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Zhao Q, Holt A, Spritzer CE, DeFrate LE, McNulty AL, Wang N. High angular resolution diffusion imaging (HARDI) of porcine menisci: a comparison of diffusion tensor imaging and generalized q-sampling imaging. Quant Imaging Med Surg 2024; 14:2738-2746. [PMID: 38617143 PMCID: PMC11007495 DOI: 10.21037/qims-23-1355] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2023] [Accepted: 02/19/2024] [Indexed: 04/16/2024]
Abstract
Background Diffusion magnetic resonance imaging (MRI) allows for the quantification of water diffusion properties in soft tissues. The goal of this study was to characterize the 3D collagen fiber network in the porcine meniscus using high angular resolution diffusion imaging (HARDI) acquisition with both diffusion tensor imaging (DTI) and generalized q-sampling imaging (GQI). Methods Porcine menisci (n=7) were scanned ex vivo using a three-dimensional (3D) HARDI spin-echo pulse sequence with an isotropic resolution of 500 µm at 7.0 Tesla. Both DTI and GQI reconstruction techniques were used to quantify the collagen fiber alignment and visualize the complex collagen network of the meniscus. The MRI findings were validated with conventional histology. Results DTI and GQI exhibited distinct fiber orientation maps in the meniscus using the same HARDI acquisition. We found that crossing fibers were only resolved with GQI, demonstrating the advantage of GQI over DTI to visualize the complex collagen fiber orientation in the meniscus. Furthermore, the MRI findings were consistent with conventional histology. Conclusions HARDI acquisition with GQI reconstruction more accurately resolves the complex 3D collagen architecture of the meniscus compared to DTI reconstruction. In the future, these technologies have the potential to nondestructively assess both normal and abnormal meniscal structure.
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Affiliation(s)
- Qi Zhao
- Physical Education Institute, Jimei University, Xiamen, China
- Department of Radiology, Duke University School of Medicine, Durham, NC, USA
| | - Abigail Holt
- Department of Orthopaedic Surgery, Duke University School of Medicine, Durham, NC, USA
| | - Charles E. Spritzer
- Department of Radiology, Duke University School of Medicine, Durham, NC, USA
| | - Louis E. DeFrate
- Department of Orthopaedic Surgery, Duke University School of Medicine, Durham, NC, USA
- Department of Biomedical Engineering, Duke University, Durham, NC, USA
| | - Amy L. McNulty
- Department of Orthopaedic Surgery, Duke University School of Medicine, Durham, NC, USA
- Department of Biomedical Engineering, Duke University, Durham, NC, USA
- Department of Pathology, Duke University School of Medicine, Durham, NC, USA
| | - Nian Wang
- Department of Radiology and Imaging Sciences, Indiana University, Indianapolis, IN, USA
- Stark Neurosciences Research Institute, Indiana University, Indianapolis, IN, USA
- Indiana Center for Musculoskeletal Health, Indiana University, Indianapolis, IN, USA
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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] [What about the content of this article? (0)] [Affiliation(s)] [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] [What about the content of this article? (0)] [Affiliation(s)] [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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Nishino K, Hashimoto Y, Nishida Y, Yamasaki S, Nakamura H. Arthroscopic surgery for symptomatic discoid lateral meniscus improves meniscal status assessed by magnetic resonance imaging T2 mapping. Arch Orthop Trauma Surg 2023. [PMID: 36811665 DOI: 10.1007/s00402-023-04819-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [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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Nischal N, Iyengar KP, Herlekar D, Botchu R. Imaging of Cartilage and Chondral Defects: An Overview. Life (Basel) 2023; 13:life13020363. [PMID: 36836719 PMCID: PMC9960762 DOI: 10.3390/life13020363] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/24/2022] [Revised: 01/15/2023] [Accepted: 01/20/2023] [Indexed: 02/03/2023] Open
Abstract
A healthy articular cartilage is paramount to joint function. Cartilage defects, whether acute or chronic, are a significant source of morbidity. This review summarizes various imaging modalities used for cartilage assessment. While radiographs are insensitive, they are still widely used to indirectly assess cartilage. Ultrasound has shown promise in the detection of cartilage defects, but its efficacy is limited in many joints due to inadequate visualization. CT arthrography has the potential to assess internal derangements of joints along with cartilage, especially in patients with contraindications to MRI. MRI remains the favored imaging modality to assess cartilage. The conventional imaging techniques are able to assess cartilage abnormalities when cartilage is already damaged. The newer imaging techniques are thus targeted at detecting biochemical and structural changes in cartilage before an actual visible irreversible loss. These include, but are not limited to, T2 and T2* mapping, dGEMRI, T1ρ imaging, gagCEST imaging, sodium MRI and integrated PET with MRI. A brief discussion of the advances in the surgical management of cartilage defects and post-operative imaging assessment is also included.
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Affiliation(s)
- Neha Nischal
- Department of Musculoskeletal Radiology, Royal Orthopedic Hospital, Birmingham B31 2AP, UK
- Department of Radiology, Holy Family Hospital, New Delhi 110025, India
| | | | - Deepak Herlekar
- Department of Orthopaedics, University Hospitals of Morecambe Bay NHS Foundation Trust, Kendal LA9 7RG, UK
| | - Rajesh Botchu
- Department of Musculoskeletal Radiology, Royal Orthopedic Hospital, Birmingham B31 2AP, UK
- Correspondence:
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Shu D, Chen F, Guo W, Ding J, Dai S. Acute changes in knee cartilage and meniscus following long-distance running in habituate runners: a systematic review on studies using quantitative magnetic resonance imaging. Skeletal Radiol 2022; 51:1333-1345. [PMID: 34854970 DOI: 10.1007/s00256-021-03943-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/20/2021] [Revised: 10/13/2021] [Accepted: 10/13/2021] [Indexed: 02/02/2023]
Abstract
OBJECTIVE Running is among the most popular recreational activities; nonetheless, the acute post-race changes of cartilage or meniscus have rarely been determined. The current study aimed to review the acute changes in knee cartilage and meniscus among habituate runners following long-distance running detected by using quantitative magnetic resonance imaging (MRI). MATERIALS AND METHODS Systematic literature search was performed on those dominate clinical databases which including MEDLINE, Cochrane, Embase, ScienceDirect, and Web of Science. Included studies should be conducted on healthy marathon runners, and the participants should be examined before and after running by using MRI. Intervention studies were excluded. RESULTS A total number of 14 studies were finally included in this review which all examined the cartilage or meniscus by using MRI functional sequences. Among them, six studies quantitatively measured the changes regarding volume of the knee cartilage or/and meniscus. Five studies found that the volume would decrease initially after running. Ten studies reported T2 (T2*) would decrease after running and returned to the baseline in a short term, while T1ρ may remain increased in months. Five studies measured subareas for T2 (T2*) value, and found that the superficial and medial subarea changed more vastly than other regions after running. CONCLUSION Runners experience transient changes in the volume and signals of knee cartilage and meniscus after long-distance running. A liquid exchange and material interaction in cartilage and meniscus was observed after running. Superficial and medial areas of knee cartilage and meniscus might be more susceptible to mechanical loading.
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Affiliation(s)
- Dingbo Shu
- School of Clinical Medicine, Hangzhou Normal University, Hangzhou, China
- Department of Radiology, Affiliated Hospital of Hangzhou Normal University, Hangzhou, China
| | - Feng Chen
- Department of Paediatrics, The Chinese University of Hong Kong, Hong Kong, China
| | - Wentong Guo
- Department of Computer Science, City University of Hong Kong, Hong Kong, China
| | - Jianping Ding
- School of Clinical Medicine, Hangzhou Normal University, Hangzhou, China
- Department of Radiology, Affiliated Hospital of Hangzhou Normal University, Hangzhou, China
| | - Siyu Dai
- School of Clinical Medicine, Hangzhou Normal University, Hangzhou, China.
- Department of Radiology, Affiliated Hospital of Hangzhou Normal University, Hangzhou, China.
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Said O, Schock J, Abrar DB, Schad P, Kuhl C, Nolte T, Knobe M, Prescher A, Truhn D, Nebelung S. In-Situ Cartilage Functionality Assessment Based on Advanced MRI Techniques and Precise Compartmental Knee Joint Loading through Varus and Valgus Stress. Diagnostics (Basel) 2021; 11:diagnostics11081476. [PMID: 34441410 PMCID: PMC8391314 DOI: 10.3390/diagnostics11081476] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2021] [Revised: 08/09/2021] [Accepted: 08/12/2021] [Indexed: 12/05/2022] Open
Abstract
Stress MRI brings together mechanical loading and MRI in the functional assessment of cartilage and meniscus, yet lacks basic scientific validation. This study assessed the response-to-loading patterns of cartilage and meniscus incurred by standardized compartmental varus and valgus loading of the human knee joint. Eight human cadaveric knee joints underwent imaging by morphologic (i.e., proton density-weighted fat-saturated and 3D water-selective) and quantitative (i.e., T1ρ and T2 mapping) sequences, both unloaded and loaded to 73.5 N, 147.1 N, and 220.6 N of compartmental pressurization. After manual segmentation of cartilage and meniscus, morphometric measures and T2 and T1ρ relaxation times were quantified. CT-based analysis of joint alignment and histologic and biomechanical tissue measures served as references. Under loading, we observed significant decreases in cartilage thickness (p < 0.001 (repeated measures ANOVA)) and T1ρ relaxation times (p = 0.001; medial meniscus, lateral tibia; (Friedman test)), significant increases in T2 relaxation times (p ≤ 0.004; medial femur, lateral tibia; (Friedman test)), and adaptive joint motion. In conclusion, varus and valgus stress MRI induces meaningful changes in cartilage and meniscus secondary to compartmental loading that may be assessed by cartilage morphometric measures as well as T2 and T1ρ mapping as imaging surrogates of tissue functionality.
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Affiliation(s)
- Oliver Said
- Department of Diagnostic and Interventional Radiology, Aachen University Hospital, 52074 Aachen, Germany; (O.S.); (P.S.); (C.K.); (T.N.); (D.T.); (S.N.)
| | - Justus Schock
- Department of Diagnostic and Interventional Radiology, Medical Faculty, University Dusseldorf, 40225 Dusseldorf, Germany;
- Correspondence:
| | - Daniel Benjamin Abrar
- Department of Diagnostic and Interventional Radiology, Medical Faculty, University Dusseldorf, 40225 Dusseldorf, Germany;
| | - Philipp Schad
- Department of Diagnostic and Interventional Radiology, Aachen University Hospital, 52074 Aachen, Germany; (O.S.); (P.S.); (C.K.); (T.N.); (D.T.); (S.N.)
| | - Christiane Kuhl
- Department of Diagnostic and Interventional Radiology, Aachen University Hospital, 52074 Aachen, Germany; (O.S.); (P.S.); (C.K.); (T.N.); (D.T.); (S.N.)
| | - Teresa Nolte
- Department of Diagnostic and Interventional Radiology, Aachen University Hospital, 52074 Aachen, Germany; (O.S.); (P.S.); (C.K.); (T.N.); (D.T.); (S.N.)
| | - Matthias Knobe
- Department of Orthopedic and Trauma Surgery, Lucerne Cantonal Hospital, 6000, Lucerne, Switzerland;
| | - Andreas Prescher
- Institute of Molecular and Cellular Anatomy, RWTH Aachen University, 52074 Aachen, Germany;
| | - Daniel Truhn
- Department of Diagnostic and Interventional Radiology, Aachen University Hospital, 52074 Aachen, Germany; (O.S.); (P.S.); (C.K.); (T.N.); (D.T.); (S.N.)
| | - Sven Nebelung
- Department of Diagnostic and Interventional Radiology, Aachen University Hospital, 52074 Aachen, Germany; (O.S.); (P.S.); (C.K.); (T.N.); (D.T.); (S.N.)
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Nishida Y, Hashimoto Y, Orita K, Nishino K, Kinoshita T, Nakamura H. Serum cartilage oligomeric matrix protein is correlated with quantitative magnetic resonance imaging and arthroscopic cartilage findings in anterior cruciate ligament deficient knees without osteoarthritic changes. Clin Rheumatol 2021; 40:4629-4638. [PMID: 34117950 DOI: 10.1007/s10067-021-05800-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2020] [Revised: 05/24/2021] [Accepted: 05/30/2021] [Indexed: 11/26/2022]
Abstract
INTRODUCTION/OBJECTIVES To investigate the association between serum biomarker [cartilage oligomeric matrix protein (COMP) and matrix metalloproteinase-3 (MMP-3)] levels and clinical, magnetic resonance imaging (MRI), and arthroscopic findings in anterior cruciate ligament (ACL)-deficient knees without osteoarthritic changes on radiographs. METHOD Patients with ACL injury of Kellgren-Lawrence grade 0 or 1 were enrolled. Serum COMP and MMP-3 levels were measured preoperatively. Correlations of serum biomarker levels with age, body mass index (BMI), duration from time of injury, Tegner activity scale (TAS) score, Lysholm knee score, International Knee Documentation Committee score, KT-1000 arthrometer measurements, whole-organ MRI score (WORMS), MRI T2 relaxation time, and arthroscopic International Cartilage Research Society (ICRS) grade were assessed by calculating Spearman correlation coefficients. Associations between intraoperative findings (cartilage, meniscus) and serum biomarker levels were determined using the Mann-Whitney U test. Multiple regression analysis was performed to investigate the correlations between serum biomarker levels and MRI and arthroscopic findings. RESULTS Ninety-eight patients with a mean age of 23.7 years were enrolled. Higher serum COMP level was correlated with older age and higher BMI, TAS score, serum MMP-3 level, WORMS, and T2 relaxation times (medial femur, medial tibia). Multivariate analysis showed that the serum COMP level was independently associated with WORMS and ICRS grade. CONCLUSIONS The serum COMP level was correlated with age, BMI, TAS score, and MMP-3 level in ACL-deficient knees and was independently correlated with WORMS and ICRS grade. Thus, the serum COMP level can help detect cartilage degeneration even in patients without radiographic osteoarthritic changes. Key Points • Serum COMP correlated with WORMS and ICRS grade in ACL deficient knee. • The serum COMP level could help in detecting cartilage degeneration, even in patients with no radiographic osteoarthritic changes.
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Affiliation(s)
- Yohei Nishida
- Department of Orthopaedic Surgery, Osaka City University Graduate School of Medicine, 1-4-3 Asahi-machi, Abeno-ku, Osaka, 545-8585, Japan
| | - Yusuke Hashimoto
- Department of Orthopaedic Surgery, Osaka City University Graduate School of Medicine, 1-4-3 Asahi-machi, Abeno-ku, Osaka, 545-8585, Japan.
| | - Kumi Orita
- Department of Orthopaedic Surgery, Osaka City University Graduate School of Medicine, 1-4-3 Asahi-machi, Abeno-ku, Osaka, 545-8585, Japan
| | - Kazuya Nishino
- Department of Orthopaedic Surgery, Osaka City University Graduate School of Medicine, 1-4-3 Asahi-machi, Abeno-ku, Osaka, 545-8585, Japan
| | - Takuya Kinoshita
- Department of Orthopaedic Surgery, Osaka City University Graduate School of Medicine, 1-4-3 Asahi-machi, Abeno-ku, Osaka, 545-8585, Japan
| | - Hiroaki Nakamura
- Department of Orthopaedic Surgery, Osaka City University Graduate School of Medicine, 1-4-3 Asahi-machi, Abeno-ku, Osaka, 545-8585, Japan
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Nishino K, Hashimoto Y, Nishida Y, Yamasaki S, Nakamura H. Magnetic Resonance Imaging T2 Relaxation Times of Articular Cartilage Before and After Arthroscopic Surgery for Discoid Lateral Meniscus. Arthroscopy 2021; 37:647-654. [PMID: 33010327 DOI: 10.1016/j.arthro.2020.09.036] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/03/2020] [Revised: 09/18/2020] [Accepted: 09/19/2020] [Indexed: 02/02/2023]
Abstract
PURPOSE To quantitatively evaluate degeneration of articular cartilage using magnetic resonance imaging (MRI) T2 mapping before and after arthroscopic surgery for discoid lateral meniscus (DLM). METHODS We retrospectively reviewed the medical records of patients who underwent arthroscopic reshaping surgery for symptomatic DLM from September 2013 to October 2017 and who had undergone follow-up for ≥2 years. MRI T2 relaxation examinations had been performed preoperatively and at 3, 6, 12, and 24 months postoperatively. The T2 relaxation times of the whole lateral femoral condyle and the tibial plateau were assessed. In addition, the lateral femoral condyle was divided into 3 subcompartmental areas: anterior, middle, and posterior. RESULTS In total, 30 knees of 27 patients were included in this study. The patients' mean age at operation was 13.3 years (range 6-23 years), and the mean follow-up period was 31.6 months. Saucerization alone was performed in 3 knees and saucerization with repair in 27 knees. The T2 relaxation time of the whole lateral femoral condyle was significantly increased at 3 and 6 months postoperatively and significantly decreased at 12 and 24 months. The T2 relaxation time of the whole lateral tibial plateau was significantly increased at 3 months postoperatively and significantly decreased at 24 months. The T2 relaxation time of the posterior subcompartment of the lateral femoral condyle was significantly increased at 3 months and significantly decreased at 12 and 24 months. CONCLUSIONS The T2 relaxation time of the lateral femorotibial joint cartilage increased at 3 and 6 months postoperatively and then had decreased at 12 and 24 months. Quantitative MRI allowed us to monitor the substantial changes in the cartilage during the early postoperative period and the recovery at the distant time point after reshaping surgery for DLM. LEVEL OF EVIDENCE Level IV, case series.
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Affiliation(s)
- Kazuya Nishino
- Department of Orthopaedic Surgery, Osaka City University Graduate School of Medicine, Osaka, Japan
| | - Yusuke Hashimoto
- Department of Orthopaedic Surgery, Osaka City University Graduate School of Medicine, Osaka, Japan.
| | - Yohei Nishida
- Department of Orthopaedic Surgery, Osaka City University Graduate School of Medicine, Osaka, Japan
| | - Shinya Yamasaki
- Department of Orthopaedic Surgery, Osaka City General Hospital, Osaka, Japan
| | - Hiroaki Nakamura
- Department of Orthopaedic Surgery, Osaka City University Graduate School of Medicine, Osaka, Japan
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Schwer J, Rahman MM, Stumpf K, Rasche V, Ignatius A, Dürselen L, Seitz AM. Degeneration Affects Three-Dimensional Strains in Human Menisci: In situ MRI Acquisition Combined With Image Registration. Front Bioeng Biotechnol 2020; 8:582055. [PMID: 33042980 PMCID: PMC7526678 DOI: 10.3389/fbioe.2020.582055] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2020] [Accepted: 08/28/2020] [Indexed: 11/20/2022] Open
Abstract
Degenerative changes of menisci contribute to the evolution of osteoarthritis in the knee joint, because they alter the load transmission to the adjacent articular cartilage. Identifying alterations in the strain response of meniscal tissue under compression that are associated with progressive degeneration may uncover links between biomechanical function and meniscal degeneration. Therefore, the goal of this study was to investigate how degeneration effects the three-dimensional (3D; axial, circumferential, radial) strain in different anatomical regions of human menisci (anterior and posterior root attachment; anterior and posterior horn; pars intermedia) under simulated compression. Magnetic resonance imaging (MRI) was performed to acquire image sequences of 12 mild and 12 severe degenerated knee joints under unloaded and loaded [25%, 50% and 100% body weight (BW)] conditions using a customized loading device. Medial and lateral menisci as well as their root attachments were manually segmented. Intensity-based rigid and non-rigid image registration were performed to obtain 3D deformation fields under the respective load levels. Finally, the 3D voxels were transformed into hexahedral finite-element models and direction-dependent local strain distributions were determined. The axial compressive strain in menisci and meniscal root attachments significantly increased on average from 3.1% in mild degenerated joints to 7.3% in severe degenerated knees at 100% BW (p ≤ 0.021). In severe degenerated knee joints, the menisci displayed a mean circumferential strain of 0.45% (mild: 0.35%) and a mean radial strain of 0.41% (mild: 0.37%) at a load level of 100% BW. No significant changes were observed in the circumferential or radial directions between mild and severe degenerated knee joints for all load levels (p > 0.05). In conclusion, high-resolution MRI was successfully combined with image registration to investigate spatial strain distributions of the meniscus and its attachments in response to compression. The results of the current study highlight that the compressive integrity of the meniscus decreases with progressing tissue degeneration, whereas the tensile properties are maintained.
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Affiliation(s)
- Jonas Schwer
- Institute of Orthopaedic Research and Biomechanics, Centre for Trauma Research Ulm, Ulm University Medical Centre, Ulm, Germany
| | - Muhammed Masudur Rahman
- Institute of Orthopaedic Research and Biomechanics, Centre for Trauma Research Ulm, Ulm University Medical Centre, Ulm, Germany.,Department of Mechanical Engineering, University of Connecticut, Storrs, CT, United States
| | - Kilian Stumpf
- Experimental Cardiovascular Imaging, Department of Internal Medicine II, University Hospital Ulm, Ulm, Germany
| | - Volker Rasche
- Experimental Cardiovascular Imaging, Department of Internal Medicine II, University Hospital Ulm, Ulm, Germany
| | - Anita Ignatius
- Institute of Orthopaedic Research and Biomechanics, Centre for Trauma Research Ulm, Ulm University Medical Centre, Ulm, Germany
| | - Lutz Dürselen
- Institute of Orthopaedic Research and Biomechanics, Centre for Trauma Research Ulm, Ulm University Medical Centre, Ulm, Germany
| | - Andreas Martin Seitz
- Institute of Orthopaedic Research and Biomechanics, Centre for Trauma Research Ulm, Ulm University Medical Centre, Ulm, Germany
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11
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Wan L, Ma Y, Yang J, Jerban S, Searleman AC, Carl M, Le N, Chang EY, Tang G, Du J. Fast quantitative three-dimensional ultrashort echo time (UTE) Cones magnetic resonance imaging of major tissues in the knee joint using extended sprial sampling. NMR Biomed 2020; 33:e4376. [PMID: 32667115 PMCID: PMC7952018 DOI: 10.1002/nbm.4376] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/28/2019] [Revised: 02/20/2020] [Accepted: 06/26/2020] [Indexed: 05/14/2023]
Abstract
The purpose of this study is to investigate the effect of extending the spiral sampling window on quantitative 3D ultrashort echo time (UTE) Cones imaging of major knee joint tissues including articular cartilage, menisci, tendons and ligaments at 3 T. Nine cadaveric human whole knee specimens were imaged on a 3 T clinical MRI scanner. A series of quantitative 3D UTE Cones imaging biomarkers including T2 *, T1 , adiabatic T1ρ , magnetization transfer ratio (MTR) and macromolecular fraction (MMF) were estimated using spiral sampling trajectories with various durations. Errors in UTE MRI biomarkers as a function of sampling time were evaluated using a nonstretched spiral trajectory as a reference standard. No significant differences were observed by increasing the spiral sampling window from 1116 to 2232 μs in the calculated T2 *, T1 , adiabatic T1ρ , MTR and MMF, as all P-values were over .05 as assessed by ANOVA with two-sided Dunnett's test. Although extending the sampling window results in signal loss for short T2 components, there was limited effect on the calculated quantitative biomarkers, with error percentages typically smaller than 5% in all the evaluated tissues. The total scan time can be reduced by up to 54% with quantification errors of less than 5% in any evaluated major tissue in the knee joint, suggesting that 3D UTE Cones MRI techniques can be greatly accelerated by using a longer spiral sampling window without causing additional quantitative bias.
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Affiliation(s)
- Lidi Wan
- Department of Radiology, Tenth People’s Hospital of Tongji University, Shanghai, China
- Department of Radiology, University of California, San Diego, CA, USA
| | - Yajun Ma
- Department of Radiology, University of California, San Diego, CA, USA
| | - Jiawei Yang
- Department of Radiology, Tenth People’s Hospital of Tongji University, Shanghai, China
| | - Saeed Jerban
- Department of Radiology, University of California, San Diego, CA, USA
| | - Adam C Searleman
- Department of Radiology, University of California, San Diego, CA, USA
| | | | - Nicole Le
- Radiology Service, Veterans Affairs San Diego Healthcare System, San Diego, CA, USA
| | - Eric Y Chang
- Department of Radiology, University of California, San Diego, CA, USA
- Radiology Service, Veterans Affairs San Diego Healthcare System, San Diego, CA, USA
| | - Guangyu Tang
- Department of Radiology, Tenth People’s Hospital of Tongji University, Shanghai, China
| | - Jiang Du
- Department of Radiology, University of California, San Diego, CA, USA
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12
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Byra M, Wu M, Zhang X, Jang H, Ma YJ, Chang EY, Shah S, Du J. Knee menisci segmentation and relaxometry of 3D ultrashort echo time cones MR imaging using attention U-Net with transfer learning. Magn Reson Med 2020; 83:1109-1122. [PMID: 31535731 PMCID: PMC6879791 DOI: 10.1002/mrm.27969] [Citation(s) in RCA: 32] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2019] [Revised: 07/11/2019] [Accepted: 08/04/2019] [Indexed: 12/24/2022]
Abstract
PURPOSE To develop a deep learning-based method for knee menisci segmentation in 3D ultrashort echo time (UTE) cones MR imaging, and to automatically determine MR relaxation times, namely the T1, T1ρ , and T 2 ∗ parameters, which can be used to assess knee osteoarthritis (OA). METHODS Whole knee joint imaging was performed using 3D UTE cones sequences to collect data from 61 human subjects. Regions of interest (ROIs) were outlined by 2 experienced radiologists based on subtracted T1ρ -weighted MR images. Transfer learning was applied to develop 2D attention U-Net convolutional neural networks for the menisci segmentation based on each radiologist's ROIs separately. Dice scores were calculated to assess segmentation performance. Next, the T1, T1ρ , T 2 ∗ relaxations, and ROI areas were determined for the manual and automatic segmentations, then compared. RESULTS The models developed using ROIs provided by 2 radiologists achieved high Dice scores of 0.860 and 0.833, while the radiologists' manual segmentations achieved a Dice score of 0.820. Linear correlation coefficients for the T1, T1ρ , and T 2 ∗ relaxations calculated using the automatic and manual segmentations ranged between 0.90 and 0.97, and there were no associated differences between the estimated average meniscal relaxation parameters. The deep learning models achieved segmentation performance equivalent to the inter-observer variability of 2 radiologists. CONCLUSION The proposed deep learning-based approach can be used to efficiently generate automatic segmentations and determine meniscal relaxations times. The method has the potential to help radiologists with the assessment of meniscal diseases, such as OA.
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Affiliation(s)
- Michal Byra
- Department of Radiology, University of California, San Diego, CA, USA
- Department of Ultrasound, Institute of Fundamental Technological Research, Polish Academy of Sciences, Warsaw, Poland
| | - Mei Wu
- Department of Radiology, University of California, San Diego, CA, USA
| | - Xiaodong Zhang
- Department of Radiology, University of California, San Diego, CA, USA
| | - Hyungseok Jang
- Department of Radiology, University of California, San Diego, CA, USA
| | - Ya-Jun Ma
- Department of Radiology, University of California, San Diego, CA, USA
| | - Eric Y Chang
- Department of Radiology, University of California, San Diego, CA, USA
- Radiology Service, VA San Diego Healthcare System, San Diego, USA
| | - Sameer Shah
- Department of Orthopedic Surgery and Bioengineering, University of California, San Diego, CA, USA
| | - Jiang Du
- Department of Radiology, University of California, San Diego, CA, USA
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13
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Capin JJ, Williams JR, Neal K, Khandha A, Durkee L, Ito N, Stefanik JJ, Snyder-Mackler L, Buchanan TS. Slower Walking Speed Is Related to Early Femoral Trochlear Cartilage Degradation After ACL Reconstruction. J Orthop Res 2020; 38:645-652. [PMID: 31710115 PMCID: PMC7028512 DOI: 10.1002/jor.24503] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/20/2019] [Accepted: 10/14/2019] [Indexed: 02/04/2023]
Abstract
Post-traumatic patellofemoral osteoarthritis (OA) is prevalent after anterior cruciate ligament reconstruction (ACLR) and early cartilage degradation may be especially common in the femoral trochlear cartilage. Determining the presence of and factors associated with early femoral trochlear cartilage degradation, a precursor to OA, is a critical preliminary step in identifying those at risk for patellofemoral OA development and designing interventions to combat the disease. Early cartilage degradation can be detected using quantitative magnetic resonance imaging measures, such as tissue T2 relaxation time. The purposes of this study were to (i) compare involved (ACLR) versus uninvolved (contralateral) femoral trochlear cartilage T2 relaxation times 6 months after ACLR, and (ii) determine the relationship between walking speed and walking mechanics 3 months after ACLR and femoral trochlear cartilage T2 relaxation times 6 months after ACLR. Twenty-six individuals (age 23 ± 7 years) after primary, unilateral ACLR participated in detailed motion analyses 3.3 ± 0.6 months after ACLR and quantitative magnetic resonance imaging 6.3 ± 0.5 months after ACLR. There were no limb differences in femoral trochlear cartilage T2 relaxation times. Slower walking speed was related to higher (worse) femoral trochlear cartilage T2 relaxation times in the involved limb (Pearson's r: -0.583, p = 0.002) and greater interlimb differences in trochlear T2 relaxation times (Pearson's r: -0.349, p = 0.080). Walking mechanics were weakly related to trochlear T2 relaxation times. Statement of clinical significance: Slower walking speed was by far the strongest predictor of worse femoral trochlear cartilage health, suggesting slow walking speed may be an early clinical indicator of future patellofemoral OA after ACLR. © 2019 Orthopaedic Research Society. Published by Wiley Periodicals, Inc. J Orthop Res 38:645-652, 2020.
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Affiliation(s)
- Jacob J. Capin
- Physical Therapy Program, Department of Physical Medicine and Rehabilitation, University of Colorado, Aurora, CO,Eastern Colorado VA Geriatric Research Education and Clinical Center (GRECC), Aurora, CO
| | - Jack R. Williams
- Mechanical Engineering Department, University of Delaware, Newark, DE, USA
| | - Kelsey Neal
- Mechanical Engineering Department, University of Delaware, Newark, DE, USA
| | - Ashutosh Khandha
- Biomedical Engineering Department, University of Delaware, Newark, DE, USA
| | - Laura Durkee
- Athletic Training Education Program, University of Delaware, Newark, DE, USA
| | - Naoaki Ito
- Biomechanics and Movement Science Program, University of Delaware, Newark, DE, USA,Physical Therapy Department, University of Delaware, Newark, DE, USA
| | - Joshua J. Stefanik
- Department of Physical Therapy, Movement and Rehabilitation Sciences, Northeastern University, Boston, MA, USA
| | - Lynn Snyder-Mackler
- Biomedical Engineering Department, University of Delaware, Newark, DE, USA,Biomechanics and Movement Science Program, University of Delaware, Newark, DE, USA,Physical Therapy Department, University of Delaware, Newark, DE, USA,Delaware Rehabilitation Institute, University of Delaware, Newark, DE, USA
| | - Thomas S. Buchanan
- Mechanical Engineering Department, University of Delaware, Newark, DE, USA,Biomedical Engineering Department, University of Delaware, Newark, DE, USA,Delaware Rehabilitation Institute, University of Delaware, Newark, DE, USA
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14
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Shimizu T, Markes AR, Samaan MA, Tanaka MS, Souza RB, Li X, Ma CB. Patients With Abnormal Limb Kinetics at 6 Months After Anterior Cruciate Ligament Reconstruction Have an Increased Risk of Persistent Medial Meniscal Abnormality at 3 Years. Orthop J Sports Med 2020; 8:2325967119895248. [PMID: 32030346 PMCID: PMC6978828 DOI: 10.1177/2325967119895248] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/16/2019] [Accepted: 09/28/2019] [Indexed: 11/26/2022] Open
Abstract
Background: Several reports have shown that altered biomechanics after anterior cruciate
ligament reconstruction (ACLR) are associated with the development of
posttraumatic osteoarthritis. However, it is not fully understood whether
altered biomechanics are associated with meniscal changes after ACLR. Purpose: To investigate changes in gait and landing biomechanics over a 3-year period
and their correlation with meniscal matrix alterations present before and
after ACLR through use of magnetic resonance T1ρ/T2 mapping, which can allow
detection of early meniscal degeneration. Study Design: Cohort study; Level of evidence, 2. Methods: A total of 36 patients with ACLR and 14 healthy controls were included in
this study. All patients underwent magnetic resonance imaging and
biomechanical analysis during gait of the injured knee and contralateral
knee preoperatively and at 6 months, 1 year, 2 years, and 3 years after
ACLR, as well as biomechanical analysis during drop-landing from 6 months to
3 years postoperatively. To evaluate biochemical changes of the mensical
matrix, T1ρ/T2 relaxation times of the meniscus were calculated. Results: Mean T1ρ/T2 values of ACLR knees were significantly higher than values in the
contralateral and control knees in the posterior lateral and medial horns up
to 1 year after surgery; however, the differences were not seen at 3 years
after surgery. The ACLR knee exhibited significantly lower peak knee flexion
moment and angle during gait at 6 months compared with baseline and
continued to decrease until 3 years. The ACLR knee exhibited significantly
lower peak vertical ground-reaction force and peak knee flexion moment and
angle during landing at 6 months. However, the differences were no longer
present at 3 years. Biomechanics at 6 months had significant correlations
with changes of mean T1ρ/T2 values in the medial posterior horn from 6
months to 3 years after ACLR. Conclusion: Although mean T1ρ/T2 values of meniscus seen before ACLR improved after 3
years, approximately 30% of patients with ACLR did not show decreases from 6
months to 3 years. Patients with abnormal lower limb kinetics of the ACLR
knee at 6 months showed less recovery in the medial posterior horn from 6
months to 3 years, suggesting that biomechanical parameters during the early
stage of recovery might be potential biomarkers for predicting persistent
medial meniscal abnormality after ACLR.
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Affiliation(s)
- Tomohiro Shimizu
- Department of Orthopaedic Surgery, University of California, San Francisco, California, USA.,Musculoskeletal Quantitative Imaging Research Group, Department of Radiology and Biomedical Imaging, University of California, San Francisco, California, USA.,Department of Orthopaedic Surgery, Faculty of Medicine and Graduate School of Medicine, Hokkaido University, Hokkaido, Japan
| | - Alexander R Markes
- Department of Orthopaedic Surgery, University of California, San Francisco, California, USA
| | - Michael A Samaan
- Musculoskeletal Quantitative Imaging Research Group, Department of Radiology and Biomedical Imaging, University of California, San Francisco, California, USA.,Department of Kinesiology and Health Promotion, University of Kentucky, Lexington, Kentucky, USA
| | - Matthew S Tanaka
- Musculoskeletal Quantitative Imaging Research Group, Department of Radiology and Biomedical Imaging, University of California, San Francisco, California, USA
| | - Richard B Souza
- Musculoskeletal Quantitative Imaging Research Group, Department of Radiology and Biomedical Imaging, University of California, San Francisco, California, USA.,Department of Physical Therapy and Rehabilitation Science, University of California, San Francisco, California, USA
| | - Xiaojuan Li
- Musculoskeletal Quantitative Imaging Research Group, Department of Radiology and Biomedical Imaging, University of California, San Francisco, California, USA.,Department of Biomedical Engineering, Program of Advanced Musculoskeletal Imaging (PAMI), Cleveland Clinic, Cleveland, Ohio, USA
| | - C Benjamin Ma
- Department of Orthopaedic Surgery, University of California, San Francisco, California, USA
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15
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Martín Noguerol T, Raya JG, Wessell DE, Vilanova JC, Rossi I, Luna A. Functional MRI for evaluation of hyaline cartilage extracelullar matrix, a physiopathological-based approach. Br J Radiol 2019; 92:20190443. [PMID: 31433668 DOI: 10.1259/bjr.20190443] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022] Open
Abstract
MRI of articular cartilage (AC) integrity has potential to become a biomarker for osteoarthritis progression. Traditional MRI sequences evaluate AC morphology, allowing for the measurement of thickness and its change over time. In the last two decades, more advanced, dedicated MRI cartilage sequences have been developed aiming to assess AC matrix composition non-invasively and detect early changes in cartilage not captured on morphological sequences. T2-mapping and T1ρ sequences can be used to estimate the relaxation times of water inside the AC. These sequences have been introduced into clinical protocols and show promising results for cartilage assessment. Extracelullar matrix can also be assessed using diffusion-weighted imaging and diffusion tensor imaging as the movement of water is limited by the presence of extracellular matrix in AC. Specific techniques for glycosaminoglycans (GAG) evaluation, such as delayed gadolinium enhanced MRI of cartilage or Chemical Exchange Saturation Transfer imaging of GAG, as well as sodium imaging have also shown utility in the detection of AC damage. This manuscript provides an educational update on the physical principles behind advanced AC MRI techniques as well as a comprehensive review of the strengths and weaknesses of each approach. Current clinical applications and potential future applications of these techniques are also discussed.
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Affiliation(s)
| | - Jose G Raya
- Department of Radiology, NYU School of Medicine, NY, USA
| | | | - Joan C Vilanova
- Department of Radiology, Clínica Girona. Institute Diagnostic Imaging (IDI), University of Girona, Girona, Spain
| | | | - Antonio Luna
- MRI unit, Radiology department, Health Time, Jaén, Spain
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16
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Trattnig S, Raudner M, Schreiner M, Roemer F, Bohndorf K. [Biochemical cartilage imaging-update 2019]. Radiologe 2019; 59:742-749. [PMID: 31187160 DOI: 10.1007/s00117-019-0558-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
BACKGROUND Cartilage imaging using magnetic resonance imaging (MRI) is increasingly used for early detection of cartilage damage. Biochemical MR methods to assess cartilage damage are essential for optimal treatment planning. PURPOSE The aim of this review is to provide an update on advanced cartilage imaging based on biochemical MR techniques. The clinical applications and additional benefits compared to conventional MRI are presented. MATERIALS AND METHODS A literature search of PubMed regarding the clinical applications of various biochemical MR methods and morphological MR imaging was performed. RESULTS While T2 mapping can be easily implemented on clinical routine MR scanners, the T1rho method is technically more demanding and is not available on all MR scanners. dGEMRIC, which can be performed with all field strengths, is now severely restricted due to the recent decision of the European Medical Agency (EMA) to withdraw linear gadolinium contrast agents from the market because of proven gadolinium deposition in the brain. Sodium imaging is the most sensitive MRI method for glycosaminoglycan (GAG), but is limited to 7 T. In addition to early diagnosis of cartilage degeneration before morphological changes are visible, biochemical MRI offers predictive markers, e.g., effect of lifestyle changes or assessing results of cartilage repair surgery. CONCLUSION Cartilage imaging based on biochemical MRI allows a shift from qualitative to quantitative MRI. Biochemical MRI plays an increasingly important role in the early diagnosis of cartilage degeneration for monitoring of disease-modifying drugs and as predictive imaging biomarker in clinical diagnostics. In cartilage repair, monitoring of the efficacy of different cartilage repair surgery techniques to develop hyaline-like cartilage can be performed with biochemical MRI.
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Affiliation(s)
- S Trattnig
- Exzellenzzentrum für Hochfeld MR, Universitätsklinik für Radiologie und Nuklearmedizin, Medizinische Universität Wien, Lazarettgasse 14, 1090, Wien, Österreich.
| | - M Raudner
- Exzellenzzentrum für Hochfeld MR, Universitätsklinik für Radiologie und Nuklearmedizin, Medizinische Universität Wien, Lazarettgasse 14, 1090, Wien, Österreich
| | - M Schreiner
- Universitätsklinik für Orthopädie und Unfallchirurgie, Medizinische Universität Wien, Währinger Gürtel 18-20, 1090, Wien, Österreich
| | - F Roemer
- Radiologisches Institut, Universitätsklinikum Erlangen, Maximiliansplatz 3, 91054, Erlangen, Deutschland
| | - K Bohndorf
- Exzellenzzentrum für Hochfeld MR, Universitätsklinik für Radiologie und Nuklearmedizin, Medizinische Universität Wien, Lazarettgasse 14, 1090, Wien, Österreich
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18
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Van Rossom S, Wesseling M, Van Assche D, Jonkers I. Topographical Variation of Human Femoral Articular Cartilage Thickness, T1rho and T2 Relaxation Times Is Related to Local Loading during Walking. Cartilage 2019; 10:229-237. [PMID: 29322877 PMCID: PMC6425544 DOI: 10.1177/1947603517752057] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/25/2022] Open
Abstract
OBJECTIVE Early detection of degenerative changes in the cartilage matrix composition is essential for evaluating early interventions that slow down osteoarthritis (OA) initiation. T1rho and T2 relaxation times were found to be effective for detecting early changes in proteoglycan and collagen content. To use these magnetic resonance imaging (MRI) methods, it is important to document the topographical variation in cartilage thickness, T1rho and T2 relaxation times in a healthy population. As OA is partially mechanically driven, the relation between these MRI-based parameters and localized mechanical loading during walking was investigated. DESIGN MR images were acquired in 14 healthy adults and cartilage thickness and T1rho and T2 relaxation times were determined. Experimental gait data was collected and processed using musculoskeletal modeling to identify weight-bearing zones and estimate the contact force impulse during gait. Variation of the cartilage properties (i.e., thickness, T1rho, and T2) over the femoral cartilage was analyzed and compared between the weight-bearing and non-weight-bearing zone of the medial and lateral condyle as well as the trochlea. RESULTS Medial condyle cartilage thickness was correlated to the contact force impulse ( r = 0.78). Lower T1rho, indicating increased proteoglycan content, was found in the medial weight-bearing zone. T2 was higher in all weight-bearing zones compared with the non-weight-bearing zones, indicating lower relative collagen content. CONCLUSIONS The current results suggest that medial condyle cartilage is adapted as a long-term protective response to localized loading during a frequently performed task and that the weight-bearing zone of the medial condyle has superior weight bearing capacities compared with the non-weight-bearing zones.
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Affiliation(s)
- Sam Van Rossom
- Human Movement Biomechanics Research Group, Department of Movement Sciences, Katholieke Universiteit Leuven, Leuven, Belgium,Sam Van Rossom, Human Movement Biomechanics Research Group, Department of Movement Sciences, Katholieke Universiteit Leuven, Tervuursevest 101, Box 1501, 3001 Leuven, Belgium.
| | - Mariska Wesseling
- Human Movement Biomechanics Research Group, Department of Movement Sciences, Katholieke Universiteit Leuven, Leuven, Belgium
| | - Dieter Van Assche
- Musculoskeletal Rehabilitation Research Group, Department of Rehabilitation Sciences, Katholieke Universiteit Leuven, Leuven, Belgium
| | - Ilse Jonkers
- Human Movement Biomechanics Research Group, Department of Movement Sciences, Katholieke Universiteit Leuven, Leuven, Belgium
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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] [What about the content of this article? (0)] [Affiliation(s)] [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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20
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Li Z, Wang H, Lu Y, Jiang M, Chen Z, Xi X, Ding X, Yan F. Diagnostic value of T1ρ and T2 mapping sequences of 3D fat-suppressed spoiled gradient (FS SPGR-3D) 3.0-T magnetic resonance imaging for osteoarthritis. Medicine (Baltimore) 2019; 98:e13834. [PMID: 30608398 PMCID: PMC6344148 DOI: 10.1097/md.0000000000013834] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/12/2023] Open
Abstract
Three-dimensional fat-suppressed spoiled gradient magnetic resonance imaging can be used to observe cartilages with high resolution.To quantify and compare the T1ρ and T2 relaxation times of the knee articular cartilage between healthy asymptomatic adults and patients with osteoarthritis (OA).This was a retrospective study of 53 patients with symptomatic OA (6 males and 47 females; aged 57.6 ± 10.0 years) and 26 healthy adults (11 males and 15 females; aged 31.7 ± 12.2 years) from the Ruijin Hospital. T1ρ and T2 relaxation times of knee cartilage were quantified using sagittal multi-echo T1ρ and T2 mapping sequences (3.0-T scanner) and analyzed by receiver operating characteristic (ROC) curve.T1ρ and T2 relaxation times in the OA group were higher than in controls (both P < .01). The sensitivity, specificity, and critical value for differentiating normal from OA cartilage were respectively 92%, 85.6%, and 45.90 ms for T1ρ, and 93.6%, 93.3%, and 50.42 ms for T2. T2 mapping sequence showed a higher area under the ROC curve (AUC) than T1ρ (0.965 vs 0.927, P = .02). The AUC for differentiating normal from Noyes IIA cartilage was 0.922 for T1ρ (cut-off: 46.0; sensitivity: 87.7%; specificity: 89.7%) and 0.954 for T2 (cut-off: 49.5; sensitivity: 91.2%; specificity: 92.3%), with no significant difference between them (P = .08).Both T1ρ and T2 mapping sequences could be used to assess OA cartilage lesions, with T2 mapping sequence demonstrating significant sensitivity for cartilage degeneration. These 2 sequences could also identify early-stage OA cartilage.
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Affiliation(s)
| | | | | | | | | | - Xiaobing Xi
- Orthopedics and Traumatology Department, Ruijin Hospital, Shanghai Jiaotong University School of Medicine, Shanghai, China
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Ma YJ, Carl M, Searleman A, Lu X, Chang EY, Du J. 3D adiabatic T 1ρ prepared ultrashort echo time cones sequence for whole knee imaging. Magn Reson Med 2018; 80:1429-1439. [PMID: 29493004 PMCID: PMC6097905 DOI: 10.1002/mrm.27131] [Citation(s) in RCA: 43] [Impact Index Per Article: 7.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2017] [Revised: 01/22/2018] [Accepted: 01/23/2018] [Indexed: 12/29/2022]
Abstract
PURPOSE To develop a 3D adiabatic T1ρ prepared ultrashort echo time cones (3D AdiabT1ρ UTE-Cones) sequence for whole knee imaging on a clinical 3T scanner. METHODS A train of adiabatic full passage pulses were used for spin locking, followed by time-efficient multispoke UTE acquisition to detect signals from both short and long T2 tissues in the whole knee joint. A modified signal model was proposed for multispoke UTE data fitting. The feasibility of this 3D AdiabT1ρ UTE-Cones technique was demonstrated through numerical simulation, phantom, and ex vivo knee sample studies. The 3D AdiabT1ρ UTE-Cones technique was then applied to 6 in vivo knee joints of healthy volunteers to measure T1ρ values of quadriceps tendon, patellar tendon, anterior cruciate ligament (ACL), posterior cruciate ligament (PCL), meniscus, patellar cartilage, and muscle. RESULTS Numerical simulation, phantom and ex vivo knee sample studies demonstrated the feasibility of whole knee imaging using the proposed multispoke 3D AdiabT1ρ UTE-Cones sequence. The healthy volunteer knee study demonstrated an averaged T1ρ of 13.9 ± 0.7 ms for the quadriceps tendon, 9.7 ± 0.8 ms for the patellar tendon, 34.9 ± 2.8 ms for the ACL, 21.6 ± 1.4 ms for the PCL, 22.5 ± 1.9 ms for the meniscus, 44.5 ± 2.4 ms for the patellar cartilage, and 43.2 ± 1.1 ms for the muscle. CONCLUSION The 3D AdiabT1ρ UTE-Cones sequence allows volumetric T1ρ assessment of both short and long T2 tissues in the knee joint on a clinical 3T scanner.
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Affiliation(s)
- Ya-Jun Ma
- Department of Radiology, University of California, San Diego, CA
| | | | - Adam Searleman
- Department of Radiology, University of California, San Diego, CA
| | - Xing Lu
- Department of Radiology, University of California, San Diego, CA
| | - Eric Y Chang
- Department of Radiology, University of California, San Diego, CA
- Radiology Service, VA San Diego Healthcare System, San Diego, CA
| | - Jiang Du
- Department of Radiology, University of California, San Diego, CA
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Behzadi C, Welsch GH, Petersen JP, Schoennagel BP, Bannas P, Kaul MG, Schoen G, Berger-Groch J, Adam G, Regier M. T2 relaxation times of the anterolateral femoral cartilage in patients after ACL-reconstruction with and without a deep lateral femoral notch sign. Eur J Radiol 2018; 106:85-91. [DOI: 10.1016/j.ejrad.2018.07.007] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2018] [Revised: 05/24/2018] [Accepted: 07/08/2018] [Indexed: 01/03/2023]
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Knox J, Pedoia V, Wang A, Tanaka M, Joseph GB, Neumann J, Link TM, Li X, Ma CB. Longitudinal changes in MR T1ρ/T2 signal of meniscus and its association with cartilage T1p/T2 in ACL-injured patients. Osteoarthritis Cartilage 2018; 26:689-96. [PMID: 29438746 DOI: 10.1016/j.joca.2018.02.001] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/10/2017] [Revised: 01/30/2018] [Accepted: 02/05/2018] [Indexed: 02/07/2023]
Abstract
OBJECTIVE To evaluate the longitudinal changes in meniscal T1ρ/T2 signal post-reconstruction in patients with acute anterior cruciate ligament (ACL) injury and to investigate the association with T1ρ/T2 signal in articular knee cartilage. METHOD In this prospective study, knees of 37 patients with ACL-injury and reconstruction in addition to 13 healthy controls were scanned using magnetic resonance imaging (MRI) T1ρ/T2 mapping. Quantitative analysis of the meniscus was performed in the anterior/posterior horns of lateral/medial meniscus fourteen sub-compartments of cartilage spanning the medial/lateral area of the tibia and femoral condyles. Meniscus T1ρ/T2 signals were compared between injured, contralateral and control knees at baseline, 6-months, 1-year and 2-years using t-tests for cross-sectional comparisons and a mixed model for longitudinal comparisons. Pearson-partial correlations between meniscal and cartilage T1ρ/T2 were evaluated. RESULTS There was a significant decrease of T1ρ/T2 signal in the posterior horn of lateral meniscus (PHLAT) of injured knees during a 2-year period. In the posterior horn of medial meniscus (PHMED), T1ρ/T2 signal of injured knees was significantly elevated at all time points post-reconstruction compared to contralateral and control knees. Within injured knees, PHMED T1ρ/T2 signal showed significant positive correlations with medial tibia (MT) cartilage T1ρ/T2 signal at all time points. CONCLUSION A significant decrease in PHLAT T1ρ/T2 signal by 2-years suggests potential tissue recovery after ACL-injury. Elevated T1ρ/T2 signal in the PHMED of injured knees at 2-years correlating with knee cartilage T1ρ/T2 signal elevations suggests involvement of the PHMED in subacute cartilage degeneration after ACL-injury and reconstruction.
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Kajabi AW, Casula V, Nissi MJ, Peuna A, Podlipská J, Lammentausta E, Saarakkala S, Guermazi A, Nieminen MT. Assessment of meniscus with adiabatic T 1ρ and T 2ρ relaxation time in asymptomatic subjects and patients with mild osteoarthritis: a feasibility study. Osteoarthritis Cartilage 2018; 26:580-587. [PMID: 29269326 DOI: 10.1016/j.joca.2017.12.006] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/03/2017] [Revised: 11/23/2017] [Accepted: 12/08/2017] [Indexed: 02/02/2023]
Abstract
OBJECTIVE To investigate the ability of magnetic resonance imaging (MRI) adiabatic relaxation times in the rotating frame (adiabatic T1ρ and T2ρ) to detect structural alterations in meniscus tissue of mild OA patients and asymptomatic volunteers. METHOD MR images of 24 subjects (age range: 50-67 years, 12 male), including 12 patients with mild osteoarthritis (OA) (Kellgren-Lawrence (KL) = 1, 2) and 12 asymptomatic volunteers, were acquired using a 3 T clinical MRI system. Morphological assessment was performed using semiquantitative MRI OA Knee Score (MOAKS). Adiabatic T1ρ and T2ρ (AdT1ρ, AdT2ρ) relaxation time maps were calculated in regions of interest (ROIs) containing medial and lateral horns of menisci. The median relaxation time values of the ROIs were compared between subjects classified based on radiographic findings and MOAKS evaluations. RESULTS MOAKS assessment of patients and volunteers indicated the presence of meniscal and cartilage lesions in both groups. For the combined cohort group, prolonged AdT1ρ was observed in the posterior horn of the medial meniscus (PHMED) in subjects with MOAKS meniscal tear (P < 0.05). AdT2ρ was statistically significantly longer in PHMED of subjects with MOAKS full-thickness cartilage loss (P < 0.05). After adjusting for multiple comparisons, differences in medians of observed AdT1ρ and AdT2ρ values between mild OA patients and asymptomatic volunteers did not reach statistical significance. CONCLUSION AdT1ρ and AdT2ρ measurements have the potential to identify changes in structural composition of meniscus tissue associated with meniscal tear and cartilage loss in a cohort group of mild OA patients and asymptomatic volunteers.
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Affiliation(s)
- A W Kajabi
- Research Unit of Medical Imaging, Physics and Technology, University of Oulu, Oulu, Finland; Medical Research Center Oulu, University of Oulu and Oulu University Hospital, Oulu, Finland.
| | - V Casula
- Research Unit of Medical Imaging, Physics and Technology, University of Oulu, Oulu, Finland; Medical Research Center Oulu, University of Oulu and Oulu University Hospital, Oulu, Finland.
| | - M J Nissi
- Department of Applied Physics, University of Eastern Finland, Kuopio, Finland.
| | - A Peuna
- Research Unit of Medical Imaging, Physics and Technology, University of Oulu, Oulu, Finland; Department of Diagnostic Radiology, Oulu University Hospital, Oulu, Finland.
| | - J Podlipská
- Research Unit of Medical Imaging, Physics and Technology, University of Oulu, Oulu, Finland; Infotech Oulu, University of Oulu, Oulu, Finland.
| | - E Lammentausta
- Research Unit of Medical Imaging, Physics and Technology, University of Oulu, Oulu, Finland; Department of Diagnostic Radiology, Oulu University Hospital, Oulu, Finland.
| | - S Saarakkala
- Research Unit of Medical Imaging, Physics and Technology, University of Oulu, Oulu, Finland; Medical Research Center Oulu, University of Oulu and Oulu University Hospital, Oulu, Finland; Department of Diagnostic Radiology, Oulu University Hospital, Oulu, Finland.
| | - A Guermazi
- Department of Radiology, Boston University School of Medicine, Boston, MA, USA.
| | - M T Nieminen
- Research Unit of Medical Imaging, Physics and Technology, University of Oulu, Oulu, Finland; Medical Research Center Oulu, University of Oulu and Oulu University Hospital, Oulu, Finland; Department of Diagnostic Radiology, Oulu University Hospital, Oulu, Finland.
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Pietrosimone B, Nissman D, Padua DA, Blackburn JT, Harkey MS, Creighton RA, Kamath GM, Healy K, Schmitz R, Driban JB, Marshall SW, Jordan JM, Spang JT. Associations between cartilage proteoglycan density and patient outcomes 12months following anterior cruciate ligament reconstruction. Knee 2018; 25:118-29. [PMID: 29329888 DOI: 10.1016/j.knee.2017.10.005] [Citation(s) in RCA: 26] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/01/2017] [Revised: 09/10/2017] [Accepted: 10/22/2017] [Indexed: 02/02/2023]
Abstract
BACKGROUND Lower proteoglycan density (PGD) of the articular cartilage may be an early marker of osteoarthritis following anterior cruciate ligament (ACL) reconstruction (ACL-R). The purpose this study was to determine associations between the Knee Injury and Osteoarthritis Outcomes Score (KOOS) and PGD of the articular cartilage in the femur and tibia 12-months following ACL-R. METHODS We evaluated KOOS pain, symptoms, function in activities of daily living (ADL), function in sport and recreation (Sport), and quality of life (QOL), as well as PGD using T1rho magnetic resonance imaging in 18 individuals 12.50±0.70months (these are all mean±standard deviation) following unilateral ACL-R (10 females, eight males; 22.39±4.19years; Marx Score=10.93±3.33). Medial and lateral load-bearing portions of the femoral and tibial condyles were sectioned into three (anterior, central and posterior) regions of interest (ROIs). T1rho relaxation times in the ACL-R knee were normalized to the same regions of interest in the non-surgical knees. Alpha levels were set at P≤0.05. RESULTS Worse KOOS outcomes were significantly associated with greater T1rho relaxation time ratios in the posterior-lateral femoral condyle [pain (r=-0.54), ADL (r=-0.56), Sport (r=-0.62) and QOL (r=-0.59)] central-lateral femoral condyle [Sport (r=-0.48) and QOL (r=-0.42)], and the anterior-medial femoral condyle [Sport (r=-0.46) and QOL (r=-0.40)]. There were no significant associations between the KOOS and T1rho outcomes for tibial ROI. CONCLUSIONS Lower PGD of the femoral cartilage in the ACL-R knees was associated with worse patient-reported outcomes.
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Ma YJ, Carl M, Shao H, Tadros AS, Chang EY, Du J. Three-dimensional ultrashort echo time cones T 1ρ (3D UTE-cones-T 1ρ ) imaging. NMR Biomed 2017; 30:10.1002/nbm.3709. [PMID: 28318066 PMCID: PMC5505275 DOI: 10.1002/nbm.3709] [Citation(s) in RCA: 31] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/19/2016] [Revised: 01/19/2017] [Accepted: 01/21/2017] [Indexed: 05/18/2023]
Abstract
We report a novel three-dimensional (3D) ultrashort echo time (UTE) sequence employing Cones trajectory and T1ρ preparation (UTE-Cones-T1ρ ) for quantitative T1ρ assessment of short T2 tissues in the musculoskeletal system. A basic 3D UTE-Cones sequence was combined with a spin-locking preparation pulse for T1ρ contrast. A relatively short TR was used to decrease the scan time, which required T1 measurement and compensation using 3D UTE-Cones data acquisitions with variable TRs. Another strategy to reduce the total scan time was to acquire multiple Cones spokes (Nsp ) after each T1ρ preparation and fat saturation. Four spin-locking times (TSL = 0-20 ms) were acquired over 12 min, plus another 7 min for T1 measurement. The 3D UTE-Cones-T1ρ sequence was compared with a two-dimensional (2D) spiral-T1ρ sequence for the imaging of a spherical CuSO4 phantom and ex vivo meniscus and tendon specimens, as well as the knee and ankle joints of healthy volunteers, using a clinical 3-T scanner. The CuSO4 phantom showed a T1ρ value of 76.5 ± 1.6 ms with the 2D spiral-T1ρ sequence, as well as 85.7 ± 3.6 and 89.2 ± 1.4 ms for the 3D UTE-Cones-T1ρ sequences with Nsp of 1 and 5, respectively. The 3D UTE-Cones-T1ρ sequence provided shorter T1ρ values for the bovine meniscus sample relative to the 2D spiral-T1ρ sequence (10-12 ms versus 16 ms, respectively). The cadaveric human Achilles tendon sample could only be imaged with the 3D UTE-Cones-T1ρ sequence (T1ρ = 4.0 ± 0.9 ms), with the 2D spiral-T1ρ sequence demonstrating near-zero signal intensity. Human studies yielded T1ρ values of 36.1 ± 2.9, 18.3 ± 3.9 and 3.1 ± 0.4 ms for articular cartilage, meniscus and the Achilles tendon, respectively. The 3D UTE-Cones-T1ρ sequence allows volumetric T1ρ measurement of short T2 tissues in vivo.
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Affiliation(s)
- Ya-jun Ma
- Department of Radiology, University of California, San Diego, San Diego, CA
| | | | - Hongda Shao
- Department of Radiology, University of California, San Diego, San Diego, CA
- Department of Radiology, Shanghai Tenth People’s Hospital, Tongji University School of Medicine, Shanghai, China
| | - Anthony S. Tadros
- Department of Radiology, University of California, San Diego, San Diego, CA
| | - Eric Y. Chang
- Department of Radiology, University of California, San Diego, San Diego, CA
- Radiology Service, VA San Diego Healthcare System, San Diego, CA
| | - Jiang Du
- Department of Radiology, University of California, San Diego, San Diego, CA
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Takao S, Nguyen TB, Yu HJ, Hagiwara S, Kaneko Y, Nozaki T, Iwamoto S, Otomo M, Schwarzkopf R, Yoshioka H. T1rho and T2 relaxation times of the normal adult knee meniscus at 3T: analysis of zonal differences. BMC Musculoskelet Disord 2017; 18:202. [PMID: 28521823 PMCID: PMC5437607 DOI: 10.1186/s12891-017-1560-y] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/11/2017] [Accepted: 05/09/2017] [Indexed: 12/03/2022] Open
Abstract
Background Prior studies describe histological and immunohistochemical differences in collagen and proteoglycan content in different meniscal zones. The aim of this study is to evaluate horizontal and vertical zonal differentiation of T1rho and T2 relaxation times of the entire meniscus from volunteers without symptom and imaging abnormality. Methods Twenty volunteers age between 19 and 38 who have no knee-related clinical symptoms, and no history of prior knee surgeries were enrolled in this study. Two T1rho mapping (b-FFE T1rho and SPGR T1rho) and T2 mapping images were acquired with a 3.0-T MR scanner. Each meniscus was divided manually into superficial and deep zones for horizontal zonal analysis. The anterior and posterior horns of each meniscus were divided manually into white, red-white and red zones for vertical zonal analysis. Zonal differences of average relaxation times among each zone, and both inter- and intra-observer reproducibility were statistically analyzed. Results In horizontal zonal analysis, T1rho relaxation times of the superficial zone tended to be higher than those of the deep zone, and this difference was statistically significant in the medial meniscal segments (84.3 ms vs 76.0 ms on b-FFE, p < 0.0001 and 96.5 ms vs 91.7 ms on SPGR, p = 0.004). In vertical zonal analysis, T1rho relaxation times of the white zone tended to be higher than those of the red zone, and this difference was statistically significant in the posterior horn of the medical meniscus (88.4 ms vs 77.1 ms on b-FFE, p < 0.001 and 104.9 ms vs 96.8 ms on SPGR, p =0.001). Likewise, T2 relaxation times of the superficial zone were significantly higher than those of the deep zone (80.4 ms vs 74.4 ms in the medial meniscus, p = 0.011). T2 relaxation times of the white zone were significantly higher than those of the red zone in the medial meniscus posterior horn (96.8 ms vs 84.3 ms, p < 0.001) and lateral meniscus anterior horn (104.6 ms vs 84.2 ms, p < 0.0001). Inter-class and intra-class correlation coefficients were excellent (>0.74) or good (0.60–0.74) in all meniscal segments on both horizontal and vertical zonal analysis, except for inter-class correlation coefficients of the lateral meniscus on SPGR. Compared with SPGR T1rho images, b-FFE T1rho images demonstrated more significant zonal differentiation with higher inter- and intra-observer reproducibility. Conclusions There are zonal differences in T1rho and T2 relaxation times of the normal meniscus.
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Affiliation(s)
- Shoichiro Takao
- Department of Radiological Sciences, University of California, Irvine, 101 The City Drive South, Rt. 140, Orange, CA, 92868, USA.,Department of Diagnostic Radiology, Graduate School of Health Sciences, Tokushima University, 3-18-15, Kuramoto-Cho, Tokushima City, 770-8509, Tokushima, Japan
| | - Tan B Nguyen
- Department of Radiological Sciences, University of California, Irvine, 101 The City Drive South, Rt. 140, Orange, CA, 92868, USA
| | - Hon J Yu
- Department of Radiological Sciences, University of California, Irvine, 101 The City Drive South, Rt. 140, Orange, CA, 92868, USA
| | - Shigeo Hagiwara
- Department of Radiological Sciences, University of California, Irvine, 101 The City Drive South, Rt. 140, Orange, CA, 92868, USA
| | - Yasuhito Kaneko
- Department of Radiological Sciences, University of California, Irvine, 101 The City Drive South, Rt. 140, Orange, CA, 92868, USA
| | - Taiki Nozaki
- Department of Radiological Sciences, University of California, Irvine, 101 The City Drive South, Rt. 140, Orange, CA, 92868, USA
| | - Seiji Iwamoto
- Department of Radiology, Tokushima University Hospital, 3-18-15, Kuramoto-Cho, Tokushima City, 770-8509, Tokushima, Japan
| | - Maki Otomo
- Department of Radiology, Tokushima University Hospital, 3-18-15, Kuramoto-Cho, Tokushima City, 770-8509, Tokushima, Japan
| | - Ran Schwarzkopf
- Department of Orthopaedic Surgery, University of California, Irvine, 101 The City Drive South, Orange, 92868, CA, USA
| | - Hiroshi Yoshioka
- Department of Radiological Sciences, University of California, Irvine, 101 The City Drive South, Rt. 140, Orange, CA, 92868, USA.
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Sasho T, Katsuragi J, Yamaguchi S, Haneishi H, Aizimu T, Tanaka T, Watanabe A, Sato Y, Akagi R, Matsumoto K, Uno T, Motoori K. Associations of three-dimensional T1 rho MR mapping and three-dimensional T2 mapping with macroscopic and histologic grading as a biomarker for early articular degeneration of knee cartilage. Clin Rheumatol 2017; 36:2109-19. [DOI: 10.1007/s10067-017-3645-2] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2017] [Revised: 03/29/2017] [Accepted: 04/18/2017] [Indexed: 12/18/2022]
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Abstract
Cartilage loss is irreversible, and to date, no effective pharmacotherapies are available to protect or regenerate cartilage. Quantitative prestructural/compositional MR imaging techniques have been developed to characterize the cartilage matrix quality at a stage where abnormal findings are early and potentially reversible, allowing intervention to halt disease progression. The goal of this article is to critically review currently available technologies, present the basic concept behind these techniques, but also to investigate their suitability as imaging biomarkers including their validity, reproducibility, risk prediction and monitoring of therapy. Moreover, we highlighted important clinical applications. This review article focuses on the currently most relevant and clinically applicable technologies, such as T2 mapping, T2*, T1ρ, delayed gadolinium enhanced MRI of cartilage (dGEMRIC), sodium imaging and glycosaminoglycan chemical exchange saturation transfer (gagCEST). To date, most information is available for T2 and T1ρ mapping. dGEMRIC has also been used in multiple clinical studies, although it requires Gd contrast administration. Sodium imaging and gagCEST are promising technologies but are dependent on high field strength and sophisticated software and hardware. LEVEL OF EVIDENCE 5 J. Magn. Reson. Imaging 2017;45:949-965.
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Affiliation(s)
- Thomas M Link
- Department of Radiology and Biomedical Imaging, University of California at San Francisco, San Francisco, California, USA
| | - Jan Neumann
- Department of Radiology and Biomedical Imaging, University of California at San Francisco, San Francisco, California, USA
| | - Xiaojuan Li
- Department of Radiology and Biomedical Imaging, University of California at San Francisco, San Francisco, California, USA
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Nebelung S, Tingart M, Pufe T, Kuhl C, Jahr H, Truhn D. Ex vivo quantitative multiparametric MRI mapping of human meniscus degeneration. Skeletal Radiol 2016; 45:1649-60. [PMID: 27639388 DOI: 10.1007/s00256-016-2480-x] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/06/2016] [Revised: 08/30/2016] [Accepted: 09/01/2016] [Indexed: 02/02/2023]
Abstract
OBJECTIVES To evaluate the diagnostic performance of T1, T1ρ, T2, T2*, and UTE-T2* (ultrashort-echo time-enhanced T2*) mapping in the refined graduation of human meniscus degeneration with histology serving as standard-of-reference. MATERIALS AND METHODS This IRB-approved intra-individual comparative ex vivo study was performed on 24 lateral meniscus body samples obtained from 24 patients undergoing total knee replacement. Samples were assessed on a 3.0-T MRI scanner using inversion-recovery (T1), spin-lock multi-gradient-echo (T1ρ), multi-spin-echo (T2) and multi-gradient-echo (T2* and UTE-T2*) sequences to determine relaxation times of quantitative MRI (qMRI) parameters. Relaxation times were calculated on the respective maps, averaged to the entire meniscus and to its zones. Histologically, samples were analyzed on a four-point score according to Williams (0-III). QMRI results and Williams (sub)scores were correlated using Spearman's ρ, while Williams grade-dependent differences were assessed using Kruskal-Wallis and Dunn's tests. Sensitivities and specificities in the detection of intact (Williams grade [WG]-0) and severely degenerate meniscus (WG-II-III) were calculated. RESULTS Except for T2*, significant increases in qMRI parameters with increasing Williams grades were observed. T1, T1ρ, T2, and UTE-T2* exhibited high sensitivity and variable specificity rates. Significant marked-to-strong correlations were observed for these parameters with each other, with histological WGs and the subscores tissue integrity and cellularity. CONCLUSIONS QMRI mapping holds promise in the objective evaluation of human meniscus. Although sufficient discriminatory power of T1, T1ρ, T2, and UTE-T2* was only demonstrated for the histological extremes, these data may aid in the future MRI-based parameterization and quantification of human meniscus degeneration.
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Behzadi C, Welsch GH, Laqmani A, Henes FO, Kaul MG, Schoen G, Adam G, Regier M. Comparison of T2* relaxation times of articular cartilage of the knee in elite professional football players and age-and BMI-matched amateur athletes. Eur J Radiol 2016; 86:105-111. [PMID: 28027735 DOI: 10.1016/j.ejrad.2016.10.028] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2016] [Revised: 09/26/2016] [Accepted: 10/26/2016] [Indexed: 11/15/2022]
Abstract
OBJECTIVE Recent investigation has underlined the potential of quantitative MR imaging to be used as a complementary tool for the diagnosis of cartilage degeneration at an early state. The presented study analyses T2* relaxation times of articular cartilage of the knee in professional athletes and compares the results to age- and BMI (Body Mass Index)-matched healthy amateur athletes. MATERIALS AND METHODS 22 professional football players and 22 age- and BMI-matched individuals were underwent knee Magnetic Resonance Imaging (MRI) at 3T including qualitative and quantitative analysis. Qualitative analysis included e.g. meniscal tears, joint effusion and bone edema. For quantitative analysis T2* (22 ET: 4.6-53.6ms) measurements in 3D data acquisition were performed. Deep and superficial layers of 22 predefined cartilage segments were analysed. All data sets were postprocessed using a dedicated software tool. Statistical analysis included Student t-test, confidence intervals and a random effects model. RESULTS In both groups, T2* relaxation times were significantly higher in the superficial compared to the deep layers (p<0.001). Professional athletes had significantly higher relaxation times in eight superficial and three deep cartilage layers in the predefined cartilage segments (p<0.05). Highly significant differences were found in the weight-bearing segments of the lateral superficial femoral condyle (p<0.001). CONCLUSION Elevated T2* values in cartilage layers of professional football players compared to amateur athletes were noted. The effects seem to predominate in superficial cartilage layers.
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Affiliation(s)
- C Behzadi
- Department of Diagnostic and Interventional Radiology and Nuclearmedicine, University Medical Center Hamburg-Eppendorf, Hamburg, 20246, Germany.
| | - G H Welsch
- Department of Sports Medicine, University Medical Center Hamburg-Eppendorf, Hamburg, 20246, Germany
| | - A Laqmani
- Department of Diagnostic and Interventional Radiology and Nuclearmedicine, University Medical Center Hamburg-Eppendorf, Hamburg, 20246, Germany
| | - F O Henes
- Department of Diagnostic and Interventional Radiology and Nuclearmedicine, University Medical Center Hamburg-Eppendorf, Hamburg, 20246, Germany
| | - M G Kaul
- Department of Diagnostic and Interventional Radiology and Nuclearmedicine, University Medical Center Hamburg-Eppendorf, Hamburg, 20246, Germany
| | - G Schoen
- Department of Medical Biometry and Epidemiology, University Medical Center, Hamburg-Eppendorf, Hamburg, 20246, Germany
| | - G Adam
- Department of Diagnostic and Interventional Radiology and Nuclearmedicine, University Medical Center Hamburg-Eppendorf, Hamburg, 20246, Germany
| | - M Regier
- Department of Diagnostic and Interventional Radiology and Nuclearmedicine, University Medical Center Hamburg-Eppendorf, Hamburg, 20246, Germany
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Abstract
The emergence of newer pharmacotherapeutic agents and surgical cartilage resurfacing techniques is driving the need for imaging modalities capable of early, accurate, and reproducible lesion detection. Magnetic resonance imaging (MRI) has emerged as a noninvasive tool for direct 2-dimensional (2D) and 3-dimensional (3D) assessment of the articular cartilage in both clinical and research settings. MRI has largely overcome the shortcomings of the current gold standard, radiography, by allowing for the detection of preclinical disease and subtle early abnormalities prior to the onset of radiographic disease, when damage is still reversible. Current MRI techniques are either morphological (2D/3D qualitative and quantitative techniques) or compositional (matrix-assessment techniques that detect macromolecular changes prior to morphological changes). MRI is evolving as a complete answer to our cartilage-imaging requirements of lesion description, treatment planning, and outcome measurement as well as in various research settings.
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Affiliation(s)
- Shaafiya Ashraf
- Government Medical College, Srinagar, Jammu and Kashmir, India
| | - Adnan Zahoor
- Government Medical College, Srinagar, Jammu and Kashmir, India.,Government Bone and Joint Hospital, Srinagar, Jammu and Kashmir, India
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Snoj Ž, Zupanc O, Salapura V. Retrospective quantitative cartilage and semi-quantitative morphological evaluation at 6 years after ACL reconstruction. Arch Orthop Trauma Surg 2016; 136:967-74. [PMID: 27139184 DOI: 10.1007/s00402-016-2463-3] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/03/2016] [Indexed: 10/21/2022]
Abstract
UNLABELLED Purpose We analyzed anterior cruciate ligament reconstruction (ACLR) patients in order to evaluate degenerative changes and the effect of meniscal insufficiency at mid-term follow-up. METHODS Sixty subjects (40 patients at 5.9 years after ACLR, 20 healthy controls) underwent 3T MRI. Quantitative cartilage T2 mapping and morphological Whole Organ Magnetic Resonance Imaging Score (WORMS) evaluation were performed. Self-reported questionnaires were used for subjective clinical evaluation. Based on the meniscal status at ACLR, further subdivision within each compartment (lateral and medial) was made: menisci intact and menisci insufficient. RESULTS The ACLR subjects showed significantly elevated T2 values and higher WORMS scores compared to the control group. T2 values of the anterior lateral femoral subcompartment were significantly higher in menisci insufficient group compared to the control group. In both compartments significantly higher WORMS scores were observed in the menisci insufficient group compared to the menisci intact group. CONCLUSIONS ACLR knees exhibit cartilage matrix and morphological degeneration at mid-term follow-up. Lateral meniscal insufficiency noted at ACLR presents a higher risk of developing degenerative changes than does the medial meniscus insufficiency; however, this difference may not be detected clinically.
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Wang A, Pedoia V, Su F, Abramson E, Kretzschmar M, Nardo L, Link TM, McCulloch CE, Jin C, Ma CB, Li X. MR T1ρ and T2 of meniscus after acute anterior cruciate ligament injuries. Osteoarthritis Cartilage 2016; 24:631-9. [PMID: 26620091 PMCID: PMC4799742 DOI: 10.1016/j.joca.2015.11.012] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/04/2015] [Revised: 10/22/2015] [Accepted: 11/17/2015] [Indexed: 02/02/2023]
Abstract
OBJECTIVE To evaluate differences in meniscal T1ρ and T2 quantification in patients with acute anterior cruciate ligament (ACL) injuries and to determine correlations of these differences with MR morphological grading and patient-reported outcomes. DESIGN Bilateral knees of 52 patients with acute ACL injury and 20 healthy controls were scanned using 3 T magnetic resonance imaging (MRI) T1ρ and T2 mapping in this prospective study. Quantitative analysis of the meniscus was performed in anterior and posterior horns of the lateral and medial menisci. Morphological meniscal damage was assessed using modified whole-organ MRI scores (WORMS). Measurements were compared between injured, uninjured contralateral, and control knees using a mixed-effects regression model. Correlations between meniscal T1ρ/T2, WORMS and Knee Injury and Osteoarthritis Outcome Scores (KOOS) were examined using partial correlation analysis. RESULTS Mean meniscal T1ρ and T2 values were significantly higher in ACL-injured knees compared to control and contralateral knees. Menisci of ACL-injured knees without tears, including those limited to modified meniscal WORMS grade 0, also had significantly higher T1ρ and T2 values compared to menisci of uninjured knees. Within ACL-injured knees, T1ρ and T2 values showed significant positive associations with meniscal WORMS and significant negative associations with KOOS. CONCLUSION Acute ACL injuries are associated with significantly increased meniscal T1ρ and T2 values in both patients with and without meniscal lesions or tears, suggesting quantitative MRI provides more sensitive measures of meniscal differences compared to traditional morphological MRI sequences. Correlation between meniscal T1ρ/T2 and KOOS suggest that quantitative MRI is reflective of the extent of patients' clinical symptoms.
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Affiliation(s)
- Amy Wang
- Department of Radiology and Biomedical Imaging, University of California, San Francisco
| | - Valentina Pedoia
- Department of Radiology and Biomedical Imaging, University of California, San Francisco
| | - Favian Su
- Department of Radiology and Biomedical Imaging, University of California, San Francisco
| | - Elijah Abramson
- Department of Radiology and Biomedical Imaging, University of California, San Francisco
| | - Martin Kretzschmar
- Department of Radiology and Biomedical Imaging, University of California, San Francisco
| | - Lorenzo Nardo
- Department of Radiology and Biomedical Imaging, University of California, San Francisco
| | - Thomas M. Link
- Department of Radiology and Biomedical Imaging, University of California, San Francisco
| | - Charles E. McCulloch
- Department of Epidemiology and Biostatistics, University of California, San Francisco
| | - Chengshi Jin
- Department of Epidemiology and Biostatistics, University of California, San Francisco
| | - C. Benjamin Ma
- Department of Orthopaedic Surgery, University of California, San Francisco
| | - Xiaojuan Li
- Department of Radiology and Biomedical Imaging, University of California, San Francisco
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Wang L, Nissi MJ, Tóth F, Shaver J, Johnson CP, Zhang J, Garwood M, Carlson CS, Ellermann JM. Multiparametric MRI of Epiphyseal Cartilage Necrosis (Osteochondrosis) with Histological Validation in a Goat Model. PLoS One 2015; 10:e0140400. [PMID: 26473611 DOI: 10.1371/journal.pone.0140400] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2015] [Accepted: 09/24/2015] [Indexed: 11/19/2022] Open
Abstract
PURPOSE To evaluate multiple MRI parameters in a surgical model of osteochondrosis (OC) in goats. METHODS Focal ischemic lesions of two different sizes were induced in the epiphyseal cartilage of the medial femoral condyles of goats at 4 days of age by surgical transection of cartilage canal blood vessels. Goats were euthanized and specimens harvested 3, 4, 5, 6, 9 and 10 weeks post-op. Ex vivo MRI scans were conducted at 9.4 Tesla for mapping the T1, T2, T1ρ, adiabatic T1ρ and TRAFF relaxation times of articular cartilage, unaffected epiphyseal cartilage, and epiphyseal cartilage within the area of the induced lesion. After MRI scans, safranin O staining was conducted to validate areas of ischemic necrosis induced in the medial femoral condyles of six goats, and to allow comparison of MRI findings with the semi-quantitative proteoglycan assessment in corresponding safranin O-stained histological sections. RESULTS All relaxation time constants differentiated normal epiphyseal cartilage from lesions of ischemic cartilage necrosis, and the histological staining results confirmed the proteoglycan (PG) loss in the areas of ischemia. In the scanned specimens, all of the measured relaxation time constants were higher in the articular than in the normal epiphyseal cartilage, consistently allowing differentiation between these two tissues. CONCLUSIONS Multiparametric MRI provided a sensitive approach to discriminate between necrotic and viable epiphyseal cartilage and between articular and epiphyseal cartilage, which may be useful for diagnosing and monitoring OC lesions and, potentially, for assessing effectiveness of treatment interventions.
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Guermazi A, Alizai H, Crema MD, Trattnig S, Regatte RR, Roemer FW. Compositional MRI techniques for evaluation of cartilage degeneration in osteoarthritis. Osteoarthritis Cartilage 2015; 23:1639-53. [PMID: 26050864 DOI: 10.1016/j.joca.2015.05.026] [Citation(s) in RCA: 155] [Impact Index Per Article: 17.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/11/2014] [Revised: 04/26/2015] [Accepted: 05/25/2015] [Indexed: 02/02/2023]
Abstract
Osteoarthritis (OA), a leading cause of disability, affects 27 million people in the United States and its prevalence is rising along with the rise in obesity. So far, biomechanical or behavioral interventions as well as attempts to develop disease-modifying OA drugs have been unsuccessful. This may be partly due to antiquated imaging outcome measures such as radiography, which are still endorsed by regulatory agencies such as the United States Food and Drug Administration (FDA) for use in clinical trials. Morphological magnetic resonance imaging (MRI) allows unparalleled multi-feature assessment of the OA joint. Furthermore, advanced MRI techniques also enable evaluation of the biochemical or ultrastructural composition of articular cartilage relevant to OA research. These compositional MRI techniques have the potential to supplement clinical MRI sequences in identifying cartilage degeneration at an earlier stage than is possible today using morphologic sequences only. The purpose of this narrative review is to describe compositional MRI techniques for cartilage evaluation, which include T2 mapping, T2* Mapping, T1 rho, dGEMRIC, gagCEST, sodium imaging and diffusion weighted imaging (DWI). We also reviewed relevant clinical studies that have utilized these techniques for the study of OA. The different techniques are complementary. Some focus on isotropy or the collagen network (e.g., T2 mapping) and others are more specific in regard to tissue composition, e.g., gagCEST or dGEMRIC that convey information on the GAG concentration. The application and feasibility of these techniques is also discussed, as they will play an important role in implementation in larger clinical trials and eventually clinical practice.
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Affiliation(s)
- A Guermazi
- Department of Radiology, Boston University School of Medicine, Boston, MA, USA; Department of Research, Aspetar Orthopaedic and Sports Medicine Hospital, Doha, Qatar.
| | - H Alizai
- Department of Radiology, University of Texas Health Science Center at San Antonio, San Antonio, TX, USA; Department of Radiology, New York University Langone Medical Center, New York, NY, USA
| | - M D Crema
- Department of Radiology, Boston University School of Medicine, Boston, MA, USA; Department of Research, Aspetar Orthopaedic and Sports Medicine Hospital, Doha, Qatar; Department of Radiology, Hospital do Coração and Teleimagem, São Paulo, Brazil
| | - S Trattnig
- Department of Biomedical Imaging and Image Guided Therapy, Medical University of Vienna, Vienna, Austria
| | - R R Regatte
- Department of Radiology, New York University Langone Medical Center, New York, NY, USA
| | - F W Roemer
- Department of Radiology, Boston University School of Medicine, Boston, MA, USA; Department of Research, Aspetar Orthopaedic and Sports Medicine Hospital, Doha, Qatar; Department of Radiology, University of Erlangen, Erlangen, Germany
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Okazaki K, Takayama Y, Osaki K, Matsuo Y, Mizu-Uchi H, Hamai S, Honda H, Iwamoto Y. Subclinical cartilage degeneration in young athletes with posterior cruciate ligament injuries detected with T1ρ magnetic resonance imaging mapping. Knee Surg Sports Traumatol Arthrosc 2015; 23:3094-100. [PMID: 25481808 DOI: 10.1007/s00167-014-3469-4] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/10/2014] [Accepted: 12/01/2014] [Indexed: 01/11/2023]
Abstract
PURPOSE Prediction of the risk of osteoarthritis in asymptomatic active patients with an isolated injury of the posterior cruciate ligament (PCL) is difficult. T1ρ magnetic resonance imaging (MRI) enables the quantification of the proteoglycan content in the articular cartilage. The purpose of this study was to evaluate subclinical cartilage degeneration in asymptomatic young athletes with chronic PCL deficiency using T1ρ MRI. METHODS Six athletes with chronic PCL deficiency (median age 17, range 14-36 years) and six subjects without any history of knee injury (median age 31.5, range 24-33 years) were recruited. Regions of interest were placed on the articular cartilage of the tibia and the distal and posterior areas of the femoral condyle, and T1ρ values were calculated. RESULTS On stress radiographs, the mean side-to-side difference in posterior laxity was 9.8 mm. The T1ρ values at the posterior area of the lateral femoral condyle and the superficial layer of the distal area of the medial and lateral femoral condyle of the patients were significantly increased compared with those of the normal controls (p < 0.05). At the tibial plateau, the T1ρ values in both the medial and lateral compartments were significantly higher in patients compared with those in the normal controls (p < 0.05). CONCLUSION T1ρ MRI detected unexpected cartilage degeneration in the well-functioning PCL-deficient knees of young athletes. One should be alert to the possibility of subclinical cartilage degeneration even in asymptomatic patients who show no degenerative changes on plain radiographs or conventional MRI. LEVEL OF EVIDENCE IV.
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Abstract
OBJECTIVE The aim of the study was to determine whether quantitative ultrashort echo time (UTE) -T1ρ magnetic resonance (MR) measurements are sensitive to proteoglycan degradation in human menisci by trypsin digestion. METHODS Conventional and quantitative UTE-T1ρ MR sequences were performed on 4 meniscal samples using a 3T scanner. Magnetic resonance imaging was performed before and after 4, 8, and 12 hours of trypsin solution immersion, inducing proteoglycan loss. One sample was used as a control. Digest solutions were analyzed for glycosaminoglycan (GAG) content. The UTE-T1ρ studies were analyzed for quantitative changes. RESULTS Images showed progressive tissue swelling, fiber disorganization, and increase in signal intensity after GAG depletion. The UTE-T1ρ values tended to increase with time after trypsin treatment (P = 0.06). Cumulative GAG loss into the bath showed a trend of increased values for trypsin-treated samples (P = 0.1). CONCLUSIONS Ultrashort echo time T1ρ measurements can noninvasively detect and quantify severity of meniscal degeneration, which has been correlated with progression of osteoarthritis.
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Affiliation(s)
- Eric Y. Chang
- Department of Radiology, VA San Diego Healthcare System, San Diego, CA 92161
- Department of Radiology, University of California, San Diego Medical Center, San Diego, CA 92103
| | - Juliana C. Campos
- Department of Radiology, University of California, San Diego Medical Center, San Diego, CA 92103
| | - Won C. Bae
- Department of Radiology, University of California, San Diego Medical Center, San Diego, CA 92103
| | - Richard Znamirowski
- Department of Radiology, University of California, San Diego Medical Center, San Diego, CA 92103
| | - Sheronda Statum
- Department of Radiology, University of California, San Diego Medical Center, San Diego, CA 92103
| | - Jiang Du
- Department of Radiology, University of California, San Diego Medical Center, San Diego, CA 92103
| | - Christine B. Chung
- Department of Radiology, VA San Diego Healthcare System, San Diego, CA 92161
- Department of Radiology, University of California, San Diego Medical Center, San Diego, CA 92103
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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] [What about the content of this article? (0)] [Affiliation(s)] [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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Osaki K, Okazaki K, Takayama Y, Matsubara H, Kuwashima U, Murakami K, Doi T, Matsuo Y, Honda H, Iwamoto Y. Characterization of Biochemical Cartilage Change After Anterior Cruciate Ligament Injury Using T1ρ Mapping Magnetic Resonance Imaging. Orthop J Sports Med 2015; 3:2325967115585092. [PMID: 26672435 PMCID: PMC4622352 DOI: 10.1177/2325967115585092] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/14/2023] Open
Abstract
BACKGROUND Patients with anterior cruciate ligament (ACL)-injured knees are at an increased risk of posttraumatic osteoarthritis (OA). OA changes secondary to ACL injuries have many variations, and when and where early cartilage degenerative change begins has not yet been established. PURPOSE To characterize the location of cartilage degeneration after ACL injury associated with time since injury using T1rho (T1ρ) mapping. STUDY DESIGN Cross-sectional study; Level of evidence, 3. METHODS In this study, 49 knees with ACL injuries and 14 normal knees from uninjured volunteers were imaged with a 3.0-T magnetic resonance scanner. Three regions of interest (ROIs) were defined in the cartilage at the weightbearing area of the femoral condyles (anterior, middle, and posterior zones). Two ROIs were defined in the tibial plateau (anterior and posterior zones). The T1ρ values within the ROIs were measured. Patients were allocated into 3 groups based on time since injury: <12 weeks (group A; 28 patients), 12 weeks to 2 years (group B; 14 patients), and >2 years to 5 years (group C; 7 patients). RESULTS Mean T1ρ values were significantly greater in the anterior and middle ROIs of the medial femoral condyle in group C compared with those in other groups (P < .05). Patients with medial meniscus injury, for whom the time since injury was ≥12 weeks, exhibited significantly greater T1ρ values in the middle areas of the medial femoral condyle versus normal knees and ACL-injured knees without medial meniscus injury. CONCLUSION The risk of cartilage degeneration in the area of the femoral condyle that contacts the tibia during small degrees of flexion increased when the time since injury was longer than 2 years. In addition, medial meniscus injury was associated with cartilage degeneration at the medial femoral condyle in the chronic phase. CLINICAL RELEVANCE Cartilage degeneration occurs more than 2 years after ACL injury and increases with medial meniscus injury. Early intervention may be desirable for meniscus injury.
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Affiliation(s)
- Kanji Osaki
- Department of Orthopaedic Surgery, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
| | - Ken Okazaki
- Department of Orthopaedic Surgery, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
- Ken Okazaki, MD, PhD, Department of Orthopaedic Surgery, Graduate School of Medical Sciences, Kyushu University. 3-1-1, Maidashi, Higashi-ku, Fukuoka, 812-8582 Japan ()
| | - Yukihisa Takayama
- Department of Clinical Radiology, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
| | - Hirokazu Matsubara
- Department of Orthopaedic Surgery, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
| | - Umito Kuwashima
- Department of Orthopaedic Surgery, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
| | - Koji Murakami
- Department of Orthopaedic Surgery, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
| | - Toshio Doi
- Department of Orthopaedic Surgery, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
| | - Yoshio Matsuo
- Department of Clinical Radiology, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
| | - Hiroshi Honda
- Department of Clinical Radiology, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
| | - Yukihide Iwamoto
- Department of Orthopaedic Surgery, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
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Li H, Chen S, Tao H, Chen S. Quantitative MRI T2 relaxation time evaluation of knee cartilage: comparison of meniscus-intact and -injured knees after anterior cruciate ligament reconstruction. Am J Sports Med 2015; 43:865-72. [PMID: 25589385 DOI: 10.1177/0363546514564151] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
BACKGROUND Associated meniscal injury is well recognized at anterior cruciate ligament (ACL) reconstruction, and it is a known risk factor for osteoarthritis. PURPOSE To evaluate and characterize the postoperative appearance of articular cartilage after different meniscal treatment in ACL-reconstructed knees using T2 relaxation time evaluation on MRI. STUDY DESIGN Cohort study; Level of evidence, 3. METHODS A total of 62 consecutive patients who under ACL reconstruction were recruited in this study, including 23 patients undergoing partial meniscectomy (MS group), 21 patients undergoing meniscal repair (MR group), and 18 patients with intact menisci (MI group) at time of surgery. Clinical evaluation, including subjective functional scores and physical examination, was performed on the same day as the MRI examination and at follow-up times ranging from 2 to 4.2 years. The MRI multiecho sagittal images were segmented to determine the T2 relaxation time value of each meniscus and articular cartilage plate. Differences in each measurement were compared among groups. RESULTS No patient had joint-line tenderness or reported pain or clicking on McMurray test or instability. There were also no statistically significant differences in functional scores or medial or lateral meniscus T2 values among the 3 groups (P > .05 for both). There was a significantly higher articular cartilage T2 value in the medial femorotibial articular cartilage for the MS group (P < .01) and the MR group (P < .05) compared with that of the MI group, while there was no significant difference in articular cartilage T2 value between the MS and MR groups (P > .05) in each articular cartilage plate. The medial tibial articular cartilage T2 value had a significant positive correlation with medial meniscus T2 value (r = 0.287; P = .024) CONCLUSION: This study demonstrates that knees with meniscectomy or meniscal repair had articular cartilage degeneration at 2 to 4 years postoperatively, with higher articular cartilage T2 relaxation time values compared with the knees with an intact meniscus.
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Affiliation(s)
- Hong Li
- Department of Sports Medicine, Huashan Hospital, Shanghai, People's Republic of China
| | - Shuang Chen
- Department of Radiology, Huashan Hospital, Shanghai, People's Republic of China
| | - Hongyue Tao
- Department of Radiology, Huashan Hospital, Shanghai, People's Republic of China
| | - Shiyi Chen
- Department of Sports Medicine, Huashan Hospital, Shanghai, People's Republic of China
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Sofu H, Yildirim T, Gürsu S, Issin A, Şahin V. Short-term effects of partial meniscectomy on the clinical results of anterior cruciate ligament reconstruction. Knee Surg Sports Traumatol Arthrosc 2015; 23:184-7. [PMID: 24682517 DOI: 10.1007/s00167-014-2960-2] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/23/2013] [Accepted: 03/19/2014] [Indexed: 10/25/2022]
Abstract
PURPOSE This study aims to analyse the short-term effects of partial meniscectomy on the clinical results of anterior cruciate ligament reconstruction surgery. METHODS Clinical outcomes of 19 patients who had partial medial meniscectomy and anterior cruciate ligament reconstruction during the same surgery (Group 1) were compared with the outcomes of 25 patients who had also reconstruction but did not have any meniscal lesion (Group 2). Median follow-up time was 29 months (range 12-67 months) in Group 1 and 27 months (range 12-70 months) in Group 2. Feeling of apprehension in sports activities, International Knee Documentation Committee (IKDC) score, KT-2000 Arthrometer(®) measurements and post-operative time to return to sports activity were the criteria for data analysis. RESULTS Eight patients (42%) in Group 1 and 5 patients (20%) in Group 2 stated feeling of apprehension in sports activities. IKDC score improved to A in 11 patients (58%) from Group 1, and 18 patients (72%) from Group 2. Mean anterior translation according to KT-2000 arthrometer measurements was 5.2 ± 1.3 mm in Group 1, and 4.6 ± 1.3 mm in Group 2. Post-operative time to return to sports activity was 8.5 ± 3.0 months in Group 1, and 6.5 ± 2.2 months in Group 2. CONCLUSION Partial meniscectomy for irreparable medial meniscal tears, applied during the same surgery with anterior cruciate ligament reconstruction, negatively affects the clinical outcomes in the short-term follow-up. This study may be a reference for long-term clinical trials and also future investigations of new methods in the treatment of similar cases. LEVEL OF EVIDENCE IV.
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Affiliation(s)
- Hakan Sofu
- Amasya Suluova State Hospital, Hürriyet Mahallesi Hastane Caddesi No: 16, Suluova, Amasya, Turkey,
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Abstract
Magnetic resonance imaging (MRI) offers the direct visualization of the human musculoskeletal (MSK) system, especially all diarthrodial tissues including cartilage, bone, menisci, ligaments, tendon, hip, synovium, etc. Conventional MRI techniques based on T1 - and T2 -weighted, proton density (PD) contrast are inconclusive in quantifying early biochemically degenerative changes in MSK system in general and articular cartilage in particular. In recent years, quantitative MR parameter mapping techniques have been used to quantify the biochemical changes in articular cartilage, with a special emphasis on evaluating joint injury, cartilage degeneration, and soft tissue repair. In this article we focus on cartilage biochemical composition, basic principles of T1ρ MRI, implementation of T1ρ pulse sequences, biochemical validation, and summarize the potential applications of the T1ρ MRI technique in MSK diseases including osteoarthritis (OA), anterior cruciate ligament (ACL) injury, and knee joint repair. Finally, we also review the potential advantages, challenges, and future prospects of T1ρ MRI for widespread clinical translation.
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Affiliation(s)
- Ligong Wang
- Collaborative Innovation Center of Radiation Medicine of Jiangsu Higher Education Institutions, Jiangsu Provincial Key Laboratory of Radiation Medicine and Protection, School of Radiation Medicine and Protection, Medical College of Soochow University, School for Radiological and Interdisciplinary Sciences (RAD-X), Soochow University, Suzhou, Jiangsu, China
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Subburaj K, Souza RB, Wyman BT, Le Graverand-Gastineau MPH, Li X, Link TM, Majumdar S. Changes in MR relaxation times of the meniscus with acute loading: an in vivo pilot study in knee osteoarthritis. J Magn Reson Imaging 2013; 41:536-43. [PMID: 24347310 DOI: 10.1002/jmri.24546] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2013] [Accepted: 11/22/2013] [Indexed: 11/09/2022] Open
Abstract
PURPOSE To prospectively evaluate changes in T1ρ and T2 relaxation times in the meniscal body with acute loading using MRI in osteoarthritic knees and to compare these findings with those of age-matched healthy controls. MATERIALS AND METHODS Female subjects above 40 years of age with (N1 = 20) and without osteoarthritis (OA) (N2 = 10) were imaged on a 3 Tesla MR scanner using a custom made loading device. MR images were acquired, with the knee flexed at 20°, with and without a compressive load of 50% of the subject's bodyweight. The subjects were categorized based on the radiographic evidence of OA. Three different zones (outer, middle, and inner) of meniscus body were defined (each occupying 1/3rd the width). After adjusting for age and body mass index in the general linear regression model, repeated measures analysis of variance was used to detect significant differences in T1ρ and T2 with and without loading. RESULTS In the unloaded condition, the average T1ρ and T2 times were elevated in the outer and middle zones of the medial meniscus in OA subjects compared with the controls. In the loaded condition, T1ρ and T2 times of the outer zone of the medial meniscus was significantly elevated in OA subjects compared with controls. Finally the change (from unloaded to loaded) was significantly higher in controls than OA subjects (15.1% versus 8.3%; P = 0.039 for ΔT1ρ , and 11.5% versus 6.9%, P = 0.049 for ΔT2 ). CONCLUSION These findings suggest that while the OA process appears to affect the relaxation times of all regions within the meniscus, it may affect some regions sooner or to a greater degree. Furthermore, the differences in the change in relaxation times between unloaded and loaded conditions may reveal evidence about load transmission failure of the outer zone of the medial meniscus in subjects with knee OA. It is possible that these metrics (ΔT1ρ and ΔT2 ) may be valuable as an early biomechanical biomarker, which could be used to predict load transmission to the underlying articular cartilage.
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Affiliation(s)
- Karupppasamy Subburaj
- Musculoskeletal and Quantitative Imaging Research Group Department of Radiology and Biomedical Imaging, University of California San Francisco, San Francisco, California, USA
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Ellermann J, Ling W, Nissi MJ, Arendt E, Carlson CS, Garwood M, Michaeli S, Mangia S. MRI rotating frame relaxation measurements for articular cartilage assessment. Magn Reson Imaging 2013; 31:1537-43. [PMID: 23993794 DOI: 10.1016/j.mri.2013.06.004] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2013] [Revised: 06/03/2013] [Accepted: 06/08/2013] [Indexed: 12/20/2022]
Abstract
In the present work we introduced two MRI rotating frame relaxation methods, namely adiabatic T1ρ and Relaxation Along a Fictitious Field (RAFF), along with an inversion-prepared Magnetization Transfer (MT) protocol for assessment of articular cartilage. Given the inherent sensitivity of rotating frame relaxation methods to slow molecular motions that are relevant in cartilage, we hypothesized that adiabatic T1ρ and RAFF would have higher sensitivity to articular cartilage degradation as compared to laboratory frame T2 and MT. To test this hypothesis, a proteoglycan depletion model was used. Relaxation time measurements were performed at 0 and 48h in 10 bovine patellar specimens, 5 of which were treated with trypsin and 5 untreated controls were stored under identical conditions in isotonic saline for 48h. Relaxation times measured at 48h were longer than those measured at 0h in both groups. The changes in T2 and MT relaxation times after 48h were approximately 3 times larger in the trypsin treated specimens as compared to the untreated group, whereas increases of adiabatic T1ρ and RAFF were 4 to 5 fold larger. Overall, these findings demonstrate a higher sensitivity of adiabatic T1ρ and RAFF to the trypsin-induced changes in bovine patellar cartilage as compared to the commonly used T2 and MT. Since adiabatic T1ρ and RAFF are advantageous for human applications as compared to standard continuous-wave T1ρ methods, adiabatic T1ρ and RAFF are promising tools for assessing cartilage degradation in clinical settings.
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Affiliation(s)
- Jutta Ellermann
- Center for Magnetic Resonance Research and Department of Radiology, University of Minnesota, Minneapolis, USA.
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Son M, Goodman SB, Chen W, Hargreaves B, Gold G, Levenston M. Regional variation in T1ρ and T2 times in osteoarthritic human menisci: correlation with mechanical properties and matrix composition. Osteoarthritis Cartilage 2013; 21:796-805. [PMID: 23499673 PMCID: PMC3909565 DOI: 10.1016/j.joca.2013.03.002] [Citation(s) in RCA: 46] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/30/2012] [Revised: 02/04/2013] [Accepted: 03/01/2013] [Indexed: 02/02/2023]
Abstract
OBJECTIVE Changes in T1ρ and T2 magnetic resonance relaxation times have been associated with articular cartilage degeneration, but similar relationships for meniscal tissue have not been extensively investigated. This work examined relationships between T1ρ and T2 measurements and biochemical and mechanical properties across regions of degenerate human menisci. DESIGN Average T1ρ and T2 relaxation times were determined for nine regions each of seven medial and 13 lateral menisci from 14 total knee replacement patients. Sulfated glycosaminoglycan (sGAG), collagen and water contents were measured for each region. Biomechanical measurements of equilibrium compressive, dynamic compressive and dynamic shear moduli were made for anterior, central and posterior regions. RESULTS T1ρ and T2 times showed similar regional patterns, with longer relaxation times in the (radially) middle region compared to the inner and outer regions. Pooled over all regions, T1ρ and T2 times showed strong correlations both with one another and with water content. Correlations with biochemical content varied depending on normalization to wet or dry mass, and both imaging parameters showed stronger correlations with collagen compared to sGAG content. Mechanical properties displayed moderate inverse correlations with increasing T1ρ and T2 times and water content. CONCLUSION Both T1ρ and T2 relaxation times correlated strongly with water content and moderately with mechanical properties in osteoarthritic menisci, but not as strongly with sGAG or collagen contents alone. While the ability of magnetic resonance imaging (MRI) to detect early osteoarthritic changes remains the subject of investigation, these results suggest that T1ρ and T2 relaxation times have limited ability to detect compositional variations in degenerate menisci.
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Affiliation(s)
- M. Son
- Department of Bioengineering, Stanford University, Stanford, CA
| | - S. B. Goodman
- Department of Bioengineering, Stanford University, Stanford, CA
- Department of Orthopaedic Surgery, Stanford University, Stanford, CA
| | - W. Chen
- GE Healthcare, Menlo Park, CA
| | | | - G.E. Gold
- Department of Bioengineering, Stanford University, Stanford, CA
- Department of Orthopaedic Surgery, Stanford University, Stanford, CA
- Department of Radiology, Stanford University, Stanford, CA
| | - M.E. Levenston
- Department of Bioengineering, Stanford University, Stanford, CA
- Department of Mechanical Engineering, Stanford University, Stanford, CA
- To whom correspondence should be addressed 233 Durand Building Stanford, CA 94305-4038 Ph: 650-723-9464 Fax: 650-725-1587
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Takayama Y, Hatakenaka M, Tsushima H, Okazaki K, Yoshiura T, Yonezawa M, Nishikawa K, Iwamoto Y, Honda H. T1ρ is superior to T2 mapping for the evaluation of articular cartilage denaturalization with osteoarthritis: Radiological–pathological correlation after total knee arthroplasty. Eur J Radiol 2013; 82:e192-8. [DOI: 10.1016/j.ejrad.2012.11.031] [Citation(s) in RCA: 34] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2012] [Revised: 10/13/2012] [Accepted: 11/20/2012] [Indexed: 12/22/2022]
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Souza RB, Feeley BT, Zarins ZA, Link TM, Li X, Majumdar S. T1rho MRI relaxation in knee OA subjects with varying sizes of cartilage lesions. Knee 2013; 20:113-9. [PMID: 23159719 PMCID: PMC3568198 DOI: 10.1016/j.knee.2012.10.018] [Citation(s) in RCA: 38] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/03/2012] [Revised: 09/24/2012] [Accepted: 10/18/2012] [Indexed: 02/02/2023]
Abstract
BACKGROUND The purpose of this investigation is to evaluate the T(1ρ) relaxation times of articular cartilage surrounding focal defects in the tibiofemoral joint. METHODS Quantitative cartilage assessment was performed using 3T MRI with T(1ρ) mapping in 19 healthy individuals and 44 OA patients. Sagittal T2-weighted fast spin echo (FSE) images were acquired for lesion assessment. Differences were determined using analysis of variance (ANOVA). RESULTS Cartilage lesions were found in 37% of controls, and 93% of OA patients. Meniscal tears were found in 16% of controls and 57% of OA patients. We observed no difference in T(1ρ) relaxation times when comparing cartilage immediately surrounding a focal defect, and the remaining cartilage within that compartment. The medial femoral condyle (MFC) had the highest incidence of cartilage defects. MFC and medial meniscus posterior horn T(1ρ) were higher in subjects having multiple focal lesions (p = 0.048, pb 0.001 respectively) and extensive full thickness lesions (p = 0.009, pb 0.001 respectively) compared to subjects with no MFC defects. Significant elevations in T(1ρ) of the adjacent compartment (medial tibia) and medial meniscus were observed in subjects with MFC lesions. CONCLUSION Increased relaxation times in the involved compartment as well as the adjacent compartment and associated meniscus underscore the interdependence of these structures at bearing load. However, no differences in cartilage composition immediately surrounding a defect were noted. Finally, an association was observed between cartilage defects and meniscal damage in advanced disease. CLINICAL RELEVANCE Cartilage defects were not associated with degeneration in the immediately adjacent cartilage.
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Affiliation(s)
- Richard B. Souza
- Department of Physical Therapy and Rehabilitation Science, University of California, San Francisco, CA, USA
,Department of Orthopaedic Surgery, University of California, San Francisco, CA, USA
,Department of Radiology and Biomedical Imaging, University of California, San Francisco, CA, USA
| | - Brian T. Feeley
- Department of Orthopaedic Surgery, University of California, San Francisco, CA, USA
| | - Zinta A. Zarins
- Department of Radiology and Biomedical Imaging, University of California, San Francisco, CA, USA
| | - Thomas M. Link
- Department of Radiology and Biomedical Imaging, University of California, San Francisco, CA, USA
| | - Xiaojuan Li
- Department of Radiology and Biomedical Imaging, University of California, San Francisco, CA, USA
| | - Sharmila Majumdar
- Department of Radiology and Biomedical Imaging, University of California, San Francisco, CA, USA
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Kijowski R, Sanogo ML, Lee KS, Muñoz del Río A, McGuine TA, Baer GS, Graf BK, De Smet AA. Short-term Clinical Importance of Osseous Injuries Diagnosed at MR Imaging in Patients with Anterior Cruciate Ligament Tear. Radiology 2012; 264:531-41. [DOI: 10.1148/radiol.12112171] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/29/2023]
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Souza RB, Baum T, Wu S, Feeley BT, Kadel N, Li X, Link TM, Majumdar S. Effects of unloading on knee articular cartilage T1rho and T2 magnetic resonance imaging relaxation times: a case series. J Orthop Sports Phys Ther 2012; 42:511-20. [PMID: 22402583 DOI: 10.2519/jospt.2012.3975] [Citation(s) in RCA: 60] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
STUDY DESIGN Case series. BACKGROUND It has been shown in rodent and canine models that cartilage composition is significantly altered in response to long-term unloading. To date, however, no in vivo human studies have investigated this topic. The objective of this case series was to determine the influence of unloading and reloading on T1rho and T2 relaxation times of articular cartilage in healthy young joints. CASE DESCRIPTION Ten patients who required 6 to 8 weeks of non-weight bearing (NWB) for injuries affecting the distal lower extremity participated in the study. Quantitative T1rho and T2 imaging of the ipsilateral knee joint was performed at 3 time points: (1) prior to surgery (baseline), (2) immediately after a period of NWB (post-NWB), and (3) after 4 weeks of full weight bearing (post-FWB). Cartilage regions of interest were segmented and overlaid on T1rho and T2 relaxation time maps for quantification. Descriptive statistics are provided for all changes. OUTCOMES Increases of 5% to 10% in T1rho times of all femoral and tibial compartments were noted post-NWB. All values returned to near-baseline levels post-FWB. Increases in medial tibia T2 times were noted post-NWB and remained elevated post-FWB. The load-bearing regions showed the most significant changes in response to unloading, with increases of up to 12%. DISCUSSION The observation of a transient shift in relaxation times confirms that cartilage composition is subject to alterations based on loading conditions. These changes appear to be mostly related to proteoglycan content and more localized to the load-bearing regions. However, following 4 weeks of full weight bearing, relaxation times of nearly all regions had returned to baseline levels, demonstrating reversibility in compositional fluctuations. LEVEL OF EVIDENCE Therapy, level 4.
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