Orientation dependence and decay characteristics of T2 * relaxation in the human meniscus studied with 7 Tesla MR microscopy and compared to histology

Ultrashort-T2* mapping at 7 tesla using an optimized pointwise encoding time reduction with radial acquisition (PETRA) sequence at standard and extended echo times

Zero echo time (ZTE) sequences capture signal from tissues with extremely short T2* and are useful for qualitative and quantitative imaging of musculoskeletal tissues' ultrashort-T2* components. One such sequence is Pointwise Encoding Time Reduction with Radial Acquisition (PETRA). While this sequence has shown promising results, it has undergone only limited testing at 7 tesla (T). The purpose of this work was to evaluate PETRA at 7T in its standard, commercially available form and with sequence code modifications to allow extended echo times for the purpose of performing ultrashort-T2* mapping. We acquired PETRA images of MnCl2 and collagen phantoms and of the knee in eight participants (5 for optimization and 3 for ultrashort-T2* mapping assessment; 5 male/3 female, 39 ± 11 years old). Images were acquired using a 1-transmit/28-receive-channel knee coil. Artifacts, signal, signal-to-noise ratio (SNR), ultrashort-T2*, the corresponding curve fit quality, and repeatability were assessed. In knee tissues, SNR was higher at TE = 0.07 msec than in a conventional-TE sequence (Dual-Echo Steady State with TE = 2.55 msec), with values of 68-337 for PETRA versus 16-30 for the same regions in the conventional-TE series. Acquisition of series for ultrashort-T2* maps was feasible at 1.50 mm isotropic acquisition resolution and TE ≤ 0.58 msec. Strong linear correlations were observed between relaxation rates (R2*) and MnCl2 concentration, and between signal and collagen concentration. Ultrashort-T2* signal decay curve fit R2 and repeatability were high for phantom and knee ultrashort-T2* <1 msec. PETRA imaging with minimal artifacts, high SNR, and scan time < 11 minutes was achieved at 7T at high (0.34 mm isotropic) resolution at TE = 0.07 msec and lower resolution (1.52 mm isotropic) at echo times ≤ 0.58 msec. Ultrashort-T2* mapping provided acceptable curve-fitting results for substances with sub-millisecond T2*.

Seven tesla knee MRI T2*-mapping detects intrasubstance meniscus degeneration in patients with posterior root tears

Background

Medial meniscus root tears often lead to knee osteoarthritis. The extent of meniscal tissue changes beyond the localized root tear is unknown.

Purpose

To evaluate if 7 Tesla 3D T2*-mapping can detect intrasubstance meniscal degeneration in patients with arthroscopically verified medial meniscus posterior root tears (MMPRTs), and assess if tissue changes extend beyond the immediate site of the posterior root tear detected on surface examination by arthroscopy.

Methods

In this prospective study we acquired 7 T knee MRIs from patients with MMPRTs and asymptomatic controls. Using a linear mixed model, we compared T2* values between patients and controls, and across different meniscal regions. Patients underwent arthroscopic assessment before MMPRT repair. Changes in pain levels before and after repair were calculated using Knee Injury & Osteoarthritis Outcome Score (KOOS). Pain changes and meniscal extrusion were correlated with T2* using Pearson correlation (r).

Results

Twenty patients (mean age 53 ± 8; 16 females) demonstrated significantly higher T2* values across the medial meniscus (anterior horn, posterior body and posterior horn: all P < .001; anterior body: P = .007), and lateral meniscus anterior (P = .024) and posterior (P < .001) horns when compared to the corresponding regions in ten matched controls (mean age 53 ± 12; 8 females). Elevated T2* values were inversely correlated with the change in pain levels before and after repair. All patients had medial meniscal extrusion of ≥2 mm. Arthroscopy did not reveal surface abnormalities in 70% of patients (14 out of 20).

Conclusions

Elevated T2* values across both medial and lateral menisci indicate that degenerative changes in patients with MMPRTs extend beyond the immediate vicinity of the posterior root tear. This suggests more widespread meniscal degeneration, often undetected by surface examinations in arthroscopy.

Ultrashort Echo Time Quantitative Magnetic Resonance Imaging of the Cruciate Ligaments in Normal Beagles

OBJECTIVE

 The aim of this study was to provide normative ultrashort echo time magnetic resonance imaging (UTE MRI) data of the patellar ligament (PL), cranial cruciate ligament (CrCL) and caudal cruciate ligament (CdCL) in non-lame Beagles.

STUDY DESIGN

 Eight stifles from four subjects obtained immediately postmortem were imaged using UTE MRI in the true sagittal plane. Regions of interest were drawn manually and the total (T2*), short T2* (T2*S) and long T2* (T2*L) values of the signal decay were calculated to evaluate the bound and free water components of the tendon. The T2*S, T2*L and T2* values were compared between the PL, CrCL and CdCL RESULTS:  The mean and standard deviation of T2*S, T2*L and T2* were as follows: 0.54 ± 0.13, 4.65 ± 1.08 and 8.35 ± 0.82 ms for the PL; 0.46 ± 0.14, 5.99 ± 0.52 and 8.88 ± 0.4 ms for the CrCL and 0.41 ± 0.13, 7.06 ± 0.57 and 9.26 ± 0.18 ms for the CdCL. Significant differences were found between the T2*L component of the PL and each CrCL/CdCL and a smaller difference was noted between the T2*L of the CrCL and CdCL (p = 0.05). No difference of the T2*S value was found between any of the ligaments.

CONCLUSION

 Establishing normative UTE data of the canine stifle is valuable for comparison in future studies in which normal and damaged ligaments may be evaluated, particularly in those affected limbs in which no instability is identified on physical examination in which normal and damaged ligaments may be evaluated.

High angular resolution diffusion imaging (HARDI) of porcine menisci: a comparison of diffusion tensor imaging and generalized q-sampling imaging

Background

Diffusion magnetic resonance imaging (MRI) allows for the quantification of water diffusion properties in soft tissues. The goal of this study was to characterize the 3D collagen fiber network in the porcine meniscus using high angular resolution diffusion imaging (HARDI) acquisition with both diffusion tensor imaging (DTI) and generalized q-sampling imaging (GQI).

Methods

Porcine menisci (n=7) were scanned ex vivo using a three-dimensional (3D) HARDI spin-echo pulse sequence with an isotropic resolution of 500 µm at 7.0 Tesla. Both DTI and GQI reconstruction techniques were used to quantify the collagen fiber alignment and visualize the complex collagen network of the meniscus. The MRI findings were validated with conventional histology.

Results

DTI and GQI exhibited distinct fiber orientation maps in the meniscus using the same HARDI acquisition. We found that crossing fibers were only resolved with GQI, demonstrating the advantage of GQI over DTI to visualize the complex collagen fiber orientation in the meniscus. Furthermore, the MRI findings were consistent with conventional histology.

Conclusions

HARDI acquisition with GQI reconstruction more accurately resolves the complex 3D collagen architecture of the meniscus compared to DTI reconstruction. In the future, these technologies have the potential to nondestructively assess both normal and abnormal meniscal structure.

Transverse Relaxation Anisotropy of the Achilles and Patellar Tendon Studied by MR Microscopy

Background

T₂* anisotropy affects the clinical assessment of tendons (magic‐angle artifact) and may be a source of T₂*‐misinterpretation.

Purpose

To analyze T₂*‐anisotropy and T₂*‐decay of Achilles and patellar tendons in vitro at microscopic resolution using a variable‐echo‐time (vTE) sequence.

Study Type

Prospective.

Specimen

Four human Achilles and four patellar tendons.

Field Strength/Sequence

A 7 T MR‐microscopy; 3D‐vTE spoiled‐gradient‐echo‐sequence (T₂*‐mapping).

Assessment

All tendons were measured at 0° and 55° relative to B₀. Additional angles were measured for one Achilles and one patellar tendon for a total of 11 angles ranging from 0° to 90°. T₂*‐decay was analyzed with mono‐ and bi‐exponential signal fitting. Mono‐exponential T₂*‐values (T₂*_m), short and long T₂*‐components (T₂*_s, T₂*_l), and the fraction of the short component F_s of the bi‐exponential T₂*‐fit were calculated. T₂*‐decay characteristics were compared with morphological MRI and histologic findings based on a region‐of‐interest analysis.

Statistical Tests

Akaike information criterion (AIC_C), F‐test, and paired t‐test. A P value smaller than the α‐level of 0.05 was considered statistically significant.

Results

T₂*_m‐values between fiber‐to‐field angles of 0° and 55° were increased on average from T₂*_m (0°) = 1.92 msec to T₂*_m (55°) = 29.86 msec (15.5‐fold) in the Achilles and T₂*_m (0°) = 1.46 msec to T₂*_m (55°) = 23.33 msec (16.0‐fold) in the patellar tendons. The changes in T₂*_m‐values were statistically significant. For the whole tendon, according to F‐test and AIC_C, a bi‐exponential model was preferred for angles close to 0°, while the mono‐exponential model tended to be preferred at angles close to 55°.

Conclusion

MR‐microscopy provides a deeper insight into the relationship between T₂*‐decay (mono‐ vs. bi‐exponential model) and tendon heterogeneity. Changes in fiber‐to‐field angle result in significant changes in T₂*‐values. Thus, we conclude that awareness of T₂*‐anisotropy should be noted in quantitative T₂*‐mapping of tendons to avoid T₂*‐misinterpretation such as a false positive detection of degeneration due to large fiber‐to‐field angles.

Evidence Level

2

Technical Efficacy

Stage 2

T2* mapping in an equine articular groove model: Visualizing changes in collagen orientation

T2* mapping is promising for the evaluation of articular cartilage collagen. In this work, a groove model in a large animal is used as a model for posttraumatic arthritis. We hypothesized that T2* mapping could be employed to differentiate between healthy and (subtly) damaged cartilage. Eight carpal joints were obtained from four adult Shetland ponies that had been included in the groove study. In this model, grooves were surgically created on the proximal articular surface of the intermediate carpal bone (radiocarpal joint) and the radial facet of the third carpal bone (middle carpal joint) by either coarse disruption or sharp incision. After 9 months, T2* mapping of the entire carpal joint was carried out on a 7.0-T whole-body magnetic resonance imaging (MRI) scanner by means of a gradient echo multi-echo sequence. Afterwards, assessment of collagen orientation was carried out based on Picrosirius Red-stained histological sections, visualized by polarized light microscopy (PLM). The average T2* relaxation time in grooved samples was lower than in contralateral control sites. Opposite to the grooved areas, the "kissing sites" had a higher average T2* relaxation time than the grooved sites. PLM showed mild changes in orientation of the collagen fibers, particularly around blunt grooves. This work shows that T2* relaxation times are different in healthy cartilage vs (early) damaged cartilage, as induced by the equine groove model. Additionally, the average T2* relaxation times are different in kissing lesions vs the grooved sites.

Musculoskeletal MRI at 7 T: do we need more or is it more than enough?

Ultra-high field magnetic resonance imaging (UHF-MRI) provides important diagnostic improvements in musculoskeletal imaging. The higher signal-to-noise ratio leads to higher spatial and temporal resolution which results in improved anatomic detail and higher diagnostic confidence. Several methods, such as T2, T2*, T1rho mapping, delayed gadolinium-enhanced, diffusion, chemical exchange saturation transfer, and magnetisation transfer techniques, permit a better tissue characterisation. Furthermore, UHF-MRI enables in vivo measurements by low-γ nuclei (²³Na, ³¹P, ¹³C, and ³⁹K) and the evaluation of different tissue metabolic pathways. European Union and Food and Drug Administration approvals for clinical imaging at UHF have been the first step towards a more routinely use of this technology, but some drawbacks are still present limiting its widespread clinical application. This review aims to provide a clinically oriented overview about the application of UHF-MRI in the different anatomical districts and tissues of musculoskeletal system and its pros and cons. Further studies are needed to consolidate the added value of the use of UHF-MRI in the routine clinical practice and promising efforts in technology development are already in progress.

Relating MR relaxation times of ex vivo meniscus to tissue degeneration through comparison with histopathology

Background

Quantitative magnetic resonance imaging (MRI), e.g. relaxation parameter mapping, may be sensitive to structural and compositional tissue changes, and could potentially be used to non-invasively detect and monitor early meniscus degeneration related to knee osteoarthritis.

Objective

To investigate MR relaxation times as potential biomarkers for meniscus degeneration through comparisons with histopathology.

Methods

We measured MR relaxation parameters in the posterior horn of 40 menisci (medial and lateral) at a wide range of degenerative stages. T1, T2 and T2* were mapped using standard and ultrashort echo time sequences at 9.4 T and compared to gold standard histology using Pauli's histopathological scoring system, including assessment of surface integrity, collagen organization, cellularity and Safranin-O staining.

Results

All three relaxation times increased with total Pauli score (mean difference per score (95% CI) for T2*: 0.62 (0.37, 0.86), T2: 0.83 (0.53, 1.1) and T1: 24.7 (16.5, 32.8) ms/score). Clear associations were seen with scores of surface integrity (mean difference per score for T2*: 3.0 (1.8, 4.2), T2: 4.0 (2.5, 5.5) and T1: 116 (75.6, 156) ms/score) and collagen organization (mean difference between highest and lowest score for T2*: 5.3 (1.6, 8.9), T2: 6.1 (1.7, 11) and T1: 204 (75.9, 332) ms). The results were less clear for the remaining histopathological measures.

Conclusions

MR relaxation times T1, T2 and T2* of ex vivo human menisci are associated with histologically verified degenerative processes, in particular related to surface integrity and collagen organization. If confirmed in vivo, MR relaxation times may thus be potential biomarkers for meniscus degeneration.

Magnetic Resonance Imaging of the Musculoskeletal System at 7T: Morphological Imaging and Beyond

In 2017, a whole-body 7T magnetic resonance imaging (MRI) device was given regulatory approval for clinical use in both the EU and United States for neuro and musculoskeletal applications. As 7 Tesla allows for higher signal-to-noise , which results in higher resolution images than those obtained on lower-field-strength scanners, it has attracted considerable attention from the musculoskeletal field, as evidenced by the increasing number of publications in the last decade. Besides morphological imaging, the quantitative MR methods, such as T₂, T₂∗, T_1ρ mapping, sodium imaging, chemical-exchange saturation transfer, and spectroscopy, substantially benefit from ultrahigh field scanning. In this review, we provide technical considerations for the individual techniques and an overview of (mostly) clinical applications for the assessment of cartilage, tendon, meniscus, and muscle. The first part of the review is dedicated to morphological applications at 7T, and the second part describes the most recent developments in quantitative MRI at 7T.

Orientation dependence and decay characteristics of T2 * relaxation in the human meniscus studied with 7 Tesla MR microscopy and compared to histology

Purpose

To evaluate: (1) the feasibility of MR microscopy T₂* mapping by performing a zonal analysis of spatially matched T₂* maps and histological images using microscopic in‐plane pixel resolution; (2) the orientational dependence of T₂* relaxation of the meniscus; and (3) the T₂* decay characteristics of the meniscus by statistically evaluating the quality of mono‐ and biexponential model.

Methods

Ultrahigh resolution T₂* mapping was performed with ultrashort echo time using a 7 Tesla MR microscopy system. Measurement of one meniscus was performed at three orientations to the main magnetic field (0, 55, and 90°). Histological assessment was performed with picrosirius red staining and polarized light microscopy. Quality of mono‐ and biexponential model fitting was tested using Akaike Information Criteria and F‐test.

Results

(1) The outer laminar layer, connective tissue fibers from the joint capsule, and the highly organized tendon‐like structures were identified using ultra‐highly resolved MRI. (2) Highly organized structures of the meniscus showed considerable changes in T₂* values with orientation. (3) No significant biexponential decay was found on a voxel‐by‐voxel–based evaluation. On a region‐of‐interest–averaged basis, significant biexponential decay was found for the tendon‐like region in a fiber‐to‐field angle of 0°.

Conclusion

The MR microscopy approach used in this study allows the identification of meniscus substructures and to quantify T₂* with a voxel resolution approximately 100 times higher than previously reported. T₂* decay showed a strong fiber‐to‐field angle dependence reflecting the anisotropic properties of the meniscal collagen fibers. No clear biexponential decay behavior was found for the meniscus substructures.