Reliability of diffraction enhanced imaging for assessment of cartilage lesions, ex vivo

The assessment of articular cartilage integrity is of value for the detection of early degenerative joint disease in both the clinical and the research settings. It was the purpose of this study to determine the accuracy and reliability of identifying articular cartilage defects through Diffraction Enhanced Imaging (DEI), a high contrast radiographic imaging technique. DEI provides two new sources of image contrast to radiography: refraction and scatter rejection, besides the absorption of conventional radiography.

Cadaveric tali were DEI imaged in the anterior-posterior position at the National Synchrotron Light Source. Two independent observers provided gross score evaluations (on a five point scale) of the trochlear surfaces. The DEI image of each trochlear surface was then graded (on a five point scale) by two additional independent observers who were blinded with regard to the gross evaluation of the articular surfaces. Inter-observer agreement for DEI grades was assessed with the weighted kappa statistic. Correlation of diffraction enhanced image score to the gross score was assessed with Spearman correlation coefficient.

The defects of articular cartilage of talar trochleae could be visualized through DEI. The Spearman correlation of gross grades with DEI grades on the 165 talar regions for observers 1 and 2 were 0.91 and 0.91, respectively. The overall weighted kappa value for inter-observer agreement was 0.93, thus considered high agreement.

DEI is accurate and reliable for detection of articular cartilage defects ex vivo. Even early stages of degeneration of cartilage can be visualized with this high contrast technique. Future studies will focus on the application of DEI to the identification of such lesions in vivo.