Quantitative versus semiquantitative MR imaging of cartilage in blood-induced arthritic ankles: preliminary findings
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Recent advances in hemophilia prophylaxis have raised the need for accurate noninvasive methods for assessment of early cartilage damage in maturing joints to guide initiation of prophylaxis. Such methods can either be semiquantitative or quantitative. Whereas semiquantitative scores are less time-consuming to be performed than quantitative methods, they are prone to subjective interpretation.
To test the feasibility of a manual segmentation and a quantitative methodology for cross-sectional evaluation of articular cartilage status in growing ankles of children with blood-induced arthritis, as compared with a semiquantitative scoring system and clinical-radiographic constructs.
Materials and methods
Twelve boys, 11 with hemophilia (A, n = 9; B, n = 2) and 1 with von Willebrand disease (median age: 13; range: 6–17), underwent physical examination and MRI at 1.5 T. Two radiologists semiquantitatively scored the MRIs for cartilage pathology (surface erosions, cartilage loss) with blinding to clinical information. An experienced operator applied a validated quantitative 3-D MRI method to determine the percentage area of denuded bone (dAB) and the cartilage thickness (ThCtAB) in the joints’ MRIs. Quantitative and semiquantitative MRI methods and clinical-radiographic constructs (Hemophilia Joint Health Score [HJHS], Pettersson radiograph scores) were compared.
Moderate correlations were noted between erosions and dAB (r = 0.62, P = 0.03) in the talus but not in the distal tibia (P > 0.05). Whereas substantial to high correlations (r range: 0.70–0.94, P < 0.05) were observed between erosions, cartilage loss, HJHS and Pettersson scores both at the distal tibia and talus levels, moderate/borderline substantial (r range: 0.55–0.61, P < 0.05) correlations were noted between dAB/ThCtAB and clinical-radiographic constructs.
Whereas the semiquantitative method of assessing cartilage status is closely associated with clinical-radiographic scores in cross-sectional studies of blood-induced arthropathy, quantitative measures provide independent information and are therefore less applicable for that research design.
KeywordsBlood-induced arthritis Hemophilia Blood-induced arthropathy Children Ankles Cartilage Magnetic resonance imaging
This study was supported by a salary award given to Dr. Andrea S. Doria through the Canadian Child Health Clinician-Scientist program. This study was funded by Bayer Healthcare Pharmaceuticals, Canada. We thank Susanne Maschek from Paracelsus Medical University, Salzburg, Austria, & Chondrometrics GmbH, Ainring, Germany, for segmentation of the MR images for the purpose of quantitative measurement of cartilage morphology.
A scientific paper on the results of this study was presented at the 2012 Society of Pediatric Radiology meeting, San Francisco, CA.
Conflict of interest
- 12.Graichen H, Eisenhart-Rothe R, Vogl T et al (2004) Quantitative assessment of cartilage status in osteoarthritis by quantitative magnetic resonance imaging: technical validation for use in analysis of cartilage volume and further morphologic parameters. Arthritis Rheum 50:811–816PubMedCrossRefGoogle Scholar
- 23.Nuss R, Kilcoyne RF (2003) A magnetic resonance imaging atlas of hemophilic arthropathy, 1st edn. Professional Publishing Group Ltd., New YorkGoogle Scholar
- 27.Moisio KC, Eckstein F, Song J et al (2008) The relationship of denuded subchondral bone area to knee pain severity and incident frequent knee pain. Osteoarthritis Cartilage 16(Suppl 4):S31 (abstract)Google Scholar
- 30.Altman DG (1991) Practical statistics for medical research. Chapman and Hall, London, pp 404–408Google Scholar
- 31.http://www.ats.ucla.edu/stat/sas/whatstat/whatstat.htm. Accessed 19 Nov 2013
- 32.Portney LG, Watkins MP (2000) Validity of measurements. In: Portney LG, Watkins MP (eds) Foundations of clinical research. Applications to practice, 2nd edn. Prentice-Hall Health, Upper Saddle River, pp 87–92Google Scholar
- 34.Eckstein F, McCulloch CE, Lynch JA et al (2012) For the OA Initiative Investigators Group. How do short-term rates of femorotibial cartilage change compare to long-term changes? Four year follow-up data from the osteoarthritis initiative. Osteoarthr Cartil 20:1250–1257PubMedCentralPubMedCrossRefGoogle Scholar
- 37.Hilliard P, Blanchette VS, Doria AS et al (2008) The Hemophilia Joint Health Score (HJHS) correlates highly with radiographic damage (Abstract). Proceedings of the XXVIII International Congress of the World Federation of Hemophilia, Istanbul, TurkeyGoogle Scholar
- 39.Keshava S, Gibikote S, Mohanta A et al (2013) Ultrasound and MRI of growing joints in healthy boys: correlation with ex-vivo phantom measurements (Abstract). Proceedings of the 56th Annual Meeting of the Society for Pediatric Radiology, San Antonio, TXGoogle Scholar