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Parillo M, Mallio CA, Dekkers IA, Rovira À, van der Molen AJ, Quattrocchi CC. Late/delayed gadolinium enhancement in MRI after intravenous administration of extracellular gadolinium-based contrast agents: is it worth waiting? MAGMA (NEW YORK, N.Y.) 2024; 37:151-168. [PMID: 38386150 DOI: 10.1007/s10334-024-01151-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/22/2023] [Revised: 01/17/2024] [Accepted: 01/30/2024] [Indexed: 02/23/2024]
Abstract
The acquisition of images minutes or even hours after intravenous extracellular gadolinium-based contrast agents (GBCA) administration ("Late/Delayed Gadolinium Enhancement" imaging; in this review, further termed LGE) has gained significant prominence in recent years in magnetic resonance imaging. The major limitation of LGE is the long examination time; thus, it becomes necessary to understand when it is worth waiting time after the intravenous injection of GBCA and which additional information comes from LGE. LGE can potentially be applied to various anatomical sites, such as heart, arterial vessels, lung, brain, abdomen, breast, and the musculoskeletal system, with different pathophysiological mechanisms. One of the most popular clinical applications of LGE regards the assessment of myocardial tissue thanks to its ability to highlight areas of acute myocardial damage and fibrotic tissues. Other frequently applied clinical contexts involve the study of the urinary tract with magnetic resonance urography and identifying pathological abdominal processes characterized by high fibrous stroma, such as biliary tract tumors, autoimmune pancreatitis, or intestinal fibrosis in Crohn's disease. One of the current areas of heightened research interest revolves around the possibility of non-invasively studying the dynamics of neurofluids in the brain (the glymphatic system), the disruption of which could underlie many neurological disorders.
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Affiliation(s)
- Marco Parillo
- Fondazione Policlinico Universitario Campus Bio-Medico, Via Alvaro del Portillo, 200, 00128, Rome, Italy
- Operative Research Unit of Diagnostic Imaging and Interventional Radiology, Department of Medicine and Surgery, Università Campus Bio-Medico Di Roma, Via Alvaro del Portillo, 200, 00128, Rome, Italy
| | - Carlo Augusto Mallio
- Fondazione Policlinico Universitario Campus Bio-Medico, Via Alvaro del Portillo, 200, 00128, Rome, Italy.
- Operative Research Unit of Diagnostic Imaging and Interventional Radiology, Department of Medicine and Surgery, Università Campus Bio-Medico Di Roma, Via Alvaro del Portillo, 200, 00128, Rome, Italy.
| | - Ilona A Dekkers
- Department of Radiology, Leiden University Medical Center, Leiden, The Netherlands
| | - Àlex Rovira
- Section of Neuroradiology, Department of Radiology, Autonomous University of Barcelona and Hospital Vall d'Hebron, Passeig Vall d'Hebron, Barcelona, Spain
| | - Aart J van der Molen
- Department of Radiology, Leiden University Medical Center, Leiden, The Netherlands
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Ehmig J, Engel G, Lotz J, Lehmann W, Taheri S, Schilling AF, Seif Amir Hosseini A, Panahi B. MR-Imaging in Osteoarthritis: Current Standard of Practice and Future Outlook. Diagnostics (Basel) 2023; 13:2586. [PMID: 37568949 PMCID: PMC10417111 DOI: 10.3390/diagnostics13152586] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2023] [Revised: 07/30/2023] [Accepted: 08/01/2023] [Indexed: 08/13/2023] Open
Abstract
Osteoarthritis (OA) is a common degenerative joint disease that affects millions of people worldwide. Magnetic resonance imaging (MRI) has emerged as a powerful tool for the evaluation and monitoring of OA due to its ability to visualize soft tissues and bone with high resolution. This review aims to provide an overview of the current state of MRI in OA, with a special focus on the knee, including protocol recommendations for clinical and research settings. Furthermore, new developments in the field of musculoskeletal MRI are highlighted in this review. These include compositional MRI techniques, such as T2 mapping and T1rho imaging, which can provide additional important information about the biochemical composition of cartilage and other joint tissues. In addition, this review discusses semiquantitative joint assessment based on MRI findings, which is a widely used method for evaluating OA severity and progression in the knee. We analyze the most common scoring methods and discuss potential benefits. Techniques to reduce acquisition times and the potential impact of deep learning in MR imaging for OA are also discussed, as these technological advances may impact clinical routine in the future.
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Affiliation(s)
- Jonathan Ehmig
- Institute of Diagnostic and Interventional Radiology, University Medical Center Göttingen, 37075 Göttingen, Germany; (J.E.); (G.E.)
| | - Günther Engel
- Institute of Diagnostic and Interventional Radiology, University Medical Center Göttingen, 37075 Göttingen, Germany; (J.E.); (G.E.)
| | - Joachim Lotz
- Institute of Diagnostic and Interventional Radiology, University Medical Center Göttingen, 37075 Göttingen, Germany; (J.E.); (G.E.)
| | - Wolfgang Lehmann
- Clinic of Trauma, Orthopedics and Reconstructive Surgery, Georg-August-University of Göttingen, 37075 Göttingen, Germany
| | - Shahed Taheri
- Clinic of Trauma, Orthopedics and Reconstructive Surgery, Georg-August-University of Göttingen, 37075 Göttingen, Germany
| | - Arndt F. Schilling
- Clinic of Trauma, Orthopedics and Reconstructive Surgery, Georg-August-University of Göttingen, 37075 Göttingen, Germany
| | - Ali Seif Amir Hosseini
- Institute of Diagnostic and Interventional Radiology, University Medical Center Göttingen, 37075 Göttingen, Germany; (J.E.); (G.E.)
| | - Babak Panahi
- Institute of Diagnostic and Interventional Radiology, University Medical Center Göttingen, 37075 Göttingen, Germany; (J.E.); (G.E.)
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3
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Ghouri A, Muzumdar S, Barr AJ, Robinson E, Murdoch C, Kingsbury SR, Conaghan PG. The relationship between meniscal pathologies, cartilage loss, joint replacement and pain in knee osteoarthritis: a systematic review. Osteoarthritis Cartilage 2022; 30:1287-1327. [PMID: 35963512 DOI: 10.1016/j.joca.2022.08.002] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/19/2021] [Revised: 08/01/2022] [Accepted: 08/01/2022] [Indexed: 02/02/2023]
Abstract
OBJECTIVE We conducted a systematic review in order to understand the relationship between imaging-visualised meniscus pathologies, hyaline cartilage, joint replacement and pain in knee osteoarthritis (OA). DESIGN A search of the Medline, Excerpta Medica database (EMBASE) and Cochrane library databases was performed for original publications reporting association between imaging-detected meniscal pathology (extrusion or tear/damage) and longitudinal and cross-sectional assessments of hyaline articular cartilage loss [assessed on magnetic resonance imaging (MRI)], incident joint replacement and pain (longitudinal and cross-sectional) in knee OA. Each association was qualitatively characterised by a synthesis of data from each analysis, based upon study design and quality scoring (including risk of bias assessment and adequacy of covariate adjustment using Cochrane recommended methodology). RESULTS In total 4,878 abstracts were screened and 82 publications were included (comprising 72 longitudinal analyses and 49 cross-sectional). Using high quality, well-adjusted data, meniscal extrusion and meniscal tear/damage were associated with longitudinal progression of cartilage loss, cross-sectional cartilage loss severity and joint replacement, independently of age, sex and body mass index (BMI). Medial and lateral meniscal tears were associated with cartilage loss when they occurred in the body and posterior horns, but not the anterior horns. There was a lack of high quality, well-adjusted meniscal pathology and pain publications and no clear independent association between meniscal extrusion or tear/damage with pain severity, progression in pain or incident frequent knee symptoms. CONCLUSION Meniscal features have strong associations with cartilage loss and joint replacement in knee OA, but weak associations with knee pain. Systematic review PROSPERO registration number: CRD 42020210910.
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Affiliation(s)
- A Ghouri
- Leeds Institute of Rheumatic and Musculoskeletal Medicine, University of Leeds and NIHR Leeds Musculoskeletal Biomedical Research Unit, Leeds, UK.
| | | | - A J Barr
- Leeds Institute of Rheumatic and Musculoskeletal Medicine, University of Leeds and NIHR Leeds Musculoskeletal Biomedical Research Unit, Leeds, UK.
| | - E Robinson
- Leeds Institute of Rheumatic and Musculoskeletal Medicine, University of Leeds and NIHR Leeds Musculoskeletal Biomedical Research Unit, Leeds, UK.
| | - C Murdoch
- Calderdale and Huddersfield NHS Foundation Trust, UK.
| | - S R Kingsbury
- Leeds Institute of Rheumatic and Musculoskeletal Medicine, University of Leeds and NIHR Leeds Musculoskeletal Biomedical Research Unit, Leeds, UK.
| | - P G Conaghan
- Leeds Institute of Rheumatic and Musculoskeletal Medicine, University of Leeds and NIHR Leeds Musculoskeletal Biomedical Research Unit, Leeds, UK.
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4
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Zhang Q, Guo W, Chen Y, Zhao Q, Liu Z, Wang W. The Glycosaminoglycan Content of Hip Cartilage in Osteonecrosis of Femoral Head: Evaluation with Delayed Gadolinium-Enhanced Magnetic Resonance Imaging of Cartilage. Cartilage 2021; 12:70-75. [PMID: 30282478 PMCID: PMC7755965 DOI: 10.1177/1947603518803732] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
OBJECTIVE Hip cartilage quality is essential for the success of joint-preserving surgery for osteonecrosis. This study aimed to characterize cartilage changes in osteonecrosis of femoral head (ONFH) using delayed gadolinium-enhanced magnetic resonance imaging of cartilage (dGEMRIC). DESIGN Fifteen asymptomatic (control) and 60 ONFH subjects were included in this study. The ONFH subjects were stratified in accordance with the Association Research Circulation Osseous (ARCO) classification (n = 15 hips per ARCO stage). All participant hips were investigated using dGEMRIC and theT1Gd data were collected and analyzed. RESULTS T1Gd value was significantly lower in the ONFH group (365.1 ± 90.5 ms; range 200-498 ms) compared with the control group (546.1 ± 26.0 ms; range 504-580 ms) (P < 0.001). The T1Gd values of ARCO stage I-IV ONFH were 460.2 ± 17.3 ms (439-498 ms), 408.9 ± 43.4 ms (337-472 ms), 359.9 ± 34.5 ms (303-412 ms), 231.5 ± 15.1 ms (200-253 ms), respectively. Decreased T1Gd value was found to correlate significantly with increased ONFH severity (P < 0.001). T1Gd value in collapse stage was significantly lower than that of noncollapse stage (295.7 ± 70.3 ms [range 200-412 ms] vs. 434.6 ± 41.7 ms [range 337-498 ms]; P < 0.001). CONCLUSIONS dGEMRIC identified hip cartilage as abnormal in ONFH, even at early-stage, as represented by decreased T1Gd, and this was further aggravated by ONFH collapse.
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Affiliation(s)
- Qidong Zhang
- Department of Orthopaedic Surgery, Beijing Key Lab Immune-Mediated Inflammatory Diseases, China-Japan Friendship Hospital, Beijing, China
| | - Wanshou Guo
- Department of Orthopaedic Surgery, Beijing Key Lab Immune-Mediated Inflammatory Diseases, China-Japan Friendship Hospital, Beijing, China
| | - Yan Chen
- Department of Radiology, China-Japan Friendship Hospital, Beijing, China
| | - Qichao Zhao
- Department of Radiology, China-Japan Friendship Hospital, Beijing, China
| | - Zhaohui Liu
- Department of Orthopaedic Surgery, Beijing Key Lab Immune-Mediated Inflammatory Diseases, China-Japan Friendship Hospital, Beijing, China
| | - Weiguo Wang
- Department of Orthopaedic Surgery, Beijing Key Lab Immune-Mediated Inflammatory Diseases, China-Japan Friendship Hospital, Beijing, China,Weiguo Wang, Department of Orthopaedic Surgery, Beijing Key Lab Immune-Mediated Inflammatory Diseases, China-Japan Friendship Hospital, Yinghua Street 2#, Chaoyang District, Beijing, 100029, China.
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5
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Eder J, Szomolanyi P, Schmid-Schwap M, Bristela M, Skolka A, Pittschieler E, Piehslinger E, Trattnig S. Early diagnosis of degenerative changes in the articular/fibrocartilaginous disc of the temporomandibular joint in patients with temporomandibular disorders using delayed gadolinium-enhanced MRI at 3 Tesla - preliminary results. Magn Reson Imaging 2019; 67:24-27. [PMID: 31843417 DOI: 10.1016/j.mri.2019.12.002] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2019] [Revised: 12/04/2019] [Accepted: 12/05/2019] [Indexed: 12/27/2022]
Abstract
BACKGROUND Delayed gadolinium enhanced MRI of cartilage (dGEMRIC) is a quantitative method for assessment of glycosaminoglycan content in connective tissues. We hypothesize that the early diagnosis of degenerative changes in the temporomandibular joint could be diagnosed using dGEMRIC technique. PURPOSE To test the compositional MRI technique, dGEMRIC, at 3 Tesla to diagnosis early the degenerative changes in the fibrocartilaginous disc of the temporomandibular joint (TMJ) in patients with temporomandibular disorders (TMD) and to compare the dGEMRIC index of patients to the healthy volunteers. METHODS Six volunteers (two men, four women; 20.8÷28.1 years) and eleven patients (22 TMJs, seven women, four men; 24÷54 years) were recruited for this prospective trial. Only patients with no morphological abnormality on MRI and without disc dislocations were included. Volunteers were used as a control group. The PD-weighted FSE sequence and the 3D GRE (DESS) sequence protocols were performed for morphological assessment. The Inversion recovery (IR) sequence was performed for T1 relaxation time measurements and intra-venous (IV) contrast agent administration was used according to the dGEMRIC protocol. T1 maps were calculated offline and ROIs were drawn on TMJ discs by a specialist trained in TMD disorders. Statistical evaluation was performed by ANOVA and correlations were calculated. RESULTS The difference between the dGEMRIC values in the TMJ articular discs of the patients and the volunteers was statistically significant (P = .019). After contrast agent administration the T1 values dropped in both groups. In patient group was the T1 drop stronger (-54% from initial pre-contrast value), while in control group was the T1 drop less pronounced (-46% from initial pre-contrast value). CONCLUSIONS dGEMRIC seems to be a useful, compositional, quantitative method, suitable also for small joints, such as the articular disc of the TMJ. The results of the dGEMRIC index in the articular disc of the TMJ imply a lower GAG content in patients with TMJ disorders.
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Affiliation(s)
- Jaryna Eder
- Division of Prosthodontics, University Clinic of Dentistry Vienna, Medical University of Vienna, Sensengasse 2a, 1090 Vienna, Austria.
| | - Pavol Szomolanyi
- High-Field MR Center, Department of Biomedical Imaging and Image-guided Therapy, Medical University of Vienna, Waehringer Guertel 18-20, 1090 Vienna, Austria; Department of Imaging Methods, Institute of Measurement Science, Slovak Academy of Sciences, Dubravska cesta 9, 84219 Bratislava, Slovakia
| | - Martina Schmid-Schwap
- Division of Prosthodontics, University Clinic of Dentistry Vienna, Medical University of Vienna, Sensengasse 2a, 1090 Vienna, Austria
| | - Margit Bristela
- Division of Prosthodontics, University Clinic of Dentistry Vienna, Medical University of Vienna, Sensengasse 2a, 1090 Vienna, Austria
| | - Astrid Skolka
- Division of Prosthodontics, University Clinic of Dentistry Vienna, Medical University of Vienna, Sensengasse 2a, 1090 Vienna, Austria
| | - Elisabeth Pittschieler
- Private practice for orthodontics and craniomandibular disorders, Reichsratsstraße 5/4a1010, Vienna, Austria
| | - Eva Piehslinger
- Division of Prosthodontics, University Clinic of Dentistry Vienna, Medical University of Vienna, Sensengasse 2a, 1090 Vienna, Austria
| | - Siegfried Trattnig
- High-Field MR Center, Department of Biomedical Imaging and Image-guided Therapy, Medical University of Vienna, Waehringer Guertel 18-20, 1090 Vienna, Austria; CD Laboratory for Molecular Clinical MR Imaging, Vienna, Austria; Austrian Cluster for Tissue Regeneration, Ludwig Boltzmann Institute for Experimental and Clinical Traumatology, Vienna, Austria
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Hangaard S, Gudbergsen H, Daugaard CL, Bliddal H, Nybing JD, Nieminen MT, Casula V, Tiderius CJ, Boesen M. Delayed gadolinium-enhanced MRI of menisci and cartilage (dGEMRIM/dGEMRIC) in obese patients with knee osteoarthritis: Cross-sectional study of 85 obese patients with intra-articular administered gadolinium contrast. J Magn Reson Imaging 2018; 48:1700-1706. [DOI: 10.1002/jmri.26190] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2018] [Accepted: 04/25/2018] [Indexed: 12/25/2022] Open
Affiliation(s)
- Stine Hangaard
- Parker Institute, Bispebjerg and Frederiksberg Hospital; Copenhagen Denmark
- Department of Radiology; Bispebjerg and Frederiksberg Hospital; Copenhagen Denmark
| | - Henrik Gudbergsen
- Parker Institute, Bispebjerg and Frederiksberg Hospital; Copenhagen Denmark
| | - Cecilie L. Daugaard
- Parker Institute, Bispebjerg and Frederiksberg Hospital; Copenhagen Denmark
- Department of Radiology; Bispebjerg and Frederiksberg Hospital; Copenhagen Denmark
| | - Henning Bliddal
- Parker Institute, Bispebjerg and Frederiksberg Hospital; Copenhagen Denmark
| | - Janus Damm Nybing
- Department of Radiology; Bispebjerg and Frederiksberg Hospital; Copenhagen Denmark
| | - Miika T. Nieminen
- Research Unit of Medical Imaging, Physics and Technology; University of Oulu; Oulu Finland
- Medical Research Center; University of Oulu and Oulu University Hospital; Oulu Finland
- Department of Diagnostic Radiology; Oulu University Hospital; Oulu Finland
| | - Victor Casula
- Research Unit of Medical Imaging, Physics and Technology; University of Oulu; Oulu Finland
- Medical Research Center; University of Oulu and Oulu University Hospital; Oulu Finland
| | - Carl-Johan Tiderius
- Department of orthopedics, Clinical Sciences Lund; Lund University, Skåne University Hospital; Lund Sweden
| | - Mikael Boesen
- Department of Radiology; Bispebjerg and Frederiksberg Hospital; Copenhagen Denmark
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Guermazi A, Crema MD, Roemer FW. Compositional Magnetic Resonance Imaging Measures of Cartilage--Endpoints for Clinical Trials of Disease-modifying Osteoarthritis Drugs? J Rheumatol 2016; 43:7-11. [PMID: 26724316 DOI: 10.3899/jrheum.150663] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Affiliation(s)
- Ali Guermazi
- Professor of Radiology, Director, Quantitative Imaging Center, Boston University School of Medicine, Boston, Massachusetts;
| | - Michel D Crema
- Department of Radiology, Boston University School of Medicine, Boston, Massachusetts, USA, and Department of Radiology, Hospital do Coração and Teleimagem, São Paulo, Brazil
| | - Frank W Roemer
- Department of Radiology, Boston University School of Medicine, Boston, Massachusetts, USA, and Department of Radiology, University of Erlangen, Erlangen, Germany
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8
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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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9
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van Tiel J, Siebelt M, Reijman M, Bos PK, Waarsing JH, Zuurmond AM, Nasserinejad K, van Osch GJVM, Verhaar JAN, Krestin GP, Weinans H, Oei EHG. Quantitative in vivo CT arthrography of the human osteoarthritic knee to estimate cartilage sulphated glycosaminoglycan content: correlation with ex-vivo reference standards. Osteoarthritis Cartilage 2016; 24:1012-20. [PMID: 26851449 DOI: 10.1016/j.joca.2016.01.137] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/07/2015] [Revised: 12/24/2015] [Accepted: 01/19/2016] [Indexed: 02/02/2023]
Abstract
OBJECTIVE Recently, computed tomography arthrography (CTa) was introduced as quantitative imaging biomarker to estimate cartilage sulphated glycosaminoglycan (sGAG) content in human cadaveric knees. Our aim was to assess the correlation between in vivo CTa in human osteoarthritis (OA) knees and ex vivo reference standards for sGAG and collagen content. DESIGN In this prospective observational study 11 knee OA patients underwent CTa before total knee replacement (TKR). Cartilage X-ray attenuation was determined in six cartilage regions. Femoral and tibial cartilage specimens harvested during TKR were re-scanned using equilibrium partitioning of an ionic contrast agent with micro-CT (EPIC-μCT), which served as reference standard for sGAG. Next, cartilage sGAG and collagen content were determined using dimethylmethylene blue (DMMB) and hydroxyproline assays. The correlation between CTa X-ray attenuation, EPIC-μCT X-ray attenuation, sGAG content and collagen content was assessed. RESULTS CTa X-ray attenuation correlated well with EPIC-μCT (r = 0.76, 95% credibility interval (95%CI) 0.64 to 0.85). CTa correlated moderately with the DMMB assay (sGAG content) (r = -0.66, 95%CI -0.87 to -0.49) and to lesser extent with the hydroxyproline assay (collagen content) (r = -0.56, 95%CI -0.70 to -0.36). CONCLUSIONS Outcomes of in vivo CTa in human OA knees correlate well with sGAG content. Outcomes of CTa also slightly correlate with cartilage collagen content. Since outcomes of CTa are mainly sGAG dependent and despite the fact that further validation using hyaline cartilage of other joints with different biochemical composition should be conducted, CTa may be suitable as quantitative imaging biomarker to estimate cartilage sGAG content in future clinical OA research.
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Affiliation(s)
- J van Tiel
- Department of Orthopedic Surgery, Erasmus MC, University Medical Center, Rotterdam, The Netherlands; Department of Radiology, Erasmus MC, University Medical Center, Rotterdam, The Netherlands.
| | - M Siebelt
- Department of Orthopedic Surgery, Erasmus MC, University Medical Center, Rotterdam, The Netherlands.
| | - M Reijman
- Department of Orthopedic Surgery, Erasmus MC, University Medical Center, Rotterdam, The Netherlands.
| | - P K Bos
- Department of Orthopedic Surgery, Erasmus MC, University Medical Center, Rotterdam, The Netherlands.
| | - J H Waarsing
- Department of Orthopedic Surgery, Erasmus MC, University Medical Center, Rotterdam, The Netherlands.
| | | | - K Nasserinejad
- Department of Biostatistics, Erasmus MC, University Medical Center, Rotterdam, The Netherlands.
| | - G J V M van Osch
- Department of Orthopedic Surgery, Erasmus MC, University Medical Center, Rotterdam, The Netherlands; Department of Otorhinolaryngology, Erasmus MC, University Medical Center Rotterdam, The Netherlands.
| | - J A N Verhaar
- Department of Orthopedic Surgery, Erasmus MC, University Medical Center, Rotterdam, The Netherlands.
| | - G P Krestin
- Department of Radiology, Erasmus MC, University Medical Center, Rotterdam, The Netherlands.
| | - H Weinans
- Department of Biomechanical Engineering, Delft University of Technology, Delft, The Netherlands; Department of Orthopedics and Department of Rheumatology, University Medical Center Utrecht, Utrecht, The Netherlands.
| | - E H G Oei
- Department of Radiology, Erasmus MC, University Medical Center, Rotterdam, The Netherlands.
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10
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van der Heijden RA, Oei EHG, Bron EE, van Tiel J, van Veldhoven PLJ, Klein S, Verhaar JAN, Krestin GP, Bierma-Zeinstra SMA, van Middelkoop M. No Difference on Quantitative Magnetic Resonance Imaging in Patellofemoral Cartilage Composition Between Patients With Patellofemoral Pain and Healthy Controls. Am J Sports Med 2016; 44:1172-8. [PMID: 26951075 DOI: 10.1177/0363546516632507] [Citation(s) in RCA: 29] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
BACKGROUND Retropatellar cartilage damage has been suggested as an etiological factor for patellofemoral pain (PFP), a common knee condition among young and physically active individuals. To date, there is no conclusive evidence for an association between cartilage defects and PFP. Nowadays, advanced quantitative magnetic resonance imaging (MRI) techniques enable estimation of cartilage composition. PURPOSE To investigate differences in patellofemoral cartilage composition between patients with PFP and healthy control subjects using quantitative MRI. STUDY DESIGN Cross-sectional study; Level of evidence, 3. METHODS Patients with PFP and healthy control subjects underwent 3.0-T MRI including delayed gadolinium-enhanced MRI of cartilage and T1ρ and T2 mapping. Differences in relaxation times of patellofemoral cartilage were compared between groups by linear regression analyses, adjusted for age, body mass index, sex, sports participation, and time of image acquisition. RESULTS This case-control study included 64 patients and 70 controls. The mean (±SD) age was 23.2 ± 6.4 years and the mean body mass index was 22.9 ± 3.4 kg/m(2); 56.7% were female. For delayed gadolinium-enhanced MRI of cartilage, the mean T1GD relaxation times of patellar (657.8 vs 669.4 ms) and femoral cartilage (661.6 vs 659.8 ms) did not significantly differ between patients and controls. In addition, no significant difference was found in mean T1ρ relaxation times of patellar (46.9 vs 46.0 ms) and femoral cartilage (50.8 vs 50.2 ms) and mean T2 relaxation times of patellar (33.2 vs 32.9 ms) and femoral cartilage (36.7 vs 36.6 ms) between patients and controls. Analysis of prespecified medial and lateral subregions within the patellofemoral cartilage also revealed no significant differences. CONCLUSION There was no difference in composition of the patellofemoral cartilage, estimated with multiple quantitative MRI techniques, between patients with PFP and healthy control subjects. However, clinically relevant differences could not be ruled out for T1ρ in the adolescent population. Retropatellar cartilage damage has long been hypothesized as an important factor in the pathogenesis of PFP, but study findings suggest that diminished patellofemoral cartilage composition is not associated with PFP.
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Affiliation(s)
- Rianne A van der Heijden
- Department of General Practice, Erasmus MC, University Medical Center, Rotterdam, the Netherlands Department of Radiology, Erasmus MC, University Medical Center, Rotterdam, the Netherlands
| | - Edwin H G Oei
- Department of Radiology, Erasmus MC, University Medical Center, Rotterdam, the Netherlands
| | - Esther E Bron
- Biomedical Imaging Group Rotterdam, Departments of Radiology and Medical Informatics, Erasmus MC, University Medical Center, Rotterdam, the Netherlands
| | - Jasper van Tiel
- Department of Radiology, Erasmus MC, University Medical Center, Rotterdam, the Netherlands Department of Orthopedic Surgery, Erasmus MC, University Medical Center, Rotterdam, the Netherlands
| | | | - Stefan Klein
- Biomedical Imaging Group Rotterdam, Departments of Radiology and Medical Informatics, Erasmus MC, University Medical Center, Rotterdam, the Netherlands
| | - Jan A N Verhaar
- Department of Orthopedic Surgery, Erasmus MC, University Medical Center, Rotterdam, the Netherlands
| | - Gabriel P Krestin
- Department of Radiology, Erasmus MC, University Medical Center, Rotterdam, the Netherlands
| | - Sita M A Bierma-Zeinstra
- Department of General Practice, Erasmus MC, University Medical Center, Rotterdam, the Netherlands Department of Orthopedic Surgery, Erasmus MC, University Medical Center, Rotterdam, the Netherlands
| | - Marienke van Middelkoop
- Department of General Practice, Erasmus MC, University Medical Center, Rotterdam, the Netherlands
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Wang A, Pedoia V, Su F, Abramson E, Kretzschmar M, Nardo L, Link TM, McCulloch CE, Jin C, Ma CB, Li X. MR T1ρ and T2 of meniscus after acute anterior cruciate ligament injuries. Osteoarthritis Cartilage 2016; 24:631-9. [PMID: 26620091 PMCID: PMC4799742 DOI: 10.1016/j.joca.2015.11.012] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/04/2015] [Revised: 10/22/2015] [Accepted: 11/17/2015] [Indexed: 02/02/2023]
Abstract
OBJECTIVE To evaluate differences in meniscal T1ρ and T2 quantification in patients with acute anterior cruciate ligament (ACL) injuries and to determine correlations of these differences with MR morphological grading and patient-reported outcomes. DESIGN Bilateral knees of 52 patients with acute ACL injury and 20 healthy controls were scanned using 3 T magnetic resonance imaging (MRI) T1ρ and T2 mapping in this prospective study. Quantitative analysis of the meniscus was performed in anterior and posterior horns of the lateral and medial menisci. Morphological meniscal damage was assessed using modified whole-organ MRI scores (WORMS). Measurements were compared between injured, uninjured contralateral, and control knees using a mixed-effects regression model. Correlations between meniscal T1ρ/T2, WORMS and Knee Injury and Osteoarthritis Outcome Scores (KOOS) were examined using partial correlation analysis. RESULTS Mean meniscal T1ρ and T2 values were significantly higher in ACL-injured knees compared to control and contralateral knees. Menisci of ACL-injured knees without tears, including those limited to modified meniscal WORMS grade 0, also had significantly higher T1ρ and T2 values compared to menisci of uninjured knees. Within ACL-injured knees, T1ρ and T2 values showed significant positive associations with meniscal WORMS and significant negative associations with KOOS. CONCLUSION Acute ACL injuries are associated with significantly increased meniscal T1ρ and T2 values in both patients with and without meniscal lesions or tears, suggesting quantitative MRI provides more sensitive measures of meniscal differences compared to traditional morphological MRI sequences. Correlation between meniscal T1ρ/T2 and KOOS suggest that quantitative MRI is reflective of the extent of patients' clinical symptoms.
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Affiliation(s)
- Amy Wang
- Department of Radiology and Biomedical Imaging, University of California, San Francisco, United States.
| | - Valentina Pedoia
- Department of Radiology and Biomedical Imaging, University of California, San Francisco, United States.
| | - Favian Su
- Department of Radiology and Biomedical Imaging, University of California, San Francisco, United States.
| | - Elijah Abramson
- Department of Radiology and Biomedical Imaging, University of California, San Francisco, United States.
| | - Martin Kretzschmar
- Department of Radiology and Biomedical Imaging, University of California, San Francisco, United States.
| | - Lorenzo Nardo
- Department of Radiology and Biomedical Imaging, University of California, San Francisco, United States.
| | - Thomas M Link
- Department of Radiology and Biomedical Imaging, University of California, San Francisco, United States.
| | - Charles E McCulloch
- Department of Epidemiology and Biostatistics, University of California, San Francisco, United States.
| | - Chengshi Jin
- Department of Epidemiology and Biostatistics, University of California, San Francisco, United States.
| | - C Benjamin Ma
- Department of Orthopaedic Surgery, University of California, San Francisco, United States.
| | - Xiaojuan Li
- Department of Radiology and Biomedical Imaging, University of California, San Francisco, United States.
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12
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Wang Y, Teichtahl AJ, Cicuttini FM. Osteoarthritis year in review 2015: imaging. Osteoarthritis Cartilage 2016; 24:49-57. [PMID: 26707992 DOI: 10.1016/j.joca.2015.07.027] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/08/2015] [Accepted: 07/30/2015] [Indexed: 02/02/2023]
Abstract
PURPOSE This narrative review covers original publications related to imaging in osteoarthritis (OA) published in English between 1 April 2014 and 30 April 2015. Novel lessons relating to imaging are described. METHODS An extensive PubMed database search was performed based on, but not limited to the terms "OA" in combination with "Magnetic resonance imaging (MRI)", "Imaging", "Radiography", "Ultrasound", "Computed tomography (CT)" and "Nuclear medicine" to extract relevant studies. In vitro data and animal studies were excluded. This review focuses on the new developments and observations based on the aforementioned imaging modalities, as well as a 'whole-organ' approach by presenting findings from different tissues (bone, meniscus, synovium, muscle and fat) and joints (hip, lumbar spine and hand). RESULTS AND CONCLUSIONS Over the past year, studies using imagine have made a major contribution to the understanding of the pathogenesis of OA. Significant work has continued at the knee, with MRI now being increasingly used to assess structural endpoints in clinical trials. This offers the exciting opportunity to explore potential disease modifying OA therapies. There has been a clear interest in the role of bone in the pathogenesis of OA. There is now a growing body of literature examining the pathogenesis of OA at the hip, lumbar spine and hand. The future of imaging in OA offers the exciting potential to better understand the disease process across all joints and develop more effective preventive and therapeutic interventions.
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Affiliation(s)
- Y Wang
- Department of Epidemiology and Preventive Medicine, School of Public Health and Preventive Medicine, Monash University, Alfred Hospital, Melbourne, VIC 3004, Australia
| | - A J Teichtahl
- Department of Epidemiology and Preventive Medicine, School of Public Health and Preventive Medicine, Monash University, Alfred Hospital, Melbourne, VIC 3004, Australia; Baker IDI Heart and Diabetes Institute, Commercial Road, Melbourne, VIC 3004, Australia
| | - F M Cicuttini
- Department of Epidemiology and Preventive Medicine, School of Public Health and Preventive Medicine, Monash University, Alfred Hospital, Melbourne, VIC 3004, Australia.
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13
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van Tiel J, Kotek G, Reijman M, Bos PK, Bron EE, Klein S, Nasserinejad K, van Osch GJVM, Verhaar JAN, Krestin GP, Weinans H, Oei EHG. Is T1ρ Mapping an Alternative to Delayed Gadolinium-enhanced MR Imaging of Cartilage in the Assessment of Sulphated Glycosaminoglycan Content in Human Osteoarthritic Knees? An in Vivo Validation Study. Radiology 2015; 279:523-31. [PMID: 26588020 DOI: 10.1148/radiol.2015150693] [Citation(s) in RCA: 57] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
Abstract
PURPOSE To determine if T1ρ mapping can be used as an alternative to delayed gadolinium-enhanced magnetic resonance imaging of cartilage (dGEMRIC) in the quantification of cartilage biochemical composition in vivo in human knees with osteoarthritis. MATERIALS AND METHODS This study was approved by the institutional review board. Written informed consent was obtained from all participants. Twelve patients with knee osteoarthritis underwent dGEMRIC and T1ρ mapping at 3.0 T before undergoing total knee replacement. Outcomes of dGEMRIC and T1ρ mapping were calculated in six cartilage regions of interest. Femoral and tibial cartilages were harvested during total knee replacement. Cartilage sulphated glycosaminoglycan (sGAG) and collagen content were assessed with dimethylmethylene blue and hydroxyproline assays, respectively. A four-dimensional multivariate mixed-effects model was used to simultaneously assess the correlation between outcomes of dGEMRIC and T1ρ mapping and the sGAG and collagen content of the articular cartilage. RESULTS T1 relaxation times at dGEMRIC showed strong correlation with cartilage sGAG content (r = 0.73; 95% credibility interval [CI] = 0.60, 0.83) and weak correlation with cartilage collagen content (r = 0.40; 95% CI: 0.18, 0.58). T1ρ relaxation times did not correlate with cartilage sGAG content (r = 0.04; 95% CI: -0.21, 0.28) or collagen content (r = -0.05; 95% CI = -0.31, 0.20). CONCLUSION dGEMRIC can help accurately measure cartilage sGAG content in vivo in patients with knee osteoarthritis, whereas T1ρ mapping does not appear suitable for this purpose. Although the technique is not completely sGAG specific and requires a contrast agent, dGEMRIC is a validated and robust method for quantifying cartilage sGAG content in human osteoarthritis subjects in clinical research.
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Affiliation(s)
- Jasper van Tiel
- From the Departments of Radiology (J.v.T., G.K., E.E.B., S.K., G.P.K., E.H.G.O.), Orthopedic Surgery (J.v.T., M.R., P.K.B., G.J.V.M.v.O., J.A.N.V.), Medical Informatics (E.E.B., S.K.), Biostatistics (K.N.), and Otorhinolaryngology (G.J.V.M.v.O.), Erasmus University Medical Center, PO Box 2040, 3000 CA Rotterdam, the Netherlands; Department of Biomechanical Engineering, Delft University of Technology, Delft, the Netherlands (H.W.); and Department of Orthopedics and Rheumatology, University Medical Center Utrecht, Utrecht, the Netherlands (H.W.)
| | - Gyula Kotek
- From the Departments of Radiology (J.v.T., G.K., E.E.B., S.K., G.P.K., E.H.G.O.), Orthopedic Surgery (J.v.T., M.R., P.K.B., G.J.V.M.v.O., J.A.N.V.), Medical Informatics (E.E.B., S.K.), Biostatistics (K.N.), and Otorhinolaryngology (G.J.V.M.v.O.), Erasmus University Medical Center, PO Box 2040, 3000 CA Rotterdam, the Netherlands; Department of Biomechanical Engineering, Delft University of Technology, Delft, the Netherlands (H.W.); and Department of Orthopedics and Rheumatology, University Medical Center Utrecht, Utrecht, the Netherlands (H.W.)
| | - Max Reijman
- From the Departments of Radiology (J.v.T., G.K., E.E.B., S.K., G.P.K., E.H.G.O.), Orthopedic Surgery (J.v.T., M.R., P.K.B., G.J.V.M.v.O., J.A.N.V.), Medical Informatics (E.E.B., S.K.), Biostatistics (K.N.), and Otorhinolaryngology (G.J.V.M.v.O.), Erasmus University Medical Center, PO Box 2040, 3000 CA Rotterdam, the Netherlands; Department of Biomechanical Engineering, Delft University of Technology, Delft, the Netherlands (H.W.); and Department of Orthopedics and Rheumatology, University Medical Center Utrecht, Utrecht, the Netherlands (H.W.)
| | - Pieter K Bos
- From the Departments of Radiology (J.v.T., G.K., E.E.B., S.K., G.P.K., E.H.G.O.), Orthopedic Surgery (J.v.T., M.R., P.K.B., G.J.V.M.v.O., J.A.N.V.), Medical Informatics (E.E.B., S.K.), Biostatistics (K.N.), and Otorhinolaryngology (G.J.V.M.v.O.), Erasmus University Medical Center, PO Box 2040, 3000 CA Rotterdam, the Netherlands; Department of Biomechanical Engineering, Delft University of Technology, Delft, the Netherlands (H.W.); and Department of Orthopedics and Rheumatology, University Medical Center Utrecht, Utrecht, the Netherlands (H.W.)
| | - Esther E Bron
- From the Departments of Radiology (J.v.T., G.K., E.E.B., S.K., G.P.K., E.H.G.O.), Orthopedic Surgery (J.v.T., M.R., P.K.B., G.J.V.M.v.O., J.A.N.V.), Medical Informatics (E.E.B., S.K.), Biostatistics (K.N.), and Otorhinolaryngology (G.J.V.M.v.O.), Erasmus University Medical Center, PO Box 2040, 3000 CA Rotterdam, the Netherlands; Department of Biomechanical Engineering, Delft University of Technology, Delft, the Netherlands (H.W.); and Department of Orthopedics and Rheumatology, University Medical Center Utrecht, Utrecht, the Netherlands (H.W.)
| | - Stefan Klein
- From the Departments of Radiology (J.v.T., G.K., E.E.B., S.K., G.P.K., E.H.G.O.), Orthopedic Surgery (J.v.T., M.R., P.K.B., G.J.V.M.v.O., J.A.N.V.), Medical Informatics (E.E.B., S.K.), Biostatistics (K.N.), and Otorhinolaryngology (G.J.V.M.v.O.), Erasmus University Medical Center, PO Box 2040, 3000 CA Rotterdam, the Netherlands; Department of Biomechanical Engineering, Delft University of Technology, Delft, the Netherlands (H.W.); and Department of Orthopedics and Rheumatology, University Medical Center Utrecht, Utrecht, the Netherlands (H.W.)
| | - Kazem Nasserinejad
- From the Departments of Radiology (J.v.T., G.K., E.E.B., S.K., G.P.K., E.H.G.O.), Orthopedic Surgery (J.v.T., M.R., P.K.B., G.J.V.M.v.O., J.A.N.V.), Medical Informatics (E.E.B., S.K.), Biostatistics (K.N.), and Otorhinolaryngology (G.J.V.M.v.O.), Erasmus University Medical Center, PO Box 2040, 3000 CA Rotterdam, the Netherlands; Department of Biomechanical Engineering, Delft University of Technology, Delft, the Netherlands (H.W.); and Department of Orthopedics and Rheumatology, University Medical Center Utrecht, Utrecht, the Netherlands (H.W.)
| | - Gerjo J V M van Osch
- From the Departments of Radiology (J.v.T., G.K., E.E.B., S.K., G.P.K., E.H.G.O.), Orthopedic Surgery (J.v.T., M.R., P.K.B., G.J.V.M.v.O., J.A.N.V.), Medical Informatics (E.E.B., S.K.), Biostatistics (K.N.), and Otorhinolaryngology (G.J.V.M.v.O.), Erasmus University Medical Center, PO Box 2040, 3000 CA Rotterdam, the Netherlands; Department of Biomechanical Engineering, Delft University of Technology, Delft, the Netherlands (H.W.); and Department of Orthopedics and Rheumatology, University Medical Center Utrecht, Utrecht, the Netherlands (H.W.)
| | - Jan A N Verhaar
- From the Departments of Radiology (J.v.T., G.K., E.E.B., S.K., G.P.K., E.H.G.O.), Orthopedic Surgery (J.v.T., M.R., P.K.B., G.J.V.M.v.O., J.A.N.V.), Medical Informatics (E.E.B., S.K.), Biostatistics (K.N.), and Otorhinolaryngology (G.J.V.M.v.O.), Erasmus University Medical Center, PO Box 2040, 3000 CA Rotterdam, the Netherlands; Department of Biomechanical Engineering, Delft University of Technology, Delft, the Netherlands (H.W.); and Department of Orthopedics and Rheumatology, University Medical Center Utrecht, Utrecht, the Netherlands (H.W.)
| | - Gabriel P Krestin
- From the Departments of Radiology (J.v.T., G.K., E.E.B., S.K., G.P.K., E.H.G.O.), Orthopedic Surgery (J.v.T., M.R., P.K.B., G.J.V.M.v.O., J.A.N.V.), Medical Informatics (E.E.B., S.K.), Biostatistics (K.N.), and Otorhinolaryngology (G.J.V.M.v.O.), Erasmus University Medical Center, PO Box 2040, 3000 CA Rotterdam, the Netherlands; Department of Biomechanical Engineering, Delft University of Technology, Delft, the Netherlands (H.W.); and Department of Orthopedics and Rheumatology, University Medical Center Utrecht, Utrecht, the Netherlands (H.W.)
| | - Harrie Weinans
- From the Departments of Radiology (J.v.T., G.K., E.E.B., S.K., G.P.K., E.H.G.O.), Orthopedic Surgery (J.v.T., M.R., P.K.B., G.J.V.M.v.O., J.A.N.V.), Medical Informatics (E.E.B., S.K.), Biostatistics (K.N.), and Otorhinolaryngology (G.J.V.M.v.O.), Erasmus University Medical Center, PO Box 2040, 3000 CA Rotterdam, the Netherlands; Department of Biomechanical Engineering, Delft University of Technology, Delft, the Netherlands (H.W.); and Department of Orthopedics and Rheumatology, University Medical Center Utrecht, Utrecht, the Netherlands (H.W.)
| | - Edwin H G Oei
- From the Departments of Radiology (J.v.T., G.K., E.E.B., S.K., G.P.K., E.H.G.O.), Orthopedic Surgery (J.v.T., M.R., P.K.B., G.J.V.M.v.O., J.A.N.V.), Medical Informatics (E.E.B., S.K.), Biostatistics (K.N.), and Otorhinolaryngology (G.J.V.M.v.O.), Erasmus University Medical Center, PO Box 2040, 3000 CA Rotterdam, the Netherlands; Department of Biomechanical Engineering, Delft University of Technology, Delft, the Netherlands (H.W.); and Department of Orthopedics and Rheumatology, University Medical Center Utrecht, Utrecht, the Netherlands (H.W.)
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Honkanen JTJ, Danso EK, Suomalainen JS, Tiitu V, Korhonen RK, Jurvelin JS, Töyräs J. Contrast enhanced imaging of human meniscus using cone beam CT. Osteoarthritis Cartilage 2015; 23:1367-76. [PMID: 25865390 DOI: 10.1016/j.joca.2015.03.037] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/11/2014] [Revised: 03/06/2015] [Accepted: 03/28/2015] [Indexed: 02/02/2023]
Abstract
OBJECTIVE Meniscal injuries can lead to mechanical overloading of articular cartilage and eventually to knee osteoarthritis. The objective was to evaluate the potential of contrast enhanced computed tomography (CECT) to image contrast agent (CA) diffusion in human menisci with a clinical cone beam CT scanner. DESIGN Isolated human menisci (n = 26) were imaged using magnetic resonance imaging (MRI) and CECT in situ. Diffusion of anionic CA into the meniscus was imaged for up to 30 h. The results of CECT were compared with water, collagen and proteoglycan (PG) contents, biomechanical properties, age and histological and MR images of the samples. RESULTS Diffusion of CA required over 25 h to reach equilibrium. The CA partition (the CA concentration in the tissue divided by that in the bath) at the 40 min time point correlated significantly with that at the 30 h time point in both lateral (r = 0.706, P = 0.007) and medial (r = 0.669, P = 0.012) menisci. Furthermore, CA partition in meniscus after 30 h of diffusion agreed qualitatively with the distribution of PGs. CONCLUSION The cross-sectional distribution of CA was consistent with that reported in a previous μCT study on bovine meniscus. The time required to reach diffusion equilibrium was found impractical for clinical applications. However, based on the present results, shorter delay between injection and imaging (e.g., 40 min) could be feasible in clinical diagnostics of meniscal pathologies.
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Affiliation(s)
- J T J Honkanen
- Department of Applied Physics, University of Eastern Finland, POB 1627, FI-70211, Kuopio, Finland; Diagnostic Imaging Centre, Kuopio University Hospital, KUH, POB 100, FI-70029, Kuopio, Finland.
| | - E K Danso
- Department of Applied Physics, University of Eastern Finland, POB 1627, FI-70211, Kuopio, Finland; Department of Clinical Neurophysiology, Kuopio University Hospital, KUH, POB 100, FI-70029, Kuopio, Finland.
| | - J-S Suomalainen
- Diagnostic Imaging Centre, Kuopio University Hospital, KUH, POB 100, FI-70029, Kuopio, Finland.
| | - V Tiitu
- Institute of Biomedicine, Anatomy, University of Eastern Finland, POB 1627, FI-70211, Kuopio, Finland.
| | - R K Korhonen
- Department of Applied Physics, University of Eastern Finland, POB 1627, FI-70211, Kuopio, Finland; Diagnostic Imaging Centre, Kuopio University Hospital, KUH, POB 100, FI-70029, Kuopio, Finland.
| | - J S Jurvelin
- Department of Applied Physics, University of Eastern Finland, POB 1627, FI-70211, Kuopio, Finland; Diagnostic Imaging Centre, Kuopio University Hospital, KUH, POB 100, FI-70029, Kuopio, Finland.
| | - J Töyräs
- Department of Applied Physics, University of Eastern Finland, POB 1627, FI-70211, Kuopio, Finland; Diagnostic Imaging Centre, Kuopio University Hospital, KUH, POB 100, FI-70029, Kuopio, Finland.
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Freutel M, Galbusera F, Ignatius A, Dürselen L. Material properties of individual menisci and their attachments obtained through inverse FE-analysis. J Biomech 2015; 48:1343-9. [PMID: 25843259 DOI: 10.1016/j.jbiomech.2015.03.014] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2015] [Accepted: 03/10/2015] [Indexed: 10/23/2022]
Abstract
Meniscal properties for computational methods have already been proposed. However, it is well known that there is high intra subject variability in the material properties of soft tissues and that disruption of the fiber network alters the biomechanics of the meniscus. Therefore, the objective of this study was to establish a non invasive method to determine the material properties of the individual menisci and their attachments using inverse FE-analyses. In a previous study, the 3D displacements of the meniscus and its attachments under axial joint loads were determined for intact porcine knees. To simulate the experimental response in individual FE-analyses (n=5), an anisotropic, hyperelastic meniscus matrix was embedded in a poroelastic model. During a particle swarm optimization, the difference between the force applied to the meniscus during the experiment and the femoral surface reaction force of the FE model at equilibrium was minimized by varying four material parameters. Afterwards, a prediction error was determined to describe how well the material parameter fit to each of the three displacement directions. Additionally, the stresses occurring in the meniscus were evaluated. The error of the material parameter optimization was on average 6.5±4.4%. The best fitting material parameter combination revealed an error of 1.2%. The highest stresses occurred in the region between the pars intermedia and posterior horn of the meniscus. The individual material properties of the meniscus were successfully obtained with a combination of previously reported, noninvasively measured 3D displacements and inverse FE-analyses. The methodology presented in this study is a promising contribution to the detection of degeneration within the meniscus.
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Affiliation(s)
- Maren Freutel
- Institute of Orthopaedic Research and Biomechanics, Centre of Musculoskeletal Research Ulm, University of Ulm, Ulm, Germany.
| | - Fabio Galbusera
- Laboratory of Biological Structures Mechanics, IRCCS Galeazzi Orthopedic Institute, Milan, Italy
| | - Anita Ignatius
- Institute of Orthopaedic Research and Biomechanics, Centre of Musculoskeletal Research Ulm, University of Ulm, Ulm, Germany
| | - Lutz Dürselen
- Institute of Orthopaedic Research and Biomechanics, Centre of Musculoskeletal Research Ulm, University of Ulm, Ulm, Germany
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