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Home / Equine Research Bank / J Orthop Res / Contrast-Enhanced Computed Tomography Scoring System for Dis...
Journal of orthopaedic research : official publication of the Orthopaedic Research Society2019; 37(10); 2138-2148; doi: 10.1002/jor.24382

Contrast-Enhanced Computed Tomography Scoring System for Distinguishing Early Osteoarthritis Disease States: A Feasibility Study.

Abstract: Early detection of osteoarthritis (OA) remains a diagnostic challenge owing to insensitive diagnostic techniques currently available. Herein a new semiquantitative scoring system, based upon contrast-enhanced computed tomographic (CECT) imaging, is described for further refinement of early OA disease staging. Trochlear ridge cartilage defects were surgically created in the femoropatellar joint of an adult horse (ACUC approved protocols). Seven weeks post-surgery, CECT imaging was performed on a clinical scanner after intra-articular injection of a cationic iodinated contrast agent, CA4+, into both injured and control femoropatellar joint compartments. The femoral cartilage surface was densely biopsied, and specimens were assessed for visual (Outerbridge score), functional (equilibrium compressive modulus), and biochemical (glycosaminoglycan content) measures of cartilage quality. Cartilage CECT attenuation was compared with cartilage quality measures using receiver operating characteristic curve analysis to establish attenuation thresholds for distinguishing among cartilage quality levels. CECT imaging identifies macroscopically damaged cartilage regions and in morphologically identical tissue provides moderately sensitive and specific semiquantitative segregation of cartilage quality based upon CECT attenuation, reflecting both glycosaminoglycan content and compressive stiffness of cartilage area under the curve (AUC = 0.83 [95% confidence interval [CI]: 0.72-0.93] for distinguishing poor quality and AUC = 0.76 [95% CI: 0.65-0.90] for distinguishing healthy quality cartilage). A semiquantitative 6-point scoring system-the Osteoarthritis Attenuation and Morphological Assessment (OAMA) score-is proposed as a tool for assessing cartilage quality from CECT images. The OAMA scoring system expands the current disease staging capability of early OA by inclusion of morphological, biochemical, and biomechanical assessments. © 2019 Orthopaedic Research Society. Published by Wiley Periodicals, Inc. J Orthop Res 37:2138-2148, 2019.
© 2019 Orthopaedic Research Society. Published by Wiley Periodicals, Inc.
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Publication Date: 2019-06-21 PubMed ID: 31136003PubMed Central: PMC6739126DOI: 10.1002/jor.24382Google Scholar: Lookup
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  • Evaluation Study
  • Journal Article
  • Research Support
  • N.I.H.
  • Extramural
  • Research Support
  • Non-U.S. Gov't

Summary

This research summary has been generated with artificial intelligence and may contain errors and omissions. Refer to the original study to confirm details provided. Submit correction.

This research introduces a new scoring system, based on contrast-enhanced computed tomographic (CECT) imaging, for early identification and staging of osteoarthritis (OA). The system, termed the Osteoarthritis Attenuation and Morphological Assessment (OAMA), proposes a more detailed and accurate method by incorporating morphological, biochemical, and biomechanical evaluations.

Research Methodology

  • The study was performed on an adult horse, on whose femoropatellar joint a cartilage defect was surgically induced, simulating early OA conditions. This was done in compliance with approved protocols.
  • The joint was injected with a cationic iodinated contrast agent, CA4+, and CECT imaging was carried out seven weeks post-surgery.
  • The femoral cartilage surface was thoroughly biopsied, and samples were evaluated based on visual (Outerbridge score), functional (equilibrium compressive modulus), and biochemical (glycosaminoglycan content) aspects to determine their quality.
  • Measurements of cartilage CECT attenuation were compared with these quality measures to set attenuation thresholds for differentiating between cartilage quality levels.

Findings

  • The CECT imaging was able to identify macroscopically damaged cartilage regions. It also proved moderately sensitive and specific for segmenting cartilage quality in morphologically identical tissue, based on CECT attenuation. This attenuation was found to be reflective of both the glycosaminoglycan content and the compressive stiffness of the cartilage area.
  • This led to the development of the OAMA score, a semiquantitative 6-point scoring system for assessing cartilage quality from CECT images. It offers a more comprehensive approach to early OA disease staging by including morphological, biochemical, and biomechanical assessments.

Significance and Implications

  • This study presents a novel approach to early detection and staging of OA, which has traditionally been a challenge due to the insensitivity of available diagnostic techniques.
  • It suggests that CECT imaging, when paired with correlated assessments of cartilage quality, can provide a robust, detailed diagnostic tool that improves upon current methods.
  • The use of the OAMA score has the potential to significantly enhance the understanding and management of OA in its early stages, allowing for more effective treatments and interventions.

Cite This Article

APA
Stewart RC, Nelson BB, Kawcak CE, Freedman JD, Snyder BD, Goodrich LR, Grinstaff MW. (2019). Contrast-Enhanced Computed Tomography Scoring System for Distinguishing Early Osteoarthritis Disease States: A Feasibility Study. J Orthop Res, 37(10), 2138-2148. https://doi.org/10.1002/jor.24382

Publication

Journal of orthopaedic research : official publication of the Orthopaedic Research Society
ISSN: 1554-527X
NlmUniqueID: 8404726
Country: United States
Language: English
Volume: 37
Issue: 10
Pages: 2138-2148

Researcher Affiliations

Stewart, Rachel C
  • Department of Biomedical Engineering, Boston University, 590 Commonwealth Avenue, Boston, Massachusetts, 02215.
  • Center for Advanced Orthopaedic Studies, Beth Israel Deaconess Medical Center, 99 Brookline Avenue, Boston, Massachusetts, 02215.
Nelson, Brad B
  • Department of Biomedical Engineering, Boston University, 590 Commonwealth Avenue, Boston, Massachusetts, 02215.
  • Department of Clinical Sciences, Gail Holmes Equine Orthopedic Research Center, College of Veterinary Medicine and Biomedical Sciences, Colorado State University, 1678 Campus Delivery, Fort Collins, Colorado, 80523.
Kawcak, Chris E
  • Department of Clinical Sciences, Gail Holmes Equine Orthopedic Research Center, College of Veterinary Medicine and Biomedical Sciences, Colorado State University, 1678 Campus Delivery, Fort Collins, Colorado, 80523.
Freedman, Jonathan D
  • Department of Biomedical Engineering, Boston University, 590 Commonwealth Avenue, Boston, Massachusetts, 02215.
  • Center for Advanced Orthopaedic Studies, Beth Israel Deaconess Medical Center, 99 Brookline Avenue, Boston, Massachusetts, 02215.
Snyder, Brian D
  • Center for Advanced Orthopaedic Studies, Beth Israel Deaconess Medical Center, 99 Brookline Avenue, Boston, Massachusetts, 02215.
Goodrich, Laurie R
  • Department of Clinical Sciences, Gail Holmes Equine Orthopedic Research Center, College of Veterinary Medicine and Biomedical Sciences, Colorado State University, 1678 Campus Delivery, Fort Collins, Colorado, 80523.
Grinstaff, Mark W
  • Department of Biomedical Engineering, Boston University, 590 Commonwealth Avenue, Boston, Massachusetts, 02215.
  • Department of Chemistry, Boston University, 590 Commonwealth Avenue, Boston, Massachusetts, 02215.
  • Department of Medicine, Boston University School of Medicine, 715 Albany St. E-113, Boston, Massachusetts, 02118.

MeSH Terms

  • Animals
  • Cartilage, Articular / diagnostic imaging
  • Contrast Media
  • Feasibility Studies
  • Horses
  • Osteoarthritis / diagnostic imaging
  • Severity of Illness Index
  • Tomography, X-Ray Computed

Grant Funding

  • Gail Holmes Equine Orthopedic Research Center
  • Wallace H. Coulter Foundation
  • T32 GM008541 / NIGMS NIH HHS
  • T32GM008541 / NIGMS NIH HHS

Conflict of Interest Statement

COMPETING INTERESTS. The authors have no commercial competing interests. MWG and BDS receiving laboratory funding from this work from the above sources.

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Citations

This article has been cited 2 times.
  1. Fantoni S, Gabucci I, Cardarelli P, Paternò G, Taibi A, Cristofori V, Trapella C, Bazzani A, Assenza M, Zanna Bonacorsi A, Conti D, Baruffaldi F. A Cationic Contrast Agent in X-ray Imaging of Articular Cartilage: Pre-Clinical Evaluation of Diffusion and Attenuation Properties.. Diagnostics (Basel) 2022 Aug 31;12(9).
    doi: 10.3390/diagnostics12092111pubmed: 36140512google scholar: lookup
  2. Gao X, Patwa AN, Deng Z, Utsunomiya H, Grinstaff MW, Ruzbarsky JJ, Snyder BD, Ravuri S, Philippon MJ, Huard J. Influence of fixation on CA4+ contrast enhanced microCT of articular cartilage and subsequent feasibility for histological evaluation.. Am J Transl Res 2021;13(8):8921-8937.
    pubmed: 34540005
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