Msk imaging paleoanthropo jd laredo

transcript

JFIM 2013: The pelvis:

An anatomical comparison in animal species and evolu=on

Jean-‐Denis Laredo MSK radiologist Denis Diderot Paris University And CNRS 7051

Age of the world and animals •  Universe: 13.8 billion years (« Big bang ») •  Earth: 4.54 billion years •  Vertebrates : 500 million years (aqua=c first) •  Dinosaurus: 100-‐50 million years •  Mammalians: 50 million years •  Primates 35 million years •  Hominidae-‐Big Monkeys (Apes) 10-‐15 million years •  Common ancestor to big monkeys and humans: 7 million years •  Australopithecus: 3 million years •  Homo Habilis: 1.8 million years •  Homo sapiens: 1 million years •  Homo sapiens sapiens: 100,000 years

Primates= simiens & prosimiens

Simiens

Catarrhiniens

Hominoïdes

Cercopithécoïdes

Platyrrhiniens Babouin, Macaque

Hominoïdes

Gibbons

Tall Monkeys (grands singes) « Apes »: Orang-‐outan, Chimpanzé,

Gorille

Hominides

Australopithecus Homo

Hominides history Foot steps in Laetoli (Tanzania)

Australopithecus afarensis (Lucy), 3 million years

Rie valley & Yves Copens theory

Primate habitat

•  Most primates have their natural environment in the trees

Primates habitat & locomo=on

Tree Brachia=on Tree

Quadrupeds

Ground quadrupeds Big monkeys

Ground bipeds Hominidae

Gibbons (hylobates)

Bonobo (chimpanzee)

Tree brachia=on versus quadrupedalism

Gibbons (hylobates) Bonobo (pan paniscus, small chimpanzee)

Human (Bipeds) anatomic characteris=cs?

Bipeds characteris=cs

•  Hand and opposing thumb allowing hand grip?

Human (Bipeds) anatomic characteris=cs

•  Hand and opposing thumb allowing hand grip: No!

1.  Foot! Humans have a specific foot anatomy

The Bonobo has 4 hands

Homo Homo : M1-‐M2 joint

1.  Foot! highly specialised in bipeds

Bonobo Homo, hallux valgus

Foot steps in Laetoli (Tanzania)

Cow Bonobo Lucy(Australopithecus) Homo habilis Homo sapiens

1.  Foot! highly specialised in bipeds 2.  Long femoral neck

Human femur

•  Femoral head: 2/3 of a sphere •  Weight-‐bearing

Human femur

•  Femoral head: 2/3 of a sphere •  Weight-‐bearing Propensity to subchondral fracture

Human femur •  Femoral head: 2/3 of a sphere (extended car=lage) •  Poor vascularisa=on Propensity to avascular necrosis

1.  Foot! highly specialised in bipeds 2.  Femoral neck 3.  Pelvis

Lucy Homo sapiens

Cow Bonobo

Quadrupeds

Bipeds

1.  Foot! highly specialised in bipeds 2.  Femoral neck 3.  Pelvis

Pelvis muscles

Lumbar spine extensionL.

abdominal wall muscles

Pelvis equilibrium

Thigh muscles

Lucy Homo

Hip joint

•  Any joint is a compromise between mobility and stability

•  Tree quadrupeds (Monkeys): Mobility >> stability

Human hip joint •  Ground bipeds (homo): ü Shoulder : mobility >> stability ü Hip joint : weight-‐bearing stability >> mobility high joint congruence

Human hip joint

•  Weight-‐bearing •  High congruence •  High fric=on Propensity to wearing : hip osteoarthri=s

Symphalangius Homo sapiens

1.  Foot 2.  Femoral neck 3.  Pelvis 4.  Lumbar Lordosis 5.  Shorter upper limb (70% of the lower limb)

Chimpanzee

Orang Homo sapiens

1.  Foot 2.  Femoral neck 3.  Pelvis 4.  Lumbar Lordosis 5.  Shorter upper limb 6.  Foramen magnum below the skull

The standing posi=on La sta=on debout

Georges Charpak discovery: Highly sensi=ve X-‐ray detector in a gazeous phase

Low dose simultaneous standing AP & lateral full body radiographs

Human pelvis is submired to high compression forces

How to resist to these compression forces ?

G. Morvan

Economic equilibrium: • Lumbar lordosis • Thoracic kyphosis • C7 Plumb Line

C7 Plumb line

Pelvic anteversion, lumbar lordosis & thoracic kyphosis allow adapta=on to anterior trunk

bending

Pelvic incidence (Duval-‐Beaupère)

Pelvic incidence: mean 55° (35-‐70)

G. Morvan

Surgical treatment of degenera=ve sta=c malalignements of the spine

•  Pierre Guigui Chief of Orthopaedic surgery Denis Diderot Paris University

1994 1994 1995

2001 2001

2001 2002

Extension

Flexion

2001 2002

Extension

Flexion

2001 2002

Extension

Flexion

Importance du grand cliché

Locomo=on

1960 1970 1980 1990 2000 2010

Motion

Life is mo=on

E"enne Jules Marey (1830 – 1904)

« Le mouvement est l’acte le plus important en ce sens que toutes les fonc5ons empruntent son concours pour s’accomplir. »

« Mo5on is at the root of all ac5ons »

Primate locomo=on

Tree Brachia=on Tree

Quadrupeds

Ground quadrupeds Big monkeys

Ground bipeds Hominidae

Bipedalism locomo=on

Homo is not the only animal using bipedalism La bipédie n’est pas le propre de l’homme

Foot steps in Laetoli (Tanzania)

Big monkeys: quadrupeds in trees and on the ground Occasionnal bipeds

Tree brachia=on versus quadrupedalism

Gibbons (hylobates) Bonobo (pan paniscus, small chimpanzee)

Hallux rigidus

Humanoïde Robot

Jean -‐Pau l Laumond

1960 1970 1980 1990 2000 2010

Faire marcher un robot

Synergie sciences de la vie et robo=que

E n g u i s e d e c o n c l u s i o n

1960 1970 1980 1990 2000 2010

Capteurs et ac=onneurs

H R P 2

DC Motor with Ironless Rotor

Pulley

Timing BeltHarmonic Drive Gear

4 caméras

Gyroscope

Accéléromètres

4 Capteurs d’effort

30 moteurs

1960 1970 1980 1990 2000 2010

La marche d’HRP2

L a m a r c h e : n i v e a u c o g n i t i f

1960 1970 1980 1990 2000 2010

La marche d’HRP2

Kajita et al, IEEE ICRA, 2003

Centre de pression

Centre de masse

S o u s – a c t i o n n e m e n t : l a m a r c h e

1960 1970 1980 1990 2000 2010

Robot and human: two different models

Locomotion

A. Berthoz, T. Pozzo, Posture and Gaits ,Elsevier, 1988 Kajita et al, IEEE ICRA, 2003 E"enne Jules Marey © Cinémathèque Française

VALUE OF BILATERAL STANDING OBLIQUE RADIOGRAPHS (« FAUX PROFIL DE LEQUESNE »)

IN THE DIAGNOSIS OF HIP OSTEOARTHRITIS

The acetabulum can be described as a croissant

Posterior Horn

Apical Roof

Anterior Horn

Anterior Roof

However, the AP radiograph only profiles the apical roof of the acetabulum.

Apical Roof

X-‐Ray

Lequesne, M.G.Laredo, J.D. The faux profil (oblique view) of the hip in the standing posi5on. Contribu5on to the evalua5on of osteoarthri5s of the adult hip. Ann Rheum Dis, 1998

Standing oblique of the hip « faux-‐profil » de Lequesne

Target hip

The SO view profiles the posterior horn, apical roof and anterior roof of the hip in contact with the radiographic table, the “target” hip.

Apical Roof

Right Hip

Target Hip

Anterior Roof

Posterior Horn

Anterior Roof

Normal OA

The Lequesne Standing Oblique is more sensi=ve than the AP Pelvis view for the diagnosis of early OA Lequesne M. ARD 1998 Conrozier T. O&C 1998 Vignon E. J Rheumatol 2004

Pa=ent posi=oning in Lyon Schuss (1) Cassere, (2) feet cushion, (3) Fluoroscopy

The SO view profiles the posterior horn, apical roof and anterior roof of the hip in contact with the radiographic table, the “target” hip.

Apical Roof

Right Hip

Target Hip

Anterior Roof

Posterior Horn

Anterior Roof

Double oblique de profil Contre-‐Faux-‐Profil:

Corne antérieure

Faux-‐ Profil: Corne postérieure

Lequesne, M.G.Laredo, J.D. The faux profil (oblique view) of the hip in the standing posi5on. Contribu5on to the evalua5on of osteoarthri5s of the adult hip. Ann Rheum Dis, 1998 Laredo, J.D., Le contre-‐faux-‐profil de hanche. en cours de publica=on

Target Hip

Non-‐target Hip

The SO view profiles the apical roof, anterior roof and anterior horn of the contralateral hip, distant from the table, the “non-‐target” hip.

Anterior Horn

Anterior Roof

Apical Roof

Right Hip Non-‐target Hip

Bilateral standing oblique (SO) radiographs of the pelvis profile the full hip joint space.

Anterior Horn

Anterior Roof

Apical Roof

Right Hip

Non-‐target Hip Target Hip

Anterior Roof

Posterior Horn

Anterior Horn

Anterior Roof

Apical Roof

Right Hip

Non-‐target Hip Target Hip

Anterior Roof

Posterior Horn

Apical Roof

Anterior Horn

Anterior Roof

Results 1: AP view

Normal JSW measurements: JSW gradient

Measurement Point

Mean mm ± sd

L 5.02 ± 0.74

Vap 4.65 ± 1.1

M 4.28 ± 1.09

L Vap M

AP view

Results 1: Standing Oblique

Normal JSW measurements: JSW gradient

SO view : Target Hip

Measurement Point

Mean mm±sd

AR 5.18± 1.2

Vct 4.43± 0.92

PS 3.69± 0.69

PH 3± 0.55

AR/PH ratio 1.77± 0.48

AR Vct PS

Results 1: Descrip=ve results Contralateral Standing Oblique

Normal JSW measurements

SO view : Non-‐target Hip

Measurement Point

Mean mm ± sd

IAH 3.83 ± 0.23

SAH 5.34 ± 1.04

Vdt 5.39 ± 1.14

Vdt SAH

Results 2 ANOVA: Overt OA versus Controls

L Vap M

SO view: Target Hip

AR Vct PS

SO view: Non-‐target Hip

Vdt SAH

AP View Vap 0.0322*

Standing Oblique

Target Hip

AR 0.00458* Vct 0.0375* PH 0.00029*

AR/PH ratio 0.00007*

Standing Oblique

Non-target Hip

IAH 0.00969* SAH 0.0112*

Results 2 ANOVA: Incipient OA versus Controls

L Vap M

SO view: Target Hip

AR Vct PS

Vdt SAH

Standing Oblique Target Hip

PH 0.02004* AR/PH ratio 0.00446*

Standing Oblique Target Hip

IAH 0.00128* SAH 0.0687

Results 3 Logis=c regression analysis

Logistic Regression to predict

Incipient OA versus Controls

View Measurement Point OR[95%CI]

Antero-Posterior View - -

Standing Oblique Contact Hip PH 2.405 [1.184 ; 4.886]

AR/PH ratio 0.273 [0.095 ; 0.787]

Standing Oblique Distant Hip SAH 0.556 [0.345 ; 0.894]

SO view: Target Hip

AR Vct PS

Vdt SAH

Results 4 Thresholds that maximalize accuracy

View Measurement Point

Threshold that maximizes accuracy

(mm) Sensitivity Specificity PPV NPV ACCURACY

Target Hip SO view

AR 4.4 34,78 (16.38-57.27)

100 (87.66-100)

100 (63,06-100)

58.1 (44.8-70.5)

59.7 (47-71.5)

PH 50 (30.6-69.4)

91.9 (78.1-98.3)

82.4 (56.6-96.2)

70.8 (55.9-83)

73.8 (61.5-84)

AR/PH ratio 1 39,29 (21,5-59,42)

97,3 (85,84-99,03)

91,67 (61,52-99,7

67,92 (53,68-80,0

72,31 (59,81-82,69

Non-target Hip

SO view SAH 4,04 41,38

(23,52-61,06) 91,89

(78,09-98,3)

80 (51,91-95,6

66,67 (52,08-79,2

69,7 (57,15-41)

IAH 75 (34.9-96.8)

100 (71.5-100)

100 (54.1-100)

84.6 (54.6-98.1)

89.5 (66.9-98.7)

Conclusions •  JSW measurements on bilateral SO radiographs allow diagnosis of early hip OA not shown by the standing AP pelvis radiograph.

•  Measurement of the AR/PH JSW ra=o provides the best diagnos=c performances.

SO view: Target Hip

AR Vct PS

Vdt SAH

antero-supero-

lateral OA

postero-infero-medial

antero-supero-

medial OA

•  Three different anatomical types of hip osteoarthritis

Msk imaging paleoanthropo jd laredo

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