Accurate joint space quantification in knee osteoarthritis: a digital x-ray tomosynthesis phantom study

Abstract Objectives To develop a deep convolutional neural network (CNN) for the segmentation of femur and tibia on plain x-ray radiographs, hence enabling an automated measurement of joint space width (JSW) to predict the severity and progression of knee osteoarthritis (KOA). Methods A CNN with ResU-Net architecture was developed for knee X-ray imaging segmentation. The efficiency was evaluated by the Intersection over Union (IoU) score by comparing the outputs with the annotated contour of the distal femur and proximal tibia. By leveraging imaging segmentation, the minimal and multiple JSWs in the tibiofemoral joint were estimated and then validated by radiologists’ measurements in the Osteoarthritis Initiative (OAI) dataset using Pearson correlation and Bland–Altman plot. The estimated JSWs were deployed to predict the radiographic severity and progression of KOA defined by Kellgren-Lawrence (KL) grades using the XGBoost model. The classification performance was assessed using F1 and area under receiver operating curve (AUC). Results The network has attained a segmentation efficiency of 98.9% IoU. Meanwhile, the agreement between the CNN-based estimation and radiologist’s measurement of minimal JSW reached 0.7801 (p < 0.0001). Moreover, the 32-point multiple JSW obtained the highest AUC score of 0.656 to classify KL-grade of KOA. Whereas the 64-point multiple JSWs achieved the best performance in predicting KOA progression defined by KL grade change within 48 months, with AUC of 0.621. The multiple JSWs outperform the commonly used minimum JSW with 0.587 AUC in KL-grade classification and 0.554 AUC in disease progression prediction. Conclusion Fine-grained characterization of joint space width of KOA yields comparable performance to the radiologist in assessing disease severity and progression. We provide a fully automated and efficient radiographic assessment tool for KOA.

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West Lake staging: A new staging system orchestrated by X-ray and MRI on knee osteoarthritis

Journal of Orthopaedic Surgery ◽

10.1177/23094990211049587 ◽

2021 ◽

Vol 29 (3) ◽

pp. 230949902110495

Author(s):

Jiaxin Huang ◽

Xi Chen ◽

Mengting Xia ◽

Shuaijie Lv ◽

Peijian Tong

Keyword(s):

Knee Osteoarthritis ◽

Cartilage Defect ◽

Staging System ◽

Joint Space ◽

Stage I ◽

Stage Ii ◽

Youden Index ◽

Full Thickness ◽

West Lake ◽

X Ray

Purpose: To investigate the differences on X-ray and MRI among each stage of knee osteoarthritis (KOA) and further propose a new staging system called West Lake (WL) staging. Methods: A cross-sectional study was conducted on patients with KOA. Stage I, II, III, and IV were divided based on stepwise treatment strategy of Knee osteoarthritis (KOA). Joint space widths (JSW) were measured on X-rays, whereas cartilage injuries (CI) and bone marrow lesions (BML) were evaluated on MRI. The differences of them across the groups were calculated by T-test. Receiver operating characteristic (ROC) curves were rendered to obtain the areas under the curves (AUC), Youden index and corresponding cut-off points. Results: Eventually, there were significant differences on JSW, CI, and BML between stage II/III and III/IV, while no significant differences between stage I/II. In stage II/III, the AUC of JSW, CI, BML was 0.99, 0.76, 0.71 and the Youden index was 0.94, 0.38, 0.45, meanwhile the cut-off points were ≤5.1 mm, >1, >2. In stage III/IV, the AUC of JSW, CI, BML was 0.96, 0.79, 0.74 and the Youden index was 0.84, 0.58, 0.38, meanwhile the cut-off points were ≤3.2 mm, >3, >4. Conclusion: The WL staging was described as follows: Stage I, X-ray shows no joint space narrow, normal MRI or MRI shows cartilage degeneration and only 1 or 2 sections are involved in BML. Stage II, X-ray shows joint space narrow, MRI shows cartilage defect but no full-thickness cartilage defect, meanwhile 3 or 4 sections are involved in BML. Stage III, X-ray shows serious joint space narrow even JSW disappeared, MRI shows full-thickness cartilage defect, more than 4 sections are involved in BML.

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West Lake Staging: A New Staging System Orchestrated by X-Ray and MRI on Knee Osteoarthritis

10.21203/rs.3.rs-135790/v1 ◽

2020 ◽

Author(s):

Jiaxin Huang ◽

Xi Chen ◽

Mengting Xia ◽

Shuaijie Lv ◽

Peijian Tong

Keyword(s):

Knee Osteoarthritis ◽

Cartilage Defect ◽

Staging System ◽

Joint Space ◽

Youden Index ◽

X Rays ◽

Full Thickness ◽

West Lake ◽

X Ray ◽

Orthopedic Surgeons

Abstract Background: Although widely used of Kellgren - Lawrence (KL) staging system on knee osteoarthritis (KOA), it still had some disadvantages. The purpose of this study was to investigate the differences on X-ray and MRI among each stage of KOA and further propose a new staging system called West Lake (WL) staging.Methods: A cross-sectional study was conducted on patients with KOA. KL stages were defined by two qualified orthopedic surgeons. Joint space widths (JSW) were measured on X-rays, whereas cartilage injuries (CI) and bone marrow lesions (BML) were evaluated on MRI. The differences of them across the groups were calculated by T-test. Receiver operating characteristic (ROC) curves were rendered to obtain the areas under the curves (AUC), Youden index and corresponding cut-off points. Agreement Index (KAPPA) was used to analyze the consistency of KL stages and WL stages assessed by two qualified orthopedic surgeons. Results: Eventually, a total of 220 patients met the criteria. There were significant differences on JSW, CI and BML between KL II/III as well as KL III/IV. In KL II/III, the AUC of JSW, CI, BML was 0.99, 0.76, 0.71 and the Youden index was 0.94, 0.38, 0.45, meanwhile the cut-off points were £5.1mm, >1, >2. In KL III/IV, the AUC of JSW, CI, BML was 0.96, 0.79, 0.74 and the Youden index was 0.84, 0.58, 0.38, meanwhile the cut-off points were £3.2mm, >3, >4. The Kappa coefficients of KL stages and WL stages were 0.31 and 0.76.Conclusion: The WL staging was described as follows: Grade 0, normal X-ray. Grade 1, X-ray shows osteophyte but no joint space narrow, normal MRI or MRI shows cartilage degeneration and only 1 or 2 sections are involved in BML. Grade 2, X-ray shows joint space narrow, MRI shows cartilage defect but no full-thickness cartilage defect, meanwhile 3 or 4 sections are involved in BML. Grade 3, X-ray shows serious joint space narrow even JSW disappeared, MRI shows full-thickness cartilage defect, more than 4 sections are involved in BML.Trial registration: The study was approved by the First Affiliated Hospital of Zhejiang Chinese Medical University (2018-ZX-026-01).

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Interpretable and parameter optimized ensemble model for knee osteoarthritis assessment using radiographs

Scientific Reports ◽

10.1038/s41598-021-93851-z ◽

2021 ◽

Vol 11 (1) ◽

Author(s):

Mohammed Bany Muhammad ◽

Mohammed Yeasin

Keyword(s):

Knee Osteoarthritis ◽

Objective Assessment ◽

Joint Space ◽

Knee Joints ◽

Ensemble Model ◽

Scale Invariant ◽

Substantial Impact ◽

X Ray ◽

Osteoarthritis Initiative

AbstractKnee osteoarthritis (KOA) is an orthopedic disorder with a substantial impact on mobility and quality of life. An accurate assessment of the KOA levels is imperative in prioritizing meaningful patient care. Quantifying osteoarthritis features such as osteophytes and joint space narrowing (JSN) from low-resolution images (i.e., X-ray images) are mostly subjective. We implement an objective assessment and quantification of KOA to aid practitioners. In particular, we developed an interpretable ensemble of convolutional neural network (CNN) models consisting of three modules. First, we developed a scale-invariant and aspect ratio preserving model to localize Knee joints. Second, we created multiple instances of "hyperparameter optimized" CNN models with diversity and build an ensemble scoring system to assess the severity of KOA according to the Kellgren–Lawrence grading (KL) scale. Third, we provided visual explanations of the predictions by the ensemble model. We tested our models using a collection of 37,996 Knee joints from the Osteoarthritis Initiative (OAI) dataset. Our results show a superior (13–27%) performance improvement compared to the state-of-the-art methods.

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Circulating IL-10 is compromised in patients predisposed to developing and in patients with severe knee osteoarthritis

Scientific Reports ◽

10.1038/s41598-021-81382-6 ◽

2021 ◽

Vol 11 (1) ◽

Author(s):

Tyler Barker ◽

Victoria E. Rogers ◽

Vanessa T. Henriksen ◽

Roy H. Trawick ◽

Nathan G. Momberger ◽

...

Keyword(s):

Knee Osteoarthritis ◽

Cruciate Ligament ◽

Ligamentous Injury ◽

Radiographic Evidence ◽

X Ray ◽

Tnf Α ◽

Total Knee ◽

Anterior Cruciate ◽

Anterior Cruciate Ligament Surgery ◽

Necrosis Factor

AbstractThe purpose of this investigation was to identify if serum interleukin (IL)-10 and tumor necrosis factor (TNF)-α concentrations and their ratio (IL-10/TNF-α) are altered in subjects predisposed to developing knee osteoarthritis following ligamentous injury and in those with severe knee osteoarthritis. Serum IL-10 and TNF-α concentrations were measured in four groups of subjects (n = 218): (1) reportedly-healthy and non-injured control subjects (CON; n = 92), (2) subjects scheduled to undergo anterior cruciate ligament surgery (ACL; n = 42), (3) non-surgical subjects with knee osteoarthritis (OA; n = 60), and (4) subjects with knee osteoarthritis scheduled to undergo total knee arthroplasty (TKA; n = 24). X-ray images were used to grade the severity of knee osteoarthritis. Serum IL-10 and the serum IL-10/TNF-α ratio were significantly lower while serum TNF-α was not significantly perturbed with severe compared to moderate knee osteoarthritis (i.e., Kellgren-Lawrence grade 4 vs. 3, respectively). Serum IL-10 was significantly lower in the absence of serum TNF-α alterations in the ACL group. We conclude that serum IL-10 concentrations are compromised in subjects predisposed to developing knee osteoarthritis following ligamentous trauma and in subjects with radiographic evidence of severe knee osteoarthritis.

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