Qualitative and Quantitative Evaluation of Morpho-Metabolic Changes in Bone Cartilage Complex of Knee Joint in Osteoarthritis Using Simultaneous 18F-NaF PET/MRI—A Pilot Study

Amarnath Jena; Nidhi Goyal; Prerana Rana; Sangeeta Taneja; Abhishek Vaish; Rajesh Botchu; Raju Vaishya

doi:10.1055/s-0042-1760285

Indian Journal of Radiology and Imaging, Table of Contents

CC BY-NC-ND 4.0 · Indian J Radiol Imaging 2023; 33(02): 173-182
DOI: 10.1055/s-0042-1760285

Original Article

Qualitative and Quantitative Evaluation of Morpho-Metabolic Changes in Bone Cartilage Complex of Knee Joint in Osteoarthritis Using Simultaneous 18F-NaF PET/MRI—A Pilot Study

Amarnath Jena

¹Department of Molecular Imaging and Nuclear Medicine, Indraprastha Apollo Hospital, New Delhi, India

,

Nidhi Goyal

²Department of Radiodiagnosis and Imaging, Indraprastha Apollo Hospitals, New Delhi, India

,

Prerana Rana

¹Department of Molecular Imaging and Nuclear Medicine, Indraprastha Apollo Hospital, New Delhi, India

³Apollo Hospitals Education and Research Foundation, Indraprastha Apollo Hospitals, New Delhi, India

,

Sangeeta Taneja

¹Department of Molecular Imaging and Nuclear Medicine, Indraprastha Apollo Hospital, New Delhi, India

,

Abhishek Vaish

⁴Department of Orthopaedics and Joint Replacement Surgery, Indraprastha Apollo Hospitals, New Delhi, India

,

Rajesh Botchu

⁵Department of Musculoskeletal Radiology, Royal Orthopedic Hospital, Birmingham, United Kingdom

,

Raju Vaishya

⁴Department of Orthopaedics and Joint Replacement Surgery, Indraprastha Apollo Hospitals, New Delhi, India

› Author Affiliations

Abstract

Background Articular cartilage (AC) loss and deterioration, as well as bone remodeling, are all symptoms of osteoarthritis (OA). As a result, an ideal imaging technique for researching OA is required, which must be sensitive to both soft tissue and bone health.

Objective The aim of this study was to assess the potential of simultaneous 18F sodium fluoride (18F-NaF) positron emission tomography/magnetic resonance imaging (PET/MRI) to identify as well as classify osseous metabolic abnormalities in knee OA and to see if degenerative changes in the cartilage and bone on MRI might be correlated with subchondral 18F-NaF uptake on PET.

Methods Sixteen (32 knees) volunteers with no past history of knee injury, with or without pain, were enrolled for the research from January to July 2021. The images of both knees were taken utilizing an molecular magnetic resonance (mMR) body matrix coil on a simultaneous PET/MRI biograph mMR. The acquisition was conducted after 45 minutes of intravenous infusion of 18F-NaF 185–370 MBq (5–10 mCi) over one PET bed for 40 minutes, while MRI sequences were performed simultaneously.

Results All pathologies showed significantly higher maximum standardized uptake value (SUV_max) than the background. Thirty-four subchondral magic spots were identified on 18F-NaF PET without any structural alteration on MRI. Bone marrow lesions (BMLs) and osteophytes with higher MRI osteoarthritis knee score (MOAKS) score showed higher 18F-NaF uptake (grade1˂grade2˂grade3). BMLs had corresponding AC degeneration. There was discordance between grade 1 osteophytes (86.6%), sclerosis (53.7%) and grade 1 BML in cruciate ligament insertion site (91.66%); they did not have high uptake of 18F-NaF. In case of cartilage, there was significant difference between AC grades and average subchondral SUV_max and T2* relaxometry (grade0˂grade1˂grade2˂grade3˂grade4). BMLs are much more metabolically active than other pathologies, while sclerosis is the least. We also found that the subchondral uptake was statistically increased in the areas of pathology:

Conclusion 18F-NaF PET/MRI was able to detect knee abnormalities unseen on MRI alone and simultaneously assessed metabolic and structural markers of knee OA across multiple tissues in the joint. Thus, it is a promising tool for detection of early metabolic changes in OA.

Keywords

osteoarthritis - knee joints - simultaneous PET/MRI - cartilage - bone

Full Text

References

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Supplementary Material

Supplementary Material