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Herger S, Wirth W, Eckstein F, Nüesch C, Egloff C, Mündermann A. Anterior cruciate ligament injury and age affect knee cartilage T2 but not thickness. Osteoarthritis Cartilage 2024:S1063-4584(24)01269-X. [PMID: 38950877 DOI: 10.1016/j.joca.2024.06.014] [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] [Received: 06/23/2023] [Revised: 06/21/2024] [Accepted: 06/26/2024] [Indexed: 07/03/2024]
Abstract
OBJECTIVE To investigate the effect of unilateral anterior cruciate ligament (ACL) injury on cartilage thickness and composition, specifically laminar transverse relaxation time (T2) by magnetic resonance imaging (MRI), in younger and older participants and to compare within-person side differences in these parameters between ACL-injured and healthy controls. DESIGN Quantitative double-echo steady-state 3 Tesla MRI-sequences were acquired in both knees of 85 participants in four groups: 20-30 years: healthy, HEA20-30, n = 24; ACL-injured, ACL20-30, n = 23; 40-60 years: healthy, HEA40-60, n = 24; ACL-injured, ACL40-60, n = 14 (ACL injury 2-10 years prior to study inclusion). Weight-bearing femorotibial cartilages were manually segmented; cartilage T2 and thickness were computed using custom software. Mean and side differences in subregional cartilage thickness, superficial and deep cartilage T2 were compared within and between groups using non-parametric statistics. RESULTS Cartilage thickness did not differ within or between groups. Only the side difference in medial femorotibial cartilage thickness was greater in ACL20-30 than in HEA20-30. Deep zone T2 was longer in the ACL-injured than in the contralateral uninjured knees and than in healthy controls, especially in the lateral compartment. Most ACL-injured participants had side differences in femorotibial deep zone T2 above the threshold derived from controls. CONCLUSION In the ACL-injured knee, early compositional differences in femorotibial cartilage (T2) appear to occur in the deep zone and precede cartilage thickness loss. These results suggest that monitoring laminar T2 after ACL injury may be useful in diagnosing and monitoring early articular cartilage changes.
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Affiliation(s)
- Simon Herger
- Department of Orthopedics and Traumatology, University Hospital Basel, Basel Switzerland; Department of Spine Surgery, University Hospital Basel, Basel, Switzerland; Department of Biomedical Engineering, University of Basel, Basel, Switzerland; Department of Clinical Research, University of Basel, Basel, Switzerland.
| | - Wolfgang Wirth
- Research Program for Musculoskeletal Imaging, Center of Anatomy and Cell Biology, and Ludwig Boltzmann Institute for Arthritis and Rehabilitation (LBIAR), Paracelsus Medical University, Salzburg, Austria; Chondrometrics GmbH, Freilassing, Germany.
| | - Felix Eckstein
- Research Program for Musculoskeletal Imaging, Center of Anatomy and Cell Biology, and Ludwig Boltzmann Institute for Arthritis and Rehabilitation (LBIAR), Paracelsus Medical University, Salzburg, Austria; Chondrometrics GmbH, Freilassing, Germany.
| | - Corina Nüesch
- Department of Orthopedics and Traumatology, University Hospital Basel, Basel Switzerland; Department of Spine Surgery, University Hospital Basel, Basel, Switzerland; Department of Biomedical Engineering, University of Basel, Basel, Switzerland; Department of Clinical Research, University of Basel, Basel, Switzerland.
| | - Christian Egloff
- Department of Orthopedics and Traumatology, University Hospital Basel, Basel Switzerland.
| | - Annegret Mündermann
- Department of Orthopedics and Traumatology, University Hospital Basel, Basel Switzerland; Department of Spine Surgery, University Hospital Basel, Basel, Switzerland; Department of Biomedical Engineering, University of Basel, Basel, Switzerland; Department of Clinical Research, University of Basel, Basel, Switzerland.
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Fuerst D, Wirth W, Gaisberger M, Hunter DJ, Eckstein F. Association of Superficial Cartilage Transverse Relaxation Time With Osteoarthritis Disease Progression: Data From the Foundation for the National Institutes of Health Biomarker Study of the Osteoarthritis Initiative. Arthritis Care Res (Hoboken) 2022; 74:1888-1893. [PMID: 33973402 PMCID: PMC8578581 DOI: 10.1002/acr.24627] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2020] [Revised: 04/11/2021] [Accepted: 04/20/2021] [Indexed: 01/07/2023]
Abstract
OBJECTIVE To study whether layer-specific cartilage transverse relaxation time (T2) and/or longitudinal change is associated with clinically relevant knee osteoarthritis (OA) disease progression. METHODS The Foundation for the National Institutes of Health Biomarker Consortium was a nested case-control study on 600 knees from 600 Osteoarthritis Initiative participants. Progressor knees had both medial tibiofemoral radiographic joint space width (JSW) loss (≥0.7 mm) and a persistent increase in Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) pain score (≥9 on a 0-100 scale) at 24-48 months from baseline (n = 194). Multiecho spin-echo (MESE) magnetic resonance images (MRIs) for cartilage T2 analysis had been acquired in the right knees only (97 progressor knees). These were compared to 104 control knees without JSW or pain progression. Fifty-three knees had JSW progression, and 57 pain progression only. Cartilage thickness segmentations obtained from double-echo steady-state MRI were matched to MESE MRI to extract superficial and deep femorotibial cartilage T2. Superficial medial femorotibial compartment (MFTC) T2 at baseline was the primary, and change in deep MFTC T2 between baseline and 12 months was the secondary analytic outcome of this post hoc exploratory study. RESULTS Baseline superficial MFTC T2 was significantly elevated in progressor knees (adjusted mean 47.2 msec [95% confidence interval (95% CI) 46.5, 48.0]) and JSW progression only knees (adjusted mean 47.3 msec [95% CI 46.3, 48.3]), respectively, versus non-progressor knees (45.8 msec [95% CI 45.0, 46.5]) after adjustment for age, sex, body mass index, WOMAC pain score, and medial joint space narrowing grade (analysis of covariance). Change in T2 was not significantly associated with case status. CONCLUSION Baseline superficial, but not deep, medial cartilage T2 is associated with clinically relevant disease progression in knee OA.
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Affiliation(s)
- David Fuerst
- Paracelsus Medical University Salzburg and Nuremberg, Salzburg, Austria, and ChondrometricsAinringGermany
| | - Wolfgang Wirth
- Paracelsus Medical University Salzburg and Nuremberg, Salzburg, Austria, and ChondrometricsAinringGermany
| | | | - David J. Hunter
- Royal North Shore Hospital and Institute of Bone and Joint Research, Kolling Institute, University of SydneySydneyNew South WalesAustralia
| | - Felix Eckstein
- Paracelsus Medical University Salzburg and Nuremberg, Salzburg, Austria, and ChondrometricsAinringGermany
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Thomas KA, Krzemiński D, Kidziński Ł, Paul R, Rubin EB, Halilaj E, Black MS, Chaudhari A, Gold GE, Delp SL. Open Source Software for Automatic Subregional Assessment of Knee Cartilage Degradation Using Quantitative T2 Relaxometry and Deep Learning. Cartilage 2021; 13:747S-756S. [PMID: 34496667 PMCID: PMC8808775 DOI: 10.1177/19476035211042406] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/17/2023] Open
Abstract
OBJECTIVE We evaluated a fully automated femoral cartilage segmentation model for measuring T2 relaxation values and longitudinal changes using multi-echo spin-echo (MESE) magnetic resonance imaging (MRI). We open sourced this model and developed a web app available at https://kl.stanford.edu into which users can drag and drop images to segment them automatically. DESIGN We trained a neural network to segment femoral cartilage from MESE MRIs. Cartilage was divided into 12 subregions along medial-lateral, superficial-deep, and anterior-central-posterior boundaries. Subregional T2 values and four-year changes were calculated using a radiologist's segmentations (Reader 1) and the model's segmentations. These were compared using 28 held-out images. A subset of 14 images were also evaluated by a second expert (Reader 2) for comparison. RESULTS Model segmentations agreed with Reader 1 segmentations with a Dice score of 0.85 ± 0.03. The model's estimated T2 values for individual subregions agreed with those of Reader 1 with an average Spearman correlation of 0.89 and average mean absolute error (MAE) of 1.34 ms. The model's estimated four-year change in T2 for individual subregions agreed with Reader 1 with an average correlation of 0.80 and average MAE of 1.72 ms. The model agreed with Reader 1 at least as closely as Reader 2 agreed with Reader 1 in terms of Dice score (0.85 vs. 0.75) and subregional T2 values. CONCLUSIONS Assessments of cartilage health using our fully automated segmentation model agreed with those of an expert as closely as experts agreed with one another. This has the potential to accelerate osteoarthritis research.
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Affiliation(s)
- Kevin A. Thomas
- Department of Biomedical Data Science,
Stanford University, Stanford, CA, USA
| | - Dominik Krzemiński
- Cardiff University Brain Research
Imaging Centre, Cardiff University, Cardiff, Wales, UK
| | - Łukasz Kidziński
- Department of Bioengineering, Stanford
University, Stanford, CA, USA
| | - Rohan Paul
- Department of Biomedical Data Science,
Stanford University, Stanford, CA, USA
| | - Elka B. Rubin
- Department of Radiology, Stanford
University, Stanford, CA, USA
| | - Eni Halilaj
- Department of Mechanical Engineering,
Carnegie Mellon University, Pittsburgh, PA, USA
| | | | - Akshay Chaudhari
- Department of Biomedical Data Science,
Stanford University, Stanford, CA, USA
- Department of Radiology, Stanford
University, Stanford, CA, USA
| | - Garry E. Gold
- Department of Bioengineering, Stanford
University, Stanford, CA, USA
- Department of Radiology, Stanford
University, Stanford, CA, USA
- Department of Orthopaedic Surgery,
Stanford University, Stanford, CA, USA
| | - Scott L. Delp
- Department of Bioengineering, Stanford
University, Stanford, CA, USA
- Department of Orthopaedic Surgery,
Stanford University, Stanford, CA, USA
- Department of Mechanical Engineering,
Stanford University, Stanford, CA, USA
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Gokyar S, Robb FJL, Kainz W, Chaudhari A, Winkler SA. MRSaiFE: An AI-based Approach Towards the Real-Time Prediction of Specific Absorption Rate. IEEE ACCESS : PRACTICAL INNOVATIONS, OPEN SOLUTIONS 2021; 9:140824-140834. [PMID: 34722096 PMCID: PMC8553142 DOI: 10.1109/access.2021.3118290] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/03/2023]
Abstract
The purpose of this study is to investigate feasibility of estimating the specific absorption rate (SAR) in MRI in real time. To this goal, SAR maps are predicted from 3T- and 7T-simulated magnetic resonance (MR) images in 10 realistic human body models via a convolutional neural network. Two-dimensional (2-D) U-Net architectures with varying contraction layers and different convolutional filters were designed to estimate the SAR distribution in realistic body models. Sim4Life (ZMT, Switzerland) was used to create simulated anatomical images and SAR maps at 3T and 7T imaging frequencies for Duke, Ella, Charlie, and Pregnant Women (at 3, 7, and 9 month gestational stages) body models. Mean squared error (MSE) was used as the cost function and the structural similarity index (SSIM) was reported. A 2-D U-Net with 4 contracting (and 4 expanding) layers and 64 convolutional filters at the initial stage showed the best compromise to estimate SAR distributions. Adam optimizer outperformed stochastic gradient descent (SGD) for all cases with an average SSIM of 90.5∓3.6 % and an average MSE of 0.7∓0.6% for head images at 7T, and an SSIM of >85.1∓6.2 % and an MSE of 0.4∓0.4% for 3T body imaging. Algorithms estimated the SAR maps for 224×224 slices under 30 ms. The proposed methodology shows promise to predict real-time SAR in clinical imaging settings without using extra mapping techniques or patient-specific calibrations.
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Affiliation(s)
- Sayim Gokyar
- Department of Radiology, Weill Cornell Medicine, New York City, NY 10065 USA
| | - Fraser J L Robb
- GE Healthcare Coils, 1515 Danner Drive, Aurora, OH 44202 USA
| | - Wolfgang Kainz
- Center for Devices and Radiological Health, U.S. Food and Drug Administration, Silver Spring, MD, USA
| | - Akshay Chaudhari
- Integrative Biomedical Imaging Informatics at Stanford (IBIIS), James H. Clark Center, 318 Campus Drive, S255 Stanford, CA 94305 USA
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