Jenny A. Tyler

MEASUREMENT OF LOCALIZED CARTILAGE VOLUME AND THICKNESS OF HUMAN KNEE JOINTS BY COMPUTER ANALYSIS OF THREE-DIMENSIONAL MAGNETIC RESONANCE IMAGES

RATIONALE AND OBJECTIVES This work demonstrates a new method for computerized measurement of the dimensions (thickness and volume) of articular cartilage for any specified region of the human knee joint. Three-dimensional magnetic resonance (MR) images optimized for cartilage contrast have been analyzed using computerized edge-detection techniques, and the reproducibility of articular cartilage thickness and volume measurements is assessed. METHODS A fat-suppressed, three-dimensional SPoiled GRass MR sequence (45/7.5/30 degrees) with total scan time of approximately 12 minutes was used to acquire volume images of human knee joints at spatial resolution of 0.6 x 1.2 x 1.2 mm. Measurements were made using six repeated scans for three healthy volunteers over a period of 2 months. The subsequent semi-automated image processing to establish total cartilage volume and cartilage thickness maps for the femur required approximately 60 minutes of operator time. RESULTS The mean coefficient of variation for total cartilage volume for the six repeated scans for the three volunteers was 3.8%, and the average coefficient of variation for the user-selected cartilage plugs was 2.0%. The cartilage thickness maps from the repeated scans of the same knee were similar. CONCLUSIONS Standard resolution MR images with fat-suppressed contrast lead to an objective and reproducible measurement of spatial dimensions of articular cartilage when analyzed semi-automatically using computerized edge-detection methods.

Cartilage swelling and loss in a spontaneous model of osteoarthritis visualized by magnetic resonance imaging

The objective of this study was to investigate whether the rate of change in cartilage pathology could be effectively monitored by magnetic resonance imaging (MRI) as part of a longitudinal investigation of an osteoarthritis model in vivo, and to define the minimum requirements necessary to establish disease progression. Magnetic resonance images of the knee of eight male Dunkin-Hartley guinea-pigs were obtained at 8, 12, 18, 24, 30, 36 and 52 weeks of age using a two-dimension spin-echo sequence with a TR of 1500 ms and TE of 40 ms. The total thickness of the femoral and tibial cartilage was measured from those images. Over the same time course, sets of spin-spin relaxation-weighted images were acquired from two additional animals of the same age, from which the T2 relaxation times of water in the articular cartilage were estimated and compared with those of muscle and adipose tissue within the same joint. The cartilage thickness of all the animals increased during the first 6 months, then either stayed thicker (4/8) or became progressively thinner (4/8). Up to 18 weeks of age, the cartilage T2 value was between 23-24 ms but became elevated by 30 weeks and the mean value was more than 40 ms at the end of the study, T2 values for the muscle and adipose tissue remained within the range 30-33 ms, or 47 ms, respectively. We concluded that in this model, cartilage thickness measurements from an magnetic resonance image would not provide a reliable marker to stage osteoarthritis progression partly because the cartilage was so thin in a joint of this size, but also because the changes with time were not linear but biphasic. However, quantitation of the T2 relaxation values may provide a more predictable indicator of cartilage pathology for longitudinal studies because the changes were monotonic and independent of cartilage thickness.

A combined analysis and magnetic resonance imaging technique for computerised automatic measurement of cartilage thickness in the distal interphalangeal joint

It is well known that magnetic resonance imaging (MRI) contrast can be controlled, albeit sometimes at the expense of image resolution and signal-to-noise ratio, and most studies of articular joints have used a single MRI protocol, which is optimised for subjective image analysis. Inevitably that single protocol frequently compromises the detection of one or another of the boundaries between which any measurement must be made. This paper describes an alternative approach in which the criteria for computerised edge detection necessary for fully automated measurement of cartilage thickness are used to define the MRI acquisition parameters. This necessitates the combined use of two MRI sequences, one optimised for the cartilage-bone boundary, and the other for cartilage-synovial fluid. This provides a highly effective combination and its efficacy is demonstrated for the distal interphalangeal joint of a range of asymptomatic adults.

Detection and monitoring of progressive degeneration of osteoarthritic cartilage by MRI

Osteoarthritis (OA) results from a failure of cells within the joint to maintain the balance between synthesis and degradation of the extracellular matrix. OA is a major cause of pain and disability in the elderly yet there is at present no effective treatment to slow down or halt progressive loss of joint function. This is partly because the condition is heterogeneous with obscure pathogenesis but also because there are no specific laboratory tests or screening procedures that provide a specific diagnosis of early OA. There is a clear need to be able to define onset of characteristic pathological changes when intervention would be timely and to monitor the natural history up to the stage of radiologically detected damage.

MR protocols for imaging the guinea pig knee

Magnetic resonance images of the femorotibial joints of male Dunkin-Hartley guinea pigs were obtained in two and three dimensions at 2.35 T using a wide range of T1- and T2-weighted imaging sequences. The effect of slice position on visualisation of articular cartilage, bone and periarticular tissues in sagittal and coronal sections was investigated along with the resolution and signal/noise ratio achievable. Based on that survey, a two-dimensional spin echo sequence (repetition time = 1500 ms, echo time = 40 ms) was found to give optimum visualisation of the normal joint anatomy with in-plane resolution of 75 x 150 microns and a 1 mm slice thickness in an imaging time of 25 min. This protocol was also found to be highly effective in distinguishing many features of the spontaneous, osteoarthritic-like pathology found in the joints of older animals compared to juveniles and therefore provides a means of monitoring disease progression longitudinally. Three-dimensional spin echo imaging methods demonstrated focal changes in signal intensity in the articular cartilage of the medial tibial plateau in older animals. The resulting imaging times of several hours, however, precludes their routine use in vivo.

Visualisation of mass transport of small organic molecules and metal ions through articular cartilage by magnetic resonance imaging

Magnetic resonance imaging of water has been used to visualise the migration of three paramagnetic species, 4-hydroxy-2,2,6,6-tetramethylpiperidine-1-oxyl (4-hydroxy-TEMPO, 1), Cu2+ ions, and copper ethylenediamine-tetraacetate (CuEDTA, 2) through cartilage on the femoral condyle of the chicken knee. The migration of copper ions is dominated by strong binding with the cartilage. In contrast, both 1 and 2 bind weakly, and their diffusion can be followed as a progressive wave through the cartilage and subsequently into the trabecular bone structure.

High resolution magnetic resonance imaging of the proximal interphalangeal joints: Correlation with histology and production of a three-dimensional data set

The magnetic resonance imaging appearance of the proximal interphalangeal joints of cadavers was correlated with histology of the same specimen allowing many small-scale features to be identified that might otherwise have been misinterpreted. It enabled the magnetic resonance signal to be understood at a tissue and cellular level, allowing identification of synovial folds extending from the extensor tendon and volar plate, the entheses of the proper collateral ligament, the epitenon of the flexor tendons and the presence of osteophytes and sites of cartilage erosion. The main difficulties in matching two-dimensional magnetic resonance images with histology were the differing section thicknesses of the two methods and shrinkage of histological specimens. There are many advantages in producing high resolution three-dimensional datasets—the magnetic resonance section thickness is reduced and the individual components of the joint can be viewed simultaneously in two or more planes. A unique magnetic resonance atlas of three dimensional joint structure is presented.

High resolution MR imaging of joint degeneration in the knee of the STR/ORT mouse

MR imaging of the knee joints of the mouse at 2.35 T produces an in-plane resolution of 35 x 70 microns and a slice thickness of 600 microns from the sagittal and coronal planes, in less than 60 min. In normal, live DBA mice, which have no known pathology, the images clearly resolve many joint structures, such as the cruciate ligaments, menisci, and articulating surfaces of the femur and tibia. Gross pathological changes were identified first in excised knees from cadaver mice of the STR/ORT strain. Males of this strain spontaneously exhibit rapid joint degeneration with increasing age compared to females, in which much milder symptoms develop more slowly. Thickening of the patellar tendon, displacement of the patella, deformity, and sclerosis were clearly distinguishable in males compared with females older than 7 mo of age. The same degenerative features were evident in MR images of the knees of the live male but not female STR/ORT mice of this age, indicating that it would be possible to monitor longitudinally by MR imaging progressive development of joint changes in this osteoarthritic model.

Magnetic resonance imaging protocol optimization for evaluation of hyaline cartilage in the distal interphalangeal joint of fingers

RATIONALE AND OBJECTIVES.To identify a single magnetic resonance imaging (MRI) protocol that will provide optimal signal-to-noise ratio, resolution, and image contrast with minimal susceptibility artifacts and that will allow clear delineation and visualization of cartilage, fluid, bone, tendons, and ligaments within the distal interphalangeal (DIP) joint of the human hand. METHODS.A highly optimized 2.4 T MRI system was constructed from a 31-cm horizontal bore magnet, using a solenoid radiofrequency coil. This was used to study the DIP joints of 16 healthy, asymptomatic volunteers. RESULTS.A range of image contrast protocols were explored, including spin-echo T1 and T2, field echo, chemical shift suppression to give water only images, and magnetization transfer. Susceptibility variations were explored by changing the field strength from 0.6 to 2.4 T. A spin-echo protocol with TR=1500 msec and TE=30 msec can routinely produce images with resolution 0.075 X 0.150 for a slice thickness of 1 mm in 13 minutes. That protocol can visualize simultaneously compact and trabecular bone, two layers of cartilage, synovial fluid, and synovium within the joint, tendons and ligaments, and the volar plate. CONCLUSIONS. Although the contrast is not fully optimized for any one tissue, the spin echo protocol (TR=1500, TE=30) provides sagittal MR images, which clearly delineate the major structures of interest within the DIP joint, and which will be used in future studies to compare changes in the DIP joint because of aging or osteoarthritis. Experience gained by applying the above methods to a total of 16 healthy, asymptomatic volunteers has enabled a single sequence to be identified, which although not optimized for any one tissue, nevertheless visualized simultaneously and clearly delineated compact and trabecular bone, two layers of cartilage, synovial fluid, and synovium within the joint.

Magnetic resonance imaging, histology, and x-ray of three stages of damage to the knees of STR/ORT mice.

RATIONALE AND OBJECTIVES The authors develop a scoring system for assessing those features of degeneration of the STR/ORT mouse knee visualizable by magnetic resonance (MR) imaging, and to validate those MR scores by comparison with x-ray and histology. METHOD Magnetic resonance imaging, histology, and x-ray have been used in a cross-sectional study to visualize the anatomy and pathology of the knees of three pairs of male STR/ORT mice and their approximately age-matched female pairs. A scoring system was developed that distinguished the faster rate of damage of the males from the slower progressive changes seen in the females. RESULTS Changes in the patellar tendon were observed in MR imaging of the 5-month-old male knee. Sagittal images showed other degenerative features such as sclerosis and loss of signal from synovial fluid after 9 months; osteophytes and degeneration of the tibial plateau were better visualized in the coronal plane. Cysts were poorly correlated to the progression of the disease. Similar trends were observed for four features scored in x-rays (sclerosis, joint space narrowing, cysts, and osteophytes) and cartilage degradation assessed using histology. In contrast, the age-matched females were less affected. CONCLUSIONS Magnetic resonance imaging can identify joint degeneration in the knees of male mice, which develops more rapidly than in age-matched females. Those observations were validated by radiology and histology.