Advanced Imaging in Osteoarthritis

Abstract

Context:Radiography is widely accepted as the gold standard for diagnosing osteoarthritis (OA), but it has limitations when assessing early stage OA and monitoring progression. While there are improvements in the treatment of OA, the challenge is early recognition.Evidence Acquisition:MEDLINE and PubMed as well as professional orthopaedic and imaging websites were reviewed from 2006 to 2016.Study Design:Clinical review.Level of Evidence:Level 4.Results:Magnetic resonance imaging (MRI) can provide the most comprehensive assessment of joint injury and OA with the advantages of being noninvasive and multiplanar with excellent soft tissue contrast. However, MRI is expensive, time consuming, and not widely used for monitoring OA clinically. Computed tomography (CT) and CT arthrography (CTA) can also be used to evaluate OA, but these are also invasive and require radiation exposure. Ultrasound is particularly useful for evaluation of synovitis but not for progression of OA.Conclusion:MRI, CT, and CTA are available for the diagnosis and monitoring of OA. Improvement in techniques and decrease in cost can allow some of these modalities to be effective methods of detecting early OA.

Applications of PET‐MRI in musculoskeletal disease

“…MRI provides an excellent opportunity to noninvasively study the complex disease processes involved in OA . In addition to its excellent high‐resolution and multi‐contrast morphologic information of joint tissues, advanced quantitative MRI techniques may provide important information about tissue microstructure such as collagen matrix organization, glycosaminoglycan (GAG) content, and hydration, which is thought to degrade before structural changes are seen with conventional imaging methods …”

“…102 In addition to its excellent high-resolution and multi-contrast morphologic information of joint tissues, advanced quantitative MRI techniques may provide important information about tissue microstructure such as collagen matrix organization, glycosaminoglycan (GAG) content, and hydration, which is thought to degrade before structural changes are seen with conventional imaging methods. 103,104 PET imaging with 18 F-NaF provides a method to assess subchondral bone activity in OA. Functional imaging of subchondral bone is vital, as this is the only highly vascularized tissue in the joint and has the ability to reflect rapid changes.…”

Advanced Magnetic Resonance Imaging in Osteoarthritis

“…To generate technically adequate scans, GAG CEST typically requires higher field strengths, such as 7 T, and long scan times; therefore, clinical application of this technique is currently limited. [11][12][13][14] Diffusion imaging provides a measurement of the mobility of water protons in various tissues. Various diffusion parameters have been correlated with changes in the cartilage matrix.…”

Dolor en la Artrosis de Rodilla

“…Las razones para esa pérdida de relación entre el dolor y los exámenes imagenológicos, se debe a varios factores como: la mayoría de las investigaciones radiográficas realizadas son con el paciente en decúbito supino o en carga de peso sin contemplar la articulación patelofemoral y aproximadamente un 24% de las mujeres afectadas por la artrosis de rodilla, tienen participación de esa articulación; segundo: la radiografía en ocasiones es normal, sin embargo, en el examen artroscópico de la articulación, existen evidencias claras de la presencia de la enfermedad, ya que la radiografía no muestra las alteraciones de la cápsula, cartílago, ligamentos y sinovial; por último, no todo dolor en la rodilla es debido a artrosis, puede ser también debido a bursitis en las inserciones tendinosas de la rodilla y afecciones de la cadera y columna. [36][37][38] Medios Diagnósticos y Patrones del Dolor Según Li Q y col., 39 el ultrasonido de alta definición y la imagen de resonancia magnética de la rodilla, ayudan a identificar las causas de dolor dentro de la articulación, como la distención articular provocada por la cantidad excesiva de líquido sinovial, daño estructural del menisco y cartílago (►Fig. 2).…”

“…2). 39,40 Los patrones de dolor en la artrosis de rodilla son dos, el primero es de tipo generalizado en la zona anterior de la rodilla, y el segundo localizado en la zona inferomedial.Esos patrones son más reconocidos desde el punto de vista clínico que radiográfico. La presencia de osteofitos en la misma localización de los síntomas es un factor de buen pronóstico.…”