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Biglands JD, Grainger AJ, Robinson P, Tanner SF, Tan AL, Feiweier T, Evans R, Emery P, O'Connor P. MRI in acute muscle tears in athletes: can quantitative T2 and DTI predict return to play better than visual assessment? Eur Radiol 2020; 30:6603-6613. [PMID: 32666321 PMCID: PMC7599135 DOI: 10.1007/s00330-020-06999-z] [Citation(s) in RCA: 21] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2020] [Revised: 04/14/2020] [Accepted: 06/03/2020] [Indexed: 11/05/2022]
Abstract
OBJECTIVES To assess the ability of quantitative T2, diffusion tensor imaging (DTI) and radiologist's scores to detect muscle changes following acute muscle tear in soccer and rugby players. To assess the ability of these parameters to predict return to play times. METHODS In this prospective, longitudinal study, 13 male athletes (age 19 to 34 years; mean 25 years) underwent MRI within 1 week of suffering acute muscle tear. Imaging included measurements of T2 and DTI parameters. Images were also assessed using modified Peetrons and British athletics muscle injury classification (BAMIC) scores. Participants returned for a second scan within 1 week of being determined fit to return to play. MRI measurements were compared between visits. Pearson's correlation between visit 1 measurements and return to play times was assessed. RESULTS There were significant differences between visits in BAMIC scores (Z = - 2.088; p = 0.037), modified Peetrons (Z = - 2.530; p = 0.011) and quantitative MRI measurements; T2, 13.12 ms (95% CI, 4.82 ms, 21.42 ms; p = 0.01); mean diffusivity (0.22 (0.04, 0.39); p = 0.02) and fractional anisotropy (0.07 (0.01, 0.14); p = 0.03). BAMIC scores showed a significant correlation with return to play time (Rs = 0.64; p = 0.02), but modified Peetrons scores and quantitative parameters did not. CONCLUSIONS T2 and DTI measurements in muscle can detect changes due to healing following muscle tear. Although BAMIC scores correlated well with return to play times, in this small study, quantitative MRI values did not, suggesting that T2 and DTI measurements are inferior predictors of return to play time compared with visual scoring. KEY POINTS • Muscle changes following acute muscle tear can be measured using T2 and diffusion measurements on MRI. • Measurements of T2 and diffusion using MRI are not as good as a radiologist's visual report at predicting return to play time after acute muscle tear.
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Affiliation(s)
- J D Biglands
- NIHR Leeds Biomedical Research Centre, Leeds Teaching Hospitals NHS Trust, Leeds, UK.
- Medical Physics and Engineering, Leeds Teaching Hospitals NHS Trust, Leeds, UK.
| | - A J Grainger
- NIHR Leeds Biomedical Research Centre, Leeds Teaching Hospitals NHS Trust, Leeds, UK
- Leeds Institute of Rheumatic and Musculoskeletal Medicine, Chapel Allerton Hospital, University of Leeds, Leeds, UK
| | - P Robinson
- NIHR Leeds Biomedical Research Centre, Leeds Teaching Hospitals NHS Trust, Leeds, UK
- Leeds Institute of Rheumatic and Musculoskeletal Medicine, Chapel Allerton Hospital, University of Leeds, Leeds, UK
| | - S F Tanner
- NIHR Leeds Biomedical Research Centre, Leeds Teaching Hospitals NHS Trust, Leeds, UK
- Medical Physics and Engineering, Leeds Teaching Hospitals NHS Trust, Leeds, UK
| | - A L Tan
- NIHR Leeds Biomedical Research Centre, Leeds Teaching Hospitals NHS Trust, Leeds, UK
- Leeds Institute of Rheumatic and Musculoskeletal Medicine, Chapel Allerton Hospital, University of Leeds, Leeds, UK
| | - T Feiweier
- Siemens Healthcare GmbH, Erlangen, Germany
| | - R Evans
- NIHR Leeds Biomedical Research Centre, Leeds Teaching Hospitals NHS Trust, Leeds, UK
| | - P Emery
- NIHR Leeds Biomedical Research Centre, Leeds Teaching Hospitals NHS Trust, Leeds, UK
- Leeds Institute of Rheumatic and Musculoskeletal Medicine, Chapel Allerton Hospital, University of Leeds, Leeds, UK
| | - P O'Connor
- NIHR Leeds Biomedical Research Centre, Leeds Teaching Hospitals NHS Trust, Leeds, UK
- Leeds Institute of Rheumatic and Musculoskeletal Medicine, Chapel Allerton Hospital, University of Leeds, Leeds, UK
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Farrow M, Biglands JD, Grainger AJ, O'Connor P, Hensor EMA, Ladas A, Tanner SF, Emery P, Tan AL. Quantitative MRI in myositis patients: comparison with healthy volunteers and radiological visual assessment. Clin Radiol 2020; 76:81.e1-81.e10. [PMID: 32958223 DOI: 10.1016/j.crad.2020.08.022] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2020] [Accepted: 08/21/2020] [Indexed: 10/23/2022]
Abstract
AIM To assess whether magnetic resonance imaging (MRI)-based measurements of T2, fat fraction, diffusion tensor imaging, and muscle volume can detect differences between the muscles of myositis patients and healthy controls, and to identify how they compare with semi-quantitative MRI diagnosis. MATERIALS AND METHODS Sixteen myositis patients and 16 age- and gender-matched healthy controls underwent MRI of their thigh. Quantitative MRI measurements and radiologists' semi-quantitative scores were assessed. Strength was assessed using an isokinetic dynamometer. RESULTS Fat fraction and T2 values were higher in myositis patients whereas muscle volume was lower compared to healthy controls. There was no difference in diffusion. Muscle strength was lower in myositis patients compared to healthy controls. In a subgroup of eight patients, scored as unaffected by radiologists, T2 values were still significantly higher in myositis patients. CONCLUSIONS Quantitative MRI measurements can detect differences between myositis patients and healthy controls. Changes in the muscles of myositis patients, undetected by visual, semi-quantitative scoring, can be detected using quantitative T2 measurements. This suggests that MRI T2 values may be useful for the management of myositis patients.
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Affiliation(s)
- M Farrow
- Leeds Institute of Rheumatic and Musculoskeletal Medicine, Chapel Allerton Hospital, University of Leeds, UK; NIHR Leeds Biomedical Research Centre, Leeds Teaching Hospitals NHS Trust, Leeds, UK; School of Pharmacy and Medical Sciences, University of Bradford, UK
| | - J D Biglands
- NIHR Leeds Biomedical Research Centre, Leeds Teaching Hospitals NHS Trust, Leeds, UK; Medical Physics and Engineering, Leeds Teaching Hospitals NHS Trust, Leeds, UK
| | - A J Grainger
- Deprtment of Radiology, Cambridge University Hospital, Cambridge, UK; Academic Department of Radiology, University of Cambridge, UK
| | - P O'Connor
- Leeds Institute of Rheumatic and Musculoskeletal Medicine, Chapel Allerton Hospital, University of Leeds, UK; NIHR Leeds Biomedical Research Centre, Leeds Teaching Hospitals NHS Trust, Leeds, UK
| | - E M A Hensor
- Leeds Institute of Rheumatic and Musculoskeletal Medicine, Chapel Allerton Hospital, University of Leeds, UK; NIHR Leeds Biomedical Research Centre, Leeds Teaching Hospitals NHS Trust, Leeds, UK
| | - A Ladas
- Imperial College Healthcare NHS Trust, Charing Cross Hospital, London, UK
| | - S F Tanner
- NIHR Leeds Biomedical Research Centre, Leeds Teaching Hospitals NHS Trust, Leeds, UK; Medical Physics and Engineering, Leeds Teaching Hospitals NHS Trust, Leeds, UK
| | - P Emery
- Leeds Institute of Rheumatic and Musculoskeletal Medicine, Chapel Allerton Hospital, University of Leeds, UK; NIHR Leeds Biomedical Research Centre, Leeds Teaching Hospitals NHS Trust, Leeds, UK
| | - A L Tan
- Leeds Institute of Rheumatic and Musculoskeletal Medicine, Chapel Allerton Hospital, University of Leeds, UK; NIHR Leeds Biomedical Research Centre, Leeds Teaching Hospitals NHS Trust, Leeds, UK.
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Cowling P, Hackney R, Dube B, Grainger AJ, Biglands JD, Stanley M, Song D, Conaghan PG, Kingsbury SR. The use of a synthetic shoulder patch for large and massive rotator cuff tears - a feasibility study. BMC Musculoskelet Disord 2020; 21:213. [PMID: 32264949 PMCID: PMC7140555 DOI: 10.1186/s12891-020-03227-z] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/09/2019] [Accepted: 03/20/2020] [Indexed: 01/26/2023] Open
Abstract
Background The aim of this study was to explore the feasibility of using a non-absorbable biocompatible polyester patch to augment open repair of massive rotator cuff tears (Patch group) and compare outcomes with other treatment options (Non-patch group). Methods Participants referred to orthopaedic clinics for rotator cuff surgery were recruited. Choice of intervention (Patch or Non-patch) was based on patient preference and intra-operative findings. Oxford Shoulder Score (OSS), Shoulder Pain and Disability Index (SPADI), and Constant score were completed at baseline and 6 months. Shoulder MRI was performed at baseline and 6 months to assess fat fraction and Goutallier classification pre- and post- treatment. Feasibility outcomes (including retention, consent and missing data) were assessed. Results Sixty-eight participants (29 in the Patch group, 39 in Non-patch group) were included (mean age 65.3 years). Conversion to consent (92.6%), missing data (0% at baseline), and attrition rate (16%) were deemed successful feasibility endpoints. There was significant improvement in the Patch group compared to Non-patch at 6 months in OSS (difference in medians 9.76 (95% CI 2.25, 17.29) and SPADI: 22.97 (95% CI 3.02, 42.92), with no substantive differences in Constant score. The patch group had a higher proportion of participants improving greater than MCID for OSS (78% vs 62%) and SPADI (63% vs 50%) respectively. Analysis of the 48 paired MRIs demonstrated a slight increase in the fat fraction for supraspinatus (53 to 55%), and infraspinatus (26 to 29%) at 6 months. These differences were similar and in the same direction when the participants were analysed by treatment group. The Goutallier score remained the same or worsened one grade in both groups equally. Conclusions This study indicates that a definitive clinical trial investigating the use of a non-absorbable patch to augment repair of massive rotator cuff tears is feasible. In such patients, the patch has the potential to improve shoulder symptoms at 6 months. Trial registration ISRCTN, ISRCTN79844053, Registered 15th October 2014 (retrospectively registered).
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Affiliation(s)
- P Cowling
- Leeds Teaching Hospitals NHS Trust, Chapel Allerton Hospital, Chapeltown Road, Leeds, LS7 4SA, UK.
| | - R Hackney
- Leeds Teaching Hospitals NHS Trust, Chapel Allerton Hospital, Chapeltown Road, Leeds, LS7 4SA, UK.,NIHR Leeds Biomedical Research Centre, Leeds, UK
| | - B Dube
- NIHR Leeds Biomedical Research Centre, Leeds, UK.,Leeds Institute of Rheumatic and Musculoskeletal Medicine, University of Leeds, Leeds, UK
| | - A J Grainger
- Leeds Teaching Hospitals NHS Trust, Chapel Allerton Hospital, Chapeltown Road, Leeds, LS7 4SA, UK.,NIHR Leeds Biomedical Research Centre, Leeds, UK
| | - J D Biglands
- Leeds Teaching Hospitals NHS Trust, Chapel Allerton Hospital, Chapeltown Road, Leeds, LS7 4SA, UK.,NIHR Leeds Biomedical Research Centre, Leeds, UK
| | - M Stanley
- Leeds Medical School, University of Leeds, Leeds, UK
| | - D Song
- Leeds Medical School, University of Leeds, Leeds, UK
| | - P G Conaghan
- NIHR Leeds Biomedical Research Centre, Leeds, UK.,Leeds Institute of Rheumatic and Musculoskeletal Medicine, University of Leeds, Leeds, UK
| | - S R Kingsbury
- NIHR Leeds Biomedical Research Centre, Leeds, UK.,Leeds Institute of Rheumatic and Musculoskeletal Medicine, University of Leeds, Leeds, UK
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Motwani M, Dobson L, Smith C, Maredia N, Sourbron S, Biglands JD, Plein S, Greenwood JP. 089 REGIONAL VARIATION IN MYOCARDIAL BLOOD FLOW IN PATIENTS WITH LEFT BUNDLE BRANCH BLOCK: A QUANTITATIVE PERFUSION CMR STUDY. Heart 2013. [DOI: 10.1136/heartjnl-2013-304019.89] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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Motwani M, Fairbairn TA, Larghat A, Mather AN, Biglands JD, Radjenovic A, Greenwood JP, Plein S. 085 Systolic vs diastolic acquisition in cardiovascular magnetic resonance myocardial perfusion imaging. Heart 2012. [DOI: 10.1136/heartjnl-2012-301877b.85] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
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Johnstone RI, Greenwood JP, Biglands JD, Plein S, Ridgway JP, Radjenovic A. Assessment of tissue edema in patients with acute myocardial infarction by computer-assisted quantification of triple inversion recovery prepared MRI of the myocardium. Magn Reson Med 2011; 66:564-73. [PMID: 21394767 DOI: 10.1002/mrm.22812] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2010] [Revised: 12/07/2010] [Accepted: 12/12/2010] [Indexed: 01/26/2023]
Abstract
The aim of this study was to design a computer algorithm to assess the extent of cardiac edema from triple inversion recovery MR images of the human left ventricular myocardium. Twenty-one patients presenting with acute myocardial infarction were scanned within 48 h of the onset of symptoms. Eight patients were scanned a second time, 4 weeks after the initial event. Myocardial edema was detected in 27 of 29 studies using visual contour-based manual segmentation. A reference standard, created from the segmentations of three raters by voxel-wise majority voting, was compared to the edema mass estimates obtained using a newly developed computer algorithm. At baseline (n=20), the reference standard yielded an edema mass of 16.4±15.0 g (mean±SD) and the computer algorithm edema mass was 16.4±12.6 g. At follow-up (n=7), the reference standard edema mass was 7.1±4.4 g compared to 16.3±7.7 g at baseline. Computer algorithm estimates showed the same pattern of change with 5.7±5.7 g at follow-up compared to 20.8±13.8 g at baseline. Although there was a significant degree of discrepancy between reference standard and computer algorithm estimates of edema mass in individual patients, their overall agreement was good, with intraclass correlation coefficient ICC(3, 1)=0.753.
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Affiliation(s)
- R I Johnstone
- Department of Medical Physics and Engineering, Leeds Teaching Hospitals Trust, and School of Medicine, University of Leeds, Leeds, United Kingdom
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