Detection of Osteophytes and Subchondral Cysts in the Knee with Use of Tomosynthesis
ABSTRACT To evaluate the diagnostic performance of tomosynthesis in depicting osteophytes and subchondral cysts, with use of magnetic resonance (MR) imaging as the reference, and to test whether the lesions detected at radiography and tomosynthesis are associated with pain.
The study was approved by local institutional review board, and all subjects gave written informed consent. Forty subjects (80 knees) older than 40 years were recruited irrespective of knee pain or radiographic osteoarthritis. Knees were imaged with radiography, tomosynthesis, and MR imaging. Presence of osteophytes and subchondral cysts in four locations of tibiofemoral joint (medial and lateral femur and tibia) was recorded. Knee pain was assessed by using the Western Ontario and McMaster University pain subscale.
MR imaging depicted 171 osteophytes and 51 subchondral cysts. Tomosynthesis had a higher sensitivity for osteophyte detection in left and right lateral femur (0.96 vs 0.75, P = .025, and 1.00 vs 0.71, P = .008, respectively), right medial femur (0.94 vs 0.72, P = .046), and right lateral tibia (1.00 vs 0.83, P = .046). For subchondral cyst detection, the sensitivity of tomosynthesis was 0.14-1.00 and that of radiography was 0.00-0.56. Both modalities had similar specificity for both lesions. Subjects with tomosynthesis-depicted osteophytes (odds ratio, 4.2-6.4; P = .001-.011) and medially located subchondral cysts (odds ratio, 6.7-17.8; P = .004-.03) were more likely to feel pain than those without. However, radiography-depicted osteophytes were more strongly associated with pain than were tomosynthesis-depicted osteophytes.
Tomosynthesis depicted more osteophytes and subchondral cysts than did radiography. Subjects with tomosynthesis-depicted osteophytes and subchondral cysts were more likely to feel pain than those without such lesions.
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ABSTRACT: Chest tomosynthesis is a relatively recently introduced technique in healthcare, which produces section images of the chest at a lower radiation dose than computed tomography (CT) and with better depth resolution than conventional chest radiography. The primary aims of the studies described in this dissertation were to compare chest tomosynthesis with conventional radiography, to evaluate the effects of clinical experience and learning with feedback on the performance of observers analyzing tomosynthesis images, and to investigate the effect of radiation dose level in tomosynthesis, in the detection of pulmonary nodules. Human observer studies were performed, in which radiologists were instructed to localize and rate pulmonary nodules in patient images. Chest CT was used as reference. The observers' performance regarding the detection of nodules was used as measure of detectability. The results of the studies indicate that the detection of pulmonary nodules is better in chest tomosynthesis than in conventional chest radiography, that experienced thoracic radiologists can quickly adapt to the new technique, that inexperienced observers may perform at a similar level to experienced radiologists after a learning session with feedback, and that a substantial reduction in the effective dose to the patient may be possible.05/2014, Degree: PhD, Supervisor: Magnus Båth, Lars Gunnar Månsson, Åse Allansdotter Johnsson
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ABSTRACT: OBJECTIVES AND METHODS: A variety of benign cystic or "cyst-like" lesions may be encountered during a routine magnetic resonance imaging (MRI) of the knee. These lesions comprise a diverse group of entities from benign cysts to complications of underlying diseases. In addition, normal anatomic bursae and recesses may be misdiagnosed as an intra-articular cystic lesion when they are distended. However, the majority of the aforementioned lesions have characteristic MR appearances that allow a confident diagnosis, thus obviating the need for additional imaging or interventional procedures. RESULTS: This article includes a comprehensive pictorial essay of the characteristic MRI features of common and uncommon benign cysts and "cyst-like" lesions in and around the knee joint. DISCUSSION: For accurate assessment of the "cystic structure", a radiologist should be able to identify typical MRI patterns that contribute in establishing the correct diagnosis and thus guiding specific therapy and avoiding unwarranted interventional procedures such as biopsy or arthroscopy. TEACHING POINTS: • Cystic lesions are common in knee MRI and the commonest, the Baker's cyst, has an incidence of 38 %. • Synovial cysts, meniscal cysts, normal knee bursae and recesses have characteristic MR appearances. • Miscellaneous "cyst-like" lesions may require a more dedicated MR protocol for a correct diagnosis.03/2013; 4(3). DOI:10.1007/s13244-013-0240-1
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ABSTRACT: Background To determine the validity of a semi-automated segmentation of bone marrow lesions (BMLs) in the knee. Methods Construct validity of the semi-automated BML segmentation method was explored in two studies performed using sagittal intermediate weighted, turbo spine echo, fat-suppressed magnetic resonance imaging sequences obtained from the Osteoarthritis Initiative. The first study (n = 48) evaluated whether tibia BML volume was different across Boston Leeds Osteoarthritis Knee Scores (BLOKS) for tibia BMLs (semiquantitative grades 0 to 3). In the second study (n = 40), we evaluated whether BML volume change was associated with changes in cartilage parameters. The knees in both studies were segmented by one investigator. We performed Wilcoxon signed-rank tests to determine if tibia BML volume was different between adjacent BLOKS BML scores and calculated Spearman correlation coefficients to assess the relationship between 2-year BML volume change and 2-year cartilage morphometry change (significance was p ≤ 0.05). Results BML volume was significantly greater between BLOKS BML score 0 and 1 (z = 2.85, p = 0.004) and BLOKS BML scores 1 and 2 (z = 3.09, p = 0.002). There was no significant difference between BLOKS BML scores 2 and 3 (z = −0.30, p = 0.77). Increased tibia BML volume was significantly related to increased tibia denuded area (Spearman r = 0.42, p = 0.008), decreased tibia cartilage thickness (Spearman r = −0.46, p = 0.004), increased femur denuded area (Spearman r = 0.35, p = 0.03), and possibly decreased femur cartilage thickness (Spearman r = −0.30, p = 0.07) but this last finding was not statistically significant. Conclusion The new, efficient, and reliable semi-automated BML segmentation method provides valid BML volume measurements that increase with greater BLOKS BML scores and confirms previous reports that BML size is associated with longitudinal cartilage loss.BMC Musculoskeletal Disorders 01/2013; 14(1):3. DOI:10.1186/1471-2474-14-3 · 1.90 Impact Factor