Duryea, J.

Hakky, M.

Ratzlaff, C.

Russell, R.

Elsevier - Publisher Connector 

Change in normalized cartilage volume
Visit time Normalized medial volume Normalized lateral volume
RMSSD CV RMSSD CV
BL-12 mo 8.0 mm3 5.2% 9.7 mm3 5.6%
BL-48 mo 7.8 mm3 5.0% 11.7 mm3 6.8%
Change in cartilage volume
Visit time Medial Volume Lateral Volume
RMSSD CV RMSSD CV
BL-12 mo 14.4 mm3 9.6% 15.3 mm3 8.8%
BL-48 mo 13.9 mm3 9.2% 17.5 mm3 10.2%
Abstracts / Osteoarthritis and Cartilage 21 (2013) S63–S312 S197longer spin lock image has low SNR. This highlights the need for
acquisition of spin lock times that cover the full range of the decay curve
for the range of T1r relaxation times expected. Robust curve ﬁtting
methods may help to minimize the effect of low-quality images arising
from long spin lock times with short T1r tissues. The results shown here
quantify the increase in measurement error as SNR and number of spin
lock times decrease. This information will help guide design of efﬁcient
and robust protocols for quantitative T1r imaging in vivo.
373
SUPERIORITY OF KNEE ULTRASOUND OVER RADIOGRAPHS IN
OSTEOPHYTE DETECTION IN KNEE OSTEOARTHRITIS
S. Slimani y, A. Haddouche z, I. Bencharif x, A. Ladjouze-Rezig k. yHadj
Lakhdar Univ., Batna, Algeria; zBlida Univ., Blida, Algeria; xConstantine
Univ., Constantine, Algeria; kAlgiers Univ., Algiers, Algeria
Purpose: Osteophytes are important signs in knee osteoarthritis as they
are one of the diagnostic criteria and in the assessment of the disease
severity (Kellgren-Lawrence grading). Musculoskeletal ultrasound
(MSUS) is being adopted by a growing number of rheumatologists
because of its cost-effectiveness and the absence of radiation exposure.
The aim of the study was to evaluate the concordance of radiographs
and MSUS in terms of detecting osteophytes in knee osteoarthritis.
Methods: A cross-sectional study in outpatients presenting with knee
osteoarthritis, according to the 1990 ACR criteria for knee osteoarthritis.
Radiographs of the knees (anteroposterior incidence) and MSUS of the
knee have been performed for each patient. Two rheumatologists
trained in MSUS (S.S and A.H) have done MSUS examinations, and had
no access to patients’ radiographs. Radiographs were sent and read by
an independent rheumatologist (B.I) in another rheumatology center.
Osteophytes were searched on 4 sites, chosen because of their easy
access by both radiographs and MSUS: medial and lateral femoral
condyles; medial and lateral superior tibial extremities. Osteophytes of
the femoropatellar compartment have not been assessed because they
require strict lateral radiographs and are not easily accessible on MSUS,
thus a concordance assessment could not be reliable on this site.
Concordance has been assessed using Kappa concordance coefﬁcient.
Results: We have examined 192 knees of 102 patients, 76.5% females,
mean age 65.2  9.7 years. Radiographic analysis allowed the detection
of osteophytes in 35.9% cases, with a mean number of 1.6 osteophyte
per knee, while MSUS detected osteophytes in 86.5% cases, with a mean
number of 2.7 osteophyte per knee. The Kappa coefﬁcient between
radiographs and MSUS was 0.183 (95% CI: 0,138-0,228). Most of the
detected osteophytes on MSUS (60.5%) were located on the femoral
condyles.
Conclusions: Concordance between radiography and MSUS in the
detection of osteophytes is poor, due to a much higher level of detection
of MSUS (2.5 more osteophytes detected with MSUS). This was made
possible since new high resolutions machines were made available. The
place of knee MSUS is still to be deﬁned in the diagnostic procedure of
knee pain, may be in case of normality of radiographs. To do this, studies
assessing sensitivity/speciﬁcity of knee MSUS in detecting infra-radio-
graphic knee osteoarthritis are required.
374
LONG TERM PATIENT REPOSITIONING REPRODUCIBILITY OF
CARTILAGE VOLUME ON KNEE MRI
R. Russell y, C. Ratzlaff y, M. Hakky z, J. Duryea y. yBrigham and Women's
Hosp., Boston, MA, USA; z Lahey Clinic, Burlington, MA, USA
Purpose: Quantitative measurement of cartilage volume in MRI image
data may be an important imaging biomarker in knee osteoarthritis
(OA) but relies on reproducible patient re-positioning and image
acquisition across time points. We previously developed a fast and
responsive method to measure cartilage volume at focal regions in the
femur. Figure 1 shows an example of this region in the medial
compartment. The purpose of the current study was to examine long-
term patient repositioning reproducibility of this method, and to
investigate systematic changes in cartilage volume in subjects without
OA or risk factors for OA.
Methods: The dominant knee image of 42 randomly selected subjects
from the OAI Control Cohort was selected from patients present at the
baseline, 12 month and 48months visits. Since duplicate scans obtained
the same day were not available, we used Control Cohort subjects and
assumed no change in cartilage volume due to OA progression.Double echo steady state (DESS) 3D sagittal images were obtained on
a 3T Siemens Trio MR system (0.365 mm x 0.365mm, 0.7 mm slice
thickness, TR 16.5 ms, TE 4.7 ms). The reader used the method to
segment two ﬁxed regions of cartilage in the medial and lateral
compartments of the knee determined with respect to a 3D cylindrical
coordinate system deﬁned by the software. Readings were performed
fully blinded to subject ID and time point. Cartilage volume at ﬁxed
locations in the medial and lateral compartments was measured
between two time point pairs: baseline (BL) to 12 month, and BL to 48
months. A second metric, reﬂecting cartilage thickness, was deﬁned as
the cartilage volume normalized to a measure of the region surface
area. Reproducibility was measured using the root mean square SD
(RMSSD) and coefﬁcient of variation (CV). To investigate possible bia-
ses or any consistent change over time, Bland Altman plots were also
produced.
Results: Results from the raw volume measurements are shown in
Table 1 and for normalized volume measurement in Table 2. The
reproducibility was substantially better for the normalized compared to
the raw volume measurements. Bland Altman plots of the normalized
volume revealed no systematic bias in the normalized volumes (Figures
2-5) or in raw volume (data not shown).
Conclusions: We observe excellent long-term reproducibility using
a normalized volume measurement. The reproducibility is degraded
when using the raw volume suggesting a bias from the cartilage region
selection component of the method. The Bland Altman plots reveal no
systematic shift, indicating a robust method and that no true cartilage
volume change occurred.
Fig. 1. Region of cartilage for measurement.Ă
Fig. 2. Medial Compartment (BL - 12 mo).Ă
Fig. 4. Lateral Compartment (BL - 12 mo).Ă
Fig. 3. Medial Compartment (BL - 48 mo).Ă
Abstracts / Osteoarthritis and Cartilage 21 (2013) S63–S312S198Fig. 5. Lateral Compartment (BL to 48 mo).Ă
375
ACCURACY OF HIGH RESOLUTION ULTRASONOGRAPHY IN
DETECTING MENISCAL TEARS
Y. Akatsu, S. Yamaguchi, T. Sasho, K. Takahashi, R. Akagi, Y.
Muramatsu, J. Katsuragi, T. Fukawa, S. Mukouyama, J. Endo. Chiba
Univ., Chiba, Japan
Purpose:MRI is the ﬁrst-line modality to diagnose meniscal pathology.
Possible alternative to MRI is an ultrasound scanning which is quick to
perform and less costly. The aim of this study was to assess the accuracy
of high resolution ultrasonography in the diagnosis of meniscal tears
with arthroscopic examination as standard reference.
Methods: Fifty pair of menisci were evaluated in 50 patients (23
females, 27 males, mean age ¼ 32.5 years, range ¼ 13-80 years). Knee
examinations were performed with high resolution ultrasonography
machine (Hi Vision Preirus, Hitachi, Japan) with 8-14 MHz linear
transducer. Inclusion criteria for the study were 1) knees that needed to
be treated or examined arthroscopically due to intra articular
pathology, and 2) unilateral involvement. Exclusion criteria were
a history of rheumatoid arthritis or other inﬂammatory disease, peri-
articular fracture, Paget's disease, joint infection, neuropathic arthrop-
athy, acromegaly, gout, and pseudogout. Examiner was not informed
preoperative diagnosis and laterality. After ultrasonographic examina-
tion, all patients underwent arthroscopic procedures within 1-3 days.
After the ﬁnal diagnosis about meniscal status was derived from
surgical reports, ultrasonographic diagnosis was compared in terms of
presence of tear as well as type of tear when tears were present.
Results: The overall sensitivity, speciﬁcity, positive predictive value, and
negative predictive value of ultrasonographic examination in the
assessment of meniscal tears amounted to 90%, 70%, 92% and 64%,
respectively. The statistical parameters were not statistically different in
medial and lateral menisci. Sensitivity, speciﬁcity, positive predictive
value and negative predictive value of ultrasonographic examination in
the assessment of medial meniscal tears vs. lateral meniscal tears were
96% vs. 65%, 74% vs. 88%, 81% vs. 81%, and 94% vs. 76%, respectively. As
for diagnostic ability in diagnosing the type of meniscal tear, the
sensitivity and positive predictive value of horizontal tear, vertical tear,
radial tear, ﬂap tear, bucket handle tear, complex tear, discoid were 71%
vs. 36%, 47% vs. 58%, 0% vs. 0%, 40% vs. 67%, 55% vs. 86%, 88% vs. 54%,
100% vs. 100%. Age, sex, body mass index (BMI), weight, did not have
a statistically signiﬁcant impact on the usefulness of ultrasonography.
Conclusions: High resolution ultrasonography had high accuracy in the
detecting the presence of tears both in medial and lateral menisci. But
type of meniscal tear was difﬁcult to diagnose.
376
AUTOMATIC SEGMENTATION OF ARTICULAR CARTILAGE FROM
COMBINED ASSESSMENT OF SODIUM AND PROTON MR KNEE
IMAGES
A. Mohd Hani y, D. Kumar y, A. Malik y, N. Walter y, R. Razak z, A.
Kiﬂie x. yCtr. for Intelligent Signal and Imaging Res., Universiti Teknologi
Petronas, Tronoh, Malaysia; zOrthopaedic Dept., Hosp. Pantai Ipoh, Ipoh,
Malaysia; xDept. of Radiology, Hosp. Pantai Ipoh, Ipoh, Malaysia


Long term patient repositioning reproducibility of cartilage volume on knee MRI 

file:///data/core-remote/dit/data/elsevier/pdf/336/aHR0cDovL2FwaS5lbHNldmllci5jb20vY29udGVudC9hcnRpY2xlL3BpaS9zMTA2MzQ1ODQxMzAwNDY0MA==.pdf

Long term patient repositioning reproducibility of cartilage volume on knee MRI

Abstract

Similar works

Full text

Available Versions

Elsevier - Publisher Connector

Elsevier - Publisher Connector