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Baumann-Jungmann PM, Giesler P, Schneider J, Jung M, Karampinos DC, Weidlich D, Gersing AS, Baumann FA, Imhoff AB, Woertler K, Bamberg F, Holwein C. MR imaging after patellar MACI and MPFL reconstruction: a comparison of isolated versus combined procedures. Skeletal Radiol 2024; 53:1319-1332. [PMID: 38240761 DOI: 10.1007/s00256-024-04582-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/18/2023] [Revised: 01/05/2024] [Accepted: 01/07/2024] [Indexed: 05/15/2024]
Abstract
OBJECTIVE To qualitatively and quantitatively evaluate the 2.5-year MRI outcome after Matrix-associated autologous chondrocyte implantation (MACI) at the patella, reconstruction of the medial patellofemoral ligament (MPFL), and combined procedures. METHODS In 66 consecutive patients (age 22.8 ± 6.4years) with MACI at the patella (n = 16), MPFL reconstruction (MPFL; n = 31), or combined procedures (n = 19) 3T MRI was performed 2.5 years after surgery. For morphological MRI evaluation WORMS and MOCART scores were obtained. In addition quantitative cartilage T2 and T1rho relaxation times were acquired. Several clinical scores were obtained. Statistical analyses included descriptive statistics, Mann-Whitney-U-tests and Pearson correlations. RESULTS WORMS scores at follow-up (FU) were significantly worse after combined procedures (8.7 ± 4.9) than after isolated MACI (4.3 ± 3.6, P = 0.005) and after isolated MPFL reconstruction (5.3 ± 5.7, P = 0.004). Bone marrow edema at the patella in the combined group was the only (non-significantly) worsening WORMS parameter from pre- to postoperatively. MOCART scores were significantly worse in the combined group than in the isolated MACI group (57 ± 3 vs 88 ± 9, P < 0.001). Perfect defect filling was achieved in 26% and 69% of cases in the combined and MACI group, respectively (P = 0.031). Global and patellar T2 values were higher in the combined group (Global T2: 34.0 ± 2.8ms) and MACI group (35.5 ± 3.1ms) as compared to the MPFL group (31.1 ± 3.2ms, P < 0.05). T2 values correlated significantly with clinical scores (P < 0.005). Clinical Cincinnati scores were significantly worse in the combined group (P < 0.05). CONCLUSION After combined surgery with patellar MACI and MPFL reconstruction inferior MRI outcomes were observed than after isolated procedures. Therefore, patients with need for combined surgery may be at particular risk for osteoarthritis.
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Affiliation(s)
- Pia M Baumann-Jungmann
- Department of Diagnostic and Interventional Radiology, Medical Center - University of Freiburg, Faculty of Medicine, University of Freiburg, Hugstetter Strasse 55, 79106, Freiburg, Germany.
- Department of Radiology, Kantonsspital Graubünden, Chur, Switzerland.
| | - Paula Giesler
- Department of Diagnostic and Interventional Radiology, Medical Center - University of Freiburg, Faculty of Medicine, University of Freiburg, Hugstetter Strasse 55, 79106, Freiburg, Germany
| | - Julia Schneider
- Department of Orthopaedic Sports Medicine, Klinikum Rechts Der Isar, Technical University of Munich, Ismaninger Strasse 22, 81675, Munich, Germany
| | - Matthias Jung
- Department of Diagnostic and Interventional Radiology, Medical Center - University of Freiburg, Faculty of Medicine, University of Freiburg, Hugstetter Strasse 55, 79106, Freiburg, Germany
| | - Dimitrios C Karampinos
- Department of Radiology, Klinikum Rechts Der Isar, Technical University of Munich, Ismaninger Strasse 22, 81675, Munich, Germany
| | - Dominik Weidlich
- Department of Radiology, Klinikum Rechts Der Isar, Technical University of Munich, Ismaninger Strasse 22, 81675, Munich, Germany
| | - Alexandra S Gersing
- Department of Radiology, Klinikum Rechts Der Isar, Technical University of Munich, Ismaninger Strasse 22, 81675, Munich, Germany
- Department of Neuroradiology, University Hospital, LMU Munich, Marchioninistrasse 15, 81377, Munich, Germany
| | - Frederic A Baumann
- Department of Vascular Medicine, Hospital of Schiers, Schiers, Switzerland
| | - Andreas B Imhoff
- Department of Orthopaedic Sports Medicine, Klinikum Rechts Der Isar, Technical University of Munich, Ismaninger Strasse 22, 81675, Munich, Germany
| | - Klaus Woertler
- Department of Radiology, Klinikum Rechts Der Isar, Technical University of Munich, Ismaninger Strasse 22, 81675, Munich, Germany
| | - Fabian Bamberg
- Department of Diagnostic and Interventional Radiology, Medical Center - University of Freiburg, Faculty of Medicine, University of Freiburg, Hugstetter Strasse 55, 79106, Freiburg, Germany
| | - Christian Holwein
- Department of Orthopaedic Sports Medicine, Klinikum Rechts Der Isar, Technical University of Munich, Ismaninger Strasse 22, 81675, Munich, Germany
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Li M, Xia Z, Li X, lan L, Mo X, Xie L, Zhan Y, Li W. Difference in quantitative MRI measurements of cartilage between Wiberg type III patella and stable patella based on a 3.0-T synthetic MRI sequence. Eur J Radiol Open 2023; 11:100526. [PMID: 37953964 PMCID: PMC10632675 DOI: 10.1016/j.ejro.2023.100526] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2023] [Revised: 09/17/2023] [Accepted: 09/30/2023] [Indexed: 11/14/2023] Open
Abstract
Purpose The purpose of this study was to investigate the difference between the quantitative MRI values of Wiberg type III and stable patellar cartilage, and to improve the accuracy of MRI quantification in early patellar cartilage damage. Methods The knee joints of 94 healthy volunteers were scanned by a GE Signa Pioneer 3.0-T synthetic MRI machine. According to the Wiberg classification, the patella was divided into types I-III. Types I-II made up the stable patella group, and type III made up the unstable patella group. Two radiologists independently measured patellar cartilage thickness and quantitative synthetic MRI values (T1, T2, PD) in both groups. Interobserver agreement for quantitative variables was assessed using the Bland-Altman method. A third radiologist assessed differences in measurements. Results The medial T2 and T1 value of Wiberg III patella did not show a normal distribution (all P > 0.05). Compared with the stable group, the Wiberg type III group had thinner cartilage of the medial surface of the patella (P < 0.05), lower cartilage T2 and PD values (P < 0.05), but a similar cartilage T1 value (P > 0.05). There was no significant difference in the cartilage thickness, T1, T2, or PD value of the lateral patella between the Wiberg type III and the stable group (P > 0.05). Conclusion There were certain differences in the cartilage thickness of the medial surface of the patella and the quantitative value of synthetic MRI in Wiberg type III patellas. Quantitative studies of patellar cartilage MRI measurements need to consider the influence of patellar morphology.
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Affiliation(s)
- Min Li
- The Second Affiliated Hospital of Guangxi Medical University, Department of Radiology, Nanning, Guangxi 530007, China
| | - Zhenyuan Xia
- The Second Affiliated Hospital of Guangxi Medical University, Department of Radiology, Nanning, Guangxi 530007, China
| | - Xiaohua Li
- The Second Affiliated Hospital of Guangxi Medical University, Department of Radiology, Nanning, Guangxi 530007, China
| | - Lan lan
- The Second Affiliated Hospital of Guangxi Medical University, Department of Radiology, Nanning, Guangxi 530007, China
| | - Xinxin Mo
- The Second Affiliated Hospital of Guangxi Medical University, Department of Radiology, Nanning, Guangxi 530007, China
| | - La Xie
- The Second Affiliated Hospital of Guangxi Medical University, Department of Radiology, Nanning, Guangxi 530007, China
| | - Yu Zhan
- The Second Affiliated Hospital of Guangxi Medical University, Department of Radiology, Nanning, Guangxi 530007, China
| | - Weixiong Li
- The Second Affiliated Hospital of Guangxi Medical University, Department of Radiology, Nanning, Guangxi 530007, China
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Roth C, Hirsch FW, Sorge I, Kiess W, Jurkutat A, Witt M, Böker E, Gräfe D. Preclinical Cartilage Changes of the Knee Joint in Adolescent Competitive Volleyball Players: A Prospective T2 Mapping Study. ROFO-FORTSCHR RONTG 2023; 195:913-923. [PMID: 37224866 DOI: 10.1055/a-2081-3245] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/26/2023]
Abstract
PURPOSE To investigate the potential effects of volleyball as a competitive sport in adolescence on the cartilage of knee joints using T2 mapping in MRI and identification of preclinical cartilage changes. Volleyball as an impact sport often leads to damage of the knee joint cartilage in adulthood. As T2 mapping is widely available and highly capable of detecting cartilage changes prior to conventional MRI sequences, such a detection may allow adolescent volleyball players to change their training regime before structural damage can occur to the cartilage and pose the risk of osteoarthritis. MATERIALS AND METHODS Comparative study of the patellar, femoral, and tibial cartilage of 60 knee joints using T2 mapping on 3 T MRI. In each case, both knees of 15 adolescent competitive volleyball athletes were compared with 15 controls. RESULTS In the group of competitive athletes, more focal cartilage changes were detected in the medial facet of the patellofemoral cartilage and in the medial femoral condyle of the knee joint cartilage (p = .01 and p <.05, respectively). Furthermore, the latter showed a diffused increase in maximal T2 mapping values (p <.04 right and p = .05 left). The distribution of changes seems to further depend on the player's position. CONCLUSION In adolescent volleyball players in competitive sports, T2 mapping demonstrates early cartilage changes in both the patellofemoral and medial femoral cartilages. The distribution of lesions depends on the player's position. Since the cascade from T2 relaxation time increase to conspicuous cartilage damage is well established, early counter-regulation (e. g., adapted training profile, targeted physiotherapy, and appropriate muscle building training) has the potential to prevent later damage. KEY POINTS · Volleyball as a competitive sport in adolescence leads to preclinical knee cartilage changes.. · Cartilage changes are both focal and diffuse.. · Jumping-intensive player positions seem to show more patellofemoral and running-intensive more condylar cartilage changes.. · Early detection of these changes could prevent progression to cartilage damage through adapted training.. CITATION FORMAT · Roth C, Hirsch F, Sorge I et al. Preclinical Cartilage Changes of the Knee Joint in Adolescent Competitive Volleyball Players: A Prospective T2 Mapping Study. Fortschr Röntgenstr 2023; 195: 913 - 923.
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Affiliation(s)
- Christian Roth
- Department of Pediatric Radiology, University Hospital Leipzig, Germany
| | | | - Ina Sorge
- Department of Pediatric Radiology, University Hospital Leipzig, Germany
| | - Wieland Kiess
- Department of Pediatrics, Leipzig University Hospital for Children and Adolescents, Leipzig, Germany
| | - Anne Jurkutat
- Department of Pediatrics, Leipzig University Hospital for Children and Adolescents, Leipzig, Germany
| | - Maren Witt
- Sports Biomechanics, Leipzig University Faculty of Sport Science, Leipzig, Germany
| | - Eva Böker
- Sports Biomechanics, Leipzig University Faculty of Sport Science, Leipzig, Germany
| | - Daniel Gräfe
- Department of Pediatric Radiology, University Hospital Leipzig, Germany
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Okada S, Taniguchi M, Yagi M, Motomura Y, Okada S, Fukumoto Y, Kobayashi M, Kanemitsu K, Ichihashi N. Ultrasonographic echo intensity in the medial femoral cartilage is enhanced prior to cartilage thinning in women with early mild knee osteoarthritis. Knee Surg Sports Traumatol Arthrosc 2023; 31:3964-3970. [PMID: 37140655 DOI: 10.1007/s00167-023-07440-w] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/22/2023] [Accepted: 04/23/2023] [Indexed: 05/05/2023]
Abstract
PURPOSE We aimed to determine whether altered cartilage echo intensity is associated with knee osteoarthritis (OA) severity and whether the alteration occurs before thinning of the femoral cartilage in knee OA. METHODS The medial femoral cartilage thickness and echo intensity of 118 women aged ≥ 50 years were assessed using an ultrasound imaging device. Based on the Kellgren-Lawrence (KL) grade and knee symptoms, participants were classified into five groups: control (asymptomatic grades 0-1), early OA (symptomatic grade 1), grade 2, grade 3, and grade 4. Analysis of covariance, with adjusted age and height, and the Sidak post hoc test were used to assess the differences in cartilage thickness and echo intensity in knees with varying OA severity. RESULTS The echo intensity on longitudinal images, equivalent to the tibiofemoral weight-bearing surface, was significantly higher in the grade 2 group than that in the control group (p = 0.049). However, no significant difference was noted in cartilage thickness (n.s.). In the grades 3 and 4 groups, cartilage thickness became thinner as OA progressed (p < 0.001 and p < 0.001, respectively). However, the cartilage echo intensity was not significantly enhanced compared with that of the grade 2 group (n.s.). There were no significant differences in the cartilage thickness and echo intensity between the early OA and control groups on the longitudinal images (n.s.). CONCLUSIONS The echo intensity of the medial femoral cartilage was high in patients with KL grade 2, without decreased thickness. Our findings suggested that higher echo intensity is a feature of early cartilage degeneration in mild knee OA. Further studies are needed to establish this feature as a useful screening parameter of early cartilage degeneration in knee OA. LEVEL OF EVIDENCE Level III.
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Affiliation(s)
- Shogo Okada
- A Human Health Sciences, Graduate School of Medicine, Kyoto University, 53 Kawahara-Cho, Shogoin, Sakyo-Ku, Kyoto, 606-8507, Japan
| | - Masashi Taniguchi
- A Human Health Sciences, Graduate School of Medicine, Kyoto University, 53 Kawahara-Cho, Shogoin, Sakyo-Ku, Kyoto, 606-8507, Japan.
| | - Masahide Yagi
- A Human Health Sciences, Graduate School of Medicine, Kyoto University, 53 Kawahara-Cho, Shogoin, Sakyo-Ku, Kyoto, 606-8507, Japan
| | - Yoshiki Motomura
- A Human Health Sciences, Graduate School of Medicine, Kyoto University, 53 Kawahara-Cho, Shogoin, Sakyo-Ku, Kyoto, 606-8507, Japan
- Kobayashi Hospital, 50-35 Kuzetakada-Cho, Minami-Ku, Kyoto, 601-8211, Japan
| | - Sayaka Okada
- A Human Health Sciences, Graduate School of Medicine, Kyoto University, 53 Kawahara-Cho, Shogoin, Sakyo-Ku, Kyoto, 606-8507, Japan
| | - Yoshihiro Fukumoto
- A Human Health Sciences, Graduate School of Medicine, Kyoto University, 53 Kawahara-Cho, Shogoin, Sakyo-Ku, Kyoto, 606-8507, Japan
- Faculty of Rehabilitation, Kansai Medical University, 18-89 Uyamahigashicho, Hirakata, Osaka, 573-1136, Japan
| | - Masashi Kobayashi
- Kobayashi Hospital, 50-35 Kuzetakada-Cho, Minami-Ku, Kyoto, 601-8211, Japan
| | - Kyoseki Kanemitsu
- Kanemitsu Clinic, 33-2 Enmamae-Cho, Kamigyo-Ku, Kyoto, 602-8307, Japan
| | - Noriaki Ichihashi
- A Human Health Sciences, Graduate School of Medicine, Kyoto University, 53 Kawahara-Cho, Shogoin, Sakyo-Ku, Kyoto, 606-8507, Japan
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Liao TC, Pedoia V, Link TM, Majumdar S, Souza RB. Association of patella alignment with cartilage relaxation times and self-reported symptoms in individuals with patellofemoral degeneration. J Orthop Res 2023; 41:562-569. [PMID: 35598282 PMCID: PMC9679042 DOI: 10.1002/jor.25384] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/11/2021] [Revised: 05/06/2022] [Accepted: 05/17/2022] [Indexed: 02/04/2023]
Abstract
To determine the cross-sectional and longitudinal associations of patella alignment with cartilage relaxation and patients' self-reported symptoms. Thirty participants with isolated patellofemoral joint (PFJ) degeneration (six males, 53.7 ± 9.3 years) and 24 controls (12 males, 47.6 ± 10.7 years) were included. Magnetic resonance assessment was performed to provide grading of structural abnormalities, cartilage relaxation times, and patella alignment. Self-reported symptoms were assessed using the self-administrated knee injury and osteoarthritis outcome score (KOOS). All participants were examined at baseline and 3 years. Statistical parametric mapping and Pearson partial correlation were used to evaluate the associations between patella alignment with cartilage relaxation times and self-reported symptoms, respectively. The analyses were performed between baseline (cross-sectional) as well as the baseline against 3 years (longitudinal). Results indicated that patella height and patella flexion were associated with T1ρ and T2 relaxation times at baseline (percentages of voxels showing significant correlation [PSV] = 10.1%-24.8%; mean correlations [R] = 0.34-0.36; mean p = 0.015-0.026). Furthermore, greater patella lateral alignment, lateral tilt, and lateral spin were associated with longer T2 times at 3 years (PSV = 11.0%-14.4%, R = 0.39-0.44, p = 0.017-0.028). Last, a higher patella was associated with a lower KOOS at baseline and at 3 years (R = -0.33 to -0.35). The study suggests that patella malalignment is a risk factor for worsening cartilage health, informing clinicians of a better rehabilitation program that targets PFJ degeneration.
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Affiliation(s)
- Tzu-Chieh Liao
- Department of Physical Therapy, University of Michigan-Flint, Flint, MI, USA
- Department of Radiology, University of Michigan, Ann Arbor, MI, USA
| | - Valentina Pedoia
- Department of Radiology and Biomedical Imaging, University of California-San Francisco, San Francisco, CA, USA
| | - Thomas M. Link
- Department of Radiology and Biomedical Imaging, University of California-San Francisco, San Francisco, CA, USA
| | - Sharmila Majumdar
- Department of Radiology and Biomedical Imaging, University of California-San Francisco, San Francisco, CA, USA
| | - Richard B. Souza
- Department of Radiology and Biomedical Imaging, University of California-San Francisco, San Francisco, CA, USA
- Department of Physical Therapy and Rehabilitation Science, University of California-San Francisco, CA, USA
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Advanced MR Imaging for Knee Osteoarthritis: A Review on Local and Brain Effects. Diagnostics (Basel) 2022; 13:diagnostics13010054. [PMID: 36611346 PMCID: PMC9818324 DOI: 10.3390/diagnostics13010054] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2022] [Revised: 12/13/2022] [Accepted: 12/20/2022] [Indexed: 12/28/2022] Open
Abstract
Knee osteoarthritis is one of the leading causes of chronic disability worldwide and is a significant social and economic burden on healthcare systems; hence it has become essential to develop methods to identify patients at risk for developing knee osteoarthritis at an early stage. Standard morphological MRI sequences are focused mostly on alterations seen in advanced stages of osteoarthritis. However, they possess low sensitivity for early, subtle, and potentially reversible changes of the degenerative process. In this review, we have summarized the state of the art with regard to innovative quantitative MRI techniques that exploit objective and quantifiable biomarkers to identify subtle alterations that occur in early stages of osteoarthritis in knee cartilage before any morphological alteration occurs and to capture potential effects on the brain. These novel MRI imaging tools are believed to have great potential for improving the current standard of care, but further research is needed to address limitations before these compositional techniques can be robustly applied in research and clinical settings.
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Khandelwal R, Kharat A, Botchu R, Koganti D, Shah VP. High resolution T2∗ mapping in assessment of knee articular cartilage on 3T MRI. J Clin Orthop Trauma 2022; 27:101823. [PMID: 35251934 PMCID: PMC8894233 DOI: 10.1016/j.jcot.2022.101823] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/14/2021] [Revised: 01/26/2022] [Accepted: 02/22/2022] [Indexed: 11/16/2022] Open
Abstract
OBJECTIVE To evaluate the spectrum of T2∗ values in healthy cartilage of young asymptomatic adults on high resolution 3T MRI. METHODS A total of 50 asymptomatic adult volunteers with age ranging from 18 to 35 years were enrolled for the study with the purpose of assessing T2∗ values in healthy cartilage without any degenerative changes. The articular cartilage was assessed on two sections, one each through the medial and lateral compartments. The cartilage was segmented into 8 regions through the tibio-femoral and patella-femoral joints. Further post processing was done using multiple ROI placement to delineate ROI areas for calculation of full thickness and zonal (superficial and deep) T2∗ values. Thus, a total of 1200 ROI areas (50 volunteers, 8 segments, and 3 areas for each segment) were assessed. RESULTS The results revealed a superior bulk T2∗ value of 29.2 ± 3.6 ms from the posterior medial femoral cartilage and 26.1 ± 3.1 ms from the patellar region. Intermediate values were obtained from posterior lateral femoral cartilage, central femoral cartilage, and trochlea. The tibial plateau cartilage had the lowest values - 19.6 ± 2.6 ms for the medial tibial plateau and 20.6 ± 2.8 ms for lateral tibial plateau. The study demonstrated substantial regional physiological variation existing in the T2∗ values across various regions of the knee joint, which could be attributed to varying amounts of shearing forces across the joint. No significant differences were noted in bulk T2∗ values between the two genders, with only the trochlear segment revealing significantly increased values in males (p = 0.007). All the cartilage segments revealed significantly increased T2∗ values in the superficial zone as compared to the deep zone. CONCLUSION There is a significant regional difference in the bulk T2∗ values of articular cartilage in a normal physiological state across various joint segments. A zonal gradient with increasing values from the deep to the superficial zone also exists. These findings can prove invaluable in assessing changes in T2∗ values occurring in diseased/degenerative cartilage.
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Affiliation(s)
- Rachit Khandelwal
- Department of Radiodiagnosis, Dr D Y Patil Medical College, Hospital and Research Centre, Pimpri, 411018, India
| | - Amit Kharat
- Department of Radiodiagnosis, Dr D Y Patil Medical College, Hospital and Research Centre, Pimpri, 411018, India
| | - Rajesh Botchu
- Royal Orthopaedic Hospital, Birmhingham, United Kingdom
| | - Deepak Koganti
- Department of Radiodiagnosis, Dr D Y Patil Medical College, Hospital and Research Centre, Pimpri, 411018, India,Corresponding author.
| | - Viraj P. Shah
- Department of Radiodiagnosis, Dr D Y Patil Medical College, Hospital and Research Centre, Pimpri, 411018, India
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Joseph GB, McCulloch CE, Sohn JH, Pedoia V, Majumdar S, Link TM. AI MSK clinical applications: cartilage and osteoarthritis. Skeletal Radiol 2022; 51:331-343. [PMID: 34735607 DOI: 10.1007/s00256-021-03909-2] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/14/2021] [Revised: 09/08/2021] [Accepted: 09/12/2021] [Indexed: 02/02/2023]
Abstract
The advancements of artificial intelligence (AI) for osteoarthritis (OA) applications have been rapid in recent years, particularly innovations of deep learning for image classification, lesion detection, cartilage segmentation, and prediction modeling of future knee OA development. This review article focuses on AI applications in OA research, first describing machine learning (ML) techniques and workflow, followed by how these algorithms are used for OA classification tasks through imaging and non-imaging-based ML models. Deep learning applications for OA research, including analysis of both radiographs for automatic detection of OA severity, and MR images for detection of cartilage/meniscus lesions and cartilage segmentation for automatic T2 quantification will be described. In addition, information on ML models that identify individuals at high risk of OA development will be provided. The future vision of machine learning applications in imaging of OA and cartilage hinges on implementation of AI for optimizing imaging protocols, quantitative assessment of cartilage, and automated analysis of disease burden yielding a faster and more efficient workflow for a radiologist with a higher level of reproducibility and precision. It may also provide risk assessment tools for individual patients, which is an integral part of precision medicine.
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Affiliation(s)
- Gabby B Joseph
- Department of Radiology and Biomedical Imaging, University of California, 185 Berry St, Suite 350, San Francisco, CA, 94158, USA.
| | - Charles E McCulloch
- Department of Epidemiology and Biostatistics, University of California, San Francisco, CA, USA
| | - Jae Ho Sohn
- Department of Radiology and Biomedical Imaging, University of California, 185 Berry St, Suite 350, San Francisco, CA, 94158, USA
| | - Valentina Pedoia
- Department of Radiology and Biomedical Imaging, University of California, 185 Berry St, Suite 350, San Francisco, CA, 94158, USA
| | - Sharmila Majumdar
- Department of Radiology and Biomedical Imaging, University of California, 185 Berry St, Suite 350, San Francisco, CA, 94158, USA
| | - Thomas M Link
- Department of Radiology and Biomedical Imaging, University of California, 185 Berry St, Suite 350, San Francisco, CA, 94158, USA
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Van Genechten W, Vuylsteke K, Struijk C, Swinnen L, Verdonk P. Joint Surface Lesions in the Knee Treated with an Acellular Aragonite-Based Scaffold: A 3-Year Follow-Up Case Series. Cartilage 2021; 13:1217S-1227S. [PMID: 33448238 PMCID: PMC8808874 DOI: 10.1177/1947603520988164] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/21/2022] Open
Abstract
OBJECTIVE The study aimed to evaluate the clinical outcome and repair capacity of a cell-free aragonite-based scaffold in patients with an isolated symptomatic joint surface lesion (JSL) of the knee. DESIGN Thirteen patients (age 33.5 ± 8.9; female 23%; body mass index 25.3 ± 3.4, K/L [Kellgren-Lawrence] 1.8) with a JSL (2.6 ± 1.7 cm2 [1.0-7.5 cm2]) of the distal femur were enrolled in a single-center prospective case series. Safety and clinical outcome was assessed by the KOOS (Knee Injury and Osteoarthritis Outcome Score), IKDC (International Knee Documentation Committee), Lysholm, and Tegner activity scale at baseline and 6, 12, 18, 24, and 36 months follow-up. The MOCART 2.0 and scaffold integration were evaluated on magnetic resonance imaging at 12, 24, and 36 months postoperatively. RESULTS Primary outcome (KOOS pain) improved with 36.5 ± 14.7 points at 12 months (P = 0.002) and 41.2 ± 14.7 points at 36 months (P = 0.002) follow-up. Similar increasing trends were observed for the other KOOS subscales, IKDC, and Lysholm score, which were significantly better at each follow-up time point relative to baseline (P < 0.05). Activity level increased from 2.75 ± 1.6 to 4.6 ± 2.2 points at final follow-up (P = 0.07). The MOCART was 61.7 ± 12.6 at 12 months and 72.9 ± 13.0 at 36 months postoperatively. Sixty-six to 100% implant integration and remodeling was observed in 73.3% cases at 36 months. No serious adverse events were reported. CONCLUSION The study demonstrated that the biphasic aragonite-based scaffold is a safe and clinically effective implant for treating small-medium sized JSLs of the distal femur in a young and active patient cohort. The implant showed satisfying osteointegration and restoration of the osteochondral unit up to 3 years postimplantation.
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Affiliation(s)
- Wouter Van Genechten
- MoRe Foundation, Antwerp, Belgium,Antwerp University, Antwerp,
Belgium,Wouter Van Genechten, MoRe Foundation,
Stevenslei 20, Antwerp 2100, Belgium.
| | | | | | - Linus Swinnen
- Department of Radiology, AZ Monica,
Antwerp-Deurne, Antwerp, Belgium
| | - Peter Verdonk
- MoRe Foundation, Antwerp, Belgium,Antwerp University, Antwerp,
Belgium,ORTHOCA, Antwerp, Belgium
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Fernquest S, Palmer A, Pereira C, Arnold C, Hirons E, Broomfield J, Newman S, Glyn-Jones S. The Response of Hip Joint Cartilage to Exercise in Children: An MRI Study Using T2-Mapping. Cartilage 2021; 13:1761S-1771S. [PMID: 32532161 PMCID: PMC8808918 DOI: 10.1177/1947603520931182] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
OBJECTIVE The aim of this study was to determine the effects of activity and cam morphology on cartilage composition during adolescence and investigate the development of cartilage composition with age. DESIGN Cross-sectional observational cohort study of individuals from football club academies and an age-matched control population, aged 9 to 18 years. Assessments included questionnaires and T2-mapping of hips. Primary imaging outcome measures were T2 relaxation time of acetabular and femoral cartilage, average alpha angle, and lateral epiphyseal extension. RESULTS The cohort consisted of 109 elite male footballers, 49 male controls, and 51 female controls. Elite male footballers had an acetabular cartilage T2 value 4.85 ms greater than male controls (P < 0.001). A significant positive correlation existed between Physical Activity Questionnaire Score and acetabular cartilage T2 value (coefficient 1.07, P < 0.001) and femoral cartilage T2 value (coefficient 0.66, P = 0.032). Individuals with a closed physis had an acetabular cartilage T2 value 7.86 ms less than individuals with an open physis. Acetabular cartilage T2 values decreased with age in elite footballers. No correlation existed between alpha angle and anterosuperior acetabular cartilage T2 value and no difference in T2 value existed between individuals with and without cam morphology. CONCLUSIONS This study demonstrates that high activity levels may significantly affect acetabular cartilage composition during adolescence, but cam morphology may not detrimentally affect cartilage composition until after adolescence.
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Affiliation(s)
- Scott Fernquest
- Botnar Research Centre, Nuffield
Department of Orthopaedics, Rheumatology, and Musculoskeletal Sciences, University
of Oxford, Oxford, UK,Scott Fernquest, Botnar Research Centre,
Nuffield Department of Orthopaedics, Rheumatology, and Musculoskeletal Sciences,
University of Oxford, Old Road, Oxford, OX3 7LD, UK.
| | - Antony Palmer
- Botnar Research Centre, Nuffield
Department of Orthopaedics, Rheumatology, and Musculoskeletal Sciences, University
of Oxford, Oxford, UK
| | - Claudio Pereira
- Botnar Research Centre, Nuffield
Department of Orthopaedics, Rheumatology, and Musculoskeletal Sciences, University
of Oxford, Oxford, UK
| | - Calum Arnold
- Botnar Research Centre, Nuffield
Department of Orthopaedics, Rheumatology, and Musculoskeletal Sciences, University
of Oxford, Oxford, UK
| | - Emma Hirons
- Botnar Research Centre, Nuffield
Department of Orthopaedics, Rheumatology, and Musculoskeletal Sciences, University
of Oxford, Oxford, UK
| | - John Broomfield
- Botnar Research Centre, Nuffield
Department of Orthopaedics, Rheumatology, and Musculoskeletal Sciences, University
of Oxford, Oxford, UK
| | - Simon Newman
- Botnar Research Centre, Nuffield
Department of Orthopaedics, Rheumatology, and Musculoskeletal Sciences, University
of Oxford, Oxford, UK
| | - Sion Glyn-Jones
- Botnar Research Centre, Nuffield
Department of Orthopaedics, Rheumatology, and Musculoskeletal Sciences, University
of Oxford, Oxford, UK
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11
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Foreman SC, Liu Y, Nevitt MC, Neumann J, Joseph GB, Lane NE, McCulloch CE, Link TM. Meniscal Root Tears and Extrusion Are Significantly Associated with the Development of Accelerated Knee Osteoarthritis: Data from the Osteoarthritis Initiative. Cartilage 2021; 13:239S-248S. [PMID: 32567341 PMCID: PMC8808926 DOI: 10.1177/1947603520934525] [Citation(s) in RCA: 25] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/19/2022] Open
Abstract
OBJECTIVE To identify joint structural risk factors, measured using quantitative compositional and semiquantitative magnetic resonance imaging (MRI) scoring, associated with the development of accelerated knee osteoarthritis (AKOA) compared with a more normal rate of knee osteoarthritis (OA) development. DESIGN From the Osteoarthritis Initiative we selected knees with no radiographic OA (Kellgren-Lawrence grade [KL] 0/1) that developed advanced-stage OA (KL 3/4; AKOA) within a 4-year timeframe and a comparison group with a more normal rate of OA development (KL 0/1 to KL 2 in 4 years). MRIs at the beginning of the 4-year timeframe were assessed for cartilage T2 values and structural abnormalities using a modified Whole-Organ Magnetic Resonance Imaging Score (WORMS). Associations of MRI findings with AKOA versus normal OA were assessed using multivariable logistic regression models. RESULTS A total of 106 AKOA and 168 subjects with normal OA development were included. Mean cartilage T2 values were not significantly associated with AKOA (odds ratio [OR] 1.06; 95% confidence interval [CI] 0.82-1.36). Risk factors for AKOA development included higher meniscus maximum scores (OR 1.37; 95% CI 1.11-1.68), presence of meniscal extrusion (OR 6.30; 95% CI 2.57-15.49), presence of root tears (OR 4.64; 95% CI 1.61-13.34), and higher medial tibia cartilage lesion scores (OR 1.96; 95% CI 1.19-3.24). CONCLUSIONS We identified meniscal damage, especially meniscal extrusion and meniscal root tears as risk factors for AKOA development. These findings contribute to identifying subjects at risk of AKOA at an early stage when preventative measures targeting modifiable risk factors such as meniscal repair surgery could still be effective.
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Affiliation(s)
- Sarah C. Foreman
- Department of Radiology and Biomedical
Imaging, University of California, San Francisco, CA, USA,Department of Radiology, Technische
Universität München, Munich, Germany,Sarah C. Foreman, Department of Radiology
and Biomedical Imaging, University of California, San Francisco, 185 Berry
Street, Lobby 6, Suite 350, San Francisco, CA 94107, USA.
| | - Yao Liu
- Department of Radiology and Biomedical
Imaging, University of California, San Francisco, CA, USA
| | - Michael C. Nevitt
- Department of Epidemiology and
Biostatistics, University of California, San Francisco, CA, USA
| | - Jan Neumann
- Department of Radiology, Technische
Universität München, Munich, Germany
| | - Gabby B. Joseph
- Department of Radiology and Biomedical
Imaging, University of California, San Francisco, CA, USA
| | - Nancy E. Lane
- Department of Medicine, University of
California, Davis, CA, USA
| | - Charles E. McCulloch
- Department of Epidemiology and
Biostatistics, University of California, San Francisco, CA, USA
| | - Thomas M. Link
- Department of Radiology and Biomedical
Imaging, University of California, San Francisco, CA, USA
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12
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Linking physical activity with clinical, functional, and structural outcomes: an evidence map using the Osteoarthritis Initiative. Clin Rheumatol 2021; 41:965-975. [PMID: 34802082 DOI: 10.1007/s10067-021-05995-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2021] [Revised: 10/28/2021] [Accepted: 11/13/2021] [Indexed: 10/19/2022]
Abstract
Physical activity is consistently recommended across clinical practice guidelines for managing knee osteoarthritis, yet prescription rates are low. Evidence mapping uses a systematic approach to visually illustrate and summarize published evidence, highlight gaps in the literature, and formulate research questions. The purpose of this study was to review and summarize evidence published from the Osteoarthritis Initiative (OAI) linking physical activity with clinical, functional, and structural knee osteoarthritis outcomes. Electronic databases were searched until June 2021. Studies from the OAI reporting subjective (Physical Activity Scale for the Elderly, PASE) or objective (accelerometry) physical activity data were included. Scatter plots were created to represent each outcome group (clinical, functional, structural) and physical activity measure (PASE, accelerometry) to map the evidence by the directional effect (positive, interaction, negative, or no effect) associated with physical activity. Forty-two articles were included in this review. Physical activity was quantified using PASE (n = 21), accelerometry (n = 20), or both (n = 1). Studies reported consistently positive physical activity effects on clinical (n = 22) and functional (n = 20) outcomes, with few exceptions. Structural (n = 15) outcomes were largely reported as interaction effects by physical activity intensity or sex, or as no significant effect. A network of interconnected outcomes emerged, with clinical and functional outcomes often reported together, and structural outcomes reported individually. This study provides an overview of current evidence linking physical activity to multiple interrelated knee osteoarthritis outcomes using an OAI-driven model. These evidence maps can be used as a framework to guide future investigations of the effects of physical activity on knee osteoarthritis.
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13
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Crowder HA, Mazzoli V, Black MS, Watkins LE, Kogan F, Hargreaves BA, Levenston ME, Gold GE. Characterizing the transient response of knee cartilage to running: Decreases in cartilage T 2 of female recreational runners. J Orthop Res 2021; 39:2340-2352. [PMID: 33483997 PMCID: PMC8295402 DOI: 10.1002/jor.24994] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/01/2020] [Revised: 11/20/2020] [Accepted: 01/19/2021] [Indexed: 02/04/2023]
Abstract
Cartilage transmits and redistributes biomechanical loads in the knee joint during exercise. Exercise-induced loading alters cartilage hydration and is detectable using quantitative magnetic resonance imaging (MRI), where T2 relaxation time (T2 ) is influenced by cartilage collagen composition, fiber orientation, and changes in the extracellular matrix. This study characterized short-term transient responses of healthy knee cartilage to running-induced loading using bilateral scans and image registration. Eleven healthy female recreational runners (33.73 ± 4.22 years) and four healthy female controls (27.25 ± 1.38 years) were scanned on a 3T GE MRI scanner with quantitative 3D double-echo in steady-state before running over-ground (runner group) or resting (control group) for 40 min. Subjects were scanned immediately post-activity at 5-min intervals for 60 min. T2 times were calculated for femoral, tibial, and patellar cartilage at each time point and analyzed using a mixed-effects model and Bonferroni post hoc. There were immediate decreases in T2 (mean ± SEM) post-run in superficial femoral cartilage of at least 3.3% ± 0.3% (p = .002) between baseline and Time 0 that remained for 25 min, a decrease in superficial tibial cartilage T2 of 2.9% ± 0.4% (p = .041) between baseline and Time 0, and a decrease in superficial patellar cartilage T2 of 3.6% ± 0.3% (p = .020) 15 min post-run. There were decreases in the medial posterior region of superficial femoral cartilage T2 of at least 5.3 ± 0.2% (p = .022) within 5 min post-run that remained at 60 min post-run. These results increase understanding of transient responses of healthy cartilage to repetitive, exercise-induced loading and establish preliminary recommendations for future definitive studies of cartilage response to running.
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Affiliation(s)
- Hollis A. Crowder
- Department of Mechanical Engineering, Stanford University, Stanford, California, USA,Department of Radiology, Stanford University, Stanford, California, USA
| | - Valentina Mazzoli
- Department of Radiology, Stanford University, Stanford, California, USA
| | - Marianne S. Black
- Department of Radiology, Stanford University, Stanford, California, USA
| | - Lauren E. Watkins
- Department of Radiology, Stanford University, Stanford, California, USA,Department of Bioengineering, Stanford University, Stanford, California, USA
| | - Feliks Kogan
- Department of Radiology, Stanford University, Stanford, California, USA
| | - Brian A. Hargreaves
- Department of Radiology, Stanford University, Stanford, California, USA,Department of Bioengineering, Stanford University, Stanford, California, USA,Department of Electrical Engineering, Stanford University, Stanford, California, USA
| | - Marc E. Levenston
- Department of Mechanical Engineering, Stanford University, Stanford, California, USA,Department of Radiology, Stanford University, Stanford, California, USA
| | - Garry E. Gold
- Department of Radiology, Stanford University, Stanford, California, USA
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14
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Gersing AS, Schwaiger BJ, Nevitt MC, Joseph GB, Feuerriegel G, Jungmann PM, Guimaraes JB, Facchetti L, McCulloch CE, Makowski MR, Link TM. Anterior cruciate ligament abnormalities are associated with accelerated progression of knee joint degeneration in knees with and without structural knee joint abnormalities: 96-month data from the Osteoarthritis Initiative. Osteoarthritis Cartilage 2021; 29:995-1005. [PMID: 33775919 PMCID: PMC8217143 DOI: 10.1016/j.joca.2021.03.011] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/11/2020] [Revised: 03/11/2021] [Accepted: 03/16/2021] [Indexed: 02/02/2023]
Abstract
OBJECTIVE To compare progression over 8 years in knee compositional cartilage degeneration and structural joint abnormalities in knees with different types of anterior cruciate ligament (ACL) abnormalities over 8 years. METHOD Baseline MR images of the right knees of 1899 individuals of the Osteoarthritis Initiative (OAI) with no evidence of or mild to moderate radiographic osteoarthritis were assessed for nontraumatic ACL abnormalities. The knees of 91 individuals showed nontraumatic ACL abnormalities (age 60.6 ± 9.8 y, 46 females; mucoid degeneration (MD), N = 37; complete tear (CT), N = 22; partial tear (PT), N = 32) and were frequency-matched to 91 individuals with normal ACL. MRIs were assessed for knee joint abnormalities using the Whole-Organ Magnetic Resonance Imaging Score (WORMS) and cartilage T2 mapping at baseline, 4- and 8-year follow-up. RESULTS Over 8 years, cartilage T2 values of the medial tibia showed a significantly greater increase in individuals with MD, PT or CT compared to those with normal ACL (adjusted rate of change/year [95% confidence interval], normal ACL: 0.06 [0.01, 0.23], MD: 0.34 [0.07, 0.73], PT, 0.21 [0.02, 0.33], CT, 0.51 [0.16, 0.78]), indicating an association of ACL abnormalities and an increased progression rate of cartilage degeneration in subjects with and without knee joint degeneration. This effect was also seen in cartilage T2 values averaged over all compartments (normal ACL: 0.08 [0.05, 0.20] vs abnormal ACL: 0.27 [0.06, 0.56]). CONCLUSIONS Over 8 years, higher progression rates of cartilage degeneration, especially in the medial tibia, were associated with ACL abnormalities compared to those with normal ACL, in subjects with and without knee joint abnormalities.
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Affiliation(s)
- Alexandra S. Gersing
- Department of Radiology and Biomedical Imaging, University of California, San Francisco,Department of Radiology, School of Medicine, Technical University of Munich, Munich, Germany,Department of Neuroradiology, University Hospital, LMU Munich, Munich, Germany
| | - Benedikt J. Schwaiger
- Department of Neuroradiology, School of Medicine, Technical University of Munich, Munich, Germany
| | - Michael C. Nevitt
- Department of Epidemiology and Biostatistics, University of California, San Francisco
| | - Gabby B. Joseph
- Department of Radiology and Biomedical Imaging, University of California, San Francisco
| | - Georg Feuerriegel
- Department of Radiology, School of Medicine, Technical University of Munich, Munich, Germany
| | - Pia M. Jungmann
- Department of Diagnostic and Interventional Radiology, Medical Center - University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Julio B. Guimaraes
- Department of Radiology and Biomedical Imaging, University of California, San Francisco
| | - Luca Facchetti
- Department of Radiology and Biomedical Imaging, University of California, San Francisco
| | - Charles E. McCulloch
- Department of Epidemiology and Biostatistics, University of California, San Francisco
| | - Marcus R. Makowski
- Department of Radiology, School of Medicine, Technical University of Munich, Munich, Germany
| | - Thomas M. Link
- Department of Radiology and Biomedical Imaging, University of California, San Francisco
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15
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Automated cartilage segmentation and quantification using 3D ultrashort echo time (UTE) cones MR imaging with deep convolutional neural networks. Eur Radiol 2021; 31:7653-7663. [PMID: 33783571 DOI: 10.1007/s00330-021-07853-6] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2020] [Revised: 12/18/2020] [Accepted: 01/15/2021] [Indexed: 10/21/2022]
Abstract
OBJECTIVE To develop a fully automated full-thickness cartilage segmentation and mapping of T1, T1ρ, and T2*, as well as macromolecular fraction (MMF) by combining a series of quantitative 3D ultrashort echo time (UTE) cones MR imaging with a transfer learning-based U-Net convolutional neural networks (CNN) model. METHODS Sixty-five participants (20 normal, 29 doubtful-minimal osteoarthritis (OA), and 16 moderate-severe OA) were scanned using 3D UTE cones T1 (Cones-T1), adiabatic T1ρ (Cones-AdiabT1ρ), T2* (Cones-T2*), and magnetization transfer (Cones-MT) sequences at 3 T. Manual segmentation was performed by two experienced radiologists, and automatic segmentation was completed using the proposed U-Net CNN model. The accuracy of cartilage segmentation was evaluated using the Dice score and volumetric overlap error (VOE). Pearson correlation coefficient and intraclass correlation coefficient (ICC) were calculated to evaluate the consistency of quantitative MR parameters extracted from automatic and manual segmentations. UTE biomarkers were compared among different subject groups using one-way ANOVA. RESULTS The U-Net CNN model provided reliable cartilage segmentation with a mean Dice score of 0.82 and a mean VOE of 29.86%. The consistency of Cones-T1, Cones-AdiabT1ρ, Cones-T2*, and MMF calculated using automatic and manual segmentations ranged from 0.91 to 0.99 for Pearson correlation coefficients, and from 0.91 to 0.96 for ICCs, respectively. Significant increases in Cones-T1, Cones-AdiabT1ρ, and Cones-T2* (p < 0.05) and a decrease in MMF (p < 0.001) were observed in doubtful-minimal OA and/or moderate-severe OA over normal controls. CONCLUSION Quantitative 3D UTE cones MR imaging combined with the proposed U-Net CNN model allows a fully automated comprehensive assessment of articular cartilage. KEY POINTS • 3D UTE cones imaging combined with U-Net CNN model was able to provide fully automated cartilage segmentation. • UTE parameters obtained from automatic segmentation were able to reliably provide a quantitative assessment of cartilage.
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16
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Liao TC, Jergas H, Tibrewala R, Bahroos E, Link TM, Majumdar S, Souza RB, Pedoia V. Longitudinal analysis of the contribution of 3D patella and trochlear bone shape on patellofemoral joint osteoarthritic features. J Orthop Res 2021; 39:506-515. [PMID: 32827327 PMCID: PMC8915432 DOI: 10.1002/jor.24836] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/06/2020] [Revised: 08/02/2020] [Accepted: 08/18/2020] [Indexed: 02/04/2023]
Abstract
To explore bone shape features that are associated with patellofemoral joint (PFJ) osteoarthritic features. Thirty subjects with PFJ degeneration (six males, 53.2 ± 9.8 years) and 23 controls (12 males, 48.1 ± 10.6 years) were included. Magnetic resonance (MR) assessment was performed to provide bone segmentation, morpholgocial grading, and cartilage relaxation times. In addition, subject self-reported symptoms were reported. Logistic regressions were used to identify the shape features that were associated with the presence and worsening of PFJ morphological lesions over 3 years, and worsening of self-reported symptoms. Statistical parametric mapping was used to evaluate the associations between shape features and cartilage relaxation times at 3 years. Results indicated that subjects with PFJ degeneration exhibited a trochlea with longer lateral condyle and shallower trochlear groove (adjusted odds ratio [OR] = 0.30; 95% confidence interval [CI]: 0.10, 0.86; P = .025). Subjects with worsening of PFJ degeneration exhibited a patella with equally distributed facets (adjusted OR = 3.14; 95% CI: 1.05, 9.37; P = .040) and lateral bump (adjusted OR = 0.14; 95% CI: 0.02, 0.83; P = .030). No shape features were associated with worsening of self-reported symptoms. Elevated T1ρ and T2 times at 3 years were associated with a patella with a lateral hook, equally distributed facets, round and thick as well as a trochlea larger in size (R = 0.38~0.46, P = .015~.025). The study demonstrated the ability of 3D statistical shape modeling to quantify patella and trochlear bone shape features that are associated with the presence and progression of PFJ osteoarthritic features.
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Affiliation(s)
- Tzu-Chieh Liao
- Department of Radiology and Biomedical Imaging, University of California-San Francisco, San Francisco, CA, USA
| | - Hannah Jergas
- Department of Radiology and Biomedical Imaging, University of California-San Francisco, San Francisco, CA, USA
| | - Radhika Tibrewala
- Department of Radiology and Biomedical Imaging, University of California-San Francisco, San Francisco, CA, USA
| | - Emma Bahroos
- Department of Radiology and Biomedical Imaging, University of California-San Francisco, San Francisco, CA, USA
| | - Thomas M. Link
- Department of Radiology and Biomedical Imaging, University of California-San Francisco, San Francisco, CA, USA
| | - Sharmila Majumdar
- Department of Radiology and Biomedical Imaging, University of California-San Francisco, San Francisco, CA, USA
| | - Richard B. Souza
- Department of Radiology and Biomedical Imaging, University of California-San Francisco, San Francisco, CA, USA,Department of Physical Therapy and Rehabilitation Science, University of California-San Francisco, CA, USA
| | - Valentina Pedoia
- Department of Radiology and Biomedical Imaging, University of California-San Francisco, San Francisco, CA, USA
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17
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Matcuk GR, Jones IA, McIntyre JA, Burt R, Hwang D, Cen S, Schein AJ, Vangsness CT. Evaluation of Knee Cartilage Diurnal, Activity, and BMI-Related Variations Using Quantitative T2 Mapping MRI and Fitbit Activity Tracking. J Knee Surg 2021; 34:251-257. [PMID: 31434143 DOI: 10.1055/s-0039-1695000] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
The aim of this study is to evaluate diurnal variation in knee cartilage 3 Tesla magnetic resonance imaging (MRI) T2 mapping relaxation times, as well as activity- and body mass index (BMI)-dependent variability, using quantitative analysis of T2 values from segmented regions of the weight-bearing articular surfaces of the medial and lateral femoral condyles and tibial plateaus. Ten healthy volunteers' daily activity (steps) were tracked with Fitbit pedometers. Sagittal MRI T2 maps were obtained in the morning and afternoon on days 2 and 3. Mean T2 values were analyzed for variation related to the number of steps taken (activity), time of day (diurnal variation), and BMI using mixed effect model. Significant (albeit small) differences in the medial femoral and medial tibial cartilage regions were identified between morning and afternoon scans (diurnal variation). Daily activity did not result in significant changes and increasing BMI only demonstrated a slight increase in T2 values for the lateral tibial plateau. These findings suggest that it may be necessary to control diurnal variation when using quantitative MRI T2 mapping to assess articular cartilage longitudinally in healthy participants. Further investigation is needed to confirm these findings and determine if they also apply to symptomatic patients.
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Affiliation(s)
- George R Matcuk
- Department of Radiology, University of Southern California, Los Angeles, California
| | - Ian A Jones
- Department of Orthopaedic Surgery, University of Southern California, Los Angeles, California
| | - J Alex McIntyre
- School of Medicine and Health Sciences, George Washington University, Washington, District of Columbia
| | - Robert Burt
- Keck School of Medicine, University of Southern California, Los Angeles, California
| | - Darryl Hwang
- Department of Radiology, University of Southern California, Los Angeles, California
| | - Steven Cen
- Department of Radiology, University of Southern California, Los Angeles, California
| | - Aaron J Schein
- Department of Radiology, University of Southern California, Los Angeles, California
| | - C Thomas Vangsness
- Department of Orthopaedic Surgery, University of Southern California, Los Angeles, California
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18
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Horiuchi S, Yu HJ, Luk A, Rudd A, Ton J, Kuoy E, Russell JA, Sharp K, Yoshioka H. T1rho and T2 mapping of ankle cartilage of female and male ballet dancers. Acta Radiol 2020; 61:1365-1376. [PMID: 32028774 DOI: 10.1177/0284185120902381] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
BACKGROUND Since ballet dancers begin their training before skeletal maturity, accurate and non-invasive identification of cartilage diseases is clinically important. Angle-dependent analysis of T1rho and T2 sequences can be useful for quantification of the composition of cartilage. PURPOSE To investigate the angle-dependent T1rho and T2 profiles of ankle cartilage in non-dancers and dancers. MATERIAL AND METHODS Ten female non-dancers, ten female dancers, and 9 male dancers were evaluated using T1rho and T2 mapping sequences. Manual segmentation of talar and tibial cartilage on these images was performed by two radiologists. Inter- and intra-rater reliabilities were calculated using intraclass correlation coefficients (ICCs) and Bland-Altman analysis. Mean thickness and volume of cartilage were estimated. Angle-dependent relaxation time profiles of talar and tibial cartilage were created. RESULTS ICCs of the number of segmented pixels were poor to excellent. Bland-Altman plots indicated that differences were associated with segment sizes. Segmented cartilage on T1rho demonstrated larger thickness and volume than those on T2 in all populations. Male dancers showed larger cartilage thickness and volume than female dancers and non-dancers. Each cartilage demonstrated angular-dependent T1rho and T2 profiles. Minimal T1rho and T2 values were observed at approximately 180°-200°; higher values were seen at the angle closer to the magic angle. Minimal T2 value of talar cartilage of dancers was larger than that of non-dancers. CONCLUSION In this small cohort study, regional and sex variations of ankle cartilage T1rho and T2 values in dancers and non-dancers were demonstrated using an angle-dependent approach.
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Affiliation(s)
- Saya Horiuchi
- Department of Radiological Sciences, University of California, Irvine, CA, USA
| | - Hon J Yu
- Department of Radiological Sciences, University of California, Irvine, CA, USA
| | - Alex Luk
- Department of Radiological Sciences, University of California, Irvine, CA, USA
| | - Adam Rudd
- Department of Radiological Sciences, University of California, Irvine, CA, USA
| | - Jimmy Ton
- Department of Radiological Sciences, University of California, Irvine, CA, USA
| | - Edward Kuoy
- Department of Radiological Sciences, University of California, Irvine, CA, USA
| | - Jeffrey A Russell
- Science and Health in Artistic Performance, Ohio University, Athens, OH, USA
| | - Kelli Sharp
- Department of Dance, The Claire Trevor School of the Arts, University of California, Irvine, CA, USA
| | - Hiroshi Yoshioka
- Department of Radiological Sciences, University of California, Irvine, CA, USA
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19
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Bindawas SM, Vennu V, Alqarni AM, Abdulrahman TA. Physical performance and activity among older adults visiting primary healthcare centres in Riyadh. J Int Med Res 2020; 48:300060520956895. [PMID: 32967499 PMCID: PMC7521052 DOI: 10.1177/0300060520956895] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/30/2023] Open
Abstract
Objective To assess physical performance (PP) and physical activity (PA) among older adults visiting primary healthcare centres (PHCCs) in Riyadh. Methods In this cross-sectional study, men and women (n = 74) aged ≥60 years were recruited from five PHCCs across Riyadh, Saudi Arabia, between 19 February and 6 August 2017. The Timed Up & Go test was used to assess PP. Self-reported PA was assessed using the Physical Activity Scale for the Elderly. Means and standard deviations were used to describe PP and PA scores across genders. A two-tailed independent samples t-test was used to estimate mean differences (MD) and 95% confidence intervals (CI) between genders. Results Men scored significantly lower than women on PP (MD: 2.11, 95% CI: 0.59 to 3.64) and PA (MD: −46.1, 95% CI: −80.96 to −11.25). Significant gender differences were observed for leisure time activities (MD: 17.35, 95% CI: 3.29 to 31.40), light household activities (MD: –10.86, 95% CI: –16.19 to –5.53) and heavy household activities (MD: –6.48, 95% CI: –11.73 to –1.23). Conclusions Men show significantly lower PP and PA than women. There are gender differences in leisure time activities and in light and heavy household activities.
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Affiliation(s)
- Saad M Bindawas
- Department of Rehabilitation Sciences, College of Applied Medical Sciences, King Saud University, Riyadh, Saudi Arabia
| | - Vishal Vennu
- Department of Rehabilitation Sciences, College of Applied Medical Sciences, King Saud University, Riyadh, Saudi Arabia
| | - Ayidh M Alqarni
- Department of Physical Therapy, King Abdullah Hospital, Bisha, Saudi Arabia
| | - Tariq A Abdulrahman
- Department of Rehabilitation Sciences, College of Applied Medical Sciences, King Saud University, Riyadh, Saudi Arabia
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20
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Liao TC, Martinez AGM, Pedoia V, Ma BC, Li X, Link TM, Majumdar S, Souza RB. Patellar Malalignment Is Associated With Patellofemoral Lesions and Cartilage Relaxation Times After Hamstring Autograft Anterior Cruciate Ligament Reconstruction. Am J Sports Med 2020; 48:2242-2251. [PMID: 32667267 DOI: 10.1177/0363546520930713] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
BACKGROUND There is growing evidence suggesting a link between patellofemoral joint (PFJ) osteoarthritis in anterior cruciate ligament (ACL)-reconstructed knees and altered joint alignment. PURPOSE To determine whether patellar alignment differs between participants with and without ACL reconstruction (ACLR) and to identify possible associations between patellar alignment and PFJ osteoarthritis features over 3 years. STUDY DESIGN Cohort study; Level of evidence, 2. METHODS A total of 37 participants with ACLR (sex, 23 male; mean ± SD age, 28.1 ± 7.4 years) and 20 healthy controls (13 male; 30.4 ± 4.8 years) participated. Patients underwent magnetic resonance imaging: (1) sagittal T2-weighted fat-saturated fast spin echo images to calculate patellar alignment, (2) sagittal 3-dimensional intermediate-weighted fast spin echo Cube sequence for clinical morphological grading (modified Whole-Organ Magnetic Resonance Imaging Score [WORMS]), and (3) sagittal combined T1ρ/T2 mapping sequence for performing voxel-based relaxometry. Patellar alignment of the ACLR knees were assessed at 6 months (baseline). One-way analysis of variance was used to compare patellar alignment among the ACLR (at 6 months), contralateral, and control knees. Within the ACLR group, a logistic regression model was used to identify if patellar alignment measures at baseline were risk factors for worsening of PFJ structural changes over 3 years. Statistical parametric mapping was used to evaluate the longitudinal associations between patellar alignment and cartilage relaxation times at 3 years. RESULTS When compared with control knees, ACLR knees exhibited a laterally and anteriorly displaced patella (P = .045 and P = .041), less flexion (P = .031), and less lateral spin (P = .012). Furthermore, excessive lateral displacement was a significant predictor of worsening of WORMS (P = .050). Lateral displacement was positively correlated with increased T1ρ and T2 in the patellar and trochlear cartilage at 3 years. Patellar lateral spin revealed similar negative findings. CONCLUSION Participants with ACLR exhibited a laterally and anteriorly displaced patella, less flexion, and less lateral spin when compared with healthy controls. Excessive patellar lateral displacement was the strongest predictor to the development of PFJ osteoarthritis features longitudinally.
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Affiliation(s)
- Tzu-Chieh Liao
- Musculoskeletal Quantitative Imaging Research, Department of Radiology and Biomedical Imaging, University of California, San Francisco, San Francisco, California, USA
| | - Alejandro G Morales Martinez
- Musculoskeletal Quantitative Imaging Research, Department of Radiology and Biomedical Imaging, University of California, San Francisco, San Francisco, California, USA
| | - Valentina Pedoia
- Musculoskeletal Quantitative Imaging Research, Department of Radiology and Biomedical Imaging, University of California, San Francisco, San Francisco, California, USA
| | - Benjamin C Ma
- Musculoskeletal Quantitative Imaging Research, Department of Radiology and Biomedical Imaging, University of California, San Francisco, San Francisco, California, USA.,Department of Orthopaedic Surgery, University of California, San Francisco, San Francisco, California, USA
| | - Xiaojuan Li
- Department of Biomedical Engineering, Program of Advanced Musculoskeletal Imaging, Cleveland Clinic, Cleveland, Ohio, USA
| | - Thomas M Link
- Musculoskeletal Quantitative Imaging Research, Department of Radiology and Biomedical Imaging, University of California, San Francisco, San Francisco, California, USA
| | - Sharmila Majumdar
- Musculoskeletal Quantitative Imaging Research, Department of Radiology and Biomedical Imaging, University of California, San Francisco, San Francisco, California, USA
| | - Richard B Souza
- Musculoskeletal Quantitative Imaging Research, Department of Radiology and Biomedical Imaging, University of California, San Francisco, San Francisco, California, USA.,Department of Physical Therapy and Rehabilitation Science, University of California, San Francisco, San Francisco, California, USA
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21
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Capin JJ, Williams JR, Neal K, Khandha A, Durkee L, Ito N, Stefanik JJ, Snyder-Mackler L, Buchanan TS. Slower Walking Speed Is Related to Early Femoral Trochlear Cartilage Degradation After ACL Reconstruction. J Orthop Res 2020; 38:645-652. [PMID: 31710115 PMCID: PMC7028512 DOI: 10.1002/jor.24503] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/20/2019] [Accepted: 10/14/2019] [Indexed: 02/04/2023]
Abstract
Post-traumatic patellofemoral osteoarthritis (OA) is prevalent after anterior cruciate ligament reconstruction (ACLR) and early cartilage degradation may be especially common in the femoral trochlear cartilage. Determining the presence of and factors associated with early femoral trochlear cartilage degradation, a precursor to OA, is a critical preliminary step in identifying those at risk for patellofemoral OA development and designing interventions to combat the disease. Early cartilage degradation can be detected using quantitative magnetic resonance imaging measures, such as tissue T2 relaxation time. The purposes of this study were to (i) compare involved (ACLR) versus uninvolved (contralateral) femoral trochlear cartilage T2 relaxation times 6 months after ACLR, and (ii) determine the relationship between walking speed and walking mechanics 3 months after ACLR and femoral trochlear cartilage T2 relaxation times 6 months after ACLR. Twenty-six individuals (age 23 ± 7 years) after primary, unilateral ACLR participated in detailed motion analyses 3.3 ± 0.6 months after ACLR and quantitative magnetic resonance imaging 6.3 ± 0.5 months after ACLR. There were no limb differences in femoral trochlear cartilage T2 relaxation times. Slower walking speed was related to higher (worse) femoral trochlear cartilage T2 relaxation times in the involved limb (Pearson's r: -0.583, p = 0.002) and greater interlimb differences in trochlear T2 relaxation times (Pearson's r: -0.349, p = 0.080). Walking mechanics were weakly related to trochlear T2 relaxation times. Statement of clinical significance: Slower walking speed was by far the strongest predictor of worse femoral trochlear cartilage health, suggesting slow walking speed may be an early clinical indicator of future patellofemoral OA after ACLR. © 2019 Orthopaedic Research Society. Published by Wiley Periodicals, Inc. J Orthop Res 38:645-652, 2020.
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Affiliation(s)
- Jacob J. Capin
- Physical Therapy Program, Department of Physical Medicine and Rehabilitation, University of Colorado, Aurora, CO,Eastern Colorado VA Geriatric Research Education and Clinical Center (GRECC), Aurora, CO
| | - Jack R. Williams
- Mechanical Engineering Department, University of Delaware, Newark, DE, USA
| | - Kelsey Neal
- Mechanical Engineering Department, University of Delaware, Newark, DE, USA
| | - Ashutosh Khandha
- Biomedical Engineering Department, University of Delaware, Newark, DE, USA
| | - Laura Durkee
- Athletic Training Education Program, University of Delaware, Newark, DE, USA
| | - Naoaki Ito
- Biomechanics and Movement Science Program, University of Delaware, Newark, DE, USA,Physical Therapy Department, University of Delaware, Newark, DE, USA
| | - Joshua J. Stefanik
- Department of Physical Therapy, Movement and Rehabilitation Sciences, Northeastern University, Boston, MA, USA
| | - Lynn Snyder-Mackler
- Biomedical Engineering Department, University of Delaware, Newark, DE, USA,Biomechanics and Movement Science Program, University of Delaware, Newark, DE, USA,Physical Therapy Department, University of Delaware, Newark, DE, USA,Delaware Rehabilitation Institute, University of Delaware, Newark, DE, USA
| | - Thomas S. Buchanan
- Mechanical Engineering Department, University of Delaware, Newark, DE, USA,Biomedical Engineering Department, University of Delaware, Newark, DE, USA,Delaware Rehabilitation Institute, University of Delaware, Newark, DE, USA
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22
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Chondrocalcinosis is associated with increased knee joint degeneration over 4 years: data from the Osteoarthritis Initiative. Osteoarthritis Cartilage 2020; 28:201-207. [PMID: 31629813 PMCID: PMC7002267 DOI: 10.1016/j.joca.2019.10.003] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/19/2019] [Revised: 08/30/2019] [Accepted: 10/05/2019] [Indexed: 02/02/2023]
Abstract
OBJECTIVE To determine if presence of calcium-containing crystals (CaC) is associated with increased knee joint degeneration over 4 years and assess if total number of CaCs deposited is a useful measure of disease burden. DESIGN Seventy subjects with CaCs in right knees at baseline were selected from the Osteoarthritis Initiative and matched to 70 subjects without evidence of CaCs. T1-weighted gradient-echo sequences were used to confirm presence of CaCs and count the numbers of distinct circumscribed CaCs. Morphological abnormalities were assessed at baseline and 4-year follow-up using the modified semi-quantitative Whole-Organ Magnetic Resonance Imaging Score (WORMS). Linear regression models were used to analyze the associations between presence of CaCs at baseline and changes in WORMS and to analyze the associations between numbers of circumscribed CaCs at baseline and changes in WORMS. RESULTS Presence of CaCs was associated with increased cartilage degeneration in the patella (coefficient: 0.33; 95% confidence interval (CI): 0.04-0.63), the medial femur (coefficient: 0.51; 95% CI: 0.18-0.83), the lateral tibia (coefficient: 0.36; 95% CI: 0.01-0.71) as well as the medial and lateral meniscus (coefficient: 0.38; 95% CI: 0.00-0.75 and coefficient: 0.72; 95% CI: 0.12-1.32). Knees with higher numbers of CaCs had increased cartilage degeneration in the patella and medial femur (coefficient: 0.09; 95% CI: 0.05-0.14; P < 0.001 and coefficient: 0.08; 95% CI: 0.02-0.14; P = 0.005). CONCLUSIONS CaCs were associated with increased cartilage and meniscus degeneration over a period of 4 years. Assessing the number of CaC depositions may be useful to evaluate risk of onset and worsening of degenerative disease.
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23
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Soutakbar H, Lamb SE, Silman AJ. The different influence of high levels of physical activity on the incidence of knee OA in overweight and obese men and women-a gender specific analysis. Osteoarthritis Cartilage 2019; 27:1430-1436. [PMID: 31326552 DOI: 10.1016/j.joca.2019.05.025] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/06/2018] [Revised: 05/10/2019] [Accepted: 05/17/2019] [Indexed: 02/02/2023]
Abstract
OBJECTIVE To investigate the influence of physical activity on incidence of knee osteoarthritis (OA) in overweight and obese men and women. DESIGN Data were extracted from the Osteoarthritis Initiative cohort on 1,667 participants without symptomatic knee OA at baseline. We used logistic regression and marginal effect models to estimate the effect of body mass index (BMI) and reported physical activity score, together with the interaction between them, on the development of radiographic knee OA, symptomatic knee OA and joint space narrowing (JSN) after 96-months. RESULTS Men in the most active quartile had almost double the likelihood of knee OA, independent of OA definition [e.g., odds ratio (OR) 2.4 (95%CI: 1.2-4.5) for radiographic knee OA]. Interaction analyses showed statistically significant interactions between physical activity and BMI on developing knee OA (i) radiographic OA interaction(P = 0.039), (ii) symptomatic OA interaction(P = 0.022), (iii) JSN interactionP = 0.012). The margin plots in men also demonstrated that the effect of physical activity on different measures of knee OA were modified by high levels of BMI. These effects were not mirrored in women where at all BMI levels, the level of reported physical activity did not influence likelihood of knee OA independent of OA definition. CONCLUSIONS In overweight and obese men, there appears to be a threshold above which increasing levels of physical activity are associated with higher risk of knee OA. This is absent in women.
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Affiliation(s)
- H Soutakbar
- University of Oxford, Nuffield Department of Orthopaedics, Rheumatology & Musculoskeletal Sciences, Oxford, UK.
| | - S E Lamb
- University of Oxford, Nuffield Department of Orthopaedics, Rheumatology & Musculoskeletal Sciences, Oxford, UK.
| | - A J Silman
- University of Oxford, Nuffield Department of Orthopaedics, Rheumatology & Musculoskeletal Sciences, Oxford, UK.
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24
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Jungmann PM, Gersing AS, Baumann F, Holwein C, Braun S, Neumann J, Zarnowski J, Hofmann FC, Imhoff AB, Rummeny EJ, Link TM. Cartilage repair surgery prevents progression of knee degeneration. Knee Surg Sports Traumatol Arthrosc 2019; 27:3001-3013. [PMID: 30542744 DOI: 10.1007/s00167-018-5321-8] [Citation(s) in RCA: 44] [Impact Index Per Article: 8.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/15/2018] [Accepted: 12/04/2018] [Indexed: 12/25/2022]
Abstract
PURPOSE To investigate, whether cartilage repair surgery for focal osteochondral defects at the knee results in less degenerative changes over 6 years in a MR imaging follow-up than morphologically initially identical defects in non-operated control subjects from the osteoarthritis initiative (OAI). METHODS A total of 32 individuals received baseline and follow-up MRI. In n = 16 patients with cartilage repair [osteochondral autograft transfer system (OATS), n = 12; spongiosa-augmented matrix-associated autologous chondrocyte implantation (MACI), n = 4] MRI was performed preoperatively and after 5.7 ± 2.3 year follow-up. Baseline MRIs of non-operated subjects from the OAI were screened for initially identical cartilage defects (n = 16). Morphological knee abnormalities were assessed using WORMS, AMADEUS and MOCART scores. A sagittal 2D MSME sequence was implemented for quantitative cartilage T2 relaxation time measurements in all (0, 2, 4, 6 and 8-years) follow-ups from the OAI and in the postoperative MRI protocol. RESULTS For both groups, focal osteochondral defects were located at the femoral condyle in 8/16 cases (5 medial, 3 lateral) and at the patella in 8/16 cases. At baseline, the mean cartilage defect size ± SD was 1.4 ± 1.3 cm2 for the control group and 1.3 ± 1.2 cm2 for the cartilage repair group (n.s.). WORMS scores were not significantly different between the cartilage repair group and the control group at baseline [mean difference ± SEM (95%CI); 0.5 ± 2.5 (- 4.7, 5.7), n.s.]. During identical follow-up times, the progression of total WORMS scores [19.9 ± 2.3 (15.0, 24.9), P < 0.001] and of cartilage defects scores in the affected (P < 0.001) and in the opposing (P = 0.029) compartment was significantly more severe in non-operated individuals (P < 0.05). In non-operated subjects, T2 values increased continuously from baseline to the 8-year follow-up (P = 0.001). CONCLUSIONS Patients with cartilage repair showed less progression of degenerative MRI changes at 6-year follow-up than a control cohort from the OAI with initially identical osteochondral defects. Patients with focal cartilage defects may profit from cartilage repair surgery since it may prevent progression of early osteoarthritis at the knee joint. LEVEL OF EVIDENCE Prognostic study, Level II.
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Affiliation(s)
- Pia M Jungmann
- Department of Neuroradiology, University Hospital of Zurich, University of Zurich, Frauenklinikstrasse 10, 8091, Zurich, Switzerland.
- Department of Radiology, Technical University of Munich, Ismaninger Strasse 22, 81675, Munich, Germany.
| | - Alexandra S Gersing
- Department of Radiology, Technical University of Munich, Ismaninger Strasse 22, 81675, Munich, Germany
| | - Frederic Baumann
- Clinical and Interventional Angiology, University Hospital of Zurich, University of Zurich, Raemistrasse 100, 8091, Zurich, Switzerland
| | - Christian Holwein
- Department of Sportsorthopedic Surgery, Technical University of Munich, Ismaninger Strasse 22, 81675, Munich, Germany
- BG Unfallklinik Murnau, Prof.-Küntscher-Strasse 8, 82418, Murnau, Germany
| | - Sepp Braun
- Department of Sportsorthopedic Surgery, Technical University of Munich, Ismaninger Strasse 22, 81675, Munich, Germany
- Gelenkpunkt, Sports and Joint Surgery Innsbruck, Olympiastrasse 39, 6020, Innsbruck, Austria
| | - Jan Neumann
- Musculoskeletal and Quantitative Imaging Research, Department of Radiology and Biomedical Imaging, University of California, San Francisco, 185 Berry Street, Suite 350, San Francisco, CA, 94107, USA
| | - Julia Zarnowski
- Musculoskeletal and Quantitative Imaging Research, Department of Radiology and Biomedical Imaging, University of California, San Francisco, 185 Berry Street, Suite 350, San Francisco, CA, 94107, USA
| | - Felix C Hofmann
- Musculoskeletal and Quantitative Imaging Research, Department of Radiology and Biomedical Imaging, University of California, San Francisco, 185 Berry Street, Suite 350, San Francisco, CA, 94107, USA
| | - Andreas B Imhoff
- Department of Sportsorthopedic Surgery, Technical University of Munich, Ismaninger Strasse 22, 81675, Munich, Germany
| | - Ernst J Rummeny
- Department of Radiology, Technical University of Munich, Ismaninger Strasse 22, 81675, Munich, Germany
| | - Thomas M Link
- Musculoskeletal and Quantitative Imaging Research, Department of Radiology and Biomedical Imaging, University of California, San Francisco, 185 Berry Street, Suite 350, San Francisco, CA, 94107, USA
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25
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Alternations of Metabolic Profiles in Synovial Fluids and the Correlation with T2 Relaxation Times of Cartilage and Meniscus-A Study on Anterior Cruciate Ligament- (ACL-) Injured Rabbit Knees at Early Stage. BIOMED RESEARCH INTERNATIONAL 2019; 2019:8491301. [PMID: 31467914 PMCID: PMC6699263 DOI: 10.1155/2019/8491301] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/17/2019] [Revised: 06/05/2019] [Accepted: 07/10/2019] [Indexed: 12/14/2022]
Abstract
Objectives To examine the metabolic profiles alterations of synovial fluids from anterior cruciate ligament- (ACL-) injured rabbit knees at early stage and analyze the correlation with T2 relaxation times of cartilage and meniscus. Methods The right knees of 15 rabbits were selected for the construction of ACL injury models, whereas the contralateral knees served as control group. After 4 weeks, both knees were examined by MRI with quantitative T2 mapping sequence, and the T2 relaxation times of cartilage and meniscus were measured. Then, the synovial fluids were obtained from both knee capsules and performed liquid chromatography-mass spectrometry analysis (LC-MS). Results The T2 relaxation times of cartilage and meniscus in ACL-injured knees were significantly higher than those in control knees (Cartilage: 41.52 ± 2.98 ms vs 36.02 ± 2.71 ms, P < 0.001; Meniscus: 33.35 ± 3.57 ms vs 27.27 ± 2.10 ms, P < 0.001). Twenty-eight differential metabolites were identified based on a total of 1569 detected signatures between ACL-injured knees and control knees. These differential metabolites primarily implied perturbations in the fluxes of lipids and steroid-based compounds. The Linear regression analysis demonstrated satisfactory correlations between glycerophospholipid metabolism and T2 relaxation times of both cartilage and meniscus in ACL-injured knees (R2 = 0.8204 and 0.8197, respectively). Conclusion ACL injury of rabbit knees resulted in elevated T2 relaxation times of cartilage and meniscus and perturbed metabolism of various lipids and steroids in synovial fluids, particularly glycerophospholipids. Glycerophospholipid metabolism related compounds could serve as potential biomarkers for early degenerative changes of cartilage and meniscus after ACL injury.
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26
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Trattnig S, Raudner M, Schreiner M, Roemer F, Bohndorf K. [Biochemical cartilage imaging-update 2019]. Radiologe 2019; 59:742-749. [PMID: 31187160 DOI: 10.1007/s00117-019-0558-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
BACKGROUND Cartilage imaging using magnetic resonance imaging (MRI) is increasingly used for early detection of cartilage damage. Biochemical MR methods to assess cartilage damage are essential for optimal treatment planning. PURPOSE The aim of this review is to provide an update on advanced cartilage imaging based on biochemical MR techniques. The clinical applications and additional benefits compared to conventional MRI are presented. MATERIALS AND METHODS A literature search of PubMed regarding the clinical applications of various biochemical MR methods and morphological MR imaging was performed. RESULTS While T2 mapping can be easily implemented on clinical routine MR scanners, the T1rho method is technically more demanding and is not available on all MR scanners. dGEMRIC, which can be performed with all field strengths, is now severely restricted due to the recent decision of the European Medical Agency (EMA) to withdraw linear gadolinium contrast agents from the market because of proven gadolinium deposition in the brain. Sodium imaging is the most sensitive MRI method for glycosaminoglycan (GAG), but is limited to 7 T. In addition to early diagnosis of cartilage degeneration before morphological changes are visible, biochemical MRI offers predictive markers, e.g., effect of lifestyle changes or assessing results of cartilage repair surgery. CONCLUSION Cartilage imaging based on biochemical MRI allows a shift from qualitative to quantitative MRI. Biochemical MRI plays an increasingly important role in the early diagnosis of cartilage degeneration for monitoring of disease-modifying drugs and as predictive imaging biomarker in clinical diagnostics. In cartilage repair, monitoring of the efficacy of different cartilage repair surgery techniques to develop hyaline-like cartilage can be performed with biochemical MRI.
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Affiliation(s)
- S Trattnig
- Exzellenzzentrum für Hochfeld MR, Universitätsklinik für Radiologie und Nuklearmedizin, Medizinische Universität Wien, Lazarettgasse 14, 1090, Wien, Österreich.
| | - M Raudner
- Exzellenzzentrum für Hochfeld MR, Universitätsklinik für Radiologie und Nuklearmedizin, Medizinische Universität Wien, Lazarettgasse 14, 1090, Wien, Österreich
| | - M Schreiner
- Universitätsklinik für Orthopädie und Unfallchirurgie, Medizinische Universität Wien, Währinger Gürtel 18-20, 1090, Wien, Österreich
| | - F Roemer
- Radiologisches Institut, Universitätsklinikum Erlangen, Maximiliansplatz 3, 91054, Erlangen, Deutschland
| | - K Bohndorf
- Exzellenzzentrum für Hochfeld MR, Universitätsklinik für Radiologie und Nuklearmedizin, Medizinische Universität Wien, Lazarettgasse 14, 1090, Wien, Österreich
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27
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T2 relaxation time measurements in tibiotalar cartilage after barefoot running and its relationship to ankle biomechanics. J Biomech 2019; 90:103-112. [DOI: 10.1016/j.jbiomech.2019.04.046] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2018] [Revised: 04/05/2019] [Accepted: 04/29/2019] [Indexed: 11/17/2022]
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28
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Bricca A, Wirth W, Juhl CB, Kemnitz J, Hunter DJ, Kwoh CK, Eckstein F, Culvenor AG. Moderate Physical Activity and Prevention of Cartilage Loss in People With Knee Osteoarthritis: Data From the Osteoarthritis Initiative. Arthritis Care Res (Hoboken) 2019; 71:218-226. [DOI: 10.1002/acr.23791] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2018] [Accepted: 10/15/2018] [Indexed: 11/08/2022]
Affiliation(s)
- Alessio Bricca
- University of Southern Denmark, Odense, Denmark, and University of Aberdeen Aberdeen UK
| | - Wolfgang Wirth
- Paracelsus Medical University Salzburg and Nuremberg, Salzburg, Austria, and Chondrometrics GmbH Ainring Germany
| | - Carsten B. Juhl
- University of Southern Denmark, Odense, University of Copenhagen, Herlev, and Gentofte Hospital Copenhagen Denmark
| | - Jana Kemnitz
- Paracelsus Medical University Salzburg and Nuremberg Salzburg Austria
| | - David J. Hunter
- Royal North Shore Hospital and University of Sydney Sydney New South Wales Australia
| | | | - Felix Eckstein
- Paracelsus Medical University Salzburg and Nuremberg, Salzburg, Austria, and Chondrometrics GmbH Ainring Germany
| | - Adam G. Culvenor
- Paracelsus Medical University Salzburg and Nuremberg, Salzburg, Austria, and La Trobe University Bundoora Australia
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29
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MacKay JW, Low SBL, Smith TO, Toms AP, McCaskie AW, Gilbert FJ. Systematic review and meta-analysis of the reliability and discriminative validity of cartilage compositional MRI in knee osteoarthritis. Osteoarthritis Cartilage 2018; 26:1140-1152. [PMID: 29550400 DOI: 10.1016/j.joca.2017.11.018] [Citation(s) in RCA: 70] [Impact Index Per Article: 11.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/03/2017] [Revised: 10/16/2017] [Accepted: 11/14/2017] [Indexed: 02/02/2023]
Abstract
OBJECTIVE To assess reliability and discriminative validity of cartilage compositional magnetic resonance imaging (MRI) in knee osteoarthritis (OA). DESIGN The study was carried out per PRISMA recommendations. We searched MEDLINE and EMBASE (1974 - present) for eligible studies. We performed qualitative synthesis of reliability data. Where data from at least two discrimination studies were available, we estimated pooled standardized mean difference (SMD) between subjects with and without OA. Discrimination analyses compared controls and subjects with mild OA (Kellgren-Lawrence (KL) grade 1-2), severe OA (KL grade 3-4) and OA not otherwise specified (NOS) where not possible to stratify. We assessed quality of the evidence using Quality Appraisal of Diagnostic Reliability (QAREL) and Quality Assessment of Diagnostic Accuracy (QUADAS-2) tools. RESULTS Fifty-eight studies were included in the reliability analysis and 26 studies were included in the discrimination analysis, with data from a total of 2,007 knees. Intra-observer, inter-observer and test-retest reliability of compositional techniques were excellent with most intraclass correlation coefficients >0.8 and coefficients of variation <10%. T1rho and T2 relaxometry were significant discriminators between subjects with mild OA and controls, and between subjects with OA (NOS) and controls (P < 0.001). T1rho showed best discrimination for mild OA (SMD [95% CI] = 0.73 [0.40 to 1.06], P < 0.001) and OA (NOS) (0.60 [0.41 to 0.80], P < 0.001). Quality of evidence was moderate for both parts of the review. CONCLUSIONS Cartilage compositional MRI techniques are reliable and, in the case of T1rho and T2 relaxometry, can discriminate between subjects with OA and controls.
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Affiliation(s)
- J W MacKay
- Department of Radiology, University of Cambridge, Cambridge, UK.
| | - S B L Low
- Department of Radiology, Norfolk & Norwich University Hospital, Norwich, UK.
| | - T O Smith
- School of Health Sciences, University of East Anglia, Norwich, UK.
| | - A P Toms
- Department of Radiology, Norfolk & Norwich University Hospital, Norwich, UK.
| | - A W McCaskie
- Division of Trauma & Orthopaedics, Department of Surgery, University of Cambridge, Cambridge UK.
| | - F J Gilbert
- Department of Radiology, University of Cambridge, Cambridge, UK.
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30
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Schwaiger BJ, Wamba JM, Gersing AS, Nevitt MC, Facchetti L, McCulloch CE, Link TM. Hyperintense signal alteration in the suprapatellar fat pad on MRI is associated with degeneration of the patellofemoral joint over 48 months: data from the Osteoarthritis Initiative. Skeletal Radiol 2018; 47:329-339. [PMID: 28944439 PMCID: PMC5871621 DOI: 10.1007/s00256-017-2771-x] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/05/2017] [Revised: 07/24/2017] [Accepted: 08/31/2017] [Indexed: 02/02/2023]
Abstract
OBJECTIVE To analyze associations of suprapatellar fat pad (SPFP) hyperintense signal alterations and mass effect with progression of patellofemoral osteoarthritis (OA) and clinical symptoms over 48 months. MATERIALS AND METHODS Subjects from the Osteoarthritis Initiative (n = 426; 51.8 ± 3.8 years; 49.8% women) without radiographic tibiofemoral OA underwent 3T-MRI of their right knees and clinical evaluation using the Knee Injury and Osteoarthritis Outcome Score at baseline and at 48 months. Elevated SPFP signal was assessed on intermediate-weighted, fat-saturated turbo spin-echo (TSE) images. Mass effect was defined as a convex posterior contour. Patellofemoral cartilage, bone marrow lesions (BML), and subchondral cysts were assessed using the Whole-Organ Magnetic Resonance Imaging Score (WORMS). Associations of SPFP imaging findings with MRI and clinical progression were assessed using general linear models and logistic regressions. RESULTS Baseline SPFP signal alterations were found in 51% of the subjects (n = 217), of whom 11% (n = 23) additionally had a mass effect. Progression of cartilage lesions was significantly higher in subjects with signal alteration versus without (adjusted mean increases, 95% CI; patella: 0.29, -0.07 to 0.64 vs -0.04, -0.40 to 0.31; p < 0.001; trochlea: 0.47, 0.16 to 0.77 vs 0.31, 0.01 to 0.61; p = 0.007). BML progression was also more likely in subjects with signal alteration (OR 1.75, 95% CI 1.09 to 2.82; p = 0.021). Mass effect was not associated with joint degeneration and SPFP findings were not associated with clinical worsening (p > 0.18 for all). CONCLUSION Patellofemoral joint degeneration over 48 months was significantly increased in subjects with SPFP signal alteration, suggesting an association between SPFP abnormalities and the progression of patellofemoral OA.
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Affiliation(s)
- Benedikt J. Schwaiger
- Department of Radiology and Biomedical Imaging, University of California, San Francisco,Department of Radiology, Klinikum rechts der Isar, Technical University of Munich, Germany
| | - John Mbapte Wamba
- Department of Radiology and Biomedical Imaging, University of California, San Francisco
| | - Alexandra S. Gersing
- Department of Radiology and Biomedical Imaging, University of California, San Francisco,Department of Radiology, Klinikum rechts der Isar, Technical University of Munich, Germany
| | - Michael C. Nevitt
- Department of Epidemiology and Biostatistics, University of California, San Francisco
| | - Luca Facchetti
- Department of Radiology and Biomedical Imaging, University of California, San Francisco
| | - Charles E. McCulloch
- Department of Epidemiology and Biostatistics, University of California, San Francisco
| | - Thomas M. Link
- Department of Radiology and Biomedical Imaging, University of California, San Francisco
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Nelson BB, Kawcak CE, Barrett MF, McIlwraith CW, Grinstaff MW, Goodrich LR. Recent advances in articular cartilage evaluation using computed tomography and magnetic resonance imaging. Equine Vet J 2018; 50:564-579. [DOI: 10.1111/evj.12808] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2017] [Accepted: 01/09/2018] [Indexed: 12/18/2022]
Affiliation(s)
- B. B. Nelson
- Gail Holmes Equine Orthopaedic Research Center Department of Clinical Sciences College of Veterinary Medicine and Biomedical Sciences, Colorado State University Fort Collins Colorado USA
| | - C. E. Kawcak
- Gail Holmes Equine Orthopaedic Research Center Department of Clinical Sciences College of Veterinary Medicine and Biomedical Sciences, Colorado State University Fort Collins Colorado USA
| | - M. F. Barrett
- Gail Holmes Equine Orthopaedic Research Center Department of Clinical Sciences College of Veterinary Medicine and Biomedical Sciences, Colorado State University Fort Collins Colorado USA
- Department of Environmental and Radiological Health Sciences Colorado State University Fort Collins Colorado USA
| | - C. W. McIlwraith
- Gail Holmes Equine Orthopaedic Research Center Department of Clinical Sciences College of Veterinary Medicine and Biomedical Sciences, Colorado State University Fort Collins Colorado USA
| | - M. W. Grinstaff
- Departments of Biomedical Engineering, Chemistry and Medicine Boston University Boston Massachusetts USA
| | - L. R. Goodrich
- Gail Holmes Equine Orthopaedic Research Center Department of Clinical Sciences College of Veterinary Medicine and Biomedical Sciences, Colorado State University Fort Collins Colorado USA
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Hofmann FC, Neumann J, Heilmeier U, Joseph GB, Nevitt MC, McCulloch CE, Link TM. Conservatively treated knee injury is associated with knee cartilage matrix degeneration measured with MRI-based T2 relaxation times: data from the osteoarthritis initiative. Skeletal Radiol 2018; 47:93-106. [PMID: 28852821 PMCID: PMC5699952 DOI: 10.1007/s00256-017-2759-6] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/25/2017] [Revised: 06/29/2017] [Accepted: 08/09/2017] [Indexed: 02/02/2023]
Abstract
OBJECTIVE To investigate the association of cartilage degeneration with previous knee injuries not undergoing surgery, determined by morphologic and quantitative 3-T magnetic resonance imaging (MRI). MATERIALS AND METHODS We performed a nested cross-sectional study of right knee MRIs from participants in the Osteoarthritis Initiative (OAI) aged 45-79 with baseline Kellgren-Lawrence score of 0-2. Cases were 142 right knees of patients with self-reported history of injury limiting the ability to walk for at least 2 days. Controls were 426 right knees without history of injury, frequency-matched to cases on age, BMI, gender, KL scores and race (1:3 ratio). Cases and controls were compared using covariate-adjusted linear regression analysis, with the outcomes of region-specific T2 mean, laminar analysis and heterogeneity measured by texture analysis to investigate early cartilage matrix abnormalities and the Whole-Organ Magnetic Resonance Imaging Score (WORMS) to investigate morphologic knee lesions. RESULTS Compared to control subjects, we found significantly higher mean T2 values in the injury [lateral tibia (28.10 ms vs. 29.11 ms, p = 0.001), medial tibia (29.70 ms vs. 30.40 ms, p = 0.014) and global knee cartilage (32.73 ms vs. 33.29 ms, p = 0.005)]. Injury subjects also had more heterogeneous cartilage as measured by GLCM texture contrast, variance and entropy (p < 0.05 in 14 out of 18 texture parameters). WORMS gradings were not significantly different between the two groups (p > 0.05). CONCLUSION A history of knee injury not treated surgically is associated with higher and more heterogeneous T2 values, but not with morphologic knee abnormalities. Our findings suggest that significant, conservatively treated knee injuries are associated with permanent cartilage matrix abnormalities.
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Affiliation(s)
- Felix C. Hofmann
- Musculoskeletal Quantitative Imaging Research Group, Department of Radiology & Biomedical Imaging, University of California San Francisco, San Francisco, CA USA,Department of Radiology, Technical University of Munich, Munich, Germany
| | - Jan Neumann
- Musculoskeletal Quantitative Imaging Research Group, Department of Radiology & Biomedical Imaging, University of California San Francisco, San Francisco, CA USA
| | - Ursula Heilmeier
- Musculoskeletal Quantitative Imaging Research Group, Department of Radiology & Biomedical Imaging, University of California San Francisco, San Francisco, CA USA
| | - Gabby B. Joseph
- Musculoskeletal Quantitative Imaging Research Group, Department of Radiology & Biomedical Imaging, University of California San Francisco, San Francisco, CA USA
| | - Michael C. Nevitt
- Department of Epidemiology and Biostatistics, University of California San Francisco, San Francisco, CA USA
| | - Charles E. McCulloch
- Department of Epidemiology and Biostatistics, University of California San Francisco, San Francisco, CA USA
| | - Thomas M. Link
- Musculoskeletal Quantitative Imaging Research Group, Department of Radiology & Biomedical Imaging, University of California San Francisco, San Francisco, CA USA
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Keng A, Sayre EC, Guermazi A, Nicolaou S, Esdaile JM, Thorne A, Singer J, Kopec JA, Cibere J. Association of body mass index with knee cartilage damage in an asymptomatic population-based study. BMC Musculoskelet Disord 2017; 18:517. [PMID: 29221481 PMCID: PMC5723095 DOI: 10.1186/s12891-017-1884-7] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/09/2017] [Accepted: 11/29/2017] [Indexed: 01/09/2023] Open
Abstract
Background Cartilage changes are an important early finding of osteoarthritis (OA), which can exist even before symptoms. Our objective was to determine the prevalence of knee cartilage damage on magnetic resonance imaging (MRI) in an asymptomatic population-based cross-sectional study and to evaluate the association of body mass index (BMI) with cartilage damage. Methods Subjects, aged 40-79 years, without knee pain (n = 73) were recruited as a random population sample and assessed for BMI (kg/m2), including current BMI (measured), past BMI at age 25 (self-reported) and change in BMI. Knee cartilage was scored semi-quantitatively (grades 0-4) on MRI. In primary analysis, cartilage damage was defined as ≥2 (at least moderate) and in a secondary analysis as ≥3 (severe). We also conducted a sensitivity analysis by dichotomizing current BMI as <25 vs. ≥25. Logistic regression was used to evaluate the association of each BMI variable with prevalent MRI-detected cartilage damage, adjusted for age and sex. Results Of 73 subjects, knee cartilage damage ≥2 and ≥3 was present in 65.4% and 28.7%, respectively. The median current BMI was 26.1, median past BMI 21.6, and median change in BMI was a gain of 2.8. For cartilage damage ≥2, current BMI had a non-statistically significant OR of 1.65 per 5 units (95% CI 0.93-2.92). For cartilage damage ≥3, current BMI showed a trend towards statistical significance with an OR of 1.70 per 5 units (95% CI 0.99-2.92). Past BMI and change in BMI were not significantly associated with cartilage damage. Current BMI ≥ 25 was statistically significantly associated with cartilage damage ≥2 (OR 3.04 (95% CI 1.10-8.42)), but not for ≥3 (OR 2.63 (95% CI 0.86-8.03)). Conclusions MRI-detected knee cartilage damage was highly prevalent in this asymptomatic population-based cohort. We report a trend towards significance of BMI with cartilage damage severity. Subjects with abnormal current BMI (≥25) had a 3-fold increased odds of cartilage damage ≥2, compared to those with normal BMI. This study lends support towards the role of obesity in the pathogenesis of knee cartilage damage at an asymptomatic stage of disease.
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Affiliation(s)
- Alvin Keng
- University of Toronto, Toronto, ON, Canada
| | - Eric C Sayre
- Arthritis Research Centre of Canada, Richmond, BC, Canada
| | - Ali Guermazi
- Section of Musculoskeletal Imaging, Boston University Medical Center, Boston, MA, USA.,Boston University School of Medicine, Boston, MA, USA
| | - Savvakis Nicolaou
- Vancouver General Hospital, Vancouver, BC, Canada.,Department of Medicine, University of British Columbia, Vancouver, BC, Canada
| | - John M Esdaile
- Arthritis Research Centre of Canada, Richmond, BC, Canada.,Department of Medicine, University of British Columbia, Vancouver, BC, Canada
| | - Anona Thorne
- Canadian HIV Trials Network, Vancouver, BC, Canada
| | - Joel Singer
- Canadian HIV Trials Network, Vancouver, BC, Canada.,School of Population and Public Health, University of British Columbia, Vancouver, BC, Canada
| | - Jacek A Kopec
- Arthritis Research Centre of Canada, Richmond, BC, Canada.,School of Population and Public Health, University of British Columbia, Vancouver, BC, Canada
| | - Jolanda Cibere
- Arthritis Research Centre of Canada, Richmond, BC, Canada. .,Department of Medicine, University of British Columbia, Vancouver, BC, Canada. .,Arthritis Research Canada Milan Ilich Arthritis Research Centre, 5591 No. 3 Road, Richmond, BC, V6X2C7, Canada.
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Hesper T, Hosalkar HS, Schleich C, Antoch G, Welsch GH, Krauspe R, Zilkens C, Bittersohl B. T2* Mapping for Hip Joint Cartilage Assessment: Pre-MRI Exercise and Time of Imaging Do Not Bias the T2* Measurement in Asymptomatic Volunteers. Cartilage 2017; 8:400-405. [PMID: 28466650 PMCID: PMC5613890 DOI: 10.1177/1947603516665446] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Objective To identify if the time of day and pre-imaging exercise matter while performing T2* mapping of hip joint cartilage at 3 T. Design Nine asymptomatic healthy volunteers (mean age 27.4 ± 4.0 years) with no obvious morphological evidence of cartilage damage were enrolled. The MRI protocol included a double-echo steady state (DESS) sequence for morphological cartilage assessment and a multi-echo data image combination sequence for the T2* measurement. T2* values were obtained between 8 and 11 a.m., between 3 and 6 p.m., and after 50 knee-bends at several time points of each measurement (0, 15, 30, 45, 60 minutes). Results We observed no differences ( P = 0.47) between the T2* values obtained in the morning (T2* = 22.9 ± 3.0 ms) and those measured in the afternoon (T2* = 23.2 ± 3.2 ms). We also observed no statistically significant differences between the T2* values at different time points ( P = 0.67) or after 50 knee-bends ( P = 0.43). Conclusions Timing of the scan and pre-imaging exercise clearly did not matter in this modality. This study consolidates the value of T2* imaging in hip joint cartilage that seems to be independent of diurnal effects and physical activity prior to MRI.
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Affiliation(s)
- Tobias Hesper
- Department of Orthopedics, Medical Faculty, Heinrich-Heine University of Düsseldorf, Düsseldorf, Germany,Tobias Hesper, Department of Orthopedics, Medical Faculty, Heinrich-Heine University, Düsseldorf, Moorenstraße 5, 40225 Düsseldorf, Germany.
| | - Harish S. Hosalkar
- Center for Hip Preservation and Children’s Orthopedics, San Diego, CA, USA
| | - Christoph Schleich
- Department of Diagnostic and Interventional Radiology, Medical Faculty, Heinrich-Heine University of Düsseldorf, Düsseldorf, Germany
| | - Gerald Antoch
- Department of Diagnostic and Interventional Radiology, Medical Faculty, Heinrich-Heine University of Düsseldorf, Düsseldorf, Germany
| | - Götz H. Welsch
- Medical Faculty, University of Hamburg, UKE-Athleticum, Hamburg, Germany
| | - Rüdiger Krauspe
- Department of Orthopedics, Medical Faculty, Heinrich-Heine University of Düsseldorf, Düsseldorf, Germany
| | - Christoph Zilkens
- Department of Orthopedics, Medical Faculty, Heinrich-Heine University of Düsseldorf, Düsseldorf, Germany
| | - Bernd Bittersohl
- Department of Orthopedics, Medical Faculty, Heinrich-Heine University of Düsseldorf, Düsseldorf, Germany
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The frequency of cartilage lesions in non-injured knees with symptomatic meniscus tears: results from an arthroscopic and NIR- (near-infrared) spectroscopic investigation. Arch Orthop Trauma Surg 2017; 137:837-844. [PMID: 28397004 DOI: 10.1007/s00402-017-2672-4] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/19/2016] [Indexed: 02/07/2023]
Abstract
INTRODUCTION Are symptomatic tear injuries to the menisci of the knee frequently or always associated with cartilage damage to the corresponding articular surfaces and other joint surfaces, respectively? METHODS A total of 137 patients (medial n = 127; lateral n = 10) underwent a meniscus resection. These patients showed no signs of a clear radiographic arthrosis and no MRI-detectable cartilage lesions > grade II. Traumatic injury was ruled out with a thorough medical history. The indication for operation was made exclusively on the basis of distinct, clinically apparent meniscus signs. In addition to the ICRS classification, all articular surfaces were examined spectroscopically (NIRS, near-infrared spectroscopy). RESULTS In 76.6% (n = 105) of all knees examined, clear cartilage damage (ICRS-grade III/IV) was found. For 43.8%, these were in the area of the patella, while for 34.3% they were in the area of the medial femur, and for 17.5%, in the area of the medial tibial plateau. More rarely, this damage was localized to the area of the trochlea (8.8%) or the lateral joint compartment (femoral 2.2%, tibial 15.3%). There were no significant differences between patients with medial or lateral meniscus lesions with respect to the distribution pattern of the joint injuries. During spectroscopic examination, pathological values were demonstrated (objective evidence of cartilage degeneration) in at least one of the examined articular surfaces (media n = 6, range 1-6). CONCLUSION Through our investigations, a high, if not complete, concomitance of degenerative cartilage lesions and degenerative meniscus damage was demonstrated. From this it can be concluded that the entity of "isolated degenerative meniscus damage" clearly does not exist in practice. It is therefore highly probable that degenerative meniscus lesions, as a part of general joint degeneration, are to be interpreted in the context of the development of arthrosis. The practical consequences still are unclear. Patients after partial meniscectomy need a longer follow-up to detect potential cartilage lesions as well as an OA progression.
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Gersing AS, Schwaiger BJ, Nevitt MC, Joseph GB, Chanchek N, Guimaraes JB, Mbapte Wamba J, Facchetti L, McCulloch CE, Link TM. Is Weight Loss Associated with Less Progression of Changes in Knee Articular Cartilage among Obese and Overweight Patients as Assessed with MR Imaging over 48 Months? Data from the Osteoarthritis Initiative. Radiology 2017; 284:508-520. [PMID: 28463057 DOI: 10.1148/radiol.2017161005] [Citation(s) in RCA: 52] [Impact Index Per Article: 7.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
Abstract
Purpose To investigate the association of weight loss with progression of cartilage changes at magnetic resonance (MR) imaging over 48 months in overweight and obese participants compared with participants of stable weight. Materials and Methods The institutional review boards of the four participating centers approved this HIPAA-compliant study. Included were (a) 640 participants (mean age, 62.9 years ± 9.1 [standard deviation]; 398 women) who were overweight or obese (body mass index cutpoints of 25 and 30 kg/m2, respectively) from the Osteoarthritis Initiative, with risk factors for osteoarthritis or mild to moderate radiographic findings of osteoarthritis, categorized into groups with (a) weight loss of more than 10% (n = 82), (b) weight loss of 5%-10% (n = 238), or (c) stable weight (n = 320) over 48 months. Participants were frequency-matched for age, sex, baseline body mass index, and Kellgren-Lawrence score. Two radiologists assessed cartilage and meniscus defects on right knee 3-T MR images at baseline and 48 months by using the modified Whole-Organ Magnetic Resonance Imaging Score (WORMS). Progression of the subscores was compared between the weight loss groups by using multivariable logistic regression models. Results Over 48 months, adjusted mean increase of cartilage WORMS was significantly smaller in the 5%-10% weight loss group (1.6; 95% confidence interval [CI]: 1.3, 1.9; P = .002) and even smaller in the group with more than 10% weight loss (1.0; 95% CI: 0.6, 1.4; P = .001) when compared with the stable weight group (2.3; 95% CI: 2.0, 2.7). Moreover, percentage of weight change was significantly associated with increase in cartilage WORMS (β = 0.2; 95% CI: 0.02, 0.4; P = .007). Conclusion Participants who lost weight over 48 months showed significantly lower cartilage degeneration, as assessed with MR imaging; rates of progression were lower with greater weight loss. © RSNA, 2017.
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Affiliation(s)
- Alexandra S Gersing
- From the Department of Radiology and Biomedical Imaging (A.S.G., B.J.S., G.B.J., N.C., J.B.G., J.M.W., L.F., T.M.L.) and Department of Epidemiology and Biostatistics (M.C.N., C.E.M.), University of California San Francisco, 185 Berry St, Suite 350, San Francisco, CA 94107. From the 2015 RSNA Annual Meeting
| | - Benedikt J Schwaiger
- From the Department of Radiology and Biomedical Imaging (A.S.G., B.J.S., G.B.J., N.C., J.B.G., J.M.W., L.F., T.M.L.) and Department of Epidemiology and Biostatistics (M.C.N., C.E.M.), University of California San Francisco, 185 Berry St, Suite 350, San Francisco, CA 94107. From the 2015 RSNA Annual Meeting
| | - Michael C Nevitt
- From the Department of Radiology and Biomedical Imaging (A.S.G., B.J.S., G.B.J., N.C., J.B.G., J.M.W., L.F., T.M.L.) and Department of Epidemiology and Biostatistics (M.C.N., C.E.M.), University of California San Francisco, 185 Berry St, Suite 350, San Francisco, CA 94107. From the 2015 RSNA Annual Meeting
| | - Gabby B Joseph
- From the Department of Radiology and Biomedical Imaging (A.S.G., B.J.S., G.B.J., N.C., J.B.G., J.M.W., L.F., T.M.L.) and Department of Epidemiology and Biostatistics (M.C.N., C.E.M.), University of California San Francisco, 185 Berry St, Suite 350, San Francisco, CA 94107. From the 2015 RSNA Annual Meeting
| | - Nattagan Chanchek
- From the Department of Radiology and Biomedical Imaging (A.S.G., B.J.S., G.B.J., N.C., J.B.G., J.M.W., L.F., T.M.L.) and Department of Epidemiology and Biostatistics (M.C.N., C.E.M.), University of California San Francisco, 185 Berry St, Suite 350, San Francisco, CA 94107. From the 2015 RSNA Annual Meeting
| | - Julio B Guimaraes
- From the Department of Radiology and Biomedical Imaging (A.S.G., B.J.S., G.B.J., N.C., J.B.G., J.M.W., L.F., T.M.L.) and Department of Epidemiology and Biostatistics (M.C.N., C.E.M.), University of California San Francisco, 185 Berry St, Suite 350, San Francisco, CA 94107. From the 2015 RSNA Annual Meeting
| | - John Mbapte Wamba
- From the Department of Radiology and Biomedical Imaging (A.S.G., B.J.S., G.B.J., N.C., J.B.G., J.M.W., L.F., T.M.L.) and Department of Epidemiology and Biostatistics (M.C.N., C.E.M.), University of California San Francisco, 185 Berry St, Suite 350, San Francisco, CA 94107. From the 2015 RSNA Annual Meeting
| | - Luca Facchetti
- From the Department of Radiology and Biomedical Imaging (A.S.G., B.J.S., G.B.J., N.C., J.B.G., J.M.W., L.F., T.M.L.) and Department of Epidemiology and Biostatistics (M.C.N., C.E.M.), University of California San Francisco, 185 Berry St, Suite 350, San Francisco, CA 94107. From the 2015 RSNA Annual Meeting
| | - Charles E McCulloch
- From the Department of Radiology and Biomedical Imaging (A.S.G., B.J.S., G.B.J., N.C., J.B.G., J.M.W., L.F., T.M.L.) and Department of Epidemiology and Biostatistics (M.C.N., C.E.M.), University of California San Francisco, 185 Berry St, Suite 350, San Francisco, CA 94107. From the 2015 RSNA Annual Meeting
| | - Thomas M Link
- From the Department of Radiology and Biomedical Imaging (A.S.G., B.J.S., G.B.J., N.C., J.B.G., J.M.W., L.F., T.M.L.) and Department of Epidemiology and Biostatistics (M.C.N., C.E.M.), University of California San Francisco, 185 Berry St, Suite 350, San Francisco, CA 94107. From the 2015 RSNA Annual Meeting
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Russell C, Pedoia V, Souza R, Majumdar S. Cross-sectional and longitudinal study of the impact of posterior meniscus horn lesions on adjacent cartilage composition, patient-reported outcomes and gait biomechanics in subjects without radiographic osteoarthritis. Osteoarthritis Cartilage 2017; 25:708-717. [PMID: 27838383 PMCID: PMC7263373 DOI: 10.1016/j.joca.2016.10.025] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/21/2016] [Revised: 10/03/2016] [Accepted: 10/31/2016] [Indexed: 02/02/2023]
Abstract
OBJECTIVE The aim of this study was to assess cross-sectional and longitudinal effects of meniscal lesions on adjacent cartilage T1ρ and T2 relaxation times, patient-reported outcomes and gait biomechanics. DESIGN Thirty patients with no cartilage morphological defects reported by Whole Organ MRI Score (WORMS) magnetic resonance imaging (MRI) grading and no radiographic osteoarthritis (OA) (Kellgren--Lawrence (KL) ≤ 1) were selected, 15 with posterior meniscus horn lesions and 15 matched controls without meniscal lesions. All were imaged on a 3T MR scanner for three consecutive years, except those who dropped from the study. Sagittal and frontal plane kinematic gait data were acquired at baseline. The Knee Injury and Osteoarthritis Outcome Score (KOOS) survey was taken each time. All images were automatically segmented and registered to an atlas for voxel-by-voxel cross-sectional and longitudinal analyses. RESULTS Relaxation time comparisons between groups showed elevated T1ρ of the lateral tibia (LP) and elevated T2 of the medial tibia (MT) and LT at 1 and 2 years in the lesion group. Longitudinal comparisons within each group revealed greater relaxation time elevations over one and 2 years in the group with lesions. KOOS Quality of Life (QOL) was significantly different between the groups at all time points (P < 0.05), as were other KOOS subcategories. No significant differences in the frontal or sagittal biomechanics were observed between the groups at baseline. CONCLUSIONS Individuals with healthy cartilage and posterior meniscal horn lesions have increased relaxation times when compared to matched controls, increased relaxation time changes over 2 years, and consistently report a lower KOOS QOL, yet show no difference in gait biomechanics.
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Affiliation(s)
- C. Russell
- Musculoskeletal Quantitative Imaging Research, Department of Radiology and Biomedical Imaging, University of California, San Francisco, San Francisco, CA, USA
| | - V. Pedoia
- Musculoskeletal Quantitative Imaging Research, Department of Radiology and Biomedical Imaging, University of California, San Francisco, San Francisco, CA, USA
| | - R.B. Souza
- Musculoskeletal Quantitative Imaging Research, Department of Radiology and Biomedical Imaging, University of California, San Francisco, San Francisco, CA, USA,Department of Physical Therapy, University of California, San Francisco, San Francisco, CA, USA
| | - S. Majumdar
- Musculoskeletal Quantitative Imaging Research, Department of Radiology and Biomedical Imaging, University of California, San Francisco, San Francisco, CA, USA,Address correspondence and reprint requests to: S. Majumdar, Musculoskeletal Quantitative Imaging Research, Department of Radiology and Biomedical Imaging, University of California, San Francisco, 1700 4th Street, Suite 203, San Francisco, CA 94158, USA. Fax: 1-(415)-353-9423. (C. Russell)
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Culvenor AG, Wirth W, Maschek S, Boeth H, Diederichs G, Duda G, Eckstein F. Longitudinal change in patellofemoral cartilage thickness, cartilage T2 relaxation times, and subchondral bone plate area in adolescent vs mature athletes. Eur J Radiol 2017. [PMID: 28624016 DOI: 10.1016/j.ejrad.2017.04.018] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
OBJECTIVE Patellofemoral cartilage changes have been evaluated in knee trauma and osteoarthritis; however, little is known about changes in patellar and trochlear cartilage thickness, T2 relaxation-time and subchondral bone plate area (tAB) during growth. Our prospective study aimed to explore longitudinal change in patellofemoral cartilage thickness, T2 and tAB in adolescent athletes, and to compare these data with those of mature (i.e., adult) athletes. MATERIALS AND METHODS 20 adolescent (age 16±1years) and 20 mature (46±5years) volleyball players were studied over 2-years (10 men and 10 women each group). 1.5T MRI 3D-VIBE and multi-echo spin-echo sequences were acquired at baseline and 2-year follow-up. Using manual segmentation and 3D reconstruction, longitudinal changes in patellar and trochlear cartilage thickness, patellar cartilage T2 (mono-exponential decay curve with five echoes [9.7-67.9ms]), and patellar and trochlear tAB were determined. RESULTS The annual increase in both patellar and trochlear cartilage thickness was 0.8% (95% confidence interval [CI] 0.6, 1.0) and 0.6% (0.3, 0.9), for adolescent males and females respectively; the longitudinal gain in patellar and trochlear tAB was 1.3% (1.1, 1.5) and 0.5% (0.2, 0.8), and 1.6% (1.1, 2.2) and 0.8% (0.3, 0.7) for adolescent males and females, respectively (no significant between-sex differences). Mature athletes showed smaller gains in tAB, and loss of <1% of cartilage thickness annually. While no significant sex-differences existed in adolescent patellar T2 changes, mature males gained significantly greater T2 than mature females (p=0.002-0.013). CONCLUSIONS Patellar and trochlear cartilage thickness and tAB were observed to increase in young athletes in late adolescence, without significant differences between sexes. Mature athletes displayed patellar cartilage loss (and T2 increases in mature males), potentially reflecting degenerative changes.
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Affiliation(s)
- Adam G Culvenor
- Institute of Anatomy, Paracelsus Medical University Salzburg & Nuremburg, Strubergasse 21, A5020, Salzburg, Austria; La Trobe Sports & Exercise Medicine Research Centre, School of Allied Health, La Trobe University, Kingsbury Drive, Bundoora 3086, Victoria, Australia.
| | - Wolfgang Wirth
- Institute of Anatomy, Paracelsus Medical University Salzburg & Nuremburg, Strubergasse 21, A5020, Salzburg, Austria.
| | - Susanne Maschek
- Institute of Anatomy, Paracelsus Medical University Salzburg & Nuremburg, Strubergasse 21, A5020, Salzburg, Austria.
| | - Heide Boeth
- Julius Wolff Institute, Charité-Universitätsmedizin, Charitéplatz 1, 10117 Berlin, Centre for Sports Science and Sports Medicine Berlin, Germany.
| | - Gerd Diederichs
- Department of Radiology, Charité-Universitätsmedizin, Charitéplatz 1, 10117 Berlin, Germany.
| | - Georg Duda
- Julius Wolff Institute, Charité-Universitätsmedizin, Charitéplatz 1, 10117 Berlin, Centre for Sports Science and Sports Medicine Berlin, Germany.
| | - Felix Eckstein
- Institute of Anatomy, Paracelsus Medical University Salzburg & Nuremburg, Strubergasse 21, A5020, Salzburg, Austria.
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Kim J, Lee HH, Kang Y, Kim TK, Lee SW, So Y, Lee WW. Maximum standardised uptake value of quantitative bone SPECT/CT in patients with medial compartment osteoarthritis of the knee. Clin Radiol 2017; 72:580-589. [PMID: 28400059 DOI: 10.1016/j.crad.2017.03.009] [Citation(s) in RCA: 44] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2016] [Revised: 03/08/2017] [Accepted: 03/14/2017] [Indexed: 11/16/2022]
Abstract
AIM To evaluate the correlation between the maximum standardised uptake value (SUVmax) from bone single-photon-emission computed tomography/computed tomography (SPECT/CT) and other imaging parameters for medial compartment osteoarthritis (OA) of the knee. MATERIALS AND METHODS Patients (n=26; male:female=2:24; age, 55.3±5.8 years) underwent quantitative knee SPECT/CT using technetium-99m (Tc-99m) hydroxymethylene diphosphonate (HDP) before surgical operation for medial OA of the knee. SUVmax was calculated using dedicated quantitative software. Visual grades of tracer uptake on bone SPECT/CT and Kellgren-Lawrence (KL) OA scores on plain radiographs were assessed using a five-point scale. Magnetic resonance imaging (MRI) scores (n=22) and patient symptom scores were also assessed. RESULTS The operated knees (n=34) had a greater SUVmax than the non-operated knees (n=18) in the medial compartment (14.1±6.1 versus 5.3±4.4, p<0.0001). In the medial compartment, the SUVmax was significantly correlated with SPECT/CT visual grades (rho=0.794, p<0.0001), KL scores (rho=0.703, p<0.0001), and MRI scores (rho=0.714-0.808, p≤0.0002); however, SUVmax and other imaging parameters were not correlated with patient symptom scores (p>0.05). CONCLUSIONS The SUVmax of quantitative bone SPECT/CT was highly correlated with traditional imaging parameters for medial compartment OA severity of the knee. Quantitative bone SPECT/CT is a promising imaging technique for the objective assessment of knee OA.
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Affiliation(s)
- J Kim
- Department of Nuclear Medicine, Seoul National University Bundang Hospital, Seongnam, Republic of Korea
| | - H-H Lee
- Department of Nuclear Medicine, Seoul National University Bundang Hospital, Seongnam, Republic of Korea
| | - Y Kang
- Department of Radiology, Seoul National University Bundang Hospital, Seongnam, Republic of Korea
| | - T K Kim
- Department of Orthopedic Surgery, Seoul National University Bundang Hospital, Seongnam, Republic of Korea
| | - S W Lee
- Department of Orthopedic Surgery, Seoul National University Bundang Hospital, Seongnam, Republic of Korea
| | - Y So
- Department of Nuclear Medicine, Konkuk University Medical Center, Konkuk University School of Medicine, Seoul, Republic of Korea
| | - W W Lee
- Department of Nuclear Medicine, Seoul National University Bundang Hospital, Seongnam, Republic of Korea; Institute of Radiation Medicine, Medical Research Center, Seoul National University, Seoul, Republic of Korea.
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40
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Jungmann PM, Baum T, Nevitt MC, Nardo L, Gersing AS, Lane NE, McCulloch CE, Rummeny EJ, Link TM. Degeneration in ACL Injured Knees with and without Reconstruction in Relation to Muscle Size and Fat Content-Data from the Osteoarthritis Initiative. PLoS One 2016; 11:e0166865. [PMID: 27918596 PMCID: PMC5137877 DOI: 10.1371/journal.pone.0166865] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2016] [Accepted: 11/04/2016] [Indexed: 12/19/2022] Open
Abstract
Background Anterior cruciate ligaments (ACL) injuries represent a major risk factor for early osteoarthritis (OA). Purpose To evaluate the prevalence and 4-year progression of knee OA measured with 3T MR-imaging in individuals with ruptured, reconstructed or normal ACL and to assess the impact of thigh muscle characteristics. Methods A total of 54 knees (23/54 male, 31/54 female) were recruited from the Osteoarthritis Initiative (OAI). At baseline, 15/54 subjects had prevalent ACL ruptures and 15/54 subjects had prevalent ACL reconstruction (24/54 normal ACL). Western Ontario and McMasters Universities Arthritis Index (WOMAC) scores, Physical Activity Scores of the Elderly (PASE) and thigh muscle characteristics including strength, fat infiltration (Goutallier score) and thigh muscle cross-sectional area (CSA) MR measurements were obtained at baseline. Whole-organ MR-imaging Scores (WORMS) were obtained at baseline and at a 4-year follow-up time-point. Multivariate regression models, adjusting for covariates (age, gender, body mass index), were used for statistical analysis. Results At baseline, subjects with prevalent ACL ruptures had worse WORMS total scores (mean±SEM, 44.1±3.5) than subjects with ACL reconstruction (30.8±4.0; P = 0.015) and worse than subjects with normal ACL (21.3±3.0; P<0.001). Cartilage scores were worse in both femorotibial compartments in ACL injured knees than in knees with normal ACL (P<0.05). Knees with ACL reconstruction showed an increased degeneration of the medial meniscus (P = 0.036), cartilage degeneration at the medial femoral condyle (P = 0.011). In a multivariate regression model, including both ACL groups and total muscle characteristics as influence parameters, high thigh muscle CSA, high muscle/ fat ratio and low Goutallier scores were associated with less degenerative changes at the knee, independent of ACL status. Knees with ACL reconstruction showed an increased progression of cartilage degeneration at the medial tibia compared to the normal ACL group (P = 0.027). Conclusions High thigh muscle CSA is associated with less degenerative changes at the knee, independent of the ACL status and may potentially be advantageous in the prevention of early OA.
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Affiliation(s)
- Pia M. Jungmann
- Department of Radiology, Technische Universitaet Muenchen, Munich, Germany
- * E-mail:
| | - Thomas Baum
- Department of Radiology, Technische Universitaet Muenchen, Munich, Germany
| | - Michael C. Nevitt
- Department of Epidemiology and Biostatistics, University of California San Francisco, San Francisco, California, United States of America
| | - Lorenzo Nardo
- Musculoskeletal and Quantitative Imaging Research, Department of Radiology and Biomedical Imaging, University of California San Francisco, San Francisco, California, United States of America
| | | | - Nancy E. Lane
- Department of Internal Medicine, UC Davis Medical Center, Sacramento, California, United States of America
| | - Charles E. McCulloch
- Department of Epidemiology and Biostatistics, University of California San Francisco, San Francisco, California, United States of America
| | - Ernst J. Rummeny
- Department of Radiology, Technische Universitaet Muenchen, Munich, Germany
| | - Thomas M. Link
- Musculoskeletal and Quantitative Imaging Research, Department of Radiology and Biomedical Imaging, University of California San Francisco, San Francisco, California, United States of America
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Goldman LH, Tang K, Facchetti L, Heilmeier U, Joseph GB, Nevitt MC, McCulloch CE, Souza RB, Link TM. Role of thigh muscle cross-sectional area and strength in progression of knee cartilage degeneration over 48 months - data from the Osteoarthritis Initiative. Osteoarthritis Cartilage 2016; 24:2082-2091. [PMID: 27457100 PMCID: PMC5614519 DOI: 10.1016/j.joca.2016.07.004] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/05/2015] [Revised: 07/06/2016] [Accepted: 07/08/2016] [Indexed: 02/02/2023]
Abstract
OBJECTIVE To determine in a 48-month longitudinal study the association of thigh muscle cross-sectional area (CSA) and strength on progression of morphologic knee cartilage degeneration using 3T magnetic resonance imaging (MRI). DESIGN Seventy Osteoarthritis Initiative (OAI) subjects aged 50-60 years, with no radiographic evidence of osteoarthritis (OA) and constant muscle strength over 48 months as measured by isometric knee extension testing were included. Baseline right thigh muscle CSAs were assessed on axial T1-weighted magnetic resonance (MR) images, and extensor to flexor CSA ratios were calculated. Degenerative knee abnormalities at baseline and 48-months were graded on right knee 3T MRIs using a modified whole organ MRI score (WORMS). Statistical analysis employed Student's t-tests and multivariable regression models adjusted for age, body mass index and gender. RESULTS Extension strength was significantly and positively correlated with baseline thigh muscle CSA (r = 0.65, P < 0.001). Greater baseline total thigh muscle CSA was significantly associated with increase of cartilage WORMS scores over 48 months in patellar (P = 0.027) and trochlear (P = 0.038) compartments, but not in other knee compartments. Among specific muscle groups, CSA of extensors (P = 0.021) and vastus medialis (VM) (P = 0.047) were associated with patellar cartilage increase in WORMS. Baseline E/F ratio had a significant positive association with patellar WORMS cartilage score increase over 48 months, P = 0.0015. There were no other significant associations between muscle CSA/ratios and increase in WORMS scores. CONCLUSION Maintenance of proper extensor to flexor muscle balance about the knee through decreased E/F ratios may slow patellofemoral cartilage deterioration, while higher extensor and VM CSA may increase patellofemoral cartilage loss.
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Affiliation(s)
- Lauren H. Goldman
- Department of Radiology and Biomedical Imaging, University of
California, San Francisco,Department of Radiology, Montefiore Medical Center
| | - Kenneth Tang
- Department of Radiology and Biomedical Imaging, University of
California, San Francisco
| | - Luca Facchetti
- Department of Radiology and Biomedical Imaging, University of
California, San Francisco,Department of Radiology, University of Brescia, Brescia, Italy
| | - Ursula Heilmeier
- Department of Radiology and Biomedical Imaging, University of
California, San Francisco
| | - Gabby B. Joseph
- Department of Radiology and Biomedical Imaging, University of
California, San Francisco
| | - Michael C. Nevitt
- Department of Epidemiology and Biostatistics, University of
California, San Francisco
| | - Charles E. McCulloch
- Department of Epidemiology and Biostatistics, University of
California, San Francisco
| | - Richard B. Souza
- Department of Radiology and Biomedical Imaging, University of
California, San Francisco,Department of Physical Therapy and Rehabilitation Science,
University of California, San Francisco
| | - Thomas M. Link
- Department of Radiology and Biomedical Imaging, University of
California, San Francisco
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Guermazi A, Crema MD, Roemer FW. Compositional Magnetic Resonance Imaging Measures of Cartilage--Endpoints for Clinical Trials of Disease-modifying Osteoarthritis Drugs? J Rheumatol 2016; 43:7-11. [PMID: 26724316 DOI: 10.3899/jrheum.150663] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Affiliation(s)
- Ali Guermazi
- Professor of Radiology, Director, Quantitative Imaging Center, Boston University School of Medicine, Boston, Massachusetts;
| | - Michel D Crema
- Department of Radiology, Boston University School of Medicine, Boston, Massachusetts, USA, and Department of Radiology, Hospital do Coração and Teleimagem, São Paulo, Brazil
| | - Frank W Roemer
- Department of Radiology, Boston University School of Medicine, Boston, Massachusetts, USA, and Department of Radiology, University of Erlangen, Erlangen, Germany
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Behzadi C, Welsch GH, Laqmani A, Henes FO, Kaul MG, Schoen G, Adam G, Regier M. Comparison of T2* relaxation times of articular cartilage of the knee in elite professional football players and age-and BMI-matched amateur athletes. Eur J Radiol 2016; 86:105-111. [PMID: 28027735 DOI: 10.1016/j.ejrad.2016.10.028] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2016] [Revised: 09/26/2016] [Accepted: 10/26/2016] [Indexed: 11/15/2022]
Abstract
OBJECTIVE Recent investigation has underlined the potential of quantitative MR imaging to be used as a complementary tool for the diagnosis of cartilage degeneration at an early state. The presented study analyses T2* relaxation times of articular cartilage of the knee in professional athletes and compares the results to age- and BMI (Body Mass Index)-matched healthy amateur athletes. MATERIALS AND METHODS 22 professional football players and 22 age- and BMI-matched individuals were underwent knee Magnetic Resonance Imaging (MRI) at 3T including qualitative and quantitative analysis. Qualitative analysis included e.g. meniscal tears, joint effusion and bone edema. For quantitative analysis T2* (22 ET: 4.6-53.6ms) measurements in 3D data acquisition were performed. Deep and superficial layers of 22 predefined cartilage segments were analysed. All data sets were postprocessed using a dedicated software tool. Statistical analysis included Student t-test, confidence intervals and a random effects model. RESULTS In both groups, T2* relaxation times were significantly higher in the superficial compared to the deep layers (p<0.001). Professional athletes had significantly higher relaxation times in eight superficial and three deep cartilage layers in the predefined cartilage segments (p<0.05). Highly significant differences were found in the weight-bearing segments of the lateral superficial femoral condyle (p<0.001). CONCLUSION Elevated T2* values in cartilage layers of professional football players compared to amateur athletes were noted. The effects seem to predominate in superficial cartilage layers.
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Affiliation(s)
- C Behzadi
- Department of Diagnostic and Interventional Radiology and Nuclearmedicine, University Medical Center Hamburg-Eppendorf, Hamburg, 20246, Germany.
| | - G H Welsch
- Department of Sports Medicine, University Medical Center Hamburg-Eppendorf, Hamburg, 20246, Germany
| | - A Laqmani
- Department of Diagnostic and Interventional Radiology and Nuclearmedicine, University Medical Center Hamburg-Eppendorf, Hamburg, 20246, Germany
| | - F O Henes
- Department of Diagnostic and Interventional Radiology and Nuclearmedicine, University Medical Center Hamburg-Eppendorf, Hamburg, 20246, Germany
| | - M G Kaul
- Department of Diagnostic and Interventional Radiology and Nuclearmedicine, University Medical Center Hamburg-Eppendorf, Hamburg, 20246, Germany
| | - G Schoen
- Department of Medical Biometry and Epidemiology, University Medical Center, Hamburg-Eppendorf, Hamburg, 20246, Germany
| | - G Adam
- Department of Diagnostic and Interventional Radiology and Nuclearmedicine, University Medical Center Hamburg-Eppendorf, Hamburg, 20246, Germany
| | - M Regier
- Department of Diagnostic and Interventional Radiology and Nuclearmedicine, University Medical Center Hamburg-Eppendorf, Hamburg, 20246, Germany
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Gersing AS, Schwaiger BJ, Heilmeier U, Joseph GB, Facchetti L, Kretzschmar M, Lynch JA, McCulloch CE, Nevitt MC, Steinbach LS, Link TM. Evaluation of Chondrocalcinosis and Associated Knee Joint Degeneration Using MR Imaging: Data from the Osteoarthritis Initiative. Eur Radiol 2016; 27:2497-2506. [PMID: 27704199 DOI: 10.1007/s00330-016-4608-8] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2016] [Revised: 09/07/2016] [Accepted: 09/13/2016] [Indexed: 12/11/2022]
Abstract
OBJECTIVES To evaluate the ability of different MRI sequences to detect chondrocalcinosis within knee cartilage and menisci, and to analyze the association with joint degeneration. METHODS Subjects with radiographic knee chondrocalcinosis (n = 90, age 67.7 ± 7.3 years, 50 women) were selected from the Osteoarthritis Initiative and matched to controls without radiographic chondrocalcinosis (n = 90). Visualization of calcium-containing crystals (CaC) was compared between 3D T1-weighted gradient-echo (T1GE), 3D dual echo steady-state (DESS), 2D intermediate-weighted (IW), and proton density (PD)-weighted fast spin-echo (FSE) sequences obtained with 3T MRI and correlated with a semiquantitative CaC score obtained from radiographs. Structural abnormalities were assessed using Whole-Organ MRI Score (WORMS) and logistic regression models were used to compare cartilage compartments with and without CaC. RESULTS Correlations between CaC counts of MRI sequences and degree of radiographic calcifications were highest for GE (rT1GE = 0.73, P < 0.001; rDESS = 0.68, P < 0.001) compared to other sequences (P > 0.05). Meniscus WORMS was significantly higher in subjects with chondrocalcinosis compared to controls (P = 0.005). Cartilage defects were significantly more frequent in compartments with CaC than without (patella: P = 0.006; lateral tibia: P < 0.001; lateral femur condyle: P = 0.017). CONCLUSIONS Gradient-echo sequences were most useful for the detection of chondrocalcinosis and presence of CaC was associated with higher prevalence of cartilage and meniscal damage. KEY POINTS • Magnetic resonance imaging is useful for assessing burden of calcium-containing crystals (CaC). • Gradient-echo sequences are superior to fast spin echo sequences for CaC imaging. • Presence of CaC is associated with meniscus and cartilage degradation.
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Affiliation(s)
- Alexandra S Gersing
- Department of Radiology and Biomedical Imaging, University of California, San Francisco, 185 Berry St, Suite 350, San Francisco, CA, 94107, USA.
| | - Benedikt J Schwaiger
- Department of Radiology and Biomedical Imaging, University of California, San Francisco, 185 Berry St, Suite 350, San Francisco, CA, 94107, USA
| | - Ursula Heilmeier
- Department of Radiology and Biomedical Imaging, University of California, San Francisco, 185 Berry St, Suite 350, San Francisco, CA, 94107, USA
| | - Gabby B Joseph
- Department of Radiology and Biomedical Imaging, University of California, San Francisco, 185 Berry St, Suite 350, San Francisco, CA, 94107, USA
| | - Luca Facchetti
- Department of Radiology and Biomedical Imaging, University of California, San Francisco, 185 Berry St, Suite 350, San Francisco, CA, 94107, USA
| | - Martin Kretzschmar
- Department of Radiology and Biomedical Imaging, University of California, San Francisco, 185 Berry St, Suite 350, San Francisco, CA, 94107, USA
| | - John A Lynch
- Department of Epidemiology and Biostatistics, University of California, San Francisco, 550 16th Street, 2nd Floor, San Francisco, CA, 94158, USA
| | - Charles E McCulloch
- Department of Epidemiology and Biostatistics, University of California, San Francisco, 550 16th Street, 2nd Floor, San Francisco, CA, 94158, USA
| | - Michael C Nevitt
- Department of Epidemiology and Biostatistics, University of California, San Francisco, 550 16th Street, 2nd Floor, San Francisco, CA, 94158, USA
| | - Lynne S Steinbach
- Department of Radiology and Biomedical Imaging, University of California, San Francisco, 185 Berry St, Suite 350, San Francisco, CA, 94107, USA
| | - Thomas M Link
- Department of Radiology and Biomedical Imaging, University of California, San Francisco, 185 Berry St, Suite 350, San Francisco, CA, 94107, USA
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Ryu YJ, Hong SH, Kim H, Choi JY, Yoo HJ, Kang Y, Park SJ, Kang HS. Fat-suppressed T 2 mapping of femoral cartilage in the porcine knee joint: A comparison with conventional T 2 mapping. J Magn Reson Imaging 2016; 45:1076-1081. [PMID: 27527688 DOI: 10.1002/jmri.25430] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2016] [Accepted: 08/01/2016] [Indexed: 12/12/2022] Open
Abstract
PURPOSE To investigate the effect of fat suppression on T2 mapping of the articular cartilage in the porcine knee joint using magnetic resonance imaging (MRI). MATERIALS AND METHODS Eleven porcine knee joints were harvested en bloc with intact capsules. We performed T2 mapping of the articular cartilage in the medial femoral condyle at 3T either with (fat-suppressed T2 mapping) or without (conventional T2 mapping) fat suppression in the sagittal plane under two frequency-encoding directions: from superior to inferior (SI) and inferior to superior (IS). Two observers measured the T2 values of the medial femoral condyle cartilage in four regions: in the anterior oblique, central horizontal, posterior oblique, and posterior vertical portions. We evaluated reproducibility of the fat-suppressed and conventional T2 mapping by changing the frequency-encoding direction. RESULTS The mean T2 values of fat-suppressed T2 mapping were significantly lower than those of conventional T2 mapping for five of eight comparisons (P < 0.017). The mean T2 values between fat-suppressed T2 -SI and fat-suppressed T2 -IS did not differ significantly in any region (P = 0.077-0.873). However, the mean T2 values of conventional T2 -SI were significantly lower compared with conventional T2 -IS in three of the regions (P < 0.05). The intraclass correlation coefficient (ICC) between the two fat-suppressed T2 maps was higher than the ICC between the two conventional T2 maps (0.276-0.800 vs. -0.032-0.455) for three regions. CONCLUSION Compared with conventional T2 mapping, fat-suppressed T2 mapping provides lower T2 values of the articular cartilage and more reproducible results for the porcine knee joint. LEVEL OF EVIDENCE 2 J. Magn. Reson. Imaging 2017;45:1076-1081.
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Affiliation(s)
- Young Jin Ryu
- Department of Radiology and Institute of Radiation Medicine, Seoul National University College of Medicine, Seoul, Korea
| | - Sung Hwan Hong
- Department of Radiology and Institute of Radiation Medicine, Seoul National University College of Medicine, Seoul, Korea
| | - Hyeonjin Kim
- Department of Radiology and Institute of Radiation Medicine, Seoul National University College of Medicine, Seoul, Korea
| | - Ja-Young Choi
- Department of Radiology and Institute of Radiation Medicine, Seoul National University College of Medicine, Seoul, Korea
| | - Hye Jin Yoo
- Department of Radiology and Institute of Radiation Medicine, Seoul National University College of Medicine, Seoul, Korea
| | - Yusuhn Kang
- Department of Radiology and Institute of Radiation Medicine, Seoul National University College of Medicine, Seoul, Korea
| | - Sang Joon Park
- Department of Radiology and Institute of Radiation Medicine, Seoul National University College of Medicine, Seoul, Korea
| | - Heung Sik Kang
- Department of Radiology and Institute of Radiation Medicine, Seoul National University College of Medicine, Seoul, Korea
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Kretzschmar M, Lin W, Nardo L, Joseph GB, Dunlop DD, Heilmeier U, Nevitt MC, Alizai H, McCulloch CE, Lynch JA, Link TM. Association of Physical Activity Measured by Accelerometer, Knee Joint Abnormalities, and Cartilage T2 Measurements Obtained From 3T Magnetic Resonance Imaging: Data From the Osteoarthritis Initiative. Arthritis Care Res (Hoboken) 2016; 67:1272-1280. [PMID: 25777255 DOI: 10.1002/acr.22586] [Citation(s) in RCA: 32] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2014] [Revised: 02/10/2015] [Accepted: 03/10/2015] [Indexed: 12/26/2022]
Abstract
OBJECTIVE To study the cross-sectional association between physical activity measured with an accelerometer, structural knee abnormalities, and cartilage T2 values assessed with 3T magnetic resonance imaging (MRI). METHODS We included 274 subjects from the Osteoarthritis Initiative cohort without definite radiographic osteoarthritis (Kellgren/Lawrence grades 0 and 1) and with at most mild pain, stiffness, and functional limitation in the study knee (Western Ontario and McMaster Universities Osteoarthritis Index scale 0-1), which had not limited their activity due to knee pain. Physical activity was measured over 7 days with an ActiGraph GT1M accelerometer. Subjects were categorized by quartile of physical activity based on the average daily minutes of moderate to vigorous physical activity (mv-PA). MRI images of the right knee (at 48-month visit) were assessed for structural abnormalities using a modified Whole-Organ Magnetic Resonance Imaging Score (WORMS) and for T2 relaxation times derived from segmented cartilage of 4 femorotibial regions and the patella. WORMS grades and T2 measurements were compared between activity quartiles using a linear regression model. Covariates included age, sex, body mass index, knee injury, family history of knee replacement, knee symptoms, hip and ankle pain, and daily wear time of the accelerometer. RESULTS Higher mv-PA was associated with increased severity (P = 0.0087) and number of lesions of the medial meniscus (P = 0.0089) and with severity of bone marrow edema lesions (P = 0.0053). No association between cartilage lesions and mv-PA was found. T2 values of cartilage (loss, damage, and abnormalities) tended to be greater in the higher quartiles of mv-PA, but the differences were nonsignificant. CONCLUSION In knees without radiographic osteoarthritis in subjects with no or mild knee pain, higher physical activity levels were associated with increases in meniscal and bone marrow edema pattern lesions.
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Affiliation(s)
| | - W Lin
- University of California, San Francisco
| | - L Nardo
- University of California, San Francisco
| | | | - D D Dunlop
- Feinberg School of Medicine, Northwestern University, Chicago, Illinois
| | | | | | - H Alizai
- University of California, San Francisco
| | | | - J A Lynch
- University of California, San Francisco
| | - T M Link
- University of California, San Francisco
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Koli J, Multanen J, Kujala UM, Häkkinen A, Nieminen MT, Kautiainen H, Lammentausta E, Jämsä T, Ahola R, Selänne H, Kiviranta I, Heinonen A. Effects of Exercise on Patellar Cartilage in Women with Mild Knee Osteoarthritis. Med Sci Sports Exerc 2016; 47:1767-74. [PMID: 25668399 DOI: 10.1249/mss.0000000000000629] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/13/2023]
Abstract
PURPOSE This study aims to investigate the effects of exercise on patellar cartilage using T2 relaxation time mapping of magnetic resonance imaging in postmenopausal women with mild patellofemoral joint osteoarthritis (OA). METHODS Eighty postmenopausal women (mean age, 58 (SD, 4.2) yr) with mild knee OA were randomized to either a supervised progressive impact exercise program three times a week for 12 months (n = 40) or a nonintervention control group (n = 40). Biochemical properties of cartilage were estimated using T2 relaxation time mapping, a parameter sensitive to collagen integrity, collagen orientation, and tissue hydration. Leg muscle strength and power, aerobic capacity, and self-rated assessment with the Knee Injury and Osteoarthritis Outcome Score were also measured. RESULTS After intervention, full-thickness patellar cartilage T2 values had medium-size effect (d = 0.59; 95% confidence interval, 0.16 to 0.97; P = 0.018); the change difference was 7% greater in the exercise group compared with the control group. In the deep half of tissue, the significant exercise effect size was medium (d = 0.56; 95% confidence interval, 0.13 to 0.99; P = 0.013); the change difference was 8% greater in the exercise group compared with controls. Furthermore, significant medium-size T2 effects were found in the total lateral segment, lateral deep, and lateral superficial zones in favor of the exercise group. Extension force was 11% greater (d = 0.63, P = 0.006) and maximal aerobic capacity was 4% greater (d = 0.55, P = 0.028) in the exercise group than in controls. No changes in Knee Injury and Osteoarthritis Outcome Score emerged between the groups. CONCLUSIONS Progressively implemented high-impact and intensive exercise creates enough stimuli and exerts favorable effects on patellar cartilage quality and physical function in postmenopausal women with mild knee OA.
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Affiliation(s)
- Jarmo Koli
- 1Department of Health Sciences, University of Jyväskylä, Jyväskylä, FINLAND; 2Department of Physical Medicine and Rehabilitation, Central Finland Central Hospital, Jyväskylä, FINLAND; 3Department of Diagnostic Radiology, Oulu University Hospital, Oulu, FINLAND; 4Medical Research Center Oulu, University of Oulu and Oulu University Hospital, Oulu, FINLAND; 5Department of Radiology, University of Oulu, Oulu, FINLAND; 6Department of General Practice and Primary Healthcare, University of Helsinki, Helsinki, FINLAND; 7Unit of Primary Healthcare, Kuopio University Hospital, Kuopio, FINLAND; 8Department of Medical Technology, Institute of Biomedicine, University of Oulu, Oulu, Finland; 9LIKES Research Center, Jyväskylä, FINLAND; and 10Department of Orthopedics and Traumatology, University of Helsinki and Helsinki University Hospital, Helsinki, FINLAND
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48
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Schwaiger BJ, Gersing AS, Mbapte Wamba J, Nevitt MC, McCulloch CE, Link TM. Can Signal Abnormalities Detected with MR Imaging in Knee Articular Cartilage Be Used to Predict Development of Morphologic Cartilage Defects? 48-Month Data from the Osteoarthritis Initiative. Radiology 2016; 281:158-67. [PMID: 27135833 DOI: 10.1148/radiol.2016152308] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
Purpose To determine the incidence with which morphologic articular cartilage defects develop over 48 months in cartilage with signal abnormalities at baseline magnetic resonance (MR) imaging in comparison with the incidence in articular cartilage without signal abnormalities at baseline. Materials and Methods The institutional review boards of all participating centers approved this HIPAA-compliant study. Right knees of 90 subjects from the Osteoarthritis Initiative (mean age, 55 years ± 8 [standard deviation]; 51% women) with cartilage signal abnormalities but without morphologic cartilage defects at 3.0-T MR imaging and without radiographic osteoarthritis (Kellgren-Lawrence score, 0-1) were frequency matched for age, sex, Kellgren-Lawrence score, and body mass index with right knees in 90 subjects without any signal abnormalities or morphologic defects in the articular cartilage (mean age, 54 years ± 5; 51% women). Individual signal abnormalities (n = 126) on intermediate-weighted fast spin-echo MR images were categorized into four subgrades: subgrade A, hypointense; subgrade B, inhomogeneous; subgrade C, hyperintense; and subgrade D, hyperintense with swelling. The development of morphologic articular cartilage defects (Whole-Organ MR Imaging Score ≥2) at 48 months was analyzed on a compartment level and was compared between groups by using generalized estimating equation logistic regression models. Results Cartilage signal abnormalities were more frequent in the patellofemoral joint than in the tibiofemoral joint (59.5% vs 39.5%). Subgrade A was seen more frequently than were subgrades C and D (36% vs 22%). Incidence of morphologic cartilage defects at 48 months was 57% in cartilage with baseline signal abnormalities, while only 4% of compartments without baseline signal abnormalities developed morphologic defects at 48 months (all compartments combined and each compartment separately, P < .01). The development of morphologic defects was not significantly more likely in any of the subgrades (P = .98) and was significantly associated with progression of bone marrow abnormalities (P = .002). Conclusion Knee cartilage signal abnormalities detected with MR imaging are precursors of morphologic defects with osteoarthritis and may serve as imaging biomarkers with which to assess risk for cartilage degeneration. (©) RSNA, 2016.
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Affiliation(s)
- Benedikt J Schwaiger
- From the Departments of Radiology and Biomedical Imaging (B.J.S., A.S.G., J.M.W., T.M.L.) and Epidemiology and Biostatistics (M.C.N., C.E.M.), University of California, San Francisco, 185 Berry St, Suite 350, San Francisco, CA 94107
| | - Alexandra S Gersing
- From the Departments of Radiology and Biomedical Imaging (B.J.S., A.S.G., J.M.W., T.M.L.) and Epidemiology and Biostatistics (M.C.N., C.E.M.), University of California, San Francisco, 185 Berry St, Suite 350, San Francisco, CA 94107
| | - John Mbapte Wamba
- From the Departments of Radiology and Biomedical Imaging (B.J.S., A.S.G., J.M.W., T.M.L.) and Epidemiology and Biostatistics (M.C.N., C.E.M.), University of California, San Francisco, 185 Berry St, Suite 350, San Francisco, CA 94107
| | - Michael C Nevitt
- From the Departments of Radiology and Biomedical Imaging (B.J.S., A.S.G., J.M.W., T.M.L.) and Epidemiology and Biostatistics (M.C.N., C.E.M.), University of California, San Francisco, 185 Berry St, Suite 350, San Francisco, CA 94107
| | - Charles E McCulloch
- From the Departments of Radiology and Biomedical Imaging (B.J.S., A.S.G., J.M.W., T.M.L.) and Epidemiology and Biostatistics (M.C.N., C.E.M.), University of California, San Francisco, 185 Berry St, Suite 350, San Francisco, CA 94107
| | - Thomas M Link
- From the Departments of Radiology and Biomedical Imaging (B.J.S., A.S.G., J.M.W., T.M.L.) and Epidemiology and Biostatistics (M.C.N., C.E.M.), University of California, San Francisco, 185 Berry St, Suite 350, San Francisco, CA 94107
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MRI findings associated with development of incident knee pain over 48 months: data from the osteoarthritis initiative. Skeletal Radiol 2016; 45:653-60. [PMID: 26919860 PMCID: PMC4815898 DOI: 10.1007/s00256-016-2343-5] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/05/2015] [Revised: 01/20/2016] [Accepted: 01/25/2016] [Indexed: 02/02/2023]
Abstract
PURPOSE The purpose of this nested case-control study was to identify baseline, incident, and progressive MRI findings visible on standard MRI clinical sequences that were associated with development of incident knee pain in subjects at risk for OA over a period of 48 months. METHODS We analyzed 60 case knees developing incident pain (WOMAC(pain) = 0 at baseline and WOMAC(pain) ≥ 5 at 48 months) and 60 control knees (WOMAC(pain) = 0 at baseline and WOMAC(pain) = 0 at 48 months) from the Osteoarthritis Initiative. 3 T knee MRIs were analyzed using a modified WORMS score (cartilage, meniscus, bone marrow) at baseline and after 48 months. Baseline and longitudinal findings were grouped into logistic regression models and compared using likelihood-ratio tests. For each model that was significant, a stepwise elimination was used to isolate significant MRI findings. RESULTS One baseline MRI finding and three findings that changed from baseline to 48 months were associated with the development of pain: at baseline, the severity of a cartilage lesion in the medial tibia was associated with incident pain--(odds ratio (OR) for incident pain = 3.05; P = 0.030). Longitudinally, an incident effusion (OR = 9.78; P = 0.005), a progressive cartilage lesion of the patella (OR = 4.59; P = 0.009), and an incident medial meniscus tear (OR = 4.91; P = 0.028) were associated with the development of pain. CONCLUSIONS Our results demonstrate that baseline abnormalities of the medial tibia cartilage as well as an incident joint effusion, progressive patella cartilage defects, and an incident medial meniscus tear over 48 months may be associated with incident knee pain. Clinically, this study helps identify MRI findings that are associated with the development of knee pain.
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van der Heijden RA, Oei EHG, Bron EE, van Tiel J, van Veldhoven PLJ, Klein S, Verhaar JAN, Krestin GP, Bierma-Zeinstra SMA, van Middelkoop M. No Difference on Quantitative Magnetic Resonance Imaging in Patellofemoral Cartilage Composition Between Patients With Patellofemoral Pain and Healthy Controls. Am J Sports Med 2016; 44:1172-8. [PMID: 26951075 DOI: 10.1177/0363546516632507] [Citation(s) in RCA: 29] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
BACKGROUND Retropatellar cartilage damage has been suggested as an etiological factor for patellofemoral pain (PFP), a common knee condition among young and physically active individuals. To date, there is no conclusive evidence for an association between cartilage defects and PFP. Nowadays, advanced quantitative magnetic resonance imaging (MRI) techniques enable estimation of cartilage composition. PURPOSE To investigate differences in patellofemoral cartilage composition between patients with PFP and healthy control subjects using quantitative MRI. STUDY DESIGN Cross-sectional study; Level of evidence, 3. METHODS Patients with PFP and healthy control subjects underwent 3.0-T MRI including delayed gadolinium-enhanced MRI of cartilage and T1ρ and T2 mapping. Differences in relaxation times of patellofemoral cartilage were compared between groups by linear regression analyses, adjusted for age, body mass index, sex, sports participation, and time of image acquisition. RESULTS This case-control study included 64 patients and 70 controls. The mean (±SD) age was 23.2 ± 6.4 years and the mean body mass index was 22.9 ± 3.4 kg/m(2); 56.7% were female. For delayed gadolinium-enhanced MRI of cartilage, the mean T1GD relaxation times of patellar (657.8 vs 669.4 ms) and femoral cartilage (661.6 vs 659.8 ms) did not significantly differ between patients and controls. In addition, no significant difference was found in mean T1ρ relaxation times of patellar (46.9 vs 46.0 ms) and femoral cartilage (50.8 vs 50.2 ms) and mean T2 relaxation times of patellar (33.2 vs 32.9 ms) and femoral cartilage (36.7 vs 36.6 ms) between patients and controls. Analysis of prespecified medial and lateral subregions within the patellofemoral cartilage also revealed no significant differences. CONCLUSION There was no difference in composition of the patellofemoral cartilage, estimated with multiple quantitative MRI techniques, between patients with PFP and healthy control subjects. However, clinically relevant differences could not be ruled out for T1ρ in the adolescent population. Retropatellar cartilage damage has long been hypothesized as an important factor in the pathogenesis of PFP, but study findings suggest that diminished patellofemoral cartilage composition is not associated with PFP.
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Affiliation(s)
- Rianne A van der Heijden
- Department of General Practice, Erasmus MC, University Medical Center, Rotterdam, the Netherlands Department of Radiology, Erasmus MC, University Medical Center, Rotterdam, the Netherlands
| | - Edwin H G Oei
- Department of Radiology, Erasmus MC, University Medical Center, Rotterdam, the Netherlands
| | - Esther E Bron
- Biomedical Imaging Group Rotterdam, Departments of Radiology and Medical Informatics, Erasmus MC, University Medical Center, Rotterdam, the Netherlands
| | - Jasper van Tiel
- Department of Radiology, Erasmus MC, University Medical Center, Rotterdam, the Netherlands Department of Orthopedic Surgery, Erasmus MC, University Medical Center, Rotterdam, the Netherlands
| | | | - Stefan Klein
- Biomedical Imaging Group Rotterdam, Departments of Radiology and Medical Informatics, Erasmus MC, University Medical Center, Rotterdam, the Netherlands
| | - Jan A N Verhaar
- Department of Orthopedic Surgery, Erasmus MC, University Medical Center, Rotterdam, the Netherlands
| | - Gabriel P Krestin
- Department of Radiology, Erasmus MC, University Medical Center, Rotterdam, the Netherlands
| | - Sita M A Bierma-Zeinstra
- Department of General Practice, Erasmus MC, University Medical Center, Rotterdam, the Netherlands Department of Orthopedic Surgery, Erasmus MC, University Medical Center, Rotterdam, the Netherlands
| | - Marienke van Middelkoop
- Department of General Practice, Erasmus MC, University Medical Center, Rotterdam, the Netherlands
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