Osteochondritis Dissecans
| Purpose | Determine stability of osteochondritis dissecans |
| Tag(s) |
|
| Panel | Musculoskeletal |
| Define-AI ID | 18050007 |
| Originator | Munib Sana |
| Panel Chair | Jay Patti |
| Panel Reviewers | Musculoskeletal Panel |
| License | |
| Status | Published |
Clinical Implementation
Value Proposition
Osteochondritis dissecans (OCDs) are acquired disorders of bone in which there is fragmentation of the articular surface to varying degrees. Treatment can be conservative or surgical depending on how likely the OCD is to heal on its own. Unstable OCDs require surgical intervention, whereas stable OCDs are generally treated conservatively. Multiple MRI features are used to predict the stability of a lesion. Although late instability (a free-floating intra-articular fragment or thin line of fluid separating two pieces of bone) is easily identified, early instability is much harder to diagnose. An algorithm that can predict the likelihood of OCD instability would help guide the management of these patients with respect to early aggressive surgical intervention versus watchful waiting and continued MRI follow-up.Narrative(s)
A 15-year-old male presents with knee pain, and an OCD is identified on the subsequent knee MRI. The algorithm evaluates the MRI and calculates the likelihood of instability. The radiologist is informed of this calculation at the time of interpretation.Workflow Description
Images are obtained from modality and sent to PACS. The radiologist identifies an OCD and activates the AI engine. AI calculates OCD as a probability of instability. A message is sent to PACS from the engine with the classification information.Considerations for Dataset Development
Procedures(s): {MRI: knee, ankle, elbow, shoulder}
Sex at Birth: {Male, Female}
Developmental Variants: Panner disease
Ossification Center: Normal developmental irregular ossification of the femoral condyles
Trauma: {Traumatic osteochondral defects}
Clinical Note: Traumatic osteochondral defects should not be included in the training data set. For example, most talar dome OCDs are post-traumatic.
Other: {Adult OCDs, Juvenile OCDs}
Clinical Note: Juvenile OCDs tend to heal with conservative management. Adult OCDs often progress to unstable fragments. Criteria for stable OCDs differs for juvenile and adult OCDs (ie, a juvenile OCD can have multiple small surrounding cysts and be stable, whereas an adult OCD with multiple small surrounding cysts is unstable).
Technical Specifications
Inputs
DICOM Study
| Procedure | MRI: Knee, ankle, elbow, shoulder |
| Data Type | DICOM |
| Modality | MRI |
| Body Region | Extremities |
Primary Outputs
Instability of OCD
| RadElement ID | RDE240 |
| Definition | Probability the OCD is unstable |
| Data Type | Numeric |
| Value Set | [0,1] 0 – Stable 1 – Unstable Or indeterminate |
| Units | Probability that OCD is unstable |
Secondary Outputs
Number of Cysts
| RadElement ID | RDE241 |
| Definition | Define number of cysts larger than 5mm. |
| Data Type | Numeric |
| Value Set |
|
| Units | Cysts |
Size of Largest Cyst
| RadElement ID | RDE242 |
| Definition | Define volume of largest cyst |
| Data Type | Numeric |
| Value Set |
|
| Units | mm3 |
Fluid Signal Intensity Between Parent and Progeny Bone
| RadElement ID | RDE243 |
| Definition | If there is a line of signal equal to the pixel intensity value of joint fluid separating the parent and progeny bone, than this feature is considered positive. |
| Data Type | Numeric |
| Value Set | [0,1] 1-Max intensity |
| Units |
|
Integrity of Overlying Cartilage
| RadElement ID | RDE244 |
| Definition | Disruption of the cartilage surface |
| Data Type | Categorical |
| Value Set | 0-Unknown 1-Focal breaks 2-Incongruity |
| Units | N/A |
Integrity of Subchondral Bone Plate
| RadElement ID | RDE245 |
| Definition | Disruption of the cartilage surface |
| Data Type | Categorical |
| Value Set | 0-Unknown 1-Focal breaks 2-Incongruity |
| Units | N/A |
Future Development Ideas
Develop OCD detection on a plain film algorithm, which would help nonspecialists by running in the background. This would be valuable to orthopedics or in the case that a patient presents with other conditions the clinician to miss OCD.
Count and compare the number of cysts larger than 5mm to the operative report to determine instability at time of surgery or follow up MRIs to track stability over time. This could be a prospective or retrospective study.
Related Datasets
No known related public datasets at this time, please us alert us if you know of any.