Objective To evaluate the association of MRI-based knee cartilage T2 measurements and focal knee lesions with knee pain in knees without radiographic osteoarthritis (OA) among subjects with OA risk factors. Methods We studied the right knees of 126 subjects from the Osteoarthritis Initiative database. We randomly selected 42 subjects aged 45–55 years with OA risk factors, right knee pain (WOMAC pain score ≥5), no left knee pain (WOMAC pain score =0) and no radiographic OA (KL-score ≤1) in the right knee. We also selected two comparison groups: 42 subjects without knee pain in either knee and 42 with bilateral knee pain. Both groups were frequency matched to subjects with right knee only pain by gender, age, BMI and KL-score. All subjects underwent 3T MRI of the right knee. Focal knee lesions were assessed and cartilage T2 measurements were performed. Results Prevalence of meniscal, bone marrow and ligamentous lesions and joint effusion were not significantly different between the groups (p>0.05), while cartilage lesions were more frequent in subjects with right only knee pain compared to subjects without knee pain (p<0.05). T2 values averaged over all compartments were similar in subjects with right only knee pain (34.4±1.8ms) and with bilateral knee pain (34.7±4.7ms), but significantly higher compared to subjects without knee pain (32.4±1.8ms) (p<0.05). Conclusion These results suggest that elevated cartilage T2 values are associated with findings of pain in the early phase of OA, while among morphological knee abnormalities only knee cartilage lesions are significantly associated with knee pain status.

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Objective To compare MRI-based knee cartilage T2 measurements and focal knee lesions and 36 month changes in these parameters, among knees of normal controls and knees of normal-weight, overweight, and obese subjects with risk factors for knee osteoarthritis (OA). Methods 267 subjects aged 45–55 years from the Osteoarthritis Initiative (OAI) database were analysed in this study. 231 subjects had risk factors for knee OA, but no radiographic OA (KL-score≤1) at baseline. 36 subjects were normal controls. Subjects with OA risk factors were stratified in three groups: normal weight (n=78), overweight (n=84), and obese (n=69). All subjects underwent 3T MRI of the right knee at baseline and after 36 months. Focal knee lesions were assessed and cartilage T2 measurements (mean T2 and T2 texture analysis) were performed. Results The baseline prevalence and severity of meniscal and cartilage lesions were highest in obese subjects and lowest in normal controls (p<0.05). Obese subjects had the highest mean T2 values and the most heterogeneous cartilage (as assessed by T2 texture analysis), while normal controls had the lowest mean T2 values and the most homogeneous cartilage at baseline (p<0.05). Increased BMI was significantly (p<0.05) associated with greater progression of cartilage lesions and constantly elevated cartilage T2 entropy over 36 months. Conclusion In pre-clinical OA, increased BMI is associated with more severe cartilage degeneration as assessed by both morphological and quantitative MRI measurements.

AIMTo determine the overall and comparative risk of procedure related perforation of balloon assisted enteroscopy (BAE) in Crohn’s disease (CD).METHODSSystematic review (PROSPERO #CRD42015016381) of studies reporting on CD patients undergoing BAE. Seventy-three studies reporting on 1812 patients undergoing 2340 BAEs were included. Primary outcome of interest was the overall and comparative risk of procedure related perforation of diagnostic BAE in CD. Secondary outcomes of interest were risk of procedure related perforation of diagnostic double balloon enteroscopy (DBE), risk of procedure related perforation of therapeutic BAE, efficacy of stricture dilation, and clinical utility of endoscopically assessing small bowel disease activity.RESULTSPer procedure perforation rate of diagnostic BAE in CD was 0.15% (95%CI: 0.05-0.45), which was similar to diagnostic BAE for all indications (0.11%; IRR = 1.41, 95%CI: 0.28-4.50). Per procedure perforation rate of diagnostic DBE in CD was 0.12% (95%CI: 0.03-0.44), which was similar to diagnostic DBE for all indications (0.22%; IRR = 0.54, 95%CI: 0.06-0.24). Per procedure perforation rate of therapeutic BAE in CD was 1.74% (95%CI: 0.85-3.55). Eighty-six percent of therapeutic perforations were secondary to stricture dilation. Dilation was attempted in 207 patients and 30% required surgery during median follow-up of 18 months. When diagnostic BAE assessed small bowel disease activity, changes in medical therapy resulted in endoscopic improvement in 77% of patients.CONCLUSIONDiagnostic BAE in CD has a similar rate of perforation as diagnostic BAE for all indications and can be safely performed in assessment of mucosal healing.

Nonalcoholic fatty liver disease (NAFLD) is the most prevalent etiology of chronic liver disease in America. NAFLD can be broadly classified in two subtypes: nonalcoholic fatty liver (NAFL), which is generally considered a benign condition with negligible risk of progression to cirrhosis, and nonalcoholic steatohepatitis (NASH), which is generally considered to be progressive with substantial risk of progression to cirrhosis. Additionally, recent studies suggest the odds of liver mortality increases amongst NASH patients with advanced fibrosis (bridging fibrosis ± cirrhosis). Liver biopsy examination is the current gold standard to accurately discriminate between NAFL vs. NASH as well as diagnose advanced fibrosis. However, due to its invasive nature, risk of bleeding (and even rarely death), prohibitive cost, and sampling error, liver biopsies are imperfect for diagnosis and monitoring of NAFLD. As a result, noninvasive biomarkers that can accurately detect NASH and advanced fibrosis without biopsy are needed. This article will discuss the most novel noninvasive biomarkers in diagnosing NASH and advanced fibrosis.