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Ann Biomed Eng. 2019 Oct 1. doi: 10.1007/s10439-019-02362-6. [Epub ahead of print]

Triple Contrast CT Method Enables Simultaneous Evaluation of Articular Cartilage Composition and Segmentation.

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Department of Applied Physics, University of Eastern Finland, P.O. Box 1627, 70211, Kuopio, Finland.
Diagnostic Imaging Center, Kuopio University Hospital, Kuopio, Finland.
Department of Applied Physics, University of Eastern Finland, P.O. Box 1627, 70211, Kuopio, Finland.
Department of Medical Physics, Turku University Hospital, Turku, Finland.
SIB-labs, University of Eastern Finland, Kuopio, Finland.
Centre d'Imagerie BioMédicale, École Polytechnique Fédérale de Lausanne, Lausanne, Switzerland.
Swiss Light Source, Paul Scherrer Institute, Villigen, Switzerland.
Center of Oncology, Kuopio University Hospital, Kuopio, Finland.
Departments of Biomedical Engineering, Chemistry, and Medicine, Boston University, Boston, MA, USA.
Diagnostic Imaging Center, Kuopio University Hospital, Kuopio, Finland.
School of Information Technology and Electrical Engineering, The University of Queensland, Brisbane, Australia.


Early degenerative changes of articular cartilage are detected using contrast-enhanced computed tomography (CT) with a cationic contrast agent (CA). However, cationic CA diffusion into degenerated cartilage decreases with proteoglycan depletion and increases with elevated water content, thus hampering tissue evaluation at early diffusion time points. Furthermore, the contrast at synovial fluid-cartilage interface diminishes as a function of diffusion time hindering accurate cartilage segmentation. For the first time, we employ quantitative dual-energy CT (QDECT) imaging utilizing a mixture of three CAs (cationic CA4+ and non-ionic gadoteridol which are sensitive to proteoglycan and water contents, respectively, and bismuth nanoparticles which highlight the cartilage surface) to simultaneously segment the articulating surfaces and determine of the cartilage condition. Intact healthy, proteoglycan-depleted, and mechanically injured bovine cartilage samples (n = 27) were halved and imaged with synchrotron microCT 2-h post immersion in triple CA or in dual CA (CA4+ and gadoteridol). CA4+ and gadoteridol partitions were determined using QDECT, and pairwise evaluation of these partitions was conducted for samples immersed in dual and triple CAs. In conclusion, the triple CA method is sensitive to proteoglycan depletion while maintaining sufficient contrast at the articular surface to enable detection of cartilage lesions caused by mechanical impact.


Computed tomography; Contrast-enhanced computed tomography; Dual contrast agent; Post-traumatic osteoarthritis; Synchrotron microCT; Triple contrast agent


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