A review of arthritis diagnosis techniques in artificial intelligence era: Current trends and research challenges

Deep learning, a branch of artificial intelligence, has achieved unprecedented performance in several domains including medicine to assist with efficient diagnosis of diseases, prediction of disease progression and pre-screening step for physicians. Due to its significant breakthroughs, deep learning is now being used for the diagnosis of arthritis, which is a chronic disease affecting young to aged population. This paper provides a survey of recent and the most representative deep learning techniques (published between 2018 to 2020) for the diagnosis of osteoarthritis and rheumatoid arthritis. The paper also reviews traditional machine learning methods (published 2015 onward) and their application for the diagnosis of these diseases. The paper identifies open problems and research gaps. We believe that deep learning can assist general practitioners and consultants to predict the course of the disease, make treatment propositions and appraise their potential benefits

An improvement in fuzzy entropy edge detection for X-ray imaging

The following paper discusses the topic of edge detection in X-ray hand images. It criticises the existing solution by highlighting a design fault, which is a carelessly chosen function and then proposes a way to eliminate the fault by replacing it with a better suited function. The search for this function and its results are also discussed in this paper. It also presents the aspect of pre- and postprocessing through filtering as another improvement in edge detection

An improvement in fuzzy entropy edge detection for X-ray imaging

The following paper discusses the topic of edge detection in X-ray hand images. It criticises the existing solution by highlighting a design fault, which is a carelessly chosen function and then proposes a way to eliminate the fault by replacing it with a better suited function. The search for this function and its results are also discussed in this paper. It also presents the aspect of pre- and postprocessing through filtering as another improvement in edge detection

Knee complaints and prognosis of osteoarthritis at 10 years : impact of ACL ruptures, meniscal tears, genetic predisposition and surgery

In this thesis we demonstrated that several known risk factors for knee OA development i.e. ACL ruptures, meniscal tears, the presence of hand OA and increased BMI, are already associated with knee OA development as demonstrated on radiographs and MR images early in life. Identifying these factors in young to middle aged patients suffering from knee complaints helps to define high risk patients who may benefit from early preventive exercise therapy or maybe disease modifying drugs which might be developed in the future. Meniscectomy and ACL reconstruction have no effect on knee OA development after 10 years in patients with sub-acute knee complaints. The in this thesis validated automatic JSW quantification method is sensitive to small changes in JSW of the finger joints. The first signs of hand OA development with this method can be detected within one or two years. In patients with traumatic meniscal tears but without knee locking symptoms, there may be some benefits from treatment with meniscectomy in long-term Sports and Recreation knee function outcomes compared to conservative treatment. Future randomized controlled trials may elucidate the effect of surgical treatment of traumatic meniscal tears.ReumafondsUBL - phd migration 201

Experimental arthritis : in vitro and in vivo models

As the primary cause of disability for people over the age of 45, arthritis actually consists of more than hundred different conditions. Osteoarthritis (OA) is the most common form of arthritis followed by rheumatoid arthritis (RA). OA is characterized by progressive articular cartilage loss and destruction, osteophyte formation, subchondral bone changes and synovial inflammation. The pathophysiology of OA is not yet completely understood, but mechanical influences, effects of aging, and genetic factors play a vital role in OA initiation and progression. Arthritis is a complex disease for two major reasons: the large number of contributing factors both in disease initiation and propagation; unknown mechanisms behind the disease development involving unknown interactions between the aforementioned factors. Studies to elucidate the pathogenesis of OA are further deterred by the relatively long dormant period where critical changes develop in both the bone and cartilage tissue with little to no outward symptoms. In order to properly address the problem of OA with effective therapeutic and preventative interventions, the mechanisms for its pathogenesis must be more clearly understood. However, as a disease not usually detected in patients until its last stages, OA proved to be a difficult subject of study. As such, both in vivo and in vitro models are employed as powerful tools for the research of OA, each with different strengths and limitations. The in vivo models address the complex and interacting mechanisms and factors for disease initiation and propagation, allowing for the study of natural disease progression over time. On the other hand, in vitro studies are better suited for the isolation of specific factors and the analysis of their contribution to the overall disease progression. By isolating a particular factor in vitro, these models have the advantage over their in vivo counterparts as a cost-effective and high throughput solution without the problem of variability between animals. The selection of an appropriate study model is important; each model introduces unique experimental conditions affects the results and provides unique insights in understanding the disease, and the results from different studies are therefore often complementary. The aim of this thesis is to combine a number of in vivo and in vitro models to gain better insights in the progression of OA, specifically focusing on the interactions between bone adaptation and cartilage degradation. Experimental Arthritis: in vitro and in vivo Models Chapter 1 reviews the current status of arthritis research and the various models currently employed in the study of OA and RA. Chapter 2 explores the subchondral bone microarchitecture changes in animal models of OA and RA using high resolution micro-computed tomography (micro CT) technique. The author had developed several in vitro arthritis models over the years, namely monolayer, multi-layered, and pellet culture using primary chondrocytes. In addition, the author also employed a co-culture model of chondrocytes, osteoblasts, and synovial cells. The best in vitro model was found to be the tissue engineered cartilage that resulted from a closed-chamber bioreactor. The resultant tissue engineered cartilage can be either non-scaffold or scaffold. Chapter 3 presents a study on the development of biphasic implants that consist of the aforementioned tissue engineered cartilage with or without various underlying biodegradable osteoconductive support materials. RA is a systemic autoimmune disease characterized by chronic joint inflammation and various degrees of bone and cartilage erosion. Study of RA animal models provides an understanding of the bone damage and its treatment. Chapter 4 presents a study utilizing a cell wall antigen induced arthritis model in rats. The aim of the study is to 1. Evaluate subchondral bone micro architecture change and 2. Investigate the efficacy of N-butyryl glucosamine (GlcNBu). The results show that GlcNBu inhibits inflammatory ankle swelling and preserves bone mineral density and bone connectivity, thus preventing further bone loss in this rat model of chronic arthritis. Subchondral bone change is hypothesized to play a significant role in the initiation and/or development of OA. Chapter 5 examines the periarticular subchondral bone changes, including bone mineral density, subchondral trabecular bone turnover, architecture, and connectivity, as well as subchondral plate thickness and mineralization using a rabbit anterior cruciate ligament transection model of osteoarthritis. Results show that orally administered Glucosamine HCl presents protective effects in subchondral bone changes in the abovementioned experimental OA model. The complexity in the development and progression of OA can be attributed to the close relationship between cartilage, subchondral bone, and neighboring tissues. Due to the complicated nature of OA progression, it is difficult to predict exactly when and how it is initiated. Numerous animal models were developed and their use has become indispensable in this field of study. To bring further clarity to the many unanswered questions concerning the role and importance of the subchondral bone in OA development, this thesis approaches the problem from two primary directions. First, we examine the minute changes of subchondral bone and cartilage to elucidate their relationship and impact on OA progression. Chapter 6 presents a study using three dimensional micro CT analyses combined with stereological histology assessment of cartilage changes in spontaneous knee osteoarthritis of two strains of guinea pig. A connection between bone remodeling and cartilage destruction is established by correlating three dimensional cartilage changes with bone remodeling. The second direction taken by this thesis is to study the OA development in a time course experiment using a slow progressive OA model. Chapter 7 examines OA progression in detail over time on both surgical induced OA (mimic secondary OA) and spontaneous OA (mimic primary OA) in guinea pigs, with special emphasis on the early stage of disease development. The progressive changes of subchondral bone over a 6 month time period is described in details for this experimental guinea pig OA model. It is now clear that increased subchondral bone turnover is a crucial step in the progression of OA and that the presence of cartilage lesion is always matched with significant bone remodeling directly below. This discovery has significant implications in both the understanding and treatment of OA. Having recognized the role of the subchondral bone in the OA progression, we hypothesize that the reduction of cartilage degeneration by suppressing subchondral bone turnover is highly achievable. Chapter 8 investigates the effect of Alendronate, a drug that prohibits bone resorption, in the aforementioned guinea pig OA model. This study demonstrates that by suppressing bone turnover, Alendronate exhibits positive effects on articular surface erosion, cartilage degradation and subchondral bone structure and mineralization; it also protected collagen and proteoglycan content of the articular cartilage. We conclude that anti-resorptive treatments have positive effects on both cartilage and bone degradation. Taken together, the thesis shows that cartilage and bone are tightly coupled together as a whole organ system. The two tissues cannot be considered separately in the study of arthritis pathogenesis; the interaction between subchondral bone and cartilage is one of the most important factors in OA progression. By suppressing subchondral bone turnover we have achieved cartilage protection in the guinea pig model of OA. This proves that increased subchondral bone turnover is a causal factor in OA progression. The combination of in vitro and in vivo models in this thesis has contributed to a better understanding of the etiology. In particular, in vitro models based on tissue engineered cartilage have been important for studying changes to the cartilage surface, and for screening of potential medication. For the study of progression of OA in the long term, the guinea pig model is very useful. This model simulates many aspects of normal development of OA in humans and can be used to evaluate treatments of OA in vivo

Shape/image registration for medical imaging : novel algorithms and applications.

This dissertation looks at two different categories of the registration approaches: Shape registration, and Image registration. It also considers the applications of these approaches into the medical imaging field. Shape registration is an important problem in computer vision, computer graphics and medical imaging. It has been handled in different manners in many applications like shapebased segmentation, shape recognition, and tracking. Image registration is the process of overlaying two or more images of the same scene taken at different times, from different viewpoints, and/or by different sensors. Many image processing applications like remote sensing, fusion of medical images, and computer-aided surgery need image registration. This study deals with two different applications in the field of medical image analysis. The first one is related to shape-based segmentation of the human vertebral bodies (VBs). The vertebra consists of the VB, spinous, and other anatomical regions. Spinous pedicles, and ribs should not be included in the bone mineral density (BMD) measurements. The VB segmentation is not an easy task since the ribs have similar gray level information. This dissertation investigates two different segmentation approaches. Both of them are obeying the variational shape-based segmentation frameworks. The first approach deals with two dimensional (2D) case. This segmentation approach starts with obtaining the initial segmentation using the intensity/spatial interaction models. Then, shape model is registered to the image domain. Finally, the optimal segmentation is obtained using the optimization of an energy functional which integrating the shape model with the intensity information. The second one is a 3D simultaneous segmentation and registration approach. The information of the intensity is handled by embedding a Willmore flow into the level set segmentation framework. Then the shape variations are estimated using a new distance probabilistic model. The experimental results show that the segmentation accuracy of the framework are much higher than other alternatives. Applications on BMD measurements of vertebral body are given to illustrate the accuracy of the proposed segmentation approach. The second application is related to the field of computer-aided surgery, specifically on ankle fusion surgery. The long-term goal of this work is to apply this technique to ankle fusion surgery to determine the proper size and orientation of the screws that are used for fusing the bones together. In addition, we try to localize the best bone region to fix these screws. To achieve these goals, the 2D-3D registration is introduced. The role of 2D-3D registration is to enhance the quality of the surgical procedure in terms of time and accuracy, and would greatly reduce the need for repeated surgeries; thus, saving the patients time, expense, and trauma

Osteoarthritis Induced Glenoid Morphology and Bone Quality: An Evaluation of Augmented Glenoid Components

Osteoarthritis of the glenoid results in regional bone density variations and bone loss that may compromise early component fixation and support. The two common morphologies, symmetric and asymmetric erosion, were characterized by bone density and morphology, and assessed on the basis of bone removal and bone quality in the context of augmented glenoid components. The bone strain field was also compared when different augmented glenoid components underwent simulated joint loading using finite element analysis. Asymmetrically eroded glenoids were found to have denser bone (

Detektion und quantitative Analyse von entzündlichen und strukturellen Veränderungen im Vergleich zur MRT

Die Magnetresonanztomographie (MRT) ist ein etabliertes Verfahren in der Arthritisdiagnostik. Entzündliche Veränderungen können dargestellt und mittels dynamischer kontrastverstärkter MRT (DCE-MRT) auch quantitativ bewertet werden. Bei der differenzierten Bewertung von strukturellen Veränderungen im Rahmen der rheumatoiden Arthritis besitzt die MRT jedoch eine geringe Spezifität. Dagegen zeigt die Computertomographie (CT) deutliche Vorteile bei der Detektion von knöchernen Läsionen. Die Durchführbarkeit der CT in der Detektion von entzündlichen Veränderungen ist daher Gegenstand der aktuellen Forschung. Zielsetzung: Ziel dieser Arbeit war es den diagnostischen Stellenwert der kontrastverstärkten CT in der Arthritisbildgebung zu untersuchen. Die Durchführbarkeit der CT-Subtraktion wurde in der Detektion von entzündlichen Veränderungen evaluiert und mittels quantitativer Analyse der Perfusion in der dynamischen kontrastverstärkten CT (DCE-CT) und DCE-MRT nachgewiesen. Ein Teilaspekt der Auswertung war die suszeptibilitätsgewichtete Sequenz (SWI) für die Erosiondetektion. Methoden: 37 Patienten mit Verdacht oder gesicherter rheumatoiden Arthritis der Hand wurden prospektiv in der kontrastverstärkten ultra-niedrigdosierten CT und MRT untersucht. Aus den gewonnenen CT-Bilddaten wurde zur Darstellung von Synovialitis und Tenosynovialitis die CT-Subtraktion berechnet und mit der MRT als Referenz verglichen. Durch Berechnung der Perfusionsparameter aus der DCE-CT und DCE-MRT wurde die Perfusion quantitativ zwischen den beiden Modalitäten verglichen. Das MRT-Protokoll beinhaltete zusätzlich zum Standardprotokoll eine SWI Sequenz. Die Bewertung der Erosion, Synovialitis und Tenosynovialitis fand durch drei Bewerter nach den etablierten Rheumatoid Arthritis Magnetic Resonance Scores (RAMRIS) Kriterien statt. Ergebnisse: Die CT-Subtraktion erzielte in der Detektion von Synovialitis eine Spezifität von 88%. Es wurde eine gute Korrelation zwischen der CT-Subtraktion und der MRT gezeigt (Pearson’s r = 0,94). Zusätzlich waren die Perfusionsparameter in beiden Modalitäten vergleichbar. Mittels DCE-CT konnte zudem die Entzündungsaktivität differenziert werden. Die SWI führte zu einer verbesserten Darstellbarkeit von Erosionen im Vergleich oder in Ergänzung zu herkömmlichen Sequenzen. Schlussfolgerung: Die CT-Perfusion stellt in der Arthritisbildgebung eine neue Modalität dar, die mit einer hohen Sicherheit entzündliche Veränderungen an Gelenken, sowie an Sehnenscheiden abbilden kann und ebenso auf quantitativer Ebene mit der DCE-MRT vergleichbare Perfusionsanalyse liefert. Zusätzlich ist sie als Goldstandard in der Detektion von knöchernen Läsionen bisher nicht zu übertreffen.Magnetic resonance imaging (MRI) is an established imaging modality in the field of arthritis imaging. Inflammatory lesions can be detected and also quantitatively assessed using dynamic contrast-enhanced MRI (DCE-MRI). However, MRI has a low specificity in the differentiated assessment of structural changes in the context of rheumatoid arthritis. In contrast, computed tomography (CT) shows obvious advantages in the detection of bony lesions. The feasibility of CT in the detection of inflammatory lesions is therefore the subject of current research. Objective: The aim of this work was to investigate the diagnostic importance of contrastenhanced CT in arthritis imaging. The feasibility of CT-subtraction in the detection of inflammatory lesions was evaluated and demonstrated by quantitative analysis of the perfusion using dynamic contrast-enhanced CT (DCE-CT) and DCE-MRI. A partial aspect was to evaluate the use of the susceptibility-weighted imaging sequence (SWI) in erosion detection. Methods: 37 patients with suspected or proven diagnosis of rheumatoid arthritis of the hand prospectively underwent contrast-enhanced ultra-low-dose CT and MRI. CTsubtraction was calculated from the obtained CT image data to represent synovitis and tenosynovitis and compared with MRI as a reference. By assessing the perfusion parameters using DCE-CT and DCE-MRI, the perfusion was compared quantitatively between these two modalities. In addition to standard protocol, the MRI protocol included the SWI sequence. The evaluation of erosion, synovitis and tenosynovitis was performed by three readers according to the established Rheumatoid Arthritis Magnetic Resonance Scores (RAMRIS) criteria. Results: CT-subtraction performed with a specificity of 88% in detection of synovitis. There was shown a good correlation between CT-subtraction and MRI (Pearson’s r = 0,94). In addition, the perfusion parameters were comparable in both modalities. Inflammatory activity was also differentiated using DCE-CT. The SWI let to an improved detection of erosions compared to or in addition to conventional sequences. Conclusion: CT-perfusion represents a new modality in arthritis imaging, which can detect inflammation of the joints and tendons with a high degree of certainty and also provides a quantitative perfusion analysis comparable to that of DCE-MRI. In addition, CT has so far not been surpassed as the gold standard in the detection of bony lesions