The influence of flip angle on the magic angle effect

Individual Evaluation of the Common Extensor Tendon and Lateral Collateral Ligament Improves the Severity Diagnostic Accuracy of Magnetic Resonance Imaging for Lateral Epicondylitis

The effectiveness of magnetic resonance imaging for diagnosing lateral epicondylitis severity is controversial. We aimed to verify whether individual evaluations of the common extensor tendon and lateral collateral ligament would improve the severity diagnostic accuracy of magnetic resonance imaging for lateral epicondylitis. We obtained coronal images of the lateral elbow in three groups: healthy, clinically mild, and clinically severe. We used our scoring system for evaluation using combined and individual methods. We developed the receiver operating characteristic curve for diagnosis using the scores of the healthy and mild groups and that for severity diagnosis using the scores of the mild and severe groups. The scores, in decreasing value, were those of the severe, mild, and healthy groups, with a significant difference in both methods. The curve for diagnosis showed an area under the curve of 0.85 for the combined evaluation and 0.89 for the individual evaluation, without a significant difference between the methods (p = 0.23). The curve for severity diagnosis showed an area under the curve of 0.69 for combined and 0.81 for individual evaluation, with a significant difference between the methods (p = 0.046). Individual evaluation of the common extensor tendon and lateral collateral ligament improved the severity diagnostic accuracy of lateral epicondylitis.

Rotator cuff tendon ultrastructure assessment with reduced-orientation dipolar anisotropy fiber imaging

OBJECTIVE

The anisotropic fibrous structure of collagen can significantly affect MRI signal intensity. Use of this magic angle effect as a contrast mechanism has been previously termed "dipolar anisotropy fiber imaging." The goal of this pilot study was to use a reduced-orientation version of dipolar anisotropy fiber imaging to study rotator cuff tendon internal fiber structure.

CONCLUSION

The reduced-orientation dipolar anisotropy fiber imaging technique can be used to delineate the complex contributions and ultrastructure of the rotator cuff.

Magnetic resonance protocols in equine lameness examination, used sequences, and interpretation

Magnetic resonance is a great diagnostic tool in equine lameness examination. Its value is most significantly visible in evaluating distal extremities. Problems with podotrochlear apparatus, laminitis or distal interphalangeal joint osteoarthritis are the most common disorders diagnosed in equine patients. Without using magnetic resonance it was impossible to clearly assess which structures are involved in each of these diseases. One of the most important things in MRI is the choice of sequence. Most commonly used are T1 GE, T2 FSE, STIR and T2* GE, in sagittal, transverse and dorsal planes. To make a reliable diagnosis it is important to compare findings in all these sequences.

Pitfalls that may mimic injuries of the triangular fibrocartilage and proximal intrinsic wrist ligaments at MR imaging

Diagnosis of injuries to the ligamentous structures of the wrist can be a challenge, particularly when there is involvement of the small, complex structures of the proximal wrist. Recent advances in magnetic resonance (MR) imaging, especially in spatial and contrast resolution, have facilitated more precise visualization of these structures. However, there are a number of pitfalls that may cause difficulty in diagnosis of injuries to the triangular fibrocartilage complex (TFCC), lunotriquetral ligament, and scapholunate ligament. Use of inappropriate MR imaging sequences and MR imaging artifacts may decrease the accuracy of diagnosis of injuries to the TFCC and wrist ligaments, whereas variant anatomy of the proximal wrist structures may mimic disease of the TFCC and wrist ligaments. Knowledge of the detailed anatomy of the wrist, as well as variant patterns of structure morphology and signal intensity, can help differentiate actual disease from normal or variant appearances at assessment with MR imaging.

Comparison of high-field and low-field magnetic resonance images of cadaver limbs of horses

Eleven limbs taken postmortem from 10 lame horses were examined by MRI in a low-field 0.27T system designed for standing horses and a high-field 1.5T system used to examine anaesthetised horses. Nine limbs were examined in the foot/pastern region and two in the fetlock region, and the results were compared with gross pathological examinations and histological examinations of selected tissues. The appearance of normal tissues was similar between the two systems, but the anatomical arrangement of the structures was different due to differences in positioning, and a magic angle artefact was observed at different sites in some imaging sequences. Articular cartilage could be differentiated into two articular surfaces in most joints in the high-field images but could generally be separated only at the joint margins in the low-field images. Abnormalities of tendon, ligament and bone detected by gross examination were detected by both forms of MRI, but some details were clearer on the high-field images. Articular cartilage found to be normal on pathological examination was also classified as normal on MRI, but lesions in articular cartilage detected on pathological examination were identified only by high-field MRI. An abnormality was detected on MRI of all the limbs that had abnormal navicular flexor fibrocartilage on pathological examination.

Asymmetric signal intensity in normal collateral ligaments of the distal interphalangeal joint in horses with a low-field MRI system due to the magic angle effect

Increased signal intensity in one of the collateral ligaments of the distal interphalangeal (DIP) joint of sound horses in images acquired using a low-field magnet with vertical orientation of the magnetic field was investigated as a possible manifestation of the magic angle effect. Three isolated equine digits were imaged using the following pulse sequences: (1) spin echo TI, (2) turbo spin echo proton density and T2, and (3) 3D gradient echo T1, in different positions by mildly changing the orientation of the long axis of the digit, in the dorsal plane, relative to the magnetic field. The signal intensity in a ligament was significantly increased when the ligament orientation relative to the magnetic field was 55 +/- 10 degrees. The signal intensity was markedly increased in pulse sequences with short echo time (TE) 5.0, 4.9, and 3.9 times increased, respectively, for 3D gradient echo T1, spin echo T1, and turbo spin echo proton density) and to a lesser extent with pulse sequences with a longer TE (1.8 times increased for turbo spin echo T2). These changes are characteristic of the magic angle effect. Because of the anatomic orientation of the collateral ligaments of the DIP joint, a slight deviation of the long axis of the digit in the dorsal plane, from the ideal horizontal position, will induce an increased signal intensity that can be confused with desmitis. Careful positioning of the foot in magnetic resonance imaging systems where B0 is perpendicular to the long axis of the digit is critical to prevent the occurrence of the magic angle effect.

Collagen structure: The molecular source of the tendon magic angle effect

This review of tendon/collagen structure shows that the orientational variation in MRI signals from tendon, which is referred to as the "magic angle" (MA) effect, is caused by irreducible separation of charges on the main chain of the collagen molecule. These charges are held apart in a vacuum by stereotactic restriction of protein folding due in large part to a high concentration of hydroxyproline ring residues in the amino acids of mammalian collagen. The elevated protein electrostatic energy is reduced in water by the large dielectric constant of the highly polar solvent (kappa approximately 80). The water molecules serve as dielectric molecules that are bound by an energy that is nearly equivalent to the electrostatic energy between the neighboring positive and negative charge pairs in a vacuum. These highly immobilized water molecules and secondary molecules in the hydrogen-bonded water network are confined to the transverse plane of the tendon. Orientational restriction causes residual dipole coupling, which is directly responsible for the frequency and phase shifts observed in orientational MRI (OMRI) described by the MA effect. Reference to a wide range of biophysical measurements shows that native hydration is a monolayer on collagen h(m) = 1.6 g/g, which divides into two components consisting of primary hydration on polar surfaces h(pp) = 0.8 g/g and secondary hydration h(s) = 0.8 g/g bridging over hydrophobic surface regions. Primary hydration further divides into side-chain hydration h(psc) = 0.54 g/g and main-chain hydration h(pmc) = 0.263 g/g. The main-chain fraction consists of water that bridges between charges on the main chain and is responsible for almost all of the enthalpy of melting DeltaH = 70 J/g-dry mass. Main-chain water bridges consist of one extremely immobilized Ramachandran water bridge per tripeptide h(Ra) = 0.0658 g/g and one double water bridge per tripeptide h(dwb) = 0.1974 g/g, with three water molecules that are sufficiently slowed to act as the spin-lattice relaxation sink for the entire tendon.

Effect of deep digital flexor tendon orientation on magnetic resonance imaging signal intensity in isolated equine limbs-the magic angle effect

Ten normal equine isolated limbs were imaged using a knee coil in a 1.5 Tesla magnetic field, with short echo time sequences (TE < 15 ms). Magnetic resonance imaging was performed on each isolated limb in different positions, with and without extension of the metacarpophalangeal joint. Deep digital flexor tendon orientation ranged from 20 to 60 degrees in relation to the static magnetic field. Increased intratendinous signal intensity was observed when the angle between the deep digital flexor tendon and the constant magnetic field approached 55 degrees ("magic angle"). The increased signal intensity was independent from extension of the metacarpophalangeal joint. Recognition of the magic angle phenomenon is essential for proper evaluation of magnetic resonance imaging studies of the equine foot.