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Carrino JA, Ibad H, Lin Y, Ghotbi E, Klein J, Demehri S, Del Grande F, Bogner E, Boesen MP, Siewerdsen JH. CT in musculoskeletal imaging: still helpful and for what? Skeletal Radiol 2024:10.1007/s00256-024-04737-w. [PMID: 38969781 DOI: 10.1007/s00256-024-04737-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/25/2024] [Revised: 06/17/2024] [Accepted: 06/17/2024] [Indexed: 07/07/2024]
Abstract
Computed tomography (CT) is a common modality employed for musculoskeletal imaging. Conventional CT techniques are useful for the assessment of trauma in detection, characterization and surgical planning of complex fractures. CT arthrography can depict internal derangement lesions and impact medical decision making of orthopedic providers. In oncology, CT can have a role in the characterization of bone tumors and may elucidate soft tissue mineralization patterns. Several advances in CT technology have led to a variety of acquisition techniques with distinct clinical applications. These include four-dimensional CT, which allows examination of joints during motion; cone-beam CT, which allows examination during physiological weight-bearing conditions; dual-energy CT, which allows material decomposition useful in musculoskeletal deposition disorders (e.g., gout) and bone marrow edema detection; and photon-counting CT, which provides increased spatial resolution, decreased radiation, and material decomposition compared to standard multi-detector CT systems due to its ability to directly translate X-ray photon energies into electrical signals. Advanced acquisition techniques provide higher spatial resolution scans capable of enhanced bony microarchitecture and bone mineral density assessment. Together, these CT acquisition techniques will continue to play a substantial role in the practices of orthopedics, rheumatology, metabolic bone, oncology, and interventional radiology.
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Affiliation(s)
- John A Carrino
- Weill Cornell Medicine, New York, NY, USA.
- Department of Radiology and Imaging, Hospital for Special Surgery, 535 East 70th Street, New York, NY, 10021, USA.
| | - Hamza Ibad
- The Russell H. Morgan Department of Radiology and Radiological Science, Johns Hopkins University School of Medicine, Baltimore, MD, 21287, USA
| | - Yenpo Lin
- Department of Medical Imaging and Intervention, Chang Gung Memorial Hospital, Taoyuan, Taiwan
| | - Elena Ghotbi
- The Russell H. Morgan Department of Radiology and Radiological Science, Johns Hopkins University School of Medicine, Baltimore, MD, 21287, USA
| | - Joshua Klein
- The Russell H. Morgan Department of Radiology and Radiological Science, Johns Hopkins University School of Medicine, Baltimore, MD, 21287, USA
| | - Shadpour Demehri
- Musculoskeletal Radiology, The Russell H. Morgan Department of Radiology and Radiological Science, Johns Hopkins University School of Medicine, 601 N. Caroline Street, JHOC 5165, Baltimore, MD, 21287, USA
| | - Filippo Del Grande
- Clinic of Radiology, Imaging Institute of Southern Switzerland (IIMSI), Ente Ospedaliero Cantonale (EOC), Via Tesserete 46, 6900, Lugano, Switzerland
- Faculty of Biomedical Sciences, Università Della Svizzera Italiana (USI), Via G. Buffi 13, 6904, Lugano, Switzerland
| | - Eric Bogner
- Department of Radiology and Imaging, Hospital for Special Surgery, 535 East 70th Street, New York, NY, 10021, USA
| | - Mikael P Boesen
- Department of Radiology, Copenhagen University Hospital, Bispebjerg and Frederiksberg, Nielsine Nielsens Vej 5, Entrance 7A, 3Rd Floor, 2400, Copenhagen, NV, Denmark
- Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Jeffrey H Siewerdsen
- Department of Imaging Physics, Institute for Data Science in Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
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Schadow JE, Maxey D, Smith TO, Finnilä MAJ, Manske SL, Segal NA, Wong AKO, Davey RA, Turmezei T, Stok KS. Systematic review of computed tomography parameters used for the assessment of subchondral bone in osteoarthritis. Bone 2024; 178:116948. [PMID: 37926204 DOI: 10.1016/j.bone.2023.116948] [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: 08/15/2023] [Revised: 10/04/2023] [Accepted: 10/19/2023] [Indexed: 11/07/2023]
Abstract
OBJECTIVE To systematically review the published parameters for the assessment of subchondral bone in human osteoarthritis (OA) using computed tomography (CT) and gain an overview of current practices and standards. DESIGN A literature search of Medline, Embase and Cochrane Library databases was performed with search strategies tailored to each database (search from 2010 to January 2023). The search results were screened independently by two reviewers against pre-determined inclusion and exclusion criteria. Studies were deemed eligible if conducted in vivo/ex vivo in human adults (>18 years) using any type of CT to assess subchondral bone in OA. Extracted data from eligible studies were compiled in a qualitative summary and formal narrative synthesis. RESULTS This analysis included 202 studies. Four groups of CT modalities were identified to have been used for subchondral bone assessment in OA across nine anatomical locations. Subchondral bone parameters measuring similar features of OA were combined in six categories: (i) microstructure, (ii) bone adaptation, (iii) gross morphology (iv) mineralisation, (v) joint space, and (vi) mechanical properties. CONCLUSIONS Clinically meaningful parameter categories were identified as well as categories with the potential to become relevant in the clinical field. Furthermore, we stress the importance of quantification of parameters to improve their sensitivity and reliability for the evaluation of OA disease progression and the need for standardised measurement methods to improve their clinical value.
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Affiliation(s)
- Jemima E Schadow
- Department of Biomedical Engineering, The University of Melbourne, Melbourne, Australia.
| | - David Maxey
- Department of Radiology, Norfolk and Norwich University Hospitals NHS Foundation Trust, Norwich, United Kingdom.
| | - Toby O Smith
- Warwick Medical School, University of Warwick, United Kingdom.
| | - Mikko A J Finnilä
- Research Unit of Health Science and Technology, Faculty of Medicine, University of Oulu, Oulu, Finland.
| | - Sarah L Manske
- Department of Radiology, McCaig Institute for Bone and Joint Health, Cumming School of Medicine, University of Calgary, Calgary, Canada.
| | - Neil A Segal
- Department of Rehabilitation Medicine, The University of Kansas Medical Center, Kansas City, United States.
| | - Andy Kin On Wong
- Joint Department of Medical Imaging, University Health Network, Toronto, Canada; Schroeder's Arthritis Institute, Toronto General Hospital Research Institute, University Health Network, Toronto, Canada.
| | - Rachel A Davey
- Department of Medicine, Austin Health, University of Melbourne, Melbourne, Australia.
| | - Tom Turmezei
- Department of Radiology, Norfolk and Norwich University Hospitals NHS Foundation Trust, Norwich, United Kingdom; Norwich Medical School, University of East Anglia, Norwich, United Kingdom.
| | - Kathryn S Stok
- Department of Biomedical Engineering, The University of Melbourne, Melbourne, Australia.
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Omoumi P, Mourad C, Ledoux JB, Hilbert T. Morphological assessment of cartilage and osteoarthritis in clinical practice and research: Intermediate-weighted fat-suppressed sequences and beyond. Skeletal Radiol 2023; 52:2185-2198. [PMID: 37154871 PMCID: PMC10509097 DOI: 10.1007/s00256-023-04343-2] [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: 11/15/2022] [Revised: 03/28/2023] [Accepted: 04/10/2023] [Indexed: 05/10/2023]
Abstract
Magnetic resonance imaging (MRI) is widely regarded as the primary modality for the morphological assessment of cartilage and all other joint tissues involved in osteoarthritis. 2D fast spin echo fat-suppressed intermediate-weighted (FSE FS IW) sequences with a TE between 30 and 40ms have stood the test of time and are considered the cornerstone of MRI protocols for clinical practice and trials. These sequences offer a good balance between sensitivity and specificity and provide appropriate contrast and signal within the cartilage as well as between cartilage, articular fluid, and subchondral bone. Additionally, FS IW sequences enable the evaluation of menisci, ligaments, synovitis/effusion, and bone marrow edema-like signal changes. This review article provides a rationale for the use of FSE FS IW sequences in the morphological assessment of cartilage and osteoarthritis, along with a brief overview of other clinically available sequences for this indication. Additionally, the article highlights ongoing research efforts aimed at improving FSE FS IW sequences through 3D acquisitions with enhanced resolution, shortened examination times, and exploring the potential benefits of different magnetic field strengths. While most of the literature on cartilage imaging focuses on the knee, the concepts presented here are applicable to all joints. KEY POINTS: 1. MRI is currently considered the modality of reference for a "whole-joint" morphological assessment of osteoarthritis. 2. Fat-suppressed intermediate-weighted sequences remain the keystone of MRI protocols for the assessment of cartilage morphology, as well as other structures involved in osteoarthritis. 3. Trends for further development in the field of cartilage and joint imaging include 3D FSE imaging, faster acquisition including AI-based acceleration, and synthetic imaging providing multi-contrast sequences.
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Affiliation(s)
- Patrick Omoumi
- Department of Radiology, Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland.
| | - Charbel Mourad
- Department of Radiology, Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland
- Department of Diagnostic and Interventional Radiology, Hôpital Libanais Geitaoui CHU, Achrafieh, Beyrouth, Lebanon
| | - Jean-Baptiste Ledoux
- Department of Radiology, Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland
| | - Tom Hilbert
- Department of Radiology, Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland
- Advanced Clinical Imaging Technology, Siemens Healthineers International AG, Lausanne, Switzerland
- LTS5, École Polytechnique FÉdÉrale de Lausanne (EPFL), Lausanne, Switzerland
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Volmer E, Mittlmeier T, Weber MA. [Ligamentous injuries of the ankle joint : Importance of radiological imaging procedures]. ORTHOPADIE (HEIDELBERG, GERMANY) 2023; 52:773-783. [PMID: 37642697 DOI: 10.1007/s00132-023-04436-9] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 06/21/2023] [Indexed: 08/31/2023]
Abstract
Injuries of the ankle joint show lesions of the lateral ligamentous apparatus with an incidence of 1 in 1000 cases. With a range of 0.3-0.7 in 1000 cases, injuries of the medial ligamentous apparatus occur more frequently than previously thought and are often overlooked. Correct imaging diagnostics of the ankle ligaments are mandatory for the prognosis and treatment planning. In cases of clinically strong suspicion of ligamentous injury or osteochondral lesions of the ankle joint, after primary radiographic evaluation magnetic resonance imaging (MRI) is primarily recommended for a more precise assessment. Additionally, the sensitivity for assessment of the ligaments with ultrasonography is good (91% vs. 97% with MRI) but its specificity is inferior compared to MRI (63% vs. 93% with MRI). Supination trauma is the most common ankle injury and attention should be paid to the anterior tibiofibular ligament and calcaneofibular ligament. In approximately 50%, injuries to the superficial layer of the medial collateral ligament complex are associated with lesions of the posterior tibiotalar ligament.
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Affiliation(s)
- Erik Volmer
- Institut für Diagnostische und Interventionelle Radiologie, Kinder- und Neuroradiologie, Universitätsmedizin Rostock, Ernst-Heydemann-Str. 6, 18057, Rostock, Deutschland.
| | - Thomas Mittlmeier
- Klinik für Unfall‑, Hand- und Wiederherstellungschirurgie, Universitätsmedizin Rostock, Rostock, Deutschland
| | - Marc-André Weber
- Institut für Diagnostische und Interventionelle Radiologie, Kinder- und Neuroradiologie, Universitätsmedizin Rostock, Ernst-Heydemann-Str. 6, 18057, Rostock, Deutschland
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Volmer E, Mittlmeier T, Weber MA. [Ligamentous injuries of the ankle joint : Importance of radiological imaging procedures]. RADIOLOGIE (HEIDELBERG, GERMANY) 2023:10.1007/s00117-023-01181-0. [PMID: 37490065 DOI: 10.1007/s00117-023-01181-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Accepted: 06/21/2023] [Indexed: 07/26/2023]
Abstract
Injuries of the ankle joint show lesions of the lateral ligamentous apparatus with an incidence of 1 in 1000 cases. With a range of 0.3-0.7 in 1000 cases, injuries of the medial ligamentous apparatus occur more frequently than previously thought and are often overlooked. Correct imaging diagnostics of the ankle ligaments are mandatory for the prognosis and treatment planning. In cases of clinically strong suspicion of ligamentous injury or osteochondral lesions of the ankle joint, after primary radiographic evaluation magnetic resonance imaging (MRI) is primarily recommended for a more precise assessment. Additionally, the sensitivity for assessment of the ligaments with ultrasonography is good (91% vs. 97% with MRI) but its specificity is inferior compared to MRI (63% vs. 93% with MRI). Supination trauma is the most common ankle injury and attention should be paid to the anterior tibiofibular ligament and calcaneofibular ligament. In approximately 50%, injuries to the superficial layer of the medial collateral ligament complex are associated with lesions of the posterior tibiotalar ligament.
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Affiliation(s)
- Erik Volmer
- Institut für Diagnostische und Interventionelle Radiologie, Kinder- und Neuroradiologie, Universitätsmedizin Rostock, Ernst-Heydemann-Str. 6, 18057, Rostock, Deutschland.
| | - Thomas Mittlmeier
- Klinik für Unfall‑, Hand- und Wiederherstellungschirurgie, Universitätsmedizin Rostock, Rostock, Deutschland
| | - Marc-André Weber
- Institut für Diagnostische und Interventionelle Radiologie, Kinder- und Neuroradiologie, Universitätsmedizin Rostock, Ernst-Heydemann-Str. 6, 18057, Rostock, Deutschland
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MRI underestimates presence and size of knee osteophytes using CT as a reference standard. Osteoarthritis Cartilage 2023; 31:656-668. [PMID: 36796577 DOI: 10.1016/j.joca.2023.01.575] [Citation(s) in RCA: 7] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/12/2022] [Revised: 01/12/2023] [Accepted: 01/31/2023] [Indexed: 02/18/2023]
Abstract
OBJECTIVE To explore the diagnostic performance of routine magnetic resonance imaging (MRI) for the cross-sectional assessment of osteophytes (OPs) in all three knee compartments using computed tomography (CT) as a reference standard. METHODS The Strontium Ranelate Efficacy in Knee Osteoarthritis (SEKOIA) trial explored the effect of 3 years of treatment with strontium ranelate in patients with primary knee OA. OPs were scored for the baseline visit only using a modified MRI Osteoarthritis Knee Score (MOAKS) scoring system in the patellofemoral (PFJ), the medial tibiofemoral (TFJ) and the lateral TFJ. Size was assessed from 0 to 3 in 18 locations. Descriptive statistics were used to describe differences in ordinal grading between CT and MRI. In addition, weighted-kappa statistics were employed to assess agreement between scoring using the two methods. Sensitivity, specificity, positive predictive value and negative predictive value as well as area under the curve (AUC) measures of diagnostic performance were employed using CT as the reference standard. RESULTS Included were 74 patients with available MRI and CT data. Mean age was 62.9 ± 7.5 years. Altogether 1,332 locations were evaluated. For the PFJ, MRI detected 141 (72%) of 197 CT-defined OPs with a w-kappa of 0.58 (95% CI [0.52-0.65]). In the medial TFJ, MRI detected 178 (81%) of 219 CT-OPs with a w-kappa of 0.58 (95% CI [0.51-0.64]). For the lateral compartment these numbers were 84 (70%) of 120 CT-OPs with a w-kappa of 0.58 (95% CI [0.50-0.66]). CONCLUSION MRI underestimates presence of osteophytes in all three knee compartments. CT may be helpful particularly regarding assessment of small osteophytes particularly in early disease.
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Song P, Cui Z, Hu L. Applications and prospects of intra-articular drug delivery system in arthritis therapeutics. J Control Release 2022; 352:946-960. [PMID: 36375618 DOI: 10.1016/j.jconrel.2022.11.018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2022] [Revised: 11/06/2022] [Accepted: 11/08/2022] [Indexed: 11/17/2022]
Abstract
Arthritis is a kind of chronic disease that affects joints and muscles with the symptoms of joint pain, inflammation and limited movement of joints. Among various clinical therapies, drug therapy has been extensively applied because of its accessibility, safety and effectiveness. In recent years, the intra-articular injection has dramatic therapeutic effects in treating arthritis with high patient compliance and low side effects. In this review, we will introduce pathology of arthritis, along with the accessible treatment and diagnosis methods, then we will summarize major advances of current hopeful intra-articular delivery systems such as microspheres, hydrogels, nanoparticles and liposomes. At last, some safety assessments in the preclinical work and the main challenges for the further development of intra-articular treatment were also discussed.
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Affiliation(s)
- Pengjin Song
- Key Laboratory of Pharmaceutical Quality Control of Hebei Province, School of Pharmaceutical Sciences, Hebei University, Baoding 071000, China
| | - Zhe Cui
- Key Laboratory of Pharmaceutical Quality Control of Hebei Province, School of Pharmaceutical Sciences, Hebei University, Baoding 071000, China.
| | - Liandong Hu
- Key Laboratory of Pharmaceutical Quality Control of Hebei Province, School of Pharmaceutical Sciences, Hebei University, Baoding 071000, China.
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Akgun E, Akgun MY. The effectiveness of bone scintigraphy in the management of low back pain. Clin Neurol Neurosurg 2022; 222:107440. [PMID: 36166994 DOI: 10.1016/j.clineuro.2022.107440] [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: 08/08/2022] [Revised: 09/04/2022] [Accepted: 09/10/2022] [Indexed: 11/16/2022]
Abstract
BACKGROUND Back and low back pain have been reported as one of the leading causes of activity restriction. While degenerative changes in the spine are among the common causes of low back pain, zygapophyseal (facet) joint pain is seen as the most widely accepted cause of back pain. Standard imaging modalities may have low predictive value in detecting the source of back pain. Thanks to radionuclide bone scintigraphy, painful lesions can be distinguished from age-related changes, especially in patients with chronic low back pain. In this study, we aimed to retrospectively evaluate the clinical results of facet-induced low back pain, which was confirmed by bone scintigraphy, after facet injection treatment. METHODS We completed a retrospective review of patients who underwent diagnostic radionuclide bone scintigraphy imaging for low back pain at our institution from 2019 to 2021. Scintigraphy imaging was often performed in conjunction with traditional diagnostic imaging. The patients underwent injection at the levels that were decided by the referring physician on the basis of the clinical symptoms, the physical examination findings, and findings on existing radiologic images, with performance of bone scanning. RESULTS The patients consisted of 24 (47.1 %) males and 27 (52.9 %) females with a mean age of 44.03 ± 9.26 years (range 34-67 years) at initial symptom onset. In the bone scintigraphy, increased radioactive uptake was detected in the facet joints of the lumbar region in 33 of 51 (64.7 %) patients. Statistically significant improvement was found in VAS-ODI and SF-36 scorings in 30 patients (90.1 %) after injection in patients with increased radioactive uptake. Statistically significant improvement was found in VAS-ODI and SF-36 scorings in 12 (66.6 %) patients who had no pathological findings with imaging modalities and were injected according to physical examination. When the two groups were compared with each other, the success rate in the group with increased radioactive uptake was found to be statistically significantly higher (p < 0.01) CONCLUSIONS: Application of this technology may lead to more reliable diagnosis and treatment of painful facet arthropathy. Appropriate diagnostic tests and determination of spinal level localization will provide satisfactory results with correct patient selection.
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Affiliation(s)
- Elife Akgun
- Department of Nuclear Medicine, Basaksehir Cam Sakura City Hospital, Istanbul, Turkey
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Hall ME, Black MS, Gold GE, Levenston ME. Validation of watershed-based segmentation of the cartilage surface from sequential CT arthrography scans. Quant Imaging Med Surg 2022; 12:1-14. [PMID: 34993056 PMCID: PMC8666781 DOI: 10.21037/qims-20-1062] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2020] [Accepted: 07/12/2021] [Indexed: 12/12/2022]
Abstract
BACKGROUND This study investigated the utility of a 2-dimensional watershed algorithm for identifying the cartilage surface in computed tomography (CT) arthrograms of the knee up to 33 minutes after an intra-articular iohexol injection as boundary blurring increased. METHODS A 2D watershed algorithm was applied to CT arthrograms of 3 bovine stifle joints taken 3, 8, 18, and 33 minutes after iohexol injection and used to segment tibial cartilage. Thickness measurements were compared to a reference standard thickness measurement and the 3-minute time point scan. RESULTS 77.2% of cartilage thickness measurements were within 0.2 mm (1 voxel) of the thickness calculated in the reference scan at the 3-minute time point. 42% fewer voxels could be segmented from the 33-minute scan than the 3-minute scan due to diffusion of the contrast agent out of the joint space and into the cartilage, leading to blurring of the cartilage boundary. The traced watershed lines were closer to the location of the cartilage surface in areas where tissues were in direct contact with each other (cartilage-cartilage or cartilage-meniscus contact). CONCLUSIONS The use of watershed dam lines to guide cartilage segmentation shows promise for identifying cartilage boundaries from CT arthrograms in areas where soft tissues are in direct contact with each other.
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Affiliation(s)
- Mary E. Hall
- Department of Mechanical Engineering, Stanford University, Stanford, CA, USA
| | - Marianne S. Black
- Department of Mechanical Engineering, Stanford University, Stanford, CA, USA
- Department of Radiology, Stanford University, Stanford, CA, USA
| | - Garry E. Gold
- Department of Radiology, Stanford University, Stanford, CA, USA
- Department of Bioengineering, Stanford University, Stanford, CA, USA
| | - Marc E. Levenston
- Department of Mechanical Engineering, Stanford University, Stanford, CA, USA
- Department of Radiology, Stanford University, Stanford, CA, USA
- Department of Bioengineering, Stanford University, Stanford, CA, USA
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Omoumi P, Schuler A, Babel H, Stoffel C, Jolles BM, Favre J. Proximal tibial osteophyte volumes are correlated spatially and with knee alignment: a quantitative analysis suggesting the influence of biochemical and mechanical factors in the development of osteophytes. Osteoarthritis Cartilage 2021; 29:1691-1700. [PMID: 34571138 DOI: 10.1016/j.joca.2021.09.008] [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: 02/11/2021] [Revised: 08/16/2021] [Accepted: 09/17/2021] [Indexed: 02/02/2023]
Abstract
OBJECTIVE To characterize the differences and correlations in osteophyte volumes between and within proximal tibial compartments, and to assess the correlations between osteophyte volumes and the femorotibial angle. DESIGN CT scans of 73 knees with predominantly medial femorotibial osteoarthritis (21 K/L2, 28 K/L3, 24 K/L4) were retrospectively analyzed using a new, reproducible method measuring total and subregional osteophyte volumes in the medial and lateral compartments. Non-parametric statistics was used for comparison and correlation analyses. RESULTS Total osteophyte volumes were larger in the medial than in the lateral compartment for all severity groups (p < 0.05). Additionally, statistically significant differences were observed among subregions of the lateral compartment in K/L3 and K/L4 knees. Statistically significant positive correlations were found between the medial and lateral total osteophyte volumes in K/L3 and K/L4 knees (ρ ≥ 0.44, p = 0.03), and among most subregional osteophyte volumes within each compartment in K/L3 knees. Markedly fewer statistically significant correlations were present in K/L2 and K/L4 knees. In K/L3 knees, the femorotibial angle was statistically significantly positively correlated with the total osteophyte volume in the medial compartment (ρ = 0.50, p = 0.01), with osteophyte volumes in most medial subregions, and with the osteophyte volume in the lateral posterior subregion (ρ = 0.40, p = 0.05). CONCLUSIONS Quantitative assessment of osteophytes may bring insight on factors influencing their development. Positive correlations of osteophyte volumes found between and within compartments suggest the influence of biochemical mediators acting on the entire joint, while positive correlations between the femorotibial angle and osteophyte volumes suggest a role of mechanical factors. These hypotheses are to be further confirmed.
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Affiliation(s)
- P Omoumi
- Lausanne University Hospital and University of Lausanne (CHUV-UNIL), Department of Diagnostic and Interventional Radiology, Lausanne, Switzerland; Cliniques Universitaires St Luc - UC Louvain, Department of Radiology, Brussels, Belgium.
| | - A Schuler
- Lausanne University Hospital and University of Lausanne (CHUV-UNIL), Department of Musculoskeletal Medicine, Swiss BioMotion Lab, Lausanne, Switzerland
| | - H Babel
- Lausanne University Hospital and University of Lausanne (CHUV-UNIL), Department of Musculoskeletal Medicine, Swiss BioMotion Lab, Lausanne, Switzerland
| | - C Stoffel
- Lausanne University Hospital and University of Lausanne (CHUV-UNIL), Department of Musculoskeletal Medicine, Swiss BioMotion Lab, Lausanne, Switzerland
| | - B M Jolles
- Lausanne University Hospital and University of Lausanne (CHUV-UNIL), Department of Musculoskeletal Medicine, Swiss BioMotion Lab, Lausanne, Switzerland; Ecole Polytechnique Fédérale Lausanne (EPFL), Institute of Microengineering, Lausanne, Switzerland
| | - J Favre
- Ecole Polytechnique Fédérale Lausanne (EPFL), Institute of Microengineering, Lausanne, Switzerland
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Pazahr S, Sutter R, Zubler V. MRI of the Elbow: How to Do It. Semin Musculoskelet Radiol 2021; 25:538-545. [PMID: 34706383 DOI: 10.1055/s-0041-1729884] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
The diagnostic cascade for elbow complaints starts with the physical examination and radiographs that already can clarify or rule out many causes. Depending on the suspected pathology, additional imaging is necessary. Magnetic resonance imaging (MRI) has the advantage of accurately demonstrating a broad spectrum of diseases. The main indication for noncontrast MRI of the elbow is chronic epicondylitis. For magnetic resonance (MR) arthrography, it is suspected chondral and osteochondral abnormalities. Indirect MR arthrography is an option when direct arthrography is not practicable. MR arthrography of the elbow with traction is feasible, with promising results for the assessment of the radiocapitellar cartilage.
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Affiliation(s)
- Shila Pazahr
- Department of Radiology, Balgrist University Hospital, Zurich, Switzerland
| | - Reto Sutter
- Department of Radiology, Balgrist University Hospital, Zurich, Switzerland
| | - Veronika Zubler
- Department of Radiology, Balgrist University Hospital, Zurich, Switzerland
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12
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MacKay JW, Watkins L, Gold G, Kogan F. [ 18F]NaF PET-MRI provides direct in-vivo evidence of the association between bone metabolic activity and adjacent synovitis in knee osteoarthritis: a cross-sectional study. Osteoarthritis Cartilage 2021; 29:1155-1162. [PMID: 33975018 PMCID: PMC8319134 DOI: 10.1016/j.joca.2021.04.014] [Citation(s) in RCA: 12] [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: 09/18/2020] [Revised: 03/22/2021] [Accepted: 04/15/2021] [Indexed: 02/02/2023]
Abstract
OBJECTIVE Synovitis is hypothesized to play a role in the development and growth of osteophytes. Our objectives were to use hybrid positron emission tomography-magnetic resonance imaging (PET-MRI) to (1) determine whether synovitis adjacent to peripheral bone subregions with increased metabolic activity is greater than adjacent to regions without increased metabolic activity and (2) assess the association between subregional bone metabolic activity and adjacent synovitis. DESIGN We recruited 11 participants (22 knees) with a diagnosis of OA in at least one knee. Simultaneous bilateral knee PET-MRI was performed. We quantified bone metabolic activity using the radiotracer [18F]sodium fluoride ([18F]NaF) with calculation of maximum standardized uptake values (SUVmax). Synovitis was quantified using dynamic contrast-enhanced MRI with calculation of Ktrans. Bone subregions were coded as osteophyte (OP), focal increased [18F]NaF uptake without osteophyte (FIU), or normal (no osteophyte or FIU). We used robust linear mixed effects models to assess differences in adjacent Ktrans between different subregion types and to assess association between Ktrans and adjacent SUVmax. RESULTS 94 OPs were detected (59 MOAKS grade 1, 30 grade 2, 5 grade 3), along with 28 FIU and 18 normal subregions. Ktrans was higher adjacent to FIU (adjusted mean [95% CI] = 0.06 [0.03,0.09]) and OPs (0.08 [0.05,0.11]) when compared to normal bone subregions (0.03 [0.00,0.09]). PET SUVmax was positively associated with adjacent Ktrans (β[95% CI] = 0.018 [0.008,0.027]). CONCLUSIONS Synovitis is more intense adjacent to peripheral bone regions with increased metabolic activity than those without, although there is some overlap. Subregional bone metabolic activity is positively associated with intensity of adjacent synovitis.
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Affiliation(s)
- J W MacKay
- Radiology, University of Cambridge, United Kingdom; Norwich Medical School, University of East Anglia, United Kingdom.
| | - L Watkins
- Radiology, Stanford University, USA; Bioengineering, Stanford University, USA
| | - G Gold
- Radiology, Stanford University, USA
| | - F Kogan
- Radiology, Stanford University, USA
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13
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Baylon EG, Crowder HA, Gold GE, Levenston ME. Non-ionic CT contrast solutions rapidly alter bovine cartilage and meniscus mechanics. Osteoarthritis Cartilage 2020; 28:1286-1297. [PMID: 32535082 PMCID: PMC7547404 DOI: 10.1016/j.joca.2020.05.013] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/24/2019] [Revised: 04/18/2020] [Accepted: 05/08/2020] [Indexed: 02/02/2023]
Abstract
OBJECTIVE To evaluate effects of a common CT contrast agent (iohexol) on the mechanical behaviors of cartilage and meniscus. METHODS Indentation responses of juvenile bovine cartilage and meniscus were monitored following exposure to undiluted contrast agent (100% CA), 50% CA/water, 50% CA/Phosphate Buffered Saline (PBS) or PBS alone, and during re-equilibration in PBS. The normalized peak force (Fpk¯), effective osmotic strain (εosm), and normalized effective contact modulus (Ec¯) were calculated for every cycle, with time constants determined for both exposure and recovery via mono- or biexponential fits to Fpk¯. RESULTS All cartilage CA groups exhibited long-term increases in Fpk¯ following exposure, although the hyperosmolal 100% CA and 50% CA/PBS groups showed an initial transient decrease. Meniscus presented opposing trends, with decreasing Fpk¯ for all CA groups. Re-equilibration in PBS for 1hr after exposure to 100% CA produced recovery to baseline Fpk¯ in cartilage but not in meniscus, and extended tests indicated that meniscus required ∼2.5 h to recover halfway. Ec¯ increased with CA exposure time for cartilage but decreased for meniscus, suggesting an increased effective stiffness for cartilage and decreased stiffness for meniscus. Long-term changes to εosm in both tissues were consistent with changes in Ec¯. CONCLUSION Exposure to iohexol solutions affected joint tissues differentially, with increased cartilage stiffness, likely relating to competing hyperosmotic and hypotonic interactions with tissue fixed charges, and decreased meniscus stiffness, likely dominated by hyperosmolarity. These altered tissue mechanics could allow non-physiological deformation during ambulatory weight-bearing, resulting in an increased risk of tissue or cell damage.
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Affiliation(s)
- E G Baylon
- Department of Mechanical Engineering, Stanford University, Stanford, CA, 94305, USA.
| | - H A Crowder
- Department of Mechanical Engineering, Stanford University, Stanford, CA, 94305, USA.
| | - G E Gold
- Department of Radiology, Stanford University, Stanford, CA, 94305, USA; Department of Bioengineering, Stanford University, Stanford, CA, 94305, USA; Department of Orthopaedic Surgery, Stanford University, Stanford, CA, 94305, USA.
| | - M E Levenston
- Department of Mechanical Engineering, Stanford University, Stanford, CA, 94305, USA; Department of Radiology, Stanford University, Stanford, CA, 94305, USA; Department of Bioengineering, Stanford University, Stanford, CA, 94305, USA.
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14
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Roemer FW, Demehri S, Omoumi P, Link TM, Kijowski R, Saarakkala S, Crema MD, Guermazi A. State of the Art: Imaging of Osteoarthritis—Revisited 2020. Radiology 2020; 296:5-21. [DOI: 10.1148/radiol.2020192498] [Citation(s) in RCA: 40] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
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15
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Wechselberger J, Neumann J, Wörtler K. Bildgebende Diagnostik bei glenohumeralen Knorpelschäden und Schulter-Früharthrose. ARTHROSKOPIE 2020. [DOI: 10.1007/s00142-020-00392-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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16
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Klaan B, Wuennemann F, Kintzelé L, Gersing AS, Weber MA. [MR and CT arthrography in cartilage imaging : Indications and implementation]. Radiologe 2019; 59:710-721. [PMID: 31286150 DOI: 10.1007/s00117-019-0564-z] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Abstract
BACKGROUND The imaging of chondral pathologies is an essential part in the work-up of acute and chronic joint diseases. Besides conventional MR imaging, CT and MR arthrography are well-established methods in evaluating articular cartilage. The application of these techniques requires knowledge of indications and safe injection procedures by the performing radiologist. PURPOSE Our goal is to describe the techniques of cross-sectional arthrographies of different joints, give an overview of general and joint-specific considerations for practical application as well as provide typical indications for cartilage imaging. MATERIALS AND METHODS A selective PubMed literature search concerning "arthrography", "CT arthrography", "MR arthrography", "arthrography cartilage", "arthrography wrist", "arthrography elbow", "arthrography shoulder", "arthrography hip", "arthrography knee", "arthrography ankle", "arthrography complications", "arthrography imaging guidance" "osteochondral lesion", "cartilage imaging" and "cartilage lesion" was performed. RESULTS AND CONCLUSION CT and MR arthrography are valuable and safe tools in cartilage imaging. They are useful to verify and specify chondral pathologies, usually after conventional MR imaging, and have an important role in evaluating the stability and therefore in therapeutic decision making of osteochondral lesions. CT arthrography is not only a substitute technique in case of MR contraindications, it can be advantageous in small joints (wrist, elbow, ankle) compared to MR arthrography due to its higher image resolution. Fluoroscopic guided joint puncture is still the most commonly used image guidance method, but the role of ultrasound is steadily increasing. Joint traction in MR arthrography is a promising technique to improve cartilage visualization, though it is not yet used in clinical routine imaging.
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Affiliation(s)
- B Klaan
- Institut für Diagnostische und Interventionelle Radiologie, Kinder- und Neuroradiologie, Universitätsmedizin Rostock, Ernst-Heydemann-Straße 6, 18057, Rostock, Deutschland.
| | - F Wuennemann
- Diagnostische und Interventionelle Radiologie, Universitätsklinikum Heidelberg, Heidelberg, Deutschland
| | - L Kintzelé
- Diagnostische und Interventionelle Radiologie, Universitätsklinikum Heidelberg, Heidelberg, Deutschland
| | - A S Gersing
- Institut für Diagnostische und Interventionelle Radiologie, Klinikum rechts der Isar, Technische Universität München, München, Deutschland
| | - M-A Weber
- Institut für Diagnostische und Interventionelle Radiologie, Kinder- und Neuroradiologie, Universitätsmedizin Rostock, Ernst-Heydemann-Straße 6, 18057, Rostock, Deutschland
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17
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The role of radiography and MRI for eligibility assessment in DMOAD trials of knee OA. Nat Rev Rheumatol 2019; 14:372-380. [PMID: 29752462 DOI: 10.1038/s41584-018-0010-z] [Citation(s) in RCA: 55] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
Currently, no disease-modifying osteoarthritis drugs (DMOADs) have been approved. Past clinical trials have failed for several reasons, including the commonly applied definition of eligibility based on radiographic assessment of joint structure. In the context of precision medicine, finding the appropriate patient for a specific treatment approach will be of increasing relevance. Phenotypic stratification by use of imaging at the time of determining eligibility for clinical trials will be paramount and cannot be achieved using radiography alone. Furthermore, identification of joints at high risk of rapid progression of osteoarthritis is needed in order to enable a more efficient DMOAD trial design. In addition, joints at high risk of collapse need to be excluded at screening. The use of MRI might offer advantages over radiography in this context. Technological advances and simplified image assessment address many of the commonly perceived barriers to the application of MRI to assessment of eligibility for DMOAD clinical trials.
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18
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Aguet J, Becce F, Dunet V, Vlassenbroek A, Coche EE, Omoumi P. Optimizing radiation dose parameters in MDCT arthrography of the shoulder: illustration of basic concepts in a cadaveric study. Skeletal Radiol 2019; 48:1261-1268. [PMID: 30725159 DOI: 10.1007/s00256-019-3150-6] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/20/2018] [Revised: 12/11/2018] [Accepted: 01/07/2019] [Indexed: 02/02/2023]
Abstract
OBJECTIVE To determine in a cadaveric study the lowest achievable radiation dose and optimal tube potential generating diagnostic image quality in multidetector computed tomography (MDCT) arthrography of the shoulder. MATERIALS AND METHODS Six shoulders from three human cadavers were scanned using a 256-MDCT system after intra-articular injection of diluted iodinated contrast material. Using six decreasing radiation dose levels (CTDIvol: 20, 15, 10, 8, 6, and 4 mGy) and for each dose level, four decreasing tube potentials (140, 120, 100, and 80 kVp), image noise and contrast-to-noise ratio (CNR) were measured. Two independent and blinded observers assessed the overall diagnostic image quality, subjective amount of noise, and severity of artifacts according to a four-point scale. Influence of those MDCT data acquisition parameters on objective and subjective image quality was analyzed using the Kruskal-Wallis and Wilcoxon signed-rank tests, and pairwise comparisons were performed. RESULTS Multidetector CT protocols with radiation doses of 15 mGy or higher, combined with tube potentials of 100 kVp or higher, were equivalent in CNR to the reference 20 mGy-140 kVp protocol (all p ≥ 0.054). Above a CTDIvol of 10 mGy and a tube potential of 120 kVp, all protocols generated diagnostic image quality and subjective noise equivalent to the 20 mGy-140 kVp protocol (all p ≥ 0.22). CONCLUSIONS Diagnostic image quality in MDCT arthrography of the shoulder can be obtained with a radiation dose of 10 mGy at an optimal tube potential of 120 kVp, corresponding to a reduction of up to 50% compared with standard-dose protocols, and as high as 500% compared with reported protocols in the literature.
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Affiliation(s)
- Julien Aguet
- Department of Diagnostic and Interventional Radiology, Lausanne University Hospital and University of Lausanne, Rue du Bugnon 46, 1011, Lausanne, Switzerland
| | - Fabio Becce
- Department of Diagnostic and Interventional Radiology, Lausanne University Hospital and University of Lausanne, Rue du Bugnon 46, 1011, Lausanne, Switzerland
| | - Vincent Dunet
- Department of Diagnostic and Interventional Radiology, Lausanne University Hospital and University of Lausanne, Rue du Bugnon 46, 1011, Lausanne, Switzerland
| | | | - Emmanuel E Coche
- Department of Radiology and Medical Imaging, Cliniques Universitaires Saint-Luc, Université Catholique de Louvain, Avenue Hippocrate 10, 1200, Bruxelles, Belgium
| | - Patrick Omoumi
- Department of Diagnostic and Interventional Radiology, Lausanne University Hospital and University of Lausanne, Rue du Bugnon 46, 1011, Lausanne, Switzerland.
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19
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Omoumi P, Babel H, Jolles BM, Favre J. Relationships between cartilage thickness and subchondral bone mineral density in non-osteoarthritic and severely osteoarthritic knees: In vivo concomitant 3D analysis using CT arthrography. Osteoarthritis Cartilage 2019; 27:621-629. [PMID: 30611905 DOI: 10.1016/j.joca.2018.12.014] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/31/2018] [Revised: 12/18/2018] [Accepted: 12/23/2018] [Indexed: 02/02/2023]
Abstract
OBJECTIVE To test whether subchondral bone mineral density (sBMD) and cartilage thickness (CTh) of femoral condyles are correlated in knees without and with severe medial femorotibial osteoarthritis (OA), using a subregional analysis with computerized tomography (CT) arthrography. METHODS CT arthrograms of 50 non-OA (18 males, 58.7 (interquartile range (IQR) = 6.6 years)) and 50 severe medial OA (24 males, 60.5 (IQR = 10.7) years) knees, were retrospectively analyzed. Bone and cartilage were segmented using custom-designed software, leading to 3D models on which each point of the subchondral surface is given a CTh and sBMD value. The average sBMD and CTh were then calculated for the entire weight-bearing regions as well as specific subregions of interest. Linear bivariate and multivariable analyses were performed to test for relationships between sBMD and CTh (regional and subregional measures, or medial-to-lateral ratios), with confounders of age, gender, femoral bone size and femorotibial angle. RESULTS In non-OA knees, the sBMD and CTh medial-to-lateral ratios were positively correlated for the total region and the external and internal subregions (r ≥ 0.341, P ≤ 0.015). In OA knees, sBMD and CTh medial-to-lateral ratios were negatively correlated for the total region and the external and central subregions (r ≤ -0.538, P < 0.001). Additional positive/negative relationships in the non-OA/OA knees were observed between sBMD and CTh measures in the medial compartment. CONCLUSIONS The positive correlation between sBMD and CTh in non-OA knees, and the negative one in OA knees, bring support to the theory of a subchondral bone/cartilage functional unit, which could help to better understand the pathophysiology of OA.
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Affiliation(s)
- P Omoumi
- Department of Diagnostic and Interventional Radiology, Centre Hospitalier Universitaire and University of Lausanne, Lausanne, Switzerland; Department of Radiology, Cliniques Universitaires St Luc - UC Louvain, Brussels, Belgium; Swiss BioMotion Lab, Department of Musculoskeletal Medicine, Centre Hospitalier Universitaire Vaudois and University of Lausanne, Lausanne, Switzerland.
| | - H Babel
- Swiss BioMotion Lab, Department of Musculoskeletal Medicine, Centre Hospitalier Universitaire Vaudois and University of Lausanne, Lausanne, Switzerland
| | - B M Jolles
- Swiss BioMotion Lab, Department of Musculoskeletal Medicine, Centre Hospitalier Universitaire Vaudois and University of Lausanne, Lausanne, Switzerland; Institute of Micro Engineering, Ecole Polytechnique Fédérale de Lausanne, Lausanne, Switzerland
| | - J Favre
- Swiss BioMotion Lab, Department of Musculoskeletal Medicine, Centre Hospitalier Universitaire Vaudois and University of Lausanne, Lausanne, Switzerland
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20
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Hayashi D, Roemer FW, Guermazi A. Imaging of Osteoarthritis by Conventional Radiography, MR Imaging, PET–Computed Tomography, and PET–MR Imaging. PET Clin 2019; 14:17-29. [DOI: 10.1016/j.cpet.2018.08.004] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
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21
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Dallaudiere B, Crombé A, Gadeau AP, Pesquer L, Peuchant A, James C, Silvestre A. Iodine contrast agents do not influence Platelet-Rich Plasma function at an early time point in vitro. J Exp Orthop 2018; 5:47. [PMID: 30374787 PMCID: PMC6206314 DOI: 10.1186/s40634-018-0162-4] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/17/2018] [Accepted: 10/17/2018] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Iodine contrast agents (ICAs) are routinely used by radiologists to help guide intra-articular infiltrations. The aim of this study was to assess the in vitro effects of ICA on platelet function of human autologous Platelet-Rich Plasma (PRP). METHODS One hundred thirty-seven consecutive patients with symptomatic femoral-patellar osteoarthritis were included. All were addressed to our institution for a fluoroscopy-guided intra-articular PRP infiltration of the pathological femoral-patellar joint. For each patient, 500 μl of PRP were sampled before intra-articular injection. First, PRP samples were mixed with 50 μl of 2 widely used ICA: Visipaque270® (Iodixanol, n = 58) and Iopamiron200® (Iopamidol, n = 69). PRP concentration ([PRP]) was measured at different delays of incubation (t = 0, 5, 10, 15, 20 and 30 min) enabling to calculate PRP ratio (defined as [PRP](t)/[PRP](0mn)) at each delay, for each mixture, in order to quantitatively assess the influence of ICA on PRP ratio. Second, the PRP samples of 10 additional patients were mixed with Visipaque270®, Visipaque270®, Iopamiron200® and phosphate buffer saline (PBS: control solution) in order to qualitatively assess the influence of ICA on platelet aggregation, using ADP, Collagen, Arachidonic acid and TRAP tests. The surface expression of human P-selectin, a marker of α-granule release, in the PRP + Visipaque270® and PRP + Iopamiron200® mixtures was finally compared. Repeated-measures ANOVA, classical 2-way ANOVA and Wilcoxon matched-pairs test were used to study the influence of ICA on PRP quality. RESULTS There was no significant change in PRP ratio during the first 30mn of incubation (p = 0.991) whatever the ICA (p = 0.926). Whatever the aggregation test, there was no significant difference in the percentage of platelet aggregation between PRP + PBS, PRP + Visipaque270® and PRP + Iopamiron200® (p = 0.998), nor between PRP + PBS and PRP + Visipaque320® (p = 0.470). Finally, there was no significant difference in P-selectin expression between the PRP + Visipaque270® and PRP + Iopamiron200® mixtures (p = 0.500). CONCLUSION At early delays of incubation, Visipaque® and Iopamiron®, which are two widely used ICA for intra-articular infiltrations, did not influence the in vitro platelet function nor the quality of PRP.
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Affiliation(s)
- B Dallaudiere
- Interventional Musculoskeletal Radiology Department, Clinique du sport de Bordeaux, F-33700, Mérignac, France. .,Centre de Résonance Magnétique des Systèmes Biologiques, UMR5536, CNRS, F-33000, Bordeaux, France. .,Université de Bordeaux, F-33076, Bordeaux, France.
| | - A Crombé
- Interventional Musculoskeletal Radiology Department, Clinique du sport de Bordeaux, F-33700, Mérignac, France.,Université de Bordeaux, F-33076, Bordeaux, France.,Department of Radiology, Institut Bergonié, F-33000, Bordeaux, France
| | - A P Gadeau
- Université de Bordeaux, F-33076, Bordeaux, France.,Biology of Cardiovascular Diseases, INSERM U1034, F-33600, Pessa, France
| | - L Pesquer
- Interventional Musculoskeletal Radiology Department, Clinique du sport de Bordeaux, F-33700, Mérignac, France
| | - A Peuchant
- Department of Pathology, Clinique du sport de Bordeaux, F-33700, Mérignac, France
| | - C James
- Université de Bordeaux, F-33076, Bordeaux, France.,Biology of Cardiovascular Diseases, INSERM U1034, F-33600, Pessa, France
| | - A Silvestre
- Interventional Musculoskeletal Radiology Department, Clinique du sport de Bordeaux, F-33700, Mérignac, France.,Université de Bordeaux, F-33076, Bordeaux, France.,Biology of Cardiovascular Diseases, INSERM U1034, F-33600, Pessa, France
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22
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Nguyen BJ, Burt A, Baldassarre RL, Smitaman E, Morshedi M, Kao S, Chang EY, Obrzut S. The prognostic and diagnostic value of 18F-FDG PET/CT for assessment of symptomatic osteoarthritis. Nucl Med Commun 2018; 39:699-706. [PMID: 29893752 DOI: 10.1097/mnm.0000000000000858] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
OBJECTIVE The objective of this study was to assess the clinical significance of increased fluorine-18-fluorodeoxyglucose (F-FDG) uptake on PET/CT in joints for evaluation of symptomatic osteoarthritis (OA) and prediction of progression. PATIENTS AND METHODS In this prospective study, shoulder, hip, and knee joints were imaged in 65 patients undergoing routine F-FDG PET/CT imaging. Patients completed the Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) questionnaire to assess joint pain, stiffness, and physical function. Standardized uptake values (SUVs) were measured in hip, knee, acromioclavicular (AC), and glenohumeral (GH) joints. Scout PET/CT images were evaluated for OA using the Kellgren and Lawrence (K/L) system. Patients were followed-up for 5 years to determine the progression of OA on the basis of follow-up imaging or surgical intervention. RESULTS SUV of knee (r=0.309, P=0.0003), hip (r=0.260, P=0.0027), AC (r=0.186, P=0.0313), and GH (r=0.191, P=0.0271) joints correlated with WOMAC overall scores. Furthermore, SUV of knee (r=0.410, P<0.0001), hip (r=0.203, P=0.0199), and AC (r=0.364, P<0.0001) joints correlated with K/L scores. The area under the receiver operating characteristic curves for SUV were 0.734 (knee), 0.678 (hip), 0.661 (AC), and 0.544 (GH) for symptomatic OA detection based on WOMAC overall z-score greater or equal to 2. Compared with K/L score [hazard ratio (HR)=0.798, P=0.5324], age (HR=0.992, P=0.8978), and WOMAC overall score (HR=1.089, P=0.1265), only SUV (HR=5.653, P=0.0229) was an independent predictor of OA progression in the knees. CONCLUSION F-FDG PET/CT may be helpful with localization of painful abnormalities in the inflamed regions of the joints, which could potentially be used to direct individualized treatment in moderate and severe OA. Furthermore, SUV measurement on F-FDG PET/CT could serve as an inflammation activity index in the knees that may be predictive of outcomes and progression rate of OA.
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Affiliation(s)
- Brian J Nguyen
- University of California San Diego School of Medicine, La Jolla
| | - Ashley Burt
- Department of Radiology, University of California San Diego
| | | | | | - Maud Morshedi
- Department of Radiology, University of California San Diego
| | - Steven Kao
- University of California San Diego School of Medicine, La Jolla
| | - Eric Y Chang
- Veterans Affairs (VA), San Diego Healthcare System, San Diego, California, USA
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23
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Omoumi P, Babel H, Jolles BM, Favre J. Cartilage can be thicker in advanced osteoarthritic knees: a tridimensional quantitative analysis of cartilage thickness at posterior aspect of femoral condyles. Br J Radiol 2018; 91:20170729. [PMID: 29595325 DOI: 10.1259/bjr.20170729] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022] Open
Abstract
OBJECTIVE To test, through tridimensional analysis, whether (1) cartilage thickness at the posterior aspect of femoral condyles differs in knees with medial femorotibial osteoarthritis (OA) compared to non-OA knees; (2) the location of the thickest cartilage at the posterior aspect of femoral condyles differs between OA and non-OA knees. METHODS CT arthrograms of knees without radiographic OA (n = 30) and with severe medial femorotibial OA (n = 30) were selected retrospectively from patients over 50 years of age. The groups did not differ in gender, age and femoral size. CT arthrograms were segmented to measure the mean cartilage thickness, the maximal cartilage thickness and its location in a region of interest at the posterior aspect of condyles. RESULTS For the medial condyle, mean and maximum cartilage thicknesses were statistically significantly higher in OA knees compared to non-OA knees [1.66 vs 1.46 mm (p = 0.03) and 2.56 vs 2.14 mm (p = 0.003), respectively]. The thickest cartilage was located in the half most medial aspect of the posterior medial condyle for both groups, without significant difference between groups. For the lateral condyle, no statistically significant difference between non-OA and OA knees was found (p ≥ 0.17). CONCLUSION Cartilage at the posterior aspect of the medial condyle, but not the lateral condyle, is statistically significantly thicker in advanced medial femorotibial OA knees compared to non-OA knees. The thickest cartilage was located in the half most medial aspect of the posterior medial condyle. These results will serve as the basis for future research to determine the histobiological processes involved in this thicker cartilage. Advances in knowledge: This study, through a quantitative tridimensional approach, shows that cartilage at the posterior aspect of the medial condyles is thicker in severe femorotibial osteoarthritic knees compared to non-OA knees. In the posterior aspect of the medial condyle, the thickest cartilage is located in the vicinity of the center of the half most medial aspect of the posterior medial condyle. These results will serve as the basis for future research to determine the histobiological processes involved in this thicker cartilage.
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Affiliation(s)
- Patrick Omoumi
- 1 Department of Diagnostic and Interventional Radiology, Centre Hospitalier Universitaire and University of Lausanne , Lausanne , Switzerland.,2 Department of Radiology, Cliniques Universitaires St Luc - UC Louvain , Brussels , Belgium.,3 Department of Musculoskeletal Medicine, Swiss BioMotion Lab, Centre Hospitalier Universitaire Vaudois and University of Lausanne , Lausanne , Switzerland
| | - Hugo Babel
- 3 Department of Musculoskeletal Medicine, Swiss BioMotion Lab, Centre Hospitalier Universitaire Vaudois and University of Lausanne , Lausanne , Switzerland
| | - Brigitte M Jolles
- 3 Department of Musculoskeletal Medicine, Swiss BioMotion Lab, Centre Hospitalier Universitaire Vaudois and University of Lausanne , Lausanne , Switzerland.,4 Institute of Microengineering, Ecole Polytechnique Fédérale de Lausanne , Lausanne , Switzerland
| | - Julien Favre
- 3 Department of Musculoskeletal Medicine, Swiss BioMotion Lab, Centre Hospitalier Universitaire Vaudois and University of Lausanne , Lausanne , Switzerland
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Nelson BB, Kawcak CE, Barrett MF, McIlwraith CW, Grinstaff MW, Goodrich LR. Recent advances in articular cartilage evaluation using computed tomography and magnetic resonance imaging. Equine Vet J 2018; 50:564-579. [DOI: 10.1111/evj.12808] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2017] [Accepted: 01/09/2018] [Indexed: 12/18/2022]
Affiliation(s)
- B. B. Nelson
- Gail Holmes Equine Orthopaedic Research Center Department of Clinical Sciences College of Veterinary Medicine and Biomedical Sciences, Colorado State University Fort Collins Colorado USA
| | - C. E. Kawcak
- Gail Holmes Equine Orthopaedic Research Center Department of Clinical Sciences College of Veterinary Medicine and Biomedical Sciences, Colorado State University Fort Collins Colorado USA
| | - M. F. Barrett
- Gail Holmes Equine Orthopaedic Research Center Department of Clinical Sciences College of Veterinary Medicine and Biomedical Sciences, Colorado State University Fort Collins Colorado USA
- Department of Environmental and Radiological Health Sciences Colorado State University Fort Collins Colorado USA
| | - C. W. McIlwraith
- Gail Holmes Equine Orthopaedic Research Center Department of Clinical Sciences College of Veterinary Medicine and Biomedical Sciences, Colorado State University Fort Collins Colorado USA
| | - M. W. Grinstaff
- Departments of Biomedical Engineering, Chemistry and Medicine Boston University Boston Massachusetts USA
| | - L. R. Goodrich
- Gail Holmes Equine Orthopaedic Research Center Department of Clinical Sciences College of Veterinary Medicine and Biomedical Sciences, Colorado State University Fort Collins Colorado USA
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Bhure U, Roos JE, Pérez Lago MDS, Steurer I, Grünig H, Hug U, Strobel K. SPECT/CT arthrography. Br J Radiol 2017; 91:20170635. [PMID: 29099611 DOI: 10.1259/bjr.20170635] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
Single photon emission CT (SPECT)/CT arthrography, the combination of CT arthrography and late phase bone SPECT/CT, has been developed in 2011 and so far used in knee, ankle and wrist joints. SPECT/CT offers functional information about increased bone turnover in combination with morphological details. Compared with SPECT/CT alone, additional intra-articular contrast enables the assessment of cartilage, menisci, ligaments and loose bodies. SPECT/CT arthrography is a promising alternative technique for the evaluation of internal derangement of joints in patients with MR contraindications and/or metallic implants. In this article, we review and report our 5-year experience with this technique illustrated with patient examples and give a perspective for future applications.
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Affiliation(s)
- Ujwal Bhure
- 1 Nuclear Medicine and Radiology, Cantonal Hospital Lucerne, Lucerne, Switzerland
| | - Justus E Roos
- 1 Nuclear Medicine and Radiology, Cantonal Hospital Lucerne, Lucerne, Switzerland
| | | | - Isabelle Steurer
- 1 Nuclear Medicine and Radiology, Cantonal Hospital Lucerne, Lucerne, Switzerland
| | - Hannes Grünig
- 1 Nuclear Medicine and Radiology, Cantonal Hospital Lucerne, Lucerne, Switzerland
| | - Urs Hug
- 2 Department of Hand and Plastic Surgery, Cantonal Hospital Lucerne, Lucerne, Switzerland
| | - Klaus Strobel
- 1 Nuclear Medicine and Radiology, Cantonal Hospital Lucerne, Lucerne, Switzerland
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Rupasov A, Cain U, Montoya S, Blickman JG. Imaging of Posttraumatic Arthritis, Avascular Necrosis, Septic Arthritis, Complex Regional Pain Syndrome, and Cancer Mimicking Arthritis. Radiol Clin North Am 2017; 55:1111-1130. [DOI: 10.1016/j.rcl.2017.04.014] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/15/2023]
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Abstract
With technologic advances and the availability of sophisticated computer software and analytical strategies, imaging plays an increasingly important role in understanding the disease process of osteoarthritis (OA). Radiography has limitations in that it can visualize only limited features of OA, such as osteophytes and joint space narrowing, but remains the most commonly used modality for establishing an imaging-based diagnosis of OA. This article describes the roles and limitations of different imaging modalities and discusses the optimum imaging protocol, imaging diagnostic criteria of OA, differential diagnoses, and what the referring physician needs to know.
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Cerny M, Omoumi P, Larbi A, Manicourt D, Perozziello A, Lecouvet FE, Berg BV, Dallaudière B. CT arthrography of adhesive capsulitis of the shoulder: Are MR signs applicable? Eur J Radiol Open 2017; 4:40-44. [PMID: 28409175 PMCID: PMC5379909 DOI: 10.1016/j.ejro.2017.03.002] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2017] [Accepted: 03/25/2017] [Indexed: 11/29/2022] Open
Abstract
OBJECTIVE To determine if diagnostic signs of adhesive capsulitis (AC) of the shoulder at Magnetic Resonance Imaging (MRI) and arthrography (MRA) are applicable to CT arthrography (CTA). METHODS 22 shoulder CTAs with AC were retrospectively reviewed for features described in MR literature. The control group was composed of 83 shoulder CTA divided into four subgroups 1) normal (N = 20), 2) omarthrosis (N = 19), 3) labral injury (N = 23), and 4) rotator cuff tear (N = 21). Two musculoskeletal radiologists assessed the rotator interval (RI) for obliteration, increased width and thickening of coracohumeral ligament (CHL). The width and capsule thickness of the axillary recess were measured. RESULTS The width of the axillary recess was significantly decreased in the AC group (4.6 ± 2.6 mm versus 9.9 ± 4.6 mm, p ≤ 0.0001; sensitivity and specificity of 84% and 80%). Thickness of the medial and lateral walls of the axillary capsule was significantly increased in the AC group (5.9 ± 1.3 mm versus 3.7 ± 1.1 mm, p ≤ 0.0001 and 5.7 ± 1 mm versus 3.5 ± 1.3 mm, p ≤ 0.0001, respectively). CHL thickness was significantly increased in the AC group (4.1 ± 1 mm (p ≤ 0.001)) in comparison to others groups. Obliteration of the RI was statistically significantly more frequent in patients with AC (72.7% (16/22) vs. 12% (10/83), p < 0.0001). Width of the RI did not differ significantly between patients and controls (p ≥ 0.428). CONCLUSION Decreased axillary width, and thickened axillary capsule are MR signs of AC applicable to CTA. Evaluation of rotator interval seems useful and reproducible only for obliteration.
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Affiliation(s)
- Milena Cerny
- Department of Radiology, Cliniques Universitaires Saint-Luc, Université Catholique de Louvain, Brussel, Belgium.,Department of Radiology, University Hospital of Lausanne, Lausanne, Switzerland
| | - Patrick Omoumi
- Department of Radiology, Cliniques Universitaires Saint-Luc, Université Catholique de Louvain, Brussel, Belgium.,Department of Radiology, University Hospital of Lausanne, Lausanne, Switzerland
| | - Ahmed Larbi
- Department of Radiology, Cliniques Universitaires Saint-Luc, Université Catholique de Louvain, Brussel, Belgium
| | - Daniel Manicourt
- Department of Rheumatology, Cliniques Universitaires Saint-Luc, Université Catholique de Louvain, Brussel, Belgium
| | | | - Frederic E Lecouvet
- Department of Radiology, Cliniques Universitaires Saint-Luc, Université Catholique de Louvain, Brussel, Belgium
| | - Bruno Vande Berg
- Department of Radiology, Cliniques Universitaires Saint-Luc, Université Catholique de Louvain, Brussel, Belgium
| | - Benjamin Dallaudière
- Department of Radiology, Cliniques Universitaires Saint-Luc, Université Catholique de Louvain, Brussel, Belgium.,Centre d'Imagerie Ostéo-articulaire, Clinique du Sport de Bordeaux-Mérignac, 2, rue Négrevergne, 33700 Mérignac, France
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Omoumi P, Michoux N, Larbi A, Lacoste L, Lecouvet FE, Perlepe V, Vande Berg BC. Multirater agreement for grading the femoral and tibial cartilage surface lesions at CT arthrography and analysis of causes of disagreement. Eur J Radiol 2017; 88:95-101. [DOI: 10.1016/j.ejrad.2016.12.026] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2016] [Revised: 11/21/2016] [Accepted: 12/24/2016] [Indexed: 10/20/2022]
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Increased 18F-FDG uptake suggests synovial inflammatory reaction with osteoarthritis: preliminary in-vivo results in humans. Nucl Med Commun 2016; 36:1215-9. [PMID: 26367212 DOI: 10.1097/mnm.0000000000000376] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/15/2023]
Abstract
OBJECTIVE The aim of this prospective study was to compare the metabolic activity of the knee joints of a group of patients with painful knees clinically (such as recurrent joint pain, joint instability, and functional limitations) consistent with osteoarthritis and those of another group of patients without such complaints, using [F]-2-fluoro-2-deoxy-D-glucose (F-FDG)-PET imaging. METHODS A total of 97 patients who participated in either painful joint prosthesis or diabetic foot research studies involving F-FDG-PET scans were asked to complete a knee pain questionnaire. The patients were asked whether they experienced pain in any joint, and if so, which joints were affected. RESULTS A total of 18 knee joints without prosthesis were reported to be painful. The maximum standardized uptake values (SUVmax) of the middle joint space and lateral synovial tissue of these 18 knees were measured and compared with those of a set of patients with control asymptomatic knees. The average SUVmax of the middle part of the joint space in the painful knees was 1.35±0.59 compared with an average SUVmax value of 0.86±0.14 in the control group (P=0.0176). The average SUVmax of the synovium in the lateral part of the painful joints was 1.17±0.49 compared with 0.73±0.31 in the control group (P=0.0161). CONCLUSION These data indicate that increased F-FDG uptake is associated with knee pain in osteoarthritis patients and that there is a positive relationship between the two parameters.
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Kuyinu EL, Narayanan G, Nair LS, Laurencin CT. Animal models of osteoarthritis: classification, update, and measurement of outcomes. J Orthop Surg Res 2016; 11:19. [PMID: 26837951 PMCID: PMC4738796 DOI: 10.1186/s13018-016-0346-5] [Citation(s) in RCA: 328] [Impact Index Per Article: 41.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/23/2015] [Accepted: 01/11/2016] [Indexed: 12/13/2022] Open
Abstract
Osteoarthritis (OA) is one of the most commonly occurring forms of arthritis in the world today. It is a debilitating chronic illness causing pain and immense discomfort to the affected individual. Significant research is currently ongoing to understand its pathophysiology and develop successful treatment regimens based on this knowledge. Animal models have played a key role in achieving this goal. Animal models currently used to study osteoarthritis can be classified based on the etiology under investigation, primary osteoarthritis, and post-traumatic osteoarthritis, to better clarify the relationship between these models and the pathogenesis of the disease. Non-invasive animal models have shown significant promise in understanding early osteoarthritic changes. Imaging modalities play a pivotal role in understanding the pathogenesis of OA and the correlation with pain. These imaging studies would also allow in vivo surveillance of the disease as a function of time in the animal model. This review summarizes the current understanding of the disease pathogenesis, invasive and non-invasive animal models, imaging modalities, and pain assessment techniques in the animals.
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Affiliation(s)
- Emmanuel L Kuyinu
- Institute for Regenerative Engineering, University of Connecticut Health, Farmington, CT, USA. .,Raymond and Beverly Sackler Center for Biomedical, Biological, Physical and Engineering Sciences, University of Connecticut Health, Farmington, CT, USA. .,Department of Orthopaedic Surgery, University of Connecticut Health, Farmington, CT, USA.
| | - Ganesh Narayanan
- Institute for Regenerative Engineering, University of Connecticut Health, Farmington, CT, USA. .,Raymond and Beverly Sackler Center for Biomedical, Biological, Physical and Engineering Sciences, University of Connecticut Health, Farmington, CT, USA. .,Department of Orthopaedic Surgery, University of Connecticut Health, Farmington, CT, USA.
| | - Lakshmi S Nair
- Institute for Regenerative Engineering, University of Connecticut Health, Farmington, CT, USA. .,Raymond and Beverly Sackler Center for Biomedical, Biological, Physical and Engineering Sciences, University of Connecticut Health, Farmington, CT, USA. .,Department of Orthopaedic Surgery, University of Connecticut Health, Farmington, CT, USA. .,Department of Biomedical Engineering, University of Connecticut, Storrs, CT, USA. .,Department of Materials Science and Engineering, University of Connecticut, Storrs, CT, USA. .,Institute of Materials Science, University of Connecticut, Storrs, CT, USA.
| | - Cato T Laurencin
- Institute for Regenerative Engineering, University of Connecticut Health, Farmington, CT, USA. .,Raymond and Beverly Sackler Center for Biomedical, Biological, Physical and Engineering Sciences, University of Connecticut Health, Farmington, CT, USA. .,Department of Orthopaedic Surgery, University of Connecticut Health, Farmington, CT, USA. .,Department of Biomedical Engineering, University of Connecticut, Storrs, CT, USA. .,Department of Materials Science and Engineering, University of Connecticut, Storrs, CT, USA. .,Institute of Materials Science, University of Connecticut, Storrs, CT, USA. .,Department of Craniofacial Sciences, School of Dental Medicine, University of Connecticut Health, Farmington, CT, USA. .,Department of Chemical and Biomolecular Engineering, University of Connecticut, Storrs, CT, USA.
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Conventional and novel imaging modalities in osteoarthritis: current state of the evidence. Curr Opin Rheumatol 2015; 27:295-303. [PMID: 25803224 DOI: 10.1097/bor.0000000000000163] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
PURPOSE OF REVIEW Imaging modalities are currently an inseparable part of osteoarthritis diagnosis. In this review, we describe the current state of evidence regarding conventional and novel imaging modalities in evaluation of osteoarthritis. Modalities including radiography (qualitative and semi-quantitative assessments), ultrasonography, computed tomography [CT; conventional multidetector CT (MDCT), cone-beam CT (CBCT) and four-dimensional CT (4DCT)], MRI (MRI; semi-quantitative, quantitative and compositional) and PET and their applications are reviewed. RECENT FINDINGS Radiography is the modality of choice for initial assessment of osteoarthritis. However, due to its low sensitivity and specificity, numerous recent investigations have proposed MRI as a powerful addition to detect and grade osteoarthritis features, which are not apparent in radiography. Semi-quantitative MRI measurements are feasible to perform in routine clinical practice. Quantitative and compositional MRI measurements have extended the amount of information an MRI examination can provide regarding the three-dimensional shape and tissue composition of articular cartilage. 4DCT and CBCT are introduced as imaging examinations that may reveal biomechanical cartilage abnormalities in osteoarthritis joint by dynamic and weight-bearing evaluations, respectively. Recent PET studies may unveil the underlying metabolic activities that can be associated with osteoarthritis. SUMMARY In addition to the established role of radiographs, MRI is the advanced modality of choice for detection and quantification of various osteoarthritis features. 4DCT and CBCT may have specified applications when diagnosis of underlying motion abnormality or dynamic changes in weight-bearing situation is suspected. Future studies should elucidate the specific clinical applications of ultrasonography and PET.
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Marenzana M, Vande Velde G. Refine, reduce, replace: Imaging of fibrosis and arthritis in animal models. Best Pract Res Clin Rheumatol 2015; 29:715-40. [DOI: 10.1016/j.berh.2016.02.001] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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34
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Vidal A, Gaumet V, Galmier MJ, Besse S, Leal F, Gachon F, Viot G, Métin J, Chezal JM, Miot-Noirault E, Auzeloux P. Development of a freeze-dried kit formulation for the preparation of 99m Tc-NTP 15-5, a radiotracer for scintigraphic imaging of proteoglycans. Appl Radiat Isot 2015; 101:1-9. [DOI: 10.1016/j.apradiso.2015.03.010] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2014] [Revised: 03/03/2015] [Accepted: 03/10/2015] [Indexed: 10/23/2022]
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Ranganath LR, Psarelli EE, Cox TF, Gallagher JA. Diagnostic tools and strategies for assessing disease progression in Alkaptonuria. Expert Opin Orphan Drugs 2015. [DOI: 10.1517/21678707.2015.1042859] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
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36
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Hunter DJ, Altman RD, Cicuttini F, Crema MD, Duryea J, Eckstein F, Guermazi A, Kijowski R, Link TM, Martel-Pelletier J, Miller CG, Mosher TJ, Ochoa-Albíztegui RE, Pelletier JP, Peterfy C, Raynauld JP, Roemer FW, Totterman SM, Gold GE. OARSI Clinical Trials Recommendations: Knee imaging in clinical trials in osteoarthritis. Osteoarthritis Cartilage 2015; 23:698-715. [PMID: 25952343 DOI: 10.1016/j.joca.2015.03.012] [Citation(s) in RCA: 98] [Impact Index Per Article: 10.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/08/2014] [Revised: 03/09/2015] [Accepted: 03/09/2015] [Indexed: 02/02/2023]
Abstract
Significant advances have occurred in our understanding of the pathogenesis of knee osteoarthritis (OA) and some recent trials have demonstrated the potential for modification of the disease course. The purpose of this expert opinion, consensus driven exercise is to provide detail on how one might use and apply knee imaging in knee OA trials. It includes information on acquisition methods/techniques (including guidance on positioning for radiography, sequence/protocol recommendations/hardware for magnetic resonance imaging (MRI)); commonly encountered problems (including positioning, hardware and coil failures, sequences artifacts); quality assurance (QA)/control procedures; measurement methods; measurement performance (reliability, responsiveness, validity); recommendations for trials; and research recommendations.
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Affiliation(s)
- D J Hunter
- Institute of Bone and Joint Research, Kolling Institute, University of Sydney, Sydney, NSW, Australia; Rheumatology Department, Royal North Shore Hospital, University of Sydney, Sydney, NSW, Australia.
| | - R D Altman
- Department of Medicine, Division of Rheumatology and Immunology, David Geffen School of Medicine, University of California at Los Angeles, Los Angeles, CA, USA
| | - F Cicuttini
- School of Public health and Preventive Medicine, Monash University, Alfred Hospital, Melbourne 3004, Australia
| | - M D Crema
- Quantitative Imaging Center, Department of Radiology, Boston University School of Medicine, Boston, MA, USA; Department of Radiology, Hospital do Coração (HCor) and Teleimagem, São Paulo, SP, Brazil
| | - J Duryea
- Department of Radiology, Brigham and Women's Hospital, Harvard Medical School, Brazil
| | - F Eckstein
- Institute of Anatomy, Paracelsus Medical University Salzburg & Nuremberg, Salzburg, Austria; Chondrometrics GmbH, Ainring, Germany
| | - A Guermazi
- Quantitative Imaging Center, Department of Radiology, Boston University School of Medicine, Boston, MA, USA
| | - R Kijowski
- Department of Radiology, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin, USA
| | - T M Link
- Department of Radiology and Biomedical Imaging, UCSF, San Francisco, USA
| | - J Martel-Pelletier
- Osteoarthritis Research Unit, University of Montreal Hospital Research Centre (CRCHUM), Montreal, Quebec, Canada
| | | | - T J Mosher
- Department of Radiology, Penn State University, Hershey, PA, USA; Department of Orthopaedic Surgery, Penn State University, Hershey, PA, USA
| | - R E Ochoa-Albíztegui
- Department of Radiology, The American British Cowdray Medical Center, Mexico City, Mexico
| | - J-P Pelletier
- Osteoarthritis Research Unit, University of Montreal Hospital Research Centre (CRCHUM), Montreal, Quebec, Canada
| | - C Peterfy
- Spire Sciences, Inc., Boca Raton, Florida, USA
| | - J-P Raynauld
- Osteoarthritis Research Unit, University of Montreal Hospital Research Centre (CRCHUM), Montreal, Quebec, Canada
| | - F W Roemer
- Quantitative Imaging Center, Department of Radiology, Boston University School of Medicine, Boston, MA, USA; Department of Radiology, University of Erlangen-Nuremberg, Erlangen, Germany
| | | | - G E Gold
- Department of Radiology, Stanford University, Stanford, CA, USA; Department of Bioengineering, Stanford University, Stanford, CA, USA; Department of Orthopaedic Surgery, Stanford University, Stanford, CA, USA
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Omoumi P, Michoux N, Roemer FW, Thienpont E, Vande Berg BC. Cartilage thickness at the posterior medial femoral condyle is increased in femorotibial knee osteoarthritis: a cross-sectional CT arthrography study (Part 2). Osteoarthritis Cartilage 2015; 23:224-31. [PMID: 25450850 DOI: 10.1016/j.joca.2014.08.017] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/05/2014] [Revised: 06/26/2014] [Accepted: 08/15/2014] [Indexed: 02/02/2023]
Abstract
OBJECTIVE To evaluate the thickness of cartilage at the posterior aspect of the medial and lateral condyle in Osteoarthritis (OA) knees compared to non-OA knees using computed tomography arthrography (CTA). DESIGN 535 consecutive knee CTAs (mean patient age = 48.7 ± 16.0; 286 males), were retrospectively analyzed. Knees were radiographically classified into OA or non-OA knees according to a modified Kellgren/Lawrence (K/L) grading scheme. Cartilage thickness at the posterior aspect of the medial and lateral femoral condyles was measured on sagittal reformations, and compared between matched OA and non-OA knees in the whole sample population and in subgroups defined by gender and age. RESULTS The cartilage of the posterior aspect of medial condyle was statistically significantly thicker in OA knees (2.43 mm (95% confidence interval (CI) = 2.36, 2.51)) compared to non-OA knees (2.13 mm (95%CI = 2.02, 2.17)) in the entire sample population (P < 0.001), as well as for all subgroups of patients over 40 years old (all P ≤ 0.01), except for females above 60 years old (P = 0.07). Increase in cartilage thickness at the posterior aspect of the medial condyle was associated with increasing K/L grade in the entire sample population, as well as for males and females separately (regression coefficient = 0.10-0.12, all P < 0.001). For the lateral condyle, there was no statistically significant association between cartilage thickness and OA (either presence of OA or K/L grade). CONCLUSIONS Cartilage thickness at the non-weight-bearing posterior aspect of the medial condyle, but not of the lateral condyle, was increased in OA knees compared to non-OA knees. Furthermore, cartilage thickness at the posterior aspect of the medial condyle increased with increasing K/L grade.
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Affiliation(s)
- P Omoumi
- Department of Radiology, Cliniques Universitaires St Luc - UC Louvain, Hippocrate Avenue 10/2942, B-1200 Brussels, Belgium; Department of Diagnostic and Interventional Radiology, Lausanne University Hospital, Bugnon 46, CH-1011 Lausanne, Switzerland.
| | - N Michoux
- Department of Radiology, Cliniques Universitaires St Luc - UC Louvain, Hippocrate Avenue 10/2942, B-1200 Brussels, Belgium
| | - F W Roemer
- Department of Radiology, Klinikum Augsburg, Augsburg, Germany
| | - E Thienpont
- Department of Orthopedic Surgery, Cliniques Universitaires St Luc - UC Louvain, Hippocrate Avenue 10/2942, B-1200 Brussels, Belgium
| | - B C Vande Berg
- Department of Radiology, Cliniques Universitaires St Luc - UC Louvain, Hippocrate Avenue 10/2942, B-1200 Brussels, Belgium
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Omoumi P, Michoux N, Thienpont E, Roemer FW, Vande Berg BC. Anatomical distribution of areas of preserved cartilage in advanced femorotibial osteoarthritis using CT arthrography (Part 1). Osteoarthritis Cartilage 2015; 23:83-7. [PMID: 25450851 DOI: 10.1016/j.joca.2014.10.006] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/05/2014] [Revised: 09/03/2014] [Accepted: 10/19/2014] [Indexed: 02/02/2023]
Abstract
OBJECTIVE To determine subregions of normal and abnormal cartilage in advanced stages of femorotibial osteoarthritis (OA) by mapping the entire femorotibial joint in a cohort of pre-total knee replacement (TKR) OA knees. DESIGN We defined an areal subdivision of the femorotibial articular cartilage surface on CT arthrography (CTA), allowing the division of the femorotibial articular surface into multiple (up to n = 204 per knee) subregions and the comparison of the same areas between different knees. Two readers independently classified each cartilage area as normal, abnormal or non-assessable in 41 consecutive pre-TKR OA knees. RESULTS A total of 6447 cartilage areas (from 41 knees) were considered assessable by both readers. The average proportion of preserved cartilage was lower in the medial femorotibial joint than in the lateral femorotibial joint for both readers (32.0/69.8% and 33.9/68.5% (medial/lateral) for reader 1 and 2 respectively, all P < 0.001). High frequencies of normal cartilage were observed at the posterior aspect of the medial condyle (up to 89%), and the anterior aspect of the lateral femorotibial compartment (up to 100%). The posterior aspect of the medial condyle was the area that most frequently exhibited preserved cartilage in the medial femorotibial joint, contrasting with the high frequency of cartilage lesions in the rest of that compartment. CONCLUSIONS Cartilage at the posterior aspect of the medial condyle, and at the anterior aspect of the lateral femorotibial compartment, may be frequently preserved in advanced grades of OA.
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Affiliation(s)
- P Omoumi
- Department of Radiology, Cliniques Universitaires St Luc - UC Louvain, Hippocrate Avenue 10/2942, B-1200 Brussels, Belgium; Department of Diagnostic and Interventional Radiology, Lausanne University Hospital, Bugnon 46, CH-1011 Lausanne, Switzerland.
| | - N Michoux
- Department of Radiology, Cliniques Universitaires St Luc - UC Louvain, Hippocrate Avenue 10/2942, B-1200 Brussels, Belgium
| | - E Thienpont
- Department of Orthopedic Surgery, Cliniques Universitaires St Luc - UC Louvain, Hippocrate Avenue 10/2942, B-1200 Brussels, Belgium
| | - F W Roemer
- Department of Radiology, Klinikum Augsburg, Augsburg, Germany
| | - B C Vande Berg
- Department of Radiology, Cliniques Universitaires St Luc - UC Louvain, Hippocrate Avenue 10/2942, B-1200 Brussels, Belgium
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Kijowski R, Roemer F, Englund M, Tiderius CJ, Swärd P, Frobell RB. Imaging following acute knee trauma. Osteoarthritis Cartilage 2014; 22:1429-43. [PMID: 25278054 DOI: 10.1016/j.joca.2014.06.024] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/06/2014] [Revised: 04/21/2014] [Accepted: 06/03/2014] [Indexed: 02/02/2023]
Abstract
Joint injury has been recognized as a potent risk factor for the onset of osteoarthritis. The vast majority of studies using imaging technology for longitudinal assessment of patients following joint injury have focused on the injured knee joint, specifically in patients with anterior cruciate ligament injury and meniscus tears where a high risk for rapid onset of post-traumatic osteoarthritis is well known. Although there are many imaging modalities under constant development, magnetic resonance (MR) imaging is the most important instrument for longitudinal monitoring after joint injury. MR imaging is sensitive for detecting early cartilage degeneration and can evaluate other joint structures including the menisci, bone marrow, tendons, and ligaments which can be sources of pain following acute injury. In this review, focusing on imaging following acute knee trauma, several studies were identified with promising short-term results of osseous and soft tissue changes after joint injury. However, studies connecting these promising short-term results to the development of osteoarthritis were limited which is likely due to the long follow-up periods needed to document the radiographic and clinical onset of the disease. Thus, it is recommended that additional high quality longitudinal studies with extended follow-up periods be performed to further investigate the long-term consequences of the early osseous and soft tissue changes identified on MR imaging after acute knee trauma.
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Affiliation(s)
- R Kijowski
- Department of Radiology, University of Wisconsin, Madison, WI, USA.
| | - F Roemer
- Department of Radiology, University of Erlangen-Nuremberg, Erlangen, Germany; Department of Radiology, Boston University, Boston, MA, USA
| | - M Englund
- Department of Orthopedics, Clinical Sciences Lund, Lund, Sweden; Clinical Epidemiology Research and Training Unit, Boston University, Boston, MA, USA
| | - C J Tiderius
- Department of Orthopedics, Clinical Sciences Lund, Lund, Sweden
| | - P Swärd
- Department of Orthopedics, Clinical Sciences Lund, Lund, Sweden
| | - R B Frobell
- Department of Orthopedics, Clinical Sciences Lund, Lund, Sweden
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Mhlanga JC, Carrino JA, Lodge M, Wang H, Wahl RL. 18F-FDG PET of the hands with a dedicated high-resolution PEM system (arthro-PET): correlation with PET/CT, radiography and clinical parameters. Eur J Nucl Med Mol Imaging 2014; 41:2337-45. [PMID: 25134669 DOI: 10.1007/s00259-014-2856-x] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/27/2013] [Accepted: 07/03/2014] [Indexed: 11/25/2022]
Abstract
PURPOSE The aim of this study was to prospectively determine the feasibility and compare the novel use of a positron emission mammography (PEM) scanner with standard PET/CT for evaluating hand osteoarthritis (OA) with (18)F-FDG. METHODS Institutional review board approval and written informed consent were obtained for this HIPAA-compliant prospective study in which 14 adults referred for oncological (18)F-FDG PET/CT underwent dedicated hand PET/CT followed by arthro-PET using the PEM device. Hand radiographs were obtained and scored for the presence and severity of OA. Summed qualitative and quantitative joint glycolytic scores for each modality were compared with the findings on plain radiography and clinical features. RESULTS Eight patients with clinical and/or radiographic evidence of OA comprised the OA group (mean age 73 ± 7.7 years). Six patients served as the control group (53.7 ± 9.3 years). Arthro-PET quantitative and qualitative joint glycolytic scores were highly correlated with PET/CT findings in the OA patients (r = 0.86. p = 0.007; r = 0.94, p = 0.001). Qualitative arthro-PET and PET/CT joint scores were significantly higher in the OA patients than in controls (38.7 ± 6.6 vs. 32.2 ± 0.4, p = 0.02; 37.5 ± 5.4 vs. 32.2 ± 0.4, p = 0.03, respectively). Quantitative arthro-PET and PET/CT maximum SUV-lean joint scores were higher in the OA patients, although they did not reach statistical significance (20.8 ± 4.2 vs. 18 ± 1.8, p = 0.13; 22.8 ± 5.38 vs. 20.1 ± 1.54, p = 0.21). By definition, OA patients had higher radiographic joint scores than controls (30.9 ± 31.3 vs. 0, p = 0.03). CONCLUSION Hand imaging using a small field of view PEM system (arthro-PET) with FDG is feasible, performing comparably to PET/CT in assessing metabolic joint activity. Arthro-PET and PET/CT showed higher joint FDG uptake in OA. Further exploration of arthro-PET in arthritis management is warranted.
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Affiliation(s)
- Joyce C Mhlanga
- Division of Nuclear Medicine, The Russell H. Morgan Department of Radiology and Radiological Sciences, Johns Hopkins University School of Medicine, Baltimore, MD, USA
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Roemer FW, Eckstein F, Hayashi D, Guermazi A. The role of imaging in osteoarthritis. Best Pract Res Clin Rheumatol 2014; 28:31-60. [PMID: 24792944 DOI: 10.1016/j.berh.2014.02.002] [Citation(s) in RCA: 66] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/15/2023]
Abstract
Osteoarthritis (OA) is the most prevalent joint disorder with no approved disease-modifying treatment available. The importance of imaging in assessing all joint structures involved in the disease process, including articular cartilage, meniscus, subarticular bone marrow, and synovium for diagnosis, prognostication, and follow-up, has been well recognized. In daily clinical practice, conventional radiography is still the most commonly used imaging technique for the evaluation of a patient with known or suspected OA and radiographic outcome measures are still the only approved end point by regulatory authorities in clinical trials. The ability of magnetic resonance imaging (MRI) to visualize all joint structures in three-dimensional fashion including tissue ultrastructure has markedly deepened our understanding of the natural history of the disease. This article describes the roles and limitations of different imaging modalities for clinical practice and research in OA, with a focus on radiography and MRI and an emphasis on the knee joint.
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Affiliation(s)
- Frank W Roemer
- Department of Radiology, Quantitative Imaging Center (QIC), Boston University School of Medicine, 820 Harrison Avenue, FGH Building, 3rd Floor, Boston, MA 02118, USA; Department of Radiology, University of Erlangen-Nuremberg, Maximiliansplatz 1, 91054 Erlangen, Germany; Department of Radiology, Klinikum Augsburg, Augsburg, Stenglinstr 2, 86156 Augsburg, Germany.
| | - Felix Eckstein
- Institute of Anatomy, Paracelsus Medical University, Strubergasse 21, 5020 Salzburg, Austria.
| | - Daichi Hayashi
- Department of Radiology, Quantitative Imaging Center (QIC), Boston University School of Medicine, 820 Harrison Avenue, FGH Building, 3rd Floor, Boston, MA 02118, USA; Department of Radiology, Bridgeport Hospital, Yale University School of Medicine, 267 Grant Street, Bridgeport, CT 06610, USA.
| | - Ali Guermazi
- Department of Radiology, Quantitative Imaging Center (QIC), Boston University School of Medicine, 820 Harrison Avenue, FGH Building, 3rd Floor, Boston, MA 02118, USA.
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Optimization of computed tomography (CT) arthrography of hip for the visualization of cartilage: an in vitro study. Skeletal Radiol 2014; 43:169-78. [PMID: 24281772 DOI: 10.1007/s00256-013-1759-4] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/22/2013] [Revised: 10/11/2013] [Accepted: 10/13/2013] [Indexed: 02/02/2023]
Abstract
OBJECTIVE We sought to optimize the kilovoltage, tube current, and the radiation dose of computed tomographic arthrography of the hip joint using in vitro methods. MATERIALS AND METHODS A phantom was prepared using a left femoral head harvested from a patient undergoing total hip arthroplasty and packed in a condom filled with iodinated contrast. The right hip joint of a cadaver was also injected with iodinated contrast. The phantom and the cadaver were scanned using different values of peak kilovoltage (kVp) and tube current (milliamp seconds, mAs). Three different regions of interest (ROI) were drawn in the cartilage, subchondral bone plate, and intraarticular contrast. The attenuation values, contrast/noise ratio (CNR), and effective dose were calculated. Two independent observers classified the quality of the contrast-cartilage interface and the cartilage-subchondral bone plate interface as (1) diagnostic quality or (2) nondiagnostic quality. RESULTS Contrast, cartilage, and subchondral bone plate attenuation values decreased at higher kVp. CNR increased with both kVp and mAs. The qualitative analysis showed that in both phantom and cadaver, at 120 kVp and 50 mAs, the contrast-cartilage and cartilage-subchondral bone plate interfaces were of diagnostic quality, with an effective dose decreased to 0.5 MSv. CONCLUSIONS The absolute effective dose is not directly related to the quality of images but to the specific combination of kVp and mAs used for image acquisition. The combination of 120 kVp and 50 mAs can be suggested to decrease the dose without adversely affect the visibility of cartilage and subchondral bone plate.
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Thienpont E, Schwab PE, Omoumi P. Wear patterns in anteromedial osteoarthritis of the knee evaluated with CT-arthrography. Knee 2014; 21 Suppl 1:S15-9. [PMID: 25382362 DOI: 10.1016/s0968-0160(14)50004-x] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/18/2014] [Revised: 08/17/2014] [Accepted: 08/20/2014] [Indexed: 02/02/2023]
Abstract
OBJECTIVE To analyze the value of CT-arthrography imaging in the diagnosis of knee osteoarthritis and to facilitate the selection of partial versus total knee replacement. METHODS A retrospective study of 100 patients that had either medial unicompartmental knee replacement (UKR) (N=50) or total knee replacement (TKR) (N=50). One observer measured lower limb mechanical alignment and osteoarthritis patterns of the knee in each compartment with radiographs, CT-arthrography and full leg standing radiographs. RESULTS All patients had Kellgren-Lawrence grade IV osteoarthritis of the medial femorotibial joint with a mean (SD) varus alignment of the lower limb (172° (3.5°) HKA-angle). Zone mechanical axis distribution showed strong correlation with HKA-axis. Arthritis patterns were different for patients selected for UKR or TKR. UKR patients had anteromedial osteoarthritis and wear of the medial facet of the patella in contrast to TKR patients who had medial osteoarthritis associated with diffuse or lateral patellofemoral wear and wear of the central or posterior zones of the lateral compartment. Medial facet wear of the patella is related to more important varus alignment of the lower limb (Kennedy zone 0 and 1). CONCLUSION CT-arthrography imaging can show lesions that are not visible on plain or stress radiographs because of central or posterior localization with surrounding intact cartilage. Patients who develop tri-compartmental osteoarthritis despite varus alignment have probably other risk factors than their mechanical alignment and should be considered candidates for TKR.
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Affiliation(s)
- Emmanuel Thienpont
- Department of Orthopaedic Surgery, Cliniques universitaires Saint Luc, Brussels, Belgium.
| | - Pierre-Emmanuel Schwab
- Department of Orthopaedic Surgery, Cliniques universitaires Saint Luc, Brussels, Belgium
| | - Patrick Omoumi
- Department of Radiology, Cliniques universitaires Saint Luc, Brussels, Belgium
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New Application of 18F-Fluoride PET for the Detection of Bone Remodeling in Early-Stage Osteoarthritis of the Hip. Clin Nucl Med 2013; 38:e379-83. [DOI: 10.1097/rlu.0b013e31828d30c0] [Citation(s) in RCA: 47] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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45
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Roman-Blas JA, Castañeda S, Largo R, Lems WF, Herrero-Beaumont G. An OA phenotype may obtain major benefit from bone-acting agents. Semin Arthritis Rheum 2013; 43:421-8. [PMID: 24016748 DOI: 10.1016/j.semarthrit.2013.07.012] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/24/2012] [Revised: 04/24/2013] [Accepted: 07/30/2013] [Indexed: 01/08/2023]
Abstract
BACKGROUND Osteoarthritis (OA) joints display relevant microstructure alterations associated to an increase in remodeling at subchondral bone, which supports its crucial role in OA pathogenesis. Despite this, the treatment of knee OA patients with antiresorptive drugs has given discordant results, suggesting the existence of a particular patient subset with good response to halting high subchondral remodeling. OBJECTIVE To identify an OA phenotype that may obtain major benefit from therapy with bone-acting agents. METHODS A systematic review of the literature was performed by searching the Medline and PubMed databases from 1990 to April 2013 using the following keywords: subchondral bone, articular cartilage, and osteoarthritis in various combinations with bone agents, bone mineral density, and scintigraphy. RESULTS Early animal and human studies provided the rationale for the beneficial use of bone agents on OA cartilage damage. Several bone-acting agents have reduced low back pain and likely spondylosis progression. Recently, strontium ranelate has been reported to exert both structural and clinical benefits in knee OA patients with radiological progression. However, other antiresorptives have shown divergent results. Human studies suggest that these contradictory results may be due to the lack of well-defined OA phenotypes and an accurate methodology to recruit and follow up these patients. CONCLUSIONS A particular subset of postmenopausal patients with high remodeling and/or low subchondral bone density may benefit from the treatment with bone-acting agents hindering OA progression. This OA population could be identified with the simultaneous use of subchondral bone dual-energy X-ray absorptiometry and scintigraphy.
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Affiliation(s)
- Jorge A Roman-Blas
- Bone and Joint Research Unit, IIS Fundación Jiménez Díaz, Universidad Autónoma, Madrid, Spain
| | - Santos Castañeda
- Department of Rheumatology, Hospital de La Princesa, IIS-Princesa, Universidad Autónoma, Madrid, Spain
| | - Raquel Largo
- Bone and Joint Research Unit, IIS Fundación Jiménez Díaz, Universidad Autónoma, Madrid, Spain
| | - Willem F Lems
- Department of Rheumatology, VU University Medical Centre, Amsterdam, The Netherlands
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Palmer AJR, Brown CP, McNally EG, Price AJ, Tracey I, Jezzard P, Carr AJ, Glyn-Jones S. Non-invasive imaging of cartilage in early osteoarthritis. Bone Joint J 2013; 95-B:738-46. [PMID: 23723266 DOI: 10.1302/0301-620x.95b6.31414] [Citation(s) in RCA: 80] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
Treatment for osteoarthritis (OA) has traditionally focused on joint replacement for end-stage disease. An increasing number of surgical and pharmaceutical strategies for disease prevention have now been proposed. However, these require the ability to identify OA at a stage when it is potentially reversible, and detect small changes in cartilage structure and function to enable treatment efficacy to be evaluated within an acceptable timeframe. This has not been possible using conventional imaging techniques but recent advances in musculoskeletal imaging have been significant. In this review we discuss the role of different imaging modalities in the diagnosis of the earliest changes of OA. The increasing number of MRI sequences that are able to non-invasively detect biochemical changes in cartilage that precede structural damage may offer a great advance in the diagnosis and treatment of this debilitating condition.
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Affiliation(s)
- A J R Palmer
- Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford, Windmill Road, Headington OX3 7LD, UK
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Gervaise A, Teixeira P, Villani N, Lecocq S, Louis M, Blum A. CT dose optimisation and reduction in osteoarticular disease. Diagn Interv Imaging 2013; 94:371-88. [DOI: 10.1016/j.diii.2012.05.017] [Citation(s) in RCA: 39] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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48
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Osteoarthritis: a review of strengths and weaknesses of different imaging options. Rheum Dis Clin North Am 2013; 39:567-91. [PMID: 23719076 DOI: 10.1016/j.rdc.2013.02.001] [Citation(s) in RCA: 55] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
Slowing of radiographic joint space narrowing represents the only recommended imaging-based outcome measure to assess structural disease progression in osteoarthritis (OA) clinical trials. There are no effective disease-modifying OA drugs. The ability of magnetic resonance (MR) to image structures within the knee and to visualize cartilage morphology and composition gives MR imaging a critical role in understanding the natural history of the disease and in the search for therapies. In this article, the roles and limitations of conventional radiography and MR imaging, focusing on knee OA, and the use of other modalities in clinical practice and OA research are described.
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Guermazi A, Hayashi D, Eckstein F, Hunter DJ, Duryea J, Roemer FW. Imaging of Osteoarthritis. Rheum Dis Clin North Am 2013; 39:67-105. [DOI: 10.1016/j.rdc.2012.10.003] [Citation(s) in RCA: 42] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/18/2023]
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50
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Evolving role of FDG PET imaging in assessing joint disorders: a systematic review. Eur J Nucl Med Mol Imaging 2011; 38:1939-55. [DOI: 10.1007/s00259-011-1863-4] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2011] [Accepted: 06/07/2011] [Indexed: 01/19/2023]
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