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European Radiology

, Volume 28, Issue 11, pp 4696–4704 | Cite as

Meniscal pathologies on MRI correlate with increased bone tracer uptake in SPECT/CT

  • Jan Rechsteiner
  • Michael T. Hirschmann
  • Milos Dordevic
  • Anna L. Falkowski
  • Enrique A. Testa
  • Felix Amsler
  • Anna Hirschmann
Musculoskeletal
  • 132 Downloads

Abstract

Objectives

To assess the relationship of subchondral bone tracer uptake (BTU) on SPECT/CT and meniscal pathologies on MRI in patients with painful knees.

Methods

Twenty-five patients who had MRI and SPECT/CT within 3 months without knee surgery or grade ≥3 cartilage lesions were prospectively included. Maximum values of each subchondral femorotibial area were quantified and a ratio was calculated in relation to a femoral shaft reference region, which represented the BTU background activity. Meniscal lesions were graded (intact/degeneration/tear) and meniscal extrusion (no/yes) was assessed using MRI by two musculoskeletal radiologists blinded to the SPECT/CT findings. One-tailed Spearman correlations served for statistics (p < 0.05).

Results

Knees with meniscal degeneration or tear showed a significantly higher BTU in the medial femorotibial compartment (p = 0.045) when compared to intact menisci. Meniscal degeneration was associated with an increased BTU in the lateral femorotibial compartment; however, this was not statistically significant (p = 0.143). Patients with an extruded meniscus showed significantly higher BTU compared to a non-extruded meniscus (p < 0.020).

Conclusions

Medial femorotibial BTU in SPECT/CT was associated with meniscal pathologies. Highest BTU was found in patients with meniscal tears. SPECT/CT appears to be a useful imaging modality to identify patients with overloading or early osteoarthritis.

Key Points

Meniscal degeneration and tears correlate significantly with increased BTU using SPECT/CT.

Medial meniscus extrusion is associated with an increased BTU in SPECT/CT.

SPECT/CT allows detection of overloading and early osteoarthritis.

Keywords

Single photon emission computed tomography/computed tomography Meniscus Knee injuries Osteoarthritis Magnetic resonance imaging 

Abbreviations

BTU

Bone tracer uptake

ICC

Intraclass correlation coefficient

OA

Osteoarthritis

SPECT

Single photon emission computerised tomography

CT

Computerised tomography

MRI

Magnetic resonance imaging

Notes

Funding

The authors state that this work has not received any funding.

Compliance with ethical standards

Guarantor

The scientific guarantor of this publication is Michael Hirschmann.

Conflict of interest

The authors of this manuscript declare no relationships with any companies, whose products or services may be related to the subject matter of the article.

Statistics and biometry

Felix Amsler kindly provided statistical advice for this manuscript.

Informed consent

Written informed consent was waived by the Institutional Review Board (EK 228/13).

Ethical approval

Institutional Review Board approval was obtained (EK 228/13).

Study subjects or cohorts overlap

Some study subjects or cohorts have been previously reported in Dordevic et al. [9].

Methodology

• prospective

• diagnostic study

• performed at one institution

References

  1. 1.
    Hunter DJ (2009) Imaging insights on the epidemiology and pathophysiology of osteoarthritis. Rheum Dis Clin North Am 35:447–463CrossRefGoogle Scholar
  2. 2.
    Englund M, Guermazi A, Lohmander LS (2009) The meniscus in knee osteoarthritis. Rheum Dis Clin North Am 35:579–590CrossRefGoogle Scholar
  3. 3.
    Englund M, Guermazi A, Lohmander SL (2009) The role of the meniscus in knee osteoarthritis: a cause or consequence? Radiol Clin North Am 47:703–712CrossRefGoogle Scholar
  4. 4.
    Englund M, Lohmander LS (2004) Risk factors for symptomatic knee osteoarthritis fifteen to twenty-two years after meniscectomy. Arthritis Rheum 50:2811–2819CrossRefGoogle Scholar
  5. 5.
    Verdonk R, Madry H, Shabshin N et al (2016) The role of meniscal tissue in joint protection in early osteoarthritis. Knee Surg Sports Traumatol Arthrosc 24:1763–1774CrossRefGoogle Scholar
  6. 6.
    Scotti C, Hirschmann MT, Antinolfi P, Martin I, Peretti GM (2013) Meniscus repair and regeneration: review on current methods and research potential. Eur Cell Mater 26:150–170CrossRefGoogle Scholar
  7. 7.
    Kim HR, So Y, Moon SG, Lee IS, Lee SH (2008) Clinical value of (99m)Tc-methylene diphosphonate (MDP) bone single photon emission computed tomography (SPECT) in patients with knee osteoarthritis. Osteoarthritis Cartilage 16:212–218CrossRefGoogle Scholar
  8. 8.
    Mucha A, Dordevic M, Testa EA, Rasch H, Hirschmann MT (2013) Assessment of the loading history of patients after high tibial osteotomy using SPECT/CT—a new diagnostic tool and algorithm. J Orthop Surg Res 8:46CrossRefGoogle Scholar
  9. 9.
    Dordevic M, Hirschmann MT, Rechsteiner J, Falkowski A, Testa E, Hirschmann A (2016) Do chondral lesions of the knee correlate with bone tracer uptake by using SPECT/CT? Radiology 278:223–231CrossRefGoogle Scholar
  10. 10.
    Noyes FR, Stabler CL (1989) A system for grading articular cartilage lesions at arthroscopy. Am J Sports Med 17:505–513CrossRefGoogle Scholar
  11. 11.
    Hirschmann MT, Wagner CR, Rasch H, Henckel J (2012) Standardized volumetric 3D-analysis of SPECT/CT imaging in orthopaedics: overcoming the limitations of qualitative 2D analysis. BMC Med Imaging 12:5CrossRefGoogle Scholar
  12. 12.
    Zanetti M, Pfirrmann CW, Schmid MR, Romero J, Seifert B, Hodler J (2003) Patients with suspected meniscal tears: prevalence of abnormalities seen on MRI of 100 symptomatic and 100 contralateral asymptomatic knees. AJR Am J Roentgenol 181:635–641CrossRefGoogle Scholar
  13. 13.
    Wang Y, Wluka AE, Pelletier JP et al (2010) Meniscal extrusion predicts increases in subchondral bone marrow lesions and bone cysts and expansion of subchondral bone in osteoarthritic knees. Rheumatology (Oxford) 49:997–1004CrossRefGoogle Scholar
  14. 14.
    Walter SD, Eliasziw M, Donner A (1998) Sample size and optimal designs for reliability studies. Stat Med 17:101–110CrossRefGoogle Scholar
  15. 15.
    Ziegler R, Goebel L, Seidel R, Cucchiarini M, Pape D, Madry H (2015) Effect of open wedge high tibial osteotomy on the lateral tibiofemoral compartment in sheep. Part III: analysis of the microstructure of the subchondral bone and correlations with the articular cartilage and meniscus. Knee Surg Sports Traumatol Arthrosc 23:2704–2714CrossRefGoogle Scholar
  16. 16.
    Kim JG, Lee YS, Bae TS et al (2013) Tibiofemoral contact mechanics following posterior root of medial meniscus tear, repair, meniscectomy, and allograft transplantation. Knee Surg Sports Traumatol Arthrosc 21:2121–2125CrossRefGoogle Scholar
  17. 17.
    Lacy KW, Cracchiolo A, Yu S, Goitz H (2016) Medial femoral condyle cartilage defect biomechanics: effect of obesity, defect size, and cartilage thickness. Am J Sports Med 44:409–416CrossRefGoogle Scholar
  18. 18.
    De Smet AA (2005) MR imaging and MR arthrography for diagnosis of recurrent tears in the postoperative meniscus. Semin Musculoskelet Radiol 9:116–124CrossRefGoogle Scholar
  19. 19.
    White LM, Schweitzer ME, Weishaupt D, Kramer J, Davis A, Marks PH (2002) Diagnosis of recurrent meniscal tears: prospective evaluation of conventional MR imaging, indirect MR arthrography, and direct MR arthrography. Radiology 222:421–429CrossRefGoogle Scholar
  20. 20.
    Zanetti M, Pfirrmann CW, Schmid MR, Romero J, Seifert B, Hodler J (2005) Clinical course of knees with asymptomatic meniscal abnormalities: findings at 2-year follow-up after MR imaging-based diagnosis. Radiology 237:993–997CrossRefGoogle Scholar
  21. 21.
    Melrose J, Fuller ES, Little CB (2017) The biology of meniscal pathology in osteoarthritis and its contribution to joint disease: beyond simple mechanics. Connect Tissue Res 58:282–294CrossRefGoogle Scholar
  22. 22.
    Guimaraes JB, Nevitt MC, McCulloch CE et al (2018) Association of weight change with progression of meniscal intrasubstance degeneration over 48 months: data from the Osteoarthritis Initiative. Eur Radiol 28:953–962CrossRefGoogle Scholar
  23. 23.
    Migliore A, Massafra U (2014) Towards the identification of early stage osteoarthritis. Clin Cases Miner Bone Metab 11:114–116PubMedPubMedCentralGoogle Scholar
  24. 24.
    Park SY, Lee SH, Lee MH, Chung HW, Shin MJ (2017) Changes in the T2 value of cartilage after meniscus transplantation over 1 year. Eur Radiol 27:1496–1504CrossRefGoogle Scholar
  25. 25.
    Apprich S, Welsch GH, Mamisch TC et al (2010) Detection of degenerative cartilage disease: comparison of high-resolution morphological MR and quantitative T2 mapping at 3.0 Tesla. Osteoarthritis Cartilage 18:1211–1217CrossRefGoogle Scholar
  26. 26.
    Dunn TC, Lu Y, Jin H, Ries MD, Majumdar S (2004) T2 relaxation time of cartilage at MR imaging: comparison with severity of knee osteoarthritis. Radiology 232:592–598CrossRefGoogle Scholar
  27. 27.
    Liebl H, Joseph G, Nevitt MC et al (2015) Early T2 changes predict onset of radiographic knee osteoarthritis: data from the osteoarthritis initiative. Ann Rheum Dis 74:1353–1359CrossRefGoogle Scholar
  28. 28.
    Javaid MK, Lynch JA, Tolstykh I et al (2010) Pre-radiographic MRI findings are associated with onset of knee symptoms: the most study. Osteoarthritis Cartilage 18:323–328CrossRefGoogle Scholar
  29. 29.
    Madry H, Kon E, Condello V et al (2016) Early osteoarthritis of the knee. Knee Surg Sports Traumatol Arthrosc 24:1753–1762CrossRefGoogle Scholar
  30. 30.
    Buck FM, Hoffmann A, Hofer B, Pfirrmann CW, Allgayer B (2009) Chronic medial knee pain without history of prior trauma: correlation of pain at rest and during exercise using bone scintigraphy and MR imaging. Skeletal Radiol 38:339–347CrossRefGoogle Scholar
  31. 31.
    Sharif M, George E, Dieppe PA (1995) Correlation between synovial fluid markers of cartilage and bone turnover and scintigraphic scan abnormalities in osteoarthritis of the knee. Arthritis Rheum 38:78–81CrossRefGoogle Scholar
  32. 32.
    Torres L, Dunlop DD, Peterfy C et al (2006) The relationship between specific tissue lesions and pain severity in persons with knee osteoarthritis. Osteoarthritis Cartilage 14:1033–1040CrossRefGoogle Scholar
  33. 33.
    Hirschmann MT, Schon S, Afifi FK et al (2013) Assessment of loading history of compartments in the knee using bone SPECT/CT: a study combining alignment and 99mTc-HDP tracer uptake/distribution patterns. J Orthop Res 31:268–274CrossRefGoogle Scholar
  34. 34.
    Hirschmann MT, Davda K, Rasch H, Arnold MP, Friederich NF (2011) Clinical value of combined single photon emission computerized tomography and conventional computer tomography (SPECT/CT) in sports medicine. Sports Med Arthrosc 19:174–181CrossRefGoogle Scholar
  35. 35.
    Jeer PJ, Mahr CC, Keene GC, Oakeshott RD (2006) Single photon emission computed tomography in planning unicompartmental knee arthroplasty. A prospective study examining the association between scan findings and intraoperative assessment of osteoarthritis. Knee 13:19–25CrossRefGoogle Scholar
  36. 36.
    Ryan PJ, Taylor M, Grevitt M et al (1993) Bone single-photon emission tomography in recent meniscal tears: an assessment of diagnostic criteria. Eur J Nucl Med 20:703–707CrossRefGoogle Scholar
  37. 37.
    Mucha A, Dordevic M, Hirschmann A et al (2015) Effect of high tibial osteotomy on joint loading in symptomatic patients with varus aligned knees: a study using SPECT/CT. Knee Surg Sports Traumatol Arthrosc 23:2315–2323CrossRefGoogle Scholar
  38. 38.
    Kim J, Lee HH, Kang Y et al (2017) Maximum standardised uptake value of quantitative bone SPECT/CT in patients with medial compartment osteoarthritis of the knee. Clin Radiol 72:580–589CrossRefGoogle Scholar
  39. 39.
    Suh MS, Lee WW, Kim YK, Yun PY, Kim SE (2016) Maximum standardized uptake value of (99m)Tc hydroxymethylene diphosphonate SPECT/CT for the evaluation of temporomandibular joint disorder. Radiology 280:890–896CrossRefGoogle Scholar

Copyright information

© European Society of Radiology 2018

Authors and Affiliations

  1. 1.Department of Orthopaedic Surgery and TraumatologyKantonsspital Baselland BruderholzBinningenSwitzerland
  2. 2.Department of RadiologyKantonsspital Baselland BruderholzBinningenSwitzerland
  3. 3.Department of Radiology and Nuclear MedicineUniversity Hospital BaselBaselSwitzerland
  4. 4.Amsler ConsultingBaselSwitzerland

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