Guide to lower extremity radiologic measurements: part 2 knee.

BackgroundAdiposity is associated with increased risk of knee osteoarthritis (OA); cartilage thickness, cartilage volume and subchondral bone area are established biomarkers in knee OA. However, there are no studies describing...

Baseline radiographic osteoarthritis and semi-quantitatively assessed meniscal damage and extrusion and cartilage damage on MRI is related to quantitatively defined cartilage thickness loss in knee osteoarthritis: the Multicenter Osteoarthritis Study

A total of 160 dogs of 21 breeds were classified into four groups, I to IV, or well, mild, moderate, and severe, respectively. The mean values of Hb. A/G ratio, TP, and Ht measured in each group were plotted on four parallel lines drawn at the same intervals. The resulting hemospectrogram was compared among the groups. In it, a broken linear graph ran from the upper to the lower part within a range of normal values in group I. It showed a shift of the A/G ratio to the left beyond a range of normal values in group II. It exhibited a shift of Hb and the A/G ratio to the left beyond a range of respective normal values in group III. It presented a shift of Hb, the A/G ratio, and TP to the left beyond a range of respective normal values and a shift of Ht to the right beyond a range of normal values in group IV. These results seemed to indicate that the hemospectrogram might be available for judgment of severity of disease.

Background:The background to this study is the consideration that the development of osteoarthritis (OA) over time may depend on the respective health status of the patients, their comorbidities and risk...

The purpose of this study was to evaluate regional differences of canine stifle articular cartilage using the quantitative magnetic resonance imaging (MRI) technique of T2 mapping. Fourteen stifle joints from seven juvenile male Beagle dogs with no evidence or prior history of pelvic limb lameness were imaged ex vivo using standard of care fast spin echo MRI and quantitative T2 mapping protocols. Regions of interest were compared between the femoral, patellar and tibial cartilages, as well as between the lateral and medial femorotibial compartments. Limbs were processed for histology with standard stains to confirm normal cartilage. The average T2 value of femoral trochlear cartilage (37.5 ± 2.3 ms) was significantly prolonged (p < 0.0001) as compared with the femoral condylar, patellar and tibial condylar cartilages (33.1 ± 1.5 ms, 32.8 ± 2.3 ms, and 28.0 ± 1.7 ms, respectively). When comparing medial and lateral condylar compartments, the lateral femoral condylar cartilage had the longest T2 values (34.8 ± 2.8 ms), as compared with the medial femoral condylar cartilage (30.9 ± 1.9 ms) and lateral tibial cartilage (29.1 ± 2.3 ms), while the medial tibial cartilage had the shortest T2 values (26.7 ± 2.4 ms). As seen in other species, regional differences in T2 values of the canine stifle joint are identified. Understanding normal regions of anticipated prolongation in different joint compartments is needed when using quantitative imaging in models of canine osteoarthritis.

Bu çalışmada Yeni Zelanda Tavşanı diz ekleminde bulunan meniscus ve eklem kapsülünün anatomik özelliklerini belirlemek ve diğer araştırmacılara kaynak sağlamak amaçlandı. Patella ve lig. patellae ile femur arasında distal’e doğru uzanan cranial femoropatellar kompartmanın, ligamentum patellae ile tuberositas tibiae arasını dolduran corpus adiposum infrapatellare’nin proximal’inde genişleyerek yayıldığı görüldü. Bu noktanın intrakapsüler enjeksiyon için en uygun yer olduğu tespit edildi. Tavşanlarda eklem boşluğu içerisinde yer alan kompartımanların birbirleriyle ilişkili olduğu görüldü. Corpus adiposum infrapatellare’nin proximal’inde genişleyen eklem kapsülünün içinde kalan boşlukların her iki yanda cranial’den caudal’e doğru seyrederek lateral ve medial femorotibial kompartmanlara geçiş sağladığı tespit edildi

To define the number and distribution of osteophytes (OPs) in bilateral knee MRI (magnetic resonance imaging) of patients with unilateral anterior cruciate ligament (ACL) rupture. Bilateral knee MRIs of 20 patients with unilateral ACL rupture and reconstruction were retrospectively analyzed for OPs. OPs were graded following the KOSS (knee OA scoring system) classification and their compartmental distribution was assessed following the WORMS (Whole-Organ Magnetic Resonance Imaging Score) classification. All examined knees revealed OPs. Knees with ACL rupture showed significant (p < 0.001) higher total numbers of OPs (mean 11.6; SD ± 4.4) than knees with intact ACL (mean 5.1; SD ± 2.3). Knees with ACL rupture showed increased OP formation in all knee compartments with predominance of marginal OPs in the lateral femorotibial compartment especially on the tibia. Our results show that after knee injury with ACL rupture and reconstruction, all knee compartments were involved in post-traumatic increase of OP formation. The most affected compartment was the lateral femorotibial compartment on the tibial side.

Ankle, hindfoot, and midfoot osteoarthritis (OA) is most commonly posttraumatic and tends to become symptomatic in younger patients. It often results from instability due to insufficiency of supportive soft tissue structures, such as ligaments and tendons. Diagnostic imaging can be helpful to detect and characterize the distribution of OA, and to assess the integrity of these supportive structures, which helps determine prognosis and guide treatment. However, the imaging findings associated with OA and instability may be subtle and unrecognized until the process is advanced, which may ultimately limit therapeutic options to salvage procedures. It is important to understand the abilities and limitations of various imaging modalities used to assess ankle, hindfoot, and midfoot OA, and to be familiar with the imaging findings of OA and instability patterns.

To determine the magnetic resonance imaging (MRI), macroscopic, and microscopic characteristics of synovial membrane inflammation, to study the relationship between disease severity and the degree of synovial inflammation on MRI and on macroscopic and microscopic examination, and to look for colocalization of chondral lesions and synovial inflammation. Thirty-nine patients with knee osteoarthritis (OA) were classified into 2 groups according to the severity of cartilage lesions as revealed by chondroscopy. Group 1 (n = 14) had mild cartilage lesion(s) without exposure of subchondral bone. Group 2 (n = 25) had severe cartilage lesion(s) with focal or diffuse exposure of subchondral bone. Synovitis was evaluated on T1-weighted MRI sequences according to the degree of synovial thickening on a 4-point scale (ranging from 0 to 3) in 5 regions of interest. Synovial membrane was macroscopically scored, and biopsies were performed on the 5 preselected sites for histologic scoring. The mean +/- SD synovial thickening score on MRI was 1.55 +/- 0.90, with no significant difference between groups 1 and 2. Intra- and interobserver reproducibility of the total synovial score was excellent, and interobserver reproducibility of the MRI grade was good. Synovitis was diffuse and associated with chondral lesions only in the medial femorotibial compartment (r = 0.49, P = 0.001). The degree of synovial thickening on MRI correlated with qualitative macroscopic analysis (r(s) = 0.58, P < 0.001) and with microscopic features (synovial lining cells [r(s) = 0.23, P < 0.007], surface fibrin deposition [r(s) = 0.12, P < 0.01], fibrosis [r(s) = 0.31, P < 0.006], edema [r(s) = 0.17, P = 0.07], congestion [r(s) = 0.30, P < 0.005], and infiltration [r(s) = 0.46, P < 0.0001]). Fibrin and infiltration parameters were more severe in end-stage disease (P = 0.009 and P = 0.02, respectively). Synovitis may be present from the onset of OA and may be evaluated on MRI. MRI evaluation of synovitis could be used to classify OA patients in clinical trials and could help to identify those who could benefit from synovium-targeted therapy.

The identification of molecular markers, which reflects differences in disease progression rates in Osteoarthritis (OA), would greatly facilitate clinical studies. Urinary Deoxypyridinoline (UDPD) and serum osteocalcin (OC) had been widely used for marker of bone metabolism, but the use for molecular marker in OA was lack of data. Recent studies show that there were conflicted results between urinary excretion of DPD and serum OC value within knee OA grading. The aim of this study is to compare of urinary excretion of DPD and the level of serum OC as destructive parameter of cartilage within the knee OA grading. This cross sectional study comprise of 69 patients with OA of knee joints. Kellgren and Lawrence scale was use for grading of OA. Group of patients with knee OA grade 2 call as group of early OA and group of patients with knee OA grade 3 and 4 calls as group of late OA. DPD in urine was measured using Immuno-chemilunescence, serum osteocalcin was measured using Elisa method. The mean value of urinary concentrations of DPD in OA patients was higher than normal value (9.79 ± 7.28 nM DPD/mM Creatinin), and the mean value of serum OC within normal value (8.49 ± 4.68 ng/mL). There were no significant differences of age, body mass index (BMI), duration of illness, urinary excretion of UDPD and serum OC level between early and late OA. In conclusion, there is no significant difference of urinary excretion of DPD and serum OC level within knee OA grading. The use of urinary DPD and serum OC as molecular markers of progression of OA needed to be explored by other longitudinal study. (Med J Indones 2004; 13: 96-101) Keywords: Knee osteoarthritis, deoxypiridinoline, osteocalcin

Objective:To study whether layer-specific cartilage transverse relaxation time(T2), and/or longitudinal change is associated with clinically relevant kneeosteoarthritis (OA) disease progression.Methods:The FNIH biomarker consortium was a nested case-control study on 600knees from 600 Osteoarthritis Initiative participants. Progressor knees hadboth medial tibiofemoral radiographic joint space width (JSW) loss(≥0.7 mm) and a persistent increase in WOMAC pain (≥9 on a0-100 scale) at 24-48 month from baseline (n=194). Multi-echo spin-echo(MESE) MRIs for cartilage T2 analysis had been acquired in the right kneesonly (97 progressor knees). These were compared to 104 control knees withoutJSW or pain progression. 53 knees had JSW progression, and 57 painprogression only. Cartilage thickness segmentations obtained from DESS MRIwere matched to MESE MRI, to extract superficial and deep femorotibialcartilage T2. Superficial medial femorotibial compartment (MFTC) T2 atbaseline was the primary, and change in deep MFTC T2 between baseline and 12months the secondary analytic outcome of this post-hoc exploratorystudy.Results:Baseline superficial MFTC T2 was significantly elevated inprogressor knees (adjusted mean 47.2ms [95% confidence interval [CI] 46.5,48.0]) and JSW progression only knees (adjusted mean 47.3ms [95% confidenceinterval [CI] 46.3, 48.3]), respectively, vs non-progressor knees (45.8ms[95% CI 45.0, 46.5]) after adjustment for age, sex, BMI, WOMAC pain, andmedial JSN grade (ANCOVA). Change in T2 was not significantly associatedwith case status.Conclusions:Baseline superficial, but not deep, medial cartilage T2 isassociated with clinically relevant disease progression in knee OA.

The Gut Microbiome and Joint Microbiome Show Alterations in Patients With Knee Osteoarthritis Versus Controls: A Systematic Review

Radiographs are a commonly used tool to assess disease progression in osteoarthritis (OA). However, it is not the preferred method of defining and following OA progression. While it is moderately responsive to change in terms of standardised response means (SRM), it is insensitive to change in cartilage measures. MRI offers a much better assessment, and OA features are much better targeted for defining and following the disease progression. Using MRI, cartilage volume/thickness loss predicts knee replacement and has similar levels of sensitivity to discriminate treatments in clinical trials. Cartilage defect is another target which was found to also be an independent predictor of some OA outcomes. In addition to cartilage, another MRI target for diagnosis and assessment of OA progression is subchondral bone alterations, especially bone marrow lesions (BMLs). BMLs independently predict OA outcomes including knee replacement and are sensitive to progression. Targeting of BMLs by bone remodelling agents demonstrates that the natural history of the disease could be diminished. MRI-detected effusion and synovitis are also promising targets of OA progression. In addition, alterations in these tissues are promising outcome measures for clinical trials. Newer MRI methods of cartilage quality assessment, including signal intensity on T1 images and dGEMRIC, have been proposed for assessing early cartilage loss. However, the requirement for a contrast agent with dGEMRIC precludes its widespread use on safety grounds. Another promising imaging modality for OA is ultrasound. However, this approach warrants further exploration as, although it has demonstrated a wide set of advantages over other imaging modalities, there are still major limitations. Evidence for use of ultrasound indices for assessing disease progression is limited. At present, this imaging modality may be better suited as a diagnostic and an explanatory tool within clinical practice rather than large-scale studies or clinical trials.

To evaluate the long-term efficacy and safety of iguratimod (IGU) in patients with knee osteoarthritis (KOA). This retrospective study included patients diagnosed with KOA at Beijing Jishuitan Hospital between July 2023 and January 2024. All participants received IGU monotherapy at a dose of 25mg twice daily for 3months and were subsequently followed for a total duration of 12months. Clinical data, including demographic characteristics, laboratory tests, and imaging assessments, were systematically collected and analyzed. Pain intensity, global disease assessment, physical function, and adverse events were evaluated at baseline, 3months, and 12months. A total of 62 patients were included in the analysis, of whom 77.4% were female. The mean age was 58.56 ± 8.57years, and disease duration ranged from less than 1year to more than 10years. At baseline, the mean Visual Analogue Scale (VAS) score was 6.08 ± 1.56, and the mean Patient Global Assessment (PGA) score was 3.94 ± 1.34. Significant reductions in both scores were observed at 3 and 12months. The VAS score decreased to 2.39 ± 1.64 at 3months and 2.65 ± 1.70 at 12months, while the PGA score declined to 1.39 ± 1.07 and 1.53 ± 1.21, respectively (all p < 0.001). The median total functional score improved markedly from 6.00 (IQR: 5.00) at baseline to 1.00 (IQR: 3.00) at 3months and 1.00 (IQR: 2.00) at 12months (p < 0.001). At 3months, 51.6% of patients achieved a squat test score of 0, and 66.1% achieved a stair climbing test score of 1; these functional gains were maintained at 12months (p < 0.001). Similar improvements were observed across additional functional domains. At both follow-up time points, 58.1% of patients reported no restriction in the chair rise test, 98.4% reported no joint stiffness, and 91.9% reported no limitation in walking distance (p < 0.001 for all comparisons). The incidence of adverse events associated with IGU monotherapy was 0.03%, and the treatment was generally well tolerated. IGU demonstrated sustained efficacy and a favorable safety profile in patients with KOA. Significant improvements in pain and physical function were observed after 3months of treatment and were maintained for at least 12months. These findings support the potential role of IGU as a long-term therapeutic option for KOA. Key Points •This study supports the potential of iguratimod as an effective long-term treatment option for patients with non-inflammatory phenotypes of KOA. •Significant and sustained improvements were observed in VAS, PGA, and physical functional scores from baseline to 3 and 12 months.

OBJETIVO: Descrever os achados clínicos, radiológicos e patológicos da síndrome SAPHO e sugerir que, apesar de ser considerada rara, esta síndrome deve estar sendo subdiagnosticada por clínicos e radiologistas, provavelmente em função do desconhecimento das suas características. MATERIAIS E MÉTODOS: Foi realizado estudo retrospectivo de seis casos confirmados desta síndrome, dando-se ênfase aos achados clínicos (idade, sexo e sintomas) e de imagem (cintilografia óssea, radiografia convencional, tomografia computadorizada e ressonância magnética). RESULTADOS: A manifestação clínica inicial de todos os pacientes foi dor na parede torácica ântero-superior há pelo menos quatro meses. Todos apresentavam achados de imagem de processo inflamatório e/ou osteíte e hiperostose nas articulações da parede torácica ântero-superior. As alterações cutâneas da síndrome, tipo pustulose palmoplantar, estiveram presentes em cinco dos seis pacientes. Em nenhum dos seis casos o diagnóstico foi sugerido na consulta clínica inicial ou na primeira interpretação das imagens feita por radiologistas não especialistas em sistema músculo-esquelético. CONCLUSÃO: Os nossos achados estão de acordo com os descritos na literatura, devendo ser considerado este diagnóstico em todo paciente que apresente quadro doloroso de parede torácica acompanhado de manifestações dermatológicas e/ou osteíte.