Characterization of Biochemical Cartilage Change After Anterior Cruciate Ligament Injury Using T1ρ Mapping Magnetic Resonance Imaging

Cartilage compositional MRI-a narrative review of technical development and clinical applications over the past three decades

Articular cartilage damage and degeneration are among hallmark manifestations of joint injuries and arthritis, classically osteoarthritis. Cartilage compositional MRI (Cart-C MRI), a quantitative technique, which aims to detect early-stage cartilage matrix changes that precede macroscopic alterations, began development in the 1990s. However, despite the significant advancements over the past three decades, Cart-C MRI remains predominantly a research tool, hindered by various technical and clinical hurdles. This paper will review the technical evolution of Cart-C MRI, delve into its clinical applications, and conclude by identifying the existing gaps and challenges that need to be addressed to enable even broader clinical application of Cart-C MRI.

Longitudinal Analysis of Knee Articular Cartilage Degeneration After Anterior Cruciate Ligament Reconstruction: Comparison of T1rho and T2 Mapping

OBJECTIVE

To assess articular cartilage degeneration in anterior cruciate ligament (ACL) reconstructed knees as detected by MR T1rho and T2 mapping relative to controls and longitudinally at 3 months and 1 year after ACL reconstruction (ACLR).

DESIGN

Twenty-five patients with acute ACL injury were enrolled (13 women and 12 men; mean age 30.8), and 14 healthy controls were selected by sex and age matching. The affected knees of the ACLR participants were imaged using a 3.0T magnetic resonance (MR) scanner 3 months and 1 year after ACLR. Cartilage T1rho and T2 values were quantified for subcompartments in the full-thickness, superficial, and deep layers and were compared with the matched subcompartments of control knees. The influence of concomitant meniscal tears identified using proton density-weighted imaging (PDWI) was also investigated.

RESULTS

In the posterior lateral tibia, T1rho and T2 values were significantly higher in ACLR participants at 3 months and slightly decreased at 1-year compared to the control group. T1rho values in the medial compartment exhibited a significant increase at 1-year compared with those of control knees, while T2 showed no significance. In cartilage with medial meniscal tears, the T1rho values in multiple medial subcompartments were significantly higher than those in cartilage without medial meniscal tears, and this alteration was relatively detectable by T1rho.

CONCLUSIONS

T1rho and T2 mapping is effective in evaluating cartilage degeneration following ACLR. T1rho may exhibit greater sensitivity for assessing the progression of early degeneration in the medial compartment after ACLR.

Femoral cartilage ultrasound echo-intensity is a valid measure of cartilage composition

This study aimed to create a conversion equation that accurately predicts cartilage magnetic resonance imaging (MRI) T2 relaxation times using ultrasound echo-intensity and common participant demographics. We recruited 15 participants with a primary anterior cruciate ligament reconstruction between the ages of 18 and 35 years at 1-5 years after surgery. A single investigator completed a transverse suprapatellar scan with the ACLR limb in max knee flexion to image the femoral trochlea cartilage. A single reader manually segmented the femoral cartilage cross-sectional area to assess the echo-intensity (i.e., mean gray-scale pixel value). At a separate visit, a T2 mapping sequence with the MRI beam set to an oblique angle was used to image the femoral trochlea cartilage. A single reader manually segmented the cartilage cross-sectional area on a single MRI slice to assess the T2 relaxation time. A stepwise, multiple linear regression was used to predict T2 relaxation time from cartilage echo-intensity and common demographic variables. We created a conversion equation using the regression betas and then used an ICC and Bland-Altman plot to assess agreement between the estimated and true T2 relaxation time. Cartilage ultrasound echo-intensity and age significantly predicted T2 relaxation time (F = 7.33, p = 0.008, R2 = 0.55). When using the new conversion equation to estimate T2 relaxation time from cartilage echo-intensity and age, there was strong agreement between the estimated and true T2 relaxation time (ICC2,k = 0.84). This study provides promising preliminary data that cartilage echo-intensity combined with age can be used as a clinically accessible tool for evaluating cartilage composition.

Degenerative changes in cartilage likely occur in the medial compartment after anterior cruciate ligament reconstruction

PURPOSE

Magnetic resonance imaging with T1ρ mapping is used to quantify the amount of glycosaminoglycan in articular cartilage, which reflects early degenerative changes. The purposes of this study were to evaluate early degenerative changes in knees after anterior cruciate ligament (ACL) reconstruction by comparing T1ρ values before and 2 years after surgery and investigate whether surgical factors and clinical outcomes are related to differences in T1ρ values.

METHODS

Fifty patients who underwent unilateral primary ACL reconstruction were evaluated using T1ρ mapping before and 2 years after surgery. Three regions of interest (ROIs) were defined in the cartilage associated with the medial (M) and lateral (L) weight-bearing areas of the femoral condyle (FC) (anterior: MFC1 and LFC1, middle: MFC2 and LFC2, and posterior: MFC3 and LFC3). Two ROIs associated with the tibial plateau (T) were defined (anterior: MT1 and LT1, and posterior: MT2 and LT2). T1ρ values within the ROIs were measured before and 2 years after surgery and compared using the paired t test. Correlations between the difference in T1ρ values at these two time points and patient characteristics, presence of a cartilaginous lesion, graft type, and postoperative anteroposterior laxity were also evaluated using Pearson's and Spearman's correlation coefficients.

RESULTS

There was a significant increase in T1ρ before versus 2 years after surgery in the MT1, MT2, LFC1, and LT1 areas, and a significant decrease in the LFC3 and LT2 areas. There was a significant correlation between postoperative anterior-posterior laxity and a postoperative increase in T1ρ values in the MFC3 (r = 0.37, P = 0.013) and MT2 (r = 0.35, P = 0.021) areas. Increases in T1ρ values in the MFC2 area were negatively correlated with KOOS symptoms (ρ = - 0.349, P = 0.027) and quality of life (ρ = - 0.374, P = 0.017) subscale scores.

CONCLUSION

Early degenerative changes in medial articular cartilage were observed with T1ρ mapping at 2 years after ACL reconstruction. Postoperative anterior-posterior laxity is correlated with an increase in T1ρ values in the posteromedial femur and tibia. An increase in T1ρ values in the central medial femoral condyle was associated with knee symptoms.

LEVEL OF EVIDENCE

III.

Quadriceps weakness associates with greater T1ρ relaxation time in the medial femoral articular cartilage 6 months following anterior cruciate ligament reconstruction

PURPOSE

Quadriceps weakness following anterior cruciate ligament reconstruction (ACLR) is linked to decreased patient-reported function, altered lower extremity biomechanics and tibiofemoral joint space narrowing. It remains unknown if quadriceps weakness is associated with early deleterious changes to femoral cartilage composition that are suggestive of posttraumatic osteoarthritis development. The purpose of the cross-sectional study was to determine if quadriceps strength was associated with T1ρ relaxation times, a marker of proteoglycan density, of the articular cartilage in the medial and lateral femoral condyles 6 months following ACLR. It is hypothesized that individuals with weaker quadriceps would demonstrate lesser proteoglycan density.

METHODS

Twenty-seven individuals (15 females, 12 males) with a patellar tendon autograft ACLR underwent isometric quadriceps strength assessments in 90°of knee flexion during a 6-month follow-up exam. Magnetic resonance images (MRI) were collected bilaterally and voxel by voxel T1ρ relaxation times were calculated using a five-image sequence and a monoexponential equation. Following image registration, the articular cartilage for the weight-bearing surfaces of the medial and lateral femoral condyles (MFC and LFC) were manually segmented and further sub-sectioned into posterior, central and anterior regions of interest (ROI) based on the corresponding meniscal anatomy viewed in the sagittal plane. Univariate linear regression models were used to determine the association between quadriceps strength and T1ρ relaxation times in the entire weight-bearing MFC and LFC, as well as the ROI in each respective limb.

RESULTS

Lesser quadriceps strength was significantly associated with greater T1ρ relaxation times in the entire weight-bearing MFC (R² = 0.14, P = 0.05) and the anterior-MFC ROI (R² = 0.22, P = 0.02) of the ACLR limb. A post hoc analysis found lesser strength and greater T1ρ relaxation times were significantly associated in a subsection of participants (n = 18) without a concomitant medial tibiofemoral compartment meniscal or chondral injury in the entire weight-bearing MFC, as well as anterior-MFC and central-MFC ROI of the ACLR and uninjured limb.

CONCLUSIONS

The association between weaker quadriceps and greater T1ρ relaxation times in the MFC suggests deficits in lower extremity muscle strength may be related to cartilage composition as early as 6 months following ACLR. Maximizing quadriceps strength in the first 6 months following ACLR may be critical for promoting cartilage health early following ACLR.

LEVEL OF EVIDENCE

Prognostic level 1.

MRI T2 and T1ρ relaxation in patients at risk for knee osteoarthritis: a systematic review and meta-analysis

Background

Magnetic resonance imaging (MRI) T2 and T1ρ relaxation are increasingly being proposed as imaging biomarkers potentially capable of detecting biochemical changes in articular cartilage before structural changes are evident. We aimed to: 1) summarize MRI methods of published studies investigating T2 and T1ρ relaxation time in participants at risk for but without radiographic knee OA; and 2) compare T2 and T1ρ relaxation between participants at-risk for knee OA and healthy controls.

Methods

We conducted a systematic review of studies reporting T2 and T1ρ relaxation data that included both participants at risk for knee OA and healthy controls. Participant characteristics, MRI methodology, and T1ρ and T2 relaxation data were extracted. Standardized mean differences (SMDs) were calculated within each study. Pooled effect sizes were then calculated for six commonly segmented knee compartments.

Results

55 articles met eligibility criteria. There was considerable variability between scanners, coils, software, scanning protocols, pulse sequences, and post-processing. Moderate risk of bias due to lack of blinding was common. Pooled effect sizes indicated participants at risk for knee OA had lengthened T2 relaxation time in all compartments (SMDs from 0.33 to 0.74; p < 0.01) and lengthened T1ρ relaxation time in the femoral compartments (SMD from 0.35 to 0.40; p < 0.001).

Conclusions

T2 and T1ρ relaxation distinguish participants at risk for knee OA from healthy controls. Greater standardization of MRI methods is both warranted and required for progress towards biomarker validation.

Electronic supplementary material

The online version of this article (10.1186/s12891-019-2547-7) contains supplementary material, which is available to authorized users.

Activities of daily living influence tibial cartilage T1rho relaxation times

Quantitative T1rho magnetic resonance imaging (MRI) can potentially help identify early-stage osteoarthritis (OA) by non-invasively assessing proteoglycan concentration in articular cartilage. T1rho relaxation times are negatively correlated with proteoglycan concentration. Cartilage compresses in response to load, resulting in water exudation, a relative increase in proteoglycan concentration, and a decrease in the corresponding T1rho relaxation times. To date, there is limited information on changes in cartilage composition resulting from daily activity. Therefore, the objective of this study was to quantify changes in tibial cartilage T1rho relaxation times in healthy human subjects following activities of daily living. It was hypothesized that water exudation throughout the day would lead to decreased T1rho relaxation times. Subjects underwent MR imaging in the morning and afternoon on the same day and were free to go about their normal activities between scans. Our findings confirmed the hypothesis that tibial cartilage T1rho relaxation times significantly decreased (by 7%) over the course of the day with loading, which is indicative of a relative increase in proteoglycan concentration. Additionally, baseline T1rho values varied with position within the cartilage, supporting a need for site-specific measurements of T1rho relaxation times. Understanding how loading alters the proteoglycan concentration in healthy cartilage may hold clinical significance pertaining to cartilage homeostasis and potentially help to elucidate a mechanism for OA development. These results also indicate that future studies using T1rho relaxation times as an indicator of cartilage health should control the loading history prior to image acquisition to ensure the appropriate interpretation of the data.

Use of 2D U-Net Convolutional Neural Networks for Automated Cartilage and Meniscus Segmentation of Knee MR Imaging Data to Determine Relaxometry and Morphometry

Purpose To analyze how automatic segmentation translates in accuracy and precision to morphology and relaxometry compared with manual segmentation and increases the speed and accuracy of the work flow that uses quantitative magnetic resonance (MR) imaging to study knee degenerative diseases such as osteoarthritis (OA). Materials and Methods This retrospective study involved the analysis of 638 MR imaging volumes from two data cohorts acquired at 3.0 T: (a) spoiled gradient-recalled acquisition in the steady state T1ρ-weighted images and (b) three-dimensional (3D) double-echo steady-state (DESS) images. A deep learning model based on the U-Net convolutional network architecture was developed to perform automatic segmentation. Cartilage and meniscus compartments were manually segmented by skilled technicians and radiologists for comparison. Performance of the automatic segmentation was evaluated on Dice coefficient overlap with the manual segmentation, as well as by the automatic segmentations' ability to quantify, in a longitudinally repeatable way, relaxometry and morphology. Results The models produced strong Dice coefficients, particularly for 3D-DESS images, ranging between 0.770 and 0.878 in the cartilage compartments to 0.809 and 0.753 for the lateral meniscus and medial meniscus, respectively. The models averaged 5 seconds to generate the automatic segmentations. Average correlations between manual and automatic quantification of T1ρ and T2 values were 0.8233 and 0.8603, respectively, and 0.9349 and 0.9384 for volume and thickness, respectively. Longitudinal precision of the automatic method was comparable with that of the manual one. Conclusion U-Net demonstrates efficacy and precision in quickly generating accurate segmentations that can be used to extract relaxation times and morphologic characterization and values that can be used in the monitoring and diagnosis of OA. © RSNA, 2018 Online supplemental material is available for this article.

Longitudinal changes in MR T1ρ/T2 signal of meniscus and its association with cartilage T1p/T2 in ACL-injured patients

OBJECTIVE

To evaluate the longitudinal changes in meniscal T1ρ/T2 signal post-reconstruction in patients with acute anterior cruciate ligament (ACL) injury and to investigate the association with T1ρ/T2 signal in articular knee cartilage.

METHOD

In this prospective study, knees of 37 patients with ACL-injury and reconstruction in addition to 13 healthy controls were scanned using magnetic resonance imaging (MRI) T1ρ/T2 mapping. Quantitative analysis of the meniscus was performed in the anterior/posterior horns of lateral/medial meniscus fourteen sub-compartments of cartilage spanning the medial/lateral area of the tibia and femoral condyles. Meniscus T1ρ/T2 signals were compared between injured, contralateral and control knees at baseline, 6-months, 1-year and 2-years using t-tests for cross-sectional comparisons and a mixed model for longitudinal comparisons. Pearson-partial correlations between meniscal and cartilage T1ρ/T2 were evaluated.

RESULTS

There was a significant decrease of T1ρ/T2 signal in the posterior horn of lateral meniscus (PHLAT) of injured knees during a 2-year period. In the posterior horn of medial meniscus (PHMED), T1ρ/T2 signal of injured knees was significantly elevated at all time points post-reconstruction compared to contralateral and control knees. Within injured knees, PHMED T1ρ/T2 signal showed significant positive correlations with medial tibia (MT) cartilage T1ρ/T2 signal at all time points.

CONCLUSION

A significant decrease in PHLAT T1ρ/T2 signal by 2-years suggests potential tissue recovery after ACL-injury. Elevated T1ρ/T2 signal in the PHMED of injured knees at 2-years correlating with knee cartilage T1ρ/T2 signal elevations suggests involvement of the PHMED in subacute cartilage degeneration after ACL-injury and reconstruction.

Principal component analysis-T1ρ voxel based relaxometry of the articular cartilage: a comparison of biochemical patterns in osteoarthritis and anterior cruciate ligament subjects

BACKGROUND

Quantitative MR, including T_1ρ mapping, has been extensively used to probe early biochemical changes in knee articular cartilage of subjects with osteoarthritis (OA) and others at risk for cartilage degeneration, such as those with anterior cruciate ligament (ACL) injury and reconstruction. However, limited studies have been performed aimed to assess the spatial location and patterns of T_1ρ. In this study we used a novel voxel-based relaxometry (VBR) technique coupled with principal component analysis (PCA) to extract relevant features so as to describe regional patterns and to investigate their similarities and differences in T_1ρ maps in subjects with OA and subjects six months after ACL reconstruction (ACLR).

METHODS

T_1ρ quantitative MRI images were collected for 180 subjects from two separate cohorts. The OA cohort included 93 osteoarthritic patients and 25 age-matched controls. The ACLR-6M cohort included 52 patients with unilateral ACL tears who were imaged 6 months after ACL reconstruction, and 10 age-matched controls. Non-rigid registration on a single template and local Z-score conversion were adopted for T_1ρ spatial and intensity normalization of all the images in the dataset. PCA was used as a data dimensionality reduction to obtain a description of all subjects in a 10-dimensional feature space. Logistic linear regression was used to identify distinctive features of OA and ACL subjects.

RESULTS

Global prolongation of the Z-score was observed in both OA and ACL subjects compared to controls [higher values in 1^st principal component (PC1); P=0.01]. In addition, relaxation time differences between superficial and deep cartilage layers of the lateral tibia and trochlea were observed to be significant distinctive features between OA and ACL subjects. OA subjects demonstrated similar values between the two cartilage layers [higher value in 2^nd principal component (PC2); P=0.008], while ACL reconstructed subjects showed T_1ρ prolongation specifically in the cartilage superficial layer (lower values in PC2; P<0.0001). T_1ρ elevation located outside of the weight-bearing area, located in the posterior and anterior aspects of the lateral femoral compartment, was also observed to be a key feature in distinguishing OA subjects from controls [higher value in 6^th principal component (PC6); P=0.007].

CONCLUSIONS

This study is the first example of T_1ρ local/regional pattern analysis and data-driven feature extraction in knees with cartilage degeneration. Our results revealed similarities and differences between OA and ACL relaxation patterns that could be potentially useful to better understand the pathogenesis of post-traumatic cartilage degeneration and the identification of imaging biomarkers for the early stratification of subjects at risk for developing post-traumatic OA.