1. Institute of Anatomy @ PMU Salzburg Paracelsus Medical University | Strubergasse 21, A-5020 Salzburg | www.pmu.ac.at

2. Team at the Institute of Anatomy Prof. Felix Eckstein, MD Martin Hudelmaier, MD Anja Ruhdorfer, MD, PhD Torben Dannhauer, PhD Wolfgang Wirth, PhD Sebastian Cotofana, MD

3. Chondrometrics GmbH  Founded in 2003  CEO: Prof. Felix Eckstein  Provides quantitative cartilage analyses for industry & academia  Overlap of people between PMU & CHM

4. Institute of Anatomy  Research focus: »Knee osteoarthritis »Structural changes of cartilage and surrounding tissues »Morphometric analyses

5. Portfolio  Morphometric analyses »Usually MRI-based »Manual or semi-automated segmentation »Dedicated software Cartilage MeniscusThigh muscles

6. Portfolio: Cartilage  Measurement of: »Cartilage thickness »Cartilage volume »Cartilage areas (subchondral bone area/ cartilage surface area)  High-resolution, high-field MRI  Manual segmentation with quality control readings P TrF cLF LT pLF MT cMF LT cLF cMF cLF MT LT

7. Portfolio: Cartilage composition  Measurement of T2 (spin-spin) relaxation time  Multi-echo spin-echo MRI  Spin-spin relaxation time in cartilage: »Collagen content »Collagen orientation »Water content  Manual segmentation with QC readings 19.4 ms 38.8 ms 58.2 ms

8. Portfolio: Meniscus  Measurement of: »3D meniscus extrusion »3D meniscus morphology »Tibia plateau coverage »Regional analysis  Manual segmentation with QC readings

9. Portfolio: Muscle  Measurement of: »3D thigh muscle volume »2D anatomical cross-sectional areas (ACSA) »Inter-muscular tissue »Subcutaneous fat »Femoral medulla & corticalis  T1 weighted spin-echo MRI  Manual / semi-automated segmentation

10. Osteoarthritis Initiative (OAI)  Longitudinal multi-center study (8 years)  4796 Participants (45-79 years at baseline)  Data and image assessments publicly available  Focus: »Identification and evaluation of risk factors for incidence / progression of knee OA »Validation of imaging biomarkers  http://www.oai.epi-ucsf.org http://www.oai.epi-ucsf.org

11. OAI: Available assessments  Assessments: »Isometric strength »Physical activity scores »Alignment measurements (full-limb x-rays, knee x-rays) »Physical performance examinations »Knee examination (Joint laxity, …) »Semi-quantitative KLG, JSN, osteophyte readings »Radiographic joint space width »MRI-based cartilage thickness, meniscus, muscle measurements  Questionnaires: »Pain (severity, frequency) »Function »Quality of Life »Medication »Nutrition »Occupation »…

12. OAI Thigh MRI  Acquisition started 100mm proximal to the distal epiphyseal line  Covers 15 slices (5mm slice thickness)  T1-weighted spin-echo MRI  Computation of comparable slices between subjects required  Specific strength (strength / ACSA) Muscle groups Quadriceps Hamstrings Adductors Sartorius Quadriceps heads Vastus medialis Vastus intermedius Vastus lateralis Rectus femors

13. ESR10: Muscle morphology and osteoarthritis disease progression  Objectives: »To identify the role of muscle tissue characteristics in predicting OA joint damage »To assess the impact of joint biomechanics on this relationship  Profile: »Background: Engineering / computer science ? »2 years + PhD program (doctorate of medical sciences) »KneeMo funding: 3 years  Project: »Automation of the segmentation of muscle ACSAs »Quantitative analysis of muscle ACSAs in OAI participants with and without progressive cartilage thickness loss

14. ESR10: Muscle morphology and osteoarthritis disease progression  Cohort selected by the OAI coordinating center (n=445 with Y4 FU)  KLG 2/3 knees (established radiographic OA) »Comparison of change in muscle ACSAs between participants with and without severe cartilage loss (matched cases & controls) »Combination with other assessments (e.g. alignment, knee injuries, joint laxity, meniscus surgery) BLY1Y2Y3Y4 Cartilage thickness Muscle ACSA Progressors Non-progressors

15. ER3: Predicting OA outcome through muscle tissue characteristics  Objective: To establish the predictive value of structural and physiological factors on outcome in KOA  Profile: »Background: Life sciences »KneeMo funding: 2 years  Project: »Quantitative analysis of muscle ACSAs in OAI participants, that underwent total knee replacement surgery »Case-control study with up to 4 years prior to surgery (n=222+) »Available assessments: Cartilage thickness measurements Meniscus measurements Semi-quantitative MRI readings (cartilage lesions, ligaments, bone-marrow lesions, …)

16. ER3: Predicting OA outcome through muscle tissue characteristics  Cohort selected as part of the OAI POMA project (Kwoh & Hunter)  Knees with confirmed knee replacement surgery BL Y1Y2 Y3Y4 Y5 Y6Y7 T0T0 T -1 T -2 T -3 T -4 T0T0 T -1 T -2 T -3 T -4 T -5 T0T0 T -1 T -2 T -3 T -4 T -5 T -6 T0T0 T -1 T -2 T -3

17. Exchange  Anatomy training »Lectures »Dissection course  Quantitative image analysis »Background (MRI) »Techniques  Small projects? »Based on data from the OAI »Quantitative analysis of a small cohort Anatomy training NanoDiaRa project meeting