KEYWORDS: Magnetic resonance imaging, Ultrasonography, Tissues, Image segmentation, Reliability, 3D acquisition, Prototyping, Inflammation, 3D metrology
Synovial inflammation is increasingly appreciated as a key feature in osteoarthritis pathogenesis and pain, but the gold standard method of measuring synovitis (MRI) is inaccessible in routine clinical care. 3-dimensional ultrasound could present a potential solution if it demonstrates good measurement properties in suprapatellar recess synovitis. We recruited five knee osteoarthritis patients awaiting knee replacement, who received both MRI and 3DUS imaging of the knee on the same day. By manually segmenting synovitis on 3DUS and MRI images, we found that 3DUS has excellent intra/inter-rater reliability for synovitis volume and differs from MRI segmentations by approximately 26.73%.
The first carpometacarpal (CMC-1) joint is a common site of osteoarthritis (OA). The joint disease commonly presents with inflammation of the synovial membrane, synovitis. Inflammation and the formation of new blood vessels, angiogenesis, are integrated processes. Increased blood flow, angiogenesis and inflammation of the synovial tissue can contribute to symptoms of OA. The role angiogenesis plays in pathogenesis and disease progression is not fully understood. Imaging modalities, such as power Doppler (PD) ultrasound (US) can detect blood flow. Recently, a new Doppler ultrasound technique, superb microvascular imaging (SMI), was developed and uses an algorithm that can more effectively visualize low-velocity blood flow. To better understand the role of angiogenesis in OA and to visualize the three-dimensional (3D) vasculature, we developed a 3DUS system. This paper is a preliminary study, which demonstrates our 3DUS system acquiring PD and SMI images for CMC-1 OA to provide quantification as well as improved blood flow visualization. As part of a clinical trial, a patient presenting with CMC-1 OA was imaged using 3DUS PD and SMI technologies to quantify the synovial volume and Doppler signals. We found synovial Doppler signals present in 3D PD and SMI images. To optimize the temperature of the device scanning solution, healthy volunteers were imaged at increasing temperatures. The Doppler signals in the blood vessels were quantified and we observed an increase in Doppler signal with higher temperatures. This work demonstrates the ability of the 3DUS PD and SMI system to detect, quantify, and visualize vessel and synovial blood flow.
First carpometacarpal osteoarthritis (CMC1) is one of the most prominent forms of hand osteoarthritis (OA) with an estimated prevalence of up to 33%. X-ray radiography is the most common imaging modality used in the diagnosis of CMC1 OA. However, studies have reported significant discrepancies between patient-related outcomes and radiographic evidence of OA, which may be attributed to the lack of x-ray soft tissue contrast. Therefore, in conjunction with rapidly expanding soft tissue modalities such as magnetic resonance imaging (MRI) and ultrasound (US) there has been an increased interest in the role that soft tissue structures, such as joint synovium plays in the progression of OA. US and MRI are excellent for imaging soft tissue structures; however, US is highly operator-dependent and is inherently 2D, while MRI is associated with long waitlist times, high operating costs, and inaccessibility to patients with mobility impairments. Three-dimensional (3D) US technology may overcome these limitations by providing a method for bedside monitoring OA progression and treatment response. This paper validates the use of our developed 3DUS device for comparing synovial volume measurements in a CMC OA patient study. The CMC1 patient was imaged to compare the measurement capabilities of 3DUS to MRI for measuring synovial tissue volumes. Results showed that there was a 29.61% difference between acquired MRI and 3DUS volumetric measurements. Furthermore, the coefficient of variance was 1.4% and 5.7% for 3DUS and MRI, respectively, suggesting that the volumetric measurements from the 3DUS image were more consistent and better suited for clinical imaging and assessment of the CMC1 joint.
Osteoarthritis (OA) is the most common chronic health condition and a leading cause of disability and pain in the United States and Canada. Current methods for monitoring the development of knee OA (KOA) involve x-ray radiography and magnetic resonance imaging (MRI) to assess femoral articular cartilage (FAC) degradation and synovial membrane inflammation. However, x-ray radiography cannot be used to quantify FAC loss or synovial membrane inflammation due to a lack of soft tissue contrast, and MRI is associated with high costs, long waitlists, long scan times, and is inaccessible to many patients. We have developed a counterbalanced point-of-care (POC) system to track multiple three-dimensional (3D) ultrasound (US) acquisitions and register them for visualizing the entire suprapatellar synovium. This work aims to validate the tracking accuracy of the POC system against an external optical tracking system. Validation was conducted using optical tracking as a reference by mounting a custom optical tracking stylus in place of the 3D US scanner on the POC system. The stylus was manipulated in 3D space and Euclidean distances were calculated using the initial and final positions of the stylus and were compared between systems to quantify POC tracking system error. Results indicated that the overall mean absolute tracking error of the POC system was 3.08 ± 2.01 mm with no statistically significant difference between the POC and optical systems (p = 0.965). The POC system has the potential to enable clinicians and researchers to obtain additional information without added complexity or discomfort to patients.
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