Erika Schneider

The osteoarthritis initiative: report on the design rationale for the magnetic resonance imaging protocol for the knee

OBJECTIVES To report on the process and criteria for selecting acquisition protocols to include in the osteoarthritis initiative (OAI) magnetic resonance imaging (MRI) study protocol for the knee. METHODS Candidate knee MR acquisition protocols identified from the literature were first optimized at 3Tesla (T). Twelve knees from 10 subjects were scanned one time with each of 16 acquisitions considered most likely to achieve the study goals and having the best optimization results. The resultant images and multi-planar reformats were evaluated for artifacts and structural discrimination of articular cartilage at the cartilage-fluid, cartilage-fat, cartilage-capsule, cartilage-meniscus and cartilage-cartilage interfaces. RESULTS The five acquisitions comprising the final OAI MRI protocol were assembled based on the study goals for the imaging protocol, the image evaluation results and the need to image both knees within a 75 min time slot, including positioning. For quantitative cartilage morphometry, fat-suppressed, 3D dual-echo in steady state (DESS) acquisitions appear to provide the best universal cartilage discrimination. CONCLUSIONS The OAI knee MRI protocol provides imaging data on multiple articular structures and features relevant to knee OA that will support a broad range of existing and anticipated measurement methods while balancing requirements for high image quality and consistency against the practical considerations of a large multi-center cohort study. Strengths of the final knee MRI protocol include cartilage quantification capabilities in three planes due to multi-planar reconstruction of a thin slice, high spatial resolution 3D DESS acquisition and the multiple, non-fat-suppressed image contrasts measured during the T2 relaxation time mapping acquisition.

Double echo steady state magnetic resonance imaging of knee articular cartilage at 3 Tesla: a pilot study for the Osteoarthritis Initiative.

Background: Quantitative magnetic resonance imaging (qMRI) may provide valuable measures of cartilage morphology in osteoarthritis (OA) but has been confined to sequences with relatively long acquisition times at 1.5 Tesla (T). Objective: To test the accuracy and precision of knee cartilage qMRI with a fast double echo, steady state (DESS) sequence with water excitation (we) at 3 T. Methods: As a pilot study for the Osteoarthritis Initiative, test-retest MR images were acquired in the knees of 19 participants with no OA to moderate degrees of clinical OA. Two double oblique coronal fast low angle shot (FLASHwe) sequences (1.5 mm slice thickness) were acquired at 3 T, and two sagittal DESSwe sequences (0.7 mm slice thickness). Double oblique coronal multiplanar reformats (MPR) were performed (1.5 mm slice thickness) from the sagittal DESSwe. Knee joint cartilage plates were quantified unpaired in random order with blinding to subject identification. Results: In the femorotibial joint, precision errors (root mean square coefficient of variation in % for unpaired analysis) for cartilage volume and thickness were 3.0–6.4% with coronal FLASHwe, 2.4–6.2% with coronal MPR DESSwe, and 2.3–8.2% with sagittal DESSwe. Correlation coefficients between DESSwe and FLASHwe ranged from r = 0.88 to 1.0. In the femoropatellar joint, precision errors (sagittal DESSwe) were 3.4–8.5%. Conclusions: DESSwe permits accurate and precise analysis of cartilage morphology in the femorotibial joint at 3 T. Further studies are needed to examine the accuracy of DESSwe in the femoropatellar joint and its ability to characterise sensitivity to longitudinal changes in cartilage morphology.

Impact of coil design on the contrast‐to‐noise ratio, precision, and consistency of quantitative cartilage morphometry at 3 Tesla: A pilot study for the osteoarthritis initiative

Phased‐array (PA) coils generally provide higher signal‐to‐noise ratios (SNRs) than quadrature knee coils. In this pilot study for the Osteoarthritis Initiative (OAI) we compared these two types of coils in terms of contrast‐to‐noise ratio (CNR), precision, and consistency of quantitative femorotibial cartilage measurements. Test‐retest measurements were acquired using coronal fast low‐angle shot with water excitation (FLASHwe) and coronal multiplanar reconstruction (MPR) of sagittal double‐echo steady state with water excitation (DESSwe) at 3T. The precision errors for cartilage volume and thickness were ≤2.6% for the quadrature coil and ≤2.3% for the PA coil with FLASHwe, and ≤2.3%/≤2.5% with DESSwe. The precision for aggregate medial and lateral cartilage measures was significantly higher than that for single plates, independently of coil and sequence. The PA coil measurements did not always fully agree with the quadrature coil measurements, and some differences were significant. The higher CNR of the PA coil did not translate directly into improved precision of cartilage measurement; however, summing up cartilage plates within the medial and lateral compartment reduced precision errors. Magn Reson Med 57:448–454, 2007.

Magnetic resonance relaxivity of dendrimer‐linked nitroxides

The relaxivity and bioreduction rates of eight dendrimer‐linked nitroxides varying in the number of nitroxides per molecule were measured and the potential use of these compounds as MR contrast agents was demonstrated. The T1 and T2 relaxivities, measured at room temperature and 1.5 T, varied linearly with the number of nitroxides per molecule for compounds with up to 16 nitroxides per molecule. Fourth‐generation polypropylenimide‐ (DAB) and third‐generation polyamidoamine‐ (PAMAM) dendrimer‐linked nitroxides were found to have greater relaxivity than gadolinium diethylenetriaminepentaacetic acid (Gd‐DTPA). The greater number of nitroxides per dendrimer increased relaxivity over that of a single nitroxide, allowing a decreased dose to achieve differential contrast with MR evaluations. Rates of nitroxide bioreduction were below detection threshold using EPR spectroscopy for generation 2 dendrimers and higher. A pilot assessment of in vivo cartilage uptake that compared intraarticular injection of three structurally different dendrimer‐linked nitroxides with Gd‐DTPA and with saline demonstrated high affinity of the DAB‐dendrimer‐linked nitroxides for normal rabbit articular cartilage. From these results, it is evident that target‐specific dendrimer‐linked nitroxides can be designed. Magn Reson Med 48:965–972, 2002.

Identifying outpatients with renal insufficiency before contrast-enhanced CT by using estimated glomerular filtration rates versus serum creatinine levels.

PURPOSE To determine whether using estimated glomerular filtration rate (eGFR) values rather than serum creatinine levels to identify patients with renal insufficiency facilitates any substantial change in the number of outpatients scheduled for computed tomography (CT) who are considered at increased risk for contrast medium-induced nephropathy. MATERIALS AND METHODS The study was HIPAA compliant and institutional review board approved for medical chart review; the requirement for informed patient consent was waived. Patients (n = 5138; 2569 women, 2569 men, 753 African Americans, 4385 non-African Americans) examined during a 2-year period formed the final study group after exclusion of patients undergoing dialysis (n = 49), for whom no age data were recorded (n = 9), and younger than 18 years (n = 113). Patient age, sex, and race and the blood urea nitrogen, albumin, and serum creatinine levels most recently measured within 6 months before CT were obtained from the electronic medical records. The number of patients with creatinine levels higher than 1.4 mg/dL was directly compared with the number of patients with eGFR values (calculated with four- and six-variable Modification of Diet in Renal Disease [MDRD] equations) lower than 60 mL/min/1.73 m(2) by using the two-tailed McNemar test. For 2689 patients, data to calculate the eGFR by using the four-variable equation were available, and for 2005 patients, data to calculate the eGFR by using the six-variable equation were available. RESULTS Among the outpatients scheduled to undergo CT, the percentage of patients with an eGFR lower than 60 mL/min/1.73 m(2) was significantly greater than the percentage of patients with a creatinine level higher than 1.4 mg/dL for both the four-variable (412 [15.3%] vs 166 [6.2%] of 2689 patients) and the six-variable (346 [17.3%] vs 117 [5.8%] of 2005 patients) MDRD equation groups (P < .001). CONCLUSION A significantly higher number of outpatients scheduled for contrast medium-enhanced CT met the National Kidney Foundation criteria for renal insufficiency when the MDRD equations were used to estimate the glomerular filtration rate compared with the number of outpatients who met the criteria on the basis of elevated creatinine levels.

Cross-sectional DXA and MR measures of tibial periarticular bone associate with radiographic knee osteoarthritis severity.

OBJECTIVE We evaluated the relationship of medial proximal tibial periarticular areal bone mineral density (paBMD) and trabecular morphometry and determined whether these bone measures differed across radiographic medial joint space narrowing (JSN) scores. METHODS 482 participants of the Osteoarthritis Initiative (OAI) Bone Ancillary Study had knee dual X-ray absorptiometry (DXA) and trabecular bone 3T magnetic resonance imaging (MRI) exams assessed at the same visit. Medial proximal tibial paBMD was measured on DXA and apparent trabecular bone volume fraction (aBV/TV), thickness (aTb.Th), number (aTb.N), and spacing (aTb.Sp) were determined from MR images. Radiographs were assessed for medial JSN scores (0-3). We evaluated associations between medial paBMD and trabecular morphometry. Whisker plots with notches of these measures versus medial JSN scores were generated and presented. RESULTS Mean age was 63.9 (9.2) years, BMI 29.6 (4.8) kg/m(2), and 53% were male. The Spearman correlation coefficients between DXA-measured medial paBMD and aBV/TV was 0.61 [95% confidence interval (CI) 0.55-0.66]; between paBMD and aTb.Th was 0.38 (95%CI 0.30-0.46); paBMD and aTb.N was 0.65 (95%CI 0.60-0.70); paBMD and aTb.Sp was -0.65 (95%CI -0.70 to -0.59). paBMD and the trabecular metrics were associated with medial JSN scores. CONCLUSION The moderate associations between periarticular trabecular bone density and morphometry and their relationship with greater severity of knee OA support hypotheses of remodeling and/or microscopic compression fractures in the natural history of OA. Longitudinal studies are needed to assess whether knee DXA will be a predictor of OA progression. Further characterization of the periarticular bone in OA utilizing complementary imaging modalities will help clarify OA pathophysiology.

Equivalence and precision of knee cartilage morphometry between different segmentation teams, cartilage regions, and MR acquisitions

OBJECTIVE To compare precision and evaluate equivalence of femorotibial cartilage volume (VC) and mean cartilage thickness over total area of bone (ThCtAB.Me) from independent segmentation teams using identical Magnetic Resonance (MR) images from three series: sagittal 3D Dual Echo in the Steady State (DESS), coronal multi-planar reformat (DESS-MPR) of DESS and coronal 3D Fast Low Angle SHot (FLASH). DESIGN Nineteen subjects underwent test-retest MR imaging at 3 T. Four teams segmented the cartilage using prospectively defined plate regions and rules. Mixed models analysis of the pooled data were used to evaluate the effect of acquisition, team and plate on precision and Pearson correlations and mixed models were used to evaluate equivalence. RESULTS Segmentation team differences dominated measurement variability in most cartilage regions for all image series. Precision of VC and ThCtAB.Me differed significantly by team and cartilage plate, but not between FLASH and DESS. Mean values of VC and ThCtAB.Me differed by team (P < 0.05) for DESS, FLASH and DESS-MPR. FLASH VC was 4-6% larger than DESS in the medial tibia and lateral central femur, and FLASH ThCtAB.Me was 5-6% larger in the medial tibia, but 4-8% smaller in the medial central femur. Correlations between DESS and FLASH for VC and ThCtAB.Me were high (r = 0.90-0.97), except for DESS vs FLASH medial central femur ThCtAB.Me (r = 0.81-0.83). CONCLUSIONS Cartilage morphology metrics from different image contrasts had similar precision, were generally equivalent, and may be combined for cross-sectional analyses if potential systematic offsets are accounted for. Data from different teams should not be pooled unless equivalence is demonstrated for cartilage metrics of interest.

The Osteoarthritis Initiative (OAI) magnetic resonance imaging quality assurance update

OBJECTIVE Longitudinal quantitative evaluation of cartilage disease requires reproducible measurements over time. We report 8 years of quality assurance (QA) metrics for quantitative magnetic resonance (MR) knee analyses from the Osteoarthritis Initiative (OAI) and show the impact of MR system, phantom, and acquisition protocol changes. METHOD Key 3T MR QA metrics, including signal-to-noise, signal uniformity, T2 relaxation times, and geometric distortion, were quantified monthly on two different phantoms using an automated program. RESULTS Over 8 years, phantom measurements showed root-mean-square coefficient-of-variation reproducibility of <0.25% (190.0 mm diameter) and <0.20% (148.0 mm length), resulting in spherical volume reproducibility of <0.35%. T2 relaxation time reproducibility varied from 1.5% to 5.3%; seasonal fluctuations were observed at two sites. All other QA goals were met except: slice thicknesses were consistently larger than nominal on turbo spin echo images; knee coil signal uniformity and signal level varied significantly over time. CONCLUSIONS The longitudinal variations for a spherical volume should have minimal impact on the accuracy and reproducibility of cartilage volume and thickness measurements as they are an order of magnitude smaller than reported for either unpaired or paired (repositioning and reanalysis) precision errors. This stability should enable direct comparison of baseline and follow-up images. Cross-comparison of the geometric results from all four OAI sites reveal that the MR systems do not statistically differ and enable results to be pooled. MR QA results identified similar technical issues as previously published. Geometric accuracy stability should have the greatest impact on quantitative analysis of longitudinal change in cartilage volume and thickness precision.

Probability of Reduced Renal Function After Contrast-Enhanced CT: A Model Based on Serum Creatinine Level, Patient Age, and Estimated Glomerular Filtration Rate

OBJECTIVE The objectives of our study were to develop a model to predict the probability of reduced renal function after outpatient contrast-enhanced CT (CECT)--based on patient age, sex, and race and on serum creatinine level before CT or directly based on estimated glomerular filtration rate (GFR) before CT--and to determine the relationship between patients with changes in creatinine level that characterize contrast-induced nephropathy and patients with reduced GFR after CECT. MATERIALS AND METHODS Of 5,187 outpatients who underwent CECT, 963 (18.6%) had serum creatinine levels obtained within 6 months before and 4 days after CECT. The estimated GFR was calculated before and after CT using the four-variable Modification of Diet in Renal Disease (MDRD) Study equation. Pre-CT serum creatinine level, age, race, sex, and pre-CT estimated GFR were tested using multiple-variable logistic regression models to determine the probability of having an estimated GFR of < 60 and < 45 mL/min/1.73 m(2) after CECT. Two thirds of the patients were used to create and one third to test the models. We also determined discordance between patients who met standard definitions of contrast-induced nephropathy and those with a reduced estimated GFR after CECT. RESULTS Significant (p < 0.002) predictors for a post-CT estimated GFR of < 60 mL/min/1.73 m(2) were age, race, sex, pre-CT serum creatinine level, and pre-CT estimated GFR. Sex, serum creatinine level, and pre-CT estimated GFR were significant factors (p < 0.001) for predicting a post-CT estimated GFR of < 45 mL/min/1.73 m(2). The probability is [exp(y) / (1 + exp(y))], where y = 6.21 - (0.10 x pre-CT estimated GFR) for an estimated GFR of < 60 mL/min/1.73 m(2), and y = 3.66 - (0.087 x pre-CT estimated GFR) for an estimated GFR of < 45 mL/min/1.73 m(2). A discrepancy between those who met contrast-induced nephropathy criteria by creatinine changes and those with a post-CT estimated GFR of < 60 mL/min/1.73 m(2) was detected in 208 of the 963 patients (21.6%). CONCLUSION The probability of a reduced estimated GFR after CECT can be predicted by the pre-CT estimated GFR using the four-variable MDRD equation. Furthermore, standard criteria for contrast-induced nephropathy are poor predictors of poor renal function after CECT. Criteria need to be established for what is an acceptable risk to manage patients undergoing CECT.

An apparatus for MR‐guided breast lesion localization and core biopsy: Design and preliminary results

System design and initial results are presented from a new unilateral MR‐guided breast lesion localization and core biopsy system. Over 150 imaging studies, an accuracy study on phantoms with 50 localization wire deployments and 33 core biopsy trials, and 19 clinical procedures are reported. The mean spatial accuracy from the lesion center for a 20‐gauge (G) needle (N = 13) was within 1.2 ± 1.4 mm (SD) and for a 14G biopsy (N = 4) 0.8 ± 1.1 mm. For sampling using a 16G core through a 14G needle, the mean accuracy was 5.6 mm (N = 2). The needle guide geometry imposed a small, calculable targeting error. For phantom measurements using the 20G device, the mean geometry‐induced error was 0.73 ± 0.43 mm. However, this contribution was, on average, 42% of the mean measured 2.35 ± 1.65 mm offset. The new device design provided an accurate and simple guidance method for localization or core biopsy of MR‐visible breast lesions. J. Magn. Reson. Imaging 2001;14:243–253.