Cluster analysis of quantitative MRI T2 and T1ρ relaxation times of cartilage identifies differences between healthy and ACL-injured individuals at 3T

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Cluster analysis of quantitative MRI T2 and T1ρ relaxation times of cartilage identifies differences between healthy and ACL-injured individuals at 3T U.D. Monu, C.D. Jordan, B.L. Samuelson, B.A. Hargreaves, G.E. Gold, E.J. McWalter Osteoarthritis and Cartilage Volume 25, Issue 4, Pages 513-520 (April 2017) DOI: 10.1016/j.joca.2016.09.015 Copyright © 2016 Osteoarthritis Research Society International Terms and Conditions

Fig. 1 i. The methods flow chart shows the image acquisition using the DESS and CubeQuant sequences (A), the pre-processing steps involving registration, quantitative map fitting and 3D manual segmentation (B) and the best fit cylinder and unwrapping of the cartilage using radial projection lines (C) to create a projection map plotting the angular location of the cartilage against the slice width in mm (D). ii. Registration: Axial rotation and re-slicing of the knee to define the anatomically based sagittal plane perpendicular to the tangential line through the most posterior points of the femoral condyles and slices of equal longitudinal coverage across the knee. Pre-rotation sagittal images demonstrate the misalignment of the posterior condyles (black arrow) that is corrected after rotation. iii. Manual segmentation: Sample ACL-injured patient with a metal artifact in one of the slices. During segmentation, sufficient distance to the artifact was left so that no signal pileup or void was captured. Osteoarthritis and Cartilage 2017 25, 513-520DOI: (10.1016/j.joca.2016.09.015) Copyright © 2016 Osteoarthritis Research Society International Terms and Conditions

Fig. 2 Cluster map pipeline showing the difference maps (A) used with the determined intensity (B) and area (C) thresholds to create the final cluster map. Osteoarthritis and Cartilage 2017 25, 513-520DOI: (10.1016/j.joca.2016.09.015) Copyright © 2016 Osteoarthritis Research Society International Terms and Conditions

Fig. 3 % Cluster areas of projection maps covered by clusters in the ACL-injured population for both T2 and T1ρ as compared to the healthy volunteers. A T2 elevation threshold of +9 ms and a T1ρ elevation threshold of +10.8 ms was applied at 6 months and 1 year with individual %CA's shown in 14 (T2) and 17 (T1ρ) ACL-injured patients and averaged %CAs shown in both populations. Osteoarthritis and Cartilage 2017 25, 513-520DOI: (10.1016/j.joca.2016.09.015) Copyright © 2016 Osteoarthritis Research Society International Terms and Conditions

Electronic Appendix Figure The difference maps and cluster projection maps of the T2 and T1ρ relaxation times of two patients demonstrate the changes in the 3D cartilage volume at 6 months and 1 year, as compared to baseline. The two patients had an ACL-tear and subsequent ACL-reconstruction. (a) The difference maps demonstrate a focal change in quantitative T2 and T1ρ values with the subsequent cluster maps while (b) demonstrates a diffused change in quantitative T2 and T1ρ values with the subsequent cluster maps. Osteoarthritis and Cartilage 2017 25, 513-520DOI: (10.1016/j.joca.2016.09.015) Copyright © 2016 Osteoarthritis Research Society International Terms and Conditions