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Schadow JE, Maxey D, Smith TO, Finnilä MAJ, Manske SL, Segal NA, Wong AKO, Davey RA, Turmezei T, Stok KS. Systematic review of computed tomography parameters used for the assessment of subchondral bone in osteoarthritis. Bone 2024; 178:116948. [PMID: 37926204 DOI: 10.1016/j.bone.2023.116948] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/15/2023] [Revised: 10/04/2023] [Accepted: 10/19/2023] [Indexed: 11/07/2023]
Abstract
OBJECTIVE To systematically review the published parameters for the assessment of subchondral bone in human osteoarthritis (OA) using computed tomography (CT) and gain an overview of current practices and standards. DESIGN A literature search of Medline, Embase and Cochrane Library databases was performed with search strategies tailored to each database (search from 2010 to January 2023). The search results were screened independently by two reviewers against pre-determined inclusion and exclusion criteria. Studies were deemed eligible if conducted in vivo/ex vivo in human adults (>18 years) using any type of CT to assess subchondral bone in OA. Extracted data from eligible studies were compiled in a qualitative summary and formal narrative synthesis. RESULTS This analysis included 202 studies. Four groups of CT modalities were identified to have been used for subchondral bone assessment in OA across nine anatomical locations. Subchondral bone parameters measuring similar features of OA were combined in six categories: (i) microstructure, (ii) bone adaptation, (iii) gross morphology (iv) mineralisation, (v) joint space, and (vi) mechanical properties. CONCLUSIONS Clinically meaningful parameter categories were identified as well as categories with the potential to become relevant in the clinical field. Furthermore, we stress the importance of quantification of parameters to improve their sensitivity and reliability for the evaluation of OA disease progression and the need for standardised measurement methods to improve their clinical value.
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Affiliation(s)
- Jemima E Schadow
- Department of Biomedical Engineering, The University of Melbourne, Melbourne, Australia.
| | - David Maxey
- Department of Radiology, Norfolk and Norwich University Hospitals NHS Foundation Trust, Norwich, United Kingdom.
| | - Toby O Smith
- Warwick Medical School, University of Warwick, United Kingdom.
| | - Mikko A J Finnilä
- Research Unit of Health Science and Technology, Faculty of Medicine, University of Oulu, Oulu, Finland.
| | - Sarah L Manske
- Department of Radiology, McCaig Institute for Bone and Joint Health, Cumming School of Medicine, University of Calgary, Calgary, Canada.
| | - Neil A Segal
- Department of Rehabilitation Medicine, The University of Kansas Medical Center, Kansas City, United States.
| | - Andy Kin On Wong
- Joint Department of Medical Imaging, University Health Network, Toronto, Canada; Schroeder's Arthritis Institute, Toronto General Hospital Research Institute, University Health Network, Toronto, Canada.
| | - Rachel A Davey
- Department of Medicine, Austin Health, University of Melbourne, Melbourne, Australia.
| | - Tom Turmezei
- Department of Radiology, Norfolk and Norwich University Hospitals NHS Foundation Trust, Norwich, United Kingdom; Norwich Medical School, University of East Anglia, Norwich, United Kingdom.
| | - Kathryn S Stok
- Department of Biomedical Engineering, The University of Melbourne, Melbourne, Australia.
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Lombardi AF, Guma M, Chung CB, Chang EY, Du J, Ma YJ. Ultrashort echo time magnetic resonance imaging of the osteochondral junction. NMR IN BIOMEDICINE 2023; 36:e4843. [PMID: 36264245 PMCID: PMC9845195 DOI: 10.1002/nbm.4843] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/25/2022] [Revised: 09/20/2022] [Accepted: 10/10/2022] [Indexed: 06/16/2023]
Abstract
Osteoarthritis is a common chronic degenerative disease that causes pain and disability with increasing incidence worldwide. The osteochondral junction is a dynamic region of the joint that is associated with the early development and progression of osteoarthritis. Despite the substantial advances achieved in the imaging of cartilage and application to osteoarthritis in recent years, the osteochondral junction has received limited attention. This is primarily related to technical limitations encountered with conventional MR sequences that are relatively insensitive to short T2 tissues and the rapid signal decay that characterizes these tissues. MR sequences with ultrashort echo time (UTE) are of great interest because they can provide images of high resolution and contrast in this region. Here, we briefly review the anatomy and function of cartilage, focusing on the osteochondral junction. We also review basic concepts and recent applications of UTE MR sequences focusing on the osteochondral junction.
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Affiliation(s)
- Alecio F. Lombardi
- Department of Radiology, University of California San Diego, CA, United States
- Research Service, Veterans Affairs San Diego Healthcare System, CA, United States
| | - Monica Guma
- Research Service, Veterans Affairs San Diego Healthcare System, CA, United States
- Department of Medicine, University of California San Diego, CA, United States
| | - Christine B. Chung
- Department of Radiology, University of California San Diego, CA, United States
- Research Service, Veterans Affairs San Diego Healthcare System, CA, United States
| | - Eric Y. Chang
- Department of Radiology, University of California San Diego, CA, United States
- Research Service, Veterans Affairs San Diego Healthcare System, CA, United States
| | - Jiang Du
- Department of Radiology, University of California San Diego, CA, United States
| | - Ya-Jun Ma
- Department of Radiology, University of California San Diego, CA, United States
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Markhardt BK, Huang BK, Spiker AM, Chang EY. Interpretation of Cartilage Damage at Routine Clinical MRI: How to Match Arthroscopic Findings. Radiographics 2022; 42:1457-1473. [PMID: 35984752 PMCID: PMC9453290 DOI: 10.1148/rg.220051] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2022] [Revised: 04/19/2022] [Accepted: 04/25/2022] [Indexed: 11/11/2022]
Abstract
This review is intended to aid in the interpretation of damage to the articular cartilage at routine clinical MRI to improve clinical management. Relevant facets of the histologic and biochemical characteristics and clinical management of cartilage are discussed, as is MRI physics. Characterization of damage to the articular cartilage with MRI demands a detailed understanding of the normal and damaged appearance of the osteochondral unit in the context of different sequence parameters. Understanding the location of the subchondral bone plate is key to determining the depth of the cartilage lesion. Defining the bone plate at MRI is challenging because of the anisotropic fibrous organization of articular cartilage, which is susceptible to the "magic angle" phenomenon and chemical shift artifacts at the interface with the fat-containing medullary cavity. These artifacts may cause overestimation of the thickness of the subchondral bone plate and, therefore, overestimation of the depth of a cartilage lesion. In areas of normal cartilage morphology, isolated hyperintense and hypointense lesions often represent degeneration of cartilage at arthroscopy. Changes in the subchondral bone marrow at MRI also increase the likelihood that cartilage damage will be visualized at arthroscopy, even when a morphologic lesion cannot be resolved, and larger subchondral lesions are associated with higher grades at arthroscopy. The clinical significance of other secondary features of cartilage damage are also reviewed, including osteophytes, intra-articular bodies, and synovitis. Online supplemental material is available for this article. Work of the U.S. Government published under an exclusive license with the RSNA.
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Affiliation(s)
- B. Keegan Markhardt
- From the Department of Radiology, Division of Musculoskeletal Imaging
and Intervention (B.K.M.), and Department of Orthopedic Surgery (A.M.S.),
University of Wisconsin-Madison, Clinical Science Center, 600 Highland Ave,
E3/311, Madison, WI 53792; Department of Radiology, Division of Musculoskeletal
Imaging, University of California, San Diego, La Jolla, Calif (B.K.H., E.Y.C.);
and Radiology Services, Veterans Affairs San Diego Healthcare System
(E.Y.C.)
| | - Brady K. Huang
- From the Department of Radiology, Division of Musculoskeletal Imaging
and Intervention (B.K.M.), and Department of Orthopedic Surgery (A.M.S.),
University of Wisconsin-Madison, Clinical Science Center, 600 Highland Ave,
E3/311, Madison, WI 53792; Department of Radiology, Division of Musculoskeletal
Imaging, University of California, San Diego, La Jolla, Calif (B.K.H., E.Y.C.);
and Radiology Services, Veterans Affairs San Diego Healthcare System
(E.Y.C.)
| | - Andrea M. Spiker
- From the Department of Radiology, Division of Musculoskeletal Imaging
and Intervention (B.K.M.), and Department of Orthopedic Surgery (A.M.S.),
University of Wisconsin-Madison, Clinical Science Center, 600 Highland Ave,
E3/311, Madison, WI 53792; Department of Radiology, Division of Musculoskeletal
Imaging, University of California, San Diego, La Jolla, Calif (B.K.H., E.Y.C.);
and Radiology Services, Veterans Affairs San Diego Healthcare System
(E.Y.C.)
| | - Eric Y. Chang
- From the Department of Radiology, Division of Musculoskeletal Imaging
and Intervention (B.K.M.), and Department of Orthopedic Surgery (A.M.S.),
University of Wisconsin-Madison, Clinical Science Center, 600 Highland Ave,
E3/311, Madison, WI 53792; Department of Radiology, Division of Musculoskeletal
Imaging, University of California, San Diego, La Jolla, Calif (B.K.H., E.Y.C.);
and Radiology Services, Veterans Affairs San Diego Healthcare System
(E.Y.C.)
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