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

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. © 2013 Orthopaedic Research Society. Published by Wiley Periodicals, Inc. J Orthop Res 32:403–412, 2014.

[1]  M J Lammi,et al.  Contrast agent enhanced pQCT of articular cartilage , 2007, Physics in medicine and biology.

[2]  Jukka S. Jurvelin,et al.  Delayed Computed Tomography Arthrography of Human Knee Cartilage In Vivo , 2012, Cartilage.

[3]  Gunther O. Hofmann,et al.  How valid is the arthroscopic diagnosis of cartilage lesions? Results of an opinion survey among highly experienced arthroscopic surgeons , 2009, Archives of Orthopaedic and Trauma Surgery.

[4]  V. Chandnani,et al.  Detection and staging of chondromalacia patellae: relative efficacies of conventional MR imaging, MR arthrography, and CT arthrography. , 1994, AJR. American journal of roentgenology.

[5]  P. Giannoudis,et al.  MRI efficacy in diagnosing internal lesions of the knee: a retrospective analysis , 2008, Journal of Trauma Management & Outcomes.

[6]  H. Weinans,et al.  CT arthrography of the human knee to measure cartilage quality with low radiation dose. , 2012, Osteoarthritis and cartilage.

[7]  G. Hofmann,et al.  Reliability in arthroscopic grading of cartilage lesions: results of a prospective blinded study for evaluation of inter-observer reliability , 2011, Archives of Orthopaedic and Trauma Surgery.

[8]  W. Palmer,et al.  KNEE ARTHROGRAPHY: Evolution and Current Status , 1998 .

[9]  J. Kellgren,et al.  Radiological Assessment of Osteo-Arthrosis , 1957, Annals of the rheumatic diseases.

[10]  Richard Kijowski,et al.  Comparison of 1.5- and 3.0-T MR imaging for evaluating the articular cartilage of the knee joint. , 2009, Radiology.

[11]  A. Karantanas,et al.  Ankle post-traumatic osteoarthritis: a CT arthrography study in patients with bi- and trimalleolar fractures , 2012, Skeletal Radiology.

[12]  D. Burstein,et al.  MRI Techniques in Early Stages of Cartilage Disease , 2000, Investigative radiology.

[13]  F. Lecouvet,et al.  Value of computed tomography arthrography with delayed acquisitions in the work-up of ganglion cysts of the tarsal tunnel: report of three cases , 2010, Skeletal Radiology.

[14]  D. Burstein,et al.  Gd‐DTPA2− as a measure of cartilage degradation , 1996, Magnetic resonance in medicine.

[15]  A. Farman,et al.  Clinical applications of cone-beam computed tomography in dental practice. , 2006, Journal.

[16]  R K Korhonen,et al.  Computed tomography detects changes in contrast agent diffusion after collagen cross-linking typical to natural aging of articular cartilage. , 2011, Osteoarthritis and cartilage.

[17]  R. Ojala,et al.  In vivo comparison of delayed gadolinium-enhanced MRI of cartilage and delayed quantitative CT arthrography in imaging of articular cartilage. , 2013, Osteoarthritis and cartilage.

[18]  J. Jurvelin,et al.  Hyperosmolaric contrast agents in cartilage tomography may expose cartilage to overload-induced cell death. , 2012, Journal of biomechanics.

[19]  J. Jurvelin,et al.  pQCT study on diffusion and equilibrium distribution of iodinated anionic contrast agent in human articular cartilage--associations to matrix composition and integrity. , 2009, Osteoarthritis and cartilage.

[20]  P. Parizel,et al.  Comparison of 1.5- and 3-T MR imaging for evaluating the articular cartilage of the knee , 2013, Knee Surgery, Sports Traumatology, Arthroscopy.

[21]  R. Haut,et al.  Rate of blunt impact loading affects changes in retropatellar cartilage and underlying bone in the rabbit patella. , 2002, Journal of biomechanics.

[22]  K. T. Scott,et al.  Protocol issues for delayed Gd(DTPA)2–‐enhanced MRI (dGEMRIC) for clinical evaluation of articular cartilage , 2001, Magnetic resonance in medicine.

[23]  M Kortesniemi,et al.  Dosimetry and image quality of four dental cone beam computed tomography scanners compared with multislice computed tomography scanners. , 2009, Dento maxillo facial radiology.

[24]  H. Weinans,et al.  Clinically applied CT arthrography to measure the sulphated glycosaminoglycan content of cartilage. , 2011, Osteoarthritis and cartilage.

[25]  N. Drage,et al.  Effective dose from cone beam CT examinations in dentistry. , 2009, The British journal of radiology.

[26]  F. Lecouvet,et al.  Cartilage lesions of the glenohumeral joint: diagnostic effectiveness of multidetector spiral CT arthrography and comparison with arthroscopy , 2007, European Radiology.

[27]  G. Hagen,et al.  Computed Tomography: Fundamentals, System Technology, Image Quality, Applications , 2012 .

[28]  D. Burstein,et al.  Glycosaminoglycan in articular cartilage: in vivo assessment with delayed Gd(DTPA)(2-)-enhanced MR imaging. , 1997, Radiology.

[29]  B. Maldague,et al.  Ganglion cysts of the knee: articular communication revealed by delayed radiography and CT after arthrography. , 1998, AJR. American journal of roentgenology.

[30]  M J Lammi,et al.  Contrast agent-enhanced computed tomography of articular cartilage: Association with tissue composition and properties , 2009, Acta radiologica.

[31]  Robert E. Guldberg,et al.  Analysis of cartilage matrix fixed charge density and three-dimensional morphology via contrast-enhanced microcomputed tomography , 2006, Proceedings of the National Academy of Sciences.

[32]  A. Bailey,et al.  Biochemical and mechanical properties of subchondral bone in osteoarthritis. , 2004, Biorheology.

[33]  C. J. Adkins.  Equilibrium thermodynamics: Frontmatter , 1983 .

[34]  D. Burstein,et al.  Hip dGEMRIC in asymptomatic volunteers and patients with early osteoarthritis: The influence of timing after contrast injection , 2007, Magnetic resonance in medicine.

[35]  Andoni P. Toms,et al.  Accuracy of magnetic resonance imaging, magnetic resonance arthrography and computed tomography for the detection of chondral lesions of the knee , 2012, Knee Surgery, Sports Traumatology, Arthroscopy.

[36]  I. Kiviranta,et al.  Contrast-Enhanced Micro–Computed Tomography in Evaluation of Spontaneous Repair of Equine Cartilage , 2012, Cartilage.

[37]  J. Dietemann,et al.  Cone-beam computed tomography arthrography: an innovative modality for the evaluation of wrist ligament and cartilage injuries , 2012, Skeletal Radiology.

[38]  Martha L. Gray,et al.  Magnetic resonance imaging of cartilage glycosaminoglycan: Basic principles, imaging technique, and clinical applications , 2008 .

[39]  F. Cicuttini,et al.  Meniscal tear as an osteoarthritis risk factor in a largely non-osteoarthritic cohort: a cross-sectional study. , 2007, The Journal of rheumatology.

[40]  N. Sverzellati,et al.  Multidetector computed tomography arthrography of the knee: diagnostic accuracy and indications. , 2009, European journal of radiology.

[41]  Willi A. Kalender,et al.  Computed tomography : fundamentals, system technology, image quality, applications , 2000 .

[42]  J Töyräs,et al.  Detection of mechanical injury of articular cartilage using contrast enhanced computed tomography. , 2011, Osteoarthritis and cartilage.

[43]  H C Charles,et al.  Clinical, radiographic, molecular and MRI-based predictors of cartilage loss in knee osteoarthritis , 2011, Annals of the rheumatic diseases.

[44]  H. Kokkonen,et al.  Diffusion and near-equilibrium distribution of MRI and CT contrast agents in articular cartilage , 2009, Physics in medicine and biology.

[45]  B. Snyder,et al.  Contrast enhanced computed tomography can predict the glycosaminoglycan content and biomechanical properties of articular cartilage. , 2010, Osteoarthritis and cartilage.