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Casula V, Kajabi AW. Quantitative MRI methods for the assessment of structure, composition, and function of musculoskeletal tissues in basic research and preclinical applications. MAGMA (NEW YORK, N.Y.) 2024:10.1007/s10334-024-01174-7. [PMID: 38904746 DOI: 10.1007/s10334-024-01174-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/31/2023] [Revised: 05/04/2024] [Accepted: 05/30/2024] [Indexed: 06/22/2024]
Abstract
Osteoarthritis (OA) is a disabling chronic disease involving the gradual degradation of joint structures causing pain and dysfunction. Magnetic resonance imaging (MRI) has been widely used as a non-invasive tool for assessing OA-related changes. While anatomical MRI is limited to the morphological assessment of the joint structures, quantitative MRI (qMRI) allows for the measurement of biophysical properties of the tissues at the molecular level. Quantitative MRI techniques have been employed to characterize tissues' structural integrity, biochemical content, and mechanical properties. Their applications extend to studying degenerative alterations, early OA detection, and evaluating therapeutic intervention. This article is a review of qMRI techniques for musculoskeletal tissue evaluation, with a particular emphasis on articular cartilage. The goal is to describe the underlying mechanism and primary limitations of the qMRI parameters, their association with the tissue physiological properties and their potential in detecting tissue degeneration leading to the development of OA with a primary focus on basic and preclinical research studies. Additionally, the review highlights some clinical applications of qMRI, discussing the role of texture-based radiomics and machine learning in advancing OA research.
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Affiliation(s)
- Victor Casula
- Research Unit of Health Sciences and Technology, Faculty of Medicine, University of Oulu, Oulu, Finland.
| | - Abdul Wahed Kajabi
- Center for Magnetic Resonance Research, University of Minnesota, Minneapolis, MN, USA
- Department of Radiology, University of Minnesota, Minneapolis, MN, USA
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Schmaranzer F, Haefeli PC, Liechti EF, Hanke MS, Tannast M, Büchler L. Improved Cartilage Quality on Delayed Gadolinium-Enhanced MRI of Hip Cartilage after Subchondral Drilling of Acetabular Cartilage Flaps in Femoroacetabular Impingement Surgery at Minimum 5-Year Follow-Up. Cartilage 2021; 13:617S-629S. [PMID: 32686503 PMCID: PMC8808901 DOI: 10.1177/1947603520941241] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/18/2022] Open
Abstract
OBJECTIVE To assess whether subchondral drilling of acetabular cartilage flaps during femoroacetabular impingement (FAI) surgery improves (1) acetabular dGEMRIC indices and (2) morphologic magnetic resonance imaging (MRI) scores, compared with hips in which no additional treatment of cartilage lesions had been performed; and (3) whether global dGEMRIC indices and MRI scores correlate. DESIGN Prospective cohort study of consecutive patients with symptomatic FAI treated with open surgery between 2000 and 2007. Patients with subchondral drilling of acetabular cartilage flaps were allocated to the study group, those without drilling to the control group. All patients underwent indirect 3-T MR arthrography to assess cartilage quality by dGEMRIC indices and a semiquantitative morphologic MRI score at minimum 5 years after surgery. dGEMRIC indices and morphologic MRI scores were compared between and among groups using analysis of covariance/paired t tests. RESULTS No significant difference was found between the global dGEMRIC indices of the study group (449 ± 147 ms, 95% CI 432-466 ms) and the control group (428 ± 143 ms, 95% CI 416-442 ms; P = 0.235). In regions with cartilage flaps, the study group showed higher dGEMRIC indices (472 ± 160 ms, 95% CI 433-510 ms) compared with the control group (390 ± 122 ms, 95% CI 367-413 ms; P < 0.001). No significant differences were found for the morphologic MRI scores. A strong inversely linear correlation between the dGEMRIC indices and the morphologic MRI scores (r = -0.727, P < 0.001) was observed. CONCLUSIONS Treatment of acetabular cartilage flaps with subchondral drilling leads to better cartilage quality in regions with cartilage flaps at minimum 5 years of follow-up.
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Affiliation(s)
- Florian Schmaranzer
- Department of Diagnostic, Interventional
and Pediatric Radiology, Inselspital Bern, University of Bern, Bern,
Switzerland,Department of Orthopaedic Surgery and
traumatology, inselspital Bern, University of Bern, Bern, Switzerland,Florian Schmaranzer, University of Bern,
Freiburgstraße, Bern, 3010, Switzerland.
| | - Pascal C. Haefeli
- Department of Orthopaedic Surgery,
Kantonsspital Luzern, Luzern, Switzerland
| | - Emanuel F. Liechti
- Department of Orthopaedic Surgery and
traumatology, inselspital Bern, University of Bern, Bern, Switzerland
| | - Markus S. Hanke
- Department of Orthopaedic Surgery and
traumatology, inselspital Bern, University of Bern, Bern, Switzerland
| | - Moritz Tannast
- Department of Orthopaedic Surgery and
Traumatology, Kantonsspital Fribourg, University of Fribourg Faculty of Science and
Medicine, Fribourg, Switzerland
| | - Lorenz Büchler
- Department of Orthopaedic Surgery and
Traumatology, Kantonsspital Aarau AG, Aarau, Switzerland
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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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Yee S, Fadell M. System-specific evaluation of the dual flip angle MRI technique for quantitative T 1 measurement. Med Phys 2021; 48:2790-2799. [PMID: 33772828 DOI: 10.1002/mp.14864] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2020] [Revised: 03/07/2021] [Accepted: 03/19/2021] [Indexed: 11/11/2022] Open
Abstract
PURPOSE To investigate if the accuracy of the dual flip angle (DFA) technique for T1 measurement is affected by the system-specific RF excitation performance. METHODS A T1 phantom, made of 12 vials of unique T1 value ranging approximately from 200 ms to 2000 ms, was built and tested on seven different clinical scanners. For each experiment, the reference T1 of each vial was obtained by the inversion recovery-based technique, and the DFA technique was applied repeatedly with several flip angle (FA) pairs conventionally proposed as optimal. The accuracy of the DFA technique for each FA pair was then evaluated by comparing the measured T1 values for the vials to the references. Any variation of the accuracy was then evaluated across different FA pairs, and across different MRI systems. To improve accuracy with a selected FA pair, the signal ratio (SR) curve, obtained from the phantom, was utilized in a calibration strategy of the DFA technique. RESULTS When combined for all the vials, the average ratio of the measured T1 to the reference generally increased as the FA pair window gradually slid from the smaller to the larger FA values. Furthermore, among several optimal FA pairs, the pair of the best accuracy varied slightly by the MRI system. The accuracy for any FA pair could be improved when the calibration strategy was utilized. CONCLUSIONS The RF excitation performance may vary by the specific FA pair and by the specific MRI system, influencing the accuracy of the DFA technique. The system-specific evaluation, and, if needed, its calibration, would help improve the accuracy of the DFA technique.
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Affiliation(s)
- Seonghwan Yee
- Department of Radiology, University of Colorado School of Medicine, Anschutz Medical Campus, Aurora, CO, 80045, USA
| | - Michael Fadell
- Department of Radiology, University of Colorado School of Medicine, Anschutz Medical Campus, Aurora, CO, 80045, USA.,Children's Hospital of Colorado, 13123 East 16th Avenue, Aurora, CO, 80045, USA
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Schmaranzer F, Afacan O, Lerch TD, Kim YJ, Siebenrock KA, Ith M, Cullmann JL, Kober T, Klarhoefer M, Tannast M, Bixby SD, Novais EN, Jung B. Magnetization-prepared 2 Rapid Gradient-Echo MRI for B 1 Insensitive 3D T1 Mapping of Hip Cartilage: An Experimental and Clinical Validation. Radiology 2021; 299:150-158. [PMID: 33620288 DOI: 10.1148/radiol.2021200085] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
Background Often used for T1 mapping of hip cartilage, three-dimensional (3D) dual-flip-angle (DFA) techniques are highly sensitive to flip angle variations related to B1 inhomogeneities. The authors hypothesized that 3D magnetization-prepared 2 rapid gradient-echo (MP2RAGE) MRI would help provide more accurate T1 mapping of hip cartilage at 3.0 T than would 3D DFA techniques. Purpose To compare 3D MP2RAGE MRI with 3D DFA techniques using two-dimensional (2D) inversion recovery T1 mapping as a standard of reference for hip cartilage T1 mapping in phantoms, healthy volunteers, and participants with hip pain. Materials and Methods T1 mapping at 3.0 T was performed in phantoms and in healthy volunteers using 3D MP2RAGE MRI and 3D DFA techniques with B1 field mapping for flip angle correction. Participants with hip pain prospectively (July 2019-January 2020) underwent indirect MR arthrography (with intravenous administration of 0.2 mmol/kg of gadoterate meglumine), including 3D MP2RAGE MRI. A 2D inversion recovery-based sequence served as a T1 reference in phantoms and in participants with hip pain. In healthy volunteers, cartilage T1 was compared between 3D MP2RAGE MRI and 3D DFA techniques. Paired t tests and Bland-Altman analysis were performed. Results Eleven phantoms, 10 healthy volunteers (median age, 27 years; range, 26-30 years; five men), and 20 participants with hip pain (mean age, 34 years ± 10 [standard deviation]; 17 women) were evaluated. In phantoms, T1 bias from 2D inversion recovery was lower for 3D MP2RAGE MRI than for 3D DFA techniques (mean, 3 msec ± 11 vs 253 msec ± 85; P < .001), and, unlike 3D DFA techniques, the deviation found with MP2RAGE MRI did not correlate with increasing B1 deviation. In healthy volunteers, regional cartilage T1 difference (109 msec ± 163; P = .008) was observed only for the 3D DFA technique. In participants with hip pain, the mean T1 bias of 3D MP2RAGE MRI from 2D inversion recovery was -23 msec ± 31 (P < .001). Conclusion Compared with three-dimensional (3D) dual-flip-angle techniques, 3D magnetization-prepared 2 rapid gradient-echo MRI enabled more accurate T1 mapping of hip cartilage, was less affected by B1 inhomogeneities, and showed high accuracy against a T1 reference in participants with hip pain. © RSNA, 2021.
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Affiliation(s)
- Florian Schmaranzer
- From the Department of Diagnostic, Interventional and Pediatric Radiology (F.S., T.D.L., M.I., J.L.C., B.J.) and Department of Orthopaedic Surgery (K.A.S., M.T.), Inselspital, University Hospital Bern, University of Bern, Freiburgstrasse, 3010 Bern, Switzerland; Departments of Orthopaedic Surgery (F.S., Y.J.K., E.N.N.) and Radiology (O.A., S.D.B.), Boston Children's Hospital, Harvard Medical School, Boston, Mass; Advanced Clinical Imaging Technology, Siemens Healthcare, Lausanne, Switzerland (T.K.); Department of Radiology, Lausanne University Hospital, University of Lausanne, Lausanne, Switzerland (T.K.); LTS5, École Polytechnique Fédérale de Lausanne (EPFL), Lausanne, Switzerland (T.K.); Siemens Healthcare, Zürich, Switzerland (M.K.); and Department of Orthopaedic Surgery, Cantonal Hospital, University of Fribourg, Fribourg, Switzerland (M.T.)
| | - Onur Afacan
- From the Department of Diagnostic, Interventional and Pediatric Radiology (F.S., T.D.L., M.I., J.L.C., B.J.) and Department of Orthopaedic Surgery (K.A.S., M.T.), Inselspital, University Hospital Bern, University of Bern, Freiburgstrasse, 3010 Bern, Switzerland; Departments of Orthopaedic Surgery (F.S., Y.J.K., E.N.N.) and Radiology (O.A., S.D.B.), Boston Children's Hospital, Harvard Medical School, Boston, Mass; Advanced Clinical Imaging Technology, Siemens Healthcare, Lausanne, Switzerland (T.K.); Department of Radiology, Lausanne University Hospital, University of Lausanne, Lausanne, Switzerland (T.K.); LTS5, École Polytechnique Fédérale de Lausanne (EPFL), Lausanne, Switzerland (T.K.); Siemens Healthcare, Zürich, Switzerland (M.K.); and Department of Orthopaedic Surgery, Cantonal Hospital, University of Fribourg, Fribourg, Switzerland (M.T.)
| | - Till D Lerch
- From the Department of Diagnostic, Interventional and Pediatric Radiology (F.S., T.D.L., M.I., J.L.C., B.J.) and Department of Orthopaedic Surgery (K.A.S., M.T.), Inselspital, University Hospital Bern, University of Bern, Freiburgstrasse, 3010 Bern, Switzerland; Departments of Orthopaedic Surgery (F.S., Y.J.K., E.N.N.) and Radiology (O.A., S.D.B.), Boston Children's Hospital, Harvard Medical School, Boston, Mass; Advanced Clinical Imaging Technology, Siemens Healthcare, Lausanne, Switzerland (T.K.); Department of Radiology, Lausanne University Hospital, University of Lausanne, Lausanne, Switzerland (T.K.); LTS5, École Polytechnique Fédérale de Lausanne (EPFL), Lausanne, Switzerland (T.K.); Siemens Healthcare, Zürich, Switzerland (M.K.); and Department of Orthopaedic Surgery, Cantonal Hospital, University of Fribourg, Fribourg, Switzerland (M.T.)
| | - Young-Jo Kim
- From the Department of Diagnostic, Interventional and Pediatric Radiology (F.S., T.D.L., M.I., J.L.C., B.J.) and Department of Orthopaedic Surgery (K.A.S., M.T.), Inselspital, University Hospital Bern, University of Bern, Freiburgstrasse, 3010 Bern, Switzerland; Departments of Orthopaedic Surgery (F.S., Y.J.K., E.N.N.) and Radiology (O.A., S.D.B.), Boston Children's Hospital, Harvard Medical School, Boston, Mass; Advanced Clinical Imaging Technology, Siemens Healthcare, Lausanne, Switzerland (T.K.); Department of Radiology, Lausanne University Hospital, University of Lausanne, Lausanne, Switzerland (T.K.); LTS5, École Polytechnique Fédérale de Lausanne (EPFL), Lausanne, Switzerland (T.K.); Siemens Healthcare, Zürich, Switzerland (M.K.); and Department of Orthopaedic Surgery, Cantonal Hospital, University of Fribourg, Fribourg, Switzerland (M.T.)
| | - Klaus A Siebenrock
- From the Department of Diagnostic, Interventional and Pediatric Radiology (F.S., T.D.L., M.I., J.L.C., B.J.) and Department of Orthopaedic Surgery (K.A.S., M.T.), Inselspital, University Hospital Bern, University of Bern, Freiburgstrasse, 3010 Bern, Switzerland; Departments of Orthopaedic Surgery (F.S., Y.J.K., E.N.N.) and Radiology (O.A., S.D.B.), Boston Children's Hospital, Harvard Medical School, Boston, Mass; Advanced Clinical Imaging Technology, Siemens Healthcare, Lausanne, Switzerland (T.K.); Department of Radiology, Lausanne University Hospital, University of Lausanne, Lausanne, Switzerland (T.K.); LTS5, École Polytechnique Fédérale de Lausanne (EPFL), Lausanne, Switzerland (T.K.); Siemens Healthcare, Zürich, Switzerland (M.K.); and Department of Orthopaedic Surgery, Cantonal Hospital, University of Fribourg, Fribourg, Switzerland (M.T.)
| | - Michael Ith
- From the Department of Diagnostic, Interventional and Pediatric Radiology (F.S., T.D.L., M.I., J.L.C., B.J.) and Department of Orthopaedic Surgery (K.A.S., M.T.), Inselspital, University Hospital Bern, University of Bern, Freiburgstrasse, 3010 Bern, Switzerland; Departments of Orthopaedic Surgery (F.S., Y.J.K., E.N.N.) and Radiology (O.A., S.D.B.), Boston Children's Hospital, Harvard Medical School, Boston, Mass; Advanced Clinical Imaging Technology, Siemens Healthcare, Lausanne, Switzerland (T.K.); Department of Radiology, Lausanne University Hospital, University of Lausanne, Lausanne, Switzerland (T.K.); LTS5, École Polytechnique Fédérale de Lausanne (EPFL), Lausanne, Switzerland (T.K.); Siemens Healthcare, Zürich, Switzerland (M.K.); and Department of Orthopaedic Surgery, Cantonal Hospital, University of Fribourg, Fribourg, Switzerland (M.T.)
| | - Jennifer L Cullmann
- From the Department of Diagnostic, Interventional and Pediatric Radiology (F.S., T.D.L., M.I., J.L.C., B.J.) and Department of Orthopaedic Surgery (K.A.S., M.T.), Inselspital, University Hospital Bern, University of Bern, Freiburgstrasse, 3010 Bern, Switzerland; Departments of Orthopaedic Surgery (F.S., Y.J.K., E.N.N.) and Radiology (O.A., S.D.B.), Boston Children's Hospital, Harvard Medical School, Boston, Mass; Advanced Clinical Imaging Technology, Siemens Healthcare, Lausanne, Switzerland (T.K.); Department of Radiology, Lausanne University Hospital, University of Lausanne, Lausanne, Switzerland (T.K.); LTS5, École Polytechnique Fédérale de Lausanne (EPFL), Lausanne, Switzerland (T.K.); Siemens Healthcare, Zürich, Switzerland (M.K.); and Department of Orthopaedic Surgery, Cantonal Hospital, University of Fribourg, Fribourg, Switzerland (M.T.)
| | - Tobias Kober
- From the Department of Diagnostic, Interventional and Pediatric Radiology (F.S., T.D.L., M.I., J.L.C., B.J.) and Department of Orthopaedic Surgery (K.A.S., M.T.), Inselspital, University Hospital Bern, University of Bern, Freiburgstrasse, 3010 Bern, Switzerland; Departments of Orthopaedic Surgery (F.S., Y.J.K., E.N.N.) and Radiology (O.A., S.D.B.), Boston Children's Hospital, Harvard Medical School, Boston, Mass; Advanced Clinical Imaging Technology, Siemens Healthcare, Lausanne, Switzerland (T.K.); Department of Radiology, Lausanne University Hospital, University of Lausanne, Lausanne, Switzerland (T.K.); LTS5, École Polytechnique Fédérale de Lausanne (EPFL), Lausanne, Switzerland (T.K.); Siemens Healthcare, Zürich, Switzerland (M.K.); and Department of Orthopaedic Surgery, Cantonal Hospital, University of Fribourg, Fribourg, Switzerland (M.T.)
| | - Markus Klarhoefer
- From the Department of Diagnostic, Interventional and Pediatric Radiology (F.S., T.D.L., M.I., J.L.C., B.J.) and Department of Orthopaedic Surgery (K.A.S., M.T.), Inselspital, University Hospital Bern, University of Bern, Freiburgstrasse, 3010 Bern, Switzerland; Departments of Orthopaedic Surgery (F.S., Y.J.K., E.N.N.) and Radiology (O.A., S.D.B.), Boston Children's Hospital, Harvard Medical School, Boston, Mass; Advanced Clinical Imaging Technology, Siemens Healthcare, Lausanne, Switzerland (T.K.); Department of Radiology, Lausanne University Hospital, University of Lausanne, Lausanne, Switzerland (T.K.); LTS5, École Polytechnique Fédérale de Lausanne (EPFL), Lausanne, Switzerland (T.K.); Siemens Healthcare, Zürich, Switzerland (M.K.); and Department of Orthopaedic Surgery, Cantonal Hospital, University of Fribourg, Fribourg, Switzerland (M.T.)
| | - Moritz Tannast
- From the Department of Diagnostic, Interventional and Pediatric Radiology (F.S., T.D.L., M.I., J.L.C., B.J.) and Department of Orthopaedic Surgery (K.A.S., M.T.), Inselspital, University Hospital Bern, University of Bern, Freiburgstrasse, 3010 Bern, Switzerland; Departments of Orthopaedic Surgery (F.S., Y.J.K., E.N.N.) and Radiology (O.A., S.D.B.), Boston Children's Hospital, Harvard Medical School, Boston, Mass; Advanced Clinical Imaging Technology, Siemens Healthcare, Lausanne, Switzerland (T.K.); Department of Radiology, Lausanne University Hospital, University of Lausanne, Lausanne, Switzerland (T.K.); LTS5, École Polytechnique Fédérale de Lausanne (EPFL), Lausanne, Switzerland (T.K.); Siemens Healthcare, Zürich, Switzerland (M.K.); and Department of Orthopaedic Surgery, Cantonal Hospital, University of Fribourg, Fribourg, Switzerland (M.T.)
| | - Sarah D Bixby
- From the Department of Diagnostic, Interventional and Pediatric Radiology (F.S., T.D.L., M.I., J.L.C., B.J.) and Department of Orthopaedic Surgery (K.A.S., M.T.), Inselspital, University Hospital Bern, University of Bern, Freiburgstrasse, 3010 Bern, Switzerland; Departments of Orthopaedic Surgery (F.S., Y.J.K., E.N.N.) and Radiology (O.A., S.D.B.), Boston Children's Hospital, Harvard Medical School, Boston, Mass; Advanced Clinical Imaging Technology, Siemens Healthcare, Lausanne, Switzerland (T.K.); Department of Radiology, Lausanne University Hospital, University of Lausanne, Lausanne, Switzerland (T.K.); LTS5, École Polytechnique Fédérale de Lausanne (EPFL), Lausanne, Switzerland (T.K.); Siemens Healthcare, Zürich, Switzerland (M.K.); and Department of Orthopaedic Surgery, Cantonal Hospital, University of Fribourg, Fribourg, Switzerland (M.T.)
| | - Eduardo N Novais
- From the Department of Diagnostic, Interventional and Pediatric Radiology (F.S., T.D.L., M.I., J.L.C., B.J.) and Department of Orthopaedic Surgery (K.A.S., M.T.), Inselspital, University Hospital Bern, University of Bern, Freiburgstrasse, 3010 Bern, Switzerland; Departments of Orthopaedic Surgery (F.S., Y.J.K., E.N.N.) and Radiology (O.A., S.D.B.), Boston Children's Hospital, Harvard Medical School, Boston, Mass; Advanced Clinical Imaging Technology, Siemens Healthcare, Lausanne, Switzerland (T.K.); Department of Radiology, Lausanne University Hospital, University of Lausanne, Lausanne, Switzerland (T.K.); LTS5, École Polytechnique Fédérale de Lausanne (EPFL), Lausanne, Switzerland (T.K.); Siemens Healthcare, Zürich, Switzerland (M.K.); and Department of Orthopaedic Surgery, Cantonal Hospital, University of Fribourg, Fribourg, Switzerland (M.T.)
| | - Bernd Jung
- From the Department of Diagnostic, Interventional and Pediatric Radiology (F.S., T.D.L., M.I., J.L.C., B.J.) and Department of Orthopaedic Surgery (K.A.S., M.T.), Inselspital, University Hospital Bern, University of Bern, Freiburgstrasse, 3010 Bern, Switzerland; Departments of Orthopaedic Surgery (F.S., Y.J.K., E.N.N.) and Radiology (O.A., S.D.B.), Boston Children's Hospital, Harvard Medical School, Boston, Mass; Advanced Clinical Imaging Technology, Siemens Healthcare, Lausanne, Switzerland (T.K.); Department of Radiology, Lausanne University Hospital, University of Lausanne, Lausanne, Switzerland (T.K.); LTS5, École Polytechnique Fédérale de Lausanne (EPFL), Lausanne, Switzerland (T.K.); Siemens Healthcare, Zürich, Switzerland (M.K.); and Department of Orthopaedic Surgery, Cantonal Hospital, University of Fribourg, Fribourg, Switzerland (M.T.)
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Abstract
OBJECTIVE. Imaging plays a critical role in the assessment of patients with femoroacetabular impingement (FAI). With better understanding of the underlying pathomechanics and advances in joint-preserving surgery, there is an increasing need to define the most appropriate imaging workup. The purpose of this article is to provide guidance on best practices for imaging of patients with FAI in light of recent advances in corrective FAI surgery. CONCLUSION. Pelvic radiography with dedicated hip projections is the basis of the diagnostic workup of patients with suspected FAI to assess arthritic changes and acetabular coverage and to screen for cam deformities. Chondrolabral lesions should be evaluated with unenhanced MRI or MR arthrography. The protocol should include a large-FOV fluid-sensitive sequence to exclude conditions that can mimic or coexist with FAI, radial imaging to accurately determine the presence of a cam deformity, and imaging of the distal femoral condyles for measurement of femoral torsion. CT remains a valuable tool for planning of complex surgical corrections. Advanced imaging, such as 3D simulation, biochemical MRI, and MR arthrography with application of leg traction, has great potential to improve surgical decision-making. Further research is needed to assess the added clinical value of these techniques.
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Abrar DB, Schleich C, Nebelung S, Frenken M, Ullrich T, Radke KL, Antoch G, Vordenbäumen S, Brinks R, Schneider M, Ostendorf B, Sewerin P. Proteoglycan loss in the articular cartilage is associated with severity of joint inflammation in psoriatic arthritis-a compositional magnetic resonance imaging study. Arthritis Res Ther 2020; 22:124. [PMID: 32471515 PMCID: PMC7257142 DOI: 10.1186/s13075-020-02219-7] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2020] [Accepted: 05/14/2020] [Indexed: 12/27/2022] Open
Abstract
Background Even though cartilage loss is a known feature of psoriatic arthritis (PsA), little is known about its role in the pathogenesis of PsA. Using delayed gadolinium-enhanced magnetic resonance imaging of cartilage (dGEMRIC) as a non-invasive marker of the tissue’s proteoglycan content, such early (i.e., pre-morphological) changes have been associated with inflammation in rheumatoid arthritis (RA). Yet, this association has not been studied before in PsA. Methods The metacarpophalangeal (MCP), proximal interphalangeal (PIP), and distal interphalangeal (DIP) joints of 17 patients with active PsA were evaluated by high-resolution clinical standard morphological and dGEMRIC sequences using a 3T MRI scanner (Magnetom Skyra, Siemens) and a dedicated 16-channel hand coil. Images were analyzed by two independent raters for dGEMRIC indices, PsA MRI scores (PsAMRIS), and total cartilage thickness (TCT). Kendall tau correlation coefficients (τ) were calculated. Results We found significant negative correlations between dGEMRIC indices and total PsAMRIS (τ = − 0.5, p = 0.012), synovitis (τ = − 0.56, p = 0.006), flexor tenosynovitis (τ = − 0.4, p = 0.049), and periarticular inflammation (τ = − 0.72, p < 0.001). Significant positive correlations were found between TCT and dGEMRIC indices at all joint levels (τ = 0.43, p < 0.001). No significant correlations were determined between dGEMRIC indices and bone erosion, bone edema, or bone proliferation. Conclusion In PsA, proteoglycan loss as assessed by dGEMRIC is associated with periarticular inflammation, synovitis, and flexor tenosynovitis, but not with bone erosion or proliferation. Thereby, these findings contribute to in vivo concepts of the disease’s pathophysiology. Beyond morphology, advanced MRI techniques may be used to assess cartilage composition in PsA and to identify early changes in the cartilage as an imaging biomarker with potential application in detection, monitoring, and prediction of outcomes of PsA. Trial registration 2014123117, December 2014.
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Affiliation(s)
- Daniel B Abrar
- University Dusseldorf, Medical Faculty, Department of Diagnostic and Interventional Radiology, D-40225, Düsseldorf, Germany.
| | - Christoph Schleich
- University Dusseldorf, Medical Faculty, Department of Diagnostic and Interventional Radiology, D-40225, Düsseldorf, Germany
| | - Sven Nebelung
- University Dusseldorf, Medical Faculty, Department of Diagnostic and Interventional Radiology, D-40225, Düsseldorf, Germany
| | - Miriam Frenken
- University Dusseldorf, Medical Faculty, Department of Diagnostic and Interventional Radiology, D-40225, Düsseldorf, Germany
| | - Tim Ullrich
- University Dusseldorf, Medical Faculty, Department of Diagnostic and Interventional Radiology, D-40225, Düsseldorf, Germany
| | - Karl Ludger Radke
- University Dusseldorf, Medical Faculty, Department of Diagnostic and Interventional Radiology, D-40225, Düsseldorf, Germany
| | - Gerald Antoch
- University Dusseldorf, Medical Faculty, Department of Diagnostic and Interventional Radiology, D-40225, Düsseldorf, Germany
| | - Stefan Vordenbäumen
- Department and Hiller Research Unit for Rheumatology, UKD, Heinrich Heine University Düsseldorf, Moorenstrasse 5, 40225, Düsseldorf, Germany
| | - Ralph Brinks
- Department and Hiller Research Unit for Rheumatology, UKD, Heinrich Heine University Düsseldorf, Moorenstrasse 5, 40225, Düsseldorf, Germany
| | - Matthias Schneider
- Department and Hiller Research Unit for Rheumatology, UKD, Heinrich Heine University Düsseldorf, Moorenstrasse 5, 40225, Düsseldorf, Germany
| | - Benedikt Ostendorf
- Department and Hiller Research Unit for Rheumatology, UKD, Heinrich Heine University Düsseldorf, Moorenstrasse 5, 40225, Düsseldorf, Germany
| | - Philipp Sewerin
- Department and Hiller Research Unit for Rheumatology, UKD, Heinrich Heine University Düsseldorf, Moorenstrasse 5, 40225, Düsseldorf, Germany
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Recognition of sacroiliac joint structural lesions: Comparison of volumetric interpolated breath-hold examination (VIBE) sequences with different slice thicknesses to T1-weighted turbo-echo. Eur J Radiol 2020; 124:108849. [DOI: 10.1016/j.ejrad.2020.108849] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2019] [Revised: 12/26/2019] [Accepted: 01/23/2020] [Indexed: 12/15/2022]
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CORR Insights®: Do dGEMRIC and T2 Imaging Correlate With Histologic Cartilage Degeneration in an Experimental Ovine FAI Model? Clin Orthop Relat Res 2019; 477:1004-1006. [PMID: 30801288 PMCID: PMC6494300 DOI: 10.1097/corr.0000000000000664] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
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10
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Do dGEMRIC and T2 Imaging Correlate With Histologic Cartilage Degeneration in an Experimental Ovine FAI Model? Clin Orthop Relat Res 2019; 477:990-1003. [PMID: 30507833 PMCID: PMC6494333 DOI: 10.1097/corr.0000000000000593] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
BACKGROUND Biochemical MRI of hip cartilage such as delayed gadolinium-enhanced MRI of cartilage (dGEMRIC) and T2 mapping is increasingly used to judge cartilage quality in the assessment of femoroacetabular impingement (FAI). The current evidence is sparse about which of these techniques yields a stronger correlation with histologic cartilage degeneration because of the difficulty in validating biochemical MRI techniques against histology in the clinical setting. Recently, an experimental ovine FAI model was established that induces chondrolabral damage and offers a validated platform to address these limitations. QUESTIONS/PURPOSES In a sheep model, we asked: (1) Do dGEMRIC and/or T2 values of acetabular and femoral cartilage correlate with histologic cartilage degeneration as assessed with the Mankin score? (2) Do simultaneously measured dGEMRIC and T2 values correlate in an experimental ovine FAI model? METHODS We performed an experimental pilot study on five female Swiss Alpine sheep (10 hips) that underwent postmortem MRI, including biochemical cartilage sequences, after a staged FAI correction had been performed on one side. No surgery was performed on the contralateral side, which served as a healthy control. In these sheep, an extraarticular intertrochanteric varus osteotomy was performed to rotate the naturally aspherical ovine femoral head into the acetabulum to induce cam-type FAI and chondrolabral damage comparable to human beings. After a 70-day ambulation period, femoral osteochondroplasty was performed and all sheep were euthanized after a total observation period of 210 days. Before they were euthanized, the sheep received a contrast agent and roamed and walked for at least 45 minutes. Hips were prepared to fit in a knee coil and MRI was performed at 3 T including a three-dimensional (3-D) dGEMRIC sequence, a two-dimensional (2-D) radial T2 mapping sequence, and a 2-D radial proton density-weighted sequence for morphologic cartilage assessment. Using specifically developed software, the 3-D dGEMRIC images and T2 maps were coregistered on the 2-D morphologic radial images. This enabled us to simultaneously measure dGEMRIC and T2 values using the identical regions of interest. dGEMRIC and T2 values of the acetabular and femoral cartilage were measured circumferentially using anatomic landmarks. After MRI, bone-cartilage samples were taken from the acetabulum and the femur and stained with toluidine blue for assessment of the histologic cartilage degeneration using the Mankin score, which was assessed in consensus by two observers. Spearman's rank correlation coefficient was used to (1) correlate dGEMRIC values and T2 values with the histologic Mankin score of femoroacetabular cartilage; and to (2) correlate dGEMRIC values and T2 values of femoroacetabular cartilage. RESULTS A moderate to fair correlation between overall dGEMRIC values of the acetabular cartilage (R = -0.430; p = 0.003) and the femoral cartilage (R = -0.334; p = 0.003) versus the histologic Mankin score was found. A moderate correlation (R = -0.515; p = 0.010) was found among peripheral dGEMRIC values of the acetabulum, the superior femoral cartilage (R = -0.500; p = 0.034), and the histologic Mankin score, respectively. No correlation between overall and regional femoroacetabular T2 values and the histologic Mankin scores was found. No correlation between overall and regional femoroacetabular dGEMRIC values and T2 values was found. CONCLUSIONS In this recently established sheep model, we found dGEMRIC values correlated well with histologic evidence of cartilage degeneration in the hip. This combination of a robust animal model and an accurate imaging technique appears to offer a noninvasive means to study the natural course of FAI and to compare the effectiveness of potential surgical options to treat it. CLINICAL RELEVANCE This translational study supports the continuing use of dGEMRIC as a biomarker for prearthritic cartilage degeneration with the ultimate goal to identify patients who will benefit most from corrective FAI surgery. The value of T2 imaging of hip cartilage warrants further investigation.
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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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12
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Link TM, Neumann J, Li X. Prestructural cartilage assessment using MRI. J Magn Reson Imaging 2016; 45:949-965. [PMID: 28019053 DOI: 10.1002/jmri.25554] [Citation(s) in RCA: 72] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2016] [Accepted: 10/25/2016] [Indexed: 12/20/2022] Open
Abstract
Cartilage loss is irreversible, and to date, no effective pharmacotherapies are available to protect or regenerate cartilage. Quantitative prestructural/compositional MR imaging techniques have been developed to characterize the cartilage matrix quality at a stage where abnormal findings are early and potentially reversible, allowing intervention to halt disease progression. The goal of this article is to critically review currently available technologies, present the basic concept behind these techniques, but also to investigate their suitability as imaging biomarkers including their validity, reproducibility, risk prediction and monitoring of therapy. Moreover, we highlighted important clinical applications. This review article focuses on the currently most relevant and clinically applicable technologies, such as T2 mapping, T2*, T1ρ, delayed gadolinium enhanced MRI of cartilage (dGEMRIC), sodium imaging and glycosaminoglycan chemical exchange saturation transfer (gagCEST). To date, most information is available for T2 and T1ρ mapping. dGEMRIC has also been used in multiple clinical studies, although it requires Gd contrast administration. Sodium imaging and gagCEST are promising technologies but are dependent on high field strength and sophisticated software and hardware. LEVEL OF EVIDENCE 5 J. Magn. Reson. Imaging 2017;45:949-965.
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Affiliation(s)
- Thomas M Link
- Department of Radiology and Biomedical Imaging, University of California at San Francisco, San Francisco, California, USA
| | - Jan Neumann
- Department of Radiology and Biomedical Imaging, University of California at San Francisco, San Francisco, California, USA
| | - Xiaojuan Li
- Department of Radiology and Biomedical Imaging, University of California at San Francisco, San Francisco, California, USA
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13
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Ahlawat S, Morris C, Fayad LM. Three-dimensional volumetric MRI with isotropic resolution: improved speed of acquisition, spatial resolution and assessment of lesion conspicuity in patients with recurrent soft tissue sarcoma. Skeletal Radiol 2016; 45:645-52. [PMID: 26897528 DOI: 10.1007/s00256-016-2348-0] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/22/2015] [Revised: 01/31/2016] [Accepted: 02/04/2016] [Indexed: 02/02/2023]
Abstract
BACKGROUND To assess the acquisition speed, lesion conspicuity, and inter-observer agreement associated with volumetric T(1)-weighted MR sequences with isotropic resolution for detecting recurrent soft-tissue sarcoma (STS). METHODS Fifteen subjects with histologically proven recurrent STS underwent MRI, including axial and coronal T(1)-weighted spin echo (T(1)-WSE) (5-mm slice thickness) and coronal 3D volumetric T(1)-weighted (fat-suppressed, volume-interpolated, breath-hold examination; repetition time/echo time, 3.7/1.4 ms; flip angle, 9.5°; 1-mm slice thickness) sequences before and after intravenous contrast administration. Subtraction imaging and multiplanar reformations (MPRs) were performed. Acquisition times for T(1)-WSE in two planes and 3D sequences were reported. Two radiologists reviewed images for quality (>50 % artifacts, 25-50 % artifacts, <25 % artifacts, and no substantial artifacts), lesion conspicuity, contrast-to-noise ratio (CNR(muscle)), recurrence size, and recurrence-to-joint distance. Descriptive and intraclass correlation (ICC) statistics are given. RESULTS Mean acquisition times were significantly less for 3D imaging compared with 2-plane T(1)-WSE (183.6 vs 342.6 s; P = 0.012). Image quality was rated as having no substantial artifacts in 13/15 and <25 % artifacts in 2/15. Lesion conspicuity was significantly improved for subtracted versus unsubtracted images (CNR(muscle), 100 ± 138 vs 181 ± 199; P = 0.05). Mean recurrent lesion size was 2.5 cm (range, 0.7-5.7 cm), and measurements on 3D sequences offered excellent interobserver agreement (ICC, 0.98 for lesion size and 0.96 for recurrence-to-joint distance with MPR views). CONCLUSION Three-dimensional volumetric sequences offer faster acquisition times, higher spatial resolution, and MPR capability compared with 2D T(1)-WSE for postcontrast imaging. Subtraction imaging provides higher lesion conspicuity for detecting recurrent STS in skeletal muscle, with excellent interobserver agreement between readers.
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Affiliation(s)
- Shivani Ahlawat
- The Russell H. Morgan Department of Radiology & Radiological Science, The Johns Hopkins Medical Institutions, 600 North Wolfe Street, Baltimore, MD, 21287, USA.
| | - Carol Morris
- Department of Orthopedic Surgery, The Johns Hopkins Medical Institutions, 601 North Caroline Street, Baltimore, MD, 21287, USA.,Department of Oncology, The Johns Hopkins Medical Institutions, 601 North Caroline Street, Baltimore, MD, 21287, USA
| | - Laura M Fayad
- The Russell H. Morgan Department of Radiology & Radiological Science, The Johns Hopkins Medical Institutions, 600 North Wolfe Street, Baltimore, MD, 21287, USA.,Department of Orthopedic Surgery, The Johns Hopkins Medical Institutions, 601 North Caroline Street, Baltimore, MD, 21287, USA.,Department of Oncology, The Johns Hopkins Medical Institutions, 601 North Caroline Street, Baltimore, MD, 21287, USA
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Nebelung S, Brill N, Tingart M, Pufe T, Kuhl C, Jahr H, Truhn D. Quantitative OCT and MRI biomarkers for the differentiation of cartilage degeneration. Skeletal Radiol 2016; 45:505-16. [PMID: 26783011 DOI: 10.1007/s00256-016-2334-6] [Citation(s) in RCA: 36] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/24/2015] [Revised: 01/05/2016] [Accepted: 01/07/2016] [Indexed: 02/02/2023]
Abstract
OBJECTIVE To evaluate the usefulness of quantitative parameters obtained by optical coherence tomography (OCT) and magnetic resonance imaging (MRI) in the comprehensive assessment of human articular cartilage degeneration. MATERIALS AND METHODS Human osteochondral samples of variable degeneration (n = 45) were obtained from total knee replacements and assessed by MRI sequences measuring T1, T1ρ, T2 and T2* relaxivity and by OCT-based quantification of irregularity (OII, optical irregularity index), homogeneity (OHI, optical homogeneity index]) and attenuation (OAI, optical attenuation index]). Samples were also assessed macroscopically (Outerbridge classification) and histologically (Mankin classification) as grade-0 (Mankin scores 0-4)/grade-I (scores 5-8)/grade-II (scores 9-10)/grade-III (score 11-14). After data normalisation, differences between Mankin grades and correlations between imaging parameters were assessed using ANOVA and Tukey's post-hoc test and Spearman's correlation coefficients, respectively. Sensitivities and specificities in the detection of Mankin grade-0 were calculated. RESULTS Significant degeneration-related increases were found for T2 and OII and decreases for OAI, while T1, T1ρ, T2* or OHI did not reveal significant changes in relation to degeneration. A number of significant correlations between imaging parameters and histological (sub)scores were found, in particular for T2 and OII. Sensitivities and specificities in the detection of Mankin grade-0 were highest for OHI/T1 and OII/T1ρ, respectively. CONCLUSION Quantitative OCT and MRI techniques seem to complement each other in the comprehensive assessment of cartilage degeneration. Sufficiently large structural and compositional changes in the extracellular matrix may thus be parameterized and quantified, while the detection of early degeneration remains challenging.
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Affiliation(s)
- Sven Nebelung
- Department of Orthopaedics, Aachen University Hospital, Pauwelsstr. 30, 52074, Aachen, Germany. .,Institute of Anatomy and Cell Biology, RWTH, Aachen, Germany.
| | - Nicolai Brill
- Fraunhofer Institute for Production Technology, Aachen, Germany
| | - Markus Tingart
- Department of Orthopaedics, Aachen University Hospital, Pauwelsstr. 30, 52074, Aachen, Germany
| | - Thomas Pufe
- Institute of Anatomy and Cell Biology, RWTH, Aachen, Germany
| | - Christiane Kuhl
- Department of Diagnostic and Interventional Radiology, Aachen University Hospital, Aachen, Germany
| | - Holger Jahr
- Department of Orthopaedics, Aachen University Hospital, Pauwelsstr. 30, 52074, Aachen, Germany
| | - Daniel Truhn
- Department of Diagnostic and Interventional Radiology, Aachen University Hospital, Aachen, Germany
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15
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Bittersohl B, Kircher J, Miese FR, Dekkers C, Habermeyer P, Fröbel J, Antoch G, Krauspe R, Zilkens C. T2* mapping and delayed gadolinium-enhanced magnetic resonance imaging in cartilage (dGEMRIC) of humeral articular cartilage--a histologically controlled study. J Shoulder Elbow Surg 2015; 24:1644-52. [PMID: 25958213 DOI: 10.1016/j.jse.2015.03.016] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/10/2014] [Revised: 02/27/2015] [Accepted: 03/07/2015] [Indexed: 02/01/2023]
Abstract
BACKGROUND Cartilage biochemical imaging modalities that include the magnetic resonance imaging (MRI) techniques of T2* mapping (sensitive to water content and collagen fiber network) and delayed gadolinium-enhanced MRI of cartilage (dGEMRIC, sensitive to the glycosaminoglycan content) can be effective instruments for early diagnosis and reliable follow-up of cartilage damage. The purpose of this study was to provide T2* mapping and dGEMRIC values in various histologic grades of cartilage degeneration in humeral articular cartilage. METHODS A histologically controlled in vitro study was conducted that included human humeral head cartilage specimens with various histologic grades of cartilage degeneration. High-resolution, 3-dimensional (3D) T2* mapping and dGEMRIC were performed that enabled the correlation of MRI and histology data. Cartilage degeneration was graded according to the Mankin score, which evaluates surface morphology, cellularity, toluidine blue staining, and tidemark integrity. SPSS software was used for statistical analyses. RESULTS Both MRI mapping values decreased significantly (P < .001) with increasing cartilage degeneration. Spearman rank analysis revealed a significant correlation (correlation coefficients ranging from -0.315 to 0.784; P < .001) between the various histologic parameters and the T2* and T1Gd mapping values. CONCLUSION This study demonstrates the feasibility of 3D T2* and dGEMRIC to identify various histologic grades of cartilage damage of humeral articular cartilage. With regard to the advantages of these mapping techniques with high image resolution and the ability to accomplish a 3D biochemically sensitive imaging, we consider that these imaging techniques can make a positive contribution to the currently evolving science and practice of cartilage biochemical imaging.
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Affiliation(s)
- Bernd Bittersohl
- Medical Faculty, Department of Orthopaedics, University Düsseldorf, Düsseldorf, Germany
| | - Jörn Kircher
- Klinik Fleetinsel Hamburg, Clinic for Orthopedic Surgery, Hamburg, Germany.
| | - Falk R Miese
- Medical Faculty, Department of Diagnostic and Interventional Radiology, University Düsseldorf, Düsseldorf, Germany
| | - Christin Dekkers
- Medical Faculty, Department of Orthopaedics, University Düsseldorf, Düsseldorf, Germany
| | - Peter Habermeyer
- ATOS-Klinik Heidelberg, Department of Shoulder and Elbow Surgery, Heidelberg, Germany
| | - Julia Fröbel
- Medical Faculty, Department of Orthopaedics, University Düsseldorf, Düsseldorf, Germany
| | - Gerald Antoch
- Medical Faculty, Department of Diagnostic and Interventional Radiology, University Düsseldorf, Düsseldorf, Germany
| | - Rüdiger Krauspe
- Medical Faculty, Department of Orthopaedics, University Düsseldorf, Düsseldorf, Germany
| | - Christoph Zilkens
- Medical Faculty, Department of Orthopaedics, University Düsseldorf, Düsseldorf, Germany
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Current knowledge and importance of dGEMRIC techniques in diagnosis of hip joint diseases. Skeletal Radiol 2015; 44:1073-83. [PMID: 25913097 DOI: 10.1007/s00256-015-2135-3] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/20/2014] [Revised: 03/10/2015] [Accepted: 03/12/2015] [Indexed: 02/02/2023]
Abstract
Accurate assessment of early hip joint cartilage alterations may help optimize patient selection and follow-up of hip joint preservation surgery. Delayed gadolinium-enhanced magnetic resonance imaging of cartilage (dGEMRIC) is sensitive to the glycosaminoglycan content in cartilage that is lost early in the development of osteoarthritis (OA). Hence, the dGEMRIC technique holds promise for the development of new diagnostic and therapeutic procedures. However, because of the location of the hip joint deep within the body and due to the fairly thin cartilage layers that require high spatial resolution, the diagnosis of early hip joint cartilage alterations may be problematic. The purpose of this review is to outline the current status of dGEMRIC in the assessment of hip joint cartilage. A literature search was performed with PubMed, using the terms "cartilage, osteoarthritis, hip joint, MRI, and dGEMRIC", considering all levels of studies. This review revealed that dGEMRIC can be reliably used in the evaluation of early stage cartilage pathology in various hip joint disorders. Modifications in the technique, such as the operation of three-dimensional imaging and dGEMRIC after intra-articular contrast medium administration, have expanded the range of application. Notably, the studies differ considerably in patient selection and technical prerequisites. Furthermore, there is a need for multicenter prospective studies with the required technical conditions in place to establish outcome based dGEMRIC data to obtain, in conjunction with clinical data, reliable threshold values for normal and abnormal cartilage, and for hips that may benefit from conservative or surgical treatment.
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Abstract
Osteoarthritis is a major source of pain, disability, and socioeconomic cost worldwide. The epidemiology of the disorder is complex and multifactorial, with genetic, biological, and biomechanical components. Aetiological factors are also joint specific. Joint replacement is an effective treatment for symptomatic end-stage disease, although functional outcomes can be poor and the lifespan of prostheses is limited. Consequently, the focus is shifting to disease prevention and the treatment of early osteoarthritis. This task is challenging since conventional imaging techniques can detect only quite advanced disease and the relation between pain and structural degeneration is not close. Nevertheless, advances in both imaging and biochemical markers offer potential for diagnosis and as outcome measures for new treatments. Joint-preserving interventions under development include lifestyle modification and pharmaceutical and surgical modalities. Some show potential, but at present few have proven ability to arrest or delay disease progression.
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Affiliation(s)
- S Glyn-Jones
- Nuffield Department of Orthopaedics, Rheumatology, and Musculoskeletal Sciences, University of Oxford, Oxford, UK
| | - A J R Palmer
- Nuffield Department of Orthopaedics, Rheumatology, and Musculoskeletal Sciences, University of Oxford, Oxford, UK.
| | - R Agricola
- Department of Orthopaedics, Erasmus MC University Medical Centre, Rotterdam, Netherlands
| | - A J Price
- Nuffield Department of Orthopaedics, Rheumatology, and Musculoskeletal Sciences, University of Oxford, Oxford, UK
| | - T L Vincent
- Nuffield Department of Orthopaedics, Rheumatology, and Musculoskeletal Sciences, University of Oxford, Oxford, UK
| | - H Weinans
- Department of Orthopaedics, University Medical Centre Utrecht, Netherlands
| | - A J Carr
- Nuffield Department of Orthopaedics, Rheumatology, and Musculoskeletal Sciences, University of Oxford, Oxford, UK
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Bittersohl B, Hosalkar HS, Hesper T, Tiderius CJ, Zilkens C, Krauspe R. Advanced Imaging in Femoroacetabular Impingement: Current State and Future Prospects. Front Surg 2015; 2:34. [PMID: 26258129 PMCID: PMC4513289 DOI: 10.3389/fsurg.2015.00034] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2015] [Accepted: 07/10/2015] [Indexed: 11/13/2022] Open
Abstract
Symptomatic femoroacetabular impingement (FAI) is now a known precursor of early osteoarthritis (OA) of the hip. In terms of clinical intervention, the decision between joint preservation and joint replacement hinges on the severity of articular cartilage degeneration. The exact threshold during the course of disease progression when the cartilage damage is irreparable remains elusive. The intention behind radiographic imaging is to accurately identify the morphology of osseous structural abnormalities and to accurately characterize the chondrolabral damage as much as possible. However, both plain radiographs and computed tomography (CT) are insensitive for articular cartilage anatomy and pathology. Advanced magnetic resonance imaging (MRI) techniques include magnetic resonance arthrography and biochemically sensitive techniques of delayed gadolinium-enhanced MRI of cartilage (dGEMRIC), T1rho (T1ρ), T2/T2* mapping, and several others. The diagnostic performance of these techniques to evaluate cartilage degeneration could improve the ability to predict an individual patient-specific outcome with non-surgical and surgical care. This review discusses the facts and current applications of biochemical MRI for hip joint cartilage assessment covering the roles of dGEMRIC, T2/T2*, and T1ρ mapping. The basics of each technique and their specific role in FAI assessment are outlined. Current limitations and potential pitfalls as well as future directions of biochemical imaging are also outlined.
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Affiliation(s)
- Bernd Bittersohl
- Department of Orthopedics, Medical Faculty, University Düsseldorf , Düsseldorf , Germany
| | - Harish S Hosalkar
- Center for Hip Preservation and Children's Orthopedics , San Diego, CA , USA
| | - Tobias Hesper
- Department of Orthopedics, Medical Faculty, University Düsseldorf , Düsseldorf , Germany
| | | | - Christoph Zilkens
- Department of Orthopedics, Medical Faculty, University Düsseldorf , Düsseldorf , Germany
| | - Rüdiger Krauspe
- Department of Orthopedics, Medical Faculty, University Düsseldorf , Düsseldorf , Germany
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Bittersohl B, Hosalkar HS, Miese FR, Schibensky J, König DP, Herten M, Antoch G, Krauspe R, Zilkens C. Zonal T2* and T1Gd assessment of knee joint cartilage in various histological grades of cartilage degeneration: an observational in vitro study. BMJ Open 2015; 5:e006895. [PMID: 25667150 PMCID: PMC4322206 DOI: 10.1136/bmjopen-2014-006895] [Citation(s) in RCA: 39] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/21/2022] Open
Abstract
OBJECTIVES Accurate assessment of cartilage status is increasingly becoming important to clinicians for offering joint preservation surgeries versus joint replacements. The goal of this study was to evaluate the validity of three-dimensional (3D), gradient-echo (GRE)-based T2* and T1Gd mapping for the assessment of various histological severities of degeneration in knee joint cartilage with potential implications for clinical management. METHODS MRI and histological assessment were conducted in 36 ex vivo lateral femoral condyle specimens. The MRI protocol included a 3D GRE multiecho data image combination sequence in order to assess the T2* decay, a 3D double-echo steady-state sequence for assessment of cartilage morphology, and a dual flip angle 3D GRE sequence with volumetric interpolated breathhold examination for the T1Gd assessment. The histological sample analysis was performed according to the Mankin system. The data were then analysed statistically and correlated. RESULTS We observed a significant decrease in the T2* and T1Gd values with increasing grades of cartilage degeneration (p<0.001) and a moderate correlation between T2* (r=0.514)/T1Gd (r=0.556) and the histological grading of cartilage degeneration (p<0.001). In addition, we noted a zonal variation in the T2* and T1Gd values reflecting characteristic zonal differences in the biochemical composition of hyaline cartilage. CONCLUSIONS This study outlines the potential of GRE-based T2* and T1Gd mapping to identify various grades of cartilage damage. Early changes in specific zones may assist clinicians in identifying methods of early intervention involving the targeted joint preservation approach versus moving forward with unicompartmental, bicompartmental or tricompartmental joint replacement procedures. TRIAL REGISTRATION NUMBER DRKS00000729.
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Affiliation(s)
- Bernd Bittersohl
- Medical Faculty, Department of Orthopaedics, University Düsseldorf, Düsseldorf, Germany
| | - Harish S Hosalkar
- Center of Hip Preservation and Children's Orthopaedics, San Diego, California, USA
| | - Falk R Miese
- Medical Faculty, Department of Diagnostic and Interventional Radiology, University Düsseldorf, Düsseldorf, Germany
| | - Jonas Schibensky
- Medical Faculty, Department of Orthopaedics, University Düsseldorf, Düsseldorf, Germany
| | | | - Monika Herten
- Medical Faculty, Clinic for Vascular and Endovascular Surgery, University Münster, Münster, Germany
| | - Gerald Antoch
- Medical Faculty, Department of Diagnostic and Interventional Radiology, University Düsseldorf, Düsseldorf, Germany
| | - Rüdiger Krauspe
- Medical Faculty, Department of Orthopaedics, University Düsseldorf, Düsseldorf, Germany
| | - Christoph Zilkens
- Medical Faculty, Department of Orthopaedics, University Düsseldorf, Düsseldorf, Germany
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Chandra SS, Surowiec R, Ho C, Xia Y, Engstrom C, Crozier S, Fripp J. Automated analysis of hip joint cartilage combining MR T2 and three‐dimensional fast‐spin‐echo images. Magn Reson Med 2015; 75:403-13. [DOI: 10.1002/mrm.25598] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2014] [Revised: 12/07/2014] [Accepted: 12/09/2014] [Indexed: 11/11/2022]
Affiliation(s)
- Shekhar S. Chandra
- School of Information Technology and Electrical EngineeringUniversity of Queensland Australia
| | | | - Charles Ho
- Steadman Philippon Research Institute (SPRI)Colorado USA
| | - Ying Xia
- School of Information Technology and Electrical EngineeringUniversity of Queensland Australia
- Australian e‐Health Research CentreCSIRO Computational Informatics Australia
| | - Craig Engstrom
- School of Human Movement Studies, University of Queensland Australia
| | - Stuart Crozier
- School of Information Technology and Electrical EngineeringUniversity of Queensland Australia
| | - Jurgen Fripp
- Australian e‐Health Research CentreCSIRO Computational Informatics Australia
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Männicke N, Schöne M, Oelze M, Raum K. Articular cartilage degeneration classification by means of high-frequency ultrasound. Osteoarthritis Cartilage 2014; 22:1577-82. [PMID: 25278067 DOI: 10.1016/j.joca.2014.06.019] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/27/2014] [Revised: 06/16/2014] [Accepted: 06/23/2014] [Indexed: 02/02/2023]
Abstract
CONTEXT To date only single ultrasound parameters were regarded in statistical analyses to characterize osteoarthritic changes in articular cartilage and the potential benefit of using parameter combinations for characterization remains unclear. OBJECTIVE Therefore, the aim of this work was to utilize feature selection and classification of a Mankin subset score (i.e., cartilage surface and cell sub-scores) using ultrasound-based parameter pairs and investigate both classification accuracy and the sensitivity towards different degeneration stages. DESIGN 40 punch biopsies of human cartilage were previously scanned ex vivo with a 40-MHz transducer. Ultrasound-based surface parameters, as well as backscatter and envelope statistics parameters were available. Logistic regression was performed with each unique US parameter pair as predictor and different degeneration stages as response variables. The best ultrasound-based parameter pair for each Mankin subset score value was assessed by highest classification accuracy and utilized in receiver operating characteristics (ROC) analysis. RESULTS The classifications discriminating between early degenerations yielded area under the ROC curve (AUC) values of 0.94-0.99 (mean ± SD: 0.97 ± 0.03). In contrast, classifications among higher Mankin subset scores resulted in lower AUC values: 0.75-0.91 (mean ± SD: 0.84 ± 0.08). Variable sensitivities of the different ultrasound features were observed with respect to different degeneration stages. CONCLUSIONS Our results strongly suggest that combinations of high-frequency ultrasound-based parameters exhibit potential to characterize different, particularly very early, degeneration stages of hyaline cartilage. Variable sensitivities towards different degeneration stages suggest that a concurrent estimation of multiple ultrasound-based parameters is diagnostically valuable. In-vivo application of the present findings is conceivable in both minimally invasive arthroscopic ultrasound and high-frequency transcutaneous ultrasound.
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Affiliation(s)
- N Männicke
- Julius Wolff Institute and Berlin-Brandenburg School for Regenerative Therapies, Charité-Universitätsmedizin Berlin, Germany
| | - M Schöne
- Julius Wolff Institute and Berlin-Brandenburg School for Regenerative Therapies, Charité-Universitätsmedizin Berlin, Germany
| | - M Oelze
- Bioacoustics Research Laboratory, Department of Electrical and Computer Engineering, University of Illinois at Urbana-Champaign, Urbana, IL, USA
| | - K Raum
- Julius Wolff Institute and Berlin-Brandenburg School for Regenerative Therapies, Charité-Universitätsmedizin Berlin, Germany.
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22
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Crema MD, Hunter DJ, Burstein D, Roemer FW, Li L, Krishnan N, Marra MD, Hellio Le-Graverand MP, Guermazi A. Delayed Gadolinium-Enhanced Magnetic Resonance Imaging of Medial Tibiofemoral Cartilage and Its Relationship With Meniscal Pathology: A Longitudinal Study Using 3.0T Magnetic Resonance Imaging. Arthritis Rheumatol 2014; 66:1517-24. [DOI: 10.1002/art.38518] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2013] [Accepted: 02/18/2014] [Indexed: 11/07/2022]
Affiliation(s)
- Michel D. Crema
- Boston University School of Medicine; Boston, Massachusetts
- Hospital do Coração and Teleimagem; São Paulo Brazil
| | | | - Deborah Burstein
- Beth Israel Deaconess Medical Center and Harvard Medical School; Boston, Massachusetts
| | - Frank W. Roemer
- Boston University School of Medicine; Boston, Massachusetts
- Klinikum Augsburg; Augsburg Germany
| | - Ling Li
- New England Baptist Hospital; Boston, Massachusetts
| | - Nitya Krishnan
- Beth Israel Deaconess Medical Center and Harvard Medical School; Boston, Massachusetts
| | | | | | - Ali Guermazi
- Boston University School of Medicine; Boston, Massachusetts
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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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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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25
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Crema MD, Hunter DJ, Burstein D, Roemer FW, Li L, Eckstein F, Krishnan N, Hellio Le-Graverand MP, Guermazi A. Association of changes in delayed gadolinium-enhanced MRI of cartilage (dGEMRIC) with changes in cartilage thickness in the medial tibiofemoral compartment of the knee: a 2 year follow-up study using 3.0 T MRI. Ann Rheum Dis 2013; 73:1935-41. [PMID: 23873880 DOI: 10.1136/annrheumdis-2012-203083] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
OBJECTIVE To determine the association between changes in the delayed gadolinium-enhanced MRI of cartilage (dGEMRIC) index over 2 years as a measure of cartilage proteoglycan concentration, with changes in cartilage thickness in the medial tibiofemoral compartment of knees in middle-aged women. METHODS One hundred and forty-eight women (one knee for each subject) aged ≥40 years were included. 3.0 T MR images of the knee were acquired at baseline, 1 year and 2 years. Three-dimensional (3D) spoiled gradient recalled echo (SPGR) sequences (for cartilage thickness) and 3D inversion recovery-prepared SPGR sequences after dGEMRIC were acquired. Segmentation was performed in the medial central (weight-bearing) femur and tibia to determine cartilage proteoglycan concentration and thickness. The association of change in the dGEMRIC indices between baseline and 1-year follow-up with (a) concomitant changes in cartilage thickness and (b) change in cartilage thickness between 1 and 2 years was assessed using linear regression. RESULTS In the whole-sample model, a decrease in dGEMRIC indices over time at the central medial femur significantly predicted an increase in cartilage thickness at both the central medial femur (p=0.008) and the medial tibia (p=0.04). CONCLUSIONS A decrease in dGEMRIC indices was associated with an increase in cartilage thickness in the medial compartment. Our results suggest that an increase in cartilage thickness may also be related to a decrease in proteoglycan concentration, which may represent swelling of cartilage in early stages of degeneration.
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Affiliation(s)
- Michel D Crema
- Department of Radiology, Quantitative Imaging Center, Boston University School of Medicine, Boston, Massachusetts, USA Boston Imaging Core Lab, Boston, Massachusetts, USA Department of Radiology, Hospital do Coração (HCor) and Teleimagem, São Paulo, Brazil
| | - David J Hunter
- Department of Rheumatology, Northern Clinical School, University of Sydney, Sydney, Australia
| | - Deborah Burstein
- Clinical Department of Radiology, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts, USA
| | - Frank W Roemer
- Department of Radiology, Quantitative Imaging Center, Boston University School of Medicine, Boston, Massachusetts, USA Department of Radiology, University of Erlangen, Erlangen, Germany
| | - Ling Li
- Division of Research, New England Baptist Hospital, Boston, Massachusetts, USA
| | - Felix Eckstein
- Institute of Anatomy and Musculoskeletal Research, Paracelsus Medical University, Salzburg, Austria Chondrometrics GmbH, Ainring, Germany
| | - Nitya Krishnan
- Clinical Department of Radiology, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts, USA
| | | | - Ali Guermazi
- Department of Radiology, Quantitative Imaging Center, Boston University School of Medicine, Boston, Massachusetts, USA Boston Imaging Core Lab, Boston, Massachusetts, USA
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Bekkers JEJ, Bartels LW, Benink RJ, Tsuchida AI, Vincken KL, Dhert WJA, Creemers LB, Saris DBF. Delayed gadolinium enhanced MRI of cartilage (dGEMRIC) can be effectively applied for longitudinal cohort evaluation of articular cartilage regeneration. Osteoarthritis Cartilage 2013; 21:943-9. [PMID: 23583465 DOI: 10.1016/j.joca.2013.03.017] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/15/2012] [Revised: 02/23/2013] [Accepted: 03/29/2013] [Indexed: 02/02/2023]
Abstract
OBJECTIVE Delayed gadolinium enhanced magnetic resonance imaging (MRI) of cartilage (dGEMRIC) facilitates non-invasive evaluation of the glycosaminoglycan content in articular cartilage. The primary aim of this study was to show that the dGEMRIC technique is able to monitor cartilage repair following regenerative cartilage treatment. DESIGN Thirty-one patients with a focal cartilage lesion underwent a dGEMRIC scan prior to cartilage repair surgery and at 3 and 12 months follow-up. At similar time points clinical improvement was monitored using the Knee injury and Osteoarthritis Outcome Score (KOOS) and Lysholm questionnaires. Per MRI scan several regions-of-interest (ROIs) were defined for different locations in the joint. The dGEMRIC index (T1gd) was calculated for each ROI. Repeated-measures analysis of variance (RMANOVA) analysis was used to evaluate improvement in clinical scores and MRI T1gd over time. Also regression analysis was performed to show the influence of local repair on cartilage quality at distant locations in the knee. RESULTS Clinical scores and the dGEMRIC T1gd per ROI showed a statistically significant improvement (P < 0.01), from baseline, at 12 months follow-up. Also, improvement from baseline in T1gd of the ROI defining the treated cartilage defect showed a direct relationship (P < 0.007) to the improvement of the T1gd of ROI at other locations in the joint. CONCLUSIONS The dGEMRIC MRI protocol is a useful method to evaluate cartilage repair. In addition, local cartilage repair influenced the cartilage quality at other location in the joint. These findings validate the use of dGEMRIC for non-invasive evaluation of the effects of cartilage regeneration.
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Affiliation(s)
- J E J Bekkers
- Department of Orthopaedics, University Medical Center Utrecht, Utrecht, The Netherlands
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