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Cheng KY, Lombardi AF, Chang EY, Chung CB. Knee Cartilage Imaging. Clin Sports Med 2021; 40:677-692. [PMID: 34509205 DOI: 10.1016/j.csm.2021.05.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
Articular cartilage injury and degeneration represent common causes of knee pain, which can be evaluated accurately and noninvasively using MRI. This review describes the structure of cartilage focusing on its histologic appearance to emphasize that structure will dictate patterns of tissue failure as well as MR appearance. In addition to identifying cartilage loss, MRI can demonstrate signal changes that correspond to intrinsic structural abnormalities which place the cartilage at risk for subsequent more serious injury or premature degeneration, allowing for earlier intervention and treatment of important causes of pain and morbidity.
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Affiliation(s)
- Karen Y Cheng
- Department of Radiology, UC San Diego Health, 200 W. Arbor Drive MC 8226, San Diego, CA 92103, USA
| | - Alecio F Lombardi
- Department of Radiology, UC San Diego Health, 200 W. Arbor Drive MC 8226, San Diego, CA 92103, USA; VA San Diego Healthcare System, Radiology Service, 3350 La Jolla Village Drive, MC 114, San Diego, CA 92161, USA
| | - Eric Y Chang
- Department of Radiology, UC San Diego Health, 200 W. Arbor Drive MC 8226, San Diego, CA 92103, USA; VA San Diego Healthcare System, Radiology Service, 3350 La Jolla Village Drive, MC 114, San Diego, CA 92161, USA
| | - Christine B Chung
- Department of Radiology, UC San Diego Health, 200 W. Arbor Drive MC 8226, San Diego, CA 92103, USA; VA San Diego Healthcare System, Radiology Service, 3350 La Jolla Village Drive, MC 114, San Diego, CA 92161, USA.
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Einarsson E, Svensson J, Folkesson E, Kestilä I, Tjörnstrand J, Peterson P, Finnilä MAJ, Hughes HV, Turkiewicz A, Saarakkala S, Englund M. Relating MR relaxation times of ex vivo meniscus to tissue degeneration through comparison with histopathology. OSTEOARTHRITIS AND CARTILAGE OPEN 2020; 2. [PMID: 33972933 DOI: 10.1016/j.ocarto.2020.100061] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Abstract
Background Quantitative magnetic resonance imaging (MRI), e.g. relaxation parameter mapping, may be sensitive to structural and compositional tissue changes, and could potentially be used to non-invasively detect and monitor early meniscus degeneration related to knee osteoarthritis. Objective To investigate MR relaxation times as potential biomarkers for meniscus degeneration through comparisons with histopathology. Methods We measured MR relaxation parameters in the posterior horn of 40 menisci (medial and lateral) at a wide range of degenerative stages. T1, T2 and T2* were mapped using standard and ultrashort echo time sequences at 9.4 T and compared to gold standard histology using Pauli's histopathological scoring system, including assessment of surface integrity, collagen organization, cellularity and Safranin-O staining. Results All three relaxation times increased with total Pauli score (mean difference per score (95% CI) for T2*: 0.62 (0.37, 0.86), T2: 0.83 (0.53, 1.1) and T1: 24.7 (16.5, 32.8) ms/score). Clear associations were seen with scores of surface integrity (mean difference per score for T2*: 3.0 (1.8, 4.2), T2: 4.0 (2.5, 5.5) and T1: 116 (75.6, 156) ms/score) and collagen organization (mean difference between highest and lowest score for T2*: 5.3 (1.6, 8.9), T2: 6.1 (1.7, 11) and T1: 204 (75.9, 332) ms). The results were less clear for the remaining histopathological measures. Conclusions MR relaxation times T1, T2 and T2* of ex vivo human menisci are associated with histologically verified degenerative processes, in particular related to surface integrity and collagen organization. If confirmed in vivo, MR relaxation times may thus be potential biomarkers for meniscus degeneration.
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Affiliation(s)
- Emma Einarsson
- Medical Radiation Physics, Department of Translational Medicine, Lund University, Malmö, Sweden
- Clinical Epidemiology Unit, Orthopedics, Department of Clinical Sciences Lund, Lund University, Lund, Sweden
| | - Jonas Svensson
- Medical Radiation Physics, Department of Translational Medicine, Lund University, Malmö, Sweden
- Medical Imaging and Physiology, Skåne University Hospital, Lund, Sweden
| | - Elin Folkesson
- Clinical Epidemiology Unit, Orthopedics, Department of Clinical Sciences Lund, Lund University, Lund, Sweden
- Molecular Skeletal Biology and Rheumatology, Department of Clinical Sciences Lund, Lund University, Lund, Sweden
| | - Iida Kestilä
- Research Unit of Medical Imaging, Physics and Technology, University of Oulu, Oulu, Finland
| | - Jon Tjörnstrand
- Orthopedics, Department of Clinical Sciences Lund, Lund University, Skåne University Hospital, Lund, Sweden
| | - Pernilla Peterson
- Medical Radiation Physics, Department of Translational Medicine, Lund University, Malmö, Sweden
- Medical Imaging and Physiology, Skåne University Hospital, Lund, Sweden
| | - Mikko A J Finnilä
- Research Unit of Medical Imaging, Physics and Technology, University of Oulu, Oulu, Finland
| | - H Velocity Hughes
- Clinical Epidemiology Unit, Orthopedics, Department of Clinical Sciences Lund, Lund University, Lund, Sweden
| | - Aleksandra Turkiewicz
- Clinical Epidemiology Unit, Orthopedics, Department of Clinical Sciences Lund, Lund University, Lund, Sweden
| | - Simo Saarakkala
- Research Unit of Medical Imaging, Physics and Technology, University of Oulu, Oulu, Finland
- Department of Diagnostic Radiology, Oulu University Hospital, Oulu, Finland
| | - Martin Englund
- Clinical Epidemiology Unit, Orthopedics, Department of Clinical Sciences Lund, Lund University, Lund, Sweden
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Baboli R, Sharafi A, Chang G, Regatte RR. Biexponential T 1ρ relaxation mapping of human knee menisci. J Magn Reson Imaging 2019; 50:824-835. [PMID: 30614152 DOI: 10.1002/jmri.26631] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2018] [Revised: 12/10/2018] [Accepted: 12/11/2018] [Indexed: 12/14/2022] Open
Abstract
BACKGROUND Measuring T1ρ in the knee menisci can potentially be used as noninvasive biomarkers in detecting early-stage osteoarthritis (OA). PURPOSE To demonstrate the feasibility of biexponential T1ρ relaxation mapping of human knee menisci. STUDY TYPE Prospective. POPULATION Eight healthy volunteers with no known inflammation, trauma, or pain in the knee and three symptomatic subjects with early knee OA. FIELD STRENGTH/SEQUENCE Customized Turbo-FLASH sequence to acquire 3D-T1ρ -weighted images on a 3 T MRI scanner. ASSESSMENT T1ρ relaxation values were assessed in 11 meniscal regions of interest (ROIs) using monoexponential and biexponential models. STATISTICAL TESTS Nonparametric rank-sum tests, Kruskal-Wallis test, and coefficient of variation. RESULTS The mean monoexponential T1ρ relaxation in the lateral menisci were 28.05 ± 4.2 msec and 37.06 ± 10.64 msec for healthy subjects and early knee OA patients, respectively, while the short and long components were 8.07 ± 0.5 msec and 72.35 ± 3.2 msec for healthy subjects and 2.63 ± 2.99 msec and 55.27 ± 24.76 msec for early knee OA patients, respectively. The mean monoexponential T1ρ relaxation in the medial menisci were 34.30 ± 3.8 msec and 37.26 ± 11.38 msec for healthy and OA patients, respectively, while the short and long components were 7.76 ± 0.7 msec and 72.19 ± 4.2 msec for healthy subjects and 3.06 ± 3.24 msec and 55.27 ± 24.59 msec for OA patients, respectively. Statistically significant (P ≤ 0.05) differences were observed in the monoexponential relaxation between some of the ROIs. The T1ρ,short was significantly lower (P = 0.02) in the patients than controls. The rmsCV% ranges were 1.51-16.6%, 3.59-14.3%, and 4.91-15.6% for T1ρ -mono, T1ρ -short, and T1ρ -long, respectively. DATA CONCLUSION Our results showed that in all ROIs, T1ρ relaxation times of outer zones (red zones) were less than inner zones (white zones). Monoexponential T1ρ was increased in medial, lateral, and body menisci of early OA while the biexponential numbers were decreased in early OA patients. LEVEL OF EVIDENCE 2 Technical Efficacy Stage: 1 J. Magn. Reson. Imaging 2019. J. Magn. Reson. Imaging 2019;50:824-835.
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Affiliation(s)
- Rahman Baboli
- From the Bernard and Irene Schwartz Center for Biomedical Imaging, Department of Radiology, New York University School of Medicine, New York, New York, USA
| | - Azadeh Sharafi
- From the Bernard and Irene Schwartz Center for Biomedical Imaging, Department of Radiology, New York University School of Medicine, New York, New York, USA
| | - Gregory Chang
- From the Bernard and Irene Schwartz Center for Biomedical Imaging, Department of Radiology, New York University School of Medicine, New York, New York, USA
| | - Ravinder R Regatte
- From the Bernard and Irene Schwartz Center for Biomedical Imaging, Department of Radiology, New York University School of Medicine, New York, New York, USA
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Chaudhari AS, Sveinsson B, Moran CJ, McWalter EJ, Johnson EM, Zhang T, Gold GE, Hargreaves BA. Imaging and T 2 relaxometry of short-T 2 connective tissues in the knee using ultrashort echo-time double-echo steady-state (UTEDESS). Magn Reson Med 2017; 78:2136-2148. [PMID: 28074498 DOI: 10.1002/mrm.26577] [Citation(s) in RCA: 30] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2016] [Revised: 10/26/2016] [Accepted: 11/19/2016] [Indexed: 12/15/2022]
Abstract
PURPOSE To develop a radial, double-echo steady-state (DESS) sequence with ultra-short echo-time (UTE) capabilities for T2 measurement of short-T2 tissues along with simultaneous rapid, signal-to-noise ratio (SNR)-efficient, and high-isotropic-resolution morphological knee imaging. METHODS THe 3D radial UTE readouts were incorporated into DESS, termed UTEDESS. Multiple-echo-time UTEDESS was used for performing T2 relaxometry for short-T2 tendons, ligaments, and menisci; and for Dixon water-fat imaging. In vivo T2 estimate repeatability and SNR efficiency for UTEDESS and Cartesian DESS were compared. The impact of coil combination methods on short-T2 measurements was evaluated by means of simulations. UTEDESS T2 measurements were compared with T2 measurements from Cartesian DESS, multi-echo spin-echo (MESE), and fast spin-echo (FSE). RESULTS UTEDESS produced isotropic resolution images with high SNR efficiency in all short-T2 tissues. Simulations and experiments demonstrated that sum-of-squares coil combinations overestimated short-T2 measurements. UTEDESS measurements of meniscal T2 were comparable to DESS, MESE, and FSE measurements while the tendon and ligament measurements were less biased than those from Cartesian DESS. Average UTEDESS T2 repeatability variation was under 10% in all tissues. CONCLUSION The T2 measurements of short-T2 tissues and high-resolution morphological imaging provided by UTEDESS makes it promising for studying the whole knee, both in routine clinical examinations and longitudinal studies. Magn Reson Med 78:2136-2148, 2017. © 2017 International Society for Magnetic Resonance in Medicine.
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Affiliation(s)
- Akshay S Chaudhari
- Department of Radiology, Stanford University, Stanford, California, USA.,Department of Bioengineering, Stanford University, Stanford, California, USA
| | - Bragi Sveinsson
- Department of Radiology, Stanford University, Stanford, California, USA.,Department of Electrical Engineering, Stanford University, Stanford, California, USA
| | - Catherine J Moran
- Department of Radiology, Stanford University, Stanford, California, USA
| | - Emily J McWalter
- Department of Mechanical Engineering, University of Saskatchewan, Saskatoon, Saskatchewan, Canada
| | - Ethan M Johnson
- Department of Electrical Engineering, Stanford University, Stanford, California, USA
| | - Tao Zhang
- Department of Radiology, Stanford University, Stanford, California, USA.,Department of Electrical Engineering, Stanford University, Stanford, California, USA
| | - Garry E Gold
- Department of Radiology, Stanford University, Stanford, California, USA.,Department of Bioengineering, Stanford University, Stanford, California, USA
| | - Brian A Hargreaves
- Department of Radiology, Stanford University, Stanford, California, USA.,Department of Bioengineering, Stanford University, Stanford, California, USA.,Department of Electrical Engineering, Stanford University, Stanford, California, USA
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