Effect of intra-articular injection of intermediate-weight hyaluronic acid on hip and knee cartilage: in-vivo evaluation using T2 mapping

The diagnostic performance comparison between T2 mapping and Dixon against the activity of thyroid-associated ophthalmopathy: a systematic review and meta-analysis

Objective

The aim of this study was to compare the diagnostic performance of T2 mapping and Dixon in thyroid-associated ophthalmopathy's disease activity.

Methods

Published studies were collected by systematically searching the databases PubMed, Embase, Cochrane Library, Google Scholar, Medline, Web of Science, CNKI, VIP, and WANFANG. The sensitivities, specificities, likelihood ratios, and diagnostic odds ratio (DOR) were confirmed. The symmetric receiver operator characteristic curve (SROC) was used to assess the threshold of T2 mapping and Dixon. Fagan's nomogram was drawn. Meta-regression and subgroup analyses were applied to distinguish the sources of heterogeneity among the included studies. The review was conducted in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) 2020 statement.

Results

A total of 17 studies were included, comprising 1,455 participants. The combined sensitivity of T2 mapping was 0.70 [95% CI (0.65-0.75)], specificity was 0.84 [95% CI (0.75-0.90)], area under the SROC curve (AUC) was 0.78 [95% CI (0.75-0.82)], and DOR was 12. The combined sensitivity of Dixon was 0.74 [95% CI (0.58-0.85)], specificity was 0.80 [95% CI (0.58-0.93)], AUC was 0.83 [95% CI (0.80-0.86)], and DOR was 11.66. The Deeks' funnel plot showed no existing publication bias. The prospective design, partial verification bias, and blinding contributed to the heterogeneity in specificity and sensitivity. The post-test probability of T2 mapping in TAO patients' disease activity was 75%, and the post-test probability of Dixon in TAO was 87%.

Conclusion

Compared with T2 mapping, Dixon presented a significantly higher sensitivity and AUC for detecting TAO disease activity. Dixon is expected to further improve the accuracy of diagnosis of TAO's disease activity.

Morphological and Quantitative Parametric MRI Follow-up of Cartilage Changes Before and After Intra-articular Injection Therapy in Patients With Mild to Moderate Knee Osteoarthritis: A Randomized, Placebo-Controlled Trial

BACKGROUND

Intra-articular injections are routinely used for conservative treatment of knee osteoarthritis (OA). The detailed comparative therapeutic effects of these injections on cartilage tissue are still unclear.

OBJECTIVE

The aim of this study was to detect and compare knee cartilage changes after intra-articular injection of glucocorticoid, hyaluronic acid, or platelet-rich plasma (PRP) to placebo using quantitative (T2 and T2* mapping) and morphological magnetic resonance imaging parameters in patients with mild or moderate osteoarthritis.

MATERIALS AND METHODS

In a double-blinded, placebo-controlled, single-center trial, knees with mild or moderate osteoarthritis (Kellgren-Lawrence grade 1-3) were randomly assigned to an intra-articular injection with 1 of these substances: glucocorticoid, hyaluronic acid, PRP, or placebo. Cartilage degeneration on baseline and follow-up magnetic resonance imaging scans (after 3 and 12 months) was assessed by 2 readers using quantitative T2 and T2* times (milliseconds) and morphological parameters (modified Outerbridge grading, subchondral bone marrow edema, subchondral cysts, osteophytes).

RESULTS

One hundred twenty knees (30 knees per treatment group) were analyzed with a median patient age of 60 years (interquartile range, 54.0-68.0 years). Interreader reliability was good for T2 (ICC, 0.76; IQR, 0.68-0.83) and T2* (ICC, 0.83; IQR, 0.76-0.88) measurements. Morphological parameters showed no significant changes between all groups after 3 and 12 months. T2 mapping after 12 months showed the following significant ( P = 0.001-0.03) changes between groups in 6 of 14 compartments: values after PRP injection decreased compared with glucocorticoid in 4 compartments (complete medial femoral condyle and central part of lateral condyle) and compared with placebo in 2 compartments (anterior and central part of medial tibial plateau); values after glucocorticoid injection decreased compared with placebo in 1 compartment (central part of medial tibial plateau). No significant changes were seen for T2 and T2* times after 3 months and T2* times after 12 months. No correlation was found between T2/T2* times and Kellgren-Lawrence grade, age, body mass index, or pain (Spearman ρ, -0.23 to 0.18).

CONCLUSIONS

Platelet-rich plasma injection has a positive long-term effect on cartilage quality in the medial femoral compartment compared to glucocorticoid, resulting in significantly improved T2 values after 12 months. For morphological cartilage parameters, injections with glucocorticoid, PRP, or hyaluronic acid showed no better effect in the short or long term compared with placebo.

Harnessing Nanomedicine for Cartilage Repair: Design Considerations and Recent Advances in Biomaterials

Cartilage injuries are escalating worldwide, particularly in aging society. Given its limited self-healing ability, the repair and regeneration of damaged articular cartilage remain formidable challenges. To address this issue, nanomaterials are leveraged to achieve desirable repair outcomes by enhancing mechanical properties, optimizing drug loading and bioavailability, enabling site-specific and targeted delivery, and orchestrating cell activities at the nanoscale. This review presents a comprehensive survey of recent research in nanomedicine for cartilage repair, with a primary focus on biomaterial design considerations and recent advances. The review commences with an introductory overview of the intricate cartilage microenvironment and further delves into key biomaterial design parameters crucial for treating cartilage damage, including microstructure, surface charge, and active targeting. The focal point of this review lies in recent advances in nano drug delivery systems and nanotechnology-enabled 3D matrices for cartilage repair. We discuss the compositions and properties of these nanomaterials and elucidate how these materials impact the regeneration of damaged cartilage. This review underscores the pivotal role of nanotechnology in improving the efficacy of biomaterials utilized for the treatment of cartilage damage.

Evaluation of Open Versus Arthroscopic Anterior Talofibular Ligament Reconstruction for Chronic Lateral Ankle Instability With Talar and Subtalar Cartilage MRI T2 Mapping: A 3-Year Prospective Study

BACKGROUND

Previous studies have examined patients with chronic lateral ankle instability (CLAI) undergoing open and arthroscopic anterior talofibular ligament (ATFL) reconstruction, reporting equivalent clinical results between the 2 procedures. However, data on the magnetic resonance imaging (MRI) outcomes on cartilage health after the 2 procedures are limited.

PURPOSE

To compare the cartilage MRI T2 values of the talar and subtalar joints between patients with CLAI undergoing open and arthroscopic ATFL reconstruction.

STUDY DESIGN

Cohort study; Level of evidence, 3.

METHODS

A prospective study was conducted on patients who underwent open or arthroscopic ATFL reconstruction between January 2018 and December 2019, with a mean follow-up duration of 3 years. MRI scans and American Orthopaedic Foot & Ankle Society (AOFAS) and Tegner score estimations were completed by patients ≤1 week before surgery, as a baseline measurement, and at a 3-year follow-up. A total of 21 healthy volunteers were included who underwent MRI at baseline. Cartilage health was evaluated using MRI T2 mapping. The talar and subtalar cartilage regions were segmented into 14 subregions.

RESULTS

At baseline, patients with CLAI had substantially higher T2 values in the medial anterior, medial center, medial posterior, and lateral center regions on the talus compared with the healthy controls (P = .009, .003, .001, and .025, respectively). Remarkable increases in T2 values in the lateral posterior region on the talus were observed from baseline to follow-up in the open group (P = .007). Furthermore, T2 values were considerably higher in the medial center, medial posterior, lateral posterior, and lateral posterior calcaneal facets of the posterior subtalar joint at follow-up in the arthroscopic group compared with the baseline values (P = .025, .002, .006, and .044, respectively). No obvious differences in ΔT2 values were noted between the 2 groups at follow-up. The AOFAS and Tegner scores remarkably improved from baseline to follow-up for the 2 groups (open: 3.25 ± 0.58 vs 5.13 ± 0.81, P < .001; arthroscopic: 3.11 ± 0.90 vs 5.11 ± 1.08, P < .001), with no considerable difference between them.

CONCLUSION

The elevated T2 values of cartilage could not be fully recovered after open or arthroscopic ATFL reconstruction. Both arthroscopic and open ATFL reconstruction displayed similar effects on cartilage health concerning ΔT2, but the arthroscopic group demonstrated more degenerative cartilage subregions than the open group.

AI MSK clinical applications: cartilage and osteoarthritis

The advancements of artificial intelligence (AI) for osteoarthritis (OA) applications have been rapid in recent years, particularly innovations of deep learning for image classification, lesion detection, cartilage segmentation, and prediction modeling of future knee OA development. This review article focuses on AI applications in OA research, first describing machine learning (ML) techniques and workflow, followed by how these algorithms are used for OA classification tasks through imaging and non-imaging-based ML models. Deep learning applications for OA research, including analysis of both radiographs for automatic detection of OA severity, and MR images for detection of cartilage/meniscus lesions and cartilage segmentation for automatic T₂ quantification will be described. In addition, information on ML models that identify individuals at high risk of OA development will be provided. The future vision of machine learning applications in imaging of OA and cartilage hinges on implementation of AI for optimizing imaging protocols, quantitative assessment of cartilage, and automated analysis of disease burden yielding a faster and more efficient workflow for a radiologist with a higher level of reproducibility and precision. It may also provide risk assessment tools for individual patients, which is an integral part of precision medicine.

Safety and efficacy of a single intra-articular injection of hyaluronic acid in osteoarthritis of the hip: a case series of 87 patients

Background

Osteoarthritis (OA) is the most prevalent form of joint disease and commonly affects the hip. Hip OA is associated with a high socioeconomic burden. Intra-articular hyaluronic acid (HA) injection may be of benefit but quality evidence for HA use in hip OA is lacking. The purpose of this study was to assess the safety and efficacy of ultrasound guided injection of a high molecular weight, non-animal derived, stabilised HA (NASHA) in patients with mild to moderate hip OA.

Methods

This single site study is an analysis of prospectively collected outcome data for 87 consecutive patients over a 2-year period who received a single HA (Durolane) injection for symptomatic hip OA. Inclusion criteria were male or female patients over 18-years of age with mild to moderate hip OA on x-ray. Patients with severe hip OA were excluded. The primary outcome measure was a modified Harris Hip Score (mHHS) questionnaire at baseline and 6-weeks with a minimal clinically important difference (MCID) of 10 points. All adverse events were recorded and assessed.

Results

Data from 87 patients, 49 women and 38 men with mean age of 54 (SD = 10.8) were analysed. At baseline, mean mHHS was 58.47 (SD 14.31). At the 6 week follow up, mean mHHS improved to 71.30 (SD 16.46), a difference of 12.83 (p < 0.01). This was greater than the MCID of 10. No significant adverse events were encountered. Five patients reported short-lived injection site pain.

Conclusion

A single injection of HA (NASHA) in the setting of hip joint OA was both safe and efficacious in this 87 patient cohort. Improvement in pain and function as measured with mHHS was statistically significant and reached the MCID of 10.

Trial registration

The study was retrospectively registered on the 1st of February 2021 in the Australian New Zealand Clinical Trials Registry with registry number ACTRN12621000098831. All research was performed in accordance with the Declaration of Helsinki.

Magnetic Resonance Imaging T2* Mapping of the Talar Dome and Subtalar Joint Cartilage 3 Years After Anterior Talofibular Ligament Repair or Reconstruction in Chronic Lateral Ankle Instability

BACKGROUND

Cartilage degeneration is a common issue in patients with chronic lateral ankle instability. However, there are limited studies regarding the effectiveness of lateral ligament surgery on preventing talar and subtalar joint cartilage from further degenerative changes.

PURPOSE

To longitudinally evaluate talar and subtalar cartilage compositional changes using magnetic resonance imaging T2* mapping in anatomic anterior talofibular ligament (ATFL)-repaired and ATFL-reconstructed ankles and to compare them with measures in asymptomatic controls.

STUDY DESIGN

Cohort study; Level of evidence, 3.

METHODS

Between January 2015 and December 2016, patients with chronic lateral ankle instability who underwent anatomic ATFL repair (n = 19) and reconstruction (n = 20) were prospectively recruited. Patients underwent 3.0-T magnetic resonance imaging at baseline and 3-year follow-up. As asymptomatic controls, 21 healthy volunteers were recruited and underwent imaging at baseline. Talar dome cartilage was divided into (1) medial anterior, central, and posterior and (2) lateral anterior, central, and posterior. Posterior subtalar cartilage was divided into (1) central talus and calcaneus and (2) lateral talus and calcaneus. Ankle function was assessed using the American Orthopaedic Foot & Ankle Society scores.

RESULTS

There were significant increases in T2* values in medial and lateral posterior and central talus cartilage from baseline to 3-year follow-up in patients who underwent repair. T2* values were significantly higher in ATFL-repaired ankles at follow-up for all cartilage regions of interest, except medial and lateral anterior and lateral central, compared with those in healthy controls. From baseline to 3-year follow-up, ATFL-reconstructed ankles had a significant increase in T2* values in lateral central and posterior cartilage. T2* values in ATFL-reconstructed ankles at follow-up were elevated in all cartilage regions of interest, except medial and lateral anterior, compared with those in healthy controls. ATFL-repaired ankles showed a greater decrease of T2* values from baseline to follow-up in lateral calcaneus cartilage than did ATFL-reconstructed ankles (P = .031). No significant differences in American Orthopaedic Foot & Ankle Society score were found between repair and reconstruction procedures (mean ± SD, 19.11 ± 7.45 vs 16.85 ± 6.24; P = .311).

CONCLUSION

Neither anatomic ATFL repair nor reconstruction could prevent the progression of talar dome and posterior subtalar cartilage degeneration; however, ankle function and activity levels were not affected over a short period. Patients who underwent ATFL repair exhibited lower T2* values in the lateral calcaneus cartilage than did those who underwent reconstruction.

T2 mapping of the sacroiliac joints in patients with axial spondyloarthritis

PURPOSE

To test whether T2 mapping of the sacro-iliac joints (SIJs) might help identifying patients with spondyloarthritis.

METHOD

This study included 20 biologic-naive patients with axial spondyloarthritis (10 females; mean age: 38 ± 9years; range, 19-47) and 27 controls (16 males; mean age = 39 ± 13years; range = 28-71) who prospectively underwent SIJs MRI at 1.5 T, including a multislice multiecho spin-echo sequence. Standard MRIs were reviewed to assess the SIJs according to the Assessment of SpondyloArthritis International Society (ASAS) criteria and SPondyloArthritis Research Consortium of Canada (SPARCC) MRI index. T2 maps obtained from multiecho sequences were used to draw regions of interests in the cartilaginous part of the SIJs. Disease activity was assessed using BASDAI questionnaire. Bland-Altman method, ROC curve analysis, Chi square, Mann-Whitney U, Pearson's and Spearman's correlation coefficient were used for data analysis.

RESULTS

According to ASAS criteria, MRI was positive for sacroiliitis in 5/20 patients (25 %). Inter-observer reproducibility of T2 values was 87 % (coefficient of repeatability = 7.0; bias = 0.49; p < .001). Mean T2 values of patients (58.5 ± 4.4 ms, range: 52.6-68.2 ms) were significantly higher (p < .001) than those of controls (44.1 ± 6.6 ms, range: 33.6-67.2 ms). A T2 value of 52.51 ms yielded 100 % sensitivity and 91.7 % specificity to differentiate patients from controls. No statistically significant association/correlation was found between T2 values and BASDAI (r=-.026, p = .827), disease duration (r = .024, p = .871), SPARCC (r=-.004, p = .981), ASAS criteria (p = .476), HLA-B27-positivity (p = .139), age (r=-.2.53, p = .891), and gender (p = .404).

CONCLUSIONS

T2 relaxation times of the SIJs were significantly higher in patients than in healthy controls, making this tool potentially helpful to early identify patients with spondyloarthritis.

Image quality of hip MR arthrography with intra-articular injection of hyaluronic acid versus gadolinium-based contrast agent in patients with femoroacetabular impingement

OBJECTIVE

To compare image quality of magnetic resonance arthrography (MRA) of the hip with intra-articular injection of high-viscosity hyaluronic acid (HA-MRA) versus Gd-based contrast agent (Gd-MRA) in patients with femoroacetabular impingement (FAI).

MATERIALS AND METHODS

Design: single-centre, observational, retrospective, inter-individual, and cross-sectional. FAI patients who underwent HA-MRA (3 mL of high-viscosity HA plus 17 mL of saline) were compared with 37 age- and sex-matched FAI patients who underwent Gd-MRA (20 mL of 2 mmol/L solution of gadopentetate dimeglumine). Two independent blinded radiologists assessed image quality for all sequences (two-dimensional proton density, non-fat-sat axial, fat-sat coronal and sagittal; three-dimensional dual-echo steady state), using a 5-point Likert scale considering separately labrum, cartilage, round ligament, transverse ligament, and capsule. Pearson χ² and Cohen κ were used.

RESULTS

The HA-MRA group was composed of 37 patients (23 males, 14 females; median age 38 years), the Gd-MRA group of 37 patients (21 males, 16 females; median age 38 years), without significant difference for age (p = 0.937) and sex (p = 0.636). Image quality did not differ between the two readers for any structure: labrum (p ≥ 0.340), cartilage (p ≥ 0.198), round ligament (p ≥ 0.255), transverse ligament (p ≥ 0.806), and capsule (p ≥ 0.314). Inter-reader agreement (κ) ranged from 0.785 to 1.000.

CONCLUSIONS

HA-MRA provided an image quality not significantly different from that of Gd-MRA. This may open the possibility of combining MRA and viscosupplementation in one single procedure.

T2 mapping of the trapeziometacarpal joint and triangular fibrocartilage complex: a feasibility and reproducibility study at 1.5 T

PURPOSE

To assess the feasibility and reproducibility of T2 relaxation time measurements of the trapeziometacarpal joint (TM) and triangular fibrocartilage complex (TFCC) on healthy subjects at 1.5 T MR.

MATERIALS AND METHODS

Thirty-four healthy volunteers underwent an axial oblique multislice multiecho spin-echo sequence of the wrist at 1.5 T, with 10 of them having performed another MR scan on a different 1.5 T scanner. Regions of interest were independently manually drawn by two musculoskeletal radiologists to include the cartilaginous part of the TM and TFCC. Intra-observer, inter-observer and inter-scanner reproducibility of T2 relaxation time measurements was tested using the Bland-Altman method.

RESULTS

The mean T2 values obtained by the two radiologists were 29.9 ± 6.5 ms and 30.0 ± 6.1 ms in the TM and 24.5 ± 2.3 ms and 24.6 ± 2.8 ms in the TFCC, respectively. The mean values of the second series of T2 measurements obtained by the senior radiologist were 29.9 ± 6.5 ms and 30.0 ± 6.3 ms in the TM and 24.3 ± 2.9 ms in the TFCC. Inter-observer reproducibility in the TM and in the TFCC was 76% and 82%, respectively. Intra-observer reproducibility in the TM and TFCC was 71% and 76%, respectively. Inter-scanner reproducibility of T2 measurements was 36% in the TM and 85% in the TFCC, respectively.

CONCLUSION

The assessment of T2 relaxation time measurements of the cartilage of the TM and the TFCC seems to be feasible and reproducible, although the inter-scanner reproducibility of T2 measurements of the TM is suboptimal. Further studies including patients are warranted to prove the utility of this tool.

T2-mapping of the sacroiliac joints at 1.5 Tesla: a feasibility and reproducibility study

OBJECTIVE

To evaluate the reproducibility of T2 relaxation time measurements of the sacroiliac joints at 1.5 T.

MATERIALS AND METHODS

Healthy volunteers underwent an oblique axial multislice multiecho spin-echo sequence of the sacroiliac joints at 1.5 T. Regions of interest were manually drawn using a dedicated software by two musculoskeletal radiologists to include the cartilaginous part of the sacroiliac joints. A senior radiologist performed the measurement twice, while a resident measured once. Intra- and inter-observer reproducibility was tested using the Bland-Altman method. Association between sex and T2 relaxation times was tested using the Mann-Whitney U test. Correlation between T2 relaxation times and body mass index (BMI) was tested using the Spearman's rho.

RESULTS

Eighty sacroiliac joints of 40 subjects (mean age: 28 ± 4.8 years, range: 20-43; mean BMI: 23.3 ± 3.1, range: 18.9-30) were imaged. The mean T2 values obtained by the senior radiologist in the first series of measurements were 42 ± 4.4 ms, whereas in the second series were 40.7 ± 4.5 ms. The mean T2 values obtained by the radiology resident were 41.1 ± 4.2 ms. Intra-observer reproducibility was 88% (coefficient of repeatability = 3.8; bias = 1.28; p < .001), while inter-observer reproducibility was 86% (4.7; -.88; p < .001). There was significant association between sex and T2 relaxation times (p = .024) and significant inverse correlation between T2 relaxation times and BMI (r = -.340, p = .002).

CONCLUSION

The assessment of T2 relaxation time measurements of sacroiliac joints seems to be highly reproducible at 1.5 T. Further studies could investigate the potential clinical application of this tool in the sacroiliac joints.

Comparison of T2 Relaxation Values in Subtalar Cartilage between Patients with Lateral Instability of the Ankle Joint and Healthy Volunteers

PURPOSE

To evaluate the difference between T2 relaxation values of the subtalar cartilage in lateral ankle instability patients and healthy volunteers.

MATERIALS AND METHODS

This institutional review board-approved study included 27 preoperative magnetic resonance imaging (MRI) examinations of 26 patients who underwent Broström operations. Data of previously enrolled healthy volunteers (12 volunteers, 13 MRIs) were used as controls. Two radiologists independently measured T2 values in eight posterior subtalar joint cartilage compartments: central calcaneus anterior (CCA) and posterior (CCP), central talus anterior (CTA) and posterior (CTP), lateral calcaneus anterior (LCA) and posterior (LCP), and lateral talus anterior (LTA) and posterior (LTP). Patient and control values were compared using linear regression analysis. Inter- and intraobserver agreement was calculated.

RESULTS

Mean T2 values were significantly higher in the patient group in all measurements of subtalar joint cartilage compartments (p < 0.05) except that in LTP (p = 0.085) measured by reviewer 1. Both inter- and intraobserver agreements were excellent.

CONCLUSIONS

The T2 relaxation values of the subtalar cartilage were significantly higher in lateral ankle instability patients compared with those of controls.

KEY POINTS

• Subtalar cartilage T2 values are increased in patients with lateral ankle instability. • This trend was demonstrated regardless of the presence of talar dome cartilage lesions. • Inter-and intraobserver agreements were excellent (intraclass coefficient range, 0.765-0.951) in subtalar cartilage T2 mapping.