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Akamatsu Y, Kobayashi H, Mitsuhashi S, Kusayama Y. Bone mineral density around the knee after open wedge high tibial osteotomy measured up to 24 months in 51 patients. Knee Surg Sports Traumatol Arthrosc 2023; 31:4910-4919. [PMID: 37589767 DOI: 10.1007/s00167-023-07539-0] [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: 04/10/2023] [Accepted: 08/02/2023] [Indexed: 08/18/2023]
Abstract
PURPOSE To evaluate bone mineral density (BMD) and radiographic and clinical outcomes of patients with varus knee osteoarthritis treated with open wedge high tibial osteotomy (OWHTO). We hypothesised that medial condyle BMD would decrease and lateral condyle BMD would increase after OWHTO. METHODS Overall, 51 patients (mean age: 65.3 years; female: 40, male: 11) treated with OWHTO were prospectively enrolled. Several angles using whole single-leg radiographs were measured preoperatively and up to 24 months postoperatively. Five square tibial regions of interest (ROI) located below the proximal tibia as T1-T5 from medial to lateral regions and two square femoral ROI as F1 and F2 from medial and lateral regions, respectively, were defined. M/L BMD ratio was used to define the medial-to-lateral condyle BMD ratio. Femoral condyle BMD (F1 and F2) around the knee, as well as lumbar spine, and ipsilateral and contralateral femoral neck BMD, were measured before OWHTO and 3, 6, 12 and 24 months after OWHTO using dual-energy X-ray absorptiometry. Furthermore, tibial condyle BMD (T1-T5) around the knee was measured before and 24 months after OWHTO. Clinical outcomes were evaluated using the Knee Society knee and function scores, the Knee Injury and Osteoarthritis Outcome Score, and the Lysholm score preoperatively and 24 months postoperatively. A power analysis was performed. RESULTS F1 BMD decreased by 19.2% from before to 3 months postoperatively. F2 BMD did not change up to 24 months after OWHTO. Femoral M/L BMD ratio decreased by 22.2% 3 months after OWHTO. T1 BMD and tibial M/L BMD ratio decreased, whilst T3, T4 and T5 BMD increased 24 months after OWHTO. Mean hip-knee-ankle angle (HKA) and weight-bearing line ratio were corrected from - 6.8° to 4.5° and 14.7 to 60.7%, respectively, postoperatively. Lumbar spine BMD did not change up to 12 months postoperatively. Ipsilateral femoral neck BMD decreased up to 6 months after OWHTO. CONCLUSION Medial femoral condyle BMD decreased rapidly within 3 months and continued to decrease up to 12 months, but lateral femoral condyle BMD did not change after OWHTO. BMD measurements around the knee condyle enabled the evaluation of the changes in stress distribution before and after OWHTO with accelerated rehabilitation. LEVEL OF EVIDENCE II.
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Affiliation(s)
- Yasushi Akamatsu
- Department of Joint Surgery, Fureai Yokohama Hospital, 2-3-3, Bandai-cho, Naka-ku, Yokohama, 231-0031, Japan.
- Department of Orthopaedic Surgery, Yokohama City University Hospital, Yokohama, Japan.
| | - Hideo Kobayashi
- Department of Orthopaedic Surgery, Yokohama City University Hospital, Yokohama, Japan
- Department of Orthopaedic Surgery, Saiseikai Yokohamashi Nanbu Hospital, Yokohama, Japan
| | - Shota Mitsuhashi
- Department of Orthopaedic Surgery, Yokohama City University Hospital, Yokohama, Japan
| | - Yoshihiro Kusayama
- Department of Orthopaedic Surgery, Yokohama City University Hospital, Yokohama, Japan
- Department of Orthopaedic Surgery, Kanagawa Prefectural Ashigarakami Hospital, Kanagawa, Japan
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Ekram S, Khalid S, Salim A, Khan I. Regulating the fate of stem cells for regenerating the intervertebral disc degeneration. World J Stem Cells 2021; 13:1881-1904. [PMID: 35069988 PMCID: PMC8727226 DOI: 10.4252/wjsc.v13.i12.1881] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/04/2021] [Revised: 07/12/2021] [Accepted: 11/15/2021] [Indexed: 02/06/2023] Open
Abstract
Lower back pain is a leading cause of disability and is one of the reasons for the substantial socioeconomic burden. The etiology of intervertebral disc (IVD) degeneration is complicated, and its mechanism is still not completely understood. Factors such as aging, systemic inflammation, biochemical mediators, toxic environmental factors, physical injuries, and genetic factors are involved in the progression of its pathophysiology. Currently, no therapy for restoring degenerated IVD is available except pain management, reduced physical activities, and surgical intervention. Therefore, it is imperative to establish regenerative medicine-based approaches to heal and repair the injured disc, repopulate the cell types to retain water content, synthesize extracellular matrix, and strengthen the disc to restore normal spine flexion. Cellular therapy has gained attention for IVD management as an alternative therapeutic option. In this review, we present an overview of the anatomical and molecular structure and the surrounding pathophysiology of the IVD. Modern therapeutic approaches, including proteins and growth factors, cellular and gene therapy, and cell fate regulators are reviewed. Similarly, small molecules that modulate the fate of stem cells for their differentiation into chondrocytes and notochordal cell types are highlighted.
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Affiliation(s)
- Sobia Ekram
- Dr. Panjwani Center for Molecular Medicine and Drug Research, International Center for Chemical and Biological Sciences, University of Karachi, Karachi 75270, Sindh, Pakistan
| | - Shumaila Khalid
- Dr. Panjwani Center for Molecular Medicine and Drug Research, International Center for Chemical and Biological Sciences, University of Karachi, Karachi 75270, Sindh, Pakistan
| | - Asmat Salim
- Dr. Panjwani Center for Molecular Medicine and Drug Research, International Center for Chemical and Biological Sciences, University of Karachi, Karachi 75270, Sindh, Pakistan
| | - Irfan Khan
- Dr. Panjwani Center for Molecular Medicine and Drug Research, International Center for Chemical and Biological Sciences, University of Karachi, Karachi 75270, Sindh, Pakistan
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Kon E, Boffa A, Andriolo L, Di Martino A, Di Matteo B, Magarelli N, Marcacci M, Onorato F, Trenti N, Zaffagnini S, Filardo G. Subchondral and intra-articular injections of bone marrow concentrate are a safe and effective treatment for knee osteoarthritis: a prospective, multi-center pilot study. Knee Surg Sports Traumatol Arthrosc 2021; 29:4232-4240. [PMID: 33772602 DOI: 10.1007/s00167-021-06530-x] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/13/2020] [Accepted: 03/04/2021] [Indexed: 12/20/2022]
Abstract
PURPOSE Subchondral bone is becoming a treatment target for knee OA patients, with promising early findings on the use of bone marrow aspirate concentrate (BMAC). The aim of this prospective, multi-centric pilot study was to evaluate safety as well as clinical and MRI outcomes of a combined approach of intra-articular and subchondral BMAC injections. METHODS Thirty patients (19 men, 11 women, 56.4 ± 8.1 years) with symptomatic knee OA were treated with a combination of an intra-articular and two subchondral BMAC injections (femoral condyle and tibial plateau). Patients were evaluated at baseline and at 1-3-6-12 months of follow-up with the IKDC subjective, VAS, KOOS, and EQ-VAS scores. The MRI evaluation was performed with the WORMS score. RESULTS No major complications were reported and only two patients were considered treatment failures, requiring a new injective or surgical treatment. The IKDC subjective score improved significantly from 40.5 ± 12.5 to 59.9 ± 16.1 at 3 months, 59.1 ± 12.2 at 6 months, and 62.6 ± 19.4 at 12 months (p < 0.0005). A similar improvement was reported for VAS pain and all KOOS subscales at all follow-ups, while EQ-VAS did not show any significant improvement. The MRI analysis showed a significant bone marrow edema reduction (p = 0.003), while the remaining WORMS parameters did not show any significant changes. CONCLUSION The pilot evaluation of this combined BMAC injective treatment showed safety and positive outcome up to 12 months of follow-up in patients with symptomatic knee OA associated with subchondral bone alterations. These findings suggest that targeting both subchondral bone and joint environment can provide promising results, and that BMAC can be a valid option for this combined approach to treat knee OA.
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Affiliation(s)
- Elizaveta Kon
- IRCCS Humanitas Research Hospital, Rozzano, MI, Italy
- Department of Biomedical Sciences, Humanitas University, Pieve Emanuele, MI, Italy
| | - Angelo Boffa
- Clinica Ortopedica e Traumatologica 2, IRCCS Istituto Ortopedico Rizzoli, Bologna, Italy.
| | - Luca Andriolo
- Clinica Ortopedica e Traumatologica 2, IRCCS Istituto Ortopedico Rizzoli, Bologna, Italy
| | - Alessandro Di Martino
- Clinica Ortopedica e Traumatologica 2, IRCCS Istituto Ortopedico Rizzoli, Bologna, Italy
| | - Berardo Di Matteo
- Department of Biomedical Sciences, Humanitas University, Pieve Emanuele, MI, Italy
- First Moscow State Medical University, Sechenov University, Moscow, Russia
| | | | - Maurilio Marcacci
- IRCCS Humanitas Research Hospital, Rozzano, MI, Italy
- Department of Biomedical Sciences, Humanitas University, Pieve Emanuele, MI, Italy
| | | | | | - Stefano Zaffagnini
- Clinica Ortopedica e Traumatologica 2, IRCCS Istituto Ortopedico Rizzoli, Bologna, Italy
| | - Giuseppe Filardo
- Applied and Translational Research (ATR) Center, IRCCS Istituto Ortopedico Rizzoli, Bologna, Italy
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Shoji T, Saka H, Inoue T, Kato Y, Fujiwara Y, Yamasaki T, Yasunaga Y, Adachi N. Preoperative T2 mapping MRI of articular cartilage values predicts postoperative osteoarthritis progression following rotational acetabular osteotomy. Bone Joint J 2021; 103-B:1472-1478. [PMID: 34465155 DOI: 10.1302/0301-620x.103b9.bjj-2021-0266.r1] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
AIMS Rotational acetabular osteotomy (RAO) has been reported to be effective in improving symptoms and preventing osteoarthritis (OA) progression in patients with mild to severe develomental dysplasia of the hip (DDH). However, some patients develop secondary OA even when the preoperative joint space is normal; determining who will progress to OA is difficult. We evaluated whether the preoperative cartilage condition may predict OA progression following surgery using T2 mapping MRI. METHODS We reviewed 61 hips with early-stage OA in 61 patients who underwent RAO for DDH. They underwent preoperative and five-year postoperative radiological analysis of the hip. Those with a joint space narrowing of more than 1 mm were considered to have 'OA progression'. Preoperative assessment of articular cartilage was also performed using 3T MRI with the T2 mapping technique. The region of interest was defined as the weightbearing portion of the acetabulum and femoral head. RESULTS There were 16 patients with postoperative OA progression. The T2 values of the centre to the anterolateral region of the acetabulum and femoral head in the OA progression cases were significantly higher than those in patients without OA progression. The preoperative T2 values in those regions were positively correlated with the narrowed joint space width. The receiver operating characteristic analysis revealed that the T2 value of the central portion in the acetabulum provided excellent discrimination, with OA progression patients having an area under the curve of 0.858. Furthermore, logistic regression analysis showed T2 values of the centre to the acetabulum's anterolateral portion as independent predictors of subsequent OA progression (p < 0.001). CONCLUSION This was the first study to evaluate the relationship between intra-articular degeneration using T2 mapping MRI and postoperative OA progression. Our findings suggest that preoperative T2 values of the hip can be better prognostic factors for OA progression than radiological measures following RAO. Cite this article: Bone Joint J 2021;103-B(9):1472-1478.
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Affiliation(s)
- Takeshi Shoji
- Department of Artificial Joints and Biomaterials, Graduate School of Biomedical and Health Sciences, Hiroshima University, Hiroshima, Japan
| | - Hideki Saka
- Department of Orthopaedic Surgery, Graduate School of Biomedical and Health Sciences, Hiroshima University, Hiroshima, Japan
| | - Tadashi Inoue
- Department of Orthopaedic Surgery, Graduate School of Biomedical and Health Sciences, Hiroshima University, Hiroshima, Japan
| | - Yuichi Kato
- Department of Orthopaedic Surgery, Graduate School of Biomedical and Health Sciences, Hiroshima University, Hiroshima, Japan
| | - Yusuke Fujiwara
- Department of Orthopaedic Surgery, Graduate School of Biomedical and Health Sciences, Hiroshima University, Hiroshima, Japan
| | - Takuma Yamasaki
- Department of Orthopaedic Surgery, Kure Medical Center and Chugoku Cancer Center, Hiroshima, Japan
| | - Yuji Yasunaga
- Department of Orthopaedic Surgery, Hiroshima Prefectural Rehabilitation Center, Hiroshima, Japan
| | - Nobuo Adachi
- Department of Orthopaedic Surgery, Graduate School of Biomedical and Health Sciences, Hiroshima University, Hiroshima, Japan
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Abstract
Osteoarthritis (OA) is a chronic, debilitating disease affecting millions of people worldwide. Management of OA involves pharmacological and non-pharmacological approaches. Conventional pharmacological treatments have limited efficacy and are associated with a number of side-effects, restricting the number of patients who can use them. New pharmacological therapies for managing OA are required and a number have been developed targeting different tissues in OA: bone and cartilage, synovium and nerves. However, there has been overall limited success. Disease-modifying osteoarthritis drugs (DMOADs) are a putative class of therapies aimed at improving OA structural pathologies and consequent symptoms. Recent DMOAD studies have demonstrated some promising therapies but also provided new considerations for future trials.
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Affiliation(s)
- Asim Ghouri
- Leeds Institute of Rheumatic and Musculoskeletal Medicine, University of Leeds and NIHR Leeds Biomedical Research Centre, Leeds, UK
| | - Philip G Conaghan
- Leeds Institute of Rheumatic and Musculoskeletal Medicine, University of Leeds and NIHR Leeds Biomedical Research Centre, Leeds, UK.
- Leeds Institute of Rheumatic and Musculoskeletal Medicine, Chapel Allerton Hospital, Chapeltown Rd, Leeds, LS7 4SA, UK.
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Eriksen EF, Shabestari M, Ghouri A, Conaghan PG. Bisphosphonates as a treatment modality in osteoarthritis. Bone 2021; 143:115352. [PMID: 32247817 DOI: 10.1016/j.bone.2020.115352] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/31/2019] [Revised: 03/15/2020] [Accepted: 03/31/2020] [Indexed: 01/09/2023]
Abstract
Osteoarthritis (OA) is affecting large proportions of the population worldwide. So far, no effective disease modifying drug has been developed for this disease, limiting the therapeutic options to pain medications, physiotherapy and ultimately surgical approaches, mainly joint implant surgery. In vitro and animal studies have demonstrated that bisphosphonates have the potential to become effective modalities for the treatment of OA. This group of pharmacological agents modulates crucial aspects of OA pathogenesis (subchondral bone turnover and loss, bone marrow edema formation, cartilage degeneration and synovitis), and have shown clear efficacy in animal models of OA. Human studies have, however, so far been disappointing with only one of six clinical studies showing clear short-term efficacy. Possible reasons for these discrepancies will be discussed.
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Affiliation(s)
- Erik Fink Eriksen
- Spesialistsenteret Pilestredet Park, Pilestredet Park 12A, NO-0176 Oslo, Norway; Institute for Clinical Dentistry, University of Oslo, Geitmyrsveien 71, 0455 Oslo, Norway.
| | - Maziar Shabestari
- Oral Health Centre of Expertise in Eastern Norway, Sørkedalsveien 10A, 0369 Oslo, Norway; Vinterbro Tannlegesenter, Sjøskogenveien 7, 1407 Vinterbro, Norway
| | - Asim Ghouri
- Leeds Institute of Rheumatic and Musculoskeletal Medicine, University of Leeds, Leeds, UK; NIHR Leeds Biomedical Research Centre, Leeds, UK
| | - Philip G Conaghan
- Leeds Institute of Rheumatic and Musculoskeletal Medicine, University of Leeds, Leeds, UK; NIHR Leeds Biomedical Research Centre, Leeds, UK
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Gersing AS, Holwein C, Suchowierski J, Feuerriegel G, Gassert FT, Baum T, Karampinos DC, Schwaiger BJ, Makowski MR, Burgkart R, Woertler K, Imhoff AB, Jungmann PM. Cartilage T 2 Relaxation Times and Subchondral Trabecular Bone Parameters Predict Morphological Outcome After Matrix-Associated Autologous Chondrocyte Implantation With Autologous Bone Grafting. Am J Sports Med 2020; 48:3573-3585. [PMID: 33200942 DOI: 10.1177/0363546520965987] [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] [Indexed: 01/31/2023]
Abstract
BACKGROUND Quantitative magnetic resonance (MR) imaging techniques are established for evaluation of cartilage composition and trabecular bone microstructure at the knee. It remains unclear whether quantitative MR parameters predict the midterm morphological outcome after matrix-associated chondrocyte implantation (MACI) with autologous bone grafting (ABG). PURPOSE To assess longitudinal changes and associations of the biochemical composition of cartilage repair tissue, the subchondral bone architecture, and morphological knee joint abnormalities on 3-T MR imaging after MACI with ABG at the knee. STUDY DESIGN Case series; Level of evidence, 4. METHODS Knees of 18 patients (28.7 ± 8.4 years [mean ± SD]; 5 women) were examined preoperatively and 3, 6, 12, and 24 months after MACI and ABG using 3-T MR imaging. Cartilage composition was assessed using T2 relaxation time measurements. Subchondral bone microstructure was quantified using a 3-dimensional phase-cycled balanced steady-state free precision sequence. Trabecular bone parameters were calculated using a dual threshold algorithm (apparent bone fraction, apparent trabecular number, and apparent trabecular separation). Morphological abnormalities were assessed using the MOCART (magnetic resonace observation of cartilage repair tissue) score, the WORMS (Whole-Organ Magnetic Resonance Imaging Score), and the CROAKS (Cartilage Repair Osteoarthritis Knee Score). Clinical symptoms were assessed using the Tegner activity and Lysholm knee scores. Statistical analyses were performed by using multiple linear regression analysis. RESULTS Total WORMS (P = .02) and MOCART (P = .001) scores significantly improved over 24 months after MACI. Clinical symptoms were significantly associated with the presence of bone marrow edema pattern abnormalities 24 months after surgery (P = .035). Overall there was a good to excellent radiological outcome found after 24 months (MOCART score, 88.8 ± 10.1). Cartilage repair T2 values significantly decreased between 12 and 24 months after MACI (P = .009). Lower global T2 values after 3 months were significantly associated with better MOCART scores after 24 months (P = .04). Moreover, trabecular bone parameters after 3 months were significantly associated with the total WORMS after 24 months (apparent bone fraction, P = .048; apparent trabecular number, P = .013; apparent trabecular separation, P = .013). CONCLUSION After MACI with ABG, early postoperative quantitative assessment of biochemical composition of cartilage and microstructure of subchondral bone may predict the outcome after 24 months. The perioperative global joint cartilage matrix quality is essential for proper proliferation of the repair tissue, reflected by MOCART scores. The subchondral bone quality of the ABG site is essential for proper maturation of the cartilage repair tissue, reflected by cartilage T2 values.
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Affiliation(s)
- Alexandra S Gersing
- Department of Radiology, Klinikum Rechts der Isar, School of Medicine, Technical University of Munich, Munich, Germany.,Department of Neuroradiology, University Hospital of Munich (LMU), Munich, Germany
| | - Christian Holwein
- Department of Orthopaedic Sports Medicine, Klinikum Rechts der Isar, School of Medicine, Technical University of Munich, Munich, Germany.,Department of Trauma and Orthopaedic Surgery, BG Unfallklinik Murnau, Murnau, Germany
| | - Joachim Suchowierski
- Department of Orthopaedic Sports Medicine, Klinikum Rechts der Isar, School of Medicine, Technical University of Munich, Munich, Germany
| | - Georg Feuerriegel
- Department of Radiology, Klinikum Rechts der Isar, School of Medicine, Technical University of Munich, Munich, Germany
| | - Florian T Gassert
- Department of Radiology, Klinikum Rechts der Isar, School of Medicine, Technical University of Munich, Munich, Germany
| | - Thomas Baum
- Department of Neuroradiology, Klinikum Rechts der Isar, School of Medicine, Technical University of Munich, Munich, Germany
| | - Dimitrios C Karampinos
- Department of Radiology, Klinikum Rechts der Isar, School of Medicine, Technical University of Munich, Munich, Germany
| | - Benedikt J Schwaiger
- Department of Radiology, Klinikum Rechts der Isar, School of Medicine, Technical University of Munich, Munich, Germany
| | - Marcus R Makowski
- Department of Radiology, Klinikum Rechts der Isar, School of Medicine, Technical University of Munich, Munich, Germany
| | | | - Klaus Woertler
- Department of Radiology, Klinikum Rechts der Isar, School of Medicine, Technical University of Munich, Munich, Germany
| | - Andreas B Imhoff
- Department of Orthopaedic Sports Medicine, Klinikum Rechts der Isar, School of Medicine, Technical University of Munich, Munich, Germany
| | - Pia M Jungmann
- Department of Radiology, Klinikum Rechts der Isar, School of Medicine, Technical University of Munich, Munich, Germany.,Department of Diagnostic and Interventional Radiology, Medical Center, Faculty of Medicine, University of Freiburg, Freiburg, Germany
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Joseph GB, McCulloch CE, Nevitt MC, Neumann J, Lynch JA, Lane NE, Link TM. Associations Between Vitamins C and D Intake and Cartilage Composition and Knee Joint Morphology Over 4 Years: Data From the Osteoarthritis Initiative. Arthritis Care Res (Hoboken) 2020; 72:1239-1247. [PMID: 31282125 DOI: 10.1002/acr.24021] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2019] [Accepted: 07/02/2019] [Indexed: 12/12/2022]
Abstract
OBJECTIVE To determine the cross-sectional and longitudinal associations of vitamin C and D intake with magnetic resonance imaging (MRI) measures of cartilage composition (T2) and joint structure (cartilage, meniscus, and bone marrow) using data from the Osteoarthritis Initiative (OAI) cohort. METHODS A total of 1,785 subjects with radiographic Kellgren/Lawrence knee grades 0-3 in the right knee were selected from the OAI database. Vitamins C and vitamin D intake (diet, supplements, and total) were assessed using the Block Brief 2000 Food Frequency Questionnaire at baseline. The MRI analysis protocol included 3T cartilage T2 quantification and semiquantitative joint morphology gradings (Whole-Organ Magnetic Resonance Imaging Score [WORMS]) at baseline and 4 years. Linear regression was used to assess the association between standardized baseline vitamin intake and both baseline WORMS scores and standardized cartilage T2 values. RESULTS Higher vitamin C intake was associated with lower average cartilage T2 values, medial tibia T2 values, and medial tibia WORMS scores (standardized coefficient range -0.07 to -0.05, P < 0.05). Higher vitamin D intake was associated with a lower cartilage WORMS sum score and medial femur WORMS score (standardized coefficient range -0.24 to -0.09, P < 0.05). Consistent use of vitamin D supplements of 400 IU at least once a week over 4 years was associated with significantly less worsening of cartilage, meniscus, and bone marrow abnormalities (odds ratio range 0.40-0.56, P < 0.05). CONCLUSION Supplementation with vitamin D over 4 years was associated with significantly less progression of knee joint abnormalities. Given the observational nature of this study, future longitudinal randomized controlled trials of vitamin D supplementation are warranted.
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Gersing AS, Feuerriegel G, Holwein C, Suchowierski J, Karampinos DC, Haller B, Baum T, Schwaiger BJ, Kirschke JS, Rummeny EJ, Imhoff AB, Woertler K, Jungmann PM. T2-relaxation time of cartilage repair tissue is associated with bone remodeling after spongiosa-augmented matrix-associated autologous chondrocyte implantation. Osteoarthritis Cartilage 2019; 27:90-98. [PMID: 30248504 DOI: 10.1016/j.joca.2018.08.023] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/30/2017] [Revised: 08/02/2018] [Accepted: 08/30/2018] [Indexed: 02/02/2023]
Abstract
OBJECTIVE To investigate whether T2 relaxation time measurements of cartilage repair tissue and structural changes of the knee joint are associated with subchondral bone architecture after spongiosa-augmented matrix-associated autologous chondrocyte implantation (MACI). DESIGN Both knees of 25 patients (25.5 ± 7.8y; 10 women) were examined preoperatively and 2.7 years after unilateral spongiosa-augmented MACI with 3T magnetic resonance (MR) imaging. Cartilage composition was assessed using T2 relaxation time measurements, subchondral trabecular bone microstructure was quantified using a 3D phase-cycled balanced steady state free-precision sequence. Structural knee joint changes were assessed using the modified Whole-Organ Magnetic Resonance Imaging Score (WORMS). The Magnetic Resonance Observation of Cartilage Repair Tissue (MOCART) score was used for the postoperative description of the area that underwent MACI. Correlations were assessed using Spearman's rank correlation coefficients. RESULTS Hypertrophy of the cartilage repair tissue was found in 2 of 25 patients, both after a MACI procedure at the patella, 21 patients showed congruent filling. In subchondral bone of the cartilage repair compartment, apparent trabecular thickness was significantly higher in compartments with elevated cartilage T2 (n = 17; 0.37 ± 0.05 mm) compared to those showing no difference in cartilage T2 compared to the same compartment in the contralateral knee (n = 8; 0.27 ± 0.05 mm; P = 0.042). Significant correlations were found between the overall progression of WORMS and the ipsilateral vs contralateral ratio of average trabecular thickness (r = 0.48, P = 0.031) and bone fraction (r = 0.57, P = 0.007). CONCLUSIONS After spongiosa-augmented MACI, T2 values of cartilage repair tissue and structural knee joint changes correlated with the quality of the underlying trabecular bone.
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Affiliation(s)
- A S Gersing
- Department of Radiology, Klinikum Rechts der Isar, Technical University of Munich, Munich, Germany.
| | - G Feuerriegel
- Department of Radiology, Klinikum Rechts der Isar, Technical University of Munich, Munich, Germany.
| | - C Holwein
- Department of Orthopaedic Sports Medicine, Klinikum Rechts der Isar, Technical University of Munich, Munich, Germany; Department of Trauma and Orthopaedic Surgery, BG Unfallklinik Murnau, Murnau, Germany.
| | - J Suchowierski
- Department of Orthopaedic Sports Medicine, Klinikum Rechts der Isar, Technical University of Munich, Munich, Germany.
| | - D C Karampinos
- Department of Radiology, Klinikum Rechts der Isar, Technical University of Munich, Munich, Germany.
| | - B Haller
- Institute of Medical Informatics, Statistics and Epidemiology, Technical University of Munich, Munich, Germany.
| | - T Baum
- Department of Neuroradiology, Klinikum Rechts der Isar, Technical University of Munich, Munich, Germany.
| | - B J Schwaiger
- Department of Radiology, Klinikum Rechts der Isar, Technical University of Munich, Munich, Germany.
| | - J S Kirschke
- Department of Neuroradiology, Klinikum Rechts der Isar, Technical University of Munich, Munich, Germany.
| | - E J Rummeny
- Department of Radiology, Klinikum Rechts der Isar, Technical University of Munich, Munich, Germany.
| | - A B Imhoff
- Department of Orthopaedic Sports Medicine, Klinikum Rechts der Isar, Technical University of Munich, Munich, Germany.
| | - K Woertler
- Department of Radiology, Klinikum Rechts der Isar, Technical University of Munich, Munich, Germany.
| | - P M Jungmann
- Department of Radiology, Klinikum Rechts der Isar, Technical University of Munich, Munich, Germany; Department of Neuroradiology, University Hospital Zurich, University of Zurich, Switzerland.
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van der Wal RJP, Attia D, Waarsing EH, Thomassen BJW, van Arkel ERA. Two-year follow-up of bone mineral density changes in the knee after meniscal allograft transplantation: Results of an explorative study. Knee 2018; 25:1091-1099. [PMID: 29933933 DOI: 10.1016/j.knee.2018.06.005] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/28/2017] [Revised: 04/18/2018] [Accepted: 06/04/2018] [Indexed: 02/02/2023]
Abstract
BACKGROUND The potential chondroprotective effect of meniscal allograft transplantation (MAT) is unclear. Subchondral bone mineral density (BMD) and subchondral bone remodeling play important roles in osteoarthritis development. Evaluation of subchondral BMD after MAT might give more insight into the potential chondroprotective effect. The purpose of this study was to determine early BMD changes in the knee after MAT. METHODS Twenty-six consecutive patients underwent MAT during 2010-2013. The BMD was measured using dual-energy x-ray absorptiometry (DXA) scan preoperatively, and six months, one and two years postoperatively. Bone mineral density was measured in six regions of interest (ROIs) in the tibia and femur (medial, central, lateral) in both treated and healthy contralateral knees. RESULTS The BMD levels of MAT knees did not significantly change during two years of follow-up in almost all ROIs. Bone mineral density was significant higher in nearly all ROIs in MAT knees at almost all follow-ups compared to healthy contralateral knees. In the healthy contralateral knees, BMD slightly, but not statistically, decreased in the first postoperative year, where it normalized to baseline values at two-year follow-up. The BMD levels in all ROIs did not significantly differ between the patients with or without chondropathy at baseline and two-year follow-up. CONCLUSION Based on the findings, MAT did not show a significant influence on BMD in the first two postoperative years. Longer follow-up is necessary to prove the potential chondroprotective effect of MAT using BMD measurements.
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Affiliation(s)
- Robert J P van der Wal
- Department of Orthopaedic Surgery, Leiden University Medical Center, Leiden, the Netherlands.
| | - David Attia
- Department of Orthopaedic Surgery and Traumatology, Haaglanden Medical Center, The Hague, the Netherlands
| | - Erwin H Waarsing
- Department of Orthopaedic Surgery, Erasmus Medical Center, Rotterdam, the Netherlands
| | - Bregje J W Thomassen
- Department of Orthopaedic Surgery and Traumatology, Haaglanden Medical Center, The Hague, the Netherlands
| | - Ewoud R A van Arkel
- Department of Orthopaedic Surgery and Traumatology, Haaglanden Medical Center, The Hague, the Netherlands
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11
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Shoji T, Yamasaki T, Izumi S, Sawa M, Akiyama Y, Yasunaga Y, Adachi N. Evaluation of articular cartilage following rotational acetabular osteotomy for hip dysplasia using T2 mapping MRI. Skeletal Radiol 2018; 47:1467-1474. [PMID: 29704036 DOI: 10.1007/s00256-018-2943-3] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/04/2018] [Revised: 03/05/2018] [Accepted: 04/02/2018] [Indexed: 02/02/2023]
Abstract
BACKGROUND Rotational acetabular osteotomy (RAO) is one of the surgical treatments for acetabular dysplasia, and satisfactory results have been reported. We evaluated the postoperative changes of articular cartilage and whether the pre-operative condition of the articular cartilage influences the clinical results using T2 mapping MRI. METHODS We reviewed 31 hips with early stage osteoarthritis in 31 patients (mean age, 39.6 years), including three men and 28 women who underwent RAO for hip dysplasia. Clinical evaluations including Japanese Orthopedic Association (JOA) score and Japanese Orthopedic Association Hip Disease Evaluation Questionnaire (JHEQ), and radiographical evaluations on X-ray were performed. Longitudinal qualitative assessment of articular cartilage was also performed using 3.0-T MRI with T2 mapping technique preoperatively, 6 months, and at 1 and 2 years postoperatively. RESULTS There was no case with progression of osteoarthritis. The mean JOA score improved from 70.1 to 93.4 points, the mean postoperative JHEQ score was 68.8 points, and radiographical data also improved postoperatively. We found that the T2 values of the cartilage at both femoral head and acetabulum increased at 6 months on coronal and sagittal views. However, they significantly decreased 1 and 2 years postoperatively. The T2 values of the center to anterolateral region of acetabulum negatively correlated with postoperative JHEQ score, particularly in pain score. CONCLUSIONS This study suggests that biomechanical and anatomical changes could apparently cause decreased T2 values 1-2 years postoperatively compared with those preoperatively. Furthermore, preoperative T2 values of the acetabulum can be prognostic factors for the clinical results of RAO.
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Affiliation(s)
- Takeshi Shoji
- Department of Orthopaedic Surgery, Graduate School of Biomedical Sciences, Hiroshima University, 1-2-3 Kasumi, Minami-ku, Hiroshima, 734-8551, Japan.
| | - Takuma Yamasaki
- Department of Orthopaedic Surgery, Graduate School of Biomedical Sciences, Hiroshima University, 1-2-3 Kasumi, Minami-ku, Hiroshima, 734-8551, Japan
| | - Soutaro Izumi
- Department of Orthopaedic Surgery, Graduate School of Biomedical Sciences, Hiroshima University, 1-2-3 Kasumi, Minami-ku, Hiroshima, 734-8551, Japan
| | - Mikiya Sawa
- Department of Orthopaedic Surgery, Graduate School of Biomedical Sciences, Hiroshima University, 1-2-3 Kasumi, Minami-ku, Hiroshima, 734-8551, Japan
| | - Yuji Akiyama
- Department of Diagnostic Radiology, Graduate School of Biomedical Sciences, Hiroshima University, 1-2-3 Kasumi, Minami-ku, Hiroshima, 734-8551, Japan
| | - Yuji Yasunaga
- Department of Orthopaedic Surgery, Hiroshima Prefectural Rehabilitation Center, 295-3 Taguchi, Saijo-town, Higashi-Hiroshima, 739-0036, Japan
| | - Nobuo Adachi
- Department of Orthopaedic Surgery, Graduate School of Biomedical Sciences, Hiroshima University, 1-2-3 Kasumi, Minami-ku, Hiroshima, 734-8551, Japan
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12
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MacKay JW, Low SBL, Smith TO, Toms AP, McCaskie AW, Gilbert FJ. Systematic review and meta-analysis of the reliability and discriminative validity of cartilage compositional MRI in knee osteoarthritis. Osteoarthritis Cartilage 2018; 26:1140-1152. [PMID: 29550400 DOI: 10.1016/j.joca.2017.11.018] [Citation(s) in RCA: 70] [Impact Index Per Article: 11.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/03/2017] [Revised: 10/16/2017] [Accepted: 11/14/2017] [Indexed: 02/02/2023]
Abstract
OBJECTIVE To assess reliability and discriminative validity of cartilage compositional magnetic resonance imaging (MRI) in knee osteoarthritis (OA). DESIGN The study was carried out per PRISMA recommendations. We searched MEDLINE and EMBASE (1974 - present) for eligible studies. We performed qualitative synthesis of reliability data. Where data from at least two discrimination studies were available, we estimated pooled standardized mean difference (SMD) between subjects with and without OA. Discrimination analyses compared controls and subjects with mild OA (Kellgren-Lawrence (KL) grade 1-2), severe OA (KL grade 3-4) and OA not otherwise specified (NOS) where not possible to stratify. We assessed quality of the evidence using Quality Appraisal of Diagnostic Reliability (QAREL) and Quality Assessment of Diagnostic Accuracy (QUADAS-2) tools. RESULTS Fifty-eight studies were included in the reliability analysis and 26 studies were included in the discrimination analysis, with data from a total of 2,007 knees. Intra-observer, inter-observer and test-retest reliability of compositional techniques were excellent with most intraclass correlation coefficients >0.8 and coefficients of variation <10%. T1rho and T2 relaxometry were significant discriminators between subjects with mild OA and controls, and between subjects with OA (NOS) and controls (P < 0.001). T1rho showed best discrimination for mild OA (SMD [95% CI] = 0.73 [0.40 to 1.06], P < 0.001) and OA (NOS) (0.60 [0.41 to 0.80], P < 0.001). Quality of evidence was moderate for both parts of the review. CONCLUSIONS Cartilage compositional MRI techniques are reliable and, in the case of T1rho and T2 relaxometry, can discriminate between subjects with OA and controls.
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Affiliation(s)
- J W MacKay
- Department of Radiology, University of Cambridge, Cambridge, UK.
| | - S B L Low
- Department of Radiology, Norfolk & Norwich University Hospital, Norwich, UK.
| | - T O Smith
- School of Health Sciences, University of East Anglia, Norwich, UK.
| | - A P Toms
- Department of Radiology, Norfolk & Norwich University Hospital, Norwich, UK.
| | - A W McCaskie
- Division of Trauma & Orthopaedics, Department of Surgery, University of Cambridge, Cambridge UK.
| | - F J Gilbert
- Department of Radiology, University of Cambridge, Cambridge, UK.
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13
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Gersing AS, Jungmann PM, Schwaiger BJ, Zarnowski J, Kopp FK, Landwehr S, Sauerschnig M, Joseph GB, Imhoff AB, Rummeny EJ, Kirschke JS, Baum T. Longitudinal changes in subchondral bone structure as assessed with MRI are associated with functional outcome after high tibial osteotomy. J ISAKOS 2018; 3:205-212. [PMID: 30705762 DOI: 10.1136/jisakos-2017-000194] [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] [Indexed: 02/05/2023]
Abstract
OBJECTIVES The primary objective of this study was to evaluate the effects of high tibial osteotomy (HTO) on subchondral bone structure assessed with magnetic resonance (MR)-based trabecular bone imaging and the correlations of these effects with functional outcome and clinical symptoms. METHODS Patients with varus malalignment (6.2±2.2°) and without a history of knee surgery (n=22; 3 women; 48.7±10.3 years) were included into this prospective study. 1.5T MR imaging was performed before and on average 1.5 years after HTO (amount of correction 4.7±2.5°) and histomorphometric parameters of the trabecular bone were calculated for the medial/ lateral tibia and femur. Functional outcome was assessed with validated scores focusing on sports activity including the Lysholm Score, Tegner Activity Scale and the adapted Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) Score. RESULTS Apparent trabecular number significantly decreased in all compartments of the tibiofemoral joint when comparing values before and on average 1.5 years after HTO (P<0.05 for all). Decrease in apparent trabecular number was significantly higher within the medial tibia compared to the lateral compartment (mean difference -0.24 mm-1 (95% confidence interval (CI): -0.33, -0.14 mm-1); P<0.001). Apparent trabecular bone thickness significantly increased within 1.5 years after HTO in the lateral femur (P=0.002) and tibia (P <0.001). The Lysholm Score and Tegner Scale demonstrated an improvement of functional outcome, and the adapted WOMAC demonstrated an improvement of pain, stiffness and physical function within 1.5 years after HTO (P<0.01), with the improvement of WOMAC correlating significantly with changes in trabecular bone thickness within the medial tibia (r= -0.48; P=0.01). CONCLUSION These findings indicate a reversal of the previous subchondral bone alterations in patients with varus malalignment after undergoing HTO, while pronounced subchondral changes were associated with a better functional outcome. LEVEL OF EVIDENCE 3.
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Affiliation(s)
- Alexandra S Gersing
- Department of Radiology, Klinikum rechts der Isar, Technical University of Munich, Munich, 81675, Germany.,Department of Radiology and Biomedical Imaging, University of California San Francisco, 185 Berry Street, Suite 350, San Francisco, CA 94107, U.S.A
| | - Pia M Jungmann
- Department of Radiology, Klinikum rechts der Isar, Technical University of Munich, Munich, 81675, Germany
| | - Benedikt J Schwaiger
- Department of Radiology, Klinikum rechts der Isar, Technical University of Munich, Munich, 81675, Germany
| | - Julia Zarnowski
- Department of Radiology, Klinikum rechts der Isar, Technical University of Munich, Munich, 81675, Germany
| | - Felix K Kopp
- Department of Radiology, Klinikum rechts der Isar, Technical University of Munich, Munich, 81675, Germany
| | - Saskia Landwehr
- Department of Orthopaedic Sports Medicine, Klinikum rechts der Isar, Technical University of Munich, Munich, 81675, Germany
| | - Martin Sauerschnig
- Department of Orthopaedic Sports Medicine, Klinikum rechts der Isar, Technical University of Munich, Munich, 81675, Germany.,Trauma Hospital Graz, Unfallkrankenhaus der Allgemeinen Unfallversicherungsanstalt (AUVA) Göstinger Straße 24, 8020 Graz, Austria
| | - Gabby B Joseph
- Department of Radiology and Biomedical Imaging, University of California San Francisco, 185 Berry Street, Suite 350, San Francisco, CA 94107, U.S.A
| | - Andreas B Imhoff
- Department of Orthopaedic Sports Medicine, Klinikum rechts der Isar, Technical University of Munich, Munich, 81675, Germany
| | - Ernst J Rummeny
- Department of Radiology, Klinikum rechts der Isar, Technical University of Munich, Munich, 81675, Germany
| | - Jan S Kirschke
- Department of Radiology, Klinikum rechts der Isar, Technical University of Munich, Munich, 81675, Germany.,Department of Neuroradiology, Klinikum rechts der Isar, Technical University of Munich, Munich, 81675, Germany
| | - Thomas Baum
- Department of Radiology, Klinikum rechts der Isar, Technical University of Munich, Munich, 81675, Germany.,Department of Neuroradiology, Klinikum rechts der Isar, Technical University of Munich, Munich, 81675, Germany
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14
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Neumann J, Hofmann FC, Heilmeier U, Ashmeik W, Tang K, Gersing AS, Schwaiger BJ, Nevitt MC, Joseph GB, Lane NE, McCulloch CE, Link TM. Type 2 diabetes patients have accelerated cartilage matrix degeneration compared to diabetes free controls: data from the Osteoarthritis Initiative. Osteoarthritis Cartilage 2018; 26:751-761. [PMID: 29605381 PMCID: PMC5962437 DOI: 10.1016/j.joca.2018.03.010] [Citation(s) in RCA: 31] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/25/2017] [Revised: 02/27/2018] [Accepted: 03/22/2018] [Indexed: 02/02/2023]
Abstract
PURPOSE Osteoarthritis (OA) and diabetes mellitus (DM) share common risk factors with a potential underlying relationship between both diseases. The purpose of this study was to investigate the longitudinal effects of DM on cartilage deterioration over 24-months with MR-based T2 relaxation time measurements. METHODS From the Osteoarthritis Initiative (OAI) cohort 196 diabetics were matched in small sets for age, sex, BMI and Kellgren-Lawrence score with 196 non-diabetic controls. Knee cartilage semi-automatic segmentation was performed on 2D multi-slice multi-echo spin-echo sequences. Texture of cartilage T2 maps was obtained via grey level co-occurrence matrix analysis. Linear regression analysis was used to compare cross-sectional and changes in T2 and texture parameters between the groups. RESULTS Both study groups were similar in age (63.3 vs 63.0 years, P = 0.70), BMI (30.9 vs 31.2 kg/m2, P = 0.52), sex (female 53.6% vs 54.1%, P = 0.92) and KL score distribution (P = 0.97). In diabetics, except for the patella, all compartments showed a significantly higher increase in mean T2 values when compared to non-diabetic controls. Global T2 values increased almost twice as much; 1.77ms vs 0.98ms (0.79ms [CI: 0.39,1.19]) (P < 0.001). Additionally, global T2 values showed a significantly higher increase in the bone layer (P = 0.006), and in a separate analysis of the texture parameters, diabetics also showed consistently higher texture values (P < 0.05), indicating a more disordered cartilage composition. CONCLUSION Cartilage T2 values in diabetics show a faster increase with a consistently more heterogeneous cartilage texture composition. DM seems to be a risk factor for developing early OA with an accelerated degeneration of the articular cartilage in the knee.
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Affiliation(s)
- J Neumann
- Musculoskeletal Quantitative Imaging Research Group, Department of Radiology & Biomedical Imaging, University of California San Francisco, San Francisco, USA.
| | - F C Hofmann
- Musculoskeletal Quantitative Imaging Research Group, Department of Radiology & Biomedical Imaging, University of California San Francisco, San Francisco, USA.
| | - U Heilmeier
- Musculoskeletal Quantitative Imaging Research Group, Department of Radiology & Biomedical Imaging, University of California San Francisco, San Francisco, USA.
| | - W Ashmeik
- Musculoskeletal Quantitative Imaging Research Group, Department of Radiology & Biomedical Imaging, University of California San Francisco, San Francisco, USA.
| | - K Tang
- Musculoskeletal Quantitative Imaging Research Group, Department of Radiology & Biomedical Imaging, University of California San Francisco, San Francisco, USA.
| | - A S Gersing
- Musculoskeletal Quantitative Imaging Research Group, Department of Radiology & Biomedical Imaging, University of California San Francisco, San Francisco, USA; Department of Diagnostic and Interventional Radiology, Technical University of Munich, Munich, Germany.
| | - B J Schwaiger
- Musculoskeletal Quantitative Imaging Research Group, Department of Radiology & Biomedical Imaging, University of California San Francisco, San Francisco, USA; Department of Diagnostic and Interventional Radiology, Technical University of Munich, Munich, Germany.
| | - M C Nevitt
- Department of Epidemiology and Biostatistics, University of California San Francisco, San Francisco, USA.
| | - G B Joseph
- Musculoskeletal Quantitative Imaging Research Group, Department of Radiology & Biomedical Imaging, University of California San Francisco, San Francisco, USA.
| | - N E Lane
- Department of Medicine and Center for Musculoskeletal Health, University of California at Davis, Sacramento, CA, USA.
| | - C E McCulloch
- Department of Epidemiology and Biostatistics, University of California San Francisco, San Francisco, USA.
| | - T M Link
- Musculoskeletal Quantitative Imaging Research Group, Department of Radiology & Biomedical Imaging, University of California San Francisco, San Francisco, USA.
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15
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Birch CE, Mensch KS, Desarno MJ, Beynnon BD, Tourville TW. Subchondral trabecular bone integrity changes following ACL injury and reconstruction: a cohort study with a nested, matched case-control analysis. Osteoarthritis Cartilage 2018; 26:762-769. [PMID: 29572129 PMCID: PMC5962427 DOI: 10.1016/j.joca.2018.02.905] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/19/2017] [Revised: 01/31/2018] [Accepted: 02/27/2018] [Indexed: 02/02/2023]
Abstract
OBJECTIVE There is limited information regarding changes in bone architecture following anterior cruciate ligament (ACL) injury. The objective of this study was to evaluate differences in tibial fractal signature in the medial and lateral compartments following ACL injury and describe how these values change following ACL-reconstruction and return to activity. DESIGN This was a prospective cohort study with a nested case-control analysis. ACL-injured subjects and matched controls were evaluated at pre-surgical baseline and post ACL reconstruction follow-up at a mean of 46 months. Serial Fractal Dimensions (FD) of tibial subchondral bone architecture were calculated in medial and lateral regions of interest in the horizontal and vertical dimensions. RESULTS In the medial and lateral compartments, there were significant differences in the vertical FD signature for ACL-injured subjects at final follow-up, when compared to the contralateral healthy tibia (medial P < 0.0001; lateral P < 0.0001) and the control group (medial P = 0.01; lateral P < 0.0001). Similarly, in the lateral compartment, there were significant differences in the horizontal FD profile for ACL-injured subjects at final follow-up, when compared to the contralateral healthy tibia (P = 0.003) and the controls (P < 0.0001). There were no significant side-to-side differences in FDs among healthy control subjects in the medial or lateral compartments at baseline or final follow-up. CONCLUSION At 46-month follow-up, FD profiles are significantly different, and show an overall lower FD signature, for ACL-injured knees when compared to the contralateral healthy knee and uninjured controls. Additionally, this study provided the first side-to-side symmetry data of medial and lateral FD values in healthy controls.
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Affiliation(s)
- C E Birch
- University of Vermont, Department of Orthopaedics and Rehabilitation, San Antonio, TX, USA.
| | - K S Mensch
- University of Texas Health Science Center at San Antonio, Department of Orthopaedics, Burlington, VT, USA.
| | - M J Desarno
- University of Vermont, Department of Medical Biostatistics, Burlington, VT, USA.
| | - B D Beynnon
- University of Vermont, Department of Orthopaedics and Rehabilitation, San Antonio, TX, USA.
| | - T W Tourville
- University of Vermont, Department of Orthopaedics and Rehabilitation, San Antonio, TX, USA; University of Vermont, Department of Rehabilitation and Movement Science, Burlington, VT, USA.
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16
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Lee DK, Song YK, Park BW, Cho HP, Yeom JS, Cho G, Cho H. The robustness of T 2 value as a trabecular structural index at multiple spatial resolutions of 7 Tesla MRI. Magn Reson Med 2018; 80:1949-1961. [PMID: 29656389 DOI: 10.1002/mrm.27202] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2018] [Revised: 03/09/2018] [Accepted: 03/11/2018] [Indexed: 12/13/2022]
Abstract
PURPOSE To evaluate the robustness of MR transverse relaxation times of trabecular bone from spin-echo and gradient-echo acquisitions at multiple spatial resolutions of 7 T. METHODS The effects of MRI resolutions to T2 and T2* of trabecular bone were numerically evaluated by Monte Carlo simulations. T2 , T2*, and trabecular structural indices from multislice multi-echo and UTE acquisitions were measured in defatted human distal femoral condyles on a 7 T scanner. Reference structural indices were extracted from high-resolution microcomputed tomography images. For bovine knee trabecular samples with intact bone marrow, T2 and T2* were measured by degrading spatial resolutions on a 7 T system. RESULTS In the defatted trabecular experiment, both T2 and T2* values showed strong ( |r| > 0.80) correlations with trabecular spacing and number, at a high spatial resolution of 125 µm3 . The correlations for MR image-segmentation-derived structural indices were significantly degraded ( |r| < 0.50) at spatial resolutions of 250 and 500 µm3 . The correlations for T2* rapidly dropped ( |r| < 0.50) at a spatial resolution of 500 µm3 , whereas those for T2 remained consistently high ( |r| > 0.85). In the bovine trabecular experiments with intact marrow, low-resolution (approximately 1 mm3 , 2 minutes) T2 values did not shorten ( |r| > 0.95 with respect to approximately 0.4 mm3 , 11 minutes) and maintained consistent correlations ( |r| > 0.70) with respect to trabecular spacing (turbo spin echo, 22.5 minutes). CONCLUSION T2 measurements of trabeculae at 7 T are robust with degrading spatial resolution and may be preferable in assessing trabecular spacing index with reduced scan time, when high-resolution 3D micro-MRI is difficult to obtain.
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Affiliation(s)
- D K Lee
- Department of Biomedical Engineering, Ulsan National Institute of Science and Technology, Ulsan, South Korea
| | - Y K Song
- Korea Basic Science Institute, Ochang, South Korea
| | - B W Park
- Department of Biomedical Engineering, Ulsan National Institute of Science and Technology, Ulsan, South Korea
| | - H P Cho
- Department of Biomedical Engineering, Ulsan National Institute of Science and Technology, Ulsan, South Korea
| | - J S Yeom
- Department of Orthopedic Surgery, Seoul National University, Seoul, South Korea
| | - G Cho
- Korea Basic Science Institute, Ochang, South Korea
| | - H Cho
- Department of Biomedical Engineering, Ulsan National Institute of Science and Technology, Ulsan, South Korea
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17
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Lo GH, Schneider E, Driban JB, Price LL, Hunter DJ, Eaton CB, Hochberg MC, Jackson RD, Kwoh CK, Nevitt MC, Lynch JA, McAlindon TE. Periarticular bone predicts knee osteoarthritis progression: Data from the Osteoarthritis Initiative. Semin Arthritis Rheum 2018; 48:155-161. [PMID: 29449014 DOI: 10.1016/j.semarthrit.2018.01.008] [Citation(s) in RCA: 25] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2017] [Revised: 12/22/2017] [Accepted: 01/10/2018] [Indexed: 12/21/2022]
Abstract
OBJECTIVE Osteoarthritis (OA) is a disease with a substantial public health burden. Quantitative assessments of periarticular bone may be a biomarker capable of monitoring early disease progression. The purpose of this study was to evaluate whether measures of periarticular bone associate with longitudinal structural progression. METHODS We conducted a 12-18 months longitudinal study using the Osteoarthritis Initiative (OAI). Participants received knee dual-energy x-ray absorptiometry (DXA), trabecular magnetic resonance (MR) imaging, and x-rays. Knee DXAs generated proximal tibial medial:lateral periarticular bone mineral density (paBMD) measures. Proximal tibial trabecular MR images were assessed for trabecular morphometry: apparent bone volume fraction (BVF), trabecular number, thickness, and spacing. Weight-bearing x-rays were assessed for medial tibiofemoral joint space narrowing (JSN). Chi-squared analyses assessed whether periarticular bone measures were predictive of worsening medial tibiofemoral JSN, adjusted for age, sex, and BMI. RESULTS In all, 444 participants, mean age 64.2 ± 9.2 years, BMI 29.5 ± 4.6kg/m2, and 52% male at baseline. Medial JSN (radiographic progression) occurred in 40 participants (9%). Higher baseline medial:lateral paBMD, apparent BVF, trabecular number and thickness, and lower baseline and decreased trabecular spacing were all associated with more progression of JSN in the medial compartment. From lowest to highest baseline medial:lateral paBMD quartile groups, 2%, 5%, 11%, and 18% had medial JSN progression, respectively, between the 36- and 48-month visits, p-values = 0.001 and 0.002 unadjusted and adjusted. The rate of change in medial:lateral paBMD, apparent BVF, and spacing were associated with more medial JSN. For rate of medial:lateral paBMD change from lowest to highest quartile, the proportion of each group that experienced medial JSN progression were 5%, 5%, 11%, and 18%, with an unadjusted and adjusted p-value of 0.005. CONCLUSION Baseline and most rates of periarticular bone change associate with knee OA structural progression, highlighting the close relationship between subchondral bone and JSN. Future studies should focus on developing these measures as predictive and pathophysiological biomarkers, and evaluating their deployment in clinical trials testing bone-targeted therapeutics.
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Affiliation(s)
- Grace H Lo
- Department of Medicine, Baylor College of Medicine, Houston, TX; Medical Care Line and Research Care Line, Houston VA HSR&D Center for Innovations in Quality, Effectiveness and Safety, Michael E. DeBakey Medical Center, Houston, TX.
| | - Erika Schneider
- Imaging Institute, Cleveland Clinic Foundation, Cleveland, OH; SciTrials, LCC, Rocky River, OH
| | | | - Lori Lyn Price
- The Institute for Clinical Research and Health Policy Studies, Tufts Medical Center, Boston, MA; Tufts Clinical and Translational Science Institute, Tufts University, Boston, MA
| | - David J Hunter
- Royal North Shore Hospital and Institute of Bone and Joint Research, Kolling Institute, University of Sydney, Australia
| | - Charles B Eaton
- Department of Family Medicine, Warren Alpert Medical School of Brown University, Providence, RI; Department of Epidemiology, School of Public Health of Brown University, Providence, RI
| | | | - Rebecca D Jackson
- Division of Endocrinology, Diabetes and Metabolism, Department of Internal Medicine, The Ohio State University, Columbus, OH
| | - C Kent Kwoh
- University of Pittsburgh School of Medicine, Pittsburgh, PA; University of Arizona Arthritis Center, Tucson, AZ
| | | | - John A Lynch
- Department of Epidemiology and Biostatistics, University of California San Francisco, San Francisco, CA
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18
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Hirvasniemi J, Thevenot J, Multanen J, Haapea M, Heinonen A, Nieminen MT, Saarakkala S. Association between radiography-based subchondral bone structure and MRI-based cartilage composition in postmenopausal women with mild osteoarthritis. Osteoarthritis Cartilage 2017; 25:2039-2046. [PMID: 28964891 DOI: 10.1016/j.joca.2017.09.008] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/19/2016] [Revised: 09/13/2017] [Accepted: 09/20/2017] [Indexed: 02/02/2023]
Abstract
OBJECTIVE Our aim was to investigate the relation between radiograph-based subchondral bone structure and cartilage composition assessed with delayed gadolinium enhanced magnetic resonance imaging of cartilage (dGEMRIC) and T2 relaxation time. DESIGN Ninety-three postmenopausal women (Kellgren-Lawrence grade 0: n = 13, 1: n = 26, 2: n = 54) were included. Radiograph-based bone structure was assessed using entropy of the Laplacian-based image (ELap) and local binary patterns (ELBP), homogeneity indices of the local angles (HIAngles,mean, HIAngles,Perp, HIAngles,Paral), and horizontal (FDHor) and vertical fractal dimensions (FDVer). Mean dGEMRIC index and T2 relaxation time of tibial cartilage were calculated to estimate cartilage composition. RESULTS HIAngles,mean (rs = -0.22) and HIAngles,Paral (rs = -0.24) in medial subchondral bone were related (P < 0.05) to dGEMRIC index of the medial tibial cartilage. ELap (rs = -0.23), FDHor,0.34 mm (r = 0.21) and FDVer,0.68 mm (r = 0.24) in medial subchondral bone were related (P < 0.05) to T2 relaxation time values of the medial tibial cartilage. FDHor at different scales in lateral subchondral bone were related (P < 0.01) to dGEMRIC index (r = 0.29-0.41) and T2 values of lateral tibial cartilage (r = -0.28 to -0.36). FDVer at larger scales were related (P < 0.05) to dGEMRIC index (r = 0.24-0.25) and T2 values of lateral tibial cartilage (r = -0.21). HIAngles,Paral (r = -0.25) and FDVer,0.68 mm (rs = 0.22) in the lateral tibial trabecular bone were related (P < 0.05) to dGEMRIC index of the lateral tibial cartilage. CONCLUSION Our results support the presumption that several tissues are affected in the early osteoarthritis (OA). Furthermore, they indicate that the detailed analysis of radiographs may serve as a complementary imaging tool for OA studies.
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Affiliation(s)
- J Hirvasniemi
- Center for Machine Vision and Signal Analysis, Faculty of Information Technology and Electrical Engineering, University of Oulu, Oulu, Finland.
| | - J Thevenot
- Research Unit of Medical Imaging, Physics and Technology, Faculty of Medicine, University of Oulu, Oulu, Finland; Infotech Oulu, University of Oulu, Oulu, Finland.
| | - J Multanen
- Department of Physical Medicine and Rehabilitation, Central Finland Central Hospital, Jyväskylä, Finland.
| | - M Haapea
- Research Unit of Medical Imaging, Physics and Technology, Faculty of Medicine, University of Oulu, Oulu, Finland; Medical Research Center Oulu, Oulu University Hospital and University of Oulu, Oulu, Finland; Department of Diagnostic Radiology, Oulu University Hospital, Oulu, Finland.
| | - A Heinonen
- Faculty of Sports and Health Sciences, University of Jyväskylä, Jyväskylä, Finland.
| | - M T Nieminen
- Research Unit of Medical Imaging, Physics and Technology, Faculty of Medicine, University of Oulu, Oulu, Finland; Infotech Oulu, University of Oulu, Oulu, Finland; Medical Research Center Oulu, Oulu University Hospital and University of Oulu, Oulu, Finland; Department of Diagnostic Radiology, Oulu University Hospital, Oulu, Finland.
| | - S Saarakkala
- Research Unit of Medical Imaging, Physics and Technology, Faculty of Medicine, University of Oulu, Oulu, Finland; Infotech Oulu, University of Oulu, Oulu, Finland; Medical Research Center Oulu, Oulu University Hospital and University of Oulu, Oulu, Finland; Department of Diagnostic Radiology, Oulu University Hospital, Oulu, Finland.
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Claessen KMJA, Canete AN, de Bruin PW, Pereira AM, Kloppenburg M, Kroon HM, Biermasz NR. Acromegalic arthropathy in various stages of the disease: an MRI study. Eur J Endocrinol 2017; 176:779-790. [PMID: 28348071 DOI: 10.1530/eje-16-1073] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/28/2016] [Revised: 03/14/2017] [Accepted: 03/24/2017] [Indexed: 11/08/2022]
Abstract
BACKGROUND Arthropathy is a prevalent and invalidating complication of acromegaly with a characteristic radiographic phenotype. We aimed to further characterize cartilage and bone abnormalities associated with acromegalic arthropathy using magnetic resonance imaging (MRI). METHODS Twenty-six patients (23% women, mean age 56.8 ± 13.4 years), with active (n = 10) and controlled acromegaly (n = 16) underwent a 3.0 T MRI of the right knee. Osteophytes, cartilage defects, bone marrow lesions and subchondral cysts were assessed by the Knee Osteoarthritis Scoring System (KOSS) method. Cartilage thickness and cartilage T2 relaxation times, in which higher values reflect increased water content and/or structural changes, were measured. Twenty-five controls (52% women, mean age: 59.6 ± 8.0 years) with primary knee OA were included for comparison. RESULTS Both in active and controlled acromegaly, structural OA defects were highly prevalent, with thickest cartilage and highest cartilage T2 relaxation times in the active patients. When compared to primary OA subjects, patients with acromegaly seem to have less cysts (12% vs 48%, P = 0.001) and bone marrow lesions (15% vs 80%, P = 0.006), but comparable prevalence of osteophytosis and cartilage defects. Patients with acromegaly had 31% thicker total joint cartilage (P < 0.001) with higher cartilage T2 relaxation times at all measured sites than primary OA subjects (P < 0.01). CONCLUSIONS Patients with active acromegaly have a high prevalence of structural OA abnormalities in combination with thick joint cartilage. In addition, T2 relaxation times of cartilage are high in active patients, indicating unhealthy cartilage with increased water content, which is (partially) reversible by adequate treatment. Patients with acromegaly have a different distribution of structural OA abnormalities visualized by MRI than primary OA subjects, especially of cartilage defects.
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Affiliation(s)
- K M J A Claessen
- Departments of Endocrinology & Metabolic Diseases and Center for Endocrine Tumors Leiden
| | | | | | - A M Pereira
- Departments of Endocrinology & Metabolic Diseases and Center for Endocrine Tumors Leiden
| | - M Kloppenburg
- Departments of RheumatologyLeiden University Medical CenterLeiden The Netherlands
| | | | - N R Biermasz
- Departments of Endocrinology & Metabolic Diseases and Center for Endocrine Tumors Leiden
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20
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Sakellariou G, Conaghan PG, Zhang W, Bijlsma JWJ, Boyesen P, D'Agostino MA, Doherty M, Fodor D, Kloppenburg M, Miese F, Naredo E, Porcheret M, Iagnocco A. EULAR recommendations for the use of imaging in the clinical management of peripheral joint osteoarthritis. Ann Rheum Dis 2017; 76:1484-1494. [DOI: 10.1136/annrheumdis-2016-210815] [Citation(s) in RCA: 114] [Impact Index Per Article: 16.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2016] [Revised: 02/25/2017] [Accepted: 03/05/2017] [Indexed: 11/04/2022]
Abstract
The increased information provided by modern imaging has led to its more extensive use. Our aim was to develop evidence-based recommendations for the use of imaging in the clinical management of the most common arthropathy, osteoarthritis (OA). A task force (including rheumatologists, radiologists, methodologists, primary care doctors and patients) from nine countries defined 10 questions on the role of imaging in OA to support a systematic literature review (SLR). Joints of interest were the knee, hip, hand and foot; imaging modalities included conventional radiography (CR), MRI, ultrasonography, CT and nuclear medicine. PubMed and EMBASE were searched. The evidence was presented to the task force who subsequently developed the recommendations. The strength of agreement for each recommendation was assessed. 17 011 references were identified from which 390 studies were included in the SLR. Seven recommendations were produced, covering the lack of need for diagnostic imaging in patients with typical symptoms; the role of imaging in differential diagnosis; the lack of benefit in monitoring when no therapeutic modification is related, though consideration is required when unexpected clinical deterioration occurs; CR as the first-choice imaging modality; consideration of how to correctly acquire images and the role of imaging in guiding local injections. Recommendations for future research were also developed based on gaps in evidence, such as the use of imaging in identifying therapeutic targets, and demonstrating the added value of imaging. These evidence-based recommendations and related research agenda provide the basis for sensible use of imaging in routine clinical assessment of people with OA.
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21
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A 20 years of progress and future of quantitative magnetic resonance imaging (qMRI) of cartilage and articular tissues—personal perspective. Semin Arthritis Rheum 2016; 45:639-47. [DOI: 10.1016/j.semarthrit.2015.11.005] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2015] [Revised: 10/25/2015] [Accepted: 11/11/2015] [Indexed: 12/21/2022]
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22
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MacKay JW, Murray PJ, Kasmai B, Johnson G, Donell ST, Toms AP. MRI texture analysis of subchondral bone at the tibial plateau. Eur Radiol 2015; 26:3034-45. [PMID: 26679180 DOI: 10.1007/s00330-015-4142-0] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2015] [Revised: 11/23/2015] [Accepted: 11/27/2015] [Indexed: 12/20/2022]
Abstract
OBJECTIVES To determine the feasibility of MRI texture analysis as a method of quantifying subchondral bone architecture in knee osteoarthritis (OA). METHODS Asymptomatic subjects aged 20-30 (group 1, n = 10), symptomatic patients aged 40-50 (group 2, n = 10) and patients scheduled for knee replacement aged 55-85 (group 3, n = 10) underwent high spatial resolution T1-weighted coronal 3T knee MRI. Regions of interest were created in the medial (MT) and lateral (LT) tibial subchondral bone from which 20 texture parameters were calculated. T2 mapping of the tibial cartilage was performed in groups 1 and 2. Mean parameter values were compared between groups using ANOVA. Linear discriminant analysis (LDA) was used to evaluate the ability of texture analysis to classify subjects correctly. RESULTS Significant differences in 18/20 and 12/20 subchondral bone texture parameters were demonstrated between groups at the MT and LT respectively. There was no significant difference in mean MT or LT cartilage T2 values between group 1 and group 2. LDA demonstrated subject classification accuracy of 97 % (95 % CI 91-100 %). CONCLUSION MRI texture analysis of tibial subchondral bone may allow detection of alteration in subchondral bone architecture in OA. This has potential applications in understanding OA pathogenesis and assessing response to treatment. KEY POINTS • Improved techniques to monitor OA disease progression and treatment response are desirable • Subchondral bone (SB) may play significant role in the development of OA • MRI texture analysis is a method of quantifying changes in SB architecture • Pilot study showed that this technique is feasible and reliable • Significant differences in SB texture were demonstrated between individuals with/without OA.
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Affiliation(s)
- James W MacKay
- Radiology Academy, Department of Radiology, Norfolk & Norwich University Hospital, Colney Lane, Norwich, Norfolk, NR4 7UB, UK.
| | - Philip J Murray
- Radiology Academy, Department of Radiology, Norfolk & Norwich University Hospital, Colney Lane, Norwich, Norfolk, NR4 7UB, UK
| | - Bahman Kasmai
- Radiology Academy, Department of Radiology, Norfolk & Norwich University Hospital, Colney Lane, Norwich, Norfolk, NR4 7UB, UK
| | - Glyn Johnson
- Radiology Academy, Department of Radiology, Norfolk & Norwich University Hospital, Colney Lane, Norwich, Norfolk, NR4 7UB, UK.,Norwich Medical School, University of East Anglia, Norwich, UK
| | - Simon T Donell
- Norwich Medical School, University of East Anglia, Norwich, UK.,Department of Trauma & Orthopaedics, Norfolk & Norwich University Hospital, Norwich, UK
| | - Andoni P Toms
- Radiology Academy, Department of Radiology, Norfolk & Norwich University Hospital, Colney Lane, Norwich, Norfolk, NR4 7UB, UK.,Norwich Medical School, University of East Anglia, Norwich, UK
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23
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Improved differentiation between knees with cartilage lesions and controls using 7T relaxation time mapping. J Orthop Translat 2015; 3:197-204. [PMID: 30035058 PMCID: PMC5986989 DOI: 10.1016/j.jot.2015.05.003] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/24/2015] [Revised: 05/14/2015] [Accepted: 05/28/2015] [Indexed: 11/25/2022] Open
Abstract
Background/Objective T1ρ and T2 relaxation mapping in knee cartilage have been used extensively at 3 Tesla (T) as markers for proteoglycan and collagen, respectively. The objective of this study was to evaluate the feasibility of T1ρ and T2 imaging of knee cartilage at 7T in comparison to 3T and to evaluate the ability of T1ρ and T2 to determine differences between normal and osteoarthritis (OA) patients. Materials and methods Twenty patients, seven healthy patients (Kellgren–Lawrence = 0), and 13 patients with signs of radiographic OA (Kellgren–Lawrence > 0) were scanned at 3T and 7T. The knee cartilage was segmented into six compartments and the T1ρ and T2 values were fit using a two-parameter model. Additionally, patients were stratified by the presence of cartilage lesions using the modified Whole Organ Magnetic Resonance Imaging Score classification of the knee. One-way analysis of variance was used to compare the healthy and OA groups at 3T and 7T. The specific absorption ratio was kept under Food and Drug Administration limits during all scans. Results T1ρ and T2 values at 3T and 7T were significantly higher in the lateral femoral condyle and patella in patients with OA. However, more regions were significant or approached significance at 7T compared with 3T, with the differences between healthy and OA patients also larger at 7T. The signal to noise ratio across all cartilage and meniscus compartments was 60% higher on average at 7T compared to 3T. Conclusion T1ρ imaging at 7T has been established as a viable imaging method for the differentiation of degenerated cartilage despite previous concerns over specific absorption rate and imaging time. The potential increased sensitivity of T1ρ and T2 imaging at 7T may be useful for future studies in the development of OA.
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24
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Kumar D, Souza RB, Subburaj K, MacLeod TD, Singh J, Calixto NE, Nardo L, Link TM, Li X, Lane NE, Majumdar S. Are There Sex Differences in Knee Cartilage Composition and Walking Mechanics in Healthy and Osteoarthritis Populations? Clin Orthop Relat Res 2015; 473:2548-58. [PMID: 25716211 PMCID: PMC4488198 DOI: 10.1007/s11999-015-4212-2] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
BACKGROUND Women are at a greater risk for knee osteoarthritis (OA), but reasons for this greater risk in women are not well understood. It may be possible that differences in cartilage composition and walking mechanics are related to greater OA risk in women. QUESTIONS/PURPOSES (1) Do women have higher knee cartilage and meniscus T1ρ than men in young healthy, middle-aged non-OA and OA populations? (2) Do women exhibit greater static and dynamic (during walking) knee loading than men in young healthy, middle-aged non-OA and OA populations? METHODS Data were collected from three cohorts: (1) young active (<35 years) (20 men, 13 women); (2) middle-aged (≥35 years) without OA (Kellgren-Lawrence [KL] grade < 2) (43 men, 65 women); and (3) middle-aged with OA (KL>1) (18 men, 25 women). T1ρ and T2 relaxation times for cartilage in the medial knee, lateral knee, and patellofemoral compartments and medial and lateral menisci were quantified with 3.0-T MRI. A subset of the participants underwent three-dimensional motion capture during walking for calculation of peak knee flexion and adduction moments, flexion and adduction impulses, and peak adduction angle. Differences in MR, radiograph, and gait parameters between men and women were compared in the three groups separately using multivariate analysis of variance. RESULTS Women had higher lateral articular cartilage T1ρ (men=40.5 [95% confidence interval {CI}, 38.8-42.3] ms; women=43.3 [95% CI, 41.9-44.7] ms; p=0.017) and patellofemoral T1ρ (men=44.4 [95% CI, 42.6-46.3] ms; women=48.4 [95% CI, 46.9-50.0] ms; p=0.002) in the OA group; and higher lateral meniscus T1ρ in the young group (men=15.3 [95% CI, 14.7-16.0] ms; women=16.4 [95% CI, 15.6-17.2] ms; p=0.045). The peak adduction moment in the second half of stance was lower in women in the middle-aged (men=2.05 [95% CI, 1.76-2.34] %BW*Ht; women=1.66 [95% CI, 1.44-1.89] %BW*Ht; p=0.037) and OA (men=2.34 [95% CI, 1.76-2.91] %BW*Ht; women=1.42 [95% CI, 0.89-1.94] %BW*Ht; p=0.022) groups. Static varus from radiographs was lower in women in the middle-aged (men=178° [95% CI, 177°-179°]; women=180° [95% CI, 179°-181°]; p=0.002) and OA (men=176° [95% CI, 175°-178°]; women=180° [95% CI, 179°-181°]; p<0.001) groups. Women had lower varus during walking in all three groups (young: men=4° [95% CI, 3°-6°]; women=2° [95% CI, 0°-3°]; p=0.013; middle-aged: men=2° [95% CI, 1°-3°]; women=0° [95% CI, -1° to 1°]; p=0.015; OA: men=4° [95% CI, 2°-6°]; women=0° [95% CI, -2° to 2°]; p=0.011). Women had a higher knee flexion moment (men=4.24 [95% CI, 3.58-4.91] %BW*Ht; women 5.40 [95% CI, 4.58-6.21] %BW*Ht; p=0.032) in the young group. CONCLUSIONS These data demonstrate differences in cartilage composition and gait mechanics between men and women in young healthy, middle-aged healthy, and OA cohorts. Considering the cross-sectional nature of the study, longitudinal research is needed to investigate if these differences in cartilage composition and walking mechanics are associated with a greater risk of lateral tibiofemoral or patellofemoral OA in women. Future studies should also investigate the relative risk of lateral versus medial patellofemoral cartilage degeneration risk in women compared with men. LEVEL OF EVIDENCE Level III, retrospective study.
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Affiliation(s)
- Deepak Kumar
- />Musculoskeletal Quantitative Imaging Research Group, Department of Radiology and Biomedical Imaging, University of California-San Francisco, San Francisco, CA USA , />Division of Physical Therapy, Department of Health Professions, Medical University of South Carolina, 151B Rutledge Ave, MSC 962, Room B309, Charleston, SC 29425 USA
| | - Richard B. Souza
- />Musculoskeletal Quantitative Imaging Research Group, Department of Radiology and Biomedical Imaging, University of California-San Francisco, San Francisco, CA USA , />Department of Physical Therapy and Rehabilitation Science, University of California-San Francisco, San Francisco, CA USA
| | - Karupppasamy Subburaj
- />Musculoskeletal Quantitative Imaging Research Group, Department of Radiology and Biomedical Imaging, University of California-San Francisco, San Francisco, CA USA , />Engineering Product Development, Singapore University of Technology and Design, Singapore, Singapore
| | - Toran D. MacLeod
- />Musculoskeletal Quantitative Imaging Research Group, Department of Radiology and Biomedical Imaging, University of California-San Francisco, San Francisco, CA USA , />Department of Physical Therapy, California State University, Sacramento, CA USA
| | - Justin Singh
- />Musculoskeletal Quantitative Imaging Research Group, Department of Radiology and Biomedical Imaging, University of California-San Francisco, San Francisco, CA USA
| | - Nathaniel E. Calixto
- />Musculoskeletal Quantitative Imaging Research Group, Department of Radiology and Biomedical Imaging, University of California-San Francisco, San Francisco, CA USA
| | - Lorenzo Nardo
- />Musculoskeletal Quantitative Imaging Research Group, Department of Radiology and Biomedical Imaging, University of California-San Francisco, San Francisco, CA USA
| | - Thomas M. Link
- />Musculoskeletal Quantitative Imaging Research Group, Department of Radiology and Biomedical Imaging, University of California-San Francisco, San Francisco, CA USA
| | - Xiaojuan Li
- />Musculoskeletal Quantitative Imaging Research Group, Department of Radiology and Biomedical Imaging, University of California-San Francisco, San Francisco, CA USA
| | - Nancy E. Lane
- />Center for Musculoskeletal Health, University of California at Davis Medical Center, Sacramento, CA USA
| | - Sharmila Majumdar
- />Musculoskeletal Quantitative Imaging Research Group, Department of Radiology and Biomedical Imaging, University of California-San Francisco, San Francisco, CA USA
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Chang G, Honig S, Liu Y, Chen C, Chu KK, Rajapakse CS, Egol K, Xia D, Saha PK, Regatte RR. 7 Tesla MRI of bone microarchitecture discriminates between women without and with fragility fractures who do not differ by bone mineral density. J Bone Miner Metab 2015; 33:285-93. [PMID: 24752823 PMCID: PMC4363287 DOI: 10.1007/s00774-014-0588-4] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/28/2013] [Accepted: 03/17/2014] [Indexed: 01/23/2023]
Abstract
Osteoporosis is a disease of poor bone quality. Bone mineral density (BMD) has limited ability to discriminate between subjects without and with poor bone quality, and assessment of bone microarchitecture may have added value in this regard. Our goals were to use 7 T MRI to: (1) quantify and compare distal femur bone microarchitecture in women without and with poor bone quality (defined clinically by presence of fragility fractures); and (2) determine whether microarchitectural parameters could be used to discriminate between these two groups. This study had institutional review board approval, and we obtained written informed consent from all subjects. We used a 28-channel knee coil to image the distal femur of 31 subjects with fragility fractures and 25 controls without fracture on a 7 T MRI scanner using a 3-D fast low angle shot sequence (0.234 mm × 0.234 mm × 1 mm, parallel imaging factor = 2, acquisition time = 7 min 9 s). We applied digital topological analysis to quantify parameters of bone microarchitecture. All subjects also underwent standard clinical BMD assessment in the hip and spine. Compared to controls, fracture cases demonstrated lower bone volume fraction and markers of trabecular number, plate-like structure, and plate-to-rod ratio, and higher markers of trabecular isolation, rod disruption, and network resorption (p < 0.05 for all). There were no differences in hip or spine BMD T-scores between groups (p > 0.05). In receiver-operating-characteristics analyses, microarchitectural parameters could discriminate cases and controls (AUC = 0.66-0.73, p < 0.05). Hip and spine BMD T-scores could not discriminate cases and controls (AUC = 0.58-0.64, p ≥ 0.08). We conclude that 7 T MRI can detect bone microarchitectural deterioration in women with fragility fractures who do not differ by BMD. Microarchitectural parameters might some day be used as an additional tool to detect patients with poor bone quality who cannot be detected by dual-energy X-ray absorptiometry (DXA).
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Affiliation(s)
- Gregory Chang
- Department of Radiology, NYU Langone Medical Center, Center for Musculoskeletal Care, 333 E. 38th Street, 6th Floor, Room 6-210, New York, NY, 10016, USA,
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Characterization of the collagen component of cartilage repair tissue of the talus with quantitative MRI: comparison of T2 relaxation time measurements with a diffusion-weighted double-echo steady-state sequence (dwDESS). Eur Radiol 2014; 25:980-6. [PMID: 25407662 DOI: 10.1007/s00330-014-3490-5] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2014] [Revised: 10/17/2014] [Accepted: 11/05/2014] [Indexed: 12/16/2022]
Abstract
OBJECTIVES The purpose of this study was to characterize the collagen component of repair tissue (RT) of the talus after autologous matrix-induced chondrogenesis (AMIC) using quantitative T2 and diffusion-weighted imaging. METHODS Mean T2 values and diffusion coefficients of AMIC-RT and normal cartilage of the talus of 25 patients with posttraumatic osteochondral lesions and AMIC repair were compared in a cross-sectional design using partially spoiled steady-state free precession (pSSFP) for T2 quantification, and diffusion-weighted double-echo steady-state (dwDESS) for diffusion measurement. RT and cartilage were graded with modified Noyes and MOCART scores on morphological sequences. An association between follow-up interval and quantitative MRI measures was assessed using multivariate regression, after stratifying the cohort according to time interval between surgery and MRI. RESULTS Mean T2 of the AMIC-RT and cartilage were 43.1 ms and 39.1 ms, respectively (p = 0.26). Mean diffusivity of the RT (1.76 μm(2)/ms) was significantly higher compared to normal cartilage (1.46 μm(2)/ms) (p = 0.0092). No correlation was found between morphological and quantitative parameters. RT diffusivity was lowest in the subgroup with follow-up >28 months (p = 0.027). CONCLUSIONS Compared to T2-mapping, dwDESS demonstrated greater sensitivity in detecting differences in the collagen matrix between AMIC-RT and cartilage. Decreased diffusivity in patients with longer follow-up times may indicate an increased matrix organization of RT. KEY POINTS • MRI is used to assess morphology of the repair tissue during follow-up. • Quantitative MRI allows an estimation of biochemical properties of the repair tissue. • Differences between repair tissue and cartilage were more significant with dwDESS than T2 mapping.
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Subchondral bone plate thickening precedes chondrocyte apoptosis and cartilage degradation in spontaneous animal models of osteoarthritis. BIOMED RESEARCH INTERNATIONAL 2014; 2014:606870. [PMID: 25045687 PMCID: PMC4086372 DOI: 10.1155/2014/606870] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/10/2014] [Accepted: 05/11/2014] [Indexed: 11/28/2022]
Abstract
Osteoarthritis (OA) is the most common joint disorder characterised by bone remodelling and cartilage degradation and associated with chondrocyte apoptosis. These processes were investigated at 10, 16, 24, and 30 weeks in Dunkin Hartley (DH) and Bristol Strain 2 (BS2) guinea pigs that develop OA spontaneously. Both strains had a more pronounced chondrocyte apoptosis, cartilage degradation, and subchondral bone changes in the medial than the lateral side of the tibia, and between strains, the changes were always greater and faster in DH than BS2. In the medial side, a significant increase of chondrocyte apoptosis and cartilage degradation was observed in DH between 24 and 30 weeks of age preceded by a progressive thickening and stiffening of subchondral bone plate (Sbp). The Sbp thickness consistently increased over the 30-week study period but the bone mineral density (BMD) of the Sbp gradually decreased after 16 weeks. The absence of these changes in the medial side of BS2 may indicate that the Sbp of DH was undergoing remodelling. Chondrocyte apoptosis was largely confined to the deep zone of articular cartilage and correlated with thickness of the subchondral bone plate suggesting that cartilage degradation and chondrocyte apoptosis may be a consequence of continuous bone remodelling during the development of OA in these animal models of OA.
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Siddiqui S, Xin Y, Emami K, D'Armiento J, Shiomi T, Profka H, Mongkolwisetwara P, Rizi R. Hyperpolarized (3)He diffusion MRI and histology of secreted frizzled related protein-1 (SFRP1) deficient lungs in a Murine model. Magn Reson Imaging 2014; 32:535-40. [PMID: 24629512 DOI: 10.1016/j.mri.2014.01.022] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2013] [Revised: 12/04/2013] [Accepted: 01/27/2014] [Indexed: 12/25/2022]
Abstract
Secreted frizzled related protein-1 (SFRP1) plays a key role in many diverse processes, including embryogenesis, tissue repair, bone formation, and tumor genesis. Previous studies have shown the effects of the SFRP1 gene on lung development using the SFRP1 knockout mouse model via histological and physiological studies. In this study, the feasibility of ADC (acquired via HP (3)He) to detect altered lung structure in the SFRP1 knockout (SFRP1(-/-)) mice was investigated, and compared to analysis by histology. This study consisted of two groups, the wild-type (WT) mice and the knockout (KO) mice with n=6 mice for each group. (3)He ADC MRI and histology were performed on all of the animals. The global Lm values of WT and KO mice were 35.0±0.8μm and 38.4±3.8μm, respectively, which translated to an increase of 9.58% in the Lm of KO mice. The mean global ADCs for the WT and KO mice were 0.12±0.01cm(2)/s and 0.13±0.01cm(2)/s, respectively, which equated to a relative increase of 8.0% in the KO mice compared to the WT mice. In the sub-analysis of the anterior, medial and posterior lung regions, Lm increased by 10.50%, 6.66% and 11.84% in the KO mice, respectively, whereas the differences in ADC between the two groups in the anterior, medial, and posterior regions were 7.3%, 8.3%, and 4.6%, respectively. These results suggest that HP MRI measurements can be used as a suitable substitute for histology to obtain valuable information about lung geometry non-invasively. This technique is also advantageous as regional measurements can be performed, which can identify lung destruction more precisely. Most importantly, this approach extends far beyond the specific pathology analyzed in this study, as it can be applied to many other pathological conditions in the lung tissue, as well to many other embryonic studies.
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Affiliation(s)
- Sarmad Siddiqui
- Department of Radiology, University of Pennsylvania, Philadelphia, PA, USA.
| | - Yi Xin
- Department of Radiology, University of Pennsylvania, Philadelphia, PA, USA
| | - Kiarash Emami
- Department of Radiology, University of Pennsylvania, Philadelphia, PA, USA
| | | | - Takayuki Shiomi
- Department of Medicine, Columbia University, New York, NY, USA
| | - Harrilla Profka
- Department of Radiology, University of Pennsylvania, Philadelphia, PA, USA
| | | | - Rahim Rizi
- Department of Radiology, University of Pennsylvania, Philadelphia, PA, USA
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Theologis AA, Haughom B, Liang F, Zhang Y, Majumdar S, Link TM, Ma CB, Li X. Comparison of T1rho relaxation times between ACL-reconstructed knees and contralateral uninjured knees. Knee Surg Sports Traumatol Arthrosc 2014; 22:298-307. [PMID: 23370983 PMCID: PMC3692610 DOI: 10.1007/s00167-013-2397-z] [Citation(s) in RCA: 60] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/19/2012] [Accepted: 01/14/2013] [Indexed: 10/27/2022]
Abstract
PURPOSE The goal of this study is to compare the cartilage of anterior cruciate ligament (ACL)-reconstructed and uninjured contralateral knees using T 1ρ MRI 12-16 months after ACL reconstructions. METHODS Eighteen patients with ACL-reconstructed knees (10 women, 8 men, mean age = 38.3 ± 7.8 years) were studied using 3T MRI. Injured and contralateral knee MR studies were acquired 12-16 months post-operatively. Cartilage sub-compartment T 1ρ values of each injured knee were compared with the contralateral knee's values. Subgroup analysis of sub-compartment T 1ρ values in both knees was performed between patients with and without meniscal tears at the time of ACL reconstruction using a paired Student's t test. RESULTS In ACL-injured knees, the T 1ρ values of the medial tibia (MT) and medial femoral condyle (MFC) were significantly elevated at 12-16 months follow-up compared to contralateral knees. Patients with a medial meniscal tear had higher MFC and MT T 1ρ values compared to respective regions in contralateral knees. Patients with lateral meniscal tears had higher lateral femoral condyle and LT T 1ρ values compared to respective regions in contralateral knees. There were no differences between the injured and contralateral knees of patients without meniscal tears. CONCLUSIONS T 1ρ MRI can detect significant changes in the medial compartments' cartilage matrix of ACL-reconstructed knees at 1 year post-operatively compared to contralateral knees. The presence of a meniscal tear at the time of ACL reconstruction is a risk factor for cartilage matrix degeneration in the femorotibial compartments on the same side as the meniscal tear.
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Affiliation(s)
- Alexander A. Theologis
- University of California, San Francisco School of Medicine, Department of Orthopaedic Surgery, 500 Parnassus Ave, MU320W, San Francisco, CA 94143
| | - Bryan Haughom
- University of California, San Francisco School of Medicine, Department of Radiology, China Basin Landing, 185 Berry Street, Suite 350, San Francisco, CA 94107
| | - Fei Liang
- University of California, San Francisco School of Medicine, Department of Radiology, China Basin Landing, 185 Berry Street, Suite 350, San Francisco, CA 94107
| | - Yu Zhang
- University of California, San Francisco School of Medicine, Department of Radiology, China Basin Landing, 185 Berry Street, Suite 350, San Francisco, CA 94107
| | - Sharmila Majumdar
- University of California, San Francisco School of Medicine, Radiology and Biomedical Imaging, 1700 4th Street, Suite 203, San Francisco, CA, 94143
| | - Thomas M. Link
- University of California, San Francisco School of Medicine, Radiology and Biomedical Imaging, 400 Parnassus Avenue, San Francisco, CA, 94122
| | - C. Benjamin Ma
- University of California, San Francisco School of Medicine, Department of Orthopaedic Surgery, 500 Parnassus Ave, MU320W, San Francisco, CA 94143
| | - Xiaojuan Li
- University of California, San Francisco School of Medicine, Department of Radiology, China Basin Landing, 185 Berry Street, Suite 350, San Francisco, CA 94107
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Podsiadlo P, Cicuttini FM, Wolski M, Stachowiak GW, Wluka AE. Trabecular bone texture detected by plain radiography is associated with an increased risk of knee replacement in patients with osteoarthritis: a 6 year prospective follow up study. Osteoarthritis Cartilage 2014; 22:71-5. [PMID: 24216061 DOI: 10.1016/j.joca.2013.10.017] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/10/2013] [Revised: 10/13/2013] [Accepted: 10/29/2013] [Indexed: 02/02/2023]
Abstract
OBJECTIVE To examine the association between trabecular bone texture and knee joint replacement (KJR) measured using a variance orientation transform (VOT) method. METHODS The association of trabecular bone texture and KJR was examined prospectively over 6 years in 123 subjects with symptomatic knee osteoarthritis (OA): data regarding KJR was available for 114 (93%). At baseline, weight-bearing anteroposterior tibio-femoral radiographs were acquired. Trabecular bone texture regions were selected from the medial and lateral subchondral tibia. The VOT method was applied to each region and five fractal bone texture parameters, i.e., mean fractal dimension (FDMEAN), fractal dimensions in the horizontal (FDH) and vertical (FDV) directions, and along the roughest part of trabecular bone (FD(Sta)), and texture aspect ratio (Str) were calculated. The association between groups with increasing baseline fractal parameters (defined using tertiles) with risk of JR was examined using logistic regression. RESULTS 28 (25%) participants' study knees underwent KJR over 6 years. Participants with KJR had lower medial FD(MEAN) and FD(H) parameters (P = 0.02 for difference). With increasing FD(MEAN), adjusted for age, gender, body mass index (BMI), osteophyte grade, joint space narrowing (JSN) grade and WOMAC pain score, the odds of KJR was reduced (P = 0.04 for trend). CONCLUSION This study suggests that the texture of medial tibial trabecular bone measured from plain radiographs is related to the risk of KJR: with increasing FD(MEAN) (the overall measure of bone texture roughness) the risk of KJR was reduced, independent of other clinical predictors of joint replacement. Tibial trabecular bone texture may be a useful marker of disease progression and a target of therapy in OA.
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Affiliation(s)
- P Podsiadlo
- Tribology Laboratory, School of Civil and Mechanical Engineering, Curtin University, Bentley, WA 6102, Australia; Tribology Laboratory, School Mechanical and Chemical Engineering, University of Western Australia, Crawley, WA 6009, Australia.
| | - F M Cicuttini
- Department of Epidemiology and Preventive Medicine, Monash University, Alfred Hospital, Melbourne, Vic 3004, Australia
| | - M Wolski
- Tribology Laboratory, School of Civil and Mechanical Engineering, Curtin University, Bentley, WA 6102, Australia
| | - G W Stachowiak
- Tribology Laboratory, School of Civil and Mechanical Engineering, Curtin University, Bentley, WA 6102, Australia
| | - A E Wluka
- Department of Epidemiology and Preventive Medicine, Monash University, Alfred Hospital, Melbourne, Vic 3004, Australia
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Early Changes of Trabecular Bone Structure in Asymptomatic Subjects With Knee Malalignment. J Comput Assist Tomogr 2014; 38:137-41. [DOI: 10.1097/rct.0b013e3182a90f08] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
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Kim BJ, Choi BH, Jin LH, Park SR, Min BH. Comparison between subchondral bone change and cartilage degeneration in collagenase- and DMM- induced osteoarthritis (OA) models in mice. Tissue Eng Regen Med 2013. [DOI: 10.1007/s13770-013-1080-2] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022] Open
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Kraus VB, Feng S, Wang S, White S, Ainslie M, Graverand MPHL, Brett A, Eckstein F, Hunter DJ, Lane NE, Taljanovic MS, Schnitzer T, Charles HC. Subchondral bone trabecular integrity predicts and changes concurrently with radiographic and magnetic resonance imaging-determined knee osteoarthritis progression. ACTA ACUST UNITED AC 2013; 65:1812-1821. [PMID: 23576116 DOI: 10.1002/art.37970] [Citation(s) in RCA: 54] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2012] [Accepted: 04/04/2013] [Indexed: 11/09/2022]
Abstract
OBJECTIVE To evaluate subchondral bone trabecular integrity (BTI) on radiographs as a predictor of knee osteoarthritis (OA) progression. METHODS Longitudinal (baseline, 12-month, and 24-month) knee radiographs were available for 60 female subjects with knee OA. OA progression was defined by 12- and 24-month changes in radiographic medial compartment minimal joint space width (JSW) and medial joint space area (JSA), and by medial tibial and femoral cartilage volume on magnetic resonance imaging. BTI of the medial tibial plateau was analyzed by fractal signature analysis using commercially available software. Receiver operating characteristic (ROC) curves for BTI were used to predict a 5% change in OA progression parameters. RESULTS Individual terms (linear and quadratic) of baseline BTI of vertical trabeculae predicted knee OA progression based on 12- and 24-month changes in JSA (P < 0.01 for 24 months), 24-month change in tibial (P < 0.05), but not femoral, cartilage volume, and 24-month change in JSW (P = 0.05). ROC curves using both terms of baseline BTI predicted a 5% change in the following OA progression parameters over 24 months with high accuracy, as reflected by the area under the curve measures: JSW 81%, JSA 85%, tibial cartilage volume 75%, and femoral cartilage volume 85%. Change in BTI was also significantly associated (P < 0.05) with concurrent change in JSA over 12 and 24 months and with change in tibial cartilage volume over 24 months. CONCLUSION BTI predicts structural OA progression as determined by radiographic and MRI outcomes. BTI may therefore be worthy of study as an outcome measure for OA studies and clinical trials.
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Affiliation(s)
| | - Sheng Feng
- Biostatistics and Bioinformatics, Duke University, Durham, NC 27710
| | - ShengChu Wang
- Biostatistics and Bioinformatics, Duke University, Durham, NC 27710
| | - Scott White
- Duke Image Analysis Laboratory, Department of Radiology, Duke University, Durham, NC 27710
| | - Maureen Ainslie
- Duke Image Analysis Laboratory, Department of Radiology, Duke University, Durham, NC 27710
| | | | - Alan Brett
- Optasia Medical, Manchester, UK and current employee of Mindways Software, Inc
| | - Felix Eckstein
- Institute of Anatomy & Musculoskeletal Research, Paracelsus Medical University (PMU), Salzburg, Austria & Chondrometrics GmbH, Ainring, Germany
| | - David J Hunter
- New England Baptist Hospital, Boston, MA and Institute of Bone and Joint Research, University of Sydney, Sydney, Australia
| | - Nancy E Lane
- University of California at Davis Medical Center, Sacramento, CA
| | | | | | - H Cecil Charles
- Duke Image Analysis Laboratory, Department of Radiology, Duke University, Durham, NC 27710
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HARTLEV L, NYENGAARD J, THOMSEN J, BOEL L, STENGAARD-PEDERSEN K, HAUGE EM. Application of design-based stereology for estimation of absolute volume and surface area of the articular and calcified cartilage compartments of undecalcified human femoral heads. J Microsc 2013; 251:133-43. [DOI: 10.1111/jmi.12055] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2012] [Accepted: 05/01/2013] [Indexed: 11/30/2022]
Affiliation(s)
- L.B. HARTLEV
- Department of Rheumatology; Aarhus University Hospital; Aarhus Denmark
| | - J.R. NYENGAARD
- Stereology and Electron Microscopy Laboratory; Center for Stochastic Geometry and Advanced Bioimaging; Aarhus University Hospital; Aarhus Denmark
| | - J.S. THOMSEN
- Department of Biomedicine - Anatomy; Aarhus University; Aarhus Denmark
| | - L.W.T. BOEL
- Institute of Forensic Medicine; Aarhus University; Aarhus Denmark
| | | | - E.-M. HAUGE
- Department of Rheumatology; Aarhus University Hospital; Aarhus Denmark
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Cox LGE, van Donkelaar CC, van Rietbergen B, Emans PJ, Ito K. Alterations to the subchondral bone architecture during osteoarthritis: bone adaptation vs endochondral bone formation. Osteoarthritis Cartilage 2013; 21:331-8. [PMID: 23142725 DOI: 10.1016/j.joca.2012.10.013] [Citation(s) in RCA: 34] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/11/2012] [Revised: 09/13/2012] [Accepted: 10/25/2012] [Indexed: 02/02/2023]
Abstract
OBJECTIVE Osteoarthritis (OA) is characterized by loss of cartilage and alterations in subchondral bone architecture. Changes in cartilage and bone tissue occur simultaneously and are spatially correlated, indicating that they are probably related. We investigated two hypotheses regarding this relationship. According to the first hypothesis, both wear and tear changes in cartilage, and remodeling changes in bone are a result of abnormal loading conditions. According to the second hypothesis, loss of cartilage and changes in bone architecture result from endochondral ossification. DESIGN With an established bone adaptation model, we simulated adaptation to high load and endochondral ossification, and investigated whether alterations in bone architecture between these conditions were different. In addition, we analyzed bone structure differences between human bone samples with increasing degrees of OA, and compared these data to the simulation results. RESULTS The simulation of endochondral ossification led to a more refined structure, with a higher number of trabeculae in agreement with the finding of a higher trabecular number in osteochondral plugs with severe OA. Furthermore, endochondral ossification could explain the presence of a "double subchondral plate" which we found in some human bone samples. However, endochondral ossification could not explain the increase in bone volume fraction that we observed, whereas adaptation to high loading could. CONCLUSION Based on the simulation and experimental data, we postulate that both endochondral ossification and adaptation to high load may contribute to OA bone structural changes, while both wear and tear and the replacement of mineralized cartilage with bone tissue may contribute cartilage thinning.
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Affiliation(s)
- L G E Cox
- Department of Biomedical Engineering, Eindhoven University of Technology, Eindhoven, The Netherlands
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Trabecular bone structure and spatial differences in articular cartilage MR relaxation times in individuals with posterior horn medial meniscal tears. Osteoarthritis Cartilage 2013; 21:86-93. [PMID: 23047010 PMCID: PMC3538917 DOI: 10.1016/j.joca.2012.09.014] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/07/2012] [Revised: 09/16/2012] [Accepted: 09/22/2012] [Indexed: 02/02/2023]
Abstract
OBJECTIVE To analyze knee trabecular bone structure and spatial cartilage T(1ρ) and T(2) relaxation times using 3-T magnetic resonance imaging (MRI) in subjects with and without tears of posterior horn of the medial meniscus (PHMM). DESIGN 3-T MRI from 59 subjects (>18 years), were used to evaluate PHMM tears based on modified Whole-Organ Magnetic Resonance Imaging Score (WORMS) scoring; and to calculate apparent trabecular bone-volume over total bone volume fraction (app. BV/TV), apparent trabecular number (app. Tb.N), apparent trabecular separation (app. Tb.Sp) and apparent trabecular thickness (app. Tb.Th) for overall femur/tibia and medial/lateral femur/tibia; and relaxation times for deep and superficial layers of articular cartilage. A repeated measures analysis using Generalized Estimating Equation (GEE) was performed to compare trabecular bone and cartilage relaxation time parameters between people with (n = 35) and without (n = 24) PHMM tears, while adjusting for age and knee OA presence. RESULTS Subjects with PHMM tears had lower app. BV/TV and app. Tb.N, and greater app. Tb.Th, and app. Tb.Sp. They also had higher T(1ρ) times in the deep cartilage layer for lateral tibia and medial femur and higher T(2) relaxation times for the deep cartilage layer across all compartments. CONCLUSIONS PHMM tears are associated with differences in underlying trabecular bone and deep layer of cartilage. Over-load of subchondral bone can lead to its sclerosis and stress shielding of trabecular bone leading to the resorptive changes observed in this study. The results underline the importance of interactions of trabecular bone and cartilage in the pathogenesis of knee OA in people with PHMM tears.
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Driban JB, Tassinari A, Lo GH, Price LL, Schneider E, Lynch JA, Eaton CB, McAlindon TE. Bone marrow lesions are associated with altered trabecular morphometry. Osteoarthritis Cartilage 2012; 20:1519-26. [PMID: 22940708 PMCID: PMC3478500 DOI: 10.1016/j.joca.2012.08.013] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/02/2012] [Revised: 08/07/2012] [Accepted: 08/22/2012] [Indexed: 02/02/2023]
Abstract
OBJECTIVE Bone marrow lesions (BMLs) are a common magnetic resonance (MR) feature in patients with osteoarthritis, however their pathological basis remains poorly understood and has not been evaluated in vivo. Our aim was to evaluate the trabecular structure associated with the presence and size of BMLs present in the same regions of interest (ROI) using quantitative MR-based trabecular morphometry. DESIGN 158 participants in the Osteoarthritis Initiative (OAI) were imaged with a coronal 3D fast imaging with steady state precession (FISP) sequence for trabecular morphometry in the same session as the OAI 3 T MR knee evaluation. The proximal medial tibial subchondral bone in the central weight-bearing ROI on these knee 3D FISP images were quantitatively evaluated for apparent bone volume fraction, trabecular number, spacing, and thickness. BMLs were also evaluated in the subchondral bone immediately adjacent to the articular cartilage. BML volume was also evaluated within the same trabecular morphometry ROI and semi-quantitatively classified as none, small, or large. Kruskal-Wallis test was used to determine if mean apparent bone volume fraction, trabecular number, spacing, or thickness differed by BML score. RESULTS Compared to knees with ROIs containing no BMLs, knees with small or large BMLs had statistically higher apparent bone volume fraction (P < 0.01), trabecular number (P < 0.01), and thickness (P = 0.02), and lower trabecular spacing (P < 0.01). CONCLUSIONS Compared to knees with ROIs containing no BMLs, knees with ROIs containing small or large BMLs had higher apparent bone volume fraction, trabecular number and thickness, but lower trabecular spacing. These findings may represent areas of locally increased bone remodeling or compression.
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Affiliation(s)
- Jeffrey B Driban
- Division of Rheumatology, Tufts Medical Center, 800 Washington Street, Box #406, Boston, MA 02111
| | - Anna Tassinari
- Division of Rheumatology, Tufts Medical Center, 800 Washington Street, Box #406, Boston, MA 02111
| | - 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, TX. Section of Immunology, Allergy, and Rheumatology, Baylor College of Medicine, Houston, TX. 1 Baylor Plaza, BCM-285, Houston, TX 77030
| | - Lori Lyn Price
- Biostatistics Research Center, Institute for Clinical Research and Health Policy Studies, Tufts Medical Center, 800 Washington Street, Box #63, Boston, MA 02111
| | - Erika Schneider
- Imaging Institute, Cleveland Clinic Foundation, 9500 Euclid Avenue HB6, Cleveland, OH 44195
| | - John A Lynch
- Department of Epidemiology and Biostatistics, University of California at San Francisco, 185 Berry Street, Lobby 5, Suite 5700, San Francisco, CA 94107
| | - Charles B. Eaton
- Departments of Family Medicine and Epidemiology, Alpert Medical School of Brown University, Center for Primary Care and Prevention, Second Floor, Memorial Hospital of Rhode Island, 111 Brewster Street, Pawtucket, RI 02864
| | - Timothy E. McAlindon
- Division of Rheumatology, Tufts Medical Center, 800 Washington Street, Box #406, Boston, MA 02111
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Valverde-Franco G, Pelletier JP, Fahmi H, Hum D, Matsuo K, Lussier B, Kapoor M, Martel-Pelletier J. In vivo bone-specific EphB4 overexpression in mice protects both subchondral bone and cartilage during osteoarthritis. ACTA ACUST UNITED AC 2012; 64:3614-25. [DOI: 10.1002/art.34638] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
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Marques J, Genant HK, Lillholm M, Dam EB. Diagnosis of osteoarthritis and prognosis of tibial cartilage loss by quantification of tibia trabecular bone from MRI. Magn Reson Med 2012; 70:568-75. [PMID: 22941674 DOI: 10.1002/mrm.24477] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2012] [Revised: 06/26/2012] [Accepted: 08/08/2012] [Indexed: 11/05/2022]
Abstract
A longitudinal study was used to investigate the quantification of osteoarthritis and prediction of tibial cartilage loss by analysis of the tibia trabecular bone from magnetic resonance images of knees. The Kellgren Lawrence (KL) grades were determined by radiologists and the levels of cartilage loss were assessed by a segmentation process. Aiming to quantify and potentially capture the structure of the trabecular bone anatomy, a machine learning approach used a set of texture features for training a classifier to recognize the trabecular bone of a knee with radiographic osteoarthritis. Using cross-validation, the bone structure marker was used to estimate for each knee both the probability of having radiographic osteoarthritis (KL >1) and the probability of rapid cartilage volume loss. The diagnostic ability reached a median area under the receiver-operator-characteristics curve of 0.92 (P < 0.0001), and the prognosis had odds ratio of 3.9 (95% confidence interval: 2.4-6.5). The medians of cartilage loss of the subjects classified as slow and rapid progressors were 1.1% and 4.9% per year, respectively. A preliminary radiological reading of the high and low risk knees put forward an hypothesis of which pathologies the bone marker could be capturing to define the prognosis of cartilage loss.
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Baseline mean and heterogeneity of MR cartilage T2 are associated with morphologic degeneration of cartilage, meniscus, and bone marrow over 3 years--data from the Osteoarthritis Initiative. Osteoarthritis Cartilage 2012; 20:727-35. [PMID: 22503812 PMCID: PMC3595156 DOI: 10.1016/j.joca.2012.04.003] [Citation(s) in RCA: 105] [Impact Index Per Article: 8.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/02/2011] [Revised: 03/20/2012] [Accepted: 04/04/2012] [Indexed: 02/02/2023]
Abstract
OBJECTIVE The purpose of this study is to determine whether the mean and heterogeneity of magnetic resonance (MR) knee cartilage T(2) relaxation time measurements at baseline are associated with morphologic degeneration of cartilage, meniscus, and bone marrow tissues over 3 years in subjects with risk factors for osteoarthritis (OA). DESIGN Subjects with risk factors for OA (n=289) with an age range of 45-55 years were selected from the Osteoarthritis Initiative (OAI) database. 3.0 Tesla MR images were analyzed using morphological gradings of cartilage, bone marrow and menisci whole-organ magnetic resonance imaging scores (WORMS scoring). A T(2) mapping sequence was used to assess the mean and heterogeneity of cartilage T(2) (gray level co-occurrence matrix texture analysis). Regression models were used to assess the relationship between baseline T(2) parameters and changes in morphologic knee WORMS scores over 3 years. RESULTS The prevalence of knee abnormalities in the cartilage (P<0.0005), meniscus (P<0.00001), and bone marrow significantly (P<0.00001) increased from baseline to 3 years in all compartments combined. The baseline mean and heterogeneity of cartilage T(2) were significantly (P<0.05) associated with morphologic joint degeneration in the cartilage, meniscus and bone marrow over 3 years. CONCLUSIONS The prevalence of knee abnormalities significantly increased over 3 years; increased cartilage T(2) at baseline predicted longitudinal morphologic degeneration in the cartilage, meniscus, and bone marrow over 3 years in subjects with risk factors for OA.
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Cross-sectional DXA and MR measures of tibial periarticular bone associate with radiographic knee osteoarthritis severity. Osteoarthritis Cartilage 2012; 20:686-93. [PMID: 22430052 PMCID: PMC3760173 DOI: 10.1016/j.joca.2012.03.006] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/28/2011] [Revised: 03/08/2012] [Accepted: 03/13/2012] [Indexed: 02/02/2023]
Abstract
OBJECTIVE We evaluated the relationship of medial proximal tibial periarticular areal bone mineral density (paBMD) and trabecular morphometry and determined whether these bone measures differed across radiographic medial joint space narrowing (JSN) scores. METHODS 482 participants of the Osteoarthritis Initiative (OAI) Bone Ancillary Study had knee dual X-ray absorptiometry (DXA) and trabecular bone 3T magnetic resonance imaging (MRI) exams assessed at the same visit. Medial proximal tibial paBMD was measured on DXA and apparent trabecular bone volume fraction (aBV/TV), thickness (aTb.Th), number (aTb.N), and spacing (aTb.Sp) were determined from MR images. Radiographs were assessed for medial JSN scores (0-3). We evaluated associations between medial paBMD and trabecular morphometry. Whisker plots with notches of these measures versus medial JSN scores were generated and presented. RESULTS Mean age was 63.9 (9.2) years, BMI 29.6 (4.8) kg/m(2), and 53% were male. The Spearman correlation coefficients between DXA-measured medial paBMD and aBV/TV was 0.61 [95% confidence interval (CI) 0.55-0.66]; between paBMD and aTb.Th was 0.38 (95%CI 0.30-0.46); paBMD and aTb.N was 0.65 (95%CI 0.60-0.70); paBMD and aTb.Sp was -0.65 (95%CI -0.70 to -0.59). paBMD and the trabecular metrics were associated with medial JSN scores. CONCLUSION The moderate associations between periarticular trabecular bone density and morphometry and their relationship with greater severity of knee OA support hypotheses of remodeling and/or microscopic compression fractures in the natural history of OA. Longitudinal studies are needed to assess whether knee DXA will be a predictor of OA progression. Further characterization of the periarticular bone in OA utilizing complementary imaging modalities will help clarify OA pathophysiology.
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Marques J, Granlund R, Lillholm M, Pettersen PC, Dam EB. Automatic analysis of trabecular bone structure from knee MRI. Comput Biol Med 2012; 42:735-42. [PMID: 22579046 DOI: 10.1016/j.compbiomed.2012.04.005] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2011] [Revised: 02/08/2012] [Accepted: 04/23/2012] [Indexed: 11/28/2022]
Abstract
We investigated the feasibility of quantifying osteoarthritis (OA) by analysis of the trabecular bone structure in low-field knee MRI. Generic texture features were extracted from the images and subsequently selected by sequential floating forward selection (SFFS), following a fully automatic, uncommitted machine-learning based framework. Six different classifiers were evaluated in cross-validation schemes and the results showed that the presence of OA can be quantified by a bone structure marker. The performance of the developed marker reached a generalization area-under-the-ROC (AUC) of 0.82, which is higher than the established cartilage markers known to relate to the OA diagnosis.
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Pinney JR, Taylor C, Doan R, Burghardt AJ, Li X, Kim HT, Benjamin Ma C, Majumdar S. Imaging longitudinal changes in articular cartilage and bone following doxycycline treatment in a rabbit anterior cruciate ligament transection model of osteoarthritis. Magn Reson Imaging 2011; 30:271-82. [PMID: 22071411 DOI: 10.1016/j.mri.2011.09.025] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2011] [Revised: 09/28/2011] [Accepted: 09/30/2011] [Indexed: 11/25/2022]
Abstract
OBJECTIVE The development of osteoarthritis following traumatic anterior cruciate ligament (ACL) injury is well established. However, few reliable indicators of early osteoarthritic changes have been established, which has limited the development of effective therapies. T(1ρ) and T(2) mapping techniques have the ability to provide highly accurate and quantitative measurements of articular cartilage degeneration in vivo. Relating these cartilaginous changes to high-resolution bone-densitometric evaluations of the late-stage osteoarthritic bone is crucial in elucidating the mechanisms of development of traumatic osteoarthritis (OA) and potential therapies for early- or late-stage intervention. METHODS Twelve rabbits were monitored with in vivo magnetic resonance imaging (MRI) scans following ACL transection surgery with a contralateral leg sham operation. Six of the rabbits were treated with oral doxycycline for the duration of the experiment. At 12 weeks, the excised knees from three animals from each group (n=6 overall) were subjected to micro-computed tomography (CT) analysis. RESULTS Consistent with previous studies, initial elevations in T(1ρ) and T(2) values in ACL-transected animals were observed with relative normalization towards values see in sham-operated legs over the 12-week study. This biphasic pattern could hold diagnostic potential to differentiate osteoarthritic cartilage by tracking the relative proportions of T(1ρ) and T(2) values as they rise with inflammation then fall as collagen and proteoglycan loss leads to further dehydration. The addition of doxycycline resulted in inconclusive, yet potentially interesting, cartilaginous changes in several compartments of the rabbit legs. Micro-CT studies demonstrated decreased bone densitometrics in ACL-transected knees. Correlation studies suggest that the cartilaginous changes may be associated with some aspects of bony change and the development of OA. CONCLUSION We conclude that there are definite relationships between cartilaginous changes as seen on MRI and late-stage microstructural bony changes after traumatic ACL injury in rabbits. In addition, doxycycline may show promise in mitigating early-stage cartilage damage that may serve to lessen late-stage osteoarthritic changes. This study demonstrates the ability to track OA progression and therapeutic efficacy with imaging modalities in vivo.
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Affiliation(s)
- James R Pinney
- UC Berkeley-UCSF Graduate Program in Bioengineering, San Francisco, CA 94158-2330, USA.
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Abstract
The newer magnetic resonance (MR) imaging methods can give insights into the initiation, progression, and eventual treatment of osteoarthritis. Sodium imaging is specific for changes in proteoglycan (PG) content without the need for an exogenous contrast agent. T1ρ imaging is sensitive to early PG depletion. Delayed gadolinium-enhanced MR imaging has high resolution and sensitivity. T2 mapping is straightforward and is sensitive to changes in collagen and water content. Ultrashort echo time MR imaging examines the osteochondral junction. Magnetization transfer provides improved contrast between cartilage and fluid. Diffusion-weighted imaging may be a valuable tool in postoperative imaging.
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Texture analysis of cartilage T2 maps: individuals with risk factors for OA have higher and more heterogeneous knee cartilage MR T2 compared to normal controls--data from the osteoarthritis initiative. Arthritis Res Ther 2011; 13:R153. [PMID: 21933394 PMCID: PMC3308083 DOI: 10.1186/ar3469] [Citation(s) in RCA: 96] [Impact Index Per Article: 7.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2011] [Revised: 08/08/2011] [Accepted: 09/20/2011] [Indexed: 12/31/2022] Open
Abstract
Introduction The goals of this study were (i) to compare the prevalence of focal knee abnormalities, the mean cartilage T2 relaxation time, and the spatial distribution of cartilage magnetic resonance (MR) T2 relaxation times between subjects with and without risk factors for Osteoarthritis (OA), (ii) to determine the relationship between MR cartilage T2 parameters, age and cartilage morphology as determined with whole-organ magnetic resonance imaging scores (WORMS) and (iii) to assess the reproducibility of WORMS scoring and T2 relaxation time measurements including the mean and grey level co-occurrence matrix (GLCM) texture parameters. Methods Subjects with risk factors for OA (n = 92) and healthy controls (n = 53) were randomly selected from the Osteoarthritis Initiative (OAI) incidence and control cohorts, respectively. The specific inclusion criteria for this study were (1) age range 45-55 years, (2) body mass index (BMI) of 19-27 kg/m2, (3) Western Ontario and McMaster University (WOMAC) pain score of zero and (4) Kellgren Lawrence (KL) score of zero at baseline. 3.0 Tesla MR images of the right knee were analyzed using morphological gradings of cartilage, bone marrow and menisci (WORMS) as well as compartment specific cartilage T2 mean and heterogeneity. Regression models adjusted for age, gender, and BMI were used to determine the difference in cartilage parameters between groups. Results While there was no significant difference in the prevalence of knee abnormalities (cartilage lesions, bone marrow lesions, meniscus lesions) between controls and subjects at risk for OA, T2 parameters (mean T2, GLCM contrast, and GLCM variance) were significantly elevated in those at risk for OA. Additionally, a positive significant association between cartilage WORMS score and cartilage T2 parameters was evident. Conclusions Overall, this study demonstrated that subjects at risk for OA have both higher and more heterogeneous cartilage T2 values than controls, and that T2 parameters are associated with morphologic degeneration.
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Pan J, Pialat JB, Joseph T, Kuo D, Joseph GB, Nevitt MC, Link TM. Knee cartilage T2 characteristics and evolution in relation to morphologic abnormalities detected at 3-T MR imaging: a longitudinal study of the normal control cohort from the Osteoarthritis Initiative. Radiology 2011; 261:507-15. [PMID: 21900614 DOI: 10.1148/radiol.11102234] [Citation(s) in RCA: 82] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
PURPOSE To determine the frequency of degenerative knee morphologic abnormalities in asymptomatic individuals by using 3-T magnetic resonance (MR) imaging and to investigate the characteristics and evolution of cartilage T2 values in relation to morphologic abnormalities with a longitudinal study. MATERIALS AND METHODS The study was approved by the institutional review board and was compliant with HIPAA. Ninety-five asymptomatic subjects aged 45-78 years who were free of risk factors for osteoarthritis (OA) were selected from the Osteoarthritis Initiative normal control cohort and examined with radiography and 3-T MR imaging. Data obtained at both baseline and 2-year follow-up were analyzed. OA-related knee abnormalities were analyzed by using the whole-organ MR imaging score (WORMS). Cartilage T2 maps were generated by using sagittal two-dimensional multiecho spin-echo images of the right knee. Statistical significance was determined with the Student t test, the paired t test, a mixed random effects model, one-way analysis of variance, and a multiple linear regression model. RESULTS Knee abnormalities were identified with a high frequency (90% at baseline and 92% at 2-year follow-up). The prevalence of hyaline cartilage lesions was particularly high (86% at baseline and 84% at follow-up). A significant longitudinal increase in T2 was detected in the tibiofemoral cartilage but not the patellofemoral cartilage (P = .0072). The longitudinal change in T2 was significantly associated with worsening of the cartilage WORMS (P = .038). CONCLUSION Asymptomatic subjects have a high frequency of OA-related morphologic abnormalities. A significant increase in tibiofemoral cartilage T2 was detected over the 2-year period. A greater increase in T2 was associated with increased progression of cartilage morphologic abnormalities.
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Affiliation(s)
- Judong Pan
- Department of Radiology and Biomedical Imaging, University of California San Francisco, San Francisco, Calif, USA.
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Winalski CS, Rajiah P. The evolution of articular cartilage imaging and its impact on clinical practice. Skeletal Radiol 2011; 40:1197-222. [PMID: 21847750 DOI: 10.1007/s00256-011-1226-z] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/20/2011] [Accepted: 06/27/2011] [Indexed: 02/02/2023]
Abstract
Over the past four decades, articular cartilage imaging has developed rapidly. Imaging now plays a critical role not only in clinical practice and therapeutic decisions but also in the basic research probing our understanding of cartilage physiology and biomechanics.
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Affiliation(s)
- Carl S Winalski
- Imaging Institute, Cleveland Clinic, 9500 Euclid Avenue, Cleveland, OH 44195, USA.
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Chang G, Wang L, Liang G, Babb JS, Wiggins GC, Saha PK, Regatte RR. Quantitative assessment of trabecular bone micro-architecture of the wrist via 7 Tesla MRI: preliminary results. MAGMA (NEW YORK, N.Y.) 2011; 24:191-9. [PMID: 21544680 PMCID: PMC3723135 DOI: 10.1007/s10334-011-0252-0] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/27/2010] [Revised: 04/04/2011] [Accepted: 04/05/2011] [Indexed: 01/03/2023]
Abstract
OBJECT The goal of this study was to determine the feasibility of performing quantitative 7 T magnetic resonance imaging (MRI) assessment of trabecular bone micro-architecture of the wrist, a common fracture site. MATERIALS AND METHODS The wrists of 4 healthy subjects (1 woman, 3 men, 28 ± 8.9 years) were scanned on a 7 T whole body MR scanner using a 3D fast low-angle shot (FLASH) sequence (TR/TE = 20/4.5 m s, 0.169 × 0.169 × 0.5 mm). Trabecular bone was segmented and divided into 4 or 8 angular subregions. Total bone volume (TBV), bone volume fraction (BVF), surface-curve ratio (SC), and erosion index (EI) were computed. Subjects were scanned twice to assess measurement reproducibility. RESULTS Group mean subregional values for TBV, BVF, SC, and EI (8 subregion analysis) were as follows: 8489 ± 3686, 0.27 ± 0.045, 9.61 ± 6.52; and 1.43 ± 1.25. Within each individual, there was subregional variation in TBV, SC, and EI (>5%), but not BVF (<5%). Intersubject variation (≥12%) existed for all parameters. Within-subject coefficients of variation were ≤10%. CONCLUSION This is the first study to perform quantitative 7T MRI assessment of trabecular bone micro-architecture of the wrist. This method could be utilized to study perturbations in bone structure in subjects with osteoporosis or other bone disorders.
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Affiliation(s)
- Gregory Chang
- Quantitative Multinuclear Musculoskeletal Imaging Group, Center for Biomedical Imaging, Department of Radiology, NYU Langone Medical Center, 660 First Avenue, 4th Floor, New York, NY 10016, USA.
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Cox LGE, van Rietbergen B, van Donkelaar CC, Ito K. Bone structural changes in osteoarthritis as a result of mechanoregulated bone adaptation: a modeling approach. Osteoarthritis Cartilage 2011; 19:676-82. [PMID: 21324371 DOI: 10.1016/j.joca.2011.02.007] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/04/2010] [Revised: 02/02/2011] [Accepted: 02/02/2011] [Indexed: 02/02/2023]
Abstract
OBJECTIVE There are strong indications that subchondral bone may play an important role in osteoarthritis (OA), making it an interesting target for medical therapies. The subchondral bone structure changes markedly during OA, and it has long been assumed that this occurs secondary to cartilage degeneration. However, for various conditions that are associated with OA, it is known that they may also induce bone structural changes in the absence of cartilage degeneration. We therefore aimed to investigate if OA bone structural changes can result from mechanoregulated bone adaptation, independent of cartilage degeneration. METHOD With a bone adaptation model, we simulated various conditions associated with OA -without altering the articular cartilage- and we evaluated if mechanoregulated bone remodeling by itself could lead to OA-like bone structural changes. RESULTS For each of the conditions, the predicted changes in bone structural parameters (bone fraction, trabecular thickness, trabecular number, and trabecular separation) were similar to those observed in OA. CONCLUSION This indicates that bone adaptation in OA can be mechanoregulated with structural changes occurring independent of cartilage degeneration.
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Affiliation(s)
- L G E Cox
- Department of Biomedical Engineering, Eindhoven University of Technology, Eindhoven, The Netherlands
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Hunter DJ, Zhang W, Conaghan PG, Hirko K, Menashe L, Reichmann WM, Losina E. Responsiveness and reliability of MRI in knee osteoarthritis: a meta-analysis of published evidence. Osteoarthritis Cartilage 2011; 19:589-605. [PMID: 21396465 PMCID: PMC3625963 DOI: 10.1016/j.joca.2010.10.030] [Citation(s) in RCA: 106] [Impact Index Per Article: 8.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/15/2010] [Revised: 10/15/2010] [Accepted: 10/17/2010] [Indexed: 02/02/2023]
Abstract
OBJECTIVE To summarize literature on the responsiveness and reliability of MRI-based measures of knee osteoarthritis (OA) structural change. METHODS A literature search was conducted using articles published up to the time of the search, April 2009. 1338 abstracts obtained with this search were preliminarily screened for relevance and of these, 243 were selected for data extraction. For this analysis we extracted data on reliability and responsiveness for every reported synovial joint tissue as it relates to MRI measurement in knee OA. Reliability was defined by inter- and intra-reader intra-class correlation (ICC), or coefficient of variation, or kappa statistics. Responsiveness was defined as standardized response mean (SRM) - ratio of mean of change over time divided by standard deviation of change. Random-effects models were used to pool data from multiple studies. RESULTS The reliability analysis included data from 84 manuscripts. The inter-reader and intra-reader ICC were excellent (range 0.8-0.94) and the inter-reader and intra-reader kappa values for quantitative and semi-quantitative measures were all moderate to excellent (range 0.52-0.88). The lowest value (kappa=0.52) corresponded to semi-quantitative synovial scoring intra-reader reliability and the highest value (ICC=0.94) for semi-quantitative cartilage morphology. The responsiveness analysis included data from 42 manuscripts. The pooled SRM for quantitative measures of cartilage morphometry for the medial tibiofemoral joint was -0.86 (95% confidence intervals (CI) -1.26 to -0.46). The pooled SRM for the semi-quantitative measurement of cartilage morphology for the medial tibiofemoral joint was 0.55 (95% CI 0.47-0.64). For the quantitative analysis, SRMs are negative because the quantitative value, indicating a loss of cartilage, goes down. For the semi-quantitative analysis, SRMs indicating a loss in cartilage are positive (increase in score). CONCLUSION MRI has evolved substantially over the last decade and its strengths include the ability to visualize individual tissue pathologies, which can be measured reliably and with good responsiveness using both quantitative and semi-quantitative techniques.
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Affiliation(s)
- D J Hunter
- Rheumatology Department, Royal North Shore Hospital and Northern Clinical School, University of Sydney, Sydney, NSW, Australia.
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