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Orava H, Paakkari P, Jäntti J, Honkanen MKM, Honkanen JTJ, Virén T, Joenathan A, Tanska P, Korhonen RK, Grinstaff MW, Töyräs J, Mäkelä JTA. Triple contrast computed tomography reveals site-specific biomechanical differences in the human knee joint-A proof of concept study. J Orthop Res 2024; 42:415-424. [PMID: 37593815 DOI: 10.1002/jor.25683] [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: 04/26/2023] [Revised: 07/05/2023] [Accepted: 08/14/2023] [Indexed: 08/19/2023]
Abstract
Cartilage and synovial fluid are challenging to observe separately in native computed tomography (CT). We report the use of triple contrast agent (bismuth nanoparticles [BiNPs], CA4+, and gadoteridol) to image and segment cartilage in cadaveric knee joints with a clinical CT scanner. We hypothesize that BiNPs will remain in synovial fluid while the CA4+ and gadoteridol will diffuse into cartilage, allowing (1) segmentation of cartilage, and (2) evaluation of cartilage biomechanical properties based on contrast agent concentrations. To investigate these hypotheses, triple contrast agent was injected into both knee joints of a cadaver (N = 1), imaged with a clinical CT at multiple timepoints during the contrast agent diffusion. Knee joints were extracted, imaged with micro-CT (µCT), and biomechanical properties of the cartilage surface were determined by stress-relaxation mapping. Cartilage was segmented and contrast agent concentrations (CA4+ and gadoteridol) were compared with the biomechanical properties at multiple locations (n = 185). Spearman's correlation between cartilage thickness from clinical CT and reference µCT images verifies successful and reliable segmentation. CA4+ concentration is significantly higher in femoral than in tibial cartilage at 60 min and further timepoints, which corresponds to the higher Young's modulus observed in femoral cartilage. In this pilot study, we show that (1) large BiNPs do not diffuse into cartilage, facilitating straightforward segmentation of human knee joint cartilage in a clinical setting, and (2) CA4+ concentration in cartilage reflects the biomechanical differences between femoral and tibial cartilage. Thus, the triple contrast agent CT shows potential in cartilage morphology and condition estimation in clinical CT.
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Affiliation(s)
- Heta Orava
- Department of Technical Physics, University of Eastern Finland, Kuopio, Finland
- Diagnostic Imaging Center, Kuopio University Hospital, Kuopio, Finland
| | - Petri Paakkari
- Department of Technical Physics, University of Eastern Finland, Kuopio, Finland
- Diagnostic Imaging Center, Kuopio University Hospital, Kuopio, Finland
| | - Jiri Jäntti
- Department of Technical Physics, University of Eastern Finland, Kuopio, Finland
- Diagnostic Imaging Center, Kuopio University Hospital, Kuopio, Finland
| | - Miitu K M Honkanen
- Department of Technical Physics, University of Eastern Finland, Kuopio, Finland
- Diagnostic Imaging Center, Kuopio University Hospital, Kuopio, Finland
| | | | - Tuomas Virén
- Center of Oncology, Kuopio University Hospital, Kuopio, Finland
| | - Anisha Joenathan
- Departments of Biomedical Engineering, Chemistry, and Medicine, Boston University, Boston, Massachusetts, USA
| | - Petri Tanska
- Department of Technical Physics, University of Eastern Finland, Kuopio, Finland
| | - Rami K Korhonen
- Department of Technical Physics, University of Eastern Finland, Kuopio, Finland
| | - Mark W Grinstaff
- Departments of Biomedical Engineering, Chemistry, and Medicine, Boston University, Boston, Massachusetts, USA
| | - Juha Töyräs
- Department of Technical Physics, University of Eastern Finland, Kuopio, Finland
- Science Service Center, Kuopio University Hospital, Kuopio, Finland
- School of Electrical Engineering and Computer Science, The University of Queensland, Brisbane, Australia
| | - Janne T A Mäkelä
- Department of Technical Physics, University of Eastern Finland, Kuopio, Finland
- Diagnostic Imaging Center, Kuopio University Hospital, Kuopio, Finland
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2
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Honkanen MKM, Mohammadi A, Te Moller NCR, Ebrahimi M, Xu W, Plomp S, Pouran B, Lehto VP, Brommer H, van Weeren PR, Korhonen RK, Töyräs J, Mäkelä JTA. Dual-contrast micro-CT enables cartilage lesion detection and tissue condition evaluation ex vivo. Equine Vet J 2023; 55:315-324. [PMID: 35353399 PMCID: PMC10084070 DOI: 10.1111/evj.13573] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2021] [Accepted: 03/10/2022] [Indexed: 12/17/2022]
Abstract
BACKGROUND Post-traumatic osteoarthritis is a frequent joint disease in the horse. Currently, equine medicine lacks effective methods to diagnose the severity of chondral defects after an injury. OBJECTIVES To investigate the capability of dual-contrast-enhanced computed tomography (dual-CECT) for detection of chondral lesions and evaluation of the severity of articular cartilage degeneration in the equine carpus ex vivo. STUDY DESIGN Pre-clinical experimental study. METHODS In nine Shetland ponies, blunt and sharp grooves were randomly created (in vivo) in the cartilage of radiocarpal and middle carpal joints. The contralateral joint served as control. The ponies were subjected to an 8-week exercise protocol and euthanised 39 weeks after surgery. CECT scanning (ex vivo) of the joints was performed using a micro-CT scanner 1 hour after an intra-articular injection of a dual-contrast agent. The dual-contrast agent consisted of ioxaglate (negatively charged, q = -1) and bismuth nanoparticles (BiNPs, q = 0, diameter ≈ 0.2 µm). CECT results were compared to histological cartilage proteoglycan content maps acquired using digital densitometry. RESULTS BiNPs enabled prolonged visual detection of both groove types as they are too large to diffuse into the cartilage. Furthermore, proportional ioxaglate diffusion inside the tissue allowed differentiation between the lesion and ungrooved articular cartilage (3 mm from the lesion and contralateral joint). The mean ioxaglate partition in the lesion was 19 percentage points higher (P < 0.001) when compared with the contralateral joint. The digital densitometry and the dual-contrast CECT findings showed good subjective visual agreement. MAIN LIMITATIONS Ex vivo study protocol and a low number of investigated joints. CONCLUSIONS The dual-CECT methodology, used in this study for the first time to image whole equine joints, is capable of effective lesion detection and simultaneous evaluation of the condition of the articular cartilage.
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Affiliation(s)
- Miitu K M Honkanen
- Department of Applied Physics, University of Eastern Finland, Kuopio, Finland.,Diagnostic Imaging Center, Kuopio University Hospital, Kuopio, Finland
| | - Ali Mohammadi
- Department of Applied Physics, University of Eastern Finland, Kuopio, Finland
| | - Nikae C R Te Moller
- Department of Clinical Sciences, Faculty of Veterinary Medicine, Utrecht University, Utrecht, The Netherlands
| | - Mohammadhossein Ebrahimi
- Department of Applied Physics, University of Eastern Finland, Kuopio, Finland.,Research Unit of Medical Imaging, Physics and Technology, Faculty of Medicine, University of Oulu, Oulu, Finland
| | - Wujun Xu
- Department of Applied Physics, University of Eastern Finland, Kuopio, Finland
| | - Saskia Plomp
- Department of Clinical Sciences, Faculty of Veterinary Medicine, Utrecht University, Utrecht, The Netherlands
| | - Behdad Pouran
- Department of Orthopedics, University Medical Center Utrecht, The Netherlands
| | - Vesa-Pekka Lehto
- Department of Applied Physics, University of Eastern Finland, Kuopio, Finland
| | - Harold Brommer
- Department of Clinical Sciences, Faculty of Veterinary Medicine, Utrecht University, Utrecht, The Netherlands
| | - P René van Weeren
- Department of Clinical Sciences, Faculty of Veterinary Medicine, Utrecht University, Utrecht, The Netherlands
| | - Rami K Korhonen
- Department of Applied Physics, University of Eastern Finland, Kuopio, Finland
| | - Juha Töyräs
- Department of Applied Physics, University of Eastern Finland, Kuopio, Finland.,School of Information Technology and Electrical Engineering, The University of Queensland, Brisbane, Australia.,Science Service Center, Kuopio University Hospital, Kuopio, Finland
| | - Janne T A Mäkelä
- Department of Applied Physics, University of Eastern Finland, Kuopio, Finland
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3
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Paesa M, Alejo T, Garcia-Alvarez F, Arruebo M, Mendoza G. New insights in osteoarthritis diagnosis and treatment: Nano-strategies for an improved disease management. WILEY INTERDISCIPLINARY REVIEWS. NANOMEDICINE AND NANOBIOTECHNOLOGY 2023; 15:e1844. [PMID: 35965293 DOI: 10.1002/wnan.1844] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/02/2021] [Revised: 06/02/2022] [Accepted: 07/12/2022] [Indexed: 11/07/2022]
Abstract
Osteoarthritis (OA) is a common chronic joint pathology that has become a predominant cause of disability worldwide. Even though the origin and evolution of OA rely on different factors that are not yet elucidated nor understood, the development of novel strategies to treat OA has emerged in the last years. Cartilage degradation is the main hallmark of the pathology though alterations in bone and synovial inflammation, among other comorbidities, are also involved during OA progression. From a molecular point of view, a vast amount of signaling pathways are implicated in the progression of the disease, opening up a wide plethora of targets to attenuate or even halt OA. The main purpose of this review is to shed light on the recent strategies published based on nanotechnology for the early diagnosis of the disease as well as the most promising nano-enabling therapeutic approaches validated in preclinical models. To address the clinical issue, the key pathways involved in OA initiation and progression are described as the main potential targets for OA prevention and early treatment. Furthermore, an overview of current therapeutic strategies is depicted. Finally, to solve the drawbacks of current treatments, nanobiomedicine has shown demonstrated benefits when using drug delivery systems compared with the administration of the equivalent doses of the free drugs and the potential of disease-modifying OA drugs when using nanosystems. We anticipate that the development of smart and specific bioresponsive and biocompatible nanosystems will provide a solid and promising basis for effective OA early diagnosis and treatment. This article is categorized under: Diagnostic Tools > In Vivo Nanodiagnostics and Imaging Implantable Materials and Surgical Technologies > Nanotechnology in Tissue Repair and Replacement.
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Affiliation(s)
- Monica Paesa
- Department of Chemical Engineering, Aragon Institute of Nanoscience (INA), University of Zaragoza, Aragón Materials Science Institute, ICMA, Zaragoza, Spain
| | - Teresa Alejo
- Department of Chemical Engineering, Aragon Institute of Nanoscience (INA), University of Zaragoza, Aragón Materials Science Institute, ICMA, Zaragoza, Spain
- Health Research Institute Aragon (IIS Aragon), Zaragoza, Spain
| | - Felicito Garcia-Alvarez
- Health Research Institute Aragon (IIS Aragon), Zaragoza, Spain
- Hospital Clínico Universitario Lozano Blesa, Department of Orthopedic Surgery & Traumatology, University of Zaragoza, Zaragoza, Spain
| | - Manuel Arruebo
- Department of Chemical Engineering, Aragon Institute of Nanoscience (INA), University of Zaragoza, Aragón Materials Science Institute, ICMA, Zaragoza, Spain
- Health Research Institute Aragon (IIS Aragon), Zaragoza, Spain
- Networking Research Center on Bioengineering, Biomaterials and Nanomedicine, CIBER-BBN, Madrid, Spain
| | - Gracia Mendoza
- Health Research Institute Aragon (IIS Aragon), Zaragoza, Spain
- Networking Research Center on Bioengineering, Biomaterials and Nanomedicine, CIBER-BBN, Madrid, Spain
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Bhattarai A, Lok JGT, Sun H, Vardhanabhuti V. Computed Tomography of Cartilage: An Exploration of Novel Cationic Bismuth Contrast Agent. Ann Biomed Eng 2022; 51:977-986. [PMID: 36446911 DOI: 10.1007/s10439-022-03110-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2022] [Accepted: 11/16/2022] [Indexed: 12/02/2022]
Abstract
Accurate diagnosis of minor cartilage injuries with delayed contrast-enhanced computed tomography (CECT) is challenging as poor diffusion and toxicity issues limit the usage of common CT contrast agents. Hence, the design of safe contrast agents with physiochemical properties suitable for fast, deep cartilage imaging is imminent. Herein, a novel cationic bismuth contrast agent (Bi-DOTAPXD) based on dodecane tetraacetic acid (DOTA) was synthesized and examined for CECT of cartilage. The complex was designed to improve diagnosis by utilising a net-positive charge for enhanced permeability through cartilage, inherent low-toxicity and high X-ray attenuation of bismuth. Osteochondral plugs (n = 12), excised from visually intact porcine articular cartilage were immersed in Bi-DOTAPXD (8 mg/mL) and Gd-DOTAPXD (10 mg/mL) contrast agents and scanned with a high-resolution microcomputed tomography scanner at multiple time-points. The mean Bi-DOTAPXD and Gd-DOTAPXD partitions at 45-min time-point were 85.7 ± 35.1 and 69.8 ± 30.2%, and the partitions correlated with the histopathological analysis of cartilage proteoglycan (PG) content (r) at 0.657 and 0.632, respectively. The time diffusion constants (τ) for Bi-DOTAPXD and Gd-DOTA were 121 and 159 min, respectively. Diffusion Bi-DOTAPXD and Gd-DOTAPXD reflected inter-sample variation in cartilage PG content. Cationic Bi-DOTAPXD may have the potential as a CT agent for the diagnosis of cartilage.
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5
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Hall ME, Wang AS, Gold GE, Levenston ME. Contrast solution properties and scan parameters influence the apparent diffusivity of computed tomography contrast agents in articular cartilage. JOURNAL OF THE ROYAL SOCIETY, INTERFACE 2022; 19:20220403. [PMID: 35919981 PMCID: PMC9346352 DOI: 10.1098/rsif.2022.0403] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
The inability to detect early degenerative changes to the articular cartilage surface that commonly precede bulk osteoarthritic degradation is an obstacle to early disease detection for research or clinical diagnosis. Leveraging a known artefact that blurs tissue boundaries in clinical arthrograms, contrast agent (CA) diffusivity can be derived from computed tomography arthrography (CTa) scans. We combined experimental and computational approaches to study protocol variations that may alter the CTa-derived apparent diffusivity. In experimental studies on bovine cartilage explants, we examined how CA dilution and transport direction (absorption versus desorption) influence the apparent diffusivity of untreated and enzymatically digested cartilage. Using multiphysics simulations, we examined mechanisms underlying experimental observations and the effects of image resolution, scan interval and early scan termination. The apparent diffusivity during absorption decreased with increasing CA concentration by an amount similar to the increase induced by tissue digestion. Models indicated that osmotically-induced fluid efflux strongly contributed to the concentration effect. Simulated changes to spatial resolution, scan spacing and total scan time all influenced the apparent diffusivity, indicating the importance of consistent protocols. With careful control of imaging protocols and interpretations guided by transport models, CTa-derived diffusivity offers promise as a biomarker for early degenerative changes.
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Affiliation(s)
- Mary E Hall
- Department of Mechanical Engineering, Stanford University, Stanford, CA, USA
| | - Adam S Wang
- Department of Radiology, Stanford University, Stanford, CA, USA.,Department of Electrical Engineering, Stanford University, Stanford, CA, USA
| | - Garry E Gold
- Department of Radiology, Stanford University, Stanford, CA, USA.,Department of Bioengineering, Stanford University, Stanford, CA, USA
| | - Marc E Levenston
- Department of Mechanical Engineering, Stanford University, Stanford, CA, USA.,Department of Radiology, Stanford University, Stanford, CA, USA
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Lawson T, Joenathan A, Patwa A, Snyder BD, Grinstaff MW. Tantalum Oxide Nanoparticles for the Quantitative Contrast-Enhanced Computed Tomography of Ex Vivo Human Cartilage: Assessment of Biochemical Composition and Biomechanics. ACS NANO 2021; 15:19175-19184. [PMID: 34882411 DOI: 10.1021/acsnano.1c03375] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/13/2023]
Abstract
Nanoparticle-based contrast agents, when used in concert with imaging modalities such as computed tomography (CT), enhance the visualization of tissues and boundary interfaces. However, the ability to determine the physiological state of the tissue via the quantitative assessment of biochemical or biomechanical properties remains elusive. We report the synthesis and characterization of tantalum oxide (Ta2O5) nanoparticle (NP) contrast agents for rapid, nondestructive, and quantitative contrast-enhanced computed tomography (CECT) to assess both the glycosaminoglycan (GAG) content and the biomechanical integrity of human metacarpal phalangeal joint (MCPJ) articular cartilage. Ta2O5 NPs 3-6 nm in diameter and coated with either nonionic poly(ethylene) glycol (PEG) or cationic trimethylammonium ligands readily diffuse into both healthy and osteoarthritic MCPJ cartilage. The CECT attenuation for the cationic and neutral NPs correlates with the glycosaminoglycan (GAG) content (R2 = 0.8975, p < 0.05 and 0.7054, respectively) and the equilibrium modulus (R2 = 0.8285, p < 0.05 and 0.9312, p < 0.05, respectively). The results highlight the importance of the surface charge and size in the design of NP agents for targeting and imaging articular cartilage. Further, nanoparticle CECT offers the visualization of both soft tissue and underlying bone unlike plain radiography, which is the standard for imaging bone in musculoskeletal diseases, and the ability to provide a real-time quantitative assessment of both hard and soft tissues to provide a comprehensive image of the disease stage, as demonstrated herein.
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Affiliation(s)
- Taylor Lawson
- Center for Advanced Orthopaedic Studies, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts 02215, United States
- Department of Mechanical Engineering, Boston University, Boston, Massachusetts 02215, United States
| | - Anisha Joenathan
- Center for Advanced Orthopaedic Studies, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts 02215, United States
- Division of Material Science, Boston University, Boston, Massachusetts 02215, United States
| | - Amit Patwa
- Center for Advanced Orthopaedic Studies, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts 02215, United States
- Department of Chemistry, School of Science, Navrachana University, Vadodara, Gujarat 391410, India
| | - Brian D Snyder
- Center for Advanced Orthopaedic Studies, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts 02215, United States
- Department of Orthopaedic Surgery, Boston Children's Hospital, Harvard Medical School, Boston, Massachusetts 02215, United States
| | - Mark W Grinstaff
- Department of Biomedical Engineering, Boston University, Boston, Massachusetts 02215, United States
- Department of Medicine, Boston University, Boston, Massachusetts 02215 United States
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7
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Bhattarai A, Mäkelä JTA, Pouran B, Kröger H, Weinans H, Grinstaff MW, Töyräs J, Turunen MJ. Effects of human articular cartilage constituents on simultaneous diffusion of cationic and nonionic contrast agents. J Orthop Res 2021; 39:771-779. [PMID: 32767676 PMCID: PMC8048551 DOI: 10.1002/jor.24824] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/04/2020] [Revised: 07/03/2020] [Accepted: 08/05/2020] [Indexed: 02/04/2023]
Abstract
Contrast-enhanced computed tomography is an emerging diagnostic technique for osteoarthritis. However, the effects of increased water content, as well as decreased collagen and proteoglycan concentrations due to cartilage degeneration, on the diffusion of cationic and nonionic agents, are not fully understood. We hypothesize that for a cationic agent, these variations increase the diffusion rate while decreasing partition, whereas, for a nonionic agent, these changes increase both the rate of diffusion and partition. Thus, we examine the diffusion of cationic and nonionic contrast agents within degraded tissue in time- and depth-dependent manners. Osteochondral plugs (N = 15, d = 8 mm) were extracted from human cadaver knee joints, immersed in a mixture of cationic CA4+ and nonionic gadoteridol contrast agents, and imaged at multiple time-points, using the dual-contrast method. Water content, and collagen and proteoglycan concentrations were determined using lyophilization, infrared spectroscopy, and digital densitometry, respectively. Superficial to mid (0%-60% depth) cartilage CA4+ partitions correlated with water content (R < -0.521, P < .05), whereas in deeper (40%-100%) cartilage, CA4+ correlated only with proteoglycans (R > 0.671, P < .01). Gadoteridol partition correlated inversely with collagen concentration (0%-100%, R < -0.514, P < .05). Cartilage degeneration substantially increased the time for CA4+ compared with healthy tissue (248 ± 171 vs 175 ± 95 minute) to reach the bone-cartilage interface, whereas for gadoteridol the time (111 ± 63 vs 179 ± 163 minute) decreased. The work clarifies the diffusion mechanisms of two different contrast agents and presents depth and time-dependent effects resulting from articular cartilage constituents. The results will inform the development of new contrast agents and optimal timing between agent administration and joint imaging.
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Affiliation(s)
- Abhisek Bhattarai
- Department of Applied PhysicsUniversity of Eastern FinlandKuopioFinland,Diagnostic Imaging CenterKuopio University HospitalKuopioFinland
| | | | - Behdad Pouran
- Department of OrthopaedicsUniversity Medical Center UtrechtUtrechtThe Netherlands
| | - Heikki Kröger
- Department of Orthopedics, Traumatology and Hand SurgeryKuopio University HospitalKuopioFinland
| | - Harrie Weinans
- Department of OrthopaedicsUniversity Medical Center UtrechtUtrechtThe Netherlands,Department of Biomechanical Engineering, Faculty of Mechanical, Maritime, and Materials EngineeringDelft University of Technology (TU Delft)DelftThe Netherlands
| | - Mark W. Grinstaff
- Departments of Biomedical Engineering, Chemistry, and MedicineBoston UniversityBostonMassachusetts
| | - Juha Töyräs
- Department of Applied PhysicsUniversity of Eastern FinlandKuopioFinland,Diagnostic Imaging CenterKuopio University HospitalKuopioFinland,School of Information Technology and Electrical EngineeringThe University of QueenslandBrisbaneAustralia
| | - Mikael J. Turunen
- Department of Applied PhysicsUniversity of Eastern FinlandKuopioFinland,SIB LabsUniversity of Eastern FinlandKuopioFinland
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8
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Lawson TB, Mäkelä JTA, Klein T, Snyder BD, Grinstaff MW. Nanotechnology and osteoarthritis; part 1: Clinical landscape and opportunities for advanced diagnostics. J Orthop Res 2021; 39:465-472. [PMID: 32827322 DOI: 10.1002/jor.24817] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/11/2020] [Revised: 07/12/2020] [Accepted: 07/27/2020] [Indexed: 02/04/2023]
Abstract
Osteoarthritis (OA) is a disease of the entire joint, often triggered by cartilage injury, mediated by a cascade of inflammatory pathways involving a complex interplay among metabolic, genetic, and enzymatic factors that alter the biochemical composition, microstructure, and biomechanical performance. Clinically, OA is characterized by degradation of the articular cartilage, thickening of the subchondral bone, inflammation of the synovium, and degeneration of ligaments that in aggregate reduce joint function and diminish quality of life. OA is the most prevalent joint disease, affecting 140 million people worldwide; these numbers are only expected to increase, concomitant with societal and financial burden of care. We present a two-part review encompassing the applications of nanotechnology to the diagnosis and treatment of OA. Herein, part 1 focuses on OA treatment options and advancements in nanotechnology for the diagnosis of OA and imaging of articular cartilage, while part 2 (10.1002/jor.24842) summarizes recent advances in drug delivery, tissue scaffolds, and gene therapy for the treatment of OA. Specifically, part 1 begins with a concise review of the clinical landscape of OA, along with current diagnosis and treatments. We next review nanoparticle contrast agents for minimally invasive detection, diagnosis, and monitoring of OA via magnetic resonace imaging, computed tomography, and photoacoustic imaging techniques as well as for probes for cell tracking. We conclude by identifying opportunities for nanomedicine advances, and future prospects for imaging and diagnostics.
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Affiliation(s)
- Taylor B Lawson
- Departments of Biomedical Engineering, Mechanical Engineering, Chemistry, and Medicine Boston University, Boston, Massachusetts
- Orthopaedics Research Department, Center for Advanced Orthopaedic Studies, Beth Israel Deaconess Medical Center and Harvard Medical School, Boston, Massachusetts
| | - Janne T A Mäkelä
- Department of Applied Physics, University of Eastern Finland, Kuopio, Finland
| | - Travis Klein
- School of Mechanical, Medical and Process Engineering, Center for Biomedical Technologies, Queensland University of Technology, Brisbane, Australia
| | - Brian D Snyder
- Orthopaedics Research Department, Center for Advanced Orthopaedic Studies, Beth Israel Deaconess Medical Center and Harvard Medical School, Boston, Massachusetts
| | - Mark W Grinstaff
- Departments of Biomedical Engineering, Mechanical Engineering, Chemistry, and Medicine Boston University, Boston, Massachusetts
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9
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Xu W, Cui P, Happonen E, Leppänen J, Liu L, Rantanen J, Majda D, Saukko A, Thapa R, Nissinen T, Tynkkynen T, Töyräs J, Fan L, Liu W, Lehto VP. Tailored Synthesis of PEGylated Bismuth Nanoparticles for X-ray Computed Tomography and Photothermal Therapy: One-Pot, Targeted Pyrolysis, and Self-Promotion. ACS APPLIED MATERIALS & INTERFACES 2020; 12:47233-47244. [PMID: 32970405 DOI: 10.1021/acsami.0c12499] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/11/2023]
Abstract
Complex experimental design is a common problem in the preparation of theranostic nanoparticles, resulting in poor reaction control, expensive production cost, and low experiment success rate. The present study aims to develop PEGylated bismuth (PEG-Bi) nanoparticles with a precisely controlled one-pot approach, which contains only methoxy[(poly(ethylene glycol)]trimethoxy-silane (PEG-silane) and bismuth oxide (Bi2O3). A targeted pyrolysis of PEG-silane was achieved to realize its roles as both the reduction and PEGylation agents. The unwanted methoxy groups of PEG-silane were selectively pyrolyzed to form reductive agents, while the useful PEG-chain was fully preserved to enhance the biocompatibility of Bi nanoparticles. Moreover, Bi2O3 not only acted as the raw material of the Bi source but also presented a self-promotion in the production of Bi nanoparticles via catalyzing the pyrolysis of PEG-silane. The reaction mechanism was systematically validated with different methods such as nuclear magnetic resonance spectroscopy. The PEG-Bi nanoparticles showed better compatibility and photothermal conversion than those prepared by the complex multiple step approaches in literature studies. In addition, the PEG-Bi nanoparticles possessed prominent performance in X-ray computed tomography imaging and photothermal cancer therapy in vivo. The present study highlights the art of precise reaction control in the synthesis of PEGylated nanoparticles for biomedical applications.
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Affiliation(s)
- Wujun Xu
- Department of Applied Physics, University of Eastern Finland, 70211 Kuopio, Finland
| | - Pang Cui
- Department of Pharmaceutical Analysis, School of Pharmacy, and Oncology Department of Xijing Hospital, The Air Force Medical University, 169th Changle West Road, Xi'an, 710032 Shaanxi, China
| | - Emilia Happonen
- Department of Applied Physics, University of Eastern Finland, 70211 Kuopio, Finland
| | - Jukka Leppänen
- School of Pharmacy, Faculty of Health Sciences, University of Eastern Finland, 70211 Kuopio, Finland
| | - Lizhi Liu
- Department of Applied Physics, University of Eastern Finland, 70211 Kuopio, Finland
| | - Jimi Rantanen
- Department of Applied Physics, University of Eastern Finland, 70211 Kuopio, Finland
| | - Dorota Majda
- Faculty of Chemistry, Jagiellonian University in Kraków, 2 Gronostajowa Street, 30-387 Kraków, Poland
| | - Annina Saukko
- Department of Applied Physics, University of Eastern Finland, 70211 Kuopio, Finland
| | - Rinez Thapa
- Department of Applied Physics, University of Eastern Finland, 70211 Kuopio, Finland
| | - Tuomo Nissinen
- Department of Applied Physics, University of Eastern Finland, 70211 Kuopio, Finland
| | - Tuulia Tynkkynen
- School of Pharmacy, Faculty of Health Sciences, University of Eastern Finland, 70211 Kuopio, Finland
| | - Juha Töyräs
- Department of Applied Physics, University of Eastern Finland, 70211 Kuopio, Finland
| | - Li Fan
- Department of Pharmaceutical Analysis, School of Pharmacy, and Oncology Department of Xijing Hospital, The Air Force Medical University, 169th Changle West Road, Xi'an, 710032 Shaanxi, China
| | - Wenchao Liu
- Department of Pharmaceutical Analysis, School of Pharmacy, and Oncology Department of Xijing Hospital, The Air Force Medical University, 169th Changle West Road, Xi'an, 710032 Shaanxi, China
| | - Vesa-Pekka Lehto
- Department of Applied Physics, University of Eastern Finland, 70211 Kuopio, Finland
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10
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Near Infrared Spectroscopy Enables Differentiation of Mechanically and Enzymatically Induced Cartilage Injuries. Ann Biomed Eng 2020; 48:2343-2353. [PMID: 32300956 PMCID: PMC7452885 DOI: 10.1007/s10439-020-02506-z] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2019] [Accepted: 04/02/2020] [Indexed: 01/29/2023]
Abstract
This study evaluates the feasibility of near infrared (NIR) spectroscopy to distinguish between different cartilage injury types associated with post-traumatic osteoarthritis and idiopathic osteoarthritis (OA) induced by mechanical and enzymatic damages. Bovine osteochondral samples (n = 72) were subjected to mechanical (n = 24) and enzymatic (n = 36) damage; NIR spectral measurements were acquired from each sample before and after damage, and from a separate control group (n = 12). Biomechanical measurements were then conducted to determine the functional integrity of the samples. NIR spectral variations resulting from different damage types were investigated and the samples classified using partial least squares discriminant analysis (PLS-DA). Partial least squares regression (PLSR) was then employed to investigate the relationship between the NIR spectra and biomechanical properties of the samples. Results of the study demonstrate that substantial spectral changes occur in the region of 1700–2200 nm due to tissue damages, while differences between enzymatically and mechanically induced damages can be observed mainly in the region of 1780–1810 nm. We conclude that NIR spectroscopy, combined with multivariate analysis, is capable of discriminating between cartilage injuries that mimic idiopathic OA and traumatic injuries based on specific spectral features. This information could be useful in determining the optimal treatment strategy during cartilage repair in arthroscopy.
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11
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Freedman JD, Ellis DJ, Lusic H, Varma GV, Grant AK, Lakin BA, Snyder BD, Grinstaff MW. dGEMRIC and CECT Comparison of Cationic and Anionic Contrast Agents in Cadaveric Human Metacarpal Cartilage. J Orthop Res 2020; 38:719-725. [PMID: 31687789 PMCID: PMC7071952 DOI: 10.1002/jor.24511] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/15/2019] [Accepted: 10/31/2019] [Indexed: 02/04/2023]
Abstract
Magnetic resonance imaging (MRI) and computed tomography (CT) are widely used to image cartilage and their diagnostic capability is enhanced in the presence of contrast agents. The aim of the study is to directly compare the performance between commercial anionic MRI (Gd(DTPA), Gd2-) and CT (Ioxaglate, Iox1-) contrast agents with novel cationic MRI (Gd(DTPA)Lys2 , Gd4+) and CT (CA4+) contrast agents for assessment of cartilage mechanical and biochemical properties using the ex vivo human osteoarthritis metacarpal cartilage model. First, indentation testing was conducted to obtain the compressive modulus of the human fifth metacarpals. The samples were then immersed in the anionic and cationic contrast agents prior to delayed gadolinium-enhanced MRI of cartilage and CT scanning, respectively. The cartilage glycosaminoglycan (GAG) content and distribution were determined using the 1,9-dimethylmethylene blue assay and Safranin-O histology. Cationic agents significantly accumulate in cartilage compared with anionic agents. Significant positive correlations (p < 0.05) exist between imaging results of cationic agents and GAG content (Gd4+: R2 = 0.43; CA4+: R2 = 0.67) and indentation equilibrium modulus (Gd4+: R2 = 0.48; CA4+: R2 = 0.77). Significant negative correlations are observed between anionic MRI relaxation times, but not contrast-enhanced computed tomography attenuation and cartilage GAG content (Gd2-: R2 = 0.56, p < 0.05; Iox1-: R2 = 0.31, p > 0.05) and indentation equilibrium modulus (Gd2-: R2 = 0.38, p < 0.05; Iox1-: R2 = 0.17, p > 0.05). MRI or CT with cationic contrast agents provides greater sensitivity than their anionic analogs at assessing the biochemical and biomechanical properties of ex vivo human metacarpal cartilage. © 2019 Orthopaedic Research Society. Published by Wiley Periodicals, Inc. J Orthop Res 38:719-725, 2020.
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Affiliation(s)
- Jonathan D. Freedman
- Department of Pharmacology, Boston University, Boston, MA,Center for Advanced Orthopaedic Studies, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA
| | - Daniel J. Ellis
- Center for Advanced Orthopaedic Studies, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA
| | - Hrvoje Lusic
- Department of Chemistry, Boston University, Boston, MA
| | - Gopal V. Varma
- Department of Radiology, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA
| | - Aaron K. Grant
- Department of Radiology, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA
| | - Benjamin A. Lakin
- Department of Biomedical Engineering, Boston University, Boston, MA,Center for Advanced Orthopaedic Studies, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA
| | - Brian D. Snyder
- Center for Advanced Orthopaedic Studies, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA,Department of Orthopaedic Surgery, Boston Children’s Hospital, Boston, MA.,Address correspondence and reprint requests to: Brian D. Snyder, M.D., Ph.D., Center for Advanced Orthopaedic Studies, Beth Israel Deaconess Medical Center, 1 Overland Street, RN 115, Boston, MA 02215, , OR, Mark W. Grinstaff, Ph.D., Departments of Biomedical Engineering and Chemistry, Boston University, 590 Commonwealth Ave, Boston, MA 02215,
| | - Mark W. Grinstaff
- Department of Pharmacology, Boston University, Boston, MA,Department of Chemistry, Boston University, Boston, MA,Department of Biomedical Engineering, Boston University, Boston, MA,Address correspondence and reprint requests to: Brian D. Snyder, M.D., Ph.D., Center for Advanced Orthopaedic Studies, Beth Israel Deaconess Medical Center, 1 Overland Street, RN 115, Boston, MA 02215, , OR, Mark W. Grinstaff, Ph.D., Departments of Biomedical Engineering and Chemistry, Boston University, 590 Commonwealth Ave, Boston, MA 02215,
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12
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Honkanen MKM, Saukko AEA, Turunen MJ, Shaikh R, Prakash M, Lovric G, Joukainen A, Kröger H, Grinstaff MW, Töyräs J. Synchrotron MicroCT Reveals the Potential of the Dual Contrast Technique for Quantitative Assessment of Human Articular Cartilage Composition. J Orthop Res 2020; 38:563-573. [PMID: 31535728 PMCID: PMC7065106 DOI: 10.1002/jor.24479] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/27/2019] [Accepted: 09/13/2019] [Indexed: 02/04/2023]
Abstract
Dual contrast micro computed tomography (CT) shows potential for detecting articular cartilage degeneration. However, the performance of conventional CT systems is limited by beam hardening, low image resolution (full-body CT), and long acquisition times (conventional microCT). Therefore, to reveal the full potential of the dual contrast technique for imaging cartilage composition we employ the technique using synchrotron microCT. We hypothesize that the above-mentioned limitations are overcome with synchrotron microCT utilizing monochromatic X-ray beam and fast image acquisition. Human osteochondral samples (n = 41, four cadavers) were immersed in a contrast agent solution containing two agents (cationic CA4+ and non-ionic gadoteridol) and imaged with synchrotron microCT at an early diffusion time point (2 h) and at diffusion equilibrium (72 h) using two monochromatic X-ray energies (32 and 34 keV). The dual contrast technique enabled simultaneous determination of CA4+ (i.e., proteoglycan content) and gadoteridol (i.e., water content) partitions within cartilage. Cartilage proteoglycan content and biomechanical properties correlated significantly (0.327 < r < 0.736, p < 0.05) with CA4+ partition in superficial and middle zones at both diffusion time points. Normalization of the CA4+ partition with gadoteridol partition within the cartilage significantly (p < 0.05) improved the detection sensitivity for human osteoarthritic cartilage proteoglycan content, biomechanical properties, and overall condition (Mankin, Osteoarthritis Research Society International, and International Cartilage Repair Society grading systems). The dual energy technique combined with the dual contrast agent enables assessment of human articular cartilage proteoglycan content and biomechanical properties based on CA4+ partition determined using synchrotron microCT. Additionally, the dual contrast technique is not limited by the beam hardening artifact of conventional CT systems. © 2019 The Authors. Journal of Orthopaedic Research® published by Wiley Periodicals, Inc. on behalf of Orthopaedic Research Society. J Orthop Res 38:563-573, 2020.
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Affiliation(s)
- Miitu K. M. Honkanen
- Department of Applied PhysicsUniversity of Eastern FinlandKuopioFinland
- Diagnostic Imaging CenterKuopio University HospitalKuopioFinland
| | - Annina E. A. Saukko
- Department of Applied PhysicsUniversity of Eastern FinlandKuopioFinland
- Department of Medical PhysicsTurku University HospitalTurkuFinland
| | - Mikael J. Turunen
- Department of Applied PhysicsUniversity of Eastern FinlandKuopioFinland
- SIB LabsUniversity of Eastern FinlandKuopioFinland
| | - Rubina Shaikh
- Department of Applied PhysicsUniversity of Eastern FinlandKuopioFinland
| | - Mithilesh Prakash
- Department of Applied PhysicsUniversity of Eastern FinlandKuopioFinland
- Diagnostic Imaging CenterKuopio University HospitalKuopioFinland
- A.I. Virtanen Institute for Molecular SciencesUniversity of Eastern FinlandKuopioFinland
| | - Goran Lovric
- Centre d'lmagerie BioMédicaleÉcole Polytechnique Fédérale de LausanneLausanneSwitzerland
- Swiss Light SourcePaul Scherrer InstituteVilligenSwitzerland
| | - Antti Joukainen
- Department of Orthopedics, Traumatology and Hand SurgeryKuopio University HospitalKuopioFinland
| | - Heikki Kröger
- Department of Orthopedics, Traumatology and Hand SurgeryKuopio University HospitalKuopioFinland
| | - Mark W. Grinstaff
- Departments of Biomedical Engineering, Chemistry, and MedicineBoston UniversityBostonMassachusetts
| | - Juha Töyräs
- Department of Applied PhysicsUniversity of Eastern FinlandKuopioFinland
- Diagnostic Imaging CenterKuopio University HospitalKuopioFinland
- School of Information Technology and Electrical EngineeringThe University of QueenslandBrisbaneQueenslandAustralia
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13
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Clark JN, Garbout A, Ferreira SA, Javaheri B, Pitsillides AA, Rankin SM, Jeffers JRT, Hansen U. Propagation phase-contrast micro-computed tomography allows laboratory-based three-dimensional imaging of articular cartilage down to the cellular level. Osteoarthritis Cartilage 2020; 28:102-111. [PMID: 31678663 DOI: 10.1016/j.joca.2019.10.007] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/02/2019] [Revised: 08/31/2019] [Accepted: 10/03/2019] [Indexed: 02/02/2023]
Abstract
OBJECTIVE High-resolution non-invasive three-dimensional (3D) imaging of chondrocytes in articular cartilage remains elusive. The aim of this study was to explore whether laboratory micro-computed tomography (micro-CT) permits imaging cells within articular cartilage. DESIGN Bovine osteochondral plugs were prepared four ways: in phosphate-buffered saline (PBS) or 70% ethanol (EtOH), both with or without phosphotungstic acid (PTA) staining. Specimens were imaged with micro-CT following two protocols: 1) absorption contrast (AC) imaging 2) propagation phase-contrast (PPC) imaging. All samples were scanned in liquid. The contrast to noise ratio (C/N) of cellular features quantified scan quality and were statistically analysed. Cellular features resolved by micro-CT were validated by standard histology. RESULTS The highest quality images were obtained using propagation phase-contrast imaging and PTA-staining in 70% EtOH. Cellular features were also visualised when stained in PBS and unstained in EtOH. Under all conditions PPC resulted in greater contrast than AC (p < 0.0001 to p = 0.038). Simultaneous imaging of cartilage and subchondral bone did not impede image quality. Corresponding features were located in both histology and micro-CT and followed the same distribution with similar density and roundness values. CONCLUSIONS Three-dimensional visualisation and quantification of the chondrocyte population within articular cartilage can be achieved across a field of view of several millimetres using laboratory-based micro-CT. The ability to map chondrocytes in 3D opens possibilities for research in fields from skeletal development through to medical device design and treatment of cartilage degeneration.
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Affiliation(s)
- J N Clark
- Department of Mechanical Engineering, Imperial College London, London, UK.
| | - A Garbout
- Imaging and Analysis Centre, Natural History Museum London, London, UK.
| | - S A Ferreira
- National Heart & Lung Institute, Faculty of Medicine, Imperial College London, London, UK.
| | - B Javaheri
- Skeletal Biology Group, Comparative Biomedical Sciences, Royal Veterinary College, UK.
| | - A A Pitsillides
- Skeletal Biology Group, Comparative Biomedical Sciences, Royal Veterinary College, UK.
| | - S M Rankin
- National Heart & Lung Institute, Faculty of Medicine, Imperial College London, London, UK.
| | - J R T Jeffers
- Department of Mechanical Engineering, Imperial College London, London, UK.
| | - U Hansen
- Department of Mechanical Engineering, Imperial College London, London, UK.
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Triple Contrast CT Method Enables Simultaneous Evaluation of Articular Cartilage Composition and Segmentation. Ann Biomed Eng 2019; 48:556-567. [PMID: 31576504 PMCID: PMC6949199 DOI: 10.1007/s10439-019-02362-6] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2019] [Accepted: 09/11/2019] [Indexed: 12/16/2022]
Abstract
Early degenerative changes of articular cartilage are detected using contrast-enhanced computed tomography (CT) with a cationic contrast agent (CA). However, cationic CA diffusion into degenerated cartilage decreases with proteoglycan depletion and increases with elevated water content, thus hampering tissue evaluation at early diffusion time points. Furthermore, the contrast at synovial fluid-cartilage interface diminishes as a function of diffusion time hindering accurate cartilage segmentation. For the first time, we employ quantitative dual-energy CT (QDECT) imaging utilizing a mixture of three CAs (cationic CA4+ and non-ionic gadoteridol which are sensitive to proteoglycan and water contents, respectively, and bismuth nanoparticles which highlight the cartilage surface) to simultaneously segment the articulating surfaces and determine of the cartilage condition. Intact healthy, proteoglycan-depleted, and mechanically injured bovine cartilage samples (n = 27) were halved and imaged with synchrotron microCT 2-h post immersion in triple CA or in dual CA (CA4+ and gadoteridol). CA4+ and gadoteridol partitions were determined using QDECT, and pairwise evaluation of these partitions was conducted for samples immersed in dual and triple CAs. In conclusion, the triple CA method is sensitive to proteoglycan depletion while maintaining sufficient contrast at the articular surface to enable detection of cartilage lesions caused by mechanical impact.
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15
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Simultaneous Quantitation of Cationic and Non-ionic Contrast Agents in Articular Cartilage Using Synchrotron MicroCT Imaging. Sci Rep 2019; 9:7118. [PMID: 31068614 PMCID: PMC6506503 DOI: 10.1038/s41598-019-43276-6] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2018] [Accepted: 04/15/2019] [Indexed: 01/15/2023] Open
Abstract
Early diagnosis of acute cartilage injuries enables monitoring of disease progression and improved treatment option planning to prevent post-traumatic osteoarthritis. In contrast-enhanced computed tomography (CECT), the changes in cationic agent diffusion within the tissue reflect cartilage degeneration. The diffusion in degenerated cartilage depends on proteoglycan (PG) content and water content, but each having an opposite effect on diffusion, thus compromising the diagnostic sensitivity. To overcome this limitation, we propose the simultaneous imaging of cationic (sensitive to PG and water contents) and non-ionic (sensitive to water content) agents. In this study, quantitative dual-energy CT (QDECT) imaging of two agents is reported for the first time at clinically feasible imaging time points. Furthermore, this is the first time synchrotron microCT with monochromatic X-rays is employed in cartilage CECT. Imaging was conducted at 1 and 2 h post contrast agent immersion. Intact, PG-depleted, and mechanically injured + PG-depleted cartilage samples (n = 33) were imaged in a mixture of cationic (iodine-based CA4+) and non-ionic (gadolinium-based gadoteridol) agents. Concurrent evaluation of CA4+ and gadoteridol partitions in cartilage is accomplished using QDECT. Subsequent normalization of the CA4+ partition with that of the gadoteridol affords CA4+ attenuations that significantly correlate with PG content – a key marker of OA.
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Honkanen MKM, Matikka H, Honkanen JTJ, Bhattarai A, Grinstaff MW, Joukainen A, Kröger H, Jurvelin JS, Töyräs J. Imaging of proteoglycan and water contents in human articular cartilage with full-body CT using dual contrast technique. J Orthop Res 2019; 37:1059-1070. [PMID: 30816584 PMCID: PMC6594070 DOI: 10.1002/jor.24256] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/06/2018] [Accepted: 02/12/2019] [Indexed: 02/04/2023]
Abstract
Assessment of cartilage composition via tomographic imaging is critical after cartilage injury to prevent post-traumatic osteoarthritis. Diffusion of cationic contrast agents in cartilage is affected by proteoglycan loss and elevated water content. These changes have opposite effects on diffusion and, thereby, reduce the diagnostic accuracy of cationic agents. Here, we apply, for the first time, a clinical full-body CT for dual contrast imaging of articular cartilage. We hypothesize that full-body CT can simultaneously determine the diffusion and partitioning of cationic and non-ionic contrast agents and that normalization of the cationic agent partition with that of the non-ionic agent minimizes the effect of water content and tissue permeability, especially at early diffusion time points. Cylindrical (d = 8 mm) human osteochondral samples (n = 45; four cadavers) of a variable degenerative state were immersed in a mixture of cationic iodinated CA4+ and non-charged gadoteridol contrast agents and imaged with a full-body CT scanner at various time points. Determination of contrast agents' distributions within cartilage was possible at all phases of diffusion. At early time points, gadoteridol, and CA4+ distributed throughout cartilage with lower concentrations in the deep cartilage. At ≥24 h, the gadoteridol concentration remained nearly constant, while the CA4+ concentration increased toward deep cartilage. Normalization of the CA4+ partition with that of gadoteridol significantly (p < 0.05) enhanced correlation with proteoglycan content and Mankin score at the early time points. To conclude, the dual contrast technique was found advantageous over single contrast imaging enabling more sensitive diagnosis of cartilage degeneration. © 2019 The Authors. Journal of Orthopaedic Research Published by Wiley Periodicals, Inc. J Orthop Res 9999:1-12, 2019.
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Affiliation(s)
- Miitu K. M. Honkanen
- Department of Applied PhysicsUniversity of Eastern FinlandKuopioFinland,Diagnostic Imaging CenterKuopio University HospitalKuopioFinland
| | - Hanna Matikka
- Department of Clinical RadiologyDiagnostic Imaging CenterKuopio University HospitalKuopioFinland
| | | | - Abhisek Bhattarai
- Department of Applied PhysicsUniversity of Eastern FinlandKuopioFinland,Diagnostic Imaging CenterKuopio University HospitalKuopioFinland
| | - Mark W. Grinstaff
- Departments of Biomedical Engineering, Chemistry, and MedicineBoston UniversityBostonMassachusetts
| | - Antti Joukainen
- Department of Orthopedics, Traumatology and Hand SurgeryKuopio University HospitalKuopioFinland
| | - Heikki Kröger
- Department of Orthopedics, Traumatology and Hand SurgeryKuopio University HospitalKuopioFinland
| | - Jukka S. Jurvelin
- Department of Applied PhysicsUniversity of Eastern FinlandKuopioFinland
| | - Juha Töyräs
- Department of Applied PhysicsUniversity of Eastern FinlandKuopioFinland,Diagnostic Imaging CenterKuopio University HospitalKuopioFinland,School of Information Technology and Electrical EngineeringThe University of QueenslandBrisbaneAustralia
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17
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Multi-scale imaging techniques to investigate solute transport across articular cartilage. J Biomech 2018; 78:10-20. [DOI: 10.1016/j.jbiomech.2018.06.012] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2018] [Revised: 06/11/2018] [Accepted: 06/19/2018] [Indexed: 12/31/2022]
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18
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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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Bhattarai A, Honkanen JTJ, Myller KAH, Prakash M, Korhonen M, Saukko AEA, Virén T, Joukainen A, Patwa AN, Kröger H, Grinstaff MW, Jurvelin JS, Töyräs J. Quantitative Dual Contrast CT Technique for Evaluation of Articular Cartilage Properties. Ann Biomed Eng 2018; 46:1038-1046. [DOI: 10.1007/s10439-018-2013-y] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2017] [Accepted: 03/21/2018] [Indexed: 12/12/2022]
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