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Ge L, Zhang X, Zhu R, Cai G. Bone marrow lesions in osteoarthritis: biomarker or treatment target? A narrative review. Skeletal Radiol 2024:10.1007/s00256-024-04725-0. [PMID: 38877110 DOI: 10.1007/s00256-024-04725-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/27/2024] [Revised: 06/05/2024] [Accepted: 06/05/2024] [Indexed: 06/16/2024]
Abstract
Osteoarthritis (OA) is a leading cause of pain, functional impairment, and disability in older adults. However, there are no effective treatments to delay and reverse OA. Magnetic resonance imaging (MRI) can assess structural abnormalities of OA by directly visualizing damage and inflammatory reactions within the tissues and detecting abnormal signals in the subchondral bone marrow region. While some studies have shown that bone marrow lesions (BMLs) are one of the early signs of the development of OA and predict structural and symptomatic progression of OA, others claimed that BMLs are prevalent in the general population and have no role in the progression of OA. In this narrative review, we screened and summarized studies with different designs that evaluated the association of BMLs with joint symptoms and structural abnormalities of OA. We also discussed whether BMLs may serve as an imaging biomarker and a treatment target for OA based on existing clinical trials.
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Affiliation(s)
- Liru Ge
- Department of Epidemiology and Biostatistics, School of Public Health, Anhui Medical University, Hefei, 230032, Anhui, China
| | - Xiaoyue Zhang
- Department of Epidemiology and Biostatistics, School of Public Health, Anhui Medical University, Hefei, 230032, Anhui, China
| | - Rui Zhu
- Department of Epidemiology and Biostatistics, School of Public Health, Anhui Medical University, Hefei, 230032, Anhui, China
| | - Guoqi Cai
- Department of Epidemiology and Biostatistics, School of Public Health, Anhui Medical University, Hefei, 230032, Anhui, China.
- Menzies Institute for Medical Research, University of Tasmania, Hobart, TAS, 7000, Australia.
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Chen X, You M, Liao K, Zhang M, Wang L, Zhou K, Chen G, Li J. Quantitative Magnetic Resonance Imaging Had Greater Sensitivity in Diagnosing Chondral Lesions of the Knee: A Systematic Review and Meta-Analysis. Arthroscopy 2024:S0749-8063(24)00091-4. [PMID: 38336108 DOI: 10.1016/j.arthro.2024.01.035] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/27/2023] [Revised: 01/21/2024] [Accepted: 01/26/2024] [Indexed: 02/12/2024]
Abstract
PURPOSE To investigate the accuracy and reliability of magnetic resonance imaging (MRI) in identifying and grading chondral lesions and explore the optimal imaging technique to image cartilage. METHOD A comprehensive search was conducted on Medline, Embase, and Cochrane Library. Eligible cohort studies published before August 2022 were included. The study reports used MRI to diagnose and grade cartilage lesions, with intraoperative findings as the reference standard. Summary estimates of diagnostic performance were obtained. The reliability of MRI interpretation was summarized. Subgroup analyses were performed based on assessed imaging techniques, field strength, and joint surface. RESULTS Forty-three trials and 3,706 patients were included in the systematic review. The overall area under curve for hierarchical summarized receiver operating characteristics was 0.91 (95% confidence interval [CI] 0.88-0.93). The pooled sensitivity for quantitative MRI, 3-dimensional MRI, and 2-dimensional MRI was 0.82 (95% CI 0.64-0.92), 0.79 (95% CI 0.74-0.83), and 0.63 (95% CI 0.51-0.73), respectively. The pooled sensitivity of 3 Tesla (3T), 1.5 Tesla (1.5T), and <1.5 Tesla MRI was 0.79 (95% CI 0.72-0.85), 0.67 (95% CI 0.60-0.74), and 0.55 (95% CI 0.39-0.71), respectively. There were differences in interobserver consistency across different studies. CONCLUSIONS In general, MRI had high specificity in discriminating normal cartilage, but its sensitivity for identifying chondral lesions is less optimal. Further analysis showed that quantitative MRI, 3D MRI, and 3T MRI demonstrate greater sensitivity compared with 2D MRI, 1.5T MRI, and <1.5 Tesla MRI. LEVEL OF EVIDENCE Level III, systematic review of Level II-III studies.
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Affiliation(s)
- Xi Chen
- Sports Medicine Center, West China Hospital, West Chian School of Medicine, Sichuan University, Chengdu, Sichuan, China; Department of Orthopedics and Orthopedic Research Institute, West China Hospital, Sichuan University, Chengdu, Sichuan, China
| | - Mingke You
- Sports Medicine Center, West China Hospital, West Chian School of Medicine, Sichuan University, Chengdu, Sichuan, China; Department of Orthopedics and Orthopedic Research Institute, West China Hospital, Sichuan University, Chengdu, Sichuan, China
| | - Kai Liao
- Department of Radiology, West China Hospital, Sichuan University, Chengdu, Sichuan, China
| | | | - Lingcheng Wang
- Sports Medicine Center, West China Hospital, West Chian School of Medicine, Sichuan University, Chengdu, Sichuan, China; Department of Orthopedics and Orthopedic Research Institute, West China Hospital, Sichuan University, Chengdu, Sichuan, China
| | - Kai Zhou
- Sports Medicine Center, West China Hospital, West Chian School of Medicine, Sichuan University, Chengdu, Sichuan, China; Department of Orthopedics and Orthopedic Research Institute, West China Hospital, Sichuan University, Chengdu, Sichuan, China
| | - Gang Chen
- Sports Medicine Center, West China Hospital, West Chian School of Medicine, Sichuan University, Chengdu, Sichuan, China; Department of Orthopedics and Orthopedic Research Institute, West China Hospital, Sichuan University, Chengdu, Sichuan, China
| | - Jian Li
- Sports Medicine Center, West China Hospital, West Chian School of Medicine, Sichuan University, Chengdu, Sichuan, China; Department of Orthopedics and Orthopedic Research Institute, West China Hospital, Sichuan University, Chengdu, Sichuan, China.
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Magnetic resonance imaging is able to detect patellofemoral focal cartilage injuries: a systematic review with meta-analysis. Knee Surg Sports Traumatol Arthrosc 2022; 31:2469-2481. [PMID: 36266368 DOI: 10.1007/s00167-022-07203-z] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/12/2022] [Accepted: 10/10/2022] [Indexed: 02/14/2023]
Abstract
PURPOSE The purpose of this study was to analyze the diagnostic accuracy of magnetic resonance imaging (MRI) to detect and grade the severity of patellofemoral (PF) cartilage injuries. METHODS A systematic review was conducted on PubMed, EMBASE and Cochrane Library databases (up to July 1st 2022) to search for studies that reported the diagnostic accuracy of MRI to detect and grade PF cartilage injuries as compared to diagnostic arthroscopy. Risk of bias was judged using the QUADAS-2 tool. Quantitative syntheses were performed to calculate the diagnostic accuracy metric-sensitivity, specificity, positive likelihood (LR+) and negative likelihood (LR-) ratios, diagnostic odds ratio (DOR)-and presented as median with 25% and 75% percentiles. The summary receiver operating characteristic (SROC) curves were also calculated. Diagnostic accuracy metrics were calculated for all PF cartilage injuries and then sub-grouped by patellar and trochlear lesions. Diagnostic accuracy was also calculated according to the grading of cartilage injuries. RESULTS Forty-five studies were included for qualitative analyses and forty studies were included for quantitative synthesis. A total of 3534 participants with a weighted mean age of 38.1 years were included. Diagnostic accuracy was generally high: sensitivity (0.8, 0.6-1.0), specificity (0.9, 0.8-1.0), LR+ (6.4, 3.1-15.3), LR- (0.3, 0.2-0.4) and DOR (21.3, 9.9-121.1). The area under the curve (AUC) of the SROC was 0.9. The diagnostic accuracy was slightly higher for patellar (sensitivity 0.8, specificity 0.8, LR+ 5.3, LR- 0.2, DOR 28.8) than for trochlear lesions (sensitivity 0.7, specificity 0.9, LR+ 5.5, LR- 0.4, DOR 14.3). The sensitivity was generally higher when grading advanced (vs. early or intermediate) cartilage injuries of the patella. CONCLUSION The MRI is able to diagnose PF cartilage injuries with reasonably high diagnostic accuracy (as compared to arthroscopy). Clinicians can rely on MRI to reliably diagnose PF cartilage injuries (with some limitations) which will play an important role in deciding for surgical or non-operative treatment. LEVEL OF EVIDENCE Level III.
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Altahawi F, Pierce J, Aslan M, Li X, Winalski CS, Subhas N. 3D MRI of the Knee. Semin Musculoskelet Radiol 2021; 25:455-467. [PMID: 34547811 DOI: 10.1055/s-0041-1730400] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
Three-dimensional (3D) magnetic resonance imaging (MRI) of the knee is widely used in musculoskeletal (MSK) imaging. Currently, 3D sequences are most commonly used for morphological imaging. Isotropic 3D MRI provides higher out-of-plane resolution than standard two-dimensional (2D) MRI, leading to reduced partial volume averaging artifacts and allowing for multiplanar reconstructions in any plane with any thickness from a single high-resolution isotropic acquisition. Specifically, isotropic 3D fast spin-echo imaging, with options for tissue weighting similar to those used in multiplanar 2D FSE imaging, is of particular interest to MSK radiologists. New applications for 3D spatially encoded sequences are also increasingly available for clinical use. These applications offer advantages over standard 2D techniques for metal artifact reduction, quantitative cartilage imaging, nerve imaging, and bone shape analysis. Emerging fast imaging techniques can be used to overcome the long acquisition times that have limited the adoption of 3D imaging in clinical protocols.
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Affiliation(s)
- Faysal Altahawi
- Section of Musculoskeletal Imaging, Imaging Institute, Cleveland Clinic, Cleveland, Ohio
| | - Jason Pierce
- Diagnostic Radiology Residency, Imaging Institute, Cleveland Clinic, Cleveland, Ohio
| | - Mercan Aslan
- Section of Musculoskeletal Imaging, Imaging Institute, Cleveland Clinic, Cleveland, Ohio
| | - Xiaojuan Li
- Section of Musculoskeletal Imaging, Imaging Institute, Cleveland Clinic, Cleveland, Ohio.,Department of Biomedical Engineering, Lerner Research Institute, Cleveland Clinic, Cleveland, Ohio
| | - Carl S Winalski
- Section of Musculoskeletal Imaging, Imaging Institute, Cleveland Clinic, Cleveland, Ohio.,Department of Biomedical Engineering, Lerner Research Institute, Cleveland Clinic, Cleveland, Ohio
| | - Naveen Subhas
- Section of Musculoskeletal Imaging, Imaging Institute, Cleveland Clinic, Cleveland, Ohio
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Abstract
Osteoarthritis, characterized by the breakdown of articular cartilage and other joint structures, is one of the most prevalent and disabling chronic diseases in the United States. Magnetic resonance imaging is a commonly used imaging modality to evaluate patients with joint pain. Both two-dimensional fast spin-echo sequences (2D-FSE) and three-dimensional (3D) sequences are used in clinical practice to evaluate articular cartilage. The 3D sequences have many advantages compared with 2D-FSE sequences, such as their high in-plane spatial resolution, thin continuous slices that reduce the effects of partial volume averaging, and ability to create multiplanar reformat images following a single acquisition. This article reviews the different 3D imaging techniques available for evaluating cartilage morphology, illustrates the strengths and weaknesses of 3D approaches compared with 2D-FSE approaches for cartilage imaging, and summarizes the diagnostic performance of 2D-FSE and 3D sequences for detecting cartilage lesions within the knee and hip joints.
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Affiliation(s)
- Richard Kijowski
- Department of Radiology, New York University Grossman School of Medicine, New York, New York
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6
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Jang H, Ma Y, Carl M, Lombardi AF, Chang EY, Du J. Feasibility of an Inversion Recovery-Prepared Fat-Saturated Zero Echo Time Sequence for High Contrast Imaging of the Osteochondral Junction. Front Endocrinol (Lausanne) 2021; 12:777080. [PMID: 35002964 PMCID: PMC8739813 DOI: 10.3389/fendo.2021.777080] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/14/2021] [Accepted: 12/02/2021] [Indexed: 12/11/2022] Open
Abstract
PURPOSE The osteochondral junction (OCJ) region-commonly defined to include the deep radial uncalcified cartilage, tidemark, calcified cartilage, and subchondral bone plate-functions to absorb mechanical stress and is commonly associated with the pathogenesis of osteoarthritis. However, magnetic resonance imaging of the OCJ region is difficult due to the tissues' short transverse relaxation times (i.e., short T2 or T2*), which result in little or no signal with conventional MRI. The goal of this study is to develop a 3D adiabatic inversion recovery prepared fat saturated zero echo time (IR-FS-ZTE) sequence for high-contrast imaging of the OCJ. METHOD An IR-FS-ZTE MR sequence was developed to image the OCJ on a clinical 3T MRI scanner. The IR-FS-ZTE sequence employed an adiabatic inversion pulse followed by a fat saturation pulse that suppressed signals from the articular cartilage and fat. At an inversion time (TI) that was matched to the nulling point of the articular cartilage, continuous ZTE imaging was performed with a smoothly rotating readout gradient, which enabled time-efficient encoding of the OCJ region's short T2 signal with a minimal echo time (TE) of 12 μs. An ex vivo experiment with six cadaveric knee joints, and an in vivo experiment with six healthy volunteers and three patients with OA were performed to evaluate the feasibility of the proposed approach for high contrast imaging of the OCJ. Contrast-to-noise ratios (CNRs) between the OCJ and its neighboring femoral and tibial cartilage were measured. RESULTS In the ex vivo experiment, IR-FS-ZTE produced improved imaging of the OCJ region over the clinical sequences, and significantly improved the contrast compared to FS-ZTE without IR preparation (p = 0.0022 for tibial cartilage and p = 0.0019 for femoral cartilage with t-test). We also demonstrated the feasibility of high contrast imaging of the OCJ region in vivo using the proposed IR-FS-ZTE sequence, thereby providing more direct information on lesions in the OCJ. Clinical MRI did not detect signal from OCJ due to the long TE (>20 ms). CONCLUSION IR-FS-ZTE allows direct imaging of the OCJ region of the human knee and may help in elucidating the role of the OCJ in cartilage degeneration.
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Affiliation(s)
- Hyungseok Jang
- Department of Radiology, University of California, San Diego, CA, United States
| | - Yajun Ma
- Department of Radiology, University of California, San Diego, CA, United States
| | | | - Alecio F. Lombardi
- Department of Radiology, University of California, San Diego, CA, United States
| | - Eric Y. Chang
- Department of Radiology, University of California, San Diego, CA, United States
- Radiology Service, VA San Diego Healthcare System, San Diego, CA, United States
| | - Jiang Du
- Department of Radiology, University of California, San Diego, CA, United States
- *Correspondence: Jiang Du,
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Masala N, Bastiaansen JAM, Di Sopra L, Roy CW, Piccini D, Yerly J, Colotti R, Stuber M. Free‐running 5D coronary MR angiography at 1.5T using LIBRE water excitation pulses. Magn Reson Med 2020; 84:1470-1485. [DOI: 10.1002/mrm.28221] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2019] [Revised: 12/31/2019] [Accepted: 01/30/2020] [Indexed: 12/12/2022]
Affiliation(s)
- Nemanja Masala
- Department of Diagnostic and Interventional Radiology Lausanne University Hospital (CHUV) and University of Lausanne (UNIL) Lausanne Switzerland
| | - Jessica A. M. Bastiaansen
- Department of Diagnostic and Interventional Radiology Lausanne University Hospital (CHUV) and University of Lausanne (UNIL) Lausanne Switzerland
| | - Lorenzo Di Sopra
- Department of Diagnostic and Interventional Radiology Lausanne University Hospital (CHUV) and University of Lausanne (UNIL) Lausanne Switzerland
| | - Christopher W. Roy
- Department of Diagnostic and Interventional Radiology Lausanne University Hospital (CHUV) and University of Lausanne (UNIL) Lausanne Switzerland
| | - Davide Piccini
- Department of Diagnostic and Interventional Radiology Lausanne University Hospital (CHUV) and University of Lausanne (UNIL) Lausanne Switzerland
- Advanced Clinical Imaging Technology Siemens Healthcare AG Lausanne Switzerland
| | - Jérôme Yerly
- Department of Diagnostic and Interventional Radiology Lausanne University Hospital (CHUV) and University of Lausanne (UNIL) Lausanne Switzerland
- Center for Biomedical Imaging (CIBM) Lausanne Switzerland
| | - Roberto Colotti
- Department of Diagnostic and Interventional Radiology Lausanne University Hospital (CHUV) and University of Lausanne (UNIL) Lausanne Switzerland
| | - Matthias Stuber
- Department of Diagnostic and Interventional Radiology Lausanne University Hospital (CHUV) and University of Lausanne (UNIL) Lausanne Switzerland
- Center for Biomedical Imaging (CIBM) Lausanne Switzerland
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Tawfik AI, Kamr WH, Taman SE. Comparison of 2D Fat Suppressed Proton Density (FS-PD) and 3D (WATS-c) MRI pulse sequences in evaluation of chondromalacia patellae. THE EGYPTIAN JOURNAL OF RADIOLOGY AND NUCLEAR MEDICINE 2019. [DOI: 10.1186/s43055-019-0102-z] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
Abstract
Background
Comparing the diagnostic performance of widely used 2D FSE technique (fat-suppressed proton density; FS-PD) and the 3D technique (water-selective cartilage scan; WATS-c) in evaluation of the chondromalacia patella by using arthroscopy as reference standard
Results
Seventy-five adult patients were enrolled in this study. They underwent MRI examinations then arthroscopy done in 2–4 days after it. MRI was done using 2D (FS-PD) and 3D (WATS-c) sequences and MR images were compared by two radiologists separately, then grading of the cartilage lesions was performed according to modified Noyes grading system and comparison between grade 0–1, 2, and 3 lesions was done using arthroscopic findings as a reference. A false-negative result is considered if there was undergrading of chondromalacia and false-positive result if chondromalacia was overgraded. Each sequence sensitivity, specificity, and accuracy was calculated by both readers.
For reader 1, the sensitivity is 69% for WATS-c and 80% for FS-PD and the accuracy is 90% for WATS-c and 92% for FS-PD and for reader 2, the sensitivity is 56% for WATS-c and 84% for FS-PD and the accuracy is 88% for WATS-c and 94% for FS-PD.
Conclusion
2D FS-PD images showed better diagnostic performance than 3D WATS-c images for evaluating chondromalacia patella.
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Mattap SM, Aitken D, Wills K, Laslett L, Ding C, Pelletier JP, Martel-Pelletier J, Graves SE, Lorimer M, Cicuttini F, Jones G. How Do MRI-Detected Subchondral Bone Marrow Lesions (BMLs) on Two Different MRI Sequences Correlate with Clinically Important Outcomes? Calcif Tissue Int 2018; 103:131-143. [PMID: 29441423 DOI: 10.1007/s00223-018-0402-8] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/14/2017] [Accepted: 02/05/2018] [Indexed: 01/30/2023]
Abstract
The aim of this study is to describe the association of bone marrow lesions (BMLs) present on two different MRI sequences with clinical outcomes, cartilage defect progression, cartilage volume loss over 2.7 years, and total knee replacement (TKR) over 13.3 years. 394 participants (50-80 years) were assessed at baseline and 2.7 years. BML presence at baseline was scored on T1-weighted fat-suppressed 3D gradient-recalled acquisition (T1) and T2-weighted fat-suppressed 2D fast spin-echo (T2) sequences. Knee pain, function, and stiffness were assessed using WOMAC. Cartilage volume and defects were assessed using validated methods. Incident TKR was determined by data linkage. BMLs were mostly present on both MRI sequences (86%). BMLs present on T2, T1, and both sequences were associated with greater knee pain and functional limitation (odds ratio = 1.49 to 1.70; all p < 0.05). Longitudinally, BMLs present on T2, T1, and both sequences were associated with worsening knee pain (β = 1.12 to 1.37, respectively; p < 0.05) and worsening stiffness (β = 0.45 to 0.52, respectively; all p < 0.05) but not worsening functional limitation or total WOMAC. BMLs present on T2, T1, and both sequences predicted site-specific cartilage defect progression (relative risk = 1.22 to 4.63; all p < 0.05) except at the medial tibial and inferior patellar sites. Lateral tibial and superior patellar BMLs present on T2, T1, and both sequences predicted site-specific cartilage volume loss (β = - 174.77 to - 140.67; p < 0.05). BMLs present on T2, T1, and both sequences were strongly associated with incident TKR. BMLs can be assessed on either T2- or T1-weighted sequences with no clinical predictive advantage of either sequence.
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Affiliation(s)
- Siti Maisarah Mattap
- Menzies Institute for Medical Research, University of Tasmania, Private Bag 23, Hobart, TAS, 7001, Australia.
| | - Dawn Aitken
- Menzies Institute for Medical Research, University of Tasmania, Private Bag 23, Hobart, TAS, 7001, Australia
| | - Karen Wills
- Menzies Institute for Medical Research, University of Tasmania, Private Bag 23, Hobart, TAS, 7001, Australia
| | - Laura Laslett
- Menzies Institute for Medical Research, University of Tasmania, Private Bag 23, Hobart, TAS, 7001, Australia
| | - Changhai Ding
- Menzies Institute for Medical Research, University of Tasmania, Private Bag 23, Hobart, TAS, 7001, Australia
| | - Jean-Pierre Pelletier
- Osteoarthritis Research Unit, University of Montreal Hospital Research Centre (CRCHUM), Montreal, QC, Canada
| | - Johanne Martel-Pelletier
- Osteoarthritis Research Unit, University of Montreal Hospital Research Centre (CRCHUM), Montreal, QC, Canada
| | - Stephen E Graves
- Australian Orthopaedic Association National Joint Replacement Registry (AOANJRR), Adelaide, SA, Australia
| | - Michelle Lorimer
- South Australian Health and Medical Research Institute (SAHMRI), Adelaide, SA, Australia
| | - Flavia Cicuttini
- Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, VIC, Australia
| | - Graeme Jones
- Menzies Institute for Medical Research, University of Tasmania, Private Bag 23, Hobart, TAS, 7001, Australia
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Cao J, Zheng B, Meng X, Lv Y, Lu H, Wang K, Huang D, Ren J. A novel ultrasound scanning approach for evaluating femoral cartilage defects of the knee: comparison with routine magnetic resonance imaging. J Orthop Surg Res 2018; 13:178. [PMID: 30012149 PMCID: PMC6048893 DOI: 10.1186/s13018-018-0887-x] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/17/2017] [Accepted: 07/09/2018] [Indexed: 01/17/2023] Open
Abstract
Background This study aimed to assess a novel ultrasound (US) scanning approach in evaluating knee femoral cartilaginous defects, compared with magnetic resonance imaging (MRI, commonly used for knee imaging) and arthroscopy (gold standard). Methods Sixty-four consecutive patients (65 knees) were prospectively evaluated between April 2010 and July 2011. Results The overall sensitivity (62.2 and 69.4%), specificity (92.9 and 90.5%), accuracy (75.4 and 78.5%), and adjusted positive (88.7 and 90.4%) and negative predictive (69.5 and 73.3%) were similar for both radiologists (weighted κ = 0.76). Furthermore, agreement between grading by US and MRI was substantial (weighted κ = 0.61). Conclusions In conclusion, the novel US scanning approach allows similar diagnostic performance compared to routine MRI for knee cartilage defects. US is more accessible, easier to perform, and less expensive than MRI, with potential advantages of easier initial screening and assessment of cartilage defects. Electronic supplementary material The online version of this article (10.1186/s13018-018-0887-x) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Junyan Cao
- Department of Medical Ultrasonics, The Third Affiliated Hospital of Sun Yat-sen University, 600 Tianhe Road, Guangzhou, 510630, People's Republic of China
| | - Bowen Zheng
- Department of Medical Ultrasonics, The Third Affiliated Hospital of Sun Yat-sen University, 600 Tianhe Road, Guangzhou, 510630, People's Republic of China
| | - Xiaochun Meng
- Department of Radiology, The Third Affiliated Hospital of Sun Yat-sen University, 600 Tianhe Road, Guangzhou, 510630, People's Republic of China
| | - Yan Lv
- Department of Medical Ultrasonics, The Third Affiliated Hospital of Sun Yat-sen University, 600 Tianhe Road, Guangzhou, 510630, People's Republic of China
| | - Huading Lu
- Department of Orthopedics, The Third Affiliated Hospital of Sun Yat-sen University, 600 Tianhe Road, Guangzhou, 510630, People's Republic of China
| | - Kun Wang
- Department of Orthopedics, The Third Affiliated Hospital of Sun Yat-sen University, 600 Tianhe Road, Guangzhou, 510630, People's Republic of China
| | - Dongmei Huang
- Department of Medical Ultrasonics, The Third Affiliated Hospital of Sun Yat-sen University, 600 Tianhe Road, Guangzhou, 510630, People's Republic of China
| | - Jie Ren
- Department of Medical Ultrasonics, The Third Affiliated Hospital of Sun Yat-sen University, 600 Tianhe Road, Guangzhou, 510630, People's Republic of China.
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Hayashi D, Li X, Murakami AM, Roemer FW, Trattnig S, Guermazi A. Understanding Magnetic Resonance Imaging of Knee Cartilage Repair: A Focus on Clinical Relevance. Cartilage 2018; 9:223-236. [PMID: 28580842 PMCID: PMC6042034 DOI: 10.1177/1947603517710309] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Abstract
The aims of this review article are (a) to describe the principles of morphologic and compositional magnetic resonance imaging (MRI) techniques relevant for the imaging of knee cartilage repair surgery and their application to longitudinal studies and (b) to illustrate the clinical relevance of pre- and postsurgical MRI with correlation to intraoperative images. First, MRI sequences that can be applied for imaging of cartilage repair tissue in the knee are described, focusing on comparison of 2D and 3D fast spin echo and gradient recalled echo sequences. Imaging features of cartilage repair tissue are then discussed, including conventional (morphologic) MRI and compositional MRI techniques. More specifically, imaging techniques for specific cartilage repair surgery techniques as described above, as well as MRI-based semiquantitative scoring systems for the knee cartilage repair tissue-MR Observation of Cartilage Repair Tissue and Cartilage Repair OA Knee Score-are explained. Then, currently available surgical techniques are reviewed, including marrow stimulation, osteochondral autograft, osteochondral allograft, particulate cartilage allograft, autologous chondrocyte implantation, and others. Finally, ongoing research efforts and future direction of cartilage repair tissue imaging are discussed.
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Affiliation(s)
- Daichi Hayashi
- Quantitative Imaging Center, Department of Radiology, Boston University School of Medicine, Boston, MA, USA,Department of Radiology, Yale New Haven Health at Bridgeport Hospital, Bridgeport, CT, USA,Daichi Hayashi, Department of Radiology, Boston University School of Medicine, 820 Harrison Avenue, FGH Building 3rd Floor, Boston, MA 02118, USA.
| | - Xinning Li
- Department of Orthopedic Surgery, Boston University School of Medicine, Boston, MA, USA
| | - Akira M. Murakami
- Quantitative Imaging Center, Department of Radiology, Boston University School of Medicine, Boston, MA, USA
| | - Frank W. Roemer
- Quantitative Imaging Center, Department of Radiology, Boston University School of Medicine, Boston, MA, USA,Department of Radiology, University of Erlangen-Nuremberg, Erlangen, Germany
| | - Siegfried Trattnig
- Department of Biomedical Imaging and Image-Guided Therapy, Medical University of Vienna, Vienna, Austria
| | - Ali Guermazi
- Quantitative Imaging Center, Department of Radiology, Boston University School of Medicine, Boston, MA, USA
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12
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Altahawi F, Subhas N. 3D MRI in Musculoskeletal Imaging: Current and Future Applications. CURRENT RADIOLOGY REPORTS 2018. [DOI: 10.1007/s40134-018-0287-3] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/24/2023]
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13
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Lee YH, Hahn S, Lim D, Suh JS. Articular cartilage grading of the knee: diagnostic performance of fat-suppressed 3D volume isotropic turbo spin-echo acquisition (VISTA) compared with 3D T1 high-resolution isovolumetric examination (THRIVE). Acta Radiol 2017; 58:190-196. [PMID: 27207633 DOI: 10.1177/0284185116646142] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Background Conventionally, two-dimensional (2D) fast spin-echo (FSE) sequences have been widely used for clinical cartilage imaging as well as gradient (GRE) sequences. Recently, three-dimensional (3D) volumetric magnetic resonance imaging (MRI) has been introduced with one 3D volumetric scan, and this is replacing slice-by-slice 2D MR scans. Purpose To evaluate the image quality and diagnostic performance of two 3D sequences for abnormalities of knee cartilage: fat-suppressed (FS) FSE-based 3D volume isotropic turbo spin-echo acquisition (VISTA) and GRE-based 3D T1 high-resolution isovolumetric examination (THRIVE). Material and Methods The institutional review board approved the protocol of this retrospective review. This study enrolled 40 patients (41 knees) with arthroscopically confirmed abnormalities of cartilage. All patients underwent isovoxel 3D-VISTA and 3D-THRIVE MR sequences on 3T MRI. We assessed the cartilage grade on the two 3D sequences using arthroscopy as a gold standard. Inter-observer agreement for each technique was evaluated with the intraclass correlation coefficient (ICC). Differences in the area under the curve (AUC) were compared between the 3D-THRIVE and 3D-VISTA. Results Although inter-observer agreement for both sequences was excellent, the inter-observer agreement for 3D-VISTA was higher than for 3D-THRIVE for cartilage grading in all regions of the knee. There was no significant difference in the diagnostic performance ( P > 0.05) between the two sequences for detecting cartilage grade. Conclusion FSE-based 3D-VISTA images had good diagnostic performance that was comparable to GRE-based 3D-THRIVE images in the evaluation of knee cartilage, and can be used in routine knee MR protocols for the evaluation of cartilage.
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Affiliation(s)
- Young Han Lee
- Department of Radiology, Research Institute of Radiological Science, Medical Convergence Research Institute, and Severance Biomedical Science Institute, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Seok Hahn
- Department of Radiology, Research Institute of Radiological Science, Medical Convergence Research Institute, and Severance Biomedical Science Institute, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Daekeon Lim
- Department of Radiology, Research Institute of Radiological Science, Medical Convergence Research Institute, and Severance Biomedical Science Institute, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Jin-Suck Suh
- Department of Radiology, Research Institute of Radiological Science, Medical Convergence Research Institute, and Severance Biomedical Science Institute, Yonsei University College of Medicine, Seoul, Republic of Korea
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Puhakka J, Afara IO, Paatela T, Sormaala MJ, Timonen MA, Virén T, Jurvelin JS, Töyräs J, Kiviranta I. In Vivo Evaluation of the Potential of High-Frequency Ultrasound for Arthroscopic Examination of the Shoulder Joint. Cartilage 2016; 7:248-55. [PMID: 27375840 PMCID: PMC4918065 DOI: 10.1177/1947603515617280] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
OBJECTIVE Accurate arthroscopic evaluation of cartilage lesions could significantly improve the outcome of repair surgery. In this study, we investigated for the first time the potential of intra-articular ultrasound as an arthroscopic tool for grading cartilage defects in the human shoulder joint in vivo and compared the outcome to results from arthroscopic evaluation and magnetic resonance imaging findings. DESIGN A total of 26 sites from 9 patients undergoing routine shoulder arthroscopy were quantitatively evaluated with a clinical intravascular (40MHz) ultrasound imaging system, using the regular arthroscopy portals. Reflection coefficient (R), integrated reflection coefficient (IRC), apparent integrated backscattering (AIB), and ultrasound roughness index (URI) were calculated, and high-resolution ultrasound images were obtained per site. Each site was visually graded according to the International Cartilage Repair Society (ICRS) system. "Ultrasound scores" corresponding to the ICRS system were determined from the ultrasound images. Magnetic resonance imaging was conducted and cartilage integrity at each site was classified into 5 grades (0 = normal, 4 = severely abnormal) by a radiologist. RESULTS R and IRC were lower at sites with damaged cartilage surface (P = 0.033 and P = 0.043, respectively) and correlated with arthroscopic ICRS grades (r s = -0.444, P = 0.023 and r s = -0.426, P = 0.03, respectively). Arthroscopic ICRS grades and ultrasound scores were significantly correlated (rs = 0.472, P = 0.015), but no significant correlation was found between magnetic resonance imaging data and other parameters. CONCLUSION The results suggest that ultrasound arthroscopy could facilitate quantitative clinical appraisal of articular cartilage integrity in the shoulder joint and provide information on cartilage lesion depth and severity for quantitative diagnostics in surgery.
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Affiliation(s)
- Jani Puhakka
- Department of Orthopaedics and Traumatology, University of Helsinki, Helsinki, Finland
| | - Isaac O. Afara
- Department of Applied Physics, University of Eastern Finland, Kuopio, Finland,Isaac O. Afara, Department of Applied Physics, University of Eastern Finland, Yliopistonranta 1 F, Melania, Kuopio, 70211 Finland.
| | - Teemu Paatela
- Department of Orthopaedics and Traumatology, University of Helsinki, Helsinki, Finland,Department of Orthopaedics and Traumatology, Helsinki University Central Hospital, Helsinki, Finland
| | - Markus J. Sormaala
- Department of Radiology, Helsinki University Hospital, Helsinki, Finland
| | - Matti A. Timonen
- Department of Applied Physics, University of Eastern Finland, Kuopio, Finland
| | - Tuomas Virén
- Cancer Centre, Kuopio University Hospital, Kuopio, Finland
| | - Jukka S. Jurvelin
- Department of Applied Physics, University of Eastern Finland, Kuopio, Finland
| | - Juha Töyräs
- Department of Applied Physics, University of Eastern Finland, Kuopio, Finland,Diagnostic Imaging Center, Kuopio University Hospital, Kuopio, Finland
| | - Ilkka Kiviranta
- Department of Orthopaedics and Traumatology, University of Helsinki, Helsinki, Finland,Department of Orthopaedics and Traumatology, Helsinki University Central Hospital, Helsinki, Finland
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Chagas-Neto FA, Nogueira-Barbosa MH, Lorenzato MM, Salim R, Kfuri-Junior M, Crema MD. Diagnostic performance of 3D TSE MRI versus 2D TSE MRI of the knee at 1.5 T, with prompt arthroscopic correlation, in the detection of meniscal and cruciate ligament tears. Radiol Bras 2016; 49:69-74. [PMID: 27141127 PMCID: PMC4851473 DOI: 10.1590/0100-3984.2015.0042] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/08/2023] Open
Abstract
Objective To compare the diagnostic performance of the three-dimensional turbo
spin-echo (3D TSE) magnetic resonance imaging (MRI) technique with the
performance of the standard two-dimensional turbo spin-echo (2D TSE)
protocol at 1.5 T, in the detection of meniscal and ligament tears. Materials and Methods Thirty-eight patients were imaged twice, first with a standard multiplanar 2D
TSE MR technique, and then with a 3D TSE technique, both in the same 1.5 T
MRI scanner. The patients underwent knee arthroscopy within the first three
days after the MRI. Using arthroscopy as the reference standard, we
determined the diagnostic performance and agreement. Results For detecting anterior cruciate ligament tears, the 3D TSE and routine 2D TSE
techniques showed similar values for sensitivity (93% and 93%, respectively)
and specificity (80% and 85%, respectively). For detecting medial meniscal
tears, the two techniques also had similar sensitivity (85% and 83%,
respectively) and specificity (68% and 71%, respectively). In addition, for
detecting lateral meniscal tears, the two techniques had similar sensitivity
(58% and 54%, respectively) and specificity (82% and 92%, respectively).
There was a substantial to almost perfect intraobserver and interobserver
agreement when comparing the readings for both techniques. Conclusion The 3D TSE technique has a diagnostic performance similar to that of the
routine 2D TSE protocol for detecting meniscal and anterior cruciate
ligament tears at 1.5 T, with the advantage of faster acquisition.
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Affiliation(s)
- Francisco Abaeté Chagas-Neto
- PhD, Professor of Radiology, Division of Radiology, Universidade de Fortaleza (Unifor) and Centro Universitário Christus; Section Head, Musculoskeletal Imaging, Hospital Antonio Prudente, Fortaleza, CE, Brazil
| | - Marcello Henrique Nogueira-Barbosa
- PhD, Full Professor of Radiology, Division of Radiology, Internal Medicine Department, Faculdade de Medicina de Ribeirão Preto da Universidade de São Paulo (FMRP-USP), Ribeirão Preto, SP, Brazil
| | | | - Rodrigo Salim
- PhD, Department of Biomechanics, Medicine and Rehabilitation of the Locomotor Apparatus, Faculdade de Medicina de Ribeirão Preto da Universidade de São Paulo (FMRP-USP), Ribeirão Preto, SP, Brazil
| | - Maurício Kfuri-Junior
- PhD, Department of Biomechanics, Medicine and Rehabilitation of the Locomotor Apparatus, Faculdade de Medicina de Ribeirão Preto da Universidade de São Paulo (FMRP-USP), Ribeirão Preto, SP, Brazil
| | - Michel Daoud Crema
- MD, Radiologist, Radiology Department, Saint-Antoine Hospital, University of Paris VI, Paris, France; Department of Radiology, Quantitative Imaging Center, Boston University School of Medicine, Boston, MA, USA; Department of Radiology and Teleimagem, Hospital do Coração (HCor), São Paulo, SP, Brazil
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Abstract
OBJECTIVE Imaging of hip cartilage is challenging because of its limited thickness and complex geometry and therefore requires advanced MRI techniques. However, cartilage abnormalities are found in a number of disease entities, and their diagnosis may impact patient management. This article will provide pertinent information about the motivation to image hip cartilage, which imaging techniques to use, and how to analyze cartilage; finally, we will discuss disease entities with regional cartilage lesions, including the typical MRI findings. CONCLUSION Because the detection and quantification of regional cartilage abnormalities are critical for guidance of operative and nonoperative management of hip disorders, radiologists should be familiar with imaging and analysis techniques for assessing hip cartilage.
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Abstract
OBJECTIVE Unenhanced MRI, indirect MR arthrography, and direct MR arthrography have been used in the radiologic evaluation of patients with suspected labral tears and chondral lesions of the hip. The purpose of this article is to examine the existing evidence for the use of these techniques in patients with hip pain and suspected labral or chondral abnormalities. CONCLUSION Evidence from a review of the radiologic literature supports the use of direct MR arthrography over unenhanced MRI and indirect MR arthrography for the detection of labral and cartilage abnormalities in the hip. Although high-resolution unenhanced 3-T MRI appears promising, limited information in the literature supports its use in the detection and characterization of chondrolabral lesions.
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Guermazi A, Roemer FW, Alizai H, Winalski CS, Welsch G, Brittberg M, Trattnig S. State of the Art: MR Imaging after Knee Cartilage Repair Surgery. Radiology 2015; 277:23-43. [DOI: 10.1148/radiol.2015141146] [Citation(s) in RCA: 75] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/26/2023]
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19
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Wluka AE, Teichtahl AJ, Maulana R, Liu BM, Wang Y, Giles GG, O'Sullivan R, Findlay D, Cicuttini FM. Bone marrow lesions can be subtyped into groups with different clinical outcomes using two magnetic resonance imaging (MRI) sequences. Arthritis Res Ther 2015; 17:270. [PMID: 26410822 PMCID: PMC4584130 DOI: 10.1186/s13075-015-0780-5] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2015] [Accepted: 09/08/2015] [Indexed: 01/30/2023] Open
Abstract
Introduction Bone marrow lesions (BMLs) are features detected on MRI that are important in the pathogenesis of knee osteoarthritis. Since BMLs reflect heterogeneous pathologies this prospective cohort study examined whether BMLs detected using different MRI sequences are associated with distinct structural and clinical endpoints. Methods A total of 297 community-based adults without knee pain were examined to identify BMLs visualised using three-dimensional T1-weighted gradient-echo fat-suppressed (T1-weighted sequences) fat-suppressed and fat-saturated FSE T2-weighted MRI sequences (T2-weighted sequences) at baseline. Cartilage volume was measured at baseline and follow-up, while incident knee pain was assessed at follow-up, an average of 2.3 years later. Results At baseline, 46 BMLs were visualised in 39 participants. Of the 45 BMLs visualised on T2-weighted sequences, 34 (74 %) were also seen on T1-weighted sequences. One BML was seen on only T1-weighted sequences. Knees with BMLs visualised on both T1- and T2-weighted sequences had significantly higher medial tibial cartilage volume loss (45 mm3/annum, standard error of the mean (SEM) 14) than those with BMLs identified on only T2-weighted sequences (−13 mm3/annum SEM 19), after adjustment for age, gender and body mass index (p = 0.01). Incident knee pain was more likely in individuals with BMLs in the medial compartment visualised on both T1- and T2-weighted (eight participants, 53 %) compared to those with BMLs on only T2-weighted sequences (0 %) or no BMLs (76 participants, 31 %, p = 0.02). Conclusions BMLs present on both T1- and T2-weighted MRI sequences were associated with increased medial tibial cartilage loss and incident knee pain compared with those BMLs seen only on T2-weighted sequences. This suggests that combining different MRI sequences may provide more informative targets in the prevention and treatment of knee osteoarthritis.
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Affiliation(s)
- Anita E Wluka
- Department of Epidemiology and Preventive Medicine, School of Public Health and Preventive Medicine, Monash University, Alfred Hospital, 99 Commercial Road, Melbourne, VIC, 3004, Australia.
| | - Andrew J Teichtahl
- Department of Epidemiology and Preventive Medicine, School of Public Health and Preventive Medicine, Monash University, Alfred Hospital, 99 Commercial Road, Melbourne, VIC, 3004, Australia. .,Baker IDI Heart and Diabetes Institute, 75 Commercial Road, Melbourne, VIC, 3004, Australia.
| | - Rheza Maulana
- Department of Epidemiology and Preventive Medicine, School of Public Health and Preventive Medicine, Monash University, Alfred Hospital, 99 Commercial Road, Melbourne, VIC, 3004, Australia.
| | - Bonnie M Liu
- Department of Epidemiology and Preventive Medicine, School of Public Health and Preventive Medicine, Monash University, Alfred Hospital, 99 Commercial Road, Melbourne, VIC, 3004, Australia.
| | - Yuanyuan Wang
- Department of Epidemiology and Preventive Medicine, School of Public Health and Preventive Medicine, Monash University, Alfred Hospital, 99 Commercial Road, Melbourne, VIC, 3004, Australia.
| | - Graham G Giles
- Cancer Epidemiology Centre, Cancer Council Victoria, Carlton, Australia and Centre for Epidemiology and Biostatistics, Melbourne School of Population and Global Health, The University of Melbourne, 207 Bouverie Street, Carlton, VIC, 3010, Australia.
| | - Richard O'Sullivan
- Healthcare Imaging Services, Epworth Hospital, 89 Bridge Road, Melbourne, VIC, 3121, Australia.
| | - David Findlay
- Discipline of Orthopaedics and Trauma, University of Adelaide, North Terrace, Adelaide, SA, 5005, Australia.
| | - Flavia M Cicuttini
- Department of Epidemiology and Preventive Medicine, School of Public Health and Preventive Medicine, Monash University, Alfred Hospital, 99 Commercial Road, Melbourne, VIC, 3004, Australia.
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Zink JV, Souteyrand P, Guis S, Chagnaud C, Fur YL, Militianu D, Mattei JP, Rozenbaum M, Rosner I, Guye M, Bernard M, Bendahan D. Standardized quantitative measurements of wrist cartilage in healthy humans using 3T magnetic resonance imaging. World J Orthop 2015; 6:641-648. [PMID: 26396941 PMCID: PMC4573509 DOI: 10.5312/wjo.v6.i8.641] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/04/2015] [Revised: 06/17/2015] [Accepted: 08/03/2015] [Indexed: 02/06/2023] Open
Abstract
AIM: To quantify the wrist cartilage cross-sectional area in humans from a 3D magnetic resonance imaging (MRI) dataset and to assess the corresponding reproducibility.
METHODS: The study was conducted in 14 healthy volunteers (6 females and 8 males) between 30 and 58 years old and devoid of articular pain. Subjects were asked to lie down in the supine position with the right hand positioned above the pelvic region on top of a home-built rigid platform attached to the scanner bed. The wrist was wrapped with a flexible surface coil. MRI investigations were performed at 3T (Verio-Siemens) using volume interpolated breath hold examination (VIBE) and dual echo steady state (DESS) MRI sequences. Cartilage cross sectional area (CSA) was measured on a slice of interest selected from a 3D dataset of the entire carpus and metacarpal-phalangeal areas on the basis of anatomical criteria using conventional image processing radiology software. Cartilage cross-sectional areas between opposite bones in the carpal region were manually selected and quantified using a thresholding method.
RESULTS: Cartilage CSA measurements performed on a selected predefined slice were 292.4 ± 39 mm2 using the VIBE sequence and slightly lower, 270.4 ± 50.6 mm2, with the DESS sequence. The inter (14.1%) and intra (2.4%) subject variability was similar for both MRI methods. The coefficients of variation computed for the repeated measurements were also comparable for the VIBE (2.4%) and the DESS (4.8%) sequences. The carpus length averaged over the group was 37.5 ± 2.8 mm with a 7.45% between-subjects coefficient of variation. Of note, wrist cartilage CSA measured with either the VIBE or the DESS sequences was linearly related to the carpal bone length. The variability between subjects was significantly reduced to 8.4% when the CSA was normalized with respect to the carpal bone length.
CONCLUSION: The ratio between wrist cartilage CSA and carpal bone length is a highly reproducible standardized measurement which normalizes the natural diversity between individuals.
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Evaluation of the Articular Cartilage of the Knee Joint Using an Isotropic Resolution 3D Fast Spin-Echo Sequence With Conventional and Radial Reformatted Images. AJR Am J Roentgenol 2015. [DOI: 10.2214/ajr.14.14265] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
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Huang M, Schweitzer ME. The role of radiology in the evolution of the understanding of articular disease. Radiology 2015; 273:S1-22. [PMID: 25340431 DOI: 10.1148/radiol.14140270] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
Both the clinical practice of radiology and the journal Radiology have had an enormous effect on our understanding of articular disease. Early descriptions of osteoarthritis (OA) appeared in Radiology. More recently, advanced physiologic magnetic resonance (MR) techniques have furthered our understanding of the early prestructural changes in patients with OA. Sodium imaging, delayed gadolinium-enhanced MR imaging of cartilage, and spin-lattice relaxation in the rotating frame (or T1ρ) sequences have advanced understanding of the pathophysiology and pathoanatomy of OA. Many pioneering articles on rheumatoid arthritis (RA) also have been published in Radiology. In the intervening decades, our understanding of the natural history of RA has been altered by these articles. Many of the first descriptions of crystalline arthropathies, including gout, calcium pyrophosphate deposition, and hydroxyapatite deposition disease, appeared in Radiology.
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Affiliation(s)
- Mingqian Huang
- From the Department of Radiology, University of Stony Brook, HSC Level 4, Room 120, Stony Brook, NY 11746
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Abstract
We tried to review the role of magnetic resonance imaging (MRI) in understanding microscopic and morphologic structure of the articular cartilage. The optimal protocols and available spin-echo sequences in present day practice are reviewed in context of common pathologies of articular cartilage. The future trends of articular cartilage imaging have been discussed with their appropriateness. In diarthrodial joints of the body, articular cartilage is functionally very important. It is frequently exposed to trauma, degeneration, and repetitive wear and tear. MRI has played a vital role in evaluation of articular cartilage. With the availability of advanced repair surgeries for cartilage lesions, there has been an increased demand for improved cartilage imaging techniques. Recent advances in imaging strategies for native and postoperative articular cartilage open up an entirely new approach in management of cartilage-related pathologies.
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Affiliation(s)
| | - Dd Rasalkar
- Department of Radiology, Kokilaben Dhirubhai Ambani Hospital, Mumbai, India
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90°-Flip-angle three-dimensional double-echo steady-state (3D-DESS) magnetic resonance imaging of the knee: Isovoxel cartilage imaging at 3T. Eur J Radiol 2014; 83:1429-32. [DOI: 10.1016/j.ejrad.2014.04.034] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2013] [Revised: 04/11/2014] [Accepted: 04/28/2014] [Indexed: 11/23/2022]
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Ruiz Santiago F, Pozuelo Calvo R, Almansa López J, Guzmán Álvarez L, Castellano García MDM. T2 mapping in patellar chondromalacia. Eur J Radiol 2014; 83:984-988. [PMID: 24713490 DOI: 10.1016/j.ejrad.2014.03.007] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2013] [Revised: 02/16/2014] [Accepted: 03/07/2014] [Indexed: 11/18/2022]
Abstract
OBJECTIVE To study the correlation between the T2 relaxation times of the patellar cartilage and morphological MRI findings of chondromalacia. METHODS This prospective study comprises 50 patients, 27 men and 23 women suffering of anterior knee pain (mean age: 29.7, SD 8.3 years; range: 16-45 years). MRI of 97 knees were performed in these patients at 1.5T magnet including sagittal T1, coronal intermediate, axial intermediate fat sat and T2 mapping. Chondromalacia was assessed using a modified version of Noyes classification. The relaxation time, T2, was studied segmenting the full thickness of the patellar cartilage in 12 areas: 4 proximal (external facet-proximal-lateral (EPL), external facet-proximal-central (EPC), internal facet-proximal-central (IPC), internal facet-proximal-medial (IPM), 4 in the middle section (external facet-middle-lateral (EML), external facet-middle-central (EMC), internal facet-middle-central (IMC), internal facet-middle-medial (IMM) and 4 distal (external facet-distal-lateral (EDL), external facet-distal-central (EDC), internal facet-distal-central (IDC), internal facet-distal-medial (IDM). RESULTS T2 values showed a significant increase in mild chondromalacia regarding normal cartilage in most of the cartilage areas (p<0.05), except in the internal distal facet (IDC and IDM), EPC, EDL, and IMM. Severe chondromalacia was characterized by a fall of T2 relaxation times with loss of statistical significant differences in comparison with normal cartilage, except in EMC and IMC, where similar values as mild chondromalacia were maintained (p<0.05). CONCLUSIONS Steepest increase in T2 values of patellar cartilage occurs in early stages of patellar cartilage degeneration. Progression of morphologic changes of chondromalacia to more severe degrees is associated to a new drop of T2 relaxation times approaching basal values in most of the areas of the patellar cartilage, except in the central area of the middle section, where T2 values remain increased.
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Affiliation(s)
- Fernando Ruiz Santiago
- Department of Radiology, Traumatology Hospital, University Hospital Virgen de las Nieves, Granada, SPAIN.
| | - Rocío Pozuelo Calvo
- Department of Rehabilitation and Physical therapy, Traumatology Hospital, University Hospital Virgen de las Nieves, Granada, SPAIN
| | - Julio Almansa López
- Department of Physic, University Hospital Virgen de las Nieves, Granada, SPAIN
| | - Luis Guzmán Álvarez
- Department of Radiology, Traumatology Hospital, University Hospital Virgen de las Nieves, Granada, SPAIN
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Al saleh H, Hernandez L, Lee KS, Rosas HG, Block WF, Kijowski R. Rapid isotropic resolution cartilage assessment using radial alternating repetition time balanced steady-state free-precession imaging. J Magn Reson Imaging 2013; 40:796-803. [PMID: 24151247 DOI: 10.1002/jmri.24425] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2013] [Accepted: 08/27/2013] [Indexed: 11/07/2022] Open
Abstract
PURPOSE To compare a balanced steady-state free-precession sequence with a radial k-space trajectory and alternating repetition time fat suppression (Radial-ATR) with other currently used fat-suppressed 3D sequences for evaluating the articular cartilage of the knee joint at 3.0T. MATERIALS AND METHODS Radial-ATR, fast spin-echo (FSE-Cube), gradient recall-echo acquired in the steady-state (GRASS), and spoiled gradient recall-echo (SPGR) sequences with similar voxel volumes and identical scan times were performed at 3.0T on both knee joints of five volunteers. Signal-to-noise ratio (SNR) and contrast-to-noise ratio (CNR) measurements were performed for all sequences using a double acquisition method and compared using Mann-Whitney Wilcoxon tests. Radial-ATR sequences with 0.3 mm and 0.4 mm isotropic resolution were also performed on the knee joints of seven volunteers and three patients with osteoarthritis. RESULTS Average SNR values for cartilage, synovial fluid, and bone marrow were 54.7, 153.3, and 12.9, respectively, for Radial ATR, 30.8, 44.1, and 1.9, respectively, for FSE-Cube, 13.3, 46.9, and 3.3, respectively, for GRASS, and 19.1, 8.1, and 2.1, respectively, for SPGR. Average CNR values between cartilage and synovial fluid and between cartilage and bone marrow were 98.6 and 41.8, respectively, for VIPR-ATR, 13.4 and 28.8, respectively, for FSE-Cube, 33.6 and 10.0, respectively, for GRASS, and 11.0 and 16.9, respectively, for SPGR. Radial-ATR had significantly higher (P < 0.001) cartilage, synovial fluid, and bone marrow SNR and significantly higher (P < 0.01) CNR between cartilage and synovial fluid and between cartilage and bone marrow than FSE-Cube, GRASS, and SPGR. Radial-ATR provided excellent visualization of articular cartilage at high isotropic resolution with no image degradation due to off-resonance banding artifacts. CONCLUSION Radial-ATR had superior SNR efficiency to other fat-suppressed 3D cartilage imaging sequences and produced high isotropic resolution images of the knee joint which could be used for evaluating articular cartilage at 3.0T.
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Affiliation(s)
- Habib Al saleh
- Department of Medical Physics, University of Wisconsin, Madison, Wisconsin, USA
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Rosas H, Kijowski R. Volumetric magnetic resonance imaging of the musculoskeletal system. Semin Roentgenol 2013; 48:140-7. [PMID: 23452461 DOI: 10.1053/j.ro.2012.11.007] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Affiliation(s)
- Humberto Rosas
- Department of Radiology, Musculoskeletal Division, University of Wisconsin School of Medicine and Public Health, Madison, WI 53792-3252, USA.
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Ciuffreda P, Lelario M, Milillo P, Vinci R, Coppolino F, Stoppino LP, Genovese EA, Macarini L. Mechanism of traumatic knee injuries and MRI findings. Musculoskelet Surg 2013; 97 Suppl 2:S127-S135. [PMID: 23949934 DOI: 10.1007/s12306-013-0279-7] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2013] [Accepted: 06/10/2013] [Indexed: 06/02/2023]
Abstract
Bone bruises are focal abnormalities in subchondral bone marrow due to trabecular microfractures as a result of traumatic force. These trauma-induced lesions are better detected with magnetic resonance (MR) imaging using water-sensitive sequences. Moreover, the pattern of bone bruise is distinctive and allows us to understand the dynamics of trauma and to predict associated soft injuries. This article discusses the mechanism of traumatic injury and MR findings.
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Affiliation(s)
- P Ciuffreda
- Department of Diagnostic Imaging, University of Foggia, Viale Luigi Pinto n.1, 71122, Foggia, Italy
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Wiewiorski M, Miska M, Kretzschmar M, Studler U, Bieri O, Valderrabano V. Delayed gadolinium-enhanced MRI of cartilage of the ankle joint: results after autologous matrix-induced chondrogenesis (AMIC)-aided reconstruction of osteochondral lesions of the talus. Clin Radiol 2013; 68:1031-8. [PMID: 23809267 DOI: 10.1016/j.crad.2013.04.016] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2012] [Revised: 04/22/2013] [Accepted: 04/30/2013] [Indexed: 12/28/2022]
Abstract
AIM To assess cartilage quality using delayed gadolinium-enhanced magnetic resonance imaging after repair of osteochondral lesions of the talus using autologous matrix-induced chondrogenesis (AMIC). MATERIALS AND METHODS A three-dimensional (3D) spoiled gradient-echo (SGE) sequence at 3 T was used to obtain quantitative T1 relaxation times before and after Gd-DTPA2 (Magnevist, 0.2 mM/kg bod weight) administration to assess 23 cases of AMIC-aided repair of osteochondral lesions of the talus. Delta relaxation rates (ΔR1) for reference cartilage (RC) and repair tissue (RT), and the relative delta relaxation rate (rΔR1) were calculated. The morphological appearance of the cartilage RT was graded on sagittal dual-echo steady-state (DESS) views according to the "magnetic resonance observation of cartilage repair tissue" (MOCART) protocol. The study was approved by the institutional review board and written consent from each patient was obtained. RESULTS The AMIC cases had a mean T1 relaxation time of 1.194 s (SD 0.207 s) in RC and 1.470 s (SD 0.384 s) in RT before contrast medium administration. The contrast-enhanced T1 relaxation time decreased to 0.480 s (SD 0.114 s) in RC and 0.411 s (SD 0.096 s) in RT. There was a significant difference (p > 0.05) between the ΔR1 in RC (1.372 × 10(-3)/s, range 0.526-3.201 × 10(-3)/s, SD 0.666 × 10(-3)/s) and RT (1.856 × 10(-3)/s, range 0.93-3.336 × 10(-3)/s, SD 0.609 × 10(-3)/s). The mean rΔR1 was 1.49, SD 0.45). The mean MOCART score at follow-up was 62.6 points (range 30-95, SD 15.3). CONCLUSION The results of the present study suggest that repair cartilage resulting from AMIC-aided repair of osteochondral lesions of the talus has a significantly lower glycosaminoglycan (GAG) content than normal hyaline cartilage, but can be regarded as having hyaline-like properties.
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Affiliation(s)
- M Wiewiorski
- Orthopaedic Department, University of Basel Hospital, Basel, Switzerland.
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Jung JY, Yoon YC, Kim HR, Choe BK, Wang JH, Jung JY. Knee derangements: comparison of isotropic 3D fast spin-echo, isotropic 3D balanced fast field-echo, and conventional 2D fast spin-echo MR imaging. Radiology 2013; 268:802-13. [PMID: 23533289 DOI: 10.1148/radiol.13121990] [Citation(s) in RCA: 44] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
PURPOSE To compare diagnostic performance, subjective image quality, and artifacts of isotropic three-dimensional (3D) intermediate-weighted (IW) fast spin-echo (SE), isotropic 3D balanced fast field-echo (FFE), and conventional two-dimensional (2D) fast SE 3.0-T MR sequences in evaluation of cartilage, ligaments, menisci, and osseous knee structures in symptomatic patients. MATERIALS AND METHODS Institutional review board approval and waiver of informed consent were obtained for this HIPAA-compliant study. One hundred MR studies, each with three data sets (3D IW fast SE, 3D balanced FFE, 2D fast SE), were reviewed retrospectively. Two radiologists independently evaluated images for cartilaginous defects, anterior cruciate ligament (ACL), posterior cruciate ligament (PCL), medial meniscus (MM), lateral meniscus (LM) tears, subchondral bone marrow signal abnormalities, subjective image quality, and image artifacts. Arthroscopic results were the reference standard. Statistical analysis was performed to calculate interobserver agreement and compare diagnostic performance of sequences. RESULTS Sensitivity and specificity were greater than 85% for all lesions. For cartilaginous defects, sensitivity of 3D IW fast SE was significantly greater than that of 3D balanced FFE (95.5% vs 89.7%). Sensitivity of 3D IW fast SE and 2D fast SE for MM, LM, and ACL tears tended to be greater than that of 3D balanced FFE. IW fast SE had a higher detection rate for subchondral bone marrow signal abnormality than did 3D balanced FFE (34% vs 21%); it also had the best image quality and fewest artifacts, followed by 2D fast SE and 3D balanced FFE. Interobserver agreement was excellent for evaluation of all intraarticular structures (κ = 0.85-1) and good to excellent for detection of subchondral bone marrow signal abnormality (κ = 0.76-0.91). CONCLUSION The performance of IW fast SE is superior to that of balanced FFE in evaluation of cartilaginous defects, with no significant difference in performance between 2D fast SE, 3D IW fast SE, and 3D balanced FFE in evaluation of meniscal and ligament tears. Subchondral bone marrow signal abnormality is more easily seen on 3D IW fast SE images, with better subjective image quality and fewer artifacts, than on images obtained with other techniques.
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Affiliation(s)
- Jin Young Jung
- Department of Radiology, Dongtan Sacred Heart Hospital, Hallym University, Hwaseong, Gyeonggi-do, Korea
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Guermazi A, Roemer FW, Haugen IK, Crema MD, Hayashi D. MRI-based semiquantitative scoring of joint pathology in osteoarthritis. Nat Rev Rheumatol 2013; 9:236-51. [DOI: 10.1038/nrrheum.2012.223] [Citation(s) in RCA: 101] [Impact Index Per Article: 9.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
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Abstract
OBJECTIVE The purposes of this review are to describe commonly available 3D MRI techniques and to discuss the literature to date regarding the utility of such techniques in the assessment of internal derangement of joints. CONCLUSION Long acquisition and postprocessing times and limited contrast characteristics have generally prohibited routine use of 3D MRI in clinical practice. However, technical advances, including higher-field-strength MRI systems, high performance gradients, high-resolution multichannel coils, and pulse sequences with shorter acquisition times, have made feasible 3D isotropic MRI with reasonable acquisition times.
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Harris JD, Brophy RH, Jia G, Price B, Knopp M, Siston RA, Flanigan DC. Sensitivity of magnetic resonance imaging for detection of patellofemoral articular cartilage defects. Arthroscopy 2012; 28:1728-37. [PMID: 22749495 DOI: 10.1016/j.arthro.2012.03.018] [Citation(s) in RCA: 35] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/03/2012] [Revised: 03/12/2012] [Accepted: 03/13/2012] [Indexed: 02/02/2023]
Abstract
PURPOSE Chondral defects within the patellofemoral compartment are common and lack the ability to heal on their own. Early detection of these lesions with a noninvasive modality would be beneficial in delaying or preventing their possible progression to osteoarthritis. We hypothesized that magnetic resonance imaging (MRI) is a sensitive, specific, and accurate imaging modality for the detection of patellofemoral chondral defects with substantial interobserver reliability and that MRI has a higher sensitivity, specificity, and accuracy for detecting patellar defects than trochlear defects. METHODS A systematic review of multiple medical databases was performed by use of the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) protocol. Analysis of studies that reported diagnostic performance of MRI in the assessment of patellofemoral chondral defects (patella and trochlea), using arthroscopy as the reference gold standard, was performed. Sensitivity, specificity, accuracy, and interobserver reliability were reported. Significant heterogeneity across studies precluded meta-analysis. RESULTS MRI was more sensitive in detection of patellar (87%) versus trochlear (72%) defects. MRI was similarly specific for patellar (86%) and trochlear (89%) defects. MRI was similarly accurate for patellar (84%) and trochlear (83%) defects. Interobserver agreement was substantial to almost perfect for both patellar and trochlear defects. CONCLUSIONS MRI is a highly sensitive, specific, and accurate noninvasive diagnostic modality for the detection of chondral defects in the patellofemoral compartment of the knee, using arthroscopy as the reference gold standard. Although there was wide variability in the statistical parameters assessed, MRI was more sensitive for detection of patellar versus trochlear defects and similarly specific and accurate for patellar and trochlear defects. Interobserver reliability is substantial to near perfect in the assessment of these lesions, without a significant difference between patellar and trochlear defects. CLINICAL RELEVANCE Use of MRI may allow early detection of chondral defects within the patellofemoral compartment, enabling clinicians to adopt strategies to delay or prevent progression to osteoarthritis. LEVEL OF EVIDENCE Level III, systematic review of Level I, II, and III studies.
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Affiliation(s)
- Joshua D Harris
- Sports Medicine Center and Cartilage Restoration Program, The Ohio State University, Columbus, USA
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Mechanism of disease in early osteoarthritis: application of modern MR imaging techniques -- a technical report. Magn Reson Imaging 2012; 31:156-61. [PMID: 22902064 DOI: 10.1016/j.mri.2012.07.005] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2011] [Revised: 05/14/2012] [Accepted: 07/11/2012] [Indexed: 11/23/2022]
Abstract
The application of biomolecular magnetic resonance imaging becomes increasingly important in the context of early cartilage changes in degenerative and inflammatory joint disease before gross morphological changes become apparent. In this limited technical report, we investigate the correlation of MRI T1, T2 and T1ρ relaxation times with quantitative biochemical measurements of proteoglycan and collagen contents of cartilage in close synopsis with histologic morphology. A recently developed MRI sequence, T1ρ, was able to detect early intracartilaginous degeneration quantitatively and also qualitatively by color mapping demonstrating a higher sensitivity than standard T2-weighted sequences. The results correlated highly with reduced proteoglycan content and disrupted collagen architecture as measured by biochemistry and histology. The findings lend support to a clinical implementation that allows rapid visual capturing of pathology on a local, millimeter level. Further information about articular cartilage quality otherwise not detectable in vivo, via normal inspection, is needed for orthopedic treatment decisions in the present and future.
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Milewski MD, Smitaman E, Moukaddam H, Katz LD, Essig DA, Medvecky MJ, Haims AH. Comparison of 3D vs. 2D fast spin echo imaging for evaluation of articular cartilage in the knee on a 3T system scientific research. Eur J Radiol 2012; 81:1637-43. [DOI: 10.1016/j.ejrad.2011.04.072] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2011] [Accepted: 04/21/2011] [Indexed: 11/28/2022]
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Preliminary Study of 1.5-T MR Arthrography of the Shoulder With 3D Isotropic Intermediate-Weighted Turbo Spin Echo. AJR Am J Roentgenol 2012; 199:W107-13. [DOI: 10.2214/ajr.11.7544] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
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Kim HS, Yoon YC, Kwon JW, Choe BK. Qualitative and quantitative assessment of isotropic ankle magnetic resonance imaging: three-dimensional isotropic intermediate-weighted turbo spin echo versus three-dimensional isotropic fast field echo sequences. Korean J Radiol 2012; 13:443-9. [PMID: 22778566 PMCID: PMC3384826 DOI: 10.3348/kjr.2012.13.4.443] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2011] [Accepted: 01/19/2012] [Indexed: 11/15/2022] Open
Abstract
Objective To compare the image quality of volume isotropic turbo spin echo acquisition (VISTA) imaging method with that of the three-dimensional (3D) isotropic fast field echo (FFE) imaging method applied for ankle joint imaging. Materials and Methods MR imaging of the ankles of 10 healthy volunteers was performed with VISTA and 3D FFE sequences by using a 3.0 T machine. Two radiologists retrospectively assessed the tissue contrast between fluid and cartilage (F-C), and fluid and the Achilles tendon (F-T) with use of a 4-point scale. For a quantitative analysis, signal-to-noise ratio (SNR) was obtained by imaging phantom, and the contrast ratios (CRs) were calculated between F-T and F-C. Statistical analyses for differences in grades of tissue contrast and CRs were performed. Results VISTA had significantly superior grades in tissue contrast of F-T (p = 0.001). Results of 3D FFE had superior grades in tissue contrast of F-C, but these result were not statistically significant (p = 0.157). VISTA had significantly superior CRs in F-T (p = 0.002), and 3D FFE had superior CRs in F-C (p = 0.003). The SNR of VISTA was higher than that of 3D FFE (49.24 vs. 15.94). Conclusion VISTA demonstrates superior tissue contrast between fluid and the Achiles tendon in terms of quantitative and qualitative analysis, while 3D FFE shows superior tissue contrast between fluid and cartilage in terms of quantitative analysis.
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Affiliation(s)
- Hyun Su Kim
- Department of Radiology, Samsung Medical Center, School of Medicine, Sungkyunkwan University, Seoul 135-710, Korea
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Value of sagittal fat-suppressed proton-density fast-spin-echo of the knee joint as a limited protocol in evaluating internal knee derangements. J Comput Assist Tomogr 2011; 35:653-61. [PMID: 21926865 DOI: 10.1097/rct.0b013e3182251016] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
PURPOSE The aim of the study was to determine the accuracy and observer agreement in the assessment of internal knee derangement using sagittal fat-suppressed proton-density fast-spin-echo (FS PD-FSE) compared with combined sagittal T1-weighted spin-echo, dual-proton-density, and T2-weighted spin-echo sequences and with arthroscopy. METHODS One hundred eighteen patients undergoing routine knee magnetic resonance (MR) imaging had additional imaging with sagittal FS PD-FSE sequences. Menisci, cruciate ligaments, extensor tendons (ETs), bone marrow, osteoarthritic changes, soft tissue edema, joint effusion, and incidental tumors were analyzed. Magnetic resonance images were independently reviewed by 2 radiologists. Fifty patients underwent knee arthroscopy. Statistical analysis compared both imaging protocols with each other and with arthroscopy. Intrareader and interreader agreements were evaluated using κ analysis. Both protocols were compared with arthroscopy. RESULTS Intrareader agreement was very high except for readings of the posterior cruciate ligament, ETs, and cartilage. Intrareader agreement did not differ significantly between the 2 readers except for ETs, bone marrow, and cartilage. Interreader percent agreements were high using both protocols and were not significantly different between the 2 readers except for posterior cruciate ligament. Compared with arthroscopy, both methods showed almost identical results regarding sensitivity, specificity, positive predictive value, and negative predictive value, except for cartilage where FS PD-FSE had increased sensitivity, whereas the combined protocol had increased specificity. CONCLUSIONS Sagittal FS PD-FSE is comparable to our regular MR protocol in assessing internal knee derangement with an overall agreement of at least 93% on all sites except cartilage. It was also comparable to arthroscopy in assessing the cruciate ligaments and menisci, but had a low specificity for cartilaginous derangements. It can replace our 3 sagittal series comprising T1- and T2-weighted and proton-density-spin-echo sequences, hence saving time and cost.
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Moriya S, Miki Y, Kanagaki M, Yamamoto A, Okudaira S, Nakamura S, Yokobayashi T, Ishikawa M. Evaluation of cartilage surface injuries using 3D-double echo steady state (3D-DESS): effect of changing flip angle from 40° to 90°. Acta Radiol 2011; 52:1138-42. [PMID: 22042983 DOI: 10.1258/ar.2011.110275] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
Abstract
BACKGROUND In magnetic resonance imaging (MRI) with 3D-double-echo steady-state (3D-DESS) sequences, the cartilage-synovial fluid contrast is reported to be better with a flip angle of 90° than with the conventional flip angle of 40°, and the detection rate of knee cartilage injury may be improved. PURPOSE To compare the diagnostic performance and certainty of diagnosis with 3D-DESS images made using two flip angle settings, 40° and 90°, for knee cartilage surface lesions of Grade 2 or above confirmed by arthroscopy. MATERIAL AND METHODS Images were obtained with 3D-DESS flip angles of 40° and 90° at 1.0T in 13 consecutive patients (2 men, 11 women, age range 18-68 years) evaluated for superficial cartilage injury by arthroscopy. Two radiologists classified the presence or absence of cartilage damage of ≥Grade 2 as 'positive (p)' or 'negative (n)', respectively. The rate of agreement with arthroscopic diagnosis was then examined, and the diagnostic performance compared. Diagnostic confidence was assessed scoring the presence or absence of cartilage damage into three categories: 3 = can diagnose with absolute confidence; 2 = can diagnose with a level of certainty as probably present or probably absent; and 1 = cannot make a diagnosis. RESULTS In a comparison of the rate of agreement between diagnosis by 3D-DESS images and arthroscopy, the rate of agreement was significantly higher and diagnostic performance was better in 90° images for the medial femoral condyle only. Diagnostic confidence was significantly better with 90° flip angle images than with 40° flip angle images for all six cartilage surfaces. CONCLUSION In evaluating knee cartilage surface lesions with 3D-DESS sequences, a flip angle setting of 90° is more effective than the conventional setting of 40°.
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Affiliation(s)
| | - Yukio Miki
- Department of Radiology, Osaka City University Graduate School of Medicine, Osaka, Japan
| | - Mitsunori Kanagaki
- Department of Diagnostic Imaging and Nuclear Medicine, Kyoto University, Kyoto, Japan
| | - Akira Yamamoto
- Department of Diagnostic Imaging and Nuclear Medicine, Kyoto University, Kyoto, Japan
| | - Shuzo Okudaira
- Department of Orthopaedics, Kyoto Police Hospital, Kyoto, Japan
| | - Shinichiro Nakamura
- Center for Musculoskeletal Research, University of Tennessee, Knoxville, TN, USA
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Roemer FW, Crema MD, Trattnig S, Guermazi A. Advances in imaging of osteoarthritis and cartilage. Radiology 2011; 260:332-54. [PMID: 21778451 DOI: 10.1148/radiol.11101359] [Citation(s) in RCA: 159] [Impact Index Per Article: 12.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
Osteoarthritis (OA) is the most frequent form of arthritis, with major implications for individual and public health care without effective treatment available. The field of joint imaging, and particularly magnetic resonance (MR) imaging, has evolved rapidly owing to technical advances and the application of these to the field of clinical research. Cartilage imaging certainly is at the forefront of these developments. In this review, the different aspects of OA imaging and cartilage assessment, with an emphasis on recent advances, will be presented. The current role of radiography, including advances in the technology for joint space width assessment, will be discussed. The development of various MR imaging techniques capable of facilitating assessment of cartilage morphology and the methods for evaluating the biochemical composition of cartilage will be presented. Advances in quantitative morphologic cartilage assessment and semiquantitative whole-organ assessment will be reviewed. Although MR imaging is the most important modality in imaging of OA and cartilage, others such as ultrasonography play a complementary role that will be discussed briefly.
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Affiliation(s)
- Frank W Roemer
- Quantitative Imaging Center, Department of Radiology, Boston University School of Medicine, 820 Harrison Ave, FGH Building, 3rd Floor, Boston, MA 02118, USA.
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Hayashi D, Guermazi A, Kwoh CK, Hannon MJ, Moore C, Jakicic JM, Green SM, Roemer FW. Semiquantitative assessment of subchondral bone marrow edema-like lesions and subchondral cysts of the knee at 3T MRI: a comparison between intermediate-weighted fat-suppressed spin echo and Dual Echo Steady State sequences. BMC Musculoskelet Disord 2011; 12:198. [PMID: 21906292 PMCID: PMC3182962 DOI: 10.1186/1471-2474-12-198] [Citation(s) in RCA: 44] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/14/2011] [Accepted: 09/09/2011] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Choice of appropriate MR pulse sequence is important for any research studies using imaging-derived data. The aim of this study was to compare semiquantitative assessment of subchondral bone marrow edema-like lesions and subchondral cysts using intermediate-weighted (IW) fat-suppressed (fs) spin echo and Dual Echo Steady State (DESS) sequences on 3 T MRI. METHODS Included were 201 subjects aged 35-65 with frequent knee pain. 3T MRI was performed with the same sequence protocol as in the Osteoarthritis Initiative (OAI). In a primary reading subchondral bone marrow edema-like lesions were assessed according to the WORMS system. Two hundred subregions with such lesions were randomly chosen. The extent of subchondral bone marrow edema-like lesions was re-evaluated separately using sagittal IW fs and DESS sequences according to WORMS. Lesion size and confidence of the differentiation between subchondral bone marrow edema-like lesions and subchondral cysts located within or adjacent to them was rated from 0 to 3. Wilcoxon signed-rank tests and chi-square statistics were used to examine differences between the two sequences. RESULTS Of 200 subchondral bone marrow edema-like lesions detected by IW fs sequence, 93 lesions (46.5%) were not depicted by the DESS sequence. The IW fs sequence depicted subchondral bone marrow edema-like lesions to a larger extent than DESS (p < 0.0001), and the opposite was true for subchondral cysts. Confidence scores for differentiation of the two types of lesions were not significantly different between the two sequences. CONCLUSIONS In direct comparison the IW fs sequence depicts more subchondral bone marrow edema-like lesions and better demonstrate the extent of their maximum size. The DESS sequence helps in the differentiation of subchondral bone marrow edema-like lesions and subchondral cysts. The IW fs sequence should be used for determination of lesion extent whenever the size of subchondral bone marrow edema-like lesions is the focus of attention.
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Affiliation(s)
- Daichi Hayashi
- Quantitative Imaging Center, Department of Radiology, Boston University School of Medicine, Boston, MA 02118, USA.
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Kijowski R, Gold GE. Routine 3D magnetic resonance imaging of joints. J Magn Reson Imaging 2011; 33:758-71. [PMID: 21448939 DOI: 10.1002/jmri.22342] [Citation(s) in RCA: 74] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
Due to its high spatial resolution and excellent tissue contrast, magnetic resonance imaging (MRI) has become the most commonly used imaging method to evaluate joints. Most musculoskeletal MRI is performed using 2D fast spin-echo sequences. However, 3D sequences have also been used for joint imaging and have the advantage of acquiring thin continuous slices through joints, which reduces the effects of partial volume averaging. With recent advances in MR technology, 3D sequences with isotropic resolution have been developed. These sequences allow high-quality multiplanar reformat images to be obtained following a single acquisition, thereby eliminating the need to repeat sequences with identical tissue contrast in different planes. Preliminary results on the diagnostic performance of 3D isotropic resolution sequences are encouraging. However, additional studies are needed to determine whether these sequences can replace currently used 2D fast spin-echo sequences for providing comprehensive joint assessment in clinical practice.
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Affiliation(s)
- Richard Kijowski
- Department of Radiology, University of Wisconsin, Madison, WI, USA.
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Hunter DJ, Guermazi A, Lo GH, Grainger AJ, Conaghan PG, Boudreau RM, Roemer FW. Evolution of semi-quantitative whole joint assessment of knee OA: MOAKS (MRI Osteoarthritis Knee Score). Osteoarthritis Cartilage 2011; 19:990-1002. [PMID: 21645627 PMCID: PMC4058435 DOI: 10.1016/j.joca.2011.05.004] [Citation(s) in RCA: 635] [Impact Index Per Article: 48.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/28/2011] [Revised: 04/07/2011] [Accepted: 05/11/2011] [Indexed: 02/07/2023]
Abstract
OBJECTIVE In an effort to evolve semi-quantitative scoring methods based upon limitations identified in existing tools, integrating expert readers' experience with all available scoring tools and the published data comparing the different scoring systems, we iteratively developed the magnetic resonance imaging (MRI) Osteoarthritis Knee Score (MOAKS). The purpose of this report is to describe the instrument and its reliability. METHODS The MOAKS instrument refines the scoring of bone marrow lesions (BMLs) (providing regional delineation and scoring across regions), cartilage (sub-regional assessment), and refines the elements of meniscal morphology (adding meniscal hypertrophy, partial maceration and progressive partial maceration) scoring. After a training and calibration session two expert readers read MRIs of 20 knees separately. In addition, one reader re-read the same 20 MRIs 4 weeks later presented in random order to assess intra-rater reliability. The analyses presented here are for both intra- and inter-rater reliability (calculated using the linear weighted kappa and overall percent agreement). RESULTS With the exception of inter-rater reliability for tibial cartilage area (kappa=0.36) and tibial osteophytes (kappa=0.49); and intra-rater reliability for tibial BML number of lesions (kappa=0.54), Hoffa-synovitis (kappa=0.42) all measures of reliability using kappa statistics were very good (0.61-0.8) or reached near-perfect agreement (0.81-1.0). Only intra-rater reliability for Hoffa-synovitis, and inter-rater reliability for tibial and patellar osteophytes showed overall percent agreement <75%. CONCLUSION MOAKS scoring shows very good to excellent reliability for the large majority of features assessed. Further iterative development and research will include assessment of its validation and responsiveness.
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Affiliation(s)
- David J Hunter
- Rheumatology Department, Royal North Shore Hospital and Northern Clinical School, University of Sydney, Sydney, NSW Australia
| | - Ali Guermazi
- Quantitative Imaging Center (QIC), Department of Radiology, Boston University School of Medicine, Boston, MA USA
| | - Grace H Lo
- Medical Care Line, Research Care Line, and Houston Health Services Research and Development (HSR&D) Center of Excellence, Michael E. DeBakey Veterans Administration Medical Center, Houston, TX; Department of Medicine, Section of Immunology, Allergy and Rheumatology, Baylor College of Medicine, Houston, TX, USA
| | - Andrew J Grainger
- Department of Radiology, Leeds Teaching Hospitals & NIHR Leeds Musculoskeletal Biomedical Research Unit, Leeds, UK
| | - Philip G Conaghan
- Section of Musculoskeletal Disease, University of Leeds & NIHR Leeds Musculoskeletal Biomedical Research Unit, Leeds, UK
| | - Robert M Boudreau
- Department of Epidemiology, Graduate School of Public Health, University of Pittsburgh, Pittsburgh, PA, USA
| | - Frank W. Roemer
- Quantitative Imaging Center (QIC), Department of Radiology, Boston University School of Medicine, Boston, MA USA,Department of Radiology, Klinikum Augsburg, Augsburg, Germany
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Zhang Z, Meng Q, Li Z, Pan B, Regatte RR, Schweitzer ME. Simultaneous visualization of nerves and vessels of the lower extremities using magnetization-prepared susceptibility weighted magnetic resonance imaging at 3.0 T. Neurosurgery 2011; 70:1-7; discussion 7. [PMID: 21768913 DOI: 10.1227/neu.0b013e31822da57f] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/14/2023] Open
Abstract
BACKGROUND Identifying the extent of involvement of the vessel and nerve, particularly in regard to preoperative evaluation and precise localization of the tumor and its relation to the structures of the extremities, has important applications for advancing the treatment of lower extremity diseases. OBJECTIVE To review the technical feasibility of simultaneous visualization of nerves and vessels of the lower extremities by using magnetization-prepared susceptibility-weighted magnetic resonance (MR) imaging (MP-SWI) at 3.0T. METHODS Ten healthy volunteers and 10 patients were studied. Optimized MP-SWI, MR neurography (MRN) based on 3D diffusion-weighted steady-state free precession imaging and contrast-enhanced MR angiography (CE-MRA) sequences were performed for each subject. The means of signal-to-noise ratio (SNR)n, SNRv, SNRm, contrast-to-noise ratio (CNR)n,m and CNRv,m were calculated and the certainty of identifying nerves and vessels was determined. CNRn,m between MP-SWI and MRN, and CNRv,m between MP-SWI and CE-MRA were compared. RESULTS MP-SWI provides slightly poorer CNRv,m than CE-MRA, whereas MP-SWI provides a better CNRn,m than MRN. In thin-slice-thickness maximum-intensity projection arbitrary planes, the sciatic nerve and its branches were clearly identified (score 1 or 2 of 2) in 17 subjects (85%); the femoral artery and the main branches were identified (score 1 or 2 of 2) in all 20 subjects (100%). The nerves are isointense to slightly hypointense to muscle, and the vessels show a more obvious hyperintense signal than muscle in MP-SWI. CONCLUSION The proposed MP-SWI demonstrates the feasibility of simultaneously visualizing nerves and vessels of the lower extremities without using an exogenous contrast agent. It may enable straightforward localization of a disease process to a specific nerve and vessel.
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Affiliation(s)
- Zhongwei Zhang
- Department of Radiology, The First Affiliated Hospital of Sun Yat-Sen University, Guangzhou, China.
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Crema MD, Roemer FW, Marra MD, Burstein D, Gold GE, Eckstein F, Baum T, Mosher TJ, Carrino JA, Guermazi A. Articular cartilage in the knee: current MR imaging techniques and applications in clinical practice and research. Radiographics 2011; 31:37-61. [PMID: 21257932 DOI: 10.1148/rg.311105084] [Citation(s) in RCA: 282] [Impact Index Per Article: 21.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
Magnetic resonance (MR) imaging is the most important imaging modality for the evaluation of traumatic or degenerative cartilaginous lesions in the knee. It is a powerful noninvasive tool for detecting such lesions and monitoring the effects of pharmacologic and surgical therapy. The specific MR imaging techniques used for these purposes can be divided into two broad categories according to their usefulness for morphologic or compositional evaluation. To assess the structure of knee cartilage, standard spin-echo (SE) and gradient-recalled echo (GRE) sequences, fast SE sequences, and three-dimensional SE and GRE sequences are available. These techniques allow the detection of morphologic defects in the articular cartilage of the knee and are commonly used in research for semiquantitative and quantitative assessments of cartilage. To evaluate the collagen network and proteoglycan content in the knee cartilage matrix, compositional assessment techniques such as T2 mapping, delayed gadolinium-enhanced MR imaging of cartilage (or dGEMRIC), T1ρ imaging, sodium imaging, and diffusion-weighted imaging are available. These techniques may be used in various combinations and at various magnetic field strengths in clinical and research settings to improve the characterization of changes in cartilage.
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Affiliation(s)
- Michel D Crema
- Department of Radiology, Quantitative Imaging Center, Boston University School of Medicine and Boston Imaging Core Laboratory, 820 Harrison Ave, FGH Building, 3rd Floor, Boston, MA 02118, USA.
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Strickland CD, Kijowski R. Morphologic Imaging of Articular Cartilage. Magn Reson Imaging Clin N Am 2011; 19:229-48. [DOI: 10.1016/j.mric.2011.02.009] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
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Welsch GH, Zak L, Mamisch TC, Paul D, Lauer L, Mauerer A, Marlovits S, Trattnig S. Advanced morphological 3D magnetic resonance observation of cartilage repair tissue (MOCART) scoring using a new isotropic 3D proton-density, turbo spin echo sequence with variable flip angle distribution (PD-SPACE) compared to an isotropic 3D steady-state free precession sequence (True-FISP) and standard 2D sequences. J Magn Reson Imaging 2011; 33:180-8. [PMID: 21182137 DOI: 10.1002/jmri.22399] [Citation(s) in RCA: 34] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022] Open
Abstract
PURPOSE To evaluate a new isotropic 3D proton-density, turbo-spin-echo sequence with variable flip-angle distribution (PD-SPACE) sequence compared to an isotropic 3D true-fast-imaging with steady-state-precession (True-FISP) sequence and 2D standard MR sequences with regard to the new 3D magnetic resonance observation of cartilage repair tissue (MOCART) score. MATERIALS AND METHODS Sixty consecutive MR scans on 37 patients (age: 32.8 ± 7.9 years) after matrix-associated autologous chondrocyte transplantation (MACT) of the knee were prospectively included. The 3D MOCART score was assessed using the standard 2D sequences and the multiplanar-reconstruction (MPR) of both isotropic sequences. Statistical, Bonferroni-corrected correlation as well as subjective quality analysis were performed. RESULTS The correlation of the different sequences was significant for the variables defect fill, cartilage interface, bone interface, surface, subchondral lamina, chondral osteophytes, and effusion (Pearson coefficients 0.514-0.865). Especially between the standard sequences and the 3D True-FISP sequence, the variables structure, signal intensity, subchondral bone, and bone marrow edema revealed lower, not significant, correlation values (0.242-0.383). Subjective quality was good for all sequences (P ≥ 0.05). Artifacts were most often visible on the 3D True-FISP sequence (P < 0.05). CONCLUSION Different isotropic sequences can be used for the 3D evaluation of cartilage repair with the benefits of isotropic 3D MRI, MPR, and a significantly reduced scan time, where the 3D PD-SPACE sequence reveals the best results.
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Affiliation(s)
- Goetz H Welsch
- MR Center, Department of Radiology, Medical University of Vienna, Vienna, Austria.
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Crema MD, Roemer FW, Hayashi D, Guermazi A. Comment on: Bone marrow lesions in people with knee osteoarthritis predict progression of disease and joint replacement: a longitudinal study. Rheumatology (Oxford) 2011; 50:996-7; author reply 997-9. [DOI: 10.1093/rheumatology/ker006] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
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Trattnig S, Winalski CS, Marlovits S, Jurvelin JS, Welsch GH, Potter HG. Magnetic Resonance Imaging of Cartilage Repair: A Review. Cartilage 2011; 2:5-26. [PMID: 26069565 PMCID: PMC4300792 DOI: 10.1177/1947603509360209] [Citation(s) in RCA: 45] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/30/2023] Open
Abstract
Articular cartilage lesions are a common pathology of the knee joint, and many patients may benefit from cartilage repair surgeries that offer the chance to avoid the development of osteoarthritis or delay its progression. Cartilage repair surgery, no matter the technique, requires a noninvasive, standardized, and high-quality longitudinal method to assess the structure of the repair tissue. This goal is best fulfilled by magnetic resonance imaging (MRI). The present article provides an overview of the current state of the art of MRI of cartilage repair. In the first 2 sections, preclinical and clinical MRI of cartilage repair tissue are described with a focus on morphological depiction of cartilage and the use of functional (biochemical) MR methodologies for the visualization of the ultrastructure of cartilage repair. In the third section, a short overview is provided on the regulatory issues of the United States Food and Drug Administration (FDA) and the European Medicines Agency (EMEA) regarding MR follow-up studies of patients after cartilage repair surgeries.
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Affiliation(s)
- Siegfried Trattnig
- MR Centre - High Field MR, Department of Radiology, Medical University of Vienna, Vienna, Austria,Siegfried Trattnig, MR Centre - High Field MR, Department of Radiology, Medical University of Vienna, Lazarettgasse 14, A-1090 Vienna, Austria
| | | | - Stephan Marlovits
- Trauma Surgery Department, Medical University of Vienna, Vienna, Austria
| | - Jukka S. Jurvelin
- Department of Physics and Mathematics, University of Eastern Finland, Kuopio, Finland
| | - Goetz H. Welsch
- MR Centre - High Field MR, Department of Radiology, Medical University of Vienna, Vienna, Austria,Department of Trauma Surgery, University Hospital of Erlangen, Erlangen, Germany
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