Jukka S Jurvelin

University of Eastern Finland, Kuopio, Northern Savo, Finland

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Publications (436)1041.68 Total impact

  • No preview · Article · Jan 2016 · SIAM Journal on Scientific Computing
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    ABSTRACT: Site-specific variation of collagen fibril orientations can affect cartilage stresses in knee joints. However, this has not been confirmed by 3-D analyses. Therefore, we present a novel method for evaluation of the effect of patient-specific collagen architecture on time-dependent mechanical responses of knee joint cartilage during gait. 3-D finite element (FE) models of a human knee joint were created with the collagen architectures obtained from T2 mapped MRI (patient-specific model) and from literature (literature model). The effect of accuracy of the implementation of collagen fibril architecture into the model was examined by using a submodel with denser FE mesh. Compared to the literature model, fibril strains and maximum principal stresses were reduced especially in the superficial/middle regions of medial tibial cartilage in the patient-specific model after the loading response of gait (up to -413 and -26%, respectively). Compared to the more coarsely meshed joint model, the patient-specific submodel demonstrated similar strain and stress distributions but increased values particularly in the superficial cartilage regions (especially stresses increased >60%). The results demonstrate that implementation of subject-specific collagen architecture of cartilage in 3-D modulates location- and time-dependent mechanical responses of human knee joint cartilage. Submodeling with more accurate implementation of collagen fibril architecture alters cartilage stresses particularly in the superficial/middle tissue.
    No preview · Article · Dec 2015 · Computer Methods in Biomechanics and Biomedical Engineering
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    ABSTRACT: Contrast enhanced computed tomography (CECT) has been proposed for diagnostics of cartilage and meniscus injuries and degeneration. As both tissues may be imaged simultaneously, CECT could provide a method for comprehensive evaluation of knee joint health. Since the composition and structure of cartilage and meniscus are different, we hypothesize that transport characteristics of anionic contrast agents also differ between the tissues. This would affect interpretation of CECT images and warrants investigation. To clarify this, we aimed to determine the transport kinematics of anionic iodine (q = -1, M = 126.9 g/mol), assumed to not be significantly affected by the steric hindrance, thus providing faster transport than large molecule contrast agents (e.g., ioxaglate). Cylindrical samples (d = 6 mm, h = 2 mm) were prepared from healthy bovine (n = 10) patella and meniscus, immersed in isotonic phosphate-buffered NaI solution (20 mgI/mL), and subsequently imaged with a micro-CT at 20 time points up to 23 h. Subsequently, normalized attenuation and contrast agent flux, as well as water, collagen, and proteoglycan (PG) contents in the tissues were determined. Normalized attenuation at equilibrium was higher (p = 0.005) in meniscus. Contrast agent flux was lower (p = 0.005) in the meniscus at 10 min, but higher (p < 0.05) between 30 and 120 min. In both tissues, contrast agent distribution at equilibrium suggested an inverse agreement with the depth-wise PG distribution. In conclusion, iodine transport into cartilage and meniscus was different, especially between the first 2 hours after the immersion. This is an important finding which should be considered during simultaneous CECT of cartilage and meniscus.
    No preview · Article · Dec 2015 · Annals of Biomedical Engineering
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    ABSTRACT: Knowledge about simultaneous contributions of tissue microstructure and elastic properties on ultrasound speed in cortical bone is limited. In a previous study, porosities and elastic coefficients of cortical bone in human femurs were shown to change with age. In the present study, influences of inter-individual and site-dependent variation in cortical bone microstructure and elastic properties on radial speed of sound (SOS; at 4, 6, and 8 MHz) were investigated using three-dimensional (3D) finite difference time domain modeling. Models with fixed (nominal model) and sample-specific (sample-specific model) values of radial elastic coefficients were compared. Elastic coefficients and microstructure for samples (n = 24) of human femoral shafts (n = 6) were derived using scanning acoustic microscopy and micro-computed tomography images, respectively. Porosity-related SOS varied more extensively in nominal models than in sample-specific models. Linear correlation between pore separation and SOS was similar (R = 0.8, p < 0.01, for 4 MHz) for both models. The determination coefficient (R2= 0.75, p < 0.05) between porosity and radial SOS, especially at 4 MHz, was highest in the posterior quadrant. The determination coefficient was lower for models with sample-specific values of radial elastic coefficient implemented (R2 < 0.33, p < 0.05), than for nominal models (0.48 < R2< 0.63, p < 0.05). This information could be useful in in vivo pulse-echo cortical thickness measurements applying constant SOS.
    No preview · Article · Dec 2015 · The Journal of the Acoustical Society of America

  • No preview · Article · Nov 2015 · Cartilage
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    ABSTRACT: Due to the lack of diagnostics in primary health care, over 75 % of osteoporotic patients are not diagnosed. A new ultrasound method for primary health care is proposed. Results suggest applicability of ultrasound method for osteoporosis diagnostics at primary health care. Introduction We lack effective screening and diagnostics of osteoporosis at primary health care. In this study, a new ultrasound (US) method is proposed for osteoporosis diagnostics. Methods A total of 572 Caucasian women (age 20 to 91 years) were examined using pulse-echo US measurements in the tibia and radius. This method provides an estimate of bone mineral density (BMD), i.e. density index (DI). Areal BMD measurements at the femoral neck (BMDneck) and total hip (BMDtotal) were determined by using axial dual-energy X-ray absorptiometry (DXA) for women older than 50 years of age (n = 445, age = 68.8 ± 8.5 years). The osteoporosis thresholds for the DI were determined according to the International Society for Clinical Densitometry (ISCD). Finally, the FRAX questionnaire was completed by 425 participants. Results Osteoporosis was diagnosed in individuals with a T-score −2.5 or less in the total hip or femoral neck (n = 75). By using the ISCD approach for the DI, only 28.7 % of the subjects were found to require an additional DXA measurement. Our results suggest that combination of US measurement and FRAX in osteoporosis management pathways would decrease the number of DXA measurements to 16 % and the same treatment decisions would be reached at 85.4 % sensitivity and 78.5 % specificity levels. Conclusions The present results demonstrate a significant correlation between the ultrasound and DXA measurements at the proximal femur. The thresholds presented here with the application to current osteoporosis management pathways show promise for the technique to significantly decrease the amount of DXA referrals and increase diagnostic coverage; however, these results need to be confirmed in future studies.
    No preview · Article · Nov 2015 · Osteoporosis International
  • Jarkko T Iivarinen · Rami K Korhonen · Jukka S Jurvelin
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    ABSTRACT: Exact physiological mechanisms behind the potential positive treatment effects of pathological tissue swelling (edema), such as increased interstitial fluid flow, are poorly understood. Finite-element model was created and the model response was matched with the deformation data from the negative pressure (suction) measurements in human (N = 11) forearm. Two experimental suction protocols were simulated to evaluate their impact on interstitial fluid flow in soft tissues. Simulated continuous suction was up to 27 times more efficient in fluid transportation compared to the cyclic suction. The continuous suction that transports the interstitial fluid effectively may help to decrease soft tissue edema.
    No preview · Article · Oct 2015 · Computer Methods in Biomechanics and Biomedical Engineering
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    ABSTRACT: Evaluation of articular cartilage and subchondral bone is essential in the diagnosis of joint diseases and injuries. Interobserver and intraobserver reproducibilities of arthroscopic grading are only poor to moderate. Thus, for quantitative and objective evaluation of cartilage and subchondral bone, ultrasound arthroscopy (UA) has been introduced to clarify this dilemma. Assessment of the clinical feasibility of high-frequency ultrasonography (US) during 6 knee arthroscopies was conducted, and the surgical technique is presented. US imaging was conducted with a flexible 9-MHz US catheter inserted into the joint through conventional portals. US and arthroscopy videos were synchronously recorded, and US parameters for cartilage and subchondral bone characteristics were measured. Arthroscopy and US imaging were combined to perform cartilage grading. UA produced quantitative data on lesion size, as well as cartilage quality, and showed subchondral bone changes. Visualization of an osteochondritis dissecans lesion not detected by conventional arthroscopy and US-guided retrograde drilling were possible with UA. To conclude, UA proved to be clinically feasible and aided in the diagnosis when assessing knee osteochondral lesions.
    No preview · Article · Sep 2015 · Arthroscopy Techniques
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    ABSTRACT: This study investigates the relationship between the optical response of human articular cartilage in the visible (VIS) and near infrared (NIR) spectral range and its matrix properties.Full-thickness osteochondral cores (dia. = 16 mm, n = 50) were extracted from human cadaver knees (N = 13) at four anatomical locations and divided into quadrants. Absorption spectra were acquired in the spectral range 400-1100 nm from one quadrant. Reference biomechanical, biochemical composition, histological, and cartilage thickness measurements were obtained from two other quadrants. A multivariate statistical technique based on partial least squares (PLS) regression was then employed to investigate the correlation between the absorption spectra and tissue properties.Our results demonstrate that cartilage optical response correlates with its function, composition and morphology, as indicated by the significant relationship between spectral predicted and measured biomechanical (79.0% ⩽ R(2) ⩽ 80.3%, p < 0.0001), biochemical (65.1% ⩽ R(2) ⩽ 81.0%, p < 0.0001), and histological scores ([Formula: see text] = 83.3%, p < 0.0001) properties. Significant correlation was also obtained with the non-calcified cartilage thickness ([Formula: see text] = 83.2%, p < 0.0001).We conclude that optical absorption of human cartilage in the VIS and NIR spectral range correlates with the overall tissue properties, thus providing knowledge that could facilitate development of systems for rapid assessment of tissue integrity.
    No preview · Article · Aug 2015 · Physiological Measurement
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    ABSTRACT: An attempt to define pre-osteoarthritis (OA) versus early OA and definitive osteoarthritis. A group of specialists in the field of cartilage science and treatment was formed to consider the nature of OA onset and its possible diagnosis. Late-stage OA, necessitating total joint replacement, is the end stage of a biological process, with many previous earlier stages. Early-stage OA has been defined and involves structural changes identified by arthroscopy or radiography. The group argued that before the "early-stage OA" there must exist a stage where cellular processes, due to the presence of risk factors, have kicked into action but have not yet resulted in structural changes. The group suggested that this stage could be called "pre-osteoarthritis" (pre-OA). The group suggests that defining points of initiation for OA in the knee could be defined, for example, by traumatic episodes or surgical meniscectomy. Such events may set in motion metabolic processes that could be diagnosed by modern MRI protocols or arthroscopy including probing techniques before structural changes of early OA have developed. Preventive measures should preferably be applied at this pre-OA stage in order to stop the projected OA "epidemic."
    Full-text · Article · Jul 2015 · Cartilage
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    ABSTRACT: Areal bone mineral density (aBMD), as measured by dual-energy X-ray absorptiometry (DXA), predicts hip fracture risk only moderately. Simulation of bone mechanics based on DXA imaging of the proximal femur, may help to improve the prediction accuracy. Therefore, we collected three (1-3) image sets, including CT images and DXA images of 34 proximal cadaver femurs (set 1, including 30 males, 4 females), 35 clinical patient CT images of the hip (set 2, including 27 males, 8 females) and both CT and DXA images of clinical patients (set 3, including 12 female patients). All CT images were segmented manually and landmarks were placed on both femurs and pelvises. Two separate statistical appearance models (SAMs) were built using the CT images of the femurs and pelvises in sets 1 and 2, respectively. The 3D shape of the femur was reconstructed from the DXA image by matching the SAMs with the DXA images. The orientation and modes of variation of the SAMs were adjusted to minimize the sum of the absolute differences between the projection of the SAMs and a DXA image. The mesh quality and the location of the SAMs with respect to the manually placed control points on the DXA image were used as additional constraints. Then, finite element (FE) models were built from the reconstructed shapes. Mean point-to-surface distance between the reconstructed shape and CT image was 1.0 mm for cadaver femurs in set 1 (leave-one-out test) and 1.4 mm for clinical subjects in set 3. The reconstructed volumetric BMD showed a mean absolute difference of 140 and 185 mg/cm(3) for set 1 and set 3 respectively. The generation of the SAM and the limitation of using only one 2D image were found to be the most significant sources of errors in the shape reconstruction. The noise in the DXA images had only small effect on the accuracy of the shape reconstruction. DXA-based FE simulation was able to explain 85% of the CT-predicted strength of the femur in stance loading. The present method can be used to accurately reconstruct the 3D shape and internal density of the femur from 2D DXA images. This may help to derive new information from clinical DXA images by producing patient-specific FE models for mechanical simulation of femoral bone mechanics. Copyright © 2015 Elsevier B.V. All rights reserved.
    Full-text · Article · Jun 2015 · Medical image analysis
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    ABSTRACT: The aim was to investigate the applicability of multivariate analysis of optical coherence tomography (OCT) information for determining structural integrity, composition and mechanical properties of articular cartilage. Equine osteochondral samples (N = 65) were imaged with OCT, and their total attenuation and backscattering coefficients (μt and μb) were measured. Subsequently, the Mankin score, optical density (OD), light absorbance in amide I region (Aamide), collagen orientation, permeability (k), fibril network modulus (Ef) and non-fibrillar matrix modulus (Em) of the samples were determined. Partial least squares (PLS) regression model was calculated to predict tissue properties from the OCT signals of the samples. Significant correlations between the measured and predicted mean collagen orientation (R(2) = 0.75, p < 0.0001), k (R(2) = 0.74, p < 0.0001), mean OD (R(2) = 0.73, p < 0.0001), Mankin scores (R(2) = 0.70, p < 0.0001), Em (R(2) = 0.50, p < 0.0001), Ef (R(2) = 0.42, p < 0.0001), and Aamide (R(2) = 0.43, p < 0.0001) were obtained. Significant correlation was also found between μb and Ef (ρ = 0.280, p = 0.03), but not between μt and any of the determined properties of articular cartilage (p > 0.05). Multivariate analysis of OCT signal provided good estimates for tissue structure, composition and mechanical properties. This technique may significantly enhance OCT evaluation of articular cartilage integrity, and could be applied, for example, in delineation of degenerated areas around cartilage injuries during arthroscopic repair surgery. Copyright © 2015. Published by Elsevier Ltd.
    No preview · Article · Jun 2015 · Osteoarthritis and Cartilage
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    ABSTRACT: Collagen, proteoglycans and chondrocytes can contribute to ultrasound scattering in articular cartilage. However, anisotropy of ultrasound scattering in cartilage is not fully characterized. We investigate this using a clinical intravascular ultrasound device with ultrasound frequencies of 9 and 40 MHz. Osteochondral samples were obtained from intact bovine patellas, and cartilage was imaged in two perpendicular directions: through articular and lateral surfaces. At both frequencies, ultrasound backscattering was higher (p < 0.05) when measured through the lateral surface of cartilage. In addition, the composition and structure of articular cartilage were investigated with multiple reference methods involving light microscopy, digital densitometry, polarized light microscopy and Fourier infrared imaging. Reference methods indicated that acoustic anisotropy of ultrasound scattering arises mainly from non-uniform distribution of chondrocytes and anisotropic orientation of collagen fibers. To conclude, ultrasound backscattering in articular cartilage was found to be anisotropic and dependent on the frequency in use. Copyright © 2015 World Federation for Ultrasound in Medicine & Biology. Published by Elsevier Inc. All rights reserved.
    No preview · Article · Apr 2015 · Ultrasound in medicine & biology
  • Mikael J. Turunen · Juha Toyras · Harri T. Kokkonen · Jukka S. Jurvelin
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    ABSTRACT: Contrast agent enhanced cone beam computed tomography (CE-CBCT), a technique capable of high-resolution in vivo imaging with small radiation dose, has been applied successfully for clinical diagnostics of cartilage degeneration, i.e., osteoarthritis (OA). As an X-ray technique, CE-CBCT may also detect changes in mineral density of subchondral bone (volumetric bone mineral density, vBMD), known to be characteristic for OA. However, its feasibility for density measurements is not clear due to limited signal-to-noise ratio and contrast of CBCT images. In the present study, we created clinically applicable hydroxyapatite phantoms and determined vBMDs of cortical bone, trabecular bone, subchondral trabecular bone and subchondral plate of 10 cadaver (ex vivo) and 10 volunteer (in vivo) distal femora using a clinical CBCT scanner, and for reference, also using a conventional CT. Our results indicated strong linear correlations between the vBMD values measured with the CT and CBCT scanners (R2 > 0.90, p < 0.001), however, absolute vBMD values were dependent on the scanner in use. Further, the differences between the vBMDs of cortical bone, trabecular bone and subchondral bone were similar and independent of the scanner. The present results indicate that the vBMD values might not be directly comparable between different instruments. However, based on our present and previous results, we propose that, for OA diagnostics, clinical CBCT enables not only quantitative analysis of articular cartilage but also subchondral bone vBMD. Quantitative information on both cartilage and subchondral bone could be beneficial in OA diagnostics.
    No preview · Article · Apr 2015
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    ABSTRACT: Meniscal injuries can lead to mechanical overloading of articular cartilage and eventually to knee osteoarthritis. The objective was to evaluate the potential using of contrast enhanced computed tomography (CECT) to image contrast agent diffusion in human menisci with a clinical cone beam CT scanner. Isolated human menisci (n=26) were imaged using magnetic resonance imaging (MRI) and CECT in situ. Diffusion of anionic contrast agent into the meniscus was imaged for up to 30 hours. The results of CECT were compared with water, collagen and proteoglycan (PG) contents, biomechanical properties, age and histological and MR images of the samples. Diffusion of contrast agent required over 25 hours to reach equilibrium. The contrast agent partition (the contrast agent concentration in the tissue divided by that in the bath) at the 40 minute time point correlated significantly with that at the 30 hour time point in both lateral (r=0.706, p=0.007) and medial (r=0.669, p=0.012) menisci. Furthermore, contrast agent partition in meniscus after 30 hours of diffusion agreed qualitatively with the distribution of PGs. The cross-sectional distribution of contrast agent was consistent with that reported in a previous μCT study on bovine meniscus. The time required to reach diffusion equilibrium was found impractical for clinical applications. However, based on the present results, shorter delay between injection and imaging (e.g. 40 minutes) could be feasible in clinical diagnostics of meniscal pathologies. Copyright © 2015. Published by Elsevier Ltd.
    No preview · Article · Apr 2015 · Osteoarthritis and Cartilage

  • No preview · Conference Paper · Mar 2015
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    Full-text · Conference Paper · Mar 2015

  • No preview · Conference Paper · Mar 2015
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    ABSTRACT: In this study, we explore topographical changes in proteoglycan distribution from femoral condylar cartilage in early osteoarthritis, acquired from both the lateral and medial condyles of anterior cruciate ligament transected (ACLT) and contralateral (CNTRL) rabbit knee joints, at 4 weeks post operation. Four sites across the cartilage surface in a parasagittal plane were defined across tissue sections taken from femoral condyles and proteoglycan (PG) content was quantified using digital densitometry. The greatest depth-wise change in PG content due to an ACLT (compared to the CNTRL group) was observed anteriorly (site C) from the most weight-bearing location within the lateral compartment. In the medial compartment, the greatest change was observed in the most weight-bearing location (site B). The depth-wise changes in PG content were observed up to 48% and 28% depth from the tissue surface at these aforementioned sites, respectively (p < 0.05). The smallest depth-wise change in PG content was observed posteriorly (site A) from the most weight-bearing location within both femoral condyles (up to 20% and up to 5% depth from the tissue surface at lateral and medial compartments, respectively). This study gives further insight into how early cartilage deterioration progresses across the parasagittal plane of the femoral condyle. This article is protected by copyright. All rights reserved. This article is protected by copyright. All rights reserved.
    No preview · Article · Mar 2015 · Journal of Orthopaedic Research
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    ABSTRACT: Meniscus adapts to joint loads by depth- and site-specific variations in its composition and structure. However, site-specific mechanical characteristics of intact meniscus under compression are poorly known. In particular, mechanical nonlinearities caused by different meniscal constituents (collagen and fluid) are not known. In the current study, in situ indentation testing was conducted to determine site-specific elastic, viscoelastic and poroelastic properties of intact human menisci. Lateral and medial menisci (n=26) were harvested from the left knee joint of 13 human cadavers. Indentation tests, using stress-relaxation and dynamic (sinusoidal) loading protocols, were conducted for menisci at different sites (anterior, middle, posterior, n=78). Sample- and site-specific axisymmetric finite element models with fibril-reinforced poroelastic properties were fitted to the corresponding stress-relaxation curves to determine the mechanical parameters. Elastic moduli, especially the instantaneous and dynamic moduli, showed site-specific variation only in the medial meniscus (p<0.05 between the sites). The instantaneous and dynamic elastic moduli of the anterior horn were significantly (p<0.05) greater in the medial than lateral meniscus. The phase angle showed no statistically significant variation between the sites (p>0.05). The values for the strain-dependent fibril network modulus (nonlinear behaviour of collagen) were significantly different (p<0.05) between all sites in the medial menisci. Additionally, there was a significant difference (p<0.01) in the strain-dependent fibril network modulus between the lateral and medial anterior horns. The initial permeability was significantly different (p<0.05) in the medial meniscus only between the middle and posterior sites. For the strain-dependent permeability coefficient, only anterior and middle sites showed a significant difference (p<0.05) in the medial meniscus. This parameter demonstrated a significant difference (p<0.05) between lateral and medial menisci at the anterior horns. Our results reveal that under in situ indentation loading, medial meniscus shows more site-dependent variation in the mechanical properties as compared to lateral meniscus. In particular, anterior horn of medial meniscus was the stiffest and showed the most nonlinear mechanical behaviour. The nonlinearity was related to both collagen fibrils and fluid. Copyright © 2015 Elsevier Ltd. All rights reserved.
    No preview · Article · Feb 2015 · Journal of Biomechanics

Publication Stats

12k Citations
1,041.68 Total Impact Points


  • 2009-2015
    • University of Eastern Finland
      • • Department of Applied Physics
      • • Department of Physics and Mathematics
      Kuopio, Northern Savo, Finland
  • 1992-2015
    • Kuopio University Hospital
      • • Department of Clinical Physiology and Nuclear Medicine
      • • Department of Clinical Neurophysiology
      Kuopio, Northern Savo, Finland
  • 2011
    • University of Jyväskylä
      • Department of Health Sciences
      Jyväskylä, Central Finland, Finland
  • 1984-2011
    • University of Kuopio
      • • Department of Physics
      • • Department of Applied Physics
      • • Department of Anatomy
      • • Department of Clinical Physiology
      Kuopio, Eastern Finland Province, Finland
  • 2005
    • Lappeenranta University of Technology
      Villmanstrand, Southern Finland Province, Finland
    • Helsinki University Central Hospital
      • Department of Orthopaedics and Traumatology
      Helsinki, Province of Southern Finland, Finland
  • 1997
    • Universität Bern
      Berna, Bern, Switzerland
  • 1995
    • Oulu University Hospital
      Uleoborg, Northern Ostrobothnia, Finland
  • 1993
    • University of Turku
      • Department of Medical Biochemistry and Genetics
      Turku, Southwest Finland, Finland