Multimodality scoring of chondral injuries in the equine fetlock joint ex vivo

J K Sarin; H Brommer; D Argüelles; P H Puhakka; S I Inkinen; I O Afara; S Saarakkala; J Töyräs

doi:10.1016/j.joca.2016.12.007

Multimodality scoring of chondral injuries in the equine fetlock joint ex vivo

Osteoarthritis Cartilage. 2017 May;25(5):790-798. doi: 10.1016/j.joca.2016.12.007. Epub 2016 Dec 10.

Authors

J K Sarin¹, H Brommer², D Argüelles³, P H Puhakka⁴, S I Inkinen⁵, I O Afara⁶, S Saarakkala⁷, J Töyräs⁸

Affiliations

¹ Department of Applied Physics, University of Eastern Finland, Kuopio, Finland; Diagnostic Imaging Center, Kuopio University Hospital, Kuopio, Finland. Electronic address: jaakko.sarin@uef.fi.
² Department of Equine Sciences, Utrecht University, Utrecht, The Netherlands. Electronic address: H.Brommer@uu.nl.
³ Veterinary Teaching Hospital, School of Veterinary Medicine, University of Helsinki, Helsinki, Finland. Electronic address: darguelles@uco.es.
⁴ Department of Applied Physics, University of Eastern Finland, Kuopio, Finland; Diagnostic Imaging Center, Kuopio University Hospital, Kuopio, Finland. Electronic address: Pia.Puhakka@essote.fi.
⁵ Department of Applied Physics, University of Eastern Finland, Kuopio, Finland. Electronic address: satu.inkinen@uef.fi.
⁶ Department of Applied Physics, University of Eastern Finland, Kuopio, Finland; Diagnostic Imaging Center, Kuopio University Hospital, Kuopio, Finland; Department of Electrical and Computer Engineering, Elizade University, Ondo, Nigeria. Electronic address: isaac.afara@uef.fi.
⁷ Research Unit of Medical Imaging, Physics and Technology, Faculty of Medicine, University of Oulu, Oulu, Finland; Medical Research Center Oulu, Oulu University Hospital and University of Oulu, Oulu, Finland; Department of Diagnostic Radiology, Oulu University Hospital, Oulu, Finland. Electronic address: simo.saarakkala@oulu.fi.
⁸ Department of Applied Physics, University of Eastern Finland, Kuopio, Finland; Diagnostic Imaging Center, Kuopio University Hospital, Kuopio, Finland. Electronic address: juha.toyras@uef.fi.

PMID: 27965140
DOI: 10.1016/j.joca.2016.12.007

Abstract

Objective: We investigate the potential of a prototype multimodality arthroscope, combining ultrasound, optical coherence tomography (OCT) and arthroscopic indentation device, for assessing cartilage lesions, and compare the reliability of this approach with conventional arthroscopic scoring ex vivo.

Design: Areas of interest (AIs, N = 43) were selected from equine fetlock joints (N = 5). Blind-coded AIs were independently scored by two equine surgeons employing International Cartilage Repair Society (ICRS) scoring system via conventional arthroscope and multimodality arthroscope, in which high-frequency ultrasound and OCT catheters were attached to an arthroscopic indentation device. In addition, cartilage stiffness was measured with the indentation device, and lesions in OCT images scored using custom-made automated software. Measurements and scorings were performed twice in two separate rounds. Finally, the scores were compared to histological ICRS scores.

Results: OCT and arthroscopic examinations showed the highest average agreements (55.2%) between the scoring by surgeons and histology scores, whereas ultrasound had the lowest (50.6%). Average intraobserver agreements of surgeons and interobserver agreements between rounds were, respectively, for conventional arthroscope (68.6%, 69.8%), ultrasound (68.6%, 68.6%), OCT (65.1%, 61.7%) and automated software (65.1%, 59.3%).

Conclusions: OCT imaging supplemented with the automated software provided the most reliable lesion scoring. However, limited penetration depth of light limits the clinical potential of OCT in assessing human cartilage thickness; thus, the combination of OCT and ultrasound could be optimal for reliable diagnostics. Present findings suggest imaging and quantitatively analyzing the entire articular surface to eliminate surgeon-related variation in the selection of the most severe lesion to be scored.

Keywords: Cartilage; Injury; Reliability; Reproducibility; Scoring.

Publication types

Comparative Study
Research Support, Non-U.S. Gov't

MeSH terms

Animals
Arthroscopy / methods
Cadaver
Cartilage, Articular / diagnostic imaging
Cartilage, Articular / pathology*
Finland
Foot Injuries / diagnostic imaging*
Foot Joints / diagnostic imaging*
Foot Joints / pathology
Horses
Injury Severity Score
Multimodal Imaging / methods*
Observer Variation
Reproducibility of Results
Tomography, Optical Coherence / methods
Ultrasonography, Doppler / methods