In vivo sodium multiple quantum spectroscopy of human articular cartilage

An Accelerated PETALUTE MRI Sequence for In Vivo Quantification of Sodium Content in Human Articular Cartilage at 3T

In this work, we demonstrate the sodium magnetic resonance imaging (MRI) capabilities of a three-dimensional (3D) dual-echo ultrashort echo time (UTE) sequence with a novel rosette petal trajectory (PETALUTE), in comparison to the 3D density-adapted (DA) radial spokes UTE sequence. We scanned five healthy subjects using a 3D dual-echo PETALUTE acquisition and two comparable implementations of 3D DA-radial spokes acquisitions, one matching the number of k-space projections (Radial-Matched Trajectories) and the other matching the total number of samples (Radial-Matched Samples) acquired in k-space. The PETALUTE acquisition enabled equivalent sodium quantification in articular cartilage volumes of interest (168.8 ± 29.9 mM) to those derived from the 3D radial acquisitions (171.62 ± 28.7 mM and 149.8 ± 22.2 mM, respectively). We achieved a shorter scan time of 2:06 for 3D PETALUTE, compared to 3:36 for 3D radial acquisitions. We also evaluated the feasibility of further acceleration of the PETALUTE sequence through retrospective compressed sensing with 2× and 4× acceleration of the first echo and showed structural similarity of 0.89 ± 0.03 and 0.87 ± 0.03 when compared to non-retrospectively accelerated reconstruction. Together, these results demonstrate improved scan time with equivalent performance of the PETALUTE sequence compared to the 3D DA-radial sequence for sodium MRI of articular cartilage.

Sodium MRI of human articular cartilage of the wrist: a feasibility study on a clinical 3T MRI scanner

OBJECTIVE

To measure sodium relaxation times and concentrations in human wrists on a clinical magnetic resonance imaging (MRI) scanner with a density-adapted radial sequence.

MATERIALS AND METHODS

Sodium MRI of human wrists was conducted on a 3T MR system using a dual-tuned ¹H/²³Na surface coil. We performed two studies with 10 volunteers each investigating either sodium T₁ (study 1) or sodium T₂* (study 2) relaxation times in the radiocarpal joint (RCJ) and midcarpal joint (MCJ). Sodium concentrations of both regions were determined.

RESULTS

No differences for transversal of longitudinal relaxation times were found between RCJ and MCJ (T_2,s*(RCJ) = (0.9 ± 0.4) ms; T_2,s*(MCJ) = (0.9 ± 0.3) ms; T_2,l*(RCJ) = (14.9 ± 0.9) ms; T_2,l*(MCJ) = (13.9 ± 1.1) ms; T₁(RCJ) = (19.0 ± 2.4) ms; T₁(MCJ) = (18.5 ± 2.1) ms). Sodium concentrations were (157.7 ± 28.4) mmol/l for study 1 and (159.8 ± 29.1) mmol/l for study 2 in the RCJ, and (172.7 ± 35.6) mmol/l for study 1 and (163.4 ± 26.3) mmol/l for study 2 in the MCJ.

CONCLUSION

We successfully determined sodium relaxation times and concentrations of the human wrist on a 3T MRI scanner.

Double quantum filtered 23 Na MRI with magic angle excitation of human skeletal muscle in the presence of B0 and B1 inhomogeneities

Double quantum filtered ²³ Na MRI with magic angle excitation (DQF-MA) can be used to selectively detect sodium ions located within anisotropic structures such as muscle fibers. It might therefore be a promising tool to analyze the microscopic environment of sodium ions, for example in the context of osmotically neutral sodium retention. However, DQF-MA imaging is challenging due to various signal dependences, on both measurement parameters and external influences. The aim of this work was to examine how B₀ in combination with B₁ inhomogeneities alter the DQF-MA signal intensity. We showed that, in the presence of B₀ inhomogeneities, flip angle schemes with only one 54.7° pulse can be favorable compared with the classical 90°-54.7°-54.7° scheme. DQF-MA images of the human lower leg were acquired at B₀  = 3 T with a nominal spatial resolution of 12 × 12 × 36 mm³ within an acquisition time of T_Acq  < 10 min, and compared with spin density weighted (DW), as well as triple quantum filtration (TQF) ²³ Na images. We found mean normalized signal-to-noise ratios of TQF/DW = 13.7 ± 2.3% (tibialis anterior), 11.9 ± 2.3% (soleus) and 11.4 ± 2.2% (gastrocnemius medialis), as well as DQF-MA/DW = 4.7 ± 1.1% (tibialis anterior), 3.3 ± 0.73% (soleus) and 3.4 ± 0.6% (gastrocnemius medialis). These ratios might serve as additional measures in future clinical studies of sodium retention within human skeletal muscle. However, the influence of B₀ and B₁ inhomogeneities should be considered when interpreting DQF-MA images.

Deep transfer learning for characterizing chondrocyte patterns in phase contrast X-Ray computed tomography images of the human patellar cartilage

Phase contrast X-ray computed tomography (PCI-CT) has been demonstrated to be effective for visualization of the human cartilage matrix at micrometer resolution, thereby capturing osteoarthritis induced changes to chondrocyte organization. This study aims to systematically assess the efficacy of deep transfer learning methods for classifying between healthy and diseased tissue patterns. We extracted features from two different convolutional neural network architectures, CaffeNet and Inception-v3 for characterizing such patterns. These features were quantitatively evaluated in a classification task measured by the area (AUC) under the Receiver Operating Characteristic (ROC) curve as well as qualitative visualization through a dimension reduction approach t-Distributed Stochastic Neighbor Embedding (t-SNE). The best classification performance, for CaffeNet, was observed when using features from the last convolutional layer and the last fully connected layer (AUCs >0.91). Meanwhile, off-the-shelf features from Inception-v3 produced similar classification performance (AUC >0.95). Visualization of features from these layers further confirmed adequate characterization of chondrocyte patterns for reliably distinguishing between healthy and osteoarthritic tissue classes. Such techniques, can be potentially used for detecting the presence of osteoarthritis related changes in the human patellar cartilage.

A robust diffusion tensor model for clinical applications of MRI to cartilage

PURPOSE

Diffusion tensor imaging (DTI) of articular cartilage is a promising technique for the early diagnosis of osteoarthritis (OA). However, in vivo diffusion tensor (DT) measurements suffer from low signal-to-noise ratio (SNR) that can result in bias when estimating the six parameters of the full DT, thus reducing sensitivity. This study seeks to validate a simplified four-parameter DT model (zeppelin) for obtaining more robust and sensitive in vivo DTI biomarkers of cartilage.

METHODS

We use simulations in a substrate to mimic changes during OA; and analytic simulations of the DT drawn from a range of fractional anisotropies (FA) measured with high-quality DT data from ex vivo human cartilage. We also use in vivo data from the knees of a healthy subject and two OA patients with Kellgren-Lawrence (KL) grades 1 and 2.

RESULTS

For simulated in vivo cartilage SNR (∼25) and anisotropy levels, the estimated mean values of MD from the DT and zeppelin models were identical to the ground truth values. However, zeppelin's FA is more accurate in measuring water restriction. More specifically, the FA estimations of the DT model were additionally biased by between +2% and +48% with respect to zeppelin values. Additionally, both mean diffusivity (MD) and FA of the zeppelin had lower parameter variance compared to the full DT (F-test, P < 0.05). We observe the same trends from in vivo values of patient data.

CONCLUSION

The zeppelin is more robust than the full DT for cartilage diffusion anisotropy and SNR at levels typically encountered in clinical applications of articular cartilage. Magn Reson Med 79:1157-1164, 2018. © 2017 International Society for Magnetic Resonance in Medicine.

Quantitative sodium magnetic resonance imaging of cartilage, muscle, and tendon

Sodium magnetic resonance imaging (MRI), or imaging of the 23Na nucleus, has been under exploration for several decades, and holds promise for potentially revealing additional biochemical information about the health of tissues that cannot currently be obtained from conventional hydrogen (or proton) MRI. This additional information could serve as an important complement to conventional MRI for many applications. However, despite these exciting possibilities, sodium MRI is not yet used routinely in clinical practice, and will likely remain strictly in the domain of exploratory research for the coming decade. This paper begins with a technical overview of sodium MRI, including the nuclear magnetic resonance (NMR) signal characteristics of the sodium nucleus, the challenges associated with sodium MRI, and the specialized pulse sequences, hardware, and reconstruction techniques required. Various applications of sodium MRI for quantitative analysis of the musculoskeletal system are then reviewed, including the non-invasive assessment of cartilage degeneration in vivo, imaging of tendinopathy, applications in the assessment of various muscular pathologies, and assessment of muscle response to exercise.

In vivo observation of quadrupolar splitting in (39)K magnetic resonance spectroscopy of human muscle tissue

The purpose of this work was to explore the origin of oscillations of the T(*)2 decay curve of (39)K observed in studies of (39)K magnetic resonance imaging of the human thigh. In addition to their magnetic dipole moment, spin-3/2 nuclei possess an electric quadrupole moment. Its interaction with non-vanishing electrical field gradients leads to oscillations in the free induction decay and to splitting of the resonance. All measurements were performed on a 7T whole-body MRI scanner (MAGNETOM 7T, Siemens AG, Erlangen, Germany) with customer-built coils. According to the theory of quadrupolar splitting, a model with three Lorentzian-shaped peaks is appropriate for (39)K NMR spectra of the thigh and calf. The frequency shifts of the satellites depend on the angle between the calf and the static magnetic field. When the leg is oriented parallel to the static magnetic field, the satellites are shifted by about 200 Hz. In the thigh, rank-2 double quantum coherences arising from anisotropic quadrupolar interaction are observed by double-quantum filtration with magic-angle excitation. In addition to the spectra, an image of the thigh with a nominal resolution of (16 × 16 × 32) mm(3) was acquired with this filtering technique in 1:17 h. From the line width of the resonances, (39)K transverse relaxation time constants T(*)2, fast  = (0.51 ± 0.01) ms and T(*)2, slow  = (6.21 ± 0.05) ms for the head were determined. In the thigh, the left and right satellite, both corresponding to the short component of the transverse relaxation time constant, take the following values: T(*)2, fast  = (1.56 ± 0.03) ms and T(*)2, fast  = (1.42 ± 0.03) ms. The centre line, which corresponds to the slow component, is T(*)2, slow  = (9.67 ± 0.04) ms. The acquisition time of the spectra was approximately 10 min. Our results agree well with a non-vanishing electrical field gradient interacting with (39)K nuclei in the intracellular space of muscle tissue.

Volumetric quantitative characterization of human patellar cartilage with topological and geometrical features on phase-contrast X-ray computed tomography

Phase-contrast X-ray computed tomography (PCI-CT) has attracted significant interest in recent years for its ability to provide significantly improved image contrast in low absorbing materials such as soft biological tissue. In the research context of cartilage imaging, previous studies have demonstrated the ability of PCI-CT to visualize structural details of human patellar cartilage matrix and capture changes to chondrocyte organization induced by osteoarthritis. This study evaluates the use of geometrical and topological features for volumetric characterization of such chondrocyte patterns in the presence (or absence) of osteoarthritic damage. Geometrical features derived from the scaling index method (SIM) and topological features derived from Minkowski Functionals were extracted from 1392 volumes of interest (VOI) annotated on PCI-CT images of ex vivo human patellar cartilage specimens. These features were subsequently used in a machine learning task with support vector regression to classify VOIs as healthy or osteoarthritic; classification performance was evaluated using the area under the receiver operating characteristic curve (AUC). Our results show that the classification performance of SIM-derived geometrical features (AUC: 0.90 ± 0.09) is significantly better than Minkowski Functionals volume (AUC: 0.54 ± 0.02), surface (AUC: 0.72 ± 0.06), mean breadth (AUC: 0.74 ± 0.06) and Euler characteristic (AUC: 0.78 ± 0.04) (p < 10(-4)). These results suggest that such geometrical features can provide a detailed characterization of the chondrocyte organization in the cartilage matrix in an automated manner, while also enabling classification of cartilage as healthy or osteoarthritic with high accuracy. Such features could potentially serve as diagnostic imaging markers for evaluating osteoarthritis progression and its response to different therapeutic intervention strategies.

Techniques and applications of in vivo diffusion imaging of articular cartilage

Early in the process of osteoarthritis (OA) the composition (water, proteoglycan [PG], and collagen) and structure of articular cartilage is altered leading to changes in its mechanical properties. A technique that can assess the composition and structure of the cartilage in vivo can provide insight in the mechanical integrity of articular cartilage and become a powerful tool for the early diagnosis of OA. Diffusion tensor imaging (DTI) has been proposed as a biomarker for cartilage composition and structure. DTI is sensitive to the PG content through the mean diffusivity and to the collagen architecture through the fractional anisotropy. However, the acquisition of DTI of articular cartilage in vivo is challenging due to the short T2 of articular cartilage (∼40 ms at 3 Tesla) and the high resolution needed (0.5-0.7 mm in plane) to depict the cartilage anatomy. We describe the pulse sequences used for in vivo DTI of articular cartilage and discus general strategies for protocol optimization. We provide a comprehensive review of measurements of DTI of articular cartilage from ex vivo validation experiments to its recent clinical applications.

Integrating dimension reduction and out-of-sample extension in automated classification of ex vivo human patellar cartilage on phase contrast X-ray computed tomography

Phase contrast X-ray computed tomography (PCI-CT) has been demonstrated as a novel imaging technique that can visualize human cartilage with high spatial resolution and soft tissue contrast. Different textural approaches have been previously investigated for characterizing chondrocyte organization on PCI-CT to enable classification of healthy and osteoarthritic cartilage. However, the large size of feature sets extracted in such studies motivates an investigation into algorithmic feature reduction for computing efficient feature representations without compromising their discriminatory power. For this purpose, geometrical feature sets derived from the scaling index method (SIM) were extracted from 1392 volumes of interest (VOI) annotated on PCI-CT images of ex vivo human patellar cartilage specimens. The extracted feature sets were subject to linear and non-linear dimension reduction techniques as well as feature selection based on evaluation of mutual information criteria. The reduced feature set was subsequently used in a machine learning task with support vector regression to classify VOIs as healthy or osteoarthritic; classification performance was evaluated using the area under the receiver-operating characteristic (ROC) curve (AUC). Our results show that the classification performance achieved by 9-D SIM-derived geometric feature sets (AUC: 0.96 ± 0.02) can be maintained with 2-D representations computed from both dimension reduction and feature selection (AUC values as high as 0.97 ± 0.02). Thus, such feature reduction techniques can offer a high degree of compaction to large feature sets extracted from PCI-CT images while maintaining their ability to characterize the underlying chondrocyte patterns.

NMR dispersion investigations of enzymatically degraded bovine articular cartilage

PURPOSE

Cross-relaxation of protons with (14) N nuclei in proteins enhances relaxivity in the quadrupolar dip range of typically 2-3 MHz Larmor frequency. The magnitude of these dips was suggested as a means of assessing the degeneracy of articular cartilage during osteoarthritis (OA). However, so far only proteoglycans have been considered whereas collagen nitrogen was neglected. This study addresses the relative importance of glycosaminoglycans (GAG), collagen, and water content for the cross-relaxation effect.

METHODS

Relaxation dispersion data were acquired for protons in samples of bovine articular cartilage, collagen, and GAG before and after the addition of trypsin or collagenase, and were compared with spatially resolved dGEMRIC experiments at 0.27 Tesla.

RESULTS

Both collagen as well as GAG show quadrupolar dips that strongly depend on hydration. For typical water concentrations in cartilage, the effect of enzymatic activity onto GAG is minor but a strong dependence on water concentration is found.

CONCLUSION

Quadrupolar dips in the (1) H relaxation dispersion of cartilage possess similar contributions from both GAG and collagen. The reduction of the cross-relaxation contribution observed in OA tissue is thus not directly proportional to GAG concentration, but maintains a collagen contribution and reflects predominantly the increase in water concentration during OA.

Feasibility of in vivo diffusion tensor imaging of articular cartilage with coverage of all cartilage regions

OBJECTIVES

To investigate the value of diffusion tensor imaging (DTI) of articular cartilage to differentiate healthy from osteoarthritis (OA) subjects in all cartilage regions.

METHODS

DTI was acquired sagittally at 7 T in ten healthy and five OA (Kellgren-Lawrence grade 2) subjects with a line scan diffusion tensor sequence (LSDTI). Three healthy volunteers and two OA subjects were examined twice to assess the test-retest reproducibility. Averaged mean diffusivity (MD) and fractional anisotropy (FA) were calculated in each cartilage region (femoral trochlea, lateral and medial femoral condyles, patella, and lateral and medial tibia).

RESULTS

The test-retest reproducibility was 2.9% for MD and 5.6% for FA. Averaged MD was significantly increased (+20%, p < 0.05) in the OA subjects in the lateral femoral condyle, lateral tibia and the femoral trochlea compartments. Averaged FA presented a trend of lower values in the OA subjects (-12%), which was only significant for the lateral tibia.

CONCLUSIONS

In vivo DTI of articular cartilage with coverage of all cartilage regions using an LSDTI sequence is feasible, shows excellent reproducibility for MD and FA, and holds potential for the diagnosis of OA.

KEY POINTS

• DTI of articular cartilage is feasible at 7 T in all cartilage regions • DTI of articular cartilage can potentially differentiate healthy and OA subjects.

Simultaneous magnetic resonance imaging and consolidation measurement of articular cartilage

Magnetic resonance imaging (MRI) offers the opportunity to study biological tissues and processes in a non-disruptive manner. The technique shows promise for the study of the load-bearing performance (consolidation) of articular cartilage and changes in articular cartilage accompanying osteoarthritis. Consolidation of articular cartilage involves the recording of two transient characteristics: the change over time of strain and the hydrostatic excess pore pressure (HEPP). MRI study of cartilage consolidation under mechanical load is limited by difficulties in measuring the HEPP in the presence of the strong magnetic fields associated with the MRI technique. Here we describe the use of MRI to image and characterize bovine articular cartilage deforming under load in an MRI compatible consolidometer while monitoring pressure with a Fabry-Perot interferometer-based fiber-optic pressure transducer.

Computer-aided diagnosis in phase contrast imaging X-ray computed tomography for quantitative characterization of ex vivo human patellar cartilage

Visualization of ex vivo human patellar cartilage matrix through the phase contrast imaging X-ray computed tomography (PCI-CT) has been previously demonstrated. Such studies revealed osteoarthritis-induced changes to chondrocyte organization in the radial zone. This study investigates the application of texture analysis to characterizing such chondrocyte patterns in the presence and absence of osteoarthritic damage. Texture features derived from Minkowski functionals (MF) and gray-level co-occurrence matrices (GLCM) were extracted from 842 regions of interest (ROI) annotated on PCI-CT images of ex vivo human patellar cartilage specimens. These texture features were subsequently used in a machine learning task with support vector regression to classify ROIs as healthy or osteoarthritic; classification performance was evaluated using the area under the receiver operating characteristic curve (AUC). The best classification performance was observed with the MF features perimeter (AUC: 0.94 ±0.08 ) and "Euler characteristic" (AUC: 0.94 ±0.07 ), and GLCM-derived feature "Correlation" (AUC: 0.93 ±0.07). These results suggest that such texture features can provide a detailed characterization of the chondrocyte organization in the cartilage matrix, enabling classification of cartilage as healthy or osteoarthritic with high accuracy.

Sodium relaxation times in the knee joint in vivo at 7T

The sodium concentration correlates directly with the concentration of proteoglycans (PG) in cartilage, the loss of which is an early signature of osteoarthritis (OA). As a result, quantitative sodium MRI is a promising technique for assessing the degradation of articular cartilage in patients with OA. Sodium relaxation times can also provide information on the degradation of cartilage: it has already been shown on bovine cartilage that T(1) and T2long are longer and T2short shorter when the PG concentration decreases. In this study, sodium T(1), T2*short and T2*long relaxation maps were measured in vivo at 7 T on 8 healthy volunteers and in 4 different regions of the cartilage in the knee joint. The patellar, femoro-tibial medial, lateral, and femoral condyle cartilage have an average T(1)~20 ms, but different T2*short (from 0.5 ms to 1.4 ms) and T2*long (from 11.4 ms to 14.8 ms). Statistically significant differences in T(1), T2*short and T2*long were observed between the different regions in cartilage (p << 10(- 5)). Statistical differences in T(1) were also observed between male and female data (p << 10(- 5)). These relaxation times measurements can further be applied as correction factors for sodium concentration maps in vivo and can also be useful as complementary information to quantitative sodium MRI in the quest for detecting early OA. These measurements were done on low resolution sodium images in order to acquire sufficient quality data for fitting (5 images for T(1) and 9 images for T2*) while keeping the total time of acquisition of the data reasonable for the volunteer's comfort (1 h 15 min).

2H double- and zero-quantum filtered NMR spectroscopy for probing the environments of water in Nafion

Multiple quantum 2H NMR spectroscopy is used to study the structure and dynamics of D2O in Nafion membranes as a function of membrane hydration. By employing both double- and zero-quantum filtered experiments, residual quadrupolar coupling constants and T2 relaxation values are obtained. The residual couplings vary from 240 to 20 Hz and the T2 values range from 20 to 180 ms, with the high hydration values having smaller couplings and longer T2 values. Analysis of the data using a water-exchange model suggests that the changes in parameters arise from a change in the fraction of time water spends in the anisotropic environments and not from changes in the order parameters that characterize the anisotropic sites. It has been found that a two-site model is needed to accurately fit the spectra above a hydration level of 10 D2O per sulfonate, with the second site having a negligible residual quadrupolar coupling. The data supports a model with two different hydration layers at high hydration and can be understood in terms of the recently proposed parallel-channel model for Nafion hydration.

Cartilage quality assessment by using glycosaminoglycan chemical exchange saturation transfer and (23)Na MR imaging at 7 T

PURPOSE

To compare a glycosaminoglycan chemical exchange saturation transfer (gagCEST) imaging method, which enables sampling of the water signal as a function of the presaturation offset (z-spectrum) at 13 points in clinically feasible imaging times, with sodium 23 ((23)Na) magnetic resonance (MR) imaging in patients after cartilage repair surgery (matrix-associated autologous chondrocyte transplantation and microfracture therapy).

MATERIALS AND METHODS

One female patient (67.3 years), and 11 male patients (median age, 28.8 years; interquartile range [IQR], 24.6-32.3 years) were examined with a 7-T whole-body system, with approval of the local ethics committee after written informed consent was obtained. A modified three-dimensional gradient-echo sequence and a 28-channel knee coil were used for gagCEST imaging. (23)Na imaging was performed with a circularly polarized knee coil by using a modified gradient-echo sequence. Statistical analysis of differences and Spearman correlation were applied.

RESULTS

The median of asymmetries in gagCEST z-spectra summed over all offsets from 0 to 1.3 ppm was 7.99% (IQR, 6.33%-8.79%) in native cartilage and 5.13% (IQR, 2.64%-6.34%) in repair tissue. A strong correlation (r = 0.701; 95% confidence interval: 0.21, 0.91) was found between ratios of signal intensity from native cartilage to signal intensity from repair tissue obtained with gagCEST or (23)Na imaging. The median of dimensionless ratios between native cartilage and repair tissue was 1.28 (IQR, 1.20-1.58) for gagCEST and 1.26 (IQR, 1.21-1.48) for (23)Na MR imaging.

CONCLUSION

The high correlation between the introduced gagCEST method and (23)Na imaging implies that gagCEST is a potentially useful biomarker for glycosaminoglycans.

Signal-to-noise optimization for sodium MRI of the human knee at 4.7 Tesla using steady state

Sodium magnetic resonance imaging of knee cartilage is a possible diagnostic method for osteoarthritis, but low signal-to-noise ratio yields low spatial resolution images and long scan times. For a given scan time, a steady-state approach with reduced repetition time and increased averaging may improve signal-to-noise ratio and hence attainable resolution. However, repetition time reduction results in increased power deposition, which must be offset with increased radiofrequency pulse length and/or reduced flip angle to maintain an acceptable specific absorption rate. Simulations varying flip angle, repetition time, and radiofrequency pulse length were performed for constant power deposition corresponding to ∼6 W/kg over the human knee at 4.7 T. For 10% agar, simulation closely matched experiment. For healthy human knee cartilage, a 37% increase in signal-to-noise ratio was predicted for steady-state over "fully relaxed" parameters while a 29% ± 4% increase was determined experimentally (n=10). Partial volume of cartilage with synovial fluid, inaccurate relaxation parameters used in simulation, and/or quadrupolar splitting may be responsible for this disagreement. Excellent quality sodium images of the human knee were produced in 9 mins at 4.7 T using the signal-to-noise ratio enhancing steady-state technique.

23Na and 2H magnetic resonance studies of osteoarthritic and osteoporotic articular cartilage

In this study, the short component of the (23)Na T(2) (T(2f)) and the (23)Na and (2)H quadrupolar interactions (nu(Q)) were measured in bone-cartilage samples of osteoarthritic (OA) and osteoporotic (OP) patients. (23)Na nu(Q) was found to increase in osteoarthritic articular cartilage relative to controls. Similar results were found in bovine cartilage following proteoglycan (PG) depletion, a condition that prevails in osteoarthritis. (23)Na nu(Q) and 1/T(2f) for articular cartilage obtained from osteoporotic patients were significantly larger than for control and osteoarthritic cartilage. Decalcification of both human and bovine articular cartilage resulted in an increase of (23)Na nu(Q) and 1/T(2f), showing the same trend as the osteoporotic samples. Differences in the ratio of the intensity of the large (2)H splitting to that of the small one in the calcified zone were also observed. In osteoporosis, this ratio was twice as large as that obtained for both control and osteoarthritic samples. The (2)H and (23)Na results can be interpreted as due to sodium ions and water molecules filling the void created by the calcium depletion and to calcium ions being located in close association with the collagen fibers. To the best of our knowledge, this is the first study reporting differences of NMR parameters in cartilage of osteoporotic patients.

Quantitative sodium MRI of the mouse prostate

A method was developed for quantitative sodium MRI of the mouse prostate at 9.4 T. A small loop-gap radiofrequency coil was constructed and dual-tuned to both the proton and sodium frequencies. The location and boundary of the mouse prostate were localized using high-resolution T(2)-weighted proton images, and sodium images were acquired with 1mm isotropic resolution using a short echo time (0.6 ms) and a long pulse repetition time (300 ms) for sodium density weighting with minimal T(1) and T(2) contrast. Sodium concentration in the prostate was estimated by comparing pixel intensities within the prostate to the pixel intensities in a pair of reference vials with known sodium concentrations, and a radiofrequency field inhomogeneity correction was performed based on field maps of a homogeneous phantom. In a group of five healthy, 5-month-old BALB/c mice, the average sodium concentration within their prostates was measured to be 173 +/- 38 mM. Muscle tissue and bladder were also clearly visible in the sodium images, and their sodium concentrations were estimated to be 40 +/- 15 mM and 210 +/- 72 mM, respectively.

Rapid isotropic 3D-sodium MRI of the knee joint in vivo at 7T

PURPOSE

To demonstrate the feasibility of acquiring high-resolution, isotropic 3D-sodium magnetic resonance (MR) images of the whole knee joint in vivo at ultrahigh field strength (7.0T) via a 3D-radial acquisition with ultrashort echo times and clinically acceptable acquisition times.

MATERIALS AND METHODS

Five healthy controls (four males, one female; mean +/- standard deviation [SD] age 28.7 +/- 4.8 years) and five patients with osteoarthritis (OA) (three males, two females; mean +/- SD age 52.4 +/- 5.6 years) underwent (23)Na MRI on a 7T, multinuclei equipped whole-body scanner. A quadrature (23)Na knee coil and a 3D-gradient echo (GRE) imaging sequence with a radial acquisition were utilized. Cartilage sodium concentration was measured and compared between the healthy controls and OA patients.

RESULTS

The average signal-to-noise ratio (SNR) for different spatial resolutions (1.2-4 mm) varied from approximately 14-120, respectively. The mean sodium concentration of healthy subjects ranged from approximately 240 +/- 28 mM/L to 280 +/- 22 mM/L. However, in OA patients the sodium concentrations were reduced significantly by approximately 30%-60%, depending on the degree of cartilage degeneration.

CONCLUSION

The preliminary results suggest that sodium imaging at 7T may be a feasible potential alternative for physiologic OA imaging and clinical diagnosis.

23Na TQF NMR imaging for the study of spinal disc tissue

A method for acquiring triple quantum filtered (TQF) (23)Na NMR images is proposed that takes advantage of the differences in transverse relaxation rates of sodium to achieve positive intensity, PI, NMR signal. This PITQF imaging sequence has been used to obtain spatially resolved one-dimensional images as a function of the TQF creation time, tau, for two human spinal disc samples. From the images the different parts of the tissue, nucleus pulposus and annulus fibrosus, can be clearly distinguished based on their signal intensity and creation time profiles. These results establish the feasibility of (23)Na TQF imaging and demonstrate that this method should be applicable for studying human disc tissues as well as spinal disc degeneration.

Novel contrast mechanisms at 3 Tesla and 7 Tesla

Osteoarthritis (OA) is the most common musculoskeletal degenerative disease, affecting millions of people. Although OA has been considered primarily a cartilage disorder associated with focal cartilage degeneration, it is accompanied by well-known changes in subchondral and trabecular bone, including sclerosis and osteophyte formation. The exact cause of OA initiation and progression remains under debate, but OA typically first affects weightbearing joints such as the knee. Magnetic resonance imaging (MRI) has been recognized as a potential tool for quantitative assessment of cartilage abnormalities due to its excellent soft tissue contrast. Over the last two decades, several new MR biochemical imaging methods have been developed to characterize the disease process and possibly predict the progression of knee OA. These new MR biochemical methods play an important role not only for diagnosis of disease at an early stage, but also for their potential use in monitoring outcome of various drug therapies (success or failure). Recent advances in multicoil radiofrequency technology and high field systems (3 T and above) significantly improve the sensitivity and specificity of imaging studies for the diagnosis of musculoskeletal disorders. The current state-of-the-art MR imaging methods are briefly reviewed for the quantitative biochemical and functional imaging assessment of musculoskeletal systems.

The application of 23Na double-quantum-filter (DQF) NMR spectroscopy for the study of spinal disc degeneration

Degenerative disc disease is an irreversible process that leads to a loss of mechanical integrity and back pain in millions of people. In this report, (23)Na double-quantum-filtered (DQF) NMR spectroscopy is used to study disc tissues in two stages of degeneration. Initial results indicate that the (23)Na DQF signal may be useful for determining the degree of degeneration. The spectral analysis reveals the presence of sodium environments with different residual quadrupolar couplings and T(2) relaxation times that we attribute to different regions, or compartments, corresponding to different biochemical regions in the tissue. In general it is found that there are compartments with no residual quadrupolar couplings, compartments with moderate couplings (200 to 1000 Hz), and compartments with couplings ranging from 1500 to 3000 Hz. The results indicate that (23)Na DQF NMR spectroscopy provides a probe of the degenerative state of the intervertebral disc tissues, and might hold potential as a novel diagnostic method for detection of disc degeneration.

Sodium and T1rho MRI for molecular and diagnostic imaging of articular cartilage

In this article, both sodium magnetic resonance (MR) and T1rho relaxation mapping aimed at measuring molecular changes in cartilage for the diagnostic imaging of osteoarthritis are reviewed. First, an introduction to structure of cartilage, its degeneration in osteoarthritis (OA) and an outline of diagnostic imaging methods in quantifying molecular changes and early diagnostic aspects of cartilage degeneration are described. The sodium MRI section begins with a brief overview of the theory of sodium NMR of biological tissues and is followed by a section on multiple quantum filters that can be used to quantify both bi-exponential relaxation and residual quadrupolar interaction. Specifically, (i) the rationale behind the use of sodium MRI in quantifying proteoglycan (PG) changes, (ii) validation studies using biochemical assays, (iii) studies on human OA specimens, (iv) results on animal models and (v) clinical imaging protocols are reviewed. Results demonstrating the feasibility of quantifying PG in OA patients and comparison with that in healthy subjects are also presented. The section concludes with the discussion of advantages and potential issues with sodium MRI and the impact of new technological advancements (e.g. ultra-high field scanners and parallel imaging methods). In the theory section on T1rho, a brief description of (i) principles of measuring T1rho relaxation, (ii) pulse sequences for computing T1rho relaxation maps, (iii) issues regarding radio frequency power deposition, (iv) mechanisms that contribute to T1rho in biological tissues and (v) effects of exchange and dipolar interaction on T1rho dispersion are discussed. Correlation of T1rho relaxation rate with macromolecular content and biomechanical properties in cartilage specimens subjected to trypsin and cytokine-induced glycosaminoglycan depletion and validation against biochemical assay and histopathology are presented. Experimental T1rho data from osteoarthritic specimens, animal models, healthy human subjects and as well from osteoarthritic patients are provided. The current status of T1rho relaxation mapping of cartilage and future directions is also discussed.

Effect of IL-1beta-induced macromolecular depletion on residual quadrupolar interaction in articular cartilage

PURPOSE

Sodium multiple-quantum filtered (MQF) NMR spectroscopy may potentially be used to measure proteoglycan (PG) depletion in cartilage caused by osteoarthritis (OA). The purpose of this work was to quantify the effect of interleukin-1 (IL-1beta)-induced macromolecule depletion on the residual quadrupolar interaction (RQI) of sodium in bovine cartilage plugs.

MATERIALS AND METHODS

Fifteen 8-mm-diameter cartilage plug specimens were cored from the articular surface of fresh bovine patellae. All plugs were kept in culture media and nine of the plugs were subjected to interleukin-1 (IL-1beta)-induced degeneration of cartilage for 4, 6, and 7 days. Sodium NMR spectra were obtained from each sample with a 1-cm-diameter solenoid coil in a 2T whole-body magnet interfaced to a custom-built spectrometer. We employed a previously described theoretical model to analyze triple-quantum filtered (TQF) and double-quantum filtered magic angle (DQFMA) spectra obtained from normal cartilage and cartilage treated with IL-1beta. The model assumes a static Gaussian distribution of the RQI frequency, omega(Q), in the sample. TQF and DQFMA spectra from each sample were fitted with the appropriate signal expressions to determine sigma (the root mean square (RMS) omegaQ), T2f, and T2s. An inversion-recovery sequence was used to determine T1 of each plug. A spectrophotometric assay was used to determine the amount of PG depleted from each plug. Histology was performed to visualize the PG loss in cartilage plugs. We defined sigma as the measure of changes in macroscopic order in the tissue.

RESULTS

Simulated spectra from the theoretical model were in excellent agreement with the experimental data. We were able to determine the relaxation times as well as sigma of each specimen from their corresponding fits. T2f ranged between 2.26-3.50 msec, decreasing with increased PG loss. Over the range of PG depletion investigated, T2s increased from 12.3 msec to 14.9 msec, and T1 increased from 16 msec to 21 msec, while sigma decreased from 180 Hz to 120 Hz. The order of macromolecules in the cartilage tissue decreased substantially with PG loss. Histology sections clearly showed qualitative visualization of the PG loss in cartilage following treatment with IL-1beta.

CONCLUSION

We demonstrated that IL-beta-induced macromolecule depletion in cartilage not only changes the relaxation characteristics of sodium but also changes RQI of the tissue. Using MQF sodium spectroscopy we quantified the changes in sigma and showed that loss of macromolecules reduces the degree of order in the tissue.

23Na MRI accurately measures fixed charge density in articular cartilage

One of the initiating steps of osteoarthritis is the loss of proteoglycan (PG) molecules from the cartilage matrix. One method for assessing cartilage integrity, therefore, is to measure the PG content or fixed charge density (FCD) of cartilage. This report shows the feasibility of calculating FCD by (23)Na MRI and introduces MRI protocols for human studies, in vivo. (23)Na MRI was used to measure the sodium concentration inside bovine patellar cartilage. The sodium concentration was then converted to FCD (mM) by considering ideal Donnan equilibrium. These FCD measurements were compared to FCD measurements obtained through standard dimethylmethylene blue PG assays. There was a high correlation (slope = 0.89, r(2) = 0.81) between the FCD measurements obtained by (23)Na MRI and those obtained by the PG assays. These methods were then employed in quantifying the FCD of articular cartilage of human volunteers in vivo. Two imaging protocols were compared: one using a birdcage coil, the other using a transmit/receive surface coil. Both methodologies gave similar results, with the average sodium concentration of normal human patellar cartilage ranging from approximately 240 to 260 mM. This corresponds to FCDs of -158 mM to -182 mM.

Detection of sodium ions in anisotropic environments through spin-lock NMR

A new method for selectively detecting sodium ions in anisotropic environments is presented. A spin-lock (SL) sequence, followed by a coherence transfer pulse, generates rank-two zero-quantum coherences, and converts them into observable transverse magnetization. The quadrupolar polarization is only generated when there are residual quadrupolar couplings in the sample, and provided the SL field strength is comparable to these couplings. This filter has proved to be more efficient than a double-quantum magic-angle (DQ-MA) filter in generating observable signal from ions in anisotropic media in both a nasal bovine cartilage sample and a liquid crystalline DNA sample. Finally, the SL filtering technique does not rely on a flip angle effect for the selection of the desired signal component, as does a DQ-MA filter, and may therefore prove desirable in an imaging experiment, due to its better tolerance to phase and flip angle imperfections.

Multiquantum filters and order in tissues

In ordered systems, where the molecular motion is anisotropic, quadrupolar and dipolar interactions are not averaged to zero. In such cases, double quantum (DQ) coherences can be formed. This review deals mainly with the effect of anisotropic motion of water molecules and sodium ions in intact biological tissues on (2)H, (1)H and (23)Na NMR spectroscopy and its application to NMR imaging (MRI). Double quantum filtered (DQF) spectra of water molecules and sodium ions were detected in a variety of ordered biological tissues. In collagen-containing tissues such as ligaments, tendons, cartilage, skin, blood vessels and nerves, the DQ coherences are formed as a result of the interaction with the collagen fibers. In red blood cells and presumably also in nerve axons it stems from the interaction with the cytoskeleton. For (23)Na, an I = 3/2 nucleus, the DQ coherences can also be formed in isotropic media. By a judicial choice of the pulse angle in the DQ pulse sequence only the DQ coherences arising from anisotropic motion are detected. For I = 1 nuclei such as 2H, DQF spectra can be observed only in ordered structures. Thus, the observation of 2H DQF spectra is an indication of order. The same is true for pairs of equivalent 1H nuclei. The dependence of the DQF signal on the creation time of the double quantum coherences is characteristic to each tissue and allows signals to be resolved from different tissues by performing the measurements at different creation times. In this way, the 2H DQF signals of the different compartments of sciatic nerve were resolved and water diffusion in each compartment was studied independently. In the axon, the diffusion was heavily restricted perpendicular to the axon's long axis, a result from which the axon diameter could be deduced. In blood vessel walls, this characteristic enabled the different layers of the vessel to be viewed and studied under strain. For 2H, a DQF spectroscopic imaging sequence was used to study the orientation of the collagen fibers in the different zones of articular cartilage and bone plug. The effect of pressure on the fibers and their return to equilibrium was studied as well. In blood vessels, a DQF image was obtained and strain maps of the different layers were calculated. The efficiency of the 1H DQF imaging technique was demonstrated on a phantom of rat tail where only the four tendons were detected at short creation times. 1H DQF imaging and spectroscopy followed the healing of a rabbit's ruptured Achilles tendon and the results were far more sensitive to the process than conventional imaging. Finally, the method was implemented on a commercial whole body MRI spectrometer. Images of human wrist and ankle showed a positive contrast for the tendons and ligaments, indicating the potential of the method for clinical imaging. (c) 2001 John Wiley & Sons, Ltd.

Human skeletal muscle: sodium MR imaging and quantification-potential applications in exercise and disease

PURPOSE

To use sodium 23 magnetic resonance (MR) imaging to quantify noninvasively total sodium in human muscle and to apply the technique in exercise and musculoskeletal disease.

MATERIALS AND METHODS

Total [Na] sodium was determined from the ratio of the relaxation-corrected (23)Na signal intensities measured from short echo-time (0.4 msec) (23)Na images to those from an external saline solution reference. The method was validated with the blinded use of saline solutions of varying sodium concentrations. [Na] was measured in the calf muscles in 10 healthy volunteers. (23)Na MR imaging also was performed in two healthy subjects after exercise, two patients with myotonic dystrophy, and two patients with osteoarthritis.

RESULTS

(23)Na MR imaging yielded a total [Na] value of 28.4 mmol/kg of wet weight +/- 3.6 (SD) in normal muscle, consistent with prior biopsy data. Spatial resolution was 0.22 mL, with signal-to-noise ratio of 10-15. Mean signal intensity elevations were 16% and 22% after exercise and 47% and 70% in dystrophic muscles compared with those at normal resting levels. In osteoarthritis, mean signal intensity reductions were 36% and 15% compared with those in unaffected knee joints.

CONCLUSION

(23)Na MR imaging can be used to quantify total [Na] in human muscle. The technique may facilitate understanding of the role of the sodium-potassium pump and perfusion in normal and diseased muscle.

Sodium visibility and quantitation in intact bovine articular cartilage using high field (23)Na MRI and MRS

Noninvasive methods of detecting cartilage degeneration can have an impact on identifying the early stages of osteoarthritis. Accurate measurement of sodium concentrations within the cartilage matrix provides a means for analyzing tissue integrity. Here a method is described for quantitating sodium concentration and visibility in cartilage, with general applications to all tissue types. The sodium concentration in bovine patellar cartilage plugs was determined by three different methods: NMR spectroscopy of whole cartilage plugs, NMR spectroscopy of liquefied cartilage in concentrated HCl, and inductively coupled plasma emission spectroscopy. Whole bovine patellae were imaged with relaxation normalized calibration phantoms to ascertain sodium concentrations inside the articular cartilage. Sodium concentrations in intact articular cartilage were found to range from approximately 200 mM on the edges to approximately 390 mM in the center, with an average of approximately 320 mM in five separate bovine patellae studied. In essence, we have created sodium distribution maps of the cartilage, showing for the first time, spatial variations of sodium concentration in intact cartilage. This average concentration measurement correlates very well with the values obtained from the spectroscopic methods. Furthermore, sodium was found to be 100% NMR visible in cartilage plugs. Applications of this method in diagnosing and monitoring treatment of osteoarthritis are discussed.

In vivo triple quantum filtered twisted projection sodium MRI of human articular cartilage

In this work, we present the first triple quantum filtered (TQF) sodium MR images of the human knee joint in vivo. A 3D TQF data set of 16 slices was obtained in 20 min using a TQF pulse sequence preencoded to a twisted projection imaging readout. Images clearly demarcate patellar cartilage and also demonstrate fluid signal suppressed by the triple quantum filter. Biexponential transverse relaxation times were calculated by fitting the TQF free induction decay to a theoretical signal expression. The average values from three healthy volunteers were T(2fall)(*) = 9.59 +/- 0.35 ms and T(2rise)(*) = 0.84 +/- 0.06 ms. Application of TQF imaging in biological tissues is discussed.

Competition between Na(+) and Li(+) for unsealed and cytoskeleton-depleted human red blood cell membrane: a (23)Na multiple quantum filtered and (7)Li NMR relaxation study

Evidence for competition between Li(+) and Na(+) for binding sites of human unsealed and cytoskeleton-depleted human red blood cell (csdRBC) membranes was obtained from the effect of added Li(+) upon the (23)Na double quantum filtered (DQF) and triple quantum filtered (TQF) NMR signals of Na(+)-containing red blood cell (RBC) membrane suspensions. We found that, at low ionic strength, the observed quenching effect of Li(+) on the (23)Na TQF and DQF signal intensity probed Li(+)/Na(+) competition for isotropic binding sites only. Membrane cytoskeleton depletion significantly decreased the isotropic signal intensity, strongly affecting the binding of Na(+) to isotropic membrane sites, but had no effect on Li(+)/Na(+) competition for those sites. Through the observed (23)Na DQF NMR spectra, which allow probing of both isotropic and anisotropic Na(+) motion, we found anisotropic membrane binding sites for Na(+) when the total ionic strength was higher than 40 mM. This is a consequence of ionic strength effects on the conformation of the cytoskeleton, in particular on the dimer-tetramer equilibrium of spectrin. The determinant involvement of the cytoskeleton in the anisotropy of Na(+) motion at the membrane surface was demonstrated by the isotropy of the DQF spectra of csdRBC membranes even at high ionic strength. Li(+) addition initially quenched the isotropic signal the most, indicating preferential Li(+)/Na(+) competition for the isotropic membrane sites. High ionic strength also increased the intensity of the anisotropic signal, due to its effect on the restructuring of the membrane cytoskeleton. Further Li(+) addition competed with Na(+) for those sites, quenching the anisotropic signal. (7)Li T(1) relaxation data for Li(+)-containing suspensions of unsealed and csdRBC membranes, in the absence and presence of Na(+) at low ionic strength, showed that cytoskeleton depletion does not affect the affinity of Na(+) for the RBC membrane, but increases the affinity of Li(+) by 50%. This clearly indicates that cytoskeleton depletion favors Li(+) relative to Na(+) binding, and thus Li(+)/Na(+) competition for its isotropic sites. Thus, this relaxation technique proves to be very sensitive to alkali metal binding to the membrane, detecting a more pronounced steric hindrance effect of the cytoskeleton network to binding of the larger hydrated Li(+) ion to the membrane phosphate groups.

Sodium multiple quantum spectroscopy of articular cartilage: effects of mechanical compression

The effects of mechanical compression on the multiple quantum coherences generated from sodium ions in articular cartilage were investigated. Cartilage samples obtained from bovine patellae were studied during compression at 0.7 MPa (100 psi) for 1 hour. The double quantum filtered spectra showed marked lineshape changes in the compressed samples. Compression did not seem to influence the lineshapes of the single quantum and triple quantum filtered spectra significantly. We found that the residual quadrupolar interaction was reduced in the compressed samples. Changes in the ordering of collagen fibers may be responsible for the observed effect.

Sodium MRI of human articular cartilage in vivo

Preliminary results from in vivo sodium MRI of human patellar articular cartilage are presented. Sodium images generated of an in vitro bovine patella clearly distinguish the region of proteoglycan depletion from the region of healthy cartilage. This provides the first evidence that sodium imaging may be used to detect changes due to osteoarthritis in vivo. The process of optimizing imaging time and signal-to-noise ratio, as well as potential implications in the detection of osteoarthritic change, are discussed.

Triple quantum sodium imaging of articular cartilage

Triple quantum (TQ) sodium imaging of bovine articular cartilage is presented. True triple quantum imaging sequence was modified to incorporate asymmetric echo acquisition. Triple quantum signal expression in the presence of residual quadrupolar interaction is presented. The filtering capability of the sequence is first demonstrated on an agarose phantom. Both single and triple quantum images of articular cartilage are compared. The TQ image shows non-zero signal intensity solely from cartilage, indicating complete suppression of signals from bone marrow and saline. The advantages of TQ imaging of articular cartilage, its feasibility in in vivo situations and further improvements in SNR are described.