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Background: Regular walking in different types of footwear may increase the mediolateral shear force, knee adduction moment, or vertical ground-reaction forces that could increase the risk of early development of knee osteoarthritis (OA). Purpose: To compare kinematic and kinetic parameters that could affect the development of knee OA in 3 footwear conditions. Study Design: Controlled laboratory study. Methods: A total of 40 asymptomatic participants performed walking trials in the laboratory at self-selected walking speeds under barefoot (BF), minimalistic (MF), and neutral (NF) footwear conditions. Knee joint parameters were described using discrete point values, and continuous curves were evaluated using statistical parametric mapping. A 3 × 1 repeated-measures analysis of variance was used to determine the main effect of footwear for both discrete and continuous data. To compare differences between footwear conditions, a post hoc paired t test was used. Results: Discrete point analyses showed a significantly greater knee power in NF compared with MF and BF in the weight absorption phase (P < .001 for both). Statistical parametric mapping analysis indicated a significantly greater knee angle in the sagittal plane at the end of the propulsive phase in BF compared with NF and MF (P = .043). Knee joint moment was significantly greater in the propulsive phase for the sagittal (P = .038) and frontal planes (P = .035) in BF compared with NF and MF and in the absorption phase in the sagittal plane (P = .034) in BF compared with MF and NF. A significant main effect of footwear was found for anteroposterior (propulsion, ↑MF, NF, ↓BF [P = .008]; absorption, ↑BF, MF, ↓NF P = .001]), mediolateral (propulsion, ↑MF, NF, ↓BF [P = .005]; absorption, ↑NF, MF, ↓BF [P = .044]), and vertical (propulsion, ↑NF, BF, ↓MF [P = .001]; absorption, ↑MF, BF, ↓NF [P < .001]) ground-reaction forces. Knee power showed a significant main effect of footwear (absorption, ↑NF, MF, ↓B

Background: Early detection of post-traumatic cartilage damage in the ankle joint in magnetic resonance images can be difficult due to disturbances to structures usually appearing over time. Purpose: To study the articular cartilage of unilateral Weber type-B/SER-type ankle fractures shortly post-trauma using T2 relaxation time. Material and Methods: Fifty one fractured ankles were gathered from consecutively screened patients, compiled initially for RCT studies, and treated at Oulu University Hospital and classified as stable (n = 28) and unstable fractures (n = 23) based on external-rotation stress test: medial clear space of ≥5 mm was interpreted as unstable. A control group of healthy young individuals (n = 19) was also gathered. All ankles were imaged on average 9 (range: 1 to 25) days after injury on a 3.0T MRI unit for T2 relaxation time assessment, and the cartilage was divided into sub-regions for comparison. Results: Control group displayed significantly higher T2 values in tibial cartilage compared to stable (six out of nine regions, p-values = .003–.043) and unstable (six out of nine regions, p-values = .001–.037) ankle fractures. No differences were detected in talar cartilage. Also, no differences were observed between stable and unstable fractures in tibial or talar cartilage. Conclusions: Lower T2 relaxation times of tibial cartilage in fractured ankles suggest intact extra cellular matrix (ECM) of the cartilage. Severity of the ankle fracture, measured by ankle stability, does not seem to increase ECM degradation immediately after trauma.

Background: Magnetic resonance fingerprinting (MRF) is a method to speed up acquisition of quantitative MRI data. However, MRF does not usually produce contrast-weighted images that are required by radiologists, limiting reachable total scan time improvement. Contrast synthesis from MRF could significantly decrease the imaging time. Purpose: To improve clinical utility of MRF by synthesizing contrast-weighted MR images from the quantitative data provided by MRF, using U-nets that were trained for the synthesis task utilizing L1- and perceptual loss functions, and their combinations. Study type: Retrospective. Population: Knee joint MRI data from 184 subjects from Northern Finland 1986 Birth Cohort (ages 33–35, gender distribution not available). Field strength and sequence: A 3 T, multislice-MRF, proton density (PD)-weighted 3D-SPACE (sampling perfection with application optimized contrasts using different flip angle evolution), fat-saturated T2-weighted 3D-space, water-excited double echo steady state (DESS). Assessment: Data were divided into training, validation, test, and radiologist’s assessment sets in the following way: 136 subjects to training, 3 for validation, 3 for testing, and 42 for radiologist’s assessment. The synthetic and target images were evaluated using 5-point Likert scale by two musculoskeletal radiologists blinded and with quantitative error metrics. Statistical tests: Friedman’s test accompanied with post hoc Wilcoxon signed-rank test and intraclass correlation coefficient. The statistical cutoff P <0.05 adjusted by Bonferroni correction as necessary was utilized. Results: The networks trained in the study could synthesize conventional images with high image quality (Likert scores 3–4 on a 5-point scale). Qualitatively, the best synthetic images were produced with combination of L1- and perceptual loss functions and perceptual loss alone, while L1-loss alone led to significantly poorer image quality (Likert scores below 3). The in

Synopsis In this study, deep convolutional neural networks (DCNN) are used to synthesize contrast-weighted magnetic resonance (MR) images from quantitative parameter maps of the knee joint obtained with magnetic resonance fingerprinting (MRF). Training of the neural networks was performed using data from 142 patients, for which both standard MR images and quantitative MRF maps of the knee were available. The study demonstrates that synthesizing contrast-weighted images from MRF-parameter maps is possible utilizing DCNNs. Furthermore, the study indicates a need to tune up the dictionary used in MRF so that the parameters expected from the target anatomy are well-covered.

In this study, we developed a gray level co-occurrence matrix-based 3D texture analysis method for dual-echo steady-state (DESS) magnetic resonance (MR) images to be used for knee cartilage analysis in osteoarthritis (OA) studies and use it to study changes in articular cartilage between different subpopulations based on their rate of progression into radiographically confirmed OA. In total, 642 series of right knee DESS MR images at 3T were obtained from baseline, 36- and 72-month follow-ups from the OA Initiative database. At baseline, all 214 subjects included in the study had Kellgren-Lawrence (KL) grade <2. Three groups were defined, based on time of progression into radiographic OA (ROA) (KL grades ≥2): control (no progression), fast progressor (ROA at 36 months), and slow progressor (ROA at 72 months) groups. 3D texture analysis was used to extract textural features for femoral and tibial cartilages. All textural features, in both femur and tibia, showed significant longitudinal changes across all groups and tissue layers. Most of the longitudinal changes were observed in progressors, but significant changes were observed also in controls. Differences between groups were mostly seen at baseline and 72 months. The method is sensitive to cartilage changes before and after ROA. It was able to detect longitudinal changes in controls and progressors and to distinguish cartilage alterations due to OA and aging. Moreover, it was able to distinguish controls and different progressor groups before any radiographic signs of OA and during OA. Thus, texture analysis could be used as a marker for the onset and progression of OA.

Objective: Immediate cartilage structural alterations in the acute phase after an anterior cruciate ligament (ACL) rupture may be a precursor to posttraumatic osteoarthritis (PTOA) development. Our aim was to describe changes in cartilage matrix in the subacute phase of the acutely ACL-injured knee compared to the contralateral uninjured knee. Design: Participants (n = 118) aged 15–40 years with an acute ACL injury were consecutively included in subacute phase after acute ACL-injury and underwent MRI (mean 29 days post trauma) of both knees. Mean T2 relaxation times, T2 spatial coefficient of variation and cartilage thickness were determined for different regions of the tibiofemoral cartilage. Differences between the acutely ACL-injured and uninjured knee were evaluated using Wilcoxon signed-rank test. Results: T2 relaxation time in injured knees was increased in multiple cartilage regions from both medial and lateral compartment compared to contralateral knees, mostly in medial trochlea and posterior tibia (P-value<0.001). In the same sites of injured knees, we observed significantly thinner cartilage. Moreover, injured knees presented shorter T2 relaxation time in superficial cartilage on lateral central femur and trochlea (P-value<0.001), and decreased T2 spatial coefficient of variation in lateral trochlea and load bearing regions of medial-central femoral condyle and central tibia in both compartments. Conclusions: Small but statistically significant differences were observed in the subacute phase between ACL-injured and uninjured knee in cartilage T2 relaxation time and cartilage thickness. Future longitudinal observations of the same cohort will allow for better understanding of early development of PTOA.

Morphological changes in knee cartilage subregions are valuable imaging-based biomarkers for understanding progression of osteoarthritis, and they are typically detected from magnetic resonance imaging (MRI). So far, accurate segmentation of cartilage has been done manually. Deep learning approaches show high promise in automating the task; however, they lack clinically relevant evaluation. We introduce a fully automatic method for segmentation and subregional assessment of articular cartilage, and evaluate its predictive power in context of radiographic osteoarthritis progression. Two data sets of 3D double-echo steady-state (DESS) MRI derived from the Osteoarthritis Initiative were used: first, n = 88; second, n = 600, 0-/12-/24-month visits. Our method performed deep learning-based segmentation of knee cartilage tissues, their subregional division via multi-atlas registration, and extraction of subregional volume and thickness. The segmentation model was developed and assessed on the first data set. Subsequently, on the second data set, the morphological measurements from our and the prior methods were analyzed in correlation and agreement, and, eventually, by their discriminative power of radiographic osteoarthritis progression over 12 and 24 months, retrospectively. The segmentation model showed very high correlation (r > 0.934) and agreement (mean difference < 116 mm³) in volumetric measurements with the reference segmentations. Comparison of our and manual segmentation methods yielded r = 0.845–0.973 and mean differences = 262–501 mm³ for weight-bearing cartilage volume, and r = 0.770–0.962 and mean differences = 0.513–1.138 mm for subregional cartilage thickness. With regard to osteoarthritis progression, our method found most of the significant associations identified using the manual segmentation method, for both 12- and 24-month subregional cartilage changes. The method may be effectively applied in osteoarthritis progression studies to extra

Background: Relaxation along Fictitious Field with rank 2 (RAFF2) has been shown to provide contrast agent-free alternative for gadolinium based Late Gadolinium Enhancement (LGE) measurement in mouse model. To characterize chronic Myocardial Infarction (MI) by using Relaxation along Fictitious Field in human myocardium without contrast agents. Methods and findings: Data for this study were collected in 18 patients with chronic infarct at 1.5 T. Scarred and remote area averages of RAFF2 relaxation time and steady state (TRAFF2 and SSRAFF2), native T₁ and T₂, Extra Cellular Volume (ECV) and LGE were calculated. Subsequently infarct sizes were determined and compared between LGE, ECV and RAFF2 maps. In addition, area of overestimation (AOE) was estimated for RAFF2 maps. The TRAFF2 and SSRAFF2, native T₁ and T₂ relaxation times, ECV and LGE values elevated at scar compared to remote area. Areas of increased LGE were highly correlated to the areas with increased SSRAFF2 (R=0.71, p<0.01) and TRAFF2 (R=0.47, p<0.05). Summary: RAFFn has been used to characterize myocardial infarction in humans and in mice. RAFFn owns potential to be used in the MI diagnosis without contrast agents.

Objective: Ultrasonography (US) has a promising role in evaluating the knee joint, but capability to visualize the femoral articular cartilage needs systematic evaluation. We measured the extent of this acoustic window by comparing standardized US images with the corresponding MRI views of the femoral cartilage. Design: Ten healthy volunteers without knee pathology underwent systematic US and MRI evaluation of both knees. The femoral cartilage was assessed on the oblique transverse axial plane with US and with 3D MRI. The acoustic window on US was compared to the corresponding views of the femoral sulcus and both condyles on MRI. The mean imaging coverage of the femoral cartilage and the cartilage thickness measurements on US and MRI were compared. Results: Mean imaging coverage of the cartilage of the medial femoral condyle was 66% (range 54%–80%) and on the lateral femoral condyle 37% (range 25%–51%) compared with MRI. Mean cartilage thickness measurement in the femoral sulcus was 3.17 mm with US and 3.61 mm with MRI (14.0% difference). The corresponding measurements in the medial femoral condyle were 1.95 mm with US and 2.35 mm with MRI (21.0% difference), and in the lateral femoral condyle, they were 2.17 mm and 2.73 mm (25.6% difference), respectively. Conclusion: Two-thirds of the articular cartilage of the medial femoral condyle, and one-third in the lateral femoral condyle, can be assessed with US. The cartilage thickness measurements seem to be underestimated by US. These results show promise for the evaluation of the weight-bearing cartilage of the medial femoral condyle with US.

Osteoarthritis (OA) is the most common degenerative joint disease, causing joint pain and functional disability in millions of people worldwide. OA is characterized by the progressive loss of articular cartilage and involves the whole joint including articular cartilage, meniscus, subchondral bone and synovium. Despite great success in modern medicine, there is still no effective treatment to prevent or cure OA. This is largely due to the absence of a reliable and sensitive biomarker that is able to identify early OA and follow up the disease progression. Early diagnosis of OA can lead the way to appropriate interventions that can potentially avoid the onset or progression of OA. Quantitative magnetic resonance imaging (qMRI) has been indirectly associated with the compositional changes and biomechanical properties of articular cartilage and meniscus. In addition to T1 and T2 relaxation time measurements, rotating frame of reference (RFR) relaxation parameters were found to be sensitive to the degenerative changes in articular cartilage and meniscus. The RFR parameters involve spin-locking irradiation, which can be modified to provide multiple relaxation methods such as continuous-wave T1ρ (CWT1ρ), adiabatic T1ρ (AdT1ρ), adiabatic T2ρ (AdT2ρ) and relaxation along a fictitious field (T_{RAFFb >). The aim of this thesis was to investigate the potential of qMRI parameters (T1, T2, CWT1ρ, AdT1ρ, AdT2ρ, TRAFF) for the assessment of structural and compositional changes in articular cartilage in a rabbit model of early OA and an equine model of post-traumatic OA. Biomechanical properties and histology were used as references. Moreover, the clinical feasibility of AdT1ρ and AdT2ρ for the evaluation of structural changes in meniscus was studied in human OA. Compared to other qMRI parameters, T1, CWT1ρ and AdT1ρ were more sensitive to the degenerative cartilage changes in both the rabbit model of early OA and the equine model of post-traumatic OA. The paramet, Tiivistelmä Nivelrikko on yleisin nivelten sairaus, joka aiheuttaa huomattavaa kipua ja liikkumisvaikeuksia miljoonille ihmisille ympäri maailmaa. Nivelrikossa nivelrusto ohenee, mutta sairaus vaikuttaa koko niveleen ja kaikkiin sen kudoksiin, nivelrustoon, nivelkierukoihin, rustonalaiseen luuhun ja nivelkapseliin. Huolimatta nykylääketieteen saavutuksista, nivelrikkoa parantavaa tai estävää hoitoa ei ole olemassa. Merkittävä syy tehokkaiden hoitojen puuttumiseen on luotettavien ja herkkien nivelrikon diagnosointimenetelmien puute. Tällaisilla menetelmillä voitaisiin tunnistaa varhaisvaiheen nivelrikko ja seurata luotettavasti sen etenemistä. Varhainen diagnoosi mahdollistaisi paremmin nivelrikon etenemisen ennaltaehkäisyn, ja sitä kautta sen hidastamisen tai jopa pysäyttämisen kokonaan. Kvantitatiivisen magneettikuvauksen avulla voidaan epäsuorasti havainnoida muutoksia nivelruston ja nivelkierukoiden rakenteellisissa sekä toiminnallisissa ominaisuuksissa. T1- ja T2-relaksaatioaikamittausten ohella niin kutsuttujen pyörivän koordinaatiston relaksaatioparametrien on havaittu olevan herkkiä nivelruston ja nivelkierukoiden degeneratiivisille muutoksille. Pyörivän koordinaatiston parametrien mittauksessa käytettyä spin-lukko-pulssia voidaan muuttaa ja siten tuottaa erilaisia kontrasteja, kuten jatkuvan aallon T1ρ (CW-T1ρ), adiabaattinen T1ρ (AdT1ρ), adiabaattinen T2ρ (AdT2ρ) ja fiktiivisen kentän relaksaatio (TRAFF). Väitöskirjatyön tavoitteena oli selvittää kvantitatiivisten magneettikuvausparametrien (T1, T2, CWT1ρ, AdT1ρ, AdT2ρ ja TRAFF) potentiaalia kanin varhaisen nivelrikon ja ponin traumaperäisen nivelrikon tautimalleissa. Nivelruston biomekaanisia ominaisuuksia ja histologiaa käytettiin verrokkimenetelminä. Väitöskirjatyössä selvitettiin AdT 1ρ:n ja AdT2ρ:n kliinistä soveltuvuutta nivelkierukan rakenteellisten ominaisuuksien arviointiin ihmisillä. Muihin magneettikuvausparametreihin verrattuna T1, CWT1ρ sekä AdT1ρ olivat herkimpiä degeneratiivisille muutoksille}

Chondral lesions lead to degenerative changes in the surrounding cartilage tissue, increasing the risk of developing post‐traumatic osteoarthritis (PTOA). This study aimed to investigate the feasibility of quantitative magnetic resonance imaging (qMRI) for evaluation of articular cartilage in PTOA. Articular explants containing surgically induced and repaired chondral lesions were obtained from the stifle joints of seven Shetland ponies (14 samples). Three age‐matched nonoperated ponies served as controls (six samples). The samples were imaged at 9.4 T. The measured qMRI parameters included T₁, T₂, continuous‐wave T1ρ (CWT1ρ), adiabatic T1ρ (AdT1ρ), and T2ρ (AdT2ρ) and relaxation along a fictitious field (TRAFF). For reference, cartilage equilibrium and dynamic moduli, proteoglycan content and collagen fiber orientation were determined. Mean values and profiles from full‐thickness cartilage regions of interest, at increasing distances from the lesions, were used to compare experimental against control and to correlate qMRI with the references. Significant alterations were detected by qMRI parameters, including prolonged T₁, CWT1ρ, and AdT1ρ in the regions adjacent to the lesions. The changes were confirmed by the reference methods. CWT1ρ was more strongly associated with the reference measurements and prolonged in the affected regions at lower spin‐locking amplitudes. Moderate to strong correlations were found between all qMRI parameters and the reference parameters (ρ = −0.531 to −0.757). T₁, low spin‐lock amplitude CWT1ρ, and AdT1ρ were most responsive to changes in visually intact cartilage adjacent to the lesions. In the context of PTOA, these findings highlight the potential of T₁, CWT1ρ, and AdT1ρ in evaluation of compositional and structural changes in cartilage.

Far too little attention has been paid to health effects of air pollution and physical (in)activity on musculoskeletal health. The purpose of the Healthy aging in industrial environment study (4HAIE) is to investigate the potential impact of physical activity in highly polluted air on musculoskeletal health. A total of 1500 active runners and inactive controls aged 18–65 will be recruited. The sample will be recruited using quota sampling based on location (the most air-polluted region in EU and a control region), age, sex, and activity status. Participants will complete online questionnaires and undergo a two-day baseline laboratory assessment, including biomechanical, physiological, psychological testing, and magnetic resonance imaging. Throughout one-year, physical activity data will be collected through Fitbit monitors, along with data regarding the incidence of injuries, air pollution, psychological factors, and behavior collected through a custom developed mobile application. Herein, we introduce a biomechanical and musculoskeletal protocol to investigate musculoskeletal and neuro-mechanical health in this 4HAIE cohort, including a design for controlling for physiological and psychological injury factors. In the current ongoing project, we hypothesize that there will be interactions of environmental, biomechanical, physiological, and psychosocial variables and that these interactions will cause musculoskeletal diseases/protection.

In this study, the rabbit model with anterior cruciate ligament transection (ACLT) was used to investigate early degenerative changes in cartilage using multiparametric quantitative magnetic resonance imaging (qMRI). ACLT was surgically induced in the knees of skeletally mature New Zealand White rabbits (n = 14). ACL transected and contralateral knee compartments—medial femur, lateral femur, medial tibia, and lateral tibia—were harvested 2 (n = 8) and 8 weeks (n = 6) postsurgery. Twelve age‐matched nonoperated rabbits served as control. qMRI was conducted at 9.4 T and included relaxation times T₁, T₂, continuous‐wave T1p (CWT1p), adiabatic T1p (AdT1p), adiabatic T2p (AdT2p), and relaxation along a fictitious field (TRAFF). For reference, quantitative histology and biomechanical measurements were carried out. Posttraumatic changes were primarily noted in the superficial half of the cartilage. Prolonged T₁, T₂, CWT1p, and AdT1p were observed in the lateral femur 2 and 8 weeks post‐ACLT, compared with the corresponding control and contralateral groups (P < .05). Collagen orientation was significantly altered in the lateral femur at 2 weeks post‐ACLT compared with the corresponding control group. In the medial femur, all the studied relaxation time parameters, except TRAFF, were increased 8 weeks post‐ACLT, as compared with the corresponding contralateral and control groups (P < .05). Similarly, significant proteoglycan loss was observed in the medial femur at 8 weeks following surgery (P < .05). Multiparametric MRI demonstrated early degenerative changes primarily in the superficial cartilage with T₁, T₂, CWT1p, and AdT1p sensitive to cartilage changes at 2 weeks after surgery.

Osteoarthritis (OA) is a common chronic condition that reduces the quality of life of millions of individuals worldwilde. In OA, the progressive degradation of articular cartilage (AC) and bone can cause joint pain and disability. Currently there is no effective treatment available for OA besides gross joint replacement surgery. This is largely due to the lack of accurate biomarkers to test potential drugs and treatments that could stop or reverse the disease progression. The primary tools in use for OA diagnostics are inadequate in the early stage of the disease and merely allow its late manifestations to be visualized. Quantitative MRI (qMRI) has demonstrated the ability to distinguish degenerated from intact AC prior to radiographic changes. Moreover, so-colled rotating frame relaxation time parameters are sensitive to the slow molecular motion domain, relevant for clinical applications. T1ρ and T2ρ relaxation time measurements using adiabatic spin-lock pulses (AdT1ρ and AdT2ρ) have shown superior sensitivity to cartilage degeneration in vitro over conventional qMRI parameters. This thesis aimed to compare the differences that exist between established qMRI methods for AC against arthroscopic evaluation as well as optimize and validate AdT1ρ and AdT2ρ mapping of cartilage in vivo. The findings showed that T1 and T2 relaxation time and delayed gadolinium enhanced MRI of cartilage (dGEMRIC) were able to discriminate among different arthroscopic grades of cartilage lesions. However, arthroscopic findings and qMRI parameters were not correlated, supporting the viewpoint that qMRI may be able to elicit more comprehensive information on the quality of remaining cartilage tissue as compared to diagnostic arthroscopy, which detects cartilage loss. AdT1ρ and AdT2ρ mapping of cartilage in vivo were successfully implemented and validated on a clinical MRI system. AdT1ρ and AdT2ρ were able to overcome limitations of, Tiivistelmä Nivelrikko on tavallinen krooninen sairaus, joka huonontaa miljoonien ihmisten elämänlaatua ympäri maailman. Nivelrikossa nivelruston ja luun asteittain etenevä rappeuma voi aiheuttaa nivelkipua ja liikuntakyvyttömyyttä. Tällä hetkellä nivelrikkoon ei ole muuta tehokasta hoitokeinoa kuin tekonivelleikkaus. Tämä johtuu suuremmaksi osaksi tarkkojen biomarkkereiden puutteesta, joiden avulla voitaisiin kokeilla mahdollisia nivelrikon pysäyttäviä tai tautia parantavia lääkkeitä tai hoitokeinoja. Nykyisin nivelrikon diagnostiikassa käytetyimmät menetelmät ovat riittämättömiä sairauden alkuvaiheessa, ja ne tunnistavat vain sairauden loppuvaiheet. Kvantitatiivisilla magneettikuvausmenetelmillä pystytään erottamaan rappeutunut ja ehjä nivelrusto toisistaan ennen röntgenkuvissa havaittavia muutoksia. Nk. pyörivän koordinaatiston relaksaatioaikaparametrit ovat herkkiä havaitsemaan hidasta molekyyliliikettä, jolla on merkitystä kliinisissä sovelluksissa. Kokeellisissa olosuhteissa T1ρ- ja T2ρ-relaksaatioaikojen mittaaminen käyttäen adiabaattisia spin-lukkopulsseja (AdT1ρ ja AdT2ρ) on osoittautunut erityisen tarkaksi nivelruston rappeutumisen toteamiseksi verrattuna perinteisiin kvantitatiivisiin magneettikuvausmenetelmiin. Tämän väitöskirjan tavoitteena oli vertailla vakiintuneita nivelrikon kvantitatiivisia magneettikuvausmenetelmiä sekä optimoida ja validoida AdT1ρ- ja AdT2ρ-menetelmien käyttöä ihmisen ruston tutkimisessa. Tulokset osoittivat, että T1- ja T2-relaksaatioajat sekä varjoainetehosteinen nivelruston magneettikuvaus pystyivät erottelemaan niveltähystyksessä määritettyjä nivelrikon eri asteita. Kuitenkaan niveltähystyslöydökset ja kvantitatiiviset magneettikuvausparametrit eivät korreloineet viitaten kvantitatiivisen magneettikuvauksen kykyyn osoittaa tarkemmin jäljellä olevan ruston laatua verrattuna niveltähystykseen, jossa arvioidaan ruston puutosta. Nivelruston AdT1ρ- ja AdT2ρ-relaksaatioaikamittaukset onnistut

Aims: Aim of this study was to compare a minimally fluoroscopic radiofrequency catheter ablation with conventional fluoroscopy-guided ablation for supraventricular tachycardias (SVTs) in terms of ionizing radiation exposure for patient and operator and to estimate patients’ lifetime attributable risks associated with such exposure. Methods and results: We performed a prospective, multicentre, randomized controlled trial in six electrophysiology (EP) laboratories in Italy. A total of 262 patients undergoing EP studies for SVT were randomized to perform a minimally fluoroscopic approach (MFA) procedure with the EnSiteTMNavXTM navigation system or a conventional approach (ConvA) procedure. The MFA was associated with a significant reduction in patients’ radiation dose (0 mSv, iqr 0–0.08 vs. 8.87 mSv, iqr 3.67–22.01; P < 0.00001), total fluoroscopy time (0 s, iqr 0–12 vs. 859 s, iqr 545–1346; P < 0.00001), and operator radiation dose (1.55 vs. 25.33 µS per procedure; P < 0.001). In the MFA group, X-ray was not used at all in 72% (96/134) of cases. The acute success and complication rates were not different between the two groups (P = ns). The reduction in patients’ exposure shows a 96% reduction in the estimated risks of cancer incidence and mortality and an important reduction in estimated years of life lost and years of life affected. Based on economic considerations, the benefits of MFA for patients and professionals are likely to justify its additional costs. Conclusion: This is the first multicentre randomized trial showing that a MFA in the ablation of SVTs dramatically reduces patients’ exposure, risks of cancer incidence and mortality, and years of life affected and lost, keeping safety and efficacy. Trial registration: clinicaltrials.gov Identifier: NCT01132274.

Most of interventional procedures in cardiology are carried out under fluoroscopic imaging guidance. Besides other peri-interventional risks, radiation exposure should be considered for its stochastic (inducing malignancy) and deterministic effects on health (tissue reactions like erythema, hair loss and cataracts). In this article we analized the radiation risk from cardiovascular imaging to both patients and medical staff and discusses how customize the X-ray system and how to implement shielding measures in the cath lab. Finally, we reviewed the most recent developments and the latest findings in catheter navigation and 3D electronatomical mapping systems that may help to reduce patient and operator exposure.