Combining T1rho and advanced diffusion MRI for noninvasively staging liver fibrosis: an experimental study in rats

PURPOSE

To investigate the value of imaging parameters derived from T1 relaxation times in the rotating frame (T1ρ or T1rho), diffusion kurtosis imaging (DKI) and intravoxel incoherent motion (IVIM) in assessment of liver fibrosis in rats and propose an optimal diagnostic model based on multiparametric MRI.

METHODS

Thirty rats were divided into one control group and four fibrosis experimental groups (n = 6 for each group). Liver fibrosis was induced by administering thioacetamide (TAA) for 2, 4, 6, and 8 weeks. T1ρ, mean kurtosis (MK), mean diffusivity (MD), perfusion fraction (f), true diffusion coefficient (D), and pseudo-diffusion coefficient (D*) were measured and compared among different fibrosis stages. An optimal diagnostic model was established and the diagnostic efficiency was evaluated by receiver operating characteristic (ROC) curve analysis.

RESULTS

The mean AUC values, sensitivity, and specificity of T1ρ and MD derived from DKI across all liver fibrosis stages were comparable but much higher than those of other imaging parameters (0.954, 92.46, 91.85 for T1ρ; 0.949, 92.52, 91.24 for MD). The model combining T1ρ and MD exhibited better diagnostic performance with higher AUC values than any individual method for staging liver fibrosis (≥ F1: 1.000 (0.884-1.000); ≥ F2: 0.935 (0.782-0.992); ≥ F3: 0.982 (0.852-1.000); F4: 0.986 (0.859-1.000)).

CONCLUSION

Among the evaluated imaging parameters, T1ρ and MD were superior for differentiating varying liver fibrosis stages. The model combining T1ρ and MD was promising to be a credible diagnostic biomarker to detect and accurately stage liver fibrosis.

Whole knee joint mapping using a phase modulated UTE adiabatic T1ρ (PM-UTE-AdiabT1ρ ) sequence

PURPOSE

To develop a 3D phase modulated UTE adiabatic T1ρ (PM-UTE-AdiabT1ρ ) sequence for whole knee joint mapping on a clinical 3 T scanner.

METHODS

This new sequence includes six major features: (1) a magnetization reset module, (2) a train of adiabatic full passage pulses for spin locking, (3) a phase modulation scheme (i.e., RF cycling pair), (4) a fat saturation module, (5) a variable flip angle scheme, and (6) a 3D UTE Cones sequence for data acquisition. A simple exponential fitting was used for T1ρ quantification. Phantom studies were performed to investigate PM-UTE-AdiabT1ρ 's sensitivity to compositional changes and reproducibility as well as its correlation with continuous wave-T1ρ measurement. The PM-UTE-AdiabT1ρ technique was then applied to five ex vivo and five in vivo normal knees to measure T1ρ values of femoral cartilage, meniscus, posterior cruciate ligament, anterior cruciate ligament, patellar tendon, and muscle.

RESULTS

The phantom study demonstrated PM-UTE-AdiabT1ρ 's high sensitivity to compositional changes, its high reproducibility, and its strong linear correlation with continuous wave-T1ρ measurement. The ex vivo and in vivo knee studies demonstrated average T1ρ values of 105.6 ± 8.4 and 77.9 ± 3.9 ms for the femoral cartilage, 39.2 ± 5.1 and 30.1 ± 2.2 ms for the meniscus, 51.6 ± 5.3 and 29.2 ± 2.4 ms for the posterior cruciate ligament, 79.0 ± 9.3 and 52.0 ± 3.1 ms for the anterior cruciate ligament, 19.8 ± 4.5 and 17.0 ± 1.8 ms for the patellar tendon, and 91.1 ± 8.8 and 57.6 ± 2.8 ms for the muscle, respectively.

CONCLUSION

The 3D PM-UTE-AdiabT1ρ sequence allows volumetric T1ρ assessment for both short and long T2 tissues in the knee joint on a clinical 3 T scanner.

Alternating Look-Locker for quantitative T1 , T1ρ and B1 3D MRI mapping

PURPOSE

To develop a new MRI method, entitled alternating Look-Locker (aLL), for quantitativeT 1 $$ {T}_1 $$ ,T 1 ρ $$ {T}_{1\uprho} $$ , andB 1 $$ {B}_1 $$ 3D mapping.

METHODS

A Look-Locker scheme that alternates magnetization from +Z and -Z axes of the laboratory frame is utilized in combination with a 3D Multi-Band Sweep Imaging with Fourier Transformation (MB-SWIFT) readout. The analytical solution describing the spin evolution during aLL, as well as the correction required for segmented acquisition were derived. The simultaneousB 1 $$ {B}_1 $$ andT 1 $$ {T}_1 $$ mapping are demonstrated on an agar/saline phantom and on an in-vivo rat head.T 1 ρ $$ {T}_{1\uprho} $$ relaxation was achieved by cyclically applying magnetization preparation (MP) modules consisting of two adiabatic pulses.T 1 ρ $$ {T}_{1\uprho} $$ values in the rat brain in-vivo and in a gadobenate dimeglumine (Gd-DTPA) phantom were compared to those obtained with a previously introduced steady-state (SS) method.

RESULTS

The accuracy and precision of the analytical solution was tested by Bloch simulations. With the application of MP modules, the aLL method provides simultaneousT 1 $$ {T}_1 $$ andT 1 ρ $$ {T}_{1\uprho} $$ maps. Conversely, without it, the method can be used for simultaneousT 1 $$ {T}_1 $$ andB 1 $$ {B}_1 $$ mapping.T 1 ρ $$ {T}_{1\uprho} $$ values were similar with both aLL and SS techniques. However, the aLL method resulted in more robust quantitative mapping compared to the SS method. Unlike the SS method, the aLL method does not require additional scans for generatingT 1 $$ {T}_1 $$ maps.

CONCLUSION

The proposed method offers a new flexible tool for quantitative mapping ofT 1 $$ {T}_1 $$ ,T 1 ρ $$ {T}_{1\uprho} $$ , andB 1 $$ {B}_1 $$ . The aLL method can also be used with readout schemes different from MB-SWIFT.

Patellar Dislocation in Adolescent Patients: Influence on Cartilage Properties Based on T1ρ Relaxation Times

BACKGROUND

Adolescents who experience a patellar dislocation have an elevated risk of patellofemoral posttraumatic osteoarthritis. Magnetic resonance imaging (MRI)-based T1ρ relaxation times were measured for adolescents to evaluate patellofemoral cartilage after patellar dislocation. Long T1ρ relaxation times are an indicator of cartilage degradation.

HYPOTHESIS

The primary hypothesis is that patellofemoral cartilage T1ρ relaxation times will be elevated in the acute phase after patellar dislocation. The secondary hypothesis is that T1ρ relaxation times will be higher for knees with multiple rather than single dislocations due to repeated traumatic injury.

STUDY DESIGN

Cross-sectional study; Level of evidence, 3.

METHODS

In total, 23 adolescents being treated for a recent patellar dislocation, 13 for a first-time dislocation (47 ± 38 days since most recent dislocation) and 10 for multiple dislocations (55 ± 24 days since most recent dislocation), and 10 healthy controls participated in MRI-based T1ρ relaxation time mapping. For multiple regions of the patellofemoral joint, mean T1ρ values were compared between the 3 groups with multiple group comparisons and post hoc tests. T1ρ relaxation times were also correlated against measures of patellofemoral anatomy and alignment for single and multiple dislocations. Statistical significance was set at P < .05.

RESULTS

T1ρ relaxation times were significantly longer for injured knees (single and multiple dislocations) than controls at the medial and central patella and central trochlear groove. For the regions on the patella, significant differences between injured and control knees exceeded 15%. No significant differences were identified between single and multiple dislocations. For the initial dislocation group, T1ρ relaxation times within multiple regions of the patellofemoral joint were significantly correlated with lateral patellar alignment or patellar height.

CONCLUSION

Elevated patellofemoral cartilage T1ρ relaxation times are consistent with a high risk of long-term patellofemoral osteoarthritis for adolescents who experience patellar dislocations. T1ρ relaxation times were elevated for multiple regions of patellofemoral cartilage. T1ρ relaxation times were expected to increase with additional dislocation episodes, but relaxation times after single and multiple dislocations were similar. After a first dislocation, parameters related to patellar maltracking were correlated with cartilage degradation.

Quantitative Assessment of Intervertebral Disc Composition by MRI: Sensitivity to Diurnal Variation

Whether diurnal variation exists in quantitative MRI indices such as the T1rho relaxation time (T1ρ) of the intervertebral disc (IVD) is yet to be explored. This prospective study aimed to evaluate the diurnal variation in T1ρ, apparent diffusion coefficient (ADC), and electrical conductivity (σ) of lumbar IVD and its relationship with other MRI or clinical indices. Lumbar spine MRI, including T1ρ imaging, diffusion-weighted imaging (DWI), and electric properties tomography (EPT), was conducted on 17 sedentary workers twice (morning and evening) on the same day. The T1ρ, ADC, and σ of IVD were compared between the time points. Their diurnal variation, if any, was tested for correlation with age, body mass index (BMI), IVD level, Pfirrmann grade, scan interval, and diurnal variation in IVD height index. The results showed a significant decrease in T1ρ and ADC and a significant increase in the σ of IVD in the evening. T1ρ variation had a weak correlation with age and scan interval, and ADC variation with scan interval. Diurnal variation exists for the T1ρ, ADC, and σ of lumbar IVD, which should be accounted for in image interpretation. This variation is thought to be due to diurnal variations in intradiscal water, proteoglycan, and sodium ion concentration.

Insights into the Age Dependency of Compositional MR Biomarkers Quantifying the Health Status of Cartilage in Metacarpophalangeal Joints

(1) Background: We aim to investigate age-related changes in cartilage structure and composition in the metacarpophalangeal (MCP) joints using magnetic resonance (MR) biomarkers. (2) Methods: The cartilage tissue of 90 MCP joints from 30 volunteers without any signs of destruction or inflammation was examined using T1, T2, and T1ρ compositional MR imaging techniques on a 3 Tesla clinical scanner and correlated with age. (3) Results: The T1ρ and T2 relaxation times showed a significant correlation with age (T1ρ: Kendall-τ-b = 0.3, p < 0.001; T2: Kendall-τ-b = 0.2, p = 0.01). No significant correlation was observed for T1 as a function of age (T1: Kendall-τ-b = 0.12, p = 0.13). (4) Conclusions: Our data show an increase in T1ρ and T2 relaxation times with age. We hypothesize that this increase is due to age-related changes in cartilage structure and composition. In future examinations of cartilage using compositional MRI, especially T1ρ and T2 techniques, e.g., in patients with osteoarthritis or rheumatoid arthritis, the age of the patients should be taken into account.

Endogenous assessment of late gadolinium enhancement grey zone in patients with non-ischaemic cardiomyopathy with T1ρ and native T1 mapping

AIMS

This study aims to validate and compare the feasibility of T1ρ and native longitudinal relaxation time (T1) mapping in detection of myocardial fibrosis in patients with non-ischaemic cardiomyopathy, focusing on the performance of both methods in identifying late gadolinium enhancement (LGE) grey zone.

METHODS AND RESULTS

Twenty-seven hypertrophic cardiomyopathy (HCM) patients, 16 idiopathic dilated cardiomyopathy (DCM) patients, and 18 healthy controls were prospectively enrolled for native T1 and T1ρ mapping imaging and then all the patients underwent enhancement scan for LGE extent and extracellular volume (ECV) values. In LGE positive patients, the LGE areas were divided into LGE core (6 SDs above remote myocardium) and grey zone (2-6 SDs above remote myocardium) according to the signal intensity of LGE. Both HCM and DCM patients showed significantly higher native T1 values and T1ρ values than controls no matter the presence of LGE (all P < 0.01). There were significant differences in native T1 and T1ρ values among four different types of myocardia (LGE core, grey zone, remote area and control, P < 0.0001). However, the T1ρ values of grey zone were significantly higher than control (P < 0.01), while the native T1 values were not (P = 0.089). T1ρ values were significantly associated with both native T1 values (r = 0.54, P < 0.001) and ECV values (r = 0.54, P < 0.001).

CONCLUSION

T1ρ mapping is a feasible method to detect myocardial fibrosis in patients with non-ischaemic cardiomyopathy no matter the presence of LGE. Compared with native T1, T1ρ may serve as a better discriminator in the identification of LGE grey zone.

3D magnetic resonance fingerprinting for rapid simultaneous T1, T2, and T1ρ volumetric mapping of human articular cartilage at 3 T

Quantitative MRI can detect early biochemical changes in cartilage; however, the conventional techniques only measure one parameter (e.g., T1 , T2 , and T1ρ ) at a time while also being comparatively slow. We implemented a 3D magnetic resonance fingerprinting (3D-MRF) technique for simultaneous, volumetric mapping of T1 , T2 , and T1ρ in knee articular cartilage in under 9 min. It is evaluated on 11 healthy volunteers (mean age: 53 ± 9 years), five mild knee osteoarthritis (OA) patients (Kellgren-Lawrence (KL) score: 2, mean age: 60 ± 4 years), and the National Institute of Standards and Technology (NIST)/International Society for Magnetic Resonance in Medicine (ISMRM) system phantom. Proton density image, and T1 , T2, T1ρ relaxation times, and B1 + were estimated in the NIST/ISMRM system phantom as well as in the human knee medial and lateral femur, medial and lateral tibia, and patellar cartilage. The repeatability and reproducibility of the proposed technique were assessed in the phantom using analysis of the Bland-Altman plots. The intrasubject repeatability was assessed with the coefficient of variation (CV) and root mean square CV (rmsCV). The Mann-Whitney U test was used to assess the difference between healthy subjects and mild knee OA patients. The Bland-Altman plots in the NIST/ISMRM phantom demonstrated an average difference of 0.001% ± 015%, 1.2% ± 7.1%, and 0.47% ± 3% between two scans from the same 3-T scanner (repeatability), and 0.002% ± 015%, 0.62% ± 10.5%, and 0.97% ± 14% between the scans acquired on two different 3-T scanners (reproducibility) for T1 , T2 , and T1ρ , respectively. The in vivo knee study showed excellent repeatability with rmsCV less than 1%, 2%, and 1% for T1 , T2 , and T1ρ , respectively. T1ρ relaxation time in the mild knee OA patients was significantly higher (p < 0.05) than in healthy subjects. The proposed 3D-MRF sequence is fast, reproducible, robust to B1 + inhomogeneity, and can simultaneously measure the T1 , T2 , T1ρ , and B1 + volumetric maps of the knee joint in a single scan within a clinically feasible scan time.

Efficient phase-cycling strategy for high-resolution 3D gradient-echo quantitative parameter mapping

Magnetization-prepared (MP) gradient-echo (GRE) sequences suffer from signal contaminations from T₁ recovery during the readout train, which can be eliminated by paired RF phase cycling (PC) at the cost of doubling the scan time. The objective of this study was to develop and validate a novel unpaired PC strategy to eliminate the time penalty for high-resolution quantitative parameter mapping in 3D MP-GRE sequences. Based on the observation that the contaminating T₁ recovery signal along the GRE readout train is independent of magnetization preparation, its impact can be eliminated using a novel curve-fitting approach with complex-valued data without needing paired PC acquisitions. Four new unpaired PC schemes were compared with two traditional paired PC schemes in both phantom and in vivo human knee studies at 3 T using a MP angle-modulated partitioned k-space spoiled gradient-echo snapshots (MAPSS) T_1ρ mapping sequence. In the phantom study, all methods resulted in consistent T_1ρ measurements (∆T_1ρ  < 0.5%) at the center slice when B₀ /B₁ values were uniform. Results were not consistent when off-center slices with nonideal B₀ /B₁ were included. Two unpaired PC schemes had comparable or significantly improved quantitative accuracy and scan-rescan reproducibility compared with the paired PC schemes. There was no significant T_1ρ quantitative variability increase or spatial fidelity loss using the new unpaired PC schemes. Unpaired PC schemes also had different T_1ρ spectral responses at different B₀ frequency offsets, which can potentially be exploited to reduce sensitivity to B₀ field inhomogeneities. The human knee study results were consistent with the phantom study findings. In conclusion, an unpaired PC strategy potentially allows more accurate quantitative parameter mapping with halved scan time compared with the paired PC approach to eliminate signal contaminations from T₁ recovery. It therefore offers additional flexibility in SNR optimization, spatial resolution improvement, and choice of imaging sampling points to obtain more accurate quantitative parameter mapping.

Elevated Patellofemoral and Tibiofemoral T1ρ Relaxation Times Following a First Time Patellar Dislocation

OBJECTIVE

The study was performed to evaluate cartilage within the knee following a first-time patellar dislocation, using elevated MRI-based T1ρ relaxation times as an indicator of low proteoglycan concentration. The hypothesis is that MRI-based T1ρ relaxation times for patellofemoral and tibiofemoral cartilage are significantly longer for knees being treated for patellar dislocation than for healthy control knees.

DESIGN

Twenty-one subjects being treated for a first-time, unilateral dislocation of the patella and 16 healthy controls participated in MRI-based T1ρ relaxation time mapping. Mean relaxation times were quantified for patellofemoral and tibiofemoral regions for injured knees, the contralateral knees, and healthy controls. T1ρ values for each region were compared between the 3 groups with generalized estimating equations. Linear regressions were also performed to correlate T1ρ relaxation times with time from injury.

RESULTS

The knees with a disloction had longer T1ρ relaxation times than the contralateral knees and control group at the medial patella and longer relaxation times than the control group at the lateral tibia (P < 0.05). T1ρ relaxation times at the medial patella also decreased with time from injury (r² = 0.21, P = 0.037).

CONCLUSIONS

Compositional changes to cartilage on the medial patella are related to traumatic impact during a dislocation. Potential exists for cartilage properties at the medial patella to improve with time. Cartilage degradation at the lateral tibia is not directly related to traumatic impact. The current baseline data are a starting point to characterize the pathway from a first-time dislocation to progressive cartilage degradation and osteoarthritis.

Characterization and correction of the effects of hepatic iron on T1ρ relaxation in the liver at 3.0T

PURPOSE

Quantitative T_1ρ imaging is an emerging technique to assess the biochemical properties of tissues. In this paper, we report our observation that liver iron content (LIC) affects T_1ρ quantification of the liver at 3.0T field strength and develop a method to correct the effect of LIC.

THEORY AND METHODS

On-resonance R_1ρ (1/T_1ρ ) is mainly affected by the intrinsic R₂ (1/T₂ ), which is influenced by LIC. As on-resonance R_1ρ is closely related to the Carr-Purcell-Meiboom-Gill (CPMG) R₂ , and because the calibration between CPMG R₂ and LIC has been reported at 1.5T, a correction method was proposed to correct the R₂ contribution to the R_1ρ . The correction coefficient was obtained from the calibration results and related transformed factors. To compensate for the difference between CPMG R₂ and R_1ρ , a scaling factor was determined using the values of CPMG R₂ and R_1ρ , obtained simultaneously from a single breath-hold from volunteers. The livers of 110 subjects were scanned to validate the correction method.

RESULTS

LIC was significantly correlated with R_1ρ in the liver. However, when the proposed correction method was applied to R_1ρ , LIC and the iron-corrected R_1ρ were not significantly correlated.

CONCLUSION

LIC can affect T_1ρ in the liver. We developed an iron-correction method for the quantification of T_1ρ in the liver at 3.0T.

Quantification correction for free-breathing myocardial T1ρ mapping in mice using a recursively derived description of a T1ρ* relaxation pathway

BACKGROUND

Fast and accurate T1ρ mapping in myocardium is still a major challenge, particularly in small animal models. The complex sequence design owing to electrocardiogram and respiratory gating leads to quantification errors in in vivo experiments, due to variations of the T1ρ relaxation pathway. In this study, we present an improved quantification method for T1ρ using a newly derived formalism of a T1ρ* relaxation pathway.

METHODS

The new signal equation was derived by solving a recursion problem for spin-lock prepared fast gradient echo readouts. Based on Bloch simulations, we compared quantification errors using the common monoexponential model and our corrected model. The method was validated in phantom experiments and tested in vivo for myocardial T1ρ mapping in mice. Here, the impact of the breath dependent spin recovery time Trec on the quantification results was examined in detail.

RESULTS

Simulations indicate that a correction is necessary, since systematically underestimated values are measured under in vivo conditions. In the phantom study, the mean quantification error could be reduced from - 7.4% to - 0.97%. In vivo, a correlation of uncorrected T1ρ with the respiratory cycle was observed. Using the newly derived correction method, this correlation was significantly reduced from r = 0.708 (p < 0.001) to r = 0.204 and the standard deviation of left ventricular T1ρ values in different animals was reduced by at least 39%.

CONCLUSION

The suggested quantification formalism enables fast and precise myocardial T1ρ quantification for small animals during free breathing and can improve the comparability of study results. Our new technique offers a reasonable tool for assessing myocardial diseases, since pathologies that cause a change in heart or breathing rates do not lead to systematic misinterpretations. Besides, the derived signal equation can be used for sequence optimization or for subsequent correction of prior study results.

Simultaneous bilateral T1 , T2 , and T1ρ relaxation mapping of the hip joint with magnetic resonance fingerprinting

Quantitative MRI can detect early biochemical changes in cartilage, but its bilateral use in clinical routines is challenging. The aim of this prospective study was to demonstrate the feasibility of magnetic resonance fingerprinting for bilateral simultaneous T₁ , T₂ , and T_1ρ mapping of the hip joint. The study population consisted of six healthy volunteers with no known trauma or pain in the hip. Monoexponential T₁ , T₂ , and T_1ρ relaxation components were assessed in femoral lateral, superolateral, and superomedial, and inferior, as well as acetabular, superolateral, and superomedial subregions in left and right hip cartilage. Aligned ranked nonparametric factorial analysis was used to assess the side's impact on the subregions. Kruskal-Wallis and Wilcoxon tests were used to compare subregions, and coefficient of variation to assess repeatability. Global averages of T₁ (676.0 ± 45.4 and 687.6 ± 44.5 ms), T₂ (22.5 ± 2.6 and 22.1 ± 2.5 ms), and T_1ρ (38.2 ± 5.5 and 38.2 ± 5.5 ms) were measured in the left and right hip, and articular cartilage, respectively. The Kruskal-Wallis test showed a significant difference between different subregions' relaxation times regardless of the hip side (p < 0.001 for T₁ , p = 0.012 for T₂ , and p < 0.001 for T_1ρ ). The Wilcoxon test showed that T₁ of femoral layers was significantly (p < 0.003) higher than that for acetabular cartilage. The experiments showed excellent repeatability with CV_rms of 1%, 2%, and 4% for T₁ , T₂ , and T_1ρ, respectively. It was concluded that bilateral T₁ , T₂ , and T_1ρ relaxation times, as well as B₁⁺ maps, can be acquired simultaneously from hip joints using the proposed MRF sequence.

Distinct patterns of altered quantitative T1ρ and functional BOLD response associated with history of suicide attempts in bipolar disorder

Despite the high risk for suicide, relatively few studies have explored the relationship between suicide and brain imaging measures in bipolar disorder. In addition, fewer studies have explored the possibility that altered brain metabolism may be associated with suicide attempt. To begin to fill in these gaps, we evaluated functional (task based fMRI) and metabolic (quantitative T1ρ) differences associated with suicide attempt in participants with bipolar disorder. Thirty-nine participants with bipolar disorder underwent fMRI during a flashing checkerboard task and 27 also underwent quantitative T1ρ. The relationship between neuroimaging and history of suicide attempt was tested using multiple regression while adjusting for age, sex, and current mood state. Differences between two measures of suicide attempt (binary: yes/no and continuous: number of attempts) were quantified using the corrected Akaike Information Criterion. Participants who had attempted suicide had greater fMRI task-related activation in visual areas and the cerebellum. The number of suicide attempts was associated with a difference in BOLD response in the amygdala, prefrontal cortex, and cerebellum. Increased quantitative T1ρ was associated with number of suicide attempts in limbic, basal ganglia, and prefrontal cortex regions. This study is a secondary analysis with a modest sample size. Differences between measures of suicide history may be due to differences in statistical power. History of suicide was associated with limbic, prefrontal, and cerebellar alterations. Results comparing those with and without suicide attempts differed from results using number of suicide attempts, suggesting that these variables have different neurobiological underpinnings.

Assessment of Calf Skeletal Muscle in Male Type 2 Diabetes Mellitus Patients With Different Courses Using T1ρ Mapping

CONTEXT

The current clinical methods for detecting skeletal muscle complications of type 2 diabetes mellitus (T2DM) are invasive and insensitive. There is an urgent need for noninvasive assessment of skeletal muscle microstructure changes during the disease progression and treatment to assist the clinical management.

OBJECTIVE

This work aimed to investigate the T2DM caused changes in the fast-twitch tibialis anterior (TA) and slow-twitch soleus (SOL) skeletal muscles using T1ρ magnetic resonance imaging (MRI).

METHODS

This cross-sectional study took place from December 2014 to December 2020 at Zhongda Hospital Southeast University. A total of 26 new-onset and 15 long-term T2DM patients were enrolled, with the addition of 20 young and 13 older healthy volunteers as age-matched controls. T1ρ relaxation times of SOL and TA muscles in different groups were measured. Parametric and nonparametric tests were used to analyze the relationship between the T1ρ values in SOL and TA muscles and the length of illness, level of fasting blood glucose, and status of homeostasis model assessment of insulin resistance (HOMA-IR).

RESULTS

T1ρ relaxation times of SOL and TA muscles both of new-onset and long-term T2DM patients were significantly higher than those of the young (P < .01, P < .05) and older healthy controls (P < .05, P < .01). Positive correlations were observed between the T1ρ relaxation times of the TA or SOL and the duration of T2DM (R2 = 0.420, R2 = 0.326), the level of fasting blood glucose (R2 = 0.253, R2 = 0.071) and HOMA-IR (R2 = 0.232, R2 = 0.414).

CONCLUSION

Quantitative MRI measurement of T1ρ provides a noninvasive tool to assess T2DM-induced changes in the skeletal muscles of T2DM patients.

Loading during Midstance of Gait Is Associated with Magnetic Resonance Imaging of Cartilage Composition Following Anterior Cruciate Ligament Reconstruction

OBJECTIVE

A complex association exists between aberrant gait biomechanics and posttraumatic knee osteoarthritis (PTOA) development. Previous research has primarily focused on the link between peak loading during the loading phase of stance and joint tissue changes following anterior cruciate ligament reconstruction (ACLR). However, the associations between loading and cartilage composition at other portions of stance, including midstance and late stance, is unclear. The objective of this study was to explore associations between vertical ground reaction force (vGRF) at each 1% increment of stance phase and tibiofemoral articular cartilage magnetic resonance imaging (MRI) T1ρ relaxation times following ACLR.

DESIGN

Twenty-three individuals (47.82% female, 22.1 ±4.1 years old) with unilateral ACLR participated in a gait assessment and T1ρ MRI collection at 12.25 ± 0.61 months post-ACLR. T1ρ relaxation times were calculated for the articular cartilage of the weightbearing medial and lateral femoral (MFC, LFC) and tibial (MTC, LTC) condyles. Separate bivariate, Pearson product moment correlation coefficients (r) were used to estimate strength of associations between T1ρ MRI relaxation times in the medial and lateral tibiofemoral articular cartilage with vGRF across the entire stance phase.

RESULTS

Greater vGRF during midstance (46%-56% of stance phase) was associated with greater T1ρ MRI relaxation times in the MFC (r ranging between 0.43 and 0.46).

CONCLUSIONS

Biomechanical gait profiles that include greater vGRF during midstance are associated with MRI estimates of lesser proteoglycan density in the MFC. Inability to unload the ACLR limb during midstance may be linked to joint tissue changes associated with PTOA development.

Diagnostic potential of T1ρ and T2 relaxations in assessing the severity of liver fibrosis and necro-inflammation

PURPOSE

To investigate the utility of T1ρ and T2 relaxations for assessing the severity of liver fibrosis (F stage) and necro-inflammation (A stage) in patients with chronic liver disease (CLD).

MATERIALS AND METHODS

We calculated T1ρ and T2 relaxations of the liver parenchyma in 82 patients who underwent liver surgery. F and A stages of enrolled patients were assessed by referring to surgically resected specimens. The relationships between T1ρ or T2 relaxation and F or A stage were assessed using one-way analysis of variance followed by Tukey's multiple comparison test, Spearman's rank correlation test and a receiver operating characteristic analysis.

RESULTS

The T1ρ and T2 values of the liver parenchyma were significantly increased as the F and A stages progressed. The T1ρ and T2 values showed significant differences between F0 and F4, between F1 and F4, and between F2 and F4. In addition, T1ρ values showed a significant difference between F0 and F3 as well. The highest diagnostic ability for fibrosis was obtained when differentiating ≥F3 from ≤F2 using T1ρ: the sensitivity was 82.8%, the specificity 79.2% and the area under the curve (AUC) 0.87. The sensitivity and AUC of T1ρ relaxation (46.9% and 0.67) were significantly higher than those of T2 relaxation (29.7% and 0.60) for differentiating ≥A1 from A0.

CONCLUSION

T1ρ and T2 relaxations have potential as a biochemical marker for assessing the severity of liver fibrosis and necro-inflammation. T1ρ relaxation may be slightly superior to T2 relaxation in terms of diagnostic ability for liver fibrosis and necro-inflammation.

Automatic hip abductor muscle fat fraction estimation and association with early OA cartilage degeneration biomarkers

The aim of this study was to develop an automatic segmentation method for hip abductor muscles and find their fat fraction associations with early stage hip osteoarthritis (OA) cartilage degeneration biomarkers. This Institutional Review Board approved, Health Insurance Portability and Accountability Act compliant prospective study recruited 61 patients with evidence of hip OA or Femoroacetabular Impingement (FAI). Magnetic resonance (MR) images were acquired for cartilage segmentation, T_1ρ and T₂ relaxation times computation and grading of cartilage lesion scores. A 3D V-Net (Dice loss, Adam optimizer, learning rate = 1e^-4 , batch size = 3) was trained to segment the three muscles (gluteus medius, gluteus minimus, and tensor fascia latae). The V-Net performance was measured using Dice, distance maps between manual and automatic masks, and Bland-Altman plots of the fat fractions and volumes. Associations between muscle fat fraction and T_1ρ , T₂ relaxation times values were found using voxel based relaxometry (VBR). A p < 0.05 was considered significant. The V-Net had a Dice of 0.90, 0.88, and 0.91 (GMed, GMin, and TFL). The VBR results found associations of fat fraction of all three muscles in early stage OA and FAI patients with T_1ρ , T₂ relaxation times. Using an automatic, validated segmentation model, the associations derived between OA biomarkers and muscle fat fractions provide insight into early changes that occur in OA, and show that hip abductor muscle fat is associated with markers of cartilage degeneration.

Endogenous T1ρ cardiovascular magnetic resonance in hypertrophic cardiomyopathy

BACKGROUND

Hypertrophic cardiomyopathy (HCM) is characterized by increased left ventricular wall thickness, cardiomyocyte hypertrophy, and fibrosis. Adverse cardiac risk characterization has been performed using late gadolinium enhancement (LGE), native T1, and extracellular volume (ECV). Relaxation time constants are affected by background field inhomogeneity. T1ρ utilizes a spin-lock pulse to decrease the effect of unwanted relaxation. The objective of this study was to study T1ρ as compared to T1, ECV, and LGE in HCM patients.

METHODS

HCM patients were recruited as part of the Novel Markers of Prognosis in Hypertrophic Cardiomyopathy study, and healthy controls were matched for comparison. In addition to cardiac functional imaging, subjects underwent T1 and T1ρ cardiovascular magnetic resonance imaging at short-axis positions at 1.5T. Subjects received gadolinium and underwent LGE imaging 15-20 min after injection covering the entire heart. Corresponding basal and mid short axis LGE slices were selected for comparison with T1 and T1ρ. Full-width half-maximum thresholding was used to determine the percent enhancement area in each LGE-positive slice by LGE, T1, and T1ρ. Two clinicians independently reviewed LGE images for presence or absence of enhancement. If in agreement, the image was labeled positive (LGE + +) or negative (LGE --); otherwise, the image was labeled equivocal (LGE + -).

RESULTS

In 40 HCM patients and 10 controls, T1 percent enhancement area (Spearman's rho = 0.61, p < 1e-5) and T1ρ percent enhancement area (Spearman's rho = 0.48, p < 0.001e-3) correlated with LGE percent enhancement area. T1 and T1ρ percent enhancement areas were also correlated (Spearman's rho = 0.28, p = 0.047). For both T1 and T1ρ, HCM patients demonstrated significantly longer relaxation times compared to controls in each LGE category (p < 0.001 for all). HCM patients also showed significantly higher ECV compared to controls in each LGE category (p < 0.01 for all), and LGE -- slices had lower ECV than LGE + + (p = 0.01).

CONCLUSIONS

Hyperenhancement areas as measured by T1ρ and LGE are moderately correlated. T1, T1ρ, and ECV were elevated in HCM patients compared to controls, irrespective of the presence of LGE. These findings warrant additional studies to investigate the prognostic utility of T1ρ imaging in the evaluation of HCM patients.

Staging Liver Fibrosis: Comparison of Native T1 Mapping, T2 Mapping, and T1ρ: An Experimental Study in Rats With Bile Duct Ligation and Carbon Tetrachloride at 11.7 T MRI

BACKGROUND

T1, T2, and T1ρ might be potential biomarkers for assessing liver fibrosis. However, few studies reported the value of them in different animal models.

PURPOSE

To investigate and compare the performances of T1, T2, and T1ρ for noninvasively staging liver fibrosis in bile duct ligation (BDL) or carbon tetrachloride (CCl₄ ) model.

STUDY TYPE

Prospective animal model.

SUBJECTS

Liver fibrosis was induced by BDL or injection of CCl₄ in 120 rats.

FIELD STRENGTH/SEQUENCE

11.7 T, T1 mapping with 10 repetition times, T2 mapping with 32 echo times, and T1ρ with 10 spin-lock times.

ASSESSMENT

T1, T2, and T1ρ were measured and correlated with liver fibrosis stages, as well as the degree of inflammation, steatosis, iron deposition, and the expression of cytokeratin 19. The discriminative performance of T1, T2, and T1ρ for staging liver fibrosis was compared.

STATISTICAL TESTS

One-way analysis of variance (ANOVA), Spearman's correlation analysis, factorial design ANOVA, and receiver operating characteristic curves (P < 0.05 was considered statistically significant).

RESULTS

T1, T2, and T1ρ (BDL: rho = 0.73, 0.85, 0.68; CCl₄ : rho = 0.80, 0.29, 0.61) were significantly correlated with liver fibrosis stages, while there was no significant difference in T2 among stage F0-F4 in the CCl₄ model (P = 0.204). The area under the curves (AUCs) range of T1, T2, and T1ρ for predicting ≥F1, ≥F2, ≥F3, and F4 were 0.76-0.95, 0.89-0.98, and 0.80-0.94 in the CCl₄ model. For the CCl₄ model, the AUCs range of T1, T2, and T1ρ for predicting ≥F1, ≥F2, ≥F3, and F4 were 0.83-0.95, 0.61-0.74, and 0.73-0.89, respectively. T2 had significantly higher AUC in the BDL model than CCl₄ model for diagnosing liver fibrosis.

DATA CONCLUSION

The most sensitive and accurate method for staging liver fibrosis appeared to be T1 in our animal models followed by T1ρ. T2 may not be suitable for evaluating liver fibrosis.

LEVEL OF EVIDENCE

1 TECHNICAL EFFICACY STAGE: 2.

No pressure, no diamonds? - Static vs. dynamic compressive in-situ loading to evaluate human articular cartilage functionality by functional MRI

Biomechanical Magnetic Resonance Imaging (MRI) of articular cartilage, i.e. its imaging under loading, is a promising diagnostic tool to assess the tissue's functionality in health and disease. This study aimed to assess the response to static and dynamic loading of histologically intact cartilage samples by functional MRI and pressure-controlled in-situ loading. To this end, 47 cartilage samples were obtained from the medial femoral condyles of total knee arthroplasties (from 24 patients), prepared to standard thickness, and placed in a standard knee joint in a pressure-controlled whole knee-joint compressive loading device. Cartilage samples' responses to static (i.e. constant), dynamic (i.e. alternating), and no loading, i.e. free-swelling conditions, were assessed before (δ₀), and after 30 min (δ₁) and 60 min (δ₂) of loading using serial T1ρ maps acquired on a 3.0T clinical MRI scanner (Achieva, Philips). Alongside texture features, relative changes in T1ρ (Δ₁, Δ₂) were determined for the upper and lower sample halves and the entire sample, analyzed using appropriate statistical tests, and referenced to histological (Mankin scoring) and biomechanical reference measures (tangent stiffness). Histological, biomechanical, and T1ρ sample characteristics at δ₀ were relatively homogenous in all samples. In response to loading, relative increases in T1ρ were strong and significant after dynamic loading (Δ₁ = 10.3 ± 17.0%, Δ₂ = 21.6 ± 21.8%, p = 0.002), while relative increases in T1ρ after static loading and in controls were moderate and not significant. Generally, texture features did not demonstrate clear loading-related associations underlying the spatial relationships of T1ρ. When realizing the clinical translation, this in-situ study suggests that serial T1ρ mapping is best combined with dynamic loading to assess cartilage functionality in humans based on advanced MRI techniques.

Simultaneous T1 , T2 , and T1ρ relaxation mapping of the lower leg muscle with MR fingerprinting

PURPOSE

To develop a novel MR-fingerprinting (MRF) pulse sequence that is insensitive to B 1 + and B₀ imperfections for simultaneous T₁ , T₂ , and T_1ρ relaxation mapping.

METHODS

We implemented a totally balanced spin-lock (TB-SL) module to encode T_1ρ relaxation into an existing MRF framework that encoded T₁ and T₂ . The spin-lock module used two 180° pulses with compensatory phases to reduce T_1ρ sensitivity to B₁ and B₀ inhomogeneities. We compared T_1ρ measured using TB-SL MRF in Bloch simulations, model agar phantoms, and in vivo experiments to those with a self-compensated spin-lock preparation module (SC-SL). The TB-SL MRF repeatability was evaluated in maps acquired in the lower leg skeletal muscle of 12 diabetic peripheral neuropathy patients, scanned two times each during visits separated by about 30 days.

RESULTS

The phantom relaxation times measured with TB-SL and SC-SL MRF were in good agreement with reference values in regions with low B₁ inhomogeneities. Compared with SC-SL, TB-SL MRF showed in experiments greater robustness against severe B₁ inhomogeneities and in Bloch simulations greater robustness against B₁ and B₀ . We measured with TB-SL MRF an average T₁ = 950.1 ± 28.7 ms, T₂ = 26.0 ± 1.2 ms, and T_1ρ = 31.7 ± 3.2 ms in skeletal muscle across patients. Bland-Altman analysis demonstrated low bias between TB-SL and SC-SL MRF and between TB-SL MRF maps acquired in two visits. The coefficient of variation was less than 3% for all measurements.

CONCLUSION

The proposed TB-SL MRF sequence is fast and insensitive to B 1 + and B₀ imperfections. It can simultaneously map T₁ , T₂ , T_1ρ , and B 1 + in a single scan and can potentially be used to study muscle composition.

Balanced spin-lock preparation for B1 -insensitive and B0 -insensitive quantification of the rotating frame relaxation time T1ρ

PURPOSE

Accurate and artifact-free T_1ρ quantification is still a major challenge due to a susceptibility of the spin-locking module to B₀ and/or B₁ field inhomogeneities. In this study, we present a novel spin-lock preparation module (B-SL) that enables an almost full compensation of both types of inhomogeneities.

METHODS

The new B-SL module contains a second 180° refocusing pulse to compensate each pulse in the preparation block by a corresponding pulse with opposite phase. For evaluation and validation of B-SL, extensive simulations as well as phantom measurements were performed. Furthermore, the new module was compared to three common established compensation methods.

RESULTS

Both simulations and measurements demonstrate a much lower susceptibility to artifacts for the B-SL module, therefore providing an improved accuracy in T_1ρ quantification. In the presence of field inhomogeneities, measurements revealed an increased banding compensation by 79% compared with the frequently used composite module. The goodness of the mono-exponential T_1ρ fitting procedure was improved by 58%.

CONCLUSION

The B-SL preparation enables the generation of accurate relaxation maps with significantly reduced artifacts, even in the case of large field imperfections. Therefore, the B-SL module is suggested to be highly beneficial for in vivo T_1ρ quantification.

Evaluation of Chronic Pancreatitis With T1 ρ MRI: A Preliminary Study

BACKGROUND

Chronic pancreatitis (CP) can result in persistent damage to the endocrine and exocrine tissues of the pancreas. There is an unmet need for quantitative methods to evaluate CP noninvasively.

PURPOSE

To investigate the utility of T₁ ρ magnetic resonance imaging (MRI) for the assessment of CP.

STUDY TYPE

Prospective.

POPULATION

Twenty patients with CP and 24 healthy volunteers.

FIELD STRENGTH/SEQUENCE

3T MRI including T₁ ρ sequence (spin lock time = 0, 1, 10, 20, 40, 60 msec).

ASSESSMENT

Pancreatic T₁ ρ values and anterior-posterior (AP) diameters in the head, body, and tail were measured in all participants. Regions of interest with circle (ROI_circle ) and free-hand (ROI_FH ) were drawn for T₁ ρ value measurements.

STATISTICAL TESTS

Mann-Whitney U-test; Wilcoxon Signed Ranks test; receiver operating characteristic (ROC) curve; and Bland-Altman analysis.

RESULTS

The T₁ ρ values of pancreatic tail and the mean T₁ ρ values for ROI_circle and the T₁ ρ values of pancreatic tail for ROI_FH in patients with CP were significantly higher than those in healthy volunteers (all P < 0.05). Pancreatic head AP diameter significantly increased, while pancreatic tail AP diameter significantly decreased in patients with CP compared with healthy volunteers (both P < 0.05). The areas under the ROC curves (AUCs) of pancreatic tail T₁ ρ values with ROI_circle and tail AP diameter in diagnosing CP were 0.744 and 0.798, respectively. A combination of pancreatic tail T₁ ρ values with ROI_circle and tail AP diameter achieved good performance for diagnosing CP (AUC = 0.838).

DATA CONCLUSION

T₁ ρ MRI might be a potential technique for the noninvasive evaluation of CP. Level of Evidence 2 Technical Efficacy Stage 2 J. MAGN. RESON. IMAGING 2021;53:577-584.

T1ρ-Mapping for Musculoskeletal Pain Diagnosis: Case Series of Variation of Water Bound Glycosaminoglycans Quantification before and after Fascial Manipulation® in Subjects with Elbow Pain

Diagnosis and management of musculoskeletal pain is a major clinical challenge. Following this need, the first aim of our study was to provide an innovative magnetic resonance technique called T_1ρ to quantify possible alterations in elbow pain, a common musculoskeletal pain syndrome that has not a clear etiology. Five patients were recruited presenting chronic elbow pain (>3 months), with an age between 30 and 70 years old. Patients underwent two T_1ρ-mapping evaluations, one before and one after the series of Fascial Manipulation^® (FM) treatments. After the first MRI evaluation, a Disability of the Arm, Shoulder and Hand (DASH) questionnaire was administered to quantify the symptoms and pain intensity. Patients then received three sessions of FM, once a week for 40 min each. A statistically significant difference was found between bound and unbound water concentration before and after FM treatment. Our preliminary data suggest that the application of the manual method seems to decrease the concentration of unbound water inside the deep fascia in the most chronic patients. This could explain the change in viscosity perceived by many practitioners as well as the decrease of symptoms due to the restoration of the normal property of the loose connective tissue. Being able to identify an altered deep fascial area may better guide therapies, contributing to a more nuanced view of the mechanisms of pain.

T(1ρ)-mapping for assessing knee joint cartilage in children with juvenile idiopathic arthritis - feasibility and repeatability

BACKGROUND

Ongoing arthritis in children with juvenile idiopathic arthritis (JIA) can result in cartilage damage.

OBJECTIVE

To study the feasibility and repeatability of T_1ρ for assessing knee cartilage in JIA and also to describe T_1ρ values and study correlation between T_1ρ and conventional MRI scores for disease activity.

MATERIALS AND METHODS

Thirteen children with JIA or suspected JIA underwent 3-tesla (T) knee MRI that included conventional sequences and a T_1ρ sequence. Segmentation of knee cartilage was carried out on T_1ρ images. We used intraclass correlation coefficient to study the repeatability of segmentation in a subset of five children. We used the juvenile arthritis MRI scoring system to discriminate inflamed from non-inflamed knees. The Mann-Whitney U and Spearman correlation compared T_1ρ between children with and without arthritis on MRI and correlated T_1ρ with the juvenile arthritis MRI score.

RESULTS

All children successfully completed the MRI examination. No images were excluded because of poor quality. Repeatability of T_1ρ measurement had an intraclass correlation coefficient (ICC) of 0.99 (P<0.001). We observed no structural cartilage damage and found no differences in T_1ρ between children with (n=7) and without (n=6) inflamed knees (37.8 ms vs. 31.7 ms, P=0.20). However, we observed a moderate correlation between T_1ρ values and the juvenile arthritis MRI synovitis score (r=0.59, P=0.04).

CONCLUSION

This pilot study suggests that T_1ρ is a feasible and repeatable quantitative imaging technique in children. T_1ρ values were associated with the juvenile arthritis MRI synovitis score.

Human articular cartilage mechanosensitivity is related to histological degeneration - a functional MRI study

OBJECTIVE

To investigate changes in response to sequential pressure-controlled loading and unloading in human articular cartilage of variable histological degeneration using serial T1ρ mapping.

METHOD

We obtained 42 cartilage samples of variable degeneration from the medial femoral condyles of 42 patients undergoing total knee replacement. Samples were placed in a standardized artificial knee joint within an MRI-compatible whole knee-joint compressive loading device and imaged before (δ₀), during (δ_ld1, δ_ld2, δ_ld3, δ_ld4, δ_ld5) and after (δ_rl1, δ_rl2, δ_rl3, δ_rl4, δ_rl5) pressure-controlled loading to 0.663 ± 0.021 kN (94% body weight) using serial T1ρ mapping (spin-lock multigradient echo sequence; 3.0T MRI system [Achieva, Philips]). Reference assessment included histology (Mankin scoring) and conventional biomechanics (Tangent stiffness). We dichotomized sample into intact (n = 21) and degenerative (n = 21) based on histology and analyzed data using Mann Whitney, Kruskal Wallis, one-way ANOVA tests and Spearman's correlation, respectively.

RESULTS

At δ₀, we found no significant differences between intact and degenerative samples, while the response-to-loading patterns were distinctly different. In intact samples, T1ρ increases were consistent and non-significant, while in degenerative samples, T1ρ increases were significantly higher (P = 0.004, δ0 vs δld1, δ0 vs δld3), yet undulating and variable. With unloading, T1ρ increases subsided, yet were persistently elevated beyond δ0.

CONCLUSION

Cartilage mechanosensitivity is related to histological degeneration and assessable by serial T1ρ mapping. Unloaded, T1ρ characteristics are not significantly different in intact vs degenerative cartilage, while load bearing is organized in intact cartilage and disorganized in degenerative cartilage.

Quantitative magnetic resonance imaging and histological hoof wall assessment of 3-year-old Quarter Horses

BACKGROUND

Few noninvasive methods are available for equine hoof wall evaluation. The highly organised wall structures and composition of proteoglycans and collagens may make this region amenable to quantitative MRI (qMRI) techniques of T1ρ and T2 mapping to identify pathology related to proteoglycan content and collagen organisation respectively.

OBJECTIVE

To establish normative T1ρ and T2 values of the equine hoof wall of 3-year-old Quarter Horses with histological comparison.

STUDY DESIGN

Cadaveric anatomical study.

METHODS

Six cadaveric left thoracic feet from 3-year-old racing Quarter Horses with no reported lameness were evaluated using T1ρ and T2 mapping. Mapping was performed at six regions of interest at the toe of each hoof including proximal and distal regions of the inner epidermis, stratum lamellatum and corium. Histology was evaluated for standard hoof morphology and proteoglycan staining.

RESULTS

T2 values of the stratum lamellatum and corium were similar (42.9 [95% CI: 41.6-44.2] ms and 44 [95% CI: 42.7-45.3] ms respectively), but both were significantly different to the inner epidermis (35.8 [95% CI: 34.5-37.1] ms, P<0.001). T1ρ values for the inner epidermis, stratum lamellatum and corium were significantly different (25.1 [95% CI: 23.1-27.1] ms, 44.4 [95% CI: 42.4-46.4] ms and 50.1 [95% CI: 48.1-52.1] ms, respectively, P<0.001). Histology demonstrated normal organised morphology. Proteoglycan staining was only visible in the stratum lamellatum and corium.

MAIN LIMITATIONS

Cadaveric study with frozen samples used.

CONCLUSIONS

Variation of qMRI metrics through the depth of the equine hoof wall was found. Although the highly ordered environment of collagen may contribute to T2 values, there was lack of evidence to support proteoglycan content as a major contributor of T1ρ values. It is possible T1ρ values had a greater dependence on total water content as the lowest values were seen in the epidermis. Additional research using qMRI is needed to determine mapping values in different disease states.

Probing chemical exchange using quantitative spin-lock R1ρ asymmetry imaging with adiabatic RF pulses

PURPOSE

CEST is commonly used to probe the effects of chemical exchange. Although R_1ρ asymmetry quantification has also been described as a promising option for detecting the effects of chemical exchanges, the existing acquisition approaches are highly susceptible to B₁ RF and B₀ field inhomogeneities. To address this problem, we report a new R_1ρ asymmetry imaging approach, AC-iTIP, which is based on the previously reported techniques of irradiation with toggling inversion preparation (iTIP) and adiabatic continuous wave constant amplitude spin-lock RF pulses (ACCSL). We also derived the optimal spin-lock RF pulse B₁ amplitude that yielded the greatest R_1ρ asymmetry.

METHODS

Bloch-McConnell simulations were used to verify the analytical formula derived for the optimal spin-lock RF pulse B₁ amplitude. The performance of the AC-iTIP approach was compared to that of the iTIP approach based on hard RF pulses and the R_1ρ -spectrum acquired using adiabatic RF pulses with the conventional fitting method. Comparisons were performed using Bloch-McConnell simulations, phantom, and in vivo experiments at 3.0T.

RESULTS

The analytical prediction of the optimal B₁ was validated. Compared to the other 2 approaches, the AC-iTIP approach was more robust under the influences of B₁ RF and B₀ field inhomogeneities. A linear relationship was observed between the measured R_1ρ asymmetry and the metabolite concentration.

CONCLUSION

The AC-iTIP approach could probe the chemical exchange effect more robustly than the existing R_1ρ asymmetry acquisition approaches. Therefore, AC-iTIP is a promising technique for metabolite imaging based on the chemical exchange effect.

Accelerated free-breathing 3D T1ρ cardiovascular magnetic resonance using multicoil compressed sensing

BACKGROUND

Endogenous contrast T1ρ cardiovascular magnetic resonance (CMR) can detect scar or infiltrative fibrosis in patients with ischemic or non-ischemic cardiomyopathy. Existing 2D T1ρ techniques have limited spatial coverage or require multiple breath-holds. The purpose of this project was to develop an accelerated, free-breathing 3D T1ρ mapping sequence with whole left ventricle coverage using a multicoil, compressed sensing (CS) reconstruction technique for rapid reconstruction of undersampled k-space data.

METHODS

We developed a cardiac- and respiratory-gated, free-breathing 3D T1ρ sequence and acquired data using a variable-density k-space sampling pattern (A = 3). The effect of the transient magnetization trajectory, incomplete recovery of magnetization between T1ρ-preparations (heart rate dependence), and k-space sampling pattern on T1ρ relaxation time error and edge blurring was analyzed using Bloch simulations for normal and chronically infarcted myocardium. Sequence accuracy and repeatability was evaluated using MnCl2 phantoms with different T1ρ relaxation times and compared to 2D measurements. We further assessed accuracy and repeatability in healthy subjects and compared these results to 2D breath-held measurements.

RESULTS

The error in T1ρ due to incomplete recovery of magnetization between T1ρ-preparations was T1ρhealthy = 6.1% and T1ρinfarct = 10.8% at 60 bpm and T1ρhealthy = 13.2% and T1ρinfarct = 19.6% at 90 bpm. At a heart rate of 60 bpm, error from the combined effects of readout-dependent magnetization transients, k-space undersampling and reordering was T1ρhealthy = 12.6% and T1ρinfarct = 5.8%. CS reconstructions had improved edge sharpness (blur metric = 0.15) compared to inverse Fourier transform reconstructions (blur metric = 0.48). There was strong agreement between the mean T1ρ estimated from the 2D and accelerated 3D data (R2 = 0.99; P < 0.05) acquired on the MnCl2 phantoms. The mean R1ρ estimated from the accelerated 3D sequence was highly correlated with MnCl2 concentration (R2 = 0.99; P < 0.05). 3D T1ρ acquisitions were successful in all human subjects. There was no significant bias between undersampled 3D T1ρ and breath-held 2D T1ρ (mean bias = 0.87) and the measurements had good repeatability (COV2D = 6.4% and COV3D = 7.1%).

CONCLUSIONS

This is the first report of an accelerated, free-breathing 3D T1ρ mapping of the left ventricle. This technique may improve non-contrast myocardial tissue characterization in patients with heart disease in a scan time appropriate for patients.

Quantitative measurement of T2, T1ρ and T1 relaxation times in articular cartilage and cartilage-bone interface by SE and UTE imaging at microscopic resolution

Both spin-echo (SE) and ultra-short echo (UTE) based MRI sequences were used on a 7 T µMRI system to quantify T2, T1ρ and T1 relaxation times from articular cartilage to the cartilage-bone interface on canine humeral specimens at 19.5 µm pixel resolution. A series of five relaxation-weighted images were acquired to calculate one relaxation map (T2, T1ρ or T1), from which the depth-dependent profiles were examined between the SE method and the UTE method, over the entire non-calcified cartilage and within the cartilage-bone interface. SE-based methods enabled the quantification of relaxation profiles over the noncalcified cartilage, from 0 µm (articular surface) to approximately 460 µm in depth (near the end of radial zone). Most of the cartilage-bone interface was imaged by the UTE-based methods, to a tissue depth of about 810 µm. Pixel-by-pixel calculation of the relaxation times between the independent SE and UTE methods correlated well with each other. A better understanding of the tissue properties reliably over the cartilage-bone interface region by a non-invasive MRI approach could contribute to the clinical diagnostics of trauma-induced osteoarthritis.

On-resonance and off-resonance continuous wave constant amplitude spin-lock and T1ρ quantification in the presence of B1 and B0 inhomogeneities

Spin-lock MRI is a valuable diagnostic imaging technology, as it can be used to probe the macromolecule environment of tissues. Quantitative T_1ρ imaging is one application of spin-lock MRI that is reported to be promising for a number of clinical applications. Spin-lock is often performed with a continuous RF wave at a constant RF amplitude either on resonance or off resonance. However, both on- and off-resonance spin-lock approaches are susceptible to B₁ and B₀ inhomogeneities, which results in image artifacts and quantification errors. In this work, we report a continuous wave constant amplitude spin-lock approach that can achieve negligible image artifacts in the presence of B₁ and B₀ inhomogeneities for both on- and off-resonance spin-lock. Under the adiabatic condition, by setting the maximum B₁ amplitude of the adiabatic pulses equal to the B₁ amplitude of spin-lock RF pulse, the spins are ensured to align along the effective field throughout the spin-lock process. We show that this results in simultaneous compensation of B₁ and B₀ inhomogeneities for both on- and off-resonance spin-lock. The relaxation effect during the entire adiabatic half passage (AHP) and reverse AHP, and the stationary solution of the Bloch-McConnell equation present at off-resonance frequency offset, are considered in the revised relaxation model. We demonstrate that these factors create a direct current component to the conventional relaxation model. In contrast to the previously reported dual-acquisition method, the revised relaxation model just requires one acquisition to perform quantification. The simulation, phantom, and in vivo experiments demonstrate that the proposed approach achieves superior image quality compared with the existing methods, and the revised relaxation model can perform T_1ρ quantification with one acquisition instead of two.

Quantification of myocardial infarct area based on TRAFFn relaxation time maps - comparison with cardiovascular magnetic resonance late gadolinium enhancement, T1ρ and T2 in vivo

BACKGROUND

Two days after myocardial infarction (MI), the infarct consists mostly on necrotic tissue, and the myocardium is transformed through granulation tissue to scar in two weeks after the onset of ischemia in mice. In the current work, we determined and optimized cardiovascular magnetic resonance (CMR) methods for the detection of MI size during the scar formation without contrast agents in mice.

METHODS

We characterized MI and remote areas with rotating frame relaxation time mapping including relaxation along fictitious field in nth rotating frame (RAFFn), T1ρ and T2 relaxation time mappings at 1, 3, 7, and 21 days after MI. These results were compared to late gadolinium enhancement (LGE) and Sirius Red-stained histology sections, which were obtained at day 21 after MI.

RESULTS

All relaxation time maps showed significant differences in relaxation time between the MI and remote area. Areas of increased signal intensities after gadolinium injection and areas with increased TRAFF2 relaxation time were highly correlated with the MI area determined from Sirius Red-stained histology sections (LGE: R2 = 0.92, P < 0.01, TRAFF2: R2 = 0.95, P < 0.001). Infarct area determined based on T1ρ relaxation time correlated highly with Sirius Red histology sections (R2 = 0.97, P < 0.01). The smallest overestimation of the LGE-defined MI area was obtained for TRAFF2 (5.6 ± 4.2%) while for T1ρ overestimation percentage was > 9% depending on T1ρ pulse power.

CONCLUSION

T1ρ and TRAFF2 relaxation time maps can be used to determine accurately MI area at various time points in the mouse heart. Determination of MI size based on TRAFF2 relaxation time maps could be performed without contrast agents, unlike LGE, and with lower specific absorption rate compared to on-resonance T1ρ relaxation time mapping.

Longitudinal changes in MR T1ρ/T2 signal of meniscus and its association with cartilage T1p/T2 in ACL-injured patients

OBJECTIVE

To evaluate the longitudinal changes in meniscal T1ρ/T2 signal post-reconstruction in patients with acute anterior cruciate ligament (ACL) injury and to investigate the association with T1ρ/T2 signal in articular knee cartilage.

METHOD

In this prospective study, knees of 37 patients with ACL-injury and reconstruction in addition to 13 healthy controls were scanned using magnetic resonance imaging (MRI) T1ρ/T2 mapping. Quantitative analysis of the meniscus was performed in the anterior/posterior horns of lateral/medial meniscus fourteen sub-compartments of cartilage spanning the medial/lateral area of the tibia and femoral condyles. Meniscus T1ρ/T2 signals were compared between injured, contralateral and control knees at baseline, 6-months, 1-year and 2-years using t-tests for cross-sectional comparisons and a mixed model for longitudinal comparisons. Pearson-partial correlations between meniscal and cartilage T1ρ/T2 were evaluated.

RESULTS

There was a significant decrease of T1ρ/T2 signal in the posterior horn of lateral meniscus (PHLAT) of injured knees during a 2-year period. In the posterior horn of medial meniscus (PHMED), T1ρ/T2 signal of injured knees was significantly elevated at all time points post-reconstruction compared to contralateral and control knees. Within injured knees, PHMED T1ρ/T2 signal showed significant positive correlations with medial tibia (MT) cartilage T1ρ/T2 signal at all time points.

CONCLUSION

A significant decrease in PHLAT T1ρ/T2 signal by 2-years suggests potential tissue recovery after ACL-injury. Elevated T1ρ/T2 signal in the PHMED of injured knees at 2-years correlating with knee cartilage T1ρ/T2 signal elevations suggests involvement of the PHMED in subacute cartilage degeneration after ACL-injury and reconstruction.

Synovial Fluid Profile at the Time of Anterior Cruciate Ligament Reconstruction and Its Association With Cartilage Matrix Composition 3 Years After Surgery

BACKGROUND

Anterior cruciate ligament tears can lead to posttraumatic osteoarthritis. In addition to biomechanical factors, changes in biochemical profiles within the knee joint after injury and anterior cruciate ligament reconstruction (ACLR) may play a role in accelerating joint degeneration. Hypothesis/Purpose: It was hypothesized that cartilage matrix composition after ACLR is associated with the degree of inflammatory response after initial injury. This study evaluated the association between the inflammatory response after injury-as indicated by cytokine, metalloproteinase, and cartilage degradation marker concentrations in synovial fluid-and articular cartilage degeneration, measured by T1ρ and T2 quantitative magnetic resonance imaging up to 3 years after ACLR.

STUDY DESIGN

Cohort study; Level of evidence, 2.

METHODS

Twenty-six subjects from a longitudinal cohort study who underwent ACLR at a mean 8.5 weeks after injury (range, 4-19 weeks) had synovial fluid aspirated at the time of surgery. Immunoassays quantified biomarkers in synovial fluid. T1ρ and T2 values of articular cartilage were calculated with magnetic resonance scans acquired prior to surgery and at 6 months and 1, 2, and 3 years after surgery. Pearson correlation coefficients were calculated among the various biomarkers. K-means clustering was used to group subjects with similar biomarker profiles. Generalized estimating equations were used to find the overall differences in T1ρ and T2 values throughout these first 3 years after surgery between the clusters while controlling for other factors.

RESULTS

Significant and strong correlations were observed between several cytokines (interleukin 6 [IL-6], IL-8, IL-10, and tumor necrosis factor α) and 2 matrix metalloproteinases (MMP-1 and MMP-3) ( P < .05). Moderate correlations were found among combinations of C-terminal crosslinked telopeptide type II collagen, N-terminal telopeptide, cartilage oligomeric matrix protein, and sulfated glycosaminoglycan ( P < .05). Two clusters were generated, 1 of which was characterized by lower concentrations of cytokines (IL-6, IL-8, IL-10, tumor necrosis factor α) and MMP-1 and MMP-3 and higher sulfated glycosaminoglycan. This cluster was associated with significantly higher T1ρ and T2 values in the medial tibial and patellar cartilage over the first 3 years after ACLR.

CONCLUSION

At the time of ACLR surgery, profiles of synovial fluid inflammatory cytokines, degradative enzymes, and cartilage breakdown products show promise as predictors of abnormal cartilage tissue integrity (increased T1ρ and T2 values) throughout the first 3 years after surgery.

CLINICAL RELEVANCE

The results suggest an intricate relationship between inflammation and cartilage turnover, which can in turn be influenced by timing after injury and patient factors.

Use of T1 relaxation time in rotating frame (T1 ρ) and apparent diffusion coefficient to estimate cerebral stroke evolution

BACKGROUND

The major factor for the appropriate treatment strategies for ischemia patients is its onset timing.

PURPOSE/HYPOTHESIS

To study to evaluate the diagnostic accuracy of T₁ relaxation time in a rotating frame (T₁ ρ) and apparent diffusion coefficient (ADC) from MRI to estimate ischemia stages.

STUDY TYPE

Prospective.

POPULATION/SUBJECTS/PHANTOM/SPECIMEN/ANIMAL MODEL

In all, 73 patients (49 males, aged 29-78 years and 24 females, aged 22-94 years) with ischemia were prospectively imaged with T₁ ρ and diffusion MRI during the postischemic period.

FIELD STRENGTH/SEQUENCE

3T/T₁ ρ and diffusion-weighted imaging (DWI).

ASSESSMENT

Ischemic parenchyma included tissue with elevated signal areas on DWI and correlative hypointense areas on ADC maps.

STATISTICAL TESTS

The sensitivity of variables to ischemia time was quantified by analyzing the respective correlations of these values with onset time.

RESULTS

ΔT₁ ρ (ipsilateral-contralateral differences in T₁ ρ) (R²  = 0.956) and T₁ ρ_ipsi (ipsilateral ischemia T₁ ρ values) (R²  = 0.941) were elevated in all ischemic lesions; these values increased linearly as a function of time, unlike ΔADC (ipsilateral-contralateral differences in ADC) (R²  = -0.410) and ADC_ipsi (ipsilateral ischemia ADC values) (R²  = 0.550). ΔT₁ ρ and T₁ ρ_ipsi were significantly different between all stages (P < 0.01), except the acute and hyperacute stages (P = 0.589 for ΔT₁ ρ, P = 0.290 for T₁ ρ_ipsi , respectively), but ΔADC and ADC_ipsi only between the late subacute and early subacute stages (P < 0.01) and the late subacute and chronic stages (P < 0.01).

DATA CONCLUSION

These data suggest that T₁ ρ can provide estimates for the ischemic time in patients. T₁ ρ has the potential to outperform diffusion for single-timepoint examination because the T₁ ρ change during strokes is positive and linear. If patients with suspected stroke are scanned by MRI within the appropriate timeframe, T₁ ρ may provide tools for evaluating stroke onset, potentially aiding in treatment strategies.

LEVEL OF EVIDENCE

4 Technical Efficacy: Stage 3 J. Magn. Reson. Imaging 2018;47:1247-1254.

Non-invasive T1ρ mapping of the human cartilage response to loading and unloading

OBJECTIVE

To define the physiological response to sequential loading and unloading in histologically intact human articular cartilage using serial T1ρ mapping, as T1ρ is considered to indicate the tissue's macromolecular content.

METHOD

18 macroscopically intact cartilage-bone samples were obtained from the central lateral femoral condyles of 18 patients undergoing total knee replacement. Serial T1ρ mapping was performed on a clinical 3.0-T MRI system using a modified prostate coil. Spin-lock multiple gradient-echo sequences prior to, during and after standardized indentation loading (displacement controlled, strain 20%) were used to obtain seven serial T1ρ maps: unloaded (δ₀), quasi-statically loaded (indentation₁-indentation₃) and under subsequent relaxation (relaxation₁-relaxation₃). After manual segmentation, zonal and regional regions-of-interest were defined. ROI-specific relative changes were calculated and statistically assessed using paired t-tests. Histological (Mankin classification) and biomechanical (unconfined compression) evaluations served as references.

RESULTS

All samples were histologically and biomechanically grossly intact (Mankin sum: 1.8 ± 1.2; Young's Modulus: 0.7 ± 0.4 MPa). Upon loading, T1ρ consistently increased throughout the entire sample thickness, primarily subpistonally (indentation₁ [M ± SD]: 9.5 ± 7.8% [sub-pistonal area, SPA] vs 4.2 ± 5.8% [peri-pistonal area, PPA]; P < 0.001). T1ρ further increased with ongoing loading (indentation₃: 14.1 ± 8.1 [SPA] vs 7.7 ± 5.9% [PPA]; P < 0.001). Even upon unloading (i.e., relaxation), T1ρ persistently increased in time.

CONCLUSION

Serial T1ρ-mapping reveals distinct and complex zonal and regional changes in articular cartilage as a function of loading and unloading. Thereby, longitudinal adaptive processes in hyaline cartilage become evident, which may be used for the tissue's non-invasive functional characterization by T1ρ.

Relationship altered between functional T1ρ and BOLD signals in bipolar disorder

INTRODUCTION

Functional neuroimaging typically relies on the blood-oxygen-level-dependent (BOLD) contrast, which is sensitive to the influx of oxygenated blood following neuronal activity. A new method, functional T1 relaxation in the rotating frame (fT1ρ) is thought to reflect changes in local brain metabolism, likely pH, and may more directly measure neuronal activity. These two methods were applied to study activation of the visual cortex in participants with bipolar disorder as compared to controls.

METHODS

Thirty-nine participants with bipolar disorder and 32 healthy controls underwent functional neuroimaging during a flashing checkerboard paradigm. Functional images were acquired in alternating blocks of BOLD and fT1ρ. Linear mixed-effect models were used to examine the relationship between these two functional imaging modalities and to test whether that relationship was altered in bipolar disorder.

RESULTS

BOLD and fT1ρ signal were strongly related in visual and cerebellar areas during the task in controls. The relationship between these two measures was reduced in bipolar disorder within the visual areas, cerebellum, striatum, and thalamus.

CONCLUSIONS

These results support a distinct mechanisms underlying BOLD and fT1ρ signals. The weakened relationship between these imaging modalities may provide a novel tool for measuring pathology in bipolar disorder and other psychiatric illnesses.

Cyclops lesions are associated with altered gait patterns and medial knee joint cartilage degeneration at 1 year after ACL-reconstruction

In this exploratory study, gait analysis and quantitative MRI (QMRI) were used to assess biomechanical differences in patients that present with cyclops lesions at 12 months after ACL-reconstruction (ACLR). Thirty ACLR patients without and 10 ACLR patients with cyclops lesions underwent 3T MR T_1ρ mapping of the reconstructed knee joint prior to ACLR and at 12 months after ACLR, as well as a gait assessment during a fixed walking speed at 12 months after ACLR. Both external sagittal and frontal plane knee joint moments and joint moment impulses were calculated and assessed throughout the stance phase of gait. ACLR patients with cyclops lesions demonstrated a significantly greater (34% larger, p = 0.03) first peak knee flexion moment (KFM) and KFM impulse (42% larger, p = 0.05), compared to those without cyclops lesions, which may suggest an increased load during the loading response phase of gait. There were no differences (p > 0.05) in knee extension or adduction joint moments or moment impulses. ACLR patients with cyclops lesions demonstrated a significantly increased change in T_1ρ (ΔT_1ρ  = 4.7 ms, p = 0.03), over 12 months, within the central medial tibia. The results of the study suggest that ACLR patients with cyclops lesions demonstrate altered sagittal plane loading patterns which may be related to an increased rate of medial tibiofemoral cartilage degeneration at 12 months after ACLR. The first peak external KFM may be an important target for intervention programs in ACLR patients with cyclops lesions in order to possibly slow the onset or progression of medial tibiofemoral cartilage degeneration. © 2017 Orthopaedic Research Society. Published by Wiley Periodicals, Inc. J Orthop Res 35:2275-2281, 2017.

Multimodal quantitative magnetic resonance imaging for lumbar intervertebral disc degeneration

The present study investigated the application of the T_1ρ and T₂ relaxation mapping magnetic resonance imaging (MRI) and diffusion-weighted imaging (DWI) in the evaluation of intervertebral disc degeneration (IDD). A total of 93 asymptomatic subjects were imaged with T_1ρ and T₂ mapping, as well as DWI. Pfirrmann grading was performed and correlation analysis was conducted for T_1ρ, T₂ and DWI results with the grading results and age. Pfirrmann grading indicated 69 cases of grade I, 240 cases of grade II, 101 cases of grade III, 43 cases of grade IV and 12 cases of grade V. MRI showed that the T_1ρ values of the nucleus pulposi at L4/5 and L5/S1 were significantly reduced (P<0.05) and no significant differences were observed in the T₂ values compared with the values of the nucleus pulposus at L1/2, L2/3 and L3/4. The apparent diffusion coefficient (ADC) values of L1/2 were significantly decreased from L2/3 and L3/4 (P<0.05). Correlation analysis revealed that the T_1ρ, T, and ADC values were positively correlated with each other. Moreover, the T_1ρvalues were significantly decreased with the increase of Pfirrmann grades (P<0.05), with the exception of grades IV and V. However, T₂ and ADC values were not significantly different between grades I and II or IV and V. In addition, the T_1ρ, T₂ and ADC values were significantly decreased with the increase of age in patients with IDD (P<0.05). T_1ρ and T₂ mapping and DWI are promising techniques for the in vivo diagnosis of IDD, which may be useful in determining the appropriate prevention and treatment options for the disease.

Three-dimensional ultrashort echo time cones T1ρ (3D UTE-cones-T1ρ ) imaging

We report a novel three-dimensional (3D) ultrashort echo time (UTE) sequence employing Cones trajectory and T_1ρ preparation (UTE-Cones-T_1ρ ) for quantitative T_1ρ assessment of short T₂ tissues in the musculoskeletal system. A basic 3D UTE-Cones sequence was combined with a spin-locking preparation pulse for T_1ρ contrast. A relatively short TR was used to decrease the scan time, which required T₁ measurement and compensation using 3D UTE-Cones data acquisitions with variable TRs. Another strategy to reduce the total scan time was to acquire multiple Cones spokes (N_sp ) after each T_1ρ preparation and fat saturation. Four spin-locking times (TSL = 0-20 ms) were acquired over 12 min, plus another 7 min for T₁ measurement. The 3D UTE-Cones-T_1ρ sequence was compared with a two-dimensional (2D) spiral-T_1ρ sequence for the imaging of a spherical CuSO₄ phantom and ex vivo meniscus and tendon specimens, as well as the knee and ankle joints of healthy volunteers, using a clinical 3-T scanner. The CuSO₄ phantom showed a T_1ρ value of 76.5 ± 1.6 ms with the 2D spiral-T_1ρ sequence, as well as 85.7 ± 3.6 and 89.2 ± 1.4 ms for the 3D UTE-Cones-T_1ρ sequences with N_sp of 1 and 5, respectively. The 3D UTE-Cones-T_1ρ sequence provided shorter T_1ρ values for the bovine meniscus sample relative to the 2D spiral-T_1ρ sequence (10-12 ms versus 16 ms, respectively). The cadaveric human Achilles tendon sample could only be imaged with the 3D UTE-Cones-T_1ρ sequence (T_1ρ  = 4.0 ± 0.9 ms), with the 2D spiral-T_1ρ sequence demonstrating near-zero signal intensity. Human studies yielded T_1ρ values of 36.1 ± 2.9, 18.3 ± 3.9 and 3.1 ± 0.4 ms for articular cartilage, meniscus and the Achilles tendon, respectively. The 3D UTE-Cones-T_1ρ sequence allows volumetric T_1ρ measurement of short T₂ tissues in vivo.

Effects of Surgical Factors on Cartilage Can Be Detected Using Quantitative Magnetic Resonance Imaging After Anterior Cruciate Ligament Reconstruction

BACKGROUND

Quantitative magnetic resonance (qMR) can be used to measure macromolecules in tissues and is a potential method of observing early cartilage changes in the development of posttraumatic osteoarthritis. Hypothesis/Purpose: We hypothesized that specific patient and surgical factors affecting cartilage matrix composition after anterior cruciate ligament (ACL) reconstruction (ACLR) can be detected using T1ρ and T2 relaxation times. Our purpose was to demonstrate this ability in a multicenter feasibility study.

STUDY DESIGN

Case series; Level of evidence, 4.

METHODS

A total of 54 patients who underwent ACLR underwent bilateral MRI at baseline before surgery and 6 months postoperatively. Operative findings were recorded. T1ρ and T2 relaxation times were calculated for 6 cartilage regions: the medial femur, lateral femur, medial tibia, lateral tibia, patella, and trochlea. A paired t test compared relaxation times at baseline and 6 months, univariate regression identified regions that influenced patient-reported outcome measures, and analysis of covariance was used to determine the surgical factors that resulted in elevated relaxation times at 6 months.

RESULTS

The injured knee had significantly prolonged T1ρ and T2 relaxation times in the tibiofemoral compartment at baseline and 6 months but had shorter values in the patellofemoral compartment compared with the uninjured knee. Prolonged T1ρ and T2 times at 6 months were noted for both the injured and uninjured knees. At 6 months, prolongation of T1ρ and T2 times in the tibial region was associated with lower patient-reported outcome measures. ACLR performed within 30 days of injury had significantly shorter T1ρ times in the tibial regions, and lateral meniscal tears treated with repair had significantly shorter T1ρ times than those treated with excision.

CONCLUSION

Prolonged relaxation times in multiple regions demonstrate how the injury affects the entire joint after an ACL tear. Changes observed in the uninjured knee may be caused by increased loading during rehabilitation, especially in the patellofemoral articular cartilage and distal femur. Relaxation times in the tibial regions may be predictive of patient symptoms at 6 months. These same regions are affected by surgical timing as early as 30 days after injury, but this may partially be reflective of the severity of the preoperative injury and the choice of treatment of meniscal tears.

Baseline cartilage quality is associated with voxel-based T1ρ and T2 following ACL reconstruction: A multicenter pilot study

In this multi-center study, voxel-based relaxometry (VBR), a novel technique to automatically quantify localized cartilage change, was used to investigate T_1ρ and T₂ relaxation times of patients with anterior cruciate ligament (ACL) tears at the time of injury and 6 months after reconstructive surgery. Sixty-four ACL-injured patients from three sites underwent bilateral 3T MR T_1ρ and T₂ mapping; 56 patients returned 6 months after surgery. Cross-sectional and longitudinal VBR comparisons of relaxation times were calculated. Noyes Score (NS) clinical grades of cartilage lesions were noted at both times and correlated with relaxation times. Lastly, patients were divided into two groups based on baseline NS grades in the injured knee. T_1ρ times of each group were assessed with VBR and compared. Results illustrate the feasibility of VBR for efficiently analyzing data from patients at different sites. Significant relaxation time elevations at baseline were observed in the injured knee compared to the uninjured, particularly in the posterolateral tibia (pLT). Longitudinally, a decrease was observed in the pLT and patella, while an increase was noted in the trochlea. Stratifying patients by baseline lesion presence revealed T_1ρ increased more 6 months after surgery in patients with lesions. Such findings propose that the presence of cartilage lesions at baseline are associated with the longitudinal progression of T_1ρ and T₂ after ACL injury, and may contribute to early cartilage degeneration. Furthermore, the speed and localized specificity of automatic VBR analysis may translate well for clinical application, as seen in this multicenter study. © 2016 Orthopaedic Research Society. Published by Wiley Periodicals, Inc. J Orthop Res 35:688-698, 2017.

Ultralow-field and spin-locking relaxation dispersion in postmortem pig brain

PURPOSE

To investigate tissue-specific differences, a quantitative comparison was made between relaxation dispersion in postmortem pig brain measured at ultralow fields (ULF) and spin locking at 7 tesla (T). The goal was to determine whether ULF-MRI has potential advantages for in vivo human brain imaging.

METHODS

Separate specimens of gray matter and white matter were investigated using an ULF-MRI system with superconducting quantum interference device (SQUID) signal detection to measure T1ULF at fields from 58.7 to 235.0 μT and using a commercial MRI scanner to measure T1ρ7T at spin-locking fields from 5.0 to 235.0 μT.

RESULTS

At matched field strengths, T1ρ7T is 50 to 100% longer than T1ULF. Furthermore, dispersion in T1ULF is close to linear between 58.7 and 235 µT, whereas dispersion in T1ρ7T is highly nonlinear over the same range. A subtle elbow in the T1ULF dispersion at approximately 140 µT is tentatively attributed to the local dipolar field of macromolecules. It is suggested that different relaxation mechanisms dominate each method and that ULF-MRI has a fundamentally different sensitivity to the macromolecular structure of neural tissue.

CONCLUSIONS

Ultralow-field MRI may offer distinct, quantitative advantages for human brain imaging, while simultaneously avoiding the severe heating limitation imposed on high-field spin locking. Magn Reson Med 78:2342-2351, 2017. © 2016 International Society for Magnetic Resonance in Medicine.

Elevated adiabatic T1ρ and T2ρ in articular cartilage are associated with cartilage and bone lesions in early osteoarthritis: A preliminary study

PURPOSE

To evaluate adiabatic T_1ρ and T_2ρ of articular cartilage in symptomatic osteoarthritis (OA) patients and asymptomatic volunteers, and to determine their association with magnetic resonance imaging (MRI)-based structural abnormalities in cartilage and bone.

MATERIALS AND METHODS

A total of 24 subjects (age range: 50-68 years; 12 female) were enrolled, including 12 early OA patients and 12 volunteers with normal joint function. Patients and volunteers underwent 3T MRI. T₂ , adiabatic T_1ρ , and T_2ρ relaxation times of knee articular cartilage were measured. Proton density (PD)- and T₁ -weighted MR image series were also obtained and separately evaluated for morphological changes using the MRI OA Knee Scoring (MOAKS) system. Comparisons using the Mann-Whitney nonparametric test were performed after dividing the study participants according to physical symptoms as determined by Western Ontario and McMaster Universities (WOMAC) score or presence of cartilage lesions, bone marrow lesions, or osteophytes.

RESULTS

Elevated adiabatic T_1ρ and T_2ρ relaxation times of articular cartilage were associated with cartilage loss (P = 0.024-0.047), physical symptoms (0.0068-0.035), and osteophytes (0.0039-0.027). Elevated adiabatic T_1ρ was also associated with bone marrow lesions (0.033).

CONCLUSION

Preliminary data suggest that elevated adiabatic T_1ρ and T_2ρ of cartilage are associated with morphological abnormalities of cartilage and bone, and thus may be applicable for in vivo OA research and diagnostics.

LEVEL OF EVIDENCE

2 Technical Efficacy: Stage 2 J. MAGN. RESON. IMAGING 2017;46:678-689.

Principal component analysis-T1ρ voxel based relaxometry of the articular cartilage: a comparison of biochemical patterns in osteoarthritis and anterior cruciate ligament subjects

BACKGROUND

Quantitative MR, including T_1ρ mapping, has been extensively used to probe early biochemical changes in knee articular cartilage of subjects with osteoarthritis (OA) and others at risk for cartilage degeneration, such as those with anterior cruciate ligament (ACL) injury and reconstruction. However, limited studies have been performed aimed to assess the spatial location and patterns of T_1ρ. In this study we used a novel voxel-based relaxometry (VBR) technique coupled with principal component analysis (PCA) to extract relevant features so as to describe regional patterns and to investigate their similarities and differences in T_1ρ maps in subjects with OA and subjects six months after ACL reconstruction (ACLR).

METHODS

T_1ρ quantitative MRI images were collected for 180 subjects from two separate cohorts. The OA cohort included 93 osteoarthritic patients and 25 age-matched controls. The ACLR-6M cohort included 52 patients with unilateral ACL tears who were imaged 6 months after ACL reconstruction, and 10 age-matched controls. Non-rigid registration on a single template and local Z-score conversion were adopted for T_1ρ spatial and intensity normalization of all the images in the dataset. PCA was used as a data dimensionality reduction to obtain a description of all subjects in a 10-dimensional feature space. Logistic linear regression was used to identify distinctive features of OA and ACL subjects.

RESULTS

Global prolongation of the Z-score was observed in both OA and ACL subjects compared to controls [higher values in 1^st principal component (PC1); P=0.01]. In addition, relaxation time differences between superficial and deep cartilage layers of the lateral tibia and trochlea were observed to be significant distinctive features between OA and ACL subjects. OA subjects demonstrated similar values between the two cartilage layers [higher value in 2^nd principal component (PC2); P=0.008], while ACL reconstructed subjects showed T_1ρ prolongation specifically in the cartilage superficial layer (lower values in PC2; P<0.0001). T_1ρ elevation located outside of the weight-bearing area, located in the posterior and anterior aspects of the lateral femoral compartment, was also observed to be a key feature in distinguishing OA subjects from controls [higher value in 6^th principal component (PC6); P=0.007].

CONCLUSIONS

This study is the first example of T_1ρ local/regional pattern analysis and data-driven feature extraction in knees with cartilage degeneration. Our results revealed similarities and differences between OA and ACL relaxation patterns that could be potentially useful to better understand the pathogenesis of post-traumatic cartilage degeneration and the identification of imaging biomarkers for the early stratification of subjects at risk for developing post-traumatic OA.

Noninvasive assessment of age, gender, and exercise effects on skeletal muscle: Initial experience with T1 ρ MRI of calf muscle

PURPOSE

To prospectively investigate age- and gender-related changes in the fast-twitch (tibialis anterior, TA) and slow-twitch (soleus, SOL) skeletal muscle of healthy rats and volunteers and to compare the exercise-related difference in health volunteers with T₁ ρ magnetic resonance imaging (MRI).

MATERIALS AND METHODS

In all, 18 rats and 70 humans were involved in this study. For the animal study, T₁ ρ relaxation times were measured in the TA and SOL rat muscle with a 3.0T MRI scanner and compared to histological data. For the human study, three groups (young, middle-aged, and elderly) of volunteers underwent T₁ ρ MRI scans (3.0T) of their calves. To further differentiate the human scans, 18 volunteers were recruited, half of them (n = 9) routinely trained with high-intensity sports, while the other half (n = 9) with no physical training. Statistical analysis was performed via paired t-test, independent-sample t-test, and analysis of variance (ANOVA). Correlations between T₁ ρ and age/gender/physical endurance were calculated.

RESULTS

The average T₁ ρ relaxation times of the TA and SOL of female rats were higher than that of male rats (P < 0.001). The T₁ ρ relaxation time of TA was significantly lower compared to SOL (P < 0.001). A significant linear correlation was observed between T₁ ρ and the type I slow-twitch fiber proportion (%) in SOL (R²  = 0.837, P < 0.001). Similarly, in human studies the average T₁ ρ relaxation times of TA were significantly lower than SOL for all age groups (P < 0.001). The higher T₁ ρ relaxation times of TA and SOL in the elderly volunteers (P < 0.001) and in the females (P < 0.05) indicated significant age- and gender-dependent differences. In high-intensity sports groups, the higher T₁ ρ in SOL (P < 0.01) and lower in TA (P < 0.05) were observed compared with the control group.

CONCLUSION

This study demonstrated that T₁ ρ MRI can be used to display the differences in fast- and slow-twitch skeletal muscle as well as potentially age-, gender-, and exercise-related differences.

LEVEL OF EVIDENCE

2 Technical Efficacy: Stage 1 J. MAGN. RESON. IMAGING 2017;46:61-70.

T1ρ Magnetic Resonance Imaging to Assess Cartilage Damage After Primary Shoulder Dislocation

BACKGROUND

Patients who suffer anterior shoulder dislocations are at higher risk of developing glenohumeral arthropathy, but little is known about the initial cartilage damage after a primary shoulder dislocation. T1ρ is a magnetic resonance imaging (MRI) technique that allows quantification of cartilage proteoglycan content and can detect physiologic changes in articular cartilage.

PURPOSE

This study aimed to establish baseline T1ρ MRI values for glenoid and humeral head cartilage, determine whether T1ρ MRI can detect glenohumeral cartilage damage after traumatic primary shoulder dislocation, and assess for patterns in cartilage damage in anterior shoulder dislocation.

STUDY DESIGN

Cross-sectional study; Level of evidence, 3.

METHODS

Nine male patients (mean age, 32.0 years; range, 20-59 years) who sustained first-time anterior shoulder dislocations underwent 3T T1ρ MRI. Five healthy controls (mean age, 27.4 years; range, 24-30 years) without prior dislocation or glenohumeral arthritis also underwent 3T T1ρ MRI. The T1ρ relaxation constant was determined for the entire glenoid and humeral head for patients with a dislocation and for healthy controls. The glenoid and humeral head were divided into 9 zones, and T1ρ values were determined for each zone in dislocated and control shoulders to identify patterns in cartilage damage in dislocated shoulders.

RESULTS

Average overall T1ρ values for humeral head cartilage in dislocated shoulders were significantly greater than in controls (41.7 ± 3.9 ms vs 38.4 ± 0.6 ms, respectively; P = .03). However, average overall T1ρ values for glenoid cartilage were not significantly different in dislocated shoulders compared with controls (44.0 ± 3.3 ms vs 44.6 ± 2.4 ms, respectively; P = .40), suggesting worse damage to humeral head cartilage. T1ρ values in the posterior-middle humeral head were higher in patients with a dislocation compared with controls (41.5 ± 3.8 ms vs 38.2 ± 2.2 ms, respectively; P = .021) and trended toward significance in the posterior-superior and middle-superior zones (35.2 ± 4.9 ms vs 31.3 ± 1.0 ms and 33.7 ± 5.0 ms vs 30.5 ± 1.3 ms, respectively; P = .056). These 3 humeral head zones are where Hill-Sachs lesions predominate. T1ρ values in the anterior-inferior glenoid zone trended toward significance in patients with a dislocation compared with controls (47.4 ± 5.0 ms vs 43.5 ± 3.5 ms, respectively; P = .073).

CONCLUSION

Humeral head cartilage sustained greater damage than glenoid cartilage in primary dislocation. T1ρ values were higher in glenohumeral zones associated with Bankart and Hill-Sachs lesions. Widespread initial cartilage damage may predispose patients to glenohumeral arthropathy.

Longitudinal study using voxel-based relaxometry: Association between cartilage T1ρ and T2 and patient reported outcome changes in hip osteoarthritis

PURPOSE

To study the local distribution of hip cartilage T_1ρ and T₂ relaxation times and their association with changes in patient reported outcome measures (PROMs) using a fully automatic, local, and unbiased method in subjects with and without hip osteoarthritis (OA).

MATERIALS AND METHODS

The 3 Tesla MRI studies of the hip were obtained for 37 healthy controls and 16 subjects with radiographic hip OA. The imaging protocol included a three-dimensional (3D) SPGR sequence and a combined 3D T_1ρ and T₂ sequence. Quantitative cartilage analysis was compared between a traditional region of interest (ROI)-based method and a fully automatic voxel-based relaxometry (VBR) method. Additionally, VBR was used to assess local T_1ρ and T₂ differences between subjects with and without OA, and to evaluate the association between T_1ρ and T₂ and 18-month changes PROMs.

RESULTS

Results for the two methods were consistent in the acetabular (R = 0.79; coefficients of variation [CV] = 2.9%) and femoral cartilage (R = 0.90; CV = 2.6%). VBR revealed local patterns of T_1ρ and T₂ elevation in OA subjects, particularly in the posterosuperior acetabular cartilage (T_1ρ : P = 0.02; T₂ : P = 0.038). Overall, higher T_1ρ and T₂ values at baseline, particularly in the anterosuperior acetabular cartilage (T_1ρ : Rho = -0.42; P = 0.002; T₂ : Rho = -0.44; P = 0.002), were associated with worsening PROMS at 18-month follow-up.

CONCLUSION

VBR is an accurate and robust method for quantitative MRI analysis in hip cartilage. VBR showed the capability to detect local variations in T_1ρ and T₂ values in subjects with and without osteoarthritis, and voxel based correlations demonstrated a regional dependence between baseline T_1ρ and T₂ values and changes in PROMs.

LEVEL OF EVIDENCE

1 J. MAGN. RESON. IMAGING 2017;45:1523-1533.