Sodium and T1rho MRI for molecular and diagnostic imaging of articular cartilage

Long-term results 8 years after autologous osteochondral transplantation: 7 T gagCEST and sodium magnetic resonance imaging with morphological and clinical correlation

OBJECTIVE

To correlate long-term clinical outcome and the results of morphological as well as advanced biochemical magnetic resonance imaging (MRI) techniques [T2-mapping, glycosaminoglycan chemical exchange saturation transfer (gagCEST), sodium-23-imaging] in patients after autologous osteochondral transplantation (AOT) in knee joints.

METHOD

Nine AOT patients (two female and seven male; median age, 49) had clinical [International Knee Documentation Committee (IKDC), modified Lysholm, visual analog scale (VAS)] and radiological long-term follow-up examinations at a median of 7.9 years (inter-quartile range, 7.7-8.2). Standard morphological MRI and T2-mapping of cartilage were performed on a 3 T MR unit. Biochemical imaging further included sodium-23-imaging and chemical exchange saturation transfer (CEST) imaging at 7 T. The Magnetic resonance Observation of CArtilage Repair Tissue (MOCART) score was used for quantitative assessment of morphological MRI.

RESULTS

Clinical outcome was good with a median modified Lysholm score of 90. Median VAS revealed 1.0 and median MOCART score 75 points. The difference between native and repair cartilage was statistically significant for all three biochemical imaging techniques. The strongest correlation was found between the results of the advanced biochemical imaging methods sodium-23 and CEST [ρ = 0.952, 95% confidence interval (CI): (0.753; 0.992)]. Comparing the results from morphological and biochemical imaging, a correlation was found between MOCART score and CEST ratio [ρ = -0.749, 95% CI: (-0.944; -0.169)]. Comparing the results from clinical scores with MRI, a correlation between modified Lysholm and T2-mapping [ρ = -0.667, 95% CI: (-0.992; -0.005)] was observed.

CONCLUSION

Long-term clinical outcome in patients 7.9 years after AOT was good, but did not correlate with morphological and biochemical imaging results except for T2-mapping.

Imaging cartilage physiology

Osteoarthritis (OA) is a common disease that results in cartilage degeneration in the joints and is a disabling condition for millions of individuals. Poor sensitivity and specificity of standard diagnostic methods have relegated treatment options to mitigating pain or surgical replacement. The advent of disease-modifying drugs holds the potential for reversing the normal course of OA and rebuilding cartilage. To aid these therapies, novel magnetic resonance imaging-based tools are required for detecting subtle early changes in cartilage physiology due to OA that may provide improved diagnoses and clinical management of patients. Some of the techniques reviewed here such as T1ρ and T2 relaxometry, magnetization transfer, chemical exchange saturation transfer, and Na magnetic resonance imaging are all biomarkers of cartilage pathological diseases that are sensitive to early biochemical changes in the extracellular matrix of cartilage. These techniques have the potential to noninvasively detect early pathological changes with the goal of aiding clinical decision making as well as contributing to the development and evaluation of potential disease-modifying therapies.

Sodium relaxation times in the knee joint in vivo at 7T

The sodium concentration correlates directly with the concentration of proteoglycans (PG) in cartilage, the loss of which is an early signature of osteoarthritis (OA). As a result, quantitative sodium MRI is a promising technique for assessing the degradation of articular cartilage in patients with OA. Sodium relaxation times can also provide information on the degradation of cartilage: it has already been shown on bovine cartilage that T(1) and T2long are longer and T2short shorter when the PG concentration decreases. In this study, sodium T(1), T2*short and T2*long relaxation maps were measured in vivo at 7 T on 8 healthy volunteers and in 4 different regions of the cartilage in the knee joint. The patellar, femoro-tibial medial, lateral, and femoral condyle cartilage have an average T(1)~20 ms, but different T2*short (from 0.5 ms to 1.4 ms) and T2*long (from 11.4 ms to 14.8 ms). Statistically significant differences in T(1), T2*short and T2*long were observed between the different regions in cartilage (p << 10(- 5)). Statistical differences in T(1) were also observed between male and female data (p << 10(- 5)). These relaxation times measurements can further be applied as correction factors for sodium concentration maps in vivo and can also be useful as complementary information to quantitative sodium MRI in the quest for detecting early OA. These measurements were done on low resolution sodium images in order to acquire sufficient quality data for fitting (5 images for T(1) and 9 images for T2*) while keeping the total time of acquisition of the data reasonable for the volunteer's comfort (1 h 15 min).

The design of a double-tuned two-port surface resonator and its application to in vivo hydrogen- and sodium-MRI

The design and construction of a two-port surface transceiver resonator for both (1)H-and (23)Na-MRI in the rodent brain at 7 T is described. Double-tuned resonators are required for accurately co-registering multi-nuclei data sets, especially when the time courses of (1)H and (23)Na signals are of interest as, for instance, when investigating the pathological progression of ischaemic stroke tissue in vivo. In the current study, a single-element two-port surface resonator was developed wherein both frequency components were measured with the same detector element but with each frequency signal routed along different output channels. This was achieved by using the null spot technique, allowing for optimal variable tuning and matching of each channel in situ within the MRI scanner. The (23)Na signal to noise ratio, measured in the ventricles of the rat brain, was increased by a factor of four compared to recent state-of-the-art rat brain studies reported in the literature. The resonator's performance was demonstrated in an in vivo rodent stroke model, where regional variations in (1)H apparent diffusion coefficient maps and the (23)Na signal were recorded in an interleaved fashion as a function of time in the acute phase of the stroke without having to exchange, re-adjust, or re-connect resonators between scans. Using the practical construction steps described in this paper, this coil design can be easily adapted for MRI of other X-nuclei, such as (17)O, (13)C, (39)K, and (43)Ca at various field strengths.

Improved assessment of cartilage repair tissue using fluid-suppressed ²³Na inversion recovery MRI at 7 Tesla: preliminary results

OBJECTIVES

To evaluate cartilage repair and native tissue using a three-dimensional (3D), radial, ultra-short echo time (UTE) (23)Na MR sequence without and with an inversion recovery (IR) preparation pulse for fluid suppression at 7 Tesla (T).

METHODS

This study had institutional review board approval. We recruited 11 consecutive patients (41.5 ± 11.8 years) from an orthopaedic surgery practice who had undergone a knee cartilage restoration procedure. The subjects were examined postoperatively (median = 26 weeks) with 7-T MRI using: proton-T2 (TR/TE = 3,000 ms/60 ms); sodium UTE (TR/TE = 100 ms/0.4 ms); fluid-suppressed, sodium UTE adiabatic IR. Cartilage sodium concentrations in repair tissue ([Na(+)](R)), adjacent native cartilage ([Na(+)](N)), and native cartilage within the opposite, non-surgical compartment ([Na(+)](N2)) were calculated using external NaCl phantoms.

RESULTS

For conventional sodium imaging, mean [Na(+)](R), [Na(+)](N), [Na(+)](N2) were 177.8 ± 54.1 mM, 170.1 ± 40.7 mM, 172.2 ± 30 mM respectively. Differences in [Na(+)](R) versus [Na(+)](N) (P = 0.59) and [Na(+)](N) versus [Na(+)](N2) (P = 0.89) were not significant. For sodium IR imaging, mean [Na(+)](R), [Na(+)](N), [Na(+)](N2) were 108.9 ± 29.8 mM, 204.6 ± 34.7 mM, 249.9 ± 44.6 mM respectively. Decreases in [Na(+)](R) versus [Na(+)](N) (P = 0.0.0000035) and [Na(+)](N) versus [Na(+)](N2) (P = 0.015) were significant.

CONCLUSIONS

Sodium IR imaging at 7 T can suppress the signal from free sodium within synovial fluid. This may allow improved assessment of [Na(+)] within cartilage repair and native tissue.

KEY POINTS

• NaIR magnetic resonance imaging can suppress signal from sodium within synovial fluid. • NaIR MRI thus allows assessment of sodium concentration within cartilage tissue alone. • This may facilitate more accurate assessment of repair tissue composition and quality.

Multichannel transceiver dual-tuned RF coil for proton/sodium MR imaging of knee cartilage at 3 T

Sodium magnetic resonance (MR) imaging is a promising technique for detecting changes of proteoglycan (PG) content in cartilage associated with knee osteoarthritis. Despite its potential clinical benefit, sodium MR imaging in vivo is challenging because of intrinsically low sodium concentration and low MR signal sensitivity. Some of the challenges in sodium MR imaging may be eliminated by the use of a high-sensitivity radiofrequency (RF) coil, specifically, a dual-tuned (DT) proton/sodium RF coil which facilitates the co-registration of sodium and proton MR images and the evaluation of both physiochemical and structural properties of knee cartilage. Nevertheless, implementation of a DT proton/sodium RF coil is technically difficult because of the coupling effect between the coil elements (particularly at high field) and the required compact design with improved coil sensitivity. In this study, we applied a multitransceiver RF coil design to develop a DT proton/sodium coil for knee cartilage imaging at 3 T. With the new design, the size of the coil was minimized, and a high signal-to-noise ratio (SNR) was achieved. DT coil exhibited high levels of reflection S11 (∼-21 dB) and transmission coefficient S12 (∼-19 dB) for both the proton and sodium coils. High SNR (range 27-38) and contrast-to-noise ratio (CNR) (range 15-21) were achieved in sodium MR imaging of knee cartilage in vivo at 3-mm(3) isotropic resolution. This DT coil performance was comparable to that measured using a sodium-only birdcage coil (SNR of 28 and CNR of 20). Clinical evaluation of the DT coil on four normal subjects demonstrated a consistent acquisition of high-resolution proton images and measurement of relative sodium concentrations of knee cartilages without repositioning of the subjects during the same MR scanning session.

Compressed sensing sodium MRI of cartilage at 7T: preliminary study

Sodium MRI has been shown to be highly specific for glycosaminoglycan (GAG) content in articular cartilage, the loss of which is an early sign of osteoarthritis (OA). Quantitative sodium MRI techniques are therefore under development in order to detect and assess early biochemical degradation of cartilage, but due to low sodium NMR sensitivity and its low concentration, sodium images need long acquisition times (15-25 min) even at high magnetic fields and are typically of low resolution. In this preliminary study, we show that compressed sensing can be applied to reduce the acquisition time by a factor of 2 at 7 T without losing sodium quantification accuracy. Alternatively, the nonlinear reconstruction technique can be used to denoise fully-sampled images. We expect to even further reduce this acquisition time by using parallel imaging techniques combined with SNR-improved 3D sequences at 3T and 7 T.

Reproducibility and repeatability of quantitative sodium magnetic resonance imaging in vivo in articular cartilage at 3 T and 7 T

Osteoarthritis is a degenerative disease of articular cartilage that may be associated with a loss of glycosaminoglycans. Quantitative sodium magnetic resonance imaging is highly specific to glycosaminoglycan content and could be used to assess the biochemical degradation of cartilage in early osteoarthritis. However, the reproducibility and repeatability of this technique are not well documented. The aim of this study is to test the reproducibility and repeatability of sodium quantification in cartilage in vivo using intraday and interday acquisitions at 3 T and 7 T, with a radial 3D sequence, with and without fluid suppression. Fluid suppression was obtained by adiabatic inversion recovery (IR WURST) and is expected to improve the sensitivity of the method to glycosaminoglycan content. The root mean square of coefficients of variation are all in the range of 7.5-13.6%. No significant intermagnet, intersequence, intraday, and interday differences in the coefficients of variation were observed. Sodium quantification using IR WURST gave values closer to those reported in the literature for healthy cartilage (220-310 mM) than radial 3D. In conclusion, IR WURST was more accurate in context of sodium measurement, with a reproducibility and repeatability comparable to other compositional magnetic resonance imaging techniques of cartilage.

T1ρ magnetic resonance imaging and discography pressure as novel biomarkers for disc degeneration and low back pain

STUDY DESIGN

Prospective magnetic resonance imaging (MRI) study of patients low back pain (LBP) requiring discography as part of their routine clinical diagnoses and asymptomatic age-matched volunteers.

OBJECTIVE

To determine whether T1ρ MRI and discography opening pressure (OP) are quantitative biomarkers of disc degeneration in LBP patients and in asymptomatic volunteers.

SUMMARY OF BACKGROUND DATA

Disc degenerative disease, a common cause of LBP, is related to the patient's prognosis and serves as a target for therapeutic interventions. However, there are few quantitative measures in the clinical setting. Discography OP and T1ρ MRI are potential biomarkers of disc degenerative disease related to biochemical composition of the intervertebral disc.

METHODS

The institutional review board approved all experiments, and informed consent was provided by each subject. Patients being treated for LBP (n = 17; 68 levels; mean age, 44 ± 6 years; and range, 30-53) and control subjects (n = 11; 44 levels; mean age, 43 ± 17 years; and range, 22-76) underwent T1ρ and T2 MRI on a Siemens 3T Tim Trio clinical scanner (Siemens Medical Solutions, Malvern, PA). The LBP patients also received multilevel provocative discography before their MRI. OP was recorded as the pressure when fluid first enters the nucleus of the intervertebral disc.

RESULTS

T1ρ was significantly lower in the painful discs (55.3 ± 3.0 ms, mean ± SE) from control (92.0 ± 4.9 ms, P < 0.001) and nonpainful discs (83.6 ± 3.2 ms, P < 0.001). Mean OP for the painful discs (11.8 ± 1.0 psi, mean ± SE) was significantly lower than that for nonpainful discs (19.1 ± 0.7 psi, P < 0.001). Both T1ρ and OP correlated moderately with Pfirrmann degenerative grade. Receiver-operating-characteristic area under the curve was 0.91 for T1ρ MRI and 0.84 for OP for predicting painful discs.

CONCLUSION

T1ρ and OP are quantitative measures of degeneration that are consistent across both control subjects and LBP patients. A significant and strong correlation exists between T1ρ values and in vivo OP measurements obtained by discography in LBP patients.

Quantitative cartilage degeneration associated with spontaneous osteoarthritis in a guinea pig model

PURPOSE

To determine (i) the feasibility and intra- and inter-scan reproducibility of T(1ρ) MRI in assessing cartilage degeneration in a guinea pig model with naturally occurring joint disease that closely mimics human osteoarthritis (OA), (ii) demonstrate the sensitivity of T(1ρ) MRI in assessing the age dependent cartilage degeneration in OA progression as compared to histopathological changes.

MATERIALS AND METHODS

Duncan-Hartley guinea pigs were obtained at various ages and maintained under an IACUC approved protocol. The left hind stifle joint was imaged using T(1ρ) MRI on a 9.4 Tesla Varian horizontal 20 cm bore scanner using a custom surface coil. Reproducibility of T(1ρ) MRI was assessed using 4-month-old guinea pigs (N = 3). Three age cohorts; 3 month (N = 8), 5 month (N = 6), and 9 month (N = 5), were used to determine the age-dependent osteoarthritic changes as measured by T(1ρ) MRI. Validation of age-dependent cartilage degeneration was confirmed by histology and Safranin-O staining.

RESULTS

T(1ρ) values obtained in the cartilage of the stifle joint in guinea pigs were highly reproducible with an inter-scan mean coefficient of variation (CV) of 6.57% and a maximum intra-scan CV of 9.29%. Mean cartilage T(1ρ) values in animals with late stage cartilage degeneration were 56.3-56.9 ms (5-9 month cohorts) were both significantly (P < 0.01) higher than that obtained from 3-month-old cohort (44 ms) demonstrating an age-dependent variation. T(1ρ) was shown to be significantly greater than T(2) . T(1ρ) dispersion was observed in this animal model for the first time showing an increase of 45% between 500 Hz and 1500 Hz spin-locking frequency. Cartilage thickness measurements were calculated from single mid-coronal histology sections from same animals used for T(1ρ) MRI. Thickness calculations showed insignificant differences between 3- and 5-month cohorts and was significantly decreased by 9 months of age (P < 0.01). A moderate correlation (R(2) = 0.45) existed between T(1ρ) values and signal intensity of Safranin-O stain.

CONCLUSION

The data presented demonstrate that T(1ρ) MRI is highly reproducible in this spontaneous model of OA and may serve as a noninvasive tool to characterize joint cartilage degeneration during OA. Age-dependent changes, verified with histological measurements of proteoglycan loss, correlated with T(1ρ) across different age groups. T(1ρ) has adequate dynamic range and is sensitive to detect and track the progression of cartilage degeneration in the guinea pig model before gross anatomical changes such as cartilage thinning has occurred. This study presents a technological advancement that would permit longitudinal studies of evaluating disease-modifying therapies useful for treating human OA.

Why radiography should no longer be considered a surrogate outcome measure for longitudinal assessment of cartilage in knee osteoarthritis

Imaging of cartilage has traditionally been achieved indirectly with conventional radiography. Loss of joint space width, or 'joint space narrowing', is considered a surrogate marker for cartilage thinning. However, radiography is severely limited by its inability to visualize cartilage, the difficulty of ascertaining the optimum and reproducible positioning of the joint in serial assessments, and the difficulty of grading joint space narrowing visually. With the availability of advanced magnetic resonance imaging (MRI) scanners, new pulse sequences, and imaging techniques, direct visualization of cartilage has become possible. MRI enables visualization not only of cartilage but also of other important features of osteoarthritis simultaneously. 'Pre-radiographic' cartilage changes depicted by MRI can be measured reliably by a semiquantitative or quantitative approach. MRI enables accurate measurement of longitudinal changes in quantitative cartilage morphology in knee osteoarthritis. Moreover, compositional MRI allows imaging of 'pre-morphologic' changes (that is, visualization of subtle intrasubstance matrix changes before any obvious morphologic alterations occur). Detection of joint space narrowing on radiography seems outdated now that it is possible to directly visualize morphologic and pre-morphologic changes of cartilage by using conventional as well as complex MRI techniques.

MR imaging of articular cartilage physiology

The newer magnetic resonance (MR) imaging methods can give insights into the initiation, progression, and eventual treatment of osteoarthritis. Sodium imaging is specific for changes in proteoglycan (PG) content without the need for an exogenous contrast agent. T1ρ imaging is sensitive to early PG depletion. Delayed gadolinium-enhanced MR imaging has high resolution and sensitivity. T2 mapping is straightforward and is sensitive to changes in collagen and water content. Ultrashort echo time MR imaging examines the osteochondral junction. Magnetization transfer provides improved contrast between cartilage and fluid. Diffusion-weighted imaging may be a valuable tool in postoperative imaging.

The evolution of articular cartilage imaging and its impact on clinical practice

Over the past four decades, articular cartilage imaging has developed rapidly. Imaging now plays a critical role not only in clinical practice and therapeutic decisions but also in the basic research probing our understanding of cartilage physiology and biomechanics.

Solid-state NMR spectroscopy provides atomic-level insights into the dehydration of cartilage

An atomic-level insight into the functioning of articular cartilage would be useful to develop prevention strategies and therapies for joint diseases such as osteoarthritis. However, the composition and structure of cartilage and their relationship to its unique mechanical properties are quite complex and pose tremendous challenges to most biophysical techniques. In this study, we present an investigation of the structure and dynamics of polymeric molecules of articular cartilage using time-resolved solid-state NMR spectroscopy during dehydration. Full-thickness cartilage explants were used in magic-angle spinning experiments to monitor the structural changes of rigid and mobile carbons. Our results reveal that the dehydration reduced the mobility of collagen amino acid residues and carbon sugar ring structures in glycosaminoglycans but had no effect on the trans-Xaa-Pro conformation. Equally interestingly, our results demonstrate that the dehydration effects are reversible, and the molecular structure and mobility are restored upon rehydration.

Osteoarthritis: an update with relevance for clinical practice

Osteoarthritis is thought to be the most prevalent chronic joint disease. The incidence of osteoarthritis is rising because of the ageing population and the epidemic of obesity. Pain and loss of function are the main clinical features that lead to treatment, including non-pharmacological, pharmacological, and surgical approaches. Clinicians recognise that the diagnosis of osteoarthritis is established late in the disease process, maybe too late to expect much help from disease-modifying drugs. Despite efforts over the past decades to develop markers of disease, still-imaging procedures and biochemical marker analyses need to be improved and possibly extended with more specific and sensitive methods to reliably describe disease processes, to diagnose the disease at an early stage, to classify patients according to their prognosis, and to follow the course of disease and treatment effectiveness. In the coming years, a better definition of osteoarthritis is expected by delineating different phenotypes of the disease. Treatment targeted more specifically at these phenotypes might lead to improved outcomes.

Relaxation dispersion in MRI induced by fictitious magnetic fields

A new method entitled Relaxation Along a Fictitious Field (RAFF) was recently introduced for investigating relaxations in rotating frames of rank ≥ 2. RAFF generates a fictitious field (E) by applying frequency-swept pulses with sine and cosine amplitude and frequency modulation operating in a sub-adiabatic regime. In the present work, MRI contrast is created by varying the orientation of E, i.e. the angle ε between E and the z″ axis of the second rotating frame. When ε > 45°, the amplitude of the fictitious field E generated during RAFF is significantly larger than the RF field amplitude used for transmitting the sine/cosine pulses. Relaxation during RAFF was investigated using an invariant-trajectory approach and the Bloch-McConnell formalism. Dipole-dipole interactions between identical (like) spins and anisochronous exchange (e.g., exchange between spins with different chemical shifts) in the fast exchange regime were considered. Experimental verifications were performed in vivo in human and mouse brain. Theoretical and experimental results demonstrated that changes in ε induced a dispersion of the relaxation rate constants. The fastest relaxation was achieved at ε ≈ 56°, where the averaged contributions from transverse components during the pulse are maximal and the contribution from longitudinal components are minimal. RAFF relaxation dispersion was compared with the relaxation dispersion achieved with off-resonance spin lock T(₁ρ) experiments. As compared with the off-resonance spin lock T(₁ρ) method, a slower rotating frame relaxation rate was observed with RAFF, which under certain experimental conditions is desirable.

MRI contrast from relaxation along a fictitious field (RAFF)

A new method to measure rotating frame relaxation and to create contrast for MRI is introduced. The technique exploits relaxation along a fictitious field (RAFF) generated by amplitude- and frequency-modulated irradiation in a subadiabatic condition. Here, RAFF is demonstrated using a radiofrequency pulse based on sine and cosine amplitude and frequency modulations of equal amplitudes, which gives rise to a stationary fictitious magnetic field in a doubly rotating frame. According to dipolar relaxation theory, the RAFF relaxation time constant (T(RAFF)) was found to differ from laboratory frame relaxation times (T(1) and T(2)) and rotating frame relaxation times (T(1ρ) and T(2ρ)). This prediction was supported by experimental results obtained from human brain in vivo and three different solutions. Results from relaxation mapping in human brain demonstrated the ability to create MRI contrast based on RAFF. The value of T(RAFF) was found to be insensitive to the initial orientation of the magnetization vector. In the RAFF method, the useful bandwidth did not decrease as the train length increased. Finally, as compared with an adiabatic pulse train of equal duration, RAFF required less radiofrequency power and therefore can be more readily used for rotating frame relaxation studies in humans.

23Na and 2H magnetic resonance studies of osteoarthritic and osteoporotic articular cartilage

In this study, the short component of the (23)Na T(2) (T(2f)) and the (23)Na and (2)H quadrupolar interactions (nu(Q)) were measured in bone-cartilage samples of osteoarthritic (OA) and osteoporotic (OP) patients. (23)Na nu(Q) was found to increase in osteoarthritic articular cartilage relative to controls. Similar results were found in bovine cartilage following proteoglycan (PG) depletion, a condition that prevails in osteoarthritis. (23)Na nu(Q) and 1/T(2f) for articular cartilage obtained from osteoporotic patients were significantly larger than for control and osteoarthritic cartilage. Decalcification of both human and bovine articular cartilage resulted in an increase of (23)Na nu(Q) and 1/T(2f), showing the same trend as the osteoporotic samples. Differences in the ratio of the intensity of the large (2)H splitting to that of the small one in the calcified zone were also observed. In osteoporosis, this ratio was twice as large as that obtained for both control and osteoarthritic samples. The (2)H and (23)Na results can be interpreted as due to sodium ions and water molecules filling the void created by the calcium depletion and to calcium ions being located in close association with the collagen fibers. To the best of our knowledge, this is the first study reporting differences of NMR parameters in cartilage of osteoporotic patients.

Knee articular cartilage damage in osteoarthritis: analysis of MR image biomarker reproducibility in ACRIN-PA 4001 multicenter trial

PURPOSE

To prospectively determine the reproducibility of quantitative magnetic resonance (MR) imaging biomarkers of the morphology and composition (spin lattice relaxation time in rotating frame [T1-ρ], T2) of knee cartilage in a multicenter multivendor trial involving patients with osteoarthritis (OA) and asymptomatic control subjects.

MATERIALS AND METHODS

This study was HIPAA compliant and approved by the institutional review committees of the participating sites, with written informed consent obtained from all participants. Fifty subjects from five sites who were deemed to have normal knee joints (n = 18), mild OA (n = 16), or moderate OA (n = 16) on the basis of Kellgren-Lawrence scores were enrolled. Each participant underwent four sequential 3-T knee MR imaging examinations with use of the same imager and with 2-63 days (median, 18 days) separating the first and last examinations. Water-excited three-dimensional T1-weighted gradient-echo imaging, T1-ρ imaging, and T2 mapping of cartilage in the axial and coronal planes were performed. Biomarker reproducibility was determined by using intraclass correlation coefficients (ICCs) and root-mean-square coefficients of variation (RMS CVs, expressed as percentages).

RESULTS

Morphometric biomarkers had high reproducibility, with ICCs of 0.989 or greater and RMS CVs lower than 4%. The largest differences between the healthy subjects and the patients with radiographically detected knee OA were those in T1-ρ values, but precision errors were relatively large. Reproducibility of T1-ρ values was higher in the thicker patellar cartilage (ICC range, 0.86-0.93; RMS CV range, 14%-18%) than in the femorotibial joints (ICC range, 0.20-0.84; RMS CV range, 7%-19%). Good to high reproducibility of T2 was observed, with ICCs ranging from 0.61 to 0.98 and RMS CVs ranging from 4% to 14%.

CONCLUSION

MR imaging measurements of cartilage morphology, T2, and patellar T1-ρ demonstrated moderate to excellent reproducibility in a clinical trial network.

Quantitative MRI using T1ρ and T2 in human osteoarthritic cartilage specimens: correlation with biochemical measurements and histology

PURPOSE

A direct correlation between T(1ρ), T(2) and quantified proteoglycan and collagen contents in human osteoarthritic cartilage has yet to be documented. We aimed to investigate the orientation effect on T(1ρ) and T(2) values in human osteoarthritic cartilage and to quantify the correlation between T(1ρ), T(2) vs. biochemical composition and histology in human osteoarthritic cartilage.

MATERIALS AND METHODS

Thirty-three cartilage specimens were collected from patients who underwent total knee arthroplasty due to severe osteoarthritis and scanned with a 3T MR scanner for T(1ρ) and T(2) quantification. Nine specimens were scanned at three different orientations with respect to the B(0): 0°, 90° and 54.7°. Core punches were taken after MRI. Collagen and proteoglycan contents were quantified using biochemical assays. Histology sections were graded using Mankin scores. The correlation between imaging parameters, biochemical contents and histological scores were studied.

RESULTS

Both mean T(1ρ) and T(2) at 54.7° were significantly higher than those measured at 90° and 0°, with T(1ρ) showing less increase compared to T(2). R(1ρ) (1/T(1ρ)) values had a significant but moderate correlation with proteoglycan contents (R=.45, P=.002), while R(2) (1/T(2)) was not correlated with proteoglycan. No significant correlation was found between relaxation times (T(1ρ) or T(2)) and collagen contents. The T(1ρ) values of specimen sections with high Mankin scores were significantly higher than those with low Mankin scores (P<.05).

CONCLUSIONS

Quantitative MRI has a great potential to provide noninvasive imaging biomarkers for cartilage degeneration in osteoarthritis.

Two- and three-dimensional multinuclear stray-field imaging of rotating samples with magic-angle spinning (STRAFI-MAS): from bio to inorganic materials

PURPOSE

To revisit and illustrate the potential of a simple and effective multidimensional stray-field imaging technique with magic-angle spinning, known as STRAFI-MAS.

MATERIALS AND METHODS

STRAFI-MAS images are acquired with a standard NMR magnet and a traditional magic-angle sample spinning (MAS) probe. The stray-field gradients are achieved by placing the MAS probe, along the z-direction, at a distance from the center of the magnet. No pulsed-field gradients are applied. The multidimensional spatial encoding is carried out by synchronizing the radiofrequency pulses with the sample MAS rotation.

RESULTS

Two-dimensional (2D) and 3D multinuclear images of various phantoms, including a tibia bone and silicon carbide, are recorded. Images of inorganic solids containing quadrupolar nuclei, (23)Na and (27)Al, are also explored for the first time by STRAFI-MAS.

CONCLUSION

We have demonstrated that STRAFI-MAS is a simple and user-friendly technique for multidimensional imaging without the need of imaging equipment. With the current advancements in NMR and MRI methodologies, STRAFI-MAS is expected to be further developed and improved. We anticipate that STRAFI-MAS can spark a wide spectrum of interest, from material to bio science, where can benefit from high-resolution images.

Sodium inversion recovery MRI of the knee joint in vivo at 7T

The loss of proteoglycans (PG) in the articular cartilage is an early signature of osteoarthritis (OA). The ensuing changes in the fixed charge density in the cartilage can be directly linked to sodium concentration via charge balance. Sodium ions in the knee joint appear in two pools: in the synovial fluids or joint effusion where the ions are in free motion and bound within the cartilage tissue where the Na(+) ions have a restricted motion. The ions in these two compartments have therefore different T₁ and T₂ relaxation times. The purpose of this study is to demonstrate the feasibility of a fluid-suppressed 3D ultrashort TE radial sodium sequence by implementing an inversion recovery (IR) preparation of the magnetization at 7T. This method could allow a more accurate and more sensitive quantification of loss of PG in patients with OA. It is shown that adiabatic pulses offer significantly improved performance in terms of robustness to B₁ and B₀ inhomogeneities when compared to the hard pulse sequence. Power deposition considerations further pose a limit to the RF inversion power, and we demonstrate in simulations and experiments how a practical compromise can be struck between clean suppression of fluid signals and power deposition levels. Two IR sequences with different types of inversion pulses (a rectangular pulse and an adiabatic pulse) were tested on a liquid phantom, ex vivo on a human knee cadaver and then in vivo on five healthy volunteers, with a (Nyquist) resolution of ∼3.6 mm and a signal-to-noise ratio of ∼30 in cartilage without IR and ∼20 with IR. Due to specific absorption rate limitations, the total acquisition time was ∼17 min for the 3D radial sequence without inversion or with the rectangular IR, and 24:30 min for the adiabatic IR sequence. It is shown that the adiabatic IR sequence generates a more uniform fluid suppression over the whole sample than the rectangular IR sequence.

T1rho (T1ρ) MR imaging in Alzheimer's disease and Parkinson's disease with and without dementia

In the current study, we aim to measure T1rho (T (1ρ)) in the hippocampus in the brain of control, Alzheimer's disease (AD), Parkinson's disease (PD), and PD patients with dementia (PDD), and to determine efficacy of T (1ρ) in differentiating these cohorts. With informed consent, 53 AD patients, 62 PD patients, 11 PDD patients, and 46 age-matched controls underwent a standardized clinical assessment including mini-mental state examination (MMSE) and brain T (1ρ) MRI on a 1.5-T clinical-scanner. T(1ρ) maps were generated by fitting each pixel's intensity as a function of the spin-lock pulse duration. In control, AD, PD and PDD, mean ± SE T (1ρ) values in the right hippocampus (RH) were 92.15 ± 2.00, 99.65 ± 1.98, 85.68 ± 1.87, 102.47 ± 4.66 ms while in the left hippocampus (LH) these values were 90.16 ± 1.82, 99.53 ± 1.91, 84.33 ± 2.03, 95.33 ± 4.64 ms. Significant difference for both RH and LH T (1ρ) across the groups (p < 0.001) was observed. Both RH and LH T (1ρ) were significantly increased in AD compared to control (p = 0.034, p = 0.001) and PD (p < 0.001, p < 0.001). In control, both RH and LH T (1ρ) values were significantly increased compared to PD (p = 0.031, p = 0.027) while compared to PDD only the RH T (1ρ) value was significantly decreased (p = 0.043). Both RH and LH T (1ρ) values in PD were significantly lower than PDD (p = 0.004, p = 0.032). No significant correlation between the T (1ρ) and age as well as between T (1ρ) and MMSE scores was observed. The serial measurement of T(1ρ) in both AD and PD may provide the nature of disease progression and may contribute to their early diagnosis.

Optical imaging: new tools for arthritis

Conventional radiography, ultrasound, CT, MRI, and nuclear imaging are the current imaging modalities used for clinical evaluation of arthritis which is highly prevalent and a leading cause of disability. Some of these types of imaging are also used for monitoring disease progression and treatment response of arthritis. However, their disadvantages limit their utilities, such as ionizing radiation for radiography, CT, and nuclear imaging; suboptimal tissue contrast resolution for radiography, CT, ultrasound, and nuclear imaging; high cost for CT and MRI and nuclear imaging; and long data-acquisition time with ensuing patient discomfort for MRI. Recently, there have been considerable advances in nonionizing noninvasive optical imaging which has demonstrated promise for early diagnosis, monitoring therapeutic interventions and disease progression of arthritis. Optical based molecular imaging modalities such as fluorescence imaging have shown high sensitivity in detection of optical contrast agents and can aid early diagnosis and ongoing evaluation of chronic inflammatory arthritis. Optical transillumination imaging or diffuse optical tomography may differentiate normal joint clear synovial fluid from turbid and pink medium early in the inflammatory process. Fourier transform infrared spectroscopy has been used to evaluate fluid composition from joints affected by arthritis. Hemodynamic changes such as angiogenesis, hypervascularization, and hypoxia in arthritic articular tissue can potentially be observed by diffuse optical tomography and photoacoustic tomography. Optical measurements could also facilitate quantification of hemodynamic properties such as blood volume and oxygenation levels at early stages of inflammatory arthritis. Optical imaging provides methodologies which should contribute to detection of early changes and monitoring of progression in pathological characteristics of arthritis, with relatively simple instrumentation.

Contrast STRAFI-MAS imaging

We demonstrate the possibility of multidimensional contrast (T(1)-, T(2)-weighted and triple-quantum filtered) magnetic resonance imaging using a simple and effective solid-state NMR technique, stray-field imaging with sample magic-angle spinning (STRAFI-MAS). This imaging technique can be easily implemented in today's standard solid-state NMR laboratory, making it a potentially valuable imaging application to material science.

Imaging cartilage physiology

Osteoarthritis (OA) is a common disease that results in cartilage degeneration in the joints and is a disabling condition for millions of individuals. Poor sensitivity and specificity of standard diagnostic methods have relegated treatment options to mitigating pain or surgical replacement. The advent of disease-modifying drugs holds the potential for reversing the normal course of OA and rebuilding cartilage. To aid these therapies, novel magnetic resonance imaging-based tools are required for detecting subtle early changes in cartilage physiology due to OA that may provide improved diagnoses and clinical management of patients. Some of the techniques reviewed here such as T1ρ and T2 relaxometry, magnetization transfer, chemical exchange saturation transfer, and Na magnetic resonance imaging are all biomarkers of cartilage pathological diseases that are sensitive to early biochemical changes in the extracellular matrix of cartilage. These techniques have the potential to noninvasively detect early pathological changes with the goal of aiding clinical decision making as well as contributing to the development and evaluation of potential disease-modifying therapies.

Quadrupolar-coupling-specific binomial pulse sequences for in vivo 23Na NMR and MRI

Aimed at selective detection of (23)Na with specific quadrupolar couplings for in vitro NMR and MRI, we present a series of quadrupolar binomial pulse sequences offering high specificity with respect to the quadrupolar couplings of the excited species. It is demonstrated that pulse sequences with an increasing number of elements, e.g., 11, 121, 1331, 14641, and 15101051, with the units representing flip angles smaller than the 90 degrees pulses typically encountered in binomial spin-1/2 solvent suppression experiments, and different phase combinations may provide a high degree of flexibility with respect to quadrupolar coupling selectivity and robustness towards rf inhomogeneity. This may facilitate efficient separation of, for example, intra and extracellular (23)Na in tissues with efficient control of the excitation (or suppression) of central as well as satellite transitions through on- and off-resonance irradiation. The pulse sequences are described in terms of their analogy to binomial liquid-state NMR solvent suppression experiments and demonstrated numerically and experimentally through NMR and MRI experiments on a 7 T horizontal small-bore animal magnet system.

23Na MR imaging at 7 T after knee matrix-associated autologous chondrocyte transplantation preliminary results

PURPOSE

To evaluate the feasibility of sodium 7-T magnetic resonance (MR) imaging in repaired tissue and native cartilage of patients after matrix-associated autologous chondrocyte transplantation (MACT) and compare results with delayed gadolinium-enhanced MR imaging of cartilage (dGEMRIC) at 3 T.

MATERIALS AND METHODS

Ethical approval was provided by the local ethics committee; written informed consent was obtained from all patients. Six women and six men (mean age, 32.8 year ± 8.2 [standard deviation] and 32.3 years ± 12.7, respectively) were included. Mean time between MACT and MR was 56 months ± 28. A variable three-dimensional (3D) gradient-echo (GRE) dual-flip-angle technique was used for T1 mapping before and after contrast agent administration at 3 T. All patients were also examined at 7 T (mean delay, 70.5 days ± 80.1). A sodium 23-only transmit-receive knee coil was used with the 3D GRE sequence. A statistical analysis of variance and Pearson correlation were applied.

RESULTS

Mean signal-to-noise ratio (SNR) was 24 in native cartilage and was 16 in transplants (P < .001). Mean sodium signal intensities normalized with the reference sample were 174 ± 53 and 267 ± 42 for repaired tissue in the cartilage transplant and healthy cartilage, respectively (P < .001). Mean postcontrast T1 values were 510 msec ± 195 and 756 msec ± 188 for repaired tissue and healthy cartilage, respectively (P = .005). Mean score of MR observation of cartilage repair tissue was 75 ± 14. Association between postcontrast T1 and normalized sodium signal values showed a high Pearson correlation coefficient (R) of 0.706 (P = .001). A high correlation of R = 0.836 (P = .001) was found between ratios of normalized sodium values and ratios of T1 postcontrast values.

CONCLUSION

With the modified 3D GRE sequence at 7 T, a sufficiently high SNR in sodium images was achieved, allowing for differentiation of repaired tissue from native cartilage after MACT. A strong correlation was found between sodium imaging and dGEMRIC in patients after MACT.

T1rho MRI quantification of arthroscopically confirmed cartilage degeneration

Nine asymptomatic subjects and six patients underwent T(1)rho MRI to determine whether Outerbridge grade 1 or 2 cartilage degeneration observed during arthroscopy could be detected noninvasively. MRI was performed 2-3 months postarthroscopy, using sagittal T(1)-weighted and axial and coronal T(1)rho MRI, from which spatial T(1)rho relaxation maps were calculated from segmented T(1)-weighted images. Median T(1)rho relaxation times of patients with arthroscopically documented cartilage degeneration and asymptomatic subjects were significantly different (P < 0.001), and median T(1)rho exceeded asymptomatic articular cartilage median T(1)rho by 2.5 to 9.2 ms. In eight observations of mild cartilage degeneration at arthroscopy (Outerbridge grades 1 and 2), mean compartment T(1)rho was elevated in five, but in all observations, large foci of increased T(1)rho were observed. It was determined that T(1)rho could detect some, but not all, Outerbridge grade 1 and 2 cartilage degeneration but that a larger patient population is needed to determine the sensitivity to these changes.

Diagnostic Modalities for Diseased Articular Cartilage-From Defect to Degeneration: A Review

The progression of cartilage matrix damage to generalized degeneration is associated with specific pathophysiological and clinical aspects. Reliable detection of stage-related characteristics of cartilage disease serves both a therapeutic and prognostic goal. Over the past years, several (pre)clinical diagnostic modalities for cartilage pathologies have been advocated. Each modality focuses on different aspects of the disease. Early diagnosis, before irreversible damage has occurred, opens up the possibility for better treatment and improves the patients' prognosis. This article gives an overview of the diagnostic modalities available for monitoring cartilage pathology and focuses on reliability, clinical value, current status, and possible applications.

Monitoring of the effect of intervertebral disc nucleus pulposus ablation by MRI

In order to investigate intervertebral disc (IVD) degeneration and repair, a quantitative non-invasive tool is needed. Various MRI methods including qCPMG, which yields dipolar echo relaxation time (T(DE)), magnetization transfer contrast (MTC), and (1)H and (2)H double quantum filtered (DQF) MRI were used in the present work to monitor changes in rat IVD after ablation of the nucleus pulposus (NP), serving as a model of severe IVD degeneration. In the intact IVD, a clear distinction between the annulus fibrosus (AF) and the NP is obtained on T(2) and T(DE) weighted images as well as on MTC maps, reflecting the high concentration of ordered collagen fibers in the AF. After ablation of the NP, the distinction between the compartments is lost. T(2) and T(DE) relaxation times are short throughout the disc and MTC is high. (1)H and (2)H DQF signal, which in intact discs is obtained only for the AF, is now observable throughout the tissue. These results indicate that after ablation, there is an ingression of collagen fibers from the AF into the area that was previously occupied by the NP, as was confirmed by histology.

Longitudinal assessment of bone marrow edema-like lesions and cartilage degeneration in osteoarthritis using 3 T MR T1rho quantification

OBJECTIVE

To quantitatively assess the relationship between bone marrow edema-like lesions (BMELs) and the associated cartilage in knee osteoarthritis (OA) using T(1rho) quantification at 3 T MRI.

MATERIALS AND METHODS

Twenty-four patients with knee OA and 14 control subjects underwent 3 T MRI. Nineteen patients and all control subjects had 1-year follow-up studies. The volume and signal intensity difference of BMELs were calculated. Cartilage degeneration was graded using the cartilage subscore of Whole-Organ MRI Score (WORMS) analysis. Cartilage T(1rho) values were calculated in each compartment as well as in cartilage overlying BMELs (OC) and surrounding cartilage (SC).

RESULTS

At baseline, 25 BMELs were found in 16 out of 24 patients. The overall T(1rho) values were significantly higher in patients with BMELs than in those without BMELs. At baseline and follow-up, both T(1rho) values and WORMS cartilage subscore grading were significantly higher in OC than SC. Cartilage T(1rho) increase from baseline to follow-up in OC was significantly higher than that in SC. An increase in T(1rho) values in OC was correlated with signal intensity of BMEL at both baseline and follow-up, but was not correlated with BMEL volume.

CONCLUSIONS

The results of this study suggest a local spatial correlation between BMELs and more advanced and accelerated cartilage degeneration. MRI T(1rho) quantification in cartilage provides a sensitive tool for evaluating such correlations.

Biochemical and physiological MR imaging of skeletal muscle at 7 tesla and above

Ultra-high field (UHF; >or=7 T) magnetic resonance imaging (MRI), with its greater signal-to-noise ratio, offers the potential for increased spatial resolution, faster scanning, and, above all, improved biochemical and physiological imaging of skeletal muscle. The increased spectral resolution and greater sensitivity to low-gamma nuclei available at UHF should allow techniques such as (1)H MR spectroscopy (MRS), (31)P MRS, and (23)Na MRI to be more easily implemented. Numerous technical challenges exist in the performance of UHF MRI, including changes in relaxation values, increased chemical shift and susceptibility artifact, radiofrequency (RF) coil design/B (1)(+) field inhomogeneity, and greater RF energy deposition. Nevertheless, the possibility of improved functional and metabolic imaging at UHF will likely drive research efforts in the near future to overcome these challenges and allow studies of human skeletal muscle physiology and pathophysiology to be possible at >or=7 T.

Imaging of lower limb cartilage

The cartilage of the lower limb joints is exposed to high levels of mechanical stress and therefore is a frequent site of degenerative and traumatic lesions. Magnetic resonance imaging (MRI) is the modality of choice for the assessment of these cartilage lesions. To date, clinically available sequences have focused on morphological defects and cartilage loss. Efforts have been made in recent years to depict cartilage lesions at an earlier stage, with new quantitative sequences focusing on the biochemical assessment of tissue.After a brief review of the hyaline cartilage structure, we review the current morphological imaging methods and the biochemical MRI techniques to assess the cartilage. We then illustrate the application of these MRI sequences for the most common degenerative and traumatic disorders affecting lower limb cartilage.

Rapid isotropic 3D-sodium MRI of the knee joint in vivo at 7T

PURPOSE

To demonstrate the feasibility of acquiring high-resolution, isotropic 3D-sodium magnetic resonance (MR) images of the whole knee joint in vivo at ultrahigh field strength (7.0T) via a 3D-radial acquisition with ultrashort echo times and clinically acceptable acquisition times.

MATERIALS AND METHODS

Five healthy controls (four males, one female; mean +/- standard deviation [SD] age 28.7 +/- 4.8 years) and five patients with osteoarthritis (OA) (three males, two females; mean +/- SD age 52.4 +/- 5.6 years) underwent (23)Na MRI on a 7T, multinuclei equipped whole-body scanner. A quadrature (23)Na knee coil and a 3D-gradient echo (GRE) imaging sequence with a radial acquisition were utilized. Cartilage sodium concentration was measured and compared between the healthy controls and OA patients.

RESULTS

The average signal-to-noise ratio (SNR) for different spatial resolutions (1.2-4 mm) varied from approximately 14-120, respectively. The mean sodium concentration of healthy subjects ranged from approximately 240 +/- 28 mM/L to 280 +/- 22 mM/L. However, in OA patients the sodium concentrations were reduced significantly by approximately 30%-60%, depending on the degree of cartilage degeneration.

CONCLUSION

The preliminary results suggest that sodium imaging at 7T may be a feasible potential alternative for physiologic OA imaging and clinical diagnosis.

Multimodal approach in the use of clinical scoring, morphological MRI and biochemical T2-mapping and diffusion-weighted imaging in their ability to assess differences between cartilage repair tissue after microfracture therapy and matrix-associated autologous chondrocyte transplantation: a pilot study

OBJECTIVE

The aim of the present pilot study is to show initial results of a multimodal approach using clinical scoring, morphological magnetic resonance imaging (MRI) and biochemical T2-relaxation and diffusion-weighted imaging (DWI) in their ability to assess differences between cartilage repair tissue after microfracture therapy (MFX) and matrix-associated autologous chondrocyte transplantation (MACT).

METHOD

Twenty patients were cross-sectionally evaluated at different post-operative intervals from 12 to 63 months after MFX and 12-59 months after MACT. The two groups were matched by age (MFX: 36.0+/-10.4 years; MACT: 35.1+/-7.7 years) and post-operative interval (MFX: 32.6+/-16.7 months; MACT: 31.7+/-18.3 months). After clinical evaluation using the Lysholm score, 3T-MRI was performed obtaining the MR observation of cartilage repair tissue (MOCART) score as well as T2-mapping and DWI for multi-parametric MRI. Quantitative T2-relaxation was achieved using a multi-echo spin-echo sequence; semi-quantitative diffusion-quotient (signal intensity without diffusion-weighting divided by signal intensity with diffusion weighting) was prepared by a partially balanced, steady-state gradient-echo pulse sequence.

RESULTS

No differences in Lysholm (P=0.420) or MOCART (P=0.209) score were observed between MFX and MACT. T2-mapping showed lower T2 values after MFX compared to MACT (P=0.039). DWI distinguished between healthy cartilage and cartilage repair tissue in both procedures (MFX: P=0.001; MACT: P=0.007). Correlations were found between the Lysholm and the MOCART score (Pearson: 0.484; P=0.031), between the Lysholm score and DWI (Pearson:-0.557; P=0.011) and a trend between the Lysholm score and T2 (Person: 0.304; P=0.193).

CONCLUSION

Using T2-mapping and DWI, additional information could be gained compared to clinical scoring or morphological MRI. In combination clinical, MR-morphological and MR-biochemical parameters can be seen as a promising multimodal tool in the follow-up of cartilage repair.

Spatial distribution and relationship of T1rho and T2 relaxation times in knee cartilage with osteoarthritis

T(1rho) and T(2) relaxation time constants have been proposed to probe biochemical changes in osteoarthritic cartilage. This study aimed to evaluate the spatial correlation and distribution of T(1rho) and T(2) values in osteoarthritic cartilage. Ten patients with osteoarthritis (OA) and 10 controls were studied at 3T. The spatial correlation of T(1rho) and T(2) values was investigated using Z-scores. The spatial variation of T(1rho) and T(2) values in patellar cartilage was studied in different cartilage layers. The distribution of these relaxation time constants was measured using texture analysis parameters based on gray-level co-occurrence matrices (GLCM). The mean Z-scores for T(1rho) and T(2) values were significantly higher in OA patients vs. controls (P < 0.05). Regional correlation coefficients of T(1rho) and T(2) Z-scores showed a large range in both controls and OA patients (0.2-0.7). OA patients had significantly greater GLCM contrast and entropy of T(1rho) values than controls (P < 0.05). In summary, T(1rho) and T(2) values are not only increased but are also more heterogeneous in osteoarthritic cartilage. T(1rho) and T(2) values show different spatial distributions and may provide complementary information regarding cartilage degeneration in OA.

Current concepts in imaging diabetic pedal osteomyelitis

Diabetic pedal osteomyelitis is primarily a manifestation of vascular insufficiency with resultant tissue ischemia, neuropathy, and infection. Nearly all cases of pedal osteomyelitis arise from a contiguous ulcer and soft tissue infection. MR imaging is the modality of choice to assess for the presence of osteomyelitis and associated soft tissue complications, to guide patient management, and to aid in limited limb resection.

Sodium MR imaging detection of mild Alzheimer disease: preliminary study

BACKGROUND AND PURPOSE

There is significant interest in the development of novel noninvasive techniques for the diagnosis of Alzheimer disease (AD) and tracking its progression. Because MR imaging has detected alterations in sodium levels that correlate with cell death in stroke, we hypothesized that there would be alterations of sodium levels in the brains of patients with AD, related to AD cell death.

MATERIALS AND METHODS

A total of 10 volunteers (5 with mild AD and 5 healthy control subjects) were scanned with a 20-minute sodium (23Na) MR imaging protocol on a 3T clinical scanner.

RESULTS

After normalizing the signal intensity from the medial temporal lobes corresponding to the hippocampus with the ventricular signal intensity, we were able to detect a 7.5% signal intensity increase in the brains of patients with AD (AD group, 68.25% +/- 3.4% vs control group, 60.75% +/- 2.9%; P < .01). This signal intensity enhancement inversely correlated with hippocampal volume (AD group, 3.22 +/- 0.50 cm3 vs control group, 3.91 +/- 0.45 cm3; r2 = 0.50).

CONCLUSIONS

This finding suggests that sodium imaging may be a clinically useful tool to detect the neuropathologic changes associated with AD.

Toward imaging biomarkers for glycosaminoglycans

Advances in the diagnosis and treatment of cartilage degeneration will be accelerated with the availability of validated biomarkers that reveal the features relevant to the health of cartilage. Using the delayed gadolinium-enhanced magnetic resonance imaging of cartilage (dGEMRIC) technique for evaluating tissue glycosaminoglycan as a case study, I review the types of evidence needed to validate imaging (or other) biomarkers. In addition, I present discussions about face validity and technical validity and offer a review of emerging data that provide pathophysiologic validity. Examples of such data include evidence that glycosaminoglycan content is restored after an injury-induced loss and evidence suggesting that dGEMRIC can indicate when it is too late for protective (load-modifying) surgery. These and other data suggest that new imaging biomarkers may indeed be able to provide a state-of-cartilage proxy that can be of use in the diagnosis and staging of disease.

Use of routine clinical multimodality imaging in a rabbit model of osteoarthritis--part I

OBJECTIVE

To evaluate in vivo the evolution of osteoarthritis (OA) lesions temporally in a rabbit model of OA with clinically available imaging modalities: computed radiography (CR), helical single-slice computed tomography (CT), and 1.5 tesla (T) magnetic resonance imaging (MRI).

METHODS

Imaging was performed on knees of anesthetized rabbits [10 anterior cruciate ligament transection (ACLT) and contralateral sham joints and six control rabbits] at baseline and at intervals up to 12 weeks post-surgery. Osteophytosis, subchondral bone sclerosis, bone marrow lesions (BMLs), femoropatellar effusion and articular cartilage were assessed.

RESULTS

CT had the highest sensitivity (90%) and specificity (91%) to detect osteophytes. A significant increase in total joint osteophyte score occurred at all time-points post-operatively in the ACLT group alone. BMLs were identified and occurred most commonly in the lateral femoral condyle of the ACLT joints and were not identified in the tibia. A significant increase in joint effusion was present in the ACLT joints until 8 weeks after surgery. Bone sclerosis or cartilage defects were not reliably assessed with the selected imaging modalities.

CONCLUSION

Combined, clinically available CT and 1.5 T MRI allowed the assessment of most of the characteristic lesions of OA and at early time-points in the development of the disease. However, the selected 1.5 T MRI sequences and acquisition times did not permit the detection of cartilage lesions in this rabbit OA model.

Osteoarthritis: current role of imaging

Osteoarthritis (OA) is the most prevalent joint disease; it is increasingly common in the aging population of Western society and has a major health economic impact. Despite surgery and symptom-oriented approaches there is no efficient treatment. Conventional radiography has played a role in the past in confirming diagnosis and demonstrating late bony changes and joint space narrowing. MRI has become the method of choice in large research endeavors and may become important for individualized treatment planning. This article focuses on radiography and MRI, with insight into other modalities, such as ultrasound, scintigraphy, and CT. Their role in OA diagnosis, follow-up, and research is discussed.