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Minnig MCC, Arbeeva L, Niethammer M, Nissman D, Lund JL, Marron JS, Golightly YM, Nelson AE. Investigating the relationship between radiographic joint space width loss and deep learning-derived magnetic resonance imaging-based cartilage thickness loss in the medial weight-bearing region of the tibiofemoral joint. OSTEOARTHRITIS AND CARTILAGE OPEN 2024; 6:100508. [PMID: 39238657 PMCID: PMC11375264 DOI: 10.1016/j.ocarto.2024.100508] [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: 07/29/2024] [Accepted: 07/30/2024] [Indexed: 09/07/2024] Open
Abstract
Objective To investigate the relationship between measures of radiographic joint space width (JSW) loss and magnetic resonance imaging (MRI)-based cartilage thickness loss in the medial weight-bearing region of the tibiofemoral joint over 12-24 months. To stratify this relationship by clinically meaningful subgroups (sex and pain status). Design We analyzed a subset of knees (n = 256) from the Osteoarthritis Initiative (OAI) likely in early stage OA based on joint space narrowing (JSN) measurements. Natural logarithm transformation was used to approximate near normal distributions for JSW loss. Pearson Correlation coefficients described the relationship between ln-transformed JSW loss and several versions of deep learning-derived MRI-based cartilage thickness loss parameters (minimum, maximum, and mean) in subregions of the femoral condyle, tibial plateau, and combined femoral and tibial regions. Linear mixed-effects models evaluated the associations between the ln-transformed radiographic and MRI-derived measures including potential confounders. Results We found weak correlations between ln-transformed JSW loss and MRI-based cartilage thickness ranging from R = -0.13 (p = 0.20) to R = 0.26 (p < 0.01). Correlations were higher (still poor) among females compared to males and painful compared to non-painful knees. Model results showed weak associations for nearly all MRI-based measures, ranging from no association to β (95% CI) = 0.25 (0.11, 0.39). Associations were higher among females compared to males and minimal differences between painful and non-painful knees. Conclusions Despite its recommended use in disease-modifying OA drug clinical trials, results suggest that JSW loss is an ineffective proxy measure of cartilage thickness loss over 12-24 months and within a localized region of the tibiofemoral joint.
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Affiliation(s)
- Mary Catherine C Minnig
- Department of Epidemiology, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Liubov Arbeeva
- Thurston Arthritis Research Center, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Marc Niethammer
- Department of Computer Science, University of North Carolina at Chapel Hill College of Arts and Sciences, Chapel Hill, NC, USA
| | - Daniel Nissman
- Department of Radiology, University of North Carolina at Chapel Hill School of Medicine, Chapel Hill, NC, USA
| | - Jennifer L Lund
- Department of Epidemiology, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - J S Marron
- Statistics and Operations Research, University of North Carolina at Chapel Hill College of Arts of Sciences, Chapel Hill, NC, USA
| | - Yvonne M Golightly
- Department of Epidemiology, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
- Thurston Arthritis Research Center, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
- College of Allied Health Professions, University of Nebraska Medical Center, Omaha, NE, USA
| | - Amanda E Nelson
- Department of Epidemiology, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
- Thurston Arthritis Research Center, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
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Güvener O, Taş S, Yüzbaşıoğlu Ü, Dağ F. Ultrasound assessment of talar cartilage thickness measurements in asymptomatic subjects with pes planus and its relationship with anthropometric parameters. Foot Ankle Surg 2024:S1268-7731(24)00157-7. [PMID: 39060193 DOI: 10.1016/j.fas.2024.07.006] [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: 03/14/2024] [Revised: 06/03/2024] [Accepted: 07/16/2024] [Indexed: 07/28/2024]
Abstract
INTRODUCTION Individuals with pes planus may have alterations in talar cartilage thickness due to changes in lower extremity alignment. The aim of this study was to measure the talar cartilage thickness of subjects with pes planus and compare the results with those of healthy controls. Another aim of the present study was to evaluate its relationship with anthropometric foot parameters. METHODS This cross-sectional study included 48 individuals (16 males and 32 females) in the pes planus group and 48 individuals in the healthy control group (14 males and 34 females) based on the Navicular Drop (ND) test and the Foot Posture Index (FPI). Talar cartilage thickness (TCT) was measured with ultrasound. Anthropometric foot parameters of the individuals, such as foot length and foot width, were evaluated using a podoscope. RESULTS TCT was higher in participants with pes planus compared to the control group (dominant side, p = 0.006; non-dominant side, p = 0.002). Foot width and length were similar in both groups for the dominant and non-dominant feet (p > 0.05). TCT on the dominant foot was positively correlated with the FPI score (r = 0.205, p = 0.045), ND score (r = 0.297, p = 0.003), foot width (r = 0.244, p = 0.017) and foot length (r = 0.253, p = 0.013). On the other hand, TCT on the non-dominant side was positively correlated with the FPI score (r = 0.235, p = 0.021), ND score (r = 0.363, p < 0.001), foot width (r = 0.270, p = 0.008) and length (r = 0.303, p = 0.003). CONCLUSION The talar cartilage of patients with pes planus seems to be thicker, and this is generally related to body weight, body mass index, foot anthropometrics, and posture characteristics. LEVEL OF EVIDENCE Level III, diagnostic comparative study.
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Affiliation(s)
- Orhan Güvener
- Mersin University Medical School, Department of Physical and Rehabilitation Medicine, Mersin 33110, Turkey.
| | - Serkan Taş
- Toros University, Faculty of Health Science, Department of Physical Therapy and Rehabilitation, Mersin 33140, Turkey
| | - Ümit Yüzbaşıoğlu
- Toros University, The Vocational School of Health Services, Department of Therapy and Rehabilitation, Mersin 33140, Turkey
| | - Figen Dağ
- Mersin University Medical School, Department of Physical and Rehabilitation Medicine, Mersin 33110, Turkey; Mersin University, The Vocational School of Health Services, Department of Medical Services and Techniques, Mersin 33110, Turkey
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Battersby HS, Holmes SC, Shumski EJ, Heredia CE, Garcia SA, Pamukoff DN. The Influence of Knee Position on Ultrasound Imaging of Femoral Cartilage in Individuals with Anterior Cruciate Ligament Reconstruction. Cartilage 2024; 15:84-93. [PMID: 37846037 PMCID: PMC11368891 DOI: 10.1177/19476035231205682] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/22/2023] [Revised: 08/07/2023] [Accepted: 09/09/2023] [Indexed: 10/18/2023] Open
Abstract
BACKGROUND Articular cartilage is important for knee function and can be imaged using ultrasound. The purpose was to compare femoral cartilage thickness and echo intensity (EI) measured at 90° and 140° of knee flexion and between limbs in a cohort with unilateral anterior cruciate ligament reconstruction (ACLR). We also examined associations between gait biomechanics and cartilage outcomes. METHODS Twenty-seven individuals with primary unilateral ACLR participated (12 men, 15 women; age = 22.3 ± 3.8 years; time since ACLR = 71.2 ± 47.2 months). Ultrasound was used to obtain femoral cartilage measurements. Gait outcomes included peak KFA (knee flexion angle) and peak external knee flexion moment (KFM). Cartilage outcomes were compared using a 2 (position) × 2 (limb) repeated measures ANOVA (analysis of variance). Gait and cartilage associations were assessed using linear regression. FINDINGS There were no position × limb interactions for any cartilage outcome (all P > 0.05). Medial (P = 0.038) and central cartilage (P < 0.001) were thicker, whereas central (P = 0.029) and lateral cartilage EI (P = 0.003) were lower when measured at 90° than those at 140° of knee flexion. Medial cartilage was thicker in the ACLR than that in the contralateral limb (P = 0.016). A larger KFM was associated with thicker medial cartilage (ΔR2 = 0.146, P = 0.021) and central cartilage (ΔR2 = 0.159, P = 0.039) measured at 140° of knee flexion in the ACLR limb but not at 90°. INTERPRETATION Findings suggest that imaging position influences cartilage thickness and EI measurements in individuals with ACLR and should be considered in study designs and clinical evaluation. A greater KFM was associated with thicker cartilage within specific portions of the distal femur.
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Affiliation(s)
| | - Skylar C. Holmes
- Department of Kinesiology, University of Massachusetts Amherst, Amherst, MA, USA
| | - Eric J. Shumski
- Department of Kinesiology, University of Georgia, Athens, GA, USA
| | | | - Steven A. Garcia
- School of Kinesiology, University of Michigan, Ann Arbor, MI, USA
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Wang K, Li Y, Lin J. Identification of diagnostic biomarkers for osteoarthritis through bioinformatics and machine learning. Heliyon 2024; 10:e27506. [PMID: 38496843 PMCID: PMC10944228 DOI: 10.1016/j.heliyon.2024.e27506] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2023] [Revised: 01/20/2024] [Accepted: 02/29/2024] [Indexed: 03/19/2024] Open
Abstract
Osteoarthritis (OA) is a prevalent degenerative joint disease characterized by cartilage degradation, inflammatory arthritis, and joint dysfunction. Currently, there is a lack of effective early diagnostic methods and treatment strategies for OA. Bioinformatics and biomarker research provide new possibilities for early detection and personalized therapy of OA. In this study, we investigated the molecular mechanisms of OA and important signaling pathways involved in disease progression through bioinformatics analysis. Firstly, using the limma package, we analyzed the differentially expressed genes (DEGs) between normal healthy samples and OA cartilage tissue samples. These DEGs were found to be primarily involved in biological processes such as extracellular matrix (ECM) binding, immune receptor activity, and cytokine activity, as well as signaling pathways including cytokine receptors, ECM-receptor interaction, and PI3K-Akt. Gene set enrichment analysis revealed that in the OA group, signaling pathways such as AMPK, B cell receptor, IL-17, and PPAR were downregulated, while calcium signaling pathway, cell adhesion molecules, ECM-receptor interaction, TGF-β signaling pathway, and Wnt signaling pathway were upregulated. Additionally, we constructed a co-expression module network using WGCNA and identified key modules associated with OA, from which we selected 7 most predictive OA characteristic genes. Among them, ANTXR1, KCNS3, SGCD, and LIN7A were correlated with the level of immune cell infiltration. This study elucidates the mechanisms underlying the development of OA and identifies potential diagnostic markers and therapeutic targets, providing important insights for early diagnosis and treatment of OA.
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Affiliation(s)
| | | | - JinXiu Lin
- Department of Orthopedics, Zibo First Hospital, Zibo, 255200, China
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Minnig MCC, Golightly YM, Nelson AE. Epidemiology of osteoarthritis: literature update 2022-2023. Curr Opin Rheumatol 2024; 36:108-112. [PMID: 38240280 PMCID: PMC10965245 DOI: 10.1097/bor.0000000000000985] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/23/2024]
Abstract
PURPOSE OF REVIEW This review highlights recently published studies on osteoarthritis (OA) epidemiology, including topics related to understudied populations and joints, imaging, and advancements in artificial intelligence (AI) methods. RECENT FINDINGS Contemporary research has improved our understanding of the burden of OA in typically understudied regions, including ethnic and racial minorities in high-income countries, the Middle East and North Africa (MENA) and Latin America. Efforts have also been made to explore the burden and risk factors in OA in previously understudied joints, such as the hand, foot, and ankle. Advancements in OA imaging techniques have occurred alongside the developments of AI methods aiming to predict disease phenotypes, progression, and outcomes. SUMMARY Continuing efforts to expand our knowledge around OA in understudied populations will allow for the creation of targeted and specific interventions and inform policy changes aimed at reducing disease burden in these groups. The burden and disability associated with OA is notable in understudied joints, warranting further research efforts that may lead to effective therapeutic options. AI methods show promising results of predicting OA phenotypes and progression, which also may encourage the creation of targeted disease modifying OA drugs (DMOADs).
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Affiliation(s)
- Mary Catherine C. Minnig
- Department of Epidemiology, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
| | - Yvonne M. Golightly
- Department of Epidemiology, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
- Thurston Arthritis Research Center, University of North Carolina, Chapel Hill, North Carolina, USA
- College of Allied Health Professions, University of Nebraska Medical Center, Omaha, Nebraska, USA
| | - Amanda E. Nelson
- Department of Epidemiology, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
- Thurston Arthritis Research Center, University of North Carolina, Chapel Hill, North Carolina, USA
- Department of Medicine, University of North Carolina, Chapel Hill, NC, USA
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Almhdie-Imjabbar A, Toumi H, Lespessailles E. Short-term variations in trabecular bone texture parameters associated to radio-clinical biomarkers improve the prediction of radiographic knee osteoarthritis progression. Sci Rep 2023; 13:21952. [PMID: 38081898 PMCID: PMC10713565 DOI: 10.1038/s41598-023-48016-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2023] [Accepted: 11/21/2023] [Indexed: 12/18/2023] Open
Abstract
The present study aims to examine whether the short-term variations in trabecular bone texture (TBT) parameters, combined with a targeted set of clinical and radiographic data, would improve the prediction of long-term radiographic knee osteoarthritis (KOA) progression. Longitudinal (baseline, 24 and 48-month) data, obtained from the Osteoarthritis Initiative cohort, were available for 1352 individuals, with preexisting OA (1 < Kellgren-Lawrence < 4) at baseline. KOA progression was defined as an increase in the medial joint space narrowing score from the 24-months to the 48-months control point. 16 regions of interest were automatically selected from each radiographic knee and analyzed using fractal dimension. Variations from baseline to 24 months in TBT descriptors as well as selected radiographic and clinical readings were calculated. Different logistic regression models were developed to evaluate the progression prediction performance when associating TBT variations with the selected clinical and radiographic readings. The most predictive model was mainly determined using the area under the receiver operating characteristic curve (AUC). The proposed prediction model including short-term variations in TBT parameters, associated with clinical covariates and radiographic scores, improved the capacity of predicting long-term radiographic KOA progression (AUC of 0.739), compared to models based solely on baseline values (AUC of 0.676, p-value < 0.008).
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Affiliation(s)
- Ahmad Almhdie-Imjabbar
- Translational Medicine Research Platform, PRIMMO, University Hospital Centre of Orleans, Orleans, France
| | - Hechmi Toumi
- Translational Medicine Research Platform, PRIMMO, University Hospital Centre of Orleans, Orleans, France
- Department of Rheumatology, University Hospital of Orleans, Orleans, France
| | - Eric Lespessailles
- Translational Medicine Research Platform, PRIMMO, University Hospital Centre of Orleans, Orleans, France.
- Department of Rheumatology, University Hospital of Orleans, Orleans, France.
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Bairagi S, Abdollahifar MA, Atake OJ, Dust W, Wiebe S, Belev G, Chapman LD, Webb MA, Zhu N, Cooper DML, Eames BF. MRI overestimates articular cartilage thickness and volume compared to synchrotron radiation phase-contrast imaging. PLoS One 2023; 18:e0291757. [PMID: 37788257 PMCID: PMC10547194 DOI: 10.1371/journal.pone.0291757] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2022] [Accepted: 09/05/2023] [Indexed: 10/05/2023] Open
Abstract
Accurate evaluation of morphological changes in articular cartilage are necessary for early detection of osteoarthritis (OA). 3T magnetic resonance imaging (MRI) has highly sensitive contrast resolution and is widely used clinically to detect OA. However, synchrotron radiation phase-contrast imaging computed tomography (SR-PCI) can also provide contrast to tissue interfaces that do not have sufficient absorption differences, with the added benefit of very high spatial resolution. Here, MRI was compared with SR-PCI for quantitative evaluation of human articular cartilage. Medial tibial condyles were harvested from non-OA donors and from OA patients receiving knee replacement surgery. Both imaging methods revealed that average cartilage thickness and cartilage volume were significantly reduced in the OA group, compared to the non-OA group. When comparing modalities, the superior resolution of SR-PCI enabled more precise mapping of the cartilage surface relative to MRI. As a result, MRI showed significantly higher average cartilage thickness and cartilage volume, compared to SR-PCI. These data highlight the potential for high-resolution imaging of articular cartilage using SR-PCI as a solution for early OA diagnosis. Recognizing current limitations of using a synchrotron for clinical imaging, we discuss its nascent utility for preclinical models, particularly longitudinal studies of live animal models of OA.
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Affiliation(s)
- Suranjan Bairagi
- Department of Anatomy, Physiology, and Pharmacology, University of Saskatchewan, Saskatoon, Saskatchewan, Canada
| | - Mohammad-Amin Abdollahifar
- Department of Anatomy, Physiology, and Pharmacology, University of Saskatchewan, Saskatoon, Saskatchewan, Canada
| | - Oghenevwogaga J. Atake
- Department of Anatomy, Physiology, and Pharmacology, University of Saskatchewan, Saskatoon, Saskatchewan, Canada
| | - William Dust
- Department of Surgery, University of Saskatchewan, Saskatoon, Saskatchewan, Canada
| | - Sheldon Wiebe
- Department of Medical Imaging, University of Saskatchewan, Saskatoon, Saskatchewan, Canada
| | - George Belev
- Canadian Light Source Inc., Saskatoon, Saskatchewan, Canada
| | - L. Dean Chapman
- Department of Anatomy, Physiology, and Pharmacology, University of Saskatchewan, Saskatoon, Saskatchewan, Canada
| | - M. Adam Webb
- Canadian Light Source Inc., Saskatoon, Saskatchewan, Canada
| | - Ning Zhu
- Canadian Light Source Inc., Saskatoon, Saskatchewan, Canada
| | - David M. L. Cooper
- Department of Anatomy, Physiology, and Pharmacology, University of Saskatchewan, Saskatoon, Saskatchewan, Canada
| | - B. Frank Eames
- Department of Anatomy, Physiology, and Pharmacology, University of Saskatchewan, Saskatoon, Saskatchewan, Canada
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Segal NA, Nevitt MC, Morales Aquino M, McFadden E, Ho M, Duryea J, Tolstykh I, Cheng H, He J, Lynch JA, Felson DT, Anderson DD. Improved responsiveness to change in joint space width over 24-month follow-up: comparison of 3D JSW on weight-bearing CT vs 2D JSW on radiographs in the MOST study. Osteoarthritis Cartilage 2023; 31:406-413. [PMID: 36526151 PMCID: PMC9974913 DOI: 10.1016/j.joca.2022.12.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/30/2022] [Revised: 11/13/2022] [Accepted: 12/06/2022] [Indexed: 12/15/2022]
Abstract
OBJECTIVE Radiographic joint space width (JSW) has been a standard for measuring knee osteoarthritis (OA) structural change. Limitations in the responsiveness of this approach might be overcome by instead measuring 3D JSW on weight-bearing CT (WBCT). This study compared the responsiveness of 3D JSW measurements using WBCT with the responsiveness of radiographic 2D JSW. DESIGN Standing, fixed-flexion knee radiographs (XR) and WBCT were acquired ancillary to the 144- and 168-month Multicenter Osteoarthritis Study visits. Tibiofemoral JSW was measured on both XR and WBCT. Responsiveness to change was defined by the standardized response mean (SRM) for change in JSW (1) at predetermined mediolateral locations (JSWx) on both modalities and (2) in the following subregions measured on WBCT images: central medial and lateral femur (CMF/CLF) and tibia (CMT/CLT), and anterior and posterior tibia (AMT/ALT, PMT/MLT). RESULTS Baseline and 24-month follow-up JSWx measurements were completed for 265 participants (58.1% women). Responsiveness of 3D JSWx for medial tibiofemoral compartment on coronal WBCT (SRM range: -0.18, -0.24) exceeded that for 2D JSWx (-0.10, -0.16). Responsiveness of 3D JSW subregional mean (-0.06, -0.36) and maximal (-1.14, -1.75) CMF and CMT and maximal CLF/CLT 3D JSW changes were statistically significantly greater in comparison with respective medial and lateral 2D JSWx (P ≤ 0.002). CONCLUSIONS Subregional 3D JSW on WBCT is substantially more responsive to 24-month changes in tibiofemoral joint structure compared to radiographic measurements. Use of subregional 3D JSW on WBCT could enable improved detection of OA structural progression over a 24-month duration in comparison with measurements made on XR.
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Affiliation(s)
- N A Segal
- University of Kansas Medical Center, Kansas City, KS, USA; The University of Iowa, Iowa City, IA, USA.
| | - M C Nevitt
- University of California-San Francisco, San Francisco, CA, USA
| | | | - E McFadden
- The University of Iowa, Iowa City, IA, USA
| | - M Ho
- The University of Iowa, Iowa City, IA, USA
| | - J Duryea
- Harvard University, Cambridge, MA, USA
| | - I Tolstykh
- University of California-San Francisco, San Francisco, CA, USA
| | - H Cheng
- University of Kansas Medical Center, Kansas City, KS, USA
| | - J He
- University of Kansas Medical Center, Kansas City, KS, USA
| | - J A Lynch
- University of California-San Francisco, San Francisco, CA, USA
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Brett A, Bowes MA, Conaghan PG. Comparison of 3D quantitative osteoarthritis imaging biomarkers from paired CT and MR images: data from the IMI-APPROACH study. BMC Musculoskelet Disord 2023; 24:76. [PMID: 36710346 PMCID: PMC9885640 DOI: 10.1186/s12891-023-06187-2] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/12/2022] [Accepted: 01/23/2023] [Indexed: 01/31/2023] Open
Abstract
INTRODUCTION MRI bone surface area and femoral bone shape (B-score) measures have been employed as quantitative endpoints in DMOAD clinical trials. Computerized Tomography (CT) imaging is more commonly used for 3D visualization of bony anatomy due to its high bone-soft tissue contrast. We aimed to compare CT and MRI assessments of 3D imaging biomarkers. METHODS We used baseline and 24-month image data from the IMI-APPROACH 2-year prospective cohort study. Femur and tibia were automatically segmented using active appearance models, a machine-learning method, to measure 3D bone shape, area and 3D joint space width (3DJSW). Linear regression was used to test for correlation between measures. Limits of agreement and bias were tested using Bland-Altman analysis. RESULTS CT-MR pairs of the same knee were available from 434 participants (78% female). B-scores from CT and MR were strongly correlated (CCC = 0.967) with minimal bias of 0.1 (SDD = 0.227). Area measures were also correlated but showed a consistent bias (MR smaller). 3DJSW showed different biases (MR larger) in both lateral and medial compartments. DISCUSSION The strong correlation and small B-score bias suggests that B-score may be measured reliably using either modality. It is likely that the bone surface identified using MR and CT will be at slightly different positions within the bone/cartilage boundary. The negative bone area bias suggests the MR bone boundary is inside the CT boundary producing smaller areas for MR, consistent with the positive 3DJSW bias. The lateral-medial 3DJSW difference is possibly due to a difference in knee pose during acquisition (extended for CT, flexed for MR). TRIAL REGISTRATION NCT03883568.
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Affiliation(s)
- Alan Brett
- Imorphics, Worthington House, Towers Business Park, Wilmslow Road, Manchester, M20 2HJ UK
| | - Michael A. Bowes
- Imorphics, Worthington House, Towers Business Park, Wilmslow Road, Manchester, M20 2HJ UK
| | - Philip G. Conaghan
- grid.454370.10000 0004 0439 7412Leeds Institute of Rheumatic and Musculoskeletal Medicine, University of Leeds & NIHR Leeds Biomedical Research Centre, Leeds, UK
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Li X, Gu X, Jiang Z, Duan H, Zhou J, Chang Y, Lu K, Chen B. Statistical modeling: Assessing the anatomic variability of knee joint space width. J Biomech 2023; 147:111420. [PMID: 36652892 DOI: 10.1016/j.jbiomech.2022.111420] [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: 07/11/2022] [Revised: 12/02/2022] [Accepted: 12/19/2022] [Indexed: 12/24/2022]
Abstract
Population-based knee joint space width (JSW) assessments are promising for the prevention and early diagnosis of osteoarthritis. This study aimed to establish the statistical shape and alignment model (SSAM) of knee joints for assessing anatomic variation in knee JSW in the healthy Chinese male population. CT scans of asymptomatic knee joints of healthy male participants (n = 107) were collected for manual segmentation to create mesh samples. The as-scanned positional error was reduced by a standard processing flow of deformable mesh registration. Principal component analysis (PCA) was performed to create a tibiofemoral SSAM that was trained on all mesh samples. The anatomic variability of the JSW in the healthy Chinese male population was then assessed using the SSAM with regression analysis and 3D analysis by color-coded mapping. Almost all PCA modes had a linear influence on the anatomic variation of the medial and lateral JSW. The JSW variability within the SSAM was mainly explained by mode 1 (45.1 % of variation), demonstrating that this mode had the greatest influence on JSW variation. 3D assessment of the JSW showed that the minimum medial JSW varied from 2.76 to 3.23 mm, and its site shifted a short distance on the medial tibial plateau. The root-mean-square fitting and generalization errors of the SSAM were below 1 mm. This study will benefit the design and optimization of prosthetic devices, and may be applicable to the prevention and early diagnosis of osteoarthritis.
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Affiliation(s)
- Xiaohu Li
- School of Health Science and Engineering, University of Shanghai for Science and Technology, Shanghai 200093, China.
| | - Xuelian Gu
- School of Health Science and Engineering, University of Shanghai for Science and Technology, Shanghai 200093, China.
| | - Ziang Jiang
- Department of Orthopaedic Surgery, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China; School of Biomedical Engineering and Med-X Research Institute, Shanghai Jiao Tong University, Shanghai, China.
| | - Huabing Duan
- School of Health Science and Engineering, University of Shanghai for Science and Technology, Shanghai 200093, China.
| | - Jincheng Zhou
- School of Health Science and Engineering, University of Shanghai for Science and Technology, Shanghai 200093, China.
| | - Yihao Chang
- School of Health Science and Engineering, University of Shanghai for Science and Technology, Shanghai 200093, China.
| | - Ke Lu
- Department of Orthopedics, Affiliated Kunshan Hospital of Jiangsu University, Jiangsu 215300, China.
| | - Bo Chen
- Department of Orthopaedics, Shanghai Key Laboratory for Prevention and Treatment of Bone and Joint Diseases, Shanghai Institute of Traumatology and Orthopaedics, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, 197 Ruijin 2nd Road, Shanghai 200025, China.
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11
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Chen T, Or CK. Automated machine learning-based prediction of the progression of knee pain, functional decline, and incidence of knee osteoarthritis in individuals at high risk of knee osteoarthritis: Data from the osteoarthritis initiative study. Digit Health 2023; 9:20552076231216419. [PMID: 38033512 PMCID: PMC10685797 DOI: 10.1177/20552076231216419] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2023] [Accepted: 11/07/2023] [Indexed: 12/02/2023] Open
Abstract
Objective This study aimed to examine the performance of machine learning models in predicting the progression of knee pain, functional decline, and incidence of knee osteoarthritis (OA) in high-risk individuals, with automated machine learning (AutoML) being used to automate the prediction process. Design There were four stages in the process of our AutoML-integrated prediction. Stage 1-Data preparation: The data of 3200 eligible individuals in the Osteoarthritis Initiative (OAI) study who were considered at high risk of knee OA at the baseline visit were extracted and used. Specifically, 1094 variables from the OAI study were used to predict the changes in knee pain, physical function, and incidence of knee OA (i.e. the first occurrence of frequent knee symptoms and definite tibial osteophytes (Kellgren and Lawrence grade ≥2)) over a 9-year period. Stage 2-Model training: The AutoML approach was used to automatically train nine widely used machine learning (ML) models. Stage 3-Model testing: The AutoML approach was used to automatically test the performance of the ML models. Stage 4-Selection of important input variables: The AutoML approach automated the process of computing the importance scores of all input variables and identifying the most important ones, using the technique of permutation feature importance. Results Using the AutoML approach, the weighted ensemble model and the CatBoost model showed the best performance among all nine ML models. For the prediction of each outcome in each year, the five most important input variables were identified, most of which were obtained from self-reported questionnaire surveys and radiographic imaging reports. Conclusion The AutoML approach has shown potential in automating the process of using ML models to predict long-term changes in knee OA-related outcomes. Its use could support the deployment of ML solutions, facilitating the provision of personalized interventions to prevent the deterioration of knee health and incident knee OA.
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Affiliation(s)
- Tianrong Chen
- Department of Industrial and Manufacturing Systems Engineering, The University of Hong Kong, Hong Kong, China
| | - Calvin Kalun Or
- Department of Industrial and Manufacturing Systems Engineering, The University of Hong Kong, Hong Kong, China
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Joo PY, Borjali A, Chen AF, Muratoglu OK, Varadarajan KM. Defining and predicting radiographic knee osteoarthritis progression: a systematic review of findings from the osteoarthritis initiative. Knee Surg Sports Traumatol Arthrosc 2022; 30:4015-4028. [PMID: 35112180 DOI: 10.1007/s00167-021-06768-5] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/16/2021] [Accepted: 10/04/2021] [Indexed: 12/11/2022]
Abstract
PURPOSE The purposes of this systematic review were to (1) identify the commonly used definitions of radiographic KOA progression, (2) summarize the important associative risk factors for disease progression based on findings from the OAI study and (3) summarize findings from radiographic KOA progression prediction modeling studies regarding the characterization of progression and outcomes. METHODS A systematic review was performed by conducting a literature search of definitions, risk factors and predictive models for radiographic KOA progression that utilized data from the OAI database. Radiographic progression was further characterized into "accelerated KOA" and "typical progression," as defined by included studies. RESULTS Of 314 studies identified, 41 studies were included in the present review. Twenty-eight (28) studies analyzed risk factors associated with KOA progression, and 13 studies created or validated prediction models or risk calculators for progression. Kellgren-Lawrence (KL) grade based on radiographs was most commonly used to characterize KOA progression (50%), followed by joint space width (JSW) narrowing (32%) generally over 48 months. Risk factors with the highest odds ratios (OR) for progression included periarticular bone mineral density (OR 10.40), any knee injury within 1 year (OR 9.22) and baseline bone mineral lesions (OR 7.92). Nine prediction modeling studies utilized both clinical and structural risk factors to inform their models, and combined models outperformed purely clinical or structural models. CONCLUSION The cumulative evidence suggests that combinations of structural and clinical risk factors may be able to predict radiographic KOA progression, particularly in patients with accelerated progression. Clinically relevant and feasible prediction models and risk calculators may provide valuable decision-making support when caring for patients at risk of KOA progression, although standardization in modeling and variable identification does not yet exist.
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Affiliation(s)
- Peter Y Joo
- Department of Orthopaedic Surgery, University of Rochester Medical Center, Rochester, NY, USA
| | - Alireza Borjali
- Harris Orthopaedics Laboratory, Department of Orthopaedic Surgery, Massachusetts General Hospital, 55 Fruit Street, GRJ-12-1223, Boston, MA, 02214, USA.,Department of Orthopaedic Surgery, Harvard Medical School, Boston, MA, USA
| | - Antonia F Chen
- Department of Orthopaedic Surgery, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
| | - Orhun K Muratoglu
- Harris Orthopaedics Laboratory, Department of Orthopaedic Surgery, Massachusetts General Hospital, 55 Fruit Street, GRJ-12-1223, Boston, MA, 02214, USA.,Department of Orthopaedic Surgery, Harvard Medical School, Boston, MA, USA
| | - Kartik M Varadarajan
- Harris Orthopaedics Laboratory, Department of Orthopaedic Surgery, Massachusetts General Hospital, 55 Fruit Street, GRJ-12-1223, Boston, MA, 02214, USA. .,Department of Orthopaedic Surgery, Harvard Medical School, Boston, MA, USA.
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13
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Oláh T, Cai X, Gao L, Walter F, Pape D, Cucchiarini M, Madry H. Quantifying the Human Subchondral Trabecular Bone Microstructure in Osteoarthritis with Clinical CT. ADVANCED SCIENCE (WEINHEIM, BADEN-WURTTEMBERG, GERMANY) 2022; 9:e2201692. [PMID: 35670136 PMCID: PMC9376842 DOI: 10.1002/advs.202201692] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/23/2022] [Revised: 04/26/2022] [Indexed: 06/12/2023]
Abstract
Osteoarthritis (OA) is characterized by critical alterations of the subchondral bone microstructure, besides the well-known cartilaginous changes. Clinical computed tomography (CT) detection of quantitative 3D microstructural subchondral bone parameters is applied to monitor changes of subchondral bone structure in different stages of human OA and is compared with micro-CT, the gold standard. Determination by clinical CT (287 µm resolution) of key microstructural parameters in tibial plateaus with mild-to-moderate and severe OA reveals strong correlations to micro-CT (35 µm), high inter- and intraobserver reliability, and small relative differences. In vivo, normal, mild-to-moderate, and severe OA are compared with clinical CT (331 µm). All approaches detect characteristic expanded trabecular structure in severe OA and fundamental microstructural correlations with clinical OA stage. Multivariate analyses at various in vivo and ex vivo imaging resolutions always reliably separate mild-to-moderate from severe OA (except mild-to-moderate OA from normal), revealing a striking similarity between 287 µm clinical and 35 µm micro-CT. Thus, accurate structural measurements using clinical CT with a resolution near the trabecular dimensions are possible. Clinical CT offers an opportunity to quantitatively monitor subchondral bone microstructure in clinical and experimental settings as an advanced tool of investigating OA and other diseases affecting bone architecture.
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Affiliation(s)
- Tamás Oláh
- Center of Experimental OrthopaedicsSaarland UniversityKirrberger Straße 100, Building 37Homburg SaarD‐66421Germany
- Cartilage Net of the Greater RegionKirrberger Straße 100, Building 37Homburg SaarD‐66421Germany
| | - Xiaoyu Cai
- Center of Experimental OrthopaedicsSaarland UniversityKirrberger Straße 100, Building 37Homburg SaarD‐66421Germany
| | - Liang Gao
- Center of Experimental OrthopaedicsSaarland UniversityKirrberger Straße 100, Building 37Homburg SaarD‐66421Germany
- Cartilage Net of the Greater RegionKirrberger Straße 100, Building 37Homburg SaarD‐66421Germany
| | - Frédéric Walter
- Clinique d'EichCentre Hospitalier de Luxembourg78 Rue d'EichLuxembourg1460Luxembourg
| | - Dietrich Pape
- Cartilage Net of the Greater RegionKirrberger Straße 100, Building 37Homburg SaarD‐66421Germany
- Clinique d'EichCentre Hospitalier de Luxembourg78 Rue d'EichLuxembourg1460Luxembourg
| | - Magali Cucchiarini
- Center of Experimental OrthopaedicsSaarland UniversityKirrberger Straße 100, Building 37Homburg SaarD‐66421Germany
- Cartilage Net of the Greater RegionKirrberger Straße 100, Building 37Homburg SaarD‐66421Germany
| | - Henning Madry
- Center of Experimental OrthopaedicsSaarland UniversityKirrberger Straße 100, Building 37Homburg SaarD‐66421Germany
- Cartilage Net of the Greater RegionKirrberger Straße 100, Building 37Homburg SaarD‐66421Germany
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14
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Fritz B, Fritz J, Fucentese SF, Pfirrmann CWA, Sutter R. Three-dimensional analysis for quantification of knee joint space width with weight-bearing CT: comparison with non-weight-bearing CT and weight-bearing radiography. Osteoarthritis Cartilage 2022; 30:671-680. [PMID: 34883245 DOI: 10.1016/j.joca.2021.11.019] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/01/2021] [Revised: 10/05/2021] [Accepted: 11/01/2021] [Indexed: 02/02/2023]
Abstract
OBJECTIVE To compare computer-based 3D-analysis for quantification of the femorotibial joint space width (JSW) using weight-bearing cone beam CT (WB-CT), non-weight-bearing multi-detector CT (NWB-CT), and weight-bearing conventional radiographs (WB-XR). DESIGN Twenty-six participants prospectively underwent NWB-CT, WB-CT, and WB-XR of the knee. For WB-CT and NWB-CT, the average and minimal JSW was quantified by 3D-analysis of the minimal distance of any point of the subchondral tibial bone surface and the femur. Associations with mechanical leg axes and osteoarthritis were evaluated. Minimal JSW of WB-CT was further compared to WB-XR. Two-tailed p-values of <0.05 were considered significant. RESULTS Significant differences existed of the average medial and lateral JSW between WB-CT and NWB-CT (medial: 4.7 vs 5.1 mm [P = 0.028], lateral: 6.3 vs 6.8 mm [P = 0.008]). The minimal JSW on WB-XR (medial:3.1 mm, lateral:5.8 mm) were significantly wider compared to WB-CT and NWB-CT (both medial:1.8 mm, lateral:2.9 mm, all p < 0.001), but not significantly different between WB-CT and NWB-CT (all p ≥ 0.869). Significant differences between WB-CT and NWB-CT existed in participants with varus knee alignment for the average and the minimal medial JSW (p = 0.004 and p = 0.011) and for participants with valgus alignment for the average lateral JSW (p = 0.013). On WB-CT, 25% of the femorotibial compartments showed bone-on-bone apposition, which was significantly higher when compared to NWB-CT (10%,P = 0.008) and WB-XR (8%,P = 0.012). CONCLUSION Combining WB-CT with 3D-based assessment allows detailed quantification of the femorotibial joint space and the effect of knee alignment on JSW. WB-CT demonstrates significantly more bone-on-bone appositions, which are underestimated or even undetectable on NWB-CT and WB-XR.
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Affiliation(s)
- B Fritz
- Department of Radiology, Balgrist University Hospital, Zurich, Switzerland; Faculty of Medicine, University of Zurich, Zurich, Switzerland.
| | - J Fritz
- New York University Grossman School of Medicine, New York University, New York, USA.
| | - S F Fucentese
- Department of Orthopedic Surgery, Balgrist University Hospital, Zurich, Switzerland; Faculty of Medicine, University of Zurich, Zurich, Switzerland.
| | - C W A Pfirrmann
- Department of Radiology, Balgrist University Hospital, Zurich, Switzerland; Faculty of Medicine, University of Zurich, Zurich, Switzerland.
| | - R Sutter
- Department of Radiology, Balgrist University Hospital, Zurich, Switzerland; Faculty of Medicine, University of Zurich, Zurich, Switzerland.
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15
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Segal NA, Anderson DD. Editorial commentary on Fritz et al. article entitled 'Three-dimensional analysis for quantification of knee joint space width with weight-bearing CT: comparison with non-weight-bearing CT and weight-bearing radiography'. Osteoarthritis Cartilage 2022; 30:629-632. [PMID: 34968720 DOI: 10.1016/j.joca.2021.12.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/29/2021] [Revised: 12/06/2021] [Accepted: 12/17/2021] [Indexed: 02/02/2023]
Affiliation(s)
- N A Segal
- Department of Rehabilitation Medicine, University of Kansas Medical Center, USA; Department of Orthopedics and Rehabilitation, University of Iowa, USA.
| | - D D Anderson
- Department of Rehabilitation Medicine, University of Kansas Medical Center, USA; Department of Orthopedics and Rehabilitation, University of Iowa, USA
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Verma DK, Kumari P, Kanagaraj S. Engineering Aspects of Incidence, Prevalence, and Management of Osteoarthritis: A Review. Ann Biomed Eng 2022; 50:237-252. [DOI: 10.1007/s10439-022-02913-4] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2021] [Accepted: 01/01/2022] [Indexed: 12/14/2022]
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17
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Harkey MS, Blackburn JT, Hackney AC, Lewek MD, Schmitz RJ, Pietrosimone B. Sex-Specific Associations between Cartilage Structure and Metabolism at Rest and Acutely Following Walking and Drop-Landing. Cartilage 2021; 13:1772S-1781S. [PMID: 32954820 PMCID: PMC8808927 DOI: 10.1177/1947603520959386] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
OBJECTIVE Cartilage health is thought to be dependent on the relationship between mechanics, structure, and metabolism, rather than these individual components in isolation. Due to sex differences in cartilage health, there is need to determine if the relationships between these cartilage components separately for males and females. Therefore, we sought to determine the sex-specific associations between cartilage structure and metabolism at rest and their acute response following walking and drop-landing in healthy individuals. DESIGN A cartilage ultrasound assessment and an ante-cubital blood draw were performed before and after walking and drop-landing conditions in 20 males and 20 females. Cartilage structure was assessed via medial and lateral femoral cartilage cross-sectional area. Cartilage metabolism was quantified with serum cartilage oligomeric matrix protein (COMP) concentration. Percent change scores from pre- to postloading were used to calculate acute alterations in cross-sectional area and COMP. Correlational analyses were used to assess the association between cartilage structure and metabolism measures separately for males and females. RESULTS In females, greater resting COMP concentration was associated with less cartilage cross-sectional area in the medial(ρ = -0.50, P = 0.03) and lateral (ρ = -0.69, P = 0.001) femur. Resting cartilage measures were not associated among males. Following walking and drop-landing, percent change scores in cartilage structure and metabolism were not associated. CONCLUSIONS This study highlights that, in females, thinner anterior femoral cartilage is associated with greater resting serum COMP concentrations, a biomarker often linked to cartilage breakdown. Future studies into the relationships between various cartilage components should consider sex-specific analyses as these relationships are sex dependent.
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Affiliation(s)
- Matthew S. Harkey
- Department of Kinesiology, Michigan
State University, East Lansing, MI, USA,Matthew S. Harkey, Department of
Kinesiology, Michigan State University, 308 W. Circle Drive #112, East Lansing,
MI 48824, USA.
| | - J. Troy Blackburn
- Department of Exercise and Sports
Science, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Anthony C. Hackney
- Department of Exercise and Sports
Science, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA,Department of Nutrition, School of
Public Health, University of North Carolina at Chapel Hill, Chapel Hill, NC,
USA
| | - Michael D. Lewek
- Division of Physical Therapy, University
of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Randy J. Schmitz
- Department of Kinesiology, University of
North Carolina at Greensboro, Greensboro, NC, USA
| | - Brian Pietrosimone
- Department of Exercise and Sports
Science, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
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Segal NA, Murphy MT, Everist BM, Brown KD, He J, Lynch JA, Nevitt MC. Clinical value of weight-bearing CT and radiographs for detecting patellofemoral cartilage visualized by MRI in the MOST study. Osteoarthritis Cartilage 2021; 29:1540-1548. [PMID: 34332048 PMCID: PMC8542599 DOI: 10.1016/j.joca.2021.07.011] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/05/2021] [Revised: 06/28/2021] [Accepted: 07/13/2021] [Indexed: 02/02/2023]
Abstract
OBJECTIVE The patellofemoral joint is frequently affected by osteoarthritis (PFOA) and is incompletely imaged on radiographs (XR). Weight-Bearing CT (WBCT) could offer advantages for visualization. This study determined the sensitivity, specificity, and accuracy of axial WBCT and lateral XR for detection of PFOA features in comparison with cartilage damage on MRI. DESIGN A convenience sample of 60 right knees from the MOST cohort were analyzed. WBCT and XR were read for OARSI JSN score and MRI for MOAKS cartilage score by two experienced musculoskeletal radiologists blinded to participant. Using MOAKS scoring on MRI (referent standard), the sensitivity, specificity and accuracy of patellofemoral OARSI JSN scores based on WBCT and XR were compared. RESULTS The mean ± SD age and BMI for the participants included (66.7% women) were 67.6 ± 9.8 years and 30.0 ± 5.3 kg/m2 respectively. WBCT demonstrated significantly greater sensitivity (0.85-0.97 on WBCT vs 0.47-0.57 on XR) and accuracy (0.85-0.92 on WBCT vs 0.48-0.57 on XR) for all parameters except lateral full-thickness cartilage loss (McNemar's test p-values all <0.001). There was moderate-to-strong and low-to-moderate agreement between PFOA findings on WBCT and XR, respectively, and semi-quantitative scores of PF cartilage on MRI. Inter-rater reliability for XR JSN [weighted kappa = 0.83 (0.64, 1.0)], WBCT JSN [kappa = 0.60 (0.48, 0.72)] and MRI MOAKS-CM [kappa = 0.70 (0.61, 0.79)] readings were good. CONCLUSION WBCT demonstrates significantly greater sensitivity and accuracy than radiographs for identification of PFOA. Given the same Relative Radiation Level as XR and improved visualization, WBCT holds promise to improve understanding of the weight-bearing patellofemoral joint.
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Affiliation(s)
- Neil A. Segal
- Department of Rehabilitation Medicine, University of Kansas Medical Center, 3901 Rainbow Boulevard, Mailstop 1046, Kansas City, KS, 66160
| | - Michael T. Murphy
- Department of Rehabilitation Medicine, University of Kansas Medical Center, Kansas City, KS, USA
| | - Brian M. Everist
- Department of Radiology, University of Kansas Medical Center, Kansas City, KS, USA
| | - Kevin D. Brown
- Department of Radiology, University of Kansas Medical Center, Kansas City, KS, USA
| | - Jianghua He
- Department of Biostatistics and Data Science, University of Kansas Medical Center, Kansas City, KS, USA
| | - John A. Lynch
- Department of Epidemiology and Biostatistics, University of California-San Francisco, San Francisco, CA, USA
| | - Michael C. Nevitt
- Department of Epidemiology and Biostatistics, University of California-San Francisco, San Francisco, CA, USA
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Khamparia A, Pandey B, Al‐Turjman F, Podder P. An intelligent
IoMT
enabled feature extraction method for early detection of knee arthritis. EXPERT SYSTEMS 2021. [DOI: 10.1111/exsy.12784] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Affiliation(s)
- Aditya Khamparia
- Department of Computer Science Babasaheb Bhimrao Ambedkar University, Satellite Center, Amethi Amethi India
| | - Babita Pandey
- Department of Computer Science Babasaheb Bhimrao Ambedkar University Lucknow India
| | - Fadi Al‐Turjman
- Artificial Intelligence Engineering Department Research Center for AI and IoT, Near East University Nicosia Turkey
| | - Prajoy Podder
- Institute of Information and Communication Technology Bangladesh University of Engineering and Technology Dhaka Bangladesh
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LÔBO CARLOSFELIPETEIXEIRA, BORDALO-RODRIGUES MARCELO, Godoy-Santos AL, Gobbi RG, Cesar Netto CD, Burssens A, Lintz F, Barg A. WEIGHT-BEARING CONE BEAM CT SCANS AND ITS USES IN ANKLE, FOOT, AND KNEE: AN UPDATE ARTICLE. ACTA ORTOPEDICA BRASILEIRA 2021; 29:105-110. [PMID: 34248411 PMCID: PMC8244836 DOI: 10.1590/1413-785220212902236939] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/21/2020] [Accepted: 08/20/2020] [Indexed: 11/22/2022]
Abstract
Imaging plays a key role in the preoperative diagnosis, surgical planning, and postsurgical assessment of the foot, ankle, and knee pathologies. Interpreting diagnostic imaging accurately is crucial for the clinical practice of orthopedic surgeons. Although among the most used imaging modalities, radiographic assessments are amenable to errors for various technical reasons and superposition of bones. Computed tomography (CT) is a conventional imaging procedure that provides high-resolution images, but fails in considering a truly weight-bearing (WB) condition. In an attempt to overcome this limitation, WB cone beam CT technology has being successfully employed in the clinical practice for the past decade. Besides economically viable and safe, the WB cone beam CT considers WB conditions and provides high-quality scans, thus allowing an equitable and correct interpretation. This review aims to address extensive description and discussion on WBCT, including imaging quality; costs; time consumption; and its applicability in common foot, ankle, and knee, conditions. With this technology increasing popularity, and considering the extensive literature on medical research, radiologists and orthopedic surgeons need to understand its potential applications and use it optimally. Level of Evidence III, Systematic review of level III studies.
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21
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Moustakidis S, Papandrianos NI, Christodolou E, Papageorgiou E, Tsaopoulos D. Dense neural networks in knee osteoarthritis classification: a study on accuracy and fairness. Neural Comput Appl 2020. [DOI: 10.1007/s00521-020-05459-5] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
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22
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Attur M, Krasnokutsky S, Zhou H, Samuels J, Chang G, Bencardino J, Rosenthal P, Rybak L, Huebner JL, Kraus VB, Abramson SB. The combination of an inflammatory peripheral blood gene expression and imaging biomarkers enhance prediction of radiographic progression in knee osteoarthritis. Arthritis Res Ther 2020; 22:208. [PMID: 32912331 PMCID: PMC7488029 DOI: 10.1186/s13075-020-02298-6] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2020] [Accepted: 08/24/2020] [Indexed: 12/19/2022] Open
Abstract
OBJECTIVE Predictive biomarkers of progression in knee osteoarthritis are sought to enable clinical trials of structure-modifying drugs. A peripheral blood leukocyte (PBL) inflammatory gene signature, MRI-based bone marrow lesions (BML) and meniscus extrusion scores, meniscal lesions, and osteophytes on X-ray each have been shown separately to predict radiographic joint space narrowing (JSN) in subjects with symptomatic knee osteoarthritis (SKOA). In these studies, we determined whether the combination of the PBL inflammatory gene expression and these imaging findings at baseline enhanced the prognostic value of either alone. METHODS PBL inflammatory gene expression (increased mRNA for IL-1β, TNFα, and COX-2), routine radiographs, and 3T knee MRI were assessed in two independent populations with SKOA: an NYU cohort and the Osteoarthritis Initiative (OAI). At baseline and 24 months, subjects underwent standardized fixed-flexion knee radiographs and knee MRI. Medial JSN (mJSN) was determined as the change in medial JSW. Progressors were defined by an mJSN cut-point (≥ 0.5 mm/24 months). Models were evaluated by odds ratios (OR) and area under the receiver operating characteristic curve (AUC). RESULTS We validated our prior finding in these two independent (NYU and OAI) cohorts, individually and combined, that an inflammatory PBL inflammatory gene expression predicted radiographic progression of SKOA after adjustment for age, sex, and BMI. Similarly, the presence of baseline BML and meniscal lesions by MRI or semiquantitative osteophyte score on X-ray each predicted radiographic medial JSN at 24 months. The combination of the PBL inflammatory gene expression and medial BML increased the AUC from 0.66 (p = 0.004) to 0.75 (p < 0.0001) and the odds ratio from 6.31 to 19.10 (p < 0.0001) in the combined cohort of 473 subjects. The addition of osteophyte score to BML and PBL inflammatory gene expression further increased the predictive value of any single biomarker. A causal analysis demonstrated that the PBL inflammatory gene expression and BML independently influenced mJSN. CONCLUSION The use of the PBL inflammatory gene expression together with imaging biomarkers as combinatorial predictive biomarkers, markedly enhances the identification of radiographic progressors. The identification of the SKOA population at risk for progression will help in the future design of disease-modifying OA drug trials and personalized medicine strategies.
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Affiliation(s)
- Mukundan Attur
- Department of Medicine, NYU Grossman School of Medicine, New York, NY, USA. .,Division of Rheumatology, Rheumatology Research laboratory, NYU Langone Orthopedic Hospital, 301 East 17th Street, Suite 1612, New York, NY, 10003, USA.
| | | | - Hua Zhou
- Applied Bioinformatics Laboratories, NYU Grossman School of Medicine, New York, NY, USA
| | - Jonathan Samuels
- Department of Medicine, NYU Grossman School of Medicine, New York, NY, USA
| | - Gregory Chang
- Department of Radiology, NYU Grossman School of Medicine, New York, NY, USA
| | - Jenny Bencardino
- Department of Radiology, NYU Grossman School of Medicine, New York, NY, USA.,Division of Musculoskeletal Imaging, Department of Radiology, Hospital of the University of Pennsylvania, Philadelphia, PA, 19104, USA
| | - Pamela Rosenthal
- Department of Medicine, NYU Grossman School of Medicine, New York, NY, USA
| | - Leon Rybak
- Applied Bioinformatics Laboratories, NYU Grossman School of Medicine, New York, NY, USA
| | | | | | - Steven B Abramson
- Department of Medicine, NYU Grossman School of Medicine, New York, NY, USA
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23
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Cultot A, Norberciak L, Coursier R, Putman S, Cortet B, Paccou J, Pascart T, Budzik JF. BONE PERFUSION AND ADIPOSITY BEYOND THE NECROTIC ZONE IN FEMORAL HEAD OSTEONECROSIS: A QUANTITATIVE MRI STUDY. Eur J Radiol 2020; 131:109206. [PMID: 32871293 DOI: 10.1016/j.ejrad.2020.109206] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2020] [Revised: 06/29/2020] [Accepted: 07/28/2020] [Indexed: 11/17/2022]
Abstract
PURPOSE To describe bone perfusion and adiposity beyond the necrotic zone with quantitative MRI techniques in osteonecrosis of the femoral head (ONFH). METHOD In this cross-sectional multicentre study, we recruited patients suffering from late-stage ONFH or hip osteoarthritis. Hip MRI included quantitative MRI sequences: chemical-shift imaging and dynamic contrast-enhanced MRI. We drew regions of interest inside the necrotic zone (inner necrosis and its border) and outside (femoral head, neck and greater trochanter) in ONFH. In the control group, regions of interest were drawn in the femoral head, femoral neck and the greater trochanter. For each region of interest, we measured fat fraction, and calculated semi-quantitative (area under the curve, initial slope) and pharmacokinetic perfusion parameters (Ktrans and Kep). RESULTS Thirty-two male adults (mean age 58 ± 9 years, range 38-74 years) were included. Sixteen patients formed the ONFH group and fifteen the control group; one was excluded. In the normal-appearing non-necrotic part of the femoral head, fat fraction was not significantly different in comparison with controls (p = 1), but Ktrans was significantly lower than in controls (0.012 ± 0.018 vs. 0.027 ± 0.045; p = 0.05). This perfusion parameter reflects exchanges between blood microvessels and bone marrow. CONCLUSIONS Our results question the concept of adipose toxicity on the macroscopic scale, and bring up the concept of regional ischemic penumbra that goes beyond the visible necrotic zone. Further studies are required to test these hypotheses in larger populations and earlier disease states.
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Affiliation(s)
- Aurélie Cultot
- Diagnostic and interventional imaging department, Lille Catholic University Hospital Group, Lille, France.
| | - Laurène Norberciak
- Biostatistics, Clinical research department, Lille Catholic University Hospital Group, Lille, France.
| | - Raphaël Coursier
- Orthopaedic surgery department, Lille Catholic University Hospital Group, Lille, France.
| | - Sophie Putman
- Orthopaedic surgery department, Roger Salengro hospital, Lille University Hospital, France.
| | - Bernard Cortet
- Rheumatology department, Roger Salengro hospital, Lille University Hospital, France; UR 4490 - PMOI - PMOI (Physiopathologie des Maladies Osseuses Inflammatoires)/MABLab (Marrow Adiposity and Bone Laboratory), Lille, France.
| | - Julien Paccou
- Rheumatology department, Roger Salengro hospital, Lille University Hospital, France; UR 4490 - PMOI - PMOI (Physiopathologie des Maladies Osseuses Inflammatoires)/MABLab (Marrow Adiposity and Bone Laboratory), Lille, France.
| | - Tristan Pascart
- UR 4490 - PMOI - PMOI (Physiopathologie des Maladies Osseuses Inflammatoires)/MABLab (Marrow Adiposity and Bone Laboratory), Lille, France; Rheumatology department, Lille Catholic University Hospital Group, Lille, France.
| | - Jean-François Budzik
- Diagnostic and interventional imaging department, Lille Catholic University Hospital Group, Lille, France; UR 4490 - PMOI - PMOI (Physiopathologie des Maladies Osseuses Inflammatoires)/MABLab (Marrow Adiposity and Bone Laboratory), Lille, France.
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Serological biomarkers in hemophilic arthropathy: Can they be used to monitor bleeding and ongoing progression of blood-induced joint disease in patients with hemophilia? Blood Rev 2020; 41:100642. [DOI: 10.1016/j.blre.2019.100642] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2019] [Revised: 09/16/2019] [Accepted: 11/12/2019] [Indexed: 12/20/2022]
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Kothari MD, Rabe KG, Anderson DD, Nevitt MC, Lynch JA, Segal NA, Franz H. The Relationship of Three-Dimensional Joint Space Width on Weight Bearing CT With Pain and Physical Function. J Orthop Res 2019; 38:10.1002/jor.24566. [PMID: 31840831 PMCID: PMC8016550 DOI: 10.1002/jor.24566] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/10/2019] [Accepted: 12/04/2019] [Indexed: 02/04/2023]
Abstract
Limitations of plain radiographs may contribute to poor sensitivity in the detection of knee osteoarthritis and poor correlation with pain and physical function. 3D joint space width, measured from weight bearing CT images, may yield a more accurate correlation with patients' symptoms. We assessed the cross-sectional association between 3D joint space width and self-reported pain and physical function. 528 knees (57% women) were analyzed from Multicenter Osteoarthritis Study participants. An upright weight bearing CT scanner was used to acquire bilateral, weight-bearing fixed-flexion images of the knees. A 3D dataset was reconstructed from cone beam projections and joint space width was calculated across the joint surface. The percentages of the apposed medial tibiofemoral joint surface with joint space width <2.0mm and <2.5mm respectively were calculated. Pain and physical function were measured using Western Ontario and McMaster Universities Osteoarthritis Index. Participants who reported greater pain severity tended to have a greater joint area with joint space width <2.0mm (p=.07 for the highest vs. the lowest tertile). Participants who reported greater functional limitations had a greater joint area with joint space width <2.0mm (p=.02 for the highest vs. the lowest tertile). There appears to be an association between the medial tibiofemoral area with joint space width <2.0mm and pain and physical function. This article is protected by copyright. All rights reserved.
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Affiliation(s)
- Mayank Dineshkumar Kothari
- The University of Kansas, Kansas City, 3901 Rainbow Boulevard, Mailstop 1046; KUMC Department of Rehabilitation Medicine, Kansas City, KS, 66160
| | - Kaitlin G Rabe
- The University of Texas at Dallas, 800 West Campbell Rd, BSB 11 Richardson, Richardson, TX, 75080
| | | | - Michael C Nevitt
- The University of California, San Francisco, San Francisco, 550 16th St, 2nd Floor, UCSF Dept of Epidemiology & Biostatistics, Mission Hall: Global Health & Clinical Sciences Building, San Francisco, CA, 94143
| | - John A Lynch
- The University of California, San Francisco, San Francisco, 550 16th St, 2nd Floor, UCSF Dept of Epidemiology & Biostatistics, Mission Hall: Global Health & Clinical Sciences Building, San Francisco, CA, 94143
| | - Neil A Segal
- The University of Kansas, Kansas City, 3901 Rainbow Boulevard, Mailstop 1046; KUMC Department of Rehabilitation Medicine, Kansas City, KS, 66160
| | - Hayden Franz
- The University of Kansas, Kansas City, 3901 Rainbow Boulevard, Mailstop 1046; KUMC Department of Rehabilitation Medicine, Kansas City, KS, 66160
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26
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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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Segmentation of Articular Cartilage and Early Osteoarthritis based on the Fuzzy Soft Thresholding Approach Driven by Modified Evolutionary ABC Optimization and Local Statistical Aggregation. Symmetry (Basel) 2019. [DOI: 10.3390/sym11070861] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022] Open
Abstract
Articular cartilage assessment, with the aim of the cartilage loss identification, is a crucial task for the clinical practice of orthopedics. Conventional software (SW) instruments allow for just a visualization of the knee structure, without post processing, offering objective cartilage modeling. In this paper, we propose the multiregional segmentation method, having ambitions to bring a mathematical model reflecting the physiological cartilage morphological structure and spots, corresponding with the early cartilage loss, which is poorly recognizable by the naked eye from magnetic resonance imaging (MRI). The proposed segmentation model is composed from two pixel’s classification parts. Firstly, the image histogram is decomposed by using a sequence of the triangular fuzzy membership functions, when their localization is driven by the modified artificial bee colony (ABC) optimization algorithm, utilizing a random sequence of considered solutions based on the real cartilage features. In the second part of the segmentation model, the original pixel’s membership in a respective segmentation class may be modified by using the local statistical aggregation, taking into account the spatial relationships regarding adjacent pixels. By this way, the image noise and artefacts, which are commonly presented in the MR images, may be identified and eliminated. This fact makes the model robust and sensitive with regards to distorting signals. We analyzed the proposed model on the 2D spatial MR image records. We show different MR clinical cases for the articular cartilage segmentation, with identification of the cartilage loss. In the final part of the analysis, we compared our model performance against the selected conventional methods in application on the MR image records being corrupted by additive image noise.
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A decision support tool for early detection of knee OsteoArthritis using X-ray imaging and machine learning: Data from the OsteoArthritis Initiative. Comput Med Imaging Graph 2019; 73:11-18. [PMID: 30784984 DOI: 10.1016/j.compmedimag.2019.01.007] [Citation(s) in RCA: 54] [Impact Index Per Article: 10.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2017] [Revised: 03/14/2018] [Accepted: 01/23/2019] [Indexed: 12/29/2022]
Abstract
This paper presents a fully developed computer aided diagnosis (CAD) system for early knee OsteoArthritis (OA) detection using knee X-ray imaging and machine learning algorithms. The X-ray images are first preprocessed in the Fourier domain using a circular Fourier filter. Then, a novel normalization method based on predictive modeling using multivariate linear regression (MLR) is applied to the data in order to reduce the variability between OA and healthy subjects. At the feature selection/extraction stage, an independent component analysis (ICA) approach is used in order to reduce the dimensionality. Finally, Naive Bayes and random forest classifiers are used for the classification task. This novel image-based approach is applied on 1024 knee X-ray images from the public database OsteoArthritis Initiative (OAI). The results show that the proposed system has a good predictive classification rate for OA detection (82.98% for accuracy, 87.15% for sensitivity and up to 80.65% for specificity).
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Harkey MS, Blackburn JT, Nissman D, Davis H, Durrington I, Rizk C, Kuismanen A, Pietrosimone B. Ultrasonographic Assessment of Femoral Cartilage in Individuals With Anterior Cruciate Ligament Reconstruction: A Case-Control Study. J Athl Train 2019; 53:1082-1088. [PMID: 30615493 DOI: 10.4085/1062-6050-376-17] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
CONTEXT Developing osteoarthritis is common after anterior cruciate ligament reconstruction (ACLR). Monitoring changes in femoral cartilage size after ACLR may be a way to detect the earliest structural alterations before the radiographic onset of osteoarthritis. Diagnostic ultrasonography (US) offers a clinically accessible and valid method for evaluating anterior femoral cartilage size. OBJECTIVE To compare the US measurements of anterior femoral cross-sectional area and cartilage thickness between limbs in individuals with a unilateral ACLR and between the ACLR limbs of these individuals and the limbs of uninjured control participants. DESIGN Case-control study. SETTING Research laboratory. PATIENTS OR OTHER PARTICIPANTS A total of 20 volunteers with an ACLR (37.0 ± 26.6 months after surgery) and 28 uninjured volunteers. MAIN OUTCOME MEASURE(S) We used US to assess anterior femoral cartilage cross-sectional area and thickness (ie, medial, lateral, and intercondylar) in the ACLR and contralateral limbs of participants with ACLR and unilaterally in the reference limbs of uninjured participants. RESULTS The ACLR limb presented with greater anterior femoral cartilage cross-sectional area (96.68 ± 22.68 mm2) than both the contralateral (85.69 ± 17.57 mm2, t19 = 4.47; P < .001) and uninjured (84.62 ± 15.89 mm2, t46 = 2.17; P = .04) limbs. The ACLR limb presented with greater medial condyle thickness (2.61 ± 0.61 mm) than both the contralateral (2.36 ± 0.47 mm, t19 = 2.78; P = .01) and uninjured limbs (2.22 ± 0.40 mm, t46 = 2.69; P = .01) and greater lateral condyle thickness (2.46 ± 0.65 mm) than the uninjured limb (2.12 ± 0.41 mm, t46 = 2.20; P = .03). CONCLUSIONS Anterior femoral cartilage cross-sectional area and thickness assessed via US were greater in the ACLR limb than in the contralateral and uninjured limbs. Greater thickness and cross-sectional area may have been due to cartilage swelling or hypertrophy after ACLR, which may affect the long-term health of the joint.
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Affiliation(s)
- Matthew S Harkey
- Division of Rheumatology, Tufts Medical Center, Boston, MA, and Department of Quantitative Health Science, University of Massachusetts Medical School, Worcester
| | - J Troy Blackburn
- Department of Exercise and Sports Science, University of North Carolina at Chapel Hill
| | - Daniel Nissman
- Department of Radiology, University of North Carolina at Chapel Hill
| | - Hope Davis
- Department of Exercise and Sports Science, University of North Carolina at Chapel Hill
| | | | - Christina Rizk
- Department of Exercise and Sports Science, University of North Carolina at Chapel Hill
| | | | - Brian Pietrosimone
- Department of Exercise and Sports Science, University of North Carolina at Chapel Hill
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Baskey SJ, Andreana M, Lanteigne E, Ridsdale A, Stolow A, Schweitzer ME. Pre-Clinical Translation of Second Harmonic Microscopy of Meniscal and Articular Cartilage Using a Prototype Nonlinear Microendoscope. IEEE JOURNAL OF TRANSLATIONAL ENGINEERING IN HEALTH AND MEDICINE-JTEHM 2018; 7:1800211. [PMID: 30701146 PMCID: PMC6342420 DOI: 10.1109/jtehm.2018.2889496] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/16/2018] [Revised: 11/05/2018] [Accepted: 11/30/2018] [Indexed: 11/06/2022]
Abstract
Previous studies using nonlinear microscopy have demonstrated that osteoarthritis (OA) is characterized by the gradual replacement of Type II collagen with Type I collagen. The objective of this study was to develop a prototype nonlinear laser scanning microendoscope capable of resolving the structural differences of collagen in various orthopaedically relevant cartilaginous surfaces. The current prototype developed a miniaturized femtosecond laser scanning instrument, mounted on an articulated positioning system, capable of both conventional arthroscopy and second-harmonic laser-scanning microscopy. Its optical system includes a multi-resolution optical system using a gradient index objective lens and a customized multi-purpose fiber optic sheath to maximize the collection of backscattered photons or provide joint capsule illumination. The stability and suitability of the prototype arthroscope to approach and image cartilage were evaluated through preliminary testing on fresh, minimally processed, and partially intact porcine knee joints. Image quality was sufficient to distinguish between hyaline cartilage and fibrocartilage through unique Type I and Type II collagen-specific characteristics. Imaging the meniscus revealed that the system was able to visualize differences in the collagen arrangement between the superficial and lamellar layers. Such detailed in vivo imaging of the cartilage surfaces could obviate the need to perform biopsies for ex vivo histological analysis in the future, and provide an alternative to conventional external imaging to characterize and diagnose progressive and degenerative cartilage diseases such as OA. Moreover, this system is readily customizable and may provide a suitable and modular platform for developing additional tools utilizing femtosecond lasers for tissue cutting within the familiar confines of two or three portal arthroscopy techniques.
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Affiliation(s)
- Stephen J Baskey
- Faculty of MedicineUniversity of OttawaOttawaONK1H 8M5Canada.,Department of Mechanical EngineeringUniversity of OttawaOttawaONK1N 6N5Canada.,Emerging Technologies Division, Molecular Photonics GroupNational Research Council CanadaOttawaONK1A 0R6Canada
| | - Marco Andreana
- Center for Medical Physics and Biomedical EngineeringMedical University of Vienna1090ViennaAustria
| | - Eric Lanteigne
- Department of Mechanical EngineeringUniversity of OttawaOttawaONK1N 6N5Canada
| | - Andrew Ridsdale
- Emerging Technologies Division, Molecular Photonics GroupNational Research Council CanadaOttawaONK1A 0R6Canada
| | - Albert Stolow
- Emerging Technologies Division, Molecular Photonics GroupNational Research Council CanadaOttawaONK1A 0R6Canada.,Department of PhysicsUniversity of OttawaOttawaONK1N 6N5Canada.,Department of ChemistryUniversity of OttawaOttawaONK1N 6N5Canada
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31
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Fotouhi A, Maleki A, Dolati S, Aghebati-Maleki A, Aghebati-Maleki L. Platelet rich plasma, stromal vascular fraction and autologous conditioned serum in treatment of knee osteoarthritis. Biomed Pharmacother 2018; 104:652-660. [DOI: 10.1016/j.biopha.2018.05.019] [Citation(s) in RCA: 34] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2018] [Revised: 04/30/2018] [Accepted: 05/07/2018] [Indexed: 12/16/2022] Open
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Hafezi-Nejad N, Guermazi A, Demehri S, Roemer FW. New imaging modalities to predict and evaluate osteoarthritis progression. Best Pract Res Clin Rheumatol 2018; 31:688-704. [PMID: 30509414 DOI: 10.1016/j.berh.2018.05.001] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2018] [Revised: 04/17/2018] [Accepted: 04/25/2018] [Indexed: 12/18/2022]
Abstract
In this narrative review, we discuss the role of different imaging methods for the evaluation of progression of structural osteoarthritis. We will focus on the role of less commonly applied imaging modalities and imaging biomarkers that were introduced in recent years or on established methods that have evolved into more prominent positions in recent years. We will highlight findings from longitudinal studies that focused on structural osteoarthritis progression as their outcome of interest. Imaging modalities discussed include plain radiography (including novel approaches of joint space width assessment and fractal signature analysis), ultrasonography (including the assessment of synovitis), magnetic resonance imaging (including semiquantitative, quantitative, and compositional evaluation), and positron emission tomography.
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Affiliation(s)
- Nima Hafezi-Nejad
- Russell H. Morgan Department of Radiology and Radiological Sciences, Johns Hopkins University, 601 N Caroline St, JHOC 4240, Baltimore, MD 21287 USA
| | - Ali Guermazi
- Department of Radiology, Boston University School of Medicine, 820 Harrison Avenue, FGH Building 3rd Floor, Boston, MA 02118, USA
| | - Shadpour Demehri
- Russell H. Morgan Department of Radiology and Radiological Sciences, Johns Hopkins University, 601 N Caroline St, JHOC 4240, Baltimore, MD 21287 USA
| | - Frank W Roemer
- Department of Radiology, Boston University School of Medicine, 820 Harrison Avenue, FGH Building 3rd Floor, Boston, MA 02118, USA; Department of Radiology, University of Erlangen-Nuremberg, Maximiliansplatz 3, 91054 Erlangen, Germany.
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Rabago D, Nourani B. Prolotherapy for Osteoarthritis and Tendinopathy: a Descriptive Review. Curr Rheumatol Rep 2018; 19:34. [PMID: 28484944 DOI: 10.1007/s11926-017-0659-3] [Citation(s) in RCA: 35] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
PURPOSE OF REVIEW Osteoarthritis and overuse tendinopathy are common chronic conditions of high societal and patient burden. The precise etiology of pain and disability in both conditions is multifactorial and not well understood. Patients are often refractory to conservative therapy. The development of new therapeutic options in both conditions is a public health priority. Prolotherapy is an injection-based outpatient regenerative therapy for chronic musculoskeletal conditions, including osteoarthritis and tendinopathy. The authors reviewed the basic science and clinical literature associated with prolotherapy for these conditions. RECENT FINDINGS Systematic review, including meta-analysis, and randomized controlled trials suggest that prolotherapy may be associated with symptom improvement in mild to moderate symptomatic knee osteoarthritis and overuse tendinopathy. Although the mechanism of action is not well understood and is likely multifactorial, a growing body of literature suggests that prolotherapy for knee osteoarthritis may be appropriate for the treatment of symptoms associated with knee osteoarthritis in carefully selected patients who are refractory to conservative therapy and deserves further basic and clinical science investigation for the treatment of osteoarthritis and tendinopathy.
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Affiliation(s)
- David Rabago
- Department of Family Medicine and Community Health, University of Wisconsin School of Medicine and Public Health, Madison, WI, 53715, USA.
| | - Bobby Nourani
- Department of Family Medicine and Community Health, University of Wisconsin School of Medicine and Public Health, Madison, WI, 53715, USA
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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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PAMUKOFF DEREKN, MONTGOMERY MELISSAM, MOFFIT TYLERJ, VAKULA MICHAELN. Quadriceps Function and Knee Joint Ultrasonography after ACL Reconstruction. Med Sci Sports Exerc 2018; 50:211-217. [DOI: 10.1249/mss.0000000000001437] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
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36
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Tummala S, Schiphof D, Byrjalsen I, Dam EB. Gender Differences in Knee Joint Congruity Quantified from MRI: A Validation Study with Data from Center for Clinical and Basic Research and Osteoarthritis Initiative. Cartilage 2018; 9:38-45. [PMID: 29219018 PMCID: PMC5724673 DOI: 10.1177/1947603516684590] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/15/2022] Open
Abstract
Objective Gender is a risk factor in the onset of osteoarthritis (OA). The aim of the study was to investigate gender differences in contact area (CA) and congruity index (CI) in the medial tibiofemoral (MTF) joint in 2 different cohorts, quantified automatically from magnetic resonance imaging (MRI). Design The CA and CI markers were validated on 2 different data sets from Center for Clinical and Basic Research (CCBR) and Osteoarthritis Initiative (OAI). The CCBR cohort consisted of 159 subjects and the OAI subcohort consisted of 1,436 subjects. From the MTF joint, the contact area was located and quantified using Euclidean distance transform. Furthermore, the CI was quantified over the contact area by assessing agreement of the first- and second-order general surface features. Then, the gender differences between CA and CI values were evaluated at different stages of radiographic OA. Results Female CAs were significantly higher than male CAs after normalization, male CIs were significantly higher than female CIs after correcting with age and body mass index ( P < 0.05), consistent across the 2 data sets. For the OAI data set, the gender differences were present at all stages of radiographic OA. Conclusion This study demonstrated the gender differences in CA and CI in MTF joints. The higher normalized CA and lower CI values in female knees may be linked with the increased risk of incidence of radiographic OA in females. These differences may help further understand the gender differences and/or to establish gender specific treatment strategies.
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Affiliation(s)
- Sudhakar Tummala
- eScience Center, Department of Computer Science, University of Copenhagen, Copenhagen, Denmark
| | - Dieuwke Schiphof
- Department of General Practice, Erasmus MC, University Medical Center, Rotterdam, The Netherlands
| | | | - Erik B. Dam
- Biomediq A/S, Copenhagen, Denmark,The D-BOARD EU Consortium,Erik B. Dam, Biomediq A/S, Fruebjergvej 3, 2100 Copenhagen, Denmark.
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37
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Das Neves Borges P, Vincent TL, Marenzana M. Application of autofluorescence robotic histology for quantitative evaluation of the 3-dimensional morphology of murine articular cartilage. Microsc Res Tech 2017; 80:1351-1360. [PMID: 28963813 PMCID: PMC5725668 DOI: 10.1002/jemt.22948] [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: 05/19/2017] [Revised: 09/04/2017] [Accepted: 09/18/2017] [Indexed: 12/17/2022]
Abstract
Murine models of osteoarthritis (OA) are increasingly important for understating pathogenesis and for testing new therapeutic approaches. Their translational potential is, however, limited by the reduced size of mouse limbs which requires a much higher resolution to evaluate their articular cartilage compared to clinical imaging tools. In experimental models, this tissue has been predominantly assessed by time-consuming histopathology using standardized semi-quantitative scoring systems. This study aimed to develop a novel imaging method for 3-dimensional (3D) histology of mouse articular cartilage, using a robotic system-termed here "3D histocutter"-which automatically sections tissue samples and serially acquires fluorescence microscopy images of each section. Tibiae dissected from C57Bl/6 mice, either naïve or OA-induced by surgical destabilization of the medial meniscus (DMM), were imaged using the 3D histocutter by exploiting tissue autofluorescence. Accuracy of 3D imaging was validated by ex vivo contrast-enhanced micro-CT and sensitivity to lesion detection compared with conventional histology. Reconstructions of tibiae obtained from 3D histocutter serial sections showed an excellent agreement with contrast-enhanced micro-CT reconstructions. Furthermore, osteoarthritic features, including articular cartilage loss and osteophytes, were also visualized. An in-house developed software allowed to automatically evaluate articular cartilage morphology, eliminating the subjectivity associated to semi-quantitative scoring and considerably increasing analysis throughput. The novelty of this methodology is, not only the increased throughput in imaging and evaluating mouse articular cartilage morphology starting from conventionally embedded samples, but also the ability to add the third dimension to conventional histomorphometry which might be useful to improve disease assessment in the model.
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Affiliation(s)
| | - Tonia L Vincent
- Kennedy Institute of Rheumatology, Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford, Roosevelt Drive, Oxford, United Kingdom
| | - Massimo Marenzana
- Department of Bioengineering, Imperial College London, London, United Kingdom.,Kennedy Institute of Rheumatology, Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford, Roosevelt Drive, Oxford, United Kingdom
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Stewart RC, Patwa AN, Lusic H, Freedman JD, Wathier M, Snyder BD, Guermazi A, Grinstaff MW. Synthesis and Preclinical Characterization of a Cationic Iodinated Imaging Contrast Agent (CA4+) and Its Use for Quantitative Computed Tomography of Ex Vivo Human Hip Cartilage. J Med Chem 2017; 60:5543-5555. [PMID: 28616978 PMCID: PMC6408935 DOI: 10.1021/acs.jmedchem.7b00234] [Citation(s) in RCA: 30] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
Contrast agents that go beyond qualitative visualization and enable quantitative assessments of functional tissue performance represent the next generation of clinically useful imaging tools. An optimized and efficient large-scale synthesis of a cationic iodinated contrast agent (CA4+) is described for imaging articular cartilage. Contrast-enhanced CT (CECT) using CA4+ reveals significantly greater agent uptake of CA4+ in articular cartilage compared to that of similar anionic or nonionic agents, and CA4+ uptake follows Donnan equilibrium theory. The CA4+ CECT attenuation obtained from imaging ex vivo human hip cartilage correlates with the glycosaminoglycan content, equilibrium modulus, and coefficient of friction, which are key indicators of cartilage functional performance and osteoarthritis stage. Finally, preliminary toxicity studies in a rat model show no adverse events, and a pharmacokinetics study documents a peak plasma concentration 30 min after dosing, with the agent no longer present in vivo at 96 h via excretion in the urine.
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Affiliation(s)
- Rachel C. Stewart
- Departments of Biomedical Engineering, Chemistry, and Medicine, Boston University, 590 Commonwealth Ave., Boston, Massachusetts 02215, United States
- Center for Advanced Orthopaedic Studies, Beth Israel Deaconess Medical Center and Harvard Medical School, 1 Overland Street, RN 115, Boston, Massachusetts 02215, United States
| | - Amit N. Patwa
- Ionic Pharmaceuticals, Boston, Massachusetts 02445, United States
| | - Hrvoje Lusic
- Ionic Pharmaceuticals, Boston, Massachusetts 02445, United States
| | - Jonathan D. Freedman
- Center for Advanced Orthopaedic Studies, Beth Israel Deaconess Medical Center and Harvard Medical School, 1 Overland Street, RN 115, Boston, Massachusetts 02215, United States
- Ionic Pharmaceuticals, Boston, Massachusetts 02445, United States
| | - Michel Wathier
- Ionic Pharmaceuticals, Boston, Massachusetts 02445, United States
| | - Brian D. Snyder
- Center for Advanced Orthopaedic Studies, Beth Israel Deaconess Medical Center and Harvard Medical School, 1 Overland Street, RN 115, Boston, Massachusetts 02215, United States
| | - Ali Guermazi
- Department of Radiology, Boston University School of Medicine, Boston, Massachusetts 02118, United States
| | - Mark W. Grinstaff
- Departments of Biomedical Engineering, Chemistry, and Medicine, Boston University, 590 Commonwealth Ave., Boston, Massachusetts 02215, United States
- Ionic Pharmaceuticals, Boston, Massachusetts 02445, United States
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Segal NA, Frick E, Duryea J, Nevitt MC, Niu J, Torner JC, Felson DT, Anderson DD. Comparison of tibiofemoral joint space width measurements from standing CT and fixed flexion radiography. J Orthop Res 2017; 35:1388-1395. [PMID: 27504863 PMCID: PMC5299055 DOI: 10.1002/jor.23387] [Citation(s) in RCA: 31] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/25/2015] [Accepted: 07/29/2016] [Indexed: 02/04/2023]
Abstract
The objective of this project was to determine the relationship between medial tibiofemoral joint space width measured on fixed-flexion radiographs and the three-dimensional joint space width distribution on low-dose, standing CT (SCT) imaging. At the 84-month visit of the Multicenter Osteoarthritis Study, 20 participants were recruited. A commercial SCT scanner for the foot and ankle was modified to image knees while standing. Medial tibiofemoral joint space width was assessed on radiographs at fixed locations from 15% to 30% of compartment width using validated software and on SCT by mapping the distances between three-dimensional subchondral bone surfaces. Individual joint space width values from radiographs were compared with three-dimensional joint space width values from corresponding sagittal plane locations using paired t-tests and correlation coefficients. For the four medial-most tibiofemoral locations, radiographic joint space width values exceeded the minimal joint space width on SCT by a mean of 2.0 mm and were approximately equal to the 61st percentile value of the joint space width distribution at each respective sagittal-plane location. Correlation coefficients at these locations were 0.91-0.97 and the offsets between joint space width values from radiographs and SCT measurements were consistent. There were greater offsets and variability in the offsets between modalities closer to the tibial spine. Joint space width measurements on fixed-flexion radiographs are highly correlated with three-dimensional joint space width from SCT. In addition to avoiding bony overlap obscuring the joint, a limitation of radiographs, the current study supports a role for SCT in the evaluation of tibiofemoral OA. © 2017 Orthopaedic Research Society. Published by Wiley Periodicals, Inc. J Orthop Res 35:1388-1395, 2017.
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Affiliation(s)
- Neil A. Segal
- Department of Rehabilitation, The University of Kansas (Kansas City, KS)
- Department of Epidemiology, The University of Iowa College of Public Health (Iowa City, IA)
| | - Eric Frick
- Department of Orthopaedics & Rehabilitation, The University of Iowa (Iowa City, IA)
| | - Jeffrey Duryea
- Brigham and Women's Hospital/Harvard Medical School (Boston, MA, USA)
| | - Michael C. Nevitt
- Department of Epidemiology & Biostatistics, University of California, San Francisco (San Francisco, CA)
| | - Jingbo Niu
- Clinical Epidemiology Research & Training Unit, Boston University School of Medicine (Boston, MA)
| | - James C. Torner
- Department of Epidemiology, The University of Iowa College of Public Health (Iowa City, IA)
| | - David T. Felson
- Clinical Epidemiology Research & Training Unit, Boston University School of Medicine (Boston, MA)
| | - Donald D. Anderson
- Department of Orthopaedics & Rehabilitation, The University of Iowa (Iowa City, IA)
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Xue Y, Zhang R, Deng Y, Chen K, Jiang T. A preliminary examination of the diagnostic value of deep learning in hip osteoarthritis. PLoS One 2017; 12:e0178992. [PMID: 28575070 PMCID: PMC5456368 DOI: 10.1371/journal.pone.0178992] [Citation(s) in RCA: 96] [Impact Index Per Article: 13.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2016] [Accepted: 05/22/2017] [Indexed: 12/15/2022] Open
Abstract
Hip Osteoarthritis (OA) is a common disease among the middle-aged and elderly people. Conventionally, hip OA is diagnosed by manually assessing X-ray images. This study took the hip joint as the object of observation and explored the diagnostic value of deep learning in hip osteoarthritis. A deep convolutional neural network (CNN) was trained and tested on 420 hip X-ray images to automatically diagnose hip OA. This CNN model achieved a balance of high sensitivity of 95.0% and high specificity of 90.7%, as well as an accuracy of 92.8% compared to the chief physicians. The CNN model performance is comparable to an attending physician with 10 years of experience. The results of this study indicate that deep learning has promising potential in the field of intelligent medical image diagnosis practice.
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Affiliation(s)
- Yanping Xue
- Department of Radiology, Beijing Chaoyang Hospital Affiliated to Capital Medical University, Beijing, China
| | | | | | | | - Tao Jiang
- Department of Radiology, Beijing Chaoyang Hospital Affiliated to Capital Medical University, Beijing, China
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Ultrasonographic assessment of medial femoral cartilage deformation acutely following walking and running. Osteoarthritis Cartilage 2017; 25:907-913. [PMID: 28043940 DOI: 10.1016/j.joca.2016.12.026] [Citation(s) in RCA: 44] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/13/2016] [Revised: 12/16/2016] [Accepted: 12/20/2016] [Indexed: 02/02/2023]
Abstract
OBJECTIVE To determine the magnitude of medial femoral cartilage deformation using ultrasonography (US) following walking and running in healthy individuals. DESIGN Twenty-five healthy participants with no history of osteoarthritis or knee injury volunteered for this study. Medial femoral cartilage thickness was assessed using US before and after three separate 30-min loading conditions: (1) walking at a self-selected speed, (2) running at a self-selected speed, and (3) sitting on a treatment table (i.e., control). Cartilage deformation was calculated as the percent change score from pre to post loading in each loading condition. The magnitude of cartilage deformation was compared between the three loading conditions. RESULTS There was no difference in baseline cartilage thickness between the three sessions (F1,24 = 0.18, P = 0.68). Cartilage deformation was different between the loading conditions (F1,24 = 47.54, P < 0.001). The walking (%Δ = -6.7, t24 = 6.90, P < 0.001, d = -1.92) and running (%Δ = -8.9, t24 = 8.14, P < 0.001, d = -1.85) conditions resulted in greater cartilage deformation when compared to the control condition (%Δ = +3.4). There was no difference in cartilage deformation between the running and walking conditions (t24 = 1.10, P = 0.28, d = 0.33). US measured medial femoral cartilage thickness demonstrated reliability and precision within a single session (ICC2,k = 0.966, SEM = 0.07 mm) and between additional sessions separated by seven (ICC2,k = 0.964, SEM = 0.08 mm) and 16 days (ICC2,k = 0.919, SEM = 0.11 mm). CONCLUSIONS US demonstrated to be a reliable and sensitive imaging modality at quantifying medial femoral cartilage deformation in healthy individuals. Both walking and running conditions created greater cartilage deformation when compared to the control conditions, but no difference was observed between the walking and running conditions.
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Incidence, prevalence, natural course and prognosis of patellofemoral osteoarthritis: the Cohort Hip and Cohort Knee study. Osteoarthritis Cartilage 2017; 25:647-653. [PMID: 27940216 DOI: 10.1016/j.joca.2016.12.006] [Citation(s) in RCA: 52] [Impact Index Per Article: 7.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/22/2016] [Revised: 10/17/2016] [Accepted: 12/01/2016] [Indexed: 02/02/2023]
Abstract
OBJECTIVE To examine the proportion of isolated patellofemoral osteoarthritis (PFOA) compared to tibiofemoral osteoarthritis (TFOA) in middle-aged participants with early osteoarthritis (OA) symptoms of the knee; to describe the natural course of PFOA compared with that of TFOA and to identify whether patients with PFOA have a different phenotype compared to patients with TFOA, or with combined PFOA and TFOA (combined osteoarthritis (COA)). DESIGN Participants with early OA symptoms of the knee were selected, completed questionnaires, underwent physical examination, and had knee radiographs at baseline, and at 2 and 5 years follow-up. Based on radiographs, participants were classified as having isolated TFOA, isolated PFOA, COA, or no radiographic OA. Multivariate logistic regression was used to identify participant characteristics associated with a specific group of OA at 2 years follow-up. RESULTS The cohort comprised 845 participants (mean age 55.9 years). At baseline, 116 had PFOA, none had TFOA or COA. Of these 116 participants, 66.3% had developed COA at 5 years follow-up. At 2 years follow-up, PFOA, TFOA and COA were present in 77 (10.8%), 39 (5.5%) and 83 (11.6%) participants, respectively. Multivariate regression analyses at 2 years follow-up showed that participants with radiographic PFOA or TFOA were not significantly different from each other with respect to signs and symptoms. CONCLUSIONS These results suggest that OA is more likely to start in the patellofemoral joint and then progress to COA in individuals with symptoms of early knee OA. No differences in TFOA and PFOA phenotypes were determined with respect to signs and symptoms.
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Telles RW, Costa-Silva L, Machado LAC, Reis RCPD, Barreto SM. Fixed-flexion knee radiography using a new positioning device produced highly repeatable measurements of joint space width: ELSA-Brasil Musculoskeletal Study (ELSA-Brasil MSK). REVISTA BRASILEIRA DE REUMATOLOGIA 2017; 57:154-161. [PMID: 28343621 DOI: 10.1016/j.rbre.2016.11.010] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2015] [Accepted: 10/21/2016] [Indexed: 11/16/2022] Open
Abstract
OBJECTIVE To describe the performance of a non-fluoroscopic fixed-flexion PA radiographic protocol with a new positioning device, developed for the assessment of knee osteoarthritis (OA) in Brazilian Longitudinal Study of Adult Health Musculoskeletal Study (ELSA-Brasil MSK). MATERIAL AND METHODS A test-retest design including 19 adults (38 knee images) was conducted. Feasibility of the radiographic protocol was assessed by image quality parameters and presence of radioanatomic alignment according to intermargin distance (IMD) values. Repeatability was assessed for IMD and joint space width (JSW) measured at three different locations. RESULTS Approximately 90% of knee images presented excellent quality. Frequencies of nearly perfect radioanatomic alignment (IMD ≤1mm) ranged from 29% to 50%, and satisfactory alignment was found in up to 71% and 76% of the images (IMD ≤1.5mm and ≤1.7mm, respectively). Repeatability analyses yielded the following results: IMD [SD of mean difference=1.08; coefficient of variation (%CV)=54.68%; intraclass correlation coefficient (ICC) (95%CI)=0.59 (0.34-0.77)]; JSW [SD of mean difference=0.34-0.61; %CV=4.48%-9.80%; ICC (95%CI)=0.74 (0.55-0.85)-0.94 (0.87-0.97)]. Adequately reproducible measurements of IMD and JSW were found in 68% and 87% of the images, respectively. CONCLUSIONS Despite the difficulty in achieving consistent radioanatomic alignment between subsequent radiographs in terms of IMD, the protocol produced highly repeatable JSW measurements when these were taken at midpoint and 10mm from the medial extremity of the medial tibial plateau. Therefore, measurements of JSW at these locations can be considered adequate for the assessment of knee OA in ELSA-Brasil MSK.
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Affiliation(s)
- Rosa Weiss Telles
- Universidade Federal de Minas Gerais, Centro de Investigação ELSA-Brasil de Minas Gerais, Faculdade de Medicina, Belo Horizonte, MG, Brazil.
| | - Luciana Costa-Silva
- Universidade Federal de Minas Gerais, Centro de Investigação ELSA-Brasil de Minas Gerais, Faculdade de Medicina, Belo Horizonte, MG, Brazil
| | - Luciana A C Machado
- Universidade Federal de Minas Gerais, Centro de Investigação ELSA-Brasil de Minas Gerais, Faculdade de Medicina, Belo Horizonte, MG, Brazil
| | - Rodrigo Citton Padilha Dos Reis
- Universidade Federal de Minas Gerais, Centro de Investigação ELSA-Brasil de Minas Gerais, Faculdade de Medicina, Belo Horizonte, MG, Brazil
| | - Sandhi Maria Barreto
- Universidade Federal de Minas Gerais, Centro de Investigação ELSA-Brasil de Minas Gerais, Faculdade de Medicina, Belo Horizonte, MG, Brazil
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Das Neves Borges P, Vincent TL, Marenzana M. Automated assessment of bone changes in cross-sectional micro-CT studies of murine experimental osteoarthritis. PLoS One 2017; 12:e0174294. [PMID: 28334010 PMCID: PMC5363908 DOI: 10.1371/journal.pone.0174294] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2016] [Accepted: 03/07/2017] [Indexed: 12/13/2022] Open
Abstract
OBJECTIVE The degradation of articular cartilage, which characterises osteoarthritis (OA), is usually paired with excessive bone remodelling, including subchondral bone sclerosis, cysts, and osteophyte formation. Experimental models of OA are widely used to investigate pathogenesis, yet few validated methodologies for assessing periarticular bone morphology exist and quantitative measurements are limited by manual segmentation of micro-CT scans. The aim of this work was to chart the temporal changes in periarticular bone in murine OA by novel, automated micro-CT methods. METHODS OA was induced by destabilisation of the medial meniscus (DMM) in 10-week old male mice and disease assessed cross-sectionally from 1- to 20-weeks post-surgery. A novel approach was developed to automatically segment subchondral bone compartments into plate and trabecular bone in micro-CT scans of tibial epiphyses. Osteophyte volume, as assessed by shape differences using 3D image registration, and by measuring total epiphyseal volume was performed. RESULTS Significant linear and volumetric structural modifications in subchondral bone compartments and osteophytes were measured from 4-weeks post-surgery and showed progressive changes at all time points; by 20 weeks, medial subchondral bone plate thickness increased by 160±19.5 μm and the medial osteophyte grew by 0.124±0.028 μm3. Excellent agreement was found when automated measurements were compared with manual assessments. CONCLUSION Our automated methods for assessing bone changes in murine periarticular bone are rapid, quantitative, and highly accurate, and promise to be a useful tool in future preclinical studies of OA progression and treatment. The current approaches were developed specifically for cross-sectional micro-CT studies but could be applied to longitudinal studies.
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Affiliation(s)
| | - Tonia L. Vincent
- Kennedy Institute of Rheumatology, Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford, Roosevelt Drive, Oxford, United Kingdom
| | - Massimo Marenzana
- Department of Bioengineering, Imperial College London, London, United Kingdom
- Kennedy Institute of Rheumatology, Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford, Roosevelt Drive, Oxford, United Kingdom
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Discovery of circulating proteins associated to knee radiographic osteoarthritis. Sci Rep 2017; 7:137. [PMID: 28273936 PMCID: PMC5427840 DOI: 10.1038/s41598-017-00195-8] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2016] [Accepted: 02/14/2017] [Indexed: 11/10/2022] Open
Abstract
Currently there are no sufficiently sensitive biomarkers able to reflect changes in joint remodelling during osteoarthritis (OA). In this work, we took an affinity proteomic approach to profile serum samples for proteins that could serve as indicators for the diagnosis of radiographic knee OA. Antibody suspension bead arrays were applied to analyze serum samples from patients with OA (n = 273), control subjects (n = 76) and patients with rheumatoid arthritis (RA, n = 244). For verification, a focused bead array was built and applied to an independent set of serum samples from patients with OA (n = 188), control individuals (n = 83) and RA (n = 168) patients. A linear regression analysis adjusting for sex, age and body mass index (BMI) revealed that three proteins were significantly elevated (P < 0.05) in serum from OA patients compared to controls: C3, ITIH1 and S100A6. A panel consisting of these three proteins had an area under the curve of 0.82 for the classification of OA and control samples. Moreover, C3 and ITIH1 levels were also found to be significantly elevated (P < 0.05) in OA patients compared to RA patients. Upon validation in additional study sets, the alterations of these three candidate serum biomarker proteins could support the diagnosis of radiographic knee OA.
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46
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Telles RW, Costa‐Silva L, Machado LA, Reis RCPD, Barreto SM. A radiografia do joelho em flexão fixa utilizando um novo posicionador produziu medidas da largura do espaço articular com alta repetibilidade: estudo ELSA‐Brasil Musculoesquelético (ELSA‐Brasil ME). REVISTA BRASILEIRA DE REUMATOLOGIA 2017. [DOI: 10.1016/j.rbr.2016.10.003] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022] Open
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Park KM, Cho TH. Therapeutic effect of acupuncture point injection with placental extract in knee osteoarthritis. JOURNAL OF INTEGRATIVE MEDICINE-JIM 2017; 15:135-141. [DOI: 10.1016/s2095-4964(17)60316-9] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
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Demehri S, Guermazi A, Kwoh CK. Diagnosis and Longitudinal Assessment of Osteoarthritis: Review of Available Imaging Techniques. Rheum Dis Clin North Am 2016; 42:607-620. [PMID: 27742017 DOI: 10.1016/j.rdc.2016.07.004] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Abstract
Osteoarthritis (OA) is a major chronic and global health care problem. Recent technological advances in imaging and postprocessing techniques have enhanced the understanding and characterization of the pathophysiology of this chronic and prevalent disease. Although plain radiograph remains the modality of choice for initial assessment of OA, recent studies have shown that advanced cross-sectional imaging can improve the early detection, grading, structural damage quantification, and risk stratification of OA. This article discusses the currently available evidence regarding both the conventional and novel imaging modalities that can be used for evaluation of patients with OA and its longitudinal assessment.
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Affiliation(s)
- Shadpour Demehri
- Division of Musculoskeletal Radiology, Russell H. Morgan Department of Radiology and Radiological Science, Johns Hopkins University, School of Medicine, 601 North Caroline Street, JHOC 5165, Baltimore, MD 21287, USA.
| | - Ali Guermazi
- Department of Radiology, Quantitative Imaging Center, Boston University School of Medicine, Boston, MA, USA
| | - C Kent Kwoh
- Division of Rheumatology, University of Arizona Arthritis Center, University of Arizona, Tucson, AZ, USA
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Smith NA, Parkinson B, Hutchinson CE, Costa ML, Spalding T. Is meniscal allograft transplantation chondroprotective? A systematic review of radiological outcomes. Knee Surg Sports Traumatol Arthrosc 2016; 24:2923-2935. [PMID: 25786823 DOI: 10.1007/s00167-015-3573-0] [Citation(s) in RCA: 84] [Impact Index Per Article: 10.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/21/2014] [Accepted: 03/05/2015] [Indexed: 01/17/2023]
Abstract
PURPOSE The primary aim of this systematic review was to examine the hypothesis that meniscal allograft transplantation is chondroprotective by identifying and appraising studies that have assessed the progression of osteoarthritis following meniscal allograft transplantation. The secondary aim was to identify and appraise radiological measures of meniscal allograft integrity following surgery. METHODS Clinical studies on human participants undergoing meniscal allograft transplantation with a minimum follow-up of 6 months were included. The primary outcome measure was any radiological osteoarthritis progression measure. Secondary outcomes included magnetic resonance measures of meniscal integrity including meniscal size, shape, healing, extrusion and signal intensity. RESULTS Thirty-eight studies with 1056 allografts were included. The weighted mean joint space loss was 0.032 mm at 4.5 years across 11 studies. Other radiological classification systems were reported in small numbers and with variable progression rates. Meniscal extrusion was present in nearly all cases, but was not associated with clinical or other radiological outcomes. Meniscal healing rates were high, although the size, shape and signal intensity were commonly altered from that of the native meniscus. The quality of the included studies was low, with a high risk of bias. CONCLUSION There is some evidence to support the hypothesis that meniscal allograft transplantation reduces the progression of osteoarthritis, although it is unlikely to be as effective as the native meniscus. If this is proven, there may be a role for prophylactic meniscal allograft transplantation in selected patients. Well-designed randomised controlled trials are needed to further test this hypothesis. LEVEL OF EVIDENCE Systematic review of studies, Level IV.
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Affiliation(s)
- Nick A Smith
- University of Warwick, Clinical Sciences Research Laboratories, Clifford Bridge Road, Coventry, West Midlands, CV2 2DX, UK.
| | - Benjamin Parkinson
- University Hospitals Coventry and Warwickshire (UHCW), Clifford Bridge Road, Coventry, CV2 2DX, UK
| | - Charles E Hutchinson
- University of Warwick, Clinical Sciences Research Laboratories, Clifford Bridge Road, Coventry, West Midlands, CV2 2DX, UK
| | - Matthew L Costa
- University of Warwick, Clinical Sciences Research Laboratories, Clifford Bridge Road, Coventry, West Midlands, CV2 2DX, UK
| | - Tim Spalding
- University Hospitals Coventry and Warwickshire (UHCW), Clifford Bridge Road, Coventry, CV2 2DX, UK
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Ijaz Khan H, Chou L, Aitken D, McBride A, Ding C, Blizzard L, Pelletier JP, Martel-Pelletier J, Cicuttini F, Jones G. Correlation Between Changes in Global Knee Structures Assessed by Magnetic Resonance Imaging and Radiographic Osteoarthritis Changes Over Ten Years in a Midlife Cohort. Arthritis Care Res (Hoboken) 2016; 68:958-64. [DOI: 10.1002/acr.22778] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2015] [Revised: 09/10/2015] [Accepted: 10/27/2015] [Indexed: 12/12/2022]
Affiliation(s)
- Hussain Ijaz Khan
- Menzies Institute for Medical Research, University of Tasmania, Hobart; Tasmania Australia
| | - Louisa Chou
- Menzies Institute for Medical Research, University of Tasmania, Hobart; Tasmania Australia
| | - Dawn Aitken
- Menzies Institute for Medical Research, University of Tasmania, Hobart; Tasmania Australia
| | - Andrew McBride
- Menzies Institute for Medical Research, University of Tasmania, Hobart; Tasmania Australia
| | - Changhai Ding
- Menzies Institute for Medical Research, University of Tasmania, Hobart; Tasmania Australia
| | - Leigh Blizzard
- Menzies Institute for Medical Research, University of Tasmania, Hobart; Tasmania Australia
| | | | | | | | - Graeme Jones
- Menzies Institute for Medical Research, University of Tasmania, Hobart; Tasmania Australia
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