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Eckstein F, Wirth W, Putz R. Sexual dimorphism in articular tissue anatomy - Key to understanding sex differences in osteoarthritis? Osteoarthritis Cartilage 2024:S1063-4584(24)01212-3. [PMID: 38871022 DOI: 10.1016/j.joca.2024.05.014] [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: 11/15/2023] [Revised: 05/06/2024] [Accepted: 05/31/2024] [Indexed: 06/15/2024]
Abstract
OBJECTIVE Osteoarthritis (OA) prevalence and incidence varies between women and men, but it is unknown whether this follows sex-specific differences in systemic factors (e.g. hormones) and/or differences in pre-morbid joint anatomy. We recognize that classifications of sex within humans cannot be reduced to female/male, but given the lack of literature on non-binary individuals, this review is limited to the sexual dimorphism of articular morphotypes. METHODS Based on a Pubmed search using relevant terms, and input from experts, we selected articles based on the authors' judgment of their relevance, interest, originality, and scientific quality; no "hard" bibliometric measures were used to evaluate their quality or importance. Focus was on clinical rather than pre-clinical studies, with most (imaging) data being available for the knee joint. RESULTS After introducing "sexual dimorphism", the specific literature on articular morphotypes is reviewed, structured by: radiographic joint space width (JSW), meniscus, ligaments, articular cartilage morphology, articular cartilage composition and deformation, and articular tissue response to treatment. CONCLUSIONS Sex-specific differences were clearly observed for JSW, meniscus damage, ligament size, and cartilage morphometry (volume, thickness, and surface areas) but not for cartilage composition. Ligament and cartilage measures were smaller in women even after matching for confounders. Taken together, the findings indicate that female (knee) joints may be structurally more vulnerable and at greater risk of OA. The "one size/sex fits all" approach must be abandoned in OA research, and all observational and interventional studies should report their results for sex-specific strata, at least in pre-specified secondary or post-hoc analyses.
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Affiliation(s)
- Felix Eckstein
- Research Program for Musculoskeletal Imaging, Center for Anatomy and Cell Biology, Paracelsus Medical University, Salzburg, Austria; Ludwig Boltzmann Institute for Arthritis and Rehabilitation (LBIAR), Paracelsus Medical University, Salzburg, Austria; Chondrometrics GmbH, Freilassing, Germany.
| | - Wolfgang Wirth
- Research Program for Musculoskeletal Imaging, Center for Anatomy and Cell Biology, Paracelsus Medical University, Salzburg, Austria; Ludwig Boltzmann Institute for Arthritis and Rehabilitation (LBIAR), Paracelsus Medical University, Salzburg, Austria; Chondrometrics GmbH, Freilassing, Germany
| | - Reinhard Putz
- Anatomische Anstalt, Ludwig Maximilians Universität München, Munich, Germany
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Eckstein F, Maschek S, Culvenor A, Sharma L, Roemer F, Duda G, Wirth W. Which risk factors determine cartilage thickness and composition change in radiographically normal knees? - Data from the Osteoarthritis Initiative. OSTEOARTHRITIS AND CARTILAGE OPEN 2023; 5:100365. [PMID: 37207279 PMCID: PMC10188628 DOI: 10.1016/j.ocarto.2023.100365] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2023] [Accepted: 04/24/2023] [Indexed: 05/21/2023] Open
Abstract
Objective Therapy for osteoarthritis ideally aims at preserving structure before radiographic change occurs. This study tests: a) whether longitudinal deterioration in cartilage thickness and composition (transverse relaxation-time T2) are greater in radiographically normal knees "at risk" of incident osteoarthritis than in those without risk factors; and b) which risk factors may be associated with these deteriorations. Design 755 knees from the Osteoarthritis Initiative were studied; all were bilaterally Kellgren Lawrence grade [KLG] 0 initially, and had magnetic resonance images available at 12- and 48-month follow-up. 678 knees were "at risk", whereas 77 were not (i.e., non-exposed reference). Cartilage thickness and composition change was determined in 16 femorotibial subregions, with deep and superficial T2 being analyzed in a subset (n = 59/52). Subregion values were used to compute location-independent change scores. Results In KLG0 knees "at risk", the femorotibial cartilage thinning score (-634 ± 516 μm) over 3 years exceeded the thickening score by approximately 20%, and was 27% greater (p < 0.01; Cohen D -0.27) than the thinning score in "non-exposed" knees (-501 ± 319 μm). Superficial and deep cartilage T2 change, however, did not differ significantly between both groups (p ≥ 0.38). Age, sex, body mass index, knee trauma/surgery history, family history of joint replacement, presence of Heberden's nodes, repetitive knee bending were not significantly associated with cartilage thinning (r2<1%), with only knee pain reaching statistical significance. Conclusions Knees "at risk" of incident knee OA displayed greater cartilage thinning scores than those "non-exposed". Except for knee pain, the greater cartilage loss was not significantly associated with demographic or clinical risk factors.
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Affiliation(s)
- F. Eckstein
- Department of Imaging and Functional Musculoskeletal Research, Institute of Anatomy and Cell Biology & Ludwig Boltzmann Intitute of Arthritis & Rehabilitation (LBIAR), Paracelsus Medical University Salzburg & Nuremberg, Salzburg, Austria
- Chondrometrics GmbH, Ainring, Germany
- Corresponding author. Institute of Anatomy & Cell Biology, Paracelsus Medical University, Strubergasse 21, A-5020 Salzburg, Austria.
| | - S. Maschek
- Department of Imaging and Functional Musculoskeletal Research, Institute of Anatomy and Cell Biology & Ludwig Boltzmann Intitute of Arthritis & Rehabilitation (LBIAR), Paracelsus Medical University Salzburg & Nuremberg, Salzburg, Austria
- Chondrometrics GmbH, Ainring, Germany
| | - A. Culvenor
- Department of Imaging and Functional Musculoskeletal Research, Institute of Anatomy and Cell Biology & Ludwig Boltzmann Intitute of Arthritis & Rehabilitation (LBIAR), Paracelsus Medical University Salzburg & Nuremberg, Salzburg, Austria
- La Trobe Sport and Exercise Medicine Research Centre, School of Allied Health La Trobe University, Bundoora, Australia
| | - L. Sharma
- Department of Medicine, Northwestern University Feinberg School of Medicine, Chicago IL, USA
| | - F.W. Roemer
- Department of Radiology, Friedrich-Alexander University Erlangen-Nürnberg & Universitätsklinikum Erlangen, Erlangen, Germany
- Department of Radiology, Boston University School of Medicine, Boston, MA, USA
| | - G.N. Duda
- Julius Wolff Institute, Berlin-Brandenburg Institute of Health at Charité – Universitätsmedizin Berlin, Germany
| | - W. Wirth
- Department of Imaging and Functional Musculoskeletal Research, Institute of Anatomy and Cell Biology & Ludwig Boltzmann Intitute of Arthritis & Rehabilitation (LBIAR), Paracelsus Medical University Salzburg & Nuremberg, Salzburg, Austria
- Chondrometrics GmbH, Ainring, Germany
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Kijowski R, Sharafi A, Zibetti MV, Chang G, Cloos MA, Regatte RR. Age-Dependent Changes in Knee Cartilage T 1 , T 2 , and T 1p Simultaneously Measured Using MRI Fingerprinting. J Magn Reson Imaging 2023; 57:1805-1812. [PMID: 36190187 PMCID: PMC10067532 DOI: 10.1002/jmri.28451] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2022] [Revised: 09/13/2022] [Accepted: 09/15/2022] [Indexed: 11/11/2022] Open
Abstract
BACKGROUND Magnetic resonance fingerprinting (MRF) techniques have been recently described for simultaneous multiparameter cartilage mapping of the knee although investigation of their ability to detect early cartilage degeneration remains limited. PURPOSE To investigate age-dependent changes in knee cartilage T1 , T2 , and T1p relaxation times measured using a three-dimensional (3D) MRF sequence in healthy volunteers. STUDY TYPE Prospective. SUBJECTS The study group consisted of 24 healthy asymptomatic human volunteers (15 males with mean age 34.9 ± 14.4 years and 9 females with mean age 44.5 ± 13.1 years). FIELD STRENGTH/SEQUENCE A 3.0 T gradient-echo-based 3D-MRF sequence was used to simultaneously create proton density-weighted images and T1 , T2 , and T1p maps of knee cartilage. ASSESSMENT Mean global cartilage and regional cartilage (lateral femur, lateral tibia, medial femur, medial tibia, and patella) T1 , T2 , and T1ρ relaxation times of the knee were measured. STATISTICAL TESTS Kruskal-Wallis tests were used to compared cartilage T1 , T2 , and T1ρ relaxation times between different age groups, while Spearman correlation coefficients was used to determine the association between age and cartilage T1 , T2 , and T1ρ relaxation times. The value of P < 0.05 was considered statistically significant. RESULTS Higher age groups showed higher global and regional cartilage T1 , T2 , and T1ρ . There was a significant difference between age groups in global cartilage T2 and T1ρ but no significant difference (P = 0.13) in global cartilage T1. Significant difference was also present between age groups in cartilage T2 and T1ρ for medial femur cartilage and medial tibia cartilage. There were significant moderate correlations between age and T2 and T1ρ for global cartilage (R2 = 0.63-0.64), medial femur cartilage (R2 = 0.50-0.56), and medial tibia cartilage (R2 = 0.54-0.66). CONCLUSION Cartilage T2 and T1p relaxation times simultaneously measured using a 3D-MRF sequence in healthy volunteers showed age-dependent changes in knee cartilage, primarily within the medial compartment.
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Affiliation(s)
- Richard Kijowski
- Bernard and Irene Schwartz Center of Biomedical Imaging, Department of Radiology, New York University Grossman School of Medicine, New York, NY, 10016, USA
| | - Azadeh Sharafi
- Bernard and Irene Schwartz Center of Biomedical Imaging, Department of Radiology, New York University Grossman School of Medicine, New York, NY, 10016, USA
| | - Marcelo V.W. Zibetti
- Bernard and Irene Schwartz Center of Biomedical Imaging, Department of Radiology, New York University Grossman School of Medicine, New York, NY, 10016, USA
| | - Gregory Chang
- Bernard and Irene Schwartz Center of Biomedical Imaging, Department of Radiology, New York University Grossman School of Medicine, New York, NY, 10016, USA
| | - Martijn A. Cloos
- Center of Advanced Imaging, University of Queensland, Brisbane, QLD, Australia
- ARC Training Center for Innovation in Biomedical Imaging Technology, University of Queensland, Brisbane, QLD, Australia
| | - Ravinder R. Regatte
- Bernard and Irene Schwartz Center of Biomedical Imaging, Department of Radiology, New York University Grossman School of Medicine, New York, NY, 10016, USA
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Frenken M, Radke KL, Schäfer ELE, Valentin B, Wilms LM, Abrar DB, Nebelung S, Martirosian P, Wittsack HJ, Müller-Lutz A. Insights into the Age Dependency of Compositional MR Biomarkers Quantifying the Health Status of Cartilage in Metacarpophalangeal Joints. Diagnostics (Basel) 2023; 13:diagnostics13101746. [PMID: 37238230 DOI: 10.3390/diagnostics13101746] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2023] [Revised: 05/10/2023] [Accepted: 05/12/2023] [Indexed: 05/28/2023] Open
Abstract
(1) Background: We aim to investigate age-related changes in cartilage structure and composition in the metacarpophalangeal (MCP) joints using magnetic resonance (MR) biomarkers. (2) Methods: The cartilage tissue of 90 MCP joints from 30 volunteers without any signs of destruction or inflammation was examined using T1, T2, and T1ρ compositional MR imaging techniques on a 3 Tesla clinical scanner and correlated with age. (3) Results: The T1ρ and T2 relaxation times showed a significant correlation with age (T1ρ: Kendall-τ-b = 0.3, p < 0.001; T2: Kendall-τ-b = 0.2, p = 0.01). No significant correlation was observed for T1 as a function of age (T1: Kendall-τ-b = 0.12, p = 0.13). (4) Conclusions: Our data show an increase in T1ρ and T2 relaxation times with age. We hypothesize that this increase is due to age-related changes in cartilage structure and composition. In future examinations of cartilage using compositional MRI, especially T1ρ and T2 techniques, e.g., in patients with osteoarthritis or rheumatoid arthritis, the age of the patients should be taken into account.
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Affiliation(s)
- Miriam Frenken
- Department of Diagnostic and Interventional Radiology, Medical Faculty, University Hospital of Dusseldorf, D-40225 Dusseldorf, Germany
| | - Karl Ludger Radke
- Department of Diagnostic and Interventional Radiology, Medical Faculty, University Hospital of Dusseldorf, D-40225 Dusseldorf, Germany
| | - Emilia Louisa Ernestine Schäfer
- Department of Diagnostic and Interventional Radiology, Medical Faculty, University Hospital of Dusseldorf, D-40225 Dusseldorf, Germany
| | - Birte Valentin
- Department of Diagnostic and Interventional Radiology, Medical Faculty, University Hospital of Dusseldorf, D-40225 Dusseldorf, Germany
| | - Lena Marie Wilms
- Department of Diagnostic and Interventional Radiology, Medical Faculty, University Hospital of Dusseldorf, D-40225 Dusseldorf, Germany
- Department of Orthopedics and Trauma Surgery, Medical Faculty, University Hospital of Dusseldorf, D-40225 Dusseldorf, Germany
| | - Daniel Benjamin Abrar
- Department of Diagnostic and Interventional Radiology, Medical Faculty, University Hospital of Dusseldorf, D-40225 Dusseldorf, Germany
| | - Sven Nebelung
- Department of Diagnostic and Interventional Radiology, Medical Faculty, University Hospital of Dusseldorf, D-40225 Dusseldorf, Germany
- Department of Diagnostic and Interventional Radiology, University Hospital Aachen, D-52074 Aachen, Germany
| | - Petros Martirosian
- Department of Diagnostic and Interventional Radiology, Medical Faculty, University Hospital of Tübingen, D-72076 Tübingen, Germany
| | - Hans-Jörg Wittsack
- Department of Diagnostic and Interventional Radiology, Medical Faculty, University Hospital of Dusseldorf, D-40225 Dusseldorf, Germany
| | - Anja Müller-Lutz
- Department of Diagnostic and Interventional Radiology, Medical Faculty, University Hospital of Dusseldorf, D-40225 Dusseldorf, Germany
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van Helvoort EM, van Spil WE, Jansen MP, Welsing PMJ, Kloppenburg M, Loef M, Blanco FJ, Haugen IK, Berenbaum F, Bacardit J, Ladel CH, Loughlin J, Bay-Jensen AC, Mobasheri A, Larkin J, Boere J, Weinans HH, Lalande A, Marijnissen ACA, Lafeber FPJG. Cohort profile: The Applied Public-Private Research enabling OsteoArthritis Clinical Headway (IMI-APPROACH) study: a 2-year, European, cohort study to describe, validate and predict phenotypes of osteoarthritis using clinical, imaging and biochemical markers. BMJ Open 2020; 10:e035101. [PMID: 32723735 PMCID: PMC7389775 DOI: 10.1136/bmjopen-2019-035101] [Citation(s) in RCA: 36] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/23/2023] Open
Abstract
PURPOSE The Applied Public-Private Research enabling OsteoArthritis Clinical Headway (APPROACH) consortium intends to prospectively describe in detail, preselected patients with knee osteoarthritis (OA), using conventional and novel clinical, imaging, and biochemical markers, to support OA drug development. PARTICIPANTS APPROACH is a prospective cohort study including 297 patients with tibiofemoral OA, according to the American College of Rheumatology classification criteria. Patients were (pre)selected from existing cohorts using machine learning models, developed on data from the CHECK cohort, to display a high likelihood of radiographic joint space width (JSW) loss and/or knee pain progression. FINDINGS TO DATE Selection appeared logistically feasible and baseline characteristics of the cohort demonstrated an OA population with more severe disease: age 66.5 (SD 7.1) vs 68.1 (7.7) years, min-JSW 2.5 (1.3) vs 2.1 (1.0) mm and Knee injury and Osteoarthritis Outcome Score pain 31.3 (19.7) vs 17.7 (14.6), except for age, all: p<0.001, for selected versus excluded patients, respectively. Based on the selection model, this cohort has a predicted higher chance of progression. FUTURE PLANS Patients will visit the hospital again at 6, 12 and 24 months for physical examination, pain and general health questionnaires, collection of blood and urine, MRI scans, radiographs of knees and hands, CT scan of the knee, low radiation whole-body CT, HandScan, motion analysis and performance-based tests.After two years, data will show whether those patients with the highest probabilities for progression experienced disease progression as compared to those wit lower probabilities (model validation) and whether phenotypes/endotypes can be identified and predicted to facilitate targeted drug therapy. TRIAL REGISTRATION NUMBER NCT03883568.
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Affiliation(s)
| | - Willem E van Spil
- Rheumatology and Clinical Immunology, UMC Utrecht, Utrecht, The Netherlands
| | - Mylène P Jansen
- Rheumatology and Clinical Immunology, UMC Utrecht, Utrecht, The Netherlands
| | - Paco M J Welsing
- Rheumatology and Clinical Immunology, UMC Utrecht, Utrecht, The Netherlands
| | - Margreet Kloppenburg
- Clinical Epidemiology, Leiden University Medical Center, Leiden, The Netherlands
- Rheumatology, Leiden Universitair Medisch Centrum, Leiden, The Netherlands
| | - Marieke Loef
- Rheumatology, Leiden Universitair Medisch Centrum, Leiden, The Netherlands
| | - Francisco J Blanco
- Servicio de Reumatologia, INIBIC-Hospital Universitario A Coruña, A Coruña, Spain
| | - Ida K Haugen
- Rheumatology, Diakonhjemmet Hospital, Oslo, Norway
| | | | - Jaume Bacardit
- School of Computing Science, Newcastle University, Newcastle upon Tyne, Tyne and Wear, UK
| | | | - John Loughlin
- Musculoskeletal Research Group, Newcastle University, Newcastle upon Tyne, Tyne and Wear, UK
| | | | - Ali Mobasheri
- Regenarative Medicine, State Research Institute Center of Innovative Medicine, Vilnius, Lithuania
| | | | | | - Harrie H Weinans
- Rheumatology and Clinical Immunology, UMC Utrecht, Utrecht, The Netherlands
- Orthopaedics, Erasmus University Medical Center, Rotterdam, The Netherlands
| | - Agnes Lalande
- Institut de Recherches Internationales Servier, Suresnes, France
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Fürst D, Wirth W, Chaudhari A, Eckstein F. Layer-specific analysis of femorotibial cartilage t2 relaxation time based on registration of segmented double echo steady state (dess) to multi-echo-spin-echo (mese) images. MAGNETIC RESONANCE MATERIALS IN PHYSICS BIOLOGY AND MEDICINE 2020; 33:819-828. [PMID: 32458188 DOI: 10.1007/s10334-020-00852-6] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/26/2020] [Revised: 04/06/2020] [Accepted: 05/12/2020] [Indexed: 12/18/2022]
Abstract
OBJECTIVE To develop and validate a 3D registration approach by which double echo steady state (DESS) MR images with cartilage thickness segmentations are used to extract the cartilage transverse relaxation time (T2) from multi-echo-spin-echo (MESE) MR images, without direct segmentations for MESE. MATERIALS AND METHODS Manual DESS segmentations of 89 healthy reference knees (healthy) and 60 knees with early radiographic osteoarthritis (early ROA) from the Osteoarthritis Initiative were registered to corresponding MESE images that had independent direct T2 segmentations. For validation purposes, (a) regression analysis of deep and superficial cartilage T2 was performed and (b) between-group differences between healthy vs. early ROA knees were compared for registered vs. direct MESE analysis. RESULTS Moderate to high correlations were observed for the deep (r = 0.80) and the superficial T2 (r = 0.81), with statistically significant between-group differences (ROA vs. healthy) of + 1.4 ms (p = 0.002) vs. + 1.3 ms (p < 0.001) for registered vs. direct T2 segmentation in the deep, and + 1.3 ms (p = 0.002) vs. + 2.3 ms (p < 0.001) in the superficial layer. DISCUSSION This registration approach enables extracting cartilage T2 from MESE scans using DESS (cartilage thickness) segmentations, avoiding the need for direct MESE T2 segmentations.
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Affiliation(s)
- David Fürst
- Ludwig Boltzmann Institute for Arthritis and Rehabilitation, Paracelsus Medical University, Salzburg, Austria.
- Department of Imaging & Functional Musculoskeletal Research, Institute of Anatomy, Cell Biology, Paracelsus Medical University Salzburg & Nuremberg, Strubergasse 21, 5020, Salzburg, Austria.
- Chondrometrics GmbH, Ainring, Germany.
| | - Wolfang Wirth
- Ludwig Boltzmann Institute for Arthritis and Rehabilitation, Paracelsus Medical University, Salzburg, Austria
- Department of Imaging & Functional Musculoskeletal Research, Institute of Anatomy, Cell Biology, Paracelsus Medical University Salzburg & Nuremberg, Strubergasse 21, 5020, Salzburg, Austria
- Chondrometrics GmbH, Ainring, Germany
| | | | - Felix Eckstein
- Ludwig Boltzmann Institute for Arthritis and Rehabilitation, Paracelsus Medical University, Salzburg, Austria
- Department of Imaging & Functional Musculoskeletal Research, Institute of Anatomy, Cell Biology, Paracelsus Medical University Salzburg & Nuremberg, Strubergasse 21, 5020, Salzburg, Austria
- Chondrometrics GmbH, Ainring, Germany
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Said O, Schock J, Krämer N, Thüring J, Hitpass L, Schad P, Kuhl C, Abrar D, Truhn D, Nebelung S. An MRI-compatible varus-valgus loading device for whole-knee joint functionality assessment based on compartmental compression: a proof-of-concept study. MAGNETIC RESONANCE MATERIALS IN PHYSICS BIOLOGY AND MEDICINE 2020; 33:839-854. [PMID: 32314105 PMCID: PMC8302563 DOI: 10.1007/s10334-020-00844-6] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/29/2020] [Revised: 03/27/2020] [Accepted: 04/06/2020] [Indexed: 02/06/2023]
Abstract
OBJECTIVE Beyond static assessment, functional techniques are increasingly applied in magnetic resonance imaging (MRI) studies. Stress MRI techniques bring together MRI and mechanical loading to study knee joint and tissue functionality, yet prototypical axial compressive loading devices are bulky and complex to operate. This study aimed to design and validate an MRI-compatible pressure-controlled varus-valgus loading device that applies loading along the joint line. METHODS Following the device's thorough validation, we demonstrated proof of concept by subjecting a structurally intact human cadaveric knee joint to serial imaging in unloaded and loaded configurations, i.e. to varus and valgus loading at 7.5 kPa (= 73.5 N), 15 kPa (= 147.1 N), and 22.5 kPa (= 220.6 N). Following clinical standard (PDw fs) and high-resolution 3D water-selective cartilage (WATSc) sequences, we performed manual segmentations and computations of morphometric cartilage measures. We used CT and radiography (to quantify joint space widths) and histology and biomechanics (to assess tissue quality) as references. RESULTS We found (sub)regional decreases in cartilage volume, thickness, and mean joint space widths reflective of areal pressurization of the medial and lateral femorotibial compartments. DISCUSSION Once substantiated by larger sample sizes, varus-valgus loading may provide a powerful alternative stress MRI technique.
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Affiliation(s)
- Oliver Said
- Department of Diagnostic and Interventional Radiology, Aachen University Hospital, Aachen, Germany
| | - Justus Schock
- Department of Diagnostic and Interventional Radiology, Medical Faculty, University Hospital Düsseldorf, University Dusseldorf, Moorenstraße 5, 40225, Düsseldorf, Germany
- Institute of Computer Vision and Imaging, RWTH University Aachen, Aachen, Germany
| | - Nils Krämer
- Department of Diagnostic and Interventional Radiology, Aachen University Hospital, Aachen, Germany
| | - Johannes Thüring
- Department of Diagnostic and Interventional Radiology, Aachen University Hospital, Aachen, Germany
| | - Lea Hitpass
- Department of Diagnostic and Interventional Radiology, Aachen University Hospital, Aachen, Germany
| | - Philipp Schad
- Department of Diagnostic and Interventional Radiology, Aachen University Hospital, Aachen, Germany
| | - Christiane Kuhl
- Department of Diagnostic and Interventional Radiology, Aachen University Hospital, Aachen, Germany
| | - Daniel Abrar
- Department of Diagnostic and Interventional Radiology, Medical Faculty, University Hospital Düsseldorf, University Dusseldorf, Moorenstraße 5, 40225, Düsseldorf, Germany
| | - Daniel Truhn
- Department of Diagnostic and Interventional Radiology, Aachen University Hospital, Aachen, Germany
- Institute of Computer Vision and Imaging, RWTH University Aachen, Aachen, Germany
| | - Sven Nebelung
- Department of Diagnostic and Interventional Radiology, Medical Faculty, University Hospital Düsseldorf, University Dusseldorf, Moorenstraße 5, 40225, Düsseldorf, Germany.
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8
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Edd SN, Babel H, Kerkour N, Jolles BM, Omoumi P, Favre J. Comprehensive description of T2 value spatial variations in non-osteoarthritic femoral cartilage using three-dimensional registration of morphological and relaxometry data. Knee 2019; 26:555-563. [PMID: 31078393 DOI: 10.1016/j.knee.2019.03.006] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/05/2018] [Revised: 01/31/2019] [Accepted: 03/17/2019] [Indexed: 02/02/2023]
Abstract
PURPOSE The aim of this study was to develop and assess a method of quantifying cartilage T2 relaxation times in a series of volumes of interest (VOIs) covering the entire cartilage of the femoral condyles. Subsequently, the method was used to test for T2 spatial variations in non-osteoarthritic (OA) knees. METHODS Ten non-OA subjects (five female, average 30 years) were enrolled after informed consent. Three-dimensional bone and cartilage models were created by double echo steady state (DESS) morphological magnetic resonance image (MRI) segmentation, and the models were semi-manually registered with multi-slice, multi-echo (MSME) T2 MRI. Mean T2 values were calculated for 12 VOIs derived from cartilage thickness literature and their respective superficial and deep layers. RESULTS Analyses showed that intra- and inter-rater reliabilities of the presented method were "good" to "excellent" in more than 90% of the VOIs. Additionally, several spatial differences in T2 values were observed, including, for the medial condyle, higher T2 values in the anterior and central VOIs versus in the posterior VOI (p < .05). T2 values were also generally higher in the superficial versus deep layers (p < .05). CONCLUSIONS The presented MRI T2 analysis method is reliable and provides a comprehensive quantification of spatial heterogeneity of healthy cartilage compositional properties. This method can be further applied to better understand knee OA pathophysiology and potentially define clinically relevant diagnostic features of the disease.
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Affiliation(s)
- Shannon N Edd
- Department of Musculoskeletal Medicine (DAL), Lausanne University Hospital (CHUV), Lausanne, Switzerland.
| | - Hugo Babel
- Department of Musculoskeletal Medicine (DAL), Lausanne University Hospital (CHUV), Lausanne, Switzerland
| | - Nadia Kerkour
- Department of Diagnostic and Interventional Radiology, Lausanne University Hospital (CHUV), Lausanne, Switzerland
| | - Brigitte M Jolles
- Department of Musculoskeletal Medicine (DAL), Lausanne University Hospital (CHUV), Lausanne, Switzerland
| | - Patrick Omoumi
- Department of Diagnostic and Interventional Radiology, Lausanne University Hospital (CHUV), Lausanne, Switzerland
| | - Julien Favre
- Department of Musculoskeletal Medicine (DAL), Lausanne University Hospital (CHUV), Lausanne, Switzerland
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9
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Williams AA, Titchenal MR, Do BH, Guha A, Chu CR. MRI UTE-T2* shows high incidence of cartilage subsurface matrix changes 2 years after ACL reconstruction. J Orthop Res 2019; 37:370-377. [PMID: 30030866 DOI: 10.1002/jor.24110] [Citation(s) in RCA: 25] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/24/2018] [Accepted: 07/13/2018] [Indexed: 02/06/2023]
Abstract
Alteration of deep cartilage matrix has been observed following anterior cruciate ligament (ACL) injury, evidenced by elevated MRI UTE-T2* values measured in small, 2-D cartilage regions of interest. This Level I diagnostic study seeks to more thoroughly evaluate deep cartilage matrix changes to medial tibiofemoral UTE-T2* maps 2 years after ACL reconstruction and examine the relative utilities of 3-D compared to 2-D assessments of cartilage UTE-T2* maps. Thirty-eight ACL-reconstructed and 20 uninjured subjects underwent MRI UTE-T2* mapping. "Small" single mid-sagittal 2-D and larger 3-D "tread mark" regions of interest were manually segmented and found to be correlated in medial cartilage (r > 0.58, p < 0.005). 3-D analyses of UTE-T2* maps showed differences to medial tibial cartilage between ACL-reconstructed and uninjured subjects (p = 0.007) that were not detected by smaller 2-D regions (p > 0.46). Quantitative comparisons show 14/38 (37%) ACL-reconstructed subjects have values >2 standard deviations higher than uninjured controls. Among a subset of ACL-reconstructed subjects with no morphologic MRI evidence of medial tibiofemoral cartilage or meniscal pathology (n = 12), elevated UTE-T2* values in "small" 2-D femoral (p = 0.011), but not larger 3-D tread mark regions of interest (p > 0.13), were observed. These data show the utility of 2-D UTE-T2* assessments of mid-sagittal weight-bearing regions of medial femoral cartilage for identifying subclinical deep cartilage matrix changes 2 years after ACLR. Clinical Significance: Mid-sagittal single slice 2-D UTE-T2* mapping may be an efficient means to assess medial femoral cartilage for subsurface matrix changes early after ACL reconstruction while 3-D assessments provide additional sensitivity to changes in the medial tibial plateau. © 2018 Orthopaedic Research Society. Published by Wiley Periodicals, Inc. J Orthop Res 37:370-377, 2019.
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Affiliation(s)
- Ashley A Williams
- Department of Orthopaedic Surgery, Stanford University, 450 Broadway Street, MC 6342, Redwood City, California 94063
- Veterans Affairs Palo Alto Health Care System, Palo Alto, California
| | - Matthew R Titchenal
- Department of Orthopaedic Surgery, Stanford University, 450 Broadway Street, MC 6342, Redwood City, California 94063
- Veterans Affairs Palo Alto Health Care System, Palo Alto, California
- Department of Mechanical Engineering, Stanford University, Stanford, California
| | - Bao H Do
- Veterans Affairs Palo Alto Health Care System, Palo Alto, California
- Department of Radiology, Stanford University, Stanford, California
| | - Aditi Guha
- Department of Orthopaedic Surgery, Stanford University, 450 Broadway Street, MC 6342, Redwood City, California 94063
- Veterans Affairs Palo Alto Health Care System, Palo Alto, California
| | - Constance R Chu
- Department of Orthopaedic Surgery, Stanford University, 450 Broadway Street, MC 6342, Redwood City, California 94063
- Veterans Affairs Palo Alto Health Care System, Palo Alto, California
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Hui Mingalone CK, Liu Z, Hollander JM, Garvey KD, Gibson AL, Banks RE, Zhang M, McAlindon TE, Nielsen HC, Georgakoudi I, Zeng L. Bioluminescence and second harmonic generation imaging reveal dynamic changes in the inflammatory and collagen landscape in early osteoarthritis. J Transl Med 2018; 98:656-669. [PMID: 29540857 PMCID: PMC7735372 DOI: 10.1038/s41374-018-0040-9] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2017] [Revised: 12/12/2017] [Accepted: 12/14/2017] [Indexed: 12/28/2022] Open
Abstract
Osteoarthritis (OA) is a leading cause of chronic disability whose mechanism of pathogenesis is largely elusive. Local inflammation is thought to play a key role in OA progression, especially in injury-associated OA. While multiple inflammatory cytokines are detected, the timing and extent of overall inflammatory activities in early OA and the manner by which joint inflammation correlates with cartilage structural damage are still unclear. We induced OA via destabilization of the medial meniscus (DMM) in NFκB luciferase reporter mice, whose bioluminescent signal reflects the activity of NFκB, a central mediator of inflammation. Bioluminescence imaging data showed that DMM and sham control joints had a similar surge of inflammation at 1-week post-surgery, but the DMM joint exhibited a delay in resolution of inflammation in subsequent weeks. A similar trend was observed with synovitis, which we found to be mainly driven by synovial cell density and inflammatory infiltration rather than synovial lining thickness. Interestingly, an association between synovitis and collagen structural damage was observed in early OA. Using Second Harmonic Generation (SHG) imaging, we analyzed collagen fiber organization in articular cartilage. Zonal differences in collagen fiber thickness and organization were observed as soon as OA initiated after DMM surgery, and persisted over time. Even at 1-week post-surgery, the DMM joint showed a decrease in collagen fiber thickness in the deep zone and an increase in collagen fiber disorganization in the superficial zone. Since we were able detect and quantify collagen structural changes very early in OA development by SHG imaging, we concluded that SHG imaging is a highly sensitive tool to evaluate pathological changes in OA. In summary, this study uncovered a dynamic profile of inflammation and joint cartilage damage during OA initiation and development, providing novel insights into OA pathology.
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Affiliation(s)
- Carrie K. Hui Mingalone
- Program in Cell, Molecular, and Developmental Biology, Sackler School of Graduate Biomedical Sciences, Tufts University, Boston, MA 02111, USA
| | - Zhiyi Liu
- Department of Biomedical Engineering, Tufts University, Medford, MA 02155, USA
| | - Judith M. Hollander
- Program in Cell, Molecular, and Developmental Biology, Sackler School of Graduate Biomedical Sciences, Tufts University, Boston, MA 02111, USA
| | - Kirsten D. Garvey
- Department of Immunology, Tufts University School of Medicine, Boston, MA 02111, USA
| | - Averi L. Gibson
- Program in Cell, Molecular, and Developmental Biology, Sackler School of Graduate Biomedical Sciences, Tufts University, Boston, MA 02111, USA
| | - Rose E. Banks
- Department of Immunology, Tufts University School of Medicine, Boston, MA 02111, USA
| | - Ming Zhang
- Division of Rheumatology, Tufts Medical Center, Boston, MA 02111, USA
| | | | - Heber C. Nielsen
- Program in Cell, Molecular, and Developmental Biology, Sackler School of Graduate Biomedical Sciences, Tufts University, Boston, MA 02111, USA
| | - Irene Georgakoudi
- Department of Biomedical Engineering, Tufts University, Medford, MA 02155, USA
| | - Li Zeng
- Program in Cell, Molecular, and Developmental Biology, Sackler School of Graduate Biomedical Sciences, Tufts University, Boston, MA, 02111, USA. .,Department of Immunology, Tufts University School of Medicine, Boston, MA, 02111, USA. .,Department of Orthopaedics, Tufts Medical Center, Boston, MA, 02111, USA.
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Wirth W, Maschek S, Beringer P, Eckstein F. Subregional laminar cartilage MR spin-spin relaxation times (T2) in osteoarthritic knees with and without medial femorotibial cartilage loss - data from the Osteoarthritis Initiative (OAI). Osteoarthritis Cartilage 2017; 25:1313-1323. [PMID: 28351705 PMCID: PMC5522340 DOI: 10.1016/j.joca.2017.03.013] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/24/2016] [Revised: 02/14/2017] [Accepted: 03/17/2017] [Indexed: 02/02/2023]
Abstract
OBJECTIVE To explore whether subregional laminar femorotibial cartilage spin-spin relaxation time (T2) is associated with subsequent radiographic progression and cartilage loss and/or whether one-year change in subregional laminar femorotibial cartilage T2 is associated with concurrent progression in knees with established radiographic OA (ROA). METHODS In this case-control study, Osteoarthritis Initiative (OAI) knees with medial femorotibial progression were selected based on one-year loss in both quantitative cartilage thickness Magnetic resonance imaging (MRI) and radiographic joint space width (JSW). Non-progressor knees were matched by sex, Body mass index (BMI), baseline Kellgren-Lawrence-grade (2/3), and pain. Baseline and one-year follow-up superficial and deep cartilage T2 was analyzed in 16 femorotibial subregions using multi-echo spin-echo MRI. RESULTS 37 knees showed medial femorotibial progression whereas 37 matched controls had no medial or lateral compartment progression. No statistically significant baseline differences between progressor and non-progressor knees in medial femorotibial cartilage T2 were observed in the superficial (48.9 ± 3.0 ms; 95% CI: [47.9, 49.9] vs 47.8 ± 3.6 ms; 95% CI: [46.6, 49.0], P = 0.07) or deep cartilage layer (40.8 ± 3.6 ms; 95% CI: [39.5, 42.0] vs 40.1 ± 4.7 ms; 95% CI: [38.5, 41.6], P = 0.29). Concurrent T2 change was more pronounced in the deep than the superficial cartilage layer. In the medial femorotibial compartment (MFTC), longitudinal change was greater in the deep layer of progressor than non-progressor knees (1.8 ± 4.5 ms; 95% CI: [0.3, 3.3] vs -0.2 ± 1.9 ms; 95% CI: [-0.8, 0.5], P = 0.02), whereas no difference was observed in the superficial layer. CONCLUSION Medial compartment cartilage T2 did not appear to be a strong prognostic factor for subsequent structural progression in the same compartment of knees with established ROA, when appropriately controlling for covariates. Yet, deep layer T2 change in the medial compartment occurred concurrent with medial femorotibial progression.
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Affiliation(s)
- W. Wirth
- Institute of Anatomy, Paracelsus Medical University Salzburg & Nuremberg, Salzburg, Austria,Chondrometris GmbH, Ainring, Germany
| | - S. Maschek
- Institute of Anatomy, Paracelsus Medical University Salzburg & Nuremberg, Salzburg, Austria,Chondrometris GmbH, Ainring, Germany
| | - P. Beringer
- Institute of Anatomy, Paracelsus Medical University Salzburg & Nuremberg, Salzburg, Austria
| | - F. Eckstein
- Institute of Anatomy, Paracelsus Medical University Salzburg & Nuremberg, Salzburg, Austria,Chondrometris GmbH, Ainring, Germany
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Colotti R, Omoumi P, Bonanno G, Ledoux JB, van Heeswijk RB. Isotropic three-dimensionalT2mapping of knee cartilage: Development and validation. J Magn Reson Imaging 2017; 47:362-371. [DOI: 10.1002/jmri.25755] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2017] [Accepted: 04/18/2017] [Indexed: 12/25/2022] Open
Affiliation(s)
- Roberto Colotti
- Department of Radiology; University Hospital (CHUV) and University of Lausanne (UNIL); Lausanne Switzerland
| | - Patrick Omoumi
- Department of Radiology; University Hospital (CHUV) and University of Lausanne (UNIL); Lausanne Switzerland
| | - Gabriele Bonanno
- Department of Radiology; University Hospital (CHUV) and University of Lausanne (UNIL); Lausanne Switzerland
- Division of Cardiology, Department of Medicine; Johns Hopkins University; Baltimore Maryland USA
- Division of MR Research, Russell Morgan Department of Radiology and Radiological Sciences; Johns Hopkins University; Baltimore Maryland USA
| | - Jean-Baptiste Ledoux
- Department of Radiology; University Hospital (CHUV) and University of Lausanne (UNIL); Lausanne Switzerland
- Centre for Biomedical Imaging (CIBM); Lausanne Switzerland
| | - Ruud B. van Heeswijk
- Department of Radiology; University Hospital (CHUV) and University of Lausanne (UNIL); Lausanne Switzerland
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