1
|
Loozen LD, Younger AS, Veljkovic AN. Preoperative and Postoperative Imaging and Outcome Scores for Osteochondral Lesion Repair of the Ankle. Foot Ankle Clin 2024; 29:235-252. [PMID: 38679436 DOI: 10.1016/j.fcl.2023.11.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 05/01/2024]
Abstract
Cartilage lesions to the ankle joint are common and can result in pain and functional limitations. Surgical treatment aims to restore the damaged cartilage's integrity and quality. However, the current evidence for establishing best practices in ankle cartilage repair is characterized by limited quality and a low level of evidence. One of the contributing factors is the lack of standardized preoperative and postoperative assessment methods to evaluate treatment effectiveness and visualize repaired cartilage. This review article seeks to examine the importance of preoperative imaging, classification systems, patient-reported outcome measures, and radiological evaluation techniques for cartilage repair surgeries.
Collapse
Affiliation(s)
- Loek D Loozen
- Division of Distal Extremities, Department of Orthopaedics, University of British Columbia, Vancouver, British Columbia, Canada; Footbridge Clinic for Integrated Orthopaedic Care, 221 Keefer Place, Vancouver, British Columbia, V6B 6C1, Canada.
| | - Alastair S Younger
- Division of Distal Extremities, Department of Orthopaedics, University of British Columbia, Vancouver, British Columbia, Canada; Footbridge Clinic for Integrated Orthopaedic Care, 221 Keefer Place, Vancouver, British Columbia, V6B 6C1, Canada
| | - Andrea N Veljkovic
- Division of Distal Extremities, Department of Orthopaedics, University of British Columbia, Vancouver, British Columbia, Canada; Footbridge Clinic for Integrated Orthopaedic Care, 221 Keefer Place, Vancouver, British Columbia, V6B 6C1, Canada; University of British Columbia, Adult Foot and Ankle Reconstructive Surgery, Department of Orthopaedics, Vancouver, British Columbia, Canada
| |
Collapse
|
2
|
Orava H, Paakkari P, Jäntti J, Honkanen MKM, Honkanen JTJ, Virén T, Joenathan A, Tanska P, Korhonen RK, Grinstaff MW, Töyräs J, Mäkelä JTA. Triple contrast computed tomography reveals site-specific biomechanical differences in the human knee joint-A proof of concept study. J Orthop Res 2024; 42:415-424. [PMID: 37593815 DOI: 10.1002/jor.25683] [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: 04/26/2023] [Revised: 07/05/2023] [Accepted: 08/14/2023] [Indexed: 08/19/2023]
Abstract
Cartilage and synovial fluid are challenging to observe separately in native computed tomography (CT). We report the use of triple contrast agent (bismuth nanoparticles [BiNPs], CA4+, and gadoteridol) to image and segment cartilage in cadaveric knee joints with a clinical CT scanner. We hypothesize that BiNPs will remain in synovial fluid while the CA4+ and gadoteridol will diffuse into cartilage, allowing (1) segmentation of cartilage, and (2) evaluation of cartilage biomechanical properties based on contrast agent concentrations. To investigate these hypotheses, triple contrast agent was injected into both knee joints of a cadaver (N = 1), imaged with a clinical CT at multiple timepoints during the contrast agent diffusion. Knee joints were extracted, imaged with micro-CT (µCT), and biomechanical properties of the cartilage surface were determined by stress-relaxation mapping. Cartilage was segmented and contrast agent concentrations (CA4+ and gadoteridol) were compared with the biomechanical properties at multiple locations (n = 185). Spearman's correlation between cartilage thickness from clinical CT and reference µCT images verifies successful and reliable segmentation. CA4+ concentration is significantly higher in femoral than in tibial cartilage at 60 min and further timepoints, which corresponds to the higher Young's modulus observed in femoral cartilage. In this pilot study, we show that (1) large BiNPs do not diffuse into cartilage, facilitating straightforward segmentation of human knee joint cartilage in a clinical setting, and (2) CA4+ concentration in cartilage reflects the biomechanical differences between femoral and tibial cartilage. Thus, the triple contrast agent CT shows potential in cartilage morphology and condition estimation in clinical CT.
Collapse
Affiliation(s)
- Heta Orava
- Department of Technical Physics, University of Eastern Finland, Kuopio, Finland
- Diagnostic Imaging Center, Kuopio University Hospital, Kuopio, Finland
| | - Petri Paakkari
- Department of Technical Physics, University of Eastern Finland, Kuopio, Finland
- Diagnostic Imaging Center, Kuopio University Hospital, Kuopio, Finland
| | - Jiri Jäntti
- Department of Technical Physics, University of Eastern Finland, Kuopio, Finland
- Diagnostic Imaging Center, Kuopio University Hospital, Kuopio, Finland
| | - Miitu K M Honkanen
- Department of Technical Physics, University of Eastern Finland, Kuopio, Finland
- Diagnostic Imaging Center, Kuopio University Hospital, Kuopio, Finland
| | | | - Tuomas Virén
- Center of Oncology, Kuopio University Hospital, Kuopio, Finland
| | - Anisha Joenathan
- Departments of Biomedical Engineering, Chemistry, and Medicine, Boston University, Boston, Massachusetts, USA
| | - Petri Tanska
- Department of Technical Physics, University of Eastern Finland, Kuopio, Finland
| | - Rami K Korhonen
- Department of Technical Physics, University of Eastern Finland, Kuopio, Finland
| | - Mark W Grinstaff
- Departments of Biomedical Engineering, Chemistry, and Medicine, Boston University, Boston, Massachusetts, USA
| | - Juha Töyräs
- Department of Technical Physics, University of Eastern Finland, Kuopio, Finland
- Science Service Center, Kuopio University Hospital, Kuopio, Finland
- School of Electrical Engineering and Computer Science, The University of Queensland, Brisbane, Australia
| | - Janne T A Mäkelä
- Department of Technical Physics, University of Eastern Finland, Kuopio, Finland
- Diagnostic Imaging Center, Kuopio University Hospital, Kuopio, Finland
| |
Collapse
|
3
|
Hall ME, Black MS, Gold GE, Levenston ME. Validation of watershed-based segmentation of the cartilage surface from sequential CT arthrography scans. Quant Imaging Med Surg 2022; 12:1-14. [PMID: 34993056 PMCID: PMC8666781 DOI: 10.21037/qims-20-1062] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2020] [Accepted: 07/12/2021] [Indexed: 12/12/2022]
Abstract
BACKGROUND This study investigated the utility of a 2-dimensional watershed algorithm for identifying the cartilage surface in computed tomography (CT) arthrograms of the knee up to 33 minutes after an intra-articular iohexol injection as boundary blurring increased. METHODS A 2D watershed algorithm was applied to CT arthrograms of 3 bovine stifle joints taken 3, 8, 18, and 33 minutes after iohexol injection and used to segment tibial cartilage. Thickness measurements were compared to a reference standard thickness measurement and the 3-minute time point scan. RESULTS 77.2% of cartilage thickness measurements were within 0.2 mm (1 voxel) of the thickness calculated in the reference scan at the 3-minute time point. 42% fewer voxels could be segmented from the 33-minute scan than the 3-minute scan due to diffusion of the contrast agent out of the joint space and into the cartilage, leading to blurring of the cartilage boundary. The traced watershed lines were closer to the location of the cartilage surface in areas where tissues were in direct contact with each other (cartilage-cartilage or cartilage-meniscus contact). CONCLUSIONS The use of watershed dam lines to guide cartilage segmentation shows promise for identifying cartilage boundaries from CT arthrograms in areas where soft tissues are in direct contact with each other.
Collapse
Affiliation(s)
- Mary E. Hall
- Department of Mechanical Engineering, Stanford University, Stanford, CA, USA
| | - Marianne S. Black
- Department of Mechanical Engineering, Stanford University, Stanford, CA, USA
- Department of Radiology, Stanford University, Stanford, CA, USA
| | - Garry E. Gold
- Department of Radiology, Stanford University, Stanford, CA, USA
- Department of Bioengineering, Stanford University, Stanford, CA, USA
| | - Marc E. Levenston
- Department of Mechanical Engineering, Stanford University, Stanford, CA, USA
- Department of Radiology, Stanford University, Stanford, CA, USA
- Department of Bioengineering, Stanford University, Stanford, CA, USA
| |
Collapse
|
4
|
Baer K, Kieser S, Schon B, Rajendran K, Ten Harkel T, Ramyar M, Löbker C, Bateman C, Butler A, Raja A, Hooper G, Anderson N, Woodfield T. Spectral CT imaging of human osteoarthritic cartilage via quantitative assessment of glycosaminoglycan content using multiple contrast agents. APL Bioeng 2021; 5:026101. [PMID: 33834156 PMCID: PMC8018795 DOI: 10.1063/5.0035312] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2020] [Accepted: 02/22/2021] [Indexed: 01/06/2023] Open
Abstract
Detection of early osteoarthritis to stabilize or reverse the damage to articular cartilage would improve patient function, reduce disability, and limit the need for joint replacement. In this study, we investigated nondestructive photon-processing spectral computed tomography (CT) for the quantitative measurement of the glycosaminoglycan (GAG) content compared to destructive histological and biochemical assay techniques in normal and osteoarthritic tissues. Cartilage-bone cores from healthy bovine stifles were incubated in 50% ioxaglate (Hexabrix®) or 100% gadobenate dimeglumine (MultiHance®). A photon-processing spectral CT (MARS) scanner with a CdTe-Medipix3RX detector imaged samples. Calibration phantoms of ioxaglate and gadobenate dimeglumine were used to determine iodine and gadolinium concentrations from photon-processing spectral CT images to correlate with the GAG content measured using a dimethylmethylene blue assay. The zonal distribution of GAG was compared between photon-processing spectral CT images and histological sections. Furthermore, discrimination and quantification of GAG in osteoarthritic human tibial plateau tissue using the same contrast agents were demonstrated. Contrast agent concentrations were inversely related to the GAG content. The GAG concentration increased from 25 μg/ml (85 mg/ml iodine or 43 mg/ml gadolinium) in the superficial layer to 75 μg/ml (65 mg/ml iodine or 37 mg/ml gadolinium) in the deep layer of healthy bovine cartilage. Deep zone articular cartilage could be distinguished from subchondral bone by utilizing the material decomposition technique. Photon-processing spectral CT images correlated with histological sections in healthy and osteoarthritic tissues. Post-imaging material decomposition was able to quantify the GAG content and distribution throughout healthy and osteoarthritic cartilage using Hexabrix® and MultiHance® while differentiating the underlying subchondral bone.
Collapse
Affiliation(s)
| | - Sandra Kieser
- Christchurch Regenerative Medicine and Tissue Engineering (CReaTE), Department of Orthopaedic Surgery and Musculoskeletal Medicine, University of Otago Christchurch, Christchurch 8011, New Zealand
| | | | | | | | - Mohsen Ramyar
- Department of Radiology, University of Otago Christchurch, Christchurch 8011, New Zealand
| | | | - Christopher Bateman
- Department of Radiology, University of Otago Christchurch, Christchurch 8011, New Zealand
| | | | | | | | - Nigel Anderson
- Department of Radiology, University of Otago Christchurch, Christchurch 8011, New Zealand
| | | |
Collapse
|
5
|
Mohammadi A, Myller KAH, Tanska P, Hirvasniemi J, Saarakkala S, Töyräs J, Korhonen RK, Mononen ME. Rapid CT-based Estimation of Articular Cartilage Biomechanics in the Knee Joint Without Cartilage Segmentation. Ann Biomed Eng 2020; 48:2965-2975. [PMID: 33179182 PMCID: PMC7723937 DOI: 10.1007/s10439-020-02666-y] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2020] [Accepted: 10/17/2020] [Indexed: 12/30/2022]
Abstract
Knee osteoarthritis (OA) is a painful joint disease, causing disabilities in daily activities. However, there is no known cure for OA, and the best treatment strategy might be prevention. Finite element (FE) modeling has demonstrated potential for evaluating personalized risks for the progression of OA. Current FE modeling approaches use primarily magnetic resonance imaging (MRI) to construct personalized knee joint models. However, MRI is expensive and has lower resolution than computed tomography (CT). In this study, we extend a previously presented atlas-based FE modeling framework for automatic model generation and simulation of knee joint tissue responses using contrast agent-free CT. In this method, based on certain anatomical dimensions measured from bone surfaces, an optimal template is selected and scaled to generate a personalized FE model. We compared the simulated tissue responses of the CT-based models with those of the MRI-based models. We show that the CT-based models are capable of producing similar tensile stresses, fibril strains, and fluid pressures of knee joint cartilage compared to those of the MRI-based models. This study provides a new methodology for the analysis of knee joint and cartilage mechanics based on measurement of bone dimensions from native CT scans.
Collapse
Affiliation(s)
- Ali Mohammadi
- Department of Applied Physics, University of Eastern Finland, POB 1627, 70211, Kuopio, Finland.
| | - Katariina A H Myller
- Diagnostic Imaging Center, Kuopio University Hospital, Kuopio, Finland.,Department of Medical Physics, Turku University Central Hospital, 20500, Turku, Finland
| | - Petri Tanska
- Department of Applied Physics, University of Eastern Finland, POB 1627, 70211, Kuopio, Finland
| | - Jukka Hirvasniemi
- Department of Radiology & Nuclear Medicine, Erasmus University Medical Center, Rotterdam, The Netherlands
| | - Simo Saarakkala
- Research Unit of Medical Imaging, Physics and Technology, Faculty of Medicine, University of Oulu, Oulu, Finland.,Department of Diagnostic Radiology, Oulu University Hospital, Oulu, Finland
| | - Juha Töyräs
- Department of Applied Physics, University of Eastern Finland, POB 1627, 70211, Kuopio, Finland.,Diagnostic Imaging Center, Kuopio University Hospital, Kuopio, Finland.,School of Information Technology and Electrical Engineering, The University of Queensland, Brisbane, Australia
| | - Rami K Korhonen
- Department of Applied Physics, University of Eastern Finland, POB 1627, 70211, Kuopio, Finland
| | - Mika E Mononen
- Department of Applied Physics, University of Eastern Finland, POB 1627, 70211, Kuopio, Finland
| |
Collapse
|
6
|
Baylon EG, Crowder HA, Gold GE, Levenston ME. Non-ionic CT contrast solutions rapidly alter bovine cartilage and meniscus mechanics. Osteoarthritis Cartilage 2020; 28:1286-1297. [PMID: 32535082 PMCID: PMC7547404 DOI: 10.1016/j.joca.2020.05.013] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/24/2019] [Revised: 04/18/2020] [Accepted: 05/08/2020] [Indexed: 02/02/2023]
Abstract
OBJECTIVE To evaluate effects of a common CT contrast agent (iohexol) on the mechanical behaviors of cartilage and meniscus. METHODS Indentation responses of juvenile bovine cartilage and meniscus were monitored following exposure to undiluted contrast agent (100% CA), 50% CA/water, 50% CA/Phosphate Buffered Saline (PBS) or PBS alone, and during re-equilibration in PBS. The normalized peak force (Fpk¯), effective osmotic strain (εosm), and normalized effective contact modulus (Ec¯) were calculated for every cycle, with time constants determined for both exposure and recovery via mono- or biexponential fits to Fpk¯. RESULTS All cartilage CA groups exhibited long-term increases in Fpk¯ following exposure, although the hyperosmolal 100% CA and 50% CA/PBS groups showed an initial transient decrease. Meniscus presented opposing trends, with decreasing Fpk¯ for all CA groups. Re-equilibration in PBS for 1hr after exposure to 100% CA produced recovery to baseline Fpk¯ in cartilage but not in meniscus, and extended tests indicated that meniscus required ∼2.5 h to recover halfway. Ec¯ increased with CA exposure time for cartilage but decreased for meniscus, suggesting an increased effective stiffness for cartilage and decreased stiffness for meniscus. Long-term changes to εosm in both tissues were consistent with changes in Ec¯. CONCLUSION Exposure to iohexol solutions affected joint tissues differentially, with increased cartilage stiffness, likely relating to competing hyperosmotic and hypotonic interactions with tissue fixed charges, and decreased meniscus stiffness, likely dominated by hyperosmolarity. These altered tissue mechanics could allow non-physiological deformation during ambulatory weight-bearing, resulting in an increased risk of tissue or cell damage.
Collapse
Affiliation(s)
- E G Baylon
- Department of Mechanical Engineering, Stanford University, Stanford, CA, 94305, USA.
| | - H A Crowder
- Department of Mechanical Engineering, Stanford University, Stanford, CA, 94305, USA.
| | - G E Gold
- Department of Radiology, Stanford University, Stanford, CA, 94305, USA; Department of Bioengineering, Stanford University, Stanford, CA, 94305, USA; Department of Orthopaedic Surgery, Stanford University, Stanford, CA, 94305, USA.
| | - M E Levenston
- Department of Mechanical Engineering, Stanford University, Stanford, CA, 94305, USA; Department of Radiology, Stanford University, Stanford, CA, 94305, USA; Department of Bioengineering, Stanford University, Stanford, CA, 94305, USA.
| |
Collapse
|
7
|
Rajendran K, Murthy NS, Frick MA, Tao S, Unger MD, LaVallee KT, Larson NB, Leng S, Maus TP, McCollough CH. Quantitative Knee Arthrography in a Large Animal Model of Osteoarthritis Using Photon-Counting Detector CT. Invest Radiol 2020; 55:349-356. [PMID: 31985604 PMCID: PMC7212750 DOI: 10.1097/rli.0000000000000648] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
OBJECTIVE The aim of this study was to grade cartilage damage in a swine model of osteoarthritis using a whole-body photon-counting detector (PCD) CT. MATERIALS AND METHODS A multienergy phantom containing gadolinium (Gd) (2, 4, 8, and 16 mg/mL) and hydroxyapatite (200 and 400 mg/cc) was scanned using a PCD-CT system (48 × 0.25 mm collimation, 80 kV, 800 mAs, D50 reconstruction kernel) to serve as calibration for material decomposition and to assess quantification accuracy. Osteoarthritis was induced in Yucatan miniswine (n = 8) using 1.2 mg monoiodoacetate (MIA) injected into a randomized knee, whereas the contralateral control knee received saline. Twenty-one days later, a contrast bolus (gadoterate meglumine, 4 mL/knee) was intra-articularly administered into both knees. The knees were simultaneously scanned on the PCD-CT system (48 × 0.25 mm collimation, 80 kV, 800 mAs). Multienergy images were reconstructed with a sharp "V71" kernel and a quantitative "D50" kernel. Image denoising was applied to the V71 images before grading cartilage damage, and an iterative material decomposition technique was applied to D50 images to generate the Gd maps. Two radiologists blinded to the knee injection status graded the cartilage integrity based on a modified International Cartilage Repair Society scoring system. Histology was performed on excised cartilage using methylene blue/basic fuchsin. Statistical analysis of grade distribution was performed using an exact test of omnibus symmetry with P < 0.05 considered significant. RESULTS Material decomposed images from the multienergy phantom scan showed delineation and quantification of Gd and hydroxyapatite with a root-mean-squared error of 0.3 mg/mL and 18.4 mg/cc, respectively. In the animal cohort, the radiologists reported chondromalacia in the MIA knees with International Cartilage Repair Society scores ranging from grade 1 (cartilage heterogeneity, n = 4 knees) to grade 3 (up to 100% cartilage loss, n = 4 knees). Grade 1 was characterized by cartilage heterogeneity and increased joint space in the patellofemoral compartment, whereas grade 3 was characterized by cartilage erosion and bone-on-bone articulation in the patellofemoral compartment. All control knees were scored as grade 0 (normal cartilage). Significant difference (P = 0.004) was observed in the grade distribution between the MIA and control knees. Gross examination of the excised knees showed cartilage lesions in the grade 3 MIA knees. The Gd maps from material decomposition showed lower contrast levels in the joint space of the MIA knee compared with the contralateral control knee due to joint effusion. Histology revealed chondrocyte loss in the MIA knee cartilage confirming the chondrotoxic effects of MIA on cartilage matrix. CONCLUSIONS We demonstrated a high-resolution and quantitative PCD-CT arthrography technique for grading cartilage damage in a large animal model of osteoarthritis. Photon-counting detector CT offers simultaneous high-resolution and multienergy imaging capabilities that allowed morphological assessment of cartilage loss and quantification of contrast levels in the joint as a marker of joint disease. Cartilage damage in the MIA knees was graded using PCD-CT images, and the image-based findings were further confirmed using histology and gross examination of the excised knees.
Collapse
Affiliation(s)
| | | | | | | | - Mark D. Unger
- Department of Anesthesiology and Oncology, Mayo Clinic, Rochester, MN
| | | | - Nicholas B. Larson
- Department of Biomedical Statistics and Informatics, Mayo Clinic, Rochester, MN
| | - Shuai Leng
- Department of Radiology, Mayo Clinic, Rochester, MN
| | | | | |
Collapse
|
8
|
Mohammadinejad R, Ashrafizadeh M, Pardakhty A, Uzieliene I, Denkovskij J, Bernotiene E, Janssen L, Lorite GS, Saarakkala S, Mobasheri A. Nanotechnological Strategies for Osteoarthritis Diagnosis, Monitoring, Clinical Management, and Regenerative Medicine: Recent Advances and Future Opportunities. Curr Rheumatol Rep 2020; 22:12. [PMID: 32248371 PMCID: PMC7128005 DOI: 10.1007/s11926-020-0884-z] [Citation(s) in RCA: 34] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
PURPOSE OF REVIEW In this review article, we discuss the potential for employing nanotechnological strategies for the diagnosis, monitoring, and clinical management of osteoarthritis (OA) and explore how nanotechnology is being integrated rapidly into regenerative medicine for OA and related osteoarticular disorders. RECENT FINDINGS We review recent advances in this rapidly emerging field and discuss future opportunities for innovations in enhanced diagnosis, prognosis, and treatment of OA and other osteoarticular disorders, the smart delivery of drugs and biological agents, and the development of biomimetic regenerative platforms to support cell and gene therapies for arresting OA and promoting cartilage and bone repair. Nanotubes, magnetic nanoparticles, and other nanotechnology-based drug and gene delivery systems may be used for targeting molecular pathways and pathogenic mechanisms involved in OA development. Nanocomposites are also being explored as potential tools for promoting cartilage repair. Nanotechnology platforms may be combined with cell, gene, and biological therapies for the development of a new generation of future OA therapeutics. Graphical Abstract.
Collapse
Affiliation(s)
- Reza Mohammadinejad
- Pharmaceutics Research Center, Institute of Neuropharmacology, Kerman University of Medical Sciences, Kerman, Iran
| | - Milad Ashrafizadeh
- Department of Basic Science, Faculty of Veterinary Medicine, University of Tabriz, Tabriz, Iran
| | - Abbas Pardakhty
- Pharmaceutics Research Center, Institute of Neuropharmacology, Kerman University of Medical Sciences, Kerman, Iran
| | - Ilona Uzieliene
- Department of Regenerative Medicine, State Research Institute Centre for Innovative Medicine, Santariskiu 5, LT-08406, Vilnius, Lithuania
| | - Jaroslav Denkovskij
- Department of Regenerative Medicine, State Research Institute Centre for Innovative Medicine, Santariskiu 5, LT-08406, Vilnius, Lithuania
| | - Eiva Bernotiene
- Department of Regenerative Medicine, State Research Institute Centre for Innovative Medicine, Santariskiu 5, LT-08406, Vilnius, Lithuania
| | - Lauriane Janssen
- Microelectronics Research Unit, Faculty of Information Technology and Electrical Engineering, University of Oulu, PL 4500, 3FI-90014, Oulu, Finland
| | - Gabriela S Lorite
- Microelectronics Research Unit, Faculty of Information Technology and Electrical Engineering, University of Oulu, PL 4500, 3FI-90014, Oulu, Finland
| | - Simo Saarakkala
- Department of Diagnostic Radiology, Oulu University Hospital, Oulu, Finland
- Research Unit of Medical Imaging, Physics and Technology, Faculty of Medicine, University of Oulu, Oulu, Finland
| | - Ali Mobasheri
- Department of Regenerative Medicine, State Research Institute Centre for Innovative Medicine, Santariskiu 5, LT-08406, Vilnius, Lithuania.
- Department of Diagnostic Radiology, Oulu University Hospital, Oulu, Finland.
- Research Unit of Medical Imaging, Physics and Technology, Faculty of Medicine, University of Oulu, Oulu, Finland.
- Centre for Sport, Exercise and Osteoarthritis Versus Arthritis, Queen's Medical Centre, Nottingham, UK.
- Sheik Salem Bin Mahfouz Scientific Chair for Treatment of Osteoarthritis with Stem Cells, King AbdulAziz University, Jeddah, Saudi Arabia.
- University Medical Center Utrecht, Department of Orthopedics and Department of Rheumatology & Clinical Immunology, 508 GA, Utrecht, The Netherlands.
| |
Collapse
|
9
|
Honkanen MKM, Saukko AEA, Turunen MJ, Shaikh R, Prakash M, Lovric G, Joukainen A, Kröger H, Grinstaff MW, Töyräs J. Synchrotron MicroCT Reveals the Potential of the Dual Contrast Technique for Quantitative Assessment of Human Articular Cartilage Composition. J Orthop Res 2020; 38:563-573. [PMID: 31535728 PMCID: PMC7065106 DOI: 10.1002/jor.24479] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/27/2019] [Accepted: 09/13/2019] [Indexed: 02/04/2023]
Abstract
Dual contrast micro computed tomography (CT) shows potential for detecting articular cartilage degeneration. However, the performance of conventional CT systems is limited by beam hardening, low image resolution (full-body CT), and long acquisition times (conventional microCT). Therefore, to reveal the full potential of the dual contrast technique for imaging cartilage composition we employ the technique using synchrotron microCT. We hypothesize that the above-mentioned limitations are overcome with synchrotron microCT utilizing monochromatic X-ray beam and fast image acquisition. Human osteochondral samples (n = 41, four cadavers) were immersed in a contrast agent solution containing two agents (cationic CA4+ and non-ionic gadoteridol) and imaged with synchrotron microCT at an early diffusion time point (2 h) and at diffusion equilibrium (72 h) using two monochromatic X-ray energies (32 and 34 keV). The dual contrast technique enabled simultaneous determination of CA4+ (i.e., proteoglycan content) and gadoteridol (i.e., water content) partitions within cartilage. Cartilage proteoglycan content and biomechanical properties correlated significantly (0.327 < r < 0.736, p < 0.05) with CA4+ partition in superficial and middle zones at both diffusion time points. Normalization of the CA4+ partition with gadoteridol partition within the cartilage significantly (p < 0.05) improved the detection sensitivity for human osteoarthritic cartilage proteoglycan content, biomechanical properties, and overall condition (Mankin, Osteoarthritis Research Society International, and International Cartilage Repair Society grading systems). The dual energy technique combined with the dual contrast agent enables assessment of human articular cartilage proteoglycan content and biomechanical properties based on CA4+ partition determined using synchrotron microCT. Additionally, the dual contrast technique is not limited by the beam hardening artifact of conventional CT systems. © 2019 The Authors. Journal of Orthopaedic Research® published by Wiley Periodicals, Inc. on behalf of Orthopaedic Research Society. J Orthop Res 38:563-573, 2020.
Collapse
Affiliation(s)
- Miitu K. M. Honkanen
- Department of Applied PhysicsUniversity of Eastern FinlandKuopioFinland
- Diagnostic Imaging CenterKuopio University HospitalKuopioFinland
| | - Annina E. A. Saukko
- Department of Applied PhysicsUniversity of Eastern FinlandKuopioFinland
- Department of Medical PhysicsTurku University HospitalTurkuFinland
| | - Mikael J. Turunen
- Department of Applied PhysicsUniversity of Eastern FinlandKuopioFinland
- SIB LabsUniversity of Eastern FinlandKuopioFinland
| | - Rubina Shaikh
- Department of Applied PhysicsUniversity of Eastern FinlandKuopioFinland
| | - Mithilesh Prakash
- Department of Applied PhysicsUniversity of Eastern FinlandKuopioFinland
- Diagnostic Imaging CenterKuopio University HospitalKuopioFinland
- A.I. Virtanen Institute for Molecular SciencesUniversity of Eastern FinlandKuopioFinland
| | - Goran Lovric
- Centre d'lmagerie BioMédicaleÉcole Polytechnique Fédérale de LausanneLausanneSwitzerland
- Swiss Light SourcePaul Scherrer InstituteVilligenSwitzerland
| | - Antti Joukainen
- Department of Orthopedics, Traumatology and Hand SurgeryKuopio University HospitalKuopioFinland
| | - Heikki Kröger
- Department of Orthopedics, Traumatology and Hand SurgeryKuopio University HospitalKuopioFinland
| | - Mark W. Grinstaff
- Departments of Biomedical Engineering, Chemistry, and MedicineBoston UniversityBostonMassachusetts
| | - Juha Töyräs
- Department of Applied PhysicsUniversity of Eastern FinlandKuopioFinland
- Diagnostic Imaging CenterKuopio University HospitalKuopioFinland
- School of Information Technology and Electrical EngineeringThe University of QueenslandBrisbaneQueenslandAustralia
| |
Collapse
|
10
|
Stewart RC, Nelson BB, Kawcak CE, Freedman JD, Snyder BD, Goodrich LR, Grinstaff MW. Contrast-Enhanced Computed Tomography Scoring System for Distinguishing Early Osteoarthritis Disease States: A Feasibility Study. J Orthop Res 2019; 37:2138-2148. [PMID: 31136003 PMCID: PMC6739126 DOI: 10.1002/jor.24382] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/22/2018] [Accepted: 05/14/2019] [Indexed: 02/04/2023]
Abstract
Early detection of osteoarthritis (OA) remains a diagnostic challenge owing to insensitive diagnostic techniques currently available. Herein a new semiquantitative scoring system, based upon contrast-enhanced computed tomographic (CECT) imaging, is described for further refinement of early OA disease staging. Trochlear ridge cartilage defects were surgically created in the femoropatellar joint of an adult horse (ACUC approved protocols). Seven weeks post-surgery, CECT imaging was performed on a clinical scanner after intra-articular injection of a cationic iodinated contrast agent, CA4+, into both injured and control femoropatellar joint compartments. The femoral cartilage surface was densely biopsied, and specimens were assessed for visual (Outerbridge score), functional (equilibrium compressive modulus), and biochemical (glycosaminoglycan content) measures of cartilage quality. Cartilage CECT attenuation was compared with cartilage quality measures using receiver operating characteristic curve analysis to establish attenuation thresholds for distinguishing among cartilage quality levels. CECT imaging identifies macroscopically damaged cartilage regions and in morphologically identical tissue provides moderately sensitive and specific semiquantitative segregation of cartilage quality based upon CECT attenuation, reflecting both glycosaminoglycan content and compressive stiffness of cartilage area under the curve (AUC = 0.83 [95% confidence interval [CI]: 0.72-0.93] for distinguishing poor quality and AUC = 0.76 [95% CI: 0.65-0.90] for distinguishing healthy quality cartilage). A semiquantitative 6-point scoring system-the Osteoarthritis Attenuation and Morphological Assessment (OAMA) score-is proposed as a tool for assessing cartilage quality from CECT images. The OAMA scoring system expands the current disease staging capability of early OA by inclusion of morphological, biochemical, and biomechanical assessments. © 2019 Orthopaedic Research Society. Published by Wiley Periodicals, Inc. J Orthop Res 37:2138-2148, 2019.
Collapse
Affiliation(s)
- Rachel C. Stewart
- Department of Biomedical Engineering, Boston University, 590 Commonwealth Avenue, Boston, MA 02215,Center for Advanced Orthopaedic Studies, Beth Israel Deaconess Medical Center, 99 Brookline Avenue, Boston, MA 02215
| | - Brad B. Nelson
- Department of Biomedical Engineering, Boston University, 590 Commonwealth Avenue, Boston, MA 02215,Gail Holmes Equine Orthopedic Research Center, Department of Clinical Sciences, College of Veterinary Medicine and Biomedical Sciences, Colorado State University, 1678 Campus Delivery, Fort Collins, CO 80523
| | - Chris E. Kawcak
- Gail Holmes Equine Orthopedic Research Center, Department of Clinical Sciences, College of Veterinary Medicine and Biomedical Sciences, Colorado State University, 1678 Campus Delivery, Fort Collins, CO 80523
| | - Jonathan D. Freedman
- Department of Biomedical Engineering, Boston University, 590 Commonwealth Avenue, Boston, MA 02215,Center for Advanced Orthopaedic Studies, Beth Israel Deaconess Medical Center, 99 Brookline Avenue, Boston, MA 02215
| | - Brian D. Snyder
- Center for Advanced Orthopaedic Studies, Beth Israel Deaconess Medical Center, 99 Brookline Avenue, Boston, MA 02215,Address correspondence and reprint requests to: Mark W. Grinstaff, Ph.D., Departments of Biomedical Engineering, Chemistry, and Medicine, Boston University, 590 Commonwealth Ave, Boston MA 02215, Phone: 617-358-3429, ; Brian D. Snyder, M.D., Ph.D., Center for Advanced Orthopaedic Studies, Beth Israel Deaconess Medical Center, 1 Overland Street, RN 115, Boston MA 02215,
| | - Laurie R. Goodrich
- Gail Holmes Equine Orthopedic Research Center, Department of Clinical Sciences, College of Veterinary Medicine and Biomedical Sciences, Colorado State University, 1678 Campus Delivery, Fort Collins, CO 80523
| | - Mark W. Grinstaff
- Department of Biomedical Engineering, Boston University, 590 Commonwealth Avenue, Boston, MA 02215,Department of Chemistry, Boston University, 590 Commonwealth Avenue, Boston, MA 02215,Department of Medicine, Boston University School of Medicine, 715 Albany St. E-113, Boston, MA 02118,Address correspondence and reprint requests to: Mark W. Grinstaff, Ph.D., Departments of Biomedical Engineering, Chemistry, and Medicine, Boston University, 590 Commonwealth Ave, Boston MA 02215, Phone: 617-358-3429, ; Brian D. Snyder, M.D., Ph.D., Center for Advanced Orthopaedic Studies, Beth Israel Deaconess Medical Center, 1 Overland Street, RN 115, Boston MA 02215,
| |
Collapse
|
11
|
Ylitalo T, Finnilä MA, Gahunia HK, Karhula SS, Suhonen H, Valkealahti M, Lehenkari P, Hæggström E, Pritzker KP, Saarakkala S, Nieminen HJ. Quantifying Complex Micro-Topography of Degenerated Articular Cartilage Surface by Contrast-Enhanced Micro-Computed Tomography and Parametric Analyses. J Orthop Res 2019; 37:855-866. [PMID: 30737811 PMCID: PMC6518937 DOI: 10.1002/jor.24245] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/03/2018] [Accepted: 01/29/2019] [Indexed: 02/04/2023]
Abstract
One of the earliest changes in osteoarthritis (OA) is a surface discontinuity of the articular cartilage (AC), and these surface changes become gradually more complex with OA progression. We recently developed a contrast enhanced micro-computed tomography (μCT) method for visualizing AC surface in detail. The present study aims to introduce a μCT analysis technique to parameterize these complex AC surface features and to demonstrate the feasibility of using these parameters to quantify degenerated AC surface. Osteochondral plugs (n = 35) extracted from 19 patients undergoing joint surgery were stained with phosphotungstic acid and imaged using μCT. The surface micro-topography of AC was analyzed with developed method. Standard root mean square roughness (Rq ) was calculated as a reference, and the Area Under Curve (AUC) for receiver operating characteristic analysis was used to compare the acquired quantitative parameters with semi-quantitative visual grading of μCT image stacks. The parameters quantifying the complex micro-topography of AC surface exhibited good sensitivity and specificity in identifying surface continuity (AUC: 0.93, [0.80 0.99]), fissures (AUC: 0.94, [0.83 0.99]) and fibrillation (AUC: 0.98, [0.88 1.0]). Standard Rq was significantly smaller compared with the complex roughness (CRq ) already with mild surface changes with all surface reference parameters - continuity, fibrillation, and fissure sum. Furthermore, only CRq showed a significant difference when comparing the intact surface with lowest fissure sum score. These results indicate that the presented method for evaluating complex AC surfaces exhibit potential to identify early OA changes in superficial AC and is dynamic throughout OA progression. © 2019 The Authors. Journal of Orthopaedic Research® Published by Wiley Periodicals, Inc. on behalf of the Orthopaedic Research Society. Society. 9999:1-12, 2019.
Collapse
Affiliation(s)
- Tuomo Ylitalo
- Research Unit of Medical Imaging, Physics and Technology, Faculty of MedicineUniversity of OuluOuluFinland,Department of PhysicsUniversity of HelsinkiHelsinkiFinland
| | - Mikko A.J. Finnilä
- Research Unit of Medical Imaging, Physics and Technology, Faculty of MedicineUniversity of OuluOuluFinland,Department of Applied Physics University of Eastern FinlandKuopioFinland,Medical Research Center OuluOulu University Hospital and University of OuluOuluFinland
| | | | - Sakari S. Karhula
- Research Unit of Medical Imaging, Physics and Technology, Faculty of MedicineUniversity of OuluOuluFinland,Infotech OuluUniversity of OuluOuluFinland
| | - Heikki Suhonen
- Department of PhysicsUniversity of HelsinkiHelsinkiFinland
| | - Maarit Valkealahti
- Department of Surgery and Intensive CareUniversity of Oulu and Oulu University HospitalOuluFinland
| | - Petri Lehenkari
- Medical Research Center OuluOulu University Hospital and University of OuluOuluFinland,Department of Surgery and Intensive CareUniversity of Oulu and Oulu University HospitalOuluFinland,Institute of Cancer Research and Translational Medicine, Department of Anatomy and Cell Biology, Faculty of MedicineUniversity of OuluOuluFinland
| | | | - Kenneth P.H. Pritzker
- Department of Laboratory Medicine and PathobiologyUniversity of TorontoTorontoCanada,Mount Sinai HospitalTorontoCanada
| | - Simo Saarakkala
- Research Unit of Medical Imaging, Physics and Technology, Faculty of MedicineUniversity of OuluOuluFinland,Infotech OuluUniversity of OuluOuluFinland,Department of Diagnostic RadiologyOulu University HospitalOuluFinland
| | - Heikki J. Nieminen
- Research Unit of Medical Imaging, Physics and Technology, Faculty of MedicineUniversity of OuluOuluFinland,Department of PhysicsUniversity of HelsinkiHelsinkiFinland,Department of Laboratory Medicine and PathobiologyUniversity of TorontoTorontoCanada,Department of Neuroscience and Biomedical EngineeringAalto UniversityEspooFinland
| |
Collapse
|
12
|
3D grating-based X-ray phase-contrast computed tomography for high-resolution quantitative assessment of cartilage: An experimental feasibility study with 3T MRI, 7T MRI and biomechanical correlation. PLoS One 2019; 14:e0212106. [PMID: 30763375 PMCID: PMC6375589 DOI: 10.1371/journal.pone.0212106] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2018] [Accepted: 01/28/2019] [Indexed: 01/21/2023] Open
Abstract
Objective Aim of this study was, to demonstrate the feasibility of high-resolution grating-based X-ray phase-contrast computed tomography (PCCT) for quantitative assessment of cartilage. Materials and methods In an experimental setup, 12 osteochondral samples were harvested from n = 6 bovine knees (n = 2 each). From each knee, one cartilage sample was degraded using 2.5% Trypsin. In addition to PCCT and biomechanical cartilage stiffness measurements, 3T and 7T MRI was performed including MSME SE T2 and ME GE T2* mapping sequences for relaxationtime measurements. Paired t-tests and receiver operating characteristics (ROC) curves were used for statistical analyses. Results PCCT provided high-resolution images for improved morphological cartilage evaluation as compared to 3T and 7T MRI. Quantitative analyses revealed significant differences between the superficial and the deep cartilage layer for T2 mapping as well as for PCCT (P<0.05). No significant difference was detected for PCCT between healthy and degraded samples (P>0.05). MRI and stiffness measurements showed significant differences between healthy and degraded osteochondral samples. Accuracy in the prediction of cartilage degradation was excellent for MRI and biomechanical analyses. Conclusion In conclusion, high-resolution grating-based X-ray PCCT cartilage imaging is feasible. In addition to MRI and biomechanical analyses it provides complementary, water content independent, information for improved morphological and quantitative characterization of articular cartilage ultrastructure.
Collapse
|
13
|
Hadjab I, Sim S, Karhula SS, Kauppinen S, Garon M, Quenneville E, Lavigne P, Lehenkari PP, Saarakkala S, Buschmann MD. Electromechanical properties of human osteoarthritic and asymptomatic articular cartilage are sensitive and early detectors of degeneration. Osteoarthritis Cartilage 2018; 26:405-413. [PMID: 29229562 DOI: 10.1016/j.joca.2017.12.002] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/25/2017] [Revised: 11/18/2017] [Accepted: 12/04/2017] [Indexed: 02/02/2023]
Abstract
OBJECTIVE To evaluate cross-correlations of ex vivo electromechanical properties with cartilage and subchondral bone plate thickness, as well as their sensitivity and specificity regarding early cartilage degeneration in human tibial plateau. METHOD Six pairs of tibial plateaus were assessed ex vivo using an electromechanical probe (Arthro-BST) which measures a quantitative parameter (QP) reflecting articular cartilage compression-induced streaming potentials. Cartilage thickness was then measured with an automated thickness mapping technique using Mach-1 multiaxial mechanical tester. Subsequently, a visual assessment was performed by an experienced orthopedic surgeon using the International Cartilage Repair Society (ICRS) grading system. Each tibial plateau was finally evaluated with μCT scanner to determine the subchondral-bone plate thickness over the entire surface. RESULTS Cross-correlations between assessments decreased with increasing degeneration level. Moreover, electromechanical QP and subchondral-bone plate thickness increased strongly with ICRS grade (ρ = 0.86 and ρ = 0.54 respectively), while cartilage thickness slightly increased (ρ = 0.27). Sensitivity and specificity analysis revealed that the electromechanical QP is the most performant to distinguish between different early degeneration stages, followed by subchondral-bone plate thickness and then cartilage thickness. Lastly, effect sizes of cartilage and subchondral-bone properties were established to evaluate whether cartilage or bone showed the most noticeable changes between normal (ICRS 0) and each early degenerative stage. Thus, the effect sizes of cartilage electromechanical QP were almost twice those of the subchondral-bone plate thickness, indicating greater sensitivity of electromechanical measurements to detect early osteoarthritis. CONCLUSION The potential of electromechanical properties for the diagnosis of early human cartilage degeneration was highlighted and supported by cartilage thickness and μCT assessments.
Collapse
Affiliation(s)
- I Hadjab
- Biomedical Engineering Institute, Polytechnique Montreal, Montreal, QC, Canada; Biomomentum Inc., 970 Michelin St., Suite 200, Laval, QC H7L 5C1, Canada.
| | - S Sim
- Biomedical Engineering Institute, Polytechnique Montreal, Montreal, QC, Canada; Biomomentum Inc., 970 Michelin St., Suite 200, Laval, QC H7L 5C1, Canada.
| | - S S Karhula
- Research Unit of Medical Imaging, Physics and Technology, Faculty of Medicine, University of Oulu, Finland; Infotech Oulu, University of Oulu, Finland.
| | - S Kauppinen
- Research Unit of Medical Imaging, Physics and Technology, Faculty of Medicine, University of Oulu, Finland.
| | - M Garon
- Biomomentum Inc., 970 Michelin St., Suite 200, Laval, QC H7L 5C1, Canada.
| | - E Quenneville
- Biomomentum Inc., 970 Michelin St., Suite 200, Laval, QC H7L 5C1, Canada.
| | - P Lavigne
- Department of Surgery, University of Montreal, Montreal, QC, Canada.
| | - P P Lehenkari
- Research Unit of Medical Imaging, Physics and Technology, Faculty of Medicine, University of Oulu, Finland; Department of Surgery and Intensive Care, University of Oulu and Oulu University Hospital, Finland.
| | - S Saarakkala
- Research Unit of Medical Imaging, Physics and Technology, Faculty of Medicine, University of Oulu, Finland; Department of Diagnostic Radiology, Oulu University Hospital, Oulu, Finland; Medical Research Center Oulu, Oulu University Hospital and University of Oulu, Finland.
| | - M D Buschmann
- Biomedical Engineering Institute, Polytechnique Montreal, Montreal, QC, Canada.
| |
Collapse
|
14
|
Nelson BB, Kawcak CE, Barrett MF, McIlwraith CW, Grinstaff MW, Goodrich LR. Recent advances in articular cartilage evaluation using computed tomography and magnetic resonance imaging. Equine Vet J 2018; 50:564-579. [DOI: 10.1111/evj.12808] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2017] [Accepted: 01/09/2018] [Indexed: 12/18/2022]
Affiliation(s)
- B. B. Nelson
- Gail Holmes Equine Orthopaedic Research Center Department of Clinical Sciences College of Veterinary Medicine and Biomedical Sciences, Colorado State University Fort Collins Colorado USA
| | - C. E. Kawcak
- Gail Holmes Equine Orthopaedic Research Center Department of Clinical Sciences College of Veterinary Medicine and Biomedical Sciences, Colorado State University Fort Collins Colorado USA
| | - M. F. Barrett
- Gail Holmes Equine Orthopaedic Research Center Department of Clinical Sciences College of Veterinary Medicine and Biomedical Sciences, Colorado State University Fort Collins Colorado USA
- Department of Environmental and Radiological Health Sciences Colorado State University Fort Collins Colorado USA
| | - C. W. McIlwraith
- Gail Holmes Equine Orthopaedic Research Center Department of Clinical Sciences College of Veterinary Medicine and Biomedical Sciences, Colorado State University Fort Collins Colorado USA
| | - M. W. Grinstaff
- Departments of Biomedical Engineering, Chemistry and Medicine Boston University Boston Massachusetts USA
| | - L. R. Goodrich
- Gail Holmes Equine Orthopaedic Research Center Department of Clinical Sciences College of Veterinary Medicine and Biomedical Sciences, Colorado State University Fort Collins Colorado USA
| |
Collapse
|
15
|
Nelson BB, Goodrich LR, Barrett MF, Grinstaff MW, Kawcak CE. Use of contrast media in computed tomography and magnetic resonance imaging in horses: Techniques, adverse events and opportunities. Equine Vet J 2017; 49:410-424. [DOI: 10.1111/evj.12689] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2016] [Accepted: 04/04/2017] [Indexed: 12/20/2022]
Affiliation(s)
- B. B. Nelson
- Gail Holmes Equine Orthopaedic Research Center, Department of Clinical Sciences; College of Veterinary Medicine and Biomedical Sciences, Colorado State University; Fort Collins Colorado USA
| | - L. R. Goodrich
- Gail Holmes Equine Orthopaedic Research Center, Department of Clinical Sciences; College of Veterinary Medicine and Biomedical Sciences, Colorado State University; Fort Collins Colorado USA
| | - M. F. Barrett
- Gail Holmes Equine Orthopaedic Research Center, Department of Clinical Sciences; College of Veterinary Medicine and Biomedical Sciences, Colorado State University; Fort Collins Colorado USA
- Department of Environmental and Radiological Health Sciences; Colorado State University; Fort Collins Colorado USA
| | - M. W. Grinstaff
- Departments of Biomedical Engineering, Chemistry, Materials Science & Engineering and Medicine; Boston University; Boston Massachusetts USA
| | - C. E. Kawcak
- Gail Holmes Equine Orthopaedic Research Center, Department of Clinical Sciences; College of Veterinary Medicine and Biomedical Sciences, Colorado State University; Fort Collins Colorado USA
| |
Collapse
|
16
|
Karhula SS, Finnilä MA, Lammi MJ, Ylärinne JH, Kauppinen S, Rieppo L, Pritzker KPH, Nieminen HJ, Saarakkala S. Effects of Articular Cartilage Constituents on Phosphotungstic Acid Enhanced Micro-Computed Tomography. PLoS One 2017; 12:e0171075. [PMID: 28135331 PMCID: PMC5279764 DOI: 10.1371/journal.pone.0171075] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2016] [Accepted: 01/14/2017] [Indexed: 02/05/2023] Open
Abstract
Contrast-enhanced micro-computed tomography (CEμCT) with phosphotungstic acid (PTA) has shown potential for detecting collagen distribution of articular cartilage. However, the selectivity of the PTA staining to articular cartilage constituents remains to be elucidated. The aim of this study was to investigate the dependence of PTA for the collagen content in bovine articular cartilage. Adjacent bovine articular cartilage samples were treated with chondroitinase ABC and collagenase to degrade the proteoglycan and the collagen constituents in articular cartilage, respectively. Enzymatically degraded samples were compared to the untreated samples using CEμCT and reference methods, such as Fourier-transform infrared imaging. Decrease in the X-ray attenuation of PTA in articular cartilage and collagen content was observed in cartilage depth of 0–13% and deeper in tissue after collagen degradation. Increase in the X-ray attenuation of PTA was observed in the cartilage depth of 13–39% after proteoglycan degradation. The X-ray attenuation of PTA-labelled articular cartilage in CEμCT is associated mainly with collagen content but the proteoglycans have a minor effect on the X-ray attenuation of the PTA-labelled articular cartilage. In conclusion, the PTA labeling provides a feasible CEμCT method for 3D characterization of articular cartilage.
Collapse
Affiliation(s)
- Sakari S. Karhula
- Research Unit of Medical Imaging, Physics and Technology, Faculty of Medicine, University of Oulu, Oulu, Finland
- Infotech Doctoral Program, University of Oulu, Oulu, Finland
- * E-mail:
| | - Mikko A. Finnilä
- Research Unit of Medical Imaging, Physics and Technology, Faculty of Medicine, University of Oulu, Oulu, Finland
- Department of Applied Physics, University of Eastern Finland, Kuopio, Finland
- Medical Research Center Oulu, Oulu University Hospital and University of Oulu, Oulu, Finland
| | - Mikko J. Lammi
- Department of Integrative Medical Biology, University of Umeå, Umeå, Sweden
- School of Public Health, Health Science Center of Xi’an Jiaotong University, Key Laboratory of Trace Elements and Endemic Diseases, National Health and Family Planning Commission, Xi’an, P. R. China
| | - Janne H. Ylärinne
- Department of Integrative Medical Biology, University of Umeå, Umeå, Sweden
| | - Sami Kauppinen
- Research Unit of Medical Imaging, Physics and Technology, Faculty of Medicine, University of Oulu, Oulu, Finland
| | - Lassi Rieppo
- Research Unit of Medical Imaging, Physics and Technology, Faculty of Medicine, University of Oulu, Oulu, Finland
- Medical Research Center Oulu, Oulu University Hospital and University of Oulu, Oulu, Finland
| | - Kenneth P. H. Pritzker
- Department of Laboratory Medicine and Pathobiology, University of Toronto, Toronto, Canada
- Mount Sinai Hospital, Toronto, Canada
| | - Heikki J. Nieminen
- Research Unit of Medical Imaging, Physics and Technology, Faculty of Medicine, University of Oulu, Oulu, Finland
- Department of Laboratory Medicine and Pathobiology, University of Toronto, Toronto, Canada
- Department of Physics, University of Helsinki, Helsinki, Finland
| | - Simo Saarakkala
- Research Unit of Medical Imaging, Physics and Technology, Faculty of Medicine, University of Oulu, Oulu, Finland
- Medical Research Center Oulu, Oulu University Hospital and University of Oulu, Oulu, Finland
- Department of Diagnostic Radiology, Oulu University Hospital, Oulu, Finland
| |
Collapse
|
17
|
Mittelstaedt D, Kahn D, Xia Y. Topographical and depth-dependent glycosaminoglycan concentration in canine medial tibial cartilage 3 weeks after anterior cruciate ligament transection surgery-a microscopic imaging study. Quant Imaging Med Surg 2016; 6:648-660. [PMID: 28090443 DOI: 10.21037/qims.2016.06.12] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
BACKGROUND Medical imaging has become an invaluable tool to diagnose damage to cartilage. Depletion of glycosaminoglycans (GAG) has been shown to be one of the early signs of cartilage degradation. In order to investigate the topographical changes in GAG concentration caused by the anterior cruciate ligament transection (ACLT) surgery in a canine model, microscopic magnetic resonance imaging (µMRI) and microscopic computed tomography (µCT) were used to measure the GAG concentration with correlation from a biochemical assay, inductively coupled plasma optical emission spectroscopy (ICP-OES), to understand where the topographical and depth-dependent changes in the GAG concentration occur. METHODS This study used eight knee joints from four canines, which were examined 3 weeks after ACLT surgery. From right (n=3) and left (n=1) medial tibias of the ACLT and the contralateral side, two ex vivo specimens from each of four locations (interior, central, exterior and posterior) were imaged before and after equilibration in contrast agents. The cartilage blocks imaged using µMRI were approximately 3 mm × 5 mm and were imaged before and after eight hours submersion in a gadolinium (Gd) contrast agent with an in-plane pixel resolution of 17.6 µm2 and an image slice thickness of 1 mm. The cartilage blocks imaged using µCT were approximately 2 mm × 1 mm and were imaged before and after 24 hours submersed in ioxaglate with an isotropic voxel resolution of 13.4 µm3. ICP-OES was used to quantify the bulk GAG at each topographical location. RESULTS The pre-contrast µMRI and µCT results did not demonstrate significant differences in GAG between the ACLT and contralateral cartilage at all topographical locations. The post-contrast µMRI and µCT results demonstrated topographically similar significant differences in GAG concentrations between the ACLT and contralateral tibia. Using µMRI, the GAG concentrations (mg/mL) were measured for the ACLT and contralateral respectively, the exterior (54.0±3.6; 70.4±4.3; P=0.001) and interior (54.9±5.9; 71.0±5.9; P=0.029) demonstrated significant differences, but not for the central (61.0±12.0; 67.4±7.2; P=0.438) or posterior (61.6±6.3; 70.3±4.4; P=0.097) locations. Using µCT, the GAG concentrations (mg/mL) were measured for the ACLT and contralateral respectively, the exterior (68.8±0.4; 87.7±4.1; P=0.023) and interior (60.5±9.1; 82.6±8.7; P=0.039) demonstrated significant differences, but not for the central (53.5±5.5; 59.1±25.6; P=0.684) or posterior (52.3±6.2; 61.5±12.7; P=0.325) locations. The depth-dependent GAG (mg/mL) profiles showed significant differences in µMRI for the transitional zone (TZ) [exterior (28.1±4.7; 47.0±8.6; P=0.01) and interior (32.6±4.8; 43.8±8.7; P=0.025)], radial zone (RZ) 1 [exterior (49.6±4.8; 71.5±5.8; P=0.001) and interior (49.4±7.4; 66.7±6.8; P=0.041)], and RZ 2 [exterior (74.9±4.7; 91.8±2.9; P=0.001) and interior (77.1±6.0; 94.8±4.5; P=0.015)], and in µCT for the superficial zone (SZ) [interior (20.6±1.2; 40.4±5.4; P=0.004)], TZ [exterior (45.6±12.0; 61.8±0.5; P=0.049) and interior (36.3±11.7; 60.8±2.0; P=0.019)], and RZ 1 [exterior (61.1±4.1; 85.3±5.6; P=0.039) and interior (53.9±4.9; 78.0±5.1; P=0.041)] for the ACLT and contralateral, respectively. ICP-OES measured significant differences in GAG were found for the exterior (42.1±19.6; 65.3±16.2; P=0.017), central (43.4±4.4; 65.3±10.6; P=0.0111), and interior (46.8±5.6; 61.7±7.3; P=0.0445) but not for the posterior (52.6±12.1; 59.0±2.6; P=0.9252) medial tibia locations compared for the ACLT and contralateral, respectively. CONCLUSIONS The detection and correlation between the three techniques show a topographic depth-dependency on the initial GAG loss in injured cartilage. This topographic and high resolution investigation of ACLT cartilage demonstrated the potential of using µMRI and µCT to study and help diagnose cartilage with very early stages of osteoarthritis.
Collapse
Affiliation(s)
- Daniel Mittelstaedt
- Department of Physics and Center for Biomedical Research, Oakland University, Rochester, MI 48309, USA
| | - David Kahn
- Department of Physics and Center for Biomedical Research, Oakland University, Rochester, MI 48309, USA
| | - Yang Xia
- Department of Physics and Center for Biomedical Research, Oakland University, Rochester, MI 48309, USA
| |
Collapse
|
18
|
Imaging of osteoarthritis (OA): What is new? Best Pract Res Clin Rheumatol 2016; 30:653-669. [PMID: 27931960 DOI: 10.1016/j.berh.2016.09.007] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2016] [Revised: 09/04/2016] [Accepted: 09/06/2016] [Indexed: 12/17/2022]
Abstract
In daily clinical practice, conventional radiography is still the most applied imaging technique to supplement clinical examination of patients with suspected osteoarthritis (OA); it may not always be needed for diagnosis. Modern imaging modalities can visualize multiple aspects of the joint, and depending on the diagnostic need, radiography may no longer be the modality of choice. Magnetic resonance imaging (MRI) provides a complete assessment of the joint and has a pivotal role in OA research. Computed tomography (CT) and nuclear medicine offer alternatives in research scenarios, while ultrasound can visualize bony and soft-tissue pathologies and is highly feasible in the clinic. In this chapter, we overview the recent literature on established and newer imaging modalities, summarizing their ability to detect and quantify the range of OA pathologies and determining how they may contribute to early OA diagnosis. This accurate imaging-based detection of pathologies will underpin true understanding of much needed structure-modifying therapies.
Collapse
|
19
|
In Vivo Contrast-Enhanced Cone Beam CT Provides Quantitative Information on Articular Cartilage and Subchondral Bone. Ann Biomed Eng 2016; 45:811-818. [DOI: 10.1007/s10439-016-1730-3] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2016] [Accepted: 09/07/2016] [Indexed: 12/17/2022]
|
20
|
Oinas J, Rieppo L, Finnilä MAJ, Valkealahti M, Lehenkari P, Saarakkala S. Imaging of Osteoarthritic Human Articular Cartilage using Fourier Transform Infrared Microspectroscopy Combined with Multivariate and Univariate Analysis. Sci Rep 2016; 6:30008. [PMID: 27445254 PMCID: PMC4956759 DOI: 10.1038/srep30008] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2015] [Accepted: 06/29/2016] [Indexed: 12/16/2022] Open
Abstract
The changes in chemical composition of human articular cartilage (AC) caused by osteoarthritis (OA) were investigated using Fourier transform infrared microspectroscopy (FTIR-MS). We demonstrate the sensitivity of FTIR-MS for monitoring compositional changes that occur with OA progression. Twenty-eight AC samples from tibial plateaus were imaged with FTIR-MS. Hyperspectral images of all samples were combined for K-means clustering. Partial least squares regression (PLSR) analysis was used to compare the spectra with the OARSI grade (histopathological grading of OA). Furthermore, the amide I and the carbohydrate regions were used to estimate collagen and proteoglycan contents, respectively. Spectral peak at 1338 cm(-1) was used to estimate the integrity of the collagen network. The layered structure of AC was revealed using the carbohydrate region for clustering. Statistically significant correlation was observed between the OARSI grade and the collagen integrity in the superficial (r = -0.55) and the deep (r = -0.41) zones. Furthermore, PLSR models predicted the OARSI grade from the superficial (r = 0.94) and the deep (r = 0.77) regions of the AC with high accuracy. Obtained results suggest that quantitative and qualitative changes occur in the AC composition during OA progression, and these can be monitored by the use of FTIR-MS.
Collapse
Affiliation(s)
- J Oinas
- Research Unit of Medical Imaging, Physics and Technology, Faculty of Medicine, University of Oulu, Finland.,Medical Research Center, University of Oulu and Oulu University Hospital, Finland
| | - L Rieppo
- Research Unit of Medical Imaging, Physics and Technology, Faculty of Medicine, University of Oulu, Finland.,Medical Research Center, University of Oulu and Oulu University Hospital, Finland
| | - M A J Finnilä
- Research Unit of Medical Imaging, Physics and Technology, Faculty of Medicine, University of Oulu, Finland.,Medical Research Center, University of Oulu and Oulu University Hospital, Finland.,Department of Applied Physics, University of Eastern Finland, Kuopio, Finland
| | - M Valkealahti
- Medical Research Center, University of Oulu and Oulu University Hospital, Finland.,Department of Surgery, Oulu University Hospital, Finland
| | - P Lehenkari
- Medical Research Center, University of Oulu and Oulu University Hospital, Finland.,Department of Surgery, Oulu University Hospital, Finland.,Research Group of Cancer and Translational Medicine, Faculty of Medicine, University of Oulu, Finland
| | - S Saarakkala
- Research Unit of Medical Imaging, Physics and Technology, Faculty of Medicine, University of Oulu, Finland.,Medical Research Center, University of Oulu and Oulu University Hospital, Finland.,Department of Diagnostic Radiology, Oulu University Hospital, Finland
| |
Collapse
|
21
|
van Tiel J, Siebelt M, Reijman M, Bos PK, Waarsing JH, Zuurmond AM, Nasserinejad K, van Osch GJVM, Verhaar JAN, Krestin GP, Weinans H, Oei EHG. Quantitative in vivo CT arthrography of the human osteoarthritic knee to estimate cartilage sulphated glycosaminoglycan content: correlation with ex-vivo reference standards. Osteoarthritis Cartilage 2016; 24:1012-20. [PMID: 26851449 DOI: 10.1016/j.joca.2016.01.137] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/07/2015] [Revised: 12/24/2015] [Accepted: 01/19/2016] [Indexed: 02/02/2023]
Abstract
OBJECTIVE Recently, computed tomography arthrography (CTa) was introduced as quantitative imaging biomarker to estimate cartilage sulphated glycosaminoglycan (sGAG) content in human cadaveric knees. Our aim was to assess the correlation between in vivo CTa in human osteoarthritis (OA) knees and ex vivo reference standards for sGAG and collagen content. DESIGN In this prospective observational study 11 knee OA patients underwent CTa before total knee replacement (TKR). Cartilage X-ray attenuation was determined in six cartilage regions. Femoral and tibial cartilage specimens harvested during TKR were re-scanned using equilibrium partitioning of an ionic contrast agent with micro-CT (EPIC-μCT), which served as reference standard for sGAG. Next, cartilage sGAG and collagen content were determined using dimethylmethylene blue (DMMB) and hydroxyproline assays. The correlation between CTa X-ray attenuation, EPIC-μCT X-ray attenuation, sGAG content and collagen content was assessed. RESULTS CTa X-ray attenuation correlated well with EPIC-μCT (r = 0.76, 95% credibility interval (95%CI) 0.64 to 0.85). CTa correlated moderately with the DMMB assay (sGAG content) (r = -0.66, 95%CI -0.87 to -0.49) and to lesser extent with the hydroxyproline assay (collagen content) (r = -0.56, 95%CI -0.70 to -0.36). CONCLUSIONS Outcomes of in vivo CTa in human OA knees correlate well with sGAG content. Outcomes of CTa also slightly correlate with cartilage collagen content. Since outcomes of CTa are mainly sGAG dependent and despite the fact that further validation using hyaline cartilage of other joints with different biochemical composition should be conducted, CTa may be suitable as quantitative imaging biomarker to estimate cartilage sGAG content in future clinical OA research.
Collapse
Affiliation(s)
- J van Tiel
- Department of Orthopedic Surgery, Erasmus MC, University Medical Center, Rotterdam, The Netherlands; Department of Radiology, Erasmus MC, University Medical Center, Rotterdam, The Netherlands.
| | - M Siebelt
- Department of Orthopedic Surgery, Erasmus MC, University Medical Center, Rotterdam, The Netherlands.
| | - M Reijman
- Department of Orthopedic Surgery, Erasmus MC, University Medical Center, Rotterdam, The Netherlands.
| | - P K Bos
- Department of Orthopedic Surgery, Erasmus MC, University Medical Center, Rotterdam, The Netherlands.
| | - J H Waarsing
- Department of Orthopedic Surgery, Erasmus MC, University Medical Center, Rotterdam, The Netherlands.
| | | | - K Nasserinejad
- Department of Biostatistics, Erasmus MC, University Medical Center, Rotterdam, The Netherlands.
| | - G J V M van Osch
- Department of Orthopedic Surgery, Erasmus MC, University Medical Center, Rotterdam, The Netherlands; Department of Otorhinolaryngology, Erasmus MC, University Medical Center Rotterdam, The Netherlands.
| | - J A N Verhaar
- Department of Orthopedic Surgery, Erasmus MC, University Medical Center, Rotterdam, The Netherlands.
| | - G P Krestin
- Department of Radiology, Erasmus MC, University Medical Center, Rotterdam, The Netherlands.
| | - H Weinans
- Department of Biomechanical Engineering, Delft University of Technology, Delft, The Netherlands; Department of Orthopedics and Department of Rheumatology, University Medical Center Utrecht, Utrecht, The Netherlands.
| | - E H G Oei
- Department of Radiology, Erasmus MC, University Medical Center, Rotterdam, The Netherlands.
| |
Collapse
|
22
|
Association between quantitative MRI and ICRS arthroscopic grading of articular cartilage. Knee Surg Sports Traumatol Arthrosc 2016; 24:2046-54. [PMID: 25209205 DOI: 10.1007/s00167-014-3286-9] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/20/2014] [Accepted: 08/27/2014] [Indexed: 12/12/2022]
Abstract
PURPOSE To investigate the association of quantitative magnetic resonance imaging (qMRI) parameters with arthroscopic grading of cartilage degeneration. Arthroscopy of the knee is considered to be the gold standard of osteoarthritis diagnostics; however, it is operator-dependent and limited to the evaluation of the articular surface. qMRI provides information on the quality of articular cartilage and its changes even at early stages of a disease. METHODS qMRI techniques included T 1 relaxation time, T 2 relaxation time, and delayed gadolinium-enhanced MRI of cartilage mapping at 3 T in ten patients. Due to a lack of generally accepted semiquantitative scoring systems for evaluating severity of cartilage degeneration during arthroscopy, the International Cartilage Repair Society (ICRS) classification system was used to grade the severity of cartilage lesions. qMRI parameters were statistically compared to arthroscopic grading conducted with the ICRS classification system. RESULTS qMRI parameters were not linearly related to arthroscopic grading. Spearman's correlation coefficients between qMRI and arthroscopic grading were not significant. The relative differences in qMRI parameters of superficial and deep cartilage varied with degeneration, suggesting different macromolecular alterations in different cartilage zones. CONCLUSIONS Results suggest that loss of cartilage and the quality of remaining tissue in the lesion site may not be directly associated with each other. The severity of cartilage degeneration may not be revealed solely by diagnostic arthroscopy, and thus, qMRI can have a role in the investigation of cartilage degeneration.
Collapse
|
23
|
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.
Collapse
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
| |
Collapse
|
24
|
Mittelstaedt D, Xia Y. Depth-Dependent Glycosaminoglycan Concentration in Articular Cartilage by Quantitative Contrast-Enhanced Micro-Computed Tomography. Cartilage 2015; 6:216-25. [PMID: 26425259 PMCID: PMC4568736 DOI: 10.1177/1947603515596418] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
OBJECTIVE A quantitative contrast-enhanced micro-computed tomography (qCECT) method was developed to investigate the depth dependency and heterogeneity of the glycosaminoglycan (GAG) concentration of ex vivo cartilage equilibrated with an anionic radiographic contrast agent, Hexabrix. DESIGN Full-thickness fresh native (n = 19 in 3 subgroups) and trypsin-degraded (n = 6) articular cartilage blocks were imaged using micro-computed tomography (μCT) at high resolution (13.4 μm(3)) before and after equilibration with various Hexabrix bathing concentrations. The GAG concentration was calculated depth-dependently based on Gibbs-Donnan equilibrium theory. Analysis of variance with Tukey's post hoc was used to test for statistical significance (P < 0.05) for effect of Hexabrix bathing concentration, and for differences in bulk and zonal GAG concentrations individually and compared between native and trypsin-degraded cartilage. RESULTS The bulk GAG concentration was calculated to be 74.44 ± 6.09 and 11.99 ± 4.24 mg/mL for native and degraded cartilage, respectively. A statistical difference was demonstrated for bulk and zonal GAG between native and degraded cartilage (P < 0.032). A statistical difference was not demonstrated for bulk GAG when comparing Hexabrix bathing concentrations (P > 0.3214) for neither native nor degraded cartilage. Depth-dependent GAG analysis of native cartilage revealed a statistical difference only in the radial zone between 30% and 50% Hexabrix bathing concentrations. CONCLUSIONS This nondestructive qCECT methodology calculated the depth-dependent GAG concentration for both native and trypsin-degraded cartilage at high spatial resolution. qCECT allows for more detailed understanding of the topography and depth dependency, which could help diagnose health, degradation, and repair of native and contrived cartilage.
Collapse
Affiliation(s)
- Daniel Mittelstaedt
- Department of Physics and Center for Biomedical Research, Oakland University, Rochester, MI, USA
| | - Yang Xia
- Department of Physics and Center for Biomedical Research, Oakland University, Rochester, MI, USA
| |
Collapse
|
25
|
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
| | | | | | | |
Collapse
|
26
|
Liukkonen J, Lehenkari P, Hirvasniemi J, Joukainen A, Virén T, Saarakkala S, Nieminen MT, Jurvelin JS, Töyräs J. Ultrasound arthroscopy of human knee cartilage and subchondral bone in vivo. ULTRASOUND IN MEDICINE & BIOLOGY 2014; 40:2039-2047. [PMID: 25023111 DOI: 10.1016/j.ultrasmedbio.2014.04.001] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/27/2013] [Revised: 01/16/2014] [Accepted: 04/04/2014] [Indexed: 06/03/2023]
Abstract
Arthroscopic ultrasound imaging enables quantitative evaluation of articular cartilage. However, the potential of this technique for evaluation of subchondral bone has not been investigated in vivo. In this study, we address this issue in clinical arthroscopy of the human knee (n = 11) by determining quantitative ultrasound (9 MHz) reflection and backscattering parameters for cartilage and subchondral bone. Furthermore, in each knee, seven anatomical sites were graded using the International Cartilage Repair Society (ICRS) system based on (i) conventional arthroscopy and (ii) ultrasound images acquired in arthroscopy with a miniature transducer. Ultrasound enabled visualization of articular cartilage and subchondral bone. ICRS grades based on ultrasound images were higher (p < 0.05) than those based on conventional arthroscopy. The higher ultrasound-based ICRS grades were expected as ultrasound reveals additional information on, for example, the relative depth of the lesion. In line with previous literature, ultrasound reflection and scattering in cartilage varied significantly (p < 0.05) along the ICRS scale. However, no significant correlation between ultrasound parameters and structure or density of subchondral bone could be demonstrated. To conclude, arthroscopic ultrasound imaging had a significant effect on clinical grading of cartilage, and it was found to provide quantitative information on cartilage. The lack of correlation between the ultrasound parameters and bone properties may be related to lesser bone change or excessive attenuation in overlying cartilage and insufficient power of the applied miniature transducer.
Collapse
Affiliation(s)
- Jukka Liukkonen
- Department of Applied Physics, University of Eastern Finland, Kuopio, Finland.
| | - Petri Lehenkari
- Department of Anatomy and Cell Biology, Institute of Biomedicine, University of Oulu, Oulu, Finland; Department of Surgery, Medical Research Center, Oulu University Hospital, Oulu, Finland; Medical Research Center Oulu, Oulu University Hospital and University of Oulu, Oulu, Finland
| | - Jukka Hirvasniemi
- Medical Research Center Oulu, Oulu University Hospital and University of Oulu, Oulu, Finland; Department of Medical Technology, University of Oulu, Oulu, Finland
| | - Antti Joukainen
- Department of Orthopaedics, Traumatology and Hand Surgery, Kuopio University Hospital, Kuopio, Finland
| | - Tuomas Virén
- Cancer Center, Kuopio University Hospital, Kuopio, Finland
| | - Simo Saarakkala
- Medical Research Center Oulu, Oulu University Hospital and University of Oulu, Oulu, Finland; Department of Medical Technology, University of Oulu, Oulu, Finland; Department of Diagnostic Radiology, Oulu University Hospital, Oulu, Finland
| | - Miika T Nieminen
- Medical Research Center Oulu, Oulu University Hospital and University of Oulu, Oulu, Finland; Department of Diagnostic Radiology, Oulu University Hospital, Oulu, Finland; Department of Radiology, University of Oulu, Oulu, Finland
| | - Jukka S Jurvelin
- Department of Applied Physics, University of Eastern Finland, Kuopio, Finland
| | - Juha Töyräs
- Department of Applied Physics, University of Eastern Finland, Kuopio, Finland; Department of Clinical Neurophysiology, Kuopio University Hospital, Kuopio, Finland
| |
Collapse
|
27
|
Freedman JD, Lusic H, Snyder BD, Grinstaff MW. Tantalum oxide nanoparticles for the imaging of articular cartilage using X-ray computed tomography: visualization of ex vivo/in vivo murine tibia and ex vivo human index finger cartilage. Angew Chem Int Ed Engl 2014; 53:8406-10. [PMID: 24981730 PMCID: PMC4303344 DOI: 10.1002/anie.201404519] [Citation(s) in RCA: 41] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2014] [Indexed: 12/20/2022]
Abstract
The synthesis and characterization of tantalum oxide (Ta2O5) nanoparticles (NPs) as new X-ray contrast media for microcomputed tomography (μCT) imaging of articular cartilage are reported. NPs, approximately 5-10 nm in size, and possessing distinct surface charges, were synthesized using phosphonate (neutral), ammonium (cationic), and carboxylate (anionic) ligands as end functional groups. Assessment of a cartilage defect in a human cadaver distal metacarpophalangeal (MCP) joint with the ammonium nanoparticles showed good visualization of damage and preferential uptake in areas surrounding the defect. Finally, an optimized nontoxic cationic NP contrast agent was evaluated in an in vivo murine model and the cartilage was imaged. These nanoparticles represent a new type of contrast agent for imaging articular cartilage, and the results demonstrate the importance of surface charge in the design of nanoparticulate agents for targeting the surface or interior zones of articular cartilage.
Collapse
Affiliation(s)
- Jonathan D. Freedman
- Departments of Biomedical Engineering, Chemistry and Pharmacology, Boston University, Boston, MA 02115 (USA), Homepage: http://people.bu.edu/mgrin/
| | - Hrvoje Lusic
- Departments of Biomedical Engineering, Chemistry and Pharmacology, Boston University, Boston, MA 02115 (USA), Homepage: http://people.bu.edu/mgrin/
| | - Brian D. Snyder
- Center for Advanced Orthopaedic Studies, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA 02115 (USA)
| | - Mark W. Grinstaff
- Departments of Biomedical Engineering, Chemistry and Pharmacology, Boston University, Boston, MA 02115 (USA), Homepage: http://people.bu.edu/mgrin/
| |
Collapse
|
28
|
Abstract
OBJECTIVE Patellofemoral instability is common and affects a predominantly young age group. Chondral injury occurs in up to 95%, and includes osteochondral fractures and loose bodies acutely and secondary degenerative changes in recurrent cases. Biomechanical abnormalities, such as trochlear dysplasia, patella alta, and increased tibial tuberosity-trochlear groove distance, predispose to both recurrent dislocations and patellofemoral arthrosis. DESIGN In this article, we review the mechanisms of chondral injury in patellofemoral instability, diagnostic modalities, the distribution of lesions seen in acute and episodic dislocation, and treatments for articular cartilage lesions of the patellofemoral joint. RESULTS Little specific evidence exists for cartilage treatments in patellofemoral instability. In general, the results of reparative and restorative procedures in the patellofemoral joint are inferior to those observed in other compartments of the knee. CONCLUSION Given the increased severity of chondral lesions and progression to osteoarthritis seen with recurrent dislocations, careful consideration should be given to early stabilisation in patients with predisposing factors.
Collapse
Affiliation(s)
- Timothy Lording
- Frankston Hospital, Frankston, Victoria, Australia
- Groupement Hospitalier Nord, Université Lyon 1, Lyon, France
| | | | - Elvire Servien
- Groupement Hospitalier Nord, Université Lyon 1, Lyon, France
| | - Philippe Neyret
- Groupement Hospitalier Nord, Université Lyon 1, Lyon, France
| |
Collapse
|
29
|
Freedman JD, Lusic H, Snyder BD, Grinstaff MW. Tantalum Oxide Nanoparticles for the Imaging of Articular Cartilage Using X-Ray Computed Tomography: Visualization of Ex Vivo/In Vivo Murine Tibia and Ex Vivo Human Index Finger Cartilage. Angew Chem Int Ed Engl 2014. [DOI: 10.1002/ange.201404519] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023]
|
30
|
Kokkonen HT, Suomalainen JS, Joukainen A, Kröger H, Sirola J, Jurvelin JS, Salo J, Töyräs J. In vivo diagnostics of human knee cartilage lesions using delayed CBCT arthrography. J Orthop Res 2014; 32:403-12. [PMID: 24249683 DOI: 10.1002/jor.22521] [Citation(s) in RCA: 46] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/18/2013] [Accepted: 10/21/2013] [Indexed: 02/04/2023]
Abstract
The aim of this study was to investigate the feasibility of delayed cone beam (CBCT) arthrography for clinical diagnostics of knee cartilage lesions. Knee joints with cartilage lesions were imaged using native radiography, MRI, and delayed CBCT arthrography techniques in vivo. The joints were imaged three times with CBCT, just before, immediately after (arthrography) and 45 min after the intra-articular injection of contrast agent. The arthrographic images enabled sensitive detection of the cartilage lesions. Use of arthrographic and delayed images together with their subtraction image enabled also detection of cartilage with inferior integrity. The contrast agent partition in intact cartilage (ICRS grade 0) was lower (p < 0.05) than that of cartilage surrounding the ICRS grade I-IV lesions. Delayed CBCT arthrography provides a novel method for diagnostics of cartilage lesions. Potentially, it can also be used in diagnostics of cartilage degeneration. Due to shorter imaging times, higher resolution, and lower costs of CT over MRI, this technique could provide an alternative for diagnostics of knee pathologies. However, for comprehensive evaluation of the clinical potential of the technique a further clinical study with a large pool of patients having a wide range of cartilage pathologies needs to be conducted.
Collapse
Affiliation(s)
- Harri T Kokkonen
- Department of Applied Physics, University of Eastern Finland, P.O. Box 1627, 70211, Kuopio, Finland
| | | | | | | | | | | | | | | |
Collapse
|
31
|
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.
Collapse
Affiliation(s)
- T J Mosher
- Department of Radiology, Penn State Hershey Medical Center, Hershey, PA, USA.
| | | | | | | |
Collapse
|