1
|
Zhang H, Ning E, Lu L, Zhou J, Shao Z, Yang X, Hao Y. Research progress of ultrasound in accurate evaluation of cartilage injury in osteoarthritis. Front Endocrinol (Lausanne) 2024; 15:1420049. [PMID: 39211448 PMCID: PMC11358554 DOI: 10.3389/fendo.2024.1420049] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/22/2024] [Accepted: 07/25/2024] [Indexed: 09/04/2024] Open
Abstract
Osteoarthritis (OA) is a prevalent cause of joint algesia, loss of function, and disability in adults, with cartilage injury being its core pathological manifestation. Since cartilage damage is non-renewable, the treatment outcome in the middle and late stages of OA is unsatisfactory, which can be minimized by changing lifestyle and other treatment modalities if diagnosed and managed in the early stages, indicating the importance of early diagnosis and monitoring of cartilage injury. Ultrasound technology has been used for timely diagnosis and even cartilage injury treatment, which is convenient and safe for the patient owing to no radiation exposure. Studies have demonstrated the effectiveness of ultrasound and its various quantitative ultrasound parameters, like ultrasound roughness index (URI), reflection coefficient (R), apparent integrated backscatter (AIB), thickness, and ultrasound elastography, in the early and accurate assessment of OA cartilage pathological changes, including surface and internal tissue, hardness, and thickness. Although many challenges are faced in the clinical application of this technology in diagnosis, ultrasound and ultrasound-assisted techniques offer a lot of promise for detecting early cartilage damage in OA. In this review, we have discussed the evaluation of ultrasonic cartilage quantitative parameters for early pathological cartilage changes.
Collapse
Affiliation(s)
- Huili Zhang
- Orthopedics and Sports Medicine Center, The Affiliated Suzhou Hospital of Nanjing Medical University, Suzhou, China
- Gusu School, Nanjing Medical University, Suzhou, China
| | - Eryu Ning
- Orthopedics and Sports Medicine Center, The Affiliated Suzhou Hospital of Nanjing Medical University, Suzhou, China
- Gusu School, Nanjing Medical University, Suzhou, China
| | - Lingfeng Lu
- Orthopedics and Sports Medicine Center, The Affiliated Suzhou Hospital of Nanjing Medical University, Suzhou, China
- Gusu School, Nanjing Medical University, Suzhou, China
| | - Jing Zhou
- Orthopedics and Sports Medicine Center, The Affiliated Suzhou Hospital of Nanjing Medical University, Suzhou, China
- Gusu School, Nanjing Medical University, Suzhou, China
| | - Zhiqiang Shao
- Orthopedics and Sports Medicine Center, The Affiliated Suzhou Hospital of Nanjing Medical University, Suzhou, China
| | - Xing Yang
- Orthopedics and Sports Medicine Center, The Affiliated Suzhou Hospital of Nanjing Medical University, Suzhou, China
- Gusu School, Nanjing Medical University, Suzhou, China
| | - Yuefeng Hao
- Orthopedics and Sports Medicine Center, The Affiliated Suzhou Hospital of Nanjing Medical University, Suzhou, China
- Gusu School, Nanjing Medical University, Suzhou, China
| |
Collapse
|
2
|
Berni M, Marchiori G, Baleani M, Giavaresi G, Lopomo NF. Biomechanics of the Human Osteochondral Unit: A Systematic Review. MATERIALS (BASEL, SWITZERLAND) 2024; 17:1698. [PMID: 38612211 PMCID: PMC11012636 DOI: 10.3390/ma17071698] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/28/2023] [Revised: 03/17/2024] [Accepted: 03/26/2024] [Indexed: 04/14/2024]
Abstract
The damping system ensured by the osteochondral (OC) unit is essential to deploy the forces generated within load-bearing joints during locomotion, allowing furthermore low-friction sliding motion between bone segments. The OC unit is a multi-layer structure including articular cartilage, as well as subchondral and trabecular bone. The interplay between the OC tissues is essential in maintaining the joint functionality; altered loading patterns can trigger biological processes that could lead to degenerative joint diseases like osteoarthritis. Currently, no effective treatments are available to avoid degeneration beyond tissues' recovery capabilities. A thorough comprehension on the mechanical behaviour of the OC unit is essential to (i) soundly elucidate its overall response to intra-articular loads for developing diagnostic tools capable of detecting non-physiological strain levels, (ii) properly evaluate the efficacy of innovative treatments in restoring physiological strain levels, and (iii) optimize regenerative medicine approaches as potential and less-invasive alternatives to arthroplasty when irreversible damage has occurred. Therefore, the leading aim of this review was to provide an overview of the state-of-the-art-up to 2022-about the mechanical behaviour of the OC unit. A systematic search is performed, according to PRISMA standards, by focusing on studies that experimentally assess the human lower-limb joints' OC tissues. A multi-criteria decision-making method is proposed to quantitatively evaluate eligible studies, in order to highlight only the insights retrieved through sound and robust approaches. This review revealed that studies on human lower limbs are focusing on the knee and articular cartilage, while hip and trabecular bone studies are declining, and the ankle and subchondral bone are poorly investigated. Compression and indentation are the most common experimental techniques studying the mechanical behaviour of the OC tissues, with indentation also being able to provide information at the micro- and nanoscales. While a certain comparability among studies was highlighted, none of the identified testing protocols are currently recognised as standard for any of the OC tissues. The fibril-network-reinforced poro-viscoelastic constitutive model has become common for describing the response of the articular cartilage, while the models describing the mechanical behaviour of mineralised tissues are usually simpler (i.e., linear elastic, elasto-plastic). Most advanced studies have tested and modelled multiple tissues of the same OC unit but have done so individually rather than through integrated approaches. Therefore, efforts should be made in simultaneously evaluating the comprehensive response of the OC unit to intra-articular loads and the interplay between the OC tissues. In this regard, a multidisciplinary approach combining complementary techniques, e.g., full-field imaging, mechanical testing, and computational approaches, should be implemented and validated. Furthermore, the next challenge entails transferring this assessment to a non-invasive approach, allowing its application in vivo, in order to increase its diagnostic and prognostic potential.
Collapse
Affiliation(s)
- Matteo Berni
- Laboratorio di Tecnologia Medica, IRCCS Istituto Ortopedico Rizzoli, Via di Barbiano 1/10, 40136 Bologna, Italy; (M.B.); (M.B.)
| | - Gregorio Marchiori
- Scienze e Tecnologie Chirurgiche, IRCCS Istituto Ortopedico Rizzoli, Via di Barbiano 1/10, 40136 Bologna, Italy;
| | - Massimiliano Baleani
- Laboratorio di Tecnologia Medica, IRCCS Istituto Ortopedico Rizzoli, Via di Barbiano 1/10, 40136 Bologna, Italy; (M.B.); (M.B.)
| | - Gianluca Giavaresi
- Scienze e Tecnologie Chirurgiche, IRCCS Istituto Ortopedico Rizzoli, Via di Barbiano 1/10, 40136 Bologna, Italy;
| | | |
Collapse
|
3
|
Oyama S, Niimi N, Mori M, Hirata H. Intra-Articular Ultrasonography Probe for Minimally Invasive Upper Extremity Arthroscopic Surgery: A Phantom Study. J Clin Med 2023; 12:5727. [PMID: 37685794 PMCID: PMC10488905 DOI: 10.3390/jcm12175727] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2023] [Revised: 08/07/2023] [Accepted: 08/29/2023] [Indexed: 09/10/2023] Open
Abstract
BACKGROUND Upper extremity arthroscopic surgery is a highly technique-dependent procedure that requires the surgeon to assess difficult cartilage conditions and manage the risk of iatrogenic damage to nerves and vessels adjacent to the joint capsule in a confined joint space, and a device that can safely assist in this procedure has been in demand. METHODS In this study, we developed a small intra-articular ultrasound (AUS) probe for upper extremity joint surgery, evaluated its safety using underwater sound field measurement, and tested its visualization with a phantom in which nerves and blood vessels were embedded. RESULTS Sound field measurement experiments confirmed the biological safety of the AUS probe's output, while confirming that sufficient output power level performance was obtained as an ultrasound measurement probe. In addition, images of blood vessels and nerves were reconstructed discriminatively using A-mode imaging of the agar phantom. CONCLUSIONS This study provides proof-of-concept of the AUS probe in upper extremity surgery. Further studies are needed to obtain approval for use in future medical devices.
Collapse
Affiliation(s)
- Shintaro Oyama
- Innovative Research Center for Preventive Medical Engineering, Institute of Innovation for Future Society, Nagoya University, Tokai National Higher Education and Research System, NIC#5, Furo-cho, Chikusa-ku, Nagoya 4648601, Aichi, Japan
- Graduate School of Medicine, Nagoya University, 65 Tsurumai-cho, Showa-ku, Nagoya 4668550, Aichi, Japan;
| | - Nobuo Niimi
- Planning and Product Development Department, Nippon Sigmax Co., Ltd., 1-24-1 Nishi-Shinjyuku, Shinjyuku-ku, Tokyo 1600023, Japan
| | - Masato Mori
- Planning and Product Development Department, Nippon Sigmax Co., Ltd., 1-24-1 Nishi-Shinjyuku, Shinjyuku-ku, Tokyo 1600023, Japan
| | - Hitoshi Hirata
- Graduate School of Medicine, Nagoya University, 65 Tsurumai-cho, Showa-ku, Nagoya 4668550, Aichi, Japan;
| |
Collapse
|
4
|
Pastrama M, Spierings J, van Hugten P, Ito K, Lopata R, van Donkelaar CC. Ultrasound-Based Quantification of Cartilage Damage After In Vivo Articulation With Metal Implants. Cartilage 2021; 13:1540S-1550S. [PMID: 34894778 PMCID: PMC8721675 DOI: 10.1177/19476035211063861] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
OBJECTIVE This study aims to evaluate the applicability of the ultrasound roughness index (URI) for quantitative assessment of cartilage quality ex vivo (post-mortem), after 6 months of in vivo articulation with a Focal Knee Resurfacing Implant (FKRI). DESIGN Goats received a metal FKRI (n = 8) or sham surgery (n = 8) in the medial femoral condyles. After 6 months animals were sacrificed, tibial plateaus were stained with Indian ink, and macroscopic scoring of the plateaus was performed based on the ink staining. The URI was calculated from high-frequency ultrasound images at several sections, covering both areas that articulated with the implant and non-articulating areas. Cartilage quality at the most damaged medial location was evaluated with a Modified Mankin Score (MMS). RESULTS The URI was significantly higher in the FKRI-articulating than in the sham plateaus at medial articulating sections, but not at sections that were not in direct contact with the implant, for example, under the meniscus. The mean macroscopic score and MMS were significantly higher in the FKRI-articulating group than in the sham group (P=0.035, P<0.001, respectively). Correlation coefficients between URI and macroscopic score were significant in medial areas that articulated with the implant. A significant correlation between URI and MMS was found at the most damaged medial location (ρ=0.72,P=0.0024). CONCLUSIONS This study demonstrates the potential of URI to evaluate cartilage roughness and altered surface morphology after in vivo articulation with a metal FKRI, rendering it a promising future tool for quantitative follow-up assessment of cartilage quality.
Collapse
Affiliation(s)
- Maria Pastrama
- Orthopaedic Biomechanics Group,
Department of Biomedical Engineering, Eindhoven University of Technology, Eindhoven,
The Netherlands,Corrinus C. van Donkelaar, Orthopaedic
Biomechanics Group, Department of Biomedical Engineering, Eindhoven University
of Technology, Groene Loper 15, 5612AP Eindhoven, The Netherlands.
| | - Janne Spierings
- Orthopaedic Biomechanics Group,
Department of Biomedical Engineering, Eindhoven University of Technology, Eindhoven,
The Netherlands
| | - Pieter van Hugten
- Department of Orthopaedics, Maastricht
UMC+, Maastricht, The Netherlands
| | - Keita Ito
- Orthopaedic Biomechanics Group,
Department of Biomedical Engineering, Eindhoven University of Technology, Eindhoven,
The Netherlands
| | - Richard Lopata
- Cardiovascular Biomechanics Group,
Photoacoustics and Ultrasound Laboratory Eindhoven, Department of Biomedical
Engineering, Eindhoven University of Technology, Eindhoven, The Netherlands
| | - Corrinus C. van Donkelaar
- Orthopaedic Biomechanics Group,
Department of Biomedical Engineering, Eindhoven University of Technology, Eindhoven,
The Netherlands
| |
Collapse
|
5
|
Kiyan W, Nakagawa Y, Mukai S, Ito A, Arai T, Kuroki H. Quantitative Parameters for the Degeneration in Cartilage and Subchondral Bone of Human Knee by 3-D Ultrasound Scanning System. ULTRASOUND IN MEDICINE & BIOLOGY 2020; 46:3239-3248. [PMID: 32980159 DOI: 10.1016/j.ultrasmedbio.2020.08.024] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/21/2020] [Revised: 06/27/2020] [Accepted: 08/24/2020] [Indexed: 06/11/2023]
Abstract
This study was aimed at investigating the use of ultrasound parameters obtained non-invasively through soft tissue (ST) to evaluate degeneration in cartilage and subchondral bone (SB) in the human knee. We developed a 3-D ultrasound system and introduced the ratio parameters Rcb and RcbT to suppress the attenuation effect in the ST or in both the ST and cartilage. As reference measurements, the grade for cartilage by visual judgment (Gsum) and ultrasound parameters for the cartilage and the SB were directly evaluated under arthroscopy. Rcb correlated significantly with Gsum (rs = -0.63) and with the corresponding parameter obtained directly under arthroscopy (r = 0.55). RcbT also correlated significantly with Gsum (rs = -0.46) but was not superior to Rcb. Rcb is considered to be an efficient parameter that reflects the total degeneration in both the cartilage and SB, including the information on cartilage thickness.
Collapse
Affiliation(s)
- Wataru Kiyan
- Department of Motor Function Analysis, Human Health Sciences, Graduate School of Medicine, Kyoto University, Kyoto, Japan; Researching Department, Furuno Electric Company, Ltd., Nishinomiya, Japan
| | - Yasuaki Nakagawa
- Department of Orthopaedic Surgery, National Hospital Organization Kyoto Medical Center, Fushimi-ku, Kyoto, Japan
| | - Shogo Mukai
- Department of Orthopaedic Surgery, National Hospital Organization Kyoto Medical Center, Fushimi-ku, Kyoto, Japan
| | - Akira Ito
- Department of Motor Function Analysis, Human Health Sciences, Graduate School of Medicine, Kyoto University, Kyoto, Japan
| | - Tatsuo Arai
- Researching Department, Furuno Electric Company, Ltd., Nishinomiya, Japan
| | - Hiroshi Kuroki
- Department of Motor Function Analysis, Human Health Sciences, Graduate School of Medicine, Kyoto University, Kyoto, Japan.
| |
Collapse
|
6
|
Prakash M, Joukainen A, Torniainen J, Honkanen MKM, Rieppo L, Afara IO, Kröger H, Töyräs J, Sarin JK. Near-infrared spectroscopy enables quantitative evaluation of human cartilage biomechanical properties during arthroscopy. Osteoarthritis Cartilage 2019; 27:1235-1243. [PMID: 31026649 DOI: 10.1016/j.joca.2019.04.008] [Citation(s) in RCA: 20] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/24/2018] [Revised: 02/11/2019] [Accepted: 04/09/2019] [Indexed: 02/02/2023]
Abstract
OBJECTIVE To investigate the feasibility of near-infrared (NIR) spectroscopy (NIRS) for evaluation of human articular cartilage biomechanical properties during arthroscopy. DESIGN A novel arthroscopic NIRS probe designed in our research group was utilized by an experienced orthopedic surgeon to measure NIR spectra from articular cartilage of human cadaver knee joints (ex vivo, n = 18) at several measurement locations during an arthroscopic surgery. Osteochondral samples (n = 265) were extracted from the measurement sites for reference analysis. NIR spectra were remeasured in a controlled laboratory environment (in vitro), after which the corresponding cartilage thickness and biomechanical properties were determined. Hybrid multivariate regression models based on principal component analysis and linear mixed effects modeling (PCA-LME) were utilized to relate cartilage in vitro spectra and biomechanical properties, as well as to account for the spatial dependency. Additionally, a k-nearest neighbors (kNN) classifier was employed to reject outlying ex vivo NIR spectra resulting from a non-optimal probe-cartilage contact. Model performance was evaluated for both in vitro and ex vivo NIR spectra via Spearman's rank correlation (ρ) and the ratio of performance to interquartile range (RPIQ). RESULTS Regression models accurately predicted cartilage thickness and biomechanical properties from in vitro NIR spectra (Model: 0.77 ≤ ρ ≤ 0.87, 2.03 ≤ RPIQ ≤ 3.0; Validation: 0.74 ≤ ρ ≤ 0.84, 1.87 ≤ RPIQ ≤ 2.90). When predicting cartilage properties from ex vivo NIR spectra (0.33 ≤ ρ ≤ 0.57 and 1.02 ≤ RPIQ ≤ 2.14), a kNN classifier enhanced the accuracy of predictions (0.52 ≤ ρ ≤ 0.87 and 1.06 ≤ RPIQ ≤ 1.88). CONCLUSION Arthroscopic NIRS could substantially enhance identification of damaged cartilage by enabling quantitative evaluation of cartilage biomechanical properties. The results demonstrate the capacity of NIRS in clinical applications.
Collapse
Affiliation(s)
- M Prakash
- Department of Applied Physics, University of Eastern Finland, Finland; Diagnostic Imaging Center, Kuopio University Hospital, Kuopio, Finland.
| | - A Joukainen
- Department of Orthopedics, Traumatology and Hand Surgery, Kuopio University Hospital, Kuopio, Finland.
| | - J Torniainen
- Department of Applied Physics, University of Eastern Finland, Finland; Diagnostic Imaging Center, Kuopio University Hospital, Kuopio, Finland.
| | - M K M Honkanen
- Department of Applied Physics, University of Eastern Finland, Finland; Diagnostic Imaging Center, Kuopio University Hospital, Kuopio, Finland.
| | - L Rieppo
- Department of Applied Physics, University of Eastern Finland, Finland; Research Unit of Medical Imaging, Physics and Technology, Faculty of Medicine, University of Oulu, Oulu, Finland.
| | - I O Afara
- Department of Applied Physics, University of Eastern Finland, Finland.
| | - H Kröger
- Department of Orthopedics, Traumatology and Hand Surgery, Kuopio University Hospital, Kuopio, Finland.
| | - J Töyräs
- Department of Applied Physics, University of Eastern Finland, Finland; Diagnostic Imaging Center, Kuopio University Hospital, Kuopio, Finland; School of Information Technology and Electrical Engineering, The University of Queensland, Brisbane, Australia.
| | - J K Sarin
- Department of Applied Physics, University of Eastern Finland, Finland; Diagnostic Imaging Center, Kuopio University Hospital, Kuopio, Finland.
| |
Collapse
|
7
|
Kiyan W, Nakagawa Y, Ito A, Iijima H, Nishitani K, Tanima-Nagai M, Mukai S, Tajino J, Yamaguchi S, Nakahata A, Zhang J, Aoyama T, Kuroki H. Ultrasound Parameters for Human Osteoarthritic Subchondral Bone ex Vivo: Comparison with Micro-Computed Tomography Parameters. ULTRASOUND IN MEDICINE & BIOLOGY 2018; 44:2115-2130. [PMID: 30064850 DOI: 10.1016/j.ultrasmedbio.2018.06.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/11/2017] [Revised: 06/01/2018] [Accepted: 06/04/2018] [Indexed: 06/08/2023]
Abstract
The aim of this study was to identify ultrasound parameters reflecting subchondral porosity (Po), subchondral plate thickness (Tpl) and bone volume fraction at the trabecular bone region (BV/TVTb). Sixteen osteoarthritic human lateral femoral condyles were evaluated ex vivo using a 15-MHz pulsed-echo ultrasound 3-D scanning system. The cartilage-subchondral bone (C-B) surface region (layer 1) and inner subchondral bone region (layer 2) were analyzed; we newly introduced entropy (ENT) and correlation (COR) of ultrasound texture parameters of the parallel (x) or perpendicular (z) direction to the C-B interface for this analysis. Po, Tpl and BV/TVTb were evaluated as reference measurements using micro-computed tomography. ENTL1x (ENT of layer 1, x-direction) and ENTL1z were significantly correlated with Po (both r values = 0.58), CORL2x with Tpl (r = -0.73) and CORL2z with BV/TVTb (r = -0.66). These are efficient indicators of the characteristics of osteoarthritis-related subchondral bone; the other texture parameters were not significant.
Collapse
Affiliation(s)
- Wataru Kiyan
- Department of Motor Function Analysis, Human Health Sciences, Graduate School of Medicine, Kyoto University, Kyoto, Japan; Researching Department, Furuno Electric Company, Ltd., Nishinomiya, Japan
| | - Yasuaki Nakagawa
- Department of Orthopaedic Surgery, National Hospital Organization Kyoto Medical Center, Kyoto, Japan
| | - Akira Ito
- Department of Motor Function Analysis, Human Health Sciences, Graduate School of Medicine, Kyoto University, Kyoto, Japan
| | - Hirotaka Iijima
- Department of Motor Function Analysis, Human Health Sciences, Graduate School of Medicine, Kyoto University, Kyoto, Japan; Department of System Design Engineering, Keio University, Yokohama, Japan
| | - Kohei Nishitani
- Department of Orthopaedic Surgery, Graduate School of Medicine, Kyoto University, Kyoto, Japan
| | - Momoko Tanima-Nagai
- Medical Genetics Branch, National Human Genome Research Institute, National Institutes of Health, Bethesda, Maryland, USA
| | - Shogo Mukai
- Department of Orthopaedic Surgery, National Hospital Organization Kyoto Medical Center, Kyoto, Japan
| | - Junichi Tajino
- Department of Motor Function Analysis, Human Health Sciences, Graduate School of Medicine, Kyoto University, Kyoto, Japan
| | - Shoki Yamaguchi
- Department of Motor Function Analysis, Human Health Sciences, Graduate School of Medicine, Kyoto University, Kyoto, Japan; Department of Physical Therapy, School of Health Sciences at Narita, International University of Health and Welfare, Narita, Chiba, Japan
| | - Akihiro Nakahata
- Department of Motor Function Analysis, Human Health Sciences, Graduate School of Medicine, Kyoto University, Kyoto, Japan
| | - Jue Zhang
- Department of Motor Function Analysis, Human Health Sciences, Graduate School of Medicine, Kyoto University, Kyoto, Japan
| | - Tomoki Aoyama
- Department of Motor Function Analysis, Human Health Sciences, Graduate School of Medicine, Kyoto University, Kyoto, Japan
| | - Hiroshi Kuroki
- Department of Motor Function Analysis, Human Health Sciences, Graduate School of Medicine, Kyoto University, Kyoto, Japan.
| |
Collapse
|
8
|
Arthroscopic near infrared spectroscopy enables simultaneous quantitative evaluation of articular cartilage and subchondral bone in vivo. Sci Rep 2018; 8:13409. [PMID: 30194446 PMCID: PMC6128946 DOI: 10.1038/s41598-018-31670-5] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2018] [Accepted: 08/23/2018] [Indexed: 01/24/2023] Open
Abstract
Arthroscopic assessment of articular tissues is highly subjective and poorly reproducible. To ensure optimal patient care, quantitative techniques (e.g., near infrared spectroscopy (NIRS)) could substantially enhance arthroscopic diagnosis of initial signs of post-traumatic osteoarthritis (PTOA). Here, we demonstrate, for the first time, the potential of arthroscopic NIRS to simultaneously monitor progressive degeneration of cartilage and subchondral bone in vivo in Shetland ponies undergoing different experimental cartilage repair procedures. Osteochondral tissues adjacent to the repair sites were evaluated using an arthroscopic NIRS probe and significant (p < 0.05) degenerative changes were observed in the tissue properties when compared with tissues from healthy joints. Artificial neural networks (ANN) enabled reliable (ρ = 0.63–0.87, NMRSE = 8.5–17.2%, RPIQ = 1.93–3.03) estimation of articular cartilage biomechanical properties, subchondral bone plate thickness and bone mineral density (BMD), and subchondral trabecular bone thickness, bone volume fraction (BV), BMD, and structure model index (SMI) from in vitro spectral data. The trained ANNs also reliably predicted the properties of an independent in vitro test group (ρ = 0.54–0.91, NMRSE = 5.9–17.6%, RPIQ = 1.68–3.36). However, predictions based on arthroscopic NIR spectra were less reliable (ρ = 0.27–0.74, NMRSE = 14.5–24.0%, RPIQ = 1.35–1.70), possibly due to errors introduced during arthroscopic spectral acquisition. Adaptation of NIRS could address the limitations of conventional arthroscopy through quantitative assessment of lesion severity and extent, thereby enhancing detection of initial signs of PTOA. This would be of high clinical significance, for example, when conducting orthopaedic repair surgeries.
Collapse
|
9
|
Zhang J, Xiao L, Tong L, Wan C, Hao Z. Quantitative Evaluation of Enzyme-Induced Porcine Articular Cartilage Degeneration Based on Observation of Entire Cartilage Layer Using Ultrasound. ULTRASOUND IN MEDICINE & BIOLOGY 2018; 44:861-871. [PMID: 29352619 DOI: 10.1016/j.ultrasmedbio.2017.11.016] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/18/2017] [Revised: 11/18/2017] [Accepted: 11/27/2017] [Indexed: 06/07/2023]
Abstract
Enzyme-induced articular cartilage degeneration resembling osteoarthritis was evaluated using a newly defined acoustic parameter, the "averaged magnitude ratio" (AMR), which has been suggested as an indicator of articular cartilage degeneration. In vitro experiments were conducted on porcine cartilage samples digested with trypsin for 2 h (n = 10) and 4 h (n = 13) and healthy control samples (n = 13). AMR was determined with 15- and 25-MHz ultrasound, and the integrated reflection coefficient (IRC) and apparent integrated backscattering coefficient (AIB) were also calculated for comparison. The Young's modulus of superficial cartilage was measured using atomic force microscopy. Performance of the AMR differs between 15 and 25 MHz, possibly because of frequency-related attenuation and resolution of ultrasound. At the proper settings, AMR exhibited a competence similar to that of IRC and AIB in detecting cartilage degeneration and could also detect differences in deeper positions. Furthermore, AMR has the advantages of being easy to measure and requiring no reference material.
Collapse
Affiliation(s)
- Jingchen Zhang
- Department of Mechanical Engineering, Tsinghua University, Beijing, China
| | - Liying Xiao
- Department of Mechanical Engineering, Tsinghua University, Beijing, China
| | - Lingying Tong
- Department of Mechanical Engineering, Tsinghua University, Beijing, China
| | - Chao Wan
- Department of Mechanical Engineering, Tsinghua University, Beijing, China; Institute of Biomechanics and Medical Engineering, Department of Engineering Mechanics, Tsinghua University, Beijing, China
| | - Zhixiu Hao
- Department of Mechanical Engineering, Tsinghua University, Beijing, China.
| |
Collapse
|
10
|
Huang YP, Zhong J, Chen J, Yan CH, Zheng YP, Wen CY. High-Frequency Ultrasound Imaging of Tidemark In Vitro in Advanced Knee Osteoarthritis. ULTRASOUND IN MEDICINE & BIOLOGY 2018; 44:94-101. [PMID: 28965723 DOI: 10.1016/j.ultrasmedbio.2017.08.1884] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/11/2017] [Revised: 07/20/2017] [Accepted: 08/28/2017] [Indexed: 06/07/2023]
Abstract
High-frequency ultrasound imaging has been widely adopted for assessment of the degenerative changes of articular cartilage in osteoarthritis (OA). Yet, there are few reports on investigating its capability to evaluate subchondral bone. Here, we employed high-frequency ultrasound imaging (25 MHz) to examine in vitro the tidemark in cylindrical osteochondral disks (n = 33) harvested from advanced OA knees of humans. We found good correspondence in morphology observed by ultrasound imaging and micro-computed tomography. Ultrasound roughness index (URI) of tidemark was derived from the raw radiofrequency signals to compare with bone quality factors, including bone volume fraction (BV/TV) and bone mineral density (BMD) measured by micro-computed tomography, using the Spearman correlation (ρ). URI of the tidemark was negatively associated with the subchondral plate BV/TV (ρ = -0.73, p <0.001), BMD (ρ = -0.40, p = 0.020), as well as the underneath trabecular bone BV/TV (ρ = -0.39, p = 0.025) and BMD (ρ = -0.43, p = 0.012). In conclusion, this preliminary study demonstrated that morphology measured by high-frequency ultrasound imaging could reflect the quality of the subchondral bone. High-frequency ultrasound is a promising imaging tool to evaluate the changes of the subchondral bone in addition to those of the overlying cartilage in OA.
Collapse
Affiliation(s)
- Yan-Ping Huang
- Interdisciplinary Division of Biomedical Engineering, Faculty of Engineering, The Hong Kong Polytechnic University, Hung Hom, Kowloon, Hong Kong SAR, China; School of Electronic and Information Engineering, South China University of Technology, Guangzhou, China
| | - Jin Zhong
- Interdisciplinary Division of Biomedical Engineering, Faculty of Engineering, The Hong Kong Polytechnic University, Hung Hom, Kowloon, Hong Kong SAR, China
| | - Jie Chen
- Interdisciplinary Division of Biomedical Engineering, Faculty of Engineering, The Hong Kong Polytechnic University, Hung Hom, Kowloon, Hong Kong SAR, China; Department of Orthopedics, Shanghai Institute of Traumatology and Orthopedics, Ruijin Hospital, Shanghai Jiaotong University School of Medicine, Shanghai, China
| | - Chun-Hoi Yan
- Department of Orthopaedics & Traumatology, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong, China
| | - Yong-Ping Zheng
- Interdisciplinary Division of Biomedical Engineering, Faculty of Engineering, The Hong Kong Polytechnic University, Hung Hom, Kowloon, Hong Kong SAR, China
| | - Chun-Yi Wen
- Interdisciplinary Division of Biomedical Engineering, Faculty of Engineering, The Hong Kong Polytechnic University, Hung Hom, Kowloon, Hong Kong SAR, China.
| |
Collapse
|
11
|
Joukainen A, Virén T, Penttilä P, Liukkonen J, Puhakka PH, Kröger H, Töyräs J. Ultrasound Arthroscopy of Hip in Treatment of Osteochondritis Dissecans. Arthrosc Tech 2017; 6:e1063-e1068. [PMID: 28970993 PMCID: PMC5621660 DOI: 10.1016/j.eats.2017.03.022] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/12/2016] [Accepted: 03/07/2017] [Indexed: 02/03/2023] Open
Abstract
An ultrasound arthroscopy (UA) technique is a promising tool for the evaluation of the articular cartilage during arthroscopic examination. However, the applicability of UA for the evaluation of the hip joint is unknown. We describe a UA assessment of a patient with osteochondritis dissecans at the femoral head. An ultrasound catheter designed for intravascular imaging was inserted into the hip joint by use of conventional arthroscopic portals, and the cartilage surfaces of the femoral head and acetabulum were investigated with ultrasound. UA provided essential quantitative information on the integrity of the articular cartilage and the condition of the subchondral plate not assessable with conventional arthroscopy. Furthermore, the UA technique provided the possibility to monitor arthroscopy-assisted retrograde drilling and bone transplantation in the hip joint.
Collapse
Affiliation(s)
- Antti Joukainen
- Department of Orthopaedics, Traumatology and Hand Surgery, Kuopio University Hospital, Kuopio, Finland,Kuopio Musculoskeletal Research Unit, University of Eastern Finland, Kuopio, Finland
| | - Tuomas Virén
- Cancer Center, Kuopio University Hospital, Kuopio, Finland,Department of Applied Physics, University of Eastern Finland, Kuopio, Finland,Address correspondence to Tuomas Virén, Ph.D., Department of Applied Physics, University of Eastern Finland, POB 1627, FI-70211 Kuopio, Finland.Department of Applied PhysicsUniversity of Eastern FinlandPOB 1627FI-70211 KuopioFinland
| | - Pekko Penttilä
- Department of Children and Adolescents, Kuopio University Hospital, Kuopio, Finland
| | - Jukka Liukkonen
- Department of Applied Physics, University of Eastern Finland, Kuopio, Finland
| | - Pia Henriikka Puhakka
- Diagnostic Imaging Center, Kuopio University Hospital, Kuopio, Finland,Department of Applied Physics, University of Eastern Finland, Kuopio, Finland
| | - Heikki Kröger
- Department of Orthopaedics, Traumatology and Hand Surgery, Kuopio University Hospital, Kuopio, Finland,Kuopio Musculoskeletal Research Unit, University of Eastern Finland, Kuopio, Finland
| | - Juha Töyräs
- Diagnostic Imaging Center, Kuopio University Hospital, Kuopio, Finland,Department of Applied Physics, University of Eastern Finland, Kuopio, Finland
| |
Collapse
|
12
|
Lakin BA, Snyder BD, Grinstaff MW. Assessing Cartilage Biomechanical Properties: Techniques for Evaluating the Functional Performance of Cartilage in Health and Disease. Annu Rev Biomed Eng 2017; 19:27-55. [DOI: 10.1146/annurev-bioeng-071516-044525] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Affiliation(s)
- Benjamin A. Lakin
- Center for Advanced Orthopedic Studies, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts 02215
- Department of Biomedical Engineering, Boston University, Boston, Massachusetts 02215
| | - Brian D. Snyder
- Center for Advanced Orthopedic Studies, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts 02215
- Orthopedic Center, Children's Hospital, Boston, Massachusetts 02115
| | - Mark W. Grinstaff
- Department of Biomedical Engineering, Boston University, Boston, Massachusetts 02215
- Department of Chemistry, Boston University, Boston, Massachusetts 02215
| |
Collapse
|
13
|
Sarin JK, Brommer H, Argüelles D, Puhakka PH, Inkinen SI, Afara IO, Saarakkala S, Töyräs J. Multimodality scoring of chondral injuries in the equine fetlock joint ex vivo. Osteoarthritis Cartilage 2017; 25:790-798. [PMID: 27965140 DOI: 10.1016/j.joca.2016.12.007] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/16/2016] [Revised: 12/01/2016] [Accepted: 12/01/2016] [Indexed: 02/02/2023]
Abstract
OBJECTIVE We investigate the potential of a prototype multimodality arthroscope, combining ultrasound, optical coherence tomography (OCT) and arthroscopic indentation device, for assessing cartilage lesions, and compare the reliability of this approach with conventional arthroscopic scoring ex vivo. DESIGN Areas of interest (AIs, N = 43) were selected from equine fetlock joints (N = 5). Blind-coded AIs were independently scored by two equine surgeons employing International Cartilage Repair Society (ICRS) scoring system via conventional arthroscope and multimodality arthroscope, in which high-frequency ultrasound and OCT catheters were attached to an arthroscopic indentation device. In addition, cartilage stiffness was measured with the indentation device, and lesions in OCT images scored using custom-made automated software. Measurements and scorings were performed twice in two separate rounds. Finally, the scores were compared to histological ICRS scores. RESULTS OCT and arthroscopic examinations showed the highest average agreements (55.2%) between the scoring by surgeons and histology scores, whereas ultrasound had the lowest (50.6%). Average intraobserver agreements of surgeons and interobserver agreements between rounds were, respectively, for conventional arthroscope (68.6%, 69.8%), ultrasound (68.6%, 68.6%), OCT (65.1%, 61.7%) and automated software (65.1%, 59.3%). CONCLUSIONS OCT imaging supplemented with the automated software provided the most reliable lesion scoring. However, limited penetration depth of light limits the clinical potential of OCT in assessing human cartilage thickness; thus, the combination of OCT and ultrasound could be optimal for reliable diagnostics. Present findings suggest imaging and quantitatively analyzing the entire articular surface to eliminate surgeon-related variation in the selection of the most severe lesion to be scored.
Collapse
Affiliation(s)
- J K Sarin
- Department of Applied Physics, University of Eastern Finland, Kuopio, Finland; Diagnostic Imaging Center, Kuopio University Hospital, Kuopio, Finland.
| | - H Brommer
- Department of Equine Sciences, Utrecht University, Utrecht, The Netherlands.
| | - D Argüelles
- Veterinary Teaching Hospital, School of Veterinary Medicine, University of Helsinki, Helsinki, Finland.
| | - P H Puhakka
- Department of Applied Physics, University of Eastern Finland, Kuopio, Finland; Diagnostic Imaging Center, Kuopio University Hospital, Kuopio, Finland.
| | - S I Inkinen
- Department of Applied Physics, University of Eastern Finland, Kuopio, Finland.
| | - I O Afara
- Department of Applied Physics, University of Eastern Finland, Kuopio, Finland; Diagnostic Imaging Center, Kuopio University Hospital, Kuopio, Finland; Department of Electrical and Computer Engineering, Elizade University, Ondo, Nigeria.
| | - S Saarakkala
- Research Unit of Medical Imaging, Physics and Technology, Faculty of Medicine, University of Oulu, Oulu, Finland; Medical Research Center Oulu, Oulu University Hospital and University of Oulu, Oulu, Finland; Department of Diagnostic Radiology, Oulu University Hospital, Oulu, Finland.
| | - J Töyräs
- Department of Applied Physics, University of Eastern Finland, Kuopio, Finland; Diagnostic Imaging Center, Kuopio University Hospital, Kuopio, Finland.
| |
Collapse
|
14
|
Puhakka J, Afara IO, Paatela T, Sormaala MJ, Timonen MA, Virén T, Jurvelin JS, Töyräs J, Kiviranta I. In Vivo Evaluation of the Potential of High-Frequency Ultrasound for Arthroscopic Examination of the Shoulder Joint. Cartilage 2016; 7:248-55. [PMID: 27375840 PMCID: PMC4918065 DOI: 10.1177/1947603515617280] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
OBJECTIVE Accurate arthroscopic evaluation of cartilage lesions could significantly improve the outcome of repair surgery. In this study, we investigated for the first time the potential of intra-articular ultrasound as an arthroscopic tool for grading cartilage defects in the human shoulder joint in vivo and compared the outcome to results from arthroscopic evaluation and magnetic resonance imaging findings. DESIGN A total of 26 sites from 9 patients undergoing routine shoulder arthroscopy were quantitatively evaluated with a clinical intravascular (40MHz) ultrasound imaging system, using the regular arthroscopy portals. Reflection coefficient (R), integrated reflection coefficient (IRC), apparent integrated backscattering (AIB), and ultrasound roughness index (URI) were calculated, and high-resolution ultrasound images were obtained per site. Each site was visually graded according to the International Cartilage Repair Society (ICRS) system. "Ultrasound scores" corresponding to the ICRS system were determined from the ultrasound images. Magnetic resonance imaging was conducted and cartilage integrity at each site was classified into 5 grades (0 = normal, 4 = severely abnormal) by a radiologist. RESULTS R and IRC were lower at sites with damaged cartilage surface (P = 0.033 and P = 0.043, respectively) and correlated with arthroscopic ICRS grades (r s = -0.444, P = 0.023 and r s = -0.426, P = 0.03, respectively). Arthroscopic ICRS grades and ultrasound scores were significantly correlated (rs = 0.472, P = 0.015), but no significant correlation was found between magnetic resonance imaging data and other parameters. CONCLUSION The results suggest that ultrasound arthroscopy could facilitate quantitative clinical appraisal of articular cartilage integrity in the shoulder joint and provide information on cartilage lesion depth and severity for quantitative diagnostics in surgery.
Collapse
Affiliation(s)
- Jani Puhakka
- Department of Orthopaedics and Traumatology, University of Helsinki, Helsinki, Finland
| | - Isaac O. Afara
- Department of Applied Physics, University of Eastern Finland, Kuopio, Finland,Isaac O. Afara, Department of Applied Physics, University of Eastern Finland, Yliopistonranta 1 F, Melania, Kuopio, 70211 Finland.
| | - Teemu Paatela
- Department of Orthopaedics and Traumatology, University of Helsinki, Helsinki, Finland,Department of Orthopaedics and Traumatology, Helsinki University Central Hospital, Helsinki, Finland
| | - Markus J. Sormaala
- Department of Radiology, Helsinki University Hospital, Helsinki, Finland
| | - Matti A. Timonen
- Department of Applied Physics, University of Eastern Finland, Kuopio, Finland
| | - Tuomas Virén
- Cancer Centre, Kuopio University Hospital, Kuopio, Finland
| | - Jukka S. Jurvelin
- Department of Applied Physics, University of Eastern Finland, Kuopio, Finland
| | - Juha Töyräs
- Department of Applied Physics, University of Eastern Finland, Kuopio, Finland,Diagnostic Imaging Center, Kuopio University Hospital, Kuopio, Finland
| | - Ilkka Kiviranta
- Department of Orthopaedics and Traumatology, University of Helsinki, Helsinki, Finland,Department of Orthopaedics and Traumatology, Helsinki University Central Hospital, Helsinki, Finland
| |
Collapse
|
15
|
Männicke N, Schöne M, Liukkonen J, Fachet D, Inkinen S, Malo MK, Oelze ML, Töyräs J, Jurvelin JS, Raum K. Species-Independent Modeling of High-Frequency Ultrasound Backscatter in Hyaline Cartilage. ULTRASOUND IN MEDICINE & BIOLOGY 2016; 42:1375-1384. [PMID: 27038804 DOI: 10.1016/j.ultrasmedbio.2016.01.018] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/09/2015] [Revised: 01/24/2016] [Accepted: 01/27/2016] [Indexed: 06/05/2023]
Abstract
Apparent integrated backscatter (AIB) is a common ultrasound parameter used to assess cartilage matrix degeneration. However, the specific contributions of chondrocytes, proteoglycan and collagen to AIB remain unknown. To reveal these relationships, this work examined biopsies and cross sections of human, ovine and bovine cartilage with 40-MHz ultrasound biomicroscopy. Site-matched estimates of collagen concentration, proteoglycan concentration, collagen orientation and cell number density were employed in quasi-least-squares linear regression analyses to model AIB. A positive correlation (R(2) = 0.51, p < 10(-4)) between AIB and a combination model of cell number density and collagen concentration was obtained for collagen orientations approximately perpendicular (>70°) to the sound beam direction. These findings indicate causal relationships between AIB and cartilage structural parameters and could aid in more sophisticated future interpretations of ultrasound backscatter.
Collapse
Affiliation(s)
- Nils Männicke
- Berlin-Brandenburg Center for Regenerative Therapies and Berlin-Brandenburg School for Regenerative Therapies, Charité-Universitätsmedizin Berlin, Berlin, Germany
| | - Martin Schöne
- Berlin-Brandenburg Center for Regenerative Therapies and Berlin-Brandenburg School for Regenerative Therapies, Charité-Universitätsmedizin Berlin, Berlin, Germany
| | - Jukka Liukkonen
- Department of Applied Physics, University of Eastern Finland, Kuopio, Finland
| | - Dominik Fachet
- Department of Biology, Chemistry and Pharmacy, Freie Universität Berlin, Berlin, Germany
| | - Satu Inkinen
- Department of Applied Physics, University of Eastern Finland, Kuopio, Finland
| | - Markus K Malo
- Department of Applied Physics, University of Eastern Finland, Kuopio, Finland
| | - Michael L Oelze
- Bioacoustics Research Laboratory, Department of Electrical and Computer Engineering, University of Illinois at Urbana-Champaign, Urbana, Illinois, USA
| | - Juha Töyräs
- Department of Applied Physics, University of Eastern Finland, Kuopio, Finland; Diagnostic Imaging Center, Kuopio University Hospital, Kuopio, Finland
| | - Jukka S Jurvelin
- Department of Applied Physics, University of Eastern Finland, Kuopio, Finland
| | - Kay Raum
- Berlin-Brandenburg Center for Regenerative Therapies and Berlin-Brandenburg School for Regenerative Therapies, Charité-Universitätsmedizin Berlin, Berlin, Germany.
| |
Collapse
|
16
|
Wang Q, Liu Z, Wang Y, Pan Q, Feng Q, Huang Q, Chen W. Quantitative Ultrasound Assessment of Cartilage Degeneration in Ovariectomized Rats with Low Estrogen Levels. ULTRASOUND IN MEDICINE & BIOLOGY 2016; 42:290-298. [PMID: 26497769 DOI: 10.1016/j.ultrasmedbio.2015.08.004] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/06/2015] [Revised: 08/03/2015] [Accepted: 08/06/2015] [Indexed: 06/05/2023]
Abstract
The aim of this study was to assess quantitatively the site-specific degeneration of articular cartilage in ovariectomized rats with low estrogen levels using a high-frequency ultrasound system. Fourteen female Sprague-Dawley rats were randomly divided into two groups (n = 7 per group): a sham group in which only the peri-ovarian fatty tissue was exteriorized and an ovariectomized group that underwent bilateral ovariectomy to create a menopause model with low estrogen levels. All animals were sacrificed at the end of the third week after ovariectomy. Hindlimbs were harvested. The articular cartilage from five anatomic sites (i.e., femoral caput [FC], medial femoral condyle [MFC], lateral femoral condyle [LFC], medial tibial plateau [MTP] and lateral tibial plateau [LTP]) was examined with ultrasound. Four parameters were extracted from the ultrasound radiofrequency data: reflection coefficient of the cartilage surface (RC1), reflection coefficient of the cartilage-bone interface (RC2), ultrasound roughness index (URI) and thickness of the cartilage tissue. The results indicated significant (p < 0.05) site dependence for cartilage thickness, URI and RC1 in the sham group. The 3-wk post-menopause ovariectomized rats exhibited significant increases (p < 0.05) in the URI at the LFC, MTP and LTP; significant decreases (p < 0.05) in RC1 at the FC, LFC and MTP; and significant decreases (p < 0.05) in cartilage thickness at the MFC, LFC, MTP and LTP. These results of this study suggest that post-menopausal estrogen reduction induces morphologic and acoustic alterations in the articular cartilage of the hip and knee joints in ovariectomized rats.
Collapse
Affiliation(s)
- Qing Wang
- Institute of Medical Information, School of Biomedical Engineering, Southern Medical University, Guangzhou, Guangdong, China; Guangdong Provincial Key Laboratory of Medical Image Processing, School of Biomedical Engineering, Southern Medical University, Guangzhou, Guangdong, China.
| | - Zhiwei Liu
- Institute of Medical Information, School of Biomedical Engineering, Southern Medical University, Guangzhou, Guangdong, China
| | - Yinong Wang
- Institute of Medical Information, School of Biomedical Engineering, Southern Medical University, Guangzhou, Guangdong, China
| | - Qingya Pan
- Institute of Medical Information, School of Biomedical Engineering, Southern Medical University, Guangzhou, Guangdong, China
| | - Qianjin Feng
- Institute of Medical Information, School of Biomedical Engineering, Southern Medical University, Guangzhou, Guangdong, China; Guangdong Provincial Key Laboratory of Medical Image Processing, School of Biomedical Engineering, Southern Medical University, Guangzhou, Guangdong, China.
| | - Qinghua Huang
- School of Electronic and Information Engineering, South China University of Technology, Guangzhou, Guangdong, China
| | - Wufan Chen
- Institute of Medical Information, School of Biomedical Engineering, Southern Medical University, Guangzhou, Guangdong, China; Guangdong Provincial Key Laboratory of Medical Image Processing, School of Biomedical Engineering, Southern Medical University, Guangzhou, Guangdong, China
| |
Collapse
|
17
|
Comparison of Intact Knee Cartilage Thickness in Patients with Traumatic Lower Extremity Amputation and Nonimpaired Individuals. Am J Phys Med Rehabil 2015; 94:602-8. [PMID: 25299529 DOI: 10.1097/phm.0000000000000216] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
OBJECTIVE The aim of this study was to assess the femoral articular cartilage thickness of the intact knee in patients with traumatic lower extremity amputation compared with nonimpaired individuals. DESIGN A total of 30 male patients with traumatic lower extremity amputation (mean [SD] age, 31.2 [6.3] yrs) and a random sample of 53 age-matched and body mass index-matched male nonimpaired individuals (mean [SD] age, 29.8 [6.3] yrs) participated in the study. Exclusion criteria were age younger than 18 yrs, history of significant knee injury, previous knee surgery, or rheumatic disease. The femoral articular cartilage thickness was measured using ultrasound at the midpoints of the medial condyle, the intercondylar notch, and the lateral condyle. Ultrasonographic cartilage measurement was performed on the intact side of the patients with amputation and on both sides of the nonimpaired individuals. RESULTS The femoral articular cartilage thickness of the intact knees of the patients with amputation was significantly decreased at the lateral and medial condyles compared with the nonimpaired individuals (P < 0.05). There was no significant difference in the measurements at the intercondylar notch between the patients with amputation and the nonimpaired individuals (P > 0.05). CONCLUSIONS There was a premature cartilage loss in the intact limb knee of the patients with traumatic amputation. This result supports the view that patients with traumatic lower extremity amputation are at increased risk for developing knee osteoarthritis in the intact limb.
Collapse
|
18
|
Inkinen SI, Liukkonen J, Tiitu V, Virén T, Jurvelin JS, Töyräs J. Ultrasound Backscattering Is Anisotropic in Bovine Articular Cartilage. ULTRASOUND IN MEDICINE & BIOLOGY 2015; 41:1958-1966. [PMID: 25933711 DOI: 10.1016/j.ultrasmedbio.2015.03.021] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/15/2014] [Revised: 03/16/2015] [Accepted: 03/19/2015] [Indexed: 06/04/2023]
Abstract
Collagen, proteoglycans and chondrocytes can contribute to ultrasound scattering in articular cartilage. However, anisotropy of ultrasound scattering in cartilage is not fully characterized. We investigate this using a clinical intravascular ultrasound device with ultrasound frequencies of 9 and 40 MHz. Osteochondral samples were obtained from intact bovine patellas, and cartilage was imaged in two perpendicular directions: through articular and lateral surfaces. At both frequencies, ultrasound backscattering was higher (p < 0.05) when measured through the lateral surface of cartilage. In addition, the composition and structure of articular cartilage were investigated with multiple reference methods involving light microscopy, digital densitometry, polarized light microscopy and Fourier infrared imaging. Reference methods indicated that acoustic anisotropy of ultrasound scattering arises mainly from non-uniform distribution of chondrocytes and anisotropic orientation of collagen fibers. To conclude, ultrasound backscattering in articular cartilage was found to be anisotropic and dependent on the frequency in use.
Collapse
Affiliation(s)
- Satu I Inkinen
- Department of Applied Physics, University of Eastern Finland, Kuopio, Finland; Cancer Center, Kuopio University Hospital, Kuopio, Finland.
| | - Jukka Liukkonen
- Department of Applied Physics, University of Eastern Finland, Kuopio, Finland
| | - Virpi Tiitu
- School of Medicine, Institute of Biomedicine, Anatomy, University of Eastern Finland, Kuopio, Finland
| | - Tuomas Virén
- Cancer Center, Kuopio University Hospital, Kuopio, Finland
| | - Jukka S Jurvelin
- Department of Applied Physics, University of Eastern Finland, Kuopio, Finland
| | - Juha Töyräs
- Department of Applied Physics, University of Eastern Finland, Kuopio, Finland; Diagnostic Imaging Centre, Kuopio University Hospital, Kuopio, Finland
| |
Collapse
|
19
|
Sun A, Bai X, Ju BF. A new method for evaluating the degeneration of articular cartilage using pulse-echo ultrasound. THE REVIEW OF SCIENTIFIC INSTRUMENTS 2015; 86:034301. [PMID: 25832249 DOI: 10.1063/1.4914044] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
Abstract
This paper presents a novel nondestructive ultrasonic technique for measuring the sound speed and acoustic impedance of articular cartilage using the pulsed Vz,t technique. Vz,t data include a series of pulsed ultrasonic echoes collected using different distances between the ultrasonic transducer and the specimen. The 2D Fourier transform is applied to the Vz,t data to reconstruct the 2D reflection spectrum Rθ,ω. To obtain the reflection coefficient of articular cartilage, the Vz,t data from a reference specimen with a well-known reflection coefficient are obtained to eliminate the dependence on the general system transfer function. The ultrasound-derived aggregate modulus (Ha) is computed based on the measured reflection coefficient and the sound speed. In the experiment, 32 cartilage-bone samples were prepared from bovine articular cartilage, and 16 samples were digested using 0.25% trypsin solution. The sound speed and Ha of these cartilage samples were evaluated before and after degeneration. The magnitude of the sound speed decreased with trypsin digestion (from 1663 ± 5.6 m/s to 1613 ± 5.3 m/s). Moreover, the Young's modulus in the corresponding degenerative state was measured and was correlated with the ultrasound-derived aggregate modulus. The ultrasound-derived aggregate modulus was determined to be highly correlated with the Young's modulus (n = 16, r>0.895, p<0.003, Pearson correlation test for each measurement). The results demonstrate the effectiveness of using the proposed method to assess the changes in sound speed and the ultrasound-derived aggregate modulus of cartilage after degeneration.
Collapse
Affiliation(s)
- Anyu Sun
- The State Key Laboratory of Fluid Power Transmission and Control, Zhejiang University, Hangzhou 310027, People's Republic of China
| | - Xiaolong Bai
- The State Key Laboratory of Fluid Power Transmission and Control, Zhejiang University, Hangzhou 310027, People's Republic of China
| | - Bing-Feng Ju
- The State Key Laboratory of Fluid Power Transmission and Control, Zhejiang University, Hangzhou 310027, People's Republic of China
| |
Collapse
|
20
|
Männicke N, Schöne M, Oelze M, Raum K. Articular cartilage degeneration classification by means of high-frequency ultrasound. Osteoarthritis Cartilage 2014; 22:1577-82. [PMID: 25278067 DOI: 10.1016/j.joca.2014.06.019] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/27/2014] [Revised: 06/16/2014] [Accepted: 06/23/2014] [Indexed: 02/02/2023]
Abstract
CONTEXT To date only single ultrasound parameters were regarded in statistical analyses to characterize osteoarthritic changes in articular cartilage and the potential benefit of using parameter combinations for characterization remains unclear. OBJECTIVE Therefore, the aim of this work was to utilize feature selection and classification of a Mankin subset score (i.e., cartilage surface and cell sub-scores) using ultrasound-based parameter pairs and investigate both classification accuracy and the sensitivity towards different degeneration stages. DESIGN 40 punch biopsies of human cartilage were previously scanned ex vivo with a 40-MHz transducer. Ultrasound-based surface parameters, as well as backscatter and envelope statistics parameters were available. Logistic regression was performed with each unique US parameter pair as predictor and different degeneration stages as response variables. The best ultrasound-based parameter pair for each Mankin subset score value was assessed by highest classification accuracy and utilized in receiver operating characteristics (ROC) analysis. RESULTS The classifications discriminating between early degenerations yielded area under the ROC curve (AUC) values of 0.94-0.99 (mean ± SD: 0.97 ± 0.03). In contrast, classifications among higher Mankin subset scores resulted in lower AUC values: 0.75-0.91 (mean ± SD: 0.84 ± 0.08). Variable sensitivities of the different ultrasound features were observed with respect to different degeneration stages. CONCLUSIONS Our results strongly suggest that combinations of high-frequency ultrasound-based parameters exhibit potential to characterize different, particularly very early, degeneration stages of hyaline cartilage. Variable sensitivities towards different degeneration stages suggest that a concurrent estimation of multiple ultrasound-based parameters is diagnostically valuable. In-vivo application of the present findings is conceivable in both minimally invasive arthroscopic ultrasound and high-frequency transcutaneous ultrasound.
Collapse
Affiliation(s)
- N Männicke
- Julius Wolff Institute and Berlin-Brandenburg School for Regenerative Therapies, Charité-Universitätsmedizin Berlin, Germany
| | - M Schöne
- Julius Wolff Institute and Berlin-Brandenburg School for Regenerative Therapies, Charité-Universitätsmedizin Berlin, Germany
| | - M Oelze
- Bioacoustics Research Laboratory, Department of Electrical and Computer Engineering, University of Illinois at Urbana-Champaign, Urbana, IL, USA
| | - K Raum
- Julius Wolff Institute and Berlin-Brandenburg School for Regenerative Therapies, Charité-Universitätsmedizin Berlin, Germany.
| |
Collapse
|
21
|
Liukkonen J, Lehenkari P, Hirvasniemi J, Joukainen A, Virén T, Saarakkala S, Nieminen MT, Jurvelin JS, Töyräs J. Ultrasound arthroscopy of human knee cartilage and subchondral bone in vivo. ULTRASOUND IN MEDICINE & BIOLOGY 2014; 40:2039-2047. [PMID: 25023111 DOI: 10.1016/j.ultrasmedbio.2014.04.001] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/27/2013] [Revised: 01/16/2014] [Accepted: 04/04/2014] [Indexed: 06/03/2023]
Abstract
Arthroscopic ultrasound imaging enables quantitative evaluation of articular cartilage. However, the potential of this technique for evaluation of subchondral bone has not been investigated in vivo. In this study, we address this issue in clinical arthroscopy of the human knee (n = 11) by determining quantitative ultrasound (9 MHz) reflection and backscattering parameters for cartilage and subchondral bone. Furthermore, in each knee, seven anatomical sites were graded using the International Cartilage Repair Society (ICRS) system based on (i) conventional arthroscopy and (ii) ultrasound images acquired in arthroscopy with a miniature transducer. Ultrasound enabled visualization of articular cartilage and subchondral bone. ICRS grades based on ultrasound images were higher (p < 0.05) than those based on conventional arthroscopy. The higher ultrasound-based ICRS grades were expected as ultrasound reveals additional information on, for example, the relative depth of the lesion. In line with previous literature, ultrasound reflection and scattering in cartilage varied significantly (p < 0.05) along the ICRS scale. However, no significant correlation between ultrasound parameters and structure or density of subchondral bone could be demonstrated. To conclude, arthroscopic ultrasound imaging had a significant effect on clinical grading of cartilage, and it was found to provide quantitative information on cartilage. The lack of correlation between the ultrasound parameters and bone properties may be related to lesser bone change or excessive attenuation in overlying cartilage and insufficient power of the applied miniature transducer.
Collapse
Affiliation(s)
- Jukka Liukkonen
- Department of Applied Physics, University of Eastern Finland, Kuopio, Finland.
| | - Petri Lehenkari
- Department of Anatomy and Cell Biology, Institute of Biomedicine, University of Oulu, Oulu, Finland; Department of Surgery, Medical Research Center, Oulu University Hospital, Oulu, Finland; Medical Research Center Oulu, Oulu University Hospital and University of Oulu, Oulu, Finland
| | - Jukka Hirvasniemi
- Medical Research Center Oulu, Oulu University Hospital and University of Oulu, Oulu, Finland; Department of Medical Technology, University of Oulu, Oulu, Finland
| | - Antti Joukainen
- Department of Orthopaedics, Traumatology and Hand Surgery, Kuopio University Hospital, Kuopio, Finland
| | - Tuomas Virén
- Cancer Center, Kuopio University Hospital, Kuopio, Finland
| | - Simo Saarakkala
- Medical Research Center Oulu, Oulu University Hospital and University of Oulu, Oulu, Finland; Department of Medical Technology, University of Oulu, Oulu, Finland; Department of Diagnostic Radiology, Oulu University Hospital, Oulu, Finland
| | - Miika T Nieminen
- Medical Research Center Oulu, Oulu University Hospital and University of Oulu, Oulu, Finland; Department of Diagnostic Radiology, Oulu University Hospital, Oulu, Finland; Department of Radiology, University of Oulu, Oulu, Finland
| | - Jukka S Jurvelin
- Department of Applied Physics, University of Eastern Finland, Kuopio, Finland
| | - Juha Töyräs
- Department of Applied Physics, University of Eastern Finland, Kuopio, Finland; Department of Clinical Neurophysiology, Kuopio University Hospital, Kuopio, Finland
| |
Collapse
|
22
|
Inkinen S, Liukkonen J, Ylärinne JH, Puhakka PH, Lammi MJ, Virén T, Jurvelin JS, Töyräs J. Collagen and chondrocyte concentrations control ultrasound scattering in agarose scaffolds. ULTRASOUND IN MEDICINE & BIOLOGY 2014; 40:2162-2171. [PMID: 24972499 DOI: 10.1016/j.ultrasmedbio.2014.03.016] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/18/2013] [Revised: 02/19/2014] [Accepted: 03/12/2014] [Indexed: 06/03/2023]
Abstract
Ultrasound imaging has been proposed for diagnostics of osteoarthritis and cartilage injuries in vivo. However, the specific contribution of chondrocytes and collagen to ultrasound scattering in articular cartilage has not been systematically studied. We investigated the role of these tissue structures by measuring ultrasound scattering in agarose scaffolds with varying collagen and chondrocyte concentrations. Ultrasound catheters with center frequencies of 9 MHz (7.1-11.0 MHz, -6 dB) and 40 MHz (30.1-45.3 MHz, -6 dB) were applied using an intravascular ultrasound device. Ultrasound backscattering quantified in a region of interest starting right below sample surface differed significantly (p < 0.05) with the concentrations of collagen and chondrocytes. An ultrasound frequency of 40 MHz, as compared with 9 MHz, was more sensitive to variations in collagen and chondrocyte concentrations. The present findings may improve diagnostic interpretation of arthroscopic ultrasound imaging and provide information necessary for development of models describing ultrasound propagation within cartilage.
Collapse
Affiliation(s)
- S Inkinen
- Department of Applied Physics, University of Eastern Finland, Kuopio, Finland; Department of Clinical Neurophysiology, Kuopio University Hospital, Kuopio, Finland.
| | - J Liukkonen
- Department of Applied Physics, University of Eastern Finland, Kuopio, Finland
| | - J H Ylärinne
- School of Medicine, Institute of Biomedicine, University of Eastern Finland, Kuopio, Finland
| | - P H Puhakka
- Department of Applied Physics, University of Eastern Finland, Kuopio, Finland; Department of Clinical Neurophysiology, Kuopio University Hospital, Kuopio, Finland
| | - M J Lammi
- School of Medicine, Institute of Biomedicine, University of Eastern Finland, Kuopio, Finland
| | - T Virén
- Cancer Center, Kuopio University Hospital, Kuopio, Finland
| | - J S Jurvelin
- Department of Applied Physics, University of Eastern Finland, Kuopio, Finland
| | - J Töyräs
- Department of Applied Physics, University of Eastern Finland, Kuopio, Finland; Department of Clinical Neurophysiology, Kuopio University Hospital, Kuopio, Finland
| |
Collapse
|
23
|
Wang Y, Huang YP, Liu A, Wan W, Zheng YP. An ultrasound biomicroscopic and water jet ultrasound indentation method for detecting the degenerative changes of articular cartilage in a rabbit model of progressive osteoarthritis. ULTRASOUND IN MEDICINE & BIOLOGY 2014; 40:1296-1306. [PMID: 24613214 DOI: 10.1016/j.ultrasmedbio.2013.12.023] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/26/2013] [Revised: 12/14/2013] [Accepted: 12/17/2013] [Indexed: 06/03/2023]
Abstract
It is important to assess the early degeneration of articular cartilage associated with osteoarthritis (OA) for early intervention and treatment planning. Previously, we have developed a high frequency ultrasound and water jet indentation method for the morphologic, acoustic and mechanical assessment of articular cartilage, using the enzymatic digestion as a model of osteoarthritic degeneration. No naturally degenerated articular cartilage has been tested with the developed method. In this study, we aimed to determine the usefulness of the developed method for detecting the natural degeneration of articular cartilage in a standard surgical model of OA in rabbits. Forty adult New Zealand white female rabbits were used in this study, which included 30 experimental rabbits undergoing the right anterior cruciate ligament transection surgery and 10 control rabbits. At the 3rd, 6th, and 9th week post-surgery, 10 experimental rabbits were sacrificed, respectively, for assessment of the knee cartilage quality. The cartilage at the medial and lateral femoral condyles and tibial plateaus (four points) was measured by the high frequency ultrasound biomicroscopy, the water jet ultrasound indentation and a contact mechanical indentation test before a histopathologic analysis for grading of degeneration severity. Measured parameters were compared among different groups classified either by post-surgery time or by histopathologic grade. The results showed a general trend of increase for ultrasound roughness index and a general trend of decrease for integrated reflection coefficient, stiffness coefficient from water-jet indentation and Young's modulus (E) from the mechanical indentation with the increase of post-surgery time. Comparisons among groups with different histopathologic grades showed similar trend with the increase of degeneration severity. The water jet ultrasound indentation method was demonstrated to be an effective method to measure the mechanical properties of the articular cartilage and with further development of arthroscopic ultrasound probe; it has the ability to assess the early degeneration of articular cartilage with measurement of morphologic, acoustic and mechanical properties of the cartilage in vivo.
Collapse
Affiliation(s)
- Yuexiang Wang
- Department of Ultrasound, Chinese People Liberation Army General Hospital, Beijing, China
| | - Yan-Ping Huang
- Interdisciplinary Division of Biomedical Engineering, Hong Kong Polytechnic University, Hong Kong, China.
| | - Aijun Liu
- Department of Pathology, Chinese People Liberation Army General Hospital, Beijing, China
| | - Wenbo Wan
- Department of Ultrasound, Chinese People Liberation Army General Hospital, Beijing, China
| | - Yong-Ping Zheng
- Interdisciplinary Division of Biomedical Engineering, Hong Kong Polytechnic University, Hong Kong, China.
| |
Collapse
|
24
|
Männicke N, Schöne M, Gottwald M, Göbel F, Oelze ML, Raum K. 3-D high-frequency ultrasound backscatter analysis of human articular cartilage. ULTRASOUND IN MEDICINE & BIOLOGY 2014; 40:244-257. [PMID: 24210857 DOI: 10.1016/j.ultrasmedbio.2013.08.015] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/19/2013] [Revised: 08/13/2013] [Accepted: 08/16/2013] [Indexed: 06/02/2023]
Abstract
High-frequency ultrasound is a promising method for non-invasive characterization of cartilage degeneration. Surface reflection and integrated spectral parameters are often used. In the work described here, human cartilage samples with varying degrees of degeneration were measured using a 40-MHz transducer. Backscatter signals originating from the superficial and transitional zones of cartilage were analyzed using amplitude, spectral and envelope statistical parameters and related to degenerative changes of the matrix given by the Mankin score. The results indicate an increased sensitivity of spectral slope and envelope statistical parameters to early matrix degeneration compared with conventional amplitude parameters. Furthermore, moderate correlations of chondrocyte number with backscatter amplitude and envelope statistics were observed, suggesting that at high frequencies, cells are one important scattering source in cartilage. An application of spectral and envelope statistical parameters to intra-articular ultrasound arthroscopy is conceivable and could improve the diagnostic potential of these examinations. Future studies are necessary to clarify the contributions of chondrocytes, extracellular matrix and collagen content to ultrasound backscatter to further improve the diagnostic potential of ultrasound for cartilage assessment.
Collapse
Affiliation(s)
- Nils Männicke
- Julius Wolff Institute and Berlin-Brandenburg School for Regenerative Therapies, Charité-Universitätsmedizin Berlin, Berlin, Germany
| | | | | | | | | | | |
Collapse
|