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Review
. 2014 Aug;66(8):1129-41.
doi: 10.1002/acr.22316.

Quantitative radiologic imaging techniques for articular cartilage composition: toward early diagnosis and development of disease-modifying therapeutics for osteoarthritis

Edwin H G Oei  1 , Jasper van Tiel, William H Robinson, Garry E Gold
Affiliations
Review

Quantitative radiologic imaging techniques for articular cartilage composition: toward early diagnosis and development of disease-modifying therapeutics for osteoarthritis

Edwin H G Oei et al. Arthritis Care Res (Hoboken). 2014 Aug.
No abstract available

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Figures

Figure 1
Figure 1
Schematic representation of articular cartilage composition and morphology in healthy (A), early-stage osteoarthritic (B), and advanced-stage osteoarthritic cartilage (C). In healthy cartilage (A), the orientation and density of the collagen fibers varies by location within the cartilage layer and regionally within the joint. Relative to the articular surface, their prevailing orientation is parallel in the superficial layer, oblique in the transitional (middle) layer, and perpendicular in the deep radial zone. Similarly, the concentration of proteoglycans varies according to location and is highest in the middle layer. In early osteoarthritis (OA) (B), proteoglycans and glycosaminoglycans leak from the cartilage and the collagen fibers change in size and orientation. These initial disease processes occur without macroscopic alterations in cartilage morphology. When OA progresses (C), morphologic changes (thinning and defects) of the cartilage appear. Color figure can be viewed in the online issue, which is available at http://onlinelibrary.wiley.com/doi/10.1002/acr.22316/abstract.
Figure 2
Figure 2
Delayed gadolinium-enhanced magnetic resonance imaging (MRI) of cartilage (dGEMRIC), T2 mapping, T1rho mapping, and sodium imaging differentiate between healthy and early-stage knee osteoarthritis (OA). Sagittal slices through the center of the medial or lateral tibiofemoral compartment of knee OA patients and healthy volunteers (insets) acquired using different quantitative MRI techniques (all images acquired in different subjects). None of the early OA patients showed clear abnormalities on the conventional MRI sequences (not shown). A, dGEMRIC color map shows a clear decrease in T1 relaxation times (purple/red) in early OA, representing loss of glycosaminoglycans. B, T2 mapping demonstrates increased T2 relaxation times (blue/purple/red) in early OA due to disorganization of the collagen matrix and increase in water content. C, T1rho mapping shows increased T1rho relaxation times (red) in a patient with moderate knee OA. D, Sodium MRI detects less sodium signal in OA compared to healthy knee cartilage (inset). PG = proteoglycan. Color figure can be viewed in the online issue, which is available at http://onlinelibrary.wiley.com/doi/10.1002/acr.22316/abstract.
Figure 3
Figure 3
Morphologic and quantitative ultrashort echo time (TE) images of the knee. Ultrashort TE morphologic (A) and quantitative T2* (B) magnetic resonance images of a cadaveric knee (male donor, age 77 years). Note that the deepest layer of articular cartilage is clearly visible as a line of high signal intensity (A, white arrows), along with focal areas of diminished signal intensity (A, red arrows) that may suggest abnormality of the deep region. (Courtesy of Christine Chung, University of California, San Diego).
Figure 4
Figure 4
Glycosaminoglycans (GAGs)–specific chemical exchange saturation transfer (gagCEST) and sodium magnetic resonance imaging (MRI) to followup cartilage repair. Proton density (A), gagCEST (B), and sodium (C) MRIs acquired at 7T of a patient 8.7 years after autologous osteochondral transplantation (white arrow). The color overlay in (B) represents the gagCEST asymmetries in percentages (the lower the values, the less GAGs are present in the cartilage). The color overlay in (C) represents the sodium signal-to-noise ratio values (the lower the values, the less GAGs are present in the cartilage). The transplantation region (white arrow) clearly contains less GAGs compared to the posterior femoral cartilage (B and C). The CEST image (B) has a relatively high spatial resolution compared to the sodium image (C), which makes the technique promising as an outcome measure for cartilage GAG content in future research. (Courtesy of Benjamin Schmitt and Siegfried Trattnig, Medical University of Vienna, MR Center of Excellence, Vienna, Austria [154]).
Figure 5
Figure 5
Quantitative computed tomography (CT) arthrography detects Glycosaminoglycans (GAGs) reduction in osteoarthritis. Representative image of a knee with medial joint space narrowing (red box, middle panel) and a normal lateral joint space (green box, middle panel). CT arthrography clearly shows higher radiographic attenuation values, indicating less GAGs in the medial knee compartment (red box, left panel) compared to the lateral tibiofemoral compartment (green box, right panel) (34). Color figure can be viewed in the online issue, which is available at http://onlinelibrary.wiley.com/doi/10.1002/acr.22316/abstract.
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