Researchers on the Path to a Cure – Spotlight on Dr. Xiaojuan Li

Last year we introduced you to Dr. Xiaojuan Li and her Osteoarthritis (OA) Center of Excellence demonstration research project. The project, “Multi-site Multi-Vendor Cross-validation of Cartilage T1rho and T2 imaging”, was completed by investigators from four sites: the Cleveland Clinic Foundation (CCF) in Ohio; the University of California, San Francisco; the University of Kentucky; and the Montefiore Hospital and Albert Einstein College of Medicine in New York. They worked to quantify biomarker assessments in cartilage images obtained through magnetic resonance imaging (MRI).

Currently, X‑rays are the “gold standard” for diagnosing OA. However, X-rays are not very sensitive and only show differences in joints after a lot of damage has already occurred. MRIs are much more sensitive and can detect subtle cellular changes within the joint earlier.

Dr. Li and the investigative team are evaluating new techniques with MRI imaging that can detect biochemical changes within the cartilage matrix before structural changes can be seen. These changes represent promising biomarkers that are more sensitive for detecting the very early stages of OA, and for evaluating cartilage changes after response to treatment.

One of the biggest challenges to testing with MRIs is the variability that can occur between MRI equipment from different manufacturers. Another challenge is the differences that occur from the way tests are done from radiologist to radiologist. The team was able to develop the same acquisition methods across MRI platforms, standardize protocols and compare the imaging results obtained from three different imaging manufacturers commonly used around the U.S. (Siemens, Philips and GE).

The investigative team is very pleased with the results of their work. “Arthritis Foundation donors made our work possible to reduce differences between MRI vendors, allowing for standardized cartilage measurement protocols to be developed,” says Dr. Li. “Our novel MRI acquisition sequences not only measure cartilage thickness and volume changes, but they also allow a much better analysis of the cartilage matrix, which can detect cartilage degeneration much earlier than current MRIs and X-rays. Medical product development and better OA treatments will be brought to market faster and at much less cost, in part because we can detect changes more quickly.”

Dr. Li has plans to refine the results of this research.  She plans to share the protocol with additional sites and find ways to speed up acquisition, as well as fully automate the quantification (measurement) process. “Our method currently takes about 10 minutes for the imaging. With a novel fast-imaging technique, we can reduce the time to less than 5 minutes. The fully automatic quantification method will remove the current, laborious manual process and reduce the potential for human error.”

“This demonstration project represents a huge advancement in the way we look at cartilage in joints,” says Angie Botto-van Bemden, PhD, Arthritis Foundation OA programs director. “These techniques allow us to take a deeper dive when looking at changes in cartilage. They allow us to see disease progression and make predictions about what will happen in individual patients, which we couldn’t do with older techniques. This will allow researchers to shorten the length of clinical trials and help new treatments get to patients faster.”

Dr. Li and her team presented the results of our OA Center of Excellence imaging biomarker demonstration research this past spring at the annual conference of the International Society of Magnetic Resonance in Medicine (Montreal, May 10-13, 2019). Dr. Li will present her team’s research results at the Arthritis Foundation’s first Fellows in Training (FIT) conference in Chicago in September. The FIT conference brings together cutting-edge arthritis researchers and rheumatology fellowship students to learn more about the current state of arthritis treatments and future directions for doctors and patients. Dr. Li has also submitted an abstract describing this research for consideration at the upcoming American College of Rheumatology conference to be held in Atlanta in November.


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