Quantification of cartilage loss in local regions of knee joints using semi-automated segmentation software: analysis of longitudinal data from the Osteoarthritis Initiative (OAI).

INTRODUCTION: Quantitative cartilage morphometry is a valuable tool to assess osteoarthritis (OA) progression. Current methodologies generally evaluate cartilage morphometry in a full or partial sub-region of the cartilage plates. This report describes the evaluation of a semi-automated cartilage segmentation software tool capable of quantifying cartilage loss in a local indexed region. METHODS: We examined the baseline and 24-month follow-up MRI image sets of twenty-four subjects from the progression cohort of Osteoarthritis Initiative (OAI), using the Kellgren-Lawrence (KL) score of 3 at baseline as the inclusion criteria. A radiologist independently marked a single region of local thinning for each subject, and three additional readers, blinded to time point, segmented the cartilage using a semi-automated software method. Each baseline-24-month segmentation pair was then registered in 3D and the change in cartilage volume was measured. RESULTS: After 3D registration, the change in cartilage volume was calculated in specified regions centered at the marked point, and for the entire medial compartment of femur. The responsiveness was quantified using the standardized response mean (SRM) values and the percentage of subjects that showed a loss in cartilage volume. The most responsive measure of change was SRM=-1.21, and was found for a region of 10mm from the indexed point. DISCUSSION: The results suggest that measurement of cartilage loss in a local region is superior to larger areas and to the total plate. There also may be an optimal region size (10mm from an indexed point) in which to measure change. In principle, the method is substantially faster than segmenting entire plates or sub-regions.

Aortoesophageal fistula due to caustic ingestion.

PURPOSE: Caustic agent ingestion may produce corrosive lesions that can extend beyond adjacent organs. We report three cases of aortoesophageal fistulas (AEF) after caustic ingestion that were diagnosed by autopsy. RESULTS: AEF is a fatal complication that should be suspected in any patient with caustic ingestion who presents with gastrointestinal bleeding. A high index of suspicion, early recognition by gastrointestinal endoscopy, computed tomography scan, and aortography are important to improve the outcome.