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Freitag J, Chamberlain M, Wickham J, Shah K, Cicuttini F, Wang Y, Solterbeck A. Safety and efficacy of an allogeneic adipose-derived mesenchymal stem cell preparation in the treatment of knee osteoarthritis: A Phase I/IIa randomised controlled trial. OSTEOARTHRITIS AND CARTILAGE OPEN 2024; 6:100500. [PMID: 39161739 PMCID: PMC11331931 DOI: 10.1016/j.ocarto.2024.100500] [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: 01/23/2024] [Accepted: 06/25/2024] [Indexed: 08/21/2024] Open
Abstract
Objectives To assess the safety and efficacy of an allogeneic adipose-derived mesenchymal stem cell preparation (MAG200) in the treatment of knee osteoarthritis over 12 months. Design A single-centre, double-blind, ascending dose, randomised controlled trial. 40 participants with moderate knee osteoarthritis were randomised to receive a single intra-articular injection of MAG200 (dose cohorts:10, 20, 50, 100 × 106 cells) or placebo. Primary objectives were safety and efficacy according to a compound responder analysis of minimal clinically important difference in pain (numerical pain rating scale [NPRS]) and function (Knee Injury and Osteoarthritis Outcome Score - Function in Daily Living subscale [KOOSADL]) at month 12. Secondary efficacy outcomes included changes from baseline in patient reported outcome measures and evaluation of disease-modification using quantitative MRI. Results Treatment was well tolerated with no treatment-related serious adverse events. MAG200 cohorts reported a greater proportion of responders than placebo and demonstrated clinical and statistically significant improvement in pain and clinically relevant improvement in all KOOS subscales. MAG200 demonstrated a reproducible treatment effect over placebo, which was clinically relevant for pain in the 10 × 106 dose cohort (mean difference NPRS:-2.25[95%CI:-4.47,-0.03, p = 0.0468]) and for function in the 20 × 106 and 100 × 106 dose cohorts (mean difference KOOSADL:10.12[95%CI:-1.51,21.76, p = 0.0863] and 10.81[95%CI:-1.42,23.04, p = 0.0810] respectively). A trend in disease-modification was observed with improvement in total knee cartilage volume in MAG200 10, 20, and 100 × 106 dose cohorts, with progression of osteoarthritis in placebo, though this was not statistically significant. No clear dose response was observed. Conclusion This early-phase study provides supportive safety and efficacy evidence to progress MAG200 to later-stage trial development. Trial registration ACTRN12617001095358/ACTRN12621000622808.
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Affiliation(s)
- Julien Freitag
- School of Rural Medicine, Charles Sturt University, Orange, NSW, 2800, Australia
- Melbourne Stem Cell Centre Research, Box Hill, VIC, 3128, Australia
- Magellan Stem Cells, 9A Sugar Gum Court, Braeside, VIC, 3195, Australia
| | | | - James Wickham
- School of Dentistry & Medical Sciences, Charles Sturt University, Orange, NSW, 2800, Australia
| | - Kiran Shah
- Magellan Stem Cells, 9A Sugar Gum Court, Braeside, VIC, 3195, Australia
| | - Flavia Cicuttini
- School of Public Health and Preventive Medicine, Monash University, Melbourne, VIC, 3004, Australia
- Department of Rheumatology, Alfred Hospital, Melbourne, VIC, 3004, Australia
| | - Yuanyuan Wang
- School of Public Health and Preventive Medicine, Monash University, Melbourne, VIC, 3004, Australia
| | - Ann Solterbeck
- Statistical Revelations Pty Ltd, Ocean Grove, VIC, 3226, Australia
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Li X, Kim J, Yang M, Ok AH, Zbýň Š, Link TM, Majumdar S, Ma CB, Spindler KP, Winalski CS. Cartilage compositional MRI-a narrative review of technical development and clinical applications over the past three decades. Skeletal Radiol 2024; 53:1761-1781. [PMID: 38980364 PMCID: PMC11303573 DOI: 10.1007/s00256-024-04734-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/19/2023] [Revised: 06/11/2024] [Accepted: 06/13/2024] [Indexed: 07/10/2024]
Abstract
Articular cartilage damage and degeneration are among hallmark manifestations of joint injuries and arthritis, classically osteoarthritis. Cartilage compositional MRI (Cart-C MRI), a quantitative technique, which aims to detect early-stage cartilage matrix changes that precede macroscopic alterations, began development in the 1990s. However, despite the significant advancements over the past three decades, Cart-C MRI remains predominantly a research tool, hindered by various technical and clinical hurdles. This paper will review the technical evolution of Cart-C MRI, delve into its clinical applications, and conclude by identifying the existing gaps and challenges that need to be addressed to enable even broader clinical application of Cart-C MRI.
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Affiliation(s)
- Xiaojuan Li
- Program of Advanced Musculoskeletal Imaging (PAMI), Cleveland Clinic, 9500 Euclid Avenue, ND20, Cleveland, OH, 44195, USA.
- Department of Biomedical Engineering, Lerner Research Institute, Cleveland Clinic, Cleveland, OH, USA.
- Department of Diagnostic Radiology, Cleveland Clinic, Cleveland, OH, USA.
| | - Jeehun Kim
- Program of Advanced Musculoskeletal Imaging (PAMI), Cleveland Clinic, 9500 Euclid Avenue, ND20, Cleveland, OH, 44195, USA
- Department of Biomedical Engineering, Lerner Research Institute, Cleveland Clinic, Cleveland, OH, USA
| | - Mingrui Yang
- Program of Advanced Musculoskeletal Imaging (PAMI), Cleveland Clinic, 9500 Euclid Avenue, ND20, Cleveland, OH, 44195, USA
- Department of Biomedical Engineering, Lerner Research Institute, Cleveland Clinic, Cleveland, OH, USA
| | - Ahmet H Ok
- Program of Advanced Musculoskeletal Imaging (PAMI), Cleveland Clinic, 9500 Euclid Avenue, ND20, Cleveland, OH, 44195, USA
- Department of Biomedical Engineering, Lerner Research Institute, Cleveland Clinic, Cleveland, OH, USA
- Department of Diagnostic Radiology, Cleveland Clinic, Cleveland, OH, USA
| | - Štefan Zbýň
- Program of Advanced Musculoskeletal Imaging (PAMI), Cleveland Clinic, 9500 Euclid Avenue, ND20, Cleveland, OH, 44195, USA
- Department of Biomedical Engineering, Lerner Research Institute, Cleveland Clinic, Cleveland, OH, USA
- Department of Diagnostic Radiology, Cleveland Clinic, Cleveland, OH, USA
| | - Thomas M Link
- Department of Radiology and Biomedical Imaging, University of California San Francisco (UCSF), San Francisco, CA, USA
| | - Sharmilar Majumdar
- Department of Radiology and Biomedical Imaging, University of California San Francisco (UCSF), San Francisco, CA, USA
| | - C Benjamin Ma
- Department of Orthopaedic Surgery, UCSF, San Francisco, CA, USA
| | - Kurt P Spindler
- Program of Advanced Musculoskeletal Imaging (PAMI), Cleveland Clinic, 9500 Euclid Avenue, ND20, Cleveland, OH, 44195, USA
- Department of Orthopaedic Surgery, Cleveland Clinic, Cleveland, OH, USA
| | - Carl S Winalski
- Program of Advanced Musculoskeletal Imaging (PAMI), Cleveland Clinic, 9500 Euclid Avenue, ND20, Cleveland, OH, 44195, USA
- Department of Biomedical Engineering, Lerner Research Institute, Cleveland Clinic, Cleveland, OH, USA
- Department of Diagnostic Radiology, Cleveland Clinic, Cleveland, OH, USA
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Zhang X, de Moura HL, Monga A, Zibetti MVW, Kijowski R, Regatte RR. Repeatability of Quantitative Knee Cartilage T 1, T 2, and T 1ρ Mapping With 3D-MRI Fingerprinting. J Magn Reson Imaging 2024; 60:688-699. [PMID: 37885320 PMCID: PMC11045656 DOI: 10.1002/jmri.29068] [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: 07/13/2023] [Revised: 10/03/2023] [Accepted: 10/05/2023] [Indexed: 10/28/2023] Open
Abstract
BACKGROUND Three-dimensional MR fingerprinting (3D-MRF) techniques have been recently described for simultaneous multiparametric mapping of knee cartilage. However, investigation of repeatability remains limited. PURPOSE To assess the intra-day and inter-day repeatabilities of knee cartilage T1, T2, and T1ρ maps using a 3D-MRF sequence for simultaneous measurement. STUDY TYPE Prospective. SUBJECTS Fourteen healthy subjects (35.4 ± 9.3 years, eight males), scanned on Day 1 and Day 7. FIELD STRENGTH/SEQUENCE 3 T/3D-MRF, T1, T2, and T1ρ maps. ASSESSMENT The acquisition of 3D-MRF cartilage (simultaneous acquisition of T1, T2, and T1ρ maps) were acquired using a dictionary pattern-matching approach. Conventional cartilage T1, T2, and T1ρ maps were acquired using variable flip angles and a modified 3D-Turbo-Flash sequence with different echo and spin-lock times, respectively, and were fitted using mono-exponential models. Each sequence was acquired on Day 1 and Day 7 with two scans on each day. STATISTICAL TESTS The mean and SD for cartilage T1, T2, and T1ρ were calculated in five manually segmented regions of interest (ROIs), including lateral femur, lateral tibia, medial femur, medial tibia, and patella cartilages. Intra-subject and inter-subject repeatabilities were assessed using coefficient of variation (CV) and intra-class correlation coefficient (ICC), respectively, on the same day and among different days. Regression and Bland-Altman analysis were performed to compare maps between the conventional and 3D-MRF sequences. RESULTS The CV in all ROIs was lower than 7.4%, 8.4%, and 7.5% and the ICC was higher than 0.56, 0.51, and 0.52 for cartilage T1, T2, and T1ρ, respectively. The MRF results had a good agreement with the conventional methods with a linear regression slope >0.61 and R2 > 0.59. CONCLUSION The 3D-MRF sequence had high intra-subject and inter-subject repeatabilities for simultaneously measuring knee cartilage T1, T2, and T1ρ with good agreement with conventional sequences. EVIDENCE LEVEL 1 TECHNICAL EFFICACY: Stage 1.
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Affiliation(s)
- Xiaoxia Zhang
- Center of Biomedical Imaging, Department of Radiology, New York University Grossman School of Medicine, New York, NY, 10016, USA
| | - Hector L. de Moura
- Center of Biomedical Imaging, Department of Radiology, New York University Grossman School of Medicine, New York, NY, 10016, USA
| | - Anmol Monga
- Center of Biomedical Imaging, Department of Radiology, New York University Grossman School of Medicine, New York, NY, 10016, USA
| | - Marcelo V. W. Zibetti
- Center of Biomedical Imaging, Department of Radiology, New York University Grossman School of Medicine, New York, NY, 10016, USA
| | - Richard Kijowski
- Center of Biomedical Imaging, Department of Radiology, New York University Grossman School of Medicine, New York, NY, 10016, USA
| | - Ravinder R. Regatte
- Center of Biomedical Imaging, Department of Radiology, New York University Grossman School of Medicine, New York, NY, 10016, USA
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Mosher TJ. Quantitative Cartilage T2 and T1rho Mapping: Is There a Clinical Role? From the AJR Special Series on Quantitative Imaging. AJR Am J Roentgenol 2024. [PMID: 39082851 DOI: 10.2214/ajr.24.31655] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/15/2024]
Abstract
Despite more than 20 years of development, the MRI-based cartilage compositional biomarkers T2 and T1rho have not been routinely applied in clinical practice. This review examines these measures' historical development and frames the challenges in the application of these quantitative imaging tools to the care of patients with cartilage injury and osteoarthritis using the hierarchical model of efficacy proposed by Fryback and Thornbury. T2 and T1rho have been validated for the evaluation of early compositional and structural changes in cartilage extracellular matrix. Yet, these biomarkers lack direct correlation with pain or function loss, lack standardization of methods for acquisition and analysis, and have a limited role in guiding therapeutic management given the absence of effective disease-modifying osteoarthritis drugs. These issues present significant challenges in the path to the biomarkers' future implementation in clinical care. Nonetheless, these MRI-based cartilage compositional biomarkers provide an essential tool for musculoskeletal research and can provide important information on the biophysical properties of cartilage that will continue to contribute to our understanding of cartilage injury and osteoarthritis pathogenesis.
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Affiliation(s)
- Timothy J Mosher
- Department of Radiology MC H066, Penn State Milton S. Hershey Medical Center, 500 University DR., Hershey, PA 17033
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Nukuto K, Gale T, Yamamoto T, Kamada K, Irrgang JJ, Musahl V, Anderst W. Reliability and changes in knee cartilage T2 relaxation time from 6 to 24 months after anatomic anterior cruciate ligament reconstruction. J Orthop Res 2024. [PMID: 39032093 DOI: 10.1002/jor.25939] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/21/2024] [Revised: 07/02/2024] [Accepted: 07/05/2024] [Indexed: 07/22/2024]
Abstract
The objectives of this study were to evaluate the reliability of cartilage T2 relaxation time measurements and to identify focal changes in T2 relaxation on the affected knee from 6 to 24 months after anatomic anterior cruciate ligament reconstruction (ACLR). Data from 41 patients who received anatomic ACLR were analyzed. A bilateral 3.0-T MRI was acquired 6 and 24 months after ACLR. T2 relaxation time was measured in subregions of the femoral condyle and the tibial plateau. The root-mean-square coefficient of variation (RMSCV) was calculated to evaluate the reliability of T2 relaxation time in the contralateral knee. Subregion changes in the affected knee T2 relaxation time were identified using the contralateral knee as a reference. The superficial and full thickness layers of the central and inner regions showed good reliability. Conversely, the outer regions on the femoral side and regions in the deep layers showed poor reliability. T2 relaxation time increased in only 3 regions on the affected knee when controlling for changes in the contralateral knee, while changes in T2 relaxation time were identified in 14 regions when not using the contralateral knee as a reference. In conclusion, evaluation of cartilage degeneration by T2 relaxation time after ACLR is most reliable for central and inner cartilage regions. Cartilage degeneration occurs in the central and outer regions of the lateral femoral condyle from 6 to 24 months after anatomic ACLR.
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Affiliation(s)
- Koji Nukuto
- Department of Orthopedic Surgery, UPMC Freddie Fu Sports Medicine Center, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, USA
- Department of Orthopaedic Surgery, Kobe University Graduate School of Medicine, Kobe, Japan
- Biodynamics Laboratory, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - Tom Gale
- Biodynamics Laboratory, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - Tetsuya Yamamoto
- Department of Orthopaedic Surgery, Kobe University Graduate School of Medicine, Kobe, Japan
| | - Kohei Kamada
- Department of Orthopedic Surgery, UPMC Freddie Fu Sports Medicine Center, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, USA
- Department of Orthopaedic Surgery, Kobe University Graduate School of Medicine, Kobe, Japan
- Biodynamics Laboratory, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - James J Irrgang
- Department of Orthopedic Surgery, UPMC Freddie Fu Sports Medicine Center, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, USA
- Department of Physical Therapy, School of Health and Rehabilitation Sciences, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - Volker Musahl
- Department of Orthopedic Surgery, UPMC Freddie Fu Sports Medicine Center, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, USA
| | - William Anderst
- Biodynamics Laboratory, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
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Nishimura Y, Ogawa M, Okamura K, Yamasaki T, Inagaki Y, Tanaka Y. Validation of compositional MRI from a histological standpoint: Advantages of three-dimensional T1ρ mapping for quantitative evaluation of articular cartilage. Magn Reson Imaging 2024; 110:210-217. [PMID: 38679298 DOI: 10.1016/j.mri.2024.04.024] [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] [Received: 05/23/2023] [Revised: 03/02/2024] [Accepted: 04/14/2024] [Indexed: 05/01/2024]
Abstract
PURPOSE We aimed to investigate the relationship between quantitative evaluation by compositional MRI, including T1ρ, and histological and macroscopic assessments, to verify the validity of compositional MRI, and examine the relationship between compositional MRI evaluation reconstructed in three dimensions (3D) and histological and visual assessments. METHOD Twenty-seven patients with knee osteoarthritis underwent T1ρ and T2 magnetic resonance imaging (MRI). Histological and gross tissue evaluations were performed on the excised bone sections of total knee arthroplasty. Semi-quantitative histological evaluation of tissue changes were assessed by measuring the optical density of digitally captured safranin O-stained and Collagen type II antibody-stained paraffin sections. Macroscopic cartilage severity was determined on a 5-grade scale (G0-G5). T1ρ and T2 values (3D and 2D), and their correlation with each of these parameters were investigated. RESULTS 3D T1 ρ is negatively correlated with histological evaluations and positively correlated with visual assessments. Only 3D T1ρ values correlated with histological quantitative evaluation (Safranin-O staining; r = -0.53, P = 0.014, Collagen type II antibody staining; r = -0.60, P = 0.019). 2D T1ρ and 3D, 2D T2 values did not correlate with histological evaluation results. Macroscopic cartilage severity grade correlated with all T1ρ and T2 values (3D T1ρ; r = 0.61, P < 0.001, 2D T1ρ; r = 0.52, P < 0.001, 3D T2; r = 0.33, P = 0.045, 2D T2; r = 0.41, P = 0.01). CONCLUSIONS 3D T1ρ mapping reflects the changes in the molecular structure of the cartilage matrix that occur in arthropathic changes and may be an effective tool for detecting cartilage degeneration.
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Affiliation(s)
- Yuki Nishimura
- Department of Orthopaedic Surgery, Nara Medical University, Kashihara, Japan
| | - Munehiro Ogawa
- Department of Sports Medicine, Nara Medical University, Kashihara, Japan.
| | - Kensuke Okamura
- Department of Orthopaedic Surgery, Nara Medical University, Kashihara, Japan
| | - Tsuyoshi Yamasaki
- Department of Orthopaedic Surgery, Nara Seiwa Medical Center, Sango Town, Ikoma-Gun, Japan
| | - Yusuke Inagaki
- Department of Rehabilitation Medicine, Nara Medical University, Kashihara, Japan
| | - Yasuhito Tanaka
- Department of Orthopaedic Surgery, Nara Medical University, Kashihara, Japan
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Casula V, Kajabi AW. Quantitative MRI methods for the assessment of structure, composition, and function of musculoskeletal tissues in basic research and preclinical applications. MAGMA (NEW YORK, N.Y.) 2024:10.1007/s10334-024-01174-7. [PMID: 38904746 DOI: 10.1007/s10334-024-01174-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/31/2023] [Revised: 05/04/2024] [Accepted: 05/30/2024] [Indexed: 06/22/2024]
Abstract
Osteoarthritis (OA) is a disabling chronic disease involving the gradual degradation of joint structures causing pain and dysfunction. Magnetic resonance imaging (MRI) has been widely used as a non-invasive tool for assessing OA-related changes. While anatomical MRI is limited to the morphological assessment of the joint structures, quantitative MRI (qMRI) allows for the measurement of biophysical properties of the tissues at the molecular level. Quantitative MRI techniques have been employed to characterize tissues' structural integrity, biochemical content, and mechanical properties. Their applications extend to studying degenerative alterations, early OA detection, and evaluating therapeutic intervention. This article is a review of qMRI techniques for musculoskeletal tissue evaluation, with a particular emphasis on articular cartilage. The goal is to describe the underlying mechanism and primary limitations of the qMRI parameters, their association with the tissue physiological properties and their potential in detecting tissue degeneration leading to the development of OA with a primary focus on basic and preclinical research studies. Additionally, the review highlights some clinical applications of qMRI, discussing the role of texture-based radiomics and machine learning in advancing OA research.
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Affiliation(s)
- Victor Casula
- Research Unit of Health Sciences and Technology, Faculty of Medicine, University of Oulu, Oulu, Finland.
| | - Abdul Wahed Kajabi
- Center for Magnetic Resonance Research, University of Minnesota, Minneapolis, MN, USA
- Department of Radiology, University of Minnesota, Minneapolis, MN, USA
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Lemainque T, Pridöhl N, Zhang S, Huppertz M, Post M, Yüksel C, Yoneyama M, Prescher A, Kuhl C, Truhn D, Nebelung S. Time-efficient combined morphologic and quantitative joint MRI: an in situ study of standardized knee cartilage defects in human cadaveric specimens. Eur Radiol Exp 2024; 8:66. [PMID: 38834751 DOI: 10.1186/s41747-024-00462-0] [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: 11/23/2023] [Accepted: 03/27/2024] [Indexed: 06/06/2024] Open
Abstract
BACKGROUND Quantitative techniques such as T2 and T1ρ mapping allow evaluating the cartilage and meniscus. We evaluated multi-interleaved X-prepared turbo-spin echo with intuitive relaxometry (MIXTURE) sequences with turbo spin-echo (TSE) contrast and additional parameter maps versus reference TSE sequences in an in situ model of human cartilage defects. METHODS Standardized cartilage defects of 8, 5, and 3 mm in diameter were created in the lateral femora of ten human cadaveric knee specimens (81 ± 10 years old; nine males, one female). MIXTURE sequences providing proton density-weighted fat-saturated images and T2 maps or T1-weighted images and T1ρ maps as well as the corresponding two- and three-dimensional TSE reference sequences were acquired before and after defect creation (3-T scanner; knee coil). Defect delineability, bone texture, and cartilage relaxation times were quantified. Appropriate parametric or non-parametric tests were used. RESULTS Overall, defect delineability and texture features were not significantly different between the MIXTURE and reference sequences (p ≤ 0.47). After defect creation, relaxation times significantly increased in the central femur (T2pre = 51 ± 4 ms [mean ± standard deviation] versus T2post = 56 ± 4 ms; p = 0.002) and all regions combined (T1ρpre = 40 ± 4 ms versus T1ρpost = 43 ± 4 ms; p = 0.004). CONCLUSIONS MIXTURE permitted time-efficient simultaneous morphologic and quantitative joint assessment based on clinical image contrasts. While providing T2 or T1ρ maps in clinically feasible scan time, morphologic image features, i.e., cartilage defects and bone texture, were comparable between MIXTURE and reference sequences. RELEVANCE STATEMENT Equally time-efficient and versatile, the MIXTURE sequence platform combines morphologic imaging using familiar contrasts, excellent image correspondence versus corresponding reference sequences and quantitative mapping information, thereby increasing the diagnostic value beyond mere morphology. KEY POINTS • Combined morphologic and quantitative MIXTURE sequences are based on three-dimensional TSE contrasts. • MIXTURE sequences were studied in an in situ human cartilage defect model. • Morphologic image features, i.e., defect delineabilty and bone texture, were investigated. • Morphologic image features were similar between MIXTURE and reference sequences. • MIXTURE allowed time-efficient simultaneous morphologic and quantitative knee joint assessment.
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Affiliation(s)
- Teresa Lemainque
- Department of Diagnostic and Interventional Radiology, Medical Faculty, RWTH Aachen University, Pauwelsstr. 30, Aachen, 52074, Germany.
| | - Nicola Pridöhl
- Department of Diagnostic and Interventional Radiology, Medical Faculty, RWTH Aachen University, Pauwelsstr. 30, Aachen, 52074, Germany
| | - Shuo Zhang
- Philips GmbH Market DACH, Hamburg, Germany
| | - Marc Huppertz
- Department of Diagnostic and Interventional Radiology, Medical Faculty, RWTH Aachen University, Pauwelsstr. 30, Aachen, 52074, Germany
| | - Manuel Post
- Department of Diagnostic and Interventional Radiology, Medical Faculty, RWTH Aachen University, Pauwelsstr. 30, Aachen, 52074, Germany
| | - Can Yüksel
- Department of Diagnostic and Interventional Radiology, Medical Faculty, RWTH Aachen University, Pauwelsstr. 30, Aachen, 52074, Germany
| | | | - Andreas Prescher
- Institute of Molecular and Cellular Anatomy, RWTH Aachen University, Aachen, 52074, Germany
| | - Christiane Kuhl
- Department of Diagnostic and Interventional Radiology, Medical Faculty, RWTH Aachen University, Pauwelsstr. 30, Aachen, 52074, Germany
| | - Daniel Truhn
- Department of Diagnostic and Interventional Radiology, Medical Faculty, RWTH Aachen University, Pauwelsstr. 30, Aachen, 52074, Germany
| | - Sven Nebelung
- Department of Diagnostic and Interventional Radiology, Medical Faculty, RWTH Aachen University, Pauwelsstr. 30, Aachen, 52074, Germany
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Williams AA, Asay JL, Asare D, Desai AD, Gold GE, Hargreaves BA, Chaudhari AS, Chu CR. Reproducibility of Quantitative Double-Echo Steady-State T 2 Mapping of Knee Cartilage. J Magn Reson Imaging 2024. [PMID: 38703134 DOI: 10.1002/jmri.29431] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2024] [Revised: 04/18/2024] [Accepted: 04/19/2024] [Indexed: 05/06/2024] Open
Abstract
BACKGROUND Cartilage T2 can detect joints at risk of developing osteoarthritis. The quantitative double-echo steady state (qDESS) sequence is attractive for knee cartilage T2 mapping because of its acquisition time of under 5 minutes. Understanding the reproducibility errors associated with qDESS T2 is essential to profiling the technical performance of this biomarker. PURPOSE To examine the combined acquisition and segmentation reproducibility of knee cartilage qDESS T2 using two different regional analysis schemes: 1) manual segmentation of subregions loaded during common activities and 2) automatic subregional segmentation. STUDY TYPE Prospective. SUBJECTS 11 uninjured participants (age: 28 ± 3 years; 8 (73%) female). FIELD STRENGTH/SEQUENCE 3-T, qDESS. ASSESSMENT Test-retest T2 maps were acquired twice on the same day and with a 1-week interval between scans. For each acquisition, average cartilage T2 was calculated in four manually segmented regions encompassing tibiofemoral contact areas during common activities and 12 automatically segmented regions from the deep-learning open-source framework for musculoskeletal MRI analysis (DOSMA) encompassing medial and lateral anterior, central, and posterior tibiofemoral regions. Test-retest T2 values from matching regions were used to evaluate reproducibility. STATISTICAL TESTS Coefficients of variation (%CV), root-mean-square-average-CV (%RMSA-CV), and intraclass correlation coefficients (ICCs) assessed test-retest T2 reproducibility. The median of test-retest standard deviations was used for T2 precision. Bland-Altman (BA) analyses examined test-retest biases. The smallest detectable difference (SDD) was defined as the BA limit of agreement of largest magnitude. Significance was accepted for P < 0.05. RESULTS All cartilage regions across both segmentation schemes demonstrated intraday and interday qDESS T2 CVs and RMSA-CVs of ≤5%. T2 ICC values >0.75 were observed in the majority of regions but were more variable in interday tibial comparisons. Test-retest T2 precision was <1.3 msec. The T2 SDD was 3.8 msec. DATA CONCLUSION Excellent CV and RMSA-CV reproducibility may suggest that qDESS T2 increases or decreases >5% (3.8 msec) could represent changes to cartilage composition. LEVEL OF EVIDENCE: 2 TECHNICAL EFFICACY Stage 2.
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Affiliation(s)
- Ashley A Williams
- Department of Orthopaedic Surgery, Stanford University, Stanford, California, USA
- VA Palo Alto Health Care System, Palo Alto, California, USA
| | - Jessica L Asay
- Department of Radiology, Stanford University, Stanford, California, USA
| | - Daniella Asare
- VA Palo Alto Health Care System, Palo Alto, California, USA
| | - Arjun D Desai
- Department of Radiology, Stanford University, Stanford, California, USA
- Department of Electrical Engineering, Stanford University, Stanford, California, USA
| | - Garry E Gold
- Department of Radiology, Stanford University, Stanford, California, USA
- Department of Bioengineering, Stanford University, Stanford, California, USA
| | - Brian A Hargreaves
- Department of Radiology, Stanford University, Stanford, California, USA
- Department of Electrical Engineering, Stanford University, Stanford, California, USA
- Department of Bioengineering, Stanford University, Stanford, California, USA
| | - Akshay S Chaudhari
- Department of Radiology, Stanford University, Stanford, California, USA
- Department of Biomedical Data Science, Stanford University, Stanford, California, USA
| | - Constance R Chu
- Department of Orthopaedic Surgery, Stanford University, Stanford, California, USA
- VA Palo Alto Health Care System, Palo Alto, California, USA
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Harkey MS, Michel N, Grozier C, Slade JM, Collins K, Pietrosimone B, Lalush D, Lisee C, Hacihaliloglu I, Fajardo R. Femoral cartilage ultrasound echo-intensity is a valid measure of cartilage composition. J Orthop Res 2024; 42:729-736. [PMID: 37874323 PMCID: PMC10978297 DOI: 10.1002/jor.25722] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/30/2023] [Revised: 08/17/2023] [Accepted: 10/17/2023] [Indexed: 10/25/2023]
Abstract
This study aimed to create a conversion equation that accurately predicts cartilage magnetic resonance imaging (MRI) T2 relaxation times using ultrasound echo-intensity and common participant demographics. We recruited 15 participants with a primary anterior cruciate ligament reconstruction between the ages of 18 and 35 years at 1-5 years after surgery. A single investigator completed a transverse suprapatellar scan with the ACLR limb in max knee flexion to image the femoral trochlea cartilage. A single reader manually segmented the femoral cartilage cross-sectional area to assess the echo-intensity (i.e., mean gray-scale pixel value). At a separate visit, a T2 mapping sequence with the MRI beam set to an oblique angle was used to image the femoral trochlea cartilage. A single reader manually segmented the cartilage cross-sectional area on a single MRI slice to assess the T2 relaxation time. A stepwise, multiple linear regression was used to predict T2 relaxation time from cartilage echo-intensity and common demographic variables. We created a conversion equation using the regression betas and then used an ICC and Bland-Altman plot to assess agreement between the estimated and true T2 relaxation time. Cartilage ultrasound echo-intensity and age significantly predicted T2 relaxation time (F = 7.33, p = 0.008, R2 = 0.55). When using the new conversion equation to estimate T2 relaxation time from cartilage echo-intensity and age, there was strong agreement between the estimated and true T2 relaxation time (ICC2,k = 0.84). This study provides promising preliminary data that cartilage echo-intensity combined with age can be used as a clinically accessible tool for evaluating cartilage composition.
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Affiliation(s)
- Matthew S Harkey
- Department of Kinesiology, Michigan State University, East Lansing, Michigan, USA
| | - Nicholas Michel
- College of Osteopathic Medicine, Michigan State University, East Lansing, Michigan, USA
| | - Corey Grozier
- Department of Kinesiology, Michigan State University, East Lansing, Michigan, USA
| | - Jill M Slade
- Department of Radiology, Michigan State University, East Lansing, Michigan, USA
| | - Katherine Collins
- Department of Kinesiology, Michigan State University, East Lansing, Michigan, USA
| | - Brian Pietrosimone
- Department of Exercise and Sports Science, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
| | - David Lalush
- Department of Biomedical Engineering, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
| | - Caroline Lisee
- Department of Exercise and Sports Science, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
| | - Ilker Hacihaliloglu
- Department of Radiology, Department of Medicine, University of British Columbia, Vancouver, Canada
| | - Ryan Fajardo
- Department of Radiology, Michigan State University, East Lansing, Michigan, USA
- Lansing Radiology Associates, Lansing, Michigan, USA
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11
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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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12
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Tong MW, Tolpadi AA, Bhattacharjee R, Han M, Majumdar S, Pedoia V. Synthetic Knee MRI T 1p Maps as an Avenue for Clinical Translation of Quantitative Osteoarthritis Biomarkers. Bioengineering (Basel) 2023; 11:17. [PMID: 38247894 PMCID: PMC10812962 DOI: 10.3390/bioengineering11010017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2023] [Revised: 12/15/2023] [Accepted: 12/21/2023] [Indexed: 01/23/2024] Open
Abstract
A 2D U-Net was trained to generate synthetic T1p maps from T2 maps for knee MRI to explore the feasibility of domain adaptation for enriching existing datasets and enabling rapid, reliable image reconstruction. The network was developed using 509 healthy contralateral and injured ipsilateral knee images from patients with ACL injuries and reconstruction surgeries acquired across three institutions. Network generalizability was evaluated on 343 knees acquired in a clinical setting and 46 knees from simultaneous bilateral acquisition in a research setting. The deep neural network synthesized high-fidelity reconstructions of T1p maps, preserving textures and local T1p elevation patterns in cartilage with a normalized mean square error of 2.4% and Pearson's correlation coefficient of 0.93. Analysis of reconstructed T1p maps within cartilage compartments revealed minimal bias (-0.10 ms), tight limits of agreement, and quantification error (5.7%) below the threshold for clinically significant change (6.42%) associated with osteoarthritis. In an out-of-distribution external test set, synthetic maps preserved T1p textures, but exhibited increased bias and wider limits of agreement. This study demonstrates the capability of image synthesis to reduce acquisition time, derive meaningful information from existing datasets, and suggest a pathway for standardizing T1p as a quantitative biomarker for osteoarthritis.
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Affiliation(s)
- Michelle W. Tong
- Department of Radiology and Biomedical Imaging, University of California San Francisco, San Francisco, CA 94143, USA (S.M.); (V.P.)
- Department of Bioengineering, University of California Berkeley, Berkeley, CA 94720, USA
| | - Aniket A. Tolpadi
- Department of Radiology and Biomedical Imaging, University of California San Francisco, San Francisco, CA 94143, USA (S.M.); (V.P.)
- Department of Bioengineering, University of California Berkeley, Berkeley, CA 94720, USA
| | - Rupsa Bhattacharjee
- Department of Radiology and Biomedical Imaging, University of California San Francisco, San Francisco, CA 94143, USA (S.M.); (V.P.)
| | - Misung Han
- Department of Radiology and Biomedical Imaging, University of California San Francisco, San Francisco, CA 94143, USA (S.M.); (V.P.)
| | - Sharmila Majumdar
- Department of Radiology and Biomedical Imaging, University of California San Francisco, San Francisco, CA 94143, USA (S.M.); (V.P.)
| | - Valentina Pedoia
- Department of Radiology and Biomedical Imaging, University of California San Francisco, San Francisco, CA 94143, USA (S.M.); (V.P.)
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13
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Farrow LD, Elias JJ, Li M, Yang M, Lartey R, Winalski CS, Li X. Patellar Dislocation in Adolescent Patients: Influence on Cartilage Properties Based on T1ρ Relaxation Times. Am J Sports Med 2023; 51:3714-3723. [PMID: 37897349 PMCID: PMC11087140 DOI: 10.1177/03635465231205562] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/30/2023]
Abstract
BACKGROUND Adolescents who experience a patellar dislocation have an elevated risk of patellofemoral posttraumatic osteoarthritis. Magnetic resonance imaging (MRI)-based T1ρ relaxation times were measured for adolescents to evaluate patellofemoral cartilage after patellar dislocation. Long T1ρ relaxation times are an indicator of cartilage degradation. HYPOTHESIS The primary hypothesis is that patellofemoral cartilage T1ρ relaxation times will be elevated in the acute phase after patellar dislocation. The secondary hypothesis is that T1ρ relaxation times will be higher for knees with multiple rather than single dislocations due to repeated traumatic injury. STUDY DESIGN Cross-sectional study; Level of evidence, 3. METHODS In total, 23 adolescents being treated for a recent patellar dislocation, 13 for a first-time dislocation (47 ± 38 days since most recent dislocation) and 10 for multiple dislocations (55 ± 24 days since most recent dislocation), and 10 healthy controls participated in MRI-based T1ρ relaxation time mapping. For multiple regions of the patellofemoral joint, mean T1ρ values were compared between the 3 groups with multiple group comparisons and post hoc tests. T1ρ relaxation times were also correlated against measures of patellofemoral anatomy and alignment for single and multiple dislocations. Statistical significance was set at P < .05. RESULTS T1ρ relaxation times were significantly longer for injured knees (single and multiple dislocations) than controls at the medial and central patella and central trochlear groove. For the regions on the patella, significant differences between injured and control knees exceeded 15%. No significant differences were identified between single and multiple dislocations. For the initial dislocation group, T1ρ relaxation times within multiple regions of the patellofemoral joint were significantly correlated with lateral patellar alignment or patellar height. CONCLUSION Elevated patellofemoral cartilage T1ρ relaxation times are consistent with a high risk of long-term patellofemoral osteoarthritis for adolescents who experience patellar dislocations. T1ρ relaxation times were elevated for multiple regions of patellofemoral cartilage. T1ρ relaxation times were expected to increase with additional dislocation episodes, but relaxation times after single and multiple dislocations were similar. After a first dislocation, parameters related to patellar maltracking were correlated with cartilage degradation.
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Affiliation(s)
| | | | - Mei Li
- Cleveland Clinic, Cleveland, OH, USA
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14
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Oei EHG, Runhaar J. Imaging of early-stage osteoarthritis: the needs and challenges for diagnosis and classification. Skeletal Radiol 2023; 52:2031-2036. [PMID: 37154872 PMCID: PMC10509094 DOI: 10.1007/s00256-023-04355-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/07/2022] [Revised: 04/26/2023] [Accepted: 04/27/2023] [Indexed: 05/10/2023]
Abstract
In an effort to boost the development of new management strategies for OA, there is currently a shift in focus towards the diagnosis and treatment of early-stage OA. It is important to distinguish diagnosis from classification of early-stage OA. Diagnosis takes place in clinical practice, whereas classification is a process to stratify participants with OA in clinical research. For both purposes, there is an important opportunity for imaging, especially with MRI. The needs and challenges differ for early-stage OA diagnosis versus classification. Although it fulfils the need of high sensitivity and specificity for making a correct diagnosis, implementation of MRI in clinical practice is challenged by long acquisition times and high costs. For classification in clinical research, more advanced MRI protocols can be applied, such as quantitative, contrast-enhanced, or hybrid techniques, as well as advanced image analysis methods including 3D morphometric assessments of joint tissues and artificial intelligence approaches. It is necessary to follow a step-wise and structured approach that comprises, technical validation, biological validation, clinical validation, qualification, and cost-effectiveness, before new imaging biomarkers can be implemented in clinical practice or clinical research.
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Affiliation(s)
- Edwin H. G. Oei
- Department of Radiology & Nuclear Medicine, Erasmus MC University Medical Center Rotterdam, PO-Box 2040, 3000 CA Rotterdam, the Netherlands
| | - Jos Runhaar
- Department of General Practice, Erasmus MC University Medical Center Rotterdam, PO-Box 2040, 3000 CA Rotterdam, the Netherlands
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15
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Okada S, Taniguchi M, Yagi M, Motomura Y, Okada S, Fukumoto Y, Kobayashi M, Kanemitsu K, Ichihashi N. Ultrasonographic echo intensity in the medial femoral cartilage is enhanced prior to cartilage thinning in women with early mild knee osteoarthritis. Knee Surg Sports Traumatol Arthrosc 2023; 31:3964-3970. [PMID: 37140655 DOI: 10.1007/s00167-023-07440-w] [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] [Received: 01/22/2023] [Accepted: 04/23/2023] [Indexed: 05/05/2023]
Abstract
PURPOSE We aimed to determine whether altered cartilage echo intensity is associated with knee osteoarthritis (OA) severity and whether the alteration occurs before thinning of the femoral cartilage in knee OA. METHODS The medial femoral cartilage thickness and echo intensity of 118 women aged ≥ 50 years were assessed using an ultrasound imaging device. Based on the Kellgren-Lawrence (KL) grade and knee symptoms, participants were classified into five groups: control (asymptomatic grades 0-1), early OA (symptomatic grade 1), grade 2, grade 3, and grade 4. Analysis of covariance, with adjusted age and height, and the Sidak post hoc test were used to assess the differences in cartilage thickness and echo intensity in knees with varying OA severity. RESULTS The echo intensity on longitudinal images, equivalent to the tibiofemoral weight-bearing surface, was significantly higher in the grade 2 group than that in the control group (p = 0.049). However, no significant difference was noted in cartilage thickness (n.s.). In the grades 3 and 4 groups, cartilage thickness became thinner as OA progressed (p < 0.001 and p < 0.001, respectively). However, the cartilage echo intensity was not significantly enhanced compared with that of the grade 2 group (n.s.). There were no significant differences in the cartilage thickness and echo intensity between the early OA and control groups on the longitudinal images (n.s.). CONCLUSIONS The echo intensity of the medial femoral cartilage was high in patients with KL grade 2, without decreased thickness. Our findings suggested that higher echo intensity is a feature of early cartilage degeneration in mild knee OA. Further studies are needed to establish this feature as a useful screening parameter of early cartilage degeneration in knee OA. LEVEL OF EVIDENCE Level III.
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Affiliation(s)
- Shogo Okada
- A Human Health Sciences, Graduate School of Medicine, Kyoto University, 53 Kawahara-Cho, Shogoin, Sakyo-Ku, Kyoto, 606-8507, Japan
| | - Masashi Taniguchi
- A Human Health Sciences, Graduate School of Medicine, Kyoto University, 53 Kawahara-Cho, Shogoin, Sakyo-Ku, Kyoto, 606-8507, Japan.
| | - Masahide Yagi
- A Human Health Sciences, Graduate School of Medicine, Kyoto University, 53 Kawahara-Cho, Shogoin, Sakyo-Ku, Kyoto, 606-8507, Japan
| | - Yoshiki Motomura
- A Human Health Sciences, Graduate School of Medicine, Kyoto University, 53 Kawahara-Cho, Shogoin, Sakyo-Ku, Kyoto, 606-8507, Japan
- Kobayashi Hospital, 50-35 Kuzetakada-Cho, Minami-Ku, Kyoto, 601-8211, Japan
| | - Sayaka Okada
- A Human Health Sciences, Graduate School of Medicine, Kyoto University, 53 Kawahara-Cho, Shogoin, Sakyo-Ku, Kyoto, 606-8507, Japan
| | - Yoshihiro Fukumoto
- A Human Health Sciences, Graduate School of Medicine, Kyoto University, 53 Kawahara-Cho, Shogoin, Sakyo-Ku, Kyoto, 606-8507, Japan
- Faculty of Rehabilitation, Kansai Medical University, 18-89 Uyamahigashicho, Hirakata, Osaka, 573-1136, Japan
| | - Masashi Kobayashi
- Kobayashi Hospital, 50-35 Kuzetakada-Cho, Minami-Ku, Kyoto, 601-8211, Japan
| | - Kyoseki Kanemitsu
- Kanemitsu Clinic, 33-2 Enmamae-Cho, Kamigyo-Ku, Kyoto, 602-8307, Japan
| | - Noriaki Ichihashi
- A Human Health Sciences, Graduate School of Medicine, Kyoto University, 53 Kawahara-Cho, Shogoin, Sakyo-Ku, Kyoto, 606-8507, Japan
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16
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Coburn SL, Crossley KM, Kemp JL, Warden SJ, West TJ, Bruder AM, Mentiplay BF, Culvenor AG. Immediate and Delayed Effects of Joint Loading Activities on Knee and Hip Cartilage: A Systematic Review and Meta-analysis. SPORTS MEDICINE - OPEN 2023; 9:56. [PMID: 37450202 PMCID: PMC10348990 DOI: 10.1186/s40798-023-00602-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 11/24/2022] [Accepted: 06/19/2023] [Indexed: 07/18/2023]
Abstract
BACKGROUND The impact of activity-related joint loading on cartilage is not clear. Abnormal loading is considered to be a mechanical driver of osteoarthritis (OA), yet moderate amounts of physical activity and rehabilitation exercise can have positive effects on articular cartilage. Our aim was to investigate the immediate effects of joint loading activities on knee and hip cartilage in healthy adults, as assessed using magnetic resonance imaging. We also investigated delayed effects of activities on healthy cartilage and the effects of activities on cartilage in adults with, or at risk of, OA. We explored the association of sex, age and loading duration with cartilage changes. METHODS A systematic review of six databases identified studies assessing change in adult hip and knee cartilage using MRI within 48 h before and after application of a joint loading intervention/activity. Studies included adults with healthy cartilage or those with, or at risk of, OA. Joint loading activities included walking, hopping, cycling, weightbearing knee bends and simulated standing within the scanner. Risk of bias was assessed using the Newcastle-Ottawa Scale. Random-effects meta-analysis estimated the percentage change in compartment-specific cartilage thickness or volume and composition (T2 relaxation time) outcomes. The Grading of Recommendations Assessment, Development and Evaluation (GRADE) system evaluated certainty of evidence. RESULTS Forty studies of 653 participants were included after screening 5159 retrieved studies. Knee cartilage thickness or volume decreased immediately following all loading activities investigating healthy adults; however, GRADE assessment indicated very low certainty evidence. Patellar cartilage thickness and volume reduced 5.0% (95% CI 3.5, 6.4, I2 = 89.3%) after body weight knee bends, and tibial cartilage composition (T2 relaxation time) decreased 5.1% (95% CI 3.7, 6.5, I2 = 0.0%) after simulated standing within the scanner. Hip cartilage data were insufficient for pooling. Secondary outcomes synthesised narratively suggest knee cartilage recovers within 30 min of walking and 90 min of 100 knee bends. We found contrasting effects of simulated standing and walking in adults with, or at risk of, OA. An increase of 10 knee bend repetitions was associated with 2% greater reduction in patellar thickness or volume. CONCLUSION There is very low certainty evidence that minimal knee cartilage thickness and volume and composition (T2 relaxation time) reductions (0-5%) occur after weightbearing knee bends, simulated standing, walking, hopping/jumping and cycling, and the impact of knee bends may be dose dependent. Our findings provide a framework of cartilage responses to loading in healthy adults which may have utility for clinicians when designing and prescribing rehabilitation programs and providing exercise advice.
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Affiliation(s)
- Sally L. Coburn
- La Trobe Sport and Exercise Medicine Research Centre, School of Allied Health, Human Services and Sport, La Trobe University, Melbourne, VIC Australia
| | - Kay M. Crossley
- La Trobe Sport and Exercise Medicine Research Centre, School of Allied Health, Human Services and Sport, La Trobe University, Melbourne, VIC Australia
| | - Joanne L. Kemp
- La Trobe Sport and Exercise Medicine Research Centre, School of Allied Health, Human Services and Sport, La Trobe University, Melbourne, VIC Australia
| | - Stuart J. Warden
- La Trobe Sport and Exercise Medicine Research Centre, School of Allied Health, Human Services and Sport, La Trobe University, Melbourne, VIC Australia
- Department of Physical Therapy, School of Health & Human Sciences, Indiana University, Indianapolis, IN USA
| | - Tom J. West
- La Trobe Sport and Exercise Medicine Research Centre, School of Allied Health, Human Services and Sport, La Trobe University, Melbourne, VIC Australia
| | - Andrea M. Bruder
- La Trobe Sport and Exercise Medicine Research Centre, School of Allied Health, Human Services and Sport, La Trobe University, Melbourne, VIC Australia
| | - Benjamin F. Mentiplay
- La Trobe Sport and Exercise Medicine Research Centre, School of Allied Health, Human Services and Sport, La Trobe University, Melbourne, VIC Australia
| | - Adam G. Culvenor
- La Trobe Sport and Exercise Medicine Research Centre, School of Allied Health, Human Services and Sport, La Trobe University, Melbourne, VIC Australia
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17
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Ogura T, Katagiri T, Kameda H. Cartilage evaluation by ultrasonography in patients with rheumatoid arthritis: a scoping review. Inflamm Regen 2023; 43:34. [PMID: 37403142 DOI: 10.1186/s41232-023-00286-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2023] [Accepted: 06/20/2023] [Indexed: 07/06/2023] Open
Abstract
BACKGROUND This study aimed to provide an overview of ultrasonographic cartilage evaluation in patients with rheumatoid arthritis (RA) and identify research gaps in the utilization of cartilage evaluation. METHODS The study was conducted in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses Extension for Scoping Reviews guidelines. A systematic literature search of the PubMed, Embase, and Cochrane Library databases was conducted for articles published up to July 2022 using the search term variations of "cartilage," "ultrasonography," and "rheumatoid arthritis." Studies that included patients with RA who underwent cartilage evaluation by ultrasonography were selected. Articles published in languages other than English and about juvenile idiopathic arthritis were excluded. RESULTS Twenty-nine articles were identified. Most were cross-sectional studies (86%), mainly involving the metacarpophalangeal (55%) and knee (34%) joints. Assessments were performed using quantitative, binary, and semi-quantitative methods in 15, 10, and 15 studies, respectively. Reliability assessments were conducted in 10 studies, which showed feasible reliability but were limited to the finger joints. The validity assessment was validated in one study each that compared cartilage thickness measurements with cadaveric specimens and histological and semi-quantitative methods with surgical specimens, respectively. Comparisons with conventional radiography were also performed in six studies, which showed significant correlations. However, there was heterogeneity in the examination and assessment methods, and no adequate longitudinal evaluation was conducted. CONCLUSION This review highlights the need for further research and validation of ultrasonographic cartilage assessment in patients with RA.
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Affiliation(s)
- Takehisa Ogura
- Department of Internal Medicine, Division of Rheumatology, Faculty of Medicine, Toho University, 2-22-36, Ohashi, Meguro-Ku, Tokyo, 153-8515, Japan.
| | - Takaharu Katagiri
- Department of Internal Medicine, Division of Rheumatology, Faculty of Medicine, Toho University, 2-22-36, Ohashi, Meguro-Ku, Tokyo, 153-8515, Japan
| | - Hideto Kameda
- Department of Internal Medicine, Division of Rheumatology, Faculty of Medicine, Toho University, 2-22-36, Ohashi, Meguro-Ku, Tokyo, 153-8515, Japan
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18
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Zibetti MVW, Menon RG, de Moura HL, Zhang X, Kijowski R, Regatte RR. Updates on Compositional MRI Mapping of the Cartilage: Emerging Techniques and Applications. J Magn Reson Imaging 2023; 58:44-60. [PMID: 37010113 PMCID: PMC10323700 DOI: 10.1002/jmri.28689] [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: 01/18/2023] [Revised: 03/06/2023] [Accepted: 03/06/2023] [Indexed: 04/04/2023] Open
Abstract
Osteoarthritis (OA) is a widely occurring degenerative joint disease that is severely debilitating and causes significant socioeconomic burdens to society. Magnetic resonance imaging (MRI) is the preferred imaging modality for the morphological evaluation of cartilage due to its excellent soft tissue contrast and high spatial resolution. However, its utilization typically involves subjective qualitative assessment of cartilage. Compositional MRI, which refers to the quantitative characterization of cartilage using a variety of MRI methods, can provide important information regarding underlying compositional and ultrastructural changes that occur during early OA. Cartilage compositional MRI could serve as early imaging biomarkers for the objective evaluation of cartilage and help drive diagnostics, disease characterization, and response to novel therapies. This review will summarize current and ongoing state-of-the-art cartilage compositional MRI techniques and highlight emerging methods for cartilage compositional MRI including MR fingerprinting, compressed sensing, multiexponential relaxometry, improved and robust radio-frequency pulse sequences, and deep learning-based acquisition, reconstruction, and segmentation. The review will also briefly discuss the current challenges and future directions for adopting these emerging cartilage compositional MRI techniques for use in clinical practice and translational OA research studies. EVIDENCE LEVEL: 2 TECHNICAL EFFICACY: Stage 2.
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Affiliation(s)
- Marcelo V. W. Zibetti
- Center of Biomedical Imaging, Department of Radiology, New York University Grossman School of Medicine, New York, New York, USA
| | - Rajiv G. Menon
- Center of Biomedical Imaging, Department of Radiology, New York University Grossman School of Medicine, New York, New York, USA
| | - Hector L. de Moura
- Center of Biomedical Imaging, Department of Radiology, New York University Grossman School of Medicine, New York, New York, USA
| | - Xiaoxia Zhang
- Center of Biomedical Imaging, Department of Radiology, New York University Grossman School of Medicine, New York, New York, USA
| | - Richard Kijowski
- Center of Biomedical Imaging, Department of Radiology, New York University Grossman School of Medicine, New York, New York, USA
| | - Ravinder R. Regatte
- Center of Biomedical Imaging, Department of Radiology, New York University Grossman School of Medicine, New York, New York, USA
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19
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Xie D, Tanaka M, Pedoia V, Li AK, Facchetti L, Neumann J, Lartey R, Souza RB, Link TM, Ma CB, Li X. Baseline cartilage T1ρ and T2 predicted patellofemoral joint cartilage lesion progression and patient-reported outcomes after ACL reconstruction. J Orthop Res 2023; 41:1310-1319. [PMID: 36268873 PMCID: PMC10413330 DOI: 10.1002/jor.25473] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/29/2021] [Revised: 08/25/2022] [Accepted: 10/18/2022] [Indexed: 02/04/2023]
Abstract
This study aims to determine if baseline T1ρ and T2 will predict cartilage morphological lesion progression in the patellofemoral joint (PFJ) and patient-reported outcomes at 2-year after anterior cruciate ligament (ACL) reconstruction (ACLR). Thirty-nine ACL-injured patients were studied at baseline and two-year after ACLR. 3 T MR T1ρ and T2 images and Knee Injury and Osteoarthritis Outcome Score (KOOS) were acquired at both time points. Voxel-based relaxometry (VBR) technique was used to detect local cartilage abnormalities. Patients were divided into progression and non-progression groups based on changes of the whole-organ magnetic resonance imaging scoring (WORMS) grading of cartilage in PFJ from baseline to 2-year, and into lower (more pain) and higher (less pain) KOOS pain groups based on 2-year KOOS pain scores, separately. Voxel-based analyses of covariance were used to compare T1ρ and T2 values at baseline between the defined groups. Using VBR analysis, the progression group at 2-year showed higher T1ρ and T2 compared with the non-progression group at baseline, with the medial femoral condyle showing the largest areas with significant differences. At two-year, 56% of patients were able to recover with respect to KOOS pain. The lower KOOS pain group at 2-year showed significantly elevated T1ρ and T2 in the patella at baseline compared with the higher KOOS pain group. In conclusion, baseline T1ρ and T2 mapping, combined with VBR analysis, may help identify ACLR patients at high risk of developing progressive PFJ cartilage lesions and worse clinical symptoms 2-year after surgery.
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Affiliation(s)
- Dongxing Xie
- Program of Advanced Musculoskeletal Imaging, Department of
Biomedical Engineering, Lerner Research Institute, Cleveland Clinic, Cleveland,
Ohio, USA
- Department of Orthopaedics, Xiangya Hospital, Central South
University, Changsha, Hunan, China
| | - Matthew Tanaka
- Department of Radiology and Biomedical Imaging, University
of California, San Francisco, San Francisco, California, USA
| | - Valentina Pedoia
- Department of Radiology and Biomedical Imaging, University
of California, San Francisco, San Francisco, California, USA
| | - Alan K. Li
- Department of Radiology and Biomedical Imaging, University
of California, San Francisco, San Francisco, California, USA
| | - Luca Facchetti
- Department of Radiology and Biomedical Imaging, University
of California, San Francisco, San Francisco, California, USA
| | - Jan Neumann
- Department of Radiology and Biomedical Imaging, University
of California, San Francisco, San Francisco, California, USA
| | - Richard Lartey
- Program of Advanced Musculoskeletal Imaging, Department of
Biomedical Engineering, Lerner Research Institute, Cleveland Clinic, Cleveland,
Ohio, USA
| | - Richard B. Souza
- Department of Physical Therapy and Rehabilitation Science,
University of California, San Francisco, San Francisco, California, USA
| | - Thomas M. Link
- Department of Radiology and Biomedical Imaging, University
of California, San Francisco, San Francisco, California, USA
| | - C. Benjamin Ma
- Department of Orthopaedic Surgery, University of
California, San Francisco, San Francisco, California, USA
| | - Xiaojuan Li
- Program of Advanced Musculoskeletal Imaging, Department of
Biomedical Engineering, Lerner Research Institute, Cleveland Clinic, Cleveland,
Ohio, USA
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20
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Kijowski R, Sharafi A, Zibetti MV, Chang G, Cloos MA, Regatte RR. Age-Dependent Changes in Knee Cartilage T 1 , T 2 , and T 1p Simultaneously Measured Using MRI Fingerprinting. J Magn Reson Imaging 2023; 57:1805-1812. [PMID: 36190187 PMCID: PMC10067532 DOI: 10.1002/jmri.28451] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2022] [Revised: 09/13/2022] [Accepted: 09/15/2022] [Indexed: 11/11/2022] Open
Abstract
BACKGROUND Magnetic resonance fingerprinting (MRF) techniques have been recently described for simultaneous multiparameter cartilage mapping of the knee although investigation of their ability to detect early cartilage degeneration remains limited. PURPOSE To investigate age-dependent changes in knee cartilage T1 , T2 , and T1p relaxation times measured using a three-dimensional (3D) MRF sequence in healthy volunteers. STUDY TYPE Prospective. SUBJECTS The study group consisted of 24 healthy asymptomatic human volunteers (15 males with mean age 34.9 ± 14.4 years and 9 females with mean age 44.5 ± 13.1 years). FIELD STRENGTH/SEQUENCE A 3.0 T gradient-echo-based 3D-MRF sequence was used to simultaneously create proton density-weighted images and T1 , T2 , and T1p maps of knee cartilage. ASSESSMENT Mean global cartilage and regional cartilage (lateral femur, lateral tibia, medial femur, medial tibia, and patella) T1 , T2 , and T1ρ relaxation times of the knee were measured. STATISTICAL TESTS Kruskal-Wallis tests were used to compared cartilage T1 , T2 , and T1ρ relaxation times between different age groups, while Spearman correlation coefficients was used to determine the association between age and cartilage T1 , T2 , and T1ρ relaxation times. The value of P < 0.05 was considered statistically significant. RESULTS Higher age groups showed higher global and regional cartilage T1 , T2 , and T1ρ . There was a significant difference between age groups in global cartilage T2 and T1ρ but no significant difference (P = 0.13) in global cartilage T1. Significant difference was also present between age groups in cartilage T2 and T1ρ for medial femur cartilage and medial tibia cartilage. There were significant moderate correlations between age and T2 and T1ρ for global cartilage (R2 = 0.63-0.64), medial femur cartilage (R2 = 0.50-0.56), and medial tibia cartilage (R2 = 0.54-0.66). CONCLUSION Cartilage T2 and T1p relaxation times simultaneously measured using a 3D-MRF sequence in healthy volunteers showed age-dependent changes in knee cartilage, primarily within the medial compartment.
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Affiliation(s)
- Richard Kijowski
- Bernard and Irene Schwartz Center of Biomedical Imaging, Department of Radiology, New York University Grossman School of Medicine, New York, NY, 10016, USA
| | - Azadeh Sharafi
- Bernard and Irene Schwartz Center of Biomedical Imaging, Department of Radiology, New York University Grossman School of Medicine, New York, NY, 10016, USA
| | - Marcelo V.W. Zibetti
- Bernard and Irene Schwartz Center of Biomedical Imaging, Department of Radiology, New York University Grossman School of Medicine, New York, NY, 10016, USA
| | - Gregory Chang
- Bernard and Irene Schwartz Center of Biomedical Imaging, Department of Radiology, New York University Grossman School of Medicine, New York, NY, 10016, USA
| | - Martijn A. Cloos
- Center of Advanced Imaging, University of Queensland, Brisbane, QLD, Australia
- ARC Training Center for Innovation in Biomedical Imaging Technology, University of Queensland, Brisbane, QLD, Australia
| | - Ravinder R. Regatte
- Bernard and Irene Schwartz Center of Biomedical Imaging, Department of Radiology, New York University Grossman School of Medicine, New York, NY, 10016, USA
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21
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Martel-Pelletier J, Paiement P, Pelletier JP. Magnetic resonance imaging assessments for knee segmentation and their use in combination with machine/deep learning as predictors of early osteoarthritis diagnosis and prognosis. Ther Adv Musculoskelet Dis 2023; 15:1759720X231165560. [PMID: 37151912 PMCID: PMC10155034 DOI: 10.1177/1759720x231165560] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2022] [Accepted: 03/23/2023] [Indexed: 05/09/2023] Open
Abstract
Knee osteoarthritis (OA) is a prevalent and disabling disease that can develop over decades. This disease is heterogeneous and involves structural changes in the whole joint, encompassing multiple tissue types. Detecting OA before the onset of irreversible changes is crucial for early management, and this could be achieved by allowing knee tissue visualization and quantifying their changes over time. Although some imaging modalities are available for knee structure assessment, magnetic resonance imaging (MRI) is preferred. This narrative review looks at existing literature, first on MRI-developed approaches for evaluating knee articular tissues, and second on prediction using machine/deep-learning-based methodologies and MRI as input or outcome for early OA diagnosis and prognosis. A substantial number of MRI methodologies have been developed to assess several knee tissues in a semi-quantitative and quantitative fashion using manual, semi-automated and fully automated systems. This dynamic field has grown substantially since the advent of machine/deep learning. Another active area is predictive modelling using machine/deep-learning methodologies enabling robust early OA diagnosis/prognosis. Moreover, incorporating MRI markers as input/outcome in such predictive models is important for a more accurate OA structural diagnosis/prognosis. The main limitation of their usage is the ability to move them in rheumatology practice. In conclusion, MRI knee tissue determination and quantification provide early indicators for individuals at high risk of developing this disease or for patient prognosis. Such assessment of knee tissues, combined with the development of models/tools from machine/deep learning using, in addition to other parameters, MRI markers for early diagnosis/prognosis, will maximize opportunities for individualized risk assessment for use in clinical practice permitting precision medicine. Future efforts should be made to integrate such prediction models into open access, allowing early disease management to prevent or delay the OA outcome.
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Affiliation(s)
- Johanne Martel-Pelletier
- Osteoarthritis Research Unit, University of
Montreal Hospital Research Centre (CRCHUM), 900 Saint-Denis, R11.412B,
Montreal, QC H2X 0A9, Canada
| | - Patrice Paiement
- Osteoarthritis Research Unit, University of
Montreal Hospital Research Centre (CRCHUM), Montreal, QC, Canada
| | - Jean-Pierre Pelletier
- Osteoarthritis Research Unit, University of
Montreal Hospital Research Centre (CRCHUM), Montreal, QC, Canada
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22
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Cao G, Gao S, Xiong B. Application of quantitative T1, T2 and T2* mapping magnetic resonance imaging in cartilage degeneration of the shoulder joint. Sci Rep 2023; 13:4558. [PMID: 36941288 PMCID: PMC10027866 DOI: 10.1038/s41598-023-31644-2] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2022] [Accepted: 03/15/2023] [Indexed: 03/23/2023] Open
Abstract
To investigate and compare the values of 3.0 T MRI T1, T2 and T2* mapping quantification techniques in evaluating cartilage degeneration of the shoulder joint. This study included 123 shoulder joints of 119 patients, which were scanned in 3.0 T MRI with axial Fat Suppression Proton Density Weighted Image (FS-PDWI), sagittal fat suppression T2 Weighted Image (FS-T2WI), coronal T1Weighted Image (T1WI), FS-PDWI, cartilage-specific T1, T2 and T2* mapping sequences. Basing on MRI images, the shoulder cartilage was classified into grades 0 1, 2, 3 and 4 according to the International Cartilage Regeneration & Joint Preservation Society (ICRS). The grading of shoulder cartilage was based on MRI images with ICRS as reference, and did not involve arthroscopy or histology.The T1, T2 and T2* relaxation values in the superior, middle and inferior bands of shoulder articular cartilage were measured at all grades, and the differences in various indicators between groups were analyzed and compared using a single-factor ANOVA test. The correlation between T1, T2 and T2* relaxation values and MRI-based grading was analyzed by SPSS software. There were 46 shoulder joints with MRI-based grade 0 in healthy control group (n = 46), while 49 and 28 shoulder joints with grade 1-2 (mild degeneration subgroup) and grade 3-4 (severe degeneration subgroup) in patient group (n = 73), accounting for 63.6% and 36.4%, respectively. The T1, T2 and T2* relaxation values of the superior, middle and inferior bands of shoulder articular cartilage were significantly and positively correlated with the MRI-based grading (P < 0.01). MRI-basedgrading of shoulder cartilage was markedly associated with age (r = 0.766, P < 0.01). With the aggravation of cartilage degeneration, T1, T2 and T2* relaxation values showed an upward trend (all P < 0.01), and T1, T2 and T2* mapping could distinguish cartilage degeneration at all levels (all P < 0.01). The T1, T2 and T2* relaxation values were significantly different between normal group and mild degeneration subgroup, normal group and severe degeneration subgroup, mild degeneration subgroup and severe degeneration subgroup (all P < 0.05). Quantitative T1, T2 and T2* mapping can quantify the degree of shoulder cartilage degeneration. All these MRI mapping quantification techniques can be used as critical supplementary sequences to assess shoulder cartilage degeneration, among which T2 mapping has the highest value.
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Affiliation(s)
- Guijuan Cao
- Department of Radiology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Jiefang Avenue #1277, 430022, Wuhan, Hubei, China
- Department of Radiology, the Central Hospital of Wuhan, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Shubo Gao
- Department of Radiology, the Central Hospital of Wuhan, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Bin Xiong
- Department of Radiology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Jiefang Avenue #1277, 430022, Wuhan, Hubei, China.
- Department of Interventional Radiology, The First Affiliated Hospital of Guangzhou Medical University, The First Affiliated Hospital of Guangzhou Medical University, Guangzhou, China.
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23
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Lartey R, Nanavati A, Kim J, Li M, Xu K, Nakamura K, Shin W, Winalski CS, Obuchowski N, Bahroos E, Link TM, Hardy PA, Peng Q, Kim J, Liu K, Fung M, Wu C, Li X. Reproducibility of T 1ρ and T 2 quantification in a multi-vendor multi-site study. Osteoarthritis Cartilage 2023; 31:249-257. [PMID: 36370959 PMCID: PMC10016129 DOI: 10.1016/j.joca.2022.10.017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/17/2022] [Revised: 10/08/2022] [Accepted: 10/10/2022] [Indexed: 11/11/2022]
Abstract
OBJECTIVE To evaluate the multi-vendor multi-site reproducibility of two-dimensional (2D) multi-echo spin-echo (MESE) T2 mapping (product sequences); and to evaluate the longitudinal reproducibility of three-dimensional (3D) magnetization-prepared angle-modulated partitioned k-space spoiled gradient echo snapshots (MAPSS) T1ρ and T2 mapping (research sequences), and 2D MESE T2 mapping, separated by 6 months, in a multi-vendor multi-site setting. METHODS Phantoms and volunteers (n = 5 from each site, n = 20 in total) were scanned on four 3 T magnetic resonance (MR) systems from four sites and three vendors (Siemens, General Electric, and Phillips). Two traveling volunteers (3 knees) scanned at all 4 sites at baseline and 6-month follow-up. Data was transferred to one site for centralized processing. Coefficients of variation (CVs) were calculated to evaluate reproducibility. RESULTS For baseline 2D MESE T2 measures, average CV were 0.37-2.45% (intra-site) and 5.96% (inter-site) for phantoms, and 3.15-8.49% (intra-site) and 14.16% (inter-site) for volunteers. For longitudinal phantom data, intra-site CVs were 1.42-3.48% for 3D MAPSS T1ρ, 1.77-3.56% for 3D MAPSS T2, and 1.02-2.54% for 2D MESE T2. For the longitudinal volunteer data, the intra-site CVs were 2.60-4.86% for 3D MAPSS T1ρ, 3.33-7.25% for 3D MAPSS T2, and 3.11-8.77% for 2D MESE T2. CONCLUSION This study demonstrated excellent intra-site reproducibility of 2D MESE T2 imaging, while its inter-site variation was slightly higher than 3D MAPSS T2 imaging (10.06% as previously reported). This study also showed excellent reproducibility of longitudinal T1ρ and T2 cartilage quantification, in a multi-vendor multi-site setting for both product 2D MESE T2 and 3D MAPSS T1p/T2 research sequences.
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Affiliation(s)
- R Lartey
- Program of Advanced Musculoskeletal Imaging (PAMI), Cleveland Clinic, OH, USA; Department of Biomedical Engineering, Lerner Research Institute, Cleveland Clinic, OH, USA
| | - A Nanavati
- Program of Advanced Musculoskeletal Imaging (PAMI), Cleveland Clinic, OH, USA; Department of Biomedical Engineering, Lerner Research Institute, Cleveland Clinic, OH, USA
| | - J Kim
- Program of Advanced Musculoskeletal Imaging (PAMI), Cleveland Clinic, OH, USA; Department of Biomedical Engineering, Lerner Research Institute, Cleveland Clinic, OH, USA
| | - M Li
- Program of Advanced Musculoskeletal Imaging (PAMI), Cleveland Clinic, OH, USA; Department of Biomedical Engineering, Lerner Research Institute, Cleveland Clinic, OH, USA
| | - K Xu
- Program of Advanced Musculoskeletal Imaging (PAMI), Cleveland Clinic, OH, USA; Department of Biomedical Engineering, Lerner Research Institute, Cleveland Clinic, OH, USA
| | - K Nakamura
- Program of Advanced Musculoskeletal Imaging (PAMI), Cleveland Clinic, OH, USA; Department of Biomedical Engineering, Lerner Research Institute, Cleveland Clinic, OH, USA
| | - W Shin
- Program of Advanced Musculoskeletal Imaging (PAMI), Cleveland Clinic, OH, USA; Department of Diagnostic Radiology, Imaging Institute, Cleveland Clinic, OH, USA
| | - C S Winalski
- Program of Advanced Musculoskeletal Imaging (PAMI), Cleveland Clinic, OH, USA; Department of Biomedical Engineering, Lerner Research Institute, Cleveland Clinic, OH, USA; Department of Diagnostic Radiology, Imaging Institute, Cleveland Clinic, OH, USA
| | - N Obuchowski
- Program of Advanced Musculoskeletal Imaging (PAMI), Cleveland Clinic, OH, USA; Quantitative Health Sciences, Lerner Research Institute, Cleveland Clinic, OH, USA
| | - E Bahroos
- Department of Radiology and Biomedical Imaging, University of California, San Francisco (UCSF), CA, USA
| | - T M Link
- Department of Radiology and Biomedical Imaging, University of California, San Francisco (UCSF), CA, USA
| | - P A Hardy
- Department of Radiology, University of Kentucky, Lexington KY, USA
| | - Q Peng
- Department of Radiology, Albert Einstein College of Medicine and Montefiore Medical Center, Bronx, NY, USA
| | - J Kim
- Arthritis Foundation, GA, USA
| | - K Liu
- Siemens Medical Solution Inc., USA
| | - M Fung
- GE Healthcare, Waukesha, WI, USA
| | - C Wu
- Department of Medical Physics, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - X Li
- Program of Advanced Musculoskeletal Imaging (PAMI), Cleveland Clinic, OH, USA; Department of Biomedical Engineering, Lerner Research Institute, Cleveland Clinic, OH, USA; Department of Diagnostic Radiology, Imaging Institute, Cleveland Clinic, OH, USA.
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24
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Eck BL, Yang M, Elias JJ, Winalski CS, Altahawi F, Subhas N, Li X. Quantitative MRI for Evaluation of Musculoskeletal Disease: Cartilage and Muscle Composition, Joint Inflammation, and Biomechanics in Osteoarthritis. Invest Radiol 2023; 58:60-75. [PMID: 36165880 PMCID: PMC10198374 DOI: 10.1097/rli.0000000000000909] [Citation(s) in RCA: 10] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
ABSTRACT Magnetic resonance imaging (MRI) is a valuable tool for evaluating musculoskeletal disease as it offers a range of image contrasts that are sensitive to underlying tissue biochemical composition and microstructure. Although MRI has the ability to provide high-resolution, information-rich images suitable for musculoskeletal applications, most MRI utilization remains in qualitative evaluation. Quantitative MRI (qMRI) provides additional value beyond qualitative assessment via objective metrics that can support disease characterization, disease progression monitoring, or therapy response. In this review, musculoskeletal qMRI techniques are summarized with a focus on techniques developed for osteoarthritis evaluation. Cartilage compositional MRI methods are described with a detailed discussion on relaxometric mapping (T 2 , T 2 *, T 1ρ ) without contrast agents. Methods to assess inflammation are described, including perfusion imaging, volume and signal changes, contrast-enhanced T 1 mapping, and semiquantitative scoring systems. Quantitative characterization of structure and function by bone shape modeling and joint kinematics are described. Muscle evaluation by qMRI is discussed, including size (area, volume), relaxometric mapping (T 1 , T 2 , T 1ρ ), fat fraction quantification, diffusion imaging, and metabolic assessment by 31 P-MR and creatine chemical exchange saturation transfer. Other notable technologies to support qMRI in musculoskeletal evaluation are described, including magnetic resonance fingerprinting, ultrashort echo time imaging, ultrahigh-field MRI, and hybrid MRI-positron emission tomography. Challenges for adopting and using qMRI in musculoskeletal evaluation are discussed, including the need for metal artifact suppression and qMRI standardization.
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Affiliation(s)
- Brendan L. Eck
- Program of Advanced Musculoskeletal Imaging, Cleveland Clinic, Cleveland, OH, USA
- Imaging Instute, Cleveland Clinic, Cleveland, OH, USA
| | - Mingrui Yang
- Program of Advanced Musculoskeletal Imaging, Cleveland Clinic, Cleveland, OH, USA
- Department of Biomedical Engineering, Lerner Research Institute, Cleveland Clinic, Cleveland, OH, USA
| | - John J. Elias
- Program of Advanced Musculoskeletal Imaging, Cleveland Clinic, Cleveland, OH, USA
- Department of Research, Cleveland Clinic Akron General, Akron, OH, USA
| | - Carl S. Winalski
- Program of Advanced Musculoskeletal Imaging, Cleveland Clinic, Cleveland, OH, USA
- Imaging Instute, Cleveland Clinic, Cleveland, OH, USA
- Department of Biomedical Engineering, Lerner Research Institute, Cleveland Clinic, Cleveland, OH, USA
| | - Faysal Altahawi
- Program of Advanced Musculoskeletal Imaging, Cleveland Clinic, Cleveland, OH, USA
- Imaging Instute, Cleveland Clinic, Cleveland, OH, USA
| | - Naveen Subhas
- Program of Advanced Musculoskeletal Imaging, Cleveland Clinic, Cleveland, OH, USA
- Imaging Instute, Cleveland Clinic, Cleveland, OH, USA
| | - Xiaojuan Li
- Program of Advanced Musculoskeletal Imaging, Cleveland Clinic, Cleveland, OH, USA
- Imaging Instute, Cleveland Clinic, Cleveland, OH, USA
- Department of Biomedical Engineering, Lerner Research Institute, Cleveland Clinic, Cleveland, OH, USA
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25
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Li H, Yang M, Kim JH, Zhang C, Liu R, Huang P, Liang D, Zhang X, Li X, Ying L. SuperMAP: Deep ultrafast MR relaxometry with joint spatiotemporal undersampling. Magn Reson Med 2023; 89:64-76. [PMID: 36128884 PMCID: PMC9617769 DOI: 10.1002/mrm.29411] [Citation(s) in RCA: 8] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2022] [Revised: 07/19/2022] [Accepted: 07/25/2022] [Indexed: 11/09/2022]
Abstract
PURPOSE To develop an ultrafast and robust MR parameter mapping network using deep learning. THEORY AND METHODS We design a deep learning framework called SuperMAP that directly converts a series of undersampled (both in k-space and parameter-space) parameter-weighted images into several quantitative maps, bypassing the conventional exponential fitting procedure. We also present a novel technique to simultaneously reconstruct T1rho and T2 relaxation maps within a single scan. Full data were acquired and retrospectively undersampled for training and testing using traditional and state-of-the-art techniques for comparison. Prospective data were also collected to evaluate the trained network. The performance of all methods is evaluated using the parameter qualification errors and other metrics in the segmented regions of interest. RESULTS SuperMAP achieved accurate T1rho and T2 mapping with high acceleration factors (R = 24 and R = 32). It exploited both spatial and temporal information and yielded low error (normalized mean square error of 2.7% at R = 24 and 2.8% at R = 32) and high resemblance (structural similarity of 97% at R = 24 and 96% at R = 32) to the gold standard. The network trained with retrospectively undersampled data also works well for the prospective data (with a slightly lower acceleration factor). SuperMAP is also superior to conventional methods. CONCLUSION Our results demonstrate the feasibility of generating superfast MR parameter maps through very few undersampled parameter-weighted images. SuperMAP can simultaneously generate T1rho and T2 relaxation maps in a short scan time.
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Affiliation(s)
- Hongyu Li
- Electrical Engineering, University at Buffalo, State University of New York, Buffalo, NY, USA
| | - Mingrui Yang
- Program of Advanced Musculoskeletal Imaging (PAMI), Cleveland Clinic, Cleveland, Ohio, USA
| | - Jee Hun Kim
- Program of Advanced Musculoskeletal Imaging (PAMI), Cleveland Clinic, Cleveland, Ohio, USA
| | - Chaoyi Zhang
- Electrical Engineering, University at Buffalo, State University of New York, Buffalo, NY, USA
| | - Ruiying Liu
- Electrical Engineering, University at Buffalo, State University of New York, Buffalo, NY, USA
| | - Peizhou Huang
- Electrical Engineering, University at Buffalo, State University of New York, Buffalo, NY, USA
| | - Dong Liang
- Paul C. Lauterbur Research Center for Biomedical Imaging, Medical AI research center, SIAT, CAS, Shenzhen, China
| | - Xiaoliang Zhang
- Biomedical Engineering, University at Buffalo, State University at New York, Buffalo, NY, USA
| | - Xiaojuan Li
- Program of Advanced Musculoskeletal Imaging (PAMI), Cleveland Clinic, Cleveland, Ohio, USA
| | - Leslie Ying
- Electrical Engineering, University at Buffalo, State University of New York, Buffalo, NY, USA
- Biomedical Engineering, University at Buffalo, State University at New York, Buffalo, NY, USA
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26
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Li X, Roemer FW, Cicuttini F, MacKay JW, Turmezei T, Link TM. Early knee OA definition-what do we know at this stage? An imaging perspective. Ther Adv Musculoskelet Dis 2023; 15:1759720X231158204. [PMID: 36937824 PMCID: PMC10017942 DOI: 10.1177/1759720x231158204] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2022] [Accepted: 02/01/2023] [Indexed: 03/16/2023] Open
Abstract
While criteria for early-stage knee osteoarthritis (OA) in a primary care setting have been proposed, the role of imaging has been limited to radiography using the standard Kellgren-Lawrence classification. Standardized imaging and interpretation are critical with radiographs, yet studies have also shown that even early stages of radiographic OA already demonstrate advanced damage to knee joint tissues such as cartilage, menisci, and bone marrow. Morphological magnetic resonance imaging (MRI) shows degenerative damage earlier than radiographs and definitions for OA using MRI have been published though no accepted definition of early OA based on MRI is currently available. The clinical significance of structural abnormalities has also not been well defined, and the differentiation between normal aging and structural OA development remains a challenge. Compositional MRI of cartilage provides information on biochemical, degenerative changes within the cartilage matrix before cartilage defects occur and when cartilage damage is potentially reversible. Studies have shown that cartilage composition can predict cartilage loss and radiographic OA. However, while this technology is most promising for characterizing early OA it has currently limited clinical application. Better standardization of compositional MRI is required, which is currently work in progress. Finally, there has been renewed interest in computed tomography (CT) for assessing early knee OA as new techniques such as weight bearing and spectral CT are available, which may provide information on joint loading, cartilage, and bone and potentially have a role in better characterizing early OA. In conclusion, while imaging may have a limited role in diagnosing early OA in a primary care setting, there are advanced imaging technologies available, which detect early degeneration and may thus significantly alter management as new therapeutic modalities evolve.
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Affiliation(s)
- Xiaojuan Li
- Department of Biomedical Engineering, Lerner Research Institute, Cleveland Clinic, Cleveland, OH, USA
| | - Frank W. Roemer
- Department of Radiology, University of Erlangen-Nuremberg, Erlangen, Germany
| | - Flavia Cicuttini
- Musculoskeletal Unit, Monash University and Rheumatology, Alfred Hospital, Melbourne, VIC, Australia
| | - Jamie W. MacKay
- Department of Radiology, University of Cambridge, Cambridge, UK
- Norwich Medical School, University of East Anglia, Norwich, UK
| | - Tom Turmezei
- Department of Radiology, Norfolk and Norwich University Hospital, Norwich, UK
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27
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Xie D, Murray J, Lartey R, Gaj S, Kim J, Li M, Eck BL, Winalski CS, Altahawi F, Jones MH, Obuchowski NA, Huston LJ, Harkins KD, Friel HT, Damon BM, Knopp MV, Kaeding CC, Spindler KP, Li X. Multi-vendor multi-site quantitative MRI analysis of cartilage degeneration 10 Years after anterior cruciate ligament reconstruction: MOON-MRI protocol and preliminary results. Osteoarthritis Cartilage 2022; 30:1647-1657. [PMID: 36049665 PMCID: PMC9671830 DOI: 10.1016/j.joca.2022.08.006] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/08/2022] [Revised: 07/12/2022] [Accepted: 08/01/2022] [Indexed: 02/02/2023]
Abstract
OBJECTIVE To describe the protocol of a multi-vendor, multi-site quantitative MRI study for knee post-traumatic osteoarthritis (PTOA), and to present preliminary results of cartilage degeneration using MR T1ρ and T2 imaging 10 years after anterior cruciate ligament reconstruction (ACLR). DESIGN This study involves three sites and two MR platforms. The patients are from a nested cohort (termed as Onsite cohort) within the Multicenter Orthopaedic Outcomes Network (MOON) cohort 10 years after ACLR. Phantoms and controls were scanned for evaluating reproducibility. Cartilage was automatically segmented, and T1ρ and T2 were compared between operated, contralateral, and control knees. RESULTS Sixty-eight ACL-reconstructed patients and 20 healthy controls were included. In phantoms, the intra-site coefficients of variation (CVs) of repeated scans ranged 1.8-2.1% for T1ρ and 1.3-1.7% for T2. The inter-site CVs ranged 1.6-2.1% for T1ρ and 1.1-1.4% for T2. In human subjects, the intra-site scan/rescan CVs ranged 2.2-3.5% for T1ρ and 2.6-4.9% for T2 for the six major compartments. In patients, operated knees showed significantly higher T1ρ and T2 values mainly in medial femoral condyle, medial tibia and trochlear cartilage compared with contralateral knees, and showed significantly higer T1ρ and T2 values in all six compartments compared to healthy control knees. The patient contralateral knees showed higher T1ρ and T2 values mainly in the lateral femoral condyle, lateral tibia, trochlear, and patellar cartilage compared to healthy control knees. CONCLUSION A platform and workflow with rigorous quality control has been established for a multi-vendor multi-site quantitative MRI study in evaluating PTOA 10 years after ACLR. Our preliminary report suggests significant cartilage matrix changes in both operated and contralateral knees compared with healthy control knees.
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Affiliation(s)
- D Xie
- Program of Advanced Musculoskeletal Imaging (PAMI), Cleveland Clinic, Cleveland, OH, USA; Department of Biomedical Engineering, Lerner Research Institute, Cleveland Clinic, Cleveland, OH, USA; Department of Orthopaedics, Xiangya Hospital, Central South University, Changsha, Hunan, China.
| | - J Murray
- Program of Advanced Musculoskeletal Imaging (PAMI), Cleveland Clinic, Cleveland, OH, USA; Department of Biomedical Engineering, Lerner Research Institute, Cleveland Clinic, Cleveland, OH, USA.
| | - R Lartey
- Program of Advanced Musculoskeletal Imaging (PAMI), Cleveland Clinic, Cleveland, OH, USA; Department of Biomedical Engineering, Lerner Research Institute, Cleveland Clinic, Cleveland, OH, USA.
| | - S Gaj
- Program of Advanced Musculoskeletal Imaging (PAMI), Cleveland Clinic, Cleveland, OH, USA; Department of Biomedical Engineering, Lerner Research Institute, Cleveland Clinic, Cleveland, OH, USA.
| | - J Kim
- Program of Advanced Musculoskeletal Imaging (PAMI), Cleveland Clinic, Cleveland, OH, USA; Department of Biomedical Engineering, Lerner Research Institute, Cleveland Clinic, Cleveland, OH, USA.
| | - M Li
- Program of Advanced Musculoskeletal Imaging (PAMI), Cleveland Clinic, Cleveland, OH, USA; Department of Biomedical Engineering, Lerner Research Institute, Cleveland Clinic, Cleveland, OH, USA.
| | - B L Eck
- Program of Advanced Musculoskeletal Imaging (PAMI), Cleveland Clinic, Cleveland, OH, USA; Department of Diagnostic Radiology, Imaging Institute, Cleveland Clinic, Cleveland, OH, USA.
| | - C S Winalski
- Program of Advanced Musculoskeletal Imaging (PAMI), Cleveland Clinic, Cleveland, OH, USA; Department of Biomedical Engineering, Lerner Research Institute, Cleveland Clinic, Cleveland, OH, USA; Department of Diagnostic Radiology, Imaging Institute, Cleveland Clinic, Cleveland, OH, USA.
| | - F Altahawi
- Program of Advanced Musculoskeletal Imaging (PAMI), Cleveland Clinic, Cleveland, OH, USA; Department of Diagnostic Radiology, Imaging Institute, Cleveland Clinic, Cleveland, OH, USA.
| | - M H Jones
- Department of Orthopaedic Surgery, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA.
| | - N A Obuchowski
- Program of Advanced Musculoskeletal Imaging (PAMI), Cleveland Clinic, Cleveland, OH, USA; Department of Quantitative Health Sciences, Lerner Research Institute, Cleveland Clinic, Cleveland, OH, USA.
| | - L J Huston
- Department of Orthopaedics and Rehabilitation, Vanderbilt University Medical Center, Nashville, TN, USA.
| | - K D Harkins
- Departments of Radiology and Radiological Sciences, Vanderbilt University Medical Center, Nashville, TN, USA.
| | - H T Friel
- MR Clinical Science, Philips Healthcare, Highland Heights, OH, USA.
| | - B M Damon
- Departments of Radiology and Radiological Sciences, Vanderbilt University Medical Center, Nashville, TN, USA.
| | - M V Knopp
- Wright Center of Innovation in Biomedical Imaging, Department of Radiology, The Ohio State University, Columbus, OH, USA.
| | - C C Kaeding
- Department of Orthopaedic Surgery, The Ohio State University, Columbus, OH, USA.
| | - K P Spindler
- Program of Advanced Musculoskeletal Imaging (PAMI), Cleveland Clinic, Cleveland, OH, USA; Department of Orthopaedic Surgery, Cleveland Clinic, Cleveland, OH, USA.
| | - X Li
- Program of Advanced Musculoskeletal Imaging (PAMI), Cleveland Clinic, Cleveland, OH, USA; Department of Biomedical Engineering, Lerner Research Institute, Cleveland Clinic, Cleveland, OH, USA; Department of Diagnostic Radiology, Imaging Institute, Cleveland Clinic, Cleveland, OH, USA.
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Fuerst D, Wirth W, Gaisberger M, Hunter DJ, Eckstein F. Association of Superficial Cartilage Transverse Relaxation Time With Osteoarthritis Disease Progression: Data From the Foundation for the National Institutes of Health Biomarker Study of the Osteoarthritis Initiative. Arthritis Care Res (Hoboken) 2022; 74:1888-1893. [PMID: 33973402 PMCID: PMC8578581 DOI: 10.1002/acr.24627] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2020] [Revised: 04/11/2021] [Accepted: 04/20/2021] [Indexed: 01/07/2023]
Abstract
OBJECTIVE To study whether layer-specific cartilage transverse relaxation time (T2) and/or longitudinal change is associated with clinically relevant knee osteoarthritis (OA) disease progression. METHODS The Foundation for the National Institutes of Health Biomarker Consortium was a nested case-control study on 600 knees from 600 Osteoarthritis Initiative participants. Progressor knees had both medial tibiofemoral radiographic joint space width (JSW) loss (≥0.7 mm) and a persistent increase in Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) pain score (≥9 on a 0-100 scale) at 24-48 months from baseline (n = 194). Multiecho spin-echo (MESE) magnetic resonance images (MRIs) for cartilage T2 analysis had been acquired in the right knees only (97 progressor knees). These were compared to 104 control knees without JSW or pain progression. Fifty-three knees had JSW progression, and 57 pain progression only. Cartilage thickness segmentations obtained from double-echo steady-state MRI were matched to MESE MRI to extract superficial and deep femorotibial cartilage T2. Superficial medial femorotibial compartment (MFTC) T2 at baseline was the primary, and change in deep MFTC T2 between baseline and 12 months was the secondary analytic outcome of this post hoc exploratory study. RESULTS Baseline superficial MFTC T2 was significantly elevated in progressor knees (adjusted mean 47.2 msec [95% confidence interval (95% CI) 46.5, 48.0]) and JSW progression only knees (adjusted mean 47.3 msec [95% CI 46.3, 48.3]), respectively, versus non-progressor knees (45.8 msec [95% CI 45.0, 46.5]) after adjustment for age, sex, body mass index, WOMAC pain score, and medial joint space narrowing grade (analysis of covariance). Change in T2 was not significantly associated with case status. CONCLUSION Baseline superficial, but not deep, medial cartilage T2 is associated with clinically relevant disease progression in knee OA.
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Affiliation(s)
- David Fuerst
- Paracelsus Medical University Salzburg and Nuremberg, Salzburg, Austria, and ChondrometricsAinringGermany
| | - Wolfgang Wirth
- Paracelsus Medical University Salzburg and Nuremberg, Salzburg, Austria, and ChondrometricsAinringGermany
| | | | - David J. Hunter
- Royal North Shore Hospital and Institute of Bone and Joint Research, Kolling Institute, University of SydneySydneyNew South WalesAustralia
| | - Felix Eckstein
- Paracelsus Medical University Salzburg and Nuremberg, Salzburg, Austria, and ChondrometricsAinringGermany
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Liu S, Li H, Liu Y, Cheng G, Yang G, Wang H, Zheng H, Liang D, Zhu Y. Highly accelerated MR parametric mapping by undersampling the k-space and reducing the contrast number simultaneously with deep learning. Phys Med Biol 2022; 67. [DOI: 10.1088/1361-6560/ac8c81] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2022] [Accepted: 08/24/2022] [Indexed: 11/12/2022]
Abstract
Abstract
Introduction. To propose a novel deep learning-based method called RG-Net (reconstruction and generation network) for highly accelerated MR parametric mapping by undersampling k-space and reducing the acquired contrast number simultaneously. Methods. The proposed framework consists of a reconstruction module and a generative module. The reconstruction module reconstructs MR images from the acquired few undersampled k-space data with the help of a data prior. The generative module then synthesizes the remaining multi-contrast images from the reconstructed images, where the exponential model is implicitly incorporated into the image generation through the supervision of fully sampled labels. The RG-Net was trained and tested on the T1ρ
mapping data from 8 volunteers at net acceleration rates of 17, respectively. Regional T1ρ
analysis for cartilage and the brain was performed to assess the performance of RG-Net. Results. RG-Net yields a high-quality T1ρ
map at a high acceleration rate of 17. Compared with the competing methods that only undersample k-space, our framework achieves better performance in T1ρ
value analysis. Conclusion. The proposed RG-Net can achieve a high acceleration rate while maintaining good reconstruction quality by undersampling k-space and reducing the contrast number simultaneously for fast MR parametric mapping. The generative module of our framework can also be used as an insertable module in other fast MR parametric mapping methods.
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Lombardi AF, Chang EY, Du J. Editorial for 'Quantitative T2 and T1ρ mapping are sensitive to ischemic injury to the epiphyseal cartilage in an in vivo piglet model of Legg-Calvé-Perthes disease'. Osteoarthritis Cartilage 2022; 30:1155-1156. [PMID: 35803488 DOI: 10.1016/j.joca.2022.06.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/09/2022] [Revised: 06/18/2022] [Accepted: 06/24/2022] [Indexed: 02/02/2023]
Affiliation(s)
- A F Lombardi
- Department of Radiology, University of California, San Diego, CA, USA; Research Service, Veterans Affairs San Diego Healthcare System, CA, USA
| | - E Y Chang
- Department of Radiology, University of California, San Diego, CA, USA; Research Service, Veterans Affairs San Diego Healthcare System, CA, USA
| | - J Du
- Department of Radiology, University of California, San Diego, CA, USA; Research Service, Veterans Affairs San Diego Healthcare System, CA, USA.
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Quantitative evaluation of the tibiofemoral joint cartilage by T2 mapping in patients with acute anterior cruciate ligament injury vs contralateral knees: results from the subacute phase using data from the NACOX study cohort. Osteoarthritis Cartilage 2022; 30:987-997. [PMID: 35421548 DOI: 10.1016/j.joca.2022.02.623] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/24/2021] [Revised: 02/03/2022] [Accepted: 02/09/2022] [Indexed: 02/02/2023]
Abstract
OBJECTIVE Immediate cartilage structural alterations in the acute phase after an anterior cruciate ligament (ACL) rupture may be a precursor to posttraumatic osteoarthritis (PTOA) development. Our aim was to describe changes in cartilage matrix in the subacute phase of the acutely ACL-injured knee compared to the contralateral uninjured knee. DESIGN Participants (n = 118) aged 15-40 years with an acute ACL injury were consecutively included in subacute phase after acute ACL-injury and underwent MRI (mean 29 days post trauma) of both knees. Mean T2 relaxation times, T2 spatial coefficient of variation and cartilage thickness were determined for different regions of the tibiofemoral cartilage. Differences between the acutely ACL-injured and uninjured knee were evaluated using Wilcoxon signed-rank test. RESULTS T2 relaxation time in injured knees was increased in multiple cartilage regions from both medial and lateral compartment compared to contralateral knees, mostly in medial trochlea and posterior tibia (P-value<0.001). In the same sites of injured knees, we observed significantly thinner cartilage. Moreover, injured knees presented shorter T2 relaxation time in superficial cartilage on lateral central femur and trochlea (P-value<0.001), and decreased T2 spatial coefficient of variation in lateral trochlea and load bearing regions of medial-central femoral condyle and central tibia in both compartments. CONCLUSION Small but statistically significant differences were observed in the subacute phase between ACL-injured and uninjured knee in cartilage T2 relaxation time and cartilage thickness. Future longitudinal observations of the same cohort will allow for better understanding of early development of PTOA. TRIAL REGISTRATION NUMBER NCT02931084.
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Roemer FW, Guermazi A, Demehri S, Wirth W, Kijowski R. Imaging in Osteoarthritis. Osteoarthritis Cartilage 2022; 30:913-934. [PMID: 34560261 DOI: 10.1016/j.joca.2021.04.018] [Citation(s) in RCA: 17] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/31/2021] [Revised: 04/22/2021] [Accepted: 04/28/2021] [Indexed: 02/02/2023]
Abstract
Osteoarthritis (OA) is the most frequent form of arthritis with major implications on both individual and public health care levels. The field of joint imaging, and particularly magnetic resonance imaging (MRI), has evolved rapidly due to the application of technical advances to the field of clinical research. This narrative review will provide an introduction to the different aspects of OA imaging aimed at an audience of scientists, clinicians, students, industry employees, and others who are interested in OA but who do not necessarily focus on OA. The current role of radiography and recent advances in measuring joint space width will be discussed. The status of cartilage morphology assessment and evaluation of cartilage biochemical composition will be presented. Advances in quantitative three-dimensional morphologic cartilage assessment and semi-quantitative whole-organ assessment of OA will be reviewed. Although MRI has evolved as the most important imaging method used in OA research, other modalities such as ultrasound, computed tomography, and metabolic imaging play a complementary role and will also be discussed.
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Affiliation(s)
- F W Roemer
- Quantitative Imaging Center, Department of Radiology, Boston University School of Medicine, FGH Building, 3rd Floor, 820 Harrison Ave, Boston, MA, 02118, USA; Department of Radiology, Friedrich-Alexander University Erlangen-Nürnberg (FAU) and Universitätsklinikum Erlangen, Maximiliansplatz 3, Erlangen, 91054, Germany.
| | - A Guermazi
- Quantitative Imaging Center, Department of Radiology, Boston University School of Medicine, FGH Building, 3rd Floor, 820 Harrison Ave, Boston, MA, 02118, USA; Department of Radiology, VA Boston Healthcare System, 1400 VFW Pkwy, Suite 1B105, West Roxbury, MA, 02132, USA
| | - S Demehri
- Russell H. Morgan Department of Radiology and Radiological Science, Johns Hopkins University School of Medicine, 600 N. Wolf Street, Park 311, Baltimore, MD, 21287, USA
| | - W Wirth
- Institute of Anatomy, Paracelsus Medical University Salzburg, Salzburg, Austria, Nüremberg, Germany; Ludwig Boltzmann Institute for Arthritis and Rehabilitation, Paracelsus Medical University Salzburg, Strubergasse 21, 5020, Salzburg, Austria; Chondrometrics, GmbH, Freilassing, Germany
| | - R Kijowski
- Department of Radiology, New York University Grossmann School of Medicine, 550 1st Avenue, 3nd Floor, New York, NY, 10016, USA
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Elias JJ, Li M, Yang M, Lartey R, Murray JP, Farrow LD, Winalski CS, Li X. Elevated Patellofemoral and Tibiofemoral T1ρ Relaxation Times Following a First Time Patellar Dislocation. Cartilage 2022; 13:19476035221102570. [PMID: 35676874 PMCID: PMC9189536 DOI: 10.1177/19476035221102570] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Abstract
OBJECTIVE The study was performed to evaluate cartilage within the knee following a first-time patellar dislocation, using elevated MRI-based T1ρ relaxation times as an indicator of low proteoglycan concentration. The hypothesis is that MRI-based T1ρ relaxation times for patellofemoral and tibiofemoral cartilage are significantly longer for knees being treated for patellar dislocation than for healthy control knees. DESIGN Twenty-one subjects being treated for a first-time, unilateral dislocation of the patella and 16 healthy controls participated in MRI-based T1ρ relaxation time mapping. Mean relaxation times were quantified for patellofemoral and tibiofemoral regions for injured knees, the contralateral knees, and healthy controls. T1ρ values for each region were compared between the 3 groups with generalized estimating equations. Linear regressions were also performed to correlate T1ρ relaxation times with time from injury. RESULTS The knees with a disloction had longer T1ρ relaxation times than the contralateral knees and control group at the medial patella and longer relaxation times than the control group at the lateral tibia (P < 0.05). T1ρ relaxation times at the medial patella also decreased with time from injury (r2 = 0.21, P = 0.037). CONCLUSIONS Compositional changes to cartilage on the medial patella are related to traumatic impact during a dislocation. Potential exists for cartilage properties at the medial patella to improve with time. Cartilage degradation at the lateral tibia is not directly related to traumatic impact. The current baseline data are a starting point to characterize the pathway from a first-time dislocation to progressive cartilage degradation and osteoarthritis.
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Affiliation(s)
- John J. Elias
- Department of Research, Cleveland Clinic Akron General, Akron, OH, USA,John J. Elias, Department of Research, Cleveland Clinic Akron General, 1 Akron General Avenue, Akron, OH 44302, USA.
| | - Mei Li
- Department of Biomedical Engineering, Cleveland Clinic, Cleveland, OH, USA
| | - Mingrui Yang
- Department of Biomedical Engineering, Cleveland Clinic, Cleveland, OH, USA
| | - Richard Lartey
- Department of Biomedical Engineering, Cleveland Clinic, Cleveland, OH, USA
| | - John P. Murray
- Department of Biomedical Engineering, Cleveland Clinic, Cleveland, OH, USA
| | - Lutul D. Farrow
- Orthopaedic & Rheumatologic Institute, Cleveland Clinic, Cleveland, OH, USA
| | - Carl S. Winalski
- Department of Diagnostic Radiology, Cleveland Clinic, Cleveland, OH, USA
| | - Xiaojuan Li
- Department of Biomedical Engineering, Cleveland Clinic, Cleveland, OH, USA
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Nieminen MT, Casula V, Nissi MJ. Compositional MRI of articular cartilage - current status and the way forward. Osteoarthritis Cartilage 2022; 30:633-635. [PMID: 35093515 DOI: 10.1016/j.joca.2022.01.006] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/18/2021] [Revised: 12/27/2021] [Accepted: 01/10/2022] [Indexed: 02/02/2023]
Affiliation(s)
- M T Nieminen
- Research Unit of Medical Imaging, Physics and Technology, University of Oulu, Oulu, Finland; Department of Diagnostic Radiology, Oulu University Hospital, Oulu, Finland; Medical Research Center, University of Oulu and Oulu University Hospital, Oulu, Finland.
| | - V Casula
- Research Unit of Medical Imaging, Physics and Technology, University of Oulu, Oulu, Finland; Medical Research Center, University of Oulu and Oulu University Hospital, Oulu, Finland
| | - M J Nissi
- Research Unit of Medical Imaging, Physics and Technology, University of Oulu, Oulu, Finland; Department of Applied Physics, University of Eastern Finland, Kuopio, Finland
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Emanuel KS, Kellner LJ, Peters MJM, Haartmans MJJ, Hooijmans MT, Emans PJ. The relation between the biochemical composition of knee articular cartilage and quantitative MRI: a systematic review and meta-analysis. Osteoarthritis Cartilage 2022; 30:650-662. [PMID: 34826570 DOI: 10.1016/j.joca.2021.10.016] [Citation(s) in RCA: 27] [Impact Index Per Article: 13.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/25/2021] [Revised: 10/20/2021] [Accepted: 10/21/2021] [Indexed: 02/02/2023]
Abstract
OBJECTIVE Early and non-invasive detection of osteoarthritis (OA) is required to enable early treatment and monitoring of interventions. Some of the earliest signs of OA are the change in proteoglycan and collagen composition. The aim of this study is to establish the relations between quantitative magnetic resonance imaging (MRI) and biochemical concentration and organization in knee articular cartilage. METHODS A preregistered systematic literature review was performed using the databases PubMed and Embase. Papers were included if quantitative MRI and a biochemical assay or polarized light microscopy (PLM) was performed on knee articular cartilage, and a quantified correlation was described. The extracted correlations were pooled using a random effects model. RESULTS 21 papers were identified. The strongest pooled correlation was found for delayed gadolinium-enhanced MRI of cartilage (dGEMRIC) vs proteoglycan concentration (r = 0.59). T1ρ relaxation times are inversely correlated to proteoglycan concentration (r = -0.54). A weak correlation between T2 relaxation times and proteoglycans was found (r = -0.38). No correlation between T2 relaxation time and collagen concentration was found (r = -0.02). A heterogeneous set of correlations between T2 relaxation times and PLM were identified, including strong correlations to anisotropy. CONCLUSION DGEMRIC measures are significantly correlated to proteoglycan concentration. The needed contrast agent is however a disadvantage; the T1ρ sequence was found as a non-invasive alternative. Remarkably, no correlation was found between T2 relaxation times and collagen concentration. T2 relaxation times is related to organization, rather than concentration of collagen fibers. PROSPERO ID CRD42020168337.
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Affiliation(s)
- K S Emanuel
- Department of Orthopedic Surgery, CAPHRI Care and Public Health Research Institute, Maastricht University Medical Center+, Maastricht, the Netherlands; Amsterdam UMC, University of Amsterdam, Department of Orthopaedic Surgery, Amsterdam Movement Sciences, Amsterdam, the Netherlands.
| | - L J Kellner
- Department of Orthopedic Surgery, CAPHRI Care and Public Health Research Institute, Maastricht University Medical Center+, Maastricht, the Netherlands.
| | - M J M Peters
- Department of Orthopedic Surgery, CAPHRI Care and Public Health Research Institute, Maastricht University Medical Center+, Maastricht, the Netherlands.
| | - M J J Haartmans
- Department of Orthopedic Surgery, CAPHRI Care and Public Health Research Institute, Maastricht University Medical Center+, Maastricht, the Netherlands.
| | - M T Hooijmans
- Amsterdam UMC, University of Amsterdam, Department of Biomedical Engineering and Physics, Amsterdam Movement Sciences, Amsterdam, the Netherlands.
| | - P J Emans
- Department of Orthopedic Surgery, CAPHRI Care and Public Health Research Institute, Maastricht University Medical Center+, Maastricht, the Netherlands.
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Fast, Accurate, and Robust T2 Mapping of Articular Cartilage by Neural Networks. Diagnostics (Basel) 2022; 12:diagnostics12030688. [PMID: 35328240 PMCID: PMC8947694 DOI: 10.3390/diagnostics12030688] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2022] [Revised: 02/25/2022] [Accepted: 03/09/2022] [Indexed: 12/31/2022] Open
Abstract
For T2 mapping, the underlying mono-exponential signal decay is traditionally quantified by non-linear Least-Squares Estimation (LSE) curve fitting, which is prone to outliers and computationally expensive. This study aimed to validate a fully connected neural network (NN) to estimate T2 relaxation times and to assess its performance versus LSE fitting methods. To this end, the NN was trained and tested in silico on a synthetic dataset of 75 million signal decays. Its quantification error was comparatively evaluated against three LSE methods, i.e., traditional methods without any modification, with an offset, and one with noise correction. Following in-situ acquisition of T2 maps in seven human cadaveric knee joint specimens at high and low signal-to-noise ratios, the NN and LSE methods were used to estimate the T2 relaxation times of the manually segmented patellofemoral cartilage. In-silico modeling at low signal-to-noise ratio indicated significantly lower quantification error for the NN (by medians of 6−33%) than for the LSE methods (p < 0.001). These results were confirmed by the in-situ measurements (medians of 10−35%). T2 quantification by the NN took only 4 s, which was faster than the LSE methods (28−43 s). In conclusion, NNs provide fast, accurate, and robust quantification of T2 relaxation times.
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Zibetti MVW, Sharafi A, Regatte RR. Optimization of spin-lock times in T 1ρ mapping of knee cartilage: Cramér-Rao bounds versus matched sampling-fitting. Magn Reson Med 2022; 87:1418-1434. [PMID: 34738252 PMCID: PMC8822470 DOI: 10.1002/mrm.29063] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2021] [Revised: 10/12/2021] [Accepted: 10/13/2021] [Indexed: 01/03/2023]
Abstract
PURPOSE To compare different optimization approaches for choosing the spin-lock times (TSLs), in spin-lattice relaxation time in the rotating frame (T1ρ ) mapping. METHODS Optimization criteria for TSLs based on Cramér-Rao lower bounds (CRLB) are compared with matched sampling-fitting (MSF) approaches for T1ρ mapping on synthetic data, model phantoms, and knee cartilage. The MSF approaches are optimized using robust methods for noisy cost functions. The MSF approaches assume that optimal TSLs depend on the chosen fitting method. An iterative non-linear least squares (NLS) and artificial neural networks (ANN) are tested as two possible T1ρ fitting methods for MSF approaches. RESULTS All optimized criteria were better than non-optimized ones. However, we observe that a modified CRLB and an MSF based on the mean of the normalized absolute error (MNAE) were more robust optimization approaches, performing well in all tested cases. The optimized TSLs obtained the best performance with synthetic data (3.5-8.0% error), model phantoms (1.5-2.8% error), and healthy volunteers (7.7-21.1% error), showing stable and improved quality results, comparing to non-optimized approaches (4.2-13.3% error on synthetic data, 2.1-6.2% error on model phantoms, 9.8-27.8% error on healthy volunteers). CONCLUSION A modified CRLB and the MSF based on MNAE are robust optimization approaches for choosing TSLs in T1ρ mapping. All optimized criteria allowed good results even using rapid scans with two TSLs when a complex-valued fitting is done with iterative NLS or ANN.
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Affiliation(s)
- Marcelo V W Zibetti
- Center for Biomedical Imaging, Department of Radiology, New York University School of Medicine, New York, NY, USA
| | - Azadeh Sharafi
- Center for Biomedical Imaging, Department of Radiology, New York University School of Medicine, New York, NY, USA
| | - Ravinder R Regatte
- Center for Biomedical Imaging, Department of Radiology, New York University School of Medicine, New York, NY, USA
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Atkinson HF, Birmingham TB, Schulz JM, Primeau CA, Leitch KM, Pritchett SL, Holdsworth DW, Giffin JR. High tibial osteotomy to neutral alignment improves medial knee articular cartilage composition. Knee Surg Sports Traumatol Arthrosc 2022; 30:1065-1074. [PMID: 33723653 DOI: 10.1007/s00167-021-06516-9] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/21/2020] [Accepted: 02/19/2021] [Indexed: 11/26/2022]
Abstract
PURPOSE The purpose of this study was to: (1) test the hypothesis that HTO improves articular cartilage composition in the medial compartment without adversely affecting the lateral compartment and patella, and; (2) explore associations between knee alignment and cartilage composition after surgery. METHODS 3T MRI and standing radiographs were obtained from 34 patients before and 1-year after HTO. Articular cartilage was segmented from T2 maps. Mechanical axis angle (MAA), posterior tibial slope, and patellar height were measured from radiographs. Changes in T2 and radiographic measures were assessed using paired t tests, and associations were assessed using Pearson correlation coefficients. RESULTS The mean (SD) MAA before and after HTO was - 6.5° (2.4) and 0.6° (3.0), respectively. There was statistically significant shortening [mean (95%CI)] of T2 in the medial femur [- 2.8 ms (- 4.2; - 1.3), p < 0.001] and medial tibia [- 2.2 ms (- 3.3; - 1.0), p < 0.001], without changes in the lateral femur [- 0.5 ms (- 1.6; 0.6), p = 0.3], lateral tibia [0.2 ms (- 0.8; 1.1), p = NS], or patella [0.5 ms (- 1.0; 2.1), p = NS). Associations between radiographic measures and T2 were low. 23% of the increase in lateral femur T2 was explained by postoperative posterior tibial slope (r = 0.48). CONCLUSION Performing medial opening wedge HTO without overcorrection improves articular cartilage composition in the medial compartment of the knee without compromising the lateral compartment or the patella. Although further research is required, these results suggest HTO is a disease structure-modifying treatment for knee OA.
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Affiliation(s)
- Hayden F Atkinson
- Robarts Research Institute, University of Western Ontario, London, Canada
- Bone and Joint Institute, University of Western Ontario, London, Canada
| | - Trevor B Birmingham
- Bone and Joint Institute, University of Western Ontario, London, Canada.
- School of Physical Therapy, Faculty of Health Sciences, University of Western Ontario, London, Canada.
| | - Jenna M Schulz
- Bone and Joint Institute, University of Western Ontario, London, Canada
- School of Physical Therapy, Faculty of Health Sciences, University of Western Ontario, London, Canada
| | - Codie A Primeau
- Bone and Joint Institute, University of Western Ontario, London, Canada
- School of Physical Therapy, Faculty of Health Sciences, University of Western Ontario, London, Canada
| | - Kristyn M Leitch
- Bone and Joint Institute, University of Western Ontario, London, Canada
| | - Stephany L Pritchett
- Schulich School of Medicine & Dentistry, University of Western Ontario, London, Canada
| | - D W Holdsworth
- Robarts Research Institute, University of Western Ontario, London, Canada
- Schulich School of Medicine & Dentistry, University of Western Ontario, London, Canada
| | - J R Giffin
- Bone and Joint Institute, University of Western Ontario, London, Canada
- Schulich School of Medicine & Dentistry, University of Western Ontario, London, Canada
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Alfuth M, Fichter P, Knicker A. Leg length discrepancy: A systematic review on the validity and reliability of clinical assessments and imaging diagnostics used in clinical practice. PLoS One 2021; 16:e0261457. [PMID: 34928991 PMCID: PMC8687568 DOI: 10.1371/journal.pone.0261457] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2021] [Accepted: 12/02/2021] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND A variety of assessments to determine leg length discrepancy (LLD) is used in clinical practice and evidence about validity and reliability may differ. OBJECTIVE The objective of this systematic review was to identify and describe the validity and reliability of different assessments and imaging diagnostics for the determination of LLD. MATERIALS AND METHODS The review was conducted following the recommendations of Preferred Reporting Items for Systematic reviews and Meta-Analyses (PRISMA). The databases Medline (PubMed) and Index to Chiropractic Literature were systematically searched. Studies regarding clinical assessments and imaging diagnostics for the diagnosis of LLD, which reported the clinimetric properties for assessment of LLD, were included and screened for methodological quality using the Quality Assessment of Studies of Diagnostic Accuracy (QUADAS-2) tool for validity studies and the Quality Appraisal of Diagnostic Reliability (QAREL) tool for reliability studies. RESULTS Thirty-seven articles on clinical assessments and 15 studies on imaging diagnostics met the eligibility criteria. Thirteen studies on the validity of clinical assessments and six studies on the validity of imaging diagnostics had a low risk of bias and low concerns regarding applicability for all domains. One study on the reliability of clinical assessments and one study on the reliability of imaging diagnostics had a low risk of bias. Main limitations were, that an analysis of sensitivity and specificity was only performed in a few studies and that a valid reference standard was lacking in numerous studies on clinical assessments. CONCLUSIONS For the clinical assessment of LLD, the block test appears to be the most useful method. Full-length standing anteroposterior radiography seems to be the most valid and reliable method and may be used as global reference standard to measure the anatomic LLD when comparing clinical methods and imaging diagnostics.
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Affiliation(s)
- Martin Alfuth
- Faculty of Health Care, Therapeutic Sciences, Niederrhein University of Applied Sciences, Krefeld, Germany
- Department of Further Education, M.Sc. Sport Physiotherapy, German Sport University Cologne, Cologne, Germany
- * E-mail:
| | - Patrick Fichter
- Department of Further Education, M.Sc. Sport Physiotherapy, German Sport University Cologne, Cologne, Germany
| | - Axel Knicker
- Institute of Movement and Neurosciences, German Sport University Cologne, Cologne, Germany
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Bupivacaine in combination with sildenafil (Viagra) and vitamin D3 have anti-inflammatory effects in osteoarthritic chondrocytes. CURRENT RESEARCH IN PHARMACOLOGY AND DRUG DISCOVERY 2021; 2:100066. [PMID: 34909684 PMCID: PMC8663929 DOI: 10.1016/j.crphar.2021.100066] [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: 08/01/2021] [Revised: 10/13/2021] [Accepted: 10/18/2021] [Indexed: 11/21/2022] Open
Abstract
Aims To treat osteoarthritic chondrocytes and thereby reduce the inflammation with a drug combination that primarily affects 5-HT- and ATP-evoked Ca2+ signaling. In osteoarthritic chondrocytes, Ca2+ signaling is elevated, resulting in increased production of ATP and inflammatory mediators. The expression of TLR4 and Na+/K+-ATPase was used to evaluate the inflammatory status of the cells. Main methods Equine chondrocytes were collected from joints with mild structural osteoarthritic changes and cultured in monolayers. The cells were treated with a combination of bupivacaine (1 pM) and sildenafil (1 μM) in combination with vitamin D3 (100 nM). A high-throughput screening system, the Flexstation 3 microplate reader, was used to measure intra- and extracellular Ca2+ signaling after exposure to 5-HT, glutamate, or ATP. Expression of inflammatory receptors was assessed by Western blotting. Key findings Drug treatment substantially reduced 5-HT- and ATP-evoked intracellular Ca2+ release and TLR4 expression compared to those in untreated chondrocytes. The combination of sildenafil, vitamin D3 together with metformin, as the ability to take up glucose is limited, increased Na+/K+-ATPase expression. Significance The combination of these three therapeutic substances at concentrations much lower than usually used, reduced expression of the inflammatory receptor TLR4 and increased the cell membrane enzyme Na+/K+-ATPase, which regulates cell volume and reduces increased intracellular Ca2+ concentrations. These remarkable results indicate that this drug combination has disease-modifying osteoarthritis drug (DMOAD) properties and may be a new clinical therapy for osteoarthritis (OA).
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Kamp B, Frenken M, Henke JM, Abrar DB, Nagel AM, Gast LV, Oeltzschner G, Wilms LM, Nebelung S, Antoch G, Wittsack HJ, Müller-Lutz A. Quantification of Sodium Relaxation Times and Concentrations as Surrogates of Proteoglycan Content of Patellar CARTILAGE at 3T MRI. Diagnostics (Basel) 2021; 11:diagnostics11122301. [PMID: 34943538 PMCID: PMC8700247 DOI: 10.3390/diagnostics11122301] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2021] [Revised: 12/03/2021] [Accepted: 12/06/2021] [Indexed: 11/25/2022] Open
Abstract
Sodium MRI has the potential to depict cartilage health accurately, but synovial fluid can influence the estimation of sodium parameters of cartilage. Therefore, this study aimed to reduce the impact of synovial fluid to render the quantitative compositional analyses of cartilage tissue technically more robust. Two dedicated protocols were applied for determining sodium T1 and T2* relaxation times. For each protocol, data were acquired from 10 healthy volunteers and one patient with patellar cartilage damage. Data recorded with multiple repetition times for T1 measurement and multi-echo data acquired with an additional inversion recovery pulse for T2* measurement were analysed using biexponential models to differentiate longitudinal relaxation components of cartilage (T1,car) and synovial fluid (T1,syn), and short (T2s*) from long (T2l*) transversal relaxation components. Sodium relaxation times and concentration estimates in patellar cartilage were successfully determined: T1,car = 14.5 ± 0.7 ms; T1,syn = 37.9 ± 2.9 ms; c(T1-protocol) = 200 ± 48 mmol/L; T2s* = 0.4 ± 0.1 ms; T2l* = 12.6 ± 0.7 ms; c(T2*-protocol) = 215 ± 44 mmol/L for healthy volunteers. In conclusion, a robust determination of sodium relaxation times is possible at a clinical field strength of 3T to quantify sodium concentrations, which might be a valuable tool to determine cartilage health.
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Affiliation(s)
- Benedikt Kamp
- Department of Diagnostic and Interventional Radiology, Medical Faculty, University Dusseldorf, D-40225 Dusseldorf, Germany; (B.K.); (J.M.H.); (D.B.A.); (L.M.W.); (S.N.); (G.A.); (H.-J.W.); (A.M.-L.)
| | - Miriam Frenken
- Department of Diagnostic and Interventional Radiology, Medical Faculty, University Dusseldorf, D-40225 Dusseldorf, Germany; (B.K.); (J.M.H.); (D.B.A.); (L.M.W.); (S.N.); (G.A.); (H.-J.W.); (A.M.-L.)
- Correspondence:
| | - Jan M. Henke
- Department of Diagnostic and Interventional Radiology, Medical Faculty, University Dusseldorf, D-40225 Dusseldorf, Germany; (B.K.); (J.M.H.); (D.B.A.); (L.M.W.); (S.N.); (G.A.); (H.-J.W.); (A.M.-L.)
- Clinic of Nuclear Medicine, Medical Faculty, University Dusseldorf, D-40225 Dusseldorf, Germany
| | - Daniel B. Abrar
- Department of Diagnostic and Interventional Radiology, Medical Faculty, University Dusseldorf, D-40225 Dusseldorf, Germany; (B.K.); (J.M.H.); (D.B.A.); (L.M.W.); (S.N.); (G.A.); (H.-J.W.); (A.M.-L.)
| | - Armin M. Nagel
- Institute of Radiology, University Hospital Erlangen, Friedrich-Alexander-Universität Erlangen-Nürnberg (FAU), D-91054 Erlangen, Germany; (A.M.N.); (L.V.G.)
- German Cancer Research Center (DKFZ), Division of Medical Physics in Radiology, D-69120 Heidelberg, Germany
| | - Lena V. Gast
- Institute of Radiology, University Hospital Erlangen, Friedrich-Alexander-Universität Erlangen-Nürnberg (FAU), D-91054 Erlangen, Germany; (A.M.N.); (L.V.G.)
| | - Georg Oeltzschner
- Russell H. Morgan Department for Radiology and Radiological Science, The Johns Hopkins University School of Medicine, Baltimore, MD 21205-2196, USA;
- F. M. Kirby Research Center for Functional Brain Imaging, Kennedy Krieger Institute, Baltimore, MD 21205-2196, USA
| | - Lena M. Wilms
- Department of Diagnostic and Interventional Radiology, Medical Faculty, University Dusseldorf, D-40225 Dusseldorf, Germany; (B.K.); (J.M.H.); (D.B.A.); (L.M.W.); (S.N.); (G.A.); (H.-J.W.); (A.M.-L.)
| | - Sven Nebelung
- Department of Diagnostic and Interventional Radiology, Medical Faculty, University Dusseldorf, D-40225 Dusseldorf, Germany; (B.K.); (J.M.H.); (D.B.A.); (L.M.W.); (S.N.); (G.A.); (H.-J.W.); (A.M.-L.)
| | - Gerald Antoch
- Department of Diagnostic and Interventional Radiology, Medical Faculty, University Dusseldorf, D-40225 Dusseldorf, Germany; (B.K.); (J.M.H.); (D.B.A.); (L.M.W.); (S.N.); (G.A.); (H.-J.W.); (A.M.-L.)
| | - Hans-Jörg Wittsack
- Department of Diagnostic and Interventional Radiology, Medical Faculty, University Dusseldorf, D-40225 Dusseldorf, Germany; (B.K.); (J.M.H.); (D.B.A.); (L.M.W.); (S.N.); (G.A.); (H.-J.W.); (A.M.-L.)
| | - Anja Müller-Lutz
- Department of Diagnostic and Interventional Radiology, Medical Faculty, University Dusseldorf, D-40225 Dusseldorf, Germany; (B.K.); (J.M.H.); (D.B.A.); (L.M.W.); (S.N.); (G.A.); (H.-J.W.); (A.M.-L.)
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Chalian M, Li X, Guermazi A, Obuchowski NA, Carrino JA, Oei EH, Link TM. The QIBA Profile for MRI-based Compositional Imaging of Knee Cartilage. Radiology 2021; 301:423-432. [PMID: 34491127 PMCID: PMC8574057 DOI: 10.1148/radiol.2021204587] [Citation(s) in RCA: 36] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2020] [Revised: 06/18/2021] [Accepted: 07/07/2021] [Indexed: 12/16/2022]
Abstract
MRI-based cartilage compositional analysis shows biochemical and microstructural changes at early stages of osteoarthritis before changes become visible with structural MRI sequences and arthroscopy. This could help with early diagnosis, risk assessment, and treatment monitoring of osteoarthritis. Spin-lattice relaxation time constant in rotating frame (T1ρ) and T2 mapping are the MRI techniques best established for assessing cartilage composition. Only T2 mapping is currently commercially available, which is sensitive to water, collagen content, and orientation of collagen fibers, whereas T1ρ is more sensitive to proteoglycan content. Clinical application of cartilage compositional imaging is limited by high variability and suboptimal reproducibility of the biomarkers, which was the motivation for creating the Quantitative Imaging Biomarkers Alliance (QIBA) Profile for cartilage compositional imaging by the Musculoskeletal Biomarkers Committee of the QIBA. The profile aims at providing recommendations to improve reproducibility and to standardize cartilage compositional imaging. The QIBA Profile provides two complementary claims (summary statements of the technical performance of the quantitative imaging biomarkers that are being profiled) regarding the reproducibility of biomarkers. First, cartilage T1ρ and T2 values are measurable at 3.0-T MRI with a within-subject coefficient of variation of 4%-5%. Second, a measured increase or decrease in T1ρ and T2 of 14% or more indicates a minimum detectable change with 95% confidence. If only an increase in T1ρ and T2 values is expected (progressive cartilage degeneration), then an increase of 12% represents a minimum detectable change over time. The QIBA Profile provides recommendations for clinical researchers, clinicians, and industry scientists pertaining to image data acquisition, analysis, and interpretation and assessment procedures for T1ρ and T2 cartilage imaging and test-retest conformance. This special report aims to provide the rationale for the proposed claims, explain the content of the QIBA Profile, and highlight the future needs and developments for MRI-based cartilage compositional imaging for risk prediction, early diagnosis, and treatment monitoring of osteoarthritis.
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Affiliation(s)
- Majid Chalian
- From the Department of Radiology, Division of Musculoskeletal Imaging
and Intervention, University of Washington, UW Radiology–Roosevelt
Clinic, 4245 Roosevelt Way NE, Box 354755, Seattle, WA 98105 (M.C.); Department
of Biomedical Engineering, Program of Advanced Musculoskeletal Imaging (PAMI)
(X.L.), and Department of Biostatistics (N.A.O.), Cleveland Clinic, Cleveland,
Ohio; Department of Radiology, Boston University School of Medicine, Boston,
Mass (A.G.); Department of Radiology and Imaging, Hospital for Special Surgery,
New York, NY (J.A.C.); Department of Radiology & Nuclear Medicine,
Erasmus MC University Medical Center, Rotterdam, the Netherlands (E.H.O.);
European Imaging Biomarkers Alliance (E.H.O.); and Department of Radiology and
Biomedical Imaging, University of California, San Francisco, Calif
(T.M.L.)
| | - Xiaojuan Li
- From the Department of Radiology, Division of Musculoskeletal Imaging
and Intervention, University of Washington, UW Radiology–Roosevelt
Clinic, 4245 Roosevelt Way NE, Box 354755, Seattle, WA 98105 (M.C.); Department
of Biomedical Engineering, Program of Advanced Musculoskeletal Imaging (PAMI)
(X.L.), and Department of Biostatistics (N.A.O.), Cleveland Clinic, Cleveland,
Ohio; Department of Radiology, Boston University School of Medicine, Boston,
Mass (A.G.); Department of Radiology and Imaging, Hospital for Special Surgery,
New York, NY (J.A.C.); Department of Radiology & Nuclear Medicine,
Erasmus MC University Medical Center, Rotterdam, the Netherlands (E.H.O.);
European Imaging Biomarkers Alliance (E.H.O.); and Department of Radiology and
Biomedical Imaging, University of California, San Francisco, Calif
(T.M.L.)
| | - Ali Guermazi
- From the Department of Radiology, Division of Musculoskeletal Imaging
and Intervention, University of Washington, UW Radiology–Roosevelt
Clinic, 4245 Roosevelt Way NE, Box 354755, Seattle, WA 98105 (M.C.); Department
of Biomedical Engineering, Program of Advanced Musculoskeletal Imaging (PAMI)
(X.L.), and Department of Biostatistics (N.A.O.), Cleveland Clinic, Cleveland,
Ohio; Department of Radiology, Boston University School of Medicine, Boston,
Mass (A.G.); Department of Radiology and Imaging, Hospital for Special Surgery,
New York, NY (J.A.C.); Department of Radiology & Nuclear Medicine,
Erasmus MC University Medical Center, Rotterdam, the Netherlands (E.H.O.);
European Imaging Biomarkers Alliance (E.H.O.); and Department of Radiology and
Biomedical Imaging, University of California, San Francisco, Calif
(T.M.L.)
| | - Nancy A. Obuchowski
- From the Department of Radiology, Division of Musculoskeletal Imaging
and Intervention, University of Washington, UW Radiology–Roosevelt
Clinic, 4245 Roosevelt Way NE, Box 354755, Seattle, WA 98105 (M.C.); Department
of Biomedical Engineering, Program of Advanced Musculoskeletal Imaging (PAMI)
(X.L.), and Department of Biostatistics (N.A.O.), Cleveland Clinic, Cleveland,
Ohio; Department of Radiology, Boston University School of Medicine, Boston,
Mass (A.G.); Department of Radiology and Imaging, Hospital for Special Surgery,
New York, NY (J.A.C.); Department of Radiology & Nuclear Medicine,
Erasmus MC University Medical Center, Rotterdam, the Netherlands (E.H.O.);
European Imaging Biomarkers Alliance (E.H.O.); and Department of Radiology and
Biomedical Imaging, University of California, San Francisco, Calif
(T.M.L.)
| | - John A. Carrino
- From the Department of Radiology, Division of Musculoskeletal Imaging
and Intervention, University of Washington, UW Radiology–Roosevelt
Clinic, 4245 Roosevelt Way NE, Box 354755, Seattle, WA 98105 (M.C.); Department
of Biomedical Engineering, Program of Advanced Musculoskeletal Imaging (PAMI)
(X.L.), and Department of Biostatistics (N.A.O.), Cleveland Clinic, Cleveland,
Ohio; Department of Radiology, Boston University School of Medicine, Boston,
Mass (A.G.); Department of Radiology and Imaging, Hospital for Special Surgery,
New York, NY (J.A.C.); Department of Radiology & Nuclear Medicine,
Erasmus MC University Medical Center, Rotterdam, the Netherlands (E.H.O.);
European Imaging Biomarkers Alliance (E.H.O.); and Department of Radiology and
Biomedical Imaging, University of California, San Francisco, Calif
(T.M.L.)
| | - Edwin H. Oei
- From the Department of Radiology, Division of Musculoskeletal Imaging
and Intervention, University of Washington, UW Radiology–Roosevelt
Clinic, 4245 Roosevelt Way NE, Box 354755, Seattle, WA 98105 (M.C.); Department
of Biomedical Engineering, Program of Advanced Musculoskeletal Imaging (PAMI)
(X.L.), and Department of Biostatistics (N.A.O.), Cleveland Clinic, Cleveland,
Ohio; Department of Radiology, Boston University School of Medicine, Boston,
Mass (A.G.); Department of Radiology and Imaging, Hospital for Special Surgery,
New York, NY (J.A.C.); Department of Radiology & Nuclear Medicine,
Erasmus MC University Medical Center, Rotterdam, the Netherlands (E.H.O.);
European Imaging Biomarkers Alliance (E.H.O.); and Department of Radiology and
Biomedical Imaging, University of California, San Francisco, Calif
(T.M.L.)
| | - Thomas M. Link
- From the Department of Radiology, Division of Musculoskeletal Imaging
and Intervention, University of Washington, UW Radiology–Roosevelt
Clinic, 4245 Roosevelt Way NE, Box 354755, Seattle, WA 98105 (M.C.); Department
of Biomedical Engineering, Program of Advanced Musculoskeletal Imaging (PAMI)
(X.L.), and Department of Biostatistics (N.A.O.), Cleveland Clinic, Cleveland,
Ohio; Department of Radiology, Boston University School of Medicine, Boston,
Mass (A.G.); Department of Radiology and Imaging, Hospital for Special Surgery,
New York, NY (J.A.C.); Department of Radiology & Nuclear Medicine,
Erasmus MC University Medical Center, Rotterdam, the Netherlands (E.H.O.);
European Imaging Biomarkers Alliance (E.H.O.); and Department of Radiology and
Biomedical Imaging, University of California, San Francisco, Calif
(T.M.L.)
| | - for the RSNA QIBA MSK Biomarker Committee
- From the Department of Radiology, Division of Musculoskeletal Imaging
and Intervention, University of Washington, UW Radiology–Roosevelt
Clinic, 4245 Roosevelt Way NE, Box 354755, Seattle, WA 98105 (M.C.); Department
of Biomedical Engineering, Program of Advanced Musculoskeletal Imaging (PAMI)
(X.L.), and Department of Biostatistics (N.A.O.), Cleveland Clinic, Cleveland,
Ohio; Department of Radiology, Boston University School of Medicine, Boston,
Mass (A.G.); Department of Radiology and Imaging, Hospital for Special Surgery,
New York, NY (J.A.C.); Department of Radiology & Nuclear Medicine,
Erasmus MC University Medical Center, Rotterdam, the Netherlands (E.H.O.);
European Imaging Biomarkers Alliance (E.H.O.); and Department of Radiology and
Biomedical Imaging, University of California, San Francisco, Calif
(T.M.L.)
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Kijowski R. Standardization of Compositional MRI of Knee Cartilage: Why and How. Radiology 2021; 301:433-434. [PMID: 34491134 DOI: 10.1148/radiol.2021211957] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Affiliation(s)
- Richard Kijowski
- From the Department of Radiology, New York University Grossman School of Medicine, 660 First Ave, 3rd Floor, New York, NY 10016
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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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Banitalebi H, Owesen C, Årøen A, Tran HT, Myklebust TÅ, Randsborg PH. Is T2 mapping reliable in evaluation of native and repair cartilage tissue of the knee? J Exp Orthop 2021; 8:34. [PMID: 33913035 PMCID: PMC8081777 DOI: 10.1186/s40634-021-00350-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/27/2021] [Accepted: 04/08/2021] [Indexed: 11/10/2022] Open
Abstract
PURPOSE To evaluate the effect of imaging plane and experience of observers on the reliability of T2 mapping of native and repair cartilage tissue of the knee. METHODS Fifteen consecutive patients from two randomised controlled trials (RCTs) were included in this cross-sectional study. Patients with an isolated knee cartilage lesion were randomised to receive either debridement or microfracture (RCT 1) or debridement or autologous chondrocyte implantation (RCT 2). T2 mapping was performed in coronal and sagittal planes two years postoperatively. A musculoskeletal radiologist, a resident of radiology and two orthopaedic surgeons measured the T2 values independently. Intraclass Correlation Coefficient (ICC) with 95% Confidence Intervals was used to calculate the inter- and intraobserver agreement. RESULTS Mean age for the patients was 36.8 ± 11 years, 8 (53%) were men. The overall interobserver agreement varied from poor to good with ICCs in the range of 0.27- 0.76 for native cartilage and 0.00 - 0.90 for repair tissue. The lowest agreement was achieved for evaluations of repair cartilage tissue. The estimated ICCs suggested higher inter- and intraobserver agreement for radiologists. On medial femoral condyles, T2 values were higher for native cartilage on coronal images (p < 0.001) and for repair tissue on sagittal images (p < 0.001). CONCLUSIONS The reliability of T2 mapping of articular cartilage is influenced by the imaging plane and the experience of the observers. This influence may be more profound for repair cartilage tissue. This is important to consider when using T2 mapping to measure outcomes after cartilage repair surgery. TRIAL REGISTRATION ClinicalTrials.gov, NCT02637505 and NCT02636881 , registered December 2015. LEVEL OF EVIDENCE II, based on prospective data from two RCTs.
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Affiliation(s)
- Hasan Banitalebi
- Department of Diagnostic Imaging, Akershus University Hospital, 1478, Lørenskog, Norway. .,Institute of Clinical Medicine, University of Oslo, Oslo, Norway.
| | - Christian Owesen
- Department of Orthopaedic Surgery, Akershus University Hospital, 1478 Lørenskog, Norway.,Oslo Sports Trauma Research Centre, Oslo, Norway
| | - Asbjørn Årøen
- Institute of Clinical Medicine, University of Oslo, Oslo, Norway.,Department of Orthopaedic Surgery, Akershus University Hospital, 1478 Lørenskog, Norway.,Oslo Sports Trauma Research Centre, Oslo, Norway
| | - Hang Thi Tran
- Department of Diagnostic Imaging, Akershus University Hospital, 1478, Lørenskog, Norway
| | - Tor Åge Myklebust
- Department of Research and Innovation, Møre and Romsdal Hospital Trust, Ålesund, Norway
| | - Per-Henrik Randsborg
- Department of Orthopaedic Surgery, Akershus University Hospital, 1478 Lørenskog, Norway.,Oslo Sports Trauma Research Centre, Oslo, Norway
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Huppertz MS, Schock J, Radke KL, Abrar DB, Post M, Kuhl C, Truhn D, Nebelung S. Longitudinal T2 Mapping and Texture Feature Analysis in the Detection and Monitoring of Experimental Post-Traumatic Cartilage Degeneration. Life (Basel) 2021; 11:life11030201. [PMID: 33807740 PMCID: PMC8000874 DOI: 10.3390/life11030201] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2021] [Revised: 03/01/2021] [Accepted: 03/03/2021] [Indexed: 11/25/2022] Open
Abstract
Background: Traumatic cartilage injuries predispose articulating joints to focal cartilage defects and, eventually, posttraumatic osteoarthritis. Current clinical-standard imaging modalities such as morphologic MRI fail to reliably detect cartilage trauma and to monitor associated posttraumatic degenerative changes with oftentimes severe prognostic implications. Quantitative MRI techniques such as T2 mapping are promising in detecting and monitoring such changes yet lack sufficient validation in controlled basic research contexts. Material and Methods: 35 macroscopically intact cartilage samples obtained from total joint replacements were exposed to standardized injurious impaction with low (0.49 J, n = 14) or high (0.98 J, n = 14) energy levels and imaged before and immediately, 24 h, and 72 h after impaction by T2 mapping. Contrast, homogeneity, energy, and variance were quantified as features of texture on each T2 map. Unimpacted controls (n = 7) and histologic assessment served as reference. Results: As a function of impaction energy and time, absolute T2 values, contrast, and variance were significantly increased, while homogeneity and energy were significantly decreased. Conclusion: T2 mapping and texture feature analysis are sensitive diagnostic means to detect and monitor traumatic impaction injuries of cartilage and associated posttraumatic degenerative changes and may be used to assess cartilage after trauma to identify “cartilage at risk”.
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Affiliation(s)
- Marc Sebastian Huppertz
- Department of Diagnostic and Interventional Radiology, Aachen University Hospital, 52074 Aachen, Germany; (M.S.H.); (M.P.); (C.K.); (D.T.)
| | - Justus Schock
- Department of Diagnostic and Interventional Radiology, Medical Faculty, University Dusseldorf, 40225 Dusseldorf, Germany; (J.S.); (K.L.R.); (D.B.A.)
| | - Karl Ludger Radke
- Department of Diagnostic and Interventional Radiology, Medical Faculty, University Dusseldorf, 40225 Dusseldorf, Germany; (J.S.); (K.L.R.); (D.B.A.)
| | - Daniel Benjamin Abrar
- Department of Diagnostic and Interventional Radiology, Medical Faculty, University Dusseldorf, 40225 Dusseldorf, Germany; (J.S.); (K.L.R.); (D.B.A.)
| | - Manuel Post
- Department of Diagnostic and Interventional Radiology, Aachen University Hospital, 52074 Aachen, Germany; (M.S.H.); (M.P.); (C.K.); (D.T.)
| | - Christiane Kuhl
- Department of Diagnostic and Interventional Radiology, Aachen University Hospital, 52074 Aachen, Germany; (M.S.H.); (M.P.); (C.K.); (D.T.)
| | - Daniel Truhn
- Department of Diagnostic and Interventional Radiology, Aachen University Hospital, 52074 Aachen, Germany; (M.S.H.); (M.P.); (C.K.); (D.T.)
| | - Sven Nebelung
- Department of Diagnostic and Interventional Radiology, Medical Faculty, University Dusseldorf, 40225 Dusseldorf, Germany; (J.S.); (K.L.R.); (D.B.A.)
- Correspondence:
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Abstract
PURPOSE OF REVIEW Osteoarthritis is a major source of disability, pain and socioeconomic cost worldwide. The epidemiology of the disorder is multifactorial including genetic, biological and biomechanical components, some of them detectable by MRI. This review provides the most recent update on MRI biomarkers which can provide functional information of the joint structures for diagnosis, prognosis and treatment response monitoring in osteoarthritis trials. RECENT FINDINGS Compositional or functional MRI can provide clinicians with valuable information on glycosaminoglycan content (chemical exchange saturation transfer, sodium MRI, T1ρ) and collagen organization (T2, T2, apparent diffusion coefficient, magnetization transfer) in joint structures. Other parameters may also provide useful information, such as volumetric measurements of joint structures or advanced image data postprocessing and analysis. Automated tools seem to have a great potential to be included in these efforts providing standardization and acceleration of the image data analysis process. SUMMARY Functional or compositional MRI has great potential to provide noninvasive imaging biomarkers for osteoarthritis. Osteoarthritis as a whole joint condition needs to be diagnosed in early stages to facilitate selection of patients into clinical trials and/or to measure treatment effectiveness. Advanced evaluation including machine learning, neural networks and multidimensional data analysis allow for wall-to-wall understanding of parameter interactions and their role in clinical evaluation of osteoarthritis.
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48
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Lee LS, Chan PK, Fung WC, Chan VWK, Yan CH, Chiu KY. Imaging of knee osteoarthritis: A review of current evidence and clinical guidelines. Musculoskeletal Care 2021; 19:363-374. [PMID: 33387447 DOI: 10.1002/msc.1536] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2020] [Revised: 12/15/2020] [Accepted: 12/15/2020] [Indexed: 12/24/2022]
Abstract
BACKGROUND Knee osteoarthritis (OA) is one of the most common and debilitating degenerative joint diseases worldwide. While radiography is the most commonly used imaging modality, it is associated with drawbacks which newer modalities such as magnetic resonance imaging (MRI) and ultrasound could overcome. Nevertheless, the role of imaging in clinical practice and research in knee OA has not been clearly defined. Furthermore, guidelines on imaging in knee OA from different authoritative bodies have not been compared in previous studies. Therefore, the present review aims to summarise existing evidence and compare guidelines on the use of different imaging modalities in evaluating knee OA. METHODS This is a narrative review based on a search of published clinical guidelines and the PubMed database for articles published between 1 January 1990 and 31 May 2020. RESULTS There is no broad consensus on the value of imaging in patients with typical OA presentation. If imaging is required, current evidence and clinical guidelines support the use of radiography and MRI as first- and second-line diagnostic modalities respectively. Since radiographic OA features have limited sensitivity and do not manifest in early stages, MRI is the preferred option for whole-joint evaluation in OA research. Discrepancies exist regarding the use of alternative imaging modalities including ultrasound, computed tomography and nuclear medicine. CONCLUSION Radiography and MRI are the imaging modalities of choice. Other modalities have their respective advantages, and more research is warranted for the standardisation of image acquisition and interpretation methodology, in order to evaluate their validity, reliability and responsiveness in OA research.
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Affiliation(s)
- Lok Sze Lee
- Department of Orthopaedics and Traumatology, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong SAR, China
| | - Ping Keung Chan
- Department of Orthopaedics and Traumatology, Queen Mary Hospital, Hong Kong SAR, China
| | - Wing Chiu Fung
- Department of Orthopaedics and Traumatology, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong SAR, China
| | - Vincent Wai Kwan Chan
- Department of Orthopaedics and Traumatology, Queen Mary Hospital, Hong Kong SAR, China
| | - Chun Hoi Yan
- Department of Orthopaedics and Traumatology, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong SAR, China
| | - Kwong Yuen Chiu
- Department of Orthopaedics and Traumatology, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong SAR, China
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Zibetti MVW, Helou ES, Sharafi A, Regatte RR. Fast multicomponent 3D-T 1ρ relaxometry. NMR IN BIOMEDICINE 2020; 33:e4318. [PMID: 32359000 PMCID: PMC7606711 DOI: 10.1002/nbm.4318] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/03/2019] [Revised: 03/10/2020] [Accepted: 04/05/2020] [Indexed: 05/06/2023]
Abstract
NMR relaxometry can provide information about the relaxation of the magnetization in different tissues, increasing our understanding of molecular dynamics and biochemical composition in biological systems. In general, tissues have complex and heterogeneous structures composed of multiple pools. As a result, bulk magnetization returns to its original state with different relaxation times, in a multicomponent relaxation. Recovering the distribution of relaxation times in each voxel is a difficult inverse problem; it is usually unstable and requires long acquisition time, especially on clinical scanners. MRI can also be viewed as an inverse problem, especially when compressed sensing (CS) is used. The solution of these two inverse problems, CS and relaxometry, can be obtained very efficiently in a synergistically combined manner, leading to a more stable multicomponent relaxometry obtained with short scan times. In this paper, we will discuss the details of this technique from the viewpoint of inverse problems.
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Affiliation(s)
- Marcelo V W Zibetti
- Center for Biomedical Imaging, Department of Radiology, New York University School of Medicine, New York, NY, US
| | - Elias S Helou
- Institute of Mathematical Sciences and Computation, University of São Paulo, São Carlos, SP, Brazil
| | - Azadeh Sharafi
- Center for Biomedical Imaging, Department of Radiology, New York University School of Medicine, New York, NY, US
| | - Ravinder R Regatte
- Center for Biomedical Imaging, Department of Radiology, New York University School of Medicine, New York, NY, US
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50
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MacKay JW, Roemer FW, Kogan F. Standardized multi-vendor compositional MRI of knee cartilage: a key step towards clinical translation? Osteoarthritis Cartilage 2020; 28:1497-1500. [PMID: 32882389 DOI: 10.1016/j.joca.2020.08.007] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/14/2020] [Accepted: 08/18/2020] [Indexed: 02/02/2023]
Affiliation(s)
- J W MacKay
- Norwich Medical School, University of East Anglia, Norwich, UK; Department of Radiology, University of Cambridge, Cambridge, UK.
| | - F W Roemer
- Department of Radiology, Friedrich-Alexander University Erlangen-Nürnberg & Universitätsklinikum Erlangen, Erlangen, Germany; Quantitative Imaging Center, Department of Radiology, Boston University School of Medicine, Boston, MA, USA
| | - F Kogan
- Department of Radiology, Stanford University, Stanford, CA, USA
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