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Lehtovirta S, Kemppainen A, Haapea M, Nevalainen M, Lammentausta E, Kyllönen E, Koivukangas V, Lehenkari P, Karppinen J, Casula V, Nieminen MT. Effects of Bariatric Surgery on Knee Articular Cartilage and Osteoarthritis Symptoms-A 12-Month Follow-Up Using T2 Relaxation Time and WOMAC Osteoarthritis Index. J Magn Reson Imaging 2024. [PMID: 38558426 DOI: 10.1002/jmri.29369] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2023] [Revised: 03/19/2024] [Accepted: 03/19/2024] [Indexed: 04/04/2024] Open
Abstract
BACKGROUND Obesity is a significant risk factor for osteoarthritis (OA). The most effective treatment for morbid obesity is bariatric surgery. PURPOSE To study the effects of potential surgically induced weight loss on knee articular cartilage and OA symptoms of obese patients over a 12-month follow-up. STUDY TYPE Prospective longitudinal cohort study. SUBJECTS 45 obese patients (38 female, BMI = 42.3 ± 6.5 kg/m2) who underwent gastric bypass (intervention group), and 46 age-matched conservative-care controls (37 female, BMI = 39.8 ± 4.6 kg/m2). FIELD STRENGTH/SEQUENCE Multiecho spin echo sequence at 3 T. ASSESSMENT Knee cartilage T2 measurements and WOMAC Indices were measured presurgery and after 12 months. The intervention group was split into successful (≥20% total weight loss (TWL)) and unsuccessful (<20% TWL) weight loss groups. T2 and WOMAC indices were also measured in controls at baseline and after 12 months. Changes among the three groups were analyzed. STATISTICAL TESTS Analysis of variance (significance level 0.05). RESULTS Twenty-six (58%) intervention patients achieved ≥20% TWL. The <20% TWL group demonstrated significantly more T2 reduction in the deep lateral femur over 12 months compared with the ≥20% TWL group (-3.83 ± 8.18 msec vs. 2.47 ± 6.54 msec, respectively), whereas no significant differences were observed on the medial femoral compartment (P = 0.385, P = 0.551, and P = 0.511 for bulk, superficial and deep regions, respectively). Changes in WOMAC indices over 12 months were significantly greater in the ≥20% TWL group compared with controls. In the <20% TWL group, pain significantly improved over 12 months compared with controls, while stiffness and function changes were not statistically significant (P = 0.063 and P = 0.051, respectively). DATA CONCLUSION Cartilage matrix, measured by T2, showed improvement on lateral femoral cartilage with <20% TWL compared with ≥20% TWL. Bariatric surgery provided significant improvements in knee symptoms with ≥20% TWL compared with conservative WL. This effect is also seen to some extent with <20% TWL compared with conservative WL. LEVEL OF EVIDENCE 2 TECHNICAL EFFICACY: Stage 4.
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Affiliation(s)
- Sami Lehtovirta
- Research Unit of Health Sciences and Technology, University of Oulu, Oulu, Finland
- Medical Research Center Oulu, University of Oulu and Oulu University Hospital, Oulu, Finland
| | - Ahti Kemppainen
- Research Unit of Health Sciences and Technology, University of Oulu, Oulu, Finland
- Medical Research Center Oulu, University of Oulu and Oulu University Hospital, Oulu, Finland
| | - Marianne Haapea
- Medical Research Center Oulu, University of Oulu and Oulu University Hospital, Oulu, Finland
- Department of Diagnostic Radiology, Oulu University Hospital, Oulu, Finland
- Research Service Unit, Oulu University Hospital, Oulu, Finland
| | - Mika Nevalainen
- Research Unit of Health Sciences and Technology, University of Oulu, Oulu, Finland
- Medical Research Center Oulu, University of Oulu and Oulu University Hospital, Oulu, Finland
- Department of Diagnostic Radiology, Oulu University Hospital, Oulu, Finland
| | - Eveliina Lammentausta
- Medical Research Center Oulu, University of Oulu and Oulu University Hospital, Oulu, Finland
- Department of Diagnostic Radiology, Oulu University Hospital, Oulu, Finland
| | - Eero Kyllönen
- Department of Physical Medicine and Rehabilitation, Oulu University Hospital, Oulu, Finland
| | | | - Petri Lehenkari
- Medical Research Center Oulu, University of Oulu and Oulu University Hospital, Oulu, Finland
- Department of Surgery, Oulu University Hospital, Oulu, Finland
- Research Unit of Translational Medicine, University of Oulu, Oulu, Finland
| | - Jaro Karppinen
- Research Unit of Health Sciences and Technology, University of Oulu, Oulu, Finland
- Rehabilitation Services of South Karelia Social and Health Care District, Lappeenranta, Finland
- Finnish Institute of Occupational Health, Oulu, Finland
| | - Victor Casula
- Research Unit of Health Sciences and Technology, University of Oulu, Oulu, Finland
- Medical Research Center Oulu, University of Oulu and Oulu University Hospital, Oulu, Finland
| | - Miika T Nieminen
- Research Unit of Health Sciences and Technology, University of Oulu, Oulu, Finland
- Medical Research Center Oulu, University of Oulu and Oulu University Hospital, Oulu, Finland
- Department of Diagnostic Radiology, Oulu University Hospital, Oulu, Finland
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Brix MAK, Järvinen J, Bode MK, Nevalainen M, Nikki M, Niinimäki J, Lammentausta E. Financial impact of incorporating deep learning reconstruction into magnetic resonance imaging routine. Eur J Radiol 2024; 175:111434. [PMID: 38520806 DOI: 10.1016/j.ejrad.2024.111434] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2024] [Accepted: 03/19/2024] [Indexed: 03/25/2024]
Abstract
PURPOSE Artificial intelligence and deep learning solutions are increasingly utilized in healthcare and radiology. The number of studies addressing their enhancement of productivity and monetary impact is, however, still limited. Our hospital has faced a need to enhance MRI scanner throughput, and we investigate the utility of new commercial deep learning reconstruction (DLR) algorithm for this purpose. In this work, a multidisciplinary team evaluated the impact of the widespread deployment of a new commercial deep learning reconstruction (DLR) algorithm for our magnetic resonance imaging scanner fleet. METHODS Our analysis centers on the DLR algorithm's effects on patient throughput and investment costs, contrasting these with alternative strategies for capacity expansion-namely, acquiring additional MRI scanners and increasing device utilization on weekends. We provide a framework for assessing the financial implications of new technologies in a trial phase, aiding in informed decision-making for healthcare investments. RESULTS We demonstrate substantial reductions in total operating costs compared to other capacity-enhancing methods. Specifically, the cost of adopting the deep learning technology for our entire scanner fleet is only 11 % compared to procuring an additional scanner and 20 % compared to the weekend utilization costs of existing devices. CONCLUSIONS Procuring DLR for our existing five-scanner fleet allows us to sustain our current MRI service levels without the need for an additional scanner, thereby achieving considerable cost savings. These reductions highlight the efficiency and economic viability of DLR in optimizing MRI service delivery.
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Affiliation(s)
- Mikael A K Brix
- Research Unit of Health Sciences and Technology, University of Oulu, Aapistie 5A, Oulu FI-90220, Finland; Department of Diagnostic Radiology, Oulu University Hospital, Kajaanintie 50, Oulu FI-90220, Finland.
| | - Jyri Järvinen
- Research Unit of Health Sciences and Technology, University of Oulu, Aapistie 5A, Oulu FI-90220, Finland; Department of Diagnostic Radiology, Oulu University Hospital, Kajaanintie 50, Oulu FI-90220, Finland
| | - Michaela K Bode
- Research Unit of Health Sciences and Technology, University of Oulu, Aapistie 5A, Oulu FI-90220, Finland; Department of Diagnostic Radiology, Oulu University Hospital, Kajaanintie 50, Oulu FI-90220, Finland
| | - Mika Nevalainen
- Research Unit of Health Sciences and Technology, University of Oulu, Aapistie 5A, Oulu FI-90220, Finland; Department of Diagnostic Radiology, Oulu University Hospital, Kajaanintie 50, Oulu FI-90220, Finland
| | - Marko Nikki
- Department of Diagnostic Radiology, Oulu University Hospital, Kajaanintie 50, Oulu FI-90220, Finland
| | - Jaakko Niinimäki
- Department of Diagnostic Radiology, Oulu University Hospital, Kajaanintie 50, Oulu FI-90220, Finland
| | - Eveliina Lammentausta
- Department of Diagnostic Radiology, Oulu University Hospital, Kajaanintie 50, Oulu FI-90220, Finland
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Oura P, Niinimäki J, Brix M, Lammentausta E, Liimatainen T, Junno A, Junno JA. Observing the fragmentation of two expanding bullet types and a full metal-jacketed bullet with computed tomography-a forensic ballistics case study. Int J Legal Med 2024; 138:671-676. [PMID: 37455274 PMCID: PMC10861703 DOI: 10.1007/s00414-023-03062-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2023] [Accepted: 07/07/2023] [Indexed: 07/18/2023]
Abstract
Computed tomography (CT) may have a crucial role in the forensic documentation and analysis of firearm injuries. The aim of this forensic ballistics case study was to explore whether two types of expanding bullets and a full metal-jacketed bullet could be differentiated by inspecting bullet fragments and fragmentation pattern in CT. Three types of .30 caliber bullets (full metal-jacketed Norma Jaktmatch, expanding full-copper Norma Ecostrike, and expanding soft-point Norma Oryx) were test fired from a distance of 5 m to blocks of 10% ballistic gelatine. CT scans of the blocks were obtained with clinical equipment and metal artifact reduction. Radiopaque fragments were identified and fragmentation parameters were obtained from the scans (total number of fragments, maximum diameter of the largest fragment, distance between entrance and the closest fragment, length of the fragment cloud, and maximum diameters of the fragment cloud). The fragmentation patterns were additionally visualized by means of 3D reconstruction. In CT, the bullet types differed in several fragmentation parameters. While the expanding full-copper bullet Ecostrike left behind only a single fragment near the end of the bullet channel, the soft-point Oryx had hundreds of fragments deposited throughout the channel. For both expanding bullets Ecostrike and Oryx, the fragments were clearly smaller than those left behind by the full metal-jacketed Jaktmatch. This was surprising as the full metal-jacketed bullet was expected to remain intact. The fragment cloud of Jaktmatch had similar mediolateral and superoinferior diameters to that of Oryx; however, fragments were deposited in the second half of the gelatine block, and not throughout the block. This case study provides a basis and potential methodology for further experiments. The findings are expected to benefit forensic practitioners with limited background information on gunshot injury cases, for example, those that involve several potential firearms or atypical gunshot wounds. The findings may prove beneficial for both human and wildlife forensics.
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Affiliation(s)
- Petteri Oura
- Department of Forensic Medicine, University of Helsinki, P.O. Box 21, FI-00014, Helsinki, Finland.
- Forensic Medicine Unit, Finnish Institute for Health and Welfare, P.O. Box 30, FI-00271, Helsinki, Finland.
- Research Unit of Health Sciences and Technology, Medical Research Center Oulu, Oulu University Hospital and University of Oulu, P.O. Box 8000, FI-90014, Oulu, Finland.
| | - Jaakko Niinimäki
- Research Unit of Health Sciences and Technology, Medical Research Center Oulu, Oulu University Hospital and University of Oulu, P.O. Box 8000, FI-90014, Oulu, Finland
- Department of Diagnostic Radiology, Oulu University Hospital, Kajaanintie 50, 90220, Oulu, Finland
| | - Mikael Brix
- Research Unit of Health Sciences and Technology, Medical Research Center Oulu, Oulu University Hospital and University of Oulu, P.O. Box 8000, FI-90014, Oulu, Finland
- Department of Diagnostic Radiology, Oulu University Hospital, Kajaanintie 50, 90220, Oulu, Finland
| | - Eveliina Lammentausta
- Department of Diagnostic Radiology, Oulu University Hospital, Kajaanintie 50, 90220, Oulu, Finland
| | - Timo Liimatainen
- Research Unit of Health Sciences and Technology, Medical Research Center Oulu, Oulu University Hospital and University of Oulu, P.O. Box 8000, FI-90014, Oulu, Finland
- Department of Diagnostic Radiology, Oulu University Hospital, Kajaanintie 50, 90220, Oulu, Finland
| | - Alina Junno
- Department of Archaeology, University of Oulu, P.O. Box 8000, FI-90014, Oulu, Finland
| | - Juho-Antti Junno
- Department of Archaeology, University of Oulu, P.O. Box 8000, FI-90014, Oulu, Finland
- Cancer and Translational Medicine Research Unit, Medical Research Center Oulu, Oulu University Hospital and University of Oulu, P.O. Box 8000, FI-90014, Oulu, Finland
- Archaelogy, University of Helsinki, P.O. Box 4, FI-00014, Helsinki, Finland
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Lehtovirta S, Casula V, Haapea M, Nortunen S, Lepojärvi S, Pakarinen H, Nieminen MT, Lammentausta E, Niinimäki J. Assessment of articular cartilage of ankle joint in stable and unstable unilateral weber type-B/SER-type ankle fractures shortly after trauma using T2 relaxation time. Acta Radiol Open 2023; 12:20584601231202033. [PMID: 37779823 PMCID: PMC10540593 DOI: 10.1177/20584601231202033] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2022] [Accepted: 09/01/2023] [Indexed: 10/03/2023] Open
Abstract
Background Early detection of post-traumatic cartilage damage in the ankle joint in magnetic resonance images can be difficult due to disturbances to structures usually appearing over time. Purpose To study the articular cartilage of unilateral Weber type-B/SER-type ankle fractures shortly post-trauma using T2 relaxation time. Material and Methods Fifty one fractured ankles were gathered from consecutively screened patients, compiled initially for RCT studies, and treated at Oulu University Hospital and classified as stable (n = 28) and unstable fractures (n = 23) based on external-rotation stress test: medial clear space of ≥5 mm was interpreted as unstable. A control group of healthy young individuals (n = 19) was also gathered. All ankles were imaged on average 9 (range: 1 to 25) days after injury on a 3.0T MRI unit for T2 relaxation time assessment, and the cartilage was divided into sub-regions for comparison. Results Control group displayed significantly higher T2 values in tibial cartilage compared to stable (six out of nine regions, p-values = .003-.043) and unstable (six out of nine regions, p-values = .001-.037) ankle fractures. No differences were detected in talar cartilage. Also, no differences were observed between stable and unstable fractures in tibial or talar cartilage. Conclusions Lower T2 relaxation times of tibial cartilage in fractured ankles suggest intact extra cellular matrix (ECM) of the cartilage. Severity of the ankle fracture, measured by ankle stability, does not seem to increase ECM degradation immediately after trauma.
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Affiliation(s)
- Sami Lehtovirta
- Research Unit of Health Sciences and Technology, University of Oulu, Oulu, Finland
- Medical Research Center, Oulu University Hospital, University of Oulu, Oulu, Finland
| | - Victor Casula
- Research Unit of Health Sciences and Technology, University of Oulu, Oulu, Finland
- Medical Research Center, Oulu University Hospital, University of Oulu, Oulu, Finland
| | - Marianne Haapea
- Department of Diagnostic Radiology, Oulu University Hospital, Oulu, Finland
| | | | | | | | - Miika T. Nieminen
- Research Unit of Health Sciences and Technology, University of Oulu, Oulu, Finland
- Medical Research Center, Oulu University Hospital, University of Oulu, Oulu, Finland
- Department of Diagnostic Radiology, Oulu University Hospital, Oulu, Finland
| | - Eveliina Lammentausta
- Medical Research Center, Oulu University Hospital, University of Oulu, Oulu, Finland
- Department of Diagnostic Radiology, Oulu University Hospital, Oulu, Finland
| | - Jaakko Niinimäki
- Research Unit of Health Sciences and Technology, University of Oulu, Oulu, Finland
- Medical Research Center, Oulu University Hospital, University of Oulu, Oulu, Finland
- Department of Diagnostic Radiology, Oulu University Hospital, Oulu, Finland
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Väärälä A, Casula V, Peuna A, Panfilov E, Mobasheri A, Haapea M, Lammentausta E, Nieminen MT. Predicting osteoarthritis onset and progression with 3D texture analysis of cartilage MRI DESS: 6-Year data from osteoarthritis initiative. J Orthop Res 2022; 40:2597-2608. [PMID: 35152476 PMCID: PMC9790756 DOI: 10.1002/jor.25293] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/29/2021] [Revised: 11/13/2021] [Accepted: 02/02/2022] [Indexed: 02/04/2023]
Abstract
In this study, we developed a gray level co-occurrence matrix-based 3D texture analysis method for dual-echo steady-state (DESS) magnetic resonance (MR) images to be used for knee cartilage analysis in osteoarthritis (OA) studies and use it to study changes in articular cartilage between different subpopulations based on their rate of progression into radiographically confirmed OA. In total, 642 series of right knee DESS MR images at 3T were obtained from baseline, 36- and 72-month follow-ups from the OA Initiative database. At baseline, all 214 subjects included in the study had Kellgren-Lawrence (KL) grade <2. Three groups were defined, based on time of progression into radiographic OA (ROA) (KL grades ≥2): control (no progression), fast progressor (ROA at 36 months), and slow progressor (ROA at 72 months) groups. 3D texture analysis was used to extract textural features for femoral and tibial cartilages. All textural features, in both femur and tibia, showed significant longitudinal changes across all groups and tissue layers. Most of the longitudinal changes were observed in progressors, but significant changes were observed also in controls. Differences between groups were mostly seen at baseline and 72 months. The method is sensitive to cartilage changes before and after ROA. It was able to detect longitudinal changes in controls and progressors and to distinguish cartilage alterations due to OA and aging. Moreover, it was able to distinguish controls and different progressor groups before any radiographic signs of OA and during OA. Thus, texture analysis could be used as a marker for the onset and progression of OA.
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Affiliation(s)
- Ari Väärälä
- Research Unit of Medical Imaging, Physics and TechnologyUniversity of OuluOuluFinland
| | - Victor Casula
- Research Unit of Medical Imaging, Physics and TechnologyUniversity of OuluOuluFinland,Medical Research CenterUniversity of Oulu and Oulu University HospitalOuluFinland
| | - Arttu Peuna
- Research Unit of Medical Imaging, Physics and TechnologyUniversity of OuluOuluFinland,Medical Research CenterUniversity of Oulu and Oulu University HospitalOuluFinland,Department of Medical ImagingCentral Finland Central HospitalJyväskyläFinland
| | - Egor Panfilov
- Research Unit of Medical Imaging, Physics and TechnologyUniversity of OuluOuluFinland
| | - Ali Mobasheri
- Research Unit of Medical Imaging, Physics and TechnologyUniversity of OuluOuluFinland,Department of Regenerative MedicineState Research Institute Centre for Innovative MedicineVilniusLithuania,Departments of Orthopedics, Rheumatology and Clinical ImmunologyUniversity Medical Center UtrechtUtrechtThe Netherlands,Department of Joint SurgeryThe First Affiliated Hospital, Sun Yat‐sen UniversityGuangzhouGuangdongChina
| | - Marianne Haapea
- Medical Research CenterUniversity of Oulu and Oulu University HospitalOuluFinland,Department of Diagnostic RadiologyOulu University HospitalOuluFinland
| | - Eveliina Lammentausta
- Research Unit of Medical Imaging, Physics and TechnologyUniversity of OuluOuluFinland,Department of Diagnostic RadiologyOulu University HospitalOuluFinland
| | - Miika T. Nieminen
- Research Unit of Medical Imaging, Physics and TechnologyUniversity of OuluOuluFinland,Medical Research CenterUniversity of Oulu and Oulu University HospitalOuluFinland,Department of Diagnostic RadiologyOulu University HospitalOuluFinland
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Ikävalko T, Laukkanen AM, McAllister A, Eklund R, Lammentausta E, Leppävuori M, Nieminen MT. Three Professional Singers' Vocal Tract Dimensions in Operatic Singing, Kulning, and Edge-A Multiple Case Study Examining Loud Singing. J Voice 2022:S0892-1997(22)00025-X. [PMID: 35277318 DOI: 10.1016/j.jvoice.2022.01.024] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2021] [Revised: 01/20/2022] [Accepted: 01/26/2022] [Indexed: 10/18/2022]
Abstract
OBJECTIVE A comprehensive understanding of how vocal tract dimensions vary among different types of loud voice productions has not yet been fully formed. This study aims to expand the existing knowledge on the topic. METHODS Three trained professional singers together practiced the vocal techniques underlying Opera and Kulning singing styles for one hour and, afterwards, phonated using these techniques on vowel [iː] at pitch C5 (523 Hz), while their vocal tracts were scanned via MRI. One of the participants also produced the samples in the Edge vocal mode using [ɛː]. Several dimensional vocal tract measurements were calculated from the MRIs. Spectral analysis was conducted on the filtered audio recorded during the MRI. RESULTS The Operatic technique demonstrated a lower larynx, a larger tongue-palate distance, and larger epilaryngeal and pharyngeal tube diameters compared to Kulning. Edge showed the highest laryngeal position, narrowest pharynx and epilarynx tubes, and the least forward-tilted larynx out of the styles studied. The spectra of Opera and Kulning showed a dominant first harmonic, while in Edge, the second harmonic was the strongest. CONCLUSIONS The results shed light on the magnitude of vocal tract changes necessary for genre-typical vocal projection. This information can be pedagogically helpful.
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Affiliation(s)
- Tero Ikävalko
- Speech and Voice Research Laboratory, Faculty of Social Sciences, Tampere University, Tampere, Finland.
| | - Anne-Maria Laukkanen
- Speech and Voice Research Laboratory, Faculty of Social Sciences, Tampere University, Tampere, Finland
| | - Anita McAllister
- Medical Unit Speech and Language Pathology, CLINTEC, Karolinska Institutet, Stockholm, Sweden; Functional Area Speech and Language Pathology, Karolinska University Hospital, Stockholm, Sweden
| | - Robert Eklund
- Department of Culture and Communication (IDA), Department of Computer Science (IDA), Linköping University, Linköping, Sweden
| | | | - Mari Leppävuori
- Community of Research in Education, Music, and the Arts, Faculty of Education, University of Oulu, Oulu, Finland; Research Unit of Medical Imaging, Physics and Technology, Faculty of Medicine, University of Oulu, Oulu, Finland
| | - Miika T Nieminen
- Department of Diagnostic Radiology, Oulu University Hospital, Oulu, Finland; Research Unit of Medical Imaging, Physics and Technology, Faculty of Medicine, University of Oulu, Oulu, Finland; Medical Research Center, Oulu University Hospital and University of Oulu, Oulu, Finland
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Leppävuori M, Lammentausta E, Peuna A, Bode MK, Jokelainen J, Ojala J, Nieminen MT. Characterizing Vocal Tract Dimensions in the Vocal Modes Using Magnetic Resonance Imaging. J Voice 2021; 35:804.e27-804.e42. [DOI: 10.1016/j.jvoice.2020.01.015] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2019] [Revised: 01/15/2020] [Accepted: 01/16/2020] [Indexed: 11/25/2022]
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Uutela A, Ovissi A, Hakkarainen A, Ristimäki A, Lundbom N, Kallio R, Soveri LM, Salminen T, Ålgars A, Halonen P, Ristamäki R, Nordin A, Blanco Sequeiros R, Rinta-Kiikka I, Lantto E, Virtanen J, Pääkkö E, Liukkonen E, Saunavaara J, Ryymin P, Lammentausta E, Osterlund P, Isoniemi H. Treatment response of colorectal cancer liver metastases to neoadjuvant or conversion therapy: a prospective multicentre follow-up study using MRI, diffusion-weighted imaging and 1H-MR spectroscopy compared with histology (subgroup in the RAXO trial). ESMO Open 2021; 6:100208. [PMID: 34325107 PMCID: PMC8332656 DOI: 10.1016/j.esmoop.2021.100208] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2021] [Revised: 06/02/2021] [Accepted: 06/17/2021] [Indexed: 02/07/2023] Open
Abstract
BACKGROUND Colorectal cancer liver metastases respond to chemotherapy and targeted agents not only by shrinking, but also by morphologic and metabolic changes. The aim of this study was to evaluate the value of advanced magnetic resonance imaging (MRI) methods in predicting treatment response and survival. PATIENTS AND METHODS We investigated contrast-enhanced MRI, apparent diffusion coefficient (ADC) in diffusion-weighted imaging and 1H-magnetic resonance spectroscopy (1H-MRS) in detecting early morphologic and metabolic changes in borderline or resectable liver metastases, as a response to first-line neoadjuvant or conversion therapy in a prospective substudy of the RAXO trial (NCT01531621, EudraCT2011-003158-24). MRI findings were compared with histology of resected liver metastases and Kaplan-Meier estimates of overall survival (OS). RESULTS In 2012-2018, 52 patients at four Finnish university hospitals were recruited. Forty-seven patients received neoadjuvant or conversion chemotherapy and 40 liver resections were carried out. Low ADC values (below median) of the representative liver metastases, at baseline and after systemic therapy, were associated with partial response according to RECIST criteria, but not with morphologic MRI changes or histology. Decreasing ADC values following systemic therapy were associated with improved OS compared to unchanged or increasing ADC, both in the liver resected subgroup (5-year OS rate 100% and 34%, respectively, P = 0.022) and systemic therapy subgroup (5-year OS rate 62% and 23%, P = 0.049). 1H-MRS revealed steatohepatosis induced by systemic therapy. CONCLUSIONS Low ADC values at baseline or during systemic therapy were associated with treatment response by RECIST but not with histology, morphologic or detectable metabolic changes. A decreasing ADC during systemic therapy is associated with improved OS both in all patients receiving systemic therapy and in the resected subgroup.
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Affiliation(s)
- A Uutela
- Department of Transplantation and Liver Surgery, Helsinki University Hospital and University of Helsinki, Helsinki, Finland
| | - A Ovissi
- Department of Radiology, HUS Medical Imaging Centre, Helsinki University Hospital and University of Helsinki, Helsinki, Finland
| | - A Hakkarainen
- Department of Radiology, HUS Medical Imaging Centre, Helsinki University Hospital and University of Helsinki, Helsinki, Finland; Department of Neuroscience and Biomedical Engineering, Aalto University School of Science, Helsinki, Finland
| | - A Ristimäki
- Department of Pathology, HUS Diagnostic Centre and Applied Tumour Genomics, Research Programs Unit, Helsinki University Hospital and University of Helsinki, Helsinki, Finland
| | - N Lundbom
- Department of Radiology, HUS Medical Imaging Centre, Helsinki University Hospital and University of Helsinki, Helsinki, Finland
| | - R Kallio
- Department of Oncology, Oulu University Hospital, Oulu, Finland
| | - L M Soveri
- Joint Municipal Authority for Health Care and Social Services in Keski-Uusimaa, Home Care Geriatric Clinic and Palliative Care, Hyvinkää, Finland
| | - T Salminen
- Department of Oncology, Tampere University Hospital and University of Tampere, Tampere, Finland
| | - A Ålgars
- Department of Oncology, Turku University Hospital and University of Turku, Turku, Finland
| | - P Halonen
- Department of Oncology, Helsinki University Hospital Comprehensive Cancer Center and University of Helsinki, Helsinki, Finland
| | - R Ristamäki
- Department of Oncology, Turku University Hospital and University of Turku, Turku, Finland
| | - A Nordin
- Department of Transplantation and Liver Surgery, Helsinki University Hospital and University of Helsinki, Helsinki, Finland
| | - R Blanco Sequeiros
- Department of Radiology, Turku University Hospital and University of Turku, Turku, Finland; Department of Radiology, Oulu University Hospital, Oulu, Finland
| | - I Rinta-Kiikka
- Department of Radiology, Medical Imaging Centre Tampere University Hospital and University of Tampere, Tampere, Finland; Department of Medical Physics, Medical Imaging Centre Tampere University Hospital and University of Tampere, Tampere, Finland
| | - E Lantto
- Department of Radiology, Päijät-Häme Central Hospital, Lahti, Finland
| | - J Virtanen
- Department of Radiology, Turku University Hospital and University of Turku, Turku, Finland
| | - E Pääkkö
- Department of Radiology, Oulu University Hospital, Oulu, Finland
| | - E Liukkonen
- Department of Radiology, Oulu University Hospital, Oulu, Finland
| | - J Saunavaara
- Department of Radiology, Turku University Hospital and University of Turku, Turku, Finland
| | - P Ryymin
- Department of Radiology, Medical Imaging Centre Tampere University Hospital and University of Tampere, Tampere, Finland; Department of Medical Physics, Medical Imaging Centre Tampere University Hospital and University of Tampere, Tampere, Finland
| | - E Lammentausta
- Department of Radiology, Oulu University Hospital, Oulu, Finland
| | - P Osterlund
- Department of Oncology, Tampere University Hospital and University of Tampere, Tampere, Finland; Department of Oncology, Helsinki University Hospital Comprehensive Cancer Center and University of Helsinki, Helsinki, Finland; Department of Pathology/Oncology, Karolinska Institutet and Karolinska sjukhuset - Tema Cancer, Stockholm, Sweden.
| | - H Isoniemi
- Department of Transplantation and Liver Surgery, Helsinki University Hospital and University of Helsinki, Helsinki, Finland
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Peuna A, Thevenot J, Saarakkala S, Nieminen MT, Lammentausta E. Machine learning classification on texture analyzed T2 maps of osteoarthritic cartilage: oulu knee osteoarthritis study. Osteoarthritis Cartilage 2021; 29:859-869. [PMID: 33631317 DOI: 10.1016/j.joca.2021.02.561] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/08/2020] [Revised: 01/04/2021] [Accepted: 02/01/2021] [Indexed: 02/02/2023]
Abstract
OBJECTIVE To introduce local binary pattern (LBP) texture analysis to cartilage osteoarthritis (OA) research and compare the performance of different classification systems in discrimination of OA subjects from healthy controls using gray-level co-occurrence matrix (GLCM) and LBP texture data. Classification algorithms were used to reduce the dimensionality of texture data into a likelihood of subject belonging to the reference class. METHOD T2 relaxation time mapping with multi-slice multi-echo spin echo sequence was performed for eighty symptomatic OA patients and 63 asymptomatic controls on a 3T clinical MRI scanner. Relaxation time maps were subjected to GLCM and LBP texture analysis, and classification algorithms were deployed with an in-house developed software. Implemented algorithms were K nearest neighbors, support vector machine, and neural network classifier. RESULTS LBP and GLCM discerned OA patients from controls with a significant difference in all studied regions. Classification models comprising GLCM and LBP showed high accuracy in classing OA patients and controls. The best performance was obtained with a multilayer perceptron type classifier with an overall accuracy of 90.2 %. CONCLUSION LBP texture analysis complements prior results with GLCM, and together LBP and GLCM serve as significant input data for classification algorithms trained for OA assessment. Presented algorithms are adaptable to versatile OA evaluations also for future gradational or predictive approaches.
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Affiliation(s)
- A Peuna
- Department of Medical Imaging, Central Finland Central Hospital, Jyväskylä, Finland; Research Unit of Medical Imaging, Physics and Technology, University of Oulu, Oulu, Finland; Medical Research Center, University of Oulu and Oulu University Hospital, Oulu, Finland.
| | - J Thevenot
- Research Unit of Medical Imaging, Physics and Technology, University of Oulu, Oulu, Finland; Medical Research Center, University of Oulu and Oulu University Hospital, Oulu, Finland
| | - S Saarakkala
- Research Unit of Medical Imaging, Physics and Technology, University of Oulu, Oulu, Finland; Medical Research Center, University of Oulu and Oulu University Hospital, Oulu, Finland
| | - M T Nieminen
- Research Unit of Medical Imaging, Physics and Technology, University of Oulu, Oulu, Finland; Department of Diagnostic Radiology, Oulu University Hospital, Oulu, Finland; Medical Research Center, University of Oulu and Oulu University Hospital, Oulu, Finland
| | - E Lammentausta
- Research Unit of Medical Imaging, Physics and Technology, University of Oulu, Oulu, Finland; Department of Diagnostic Radiology, Oulu University Hospital, Oulu, Finland; Medical Research Center, University of Oulu and Oulu University Hospital, Oulu, Finland
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10
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Munukka M, Waller B, Häkkinen A, Nieminen MT, Lammentausta E, Kujala UM, Paloneva J, Kautiainen H, Kiviranta I, Heinonen A. Effects of progressive aquatic resistance training on symptoms and quality of life in women with knee osteoarthritis: A secondary analysis. Scand J Med Sci Sports 2020; 30:1064-1072. [PMID: 31999876 DOI: 10.1111/sms.13630] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2019] [Accepted: 01/27/2020] [Indexed: 12/15/2022]
Abstract
OBJECTIVE To conduct a secondary analysis to study the effects, those 4 months of aquatic resistance training have on self-assessed symptoms and quality of life in post-menopausal women with mild knee osteoarthritis (OA), after the intervention and after a 12-month follow-up period. METHODS A total of 87 post-menopausal volunteer women, aged 60-68 years, with mild knee OA were recruited in a randomized, controlled, 4-month aquatic training trial (RCT) and randomly assigned to an intervention (n = 43) and a control (n = 44) group. The intervention group participated in 48 supervised aquatic resistance training sessions over 4 months while the control group maintained their usual level of physical activity. Additionally, 77 participants completed the 12-month post-intervention follow-up period. Self-assessed symptoms were estimated using the OA-specific Western Ontario and McMaster University Osteoarthritis Index (WOMAC) and Health-related Quality of life (HRQoL) using the generic Short-form Health Survey (SF-36). RESULTS After 4 months of aquatic resistance training, there was a significant decrease in the stiffness dimension of WOMAC -8.5 mm (95% CI = -14.9 to -2.0, P = .006) in the training group compared to the controls. After the cessation of the training, this benefit was no longer observed during the 12-month follow-up. No between-group differences were observed in any of the SF-36 dimensions. CONCLUSIONS The results of this study show that participation in an intensive aquatic resistance training program did not have any short- or long-term impact on pain and physical function or quality of life in women with mild knee OA. However, a small short-term decrease in knee stiffness was observed.
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Affiliation(s)
- Matti Munukka
- Faculty of Sport and Health Sciences, University of Jyväskylä, Jyväskylä, Finland
| | - Benjamin Waller
- Faculty of Sport and Health Sciences, University of Jyväskylä, Jyväskylä, Finland.,Physical Activity, Physical Education, Sport and Health Research Centre (PAPESH), Sports Science Department, School of Science and Engineering, Reykjavik University, Reykjavik, Iceland
| | - Arja Häkkinen
- Faculty of Sport and Health Sciences, University of Jyväskylä, Jyväskylä, Finland.,Department of Physical Medicine and Rehabilitation, Central Finland Central Hospital, Jyväskylä, Finland
| | - Miika T Nieminen
- Research Unit of Medical Imaging, Physics and Technology, University of Oulu, Oulu, Finland.,Department of Diagnostic Radiology, Oulu University Hospital, Oulu, Finland.,Medical Research Center, University of Oulu and Oulu University Hospital, Oulu, Finland
| | | | - Urho M Kujala
- Faculty of Sport and Health Sciences, University of Jyväskylä, Jyväskylä, Finland
| | - Juha Paloneva
- Department of Surgery, Central Finland Central Hospital, Jyväskylä, Finland
| | - Hannu Kautiainen
- Department of General Practice and Primary Health Care, University of Helsinki, Helsinki, Finland.,Unit of Primary Health Care, Kuopio University Hospital, Kuopio, Finland
| | - Ilkka Kiviranta
- Department of Orthopaedics and Traumatology, University of Helsinki, and Helsinki University Hospital, Helsinki, Finland
| | - Ari Heinonen
- Faculty of Sport and Health Sciences, University of Jyväskylä, Jyväskylä, Finland
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11
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Lehtovirta S, Mäkitie RE, Casula V, Haapea M, Niinimäki J, Niinimäki T, Peuna A, Lammentausta E, Mäkitie O, Nieminen MT. Defective WNT signaling may protect from articular cartilage deterioration - a quantitative MRI study on subjects with a heterozygous WNT1 mutation. Osteoarthritis Cartilage 2019; 27:1636-1646. [PMID: 31299386 DOI: 10.1016/j.joca.2019.07.001] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/25/2019] [Revised: 06/01/2019] [Accepted: 07/03/2019] [Indexed: 02/02/2023]
Abstract
OBJECTIVE WNT signaling is of key importance in chondrogenesis and defective WNT signaling may contribute to the pathogenesis of osteoarthritis and other cartilage diseases. Biochemical composition of articular cartilage in patients with aberrant WNT signaling has not been studied. Our objective was to assess the knee articular cartilage in WNT1 mutation-positive individuals using a 3.0T MRI unit to measure cartilage thickness, relaxation times, and texture features. DESIGN Cohort comprised mutation-positive (N = 13; age 17-76 years) and mutation-negative (N = 13; 16-77 years) subjects from two Finnish families with autosomal dominant WNT1 osteoporosis due to a heterozygous missense mutation c.652T>G (p.C218G) in WNT1. All subjects were imaged with a 3.0T MRI unit and assessed for cartilage thickness, T2 and T1ρ relaxation times, and T2 texture features contrast, dissimilarity and homogeneity of T2 relaxation time maps in six regions of interest (ROIs) in the tibiofemoral cartilage. RESULTS All three texture features showed opposing trends with age between the groups in the medial tibiofemoral cartilage (P = 0.020-0.085 for the difference of the regression coefficients), the mutation-positive individuals showing signs of cartilage preservation. No significant differences were observed in the lateral tibiofemoral cartilage. Cartilage thickness and means of T2 relaxation time did not differ between groups. Means of T1ρ relaxation time were significantly different in one ROI but the regression analysis displayed no differences. CONCLUSIONS Our results show less age-related cartilage deterioration in the WNT1 mutation-positive than the mutation-negative subjects. This suggests, that the WNT1 mutation may alter cartilage turnover and even have a potential cartilage-preserving effect.
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Affiliation(s)
- S Lehtovirta
- Research Unit of Medical Imaging, Physics and Technology, University of Oulu, Oulu, FI-90014, Finland; Medical Research Center, University of Oulu and Oulu University Hospital, Oulu, FI-90220, Finland
| | - R E Mäkitie
- Folkhälsan Institute of Genetics and Research Program for Clinical and Molecular Metabolism, Faculty of Medicine, University of Helsinki, Helsinki, FI-00290, Finland.
| | - V Casula
- Research Unit of Medical Imaging, Physics and Technology, University of Oulu, Oulu, FI-90014, Finland; Medical Research Center, University of Oulu and Oulu University Hospital, Oulu, FI-90220, Finland
| | - M Haapea
- Medical Research Center, University of Oulu and Oulu University Hospital, Oulu, FI-90220, Finland; Department of Diagnostic Radiology, Oulu University Hospital, Oulu, FI-90220, Finland
| | - J Niinimäki
- Research Unit of Medical Imaging, Physics and Technology, University of Oulu, Oulu, FI-90014, Finland; Medical Research Center, University of Oulu and Oulu University Hospital, Oulu, FI-90220, Finland; Department of Diagnostic Radiology, Oulu University Hospital, Oulu, FI-90220, Finland
| | - T Niinimäki
- Department of Orthopedics, Oulu University Hospital, Oulu, FI-90220, Finland
| | - A Peuna
- Medical Research Center, University of Oulu and Oulu University Hospital, Oulu, FI-90220, Finland; Department of Diagnostic Radiology, Oulu University Hospital, Oulu, FI-90220, Finland
| | - E Lammentausta
- Medical Research Center, University of Oulu and Oulu University Hospital, Oulu, FI-90220, Finland; Department of Diagnostic Radiology, Oulu University Hospital, Oulu, FI-90220, Finland
| | - O Mäkitie
- Folkhälsan Institute of Genetics and Research Program for Clinical and Molecular Metabolism, Faculty of Medicine, University of Helsinki, Helsinki, FI-00290, Finland; Children's Hospital, University of Helsinki and Helsinki University Hospital, Helsinki, FI-00290, Finland; Center for Molecular Medicine, Karolinska Institutet, and Clinical Genetics, Karolinska University Hospital, SE-171 76, Stockholm, Sweden
| | - M T Nieminen
- Research Unit of Medical Imaging, Physics and Technology, University of Oulu, Oulu, FI-90014, Finland; Medical Research Center, University of Oulu and Oulu University Hospital, Oulu, FI-90220, Finland; Department of Diagnostic Radiology, Oulu University Hospital, Oulu, FI-90220, Finland
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12
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Kajabi AW, Casula V, Nissi MJ, Peuna A, Podlipská J, Lammentausta E, Saarakkala S, Guermazi A, Nieminen MT. Assessment of meniscus with adiabatic T 1ρ and T 2ρ relaxation time in asymptomatic subjects and patients with mild osteoarthritis: a feasibility study. Osteoarthritis Cartilage 2018; 26:580-587. [PMID: 29269326 DOI: 10.1016/j.joca.2017.12.006] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/03/2017] [Revised: 11/23/2017] [Accepted: 12/08/2017] [Indexed: 02/02/2023]
Abstract
OBJECTIVE To investigate the ability of magnetic resonance imaging (MRI) adiabatic relaxation times in the rotating frame (adiabatic T1ρ and T2ρ) to detect structural alterations in meniscus tissue of mild OA patients and asymptomatic volunteers. METHOD MR images of 24 subjects (age range: 50-67 years, 12 male), including 12 patients with mild osteoarthritis (OA) (Kellgren-Lawrence (KL) = 1, 2) and 12 asymptomatic volunteers, were acquired using a 3 T clinical MRI system. Morphological assessment was performed using semiquantitative MRI OA Knee Score (MOAKS). Adiabatic T1ρ and T2ρ (AdT1ρ, AdT2ρ) relaxation time maps were calculated in regions of interest (ROIs) containing medial and lateral horns of menisci. The median relaxation time values of the ROIs were compared between subjects classified based on radiographic findings and MOAKS evaluations. RESULTS MOAKS assessment of patients and volunteers indicated the presence of meniscal and cartilage lesions in both groups. For the combined cohort group, prolonged AdT1ρ was observed in the posterior horn of the medial meniscus (PHMED) in subjects with MOAKS meniscal tear (P < 0.05). AdT2ρ was statistically significantly longer in PHMED of subjects with MOAKS full-thickness cartilage loss (P < 0.05). After adjusting for multiple comparisons, differences in medians of observed AdT1ρ and AdT2ρ values between mild OA patients and asymptomatic volunteers did not reach statistical significance. CONCLUSION AdT1ρ and AdT2ρ measurements have the potential to identify changes in structural composition of meniscus tissue associated with meniscal tear and cartilage loss in a cohort group of mild OA patients and asymptomatic volunteers.
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Affiliation(s)
- A W Kajabi
- Research Unit of Medical Imaging, Physics and Technology, University of Oulu, Oulu, Finland; Medical Research Center Oulu, University of Oulu and Oulu University Hospital, Oulu, Finland.
| | - V Casula
- Research Unit of Medical Imaging, Physics and Technology, University of Oulu, Oulu, Finland; Medical Research Center Oulu, University of Oulu and Oulu University Hospital, Oulu, Finland.
| | - M J Nissi
- Department of Applied Physics, University of Eastern Finland, Kuopio, Finland.
| | - A Peuna
- Research Unit of Medical Imaging, Physics and Technology, University of Oulu, Oulu, Finland; Department of Diagnostic Radiology, Oulu University Hospital, Oulu, Finland.
| | - J Podlipská
- Research Unit of Medical Imaging, Physics and Technology, University of Oulu, Oulu, Finland; Infotech Oulu, University of Oulu, Oulu, Finland.
| | - E Lammentausta
- Research Unit of Medical Imaging, Physics and Technology, University of Oulu, Oulu, Finland; Department of Diagnostic Radiology, Oulu University Hospital, Oulu, Finland.
| | - S Saarakkala
- Research Unit of Medical Imaging, Physics and Technology, University of Oulu, Oulu, Finland; Medical Research Center Oulu, University of Oulu and Oulu University Hospital, Oulu, Finland; Department of Diagnostic Radiology, Oulu University Hospital, Oulu, Finland.
| | - A Guermazi
- Department of Radiology, Boston University School of Medicine, Boston, MA, USA.
| | - M T Nieminen
- Research Unit of Medical Imaging, Physics and Technology, University of Oulu, Oulu, Finland; Medical Research Center Oulu, University of Oulu and Oulu University Hospital, Oulu, Finland; Department of Diagnostic Radiology, Oulu University Hospital, Oulu, Finland.
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13
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Svärd T, Lakovaara M, Pakarinen H, Haapea M, Kiviranta I, Lammentausta E, Jurvelin J, Tervonen O, Ojala R, Nieminen M. Quantitative MRI of Human Cartilage In Vivo: Relationships with Arthroscopic Indentation Stiffness and Defect Severity. Cartilage 2018; 9:46-54. [PMID: 29219019 PMCID: PMC5724675 DOI: 10.1177/1947603516684592] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Objective To investigate the association of cartilage defect severity, as determined by the International Cartilage Repair Society (ICRS) grading with indentation stiffness and T2 relaxation time of magnetic resonance imaging (MRI), a biomarker for the integrity of articular cartilage. Design Twenty-one patients scheduled for arthroscopic were included in the study. Prior to arthroscopy, subjects underwent quantitative MRI of articular cartilage, namely T2 relaxation time mapping at 1.5 T. Within 2 months, subjects underwent arthroscopy, which also included ICRS grading and measurement of arthroscopic indentation stiffness. Arthroscopic evaluations and T2 mapping at anterior, central, and posterior medial and lateral femoral condyles were correlated using a colocalization scheme. Differences in Young's modulus, as derived by indentation tests, and T2 times between ICRS grades were analyzed using Mann-Whitney's U or Kruskal-Wallis H tests. The correlation between modulus and T2 times was analyzed using Spearman's rank correlation coefficients. Results Modulus and T2 showed significant topographical variation. In the anterior region of interest (ROI) on the medial condyle the modulus showed a negative association with ICRS grade ( P = 0.040) and the T2 times were longer in ICRS grade 2 compared with grades 0 and 1 ( P = 0.047). Similar, but nonsignificant associations were found in the central ROI on the medial condyle. No significant correlations were observed between the indentation modulus and T2 times. Conclusions Cartilage degeneration is identified both with mechanical indentation and T2 mapping in MRI. However, in this study, indentation stiffness and T2 relaxation time in vivo, were not associated.
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Affiliation(s)
- Tuomas Svärd
- Department of Diagnostic Radiology, Oulu University Hospital, Oulu, Oulun lääni, Finland,Tuomas Svärd, Department of Diagnostic Radiology, Oulu University Hospital, POB 50, Oulu, Oulun lääni 90029, Finland.
| | | | - Harri Pakarinen
- Department of Orthopaedic Surgery, Oulu University Hospital, Oulu, Oulun lääni, Finland
| | - Marianne Haapea
- Department of Diagnostic Radiology, Oulu University Hospital, Oulu, Oulun lääni, Finland,Medical Research Center, University of Oulu and Oulu University Hospital, Oulu, Oulun lääni, Finland
| | - Ilkka Kiviranta
- Department of Orthopaedics and Traumatology, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
| | - Eveliina Lammentausta
- Department of Diagnostic Radiology, Oulu University Hospital, Oulu, Oulun lääni, Finland
| | - Jukka Jurvelin
- Department of Applied Physics, University of Eastern Finland, Kuopio, Finland
| | - Osmo Tervonen
- Department of Diagnostic Radiology, Oulu University Hospital, Oulu, Oulun lääni, Finland,Medical Research Center, University of Oulu and Oulu University Hospital, Oulu, Oulun lääni, Finland,Research Unit of Medical Imaging, Physics and Technology, University of Oulu, Oulu, Oulun lääni, Finland
| | | | - Miika Nieminen
- Department of Diagnostic Radiology, Oulu University Hospital, Oulu, Oulun lääni, Finland,Medical Research Center, University of Oulu and Oulu University Hospital, Oulu, Oulun lääni, Finland,Research Unit of Medical Imaging, Physics and Technology, University of Oulu, Oulu, Oulun lääni, Finland
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14
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Munukka M, Waller B, Häkkinen A, Nieminen MT, Lammentausta E, Kujala UM, Paloneva J, Kautiainen H, Kiviranta I, Heinonen A. Physical Activity Is Related with Cartilage Quality in Women with Knee Osteoarthritis. Med Sci Sports Exerc 2017; 49:1323-1330. [PMID: 28240703 DOI: 10.1249/mss.0000000000001238] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Abstract
PURPOSE To study the relationship between 12-month leisure-time physical activity (LTPA) level and changes in estimated biochemical composition of tibiofemoral cartilage in postmenopausal women with mild knee osteoarthritis (OA). METHODS Originally, 87 volunteer postmenopausal women, age 60 to 68 yr, with mild knee OA (Kellgren Lawrence I/II and knee pain) participated in a randomized controlled, 4-month aquatic training trial (RCT), after which 76 completed the 12-month postintervention follow-up period. Self-reported LTPA was collected along the 12-month period using a diary from which MET task hours per month were calculated. Participants were divided into MET task hour tertiles: 1, lowest (n = 25); 2 = middle (n = 25) and 3 = highest (n = 26). The biochemical composition of the cartilage was estimated using transverse relaxation time (T2) mapping sensitive to the properties of the collagen network and delayed gadolinium-enhanced magnetic resonance imaging of the cartilage (dGEMRIC index) sensitive to the cartilage glycosaminoglycan content. Secondary outcomes were cardiorespiratory fitness, isometric knee extension and flexion force, and the knee injury and OA outcome questionnaire. RESULTS During the 12-month follow-up period, there was a significant linear relationship between higher LTPA level and increased dGEMRIC index changes in the posterior region of interest (ROI) of the lateral (P = 0.003 for linearity) and medial (P = 0.006) femoral cartilage. Furthermore, these changes were seen in the posterior lateral femoral cartilage superficial (P = 0.004) and deep (P = 0.007) ROI and in the posterior medial superficial ROI (P < 0.001). There was no linear relationship between LTPA level and other measured variables. CONCLUSIONS These results suggest that higher LTPA level is related to regional increases in estimated glycosaminoglycan content of tibiofemoral cartilage in postmenopausal women with mild knee OA as measured with dGEMRIC index during a 12-month period.
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Affiliation(s)
- Matti Munukka
- 1Faculty of Sport and Health Sciences, University of Jyväskylä, Jyväskylä, FINLAND; 2Department of Physical Medicine and Rehabilitation, Central Finland Central Hospital, Jyväskylä, FINLAND; 3Research Unit of Medical Imaging, Physics and Technology, University of Oulu, Oulu, FINLAND; 4Department of Diagnostic Radiology, Oulu University Hospital, Oulu, FINLAND; 5Medical Research Center, University of Oulu and Oulu University Hospital, Oulu, FINLAND; 6Department of Surgery, Central Finland Central Hospital, Jyväskylä, FINLAND; 7Department of General Practice and Primary Health Care, University of Helsinki, Helsinki, FINLAND; 8Unit of Primary Health Care, Kuopio University Hospital, Kuopio, FINLAND; and 9Department of Orthopaedics and Traumatology, University of Helsinki, and Helsinki University Hospital, Helsinki, FINLAND
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15
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Moström EB, Lammentausta E, Finnbogason T, Weidenhielm L, Janarv PM, Tiderius CJ. T2 mapping and post-contrast T1 (dGEMRIC) of the patellar cartilage: 12-year follow-up after patellar stabilizing surgery in childhood. Acta Radiol Open 2017; 6:2058460117738808. [PMID: 29123919 PMCID: PMC5661686 DOI: 10.1177/2058460117738808] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2017] [Accepted: 09/18/2017] [Indexed: 12/29/2022] Open
Abstract
Background Cartilage degeneration has been reported after recurrent patellar dislocation. However, effects of surgical stabilization in childhood have not yet been described. Purpose To examine the cartilage quality in very young adults operated with a patellar stabilizing procedure due to recurrent patellar dislocation in childhood, and evaluate if cartilage quality correlates with clinical parameters and patient-reported outcomes. Material and Methods Seventeen patients were investigated ≥ 5 years (mean = 11.6 years) after patellar stabilizing surgery in childhood. Pre-contrast T2 relaxation times were analyzed in four superficial and four deep patellar cartilage regions of both knees. Two hours after 0.2 mM/kg Gd-DTPA2 i.v., post-contrast T1 (T1(Gd)) was analyzed in the same regions. Patient-reported outcomes (KOOS, Kujala, and Tegner scores) and recurrence rates were evaluated. Results Comparing operated to healthy side, neither T2 nor dGEMRIC differed between the operated and the reference knee regarding the superficial half of the cartilage. In the deep half of the cartilage, T1(Gd) was shorter in the central part of the cartilage, whereas T2 was longer medially (P < 0.05). A low score in the KOOS subscales Symptom and Sports & Recreation, was correlated to the degenerative changes detected by T1(Gd) (r = 0.5, P = 0.041). Conclusion In general, our findings demonstrate good cartilage quality 12 years after patellar stabilizing surgery during childhood. The subtle changes in T2 and T1(Gd) in the deep cartilage layer may be a result of altered biomechanics, although very early degenerative changes cannot be excluded. The short T1(Gd) centrally may reflect lower glycosaminoglycan content, whereas the increase in T2 medially indicates increased cartilage hydration.
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Affiliation(s)
- Eva Bengtsson Moström
- Department of Women's and Children's Health, Karolinska Institutet, Stockholm, Sweden
| | - Eveliina Lammentausta
- Department of Diagnostic Radiology, Oulu University Hospital, Finland.,Medical Research Center Oulu, Oulu University Hospital and University of Oulu, Finland
| | | | - Lars Weidenhielm
- Stockholm Sports Trauma Research Center, Department of Molecular Medicine and Surgery, Karolinska Institutet, Stockholm, Sweden
| | - Per-Mats Janarv
- Department of Women's and Children's Health, Karolinska Institutet, Stockholm, Sweden.,Stockholm Sports Trauma Research Center, Department of Molecular Medicine and Surgery, Karolinska Institutet, Stockholm, Sweden
| | - Carl Johan Tiderius
- Department of Orthopaedics, Skane University Hospital, Lund University, Sweden
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16
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Peuna A, Hekkala J, Haapea M, Podlipská J, Guermazi A, Saarakkala S, Nieminen MT, Lammentausta E. Variable angle gray level co-occurrence matrix analysis of T2
relaxation time maps reveals degenerative changes of cartilage in knee osteoarthritis: Oulu knee osteoarthritis study. J Magn Reson Imaging 2017; 47:1316-1327. [DOI: 10.1002/jmri.25881] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2017] [Accepted: 10/10/2017] [Indexed: 12/25/2022] Open
Affiliation(s)
- Arttu Peuna
- Research Unit of Medical Imaging; Physics and Technology, University of Oulu; Oulu Finland
- Department of Diagnostic Radiology; Oulu University Hospital; Oulu Finland
- Medical Research Center; University of Oulu and Oulu University Hospital; Oulu Finland
| | - Joonas Hekkala
- Research Unit of Medical Imaging; Physics and Technology, University of Oulu; Oulu Finland
| | - Marianne Haapea
- Research Unit of Medical Imaging; Physics and Technology, University of Oulu; Oulu Finland
- Department of Diagnostic Radiology; Oulu University Hospital; Oulu Finland
- Medical Research Center; University of Oulu and Oulu University Hospital; Oulu Finland
| | - Jana Podlipská
- Research Unit of Medical Imaging; Physics and Technology, University of Oulu; Oulu Finland
| | - Ali Guermazi
- Quantitative Imaging Center, Department of Radiology; Boston University School of Medicine; Boston Massachusetts USA
| | - Simo Saarakkala
- Research Unit of Medical Imaging; Physics and Technology, University of Oulu; Oulu Finland
- Department of Diagnostic Radiology; Oulu University Hospital; Oulu Finland
- Medical Research Center; University of Oulu and Oulu University Hospital; Oulu Finland
| | - Miika T. Nieminen
- Research Unit of Medical Imaging; Physics and Technology, University of Oulu; Oulu Finland
- Department of Diagnostic Radiology; Oulu University Hospital; Oulu Finland
- Medical Research Center; University of Oulu and Oulu University Hospital; Oulu Finland
| | - Eveliina Lammentausta
- Research Unit of Medical Imaging; Physics and Technology, University of Oulu; Oulu Finland
- Department of Diagnostic Radiology; Oulu University Hospital; Oulu Finland
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17
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Waller B, Munukka M, Rantalainen T, Lammentausta E, Nieminen MT, Kiviranta I, Kautiainen H, Häkkinen A, Kujala UM, Heinonen A. Effects of high intensity resistance aquatic training on body composition and walking speed in women with mild knee osteoarthritis: a 4-month RCT with 12-month follow-up. Osteoarthritis Cartilage 2017; 25:1238-1246. [PMID: 28263901 DOI: 10.1016/j.joca.2017.02.800] [Citation(s) in RCA: 51] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/03/2016] [Revised: 01/31/2017] [Accepted: 02/21/2017] [Indexed: 02/02/2023]
Abstract
OBJECTIVE To investigate the effects of 4-months intensive aquatic resistance training on body composition and walking speed in post-menopausal women with mild knee osteoarthritis (OA), immediately after intervention and after 12-months follow-up. Additionally, influence of leisure time physical activity (LTPA) will be investigated. DESIGN This randomised clinical trial assigned eighty-seven volunteer postmenopausal women into two study arms. The intervention group (n = 43) participated in 48 supervised intensive aquatic resistance training sessions over 4-months while the control group (n = 44) maintained normal physical activity. Eighty four participants continued into the 12-months' follow-up period. Body composition was measured with dual-energy X-ray absorptiometry (DXA). Walking speed over 2 km and the knee injury and osteoarthritis outcome score (KOOS) were measured. LTPA was recorded with self-reported diaries. RESULTS After the 4-month intervention there was a significant decrease (P = 0.002) in fat mass (mean change: -1.17 kg; 95% CI: -2.00 to -0.43) and increase (P = 0.002) in walking speed (0.052 m/s; 95% CI: 0.018 to 0.086) in favour of the intervention group. Body composition returned to baseline after 12-months. In contrast, increased walking speed was maintained (0.046 m/s; 95% CI 0.006 to 0.086, P = 0.032). No change was seen in lean mass or KOOS. Daily LTPA over the 16-months had a significant effect (P = 0.007) on fat mass loss (f2 = 0.05) but no effect on walking speed. CONCLUSIONS Our findings show that high intensity aquatic resistance training decreases fat mass and improves walking speed in post-menopausal women with mild knee OA. Only improvements in walking speed were maintained at 12-months follow-up. Higher levels of LTPA were associated with fat mass loss. TRIAL REGISTRATION NUMBER ISRCTN65346593.
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Affiliation(s)
- B Waller
- Faculty of Sport and Health Sciences, University of Jyväskylä, Jyväskylä, Finland.
| | - M Munukka
- Faculty of Sport and Health Sciences, University of Jyväskylä, Jyväskylä, Finland.
| | - T Rantalainen
- Institute for Physical Activity and Nutrition (IPAN), School of Exercise and Nutrition Sciences, Deakin University, Melbourne, Australia.
| | - E Lammentausta
- Department of Diagnostic Radiology, Oulu University Hospital, Oulu, Finland.
| | - M T Nieminen
- Department of Diagnostic Radiology, Oulu University Hospital, Oulu, Finland; Research Unit of Medical Imaging, Physics and Technology, University of Oulu, Oulu, Finland; Medical Research Center, University of Oulu and Oulu University Hospital, Finland.
| | - I Kiviranta
- Department of Orthopedics and Traumatology, University of Helsinki and Helsinki University Hospital, Helsinki, Finland.
| | - H Kautiainen
- Department of General Practice and Primary Health Care, University of Helsinki, Helsinki, Finland; Unit of Primary Health Care, Kuopio University Hospital, Kuopio, Finland.
| | - A Häkkinen
- Faculty of Sport and Health Sciences, University of Jyväskylä, Jyväskylä, Finland.
| | - U M Kujala
- Faculty of Sport and Health Sciences, University of Jyväskylä, Jyväskylä, Finland.
| | - A Heinonen
- Faculty of Sport and Health Sciences, University of Jyväskylä, Jyväskylä, Finland.
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18
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Korpi RM, Alestalo K, Ruuska T, Lammentausta E, Borra R, Yannopoulos F, Lehtonen S, Korpi JT, Lappi-Blanco E, Anttila V, Lehenkari P, Juvonen T, Blanco Sequieros R. Two novel direct SPIO labels and in vivo MRI detection of labeled cells after acute myocardial infarct. Acta Radiol Open 2017; 6:2058460117718407. [PMID: 28811932 PMCID: PMC5544151 DOI: 10.1177/2058460117718407] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2016] [Accepted: 06/08/2017] [Indexed: 11/17/2022] Open
Abstract
BACKGROUND Acute myocardial infarction (AMI) is a leading cause of morbidity and mortality worldwide. Cellular decay due hypoxia requires rapid and validated methods for possible therapeutic cell transplantation. PURPOSE To develop direct and rapid superparamagnetic iron oxide (SPIO) cell label for a large-animal model and to assess in vivo cell targeting by magnetic resonance imaging (MRI) in an experimental AMI model. MATERIAL AND METHODS Bone marrow mononuclear cells (BMMNCs) were labeled with SPIO particles using two novel direct labeling methods (rotating incubation method and electroporation). Labeling, iron incorporation in cells and label distribution, cellular viability, and proliferation were validated in vitro. An AMI porcine model was used to evaluate the direct labeling method (rotating incubation method) by examining targeting of labeled BMMNCs using MRI and histology. RESULTS Labeling (1 h) did not alter either cellular differentiation potential or viability of cells in vitro. Cellular relaxation values at 9.4 T correlated with label concentration and MRI at 1.5 T showing 89 ± 4% signal reduction compared with non-labeled cells in vitro. In vivo, a high spatial correlation between MRI and histology was observed. The extent of macroscopic pathological myocardial changes (hemorrhage) correlated with altered function detected on MRI. CONCLUSION We demonstrated two novel direct SPIO labeling methods and demonstrated the feasibility of clinical MRI for monitoring targeting of the labeled cells in animal models of AMI.
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Affiliation(s)
- Riikka M Korpi
- Department of Diagnostic Radiology, University of Oulu and Oulu University Hospital, Oulu, Finland
- Department of Radiology, Helsinki University Hospital, Helsinki, Finland
| | - Kirsi Alestalo
- Department of Surgery and Clinical Research Center, University of Oulu and Oulu University Hospital, Oulu, Finland
- Department of Anatomy and Cell Biology, University of Oulu, Oulu, Finland
| | - Timo Ruuska
- Department of Anatomy and Cell Biology, University of Oulu, Oulu, Finland
| | - Eveliina Lammentausta
- Department of Diagnostic Radiology, University of Oulu and Oulu University Hospital, Oulu, Finland
| | - Ronald Borra
- Medical Imaging Center of Southwest Finland, Turku University Hospital, Turku, Findland
- A.A. Martinos Center for Biomedical Imaging, Massachusetts General Hospital, Boston, MA, USA
| | - Fredrik Yannopoulos
- Department of Surgery and Clinical Research Center, University of Oulu and Oulu University Hospital, Oulu, Finland
| | - Siri Lehtonen
- MRC Oulu and Department of Obstetrics and Gynecology, Oulu University Hospital and PEDEGO Research Unit, University of Oulu, Oulu, Finland
| | - Jarkko T Korpi
- Department of Otorhinolaryngology, Head and Neck Surgery, Helsinki University Hospital, Helsinki, Finland
| | - Elisa Lappi-Blanco
- Department of Pathology, University of Oulu and Oulu University Hospital, Oulu, Finland
| | - Vesa Anttila
- Department of Surgery and Clinical Research Center, University of Oulu and Oulu University Hospital, Oulu, Finland
| | - Petri Lehenkari
- Department of Surgery and Clinical Research Center, University of Oulu and Oulu University Hospital, Oulu, Finland
- Department of Anatomy and Cell Biology, University of Oulu, Oulu, Finland
| | - Tatu Juvonen
- Department of Surgery and Clinical Research Center, University of Oulu and Oulu University Hospital, Oulu, Finland
- Department of Cardiac Surgery, HUCH Heart and Lung Center, Helsinki, Finland
| | - Roberto Blanco Sequieros
- Department of Diagnostic Radiology, University of Oulu and Oulu University Hospital, Oulu, Finland
- Department of Radiology, University of Turku and Turku University Hospital, Turku, Finland
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19
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Multanen J, Rantalainen T, Kautiainen H, Ahola R, Jämsä T, Nieminen MT, Lammentausta E, Häkkinen A, Kiviranta I, Heinonen A. Effect of progressive high-impact exercise on femoral neck structural strength in postmenopausal women with mild knee osteoarthritis: a 12-month RCT. Osteoporos Int 2017; 28:1323-1333. [PMID: 28035445 DOI: 10.1007/s00198-016-3875-1] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/12/2016] [Accepted: 12/07/2016] [Indexed: 11/27/2022]
Abstract
UNLABELLED It is uncertain whether subjects with mild knee osteoarthritis, and who may be at risk of osteoporosis, can exercise safely with the aim of improving hip bone strength. This RCT showed that participating in a high-impact exercise program improved femoral neck strength without any detrimental effects on knee cartilage composition. INTRODUCTION No previous studies have examined whether high-impact exercise can improve bone strength and articular cartilage quality in subjects with mild knee osteoarthritis. In this 12-month RCT, we assessed the effects of progressive high-impact exercise on femoral neck structural strength and biochemical composition of knee cartilage in postmenopausal women. METHODS Eighty postmenopausal women with mild knee radiographic osteoarthritis were randomly assigned into the exercise (n = 40) or control (n = 40) group. Femoral neck structural strength was assessed with dual-energy X-ray absorptiometry. The knee cartilage region exposed to exercise loading was measured by the quantitative MRI techniques of T2 mapping and delayed gadolinium-enhanced MRI of cartilage (dGEMRIC). Also, an accelerometer-based body movement monitor was used to evaluate the total physical activity loading on the changes of femoral neck strength in all participants. Training effects on the outcome variables were estimated by the bootstrap analysis of covariance. RESULTS A significant between-group difference in femoral neck bending strength in favor of the trainees was observed after the 12-month intervention (4.4%, p < 0.01). The change in femoral neck bending strength remained significant after adjusting for baseline value, age, height, and body mass (4.0%, p = 0.020). In all participants, the change in bending strength was associated with the total physical activity loading (r = 0.29, p = 0.012). The exercise participation had no effect on knee cartilage composition. CONCLUSION The high-impact training increased femoral neck strength without having any harmful effect on knee cartilage in women with mild knee osteoarthritis. These findings imply that progressive high-impact exercise is a feasible method in seeking to prevent hip fractures in postmenopausal women whose articular cartilage may also be frail.
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Affiliation(s)
- J Multanen
- Department of Physical Medicine and Rehabilitation, Central Finland Central Hospital, Keskussairaalantie 19, 40620, Jyväskylä, Finland.
- Department of Health Sciences, University of Jyväskylä, Jyväskylä, Finland.
| | - T Rantalainen
- Center for Physical Activity and Nutrition Research, School of Exercise and Nutrition Sciences, Deakin University Melbourne, Melbourne, Australia
| | - H Kautiainen
- Department of General Practice and Primary Health Care, University of Helsinki, Helsinki, Finland
- Unit of Primary Health Care, Kuopio University Hospital, Kuopio, Finland
| | - R Ahola
- Research Unit of Medical Imaging, Physics and Technology, University of Oulu, Oulu, Finland
| | - T Jämsä
- Research Unit of Medical Imaging, Physics and Technology, University of Oulu, Oulu, Finland
- Medical Research Center Oulu, Oulu University Hospital and University of Oulu, Oulu, Finland
- Department of Diagnostic Radiology, Oulu University Hospital, Oulu, Finland
| | - M T Nieminen
- Research Unit of Medical Imaging, Physics and Technology, University of Oulu, Oulu, Finland
- Department of Diagnostic Radiology, Oulu University Hospital, Oulu, Finland
- Department of Radiology, University of Oulu, Oulu, Finland
| | - E Lammentausta
- Department of Diagnostic Radiology, Oulu University Hospital, Oulu, Finland
| | - A Häkkinen
- Department of Physical Medicine and Rehabilitation, Central Finland Central Hospital, Keskussairaalantie 19, 40620, Jyväskylä, Finland
- Department of Health Sciences, University of Jyväskylä, Jyväskylä, Finland
| | - I Kiviranta
- Department of Orthopaedics and Traumatology, University of Helsinki, and Helsinki University Hospital, Helsinki, Finland
| | - A Heinonen
- Department of Physical Medicine and Rehabilitation, Central Finland Central Hospital, Keskussairaalantie 19, 40620, Jyväskylä, Finland
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20
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Casula V, Nissi MJ, Podlipská J, Haapea M, Koski JM, Saarakkala S, Guermazi A, Lammentausta E, Nieminen MT. Elevated adiabatic T 1ρ and T 2ρ in articular cartilage are associated with cartilage and bone lesions in early osteoarthritis: A preliminary study. J Magn Reson Imaging 2017; 46:678-689. [PMID: 28117922 DOI: 10.1002/jmri.25616] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2016] [Accepted: 12/13/2016] [Indexed: 12/13/2022] Open
Abstract
PURPOSE To evaluate adiabatic T1ρ and T2ρ of articular cartilage in symptomatic osteoarthritis (OA) patients and asymptomatic volunteers, and to determine their association with magnetic resonance imaging (MRI)-based structural abnormalities in cartilage and bone. MATERIALS AND METHODS A total of 24 subjects (age range: 50-68 years; 12 female) were enrolled, including 12 early OA patients and 12 volunteers with normal joint function. Patients and volunteers underwent 3T MRI. T2 , adiabatic T1ρ , and T2ρ relaxation times of knee articular cartilage were measured. Proton density (PD)- and T1 -weighted MR image series were also obtained and separately evaluated for morphological changes using the MRI OA Knee Scoring (MOAKS) system. Comparisons using the Mann-Whitney nonparametric test were performed after dividing the study participants according to physical symptoms as determined by Western Ontario and McMaster Universities (WOMAC) score or presence of cartilage lesions, bone marrow lesions, or osteophytes. RESULTS Elevated adiabatic T1ρ and T2ρ relaxation times of articular cartilage were associated with cartilage loss (P = 0.024-0.047), physical symptoms (0.0068-0.035), and osteophytes (0.0039-0.027). Elevated adiabatic T1ρ was also associated with bone marrow lesions (0.033). CONCLUSION Preliminary data suggest that elevated adiabatic T1ρ and T2ρ of cartilage are associated with morphological abnormalities of cartilage and bone, and thus may be applicable for in vivo OA research and diagnostics. LEVEL OF EVIDENCE 2 Technical Efficacy: Stage 2 J. MAGN. RESON. IMAGING 2017;46:678-689.
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Affiliation(s)
- Victor Casula
- Research Unit of Medical Imaging, Physics and Technology, University of Oulu, Oulu, Finland.,Medical Research Center Oulu, University of Oulu and Oulu University Hospital, Oulu, Finland
| | - Mikko J Nissi
- Department of Applied Physics, University of Eastern Finland, Kuopio, Finland.,Diagnostic Imaging Center, Kuopio University Hospital, Kuopio, Finland
| | - Jana Podlipská
- Research Unit of Medical Imaging, Physics and Technology, University of Oulu, Oulu, Finland.,Infotech Oulu, University of Oulu, Oulu, Finland
| | - Marianne Haapea
- Medical Research Center Oulu, University of Oulu and Oulu University Hospital, Oulu, Finland.,Department of Diagnostic Radiology, Oulu University Hospital, Oulu, Finland
| | - Juhani M Koski
- Department of Internal Medicine, Mikkeli Central Hospital, Mikkeli, Finland
| | - Simo Saarakkala
- Research Unit of Medical Imaging, Physics and Technology, University of Oulu, Oulu, Finland.,Medical Research Center Oulu, University of Oulu and Oulu University Hospital, Oulu, Finland.,Department of Diagnostic Radiology, Oulu University Hospital, Oulu, Finland
| | - Ali Guermazi
- Quantitative Imaging Center, Department of Radiology, Boston University School of Medicine, Boston, Massachusetts, USA
| | | | - Miika T Nieminen
- Research Unit of Medical Imaging, Physics and Technology, University of Oulu, Oulu, Finland.,Medical Research Center Oulu, University of Oulu and Oulu University Hospital, Oulu, Finland.,Department of Diagnostic Radiology, Oulu University Hospital, Oulu, Finland
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21
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Munukka M, Waller B, Rantalainen T, Häkkinen A, Nieminen MT, Lammentausta E, Kujala UM, Paloneva J, Sipilä S, Peuna A, Kautiainen H, Selänne H, Kiviranta I, Heinonen A. Efficacy of progressive aquatic resistance training for tibiofemoral cartilage in postmenopausal women with mild knee osteoarthritis: a randomised controlled trial. Osteoarthritis Cartilage 2016; 24:1708-1717. [PMID: 27211862 DOI: 10.1016/j.joca.2016.05.007] [Citation(s) in RCA: 46] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/21/2016] [Revised: 04/19/2016] [Accepted: 05/09/2016] [Indexed: 02/02/2023]
Abstract
OBJECTIVE To study the efficacy of aquatic resistance training on biochemical composition of tibiofemoral cartilage in postmenopausal women with mild knee osteoarthritis (OA). DESIGN Eighty seven volunteer postmenopausal women, aged 60-68 years, with mild knee OA (Kellgren-Lawrence grades I/II and knee pain) were recruited and randomly assigned to an intervention (n = 43) and control (n = 44) group. The intervention group participated in 48 supervised aquatic resistance training sessions over 16 weeks while the control group maintained usual level of physical activity. The biochemical composition of the medial and lateral tibiofemoral cartilage was estimated using single-slice transverse relaxation time (T2) mapping and delayed gadolinium-enhanced magnetic resonance imaging of cartilage (dGEMRIC index). Secondary outcomes were cardiorespiratory fitness, isometric knee extension and flexion force and knee injury and OA outcome (KOOS) questionnaire. RESULTS After 4-months aquatic training, there was a significant decrease in both T2 -1.2 ms (95% confidence interval (CI): -2.3 to -0.1, P = 0.021) and dGEMRIC index -23 ms (-43 to -3, P = 0.016) in the training group compared to controls in the full thickness posterior region of interest (ROI) of the medial femoral cartilage. Cardiorespiratory fitness significantly improved in the intervention group by 9.8% (P = 0.010). CONCLUSIONS Our results suggest that, in postmenopausal women with mild knee OA, the integrity of the collagen-interstitial water environment (T2) of the tibiofemoral cartilage may be responsive to low shear and compressive forces during aquatic resistance training. More research is required to understand the exact nature of acute responses in dGEMRIC index to this type of loading. Further, aquatic resistance training improves cardiorespiratory fitness. TRIAL REGISTRATION NUMBER ISRCTN65346593.
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Affiliation(s)
- M Munukka
- Department of Health Sciences, University of Jyväskylä, Jyväskylä, Finland.
| | - B Waller
- Department of Health Sciences, University of Jyväskylä, Jyväskylä, Finland.
| | - T Rantalainen
- Institute for Physical Activity and Nutrition (IPAN), School of Exercise and Nutrition Sciences, Deakin University, Melbourne, Australia.
| | - A Häkkinen
- Department of Health Sciences, University of Jyväskylä, Jyväskylä, Finland; Department of Physical Medicine and Rehabilitation, Central Finland Central Hospital, Jyväskylä, Finland.
| | - M T Nieminen
- Department of Diagnostic Radiology, Oulu University Hospital, Oulu, Finland; Research Unit of Medical Imaging, Physics and Technology, University of Oulu, Oulu, Finland; Medical Research Center, University of Oulu and Oulu University Hospital.
| | - E Lammentausta
- Department of Diagnostic Radiology, Oulu University Hospital, Oulu, Finland.
| | - U M Kujala
- Department of Health Sciences, University of Jyväskylä, Jyväskylä, Finland.
| | - J Paloneva
- Department of Surgery, Central Finland Central Hospital, Jyväskylä, Finland.
| | - S Sipilä
- Department of Health Sciences, University of Jyväskylä, Jyväskylä, Finland; Gerontology Research Center, University of Jyväskylä, Finland.
| | - A Peuna
- Department of Diagnostic Radiology, Oulu University Hospital, Oulu, Finland; Research Unit of Medical Imaging, Physics and Technology, University of Oulu, Oulu, Finland.
| | - H Kautiainen
- Department of General Practice and Primary Health Care, University of Helsinki, Helsinki, Finland; Unit of Primary Health Care, Kuopio University Hospital, Kuopio, Finland.
| | - H Selänne
- Mehiläinen Sports Medical Clinic, Jyväskylä, Finland.
| | - I Kiviranta
- Department of Orthopaedics and Traumatology, University of Helsinki, and Helsinki University Hospital, Helsinki, Finland.
| | - A Heinonen
- Department of Health Sciences, University of Jyväskylä, Jyväskylä, Finland.
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22
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Sigurdsson U, Müller G, Siversson C, Lammentausta E, Svensson J, Tiderius CJ, Dahlberg LE. Delayed gadolinium-enhanced MRI of meniscus (dGEMRIM) and cartilage (dGEMRIC) in healthy knees and in knees with different stages of meniscus pathology. BMC Musculoskelet Disord 2016; 17:406. [PMID: 27682996 PMCID: PMC5041400 DOI: 10.1186/s12891-016-1244-z] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/06/2016] [Accepted: 09/08/2016] [Indexed: 12/23/2022] Open
Abstract
Background Lesions in the meniscus are risk factors for developing knee osteoarthritis (OA), not least because of the role of the meniscus in the pathological progression of OA. Delayed gadolinium enhanced MRI of cartilage (dGEMRIC) has extensively been used to identify pre-radiographic cartilage changes in OA. In contrast, its counterpart with regard to examination of the meniscus, gadolinium enhanced MRI of meniscus (dGEMRIM), has been less utilized. In this study we use 3D dGEMRIM in patients with meniscus lesions and compare them with previous results of healthy individuals. Methods Eighteen subjects with MRI-verified posteromedial meniscus lesions and 12 healthy subjects with non-injured and non-symptomatic knee joints, together 30 volunteers, were examined using 3D Look-Locker sequence after intravenous injection of Gd-DTPA2− (0.2 mmol/kg body weight). Relaxation time (T1) was measured in the posterior meniscus and femoral cartilage before and 60, 90, 120 and 180 min after injection. Relaxation rate (R1 = 1/T1) and change in relaxation rate (ΔR1) were calculated. For statistical analyses, Student’s t-test and Analysis of Variance (ANOVA) were used. Results The pre-contrast diagnostic MRI identified two sub-cohorts in the 18 patients with regard to meniscus injury: 1) 11 subjects with MRI verified pathological intrameniscal changes (grade 2) in the posteromedial meniscus only and no obvious cartilage changes. The lateral meniscus showed no pathology. 2) 7 subjects with MRI verified pathological rupture (grade 3) of the posteromedial meniscus and pathological changes in the lateral meniscus and/or medial and lateral joint cartilage. Comparisons of pathological and healthy posteromedial meniscus revealed opposite patterns in both T1Gd and ΔR1 values between pathological meniscus grade 2 and grade 3. The concentration of the contrast agent was lower than in healthy meniscus in grade 2 lesions (p = 0.046) but tended to increase in grade 3 lesions (p = 0.110). Maximum concentration of contrast agent was reached after 180 min in both cartilage and menisci (except for grade 3 menisci where the maximum concentration was reached after 90 min). Conclusion dGEMRIM and dGEMRIC may be feasible to combine in vivo, preferably with one examination before and one 2 h after contrast injection. Possible different dGEMRIM patterns at different stages of meniscus lesions must be taken into account when evaluating meniscus pathology.
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Affiliation(s)
- Ulf Sigurdsson
- Department of Orthopaedics, Lund University, Skåne University Hospital, SE-205 02, Malmö, Sweden.
| | - Gunilla Müller
- Institute of Radiology und Scintigraphy, Kantonsspital Lucerne, Spitalstrasse, 6000, Lucerne, Switzerland
| | - Carl Siversson
- Medical Radiation Physics, Department of Translational Medicine, Lund University, Skåne University Hospital, SE-205 02, Malmö, Sweden
| | - Eveliina Lammentausta
- Department of Diagnostic Radiology, Oulu University Hospital, PO Box 50, FI-90029 OYS, Oulu, Finland
| | - Jonas Svensson
- Medical Imaging and Physiology, Skåne University Hospital, SE-221 85, Lund, Sweden
| | - Carl-Johan Tiderius
- Department of Orthopaedics, Clinical Sciences Lund, Lund University, Skåne University Hospital, SE-221 85, Lund, Sweden
| | - Leif E Dahlberg
- Department of Orthopaedics, Clinical Sciences Lund, Lund University, Skåne University Hospital, SE-221 85, Lund, Sweden
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23
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Koli J, Multanen J, Kujala UM, Häkkinen A, Nieminen MT, Kautiainen H, Lammentausta E, Jämsä T, Ahola R, Selänne H, Kiviranta I, Heinonen A. Effects of Exercise on Patellar Cartilage in Women with Mild Knee Osteoarthritis. Med Sci Sports Exerc 2016; 47:1767-74. [PMID: 25668399 DOI: 10.1249/mss.0000000000000629] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/13/2023]
Abstract
PURPOSE This study aims to investigate the effects of exercise on patellar cartilage using T2 relaxation time mapping of magnetic resonance imaging in postmenopausal women with mild patellofemoral joint osteoarthritis (OA). METHODS Eighty postmenopausal women (mean age, 58 (SD, 4.2) yr) with mild knee OA were randomized to either a supervised progressive impact exercise program three times a week for 12 months (n = 40) or a nonintervention control group (n = 40). Biochemical properties of cartilage were estimated using T2 relaxation time mapping, a parameter sensitive to collagen integrity, collagen orientation, and tissue hydration. Leg muscle strength and power, aerobic capacity, and self-rated assessment with the Knee Injury and Osteoarthritis Outcome Score were also measured. RESULTS After intervention, full-thickness patellar cartilage T2 values had medium-size effect (d = 0.59; 95% confidence interval, 0.16 to 0.97; P = 0.018); the change difference was 7% greater in the exercise group compared with the control group. In the deep half of tissue, the significant exercise effect size was medium (d = 0.56; 95% confidence interval, 0.13 to 0.99; P = 0.013); the change difference was 8% greater in the exercise group compared with controls. Furthermore, significant medium-size T2 effects were found in the total lateral segment, lateral deep, and lateral superficial zones in favor of the exercise group. Extension force was 11% greater (d = 0.63, P = 0.006) and maximal aerobic capacity was 4% greater (d = 0.55, P = 0.028) in the exercise group than in controls. No changes in Knee Injury and Osteoarthritis Outcome Score emerged between the groups. CONCLUSIONS Progressively implemented high-impact and intensive exercise creates enough stimuli and exerts favorable effects on patellar cartilage quality and physical function in postmenopausal women with mild knee OA.
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Affiliation(s)
- Jarmo Koli
- 1Department of Health Sciences, University of Jyväskylä, Jyväskylä, FINLAND; 2Department of Physical Medicine and Rehabilitation, Central Finland Central Hospital, Jyväskylä, FINLAND; 3Department of Diagnostic Radiology, Oulu University Hospital, Oulu, FINLAND; 4Medical Research Center Oulu, University of Oulu and Oulu University Hospital, Oulu, FINLAND; 5Department of Radiology, University of Oulu, Oulu, FINLAND; 6Department of General Practice and Primary Healthcare, University of Helsinki, Helsinki, FINLAND; 7Unit of Primary Healthcare, Kuopio University Hospital, Kuopio, FINLAND; 8Department of Medical Technology, Institute of Biomedicine, University of Oulu, Oulu, Finland; 9LIKES Research Center, Jyväskylä, FINLAND; and 10Department of Orthopedics and Traumatology, University of Helsinki and Helsinki University Hospital, Helsinki, FINLAND
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24
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Hawezi ZK, Lammentausta E, Svensson J, Roos EM, Dahlberg LE, Tiderius CJ. Regional dGEMRIC analysis in patients at risk of osteoarthritis provides additional information about activity related changes in cartilage structure. Acta Radiol 2016; 57:468-74. [PMID: 26113741 DOI: 10.1177/0284185115591237] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2015] [Accepted: 05/18/2015] [Indexed: 01/30/2023]
Abstract
BACKGROUND Previously, a positive effect of exercise on cartilage structure was indicated with delayed gadolinium-enhanced magnetic resonance imaging (MRI) of cartilage (dGEMRIC). However, in that study only one full-thickness region of interest (ROI) in the medial femoral condyle was analyzed. PURPOSE To improve the knowledge about exercise effects on cartilage structure by re-analyzing previous images with regional dGEMRIC analysis. MATERIAL AND METHODS Thirty patients (age range, 38-50 years) with a previous medial meniscus resection were divided into three groups according to self-reported change in physical activity (PA) level in a 4-month exercise intervention study: Group I (n = 11), increased PA level; Group II (n = 13), no change in PA level; and Group III (n = 6), reduced PA level. dGEMRIC index was analyzed at inclusion and after 4 months. Anterior (less load) and posterior (more load) ROIs of medial and lateral femoral condyles were analyzed, as well as superficial and deep cartilage regions. RESULTS Group I increased the dGEMRIC index in the posterior cartilage (P = 0.004). The increase was larger in the lateral (P = 0.005) than the medial compartment in both superficial and deep cartilage regions. The dGEMRIC index did not change in Group II. In Group III, the dGEMRIC index decreased in the medial posterior cartilage (P = 0.03). CONCLUSION In patients with a previous medial meniscectomy, the beneficial effect of exercise varies between different locations within the joint, the largest improvement being observed in lateral posterior cartilage, i.e. the load-bearing cartilage in the compartment without a meniscus lesion. The effects of exercise do not seem to vary with cartilage depth.
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Affiliation(s)
- ZK Hawezi
- Department of Clinical Sciences, Lund University, Lund, Sweden
| | - E Lammentausta
- Department of Diagnostic Radiology, Oulu University Hospital, Finland
| | - J Svensson
- Department of Radiation Physics, Skåne University Hospital Malmö, Lund University, Sweden
| | - EM Roos
- Institute of Sports Science and Clinical Biomechanics, University of Southern Denmark, Odense, Denmark
| | - LE Dahlberg
- Department of Clinical Sciences, Lund University, Lund, Sweden
| | - CJ Tiderius
- Department of Orthopedics, Skåne University Hospital, Lund University, Sweden
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Casula V, Autio J, Nissi MJ, Auerbach EJ, Ellermann J, Lammentausta E, Nieminen MT. Validation and optimization of adiabatic T 1ρ and T 2ρ for quantitative imaging of articular cartilage at 3 T. Magn Reson Med 2016; 77:1265-1275. [PMID: 26946182 DOI: 10.1002/mrm.26183] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2015] [Revised: 02/02/2016] [Accepted: 02/06/2016] [Indexed: 12/22/2022]
Abstract
PURPOSE The aim of the present work was to validate and optimize adiabatic T1ρ and T2ρ mapping for in vivo measurements of articular cartilage at 3 Tesla (T). METHODS Phantom and in vivo experiments were systematically performed on a 3T clinical system to evaluate the sequences using hyperbolic secant HS1 and HS4 pulses. R1ρ and R2ρ relaxation rates were studied as a function of agarose and chondroitin sulfate concentration and pulse duration. Optimal in vivo protocol was determined by imaging the articular cartilage of two volunteers and varying the sequence parameters, and successively applied in eight additional subjects. Reproducibility was assessed in phantoms and in vivo. RESULTS Relaxation rates depended on agarose and chondroitin sulfate concentration. The sequences were able to generate relaxation time maps with pulse lengths of 8 and 6 ms for HS1 and HS4, respectively. In vivo findings were in good agreement with the phantoms. The implemented adiabatic T1ρ and T2ρ sequences demonstrated regional variation in relaxation time maps of femorotibial cartilage. Reproducibility in phantoms and in vivo was good to excellent for both adiabatic T1ρ and T2ρ . CONCLUSIONS The findings indicate that sequences are suitable for quantitative in vivo assessment of articular cartilage at 3 T. Magn Reson Med 77:1265-1275, 2017. © 2016 International Society for Magnetic Resonance in Medicine.
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Affiliation(s)
- Victor Casula
- Research Unit of Medical Imaging, Physics and Technology, University of Oulu, Oulu, Finland.,Medical Research Center, University of Oulu and Oulu University Hospital, Oulu, Finland
| | - Joonas Autio
- Center for Life Science and Technologies, RIKEN, Kobe, Japan
| | - Mikko J Nissi
- Research Unit of Medical Imaging, Physics and Technology, University of Oulu, Oulu, Finland.,Center for Magnetic Resonance Research, Department of Radiology, University of Minnesota, Minneapolis, MN.,Department of Applied Physics, University of Eastern Finland, Kuopio, Finland.,Diagnostic Imaging Center, Kuopio University Hospital, Kuopio, Finland
| | - Edward J Auerbach
- Center for Magnetic Resonance Research, Department of Radiology, University of Minnesota, Minneapolis, MN
| | - Jutta Ellermann
- Center for Magnetic Resonance Research, Department of Radiology, University of Minnesota, Minneapolis, MN
| | | | - Miika T Nieminen
- Research Unit of Medical Imaging, Physics and Technology, University of Oulu, Oulu, Finland.,Medical Research Center, University of Oulu and Oulu University Hospital, Oulu, Finland.,Department of Diagnostic Radiology, Oulu University Hospital, Oulu, Finland
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26
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Podlipská J, Guermazi A, Lehenkari P, Niinimäki J, Roemer FW, Arokoski JP, Kaukinen P, Liukkonen E, Lammentausta E, Nieminen MT, Tervonen O, Koski JM, Saarakkala S. Comparison of Diagnostic Performance of Semi-Quantitative Knee Ultrasound and Knee Radiography with MRI: Oulu Knee Osteoarthritis Study. Sci Rep 2016. [PMID: 26926836 DOI: 10.1038/srep22365.erratum.in:scirep.2016sep,16(6),pp.33109] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/23/2023] Open
Abstract
Osteoarthritis (OA) is a common degenerative musculoskeletal disease highly prevalent in aging societies worldwide. Traditionally, knee OA is diagnosed using conventional radiography. However, structural changes of articular cartilage or menisci cannot be directly evaluated using this method. On the other hand, ultrasound is a promising tool able to provide direct information on soft tissue degeneration. The aim of our study was to systematically determine the site-specific diagnostic performance of semi-quantitative ultrasound grading of knee femoral articular cartilage, osteophytes and meniscal extrusion, and of radiographic assessment of joint space narrowing and osteophytes, using MRI as a reference standard. Eighty asymptomatic and 79 symptomatic subjects with mean age of 57.7 years were included in the study. Ultrasound performed best in the assessment of femoral medial and lateral osteophytes, and medial meniscal extrusion. In comparison to radiography, ultrasound performed better or at least equally well in identification of tibio-femoral osteophytes, medial meniscal extrusion and medial femoral cartilage morphological degeneration. Ultrasound provides relevant additional diagnostic information on tissue-specific morphological changes not depicted by conventional radiography. Consequently, the use of ultrasound as a complementary imaging tool along with radiography may enable more accurate and cost-effective diagnostics of knee osteoarthritis at the primary healthcare level.
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Affiliation(s)
- Jana Podlipská
- Research Unit of Medical Imaging, Physics and Technology, Infotech Oulu, University of Oulu, Oulu, Finland
| | - Ali Guermazi
- Department of Radiology, Boston University School of Medicine, Boston, MA, USA
| | - Petri Lehenkari
- Departments of Anatomy and Surgery Clinic, Medical Research Center, University of Oulu and Oulu University Hospital, Oulu, Finland
| | - Jaakko Niinimäki
- Research Unit of Medical Imaging, Physics and Technology, Medical Research Center, University of Oulu and Oulu University Hospital, Oulu, Finland
- Department of Diagnostic Radiology, Oulu University Hospital, Oulu, Finland
| | - Frank W Roemer
- Department of Radiology, Boston University School of Medicine, Boston, MA, USA
- Department of Radiology, University of Erlangen-Nuremberg, Erlangen, Germany
| | - Jari P Arokoski
- Institute of Clinical Medicine, University of Eastern Finland, Kuopio, Finland
- Department of Physical and Rehabilitation Medicine, Kuopio University Hospital, Kuopio, Finland
| | - Päivi Kaukinen
- Institute of Clinical Medicine, University of Eastern Finland, Kuopio, Finland
- Department of Physical and Rehabilitation Medicine, Kuopio University Hospital, Kuopio, Finland
| | - Esa Liukkonen
- Research Unit of Medical Imaging, Physics and Technology, Medical Research Center, University of Oulu and Oulu University Hospital, Oulu, Finland
- Department of Diagnostic Radiology, Oulu University Hospital, Oulu, Finland
| | - Eveliina Lammentausta
- Research Unit of Medical Imaging, Physics and Technology, Medical Research Center, University of Oulu and Oulu University Hospital, Oulu, Finland
- Department of Diagnostic Radiology, Oulu University Hospital, Oulu, Finland
| | - Miika T Nieminen
- Research Unit of Medical Imaging, Physics and Technology, Medical Research Center, University of Oulu and Oulu University Hospital, Oulu, Finland
- Department of Diagnostic Radiology, Oulu University Hospital, Oulu, Finland
| | - Osmo Tervonen
- Research Unit of Medical Imaging, Physics and Technology, Medical Research Center, University of Oulu and Oulu University Hospital, Oulu, Finland
- Department of Diagnostic Radiology, Oulu University Hospital, Oulu, Finland
| | - Juhani M Koski
- Department of Internal Medicine, Mikkeli Central Hospital, Mikkeli, Finland
| | - Simo Saarakkala
- Research Unit of Medical Imaging, Physics and Technology, Medical Research Center, University of Oulu and Oulu University Hospital, Oulu, Finland
- Department of Diagnostic Radiology, Oulu University Hospital, Oulu, Finland
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Tonttila PP, Lantto J, Pääkkö E, Piippo U, Kauppila S, Lammentausta E, Ohtonen P, Vaarala MH. Prebiopsy Multiparametric Magnetic Resonance Imaging for Prostate Cancer Diagnosis in Biopsy-naive Men with Suspected Prostate Cancer Based on Elevated Prostate-specific Antigen Values: Results from a Randomized Prospective Blinded Controlled Trial. Eur Urol 2016; 69:419-25. [DOI: 10.1016/j.eururo.2015.05.024] [Citation(s) in RCA: 123] [Impact Index Per Article: 15.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2015] [Accepted: 05/14/2015] [Indexed: 10/23/2022]
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Räsänen LP, Mononen ME, Lammentausta E, Nieminen MT, Jurvelin JS, Korhonen RK. Three dimensional patient-specific collagen architecture modulates cartilage responses in the knee joint during gait. Comput Methods Biomech Biomed Engin 2015; 19:1225-40. [PMID: 26714834 DOI: 10.1080/10255842.2015.1124269] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
Site-specific variation of collagen fibril orientations can affect cartilage stresses in knee joints. However, this has not been confirmed by 3-D analyses. Therefore, we present a novel method for evaluation of the effect of patient-specific collagen architecture on time-dependent mechanical responses of knee joint cartilage during gait. 3-D finite element (FE) models of a human knee joint were created with the collagen architectures obtained from T2 mapped MRI (patient-specific model) and from literature (literature model). The effect of accuracy of the implementation of collagen fibril architecture into the model was examined by using a submodel with denser FE mesh. Compared to the literature model, fibril strains and maximum principal stresses were reduced especially in the superficial/middle regions of medial tibial cartilage in the patient-specific model after the loading response of gait (up to -413 and -26%, respectively). Compared to the more coarsely meshed joint model, the patient-specific submodel demonstrated similar strain and stress distributions but increased values particularly in the superficial cartilage regions (especially stresses increased >60%). The results demonstrate that implementation of subject-specific collagen architecture of cartilage in 3-D modulates location- and time-dependent mechanical responses of human knee joint cartilage. Submodeling with more accurate implementation of collagen fibril architecture alters cartilage stresses particularly in the superficial/middle tissue.
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Affiliation(s)
- Lasse P Räsänen
- a Department of Applied Physics , University of Eastern Finland , Kuopio , Finland.,b Diagnostic Imaging Centre, Kuopio University Hospital , Kuopio , Finland
| | - Mika E Mononen
- a Department of Applied Physics , University of Eastern Finland , Kuopio , Finland
| | - Eveliina Lammentausta
- c Department of Diagnostic Radiology , Oulu University Hospital , Oulu , Finland.,e Medical Research Center, University of Oulu and Oulu University Hospital , Oulu , Finland
| | - Miika T Nieminen
- c Department of Diagnostic Radiology , Oulu University Hospital , Oulu , Finland.,d Department of Radiology , Institute of Diagnostics, University of Oulu , Oulu , Finland.,e Medical Research Center, University of Oulu and Oulu University Hospital , Oulu , Finland
| | - Jukka S Jurvelin
- a Department of Applied Physics , University of Eastern Finland , Kuopio , Finland.,b Diagnostic Imaging Centre, Kuopio University Hospital , Kuopio , Finland
| | - Rami K Korhonen
- a Department of Applied Physics , University of Eastern Finland , Kuopio , Finland.,b Diagnostic Imaging Centre, Kuopio University Hospital , Kuopio , Finland
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Lepojärvi ES, Piira OP, Pääkkö E, Lammentausta E, Risteli J, Miettinen JA, Perkiömäki JS, Huikuri HV, Junttila MJ. Serum PINP, PIIINP, galectin-3, and ST2 as surrogates of myocardial fibrosis and echocardiographic left venticular diastolic filling properties. Front Physiol 2015. [PMID: 26217237 PMCID: PMC4499700 DOI: 10.3389/fphys.2015.00200] [Citation(s) in RCA: 32] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/23/2023] Open
Abstract
Objectives and Background: Serum biomarkers have been proposed to reflect fibrosis of several human tissues, but their specific role in the detection of myocardial fibrosis has not been well-established. We studied the association between N-terminal propeptide of type I and III procollagen (PINP, PIIINP, respectively), galectin-3 (gal-3), soluble ST2 (ST2), and myocardial fibrosis measured by late gadolinium enhanced cardiac magnetic resonance imaging (LGE CMR) and their relation to left ventricular diastolic filling properties measured by tissue Doppler echocardiography (E/e') in patients with stable coronary artery disease (CAD). Methods and Results: We determined the PINP, PIIINP, gal-3, and ST2 serum levels and performed LGE CMR and echocardiography on 63 patients with stable CAD without a history of prior myocardial infarction. Myocardial late gadolinium enhancement T1 relaxation time was defined as a specific marker of myocardial fibrosis. ST2, PINP, and PIIINP did not have a significant correlation with the post-LGE T1 relaxation time tertiles (NS for all), but the lowest post-LGE T1 relaxation time tertile had significantly higher gal-3 values than the other two tertiles (p = 0.002 and 0.002) and higher E/é-values (p = 0.009) compared to the highest T1 relaxation time tertile. ST2 (p = 0.025 and 0.029), gal-3 (p = 0.003 and < 0.001) and PIIINP (p = 0.001 and 0.007) levels were also significantly higher in the highest E/é tertile, compared to the other two tertiles. Conclusions: Elevated serum levels of gal-3 reflect the degree of myocardial fibrosis assessed by LGE CMR. Gal-3, ST2, and PIIINP are also elevated in patients with impaired LV diastolic function, suggesting that these biomarkers are useful surrogates of structural and functional abnormality of the myocardium.
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Affiliation(s)
- E Samuli Lepojärvi
- Department of Internal Medicine, Medical Research Center Oulu, University of Oulu Oulu, Finland
| | - Olli-Pekka Piira
- Department of Internal Medicine, Medical Research Center Oulu, University of Oulu Oulu, Finland
| | - Eija Pääkkö
- Department of Radiology, Oulu University Hospital Oulu, Finland
| | | | - Juha Risteli
- Department of Clinical Chemistry, Institute of Diagnostics, University of Oulu Oulu, Finland
| | - Johanna A Miettinen
- Department of Internal Medicine, Medical Research Center Oulu, University of Oulu Oulu, Finland
| | - Juha S Perkiömäki
- Department of Internal Medicine, Medical Research Center Oulu, University of Oulu Oulu, Finland
| | - Heikki V Huikuri
- Department of Internal Medicine, Medical Research Center Oulu, University of Oulu Oulu, Finland
| | - M Juhani Junttila
- Department of Internal Medicine, Medical Research Center Oulu, University of Oulu Oulu, Finland
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Hannila I, Lammentausta E, Tervonen O, Nieminen MT. The repeatability of T2 relaxation time measurement of human knee articular cartilage. MAGMA 2015; 28:547-53. [PMID: 26162930 DOI: 10.1007/s10334-015-0494-3] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/17/2015] [Revised: 05/22/2015] [Accepted: 06/19/2015] [Indexed: 10/23/2022]
Abstract
OBJECTIVES To assess short- and long-term repeatability of T2 relaxation time measurements of the knee articular cartilage. MATERIALS AND METHODS The right knees of nine asymptomatic volunteers (age 30-38 years, five male, four female) were imaged at 1.5 T in three sessions 1 and 2 weeks apart. To observe short-term repeatability, the measurements were repeated three times within one of the three imaging sessions for each volunteer. T2 relaxation time was mapped using a multi-slice multi-echo spin echo sequence in axial and sagittal planes. Cartilage was manually segmented and repeatability, as measured by root-mean-square coefficient of variation (CVRMS) was evaluated both for the entire bulk cartilage of each joint surface in the slice and separately for each region of interest (ROI) at different topographical locations and separately for the superficial and deep half of each ROI. RESULTS For bulk T2, the long-term repeatability was 3.2, 5.4, and 3.7%, and the short-term reproducibility was 3.9, 3.9, and 3.4% for bulk femoral, tibial, and patellar cartilage, respectively. There were no significant differences between long-term and short-term repeatability in superficial or deep cartilage when comparing CVRMS values (p = 0.338 and 0.700, respectively). For individual ROIs, the repeatability varied between 2.5 and 22.2% depending on the topographical location. CONCLUSION The current results show mostly good repeatability. However, there were remarkable variations of T2 between bulk cartilage and different ROIs, bulk cartilage showing better repeatability. With careful patient positioning T2 can be accurately determined for different cartilage surfaces.
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Affiliation(s)
- Ilkka Hannila
- Department of Diagnostic Radiology, Oulu University Hospital (OYS), Kajaanintie, POB 50, 90029, Oulu, Finland. .,Medical Research Center Oulu, Oulu University Hospital and University of Oulu, Oulu, Finland.
| | - Eveliina Lammentausta
- Department of Diagnostic Radiology, Oulu University Hospital (OYS), Kajaanintie, POB 50, 90029, Oulu, Finland.,Medical Research Center Oulu, Oulu University Hospital and University of Oulu, Oulu, Finland
| | - Osmo Tervonen
- Department of Diagnostic Radiology, Oulu University Hospital (OYS), Kajaanintie, POB 50, 90029, Oulu, Finland.,Center for Medical Imaging, Physics and Technology, University of Oulu, Oulu, Finland.,Medical Research Center Oulu, Oulu University Hospital and University of Oulu, Oulu, Finland
| | - Miika Tapio Nieminen
- Department of Diagnostic Radiology, Oulu University Hospital (OYS), Kajaanintie, POB 50, 90029, Oulu, Finland.,Center for Medical Imaging, Physics and Technology, University of Oulu, Oulu, Finland.,Medical Research Center Oulu, Oulu University Hospital and University of Oulu, Oulu, Finland
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31
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Multanen J, Heinonen A, Häkkinen A, Kautiainen H, Kujala U, Lammentausta E, Jämsä T, Kiviranta I, Nieminen M. Bone and cartilage characteristics in postmenopausal women with mild knee radiographic osteoarthritis and those without radiographic osteoarthritis. J Musculoskelet Neuronal Interact 2015; 15:69-77. [PMID: 25730654 PMCID: PMC5123610] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
OBJECTIVES To evaluate the association between radiographically-assessed knee osteoarthritis and femoral neck bone characteristics in women with mild knee radiographic osteoarthritis and those without radiographic osteoarthritis. METHODS Ninety postmenopausal women (mean age [SD], 58 [4] years; height, 163 [6] cm; weight, 71 [11] kg) participated in this cross-sectional study. The severity of radiographic knee osteoarthritis was defined using Kellgren-Lawrence grades 0=normal (n=12), 1=doubtful (n=25) or 2=minimal (n=53). Femoral neck bone mineral content (BMC), section modulus (Z), and cross-sectional area (CSA) were measured with DXA. The biochemical composition of ipsilateral knee cartilage was estimated using quantitative MRI measures, T2 mapping and dGEMRIC. The associations between radiographic knee osteoarthritis grades and bone and cartilage characteristics were analyzed using generalized linear models. RESULTS Age-, height-, and weight-adjusted femoral neck BMC (p for linearity=0.019), Z (p for linearity=0.033), and CSA (p for linearity=0.019) increased significantly with higher knee osteoarthritis grades. There was no linear relationship between osteoarthritis grades and knee cartilage indices. CONCLUSIONS Increased DXA assessed hip bone strength is related to knee osteoarthritis severity. These results are hypothesis driven that there is an inverse relationship between osteoarthritis and osteoporosis. However, MRI assessed measures of cartilage do not discriminate mild radiographic osteoarthritis severity.
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Affiliation(s)
- J. Multanen
- Department of Physical Medicine and Rehabilitation, Central Finland Central Hospital, Jyväskylä, Finland,Department of Health Sciences, University of Jyväskylä, Jyväskylä, Finland,Corresponding author: J. Multanen, Department of Physical Medicine and Rehabilitation, Central Finland Central Hospital, Keskussairaalantie 19, 40620 Jyväskylä, Finland E-mail:
| | - A. Heinonen
- Department of Health Sciences, University of Jyväskylä, Jyväskylä, Finland
| | - A. Häkkinen
- Department of Physical Medicine and Rehabilitation, Central Finland Central Hospital, Jyväskylä, Finland,Department of Health Sciences, University of Jyväskylä, Jyväskylä, Finland
| | - H. Kautiainen
- Department of General Practice and Primary Health Care, University of Helsinki, Helsinki, Finland,Unit of Primary Health Care, Kuopio University Hospital, Kuopio, Finland
| | - U.M. Kujala
- Department of Health Sciences, University of Jyväskylä, Jyväskylä, Finland
| | - E. Lammentausta
- Department of Diagnostic Radiology, Oulu University Hospital, Oulu, Finland
| | - T. Jämsä
- Department of Diagnostic Radiology, Oulu University Hospital, Oulu, Finland,Department of Medical Technology, Institute of Biomedicine, University of Oulu, Oulu, Finland,Medical Research Center Oulu, Oulu University Hospital and University of Oulu, Oulu, Finland
| | - I. Kiviranta
- Department of Orthopaedics and Traumatology, University of Helsinki, and Helsinki University Hospital, Helsinki, Finland
| | - M.T. Nieminen
- Department of Diagnostic Radiology, Oulu University Hospital, Oulu, Finland,Department of Radiology, University of Oulu, Oulu, Finland
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Rosenholm JM, Korpi RM, Lammentausta E, Lehtonen S, Lehenkari P, Niemi R, Xiao W, Zhang J, Lindberg D, Gu H, Sahlgren C, Blanco Sequeiros R. Novel, fast-processed crystalline and amorphous manganese oxide nanoparticles for stem cell labeling. Inorg Chem Front 2015. [DOI: 10.1039/c5qi00033e] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
MnO(x) nanostructures were developed to be utilized as contrast agents for cellular labeling and tracking by MR-imaging.
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Munukka M, Waller B, Multanen J, Rantalainen T, Häkkinen A, Nieminen MT, Lammentausta E, Kujala UM, Paloneva J, Kautiainen H, Kiviranta I, Heinonen A. Relationship between lower limb neuromuscular performance and bone strength in postmenopausal women with mild knee osteoarthritis. J Musculoskelet Neuronal Interact 2014; 14:418-424. [PMID: 25524967] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
Abstract
OBJECTIVES To investigate whether neuromuscular performance predicts lower limb bone strength in different lower limb sites in postmenopausal women with mild knee osteoarthritis (OA). METHODS Neuromuscular performance of 139 volunteer women aged 50-68 with mild knee OA was measured using maximal counter movement jump test, isometric knee flexion and extension force and figure-of-eight-running test. Femoral neck section modulus (Z, mm(3)) was determined by data obtained from dual-energy X-ray absorptiometry. Data obtained using peripheral quantitative computed tomography was used to asses distal tibia compressive (BSId, g(2)/cm(4)) and tibial mid-shaft bending (SSImax(mid), mm(3)) strength indices. RESULTS After adjustment for height, weight and age, counter movement jump peak power production was the strongest independent predictor for Z (β=0.44; p<0.001) and for BSId (β=0.32; p=0.003). This was also true in concentric net impulse for Z (β=0.37; p=0.001) and for BSId (β=0.40; p<0.001). Additionally, knee extension force (β=0.30; p<0.001) and figure-of-eight-running test (β= -0.32; p<0.001) were among strongest independent predictors for BSId after adjustments. For SSImax(mid), concentric net impulse (β=0.33; p=0.002) remained as the strongest independent predictor after adjustments. CONCLUSIONS Neuromuscular performance in postmenopausal women with mild knee OA predicted lower limb bone strength in every measured skeletal site.
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Affiliation(s)
- M Munukka
- Department of Health Sciences, University of Jyväskylä, Jyväskylä, Finland
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Bengtsson Moström E, Lammentausta E, Finnbogason T, Weidenhielm L, Janarv PM, Tiderius CJ. Pre- and postcontrast T1 and T2 mapping of patellar cartilage in young adults with recurrent patellar dislocation. Magn Reson Med 2014; 74:1363-9. [PMID: 25421491 DOI: 10.1002/mrm.25511] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2014] [Revised: 10/11/2014] [Accepted: 10/13/2014] [Indexed: 02/05/2023]
Abstract
PURPOSE To examine the cartilage quality in young adults with recurrent patellar dislocation in childhood using different magnetic resonance imaging parameters. METHODS Sixteen young adults with unilateral recurrent patellar dislocation were investigated ≥5 y (mean, 8.5 y) after the first dislocation. Pre- and postcontrast T1 and precontrast T2 relaxation times were analyzed in four superficial and four deep patellar cartilage regions of both knees. Two hours after intravenous injection of 0.2 mM/kg Gd-DTPA(2-), postcontrast T1 [T1(Gd)] and ΔR1 [1/T1 (precontrast) - 1/T1 (postcontrast)] were analyzed in the regions. Muscle performance and patient-reported outcome were evaluated. RESULTS When comparing the injured side with the noninjured side, differences were seen in the superficial half but not the deep half of the cartilage. T1(Gd) was shorter in the central part, whereas T2 was shorter in the periphery of the patellar cartilage (P < 0.05). ΔR1 demonstrated similar differences between healthy and diseased cartilage as T1(Gd) alone. The knee function was not correlated to the degenerative changes. CONCLUSION The short T1(Gd) centrally indicates degenerative cartilage changes consistent with loss of glycosaminoglycans. Precontrast and ΔR1 calculations may be excluded in clinical dGEMRIC, which simplifies the procedure. A decrease in T2 may be a very early sign of joint pathology but warrants further investigation.
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Affiliation(s)
| | - Eveliina Lammentausta
- Department of Diagnostic Radiology, Oulu University Hospital, Oulu, Finland.,Medical Research Center Oulu, Oulu University Hospital and University of Oulu, Oulu, Finland
| | - Thröstur Finnbogason
- Department of Paediatric Radiology, Karolinska University Hospital, Stockholm, Sweden
| | - Lars Weidenhielm
- Stockholm Sports Trauma Research Center, Department of Molecular Medicine and Surgery, Karolinska Institutet, Stockholm, Sweden
| | - Per-Mats Janarv
- Department of Womens and Childrens Health, Karolinska Institutet, Stockholm, Sweden
| | - Carl Johan Tiderius
- Department of Orthopaedics, Skane University Hospital, Lund University, Lund, Sweden
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Rahtu-Korpela L, Karsikas S, Hörkkö S, Blanco Sequeiros R, Lammentausta E, Mäkelä KA, Herzig KH, Walkinshaw G, Kivirikko KI, Myllyharju J, Serpi R, Koivunen P. HIF prolyl 4-hydroxylase-2 inhibition improves glucose and lipid metabolism and protects against obesity and metabolic dysfunction. Diabetes 2014; 63:3324-33. [PMID: 24789921 DOI: 10.2337/db14-0472] [Citation(s) in RCA: 79] [Impact Index Per Article: 7.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
Obesity is a major public health problem, predisposing subjects to metabolic syndrome, type 2 diabetes, and cardiovascular diseases. Specific prolyl 4-hydroxylases (P4Hs) regulate the stability of the hypoxia-inducible factor (HIF), a potent governor of metabolism, with isoenzyme 2 being the main regulator. We investigated whether HIF-P4H-2 inhibition could be used to treat obesity and its consequences. Hif-p4h-2-deficient mice, whether fed normal chow or a high-fat diet, had less adipose tissue, smaller adipocytes, and less adipose tissue inflammation than their littermates. They also had improved glucose tolerance and insulin sensitivity. Furthermore, the mRNA levels of the HIF-1 targets glucose transporters, glycolytic enzymes, and pyruvate dehydrogenase kinase-1 were increased in their tissues, whereas acetyl-CoA concentration was decreased. The hepatic mRNA level of the HIF-2 target insulin receptor substrate-2 was higher, whereas that of two key enzymes of fatty acid synthesis was lower. Serum cholesterol levels and de novo lipid synthesis were decreased, and the mice were protected against hepatic steatosis. Oral administration of an HIF-P4H inhibitor, FG-4497, to wild-type mice with metabolic dysfunction phenocopied these beneficial effects. HIF-P4H-2 inhibition may be a novel therapy that not only protects against the development of obesity and its consequences but also reverses these conditions.
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Affiliation(s)
- Lea Rahtu-Korpela
- Biocenter Oulu, Faculty of Biochemistry and Molecular Medicine, Oulu Center for Cell-Matrix Research, University of Oulu, FIN-90014 Oulu, Finland
| | - Sara Karsikas
- Biocenter Oulu, Faculty of Biochemistry and Molecular Medicine, Oulu Center for Cell-Matrix Research, University of Oulu, FIN-90014 Oulu, Finland
| | - Sohvi Hörkkö
- Nordlab Oulu, Oulu University Hospital, FIN-90220 Oulu, Finland Department of Medical Microbiology and Immunology, Medical Research Center, University of Oulu, FIN-90014 Oulu, Finland
| | - Roberto Blanco Sequeiros
- Department of Radiology, Oulu University Hospital and University of Oulu, FIN-90029 Oulu, Finland
| | - Eveliina Lammentausta
- Department of Radiology, Oulu University Hospital and University of Oulu, FIN-90029 Oulu, Finland
| | - Kari A Mäkelä
- Biocenter Oulu, Department of Physiology, University of Oulu, FIN-90014 Oulu, Finland
| | - Karl-Heinz Herzig
- Biocenter Oulu, Department of Physiology, University of Oulu, FIN-90014 Oulu, Finland
| | | | - Kari I Kivirikko
- Biocenter Oulu, Faculty of Biochemistry and Molecular Medicine, Oulu Center for Cell-Matrix Research, University of Oulu, FIN-90014 Oulu, Finland
| | - Johanna Myllyharju
- Biocenter Oulu, Faculty of Biochemistry and Molecular Medicine, Oulu Center for Cell-Matrix Research, University of Oulu, FIN-90014 Oulu, Finland
| | - Raisa Serpi
- Biocenter Oulu, Faculty of Biochemistry and Molecular Medicine, Oulu Center for Cell-Matrix Research, University of Oulu, FIN-90014 Oulu, Finland
| | - Peppi Koivunen
- Biocenter Oulu, Faculty of Biochemistry and Molecular Medicine, Oulu Center for Cell-Matrix Research, University of Oulu, FIN-90014 Oulu, Finland
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Sigurdsson U, Siversson C, Lammentausta E, Svensson J, Tiderius CJ, Dahlberg LE. In vivo transport of Gd-DTPA2- into human meniscus and cartilage assessed with delayed gadolinium-enhanced MRI of cartilage (dGEMRIC). BMC Musculoskelet Disord 2014; 15:226. [PMID: 25005036 PMCID: PMC4125346 DOI: 10.1186/1471-2474-15-226] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/11/2013] [Accepted: 07/01/2014] [Indexed: 11/11/2022] Open
Abstract
Background Impaired stability is a risk factor in knee osteoarthritis (OA), where the whole joint and not only the joint cartilage is affected. The meniscus provides joint stability and is involved in the early pathological progress of OA. Delayed gadolinium-enhanced MRI of cartilage (dGEMRIC) has been used to identify pre-radiographic changes in the cartilage in OA, but has been used less commonly to examine the meniscus, and then using only a double dose of the contrast agent. The purpose of this study was to enable improved early OA diagnosis by investigate the temporal contrast agent distribution in the meniscus and femoral cartilage simultaneously, in healthy volunteers, using 3D dGEMRIC at two different doses of the contrast agent Gd-DTPA2-. Methods The right knee in 12 asymptomatic volunteers was examined using a 3D Look-Locker sequence on two occasions after an intravenous injection of a double or triple dose of Gd-DTPA2- (0.2 or 0.3 mmol/kg body weight). The relaxation time (T1) and relaxation rate (R1 = 1/T1) were measured in the meniscus and femoral cartilage before, and 60, 90, 120 and 180 minutes after injection, and the change in relaxation rate (ΔR1) was calculated. Paired t-test and Analysis of Variance (ANOVA) were used for statistical evaluation. Results The triple dose yielded higher concentrations of Gd-DTPA2- in the meniscus and cartilage than the double dose, but provided no additional information. The observed patterns of ΔR1 were similar for double and triple doses of the contrast agent. ΔR1 was higher in the meniscus than in femoral cartilage in the corresponding compartments at all time points after injection. ΔR1 increased until 90-180 minutes in both the cartilage and the meniscus (p < 0.05), and was lower in the medial than in the lateral meniscus at all time points (p < 0.05). A faster increase in ΔR1 was observed in the vascularized peripheral region of the posterior medial meniscus, than in the avascular central part of the posterior medial meniscus during the first 60 minutes (p < 0.05). Conclusion It is feasible to examine undamaged meniscus and cartilage simultaneously using dGEMRIC, preferably 90 minutes after the injection of a double dose of Gd-DTPA2- (0.2 mmol/kg body weight).
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Affiliation(s)
- Ulf Sigurdsson
- Department of Orthopaedics, Lund University, Skåne University Hospital, SE-205 02 Malmö, Sweden.
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Multanen J, Nieminen MT, Häkkinen A, Kujala UM, Jämsä T, Kautiainen H, Lammentausta E, Ahola R, Selänne H, Ojala R, Kiviranta I, Heinonen A. Effects of high-impact training on bone and articular cartilage: 12-month randomized controlled quantitative MRI study. J Bone Miner Res 2014; 29:192-201. [PMID: 23775755 DOI: 10.1002/jbmr.2015] [Citation(s) in RCA: 47] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/15/2013] [Revised: 05/17/2013] [Accepted: 06/03/2013] [Indexed: 01/03/2023]
Abstract
Osteoarthritis and osteoporosis often coexist in postmenopausal women. The simultaneous effect of bone-favorable high-impact training on these diseases is not well understood and is a topic of controversy. We evaluated the effects of high-impact exercise on bone mineral content (BMC) and the estimated biochemical composition of knee cartilage in postmenopausal women with mild knee osteoarthritis. Eighty women aged 50 to 66 years with mild knee osteoarthritis were randomly assigned to undergo supervised progressive exercise three times a week for 12 months (n = 40) or to a nonintervention control group (n = 40). BMC of the femoral neck, trochanter, and lumbar spine was measured by dual-energy X-ray absorptiometry (DXA). The biochemical composition of cartilage was estimated using delayed gadolinium-enhanced magnetic resonance imaging (MRI) cartilage (dGEMRIC), sensitive to cartilage glycosaminoglycan content, and transverse relaxation time (T2) mapping that is sensitive to the properties of the collagen network. In addition, we evaluated clinically important symptoms and physical performance-related risk factors of falling: cardiorespiratory fitness, dynamic balance, maximal isometric knee extension and flexion forces, and leg power. Thirty-six trainees and 40 controls completed the study. The mean gain in femoral neck BMC in the exercise group was 0.6% (95% CI, -0.2% to 1.4%) and the mean loss in the control group was -1.2% (95% CI, -2.1% to -0.4%). The change in baseline, body mass, and adjusted body mass change in BMC between the groups was significant (p = 0.005), whereas no changes occurred in the biochemical composition of the cartilage, as investigated by MRI. Balance, muscle force, and cardiorespiratory fitness improved significantly more (3% to 11%) in the exercise group than in the control group. Progressively implemented high-impact training, which increased bone mass, did not affect the biochemical composition of cartilage and may be feasible in the prevention of osteoporosis and physical performance-related risk factors of falling in postmenopausal women.
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Affiliation(s)
- Juhani Multanen
- Department of Health Sciences, University of Jyväskylä, Jyväskylä, Finland
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Toljamo PS, Pulkkinen P, Lammentausta E, Tervonen O, Jämsä T, Nieminen MT. Bone mineral density and geometry parameters determined in vitro from dual-energy digital radiography images in the assessment of bone maximal load of reindeer femora. Acta Radiol 2013; 54:961-5. [PMID: 23761551 DOI: 10.1177/0284185113486372] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND Dual-energy digital radiography (DEDR) has been shown to be a potential method to determine bone mineral density (BMD) and predict maximal load with similar accuracy as standard bone densitometry using DXA (dual-energy X-ray absorptiometry). In addition to bone density, bone geometry has also been shown to have effect on bone fragility and fracture risk. PURPOSE To examine the combination of BMD and geometry parameters, as determined from a DEDR experiment, to predict bone maximal load. MATERIAL AND METHODS Reindeer femora (n = 47) were imaged at two energies (79 kVp and 100 kVp) using a clinical digital radiography system. BMD was determined in four regions from these images using the DXA calculation principle. Various geometrical parameters were determined from the 79 kVp image. Femora were mechanically tested using axial loading configuration. Pearson correlation coefficients were determined between geometrical parameters and BMDs or maximal load. Multiple stepwise linear regression analysis was used to find the best combination to predict bone maximal load. RESULTS From the geometrical parameters, femoral shaft diameter (FSD) and femoral neck axis length (FNAL) correlated best with the maximal load (r = 0.629 and r = 0.446, P < 0.01, respectively). The best combination of parameters to predict bone fragility was BMD at Ward's triangle, FSD and FNAL (r = 0.787, P < 0.05), whereas the correlation coefficient between BMD at Ward's triangle and maximal load was 0.653 (P < 0.05). CONCLUSION The combination of DEDR-based BMD and geometrical parameters predicts reindeer bone maximal load with reasonable accuracy and the combined analysis improves the prediction of maximal load compared to BMD prediction only.
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Affiliation(s)
| | - Pasi Pulkkinen
- Department of Medical Technology, University of Oulu, Oulu
| | | | - Osmo Tervonen
- Department of Diagnostic Radiology, Oulu University Hospital, Oulu
- Department of Radiology, University of Oulu, Oulu, Finland
| | - Timo Jämsä
- Department of Medical Technology, University of Oulu, Oulu
- Department of Diagnostic Radiology, Oulu University Hospital, Oulu
| | - Miika T Nieminen
- Department of Diagnostic Radiology, Oulu University Hospital, Oulu
- Department of Radiology, University of Oulu, Oulu, Finland
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Carstens A, Kirberger RM, Velleman M, Dahlberg LE, Fletcher L, Lammentausta E. FEASIBILITY FOR MAPPING CARTILAGE T1 RELAXATION TIMES IN THE DISTAL METACARPUS3/METATARSUS3 OF THOROUGHBRED RACEHORSES USING DELAYED GADOLINIUM-ENHANCED MAGNETIC RESONANCE IMAGING OF CARTILAGE (d
GEMRIC): NORMAL CADAVER STUDY. Vet Radiol Ultrasound 2013; 54:365-372. [DOI: 10.1111/vru.12030] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2012] [Accepted: 02/08/2013] [Indexed: 11/27/2022] Open
Affiliation(s)
- Ann Carstens
- Section Diagnostic Imaging; Department of Companion Animal Clinical Studies; Faculty of Veterinary Science; University of Pretoria; Private Bag X04 Onderstepoort 0110 Pretoria South Africa
| | - Robert M. Kirberger
- Section Diagnostic Imaging; Department of Companion Animal Clinical Studies; Faculty of Veterinary Science; University of Pretoria; Private Bag X04 Onderstepoort 0110 Pretoria South Africa
| | - Mark Velleman
- Little Company of Mary Hospital; George Storrar Ave Pretoria South Africa
| | - Leif E. Dahlberg
- Joint and Soft Tissue Unit; Department of Clinical Sciences; Malmö; Lund University, Department of Orthopaedics, Malmö University Hospital; SE-205 02 Malmö Sweden
| | - Lizelle Fletcher
- Department of Statistics; University of Pretoria; Pretoria South Africa
| | - Eveliina Lammentausta
- Joint and Soft Tissue Unit; Department of Clinical Sciences; Malmö; Lund University, Department of Orthopaedics, Malmö University Hospital; SE-205 02 Malmö Sweden
- Department of Diagnostic Radiology; Oulu University Hospital; POB 50 FI-90029 OYS Oulu Finland
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Hirvasniemi J, Kulmala KAM, Lammentausta E, Ojala R, Lehenkari P, Kamel A, Jurvelin JS, Töyräs J, Nieminen MT, Saarakkala S. In vivo comparison of delayed gadolinium-enhanced MRI of cartilage and delayed quantitative CT arthrography in imaging of articular cartilage. Osteoarthritis Cartilage 2013; 21:434-42. [PMID: 23274105 DOI: 10.1016/j.joca.2012.12.009] [Citation(s) in RCA: 33] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/02/2012] [Revised: 10/23/2012] [Accepted: 12/16/2012] [Indexed: 02/02/2023]
Abstract
OBJECTIVE To compare delayed gadolinium-enhanced magnetic resonance imaging (MRI) of cartilage (dGEMRIC) and delayed quantitative computed tomography (CT) arthrography (dQCTA) to each other, and their association to arthroscopy. Additionally, the relationship between dGEMRIC with intravenous (dGEMRIC(IV)) and intra-articular contrast agent administration (dGEMRIC(IA)) was determined. DESIGN Eleven patients with knee pain were scanned at 3 T MRI and 64-slice CT before arthroscopy. dQCTA was performed at 5 and 45 min after intra-articular injection of ioxaglate. Both dGEMRIC(IV) and dGEMRIC(IA) were performed at 90 min after gadopentetate injection. dGEMRIC indices and change in relaxation rates (ΔR(1)) were separately calculated for dGEMRIC(IV) and dGEMRIC(IA). dGEMRIC and dQCTA parameters were calculated for predetermined sites at the knee joint that were International Cartilage Repair Society (ICRS) graded in arthroscopy. RESULTS dQCTA normalized with the contrast agent concentration in synovial fluid (SF) and dGEMRIC(IV) correlated significantly, whereas dGEMRIC(IA) correlated with the normalized dQCTA only when dGEMRIC(IA) was also normalized with the contrast agent concentration in SF. Correlation was strongest between normalized dQCTA at 45 min and ΔR(1,IV) (r(s) = 0.72 [95% CI 0.56-0.83], n = 49, P < 0.01) and ΔR(1,IA) normalized with ΔR(1) in SF (r(s) = 0.70 [0.53-0.82], n = 52, P < 0.01). Neither dGEMRIC nor dQCTA correlated with arthroscopic grading. dGEMRIC(IV) and non-normalized dGEMRIC(IA) were not related while ΔR(1,IV) correlated with normalized ΔR(1,IA) (r(s) = 0.52 [0.28-0.70], n = 50, P < 0.01). CONCLUSIONS This study suggests that dQCTA is in best agreement with dGEMRIC(IV) at 45 min after CT contrast agent injection. dQCTA and dGEMRIC were not related to arthroscopy, probably because the remaining cartilage is analysed in dGEMRIC and dQCTA, whereas in arthroscopy the absence of cartilage defines the grading. The findings indicate the importance to take into account the contrast agent concentration in SF in dQCTA and dGEMRIC(IA).
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Affiliation(s)
- J Hirvasniemi
- Department of Medical Technology, University of Oulu, Oulu, Finland.
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Räsänen LP, Mononen ME, Nieminen MT, Lammentausta E, Jurvelin JS, Korhonen RK. Implementation of subject-specific collagen architecture of cartilage into a 2D computational model of a knee joint--data from the Osteoarthritis Initiative (OAI). J Orthop Res 2013; 31:10-22. [PMID: 22767415 DOI: 10.1002/jor.22175] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/16/2011] [Accepted: 05/27/2012] [Indexed: 02/04/2023]
Abstract
A subject-specific collagen architecture of cartilage, obtained from T(2) mapping of 3.0 T magnetic resonance imaging (MRI; data from the Osteoarthritis Initiative), was implemented into a 2D finite element model of a knee joint with fibril-reinforced poroviscoelastic cartilage properties. For comparison, we created two models with alternative collagen architectures, addressing the potential inaccuracies caused by the nonoptimal estimation of the collagen architecture from MRI. Also two models with constant depth-dependent zone thicknesses obtained from literature were created. The mechanical behavior of the models were analyzed and compared under axial impact loading of 846N. Compared to the model with patient-specific collagen architecture, the cartilage model without tangentially oriented collagen fibrils in the superficial zone showed up to 69% decrease in maximum principal stress and fibril strain and 35% and 13% increase in maximum principal strain and pore pressure, respectively, in the superficial layers of the cartilage. The model with increased thickness for the superficial and middle zones, as obtained from the literature, demonstrated at most 73% increase in stress, 143% increase in fibril strain, and 26% and 23% decrease in strain and pore pressure, respectively, in the intermediate cartilage. The present results demonstrate that the computational model of a knee joint with the collagen architecture of cartilage estimated from patient-specific MRI or literature lead to different stress and strain distributions. The findings also suggest that minor errors in the analysis of collagen architecture from MRI, for example due to the analysis method or MRI resolution, can lead to alterations in knee joint stresses and strains.
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Affiliation(s)
- Lasse P Räsänen
- Department of Applied Physics, University of Eastern Finland, POB 1627, FI-70210 Kuopio, Finland.
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Carstens A, Kirberger RM, Dahlberg LE, Prozesky L, Fletcher L, Lammentausta E. VALIDATION OF DELAYED GADOLINIUM-ENHANCED MAGNETIC RESONANCE IMAGING OF CARTILAGE AND T2 MAPPING FOR QUANTIFYING DISTAL METACARPUS/METATARSUS CARTILAGE THICKNESS IN THOROUGHBRED RACEHORSES. Vet Radiol Ultrasound 2012; 54:139-48. [DOI: 10.1111/vru.12002] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2012] [Accepted: 09/26/2012] [Indexed: 01/03/2023] Open
Affiliation(s)
- Ann Carstens
- Section of Diagnostic Imaging; Department of Companion Animal Clinical Studies; University of Pretoria; South Africa
| | - Robert M. Kirberger
- Section of Diagnostic Imaging; Department of Companion Animal Clinical Studies; University of Pretoria; South Africa
| | | | - Leon Prozesky
- Department of Pathology; University of Pretoria; South Africa
| | - Lizelle Fletcher
- Faculty of Veterinary Science, and the Department of Statistics; University of Pretoria; South Africa
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Abstract
OBJECTIVE We investigated the feasibility of delayed computed tomography (CT) arthrography for evaluation of human knee cartilage in vivo. Especially, the diffusion of contrast agent out of the joint space and the optimal time points for imaging were determined. DESIGN Two patients were imaged using delayed CT arthrography and delayed gadolinium-enhanced magnetic resonance imaging of cartilage (dGEMRIC) techniques. RESULTS Two hours after injection, the concentration of contrast agent in the joint space was still high enough (20% to 24.5% of the initial concentration at 0 minutes) to allow delayed CT arthrography. The half-life of the contrast agent in the joint space varied from 30 to 60 minutes. The contrast agent concentration in patellar and femoral cartilage reached the maximum after 30 and 60 minutes, respectively. According to dGEMRIC, there were no differences between patients. However, in delayed CT arthrography, the penetration of the contrast agent was higher in the osteoarthritic knee cartilage. CONCLUSIONS Contrast agent remained in the joint space long enough to enable delayed CT arthrography of cartilage. After 30 minutes, the normalized contrast agent concentration was higher in the cartilage of the osteoarthritic knee in comparison with the healthy knee. To conclude, delayed CT arthrography exhibited potential for use in the clinical evaluation of cartilage integrity.
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Affiliation(s)
- Harri T. Kokkonen
- Department of Applied Physics, University of Eastern Finland, Kuopio, Finland,Department of Clinical Neurophysiology, Kuopio University Hospital, Kuopio, Finland
| | - Antti S. Aula
- Department of Medical Physics, Imaging Centre, Tampere University Hospital, Tampere, Finland
| | - Heikki Kröger
- Department of Orthopaedics, Traumatology and Hand Surgery, Kuopio University Hospital, Kuopio, Finland
| | | | | | - Esa Mervaala
- Department of Clinical Neurophysiology, Kuopio University Hospital, Kuopio, Finland,Institute of Clinical Medicine, Clinical Neurophysiology, University of Eastern Finland, 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,Department of Clinical Neurophysiology, Kuopio University Hospital, Kuopio, Finland
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Stubendorff JJ, Lammentausta E, Struglics A, Lindberg L, Heinegård D, Dahlberg LE. Is cartilage sGAG content related to early changes in cartilage disease? Implications for interpretation of dGEMRIC. Osteoarthritis Cartilage 2012; 20:396-404. [PMID: 22334095 DOI: 10.1016/j.joca.2012.01.015] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/07/2011] [Revised: 01/06/2012] [Accepted: 01/17/2012] [Indexed: 02/02/2023]
Abstract
OBJECTIVE This study investigates sulphated glycosaminoglycans (sGAG) content changes in early osteoarthritis (OA), and whether contrast-enhanced magnetic resonance imaging (MRI) of cartilage in vitro may identify early event of OA pathology. METHOD Osteochondral plugs from patients with hip OA or femoral neck fracture (reference group) were collected and analysed by 1.5 T MRI with ΔR1 as a measure of cartilage contrast concentration. Cartilage hydration, contents of sGAG, cartilage oligomeric matrix protein (COMP), hydroxyproline, denatured collagen, and aggrecan TEGE(392) neoepitope were determined and histological grading was performed. RESULTS sGAG content correlated to ΔR1, although no difference in either of these parameters was detectable between OA and reference cartilage at 4 h of contrast equilibration. In contrast, biochemical analysis of other cartilage matrix constituents showed distinct alterations typical for early cartilage degradation in OA cartilage and with clear evidence for increased aggrecan turnover. CONCLUSION In the present in vitro study, cartilage sGAG content could not distinguish between early OA cartilage and reference cartilage. Given, that delayed gadolinium enhanced MRI of cartilage (dGEMRIC) indicates early events in the pathogenesis of OA in vivo, our results from the in vitro studies imply other, additional factors than cartilage sGAG content, e.g., alterations in diffusion or increased supply of contrast agent in the diseased joint. Alternatively, an altered dGEMRIC reflects later stages of OA, when sGAG content decreases. Further investigations are warranted, to understand variations in sGAG content in pathology, an essential background for interpreting dGEMRIC measurements.
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Affiliation(s)
- J J Stubendorff
- Joint and Soft Tissue Unit, Department of Clinical Sciences Malmö, Lund University, Department of Orthopaedics, Skåne University Hospital, Malmö, SE-20502 Malmö, Sweden.
| | - E Lammentausta
- Joint and Soft Tissue Unit, Department of Clinical Sciences Malmö, Lund University, Department of Orthopaedics, Skåne University Hospital, Malmö, SE-20502 Malmö, Sweden; Department of Diagnostic Radiology, Oulu University Hospital, POB 50, FI-90029 OYS, Oulu, Finland
| | - A Struglics
- Department of Orthopaedics, Clinical Sciences Lund, Lund University, Lund 221 84, Sweden
| | - L Lindberg
- Joint and Soft Tissue Unit, Department of Clinical Sciences Malmö, Lund University, Department of Orthopaedics, Skåne University Hospital, Malmö, SE-20502 Malmö, Sweden
| | - D Heinegård
- Department of Clinical Sciences Lund, BMC C12 Lund University, SE-22184 Lund, Sweden
| | - L E Dahlberg
- Joint and Soft Tissue Unit, Department of Clinical Sciences Malmö, Lund University, Department of Orthopaedics, Skåne University Hospital, Malmö, SE-20502 Malmö, Sweden
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Toljamo PS, Lammentausta E, Pulkkinen P, Tervonen O, Jämsä T, Nieminen MT. Dual-energy digital radiography in the assessment of bone mechanical properties. Physiol Meas 2011; 33:29-37. [DOI: 10.1088/0967-3334/33/1/29] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
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Hawezi ZK, Lammentausta E, Svensson J, Dahlberg LE, Tiderius CJ. In vivo transport of Gd-DTPA(2-) in human knee cartilage assessed by depth-wise dGEMRIC analysis. J Magn Reson Imaging 2011; 34:1352-8. [PMID: 21954084 DOI: 10.1002/jmri.22750] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022] Open
Abstract
PURPOSE To investigate the transport of Gd-DTPA(2-) in different layers of femoral knee cartilage in vivo. MATERIALS AND METHODS T(1) measurements (1.5 Tesla) were performed in femoral knee cartilage of 23 healthy volunteers. The weight-bearing central cartilage was analyzed before contrast and at eight time points after an intravenous injection of Gd-DTPA(2-) : 12-60 min (4 volunteers) and 1-4 h (19 volunteers). Three regions of interest were segmented manually: deep, middle, and superficial. RESULTS Before contrast injection, a depth-wise variation of T(1) was observed with 50% higher values in the superficial region compared with the deep region. In the deep region, the uptake of Gd-DTPA(2-) was not detected until 36 min and the concentration increased until 240 min, whereas in the superficial region, the uptake was seen already at 12 min and the concentration decreased after 180 min (P < 0.01). There was a difference between medial and lateral compartment regarding bulk, but not superficial Gd-DTPA(2-) concentration. The bulk gadolinium concentration was negatively related to the cartilage thickness (r = -0.68; P < 0.01). CONCLUSION The depth-wise and thickness dependent variations in Gd-DTPA(2) transport influence the interpretation of bulk dGEMRIC analysis in vivo. In thick cartilage, incomplete penetration of Gd-DTPA(2) will yield a falsely too long T(1) .
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Affiliation(s)
- Zana K Hawezi
- Joint and Soft Tissue Unit, Department of Clinical Sciences, Lund University, Malmö, Sweden
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Prantner V, Isaksson H, Närväinen J, Lammentausta E, Nissi MJ, Avela J, Gröhn OHJ, Jurvelin JS. NMR relaxation times of trabecular bone—reproducibility, relationships to tissue structure and effects of sample freezing. Phys Med Biol 2010; 55:7363-75. [DOI: 10.1088/0031-9155/55/23/012] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
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Tahvanainen PS, Lammentausta E, Pulkkinen P, Tervonen O, Jämsä T, Nieminen MT. Dual-energy digital radiography for the assessment of bone mineral density. Acta Radiol 2010; 51:543-8. [PMID: 20429753 DOI: 10.3109/02841851003698222] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
BACKGROUND Bone mineral density (BMD) is usually determined by dual-energy X-ray absorptiometry (DXA). Digital radiography (DR) has enabled the application of dual-energy techniques for separating bone and soft tissue, but it is not clear yet whether BMD information can reliably be obtained using DR. PURPOSE To determine the ability of dual-energy digital radiography (DEDR) to predict BMD as determined by DXA. MATERIAL AND METHODS Reindeer femora (n=15) were imaged in a water bath at a typical clinical imaging voltage of 79 kVp and additionally at 100 kVp on a DR system. BMD was determined in four segmented regions (femoral neck, trochanter, inter-trochanter, Ward's triangle) from these images using the DXA calculation principle. BMD results as determined by DEDR were compared with BMD values as determined by DXA. RESULTS Significant moderate to high linear correlations (0.66-0.76) were observed at the femoral neck, Ward's triangle, and trochanter between BMD values as determined by the two techniques. The coefficient of variation (CV(RMS)) ranged between 2.2 and 4.7% and 0.2 and 1.8% for DEDR and DXA analyses, respectively. CONCLUSION DXA-based BMD information can be obtained with moderate precision and accuracy using DEDR. In future, combining BMD measurements using DEDR with structural and geometrical information available on digital radiographs could enable a more comprehensive assessment of bone.
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Affiliation(s)
- Päivi S. Tahvanainen
- Department of Diagnostic Radiology, Oulu University Hospital, University of Oulu, Oulu, Finland
- Department of Medical Technology, University of Oulu, Oulu, Finland
| | - Eveliina Lammentausta
- Department of Diagnostic Radiology, Oulu University Hospital, University of Oulu, Oulu, Finland
| | - Pasi Pulkkinen
- Department of Medical Technology, University of Oulu, Oulu, Finland
| | - Osmo Tervonen
- Department of Diagnostic Radiology, Oulu University Hospital, University of Oulu, Oulu, Finland
- Department of Radiology, University of Oulu, Oulu, Finland
| | - Timo Jämsä
- Department of Diagnostic Radiology, Oulu University Hospital, University of Oulu, Oulu, Finland
- Department of Medical Technology, University of Oulu, Oulu, Finland
| | - Miika T. Nieminen
- Department of Diagnostic Radiology, Oulu University Hospital, University of Oulu, Oulu, Finland
- Department of Medical Technology, University of Oulu, Oulu, Finland
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Kiviranta P, Lammentausta E, Töyräs J, Nieminen HJ, Julkunen P, Kiviranta I, Jurvelin JS. Differences in acoustic properties of intact and degenerated human patellar cartilage during compression. Ultrasound Med Biol 2009; 35:1367-1375. [PMID: 19540653 DOI: 10.1016/j.ultrasmedbio.2009.03.003] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/03/2008] [Revised: 02/21/2009] [Accepted: 03/04/2009] [Indexed: 05/27/2023]
Abstract
Ultrasound indentation measurements have been shown to provide means to assess cartilage integrity and mechanical properties. To determine cartilage stiffness in the ultrasound indentation geometry, cartilage is compressed with an ultrasound transducer to determine the induced strain from the ultrasound signal using the time-of-flight principle. As the ultrasound speed in cartilage has been shown to vary during compression, the assumption of constant speed generates significant errors in the values of mechanical parameters. This variation in ultrasound speed has been investigated in intact cartilage, however, its existence and significance in degenerated tissue is unknown. In the present study, we investigate this issue with both intact and spontaneously degenerated human tissue. To accomplish this aim, we determined ultrasound speed and attenuation in human patellar cartilage (n=68) during mechanical loading. For reference, cartilage mechanical properties and proteoglycan, collagen and water contents were determined. The acoustic properties were related to the composition and mechanical properties of the samples. Ultrasound speed showed significant, site-dependent variation and it was significantly associated (r=0.79-0.81, p<0.01) with the mechanical properties of cartilage. The compression related decrease in ultrasound speed showed statistically significant variation between different stages of degeneration. Error simulations revealed that changes in ultrasound speed during 2% compression could generate errors up to 15% in the values of elastic moduli of samples with early degeneration, if determined with the ultrasound indentation technique. In samples with advanced degeneration, the error was significantly (p<0.05) smaller being 2% on average. As the compression related variation in ultrasound speed was lower in more degenerated samples, the mechanical parameters could be diagnosed more reliably in tissue showing advanced degeneration. The present results address the need to consider possible uncertainties in mechano-acoustic measurements of articular cartilage and call for methods to correct the effect of variable sound speed during compression.
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Affiliation(s)
- Panu Kiviranta
- Department of Physics, University of Kuopio, Kuopio, Finland.
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Multanen J, Rauvala E, Lammentausta E, Ojala R, Kiviranta I, Häkkinen A, Nieminen MT, Heinonen A. Reproducibility of imaging human knee cartilage by delayed gadolinium-enhanced MRI of cartilage (dGEMRIC) at 1.5 Tesla. Osteoarthritis Cartilage 2009; 17:559-64. [PMID: 19121954 DOI: 10.1016/j.joca.2008.12.001] [Citation(s) in RCA: 58] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/28/2008] [Accepted: 12/01/2008] [Indexed: 02/02/2023]
Abstract
OBJECTIVE The purpose of this study was to investigate the day-to-day reproducibility of the delayed gadolinium-enhanced MRI of cartilage (dGEMRIC) measurement at different knee joint surfaces in healthy subjects at 1.5 Tesla (T). METHODS The dGEMRIC experiment was repeated for 10 asymptomatic volunteers three times with an average interval of 5 days between scans. The measurement was performed from a single sagittal slice through the center of the lateral femoral condyle and from the center of the patella in the axial plane. Cartilage was manually segmented into superficial, deep and full-thickness regions of interests (ROIs) at different topographical locations of the femur, tibia and patella. The reproducibility was evaluated separately for each ROI as well as for the entire bulk cartilage in the slice of each joint surface. RESULTS The reproducibility at various ROIs expressed by root-mean-square average coefficient of variation (CV(RMS)) ranged between 4.7-12.9%. Thirty out of thirty-three ROIs showed a CV(RMS) less than 10%. Intraclass correlation coefficient (ICC) ranged between 0.45 and 0.98. The CV(RMS) and ICC for bulk dGEMRIC were 4.2% and 0.95 for femur, 5.5% and 0.87 for tibia, and 4.8% and 0.97 for patella. CONCLUSIONS The dGEMRIC technique showed good day-to-day reproducibility, on the average 8% for small deep or superficial segments, 7% for full-thickness ROIs and 5% for bulk ROIs covering all visible cartilage in a single joint surface. We conclude that dGEMRIC imaging at field strength 1.5 T can be used as a reliable instrument for the assessment of articular cartilage when staff has been carefully trained.
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Affiliation(s)
- J Multanen
- Department of Health Sciences, University of Jyväskylä, Jyväskylä, Finland.
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