F. Roemer (Erlangen, DE)

University of Erlangen-Nuremberg Radiology
Dr. Frank Roemer is a German board-certified musculoskeletal radiologist with a strong focus on MRI. He is Professor of Radiology at the University of Erlangen; Adjunct Professor at Boston University; Co-Director of the Quantitative Imaging Center at Boston University School of Medicine and Chief of Musculoskeletal Research at the Department of Radiology at the University of Erlangen; Erlangen; Germany. He is also CMO and Director of Reseach at Boston Imaging Core Lab (BICL); a company offering image assessment services to academia and the pharmaceutical industry with a focus on MSK disorders and in particular OA. Dr. Roemer is an internationally recognized scientist and has authored > 300 scientific publications. Dr. Roemer’s research interests include imaging of musculoskeletal diseases; with a focus on MRI and osteoarthritis; and imaging in sports medicine. He is regularly invited internationally to present at major scientific conferences; has authored multiple book chapters; and educational and scientific exhibits at various international radiological; orthopaedic and rheumatological meetings. He is Associate Editor of one the leading journals of orthopedics and rheumatology “Osteoarthritis Cartilage” since 2011. He is working in close collaboration with multiple leading scientific institutions worldwide focusing on osteoarthritis and MSK disorders.

Presenter Of 1 Presentation

Extended Abstract (for invited Faculty only) Others

8.3.3 - New Modalities in Joint Imaging

Presentation Topic
Others
Date
13.04.2022
Lecture Time
11:15 - 11:30
Room
Potsdam 3
Session Name
Session Type
Special Session

Abstract

Introduction

New Modalities in Joint Imaging

Content

Largely due to the application of MRI to large clinical studies, it is now accepted consensus to perceive degenerative joint disease as a multi-tissue disorder eventually leading to joint failure. Whole joint MRI assessment has contributed much to this change in perception. In addition, the heterogeneous nature of the clinical and structural manifestations of degenerative joint disorders have led to recent suggestions that there may be several phenotypes or subpopulations that are characterized by distinct clinical manifestations of disease, by certain laboratory parameters, biochemical markers, and/or imaging findings. Three main structural phenotypes have been proposed, i.e. meniscus/cartilage, subchondral bone and inflammation. These may progress differently and may represent specific tissue targets for future therapeutic approaches. Recently, a scoring instrument, has been presented that enables phenotypic characterization based on simplified MRI assessment that will be introduced. Combined with accelerated image acquisition, MRI may now be used in screening endeavors for osteoarthritis clinical trials.

Quantitative measurement of cartilage morphology exploits the three-dimensional nature of MRI data to assess morphologic tissue parameters as continuous variables based on segmentation approaches. By removing the link between magnitude and location of change, location-independent analyses such as the “ordered values”-approach or thinning/thickening scores circumvent the challenge of selecting a particular joint compartment or subregion as an outcome measure of progression a priori. Quantitative measurements of cartilage volume and thickness change have been used as outcomes in interventional trials.

Compositional MRI can detect changes in cartilage composition and ultra-structure during the earliest stages of cartilage degeneration prior to the onset of morphologic cartilage loss. A wide variety of compositional MRI methods have been used to evaluate patients with joint disorders including T2 mapping, sodium imaging, T2* mapping, gagCEST imaging, T1-rho mapping, diffusion-weighted imaging, ultra-short echo-time imaging, and delayed gadolinium enhanced MRI of cartilage (dGEMRIC) that will be dicussed. In addition, recent developments in MRI hardware including evolution and potential clinical application of ultrahigh field MRI at 7 T and modern low-field MRI systems will be introduced.

Ultrasound provides real-time, multi-planar imaging at relatively low cost. It offers reliable assessment of several inflammatory and structural abnormalities, without contrast administration or exposure to radiation. Ultrasound is able to visualize the patellofemoral joint including the anterior femoral surface and Hoffa’s fat pad, and the medial and lateral joint line including osteophytes and the body of the meniscus. Ultrasonography has proven to be a useful adjuvant to routine clinical assessment to aid management of disease, rather than a stand-alone diagnostic test

While CT has higher spatial resolution and superior multi-planar capabilities than MRI, it has less versatile tissue contrast. CT arthrography can improve tissue contrast through use of intra-articular iodinated contrast agents. CT arthrography is considered the in-vivo reference standard for measuring cartilage thickness and has high diagnostic performance for detecting cartilage defects and meniscus tears. Furthermore, CT arthrography can provide in-vivo assessment of the proteoglycan content of cartilage. Dual-energy CT (DECT) can distinguish between structures with similar densities but different elemental compositions based upon attenuation differences. DECT can improve characterization of crystal deposition diseases. DECT can also create bone subtraction images that can identify attenuation changes within bone marrow due to post-traumatic and degenerative bone marrow edema lesions. Newly developed extremity cone beam CT provides high-resolution imaging of the knee and ankle in the weight-bearing position with low radiation doses. Weight-bearing CT (WBCT) can assess structural features of knee joint degeneration and measure tibiofemoral joint space width with high scan-rescan reliability. WBCT may have a role in assessing relevance of articular structures that show change under weight-bearing conditions. In addition to WBCT, four-dimensional CT has been developed, which is not only able to detect patellofemoral maltracking, which is an important risk factor for patellofemoral osteoarthritis but can also provide an accurate and reliable visual assessment of patellar tracking.

Molecular imaging techniques have been used to evaluate joints including single-photon emission computed tomography (SPECT) to assess bone turnover, and positron emission tomography (PET) imaging, which utilizes 18F-fluorodeoxyglucose (FDG) to assess metabolic activity and 18F-SodiumFluoride (NaF) to assess bone turnover. Both SPECT and PET are typically combined with CT or MRI to provide improved anatomic localization of radiopharmaceutical uptake and to correlate findings of metabolic activity and bone turn-over with morphologic and compositional findings of joint degeneration. 18F-FDG uptake on PET imaging is correlated with the severity of synovitis in subjects with knee osteoarthritis. Furthermore, 18F-NaF uptake but not 18F-FDG uptake is seen in bone marrow edema lesions, osteophytes, and subchondral sclerosis.

In summary, conventional radiography remains the initial and most widely used imaging technique for evaluation of a patient with joint pain or a known or suspected diagnosis of osteoarthritis. In research and clinical trials, it is still an important tool for stratifying patients into different categories for inclusion criteria and eligibility. MRI plays a crucial role in multi-tissue joint assessment and in guiding future therapies due to its ability to image the joint as a whole organ and to directly and three-dimensionally assess cartilage morphology and composition. Ultrasound plays an important role in the diagnosis and follow-up of inflammatory joint pathologies in clinical practice. The clinical role of CT, scintigraphy, and PET in the diagnosis and follow-up of OA is still limited but is rapidly advancing. A comparative summary of the strengths and limitations of currently available imaging methods for the evaluation joint disorders is shown below.

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References

Roemer FW, Demehri S, Omoumi P, Link TM, Kijowski R, Saarakkala S, et al. State of the Art: Imaging of Osteoarthritis-Revisited 2020. Radiology. 2020;296(1):5-21.

Guermazi A, Alizai H, Crema MD, Trattnig S, Regatte RR, Roemer FW. Compositional MRI techniques for evaluation of cartilage degeneration in osteoarthritis. Osteoarthritis Cartilage. 2015;23(10):1639-53.

Roemer FW, Kwoh CK, Hayashi D, Felson DT, Guermazi A. The role of radiography and MRI for eligibility assessment in DMOAD trials of knee OA. Nat Rev Rheumatol. 2018;14(6):372-80.

Roemer FW, Collins J, Kwoh CK, Hannon MJ, Neogi T, Felson DT, et al. MRI-based screening for structural definition of eligibility in clinical DMOAD trials: Rapid OsteoArthritis MRI Eligibility Score (ROAMES). Osteoarthritis Cartilage. 2020;28(1):71-81.

Eckstein F, Ateshian G, Burgkart R, Burstein D, Cicuttini F, Dardzinski B, et al. Proposal for a nomenclature for magnetic resonance imaging based measures of articular cartilage in osteoarthritis. Osteoarthritis Cartilage. 2006;14(10):974-83.

Wirth W, Nevitt M, Hellio Le Graverand MP, Benichou O, Dreher D, Davies RY, et al. Sensitivity to change of cartilage morphometry using coronal FLASH, sagittal DESS, and coronal MPR DESS protocols--comparative data from the Osteoarthritis Initiative (OAI). Osteoarthritis Cartilage. 2010;18(4):547-54.

Eckstein F, Buck R, Wirth W. Location-independent analysis of structural progression of osteoarthritis-Taking it all apart, and putting the puzzle back together makes the difference. Semin Arthritis Rheum. 2017;46(4):404-10.

Hochberg MC, Guermazi A, Guehring H, Aydemir A, Wax S, Fleuranceau-Morel P, et al. Effect of Intra-Articular Sprifermin vs Placebo on Femorotibial Joint Cartilage Thickness in Patients With Osteoarthritis: The FORWARD Randomized Clinical Trial. JAMA. 2019;322(14):1360-70.

Liebl H, Joseph G, Nevitt MC, Singh N, Heilmeier U, Subburaj K, et al. Early T2 changes predict onset of radiographic knee osteoarthritis: data from the osteoarthritis initiative. Ann Rheum Dis. 2015;74(7):1353-9.

Keen HI, Wakefield RJ, Conaghan PG. A systematic review of ultrasonography in osteoarthritis. Ann Rheum Dis. 2009;68(5):611-9

Vande Berg BC, Lecouvet FE, Poilvache P, Jamart J, Materne R, Lengele B, et al. Assessment of knee cartilage in cadavers with dual-detector spiral CT arthrography and MR imaging. Radiology. 2002;222(2):430-6.

Omoumi P, Babel H, Jolles BM, Favre J. Relationships between cartilage thickness and subchondral bone mineral density in non-osteoarthritic and severely osteoarthritic knees: In vivo concomitant 3D analysis using CT arthrography. Osteoarthritis Cartilage. 2019;27(4):621-9.

Segal NA, Bergin J, Kern A, Findlay C, Anderson DD. Test-retest reliability of tibiofemoral joint space width measurements made using a low-dose standing CT scanner. Skeletal Radiol. 2017;46(2):217-22.

Kogan F, Fan AP, McWalter EJ, Oei EHG, Quon A, Gold GE. PET/MRI of metabolic activity in osteoarthritis: A feasibility study. J Magn Reson Imaging. 2017;45(6):1736-45.

Savic D, Pedoia V, Seo Y, Yang J, Bucknor M, Franc BL, et al. Imaging Bone-Cartilage Interactions in Osteoarthritis Using [(18)F]-NaF PET-MRI. Mol Imaging. 2016;15:1-12.

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