Bone and cartilage demonstrate changes localized to bone marrow edema-like lesions within osteoarthritic knees G.J. Kazakia, D. Kuo, J. Schooler, S.

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Bone and cartilage demonstrate changes localized to bone marrow edema-like lesions within osteoarthritic knees G.J. Kazakia, D. Kuo, J. Schooler, S. Siddiqui, S. Shanbhag, G. Bernstein, A. Horvai, S. Majumdar, M. Ries, X. Li Osteoarthritis and Cartilage Volume 21, Issue 1, Pages 94-101 (January 2013) DOI: 10.1016/j.joca.2012.09.008 Copyright © 2012 Osteoarthritis Research Society International Terms and Conditions

Fig. 1 Schematic of study workflow. The tibial plateau is obtained during surgery and scanned via MR and HR-pQCT. A contour delineating the BMEL region is defined on T2-weighted FSE images and transformed to the HR-pQCT coordinate system following spatial registration of the two data sets. Cartilage overlying BMEL (red) is differentiated from surrounding cartilage (green) and overlaid onto the reconstructed T1ρ and T2 maps for cartilage parameter calculation. Adjacent slices containing BMEL are dissected from the specimen and processed for μCT imaging and FTIR spectroscopy (slice A) and histology (slice B). Osteoarthritis and Cartilage 2013 21, 94-101DOI: (10.1016/j.joca.2012.09.008) Copyright © 2012 Osteoarthritis Research Society International Terms and Conditions

Fig. 2 Representative renderings of HR-pQCT and μCT data. Left: sagittal cut-away view of an HR-pQCT scan of the entire tibial plateau, with BMEL analysis contour overlaid. Right: μCT scans of a BMEL and a non-BMEL region, with analysis region overlaid. Osteoarthritis and Cartilage 2013 21, 94-101DOI: (10.1016/j.joca.2012.09.008) Copyright © 2012 Osteoarthritis Research Society International Terms and Conditions

Fig. 3 T1ρ and T2 values in cartilage overlying BMEL regions compared to those in surrounding cartilage. T1ρ values (left, n = 5 from four donors) were significantly higher (P = 0.046) in the cartilage overlying the lesion. T2 values (left, n = 4 from three donors) followed the same trend but did not reach significance. Osteoarthritis and Cartilage 2013 21, 94-101DOI: (10.1016/j.joca.2012.09.008) Copyright © 2012 Osteoarthritis Research Society International Terms and Conditions

Fig. 4 FTIR parameter values within BMEL regions compared to those in non-BMEL bone (n = 16 from 10 donors). Mineral-to-matrix ratio (left, P < 0.001) and carbonate-to-matrix ratio (right, P = 0.008) were reduced within BMEL tissue. Error bars indicate 95% confidence intervals. Osteoarthritis and Cartilage 2013 21, 94-101DOI: (10.1016/j.joca.2012.09.008) Copyright © 2012 Osteoarthritis Research Society International Terms and Conditions

Fig. 5 Histological sections (H&E stained) taken from regions of the tibial plateau with evidence of BMEL (A, B, C) and without BMEL (D, E). The corresponding T2-weighted fat-saturated FSE image is shown below for reference. BMEL regions display mixed pathology including infiltration of marrow space by fibrous collagen network (A, B, C), bone remodeling (A) and formation (B, C). Fibrillation of overlying cartilage can also be seen (A). Tissues taken from uninvolved regions of the tibial plateau show none of these features, but rather confirm quiescent bone with adipocyte-filled marrow space (D, E). Osteoarthritis and Cartilage 2013 21, 94-101DOI: (10.1016/j.joca.2012.09.008) Copyright © 2012 Osteoarthritis Research Society International Terms and Conditions