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Sun D, Liu X, Xu L, Meng Y, Kang H, Li Z. Advances in the Treatment of Partial-Thickness Cartilage Defect. Int J Nanomedicine 2022; 17:6275-6287. [PMID: 36536940 PMCID: PMC9758915 DOI: 10.2147/ijn.s382737] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2022] [Accepted: 11/23/2022] [Indexed: 04/17/2024] Open
Abstract
Partial-thickness cartilage defects (PTCDs) of the articular surface is the most common problem in cartilage degeneration, and also one of the main pathogenesis of osteoarthritis (OA). Due to the lack of a clear diagnosis, the symptoms are often more severe when full-thickness cartilage defect (FTCDs) is present. In contrast to FTCDs and osteochondral defects (OCDs), PTCDs does not injure the subchondral bone, there is no blood supply and bone marrow exudation, and the nearby microenvironment is unsuitable for stem cells adhesion, which completely loses the ability of self-repair. Some clinical studies have shown that partial-thickness cartilage defects is as harmful as full-thickness cartilage defects. Due to the poor effect of conservative treatment, the destructive surgical treatment is not suitable for the treatment of partial-thickness cartilage defects, and the current tissue engineering strategies are not effective, so it is urgent to develop novel strategies or treatment methods to repair PTCDs. In recent years, with the interdisciplinary development of bioscience, mechanics, material science and engineering, many discoveries have been made in the repair of PTCDs. This article reviews the current status and research progress in the treatment of PTCDs from the aspects of diagnosis and modeling of PTCDs, drug therapy, tissue transplantation repair technology and tissue engineering ("bottom-up").
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Affiliation(s)
- Daming Sun
- Wuhan Sports University, Wuhan, People’s Republic of China
- Department of Orthopedics, Wuhan Third Hospital, Tongren Hospital of Wuhan University, Wuhan, People’s Republic of China
| | - Xiangzhong Liu
- Department of Orthopedics, Wuhan Third Hospital, Tongren Hospital of Wuhan University, Wuhan, People’s Republic of China
| | - Liangliang Xu
- Wuhan Sports University, Wuhan, People’s Republic of China
| | - Yi Meng
- Wuhan Sports University, Wuhan, People’s Republic of China
| | - Haifei Kang
- Biomedical Materials and Engineering Research Center of Hubei Province, Wuhan University of Technology, Wuhan, People’s Republic of China
| | - Zhanghua Li
- Department of Orthopedics, Wuhan Third Hospital, Tongren Hospital of Wuhan University, Wuhan, People’s Republic of China
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Wang N, Wen Q, Maharjan S, Mirando AJ, Qi Y, Hilton MJ, Spritzer CE. Magic angle effect on diffusion tensor imaging in ligament and brain. Magn Reson Imaging 2022; 92:243-250. [PMID: 35777687 PMCID: PMC10155228 DOI: 10.1016/j.mri.2022.06.008] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2021] [Revised: 06/09/2022] [Accepted: 06/22/2022] [Indexed: 10/17/2022]
Abstract
PURPOSE To evaluate the magic angle effect on diffusion tensor imaging (DTI) measurements in rat ligaments and mouse brains. METHODS Three rat knee joints and three mouse brains were scanned at 9.4 T using a modified 3D diffusion-weighted spin echo pulse sequence with the isotropic spatial resolution of 45 μm. The b value was 1000 s/mm2 for rat knee and 4000 s/mm2 for mouse brain. DTI model was used to investigate the quantitative metrics at different orientations with respect to the main magnetic field. The collagen fiber structure of the ligament was validated with polarized light microscopy (PLM) imaging. RESULTS The signal intensity, signal-to-noise ratio (SNR), and DTI metrics in the ligament were strongly dependent on the collagen fiber orientation with respect to the main magnetic field from both simulation and actual MRI scans. The variation of fractional anisotropy (FA) was about ~32%, and the variation of mean diffusivity (MD) was ~11%. These findings were further validated with the numerical simulation at different SNRs (~10.0 to 86.0). Compared to the ligament, the DTI metrics showed little orientation dependence in mouse brains. CONCLUSION Magic angle effect plays an important role in DTI measurements in the highly ordered collagen-rich tissues, while MD showed less orientation dependence than FA.
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Affiliation(s)
- Nian Wang
- Department of Radiology and Imaging Sciences, Indiana University, Indianapolis, IN, USA; Indiana Center for Musculoskeletal Health, Indiana University, Indianapolis, IN, USA; Stark Neurosciences Research Institute, Indiana University, Indianapolis, IN, USA.
| | - Qiuting Wen
- Department of Radiology and Imaging Sciences, Indiana University, Indianapolis, IN, USA
| | - Surendra Maharjan
- Department of Radiology and Imaging Sciences, Indiana University, Indianapolis, IN, USA
| | - Anthony J Mirando
- Department of Orthopaedic Surgery, Duke University School of Medicine, Durham, NC, USA
| | - Yi Qi
- Center for In Vivo Microscopy, Duke University School of Medicine, Durham, NC, USA
| | - Matthew J Hilton
- Department of Orthopaedic Surgery, Duke University School of Medicine, Durham, NC, USA; Department of Cell Biology, Duke University School of Medicine, Durham, NC, USA
| | - Charles E Spritzer
- Department of Radiology, Duke University School of Medicine, Durham, NC, USA
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T2*-Mapping of Knee Cartilage in Response to Mechanical Loading in Alpine Skiing: A Feasibility Study. Diagnostics (Basel) 2022; 12:diagnostics12061391. [PMID: 35741201 PMCID: PMC9222057 DOI: 10.3390/diagnostics12061391] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2022] [Revised: 05/30/2022] [Accepted: 06/01/2022] [Indexed: 12/10/2022] Open
Abstract
Purpose: This study intends to establish a study protocol for the quantitative magnetic resonance imaging (qMRI) measurement of biochemical changes in knee cartilage induced by mechanical stress during alpine skiing with the implementation of new spring-loaded ski binding. Methods: The MRI-knee-scans (T2*-mapping) of four skiers using a conventional and a spring-loaded ski binding system, alternately, were acquired before and after 1 h/4 h of exposure to alpine skiing. Intrachondral T2* analysis on 60 defined regions of interest in the femorotibial knee joint (FTJ) was conducted. Intra- and interobserver variability and relative changes in the cartilage T2* signal and thickness were calculated. Results: A relevant decrease in the T2* time after 4 h of alpine skiing could be detected at the majority of measurement times. After overnight recovery, the T2* time increased above baseline. Although, the total T2* signal in the superficial cartilage layers was higher than that in the lower ones, no differences between the layers in the T2* changes could be detected. The central and posterior cartilage zones of the FTJ responded with a stronger T2* alteration than the anterior zones. Conclusions: For the first time, a quantitative MRI study setting could be established to detect early knee cartilage reaction due to alpine skiing. Relevant changes in the T2* time and thus in the intrachondral collagen microstructure and the free water content were observed.
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Badar F, Xia Y. The interface region between articular cartilage and bone by μMRI and PLM at microscopic resolutions. Microsc Res Tech 2021; 85:1483-1493. [PMID: 34859542 DOI: 10.1002/jemt.24011] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2021] [Revised: 10/27/2021] [Accepted: 11/15/2021] [Indexed: 11/07/2022]
Abstract
This dual-modality microscopic imaging study quantifies the interface region between the noncalcified cartilage and the subchondral bone plate, which includes the deep portion of the noncalcified articular cartilage and the zone of calcified cartilage (ZCC). This interface region is typically not visible in routine MRI but becomes visible in MRI with the application of an ultra-short echo time (UTE) sequence. A number of cartilage-bone blocks from a well-documented canine humeral head were harvested for imaging by microscopic MRI (μMRI) and PLM (polarized light microscopy). In μMRI, T2 anisotropic images were acquired by 2D gradient-echo, magnetization-prepared spin-echo and UTE sequences at the 0° and 55° (the magic angle) orientations at 11.7 μm/pixel resolution. In PLM, quantitative optical retardation (nm) and collagen orientation (°) were mapped from the thin sections from the same μMRI specimens at 0.5-2 μm pixel resolutions. The orientational and organizational architecture of the collagen matrix in this interface region was quantified and correlated between the complementary imaging. The magic angle effect as seen in the noncalcified cartilage was statistically confirmed in ZCC in μMRI, which was further supported by quantitative PLM. With an enhanced understanding of the tissue properties in this important interface region, it will potentially be possible to monitor the changes of this tissue region which is instrumental to the initiation and development of osteoarthritis and other joint diseases.
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Affiliation(s)
- Farid Badar
- Department of Physics and Center for Biomedical Research, Oakland University, Rochester, Michigan, USA
| | - Yang Xia
- Department of Physics and Center for Biomedical Research, Oakland University, Rochester, Michigan, USA
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Zhao Q, Ridout RP, Shen J, Wang N. Effects of Angular Resolution and b Value on Diffusion Tensor Imaging in Knee Joint. Cartilage 2021; 13:295S-303S. [PMID: 33843284 PMCID: PMC8804734 DOI: 10.1177/19476035211007909] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/04/2023] Open
Abstract
OBJECTIVE To investigate the influences of the diffusion gradient directions (angular resolution) and the strength of the diffusion gradient (b value) on diffusion tensor imaging (DTI) metrics and tractography of various connective tissues in knee joint. DESIGN Two rat knee joints were scanned on a preclinical 9.4-T system using a 3-dimensional diffusion-weighted spin echo pulse sequence. One protocol with b value of 500, 1500, and 2500 s/mm2 were acquired separately using 43 diffusion gradient directions. The other protocol with b value of 1000 s/mm2 was performed using 147 diffusion gradient directions. The in-plane resolution was 45 µm isotropic. Fractional anisotropy (FA) and mean diffusivity (MD) were compared at different angular resolution. Tractography was quantitatively evaluated at different b values and angular resolutions in cartilage, ligament, meniscus, and growth plate. RESULTS The ligament showed higher FA value compared with growth plate and cartilage. The FA values were largely overestimated at the angular resolution of 6. Compared with FA, MD showed less sensitivity to the angular resolution. The fiber tracking was failed at low angular resolution (6 diffusion gradient directions) or high b value (2500 s/mm2). The quantitative measurements of tract length and track volume were strongly dependent on angular resolution and b value. CONCLUSIONS To obtain consistent DTI outputs and tractography in knee joint, the scan may require a proper b value (ranging from 500 to 1500 s/mm2) and sufficient angular resolution (>14) with signal-to-noise ratio >10.
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Affiliation(s)
- Qi Zhao
- School of Psychology, Shanghai
University of Sport, Shanghai, China
| | - Rees P. Ridout
- Pratt School of Engineering, Duke
University, Durham, NC, USA
| | - Jikai Shen
- Pratt School of Engineering, Duke
University, Durham, NC, USA
| | - Nian Wang
- Department of Radiology, Duke
University School of Medicine, Durham, NC, USA,Department of Radiology and Imaging
Sciences, Indiana University School of Medicine, Indianapolis, IN, USA,Nian Wang, Department of Radiology and
Imaging Sciences, Indiana University School of Medicine, Indianapolis, IN 46202,
USA.
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Banjar M, Horiuchi S, Gedeon DN, Yoshioka H. Review of Quantitative Knee Articular Cartilage MR Imaging. Magn Reson Med Sci 2021; 21:29-40. [PMID: 34471014 PMCID: PMC9199985 DOI: 10.2463/mrms.rev.2021-0052] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022] Open
Abstract
Osteoarthritis (OA) is one of the most prevalent disorders in today’s society, resulting in significant socio-economic costs and morbidity. MRI is widely used as a non-invasive imaging tool for OA of the knee. However, conventional knee MRI has limitations to detect subtle early cartilage degeneration before morphological changes are visually apparent. Novel MRI pulse sequences for cartilage assessment have recently received increased attention due to newly developed compositional MRI techniques, including: T2 mapping, T1rho mapping, delayed gadolinium-enhanced MRI of cartilage (dGEMRIC), sodium MRI, diffusion-weighted imaging (DWI)/ diffusion tensor imaging (DTI), ultrashort TE (uTE), and glycosaminoglycan specific chemical exchange saturation transfer (gagCEST) imaging. In this article, we will first review these quantitative assessments. Then, we will discuss the variations of quantitative values of knee articular cartilage with cartilage layer (depth)- and angle (regional)-dependent approaches. Multiple MRI sequence techniques can discern qualitative differences in knee cartilage. Normal articular hyaline cartilage has a zonal variation in T2 relaxation times with increasing T2 values from the subchondral bone to the articular surface. T1rho values were also higher in the superficial layer than in the deep layer in most locations in the medial and lateral femoral condyles, including the weight-bearing portion. Magic angle effect on T2 mapping is clearly observed in the both medial and lateral femoral condyles, especially within the deep layers. One of the limitations for clinical use of these compositional assessments is a long scan time. Recent new approaches with compressed sensing (CS) and MR fingerprinting (MRF) have potential to provide accurate and fast quantitative cartilage assessments.
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Affiliation(s)
- Mai Banjar
- Medical Imaging Department, King Abdullah Medical Complex Jeddah
| | - Saya Horiuchi
- Department of Radiology, St Luke's International Hospital
| | - David N Gedeon
- Department of Radiological Sciences, University of California, Irvine
| | - Hiroshi Yoshioka
- Department of Radiological Sciences, University of California, Irvine
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Truhn D, Zwingenberger KT, Schock J, Abrar DB, Radke KL, Post M, Linka K, Knobe M, Kuhl C, Nebelung S. No pressure, no diamonds? - Static vs. dynamic compressive in-situ loading to evaluate human articular cartilage functionality by functional MRI. J Mech Behav Biomed Mater 2021; 120:104558. [PMID: 33957568 DOI: 10.1016/j.jmbbm.2021.104558] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2020] [Revised: 03/22/2021] [Accepted: 04/19/2021] [Indexed: 01/21/2023]
Abstract
Biomechanical Magnetic Resonance Imaging (MRI) of articular cartilage, i.e. its imaging under loading, is a promising diagnostic tool to assess the tissue's functionality in health and disease. This study aimed to assess the response to static and dynamic loading of histologically intact cartilage samples by functional MRI and pressure-controlled in-situ loading. To this end, 47 cartilage samples were obtained from the medial femoral condyles of total knee arthroplasties (from 24 patients), prepared to standard thickness, and placed in a standard knee joint in a pressure-controlled whole knee-joint compressive loading device. Cartilage samples' responses to static (i.e. constant), dynamic (i.e. alternating), and no loading, i.e. free-swelling conditions, were assessed before (δ0), and after 30 min (δ1) and 60 min (δ2) of loading using serial T1ρ maps acquired on a 3.0T clinical MRI scanner (Achieva, Philips). Alongside texture features, relative changes in T1ρ (Δ1, Δ2) were determined for the upper and lower sample halves and the entire sample, analyzed using appropriate statistical tests, and referenced to histological (Mankin scoring) and biomechanical reference measures (tangent stiffness). Histological, biomechanical, and T1ρ sample characteristics at δ0 were relatively homogenous in all samples. In response to loading, relative increases in T1ρ were strong and significant after dynamic loading (Δ1 = 10.3 ± 17.0%, Δ2 = 21.6 ± 21.8%, p = 0.002), while relative increases in T1ρ after static loading and in controls were moderate and not significant. Generally, texture features did not demonstrate clear loading-related associations underlying the spatial relationships of T1ρ. When realizing the clinical translation, this in-situ study suggests that serial T1ρ mapping is best combined with dynamic loading to assess cartilage functionality in humans based on advanced MRI techniques.
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Affiliation(s)
- Daniel Truhn
- Aachen University Hospital, Department of Diagnostic and Interventional Radiology, D-52074, Aachen, Germany
| | - Ken Tonio Zwingenberger
- Aachen University Hospital, Department of Diagnostic and Interventional Radiology, D-52074, Aachen, Germany
| | - Justus Schock
- University Düsseldorf, Medical Faculty, Department of Diagnostic and Interventional Radiology, D-40225, Düsseldorf, Germany; Institute of Imaging and Computer Vision, RWTH Aachen University, D-52074, Aachen, Germany
| | - Daniel Benjamin Abrar
- University Düsseldorf, Medical Faculty, Department of Diagnostic and Interventional Radiology, D-40225, Düsseldorf, Germany
| | - Karl Ludger Radke
- University Düsseldorf, Medical Faculty, Department of Diagnostic and Interventional Radiology, D-40225, Düsseldorf, Germany
| | - Manuel Post
- Aachen University Hospital, Department of Diagnostic and Interventional Radiology, D-52074, Aachen, Germany
| | - Kevin Linka
- Hamburg University of Technology, Department of Continuum and Materials Mechanics, D-21073, Hamburg, Germany
| | - Matthias Knobe
- Cantonal Hospital Lucerne, Department of Orthopaedic and Trauma Surgery, CH-6000, Lucerne, Switzerland
| | - Christiane Kuhl
- Aachen University Hospital, Department of Diagnostic and Interventional Radiology, D-52074, Aachen, Germany
| | - Sven Nebelung
- University Düsseldorf, Medical Faculty, Department of Diagnostic and Interventional Radiology, D-40225, Düsseldorf, Germany.
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Horiuchi S, Yu HJ, Luk A, Rudd A, Ton J, Kuoy E, Russell JA, Sharp K, Yoshioka H. T1rho and T2 mapping of ankle cartilage of female and male ballet dancers. Acta Radiol 2020; 61:1365-1376. [PMID: 32028774 DOI: 10.1177/0284185120902381] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
BACKGROUND Since ballet dancers begin their training before skeletal maturity, accurate and non-invasive identification of cartilage diseases is clinically important. Angle-dependent analysis of T1rho and T2 sequences can be useful for quantification of the composition of cartilage. PURPOSE To investigate the angle-dependent T1rho and T2 profiles of ankle cartilage in non-dancers and dancers. MATERIAL AND METHODS Ten female non-dancers, ten female dancers, and 9 male dancers were evaluated using T1rho and T2 mapping sequences. Manual segmentation of talar and tibial cartilage on these images was performed by two radiologists. Inter- and intra-rater reliabilities were calculated using intraclass correlation coefficients (ICCs) and Bland-Altman analysis. Mean thickness and volume of cartilage were estimated. Angle-dependent relaxation time profiles of talar and tibial cartilage were created. RESULTS ICCs of the number of segmented pixels were poor to excellent. Bland-Altman plots indicated that differences were associated with segment sizes. Segmented cartilage on T1rho demonstrated larger thickness and volume than those on T2 in all populations. Male dancers showed larger cartilage thickness and volume than female dancers and non-dancers. Each cartilage demonstrated angular-dependent T1rho and T2 profiles. Minimal T1rho and T2 values were observed at approximately 180°-200°; higher values were seen at the angle closer to the magic angle. Minimal T2 value of talar cartilage of dancers was larger than that of non-dancers. CONCLUSION In this small cohort study, regional and sex variations of ankle cartilage T1rho and T2 values in dancers and non-dancers were demonstrated using an angle-dependent approach.
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Affiliation(s)
- Saya Horiuchi
- Department of Radiological Sciences, University of California, Irvine, CA, USA
| | - Hon J Yu
- Department of Radiological Sciences, University of California, Irvine, CA, USA
| | - Alex Luk
- Department of Radiological Sciences, University of California, Irvine, CA, USA
| | - Adam Rudd
- Department of Radiological Sciences, University of California, Irvine, CA, USA
| | - Jimmy Ton
- Department of Radiological Sciences, University of California, Irvine, CA, USA
| | - Edward Kuoy
- Department of Radiological Sciences, University of California, Irvine, CA, USA
| | - Jeffrey A Russell
- Science and Health in Artistic Performance, Ohio University, Athens, OH, USA
| | - Kelli Sharp
- Department of Dance, The Claire Trevor School of the Arts, University of California, Irvine, CA, USA
| | - Hiroshi Yoshioka
- Department of Radiological Sciences, University of California, Irvine, CA, USA
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Mahar R, Batool S, Badar F, Xia Y. Quantitative measurement of T2, T1ρ and T1 relaxation times in articular cartilage and cartilage-bone interface by SE and UTE imaging at microscopic resolution. JOURNAL OF MAGNETIC RESONANCE (SAN DIEGO, CALIF. : 1997) 2018; 297:76-85. [PMID: 30366222 PMCID: PMC6289866 DOI: 10.1016/j.jmr.2018.10.008] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/10/2018] [Revised: 10/09/2018] [Accepted: 10/11/2018] [Indexed: 05/25/2023]
Abstract
Both spin-echo (SE) and ultra-short echo (UTE) based MRI sequences were used on a 7 T µMRI system to quantify T2, T1ρ and T1 relaxation times from articular cartilage to the cartilage-bone interface on canine humeral specimens at 19.5 µm pixel resolution. A series of five relaxation-weighted images were acquired to calculate one relaxation map (T2, T1ρ or T1), from which the depth-dependent profiles were examined between the SE method and the UTE method, over the entire non-calcified cartilage and within the cartilage-bone interface. SE-based methods enabled the quantification of relaxation profiles over the noncalcified cartilage, from 0 µm (articular surface) to approximately 460 µm in depth (near the end of radial zone). Most of the cartilage-bone interface was imaged by the UTE-based methods, to a tissue depth of about 810 µm. Pixel-by-pixel calculation of the relaxation times between the independent SE and UTE methods correlated well with each other. A better understanding of the tissue properties reliably over the cartilage-bone interface region by a non-invasive MRI approach could contribute to the clinical diagnostics of trauma-induced osteoarthritis.
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Affiliation(s)
- Rohit Mahar
- Department of Physics and Center for Biomedical Research, Oakland University, Rochester, MI 48309, USA
| | - Syeda Batool
- Department of Physics and Center for Biomedical Research, Oakland University, Rochester, MI 48309, USA
| | - Farid Badar
- Department of Physics and Center for Biomedical Research, Oakland University, Rochester, MI 48309, USA
| | - Yang Xia
- Department of Physics and Center for Biomedical Research, Oakland University, Rochester, MI 48309, USA.
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