Artificially produced cartilage lesions in small joints: Detection with optimized MRI-sequences

doi:10.1016/S0730-725X(97)00026-X

Magnetic Resonance Imaging

Volume 15, Issue 8, 1997, Pages 949-956

https://doi.org/10.1016/S0730-725X(97)00026-X Get rights and content

Abstract

The purpose of this study was to evaluate different magnetic resonance imaging (MRI) pulse sequences in the detection of artificial cartilage lesions in small joints using an animal model. A total of 32 artificial cartilage lesions were created in the knee joints of 20 rabbits. Twenty lesions were produced 4 weeks and 12 lesions 1 h before the MRI examination, performed in an extremity coil at 1.0 T. All joints were examined with five imaging sequences: (1) a conventional T1-weighted spin-echo (SE)-sequence (repetition time [TR] 600 ms, echo time [TE] 15 ms), (2) a T2-weighted turbo-SE-sequence (TR 2000ms, TE 85 ms), (3) a two-dimensional (2D) gradient echo (GE)-sequence (TR 440 ms, TE 10 ms, flip angle 60°) and (4,5) two three-dimensional (3D) GE-sequences (TR 40 ms, TE 7 ms, flip angle 40°, with fat suppression (FS) and TR 30 ms, TE 9 ms, flip angle 40°). Two examinations had to be excluded because of insufficient image quality and the remaining examinations were analyzed by two experienced radiologists. The MRI images were correlated with the pathologic findings and anatomical structures were scored according to a 5-level scale. Direct comparison of the pathological and MRI findings showed that 19 of the 30 artificially induced cartilage lesions were detected with the FS 3D GE-sequence, 13 with the 2D GE-sequence, 11 with the 3D GE-sequence, 3 with the T1-weighted SE-sequence, and 2 with the T1-weighted SE-sequence. The highest percentage of artificial cartilage lesions was demonstrated using a fat-suppressed 3D GE-sequence. However, the analysis of cartilage defects in small joints with optimized sequences as well as clinical routine hardware and software had limitations. Therefore a pilot study was performed analyzing newly developed high resolution FS 3D GE images obtained from 5 rabbit knees with 10 cartilage lesions at 1.5 T. Two sequences were used with 1.0 and 0.5 mm slice thickness, a matrix of 256 × 256 and 512 × 256 and a field of view of 12 × 6 and 8 × 6 cm. In this small subset detection rates were substantially higher than in the 30 rabbit knees examined before.

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In contrast to radiography, magnetic resonance imaging (MRI) is capable of directly visualizing the articular cartilage. MRI has been increasingly investigated in OA because it allows accurate morphologic assessment and reproducible quantitative measurements of the cartilage9–14. Quantitative MRI was proven to be an accurate method for cartilage volumetric and thickness measurements, and has been used in OA patients for over 10 years15,16.
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At 3 and 5 months, the MT.ThC measured in the minimum interbone distance area was the thinnest MR-based MT.ThC. It was significantly lower in the operated group and among the four evaluated MT.ThC, it was the most discriminative between the normal and the operated groups (P < 0.05). The MT.ThC measured in the minimum interbone distance area was also the most sensitive to change in the operated group (66.4% MT.ThC loss, P = 0.003) while no significant changes were observed in the control group.
Quantitative 3D HR μMRI allowed for non-invasive longitudinal MT.ThC measurements in four different locations in both the normal and the operated rabbits. We concluded the MT.ThC measured in the minimum interbone distance area reflected the severity of the disease and was the most effective to measure the progression of the medial tibial cartilage destruction.
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Computer-aided quantification of focal cartilage lesions using MRI: Accuracy and initial arthroscopic comparison
2005, Osteoarthritis and Cartilage
Citation Excerpt :
Plain radiographs are also commonly used to determine the progress of OA of the knee, but poorly detect both mild cartilage lesions, and severe focal cartilage erosions in weight-bearing conditions4. On the other hand, magnetic resonance imaging (MRI) is a non-invasive, sensitive and accurate tool to depict cartilage lesions as well as cartilage morphology5–10,31. A number of computer-aided analyses using MRI have been proposed to accurately quantify cartilage thickness and volume in healthy joints, as well as in diseased knees by using image postprocessing techniques11–18,30.
The purpose of the study was to validate a Gradient Peak Method (GPM) by evaluating its accuracy and consistency at different magnetic field strengths. The GPM using magnetic resonance imaging (MRI) was previously proposed to quantitatively assess the morphology of focal cartilage lesions, and its feasibility was demonstrated.
GPM quantifies the morphologic properties of cartilage lesions based on their three-dimensional geometry. Twenty-two conical and cylindrical lesions were surgically created on fresh porcine knees, and the results obtained by GPM were compared with manually measured lesion dimensions. Another 15 focal lesions of various shapes were created and scanned, and the quantification results were compared at 1.5 Tesla and 3 Tesla. Additionally, cartilage lesions in three patients were scanned, quantified by GPM, and compared with arthroscopic visualization and measurements.
The average absolute errors of GPM (depth: ≤0.4 mm; diameter: ≤1.4 mm) were within twice the in-plane resolution in depth estimates and within the slice thickness in diameter estimates. Analysis also suggested that the quantifications of GPM using 1.5 Tesla and 3 Tesla data were not statistically different. Moreover, the GPM results were shown to be consistent with the lesion measurements obtained arthroscopically.
The GPM using MRI provides estimates of lesion thickness, depth, diameter, and area. With this validation, the method can be potentially used as an auxiliary tool to help radiologists and physicians assess cartilage lesions quantitatively and monitor disease progression.
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Citation Excerpt :
Furthermore, at least one study suggests that conventional radiographs are unreliable for evaluating cartilage loss in patients with early osteoarthritis since, in most instances, joint space narrowing is secondary to meniscal extrusion rather than thinning of cartilage21. Although not currently being utilized as a first-line diagnostic tool, MRI has shown merit in the identification of cartilage and its contours in situ22–25, in animal joints26–35, in human knee joints1–10,36–44, shoulder45, and in small joints46–50. It has been shown that lesions and biochemical abnormalities in cartilage correlate to signal intensity abnormalities that are seen with MRI3,5,8,10,37,39.
The assessment of articular cartilage integrity is of value for the detection of early degenerative joint disease in both the clinical and the research settings. It was the purpose of this study to determine the accuracy and reliability of identifying articular cartilage defects through Diffraction Enhanced Imaging (DEI), a high contrast radiographic imaging technique. DEI provides two new sources of image contrast to radiography: refraction and scatter rejection, besides the absorption of conventional radiography.
Cadaveric tali were DEI imaged in the anterior–posterior position at the National Synchrotron Light Source. Two independent observers provided gross score evaluations (on a five point scale) of the trochlear surfaces. The DEI image of each trochlear surface was then graded (on a five point scale) by two additional independent observers who were blinded with regard to the gross evaluation of the articular surfaces. Inter-observer agreement for DEI grades was assessed with the weighted κ statistic. Correlation of diffraction enhanced image score to the gross score was assessed with Spearman correlation coefficient.
The defects of articular cartilage of talar trochleae could be visualized through DEI. The Spearman correlation of gross grades with DEI grades on the 165 talar regions for observers 1 and 2 were 0.91 and 0.91, respectively. The overall weighted κ value for inter-observer agreement was 0.93, thus considered high agreement.
DEI is accurate and reliable for detection of articular cartilage defects ex vivo. Even early stages of degeneration of cartilage can be visualized with this high contrast technique. Future studies will focus on the application of DEI to the identification of such lesions in vivo.
Measurement accuracy of focal cartilage defects from MRI and correlation of MRI graded lesions with histology: A preliminary study
2003, Osteoarthritis and Cartilage
Objectives: Although accurate spatial measurement of cartilage thickness from MRI is possible, no studies have assessed the accuracy of measuring cartilage defect dimensions from MRI. In addition, current MR grading scales for assessing cartilage lesions have limited categories, and little is known about how well these scales correlate with histological assessment of the lesion. The objective of this preliminary study is to address both these issues.
Methods: We performed two experiments on four cadaver knee joints from elderly donors: Experiment 1 assessed the accuracy of measuring controlled defects in cartilage, and Experiment 2 compared MRI grading (Noyes scale) of natural cartilage lesions to histological grading (Mankin scale) of the sectioned cartilage tissue. MRI was performed on 1.5 T clinical scanner (fat-suppressed 3D-SPGR at TR/TE/α=55/13.5/45 and 256×256 matrix).
Results: The mean difference between defect diameters measured and introduced was less than 0.1 mm, which was statistically insignificant (P=0.754). Defect depth was less accurate at >0.4 mm, significantly under predicting actual defect depth (P=0.004). Correlation between Noyes grading scores and Mankin grading scores of natural lesions was moderately high (r=0.7) and statistically significant (P=0.001).
Conclusions: Three-dimensional mapping of cartilage thickness shows great promise for the accurate measurement of focal cartilage defects, though improvement is needed. The Noyes grading scale is consistent with histological Mankin grading of cartilage lesions, though enhancement of MR grading scales is needed, and warranted, based on the signal intensity information available from clinical MRI. Integration of these two analyses—focal defect measurement and signal intensity analysis—could potentially result in a valuable clinical tool for early osteoarthritis diagnosis and longitudinal tracking.
The total volume and the complete thickness of articular cartilage determined by MRI
2003, Osteoarthritis and Cartilage

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Original contributionArtificially produced cartilage lesions in small joints: Detection with optimized MRI-sequences

Abstract

Radiol. Clin North Am.

Magn. Reson. Imaging

MR imaging of the arthritic knee: Improved discrimination of cartilage, synovium and effusion with pulsed saturation transfer and fat-suppressed T1-weighted sequences

Radiology

Quantification of articular cartilage in the knee with pulse saturation transfer subtraction and fat-suppressed MR imaging: Optimization and validation

Radiology

Knee joint hyaline cartilage defects: A comparative study of MR and anatomic sections

J. Comput. Assist. Tomogr.

Quantitative evaluation of hyaline cartilage disorders using FLASH sequence: 1. Method and animal experiments

Acta Radiol.

Quantitative evaluation of hyaline cartilage disorders using FLASH sequence: 2. Clinical applications

Acta Radiol.

Darstellung des hyalinen Gelenkknorpels mit der MR-Tomographie mittels einer Gradientenecho-Sequenz mit Fett-Wasser-Phasenkohaerenz

Fortschr. Roentgenstr.

Knee hyaline cartilage evaluated with MR imaging: A cadaveric study involving multiple imaging sequences and intraarticular injection of gadolinium and saline solution

Radiology

Patellar cartilage lesions: In vitro detection and staging with MR imaging and pathologic correlation

Radiology

Evaluation of articular cartilage: Radiographic and cross-sectional imaging techniques

RadioGraphics

Stability of osteochondral fragments of the femoral condyle: Magnetic resonance imaging with histopathologic correlation in an animal model

Skeletal Radiol.

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

Invest. Radiol.

Original contribution
Artificially produced cartilage lesions in small joints: Detection with optimized MRI-sequences