MRI protocols for whole-organ assessment of the knee in osteoarthritis

Synarc Inc., San Francisco, CA 94105, USA.
Osteoarthritis and Cartilage (Impact Factor: 4.17). 02/2006; 14 Suppl A(supplement 1):A95-111. DOI: 10.1016/j.joca.2006.02.029
Source: PubMed


One of the critical challenges in developing structure-modifying therapies for arthritis, especially osteoarthritis (OA), is measuring changes in progression of joint destruction. Magnetic resonance imaging (MRI) offers considerable promise in this regard. Not only can MRI quantify articular cartilage volume and morphology with high precision and accuracy, but it can also examine several other important articular components, and thus offer a unique opportunity to evaluate the knee and other joints as whole organs. On December 5 and 6, 2002, OMERACT (Outcome Measures in Rheumatology Clinical Trials) and OARSI (Osteoarthritis Research Society International), with support from various pharmaceutical companies listed at the beginning of this supplement, held a Workshop for Consensus on Osteoarthritis Imaging in Bethesda, MD. The aim of the Workshop was to provide a state-of-the-art review of imaging outcome measures for OA of the knee to help guide scientists and pharmaceutical companies who want to use MRI in multi-site studies of OA. Applications of MRI were initially reviewed by a multidisciplinary, international panel of expert scientists and physicians from academia, the pharmaceutical industry and regulatory agencies. The findings of the panel were then presented to a wider group of participants for open discussion. The following report summarizes the results of these discussions with respect to MRI acquisition techniques for whole-organ assessment of the knee in OA. The discussion reviews the selection and qualification of imaging sites for clinical trials, designing imaging protocols for whole-organ assessment of OA, and key considerations in image quality (IQ) control and data management.

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Available from: Bernard Dardzinski, Oct 08, 2014
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    • "Furthermore, T 1w GE sequences can adopt Fat Suppression (FS) to increase the contrast between the bone and cartilage removing most of the signal from the bone, so providing a sharper delineation of the BCI[5]. Three-dimensional fat suppressed spoiled gradient-echo (FS SPGR)[5]and DESS (Dual Echo Steady State)[17]sequences are commonly used in clinical examinations for the quantitative imaging of the cartilage. SPGR[7]and DESS sequences adopt FS to increase the contrast of the cartilage and evidence micro lesions. "
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    ABSTRACT: Segmentation of cartilage from Magnetic Resonance (MR) images has evolved as a tool for the diagnosis of knee joint pathologies. However, accuracy and reproducibility of automated methods of cartilage segmentation may require the prior extraction of bone surfaces from MR imaging sequences specifically designed to evidence the cartilage and not the bone. Thus a priori knowledge of knee joint structures and fully automated segmentation methods are adopted to provide reliable detection of bone surfaces. In this paper, we review knee bone segmentation methods from MR images. We classified the methods proposed in literature according to the level of a priori knowledge, the level of automation and the level of manual user interaction. Furthermore we discuss the segmentation results in literature in relation to the MR sequences used to image the bone.
    Full-text · Article · Feb 2016 · Biocybernetics and Biomedical Engineering
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    • "Subchondral bone marrow lesions (BMLs) are common findings on magnetic resonance (MR) images of knees with osteoarthritis (OA) and relate to structural and symptomatic progression of OA [1] [2] [3]. While BMLs are often assessed on intermediate-weighted fat suppressed (IW FS) or similar sequences [4] some researchers have also evaluated BMLs on 3-dimensional dual echo steady state (3D DESS) sequences or other similar sequences that are used for cartilage measurements [5]. The latter approach enables a time-and costefficient method to assess changes in BMLs and cartilage on the same sequence [6]. "
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    ABSTRACT: Subchondral bone marrow lesions (BMLs) are related to structural and symptomatic osteoarthritis progression. However, it is unclear how sequence selection influences a quantitative BML measurement and its construct validity. We compared quantitative assessment of BMLs on intermediate-weighted fat suppressed (IW FS) turbo spin echo and 3-dimensional dual echo steady state (3D DESS) sequences. We used a customized software to measure 30 knees’ (24- and 48-month MR images) BMLs on both sequences. The results showed that the IW FS sequences have much larger BML volumes (median: IW FS = 1840 mm 3 ; DESS = 191 mm 3 ) and BML volume change (between 24 and 48 months) than DESS sequence and demonstrate more BML volume change. The 24-month BML volume on IW FS is correlated with BML volume on DESS ( r s = 0.83). BML volume change on IW FS is not significantly correlated with change on DESS. The 24-month WOMAC pain is correlated with the 24-month BMLs on IW FS ( r s = 0.39) but not DESS. The change in WOMAC pain is correlated with BML volume change on IW FS ( r s = 0.37) but not DESS. Overall, BML quantification on IW FS offers better validity and statistical power than BML quantification on a 3D DESS sequence.
    Full-text · Article · Nov 2015
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    • "A board-certified radiologist (WV) with 7 years of experience and a fourth-year radiology resident (LN) with 3 years of experience read the images independently and graded meniscus, cartilage, and bone marrow lesions. Cartilage and bone marrow lesions were assessed in five compartments (patella, medial femur, medial tibia, lateral femur, and lateral tibia) by using a modified semi-quantitative WORMS [16,26,27], and the highest grade of lesion was recorded for each region. In case of disagreement, a consensus reading was performed with a musculoskeletal radiologist with 22 years of experience (TML). "
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    ABSTRACT: The goals of this study were (i) to compare the prevalence of focal knee abnormalities, the mean cartilage T2 relaxation time, and the spatial distribution of cartilage magnetic resonance (MR) T2 relaxation times between subjects with and without risk factors for Osteoarthritis (OA), (ii) to determine the relationship between MR cartilage T2 parameters, age and cartilage morphology as determined with whole-organ magnetic resonance imaging scores (WORMS) and (iii) to assess the reproducibility of WORMS scoring and T2 relaxation time measurements including the mean and grey level co-occurrence matrix (GLCM) texture parameters. Subjects with risk factors for OA (n = 92) and healthy controls (n = 53) were randomly selected from the Osteoarthritis Initiative (OAI) incidence and control cohorts, respectively. The specific inclusion criteria for this study were (1) age range 45-55 years, (2) body mass index (BMI) of 19-27 kg/m2, (3) Western Ontario and McMaster University (WOMAC) pain score of zero and (4) Kellgren Lawrence (KL) score of zero at baseline. 3.0 Tesla MR images of the right knee were analyzed using morphological gradings of cartilage, bone marrow and menisci (WORMS) as well as compartment specific cartilage T2 mean and heterogeneity. Regression models adjusted for age, gender, and BMI were used to determine the difference in cartilage parameters between groups. While there was no significant difference in the prevalence of knee abnormalities (cartilage lesions, bone marrow lesions, meniscus lesions) between controls and subjects at risk for OA, T2 parameters (mean T2, GLCM contrast, and GLCM variance) were significantly elevated in those at risk for OA. Additionally, a positive significant association between cartilage WORMS score and cartilage T2 parameters was evident. Overall, this study demonstrated that subjects at risk for OA have both higher and more heterogeneous cartilage T2 values than controls, and that T2 parameters are associated with morphologic degeneration.
    Full-text · Article · Sep 2011 · Arthritis research & therapy
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