In vivo micro-imaging using alternating navigator echoes with applications to cancellous bone structural analysis

Bone Structure Analysis of the Radius Using Ultrahigh Field (7T) MRI: Relevance of Technical Parameters and Comparison with 3T MRI and Radiography

Bone fractal signature analysis (FSA-also termed bone texture analysis) is a tool that assesses structural changes that may relate to clinical outcomes and functions. Our aim was to compare bone texture analysis of the distal radius in patients and volunteers using radiography and 3T and 7T magnetic resonance imaging (MRI)-a patient group (n = 25) and a volunteer group (n = 25) were included. Participants in the patient group had a history of chronic wrist pain with suspected or confirmed osteoarthritis and/or ligament instability. All participants had 3T and 7T MRI including T1-weighted turbo spin echo (TSE) sequences. The 7T MRI examination included an additional high-resolution (HR) T1 TSE sequence. Radiographs of the wrist were acquired for the patient group. When comparing patients and volunteers (unadjusted for gender and age), we found a statistically significant difference of horizontal and vertical fractal dimensions (FDs) using 7T T1 TSE-HR images in low-resolution mode (horizontal: p = 0.04, vertical: p = 0.01). When comparing radiography to the different MRI sequences, we found a statistically significant difference for low- and high-resolution horizontal FDs between radiography and 3T T1 TSE and 7T T1 TSE-HR. Vertical FDs were significantly different only between radiographs and 3T T1 TSE in the high-resolution mode; FSA measures obtained from 3T and 7T MRI are highly dependent on the sequence and reconstruction resolution used, and thus are not easily comparable between MRI systems and applied sequences.

The reproducibility of measuring trabecular bone parameters using a commercially available high-resolution magnetic resonance imaging approach: A pilot study

Bone imaging is currently the best non-invasive way to assess changes to bone associated with aging or chronic disease. However, common imaging techniques such as dual energy x-ray absorptiometry are associated with limitations. Magnetic resonance imaging (MRI) is a radiation-free technique that can measure bone microarchitecture. However, published MRI bone assessment protocols use specialized MRI coils and sequences and therefore have limited transferability across institutions. We developed a protocol on a Siemens 3 Tesla MRI machine, using a commercially available coil (Siemens 15 CH knee coil), and manufacturer supplied sequences to acquire images at the tibia. We tested the reproducibility of the FSE and the GE Axial sequences and hypothesized that both would generate reproducible trabecular bone parameters. Eight healthy adults (age 25.5 ± 5.4 years) completed three measurements of each MRI sequence at the tibia. Each of the images was processed for 8 different bone parameters (such as volumetric bone volume fraction). We computed the coefficient of variation (CV) and intraclass correlation coefficients (ICC) to assess reproducibility and reliability. Both sequences resulted in trabecular parameters that were reproducible (CV <5% for most) and reliable (ICC >80% for all). Our study is one of the first to report that a commercially available MRI protocol can result in reproducible data, and is significant as MRI may be an accessible method to measure bone microarchitecture in clinical or research environments. This technique requires further testing, including validation and evaluation in other populations.

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Trabecular bone is difficult to measure using commercial MRI techniques

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Reproducibility of a MRI protocol measuring trabecular bone was assessed

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Tibia trabecular bone was reproducible using a knee coil and a FSE Axial sequence

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Tibia trabecular bone was reproducible using a knee coil and a GE Axial sequence

Morphobiochemical diagnosis of acute trabecular microfractures using gamma correction Tc-99m HDP pinhole bone scan with histopathological verification

We prospectively performed gamma correction pinhole bone scan (GCPBS) and histopathologic verification study to make simultaneous morphobiochemical diagnosis of trabecular microfractures (TMF) occurred in the femoral head as a part of femoral neck fracture.Materials consisted of surgical specimens of the femoral head in 6 consecutive patients. The specimens were imaged using Tc-99m hydroxymethylene diphosphonate (HDP) pinhole scan and processed by the gamma correction. After cleansing with 10% formalin solution, injured specimen surface was observed using a surgical microscope to record TMF. Morphological findings shown in the photograph, naive pinhole bone scan, GCPBS, and hematoxylin-eosin (H&E) stain of the specimen were reciprocally correlated for histological verification and the usefulness of suppression and enhancement of Tc-99m HDP uptake was biochemically investigated in TMF and edema and hemorrhage using gamma correction.On the one hand, GCPBS was able to depict the calcifying calluses in TMF with enhanced Tc-99m HDP uptake. They were pinpointed, speckled, round, ovoid, rod-like, geographic, and crushed in shape. The smallest callus measured was 0.23 mm in this series. On the other hand, GCPBS biochemically was able to discern the calluses with enhanced high Tc-99m HDP uptake from the normal and edema dipped and hemorrhage irritated trabeculae with washed out uptake.Morphobiochemically, GCPBS can clearly depict microfractures in the femoral head produced by femoral neck fracture. It discerns the microcalluses with enhanced Tc-99m HDP uptake from the intact and edema dipped and hemorrhage irritated trabeculae with suppressed washed out Tc-99m HDP uptake. Both conventional pinhole bone scan and gamma correction are useful imaging means to specifically diagnose the microcalluses naturally formed in TMF.

Advances in imaging approaches to fracture risk evaluation

Fragility fractures are a growing problem worldwide, and current methods for diagnosing osteoporosis do not always identify individuals who require treatment to prevent a fracture and may misidentify those not a risk. Traditionally, fracture risk is assessed using dual-energy X-ray absorptiometry, which provides measurements of areal bone mineral density at sites prone to fracture. Recent advances in imaging show promise in adding new information that could improve the prediction of fracture risk in the clinic. As reviewed herein, advances in quantitative computed tomography (QCT) predict hip and vertebral body strength; high-resolution HR-peripheral QCT (HR-pQCT) and micromagnetic resonance imaging assess the microarchitecture of trabecular bone; quantitative ultrasound measures the modulus or tissue stiffness of cortical bone; and quantitative ultrashort echo-time MRI methods quantify the concentrations of bound water and pore water in cortical bone, which reflect a variety of mechanical properties of bone. Each of these technologies provides unique characteristics of bone and may improve fracture risk diagnoses and reduce prevalence of fractures by helping to guide treatment decisions.

Gamma correction 99mTc-hydroxymethylene diphosphonate pinhole bone scan diagnosis and histopathological verification of trabecular contusion in young rats

The aim of this rat experiment using gamma correction pinhole bone scan (GCPBS) was two-fold: first, to confirm whether specific unwashed micro Tc-hydroxymethylene diphosphonate (Tc-HDP) uptake occurs in trabecular contusion (TC) and washed out uptake occurs in edema and/or hemorrhage-irritated trabeculae, and, second, to histopathologically identify the tissue in which the Tc-HDP uptake is unwashed. Five young Sprague-Dawley rats were used for the contusion model and one rat was used as a control. Trauma was inflicted on the femoral shaft with a free-falling iron ball. The presence of injury was confirmed by means of Tc-HDP pinhole bone scan and radiography with built-in scales. All rats were carefully killed for histopathologic verification. The size and shape of the unwashed high Tc-HDP uptake in TC were assessed on a 50-fold magnified GCPBS (mGCPBS), and the findings were compared with those of hematoxylin eosin (H&E) stain findings. mGCPBS showed TC with osteoblastic rimming and high unwashed Tc-HDP uptake. H&E stain findings showed osteoblastic rimming. The smallest TC was 0.03 mm in transaxial diameter on both mGCPBS and H&E stain findings. The four shapes of TC were bar-like, round, ovoid, and pinpointed in the longitudinal, oblique, and transaxial sections. The size and shape shown on mGCPBS and H&E stain findings were in good accord, demonstrating that TC was coated with osteoblastic rimming, which is pathognomonic of contusion. This sign was not seen for the control rat. mGCPBS is useful in the diagnosis of TC because osteoblastic rimming, typically stained in the base, is marked with unwashed high Tc-HDP uptake.

Registration-based autofocusing technique for automatic correction of motion artifacts in time-series studies of high-resolution bone MRI

PURPOSE

To develop a registration-based autofocusing (RAF) motion correction technique for high-resolution trabecular bone (TB) imaging and to evaluate its performance on in vivo MR data.

MATERIALS AND METHODS

The technique combines serial registration with a previously developed motion correction technique - autofocusing - for automatic correction of subject movement degradation of MR images acquired in longitudinal studies. The method was tested on in vivo images of the distal radius to measure improvements in serial reproducibility of parameters in 12 women (ages 50-75 years), and to compare with the navigator echo-based correction and autofocusing. Furthermore, the technique's ability to optimize the sensitivity to detect simulated bone loss was ascertained.

RESULTS

The new technique yielded superior reproducibility of image-derived structural and mechanical parameters. Average coefficient of variation across all parameters improved by 12.5%, 27.0%, 33.5%, and 37.0%, respectively, following correction by navigator echoes, autofocusing, and the RAF technique (without and with correction for rotational motion); average intra-class correlation coefficient increased by 1.2%, 2.2%, 2.8%, and 3.2%, respectively. Furthermore, simulated bone loss (5%) was well recovered independent of the choice of reference image (4.71% or 4.86% with respect to using either the original or the image subjected to bone loss) in the time series.

CONCLUSION

The data suggest that our technique simultaneously corrects for intra-scan motion corruption while improving inter-scan registration. Furthermore, the technique is not biased by small changes in bone architecture between time-points.

Effects of testosterone and growth hormone on the structural and mechanical properties of bone by micro-MRI in the distal tibia of men with hypopituitarism

CONTEXT

Severe deficiencies of testosterone (T) and GH are associated with low bone mineral density (BMD) and increased fracture risk. Replacement of T in hypogonadal men improves several bone parameters. Replacement of GH in GH-deficient men improves BMD.

OBJECTIVE

Our objective was to determine whether T and GH treatment together improves the structural and mechanical parameters of bone more than T alone in men with hypopituitarism.

DESIGN AND SUBJECTS

This randomized, prospective, 2-year study included 32 men with severe deficiencies of T and GH due to panhypopituitarism.

INTERVENTION

Subjects were randomized to receive T alone (n = 15) or T and GH (n = 17) for 2 years.

MAIN OUTCOME MEASURES

We evaluated magnetic resonance microimaging-derived structural (bone volume fraction [BVF] and trabecular thickness) and mechanical (axial stiffness [AS], a measure of bone strength) properties of the distal tibia at baseline and after 1 and 2 years of treatment.

RESULTS

Treatment with T and GH did not affect BVF, thickness, or AS differently from T alone. T treatment in all subjects for 2 years increased trabecular BVF by 9.6% (P < .0001), trabecular thickness by 2.6% (P < .001), and trabecular AS by 9.8% (P < .001). In contrast, testosterone treatment in all subjects significantly increased cortical thickness by 2.4% (P < .01) but decreased cortical BVF by -4.7% (P < .01) and cortical AS by -6.9% (P < .01).

CONCLUSION

Combined T and GH treatment of men with hypopituitarism for 2 years did not improve the measured structural or mechanical parameters of the distal tibia more than T alone. However, testosterone significantly increased the structural and mechanical properties of trabecular bone but decreased most of these properties of cortical bone, illustrating the potential importance of assessing trabecular and cortical bone separately in future studies of the effect of testosterone on bone.

Vertebral deformities and fractures are associated with MRI and pQCT measures obtained at the distal tibia and radius of postmenopausal women

SUMMARY

We investigated the association of postmenopausal vertebral deformities and fractures with bone parameters derived from distal extremities using MRI and pQCT. Distal extremity measures showed variable degrees of association with vertebral deformities and fractures, highlighting the systemic nature of postmenopausal bone loss.

INTRODUCTION

Prevalent vertebral deformities and fractures are known to predict incident further fractures. However, the association of distal extremity measures and vertebral deformities in postmenopausal women has not been fully established.

METHODS

This study involved 98 postmenopausal women (age range 60-88 years, mean 70 years) with DXA BMD T-scores at either the hip or spine in the range of -1.5 to -3.5. Wedge, biconcavity, and crush deformities were computed on the basis of spine MRI. Vertebral fractures were assessed using Eastell's criterion. Distal tibia and radius stiffness was computed using MRI-based finite element analysis. BMD at the distal extremities were obtained using pQCT.

RESULTS

Several distal extremity MRI and pQCT measures showed negative association with vertebral deformity on the basis of single parameter correlation (r up to 0.67) and two-parameter regression (r up to 0.76) models involving MRI stiffness and pQCT BMD. Subjects who had at least one prevalent vertebral fracture showed decreased MRI stiffness (up to 17.9 %) and pQCT density (up to 34.2 %) at the distal extremities compared to the non-fracture group. DXA lumbar spine BMD T-score was not associated with vertebral deformities.

CONCLUSIONS

The association between vertebral deformities and distal extremity measures supports the notion of postmenopausal osteoporosis as a systemic phenomenon.

Potential of in vivo MRI-based nonlinear finite-element analysis for the assessment of trabecular bone post-yield properties

PURPOSE

Bone strength is the key factor impacting fracture risk. Assessment of bone strength from high-resolution (HR) images have largely relied on linear micro-finite element analysis (μFEA) even though failure always occurs beyond the yield point, which is outside the linear regime. Nonlinear μFEA may therefore be more informative in predicting failure behavior. However, existing nonlinear models applied to trabecular bone (TB) have largely been confined to micro-computed tomography (μCT) and, more recently, HR peripheral quantitative computed tomography (HR-pQCT) images, and typically have ignored evaluation of the post-yield behavior. The primary purpose of this work was threefold: (1) to provide an improved algorithm and program to assess TB yield as well as post-yield properties; (2) to explore the potential benefits of nonlinear μFEA beyond its linear counterpart; and (3) to assess the feasibility and practicality of performing nonlinear analysis on desktop computers on the basis of micro-magnetic resonance (μMR) images obtained in vivo in patients.

METHODS

A method for nonlinear μFE modeling of TB yield as well as post-yield behavior has been designed where material nonlinearity is captured by adjusting the tissue modulus iteratively according to the tissue-level effective strain obtained from linear analysis using a computationally optimized algorithm. The software allows for images at in vivo μMRI resolution as input with retention of grayscale information. Associations between axial stiffness estimated from linear analysis and yield as well as post-yield parameters from nonlinear analysis were investigated from in vivo μMR images of the distal tibia (N = 20; ages: 58-84) and radius (N = 20; ages: 50-75).

RESULTS

All simulations were completed in 1 h or less for 61 strain levels using a desktop computer (dual quad-core Xeon 3.16 GHz CPUs equipped with 40 GB of RAM). Although yield stress and ultimate stress correlated strongly (R(2) > 0.95, p < 0.001) with axial stiffness, toughness correlated moderately at the distal tibia (R(2) = 0.81, p < 0.001) and only weakly at the distal radius (R(2) = 0.34, p = 0.007). Further, toughness was found to vary by up to 16% for bone of very similar axial stiffness (<2%).

CONCLUSIONS

The work demonstrates the practicality of nonlinear μFE simulations at in vivo μMRI resolution, as well as its potential for providing additional information beyond that obtainable from linear analysis. The data suggest that a direct assessment of toughness may provide information not captured by stiffness.

Assessment of trabecular bone yield and post-yield behavior from high-resolution MRI-based nonlinear finite element analysis at the distal radius of premenopausal and postmenopausal women susceptible to osteoporosis

RATIONALE AND OBJECTIVES

To assess the performance of a nonlinear microfinite element model on predicting trabecular bone yield and post-yield behavior based on high-resolution in vivo magnetic resonance images via the serial reproducibility.

MATERIALS AND METHODS

The nonlinear model captures material nonlinearity by iteratively adjusting tissue-level modulus based on tissue-level effective strain. It enables simulations of trabecular bone yield and post-yield behavior from micro magnetic resonance images at in vivo resolution by solving a series of nonlinear systems via an iterative algorithm on a desktop computer. Measures of mechanical competence (yield strain/strength, ultimate strain/strength, modulus of resilience, and toughness) were estimated at the distal radius of premenopausal and postmenopausal women (N = 20, age range 50-75) in whom osteoporotic fractures typically occur. Each subject underwent three scans (20.2 ± 14.5 days). Serial reproducibility was evaluated via coefficient of variation (CV) and intraclass correlation coefficient (ICC).

RESULTS

Nonlinear simulations were completed in an average of 14 minutes per three-dimensional image data set involving analysis of 61 strain levels. The predicted yield strain/strength, ultimate strain/strength, modulus of resilience, and toughness had a mean value of 0.78%, 3.09 MPa, 1.35%, 3.48 MPa, 14.30 kPa, and 32.66 kPa, respectively, covering a substantial range by a factor of up to 4. Intraclass correlation coefficient ranged from 0.986 to 0.994 (average 0.991); CV ranged from 1.01% to 5.62% (average 3.6%), with yield strain and toughness having the lowest and highest CV values, respectively.

CONCLUSIONS

The data suggest that the yield and post-yield parameters have adequate reproducibility to evaluate treatment effects in interventional studies within short follow-up periods.

Evaluation of trabecular microarchitecture in nonosteoporotic postmenopausal women with and without fracture

This study compared microscopic magnetic resonance imaging (µMRI) parameters of trabecular microarchitecture between postmenopausal women with and without fracture who have normal or osteopenic bone mineral density (BMD) on dual-energy X-ray absorptiometry (DXA). It included 36 postmenopausal white women 50 years of age and older with normal or osteopenic BMD (T-scores better than -2.5 at the lumbar spine, proximal femur, and one-third radius on DXA). Eighteen women had a history of low-energy fracture, whereas 18 women had no history of fracture and served as an age, race, and ultradistal radius BMD-matched control group. A three-dimensional fast large-angle spin-echo (FLASE) sequence with 137 µm × 137 µm × 400 µm resolution was performed through the nondominant wrist of all 36 women using the same 1.5T scanner. The high-resolution images were used to measure trabecular bone volume fraction, trabecular thickness, surface-to-curve ratio, and erosion index. Wilcoxon signed-rank tests were used to compare differences in BMD and µMRI parameters between postmenopausal women with and without fracture. Post-menopausal women with fracture had significantly lower (p < 0.05) trabecular bone volume fraction and surface-to-curve ratio and significantly higher (p < 0.05) erosion index than postmenopausal women without fracture. There was no significant difference between postmenopausal women with and without fracture in trabecular thickness (p = 0.80) and BMD of the spine (p = 0.21), proximal femur (p = 0.19), one-third radius (p = 0.47), and ultradistal radius (p = 0.90). Postmenopausal women with normal or osteopenic BMD who had a history of low-energy fracture had significantly different (p < 0.05) µMRI parameters than an age, race, and ultradistal radius BMD-matched control group of postmenopausal women with no history of fracture. Our study suggests that µMRI can be used to identify individuals without a DXA-based diagnosis of osteoporosis who have impaired trabecular microarchitecture and thus a heretofore-unappreciated elevated fracture risk.

Micro-MR imaging-based computational biomechanics demonstrates reduction in cortical and trabecular bone strength after renal transplantation

PURPOSE

To examine the ability of three-dimensional micro-magnetic resonance (MR) imaging-based computational biomechanics to detect mechanical alterations in trabecular bone and cortical bone in the distal tibia of incident renal transplant recipients 6 months after renal transplantation and compare them with bone mineral density (BMD) outcomes.

MATERIALS AND METHODS

The study was approved by the institutional review board and complied with HIPAA guidelines. Written informed consent was obtained from all subjects. Micro-MR imaging of distal tibial metaphysis was performed within 2 weeks after renal transplantation (baseline) and 6 months later in 49 participants (24 female; median age, 44 years; range, 19-61 years) with a clinical 1.5-T whole-body imager using a modified three-dimensional fast large-angle spin-echo pulse sequence. Micro-finite-element models for cortical bone, trabecular bone, and whole-bone section were generated from each image by delineating the endosteal and periosteal boundaries. Mechanical parameters (stiffness and failure load) were estimated with simulated uniaxial compression tests on the micro-finite-element models. Structural parameters (trabecular bone volume fraction [BV/TV, bone volume to total volume ratio], trabecular thickness [TbTh], and cortical thickness [CtTh]) were computed from micro-MR images. Total hip and spine areal BMD were determined with dual-energy x-ray absorptiometry (DXA). Parameters obtained at the follow-up were compared with the baseline values by using parametric or nonparametric tests depending on the normality of data.

RESULTS

All mechanical parameters were significantly lower at 6 months compared with baseline. Decreases in cortical bone, trabecular bone, and whole-bone stiffness were 3.7% (P = .03), 4.9% (P = .03), and 4.3% (P = .003), respectively. Decreases in cortical bone, trabecular bone, and whole-bone failure strength were 7.6% (P = .0003), 6.0% (P = .004), and 5.6% (P = .0004), respectively. Conventional structural measures, BV/TV, TbTh, and CtTh, did not change significantly. Spine BMD decreased by 2.9% (P < .0001), while hip BMD did not change significantly at DXA.

CONCLUSION

MR imaging-based micro-finite-element analysis suggests that stiffness and failure strength of the distal tibia decrease over a 6-month interval after renal transplantation.

On the significance of motion degradation in high-resolution 3D μMRI of trabecular bone

RATIONALE AND OBJECTIVES

Subtle subject movement during high-resolution three-dimensional micro-magnetic resonance imaging of trabecular bone (TB) causes blurring, thereby rendering the data unreliable for quantitative analysis. In this work, the effects of translational and rotational motion displacements were evaluated qualitatively and quantitatively.

MATERIALS AND METHODS

In experiment 1, motion was induced by applying various simulated and previously observed in vivo trajectories as phase shifts to k-space or rotation angles to k-space segments of a virtually motion-free data set. In experiment 2, images that were visually free of motion artifacts from two groups of 10 healthy individuals, differing in age, were selected to probe the effects of motion on TB parameters. In both experiments, images were rated for motion severity, and the scores were compared to a focus criterion, the normalized gradient squared.

RESULTS

Strong correlations were observed between the motion quality scores and the corresponding normalized gradient squared values (R(2) = 0.52-0.64, P < .01). The results from experiment 1 demonstrated consistently lower image quality and alterations in structural parameters of 9% to 45% with increased amplitude of displacements. In experiment 2, the significant differences in structural parameter group means of the motion-free images were lost upon motion degradation. Autofocusing, a postprocessing correction method, partially recovered the sharpness of the original motion-free images in 13 of 20 subjects.

CONCLUSIONS

Quantitative TB structural measures are highly sensitive to subtle motion-induced degradation, which adversely affects precision and statistical power. The results underscore the influence of subject movement in high-resolution three-dimensional micro-magnetic resonance imaging and its correction for TB structure analysis.

Real-time motion correction for high-resolution larynx imaging

Motion--both rigid-body and nonrigid--is the main limitation to in vivo, high-resolution larynx imaging. In this work, a new real-time motion compensation algorithm is introduced. Navigator data are processed in real time to compute the displacement information, and projections are corrected using phase modulation in k-space. Upon automatic feedback, the system immediately reacquires the data most heavily corrupted by nonrigid motion, i.e., the data whose corresponding projections could not be properly corrected. This algorithm overcomes the shortcomings of the so-called diminishing variance algorithm by combining it with navigator-based rigid-body motion correction. Because rigid-body motion correction is performed first, continual bulk motion no longer impedes nor prevents the convergence of the algorithm. Phantom experiments show that the algorithm properly corrects for translations and reacquires data corrupted by nonrigid motion. Larynx imaging was performed on healthy volunteers, and substantial reduction of motion artifacts caused by bulk shift, swallowing, and coughing was achieved.

Accuracy of high-resolution in vivo micro magnetic resonance imaging for measurements of microstructural and mechanical properties of human distal tibial bone

Micro magnetic resonance imaging (µMRI) is an in vivo imaging method that permits 3D quantification of cortical and trabecular bone microstructure. µMR images can also be used for building microstructural finite element (µFE) models to assess bone stiffness, which highly correlates with bone's resistance to fractures. In order for µMRI-based microstructural and µFE analyses to become standard clinical tools for assessing bone quality, validation with a current gold standard, namely, high-resolution micro computed tomography (µCT), is required. Microstructural measurements of 25 human cadaveric distal tibias were performed for the registered µMR and µCT images, respectively. Next, whole bone stiffness, trabecular bone stiffness, and elastic moduli of cubic subvolumes of trabecular bone in both µMR and µCT images were determined by voxel-based µFE analysis. The bone volume fraction (BV/TV), trabecular number (Tb.N*), trabecular spacing (Tb.Sp*), cortical thickness (Ct.Th), and structure model index (SMI) based on µMRI showed strong correlations with µCT measurements (r(2) = 0.67 to 0.97), and bone surface-to-volume ratio (BS/BV), connectivity density (Conn.D), and degree of anisotropy (DA) had significant but moderate correlations (r(2) = 0.33 to 0.51). Each of these measurements also contributed to one or many of the µFE-predicted mechanical properties. However, model-independent trabecular thickness (Tb.Th*) based on µMRI had no correlation with the µCT measurement and did not contribute to any mechanical measurement. Furthermore, the whole bone and trabecular bone stiffness based on µMRI were highly correlated with those of µCT images (r(2) = 0.86 and 0.96), suggesting that µMRI-based µFE analyses can directly and accurately quantify whole bone mechanical competence. In contrast, the elastic moduli of the µMRI trabecular bone subvolume had significant but only moderate correlations with their gold standards (r(2) = 0.40 to 0.58). We conclude that most microstructural and mechanical properties of the distal tibia can be derived efficiently from µMR images and can provide additional information regarding bone quality.

Structural and mechanical parameters of trabecular bone estimated from in vivo high-resolution magnetic resonance images at 3 tesla field strength

PURPOSE

To evaluate the performance of a new 3 Tesla (T) high-resolution trabecular bone (TB) imaging technique at two resolution regimens in terms of serial reproducibility and sensitivity.

MATERIALS AND METHODS

The left distal tibial metaphysis of seven healthy volunteers was imaged at three time-points using a FLASE (fast large-angle spin-echo) pulse sequence at 137 x 137 x 410 mum(3) and (160 mum)(3) voxel sizes. Image artifacts, motion degradation, and serial image volume misalignments were controlled to maximize reproducibility of image-derived measures of scale, topology, orientation in terms of structural anisotropy, and finite-element derived Young's and shear moduli. Coefficients of variation (CV) and intraclass correlation coefficients (ICC) for structural and mechanical parameters were evaluated as measures of reproducibility and reliability. The ability of structural and mechanical parameters to distinguish between subjects was tested by analysis of variance.

RESULTS

Reproducibility was generally higher in the anisotropic data (CVs 1-5% versus 1-9% for isotropic images). Anisotropic voxel size yielded greater measurement reliability (ICCs 0.75-0.99, mean = 0.92 versus 0.62-0.99, mean = 0.86) and better discrimination of the seven subjects (75% versus 50% of the possible comparisons were significantly different [P < 0.05]) except for measures of structural anisotropy and topology. Isotropic resolution improved detection of structural orientation and permitted visualization of small perforations in longitudinal trabecular plates not detected at anisotropic resolution.

CONCLUSION

Improved image acquisition and processing techniques enhance reproducibility of structural and mechanical parameters derived from high-resolution MRI of metaphyseal bone in the distal tibia.

High-resolution imaging techniques for the assessment of osteoporosis

The importance of assessing the bone's microarchitectural make-up in addition to its mineral density in the context of osteoporosis has been emphasized in several publications. The high spatial resolution required to resolve the bone's microstructure in a clinically feasible scan time is challenging. At present, the best suited modalities meeting these requirements in vivo are high-resolution peripheral quantitative imaging (HR-pQCT) and magnetic resonance imaging (MRI). Whereas HR-pQCT is limited to peripheral skeleton regions like the wrist and ankle, MRI can also image other sites like the proximal femur but usually with lower spatial resolution. In addition, multidetector computed tomography has been used for high-resolution imaging of trabecular bone structure; however, the radiation dose is a limiting factor. This article provides an overview of the different modalities, technical requirements, and recent developments in this emerging field. Details regarding imaging protocols as well as image postprocessing methods for bone structure quantification are discussed.

3D fast spin echo with out-of-slab cancellation: a technique for high-resolution structural imaging of trabecular bone at 7 Tesla

Spin-echo-based pulse sequences are desirable for the application of high-resolution imaging of trabecular bone but tend to involve high-power deposition. Increased availability of ultrahigh field scanners has opened new possibilities for imaging with increased signal-to-noise ratio (SNR) efficiency, but many pulse sequences that are standard at 1.5 and 3 T exceed specific absorption rate limits at 7 T. A modified, reduced specific absorption rate, three-dimensional, fast spin-echo pulse sequence optimized specifically for in vivo trabecular bone imaging at 7 T is introduced. The sequence involves a slab-selective excitation pulse, low-power nonselective refocusing pulses, and phase cycling to cancel undesired out-of-slab signal. In vivo images of the distal tibia were acquired using the technique at 1.5, 3, and 7 T field strengths, and SNR was found to increase at least linearly using receive coils of identical geometry. Signal dependence on the choice of refocusing flip angles in the echo train was analyzed experimentally and theoretically by combining the signal from hundreds of coherence pathways, and it is shown that a significant specific absorption rate reduction can be achieved with negligible SNR loss.

In vivo high-resolution magnetic resonance skin imaging at 1.5 T and 3 T

As a noninvasive modality, MR is attractive for in vivo skin imaging. Its unique soft tissue contrast makes it an ideal imaging modality to study the skin water content and to resolve the different skin layers. In this work, the challenges of in vivo high-resolution skin imaging are addressed. Three 3D Cartesian sequences are customized to achieve high-resolution imaging and their respective performance is evaluated. The balanced steady-state free precession (bSSFP) and gradient echo (GRE) sequences are fast but can be sensitive to off-resonance artifacts. The fast large-angle spin echo (FLASE) sequence provides a sharp depiction of the hypodermis structures but results in more specific absorption rate (SAR). The effect of increasing the field strength is assessed. As compared to 1.5 T, signal-to-noise ratio at 3 T slightly increases in the hypodermis and almost doubles in the dermis. The need for fat/water separation is acknowledged and a solution using an interleaved three-point Dixon method and an iterative reconstruction is shown to be effective. The effects of motion are analyzed and two techniques to prevent motion and correct for it are evaluated. Images with 117 x 117 x 500 microm(3) resolution are obtained in imaging times under 6 min.

Mechanical implications of estrogen supplementation in early postmenopausal women

Whereas the structural implications of drug intervention are well established, there are few data on the possible mechanical consequences of treatment. In this work we examined the changes in elastic and shear moduli (EM and SM) in a region of trabecular bone in the distal radius and distal tibia of early postmenopausal women on the basis of MRI-based micro-finite-element (microFE) analysis. Whole-section axial stiffness (AS) encompassing both trabecular and cortical compartments was evaluated as well. The study was conducted on previously acquired high-resolution images at the two anatomic sites. Images were processed to yield a 3D voxel array of bone-volume fraction (BVF), which was converted to a microFE model of hexahedral elements in which tissue modulus was set proportional to voxel BVF. The study comprised 65 early postmenopausal women (age range 45 to 55 years), of whom 32 had chosen estrogen supplementation (estradiol group); the remainder had not (control group). Subjects had been scanned at baseline and 12 and 24 months thereafter. At the distal tibia, EM and SM were reduced by 2.9% to 5.5% in the control group (p < .05 to <.005), but there was no change in the estradiol subjects. AS decreased 3.9% (4.0%) in controls (p < .005) and increased by 5.8% (6.2%) in estradiol group subjects (p < .05) at 12 (24) months. At the distal radius, EM and SM changes from baseline were not significant, but at both time points AS was increased in estradiol group subjects and decreased in controls (p < .005 to <.05), albeit by a smaller margin than at the tibia. EM and SM were strongly correlated with BV/TV (r(2) = 0.44 to 0.92) as well as with topologic parameters expressing the ratio of plates to rods (r(2) = 0.45 to 0.82), jointly explaining up to 96% of the variation in the mechanical parameters. Finally, baseline AS was strongly correlated between the two anatomic sites (r(2) = 0.58), suggesting that intersubject variations in the bone's mechanical competence follows similar mechanisms. In conclusion, the results demonstrate that micro-MRI-based microFE models are suited for the study of the mechanical implications of antiresorptive treatment. The data further highlight the anabolic effect of short-term estrogen supplementation.

Spin-echo micro-MRI of trabecular bone using improved 3D fast large-angle spin-echo (FLASE)

Fast large-angle spin echo (FLASE) is a common pulse sequence designed for quantitative imaging of trabecular bone (TB) microarchitecture. However, imperfections in the nonselective phase-reversal pulse render it prone to stimulated echo artifacts. The problem is further exacerbated at isotropic resolution. Here, a substantially improved RF-spoiled FLASE sequence (sp-FLASE) is described and its performance is illustrated with data at 1.5T and 3T. Additional enhancements include navigator echoes for translational motion sensing applied in a slice parallel to the imaging slab. Whereas recent work suggests the use of fully-balanced FLASE (b-FLASE) to be advantageous from a signal-to-noise ratio (SNR) point of view, evidence is provided here that the greater robustness of sp-FLASE may outweigh the benefits of the minor SNR gain of b-FLASE for the target application of TB imaging in the distal extremities, sites of exclusively fatty marrow. Results are supported by a theoretical Bloch equation analysis and the pulse sequence dependence of the effective T(2) of triglyceride protons. Last, sp-FLASE images are shown to provide detailed and reproducible visual depiction of trabecular networks in three dimensions at both anisotropic (137 x 137 x 410 microm(3)) and isotropic (160 x 160 x 160 microm(3)) resolutions in the human distal tibia in vivo.

Trabecular bone structure analysis in the limited spatial resolution regime of in vivo MRI

RATIONALE AND OBJECTIVES

To develop a method for processing and visualization of trabecular bone networks on the basis of magnetic resonance (MR) images acquired in the limited spatial resolution regime of in vivo imaging at which trabecular thickness is comparable to voxel size.

MATERIALS AND METHODS

A sequence of processing steps for analyzing the topologic structure of trabecular bone networks is presented and evaluated using three types of datasets: images of synthetic structures with various levels of superimposed Gaussian noise, micro-computed tomographic images of human trabecular bone downsampled to in vivo resolution, and in vivo micro-MR images from a prior longitudinal study investigating the structural implications of testosterone treatment of hypogonadal men. The simulated images were analyzed at a voxel size of 150 microm(3), the clinical MR image data had been acquired with 137 x 137 x 410 microm(3) voxel size. The technique is a modification to the virtual bone biopsy processing chain that involves a sinc convolution step immediately preceding binarization, and employs the Manzanera-Bernard thinning algorithm for obtaining the three-dimensional skeleton before topologic classification. The detectability of plate and rod bone elements was also analyzed theoretically.

RESULTS

As compared with previously published techniques, the approach produced a more accurate bone skeleton in the micro-computed tomographic and simulation experiments, with clear improvement in preservation of rod and plate elements. Simulations suggest that rods are detectable down to a diameter of approximately 50% of the MR image voxel length, whereas plates can be detected at thicknesses of 20% or more of voxel length. For in vivo studies, it was shown that the method could recover the treatment response in terms of the ensuing topologic changes in patients undergoing antiresorptive treatment.

CONCLUSIONS

The algorithm for processing of in vivo micro-MR images of trabecular bone is superior to prior approaches in preserving the topology of the network in the presence of noise.

In vivo magnetic resonance detects rapid remodeling changes in the topology of the trabecular bone network after menopause and the protective effect of estradiol

INTRODUCTION

Estrogen depletion after menopause is accompanied by bone loss and architectural deterioration of trabecular bone. The hypothesis underlying this work is that the microMRI-based virtual bone biopsy can capture the temporal changes of scale and topology of the trabecular network and that estrogen supplementation preserves the integrity of the trabecular network.

MATERIALS AND METHODS

Subjects studied were early postmenopausal women, 45-55 yr of age (N = 65), of whom 32 were on estrogen (estradiol group), and the remainder were not (control group). Early menopause was defined by amenorrhea for 6-24 mo and elevated serum follicle-stimulating hormone (FSH) concentration. The subjects were evaluated with three imaging modalities at baseline and 12 and 24 mo to determine the temporal changes in trabecular and cortical architecture and density. microMRI of the distal radius and tibia was performed at 137 x 137 x 410-microm(3) voxel size. The resulting bone volume fraction maps were Fourier interpolated to a final voxel size of 45.7 x 45.7 x 136.7 microm(3), binarized, skeletonized, and subjected to 3D digital topological analysis (DTA). Skeletonization converts trabecular rods to curves and plates to surfaces. Parameters quantifying scale included BV/TV, whereas DTA parameters included the volume densities of curves (C) and surface (S)-type voxels, as well as composite parameters: the surface/curve ratio (S/C), and erosion index (EI, ratio of the sum of parameters expected to increase with osteoclastic resorption divided by the sum of those expected to decrease). For comparison, pQCT of the same peripheral locations was conducted, and trabecular density and cortical structural parameters were measured. Areal BMD of the lumbar vertebrae and hip was also measured.

RESULTS

Substantial changes in trabecular architecture of the distal tibia, in particular as they relate to topology of the network, were detected after 12 mo in the control group. S/C decreased 5.6% (p < 0.0005), and EI increased 7.1% (p < 0.0005). Most curve- and profile-type voxels (representative of trabecular struts), increased significantly (p < 0.001). Curve and profile edges resulting from disconnection of rod-like trabeculae increased by 9.8% and 5.1% (p = 0.0001 and <0.001, respectively). Similarly, DXA BMD in the spine and hip decreased 2.6% and 1.3% (p < 0.0001 and <0.005, respectively), and pQCT cortical area decreased 3.6% (p = 0.0001). However, neither trabecular density nor BV/TV changed. Furthermore, none of the parameters measured in the estradiol group were significantly different after 12 mo. Substantial differences in the mean changes from baseline between the estradiol treatment and control groups, in particular after 24 mo, were observed, with relative group differences as large as 13% (S/C, p = 0.005), and the relative changes in the two groups had the opposite sign for most parameters. The observed temporal alterations in architecture are consistent with remodeling changes that involve gradual conversion of plate-like to rod-like trabecular bone along with disconnection of trabecular elements, even in the absence of a net loss of trabecular bone. The high-resolution 3D rendered images provide direct evidence of the above remodeling changes in individual subjects. The radius structural data indicated similar trends but offered no definitive conclusions.

CONCLUSIONS

The short-term temporal changes in trabecular architecture after menopause, and the protective effects of estradiol ensuring maintenance of a more plate-like TB architecture, reported here, have not previously been observed in vivo. This work suggests that MRI-based in vivo micromorphometry of trabecular bone has promise as a tool for monitoring osteoporosis treatment.

Underdeveloped trabecular bone microarchitecture is detected in children with cerebral palsy using high-resolution magnetic resonance imaging

Using high resolution magnetic resonance imaging, we detected severely underdeveloped trabecular bone microarchitecture in the distal femur of children with cerebral palsy who can not ambulate independently vs. typically developing controls. Furthermore, very good short-term reliability of trabecular bone microarchitecture measurements was observed in both groups of children.

INTRODUCTION

Severe forms of cerebral palsy (CP) are associated with very low areal bone mineral density and a very high incidence of fracture in the distal femur; however, the state of trabecular bone microarchitecture has not been evaluated. Furthermore, the short-term reliability of trabecular bone microarchitecture assessment in children using high-resolution magnetic resonance imaging (MRI) has not been determined.

METHODS

Apparent bone volume to total volume (appBV/TV), trabecular number, (appTb.N), trabecular thickness (appTb.Th) and trabecular separation (appTb.Sp) were determined in the distal femur of non-ambulatory children with CP and typically developing children using MRI.

RESULTS

Children with CP had a 30% lower appBV/TV, a 21% lower appTb.N, a 12% lower appTb.Th and a 48% higher appTb.Sp in the distal femur than controls (n = 10/group; P < 0.001). The short-term reliability of the trabecular bone microarchitecture measures was very good, with coefficients of variation ranging from 2.0 to 3.0% in children with CP (n = 6) and 1.8 to 3.5% in control children (n = 6).

CONCLUSIONS

Underdeveloped trabecular bone microarchitecture can be detected in the distal femur of children with CP who can not ambulate independently using high-resolution MRI. Furthermore, MRI can be used to assess trabecular bone microarchitecture in children with a high degree of reliability.

Trabecular structure quantified with the MRI-based virtual bone biopsy in postmenopausal women contributes to vertebral deformity burden independent of areal vertebral BMD

In postmenopausal women with a wide range of vertebral deformities, MRI-based structural measures of topology and scale at the distal radius are shown to account for as much as 30% of vertebral deformity, independent of integral vertebral BMD.

INTRODUCTION

Trabecular bone architecture has been postulated to contribute to overall bone strength independent of vertebral BMD measured by DXA. However, there has thus far been only sparse in vivo evidence to support this hypothesis.

MATERIALS AND METHODS

Postmenopausal women, 60-80 yr of age, were screened by DXA, and those with T-scores at either the hip or spine falling within the range of -2.5 +/- 1.0 were studied with the MRI-based virtual bone biopsy, along with heel broadband ultrasound absorption and pQCT of the tibia. The data from 98 subjects meeting the enrollment criteria were subjected to microMRI at the distal tibia and radius, and measures of topology and scale of the trabecular bone network were computed. A spinal deformity index (SDI) was obtained from morphometric measurements in midline sagittal MR images of the thoracic and lumbar spine to evaluate associations between structure and deformity burden.

RESULTS

A number of structural indices obtained at the distal radius were correlated with the SDI. Among these were the topological surface density (a measure of trabecular plates) and trabecular bone volume fraction, which were inversely correlated with SDI (p < 0.0001). Combinations of two structural parameters accounted for up to 30% of the variation in SDI (p < 0.0001) independent of spinal BMD, which was not significantly correlated. pQCT trabecular BMD was also weakly associated, whereas broadband ultrasound absorption was not. No significant association between SDI and structural indices were found at the tibia.

CONCLUSIONS

Structural measures at the distal radius obtained in vivo by microMRI explained a significant portion of the variation in total spinal deformity burden in postmenopausal women independent of areal BMD.

Image metric-based correction (autofocusing) of motion artifacts in high-resolution trabecular bone imaging

PURPOSE

To evaluate the performance of the autofocusing (AF) motion correction technique in high-resolution trabecular bone imaging where image signal-to noise ratio (SNR) is limited.

MATERIALS AND METHODS

Raw data from 26 clinical three-dimensional (3D) wrist exams were motion corrected using AF for both in-plane rotation and translation. Changes in image metrics (a measurement of image sharpness) and structural parameters subsequently computed, were used to gauge the performance of the AF algorithm, and comparisons were made with translation-only navigator-corrected results.

RESULTS

On average, AF generated images with higher image sharpness compared to the navigator echo technique. The average normalized gradient squared (NGS) metric improved by 0.40%, 0.73%, and 0.84%, respectively, following translation-only navigator, translation-only AF and combined rotation/translation AF. For all structural parameters, the rotation/translation AF resulted in an approximately two-fold greater change compared to the navigator technique.

CONCLUSION

The data provide evidence that errors from subtle translational and rotational motion in the structural parameters in high-resolution trabecular bone images are alleviated by AF and that the resulting improvements are superior to translation-only 2D navigator correction.

Structural and functional assessment of trabecular and cortical bone by micro magnetic resonance imaging

Osteoporosis is a multifactorial disorder of bone mineral homeostasis affecting the elderly. It is a major public health issue with significant socioeconomic consequences. Recent findings suggest that bone loss-the key manifestation of the disease-is accompanied by architectural deterioration, both affecting the bone's mechanical competence and susceptibility to fracture. This article reviews the potential of quantitative micro MRI (mu-MRI), including a discussion of the technical requirements for image acquisition, processing, and analysis for assessing the architectural implications of osteoporosis and as a means to monitor the response to treatment. With current technology, the resolution achievable in clinically acceptable scan times and necessary signal-to-noise ratio (SNR) is comparable to trabecular thickness. This limited spatial resolution regime demands processing and analysis algorithms designed to operate under such limiting conditions. It is shown that three different classes of structural parameters can be distinguished, characterizing scale, topology, and orientation. There is considerable evidence that osteoporotic bone loss affects all three classes but that topological changes, resulting from conversion of trabecular plates to rods, with the latter's eventual disconnection, are particularly prominent. Clinical applications discussed can be divided into those dealing with assessment of osteoporotic fracture risk as opposed to the study of the effect of disease progression and regression in response to treatment. Current data suggest that noninvasive assessment of cortical and trabecular bone (TB) architecture by mu-MRI may provide new surrogate endpoints to assess the efficacy of intervention in osteoporosis treatment and prevention.

Noninvasive assessment of bone microarchitecture by MRI

In determining fracture risk, it has become apparent that bone mineral density accounts for only a portion of bone strength, with the remainder being determined by the material and structural properties of the bone tissue. Over the past 15 years, high-resolution MRI has provided a window into the structural nature of bone disease. Cross-sectional studies imaging the trabecular bone in patients with conditions ranging from postmenopausal osteoporosis to organ transplantation to renal osteodystrophy have all demonstrated a correlation of microarchitecture with fracture burden and have done so at a variety of anatomic sites. Recently, the utility of longitudinal studies for monitoring treatment in vivo has been demonstrated. This technique is noninvasive, involving no contrast or ionizing radiation, and provides useful clinical information independent of bone mineral density, thereby allowing for better classification of those at high risk for fracture.

Quantitative MRI for the assessment of bone structure and function

Osteoporosis is the most common degenerative disease in the elderly. It is characterized by low bone mass and structural deterioration of bone tissue, leading to morbidity and increased fracture risk in the hip, spine and wrist-all sites of predominantly trabecular bone. Bone densitometry, currently the standard methodology for diagnosis and treatment monitoring, has significant limitations in that it cannot provide information on the structural manifestations of the disease. Recent advances in imaging, in particular MRI, can now provide detailed insight into the architectural consequences of disease progression and regression in response to treatment. The focus of this review is on the emerging methodology of quantitative MRI for the assessment of structure and function of trabecular bone. During the past 10 years, various approaches have been explored for obtaining image-based quantitative information on trabecular architecture. Indirect methods that do not require resolution on the scale of individual trabeculae and therefore can be practiced at any skeletal location, make use of the induced magnetic fields in the intertrabecular space. These fields, which have their origin in the greater diamagnetism of bone relative to surrounding marrow, can be measured in various ways, most typically in the form of R2', the recoverable component of the total transverse relaxation rate. Alternatively, the trabecular network can be quantified by high-resolution MRI (micro-MRI), which requires resolution adequate to at least partially resolve individual trabeculae. Micro-MRI-based structure analysis is therefore technically demanding in terms of image acquisition and algorithms needed to extract the structural information under conditions of limited signal-to-noise ratio and resolution. Other requirements that must be met include motion correction and image registration, both critical for achieving the reproducibility needed in repeat studies. Key clinical applications targeted involve fracture risk prediction and evaluation of the effect of therapeutic intervention.

Improved optimization strategies for autofocusing motion compensation in MRI via the analysis of image metric maps

Autofocusing is a postprocessing technique for motion correction, which optimizes an image quality metric against various trial motions. In this work, image metric maps, which are measures of image quality plotted as a function of in-plane 2-D trial translations, are systematically studied to develop improved autofocusing motion correction algorithms. It is shown that determining object motion with autofocusing is equivalent to an image metric map optimization problem. These maps provide insights into the motion compensation process and help improve several aspects of the correction algorithm, including the selection of the image metric and motion search strategy. A highly efficient and robust 2-D global optimization method is devised, exploiting the properties of the metric map pattern. The improved algorithm is used to correct phantom and clinical MR images with in-plane 2-D translational motion and is shown to be more effective than existing methods.

Implications of pulse sequence in structural imaging of trabecular bone

PURPOSE

To investigate the SNR and image properties of 3D steady-state free precession (SSFP), fast large-angle spin echo (FLASE), gradient-recalled acquisition in steady state (GRASS), and spoiled GRASS (SPGR) for structural imaging of trabecular bone (TB).

MATERIALS AND METHODS

SNR was examined theoretically and experimentally on phantoms, bone specimens, and in vivo. The bone volume fraction, TB thickness, and echo time (TE) dependence of the thickness were compared. The trabecula was modeled as a cylinder in simulations to examine the intra-voxel spin-dephasing in SSFP and GRASS. Images were acquired on a 1.5 T Siemens Sonata system (40 mT/m maximum gradient, 200 T/m/s peak slew rate).

RESULTS

Within the hardware and safety limit constraints, SNR of FLASE was superior, followed by SSFP, GRASS, and SPGR. The trabecular thickness derived from gradient-echo images was 10-45% greater than that obtained with FLASE. Conversely, SSFP images delineated partial volume trabeculae better than FLASE. Simulations indicated that the artifactual thickening was more severe in SSFP than in GRASS, which was attributed to off-resonance effects from the induced gradients at the bone/marrow interface.

CONCLUSION

FLASE had the highest SNR and was insensitive to susceptibility dephasing. Although SSFP has superior SNR compared to GRASS, off-resonance effects and duty cycle limitations may compromise its practicality in this application. Inc.

Fast Low-Angle Dual Spin-Echo (FLADE): A new robust pulse sequence for structural imaging of trabecular bone

Mechanical strength and fracture resistance of trabecular bone (TB) are largely determined by the structural arrangement of individual trabeculae. Fast 3D spin-echo approaches are preferable to gradient echoes in that they are less sensitive to local induced gradients at the bone/marrow interface caused by magnetic susceptibility difference between the two tissues. FLASE is a 3D pulse sequence that serves this purpose. Here, we present a new pulse sequence dubbed FLADE (fast low-angle dual spin-echo) that overcomes some of the limitations inherent to FLASE, such as sensitivity to artifactual stimulated echoes. The double-echo sequence features a flip angle <90 degrees allowing for TR << T(1). The second phase-reversal pulse has the dual function of creating a second echo and restoring inverted longitudinal magnetization. The prolonged TR, made possible by sampling only half of k(z)-space, is used to collect navigator echoes in adjacent slabs for sensing subpixel translational displacements. FLADE is shown to provide SNR comparable to FLASE while having narrower point-spread function and being more robust to imperfections in the nonselective 180 degree pulses. Structural parameters derived from the in vivo images with the two pulse sequences are highly correlated, therefore suggesting that clinical data obtained with either pulse sequence can be merged.

Effect of testosterone replacement on trabecular architecture in hypogonadal men

We evaluated the effect of testosterone treatment on trabecular architecture by microMRI in 10 untreated severely hypogonadal men. After 2 years, microMRI parameters of trabecular connectivity improved significantly, suggesting the possibility that testosterone improves trabecular architecture.

INTRODUCTION

Osteoporosis, characterized by low BMD and diminished bone quality, is a significant public health problem in men. Hypogonadal men have decreased BMD and deteriorated trabecular architecture compared with eugonadal men, and testosterone treatment improves their BMD. We tested the hypothesis that testosterone replacement in hypogonadal men would also improve their trabecular architecture.

MATERIALS AND METHODS

We selected 10 untreated severely hypogonadal men and treated them with a testosterone gel for 24 months to maintain their serum testosterone concentrations within the normal range. Each subject was assessed before and after 6, 12, and 24 months of testosterone treatment by magnetic resonance microimaging (microMRI) of the distal tibia and by DXA of the spine and hip. The microMRI parameters reflect the integrity of the trabecular network and include the ratio of all surface voxels (representing plates) to curve voxels (representing rods) and the topological erosion index, a ratio of topological parameters expected to increase on trabecular deterioration to those expected to decrease. The higher the surface-to-curve ratio and the lower the topological erosion index, the more intact the trabecular network.

RESULTS

Serum testosterone concentrations increased to midnormal after 3 months of treatment and remained normal thereafter. After 24 months of testosterone treatment, BMD of the spine increased 7.4% (p<0.001), and of the total hip increased 3.8% (p=0.008). Architectural parameters assessed by microMRI also changed: the surface-to-curve ratio increased 11% (p=0.004) and the topological erosion index decreased 7.5% (p=0.004).

CONCLUSIONS

These results suggest the possibility that testosterone replacement of hypogonadal men improves trabecular architecture.

Chemical-shift micro-imaging of subcutaneous lesions

A chemical-shift imaging technique was used for the study of small subcutaneous lesions. This study concerns micro-imaging of two females suffering from a tenosynovial giant cell tumor and an epidermal cyst. High-resolution water, fat and chemical-shift artifact-free images were obtained on a whole-body MR unit (1.5 T) equipped with a 23-mm microscopy surface coil and standard gradients (23 mT/m). A significant improvement in signal-to-noise ratio was achieved by reducing the receiver bandwidth to values below +/-10 kHz. The image data sets were acquired with resolution 0.1 x 0.13 mm in the plane, slice thickness 0.5 mm and with acquisition time less than 3 min. Spatial resolution, fat suppression, image texture and edge delineation were improved on spectroscopic images compared with those on conventional MR images.

Quantitative high-resolution magnetic resonance imaging reveals structural implications of renal osteodystrophy on trabecular and cortical bone

PURPOSE

To explore the potential role of micro-magnetic resonance imaging (micro-MRI) for quantifying trabecular and cortical bone structural parameters in renal osteodystrophy (ROD), a multifactorial disorder of bone metabolism, traditionally evaluated by bone biopsy.

MATERIALS AND METHODS

Seventeen hemodialysis patients (average PTH level = 502 +/- 415 microg/liter) were compared with 17 age-, gender-, and body mass index (BMI)-matched control subjects. The average dialysis duration for the patients was 5.5 years (range = 0.96-18.2 years). Three-dimensional (3D) fast large-angle spin-echo (FLASE) MR images of the distal tibia (voxel size = 137 x 137 x 410 microm(3)) were processed to yield bone volume fraction (BV/TV). From a skeletonized representation of the trabecular bone network, the topology of each bone voxel was determined providing surface and curve voxel densities (SURF and CURV) and the topological erosion index (EI). Further, high-resolution two-dimensional (2D) spin-echo images were collected at the tibial midshaft for measurement of cortical bone cross-sectional area (CCA), relative CCA expressed as a percentage of total bone area (RCA), and mean cortical thickness (MCT).

RESULTS

The data show both RCA and MCT to be lower in the patients (61.2 vs. 69.1%, P = 0.008, and 4.53 vs. 5.19 mm, P = 0.01). BV/TV and SURF were lower, while EI was increased in the patients, although these differences were not quite significant (P = 0.06-0.09). All of the cortical and trabecular findings are consistent with increased bone fragility.

CONCLUSION

The data suggest that micro-MRI may have potential to characterize the structural implications of metabolic bone disease, potentially providing a noninvasive tool for the evaluation of therapies for ROD.

Reproducibility and error sources of micro-MRI-based trabecular bone structural parameters of the distal radius and tibia

The mechanical competence of trabecular bone is significantly determined, next to material density, by its three-dimensional (3D) structure. Recent advances in micromagnetic resonance imaging (micro-MRI) acquisition and processing techniques allow the 3D trabecular structure to be analyzed in vivo at peripheral sites such as the distal radius and tibia. The practicality of micro-MRI-based noninvasive virtual bone biopsy (VBB) for longitudinal studies of patients hinges on the reproducibility of the derived structural parameters, which largely determine the size of the effect that can be detected at a given power and significance level. In this paper, the reproducibility of micro-MRI-derived trabecular bone structure measures was examined by performing repeat studies in six healthy subjects in whom the distal aspects of the radius and tibia were scanned with a 3D spin-echo sequence at 137 x 137 x 410 microm3 voxel size. Bone volume fraction (BV/TV) and digital topological analysis (DTA) structural parameters including the topological bone surface-to-curve ratio (SCR) and topological erosion index (TEI) were evaluated after subjecting the raw images to a cascade of processing steps. The average coefficient of variation was 4-7% and was comparable for the two anatomic sites and for all parameters measured. The reliability expressed in terms of the intraclass correlation coefficient ranged from 0.95 to 0.97 in the radius and 0.68 to 0.92 in the tibia. Error analysis based on simulations suggests involuntary patient motion, primarily rotation, to be the chief source of imprecision, followed by failure to accurately match the analysis volumes in repeat studies.

Coherence-induced artifacts in large-flip-angle steady-state spin-echo imaging

High-resolution imaging of trabecular bone aimed at analyzing the bone's microarchitecture is preferably performed with spin-echo-type pulse sequences. Unlike gradient echoes, spin-echoes are immune to artifactual broadening of trabeculae caused by local static field gradients near the bone-bone marrow interface and signal loss from chemical shift dephasing at k-space center. However, the previously practiced 3D fast large-angle spin-echo (FLASE) pulse sequence was found to be prone to a low-frequency modulation artifact in both the readout and slice direction. The artifact is caused by deviations in the effective flip angle of the nonselective 180 degrees pulse, which converts a fraction of the phase-encoded transverse magnetization to longitudinal magnetization. The latter recurs as transverse magnetization in the subsequent pulse sequence cycle forming a spurious stimulated echo. The objective of this work was to perform a k-space analysis of this steady-state artifact and propose two modifications of the original 3D FLASE that effectively remove it. The results of the simulations were in exact agreement with the experiments and the proposed remedy was found to eliminate the artifact.

Role of magnetic resonance for assessing structure and function of trabecular bone

The strength of trabecular bone and its resistance to fracture traditionally have been associated with apparent density. This paradigm assumes that neither the ultrastructural nor microstructural make-up of the bone is altered during aging and osteoporosis. During the past decade there has been growing evidence from both laboratory and clinical studies against this view. Recent advances in noninvasive imaging technology, notably micro-magnetic resonance imaging (micro MRI) and computed tomography, offer an opportunity to test the hypothesis that architecture is an independent contributor to bone strength. MRI appears to be ideally suited for this task because bone marrow has uniform high signal intensity while bone appears with background intensity, thus yielding a binary system tomographic system. However, in vivo trabecular bone imaging is hampered by the limited signal-to-noise ratio that precludes voxel sizes much smaller than trabecular thickness, which would be required to yield a bimodal intensity histogram for segmentation of the image into bone and marrow. The resulting partial volume blurring leads to fuzzy boundaries. Successful structure analysis thus demands more elaborate processing strategies. This article reviews new approaches conceived in the authors' laboratory toward acquisition, processing, and structural analysis of trabecular bone images in the limited spatial resolution regimen of in vivo micro MRI. These methods are shown to provide detailed insight into the three-dimensional trabecular network topology and scale at the distal radius or distal tibia that typically serve as surrogate sites. The micro MRI-derived structural parameters are shown to be associated with the bone's biomechanical properties and fracture resistance. Further, the technology has advanced to a stage permitting serial studies in laboratory animals and humans as a means to evaluate the effects of treatment. The method currently is confined to peripheral skeletal sites, and its extension to typical fracture sites such as the proximal femur hinges on further advances in detection sensitivity.

Motion correction using the k-space phase difference of orthogonal acquisitions

Rigid body translations of an object in MRI create image artifacts along the phase-encode (PE) direction in standard 2DFT imaging. If two images are acquired with swapped PE direction, it is possible to determine and correct for arbitrary in-plane translational interview motions in both images directly from phase differences in the k-space acquisitions by solving a large system of linear equations. For example, if one assumes two N x N 2D acquisitions with in-plane translational interview motion, 4N unknown motions may corrupt the two images, but the phase difference at each point in k-space yields a system of N(2) equations in these 4N unknowns. If the acquisitions have orthogonal PE directions, this highly overdetermined system of equations can be solved to provide the motion records, which in turn can be used to correct the motion artifacts in each image. The theory of this orthogonal k-space phase difference (ORKPHAD) technique is described, and results are presented for synthetic and in vivo motion-corrupted data sets. In all cases, the data showed clear improvement of translation-induced artifacts. These methods do not require special pulse sequences and are theoretically generalizable to partial Fourier imaging and 3D acquisitions.

Phase coherent averaging in magnetic resonance spectroscopy using interleaved navigator scans: compensation of motion artifacts and magnetic field instabilities

The quality of spectra in (1)H magnetic resonance spectroscopy (MRS) is strongly affected by temporal signal instabilities during the acquisition. One reason for these instabilities are hardware imperfections, e.g., drifts of the main magnetic field in superconducting magnets. This is of special concern in high-field systems where the specification of the field stability is close to the spectral linewidth. A second major potential source of artifacts, particularly in clinical MRS, is patient motion. Using standard acquisition schemes of phase-cycled averaging of the individual acquisitions, long-term effects (field drifts) as well as changes on a shorter time scale (motion) can severely reduce spectral quality. The new technique for volume-selective MRS presented here is based on the additional interleaved acquisition of a navigator signal during the recovery time of the metabolite acquisition. It corrects for temporal signal instabilities by means of a deconvolution of the metabolite and the navigator signal. This leads to phase-corrected individual metabolite scans and upon summation to a phase-coherent averaging scheme. The interleaved navigator acquisition does not require any user interaction or supervision, while sequence efficiency is maintained.

Subvoxel processing: a method for reducing partial volume blurring with application to in vivo MR images of trabecular bone

Partial volume blurring precludes accurate measurement of structural dimensions in the limited-resolution regime in which image voxel size is larger than the typical structural element to be resolved. Since acquiring images at increased resolution often exacts an unacceptable signal-to-noise ratio (SNR) penalty, methods to alleviate the adverse effects of partial volume blurring are instrumental for the accurate measurement of architectural parameters in applications such as predicting the mechanical competence of trabecular bone networks. In the current work, a novel post-processing method, referred to as "subvoxel processing," is described for increasing apparent image resolution. The method is applicable to volumes of interest containing material phases of two discrete signal intensities. The principal strategy consists of subdividing voxels and assigning voxel intensities to each subvoxel on the basis of local neighborhood criteria and strict mass conservation. In the current work, the method's accuracy has been evaluated using microcomputed tomography images (22 x 22 x 22 microm(3) voxel size) of human trabecular bone. The results demonstrate that subvoxel processing is significantly more accurate than trilinear interpolation in decreasing apparent voxel size, especially in the presence of noise. In addition, the method's effectiveness is illustrated with MR images of human trabecular bone acquired in vivo at 137 x 137 x 350 microm(3) voxel size. The subvoxel-processed images are shown to have architectural features characteristic of images acquired at higher spatial resolution.

Digital topological analysis of in vivo magnetic resonance microimages of trabecular bone reveals structural implications of osteoporosis

Osteoporosis is a disease characterized by bone volume loss and architectural deterioration. The majority of work aimed at evaluating the structural implications of the disease has been performed based on stereologic analysis of histomorphometric sections. Only recently noninvasive imaging methods have emerged that provide sufficient resolution to resolve individual trabeculae. In this article, we apply digital topological analysis (DTA) to magnetic resonance microimages (mu-MRI) of the radius obtained at 137 x 137 x 350 microm3 voxel size in a cohort of 79 women of widely varying bone mineral density (BMD) and vertebral deformity status. DTA is a new method that allows unambiguous determination of the three-dimensional (3D) topology of each voxel in a trabecular bone network. The analysis involves generation of a bone volume fraction map, which is subjected to subvoxel processing to alleviate partial volume blurring, followed by thresholding and skeletonization. The skeletonized images contain only surfaces, profiles, curves, and their mutual junctions as the remnants of trabecular plates and rods after skeletonization. DTA parameters were compared with integral BMD in the lumbar spine and femur as well as MR-derived bone volume fraction (BV/TV). Vertebral deformities were determined based on sagittal MRIs of the spine with a semiautomatic method and the number of deformities counted after threshold setting. DTA structural indices were found the strongest discriminators of subjects with deformities from those without deformities. Subjects with deformities (n = 29) had lower topological surface (SURF) density (p < 0.0005) and surface-to-curve ratio (SCR; a measure of the ratio of platelike to rodlike trabeculae; p < 0.0005) than those without. Profile interior (PI) density, a measure of intact trabecular rods, was also lower in the deformity group (p < 0.0001). These data provide the first in vivo evidence for the structural implications inherent in postmenopausal osteoporosis accompanying bone loss, that is, the conversion of trabecular plates to rods and disruption of rods due to repeated osteoclastic resorption.

Trabecular structure assessment in lumbar vertebrae specimens using quantitative magnetic resonance imaging and relationship with mechanical competence

The purpose of this study was to use quantitative magnetic resonance imaging (MRI; high-resolution [HR] and relaxometry) to assess trabecular bone structure in lumbar vertebrae specimens and to compare these techniques with bone mineral density (BMD) in predicting stress values obtained from mechanical tests. Fourteen vertebral midsagittal sections from lumbar vertebrae L3 were obtained from cadavers (aged 22-76 years). HR images with a slice thickness of 300 microm and an in-plane spatial resolution of 117 microm2 x 117 microm2 were obtained. Transverse relaxation time T2' distribution was measured by using an asymmetric spin-echo (ASE) sequence. Traditional morphometric measures of bone structure such as apparent trabecular bone fraction (app. BV/TV), apparent trabecular bone number (app. Tb.N), apparent trabecular bone separation (app. Tb.Sp), and apparent trabecular bone thickness (app. Tb.Th) as well as the directional mean intercept length (MIL) were calculated. Additionally, BMD measurements of these sections were obtained by dual-energy X-ray absorptiometry (DXA) and biomechanical properties such as directional stress values (to fracture) were determined on adjacent specimens. With the exception of T2', all morphological parameters correlated very well with age, BMD, and stress values (R between 0.79 and 0.92). However, in the direction perpendicular to the magnetic field, T2' values enhanced the adjusted R2 correlation value with horizontal (M/L) stress values in addition to BMD from 0.70 to 0.91 (p < 0.05).

Trabecular bone volume fraction mapping by low-resolution MRI

Trabecular bone volume fraction (TBVF) is highly associated with the mechanical competence of trabecular bone. TBVF is ordinarily measured by histomorphometry from bone biopsies or, noninvasively, by means of high-resolution microcomputed tomography and, more recently, by micro-MRI. The latter methods require spatial resolution sufficient to resolve trabeculae, along with segmentation techniques that allow unambiguous assignment of the signal to bone or bone marrow. In this article it is shown that TBVF can be measured under low-resolution conditions by exploiting the attenuation of the MR signal resulting from fractional occupancy of the imaging voxel by bone and bone marrow, provided that a reference signal is available from a marrow volume devoid of trabeculation. The method requires accurate measurement of apparent proton density, which entails correction for various sources of error. Key among these are the spatial nonuniformity in the RF field amplitude and effects of the slice profile, which are determined by B(1) field mapping and numerical integration of the Bloch equations, respectively. By contrast, errors from variations in bone marrow composition (hematopoietic vs. fatty) between trabecular and reference site are predicted to be small and usually negligible. The method was evaluated in phantoms and in vivo in the distal radius and found to be accurate to 1% in marrow volume fraction. Finally, in a group of 12 patients of varying skeletal status, TBVF in the calcaneus was found to strongly correlate with integral bone mineral density of the lumbar vertebrae (r(2) = 0.83, p < 0.0001). The method may fail in large imaging objects such as the human trunk at high magnetic field where standing wave and RF penetration effects cause intensity variations that cannot be corrected. Magn Reson Med 46:103-113, 2001.