Imaging of Osteoarthritis—Latest Advancements

Targeted CE per ARRT’s Discipline, Category, and Subcategory classification:
[Note: Discipline-specific Targeted CE credits may be less than the total Category A credits approved for this course.]

Computed Tomography: 0.50
Procedures: 0.50
Head, Spine, and Musculoskeletal: 0.50

Magnetic Resonance Imaging: 1.25
Procedures: 1.25
Musculoskeletal: 1.25

Nuclear Medicine Technology: 0.25
Procedures: 0.25
Other Imaging Procedures: 0.25

Radiography: 0.50
Procedures: 0.50
Extremity Procedures: 0.50

Registered Radiologist Assistant: 1.25
Procedures: 1.25
Musculoskeletal and Endocrine Sections: 1.25

Sonography: 0.50
Procedures: 0.50
Superficial Structures and Other Sonographic Procedures: 0.50

Outline

1. Introduction
2. Radiography
3. US Imaging
4. CT Imaging
5. Nuclear Medicine
6. Semiquantitative MRI Assessment
7. Quantitative MRI Analysis of Articular Cartilage
8. Compositional MRI
9. Artificial Intelligence in MRI Assessment
10. Other Joints, Beyond the Knee
11. Treatments for OA
12. Outlook for OA

Objectives

Upon completion of this course, students will:

1. describe the estimated proportion of the population aged 45 years or older that will have physician-diagnosed knee OA
2. list the factors that may play an important role in the early stages of osteoarthritis
3. identify the imaging modality that has traditionally been used to assess osteoarthritis structural changes
4. identify the most important imaging modality used to evaluate osteoarthritis in a research context
5. describe the imaging features associated with the different grades of the Kellgren-Lawrence grading scheme
6. describe the most widely applied radiographic criterion for defining the presence of structural osteoarthritis
7. identify the Kellgren-Lawrence grade of OA associated with a definite osteophyte on radiographs
8. describe the use of imaging in phase III clinical trials of OA drugs
9. identify the radiographic view commonly used to visualize joint space narrowing in the knee
10. list the strengths of US over other modalities in the assessment of OA
11. describe the sensitivity of US imaging over radiography in the evaluation of abnormalities in the knee
12. identify the CT imaging technique that can discriminate meniscal calcium pyrophosphate deposits from calcium hydroxyapatite
13. describe the temporal resolution of four-dimensional CT used for kinematic CT acquisitions of the knee
14. identify the CT technique that requires the intra-articular injection of contrast material
15. list the knee structures which can be assessed accurately with CT arthrography
16. describe the usefulness of PET imaging in the setting of OA
17. identify the imaging modality that does not play a role in the diagnosis and decision-making processes of knee OA
18. describe the first published MRI scoring system that has been used extensively for almost 2 decades in a multitude of OA studies worldwide
19. list the semiquantitative MRI scoring systems that assess cartilage size and depth on a scale from 0 to 3
20. list the semiquantitative MRI scoring systems that include assessment of the Hoffa fat pad for synovitis
21. list the three main structural phenotypes of OA
22. identify the semiquantitative MRI scoring system that can achieve phenotypic characterization of OA based on a simplified MRI assessment
23. list the compositional MRI techniques that assess glycosaminoglycans in cartilage
24. list the compositional MRI techniques that can be limited by magic angle effects
25. describe the location of regional cartilage thickening that may be an early event in OA pathophysiology
26. list the OA treatments that are evaluated using quantitative MRI measurements of cartilage volume and thickness change
27. identify the compositional MRI techniques that have been used to evaluate OA in most research studies
28. describe the use of compositional MRI using T2 quantification in the assessment of OA
29. identify the body joints where T1ρ mapping has been shown to be a predictor of OA progression.
30. list the tissues that have been successfully segmented using deep learning approaches in fully automated MRI segmentation
31. describe the use of deep learning methods to assign grades to assess OA severity on knee radiographs
32. list the OA-associated structural joint pathologies that can be identified by MRI deep learning approaches
33. describe subtle but clinically relevant changes at MRI that may be missed by deep learning neural networks
34. list the reasons why less attention has been paid to imaging OA in the hip
35. describe the evaluation focus of the Hip Inflammation MRI Scoring System
36. identify the imaging techniques that can assess the biochemical composition of cartilage
37. identify the imaging techniques associated with a long imaging time
38. describe the compositional MRI technique used to evaluate the hip prior to acetabular osteotomy in patients with developmental hip dysplasia
39. describe treatments for OA based on the recommended hierarchy of management
40. identify the class of drugs associated with safety concerns during clinical trials