Lauren Watkins

All Publications

• Correction to: Multimodal positron emission tomography (PET) imaging in non-oncologic musculoskeletal radiology. Skeletal radiology Kogan, F., Yoon, D., Teeter, M. G., Chaudhari, A. J., Hales, L., Barbieri, M., Gold, G. E., Vainberg, Y., Goyal, A., Watkins, L. 2024

  View details for DOI 10.1007/s00256-024-04667-7

  View details for PubMedID 38557699

• Multimodal positron emission tomography (PET) imaging in non-oncologic musculoskeletal radiology. Skeletal radiology Kogan, F., Yoon, D., Teeter, M. G., Chaudhari, A. J., Hales, L., Barbieri, M., Gold, G. E., Vainberg, Y., Goyal, A., Watkins, L. 2024

  Abstract

  Musculoskeletal (MSK) disorders are associated with large impacts on patient's pain and quality of life. Conventional morphological imaging of tissue structure is limited in its ability to detect pain generators, early MSK disease, and rapidly assess treatment efficacy. Positron emission tomography (PET), which offers unique capabilities to evaluate molecular and metabolic processes, can provide novel information about early pathophysiologic changes that occur before structural or even microstructural changes can be detected. This sensitivity not only makes it a powerful tool for detection and characterization of disease, but also a tool able to rapidly assess the efficacy of therapies. These benefits have garnered more attention to PET imaging of MSK disorders in recent years. In this narrative review, we discuss several applications of multimodal PET imaging in non-oncologic MSK diseases including arthritis, osteoporosis, and sources of pain and inflammation. We also describe technical considerations and recent advancements in technology and radiotracers as well as areas of emerging interest for future applications of multimodal PET imaging of MSK conditions. Overall, we present evidence that the incorporation of PET through multimodal imaging offers an exciting addition to the field of MSK radiology and will likely prove valuable in the transition to an era of precision medicine.

  View details for DOI 10.1007/s00256-024-04640-4

  View details for PubMedID 38492029

  View details for PubMedCentralID 6899769

• Changes in tissue sodium concentration and sodium relaxation times during the maturation of human knee cartilage: Ex vivo 23 Na MRI study at 10.5 T. Magnetic resonance in medicine Zbýň, Š., Ludwig, K. D., Watkins, L. E., Lagore, R. L., Nowacki, A., Tóth, F., Tompkins, M. A., Zhang, L., Adriany, G., Gold, G. E., Shea, K. G., Nagel, A. M., Carlson, C. S., Metzger, G. J., Ellermann, J. M. 2023

  Abstract

  To evaluate the influence of skeletal maturation on sodium (23 Na) MRI relaxation parameters and the accuracy of tissue sodium concentration (TSC) quantification in human knee cartilage.Twelve pediatric knee specimens were imaged with whole-body 10.5 T MRI using a density-adapted 3D radial projection sequence to evaluate 23 Na parameters: B1 + , T1 , biexponential T 2 * $$ {\mathrm{T}}_2^{\ast } $$ , and TSC. Water, collagen, and sulfated glycosaminoglycan (sGAG) content were calculated from osteochondral biopsies. The TSC was corrected for B1 + , relaxation, and water content. The literature-based TSC (TSCLB ) used previously published values for corrections, whereas the specimen-specific TSC (TSCSP ) used measurements from individual specimens. 23 Na parameters were evaluated in eight cartilage compartments segmented on proton images. Associations between 23 Na parameters, TSCLB  - TSCSP difference, biochemical content, and age were determined.From birth to 12 years, cartilage water content decreased by 18%; collagen increased by 59%; and sGAG decreased by 36% (all R2  ≥ 0.557). The short T 2 * $$ {\mathrm{T}}_2^{\ast } $$ ( T 2 * S $$ {{\mathrm{T}}_2^{\ast}}_{\mathrm{S}} $$ ) decreased by 72%, and the signal fraction relaxing with T 2 * S $$ {{\mathrm{T}}_2^{\ast}}_{\mathrm{S}} $$ ( fT 2 * S $$ {{\mathrm{fT}}_2^{\ast}}_{\mathrm{S}} $$ ) increased by 55% during the first 5 years but remained relatively stable after that. TSCSP was significantly correlated with sGAG content from biopsies (R2  = 0.739). Depending on age, TSCLB showed higher or lower values than TSCSP . The TSCLB  - TSCSP difference was significantly correlated with T 2 * S $$ {{\mathrm{T}}_2^{\ast}}_{\mathrm{S}} $$ (R2  = 0.850), fT 2 * S $$ {{\mathrm{fT}}_2^{\ast}}_{\mathrm{S}} $$ (R2  = 0.651), and water content (R2  = 0.738).TSC and relaxation parameters measured with 23 Na MRI provide noninvasive information about changes in sGAG content and collagen matrix during cartilage maturation. Cartilage TSC quantification assuming fixed relaxation may be feasible in children older than 5 years.

  View details for DOI 10.1002/mrm.29930

  View details for PubMedID 37997011

• [Formula: see text] Field inhomogeneity correction for qDESS [Formula: see text] mapping: application to rapid bilateral knee imaging. Magma (New York, N.Y.) Barbieri, M., Watkins, L. E., Mazzoli, V., Desai, A. D., Rubin, E., Schmidt, A., Gold, G. E., Hargreaves, B. A., Chaudhari, A. S., Kogan, F. 2023

  Abstract

  [Formula: see text] mapping is a powerful tool for studying osteoarthritis (OA) changes and bilateral imaging may be useful in investigating the role of between-knee asymmetry in OA onset and progression. The quantitative double-echo in steady-state (qDESS) can provide fast simultaneous bilateral knee [Formula: see text] and high-resolution morphometry for cartilage and meniscus. The qDESS uses an analytical signal model to compute [Formula: see text] relaxometry maps, which require knowledge of the flip angle (FA). In the presence of [Formula: see text] inhomogeneities, inconsistencies between the nominal and actual FA can affect the accuracy of [Formula: see text] measurements. We propose a pixel-wise [Formula: see text] correction method for qDESS [Formula: see text] mapping exploiting an auxiliary [Formula: see text] map to compute the actual FA used in the model.The technique was validated in a phantom and in vivo with simultaneous bilateral knee imaging. [Formula: see text] measurements of femoral cartilage (FC) of both knees of six healthy participants were repeated longitudinally to investigate the association between [Formula: see text] variation and [Formula: see text].The results showed that applying the [Formula: see text] correction mitigated [Formula: see text] variations that were driven by [Formula: see text] inhomogeneities. Specifically, [Formula: see text] left-right symmetry increased following the [Formula: see text] correction ([Formula: see text] = 0.74 > [Formula: see text] = 0.69). Without the [Formula: see text] correction, [Formula: see text] values showed a linear dependence with [Formula: see text]. The linear coefficient decreased using the [Formula: see text] correction (from 24.3 ± 1.6 ms to 4.1 ± 1.8) and the correlation was not statistically significant after the application of the Bonferroni correction (p value > 0.01).The study showed that [Formula: see text] correction could mitigate variations driven by the sensitivity of the qDESS [Formula: see text] mapping method to [Formula: see text], therefore, increasing the sensitivity to detect real biological changes. The proposed method may improve the robustness of bilateral qDESS [Formula: see text] mapping, allowing for an accurate and more efficient evaluation of OA pathways and pathophysiology through longitudinal and cross-sectional studies.

  View details for DOI 10.1007/s10334-023-01094-y

  View details for PubMedID 37142852

  View details for PubMedCentralID 2268124

• Generalizability of Deep Learning Segmentation Algorithms for Automated Assessment of Cartilage Morphology and MRI Relaxometry. Journal of magnetic resonance imaging : JMRI Schmidt, A. M., Desai, A. D., Watkins, L. E., Crowder, H. A., Black, M. S., Mazzoli, V., Rubin, E. B., Lu, Q., MacKay, J. W., Boutin, R. D., Kogan, F., Gold, G. E., Hargreaves, B. A., Chaudhari, A. S. 2022

  Abstract

  BACKGROUND: Deep learning (DL)-based automatic segmentation models can expedite manual segmentation yet require resource-intensive fine-tuning before deployment on new datasets. The generalizability of DL methods to new datasets without fine-tuning is not well characterized.PURPOSE: Evaluate the generalizability of DL-based models by deploying pretrained models on independent datasets varying by MR scanner, acquisition parameters, and subject population.STUDY TYPE: Retrospective based on prospectively acquired data.POPULATION: Overall test dataset: 59 subjects (26 females); Study 1: 5 healthy subjects (zero females), Study 2: 8 healthy subjects (eight females), Study 3: 10 subjects with osteoarthritis (eight females), Study 4: 36 subjects with various knee pathology (10 females).FIELD STRENGTH/SEQUENCE: A 3-T, quantitative double-echo steady state (qDESS).ASSESSMENT: Four annotators manually segmented knee cartilage. Each reader segmented one of four qDESS datasets in the test dataset. Two DL models, one trained on qDESS data and another on Osteoarthritis Initiative (OAI)-DESS data, were assessed. Manual and automatic segmentations were compared by quantifying variations in segmentation accuracy, volume, and T2 relaxation times for superficial and deep cartilage.STATISTICAL TESTS: Dice similarity coefficient (DSC) for segmentation accuracy. Lin's concordance correlation coefficient (CCC), Wilcoxon rank-sum tests, root-mean-squared error-coefficient-of-variation to quantify manual vs. automatic T2 and volume variations. Bland-Altman plots for manual vs. automatic T2 agreement. A P value<0.05 was considered statistically significant.RESULTS: DSCs for the qDESS-trained model, 0.79-0.93, were higher than those for the OAI-DESS-trained model, 0.59-0.79. T2 and volume CCCs for the qDESS-trained model, 0.75-0.98 and 0.47-0.95, were higher than respective CCCs for the OAI-DESS-trained model, 0.35-0.90 and 0.13-0.84. Bland-Altman 95% limits of agreement for superficial and deep cartilage T2 were lower for the qDESS-trained model, ±2.4msec and ±4.0msec, than the OAI-DESS-trained model, ±4.4msec and ±5.2msec.DATA CONCLUSION: The qDESS-trained model may generalize well to independent qDESS datasets regardless of MR scanner, acquisition parameters, and subject population.EVIDENCE LEVEL: 1 TECHNICAL EFFICACY: Stage 1.

  View details for DOI 10.1002/jmri.28365

  View details for PubMedID 35852498

• Non-contrast MRI of synovitis in the knee using quantitative DESS. European radiology Thoenen, J., Stevens, K. J., Turmezei, T. D., Chaudhari, A., Watkins, L. E., McWalter, E. J., Hargreaves, B. A., Gold, G. E., MacKay, J. W., Kogan, F. 2021

  Abstract

  OBJECTIVES: To determine whether synovitis graded by radiologists using hybrid quantitative double-echo in steady-state (qDESS) images can be utilized as a non-contrast approach to assess synovitis in the knee, compared against the reference standard of contrast-enhanced MRI (CE-MRI).METHODS: Twenty-two knees (11 subjects) with moderate to severe osteoarthritis (OA) were scanned using CE-MRI, qDESS with a high diffusion weighting (qDESSHigh), and qDESS with a low diffusion weighting (qDESSLow). Four radiologists graded the overall impression of synovitis, their diagnostic confidence, and regional grading of synovitis severity at four sites (suprapatellar pouch, intercondylar notch, and medial and lateral peripatellar recesses) in the knee using a 4-point scale. Agreement between CE-MRI and qDESS, inter-rater agreement, and intra-rater agreement were assessed using a linearly weighted Gwet's AC2.RESULTS: Good agreement was seen between CE-MRI and both qDESSLow (AC2=0.74) and qDESSHigh (AC2=0.66) for the overall impression of synovitis, but both qDESS sequences tended to underestimate the severity of synovitis compared to CE-MRI. Good inter-rater agreement was seen for both qDESS sequences (AC2=0.74 for qDESSLow, AC2=0.64 for qDESSHigh), and good intra-rater agreement was seen for both sequences as well (qDESSLow AC2=0.78, qDESSHigh AC2=0.80). Diagnostic confidence was moderate to high for qDESSLow (mean=2.36) and slightly less than moderate for qDESSHigh (mean=1.86), compared to mostly high confidence for CE-MRI (mean=2.73).CONCLUSIONS: qDESS shows potential as an alternative MRI technique for assessing the severity of synovitis without the use of a gadolinium-based contrast agent.KEY POINTS: The use of the quantitative double-echo in steady-state (qDESS) sequence for synovitis assessment does not require the use of a gadolinium-based contrast agent. Preliminary results found that low diffusion-weighted qDESS (qDESSLow) shows good agreement to contrast-enhanced MRI for characterization of the severity of synovitis, with a relative bias towards underestimation of severity. Preliminary results also found that qDESSLow shows good inter- and intra-rater agreement for the depiction of synovitis, particularly for readers experienced with the sequence.

  View details for DOI 10.1007/s00330-021-08025-2

  View details for PubMedID 33993332

• [18F]NaF PET-MRI provides direct in-vivo evidence of the association between bone metabolic activity and adjacent synovitis in knee osteoarthritis: a cross-sectional study. Osteoarthritis and cartilage MacKay, J., Watkins, L., Gold, G., Kogan, F. 2021

  Abstract

  OBJECTIVE: Synovitis is hypothesized to play a role in the development and growth of osteophytes. Our objectives were to use hybrid positron emission tomography-magnetic resonance imaging (PET-MRI) to (1) determine whether synovitis adjacent to peripheral bone subregions with increased metabolic activity is greater than adjacent to regions without increased metabolic activity and (2) assess the association between subregional bone metabolic activity and adjacent synovitis.DESIGN: We recruited 11 participants (22 knees) with a diagnosis of OA in at least one knee. Simultaneous bilateral knee PET-MRI was performed. We quantified bone metabolic activity using the radiotracer [18F]sodium fluoride ([18F]NaF) with calculation of maximum standardized uptake values (SUVmax). Synovitis was quantified using dynamic contrast-enhanced MRI with calculation of Ktrans. Bone subregions were coded as osteophyte (OP), focal increased [18F]NaF uptake without osteophyte (FIU), or normal (no osteophyte or FIU). We used robust linear mixed effects models to assess differences in adjacent Ktrans between different subregion types and to assess association between Ktrans and adjacent SUVmax.RESULTS: 94 OPs were detected (59 MOAKS grade 1, 30 grade 2, 5 grade 3), along with 28 FIU and 18 normal subregions. Ktrans was higher adjacent to FIU (adjusted mean[95% CI] = 0.06[0.03,0.09]) and OPs (0.08[0.05,0.11]) when compared to normal bone subregions (0.03[0.00,0.09]). PET SUVmax was positively associated with adjacent Ktrans (beta[95% CI]=0.018[0.008,0.027]).CONCLUSIONS: Synovitis is more intense adjacent to peripheral bone regions with increased metabolic activity than those without, although there is some overlap. Subregional bone metabolic activity is positively associated with intensity of adjacent synovitis.

  View details for DOI 10.1016/j.joca.2021.04.014

  View details for PubMedID 33975018

• Assessment of Quantitative [18F]Sodium Fluoride PET Measures of Knee Subchondral Bone Perfusion and Mineralization in Osteoarthritic and Healthy Subjects. Osteoarthritis and cartilage Watkins, L., MacKay, J., Haddock, B., Mazzoli, V., Uhlrich, S., Gold, G., Kogan, F. 2021

  Abstract

  OBJECTIVE: Molecular information derived from dynamic [18F]sodium fluoride ([18F]NaF) PET imaging holds promise as a quantitative marker of bone metabolism. The objective of this work was to evaluate physiological mechanisms of [18F]NaF uptake in subchondral bone of individuals with and without knee osteoarthritis (OA).METHODS: Eleven healthy volunteers and twenty OA subjects were included. Both knees of all subjects were scanned simultaneously using a 3T hybrid PET/MRI system. MRI MOAKS assessment was performed to score the presence and size of osteophytes, bone marrow lesions, and cartilage lesions. Subchondral bone kinetic parameters of bone perfusion (K1), tracer extraction fraction, and total tracer uptake into bone (Ki) were evaluated using the Hawkins 3-compartment model. Measures were compared between structurally normal-appearing bone regions and those with structural findings.RESULTS: Mean and maximum SUV and kinetic parameters Ki, K1, and extraction fraction were significantly different between Healthy subjects and subjects with OA. Between-group differences in metabolic parameters were observed both in regions where the OA group had degenerative changes as well as in regions that appeared structurally normal.CONCLUSIONS: Results suggest that bone metabolism is altered in OA subjects, including bone regions with and without structural findings, compared to healthy subjects. Kinetic parameters of [18F]NaF uptake in subchondral bone show potential to quantitatively evaluate the role of bone physiology in OA initiation and progression. Objective measures of bone metabolism from [18F]NaF PET imaging can complement assessments of structural abnormalities observed on MRI.

  View details for DOI 10.1016/j.joca.2021.02.563

  View details for PubMedID 33639259

• Characterizing the transient response of knee cartilage to running: Decreases in cartilage T2 of female recreational runners. Journal of orthopaedic research : official publication of the Orthopaedic Research Society Crowder, H. A., Mazzoli, V. n., Black, M. S., Watkins, L. E., Kogan, F. n., Hargreaves, B. A., Levenston, M. E., Gold, G. E. 2021

  Abstract

  Cartilage transmits and redistributes biomechanical loads in the knee joint during exercise. Exercise-induced loading alters cartilage hydration and is detectable using quantitative MRI, where T2 relaxation time (T2 ) is influenced by cartilage collagen composition, fiber orientation, and changes in extracellular matrix. This study characterized short-term transient responses of healthy knee cartilage to running-induced loading using bilateral scans and image registration. Eleven healthy female recreational runners (33.73±4.22 years) and four healthy female controls (27.25±1.38 years) were scanned on a 3T GE MRI scanner with qDESS before running over-ground (runner group) or resting (control group) for 40 minutes. Subjects were scanned immediately post-activity at five-minute intervals for 60 minutes. T2 times were calculated for femoral, tibial, and patellar cartilage at each time point and analyzed using a mixed-effects model and Bonferroni post-hoc. There were immediate decreases in T2 (mean±SEM) post-run in superficial femoral cartilage of at least 3.3±0.3% (P=0.002) between baseline and Time 0 that remained for 25 minutes, a decrease in superficial tibial cartilage T2 of 2.9±0.4% (P=0.041) between baseline and Time 0, and a decrease in superficial patellar cartilage T2 of 3.6±0.3% (P=0.020) 15 minutes post-run. There were decreases in the medial posterior region of superficial femoral cartilage T2 of at least 5.3±0.2% (P=0.022) within five minutes post-run that remained at 60 minutes post-run. Clinical Significance: These results increase understanding of transient responses of healthy cartilage to repetitive, exercise-induced loading and establish preliminary recommendations for future definitive studies of cartilage response to running. This article is protected by copyright. All rights reserved.

  View details for DOI 10.1002/jor.24994

  View details for PubMedID 33483997

• Evaluating the Relationship between Dynamic Na[F-18]F-Uptake Parameters and MRI Knee Osteoarthritic Findings Watkins, L., MacKay, J., Haddock, B., Mazzoli, V., Uhlrich, S., Gold, G., Kogan, F. SOC NUCLEAR MEDICINE INC. 2020

  View details for Web of Science ID 000568290500163

• Effects of Dynamic Na[F-18]F- Duration on Uptake Parameters in the Knee Watkins, L., Haddock, B., Kogan, F. SOC NUCLEAR MEDICINE INC. 2020

  View details for Web of Science ID 000568290500158

• Rapid volumetric gagCEST imaging of knee articular cartilage at 3 T: evaluation of improved dynamic range and an osteoarthritic population. NMR in biomedicine Watkins, L. E., Rubin, E. B., Mazzoli, V. n., Uhlrich, S. D., Desai, A. D., Black, M. n., Ho, G. K., Delp, S. L., Levenston, M. E., Beaupré, G. S., Gold, G. E., Kogan, F. n. 2020: e4310

  Abstract

  Chemical exchange saturation transfer of glycosaminoglycans, gagCEST, is a quantitative MR technique that has potential for assessing cartilage proteoglycan content at field strengths of 7 T and higher. However, its utility at 3 T remains unclear. The objective of this work was to implement a rapid volumetric gagCEST sequence with higher gagCEST asymmetry at 3 T to evaluate its sensitivity to osteoarthritic changes in knee articular cartilage and in comparison with T2 and T1ρ measures. We hypothesize that gagCEST asymmetry at 3 T decreases with increasing severity of osteoarthritis (OA). Forty-two human volunteers, including 10 healthy subjects and 32 subjects with medial OA, were included in the study. Knee Injury and Osteoarthritis Outcome Scores (KOOS) were assessed for all subjects, and Kellgren-Lawrence grading was performed for OA volunteers. Healthy subjects were scanned consecutively at 3 T to assess the repeatability of the volumetric gagCEST sequence at 3 T. For healthy and OA subjects, gagCEST asymmetry and T2 and T1ρ relaxation times were calculated for the femoral articular cartilage to assess sensitivity to OA severity. Volumetric gagCEST imaging had higher gagCEST asymmetry than single-slice acquisitions (p = 0.015). The average scan-rescan coefficient of variation was 6.8%. There were no significant differences in average gagCEST asymmetry between younger and older healthy controls (p = 0.655) or between healthy controls and OA subjects (p = 0.310). T2 and T1ρ relaxation times were elevated in OA subjects (p < 0.001 for both) compared with healthy controls and both were moderately correlated with total KOOS scores (rho = -0.181 and rho = -0.332 respectively). The gagCEST technique developed here, with volumetric scan times under 10 min and high gagCEST asymmetry at 3 T, did not vary significantly between healthy subjects and those with mild-moderate OA. This further supports a limited utility for gagCEST imaging at 3 T for assessment of early changes in cartilage composition in OA.

  View details for DOI 10.1002/nbm.4310

  View details for PubMedID 32445515

• Flexible and efficient optimization of quantitative sequences using automatic differentiation of Bloch simulations. Magnetic resonance in medicine Lee, P. K., Watkins, L. E., Anderson, T. I., Buonincontri, G., Hargreaves, B. A. 2019

  Abstract

  PURPOSE: To investigate a computationally efficient method for optimizing the Cramer-Rao Lower Bound (CRLB) of quantitative sequences without using approximations or an analytical expression of the signal.METHODS: Automatic differentiation was applied to Bloch simulations and used to optimize several quantitative sequences without the need for approximations or an analytical expression. The results were validated with in vivo measurements and comparisons to prior art. Multi-echo spin echo and DESPO T 1 were used as benchmarks to verify the CRLB implementation. The CRLB of the Magnetic Resonance Fingerprinting (MRF) sequence, which has a complicated analytical formulation, was also optimized using automatic differentiation.RESULTS: The sequence parameters obtained for multi-echo spin echo and DESPO T 1 matched results obtained using conventional methods. In vivo, MRF scans demonstrate that the CRLB optimization obtained with automatic differentiation can improve performance in presence of white noise. For MRF, the CRLB optimization converges in 1.1 CPU hours for N TR = 400 and has O ( N TR ) asymptotic runtime scaling for the calculation of the CRLB objective and gradient.CONCLUSIONS: Automatic differentiation can be used to optimize the CRLB of quantitative sequences without using approximations or analytical expressions. For MRF, the runtime is computationally efficient and can be used to investigate confounding factors as well as MRF sequences with a greater number of repetitions.

  View details for DOI 10.1002/mrm.27832

  View details for PubMedID 31131500

• Acellular and cellular high-density, collagen-fibril constructs with suprafibrillar organization BIOMATERIALS SCIENCE Blum, K. M., Novak, T., Watkins, L., Neu, C. P., Wallace, J. M., Bart, Z. R., Voytik-Harbin, S. L. 2016; 4 (4): 711-723

  View details for DOI 10.1039/c5bm00443h

  View details for Web of Science ID 000372997600016