M. Siebelt, J. van Tiel, J. H. Waarsing, T. M. Piscaer, M

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Clinically applied CT arthrography to measure the sulphated glycosaminoglycan content of cartilage M. Siebelt, J. van Tiel, J.H. Waarsing, T.M. Piscaer, M. van Straten, R. Booij, M.L. Dijkshoorn, G.J. Kleinrensink, J.A.N. Verhaar, G.P. Krestin, H. Weinans, E.H.G. Oei Osteoarthritis and Cartilage Volume 19, Issue 10, Pages 1183-1189 (October 2011) DOI: 10.1016/j.joca.2011.07.006 Copyright © 2011 Osteoarthritis Research Society International Terms and Conditions

Fig. 1 Representative sagittally reconstructed images of a knee joint from ncCT (A–C) and after intra-articular contrast injection for CTa (D–F), after segmentation into a binary dataset showing the definition of the ROIs. (G–I), and a 3D representation of all seven analyzed ROIs (J–M): weight-bearing medial and lateral condyle (wbMC/wbLC; posterior medial and lateral condyle of the femur (pMC/pLC); weight-bearing medial and lateral plateau of the tibia (wbMP/wbLP); mid portion of patellar cartilage (mpP). Osteoarthritis and Cartilage 2011 19, 1183-1189DOI: (10.1016/j.joca.2011.07.006) Copyright © 2011 Osteoarthritis Research Society International Terms and Conditions

Fig. 2 Contrast diffusion into cartilage. Comparison of cartilage attenuation between ncCT and CTa scans. A: Box plot of mean attenuation in cartilage from CT and CTa scans per anatomical region. Boxes range from twenty-fifth to seventy-fifth percentile, whiskers run from min to max, the horizontal line in the box represents the median and the plus sign shows the mean. B: Correlated results of mean attenuation from EPIC-μCT and clinical CT scans with and without injected contrast for all anatomical regions combined (n=57). ∗∗∗: P<0.0001. Osteoarthritis and Cartilage 2011 19, 1183-1189DOI: (10.1016/j.joca.2011.07.006) Copyright © 2011 Osteoarthritis Research Society International Terms and Conditions

Fig. 3 Correlation plots of mean attenuation from EPIC-μCT and CTa. A: weight-bearing cartilage of medial and lateral plateaus (n=17). B: weight-bearing and posterior cartilage of medial and lateral condyles (n=17). C: mid-portion of patellar cartilage (n=8). D: pooled results for both tibial and femoral compartments (n=49). E: pooled results for all ROIs (n=57). The dashed lines indicate the 95% confidence interval of the best fit regression line. wbMP: weight-bearing medial plateau, wbMC: weight-bearing medial condyle, pMC: posterior medial condyle, mpP: mid-portion patella, wbLP: weight-bearing lateral plateau, wbLC: weight-bearing lateral condyle, pLC: posterior lateral condyle. Osteoarthritis and Cartilage 2011 19, 1183-1189DOI: (10.1016/j.joca.2011.07.006) Copyright © 2011 Osteoarthritis Research Society International Terms and Conditions

Fig. 4 Images of both EPIC-μCT and CTa. The attenuation of cartilage regions is visualized in colour and representative for sGAG content. High levels of attenuation represent a low sGAG-distribution. Osteoarthritis and Cartilage 2011 19, 1183-1189DOI: (10.1016/j.joca.2011.07.006) Copyright © 2011 Osteoarthritis Research Society International Terms and Conditions

Fig. 5 Predictive CTa value (horizontal axis) based best fitted model from EPIC-μCT (sGAG) and ncCT residuals (cartilage ECM composition) correlated with mean attenuation of CTa (vertical axis) (n=57). The dashed lines indicate the 95% confidence interval of the best fit regression line. wbMP: weight-bearing medial plateau, wbMC: weight-bearing medial condyle, pMC: posterior medial condyle, mpP: mid-portion patella, wbLP: weight-bearing lateral plateau, wbLC: weight-bearing lateral condyle, pLC: posterior lateral condyle. Osteoarthritis and Cartilage 2011 19, 1183-1189DOI: (10.1016/j.joca.2011.07.006) Copyright © 2011 Osteoarthritis Research Society International Terms and Conditions