B.), Boston Children's Hospital, Harvard Medical School, Boston, Mass; Advanced Clinical Imaging Technology, Siemens Healthcare, Lausanne, Switzerland (T.K.); Department of Radiology, Lausanne University Hospital, University of Lausanne, Lausanne, Switzerland (T.K.); LTS5, École Polytechnique Fédérale de Lausanne (EPFL), Lausanne, Switzerland (T.K.); Siemens Healthcare, Zürich, Switzerland (M.K.); and Department of Orthopaedic Surgery, Cantonal Hospital, University of Fribourg, Fribourg, Switzerland (M.T.)
| | - Sarah D Bixby
- From the Department of Diagnostic, Interventional and Pediatric Radiology (F.S., T.D.L., M.I., J.L.C., B.J.) and Department of Orthopaedic Surgery (K.A.S., M.T.), Inselspital, University Hospital Bern, University of Bern, Freiburgstrasse, 3010 Bern, Switzerland; Departments of Orthopaedic Surgery (F.S., Y.J.K., E.N.N.) and Radiology (O.A., S.D.B.), Boston Children's Hospital, Harvard Medical School, Boston, Mass; Advanced Clinical Imaging Technology, Siemens Healthcare, Lausanne, Switzerland (T.K.); Department of Radiology, Lausanne University Hospital, University of Lausanne, Lausanne, Switzerland (T.K.); LTS5, École Polytechnique Fédérale de Lausanne (EPFL), Lausanne, Switzerland (T.K.); Siemens Healthcare, Zürich, Switzerland (M.K.); and Department of Orthopaedic Surgery, Cantonal Hospital, University of Fribourg, Fribourg, Switzerland (M.T.)
| | - Eduardo N Novais
- From the Department of Diagnostic, Interventional and Pediatric Radiology (F.S., T.D.L., M.I., J.L.C., B.J.) and Department of Orthopaedic Surgery (K.A.S., M.T.), Inselspital, University Hospital Bern, University of Bern, Freiburgstrasse, 3010 Bern, Switzerland; Departments of Orthopaedic Surgery (F.S., Y.J.K., E.N.N.) and Radiology (O.A., S.D.B.), Boston Children's Hospital, Harvard Medical School, Boston, Mass; Advanced Clinical Imaging Technology, Siemens Healthcare, Lausanne, Switzerland (T.K.); Department of Radiology, Lausanne University Hospital, University of Lausanne, Lausanne, Switzerland (T.K.); LTS5, École Polytechnique Fédérale de Lausanne (EPFL), Lausanne, Switzerland (T.K.); Siemens Healthcare, Zürich, Switzerland (M.K.); and Department of Orthopaedic Surgery, Cantonal Hospital, University of Fribourg, Fribourg, Switzerland (M.T.)
| | - Bernd Jung
- From the Department of Diagnostic, Interventional and Pediatric Radiology (F.S., T.D.L., M.I., J.L.C., B.J.) and Department of Orthopaedic Surgery (K.A.S., M.T.), Inselspital, University Hospital Bern, University of Bern, Freiburgstrasse, 3010 Bern, Switzerland; Departments of Orthopaedic Surgery (F.S., Y.J.K., E.N.N.) and Radiology (O.A., S.D.B.), Boston Children's Hospital, Harvard Medical School, Boston, Mass; Advanced Clinical Imaging Technology, Siemens Healthcare, Lausanne, Switzerland (T.K.); Department of Radiology, Lausanne University Hospital, University of Lausanne, Lausanne, Switzerland (T.K.); LTS5, École Polytechnique Fédérale de Lausanne (EPFL), Lausanne, Switzerland (T.K.); Siemens Healthcare, Zürich, Switzerland (M.K.); and Department of Orthopaedic Surgery, Cantonal Hospital, University of Fribourg, Fribourg, Switzerland (M.T.)
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Cloos MA, Assländer J, Abbas B, Fishbaugh J, Babb JS, Gerig G, Lattanzi R. Rapid Radial T 1 and T 2 Mapping of the Hip Articular Cartilage With Magnetic Resonance Fingerprinting. J Magn Reson Imaging 2019; 50:810-815. [PMID: 30584691 PMCID: PMC6591100 DOI: 10.1002/jmri.26615] [Citation(s) in RCA: 43] [Impact Index Per Article: 8.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2018] [Revised: 11/21/2018] [Accepted: 11/21/2018] [Indexed: 12/20/2022] Open
Abstract
BACKGROUND Quantitative MRI can detect early changes in cartilage biochemical components, but its routine clinical implementation is challenging. PURPOSE To introduce a novel technique to measure T1 and T2 along radial sections of the hip for accurate and reproducible multiparametric quantitative cartilage assessment in a clinically feasible scan time. STUDY TYPE Reproducibility, technical validation. SUBJECTS/PHANTOM A seven-compartment phantom and three healthy volunteers. FIELD STRENGTH/SEQUENCE A novel MR pulse sequence that simultaneously measures proton density (PD), T1 , and T2 at 3 T was developed. Automatic positioning and semiautomatic cartilage segmentation were implemented to improve consistency and simplify workflow. ASSESSMENT Intra- and interscanner variability of our technique was assessed over multiple scans on three different MR scanners. STATISTICAL TESTS For each scan, the median of cartilage T1 and T2 over six radial slices was calculated. Restricted maximum likelihood estimation of variance components was used to estimate intrasubject variances reflecting variation between results from the two scans using the same scanner (intrascanner variance) and variation among results from the three scanners (interscanner variance). RESULTS The estimation error for T1 and T2 with respect to reference standard measurements was less than 3% on average for the phantom. The average interscanner coefficient of variation was 1.5% (1.2-1.9%) and 0.9% (0.0-3.7%) for T1 and T2 , respectively, in the seven compartments of the phantom. Total scan time in vivo was 7:13 minutes to obtain PD, T1 , and T2 maps along six radial hip sections at 0.6 × 0.6 × 4.0 mm3 voxel resolution. Interscanner variability for the in vivo study was 1.99% and 5.46% for T1 and T2 , respectively. in vivo intrascanner variability was 1.15% for T1 and 3.24% for T2 . DATA CONCLUSION Our method, which includes slice positioning, model-based parameter estimation, and cartilage segmentation, is highly reproducible. It could enable employing quantitative hip cartilage evaluation for longitudinal and multicenter studies. LEVEL OF EVIDENCE 1 Technical Efficacy: Stage 1 J. Magn. Reson. Imaging 2019;50:810-815.
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Affiliation(s)
- Martijn A. Cloos
- Center for Advanced Imaging Innovation and Research (CAIR) and Bernard and Irene Schwartz Center for Biomedical Imaging, Department of Radiology, New York University School of Medicine, 660 1 Ave. New York, NY 10016 USA
- The Sackler Institute of Graduate Biomedical Sciences, New York University School of Medicine550 First Avenue, New York, NY 10016 USA
| | - Jakob Assländer
- Center for Advanced Imaging Innovation and Research (CAIR) and Bernard and Irene Schwartz Center for Biomedical Imaging, Department of Radiology, New York University School of Medicine, 660 1 Ave. New York, NY 10016 USA
| | - Batool Abbas
- Visualization, Imaging and Data Analysis (VIDA), New York University Tandon School of Engineering, 2 Metro Tech Center, Brooklyn, NY 11201 USA
| | - James Fishbaugh
- Visualization, Imaging and Data Analysis (VIDA), New York University Tandon School of Engineering, 2 Metro Tech Center, Brooklyn, NY 11201 USA
| | - James S. Babb
- Center for Advanced Imaging Innovation and Research (CAIR) and Bernard and Irene Schwartz Center for Biomedical Imaging, Department of Radiology, New York University School of Medicine, 660 1 Ave. New York, NY 10016 USA
| | - Guido Gerig
- Visualization, Imaging and Data Analysis (VIDA), New York University Tandon School of Engineering, 2 Metro Tech Center, Brooklyn, NY 11201 USA
| | - Riccardo Lattanzi
- Center for Advanced Imaging Innovation and Research (CAIR) and Bernard and Irene Schwartz Center for Biomedical Imaging, Department of Radiology, New York University School of Medicine, 660 1 Ave. New York, NY 10016 USA
- The Sackler Institute of Graduate Biomedical Sciences, New York University School of Medicine550 First Avenue, New York, NY 10016 USA
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Automatic MRI-based Three-dimensional Models of Hip Cartilage Provide Improved Morphologic and Biochemical Analysis. Clin Orthop Relat Res 2019; 477:1036-1052. [PMID: 30998632 PMCID: PMC6494340 DOI: 10.1097/corr.0000000000000755] [Citation(s) in RCA: 34] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
BACKGROUND The time-consuming and user-dependent postprocessing of biochemical cartilage MRI has limited the use of delayed gadolinium-enhanced MRI of cartilage (dGEMRIC). An automated analysis of biochemical three-dimensional (3-D) images could deliver a more time-efficient and objective evaluation of cartilage composition, and provide comprehensive information about cartilage thickness, surface area, and volume compared with manual two-dimensional (2-D) analysis. QUESTIONS/PURPOSES (1) How does the 3-D analysis of cartilage thickness and dGEMRIC index using both a manual and a new automated method compare with the manual 2-D analysis (gold standard)? (2) How does the manual 3-D analysis of regional patterns of dGEMRIC index, cartilage thickness, surface area and volume compare with a new automatic method? (3) What is the interobserver reliability and intraobserver reproducibility of software-assisted manual 3-D and automated 3-D analysis of dGEMRIC indices, thickness, surface, and volume for two readers on two time points? METHODS In this IRB-approved, retrospective, diagnostic study, we identified the first 25 symptomatic hips (23 patients) who underwent a contrast-enhanced MRI at 3T including a 3-D dGEMRIC sequence for intraarticular pathology assessment due to structural hip deformities. Of the 23 patients, 10 (43%) were male, 16 (64%) hips had a cam deformity and 16 (64%) hips had either a pincer deformity or acetabular dysplasia. The development of an automated deep-learning-based approach for 3-D segmentation of hip cartilage models was based on two steps: First, one reader (FS) provided a manual 3-D segmentation of hip cartilage, which served as training data for the neural network and was used as input data for the manual 3-D analysis. Next, we developed the deep convolutional neural network to obtain an automated 3-D cartilage segmentation that we used as input data for the automated 3-D analysis. For actual analysis of the manually and automatically generated 3-D cartilage models, a dedicated software was developed. Manual 2-D analysis of dGEMRIC indices and cartilage thickness was performed at each "full-hour" position on radial images and served as the gold standard for comparison with the corresponding measurements of the manual and the automated 3-D analysis. We measured dGEMRIC index, cartilage thickness, surface area, and volume for each of the four joint quadrants and compared the manual and the automated 3-D analyses using mean differences. Agreement between the techniques was assessed using intraclass correlation coefficients (ICC). The overlap between 3-D cartilage volumes was assessed using dice coefficients and means of all distances between surface points of the models were calculated as average surface distance. The interobserver reliability and intraobserver reproducibility of the software-assisted manual 3-D and the automated 3-D analysis of dGEMRIC indices, thickness, surface and volume was assessed for two readers on two different time points using ICCs. RESULTS Comparable mean overall difference and almost-perfect agreement in dGEMRIC indices was found between the manual 3-D analysis (8 ± 44 ms, p = 0.005; ICC = 0.980), the automated 3-D analysis (7 ± 43 ms, p = 0.015; ICC = 0.982), and the manual 2-D analysis.Agreement for measuring overall cartilage thickness was almost perfect for both 3-D methods (ICC = 0.855 and 0.881) versus the manual 2-D analysis. A mean difference of -0.2 ± 0.5 mm (p < 0.001) was observed for overall cartilage thickness between the automated 3-D analysis and the manual 2-D analysis; no such difference was observed between the manual 3-D and the manual 2-D analysis.Regional patterns were comparable for both 3-D methods. The highest dGEMRIC indices were found posterosuperiorly (manual: 602 ± 158 ms; p = 0.013, automated: 602 ± 158 ms; p = 0.012). The thickest cartilage was found anteroinferiorly (manual: 5.3 ± 0.8 mm, p < 0.001; automated: 4.3 ± 0.6 mm; p < 0.001). The smallest surface area was found anteroinferiorly (manual: 134 ± 60 mm; p < 0.001, automated: 155 ± 60 mm; p < 0.001). The largest volume was found anterosuperiorly (manual: 2343 ± 492 mm; p < 0.001, automated: 2294 ± 467 mm; p < 0.001). Mean average surface distance was 0.26 ± 0.13 mm and mean Dice coefficient was 86% ± 3%. Intraobserver reproducibility and interobserver reliability was near perfect for overall analysis of dGEMRIC indices, thickness, surface area, and volume (ICC range, 0.962-1). CONCLUSIONS The presented deep learning approach for a fully automatic segmentation of hip cartilage enables an accurate, reliable and reproducible analysis of dGEMRIC indices, thickness, surface area, and volume. This time-efficient and objective analysis of biochemical cartilage composition and morphology yields the potential to improve patient selection in femoroacetabular impingement (FAI) surgery and to aid surgeons with planning of acetabuloplasty and periacetabular osteotomies in pincer FAI and hip dysplasia. In addition, this validation paves way to the large-scale use of this method for prospective trials which longitudinally monitor the effect of reconstructive hip surgery and the natural course of osteoarthritis. LEVEL OF EVIDENCE Level III, diagnostic study.
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Peterson P, Tiderius CJ, Olsson E, Lundin B, Olsson LE, Svensson J. Knee dGEMRIC at 7 T: comparison against 1.5 T and evaluation of T 1-mapping methods. BMC Musculoskelet Disord 2018; 19:149. [PMID: 29769051 PMCID: PMC5956845 DOI: 10.1186/s12891-018-2071-1] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/17/2018] [Accepted: 04/30/2018] [Indexed: 12/28/2022] Open
Abstract
Background dGEMRIC (delayed Gadolinium Enhanced Magnetic Resonance Image of Cartilage) is a well-established technique for cartilage quality assessment in osteoarthritis at clinical field strengths. The method is robust, but requires injection of contrast agent and a cumbersome examination procedure. New non-contrast-agent-based techniques for cartilage quality assessment are currently being developed at 7 T. However, dGEMRIC remains an important reference technique during this development. The aim of this work was to compare T1 mapping for dGEMRIC at 7 T and 1.5 T, and to evaluate three T1-mapping methods at 7 T. Methods The knee of 10 healthy volunteers and 9 patients with early signs of cartilage degradation were examined at 1.5 T and 7 T after a single (one) contrast agent injection (Gd-(DTPA)2−). Inversion recovery (IR) sequences were acquired at both field strengths, and at 7 T variable flip angle (VFA) and Look-Locker (LL) sequences were additionally acquired. T1 maps were calculated and average T1 values were estimated within superficial and deep regions-of-interest (ROIs) in the lateral and medial condyles, respectively. Results T1 values were 1.8 (1.4–2.3) times longer at 7 T. A strong correlation was detected between 1.5 T and 7 T T1 values (r = 0.80). For IR, an additional inversion time was required to avoid underestimation (bias±limits of agreement − 127 ± 234 ms) due to the longer T1 values at 7 T. Out of the two 3D sequences tested, LL resulted in more accurate and precise T1 estimation compared to VFA (average bias±limits of agreement LL: 12 ± 202 ms compared to VFA: 25 ± 622 ms). For both, B1 correction improved agreement to IR. Conclusion With an adapted sampling scheme, dGEMRIC T1 mapping is feasible at 7 T and correlates well to 1.5 T. If 3D is to be used for T1 mapping of the knee at 7 T, LL is preferred and VFA is not recommended. For VFA and LL, B1 correction is necessary for accurate T1 estimation.
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Affiliation(s)
- Pernilla Peterson
- Medical Radiation Physics, Department of Translational Medicine, Lund University, Inga Marie Nilssons gata 49, SE-205 02, Malmö, Sweden. .,Department of Oncology and Radiation Physics, Skåne University Hospital, Inga Marie Nilssons gata 49, SE-205 02, Malmö, Sweden.
| | - Carl Johan Tiderius
- Orthopedics, Department of Clinical Sciences, Lund University, Skåne University Hospital, SE-221 85, Lund, Sweden
| | - Emma Olsson
- Medical Radiation Physics, Department of Translational Medicine, Lund University, Inga Marie Nilssons gata 49, SE-205 02, Malmö, Sweden
| | - Björn Lundin
- Department of Medical Imaging and Physiology, Skåne University Hospital, SE-221 85, Lund, Sweden
| | - Lars E Olsson
- Medical Radiation Physics, Department of Translational Medicine, Lund University, Inga Marie Nilssons gata 49, SE-205 02, Malmö, Sweden.,Department of Oncology and Radiation Physics, Skåne University Hospital, Inga Marie Nilssons gata 49, SE-205 02, Malmö, Sweden
| | - Jonas Svensson
- Medical Radiation Physics, Department of Translational Medicine, Lund University, Inga Marie Nilssons gata 49, SE-205 02, Malmö, Sweden.,Department of Medical Imaging and Physiology, Skåne University Hospital, SE-221 85, Lund, Sweden
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Schmaranzer F, Haefeli PC, Hanke MS, Liechti EF, Werlen SF, Siebenrock KA, Tannast M. How Does the dGEMRIC Index Change After Surgical Treatment for FAI? A Prospective Controlled Study: Preliminary Results. Clin Orthop Relat Res 2017; 475:1080-1099. [PMID: 27709422 PMCID: PMC5339130 DOI: 10.1007/s11999-016-5098-3] [Citation(s) in RCA: 35] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
BACKGROUND Delayed gadolinium-enhanced MRI of cartilage (dGEMRIC) allows an objective, noninvasive, and longitudinal quantification of biochemical cartilage properties. Although dGEMRIC has been used to monitor the course of cartilage degeneration after periacetabular osteotomy (PAO) for correction of hip dysplasia, such longitudinal data are currently lacking for femoroacetabular impingement (FAI). QUESTIONS/PURPOSES (1) How does the mean acetabular and femoral dGEMRIC index change after surgery for FAI at 1-year followup compared with a similar group of patients with FAI treated without surgery? (2) Does the regional distribution of the acetabular and femoral dGEMRIC index change for the two groups over time? (3) Is there a correlation between the baseline dGEMRIC index and the change of patient-reported outcome measures (PROMs) at 1-year followup? (4) Among those treated surgically, can dGEMRIC indices distinguish between intact and degenerated cartilage? METHODS We performed a prospective, comparative, nonrandomized, longitudinal study. At the time of enrollment, the patients' decision whether to undergo surgery or choose nonoperative treatment was not made yet. Thirty-nine patients (40 hips) who underwent either joint-preserving surgery for FAI (20 hips) or nonoperative treatment (20 hips) were included. The two groups did not differ regarding Tönnis osteoarthritis score, preoperative PROMs, or baseline dGEMRIC indices. There were more women (60% versus 30%, p = 0.003) in the nonoperative group and patients were older (36 ± 8 years versus 30 ± 8 years, p = 0.026) and had lower alpha angles (65° ± 10° versus 73° ± 12°, p = 0.022) compared with the operative group. We used a 3.0-T scanner and a three-dimensional dual flip-angle gradient-echo technique for the dGEMRIC technique for the baseline and the 1-year followup measurements. dGEMRIC indices of femoral and acetabular cartilage were measured separately on the initial and followup radial dGEMRIC reformats in direct comparison with morphologic radial images. Regions of interest were placed manually peripherally and centrally within the cartilage based on anatomic landmarks at the clockface positions. The WOMAC, the Hip disability and Osteoarthritis Outcome Score, and the modified Harris hip score were used as PROMs. Among those treated surgically, the intraoperative damage according to the Beck grading was recorded and compared with the baseline dGEMRIC indices. RESULTS Although both the operative and the nonoperative groups experienced decreased dGEMRIC indices, the declines were more pronounced in the operative group (-96 ± 112 ms versus -16 ± 101 ms on the acetabular side and -96 ± 123 ms versus -21 ± 83 ms on the femoral side in the operative and nonoperative groups, respectively; p < 0.001 for both). Patients undergoing hip arthroscopy and surgical hip dislocation experienced decreased dGEMRIC indices; the decline in femoral dGEMRIC indices was more pronounced in hips after surgical hip dislocation (-120 ± 137 ms versus -61 ± 89 ms, p = 0.002). In the operative group a decline in dGEMRIC indices was observed in 43 of 44 regions over time. In the nonoperative group a decline in dGEMRIC indices was observed in four of 44 regions over time. The strongest correlation among patients treated surgically was found between the change in WOMAC and baseline dGEMRIC indices for the entire joint (R = 0.788, p < 0.001). Among those treated nonoperatively, no correlation between baseline dGEMRIC indices and change in PROMs was found. In the posterosuperior quadrant, the dGEMRIC index was higher for patients with intact cartilage compared with hips with chondral lesions (592 ± 203 ms versus 444 ± 205 ms, p < 0.001). CONCLUSIONS We found a decline in acetabular, femoral, and regional dGEMRIC indices for the surgically treated group at 1-year followup despite an improvement in all PROMs. We observed a similar but less pronounced decrease in the dGEMRIC index in symptomatic patients without surgical treatment indicating continuous cartilage degeneration. Although treatment of FAI is intended to alter the forces acting across the hip by eliminating impingement, its effects on cartilage biology are not clear. dGEMRIC provides a noninvasive method of assessing these effects. Longer term studies will be needed to determine whether the matrix changes of the bradytrophic cartilage seen here are permanent or clinically important. LEVEL OF EVIDENCE Level II, therapeutic study.
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Affiliation(s)
- Florian Schmaranzer
- Department of Orthopaedic Surgery, Inselspital, University of Bern, Freiburgstrasse, Bern, 3010 Switzerland
| | - Pascal C. Haefeli
- Department of Orthopaedic Surgery, Inselspital, University of Bern, Freiburgstrasse, Bern, 3010 Switzerland
| | - Markus S. Hanke
- Department of Orthopaedic Surgery, Inselspital, University of Bern, Freiburgstrasse, Bern, 3010 Switzerland
| | - Emanuel F. Liechti
- Department of Orthopaedic Surgery, Inselspital, University of Bern, Freiburgstrasse, Bern, 3010 Switzerland
| | | | - Klaus A. Siebenrock
- Department of Orthopaedic Surgery, Inselspital, University of Bern, Freiburgstrasse, Bern, 3010 Switzerland
| | - Moritz Tannast
- Department of Orthopaedic Surgery, Inselspital, University of Bern, Freiburgstrasse, Bern, 3010 Switzerland
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Rangwala NA, Dregely I, Wu HH, Sung K. Optimization and evaluation of reference region variable flip angle (RR-VFA)
B1+ and T
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Mapping in the Prostate at 3T. J Magn Reson Imaging 2016; 45:751-760. [DOI: 10.1002/jmri.25410] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2016] [Accepted: 07/19/2016] [Indexed: 11/10/2022] Open
Affiliation(s)
- Novena A. Rangwala
- Department of Radiological Sciences; University of California Los Angeles; California USA
| | - Isabel Dregely
- Department of Radiological Sciences; University of California Los Angeles; California USA
| | - Holden H. Wu
- Department of Radiological Sciences; University of California Los Angeles; California USA
| | - Kyunghyun Sung
- Department of Radiological Sciences; University of California Los Angeles; California USA
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Lazik A, Theysohn JM, Geis C, Johst S, Ladd ME, Quick HH, Kraff O. 7 Tesla quantitative hip MRI: T1, T2 and T2* mapping of hip cartilage in healthy volunteers. Eur Radiol 2015; 26:1245-53. [DOI: 10.1007/s00330-015-3964-0] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2015] [Revised: 07/28/2015] [Accepted: 08/03/2015] [Indexed: 12/26/2022]
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11
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Current knowledge and importance of dGEMRIC techniques in diagnosis of hip joint diseases. Skeletal Radiol 2015; 44:1073-83. [PMID: 25913097 DOI: 10.1007/s00256-015-2135-3] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/20/2014] [Revised: 03/10/2015] [Accepted: 03/12/2015] [Indexed: 02/02/2023]
Abstract
Accurate assessment of early hip joint cartilage alterations may help optimize patient selection and follow-up of hip joint preservation surgery. Delayed gadolinium-enhanced magnetic resonance imaging of cartilage (dGEMRIC) is sensitive to the glycosaminoglycan content in cartilage that is lost early in the development of osteoarthritis (OA). Hence, the dGEMRIC technique holds promise for the development of new diagnostic and therapeutic procedures. However, because of the location of the hip joint deep within the body and due to the fairly thin cartilage layers that require high spatial resolution, the diagnosis of early hip joint cartilage alterations may be problematic. The purpose of this review is to outline the current status of dGEMRIC in the assessment of hip joint cartilage. A literature search was performed with PubMed, using the terms "cartilage, osteoarthritis, hip joint, MRI, and dGEMRIC", considering all levels of studies. This review revealed that dGEMRIC can be reliably used in the evaluation of early stage cartilage pathology in various hip joint disorders. Modifications in the technique, such as the operation of three-dimensional imaging and dGEMRIC after intra-articular contrast medium administration, have expanded the range of application. Notably, the studies differ considerably in patient selection and technical prerequisites. Furthermore, there is a need for multicenter prospective studies with the required technical conditions in place to establish outcome based dGEMRIC data to obtain, in conjunction with clinical data, reliable threshold values for normal and abnormal cartilage, and for hips that may benefit from conservative or surgical treatment.
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Le Y, Dale B, Akisik F, Koons K, Lin C. Improved T1, contrast concentration, and pharmacokinetic parameter quantification in the presence of fat with two-point Dixon for dynamic contrast-enhanced magnetic resonance imaging. Magn Reson Med 2015; 75:1677-84. [PMID: 25988338 DOI: 10.1002/mrm.25639] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2014] [Revised: 01/06/2015] [Accepted: 01/07/2015] [Indexed: 11/06/2022]
Abstract
PURPOSE To evaluate the impact of fat and fat-suppression on the quantification of T1, gadolinium concentration, and pharmacokinetic parameters in DCE-MRI. METHODS T1 values were measured in fat-free phantoms using variable flip angle with no fat suppression, quick or interleaved fat saturation (QFS), or two-point Dixon and were compared with reference values measured with inversion recovery-prepared turbo spin echo. Relaxivity of gadolinium-benzyloxypropionictetraacetate (Gd-BOPTA) was measured in emulsions of Gd-BOPTA solution and fat using Dixon in-phase and water-only images. Liver T1 and pharmacokinetic parameters of 15 patients were calculated from Dixon in-phase and water-only images and were correlated with liver fat signal fraction. RESULTS T1 values measured using Dixon water-only and non-fat-suppressed images matched the reference values; while T1 values measured using QFS showed large deviations. Relaxivities and Gd measured in the Dixon water-only images were less affected by the fat than those measured in the in-phase images. The correlation between liver fat fraction and the differences in measured pharmacokinetic parameters using Dixon in-phase and water-only images were significant (P < 0.05) for T1, K(trans), and incremental area under the curve, but not Ve (P = 0.1). CONCLUSION Dixon water-only images provided more reliable estimation of T1, Gd, and pharmacokinetic parameters when fat was present.
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Affiliation(s)
- Yuan Le
- Department of Radiology and Imaging Science, Indiana University School of Medicine, Indianapolis, Indiana, USA
| | - Brian Dale
- Siemens Medical Solutions, USA, MR R&D, Morrisville, North Carolina, USA
| | - Fatih Akisik
- Department of Radiology and Imaging Science, Indiana University School of Medicine, Indianapolis, Indiana, USA
| | - Karen Koons
- Department of Radiology, Indiana University Health, Indianapolis, Indiana, USA
| | - Chen Lin
- Department of Radiology and Imaging Science, Indiana University School of Medicine, Indianapolis, Indiana, USA
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13
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Hingsammer AM, Kalish LA, Stelzeneder D, Bixby S, Mamisch TC, Connell P, Millis MB, Kim YJ. Does periacetabular osteotomy for hip dysplasia modulate cartilage biochemistry? J Bone Joint Surg Am 2015; 97:544-50. [PMID: 25834078 DOI: 10.2106/jbjs.m.01233] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
BACKGROUND The aim of periacetabular osteotomy is to improve joint mechanics in patients with developmental dysplasia of the hip. In our study, we tried to determine whether the proteoglycan content, as measured with delayed gadolinium-enhanced magnetic resonance imaging of cartilage (dGEMRIC), can be modulated with the alteration of the hip joint biomechanics. METHODS In this prospective cohort study, thirty-seven patients (thirty-seven hips) with no or minimal osteoarthritis were treated with periacetabular osteotomy for symptomatic acetabular dysplasia. All patients had preoperative and one-year follow-up dGEMRIC scans. Twenty-eight of the thirty-seven also had two-year scans. The changes in dGEMRIC findings and hip morphology between the preoperative visit and the examinations at one and two years following the periacetabular osteotomy were assessed. RESULTS The mean preoperative dGEMRIC index (and standard deviation) was 561.6 ± 117.6 ms; this decreased to 515.2 ± 118.4 ms at one year after periacetabular osteotomy but subsequently recovered to 529.2 ± 99.1 ms at two years postoperatively. The decrease in the dGEMRIC index of the acetabular cartilage after surgery appears to be most pronounced at the superior aspect of the acetabulum, where the decrease in mechanical loading after periacetabular osteotomy would be most pronounced. All domains of the Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) demonstrated significant improvement from the preoperative to the postoperative visits (all p < 0.001). CONCLUSIONS Periacetabular osteotomy for developmental dysplasia of the hip appears to alter the mechanical loading of articular cartilage in the hip, which in turn alters the cartilage matrix composition, as demonstrated by dGEMRIC.
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Affiliation(s)
- Andreas M Hingsammer
- Department of Orthopaedic Surgery, Child and Adult Hip Program (A.M.H., D.S., P.C., M.B.M., and Y.-J. K.), Clinical Research Program (L.A.K.), and Department of Radiology (S.B.), Boston Children's Hospital, 300 Longwood Avenue, Hunnewell 225, Boston, MA 02115. E-mail address for Y.-J. Kim:
| | - Leslie A Kalish
- Department of Orthopaedic Surgery, Child and Adult Hip Program (A.M.H., D.S., P.C., M.B.M., and Y.-J. K.), Clinical Research Program (L.A.K.), and Department of Radiology (S.B.), Boston Children's Hospital, 300 Longwood Avenue, Hunnewell 225, Boston, MA 02115. E-mail address for Y.-J. Kim:
| | - David Stelzeneder
- Department of Orthopaedic Surgery, Child and Adult Hip Program (A.M.H., D.S., P.C., M.B.M., and Y.-J. K.), Clinical Research Program (L.A.K.), and Department of Radiology (S.B.), Boston Children's Hospital, 300 Longwood Avenue, Hunnewell 225, Boston, MA 02115. E-mail address for Y.-J. Kim:
| | - Sarah Bixby
- Department of Orthopaedic Surgery, Child and Adult Hip Program (A.M.H., D.S., P.C., M.B.M., and Y.-J. K.), Clinical Research Program (L.A.K.), and Department of Radiology (S.B.), Boston Children's Hospital, 300 Longwood Avenue, Hunnewell 225, Boston, MA 02115. E-mail address for Y.-J. Kim:
| | - Tallal Charles Mamisch
- Department of Orthopaedic Surgery, Inselspital Bern, University of Bern, 3010 Bern, Switzerland
| | - Patricia Connell
- Department of Orthopaedic Surgery, Child and Adult Hip Program (A.M.H., D.S., P.C., M.B.M., and Y.-J. K.), Clinical Research Program (L.A.K.), and Department of Radiology (S.B.), Boston Children's Hospital, 300 Longwood Avenue, Hunnewell 225, Boston, MA 02115. E-mail address for Y.-J. Kim:
| | - Michael B Millis
- Department of Orthopaedic Surgery, Child and Adult Hip Program (A.M.H., D.S., P.C., M.B.M., and Y.-J. K.), Clinical Research Program (L.A.K.), and Department of Radiology (S.B.), Boston Children's Hospital, 300 Longwood Avenue, Hunnewell 225, Boston, MA 02115. E-mail address for Y.-J. Kim:
| | - Young-Jo Kim
- Department of Orthopaedic Surgery, Child and Adult Hip Program (A.M.H., D.S., P.C., M.B.M., and Y.-J. K.), Clinical Research Program (L.A.K.), and Department of Radiology (S.B.), Boston Children's Hospital, 300 Longwood Avenue, Hunnewell 225, Boston, MA 02115. E-mail address for Y.-J. Kim:
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Siversson C, Akhondi-Asl A, Bixby S, Kim YJ, Warfield SK. Three-dimensional hip cartilage quality assessment of morphology and dGEMRIC by planar maps and automated segmentation. Osteoarthritis Cartilage 2014; 22:1511-5. [PMID: 25278060 PMCID: PMC4404159 DOI: 10.1016/j.joca.2014.08.012] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/01/2014] [Revised: 08/11/2014] [Accepted: 08/24/2014] [Indexed: 02/02/2023]
Abstract
OBJECTIVE The quantitative interpretation of hip cartilage magnetic resonance imaging (MRI) has been limited by the difficulty of identifying and delineating the cartilage in a three-dimensional (3D) dataset, thereby reducing its routine usage. In this paper a solution is suggested by unfolding the cartilage to planar two-dimensional (2D) maps on which both morphology and biochemical degeneration patterns can be investigated across the entire hip joint. DESIGN Morphological TrueFISP and biochemical delayed gadolinium enhanced MRI of cartilage (dGEMRIC) hip images were acquired isotropically for 15 symptomatic subjects with mild or no radiographic osteoarthritis (OA). A multi-template based label fusion technique was used to automatically segment the cartilage tissue, followed by a geometric projection algorithm to generate the planar maps. The segmentation performance was investigated through a leave-one-out study, for two different fusion methods and as a function of the number of utilized templates. RESULTS For each of the generated planar maps, various patterns could be seen, indicating areas of healthy and degenerated cartilage. Dice coefficients for cartilage segmentation varied from 0.76 with four templates to 0.82 with 14 templates. Regional analysis suggests even higher segmentation performance in the superior half of the cartilage. CONCLUSIONS The proposed technique is the first of its kind to provide planar maps that enable straightforward quantitative assessment of hip cartilage morphology and dGEMRIC values. This technique may have important clinical applications for patient selection for hip preservation surgery, as well as for epidemiological studies of cartilage degeneration patterns. It is also shown that 10-15 templates are sufficient for accurate segmentation in this application.
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Affiliation(s)
- Carl Siversson
- Computational Radiology Laboratory, Boston Children's Hospital, Harvard Medical School, Boston, MA, United States,Department of Medical Radiation Physics, Lund University, Malmö, Sweden
| | - Alireza Akhondi-Asl
- Computational Radiology Laboratory, Boston Children's Hospital, Harvard Medical School, Boston, MA, United States
| | - Sarah Bixby
- Department of Radiology, Boston Children's Hospital, Harvard Medical School, Boston, MA, United States
| | - Young-Jo Kim
- Department of Orthopaedic Surgery, Boston Children's Hospital, Harvard Medical School, Boston, MA, United States
| | - Simon K. Warfield
- Computational Radiology Laboratory, Boston Children's Hospital, Harvard Medical School, Boston, MA, United States
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Mosher TJ, Walker EA, Petscavage-Thomas J, Guermazi A. Osteoarthritis year 2013 in review: imaging. Osteoarthritis Cartilage 2013; 21:1425-35. [PMID: 23891696 DOI: 10.1016/j.joca.2013.07.010] [Citation(s) in RCA: 37] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/02/2013] [Revised: 06/24/2013] [Accepted: 07/13/2013] [Indexed: 02/02/2023]
Abstract
PURPOSE To review recent original research publications related to imaging of osteoarthritis (OA) and identify emerging trends and significant advances. METHODS Relevant articles were identified through a search of the PubMed database using the query terms "OA" in combination with "imaging", "radiography", "MRI", "ultrasound", "computed tomography", and "nuclear medicine"; either published or in press between March 2012 and March 2013. Abstracts were reviewed to exclude review articles, case reports, and studies not focused on imaging using routine clinical imaging measures. RESULTS Initial query yielded 932 references, which were reduced to 328 citations following the initial review. MRI (118 references) and radiography (129 refs) remain the primary imaging modalities in OA studies, with fewer reports using computed tomography (CT) (35 refs) and ultrasound (23 refs). MRI parametric mapping techniques remain an active research area (33 refs) with growth in T2*- and T1-rho mapping publications compared to prior years. Although the knee is the major joint studied (210 refs) there is interest in the hip (106 refs) and hand (29 refs). Imaging continues to focus on evaluation of cartilage (173 refs) and bone (119 refs). CONCLUSION Imaging plays a major role in OA research with publications continuing along traditional lines of investigation. Translational and clinical research application of compositional MRI techniques is becoming more common driven in part by the availability of T2 mapping data from the Osteoarthritis Initiative (OAI). New imaging techniques continue to be developed with a goal of identifying methods with greater specificity and responsiveness to changes in the joint, and novel functional neuroimaging techniques to study central pain. Publications related to imaging of OA continue to be heavily focused on quantitative and semiquantitative MRI evaluation of the knee with increasing application of compositional MRI techniques in the hip.
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Affiliation(s)
- T J Mosher
- Department of Radiology, Penn State Hershey Medical Center, Hershey, PA, USA.
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Symptomatic femoroacetabular impingement: does the offset decrease correlate with cartilage damage? A pilot study. Clin Orthop Relat Res 2013; 471:2173-82. [PMID: 23361934 PMCID: PMC3676629 DOI: 10.1007/s11999-013-2812-2] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
BACKGROUND Current measures of the reduced head-neck offset such as residual deformity of slipped capital femoral epiphysis (SCFE) including the alpha angle, which measures the femoral head-neck sphericity but does not account for acetabular abnormalities, do not represent the true magnitude of the deformity and the mechanical consequences. The beta angle (angle between the femoral head-neck junction and acetabular rim) accounts for the morphology of both the acetabulum and femur and, thus, may be the more appropriate parameter for assessing SCFE deformity. QUESTIONS/PURPOSES We determined (1) whether the beta angle could be reliably measured on MRI; and (2) whether the beta angle correlates with the cartilage status. METHODS We recruited 10 adult patients (mean age, 28 years) with symptomatic cam femoroacetabular impingement and 15 asymptomatic volunteers (mean age, 24 years) to have three-dimensional MRI including delayed gadolinium-enhanced MRI of cartilage (dGEMRIC) for cartilage status assessment. Corresponding alpha angles, beta angles, and acetabular dGEMRIC indices were obtained in seven radial reformats to assess the hip in seven regions (anterior to superior and posterior). RESULTS We noted high reproducibility for both alpha and beta angle measurements. The dGEMRIC indices correlated with beta angles in the superoinferior and superior regions but not the alpha angles. CONCLUSIONS Beta angle measurement in radial MR images is reproducible and appears to correspond to cartilage damage in the superior regions of the hip. The beta angle may be a useful parameter to assess hip deformity in the followup of SCFE although further confirmation is warranted.
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Wang H, Cao Y. Spatially regularized T(1) estimation from variable flip angles MRI. Med Phys 2012; 39:4139-48. [PMID: 22830747 DOI: 10.1118/1.4722747] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022] Open
Abstract
PURPOSE To develop efficient algorithms for fast voxel-by-voxel quantification of tissue longitudinal relaxation time (T(1)) from variable flip angles magnetic resonance images (MRI) to reduce voxel-level noise without blurring tissue edges. METHODS T(1) estimations regularized by total variation (TV) and quadratic penalty are developed to measure T(1) from fast variable flip angles MRI and to reduce voxel-level noise without decreasing the accuracy of the estimates. First, a quadratic surrogate for a log likelihood cost function of T(1) estimation is derived based upon the majorization principle, and then the TV-regularized surrogate function is optimized by the fast iterative shrinkage thresholding algorithm. A fast optimization algorithm for the quadratically regularized T(1) estimation is also presented. The proposed methods are evaluated by the simulated and experimental MR data. RESULTS The means of the T(1) values in the simulated brain data estimated by the conventional, TV-regularized, and quadratically regularized methods have less than 3% error from the true T(1) in both GM and WM tissues with image noise up to 9%. The relative standard deviations (SDs) of the T(1) values estimated by the conventional method are more than 12% and 15% when the images have 7% and 9% noise, respectively. In comparison, the TV-regularized and quadratically regularized methods are able to suppress the relative SDs of the estimated T(1) to be less than 2% and 3%, respectively, regardless of the image noise level. However, the quadratically regularized method tends to overblur the edges compared to the TV-regularized method. CONCLUSIONS The spatially regularized methods improve quality of T(1) estimation from multiflip angles MRI. Quantification of dynamic contrast-enhanced MRI can benefit from the high quality measurement of native T(1).
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Affiliation(s)
- Hesheng Wang
- Department of Radiation Oncology, University of Michigan, Ann Arbor, MI 48109, USA.
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