Delayed Computed Tomography Arthrography of Human Knee Cartilage <i>In Vivo</i>

Kokkonen, Harri; Aula, Antti; Kröger, Heikki; Suomalainen, Juha-Sampo; Lammentausta, Eveliina; Mervaala, Esa; Jurvelin, Jukka S.; Töyräs, Juha

doi:10.1177/1947603512447300

Cited by 37 publications

(61 citation statements)

References 25 publications

(35 reference statements)

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“…In vivo, the diffusion of an anionic contrast agent reaches its maximum concentration in the cartilage at 30–60 min after the injection being a result of physiological clearance, while it takes longer for cationic contrast agents (hours; currently the only in vivo report is with rabbit knee joints) . The diffusion time and in vitro conditions of the contrast agents are limitations of this laboratory study and for the clinical applicability.…”

Section: Discussionmentioning

confidence: 92%

“…Contrast‐enhanced computed tomography (CECT) enables detection of changes in cartilage composition along with quantitative evaluation of subchondral bone density and structure . Advantages of CECT compared with MRI are shorter acquisition times, higher resolution, and lower costs.…”

mentioning

confidence: 99%

“…Contrast-enhanced computed tomography (CECT) enables detection of changes in cartilage composition along with quantitative evaluation of subchondral bone density and structure. [7][8][9][10][11] Advantages of CECT compared with MRI are shorter acquisition times, higher resolution, and lower costs. Delayed CECT 7,8,12 allows the detection of early degenerative changes since degeneration alters contrast agent diffusion within cartilage.…”

mentioning

confidence: 99%

“…[7][8][9][10][11] Advantages of CECT compared with MRI are shorter acquisition times, higher resolution, and lower costs. Delayed CECT 7,8,12 allows the detection of early degenerative changes since degeneration alters contrast agent diffusion within cartilage. Originally, anionic contrast agents were used in CECT [13][14][15] ; however, recent studies have introduced cationic contrast agents for cartilage imaging showing improved sensitivity for PG loss.…”

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confidence: 99%

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Synchrotron MicroCT Reveals the Potential of the Dual Contrast Technique for Quantitative Assessment of Human Articular Cartilage Composition

Honkanen

Saukko

Turunen

et al. 2019

Journal Orthopaedic Research

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Dual contrast micro computed tomography (CT) shows potential for detecting articular cartilage degeneration. However, the performance of conventional CT systems is limited by beam hardening, low image resolution (full‐body CT), and long acquisition times (conventional microCT). Therefore, to reveal the full potential of the dual contrast technique for imaging cartilage composition we employ the technique using synchrotron microCT. We hypothesize that the above‐mentioned limitations are overcome with synchrotron microCT utilizing monochromatic X‐ray beam and fast image acquisition. Human osteochondral samples (n = 41, four cadavers) were immersed in a contrast agent solution containing two agents (cationic CA4+ and non‐ionic gadoteridol) and imaged with synchrotron microCT at an early diffusion time point (2 h) and at diffusion equilibrium (72 h) using two monochromatic X‐ray energies (32 and 34 keV). The dual contrast technique enabled simultaneous determination of CA4+ (i.e., proteoglycan content) and gadoteridol (i.e., water content) partitions within cartilage. Cartilage proteoglycan content and biomechanical properties correlated significantly (0.327 < r < 0.736, p < 0.05) with CA4+ partition in superficial and middle zones at both diffusion time points. Normalization of the CA4+ partition with gadoteridol partition within the cartilage significantly (p < 0.05) improved the detection sensitivity for human osteoarthritic cartilage proteoglycan content, biomechanical properties, and overall condition (Mankin, Osteoarthritis Research Society International, and International Cartilage Repair Society grading systems). The dual energy technique combined with the dual contrast agent enables assessment of human articular cartilage proteoglycan content and biomechanical properties based on CA4+ partition determined using synchrotron microCT. Additionally, the dual contrast technique is not limited by the beam hardening artifact of conventional CT systems. © 2019 The Authors. Journal of Orthopaedic Research® published by Wiley Periodicals, Inc. on behalf of Orthopaedic Research Society. J Orthop Res 38:563–573, 2020

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Section: Discussionmentioning

confidence: 92%

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confidence: 99%

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confidence: 99%

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confidence: 99%

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Synchrotron MicroCT Reveals the Potential of the Dual Contrast Technique for Quantitative Assessment of Human Articular Cartilage Composition

Honkanen

Saukko

Turunen

et al. 2019

Journal Orthopaedic Research

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“…The present CBCT technique could indicate the differences in vBMD of cortical, trabecular and subchondral bone. Especially in diagnostics of OA and knee injuries, quantitative and qualitative information on subchondral bone, together with diagnostics of articular cartilage and meniscus [8]- [11], [18], could improve understanding on role of different joint structures in cartilage degeneration.…”

Section: Discussionmentioning

confidence: 99%

Quantitative Evaluation of Knee Subchondral Bone Mineral Density Using Cone Beam Computed Tomography

Turunen

Töyräs

Kokkonen

et al. 2015

IEEE Trans. Med. Imaging

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Contrast agent enhanced cone beam computed tomography (CE-CBCT), a technique capable of high-resolution in vivo imaging with small radiation dose, has been applied successfully for clinical diagnostics of cartilage degeneration, i.e., osteoarthritis (OA). As an X-ray technique, CE-CBCT may also detect changes in mineral density of subchondral bone (volumetric bone mineral density, vBMD), known to be characteristic for OA. However, its feasibility for density measurements is not clear due to limited signal-to-noise ratio and contrast of CBCT images. In the present study, we created clinically applicable hydroxyapatite phantoms and determined vBMDs of cortical bone, trabecular bone, subchondral trabecular bone and subchondral plate of 10 cadaver (ex vivo) and 10 volunteer (in vivo) distal femora using a clinical CBCT scanner, and for reference, also using a conventional CT scanner. Our results indicated strong linear correlations between the vBMD values measured with the CT and CBCT scanners , however, absolute vBMD values were dependent on the scanner in use. Further, the differences between the vBMDs of cortical bone, trabecular bone and subchondral bone were similar and independent of the scanner. The present results indicate that vBMD values might not be directly comparable between different instruments. However, based on our present and previous results, we propose that, for OA diagnostics, clinical CBCT enables not only quantitative analysis of articular cartilage but also subchondral bone vBMD. Quantitative information on both cartilage and subchondral bone could be beneficial in OA diagnostics.

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In vivo diagnostics of human knee cartilage lesions using delayed CBCT arthrography

et al. 2013

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The aim of this study was to investigate the feasibility of delayed cone beam (CBCT) arthrography for clinical diagnostics of knee cartilage lesions. Knee joints with cartilage lesions were imaged using native radiography, MRI, and delayed CBCT arthrography techniques in vivo. The joints were imaged three times with CBCT, just before, immediately after (arthrography) and 45 min after the intra-articular injection of contrast agent. The arthrographic images enabled sensitive detection of the cartilage lesions. Use of arthrographic and delayed images together with their subtraction image enabled also detection of cartilage with inferior integrity. The contrast agent partition in intact cartilage (ICRS grade 0) was lower (p < 0.05) than that of cartilage surrounding the ICRS grade I-IV lesions. Delayed CBCT arthrography provides a novel method for diagnostics of cartilage lesions. Potentially, it can also be used in diagnostics of cartilage degeneration. Due to shorter imaging times, higher resolution, and lower costs of CT over MRI, this technique could provide an alternative for diagnostics of knee pathologies. However, for comprehensive evaluation of the clinical potential of the technique a further clinical study with a large pool of patients having a wide range of cartilage pathologies needs to be conducted. Keywords: cartilage lesions; contrast agent diffusion; computed tomography; delayed CBCT arthrography; osteoarthrosis Cartilage lesions are common and can lead to progressive joint degeneration at high cost for the healthcare system. Early diagnosis and grading of cartilage lesions could improve the early selection of treatment, enable monitoring the effect of new treatments and therefore reduce the risk for post traumatic osteoarthritis (OA).Detection of acute cartilage lesions or early OA is challenging since cartilage is not visible in X-ray imaging. Resolution of magnetic resonance imaging (MRI) is limited, and queuing times are long, but it is still the routine method used in cartilage lesion diagnostics and in clinical decision making for or against arthroscopy. In planar X-ray imaging the Xray attenuation of the cartilage is similar with that of the surrounding soft tissues and therefore cartilage is not visible in the images. For this reason diagnosis is mainly based on decreased joint separation and changes in subchondral bone. On the other hand, MRI is not based on ionizing radiation and can be used to visualize soft tissues enabling detection of cartilage defects. Cone beam computed tomography (CBCT) utilizes a conical X-ray beam, covering a large volume with a single rotation about the patient. Due to differences in imaging geometry and collimation of X-rays the radiation dose of CBCT is much smaller than that of spiral CT.1 MRI is especially useful for diagnostics of meniscal tears and lesions of anterior cruciate ligament (ACL) with accuracies of 81% to 98% and specificities of 69% to 98%, respectively, 2 but in the diagnostics of cartilage lesions its sensitivity and specificity ha...

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Delayed Computed Tomography Arthrography of Human Knee Cartilage In Vivo

Cited by 37 publications

References 25 publications

Synchrotron MicroCT Reveals the Potential of the Dual Contrast Technique for Quantitative Assessment of Human Articular Cartilage Composition

Synchrotron MicroCT Reveals the Potential of the Dual Contrast Technique for Quantitative Assessment of Human Articular Cartilage Composition

Quantitative Evaluation of Knee Subchondral Bone Mineral Density Using Cone Beam Computed Tomography

In vivo diagnostics of human knee cartilage lesions using delayed CBCT arthrography

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