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Firth AD, Pritchett SL, Milner JS, Atkinson HF, Bryant DM, Holdsworth DW, Getgood AMJ. Quantitative Magnetic Resonance Imaging of Lateral Compartment Articular Cartilage After Lateral Extra-articular Tenodesis. Am J Sports Med 2024; 52:909-918. [PMID: 38385189 DOI: 10.1177/03635465241228193] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/23/2024]
Abstract
BACKGROUND Concerns have arisen that anterior cruciate ligament reconstruction (ACLR) with lateral extra-articular tenodesis (LET) may accelerate the development of posttraumatic osteoarthritis in the lateral compartment of the knee. PURPOSE/HYPOTHESIS The purpose of this study was to evaluate whether the augmentation of ACLR with LET affects the quality of lateral compartment articular cartilage on magnetic resonance imaging (MRI) at 2 years postoperatively. We hypothesized that there would be no difference in T1rho and T2 relaxation times when comparing ACLR alone with ACLR + LET. STUDY DESIGN Randomized controlled trial; Level of evidence, 1. METHODS A consecutive subgroup of patients at the Fowler Kennedy Sport Medicine Clinic participating in the STABILITY 1 Study underwent bilateral 3-T MRI at 2 years after surgery. The primary outcome was T1rho and T2 relaxation times. Articular cartilage in the lateral compartment was manually segmented into 3 regions of the tibia (lateral tibia [LT]-1 to LT-3) and 5 regions of the femur (lateral femoral condyle [LFC]-1 to LFC-5). Analysis of covariance was used to compare relaxation times between groups, adjusted for lateral meniscal tears and treatment, cartilage and bone marrow lesions, contralateral relaxation times, and time since surgery. Semiquantitative MRI scores according to the Anterior Cruciate Ligament OsteoArthritis Score were compared between groups. Correlations were used to determine the association between secondary outcomes (including results of the International Knee Documentation Committee score, Knee injury and Osteoarthritis Outcome Score, Lower Extremity Functional Scale, 4-Item Pain Intensity Measure, hop tests, and isokinetic quadriceps and hamstring strength tests) and cartilage relaxation. RESULTS A total of 95 participants (44 ACLR alone, 51 ACLR + LET) with a mean age of 18.8 years (61.1% female [58/95]) underwent 2-year MRI (range, 20-36 months). T1rho relaxation times were significantly elevated for the ACLR + LET group in LT-1 (37.3 ± 0.7 ms vs 34.1 ± 0.8 ms, respectively; P = .005) and LFC-2 (43.9 ± 0.9 ms vs 40.2 ± 1.0 ms, respectively; P = .008) compared with the ACLR alone group. T2 relaxation times were significantly elevated for the ACLR + LET group in LFC-1 (51.2 ± 0.7 ms vs 49.1 ± 0.7 ms, respectively; P = .03) and LFC-4 (45.9 ± 0.5 ms vs 44.2 ± 0.6 ms, respectively; P = .04) compared with the ACLR alone group. All effect sizes were small to medium. There was no difference in Anterior Cruciate Ligament OsteoArthritis Scores between groups (P = .99). Weak negative associations (rs = -0.27 to -0.22; P < .05) were found between relaxation times and quadriceps and hamstring strength in the anterolateral knee, while all other correlations were nonsignificant (P > .05). CONCLUSION Increased relaxation times demonstrating small to medium effect sizes suggested early biochemical changes in articular cartilage of the anterolateral compartment in the ACLR + LET group compared with the ACLR alone group. Further evidence and long-term follow-up are needed to better understand the association between these results and the potential risk of the development of osteoarthritis in our patient cohort.
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Affiliation(s)
- Andrew D Firth
- Department of Epidemiology and Biostatistics, Schulich School of Medicine and Dentistry, Western University, London, Ontario, Canada
| | - Stephany L Pritchett
- Division of Musculoskeletal Imaging, Department of Medical Imaging, Schulich School of Medicine and Dentistry, Western University, London, Ontario, Canada
| | - Jaques S Milner
- Imaging Research Laboratories, Robarts Research Institute, Western University, London, Ontario, Canada
| | - Hayden F Atkinson
- School of Physical Therapy, Western University, London, Ontario, Canada
- Bone and Joint Institute, Western University, London, Ontario, Canada
| | - Dianne M Bryant
- School of Physical Therapy, Western University, London, Ontario, Canada
- Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, Ontario, Canada
| | - David W Holdsworth
- Imaging Research Laboratories, Robarts Research Institute, Western University, London, Ontario, Canada
- Department of Medical Biophysics, Schulich School of Medicine and Dentistry, Western University, London, Ontario, Canada
| | - Alan M J Getgood
- Fowler Kennedy Sport Medicine Clinic, Western University, London, Ontario, Canada
- Department of Orthopaedic Surgery, Schulich School of Medicine and Dentistry, Western University, London, Ontario, Canada
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Nosrat C, Gao KT, Bhattacharjee R, Pedoia V, Koff MF, Gold GE, Potter HG, Majumdar S. Multiparametric MRI of Knees in Collegiate Basketball Players: Associations With Morphological Abnormalities and Functional Deficits. Orthop J Sports Med 2023; 11:23259671231216490. [PMID: 38107843 PMCID: PMC10722938 DOI: 10.1177/23259671231216490] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/22/2023] [Accepted: 06/29/2023] [Indexed: 12/19/2023] Open
Abstract
Background Rates of cartilage degeneration in asymptomatic elite basketball players are significantly higher compared with the general population due to excessive loads on the knee. Compositional quantitative magnetic resonance imaging (qMRI) techniques can identify local biochemical changes of macromolecules observed in cartilage degeneration. Purpose/Hypothesis The purpose of this study was to utilize multiparametric qMRI to (1) quantify how T1ρ and T2 relaxation times differ based on the presence of anatomic abnormalities and (2) correlate T1ρ and T2 with self-reported functional deficits. It was hypothesized that prolonged relaxation times will be associated with knees with MRI-graded abnormalities and knees belonging to basketball players with greater self-reported functional deficits. Study Design Cross-sectional study; Level of evidence, 3. Methods A total of 75 knees from National Collegiate Athletic Association Division I basketball players (40 female, 35 male) were included in this multicenter study. All players completed the Knee injury and Osteoarthritis Outcome Score (KOOS) and had bilateral knee MRI scans taken. T1ρ and T2 were calculated on a voxel-by-voxel basis. The cartilage surfaces were segmented into 6 compartments: lateral femoral condyle, lateral tibia, medial femoral condyle, medial tibia (MT), patella (PAT), and trochlea (TRO). Lesions from the MRI scans were graded for imaging abnormalities, and statistical parametric mapping was performed to study cross-sectional differences based on MRI scan grading of anatomic knee abnormalities. Pearson partial correlations between relaxation times and KOOS subscore values were computed, obtaining r value statistical parametric mappings and P value clusters. Results Knees without patellar tendinosis displayed significantly higher T1ρ in the PAT compared with those with patellar tendinosis (average percentage difference, 10.4%; P = .02). Significant prolongation of T1ρ was observed in the MT, TRO, and PAT of knees without compared with those with quadriceps tendinosis (average percentage difference, 12.7%, 13.3%, and 13.4%, respectively; P ≤ .05). A weak correlation was found between the KOOS-Symptoms subscale values and T1ρ/T2. Conclusion Certain tissues that bear the brunt of impact developed tendinosis but spared cartilage degeneration. Whereas participants reported minimal functional deficits, their high-impact activities resulted in structural damage that may lead to osteoarthritis after their collegiate careers.
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Affiliation(s)
- Cameron Nosrat
- Department of Radiology and Biomedical Imaging, University of California, San Francisco, California, USA
| | - Kenneth T. Gao
- Department of Radiology and Biomedical Imaging, University of California, San Francisco, California, USA
| | - Rupsa Bhattacharjee
- Department of Radiology and Biomedical Imaging, University of California, San Francisco, California, USA
| | - Valentina Pedoia
- Department of Radiology and Biomedical Imaging, University of California, San Francisco, California, USA
| | - Matthew F. Koff
- Department of Radiology and Imaging, Hospital for Special Surgery, New York City, New York, USA
| | - Garry E. Gold
- Department of Radiology, Stanford University, Stanford, California, USA
| | - Hollis G. Potter
- Department of Radiology and Imaging, Hospital for Special Surgery, New York City, New York, USA
| | - Sharmila Majumdar
- Department of Radiology and Biomedical Imaging, University of California, San Francisco, California, USA
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Bae WC, Malis V, Kassai Y, Miyazaki M. 3D T1rho sequences with FASE, UTE, and MAPSS acquisitions for knee evaluation. Jpn J Radiol 2023; 41:1308-1315. [PMID: 37247122 DOI: 10.1007/s11604-023-01453-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2023] [Accepted: 05/16/2023] [Indexed: 05/30/2023]
Abstract
PURPOSE For biochemical evaluation of soft tissues of the knee, T1rho magnetic resonance imaging (MRI) has been proposed. Purpose of this study was to compare three T1rho sequences based on fast advanced spin echo (FASE), ultrashort echo time (UTE), and magnetization-prepared angle-modulated partitioned k-space spoiled gradient echo snapshots (MAPSS) acquisitions for the knee evaluation. MATERIALS AND METHODS We developed two T1rho sequences using 3D FASE or 3D radial UTE acquisitions. 3D MAPSS T1rho was provided by the manufacturer. Agarose phantoms with varying concentrations were imaged. Additionally, bilateral knees of asymptomatic subjects were imaged sagittally. T1rho values of the phantoms and 4 regions of interest (ROI) of the knees (i.e., anterior and posterior meniscus, femoral and tibial cartilage) were determined. RESULTS In phantoms, all T1rho values monotonically decreased with increasing agarose concentration. 3D MAPSS T1rho values of 51, 34, and 38 ms were found for 2, 3, and 4% agarose, respectively, similar to published values on another platform. In the knee, the raw images were detailed with good contrast. Cartilage and meniscus T1rho values varied with the pulse sequence, being the lowest in the 3D UTE T1rho sequence. Comparing different ROIs, menisci generally had lower T1rho values compared to cartilage, as expected in healthy knees. CONCLUSION We have successfully developed and implemented the new T1rho sequences and validated them using agarose phantoms and volunteer knees. All sequences were optimized to be clinically feasible (~ 5 min or less) and yielded satisfactory image quality and T1rho values consistent with the literature.
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Affiliation(s)
- Won C Bae
- Department of Radiology, University of California-San Diego, 9427 Health Sciences Drive, La Jolla, CA, USA.
- Department of Radiology, VA San Diego Healthcare System, San Diego, CA, USA.
| | - Vadim Malis
- Department of Radiology, University of California-San Diego, 9427 Health Sciences Drive, La Jolla, CA, USA
| | | | - Mitsue Miyazaki
- Department of Radiology, University of California-San Diego, 9427 Health Sciences Drive, La Jolla, CA, USA
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Arthroscopic surgery for symptomatic discoid lateral meniscus improves meniscal status assessed by magnetic resonance imaging T2 mapping. Arch Orthop Trauma Surg 2023:10.1007/s00402-023-04819-9. [PMID: 36811665 DOI: 10.1007/s00402-023-04819-9] [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: 07/27/2022] [Accepted: 02/13/2023] [Indexed: 02/24/2023]
Abstract
INTRODUCTION Discoid lateral meniscus (DLM) is an anatomic knee variant associated with increased tears and degeneration. This study aimed to quantify meniscal status with magnetic resonance imaging (MRI) T2 mapping before and after arthroscopic reshaping surgery for DLM. MATERIALS AND METHODS We retrospectively reviewed the records of patients undergoing arthroscopic reshaping surgery for symptomatic DLM with ≥ 2-year follow-up. MRI T2 mapping was performed preoperatively and at 12 and 24 months postoperatively. T2 relaxation times of the anterior and posterior horns of both menisci and of the adjacent cartilage were assessed. RESULTS Thirty-six knees from 32 patients were included. The mean age at surgery was 13.7 years (range 7-24), and the mean follow-up duration was 31.0 months. Saucerization alone was performed on five knees and saucerization with repair on 31 knees. Preoperatively, the T2 relaxation time of the anterior horn of the lateral meniscus was significantly longer than that of the medial meniscus (P < 0.01). T2 relaxation time significantly decreased at 12 and 24 months postoperatively (P < 0.01). Assessments of the posterior horn were comparable. The T2 relaxation time was significantly longer in the tear versus non-tear side at each time point (P < 0.01). There were significant correlations between the T2 relaxation time of the meniscus and that of the corresponding area of the lateral femoral condyle cartilage (anterior horn: r = 0.504, P = 0.002; posterior horn: r = 0.365, P = 0.029). CONCLUSIONS The T2 relaxation time of symptomatic DLM was significantly longer than that of the medial meniscus preoperatively, and it decreased 24 months after arthroscopic reshaping surgery. The meniscal T2 relaxation time of the tear side was significantly longer than that of the non-tear side. There were significant correlations between the cartilage and meniscal T2 relaxation times at 24 months after surgery.
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Eck BL, Yang M, Elias JJ, Winalski CS, Altahawi F, Subhas N, Li X. Quantitative MRI for Evaluation of Musculoskeletal Disease: Cartilage and Muscle Composition, Joint Inflammation, and Biomechanics in Osteoarthritis. Invest Radiol 2023; 58:60-75. [PMID: 36165880 PMCID: PMC10198374 DOI: 10.1097/rli.0000000000000909] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
ABSTRACT Magnetic resonance imaging (MRI) is a valuable tool for evaluating musculoskeletal disease as it offers a range of image contrasts that are sensitive to underlying tissue biochemical composition and microstructure. Although MRI has the ability to provide high-resolution, information-rich images suitable for musculoskeletal applications, most MRI utilization remains in qualitative evaluation. Quantitative MRI (qMRI) provides additional value beyond qualitative assessment via objective metrics that can support disease characterization, disease progression monitoring, or therapy response. In this review, musculoskeletal qMRI techniques are summarized with a focus on techniques developed for osteoarthritis evaluation. Cartilage compositional MRI methods are described with a detailed discussion on relaxometric mapping (T 2 , T 2 *, T 1ρ ) without contrast agents. Methods to assess inflammation are described, including perfusion imaging, volume and signal changes, contrast-enhanced T 1 mapping, and semiquantitative scoring systems. Quantitative characterization of structure and function by bone shape modeling and joint kinematics are described. Muscle evaluation by qMRI is discussed, including size (area, volume), relaxometric mapping (T 1 , T 2 , T 1ρ ), fat fraction quantification, diffusion imaging, and metabolic assessment by 31 P-MR and creatine chemical exchange saturation transfer. Other notable technologies to support qMRI in musculoskeletal evaluation are described, including magnetic resonance fingerprinting, ultrashort echo time imaging, ultrahigh-field MRI, and hybrid MRI-positron emission tomography. Challenges for adopting and using qMRI in musculoskeletal evaluation are discussed, including the need for metal artifact suppression and qMRI standardization.
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Affiliation(s)
- Brendan L. Eck
- Program of Advanced Musculoskeletal Imaging, Cleveland Clinic, Cleveland, OH, USA
- Imaging Instute, Cleveland Clinic, Cleveland, OH, USA
| | - Mingrui Yang
- Program of Advanced Musculoskeletal Imaging, Cleveland Clinic, Cleveland, OH, USA
- Department of Biomedical Engineering, Lerner Research Institute, Cleveland Clinic, Cleveland, OH, USA
| | - John J. Elias
- Program of Advanced Musculoskeletal Imaging, Cleveland Clinic, Cleveland, OH, USA
- Department of Research, Cleveland Clinic Akron General, Akron, OH, USA
| | - Carl S. Winalski
- Program of Advanced Musculoskeletal Imaging, Cleveland Clinic, Cleveland, OH, USA
- Imaging Instute, Cleveland Clinic, Cleveland, OH, USA
- Department of Biomedical Engineering, Lerner Research Institute, Cleveland Clinic, Cleveland, OH, USA
| | - Faysal Altahawi
- Program of Advanced Musculoskeletal Imaging, Cleveland Clinic, Cleveland, OH, USA
- Imaging Instute, Cleveland Clinic, Cleveland, OH, USA
| | - Naveen Subhas
- Program of Advanced Musculoskeletal Imaging, Cleveland Clinic, Cleveland, OH, USA
- Imaging Instute, Cleveland Clinic, Cleveland, OH, USA
| | - Xiaojuan Li
- Program of Advanced Musculoskeletal Imaging, Cleveland Clinic, Cleveland, OH, USA
- Imaging Instute, Cleveland Clinic, Cleveland, OH, USA
- Department of Biomedical Engineering, Lerner Research Institute, Cleveland Clinic, Cleveland, OH, USA
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Comparison of meniscal T1rho- and T2*-relaxation times in professional female volleyball players and healthy controls using 3T MRI: A pilot study. Eur J Radiol 2022; 155:110503. [DOI: 10.1016/j.ejrad.2022.110503] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2022] [Revised: 08/22/2022] [Accepted: 08/24/2022] [Indexed: 11/19/2022]
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Quantitative evaluation of the tibiofemoral joint cartilage by T2 mapping in patients with acute anterior cruciate ligament injury vs contralateral knees: results from the subacute phase using data from the NACOX study cohort. Osteoarthritis Cartilage 2022; 30:987-997. [PMID: 35421548 DOI: 10.1016/j.joca.2022.02.623] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/24/2021] [Revised: 02/03/2022] [Accepted: 02/09/2022] [Indexed: 02/02/2023]
Abstract
OBJECTIVE Immediate cartilage structural alterations in the acute phase after an anterior cruciate ligament (ACL) rupture may be a precursor to posttraumatic osteoarthritis (PTOA) development. Our aim was to describe changes in cartilage matrix in the subacute phase of the acutely ACL-injured knee compared to the contralateral uninjured knee. DESIGN Participants (n = 118) aged 15-40 years with an acute ACL injury were consecutively included in subacute phase after acute ACL-injury and underwent MRI (mean 29 days post trauma) of both knees. Mean T2 relaxation times, T2 spatial coefficient of variation and cartilage thickness were determined for different regions of the tibiofemoral cartilage. Differences between the acutely ACL-injured and uninjured knee were evaluated using Wilcoxon signed-rank test. RESULTS T2 relaxation time in injured knees was increased in multiple cartilage regions from both medial and lateral compartment compared to contralateral knees, mostly in medial trochlea and posterior tibia (P-value<0.001). In the same sites of injured knees, we observed significantly thinner cartilage. Moreover, injured knees presented shorter T2 relaxation time in superficial cartilage on lateral central femur and trochlea (P-value<0.001), and decreased T2 spatial coefficient of variation in lateral trochlea and load bearing regions of medial-central femoral condyle and central tibia in both compartments. CONCLUSION Small but statistically significant differences were observed in the subacute phase between ACL-injured and uninjured knee in cartilage T2 relaxation time and cartilage thickness. Future longitudinal observations of the same cohort will allow for better understanding of early development of PTOA. TRIAL REGISTRATION NUMBER NCT02931084.
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Shao H, Yang J, Ma Y, Su X, Tang G, Jiang J, Du J, Liu J. Evaluation of cartilage degeneration using multiparametric quantitative ultrashort echo time-based MRI: an ex vivo study. Quant Imaging Med Surg 2022; 12:1738-1749. [PMID: 35284286 PMCID: PMC8899946 DOI: 10.21037/qims-21-550] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2021] [Accepted: 11/10/2021] [Indexed: 01/26/2024]
Abstract
BACKGROUND The quantitative MR techniques developed rapidly, vary MR-biomarkers have shown the ability to assess the quality of articular cartilage. This study aimed to investigate the diagnostic efficacy of multi-parametric quantitative ultrashort echo time (UTE)-based MRI for evaluating human cartilage degeneration. METHODS Twenty fresh anterolateral femoral condyle samples were obtained from 20 patients (age, 58.8±6.6 years; 6 females) who underwent total knee arthroplasty due to primary osteoarthritis (OA). The samples were imaged using UTE-based magnetization transfer (UTE-MT), UTE-based adiabatic T1ρ (UTE-AdiabT1ρ), UTE-based T2* (UTE-T2*), and CubeQuant-T2 sequences. Cartilage degeneration was classified based on the OA Research Society International grade and polarized light microscopy (PLM) collagen organization score. Spearman's correlation analysis was used to determine the relationships between quantitative MRI biomarkers [UTE-MT ratio (UTE-MTR), UTE-AdiabT1ρ, UTE-T2*, and CubeQuant-T2], OA Research Society International grade, and PLM collagen organization score. The diagnostic efficacy of each MRI biomarker for the detection of mild cartilage degeneration was assessed using the area under the receiver operating characteristic (ROC) curve (AUC). RESULTS Of the quantitative MRI biomarkers, UTE-MTR had the strongest correlation with both OA Research Society International grade (r=-0.709, P<0.001) and PLM collagen organization score (r=0.579, P<0.001). The UTE-MTR and UTE-AdiabT1ρ values showed significant differences between the normal group and the mild degeneration group (P=0.047 and 0.015, respectively), while UTE-T2* and CubeQuant-T2 did not. The UTE-MTR values were 15.90%±1.06% and 14.59%±1.35% for normal and mildly degenerated cartilage, respectively. The UTE-AdiabT1ρ values were 40.19±2.87 and 42.6±2.26 ms for normal and mildly degenerated cartilage, respectively. ROC analysis showed that UTE-MTR (AUC =0.805, P=0.001, sensitivity =73.7%, specificity =89.5%) had the highest diagnostic efficacy for mild cartilage degeneration, while UTE-AdiabT1ρ (AUC =0.727, P=0.017) and CubeQuant-T2 (AUC =0.712, P=0.026) showed lower diagnostic efficacy. CONCLUSIONS Quantitative UTE-MT and UTE-AdiabT1ρ biomarkers may potentially be used in the evaluation of early cartilage degeneration.
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Affiliation(s)
- Hongda Shao
- Department of Nuclear Medicine, Ren Ji Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Jiawei Yang
- Department of Radiology, The First Affiliated Hospital, College of Medicine, Zhejiang University, Hangzhou, China
- Department of Radiology, Shanghai Tenth People’s Hospital, Tongji University School of Medicine, Shanghai, China
| | - Yajun Ma
- Department of Radiology, University of California, San Diego, San Diego, CA, USA
| | - Xiaolian Su
- Department of Radiology, Shanghai Tenth People’s Hospital, Tongji University School of Medicine, Shanghai, China
| | - Guangyu Tang
- Department of Radiology, Shanghai Tenth People’s Hospital, Tongji University School of Medicine, Shanghai, China
| | - Junjie Jiang
- Department of Orthopedics, People’s Hospital of Jingjiang, Jingjiang, China
- Department of Orthopedics, Shanghai Tenth People’s Hospital, Tongji University School of Medicine, Shanghai, China
| | - Jiang Du
- Department of Radiology, University of California, San Diego, San Diego, CA, USA
| | - Jianjun Liu
- Department of Nuclear Medicine, Ren Ji Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
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Flannery SW, Kiapour AM, Edgar DJ, Murray MM, Beveridge JE, Fleming BC. A transfer learning approach for automatic segmentation of the surgically treated anterior cruciate ligament. J Orthop Res 2022; 40:277-284. [PMID: 33458865 PMCID: PMC8285460 DOI: 10.1002/jor.24984] [Citation(s) in RCA: 13] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/28/2020] [Revised: 12/17/2020] [Accepted: 01/11/2021] [Indexed: 02/04/2023]
Abstract
Quantitative magnetic resonance imaging enables quantitative assessment of the healing anterior cruciate ligament or graft post-surgery, but its use is constrained by the need for time consuming manual image segmentation. The goal of this study was to validate a deep learning model for automatic segmentation of repaired and reconstructed anterior cruciate ligaments. We hypothesized that (1) a deep learning model would segment repaired ligaments and grafts with comparable anatomical similarity to intact ligaments, and (2) automatically derived quantitative features (i.e., signal intensity and volume) would not be significantly different from those obtained by manual segmentation. Constructive Interference in Steady State sequences were acquired of ACL repairs (n = 238) and grafts (n = 120). A previously validated model for intact ACLs was retrained on both surgical groups using transfer learning. Anatomical performance was measured with Dice coefficient, sensitivity, and precision. Quantitative features were compared to ground truth manual segmentation. Automatic segmentation of both surgical groups resulted in decreased anatomical performance compared to intact ACL automatic segmentation (repairs/grafts: Dice coefficient = .80/.78, precision = .79/.78, sensitivity = .82/.80), but neither decrease was statistically significant (Kruskal-Wallis: Dice coefficient p = .02, precision p = .09, sensitivity p = .17; Dunn post-hoc test for Dice coefficient: repairs/grafts p = .054/.051). There were no significant differences in quantitative features between the ground truth and automatic segmentation of repairs/grafts (0.82/2.7% signal intensity difference, p = .57/.26; 1.7/2.7% volume difference, p = .68/.72). The anatomical similarity performance and statistical similarities of quantitative features supports the use of this automated segmentation model in quantitative magnetic resonance imaging pipelines, which will accelerate research and provide a step towards clinical applicability.
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Affiliation(s)
- Sean W. Flannery
- Department of Orthopaedics, Warren Alpert Medical School of Brown University/Rhode Island Hospital, Providence, RI, USA
| | - Ata M. Kiapour
- Division of Sports Medicine, Department of Orthopaedic Surgery, Boston Children’s Hospital, Harvard Medical School, Boston, MA, USA
| | - David J. Edgar
- Department of Orthopaedics, Warren Alpert Medical School of Brown University/Rhode Island Hospital, Providence, RI, USA
| | - Martha M. Murray
- Division of Sports Medicine, Department of Orthopaedic Surgery, Boston Children’s Hospital, Harvard Medical School, Boston, MA, USA
| | - Jillian E. Beveridge
- Department of Orthopaedics, Warren Alpert Medical School of Brown University/Rhode Island Hospital, Providence, RI, USA,Department of Biomedical Engineering, Cleveland Clinic, Cleveland, OH, USA
| | - Braden C. Fleming
- Department of Orthopaedics, Warren Alpert Medical School of Brown University/Rhode Island Hospital, Providence, RI, USA
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10
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Chalian M, Li X, Guermazi A, Obuchowski NA, Carrino JA, Oei EH, Link TM. The QIBA Profile for MRI-based Compositional Imaging of Knee Cartilage. Radiology 2021; 301:423-432. [PMID: 34491127 PMCID: PMC8574057 DOI: 10.1148/radiol.2021204587] [Citation(s) in RCA: 35] [Impact Index Per Article: 11.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2020] [Revised: 06/18/2021] [Accepted: 07/07/2021] [Indexed: 12/16/2022]
Abstract
MRI-based cartilage compositional analysis shows biochemical and microstructural changes at early stages of osteoarthritis before changes become visible with structural MRI sequences and arthroscopy. This could help with early diagnosis, risk assessment, and treatment monitoring of osteoarthritis. Spin-lattice relaxation time constant in rotating frame (T1ρ) and T2 mapping are the MRI techniques best established for assessing cartilage composition. Only T2 mapping is currently commercially available, which is sensitive to water, collagen content, and orientation of collagen fibers, whereas T1ρ is more sensitive to proteoglycan content. Clinical application of cartilage compositional imaging is limited by high variability and suboptimal reproducibility of the biomarkers, which was the motivation for creating the Quantitative Imaging Biomarkers Alliance (QIBA) Profile for cartilage compositional imaging by the Musculoskeletal Biomarkers Committee of the QIBA. The profile aims at providing recommendations to improve reproducibility and to standardize cartilage compositional imaging. The QIBA Profile provides two complementary claims (summary statements of the technical performance of the quantitative imaging biomarkers that are being profiled) regarding the reproducibility of biomarkers. First, cartilage T1ρ and T2 values are measurable at 3.0-T MRI with a within-subject coefficient of variation of 4%-5%. Second, a measured increase or decrease in T1ρ and T2 of 14% or more indicates a minimum detectable change with 95% confidence. If only an increase in T1ρ and T2 values is expected (progressive cartilage degeneration), then an increase of 12% represents a minimum detectable change over time. The QIBA Profile provides recommendations for clinical researchers, clinicians, and industry scientists pertaining to image data acquisition, analysis, and interpretation and assessment procedures for T1ρ and T2 cartilage imaging and test-retest conformance. This special report aims to provide the rationale for the proposed claims, explain the content of the QIBA Profile, and highlight the future needs and developments for MRI-based cartilage compositional imaging for risk prediction, early diagnosis, and treatment monitoring of osteoarthritis.
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Affiliation(s)
- Majid Chalian
- From the Department of Radiology, Division of Musculoskeletal Imaging
and Intervention, University of Washington, UW Radiology–Roosevelt
Clinic, 4245 Roosevelt Way NE, Box 354755, Seattle, WA 98105 (M.C.); Department
of Biomedical Engineering, Program of Advanced Musculoskeletal Imaging (PAMI)
(X.L.), and Department of Biostatistics (N.A.O.), Cleveland Clinic, Cleveland,
Ohio; Department of Radiology, Boston University School of Medicine, Boston,
Mass (A.G.); Department of Radiology and Imaging, Hospital for Special Surgery,
New York, NY (J.A.C.); Department of Radiology & Nuclear Medicine,
Erasmus MC University Medical Center, Rotterdam, the Netherlands (E.H.O.);
European Imaging Biomarkers Alliance (E.H.O.); and Department of Radiology and
Biomedical Imaging, University of California, San Francisco, Calif
(T.M.L.)
| | - Xiaojuan Li
- From the Department of Radiology, Division of Musculoskeletal Imaging
and Intervention, University of Washington, UW Radiology–Roosevelt
Clinic, 4245 Roosevelt Way NE, Box 354755, Seattle, WA 98105 (M.C.); Department
of Biomedical Engineering, Program of Advanced Musculoskeletal Imaging (PAMI)
(X.L.), and Department of Biostatistics (N.A.O.), Cleveland Clinic, Cleveland,
Ohio; Department of Radiology, Boston University School of Medicine, Boston,
Mass (A.G.); Department of Radiology and Imaging, Hospital for Special Surgery,
New York, NY (J.A.C.); Department of Radiology & Nuclear Medicine,
Erasmus MC University Medical Center, Rotterdam, the Netherlands (E.H.O.);
European Imaging Biomarkers Alliance (E.H.O.); and Department of Radiology and
Biomedical Imaging, University of California, San Francisco, Calif
(T.M.L.)
| | - Ali Guermazi
- From the Department of Radiology, Division of Musculoskeletal Imaging
and Intervention, University of Washington, UW Radiology–Roosevelt
Clinic, 4245 Roosevelt Way NE, Box 354755, Seattle, WA 98105 (M.C.); Department
of Biomedical Engineering, Program of Advanced Musculoskeletal Imaging (PAMI)
(X.L.), and Department of Biostatistics (N.A.O.), Cleveland Clinic, Cleveland,
Ohio; Department of Radiology, Boston University School of Medicine, Boston,
Mass (A.G.); Department of Radiology and Imaging, Hospital for Special Surgery,
New York, NY (J.A.C.); Department of Radiology & Nuclear Medicine,
Erasmus MC University Medical Center, Rotterdam, the Netherlands (E.H.O.);
European Imaging Biomarkers Alliance (E.H.O.); and Department of Radiology and
Biomedical Imaging, University of California, San Francisco, Calif
(T.M.L.)
| | - Nancy A. Obuchowski
- From the Department of Radiology, Division of Musculoskeletal Imaging
and Intervention, University of Washington, UW Radiology–Roosevelt
Clinic, 4245 Roosevelt Way NE, Box 354755, Seattle, WA 98105 (M.C.); Department
of Biomedical Engineering, Program of Advanced Musculoskeletal Imaging (PAMI)
(X.L.), and Department of Biostatistics (N.A.O.), Cleveland Clinic, Cleveland,
Ohio; Department of Radiology, Boston University School of Medicine, Boston,
Mass (A.G.); Department of Radiology and Imaging, Hospital for Special Surgery,
New York, NY (J.A.C.); Department of Radiology & Nuclear Medicine,
Erasmus MC University Medical Center, Rotterdam, the Netherlands (E.H.O.);
European Imaging Biomarkers Alliance (E.H.O.); and Department of Radiology and
Biomedical Imaging, University of California, San Francisco, Calif
(T.M.L.)
| | - John A. Carrino
- From the Department of Radiology, Division of Musculoskeletal Imaging
and Intervention, University of Washington, UW Radiology–Roosevelt
Clinic, 4245 Roosevelt Way NE, Box 354755, Seattle, WA 98105 (M.C.); Department
of Biomedical Engineering, Program of Advanced Musculoskeletal Imaging (PAMI)
(X.L.), and Department of Biostatistics (N.A.O.), Cleveland Clinic, Cleveland,
Ohio; Department of Radiology, Boston University School of Medicine, Boston,
Mass (A.G.); Department of Radiology and Imaging, Hospital for Special Surgery,
New York, NY (J.A.C.); Department of Radiology & Nuclear Medicine,
Erasmus MC University Medical Center, Rotterdam, the Netherlands (E.H.O.);
European Imaging Biomarkers Alliance (E.H.O.); and Department of Radiology and
Biomedical Imaging, University of California, San Francisco, Calif
(T.M.L.)
| | - Edwin H. Oei
- From the Department of Radiology, Division of Musculoskeletal Imaging
and Intervention, University of Washington, UW Radiology–Roosevelt
Clinic, 4245 Roosevelt Way NE, Box 354755, Seattle, WA 98105 (M.C.); Department
of Biomedical Engineering, Program of Advanced Musculoskeletal Imaging (PAMI)
(X.L.), and Department of Biostatistics (N.A.O.), Cleveland Clinic, Cleveland,
Ohio; Department of Radiology, Boston University School of Medicine, Boston,
Mass (A.G.); Department of Radiology and Imaging, Hospital for Special Surgery,
New York, NY (J.A.C.); Department of Radiology & Nuclear Medicine,
Erasmus MC University Medical Center, Rotterdam, the Netherlands (E.H.O.);
European Imaging Biomarkers Alliance (E.H.O.); and Department of Radiology and
Biomedical Imaging, University of California, San Francisco, Calif
(T.M.L.)
| | - Thomas M. Link
- From the Department of Radiology, Division of Musculoskeletal Imaging
and Intervention, University of Washington, UW Radiology–Roosevelt
Clinic, 4245 Roosevelt Way NE, Box 354755, Seattle, WA 98105 (M.C.); Department
of Biomedical Engineering, Program of Advanced Musculoskeletal Imaging (PAMI)
(X.L.), and Department of Biostatistics (N.A.O.), Cleveland Clinic, Cleveland,
Ohio; Department of Radiology, Boston University School of Medicine, Boston,
Mass (A.G.); Department of Radiology and Imaging, Hospital for Special Surgery,
New York, NY (J.A.C.); Department of Radiology & Nuclear Medicine,
Erasmus MC University Medical Center, Rotterdam, the Netherlands (E.H.O.);
European Imaging Biomarkers Alliance (E.H.O.); and Department of Radiology and
Biomedical Imaging, University of California, San Francisco, Calif
(T.M.L.)
| | - for the RSNA QIBA MSK Biomarker Committee
- From the Department of Radiology, Division of Musculoskeletal Imaging
and Intervention, University of Washington, UW Radiology–Roosevelt
Clinic, 4245 Roosevelt Way NE, Box 354755, Seattle, WA 98105 (M.C.); Department
of Biomedical Engineering, Program of Advanced Musculoskeletal Imaging (PAMI)
(X.L.), and Department of Biostatistics (N.A.O.), Cleveland Clinic, Cleveland,
Ohio; Department of Radiology, Boston University School of Medicine, Boston,
Mass (A.G.); Department of Radiology and Imaging, Hospital for Special Surgery,
New York, NY (J.A.C.); Department of Radiology & Nuclear Medicine,
Erasmus MC University Medical Center, Rotterdam, the Netherlands (E.H.O.);
European Imaging Biomarkers Alliance (E.H.O.); and Department of Radiology and
Biomedical Imaging, University of California, San Francisco, Calif
(T.M.L.)
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11
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Zhu J, Hu N, Hou J, Liang X, Wang Y, Zhang H, Wang P, Chen T, Chen W, Wang L. T 1rho mapping of cartilage and menisci in patients with hyperuricaemia at 3 T: a preliminary study. Clin Radiol 2021; 76:710.e1-710.e8. [PMID: 34016388 DOI: 10.1016/j.crad.2021.04.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2021] [Revised: 04/14/2021] [Accepted: 04/27/2021] [Indexed: 11/16/2022]
Abstract
AIM To compare and assess T1rho values of the femorotibial cartilage compartments and subregional menisci in patients with hyperuricaemia at 3 T. MATERIALS AND METHODS Thirty-two patients were enrolled in the study and were subdivided into two subgroups: 15 healthy controls (three women, 12 men; mean age = 45.3 ± 10.9 years, age range 25-72 years) and 17 patients with asymptomatic hyperuricaemia (two women, 15 men; mean age = 44.4 ± 12.7 years, age range 26-77 years). All patients were evaluated using 3 T magnetic resonance imaging (MRI) using an eight-channel phased-array knee coil (transmit-receive). Wilcoxon's rank sum test and analysis of covariance (ANCOVA) were conducted to determine whether there were any statistically significant differences in the T1rho values of the femorotibial cartilage compartments and subregional menisci between the two subgroups. RESULTS Lateral tibial cartilage (45.8 ± 2.9 ms) in the healthy subgroup had significantly lower (p<0.05) T1rho values than those of all subcompartments of the femorotibial cartilage in the hyperuricaemia subgroup. The lateral femoral cartilage (LF) in hyperuricaemia (54.6 ± 3.9 ms) subgroup had significantly higher (p<0.05) T1rho values than those of all subcompartments of the femorotibial cartilage except the LF in the healthy subgroup. Significantly higher (p<0.05) T1rho values existed in the LF of the healthy (54.6 ± 4.7 ms) subgroup in comparison with those of all subcompartments of femorotibial cartilage except the LF in hyperuricaemia subgroup. CONCLUSIONS T1rho values in certain compartments of the femorotibial cartilage in patients with hyperuricaemia are elevated compared to those in healthy patients presumably due to reduced proteoglycan content, to which particular attention should be paid when diagnosing and treating the patients with hyperuricaemia in a clinical setting.
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Affiliation(s)
- J Zhu
- Department of Radiology, The Second Affiliated Hospital of Soochow University, Suzhou, Jiangsu, 215004, China
| | - N Hu
- Department of Radiology, The Second Affiliated Hospital of Soochow University, Suzhou, Jiangsu, 215004, China
| | - J Hou
- Department of Imaging and Interventional Radiology, Prince of Wales Hospital, The Chinese University of Hong Kong, Shatin, NT, Hong Kong Special Administrative Region, China
| | - X Liang
- Mary Mackillop Institute for Health Research, Australian Catholic University, Melbourne, Australia; Florey Institute of Neuroscience and Mental Health, University of Melbourne, Melbourne, Australia
| | - Y Wang
- Department of Radiation Physics, Zhejiang Cancer Hospital, Hangzhou, Zhejiang, 310022, China
| | - H Zhang
- Department of Imaging and Interventional Radiology, Prince of Wales Hospital, The Chinese University of Hong Kong, Shatin, NT, Hong Kong Special Administrative Region, China
| | - P Wang
- Vanderbilt University Institute of Imaging Science, 1161 21st Avenue South, MCN AA-1105, Nashville, TN, 37232-2310, USA
| | - T Chen
- Department of Radiology, The Second Affiliated Hospital of Soochow University, Suzhou, Jiangsu, 215004, China
| | - W Chen
- Department of Imaging and Interventional Radiology, Prince of Wales Hospital, The Chinese University of Hong Kong, Shatin, NT, Hong Kong Special Administrative Region, China
| | - L Wang
- Collaborative Innovation Center of Radiological Medicine of Jiangsu Higher Education Institutions; School of Radiation Medicine and Protection, Medical College of Soochow University; School for Radiological and Interdisciplinary Sciences (RAD-X), Soochow University, Suzhou, Jiangsu, 215123, China.
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12
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Flannery SW, Kiapour AM, Edgar DJ, Murray MM, Fleming BC. Automated magnetic resonance image segmentation of the anterior cruciate ligament. J Orthop Res 2021; 39:831-840. [PMID: 33241856 PMCID: PMC8005419 DOI: 10.1002/jor.24926] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/01/2020] [Revised: 10/27/2020] [Accepted: 11/19/2020] [Indexed: 02/04/2023]
Abstract
The objective of this study was to develop an automated segmentation method for the anterior cruciate ligament that is capable of facilitating quantitative assessments of the ligament in clinical and research settings. A modified U-Net fully convolutional network model was trained, validated, and tested on 246 Constructive Interference in Steady State magnetic resonance images of intact anterior cruciate ligaments. Overall model performance was assessed on the image set relative to an experienced (>5 years) "ground truth" segmenter in two domains: anatomical similarity and the accuracy of quantitative measurements (i.e., signal intensity and volume) obtained from the automated segmentation. To establish model reliability relative to manual segmentation, a subset of the imaging data was resegmented by the ground truth segmenter and two additional segmenters (A, 6 months and B, 2 years of experience), with their performance evaluated relative to the ground truth. The final model scored well on anatomical performance metrics (Dice coefficient = 0.84, precision = 0.82, and sensitivity = 0.85). The median signal intensities and volumes of the automated segmentations were not significantly different from ground truth (0.3% difference, p = .9; 2.3% difference, p = .08, respectively). When the model results were compared with the independent segmenters, the model predictions demonstrated greater median Dice coefficient (A = 0.73, p = .001; B = 0.77, p = NS) and sensitivity (A = 0.68, p = .001; B = 0.72, p = .003). The model performed equivalently well to retest segmentation by the ground truth segmenter on all measures. The quantitative measures extracted from the automated segmentation model did not differ from those of manual segmentation, enabling their use in quantitative magnetic resonance imaging pipelines to evaluate the anterior cruciate ligament.
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Affiliation(s)
- Sean W. Flannery
- Center for Biomedical Engineering, Brown University,
Providence, RI,Department of Orthopaedics, Warren Alpert Medical School of
Brown University/Rhode Island Hospital, Providence, RI
| | - Ata M. Kiapour
- Department of Orthopaedic Surgery, Boston Children’s
Hospital, Harvard Medical School, Boston, MA
| | - David J. Edgar
- Center for Biomedical Engineering, Brown University,
Providence, RI,Department of Orthopaedics, Warren Alpert Medical School of
Brown University/Rhode Island Hospital, Providence, RI
| | - Martha M. Murray
- Department of Orthopaedic Surgery, Boston Children’s
Hospital, Harvard Medical School, Boston, MA
| | - Braden C. Fleming
- Center for Biomedical Engineering, Brown University,
Providence, RI,Department of Orthopaedics, Warren Alpert Medical School of
Brown University/Rhode Island Hospital, Providence, RI
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13
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Kijowski R, Demehri S, Roemer F, Guermazi A. Osteoarthritis year in review 2019: imaging. Osteoarthritis Cartilage 2020; 28:285-295. [PMID: 31877380 DOI: 10.1016/j.joca.2019.11.009] [Citation(s) in RCA: 26] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/31/2019] [Revised: 10/17/2019] [Accepted: 11/15/2019] [Indexed: 02/02/2023]
Abstract
OBJECTIVE To provide a narrative review of original articles on osteoarthritis (OA) imaging published between April 1, 2018 and March 30, 2019. METHODS All original research articles on OA imaging published in English between April 1, 2018 and March 30, 2019 were identified using a PubMed database search. The search terms of "Osteoarthritis" or "OA" were combined with the search terms "Radiography", "X-Rays", "Magnetic Resonance Imaging", "MRI", "Ultrasound", "US", "Computed Tomography", "Dual Energy X-Ray Absorptiometry", "DXA", "DEXA", "CT", "Nuclear Medicine", "Scintigraphy", "Single-Photon Emission Computed Tomography", "SPECT", "Positron Emission Tomography", "PET", "PET-CT", or "PET-MRI". Articles were reviewed to determine relevance based upon the following criteria: 1) study involved human subjects with OA or risk factors for OA and 2) study involved imaging to evaluate OA disease status or OA treatment response. Relevant articles were ranked according to scientific merit, with the best publications selected for inclusion in the narrative report. RESULTS The PubMed search revealed a total of 1257 articles, of which 256 (20.4%) were considered relevant to OA imaging. Two-hundred twenty-six (87.1%) articles involved the knee joint, while 195 (76.2%) articles involved the use of magnetic resonance imaging (MRI). The proportion of published studies involving the use of MRI was higher than previous years. An increasing number of articles were also published on imaging of subjects with joint injury and on deep learning application in OA imaging. CONCLUSION MRI and other imaging modalities continue to play an important role in research studies designed to better understand the pathogenesis, progression, and treatment of OA.
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Affiliation(s)
- R Kijowski
- Department of Radiology, University of Wisconsin-Madison, Madison, WI, USA.
| | - S Demehri
- Department of Radiology, Johns Hopkins University, Baltimore, MD, USA.
| | - F Roemer
- Department of Radiology, Boston University, Boston, MA, USA; Department of Radiology, Friedrich-Alexander University Erlangen-Nürnberg (FAU), Universitätsklinikum Erlangen, Erlangen, Germany.
| | - A Guermazi
- Department of Radiology, Boston University, Boston, MA, USA.
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14
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Lansdown DA, Ma CB. Clinical Utility of Advanced Imaging of the Knee. J Orthop Res 2020; 38:473-482. [PMID: 31498473 DOI: 10.1002/jor.24462] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/07/2019] [Accepted: 07/17/2019] [Indexed: 02/04/2023]
Abstract
Advanced imaging modalities, including computed tomography, magnetic resonance imaging (MRI), and dynamic fluoroscopic imaging, allow for a comprehensive evaluation of the knee joint. Compositional sequences for MRI can allow for an evaluation of the biochemical properties of cartilage, meniscus, and ligament that offer further insight into pathology that may not be apparent on conventional clinical imaging. Advances in image processing, shape modeling, and dynamic studies also offer a novel way to evaluate common conditions and to monitor patients after treatment. The purpose of this article is to review advanced imaging modalities of the knee and their current and anticipated future applications to clinical practice. © 2019 Orthopaedic Research Society. Published by Wiley Periodicals, Inc. J Orthop Res 38:473-482, 2020.
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Affiliation(s)
- Drew A Lansdown
- Department of Orthopedic Surgery, Sports Medicine & Shoulder Surgery, University of California, San Francisco, San Francisco, California
| | - C Benjamin Ma
- Department of Orthopedic Surgery, Sports Medicine & Shoulder Surgery, University of California, San Francisco, San Francisco, California
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15
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Eijgenraam SM, Chaudhari AS, Reijman M, Bierma-Zeinstra SMA, Hargreaves BA, Runhaar J, Heijboer FWJ, Gold GE, Oei EHG. Time-saving opportunities in knee osteoarthritis: T 2 mapping and structural imaging of the knee using a single 5-min MRI scan. Eur Radiol 2019; 30:2231-2240. [PMID: 31844957 PMCID: PMC7062657 DOI: 10.1007/s00330-019-06542-9] [Citation(s) in RCA: 21] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2019] [Revised: 10/09/2019] [Accepted: 10/23/2019] [Indexed: 12/22/2022]
Abstract
Objectives To assess the discriminative power of a 5-min quantitative double-echo steady-state (qDESS) sequence for simultaneous T2 measurements of cartilage and meniscus, and structural knee osteoarthritis (OA) assessment, in a clinical OA population, using radiographic knee OA as reference standard. Methods Fifty-three subjects were included and divided over three groups based on radiographic and clinical knee OA: 20 subjects with no OA (Kellgren-Lawrence grade (KLG) 0), 18 with mild OA (KLG2), and 15 with moderate OA (KLG3). All patients underwent a 5-min qDESS scan. We measured T2 relaxation times in four cartilage and four meniscus regions of interest (ROIs) and performed structural OA evaluation with the MRI Osteoarthritis Knee Score (MOAKS) using qDESS with multiplanar reformatting. Between-group differences in T2 values and MOAKS were calculated using ANOVA. Correlations of the reference standard (i.e., radiographic knee OA) with T2 and MOAKS were assessed with correlation analyses for ordinal variables. Results In cartilage, mean T2 values were 36.1 ± SD 4.3, 40.6 ± 5.9, and 47.1 ± 4.3 ms for no, mild, and moderate OA, respectively (p < 0.001). In menisci, mean T2 values were 15 ± 3.6, 17.5 ± 3.8, and 20.6 ± 4.7 ms for no, mild, and moderate OA, respectively (p < 0.001). Statistically significant correlations were found between radiographic OA and T2 and between radiographic OA and MOAKS in all ROIs (p < 0.05). Conclusion Quantitative T2 and structural assessment of cartilage and meniscus, using a single 5-min qDESS scan, can distinguish between different grades of radiographic OA, demonstrating the potential of qDESS as an efficient tool for OA imaging. Key Points • Quantitative T2values of cartilage and meniscus as well as structural assessment of the knee with a single 5-min quantitative double-echo steady-state (qDESS) scan can distinguish between different grades of knee osteoarthritis (OA). • Quantitative and structural qDESS-based measurements correlate significantly with the reference standard, radiographic degree of OA, for all cartilage and meniscus regions. • By providing quantitative measurements and diagnostic image quality in one rapid MRI scan, qDESS has great potential for application in large-scale clinical trials in knee OA. Electronic supplementary material The online version of this article (10.1007/s00330-019-06542-9) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Susanne M Eijgenraam
- Deptartment of Radiology & Nuclear Medicine, Erasmus MC, University Medical Center, Dr. Molewaterplein 40, Room Nd-547, 3015, GD, Rotterdam, The Netherlands.,Deptartment of Orthopedic Surgery, Erasmus MC, University Medical Center, Rotterdam, The Netherlands
| | | | - Max Reijman
- Deptartment of Orthopedic Surgery, Erasmus MC, University Medical Center, Rotterdam, The Netherlands
| | - Sita M A Bierma-Zeinstra
- Deptartment of Orthopedic Surgery, Erasmus MC, University Medical Center, Rotterdam, The Netherlands.,Deptartment of General Practice, Erasmus MC, University Medical Center, Rotterdam, The Netherlands
| | - Brian A Hargreaves
- Deptartment of Radiology, Stanford University, Stanford, CA, USA.,Deptartment of Electrical Engineering, Stanford University, Stanford, CA, USA.,Deptartment of Bioengineering, Stanford University, Stanford, CA, USA
| | - Jos Runhaar
- Deptartment of General Practice, Erasmus MC, University Medical Center, Rotterdam, The Netherlands
| | - Frank W J Heijboer
- Deptartment of Orthopedic Surgery, Erasmus MC, University Medical Center, Rotterdam, The Netherlands
| | - Garry E Gold
- Deptartment of Radiology, Stanford University, Stanford, CA, USA.,Deptartment of Bioengineering, Stanford University, Stanford, CA, USA.,Deptartment of Orthopedic Surgery, Stanford University, Stanford, CA, USA
| | - Edwin H G Oei
- Deptartment of Radiology & Nuclear Medicine, Erasmus MC, University Medical Center, Dr. Molewaterplein 40, Room Nd-547, 3015, GD, Rotterdam, The Netherlands.
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16
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Arthrose am Kniegelenk. ARTHROSKOPIE 2019. [DOI: 10.1007/s00142-018-0237-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
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17
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Osteoarthritis year in review 2018: imaging. Osteoarthritis Cartilage 2019; 27:401-411. [PMID: 30590194 DOI: 10.1016/j.joca.2018.12.009] [Citation(s) in RCA: 25] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/16/2018] [Revised: 12/10/2018] [Accepted: 12/17/2018] [Indexed: 02/02/2023]
Abstract
PURPOSE To provide a narrative review of the most relevant original research published in 2017/2018 on osteoarthritis imaging. METHODS The PubMed database was used to recover all relevant articles pertaining to osteoarthritis and medical imaging published between 1 April 2017 and 31 March 2018. Review articles, case studies and in vitro or animal studies were excluded. The original publications were subjectively sorted based on relevance, novelty and impact. RESULTS AND CONCLUSIONS The publication search yielded 1,155 references. In the assessed publications, the most common imaging modalities were radiography (N = 708) and magnetic resonance imaging (MRI) (355), followed by computed tomography (CT) (220), ultrasound (85) and nuclear medicine (17). An overview of the most important publications to the osteoarthritis (OA) research community is presented in this narrative review. Imaging studies play an increasingly important role in OA research, and have helped us to understand better the pathophysiology of OA. Radiography and MRI continue to be the most applied imaging modalities, while quantitative MRI methods and texture analysis are becoming more popular. The value of ultrasound in OA research has been demonstrated. Several multi-modality predictive models have been developed. Deep learning has potential for more automatic and standardized analyses in future OA imaging research.
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18
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Markes AR, Knox J, Zhong Q, Pedoia V, Li X, Ma CB. An Abnormal Tibial Position Is Associated With Alterations in the Meniscal Matrix: A 3-Year Longitudinal Study After Anterior Cruciate Ligament Reconstruction. Orthop J Sports Med 2019; 7:2325967118820057. [PMID: 30671489 PMCID: PMC6329038 DOI: 10.1177/2325967118820057] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/21/2022] Open
Abstract
Background: An altered tibial position is still present despite anterior cruciate ligament (ACL) reconstruction. It has been demonstrated that an abnormal tibial position after an ACL injury may play a role in subsequent injuries to the meniscus, which can lead to early cartilage degeneration. Purpose: To determine changes in both the tibial position and the meniscal matrix present before and after ACL reconstruction as well as to evaluate the association between these 2 variables in ACL-injured knees 3 years after reconstruction. Study Design: Cohort study; Level of evidence, 2. Methods: Bilateral knee magnetic resonance imaging (MRI) of 32 patients with unilateral ACL injuries was performed before reconstruction; 13 control participants also underwent MRI. Follow-up MRI was performed up to 3 years after surgery. Tibial position, internal tibial rotation, and T1ρ and T2 values of the menisci were calculated using an in-house MATLAB program. Student t tests and multiple linear regression were used to compare differences between injured, uninjured, and control knees as well as to assess correlations between the tibial position at 3 years and 3-year changes in quantitative MRI meniscal relaxation values. Results: The tibial position of injured knees was more anterior than that of uninjured knees at baseline, 6 months, and 1, 2, and 3 years (P < .05 for all). The T1ρ and T2 values of the menisci of injured knees were greater than those of uninjured and control knees in the posterior lateral and posterior medial horns up to 1 and 2 years after surgery, respectively (P < .05 for all). The tibial position at 3 years was associated with increased T2 values from baseline to 3 years in the posterior medial horn (β = 0.397; P = .031) and anterior medial horn (β = 0.360; P = .040). Conclusion: Results of the current study indicate that there is a persistently altered tibial position after ACL reconstruction. Initial preoperative meniscal abnormalities show prolonged but gradual improvement. Additionally, correlations between the tibial position and changes in the medial meniscal matrix suggest that the tibial position may play a role in the increased susceptibility to medial meniscal tears seen after reconstruction. The development of newer surgical techniques must address a persistently altered tibial position. Quantitative MRI is an effective instrument to evaluate meniscal matrix changes and can serve as an early radiological tool for meniscal injuries.
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Affiliation(s)
- Alexander R Markes
- University of California, San Francisco, School of Medicine, San Francisco, California, USA
| | - Joseph Knox
- University of California, San Francisco, School of Medicine, San Francisco, California, USA
| | - Qunjie Zhong
- Department of Radiology and Biomedical Imaging, University of California, San Francisco, San Francisco, California, USA
| | - Valentina Pedoia
- Department of Radiology and Biomedical Imaging, University of California, San Francisco, San Francisco, California, USA
| | - Xiaojuan Li
- Department of Radiology and Biomedical Imaging, University of California, San Francisco, San Francisco, California, USA
| | - C Benjamin Ma
- Department of Orthopaedic Surgery, University of California, San Francisco, San Francisco, California, USA
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19
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Affiliation(s)
| | | | - O Kenechi Nwawka
- Department of Radiology and Imaging, Hospital for Special Surgery, New York, NY, USA
| | - Hollis G Potter
- Sports Health Associate Editor for Imaging, Department of Radiology and Imaging, Hospital for Special Surgery, New York, NY, USA
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