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Truhn D, Zwingenberger KT, Schock J, Abrar DB, Radke KL, Post M, Linka K, Knobe M, Kuhl C, Nebelung S. No pressure, no diamonds? - Static vs. dynamic compressive in-situ loading to evaluate human articular cartilage functionality by functional MRI. J Mech Behav Biomed Mater 2021; 120:104558. [PMID: 33957568 DOI: 10.1016/j.jmbbm.2021.104558] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2020] [Revised: 03/22/2021] [Accepted: 04/19/2021] [Indexed: 01/21/2023]
Abstract
Biomechanical Magnetic Resonance Imaging (MRI) of articular cartilage, i.e. its imaging under loading, is a promising diagnostic tool to assess the tissue's functionality in health and disease. This study aimed to assess the response to static and dynamic loading of histologically intact cartilage samples by functional MRI and pressure-controlled in-situ loading. To this end, 47 cartilage samples were obtained from the medial femoral condyles of total knee arthroplasties (from 24 patients), prepared to standard thickness, and placed in a standard knee joint in a pressure-controlled whole knee-joint compressive loading device. Cartilage samples' responses to static (i.e. constant), dynamic (i.e. alternating), and no loading, i.e. free-swelling conditions, were assessed before (δ0), and after 30 min (δ1) and 60 min (δ2) of loading using serial T1ρ maps acquired on a 3.0T clinical MRI scanner (Achieva, Philips). Alongside texture features, relative changes in T1ρ (Δ1, Δ2) were determined for the upper and lower sample halves and the entire sample, analyzed using appropriate statistical tests, and referenced to histological (Mankin scoring) and biomechanical reference measures (tangent stiffness). Histological, biomechanical, and T1ρ sample characteristics at δ0 were relatively homogenous in all samples. In response to loading, relative increases in T1ρ were strong and significant after dynamic loading (Δ1 = 10.3 ± 17.0%, Δ2 = 21.6 ± 21.8%, p = 0.002), while relative increases in T1ρ after static loading and in controls were moderate and not significant. Generally, texture features did not demonstrate clear loading-related associations underlying the spatial relationships of T1ρ. When realizing the clinical translation, this in-situ study suggests that serial T1ρ mapping is best combined with dynamic loading to assess cartilage functionality in humans based on advanced MRI techniques.
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Affiliation(s)
- Daniel Truhn
- Aachen University Hospital, Department of Diagnostic and Interventional Radiology, D-52074, Aachen, Germany
| | - Ken Tonio Zwingenberger
- Aachen University Hospital, Department of Diagnostic and Interventional Radiology, D-52074, Aachen, Germany
| | - Justus Schock
- University Düsseldorf, Medical Faculty, Department of Diagnostic and Interventional Radiology, D-40225, Düsseldorf, Germany; Institute of Imaging and Computer Vision, RWTH Aachen University, D-52074, Aachen, Germany
| | - Daniel Benjamin Abrar
- University Düsseldorf, Medical Faculty, Department of Diagnostic and Interventional Radiology, D-40225, Düsseldorf, Germany
| | - Karl Ludger Radke
- University Düsseldorf, Medical Faculty, Department of Diagnostic and Interventional Radiology, D-40225, Düsseldorf, Germany
| | - Manuel Post
- Aachen University Hospital, Department of Diagnostic and Interventional Radiology, D-52074, Aachen, Germany
| | - Kevin Linka
- Hamburg University of Technology, Department of Continuum and Materials Mechanics, D-21073, Hamburg, Germany
| | - Matthias Knobe
- Cantonal Hospital Lucerne, Department of Orthopaedic and Trauma Surgery, CH-6000, Lucerne, Switzerland
| | - Christiane Kuhl
- Aachen University Hospital, Department of Diagnostic and Interventional Radiology, D-52074, Aachen, Germany
| | - Sven Nebelung
- University Düsseldorf, Medical Faculty, Department of Diagnostic and Interventional Radiology, D-40225, Düsseldorf, Germany.
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2
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Linka K, Thüring J, Rieppo L, Aydin RC, Cyron CJ, Kuhl C, Merhof D, Truhn D, Nebelung S. Machine learning-augmented and microspectroscopy-informed multiparametric MRI for the non-invasive prediction of articular cartilage composition. Osteoarthritis Cartilage 2021; 29:592-602. [PMID: 33545330 DOI: 10.1016/j.joca.2020.12.022] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/18/2020] [Revised: 12/22/2020] [Accepted: 12/22/2020] [Indexed: 02/02/2023]
Abstract
BACKGROUND Articular cartilage degeneration is the hallmark change of osteoarthritis, a severely disabling disease with high prevalence and considerable socioeconomic and individual burden. Early, potentially reversible cartilage degeneration is characterized by distinct changes in cartilage composition and ultrastructure, while the tissue's morphology remains largely unaltered. Hence, early degenerative changes may not be diagnosed by clinical standard diagnostic tools. METHODS Against this background, this study introduces a novel method to determine the tissue composition non-invasively. Our method involves quantitative MRI parameters (i.e., T1, T1ρ, T2 and [Formula: see text] maps), compositional reference measurements (i.e., microspectroscopically determined local proteoglycan [PG] and collagen [CO] contents) and machine learning techniques (i.e., artificial neural networks [ANNs] and multivariate linear models [MLMs]) on 17 histologically grossly intact human cartilage samples. RESULTS Accuracy and precision were higher in ANN-based predictions than in MLM-based predictions and moderate-to-strong correlations were found between measured and predicted compositional parameters. CONCLUSION Once trained for the clinical setting, advanced machine learning techniques, in particular ANNs, may be used to non-invasively determine compositional features of cartilage based on quantitative MRI parameters with potential implications for the diagnosis of (early) degeneration and for the monitoring of therapeutic outcomes.
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Affiliation(s)
- K Linka
- Institute of Continuum and Materials Mechanics, Hamburg University of Technology, Hamburg, 21073, Germany.
| | - J Thüring
- Department of Diagnostic and Interventional Radiology, Aachen University Hospital, Aachen, 52074, Germany.
| | - L Rieppo
- Research Unit of Medical Imaging, Physics and Technology, Faculty of Medicine, University of Oulu, Finland.
| | - R C Aydin
- Institute of Materials Research, Materials Mechanics, Helmholtz-Zentrum Geesthacht, Geesthacht, Germany.
| | - C J Cyron
- Institute of Continuum and Materials Mechanics, Hamburg University of Technology, Hamburg, 21073, Germany; Institute of Materials Research, Materials Mechanics, Helmholtz-Zentrum Geesthacht, Geesthacht, Germany.
| | - C Kuhl
- Department of Diagnostic and Interventional Radiology, Aachen University Hospital, Aachen, 52074, Germany.
| | - D Merhof
- Institute of Imaging and Computer Vision, RWTH Aachen University, Aachen, 52074, Germany.
| | - D Truhn
- Department of Diagnostic and Interventional Radiology, Aachen University Hospital, Aachen, 52074, Germany; Institute of Imaging and Computer Vision, RWTH Aachen University, Aachen, 52074, Germany.
| | - S Nebelung
- Department of Diagnostic and Interventional Radiology, Medical Faculty, University of Dusseldorf, 40225, Dusseldorf, Germany.
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Hafner T, Post M, Said O, Schad P, Schock J, Abrar DB, Knobe M, Kuhl C, Truhn D, Nebelung S. Identifying the imaging correlates of cartilage functionality based on quantitative MRI mapping - The collagenase exposure model. Acta Biomater 2020; 117:310-321. [PMID: 32980541 DOI: 10.1016/j.actbio.2020.09.032] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2020] [Revised: 09/16/2020] [Accepted: 09/17/2020] [Indexed: 01/05/2023]
Abstract
Cartilage functionality is determined by tissue structure and composition. If altered, cartilage is predisposed to premature degeneration. This pathomimetical study of early osteoarthritis evaluated the dose-dependant effects of collagenase-induced collagen disintegration and proteoglycan depletion on cartilage functionality as assessed by serial T1, T1ρ, T2, and T2* mapping under loading. 30 human femoral osteochondral samples underwent imaging on a clinical 3.0 T MRI scanner (Achieva, Philips) in the unloaded reference configuration (δ0) and under pressure-controlled quasi-static indentation loading to 15.1 N (δ1) and to 28.6 N (δ2). Imaging was performed before and after exposure to low (LC, 0.5 mg/mL; n = 10) or high concentration (HC, 1.5 mg/mL; n = 10) of collagenase. Untreated samples served as controls (n = 10). Loading responses were determined for the entire sample and the directly loaded (i.e. sub-pistonal) and bilaterally adjacent (i.e. peri‑pistonal) regions, referenced histologically, quantified as relative changes, and analysed using adequate parametric and non-parametric statistical tests. Dose-dependant surface disintegration and tissue loss were reflected by distinctly different pre- and post-exposure response-to-loading patterns. While T1 generally decreased with loading, regardless of collagenase exposure, T1ρ increased significantly after HC exposure (p = 0.008). Loading-induced decreases in T2 were significant after LC exposure (p = 0.006), while changes in T2* were ambiguous. In conclusion, aberrant loading-induced changes in T2 and T1ρ reflect moderate and severe matrix changes, respectively, and indicate the close interrelatedness of matrix changes and functionality in cartilage.
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Affiliation(s)
- Tobias Hafner
- Aachen University Hospital, Department of Diagnostic and Interventional Radiology,D-52074 Aachen, Germany
| | - Manuel Post
- Aachen University Hospital, Department of Diagnostic and Interventional Radiology,D-52074 Aachen, Germany
| | - Oliver Said
- Aachen University Hospital, Department of Diagnostic and Interventional Radiology,D-52074 Aachen, Germany
| | - Philipp Schad
- Aachen University Hospital, Department of Diagnostic and Interventional Radiology,D-52074 Aachen, Germany
| | - Justus Schock
- University Dusseldorf, Medical Faculty, Department of Diagnostic and Interventional Radiology, D-40225 Dusseldorf, Germany; Institute of Computer Vision and Imaging, RWTH University Aachen, D-52074 Aachen, Germany
| | - Daniel Benjamin Abrar
- University Dusseldorf, Medical Faculty, Department of Diagnostic and Interventional Radiology, D-40225 Dusseldorf, Germany
| | - Matthias Knobe
- Clinic for Orthopaedic and Trauma Surgery, Cantonal Hospital Luzern, CH-6004 Luzern, Switzerland
| | - Christiane Kuhl
- Aachen University Hospital, Department of Diagnostic and Interventional Radiology,D-52074 Aachen, Germany
| | - Daniel Truhn
- Aachen University Hospital, Department of Diagnostic and Interventional Radiology,D-52074 Aachen, Germany
| | - Sven Nebelung
- University Dusseldorf, Medical Faculty, Department of Diagnostic and Interventional Radiology, D-40225 Dusseldorf, Germany.
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4
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Hafner T, Schock J, Post M, Abrar DB, Sewerin P, Linka K, Knobe M, Kuhl C, Truhn D, Nebelung S. A serial multiparametric quantitative magnetic resonance imaging study to assess proteoglycan depletion of human articular cartilage and its effects on functionality. Sci Rep 2020; 10:15106. [PMID: 32934341 PMCID: PMC7492285 DOI: 10.1038/s41598-020-72208-y] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2020] [Accepted: 08/21/2020] [Indexed: 02/06/2023] Open
Abstract
Water, collagen, and proteoglycans determine articular cartilage functionality. If altered, susceptibility to premature degeneration is increased. This study investigated the effects of enzymatic proteoglycan depletion on cartilage functionality as assessed by advanced Magnetic Resonance Imaging (MRI) techniques under standardized loading. Lateral femoral condylar cartilage-bone samples from patients undergoing knee replacement (n = 29) were serially imaged by Proton Density-weighted and T1, T1ρ, T2, and T2* mapping sequences on a clinical 3.0 T MRI scanner (Achieva, Philips). Using pressure-controlled indentation loading, samples were imaged unloaded and quasi-statically loaded to 15.1 N and 28.6 N, and both before and after exposure to low-concentrated (LT, 0.1 mg/mL, n = 10) or high-concentrated trypsin (HT, 1.0 mg/mL, n = 10). Controls were not treated (n = 9). Responses to loading were assessed for the entire sample and regionally, i.e. sub- and peri-pistonally, and zonally, i.e. upper and lower sample halves. Trypsin effects were quantified as relative changes (Δ), analysed using appropriate statistical tests, and referenced histologically. Histological proteoglycan depletion was reflected by significant sub-pistonal decreases in T1 (p = 0.003) and T2 (p = 0.008) after HT exposure. Loading-induced changes in T1ρ and T2* were not related. In conclusion, proteoglycan depletion alters cartilage functionality and may be assessed using serial T1 and T2 mapping under loading.
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Affiliation(s)
- Tobias Hafner
- Department of Diagnostic and Interventional Radiology, Aachen University Hospital, Aachen, Germany
| | - Justus Schock
- Medical Faculty, Department of Diagnostic and Interventional Radiology, University Hospital Düsseldorf, Moorenstraße 5, 40225, Dusseldorf, Germany.,Institute of Computer Vision and Imaging, RWTH University Aachen, Aachen, Germany
| | - Manuel Post
- Department of Diagnostic and Interventional Radiology, Aachen University Hospital, Aachen, Germany
| | - Daniel Benjamin Abrar
- Medical Faculty, Department of Diagnostic and Interventional Radiology, University Hospital Düsseldorf, Moorenstraße 5, 40225, Dusseldorf, Germany
| | - Philipp Sewerin
- Medical Faculty, Department and Hiller-Research-Unit for Rheumatology, University Hospital Düsseldorf, Düsseldorf, Germany
| | - Kevin Linka
- Department of Continuum and Materials Mechanics, Hamburg University of Technology, Hamburg, Germany
| | - Matthias Knobe
- Clinic for Orthopaedic and Trauma Surgery, Cantonal Hospital Luzern, Luzern, Switzerland
| | - Christiane Kuhl
- Department of Diagnostic and Interventional Radiology, Aachen University Hospital, Aachen, Germany
| | - Daniel Truhn
- Department of Diagnostic and Interventional Radiology, Aachen University Hospital, Aachen, Germany
| | - Sven Nebelung
- Medical Faculty, Department of Diagnostic and Interventional Radiology, University Hospital Düsseldorf, Moorenstraße 5, 40225, Dusseldorf, Germany.
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5
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Nebelung S, Post M, Knobe M, Shah D, Schleich C, Hitpass L, Kuhl C, Thüring J, Truhn D. Human articular cartilage mechanosensitivity is related to histological degeneration - a functional MRI study. Osteoarthritis Cartilage 2019; 27:1711-1720. [PMID: 31319176 DOI: 10.1016/j.joca.2019.07.006] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/15/2019] [Revised: 06/13/2019] [Accepted: 07/03/2019] [Indexed: 02/02/2023]
Abstract
OBJECTIVE To investigate changes in response to sequential pressure-controlled loading and unloading in human articular cartilage of variable histological degeneration using serial T1ρ mapping. METHOD We obtained 42 cartilage samples of variable degeneration from the medial femoral condyles of 42 patients undergoing total knee replacement. Samples were placed in a standardized artificial knee joint within an MRI-compatible whole knee-joint compressive loading device and imaged before (δ0), during (δld1, δld2, δld3, δld4, δld5) and after (δrl1, δrl2, δrl3, δrl4, δrl5) pressure-controlled loading to 0.663 ± 0.021 kN (94% body weight) using serial T1ρ mapping (spin-lock multigradient echo sequence; 3.0T MRI system [Achieva, Philips]). Reference assessment included histology (Mankin scoring) and conventional biomechanics (Tangent stiffness). We dichotomized sample into intact (n = 21) and degenerative (n = 21) based on histology and analyzed data using Mann Whitney, Kruskal Wallis, one-way ANOVA tests and Spearman's correlation, respectively. RESULTS At δ0, we found no significant differences between intact and degenerative samples, while the response-to-loading patterns were distinctly different. In intact samples, T1ρ increases were consistent and non-significant, while in degenerative samples, T1ρ increases were significantly higher (P = 0.004, δ0 vs δld1, δ0 vs δld3), yet undulating and variable. With unloading, T1ρ increases subsided, yet were persistently elevated beyond δ0. CONCLUSION Cartilage mechanosensitivity is related to histological degeneration and assessable by serial T1ρ mapping. Unloaded, T1ρ characteristics are not significantly different in intact vs degenerative cartilage, while load bearing is organized in intact cartilage and disorganized in degenerative cartilage.
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Affiliation(s)
- S Nebelung
- Department of Diagnostic and Interventional Radiology, Aachen University Hospital, Aachen, Germany.
| | - M Post
- Department of Diagnostic and Interventional Radiology, Aachen University Hospital, Aachen, Germany.
| | - M Knobe
- Department of Orthopaedic Trauma, Aachen University Hospital, Aachen, Germany.
| | - D Shah
- Department of Diagnostic and Interventional Radiology, Aachen University Hospital, Aachen, Germany.
| | - C Schleich
- Department of Diagnostic and Interventional Radiology, University of Düsseldorf, Düsseldorf, Germany.
| | - L Hitpass
- Department of Diagnostic and Interventional Radiology, Aachen University Hospital, Aachen, Germany.
| | - C Kuhl
- Department of Diagnostic and Interventional Radiology, Aachen University Hospital, Aachen, Germany.
| | - J Thüring
- Department of Diagnostic and Interventional Radiology, Aachen University Hospital, Aachen, Germany.
| | - D Truhn
- Department of Diagnostic and Interventional Radiology, Aachen University Hospital, Aachen, Germany; Institute of Imaging and Computer Vision, RWTH Aachen University, Aachen, Germany.
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6
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Towards Patient-Specific Computational Modelling of Articular Cartilage on the Basis of Advanced Multiparametric MRI Techniques. Sci Rep 2019; 9:7172. [PMID: 31073178 PMCID: PMC6509121 DOI: 10.1038/s41598-019-43389-y] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2018] [Accepted: 04/23/2019] [Indexed: 12/13/2022] Open
Abstract
Cartilage degeneration is associated with tissue softening and represents the hallmark change of osteoarthritis. Advanced quantitative Magnetic Resonance Imaging (qMRI) techniques allow the assessment of subtle tissue changes not only of structure and morphology but also of composition. Yet, the relation between qMRI parameters on the one hand and microstructure, composition and the resulting functional tissue properties on the other hand remain to be defined. To this end, a Finite-Element framework was developed based on an anisotropic constitutive model of cartilage informed by sample-specific multiparametric qMRI maps, obtained for eight osteochondral samples on a clinical 3.0 T MRI scanner. For reference, the same samples were subjected to confined compression tests to evaluate stiffness and compressibility. Moreover, the Mankin score as an indicator of histological tissue degeneration was determined. The constitutive model was optimized against the resulting stress responses and informed solely by the sample-specific qMRI parameter maps. Thereby, the biomechanical properties of individual samples could be captured with good-to-excellent accuracy (mean R2 [square of Pearson's correlation coefficient]: 0.966, range [min, max]: 0.904, 0.993; mean Ω [relative approximated error]: 33%, range [min, max]: 20%, 47%). Thus, advanced qMRI techniques may be complemented by the developed computational model of cartilage to comprehensively evaluate the functional dimension of non-invasively obtained imaging biomarkers. Thereby, cartilage degeneration can be perspectively evaluated in the context of imaging and biomechanics.
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7
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Nebelung S, Post M, Knobe M, Tingart M, Emans P, Thüring J, Kuhl C, Truhn D. Detection of Early-Stage Degeneration in Human Articular Cartilage by Multiparametric MR Imaging Mapping of Tissue Functionality. Sci Rep 2019; 9:5895. [PMID: 30976065 PMCID: PMC6459828 DOI: 10.1038/s41598-019-42543-w] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2019] [Accepted: 04/03/2019] [Indexed: 12/15/2022] Open
Abstract
To assess human articular cartilage tissue functionality by serial multiparametric quantitative MRI (qMRI) mapping as a function of histological degeneration. Forty-nine cartilage samples obtained during total knee replacement surgeries were placed in a standardized artificial knee joint within an MRI-compatible compressive loading device and imaged in situ and at three loading positions, i.e. unloaded, at 2.5 mm displacement (20% body weight [BW]) and at 5 mm displacement (110% BW). Using a clinical 3.0 T MRI system (Achieva, Philips), serial T1, T1ρ, T2 and T2* maps were generated for each sample and loading position. Histology (Mankin scoring) and biomechanics (Young’s modulus) served as references. Samples were dichotomized as intact (int, n = 27) or early degenerative (deg, n = 22) based on histology and analyzed using repeated-measures ANOVA and unpaired Student’s t-tests after log-transformation. For T1ρ, T2 and T2*, significant loading-induced differences were found in deg (in contrast to int) samples, while for T1 significant decreases in all zones were observed, irrespective of degeneration. In conclusion, cartilage functionality may be visualized using serial qMRI parameter mapping and the response-to-loading patterns are associated with histological degeneration. Hence, loading-induced changes in qMRI parameter maps provide promising surrogate parameters of tissue functionality and status in health and disease.
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Affiliation(s)
- Sven Nebelung
- Department of Diagnostic and Interventional Radiology, Aachen University Hospital, Aachen, Germany.
| | - Manuel Post
- Department of Diagnostic and Interventional Radiology, Aachen University Hospital, Aachen, Germany
| | - Matthias Knobe
- Department of Trauma Surgery, Aachen University Hospital, Aachen, Germany
| | - Markus Tingart
- Department of Orthopaedics, Aachen University Hospital, Aachen, Germany
| | - Pieter Emans
- Department of Orthopaedic Surgery, Maastricht University Medical Center, Maastricht, The Netherlands
| | - Johannes Thüring
- Department of Diagnostic and Interventional Radiology, Aachen University Hospital, Aachen, Germany
| | - Christiane Kuhl
- Department of Diagnostic and Interventional Radiology, Aachen University Hospital, Aachen, Germany
| | - Daniel Truhn
- Department of Diagnostic and Interventional Radiology, Aachen University Hospital, Aachen, Germany.,Institute of Imaging and Computer Vision, RWTH Aachen, Aachen, Germany
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8
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Nebelung S, Sondern B, Jahr H, Tingart M, Knobe M, Thüring J, Kuhl C, Truhn D. Non-invasive T1ρ mapping of the human cartilage response to loading and unloading. Osteoarthritis Cartilage 2018; 26:236-244. [PMID: 29175373 DOI: 10.1016/j.joca.2017.11.009] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/03/2017] [Revised: 09/21/2017] [Accepted: 11/13/2017] [Indexed: 02/02/2023]
Abstract
OBJECTIVE To define the physiological response to sequential loading and unloading in histologically intact human articular cartilage using serial T1ρ mapping, as T1ρ is considered to indicate the tissue's macromolecular content. METHOD 18 macroscopically intact cartilage-bone samples were obtained from the central lateral femoral condyles of 18 patients undergoing total knee replacement. Serial T1ρ mapping was performed on a clinical 3.0-T MRI system using a modified prostate coil. Spin-lock multiple gradient-echo sequences prior to, during and after standardized indentation loading (displacement controlled, strain 20%) were used to obtain seven serial T1ρ maps: unloaded (δ0), quasi-statically loaded (indentation1-indentation3) and under subsequent relaxation (relaxation1-relaxation3). After manual segmentation, zonal and regional regions-of-interest were defined. ROI-specific relative changes were calculated and statistically assessed using paired t-tests. Histological (Mankin classification) and biomechanical (unconfined compression) evaluations served as references. RESULTS All samples were histologically and biomechanically grossly intact (Mankin sum: 1.8 ± 1.2; Young's Modulus: 0.7 ± 0.4 MPa). Upon loading, T1ρ consistently increased throughout the entire sample thickness, primarily subpistonally (indentation1 [M ± SD]: 9.5 ± 7.8% [sub-pistonal area, SPA] vs 4.2 ± 5.8% [peri-pistonal area, PPA]; P < 0.001). T1ρ further increased with ongoing loading (indentation3: 14.1 ± 8.1 [SPA] vs 7.7 ± 5.9% [PPA]; P < 0.001). Even upon unloading (i.e., relaxation), T1ρ persistently increased in time. CONCLUSION Serial T1ρ-mapping reveals distinct and complex zonal and regional changes in articular cartilage as a function of loading and unloading. Thereby, longitudinal adaptive processes in hyaline cartilage become evident, which may be used for the tissue's non-invasive functional characterization by T1ρ.
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Affiliation(s)
- S Nebelung
- Department of Diagnostic and Interventional Radiology, Aachen University Hospital, Aachen, Germany.
| | - B Sondern
- Department of Diagnostic and Interventional Radiology, Aachen University Hospital, Aachen, Germany.
| | - H Jahr
- Department of Orthopaedics, Aachen University Hospital, Aachen, Germany.
| | - M Tingart
- Department of Orthopaedics, Aachen University Hospital, Aachen, Germany.
| | - M Knobe
- Department of Orthopaedic Trauma, Aachen University Hospital, Aachen, Germany.
| | - J Thüring
- Department of Diagnostic and Interventional Radiology, Aachen University Hospital, Aachen, Germany.
| | - C Kuhl
- Department of Diagnostic and Interventional Radiology, Aachen University Hospital, Aachen, Germany.
| | - D Truhn
- Department of Diagnostic and Interventional Radiology, Aachen University Hospital, Aachen, Germany.
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9
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Nebelung S, Brill N, Tingart M, Pufe T, Kuhl C, Jahr H, Truhn D. Quantitative OCT and MRI biomarkers for the differentiation of cartilage degeneration. Skeletal Radiol 2016; 45:505-16. [PMID: 26783011 DOI: 10.1007/s00256-016-2334-6] [Citation(s) in RCA: 36] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/24/2015] [Revised: 01/05/2016] [Accepted: 01/07/2016] [Indexed: 02/02/2023]
Abstract
OBJECTIVE To evaluate the usefulness of quantitative parameters obtained by optical coherence tomography (OCT) and magnetic resonance imaging (MRI) in the comprehensive assessment of human articular cartilage degeneration. MATERIALS AND METHODS Human osteochondral samples of variable degeneration (n = 45) were obtained from total knee replacements and assessed by MRI sequences measuring T1, T1ρ, T2 and T2* relaxivity and by OCT-based quantification of irregularity (OII, optical irregularity index), homogeneity (OHI, optical homogeneity index]) and attenuation (OAI, optical attenuation index]). Samples were also assessed macroscopically (Outerbridge classification) and histologically (Mankin classification) as grade-0 (Mankin scores 0-4)/grade-I (scores 5-8)/grade-II (scores 9-10)/grade-III (score 11-14). After data normalisation, differences between Mankin grades and correlations between imaging parameters were assessed using ANOVA and Tukey's post-hoc test and Spearman's correlation coefficients, respectively. Sensitivities and specificities in the detection of Mankin grade-0 were calculated. RESULTS Significant degeneration-related increases were found for T2 and OII and decreases for OAI, while T1, T1ρ, T2* or OHI did not reveal significant changes in relation to degeneration. A number of significant correlations between imaging parameters and histological (sub)scores were found, in particular for T2 and OII. Sensitivities and specificities in the detection of Mankin grade-0 were highest for OHI/T1 and OII/T1ρ, respectively. CONCLUSION Quantitative OCT and MRI techniques seem to complement each other in the comprehensive assessment of cartilage degeneration. Sufficiently large structural and compositional changes in the extracellular matrix may thus be parameterized and quantified, while the detection of early degeneration remains challenging.
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Affiliation(s)
- Sven Nebelung
- Department of Orthopaedics, Aachen University Hospital, Pauwelsstr. 30, 52074, Aachen, Germany. .,Institute of Anatomy and Cell Biology, RWTH, Aachen, Germany.
| | - Nicolai Brill
- Fraunhofer Institute for Production Technology, Aachen, Germany
| | - Markus Tingart
- Department of Orthopaedics, Aachen University Hospital, Pauwelsstr. 30, 52074, Aachen, Germany
| | - Thomas Pufe
- Institute of Anatomy and Cell Biology, RWTH, Aachen, Germany
| | - Christiane Kuhl
- Department of Diagnostic and Interventional Radiology, Aachen University Hospital, Aachen, Germany
| | - Holger Jahr
- Department of Orthopaedics, Aachen University Hospital, Pauwelsstr. 30, 52074, Aachen, Germany
| | - Daniel Truhn
- Department of Diagnostic and Interventional Radiology, Aachen University Hospital, Aachen, Germany
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10
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Osteoarthritic changes in vervet monkey knees correlate with meniscus degradation and increased matrix metalloproteinase and cytokine secretion. Osteoarthritis Cartilage 2015; 23:1780-9. [PMID: 26033163 PMCID: PMC4642681 DOI: 10.1016/j.joca.2015.05.020] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/08/2014] [Revised: 05/19/2015] [Accepted: 05/21/2015] [Indexed: 02/02/2023]
Abstract
OBJECTIVE Meniscus injury increases osteoarthritis risk but its pathobiology in osteoarthritis is unclear. We hypothesized that older adult vervet monkeys would exhibit knee osteoarthritic changes and the degenerative menisci from these animals would secrete matrix metalloproteinases (MMPs) and pro-inflammatory cytokines that contribute to the development of osteoarthritis. DESIGN In a cross sectional analysis of healthy young adult (9-12 years) and old (19-26 years) adult female vervet monkeys, knees were evaluated in vivo with computed tomography (CT) imaging, and joint tissues were morphologically graded at necropsy. Meniscus explants were subsequently cultured to evaluate meniscal MMP and cytokine secretion. RESULTS CT images revealed significant bony osteoarthritic changes in 80% of older monkeys which included increases in osteophyte number and meniscal calcification. Meniscus and cartilage degradation scores were greater in the older monkeys and were positively correlated (r > 0.7). Menisci from older animals exhibiting osteoarthritic changes secreted significantly more MMP-1, MMP-3, and MMP-8 than healthy menisci from younger monkeys. Older menisci without significant osteoarthritic changes secreted more IL-7 than healthy young menisci while older osteoarthritic menisci secreted more IL-7 and granulocyte-macrophage colony-stimulating factor than healthy older menisci. CONCLUSIONS Aged vervets develop naturally occurring knee osteoarthritis that includes involvement of the meniscus. Degenerative menisci secreted markedly increased amounts of matrix-degrading enzymes and inflammatory cytokines. These factors would be expected to act on the meniscus tissue and local joint tissues and may ultimately promote osteoarthritis development. These finding also suggest vervet monkeys are a useful animal model for studying the progression of osteoarthritis.
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Ashinsky BG, Coletta CE, Bouhrara M, Lukas VA, Boyle JM, Reiter DA, Neu CP, Goldberg IG, Spencer RG. Machine learning classification of OARSI-scored human articular cartilage using magnetic resonance imaging. Osteoarthritis Cartilage 2015; 23:1704-12. [PMID: 26067517 PMCID: PMC4577440 DOI: 10.1016/j.joca.2015.05.028] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/12/2015] [Revised: 05/14/2015] [Accepted: 05/26/2015] [Indexed: 02/02/2023]
Abstract
OBJECTIVE The purpose of this study is to evaluate the ability of machine learning to discriminate between magnetic resonance images (MRI) of normal and pathological human articular cartilage obtained under standard clinical conditions. METHOD An approach to MRI classification of cartilage degradation is proposed using pattern recognition and multivariable regression in which image features from MRIs of histologically scored human articular cartilage plugs were computed using weighted neighbor distance using compound hierarchy of algorithms representing morphology (WND-CHRM). The WND-CHRM method was first applied to several clinically available MRI scan types to perform binary classification of normal and osteoarthritic osteochondral plugs based on the Osteoarthritis Research Society International (OARSI) histological system. In addition, the image features computed from WND-CHRM were used to develop a multiple linear least-squares regression model for classification and prediction of an OARSI score for each cartilage plug. RESULTS The binary classification of normal and osteoarthritic plugs yielded results of limited quality with accuracies between 36% and 70%. However, multiple linear least-squares regression successfully predicted OARSI scores and classified plugs with accuracies as high as 86%. The present results improve upon the previously-reported accuracy of classification using average MRI signal intensities and parameter values. CONCLUSION MRI features detected by WND-CHRM reflect cartilage degradation status as assessed by OARSI histologic grading. WND-CHRM is therefore of potential use in the clinical detection and grading of osteoarthritis.
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Affiliation(s)
- B G Ashinsky
- Magnetic Resonance Imaging and Spectroscopy Section, National Institute on Aging, National Institutes of Health, Baltimore, MD, United States.
| | - C E Coletta
- Image Informatics and Computational Biology Unit, National Institute on Aging, National Institutes of Health, Baltimore, MD, United States.
| | - M Bouhrara
- Magnetic Resonance Imaging and Spectroscopy Section, National Institute on Aging, National Institutes of Health, Baltimore, MD, United States.
| | - V A Lukas
- Magnetic Resonance Imaging and Spectroscopy Section, National Institute on Aging, National Institutes of Health, Baltimore, MD, United States.
| | - J M Boyle
- Magnetic Resonance Imaging and Spectroscopy Section, National Institute on Aging, National Institutes of Health, Baltimore, MD, United States.
| | - D A Reiter
- Laboratory of Clinical Investigation, National Institute on Aging, National Institutes of Health, Baltimore, MD, United States.
| | - C P Neu
- Weldon School of Biomedical Engineering, Purdue University, West Lafayette, IN, United States.
| | - I G Goldberg
- Image Informatics and Computational Biology Unit, National Institute on Aging, National Institutes of Health, Baltimore, MD, United States.
| | - R G Spencer
- Magnetic Resonance Imaging and Spectroscopy Section, National Institute on Aging, National Institutes of Health, Baltimore, MD, United States.
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Bittersohl B, Kircher J, Miese FR, Dekkers C, Habermeyer P, Fröbel J, Antoch G, Krauspe R, Zilkens C. T2* mapping and delayed gadolinium-enhanced magnetic resonance imaging in cartilage (dGEMRIC) of humeral articular cartilage--a histologically controlled study. J Shoulder Elbow Surg 2015; 24:1644-52. [PMID: 25958213 DOI: 10.1016/j.jse.2015.03.016] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/10/2014] [Revised: 02/27/2015] [Accepted: 03/07/2015] [Indexed: 02/01/2023]
Abstract
BACKGROUND Cartilage biochemical imaging modalities that include the magnetic resonance imaging (MRI) techniques of T2* mapping (sensitive to water content and collagen fiber network) and delayed gadolinium-enhanced MRI of cartilage (dGEMRIC, sensitive to the glycosaminoglycan content) can be effective instruments for early diagnosis and reliable follow-up of cartilage damage. The purpose of this study was to provide T2* mapping and dGEMRIC values in various histologic grades of cartilage degeneration in humeral articular cartilage. METHODS A histologically controlled in vitro study was conducted that included human humeral head cartilage specimens with various histologic grades of cartilage degeneration. High-resolution, 3-dimensional (3D) T2* mapping and dGEMRIC were performed that enabled the correlation of MRI and histology data. Cartilage degeneration was graded according to the Mankin score, which evaluates surface morphology, cellularity, toluidine blue staining, and tidemark integrity. SPSS software was used for statistical analyses. RESULTS Both MRI mapping values decreased significantly (P < .001) with increasing cartilage degeneration. Spearman rank analysis revealed a significant correlation (correlation coefficients ranging from -0.315 to 0.784; P < .001) between the various histologic parameters and the T2* and T1Gd mapping values. CONCLUSION This study demonstrates the feasibility of 3D T2* and dGEMRIC to identify various histologic grades of cartilage damage of humeral articular cartilage. With regard to the advantages of these mapping techniques with high image resolution and the ability to accomplish a 3D biochemically sensitive imaging, we consider that these imaging techniques can make a positive contribution to the currently evolving science and practice of cartilage biochemical imaging.
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Affiliation(s)
- Bernd Bittersohl
- Medical Faculty, Department of Orthopaedics, University Düsseldorf, Düsseldorf, Germany
| | - Jörn Kircher
- Klinik Fleetinsel Hamburg, Clinic for Orthopedic Surgery, Hamburg, Germany.
| | - Falk R Miese
- Medical Faculty, Department of Diagnostic and Interventional Radiology, University Düsseldorf, Düsseldorf, Germany
| | - Christin Dekkers
- Medical Faculty, Department of Orthopaedics, University Düsseldorf, Düsseldorf, Germany
| | - Peter Habermeyer
- ATOS-Klinik Heidelberg, Department of Shoulder and Elbow Surgery, Heidelberg, Germany
| | - Julia Fröbel
- Medical Faculty, Department of Orthopaedics, University Düsseldorf, Düsseldorf, Germany
| | - Gerald Antoch
- Medical Faculty, Department of Diagnostic and Interventional Radiology, University Düsseldorf, Düsseldorf, Germany
| | - Rüdiger Krauspe
- Medical Faculty, Department of Orthopaedics, University Düsseldorf, Düsseldorf, Germany
| | - Christoph Zilkens
- Medical Faculty, Department of Orthopaedics, University Düsseldorf, Düsseldorf, Germany
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Lukas VA, Fishbein KW, Lin PC, Schär M, Schneider E, Neu CP, Spencer RG, Reiter DA. Classification of histologically scored human knee osteochondral plugs by quantitative analysis of magnetic resonance images at 3T. J Orthop Res 2015; 33:640-50. [PMID: 25641500 PMCID: PMC5875433 DOI: 10.1002/jor.22810] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/21/2014] [Accepted: 12/10/2014] [Indexed: 02/04/2023]
Abstract
This work evaluates the ability of quantitative MRI to discriminate between normal and pathological human osteochondral plugs characterized by the Osteoarthritis Research Society International (OARSI) histological system. Normal and osteoarthritic human osteochondral plugs were scored using the OARSI histological system and imaged at 3 T using MRI sequences producing T1 and T2 contrast and measuring T1, T2, and T2* relaxation times, magnetization transfer, and diffusion. The classification accuracies of quantitative MRI parameters and corresponding weighted image intensities were evaluated. Classification models based on the Mahalanobis distance metric for each MRI measurement were trained and validated using leave-one-out cross-validation with plugs grouped according to OARSI histological grade and score. MRI measurements used for classification were performed using a region-of-interest analysis which included superficial, deep, and full-thickness cartilage. The best classifiers based on OARSI grade and score were T1- and T2-weighted image intensities, which yielded accuracies of 0.68 and 0.75, respectively. Classification accuracies using OARSI score-based group membership were generally higher when compared with grade-based group membership. MRI-based classification--either using quantitative MRI parameters or weighted image intensities--is able to detect early osteoarthritic tissue changes as classified by the OARSI histological system. These findings suggest the benefit of incorporating quantitative MRI acquisitions in a comprehensive clinical evaluation of OA.
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Affiliation(s)
- Vanessa A. Lukas
- Laboratory of Clinical Investigation, National Institute on Aging, National Institutes of Health, 3001 S. Hanover Street, Baltimore, Maryland
| | - Kenneth W. Fishbein
- Laboratory of Clinical Investigation, National Institute on Aging, National Institutes of Health, 3001 S. Hanover Street, Baltimore, Maryland
| | - Ping-Chang Lin
- Department of Radiology, Howard University College of Medicine, Washington, District of Columbia
| | | | - Erika Schneider
- Imaging Institute, Cleveland Clinic Foundation, Cleveland, Ohio
| | - Corey P. Neu
- Weldon School of Biomedical Engineering, Purdue University, West Lafayette, Indiana
| | - Richard G. Spencer
- Laboratory of Clinical Investigation, National Institute on Aging, National Institutes of Health, 3001 S. Hanover Street, Baltimore, Maryland
| | - David A. Reiter
- Laboratory of Clinical Investigation, National Institute on Aging, National Institutes of Health, 3001 S. Hanover Street, Baltimore, Maryland
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Bittersohl B, Hosalkar HS, Miese FR, Schibensky J, König DP, Herten M, Antoch G, Krauspe R, Zilkens C. Zonal T2* and T1Gd assessment of knee joint cartilage in various histological grades of cartilage degeneration: an observational in vitro study. BMJ Open 2015; 5:e006895. [PMID: 25667150 PMCID: PMC4322206 DOI: 10.1136/bmjopen-2014-006895] [Citation(s) in RCA: 39] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/21/2022] Open
Abstract
OBJECTIVES Accurate assessment of cartilage status is increasingly becoming important to clinicians for offering joint preservation surgeries versus joint replacements. The goal of this study was to evaluate the validity of three-dimensional (3D), gradient-echo (GRE)-based T2* and T1Gd mapping for the assessment of various histological severities of degeneration in knee joint cartilage with potential implications for clinical management. METHODS MRI and histological assessment were conducted in 36 ex vivo lateral femoral condyle specimens. The MRI protocol included a 3D GRE multiecho data image combination sequence in order to assess the T2* decay, a 3D double-echo steady-state sequence for assessment of cartilage morphology, and a dual flip angle 3D GRE sequence with volumetric interpolated breathhold examination for the T1Gd assessment. The histological sample analysis was performed according to the Mankin system. The data were then analysed statistically and correlated. RESULTS We observed a significant decrease in the T2* and T1Gd values with increasing grades of cartilage degeneration (p<0.001) and a moderate correlation between T2* (r=0.514)/T1Gd (r=0.556) and the histological grading of cartilage degeneration (p<0.001). In addition, we noted a zonal variation in the T2* and T1Gd values reflecting characteristic zonal differences in the biochemical composition of hyaline cartilage. CONCLUSIONS This study outlines the potential of GRE-based T2* and T1Gd mapping to identify various grades of cartilage damage. Early changes in specific zones may assist clinicians in identifying methods of early intervention involving the targeted joint preservation approach versus moving forward with unicompartmental, bicompartmental or tricompartmental joint replacement procedures. TRIAL REGISTRATION NUMBER DRKS00000729.
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Affiliation(s)
- Bernd Bittersohl
- Medical Faculty, Department of Orthopaedics, University Düsseldorf, Düsseldorf, Germany
| | - Harish S Hosalkar
- Center of Hip Preservation and Children's Orthopaedics, San Diego, California, USA
| | - Falk R Miese
- Medical Faculty, Department of Diagnostic and Interventional Radiology, University Düsseldorf, Düsseldorf, Germany
| | - Jonas Schibensky
- Medical Faculty, Department of Orthopaedics, University Düsseldorf, Düsseldorf, Germany
| | | | - Monika Herten
- Medical Faculty, Clinic for Vascular and Endovascular Surgery, University Münster, Münster, Germany
| | - Gerald Antoch
- Medical Faculty, Department of Diagnostic and Interventional Radiology, University Düsseldorf, Düsseldorf, Germany
| | - Rüdiger Krauspe
- Medical Faculty, Department of Orthopaedics, University Düsseldorf, Düsseldorf, Germany
| | - Christoph Zilkens
- Medical Faculty, Department of Orthopaedics, University Düsseldorf, Düsseldorf, Germany
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Abstract
The purpose of this study was to assess the long-term consequences to the donor site of microvascular transfer of one or two toes. This was achieved retrospectively by patient-reported, clinician-based and functional testing. Weight-bearing radiographs were taken of both feet. Seventy-four patients (80 feet, 84 transferred toes) participated in this study. After a median of 16 years follow-up, most patients reported no or only minor complaints concerning the donor site. Cold intolerance and pain during exertion were the most commonly reported complaints. According to the two functional scores used, 92% of patients reported no or minor complaint and 83% of patients received a good result at the donor feet. Maintaining first ray alignment and avoiding early postoperative complications predicted a better outcome. Even though donor site ramifications should be expected after microvascular transfer of toes, patient satisfaction remains high.
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Affiliation(s)
- T Kotkansalo
- Division of Diseases of the Musculosceletal System, University of Turku, Turku, Finland
| | - P Elo
- Regional Imaging Centre, University of Tampere, Tampere, Finland
| | - T Luukkaala
- Pirkanmaa Hospital District and School of Health Sciences, University of Tampere, Tampere, Finland
| | - S K Vilkki
- Department of Hand and Microsurgery, University of Tampere, Tampere, Finland
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Gelber PE, Batista J, Millan-Billi A, Patthauer L, Vera S, Gomez-Masdeu M, Monllau JC. Magnetic resonance evaluation of TruFit® plugs for the treatment of osteochondral lesions of the knee shows the poor characteristics of the repair tissue. Knee 2014; 21:827-32. [PMID: 24856089 DOI: 10.1016/j.knee.2014.04.013] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/31/2013] [Revised: 04/22/2014] [Accepted: 04/27/2014] [Indexed: 02/02/2023]
Abstract
BACKGROUND Treatment of osteochondral lesions of the knee with synthetic scaffolds seems to offer a good surgical option preventing donor site morbidity. The TruFit® plug has frequently been shown to not properly incorporate into. OBJECTIVE To evaluate the relationship between MRI findings and functional scores of patients with osteochondral lesions of the knee treated with TruFit®. METHODS Patients were evaluated with MOCART score for magnetic resonance imaging assessment of the repair tissue. KOOS, SF-36 and VAS were used for clinical evaluation. Correlation between size of the treated chondral defect and functional scores was also analyzed. RESULTS Fifty-seven patients with median follow-up of 44.8 months (range 24-73) were included. KOOS, SF-36 and VAS improved from a mean 58.5, 53.9 and 8.5 points to a mean 87.4, 86.6 and 1.2 at last follow-up (p<0.001). Larger lesions showed less improvement in KOOS (p=0.04) and SF-36 (p=0.029). Median Tegner values were restored to preinjury situation (5, range 2-10). Mean MOCART score was 43.2 ± 16.1. Although the cartilage layer had good integration, it showed high heterogeneity and no filling of the subchondral bone layer. CONCLUSIONS TruFit® failed to restore the normal MRI aspect of the subchondral bone and lamina in most cases. The appearance of the chondral layer in MRI was partially re-established. This unfavourable MRI appearance did not adversely influence the patient's outcome in the short time and they restored their previous level of activity. There was an inverse linear relationship between the size of the lesion and the functional scores. LEVEL OF EVIDENCE Therapeutic case series; level 4.
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Affiliation(s)
- Pablo Eduardo Gelber
- ICATME-Hospital Universitari Quirón-Dexeus, Universitat Autònoma de Barcelona, Sabino de Arana 5-19, 08028 Barcelona, Spain; Hospital de la Santa Creu i Sant Pau, Universitat Autònoma de Barcelona, Sant Quintí 89, 08041 Barcelona, Spain.
| | - Jorge Batista
- Centro Artroscópico Jorge Batista S.A., Pueyrredón 2446 5° B, C1119ACU Ciudad Autónoma de Buenos Aires, Argentina
| | - Angélica Millan-Billi
- Hospital de la Santa Creu i Sant Pau, Universitat Autònoma de Barcelona, Sant Quintí 89, 08041 Barcelona, Spain
| | - Luciano Patthauer
- Centro Artroscópico Jorge Batista S.A., Pueyrredón 2446 5° B, C1119ACU Ciudad Autónoma de Buenos Aires, Argentina
| | - Silvia Vera
- Centro Artroscópico Jorge Batista S.A., Pueyrredón 2446 5° B, C1119ACU Ciudad Autónoma de Buenos Aires, Argentina
| | - Mireia Gomez-Masdeu
- Hospital de la Santa Creu i Sant Pau, Universitat Autònoma de Barcelona, Sant Quintí 89, 08041 Barcelona, Spain
| | - Juan Carlos Monllau
- ICATME-Hospital Universitari Quirón-Dexeus, Universitat Autònoma de Barcelona, Sabino de Arana 5-19, 08028 Barcelona, Spain; Parc de Salut Mar, Universitat Autònoma de Barcelona, Passeig Marítim 25, 08003 Barcelona, Spain
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Sunk IG, Amoyo-Minar L, Stamm T, Haider S, Niederreiter B, Supp G, Soleiman A, Kainberger F, Smolen JS, Bobacz K. Interphalangeal Osteoarthritis Radiographic Simplified (iOARS) score: a radiographic method to detect osteoarthritis of the interphalangeal finger joints based on its histopathological alterations. Ann Rheum Dis 2013; 73:1983-9. [DOI: 10.1136/annrheumdis-2012-203117] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
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Reproductive status and sex show strong effects on knee OA in a baboon model. Osteoarthritis Cartilage 2013; 21:839-48. [PMID: 23499674 PMCID: PMC3648634 DOI: 10.1016/j.joca.2013.03.003] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/15/2012] [Revised: 12/27/2012] [Accepted: 03/06/2013] [Indexed: 02/02/2023]
Abstract
OBJECTIVE We aimed to characterize severity and occurrence of knee osteoarthritis (OA), and effects of age, sex, body mass, and reproductive status on population-level normal variation in this condition in the baboon, a natural model of human knee OA. METHODS We visually inspected articular cartilage of distal right femora of 464 baboons (309 females, 155 males) and assigned an OA severity score (comparable to a modified Outerbridge score) from 1 = unaffected to 4 = advanced OA (eburnation). Presence/absence of osteophytes was recorded. We tested for significant effects of age, sex, body mass, and, in females, reproductive status (pre-, peri-, or post-menopausal) on OA. When appropriate, analyses were repeated on an age-matched subset (153 of each sex). RESULTS Knee OA was more frequent and severe in older animals (P < 0.0001), but significant age variation was apparent in each severity grade. Sex differences within the younger and older age groups suggest that males develop knee OA earlier, but females progress more quickly to advanced disease. There is a strong relationship between reproductive status and OA severity grade in females (P = 0.0005) with more severe OA in peri- and post-menopausal female baboons, as in humans. CONCLUSIONS Idiopathic knee OA is common in adult baboons. Occurrence and severity are influenced strongly by reproductive status in females, and by sex with regard to patterns of disease progression - providing an animal model to investigate sex-specific variation in OA susceptibility in which the environmental heterogeneity inherent in human populations is vastly reduced.
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Zilkens C, Miese F, Herten M, Kurzidem S, Jäger M, König D, Antoch G, Krauspe R, Bittersohl B. Validity of gradient-echo three-dimensional delayed gadolinium-enhanced magnetic resonance imaging of hip joint cartilage: A histologically controlled study. Eur J Radiol 2013; 82:e81-6. [DOI: 10.1016/j.ejrad.2012.09.024] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2012] [Revised: 09/13/2012] [Accepted: 09/28/2012] [Indexed: 10/27/2022]
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Bittersohl B, Miese FR, Hosalkar HS, Herten M, Antoch G, Krauspe R, Zilkens C. T2* mapping of hip joint cartilage in various histological grades of degeneration. Osteoarthritis Cartilage 2012; 20:653-60. [PMID: 22469845 DOI: 10.1016/j.joca.2012.03.011] [Citation(s) in RCA: 67] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/22/2011] [Revised: 03/14/2012] [Accepted: 03/21/2012] [Indexed: 02/02/2023]
Abstract
OBJECTIVE To evaluate T2* values in various histological severities of osteoarthritis (OA). METHOD Magnetic resonance imaging (MRI) and T2* mapping including a three-dimensional (3D) double-echo steady-state (DESS) sequence for morphological cartilage assessment and a 3D multiecho data image combination (MEDIC) sequence for T2* mapping were conducted in 21 human femoral head specimens with varying severities of OA. Subsequently, histological assessment was undertaken in all specimens to correlate the observations of T2* mapping with histological analyses. According to the Mankin score, four grades of histological changes were determined: grade 0 (Mankin scores of 0-4), grade I (scores of 5-8), grade II (scores of 9-10), and grade III (scores of 11-14). For reliability assessment, cartilage T2* measurements were repeated after 4 weeks in 10 randomly selected femoral head specimens. RESULTS T2* values decreased significantly with increasing cartilage degeneration (total P-values <0.001) ranging from 36.3 ± 4.3 ms in grade 0 regions to 22.8 ± 4.3 ms in regions with grade III changes. Pearson correlation analysis proved a fair correlation between T2* values and Mankin score (correlation coefficient = -0.362) that was statistically significant (P-value <0.001). Intra-class correlation (ICC) analysis demonstrated high intra-observer reproducibility for the T2* measurement (ICC: 0.949, P < 0.001). CONCLUSIONS Given the advantages of the T2* mapping technique with no need for contrast medium, high image resolution and ability to perform 3D biochemically sensitive imaging, T2* mapping may be a strong addition to the currently evolving era of cartilage biochemical imaging.
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Affiliation(s)
- B Bittersohl
- University Düsseldorf, Medical Faculty, Orthopedic Department, 40225 Dusseldorf, Germany.
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Abstract
The newer magnetic resonance (MR) imaging methods can give insights into the initiation, progression, and eventual treatment of osteoarthritis. Sodium imaging is specific for changes in proteoglycan (PG) content without the need for an exogenous contrast agent. T1ρ imaging is sensitive to early PG depletion. Delayed gadolinium-enhanced MR imaging has high resolution and sensitivity. T2 mapping is straightforward and is sensitive to changes in collagen and water content. Ultrashort echo time MR imaging examines the osteochondral junction. Magnetization transfer provides improved contrast between cartilage and fluid. Diffusion-weighted imaging may be a valuable tool in postoperative imaging.
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Abstract
Musculoskeletal MRI is advancing rapidly, with innovative technology and significant potential for immediate clinical impact. In particular, cartilage imaging has become a topic of increasing interest as our aging population develops diseases such as osteoarthritis. Advances in MRI hardware and software have led to increased image quality and tissue contrast. Additional developments have allowed the assessment of cartilage macromolecular content, which may be crucial to the early detection of musculoskeletal diseases. This comprehensive article considers current morphological and physiological cartilage imaging techniques, their clinical applications, and their potential to contribute to future improvements in the imaging of cartilage.
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Long-term results of finger reconstruction with microvascular toe transfers after trauma. J Plast Reconstr Aesthet Surg 2011; 64:1291-9. [DOI: 10.1016/j.bjps.2011.04.036] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2010] [Revised: 04/15/2011] [Accepted: 04/28/2011] [Indexed: 11/24/2022]
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Crema MD, Roemer FW, Guermazi A. Magnetic Resonance Imaging in Knee Osteoarthritis Research: Semiquantitative and Compositional Assessment. Magn Reson Imaging Clin N Am 2011; 19:295-321. [DOI: 10.1016/j.mric.2011.02.003] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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Kotkansalo T, Vilkki S, Elo P, Luukkaala T. Long-term functional results of microvascular toe-to-thumb reconstruction. J Hand Surg Eur Vol 2011; 36:194-204. [PMID: 21051468 DOI: 10.1177/1753193410387331] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
The purpose of this study was to evaluate the long-term functional results of microvascular toe-to-thumb reconstruction after trauma. Forty-one patients meeting the inclusion criteria were available for a clinical follow-up study. The function of the hand was assessed with questionnaires as well as with modified Tamai and Sollerman hand function tests. According to the questionnaires, most activities were considered easy or quite easy and the majority of the patients (36/41) managed with no or minor complaints. Clinical tests showed good recovery of function. Patient satisfaction was high. There were superficial infections in five hands and in six donor feet. In total, 16 late corrective operations were done to eight patients. Microvascular toe transfer is a good option for grip reconstruction after thumb amputation. The extent of the initial injury influences the achievable outcome, yet even a single toe transfer can restore adequate grip function.
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Affiliation(s)
- T Kotkansalo
- Department of Hand and Microsurgery, Tampere University Hospital, Tampere, Finland.
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Wachsmuth L, Lindhorst E, Wrubel S, Hadzhiyski H, Hudelmaier M, Eckstein F, Chrubasik S. Micro-Morphometrical Assessment of the Effect of Harpagophytum procumbens
Extract on Articular Cartilage in Rabbits with Experimental Osteoarthritis using Magnetic Resonance Imaging. Phytother Res 2011; 25:1133-40. [DOI: 10.1002/ptr.3410] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2010] [Revised: 12/20/2010] [Accepted: 12/28/2010] [Indexed: 11/07/2022]
Affiliation(s)
- L. Wachsmuth
- Institute of Medical Physics; University of Erlangen; Germany
| | - E. Lindhorst
- Department of Surgery; University of Marburg; Germany
| | - S. Wrubel
- Institute of Anatomy, LMU München; Munich Germany
| | - H. Hadzhiyski
- Institute of Forensic Medicine; University of Freiburg; Germany
| | - M. Hudelmaier
- Institute of Anatomy and Musculoskeletal Research; Paracelsus Medical University, Salzburg, Austria & Chondrometrics GmbH, Ainring
| | - F. Eckstein
- Institute of Anatomy and Musculoskeletal Research; Paracelsus Medical University, Salzburg, Austria & Chondrometrics GmbH, Ainring
| | - S. Chrubasik
- Institute of Forensic Medicine; University of Freiburg; Germany
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Roemer FW, Eckstein F, Guermazi A. Magnetic resonance imaging-based semiquantitative and quantitative assessment in osteoarthritis. Rheum Dis Clin North Am 2010; 35:521-55. [PMID: 19931802 DOI: 10.1016/j.rdc.2009.08.006] [Citation(s) in RCA: 45] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
Whole organ magnetic resonance imaging (MRI)-based semiquantitative (SQ) assessment of knee osteoarthritis (OA), based on reliable scoring methods and expert reading, has become a powerful research tool in OA. SQ morphologic scoring has been applied to large observational cross-sectional and longitudinal epidemiologic studies as well as interventional clinical trials. SQ whole organ scoring analyzes all joint structures that are potentially relevant as surrogate outcome measures of OA and potential disease modification, including cartilage, subchondral bone, osteophytes, intra- and periarticular ligaments, menisci, synovial lining, cysts, and bursae. Resources needed for SQ scoring rely on the MRI protocol, image quality, experience of the expert readers, method of documentation, and the individual scoring system that will be applied. The first part of this article discusses the different available OA whole organ scoring systems, focusing on MRI of the knee, and also reviews alternative approaches. Rheumatologists are made aware of artifacts and differential diagnoses when applying any of the SQ scoring systems. The second part focuses on quantitative approaches in OA, particularly measurement of (subregional) cartilage loss. This approach allows one to determine minute changes that occur relatively homogeneously across cartilage structures and that are not apparent to the naked eye. To this end, the cartilage surfaces need to be segmented by trained users using specialized software. Measurements of knee cartilage loss based on water-excitation spoiled gradient recalled echo acquisition in the steady state, fast low-angle shot, or double-echo steady-state imaging sequences reported a 1% to 2% decrease in cartilage thickness annually, and a high degree of spatial heterogeneity of cartilage thickness changes in femorotibial subregions between subjects. Risk factors identified by quantitative measurement technology included a high body mass index, meniscal extrusion and meniscal tears, knee malalignment, advanced radiographic OA grade, bone marrow alterations, and focal cartilage lesions.
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Affiliation(s)
- Frank W Roemer
- Quantitative Imaging Center, Department of Radiology, Boston University School of Medicine, FGH Building, 3rd floor, 820 Harrison Avenue, Boston, MA 02118, USA.
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Bagheri MH, Nazhvani SD, Nikahval B, Pakbaz S, Tanideh N, Mehrabani D. Articular cartilage changes in experimental osteoarthritis in rabbits: MRI and morphological findings. ACTA ACUST UNITED AC 2010. [DOI: 10.1007/s00580-009-0951-3] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Roemer FW, Guermazi A. MR imaging-based semiquantitative assessment in osteoarthritis. Radiol Clin North Am 2009; 47:633-54. [PMID: 19631073 DOI: 10.1016/j.rcl.2009.03.005] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
Whole-organ semiquantitative (SQ) assessment by expert readers has become a powerful research tool in understanding the natural history of osteoarthritis (OA). SQ morphologic scoring has been applied to observational large cross-sectional and longitudinal epidemiologic studies in addition to interventional clinical trials. In comparison to quantitative and biochemical assessment of cartilage, SQ whole-organ scoring also analyzes additional joint structures that are potentially relevant as surrogate outcome measures for interventional approaches. Resources needed for SQ scoring rely on the MR imaging protocol, image quality, experience of the expert readers, method of documentation, and individual scoring system that is applied. This article discusses the different available OA whole-organ scoring systems, focusing on MR imaging of the knee, and also reviews alternative approaches.
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Affiliation(s)
- Frank W Roemer
- Quantitative Imaging Center, Department of Radiology, Boston University School of Medicine, 820 Harrison Avenue, FGH Building, 3rd Floor, Boston, MA 02118, USA.
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30
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Experimental model to evaluate in vivo and in vitro cartilage MR imaging by means of histological analyses. Eur J Radiol 2009; 70:561-9. [DOI: 10.1016/j.ejrad.2008.02.031] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2008] [Revised: 02/26/2008] [Accepted: 02/29/2008] [Indexed: 11/21/2022]
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Gahunia HK, Kessler MJ, Houpt JB, Renlund RC, Peel SAF, Babyn PS, Pritzker KPH. Spontaneous Osteonecrosis of the Knee in Macaca mulatta. INT J PRIMATOL 2009. [DOI: 10.1007/s10764-009-9351-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Murray RC, Blunden TS, Branch MV, Tranquille CA, Dyson SJ, Parkin TDH, Goodship AE. Evaluation of age-related changes in the structure of the equine tarsometatarsal osteochondral unit. Am J Vet Res 2009; 70:30-6. [PMID: 19119946 DOI: 10.2460/ajvr.70.1.30] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
OBJECTIVE To investigate effects of age on thickness and morphologic characteristics of hyaline cartilage, calcified cartilage, total cartilage, and subchondral bone (SCB) in the equine tarsometatarsal joint. SAMPLE POPULATION 23 tarsal joints from cadavers of 23 ponies (11 days to 25 years old); ponies were limited to pasture exercise and euthanatized for reasons not related to this study. Procedures-Tarsi were allocated into several age groups (11 days old [n = 3], 6 to 9 months old [4], 2 to 3 years old [3], 6 to 8 years old [4], 11 to 17 years old [6], and 20 to 25 years old [3]). Histologic examination and histomorphometric measurement of hyaline cartilage, calcified cartilage, total cartilage, and SCB were performed at medial and lateral sites. RESULTS A significant decrease was detected in thickness of hyaline cartilage and total cartilage with increasing age, but there was a significant increase in thickness of calcified cartilage and SCB with increasing age. Differences in chondrocyte and collagen fiber arrangement, tidemark, and osteochondral junction morphology were evident among age groups. CONCLUSIONS AND CLINICAL RELEVANCE These findings suggested that the various tissues of the osteochondral unit change in different ways with age. The response of each tissue may be related to relative response of the tissues to strains induced by pasture exercise but could have an influence on how the overall properties of the osteochondral unit change with age. The findings may also be suggestive of changes that develop prior to the onset of osteoarthritis.
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Affiliation(s)
- Rachel C Murray
- Centre for Equine Studies, The Animal Health Trust, Lanwades Park, Kentford, Newmarket, Suffolk CB8 7UU, England
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Bolbos R, Benoit-Cattin H, Langlois JB, Chomel A, Chereul E, Odet C, Janier M, Pastoureau P, Beuf O. Measurement of knee cartilage thickness using MRI: a reproducibility study in a meniscectomized guinea pig model of osteoarthritis. NMR IN BIOMEDICINE 2008; 21:366-75. [PMID: 17708519 DOI: 10.1002/nbm.1198] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/16/2023]
Abstract
The in vivo precision (reproducibility) of quantitative MRI is of particular importance in osteoarthritis (OA) progression of small magnitude and response to therapy. In this study, three-dimensional high-resolution MRI performed at 7 T was used to assess the short-term reproducibility of measurements of mean tibial cartilage thickness in a meniscectomized guinea pig model of OA. MR image acquisition was repeated five times in nine controls (SHAM) and 10 osteoarthritic animals 3 months after meniscectomy (MNX), in vivo. The animals were then killed for histomorphometric assessment and correlation with the MRI-based measurements. Medial tibial cartilage thickness was measured on MR images using semi-automatic dedicated 3D software developed in-house. The reproducibility of measurements of cartilage thickness was assessed by five repeated MRI examinations with a short recovery delay between examinations (48 h). The computed coefficients of variation were 8.9% for the SHAM group and 8.2% for the MNX group. The coefficients of variation were compatible with expected thickness variations between normal and pathological animals. A positive agreement and significant partial correlation (Spearman r' = 0.74; P < 0.01) between the MRI and histomorphometric data was established. Three-dimensional high-resolution MRI is a promising non-invasive research tool for in vivo follow-up. This modality could be used for staging and monitoring therapy response in small-animal models of OA.
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Affiliation(s)
- R Bolbos
- Plate-forme ANIMAGE, Université Claude Bernard Lyon I, Rhône-Alpes Genopole, Lyon, France
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Boulocher C, Chereul E, Langlois JB, Armenean M, Duclos ME, Viguier E, Roger T, Vignon E. Non-invasive in vivo quantification of the medial tibial cartilage thickness progression in an osteoarthritis rabbit model with quantitative 3D high resolution micro-MRI. Osteoarthritis Cartilage 2007; 15:1378-87. [PMID: 17576081 DOI: 10.1016/j.joca.2007.04.012] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/18/2006] [Accepted: 04/24/2007] [Indexed: 02/02/2023]
Abstract
OBJECTIVE To develop a quantitative non-invasive in vivo three-dimensional (3D) high resolution (HR) micro-magnetic resonance imaging (microMRI) protocol to measure the medial tibial cartilage thickness (MT.ThC) in the normal rabbit and in the anterior cruciate ligament transection (ACLT) rabbit model of osteoarthritis and quantify the progression of MT.ThC. METHODS The left knee of 10 control and 40 operated rabbits was imaged in vivo with a 7T microMRI system at 3 and 5 months after ACLT. A 3D fast low angle short (FLASH) fat-suppressed MRI protocol was implemented leading to 44x176 microm(3) spatial resolution and to 44 microm(3) isotropic voxel after cubic interpolation. Semi-automatic MT.ThC measurements were made in 3D, in four different locations, in vivo and longitudinally in both groups. At 5 months, gross macroscopy, visual analogical evaluation of the cartilage and histology were compared to the MR-based MT.ThC. RESULTS At 3 and 5 months, the MT.ThC measured in the minimum interbone distance area was the thinnest MR-based MT.ThC. It was significantly lower in the operated group and among the four evaluated MT.ThC, it was the most discriminative between the normal and the operated groups (P<0.05). The MT.ThC measured in the minimum interbone distance area was also the most sensitive to change in the operated group (66.4% MT.ThC loss, P=0.003) while no significant changes were observed in the control group. CONCLUSION Quantitative 3D HR microMRI allowed for non-invasive longitudinal MT.ThC measurements in four different locations in both the normal and the operated rabbits. We concluded the MT.ThC measured in the minimum interbone distance area reflected the severity of the disease and was the most effective to measure the progression of the medial tibial cartilage destruction.
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Affiliation(s)
- C Boulocher
- Université de Lyon, UR RTI2B, Lyon F-69003, France.
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Duc SR, Koch P, Schmid MR, Horger W, Hodler J, Pfirrmann CWA. Diagnosis of articular cartilage abnormalities of the knee: prospective clinical evaluation of a 3D water-excitation true FISP sequence. Radiology 2007; 243:475-82. [PMID: 17400759 DOI: 10.1148/radiol.2432060274] [Citation(s) in RCA: 76] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
PURPOSE To prospectively evaluate the accuracy of three-dimensional (3D) water-excitation true fast imaging with steady-state precession (FISP) in the assessment of cartilage abnormalities of the knee, by using surgery as the reference standard. MATERIALS AND METHODS The study was approved by the hospital institutional review board. Written informed consent was obtained from all patients. Twenty-nine patients (30 knees) with a mean age of 56 years (range, 18-86 years) were prospectively evaluated with a sagittal 3D true FISP magnetic resonance (MR) sequence. The mean interval between MR imaging and surgery was 1 day (range, 0-9 days). During surgery, the articular surfaces of the knee were evaluated by using a modified Noyes score. The MR images were evaluated by two blinded readers on two separate occasions. Diagnostic performance was evaluated by setting the cutoff for abnormality between grade 1 (intact cartilage surface) and grade 2 (cartilage defects). Statistical methods used included calculation of sensitivity, specificity, and accuracy, with 95% confidence intervals (Wilson score method) and calculation of kappa values with standard errors. RESULTS Overall sensitivity, specificity, and accuracy for the two readers and the two evaluations ranged from 56% to 66%, 78% to 93%, and 71% to 75%, respectively. Interobserver agreement was substantial for both the first (kappa = 0.73) and the second (kappa = 0.65) evaluation. Intraobserver agreement was almost perfect (kappa = 0.84) for reader 1 and moderate (kappa = 0.60) for reader 2. CONCLUSION The 3D water-excitation true FISP MR sequence allows assessment of the articular cartilage of the knee with moderate-to-high specificity and low-to-moderate sensitivity.
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Affiliation(s)
- Sylvain R Duc
- Department of Radiology, University Hospital, Balgrist, Forchstrasse 340, CH-8008 Zurich, Switzerland
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Pritzker KPH, Gay S, Jimenez SA, Ostergaard K, Pelletier JP, Revell PA, Salter D, van den Berg WB. Osteoarthritis cartilage histopathology: grading and staging. Osteoarthritis Cartilage 2006; 14:13-29. [PMID: 16242352 DOI: 10.1016/j.joca.2005.07.014] [Citation(s) in RCA: 1566] [Impact Index Per Article: 87.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/03/2004] [Accepted: 07/14/2005] [Indexed: 02/02/2023]
Abstract
OBJECTIVE Current osteoarthritis (OA) histopathology assessment methods have difficulties in their utility for early disease, as well as their reproducibility and validity. Our objective was to devise a more useful method to assess OA histopathology that would have wide application for clinical and experimental OA assessment and would become recognized as the standard method. DESIGN An OARSI Working Group deliberated on principles, standards and features for an OA cartilage pathology assessment system. Using current knowledge of the pathophysiology of OA morphologic features, a proposed system was presented at OARSI 2000. Subsequently, this was widely circulated for comments amongst experts in OA pathology. RESULTS An OA cartilage pathology assessment system based on six grades, which reflect depth of the lesion and four stages reflecting extent of OA over the joint surface was developed. CONCLUSIONS The OARSI cartilage OA histopathology grading system appears consistent and simple to apply. Further studies are required to confirm the system's utility.
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Affiliation(s)
- K P H Pritzker
- Pathology and Laboratory Medicine, Mount Sinai Hospital, Toronto, Canada.
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Calvo E, Palacios I, Delgado E, Sánchez-Pernaute O, Largo R, Egido J, Herrero-Beaumont G. Histopathological correlation of cartilage swelling detected by magnetic resonance imaging in early experimental osteoarthritis. Osteoarthritis Cartilage 2004; 12:878-86. [PMID: 15501403 DOI: 10.1016/j.joca.2004.07.007] [Citation(s) in RCA: 103] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/21/2004] [Accepted: 07/26/2004] [Indexed: 02/02/2023]
Abstract
OBJECTIVE We previously reported that an increase of cartilage thickness is the earliest measurable change by magnetic resonance imaging (MRI) in early stages of experimental osteoarthritis (OA). Our present objective was to study the microscopic translation of this finding in order to know whether the cartilage thickness increment represents the earliest structural damage or whether it alternatively constitutes a non-progressive reversible phenomenon. METHODS OA was induced by partial medial meniscectomy in rabbits. Normal and sham-operated animals were used as controls. Gross and microscopic cartilage changes were sequentially assessed after surgery at 0, 2, 4, 6, 8, 10 and 52 weeks, and compared to MRI findings. RESULTS The swelling of cartilage detected by MRI correlated with depletion in matrix proteoglycans and cellular loss, which were closely related to the progression of OA at the earliest stages. Abnormalities of the cartilage structure appeared only in advanced OA. CONCLUSION Cartilage swelling detected by MRI is due to proteoglycan depletion and represents the earliest abnormality in OA. Because it is accompanied by cellular loss, it cannot be merely attributed to surgical trauma and represents true tissue damage. The biological meaning of volume variations detected by MRI should be assessed carefully taking into account the disease stage as an increase in cartilage height also reflects cartilage damage and not a reparative process.
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Affiliation(s)
- E Calvo
- Department of Orthopaedic Surgery, Fundación Jiménez Díaz, Universidad Autónoma, Madrid, Spain.
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David-Vaudey E, Ghosh S, Ries M, Majumdar S. T2 relaxation time measurements in osteoarthritis. Magn Reson Imaging 2004; 22:673-82. [PMID: 15172061 DOI: 10.1016/j.mri.2004.01.071] [Citation(s) in RCA: 167] [Impact Index Per Article: 8.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2003] [Accepted: 01/30/2004] [Indexed: 11/27/2022]
Abstract
Quantification of changes in T(2) relaxation time, in human cartilage, with progression of osteoarthritis (OA), and evaluation of qualitative correlations with clinical evaluation, histology and polarized light microscopy (PLM). Cartilage-bone plugs were harvested from fresh cadaveric knees (n = 10) and specimens after surgical knee replacement (n = 2) at 12 locations, including lateral and medial sides of tibia, femora and patella. Magnetic resonance imaging was performed at 1.5 Tesla using a.2D spin echo sequence. Histological slices were assessed for OA severity through a grading scale based on combined histological and PLM results. T(2) values in clinically moderate OA were generally higher than in severe OA and normal cartilage. Significant association was established between normal and early OA subjects and T(2) variation, in the medial compartment of the knee (p < 0.05) but especially in the medial tibial cartilage (p < 0.00005). As expected, medial and lateral tibio-femoral compartments underwent more severe degeneration. Additionally, there were intracompartmental variation of the relaxation times and histological patterns, which demonstrate the underlying focal involvement of OA in the knee. Furthermore, T(2) values reflected OA pathogenesis with a positive correlation with histology grading scale. Finally, increased T(2) is correlated to histological degeneration of cartilage and may be a good marker for early OA in tibial articular cartilage.
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Affiliation(s)
- Eve David-Vaudey
- Department of Radiology, University of California, San Francisco, USA
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Tessier JJ, Bowyer J, Brownrigg NJ, Peers IS, Westwood FR, Waterton JC, Maciewicz RA. Characterisation of the guinea pig model of osteoarthritis by in vivo three-dimensional magnetic resonance imaging. Osteoarthritis Cartilage 2003; 11:845-53. [PMID: 14629960 DOI: 10.1016/s1063-4584(03)00162-6] [Citation(s) in RCA: 55] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
OBJECTIVE To characterise longitudinal changes in joint integrity and cartilage volume in vivo in the guinea pig spontaneous osteoarthritis (OA) model by magnetic resonance imaging (MRI). METHODS Guinea pigs knee were imaged in vivo by high-resolution three-dimensional (3D) MRI between the ages of 3 and 12 months. Image analysis was performed to assess qualitative knee joint changes between 3 and 12 months (n=16) and quantitative volumetric changes of the medial tibial cartilage between 9 and 12 months (n=7). After imaging, animals were killed and knees were assessed macroscopically and histologically. RESULTS From 3 to 6 months qualitative observation by MRI and histopathology indicated localised cartilage swelling on the medial tibial plateau. At 6 months, bone cysts had developed in the epiphysis. At 9 months, we observed by MRI and histopathology, fragmentation of the medial tibial cartilage in areas not protected by the meniscus. Cartilage degeneration had intensified at 12 months with evidence of widespread loss of cartilage throughout the tibial plateau. Segmentation of the MR cartilage images showed a 36% loss of volume between 9 and 12 months. CONCLUSIONS We have achieved 3D image acquisition and segmentation of knee cartilage in a guinea pig model of chronic OA, which permits measurements previously only possible in man. High resolution and short acquisition time allowed qualitative longitudinal characterisation of the entire knee joint and enabled us to quantify for the first time longitudinal tibial cartilage volume loss associated with disease progression.
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Affiliation(s)
- J J Tessier
- Enabling Science and Technology, AstraZeneca, Mereside, Alderley Park, Macclesfield, Cheshire SK10 4TG, UK.
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Wachsmuth L, Keiffer R, Juretschke HP, Raiss RX, Kimmig N, Lindhorst E. In vivo contrast-enhanced micro MR-imaging of experimental osteoarthritis in the rabbit knee joint at 7.1T1. Osteoarthritis Cartilage 2003; 11:891-902. [PMID: 14629965 DOI: 10.1016/j.joca.2003.08.008] [Citation(s) in RCA: 32] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
OBJECTIVE In this longitudinal MR study the early stages of joint pathology in two surgically-induced rabbit models of osteoarthritis (OA) were monitored by in vivo contrast-enhanced MRI at 7.1T. Qualitative and quantitative MR data were compared with macroscopic and microscopic findings. METHOD Scanning of mature, male New Zealand White rabbits (N=12) was performed before surgery, and at 2, 4, and 8 weeks after unilateral transection of the anterior cruciate ligament (ACLT), medial meniscectomy (ME), or sham operation. MR-images were simultaneously obtained of both knee joints after intravenous injection of Magnevist. We implemented a 2D T1-weighted (T1w) coronal, fat-saturated gradientecho protocol (68 x 138 microm2, slice thickness 1 mm). Additionally, consecutive 3D gradientecho images were obtained from two sham-operated and two rabbits of the ME group (234 x 273 x 234 microm(3)). ACLT animals were sacrificed at 2 weeks (N=1), and 8 weeks (N=3), ME animals were sacrificed at 4 weeks (N=2), and 8 weeks (N=4), and sham-operated animals were sacrificed at 2 weeks (N=1) and 8 weeks (N=1), respectively. RESULTS Both OA models reflected important characteristics of the clinical picture of OA. With MR we were able to monitor time dependently the decline of synovial effusion and the formation of osteophytes. Morphologic MR examination showed a moderate to high accuracy for detecting synovial effusion (75%), meniscus (86%) and cruciate ligament (91%) lesions, and osteophytes (88%) as assessed by macroscopic examination. False-negative MR findings for gross macroscopic changes were due to the relative high slice thickness in 2D scans and the fact that the slices only covered the main weightbearing area of the femorotibial joint. Contour abnormalities of articular cartilage were not reliably detected. Quantitative analysis revealed a statistically significant increase of cartilage signal intensity in medial tibial cartilage (48+/-9% ACLT, and 29+/-9% ME in 2D datasets) as compared to contralateral control knees in two-week scans. Signal enhancement persisted or increased at later dates. CONCLUSION With high-resolution contrast-enhanced MRI at 7.1T the time course of gross pathologic changes in rabbit knees with surgically induced OA can be monitored. Still insufficient spatial resolution and image contrast of the applied 2D protocols limit the sensitivity and prohibit detection of articular cartilage contour abnormalities. However, signal alterations in the cartilage layer indicate alterations of tissue composition at a very early stage of OA development. When used with 3D protocols, contrast-enhanced MRI offers a promising tool for qualitative and quantitative in vivo monitoring of OA in rabbit models.
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Affiliation(s)
- Lydia Wachsmuth
- Institute of Medical Physics, University Erlangen-Nuernberg, Erlangen, Germany.
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Calvo E, Palacios I, Delgado E, Ruiz-Cabello J, Hernández P, Sánchez-Pernaute O, Egido J, Herrero-Beaumont G. High-resolution MRI detects cartilage swelling at the early stages of experimental osteoarthritis. Osteoarthritis Cartilage 2001; 9:463-72. [PMID: 11467895 DOI: 10.1053/joca.2001.0413] [Citation(s) in RCA: 107] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
OBJECTIVE The progressive early changes in cartilage and subchondral bone in an experimental model of osteoarthritis (OA) were investigated with high-resolution magnetic resonance imaging (MRI) and microradiography. METHODS Partial medial meniscectomy was performed in the left knee of 16 rabbits. Four normal and four sham-operated additional rabbits were used as controls. Changes in cartilage and subchondral bone were sequentially assessed after surgery with MRI at 0, 2, 4, 6, 8 and 10 weeks, subchondral bone variations quantified postoperatively on microradiographs of sagittal sections at 6 and 10 weeks and the macroscopic alterations graded according to the severity of joint changes. RESULTS MRI demonstrated a progressive increase in the articular cartilage thickness in the weight-bearing area of the femur at weeks 4, 6 and 8 vs basal. Tibial cartilage thickness only showed a significant increment at week 6. No significant abnormalities were detected on X-rays in subchondral bone when compared to controls. Macroscopically, 4 weeks after the operation OA rabbits had only slight cartilage discoloration. Cartilage eburnation, pitting, superficial erosions and osteophytes were detected at week 6. These abnormalities were more evident at 8 and 10 weeks after meniscectomy. CONCLUSION The focal increase in cartilage thickness is one of the earliest measurable changes in OA and preceeds subchondral bone remodeling. The measurement of cartilage thickness variations with MRI can be used to follow the course of OA and to evaluate the potential beneficial effect of novel therapies.
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Affiliation(s)
- E Calvo
- Department of Orthopaedic Surgery, Rheumatology Service and Inflammation Research Unit, Fundación Jiménez Díaz, Universidad Autónoma, Madrid, Spain
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Murray RC, Zhu CF, Goodship AE, Lakhani KH, Agrawal CM, Athanasiou KA. Exercise affects the mechanical properties and histological appearance of equine articular cartilage. J Orthop Res 1999; 17:725-31. [PMID: 10569483 DOI: 10.1002/jor.1100170516] [Citation(s) in RCA: 51] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
Dorsal carpal osteochondral injury is a major cause of reduced performance in horses undergoing high-intensity training. It was hypothesised that the mechanical behaviour and histology of cartilage are influenced by the intensity of exercise and by location within a joint. Relationships between histology and mechanical behaviour were identified in 2-year-old horses undergoing 19 weeks of high-intensity treadmill training or low-intensity exercise and then compared between groups. Dorsal and palmar test sites were identified on radial, intermediate, and third carpal articular surfaces after euthanasia. The mechanical properties of cartilage were determined with an automated creep indentation apparatus as previously described for equine cartilage. Cartilage morphology was assessed with use of sections stained with haematoxylin and eosin and toluidine blue. Dorsal cartilage was less permeable, thinner, and had a loss of chondrocyte alignment compared with palmar cartilage. Cartilage from strenuously trained horses showed more fibrillation and chondrocyte clusters than did cartilage from gently exercised animals. Dorsal radial carpal cartilage and third carpal cartilage of strenuously trained animals were significantly less stiff than that from gently exercised animals, and the former had reduced superficial toluidine blue staining compared with that from the gently exercised group. These results indicate that topographical and exercise-related differences exist in the morphology and mechanical properties of carpal cartilage and suggest that strenuous training may lead to deterioration of cartilage at sites with a high clinical incidence of lesions.
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Affiliation(s)
- R C Murray
- Centre for Equine Studies, Animal Health Trust, Kentford, Newmarket, Suffolk, England.
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Muellner T, Egkher A, Nikolic A, Funovics M, Metz V. Open meniscal repair: clinical and magnetic resonance imaging findings after twelve years. Am J Sports Med 1999; 27:16-20. [PMID: 9934413 DOI: 10.1177/03635465990270011001] [Citation(s) in RCA: 71] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
The purpose of this study was to document the longterm clinical, radiographic, and magnetic resonance imaging results after open meniscal repair. Twenty-two patients, with 23 open meniscal repairs, were evaluated after a mean follow-up of 12.9 years using patient history, physical examination, KT-1000 arthrometer testing, the "Orthopaedische Arbeitsgemeinschaft Knie" knee evaluation scheme, Tegner activity score, weightbearing radiographs, and magnetic resonance imaging. Two of the 22 patients had retears and both occurred in unstable knees. Radiographs revealed no degenerative changes in 17 of the 23 compartments. Grade III and IV signal alterations were present on magnetic resonance imaging scans in more than 50% of the repaired menisci. We concluded that the longterm survival rate of repaired menisci was 91%, and that magnetic resonance imaging is unsuitable for diagnosis of the healing process of a repaired meniscus.
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Affiliation(s)
- T Muellner
- University Clinic of Traumatology, University of Vienna Medical School, Austria
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Munasinghe JP, Tyler JA, Hodgson RJ, Barry MA, Gresham GA, Evans R, Hall LD. Magnetic resonance imaging, histology, and x-ray of three stages of damage to the knees of STR/ORT mice. Invest Radiol 1996; 31:630-8. [PMID: 8889652 DOI: 10.1097/00004424-199610000-00005] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
RATIONALE AND OBJECTIVES The authors develop a scoring system for assessing those features of degeneration of the STR/ORT mouse knee visualizable by magnetic resonance (MR) imaging, and to validate those MR scores by comparison with x-ray and histology. METHOD Magnetic resonance imaging, histology, and x-ray have been used in a cross-sectional study to visualize the anatomy and pathology of the knees of three pairs of male STR/ORT mice and their approximately age-matched female pairs. A scoring system was developed that distinguished the faster rate of damage of the males from the slower progressive changes seen in the females. RESULTS Changes in the patellar tendon were observed in MR imaging of the 5-month-old male knee. Sagittal images showed other degenerative features such as sclerosis and loss of signal from synovial fluid after 9 months; osteophytes and degeneration of the tibial plateau were better visualized in the coronal plane. Cysts were poorly correlated to the progression of the disease. Similar trends were observed for four features scored in x-rays (sclerosis, joint space narrowing, cysts, and osteophytes) and cartilage degradation assessed using histology. In contrast, the age-matched females were less affected. CONCLUSIONS Magnetic resonance imaging can identify joint degeneration in the knees of male mice, which develops more rapidly than in age-matched females. Those observations were validated by radiology and histology.
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Affiliation(s)
- J P Munasinghe
- Herchel Smith Laboratory for Medicinal Chemistry, Cambridge University School of Clinical Medicine, England
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Lim KK, Kessler MJ, Pritzker KP, Turnquist JE, Dieppe PA. Osteoarthritis of the hand in nonhuman primates: a clinical, radiographic, and skeletal survey of Cayo Santiago rhesus macaques. J Med Primatol 1996; 25:301-8. [PMID: 8906610 DOI: 10.1111/j.1600-0684.1996.tb00214.x] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
We describe the relative prevalence and pattern of distribution of osteoarthritis (OA) in the hands of elderly (> 15 years) rhesus macaques using clinical, radiographic, and skeletal examinations. In the clinical study the prevalence of nodes was 72% and 16% in the distal inter-phalangeal joints (DIPJ) and proximal inter-phalangeal joints (PIPJ), respectively, 31% of all monkeys had polyarticular nodes. Radiographic OA was present in 55%, 9.1%, and 0% of the DIPJs, PIPJs, and thumb base, respectively. Skeletal OA as defined by joint surface eburnation for the DIPJ, PIPJ, and thumb base were 16%, 8%, and 2%, respectively. A similar pattern of hand OA with humans is described except for the thumb base OA. This may be due to the relatively rudimentary manipulative role of the macaque thumb. The finding of polyarticular nodal OA raises the possibility of a common pathogenensis for IPJ OA amongst primates.
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Affiliation(s)
- K K Lim
- University of Bristol, Department of Medicine, U.K
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