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Xie Y, Li H, Chen Y, Cai J, Tao H, Chen S. More severe supraspinatus tendon degeneration on the contralateral shoulders in patients treated for symptomatic rotator cuff tears compared to healthy controls: a quantitative MRI-based study. Acta Radiol 2024; 65:616-624. [PMID: 38232947 DOI: 10.1177/02841851231222812] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2024]
Abstract
BACKGROUND Patients treated for symptomatic rotator cuff tear (RCT) on one shoulder seem to have a higher prevalence of RCT on the contralateral shoulder. PURPOSE To compare the supraspinatus (SSP) tendon and RC muscle properties on the contralateral shoulder in patients after repair surgery to those healthy individuals using quantitative magnetic resonance imaging (MRI). MATERIAL AND METHODS A total of 23 patients treated for RCT (group A) and 23 healthy controls (group B) were recruited. Constant score, visual analog scale score (VAS), and MRI examinations were conducted. The SSP tendon structural status was graded based on the Zlatkin classification and quantified on ultrashort echo time (UTE)-T2* mapping images. Fatty degeneration of RC muscles was classified according to the Goutallier classification and quantified on T2 mapping. RESULTS The Constant and VAS scores were comparable between groups A and B (all P >0.05). No significant differences were observed in tendon structural status between the two groups (P >0.05). However, significant differences were established in UTE-T2* values of the SSP tendon on the distal subregion between groups A and B (16.4 ± 2.4 ms vs. 14.8 ± 1.2 ms; P = 0.01). Regarding muscle degeneration, no significant differences were displayed in T2 values and Goutallier classification of RC muscles (all P >0.05). CONCLUSION Patients with a treated RCT demonstrated inferior SSP tendon in the distal subregion on the contralateral shoulders one year postoperatively compared to that of healthy controls based on quantitative MRI data.
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Affiliation(s)
- Yuxue Xie
- Department of Radiology & Institute of Medical Functional and Molecular Imaging, Huashan Hospital, Fudan University, Shanghai, PR China
| | - Haoxiong Li
- Department of Radiology & Institute of Medical Functional and Molecular Imaging, Huashan Hospital, Fudan University, Shanghai, PR China
| | - Ye Chen
- Department of Radiology & Institute of Medical Functional and Molecular Imaging, Huashan Hospital, Fudan University, Shanghai, PR China
| | - Jiajie Cai
- Department of Radiology & Institute of Medical Functional and Molecular Imaging, Huashan Hospital, Fudan University, Shanghai, PR China
| | - Hongyue Tao
- Department of Radiology & Institute of Medical Functional and Molecular Imaging, Huashan Hospital, Fudan University, Shanghai, PR China
| | - Shuang Chen
- Department of Radiology & Institute of Medical Functional and Molecular Imaging, Huashan Hospital, Fudan University, Shanghai, PR China
- National Clinical Research Center for Aging and Medicine, Huashan Hospital, Fudan University, Shanghai, PR China
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McNish R, Lohse K, Pruthi S, Hastings MK, Zheng J, Zellers JA. Achilles tendon assessment on quantitative MRI: Sources of variability and relationships to tendinopathy. Scand J Med Sci Sports 2024; 34:e14650. [PMID: 38712745 PMCID: PMC11081531 DOI: 10.1111/sms.14650] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2024] [Revised: 04/24/2024] [Accepted: 04/25/2024] [Indexed: 05/08/2024]
Abstract
Quantitative MRI (qMRI) measures are useful in assessing musculoskeletal tissues, but application to tendon has been limited. The purposes of this study were to optimize, identify sources of variability, and establish reproducibility of qMRI to assess Achilles tendon. Additionally, preliminarily estimates of effect of tendon pathology on qMRI metrics and structure-function relationships between qMRI measures and ankle performance were examined. T1, T1ρ, T2, and T2* maps of the Achilles tendon were obtained using a 3T MRI scanner. In participants with asymptomatic tendons (n = 21), MRI procedures were repeated twice, and region of interest selection was performed by three raters. Variance decomposition and reproducibility statistics were completed. To estimate the effect of pathology, qMRI measures from individuals with asymptomatic tendons were compared to qMRI measures from a pilot group of individuals with Achilles tendinopathy (n = 7). Relationships between qMRI and ankle performance measures were assessed. Between-participant variation accounted for the majority of variability (46.7%-64.0%) in all qMRI measures except T2*. ICCs met or exceeded 0.7 for all qMRI measures when averaged across raters or scans. Relaxation times were significantly longer in tendinopathic tendons (mean (SD) T1: 977.8 (208.6) ms, T1ρ: 35.4 (7.1) ms, T2: 42.8 (7.9) ms, T2*: 14.1 (7.6) ms, n = 7) compared to asymptomatic control tendons (T1: 691.7 (32.4) ms, T1ρ: 24.0 (3.6) ms, T2: 24.4 (7.5) ms, T2*: 9.5 (3.4) ms, n = 21) (p < 0.011 for all comparisons). T1 related to functional performance measures in symptomatic and asymptomatic groups. Study findings suggest that qMRI is reliable to assess the Achilles tendon. qMRI quantitatively assesses the presence of tendon pathology and relates to functional performance outcomes, supporting the utility of incorporating qMRI in research and clinic.
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Affiliation(s)
- Reika McNish
- Program in Physical Therapy, Washington University School of Medicine, St. Louis, Missouri, USA
| | - Keith Lohse
- Program in Physical Therapy, Washington University School of Medicine, St. Louis, Missouri, USA
- Department of Neurology, Washington University in St. Louis, St. Louis, Missouri, USA
| | - Saksham Pruthi
- School of Medicine, Saint Louis University, St. Louis, Missouri, USA
| | - Mary K Hastings
- Program in Physical Therapy, Washington University School of Medicine, St. Louis, Missouri, USA
- Department of Orthopaedic Surgery, Washington University in St. Louis, St. Louis, Missouri, USA
| | - Jie Zheng
- Mallinckrodt Institute of Radiology, Washington University School of Medicine, St. Louis, Missouri, USA
| | - Jennifer A Zellers
- Program in Physical Therapy, Washington University School of Medicine, St. Louis, Missouri, USA
- Department of Orthopaedic Surgery, Washington University in St. Louis, St. Louis, Missouri, USA
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Malhi BS, Moazamian D, Shin SH, Athertya JS, Silva L, Jerban S, Jang H, Chang E, Ma Y, Carl M, Du J. Bi-Exponential 3D UTE-T1ρ Relaxation Mapping of Ex Vivo Human Knee Patellar Tendon at 3T. Bioengineering (Basel) 2024; 11:66. [PMID: 38247943 PMCID: PMC10813751 DOI: 10.3390/bioengineering11010066] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2023] [Revised: 12/30/2023] [Accepted: 01/03/2024] [Indexed: 01/23/2024] Open
Abstract
Introduction: The objective of this study was to assess the bi-exponential relaxation times and fractions of the short and long components of the human patellar tendon ex vivo using three-dimensional ultrashort echo time T1ρ (3D UTE-T1ρ) imaging. Materials and Methods: Five cadaveric human knee specimens were scanned using a 3D UTE-T1ρ imaging sequence on a 3T MR scanner. A series of 3D UTE-T1ρ images were acquired and fitted using single-component and bi-component models. Single-component exponential fitting was performed to measure the UTE-T1ρ value of the patellar tendon. Bi-component analysis was performed to measure the short and long UTE-T1ρ values and fractions. Results: The single-component analysis showed a mean single-component UTE-T1ρ value of 8.4 ± 1.7 ms for the five knee patellar tendon samples. Improved fitting was achieved with bi-component analysis, which showed a mean short UTE-T1ρ value of 5.5 ± 0.8 ms with a fraction of 77.6 ± 4.8%, and a mean long UTE-T1ρ value of 27.4 ± 3.8 ms with a fraction of 22.4 ± 4.8%. Conclusion: The 3D UTE-T1ρ sequence can detect the single- and bi-exponential decay in the patellar tendon. Bi-component fitting was superior to single-component fitting.
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Affiliation(s)
- Bhavsimran Singh Malhi
- Department of Radiology, University of California, La Jolla, San Diego, CA 92037, USA; (B.S.M.); (D.M.); (S.H.S.); (J.S.A.); (L.S.); (S.J.); (H.J.); (E.C.); (Y.M.); (M.C.)
| | - Dina Moazamian
- Department of Radiology, University of California, La Jolla, San Diego, CA 92037, USA; (B.S.M.); (D.M.); (S.H.S.); (J.S.A.); (L.S.); (S.J.); (H.J.); (E.C.); (Y.M.); (M.C.)
| | - Soo Hyun Shin
- Department of Radiology, University of California, La Jolla, San Diego, CA 92037, USA; (B.S.M.); (D.M.); (S.H.S.); (J.S.A.); (L.S.); (S.J.); (H.J.); (E.C.); (Y.M.); (M.C.)
| | - Jiyo S. Athertya
- Department of Radiology, University of California, La Jolla, San Diego, CA 92037, USA; (B.S.M.); (D.M.); (S.H.S.); (J.S.A.); (L.S.); (S.J.); (H.J.); (E.C.); (Y.M.); (M.C.)
| | - Livia Silva
- Department of Radiology, University of California, La Jolla, San Diego, CA 92037, USA; (B.S.M.); (D.M.); (S.H.S.); (J.S.A.); (L.S.); (S.J.); (H.J.); (E.C.); (Y.M.); (M.C.)
| | - Saeed Jerban
- Department of Radiology, University of California, La Jolla, San Diego, CA 92037, USA; (B.S.M.); (D.M.); (S.H.S.); (J.S.A.); (L.S.); (S.J.); (H.J.); (E.C.); (Y.M.); (M.C.)
| | - Hyungseok Jang
- Department of Radiology, University of California, La Jolla, San Diego, CA 92037, USA; (B.S.M.); (D.M.); (S.H.S.); (J.S.A.); (L.S.); (S.J.); (H.J.); (E.C.); (Y.M.); (M.C.)
| | - Eric Chang
- Department of Radiology, University of California, La Jolla, San Diego, CA 92037, USA; (B.S.M.); (D.M.); (S.H.S.); (J.S.A.); (L.S.); (S.J.); (H.J.); (E.C.); (Y.M.); (M.C.)
- Radiology Service, Veterans Affairs San Diego Healthcare System, La Jolla, San Diego, CA 92161, USA
| | - Yajun Ma
- Department of Radiology, University of California, La Jolla, San Diego, CA 92037, USA; (B.S.M.); (D.M.); (S.H.S.); (J.S.A.); (L.S.); (S.J.); (H.J.); (E.C.); (Y.M.); (M.C.)
| | - Michael Carl
- Department of Radiology, University of California, La Jolla, San Diego, CA 92037, USA; (B.S.M.); (D.M.); (S.H.S.); (J.S.A.); (L.S.); (S.J.); (H.J.); (E.C.); (Y.M.); (M.C.)
- General Electric Health Care, San Diego, CA 92037, USA
| | - Jiang Du
- Department of Radiology, University of California, La Jolla, San Diego, CA 92037, USA; (B.S.M.); (D.M.); (S.H.S.); (J.S.A.); (L.S.); (S.J.); (H.J.); (E.C.); (Y.M.); (M.C.)
- Radiology Service, Veterans Affairs San Diego Healthcare System, La Jolla, San Diego, CA 92161, USA
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Zellers JA, Edalati M, Eekhoff JD, McNish R, Tang SY, Lake SP, Mueller MJ, Hastings MK, Zheng J. Quantative MRI predicts tendon mechanical behavior, collagen composition, and organization. J Orthop Res 2023; 41:2329-2338. [PMID: 36324161 PMCID: PMC10151441 DOI: 10.1002/jor.25471] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/13/2022] [Revised: 09/06/2022] [Accepted: 10/08/2022] [Indexed: 11/05/2022]
Abstract
Quantitative magnetic resonance imaging (qMRI) measures have provided insights into the composition, quality, and structure-function of musculoskeletal tissues. Low signal-to-noise ratio has limited application to tendon. Advances in scanning sequences and sample positioning have improved signal from tendon allowing for evaluation of structure and function. The purpose of this study was to elucidate relationships between tendon qMRI metrics (T1, T2, T1ρ and diffusion tensor imaging [DTI] metrics) with tendon tissue mechanics, collagen concentration and organization. Sixteen human Achilles tendon specimens were collected, imaged with qMRI, and subjected to mechanical testing with quantitative polarized light imaging. T2 values were related to tendon mechanics [peak stress (rsp = 0.51, p = 0.044), equilibrium stress (rsp = 0.54, p = 0.033), percent relaxation (rsp = -0.55, p = 0.027), hysteresis (rsp = -0.64, p = 0.007), linear modulus (rsp = 0.67, p = 0.009)]. T1ρ had a statistically significant relationship with percent relaxation (r = 0.50, p = 0.048). Collagen content was significantly related to DTI measures (range of r = 0.56-0.62). T2 values from a single slice of the midportion of human Achilles tendons were strongest predictors of tendon tensile mechanical metrics. DTI diffusivity indices (mean diffusivity, axial diffusivity, radial diffusivity) were strongly correlated with collagen content. These findings build on a growing body of literature supporting the feasibility of qMRI to characterize tendon tissue and noninvasively measure tendon structure and function. Statement of Clinical Significance: Quantitative MRI can be applied to characterize tendon tissue and is a noninvasive measure that relates to tendon composition and mechanical behavior.
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Affiliation(s)
- Jennifer A. Zellers
- Program in Physical Therapy; Washington University School of Medicine in St. Louis
- Department of Orthopaedic Surgery; Washington University School of Medicine in St. Louis
| | - Masoud Edalati
- Mallinckrodt Institute of Radiology; Washington University School of Medicine in St. Louis
| | - Jeremy D. Eekhoff
- Department of Biomedical Engineering; Washington University in St. Louis
| | - Reika McNish
- Program in Physical Therapy; Washington University School of Medicine in St. Louis
| | - Simon Y. Tang
- Department of Orthopaedic Surgery; Washington University School of Medicine in St. Louis
| | - Spencer P. Lake
- Department of Orthopaedic Surgery; Washington University School of Medicine in St. Louis
- Department of Mechanical Engineering & Materials Science; Washington University in St. Louis
| | - Michael J. Mueller
- Program in Physical Therapy; Washington University School of Medicine in St. Louis
- Mallinckrodt Institute of Radiology; Washington University School of Medicine in St. Louis
| | - Mary K. Hastings
- Program in Physical Therapy; Washington University School of Medicine in St. Louis
- Department of Orthopaedic Surgery; Washington University School of Medicine in St. Louis
| | - Jie Zheng
- Mallinckrodt Institute of Radiology; Washington University School of Medicine in St. Louis
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Asai K, Nakase J, Yoshimizu R, Kimura M, Kanayama T, Yanatori Y, Tsuchiya H. High initial graft tension is a post-operative risk factor for high UTE T2* value of the graft 6 months after anterior cruciate ligament reconstruction. Knee 2023; 40:143-151. [PMID: 36434971 DOI: 10.1016/j.knee.2022.11.015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/16/2022] [Revised: 09/09/2022] [Accepted: 11/03/2022] [Indexed: 11/25/2022]
Abstract
BACKGROUND To evaluate the risk factor of "ligamentization" using the ultrashort echo time (UTE)-T2* imaging. METHODS Fifty-nine patients (23 males and 36 females, age of 21.9 ± 10.6 years old) who underwent anterior cruciate ligament (ACL) reconstruction with hamstring tendon were evaluated. The UTE T2* values of the reconstructed ACL at 6 months postoperatively were calculated. Circular regions of interest (5-10 mm2) were set at the proximal, mid-substance, and distal regions of the reconstructed ACL. The UTE T2* values of the entire reconstructed ACL were calculated as the average of these three points. Patients were divided into high (27 knees) and low (32 knees) UTE T2* groups by calculating whether their UTE T2* values were greater than the median of the UTE T2* values of all patients. Risk factors for high UTE T2* values were evaluated. Clinical outcomes were compared between the two groups. RESULTS There were no significant differences in any measured parameters and clinical outcomes between the two UTE T2* groups. Logistic regression analysis revealed that graft tension was a significant risk factor for patients with high UTE-T2* values (P = 0.047, odds ratio [OR] = 2.285). The UTE-T2* values of the 20 N graft tension using the Tension loc system were significantly lower than those of the 40 N using double-spike plate (DSP) with screws at each site and the 30 N using the Tension loc system at the distal site. CONCLUSIONS Higher graft tension was an independent risk factor for high UTE T2* values of the reconstructed ACL.
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Affiliation(s)
- Kazuki Asai
- Department of Orthopedic Surgery, Graduate School of Medical Science Kanazawa University, 13-1 Takara-machi, Kanazawa-city 920-8641, Japan; Department of Orthopedic Surgery, KKR Hokuriku Hospital, 13-43 izumigaoka nicyoume, Kanazawa-city 921-8035, Japan
| | - Junsuke Nakase
- Department of Orthopedic Surgery, Graduate School of Medical Science Kanazawa University, 13-1 Takara-machi, Kanazawa-city 920-8641, Japan.
| | - Rikuto Yoshimizu
- Department of Orthopedic Surgery, Graduate School of Medical Science Kanazawa University, 13-1 Takara-machi, Kanazawa-city 920-8641, Japan
| | - Mitsuhiro Kimura
- Department of Orthopedic Surgery, Graduate School of Medical Science Kanazawa University, 13-1 Takara-machi, Kanazawa-city 920-8641, Japan
| | - Tomoyuki Kanayama
- Department of Orthopedic Surgery, Graduate School of Medical Science Kanazawa University, 13-1 Takara-machi, Kanazawa-city 920-8641, Japan
| | - Yusuke Yanatori
- Department of Orthopedic Surgery, Graduate School of Medical Science Kanazawa University, 13-1 Takara-machi, Kanazawa-city 920-8641, Japan
| | - Hiroyuki Tsuchiya
- Department of Orthopedic Surgery, Graduate School of Medical Science Kanazawa University, 13-1 Takara-machi, Kanazawa-city 920-8641, Japan
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Fang Y, Zhu D, Wu W, Yu W, Li S, Ma Y. Assessment of Achilles Tendon Changes After Long‐Distance Running Using Ultrashort Echo Time Magnetization Transfer
MR
Imaging. J Magn Reson Imaging 2022; 56:814-823. [PMID: 35060638 DOI: 10.1002/jmri.28072] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2021] [Revised: 01/06/2022] [Accepted: 01/08/2022] [Indexed: 11/10/2022] Open
Affiliation(s)
- Yijie Fang
- Department of Radiology The Fifth Affiliated Hospital of Sun Yat‐sen University Zhuhai China
- Guangdong Provincial Key Laboratory of Biomedical Imaging The Fifth Affiliated Hospital, Sun Yat‐sen University Zhuhai China
| | - Dantian Zhu
- Department of Radiology The Fifth Affiliated Hospital of Sun Yat‐sen University Zhuhai China
- Guangdong Provincial Key Laboratory of Biomedical Imaging The Fifth Affiliated Hospital, Sun Yat‐sen University Zhuhai China
| | - Wenhao Wu
- Department of Radiology The Fifth Affiliated Hospital of Sun Yat‐sen University Zhuhai China
- Guangdong Provincial Key Laboratory of Biomedical Imaging The Fifth Affiliated Hospital, Sun Yat‐sen University Zhuhai China
| | - Wenjun Yu
- Department of Radiology The Fifth Affiliated Hospital of Sun Yat‐sen University Zhuhai China
- Guangdong Provincial Key Laboratory of Biomedical Imaging The Fifth Affiliated Hospital, Sun Yat‐sen University Zhuhai China
| | - Shaolin Li
- Department of Radiology The Fifth Affiliated Hospital of Sun Yat‐sen University Zhuhai China
- Guangdong Provincial Key Laboratory of Biomedical Imaging The Fifth Affiliated Hospital, Sun Yat‐sen University Zhuhai China
| | - Ya‐Jun Ma
- Department of Radiology University of California, San Diego San Diego California USA
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Comparison of zero echo time MRI with T1-weighted fast spin echo for the recognition of sacroiliac joint structural lesions using CT as the reference standard. Eur Radiol 2022; 32:3963-3973. [DOI: 10.1007/s00330-021-08513-5] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2021] [Revised: 11/04/2021] [Accepted: 12/10/2021] [Indexed: 02/07/2023]
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Sandberg JK, Young VA, Yuan J, Hargreaves BA, Wishah F, Vasanawala SS. Zero echo time pediatric musculoskeletal magnetic resonance imaging: initial experience. Pediatr Radiol 2021; 51:2549-2560. [PMID: 34156504 DOI: 10.1007/s00247-021-05125-5] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/09/2020] [Revised: 03/24/2021] [Accepted: 06/10/2021] [Indexed: 11/30/2022]
Abstract
BACKGROUND Projection radiography (XR) is often supplemented by both CT (to evaluate osseous structures with ionizing radiation) and MRI (for marrow and soft-tissue assessment). Zero echo time (ZTE) MR imaging produces a "CT-like" osseous contrast that might obviate CT. OBJECTIVE This study investigated our institution's initial experience in implementing an isotropic ZTE MR imaging sequence for pediatric musculoskeletal examinations. MATERIALS AND METHODS Pediatric patients referred for extremity MRI at 3 tesla (T) underwent ZTE MR imaging to yield images with contrast similar to that of CT. A radiograph-like image was also created with ray-sum image processing. We assessed ZTE-CT/XR anatomical image quality (Sanat) from 0 (nondiagnostic) to 5 (outstanding). Further, we made image comparisons on a 5-point scale (Scomp) (range of -2 = conventional CT/XR greater anatomical delineation to +2 = ZTE-CT/XR greater anatomical delineation; 0=same) for three cohorts: (1) ZTE-XR to conventional radiography, (2) ZTE-CT to conventional CT and (3) pathological lesion assessment on ZTE-XR to conventional radiography. We measured cortical thickness of ZTE-XR and ZTE-CT and compared these with conventional imaging. We calculated confidence interval of proportions, Wilcoxon rank sum test and intraclass correlation coefficients for inter-reader agreement. RESULTS Cohorts 1, 2 and 3 consisted of 40, 20 and 35 cases, respectively (age range 0.6-23.0 years). ZTE-CT versus CT and ZTE-XR versus radiography of cortical thicknesses were not significantly different (P=0.55 and P=0.31, respectively). Cortical delineation was rated diagnostic or better (score of 3, 4 or 5) in all cases (confidence interval of proportions = 100%) for ZTE-CT/XR. Similarly, intramedullary cavity delineation was rated diagnostic or better in all cases for ZTE-CT, and ZTE-XR was at least diagnostic in 58-63% of cases. For cohort 2, cortex and intramedullary cavity Scomp for ZTE-CT was comparable to those of conventional CT, with confidence interval of proportion (sum of score of -1 to +2) of 93-100% and 95%, respectively. Pathology visualized on ZTE-CT/XR was comparable; Scomp confidence interval of proportions was 95%/97-100%, with improved delineation of non-displaced fractures on ZTE-XR. Readers had moderate to near-perfect intraclass correlation coefficient (range=0.60-0.93). CONCLUSION Implementation of a diagnostic-quality ZTE MRI sequence in the pediatric population is feasible and can be performed as a complementary pulse sequence to enhance musculoskeletal MRI studies. Compared to conventional CT, ZTE has comparable cortical delineation, intramedullary cavity and pathology visualization. While not intended as a replacement for conventional radiography, ZTE-XR provides similar visualization of pathology.
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Affiliation(s)
- Jesse K Sandberg
- Department of Radiology, Stanford University School of Medicine, 725 Welch Road, Room 1844, Stanford, CA, 94305, USA.
| | - Victoria A Young
- Department of Radiology, Stanford University School of Medicine, 725 Welch Road, Room 1844, Stanford, CA, 94305, USA
| | - Jianmin Yuan
- Department of Radiology, Stanford University School of Medicine, 725 Welch Road, Room 1844, Stanford, CA, 94305, USA
| | - Brian A Hargreaves
- Department of Radiology, Stanford University School of Medicine, 725 Welch Road, Room 1844, Stanford, CA, 94305, USA
| | - Fidaa Wishah
- Department of Radiology, Stanford University School of Medicine, 725 Welch Road, Room 1844, Stanford, CA, 94305, USA
| | - Shreyas S Vasanawala
- Department of Radiology, Stanford University School of Medicine, 725 Welch Road, Room 1844, Stanford, CA, 94305, USA
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Okuda M, Kobayashi S, Toyooka K, Yoshimizu R, Nakase J, Hayashi H, Ueda Y, Gabata T. Quantitative differentiation of tendon and ligament using magnetic resonance imaging ultrashort echo time T2* mapping of normal knee joint. Acta Radiol 2021; 63:1489-1496. [PMID: 34558315 DOI: 10.1177/02841851211043834] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND Ligaments and tendons are difficult to differentiate on conventional magnetic resonance imaging (MRI). Ligaments and tendons are different histologically, and tendon graft ligamentization is known to occur after anterior cruciate ligament (ACL) reconstruction. PURPOSE To quantify and differentiate the ultrashort echo time T2* (UTE-T2*) values of normal knee ligaments and tendons using a 1.5-T MRI scanner. MATERIAL AND METHODS The right knees of 12 healthy volunteers (6 men, 6 women; mean age = 30.8 ± 9.6 years) were scanned using a UTE-T2* sequence and the UTE-T2* values of the proximal, middle, and distal portions of the ACL, posterior cruciate ligament (PCL), and patellar tendon (PT) were evaluated. Two doctors manually drew the regions of interest four times and intra- and inter-observer reliability were evaluated by intraclass correlation coefficients. RESULTS The UTE-T2* values of ACL at the proximal, middle, distal, and mean were 12.0 ± 2.3, 11.3 ± 2.3, 12.3 ± 2.6, and 11.9 ± 2.4 ms, respectively. The UTE-T2* values of the PCL at each site were 6.9 ± 1.5, 9.0 ± 1.8, 8.8 ± 2.4, and 8.3 ± 2.1 ms, respectively. The UTE-T2* values of the PT at each site were 7.1 ± 1.7, 4.3 ± 1.7, 4.3 ± 1.8, and 5.2 ± 2.1 ms, respectively. Both intra- and inter-observer reliability showed high agreement rates. There were significant differences among the ACL mean, PCL mean, and PT mean, with a P value <0.01 in all cases. CONCLUSION This study confirms that UTE-T2* mapping can quantify the ACL, PCL, and PT, and tendons and ligaments can be differentiated using the UTE-T2* values in normal volunteer knee joints.
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Affiliation(s)
- Miho Okuda
- Department of Radiology, Kanazawa University Hospital, Kanazawa, Japan
| | - Satoshi Kobayashi
- Department of Quantum Medical Technology, Graduate School of Medical Sciences, Kanazawa University, Kanazawa, Japan
| | - Kazu Toyooka
- Department of Orthopaedic Surgery, Graduate School of Medical Science, Kanazawa University, Kanazawa, Japan
| | - Rikuto Yoshimizu
- Department of Orthopaedic Surgery, Graduate School of Medical Science, Kanazawa University, Kanazawa, Japan
| | - Junsuke Nakase
- Department of Orthopaedic Surgery, Graduate School of Medical Science, Kanazawa University, Kanazawa, Japan
| | - Hiroyuki Hayashi
- Division of Radiology, Kanazawa University Hospital, Kanazawa, Japan
| | - Yu Ueda
- MR Clinical Science, Philips Japan, Minato-ku, Japan
| | - Toshifumi Gabata
- Department of Radiology, Graduate School of Medical Sciences, Kanazawa University, Kanazawa, Japan
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Abstract
Computed tomography (CT) is most commonly used to produce three-dimensional (3D) models for evaluating bone and joint morphology in clinical practice. However, 3D models created from magnetic resonance imaging (MRI) data can be equally effective for comprehensive and accurate assessment of osseous and soft tissue structure morphology and pathology. The quality of 3D MRI models has steadily increased over time, with growing potential to replace 3D CT models in various musculoskeletal (MSK) applications. In practice, a single MRI examination for two-dimensional and 3D assessments can increase the value of MRI and simplify the pre- and postoperative imaging work-up. Multiple studies have shown excellent performance of 3D MRI models in shoulder injuries, in the hip in the setting of femoroacetabular impingement, and in the knee for the creation of bone surface models. Therefore, the utility of 3D MRI postprocessed models is expected to continue to rise and broaden in applications. Computer-based and artificial intelligence-assisted postprocessing techniques have tremendous potential to improve the efficiency of 3D model creation, opening many research avenues to validate the applicability of 3D MRI and establish 3D-specific quantitative assessment criteria. We provide a practice-focused overview of 3D MRI acquisition strategies, postprocessing techniques for 3D model creation, MSK applications of 3D MRI models, and an illustration of cases from our daily clinical practice.
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Affiliation(s)
- Mohammad Samim
- Department of Radiology, NYU Langone Medical Center, New York, New York
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11
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Malmgaard-Clausen NM, Tran P, Svensson RB, Hansen P, Nybing JD, Magnusson SP, Kjaer M. Magnetic Resonance T 2 * Is Increased in Patients With Early-Stage Achilles and Patellar Tendinopathy. J Magn Reson Imaging 2021; 54:832-839. [PMID: 33719139 DOI: 10.1002/jmri.27600] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2020] [Revised: 02/25/2021] [Accepted: 03/03/2021] [Indexed: 11/05/2022] Open
Abstract
BACKGROUND T2 * mapping has proven useful in tendon research and may have the ability to detect subtle changes at an early stage of tendinopathy. PURPOSE To investigate the difference in T2 * between patients with early tendinopathy and healthy controls, and to investigate the relationship between T2 * and clinical outcomes, tendon size, and mechanical properties. STUDY TYPE Prospective cross-sectional. SUBJECTS Sixty-five patients with early tendinopathy and 25 healthy controls. FIELD STRENGTH/SEQUENCE Three Tesla, ultrashort time to echo magnetic resonance imaging. ASSESSMENT Tendon T2 * was quantified using a monoexponential fitting algorithm. Clinical symptoms were evaluated using the Victorian Institute of Sports Assessment-Achilles/Patella (VISA-A/VISA-P). In vivo mechanical properties were measured using an ultrasound-based method that determined force and deformation simultaneously in tendons of patellar tendinopathy patients. STATISTICAL TESTS A generalized linear model adjusted for age was applied to investigate the difference between patients and controls. In the two patient groups, linear regressions were applied to investigate the association between T2 * and tendon size, clinical outcomes, and biomechanical properties. RESULTS There was a significant difference in T2 * between patients and healthy controls (204.8 [95% CI: 44.5-365.0] μsec, P < 0.05). There was a positive correlation between tendon size and T2 * for both Achilles (r = 0.72; P < 0.05) and patellar tendons (r = 0.53; P < 0.05). There was no significant correlation between VISA-A and T2 * (r = -0.2; P = 0.17) or VISA-P and T2 * (r = -0.5; P = 0.0504). Lastly, there was a negative correlation between modulus and T2 * (r = -0.51; P < 0.05). DATA CONCLUSIONS T2 * mapping can detect subtle structural changes that translate to altered mechanical properties in early-phase tendinopathy. However, T2 * did not correlate with clinical scores in patients with early-phase Achilles and patellar tendinopathy. Thus, T2 * mapping may serve as a tool for early detection of structural changes in tendinopathy but does not necessarily describe the clinical severity of disease. LEVEL OF EVIDENCE 1 TECHNICAL EFFICACY STAGE: 2.
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Affiliation(s)
- Nikolaj M Malmgaard-Clausen
- Department of Orthopedic Surgery, Institute of Sports Medicine Copenhagen, Bispebjerg and Frederiksberg Hospital, Copenhagen, Denmark.,Faculty of Health Sciences, Center for Healthy Aging, University of Copenhagen, Copenhagen, Denmark
| | - Peter Tran
- Department of Orthopedic Surgery, Institute of Sports Medicine Copenhagen, Bispebjerg and Frederiksberg Hospital, Copenhagen, Denmark.,Faculty of Health Sciences, Center for Healthy Aging, University of Copenhagen, Copenhagen, Denmark
| | - Rene B Svensson
- Department of Orthopedic Surgery, Institute of Sports Medicine Copenhagen, Bispebjerg and Frederiksberg Hospital, Copenhagen, Denmark.,Faculty of Health Sciences, Center for Healthy Aging, University of Copenhagen, Copenhagen, Denmark
| | - Philip Hansen
- Department of Radiology, Copenhagen University Hospital, Bispebjerg and Frederiksberg, Copenhagen, Denmark
| | - Janus D Nybing
- Department of Radiology, Copenhagen University Hospital, Bispebjerg and Frederiksberg, Copenhagen, Denmark
| | - Stig Peter Magnusson
- Department of Orthopedic Surgery, Institute of Sports Medicine Copenhagen, Bispebjerg and Frederiksberg Hospital, Copenhagen, Denmark.,Faculty of Health Sciences, Center for Healthy Aging, University of Copenhagen, Copenhagen, Denmark.,Department of Physical and Occupational Therapy, Bispebjerg and Frederiksberg Hospital, Copenhagen, Denmark
| | - Michael Kjaer
- Department of Orthopedic Surgery, Institute of Sports Medicine Copenhagen, Bispebjerg and Frederiksberg Hospital, Copenhagen, Denmark.,Faculty of Health Sciences, Center for Healthy Aging, University of Copenhagen, Copenhagen, Denmark
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12
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Loegering IF, Denning SC, Johnson KM, Liu F, Lee KS, Thelen DG. Ultrashort echo time (UTE) imaging reveals a shift in bound water that is sensitive to sub-clinical tendinopathy in older adults. Skeletal Radiol 2021; 50:107-113. [PMID: 32642791 PMCID: PMC7677198 DOI: 10.1007/s00256-020-03538-1] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/31/2019] [Revised: 06/28/2020] [Accepted: 06/29/2020] [Indexed: 02/02/2023]
Abstract
OBJECTIVE Use ultrashort echo time (UTE) magnetic resonance imaging to quantify bound water components of asymptomatic older Achilles tendons and investigate the relationship between UTE findings and imaging assessment of sub-clinical tendinopathy. MATERIALS AND METHODS Thirteen young (age 25 ± 4.8) and thirteen older (age 67 ± 4.7) adults were tested. A UTE sequence was used to quantify the transverse relaxation times of bound ([Formula: see text]) and free ([Formula: see text]) water and the bound water fraction (Fs) in the Achilles tendon. Anatomical images were collected and graded by a musculoskeletal radiologist to identify signs of sub-clinical tendinopathy. Two-sample t tests were used to compare [Formula: see text], [Formula: see text], and Fs between age groups and between adults with and without sub-clinical tendinopathy. RESULTS Older tendons exhibited a 60% longer [Formula: see text] (p = 0.004), similar [Formula: see text] (p = 0.86), and 5% smaller Fs (p = 0.048) than young tendons. Seven older adult tendons exhibited tendon thickening and increased signal intensity indicative of sub-clinical tendinopathy. This subset of tendons exhibited a 7% smaller bound water fraction (p = 0.02) and significantly longer [Formula: see text] (p < 0.001) than the normal tendons from young and older adults. CONCLUSION Older adult tendons exhibited unique UTE signatures that are consistent with disruption of the collagen fiber network and changes in macromolecular content. UTE imaging metrics were sensitive to early indicators of tissue degeneration identified on anatomical images and hence could provide a quantitative biomarker by which to track changes in tissue health resulting from injury, disease, and treatment.
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Affiliation(s)
- Isaac F Loegering
- Department of Biomedical Engineering, University of Wisconsin-Madison, 1513 University Ave, Madison, WI, 53706, USA
| | - Sarah C Denning
- Department of Biomedical Engineering, University of Wisconsin-Madison, 1513 University Ave, Madison, WI, 53706, USA
| | - Kevin M Johnson
- Department of Medical Physics, University of Wisconsin-Madison, 1111 Highland Ave, Madison, WI, 53705, USA
| | - Fang Liu
- Department of Radiology, Massachusetts General Hospital, Harvard Medical School, Boston, MA, 02114, USA
| | - Kenneth S Lee
- University of Wisconsin School of Medicine & Public Health, 600 Highland Avenue, Madison, WI, 53792, USA
| | - Darryl G Thelen
- Department of Mechanical Engineering, University of Wisconsin-Madison, 1513 University Ave, Madison, WI, 53706, USA.
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13
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Jang H, McMillan AB, Ma Y, Jerban S, Chang EY, Du J, Kijowski R. Rapid single scan ramped hybrid-encoding for bicomponent T2* mapping in a human knee joint: A feasibility study. NMR IN BIOMEDICINE 2020; 33:e4391. [PMID: 32761692 PMCID: PMC7584401 DOI: 10.1002/nbm.4391] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/27/2019] [Revised: 06/20/2020] [Accepted: 07/21/2020] [Indexed: 05/03/2023]
Abstract
The purpose of this study is to determine the feasibility of using a single scan ramped hybrid-encoding (RHE) method for rapid bicomponent T2* analysis of the human knee joint. The proposed method utilizes RHE to acquire ultrashort echo time (UTE) and subsequent gradient echo images at 16 different echo times ranging between 40 μs and 30 ms in a single scan. In the proposed RHE technique, UTE imaging was followed by acquisition of 14 gradient recalled echo images, where an additional UTE image was obtained within the first readout by oversampling single point imaging (SPI) encoding. The single scan RHE method with a 9-minute scan time was performed on human cadaveric knee joints from six donors and in vivo knee joints from four healthy volunteers at 3 T. A bicomponent signal model was used to characterize the short T2* and long T2* water components. Mean bicomponent T2* parameters for patellar tendon, anterior cruciate ligament (ACL), posterior cruciate ligament (PCL) and meniscus were calculated. In the experimental results, the RHE technique provided bicomponent T2* parameter estimations of tendon, ACL, PCL and meniscus, which were similar to previously reported values in the literature. In conclusion, the proposed single scan RHE technique provides rapid bicomponent T2* analysis of the human knee joint with a total scan time of less than 9 minutes.
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Affiliation(s)
- Hyungseok Jang
- Department of Radiology, University of California San Diego, San Diego, CA 92103, USA
- Corresponding Author: Hyungseok Jang, Ph.D., University of California, San Diego, Department of Radiology, 200 West Arbor Drive, San Diego, CA 92103-8226, Phone (858) 246-2225,
| | - Alan B McMillan
- Department of Radiology, University of Wisconsin Madison, Madison, WI 53705, USA
| | - Yajun Ma
- Department of Radiology, University of California San Diego, San Diego, CA 92103, USA
| | - Saeed Jerban
- Department of Radiology, University of California San Diego, San Diego, CA 92103, USA
| | - Eric Y Chang
- Department of Radiology, University of California San Diego, San Diego, CA 92103, USA
- Radiology Service, VA San Diego Healthcare System, San Diego, CA 92037, USA
| | - Jiang Du
- Department of Radiology, University of California San Diego, San Diego, CA 92103, USA
| | - Richard Kijowski
- Department of Radiology, University of Wisconsin Madison, Madison, WI 53705, USA
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14
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Xie Y, Liu S, Qu J, Wu P, Tao H, Chen S. Quantitative Magnetic Resonance Imaging UTE-T2* Mapping of Tendon Healing After Arthroscopic Rotator Cuff Repair: A Longitudinal Study. Am J Sports Med 2020; 48:2677-2685. [PMID: 32813550 DOI: 10.1177/0363546520946772] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
BACKGROUND Quantitative ultrashort echo time-T2* (UTE-T2*) mapping shows promise for the detection of potential tendon biochemical conditions, while validation against established clinical studies in the shoulder is needed. PURPOSE To evaluate and characterize the healing process of the repaired rotator cuff based on longitudinal changes in UTE-T2* values, clinical outcomes, and repair status in patients after arthroscopic rotator cuff repair (ARCR). STUDY DESIGN Cohort study; Level of evidence, 2. METHODS Patients with ARCR (n = 25) underwent quantitative MRI and clinical examinations at serial follow-up time points: 3, 6, 12, and 24 months postoperatively. Age-matched healthy controls (n = 15) were evaluated at 3 and 12 months after enrollment. Clinical scores included the Constant, American Shoulder and Elbow Surgeons, and Fudan University Shoulder score, and visual analog scale for pain. The MRI examination included UTE-T2*mapping. UTE-T2* maps were generated for T2* values at the healing site. Sugaya classification was adopted to evaluate the repair status. Longitudinal analyses of clinical outcomes, UTE-T2* changes, and Sugaya classification were conducted. RESULTS The overall retear rate was 8% (2/25, all Sugaya type IV). All patients (including the ones with retear) achieved satisfactory outcomes at 12 months that lasted to 24 months on the basis of clinical scores. The mean UTE-T2* values at the healing site showed an increase from 3 to 6 months (P = .03) and then decreased to a level similar to that observed in age-matched healthy tendons at 12 months (P = .1). No significant differences were found between UTE-T2* values at 12 and 24 months (P = .6). UTE-T2* values at the healing site significantly varied with the repair status according to Sugaya classification (P < .05). Moreover, significant correlations were noted between clinical scores and UTE-T2* values at 6 months (r = -0.6 to -0.3; all P < .05) and 12 months (r = -0.6 to -0.2; all P < .05). CONCLUSION This study indicated a healing-related relationship between clinical outcomes and quantitative UTE-T2* values, which highlights the potential of using UTE-T2* mapping to track the tendon-healing process noninvasively. Moreover, the repaired tendon was comparable to age-matched healthy controls at 12-month follow-up based on UTE-T2* values.
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Affiliation(s)
- Yuxue Xie
- Department of Radiology and Institute of Medical Functional and Molecular Imaging, Huashan Hospital, Fudan University, Shanghai, China
| | - Shaohua Liu
- Department of Sports Medicine, Huashan Hospital, Fudan University, Shanghai, China
| | | | - Puye Wu
- GE Healthcare, MR Research, Beijing, China
| | - Hongyue Tao
- Department of Radiology and Institute of Medical Functional and Molecular Imaging, Huashan Hospital, Fudan University, Shanghai, China
| | - Shuang Chen
- Department of Radiology and Institute of Medical Functional and Molecular Imaging, Huashan Hospital, Fudan University, Shanghai, China
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15
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Breda SJ, Poot DHJ, Papp D, de Vries BA, Kotek G, Krestin GP, Hernández-Tamames JA, de Vos RJ, Oei EHG. Tissue-Specific T 2 * Biomarkers in Patellar Tendinopathy by Subregional Quantification Using 3D Ultrashort Echo Time MRI. J Magn Reson Imaging 2020; 52:420-430. [PMID: 32108398 PMCID: PMC7496783 DOI: 10.1002/jmri.27108] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2020] [Revised: 02/13/2020] [Accepted: 02/13/2020] [Indexed: 12/21/2022] Open
Abstract
Background Quantitative MRI of patellar tendinopathy (PT) can be challenging due to spatial variation of T2* relaxation times. Purpose 1) To compare T2* quantification using a standard approach with analysis in specific tissue compartments of the patellar tendon. 2) To evaluate test–retest reliability of different methods for fitting ultrashort echo time (UTE)‐relaxometry data. Study Type Prospective. Subjects Sixty‐five athletes with PT. Field Strength/Sequence 3D UTE scans covering the patellar tendon were acquired using a 3.0T scanner and a 16‐channel surface coil. Assessment Voxelwise median T2* was quantified with monoexponential, fractional‐order, and biexponential fitting. We applied two methods for T2* analysis: first, a standard approach by analyzing all voxels covering the proximal patellar tendon. Second, within subregions of the patellar tendon, by using thresholds on biexponential fitting parameter percentage short T2* (0–30% for mostly long T2*, 30–60% for mixed T2*, and 60–100% for mostly short T2*). Statistical Tests Average test–retest reliability was assessed in three athletes using coefficients‐of‐variation (CV) and coefficients‐of‐repeatability (CR). Results With standard image analysis, we found a median [interquartile range, IQR] monoexponential T2* of 6.43 msec [4.32–8.55] and fractional order T2* 4.39 msec [3.06–5.78]. The percentage of short T2* components was 52.9% [35.5–69.6]. Subregional monoexponential T2* was 13.78 msec [12.11–16.46], 7.65 msec [6.49–8.61], and 3.05 msec [2.52–3.60] and fractional order T2* 11.82 msec [10.09–14.44], 5.14 msec [4.25–5.96], and 2.19 msec [1.82–2.64] for 0–30%, 30–60%, and 60–100% short T2*, respectively. Biexponential component short T2* was 1.693 msec [1.417–2.003] for tissue with mostly short T2* and long T2* of 15.79 msec [13.47–18.61] for mostly long T2*. The average CR (CV) was 2 msec (15%), 2 msec (19%) and 10% (22%) for monoexponential, fractional order and percentage short T2*, respectively. Data Conclusion Patellar tendinopathy is characterized by regional variability in binding states of water. Quantitative multicompartment T2* analysis in PT can be facilitated using a voxel selection method based on using biexponential fitting parameters. Level of Evidence 1 Technical Efficacy Stage 1 J. Magn. Reson. Imaging 2020;52:420–430.
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Affiliation(s)
- Stephan J Breda
- Department of Radiology & Nuclear Medicine, Erasmus MC University Medical Center Rotterdam, Rotterdam, The Netherlands.,Department of Orthopedics and Sports Medicine, Erasmus MC University Medical Center Rotterdam, Rotterdam, The Netherlands
| | - Dirk H J Poot
- Department of Radiology & Nuclear Medicine, Erasmus MC University Medical Center Rotterdam, Rotterdam, The Netherlands
| | - Dorottya Papp
- Department of Radiology & Nuclear Medicine, Erasmus MC University Medical Center Rotterdam, Rotterdam, The Netherlands
| | - Bas A de Vries
- Department of Radiology & Nuclear Medicine, Erasmus MC University Medical Center Rotterdam, Rotterdam, The Netherlands
| | - Gyula Kotek
- Department of Radiology & Nuclear Medicine, Erasmus MC University Medical Center Rotterdam, Rotterdam, The Netherlands
| | - Gabriel P Krestin
- Department of Radiology & Nuclear Medicine, Erasmus MC University Medical Center Rotterdam, Rotterdam, The Netherlands
| | - Juan A Hernández-Tamames
- Department of Radiology & Nuclear Medicine, Erasmus MC University Medical Center Rotterdam, Rotterdam, The Netherlands
| | - Robert-Jan de Vos
- Department of Orthopedics and Sports Medicine, Erasmus MC University Medical Center Rotterdam, Rotterdam, The Netherlands
| | - Edwin H G Oei
- Department of Radiology & Nuclear Medicine, Erasmus MC University Medical Center Rotterdam, Rotterdam, The Netherlands
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16
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Shultz SJ, Schmitz RJ, Cameron KL, Ford KR, Grooms DR, Lepley LK, Myer GD, Pietrosimone B. Anterior Cruciate Ligament Research Retreat VIII Summary Statement: An Update on Injury Risk Identification and Prevention Across the Anterior Cruciate Ligament Injury Continuum, March 14-16, 2019, Greensboro, NC. J Athl Train 2019; 54:970-984. [PMID: 31461312 PMCID: PMC6795093 DOI: 10.4085/1062-6050-54.084] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Affiliation(s)
- Sandra J. Shultz
- Applied Neuromechanics Research Laboratory, University of North Carolina at Greensboro
| | - Randy J. Schmitz
- Applied Neuromechanics Research Laboratory, University of North Carolina at Greensboro
| | - Kenneth L. Cameron
- John A. Feagin Jr Sports Medicine Fellowship, Keller Army Hospital, United States Military Academy, West Point, NY
| | - Kevin R. Ford
- Human Biomechanics and Physiology Laboratory, Department of Physical Therapy, High Point University, NC
| | - Dustin R. Grooms
- Ohio Musculoskeletal & Neurological Institute and Division of Athletic Training, School of Applied Health Sciences and Wellness, College of Health Sciences and Professions, Ohio University, Athens
| | | | - Gregory D. Myer
- The SPORT Center, Division of Sports Medicine, and Departments of Pediatrics and Orthopaedic Surgery, Cincinnati Children's Hospital Medical Center, College of Medicine, University of Cincinnati, OH
| | - Brian Pietrosimone
- MOTION Science Institute, Department of Exercise and Sport Science, University of North Carolina at Chapel Hill
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17
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Chen X, Qiu B. A pilot study of short T2* measurements with ultrashort echo time imaging at 0.35 T. Biomed Eng Online 2018; 17:70. [PMID: 29866123 PMCID: PMC5987637 DOI: 10.1186/s12938-018-0505-5] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2018] [Accepted: 05/23/2018] [Indexed: 11/10/2022] Open
Abstract
PURPOSE Ultrashort echo time (UTE) sequences play a key role in imaging and quantifying short T2 species. However, almost all of the relevant studies was conducted at relatively high fields. The purpose of this work was to further explore the feasibility of UTE imaging and T2* measurement for short T2 species at low fields. METHODS A 2D UTE sequence with an echo time (TE) of 0.37 ms was developed on a 0.35 T permanent magnet scanner. This sequence acquires multiecho images to fit the monoexponential signal decay model for quantitative T2* calculations. In the phantom experiments, MnCl2 solutions with different T2* values were used to assess the curve fitting model in low fields. In the in vivo experiments, T2* measurements were performed on the Achilles tendon of five normal volunteers. RESULTS The phantom studies showed a significant linear relationship between the MnCl2 solution concentration and R2* (1/T2*) values, which indicated the stability and accuracy of the T2* quantification model. The in vivo studies demonstrated that mean T2* value of Achilles tendon is 1.83 ± 0.21 ms, and the mean coefficient of determination (R-squared) was 0.996. CONCLUSIONS Both phantom and in vivo experiments showed that UTE imaging and quantification for short T2 components were feasible at low field 0.35 T scanner. This pilot study presents preliminary conclusions for future work.
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Affiliation(s)
- Xiuyuan Chen
- Center for Biomedical Engineering, University of Science and Technology of China, Jinzhai Road, NO.96, Hefei, 230026, China
| | - Bensheng Qiu
- Center for Biomedical Engineering, University of Science and Technology of China, Jinzhai Road, NO.96, Hefei, 230026, China.
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18
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Wengler K, Tank D, Fukuda T, Paci JM, Huang M, Schweitzer ME, He X. Diffusion tensor imaging of human Achilles tendon by stimulated echo readout-segmented EPI (ste-RS-EPI). Magn Reson Med 2018; 80:2464-2474. [PMID: 29732609 DOI: 10.1002/mrm.27220] [Citation(s) in RCA: 20] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2018] [Revised: 03/13/2018] [Accepted: 03/26/2018] [Indexed: 11/11/2022]
Abstract
PURPOSE Healing, regeneration, and remodeling of the injured Achilles tendon are associated with notable changes in tendon architecture. However, assessing Achilles microstructural properties with conventional diffusion tension imaging (DTI) remains a challenge because of very short T2 / <mml:math xmlns:mml="http://www.w3.org/1998/Math/MathML"> <mml:mrow><mml:msubsup><mml:mi>T</mml:mi> <mml:mn>2</mml:mn> <mml:mo>*</mml:mo></mml:msubsup> </mml:mrow> </mml:math> values of the tendon. Hence, the objective of this study was to develop a novel Achilles tendon DTI protocol for a non-invasive investigation of the changes of microstructural integrity in tendinopathy. METHODS A novel stimulated echo readout-segmented EPI (ste-RS-EPI) DTI sequence was proposed to achieve a TE of ∼14-20 ms for typical b-values of 400-800 s/mm2 on clinical 3T MRI scanners. To further boost tendon MR signal, the Achilles was positioned at the magic angle (∼55 °) with respect to the scanner B0 field. The sensitivity of the developed protocol was evaluated in 19 healthy participants and 6 patients with clinically confirmed tendinopathy. RESULTS Compared to spin echo RS-EPI DTI protocol, ste-RS-EPI provided an ∼100-200% increase in Achilles MR signal. Tendinopathic Achilles demonstrated a high degree of microstructural disruption based on DTI tractography analysis, with significantly lower (P < 0.05) axial diffusivity (1.20 ± 0.19 vs. 1.39 ± 0.10 × 10-3 mm2 /s), radial diffusivity (0.72 ± 0.11 vs. 0.81 ± 0.08 × 10-3 mm2 /s), and mean diffusivity (0.87 ± 0.14 vs. 1.00 ± 0.07 × 10-3 mm2 /s), but no significant difference in fractional anisotropy (0.38 ± 0.04 vs. 0.38 ± 0.05; P = 0.86). CONCLUSION Achilles tendon ste-RS-EPI DTI can non-invasively detect the tendinopathy-induced changes to microstructural integrity, consistent with the disruption of collagen arrangement and increased cellularity. This study demonstrated the robustness and sensitivity of the proposed protocol in Achilles tendinopathy.
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Affiliation(s)
- Kenneth Wengler
- Department of Biomedical Engineering, Stony Brook University, Stony Brook, New York
| | - Dharmesh Tank
- Department of Radiology, Stony Brook University, Stony Brook, New York
| | - Takeshi Fukuda
- Department of Radiology, Stony Brook University, Stony Brook, New York
| | - James M Paci
- Department of Orthopaedic Surgery, Stony Brook University, Stony Brook, New York
| | - Mingqian Huang
- Department of Radiology, Stony Brook University, Stony Brook, New York
| | - Mark E Schweitzer
- Department of Radiology, Stony Brook University, Stony Brook, New York
| | - Xiang He
- Department of Radiology, Stony Brook University, Stony Brook, New York
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19
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Breighner RE, Endo Y, Konin GP, Gulotta LV, Koff MF, Potter HG. Technical Developments: Zero Echo Time Imaging of the Shoulder: Enhanced Osseous Detail by Using MR Imaging. Radiology 2018; 286:960-966. [DOI: 10.1148/radiol.2017170906] [Citation(s) in RCA: 68] [Impact Index Per Article: 11.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Affiliation(s)
- Ryan E. Breighner
- From the Department of Radiology and Imaging (R.E.B., Y.E., G.P.K., M.F.K., H.G.P.) and Department of Orthopedic Surgery and Sports Medicine (L.V.G.), Hospital for Special Surgery, 535 E 70th St, New York, NY 10021
| | - Yoshimi Endo
- From the Department of Radiology and Imaging (R.E.B., Y.E., G.P.K., M.F.K., H.G.P.) and Department of Orthopedic Surgery and Sports Medicine (L.V.G.), Hospital for Special Surgery, 535 E 70th St, New York, NY 10021
| | - Gabrielle P. Konin
- From the Department of Radiology and Imaging (R.E.B., Y.E., G.P.K., M.F.K., H.G.P.) and Department of Orthopedic Surgery and Sports Medicine (L.V.G.), Hospital for Special Surgery, 535 E 70th St, New York, NY 10021
| | - Lawrence V. Gulotta
- From the Department of Radiology and Imaging (R.E.B., Y.E., G.P.K., M.F.K., H.G.P.) and Department of Orthopedic Surgery and Sports Medicine (L.V.G.), Hospital for Special Surgery, 535 E 70th St, New York, NY 10021
| | - Matthew F. Koff
- From the Department of Radiology and Imaging (R.E.B., Y.E., G.P.K., M.F.K., H.G.P.) and Department of Orthopedic Surgery and Sports Medicine (L.V.G.), Hospital for Special Surgery, 535 E 70th St, New York, NY 10021
| | - Hollis G. Potter
- From the Department of Radiology and Imaging (R.E.B., Y.E., G.P.K., M.F.K., H.G.P.) and Department of Orthopedic Surgery and Sports Medicine (L.V.G.), Hospital for Special Surgery, 535 E 70th St, New York, NY 10021
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20
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Bae WC, Ruangchaijatuporn T, Chung CB. New Techniques in MR Imaging of the Ankle and Foot. Magn Reson Imaging Clin N Am 2017; 25:211-225. [PMID: 27888849 DOI: 10.1016/j.mric.2016.08.009] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
Foot and ankle disorders are common in everyday clinical practice. MR imaging is frequently required for diagnosis given the variety and complexity of foot and ankle anatomy. Although conventional MR imaging plays a significant role in diagnosis, contemporary management increasingly relies on advanced imaging for monitoring therapeutic response. There is an expanding need for identification of biomarkers for musculoskeletal tissues. Advanced imaging techniques capable of imaging these tissue substrates will be increasingly used in routine clinical practice. Radiologists should therefore become familiar with these innovative MR techniques. Many such techniques are already widely used in other organ systems.
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Affiliation(s)
- Won C Bae
- Radiology Service, Veterans Affairs San Diego Healthcare System, 3350 La Jolla Village Drive, MC 114, San Diego, CA 92161, USA; Department of Radiology, UCSD MSK Imaging Research Lab, University of California, San Diego, 9427 Health Sciences Drive, La Jolla, CA 92093-0997, USA
| | - Thumanoon Ruangchaijatuporn
- Department of Diagnostic and Therapeutic Radiology, Faculty of Medicine, Ramathibodi Hospital, Mahidol University, 270 Rama VI Road, Ratchatewi, Bangkok 10400, Thailand
| | - Christine B Chung
- Radiology Service, Veterans Affairs San Diego Healthcare System, 3350 La Jolla Village Drive, MC 114, San Diego, CA 92161, USA; Department of Radiology, UCSD MSK Imaging Research Lab, University of California, San Diego, 9427 Health Sciences Drive, La Jolla, CA 92093-0997, USA.
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Abstract
Ultrashort TE (UTE) sequences have the capability to image tissues with very short T2s that typically appear as low signal in clinical sequences. UTE sequences can also be used in multi-echo acquisitions which allow assessment of the T2s of these tissues. Here we study the accuracy of such T2 measurements when combined with fat saturation (FS).
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Abstract
OBJECTIVE The purposes of this article are to present a state-of-the-art routine protocol for MRI of the ankle, to provide problem-solving tools based on specific clinical indications, and to introduce principles for the implementation of ultrashort echo time MRI of the ankle, including morphologic and quantitative assessment. CONCLUSION Ankle injury is common among both athletes and the general population, and MRI is the established noninvasive means of evaluation. The design of an ankle protocol depends on various factors. Higher magnetic field improves signal-to-noise ratio but increases metal artifact. Specialized imaging planes are useful but prolong acquisition times. MR neurography is useful, but metal reduction techniques are needed whenever a metal prosthesis is present. An ultrashort echo time sequence is a valuable tool for both structural and quantitative evaluation.
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Wilson KJ, Surowiec RK, Johnson NS, Lockard CA, Clanton TO, Ho CP. T2* Mapping of Peroneal Tendons Using Clinically Relevant Subregions in an Asymptomatic Population. Foot Ankle Int 2017; 38:677-683. [PMID: 28552042 DOI: 10.1177/1071100717693208] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
BACKGROUND Peroneal tendon evaluation is particularly demanding using current magnetic resonance imaging (MRI) techniques because of their curving path around the lateral malleolus. Quantifiable, objective data on the health of the peroneal tendons could be useful for improving diagnosis of tendon pathology and tracking post-treatment responses. The purpose of this study was to establish a method and normative T2-star (T2*) values for the peroneal tendons in a screened asymptomatic cohort using clinically reproducible subregions, providing a baseline for comparison with peroneal tendon pathology. METHODS Unilateral ankle scans were acquired for 26 asymptomatic volunteers with a 3-Tesla MRI system using a T2* mapping sequence in the axial and sagittal planes. The peroneus brevis and peroneus longus tendons were manually segmented and subregions were isolated in the proximity of the lateral malleolus. Summary statistics for T2* values were calculated. RESULTS The peroneus brevis tendon exhibited a mean T2* value of 12 ms and the peroneus longus tendon was 11 ms. Subregions distal to the lateral malleolus had significantly higher T2* values ( P < .05) than the subregions proximal in both tendons, in both the axial and sagittal planes. CONCLUSION Peroneal tendon regions distal to the inferior tip of the lateral malleolus had significantly higher T2* values than those regions proximal, which could be related to anatomical differences along the tendon. CLINICAL RELEVANCE This study provides a quantitative method and normative baseline T2* mapping values for comparison with symptomatic clinically compromised peroneal tendon patients.
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Affiliation(s)
| | | | | | | | | | - Charles P Ho
- 1 Steadman Philippon Research Institute, Vail, CO, USA
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Kijowski R, Wilson JJ, Liu F. Bicomponent ultrashort echo time T2* analysis for assessment of patients with patellar tendinopathy. J Magn Reson Imaging 2017; 46:1441-1447. [PMID: 28263448 DOI: 10.1002/jmri.25689] [Citation(s) in RCA: 35] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2016] [Accepted: 02/10/2017] [Indexed: 12/20/2022] Open
Abstract
PURPOSE To compare bicomponent ultrashort echo time (UTE) T2* parameters of patellar tendon between healthy volunteers and patients with patellar tendinopathy. MATERIALS AND METHODS This study was performed with Institutional Review Board approval and with all subjects signing informed consent. A UTE- T2* mapping sequence was performed at 3.0T on the knees of 10 healthy volunteers and in 11 patients with patellar tendinopathy. The UTE- T2* relaxation times of the fast relaxing macromolecular bound water component ( T2*F) and the slow relaxing bulk water component ( T2*S) and the fraction of the fast relaxing macromolecular bound water component (FF ) of patellar tendon were measured in all subjects. Wilcoxon rank-sum tests were used to compare UTE- T2* parameters between healthy volunteers and patients with patellar tendinopathy. RESULTS Mean T2*F, T2*S, and FF of the patellar tendon was 1.5 msec, 23.1 msec, and 79.5%, respectively, for healthy volunteers and 1.9 msec, 22.3 msec, and 75.5%, respectively, for patients with patellar tendinopathy. There were statistically significant differences between groups of subjects for T2*F (P = 0.01) and FF (P = 0.007) but not T2*S (P = 0.10) of the patellar tendon. CONCLUSION Patients with patellar tendinopathy had significantly higher T2*F and significantly lower FF of patellar tendon than healthy volunteers, which suggests that bicomponent UTE- T2* parameters can detect changes in the composition and microstructure of degenerative tendon. LEVEL OF EVIDENCE 1 Technical Efficacy: Stage 2 J. Magn. Reson. Imaging 2017;46:1441-1447.
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Affiliation(s)
- Richard Kijowski
- Department of Radiology, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin, USA
| | - John J Wilson
- Department of Orthopedics and Rehabilitation, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin, USA
| | - Fang Liu
- Department of Radiology, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin, USA
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