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Turmezei TD, Malhotra K, MacKay JW, Gee AH, Treece GM, Poole KES, Welck MJ. 3-D joint space mapping at the ankle from weight-bearing CT: reproducibility, repeatability, and challenges for standardisation. Eur Radiol 2023; 33:8333-8342. [PMID: 37256354 PMCID: PMC10598168 DOI: 10.1007/s00330-023-09718-6] [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: 12/05/2022] [Revised: 03/08/2023] [Accepted: 03/20/2023] [Indexed: 06/01/2023]
Abstract
OBJECTIVES We present a 3-D approach to joint space width (JSW) measurement across the ankle from weight-bearing CT (WBCT) to demonstrate inter-operator reproducibility, test-retest repeatability, and how differences in angulation affect ankle JSW distribution. METHODS One side from repeat WBCT imaging of both feet and ankles was analysed from 23 individuals as part of their routine clinical care pathway. Joint space mapping was performed at four facets across the talus: talonavicular, talar dome and medial gutter (dome-medial), lateral gutter, and posterior subtalar. Inter-operator reproducibility was calculated for two users, while test-retest repeatability was calculated by comparing the two visits, both presented as Bland-Altman statistics. Statistical parametric mapping determined any significant relationships between talocrural joint space angulation and 3-D JSW distribution. RESULTS The average ± standard deviation interval between imaging was 74.0 ± 29.6 days. Surface averaged bias ± limits of agreement were similar for reproducibility and repeatability, the latter being: talonavicular 0.01 ± 0.26 mm, dome-medial 0.00 ± 0.28 mm, lateral gutter - 0.02 ± 0.40 mm, and posterior subtalar 0.02 ± 0.34 mm. Results are presented as 3-D distribution maps, with optimum test-retest repeatability reaching a smallest detectable difference of ± 0.15 mm. CONCLUSIONS Joint space mapping is a robust approach to 3-D quantification of JSW measurement, inter-operator reproducibility, and test-retest repeatability at the ankle, with sensitivity reaching a best value of ± 0.15 mm. Standardised imaging protocols and optimised metal artefact reduction will be needed to further understand the clinical value of these 3-D measures derived from WBCT. CLINICAL RELEVANCE STATEMENT Weight-bearing computed tomography is an increasingly important tool in the clinical assessment of orthopaedic ankle disorders. This paper establishes the performance of measuring 3-D joint space width using this technology, which is an important surrogate marker for severity of osteoarthritis. KEY POINTS • Joint space width values and error metrics from across the ankle measured from weight-bearing CT can be presented as 3-D maps that show topographic variation. • The best sensitivity for detecting meaningful change in 3-D joint space width at the ankle was ± 0.15 mm, a value less than the isotropic imaging voxel dimensions. • Standardised imaging protocols and optimised metal artefact reduction will be needed to understand the clinical value of 3-D measures from weight-bearing CT.
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Affiliation(s)
- Tom D Turmezei
- Department of Radiology, Norfolk and Norwich University Hospital NHS Foundation Trust, Colney Lane, Norwich, UK.
- Norwich Medical School, University of East Anglia, Norwich Research Park, Norwich, UK.
| | - Karan Malhotra
- Royal National Orthopaedic Hospital NHS Trust, Brockley Hill, Stanmore, UK
| | - James W MacKay
- Norwich Medical School, University of East Anglia, Norwich Research Park, Norwich, UK
- Department of Radiology, University of Cambridge, Hills Road, Cambridge, UK
| | - Andrew H Gee
- Cambridge University Engineering Department, Trumpington Street, Cambridge, UK
| | - Graham M Treece
- Cambridge University Engineering Department, Trumpington Street, Cambridge, UK
| | - Kenneth E S Poole
- Department of Medicine, University of Cambridge, Hills Road, Cambridge, UK
| | - Matthew J Welck
- Royal National Orthopaedic Hospital NHS Trust, Brockley Hill, Stanmore, UK
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Turmezei TD, Shelmerdine SC, Ashok AH, Goh V. Academic clinical fellows in radiology: how can we improve success? Clin Radiol 2023; 78:e300-e310. [PMID: 36702709 DOI: 10.1016/j.crad.2022.12.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2022] [Revised: 12/07/2022] [Accepted: 12/14/2022] [Indexed: 01/12/2023]
Abstract
AIM To survey past and current radiology academic clinical fellows (ACFs) for feedback on their experiences, academic achievements, challenges faced in balancing academic and clinical responsibilities, and opinion on how to optimise the fellowship programme. MATERIALS & METHODS A 26-question online survey approved by the Royal College of Radiologists (RCR) Academic Committee was distributed over a 7-month period (June 2021 to January 2022) to current and past radiology ACFs via the National Institute for Health and Care Research (NIHR) integrated academic training imaging leads, radiology training programme directors, and social media. RESULTS Thirty-five survey responses were received from past or present ACFs. Of the respondents, 42.8% (15/35) entered ACF training from another research post, and most continued their academic interests after ACF training (59.3%, 16/27 that had completed the post). The majority (22/35, 63%) had or were in the process of obtaining a postgraduate research degree. The most common academic outputs were scientific publications and national/international conference presentations. Most (23/35, 66%) would recommend the ACF post to colleagues, although some found it challenging balancing on-call and examination commitments during training. CONCLUSIONS Entry into the radiology ACF programme is often after a prior academic post. Many ACFs appear to enjoy their fellowship experience and continue academic interests after training, some achieving higher research degrees. Challenges in balancing clinical workload require some flexibility from local clinical and academic supervisors. Suggestions for alternative structuring of the ACF pathway and how to optimise entry into these competitive posts are also outlined.
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Affiliation(s)
- T D Turmezei
- Norwich Medical School, University of East Anglia, Norwich, UK; Department of Radiology, Norfolk & Norwich University Hospital, Norwich, UK
| | - S C Shelmerdine
- Department of Clinical Radiology, Great Ormond Street Hospital, London, UK; UCL Great Ormond Street Institute of Child Health, Great Ormond Street Hospital for Children, London, UK; NIHR Great Ormond Street Hospital Biomedical Research Centre, London, UK; Department of Clinical Radiology, St George's Hospital, London, UK.
| | - A H Ashok
- Department of Radiology, University of Cambridge, Cambridge, UK; Department of Radiology, Addenbrooke's Hospital, Cambridge University Hospitals NHS Foundation Trust, Cambridge, UK
| | - V Goh
- School of Biomedical Engineering & Imaging Sciences, Faculty of Life Sciences & Medicine, King's College London, London, UK; Department of Radiology, Guy's and St Thomas' Hospital, London, UK
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Turmezei TD, Low SB, Rupret S, Treece GM, Gee AH, MacKay JW, Lynch JA, Poole KES, Segal NA. Multiparametric 3-D analysis of bone and joint space width at the knee from weight bearing computed tomography. Osteoarthr Imaging 2022; 2:100069. [PMID: 36249485 PMCID: PMC9559750 DOI: 10.1016/j.ostima.2022.100069] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/16/2023]
Abstract
OBJECTIVE Computed tomography (CT) can deliver multiple parameters relevant to osteoarthritis. In this study we demonstrate that a 3-D multiparametric approach at the weight bearing knee with cone beam CT is feasible, can include multiple parameters from across the joint space, and can reveal stronger relationships with disease status in combination. DESIGN 33 participants with knee weight bearing CT (WBCT) were analysed with joint space mapping and cortical bone mapping to deliver joint space width (JSW), subchondral bone plate thickness, endocortical thickness, and trabecular attenuation at both sides of the joint. All data were co-localised to the same canonical surface. Statistical parametric mapping (SPM) was applied in uni- and multivariate models to demonstrate significant dependence of parameters on Kellgren & Lawrence grade (KLG). Correlation between JSW and bony parameters and 2-week test-retest repeatability were also calculated. RESULTS SPM revealed that the central-to-posterior medial tibiofemoral joint space was significantly narrowed by up to 0.5 mm with significantly higher tibial trabecular attenuation up to 50 units for each increment in KLG as single features, and in a wider distribution when combined (p<0.05). These were also more strongly correlated with worsening KLG grade category. Test-retest repeatability was subvoxel (0.37 mm) for nearly all thickness parameters. CONCLUSIONS 3-D JSW and tibial trabecular attenuation are repeatable and significantly dependent on radiographic disease severity at the weight bearing knee joint not just alone, but more strongly in combination. A quantitative multiparametric approach with WBCT may have potential for more sensitive investigation of disease progression in osteoarthritis.
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Affiliation(s)
- Tom D Turmezei
- Norfolk and Norwich University Hospital NHS Foundation Trust, Colney Lane, Norwich, UK
- University of East Anglia, Norwich Research Park, Norwich, UK
| | - Samantha B Low
- University of East Anglia, Norwich Research Park, Norwich, UK
| | - Simon Rupret
- University Hospitals Bristol and Weston NHS Foundation Trust, Marlborough Street, Bristol, UK
| | - Graham M Treece
- Cambridge University Engineering Department, Trumpington Street, Cambridge, UK
| | - Andrew H Gee
- Cambridge University Engineering Department, Trumpington Street, Cambridge, UK
| | - James W MacKay
- Norfolk and Norwich University Hospital NHS Foundation Trust, Colney Lane, Norwich, UK
- University of East Anglia, Norwich Research Park, Norwich, UK
| | - John A Lynch
- University of California San Francisco, 550 16th Street, San Francisco, USA
| | - Kenneth ES Poole
- University of Cambridge Department of Medicine, Hills Road, Cambridge, UK
| | - Neil A Segal
- University of Kansas Medical Center, 3901 Rainbow Boulevard, Kansas City, USA
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Jansen MP, Mastbergen SC, MacKay JW, Turmezei TD, Lafeber F. Knee joint distraction results in MRI cartilage thickness increase up to ten years after treatment. Rheumatology (Oxford) 2021; 61:974-982. [PMID: 34022055 PMCID: PMC8889280 DOI: 10.1093/rheumatology/keab456] [Citation(s) in RCA: 10] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2021] [Revised: 05/12/2021] [Indexed: 01/21/2023] Open
Abstract
Objectives Knee joint distraction (KJD) has been shown to result in long-term clinical improvement and short-term cartilage restoration in young OA patients. The objective of the current study was to evaluate MRI cartilage thickness up to 10 years after KJD treatment, using a 3D surface-based approach. Methods Twenty end-stage knee OA patients were treated with KJD. MRI scans (1.5 T) were performed before and at 1, 2, 5, 7, and 10 years after treatment. Tibia and femur cartilage segmentation and registration to a canonical surface were performed semi-automatically. Statistical parametric mapping with linear mixed models was used to analyse whole-joint changes. The influence of baseline patient characteristics was analysed with statistical parametric mapping using linear regression. Relevant weight-bearing parts of the femur were selected to obtain the average cartilage thickness in the femur and tibia of the most- (MAC) and least-affected compartment. These compartmental changes over time were analysed using repeated measures ANOVA; missing data was imputed. In all cases, P <0.05 was considered statistically significant. Results One and 2 years post-treatment, cartilage in the MAC weight-bearing region was significantly thicker than pre-treatment, gradually thinning after 5 years, but still increased at 10 years post-treatment. Long-term results showed that areas in the least-affected compartment were significantly thicker than pre-treatment. Male sex and more severe OA at baseline somewhat predicted shorter-term benefit (P >0.05). Compartmental analyses showed significant short- and long-term thickness increase in the tibia and femur MAC (all P <0.05). Conclusion KJD results in significant short- and long-term cartilage regeneration, up to 10 years post-treatment. Trial registration Netherlands Trial Register, https://www.trialregister.nl, NL419.
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Affiliation(s)
- Mylène P Jansen
- Department of Rheumatology & Clinical Immunology, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Simon C Mastbergen
- Department of Rheumatology & Clinical Immunology, University Medical Center Utrecht, Utrecht, The Netherlands
| | - James W MacKay
- Norwich Medical School, University of East Anglia, Norwich, United Kingdom.,Department of Radiology, University of Cambridge, Cambridge, United Kingdom
| | - Tom D Turmezei
- Norwich Medical School, University of East Anglia, Norwich, United Kingdom.,Department of Radiology, Norfolk & Norwich University Hospital, Norwich, United Kingdom
| | - Floris Lafeber
- Department of Rheumatology & Clinical Immunology, University Medical Center Utrecht, Utrecht, The Netherlands
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Turmezei TD, B Low S, Rupret S, Treece GM, Gee AH, MacKay JW, Lynch JA, Poole KES, Segal NA. Quantitative Three-dimensional Assessment of Knee Joint Space Width from Weight-bearing CT. Radiology 2021; 299:649-659. [PMID: 33847516 DOI: 10.1148/radiol.2021203928] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
Background Imaging of structural disease in osteoarthritis has traditionally relied on MRI and radiography. Joint space mapping (JSM) can be used to quantitatively map joint space width (JSW) in three dimensions from CT images. Purpose To demonstrate the reproducibility, repeatability, and feasibility of JSM of the knee using weight-bearing CT images. Materials and Methods Two convenience samples of weight-bearing CT images of left and right knees with radiographic Kellgren-Lawrence grades (KLGs) less than or equal to 2 were acquired from 2014 to 2018 and were analyzed retrospectively with JSM to deliver three-dimensional JSW maps. For reproducibility, images of three sets of knees were used for novice training, and then the JSM output was compared against an expert's assessment. JSM was also performed on 2-week follow-up images in the second cohort, yielding three-dimensional JSW difference maps for repeatability. Statistical parametric mapping was performed on all knee imaging data (KLG, 0-4) to show the feasibility of a surface-based analysis in three dimensions. Results Reproducibility (in 20 individuals; mean age, 58 years ± 7 [standard deviation]; mean body mass index, 28 kg/m2 ± 6; 14 women) and repeatability (in nine individuals; mean age, 53 years ± 6; mean body mass index, 26 kg/m2 ± 4; seven women) reached their lowest performance at a smallest detectable difference less than ±0.1 mm in the central medial tibiofemoral joint space for individuals without radiographically demonstrated disease. The average root mean square coefficient of variation was less than 5% across all groups. Statistical parametric mapping (33 individuals; mean age, 57 years ± 7; mean body mass index, 27 kg/m2 ± 6; 23 women) showed that the central-to-posterior medial joint space was significantly narrower by 0.5 mm for each incremental increase in the KLG (threshold P < .05). One knee (KLG, 2) demonstrated a baseline versus 24-month change in its three-dimensional JSW distribution that was beyond the smallest detectable difference across the lateral joint space. Conclusion Joint space mapping of the knee using weight-bearing CT images is feasible, demonstrating a relationship between the three-dimensional joint space width distribution and structural joint disease. It is reliably learned by novice users, can be personalized for disease phenotypes, and can be used to achieve a smallest detectable difference that is at least 50% smaller than that reported to be achieved at the highest performance level in radiography. © RSNA, 2021 Online supplemental material is available for this article. See also the editorial by Roemer in this issue.
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Affiliation(s)
- Tom D Turmezei
- From the Department of Radiology, Norfolk and Norwich University Hospitals NHS Foundation Trust, Colney Lane, Norwich NR4 7UY, England (T.D.T., J.W.M.); Norwich Medical School, University of East Anglia, Norwich, England (T.D.T., J.W.M.); Royal Liverpool University Hospital, Liverpool, England (S.B.L.); Department of Radiology, University Hospitals Bristol and Weston NHS Foundation Trust, Bristol, England (S.R.); Departments of Engineering (G.M.T., A.H.G.) and Medicine (K.E.S.P.), University of Cambridge, Cambridge, England; Department of Epidemiology and Biostatistics, University of California-San Francisco, San Francisco, Calif (J.A.L.); and Department of Physical Medicine and Rehabilitation, Kansas University Medical Center, Kansas City, Kan (N.A.S.)
| | - Samantha B Low
- From the Department of Radiology, Norfolk and Norwich University Hospitals NHS Foundation Trust, Colney Lane, Norwich NR4 7UY, England (T.D.T., J.W.M.); Norwich Medical School, University of East Anglia, Norwich, England (T.D.T., J.W.M.); Royal Liverpool University Hospital, Liverpool, England (S.B.L.); Department of Radiology, University Hospitals Bristol and Weston NHS Foundation Trust, Bristol, England (S.R.); Departments of Engineering (G.M.T., A.H.G.) and Medicine (K.E.S.P.), University of Cambridge, Cambridge, England; Department of Epidemiology and Biostatistics, University of California-San Francisco, San Francisco, Calif (J.A.L.); and Department of Physical Medicine and Rehabilitation, Kansas University Medical Center, Kansas City, Kan (N.A.S.)
| | - Simon Rupret
- From the Department of Radiology, Norfolk and Norwich University Hospitals NHS Foundation Trust, Colney Lane, Norwich NR4 7UY, England (T.D.T., J.W.M.); Norwich Medical School, University of East Anglia, Norwich, England (T.D.T., J.W.M.); Royal Liverpool University Hospital, Liverpool, England (S.B.L.); Department of Radiology, University Hospitals Bristol and Weston NHS Foundation Trust, Bristol, England (S.R.); Departments of Engineering (G.M.T., A.H.G.) and Medicine (K.E.S.P.), University of Cambridge, Cambridge, England; Department of Epidemiology and Biostatistics, University of California-San Francisco, San Francisco, Calif (J.A.L.); and Department of Physical Medicine and Rehabilitation, Kansas University Medical Center, Kansas City, Kan (N.A.S.)
| | - Graham M Treece
- From the Department of Radiology, Norfolk and Norwich University Hospitals NHS Foundation Trust, Colney Lane, Norwich NR4 7UY, England (T.D.T., J.W.M.); Norwich Medical School, University of East Anglia, Norwich, England (T.D.T., J.W.M.); Royal Liverpool University Hospital, Liverpool, England (S.B.L.); Department of Radiology, University Hospitals Bristol and Weston NHS Foundation Trust, Bristol, England (S.R.); Departments of Engineering (G.M.T., A.H.G.) and Medicine (K.E.S.P.), University of Cambridge, Cambridge, England; Department of Epidemiology and Biostatistics, University of California-San Francisco, San Francisco, Calif (J.A.L.); and Department of Physical Medicine and Rehabilitation, Kansas University Medical Center, Kansas City, Kan (N.A.S.)
| | - Andrew H Gee
- From the Department of Radiology, Norfolk and Norwich University Hospitals NHS Foundation Trust, Colney Lane, Norwich NR4 7UY, England (T.D.T., J.W.M.); Norwich Medical School, University of East Anglia, Norwich, England (T.D.T., J.W.M.); Royal Liverpool University Hospital, Liverpool, England (S.B.L.); Department of Radiology, University Hospitals Bristol and Weston NHS Foundation Trust, Bristol, England (S.R.); Departments of Engineering (G.M.T., A.H.G.) and Medicine (K.E.S.P.), University of Cambridge, Cambridge, England; Department of Epidemiology and Biostatistics, University of California-San Francisco, San Francisco, Calif (J.A.L.); and Department of Physical Medicine and Rehabilitation, Kansas University Medical Center, Kansas City, Kan (N.A.S.)
| | - James W MacKay
- From the Department of Radiology, Norfolk and Norwich University Hospitals NHS Foundation Trust, Colney Lane, Norwich NR4 7UY, England (T.D.T., J.W.M.); Norwich Medical School, University of East Anglia, Norwich, England (T.D.T., J.W.M.); Royal Liverpool University Hospital, Liverpool, England (S.B.L.); Department of Radiology, University Hospitals Bristol and Weston NHS Foundation Trust, Bristol, England (S.R.); Departments of Engineering (G.M.T., A.H.G.) and Medicine (K.E.S.P.), University of Cambridge, Cambridge, England; Department of Epidemiology and Biostatistics, University of California-San Francisco, San Francisco, Calif (J.A.L.); and Department of Physical Medicine and Rehabilitation, Kansas University Medical Center, Kansas City, Kan (N.A.S.)
| | - John A Lynch
- From the Department of Radiology, Norfolk and Norwich University Hospitals NHS Foundation Trust, Colney Lane, Norwich NR4 7UY, England (T.D.T., J.W.M.); Norwich Medical School, University of East Anglia, Norwich, England (T.D.T., J.W.M.); Royal Liverpool University Hospital, Liverpool, England (S.B.L.); Department of Radiology, University Hospitals Bristol and Weston NHS Foundation Trust, Bristol, England (S.R.); Departments of Engineering (G.M.T., A.H.G.) and Medicine (K.E.S.P.), University of Cambridge, Cambridge, England; Department of Epidemiology and Biostatistics, University of California-San Francisco, San Francisco, Calif (J.A.L.); and Department of Physical Medicine and Rehabilitation, Kansas University Medical Center, Kansas City, Kan (N.A.S.)
| | - Kenneth E S Poole
- From the Department of Radiology, Norfolk and Norwich University Hospitals NHS Foundation Trust, Colney Lane, Norwich NR4 7UY, England (T.D.T., J.W.M.); Norwich Medical School, University of East Anglia, Norwich, England (T.D.T., J.W.M.); Royal Liverpool University Hospital, Liverpool, England (S.B.L.); Department of Radiology, University Hospitals Bristol and Weston NHS Foundation Trust, Bristol, England (S.R.); Departments of Engineering (G.M.T., A.H.G.) and Medicine (K.E.S.P.), University of Cambridge, Cambridge, England; Department of Epidemiology and Biostatistics, University of California-San Francisco, San Francisco, Calif (J.A.L.); and Department of Physical Medicine and Rehabilitation, Kansas University Medical Center, Kansas City, Kan (N.A.S.)
| | - Neil A Segal
- From the Department of Radiology, Norfolk and Norwich University Hospitals NHS Foundation Trust, Colney Lane, Norwich NR4 7UY, England (T.D.T., J.W.M.); Norwich Medical School, University of East Anglia, Norwich, England (T.D.T., J.W.M.); Royal Liverpool University Hospital, Liverpool, England (S.B.L.); Department of Radiology, University Hospitals Bristol and Weston NHS Foundation Trust, Bristol, England (S.R.); Departments of Engineering (G.M.T., A.H.G.) and Medicine (K.E.S.P.), University of Cambridge, Cambridge, England; Department of Epidemiology and Biostatistics, University of California-San Francisco, San Francisco, Calif (J.A.L.); and Department of Physical Medicine and Rehabilitation, Kansas University Medical Center, Kansas City, Kan (N.A.S.)
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MacKay JW, Kaggie JD, Treece GM, McDonnell SM, Khan W, Roberts AR, Janiczek RL, Graves MJ, Turmezei TD, McCaskie AW, Gilbert FJ. Three-Dimensional Surface-Based Analysis of Cartilage MRI Data in Knee Osteoarthritis: Validation and Initial Clinical Application. J Magn Reson Imaging 2020; 52:1139-1151. [PMID: 32447815 DOI: 10.1002/jmri.27193] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [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: 02/20/2020] [Revised: 04/23/2020] [Accepted: 04/24/2020] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Traditional quantitative analysis of cartilage with MRI averages measurements (eg, thickness) across regions-of-interest (ROIs) which may reduce responsiveness. PURPOSE To validate and describe clinical application of a semiautomated surface-based method for analyzing cartilage relaxation times ("composition") and morphology on MRI, 3D cartilage surface mapping (3D-CaSM). STUDY TYPE Validation study in cadaveric knees and prospective observational (cohort) study in human participants. POPULATION Four cadaveric knees and 14 participants aged 40-60 with mild-moderate knee osteoarthritis (OA) and 6 age-matched healthy volunteers, imaged at baseline, 1, and 6 months. FIELD STRENGTH/SEQUENCE 3D spoiled gradient echo, T1 rho/T2 magnetization-prepared 3D fast spin echo for mapping of T1 rho/T2 relaxation times and delayed gadolinium enhanced MRI of cartilage (dGEMRIC) using variable flip angle T1 relaxation time mapping at 3T. ASSESSMENT 3D-CaSM was validated against high-resolution peripheral quantitative computed tomography (HRpQCT) in cadaveric knees, with comparison to expert manual segmentation. The clinical study assessed test-retest repeatability and sensitivity to change over 6 months for cartilage thickness and relaxation times. STATISTICAL TESTS Bland-Altman analysis was performed for the validation study and evaluation of test-retest repeatability. Six-month changes were assessed via calculation of the percentage of each cartilage surface affected by areas of significant change (%SC), defined using thresholds based on area and smallest detectable difference (SDD). RESULTS Bias and precision (0.06 ± 0.25 mm) of 3D-CaSM against reference HRpQCT data were comparable to expert manual segmentation (-0.13 ± 0.26 mm). 3D-CaSM demonstrated significant (>SDD) 6-month changes in cartilage thickness and relaxation times in both OA participants and healthy controls. The parameter demonstrating the greatest 6-month change was T2 relaxation time (OA median %SC [IQR] = 8.8% [5.5 to 12.6]). DATA CONCLUSION This study demonstrates the construct validity and potential clinical utility of 3D-CaSM, which may offer advantages to conventional ROI-based methods. LEVEL OF EVIDENCE 2. TECHNICAL EFFICACY STAGE 2. J. Magn. Reson. Imaging 2020;52:1139-1151.
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Affiliation(s)
- James W MacKay
- Department of Radiology, University of Cambridge, Cambridge, UK
- Norwich Medical School, University of East Anglia, Norwich, UK
| | - Joshua D Kaggie
- Department of Radiology, University of Cambridge, Cambridge, UK
| | - Graham M Treece
- Department of Engineering, University of Cambridge, Cambridge, UK
| | - Stephen M McDonnell
- Division of Trauma & Orthopaedics, Department of Surgery, University of Cambridge, Cambridge, UK
| | - Wasim Khan
- Division of Trauma & Orthopaedics, Department of Surgery, University of Cambridge, Cambridge, UK
| | - Alexandra R Roberts
- Clinical Imaging, GlaxoSmithKline, London, UK
- Antaros Medical, Uppsala, Sweden
| | | | - Martin J Graves
- Department of Radiology, University of Cambridge, Cambridge, UK
| | - Tom D Turmezei
- Norwich Medical School, University of East Anglia, Norwich, UK
- Department of Radiology, Norfolk & Norwich University Hospital, Norwich, UK
| | - Andrew W McCaskie
- Division of Trauma & Orthopaedics, Department of Surgery, University of Cambridge, Cambridge, UK
| | - Fiona J Gilbert
- Department of Radiology, University of Cambridge, Cambridge, UK
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Turmezei TD, Treece GM, Gee AH, Sigurdsson S, Jonsson H, Aspelund T, Gudnason V, Poole KES. Quantitative 3D imaging parameters improve prediction of hip osteoarthritis outcome. Sci Rep 2020; 10:4127. [PMID: 32139721 PMCID: PMC7058047 DOI: 10.1038/s41598-020-59977-2] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2019] [Accepted: 02/03/2020] [Indexed: 11/29/2022] Open
Abstract
Osteoarthritis is an increasingly important health problem for which the main treatment remains joint replacement. Therapy developments have been hampered by a lack of biomarkers that can reliably predict disease, while 2D radiographs interpreted by human observers are still the gold standard for clinical trial imaging assessment. We propose a 3D approach using computed tomography—a fast, readily available clinical technique—that can be applied in the assessment of osteoarthritis using a new quantitative 3D analysis technique called joint space mapping (JSM). We demonstrate the application of JSM at the hip in 263 healthy older adults from the AGES-Reykjavík cohort, examining relationships between 3D joint space width, 3D joint shape, and future joint replacement. Using JSM, statistical shape modelling, and statistical parametric mapping, we show an 18% improvement in prediction of joint replacement using 3D metrics combined with radiographic Kellgren & Lawrence grade (AUC 0.86) over the existing 2D FDA-approved gold standard of minimum 2D joint space width (AUC 0.73). We also show that assessment of joint asymmetry can reveal significant differences between individuals destined for joint replacement versus controls at regions of the joint that are not captured by radiographs. This technique is immediately implementable with standard imaging technologies.
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Affiliation(s)
- T D Turmezei
- Department of Radiology, Norfolk and Norwich University Hospital, Norwich, UK.
| | - G M Treece
- Cambridge University Engineering Department, Cambridge, UK
| | - A H Gee
- Cambridge University Engineering Department, Cambridge, UK
| | | | - H Jonsson
- Department of Rheumatology, Landspitalinn University Hospital, Reykjavik, Iceland
| | - T Aspelund
- Department of Medicine, University of Iceland, Reykjavik, Iceland
| | - V Gudnason
- Department of Medicine, University of Iceland, Reykjavik, Iceland
| | - K E S Poole
- Department of Medicine, University of Cambridge, Cambridge, UK
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Turmezei TD, Fotiadou A, Lomas DJ, Hopper MA, Poole KES. A new CT grading system for hip osteoarthritis. Osteoarthritis Cartilage 2014; 22:1360-6. [PMID: 24642349 DOI: 10.1016/j.joca.2014.03.008] [Citation(s) in RCA: 20] [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] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/06/2014] [Revised: 02/13/2014] [Accepted: 03/04/2014] [Indexed: 02/02/2023]
Abstract
OBJECTIVES We have developed a new grading system for hip osteoarthritis using clinical computed tomography (CT). This technique was compared with Kellgren and Lawrence (K&L) grading and minimum joint space width (JSW) measurement in digitally reconstructed radiographs (DRRs) from the same CT data. In this paper we evaluate and compare the accuracy and reliability of these measures in the assessment of radiological disease. DESIGN CT imaging of hips from 30 female volunteers aged 66 ± 17 years were used in two reproducibility studies, one testing the reliability of the new system, the other testing K&L grading and minimum JSW measurement in DRRs. RESULTS Intra- and inter-observer reliability was substantial for CT grading according to weighted kappa (0.74 and 0.75 respectively), while intra- and inter-observer reliability was at worst moderate (0.57) and substantial (0.63) respectively for DRR K&L grading. Bland-Altman analysis showed a systematic difference in minimum JSW measurement of 0.82 mm between reviewers, with a least detectable difference of 1.06 mm. The area under the curve from ROC analysis was 0.91 for our CT composite score. CONCLUSIONS CT grading of hip osteoarthritis (categorised as none, developing and established) has substantial reliability. Sensitivity was increased when CT features of osteoarthritis were assigned a composite score (0 = none to 7 = severest) that also performed well as a diagnostic test, but at the cost of reliability. Having established feasibility and reliability for this new CT system, sensitivity testing and validation against clinical measures of hip osteoarthritis will now be performed.
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Affiliation(s)
- T D Turmezei
- Department of Engineering, University of Cambridge, Trumpington Street, Cambridge CB2 1PZ, UK; Department of Radiology, Box 218, Level 5, Addenbrooke's Hospital, Hills Road, Cambridge CB2 0QQ, UK; Department of Medicine, Box 157, Level 5, Addenbrooke's Hospital, Hills Road, Cambridge CB2 0QQ, UK.
| | - A Fotiadou
- Department of Radiology, Hinchingbrooke Health Care NHS Trust, Hinchingbrooke Hospital, Hinchingbrooke Park, Huntingdon PE29 6NT, UK
| | - D J Lomas
- Department of Radiology, Box 218, Level 5, Addenbrooke's Hospital, Hills Road, Cambridge CB2 0QQ, UK
| | - M A Hopper
- Department of Radiology, Box 218, Level 5, Addenbrooke's Hospital, Hills Road, Cambridge CB2 0QQ, UK
| | - K E S Poole
- Department of Medicine, Box 157, Level 5, Addenbrooke's Hospital, Hills Road, Cambridge CB2 0QQ, UK
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Turmezei TD, Lomas DJ, Hopper MA, Poole KES. Severity mapping of the proximal femur: a new method for assessing hip osteoarthritis with computed tomography. Osteoarthritis Cartilage 2014; 22:1488-98. [PMID: 24631578 DOI: 10.1016/j.joca.2014.03.007] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.9] [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: 01/03/2014] [Revised: 02/13/2014] [Accepted: 03/04/2014] [Indexed: 02/02/2023]
Abstract
OBJECTIVE Plain radiography has been the mainstay of imaging assessment in osteoarthritis for over 50 years, but it does have limitations. Here we present the methodology and results of a new technique for identifying, grading, and mapping the severity and spatial distribution of osteoarthritic disease features at the hip in 3D with clinical computed tomography (CT). DESIGN CT imaging of 456 hips from 230 adult female volunteers (mean age 66 ± 17 years) was reviewed using 3D multiplanar reformatting to identify bone-related radiological features of osteoarthritis, namely osteophytes, subchondral cysts and joint space narrowing. Scoresheets dividing up the femoral head, head-neck region and the joint space were used to register the location and severity of each feature (scored from 0 to 3). Novel 3D cumulative feature severity maps were then created to display where the most severe disease features from each individual were anatomically located across the cohort. RESULTS Feature severity maps showed a propensity for osteophytes at the inferoposterior and superolateral femoral head-neck junction. Subchondral cysts were a less common and less localised phenomenon. Joint space narrowing <1.5 mm was recorded in at least one sector of 83% of hips, but most frequently in the posterolateral joint space. CONCLUSIONS This is the first description of hip osteoarthritis using unenhanced clinical CT in which we describe the co-localisation of posterior osteophytes and joint space narrowing for the first time. We believe this technique can perform several important roles in future osteoarthritis research, including phenotyping and sensitive disease assessment in 3D.
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Affiliation(s)
- T D Turmezei
- Department of Engineering, University of Cambridge, Trumpington Street, Cambridge CB2 1PZ, UK; Department of Radiology, Box 218, Level 5, Addenbrooke's Hospital, Hills Road, Cambridge CB2 0QQ, UK; Department of Medicine, Box 157, Level 5, Addenbrooke's Hospital, Hills Road, Cambridge CB2 0QQ, UK.
| | - D J Lomas
- Department of Radiology, Box 218, Level 5, Addenbrooke's Hospital, Hills Road, Cambridge CB2 0QQ, UK
| | - M A Hopper
- Department of Radiology, Box 218, Level 5, Addenbrooke's Hospital, Hills Road, Cambridge CB2 0QQ, UK
| | - K E S Poole
- Department of Medicine, Box 157, Level 5, Addenbrooke's Hospital, Hills Road, Cambridge CB2 0QQ, UK
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Turmezei TD. The linguistic roots of Modern English anatomical terminology. Clin Anat 2012; 25:1015-22. [PMID: 22461143 DOI: 10.1002/ca.22062] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2010] [Revised: 02/19/2011] [Accepted: 02/11/2012] [Indexed: 11/05/2022]
Affiliation(s)
- Tom D Turmezei
- Bone Research Group, Department of Medicine, Addenbrooke's Hospital, University of Cambridge, Cambridge, United Kingdom.
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Yu D, Turmezei TD, Kerslake RW. FIESTA: an MR arthrography celebration of shoulder joint anatomy, variants, and their mimics. Clin Anat 2012; 26:213-27. [PMID: 22431407 DOI: 10.1002/ca.22066] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2010] [Revised: 11/12/2011] [Accepted: 02/14/2012] [Indexed: 01/03/2023]
Abstract
Magnetic resonance (MR) arthrography is currently the gold standard radiological investigation for shoulder joint instability. Not only does this investigation allow for identification of important disease processes, but the reduced slice thickness and increased in-plane resolution allowed by the latest imaging sequences also gives excellent demonstration of shoulder joint internal anatomy. This article describes the technique of MR arthrography of the shoulder practiced at our institution, briefly outlining features of the FIESTA (fast imaging employing steady state acquisition) MR sequence employed, including its advantages and limitations. A pictorial review of shoulder MR arthrography performed with this technique is presented, concentrating on normal shoulder joint internal anatomy and anatomical variants that may mimic pathology.
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Affiliation(s)
- D Yu
- Department of Radiology, Nottingham University Hospitals NHS Trust, Queen's Medical Centre, Nottingham, United Kingdom.
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Affiliation(s)
- V K Wong
- Queen's Medical Centre, Nottingham NG7 2UH, UK.
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Turmezei TD, Poole KES. Computed tomography of subchondral bone and osteophytes in hip osteoarthritis: the shape of things to come? Front Endocrinol (Lausanne) 2011; 2:97. [PMID: 22649393 PMCID: PMC3355868 DOI: 10.3389/fendo.2011.00097] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.9] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/24/2011] [Accepted: 11/21/2011] [Indexed: 11/13/2022] Open
Abstract
Bone is a fundamental component of the disordered joint homeostasis seen in osteoarthritis, a disease that has been primarily characterized by the breakdown of articular cartilage accompanied by local bone changes and a limited degree of joint inflammation. In this review we consider the role of computed tomography imaging and computational analysis in osteoarthritis research, focusing on subchondral bone and osteophytes in the hip. We relate what is already known in this area to what could be explored through this approach in the future in relation to both clinical research trials and the underlying cellular and molecular science of osteoarthritis. We also consider how this area of research could impact on our understanding of the genetics of osteoarthritis.
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Affiliation(s)
- Tom D. Turmezei
- Department of Radiology, Addenbrooke’s Hospital, Cambridge University Hospitals NHS TrustCambridge, UK
- Bone Research Group, Department of Medicine, Addenbrooke’s Hospital, University of CambridgeCambridge, UK
- *Correspondence: Tom D. Turmezei, Bone Research Group, Department of Medicine, Addenbrooke’s Hospital, Level 5, Box 157, Hills Road, Cambridge CB2 0QQ, UK. e-mail:
| | - Ken E. S. Poole
- Bone Research Group, Department of Medicine, Addenbrooke’s Hospital, University of CambridgeCambridge, UK
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Wong VK, Lissack ME, Turmezei TD, Maitland JA. Salmonella pyomyositis complicating sickle cell anemia: a case report. J Med Case Rep 2010; 4:198. [PMID: 20591146 PMCID: PMC2904793 DOI: 10.1186/1752-1947-4-198] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2009] [Accepted: 06/30/2010] [Indexed: 01/22/2023] Open
Abstract
Introduction Pyomyositis is a bacterial infection of skeletal muscle and a rare complication of sickle cell anemia. It may present a difficult problem in diagnosis, leading to delay in appropriate treatment and development of complications including abscess formation and osteomyelitis. Case presentation We report the case of a 44-year-old Afro-Caribbean woman with homozygous sickle cell disease who presented with chest crisis and later developed pyomyositis of her hip and pelvic muscles. Salmonella agbeni was isolated from blood cultures and magnetic resonance imaging confirmed the diagnosis in this case. It is noteworthy of this case that there were no antecedent signs of gastroenteritis. Drainage was not appropriate and she was treated with intravenous antibiotics for six weeks. Conclusions Focal Salmonella infections are uncommon in soft tissue. Pyomyositis should be considered in patients with sickle cell anemia that continue to have muscle pain and high fevers, despite initial management of their sickle cell crisis. Radiological imaging, particularly magnetic resonance imaging, is a crucial tool in establishing the diagnosis.
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Affiliation(s)
- Vanessa K Wong
- Department of Microbiology, Queen's Medical Centre, Derby Road, Nottingham, NG7 2UH, UK.
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