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Chalian M, Pooyan A, Alipour E, Roemer FW, Guermazi A. What is New in Osteoarthritis Imaging? Radiol Clin North Am 2024; 62:739-753. [PMID: 39059969 DOI: 10.1016/j.rcl.2024.02.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/28/2024]
Abstract
Osteoarthritis (OA) is the leading joint disorder globally, affecting a significant proportion of the population. Recent studies have changed our understanding of OA, viewing it as a complex pathology of the whole joint with a multifaceted etiology, encompassing genetic, biological, and biomechanical elements. This review highlights the role of imaging in diagnosing and monitoring OA. Today's role of radiography is discussed, while also elaborating on the advances in computed tomography and magnetic resonance imaging, discussing semiquantitative methods, quantitative morphologic and compositional techniques, and giving an outlook on the potential role of artificial intelligence in OA research.
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Affiliation(s)
- Majid Chalian
- Department of Radiology, University of Washington, Seattle, USA; Musculoskeletal Imaging and Intervention, University of Washington, UW Radiology, Roosevelt Clinic, 4245 Roosevelt Way, NE Box 354755, Seattle, WA 98105, USA
| | - Atefe Pooyan
- Department of Radiology, University of Washington, Seattle, USA; Musculoskeletal Imaging and Intervention, University of Washington, UW Radiology, Roosevelt Clinic, 4245 Roosevelt Way, NE Box 354755, Seattle, WA 98105, USA
| | - Ehsan Alipour
- Department of Radiology, University of Washington, Seattle, USA; Musculoskeletal Imaging and Intervention, University of Washington, UW Radiology, Roosevelt Clinic, 4245 Roosevelt Way, NE Box 354755, Seattle, WA 98105, USA
| | - Frank W Roemer
- Department of Radiology, Friedrich-Alexander University Erlangen-Nürnberg; Universitätsklinikum Erlangen, Erlangen, Germany; Department of Radiology, Quantitative Imaging Center, Boston University School of Medicine
| | - Ali Guermazi
- Department of Radiology, Quantitative Imaging Center, Boston University School of Medicine; Department of Radiology, VA Boston Healthcare System, Boston, MA, USA.
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Collins JE, Roemer FW, Guermazi A. Approaches to optimize analyses of multidimensional ordinal MRI data in osteoarthritis research: A perspective. OSTEOARTHRITIS AND CARTILAGE OPEN 2024; 6:100465. [PMID: 38601258 PMCID: PMC11004399 DOI: 10.1016/j.ocarto.2024.100465] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2024] [Accepted: 03/22/2024] [Indexed: 04/12/2024] Open
Abstract
Objective Knee osteoarthritis (OA) is a disease of the whole joint involving multiple tissue types. MRI-based semi-quantitative (SQ) scoring of knee OA is a method to perform multi-tissue joint assessment and has been shown to be a valid and reliable way to measure structural multi-tissue involvement and progression of the disease. While recent work has described how SQ scoring may be used for clinical trial enrichment and disease phenotyping in OA, less guidance is available for how these parameters may be used to assess study outcomes. Design Here we present recommendations for summarizing disease progression within specific tissue types. We illustrate how various methods may be used to quantify longitudinal change using SQ scoring and review examples from the literature. Results Approaches to quantify longitudinal change across subregions include the count of number of subregions, delta-subregion, delta-sum, and maximum grade changes. Careful attention should be paid to features that may fluctuate, such as bone marrow lesions, or with certain interventions, for example pharmacologic interventions with anticipated cartilage anabolic effects. The statistical approach must align with the nature of the outcome. Conclusions SQ scoring presents a way to understand disease progression across the whole joint. As OA is increasingly recognized as a heterogeneous disease with different phenotypes a better understanding of longitudinal progression across tissue types may present an opportunity to match study outcome to patient phenotype or to treatment mechanism of action.
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Affiliation(s)
- Jamie E. Collins
- Orthopaedics and Arthritis Center of Outcomes Research, Brigham and Women's Hospital, Harvard Medical School, 75 Francis Street, BTM Suite 5016, Boston, MA, 02115, USA
| | - Frank W. Roemer
- Quantitative Imaging Center, Department of Radiology, Boston University School of Medicine, 820 Harrison Avenue, FGH Building, 4th Floor, Boston, MA, 02118, USA
- Department of Radiology, Friedrich-Alexander University Erlangen-Nürnberg (FAU), Universitätsklinikum Erlangen, Maximiliansplatz 3, 91054 Erlangen, Germany
| | - Ali Guermazi
- Quantitative Imaging Center, Department of Radiology, Boston University School of Medicine, 820 Harrison Avenue, FGH Building, 4th Floor, Boston, MA, 02118, USA
- Department of Radiology, VA Boston Healthcare System, 1400 VFW Parkway, Suite 1B105, West Roxbury, MA, 02132, USA
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Gatti AA, Blankemeier L, Van Veen D, Hargreaves B, Delp SL, Gold GE, Kogan F, Chaudhari AS. ShapeMed-Knee: A Dataset and Neural Shape Model Benchmark for Modeling 3D Femurs. MEDRXIV : THE PREPRINT SERVER FOR HEALTH SCIENCES 2024:2024.05.06.24306965. [PMID: 38766040 PMCID: PMC11100941 DOI: 10.1101/2024.05.06.24306965] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/22/2024]
Abstract
Analyzing anatomic shapes of tissues and organs is pivotal for accurate disease diagnostics and clinical decision-making. One prominent disease that depends on anatomic shape analysis is osteoarthritis, which affects 30 million Americans. To advance osteoarthritis diagnostics and prognostics, we introduce ShapeMed-Knee, a 3D shape dataset with 9,376 high-resolution, medical-imaging-based 3D shapes of both femur bone and cartilage. Besides data, ShapeMed-Knee includes two benchmarks for assessing reconstruction accuracy and five clinical prediction tasks that assess the utility of learned shape representations. Leveraging ShapeMed-Knee, we develop and evaluate a novel hybrid explicit-implicit neural shape model which achieves up to 40% better reconstruction accuracy than a statistical shape model and implicit neural shape model. Our hybrid models achieve state-of-the-art performance for preserving cartilage biomarkers; they're also the first models to successfully predict localized structural features of osteoarthritis, outperforming shape models and convolutional neural networks applied to raw magnetic resonance images and segmentations. The ShapeMed-Knee dataset provides medical evaluations to reconstruct multiple anatomic surfaces and embed meaningful disease-specific information. ShapeMed-Knee reduces barriers to applying 3D modeling in medicine, and our benchmarks highlight that advancements in 3D modeling can enhance the diagnosis and risk stratification for complex diseases. The dataset, code, and benchmarks will be made freely accessible.
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Affiliation(s)
- Anthony A Gatti
- Department of Radiology at Stanford University, Stanford, CA, 94305, USA
| | - Louis Blankemeier
- Department of Electrical Engineering at Stanford University, Stanford, CA, 94305, USA
| | - Dave Van Veen
- Department of Electrical Engineering at Stanford University, Stanford, CA, 94305, USA
| | - Brian Hargreaves
- Department of Radiology at Stanford University, Stanford, CA, 94305, USA
| | - Scott L Delp
- Department of Bioengineering at Stanford University, Stanford, CA, 94305, USA
| | - Garry E Gold
- Department of Radiology at Stanford University, Stanford, CA, 94305, USA
| | - Feliks Kogan
- Department of Radiology at Stanford University, Stanford, CA, 94305, USA
| | - Akshay S Chaudhari
- Department of Radiology at Stanford University, Stanford, CA, 94305, USA
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Lemainque T, Huppertz MS, Yüksel C, Siepmann R, Kuhl C, Roemer F, Truhn D, Nebelung S. [Current MR imaging of cartilage in the context of knee osteoarthritis (part 1) : Principles and sequences]. RADIOLOGIE (HEIDELBERG, GERMANY) 2024; 64:295-303. [PMID: 38158404 DOI: 10.1007/s00117-023-01252-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 12/01/2023] [Indexed: 01/03/2024]
Abstract
Magnetic resonance imaging (MRI) is the clinical method of choice for cartilage imaging in the context of degenerative and nondegenerative joint diseases. The MRI-based definitions of osteoarthritis rely on the detection of osteophytes, cartilage pathologies, bone marrow edema and meniscal lesions but currently a scientific consensus is lacking. In the clinical routine proton density-weighted, fat-suppressed 2D turbo spin echo sequences with echo times of 30-40 ms are predominantly used, which are sufficiently sensitive and specific for the assessment of cartilage. The additionally acquired T1-weighted sequences are primarily used for evaluating other intra-articular and periarticular structures. Diagnostically relevant artifacts include magic angle and chemical shift artifacts, which can lead to artificial signal enhancement in cartilage or incorrect representations of the subchondral lamina and its thickness. Although scientifically validated, high-resolution 3D gradient echo sequences (for cartilage segmentation) and compositional MR sequences (for quantification of physical tissue parameters) are currently reserved for scientific research questions. The future integration of artificial intelligence techniques in areas such as image reconstruction (to reduce scan times while maintaining image quality), image analysis (for automated identification of cartilage defects), and image postprocessing (for automated segmentation of cartilage in terms of volume and thickness) will significantly improve the diagnostic workflow and advance the field further.
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Affiliation(s)
- Teresa Lemainque
- Klinik für Diagnostische und Interventionelle Radiologie, Universitätsklinikum Aachen, Pauwelsstr. 30, 52074, Aachen, Deutschland
| | - Marc Sebastian Huppertz
- Klinik für Diagnostische und Interventionelle Radiologie, Universitätsklinikum Aachen, Pauwelsstr. 30, 52074, Aachen, Deutschland
| | - Can Yüksel
- Klinik für Diagnostische und Interventionelle Radiologie, Universitätsklinikum Aachen, Pauwelsstr. 30, 52074, Aachen, Deutschland
| | - Robert Siepmann
- Klinik für Diagnostische und Interventionelle Radiologie, Universitätsklinikum Aachen, Pauwelsstr. 30, 52074, Aachen, Deutschland
| | - Christiane Kuhl
- Klinik für Diagnostische und Interventionelle Radiologie, Universitätsklinikum Aachen, Pauwelsstr. 30, 52074, Aachen, Deutschland
| | - Frank Roemer
- Radiologisches Institut, Universitätsklinikum Erlangen & Friedrich-Alexander-Universität Erlangen-Nürnberg, Schloßplatz 4, 91054, Erlangen, Deutschland
- Department of Radiology, Chobanian & Avedisian School of Medicine, Boston University, Boston, MA, USA
| | - Daniel Truhn
- Klinik für Diagnostische und Interventionelle Radiologie, Universitätsklinikum Aachen, Pauwelsstr. 30, 52074, Aachen, Deutschland
| | - Sven Nebelung
- Klinik für Diagnostische und Interventionelle Radiologie, Universitätsklinikum Aachen, Pauwelsstr. 30, 52074, Aachen, Deutschland.
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Wirth W, Ladel C, Maschek S, Wisser A, Eckstein F, Roemer F. Quantitative measurement of cartilage morphology in osteoarthritis: current knowledge and future directions. Skeletal Radiol 2023; 52:2107-2122. [PMID: 36380243 PMCID: PMC10509082 DOI: 10.1007/s00256-022-04228-w] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/29/2022] [Revised: 10/29/2022] [Accepted: 10/31/2022] [Indexed: 11/16/2022]
Abstract
Quantitative measures of cartilage morphology ("cartilage morphometry") extracted from high resolution 3D magnetic resonance imaging (MRI) sequences have been shown to be sensitive to osteoarthritis (OA)-related change and also to treatment interventions. Cartilage morphometry is therefore nowadays widely used as outcome measure for observational studies and randomized interventional clinical trials. The objective of this narrative review is to summarize the current status of cartilage morphometry in OA research, to provide insights into aspects relevant for the design of future studies and clinical trials, and to give an outlook on future developments. It covers the aspects related to the acquisition of MRIs suitable for cartilage morphometry, the analysis techniques needed for deriving quantitative measures from the MRIs, the quality assurance required for providing reliable cartilage measures, and the appropriate participant recruitment criteria for the enrichment of study cohorts with knees likely to show structural progression. Finally, it provides an overview over recent clinical trials that relied on cartilage morphometry as a structural outcome measure for evaluating the efficacy of disease-modifying OA drugs (DMOAD).
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Affiliation(s)
- Wolfgang Wirth
- Department of Imaging & Functional Musculoskeletal Research, Institute of Anatomy & Cell Biology, Paracelsus Medical University Salzburg & Nuremberg, Strubergasse 21, 5020 Salzburg, Austria
- Ludwig Boltzmann Inst. for Arthritis and Rehabilitation, Paracelsus Medical University Salzburg & Nuremberg, Salzburg, Austria
- Chondrometrics GmbH, Freilassing, Germany
| | | | - Susanne Maschek
- Department of Imaging & Functional Musculoskeletal Research, Institute of Anatomy & Cell Biology, Paracelsus Medical University Salzburg & Nuremberg, Strubergasse 21, 5020 Salzburg, Austria
- Chondrometrics GmbH, Freilassing, Germany
| | - Anna Wisser
- Department of Imaging & Functional Musculoskeletal Research, Institute of Anatomy & Cell Biology, Paracelsus Medical University Salzburg & Nuremberg, Strubergasse 21, 5020 Salzburg, Austria
- Ludwig Boltzmann Inst. for Arthritis and Rehabilitation, Paracelsus Medical University Salzburg & Nuremberg, Salzburg, Austria
- Chondrometrics GmbH, Freilassing, Germany
| | - Felix Eckstein
- Department of Imaging & Functional Musculoskeletal Research, Institute of Anatomy & Cell Biology, Paracelsus Medical University Salzburg & Nuremberg, Strubergasse 21, 5020 Salzburg, Austria
- Ludwig Boltzmann Inst. for Arthritis and Rehabilitation, Paracelsus Medical University Salzburg & Nuremberg, Salzburg, Austria
- Chondrometrics GmbH, Freilassing, Germany
| | - Frank Roemer
- Quantitative Imaging Center, Department of Radiology, Boston University School of Medicine, Boston, MA USA
- Department of Radiology, Universitätsklinikum Erlangen and Friedrich-Alexander-University Erlangen-Nürnberg (FAU), Erlangen, Germany
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Roemer F, Maschek S, Wisser A, Guermazi A, Hunter D, Eckstein F, Wirth W. Worsening of Articular Tissue Damage as Defined by Semi-Quantitative MRI Is Associated With Concurrent Quantitative Cartilage Loss Over 24 Months. Cartilage 2023; 14:39-47. [PMID: 36624993 PMCID: PMC10076901 DOI: 10.1177/19476035221147677] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/11/2023] Open
Abstract
OBJECTIVE To assess the association of worsening of magnetic resonance imaging (MRI) semi-quantitative (SQ) tissue features with concurrent change in quantitative (Q) cartilage thickness measurements over 24 months within the Foundation for the National Institutes of Health (FNIH) Biomarker Consortium study. METHODS In all, 599 participants were included. SQ assessment included cartilage damage, meniscal extrusion and damage, osteophytes, bone marrow lesions (BMLs), and effusion- and Hoffa-synovitis. Change in medial compartment Q cartilage thickness was stratified by concurrent ipsicompartmental SQ changes. Between-group comparisons were performed using analysis of covariance (ANCOVA) with adjustment for age, sex, and body mass index (BMI). Results were presented as adjusted mean difference. RESULTS Knees with any increase in SQ cartilage scores in the medial compartment (n = 268) showed more Q cartilage loss compared to knees that remained stable (mean adjusted difference [MAD] = -0.16 mm, 95% confidence interval [CI]: [-0.19, -0.13] mm). Knees with any increase in meniscal extrusion in the medial compartment (n = 98) showed more Q cartilage loss than knees without (MAD = -0.18 mm, 95% CI: [-0.22, -0.14] mm. Comparable findings were seen for meniscal damage worsening. Regarding BMLs, an increase by one subregion resulted in a MAD of Q cartilage loss of -0.10 mm, 95% CI: [-0.14, -0.06] mm, while this effect almost tripled for change in two or more subregions. Increase in either effusion- and/or Hoffa-synovitis by one grade resulted in a MAD of -0.07 mm, 95% CI: [-0.10, -0.03] mm. CONCLUSION Worsening of SQ cartilage damage, meniscal extrusion and damage, number of subregions affected by BML, maximum size of BMLs and worsening of effusion- and/or Hoffa synovitis is associated with increased Q cartilage loss.
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Affiliation(s)
- Frank Roemer
- Friedrich-Alexander-Universitat Erlangen-Nürnberg, Erlangen, Germany
| | - Susanne Maschek
- Paracelsus Medizinische Privatuniversität, Salzburg, Austria
| | - Anna Wisser
- Paracelsus Medizinische Privatuniversität, Salzburg, Austria
| | | | - David Hunter
- The University of Sydney, Sydney, NSW, Australia
| | - Felix Eckstein
- Paracelsus Medizinische Privatuniversität, Salzburg, Austria
| | - Wolfgang Wirth
- Paracelsus Medizinische Privatuniversität, Salzburg, Austria
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Dam EB, Desai AD, Deniz CM, Rajamohan HR, Regatte R, Iriondo C, Pedoia V, Majumdar S, Perslev M, Igel C, Pai A, Gaj S, Yang M, Nakamura K, Li X, Maqbool H, Irmakci I, Song SE, Bagci U, Hargreaves B, Gold G, Chaudhari A. Towards Automatic Cartilage Quantification in Clinical Trials - Continuing from the 2019 IWOAI Knee Segmentation Challenge. OSTEOARTHRITIS IMAGING 2023; 3:100087. [PMID: 39036792 PMCID: PMC11258861 DOI: 10.1016/j.ostima.2023.100087] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 07/23/2024]
Abstract
Objective To evaluate whether the deep learning (DL) segmentation methods from the six teams that participated in the IWOAI 2019 Knee Cartilage Segmentation Challenge are appropriate for quantifying cartilage loss in longitudinal clinical trials. Design We included 556 subjects from the Osteoarthritis Initiative study with manually read cartilage volume scores for the baseline and 1-year visits. The teams used their methods originally trained for the IWOAI 2019 challenge to segment the 1130 knee MRIs. These scans were anonymized and the teams were blinded to any subject or visit identifiers. Two teams also submitted updated methods. The resulting 9,040 segmentations are available online.The segmentations included tibial, femoral, and patellar compartments. In post-processing, we extracted medial and lateral tibial compartments and geometrically defined central medial and lateral femoral sub-compartments. The primary study outcome was the sensitivity to measure cartilage loss as defined by the standardized response mean (SRM). Results For the tibial compartments, several of the DL segmentation methods had SRMs similar to the gold standard manual method. The highest DL SRM was for the lateral tibial compartment at 0.38 (the gold standard had 0.34). For the femoral compartments, the gold standard had higher SRMs than the automatic methods at 0.31/0.30 for medial/lateral compartments. Conclusion The lower SRMs for the DL methods in the femoral compartments at 0.2 were possibly due to the simple sub-compartment extraction done during post-processing. The study demonstrated that state-of-the-art DL segmentation methods may be used in standardized longitudinal single-scanner clinical trials for well-defined cartilage compartments.
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Affiliation(s)
- Erik B Dam
- University of Copenhagen, Copenhagen, Denmark
| | | | - Cem M Deniz
- New York University, Langone Health, New York, NY USA
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | - Ulas Bagci
- Northwestern University, Evanston, IL USA
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Brett A, Bowes MA, Conaghan PG. Comparison of 3D quantitative osteoarthritis imaging biomarkers from paired CT and MR images: data from the IMI-APPROACH study. BMC Musculoskelet Disord 2023; 24:76. [PMID: 36710346 PMCID: PMC9885640 DOI: 10.1186/s12891-023-06187-2] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/12/2022] [Accepted: 01/23/2023] [Indexed: 01/31/2023] Open
Abstract
INTRODUCTION MRI bone surface area and femoral bone shape (B-score) measures have been employed as quantitative endpoints in DMOAD clinical trials. Computerized Tomography (CT) imaging is more commonly used for 3D visualization of bony anatomy due to its high bone-soft tissue contrast. We aimed to compare CT and MRI assessments of 3D imaging biomarkers. METHODS We used baseline and 24-month image data from the IMI-APPROACH 2-year prospective cohort study. Femur and tibia were automatically segmented using active appearance models, a machine-learning method, to measure 3D bone shape, area and 3D joint space width (3DJSW). Linear regression was used to test for correlation between measures. Limits of agreement and bias were tested using Bland-Altman analysis. RESULTS CT-MR pairs of the same knee were available from 434 participants (78% female). B-scores from CT and MR were strongly correlated (CCC = 0.967) with minimal bias of 0.1 (SDD = 0.227). Area measures were also correlated but showed a consistent bias (MR smaller). 3DJSW showed different biases (MR larger) in both lateral and medial compartments. DISCUSSION The strong correlation and small B-score bias suggests that B-score may be measured reliably using either modality. It is likely that the bone surface identified using MR and CT will be at slightly different positions within the bone/cartilage boundary. The negative bone area bias suggests the MR bone boundary is inside the CT boundary producing smaller areas for MR, consistent with the positive 3DJSW bias. The lateral-medial 3DJSW difference is possibly due to a difference in knee pose during acquisition (extended for CT, flexed for MR). TRIAL REGISTRATION NCT03883568.
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Affiliation(s)
- Alan Brett
- Imorphics, Worthington House, Towers Business Park, Wilmslow Road, Manchester, M20 2HJ UK
| | - Michael A. Bowes
- Imorphics, Worthington House, Towers Business Park, Wilmslow Road, Manchester, M20 2HJ UK
| | - Philip G. Conaghan
- grid.454370.10000 0004 0439 7412Leeds Institute of Rheumatic and Musculoskeletal Medicine, University of Leeds & NIHR Leeds Biomedical Research Centre, Leeds, UK
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Mathiessen A, Ashbeck EL, Huang E, Bedrick EJ, Kwoh CK, Duryea J. Cartilage Topography Assessment With Local-Area Cartilage Segmentation for Knee Magnetic Resonance Imaging. Arthritis Care Res (Hoboken) 2022; 74:2013-2023. [PMID: 34219396 PMCID: PMC8727638 DOI: 10.1002/acr.24745] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2021] [Revised: 06/09/2021] [Accepted: 07/01/2021] [Indexed: 02/05/2023]
Abstract
OBJECTIVE Local-area cartilage segmentation (LACS) software was developed to segment medial femur (MF) cartilage on magnetic resonance imaging (MRI). Our objectives were 1) to extend LACS to the lateral femur (LF), medial tibia (MT), and lateral tibia (LT), 2) to compare LACS to an established manual segmentation method, and 3) to visualize cartilage responsiveness over each cartilage plate. METHODS Osteoarthritis Initiative participants with symptomatic knee osteoarthritis (OA) were selected, including knees selected at random (n = 40) and knees identified with loss of cartilage based on manual segmentation (Chondrometrics GmbH), an enriched sample of 126 knees. LACS was used to segment cartilage in the MF, LF, MT, and LT on sagittal 3D double-echo steady-state MRI scans at baseline and at 2-year follow-up. We compared LACS and Chondrometrics average thickness measures by estimating the correlation in each cartilage plate and estimating the standardized response mean (SRM) for 2-year cartilage change. We illustrated cartilage loss topographically with SRM heatmaps. RESULTS The estimated correlation between LACS and Chondrometrics measures was r = 0.91 (95% confidence interval [95% CI] 0.86, 0.94) for LF, r = 0.93 (95% CI 0.89, 0.95) for MF, r = 0.97 (95% CI 0.96, 0.98) for LT, and r = 0.87 (95% CI 0.81, 0.91) for MT. Estimated SRMs for LACS and Chondrometrics measures were similar in the random sample, and SRM heatmaps identified subregions of LACS-measured cartilage loss. CONCLUSION LACS cartilage thickness measurement in the MF and LF and tibia correlated well with established manual segmentation-based measurement, with similar responsiveness to change, among knees with symptomatic knee OA. LACS measurement of cartilage plate topography enables spatiotemporal analysis of cartilage loss in future knee OA studies.
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Affiliation(s)
- Alexander Mathiessen
- Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
- Diakonhjemmet Hospital, Department of Rheumatology, Oslo, Norway
- Institute of Clinical Medicine, University of Oslo, Oslo, Norway
| | - Erin L. Ashbeck
- University of Arizona Arthritis Center, the University of Arizona College of Medicine, Tucson, AZ, USA
| | - Emily Huang
- Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
| | - Edward John Bedrick
- Department of Epidemiology and Biostatistics, Mel and Enid Zuckerman College of Public Health, University of Arizona, Tucson, AZ, USA
| | - C. Kent Kwoh
- University of Arizona Arthritis Center, the University of Arizona College of Medicine, Tucson, AZ, USA
| | - Jeffrey Duryea
- Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
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Gauffenic A, Bazin D, Combes C, Daudon M, Ea HK. Pathological calcifications in the human joint. CR CHIM 2022. [DOI: 10.5802/crchim.193] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
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Andersen C, Griffin JF, Jacobsen S, Østergaard S, Walters M, Mori Y, Lindegaard C. Validation of ultrasonography for measurement of cartilage thickness in the equine carpus. Vet Radiol Ultrasound 2022; 63:478-489. [PMID: 35347811 PMCID: PMC9545370 DOI: 10.1111/vru.13085] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2021] [Revised: 01/05/2022] [Accepted: 01/16/2022] [Indexed: 12/04/2022] Open
Abstract
Articular cartilage thinning is an important hallmark of osteoarthritis (OA), and ultrasonography (US) is a clinically accessible tool potentially suitable for repeated evaluation. The aim of the present prospective methods comparison study was to validate US as a tool for measuring cartilage thickness in the carpus of the horse. Eight Standardbred trotters underwent US examination with 9 and 15 MHz linear transducers. Six anatomical locations in the radiocarpal joint (RCJ) and middle carpal joint (MCJ) were examined. The same joints were assessed by ultrahigh field (9.4 Tesla) magnetic resonance imaging (MRI) and histology. Associations between measurements obtained by the different modalities were assessed by ANOVA, Deming regression, Pearson correlation and Bland–Altman plots. Histologically assessed total cartilage thickness (the noncalcified cartilage (NCC) plus the calcified cartilage zone (CCZ)) overestimated thickness compared to MRI (P < 0.01) and US (P < 0.01). US 15 MHz had substantial agreement with MRI and NCC histology, and repeatability was acceptable (coefficient of variation = 8.6–17.9%) when used for assessment of cartilage thickness in the RCJ. In contrast, 9 MHz US showed poorer agreement with MRI and NCC histology, as it overestimated the thickness of thin cartilage and underestimated the thickness of thicker cartilage in the RCJ and MCJ. Moreover, repeatability was suboptimal (coefficient of variation = 10.4–26.3%). A 15 MHz transducer US is recommended for detecting changes in RCJ cartilage thickness or monitoring development over time, and it has the potential for noninvasive assessment of cartilage health in horses.
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Affiliation(s)
- Camilla Andersen
- Department of Veterinary Clinical Sciences, Faculty of Health and Medical Sciences, University of Copenhagen, Taastrup, Denmark
| | - John F Griffin
- Department of Large Animal Clinical Sciences, Texas A&M University, College Station, Texas, USA
| | - Stine Jacobsen
- Department of Veterinary Clinical Sciences, Faculty of Health and Medical Sciences, University of Copenhagen, Taastrup, Denmark
| | - Stine Østergaard
- Department of Veterinary Clinical Sciences, Faculty of Health and Medical Sciences, University of Copenhagen, Taastrup, Denmark
| | - Marie Walters
- Department of Veterinary Clinical Sciences, Faculty of Health and Medical Sciences, University of Copenhagen, Taastrup, Denmark
| | - Yuki Mori
- Center for Translational Neuromedicine, Faculty of Health & Medical Sciences, University of Copenhagen, Copenhagen N, Denmark
| | - Casper Lindegaard
- Department of Veterinary Clinical Sciences, Faculty of Health and Medical Sciences, University of Copenhagen, Taastrup, Denmark
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Latourte A, Rat AC, Omorou A, Ngueyon-Sime W, Eymard F, Sellam J, Roux C, Ea HK, Cohen-Solal M, Bardin T, Beaudreuil J, Guillemin F, Richette P. Do Glucocorticoid Injections Increase the Risk of Knee Osteoarthritis Progression Over 5 Years? Arthritis Rheumatol 2022; 74:1343-1351. [PMID: 35289131 DOI: 10.1002/art.42118] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2021] [Revised: 01/25/2022] [Accepted: 03/09/2022] [Indexed: 12/20/2022]
Abstract
OBJECTIVE Recent findings have demonstrated that intraarticular (IA) glucocorticoid injections can be deleterious for knees with osteoarthritis (OA). This study was undertaken to assess, in a real-life setting, the risk of knee OA progression in patients who received IA glucocorticoid injections over a 5-year follow-up period. METHODS We used marginal structural modeling with inverse probability of treatment weighting to determine the causal association between IA glucocorticoid injections and the 5-year risk of disease progression in patients with symptomatic knee OA from the Knee and Hip Osteoarthritis Long-term Assessment cohort. OA progression was defined as an incident total knee replacement (TKR) and/or radiographic worsening (Kellgren/Lawrence [K/L] grade or joint space narrowing [JSN]). We also examined these outcomes in knees that received IA hyaluronan (IAHA) injections. RESULTS Among the 564 patients with knee OA included in the study sample, 51 (9.0%) and 99 (17.5%) received IA glucocorticoid or IAHA injections, respectively, and 414 (63.1%) did not receive any injection during follow-up. Compared to untreated knees, those treated with IA glucocorticoid injections had a similar risk of incident TKR (hazard ratio [HR] 0.92 [95% confidence interval (95% CI) 0.20, 4.14]; P = 0.91) or K/L grade worsening (HR 1.33 [95% CI 0.64, 2.79]; P = 0.44). IAHA injections had no effect on the risk of TKR (HR 0.81 [95% CI 0.14, 4.63]; P = 0.81) or K/L grade worsening (HR 1.36 [95% CI 0.85, 2.17]; P = 0.20). Similar results were obtained for JSN, and when TKR and radiographic outcomes were combined. CONCLUSION In this study, IA glucocorticoid injections for symptomatic knee OA did not significantly increase the 5-year risk of incident TKR or radiographic worsening. These findings should be interpreted cautiously and replicated in other cohorts.
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Affiliation(s)
- Augustin Latourte
- Université de Paris, INSERM, UMR-S 1132 BIOSCAR, and Rheumatology Department, AP-HP, Lariboisière Hospital, Paris, France
| | - Anne-Christine Rat
- Caen Normandie University, UMR-S 1075-Mobilités: Vieillissement, Pathologie, Santé COMETE, Caen, France, Rheumatology Department, CHU Caen, Caen, France, and Université de Lorraine, EA 4360, APEMAC, Nancy, France
| | - Abdou Omorou
- Université de Lorraine, EA 4360, APEMAC, and Inserm CIC 1433 Epidémiologie Clinique, CHRU Nancy, Université de Lorraine Vandoeuvre-lès-Nancy, Nancy, France
| | | | - Florent Eymard
- Rheumatology Department, Henri Mondor Hospital, AP-HP, Créteil, France
| | - Jérémie Sellam
- Rheumatology Department, Sorbonne Université, AP-HP, Saint-Antoine Hospital, Inserm UMRS_938, FHU PaCeMM, Paris, France
| | - Christian Roux
- Rheumatology Department, CHU Pasteur 2, LAMHESS EA6309, UMR7277 iBV CNRS, Nice Sophia Antipolis University, France
| | - Hang-Korng Ea
- Université de Paris, INSERM, UMR-S 1132 BIOSCAR, and Rheumatology Department, AP-HP, Lariboisière Hospital, Paris, France
| | - Martine Cohen-Solal
- Université de Paris, INSERM, UMR-S 1132 BIOSCAR, and Rheumatology Department, AP-HP, Lariboisière Hospital, Paris, France
| | - Thomas Bardin
- Université de Paris, INSERM, UMR-S 1132 BIOSCAR, and Rheumatology Department, AP-HP, Lariboisière Hospital, Paris, France
| | - Johann Beaudreuil
- Université de Paris, INSERM, UMR-S 1132 BIOSCAR, and Physical Medicine and Rehabilitation department, Lariboisière-Fernand Widal hospital, Paris, France
| | - Francis Guillemin
- Université de Lorraine, EA 4360, APEMAC, and Inserm CIC 1433 Epidémiologie Clinique, CHRU Nancy, Université de Lorraine Vandoeuvre-lès-Nancy, Nancy, France
| | - Pascal Richette
- Université de Paris, INSERM, UMR-S 1132 BIOSCAR, and Rheumatology Department, AP-HP, Lariboisière Hospital, Paris, France
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13
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The Use of Scoring Hip Osteoarthritis with MRI as an Assessment Tool for Physiotherapeutic Treatment in Patients with Osteoarthritis of the Hip. J Clin Med 2021; 11:jcm11010017. [PMID: 35011758 PMCID: PMC8745579 DOI: 10.3390/jcm11010017] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2021] [Revised: 12/12/2021] [Accepted: 12/17/2021] [Indexed: 11/16/2022] Open
Abstract
Rehabilitation programs are considered effective at reducing the impact of osteoarthritis (OA) of the hip; however, studies using reliable measures related to OA biomarkers to assess the effects of rehabilitation are lacking. The objective of this study was to investigate whether an MRI-based (Magnetic Resonance Imaging-based), semi-quantitative system for an OA severity assessment is feasible for the evaluation of the structural changes in the joint observed during a long-term physiotherapy program in patients with hip OA. The study group consisted of 37 adult OA patients who participated in a 12-month physiotherapy program. The Scoring hip osteoarthritis with MRI (SHOMRI) system was used to evaluate the severity of structural changes related to hip OA. Hip disability and the osteoarthritis outcome score (HOOS) and the core set of performance-based tests recommended by Osteoarthritis Research Society International were used for functional assessment. SHOMRI showed excellent inter- and intra-rater agreement, proving to be a reliable method for the evaluation of hip abnormalities. At the 12-month follow-up no statistically significant changes were observed within the hip joint; however, a trend of structural progression was detected. There was a negative correlation between most of the SHOMRI and HOOS subscales at baseline and the 12-month follow-up. Although SHOMRI provides a reliable assessment of the hip joint in patients with OA it showed a limited value in detecting significant changes over time in the patients receiving physiotherapy over a 12-month period.
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14
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Said O, Schock J, Abrar DB, Schad P, Kuhl C, Nolte T, Knobe M, Prescher A, Truhn D, Nebelung S. In-Situ Cartilage Functionality Assessment Based on Advanced MRI Techniques and Precise Compartmental Knee Joint Loading through Varus and Valgus Stress. Diagnostics (Basel) 2021; 11:diagnostics11081476. [PMID: 34441410 PMCID: PMC8391314 DOI: 10.3390/diagnostics11081476] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2021] [Revised: 08/09/2021] [Accepted: 08/12/2021] [Indexed: 12/05/2022] Open
Abstract
Stress MRI brings together mechanical loading and MRI in the functional assessment of cartilage and meniscus, yet lacks basic scientific validation. This study assessed the response-to-loading patterns of cartilage and meniscus incurred by standardized compartmental varus and valgus loading of the human knee joint. Eight human cadaveric knee joints underwent imaging by morphologic (i.e., proton density-weighted fat-saturated and 3D water-selective) and quantitative (i.e., T1ρ and T2 mapping) sequences, both unloaded and loaded to 73.5 N, 147.1 N, and 220.6 N of compartmental pressurization. After manual segmentation of cartilage and meniscus, morphometric measures and T2 and T1ρ relaxation times were quantified. CT-based analysis of joint alignment and histologic and biomechanical tissue measures served as references. Under loading, we observed significant decreases in cartilage thickness (p < 0.001 (repeated measures ANOVA)) and T1ρ relaxation times (p = 0.001; medial meniscus, lateral tibia; (Friedman test)), significant increases in T2 relaxation times (p ≤ 0.004; medial femur, lateral tibia; (Friedman test)), and adaptive joint motion. In conclusion, varus and valgus stress MRI induces meaningful changes in cartilage and meniscus secondary to compartmental loading that may be assessed by cartilage morphometric measures as well as T2 and T1ρ mapping as imaging surrogates of tissue functionality.
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Affiliation(s)
- Oliver Said
- Department of Diagnostic and Interventional Radiology, Aachen University Hospital, 52074 Aachen, Germany; (O.S.); (P.S.); (C.K.); (T.N.); (D.T.); (S.N.)
| | - Justus Schock
- Department of Diagnostic and Interventional Radiology, Medical Faculty, University Dusseldorf, 40225 Dusseldorf, Germany;
- Correspondence:
| | - Daniel Benjamin Abrar
- Department of Diagnostic and Interventional Radiology, Medical Faculty, University Dusseldorf, 40225 Dusseldorf, Germany;
| | - Philipp Schad
- Department of Diagnostic and Interventional Radiology, Aachen University Hospital, 52074 Aachen, Germany; (O.S.); (P.S.); (C.K.); (T.N.); (D.T.); (S.N.)
| | - Christiane Kuhl
- Department of Diagnostic and Interventional Radiology, Aachen University Hospital, 52074 Aachen, Germany; (O.S.); (P.S.); (C.K.); (T.N.); (D.T.); (S.N.)
| | - Teresa Nolte
- Department of Diagnostic and Interventional Radiology, Aachen University Hospital, 52074 Aachen, Germany; (O.S.); (P.S.); (C.K.); (T.N.); (D.T.); (S.N.)
| | - Matthias Knobe
- Department of Orthopedic and Trauma Surgery, Lucerne Cantonal Hospital, 6000, Lucerne, Switzerland;
| | - Andreas Prescher
- Institute of Molecular and Cellular Anatomy, RWTH Aachen University, 52074 Aachen, Germany;
| | - Daniel Truhn
- Department of Diagnostic and Interventional Radiology, Aachen University Hospital, 52074 Aachen, Germany; (O.S.); (P.S.); (C.K.); (T.N.); (D.T.); (S.N.)
| | - Sven Nebelung
- Department of Diagnostic and Interventional Radiology, Aachen University Hospital, 52074 Aachen, Germany; (O.S.); (P.S.); (C.K.); (T.N.); (D.T.); (S.N.)
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15
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Horng A, Stroebel J, Geith T, Milz S, Pacureanu A, Yang Y, Cloetens P, Lovric G, Mittone A, Bravin A, Coan P. Multiscale X-ray phase contrast imaging of human cartilage for investigating osteoarthritis formation. J Biomed Sci 2021; 28:42. [PMID: 34098949 PMCID: PMC8182937 DOI: 10.1186/s12929-021-00739-1] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2021] [Accepted: 06/01/2021] [Indexed: 12/14/2022] Open
Abstract
Background The evolution of cartilage degeneration is still not fully understood, partly due to its thinness, low radio-opacity and therefore lack of adequately resolving imaging techniques. X-ray phase-contrast imaging (X-PCI) offers increased sensitivity with respect to standard radiography and CT allowing an enhanced visibility of adjoining, low density structures with an almost histological image resolution. This study examined the feasibility of X-PCI for high-resolution (sub-) micrometer analysis of different stages in tissue degeneration of human cartilage samples and compare it to histology and transmission electron microscopy. Methods Ten 10%-formalin preserved healthy and moderately degenerated osteochondral samples, post-mortem extracted from human knee joints, were examined using four different X-PCI tomographic set-ups using synchrotron radiation the European Synchrotron Radiation Facility (France) and the Swiss Light Source (Switzerland). Volumetric datasets were acquired with voxel sizes between 0.7 × 0.7 × 0.7 and 0.1 × 0.1 × 0.1 µm3. Data were reconstructed by a filtered back-projection algorithm, post-processed by ImageJ, the WEKA machine learning pixel classification tool and VGStudio max. For correlation, osteochondral samples were processed for histology and transmission electron microscopy. Results X-PCI provides a three-dimensional visualization of healthy and moderately degenerated cartilage samples down to a (sub-)cellular level with good correlation to histologic and transmission electron microscopy images. X-PCI is able to resolve the three layers and the architectural organization of cartilage including changes in chondrocyte cell morphology, chondrocyte subgroup distribution and (re-)organization as well as its subtle matrix structures. Conclusions X-PCI captures comprehensive cartilage tissue transformation in its environment and might serve as a tissue-preserving, staining-free and volumetric virtual histology tool for examining and chronicling cartilage behavior in basic research/laboratory experiments of cartilage disease evolution.
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Affiliation(s)
- Annie Horng
- Department of Clinical Radiology, Faculty of Medicine, Ludwig-Maximilians-University, Marchioninistr. 15, 81377, Munich, Germany.,RZM - Radiologisches Zentrum Munich-Pasing, Pippinger Str. 25, 81245, Munich, Germany
| | - Johannes Stroebel
- Department of Medical Physics, Faculty of Physics, Ludwig-Maximilians-University Munich, Am Coulombwall 1, 85748, Garching, Germany
| | - Tobias Geith
- Department of Interventional Radiology, Klinikum Rechts der Isar of the Technical University of Munich, Munich, Germany
| | - Stefan Milz
- Faculty of Medicine, Anatomische Anstalt, Neuroanatomy, Ludwig Maximilians University, Munich, Germany
| | | | - Yang Yang
- European Synchrotron Radiation Facility, Grenoble, France.,National Synchrotron Light Source II, Brookhaven National Laboratory, Upton, NY, 11973, USA
| | - Peter Cloetens
- European Synchrotron Radiation Facility, Grenoble, France
| | - Goran Lovric
- Paul Scherrer Institute (Swiss Light Source), Villigen, Switzerland
| | | | - Alberto Bravin
- European Synchrotron Radiation Facility, Grenoble, France
| | - Paola Coan
- Department of Clinical Radiology, Faculty of Medicine, Ludwig-Maximilians-University, Marchioninistr. 15, 81377, Munich, Germany. .,Department of Medical Physics, Faculty of Physics, Ludwig-Maximilians-University Munich, Am Coulombwall 1, 85748, Garching, Germany.
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16
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Wirth W, Eckstein F, Kemnitz J, Baumgartner CF, Konukoglu E, Fuerst D, Chaudhari AS. Accuracy and longitudinal reproducibility of quantitative femorotibial cartilage measures derived from automated U-Net-based segmentation of two different MRI contrasts: data from the osteoarthritis initiative healthy reference cohort. MAGMA (NEW YORK, N.Y.) 2021; 34:337-354. [PMID: 33025284 PMCID: PMC8154803 DOI: 10.1007/s10334-020-00889-7] [Citation(s) in RCA: 19] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/09/2020] [Revised: 08/22/2020] [Accepted: 09/10/2020] [Indexed: 12/19/2022]
Abstract
OBJECTIVE To evaluate the agreement, accuracy, and longitudinal reproducibility of quantitative cartilage morphometry from 2D U-Net-based automated segmentations for 3T coronal fast low angle shot (corFLASH) and sagittal double echo at steady-state (sagDESS) MRI. METHODS 2D U-Nets were trained using manual, quality-controlled femorotibial cartilage segmentations available for 92 Osteoarthritis Initiative healthy reference cohort participants from both corFLASH and sagDESS (n = 50/21/21 training/validation/test-set). Cartilage morphometry was computed from automated and manual segmentations for knees from the test-set. Agreement and accuracy were evaluated from baseline visits (dice similarity coefficient: DSC, correlation analysis, systematic offset). The longitudinal reproducibility was assessed from year-1 and -2 follow-up visits (root-mean-squared coefficient of variation, RMSCV%). RESULTS Automated segmentations showed high agreement (DSC 0.89-0.92) and high correlations (r ≥ 0.92) with manual ground truth for both corFLASH and sagDESS and only small systematic offsets (≤ 10.1%). The automated measurements showed a similar test-retest reproducibility over 1 year (RMSCV% 1.0-4.5%) as manual measurements (RMSCV% 0.5-2.5%). DISCUSSION The 2D U-Net-based automated segmentation method yielded high agreement compared with manual segmentation and also demonstrated high accuracy and longitudinal test-retest reproducibility for morphometric analysis of articular cartilage derived from it, using both corFLASH and sagDESS.
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Affiliation(s)
- Wolfgang Wirth
- Department of Imaging and Functional Musculoskeletal Research, Institute of Anatomy and Cell Biology, Paracelsus Medical University Salzburg and Nuremberg, Strubergasse 21, 5020, Salzburg, Austria.
- Ludwig Boltzmann Institute for Arthritis and Rehabilitation, Paracelsus Medical University, Salzburg, Austria.
- Chondrometrics GmbH, Ainring, Germany.
| | - Felix Eckstein
- Department of Imaging and Functional Musculoskeletal Research, Institute of Anatomy and Cell Biology, Paracelsus Medical University Salzburg and Nuremberg, Strubergasse 21, 5020, Salzburg, Austria
- Ludwig Boltzmann Institute for Arthritis and Rehabilitation, Paracelsus Medical University, Salzburg, Austria
- Chondrometrics GmbH, Ainring, Germany
| | - Jana Kemnitz
- Department of Imaging and Functional Musculoskeletal Research, Institute of Anatomy and Cell Biology, Paracelsus Medical University Salzburg and Nuremberg, Strubergasse 21, 5020, Salzburg, Austria
| | | | | | - David Fuerst
- Department of Imaging and Functional Musculoskeletal Research, Institute of Anatomy and Cell Biology, Paracelsus Medical University Salzburg and Nuremberg, Strubergasse 21, 5020, Salzburg, Austria
- Ludwig Boltzmann Institute for Arthritis and Rehabilitation, Paracelsus Medical University, Salzburg, Austria
- Chondrometrics GmbH, Ainring, Germany
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17
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Wirth W, Eckstein F, Culvenor AG, Hudelmaier MI, Stefan Lohmander L, Frobell RB. Early anterior cruciate ligament reconstruction does not affect 5 year change in knee cartilage thickness: secondary analysis of a randomized clinical trial. Osteoarthritis Cartilage 2021; 29:518-526. [PMID: 33549723 DOI: 10.1016/j.joca.2021.01.004] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/24/2020] [Revised: 12/30/2020] [Accepted: 01/20/2021] [Indexed: 02/02/2023]
Abstract
OBJECTIVE To compare 5-year change in femorotibial cartilage thickness in 121 young, active adults with an acute anterior cruciate ligament (ACL) tear randomized to a strategy of structured rehabilitation plus early ACL reconstruction (ACLR) or structured rehabilitation plus optional delayed ACLR. DESIGN 62 patients were randomized to early ACLR, 59 to optional delayed ACLR. Magnetic resonance imaging (MRI) was acquired within 4 weeks of injury, at two- and 5-years follow-up. Main outcome was 5-year change in overall femorotibial cartilage thickness. Secondary outcomes included the location-independent cartilage ChangeScore, summarizing thinning and thickening in 16 femorotibial subregions. An exploratory as-treated comparison was performed additionally. RESULTS Baseline and at least one follow-up MRI were available for 117 patients. Over 5 years, a comparable increase in overall femorotibial cartilage thickness was observed for patients randomized to early ACLR (n = 59) and patients randomized to optional delayed ACLR (n = 58, adjusted mean difference: -5 μm, 95% CI: [-118, 108]μm). However, the location-independent cartilage ChangeScore was greater in those treated with early ACLR than in patients treated with optional delayed ACLR (adjusted mean difference: 403 μm [119, 687]μm). As-treated analysis showed no between-group differences for the main outcome, while the location-independent cartilage ChangeScore was greater for patients treated with early (adjusted mean difference: 632 μm [268, 996]μm) or delayed ACLR (adjusted mean difference: 449 μm [108, 791]μm) than for patients treated with rehabilitation alone. CONCLUSIONS In young active adults with acute ACL-injury, choice of treatment strategy for the injured ACL did not modify the magnitude of 5-year change in overall femorotibial cartilage thickness. TRIAL REGISTRATION ISRCTN84752559.
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Affiliation(s)
- W Wirth
- Department for Imaging & Functional Musculoskeletal Research, Institute of Anatomy & Cell Biology, Paracelsus Medical University Salzburg & Nuremberg, Salzburg, Austria; Ludwig Boltzmann Institute for Arthritis and Rehabilitation, Paracelsus Medical University, Salzburg, Austria; Chondrometrics GmbH, Ainring, Germany.
| | - F Eckstein
- Department for Imaging & Functional Musculoskeletal Research, Institute of Anatomy & Cell Biology, Paracelsus Medical University Salzburg & Nuremberg, Salzburg, Austria; Ludwig Boltzmann Institute for Arthritis and Rehabilitation, Paracelsus Medical University, Salzburg, Austria; Chondrometrics GmbH, Ainring, Germany.
| | - A G Culvenor
- Department for Imaging & Functional Musculoskeletal Research, Institute of Anatomy & Cell Biology, Paracelsus Medical University Salzburg & Nuremberg, Salzburg, Austria; La Trobe Sport & Exercise Medicine Research Centre, School of Allied Health, Human Services and Sport, La Trobe University, Bundoora, Australia.
| | - M I Hudelmaier
- Department for Imaging & Functional Musculoskeletal Research, Institute of Anatomy & Cell Biology, Paracelsus Medical University Salzburg & Nuremberg, Salzburg, Austria.
| | - L Stefan Lohmander
- Department of Clinical Sciences Lund, Orthopaedics, Lund University, Lund, Sweden.
| | - R B Frobell
- Department of Clinical Sciences Lund, Orthopaedics, Lund University, Lund, Sweden.
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18
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MacKay J, Guermazi A, Kwoh CK, See PLP, Jarraya M, Li L, Hannon MJ, Fujii T, Roemer FW. MRI-defined Osteophyte Presence and Concomitant Cartilage Damage in Knees with Incident Tibiofemoral Osteoarthritis: Data From The Pivotal Osteoarthritis Initiative Magnetic Resonance Imaging Analyses (POMA) Study. Arthritis Care Res (Hoboken) 2021; 74:1513-1519. [PMID: 33770420 DOI: 10.1002/acr.24605] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2020] [Revised: 02/05/2021] [Accepted: 03/23/2021] [Indexed: 11/08/2022]
Abstract
OBJECTIVE To describe compartmental frequencies of MRI-defined osteophytes and co-localized cartilage damage and evaluate the associations of osteophyte (OP) size with any ipsicompartmental cartilage damage in knees with incident tibiofemoral radiographic knee osteoarthritis (ROA). METHODS We evaluated knees from the Osteoarthritis Initiative without ROA at baseline that developed ROA during a 4-year interval. Semi-quantitative MRI scoring of osteophytes and cartilage damage was performed at the time point when ROA was diagnosed, defined as Kellgren-Lawrence grade ≥ 2, using the MOAKS instrument. The frequencies of maximum osteophyte size and maximum grade of ipsicompartmental (i.e., patellofemoral, medial tibiofemoral, lateral tibiofemoral, posterior femur) cartilage damage were assessed. Generalized estimating equations were used to determine the association of MRI-defined maximum osteophyte size with presence of any (excluding focal superficial defects) ipsicompartmental cartilage damage. RESULTS 296 knees that did not have tibiofemoral ROA at the baseline visit but developed ROA during the 48- month observational period were included. In the patellofemoral, medial tibiofemoral and lateral tibiofemoral compartments, the most frequent OP grade was 1 (67.6%, 59.1% and 51.7%, respectively), and in the posterior femur it was 0 (51.7%). For all compartments except the posterior femur, a linear trend was found between increasing maximum OP size and the presence of any concomitant cartilage damage. CONCLUSIONS In this sample of knees with incident tibiofemoral ROA, the patellofemoral joint showed more severe cartilage damage than other compartments regardless of concomitant osteophyte size. In the posterior femur, cartilage damage was rare despite the presence or size of concomitant osteophytes.
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Affiliation(s)
- James MacKay
- Department of Radiology, Norwich Medical School, University of East Anglia, NR4 7UQ, Norwich, UK.,Department of Radiology, University of Cambridge, School of Clinical Medicine, Addenbrooke's Hospital, Box 218, Level 5, Cambridge, CB2 0QQ, UK
| | - Ali Guermazi
- Quantitative Imaging Center, Department of Radiology, Boston University School of Medicine, FGH Building, 820 Harrison Avenue, Boston, MA, 02118, USA.,Department of Radiology, Boston Healthcare System, 1400 VFW Parkway, Suite 1B105, West Roxbury, 02132, USA
| | - C Kent Kwoh
- University of Arizona, Arthritis Center & Division of Rheumatology, University of Arizona College of Medicine, 1501 N Campbell Ave, Tucson, AZ, 85724, USA
| | - P L Paul See
- Quantitative Imaging Center, Department of Radiology, Boston University School of Medicine, FGH Building, 820 Harrison Avenue, Boston, MA, 02118, USA.,Department of Diagnostic Radiology, Khoo Teck Puat Hospital, 90 Yishun Central, Singapore, 768828
| | - Mohamed Jarraya
- Department of Radiology, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | - Ling Li
- Pfizer, Inc, New York, NY, USA
| | - Michael J Hannon
- Division of Rheumatology and Clinical Immunology, University of Pittsburgh, School of Medicine, S700 Biomedical Science Tower, 3500 Terrace Street, Pittsburgh, PA, 15261, USA.,Pinney Associates, 201 N Craig Street # 320, Pittsburgh, PA, 15213, USA
| | - Tomoko Fujii
- Department of Medical Research and Management for Musculoskeletal Pain, 22nd Century Medical and Research Center, Faculty of Medicine, The University of Tokyo Hospital, 7-3-1 Hongo, Bunkyo-ku, Tokyo, 113-8655, Japan
| | - Frank W Roemer
- Quantitative Imaging Center, Department of Radiology, Boston University School of Medicine, FGH Building, 820 Harrison Avenue, Boston, MA, 02118, USA.,Department of Radiology, Friedrich-Alexander University Erlangen-Nürnberg & Universitätsklinikum Erlangen, Erlangen, Germany
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19
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Brett A, Bowes MA, Conaghan PG, Ladel C, Guehring H, Moreau F, Eckstein F. Automated MRI assessment confirms cartilage thickness modification in patients with knee osteoarthritis: post-hoc analysis from a phase II sprifermin study. Osteoarthritis Cartilage 2020; 28:1432-1436. [PMID: 32860991 DOI: 10.1016/j.joca.2020.08.005] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/03/2020] [Revised: 08/10/2020] [Accepted: 08/17/2020] [Indexed: 02/02/2023]
Abstract
BACKGROUND Sprifermin is under investigation as a potential disease-modifying osteoarthritis drug. Previously, 2-year results from the FORWARD study showed significant dose-dependent modification of cartilage thickness in the total femorotibial joint (TFTJ), medial and lateral femorotibial compartments (MFTC, LFTC), and central medial and lateral TFTJ subregions, by quantitative magnetic resonance imaging (qMRI) using manual segmentation. OBJECTIVE To determine whether qMRI findings from FORWARD could be reproduced by an independent method of automated segmentation using an identical dataset and similar anatomical regions in a post-hoc analysis. METHOD Cartilage thickness was assessed at baseline and 6, 12, 18 and 24 months, using automated cartilage segmentation with active appearance models, a supervised machine learning method. Images were blinded for treatment and timepoint. Treatment effect was assessed by observed and adjusted changes using a linear mixed model for repeated measures. RESULTS Based on automated segmentation, statistically significant, dose-dependent structural modification of cartilage thickness was observed over 2 years with sprifermin vs placebo for TFTJ (overall treatment effect and dose response, both P < 0.001), MFTC (P = 0.004 and P = 0.044), and LFTC (both P < 0.001) regions. For highest dose, in the central medial tibial (P = 0.008), central lateral tibial (P < 0.001) and central lateral femoral (P < 0.001) regions. CONCLUSIONS Cartilage thickness assessed by automated segmentation provided a consistent dose response in structural modification compared with manual segmentation. This is the first time that two independent quantification methods of image analysis have reached the same conclusions in an interventional trial, strengthening the conclusions that sprifermin modifies structural progression in knee osteoarthritis.
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Affiliation(s)
| | | | - P G Conaghan
- Leeds Institute of Rheumatic and Musculoskeletal Medicine, University of Leeds & NIHR Leeds Biomedical Research Centre, Leeds, UK.
| | - C Ladel
- Merck KGaA, Darmstadt, Germany.
| | | | | | - F Eckstein
- Department of Imaging and Functional Musculoskeletal Research, Institute of Anatomy & Cell Biology, Paracelsus Medical University Salzburg & Nuremberg, Salzburg, Austria; Chondrometrics GmbH, Ainring, Germany.
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20
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Bernotiene E, Bagdonas E, Kirdaite G, Bernotas P, Kalvaityte U, Uzieliene I, Thudium CS, Hannula H, Lorite GS, Dvir-Ginzberg M, Guermazi A, Mobasheri A. Emerging Technologies and Platforms for the Immunodetection of Multiple Biochemical Markers in Osteoarthritis Research and Therapy. Front Med (Lausanne) 2020; 7:572977. [PMID: 33195320 PMCID: PMC7609858 DOI: 10.3389/fmed.2020.572977] [Citation(s) in RCA: 20] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2020] [Accepted: 08/31/2020] [Indexed: 12/12/2022] Open
Abstract
Biomarkers, especially biochemical markers, are important in osteoarthritis (OA) research, clinical trials, and drug development and have potential for more extensive use in therapeutic monitoring. However, they have not yet had any significant impact on disease diagnosis and follow-up in a clinical context. Nevertheless, the development of immunoassays for the detection and measurement of biochemical markers in OA research and therapy is an active area of research and development. The evaluation of biochemical markers representing low-grade inflammation or extracellular matrix turnover may permit OA prognosis and expedite the development of personalized treatment tailored to fit particular disease severities. However, currently detection methods have failed to overcome specific hurdles such as low biochemical marker concentrations, patient-specific variation, and limited utility of single biochemical markers for definitive characterization of disease status. These challenges require new and innovative approaches for development of detection and quantification systems that incorporate clinically relevant biochemical marker panels. Emerging platforms and technologies that are already on the way to implementation in routine diagnostics and monitoring of other diseases could potentially serve as good technological and strategic examples for better assessment of OA. State-of-the-art technologies such as advanced multiplex assays, enhanced immunoassays, and biosensors ensure simultaneous screening of a range of biochemical marker targets, the expansion of detection limits, low costs, and rapid analysis. This paper explores the implementation of such technologies in OA research and therapy. Application of novel immunoassay-based technologies may shed light on poorly understood mechanisms in disease pathogenesis and lead to the development of clinically relevant biochemical marker panels. More sensitive and specific biochemical marker immunodetection will complement imaging biomarkers and ensure evidence-based comparisons of intervention efficacy. We discuss the challenges hindering the development, testing, and implementation of new OA biochemical marker assays utilizing emerging multiplexing technologies and biosensors.
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Affiliation(s)
- Eiva Bernotiene
- Department of Regenerative Medicine, State Research Institute Centre for Innovative Medicine, Vilnius, Lithuania
| | - Edvardas Bagdonas
- Department of Regenerative Medicine, State Research Institute Centre for Innovative Medicine, Vilnius, Lithuania
| | - Gailute Kirdaite
- Department of Experimental, Preventive and Clinical Medicine, State Research Institute Centre for Innovative Medicine, Vilnius, Lithuania
| | - Paulius Bernotas
- Department of Regenerative Medicine, State Research Institute Centre for Innovative Medicine, Vilnius, Lithuania
| | - Ursule Kalvaityte
- Department of Regenerative Medicine, State Research Institute Centre for Innovative Medicine, Vilnius, Lithuania
| | - Ilona Uzieliene
- Department of Regenerative Medicine, State Research Institute Centre for Innovative Medicine, Vilnius, Lithuania
| | | | - Heidi Hannula
- Microelectronics Research Unit, Faculty of Information Technology and Electrical Engineering, University of Oulu, Oulu, Finland
| | - Gabriela S. Lorite
- Microelectronics Research Unit, Faculty of Information Technology and Electrical Engineering, University of Oulu, Oulu, Finland
| | - Mona Dvir-Ginzberg
- Laboratory of Cartilage Biology, Institute of Dental Sciences, Hebrew University of Jerusalem, Jerusalem, Israel
| | - Ali Guermazi
- Department of Radiology, Veterans Affairs Boston Healthcare System, Boston University School of Medicine, Boston, MA, United States
| | - Ali Mobasheri
- Department of Regenerative Medicine, State Research Institute Centre for Innovative Medicine, Vilnius, Lithuania
- Research Unit of Medical Imaging, Physics and Technology, Faculty of Medicine, University of Oulu, Oulu, Finland
- Departments of Orthopedics, Rheumatology and Clinical Immunology, University Medical Center Utrecht, Utrecht, Netherlands
- Centre for Sport, Exercise and Osteoarthritis Versus Arthritis, Queen's Medical Centre, Nottingham, United Kingdom
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21
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Schad P, Wollenweber M, Thüring J, Schock J, Eschweiler J, Palm G, Radermacher K, Eckstein F, Prescher A, Kuhl C, Truhn D, Nebelung S. Magnetic resonance imaging of human knee joint functionality under variable compressive in-situ loading and axis alignment. J Mech Behav Biomed Mater 2020; 110:103890. [DOI: 10.1016/j.jmbbm.2020.103890] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2020] [Revised: 04/23/2020] [Accepted: 05/25/2020] [Indexed: 12/13/2022]
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22
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Gregory JS, Barr RJ, Yoshida K, Alesci S, Reid DM, Aspden RM. Statistical shape modelling provides a responsive measure of morphological change in knee osteoarthritis over 12 months. Rheumatology (Oxford) 2020; 59:2419-2426. [PMID: 31943121 DOI: 10.1093/rheumatology/kez610] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2018] [Revised: 11/02/2019] [Indexed: 11/12/2022] Open
Abstract
OBJECTIVES Responsive biomarkers are needed to assess the progression of OA and their lack has hampered previous clinical trials. Statistical shape modelling (SSM) from radiographic images identifies those at greatest risk of fast-progression or joint replacement, but its sensitivity to change has not previously been measured. This study evaluates the responsiveness of SSM in knee OA in a 12-month observational study. METHODS A total of 109 people were recruited who had undergone knee radiographs in the previous 12 months, and were grouped based on severity of radiographic OA (Kellgren-Lawrence grading). An SSM was built from three dual-energy X-ray absorptiometry scans at 6-month intervals. Change-over-time and OA were assessed using generalized estimating equations, standardized response means (SRM) and reliable change indices. RESULTS Mode 1 showed typical features of radiographic OA and had a strong link with Kellgren-Lawrence grading but did not change significantly during the study. Mode 3 showed asymmetrical changes consistent with medial cartilage loss, osteophytes and joint malalignment, and was responsive to change, with a 12-month SRM of 0.63. The greatest change was observed in the moderate radiographic OA group (SRM 0.92) compared with the controls (SRM 0.21), and the reliable change index identified 14% of this group whose progression was clinically significant. CONCLUSION Shape changes linked the progression of osteophytosis with increasing malalignment within the joint. Modelling of the whole joint enabled quantification of change beyond the point where bone-to-bone contact has been made. The knee SSM is, therefore, a responsive biomarker for radiographic change in knees over 12 months.
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Affiliation(s)
- Jennifer S Gregory
- School of Medicine, Medical Sciences and Nutrition, University of Aberdeen
| | - Rebecca J Barr
- School of Medicine, Medical Sciences and Nutrition, University of Aberdeen.,Medicines Monitoring Unit (MEMO), Division of Molecular & Clinical Medicine, School of Medicine, University of Dundee, Aberdeen, UK
| | - Kanako Yoshida
- School of Medicine, Medical Sciences and Nutrition, University of Aberdeen
| | | | - David M Reid
- School of Medicine, Medical Sciences and Nutrition, University of Aberdeen
| | - Richard M Aspden
- School of Medicine, Medical Sciences and Nutrition, University of Aberdeen
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23
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The effect of chickpea broth on knee osteoarthritis—A Pilot non-randomised open-labeled clinical study. ADVANCES IN INTEGRATIVE MEDICINE 2020. [DOI: 10.1016/j.aimed.2020.01.004] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
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24
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Said O, Schock J, Krämer N, Thüring J, Hitpass L, Schad P, Kuhl C, Abrar D, Truhn D, Nebelung S. An MRI-compatible varus-valgus loading device for whole-knee joint functionality assessment based on compartmental compression: a proof-of-concept study. MAGNETIC RESONANCE MATERIALS IN PHYSICS BIOLOGY AND MEDICINE 2020; 33:839-854. [PMID: 32314105 PMCID: PMC8302563 DOI: 10.1007/s10334-020-00844-6] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/29/2020] [Revised: 03/27/2020] [Accepted: 04/06/2020] [Indexed: 02/06/2023]
Abstract
OBJECTIVE Beyond static assessment, functional techniques are increasingly applied in magnetic resonance imaging (MRI) studies. Stress MRI techniques bring together MRI and mechanical loading to study knee joint and tissue functionality, yet prototypical axial compressive loading devices are bulky and complex to operate. This study aimed to design and validate an MRI-compatible pressure-controlled varus-valgus loading device that applies loading along the joint line. METHODS Following the device's thorough validation, we demonstrated proof of concept by subjecting a structurally intact human cadaveric knee joint to serial imaging in unloaded and loaded configurations, i.e. to varus and valgus loading at 7.5 kPa (= 73.5 N), 15 kPa (= 147.1 N), and 22.5 kPa (= 220.6 N). Following clinical standard (PDw fs) and high-resolution 3D water-selective cartilage (WATSc) sequences, we performed manual segmentations and computations of morphometric cartilage measures. We used CT and radiography (to quantify joint space widths) and histology and biomechanics (to assess tissue quality) as references. RESULTS We found (sub)regional decreases in cartilage volume, thickness, and mean joint space widths reflective of areal pressurization of the medial and lateral femorotibial compartments. DISCUSSION Once substantiated by larger sample sizes, varus-valgus loading may provide a powerful alternative stress MRI technique.
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Affiliation(s)
- Oliver Said
- Department of Diagnostic and Interventional Radiology, Aachen University Hospital, Aachen, Germany
| | - Justus Schock
- Department of Diagnostic and Interventional Radiology, Medical Faculty, University Hospital Düsseldorf, University Dusseldorf, Moorenstraße 5, 40225, Düsseldorf, Germany
- Institute of Computer Vision and Imaging, RWTH University Aachen, Aachen, Germany
| | - Nils Krämer
- Department of Diagnostic and Interventional Radiology, Aachen University Hospital, Aachen, Germany
| | - Johannes Thüring
- Department of Diagnostic and Interventional Radiology, Aachen University Hospital, Aachen, Germany
| | - Lea Hitpass
- Department of Diagnostic and Interventional Radiology, Aachen University Hospital, Aachen, Germany
| | - Philipp Schad
- Department of Diagnostic and Interventional Radiology, Aachen University Hospital, Aachen, Germany
| | - Christiane Kuhl
- Department of Diagnostic and Interventional Radiology, Aachen University Hospital, Aachen, Germany
| | - Daniel Abrar
- Department of Diagnostic and Interventional Radiology, Medical Faculty, University Hospital Düsseldorf, University Dusseldorf, Moorenstraße 5, 40225, Düsseldorf, Germany
| | - Daniel Truhn
- Department of Diagnostic and Interventional Radiology, Aachen University Hospital, Aachen, Germany
- Institute of Computer Vision and Imaging, RWTH University Aachen, Aachen, Germany
| | - Sven Nebelung
- Department of Diagnostic and Interventional Radiology, Medical Faculty, University Hospital Düsseldorf, University Dusseldorf, Moorenstraße 5, 40225, Düsseldorf, Germany.
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Eijgenraam SM, Chaudhari AS, Reijman M, Bierma-Zeinstra SMA, Hargreaves BA, Runhaar J, Heijboer FWJ, Gold GE, Oei EHG. Time-saving opportunities in knee osteoarthritis: T 2 mapping and structural imaging of the knee using a single 5-min MRI scan. Eur Radiol 2020; 30:2231-2240. [PMID: 31844957 PMCID: PMC7062657 DOI: 10.1007/s00330-019-06542-9] [Citation(s) in RCA: 21] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2019] [Revised: 10/09/2019] [Accepted: 10/23/2019] [Indexed: 12/22/2022]
Abstract
OBJECTIVES To assess the discriminative power of a 5-min quantitative double-echo steady-state (qDESS) sequence for simultaneous T2 measurements of cartilage and meniscus, and structural knee osteoarthritis (OA) assessment, in a clinical OA population, using radiographic knee OA as reference standard. METHODS Fifty-three subjects were included and divided over three groups based on radiographic and clinical knee OA: 20 subjects with no OA (Kellgren-Lawrence grade (KLG) 0), 18 with mild OA (KLG2), and 15 with moderate OA (KLG3). All patients underwent a 5-min qDESS scan. We measured T2 relaxation times in four cartilage and four meniscus regions of interest (ROIs) and performed structural OA evaluation with the MRI Osteoarthritis Knee Score (MOAKS) using qDESS with multiplanar reformatting. Between-group differences in T2 values and MOAKS were calculated using ANOVA. Correlations of the reference standard (i.e., radiographic knee OA) with T2 and MOAKS were assessed with correlation analyses for ordinal variables. RESULTS In cartilage, mean T2 values were 36.1 ± SD 4.3, 40.6 ± 5.9, and 47.1 ± 4.3 ms for no, mild, and moderate OA, respectively (p < 0.001). In menisci, mean T2 values were 15 ± 3.6, 17.5 ± 3.8, and 20.6 ± 4.7 ms for no, mild, and moderate OA, respectively (p < 0.001). Statistically significant correlations were found between radiographic OA and T2 and between radiographic OA and MOAKS in all ROIs (p < 0.05). CONCLUSION Quantitative T2 and structural assessment of cartilage and meniscus, using a single 5-min qDESS scan, can distinguish between different grades of radiographic OA, demonstrating the potential of qDESS as an efficient tool for OA imaging. KEY POINTS • Quantitative T2values of cartilage and meniscus as well as structural assessment of the knee with a single 5-min quantitative double-echo steady-state (qDESS) scan can distinguish between different grades of knee osteoarthritis (OA). • Quantitative and structural qDESS-based measurements correlate significantly with the reference standard, radiographic degree of OA, for all cartilage and meniscus regions. • By providing quantitative measurements and diagnostic image quality in one rapid MRI scan, qDESS has great potential for application in large-scale clinical trials in knee OA.
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Affiliation(s)
- Susanne M Eijgenraam
- Deptartment of Radiology & Nuclear Medicine, Erasmus MC, University Medical Center, Dr. Molewaterplein 40, Room Nd-547, 3015, GD, Rotterdam, The Netherlands
- Deptartment of Orthopedic Surgery, Erasmus MC, University Medical Center, Rotterdam, The Netherlands
| | | | - Max Reijman
- Deptartment of Orthopedic Surgery, Erasmus MC, University Medical Center, Rotterdam, The Netherlands
| | - Sita M A Bierma-Zeinstra
- Deptartment of Orthopedic Surgery, Erasmus MC, University Medical Center, Rotterdam, The Netherlands
- Deptartment of General Practice, Erasmus MC, University Medical Center, Rotterdam, The Netherlands
| | - Brian A Hargreaves
- Deptartment of Radiology, Stanford University, Stanford, CA, USA
- Deptartment of Electrical Engineering, Stanford University, Stanford, CA, USA
- Deptartment of Bioengineering, Stanford University, Stanford, CA, USA
| | - Jos Runhaar
- Deptartment of General Practice, Erasmus MC, University Medical Center, Rotterdam, The Netherlands
| | - Frank W J Heijboer
- Deptartment of Orthopedic Surgery, Erasmus MC, University Medical Center, Rotterdam, The Netherlands
| | - Garry E Gold
- Deptartment of Radiology, Stanford University, Stanford, CA, USA
- Deptartment of Bioengineering, Stanford University, Stanford, CA, USA
- Deptartment of Orthopedic Surgery, Stanford University, Stanford, CA, USA
| | - Edwin H G Oei
- Deptartment of Radiology & Nuclear Medicine, Erasmus MC, University Medical Center, Dr. Molewaterplein 40, Room Nd-547, 3015, GD, Rotterdam, The Netherlands.
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Capin JJ, Williams JR, Neal K, Khandha A, Durkee L, Ito N, Stefanik JJ, Snyder-Mackler L, Buchanan TS. Slower Walking Speed Is Related to Early Femoral Trochlear Cartilage Degradation After ACL Reconstruction. J Orthop Res 2020; 38:645-652. [PMID: 31710115 PMCID: PMC7028512 DOI: 10.1002/jor.24503] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/20/2019] [Accepted: 10/14/2019] [Indexed: 02/04/2023]
Abstract
Post-traumatic patellofemoral osteoarthritis (OA) is prevalent after anterior cruciate ligament reconstruction (ACLR) and early cartilage degradation may be especially common in the femoral trochlear cartilage. Determining the presence of and factors associated with early femoral trochlear cartilage degradation, a precursor to OA, is a critical preliminary step in identifying those at risk for patellofemoral OA development and designing interventions to combat the disease. Early cartilage degradation can be detected using quantitative magnetic resonance imaging measures, such as tissue T2 relaxation time. The purposes of this study were to (i) compare involved (ACLR) versus uninvolved (contralateral) femoral trochlear cartilage T2 relaxation times 6 months after ACLR, and (ii) determine the relationship between walking speed and walking mechanics 3 months after ACLR and femoral trochlear cartilage T2 relaxation times 6 months after ACLR. Twenty-six individuals (age 23 ± 7 years) after primary, unilateral ACLR participated in detailed motion analyses 3.3 ± 0.6 months after ACLR and quantitative magnetic resonance imaging 6.3 ± 0.5 months after ACLR. There were no limb differences in femoral trochlear cartilage T2 relaxation times. Slower walking speed was related to higher (worse) femoral trochlear cartilage T2 relaxation times in the involved limb (Pearson's r: -0.583, p = 0.002) and greater interlimb differences in trochlear T2 relaxation times (Pearson's r: -0.349, p = 0.080). Walking mechanics were weakly related to trochlear T2 relaxation times. Statement of clinical significance: Slower walking speed was by far the strongest predictor of worse femoral trochlear cartilage health, suggesting slow walking speed may be an early clinical indicator of future patellofemoral OA after ACLR. © 2019 Orthopaedic Research Society. Published by Wiley Periodicals, Inc. J Orthop Res 38:645-652, 2020.
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Affiliation(s)
- Jacob J. Capin
- Physical Therapy Program, Department of Physical Medicine and Rehabilitation, University of Colorado, Aurora, CO,Eastern Colorado VA Geriatric Research Education and Clinical Center (GRECC), Aurora, CO
| | - Jack R. Williams
- Mechanical Engineering Department, University of Delaware, Newark, DE, USA
| | - Kelsey Neal
- Mechanical Engineering Department, University of Delaware, Newark, DE, USA
| | - Ashutosh Khandha
- Biomedical Engineering Department, University of Delaware, Newark, DE, USA
| | - Laura Durkee
- Athletic Training Education Program, University of Delaware, Newark, DE, USA
| | - Naoaki Ito
- Biomechanics and Movement Science Program, University of Delaware, Newark, DE, USA,Physical Therapy Department, University of Delaware, Newark, DE, USA
| | - Joshua J. Stefanik
- Department of Physical Therapy, Movement and Rehabilitation Sciences, Northeastern University, Boston, MA, USA
| | - Lynn Snyder-Mackler
- Biomedical Engineering Department, University of Delaware, Newark, DE, USA,Biomechanics and Movement Science Program, University of Delaware, Newark, DE, USA,Physical Therapy Department, University of Delaware, Newark, DE, USA,Delaware Rehabilitation Institute, University of Delaware, Newark, DE, USA
| | - Thomas S. Buchanan
- Mechanical Engineering Department, University of Delaware, Newark, DE, USA,Biomedical Engineering Department, University of Delaware, Newark, DE, USA,Delaware Rehabilitation Institute, University of Delaware, Newark, DE, USA
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Aoki K, Ogihara N, Tanaka M, Haniu H, Saito N. Carbon nanotube-based biomaterials for orthopaedic applications. J Mater Chem B 2020; 8:9227-9238. [DOI: 10.1039/d0tb01440k] [Citation(s) in RCA: 19] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
Carbon nanotubes can enhance the functionality of orthopedic applications.
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Affiliation(s)
- Kaoru Aoki
- Physical Therapy Division
- School of Health Sciences
- Shinshu University
- Nagano 390-8621
- Japan
| | - Nobuhide Ogihara
- Department of Orthopaedic Surgery
- Ina Central Hospital
- Nagano 396-8555
- Japan
| | - Manabu Tanaka
- Department of Orthopaedic Surgery
- Okaya City Hospital
- Nagano 394-8512
- Japan
| | - Hisao Haniu
- Department of Biomedical Engineering
- Graduate School of Medicine
- Science and Technology
- Shinshu University
- Nagano 390-8621
| | - Naoto Saito
- Institute for Biomedical Sciences
- Interdisciplinary Cluster for Cutting Edge Research
- Shinshu University
- Matsumoto
- Nagano 390-8621
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28
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Validation of a novel blinding method for measuring postoperative knee articular cartilage using magnetic resonance imaging. MAGNETIC RESONANCE MATERIALS IN PHYSICS BIOLOGY AND MEDICINE 2019; 32:693-702. [PMID: 31300932 DOI: 10.1007/s10334-019-00766-y] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/17/2019] [Revised: 06/18/2019] [Accepted: 06/19/2019] [Indexed: 12/13/2022]
Abstract
OBJECTIVES To test PEEK implant-associated MRI artifacts, a method for blinding MRI readers, the repeatability of cartilage thickness measures before and 6 weeks after high tibial osteotomy (HTO), and the sensitivity to change of cartilage thickness 12 months after HTO. MATERIALS AND METHODS Ten patients underwent HTO using a PEEK implant and 3 T-MRI before, 6 weeks and 12 months after surgery. Masks were applied to hide implant visibility on 48 MRI pairs, which were assessed by 7 readers (blinded to time). One blinded reader measured femorotibial cartilage thickness from masked MRIs. RESULTS No artifacts were produced. Readers were unable to identify scans by time greater than by chance. Cartilage thickness before and 6 weeks after surgery was not significantly different and indicated excellent repeatability. Medial cartilage thickness increases 12 M postoperatively approached statistical significance (p = 0.06), with no lateral changes observed. Half of the participants had an increase in medial cartilage thickness at 12 M that exceeded the minimal detectable change. Standardized response mean values were moderate-to-large. DISCUSSION Postoperative measures of cartilage thickness are repeatable, consistent and sensitive to change when artifact is eliminated, and a validated blinding technique is used. These results provide proof of concept for accurately measuring increases in medial knee articular cartilage after medial opening wedge HTO.
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29
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Conaghan PG. Corticosteroids and osteoarthritis progression: a confounded issue. Osteoarthritis Cartilage 2019; 27:e5-e6. [PMID: 30898622 DOI: 10.1016/j.joca.2019.02.799] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/19/2019] [Accepted: 02/21/2019] [Indexed: 02/02/2023]
Affiliation(s)
- P G Conaghan
- Leeds Institute of Rheumatic and Musculoskeletal Medicine, University of Leeds and NIHR Leeds Biomedical Research Centre, Leeds, UK
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30
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Bowes MA, Guillard GA, Vincent GR, Brett AD, Wolstenholme CBH, Conaghan PG. Precision, Reliability, and Responsiveness of a Novel Automated Quantification Tool for Cartilage Thickness: Data from the Osteoarthritis Initiative. J Rheumatol 2019; 47:282-289. [DOI: 10.3899/jrheum.180541] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/26/2019] [Indexed: 11/22/2022]
Abstract
Objective.Accurate automated segmentation of cartilage should provide rapid reliable outcomes for both epidemiological studies and clinical trials. We aimed to assess the precision and responsiveness of cartilage thickness measured with careful manual segmentation or a novel automated technique.Methods.Agreement of automated segmentation was assessed against 2 manual segmentation datasets: 379 magnetic resonance images manually segmented in-house (training set), and 582 from the Osteoarthritis Initiative with data available at 0, 1, and 2 years (biomarkers set). Agreement of mean thickness was assessed using Bland-Altman plots, and change with pairwise Student t test in the central medial femur (cMF) and tibia regions (cMT). Repeatability was assessed on a set of 19 knees imaged twice on the same day. Responsiveness was assessed using standardized response means (SRM).Results.Agreement of manual versus automated methods was excellent with no meaningful systematic bias (training set: cMF bias 0.1 mm, 95% CI ± 0.35; biomarkers set: bias 0.1 mm ± 0.4). The smallest detectable difference for cMF was 0.13 mm (coefficient of variation 3.1%), and for cMT 0.16 mm(2.65%). Reported change using manual segmentations in the cMF region at 1 year was −0.031 mm (95% CI −0.022, −0.039), p < 10−4, SRM −0.31 (−0.23, −0.38); and at 2 years was −0.071 (−0.058, −0.085), p < 10−4, SRM −0.43 (−0.36, −0.49). Reported change using automated segmentations in the cMF at 1 year was −0.059 (−0.047, −0.071), p < 10−4, SRM −0.41 (−0.34, −0.48); and at 2 years was −0.14 (−0.123, −0.157, p < 10−4, SRM −0.67 (−0.6, −0.72).Conclusion.A novel cartilage segmentation method provides highly accurate and repeatable measures with cartilage thickness measurements comparable to those of careful manual segmentation, but with improved responsiveness.
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31
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Deveza LA, Downie A, Tamez-Peña JG, Eckstein F, Van Spil WE, Hunter DJ. Trajectories of femorotibial cartilage thickness among persons with or at risk of knee osteoarthritis: development of a prediction model to identify progressors. Osteoarthritis Cartilage 2019; 27:257-265. [PMID: 30347226 DOI: 10.1016/j.joca.2018.09.015] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/01/2018] [Revised: 09/20/2018] [Accepted: 09/27/2018] [Indexed: 02/02/2023]
Abstract
OBJECTIVE There is significant variability in the trajectory of structural progression across people with knee osteoarthritis (OA). We aimed to identify distinct trajectories of femorotibial cartilage thickness over 2 years and develop a prediction model to identify individuals experiencing progressive cartilage loss. METHODS We analysed data from the Osteoarthritis Initiative (OAI) (n = 1,014). Latent class growth analysis (LCGA) was used to identify trajectories of medial femorotibial cartilage thickness assessed on magnetic resonance imaging (MRI) at baseline, 1 and 2 years. Baseline characteristics were compared between trajectory-based subgroups and a prediction model was developed including those with frequent knee symptoms at baseline (n = 686). To examine clinical relevance of the trajectories, we assessed their association with concurrent changes in knee pain and incidence of total knee replacement (TKR) over 4 years. RESULTS The optimal model identified three distinct trajectories: (1) stable (87.7% of the population, mean change -0.08 mm, SD 0.19); (2) moderate cartilage loss (10.0%, -0.75 mm, SD 0.16) and (3) substantial cartilage loss (2.2%, -1.38 mm, SD 0.23). Higher Western Ontario & McMaster Universities Osteoarthritis Index (WOMAC) pain scores, family history of TKR, obesity, radiographic medial joint space narrowing (JSN) ≥1 and pain duration ≤1 year were predictive of belonging to either the moderate or substantial cartilage loss trajectory [area under the curve (AUC) 0.79, 95% confidence interval (CI) 0.74, 0.84]. The two progression trajectories combined were associated with pain progression (OR 1.99, 95% CI 1.34, 2.97) and incidence of TKR (OR 4.34, 1.62, 11.62). CONCLUSIONS A minority of individuals follow a progressive cartilage loss trajectory which was strongly associated with poorer clinical outcomes. If externally validated, the prediction model may help to select individuals who may benefit from cartilage-targeted therapies.
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Affiliation(s)
- L A Deveza
- Rheumatology Department, Royal North Shore Hospital and Institute of Bone and Joint Research, Kolling Institute, University of Sydney, Sydney, New South Wales, Australia.
| | - A Downie
- School of Public Health, Sydney Medical School, University of Sydney, Sydney, New South Wales, Australia; Faculty of Science and Engineering, Macquarie University, Sydney, New South Wales, Australia.
| | - J G Tamez-Peña
- Tecnologico de Monterrey, Escuela de Medicina y Ciencias de La Salud, Monterrey, NL, Mexico.
| | - F Eckstein
- Paracelsus Medical University, Institute of Anatomy Salzburg & Nuremberg, Salzburg, Austria; Chondrometrics GmbH, Ainring, Germany.
| | - W E Van Spil
- Department of Rheumatology & Clinical Immunology, University Medical Center Utrecht, Utrecht, The Netherlands.
| | - D J Hunter
- Rheumatology Department, Royal North Shore Hospital and Institute of Bone and Joint Research, Kolling Institute, University of Sydney, Sydney, New South Wales, Australia.
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Nielsen FK, Boesen M, Jurik AG, Bliddal H, Nybing JD, Ellegaard K, Bartholdy C, Bandak E, Henriksen M. The effect of intra-articular glucocorticosteroids and exercise on symptoms and bone marrow lesions in knee osteoarthritis: a secondary analysis of results from a randomized controlled trial. Osteoarthritis Cartilage 2018; 26:895-902. [PMID: 29499289 DOI: 10.1016/j.joca.2018.02.900] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/23/2017] [Revised: 02/18/2018] [Accepted: 02/20/2018] [Indexed: 02/02/2023]
Abstract
OBJECTIVE To evaluate if the relative volume of bone marrow lesions (BMLs) changed in patients with knee osteoarthritis (OA) during a therapeutic study. DESIGN This study is a sub-study to a larger clinical trial which compared the clinical effects of intra-articular corticosteroid injection in knee OA to placebo injection, both given prior to exercise therapy. Clinical assessment using the Knee injury and Osteoarthritis Outcome Score (KOOS) and magnetic resonance imaging (MRI) examinations with BML assessments were performed at baseline and follow-up after 14 weeks and 26 weeks, respectively. The BML volume was determined using a computer assisted method focusing on participants with valid baseline and follow-up MRI examinations. Any changes in BML and KOOS were analyzed and investigated for associations. RESULTS Fifty participants received steroid and placebo injection, respectively, of which 41 and 45 had complete MRI examinations at week 14, and 36 and 33 at week 26, respectively. All participants received 12 weeks of exercise. A significant change in relative BML volume was observed between the corticosteroid group and the placebo group after 14 weeks [-1.1% vs 2.7%; between-group difference, 3.8% (95% CI 0.5-7.0)] but not after 26 weeks [0.8% vs 1.6%; between-group difference, 0.8% (95% CI -2.8 to 4.4)]. No significant association was found between changes in relative BML volume and KOOS. CONCLUSIONS Despite the statistically significant difference in BML volume at 14 weeks after corticosteroid injection and 12 weeks exercise therapy compared to placebo injection and exercise, there is very little evidence on a relationship between corticosteroids and BML volume. EU CLINICAL TRIALS REGISTER EudraCT number: 2012-002607-18.
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Affiliation(s)
- F K Nielsen
- Department of Radiology, Aarhus University Hospital, Noerrebrogade 44, 8000 Aarhus, Denmark; The Parker Institute, Copenhagen University Hospital Bispebjerg-Frederiksberg, Ndr. Fasanvej 57, 2000 Frederiksberg, Denmark.
| | - M Boesen
- Department of Radiology, Bispebjerg and Frederiksberg Hospital, Ndr. Fasanvej 57, 2000 Frederiksberg, Denmark.
| | - A G Jurik
- Department of Radiology, Aarhus University Hospital, Noerrebrogade 44, 8000 Aarhus, Denmark; Institute of Clinical Medicine, Aarhus University, Denmark.
| | - H Bliddal
- The Parker Institute, Copenhagen University Hospital Bispebjerg-Frederiksberg, Ndr. Fasanvej 57, 2000 Frederiksberg, Denmark.
| | - J D Nybing
- Department of Radiology, Bispebjerg and Frederiksberg Hospital, Ndr. Fasanvej 57, 2000 Frederiksberg, Denmark.
| | - K Ellegaard
- The Parker Institute, Copenhagen University Hospital Bispebjerg-Frederiksberg, Ndr. Fasanvej 57, 2000 Frederiksberg, Denmark.
| | - C Bartholdy
- The Parker Institute, Copenhagen University Hospital Bispebjerg-Frederiksberg, Ndr. Fasanvej 57, 2000 Frederiksberg, Denmark; The Department of Physical and Occupational Therapy, Copenhagen University Hospital Bispebjerg-Frederiksberg, Bispebjerg Bakke 23, 2400 København NV, Denmark.
| | - E Bandak
- The Parker Institute, Copenhagen University Hospital Bispebjerg-Frederiksberg, Ndr. Fasanvej 57, 2000 Frederiksberg, Denmark.
| | - M Henriksen
- The Parker Institute, Copenhagen University Hospital Bispebjerg-Frederiksberg, Ndr. Fasanvej 57, 2000 Frederiksberg, Denmark; The Department of Physical and Occupational Therapy, Copenhagen University Hospital Bispebjerg-Frederiksberg, Bispebjerg Bakke 23, 2400 København NV, Denmark.
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Hafezi-Nejad N, Guermazi A, Demehri S, Roemer FW. New imaging modalities to predict and evaluate osteoarthritis progression. Best Pract Res Clin Rheumatol 2018; 31:688-704. [PMID: 30509414 DOI: 10.1016/j.berh.2018.05.001] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2018] [Revised: 04/17/2018] [Accepted: 04/25/2018] [Indexed: 12/18/2022]
Abstract
In this narrative review, we discuss the role of different imaging methods for the evaluation of progression of structural osteoarthritis. We will focus on the role of less commonly applied imaging modalities and imaging biomarkers that were introduced in recent years or on established methods that have evolved into more prominent positions in recent years. We will highlight findings from longitudinal studies that focused on structural osteoarthritis progression as their outcome of interest. Imaging modalities discussed include plain radiography (including novel approaches of joint space width assessment and fractal signature analysis), ultrasonography (including the assessment of synovitis), magnetic resonance imaging (including semiquantitative, quantitative, and compositional evaluation), and positron emission tomography.
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Affiliation(s)
- Nima Hafezi-Nejad
- Russell H. Morgan Department of Radiology and Radiological Sciences, Johns Hopkins University, 601 N Caroline St, JHOC 4240, Baltimore, MD 21287 USA
| | - Ali Guermazi
- Department of Radiology, Boston University School of Medicine, 820 Harrison Avenue, FGH Building 3rd Floor, Boston, MA 02118, USA
| | - Shadpour Demehri
- Russell H. Morgan Department of Radiology and Radiological Sciences, Johns Hopkins University, 601 N Caroline St, JHOC 4240, Baltimore, MD 21287 USA
| | - Frank W Roemer
- Department of Radiology, Boston University School of Medicine, 820 Harrison Avenue, FGH Building 3rd Floor, Boston, MA 02118, USA; Department of Radiology, University of Erlangen-Nuremberg, Maximiliansplatz 3, 91054 Erlangen, Germany.
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Baboli R, Sharafi A, Chang G, Regatte RR. Isotropic morphometry and multicomponent T 1 ρ mapping of human knee articular cartilage in vivo at 3T. J Magn Reson Imaging 2018; 48:1707-1716. [PMID: 29717787 DOI: 10.1002/jmri.26173] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2018] [Accepted: 04/13/2018] [Indexed: 12/14/2022] Open
Abstract
BACKGROUND The progressive loss of hyaline articular cartilage due to osteoarthritis (OA) changes the functional and biochemical properties of cartilage. Measuring the T1 ρ along with the morphological assessment can potentially be used as noninvasive biomarkers in detecting early-stage OA. To correlate the biochemical and morphological data, submillimeter isotropic resolution for both studies is required. PURPOSE To implement a high spatial resolution 3D-isotropic-MRI sequence for simultaneous assessment of morphological and biexponential T1 ρ relaxometry of human knee cartilage in vivo. STUDY TYPE Prospective. POPULATION Ten healthy volunteers with no known inflammation, trauma, or pain in the knee. FIELD STRENGTH/SEQUENCE Standard FLASH sequence and customized Turbo-FLASH sequence to acquire 3D-isotropic-T1 ρ-weighted images on a 3T MRI scanner. ASSESSMENT The mean volume and thickness along with mono- and biexponential T1 ρ relaxations were assessed in the articular cartilage of 10 healthy volunteers. STATISTICAL TESTS Nonparametric rank-sum tests. Bland-Altman analysis and coefficient of variation. RESULTS The mean monoexponential T1 ρ relaxation was 40.7 ± 4.8 msec, while the long and short components were 58.2 ± 3.9 msec and 6.5 ± 0.6 msec, respectively. The mean fractions of long and short T1 ρ relaxation components were 63.7 ± 5.9% and 36.3 ± 5.9%, respectively. Statistically significant (P ≤ 0.03) differences were observed in the monoexponential and long components between some of the regions of interest (ROIs). No gender differences between biexponential components were observed (P > 0.05). Mean cartilage volume and thickness were 25.9 ± 6.4 cm3 and 2.2 ± 0.7 mm, respectively. Cartilage volume (P = 0.01) and thickness (P = 0.03) were significantly higher in male than female participants across all ROIs. Bland-Altman analysis showed agreement between two morphological methods with limits of agreement between -1000 mm3 and +1100 mm3 for volume, and -0.78 mm and +0.46 mm for thickness, respectively. DATA CONCLUSION Simultaneous assessment of morphological and multicomponent T1 ρ relaxation of knee joint with 0.7 × 0.7 × 0.7 mm isotropic spatial resolution is demonstrated in vivo. Comparison with a standard method showed that the proposed technique is suitable for assessing the volume and thickness of articular cartilage. LEVEL OF EVIDENCE 2 Technical Efficacy: Stage 1 J. Magn. Reson. Imaging 2018;48:1707-1716.
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Affiliation(s)
- Rahman Baboli
- Bernard and Irene Schwartz Center for Biomedical Imaging, Department of Radiology, New York University School of Medicine, New York, New York, USA
| | - Azadeh Sharafi
- Bernard and Irene Schwartz Center for Biomedical Imaging, Department of Radiology, New York University School of Medicine, New York, New York, USA
| | - Gregory Chang
- Bernard and Irene Schwartz Center for Biomedical Imaging, Department of Radiology, New York University School of Medicine, New York, New York, USA
| | - Ravinder R Regatte
- Bernard and Irene Schwartz Center for Biomedical Imaging, Department of Radiology, New York University School of Medicine, New York, New York, USA
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Ogata T, Ideno Y, Akai M, Seichi A, Hagino H, Iwaya T, Doi T, Yamada K, Chen AZ, Li Y, Hayashi K. Effects of glucosamine in patients with osteoarthritis of the knee: a systematic review and meta-analysis. Clin Rheumatol 2018; 37:2479-2487. [PMID: 29713967 PMCID: PMC6097075 DOI: 10.1007/s10067-018-4106-2] [Citation(s) in RCA: 34] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2017] [Revised: 03/14/2018] [Accepted: 04/10/2018] [Indexed: 12/19/2022]
Abstract
Osteoarthritis (OA) of the knee is one of the main causes of mobility decline in the elderly. Non-surgical treatments such as administration of supplements to strengthen the joint cartilage matrix have become popular not only for pain relief but also for joint preservation. Glucosamine has been used in many countries based on the increasing evidence of its effectiveness for OA. Although there are many previous studies and systematic reviews, the findings vary and different conclusions have been drawn. We aimed to review recent randomized controlled trials on glucosamine for knee OA to reveal up-to-date findings about this supplement. We also performed a meta-analysis of some of the outcomes to overcome the unsolved bias in each study. Eighteen articles written between 2003 and 2016 were analyzed. Many used visual analogue scale (VAS) pain scores and the Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC), which were assessed in our meta-analysis. We found a marginally favorable effect of glucosamine on VAS pain scores. The effect on knee function, as measured by the WOMAC, was small and not significant. A newly established knee OA scale, the Japanese Knee Osteoarthritis Measure (JKOM), is commonly used in Japan. Although the number of subjects was small, the JKOM meta-analysis indicated that glucosamine is superior to a placebo in alleviating knee OA symptoms. Given this, we concluded that glucosamine has the potential to alleviate knee OA pain. Further studies are needed to evaluate the effect of glucosamine on knee function and joint preservation, as well as to evaluate the combined effect with other components, such as chondroitin.
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Affiliation(s)
- Toru Ogata
- National Rehabilitation Center for Persons with Disabilities, 4-1, Namiki, Tokorozawa, Saitama, Japan
| | - Yuki Ideno
- Gunma University Initiative for Advanced Research, 39-15, Showa-cho, Maebashi, Gunma, Japan
| | - Masami Akai
- International University of Health and Welfare, 1-3-3, Minamiaoyama, Minato-ku, Tokyo, Japan
| | - Atsushi Seichi
- Department of Orthopaedic Surgery, Mitsui Memorial Hospital, 1, Kandaizumi-cho, Chiyoda-ku, Tokyo, Japan
| | - Hiroshi Hagino
- Rehabilitation Division, Tottori University Hospital, 36-1, Nishimachi, Yonagoshi, Tottori, Japan.,School of Health Science, Faculty of Medicine, Tottori University, 36-1, Nishimachi, Yonagoshi, Tottori, Japan
| | - Tsutomu Iwaya
- Nagano University of Health & Medicine, 11-1, Imaihara, Kawanakajimacho, Naganoshi, Nagano, Japan
| | - Toru Doi
- National Rehabilitation Center for Persons with Disabilities, 4-1, Namiki, Tokorozawa, Saitama, Japan.,Department of Orthopaedic Surgery, Graduate School of Medicine, The University of Tokyo, 7-3-1, Hongo, Bunkyo-ku, Tokyo, Japan
| | - Keiko Yamada
- Department of Orthopaedic Surgery, Graduate School of Medicine, The University of Tokyo, 7-3-1, Hongo, Bunkyo-ku, Tokyo, Japan
| | - Ai-Zhen Chen
- School of Health Sciences, Gunma University, 39-15, Showa-cho, Maebashi, Gunma, Japan
| | - Yingzi Li
- NPO International Eco-Health Research Group, 133-4, Horiguchicho, Isesakishi, Gunma, Japan
| | - Kunihiko Hayashi
- School of Health Sciences, Gunma University, 39-15, Showa-cho, Maebashi, Gunma, Japan.
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Steidle-Kloc E, Culvenor AG, Dörrenberg J, Wirth W, Ruhdorfer A, Eckstein F. Relationship Between Knee Pain and Infrapatellar Fat Pad Morphology: A Within- and Between-Person Analysis From the Osteoarthritis Initiative. Arthritis Care Res (Hoboken) 2018; 70:550-557. [PMID: 28704603 DOI: 10.1002/acr.23326] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2016] [Accepted: 07/11/2017] [Indexed: 12/31/2022]
Abstract
OBJECTIVE Inflammation is known to be strongly associated with knee pain in osteoarthritis. The infrapatellar fat pad represents a potential source of proinflammatory cytokines. Yet the relationship between infrapatellar fat pad morphology and osteoarthritis symptoms is unclear. METHODS Here we investigate quantitative imaging parameters of infrapatellar fat pad morphology between painful versus contralateral pain-free legs of subjects with unilateral knee pain and patients with chronic knee pain versus those of matched pain-free control subjects. A total of 46 subjects with strictly unilateral frequent knee pain and bilateral radiographic osteoarthritis (Kellgren/Lawrence grade 2/3) were drawn from the Osteoarthritis Initiative. Further, 43 subjects with chronic knee pain over 4 years and 43 matched pain-free controls without pain over this period were studied. Infrapatellar fat pad morphology (volume, surface area, and depth) was determined by manual segmentation of sagittal magnetic resonance images. RESULTS No significant differences in infrapatellar fat pad morphology were observed between painful versus painless knees of persons with strictly unilateral knee pain (mean difference -0.7% (95% confidence interval [95% CI] -0.6, 0.9; P = 0.64) or between chronically painful knees versus matched painless controls (-2.1% [95% CI -2.2, 1.1]; P = 0.51). CONCLUSION Independent of the ambiguous role of the infrapatellar fat pad in knee osteoarthritis (a potential source of proinflammatory cytokines or a mechanical shock absorber), the size of the infrapatellar fat pad does not appear to be related to knee pain.
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Affiliation(s)
- Eva Steidle-Kloc
- Paracelsus Medical University Salzburg and Nuremberg, Salzburg, Austria
| | - Adam G Culvenor
- Paracelsus Medical University Salzburg and Nuremberg, Salzburg, Austria, and La Trobe University, Bundoora, Victoria, Australia
| | - Jan Dörrenberg
- Paracelsus Medical University Salzburg and Nuremberg, Salzburg, Austria
| | - Wolfgang Wirth
- Paracelsus Medical University Salzburg and Nuremberg, Salzburg, Austria
| | - Anja Ruhdorfer
- Paracelsus Medical University Salzburg and Nuremberg, Salzburg, Austria
| | - Felix Eckstein
- Paracelsus Medical University Salzburg and Nuremberg, Salzburg, Austria
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Dam EB, Runhaar J, Bierma-Zienstra S, Karsdal M. Cartilage cavity-an MRI marker of cartilage lesions in knee OA with Data from CCBR, OAI, and PROOF. Magn Reson Med 2018; 80:1219-1232. [DOI: 10.1002/mrm.27130] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2017] [Revised: 01/16/2018] [Accepted: 01/22/2018] [Indexed: 01/18/2023]
Affiliation(s)
- Erik B. Dam
- Biomediq; Copenhagen Denmark
- University of Copenhagen; Copenhagen Denmark
- The D-BOARD European Consortium for Biomarker Discovery
| | - Jos Runhaar
- Erasmus University Medical Center; Rotterdam the Netherlands
- The D-BOARD European Consortium for Biomarker Discovery
| | - Sita Bierma-Zienstra
- Erasmus University Medical Center; Rotterdam the Netherlands
- The D-BOARD European Consortium for Biomarker Discovery
| | - Morten Karsdal
- Nordic Bioscience; Copenhagen Denmark
- The D-BOARD European Consortium for Biomarker Discovery
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Wirth W, Maschek S, Beringer P, Eckstein F. Subregional laminar cartilage MR spin-spin relaxation times (T2) in osteoarthritic knees with and without medial femorotibial cartilage loss - data from the Osteoarthritis Initiative (OAI). Osteoarthritis Cartilage 2017; 25:1313-1323. [PMID: 28351705 PMCID: PMC5522340 DOI: 10.1016/j.joca.2017.03.013] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/24/2016] [Revised: 02/14/2017] [Accepted: 03/17/2017] [Indexed: 02/02/2023]
Abstract
OBJECTIVE To explore whether subregional laminar femorotibial cartilage spin-spin relaxation time (T2) is associated with subsequent radiographic progression and cartilage loss and/or whether one-year change in subregional laminar femorotibial cartilage T2 is associated with concurrent progression in knees with established radiographic OA (ROA). METHODS In this case-control study, Osteoarthritis Initiative (OAI) knees with medial femorotibial progression were selected based on one-year loss in both quantitative cartilage thickness Magnetic resonance imaging (MRI) and radiographic joint space width (JSW). Non-progressor knees were matched by sex, Body mass index (BMI), baseline Kellgren-Lawrence-grade (2/3), and pain. Baseline and one-year follow-up superficial and deep cartilage T2 was analyzed in 16 femorotibial subregions using multi-echo spin-echo MRI. RESULTS 37 knees showed medial femorotibial progression whereas 37 matched controls had no medial or lateral compartment progression. No statistically significant baseline differences between progressor and non-progressor knees in medial femorotibial cartilage T2 were observed in the superficial (48.9 ± 3.0 ms; 95% CI: [47.9, 49.9] vs 47.8 ± 3.6 ms; 95% CI: [46.6, 49.0], P = 0.07) or deep cartilage layer (40.8 ± 3.6 ms; 95% CI: [39.5, 42.0] vs 40.1 ± 4.7 ms; 95% CI: [38.5, 41.6], P = 0.29). Concurrent T2 change was more pronounced in the deep than the superficial cartilage layer. In the medial femorotibial compartment (MFTC), longitudinal change was greater in the deep layer of progressor than non-progressor knees (1.8 ± 4.5 ms; 95% CI: [0.3, 3.3] vs -0.2 ± 1.9 ms; 95% CI: [-0.8, 0.5], P = 0.02), whereas no difference was observed in the superficial layer. CONCLUSION Medial compartment cartilage T2 did not appear to be a strong prognostic factor for subsequent structural progression in the same compartment of knees with established ROA, when appropriately controlling for covariates. Yet, deep layer T2 change in the medial compartment occurred concurrent with medial femorotibial progression.
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Affiliation(s)
- W. Wirth
- Institute of Anatomy, Paracelsus Medical University Salzburg & Nuremberg, Salzburg, Austria,Chondrometris GmbH, Ainring, Germany
| | - S. Maschek
- Institute of Anatomy, Paracelsus Medical University Salzburg & Nuremberg, Salzburg, Austria,Chondrometris GmbH, Ainring, Germany
| | - P. Beringer
- Institute of Anatomy, Paracelsus Medical University Salzburg & Nuremberg, Salzburg, Austria
| | - F. Eckstein
- Institute of Anatomy, Paracelsus Medical University Salzburg & Nuremberg, Salzburg, Austria,Chondrometris GmbH, Ainring, Germany
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Schaefer LF, Sury M, Yin M, Jamieson S, Donnell I, Smith SE, Lynch JA, Nevitt MC, Duryea J. Quantitative measurement of medial femoral knee cartilage volume - analysis of the OA Biomarkers Consortium FNIH Study cohort. Osteoarthritis Cartilage 2017; 25:1107-1113. [PMID: 28153788 PMCID: PMC5466831 DOI: 10.1016/j.joca.2017.01.010] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/13/2016] [Revised: 01/17/2017] [Accepted: 01/22/2017] [Indexed: 02/02/2023]
Abstract
OBJECTIVE Large studies of knee osteoarthritis (KOA) require well-characterized efficient methods to assess progression. We previously developed the local-area cartilage segmentation (LACS) software method, to measure cartilage volume on magnetic resonance imaging (MRI) scans. The present study further validates this method in a larger patient cohort and assesses predictive validity in a case-control study. METHOD The OA Biomarkers Consortium FNIH Project, a case-control study of KOA progression nested within the Osteoarthritis Initiative (OAI), includes 600 subjects in four subgroups based on radiographic and pain progression. Our software tool measured change in medial femoral cartilage volume in a central weight-bearing region. Different sized regions of cartilage were assessed to explore their sensitivity to change. The readings were performed on MRI scans at the baseline and 24-month visits. We used standardized response means (SRMs) for responsiveness and logistic regression for predictive validity. RESULTS Cartilage volume change was associated strongly with radiographic progression (odds ratios (OR) = 4.66; 95% confidence intervals (CI) = 2.85-7.62). OR were significant but of lesser magnitude for the combined radiographic and pain progression outcome (OR = 1.70; 95% CI = 1.40-2.07). For the full 600 subjects, theSRM was -0.51 for the largest segmented area. Smaller areas of cartilage segmentation were also able to predict the case-control status. The average reader time for the largest area was less than 20 min per scan. Smaller areas could be assessed with less reader time. CONCLUSION We demonstrated that the LACS method is fast, responsive, and associated with radiographic and pain progression, and is appropriate for existing and future large studies of KOA.
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Affiliation(s)
- Lena F. Schaefer
- Brigham and Women's Hospital, Harvard Medical School, Boston, MA
| | - Meera Sury
- Brigham and Women's Hospital, Harvard Medical School, Boston, MA
| | - Ming Yin
- Brigham and Women's Hospital, Harvard Medical School, Boston, MA
| | - Scott Jamieson
- Brigham and Women's Hospital, Harvard Medical School, Boston, MA
| | - Isaac Donnell
- Brigham and Women's Hospital, Harvard Medical School, Boston, MA
| | - Stacy E. Smith
- Brigham and Women's Hospital, Harvard Medical School, Boston, MA
| | | | | | - Jeffrey Duryea
- Brigham and Women's Hospital, Harvard Medical School, Boston, MA
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Moyer R, Wirth W, Eckstein F. Longitudinal Changes in Magnetic Resonance Imaging-Based Measures of Femorotibial Cartilage Thickness as a Function of Alignment and Obesity: Data From the Osteoarthritis Initiative. Arthritis Care Res (Hoboken) 2017; 69:959-965. [PMID: 27696763 DOI: 10.1002/acr.23096] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2016] [Revised: 09/08/2016] [Accepted: 09/20/2016] [Indexed: 11/11/2022]
Abstract
OBJECTIVE To investigate the interaction between malalignment and body mass index (BMI) on cartilage thickness change in patients with knee osteoarthritis (OA). METHODS Femorotibial cartilage thickness was measured from baseline to 2 years in 558 knees with radiographic OA. Cartilage thickness was determined in the central weight-bearing medial femorotibial cartilage (cMFTC) and lateral (cLFTC) compartments. Femorotibial angle (FTA) was stratified into neutral, minor, and definite malalignment. BMI was stratified using World Health Organization classifications for normal, overweight, and obese. Multivariable linear regression models were used to investigate the interaction between alignment and BMI, adjusting for age, sex, and disease severity. RESULTS There was no significant interaction for continuous measures of alignment and BMI (P = 0.301 for cMFTC and P = 0.852 for cLFTC). Using BMI tertiles, the association between alignment and medial or lateral cartilage thickness loss was not moderated by BMI, despite a significant association of malalignment with greater cartilage thickness loss (P ≤ 0.005). Using FTA tertiles, the association between BMI and medial cartilage thickness loss was approximately 3 times greater in knees with definite malalignment (P = 0.149) and approximately 5 times greater in knees with minor malalignment (P = 0.006). Specifically, knees with minor varus significantly modified this relationship (P = 0.021). CONCLUSION Malalignment was significantly associated with cartilage thickness loss per degree increase in malalignment, but was not moderated by BMI. BMI was significantly associated with greater rates of medial cartilage thickness loss per unit increase in BMI but only in knees with minor varus malalignment. These findings have implications for better understanding patient subgroups and intervention strategies targeting risk factors for knee OA.
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Affiliation(s)
- Rebecca Moyer
- Rebecca Moyer, PT, PhD: Dalhousie University, Halifax, Nova Scotia, Canada
| | - Wolfgang Wirth
- Institute of Anatomy, Paracelsus Medical University Salzburg & Nuremberg, Salzburg, Austria, and Chondrometrics GmbH, Ainring, Germany
| | - Felix Eckstein
- Institute of Anatomy, Paracelsus Medical University Salzburg & Nuremberg, Salzburg, Austria, and Chondrometrics GmbH, Ainring, Germany
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Waldstein W, Kasparek MF, Faschingbauer M, Windhager R, Boettner F. Lateral-compartment Osteophytes are not Associated With Lateral-compartment Cartilage Degeneration in Arthritic Varus Knees. Clin Orthop Relat Res 2017; 475:1386-1392. [PMID: 27830485 PMCID: PMC5384912 DOI: 10.1007/s11999-016-5155-y] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/19/2016] [Accepted: 10/31/2016] [Indexed: 01/31/2023]
Abstract
BACKGROUND Progression of arthritis in the lateral compartment is one of the main failure modes of unicompartmental knee arthroplasty (UKA). The decision regarding whether to perform a medial UKA sometimes is made based on whether lateral-compartment osteophytes are visible on plain radiographs obtained before surgery, but it is not clear whether the presence of lateral-compartment osteophytes signifies that the cartilage in the lateral compartment is arthritic. QUESTIONS/PURPOSES (1) Is the presence of lateral compartment osteophytes associated with biomechanical properties of lateral-compartment cartilage, and (2) are osteophytes in the lateral compartment associated with particular histologic features of cartilage in the lateral compartment? METHODS Between May 2010 and January 2012, we performed 201 TKAs for varus osteoarthritis confirmed on standardized AP hip-to-ankle standing radiographs. All patients with a varus deformity were considered for this prospective study. During the enrollment period, 100 patients (101 knees) were not enrolled for this study because of declined consent or because they were unable to perform all required preoperative radiographic examinations. That left 84 patients (100 knees), of whom an additional 23 patients (27%) were excluded because either radiographic or biomechanical data were missing. For final analysis, 61 patients (71 knees) were available. There were 29 males (48%) and 32 females (52%) with a mean age of 65 years (range, 49-89 years). Their mean BMI was 26 kg/m2 (range, 17-47 kg/m2). Lateral-compartment osteophytes were graded by two observers on AP standing knee radiographs based on a template of the Osteoarthritis Research Society International (OARSI) radiographic atlas. During surgery, osteochondral plugs were harvested from the lateral tibial plateau and the distal lateral femur for biomechanical and histologic assessments. The intrinsic material coefficients aggregate modulus (Ha) and dynamic modulus (DM) were determined by applying a compressive load of 20 g for 1 hour. The histologic analysis was performed according to the qualitative osteoarthritis cartilage histopathology assessment system. The Mann-Whitney U test was performed to compare the distribution of variables. Power analysis was performed for the Mann-Whitney U test using an alpha of 0.05, a power of 80%, and a sample size of 71 resulting in a detectable effect size of 0.6. Owing to the limited sample size, only medium or large effects in changes of biomechanical properties can be excluded with adequate power. RESULTS Ha and DM were not different with the numbers available when comparing knees with osteophyte Grades 0, 1, and 2 on the lateral tibia. For Grade 3 tibial osteophytes (n = 3), the lateral tibia cartilage showed low Ha (0.39 MPa; SD, 0.17 MPa) and low DM (2.85 MPa; SD, 2.12 MPa). On the lateral femur, no differences of Ha and DM were observed with the numbers available between Grades 0 to 3 osteophytes. No differences with the numbers available in the OARSI histologic grades on the lateral tibia plateau and the distal lateral femur were observed between the different osteophyte grades. CONCLUSIONS Lateral-compartment osteophytes are not associated with biomechanically weaker cartilage or with more-advanced histologic signs of degeneration of lateral-compartment cartilage in knees with varus arthritis. Given the small sample size of 71, the study was underpowered to detect small-to-modest decreases in biomechanical properties. Future studies with larger sample sizes are needed to confirm the current findings. CLINICAL RELEVANCE Factors other than the presence or absence of lateral-compartment osteophytes should be considered when evaluating patients with medial-compartment arthritis for medial UKA. Future studies are required to define the limitations of plain radiographs to rule out cartilage degeneration in the lateral compartment of varus knees.
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MESH Headings
- Aged
- Aged, 80 and over
- Arthroplasty, Replacement, Knee/adverse effects
- Biomechanical Phenomena
- Cartilage, Articular/diagnostic imaging
- Cartilage, Articular/pathology
- Cartilage, Articular/physiopathology
- Cartilage, Articular/surgery
- Female
- Humans
- Knee Joint/diagnostic imaging
- Knee Joint/pathology
- Knee Joint/physiopathology
- Knee Joint/surgery
- Male
- Middle Aged
- Osteoarthritis, Knee/diagnostic imaging
- Osteoarthritis, Knee/pathology
- Osteoarthritis, Knee/physiopathology
- Osteoarthritis, Knee/surgery
- Osteophyte/diagnostic imaging
- Osteophyte/pathology
- Patient Selection
- Predictive Value of Tests
- Retrospective Studies
- Risk Assessment
- Risk Factors
- Treatment Outcome
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Affiliation(s)
- Wenzel Waldstein
- Department of Orthopedic Surgery, Vienna General Hospital, Medical University of Vienna, Waehringer Guertel 18-20, 1090, Vienna, Austria
| | - Maximilian F Kasparek
- Adult Reconstruction & Joint Replacement Division, Hospital for Special Surgery, 535 East 70th Street, New York, NY, 10021, USA
| | - Martin Faschingbauer
- Department of Orthopedic Surgery, Ulm University Hospital, University of Ulm, Oberer Eselsberg 45, 89081, Ulm, Germany
| | - Reinhard Windhager
- Department of Orthopedic Surgery, Vienna General Hospital, Medical University of Vienna, Waehringer Guertel 18-20, 1090, Vienna, Austria
| | - Friedrich Boettner
- Adult Reconstruction & Joint Replacement Division, Hospital for Special Surgery, 535 East 70th Street, New York, NY, 10021, USA.
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Eckstein F, Buck R, Wirth W. Location-independent analysis of structural progression of osteoarthritis—Taking it all apart, and putting the puzzle back together makes the difference. Semin Arthritis Rheum 2017; 46:404-410. [DOI: 10.1016/j.semarthrit.2016.08.016] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2016] [Revised: 08/12/2016] [Accepted: 08/23/2016] [Indexed: 10/21/2022]
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Wirth W, Maschek S, Eckstein F. Sex- and age-dependence of region- and layer-specific knee cartilage composition (spin-spin-relaxation time) in healthy reference subjects. Ann Anat 2016; 210:1-8. [PMID: 27836800 DOI: 10.1016/j.aanat.2016.10.010] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2016] [Revised: 10/19/2016] [Accepted: 10/29/2016] [Indexed: 12/18/2022]
Abstract
Compositional measures of articular cartilage are accessible in vivo by magnetic resonance imaging (MRI) based relaxometry and cartilage spin-spin transverse relaxation time (T2) has been related to tissue hydration, collagen content and orientation, and mechanical (functional) properties of articular cartilage. The objective of the current study was therefore to evaluate subregional variation, and sex- and age-differences, in laminar (deep and superficial) femorotibial cartilage T2 relaxation time in healthy adults. To this end, we studied the right knees of 92 healthy subjects from the Osteoarthritis Initiative reference cohort (55 women, 37 men; age range 45-78 years; BMI 24.4±3.1) without knee pain, radiographic signs, or risk factors of knee osteoarthritis in either knee. T2 of the deep and superficial femorotibial cartilages was determined in 16 femorotibial subregions, using a multi-echo spin-echo (MESE) MRI sequence. Significant subregional variation in femorotibial cartilage T2 was observed for the superficial and for the deep (both p<0.001) cartilage layer (Friedman test). Yet, layer- and region-specific femorotibial T2 did not differ between men and women, or between healthy adults below and above the median age (54 years). In conclusion, this first study to report subregional (layer-specific) compositional variation of femorotibial cartilage T2 in healthy adults identifies significant differences in both superficial and deep cartilage T2 between femorotibial subregions. However, no relevant sex- or age-dependence of cartilage T2 was observed between age 45-78 years. The findings suggest that a common, non-sex-specific set of layer-and region-specific T2 reference values can be used to identify compositional pathology in joint disease for this age group.
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Affiliation(s)
- Wolfgang Wirth
- Institute of Anatomy, Paracelsus Medical University, Salzburg, Austria; Chondrometrics GmbH, Ainring, Germany.
| | - Susanne Maschek
- Institute of Anatomy, Paracelsus Medical University, Salzburg, Austria; Chondrometrics GmbH, Ainring, Germany
| | - Felix Eckstein
- Institute of Anatomy, Paracelsus Medical University, Salzburg, Austria; Chondrometrics GmbH, Ainring, Germany
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Bowes MA, Maciewicz RA, Waterton JC, Hunter DJ, Conaghan PG. Bone Area Provides a Responsive Outcome Measure for Bone Changes in Short-term Knee Osteoarthritis Studies. J Rheumatol 2016; 43:2179-2182. [DOI: 10.3899/jrheum.151118] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/11/2016] [Indexed: 01/24/2023]
Abstract
Objective.To analyze the 3-D bone area from an osteoarthritis (OA) cohort demonstrating no change in cartilage thickness.Methods.Twenty-seven women with painful medial knee OA had magnetic resonance images at 0, 3, and 6 months. Images were analyzed using active appearance models.Results.At 3 and 6 months, the mean change in medial femoral bone area was 0.34% (95% CI 0.04–0.64) and 0.61% (95% CI 0.32–0.90), respectively. Forty-one percent of the subjects had progression greater than the smallest detectable difference at 6 months.Conclusion.In this small cohort at high risk of OA progression, bone area changed at 3 and 6 months when cartilage morphometric measures did not.
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A 20 years of progress and future of quantitative magnetic resonance imaging (qMRI) of cartilage and articular tissues—personal perspective. Semin Arthritis Rheum 2016; 45:639-47. [DOI: 10.1016/j.semarthrit.2015.11.005] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2015] [Revised: 10/25/2015] [Accepted: 11/11/2015] [Indexed: 12/21/2022]
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46
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Eckstein F, Boudreau R, Wang Z, Hannon MJ, Duryea J, Wirth W, Cotofana S, Guermazi A, Roemer F, Nevitt M, John MR, Ladel C, Sharma L, Hunter DJ, Kwoh CK. Comparison of radiographic joint space width and magnetic resonance imaging for prediction of knee replacement: A longitudinal case-control study from the Osteoarthritis Initiative. Eur Radiol 2016; 26:1942-51. [PMID: 26376884 PMCID: PMC4794411 DOI: 10.1007/s00330-015-3977-8] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2015] [Revised: 04/27/2015] [Accepted: 08/10/2015] [Indexed: 10/23/2022]
Abstract
OBJECTIVE To evaluate whether change in fixed-location measures of radiographic joint space width (JSW) and cartilage thickness by MRI predict knee replacement. METHODS Knees replaced between 36 and 60 months' follow-up in the Osteoarthritis Initiative were each matched with one control by age, sex and radiographic status. Radiographic JSW was determined from fixed flexion radiographs and subregional femorotibial cartilage thickness from 3 T MRI. Changes between the annual visit before replacement (T0) and 2 years before T0 (T-2) were compared using conditional logistic regression. RESULTS One hundred and nineteen knees from 102 participants (55.5 % women; age 64.2 ± 8.7 [mean ± SD] years) were studied. Fixed-location JSW change at 22.5 % from medial to lateral differed more between replaced and control knees (case-control [cc] OR = 1.57; 95 % CI: 1.23-2.01) than minimum medial JSW change (ccOR = 1.38; 95 % CI: 1.11-1.71). Medial femorotibial cartilage loss displayed discrimination similar to minimum JSW, and central tibial cartilage loss similar to fixed-location JSW. Location-independent thinning and thickening scores were elevated prior to knee replacement. CONCLUSIONS Discrimination of structural progression between knee pre-placement cases versus controls was stronger for fixed-location than minimum radiographic JSW. MRI displayed similar discrimination to radiography and suggested greater simultaneous cartilage thickening and loss prior to knee replacement. KEY POINTS • Fixed-location JSW predicts surgical knee replacement more strongly than minimum JSW. • MRI predicts knee replacement with similar accuracy to radiographic JSW. • MRI reveals greater cartilage thinning and thickening prior to knee replacement.
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Affiliation(s)
- Felix Eckstein
- Institute of Anatomy, Paracelsus Medical University Salzburg & Nuremberg Austria & Chondrometrics GmbH, Ainring, Germany.
| | - Robert Boudreau
- Department of Epidemiology, Graduate School of Public Health, University of Pittsburgh, Pittsburgh, PA, USA
| | - Zhijie Wang
- Division of Rheumatology and Clinical Immunology, University of Pittsburgh and Pittsburgh VAHS, Pittsburgh, PA, USA
| | - Michael J Hannon
- Division of Rheumatology and Clinical Immunology, University of Pittsburgh and Pittsburgh VAHS, Pittsburgh, PA, USA
| | - Jeff Duryea
- Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
| | - Wolfgang Wirth
- Institute of Anatomy, Paracelsus Medical University Salzburg & Nuremberg Austria & Chondrometrics GmbH, Ainring, Germany
| | - Sebastian Cotofana
- Institute of Anatomy, Paracelsus Medical University Salzburg & Nuremberg Austria & Chondrometrics GmbH, Ainring, Germany
| | - Ali Guermazi
- Boston University School of Medicine and Boston Imaging Core Lab (BICL), LLC, Boston, MA, USA
| | - Frank Roemer
- Boston University School of Medicine and Boston Imaging Core Lab (BICL), LLC, Boston, MA, USA
- Department of Radiology, University of Erlangen-Nuremberg, Erlangen, Germany
| | | | | | | | - Leena Sharma
- Department of Medicine, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA
| | - David J Hunter
- Royal North Shore Hospital & Institute of Bone and Joint Research, Kolling Institute, University Sydney, Sydney, NSW, Australia
| | - C Kent Kwoh
- Division of Rheumatology and the University of Arizona Arthritis Center, University of Arizona, Tucson, AZ, USA
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Faschingbauer M, Renner L, Waldstein W, Boettner F. Are lateral compartment osteophytes a predictor for lateral cartilage damage in varus osteoarthritic knees?: Data from the Osteoarthritis Initiative. Bone Joint J 2016; 97-B:1634-9. [PMID: 26637677 DOI: 10.1302/0301-620x.97b12.36465] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
We studied whether the presence of lateral osteophytes on plain radiographs was a predictor for the quality of cartilage in the lateral compartment of patients with varus osteoarthritic of the knee (Kellgren and Lawrence grade 2 to 3). The baseline MRIs of 344 patients from the Osteoarthritis Initiative (OAI) who had varus osteoarthritis (OA) of the knee on hip-knee-ankle radiographs were reviewed. Patients were categorised using the Osteoarthritis Research Society International (OARSI) osteophyte grading system into 174 patients with grade 0 (no osteophytes), 128 grade 1 (mild osteophytes), 28 grade 2 (moderate osteophytes) and 14 grade 3 (severe osteophytes) in the lateral compartment (tibia). All patients had Kellgren and Lawrence grade 2 or 3 arthritis of the medial compartment. The thickness and volume of the lateral cartilage and the percentage of full-thickness cartilage defects in the lateral compartment was analysed. There was no difference in the cartilage thickness or cartilage volume between knees with osteophyte grades 0 to 3. The percentage of full-thickness cartilage defects on the tibial side increased from < 2% for grade 0 and 1 to 10% for grade 3. The lateral compartment cartilage volume and thickness is not influenced by the presence of lateral compartment osteophytes in patients with varus OA of the knee. Large lateral compartment osteophytes (grade 3) increase the likelihood of full-thickness cartilage defects in the lateral compartment.
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Affiliation(s)
- M Faschingbauer
- Hospital for Special Surgery, 535 70th Street, New York, New York 10021, USA
| | - L Renner
- Hospital for Special Surgery, 535 70th Street, New York, New York 10021, USA
| | - W Waldstein
- Medical University of Vienna, Vienna, Austria
| | - F Boettner
- Hospital for Special Surgery, 535 70th Street, New York, New York 10021, USA
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48
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Eckstein F, Collins JE, Nevitt MC, Lynch JA, Kraus VB, Katz JN, Losina E, Wirth W, Guermazi A, Roemer FW, Hunter DJ. Brief Report: Cartilage Thickness Change as an Imaging Biomarker of Knee Osteoarthritis Progression: Data From the Foundation for the National Institutes of Health Osteoarthritis Biomarkers Consortium. Arthritis Rheumatol 2016; 67:3184-9. [PMID: 26316262 DOI: 10.1002/art.39324] [Citation(s) in RCA: 111] [Impact Index Per Article: 13.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2015] [Accepted: 08/06/2015] [Indexed: 11/09/2022]
Abstract
OBJECTIVE To investigate the association of cartilage thickness change over 24 months, as determined by magnetic resonance imaging (MRI), with knee osteoarthritis (OA) progression at 24-48 months. METHODS This nested case-control study included 600 knees with a baseline Kellgren/Lawrence (K/L) grade of 1-3 from 600 Osteoarthritis Initiative (OAI) participants. Case knees (n = 194) had both medial tibiofemoral radiographic joint space loss (≥0.7 mm) and a persistent increase in the Western Ontario and McMaster Universities Osteoarthritis Index pain score (≥9 on a 0-100 scale) 24-48 months from baseline. Control knees (n = 406) included 200 with neither radiographic nor pain progression, 103 with radiographic progression only, and 103 with pain progression only. Medial and lateral femorotibial cartilage was segmented from sagittal 3T MRIs at baseline, 12 months, and 24 months. Logistic regression was used to assess the association of change in cartilage thickness, with a focus on the central medial femorotibial compartment, and OA progression. RESULTS Central medial femorotibial compartment thickness loss was significantly associated with case status, with an odds ratio (OR) of 1.9 (95% confidence interval [95% CI] 1.6-2.3) (P < 0.0001). Association with case status reached P < 0.05 for both the central femur (OR 1.8 [95% CI 1.5-2.2]) and the central tibia (OR 1.6 [95% CI 1.3-1.9]). Lateral femorotibial compartment cartilage thickness loss, in contrast, was not significantly associated with case status. A reduction in central medial femorotibial compartment cartilage thickness was strongly associated with radiographic progression (OR 4.0 [95% CI 2.9-5.3]; P < 0.0001) and only weakly associated with pain progression (OR 1.3 [95% CI 1.1-1.6]; P < 0.01). CONCLUSION Our findings indicate that loss of medial femorotibial cartilage thickness over 24 months is associated with the combination of radiographic and pain progression in the knee, with a stronger association for radiographic progression.
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Affiliation(s)
- F Eckstein
- Institute of Anatomy, Paracelsus Medical University, Salzburg, Austria, and Chondrometrics GmbH, Ainring, Germany
| | - J E Collins
- Brigham and Women's Hospital and Harvard Medical School, Boston, Massachusetts
| | | | - J A Lynch
- University of California, San Francisco
| | - V B Kraus
- Duke University School of Medicine, Durham, North Carolina
| | - J N Katz
- Brigham and Women's Hospital and Harvard Medical School, Boston, Massachusetts
| | - E Losina
- Brigham and Women's Hospital and Harvard Medical School, Boston, Massachusetts
| | - W Wirth
- Institute of Anatomy, Paracelsus Medical University, Salzburg, Austria, and Chondrometrics GmbH, Ainring, Germany
| | - A Guermazi
- Boston University School of Medicine and Boston Core Imaging Lab, Boston, Massachusetts
| | - F W Roemer
- Boston University School of Medicine and Boston Core Imaging Lab, Boston, Massachusetts, and University of Erlangen-Nuremberg, Erlangen, Germany
| | - D J Hunter
- Royal North Shore Hospital, Kolling Institute of Medical Research, and University of Sydney, Sydney, New South Wales, Australia
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Eckstein F, Wirth W, Guermazi A, Maschek S, Aydemir A. Brief report: intraarticular sprifermin not only increases cartilage thickness, but also reduces cartilage loss: location-independent post hoc analysis using magnetic resonance imaging. Arthritis Rheumatol 2016; 67:2916-22. [PMID: 26138203 PMCID: PMC5061102 DOI: 10.1002/art.39265] [Citation(s) in RCA: 54] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2014] [Accepted: 06/25/2015] [Indexed: 01/01/2023]
Abstract
Objective To determine whether an anabolic drug (sprifermin) is capable of reducing cartilage loss wherever it occurs in a given knee, using a subject‐specific, location‐independent analysis of cartilage change in patients with knee osteoarthritis (OA). Methods Study participants (n = 168; ages ≥40 years, 69% women) had symptomatic femorotibial OA not confined to the medial compartment. Sprifermin (10, 30, or 100 μg) or placebo was injected intraarticularly 3 times over 3 weeks, both after randomization (baseline) and 3 months later. Coronal magnetic resonance images were acquired at baseline and 3, 6, and 12 months after treatment. The femorotibial cartilage of each subject was segmented, and changes in cartilage thickness were computed across 16 subregions. Location‐independent post hoc analysis was used to compute summary scores of negative and positive changes in the subregions, summarized as the total cartilage thinning sum score (ThCTnS) and the total cartilage thickening sum score (ThCTkS), capturing change in either direction in each knee. Ordered values of the magnitude of subject‐specific subregional changes in thickness were determined. The ThCTnS and ThCTkS in each sprifermin dose group at 12 months of followup were compared with the values in the matched placebo groups, using the Wilcoxon‐Mann‐Whitney test. Results The mean ± SD ThCTnS was −591 ± 617 μm (median −360 μm, Q1/Q3 = −820/−200 μm) in patients treated with 100 μg sprifermin (n = 57), and −921 ± 777 μm (median −745 μm, Q1/Q3 = −1,190/−380 μm) in patients given placebo (n = 18). The mean difference in the ThCTnS between the 100‐μg sprifermin group and the placebo group was 331 μm (95% confidence interval [95% CI] 24, 685), a difference that was statistically significant (P = 0.03). The mean difference in the ThCTkS in the 100‐μg sprifermin group compared with the placebo group was 237 μm (95% CI 34, 440), also a statistically significant difference (P = 0.028). Conclusion Sprifermin not only increases cartilage thickness, but also reduces cartilage loss. Subject‐specific, location‐independent analysis of both cartilage thinning and thickening represents a sensitive and informative approach for studying the effects of disease‐modifying OA drugs.
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Affiliation(s)
- Felix Eckstein
- Institute of Anatomy, Paracelsus Medical University Salzburg & Nuremberg, Salzburg, Austria and Chondrometrics GmbH, Ainring, Germany
| | - Wolfgang Wirth
- Institute of Anatomy, Paracelsus Medical University Salzburg & Nuremberg, Salzburg, Austria and Chondrometrics GmbH, Ainring, Germany
| | - Ali Guermazi
- Boston University School of Medicine and Boston Imaging Core Lab, LLC, Boston, Massachusetts
| | - Susanne Maschek
- Institute of Anatomy, Paracelsus Medical University Salzburg & Nuremberg, Salzburg, Austria and Chondrometrics GmbH, Ainring, Germany
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50
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Trencart P, Alexander K, De Lasalle J, Laverty S. Radiographic evaluation of the width of the femorotibial joint space in horses. Am J Vet Res 2016; 77:127-36. [DOI: 10.2460/ajvr.77.2.127] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
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