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Li X, Kim J, Yang M, Ok AH, Zbýň Š, Link TM, Majumdar S, Ma CB, Spindler KP, Winalski CS. Cartilage compositional MRI-a narrative review of technical development and clinical applications over the past three decades. Skeletal Radiol 2024; 53:1761-1781. [PMID: 38980364 PMCID: PMC11303573 DOI: 10.1007/s00256-024-04734-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/19/2023] [Revised: 06/11/2024] [Accepted: 06/13/2024] [Indexed: 07/10/2024]
Abstract
Articular cartilage damage and degeneration are among hallmark manifestations of joint injuries and arthritis, classically osteoarthritis. Cartilage compositional MRI (Cart-C MRI), a quantitative technique, which aims to detect early-stage cartilage matrix changes that precede macroscopic alterations, began development in the 1990s. However, despite the significant advancements over the past three decades, Cart-C MRI remains predominantly a research tool, hindered by various technical and clinical hurdles. This paper will review the technical evolution of Cart-C MRI, delve into its clinical applications, and conclude by identifying the existing gaps and challenges that need to be addressed to enable even broader clinical application of Cart-C MRI.
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Affiliation(s)
- Xiaojuan Li
- Program of Advanced Musculoskeletal Imaging (PAMI), Cleveland Clinic, 9500 Euclid Avenue, ND20, Cleveland, OH, 44195, USA.
- Department of Biomedical Engineering, Lerner Research Institute, Cleveland Clinic, Cleveland, OH, USA.
- Department of Diagnostic Radiology, Cleveland Clinic, Cleveland, OH, USA.
| | - Jeehun Kim
- Program of Advanced Musculoskeletal Imaging (PAMI), Cleveland Clinic, 9500 Euclid Avenue, ND20, Cleveland, OH, 44195, USA
- Department of Biomedical Engineering, Lerner Research Institute, Cleveland Clinic, Cleveland, OH, USA
| | - Mingrui Yang
- Program of Advanced Musculoskeletal Imaging (PAMI), Cleveland Clinic, 9500 Euclid Avenue, ND20, Cleveland, OH, 44195, USA
- Department of Biomedical Engineering, Lerner Research Institute, Cleveland Clinic, Cleveland, OH, USA
| | - Ahmet H Ok
- Program of Advanced Musculoskeletal Imaging (PAMI), Cleveland Clinic, 9500 Euclid Avenue, ND20, Cleveland, OH, 44195, USA
- Department of Biomedical Engineering, Lerner Research Institute, Cleveland Clinic, Cleveland, OH, USA
- Department of Diagnostic Radiology, Cleveland Clinic, Cleveland, OH, USA
| | - Štefan Zbýň
- Program of Advanced Musculoskeletal Imaging (PAMI), Cleveland Clinic, 9500 Euclid Avenue, ND20, Cleveland, OH, 44195, USA
- Department of Biomedical Engineering, Lerner Research Institute, Cleveland Clinic, Cleveland, OH, USA
- Department of Diagnostic Radiology, Cleveland Clinic, Cleveland, OH, USA
| | - Thomas M Link
- Department of Radiology and Biomedical Imaging, University of California San Francisco (UCSF), San Francisco, CA, USA
| | - Sharmilar Majumdar
- Department of Radiology and Biomedical Imaging, University of California San Francisco (UCSF), San Francisco, CA, USA
| | - C Benjamin Ma
- Department of Orthopaedic Surgery, UCSF, San Francisco, CA, USA
| | - Kurt P Spindler
- Program of Advanced Musculoskeletal Imaging (PAMI), Cleveland Clinic, 9500 Euclid Avenue, ND20, Cleveland, OH, 44195, USA
- Department of Orthopaedic Surgery, Cleveland Clinic, Cleveland, OH, USA
| | - Carl S Winalski
- Program of Advanced Musculoskeletal Imaging (PAMI), Cleveland Clinic, 9500 Euclid Avenue, ND20, Cleveland, OH, 44195, USA
- Department of Biomedical Engineering, Lerner Research Institute, Cleveland Clinic, Cleveland, OH, USA
- Department of Diagnostic Radiology, Cleveland Clinic, Cleveland, OH, USA
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Toguchi K, Watanabe A, Horii M, Watanabe S, Itoh R, Sakamoto T, Murata Y, Ohtori S, Sasho T. Longitudinal Analysis of Knee Articular Cartilage Degeneration After Anterior Cruciate Ligament Reconstruction: Comparison of T1rho and T2 Mapping. Cartilage 2024:19476035241264013. [PMID: 39058092 DOI: 10.1177/19476035241264013] [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: 07/28/2024] Open
Abstract
OBJECTIVE To assess articular cartilage degeneration in anterior cruciate ligament (ACL) reconstructed knees as detected by MR T1rho and T2 mapping relative to controls and longitudinally at 3 months and 1 year after ACL reconstruction (ACLR). DESIGN Twenty-five patients with acute ACL injury were enrolled (13 women and 12 men; mean age 30.8), and 14 healthy controls were selected by sex and age matching. The affected knees of the ACLR participants were imaged using a 3.0T magnetic resonance (MR) scanner 3 months and 1 year after ACLR. Cartilage T1rho and T2 values were quantified for subcompartments in the full-thickness, superficial, and deep layers and were compared with the matched subcompartments of control knees. The influence of concomitant meniscal tears identified using proton density-weighted imaging (PDWI) was also investigated. RESULTS In the posterior lateral tibia, T1rho and T2 values were significantly higher in ACLR participants at 3 months and slightly decreased at 1-year compared to the control group. T1rho values in the medial compartment exhibited a significant increase at 1-year compared with those of control knees, while T2 showed no significance. In cartilage with medial meniscal tears, the T1rho values in multiple medial subcompartments were significantly higher than those in cartilage without medial meniscal tears, and this alteration was relatively detectable by T1rho. CONCLUSIONS T1rho and T2 mapping is effective in evaluating cartilage degeneration following ACLR. T1rho may exhibit greater sensitivity for assessing the progression of early degeneration in the medial compartment after ACLR.
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Affiliation(s)
- Kaoru Toguchi
- Department of Orthopaedic Surgery, Graduate School of Medicine, Chiba University, Chiba, Japan
| | - Atsuya Watanabe
- Osteoarthritis Center, Medical Corporation Jyunhokai, Chiba, Japan
| | - Manato Horii
- Department of Orthopaedic Surgery, Graduate School of Medicine, Chiba University, Chiba, Japan
| | - Shotaro Watanabe
- Department of Orthopaedic Surgery, Graduate School of Medicine, Chiba University, Chiba, Japan
| | - Ryu Itoh
- Department of Orthopaedic Surgery, Graduate School of Medicine, Chiba University, Chiba, Japan
| | - Takuya Sakamoto
- Department of Orthopaedic Surgery, Graduate School of Medicine, Chiba University, Chiba, Japan
| | - Yasuaki Murata
- Department of Orthopaedic Surgery, Teikyo University Chiba Medical Center, Chiba, Japan
| | - Seiji Ohtori
- Department of Orthopaedic Surgery, Graduate School of Medicine, Chiba University, Chiba, Japan
- Center for Preventive Medical Sciences, Chiba University, Chiba, Japan
| | - Takahisa Sasho
- Department of Orthopaedic Surgery, Graduate School of Medicine, Chiba University, Chiba, Japan
- Center for Preventive Medical Sciences, Chiba University, Chiba, Japan
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Eckstein F, Brisson NM, Maschek S, Wisser A, Berenbaum F, Duda GN, Wirth W. Clinical validation of fully automated laminar knee cartilage transverse relaxation time (T2) analysis in anterior cruciate ligament (ACL)-injured knees- on behalf of the osteoarthritis (OA)-Bio consortium. Quant Imaging Med Surg 2024; 14:4319-4332. [PMID: 39022226 PMCID: PMC11250285 DOI: 10.21037/qims-24-194] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2024] [Accepted: 05/06/2024] [Indexed: 07/20/2024]
Abstract
Background Magnetic resonance imaging (MRI) cartilage transverse relaxation time (T2) reflects cartilage composition, mechanical properties, and early osteoarthritis (OA). T2 analysis requires cartilage segmentation. In this study, we clinically validate fully automated T2 analysis at 1.5 Tesla (T) in anterior cruciate ligament (ACL)-injured and healthy knees. Methods We studied 71 participants: 20 ACL-injured patients with, and 22 without dynamic knee instability, 13 with surgical reconstruction, and 16 healthy controls. Sagittal multi-echo-spin-echo (MESE) MRIs were acquired at baseline and 1-year follow-up. Femorotibial cartilage was segmented manually; a convolutional neural network (CNN) algorithm was trained on MRI data from the same scanner. Results Dice similarity coefficients (DSCs) of automated versus manual segmentation in the 71 participants were 0.83 (femora) and 0.89 (tibiae). Deep femorotibial T2 was similar between automated (45.7±2.6 ms) and manual (45.7±2.7 ms) segmentation (P=0.828), whereas superficial layer T2 was slightly overestimated by automated analysis (53.2±2.2 vs. 52.1±2.1 ms for manual; P<0.001). T2 correlations were r=0.91-0.99 for deep and r=0.86-0.97 for superficial layers across regions. The only statistically significant T2 increase over 1 year was observed in the deep layer of the lateral femur [standardized response mean (SRM) =0.58 for automated vs. 0.52 for manual analysis; P<0.001]. There was no relevant difference in baseline/longitudinal T2 values/changes between the ACL-injured groups and healthy participants, with either segmentation method. Conclusions This clinical validation study suggests that automated cartilage T2 analysis from MESE at 1.5T is technically feasible and accurate. More efficient 3D sequences and longer observation intervals may be required to detect the impact of ACL injury induced joint instability on cartilage composition (T2).
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Affiliation(s)
- Felix Eckstein
- Chondrometrics GmbH, Freilassing, Germany
- Research Program for Musculoskeletal Imaging, Center for Anatomy and Cell Biology & Ludwig Boltzmann Institute for Arthritis and Rehabilitation (LBIAR), Paracelsus Medical University, Salzburg, Austria
| | - Nicholas M. Brisson
- Julius Wolff Institute, Berlin Institute of Health at Charité – Universitätsmedizin Berlin, Berlin, Germany
- Berlin Movement Diagnostics (BeMoveD), Center for Musculoskeletal Surgery, Charité – Universitätsmedizin Berlin, Berlin, Germany
| | | | - Anna Wisser
- Chondrometrics GmbH, Freilassing, Germany
- Research Program for Musculoskeletal Imaging, Center for Anatomy and Cell Biology & Ludwig Boltzmann Institute for Arthritis and Rehabilitation (LBIAR), Paracelsus Medical University, Salzburg, Austria
| | - Francis Berenbaum
- Moving Biotech, Lille, France
- Department of Rheumatology, Sorbonne University, INSERM, AP-HP, Saint-Antoine Hospital, Paris, France
| | - Georg N. Duda
- Julius Wolff Institute, Berlin Institute of Health at Charité – Universitätsmedizin Berlin, Berlin, Germany
- Berlin Movement Diagnostics (BeMoveD), Center for Musculoskeletal Surgery, Charité – Universitätsmedizin Berlin, Berlin, Germany
| | - Wolfgang Wirth
- Chondrometrics GmbH, Freilassing, Germany
- Research Program for Musculoskeletal Imaging, Center for Anatomy and Cell Biology & Ludwig Boltzmann Institute for Arthritis and Rehabilitation (LBIAR), Paracelsus Medical University, Salzburg, Austria
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Quantitative evaluation of the tibiofemoral joint cartilage by T2 mapping in patients with acute anterior cruciate ligament injury vs contralateral knees: results from the subacute phase using data from the NACOX study cohort. Osteoarthritis Cartilage 2022; 30:987-997. [PMID: 35421548 DOI: 10.1016/j.joca.2022.02.623] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/24/2021] [Revised: 02/03/2022] [Accepted: 02/09/2022] [Indexed: 02/02/2023]
Abstract
OBJECTIVE Immediate cartilage structural alterations in the acute phase after an anterior cruciate ligament (ACL) rupture may be a precursor to posttraumatic osteoarthritis (PTOA) development. Our aim was to describe changes in cartilage matrix in the subacute phase of the acutely ACL-injured knee compared to the contralateral uninjured knee. DESIGN Participants (n = 118) aged 15-40 years with an acute ACL injury were consecutively included in subacute phase after acute ACL-injury and underwent MRI (mean 29 days post trauma) of both knees. Mean T2 relaxation times, T2 spatial coefficient of variation and cartilage thickness were determined for different regions of the tibiofemoral cartilage. Differences between the acutely ACL-injured and uninjured knee were evaluated using Wilcoxon signed-rank test. RESULTS T2 relaxation time in injured knees was increased in multiple cartilage regions from both medial and lateral compartment compared to contralateral knees, mostly in medial trochlea and posterior tibia (P-value<0.001). In the same sites of injured knees, we observed significantly thinner cartilage. Moreover, injured knees presented shorter T2 relaxation time in superficial cartilage on lateral central femur and trochlea (P-value<0.001), and decreased T2 spatial coefficient of variation in lateral trochlea and load bearing regions of medial-central femoral condyle and central tibia in both compartments. CONCLUSION Small but statistically significant differences were observed in the subacute phase between ACL-injured and uninjured knee in cartilage T2 relaxation time and cartilage thickness. Future longitudinal observations of the same cohort will allow for better understanding of early development of PTOA. TRIAL REGISTRATION NUMBER NCT02931084.
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Wellsandt E, Kallman T, Golightly Y, Podsiadlo D, Dudley A, Vas S, Michaud K, Tao M, Sajja B, Manzer M. Knee joint unloading and daily physical activity associate with cartilage T2 relaxation times 1 month after ACL injury. J Orthop Res 2022; 40:138-149. [PMID: 33783030 PMCID: PMC8478972 DOI: 10.1002/jor.25034] [Citation(s) in RCA: 13] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/23/2020] [Revised: 02/14/2021] [Accepted: 03/10/2021] [Indexed: 02/04/2023]
Abstract
Osteoarthritis (OA) is prevalent after anterior cruciate ligament (ACL) injury, but mechanismsunderlying its development are poorly understood. The purpose of this study was to determine if gait biomechanics and daily physical activity (PA) associate with cartilage T2 relaxation times, a marker of collagen organization and water content, 1 month after ACL injury. Twenty-seven participants (15-35 years old) without chondral lesions completed magnetic resonance imaging, three-dimensional gait analysis, and 1 week of PA accelerometry. Interlimb differences and ratios were calculated for gait biomechanics and T2 relaxation times, respectively. Multiple linear regression models adjusted for age, sex, and concomitant meniscus injury were used to determine the association between gait biomechanics and PA with T2 relaxation times, respectively. Altered knee adduction moment (KAM) impulse, less knee flexion excursion (kEXC) and higher daily step counts accounted for 35.8%-65.8% of T2 relaxation time variation in the weightbearing and posterior cartilage of the medial and lateral compartment (all p ≤ .011). KAM impulse was the strongest factor for T2 relaxation times in all models (all p ≤ .001). Lower KAM impulse associated with longer T2 relaxation times in the injured medial compartment (β = -.720 to -.901) and shorter T2 relaxation in the lateral compartment (β = .713 to .956). At 1 month after ACL injury, altered KAM impulse, less kEXC, and higher PA associated with longer T2 relaxation times, which may indicate poorer cartilage health. Statement of Clinical Significance: Gait biomechanics and daily PA are modifiable targets that may improve cartilage health acutely after ACL injury and slow progression to OA.
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Affiliation(s)
- Elizabeth Wellsandt
- Division of Physical Therapy Education, University of Nebraska Medical Center, Omaha, Nebraska, USA,Department of Orthopedic Surgery and Rehabilitation, University of Nebraska Medical Center, Omaha, Nebraska, USA
| | - Tyler Kallman
- College of Medicine, University of Nebraska Medical Center, Omaha, Nebraska, USA
| | - Yvonne Golightly
- Department of Epidemiology, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA,Thurston Arthritis Research Center, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA,Division of Physical Therapy, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA,Injury Prevention Research Center, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
| | - Daniel Podsiadlo
- Division of Physical Therapy Education, University of Nebraska Medical Center, Omaha, Nebraska, USA
| | - Andrew Dudley
- Department of Genetics Cell Biology and Anatomy, University of Nebraska Medical Center, Omaha, Nebraska, USA
| | - Stephanie Vas
- Department of Clinical Diagnostic and Therapeutic Sciences, University of Nebraska Medical Center, Omaha, Nebraska, USA
| | - Kaleb Michaud
- Department of Internal Medicine, University of Nebraska Medical Center, Omaha, Nebraska, USA,Forward, The National Databank for Rheumatic Diseases, Wichita, Kansas, USA
| | - Matthew Tao
- Division of Physical Therapy Education, University of Nebraska Medical Center, Omaha, Nebraska, USA,Department of Orthopedic Surgery and Rehabilitation, University of Nebraska Medical Center, Omaha, Nebraska, USA
| | - Balasrinivasa Sajja
- Department of Radiology, University of Nebraska Medical Center, Omaha, Nebraska, USA
| | - Melissa Manzer
- Department of Radiology, University of Nebraska Medical Center, Omaha, Nebraska, USA
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6
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Larson D, Vu V, Ness BM, Wellsandt E, Morrison S. A Multi-Systems Approach to Human Movement after ACL Reconstruction: The Musculoskeletal System. Int J Sports Phys Ther 2021; 17:27-46. [PMID: 35237463 PMCID: PMC8856762 DOI: 10.26603/001c.29456] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Abstract
Several negative adaptations to the musculoskeletal system occur following anterior cruciate ligament (ACL) injury and ACL reconstruction (ACLR) such as arthrogenic muscle inhibition, decreased lower extremity muscle size, strength, power, as well as alterations to bone and cartilage. These changes have been associated with worse functional outcomes, altered biomechanics, and increased risk for re-injury and post-traumatic osteoarthritis. After ACL injury and subsequent ACLR, examination and evaluation of the musculoskeletal system is paramount to guiding clinical decision making during the rehabilitation and the return to sport process. The lack of access many clinicians have to devices necessary for gold standard assessment of muscle capacities and force profiles is often perceived as a significant barrier to best practices. Fortunately, testing for deficits can be accomplished with methods available to the clinician without access to costly equipment or time-intensive procedures. Interventions to address musculoskeletal system deficits can be implemented with a periodized program. This allows for restoration of physical capacities by adequately developing and emphasizing physical qualities beginning with mobility and movement, and progressing to work capacity and neuromuscular re-education, strength, explosive strength, and elastic or reactive strength. Additional considerations to aid in addressing strength deficits will be discussed such as neuromuscular electrical stimulation, volume and intensity, eccentric training, training to failure, cross-education, and biomechanical considerations. The American Physical Therapy Association adopted a new vision statement in 2013 which supported further development of the profession's identity by promoting the movement system, yet validation of the movement system has remained a challenge. Application of a multi-physiologic systems approach may offer a unique understanding of the musculoskeletal system and its integration with other body systems after ACLR. The purpose of this clinical commentary is to highlight important musculoskeletal system considerations within a multi-physiologic system approach to human movement following ACLR. LEVEL OF EVIDENCE 5.
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Affiliation(s)
| | - Vien Vu
- Samaritan Athletic Medicine; Oregon State University Athletics Department
| | - Brandon M Ness
- Doctor of Physical Therapy Program, Tufts University School of Medicine
| | - Elizabeth Wellsandt
- Division of Physical Therapy Education, University of Nebraska Medical Center; Department of Orthopaedic Surgery and Rehabilitation, University of Nebraska Medical Center
| | - Scot Morrison
- PhysioPraxis PLLC; Department of Neuroscience, Biomedicine and Movement Sciences, University of Verona
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7
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Fernquest S, Palmer A, Gammer B, Hirons E, Kendrick B, Taylor A, De Berker H, Bangerter N, Carr A, Glyn-Jones S. Compositional MRI of the Hip: Reproducibility, Effect of Joint Unloading, and Comparison of T2 Relaxometry with Delayed Gadolinium-Enhanced Magnetic Resonance Imaging of Cartilage. Cartilage 2021; 12:418-430. [PMID: 30971110 PMCID: PMC8461155 DOI: 10.1177/1947603519841670] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/05/2023] Open
Abstract
OBJECTIVE Our aim was to compare T2 with delayed gadolinium-enhanced magnetic resonance imaging of cartilage (dGEMRIC) in the hip and assess the reproducibility and effect of joint unloading on T2 mapping. DESIGN Ten individuals at high risk of developing hip osteoarthritis (SibKids) underwent contemporaneous T2 mapping and dGEMRIC in the hip (10 hips). Twelve healthy volunteers underwent T2 mapping of both hips (24 hips) at time points 25, 35, 45, and 55 minutes post offloading. Acetabular and femoral cartilage was manually segmented into regions of interest. The relationship between T2 and dGEMRIC values from anatomically corresponding regions of interests was quantified using Pearson's correlation. The reproducibility of image analysis for T2 and dGEMRIC, and reproducibility of image acquisition for T2, was quantified using the intraclass correlation coefficient (ICC), root mean square coefficient of variance (RMSCoV), smallest detectable difference (SDD), and Bland-Altman plots. The paired t test was used to determine if difference existed in T2 values at different unloading times. RESULTS T2 values correlated most strongly with dGEMRIC values in diseased cartilage (r = -0.61, P = <0.001). T2 image analysis (segmentation) reproducibility was ICC = 0.96 to 0.98, RMSCoV = 3.5% to 5.2%, and SDD = 2.2 to 3.5 ms. T2 values at 25 minutes unloading were not significantly different to longer unloading times (P = 0.132). SDD for T2 image acquisition reproducibility was 7.1 to 7.4 ms. CONCLUSIONS T2 values in the hip correlate well with dGEMRIC in areas of cartilage damage. T2 shows high reproducibility and values do not change beyond 25 minutes of joint unloading.
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Affiliation(s)
- Scott Fernquest
- Botnar Research Centre, Nuffield Department of Orthopaedics, Rheumatology, and Musculoskeletal Sciences, University of Oxford, Oxford, UK,Scott Fernquest, Botnar Research Centre, Old Road, Oxford OX3 7LD, UK.
| | - Antony Palmer
- Botnar Research Centre, Nuffield Department of Orthopaedics, Rheumatology, and Musculoskeletal Sciences, University of Oxford, Oxford, UK
| | - Bonnie Gammer
- Botnar Research Centre, Nuffield Department of Orthopaedics, Rheumatology, and Musculoskeletal Sciences, University of Oxford, Oxford, UK
| | - Emma Hirons
- Botnar Research Centre, Nuffield Department of Orthopaedics, Rheumatology, and Musculoskeletal Sciences, University of Oxford, Oxford, UK
| | - Benjamin Kendrick
- Botnar Research Centre, Nuffield Department of Orthopaedics, Rheumatology, and Musculoskeletal Sciences, University of Oxford, Oxford, UK
| | - Adrian Taylor
- Botnar Research Centre, Nuffield Department of Orthopaedics, Rheumatology, and Musculoskeletal Sciences, University of Oxford, Oxford, UK
| | - Henry De Berker
- Botnar Research Centre, Nuffield Department of Orthopaedics, Rheumatology, and Musculoskeletal Sciences, University of Oxford, Oxford, UK
| | - Neal Bangerter
- Electrical and Computer Engineering Department, Brigham Young University, Provo, UT, USA
| | - Andrew Carr
- Botnar Research Centre, Nuffield Department of Orthopaedics, Rheumatology, and Musculoskeletal Sciences, University of Oxford, Oxford, UK
| | - Sion Glyn-Jones
- Botnar Research Centre, Nuffield Department of Orthopaedics, Rheumatology, and Musculoskeletal Sciences, University of Oxford, Oxford, UK
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Song K, Wikstrom EA. Plausible mechanisms of and techniques to assess ankle joint degeneration following lateral ankle sprains: a narrative review. PHYSICIAN SPORTSMED 2019; 47:275-283. [PMID: 30739572 DOI: 10.1080/00913847.2019.1581511] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Abstract
Lateral ankle sprain (LAS) is the most common lower extremity musculoskeletal injury sustained during daily life and sport. The cascade of events that starts with ligamentous trauma leads to clinical manifestations such as recurrent sprains and giving way episodes, hallmark characteristics of chronic ankle instability (CAI). The sequelae of lateral ankle sprains and CAI appear to contribute to aberrant biomechanics. Combined, joint trauma and aberrant biomechanics appear to directly and/or indirectly play a role in talar cartilage degeneration. Up to 80% of all cases of ankle osteoarthritis (OA) are post-traumatic in nature and common etiologies for ankle post-traumatic osteoarthritis (PTOA) are histories of a single and recurrent ankle sprains. Despite known links between LAS, CAI, and PTOA and evidence demonstrating the burden of LAS and its sequelae, early pathoetiological changes of ankle PTOA and how they can be assessed are poorly understood. Therefore, the purpose of this paper is to review the plausible mechanistic links among LAS and its sequelae of CAI and PTOA as well as review non-surgical techniques that can quantify talar cartilage health. Understanding the pathway from ligamentous ankle injury to ankle PTOA is vital to developing theoretically sound therapeutic interventions aimed at slowing ankle PTOA progression. Further, directly assessing talar cartilage health non-surgically provides opportunities to quantify if current and novel intervention strategies are able to slow the progression of ankle PTOA.
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Affiliation(s)
- Kyeongtak Song
- Department of Exercise & Sport Science, University of North Carolina at Chapel Hill , Chapel Hill , NC , USA.,Human Movement Science Curriculum, University of North Carolina at Chapel Hill , Chapel Hill , NC , USA
| | - Erik A Wikstrom
- Department of Exercise & Sport Science, University of North Carolina at Chapel Hill , Chapel Hill , NC , USA
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9
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Chu CR. Concepts Important to Secondary Prevention of Posttraumatic Osteoarthritis. J Athl Train 2019; 54:987-988. [PMID: 31437015 DOI: 10.4085/1062-6050-54.082] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Affiliation(s)
- Constance R Chu
- Department of Orthopaedic Surgery, Stanford University School of Medicine, Redwood City, CA
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10
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Atkinson HF, Birmingham TB, Moyer RF, Yacoub D, Kanko LE, Bryant DM, Thiessen JD, Thompson RT. MRI T2 and T1ρ relaxation in patients at risk for knee osteoarthritis: a systematic review and meta-analysis. BMC Musculoskelet Disord 2019; 20:182. [PMID: 31039785 PMCID: PMC6492327 DOI: 10.1186/s12891-019-2547-7] [Citation(s) in RCA: 53] [Impact Index Per Article: 10.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/07/2019] [Accepted: 03/28/2019] [Indexed: 12/19/2022] Open
Abstract
Background Magnetic resonance imaging (MRI) T2 and T1ρ relaxation are increasingly being proposed as imaging biomarkers potentially capable of detecting biochemical changes in articular cartilage before structural changes are evident. We aimed to: 1) summarize MRI methods of published studies investigating T2 and T1ρ relaxation time in participants at risk for but without radiographic knee OA; and 2) compare T2 and T1ρ relaxation between participants at-risk for knee OA and healthy controls. Methods We conducted a systematic review of studies reporting T2 and T1ρ relaxation data that included both participants at risk for knee OA and healthy controls. Participant characteristics, MRI methodology, and T1ρ and T2 relaxation data were extracted. Standardized mean differences (SMDs) were calculated within each study. Pooled effect sizes were then calculated for six commonly segmented knee compartments. Results 55 articles met eligibility criteria. There was considerable variability between scanners, coils, software, scanning protocols, pulse sequences, and post-processing. Moderate risk of bias due to lack of blinding was common. Pooled effect sizes indicated participants at risk for knee OA had lengthened T2 relaxation time in all compartments (SMDs from 0.33 to 0.74; p < 0.01) and lengthened T1ρ relaxation time in the femoral compartments (SMD from 0.35 to 0.40; p < 0.001). Conclusions T2 and T1ρ relaxation distinguish participants at risk for knee OA from healthy controls. Greater standardization of MRI methods is both warranted and required for progress towards biomarker validation. Electronic supplementary material The online version of this article (10.1186/s12891-019-2547-7) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Hayden F Atkinson
- School of Physical Therapy, Faculty of Health Sciences, University of Western Ontario, London, Ontario, Canada.,Wolf Orthopaedic Biomechanics Laboratory, Fowler Kennedy Sport Medicine Clinic, University of Western Ontario, London, Ontario, Canada.,Bone and Joint Institute, University of Western Ontario, London, Ontario, Canada
| | - Trevor B Birmingham
- School of Physical Therapy, Faculty of Health Sciences, University of Western Ontario, London, Ontario, Canada. .,Wolf Orthopaedic Biomechanics Laboratory, Fowler Kennedy Sport Medicine Clinic, University of Western Ontario, London, Ontario, Canada. .,Bone and Joint Institute, University of Western Ontario, London, Ontario, Canada. .,Musculoskeletal Rehabilitation, Elborn College, University of Western Ontario, London, Ontario, N6G 1H1, Canada.
| | - Rebecca F Moyer
- Bone and Joint Institute, University of Western Ontario, London, Ontario, Canada.,School of Physiotherapy, Faculty of Health, Dalhousie University, Halifax, Nova Scotia, Canada
| | - Daniel Yacoub
- Faculty of Health Sciences, University of Western Ontario, London, Ontario, Canada
| | - Lauren E Kanko
- School of Physical Therapy, Faculty of Health Sciences, University of Western Ontario, London, Ontario, Canada.,Wolf Orthopaedic Biomechanics Laboratory, Fowler Kennedy Sport Medicine Clinic, University of Western Ontario, London, Ontario, Canada.,Bone and Joint Institute, University of Western Ontario, London, Ontario, Canada
| | - Dianne M Bryant
- School of Physical Therapy, Faculty of Health Sciences, University of Western Ontario, London, Ontario, Canada.,Wolf Orthopaedic Biomechanics Laboratory, Fowler Kennedy Sport Medicine Clinic, University of Western Ontario, London, Ontario, Canada.,Bone and Joint Institute, University of Western Ontario, London, Ontario, Canada
| | - Jonathan D Thiessen
- Schulich School of Medicine and Dentistry, University of Western Ontario, London, Ontario, Canada.,Imaging Program, Lawson Health Research Institute, London, Ontario, Canada
| | - R Terry Thompson
- Schulich School of Medicine and Dentistry, University of Western Ontario, London, Ontario, Canada.,Imaging Program, Lawson Health Research Institute, London, Ontario, Canada
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Combined morphological and functional liver MRI using spin-lattice relaxation in the rotating frame (T1ρ) in conjunction with Gadoxetic Acid-enhanced MRI. Sci Rep 2019; 9:2083. [PMID: 30765741 PMCID: PMC6375916 DOI: 10.1038/s41598-018-37689-y] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2018] [Accepted: 12/12/2018] [Indexed: 12/13/2022] Open
Abstract
Noninvasive early detection of liver cirrhosis and fibrosis is essential for management and therapy. The aim was to investigated whether a combination of the functional parameter relative enhancement (RE) on Gadoxetic Acid magnetic resonance imaging (Gd-EOB-DTPA-enhanced MRI) and the fibrosis parameter T1ρ distinguishes cirrhosis and healthy liver. We analyzed patients with Gd-EOB-DTPA-enhanced MRI and T1ρ mapping. Signal intensity was measured before and after contrast; RE was calculated. T1ρ was measured with circular regions of interest (T1ρ-cROI). A quotient of RE and T1ρ-cROI was calculated: the fibrosis function quotient (FFQ). Cirrhosis was evaluated based on morphology and secondary changes. 213 datasets were included. The difference between cirrhotic and noncirrhotic liver was 51.11 ms vs. 47.56 ms for T1ρ-cROI (p < 0.001), 0.59 vs. 0.70 for RE (p < 0.001), and 89.53 vs. 70.83 for FFQ (p < 0.001). T1ρ-cROI correlated with RE, r = −0.14 (p < 0.05). RE had an AUC of 0.73. The largest AUC had the FFQ with 0.79. The best cutoff value was 48.34 ms for T1ρ-cROI, 0.70 for RE and 78.59 ms for FFQ. In conclusion T1ρ and RE can distinguish between cirrhotic and noncirrhotic liver. The FFQ, which is the combination of the two, improves diagnostic performance.
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Wellsandt E, Axe MJ, Snyder-Mackler L. Poor Performance on Single-Legged Hop Tests Associated With Development of Posttraumatic Knee Osteoarthritis After Anterior Cruciate Ligament Injury. Orthop J Sports Med 2018; 6:2325967118810775. [PMID: 30505875 PMCID: PMC6259076 DOI: 10.1177/2325967118810775] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/31/2022] Open
Abstract
Background The risk for knee osteoarthritis (OA) is substantially increased after anterior cruciate ligament (ACL) injury. Tools are needed to identify characteristics of patients after ACL injury who are most at risk for posttraumatic OA. Purpose To determine whether clinical measures of knee function after ACL injury are associated with the development of radiographic knee OA 5 years after injury. Study Design Cohort study; Level of evidence, 2. Methods A total of 76 athletes (mean age, 28.7 ± 11.3 years; 35.5% female) with ACL injury were included. Clinical measures of knee function (quadriceps strength, single-legged hop tests, patient-reported outcomes) were assessed after initial impairment resolution (baseline), after 10 additional preoperative or nonoperative rehabilitation sessions (posttraining), and 6 months after ACL reconstruction or nonoperative rehabilitation. Posterior-anterior bent-knee radiographs were completed at 5 years and graded in the medial compartment by use of the Kellgren-Lawrence system. Logistic regression models were used at each of the 3 time points to determine the ability of clinical measures to predict knee OA at 5 years. Results Of the 76 patients, 9 (11.8%) had knee OA at 5 years. After adjustment for ACL reconstruction compared with nonoperative management, ipsilateral second ACL injuries, and the presence of contralateral knee OA, clinical measures of knee function at posttraining (6-m timed hop, Knee Outcomes Survey-Activities of Daily Living Scale) explained the most variance in posttraumatic OA development at 5 years (P = .006; ▵R 2, 27.5%). The 6-m hop test was the only significant posttraining predictor of OA at 5 years (P = .023; patients without OA, 96.6% ± 5.4%; patients with OA, 84.9% ± 14.1%). Similar significant group differences in hop scores and subjective knee function were present at baseline. No significant group differences in clinical measures existed at 6 months after ACL reconstruction or nonoperative rehabilitation. Conclusion Poor performance in single-legged hop tests early after ACL injury but not after reconstruction or nonoperative rehabilitation is associated with the development of radiographic posttraumatic knee OA 5 years after injury. Clinical measures of knee function were most predictive of subsequent OA development following an extended period of rehabilitation early after ACL injury.
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Affiliation(s)
- Elizabeth Wellsandt
- Biomechanics and Movement Science Program, University of Delaware, Newark, Delaware, USA.,Division of Physical Therapy Education, University of Nebraska Medical Center, Omaha, Nebraska, USA
| | - Michael J Axe
- First State Orthopaedics, Newark, Delaware, USA.,Department of Physical Therapy, University of Delaware, Newark, Delaware, USA
| | - Lynn Snyder-Mackler
- Biomechanics and Movement Science Program, University of Delaware, Newark, Delaware, USA.,Department of Physical Therapy, University of Delaware, Newark, Delaware, USA
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Sheehan FT, Brainerd EL, Troy KL, Shefelbine SJ, Ronsky JL. Advancing quantitative techniques to improve understanding of the skeletal structure-function relationship. J Neuroeng Rehabil 2018; 15:25. [PMID: 29558970 PMCID: PMC5859431 DOI: 10.1186/s12984-018-0368-9] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2017] [Accepted: 03/07/2018] [Indexed: 12/13/2022] Open
Abstract
Although all functional movement arises from the interplay between the neurological, skeletal, and muscular systems, it is the skeletal system that forms the basic framework for functional movement. Central to understanding human neuromuscular development, along with the genesis of musculoskeletal pathologies, is quantifying how the human skeletal system adapts and mal-adapts to its mechanical environment. Advancing this understanding is hampered by an inability to directly and non-invasively measure in vivo strains, stresses, and forces on bone. Thus, we traditionally have turned to animal models to garner such information. These models enable direct in vivo measures that are not available for human subjects, providing information in regards to both skeletal adaptation and the interplay between the skeletal and muscular systems. Recently, there has been an explosion of new imaging and modeling techniques providing non-invasive, in vivo measures and estimates of skeletal form and function that have long been missing. Combining multiple modalities and techniques has proven to be one of our most valuable resources in enhancing our understanding of the form-function relationship of the human skeletal, muscular, and neurological systems. Thus, to continue advancing our knowledge of the structural-functional relationship, validation of current tools is needed, while development is required to limit the deficiencies in these tools and develop new ones.
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Affiliation(s)
| | | | - Karen L Troy
- Worcester Polytechnic Institute, Worcester, MA, USA
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14
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Associations between cartilage proteoglycan density and patient outcomes 12months following anterior cruciate ligament reconstruction. Knee 2018; 25:118-129. [PMID: 29329888 DOI: 10.1016/j.knee.2017.10.005] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/01/2017] [Revised: 09/10/2017] [Accepted: 10/22/2017] [Indexed: 02/02/2023]
Abstract
BACKGROUND Lower proteoglycan density (PGD) of the articular cartilage may be an early marker of osteoarthritis following anterior cruciate ligament (ACL) reconstruction (ACL-R). The purpose this study was to determine associations between the Knee Injury and Osteoarthritis Outcomes Score (KOOS) and PGD of the articular cartilage in the femur and tibia 12-months following ACL-R. METHODS We evaluated KOOS pain, symptoms, function in activities of daily living (ADL), function in sport and recreation (Sport), and quality of life (QOL), as well as PGD using T1rho magnetic resonance imaging in 18 individuals 12.50±0.70months (these are all mean±standard deviation) following unilateral ACL-R (10 females, eight males; 22.39±4.19years; Marx Score=10.93±3.33). Medial and lateral load-bearing portions of the femoral and tibial condyles were sectioned into three (anterior, central and posterior) regions of interest (ROIs). T1rho relaxation times in the ACL-R knee were normalized to the same regions of interest in the non-surgical knees. Alpha levels were set at P≤0.05. RESULTS Worse KOOS outcomes were significantly associated with greater T1rho relaxation time ratios in the posterior-lateral femoral condyle [pain (r=-0.54), ADL (r=-0.56), Sport (r=-0.62) and QOL (r=-0.59)] central-lateral femoral condyle [Sport (r=-0.48) and QOL (r=-0.42)], and the anterior-medial femoral condyle [Sport (r=-0.46) and QOL (r=-0.40)]. There were no significant associations between the KOOS and T1rho outcomes for tibial ROI. CONCLUSIONS Lower PGD of the femoral cartilage in the ACL-R knees was associated with worse patient-reported outcomes.
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15
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Automated T2-mapping of the Menisci From Magnetic Resonance Images in Patients with Acute Knee Injury. Acad Radiol 2017; 24:1295-1304. [PMID: 28551397 DOI: 10.1016/j.acra.2017.03.025] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2016] [Revised: 12/23/2016] [Accepted: 03/30/2017] [Indexed: 12/27/2022]
Abstract
RATIONALE AND OBJECTIVES This study aimed to evaluate the accuracy of an automated method for segmentation and T2 mapping of the medial meniscus (MM) and lateral meniscus (LM) in clinical magnetic resonance images from patients with acute knee injury. MATERIALS AND METHODS Eighty patients scheduled for surgery of an anterior cruciate ligament or meniscal injury underwent magnetic resonance imaging of the knee (multiplanar two-dimensional [2D] turbo spin echo [TSE] or three-dimensional [3D]-TSE examinations, T2 mapping). Each meniscus was automatically segmented from the 2D-TSE (composite volume) or 3D-TSE images, auto-partitioned into anterior, mid, and posterior regions, and co-registered onto the T2 maps. The Dice similarity index (spatial overlap) was calculated between automated and manual segmentations of 2D-TSE (15 patients), 3D-TSE (16 patients), and corresponding T2 maps (31 patients). Pearson and intraclass correlation coefficients (ICC) were calculated between automated and manual T2 values. T2 values were compared (Wilcoxon rank sum tests) between torn and non-torn menisci for the subset of patients with both manual and automated segmentations to compare statistical outcomes of both methods. RESULTS The Dice similarity index values for the 2D-TSE, 3D-TSE, and T2 map volumes, respectively, were 76.4%, 84.3%, and 75.2% for the MM and 76.4%, 85.1%, and 76.1% for the LM. There were strong correlations between automated and manual T2 values (rMM = 0.95, ICCMM = 0.94; rLM = 0.97, ICCLM = 0.97). For both the manual and the automated methods, T2 values were significantly higher in torn than in non-torn MM for the full meniscus and its subregions (P < .05). Non-torn LM had higher T2 values than non-torn MM (P < .05). CONCLUSIONS The present automated method offers a promising alternative to manual T2 mapping analyses of the menisci and a considerable advance for integration into clinical workflows.
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16
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Cluster analysis of quantitative MRI T 2 and T 1ρ relaxation times of cartilage identifies differences between healthy and ACL-injured individuals at 3T. Osteoarthritis Cartilage 2017; 25:513-520. [PMID: 27720806 PMCID: PMC5359021 DOI: 10.1016/j.joca.2016.09.015] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/10/2016] [Revised: 08/07/2016] [Accepted: 09/22/2016] [Indexed: 02/02/2023]
Abstract
PURPOSE To identify focal lesions of elevated MRI T2 and T1ρ relaxation times in articular cartilage of an ACL-injured group using a novel cluster analysis technique. MATERIALS AND METHODS Eighteen ACL-injured patients underwent 3T MRI T2 and T1ρ relaxometry at baseline, 6 months and 1 year and six healthy volunteers at baseline, 1 day and 1 year. Clusters of contiguous pixels above or below T2 and T1ρ intensity and area thresholds were identified on a projection map of the 3D femoral cartilage surface. The total area of femoral cartilage plate covered by clusters (%CA) was split into areas above (%CA+) and below (%CA-) the thresholds and the differences in %CA(+ or -) over time in the ACL-injured group were determined using the Wilcoxon signed rank test. RESULTS %CA+ was greater in the ACL-injured patients than the healthy volunteers at 6 months and 1 year with average %CA+ of 5.2 ± 4.0% (p = 0.0054) and 6.6 ± 3.7% (p = 0.0041) for T2 and 6.2 ± 7.1% (p = 0.063) and 8.2 ± 6.9% (p = 0.042) for T1ρ, respectively. %CA- at 6 months and 1 year was 3.0 ± 1.8% (p > 0.1) and 5.9 ± 5.0% (p > 0.1) for T2 and 4.4 ± 4.9% (p > 0.1) and 4.5 ± 4.6% (p > 0.1) for T1ρ, respectively. CONCLUSION With the proposed cluster analysis technique, we have quantified cartilage lesion coverage and demonstrated that the ACL-injured group had greater areas of elevated T2 and T1ρ relaxation times as compared to healthy volunteers.
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17
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Martin JA, Anderson DD, Goetz JE, Fredericks D, Pedersen DR, Ayati BP, Marsh JL, Buckwalter JA. Complementary models reveal cellular responses to contact stresses that contribute to post-traumatic osteoarthritis. J Orthop Res 2017; 35:515-523. [PMID: 27509320 PMCID: PMC5303196 DOI: 10.1002/jor.23389] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/20/2016] [Accepted: 08/05/2016] [Indexed: 02/04/2023]
Abstract
Two categories of joint overloading cause post-traumatic osteoarthritis (PTOA): single acute traumatic loads/impactions and repetitive overloading due to incongruity/instability. We developed and refined three classes of complementary models to define relationships between joint overloading and progressive cartilage loss across the spectrum of acute injuries and chronic joint abnormalities: explant and whole joint models that allow probing of cellular responses to mechanical injury and contact stresses, animal models that enable study of PTOA pathways in living joints and pre-clinical testing of treatments, and patient-specific computational models that define the overloading that causes OA in humans. We coordinated methodologies across models so that results from each informed the others, maximizing the benefit of this complementary approach. We are incorporating results from these investigations into biomathematical models to provide predictions of PTOA risk and guide treatment. Each approach has limitations, but each provides opportunities to elucidate PTOA pathogenesis. Taken together, they help define levels of joint overloading that cause cartilage destruction, show that both forms of overloading can act through the same biologic pathways, and create a framework for initiating clinical interventions that decrease PTOA risk. Considered collectively, studies extending from explants to humans show that thresholds of joint overloading that cause cartilage loss can be defined, that to at least some extent both forms of joint overloading act through the same biologic pathways, and interventions that interrupt these pathways prevent cartilage damage. These observations suggest that treatments that decrease the risk of all forms of OA progression can be discovered. © 2016 Orthopaedic Research Society. Published by Wiley Periodicals, Inc. J Orthop Res 35:515-523, 2017.
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Affiliation(s)
- James A. Martin
- Departments of Orthopedics and Rehabilitation, University of Iowa, Iowa City Iowa,Departments of Biomedical Engineering, University of Iowa, Iowa City Iowa
| | - Donald D. Anderson
- Departments of Orthopedics and Rehabilitation, University of Iowa, Iowa City Iowa,Departments of Biomedical Engineering, University of Iowa, Iowa City Iowa
| | - Jessica E. Goetz
- Departments of Orthopedics and Rehabilitation, University of Iowa, Iowa City Iowa,Departments of Biomedical Engineering, University of Iowa, Iowa City Iowa
| | - Douglas Fredericks
- Departments of Orthopedics and Rehabilitation, University of Iowa, Iowa City Iowa
| | - Douglas R. Pedersen
- Departments of Orthopedics and Rehabilitation, University of Iowa, Iowa City Iowa,Departments of Biomedical Engineering, University of Iowa, Iowa City Iowa
| | - Bruce P. Ayati
- Departments of Orthopedics and Rehabilitation, University of Iowa, Iowa City Iowa,Departments of Mathematics, University of Iowa, Iowa City Iowa
| | - J. Lawrence Marsh
- Departments of Orthopedics and Rehabilitation, University of Iowa, Iowa City Iowa
| | - Joseph A. Buckwalter
- Departments of Orthopedics and Rehabilitation, University of Iowa, Iowa City Iowa,Iowa City Veterans Administration Medical Center
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18
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Eagle S, Potter HG, Koff MF. Morphologic and quantitative magnetic resonance imaging of knee articular cartilage for the assessment of post-traumatic osteoarthritis. J Orthop Res 2017; 35:412-423. [PMID: 27325163 DOI: 10.1002/jor.23345] [Citation(s) in RCA: 31] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/16/2016] [Accepted: 06/14/2016] [Indexed: 02/04/2023]
Abstract
Orthopedic trauma, such as anterior cruciate ligament (ACL) disruption, is a common source of osteoarthritis in the knee. Magnetic resonance imaging (MRI) is a non-invasive multi-planar imaging modality commonly used to evaluate hard and soft tissues of diarthrodial joints following traumatic injury. The contrast provided by generated images enables the evaluation of bone marrow lesions as well as delamination and degeneration of articular cartilage. We will provide background information about MRI signal generation and decay (T1 and T2 values), the utility of morphologic MRI, and the quantitative MRI techniques of T1ρ , T2 , and T2 * mapping, to evaluate subjects with traumatic knee injuries, such as ACL rupture. Additionally, we will provide information regarding the dGEMRIC, sodium, and gagCEST imaging techniques. Finally, the description and utility of newer post hoc analysis techniques, such as texture analysis, will be given. Continued development and refinement of these advanced MRI techniques will facilitate their clinical translation. © 2016 Orthopaedic Research Society. Published by Wiley Periodicals, Inc. J Orthop Res 35:412-423, 2017.
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Affiliation(s)
- Sonja Eagle
- MRI Laboratory, Department of Radiology and Imaging-MRI, Hospital for Special Surgery, 535 East 70th Street, Room: BW-08G, New York, New York, 10021
| | - Hollis G Potter
- MRI Laboratory, Department of Radiology and Imaging-MRI, Hospital for Special Surgery, 535 East 70th Street, Room: BW-08G, New York, New York, 10021
| | - Matthew F Koff
- MRI Laboratory, Department of Radiology and Imaging-MRI, Hospital for Special Surgery, 535 East 70th Street, Room: BW-08G, New York, New York, 10021
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19
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Pedersen DR, El-Khoury GY, Thedens DR, Saad-Eldine M, Phisitkul P, Amendola A. Bone contusion progression from traumatic knee injury: association of rate of contusion resolution with injury severity. Open Access J Sports Med 2017; 8:9-15. [PMID: 28203112 PMCID: PMC5293505 DOI: 10.2147/oajsm.s118811] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
BACKGROUND Bone contusions are frequently encountered in magnetic resonance imaging (MRI) evaluation of knee anterior cruciate ligament (ACL) injuries. Their role as indicators of injury severity remains unclear, primarily due to indeterminate levels of joint injury forces and to a lack of preinjury imaging. PURPOSE The purpose of this study was to 1) quantify bone contusion pathogenesis following traumatic joint injuries using fixed imaging follow-ups, and 2) assess the feasibility of using longitudinal bone contusion volumes as an indicator of knee injury severity. STUDY DESIGN Prospective sequential MRI follow-ups of a goat cohort exposed to controlled stifle trauma in vivo were compared to parallel clinical MRI follow-ups of a human ACL tear patient series. METHODS Reproducible cartilage impact damage of various energy magnitudes was applied in a survival goat model, coupled with partial resection of anterior portions of medial menisci. Both emulate injury patterns to the knee osteochondral structures commonly encountered in human ACL injury imaging as well as instability from resultant ligament laxity. Longitudinal clinical MRI sequences portrayed stifle bone contusion evolution through 6 months after the inciting event. RESULTS In the first 2 weeks, biological response variability dominated the whole-joint response with no apparent correlation to trauma severity. Control goats subjected to partial meniscectomy alone exhibited minimal bone response. Thereafter, 0.6 J impact bone contusions portrayed a faster rate of resolution than those induced by 1.2 J cartilage impacts. CONCLUSION Bone contusion sizes combined with time of persistence are likely better measures of joint injury severity than isolated bone contusion volume.
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Affiliation(s)
| | | | - Dan R Thedens
- Department of Electrical and Computer Engineering, University of Iowa, Iowa City, IA
| | | | | | - Annunziato Amendola
- Department of Orthopaedics and Sports Medicine, Duke University Medical School, Durham, NC, USA
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20
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Gong J, Pedoia V, Facchetti L, Link TM, Ma CB, Li X. Bone marrow edema-like lesions (BMELs) are associated with higher T 1ρ and T 2 values of cartilage in anterior cruciate ligament (ACL)-reconstructed knees: a longitudinal study. Quant Imaging Med Surg 2016; 6:661-670. [PMID: 28090444 DOI: 10.21037/qims.2016.12.11] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
BACKGROUND To evaluate the longitudinal changes of bone marrow edema-like lesions (BMELs) in patients after anterior cruciate ligament (ACL) reconstruction and to investigate the effect of BMELs on cartilage matrix composition changes measured using MR T1ρ and T2 mapping. METHODS Patients with acute ACL tear were enrolled in a prospective study. MR imaging was performed at baseline (before surgeries) and at 6-month, 1-year and 2-year after ACL reconstruction. MR imaging included sagittal high-resolution, 3D fast spin-echo (CUBE) sequences for BMEL evaluation, and 3D T1ρ mapping and T2 mapping for cartilage assessment. BMELs were assessed using whole-organ magnetic resonance imaging score (WORMS), and the volume of BMELs was measured by a semi-automatic method. Generalized estimating equation (GEE) was used to explore association between BMELs at baseline and cartilage changes during follow-up. RESULTS Fifty four patients were included in the present study and 39 patients had completed 2-year follow-up. BMELs were noted in 42 injured knees (77.8%) with 105 lesions and in 7 contralateral knees (13.0%) with 9 lesions (χ2=45.763, P<0.001) at the baseline. The WORMS and volume of BMELs of the injured knees were 2.36±0.65 and 386.98±382.54 mm3 (r=0.681, P<0.001), respectively. 87 BMELs were found at baseline in 34 patients (87.2%) of the 39 patients who had completed 2 years follow-up. During the follow-up, 18 (20.7%), 12 (13.8%), and 5 (5.7%) baseline lesions were still seen at 6-month, 1-year and 2-year, respectively. The changes of BMELs prevalence regarding bone compartments over time points were statistically significant (χ2=163.660, P<0.001). Except T2 value at 6 months, T1ρ and T2 values of cartilage overlying baseline BMELs in the injured knees were higher than that of anatomically matched cartilage in the contralateral knees at baseline and each follow-up time-point. In the injured knees, GEE analysis showed that baseline BMELs were significantly associated with higher T1ρ and T2 values of cartilage after adjustment of age, gender, body mass index (BMI), effusion and meniscus tear. The association between BMELs and Knee Injury and Osteoarthritis Outcome Scores (KOOS) scores was not statistically significant. CONCLUSIONS BMEL is a common finding in patients with acute ACL injury and resolves rapidly over time after ACL reconstruction. It is often associated with increased T1ρ and T2 values of cartilage. BMEL at baseline is an independent predictor for faster cartilage degeneration during follow-up.
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Affiliation(s)
- Jingshan Gong
- Department of Radiology, Shenzhen People's Hospital, the Second Clinical Medical College, Jinan University, Shenzhen 518020, China;; Department of Radiology and Biomedical Imaging, University of California San Francisco, San Francisco, CA 94107, USA
| | - Valentina Pedoia
- Department of Radiology and Biomedical Imaging, University of California San Francisco, San Francisco, CA 94107, USA
| | - Luca Facchetti
- Department of Radiology and Biomedical Imaging, University of California San Francisco, San Francisco, CA 94107, USA
| | - Thomas M Link
- Department of Radiology and Biomedical Imaging, University of California San Francisco, San Francisco, CA 94107, USA
| | - C Benjamin Ma
- Department of Orthopaedic Surgery, University of California, San Francisco, CA 94107, USA
| | - Xiaojuan Li
- Department of Radiology and Biomedical Imaging, University of California San Francisco, San Francisco, CA 94107, USA
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Palmieri-Smith RM, Wojtys EM, Potter HG. Early Cartilage Changes After Anterior Cruciate Ligament Injury: Evaluation With Imaging and Serum Biomarkers-A Pilot Study. Arthroscopy 2016; 32:1309-18. [PMID: 26944669 DOI: 10.1016/j.arthro.2015.12.045] [Citation(s) in RCA: 32] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/26/2015] [Revised: 10/06/2015] [Accepted: 12/17/2015] [Indexed: 02/02/2023]
Abstract
PURPOSE To determine if magnetic resonance imaging markers of cartilage matrix and morphology and circulating serum biomarkers of inflammation and matrix degradation differ over time in patients with anterior cruciate ligament (ACL) injury and bone marrow edema lesions (BMELs) when compared with matched control subjects. METHODS We performed a case-control study, in which 11 ACL-injured subjects scheduled to undergo reconstruction and 11 matched control subjects were scheduled for testing. Participants were selected for the ACL reconstruction (ACLR) group if they injured their ACL while participating in sports, were aged 14 to 30 years, had 1 or more BMELs, and were scheduled to undergo bone-patellar tendon-bone ACLR. Testing required patients to undergo magnetic resonance imaging for measurement of T2 relaxation times in standardized regions of interest over the medial and lateral tibial plateaus and femoral condyles and have blood drawn for measurement of cartilage oligomeric matrix protein (COMP) and C-reactive protein levels before ligament reconstruction and 1 year after surgery. RESULTS ACL patients had prolonged T2 relaxation times, indicative of cartilage matrix degradation, in the superficial central lateral tibial plateau (P = .02) and deep medial tibial plateau when compared with control subjects (P = .0001). Prolonged T2 relaxation times were also noted over the lateral femoral condyle at baseline for ACL patients compared with control subjects (P = .001), but the differences resolved by 1 year (P = .98). Circulating serum COMP levels were greater in ACL patients (233.23 ± 88.26 ng/mL) compared with control subjects (169.05 ± 64.53 ng/mL, P = .05). CONCLUSIONS T2 mapping showed prolonged relaxation times in the lateral compartment of the knee in ACLR patients with lateral BMELs. Furthermore, prolonged T2 relaxation times were apparent in the medial compartment of the knee in ACL-injured patients where bone marrow lesions were not present. Higher serum COMP levels were present in ACL-injured subjects when compared with control subjects. LEVEL OF EVIDENCE Level II, prospective case-control study.
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Affiliation(s)
- Riann M Palmieri-Smith
- School of Kinesiology, University of Michigan, Ann Arbor, Michigan, U.S.A.; Department of Orthopaedic Surgery, University of Michigan, Ann Arbor, Michigan, U.S.A..
| | - Edward M Wojtys
- Department of Orthopaedic Surgery, University of Michigan, Ann Arbor, Michigan, U.S.A
| | - Hollis G Potter
- Department of Radiology and Imaging, Hospital for Special Surgery, New York, New York, U.S.A
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22
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Gilani IA, Sepponen R. Quantitative rotating frame relaxometry methods in MRI. NMR IN BIOMEDICINE 2016; 29:841-861. [PMID: 27100142 DOI: 10.1002/nbm.3518] [Citation(s) in RCA: 33] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/07/2013] [Revised: 01/21/2016] [Accepted: 02/18/2016] [Indexed: 06/05/2023]
Abstract
Macromolecular degeneration and biochemical changes in tissue can be quantified using rotating frame relaxometry in MRI. It has been shown in several studies that the rotating frame longitudinal relaxation rate constant (R1ρ ) and the rotating frame transverse relaxation rate constant (R2ρ ) are sensitive biomarkers of phenomena at the cellular level. In this comprehensive review, existing MRI methods for probing the biophysical mechanisms that affect the rotating frame relaxation rates of the tissue (i.e. R1ρ and R2ρ ) are presented. Long acquisition times and high radiofrequency (RF) energy deposition into tissue during the process of spin-locking in rotating frame relaxometry are the major barriers to the establishment of these relaxation contrasts at high magnetic fields. Therefore, clinical applications of R1ρ and R2ρ MRI using on- or off-resonance RF excitation methods remain challenging. Accordingly, this review describes the theoretical and experimental approaches to the design of hard RF pulse cluster- and adiabatic RF pulse-based excitation schemes for accurate and precise measurements of R1ρ and R2ρ . The merits and drawbacks of different MRI acquisition strategies for quantitative relaxation rate measurement in the rotating frame regime are reviewed. In addition, this review summarizes current clinical applications of rotating frame MRI sequences. Copyright © 2016 John Wiley & Sons, Ltd.
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Affiliation(s)
- Irtiza Ali Gilani
- Brain Research Unit, Department of Neuroscience and Biomedical Engineering, Aalto University, Aalto, Finland
- Advanced Magnetic Imaging Center, Aalto University, Aalto, Finland
- National Magnetic Resonance Research Center (UMRAM), Bilkent University, Ankara, Turkey
| | - Raimo Sepponen
- Department of Electronics, School of Electrical Engineering, Aalto University, Aalto, Finland
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Feasibility of Dual Flip Angle-Based Fast 3-Dimensional T1 Mapping for Delayed Gadolinium-Enhanced Magnetic Resonance Imaging of Cartilage of the Knee: A Histologically Controlled Study. J Comput Assist Tomogr 2016; 40:442-6. [PMID: 26938692 DOI: 10.1097/rct.0000000000000378] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
OBJECTIVE The aim of the study was to validate dual-flip angle-based fast 3-dimensional (3D) T1 mapping for delayed gadolinium-enhanced magnetic resonance imaging (MRI) of cartilage (dGEMRIC) by means of histological analyses in the assessment of the cartilage of the knee in a porcine model. METHODS A total of 15 mini pigs were included in this study. The left knee anterior cruciate ligaments of all mini pigs were transected. The mini pigs were divided into 3 groups postoperatively, with 5 pigs randomly assigned to 1 group. Dual-flip angle-based fast T1 mapping for dGEMRIC was obtained in the sagittal planes at 0 week (group 1), 3 weeks (group 2), and 6 weeks (group 3) after operation, using an 8-channel knee coil. Magnetic resonance imaging was performed at 3T with dual-flip angle-based fast 3D T1 mapping sequence for morphological cartilage assessment of dGEMRIC T1 values. After MRI analysis, histological and biochemical composition (water, collagen, and glycosaminoglycan [GAG]) of the knee cartilage in the medial femoral condyle was quantified ex vivo. RESULTS The T1 values obtained by the dual-flip angle-based fast 3D T1 mapping were positively correlated with the glycosaminoglycan content (r = 0.85; P < 0.05). The values had no significant correlation with the collagen content. The dGEMRIC-T1 values obtained by this method showed the medial femoral condyle cartilage in the anterior cruciate ligament-transected knee after transection decreased with time (P < 0.05). Histological sections of cartilage damage were correlated with MRI data. CONCLUSIONS This study demonstrated the reliability of using dual-flip angle-based fast T1 mapping for dGEMRIC for the biochemical assessment of early cartilage degeneration. This technique is a powerful tool for researchers and clinicians to acquire sufficient resolution data within a reasonable scan time.
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Kuyinu EL, Narayanan G, Nair LS, Laurencin CT. Animal models of osteoarthritis: classification, update, and measurement of outcomes. J Orthop Surg Res 2016; 11:19. [PMID: 26837951 PMCID: PMC4738796 DOI: 10.1186/s13018-016-0346-5] [Citation(s) in RCA: 345] [Impact Index Per Article: 43.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/23/2015] [Accepted: 01/11/2016] [Indexed: 12/13/2022] Open
Abstract
Osteoarthritis (OA) is one of the most commonly occurring forms of arthritis in the world today. It is a debilitating chronic illness causing pain and immense discomfort to the affected individual. Significant research is currently ongoing to understand its pathophysiology and develop successful treatment regimens based on this knowledge. Animal models have played a key role in achieving this goal. Animal models currently used to study osteoarthritis can be classified based on the etiology under investigation, primary osteoarthritis, and post-traumatic osteoarthritis, to better clarify the relationship between these models and the pathogenesis of the disease. Non-invasive animal models have shown significant promise in understanding early osteoarthritic changes. Imaging modalities play a pivotal role in understanding the pathogenesis of OA and the correlation with pain. These imaging studies would also allow in vivo surveillance of the disease as a function of time in the animal model. This review summarizes the current understanding of the disease pathogenesis, invasive and non-invasive animal models, imaging modalities, and pain assessment techniques in the animals.
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Affiliation(s)
- Emmanuel L Kuyinu
- Institute for Regenerative Engineering, University of Connecticut Health, Farmington, CT, USA. .,Raymond and Beverly Sackler Center for Biomedical, Biological, Physical and Engineering Sciences, University of Connecticut Health, Farmington, CT, USA. .,Department of Orthopaedic Surgery, University of Connecticut Health, Farmington, CT, USA.
| | - Ganesh Narayanan
- Institute for Regenerative Engineering, University of Connecticut Health, Farmington, CT, USA. .,Raymond and Beverly Sackler Center for Biomedical, Biological, Physical and Engineering Sciences, University of Connecticut Health, Farmington, CT, USA. .,Department of Orthopaedic Surgery, University of Connecticut Health, Farmington, CT, USA.
| | - Lakshmi S Nair
- Institute for Regenerative Engineering, University of Connecticut Health, Farmington, CT, USA. .,Raymond and Beverly Sackler Center for Biomedical, Biological, Physical and Engineering Sciences, University of Connecticut Health, Farmington, CT, USA. .,Department of Orthopaedic Surgery, University of Connecticut Health, Farmington, CT, USA. .,Department of Biomedical Engineering, University of Connecticut, Storrs, CT, USA. .,Department of Materials Science and Engineering, University of Connecticut, Storrs, CT, USA. .,Institute of Materials Science, University of Connecticut, Storrs, CT, USA.
| | - Cato T Laurencin
- Institute for Regenerative Engineering, University of Connecticut Health, Farmington, CT, USA. .,Raymond and Beverly Sackler Center for Biomedical, Biological, Physical and Engineering Sciences, University of Connecticut Health, Farmington, CT, USA. .,Department of Orthopaedic Surgery, University of Connecticut Health, Farmington, CT, USA. .,Department of Biomedical Engineering, University of Connecticut, Storrs, CT, USA. .,Department of Materials Science and Engineering, University of Connecticut, Storrs, CT, USA. .,Institute of Materials Science, University of Connecticut, Storrs, CT, USA. .,Department of Craniofacial Sciences, School of Dental Medicine, University of Connecticut Health, Farmington, CT, USA. .,Department of Chemical and Biomolecular Engineering, University of Connecticut, Storrs, CT, USA.
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Novakofski KD, Pownder SL, Koff MF, Williams RM, Potter HG, Fortier LA. High-Resolution Methods for Diagnosing Cartilage Damage In Vivo. Cartilage 2016; 7:39-51. [PMID: 26958316 PMCID: PMC4749750 DOI: 10.1177/1947603515602307] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/23/2022] Open
Abstract
Advances in current clinical modalities, including magnetic resonance imaging and computed tomography, allow for earlier diagnoses of cartilage damage that could mitigate progression to osteoarthritis. However, current imaging modalities do not detect submicrometer damage. Developments in in vivo or arthroscopic techniques, including optical coherence tomography, ultrasonography, bioelectricity including streaming potential measurement, noninvasive electroarthrography, and multiphoton microscopy can detect damage at an earlier time point, but they are limited by a lack of penetration and the ability to assess an entire joint. This article reviews current advancements in clinical and developing modalities that can aid in the early diagnosis of cartilage injury and facilitate studies of interventional therapeutics.
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Affiliation(s)
| | | | - Matthew F. Koff
- MRI Laboratory, Hospital for Special Surgery, New York, NY, USA
| | | | | | - Lisa A. Fortier
- Department of Clinical Sciences, Cornell University, Ithaca, NY, USA,Lisa A. Fortier, Department of Clinical Sciences, Cornell University, VMC C3-181, Ithaca, NY 14853, USA. Email
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Wáng YXJ, Zhang Q, Li X, Chen W, Ahuja A, Yuan J. T1ρ magnetic resonance: basic physics principles and applications in knee and intervertebral disc imaging. Quant Imaging Med Surg 2015; 5:858-85. [PMID: 26807369 PMCID: PMC4700236 DOI: 10.3978/j.issn.2223-4292.2015.12.06] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2015] [Accepted: 12/06/2015] [Indexed: 12/15/2022]
Abstract
T1ρ relaxation time provides a new contrast mechanism that differs from T1- and T2-weighted contrast, and is useful to study low-frequency motional processes and chemical exchange in biological tissues. T1ρ imaging can be performed in the forms of T1ρ-weighted image, T1ρ mapping and T1ρ dispersion. T1ρ imaging, particularly at low spin-lock frequency, is sensitive to B0 and B1 inhomogeneity. Various composite spin-lock pulses have been proposed to alleviate the influence of field inhomogeneity so as to reduce the banding-like spin-lock artifacts. T1ρ imaging could be specific absorption rate (SAR) intensive and time consuming. Efforts to address these issues and speed-up data acquisition are being explored to facilitate wider clinical applications. This paper reviews the T1ρ imaging's basic physic principles, as well as its application for cartilage imaging and intervertebral disc imaging. Compared to more established T2 relaxation time, it has been shown that T1ρ provides more sensitive detection of proteoglycan (PG) loss at early stages of cartilage degeneration. T1ρ has also been shown to provide more sensitive evaluation of annulus fibrosis (AF) degeneration of the discs.
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Eckstein F, Wirth W, Lohmander LS, Hudelmaier MI, Frobell RB. Five-year followup of knee joint cartilage thickness changes after acute rupture of the anterior cruciate ligament. Arthritis Rheumatol 2015; 67:152-61. [PMID: 25252019 DOI: 10.1002/art.38881] [Citation(s) in RCA: 63] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2014] [Accepted: 09/11/2014] [Indexed: 12/13/2022]
Abstract
OBJECTIVE Anterior cruciate ligament (ACL) rupture involves an increased risk of osteoarthritis. The purpose of this study was to explore changes in cartilage thickness over 5 years after ACL rupture. METHODS A total of 121 young active adults (ages 18-35 years; 26% women) from the Knee ACL, Nonsurgical versus Surgical Treatment (KANON) study, who had acute traumatic rupture of the ACL were studied. Sagittal magnetic resonance images were acquired within 4 weeks of ACL rupture (baseline) and at the 2-year and 5-year followup assessments. Medial and lateral femorotibial cartilage was segmented (with blinding to acquisition order), and the mean cartilage thickness was computed across 16 femorotibial subregions. Total femorotibial cartilage thickness change was the primary analytic focus. Maximal subregional mean cartilage thickness loss (ordered value 1 [OV1]) and gain (ordered value 16 [OV16]), independent of its specific location in individual knees, were the secondary analytic focus. RESULTS Overall femorotibial cartilage thickness increased by 31 μm/year over 5 years (95% confidence interval 18, 44). The increase was similar in men and women and was significantly greater in those younger, as compared with those older, than the median age (25.3 years). The rate of total cartilage thickness change did not differ significantly between the first 2 years and the later 3 years. However, the maximal annualized subregional cartilage loss (OV1) and gain (OV16) were both significantly greater (P < 0.001 and P < 0.05, respectively) during the earlier interval than during the later interval (-115 versus -54 μm [OV1] and 116 versus 69 μm [OV16]). CONCLUSION Cartilage thickening was observed over 5 years following ACL injury, particularly in the medial femorotibial compartment and in younger subjects. Major perturbations in cartilage homeostasis were seen over the first 2 years after ACL rupture, with simultaneous subregional thinning and thickening occurring within the same cartilage plate or compartment.
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Affiliation(s)
- F Eckstein
- Institute of Anatomy, Paracelsus Medical University, Salzburg and Nuremberg, Salzburg, Austria, and Chondrometrics GmbH, Ainring, Germany
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Oei EHG, van Tiel J, Robinson WH, Gold GE. Quantitative radiologic imaging techniques for articular cartilage composition: toward early diagnosis and development of disease-modifying therapeutics for osteoarthritis. Arthritis Care Res (Hoboken) 2014; 66:1129-41. [PMID: 24578345 DOI: 10.1002/acr.22316] [Citation(s) in RCA: 53] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2013] [Accepted: 02/18/2014] [Indexed: 12/19/2022]
Affiliation(s)
- Edwin H G Oei
- Stanford University, Stanford, California; Erasmus MC, University Medical Center, Rotterdam, The Netherlands
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Wang L, Regatte RR. T₁ρ MRI of human musculoskeletal system. J Magn Reson Imaging 2014; 41:586-600. [PMID: 24935818 DOI: 10.1002/jmri.24677] [Citation(s) in RCA: 71] [Impact Index Per Article: 7.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2014] [Accepted: 06/03/2014] [Indexed: 12/21/2022] Open
Abstract
Magnetic resonance imaging (MRI) offers the direct visualization of the human musculoskeletal (MSK) system, especially all diarthrodial tissues including cartilage, bone, menisci, ligaments, tendon, hip, synovium, etc. Conventional MRI techniques based on T1 - and T2 -weighted, proton density (PD) contrast are inconclusive in quantifying early biochemically degenerative changes in MSK system in general and articular cartilage in particular. In recent years, quantitative MR parameter mapping techniques have been used to quantify the biochemical changes in articular cartilage, with a special emphasis on evaluating joint injury, cartilage degeneration, and soft tissue repair. In this article we focus on cartilage biochemical composition, basic principles of T1ρ MRI, implementation of T1ρ pulse sequences, biochemical validation, and summarize the potential applications of the T1ρ MRI technique in MSK diseases including osteoarthritis (OA), anterior cruciate ligament (ACL) injury, and knee joint repair. Finally, we also review the potential advantages, challenges, and future prospects of T1ρ MRI for widespread clinical translation.
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Affiliation(s)
- Ligong Wang
- Collaborative Innovation Center of Radiation Medicine of Jiangsu Higher Education Institutions, Jiangsu Provincial Key Laboratory of Radiation Medicine and Protection, School of Radiation Medicine and Protection, Medical College of Soochow University, School for Radiological and Interdisciplinary Sciences (RAD-X), Soochow University, Suzhou, Jiangsu, China
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Abstract
MRI has been established as an essential tool for accurate diagnosis in patients with musculoskeletal trauma. Its major advantages include excellent soft tissue contrast, high spatial resolution and lack of ionizing radiation. Although plain radiographs remain the basic tool for diagnosis and treatment planning in bone fractures assisted by CT in pelvic, spine and large joints injuries, there are specific circumstances that require MRI. For instance, tendinous, ligamentous, intraarticular structures such as the cartilage and menisci, and intramedullary injury are seen mostly with MRI. Volumetric 3D techniques are now commercially available and provide higher spatial resolution which improves anatomic detail, allows multiplanar reformations and reduces the acquisition time. Newer applications on quantitative rather than morphologic imaging, such as relaxometry and diffusion tensor imaging, may be of paramount importance in treatment planning in the near future. Software improvements reduce metal induced artefacts, allowing thus imaging of the postoperative patient with metallic implants. A tendency towards a structured reporting pattern and standardised medical communication needs to be further explored for the benefit of orthopaedic surgeons, radiologists and patients.
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Wang L, Regatte RR. Quantitative mapping of human cartilage at 3.0T: parallel changes in T₂, T₁ρ, and dGEMRIC. Acad Radiol 2014; 21:463-71. [PMID: 24594416 DOI: 10.1016/j.acra.2013.12.010] [Citation(s) in RCA: 33] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2013] [Revised: 12/14/2013] [Accepted: 12/15/2013] [Indexed: 10/25/2022]
Abstract
RATIONALE AND OBJECTIVES The objectives of this study were to measure the parallel changes of transverse relaxation times (T₂), spin-lattice relaxation time in the rotating frame (T₁ρ), and the delayed gadolinium-enhanced magnetic resonance imaging of cartilage (dGEMRIC)-T1 mapping of human knee cartilage in detecting cartilage degeneration at 3.0T. MATERIALS AND METHODS Healthy volunteers (n = 10, mean age 35.6 years) and patients (n = 10, mean age 65 years) with early knee osteoarthritis (OA) were scanned at 3.0T MR using an 8-channel phased array knee coil (transmit-receive). Quantitative assessment of T₂, T₁ρ, and dGEMRIC-T₁ values (global and regional) were correlated between asymptomatic subjects and patients with OA. RESULTS The average T₂ (39 ± 2 milliseconds [mean ± standard deviation] vs. 47 ± 6 milliseconds, P < .0007) and T₁ρ (48 ± 3 vs. 62 ± 8 milliseconds, P < .0002) values were all markedly increased in all patients with OA when compared to healthy volunteers. The average dGEMRIC-T₁ (1244 ± 134 vs. 643 ± 227 milliseconds, P < .000002) value was sharply decreased after intravenous administration of gadolinium contrast agent in all patients with OA. CONCLUSIONS The research results showed that all the T₂, T₁ρ, and dGEMRIC-T₁ relaxation times varied with the cartilage degeneration. The dGEMRIC-T₁ and T₁ρ relaxation times seem to be more sensitive than T₂ in detecting early cartilage degeneration. The preliminary study demonstrated that the early biochemical changes in knee osteoarthritic patients could be detected noninvasively in in vivo using T₁ρ and dGEMRIC-T₁ mapping.
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Mosher TJ, Walker EA, Petscavage-Thomas J, Guermazi A. Osteoarthritis year 2013 in review: imaging. Osteoarthritis Cartilage 2013; 21:1425-35. [PMID: 23891696 DOI: 10.1016/j.joca.2013.07.010] [Citation(s) in RCA: 37] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/02/2013] [Revised: 06/24/2013] [Accepted: 07/13/2013] [Indexed: 02/02/2023]
Abstract
PURPOSE To review recent original research publications related to imaging of osteoarthritis (OA) and identify emerging trends and significant advances. METHODS Relevant articles were identified through a search of the PubMed database using the query terms "OA" in combination with "imaging", "radiography", "MRI", "ultrasound", "computed tomography", and "nuclear medicine"; either published or in press between March 2012 and March 2013. Abstracts were reviewed to exclude review articles, case reports, and studies not focused on imaging using routine clinical imaging measures. RESULTS Initial query yielded 932 references, which were reduced to 328 citations following the initial review. MRI (118 references) and radiography (129 refs) remain the primary imaging modalities in OA studies, with fewer reports using computed tomography (CT) (35 refs) and ultrasound (23 refs). MRI parametric mapping techniques remain an active research area (33 refs) with growth in T2*- and T1-rho mapping publications compared to prior years. Although the knee is the major joint studied (210 refs) there is interest in the hip (106 refs) and hand (29 refs). Imaging continues to focus on evaluation of cartilage (173 refs) and bone (119 refs). CONCLUSION Imaging plays a major role in OA research with publications continuing along traditional lines of investigation. Translational and clinical research application of compositional MRI techniques is becoming more common driven in part by the availability of T2 mapping data from the Osteoarthritis Initiative (OAI). New imaging techniques continue to be developed with a goal of identifying methods with greater specificity and responsiveness to changes in the joint, and novel functional neuroimaging techniques to study central pain. Publications related to imaging of OA continue to be heavily focused on quantitative and semiquantitative MRI evaluation of the knee with increasing application of compositional MRI techniques in the hip.
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Affiliation(s)
- T J Mosher
- Department of Radiology, Penn State Hershey Medical Center, Hershey, PA, USA.
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Hirose J, Nishioka H, Okamoto N, Oniki Y, Nakamura E, Yamashita Y, Usuku K, Mizuta H. Articular cartilage lesions increase early cartilage degeneration in knees treated by anterior cruciate ligament reconstruction: T1ρ mapping evaluation and 1-year follow-up. Am J Sports Med 2013; 41:2353-61. [PMID: 23925576 DOI: 10.1177/0363546513496048] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
BACKGROUND Articular cartilage degeneration can develop after anterior cruciate ligament reconstruction (ACLR). Although radiological studies have identified risk factors for the progression of degenerative cartilage changes in the long term, risk factors in the early postoperative period remain to be documented. HYPOTHESIS Cartilage lesions that are present at surgery progress to cartilage degeneration in the early phase after ACLR. STUDY DESIGN Case series; Level of evidence, 4. METHODS T1ρ is the spin-lattice relaxation in the rotating frame magnetic resonance imaging. Sagittal T1ρ maps of the femorotibial joint were obtained before and 1 year after ACLR in 23 patients with ACL injuries. Four regions of interest (ROIs) were placed on images of the cartilage in the medial and lateral femoral condyle (MFC, LFC) and the medial and lateral tibia plateau (MTP, LTP). Changes in the T1ρ value (milliseconds) of each ROI were recorded, and differences between patients with and without cartilage lesions were evaluated. The relationship between changes in the T1ρ value and meniscal tears was also studied. RESULTS Arthroscopy at ACLR detected cartilage lesions in 15 MFCs, 7 LFCs, and 2 LTPs. The baseline T1ρ value of the MFC and LFC was significantly higher in patients with cartilage lesions (MFC, 40.7 ms; LFC, 42.2 ms) than in patients without cartilage lesions (MFC, 38.0 ms, P = .025; LFC, 39.4 ms, P = .010). At 1-year follow-up, the T1ρ value of the MFC and LFC was also significantly higher in patients with lesions (MFC, 43.1 ms; LFC, 42.7 ms) than in patients without such lesions (MFC, 39.1 ms, P = .002; LFC, 40.4 ms, P = .023, respectively). In patients with cartilage injury, the T1ρ value of the MFC increased during the year after treatment (P = .002). There was no significant difference in the baseline and follow-up T1ρ value in patients with or without meniscal tears on each side although the T1ρ value of the MFC, MTP, and LFC increased during the first year after surgery regardless of the presence or absence of meniscal injuries. CONCLUSION Using T1ρ mapping to detect minimal changes, our study demonstrated that cartilage lesions are related to progressive degenerative cartilage changes during the early phase after ACLR.
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Affiliation(s)
- Jun Hirose
- Jun Hirose, Department of Orthopaedic Surgery, Faculty of Life Sciences, Kumamoto University, 1-1-1 Honjo, Chuo-ku, Kumamoto, 860-8556, Japan.
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Palmer AJR, Brown CP, McNally EG, Price AJ, Tracey I, Jezzard P, Carr AJ, Glyn-Jones S. Non-invasive imaging of cartilage in early osteoarthritis. Bone Joint J 2013; 95-B:738-46. [PMID: 23723266 DOI: 10.1302/0301-620x.95b6.31414] [Citation(s) in RCA: 80] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
Treatment for osteoarthritis (OA) has traditionally focused on joint replacement for end-stage disease. An increasing number of surgical and pharmaceutical strategies for disease prevention have now been proposed. However, these require the ability to identify OA at a stage when it is potentially reversible, and detect small changes in cartilage structure and function to enable treatment efficacy to be evaluated within an acceptable timeframe. This has not been possible using conventional imaging techniques but recent advances in musculoskeletal imaging have been significant. In this review we discuss the role of different imaging modalities in the diagnosis of the earliest changes of OA. The increasing number of MRI sequences that are able to non-invasively detect biochemical changes in cartilage that precede structural damage may offer a great advance in the diagnosis and treatment of this debilitating condition.
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Affiliation(s)
- A J R Palmer
- Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford, Windmill Road, Headington OX3 7LD, UK
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Matzat SJ, van Tiel J, Gold GE, Oei EHG. Quantitative MRI techniques of cartilage composition. Quant Imaging Med Surg 2013; 3:162-74. [PMID: 23833729 DOI: 10.3978/j.issn.2223-4292.2013.06.04] [Citation(s) in RCA: 43] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2013] [Accepted: 06/24/2013] [Indexed: 12/15/2022]
Abstract
Due to aging populations and increasing rates of obesity in the developed world, the prevalence of osteoarthritis (OA) is continually increasing. Decreasing the societal and patient burden of this disease motivates research in prevention, early detection of OA, and novel treatment strategies against OA. One key facet of this effort is the need to track the degradation of tissues within joints, especially cartilage. Currently, conventional imaging techniques provide accurate means to detect morphological deterioration of cartilage in the later stages of OA, but these methods are not sensitive to the subtle biochemical changes during early disease stages. Novel quantitative techniques with magnetic resonance imaging (MRI) provide direct and indirect assessments of cartilage composition, and thus allow for earlier detection and tracking of OA. This review describes the most prominent quantitative MRI techniques to date-dGEMRIC, T2 mapping, T1rho mapping, and sodium imaging. Other, less-validated methods for quantifying cartilage composition are also described-Ultrashort echo time (UTE), gagCEST, and diffusion-weighted imaging (DWI). For each technique, this article discusses the proposed biochemical correlates, as well its advantages and limitations for clinical and research use. The article concludes with a detailed discussion of how the field of quantitative MRI has progressed to provide information regarding two specific patient populations through clinical research-patients with anterior cruciate ligament rupture and patients with impingement in the hip. While quantitative imaging techniques continue to rapidly evolve, specific challenges for each technique as well as challenges to clinical applications remain.
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