Funding

Osteoarthritis Initiative

Updated June 24, 1999 (historical)

Summary of Imaging Subcommittee Discussions

Subcommittee participants:

Victor Goldberg, Chair (Case Western Reserve University)1
Chhanda Dutta (National Institute on Aging)
David Wilde (National Center for Research Resources)
Deborah Burstein (Harvard Medical School)
Ken Brandt (University of Indiana)
Charles Peterfy (Synarc)
Micael Daley (Sanofi-Synthelabo)
Iris Loew-Friedrich (Hoechst Marion Roussel (US)
Elizabeth Arner (DuPont)
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1 representing the American Academy of Orthopaedic Research

Focus questions for consideration include:

  • Which imaging modalities might hold promise for measuring the risk for/or progression of OA? What imaging technologies should be considered as priorities to evaluate by the consortium?

  • What standardization protocols should be developed?

  • Is there a need to include/encourage technology/software developers to participate in the development of the consortium? If so, how?

  • Building on currently existing radiographic parameters of measuring OA, how can future cohorts foster more precise and accurate measures of disease?

  • Should the focus be on cartilage, bone or combination of the two?

  • Is there any role for: kinesthetic imaging? ergonomics? joints in motion?

Imaging should take into consideration issues such as muscle strength/physical function. The focus should be on the joint as an organ thus including not only cartilage but also bone, ligament, synovium, tendon, and muscle. OA as a clinical entity is associated with varying presentations. Unless one has selected the cohort to be studied, it becomes difficult to determine which imaging mode is most valuable. The discussions emphasized the need to define the natural history of the disease and to evaluate the impact of exercise on disease progression.

  1. What imaging technologies should be considered as priorities to evaluate?

    The imaging technology used would depend on purpose:

    • Detection of new cases

    • Documentation of progression

    • Monitoring therapy (safety & efficacy)

  2. What are the relevant joints to study?

    Knee vs. ankle: knee is the major public health problem. Also the knee is an ideal joint for imaging purposes.
    Once hip OA becomes symptomatic the progression is rapid and leads to faster hip replacement. The progression of knee OA is slower and does not proceed as rapidly to joint replacement.

  3. What is the purpose of the bioimaging biomarkers?

  4. What quality control issues should be used for current imaging techniques to insure proper and uniform positioning of patient, of the joint; this becomes very important if one desires to monitor progression and not merely incidence?

  5. What are the new imaging modalities?

    Application of fluoroscopy - can we have high reproducibility of imaging fluoroscopy?
    Digitization of images - joint space width and thickness in knee and hip - this increases precision 2x, 3x
    NMR spectroscopy - signal to noise ratio is the major problem for use in OA

  6. Low load on old bone vs. heavy load on young bone. What is the role of subchondral bone in OA? Maybe CT would be useful? CT to supplement MRI scan?

  7. Instead of trying to develop new imaging techniques one feasible approach may be to develop new application of currently existing technologies.

  8. Imaging techniques, which provide " compositional " information on the joint. Can we quantify amounts of collagen or proteoglycan remaining in the affected joint?

Agenda Items To Be Addressed:

  1. Which joints and tissues should be studied? Patients/ Cohorts?

  2. Relationship of imaging to clinical symptoms such as pain and function? (Structural and function)

    • Radiography

    • C.T.

    • Magnetic resonance

  3. Relationship between image and progression?

  4. Imaging needs to speed up approval procedure.

  5. Developing imaging methodology for structural changes, which are predictive of disease progression.

  6. What is the minimal time course to demonstrate a change?

  7. Standardization issue.

  8. Promising imaging modalities

  9. Database needs.

Possible Topics to address questions:

  1. Fluoroscopes technology / standardization

  2. Performance matrix of imaging for clinical trial

  3. Chemistry / structural issues of imaging.

    • MRI

    • Sodium Imaging

  4. OCI (Optical Coherence Tomography) application in knee OA.

  5. Exportability of standardization procedures to clinical trials

  6. Kinematics and Imaging of knee joints Animal models - In Vivo and Ex vivo Validation of Imaging techniques.

  7. Overview/ Introduction to the interface of the different areas of importance to the development of Bioimaging Biomarkers.

  8. What are the respective strengths / weaknesses of bioimaging vs. biochemical biomarkers? The outcome being the onset and progression of OA.