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Using IntelliSpace Portal for assessment of cartilage

Application Tip
van Meel, Marius Philips Healthcare • Netherlands
van Poppel, Siryl Philips Healthcare • Netherlands
Peusens, Harry Philips Healthcare • Netherlands

IntelliSpace Portal is a thin-client solution, designed to work virtually anywhere and without the need for a special workstation. Cartilage Assessment is one of the powerful applications offered on IntelliSpace. It features creation of rectangular and curved layered ROIs, and for detailed cartilage analysis it provides subdivision of different layers in cartilage. The package also provides calculated T2 values (T2 being usually higher in damaged cartilage). The possibilities this cartilage package offers are developed to support patient communication, to evaluate disease progression and to compare results in follow-up after therapy.

Tip 1: Benefit from the immediate results

Users of postprocessing packages often indicate that reduction of postprocessing time and reproducibility of results are important conditions for adoption of analysis tools in clinical routine. That’s why IntelliSpace Portal is designed for fast and easy processing. The Cartilage Assessment application is an excellent example of this philosophy.

When the package opens, it has already selected the correct image series from the study, and the T2 map is shown as a fused overlay on the original series. The screen layout supports the physician by providing the relevant information at a glance.

                      Anatomical image                          T2 color map fused with anatomical image

     Table viewer                                           Graph viewer

Tip 2: Follow the task-guided workflow

The left part of the screen provides task guidance: all choices are presented in a logical order with default choices already pre-selected. This guided workflow makes the package easy to use; it requires only a few clicks for fast and easy viewing. This helps to obtain reproducible results – even between different users – and to reduce training efforts of staff.

1. Rectangular layered ROI
A rectangular layered ROI can be used to quickly analyze focal lesions. The ROI can be divided in 1 to 3 layers.

2. Curved layered ROI
A curved layered ROI can be used to segment a complete cartilage structure. By placing multiple points to define the ROI, the actual curvature of the cartilage can be followed.

Layers and segments
Drag the slider to quickly change the number of layers in the ROI within the range from 1 to 3. Curved layered ROIs can further be divided into segments to help analyze cartilage structure.

3. Optimize Coloc Overlay
See tip 5 on using these tools to optimize the color maps display.

4. Generates Maps
Use this button to produce the T2 color maps, optionally rename the generated series. Drawn ROIs will not be displayed on the maps.

Click the question mark to reveal relevant tips.

Tip 3: Adapt the T2 color map to your preference

At first use, the default “Reversed Rainbow” style will show, with a T2 value range of 1 to 81 ms. This can be changed according to your preference and new settings can be stored. Changing the color scale affects the visualization of the results in the graph viewer.

The T2 value range can be changed to preset 0-100 ms, or a user defined range can be set via Modify range.

Tip 4: Drawing a rectangular layered ROI for focal lesion analysis

A rectangular layered ROI can be used to analyze focal lesions. A default ROI has three layers and can be drawn in the anatomical viewer or directly on the color map.

Draw the ROI by placing the first point on the bonecartilage interface on one side of the lesion and the second point on the other side of the lesion. Then drag the cursor to the cartilage surface for placing the third point. This finishes the ROI drawing.

The table viewer shows the average T2 value per layer for each ROI. The graph viewer displays the average T2 values in a bar chart. Bar color corresponds to the average T2 value in the selected color scale.

Click on an ROI in the table viewer to jump to the slice it is drawn on – useful when ROIs are in different slices.

The graph viewer only shows graphs of the selected ROI. Click in the table viewer to quickly select ROI’s. Up to three rectangular layered ROIs can be displayed simultaneously in the graph viewer.

Tip 5: Drawing a curved layered ROI adapted to the cartilage shape

A curved layered ROI is used to analyze a complete cartilage structure. The curved ROI can be adapted to the actual shape of cartilage.

A curved layered ROI can be drawn on the anatomical image or directly on the color map. When drawing on the color map, it might be useful to adapt the opacity of the color map with the slider, or by dragging with the right mouse button in the color map directly.

 Click the  Then draw the cartilage surface in a similar manner.
Click the "Draw bone surface" icon, and draw a line across the bone-cartilage interface by placing multiple points. Double click the last point to finalize. As this is a precise task, it is important to zoom in to the assessed area.
Then draw the cartilage surface in a similar manner.

 After drawing, segments can be resized, for instance to the lesion size or weight-baring area.
After drawing, segments can be resized, for instance to the lesion size or weight-baring area.

 The ROI name can be changed by clicking on it.
The ROI name can be changed by clicking on it.

Tip 6: Cut out colors for enhanced visibility of results

Two types of cut-out are possible to create a clear display of relevant results.

The option “Suppress colors outside ROIs” provides good results with curved ROIs where the cartilage structure has been segmented by the user. It affects only the slices with the ROI.

Manual cut-out is recommended for rectangular ROIs, or when only color maps are generated. A manual cut-out will propagate over all slices.

Tip 7: Example micro fracture treatment results

A curved layered ROI is drawn on a knee after micro fracture treatment. Segment B was resized to the size of the treatment area. The graph viewer provides an easy way to see the results in a glance. It displays all three segments, each subdivided into three layers. Segment B, the treatment area, shows slightly increased T2 in the deep layer, but the intermediate and superficial layers have the highest T2 (blue in this case). Usually damaged cartilage has higher T2 values.

Tip 8: Exporting results

To export the results as Comma Separated Values, first click the table viewer and then press 'Ctrl C'. The results can now be pasted into any spreadsheet program.

A selected image or the entire display can be saved as secondary capture to the Portal database or directly to the PACS.

Alternatively, all results can be saved to a customizable report that can be shared with referring physicians.

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Oct 25, 2012

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Application Tip
cartilage, Knee, Musculoskeletal

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