Signal intensity alteration and maximal area of pericruciate fat pad are associated with incident radiographic osteoarthritis: data from the Osteoarthritis Initiative

Integration of Anterior and Posterior Ultrasonography for Comprehensive Anterior Cruciate Ligament Visualization: A Novel Approach

OBJECTIVE

Alternative medical imaging techniques are necessary to address the limitations of magnetic resonance imaging (MRI). Therefore, this study aimed to develop an ultrasonographic method that integrates anterior and posterior approaches for measuring the entire length of the anterior cruciate ligament (ACL). We validated this method by identifying the middle ACL during arthroscopy and comparing the results to those of MRI. We hypothesized that the ACL length measurements obtained via ultrasonography and MRI would not differ significantly and that the posterior approach would provide a longer visual field of the ACL than the anterior approach.

METHODS

Thirty-six patients (21 males, 15 females) diagnosed with meniscal injury or internal knee derangement were included. During arthroscopy, the surgeon identified the middle ACL using Ti-Cron™ sutures. Ultrasonographic approaches from the anterior and posterior perspectives were used to identify the distal and proximal ACL, respectively. The ACL length was measured using both ultrasonography and MRI, and the visual fields from both approaches were compared.

RESULTS

One participant was excluded because of a torn ACL, and seven participants were excluded because of poor ultrasonographic image quality. The ACL length of the 28 included patients did not differ significantly between ultrasonography and MRI, with a moderate correlation between the two measurements. The visualized proportion of the ACL was greater through the posterior approach than through the anterior approach.

CONCLUSIONS

This ultrasonographic method visualizes the entire ACL length by combining anterior and posterior approaches, with the posterior offering a more extensive and clinically significant visual field.

Diagnostic Value of Pericruciate Fat Pad Measurement by MRI in Patients With Knee Articular Cartilage Injury

Aims/Background The diagnosis and treatment of knee joint injuries is an important medical topic. Magnetic resonance imaging (MRI) technology can aid in the clear visualization of the knee joint's internal structure. The correlation of pericruciate fat pad (PCFP) grading with cartilage injuries offers guidance in condition assessment and treatment. Therefore, this study aimed to investigate the value of MRI measurement of PCFP in the diagnosis and assessment of patients with knee cartilage injuries. Methods A total of 210 patients who underwent knee MRI examination in our hospital from January 2022 to June 2024 were retrospectively selected. All MRI examinations were conducted in accordance with a set of unified parameter standards, and the general data of patients were collected and analyzed. The relationship between PCFP grading and injury of various parts was analyzed, and the efficacy analysis of PCFP grading in diagnosing injury was analyzed. Results The comparison of the infrapatellar fat pad (IPFP)_Fat Fraction (FF) value, PCFP_FF value, and PCFP_Transverse Relaxation Time (T2) value between the two groups of patients revealed significant differences (p < 0.05). The results of binary logistic regression analysis showed that the FF value and T2 value of PCFP were independent influencing factors for knee cartilage injury (p < 0.05). According to Pearson correlation results, PCFP was positively correlated with injuries to the medial femoral ankle, medial compartment, and lateral femoral ankle (r = 0.293, 0.335, 0.277, p < 0.05). Using arthroscopy results as the gold standard, we found that the PCFP grading-based diagnosis had a sensitivity of 92.86% (130/140), a specificity of 95.71% (67/70), and an accuracy of 93.81% (197/210). In terms of different grades, PCFP grading has an accuracy rate of 95.17% in grade 0 diagnosis, 93.55% in grade 1, 95.71% in grade 2, 90.00% in grade 3, and 77.77% in grade 4. Conclusion MRI measurement of PCFP is highly sensitive, specific and accurate in the diagnosis of patients with knee articular cartilage injury, with a high accuracy in grading injuries, which is helpful for clinical diagnosis.

Ultrasound findings of unplanned extraction of tunneled central venous catheters due to complications within subcutaneous tissue

PURPOSE

Tunneled central venous catheters (CVC) are essential medical devices for pediatric patients facing extended treatment periods. This study aimed to demonstrate the usefulness of ultrasound in evaluating complications in subcutaneous tissue associated with unplanned extraction of tunneled CVC.

METHODS

Twenty-five patients who underwent ultrasound examination for suspected complications in the subcutaneous tissue associated with tunneled areas from CVC were included. The following patient characteristics and imaging findings were evaluated: infection in subcutaneous tissue, high echogenicity and hypoechoic effusion around the catheter within the subcutaneous tissue, and hyperechoic foci around the catheter. Patients with CVC were classified into two groups: those with and those without unplanned extraction of tunneled CVC. Fisher's exact test was used to compare the two groups.

RESULTS

Nine patients had unplanned extraction of tunneled CVC. A significant difference was found in infection at tunneled areas (presence/absence in patients with vs. those without unplanned extraction = 7/2 vs. 2/14, P = 0.002), as well as in hypoechoic effusion around the catheter within the subcutaneous tissues (presence/absence in patients with vs. those without unplanned extraction = 9/0 vs. 3/13, P < 0.001). However, no significant differences were found in the presence or absence of high echogenicity (presence/absence in patients with vs. those without unplanned extraction = 7/2 vs. 6/10, P = 0.097) or hyperechoic foci around the catheter (presence/absence in patients with vs. those without unplanned extraction = 3/6 vs. 1/15, P = 0.116).

CONCLUSION

The ultrasound findings were useful for determining the necessity of tunneled CVC extraction. These results will be helpful for improving management of pediatric patients with CVC.

Qualitative and Quantitative Measures in the Infrapatellar Fat Pad in Older Adults: Associations with Knee Pain, Radiographic Osteoarthritis, Kinematics, and Kinetics of the Knee

RATIONALE AND OBJECTIVES

The purpose of this study is to delineate cross-sectional associations between qualitative and quantitative measures of the infrapatellar fat pad (IPFP) and knee symptoms, structure, kinematics, and kinetics in older adults.

METHODS

Ninety eligible subjects (90 knees, mean age 54.0 years, 68.9% female) were examined at our center. We used T2-weighted fat-suppressed magnetic resonance imaging (MRI) to evaluate signal intensity alteration, maximum sagittal area, and depth of the IPFP. Symptomatic osteoarthritis (SOA) was a pain subscale score greater than 0 on the Western Ontario McMaster Osteoarthritis Index. A Kellgren-Lawrence grade ≥ 2 identified incident radiographic osteoarthritis (iROA). Three-dimensional gait data were employed to analyze knee joint kinematics and kinetics. Correlation and regression analyzes assessed associations between IPFP measurements and SOA, iROA, kinematics, and kinetics.

RESULTS

There were strong and positive associations between IPFP signal intensity alteration and both SOA and iROA in multivariable regression analyzes [OR (95% CI): 2.849 (1.440 to 5.636), 2.356 (1.236 to 4.492), respectively]. Conversely, a significant negative correlation was observed between IPFP maximum area and flexion angle [B (95%CI): - 1.557 (-2.549 to -0.564)]. Moreover, adjusting for covariates did not reveal any significant correlation between IPFP parameters and other indicators (P > 0.05, respectively).

CONCLUSION

IPFP signal intensity alteration and area were associated with knee clinical symptoms, structural abnormalities, and flexion angle in adults over 40, respectively. These findings suggest that IPFP may be a crucial imaging biomarker in early and middle knee osteoarthritis.

Radiomics analysis using magnetic resonance imaging of bone marrow edema for diagnosing knee osteoarthritis

This study aimed to develop and validate a bone marrow edema model using a magnetic resonance imaging-based radiomics nomogram for the diagnosis of osteoarthritis. Clinical and magnetic resonance imaging (MRI) data of 302 patients with and without osteoarthritis were retrospectively collected from April 2022 to October 2023 at Longhua Hospital affiliated with the Shanghai University of Traditional Chinese Medicine. The participants were randomly divided into two groups (a training group, n = 211 and a testing group, n = 91). We used logistic regression to analyze clinical characteristics and established a clinical model. Radiomics signatures were developed by extracting radiomic features from the bone marrow edema area using MRI. A nomogram was developed based on the rad-score and clinical characteristics. The diagnostic performance of the three models was compared using the receiver operating characteristic curve and Delong's test. The accuracy and clinical application value of the nomogram were evaluated using calibration curve and decision curve analysis. Clinical characteristics such as age, radiographic grading, Western Ontario and McMaster Universities Arthritis Index score, and radiological features were significantly correlated with the diagnosis of osteoarthritis. The Rad score was constructed from 11 radiological features. A clinical model was developed to diagnose osteoarthritis (training group: area under the curve [AUC], 0.819; testing group: AUC, 0.815). Radiomics models were used to effectively diagnose osteoarthritis (training group,: AUC, 0.901; testing group: AUC, 0.841). The nomogram model composed of Rad score and clinical characteristics had better diagnostic performance than a simple clinical model (training group: AUC, 0.906; testing group: AUC, 0.845; p < 0.01). Based on DCA, the nomogram model can provide better diagnostic performance in most cases. In conclusion, the MRI-bone marrow edema-based radiomics-clinical nomogram model showed good performance in diagnosing early osteoarthritis.

Abnormalities of the pericruciate fat pad: Correlations with the location and severity of chondral lesions of the knee

PURPOSE

The aim of this study was to evaluate the relationship between the grade of signal change of the pericruciate fat pad (PCFP) and the location and severity of cartilage alterations in the knee on magnetic resonance imaging (MRI).

MATERIALS AND METHODS

This retrospective study included 234 patients (M:F = 96:138, mean: 51 years) who underwent knee MRI. Two experienced musculoskeletal radiologists assessed any PCFP alterations (as grades 0-3) and chondral lesions using the modified Outerbridge grade (as grades 0-4). Bone marrow lesions (BMLs), meniscal status, anterior cruciate ligament alterations, and effusion-synovitis were also evaluated on the MRI. The relationships between PCFP alteration and MR findings (including the grade of chondral lesion) were evaluated.

RESULTS

Signal changes in the PCFP were detected in 150 cases by Reader 1 (grade 0, 67 cases; grade 1, 53 cases; grade 2, 21 cases; grade 3, 9 cases) and in 154 cases by Reader 2 (grade 0, 59 cases; grade 1, 61 cases; grade 2, 24 cases; grade 3, 10 cases). The grade of PCFP signal change was statistically significantly correlated with the grade of the chondral lesion of the medial femoral condyle (MFC) (p = 0.029 and p = 0.003, respectively) and the medial tibial plateau (MTP) (p = 0.045, p = 0.002, Readers 1 and 2, respectively). The grade of PCFP signal change was significantly correlated with the grade of the BMLs of the MFC, MTP, and lateral femoral condyle (p < 0.05) for both readers. PCFP alteration was related to effusion-synovitis and tears of the medial meniscus.

CONCLUSIONS

The grade of PCFP signal change was correlated with the severity of the cartilage alteration in the medial compartment of the knee joint and was also correlated with BMLs in the medial compartment, medial meniscal tears, and synovitis. Therefore, signal change in the PFCP seen on MRI can be an additional clue of the presence of osteoarthritis in the knee, particularly in the medial compartment.

Bone marrow lesions in osteoarthritis: From basic science to clinical implications

Osteoarthritis (OA) is the most prevalent musculoskeletal disease characterized by multiple joint structure damages, including articular cartilage, subchondral bone and synovium, resulting in disability and economic burden. Bone marrow lesions (BMLs) are common and important magnetic resonance imaging (MRI) features in OA patients. Basic and clinical research on subchondral BMLs in the pathogenesis of OA has been a hotspot. New evidence shows that subchondral bone degeneration, including BML and angiogenesis, occurs not only at or after cartilage degeneration, but even earlier than cartilage degeneration. Although BMLs are recognized as important biomarkers for OA, their exact roles in the pathogenesis of OA are still unclear, and disputes about the clinical impact and treatment of BMLs remain. This review summarizes the current basic and clinical research progress of BMLs. We particularly focus on molecular pathways, cellular abnormalities and microenvironmental changes of subchondral bone that contributed to the formation of BMLs, and emphasize the crosstalk between subchondral bone and cartilage in OA development. Finally, potential therapeutic strategies targeting BMLs in OA are discussed, which provides novel strategies for OA treatment.