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Quantitative Dual Contrast CT Technique for Evaluation of Articular Cartilage Properties

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Abstract

Impact injuries of cartilage may initiate post-traumatic degeneration, making early detection of injury imperative for timely surgical or pharmaceutical interventions. Cationic (positively-charged) CT contrast agents detect loss of cartilage proteoglycans (PGs) more sensitively than anionic (negatively-charged) or non-ionic (non-charged, i.e., electrically neutral) agents. However, degeneration related loss of PGs and increase in water content have opposite effects on the diffusion of the cationic agent, lowering its sensitivity. In contrast to cationic agents, diffusion of non-ionic agents is governed only by steric hindrance and water content of cartilage. We hypothesize that sensitivity of an iodine(I)-based cationic agent may be enhanced by simultaneous use of a non-ionic gadolinium(Gd)-based agent. We introduce a quantitative dual energy CT technique (QDECT) for simultaneous quantification of two contrast agents in cartilage. We employ this technique to improve the sensitivity of cationic CA4+ (q =+4) by normalizing its partition in cartilage with that of non-ionic gadoteridol. The technique was evaluated with measurements of contrast agent mixtures of known composition and human osteochondral samples (n = 57) after immersion (72 h) in mixture of CA4+ and gadoteridol. Samples were arthroscopically graded and biomechanically tested prior to QDECT (50/100 kV). QDECT determined contrast agent mixture compositions correlated with the true compositions (R2= 0.99, average error = 2.27%). Normalizing CA4+ partition in cartilage with that of gadoteridol improved correlation with equilibrium modulus (from ρ = 0.701 to 0.795). To conclude, QDECT enables simultaneous quantification of I and Gd contrast agents improving diagnosis of cartilage integrity and biomechanical status.

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Acknowledgments

Sandra Sefa (B.Sc.) is acknowledged for assistance with the biomechanical measurements. Jaakko Sarin, M.Sc.(Tech) is acknowledged for assistance in sample extraction. Academy of Finland (Projects 269315, 307932), Kuopio University Hospital (VTR 5041746, 5041757, PY210), Instrumentarium Science Foundation (170033) and Doctoral Program in Science, Technology and Computing (SCITECO, University of Eastern Finland) are acknowledged for financial support.

Conflicts of interests

The authors have no conflicts of interest.

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Authors and Affiliations

  1. Department of Applied Physics, University of Eastern Finland, P.O. Box 1627, FI-70211, Kuopio, Finland

    Abhisek Bhattarai, Katariina A. H. Myller, Mithilesh Prakash, Miitu Korhonen, Annina E. A. Saukko, Jukka S. Jurvelin & Juha Töyräs

  2. Diagnostic Imaging Center, Kuopio University Hospital, P.O. Box 100, FI-70029, Kuopio, Finland

    Abhisek Bhattarai, Katariina A. H. Myller, Mithilesh Prakash, Miitu Korhonen & Juha Töyräs

  3. Center of Oncology, Kuopio University Hospital, Kuopio, Finland

    Juuso T. J. Honkanen & Tuomas Virén

  4. Department of Orthopedics, Traumatology and Hand Surgery, Kuopio University Hospital, Kuopio, Finland

    Antti Joukainen & Heikki Kröger

  5. Departments of Biomedical Engineering, Chemistry, and Medicine, Boston University, Boston, MA, USA

    Amit N. Patwa & Mark W. Grinstaff

  6. School of Liberal Studies and Education, Navrachana University, Vadodara, Gujarat, India

    Amit N. Patwa

Authors
  1. Abhisek Bhattarai
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  2. Juuso T. J. Honkanen
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  3. Katariina A. H. Myller
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  6. Annina E. A. Saukko
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  8. Antti Joukainen
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  9. Amit N. Patwa
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  10. Heikki Kröger
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  12. Jukka S. Jurvelin
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  13. Juha Töyräs
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Correspondence to Abhisek Bhattarai.

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Associate Editor Eric M. Darling oversaw the review of this article.

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Bhattarai, A., Honkanen, J.T.J., Myller, K.A.H. et al. Quantitative Dual Contrast CT Technique for Evaluation of Articular Cartilage Properties. Ann Biomed Eng 46, 1038–1046 (2018). https://doi.org/10.1007/s10439-018-2013-y

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