Radio Logical Assessment of OA Final

8/7/2019 Radio Logical Assessment of OA Final

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Dr OMAR HUSSEIN

Professor of Radiology

Ain Shams University


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Os Is one of the most prevalent and disablingchronic conditions affecting older adults and asignificant public health problem among adults ofworking age.

Worldwide, osteoarthritis is the most commonform of arthritis, noninflammatory, nonsystemicdisease

Pain and limitation of motion restrict theindependence of older adults by impairing theirperformance of activities of dailyliving.

Osteoarthritis ???


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Prevalence increases exponentially beyond the ageof 50 with about 80-90% of both sexes having

osteoarthritis by age 65; Before age 50: Men more affected than women.

After age 50: Incidence greater in women.

It affects over 1/3 of men (37%) and just over half ofwomen (53%) in this age group.

2002 Pfizer Inc. All rights reserved.

older adultsWomen Men

53% 37%


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Affects one or more weight-bearing joints

Hand, wrist, lower cervical spine, lumbar spine and

sacroiliac, hip, knees, ankles, feet Aches and stiffness

Symptoms increase with activity; diminish with rest

Usually no redness of adjacent tissues

Sometimes nocturnal pain may be referred

4


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Primary Osteoarthritis.

Secondary Osteoarthritis.


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DIPs

PIPsCMCs

Base of

big toe

Neck

LowerBack

Hips

Knees


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2002 Pfizer Inc. All rights reserved.

Joint = one + Cartilage +

Synovial Fluid


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Pathological characteristics: Erosion of the articular cartilage

Sclerosis of subchondral bone

Formation of bone spurs or osteophytes

Synovial membrane is indirectly affected Fragments of fibrocartilage cause inflammation pain

Fibrous repair of joint capsule restricts motion Osteophytes form pain and loss of motion

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Early changes may be arrestedor .delayed


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Early

Cartilage softens.

ModerateCartilage thinner.

bone ends hypertrophy and spurs.

Advanced

Cartilage destruction.

Secondary inflammation of synovial membrane.

Late ankylosis.


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Clinical

Labor

atory m

arker

s

Imaging

Thermography

Arthroscopy


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DIAGNOSIS:

Plain radiography

US

MRI

CT

Scintigraphy

MONITORING:


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Joint space narrowing , asymmetrical, may be onlyfinding in early disease

Subchondral bone sclerosis

Subchondral cysts Osteophytes

Central bone erosions occur in distalinterphalangeal joints of fingers

Deformities Heberden (osteophytes at DIJ ) and Bouchard

(osteophytes at PIJ ) nodes.

Subluxation


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Plain X-Ray of the shoulder and wrist joints show osteophytes.


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The KL scale is a standard radiologic gradingsystem for osteoarthritis .

Features considered evidence of osteoarthritisare osteophytes in the joint margins, narrowingof joint spaces, and subchondral sclerosis.


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On the basis of these features, the following KLscores were defined :

0 no features of osteoarthritis;

1 doubtful osteoarthritis, with minute osteophytes

of doubtful importance; 2 minimal osteoarthritis, with definite osteophytes

but unimpaired joint space;

3 moderate osteoarthritis, with osteophytes and

moderate diminution of joint space; and 4 severe osteoarthritis, with greatly impaired joint

space and sclerosis of subchondral bone.


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Link T M et al. Radiology 2003;226:373-381

Score 1 score 2 score 3 score 4


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X-rays of osteoarthritis do not detect earlycartilage abnormalities.

Also, x-rays can show mild osteoarthritis while

a patient may be experiencing severesymptoms.

Conversely, an x-ray may show changesindicative of advanced or severe osteoarthritiswhile a patient may have few or no symptoms.


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From head to toe :-

ShoulderShoulder

HipHipWristWrist

KneeKnee

AnkleAnkle

UltrasoundUltrasound


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There is NO contraindication.

Non-invasive.

It is able to visualise the examined parttogether with surrounding structures.

Early detection cartilage and synovium andeffusion.

ALSO Allows foraspiration and injectionprocedures


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Hand Sonography shows synovitis of the 2nd MP joint


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Hand Sonography shows Carpometacarpal

osteoarthritis of the thumb


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Ankle Sonography shows joint effusion and synovitisbetween navicular and cuniform bones.


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Knee Sonography shows osteophtes and protrusion of medialmensicus and MCL associated with effusion.


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Operator Dependence

Difficult through Bone, air/gas

Obesity

Limitation of US


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Now Available Inexpensive relatively Excellent visualization of

bony details In secondary OA

Skeletal evaluation in cases of

trauma. Congenital anomalies.

MSCT :-Give more details byReformatting images and

3-D reconstruction

Ionizing radiation

Patient cooperation

With AGAINST


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Plain X-ray and CT of the hip shows bony fragments


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Ankle CT shows osteophytes, subchondral sclerosis

and diminished joint space.


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Hip CT-Arthrography shows superior and anterior jointspace narrowing (blue circle) with denuded chondralsurface (yellow arrow), subchondral cysts and sclerosis.


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CT knee arthrography shows Loose bodies (arrow).


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Multi-planar scanning.

Non ionizing radiation.

Safer contrast agent.

The best joint and softtissue characterization .

Can detect early bonechange (bone edema).

?? Availability. Expensive?????? Require more time Patient cooperation Sedation requiredContraindications for MR Cranial Metal (Head, Brain,

Orbit). Pacemaker (sensing). Prosthesis. Claustrophobia.

WithAGAINST


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Conventional

Advanced


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Cartilage lesions

Bone marrow edema

Osteophyte


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Grade I lesions as having areas ofinhomogeneous signal intensity of cartilage

Grade IIa lesions, as cartilage defects

involving less than half of the articularcartilage thickness

Grade IIb lesions, as cartilage defects involvingmore than half of the cartilage but less than fullthickness

Grade III lesions, as cartilage defects exposingthe bone.


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Bone marrow edema pattern is defined asdiffuse subchondral low signal intensity on T1-weighted images and high signal intensity on

T2-weighted images. Edema pattern is mild when it is less than 1 cm

in diameter in the long axis on fat-suppressedT2-weighted images.

Moderate when its diameter is 12 cm

Severe when its diameter is larger than 2 cm inthe long axis.


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Osteophytes are classified as mild when theywere located in the joint margins and were lessthan 0.5 cm in diameter when measured from

the base to the tip on T1-weighted images;

when osteophytes were larger than 0.5 cm indiameter, they were defined as severe.


KL 1


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KL 1 , cart.thinning

KL 1, osteophytes

KL 2 , cart. ThinningG II

KL 2, cart.Thinning,G III

KL 3, G IIItibia

KL 4 ,G III

KL 3 BMedema,effusion

KL 4, BMedema,effusion


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A central osteophyte

(arrow) in a patient withadvanced osteoarthritis

with cartilage defects

(arrowhead) at thefemurand tibia


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EffusionGrade II lesionKL 1


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Subchond.cyst, destructionof med.meniscus, effusion

Grade III cartilageKL score 4


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Shoulder MR-Arthrography, SE T1-weighted sequences in axialplanes shows inferior osteophytes (blue arrows) with carilage loss

of the humeral head (yellow arrows).


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Ankle MRI shows Posterior subtalar joint arthritis with bone marrowoedema.


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Delayed Contrast Enhanced MRI of Cartilage

(dGEMRIC) is a new MRI technique

It provides a 3 D image of the joint thatmeasures the volume of cartilage which may

identify early change in cartilage metabolism

Magn Reson Med 49:488492, 2003. Wiley-Liss, Inc


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dGEMRICdGEMRIC MRI ofMRI of leftKnee OAKnee OASagittal T2 map

shows areas withmarkedly increasedT2 values at weight-bearing andposterior aspect of

medial femoralcondyle that areyellow and red


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Colour Map MRI

The end of the femur is erodedand jagged; cracks causingweakening in both bones arealso visible.


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Radionuclide scanning shows increasedactivity during the bone phase in thesubarticular region of any affected joint.

These changes are apparent years before thetypical radiographic changes appear and reflectthe vascular reaction and osteoblastic activitythat are present even in the early stages of

cartilage loss. Scintigraphy , although sensitive, lacks

specificity


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Symmetrical increased isotopeaccumulation in the knees and shoulders


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Finally,

Which modality

.select ?


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In early OAUltrasonography.

MRI and dGEMRIC.

Bone scan (Scintigraphy).

In moderate OA

computed tomography (CT) scan .

X-rays .

In Advanced OA

X-rays .


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Thanks for your attentionThanks for your attention

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Radio Logical Assessment of OA Final

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