The application of optical coherence tomography in musculoskeletal disease

Sensing the future: A review on emerging technologies for assessing and monitoring bone health

Bone health is crucial at all stages of life. Several medical conditions and changes in lifestyle affect the growth, structure, and functions of bones. This may lead to the development of bone degenerative disorders, such as osteoporosis, osteoarthritis, rheumatoid arthritis, etc., which are major public health concerns worldwide. Accurate and reliable measurement and monitoring of bone health are important aspects for early diagnosis and interventions to prevent such disorders. Significant progress has recently been made in developing new sensing technologies that offer non-invasive, low-cost, and accurate measurements of bone health. In this review, we have described bone remodeling processes and common bone disorders. We have also compiled information on the bone turnover markers for their use as biomarkers in biosensing devices to monitor bone health. Second, this review details biosensing technology for bone health assessment, including the latest developments in various non-invasive techniques, including dual-energy X-ray absorptiometry, magnetic resonance imaging, computed tomography, and biosensors. Further, we have also discussed the potential of emerging technologies, such as biosensors based on nano- and micro-electromechanical systems and application of artificial intelligence in non-invasive techniques for improving bone health assessment. Finally, we have summarized the advantages and limitations of each technology and described clinical applications for detecting bone disorders and monitoring treatment outcomes. Overall, this review highlights the potential of emerging technologies for improving bone health assessment with the potential to revolutionize clinical practice and improve patient outcomes. The review highlights key challenges and future directions for biosensor research that pave the way for continued innovations to improve diagnosis, monitoring, and treatment of bone-related diseases.

Quantitative assessment of rat bone regeneration using complex master-slave optical coherence tomography

BACKGROUND

The need for hard and soft tissues in oral implantology determined the development of methods and techniques to increase bone volume and their quality with different alternative materials used as substituents of patient's natural bone. In addition, laser radiation can be used to accelerate the repair of fractures and to produce an increased volume of formed callus, as well as an increased bone mineral density.

METHODS

The aim of this work is to evaluate the capability of an in-house developed multimodal complex master slave (CMS) enhanced swept source (SS) optical coherence tomography (OCT) imaging instrument to analyze the increase in the quantity and the improvement of the quality of newly-formed bone using low level laser therapy (LLLT). Bone formation is quantitatively assessed in 5 mm cylindrical defects made in the calvaria part of the skull of living rats. Samples are divided in three study groups: A, a negative control group, for which the natural healing process of the defect is investigated; B, a positive control group, for which bovine graft is used to stimulate bone formation, and C, a study group, in which bovine graft is added to the created defects and LLLT is applied throughout the entire healing period. The animals are sacrificed after 14, 21, and 30 days, and the samples are imaged using the multimodal CMS/SS-OCT instrument.

RESULTS

The method allows for the simultaneous monitoring of the bone tissue via two perpendicular cross-sections and nine en-face images taken at adjustable depths into the sample. A global image with course axial resolution allows for the positioning of the field-of-view of the system on the area of interest on the tissue. The quantitative assessment of the process of bone formation is completed using the differences in brightness between the native bone, the artificial bone graft, and the newly-formed bone.

CONCLUSIONS

Group C is demonstrated to have a higher volume of newly-formed bone than Group B, which is better from this point of view than Group A. By analyzing the evolution of this volume of new bone in time, the most significant difference was after 21 days, therefore approximately after two thirds of the total time interval analyzed. After 30 days, the volumes of bone tend to move closer, as they begin to fill the available gap. The study demonstrates that OCT can assess quantitatively the positive impact of LLLT on bone regeneration.

Label-free photoacoustic microscopy for in-vivo tendon imaging using a fiber-based pulse laser

Tendons are tough, flexible, and ubiquitous tissues that connect muscle to bone. Tendon injuries are a common musculoskeletal injury, which affect 7% of all patients and are involved in up to 50% of sports-related injuries in the United States. Various imaging modalities are used to evaluate tendons, and both magnetic resonance imaging and sonography are used clinically to evaluate tendons with non-invasive and non-ionizing radiation. However, these modalities cannot provide 3-dimensional (3D) structural images and are limited by angle dependency. In addition, anisotropy is an artifact that is unique to the musculoskeletal system. Thus, great care should be taken during tendon imaging. The present study evaluated a functional photoacoustic microscopy system for in-vivo tendon imaging without labeling. Tendons have a higher density of type 1 collagen in a cross-linked triple-helical formation (65–80% dry-weight collagen and 1–2% elastin in a proteoglycan-water matrix) than other tissues, which provides clear endogenous absorption contrast in the near-infrared spectrum. Therefore, photoacoustic imaging with a high sensitivity to absorption contrast is a powerful tool for label-free imaging of tendons. A pulsed near-infrared fiber-based laser with a centered wavelength of 780 nm was used for the imaging, and this system successfully provided a 3D image of mouse tendons with a wide field of view (5 × 5 mm²).

Biomarkers of (osteo)arthritis

Arthritic diseases are a major cause of disability and morbidity, and cause an enormous burden for health and social care systems globally. Osteoarthritis (OA) is the most common form of arthritis. The key risk factors for the development of OA are age, obesity, joint trauma or instability. Metabolic and endocrine diseases can also contribute to the pathogenesis of OA. There is accumulating evidence to suggest that OA is a whole-organ disease that is influenced by systemic mediators, inflammaging, innate immunity and the low-grade inflammation induced by metabolic syndrome. Although all joint tissues are implicated in disease progression in OA, articular cartilage has received the most attention in the context of aging, injury and disease. There is increasing emphasis on the early detection of OA as it has the capacity to target and treat the disease more effectively. Indeed it has been suggested that this is the era of "personalized prevention" for OA. However, the development of strategies for the prevention of OA require new and sensitive biomarker tools that can detect the disease in its molecular and pre-radiographic stage, before structural and functional alterations in cartilage integrity have occurred. There is also evidence to support a role for biomarkers in OA drug discovery, specifically the development of disease modifying osteoarthritis drugs. This Special Issue of Biomarkers is dedicated to recent progress in the field of OA biomarkers. The papers in this Special Issue review the current state-of-the-art and discuss the utility of OA biomarkers as diagnostic and prognostic tools.

Study of Collagen Birefringence in Different Grades of Oral Squamous Cell Carcinoma Using Picrosirius Red and Polarized Light Microscopy

Objectives. The present study was done to evaluate birefringence pattern of collagen fibres in different grades of oral squamous cell carcinoma using Picrosirius red stain and polarization microscopy and to determine if there is a change in collagen fibres between different grades of oral squamous cell carcinoma. Materials and Methods. Picrosirius red stained 5 μm thick sections of previously diagnosed different grades of squamous cell carcinoma and normal oral mucosa were studied under polarization microscopy for arrangement as well as birefringence of collagen fibres around tumour islands. Results. It was found that thin collagen fibres increased and thick collagen fibres decreased with dedifferentiation of OSCC (P < 0.0001). It was observed that there was change in polarization colours of thick fibres from yellowish orange to greenish yellow with dedifferentiation of OSCC indicating loosely packed fibres (P < 0.0001). Conclusion. There was a gradual change of birefringence of collagen from yellowish orange to greenish yellow from well to poorly differentiated squamous cell carcinoma, indicating that there is a change from mature form of collagen to immature form as tumour progresses. Studying collagen fibres with Picrosirius red for stromal changes around tumour islands along with routine staining may help in predicting the prognosis of tumour.

Morphometric grading of osteoarthritis by optical coherence tomography--an ex vivo study

Optical Coherence Tomography (OCT) yields microscopic cross-sectional images of cartilage in real time and at high resolution. As yet, comprehensive grading of degenerative cartilage changes based on OCT has rarely been performed. This study investigated the potential of quantitative OCT using algorithm-based image parameters such as irregularity (OII - Optical Irregularity Index), homogeneity (OHI - Optical Homogeneity Index) and attenuation (OAI - Optical Attenuation Index) in the objective grading of cartilage degeneration. Therefore, OCT was used to image and assess 113 human osteochondral samples obtained from total knee replacements. Processing included the analysis of OII (by calculation of the standard deviation with regards to a fitted surface), of OHI (by edge detection of tissue signal changes) and of OAI (by analysis of relative imaging depth). Additionally, samples were subject to macroscopic (Outerbridge grading), biomechanical (elastic stiffness), qualitative OCT and histological evaluation (Modified Mankin grading). Significant correlations were found between all outcome measures. OII and OHI were effective in assessing cartilage surface, integrity and homogeneity, while OAI could discriminate between unmineralized and mineralized cartilage, respectively. Therefore, quantitative OCT holds potential as a diagnostic tool for more reliable, standardized and objective assessment of cartilage tissue properties.

Comparison of hip joint cartilage degeneration assessed by histology and ex vivo optical coherence tomography

The aim of this study is to validate optical coherence tomography (OCT) in assessing human articular cartilage by means of histological analyses. Twenty resected human femoral head specimens were evaluated with OCT and histological analysis. OCT and histological evaluation was performed according to the Bear and the Mankin criteria. OCT grades and Mankin scores (total score and sub-score structure) were correlated and intra-/inter-observer agreement for repeated OCT evaluations was tested by interclass-correlation coefficient (ICC) analysis. OCT grades and Mankin scores were correlated [Spearman correlation=0.742 (total) and 0.656 (structure), P<0.001], revealing significant differences between the histological scores in various OCT grades of cartilage degeneration (P<0.001). Intra-observer (ICC 0.930) and inter-observer (ICC 0.933) reliability was high (P<0.001). OCT appears to be reliable in the assessment of human articular cartilage. Further studies on intra-operative cartilage evaluation by OCT are necessary to substantiate its applicability in clinical routine.

Removal of artifacts in knee joint vibroarthrographic signals using ensemble empirical mode decomposition and detrended fluctuation analysis

High-resolution knee joint vibroarthrographic (VAG) signals can help physicians accurately evaluate the pathological condition of a degenerative knee joint, in order to prevent unnecessary exploratory surgery. Artifact cancellation is vital to preserve the quality of VAG signals prior to further computer-aided analysis. This paper describes a novel method that effectively utilizes ensemble empirical mode decomposition (EEMD) and detrended fluctuation analysis (DFA) algorithms for the removal of baseline wander and white noise in VAG signal processing. The EEMD method first successively decomposes the raw VAG signal into a set of intrinsic mode functions (IMFs) with fast and low oscillations, until the monotonic baseline wander remains in the last residue. Then, the DFA algorithm is applied to compute the fractal scaling index parameter for each IMF, in order to identify the anti-correlation and the long-range correlation components. Next, the DFA algorithm can be used to identify the anti-correlated and the long-range correlated IMFs, which assists in reconstructing the artifact-reduced VAG signals. Our experimental results showed that the combination of EEMD and DFA algorithms was able to provide averaged signal-to-noise ratio (SNR) values of 20.52 dB (standard deviation: 1.14 dB) and 20.87 dB (standard deviation: 1.89 dB) for 45 normal signals in healthy subjects and 20 pathological signals in symptomatic patients, respectively. The combination of EEMD and DFA algorithms can ameliorate the quality of VAG signals with great SNR improvements over the raw signal, and the results were also superior to those achieved by wavelet matching pursuit decomposition and time-delay neural filter.

Imaging the hard/soft tissue interface

Interfaces between different tissues play an essential role in the biomechanics of native tissues and their recapitulation is now recognized as critical to function. As a consequence, imaging the hard/soft tissue interface has become increasingly important in the area of tissue engineering. Particularly as several biotechnology based products have made it onto the market or are close to human trials and an understanding of their function and development is essential. A range of imaging modalities have been developed that allow a wealth of information on the morphological and physical properties of samples to be obtained non-destructively in vivo or via destructive means. This review summarizes the use of a selection of imaging modalities on interfaces to date considering the strengths and weaknesses of each. We will also consider techniques which have not yet been utilized to their full potential or are likely to play a role in future work in the area.