Quantifying the Tibiofemoral Joint Space Using X-ray Tomosynthesis

Purpose: Digital x-ray tomosynthesis (DTS) has the potential to provide 3D information about the knee joint in a load-bearing posture, which may improve diagnosis and monitoring of knee osteoarthritis compared with projection radiography, the current standard of care. Manually quantifying and visualizing the joint space width (JSW) from 3D tomosynthesis datasets may be challenging. This work developed a semiautomated algorithm for quantifying the 3D tibiofemoral JSW from reconstructed DTS images. The algorithm was validated through anthropomorphic phantom experiments and applied to three clinical datasets. Methods: A user-selected volume of interest within the reconstructed DTS volume was enhanced with 1D multiscale gradient kernels. The edge-enhanced volumes were divided by polarity into tibial and femoral edge maps and combined across kernel scales. A 2D connected components algorithm was performed to determine candidate tibial and femoral edges. A 2D joint space width map (JSW) was constructed to represent the 3D tibiofemoral joint space. To quantify the algorithm accuracy, an adjustable knee phantom was constructed, and eleven posterior–anterior (PA) and lateral DTS scans were acquired with the medial minimum JSW of the phantom set to 0–5 mm in 0.5 mm increments (VolumeRadTM, GE Healthcare, Chalfont St. Giles, United Kingdom). The accuracy of the algorithm was quantified by comparing the minimum JSW in a region of interest in the medial compartment of the JSW map to the measured phantom setting for each trial. In addition, the algorithm was applied to DTS scans of a static knee phantom and the JSW map compared to values estimated from a manually segmented computed tomography (CT) dataset. The algorithm was also applied to three clinical DTS datasets of osteoarthritic patients. Results: The algorithm segmented the JSW and generated a JSW map for all phantom and clinical datasets. For the adjustable phantom, the estimated minimum JSW values were plotted against the measured values for all trials. A linear fit estimated a slope of 0.887 (R2¼0.962) and a mean error across all trials of 0.34 mm for the PA phantom data. The estimated minimum JSW values for the lateral adjustable phantom acquisitions were found to have low correlation to the measured values (R2¼0.377), with a mean error of 2.13 mm. The error in the lateral adjustable-phantom datasets appeared to be caused by artifacts due to unrealistic features in the phantom bones. JSW maps generated by DTS and CT varied by a mean of 0.6 mm and 0.8 mm across the knee joint, for PA and lateral scans. The tibial and femoral edges were successfully segmented and JSW maps determined for PA and lateral clinical DTS datasets. Conclusions: A semiautomated method is presented for quantifying the 3D joint space in a 2D JSW map using tomosynthesis images. The proposed algorithm quantified the JSW across the knee joint to sub-millimeter accuracy for PA tomosynthesis acquisitions. Overall, the results suggest that x-ray tomosynthesis may be beneficial for diagnosing and monitoring disease progression or treatment of osteoarthritis by providing quantitative images of JSW in the load-bearing knee

Magnetic resonance imaging of knee hyaline cartilage and intraarticular pathology

Injuries to the hyaline cartilage of the knee joint are difficult to diagnose without invasive techniques. Even though these defects may be the most important prog nostic factors in assessing knee joint injury, they are usually not diagnosed until arthrotomy or arthroscopy. Once injuries to hyaline cartilage are found and/or treated, no technique exists to follow these over time. Plain radiographs, arthrograms, and even computed tomography fail to detail most hyaline cartilage defects. We used magnetic resonance imaging (MRI) to eval uate five fresh frozen cadaver limbs and 10 patients whose pathology was known from arthrotomy or ar throscopic examination. Using a 0.35 Tesla supercon ducting magnet and spin-echo imaging technique with a head coil, we found that intraarticular fluid or air helped to delineate hyaline cartilage pathology. The multiplane capability of MRI proved to be excellent in detailing small (3 mm or more) defects on the femoral condyles and patellar surface. Cruciate ligaments were best visualized on sagittal oblique projections while meniscal pathology was best seen on true sagittal and coronal projections. MRI shows great promise in providing a noninvasive technique of evaluating hyaline cartilage defects, their response to treatment, and detailed anatomical infor mation about cruciate ligaments and menisci.Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/67078/2/10.1177_036354658701500505.pd

Synchrotron imaging of bovine and human ovaries ex vivo

Background and Rationale: Reproductive dysfunction affects more than 15% of Canadian women; however, the underlying causes remain largely unknown. Ultrasonography is the most commonly used research and diagnostic tool for imaging the ovaries and uterus. However, current ultrasonographic techniques allow the detection of ovarian structures (eg. follicles, corpora lutea) at diameters of only ≥2 mm. The increased effectiveness of synchrotron technology for imaging ovaries in comparison to conventional imaging methods is currently unknown. Overall Objective: The overall objective of this research was to determine the effectiveness of synchrotron techniques for imaging ovaries. We hypothesized that synchrotron techniques would provide greater contrast for visualizing structural details of follicles, corpora lutea (CL), and cumulus oocyte complexes (COC), compared to conventional ultrasonography. Materials and Methods: Three studies were conducted to evaluate phase-contrast based synchrotron imaging methods. The first study involved Diffraction Enhanced Imaging (DEI) of bovine ovaries (n=6). The second study involved Propagation-Based Computed Tomography (PB-CT) imaging of bovine (n=4) and human ovaries (n=4). A third, preliminary study was conducted to explore the use of Talbot Grating Interferometry (TGI-CT) imaging of bovine (n=1) and human ovaries (n=1). Fresh and formalin-fixed bovine and human ovaries were imaged without or with contrast injection into the ovarian artery. Following synchrotron imaging, all ovarian samples were evaluated using diagnostic ultrasonography and histology. Images obtained using synchrotron techniques, ultrasonography and histology were qualitative and quantitatively compared. Results: DEI allowed the identification of 71% of follicles ≥2 mm and 67% of CL detected using ultrasonography. Mean follicle diameter was similar between DEI (9.6 ± 2.4 mm), ultrasonography (9.0 ± 2.6 mm), and histology (6.9 ± 1.9 mm) for fresh ovaries without contrast (P = 0.70). Likewise, no difference in CL diameter was detected between DEI (11.64 ± 1.67 mm), ultrasonography (9.34 ± 0.35 mm), and histology (9.6 ± 0.4 mm), (P = 0.34). Antral Follicle Count (AFC; ≥2mm) was similar between ultrasonography (6.5 ± 0.7 mm, fresh with no contrast; 6.5 ± 2.5 mm, preserved with no contrast) and DEI ( 4.5 ± 0.5 mm, fresh with no contrast; 6.5 ± 0.50 mm, preserved with no contrast) (P > 0.05). However, the contrast resolution for differentiating follicles and CL was inferior with DEI compared to ultrasonography. Small antral follicles <2mm, cell layers comprising the follicle wall and COC were not detected using either DEI or ultrasonography. PB-CT imaging enabled the visualization of 100% of follicles ≥2 mm and 100% of CL that were detected with ultrasonography. CL containing a central cystic cavity were identified using PB-CT; however, CL without a central cystic cavity were not well-visualized. Mean follicle and luteal diameters did not differ among PB-CT, ultrasonography and histology (P>0.05). PB-CT was superior to ultrasonography for detecting small antral follicles <2 mm in bovine ovaries (P = 0.04), and the granulosa and theca cell layers of the follicle wall in bovine and human ovaries (P < 0.0001). However, TGI-CT images exhibited greater contrast resolution for visualizing small and large antral follicles, CL, and the cell layers of the follicle wall compared to both PB-CT and ultrasonography. High contrast structures resembling COC were detected with both PB-CT and TGI-CT, but not with ultrasonography. Only TGI-CT permitted the visualization of the oocyte within the COC in fresh and preserved ovaries. Conclusions: DEI was inferior to ultrasonography for detecting ovarian follicles and CL. PB-CT was superior to ultrasonography for visualizing follicles <2 mm, COC, and the cell layers of the follicle wall. However, PB-CT was as effective as ultrasonography for detecting and measuring follicles ≥2 mm and cystic CL. Preliminary findings suggest that TGI-CT provides the greatest contrast for imaging both ovarian macro- and microanatomy compared to PB-CT, DEI, and ultrasonography

Ultrasound for Knee Osteoarthritis Screening: A Panoramic Reconstruction of the Knee Joint

Osteoarthritis (OA) is a significant and growing disease. Ultrasound (US) imaging provides an accessible method of imaging soft and hard tissue in the assessment of musculoskeletal morphology, particularly in screening for OA. The team created a device, protocol, and reconstruction software to acquire images of and measure the knee articular cartilage thickness, a proxy for joint space width. The resulting device can be used to detect and monitor progress of joint space narrowing. Using the device, the femoral articular cartilage thickness was measured with up to 5 mm of resolution as compared to that of the gold standard, MRI

Advanced Imaging of Inflammation in Knee Osteoarthritis

This thesis focuses on imaging methods to study the role of inflammation in knee osteoarthritis. The aims of this thesis are I) to evaluate disturbed perfusion patterns in subchondral bone and the infrapatellar fat pad using perfusion MRI, and II) to assess new magnetic resonance and ultrasound imaging methods for diagnosis of synovitis in knee osteoarthritis

Development of diffraction enhanced computed tomography for imaging joints

This research was inspired by a need to discover more refined technologies for imaging growing joints to facilitate research in childhood arthritis, which is among the most common chronic conditions of childhood. The objective of this project was to develop and test a new technology for imaging growing joints using diffraction enhanced imaging (DEI) combined with computed tomography (CT) using a synchrotron radiation source. DEI is a modality that derives contrast from x-ray refraction, extinction (an extreme form of scatter rejection), and absorption (as in conventional radiography). The ability to add to an image’s contrast from the refraction of x-rays, rather than that solely from absorption, generates more detailed visualization of soft tissue and of interfaces between tissues. Additionally, refraction-based imaging allows reduction of absorbed radiation dose by the sample tissue. For this research, stifle joints from four-week piglet joints were imaged by DEI-CT using the BioMedical Imaging and Therapy (BMIT) beamline at the Canadian Light Source (CLS) synchrotron facility. This new modality for imaging growing joints incorporated a novel feedback control to maintain precise alignment of the analyzer crystal, which is used to re- diffract the beam that passes through the object, throughout the scanning procedure. Results showed that high-resolution DEI-CT provided three-dimensional images of the bone and soft tissue of growing joints at a resolution on the order of microns. Fine detail within and between all joint structures and tissues, including striking detail of cartilage vasculature, a iii characteristic of growing but not mature joints, was demonstrated. This report documents for the first time that DEI combined with CT and using a synchrotron radiation source can generate more detailed images of intact, growing joints than is currently available from conventional imaging modalities. The development of this high resolution imaging system, which provides excellent contrast for both hard and soft tissues, fills an important gap in the suite of imaging modalities available for joint research, particularly during growth