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Ryan Robert Armbruster¹, Anjali Talluru², Arijitt Barthakur³, Warren Bilker⁴, Ravinder Reddy³, and Susanta Sarkar^5
1Bioengineering, University of Pennsylvania, Philadelphia, PA, United States, ²University of Pittsburg, Pittsburg, PA, United States, ³Radiology, University of Pennsylvania, Philadelphia, PA, United States, ⁴Biostatistics and Epidemiology, University of Pennsylvania, Philadelphia, PA, United States, ⁵Cadenzamed LLC, Berwyn, PA, United States

Keywords: Cartilage, Osteoarthritis

Osteoarthritis (OA) is a debilitating disease that results in cartilage loss and pain, but no drug is currently available for OA, largely due to the absence of a reliable index for measuring disease modifying effects of drug candidates in clinical trials. T1ρ MRI promises to be a reliable method because it provides a measure of cartilage degradation. However, it is critical to establish its reproducibility across MRI vendors before its universal use in clinical studies. Here we report the establishment of a clinically relevant reproducibility error in T1ρ in 25 healthy volunteer knees within and across 3T MRI scanners.

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Veronika Janacova¹, Vladimir Juras ¹, Pavol Szomolanyi^1,2, Diana Bencikova¹, and Siegfried Trattnig^1,3,4,5
1High Field MR Centre, Department of Biomedical Imaging and Image-guided Therapy, Medical University of Vienna, Vienna, Austria, ²Institute of Measurement Science, Slovak Academy of Sciences, Bratislava, Slovakia, ³CD Laboratory for MR Imaging Biomarkers (BIOMAK), Vienna, Austria, ⁴Austrian Cluster for Tissue Regeneration, Ludwig Boltzmann Institute for Experimental and Clinical Traumatology, Vienna, Austria, ⁵Institute for Clinical Molecular MRI in the Musculoskeletal System, Karl Landsteiner Society, Vienna, Austria

Keywords: Cartilage, Quantitative Imaging, Ultra-fast

Quantitative T₂ maps have been used for more than a decade in musculoskeletal MR research as a tool for cartilage assessment. In this work, we compared T₂ mapping of knee cartilage with ultrafast radial turbo-spin-echo sequence to conventional multi-echo spin echo sequence. We used radial turbo-spin-echo T₂ maps to track dynamic changes in knee cartilage during compression. Correlation between the two methods was found  in multiple cartilage regions. Dynamic change in T₂ values was observable on T₂ maps during first two minutes of compression. We demonstrated that radial-TSE sequence allows for fast determination of T₂ values of the knee cartilage.

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Gabby B Joseph¹, Melia Takakusagi¹, Gino Arcilla¹, John Lynch², Valentina Pedoia¹, Sharmila Majumdar¹, Nancy E. Lane³, Michael C Nevitt², Charles E McCulloch², and Thomas M. Link^1
1Department of Radiology and Biomedical Imaging, UCSF, San Francisco, CA, United States, ²Department of Epidemiology and Biostatistics, UCSF, San Francisco, CA, United States, ³Department of Rheumatology, UC Davis, Davis, CA, United States

Keywords: Osteoarthritis, Cartilage

This study assessed the relationship between 4-year changes in: (1) body weight and outcomes of joint-adjacent subcutaneous fat (SCF) and cartilage thickness, and (2) joint-adjacent SCF and knee cartilage thickness. A total of 399 individuals from the Osteoarthritis Initiative with >10% weight gain and >-10% weight loss over 4 years were compared with controls with less than 3% weight change. Weight gain and loss were associated with increases, and decreases, respectively in joint-adjacent SCF. Increases in SCF adjacent to the medial femur were associated with decreases in average cartilage thickness and in several medial and lateral locations in the knee.

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Rupsa Bhattacharjee¹, Johanna Luitjens¹, Misung Han¹, Rafeek Thahakoya¹, Koren E. Roach¹, Richard B. Souza^1,2, Valentina Pedoia¹, and Sharmila Majumdar^1
1Department of Radiology and Biomedical Imaging, University of California, San Francisco (UCSF), San Francisco, CA, United States, ²Department of Physical Therapy and Rehabilitation Science, University of California, San Francisco (UCSF), San Francisco, CA, United States

Keywords: Cartilage, Osteoarthritis, Bilateral, Hip, Knee

It is well documented that osteoarthritis often affects multiple joints in patients with the disease.  However, direct associations between limbs and across the joints of the lower extremity remains understudied. With bilateral hip and knee MRI of 18 patients, this study utilizes automated segmentation and VBR-atlas-based methods to explore the associations between twelve femoral and acetabular sub-compartments with trochlear and patellar cartilage T1rho, T2 values. Significant negative correlations between the patellar T2 and anterior hip femoral T1rho and T2 values, suggest a probable ongoing gait dysfunction. The data-distribution indicates possibility of a subgroup of patients having different progression and compensatory trajectories, to be explored further with gait pattern analysis.

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Vadim Malis¹, Yoshimori Kassai², Mitsue Miyazaki¹, and Won Bae^1,3
1Radiology, University of California, San Diego, La Jolla, CA, United States, ²Canon Medical Systems Corp, Otawara, Japan, ³VA San Diego Healthcare System, San Diego, CA, United States

Keywords: Cartilage, Tissue Characterization, T1rho

Three T1rho sequences based using 3D FASE, 3D UTE, and 3D MAPSS acquisitions were developed and compared by imaging agarose phantoms and normal human knees. The sequences utilize 4 to 6 spin lock times, and can be acquired in about 5 min or less. On phantoms, all three sequences resulted in consistent T1rho values that decreased with increasing agarose concentration, similar to past reports. T1rho values of cartilage and menisci were also in line with previously reported values. This work will be useful for evaluating knee osteoarthritis and other musculoskeletal diseases.

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ALLEN A CHAMPAGNE¹, TAYLOR M ZULEGER^2,3,4,5, DANIEL R SMITH^2,4,5, ALEXIS B SLUTSKY-GANESH^2,4,5,6, SHAYLA M WARREN^2,4,5, LEXIE M SENGKHAMMEE^2,4,5, SAGAR MANDAVA⁷, HONGJIANG WEI⁸, DAVIDE D BARDANA⁹, GREG D MYER^2,4,5,10, and JED A DIEKFUSS^2,4,5
1School of Medicine, Queen's University, Kingston, ON, Canada, ²Emory Sports Performance And Research Center, Flowery Branch, GA, United States, ³Neuroscience Graduate Program, University of Cincinnati, Cincinnati, OH, United States, ⁴Emory Sports Medicine Center, Atlanta, GA, United States, ⁵Department of Orthopaedics, Emory University School of Medicine, Atlanta, GA, United States, ⁶Department of Kinesiology, University of North Carolina at Greensboro, Greensboro, NC, United States, ⁷GE Healthcare, Atlanta, GA, United States, ⁸School of Biomedical Engineering, Shanghai Jiao Tong University, Shanghai, China, ⁹Department of Orthopaedics, Queen's University, Kingston, ON, Canada, ¹⁰The Micheli Center for Sports Injury Prevention, Waltham, MA, United States

Keywords: Cartilage, Quantitative Imaging, T1rho, knee

There is limited standardization of T1ρ acquisition parameters with respect to spin lock times (TSLs). Shorter TSL durations are susceptible to underestimating knee cartilage T1ρ relaxation times, warranting optimization for maximal measurement stability. Additionally, vertical estimation of T1ρ relaxation times throughout cartilage layers is limited. Here, we utilized 40 healthy knees to demonstrate enhanced T1ρ relaxation time measurement stability with maximum TSLs of 90 to 120ms compared to shorter TSL durations. Depth-specific differences in T1ρ were further compartmentalized into deep and superficial knee cartilage layers, highlighting the potential for T1ρ to indirectly and non-invasively evaluate proteoglycan content across cartilaginous layers.

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Yongcheng Yao¹ and Weitian Chen^1
1Department of Imaging and Interventional Radiology, The Chinese University of Hong Kong, Shatin, Hong Kong

Keywords: Cartilage, Cartilage, morphometrics

We proposed a deep-learning-based system for automatic knee articular cartilage morphometrics. It produces regional metrics including full-thickness cartilage loss (FCL), mean thickness, surface area, and volume. The proposed system comprises deep learning models and algorithms that work collaboratively. We have trained convolutional neural networks for tissue segmentation, template construction, and image registration. We designed modules and pipelines for cartilage thickness mapping, cartilage lesion quantification, and cartilage parcellation. Results shows superior accuracy of the thickness mapping method and robustness of the cartilage parcellation method. The proposed FCL estimation method filled the gap in automatic cartilage lesions quantification.

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Ashley A. Williams¹, Nicholas P Drain², Yongxian Qian³, Kathryn J. Stevens⁴, and Constance R. Chu^1
1Orthopaedic Surgery, Stanford University, Stanford, CA, United States, ²Orthopaedic Surgery, University of Pittsburgh, Pittsburgh, PA, United States, ³Department of Radiology, New York University Grossman School of Medicine, New York, NY, United States, ⁴Department of Radiology, Stanford University, Stanford, CA, United States

Keywords: Osteoarthritis, Relaxometry, UTE-T2*, meniscus, radiography

This study examines whether compositional degeneration of the meniscus is a potential predictor of future radiographic knee OA.  Mensical UTE-T2* maps acquired prior to anterior cruciate ligament reconstruction (ACLR) were compared to knee radiographs collected 11 years later in 11 ACLR patients.  On average, pre-operative posterior medial and lateral meniscal UTE-T2* values were 39% and 33% higher in knees with KL grade ≥ 2 compared to knees with KL grades 0-1 at 11-year follow-up (p=0.016, 0.034). Thus, elevated meniscal UTE-T2* in the context of an ACLR knee may be a warning of increased risk for radiographic osteoarthritis many years later.

Peng Luo¹, Wentao Hu², Yongming Dai², and Guanwu Li^1
1Department of Radiology, Yueyang Hospital of Integrated Traditional Chinese and Western Medicine, Shanghai University of Traditional Chinese Medicine, Shanghai, China, ²Central Research Institue, United Imaging Healthcare, Shanghai, China

Keywords: Cartilage, Diffusion/other diffusion imaging techniques

Early OA is subclinical for anatomic change of cartilage, making it difficult for conventional MRI detection. This study is aimed to apply diffusion-relaxation correlation spectrum imaging (DR-CSI) to knee early-stage OA detection. DR-CSI compartment volume fractions V_A, V_B and V_C had correlation with the modified Whole-Organ MR Imaging Scores (WORMS). V_C had better ability than V_A, V_B, V_D, T2 and ADC to discriminate early OA patients from healthy controls. The results illustrated that DR-CSI compartment volume fractions may be sensitive indicators for detecting early-stage degeneration in knee articular cartilage.

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Jessica Lauren Asay¹, Anthony A Gatti¹, Arjun D Desai¹, Emily J McWalter², Shannon N Edd³, Thomas P Andriacchi³, Nicholas J Giori^4,5, and Garry E Gold^1
1Radiology, Stanford University, Stanford, CA, United States, ²Mechanical Engineering and Division of Biomedical Engineering, University of Saskatchewan, Saskatoon, SK, Canada, ³Mechanical Engineering, Stanford University, Stanford, CA, United States, ⁴VA Palo Alto Health Care System, Palo Alto, CA, United States, ⁵Orthopedic Surgery, Stanford University, Stanford, CA, United States

Keywords: Cartilage, Joints, Meniscus, Knee, Patient Reported Outcomes

Meniscectomies are common but not always successful in treating degenerative meniscus tears. Preoperative patient reported outcomes (PROs) and quantitative MRI could help surgeons decide candidacy for meniscectomy. This study demonstrated that pre-operative T₂ relaxation times in the medial central femoral cartilage are correlated to pre-operative PROs in patients with degenerative meniscal tears and are predictive of 1 and 2-year changes in PROs post-operation. This study suggests patients who have longer T₂ relaxation times pre-operation might not benefit as much from a meniscectomy.

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Andrew C Yung¹, Emily Sullivan^2,3, Jessica C Küpper^2,4, Kirsten Bale¹, Piotr Kozlowski¹, and David Wilson^2,4
1UBC MRI Research Centre, Radiology, University of British Columbia, Vancouver, BC, Canada, ²Centre for Hip Health and Mobility, Vancouver, BC, Canada, ³School of Biomedical Engineering, University of British Columbia, Vancouver, BC, Canada, ⁴Orthopaedics, University of British Columbia, Vancouver, BC, Canada

Keywords: Cartilage, Osteoarthritis, Strain

We present a novel approach to cartilage multi-echo data where T2 reflects focal changes in strain along the cartilage depth, and the signal amplitude reflects a measure of water content which presents a simpler pattern of change that reflects strain.  Ex vivo bovine knee samples were scanned at 9.4T while under load, with high resolution along the cartilage depth to allow direct measurement of strain. Changes in water content were found to be more spatially uniform than the complex depth dependence shown by T2, and showed a high degree of correlation to whole-cartilage averages of bulk strain.

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Erin C Argentieri¹, Sara E Sacher¹, Ek Tsoon Tan¹, Garry Gold², Hollis G Potter¹, Sharmila Majumdar³, and Matthew F Koff^1
1Radiology and Imaging, Hospital for Special Surgery, New York, NY, United States, ²Stanford University, Stanford, CA, United States, ³University of California San Francisco, San Francisco, CA, United States

Keywords: Cartilage, Quantitative Imaging

Results of the current study demonstrate compartment- and region-specific differences in medial and lateral meniscal T2* values. Meniscal T2* values may provide a non-invasive means to assess response of the tissue specific to the loading environment and identify the early onset meniscal degeneration. A better understanding of the early changes in meniscal T2* values may help define the progression of meniscal degeneration, prior to the onset of gross morphologic defects.

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Erin C Argentieri¹, Kenneth Gao¹, Valentina Pedoia¹, Garry Gold², Matthew F Koff³, Hollis G Potter³, and Sharmila Majumdar^1
1Radiology, University of California San Francisco, San Francisco, CA, United States, ²Radiology, Stanford University, Stanford, CA, United States, ³Radiology and Imaging, Hospital for Special Surgery, New York, NY, United States

Keywords: Cartilage, MSK

Features of tibial bone morphology such as tibial slope and tibial spine volume have a significant impact on overall joint mechanics and, results of the current study indicate that these feature of tibial bone shape impact both medial and lateral meniscal T2* metrics.

Lin Qiu¹, Long Qian², and Xiang-Ran Cai^1
1Medical Imaging Center, First Affiliated Hospital, Jinan university, Guangzhou, China, ²MR Research, GE Healthcare, Guangzhou, China

Keywords: Cartilage, Osteoarthritis

IDEAL-IQ and T2 mapping sequences are capable of objectively assessing fat and water content in the adipose tissue around the knee joint. The severity of KOA is related to the fat and water content of knee adipose tissue.

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Stefan Zbyn^1,2,3, Richard Lartey^1,2, Jeehun Kim^1,2, Carl S. Winalski^1,2,3, and Xiaojuan Li^1,2,3
1Program of Advanced Musculoskeletal Imaging (PAMI), Cleveland Clinic, Cleveland, OH, United States, ²Department of Biomedical Engineering, Lerner Research Institute, Cleveland Clinic, Cleveland, OH, United States, ³Department of Diagnostic Radiology, Imaging Institute, Cleveland Clinic, Cleveland, OH, United States

Keywords: Cartilage, Relaxometry, Meniscus

The aim of this study was to evaluate the in vivo scan-rescan repeatability of T2 and T1ρ quantification in knee cartilage and meniscus of patients with knee pain at 7 Tesla. Four subjects were scanned-rescanned on the same day using the 10-minutes-long MAPSS sequence for simultaneous T2 and T1ρ mapping. Coefficients of variation and Bland-Altman plots showed excellent scan-rescan repeatability of in vivo T2 and T1ρ quantification in cartilage and meniscus at 7 Tesla. Our results indicate that fast T2 and T1ρ mapping with four echo and four spin-lock times remains sensitive to cartilage degeneration.

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Bhavsimran Malhi¹, Dina Moazamian¹, Michael Carl², Jiyo Athertya¹, Saeed Jerban¹, Hyungseok Jang¹, Yajun Ma¹, Eric Chang^1,3, and Jiang Du^1,4,5
1Department of Radiology, University of California, San Diego, USA, San Diego, CA, United States, ²GE Healthcare, San Diego, USA, San Diego, CA, United States, ³Veterans Affairs San Diego Helath Care system, San Diego, USA, San Diego, CA, United States, ⁴Veterans Affairs San Diego Health Care System, San Diego, CA, USA, San Diego, CA, United States, ⁵Department of Bioengineering, University of California, San Diego, USA, San Diego, CA, United States

Keywords: Tendon/Ligament, Tendon/Ligament, UTE, MRI

UTE sequences have been previously used to image short T2 tissues. T1ρ has shown promising results in assessing macromolecules and has been proposed as a potential biomarker for tissue degeneration. In this study, we aimed to demonstrate bi-exponential relaxation of the patellar tendon at 3T, using the 3D ultrashort echo time T1ρ (UTE-T1ρ) sequence. Five ex-vivo knee joints were scanned, and we were able to demonstrate better fitting with a bi-component model and better discern the long and short relaxation components of the tissue, along with their respective fractions

Lin Mu¹, Qianting Wang¹, Jiahui Fu², Dong Dong², Yueluan Jiang³, Lin Li⁴, and Huimao Zhang^2
1The First Hospital of Jilin University, Changchun, China, ²Radiology, The First Hospital of Jilin University, Changchun, China, ³MR Scientific Marketing, Diagnostic Imaging, Siemens Healthineers Ltd, Beijing, China, ⁴Radiology, The First Hospital of Jilin University, changchun, China

Keywords: Cartilage, MSK

Quantitative MRI assigns absolute quantification of T1,T2 and PD based on tissue characteristics, such as the T2 metric values a surrogate marker for cartilage collagen integrity. The QRAPMASTER technology enables inline generation of quantitative T1maps and T2 maps and scans of high image quality, representing a promising synthetic MRI option that appears clinically feasible and may eventually facilitate the time neutral acquisition of quantitative T1 maps, T2 maps in the knee MRI.

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Heather Hanegraaf¹, Rianne A. van der Heijden^1,2, Edwin H.G. Oei¹, Marienke van Middelkoop³, Stefan Klein¹, and Jukka Hirvasniemi^1
1Department of Radiology & Nuclear Medicine, Erasmus MC University Medical Center, Rotterdam, Netherlands, ²Department of Radiology, University of Wisconsin-Madison, Madison, WI, United States, ³Department of General Practice, Erasmus MC University Medical Center, Rotterdam, Netherlands

Keywords: Osteoarthritis, Segmentation

To investigate the generalizability of deep learning segmentation models, three different nnU-Nets (2D, 3D, and ensemble) were trained on the OAI dataset and tested on a different dataset. In addition to the nnU-Nets trained on the original OAI data, the style of the test set was transferred to the training set using a CycleGAN method and the nnU-Nets were trained again. Depending on the tissue, the 3D nnU-Net or the ensemble trained on the original or stylized training data had the highest segmentation accuracy in the test set. The results indicate that nnU-Net may generalize well to independent datasets.

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Zhisen Hu¹, Peter J Lally¹, and Neal K Bangerter^1
1Department of Bioengineering, Imperial College London, London, United Kingdom

Keywords: Osteoarthritis, Segmentation

Knee Osteoarthritis (OA) is serious and prevalent today. Image segmentation of high-resolution MRI scans measuring cartilage volume and thickness is useful to track knee OA progression in the early stages and avoid joint replacement. In this work, we developed a cheap and efficient automated technique based on U-Net for knee cartilage segmentation, paying more attention to boundary information. Our model outperforms many existing models for segmentation of the femoral cartilage and performs as well as other techniques for other cartilage compartments. The boundary loss appears to improve cartilage segmentation for the edge slices with smaller cartilage volume.

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Yijie Fang¹, Dantian Zhu¹, Wenhao Wu¹, Shaolin Li¹, Long Qian², and Yajun Ma^3
1Department of Radiology,Fifth Affiliated Hospital, Sun Yat-Sen University, Zhuhai, China, ²MR Research, GE Healthcare, Beijing, China, ³University of California, San Diego, Department of Radiology, San Diego, CA, United States

Keywords: MSK, Joints

In this study, a 3D UTE-MT preparation will be used to detecting changes in the meniscus of amateur marathon runners before and after a marathon. In this prospective cohort study, 23 amateur marathon runners were enrolled. There were three MRI scans (pre-race, 2 days post-race, and 4 weeks post-race) using the UTE-MT and UTE-T2* sequences. UTE-MTR values decreased 2 days post-race and increased after 4 weeks of rest. Conversely, the UTE-T2* values increased 2 days post-race and increased after 4 weeks of rest. UTE-MTR is a promising biomarker for the detection of changes in the meniscus after a marathon.