T1ρ and T2 relaxation times predict progression of knee osteoarthritis

SummaryObjectiveTo evaluate whether T2 and T1ρ relaxation times of knee cartilage determined with 3T magnetic resonance imaging (MRI) at baseline predict longitudinal progression of cartilage degenerative changes.MethodsQuantitative analysis of cartilage was performed using 3T MRI with both T2 and T1ρ mapping techniques in 55 subjects without evidence of severe osteoarthritis (OA) [Kellgren–Lawrence (KL) score of 0–3] at baseline. Morphological abnormalities of cartilage, menisci, ligaments and bone marrow were analyzed on sagittal fat-saturated intermediate-weighted fast spin echo (FSE) sequences. Progression of degenerative changes was analyzed over a period of 2 years. Progression was detected in 27 subjects while in 28 subjects no changes were found. Differences between T2 and T1ρ relaxation times in these two cohorts were compared using one-way analysis of variance (ANOVA) and t tests.ResultsBaseline T2 and T1ρ values were significantly higher in the progression cohort in all compartments (P < 0.05) except the lateral tibia (LT) for T2 and the medial tibia (MT) for T1ρ. Progression of cartilage degenerative disease was most pronounced at the medial femoral condyles and at the femoro-patellar joint; differences between the two cohorts for T2 and T1ρ were also most significant in these compartments.ConclusionsT2 and T1ρ measurements were significantly higher at baseline in individuals that showed progression of cartilage abnormalities over a period of 2 years and may therefore serve as potential predictors for progression of degenerative cartilage abnormalities in knee OA

Vastus lateralis/vastus medialis cross-sectional area ratio impacts presence and degree of knee joint abnormalities and cartilage T2 determined with 3T MRI – an analysis from the incidence cohort of the Osteoarthritis Initiative

SummaryObjectiveTo study the role of vastus lateralis/vastus medialis cross-sectional area CSA ratio (VL/VM CSA ratio) in preclinical knee osteoarthritis (OA) using magnetic resonance imaging (MRI)-based cartilage T2 mapping technique and morphological analysis at 3.0T in non-symptomatic, middle-aged subjects.Material and methods174 non-symptomatic individuals aged 45–55 years with OA risk factors were selected from the Osteoarthritis Initiative (OAI) incidence cohort. OA-related knee abnormalities were analyzed using the whole-organ magnetic resonance imaging score (WORMS). Knee cartilage T2 maps were generated using sagittal 2D multi-echo spin-echo images of the right knee. CSA of thigh muscles was measured using axial T1W images of the right mid thigh. Spline-based segmentation of cartilage and muscles was performed on a SUN/SPARC workstation. Muscle measurements were normalized to body size using body surface area (BSA). Statistical significance was determined using Student’s t-test, Pearson correlation test, and multiple regression models. To correct for multiple testing, Bonferroni adjustments were applied across all tests within each of the primary results tables (Tables III–VII).ResultsHigher T2 values were associated with increased prevalence and severity of cartilage degeneration. In our study, male and female subjects with higher VL/VM CSA ratio demonstrated significantly lower mean cartilage T2 values (all compartments combined) (mean 44.10 vs 45.17, P=0.0017), and significantly lower WORMS scores (mean 14.12 vs 18.68, P=0.0316). Regression analyses of combined mean cartilage T2 using VL/VM CSA ratio as a continuous predictor showed a significant curvilinear relationship between these two variables (P=0.0082).ConclusionOur results suggested that higher VL/VM CSA ratio is associated with lower T2 values and decreased presence and severity of OA-related morphological changes. Additional studies will be needed to determine causality

In vivo T1ρ and T2 mapping of articular cartilage in osteoarthritis of the knee using 3T MRI

SummaryObjectiveEvaluation and treatment of patients with early stages of osteoarthritis (OA) is dependent upon an accurate assessment of the cartilage lesions. However, standard cartilage dedicated magnetic resonance (MR) techniques are inconclusive in quantifying early degenerative changes. The objective of this study was to determine the ability of MR T1rho (T1ρ) and T2 mapping to detect cartilage matrix degeneration between normal and early OA patients.MethodSixteen healthy volunteers (mean age 41.3) without clinical or radiological evidence of OA and 10 patients (mean age 55.9) with OA were scanned using a 3Tesla (3T) MR scanner. Cartilage volume and thickness, and T1ρ and T2 values were compared between normal and OA patients. The relationship between T1ρ and T2 values, and Kellgren–Lawrence scores based on plain radiographs and the cartilage lesion grading based on MR images were studied.ResultsThe average T1ρ and T2 values were significantly increased in OA patients compared with controls (52.04±2.97ms vs 45.53±3.28ms with P=0.0002 for T1ρ, and 39.63±2.69ms vs 34.74±2.48ms with P=0.001 for T2). Increased T1ρ and T2 values were correlated with increased severity in radiographic and MR grading of OA. T1ρ has a larger range and higher effect size than T2, 3.7 vs 3.0.ConclusionOur results suggest that both in vivo T1ρ and T2 relaxation times increase with the degree of cartilage degeneration. T1ρ relaxation time may be a more sensitive indicator for early cartilage degeneration than T2. The ability to detect early cartilage degeneration prior to morphologic changes may allow us to critically monitor the course of OA and injury progression, and to evaluate the success of treatment to patients with early stages of OA

Development of an integrated economic and ecological framework for ecosystem-based fisheries management in New England

Author Posting. © The Author(s), 2012. This is the author's version of the work. It is posted here by permission of Elsevier B.V. for personal use, not for redistribution. The definitive version was published in Progress in Oceanography 102 (2012): 93-101, doi:10.1016/j.pocean.2012.03.007.We present an integrated economic-ecological framework designed to help assess the implementation of ecosystem-based fisheries management (EBFM) in New England. We develop the framework by linking a computable general equilibrium (CGE) model of a coastal economy to an end-to-end (E2E) model of a marine food web for Georges Bank. We focus on the New England region using coastal county economic data for a restricted set of industry sectors and marine ecological data for three top level trophic feeding guilds: planktivores, benthivores, and piscivores. We undertake numerical simulations to model the welfare effects of changes in alternative combinations of yields from feeding guilds and alternative manifestations of biological productivity. We estimate the economic and distributional effects of these alternative simulations across a range of consumer income levels. This framework could be used to extend existing methodologies for assessing the impacts on human communities of groundfish stock rebuilding strategies, such as those expected through the implementation of the sector management program in the US northeast fishery. We discuss other possible applications of and modifications and limitations to the framework.This work was supported by the NOAA Saltonstall-Kennedy Grant Program (Award No. NA09NMF4270097), the MIT Sea Grant College Program (NOAA Award No. NA10OAR4170086, Subaward No. 5710002974), and the Johnson Endowment of the WHOI Marine Policy Center

'Education, education, education' : legal, moral and clinical

This article brings together Professor Donald Nicolson's intellectual interest in professional legal ethics and his long-standing involvement with law clinics both as an advisor at the University of Cape Town and Director of the University of Bristol Law Clinic and the University of Strathclyde Law Clinic. In this article he looks at how legal education may help start this process of character development, arguing that the best means is through student involvement in voluntary law clinics. And here he builds upon his recent article which argues for voluntary, community service oriented law clinics over those which emphasise the education of students