Magnetic Resonance Imaging-Based Semiquantitative and Quantitative Assessment in Osteoarthritis

doi:10.1016/j.rdc.2009.08.006

Rheumatic Disease Clinics of North America

Volume 35, Issue 3, August 2009, Pages 521-555

https://doi.org/10.1016/j.rdc.2009.08.006 Get rights and content

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Whole Joint Assessment on Magnetic Resonance Imaging of the Knee

Whole organ assessment of scoring different joint structures on MRI has shown adequate reliability, specificity, and sensitivity, as well as an ability to detect lesion progression.13, 21, 27, 34, 35 To date, 3 SQ scoring systems for whole organ assessment of knee OA have been published and have been applied in epidemiologic studies or clinical trials: the Whole Organ Magnetic Resonance Imaging Score (WORMS),¹³ the Knee Osteoarthritis Scoring System (KOSS),²¹ and the Boston-Leeds Osteoarthritis

Quantitative measurement of cartilage in osteoarthritis

Quantitative measurement of the cartilage exploits the 3D nature of MRI data sets to assess tissue dimensions (ie, volume, thickness, or others) or signal as continuous variables (Fig. 18). The strength of this approach is that it is less observer dependent and more objective than scoring methods, and that relatively small changes in cartilage morphology over time, which occur over larger areas, may be detected, although they are not apparent to the naked eye. Recently it was reported that

Future directions

The OAI is a recent large research study jointly sponsored by public institutions such as the National Institutes of Health and the National Institute of Arthritis and Musculoskeletal and Skin Diseases, and the pharmaceutical industry, with almost 5000 participants being studied for a period of 4 years using 3 T MRI (approximately 1500 with symptomatic and radiographic OA and approximately 3500 with risk factors of OA). Year-4 acquisitions have begun and baseline, year-1, and year-2 follow-up

Summary

With several large, currently ongoing epidemiologic studies, huge amounts of image data are being acquired and, in the case of the OAI, made publicly available. These data will allow the research community ample opportunity to use SQ, quantitative, and compositional MRI assessment to deepen knowledge on risk factors for disease development and progression. In addition, novel analytical approaches will have to be developed to define those subcohorts that will be of relevance for answering

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High-resolution CINE imaging of active guided knee motion using continuously acquired golden-angle radial MRI and rotary sensor information
2022, Magnetic Resonance Imaging
Citation Excerpt :
Prior work presented CINE knee images from 2D dynamic data with spatial resolution between 0.7 and 1.17 mm2 acquired with Cartesian sequences [8–13,15–17]. To synchronize the joint motion with data acquisition and reconstruction, these studies used optical sensors and transducers [4,5,10,11], a plethysmograph [10,11], or a pseudo-electrocardiogram via a pneumatic pressure transducer [12,13,17] to mark a position in the motion cycle that acted as a trigger for the MRI acquisition. One potential problem with such an approach is inconsistent joint motion throughout the motion cycles.
To explore and extend on dynamic imaging of joint motion, an MRI-safe device guiding knee motion with an attached rotary encoder was used in MRI measurements of multiple knee flexion-extension cycles using radial gradient echo imaging with the golden-angle as azimuthal angle increment. Reproducibility of knee motion was investigated. Real-time and CINE mode anatomical images were reconstructed for different knee flexion angles by synchronizing the encoder information with the MRI data, and performing flexion angle selective gating across multiple motion cycles. When investigating the influence of the rotation angle window width on reconstructed CINE images, it was found that angle windows between 0.5° and 3° exhibited acceptable image sharpness without suffering from significant motion-induced blurring. Furthermore, due to flexible retrospective image reconstruction afforded by the radial golden-angle imaging, the number of motion cycles included in the reconstruction could be retrospectively reduced to investigate the corresponding influence of acquisition time on image quality. Finally, motion reproducibility between motion cycles and accuracy of the flexion angle selective gating were sufficient to acquire whole-knee 3D dynamic imaging with a retrospectively gated 3D cone UTE sequence.
Gender-related differences in concomitant articular injuries after acute lateral patellar dislocation
2021, Injury
To explore the gender differences in the concomitant articular injuries after acute lateral patellar dislocation (LPD).
Magnetic resonance images were prospectively analyzed in 166 patients after an acute LPD. Concomitant articular injuries included bone contusion, medial patellofemoral ligament (MPFL) injury, articular cartilage lesion, and vastus medialis obliquus (VMO) lesion. Statistical analyses were performed between the patient's gender and the incidence of concomitant articular injuries in adolescent and adult subgroups.
The incidence of partial and complete MPFL tear in adolescent males and females were (45%, 50%) and (63.2%, 29.8%), respectively. Compared with adolescent females, adolescent males showed higher incidence of complete MPFL tear (P = 0.049). The incidence of articular cartilage lesion of patella in adolescent males and females were 40% and 21.1%, respectively. Compared with adolescent females, adolescent males showed higher incidence of articular cartilage lesion of the patella (P = 0.043). No correlations were identified in other injuries in the adolescent group. The incidence of partial and complete MPFL tear in adult males and females were (34.4%, 65.6%) and (56.8%, 37.8%), respectively. Compared with adult females, adult males showed higher incidence of complete MPFL tear (P = 0.036). The incidence of articular cartilage lesion of patella in adult males and females were 56.3% and 32.4%, respectively. Compared with adult females, adult males showed higher incidence of articular cartilage lesion of patella (P = 0.047). The incidence of VMO injury in adult males and females were 59.4% and 35.1%, respectively. Compared with adult females, adult males showed higher incidence of VMO injury (P = 0.044). No correlations were identified in other injuries in the adult group.
Compared with females, males predispose to complete MPFL tear and articular cartilage lesion of patella after acute LPD. Compared with female adults, male adults predispose to VMO injury.
Injury patterns of medial patellofemoral ligament and correlation analysis with articular cartilage lesions of the lateral femoral condyle after acute lateral patellar dislocation in adults: An MRI evaluation
2015, Injury
Citation Excerpt :
Lastly, the cartilage-specific sequences were not applied in the MR examinations, such as spoiled gradient-recalled echo and fast low-angle shot sequences, which provide a high spatial resolution and have therefore been described as being useful in segmenting techniques for quantitative cartilage studies. However, the disadvantages of these sequences are a high sensitivity to susceptibility artefacts and a limited visualisation of the subchondral bone, menisci and ligaments [35,52,53]. Previous reports also showed that 1.5 T MRI with fat-suppressed fast spin-echo proton-density-weighted sequences can be used to evaluate the cartilage of the knee with accuracy comparable to that of other cartilage-specific sequence protocols [35,54,55].
The purpose of this study was to investigate the injury characteristics of medial patellofemoral ligament (MPFL), and to analyse the correlations between the injury patterns of MPFL and articular cartilage lesions of the lateral femoral condyle in adults with acute lateral patellar dislocation (LPD).
Magnetic resonance (MR) images were prospectively obtained in 121 consecutive adults with acute LPD. Images were acquired using standardised protocols and these were independently evaluated by two radiologists.
Forty-eight cases of partial MPFL tear and 71 cases of complete MPFL tear were identified. Injuries occurred at an isolated femoral attachment (FEM) in 48 cases, an isolated patellar insertion (PAT) in 36 cases and an isolated mid-substance (MID) in five cases. More than one site of injury to the MPFL (COM) was identified in 30 cases.
The prevalence rate of chondral and osteochondral lesions of the lateral femoral condyle were 4.2% (2/48) and 6.3% (3/48) in the FEM subgroup, 19.4% (7/36) and 22.2% (8/36) in the PAT subgroup and 6.7% (2/30) and 13.3% (4/30) in the COM subgroup, respectively. The PAT subgroup showed significantly higher prevalence rate of chondral and osteochondral lesions in the lateral femoral condyle when compared with the FEM subgroup.
The prevalence rate of chondral and osteochondral lesions of the lateral femoral condyle were 8.5% (6/71) and 19.7% (14/71) in the complete MPFL tear subgroup and 10.4% (5/48) and 4.2% (2/58) in the partial MPFL tear subgroup, respectively. The subgroup of the complete MPFL tear showed significantly higher prevalence rate of osteochondral lesions in the lateral femoral condyle when compared with the subgroup of the partial MPFL tear.
Firstly, the MPFL is most easily injured at the FEM, and secondly at the PAT in adults after acute LPD. The complete MPFL tear is more often concomitant with osteochondral lesions of the lateral femoral condyle than the partial MPFL tear. The isolated patellar-sided MPFL tear is more easily concomitant with chondral lesions and osteochondral lesions of the lateral femoral condyle than the isolated femoral-sided MPFL tear.
Injury patterns of medial patellofemoral ligament and correlation analysis with articular cartilage lesions of the lateral femoral condyle after acute lateral patellar dislocation in children and adolescents: An MRI evaluation
2015, Injury
The purpose of this study was to investigate the injury characteristics of medial patellofemoral ligament (MPFL), and to analyse the correlations between the injury patterns of MPFL and articular cartilage lesions of the lateral femoral condyle in children and adolescents with acute lateral patellar dislocation (LPD).
Magnetic resonance (MR) images were prospectively obtained in 127 consecutive children and adolescents with acute LPD. Images were acquired using standardised protocols and these were independently evaluated by two radiologists.
Fifty-four cases of partial MPFL tear and 69 cases of complete MPFL tear were identified. Injuries occurred at an isolated patellar insertion (PAT) in 47 cases, an isolated femoral attachment (FEM) in 41 cases and an isolated mid-substance (MID) in four cases. More than one site of injury to the MPFL (COM) was identified in 31 cases.
The prevalence rate of chondral and osteochondral lesions of the lateral femoral condyle were 23.4% (11/47) and 29.8% (14/47) in the PAT subgroup, 7.3% (3/41) and 9.8% (4/41) in the FEM subgroup and 25.8% (8/31) and 32.3% (10/31) in the COM subgroup, respectively. The PAT and COM subgroups showed significantly higher prevalence rate of chondral and osteochondral lesions in the lateral femoral condyle when compared with the FEM subgroup.
The prevalence rate of chondral and osteochondral lesions of the lateral femoral condyle were 17.4% (12/69) and 30.4% (21/69) in the complete MPFL tear subgroup and 20.4% (11/54) and 13% (7/54) in the partial MPFL tear subgroup, respectively. The subgroup of the complete MPFL tear showed significantly higher prevalence rate of osteochondral lesions in the lateral femoral condyle when compared with the subgroup of the partial MPFL tear.
Firstly, the MPFL is most easily injured at the PAT, and secondly at the FEM in children and adolescents after acute LPD. The complete MPFL tear is more often concomitant with osteochondral lesions of the lateral femoral condyle than the partial MPFL tear. The isolated patellar-sided MPFL tear and the combined MPFL tear are more easily concomitant with chondral lesions and osteochondral lesions of the lateral femoral condyle than the isolated femoral-sided MPFL tear.
2D and 3D MOCART scoring systems assessed by 9.4T high-field MRI correlate with elementary and complex histological scoring systems in a translational model of osteochondral repair
2014, Osteoarthritis and Cartilage
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Magnetic resonance imaging (MRI) is of great value for translational studies of osteochondral repair1–3. MRI is the major noninvasive tool to assess the structure of normal and osteoarthritic articular cartilage and cartilaginous repair tissues4–10. Particularly the development of the 2D and 3D MOCART system has greatly influenced and advanced non-destructive investigations of cartilage repair11–14.
To compare the 2D and 3D MOCART system obtained with 9.4 T high-field magnetic resonance imaging (MRI) for the ex vivo analysis of osteochondral repair in a translational model and to correlate the data with semiquantitative histological analysis.
Osteochondral samples representing all levels of repair (sheep medial femoral condyles; n = 38) were scanned in a 9.4 T high-field MRI. The 2D and adapted 3D MOCART systems were used for grading after point allocation to each category. Each score was correlated with corresponding reconstructions between both MOCART systems. Data were next correlated with corresponding categories of an elementary (Wakitani) and a complex (Sellers) histological scoring system as gold standards.
Correlations between most 2D and 3D MOCART score categories were high, while mean total point values of 3D MOCART scores tended to be 15.8–16.1 points higher compared to the 2D MOCART scores based on a Bland–Altman analysis. “Defect fill” and “total points” of both MOCART scores correlated with corresponding categories of Wakitani and Sellers scores (all P ≤ 0.05). “Subchondral bone plate” also correlated between 3D MOCART and Sellers scores (P < 0.001).
Most categories of the 2D and 3D MOCART systems correlate, while total scores were generally higher using the 3D MOCART system. Structural categories “total points” and “defect fill” can reliably be assessed by 9.4 T MRI evaluation using either system, “subchondral bone plate” using the 3D MOCART score. High-field MRI is valuable to objectively evaluate osteochondral repair in translational settings.
Assessment of hyaline cartilage matrix composition using near infrared spectroscopy
2014, Matrix Biology
Changes in the composition of the extracellular matrix (ECM) are characteristic of injury or disease in cartilage tissue. Various imaging modalities and biochemical techniques have been used to assess the changes in cartilage tissue but lack adequate sensitivity, or in the case of biochemical techniques, result in destruction of the sample. Fourier transform near infrared (FT-NIR) spectroscopy has shown promise for the study of cartilage composition. In the current study NIR spectroscopy was used to identify the contributions of individual components of cartilage in the NIR spectra by assessment of the major cartilage components, collagen and chondroitin sulfate, in pure component mixtures. The NIR spectra were obtained using homogenous pellets made by dilution with potassium bromide. A partial least squares (PLS) model was calculated to predict composition in bovine cartilage samples. Characteristic absorbance peaks between 4000 and 5000 cm⁻¹ could be attributed to components of cartilage, i.e. collagen and chondroitin sulfate. Prediction of the amount of collagen and chondroitin sulfate in tissues was possible within 8% (w/dw) of values obtained by gold standard biochemical assessment. These results support the use of NIR spectroscopy for in vitro and in vivo applications to assess matrix composition of cartilage tissues, especially when tissue destruction should be avoided.

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: A version of this article originally appeared in the 47:4 issue of Radiologic Clinics of North America.

: Disclosure: A.G. is president of Boston Imaging Core Lab, LLC (BICL), Boston, MA, a company providing radiological image assessment services. He is shareholder of Synarc, Inc. F.W.R. is shareholder of BICL. F.E. is co-owner and CEO of Chondrometrics GmbH; he provides consulting services to Pfizer Inc, Merck Serono Inc, Wyeth Inc, Novo Nordisk Inc, and Novartis Inc.

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