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Battersby HS, Holmes SC, Shumski EJ, Heredia CE, Garcia SA, Pamukoff DN. The Influence of Knee Position on Ultrasound Imaging of Femoral Cartilage in Individuals with Anterior Cruciate Ligament Reconstruction. Cartilage 2024; 15:84-93. [PMID: 37846037 DOI: 10.1177/19476035231205682] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/18/2023] Open
Abstract
BACKGROUND Articular cartilage is important for knee function and can be imaged using ultrasound. The purpose was to compare femoral cartilage thickness and echo intensity (EI) measured at 90° and 140° of knee flexion and between limbs in a cohort with unilateral anterior cruciate ligament reconstruction (ACLR). We also examined associations between gait biomechanics and cartilage outcomes. METHODS Twenty-seven individuals with primary unilateral ACLR participated (12 men, 15 women; age = 22.3 ± 3.8 years; time since ACLR = 71.2 ± 47.2 months). Ultrasound was used to obtain femoral cartilage measurements. Gait outcomes included peak KFA (knee flexion angle) and peak external knee flexion moment (KFM). Cartilage outcomes were compared using a 2 (position) × 2 (limb) repeated measures ANOVA (analysis of variance). Gait and cartilage associations were assessed using linear regression. FINDINGS There were no position × limb interactions for any cartilage outcome (all P > 0.05). Medial (P = 0.038) and central cartilage (P < 0.001) were thicker, whereas central (P = 0.029) and lateral cartilage EI (P = 0.003) were lower when measured at 90° than those at 140° of knee flexion. Medial cartilage was thicker in the ACLR than that in the contralateral limb (P = 0.016). A larger KFM was associated with thicker medial cartilage (ΔR2 = 0.146, P = 0.021) and central cartilage (ΔR2 = 0.159, P = 0.039) measured at 140° of knee flexion in the ACLR limb but not at 90°. INTERPRETATION Findings suggest that imaging position influences cartilage thickness and EI measurements in individuals with ACLR and should be considered in study designs and clinical evaluation. A greater KFM was associated with thicker cartilage within specific portions of the distal femur.
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Affiliation(s)
| | - Skylar C Holmes
- Department of Kinesiology, University of Massachusetts Amherst, Amherst, MA, USA
| | - Eric J Shumski
- Department of Kinesiology, University of Georgia, Athens, GA, USA
| | | | - Steven A Garcia
- School of Kinesiology, University of Michigan, Ann Arbor, MI, USA
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Hamsayeh Abbasi Niasar E, Brenneman Wilson EC, Quenneville CE, Maly MR, Li LP. Region partitioning of articular cartilage with streaming-potential-based parameters and indentation maps. J Mech Behav Biomed Mater 2024; 154:106534. [PMID: 38581961 DOI: 10.1016/j.jmbbm.2024.106534] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2023] [Revised: 03/17/2024] [Accepted: 03/30/2024] [Indexed: 04/08/2024]
Abstract
Articular cartilage exhibits site-specific tissue inhomogeneity, for which the tissue properties may continuously vary across the articular surface. To facilitate practical applications such as studying site-specific cartilage degeneration, the inhomogeneity may be approximated with several distinct region-wise variations, with one set of tissue properties for one region. A clustering method was previously developed to partition such regions using cartilage indentation-relaxation and thickness mapping instead of simply using surface geometry. In the present study, a quantitative parameter based on streaming potential measurement was introduced as an additional feature to assess the applicability of the methodology with independent datasets. Experimental data were collected from 24 sets of femoral condyles, extracted from fresh porcine stifle joints, through streaming potential mapping, automated indentation, and needle penetration tests. K-means clustering and Elbow method were used to find optimal region partitions. Consistent with previous findings, three regions were suggested for either lateral or medial condyle regardless of left or right joint. The region shapes were approximately triangular or trapezoidal, which was similar to what was found previously. Streaming potentials were confirmed to be region-dependent, but not significantly different among joints. The cartilage was significantly thicker in the medial than lateral condyles. The region areas were consistent among joints, and comparable to that found in a previous study. The present study demonstrated the capability of region partitioning methods with different variables, which may facilitate new applications whenever site-specific tissue properties must be considered.
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Affiliation(s)
| | | | - C E Quenneville
- Department of Mechanical Engineering, McMaster University, Hamilton, ON, Canada
| | - M R Maly
- Department of Kinesiology and Health Sciences, University of Waterloo, ON, Canada
| | - L P Li
- Department of Mechanical and Manufacturing Engineering, University of Calgary, AB, Canada.
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Abusara Z, Moo EK, Haider I, Timmermann C, Miller S, Timmermann S, Herzog W. Functional Assessment of Human Articular Cartilage Using Second Harmonic Generation (SHG) Imaging: A Feasibility Study. Ann Biomed Eng 2024; 52:1009-1020. [PMID: 38240956 DOI: 10.1007/s10439-023-03437-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2023] [Accepted: 12/26/2023] [Indexed: 03/16/2024]
Abstract
Many arthroscopic tools developed for knee joint assessment are contact-based, which is challenging for in vivo application in narrow joint spaces. Second harmonic generation (SHG) laser imaging is a non-invasive and non-contact method, thus presenting an attractive alternative. However, the association between SHG-based measures and cartilage quality has not been established systematically. Here, we investigated the feasibility of using image-based measures derived from SHG microscopy for objective evaluation of cartilage quality as assessed by mechanical testing. Human tibial plateaus harvested from nine patients were used. Cartilage mechanical properties were determined using indentation stiffness (Einst) and streaming potential-based quantitative parameters (QP). The correspondence of the cartilage electromechanical properties (Einst and QP) and the image-based measures derived from SHG imaging, tissue thickness and cell viability were evaluated using correlation and logistic regression analyses. The SHG-related parameters included the newly developed volumetric fraction of organised collagenous network (Φcol) and the coefficient of variation of the SHG intensity (CVSHG). We found that Φcol correlated strongly with Einst and QP (ρ = 0.97 and - 0.89, respectively). CVSHG also correlated, albeit weakly, with QP and Einst, (|ρ| = 0.52-0.58). Einst and Φcol were the most sensitive predictors of cartilage quality whereas CVSHG only showed moderate sensitivity. Cell viability and tissue thickness, often used as measures of cartilage health, predicted the cartilage quality poorly. We present a simple, objective, yet effective image-based approach for assessment of cartilage quality. Φcol correlated strongly with electromechanical properties of cartilage and could fuel the continuous development of SHG-based arthroscopy.
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Affiliation(s)
- Ziad Abusara
- Human Performance Laboratory, Faculty of Kinesiology, University of Calgary, Calgary, Canada.
- McCaig Institute for Bone and Joint Health, Cumming School of Medicine, University of Calgary, Calgary, Canada.
| | - Eng Kuan Moo
- Human Performance Laboratory, Faculty of Kinesiology, University of Calgary, Calgary, Canada
- Department of Mechanical and Aerospace Engineering, Faculty of Engineering and Design, Carleton University, Ottawa, Canada
| | - Ifaz Haider
- Human Performance Laboratory, Faculty of Kinesiology, University of Calgary, Calgary, Canada
- McCaig Institute for Bone and Joint Health, Cumming School of Medicine, University of Calgary, Calgary, Canada
| | - Claire Timmermann
- Human Performance Laboratory, Faculty of Kinesiology, University of Calgary, Calgary, Canada
| | - Sue Miller
- McCaig Institute for Bone and Joint Health, Cumming School of Medicine, University of Calgary, Calgary, Canada
- Section of Orthopaedic Surgery, Department of Surgery, University of Calgary, Calgary, Canada
- Taylor Institute for Teaching and Learning, University of Calgary, Calgary, Canada
| | - Scott Timmermann
- McCaig Institute for Bone and Joint Health, Cumming School of Medicine, University of Calgary, Calgary, Canada
- Section of Orthopaedic Surgery, Department of Surgery, University of Calgary, Calgary, Canada
| | - Walter Herzog
- Human Performance Laboratory, Faculty of Kinesiology, University of Calgary, Calgary, Canada
- McCaig Institute for Bone and Joint Health, Cumming School of Medicine, University of Calgary, Calgary, Canada
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Yao Y, Zhong J, Zhang L, Khan S, Chen W. CartiMorph: A framework for automated knee articular cartilage morphometrics. Med Image Anal 2024; 91:103035. [PMID: 37992496 DOI: 10.1016/j.media.2023.103035] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2022] [Revised: 08/25/2023] [Accepted: 11/13/2023] [Indexed: 11/24/2023]
Abstract
We introduce CartiMorph, a framework for automated knee articular cartilage morphometrics. It takes an image as input and generates quantitative metrics for cartilage subregions, including the percentage of full-thickness cartilage loss (FCL), mean thickness, surface area, and volume. CartiMorph leverages the power of deep learning models for hierarchical image feature representation. Deep learning models were trained and validated for tissue segmentation, template construction, and template-to-image registration. We established methods for surface-normal-based cartilage thickness mapping, FCL estimation, and rule-based cartilage parcellation. Our cartilage thickness map showed less error in thin and peripheral regions. We evaluated the effectiveness of the adopted segmentation model by comparing the quantitative metrics obtained from model segmentation and those from manual segmentation. The root-mean-squared deviation of the FCL measurements was less than 8%, and strong correlations were observed for the mean thickness (Pearson's correlation coefficient ρ∈[0.82,0.97]), surface area (ρ∈[0.82,0.98]) and volume (ρ∈[0.89,0.98]) measurements. We compared our FCL measurements with those from a previous study and found that our measurements deviated less from the ground truths. We observed superior performance of the proposed rule-based cartilage parcellation method compared with the atlas-based approach. CartiMorph has the potential to promote imaging biomarkers discovery for knee osteoarthritis.
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Affiliation(s)
- Yongcheng Yao
- CU Lab of AI in Radiology (CLAIR), Department of Imaging and Interventional Radiology, The Chinese University of Hong Kong, Hong Kong, China.
| | - Junru Zhong
- CU Lab of AI in Radiology (CLAIR), Department of Imaging and Interventional Radiology, The Chinese University of Hong Kong, Hong Kong, China
| | - Liping Zhang
- CU Lab of AI in Radiology (CLAIR), Department of Imaging and Interventional Radiology, The Chinese University of Hong Kong, Hong Kong, China
| | - Sheheryar Khan
- School of Professional Education and Executive Development, The Hong Kong Polytechnic University, Hong Kong, China
| | - Weitian Chen
- CU Lab of AI in Radiology (CLAIR), Department of Imaging and Interventional Radiology, The Chinese University of Hong Kong, Hong Kong, China.
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Cummings J, Gao K, Chen V, Martinez AM, Iriondo C, Caliva F, Majumdar S, Pedoia V. The knee connectome: A novel tool for studying spatiotemporal change in cartilage thickness. J Orthop Res 2024; 42:43-53. [PMID: 37254620 PMCID: PMC10687317 DOI: 10.1002/jor.25637] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/07/2023] [Revised: 05/15/2023] [Accepted: 05/28/2023] [Indexed: 06/01/2023]
Abstract
Cartilage thickness change is a well-documented biomarker of osteoarthritis pathogenesis. However, there is still much to learn about the spatial and temporal patterns of cartilage thickness change in health and disease. In this study, we develop a novel analysis method for elucidating such patterns using a functional connectivity approach. Descriptive statistics are reported for 1186 knees that did not develop osteoarthritis during the 8 years of observation, which we present as a model of cartilage thickness change related to healthy aging. Within the control population, patterns vary greatly between male and female subjects, while body mass index (BMI) has a more moderate impact. Finally, several differences are shown between knees that did and did not develop osteoarthritis. Some but not all significance appears to be accounted for by differences in sex, BMI, and knee alignment. With this work, we present the connectome as a novel tool for studying spatiotemporal dynamics of tissue change.
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Affiliation(s)
- Jennifer Cummings
- Department of Radiology and Biomedical Imaging, University of California, San Francisco, San Francisco, California, USA
- Department of Bioengineering, University of California, San Francisco and University of California, Berkeley Joint Graduate Group in Bioengineering, San Francisco, California, USA
| | - Kenneth Gao
- Department of Radiology and Biomedical Imaging, University of California, San Francisco, San Francisco, California, USA
- Department of Bioengineering, University of California, San Francisco and University of California, Berkeley Joint Graduate Group in Bioengineering, San Francisco, California, USA
| | - Vincent Chen
- Department of Radiology and Biomedical Imaging, University of California, San Francisco, San Francisco, California, USA
| | - Alejandro Morales Martinez
- Department of Radiology and Biomedical Imaging, University of California, San Francisco, San Francisco, California, USA
- Department of Bioengineering, University of California, San Francisco and University of California, Berkeley Joint Graduate Group in Bioengineering, San Francisco, California, USA
| | - Claudia Iriondo
- Department of Radiology and Biomedical Imaging, University of California, San Francisco, San Francisco, California, USA
- Department of Bioengineering, University of California, San Francisco and University of California, Berkeley Joint Graduate Group in Bioengineering, San Francisco, California, USA
| | - Francesco Caliva
- Department of Radiology and Biomedical Imaging, University of California, San Francisco, San Francisco, California, USA
| | - Sharmila Majumdar
- Department of Radiology and Biomedical Imaging, University of California, San Francisco, San Francisco, California, USA
| | - Valentina Pedoia
- Department of Radiology and Biomedical Imaging, University of California, San Francisco, San Francisco, California, USA
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Grothues S, Becker AK, Hohlmann B, Radermacher K. Parameter-based patient-specific restoration of physiological knee morphology for optimized implant design and matching. BIOMED ENG-BIOMED TE 2023; 68:537-544. [PMID: 37185164 DOI: 10.1515/bmt-2023-0017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2023] [Accepted: 04/03/2023] [Indexed: 05/17/2023]
Abstract
Total knee arthroplasty (TKA) patients may present with genetic deformities, such as trochlear dysplasia, or deformities related to osteoarthritis. This pathologic morphology should be corrected by TKA to compensate for related functional deficiencies. Hence, a reconstruction of an equivalent physiological knee morphology would be favorable for detailed preoperative planning and the patient-specific implant selection or design process. A parametric database of 673 knees, each described by 36 femoral parameter values, was used. Each knee was classified as pathological or physiological based on cut-off values from literature. A clinical and a mathematical classification approach were developed to distinguish between affected and unaffected parameters. Three different prediction methods were used for the restoration of physiological parameter values: regression, nearest neighbor search and artificial neural networks. Several variants of the respective prediction model were considered, such as different network architectures. Regarding all methods, the model variant chosen resulted in a prediction error below the parameters' standard deviation, while the regression yielded the lowest errors. Future analyses should consider other deformities, also of tibia and patella. Furthermore, the functional consequences of the parameter changes should be analyzed.
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Affiliation(s)
- Sonja Grothues
- Chair of Medical Engineering, Helmholtz-Institute for Biomedical Engineering, RWTH Aachen University, Aachen, Germany
| | - Ann-Kristin Becker
- Chair of Medical Engineering, Helmholtz-Institute for Biomedical Engineering, RWTH Aachen University, Aachen, Germany
| | - Benjamin Hohlmann
- Chair of Medical Engineering, Helmholtz-Institute for Biomedical Engineering, RWTH Aachen University, Aachen, Germany
| | - Klaus Radermacher
- Chair of Medical Engineering, Helmholtz-Institute for Biomedical Engineering, RWTH Aachen University, Aachen, Germany
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Keefe TH, Minnig MC, Arbeeva L, Niethammer M, Xu Z, Shen Z, Chen B, Nissman DB, Golightly YM, Marron J, Nelson AE. Patterns of variation among baseline femoral and tibial cartilage thickness and clinical features: Data from the osteoarthritis initiative. OSTEOARTHRITIS AND CARTILAGE OPEN 2023; 5:100334. [PMID: 36817090 PMCID: PMC9932103 DOI: 10.1016/j.ocarto.2023.100334] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2022] [Revised: 12/21/2022] [Accepted: 01/12/2023] [Indexed: 01/25/2023] Open
Abstract
Objective To employ novel methodologies to identify phenotypes in knee OA based on variation among three baseline data blocks: 1) femoral cartilage thickness, 2) tibial cartilage thickness, and 3) participant characteristics and clinical features. Methods Baseline data were from 3321 Osteoarthritis Initiative (OAI) participants with available cartilage thickness maps (6265 knees) and 77 clinical features. Cartilage maps were obtained from 3D DESS MR images using a deep-learning based segmentation approach and an atlas-based analysis developed by our group. Angle-based Joint and Individual Variation Explained (AJIVE) was used to capture and quantify variation, both shared among multiple data blocks and individual to each block, and to determine statistical significance. Results Three major modes of variation were shared across the three data blocks. Mode 1 reflected overall thicker cartilage among men, those with higher education, and greater knee forces; Mode 2 showed associations between worsening Kellgren-Lawrence Grade, medial cartilage thinning, and worsening symptoms; and Mode 3 contrasted lateral and medial-predominant cartilage loss associated with BMI and malalignment. Each data block also demonstrated individual, independent modes of variation consistent with the known discordance between symptoms and structure in knee OA and reflecting the importance of features such as physical function, symptoms, and comorbid conditions independent of structural damage. Conclusions This exploratory analysis, combining the rich OAI dataset with novel methods for determining and visualizing cartilage thickness, reinforces known associations in knee OA while providing insights into the potential for data integration in knee OA phenotyping.
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Affiliation(s)
- Thomas H. Keefe
- Statistics and Operations Research, University of North Carolina at Chapel Hill College of Arts and Sciences, Chapel Hill, North Carolina, USA
| | - Mary Catherine Minnig
- Thurston Arthritis Research Center, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
- Department of Epidemiology, University of North Carolina at Chapel Hill Gillings School of Global Public Health, Chapel Hill, North Carolina, USA
| | - Liubov Arbeeva
- Thurston Arthritis Research Center, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
| | - Marc Niethammer
- Department of Computer Science, University of North Carolina at Chapel Hill College of Arts and Sciences, Chapel Hill, North Carolina, USA
| | - Zhenlin Xu
- Department of Computer Science, University of North Carolina at Chapel Hill College of Arts and Sciences, Chapel Hill, North Carolina, USA
| | - Zhengyang Shen
- Department of Computer Science, University of North Carolina at Chapel Hill College of Arts and Sciences, Chapel Hill, North Carolina, USA
| | - Boqi Chen
- Department of Computer Science, University of North Carolina at Chapel Hill College of Arts and Sciences, Chapel Hill, North Carolina, USA
| | - Daniel B. Nissman
- Department of Radiology, University of North Carolina at Chapel Hill School of Medicine, Chapel Hill, North Carolina, USA
| | - Yvonne M. Golightly
- Thurston Arthritis Research Center, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
- Department of Epidemiology, University of North Carolina at Chapel Hill Gillings School of Global Public Health, Chapel Hill, North Carolina, USA
- College of Allied Health Professions, University of Nebraska Medical Center, Omaha, NE 68198, USA
| | - J.S. Marron
- Statistics and Operations Research, University of North Carolina at Chapel Hill College of Arts and Sciences, Chapel Hill, North Carolina, USA
| | - Amanda E. Nelson
- Thurston Arthritis Research Center, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
- Department of Epidemiology, University of North Carolina at Chapel Hill Gillings School of Global Public Health, Chapel Hill, North Carolina, USA
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Van Oevelen A, Van den Borre I, Duquesne K, Pizurica A, Victor J, Nauwelaers N, Claes P, Audenaert E. Wear patterns in knee OA correlate with native limb geometry. Front Bioeng Biotechnol 2022; 10:1042441. [DOI: 10.3389/fbioe.2022.1042441] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2022] [Accepted: 11/07/2022] [Indexed: 11/19/2022] Open
Abstract
Background: To date, the amount of cartilage loss is graded by means of discrete scoring systems on artificially divided regions of interest (ROI). However, optimal statistical comparison between and within populations requires anatomically standardized cartilage thickness assessment. Providing anatomical standardization relying on non-rigid registration, we aim to compare morphotypes of a healthy control cohort and virtual reconstructed twins of end-stage knee OA subjects to assess the shape-related knee OA risk and to evaluate possible correlations between phenotype and location of cartilage loss.Methods: Out of an anonymized dataset provided by the Medacta company (Medacta International SA, Castel S. Pietro, CH), 798 end-stage knee OA cases were extracted. Cartilage wear patterns were observed by computing joint space width. The three-dimensional joint space width data was translated into a two-dimensional pixel image, which served as the input for a principal polynomial autoencoder developed for non-linear encoding of wear patterns. Virtual healthy twin reconstruction enabled the investigation of the morphology-related risk for OA requiring joint arthroplasty.Results: The polynomial autoencoder revealed 4 dominant, orthogonal components, accounting for 94% of variance in the latent feature space. This could be interpreted as medial (54.8%), bicompartmental (25.2%) and lateral (9.1%) wear. Medial wear was subdivided into anteromedial (11.3%) and posteromedial (10.4%) wear. Pre-diseased limb geometry had a positive predictive value of 0.80 in the prediction of OA incidence (r 0.58, p < 0.001).Conclusion: An innovative methodological workflow is presented to correlate cartilage wear patterns with knee joint phenotype and to assess the distinct knee OA risk based on pre-diseased lower limb morphology. Confirming previous research, both alignment and joint geometry are of importance in knee OA disease onset and progression.
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Babel H, Omoumi P, Cosendey K, Stanovici J, Cadas H, Jolles BM, Favre J. An Expert-Supervised Registration Method for Multiparameter Description of the Knee Joint Using Serial Imaging. J Clin Med 2022; 11:jcm11030548. [PMID: 35160002 PMCID: PMC8837137 DOI: 10.3390/jcm11030548] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2021] [Revised: 01/11/2022] [Accepted: 01/21/2022] [Indexed: 01/25/2023] Open
Abstract
As knee osteoarthritis is a disease of the entire joint, our pathophysiological understanding could be improved by the characterization of the relationships among the knee components. Diverse quantitative parameters can be characterized using magnetic resonance imaging (MRI) and computed tomography (CT). However, a lack of methods for the coordinated measurement of multiple parameters hinders global analyses. This study aimed to design an expert-supervised registration method to facilitate multiparameter description using complementary image sets obtained by serial imaging. The method is based on three-dimensional tissue models positioned in the image sets of interest using manually placed attraction points. Two datasets, with 10 knees CT-scanned twice and 10 knees imaged by CT and MRI were used to assess the method when registering the distal femur and proximal tibia. The median interoperator registration errors, quantified using the mean absolute distance and Dice index, were ≤0.45 mm and ≥0.96 unit, respectively. These values differed by less than 0.1 mm and 0.005 units compared to the errors obtained with gold standard methods. In conclusion, an expert-supervised registration method was introduced. Its capacity to register the distal femur and proximal tibia supports further developments for multiparameter description of healthy and osteoarthritic knee joints, among other applications.
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Affiliation(s)
- Hugo Babel
- Swiss BioMotion Lab, Lausanne University Hospital and University of Lausanne (CHUV-UNIL), CH-1011 Lausanne, Switzerland; (H.B.); (K.C.); (B.M.J.)
| | - Patrick Omoumi
- Service of Diagnostic and Interventional Radiology, Lausanne University Hospital and University of Lausanne (CHUV-UNIL), CH-1011 Lausanne, Switzerland;
- Department of Radiology, Cliniques Universitaires St Luc-UC Louvain, BE-1200 Brussels, Belgium
| | - Killian Cosendey
- Swiss BioMotion Lab, Lausanne University Hospital and University of Lausanne (CHUV-UNIL), CH-1011 Lausanne, Switzerland; (H.B.); (K.C.); (B.M.J.)
| | - Julien Stanovici
- Service of Orthopedics and Traumatology, Lausanne University Hospital and University of Lausanne (CHUV-UNIL), CH-1011 Lausanne, Switzerland;
| | - Hugues Cadas
- Unité Facultaire d’Anatomie et de Morphologie, University of Lausanne (UNIL), CH-1005 Lausanne, Switzerland;
| | - Brigitte M. Jolles
- Swiss BioMotion Lab, Lausanne University Hospital and University of Lausanne (CHUV-UNIL), CH-1011 Lausanne, Switzerland; (H.B.); (K.C.); (B.M.J.)
- Institute of Microengineering, Ecole Polytechnique Fédérale Lausanne (EPFL), CH-1015 Lausanne, Switzerland
| | - Julien Favre
- Swiss BioMotion Lab, Lausanne University Hospital and University of Lausanne (CHUV-UNIL), CH-1011 Lausanne, Switzerland; (H.B.); (K.C.); (B.M.J.)
- Correspondence:
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Daszkiewicz K, Łuczkiewicz P. Biomechanics of the medial meniscus in the osteoarthritic knee joint. PeerJ 2021; 9:e12509. [PMID: 34900428 PMCID: PMC8627128 DOI: 10.7717/peerj.12509] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2021] [Accepted: 10/27/2021] [Indexed: 11/20/2022] Open
Abstract
Background Increased mechanical loading and pathological response of joint tissue to the abnormal mechanical stress can cause degradation of cartilage characteristic of knee osteoarthritis (OA). Despite osteoarthritis is risk factor for the development of meniscal lesions the mechanism of degenerative meniscal lesions is still unclear. Therefore, the aim of the study is to investigate the influence of medial compartment knee OA on the stress state and deformation of the medial meniscus. Methods The finite element method was used to simulate the stance phase of the gait cycle. An intact knee model was prepared based on magnetic resonance scans of the left knee joint of a healthy volunteer. Degenerative changes in the medial knee OA model were simulated by nonuniform reduction in articular cartilage thickness in specific areas and by a decrease in the material parameters of cartilage and menisci. Two additional models were created to separately evaluate the effect of alterations in articular cartilage geometry and material parameters of the soft tissues on the results. A nonlinear dynamic analysis was performed for standardized knee loads applied to the tibia bone. Results The maximum von Mises stress of 26.8 MPa was observed in the posterior part of the medial meniscus body in the OA model. The maximal hoop stress for the first peak of total force was 83% greater in the posterior horn and only 11% greater in the anterior horn of the medial meniscus in the OA model than in the intact model. The reduction in cartilage thickness caused an increase of 57% in medial translation of the medial meniscus body. A decrease in the compressive modulus of menisci resulted in a 2.5-fold greater reduction in the meniscal body width compared to the intact model. Conclusions Higher hoop stress levels on the inner edge of the posterior part of the medial meniscus in the OA model than in the intact model are associated with a greater medial translation of the meniscus body and a greater reduction in its width. The considerable increase in hoop stresses shows that medial knee OA may contribute to the initiation of meniscal radial tears.
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Affiliation(s)
- Karol Daszkiewicz
- Department of Mechanics of Materials and Structures, Faculty of Civil and Environmental Engineering, Gdańsk University of Technology, Gdańsk, Poland
| | - Piotr Łuczkiewicz
- II Department of Orthopaedics and Kinetic Organ Traumatology, Medical University of Gdańsk, Gdańsk, Poland
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Rapagna S, Roberts BC, Solomon LB, Reynolds KJ, Thewlis D, Perilli E. Tibial cartilage, subchondral bone plate and trabecular bone microarchitecture in varus- and valgus-osteoarthritis versus controls. J Orthop Res 2021; 39:1988-1999. [PMID: 33241575 DOI: 10.1002/jor.24914] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/26/2020] [Revised: 10/26/2020] [Accepted: 11/08/2020] [Indexed: 02/04/2023]
Abstract
This preliminary study quantified tibia cartilage thickness (Cart.Th), subchondral bone plate thickness (SBPl.Th) and subchondral trabecular bone (STB) microarchitecture in subjects with varus- or valgus- malaligned knees diagnosed with end-stage knee osteoarthritis (OA) and compared them to controls (non-OA). Tibial plateaus from 25 subjects with knee-OA (undergoing knee arthroplasty) and 15 cadavers (controls) were micro-CT scanned (17 µm/voxel). Joint alignment was classified radiographically for OA subjects (varus-aligned n = 18, valgus-aligned n = 7). Cart.Th, SBPl.Th, STB bone volume fraction (BV/TV) and their medial-to-lateral ratios were analyzed in anteromedial, anterolateral, posteromedial and posterolateral subregions. Varus-OA and valgus-OA were compared to controls. Compared to controls (1.19-1.54 mm), Cart.Th in varus-OA was significantly lower anteromedially (0.58 mm, -59%) and higher laterally (2.19-2.47 mm, +60-63%); in valgus-OA, Cart.Th was significantly higher posteromedially (1.86 mm, +56%). Control medial-to-lateral Cart.Th ratios were around unity (0.8-1.1), in varus-OA significantly below (0.2-0.6) and in valgus-OA slightly above (1.0-1.3) controls. SBPl.Th and BV/TV were significantly higher medially in varus-OA (0.58-0.72 mm and 37-44%, respectively) and laterally in valgus-OA (0.60-0.61 mm and 32-37%), compared to controls (0.26-0.47 mm and 18-37%). In varus-OA, the medial-to-lateral SBPl.Th and BV/TV ratios were above unity (1.4-2.4) and controls (0.8-2.1); in valgus-OA they were closer to unity (0.8-1.1) and below controls. Varus- and valgus-OA tibia differ significantly from controls in Cart.Th, SBPl.Th and STB microarchitecture depending on joint alignment, suggesting structural changes in OA may reflect differences in medial-to-lateral load distribution upon the tibial plateau. Here we identified an inverse relationship between cartilage thickness and underlying subchondral bone, suggesting a whole-joint response in OA to daily stimuli.
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Affiliation(s)
- Sophie Rapagna
- Medical Device Research Institute, College of Science and Engineering, Flinders University, Adelaide, South Australia, Australia
| | - Bryant C Roberts
- Medical Device Research Institute, College of Science and Engineering, Flinders University, Adelaide, South Australia, Australia.,Department of Oncology and Metabolism, Insigneo Institute for In Silico Medicine, The University of Sheffield, Sheffield, UK
| | - Lucian B Solomon
- Centre for Orthopaedic and Trauma Research, The University of Adelaide, Adelaide, South Australia, Australia.,Department of Orthopaedics and Trauma, Royal Adelaide Hospital, Adelaide, South Australia, Australia
| | - Karen J Reynolds
- Medical Device Research Institute, College of Science and Engineering, Flinders University, Adelaide, South Australia, Australia
| | - Dominic Thewlis
- Centre for Orthopaedic and Trauma Research, The University of Adelaide, Adelaide, South Australia, Australia
| | - Egon Perilli
- Medical Device Research Institute, College of Science and Engineering, Flinders University, Adelaide, South Australia, Australia
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Iriondo C, Liu F, Calivà F, Kamat S, Majumdar S, Pedoia V. Towards understanding mechanistic subgroups of osteoarthritis: 8-year cartilage thickness trajectory analysis. J Orthop Res 2021; 39:1305-1317. [PMID: 32897602 DOI: 10.1002/jor.24849] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/10/2020] [Revised: 07/23/2020] [Accepted: 09/02/2020] [Indexed: 02/04/2023]
Abstract
Many studies have validated cartilage thickness as a biomarker for knee osteoarthritis (OA); however, few studies investigate beyond cross-sectional observations or comparisons across two timepoints. By characterizing the trajectory of cartilage thickness changes over 8 years in healthy individuals from the OA initiative data set, this study discovers associations between the dynamics of cartilage changes and OA incidence. A fully automated cartilage segmentation and thickness measurement method were developed and validated against manual measurements: mean absolute error = 0.11-0.14 mm (n = 4129 knees) and automatic reproducibility = 0.04-0.07 mm (n = 316 knees). The mean thickness for the medial and lateral tibia (MT, LT), central weight-bearing medial and lateral femur (cMF, cLF), and patella (P) cartilage compartments were quantified for 1453 knees at seven timepoints. Trajectory subgroups were defined per cartilage compartment such as stable, thinning to thickening, accelerated thickening, plateaued thickening, thickening to thinning, accelerated thinning, or plateaued thinning. For tibiofemoral compartments, the stable (22%-36%) and plateaued thinning (22%-37%) trajectories were the most common, with an average initial velocity (μm/month), acceleration (μm/month2 ) for the plateaued thinning trajectories LT: -2.66, 0.0326; MT: -2.49, 0.0365; cMF: -3.51, 0.0509; and cLF: -2.68, 0.041. In the patella compartment, the plateaued thinning (35%) and thickening to thinning (24%) trajectories were the most common, with an average initial velocity, acceleration for each -4.17, 0.0424; 1.95, -0.0835. Knees with nonstable trajectories had higher adjusted odds of OA incidence than stable trajectories: accelerated thickening, accelerated thinning, and plateaued thinning trajectories of the MT had adjusted odds ratio (OR) of 18.9, 5.48, and 1.47, respectively; in the cMF, adjusted OR of 8.55, 10.1, and 2.61, respectively.
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Affiliation(s)
- Claudia Iriondo
- Department of Radiology and Biomedical Imaging, University of California, San Francisco, San Francisco, California, USA.,Department of Bioengineering, University of California, San Francisco and University of California, Berkeley Joint Graduate Group in Bioengineering, San Francisco, California, USA
| | - Felix Liu
- Department of Radiology and Biomedical Imaging, University of California, San Francisco, San Francisco, California, USA
| | - Francesco Calivà
- Department of Radiology and Biomedical Imaging, University of California, San Francisco, San Francisco, California, USA
| | - Sarthak Kamat
- Department of Radiology and Biomedical Imaging, University of California, San Francisco, San Francisco, California, USA
| | - Sharmila Majumdar
- Department of Radiology and Biomedical Imaging, University of California, San Francisco, San Francisco, California, USA
| | - Valentina Pedoia
- Department of Radiology and Biomedical Imaging, University of California, San Francisco, San Francisco, California, USA
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13
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Matson A, Kunkel Z, Bernal-Crespo V, Chainani A, Chainani M, Finley S, Friedman L, Little D, Garrigues G. The histopathology of the humeral head in glenohumeral osteoarthritis. OSTEOARTHRITIS AND CARTILAGE OPEN 2021; 3:100147. [DOI: 10.1016/j.ocarto.2021.100147] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2020] [Revised: 02/16/2021] [Accepted: 02/18/2021] [Indexed: 11/16/2022] Open
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Longitudinal changes in tibial and femoral cartilage thickness are associated with baseline ambulatory kinetics and cartilage oligomeric matrix protein (COMP) measures in an asymptomatic aging population. Osteoarthritis Cartilage 2021; 29:687-696. [PMID: 33610822 DOI: 10.1016/j.joca.2021.02.006] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/26/2020] [Revised: 01/07/2021] [Accepted: 02/02/2021] [Indexed: 02/02/2023]
Abstract
OBJECTIVE To address the need for early knee osteoarthritis (OA) markers by testing if longitudinal cartilage thickness changes are associated with specific biomechanical and biological measures acquired at a baseline test in asymptomatic aging subjects. DESIGN Thirty-eight asymptomatic subjects over age 45 years were studied at baseline and at an average of 7-9 year follow-up. Gait mechanics and knee MRI were measured at baseline and MRI was obtained at follow-up to assess cartilage thickness changes. A subset of the subjects (n = 12) also had serum cartilage oligomeric matrix protein measured at baseline in response to a mechanical stimulus (30-min walk) (mCOMP). Baseline measures, including the knee extension (KEM), flexion (KFM), adduction (KAM) moments and mCOMP, were tested for associations with cartilage thickness changes in specific regions of the knee. RESULTS Cartilage change in the full medial femoral condyle (p = 0.005) and external medial femoral region (p = 0.041) was negatively associated with larger early stance peak KEM. Similarly, cartilage change in the full medial femoral region (p = 0.009) and medial femoral external region (p = 0.043) was negatively associated with larger first peak KAM, while cartilage change in the anterior medial tibia was positively associated with larger first peak KAM (p = 0.003). Cartilage change in the anterior medial tibia was also significantly associated (p = 0.011) with mCOMP levels 5.5-h post-activity (percentage of pre-activity levels). CONCLUSIONS Interactions found between gait, mechanically-stimulated serum biomarkers, and cartilage thickness in an at-risk aging asymptomatic population suggest the opportunity for early detection of OA with new approaches that bridge across disciplines and scales.
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Longitudinal Femoral Cartilage T2 Relaxation Time and Thickness Changes with Fast Sequential Radiographic Progression of Medial Knee Osteoarthritis-Data from the Osteoarthritis Initiative (OAI). J Clin Med 2021; 10:jcm10061294. [PMID: 33801000 PMCID: PMC8003903 DOI: 10.3390/jcm10061294] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2020] [Revised: 03/12/2021] [Accepted: 03/17/2021] [Indexed: 11/24/2022] Open
Abstract
This study tested for longitudinal changes in femoral cartilage T2 relaxation time and thickness in fast-progressing medial femorotibial osteoarthritis (OA). From the Osteoarthritis Initiative (OAI) database, nineteen knees fulfilled the inclusion criteria, which included medial femorotibial OA and sequential progression from Kellgren–Lawrence grade (KL) 1 to KL2 to KL3 within five years. Median T2 value and mean thickness were calculated for six condylar volumes of interest (VOIs; medial/lateral anterior, central, posterior) and six sub-VOIs (medial/lateral anterior external, central, internal). T2 value and thickness changes between severity timepoints were tested using repeated statistics. T2 values increased between KL1 and KL2 and between KL1 and KL3 in the medial compartment (p ≤ 0.02), whereas both increases and decreases were observed between the same timepoints in the lateral compartment (p ≤ 0.02). Cartilage thickness decreased in VOI/subVOIs of the medial compartment from KL1 to KL2 and KL3 (p ≤ 0.014). Cartilage T2 value and thickness changes varied spatially over the femoral condyles. While all T2 changes occurred in the early radiographic stages of OA, thickness changes occurred primarily in the later stages. These data therefore support the use of T2 relaxation time analyses in methods of detecting disease-related change during early OA, a valuable period for therapeutic interventions.
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Favre J, Babel H, Cavinato A, Blazek K, Jolles BM, Andriacchi TP. Analyzing Femorotibial Cartilage Thickness Using Anatomically Standardized Maps: Reproducibility and Reference Data. J Clin Med 2021; 10:461. [PMID: 33530358 PMCID: PMC7865848 DOI: 10.3390/jcm10030461] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2020] [Revised: 01/20/2021] [Accepted: 01/22/2021] [Indexed: 12/26/2022] Open
Abstract
Alterations in cartilage thickness (CTh) are a hallmark of knee osteoarthritis, which remain difficult to characterize at high resolution, even with modern magnetic resonance imaging (MRI), due to a paucity of standardization tools. This study aimed to assess a computational anatomy method producing standardized two-dimensional femorotibial CTh maps. The method was assessed with twenty knees, processed following three common experimental scenarios. Cartilage thickness maps were obtained for the femorotibial cartilages by reconstructing bone and cartilage mesh models in tree-dimension, calculating three-dimensional CTh maps, and anatomically standardizing the maps. The intra-operator accuracy (median (interquartile range, IQR) of -0.006 (0.045) mm), precision (0.152 (0.070) mm), entropy (7.02 (0.71) and agreement (0.975 (0.020))) results suggested that the method is adequate to capture the spatial variations in CTh and compare knees at varying osteoarthritis stages. The lower inter-operator precision (0.496 (0.132) mm) and agreement (0.808 (0.108)) indicate a possible loss of sensitivity to detect differences in a setting with multiple operators. The results confirmed the promising potential of anatomically standardized maps, with the lower inter-operator reproducibility stressing the need to coordinate operators. This study also provided essential reference data and indications for future research using CTh maps.
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Affiliation(s)
- Julien Favre
- Swiss BioMotion Lab, Department of Musculoskeletal Medicine, Lausanne University Hospital and University of Lausanne (CHUV-UNIL), CH-1011 Lausanne, Switzerland; (J.F.); (A.C.); (B.M.J.)
- Department of Mechanical Engineering, Stanford University, Stanford, CA 94305, USA; (K.B.); (T.P.A.)
| | - Hugo Babel
- Swiss BioMotion Lab, Department of Musculoskeletal Medicine, Lausanne University Hospital and University of Lausanne (CHUV-UNIL), CH-1011 Lausanne, Switzerland; (J.F.); (A.C.); (B.M.J.)
| | - Alessandro Cavinato
- Swiss BioMotion Lab, Department of Musculoskeletal Medicine, Lausanne University Hospital and University of Lausanne (CHUV-UNIL), CH-1011 Lausanne, Switzerland; (J.F.); (A.C.); (B.M.J.)
- Department of Mechanical Engineering, Stanford University, Stanford, CA 94305, USA; (K.B.); (T.P.A.)
| | - Katerina Blazek
- Department of Mechanical Engineering, Stanford University, Stanford, CA 94305, USA; (K.B.); (T.P.A.)
- Palo Alto VA, Palo Alto, CA 94304, USA
| | - Brigitte M. Jolles
- Swiss BioMotion Lab, Department of Musculoskeletal Medicine, Lausanne University Hospital and University of Lausanne (CHUV-UNIL), CH-1011 Lausanne, Switzerland; (J.F.); (A.C.); (B.M.J.)
- Institute of Microengineering, Ecole Polytechnique Fédérale Lausanne (EPFL), CH-1015 Lausanne, Switzerland
| | - Thomas P. Andriacchi
- Department of Mechanical Engineering, Stanford University, Stanford, CA 94305, USA; (K.B.); (T.P.A.)
- Palo Alto VA, Palo Alto, CA 94304, USA
- Department of Orthopaedic Surgery, Stanford University, Redwood City, CA 94061, USA
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17
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Three-Dimensional Quantification of Bone Mineral Density in the Distal Femur and Proximal Tibia Based on Computed Tomography: In Vitro Evaluation of an Extended Standardization Method. J Clin Med 2021; 10:jcm10010160. [PMID: 33466413 PMCID: PMC7796434 DOI: 10.3390/jcm10010160] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2020] [Revised: 12/21/2020] [Accepted: 12/22/2020] [Indexed: 12/16/2022] Open
Abstract
While alterations in bone mineral density (BMD) are of interest in a number of musculoskeletal conditions affecting the knee, their analysis is limited by a lack of tools able to take full advantage of modern imaging modalities. This study introduced a new method, combining computed tomography (CT) and computational anatomy algorithms, to produce standardized three-dimensional BMD quantification in the distal femur and proximal tibia. The method was evaluated on ten cadaveric knees CT-scanned twice and processed following three different experimental settings to assess the influence of different scans and operators. The median reliability (intraclass correlation coefficient (ICC)) ranged from 0.96 to 0.99 and the median reproducibility (precision error (RMSSD)) ranged from 3.97 to 10.75 mg/cc for the different experimental settings. In conclusion, this paper presented a method to standardize three-dimensional knee BMD with excellent reliability and adequate reproducibility to be used in research and clinical applications. The perspectives offered by this novel method are further reinforced by the fact it relies on conventional CT scan of the knee. The standardization method introduced in this work is not limited to BMD and could be adapted to quantify other bone parameters in three dimension based on CT images or images acquired using different modalities.
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18
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Aoki H, Ozeki N, Katano H, Hyodo A, Miura Y, Matsuda J, Takanashi K, Suzuki K, Masumoto J, Okanouchi N, Fujiwara T, Sekiya I. Relationship between medial meniscus extrusion and cartilage measurements in the knee by fully automatic three-dimensional MRI analysis. BMC Musculoskelet Disord 2020; 21:742. [PMID: 33183257 PMCID: PMC7664063 DOI: 10.1186/s12891-020-03768-3] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/02/2020] [Accepted: 11/03/2020] [Indexed: 01/03/2023] Open
Abstract
BACKGROUND We developed a fully automatic three-dimensional knee MRI analysis software that can quantify meniscus extrusion and cartilage measurements, including the projected cartilage area ratio (PCAR), which represents the ratio of the subject's actual cartilage area to their ideal cartilage area. We also collected 3D MRI knee data from 561 volunteers (aged 30-79 years) from the "Kanagawa Knee Study." Our purposes were to verify the accuracy of the software for automatic cartilage and meniscus segmentation using knee MRI and to examine the relationship between medial meniscus extrusion measurements and cartilage measurements from Kanagawa Knee Study data. METHODS We constructed a neural network for the software by randomly choosing 10 healthy volunteers and 103 patients with knee pain. We validated the algorithm by randomly selecting 108 of these 113 subjects for training, and determined Dice similarity coefficients from five other subjects. We constructed a neural network using all data (113 subjects) for training. Cartilage thickness, cartilage volume, and PCAR in the medial femoral, lateral femoral, medial tibial, and lateral tibial regions were quantified by using the trained software on Kanagawa Knee Study data and their relationship with subject height was investigated. We also quantified the medial meniscus coverage ratio (MMCR), defined as the ratio of the overlapping area between the medial meniscus area and the medial tibial cartilage area to the medial tibial cartilage area. Finally, we examined the relationship between MMCR and PCAR at middle central medial tibial (mcMT) subregion located in the center of nine subregions in the medial tibial cartilage. RESULTS Dice similarity coefficients for cartilage and meniscus were both approximately 0.9. The femoral and tibial cartilage thickness and volume at each region correlated with height, but PCAR did not correlate with height in most settings. PCAR at the mcMT was significantly correlated with MMCR. CONCLUSIONS Our software showed high segmentation accuracy for the knee cartilage and meniscus. PCAR was more useful than cartilage thickness or volume since it was less affected by height. Relations ips were observed between the medial tibial cartilage measurements and the medial meniscus extrusion measurements in our cross-sectional study. TRIAL REGISTRATION UMIN, UMIN000032826 ; 1 September 2018.
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Affiliation(s)
- Hayato Aoki
- Center for Stem Cell and Regenerative Medicine, Department of Applied Regenerative Medicine, Tokyo Medical and Dental University, 1-5-45 Yushima, Bunkyo-ku, Tokyo, 113-8510, Japan
| | - Nobutake Ozeki
- Center for Stem Cell and Regenerative Medicine, Department of Applied Regenerative Medicine, Tokyo Medical and Dental University, 1-5-45 Yushima, Bunkyo-ku, Tokyo, 113-8510, Japan
| | - Hisako Katano
- Center for Stem Cell and Regenerative Medicine, Department of Applied Regenerative Medicine, Tokyo Medical and Dental University, 1-5-45 Yushima, Bunkyo-ku, Tokyo, 113-8510, Japan
| | - Akinobu Hyodo
- Center for Stem Cell and Regenerative Medicine, Department of Applied Regenerative Medicine, Tokyo Medical and Dental University, 1-5-45 Yushima, Bunkyo-ku, Tokyo, 113-8510, Japan
| | - Yugo Miura
- Center for Stem Cell and Regenerative Medicine, Department of Applied Regenerative Medicine, Tokyo Medical and Dental University, 1-5-45 Yushima, Bunkyo-ku, Tokyo, 113-8510, Japan
| | - Junpei Matsuda
- Center for Stem Cell and Regenerative Medicine, Department of Applied Regenerative Medicine, Tokyo Medical and Dental University, 1-5-45 Yushima, Bunkyo-ku, Tokyo, 113-8510, Japan
| | - Kimiko Takanashi
- Center for Stem Cell and Regenerative Medicine, Department of Applied Regenerative Medicine, Tokyo Medical and Dental University, 1-5-45 Yushima, Bunkyo-ku, Tokyo, 113-8510, Japan
| | | | | | | | - Takeo Fujiwara
- Department of Global Health Promotion, Tokyo Medical and Dental University, Tokyo, Japan
| | - Ichiro Sekiya
- Center for Stem Cell and Regenerative Medicine, Department of Applied Regenerative Medicine, Tokyo Medical and Dental University, 1-5-45 Yushima, Bunkyo-ku, Tokyo, 113-8510, Japan.
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Babel H, Wägeli L, Sonmez B, Thiran JP, Omoumi P, Jolles BM, Favre J. A Registration Method for Three-Dimensional Analysis of Bone Mineral Density in the Proximal Tibia. J Biomech Eng 2020; 143:1086639. [PMID: 32879939 DOI: 10.1115/1.4048335] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2019] [Indexed: 12/28/2022]
Abstract
Although alterations in bone mineral density (BMD) at the proximal tibia have been suggested to play a role in various musculoskeletal conditions, their pathophysiological implications and their value as markers for diagnosis remain unclear. Improving our understanding of proximal tibial BMD requires novel tools for three-dimensional (3D) analysis of BMD distribution. Three-dimensional imaging is possible with computed tomography (CT), but computational anatomy algorithms are missing to standardize the quantification of 3D proximal tibial BMD, preventing distribution analyses. The objectives of this study were to develop and assess a registration method, suitable with routine knee CT scans, to allow the standardized quantification of 3D BMD distribution in the proximal tibia. Second, as an example of application, the study aimed to characterize the distribution of BMD below the tibial cartilages in healthy knees. A method was proposed to register both the surface (vertices) and the content (voxels) of proximal tibias. The method combines rigid transformations to account for differences in bone size and position in the scanner's field of view and to address inconsistencies in the portion of the tibial shaft included in routine CT scan, with a nonrigid transformation locally matching the proximal tibias. The method proved to be highly reproducible and provided a comprehensive description of the relationship between bone depth and BMD. Specifically it reported significantly higher BMD in the first 6 mm of bone than deeper in the proximal tibia. In conclusion, the proposed method offers promising possibilities to analyze BMD and other properties of the tibia in 3D.
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Affiliation(s)
- Hugo Babel
- Swiss BioMotion Lab, Department of Musculoskeletal Medicine, Lausanne University Hospital and University of Lausanne (CHUV-UNIL), Lausanne CH-1011, Switzerland
| | - Loïc Wägeli
- Swiss BioMotion Lab, Department of Musculoskeletal Medicine, Lausanne University Hospital and University of Lausanne (CHUV-UNIL), Lausanne CH-1011, Switzerland
| | - Berke Sonmez
- Swiss BioMotion Lab, Department of Musculoskeletal Medicine, Lausanne University Hospital and University of Lausanne (CHUV-UNIL), Lausanne CH-1011, Switzerland
| | - Jean-Philippe Thiran
- Signal Processing Laboratory, Ecole Polytechnique Fédérale Lausanne (EPFL), Lausanne CH-1015, Switzerland.,Service of Diagnostic and Interventional Radiology, Lausanne University Hospital and University of Lausanne (CHUV-UNIL), Lausanne CH-1011, Switzerland
| | - Patrick Omoumi
- Service of Diagnostic and Interventional Radiology, Lausanne University Hospital and University of Lausanne (CHUV-UNIL), Lausanne CH-1011, Switzerland
| | - Brigitte M Jolles
- Swiss BioMotion Lab, Department of Musculoskeletal Medicine, Lausanne University Hospital and University of Lausanne (CHUV-UNIL), Lausanne CH-1011, Switzerland.,Institute of Microengineering, Ecole Polytechnique Fédérale Lausanne (EPFL), Lausanne CH-1015, Switzerland
| | - Julien Favre
- Swiss BioMotion Lab, Department of Musculoskeletal Medicine, Lausanne University Hospital and University of Lausanne (CHUV-UNIL), Lausanne CH-1011, Switzerland
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Babel H, Omoumi P, Andriacchi TP, Jolles BM, Favre J. New insight on the subchondral bone and cartilage functional unit: Bone mineral density and cartilage thickness are spatially correlated in non-osteoarthritic femoral condyles. OSTEOARTHRITIS AND CARTILAGE OPEN 2020; 2:100079. [DOI: 10.1016/j.ocarto.2020.100079] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2019] [Accepted: 05/27/2020] [Indexed: 01/02/2023] Open
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Bach Cuadra M, Favre J, Omoumi P. Quantification in Musculoskeletal Imaging Using Computational Analysis and Machine Learning: Segmentation and Radiomics. Semin Musculoskelet Radiol 2020; 24:50-64. [DOI: 10.1055/s-0039-3400268] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
AbstractAlthough still limited in clinical practice, quantitative analysis is expected to increase the value of musculoskeletal (MSK) imaging. Segmentation aims at isolating the tissues and/or regions of interest in the image and is crucial to the extraction of quantitative features such as size, signal intensity, or image texture. These features may serve to support the diagnosis and monitoring of disease. Radiomics refers to the process of extracting large amounts of features from radiologic images and combining them with clinical, biological, genetic, or any other type of complementary data to build diagnostic, prognostic, or predictive models. The advent of machine learning offers promising prospects for automatic segmentation and integration of large amounts of data. We present commonly used segmentation methods and describe the radiomics pipeline, highlighting the challenges to overcome for adoption in clinical practice. We provide some examples of applications from the MSK literature.
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Affiliation(s)
- Meritxell Bach Cuadra
- Department of Radiology, Lausanne University Hospital and University of Lausanne (UNIL), Lausanne, Switzerland
- Centre d'Imagerie BioMédicale (CIBM), Lausanne University Hospital (CHUV) and University of Lausanne (UNIL), Lausanne, Switzerland
- Signal Processing Laboratory (LTS5), École Polytechnique Fédérale de Lausanne (EPFL), Lausanne, Switzerland
| | - Julien Favre
- Swiss BioMotion Lab, Department of Musculoskeletal Medicine, Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland
| | - Patrick Omoumi
- Department of Radiology, Lausanne University Hospital and University of Lausanne (UNIL), Lausanne, Switzerland
- Swiss BioMotion Lab, Department of Musculoskeletal Medicine, Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland
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Omoumi P, Babel H, Jolles BM, Favre J. Relationships between cartilage thickness and subchondral bone mineral density in non-osteoarthritic and severely osteoarthritic knees: In vivo concomitant 3D analysis using CT arthrography. Osteoarthritis Cartilage 2019; 27:621-629. [PMID: 30611905 DOI: 10.1016/j.joca.2018.12.014] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/31/2018] [Revised: 12/18/2018] [Accepted: 12/23/2018] [Indexed: 02/02/2023]
Abstract
OBJECTIVE To test whether subchondral bone mineral density (sBMD) and cartilage thickness (CTh) of femoral condyles are correlated in knees without and with severe medial femorotibial osteoarthritis (OA), using a subregional analysis with computerized tomography (CT) arthrography. METHODS CT arthrograms of 50 non-OA (18 males, 58.7 (interquartile range (IQR) = 6.6 years)) and 50 severe medial OA (24 males, 60.5 (IQR = 10.7) years) knees, were retrospectively analyzed. Bone and cartilage were segmented using custom-designed software, leading to 3D models on which each point of the subchondral surface is given a CTh and sBMD value. The average sBMD and CTh were then calculated for the entire weight-bearing regions as well as specific subregions of interest. Linear bivariate and multivariable analyses were performed to test for relationships between sBMD and CTh (regional and subregional measures, or medial-to-lateral ratios), with confounders of age, gender, femoral bone size and femorotibial angle. RESULTS In non-OA knees, the sBMD and CTh medial-to-lateral ratios were positively correlated for the total region and the external and internal subregions (r ≥ 0.341, P ≤ 0.015). In OA knees, sBMD and CTh medial-to-lateral ratios were negatively correlated for the total region and the external and central subregions (r ≤ -0.538, P < 0.001). Additional positive/negative relationships in the non-OA/OA knees were observed between sBMD and CTh measures in the medial compartment. CONCLUSIONS The positive correlation between sBMD and CTh in non-OA knees, and the negative one in OA knees, bring support to the theory of a subchondral bone/cartilage functional unit, which could help to better understand the pathophysiology of OA.
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Affiliation(s)
- P Omoumi
- Department of Diagnostic and Interventional Radiology, Centre Hospitalier Universitaire and University of Lausanne, Lausanne, Switzerland; Department of Radiology, Cliniques Universitaires St Luc - UC Louvain, Brussels, Belgium; Swiss BioMotion Lab, Department of Musculoskeletal Medicine, Centre Hospitalier Universitaire Vaudois and University of Lausanne, Lausanne, Switzerland.
| | - H Babel
- Swiss BioMotion Lab, Department of Musculoskeletal Medicine, Centre Hospitalier Universitaire Vaudois and University of Lausanne, Lausanne, Switzerland
| | - B M Jolles
- Swiss BioMotion Lab, Department of Musculoskeletal Medicine, Centre Hospitalier Universitaire Vaudois and University of Lausanne, Lausanne, Switzerland; Institute of Micro Engineering, Ecole Polytechnique Fédérale de Lausanne, Lausanne, Switzerland
| | - J Favre
- Swiss BioMotion Lab, Department of Musculoskeletal Medicine, Centre Hospitalier Universitaire Vaudois and University of Lausanne, Lausanne, Switzerland
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Harkey MS, Davis JE, Lu B, Price LL, Eaton CB, Lo GH, Barbe MF, Ward RJ, Zhang M, Liu SH, Lapane KL, MacKay JW, McAlindon TE, Driban JB. Diffuse tibiofemoral cartilage change prior to the development of accelerated knee osteoarthritis: Data from the osteoarthritis initiative. Clin Anat 2018; 32:369-378. [PMID: 30521068 DOI: 10.1002/ca.23321] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2018] [Revised: 11/30/2018] [Accepted: 12/01/2018] [Indexed: 01/23/2023]
Abstract
We compared the spatial distribution of tibiofemoral cartilage change between individuals who will develop accelerated knee osteoarthritis (KOA) versus typical onset of KOA prior to the development of radiographic KOA. We conducted a longitudinal case-control analysis of 129 individuals from the Osteoarthritis Initiative. We assessed the percent change in tibiofemoral cartilage on magnetic resonance images at 36 informative locations from 2 to 1 year prior to the development of accelerated (n = 44) versus typical KOA (n = 40). We defined cartilage change in the accelerated and typical KOA groups at 36 informative locations based on thresholds of cartilage percent change in a no KOA group (n = 45). We described the spatial patterns of cartilage change in the accelerated KOA and typical KOA groups and performed a logistic regression to determine if diffuse cartilage change (predictor; at least half of the tibiofemoral regions demonstrating change in multiple informative locations) was associated with KOA group (outcome). There was a non-significant trend that individuals with diffuse tibiofemoral cartilage change were 2.2 times more likely to develop accelerated knee OA when compared with individuals who develop typical knee OA (OR [95% CI] = 2.2 [0.90-5.14]. Adults with accelerated or typical KOA demonstrate heterogeneity in spatial distribution of cartilage thinning and thickening. These results provide preliminary evidence of a different spatial pattern of cartilage change between individuals who will develop accelerated versus typical KOA. These data suggest there may be different mechanisms driving the early structural disease progression between accelerated versus typical KOA. Clin. Anat. 32:369-378, 2019. © 2018 Wiley Periodicals, Inc.
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Affiliation(s)
- Matthew S Harkey
- Division of Rheumatology, Allergy, and Immunology, Tufts Medical Center, Boston, Massachusetts.,Department of Quantitative Health Sciences, University of Massachusetts Medical School, Worcester, Massachusetts
| | - Julie E Davis
- Division of Rheumatology, Allergy, and Immunology, Tufts Medical Center, Boston, Massachusetts
| | - Bing Lu
- Division of Rheumatology, Immunology and Allergy, Brigham & Women's Hospital and Harvard Medical School, Boston, Massachusetts
| | - Lori Lyn Price
- The Institute for Clinical Research and Health Policy Studies, Tufts Medical Center, Boston, Massachusetts.,Tufts Clinical and Translational Science Institute, Tufts University, Boston, Massachusetts
| | - Charles B Eaton
- Center for Primary Care and Prevention, Alpert Medical School of Brown University, Pawtucket, Rhode Island
| | - Grace H Lo
- Medical Care Line and Research Care Line, Houston Health Services Research and Development (HSR&D) Center of Excellence Michael E. DeBakey VAMC, Houston, Texas.,Section of Immunology, Allergy, and Rheumatology, Baylor College of Medicine, Houston, Texas
| | - Mary F Barbe
- Department of Anatomy and Cell Biology, Temple University School of Medicine, Philadelphia, Pennsylvania
| | - Robert J Ward
- Department of Radiology, Tufts Medical Center, Boston, Massachusetts
| | - Ming Zhang
- Division of Rheumatology, Allergy, and Immunology, Tufts Medical Center, Boston, Massachusetts.,Department of Computer Science and Networking, Wentworth Institute of Technology, Boston, Massachusetts
| | - Shao-Hsien Liu
- Division of Epidemiology of Chronic Diseases and Vulnerable Populations, Department of Quantitative Health Sciences, University of Massachusetts Medical School, Boston, Massachusetts
| | - Kate L Lapane
- Division of Epidemiology of Chronic Diseases and Vulnerable Populations, Department of Quantitative Health Sciences, University of Massachusetts Medical School, Boston, Massachusetts
| | - James W MacKay
- Department of Radiology, University of Cambridge School of Clinical Medicine, Cambridge, United Kingdom
| | - Timothy E McAlindon
- Division of Rheumatology, Allergy, and Immunology, Tufts Medical Center, Boston, Massachusetts
| | - Jeffrey B Driban
- Division of Rheumatology, Allergy, and Immunology, Tufts Medical Center, Boston, Massachusetts
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24
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Slattery CA, Kweon CY, Hagen MS, Gee AO, Williamson RV. Comparison of medial and lateral posterior femoral condyle articular cartilage wear patterns. Knee 2018; 25:1165-1170. [PMID: 30414791 DOI: 10.1016/j.knee.2018.08.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/12/2018] [Revised: 07/30/2018] [Accepted: 08/14/2018] [Indexed: 02/02/2023]
Abstract
BACKGROUND While degenerative changes to the articular cartilage of the anterior and distal portions of the femoral condyles have been well studied in the literature, the changes that occur on the posterior femoral condyle are not as clear. The purpose of this study was to assess the difference in articular cartilage thickness between the medial and lateral posterior femoral condyles in knees undergoing unicompartmental knee arthroplasty. METHODS A retrospective review of prospectively gathered data on 107 consecutive patients undergoing unicompartmental knee arthroplasty performed by a single surgeon was performed. The remaining articular cartilage thickness after resection of the posterior femoral condyle was measured and simple analysis conducted to compare cartilage thickness between medial and lateral posterior femoral condyles. RESULTS Ninety-two medial unicompartmental arthroplasties and 15 lateral unicompartmental arthroplasties were performed during the 16 month study period. The majority of lateral UKA patients were female and had lower BMI than medial UKA patients. The articular cartilage thickness on the medial posterior femoral condyle was 3 mm ± 1 mm (mean ± standard deviation) and 1 mm ± 1 mm on the lateral side (p-value <0.001). CONCLUSIONS There is a significant difference in articular cartilage thickness between the medial and lateral posterior femoral condyles in patients undergoing unicompartmental knee arthroplasty. This coincides with a potentially inherently different pattern of articular cartilage degeneration between the medial and lateral compartments of the knee and has implications on implant designs and resurfacing techniques about the knee.
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Affiliation(s)
- Casey A Slattery
- Department of Orthopaedic Surgery & Sports Medicine, University of Washington, 3800 Montlake Blvd NE, Campus Box 354060, Seattle, WA 98195-4060, USA.
| | - Christopher Y Kweon
- Department of Orthopaedic Surgery & Sports Medicine, University of Washington, 3800 Montlake Blvd NE, Campus Box 354060, Seattle, WA 98195-4060, USA.
| | - Mia S Hagen
- Department of Orthopaedic Surgery & Sports Medicine, University of Washington, 3800 Montlake Blvd NE, Campus Box 354060, Seattle, WA 98195-4060, USA.
| | - Albert O Gee
- Department of Orthopaedic Surgery & Sports Medicine, University of Washington, 3800 Montlake Blvd NE, Campus Box 354060, Seattle, WA 98195-4060, USA.
| | - Richard V Williamson
- Department of Orthopedics and Sports Medicine, Skagit Regional Clinics, 2320 Freeway Drive, Mount Vernon, WA 98273, USA.
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25
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Edd SN, Omoumi P, Andriacchi TP, Jolles BM, Favre J. Modeling knee osteoarthritis pathophysiology using an integrated joint system (IJS): a systematic review of relationships among cartilage thickness, gait mechanics, and subchondral bone mineral density. Osteoarthritis Cartilage 2018; 26:1425-1437. [PMID: 30056214 DOI: 10.1016/j.joca.2018.06.017] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/01/2018] [Revised: 06/08/2018] [Accepted: 06/26/2018] [Indexed: 02/02/2023]
Abstract
OBJECTIVE To introduce an integrated joint system (IJS) model of joint health and osteoarthritis (OA) pathophysiology through a systematic review of the cross-sectional relationships among three knee properties (cartilage thickness, gait mechanics, and subchondral bone mineral density). METHODS Searches using keywords associated with the three knee properties of interest were performed in PubMed, Scopus, and Ovid databases. English-language articles reporting cross-sectional correlations between at least two knee properties in healthy or tibiofemoral OA human knees were included. A narrative synthesis of the data was conducted. RESULTS Of the 5600 retrieved articles, 13 were included, eight of which reported relationships between cartilage thickness and gait mechanics. The 744 tested knees were separated into three categories based on knee health: 199 healthy, 340 at-risk/early OA, and 205 late OA knees. Correlations between knee adduction moment and medial-to-lateral cartilage thickness ratios were generally positive in healthy, inconclusive in at-risk/early OA, and negative in late OA knees. Knee adduction moment was positively correlated with medial-to-lateral tibial subchondral bone mineral density ratios in knees of all health categories. One study reported a positive correlation between lateral tibial subchondral bone mineral density and femoral cartilage thickness in at-risk/early OA knees. CONCLUSIONS The correlations identified between knee properties in this review agreed with the proposed relationship-based IJS model of OA pathophysiology. Accordingly, the IJS model could provide insights into overcoming current barriers to developing disease-modifying treatments by considering multiple aspects of OA disease, aspects that could be assessed simultaneously at an in vivo system level.
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Affiliation(s)
- S N Edd
- Centre Hospitalier Universitaire Vaudois (CHUV), University of Lausanne (UNIL), Department of Musculoskeletal Medicine (DAL), Swiss BioMotion Lab, Lausanne, Switzerland.
| | - P Omoumi
- Centre Hospitalier Universitaire Vaudois (CHUV), University of Lausanne (UNIL), Department of Diagnostic and Interventional Radiology, Lausanne, Switzerland.
| | - T P Andriacchi
- Department of Mechanical Engineering, Stanford, CA, USA; Palo Alto Veterans Affairs, Palo Alto, CA, USA; Department of Orthopaedic Surgery, Stanford University Medical Center, Stanford, CA, USA.
| | - B M Jolles
- Centre Hospitalier Universitaire Vaudois (CHUV), University of Lausanne (UNIL), Department of Musculoskeletal Medicine (DAL), Swiss BioMotion Lab, Lausanne, Switzerland; Ecole Polytechnique Fédérale de Lausanne (EPFL), Institute of Microengineering, Lausanne, Switzerland.
| | - J Favre
- Centre Hospitalier Universitaire Vaudois (CHUV), University of Lausanne (UNIL), Department of Musculoskeletal Medicine (DAL), Swiss BioMotion Lab, Lausanne, Switzerland.
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26
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Mezlini‐Gharsallah H, Youssef R, Uk S, Laredo JD, Chappard C. Three-dimensional mapping of the joint space for the diagnosis of knee osteoarthritis based on high resolution computed tomography: Comparison with radiographic, outerbridge, and meniscal classifications. J Orthop Res 2018; 36:2380-2391. [PMID: 29663495 PMCID: PMC6175338 DOI: 10.1002/jor.24015] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/27/2017] [Accepted: 03/30/2018] [Indexed: 02/04/2023]
Abstract
One of the most important characteristic of knee osteoarthritis (OA) is the joint space (JS) width narrowing. Measurements are usually performed on two dimensional (2D) X-rays. We propose and validate a new method to assess the 3D joint space at the medial knee compartment using high resolution peripheral computed tomography images. A semi-automated method was developed to obtain a distance 3D map between femur an tibia with the following parameters: volume, minimum, maximum, mean, standard deviation, median, asymmetry, and entropy. We analyzed 71 knee specimens (mean age: 85 years), radiographs were performed for the Kellgren Lawrence (KL) score grading. In a subgroup of 41 specimens, the histopathological Outerbridge and meniscal classifications were performed and then cores were harvested from the tibial plateau in three different positions (posterior, central, and peripheral) and imaged at 10 µm of resolution to measure the cartilage thickness. Minimum, maximum, mean, and median were statistically lower and entropy higher between knee specimens classified as KL = 0 and KL = 3-4. Gr1 and 2 were statistically different from Gr3-4 for minimum, asymmetry, entropy using the Outerbridge classification and Gr1 was statistically different from Gr3-4 using the meniscal classification. Asymmetry, minimum, mean, median and entropy were significantly correlated with cartilage thickness. Parameters extracted from a 3D map of the medial joint space indicate local variations of JS and are related to local measurements of tibial cartilage thickness, and could be consequently useful to identify early OA. © 2018 The Authors. Journal of Orthopaedic Research® Published by Wiley Periodicals, Inc. on behalf of Orthopaedic Research Society. J Orthop Res 36:2380-2391, 2018.
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Affiliation(s)
- Houda Mezlini‐Gharsallah
- B2OA UMR 7052 CNRS Paris Diderot University10 Avenue de Verdun 75010 Paris,Sorbonne Paris CitéParisFrance
| | - Rabaa Youssef
- CEA Linklab Site El Ghazala Technopark 2088 Ariana TunisTunisia,COSIM, Carthage UniversityCarthageTunisia
| | - Stéphanie Uk
- B2OA UMR 7052 CNRS Paris Diderot University10 Avenue de Verdun 75010 Paris,Sorbonne Paris CitéParisFrance
| | - Jean D. Laredo
- B2OA UMR 7052 CNRS Paris Diderot University10 Avenue de Verdun 75010 Paris,Sorbonne Paris CitéParisFrance,Radiology Department Hospital Lariboisière2 Rue Ambroise Paré 75475 Paris Cédex 10, Sorbonne Paris CitéFrance
| | - Christine Chappard
- B2OA UMR 7052 CNRS Paris Diderot University10 Avenue de Verdun 75010 Paris,Sorbonne Paris CitéParisFrance
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27
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Method for Segmentation of Knee Articular Cartilages Based on Contrast-Enhanced CT Images. Ann Biomed Eng 2018; 46:1756-1767. [PMID: 30132213 DOI: 10.1007/s10439-018-2081-z] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2018] [Accepted: 06/20/2018] [Indexed: 12/22/2022]
Abstract
Segmentation of contrast-enhanced computed tomography (CECT) images enables quantitative evaluation of morphology of articular cartilage as well as the significance of the lesions. Unfortunately, automatic segmentation methods for CECT images are currently lacking. Here, we introduce a semiautomated technique to segment articular cartilage from in vivo CECT images of human knee. The segmented cartilage geometries of nine knee joints, imaged using a clinical CT-scanner with an intra-articular contrast agent, were compared with manual segmentations from CT and magnetic resonance (MR) images. The Dice similarity coefficients (DSCs) between semiautomatic and manual CT segmentations were 0.79-0.83 and sensitivity and specificity values were also high (0.76-0.86). When comparing semiautomatic and manual CT segmentations, mean cartilage thicknesses agreed well (intraclass correlation coefficient = 0.85-0.93); the difference in thickness (mean ± SD) was 0.27 ± 0.03 mm. Differences in DSC, when MR segmentations were compared with manual and semiautomated CT segmentations, were statistically insignificant. Similarly, differences in volume were not statistically significant between manual and semiautomatic CT segmentations. Semiautomation decreased the segmentation time from 450 ± 190 to 42 ± 10 min per joint. The results reveal that the proposed technique is fast and reliable for segmentation of cartilage. Importantly, this is the first study presenting semiautomated segmentation of cartilage from CECT images of human knee joint with minimal user interaction.
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28
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Baboli R, Sharafi A, Chang G, Regatte RR. Isotropic morphometry and multicomponent T 1 ρ mapping of human knee articular cartilage in vivo at 3T. J Magn Reson Imaging 2018; 48:1707-1716. [PMID: 29717787 DOI: 10.1002/jmri.26173] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2018] [Accepted: 04/13/2018] [Indexed: 12/14/2022] Open
Abstract
BACKGROUND The progressive loss of hyaline articular cartilage due to osteoarthritis (OA) changes the functional and biochemical properties of cartilage. Measuring the T1 ρ along with the morphological assessment can potentially be used as noninvasive biomarkers in detecting early-stage OA. To correlate the biochemical and morphological data, submillimeter isotropic resolution for both studies is required. PURPOSE To implement a high spatial resolution 3D-isotropic-MRI sequence for simultaneous assessment of morphological and biexponential T1 ρ relaxometry of human knee cartilage in vivo. STUDY TYPE Prospective. POPULATION Ten healthy volunteers with no known inflammation, trauma, or pain in the knee. FIELD STRENGTH/SEQUENCE Standard FLASH sequence and customized Turbo-FLASH sequence to acquire 3D-isotropic-T1 ρ-weighted images on a 3T MRI scanner. ASSESSMENT The mean volume and thickness along with mono- and biexponential T1 ρ relaxations were assessed in the articular cartilage of 10 healthy volunteers. STATISTICAL TESTS Nonparametric rank-sum tests. Bland-Altman analysis and coefficient of variation. RESULTS The mean monoexponential T1 ρ relaxation was 40.7 ± 4.8 msec, while the long and short components were 58.2 ± 3.9 msec and 6.5 ± 0.6 msec, respectively. The mean fractions of long and short T1 ρ relaxation components were 63.7 ± 5.9% and 36.3 ± 5.9%, respectively. Statistically significant (P ≤ 0.03) differences were observed in the monoexponential and long components between some of the regions of interest (ROIs). No gender differences between biexponential components were observed (P > 0.05). Mean cartilage volume and thickness were 25.9 ± 6.4 cm3 and 2.2 ± 0.7 mm, respectively. Cartilage volume (P = 0.01) and thickness (P = 0.03) were significantly higher in male than female participants across all ROIs. Bland-Altman analysis showed agreement between two morphological methods with limits of agreement between -1000 mm3 and +1100 mm3 for volume, and -0.78 mm and +0.46 mm for thickness, respectively. DATA CONCLUSION Simultaneous assessment of morphological and multicomponent T1 ρ relaxation of knee joint with 0.7 × 0.7 × 0.7 mm isotropic spatial resolution is demonstrated in vivo. Comparison with a standard method showed that the proposed technique is suitable for assessing the volume and thickness of articular cartilage. LEVEL OF EVIDENCE 2 Technical Efficacy: Stage 1 J. Magn. Reson. Imaging 2018;48:1707-1716.
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Affiliation(s)
- Rahman Baboli
- Bernard and Irene Schwartz Center for Biomedical Imaging, Department of Radiology, New York University School of Medicine, New York, New York, USA
| | - Azadeh Sharafi
- Bernard and Irene Schwartz Center for Biomedical Imaging, Department of Radiology, New York University School of Medicine, New York, New York, USA
| | - Gregory Chang
- Bernard and Irene Schwartz Center for Biomedical Imaging, Department of Radiology, New York University School of Medicine, New York, New York, USA
| | - Ravinder R Regatte
- Bernard and Irene Schwartz Center for Biomedical Imaging, Department of Radiology, New York University School of Medicine, New York, New York, USA
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29
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Omoumi P, Babel H, Jolles BM, Favre J. Cartilage can be thicker in advanced osteoarthritic knees: a tridimensional quantitative analysis of cartilage thickness at posterior aspect of femoral condyles. Br J Radiol 2018; 91:20170729. [PMID: 29595325 DOI: 10.1259/bjr.20170729] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022] Open
Abstract
OBJECTIVE To test, through tridimensional analysis, whether (1) cartilage thickness at the posterior aspect of femoral condyles differs in knees with medial femorotibial osteoarthritis (OA) compared to non-OA knees; (2) the location of the thickest cartilage at the posterior aspect of femoral condyles differs between OA and non-OA knees. METHODS CT arthrograms of knees without radiographic OA (n = 30) and with severe medial femorotibial OA (n = 30) were selected retrospectively from patients over 50 years of age. The groups did not differ in gender, age and femoral size. CT arthrograms were segmented to measure the mean cartilage thickness, the maximal cartilage thickness and its location in a region of interest at the posterior aspect of condyles. RESULTS For the medial condyle, mean and maximum cartilage thicknesses were statistically significantly higher in OA knees compared to non-OA knees [1.66 vs 1.46 mm (p = 0.03) and 2.56 vs 2.14 mm (p = 0.003), respectively]. The thickest cartilage was located in the half most medial aspect of the posterior medial condyle for both groups, without significant difference between groups. For the lateral condyle, no statistically significant difference between non-OA and OA knees was found (p ≥ 0.17). CONCLUSION Cartilage at the posterior aspect of the medial condyle, but not the lateral condyle, is statistically significantly thicker in advanced medial femorotibial OA knees compared to non-OA knees. The thickest cartilage was located in the half most medial aspect of the posterior medial condyle. These results will serve as the basis for future research to determine the histobiological processes involved in this thicker cartilage. Advances in knowledge: This study, through a quantitative tridimensional approach, shows that cartilage at the posterior aspect of the medial condyles is thicker in severe femorotibial osteoarthritic knees compared to non-OA knees. In the posterior aspect of the medial condyle, the thickest cartilage is located in the vicinity of the center of the half most medial aspect of the posterior medial condyle. These results will serve as the basis for future research to determine the histobiological processes involved in this thicker cartilage.
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Affiliation(s)
- Patrick Omoumi
- 1 Department of Diagnostic and Interventional Radiology, Centre Hospitalier Universitaire and University of Lausanne , Lausanne , Switzerland.,2 Department of Radiology, Cliniques Universitaires St Luc - UC Louvain , Brussels , Belgium.,3 Department of Musculoskeletal Medicine, Swiss BioMotion Lab, Centre Hospitalier Universitaire Vaudois and University of Lausanne , Lausanne , Switzerland
| | - Hugo Babel
- 3 Department of Musculoskeletal Medicine, Swiss BioMotion Lab, Centre Hospitalier Universitaire Vaudois and University of Lausanne , Lausanne , Switzerland
| | - Brigitte M Jolles
- 3 Department of Musculoskeletal Medicine, Swiss BioMotion Lab, Centre Hospitalier Universitaire Vaudois and University of Lausanne , Lausanne , Switzerland.,4 Institute of Microengineering, Ecole Polytechnique Fédérale de Lausanne , Lausanne , Switzerland
| | - Julien Favre
- 3 Department of Musculoskeletal Medicine, Swiss BioMotion Lab, Centre Hospitalier Universitaire Vaudois and University of Lausanne , Lausanne , Switzerland
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30
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Zeighami A, Aissaoui R, Dumas R. Knee medial and lateral contact forces in a musculoskeletal model with subject-specific contact point trajectories. J Biomech 2018; 69:138-145. [PMID: 29397108 DOI: 10.1016/j.jbiomech.2018.01.021] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2017] [Revised: 01/08/2018] [Accepted: 01/14/2018] [Indexed: 01/27/2023]
Abstract
Contact point (CP) trajectory is a crucial parameter in estimating medial/lateral tibio-femoral contact forces from the musculoskeletal (MSK) models. The objective of the present study was to develop a method to incorporate the subject-specific CP trajectories into the MSK model. Ten healthy subjects performed 45 s treadmill gait trials. The subject-specific CP trajectories were constructed on the tibia and femur as a function of extension-flexion using low-dose bi-plane X-ray images during a quasi-static squat. At each extension-flexion position, the tibia and femur CPs were superimposed in the three directions on the medial side, and in the anterior-posterior and proximal-distal directions on the lateral side to form the five kinematic constraints of the knee joint. The Lagrange multipliers associated to these constraints directly yielded the medial/lateral contact forces. The results from the personalized CP trajectory model were compared against the linear CP trajectory and sphere-on-plane CP trajectory models which were adapted from the commonly used MSK models. Changing the CP trajectory had a remarkable impact on the knee kinematics and changed the medial and lateral contact forces by 1.03 BW and 0.65 BW respectively, in certain subjects. The direction and magnitude of the medial/lateral contact force were highly variable among the subjects and the medial-lateral shift of the CPs alone could not determine the increase/decrease pattern of the contact forces. The suggested kinematic constraints are adaptable to the CP trajectories derived from a variety of joint models and those experimentally measured from the 3D imaging techniques.
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Affiliation(s)
- A Zeighami
- Laboratoire de Recherche en Imagerie et Orthopédie (LIO), École de Technologie Supérieure (ÉTS), Center de Recherche du CHUM, Montréal, Québec, Canada.
| | - R Aissaoui
- Laboratoire de Recherche en Imagerie et Orthopédie (LIO), École de Technologie Supérieure (ÉTS), Center de Recherche du CHUM, Montréal, Québec, Canada.
| | - R Dumas
- Université Lyon, Université Claude Bernard Lyon 1, IFSTTAR, UMR_T9406, LBMC, F69622 Lyon, France.
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31
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Hadjab I, Sim S, Karhula SS, Kauppinen S, Garon M, Quenneville E, Lavigne P, Lehenkari PP, Saarakkala S, Buschmann MD. Electromechanical properties of human osteoarthritic and asymptomatic articular cartilage are sensitive and early detectors of degeneration. Osteoarthritis Cartilage 2018; 26:405-413. [PMID: 29229562 DOI: 10.1016/j.joca.2017.12.002] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/25/2017] [Revised: 11/18/2017] [Accepted: 12/04/2017] [Indexed: 02/02/2023]
Abstract
OBJECTIVE To evaluate cross-correlations of ex vivo electromechanical properties with cartilage and subchondral bone plate thickness, as well as their sensitivity and specificity regarding early cartilage degeneration in human tibial plateau. METHOD Six pairs of tibial plateaus were assessed ex vivo using an electromechanical probe (Arthro-BST) which measures a quantitative parameter (QP) reflecting articular cartilage compression-induced streaming potentials. Cartilage thickness was then measured with an automated thickness mapping technique using Mach-1 multiaxial mechanical tester. Subsequently, a visual assessment was performed by an experienced orthopedic surgeon using the International Cartilage Repair Society (ICRS) grading system. Each tibial plateau was finally evaluated with μCT scanner to determine the subchondral-bone plate thickness over the entire surface. RESULTS Cross-correlations between assessments decreased with increasing degeneration level. Moreover, electromechanical QP and subchondral-bone plate thickness increased strongly with ICRS grade (ρ = 0.86 and ρ = 0.54 respectively), while cartilage thickness slightly increased (ρ = 0.27). Sensitivity and specificity analysis revealed that the electromechanical QP is the most performant to distinguish between different early degeneration stages, followed by subchondral-bone plate thickness and then cartilage thickness. Lastly, effect sizes of cartilage and subchondral-bone properties were established to evaluate whether cartilage or bone showed the most noticeable changes between normal (ICRS 0) and each early degenerative stage. Thus, the effect sizes of cartilage electromechanical QP were almost twice those of the subchondral-bone plate thickness, indicating greater sensitivity of electromechanical measurements to detect early osteoarthritis. CONCLUSION The potential of electromechanical properties for the diagnosis of early human cartilage degeneration was highlighted and supported by cartilage thickness and μCT assessments.
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Affiliation(s)
- I Hadjab
- Biomedical Engineering Institute, Polytechnique Montreal, Montreal, QC, Canada; Biomomentum Inc., 970 Michelin St., Suite 200, Laval, QC H7L 5C1, Canada.
| | - S Sim
- Biomedical Engineering Institute, Polytechnique Montreal, Montreal, QC, Canada; Biomomentum Inc., 970 Michelin St., Suite 200, Laval, QC H7L 5C1, Canada.
| | - S S Karhula
- Research Unit of Medical Imaging, Physics and Technology, Faculty of Medicine, University of Oulu, Finland; Infotech Oulu, University of Oulu, Finland.
| | - S Kauppinen
- Research Unit of Medical Imaging, Physics and Technology, Faculty of Medicine, University of Oulu, Finland.
| | - M Garon
- Biomomentum Inc., 970 Michelin St., Suite 200, Laval, QC H7L 5C1, Canada.
| | - E Quenneville
- Biomomentum Inc., 970 Michelin St., Suite 200, Laval, QC H7L 5C1, Canada.
| | - P Lavigne
- Department of Surgery, University of Montreal, Montreal, QC, Canada.
| | - P P Lehenkari
- Research Unit of Medical Imaging, Physics and Technology, Faculty of Medicine, University of Oulu, Finland; Department of Surgery and Intensive Care, University of Oulu and Oulu University Hospital, Finland.
| | - S Saarakkala
- Research Unit of Medical Imaging, Physics and Technology, Faculty of Medicine, University of Oulu, Finland; Department of Diagnostic Radiology, Oulu University Hospital, Oulu, Finland; Medical Research Center Oulu, Oulu University Hospital and University of Oulu, Finland.
| | - M D Buschmann
- Biomedical Engineering Institute, Polytechnique Montreal, Montreal, QC, Canada.
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32
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Das Neves Borges P, Vincent TL, Marenzana M. Application of autofluorescence robotic histology for quantitative evaluation of the 3-dimensional morphology of murine articular cartilage. Microsc Res Tech 2017; 80:1351-1360. [PMID: 28963813 PMCID: PMC5725668 DOI: 10.1002/jemt.22948] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2017] [Revised: 09/04/2017] [Accepted: 09/18/2017] [Indexed: 12/17/2022]
Abstract
Murine models of osteoarthritis (OA) are increasingly important for understating pathogenesis and for testing new therapeutic approaches. Their translational potential is, however, limited by the reduced size of mouse limbs which requires a much higher resolution to evaluate their articular cartilage compared to clinical imaging tools. In experimental models, this tissue has been predominantly assessed by time-consuming histopathology using standardized semi-quantitative scoring systems. This study aimed to develop a novel imaging method for 3-dimensional (3D) histology of mouse articular cartilage, using a robotic system-termed here "3D histocutter"-which automatically sections tissue samples and serially acquires fluorescence microscopy images of each section. Tibiae dissected from C57Bl/6 mice, either naïve or OA-induced by surgical destabilization of the medial meniscus (DMM), were imaged using the 3D histocutter by exploiting tissue autofluorescence. Accuracy of 3D imaging was validated by ex vivo contrast-enhanced micro-CT and sensitivity to lesion detection compared with conventional histology. Reconstructions of tibiae obtained from 3D histocutter serial sections showed an excellent agreement with contrast-enhanced micro-CT reconstructions. Furthermore, osteoarthritic features, including articular cartilage loss and osteophytes, were also visualized. An in-house developed software allowed to automatically evaluate articular cartilage morphology, eliminating the subjectivity associated to semi-quantitative scoring and considerably increasing analysis throughput. The novelty of this methodology is, not only the increased throughput in imaging and evaluating mouse articular cartilage morphology starting from conventionally embedded samples, but also the ability to add the third dimension to conventional histomorphometry which might be useful to improve disease assessment in the model.
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Affiliation(s)
| | - Tonia L Vincent
- Kennedy Institute of Rheumatology, Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford, Roosevelt Drive, Oxford, United Kingdom
| | - Massimo Marenzana
- Department of Bioengineering, Imperial College London, London, United Kingdom.,Kennedy Institute of Rheumatology, Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford, Roosevelt Drive, Oxford, United Kingdom
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Colotti R, Omoumi P, Bonanno G, Ledoux JB, van Heeswijk RB. Isotropic three-dimensionalT2mapping of knee cartilage: Development and validation. J Magn Reson Imaging 2017; 47:362-371. [DOI: 10.1002/jmri.25755] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2017] [Accepted: 04/18/2017] [Indexed: 12/25/2022] Open
Affiliation(s)
- Roberto Colotti
- Department of Radiology; University Hospital (CHUV) and University of Lausanne (UNIL); Lausanne Switzerland
| | - Patrick Omoumi
- Department of Radiology; University Hospital (CHUV) and University of Lausanne (UNIL); Lausanne Switzerland
| | - Gabriele Bonanno
- Department of Radiology; University Hospital (CHUV) and University of Lausanne (UNIL); Lausanne Switzerland
- Division of Cardiology, Department of Medicine; Johns Hopkins University; Baltimore Maryland USA
- Division of MR Research, Russell Morgan Department of Radiology and Radiological Sciences; Johns Hopkins University; Baltimore Maryland USA
| | - Jean-Baptiste Ledoux
- Department of Radiology; University Hospital (CHUV) and University of Lausanne (UNIL); Lausanne Switzerland
- Centre for Biomedical Imaging (CIBM); Lausanne Switzerland
| | - Ruud B. van Heeswijk
- Department of Radiology; University Hospital (CHUV) and University of Lausanne (UNIL); Lausanne Switzerland
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