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To determine the associations between Black race and the presence of radiographic, symptomatic, and clinical hand osteoarthritis (OA).Using available hand radiographs from the Osteoarthritis Initiative cohort (total 4,699; n = 849 Black subjects [18.1%], n = 3,850 non-Black subjects [81.9%]), a propensity score-matching method was used to match Black subjects with non-Black subjects for known potential risk factors of hand OA (age, sex, body mass index, smoking status, cardiovascular disease, osteoporosis, excessive occupation- or recreation-related hand use, and knee OA). Posteroanterior radiographs of subjects' dominant hands were reviewed by a musculoskeletal radiologist in a blinded manner. To assess the severity of hand OA, the modified Kellgren/Lawrence (K/L) radiographic OA scoring scale (grades 0-4) was used, and the presence of erosive OA in the hand joints was recorded. Associations between race and the severity of hand OA (measured as the summed modified K/L grade), presence of radiographic hand OA (modified K/L grade ≥2), presence of erosive hand OA, presence of symptomatic hand OA (radiographic OA with hand pain), and presence of clinical hand OA (indicated by clinical findings of Heberden's nodes in the hands) were studied using regression models. In these models, beta coefficients or odds ratios (ORs) with 95% confidence intervals (95% CIs) were calculated for the associations between Black race and any of these radiographic and symptomatic hand OA phenotypes.Black subjects had less severe hand OA (β = -1.93 [95% CI -2.53, -1.34]), as well as a lower risk of developing radiographic hand OA (OR 0.79 [95% CI 0.66, 0.94]), erosive hand OA (OR 0.23 [95% CI 0.11, 0.47]), symptomatic hand OA (OR 0.63 [95% CI 0.49, 0.82]), and clinical hand OA (OR 0.49 [95% CI 0.41, 0.60]), as compared to non-Black subjects.In contrast to the well-established association between Black race and knee or hip OA, the findings of this study suggest that the risk of hand OA is lower in Black subjects compared to non-Black subjects, which is not mediated by known hand OA risk factors. Future studies are warranted to determine the mediating protective factors for hand OA among Black subjects.

OBJECTIVE: To develop and evaluate deep learning (DL) risk assessment models for predicting pain progression in subjects with or at risk for knee osteoarthritis (OA). MATERIALS AND METHODS: The incidence and progression cohorts of the Osteoarthritis Initiative, a multi-center longitudinal study involving 9348 knees in 4674 subjects with of at risk for knee OA that began in 2004 and is ongoing, was used to conduct this retrospective analysis. A subset of knees without and with pain progression (defined as nine point or greater increase in pain score between baseline and two or more follow-up time over the first 48-months) were randomly stratified into training (4200 knees with mean age of 61.0 years and 60% female) and hold-out testing (500 knees with mean age of 60.8 years and 60% female) datasets. A DL model was developed to predict pain progression using baseline knee radiographs. An artificial neural network was used to develop a traditional risk assessment model to predict pain progression using demographic, clinical, and radiographic risk factors. A combined model was developed to combine demographic, clinical, and radiographic risk factors with DL analysis of baseline knee radiographs. Area under the curve (AUC) analysis was performed using the hold-out testing dataset to evaluate model performance. RESULTS: The traditional model had an AUC of 0.692 (66.9% sensitivity and 64.1% specificity). The DL model had an AUC of 0.770 (76.7% sensitivity and 70.5% specificity), which was significantly higher (p

To evaluate the reliability and validity of measuring subchondral trabecular biomarkers in “conventional” intermediate-weighted (IW) MRI sequences and to assess the predictive value of biomarker changes for predicting near-term symptomatic and structural progressions in knee osteoarthritis (OA). For this study, a framework for measuring trabecular biomarkers in the proximal medial tibia in the “conventional” IW MRI sequence was developed. The reliability of measuring these biomarkers (trabecular thickness [cTbTh], spacing [cTbSp], connectivity density [cConnD], and bone-to-total volume ratio [cBV/TV]) was evaluated in the Bone Ancillary Study (within the Osteoarthritis Initiative [OAI]). The validity of these measurements was assessed by comparing to “apparent” biomarkers (from high-resolution steady-state MRI sequence) and peri-articular bone marrow density (BMD, from dual-energy X-ray absorptiometry). The association of these biomarker changes from baseline to 24 months (using the Reliable Change Index) with knee OA progression was studied in the FNIH OA Biomarkers Consortium (within the OAI). Pain and radiographic progression were evaluated by comparing baseline WOMAC pain score and radiographic joint space width with the 24-to-48-month scores/measurements. Associations between biomarker changes and these outcomes were studied using logistic regression adjusted for the relevant covariates. With acceptable reliability, the cTbTh and cBV/TV, but not cTbSp or cConnD, were modestly associated with the “apparent” biomarkers and peri-articular BMD (β: 1.10 [95% CI: 0.45–1.75], p value: 0.001 and β: 3.69 [95% CI: 2.56–4.83], p value: < 0.001, respectively). Knees with increased cTbTh had higher (OR: 1.44 [95% CI: 1.03–2.02], p value: 0.035) and knees with decreased cTbTh (OR: 0.69 [95% CI: 0.49–0.95], p value: 0.026) or decreased cBV/TV (OR: 0.67 [95% CI: 0.48–0.93], p value: 0.018) had lower odds of experiencing OA pain progression over the follow-ups. Measurement of certain “conventional” MRI-based subchondral trabecular biomarkers has high reliability and modest validity. Though modest, there are significant associations between these biomarker changes and knee OA pain progression up to 48-month follow-up. • Despite the lower spatial resolution than what is required to accurately study the subchondral trabecular microstructures, the “conventional” IW MRI sequences may retain adequate information that allows quantification of trabecular microstructure biomarkers. • Subchondral trabecular biomarkers obtained from “conventional” IW MRI sequences (i.e., cTbTh, cTbSp, and cBV/TV) are reliable and valid measures of trabecular microstructure changes compared to those from “apparent” trabecular biomarkers (from the FISP MRI sequence) and peri-articular BMD (from DXA). • Increased trabecular thickness and bone-to-total ratio (cTbTh and cBV/TV, obtained from “conventional” IW MRI sequences) from baseline to 24-month visits may be associated with higher odds of knee OA pain progression over 48 months of follow-up.

To determine whether kneeling activity is associated with the MRI measures of patellofemoral (PF) joint cartilage damage worsening in subjects with/without patella alta (PA). Baseline and 24-month 3-T MR images and semi-quantitative MRI Osteoarthritis Knee Score (MOAKS) of PF joint of 600 subjects from the FNIH study, a nested study within the Osteoarthritis Initiative (OAI), were extracted. At baseline visit, subjects were asked how many days per week they participated in kneeling activities lasted ≥ 30 min. Insall-Salvati ratio (ISR) (patellar tendon/patellar height) was measured on baseline MRIs by a musculoskeletal radiologist; ISR ≥ 1.3 was considered PA. Regression analysis adjusted for confounding variables was used to assess the impact of kneeling on worsening of MOAKS cartilage over 24 months. The potential moderating effect of PA was evaluated using adjusted regression analysis. Six hundred subjects (58.8% female, years, BMI = 30.7 ± 4.8 kg/m2) were included; 13.7%, 6.2%, and 5.5% of participants reported 1 day, 2–5 days, and ≥ 6 days of kneeling activities per week. A higher frequency of kneeling activity was associated with the increased risk of MOAKS cartilage score worsening (adjusted OR (95% CI): 2.33 (1.08–5.06)). Stratification analysis showed that only ≥ 6 days/week of kneeling activities was associated with the worsening of MOAKS cartilage scores (2.74 (1.03–7.27)). When we included the presence of PA in regression models, the OR (95% CI) for the association between kneeling and PF cartilage damage will decrease to 1.26 (0.78–2.04), suggesting the potential role of PA as the moderator variable. Extensive kneeling activity (≥ 6 days/week) may be associated with the MRI-based worsening of PF cartilage damage, specifically in subjects with an underlying patella alta. • Frequent daily kneeling activity is associated with a higher risk of patellofemoral cartilage damage resulting in patellofemoral osteoarthritis. • The cartilage damage associated with extensive kneeling activity may be worse in subjects with an underlying patella alta (i.e., high-riding patella).

Background The overall rate of hip fractures not identified on radiographs but that require surgery (ie, surgical hip fractures) remains unclear in elderly patients who are suspected to have such fractures based on clinical findings. Moreover, the importance of advanced imaging in these patients has not been comprehensively assessed. Purpose To estimate the frequency of radiographically occult hip fracture in elderly patients, to define the higher-risk subpopulation, and to determine the diagnostic performance of CT and bone scanning in the detection of occult fractures by using MRI as the reference standard. Materials and Methods A literature search was performed to identify English-language observational studies published from inception to September 27, 2018. Studies were included if patients were clinically suspected to have hip fracture but there was no radiographic evidence of surgical hip fracture (including absence of any definite fracture or only presence of isolated greater trochanter [GT] fracture). The rate of surgical hip fracture was reported in each study in which MRI was used as the reference standard. The pooled rate of occult fracture, diagnostic performance of CT and bone scanning, and strength of evidence (SOE) were assessed. Results Thirty-five studies were identified (2992 patients; mean age, 76.8 years ± 6.0 [standard deviation]; 66% female). The frequency of radiographically occult surgical hip fracture was 39% (1110 of 2835 patients; 95% confidence interval [CI]: 35%, 43%) in studies of patients with no definite radiographic fracture and 92% (134 of 157 patients; 95% CI: 83%, 98%) in studies of patients with radiographic evidence of isolated GT fracture (moderate SOE). The frequency of occult fracture was higher in patients aged at least 80 years (44%, 529 of 1184), those with an equivocal radiographic report (58%, 71 of 126), and those with a history of trauma (41%, 977 of 2370) (moderate SOE). CT and bone scanning yielded comparable diagnostic performance in the detection of radiographically occult hip fracture (

Osteoarthritis (OA) is a highly prevalent chronic condition with marked implications for affected individuals and public health care. There are available treatments to manage pain and symptoms but no effective treatment for OA. In the past 10 years, joint imaging, particularly MRI, has evolved rapidly due to technical advances and their application to clinical research, which has led to abundant evidence regarding the natural history of the disease. Radiography remains the primary imaging modality in clinical practice for the diagnosis and follow-up of OA. The many developments in MRI techniques capable of assessing cartilage morphologic features and the methods for evaluating its biochemical composition will be discussed. Advances in quantitative morphologic cartilage assessment and semiquantitative whole-organ assessment will be reviewed, as will other modalities such as US, CT and CT arthrography, and nuclear medicine techniques that play a complementary role. Various therapeutic approaches and ongoing developments, including the impact of artificial intelligence on the field of OA imaging, will also be discussed.

Ulnar-sided wrist pain can be a diagnostic challenge for clinicians and radiologists. The ulnar wrist has complex morphology and is composed of many small bone and soft tissue structures. Within these structures, a wide variety of pathologic conditions can occur. To successfully diagnose and treat these pathologic conditions, clinicians and radiologists must have a strong understanding of the advanced imaging techniques available to them. In this review, the authors present a brief review of the normal ulnar wrist anatomy, discuss the differential diagnosis of ulnar-sided wrist pain, and examine the indications for different advanced imaging modalities.

The electronic medical record (EMR) can reveal preferences of clinicians regarding imaging services. We sought to evaluate viewing habits for reports and images of musculoskeletal (MSK) studies by ordering clinicians. We hypothesized that MSK reports are important to clinical management, especially for advanced imaging modalities. We tracked the image and report access of all MSK studies ordered in September 2016 over 8 months using logs of the EMR (Epic Systems, Verona, WI), and by an independent analysis of the institutional PACS (Picture Archiving and Communication Systems) (Carestream Health, Rochester, NY). The time stamps were extracted for when images and reports were viewed. We categorized MSK studies by modality and provider department. We also compared the rates of viewing reports and images among different modalities and departments using the chi-square test. Of the 8143 viewed MSK studies, 7842 (96.3%) reports (with/without images) and 3916 (48.1%) imaging data (with/without reports) were viewed. Viewing reports alone occurred in 4227 (51.9%) studies. CT and MRI reports alone views occurred more often in comparison to radiographs ([482/706; 68.3%] for CT and [981/1713; 57.3%] for MRI vs. [2764/5724; 48.3%] for radiography, p

Given the coexistence and possible interactions between patellofemoral and tibiofemoral compartments, roles of patellofemoral morphology measurements in tibiofemoral osteoarthritis (OA) have not been investigated extensively. We aimed to determine whether patellofemoral morphology is associated with the presence and longitudinal worsening of tibiofemoral OA in participants of the Osteoarthritis Initiative (OAI). Baseline knee MRIs of 600 participants were read by two independent blinded observers in consensus to determine patellofemoral morphology measurements including tibial tuberosity to trochlear groove (TT–TG) distance, trochlear groove depth (TGD), lateral patellar tilt (LPT), and Insall–Salvati ratio (ISR). Radiographic and MRI OA knee scoring (MOAKS) measurements were extracted from baseline and 2-year follow-up readings. Associations between baseline patellofemoral morphology metrics with radiographic medial tibiofemoral compartment (MTFC) joint space loss (> 0.7 mm, between baseline and 2nd–4th-year readings), and MRI-derived cartilage damage, bone marrow lesions (BMLs), and osteophytes (baseline to 2 years), were investigated using regression models adjusted for age, sex, body mass index, and knee alignment. P values were corrected using the Benjamini–Hochberg procedure. Patellofemoral morphology measurements were not associated with longitudinal joint space loss in the MTFC or MOAKS determinants. Only TT–TG distance was associated with the baseline number of subregions with cartilage defects (OR (95% CI), 1.09 (1.04–1.14), corrected p value ≤ 0.01), BMLs (OR (95% CI), 1.1 (1.04–1.17), corrected p value = 0.01), and osteophytes (OR (95% CI), 1.09 (1.05–1.14), corrected p value ≤ 0.01) in the lateral tibiofemoral compartment (LTFC), and worsening of LTFC cartilage defects over 2 years (OR (95% CI), 1.09 (1.03–1.16), corrected p value = 0.02). Higher TT–TG distance was associated with concurrent MRI-derived OA-related structural damages and 2-year follow-up worsening only in LTFC. No associations were detected between patellofemoral morphology measurements and MTFC OA progression. • Of all patellofemoral morphology measurements, the only lateralization of the tibial tubercle may be considered as a risk factor for lateral (not medial) tibiofemoral osteoarthritis worsening. • Patellofemoral morphology measurements of patella alta, trochlear dysplasia, patellar tilt, and lateralization of the tibial tubercle are not associated with radiographic and MRI-based medial tibiofemoral osteoarthritis worsening over 2 years. • Using longitudinal MRI data, each millimeter increase of TT–TG distance is associated with a 9% (95% confidence interval, 3–16%) increase in odds of longitudinal cartilage defects in the lateral tibiofemoral (but not medial) compartment over 2 years.

Background Given the central role of skeletal muscles in glucose homeostasis, deposition of adipose depots beneath the fascia of muscles (versus subcutaneous adipose tissue [SAT]) may precede insulin resistance and type 2 diabetes (T2D) incidence. This study was aimed to investigate the associations between computed tomography (CT)–derived biomarkers for adipose tissue and T2D incidence in normoglycemic adults. Methods and findings This study was a population-based multiethnic retrospective cohort of 1,744 participants in the Multi-Ethnic Study of Atherosclerosis (MESA) with normoglycemia (baseline fasting plasma glucose [FPG] less than 100 mg/dL) from 6 United States of America communities. Participants were followed from April 2010 and January 2012 to December 2017, for a median of 7 years. The intermuscular adipose tissue (IMAT) and SAT areas were measured in baseline chest CT exams and were corrected by height squared (SAT and IMAT indices) using a predefined measurement protocol. T2D incidence, as the main outcome, was based on follow-up FPG, review of hospital records, or self-reported physician diagnoses. Participants’ mean age was 69 ± 9 years at baseline, and 977 (56.0%) were women. Over a median of 7 years, 103 (5.9%) participants were diagnosed with T2D, and 147 (8.4%) participants died. The IMAT index (hazard ratio [HR]: 1.27 [95% confidence interval [CI]: 1.15–1.41] per 1-standard deviation [SD] increment) and the SAT index (HR: 1.43 [95% CI: 1.16–1.77] per 1-SD increment) at baseline were associated with T2D incidence over the follow-up. The associations of the IMAT and SAT indices with T2D incidence were attenuated after adjustment for body mass index (BMI) and waist circumference, with HRs of 1.23 (95% CI: 1.09–1.38) and 1.29 (95% CI: 0.96–1.74) per 1-SD increment, respectively. The limitations of this study include unmeasured residual confounders and one-time measurement of adipose tissue biomarkers. Conclusions In this study, we observed an association between IMAT at baseline and T2D incidence over the follow-up. This study suggests the potential role of intermuscular adipose depots in the pathophysiology of T2D. Trial registration ClinicalTrials.gov NCT00005487, In a cohort study, Shadpour Demehri and colleagues investigate the association between adipose tissue biomarkers and type 2 diabetes incidence in normoglycemic participants in US., Author summary Why was this study done? This study was designed to investigate the associations between computed tomography (CT)–derived biomarkers for adipose tissue at baseline and type 2 diabetes (T2D) incidence in normoglycemic adults. What did the researchers do and find? We assessed 1,744 normoglycemic participants with chest CT exams between 2010 and 2012. The intermuscular adipose tissue (IMAT) and subcutaneous adipose tissue (SAT) areas were measured in these chest CT exams using a predefined measurement protocol. Participants were followed from April 2010 and January 2012 to December 2017, for a median of 7 years, for T2D incidence. T2D incidence was based on follow-up fasting plasma glucose (FPG), review of hospital records, or self-reported physician diagnoses. This study found that a higher CT-derived IMAT at baseline was associated with T2D incidence over the follow-up. What do these findings mean? In normoglycemic participants, the IMAT deposition was associated with T2D incidence. This study suggests the potential role of intermuscular adipose depots in the pathophysiology of T2D. The CT-derived adipose tissue biomarkers are obtainable from CT exams performed for other initial indications and can extend the value of the routinely performed chest CT exams. Such biomarkers may be associated with T2D incidence.

Objective.To investigate the metabolic syndrome (MetS) association with radiographic and symptomatic hand osteoarthritis (HOA).Methods.Using 1:2 propensity score matching for relevant confounders, we included 2509 participants (896 MetS positive and 1613 MetS negative) from the Osteoarthritis Initiative dataset. MetS and its components, according to the International Diabetes Federation criteria, were extracted from baseline data, and included hypertension, abdominal obesity, dyslipidemia, and diabetes. We scored distinct hand joints based on the modified Kellgren-Lawrence (mKL) grade of baseline radiographs, with HOA defined as mKL ≥ 2. In the cross-sectional analysis, we investigated the association between MetS and its components with radiographic HOA and the presence of nodal and erosive HOA phenotypes using regression models. In the longitudinal analysis, we performed Cox regression analysis for hand pain incidence in follow-up visits.Results.MetS was associated with higher odds of radiographic HOA, including the number of joints with OA (OR 1.32, 95% CI 1.08–1.62), the sum of joints mKLs (OR 2.42, 95% CI 1.24–4.71), mainly in distal interphalangeal joints (DIPs) and proximal interphalangeal joints (PIPs; OR 1.52, 95% CI 1.08–2.14 and OR 1.38, 95% CI 1.09–1.75, respectively), but not metacarpophalangeal (MCP) and first carpometacarpal (CMC1) joints. Hand pain incidence during follow-up was higher with MetS presence (HR 1.25, 95% CI 1.07–1.47). The erosive HOA phenotype and joints’ nodal involvement were more frequent with MetS (OR 1.40, 95% CI 1.01–1.97 and OR 1.28, 95% CI 1.02–1.60, respectively).Conclusion.MetS, a potentially modifiable risk factor, is associated with radiographic DIP and PIP OA and longitudinal hand pain incidence while sparing MCPs and CMC1s. Nodal and erosive HOA phenotypes are associated with MetS, suggestive of possible distinct pathophysiology.

We thank Roemer and Guermazi for their Letter, “Biochemical cartilage changes based on MRI-defined T2 relaxation times do not equal OA detection” (1). In their comments on our paper (2), the authors (1) raise questions about osteoarthritis (OA) incidence, visual signs of disease on the images, MRI-based scoring systems, and radiomics which we address below. In ref. 2, we propose a fully automated machine learning technique for discovery of imaging biomarkers in the cartilage of asymptomatic individuals for prediction of future symptomatic OA. We overcome a long-standing limitation of machine learning regarding explainability, by enabling visual recognition of classification biomarkers. First, regarding OA incidence, the American College of Rheumatology publication (3) cited by the authors (1) recommends diagnosis based on … [↵][1]1To whom correspondence may be addressed. Email: skundu2{at}jhmi.edu. [1]: #xref-corresp-1-1

Background Obesity and sarcopenia are associated with mortality in chronic obstructive pulmonary disease (COPD). Routine chest CT examinations may allow assessment of obesity and sarcopenia by soft-tissue markers for predicting risks of mortality. Purpose To investigate associations between soft-tissue markers subcutaneous adipose tissue (SAT), intermuscular adipose tissue (IMAT), and pectoralis muscle (PM) index from chest CT with mortality in participants with COPD. Materials and Methods In this secondary analysis of a prospectively enrolled cohort from the Multi-Ethnic Study of Atherosclerosis, participants with available chest CT in 2010-2012 were included. CT examinations were analyzed to determine SAT, IMAT (within PM), and PM areas. The spirometry evaluations were used to establish COPD diagnosis. Mortality data were extracted from the National Death Index (April 2010 to December 2017). The correlations of the soft-tissue markers with fat mass index were studied. The associations of these markers and risks of mortality in participants with COPD were assessed by using Cox proportional-hazard models adjusted for confounders. Results Among 2994 participants who were included (mean age, 69 years ± 9 [standard deviation]; 1551 women), 265 had COPD (9%; mean age, 72 years ± 9; 162 men) and 49 participants with COPD (18%) died during follow-up. The SAT, IMAT, and PM areas had moderate-to-excellent reliabilities (intraclass correlation coefficient, 0.88-0.99). In the 2994 participants, the SAT (ρ = 0.80; 95% CI: 0.78, 0.81; P < .001) and IMAT indexes (ρ = 0.37; 95% CI: 0.34, 0.41; P < .001) were correlated with fat mass index. Those with COPD and higher SAT index had lower risks of mortality (hazard ratio, 0.2; 95% CI: 0.1, 0.4; P < .001, per doubling), whereas a higher IMAT index was associated with a higher risk of mortality (hazard ratio, 1.4; 95% CI: 1.0, 1.9; P = .04, per doubling). Conclusion Soft-tissue markers were reliably obtained by using chest CT performed for lung assessment. In participants with chronic obstructive pulmonary disease, a high intermuscular adipose tissue index was associated with a higher risk of mortality than was a high subcutaneous adipose tissue index. © RSNA, 2021 Online supplemental material is available for this article. See also the editorial by Sverzellati and Cademartiri in this issue.

Osteoarthritis (OA) is the most frequent form of arthritis with major implications on both individual and public health care levels. The field of joint imaging, and particularly magnetic resonance imaging (MRI), has evolved rapidly due to the application of technical advances to the field of clinical research. This narrative review will provide an introduction to the different aspects of OA imaging aimed at an audience of scientists, clinicians, students, industry employees, and others who are interested in OA but who do not necessarily focus on OA. The current role of radiography and recent advances in measuring joint space width will be discussed. The status of cartilage morphology assessment and evaluation of cartilage biochemical composition will be presented. Advances in quantitative three-dimensional morphologic cartilage assessment and semi-quantitative whole-organ assessment of OA will be reviewed. Although MRI has evolved as the most important imaging method used in OA research, other modalities such as ultrasound, computed tomography, and metabolic imaging play a complementary role and will also be discussed.

To investigate the associations of medial and lateral patellofemoral osteoarthritis (PF-OA) at baseline with symptomatic and radiographic OA outcomes in the medial tibiofemoral compartment (MTFC) over 4 years, according to baseline overweight status. Data and MRI images of 600 subjects in the FNIH-OA biomarkers consortium were used. Symptomatic worsening and radiographic progression of MTFC-OA were defined using Western Ontario and McMaster Universities Arthritis Index (WOMAC) pain scores and MTFC joint space narrowing (JSN) from baseline to 4-year follow-up. Baseline MRIs were read to establish PF-OA diagnosis. The association between baseline regional PF-OA pattern and odds for MTFC-OA progression was evaluated using regression models (adjusted for relevant confounding covariates including body mass index (BMI), age, sex, PF alignment measurements, KL grade, and knee alignment). To evaluate the effect modifying role for overweight status, stratification analysis was performed (BMI ≥ 25 vs.

Introduction: Conventional resolution coronary CTA (CRCT) is frequently avoided in patients with heavy calcification and prior stents given the diminished diagnostic accuracy. Ultra-high-resolution CT (UHRCT) with detector width of 0.25 mm may overcome partial volume effect limitations. Hypothesis: We hypothesize that UHRCT yields high accuracy for detecting obstructive coronary arterial stenoses in patients with severe coronary artery disease using cardiac catheterization as reference standard. Methods: Nine patients ≥45 years with severe coronary artery disease referred for invasive coronary angiography were prospectively enrolled at a single center. Patients underwent UHRCT within 30 days prior to catheterization and results for significant coronary artery stenoses (≥70%) by visual assessment by blinded expert readers for the two tests were compared. Diagnostic accuracy assessment was performed at a patient-level (N=9) and vessel-level (N=36). Results: Median patient age was 67 (range 53-77). Six patients were obese and 6 had prior stent placement. Estimated radiation dose was 9.3 mSv. Mean Agatston calcium score of patients without stents was 1,688. UHRCT correctly classified all patients as having obstructive or non-obstructive coronary heart disease, respectively, yielding 100% accuracy (95% confidence interval [CI] 64-100%). On a vessel level UHRCT had an accuracy of 93% (95% CI 78-98%). Conclusions: Our initial experience with UHRCT in patients with severe coronary calcification or prior stenting suggests high accuracy for detecting and excluding obstructive stenoses. These results warrant further studies to confirm a role of UHRCT in this challenging population.

Introduction: Metabolic syndrome (MetS) has been cited as a potentially modifiable risk factor for the cardiovascular outcomes. Hypothesis Pectoralis muscle (PM) and intermuscular adipose tissue (IntM AT) areas on chest CT images may be readily obtainable soft tissue biomarkers for MetS screening. Methods: Out of 3,204 subjects in the MESA study with available chest CT scan in the exam 5 (4/2010 to 2/2012), 2,975 subjects had quality-essential images and were included in this analysis. The PM and IntM AT areas in the CT images were measured using a framework for image segmentation in the slice above the aortic arch.The presence of MetS subcomponents and the MetS diagnosis for this sample were determined using the NCEP ATP III. The associations between PM and IntM AT areas with MetS subcomponents and diagnosis were studied using regression (adjusted for relevant confounders). The ROC curves were used to defining the optimal cut-off points (using the Youden’s Index) for MetS diagnosis. Results: The mean age of subjects was 69.29±9.26 (1,434 men and 1,541 women). In this sample, 1,065 (35.80%) subjects were diagnosed with MetS. IntM AT (OR:1.07(1.02-1.13)), but not the PM (OR:0.98(0.97-1.00)) area, was associated with MetS. Using the ROC curve, the optimal cut-off points of the IntM AT areas and PM for MetS diagnosis were 16.22 and 1.87, respectively. The cut-off point for the PM were highly sensitive (87.1%) but not specific (16.4%). Conclusion: Quantitative analysis of PM and IntM AT areas, measured in a predefined “single slice” of the chest CT image using an in-house semiautomatic framework, may be used as an imaging biomarker for MetS.

Introduction: Tracheobronchial calcification (TBC), is a readily available potential biomarker in non-contrast chest CT scans, including cardiac calcium scan CTs. However, there is a paucity in literature investigating how this measure contributes to CVD risk prediction. Hypothesis: TBC is associated with CVD and mortality events independent from CAC score. Methods: Available non-contrast chest CT images from Johns Hopkins Hospital field center within the fifth exam of the MESA cohort (2010-2012) were re-analyzed as part of the MESArthritis ancillary study. The calcifications observed in the wall of tracheobronchial tree were measured from aortic arch to carina, by calcium scoring package (VScore, Vitrea 7.11, Vital Images). Outlier values were excluded using the Interquartile range-based outlier fence estimates. Association of TBC with cardiovascular risk factors was investigated by linear regression models. Cox proportional hazard models were applied for CVD and mortality event prediction by TBC with and without adjustment for age, gender, race, CAC, and Framingham global CVD risk score (FRS). Results: After exclusion of 39 outliers, a total of 382 participants (51.2% female) with a mean age of 69.9 (±8.82) were included. TBC was associated with age (β=3.26, p:.002), gender (β=96.30, p Conclusions: Quantification of calcifications in tracheobronchial area can be used to predict CHD, CVD and all-cause mortality and augment the predictive power of the highly validated CAC and FRS for CHD events.

Introduction: Costal cartilage calcification (CCC) is an evident yet usually neglected finding in calcium scoring CT scans. Although CAC score is a well-known predictive marker for CVD, little is known about the potential association between CCC and CVD risk factors (RFs) and events. Hypothesis: CCC is associated with CVD RFs and is predictive of CVD events independent from CAC score. Methods: Cardiac CAC score images from Johns Hopkins Hospital field center acquired within the fifth exam of the MESA cohort (2010-2012) were re-analyzed as part of the MESArthritis ancillary study. The CCC was measured bilaterally for the first pair of cartilages at the superior end of image FOVs using calcium scoring package (VScore, Vitrea 7.11, Vital Images) with a 180 HU cut-off. Outlier values were excluded using the IQR-based outlier fence estimates. Association of CCC with CVD RFs, and CVD and mortality time-to-event was investigated by multivariable linear regression and Cox proportional hazard models, respectively. Results: After exclusion of 3 outliers, 329 participants (53% female) with a mean age of 70.1 (±8.75) were included. In cross-sectional analysis, in addition to age (β=8.86, p:.003) and gender (376.0, p Conclusions: CCC is associated with diabetes and can be used to predict CHD and CVD events and augment the predictive power of the highly validated CAC and FRS for CHD events. However, this scoring should be validated in other larger cohorts.

Many diseases have no visual cues in the early stages, eluding image-based detection. Today, osteoarthritis (OA) is detected after bone damage has occurred, at an irreversible stage of the disease. Currently no reliable method exists for OA detection at a reversible stage. We present an approach that enables sensitive OA detection in presymptomatic individuals. Our approach combines optimal mass transport theory with statistical pattern recognition. Eighty-six healthy individuals were selected from the Osteoarthritis Initiative, with no symptoms or visual signs of disease on imaging. On 3-y follow-up, a subset of these individuals had progressed to symptomatic OA. We trained a classifier to differentiate progressors and nonprogressors on baseline cartilage texture maps, which achieved a robust test accuracy of 78% in detecting future symptomatic OA progression 3 y prior to symptoms. This work demonstrates that OA detection may be possible at a potentially reversible stage. A key contribution of our work is direct visualization of the cartilage phenotype defining predictive ability as our technique is generative. We observe early biochemical patterns of fissuring in cartilage that define future onset of OA. In the future, coupling presymptomatic OA detection with emergent clinical therapies could modify the outcome of a disease that costs the United States healthcare system $16.5 billion annually. Furthermore, our technique is broadly applicable to earlier image-based detection of many diseases currently diagnosed at advanced stages today.

Increased subchondral bone angiogenesis with blood vessels breaching the tidemark into the avascular cartilage is a diagnostic feature of human osteoarthritis. However, the mechanisms that initiate subchondral bone angiogenesis remain unclear. We show that abnormally increased platelet-derived growth factor–BB (PDGF-BB) secretion by mononuclear preosteoclasts induces subchondral bone angiogenesis, contributing to osteoarthritis development. In mice after destabilization of the medial meniscus (DMM), aberrant joint subchondral bone angiogenesis developed during an early stage of osteoarthritis, before articular cartilage damage occurred. Mononuclear preosteoclasts in subchondral bone secrete excessive amounts of PDGF-BB, which activates platelet-derived growth factor receptor–β (PDGFR-β) signaling in pericytes for neo-vessel formation. Selective knockout of PDGF-BB in preosteoclasts attenuates subchondral bone angiogenesis and abrogates joint degeneration and subchondral innervation induced by DMM. Transgenic mice that express PDGF-BB in preosteoclasts recapitulate pathological subchondral bone angiogenesis and develop joint degeneration and subchondral innervation spontaneously. Our study provides the first evidence to our knowledge that PDGF-BB derived from preosteoclasts is a key driver of pathological subchondral bone angiogenesis during osteoarthritis development and offers a new avenue for developing early treatments for this disease.

To evaluate the influence of weight-bearing (WB) load in standard axial ankle syndesmotic measurements using cone beam CT (CBCT) examination of asymptomatic uninjured ankles. In this IRB approved, prospective study, patients with previous unilateral ankle fractures were recruited. We simultaneously scanned the injured ankles and asymptomatic contralateral ankles of 27 patients in both WB and NWB modes. For this study, only asymptomatic contralateral ankles with normal plain radiographs were included. Twelve standardized syndesmosis measurements at two axial planes (10 mm above the tibial plafond and 5 mm below the talar dome) were obtained by two expert readers using a custom CBCT viewer with the capability for geometric measurements between user-identified anatomical landmarks. Inter-reader reliability between two readers was obtained using the intra-class correlation coefficient (ICC). We compared the WB and NWB measurements using paired t test. Significant agreement was observed between two readers for both WB and NWB measurements (p

To determine the association of superolateral Hoffa’s fat pad (SHFP) oedema and patellofemoral joint structural damage in participants of Foundation for the National Institute of Health Osteoarthritis Biomarkers Consortium study. Baseline and 24-month MRIs of 600 subjects were assessed. The presence of SHFP oedema (using 0–3 grading scale) and patellar morphology metrics were determined using baseline MRI. Quantitative patellar cartilage volume and semi-quantitative MRI osteoarthritis knee score (MOAKS) variables were extracted. The associations between SHFP oedema and patellar cartilage damage, bone marrow lesion (BML), osteophyte and morphology were evaluated in cross-sectional model. In longitudinal analysis, the associations between oedema and cartilage volume loss (defined using reliable change index) and MOAKS worsening were evaluated. In cross-sectional evaluations, the presence of SHFP oedema was associated with simultaneous lateral patellar cartilage/BML defects and inferior-medial patellar osteophyte size. A significant positive correlation between the degree of patella alta and SHFP oedema was detected (r = 0.259, p < 0.001). The presence of oedema was associated with 24-month cartilage volume loss (odds ratio (OR) 2.11, 95% confidence interval 1.46–3.06) and medial patellar BML size (OR 1.92 (1.15–3.21)) and number (OR 2.50 (1.29–4.88)) worsening. The optimal cut-off value for the grade of baseline SHFP oedema regarding both presence and worsening of patellar structural damage was ≥ 1 (presence of any SHFP hyperintensity). The presence of SHFP oedema could be considered as a predictor of future patellar cartilage loss and BML worsening, and an indicator of simultaneous cartilage, BML and osteophyte defects. • SHFP oedema was associated with simultaneous lateral patellar OA-related structural damage. • SHFP oedema was associated with longitudinal patellar cartilage loss over 24 months. • SHFP oedema could be considered as indicator and predictor of patellar OA.

Summary Objective This narrative review covers original research publications related to imaging advancements in osteoarthritis (OA) published in the English language between 1 st April 2016 and 30 th April 2017. Methods Relevant human studies (excluding pre-clinical and in vitro studies), were searched and selected from PubMed database using the search terms of "osteoarthritis (OA)" in combination with "radiography", "magnetic resonance imaging (MRI)", "computed tomography (CT)", "ultrasound", "positron emission tomography (PET)," "single-photon emission computed tomography (SPECT)," and "scintigraphy". The included studies were sorted according to their relevance, novelty, and impact. Original research articles with both imaging advancements and novel clinical information were discussed in this review. Results A large portion of the published studies were focused on MRI-based semi-quantitative and quantitative (morphological and structural) metrics of the knee joint to assess OA-related structural damages. New imaging technologies, such as PET, have been investigated for OA diagnosis and characterization, the delineation of predictive factors for OA progression, and to monitor the treatment responses. Conclusion Advanced imaging modalities play a pivotal role in OA research, and make a significant contribution to our understanding of OA diagnosis, pathogenesis, risk stratification, and prognosis.

We present the case of a man with oligometastatic prostate cancer who underwent a PSMA-targeted 18F-DCFPyL PET/CT scan in order to illustrate how the PSMA-RADS grading sytem can be successfully used to support clinical decision-making and treatment planning. Notably, the presented patient was found to have an equivocal bone lesion (PSMA-RADS-3B) which was further worked up with a tumor protocol MRI and found to be definitively benign (PSMA-RADS-1B) and thus removed from the oligometastatic treatment plan. Remaining avid lesions were incorporated into the treatment plan or deferred for later work-up or monitoring, as indicated within the PSMA-RADS framework. Keywords: PSMA, DCFPyL, Prostate cancer, Oligometastatic

The primary goal of comparative effectiveness research (CER) is to define the optimal choice among alternative diagnostic and interventional strategies for a given clinical scenario among major stakeholders in the health care system. In an era where health care decision makers are demanding greater evidence of improved patient outcomes from the use of medical technologies, musculoskeletal (MSK) imagers must be more engaged in generating quality CER. We provide an overview of CER and its expanding role in U.S. health care, the current funding environment for CER and MSK imaging, potential areas for CER in MSK radiology, and a discussion of foreseeable challenges for CER in MSK imaging.

Purpose To investigate the risk of radiographic joint space narrowing (JSN) progression evaluated in subjects with and those without underlying osteoarthritis at baseline and knee replacement (KR) associated with meniscal surgery in subjects with and those without a reported history of preceding knee trauma. Materials and Methods The HIPAA-compliant protocol was approved by the institutional review boards of the participating centers. Written informed consent was obtained from all participants. Subjects who underwent meniscal surgery with a preceding knee trauma at baseline (n = 564) and those without (n = 147) were drawn from the Osteoarthritis Initiative cohort (n = 4796). Radiographic JSN progression was evaluated by using Osteoarthritis Research Society International grading (progression in 1st-, 2nd-, 3rd-, 4th-, 6th-, or 8th-year radiographic findings compared with baseline). KR was assessed up to the 9th year of study (days passed from inclusion to KR or last follow-up). Cox hazard analysis was used to extract the adjusted hazard ratios (HRs) with adjustments for baseline age, sex, body mass index, physical activity, symptoms, and radiographic osteoarthritis features (Kellgren and Lawrence [KL] grade). Results Meniscal surgery with a history of preceding knee trauma was not associated with radiographic progression of JSN (adjusted HR, 0.91 [95% confidence interval {CI}: 0.78, 1.07]) or KR (adjusted HR, 1.02 [95% CI: 0.79, 1.34]; P = .854). However, meniscal surgery without a history of preceding knee trauma was associated with radiographic progression of JSN (adjusted HR, 1.27 [95% CI: 1.00, 1.63]) and KR (adjusted HR, 2.09 [95% CI: 1.52, 2.89]; P.001). Additionally, there was a higher risk of KR in subjects with radiographic KL grade of less than 2 (adjusted HR, 6.97 [95% CI: 3.56, 13.64]; P.001) at baseline in comparison with KL grade of at least 2 (adjusted HR, 1.76 [95% CI: 1.22, 2.54]; P.05). Conclusion In contrast to subjects without a reported preceding trauma, meniscal surgery is not independently associated with increased risk of radiographic JSN progression and KR in patients with a reported preceding trauma.

OBJECTIVE: To develop and evaluate deep learning (DL) risk assessment models for predicting the progression of radiographic medial joint space loss using baseline knee X-rays. METHODS: Knees from the Osteoarthritis Initiative without and with progression of radiographic joint space loss (defined as ≥ 0.7mm decrease in medial joint space width measurement between baseline and 48-month follow-up X-rays) were randomly stratified into training (1400 knees) and hold-out testing (400 knees) datasets. A DL network was trained to predict the progression of radiographic joint space loss using the baseline knee X-rays. An artificial neural network was used to develop a traditional model for predicting progression utilizing demographic and radiographic risk factors. A combined joint training model was developed using a DL network to extract information from baseline knee X-rays as a feature vector, which was further concatenated with the risk factor data vector. Area under the curve (AUC) analysis was performed using the hold-out test dataset to evaluate model performance. RESULTS: The traditional model had an AUC of 0.660 (61.5% sensitivity and 64.0% specificity) for predicting progression. The DL model had an AUC of 0.799 (78.0% sensitivity and 75.5% specificity), which was significantly higher (p

Background The exact contribution of statins to knee osteoarthritis (OA) radiographic outcomes and the characteristics of patients with OA as potential responders to statins remain unclear. Purpose To evaluate the effect of statin use on the incidence of radiographic knee OA (development of Kellgren-Lawrence grade ≥2) and progression of joint space narrowing (JSN) according to the nodal OA status defined according to the presence of Heberden nodes (HNs). Materials and Methods Institutional review boards approved this HIPAA-compliant protocol, and all participants gave informed consent. The Osteoarthritis Initiative (OAI) cohort, which began in 2004 and is ongoing (https://clinicaltrials.gov identifier, NCT00080171), was used to conduct a longitudinal 1:1 propensity score-matched retrospective analysis of prospectively collected data. Participants were classified as having HN-positive or HN-negative findings according to the presence of HNs at baseline physical examination. In each cohort, per-protocol and new-user design were used to match statin initiators (participants who reported ≤1 year of statin use before enrollment) and nonusers (participants who reported no statin use before enrollment) for variables that potentially contributed to confounding by indication bias. Participants were followed up annually over 8 years. Any associations between statin use and longitudinal knee OA radiographic incidence, JSN progression, or nonacceptable symptomatic state incidence was assessed by using hazard ratios (HRs) of Cox regression. Results In the longitudinal analysis, there were 832 knees of 602 participants (pair-matched knees of statin initiators and nonusers) in the HN-positive cohort (mean age, 64.7 years ± 8.0 [standard deviation]; 377 patients were female [62.6%]) and 386 knees of 285 participants in the HN-negative cohort (mean age, 58.9 years ± 8.2; 144 patients were female [50.5%]). In the HN-positive cohort, statin users had 46% lower risk of JSN progression in comparison with matched nonusers (HR, 0.54; 95% confidence interval [CI]: 0.36, 0.93; P = .02). In contrast, in the HN-negative cohort, statin use had no association with radiographic JSN progression (HR, 1.37; [95% CI: 0.74, 2.53]; P = .32). Conclusion Statin use was associated with reduced risk of radiographic knee osteoarthritis joint space narrowing progression in patients with nodal osteoarthritis. © RSNA, 2019 Online supplemental material is available for this article.

Summary Objective To provide a narrative review of original articles on osteoarthritis (OA) imaging published between April 1, 2018 and March 30, 2019. Methods All original research articles on OA imaging published in English between April 1, 2018 and March 30, 2019 were identified using a PubMed database search. The search terms of “Osteoarthritis” or “OA” were combined with the search terms “Radiography”, “X-Rays”, “Magnetic Resonance Imaging”, “MRI”, “Ultrasound”, “US”, “Computed Tomography”, “Dual Energy X-Ray Absorptiometry”, “DXA”, “DEXA”, “CT”, “Nuclear Medicine”, “Scintigraphy”, “Single-Photon Emission Computed Tomography”, “SPECT”, “Positron Emission Tomography”, “PET”, “PET-CT”, or “PET-MRI”. Articles were reviewed to determine relevance based upon the following criteria: 1) study involved human subjects with OA or risk factors for OA and 2) study involved imaging to evaluate OA disease status or OA treatment response. Relevant articles were ranked according to scientific merit, with the best publications selected for inclusion in the narrative report. Results The PubMed search revealed a total of 1257 articles, of which 256 (20.4%) were considered relevant to OA imaging. Two-hundred twenty-six (87.1%) articles involved the knee joint, while 195 (76.2%) articles involved the use of magnetic resonance imaging (MRI). The proportion of published studies involving the use of MRI was higher than previous years. An increasing number of articles were also published on imaging of subjects with joint injury and on deep learning application in OA imaging. Conclusion MRI and other imaging modalities continue to play an important role in research studies designed to better understand the pathogenesis, progression, and treatment of OA.

PURPOSE: Conventional CT technology yields only modest accuracy of coronary artery stenosis assessment in severely calcified lesions. Reported herein are this study's initial observations on the potential of ultra-high-resolution CT (UHR-CT) for evaluating severely calcified coronary arterial lesions. MATERIALS AND METHODS: Fifteen patients 45 years of age or older, with history of coronary artery disease, referred for invasive coronary angiography, were prospectively enrolled. Patients underwent UHR-CT within 30 days prior to cardiac catheterization. Image noise levels and diagnostic confidence (level 1–5) using UHR-CT were compared with reconstructed images simulating conventional CT technology. Stenosis assessment for the major coronary arteries and the left main coronary artery with UHR-CT and invasive angiography were compared. Results from clinically driven coronary CT using conventional technology were considered for comparison when available. RESULTS: Mean patient age was 67 years (range, 53–79 years). Thirteen patients were men, nine had obesity. Radiation dose was 9.3 mSv owing to expanded x-ray exposure to accommodate research software application (70%–99% of R-R cycle). Overall image noise was considerably greater for UHR-CT (50.9 ± 7.8 [standard deviation]) versus conventional CT image reconstruction (19.5 ± 8.3, P < .01), yet diagnostic confidence scores for UHR-CT were high (4.3 ± 0.9). Average calcium score in patients without stents (n = 6) was 1205, and of 86 vessels evaluated, 22 had 70% or greater stenosis depicted with invasive angiography (26%). Stenosis comparison with invasive angiography yielded 86% (19 of 22) sensitivity and 88% (56 of 64) specificity (95% CI: 65%, 97%; and 77%, 95%, respectively). CONCLUSION: Initial observations suggest UHR-CT may be effective in overcoming the limitation of conventional CT for accurately evaluating coronary artery stenoses in severely calcified vessels. Keywords: CT-Angiography, Coronary Arteries, Arteriosclerosis Clinical trial registration no. NCT04272060 See also commentary by Shanbhag and Chen in this issue. © RSNA, 2021

Osteoarthritis (OA) is a major chronic and global health care problem. Recent technological advances in imaging and postprocessing techniques have enhanced the understanding and characterization of the pathophysiology of this chronic and prevalent disease. Although plain radiograph remains the modality of choice for initial assessment of OA, recent studies have shown that advanced cross-sectional imaging can improve the early detection, grading, structural damage quantification, and risk stratification of OA. This article discusses the currently available evidence regarding both the conventional and novel imaging modalities that can be used for evaluation of patients with OA and its longitudinal assessment.

Summary Objective To assess the association between physical activity and cartilage damage progression in medial tibiofemoral compartment (MTFC) using 2-year follow-up magnetic resonance imaging (MRI) in subjects with denuded areas of subchondral bone (dABs) at the central weight-bearing medial femur (cMF) at baseline MRI examination. Methods One hundred subjects from the Osteoarthritis Initiative (OAI) progression cohort with dABs at the cMF at 3T MRI at baseline (51% men; mean age 62.2 years, range 45–79) were included. Sagittal 3D dual-echo steady-state with water excitation images were used to assess 2-year MTFC cartilage change. Associations between 2-year average Physical Activity Scale for the Elderly (PASE) and 2-year MTFC cartilage change were assessed by linear regression analysis. Subgroup analyses were performed. Results No associations between PASE and 2-year MTFC cartilage change were observed in the entire cohort. Similarly, in the subgroup with cartilage loss during the 2 years, the non-refuted confidence intervals for the regression coefficients were tightly clustered around the null value (regression coefficients for: mean cMF.ThCtAB = −0.00059; 98.75% CI: −0.00130 to 0.00012), cMF.dAB% = 0.02176; 98.75% CI: −0.02514 to 0.06865, Mean MT.ThCtAB = −0.00013; 98.75% CI: −0.00064 to 0.00038, MT.dAB% = 0.02543; 98.75% CI: −0.01485 to 0.06571. Conclusion In the entire group of subjects with dABs at the cMF at baseline, no association between physical activity and 2-year MTFC cartilage change was detected. Due to the limited sample size of our study, small-sized effects may not have been detected in our study.

The aim of this study was to prospectively test the hypothesis that a compressed sensing-based slice encoding for metal artifact correction (SEMAC) turbo spin echo (TSE) pulse sequence prototype facilitates high-resolution metal artifact reduction magnetic resonance imaging (MRI) of cobalt-chromium knee arthroplasty implants within acquisition times of less than 5 minutes, thereby yielding better image quality than high-bandwidth (BW) TSE of similar length and similar image quality than lengthier SEMAC standard of reference pulse sequences.This prospective study was approved by our institutional review board. Twenty asymptomatic subjects (12 men, 8 women; mean age, 56 years; age range, 44-82 years) with total knee arthroplasty implants underwent MRI of the knee using a commercially available, clinical 1.5 T MRI system. Two compressed sensing-accelerated SEMAC prototype pulse sequences with 8-fold undersampling and acquisition times of approximately 5 minutes each were compared with commercially available high-BW and SEMAC pulse sequences with acquisition times of approximately 5 minutes and 11 minutes, respectively. For each pulse sequence type, sagittal intermediate-weighted (TR, 3750-4120 milliseconds; TE, 26-28 milliseconds; voxel size, 0.5 × 0.5 × 3 mm) and short tau inversion recovery (TR, 4010 milliseconds; TE, 5.2-7.5 milliseconds; voxel size, 0.8 × 0.8 × 4 mm) were acquired. Outcome variables included image quality, display of the bone-implant interfaces and pertinent knee structures, artifact size, signal-to-noise ratio (SNR), and contrast-to-noise ratio (CNR). Statistical analysis included Friedman, repeated measures analysis of variances, and Cohen weighted k tests. Bonferroni-corrected P values of 0.005 and less were considered statistically significant.Image quality, bone-implant interfaces, anatomic structures, artifact size, SNR, and CNR parameters were statistically similar between the compressed sensing-accelerated SEMAC prototype and SEMAC commercial pulse sequences. There was mild blur on images of both SEMAC sequences when compared with high-BW images (P0.001), which however did not impair the assessment of knee structures. Metal artifact reduction and visibility of central knee structures and bone-implant interfaces were good to very good and significantly better on both types of SEMAC than on high-BW images (P0.004). All 3 pulse sequences showed peripheral structures similarly well. The implant artifact size was 46% to 51% larger on high-BW images when compared with both types of SEMAC images (P0.0001). Signal-to-noise ratios and CNRs of fat tissue, tendon tissue, muscle tissue, and fluid were statistically similar on intermediate-weighted MR images of all 3 pulse sequence types. On short tau inversion recovery images, the SNRs of tendon tissue and the CNRs of fat and fluid, fluid and muscle, as well as fluid and tendon were significantly higher on SEMAC and compressed sensing SEMAC images (P0.005, respectively).We accept the hypothesis that prospective compressed sensing acceleration of SEMAC is feasible for high-quality metal artifact reduction MRI of cobalt-chromium knee arthroplasty implants in less than 5 minutes and yields better quality than high-BW TSE and similarly high quality than lengthier SEMAC pulse sequences.

Rationale and Objectives The study aimed to perform a systematic review and meta-analysis for evaluating the diagnostic accuracy of 1.5 Tesla and 3.0 Tesla magnetic resonance imaging (MRI), and magnetic resonance arthrography (MRA), in the detection of scapholunate interosseous ligament (SLIL) injury. Materials and Methods A literature search was performed (until July 2015) using the PubMed (MEDLINE), Embase, ISI Web of Science, Scopus, and conference proceedings. Original studies evaluating the diagnostic accuracy of MRI or MRA in the detection of SLIL injuries using arthroscopy or open surgery as the reference standard were included. Results Of the initial 930 published records and 103 conference proceedings, 24 studies (1902 MRI examinations) were included (median SLIL injury prevalence: 33% [interquartile range: 25–42]). Heterogeneity was detected for 1.5 T MRI (chi-square: 47.93, P P value: 0.09) and MRA (chi-square: 14.54, P value: 0.34) studies. The sensitivities of 1.5 T MRI, 3.0 T MRI, and MRA for detection of SLIL injury were 45.7% (95% confidence interval: 40.1–51.4), 75.7% (66.8–83.2), and 82.1% (76.1–87.2), respectively. The specificities of 1.5 T MRI, 3.0 T MRI, and MRA for detection of SLIL injury were 80.5% (77.3–83.4), 97.1% (89.8–99.6), and 92.8% (90.2–94.9), respectively. The diagnostic odds ratios of 1.5 T MRI, 3.0 T MRI, and MRA for detection of SLIL injury were 5.56 (2.71–11.39), 23.23 (3.16–171.00), and 65.04 (32.89–128.62) ( P value Conclusions MRA is superior to 3.0 T MRI, and 3.0 T MRI is superior to 1.5 T MRI in terms of diagnostic performance. 3.0 T MRI has the highest specificity for the detection of SLIL injuries.

The inherently unstable anatomy of glenohumeral (GH) joint predisposes it to shoulder dislocation. Shoulder dislocation can occur either due to acute trauma or due to chronic microtraumas in the setting of underlying morphological abnormality. A plain radiograph is the initial imaging modality for diagnosis and management of shoulder dislocation and its associated osseous abnormalities such as Hill-Sachs deformity or osseous Bankart lesion. However, advanced imaging techniques such as multidetector CT (MDCT) with three-dimensional (3D) volume rendering and MRI can be helpful in further characterization of osseous abnormalities and detection of associated soft tissue injuries, respectively. These additional findings may be useful for optimal surgical repair for GH joint stabilization. In this pictorial essay, we present the clinically relevant osseous and soft tissue pathologies in various types of shoulder dislocation, with emphasis on pathologies that can be demonstrated using advanced imaging examinations. Discussed pathologies include glenoid fractures, labral tears, Bankart lesion, Hill-Sachs defect, Perthes lesion, anterior labral posterior sleeve avulsion (ALPSA), glenolabral articular disruption (GLAD), humeral avulsion of the glenohumeral ligament (HAGL), Kim lesion, and other associated soft tissue and nerve injuries.

Little has been reported on the relationship between patellar maltracking and instability. Patellar maltracking has been subjectively described with the "J sign" but is difficult to assess objectively using traditional imaging. Dynamic kinematic computed tomography (DKCT) allows dynamic assessment of the patellofemoral joint. DKCT was used to visualize and quantify patellar maltracking patterns, and severity of maltracking was correlated with the presence or absence of patellar instability symptoms.Seventy-six knees in 38 patients were analysed using DKCT. Maltracking was defined as deviation of the patella from the trajectory of the trochlear groove and was characterized by patellar bisect offset, which was measured at 10° intervals of knee flexion during active flexion and extension. Bisect offset measurements were grouped by number of quadrants of maximum lateral patellar motion, with one, two, and three quadrants corresponding to 75-99, 100-125, and125 %, respectively. Patellar instability symptoms were correlated with maltracking severity.Two knees were excluded because of poor imaging quality. Fifty of 74 knees had patellar instability, and 13 patients had bilateral symptoms. Of these, four (8 %) had normal tracking patterns; 41 (82 %) had increased lateral translation in extension, which we termed the J-sign pattern; 4 (8 %) had persistent lateralization of the patella throughout range of motion; and 1 had increased lateral translation in flexion. In knees with the J-sign pattern, degree of maltracking was graded by severity: J1 (n = 24), J2 (n = 19), and J3 (n = 15). The sensitivities of J-sign grades in predicting patellar instability symptoms were 50 % (J1), 80 % (J2), and 93 % (J3) (p 0.01). There were significant differences in sensitivity between knees with no J sign or J1 versus J2 or J3 (p = 0.02).DKCT showed several patellar maltracking patterns in patients with patellar instability. A J-sign pattern with more than two quadrants of lateral translation correlated with the presence of patellar instability symptoms. Incorporation of this approach of objectively quantifying maltracking patterns is recommended in the evaluation of patellofemoral instability.IV.

Summary Objectives To determine the association between the long-term use of analgesics and progression of osteoarthritis (OA) as evidenced by up to 3-years follow-up worsening of radiographic Kellgren–Lawrence (KL) grade and incidence of knee replacement (KR). Design Using nearest neighbor matching of the propensity scores with caliper in the Osteoarthritis Initiative (OAI) cohort, 173 index (Analgesic +) and 173 referent (Analgesic −) subjects were included. Analgesic + and − subjects had analgesics in all and none of their visits, respectively. Analgesic + and − subjects were balanced in their demographics, baseline, first, second and third year body mass index (BMI), Western Ontario and McMaster (WOMAC) total score, Physical and Mental health summary scales (SF-12), Physical Activity Scale for the Elderly (PASE) and Charleston Comorbidity Scale. Analgesic + and − subjects were also matched for baseline radiographic KL grade. Interval increase in the KL grade and incidence of KR were defined as the outcome. Results Included subjects had average 6.5 years of follow-up. By the third year, 44 subjects had an interval increase in the KL grade; 29 in Analgesic + and 15 among Analgesic − subjects ( P = 0.024). By the eighth-year, 41 subjects had their first KR; 29 in Analgesic + and 12 among Analgesic − subjects ( P = 0.005). Hazard Ratio (HR) of OA progression and KR for Analgesic + subjects was 1.91 (1.02–3.57) and 2.57 (1.31–5.04), respectively. Conclusions Long-term use of analgesics may be associated with radiographic progression of knee OA and increased risk of future KR.

Background: The cause of mucoid degeneration (MD) of the anterior cruciate ligament (ACL), which is commonly observed on magnetic resonance imaging (MRI) of patients with knee pain, has yet to be elucidated. Despite the limited evidence on the relationship between ACL lesions (injury and MD) and tibial morphologic features (ie, posterior tibial slope), the potential association between the presence of ACL MD and medial and lateral tibial slope (MTS and LTS) has not been well-established. Purpose: To investigate whether MTS and LTS measurements are associated with the presence of ACL MD. Study Design: Cross-sectional study; Level of evidence, 3. Methods: Consecutive knee MRI examinations of patients referred by an orthopaedic surgeon for potential internal joint derangements were identified within a 4-year period. The presence of ACL MD and the MTS/LTS values were assessed by independent expert observers in consensus in a blinded fashion. From 413 consecutive knee MRI scans, a sample of 80 knees, including 32 knees with ACL MD (cases) and 48 knees with normal ACL (controls), were selected using propensity score matching method for age, sex, body mass index, and presence of severe medial tibiofemoral compartment cartilage damage. The association between ACL MD and MTS/LTS was evaluated using conditional regression models. Results: Knees with ACL MD had higher values of LTS (mean ± SD, 7.18° ± 3.58°) in comparison with control knees (5.32° ± 3.35°). Conditional regression analysis revealed a significant association between LTS measurements (not MTS) and ACL MD; every 1° increase in LTS was associated with a 17% (95% CI, 1%-35%) higher probability of having ACL MD. Conclusion: Excessive LTS was associated with the presence of ACL MD, independent of participants’ age, sex, BMI, and cartilage damage severity.