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

Analysis of blurring due to short T2 decay at different resolutions in 23Na MRI

The nuclear magnetic resonance signal from sodium (23Na) nuclei demonstrates a fast bi-exponential T2 decay in biological tissues (T2,short = 0.5-5 ms and T2,long = 10-30 ms). Hence, blurring observed in sodium images acquired with center-out sequences is generally assumed to be dominated by signal attenuation at higher k-space frequencies. Most of the studies in the field primarily focus on the impact of readout duration on blurring but neglect the impact of resolution. In this paper, we examine the blurring effect of short T2 on images at different resolutions. A series of simulations, as well as phantom and in vivo scans were performed at varying resolutions and readout durations in order to evaluate progressive changes in image quality. We demonstrate that, given a fixed readout duration, T2 decay produces distinct blurring effects at different resolutions. Therefore, in addition to voxel size-dependent partial volume effects, the choice of resolution adds additional T2-dependent blurring.

Changes in tissue sodium concentration and sodium relaxation times during the maturation of human knee cartilage: Ex vivo 23 Na MRI study at 10.5 T

PURPOSE

To evaluate the influence of skeletal maturation on sodium (23 Na) MRI relaxation parameters and the accuracy of tissue sodium concentration (TSC) quantification in human knee cartilage.

METHODS

Twelve pediatric knee specimens were imaged with whole-body 10.5 T MRI using a density-adapted 3D radial projection sequence to evaluate 23 Na parameters: B1 + , T1 , biexponentialT 2 * $$ {\mathrm{T}}_2^{\ast } $$ , and TSC. Water, collagen, and sulfated glycosaminoglycan (sGAG) content were calculated from osteochondral biopsies. The TSC was corrected for B1 + , relaxation, and water content. The literature-based TSC (TSCLB ) used previously published values for corrections, whereas the specimen-specific TSC (TSCSP ) used measurements from individual specimens. 23 Na parameters were evaluated in eight cartilage compartments segmented on proton images. Associations between 23 Na parameters, TSCLB  - TSCSP difference, biochemical content, and age were determined.

RESULTS

From birth to 12 years, cartilage water content decreased by 18%; collagen increased by 59%; and sGAG decreased by 36% (all R2  ≥ 0.557). The shortT 2 * $$ {\mathrm{T}}_2^{\ast } $$ (T 2 * S $$ {{\mathrm{T}}_2^{\ast}}_{\mathrm{S}} $$ ) decreased by 72%, and the signal fraction relaxing withT 2 * S $$ {{\mathrm{T}}_2^{\ast}}_{\mathrm{S}} $$ (fT 2 * S $$ {{\mathrm{fT}}_2^{\ast}}_{\mathrm{S}} $$ ) increased by 55% during the first 5 years but remained relatively stable after that. TSCSP was significantly correlated with sGAG content from biopsies (R2  = 0.739). Depending on age, TSCLB showed higher or lower values than TSCSP . The TSCLB  - TSCSP difference was significantly correlated withT 2 * S $$ {{\mathrm{T}}_2^{\ast}}_{\mathrm{S}} $$ (R2  = 0.850),fT 2 * S $$ {{\mathrm{fT}}_2^{\ast}}_{\mathrm{S}} $$ (R2  = 0.651), and water content (R2  = 0.738).

CONCLUSION

TSC and relaxation parameters measured with 23 Na MRI provide noninvasive information about changes in sGAG content and collagen matrix during cartilage maturation. Cartilage TSC quantification assuming fixed relaxation may be feasible in children older than 5 years.

Simultaneous 3D acquisition of 1 H MRF and 23 Na MRI

PURPOSE

To develop a 3D MR technique to simultaneously acquire proton multiparametric maps (T₁ , T₂ , and proton density) and sodium density weighted images over the whole brain.

METHODS

We implemented a 3D stack-of-stars MR pulse sequence which consists of interleaved proton (¹ H) and sodium (²³ Na) excitations, tailored slice encoding gradients that can encode the same slice for both nuclei, and simultaneous readout with different radial trajectories (¹ H, full-radial; ²³ Na, center-out radial). The receive chain of our 7T scanner was modified to enable simultaneous acquisition of ¹ H and ²³ Na signal. A heuristically optimized flip angle train was implemented for proton MR fingerprinting (MRF). The SNR and the accuracy of proton T₁ and T₂ were evaluated in phantoms. Finally, in vivo application of the method was demonstrated in five healthy subjects.

RESULTS

The SNR for the simultaneous measurement was almost identical to that for the single-nucleus measurements (<2% change). The proton T₁ and T₂ maps remained similar to the results from a reference 2D MRF technique (normalized RMS error in T₁ ≈ 4.2% and T₂ ≈ 11.3%). Measurements in healthy subjects corroborated these results and demonstrated the feasibility of our method for in vivo application. The in vivo T₁ values measured using our method were lower than the results measured by other conventional techniques.

CONCLUSIONS

With the 3D simultaneous implementation, we were able to acquire sodium and proton density weighted images in addition to proton T₁ , T₂ , and B1+ from ¹ H MRF that covers the whole brain volume within 21 min.

Emerging role of integrated PET-MRI in osteoarthritis

Osteoarthritis (OA) is a common degenerative disorder of the articular cartilage, which is associated with hypertrophic changes in the bone, synovial inflammation, subchondral sclerosis, and joint space narrowing (JSN). Radiography remains the first line of imaging till now. Due to the lack of soft-tissue depiction in radiography, researchers are exploring various imaging techniques to detect OA at an early stage and understand its pathophysiology to restrict its progression and discover disease-modifying agents in OA. As the OA relates to the degradation of articular cartilage and remodeling of the underlying bone, an optimal imaging tool must be sensitive to the bone and soft tissue health. In that line, many non-invasive imaging and minimally invasive techniques have been explored. Out of these, the non-invasive compositional magnetic resonance imaging (MRI) for evaluation of the integrity of articular cartilage and positron emission tomography (PET) scan with fluorodeoxyglucose (FDG) and more specific bone-seeking tracer like sodium fluoride (18F-NaF) for bone cartilage interface are some of the leading areas of ongoing work. Integrated PET-MRI system, a new hybrid modality that combines the virtues of the above two individual modalities, allows detailed imaging of the entire joint, including soft tissue cartilage and bone, and holds great potential to research complex disease processes of OA. This narrative review attempts to signify individual characteristics of MRI, PET, the fusion of these characteristics in PET-MRI, and the ongoing research on PET-MRI as a potential tool to understand the pathophysiology of OA.

Review of Quantitative Knee Articular Cartilage MR Imaging

Osteoarthritis (OA) is one of the most prevalent disorders in today’s society, resulting in significant socio-economic costs and morbidity. MRI is widely used as a non-invasive imaging tool for OA of the knee. However, conventional knee MRI has limitations to detect subtle early cartilage degeneration before morphological changes are visually apparent. Novel MRI pulse sequences for cartilage assessment have recently received increased attention due to newly developed compositional MRI techniques, including: T2 mapping, T1rho mapping, delayed gadolinium-enhanced MRI of cartilage (dGEMRIC), sodium MRI, diffusion-weighted imaging (DWI)/ diffusion tensor imaging (DTI), ultrashort TE (uTE), and glycosaminoglycan specific chemical exchange saturation transfer (gagCEST) imaging. In this article, we will first review these quantitative assessments. Then, we will discuss the variations of quantitative values of knee articular cartilage with cartilage layer (depth)- and angle (regional)-dependent approaches. Multiple MRI sequence techniques can discern qualitative differences in knee cartilage. Normal articular hyaline cartilage has a zonal variation in T2 relaxation times with increasing T2 values from the subchondral bone to the articular surface. T1rho values were also higher in the superficial layer than in the deep layer in most locations in the medial and lateral femoral condyles, including the weight-bearing portion. Magic angle effect on T2 mapping is clearly observed in the both medial and lateral femoral condyles, especially within the deep layers. One of the limitations for clinical use of these compositional assessments is a long scan time. Recent new approaches with compressed sensing (CS) and MR fingerprinting (MRF) have potential to provide accurate and fast quantitative cartilage assessments.

Can sodium MRI be used as a method for mapping of cartilage stiffness?

Objective

Sodium concentration is responsible for (at least part of) the stiffness of articular cartilage due to the osmotic pressure it generates. Therefore, we hypothesized that we could use sodium MRI to approximate the stiffness of cartilage to assess early cartilage degeneration.

Methods

Four human tibial plateaus were retrieved from patients undergoing total knee replacement (TKR), and their cartilage stiffness mapped with indentation testing, after which samples were scanned in a 7 T MRI to determine sodium concentration. The relation of biomechanical parameters to MRI sodium and glycosaminoglycan (GAG) concentration was explored by a linear mixed model.

Results

Weak correlations of GAG concentration with apparent peak modulus (p = 0.0057) and apparent equilibrium modulus (p = 0.0181) were observed and lack of correlation of GAG concentration versus MRI sodium concentration was observed. MRI sodium concentration was not correlated with apparent peak modulus, though a moderate correlation of MRI sodium concentration with permeability was shown (p = 0.0014).

Discussion and conclusion

Although there was correlation between GAG concentration and cartilage stiffness, this was not similar with sodium concentration as measured by MRI. Thus, if the correlation between MRI sodium imaging and GAG concentration could be resolved, this strategy for assessing cartilage functional quality still holds promise.

Electronic supplementary material

The online version of this article (10.1007/s10334-020-00893-x) contains supplementary material, which is available to authorized users.

Musculoskeletal MRI at 7 T: do we need more or is it more than enough?

Ultra-high field magnetic resonance imaging (UHF-MRI) provides important diagnostic improvements in musculoskeletal imaging. The higher signal-to-noise ratio leads to higher spatial and temporal resolution which results in improved anatomic detail and higher diagnostic confidence. Several methods, such as T2, T2*, T1rho mapping, delayed gadolinium-enhanced, diffusion, chemical exchange saturation transfer, and magnetisation transfer techniques, permit a better tissue characterisation. Furthermore, UHF-MRI enables in vivo measurements by low-γ nuclei (²³Na, ³¹P, ¹³C, and ³⁹K) and the evaluation of different tissue metabolic pathways. European Union and Food and Drug Administration approvals for clinical imaging at UHF have been the first step towards a more routinely use of this technology, but some drawbacks are still present limiting its widespread clinical application. This review aims to provide a clinically oriented overview about the application of UHF-MRI in the different anatomical districts and tissues of musculoskeletal system and its pros and cons. Further studies are needed to consolidate the added value of the use of UHF-MRI in the routine clinical practice and promising efforts in technology development are already in progress.

Sodium MRI of human articular cartilage of the wrist: a feasibility study on a clinical 3T MRI scanner

OBJECTIVE

To measure sodium relaxation times and concentrations in human wrists on a clinical magnetic resonance imaging (MRI) scanner with a density-adapted radial sequence.

MATERIALS AND METHODS

Sodium MRI of human wrists was conducted on a 3T MR system using a dual-tuned ¹H/²³Na surface coil. We performed two studies with 10 volunteers each investigating either sodium T₁ (study 1) or sodium T₂* (study 2) relaxation times in the radiocarpal joint (RCJ) and midcarpal joint (MCJ). Sodium concentrations of both regions were determined.

RESULTS

No differences for transversal of longitudinal relaxation times were found between RCJ and MCJ (T_2,s*(RCJ) = (0.9 ± 0.4) ms; T_2,s*(MCJ) = (0.9 ± 0.3) ms; T_2,l*(RCJ) = (14.9 ± 0.9) ms; T_2,l*(MCJ) = (13.9 ± 1.1) ms; T₁(RCJ) = (19.0 ± 2.4) ms; T₁(MCJ) = (18.5 ± 2.1) ms). Sodium concentrations were (157.7 ± 28.4) mmol/l for study 1 and (159.8 ± 29.1) mmol/l for study 2 in the RCJ, and (172.7 ± 35.6) mmol/l for study 1 and (163.4 ± 26.3) mmol/l for study 2 in the MCJ.

CONCLUSION

We successfully determined sodium relaxation times and concentrations of the human wrist on a 3T MRI scanner.

Simultaneous proton magnetic resonance fingerprinting and sodium MRI

PURPOSE

The goal of this work is to demonstrate a method for the simultaneous acquisition of proton multiparametric maps (T1 , T2 , and proton density) and sodium density images in 1 single scan. We hope that the development of such capabilities will help to ease the implementation of sodium MRI in clinical trials and provide more opportunities for researchers to investigate metabolism through sodium MRI.

METHODS

We developed a sequence based on magnetic resonance fingerprinting (MRF), which contains interleaved proton (1 H) and sodium (23 Na) excitations followed by a simultaneous center-out radial readout for both nuclei. The receive chain of a 7T scanner was modified to enable simultaneous acquisition of 1 H and 23 Na signal. The obtained signal-to-noise ratio (SNR) was evaluated, and the accuracy of both proton T1 , T2 , and B 1 + and sodium density maps were verified in phantoms. Finally, the method was demonstrated in 2 healthy subjects.

RESULTS

The SNR obtained using the simultaneous measurement was almost identical to single-nucleus measurements (<1% change). Similarly, the proton T1 and T2 maps remained stable (normalized root mean square error in T1 ≈ 2.2%, in T2 ≈ 1.4%, and B 1 + ≈ 5.4%), which indicates that the proposed sequence and hardware have no significant effects on the signal from either nucleus. In vivo measurements corroborated these results and demonstrated the feasibility of our method for in vivo application.

CONCLUSIONS

With the proposed approach, we were able to simultaneously acquire sodium density images in addition to proton T1 , T2 , and B 1 + maps as well as proton density images.

Magnetic Resonance Imaging of the Musculoskeletal System at 7T: Morphological Imaging and Beyond

In 2017, a whole-body 7T magnetic resonance imaging (MRI) device was given regulatory approval for clinical use in both the EU and United States for neuro and musculoskeletal applications. As 7 Tesla allows for higher signal-to-noise , which results in higher resolution images than those obtained on lower-field-strength scanners, it has attracted considerable attention from the musculoskeletal field, as evidenced by the increasing number of publications in the last decade. Besides morphological imaging, the quantitative MR methods, such as T₂, T₂∗, T_1ρ mapping, sodium imaging, chemical-exchange saturation transfer, and spectroscopy, substantially benefit from ultrahigh field scanning. In this review, we provide technical considerations for the individual techniques and an overview of (mostly) clinical applications for the assessment of cartilage, tendon, meniscus, and muscle. The first part of the review is dedicated to morphological applications at 7T, and the second part describes the most recent developments in quantitative MRI at 7T.

[Biochemical cartilage imaging-update 2019]

BACKGROUND

Cartilage imaging using magnetic resonance imaging (MRI) is increasingly used for early detection of cartilage damage. Biochemical MR methods to assess cartilage damage are essential for optimal treatment planning.

PURPOSE

The aim of this review is to provide an update on advanced cartilage imaging based on biochemical MR techniques. The clinical applications and additional benefits compared to conventional MRI are presented.

MATERIALS AND METHODS

A literature search of PubMed regarding the clinical applications of various biochemical MR methods and morphological MR imaging was performed.

RESULTS

While T2 mapping can be easily implemented on clinical routine MR scanners, the T1rho method is technically more demanding and is not available on all MR scanners. dGEMRIC, which can be performed with all field strengths, is now severely restricted due to the recent decision of the European Medical Agency (EMA) to withdraw linear gadolinium contrast agents from the market because of proven gadolinium deposition in the brain. Sodium imaging is the most sensitive MRI method for glycosaminoglycan (GAG), but is limited to 7 T. In addition to early diagnosis of cartilage degeneration before morphological changes are visible, biochemical MRI offers predictive markers, e.g., effect of lifestyle changes or assessing results of cartilage repair surgery.

CONCLUSION

Cartilage imaging based on biochemical MRI allows a shift from qualitative to quantitative MRI. Biochemical MRI plays an increasingly important role in the early diagnosis of cartilage degeneration for monitoring of disease-modifying drugs and as predictive imaging biomarker in clinical diagnostics. In cartilage repair, monitoring of the efficacy of different cartilage repair surgery techniques to develop hyaline-like cartilage can be performed with biochemical MRI.

Tissue sodium concentration and sodium T1 mapping of the human brain at 3 T using a Variable Flip Angle method

PURPOSE

The state-of-the-art method to quantify sodium concentrations in vivo consists in a fully relaxed 3D spin-density (SD) weighted acquisition. Nevertheless, most sodium MRI clinical studies use short-TR SD acquisitions to reduce acquisition durations. We present a clinically viable implementation of the Variable Flip Angle (VFA) method for robust and clinically viable quantification of total sodium concentration (TSC) and longitudinal relaxation rates in vivo in human brain at 3 T.

METHODS

Two non-Cartesian steady-state spoiled ultrashort echo time (UTE) scans, performed at optimized flip angles, repetition time and pulse length determined under specific absorption rate constraints, are used to simultaneously compute T₁ and total sodium concentration (TSC) maps using the VFA method. Images are reconstructed using the non-uniform Fast Fourier Transform algorithm and TSC maps are corrected for possible inhomogeneity of coil transmission and reception profiles. Fractioned acquisitions are used to correct for potential patient motion. TSC quantifications obtained using the VFA method are validated at first in comparison with a fully-relaxed SD acquisition in a calibration phantom. The robustness of similar VFA acquisitions are compared to the short-TR SD approach in vivo on seven healthy volunteers.

RESULTS

The VFA method resulted in consistent TSC and T₁ estimates across our cohort of healthy subjects, with mean TSC of 38.1 ± 5.0 mmol/L and T₁ of 39.2 ± 4.4 ms. These results are in agreement with previously reported values in literature TSC estimations and with the predictions of a 2-compartment model. However, the short-TR SD acquisition systematically underestimated the sodium concentration with a mean TSC of 31 ± 4.5 mmol/L.

CONCLUSION

The VFA method can be applied successfully to image sodium at 3 T in about 20 min and provides robust and intrinsically T₁-corrected TSC maps.

[Femoroacetabular impingement - Update 2019]

BACKGROUND

Since the first description of the femoroacetabular impingement (FAI) concept diagnostic imaging of FAI has continuously been developed.

OBJECTIVE

The biomechanical concept is explained and an update on diagnostic imaging of FAI is presented.

MATERIAL AND METHODS

Based on a literature search this review article presents the current state of knowledge about FAI mechanisms and gives an overview on state of the art radiological diagnostics. A perspective on new imaging methods is also given.

RESULTS

The FAI is a dynamic phenomenon with a mechanical conflict between the femoral head and/or neck and the acetabulum. It is usually suspected clinically; however, imaging plays an essential role in establishing the diagnosis by detecting and defining the underlying deformities of the proximal femur (cam deformity) and the acetabulum (pincer deformity) and by evaluating associated lesions of the articular cartilage and labrum. Basic imaging diagnostics consist of anteroposterior and lateral radiographs. Magnetic resonance imaging (MRI) and MR arthrography are the preferred imaging modalities for detailed analysis of deformities, for the detection and graduation of lesions of articular cartilage (sensitivity 58-91%) and labral lesions (sensitivity 50-92%). Simultaneously, these methods can exclude other hip diseases. Current standards and new developments in FAI imaging are presented.

CONCLUSION

For the diagnosis of FAI typical clinical and imaging findings are required. Radiological diagnostics are an indispensable component in establishing the diagnosis of FAI, in the differentiation of the underlying deformities and in the assessment of treatment-relevant joint damage.

Quantitative sodium MR imaging: A review of its evolving role in medicine

Sodium magnetic resonance (MR) imaging in humans has promised metabolic information that can improve medical management in important diseases. This technology has yet to find a role in clinical practice, lagging proton MR imaging by decades. This review covers the literature that demonstrates that this delay is explained by initial challenges of low sensitivity at low magnetic fields and the limited performance of gradients and electronics available in the 1980s. These constraints were removed by the introduction of 3T and now ultrahigh (≥7T) magnetic field scanners with superior gradients and electronics for proton MR imaging. New projection pulse sequence designs have greatly improved sodium acquisition efficiency. The increased field strength has provided the expected increased sensitivity to achieve resolutions acceptable for metabolic interpretation even in small target tissues. Consistency of quantification of the sodium MR image to provide metabolic parametric maps has been demonstrated by several different pulse sequences and calibration procedures. The vital roles of sodium ion in membrane transport and the extracellular matrix will be reviewed to indicate the broad opportunities that now exist for clinical sodium MR imaging. The final challenge is for the technology to be supplied on clinical ≥3T scanners.

Imaging of Cartilage in the Athlete

MRI remains the optimal imaging modality to evaluate cartilage injuries in the athlete. As these injuries have no intrinsic healing capacity, early and accurate noninvasive diagnosis remains integral to determining the most appropriate treatment option in this class of patients. Although surgical success depends primarily on clinical outcomes, MRI evaluation can provide pertinent information regarding the status of the surgical repair and the progression of cartilage disease.

Sex differences in sodium deposition in human muscle and skin

The aim of this work was to investigate possible sex differences in the patterns of sodium deposition between muscle and skin using sodium MRI. A total of 38 subjects were examined for comparisons: 20 males, aged 25-79years with a median age of 51; 18 females, aged 38-66years, median age 53. All subjects underwent sodium MRI scans of the calf muscles together with cross sections through four calibration standards containing known sodium contents (10mM, 20mM, 30mM, and 40mM). Tissue sodium concentrations (TSC) in muscle and skin were then calculated by comparing signal intensities between tissues and reference standards using a linear analysis. A Wilcoxon rank sum test was applied to the ΔTSC (=TSCmuscle-TSCskin) series of males and females to examine if they were significantly different. Finally, a multiple linear regression was utilized to account for the effects from two potential confounders, age and body mass index (BMI). We found that sodium content appears to be higher in skin than in muscle for men, however women tend to have higher muscle sodium than skin sodium. This sex-relevant sodium deposition is statistically significant (P=3.10×10-5) by the Wilcoxon rank sum test, and this difference in distribution seems to be more reliable with increasing age. In the multiple linear regression, gender still has a statistically significant effect (P<1.0×10-4) on the difference between sodium deposition in muscle and skin, while taking the effects of age and BMI into account.

Changes in Cartilage and Tendon Composition of Patients With Type I Diabetes Mellitus: Identification by Quantitative Sodium Magnetic Resonance Imaging at 7 T

OBJECTIVE

The aim of this study was to investigate possible biochemical alterations in tendons and cartilage caused by type 1 diabetes mellitus (DM1), using quantitative in vivo 7 T sodium magnetic resonance (MR) imaging.

MATERIALS AND METHODS

The institutional review board approved this prospective study, and written informed consent was obtained. Eight DM1 patients with no history of knee trauma and 9 healthy age- and weight-matched volunteers were examined at 7 T using dedicated knee coils.All participants underwent morphological and sodium MR imaging. Region-of-interest analysis was performed manually for the non-weight-bearing area of the femoral condyle cartilage and for the patella tendon. Two readers read the image data sets independently, twice, for intrareader and interreader agreement. Normalized mean sodium signal intensity (NMSI) values were compared between patients and volunteers for each reader using analysis of variance.

RESULTS

On morphological images, cartilage in the non-weight-bearing area and the patellar tendon was intact in all patients. On sodium MR imaging, bivariate analysis of variance showed significantly lower mean NMSI values in the cartilage (P = 0.008) and significantly higher values in the tendons (P = 0.025) of patients compared with those of volunteers.

CONCLUSION

Our study showed significantly different NMSI values between DM1 patients and matched volunteers. Differences observed in the cartilage and tendon might be associated with a DM1-related alteration of biochemical composition that occurs before it can be visualized on morphological MR sequences.

Optimized cartilage visualization using 7-T sodium ((23)Na) imaging after patella dislocation

PURPOSE

Retropatellar cartilage lesions often occur in the course of recurrent patella dislocation. Aim of this study was to develop a more detailed method for examining cartilage tissue, in order to reduce patient discomfort and time of care.

METHODS

For detailed diagnosing, a 7-T MRI of the knee joint and patella was performed in nine patients, with mean age of 26.4 years, after patella dislocation to measure the cartilage content in three different regions of interest of the patella. Axial sodium ((23)Na) images were derived from an optimized 3D GRE sequence on a 7-T MR scanner. Morphological cartilage grading was performed, and sodium signal-to-noise ratio (SNR) values were calculated. Mean global sodium values and SNR were compared between patients and volunteers.

RESULTS

Two out of nine patients showed a maximum cartilage defect of International Cartilage Repair Society (ICRS) grade 3, three of grade 2, three of  grade 1, and one patient showed no cartilage defect. The mean SNR in sodium images for cartilage was 13.4 ± 2.5 in patients and 14.6 ± 3.7 in volunteers (n.s.). A significant negative correlation between age and global sodium SNR for cartilage was found in the medial facet (R = -0.512; R (2) = 0.26; p = 0.030). Mixed-model ANOVA yielded a marked decrease of the sodium SNR, with increasing grade of cartilage lesions (p < 0.001).

CONCLUSIONS

Utilization of the (23)Na MR imaging will make earlier detection of alterations to the patella cartilage after dislocation possible and will help prevent subsequent disease due to start adequate therapy earlier in the rehabilitation process.

LEVEL OF EVIDENCE

II.

Evaluation of cartilage repair and osteoarthritis with sodium MRI

The growing need for early diagnosis and higher specificity than that which can be achieved with morphological MRI is a driving force in the application of methods capable of probing the biochemical composition of cartilage tissue, such as sodium imaging. Unlike morphological imaging, sodium MRI is sensitive to even small changes in cartilage glycosaminoglycan content, which plays a key role in cartilage homeostasis. Recent advances in high- and ultrahigh-field MR systems, gradient technology, phase-array radiofrequency coils, parallel imaging approaches, MRI acquisition strategies and post-processing developments have resulted in many clinical in vivo sodium MRI studies of cartilage, even at 3 T. Sodium MRI has great promise as a non-invasive tool for cartilage evaluation. However, further hardware and software improvements are necessary to complete the translation of sodium MRI into a clinically feasible method for 3-T systems. This review is divided into three parts: (i) cartilage composition, pathology and treatment; (ii) sodium MRI; and (iii) clinical sodium MRI studies of cartilage with a focus on the evaluation of cartilage repair tissue and osteoarthritis.

Improved differentiation between knees with cartilage lesions and controls using 7T relaxation time mapping

Background/Objective

T1_ρ and T2 relaxation mapping in knee cartilage have been used extensively at 3 Tesla (T) as markers for proteoglycan and collagen, respectively. The objective of this study was to evaluate the feasibility of T1_ρ and T2 imaging of knee cartilage at 7T in comparison to 3T and to evaluate the ability of T1_ρ and T2 to determine differences between normal and osteoarthritis (OA) patients.

Materials and methods

Twenty patients, seven healthy patients (Kellgren–Lawrence = 0), and 13 patients with signs of radiographic OA (Kellgren–Lawrence > 0) were scanned at 3T and 7T. The knee cartilage was segmented into six compartments and the T1_ρ and T2 values were fit using a two-parameter model. Additionally, patients were stratified by the presence of cartilage lesions using the modified Whole Organ Magnetic Resonance Imaging Score classification of the knee. One-way analysis of variance was used to compare the healthy and OA groups at 3T and 7T. The specific absorption ratio was kept under Food and Drug Administration limits during all scans.

Results

T1_ρ and T2 values at 3T and 7T were significantly higher in the lateral femoral condyle and patella in patients with OA. However, more regions were significant or approached significance at 7T compared with 3T, with the differences between healthy and OA patients also larger at 7T. The signal to noise ratio across all cartilage and meniscus compartments was 60% higher on average at 7T compared to 3T.

Conclusion

T1_ρ imaging at 7T has been established as a viable imaging method for the differentiation of degenerated cartilage despite previous concerns over specific absorption rate and imaging time. The potential increased sensitivity of T1_ρ and T2 imaging at 7T may be useful for future studies in the development of OA.

Magnetic resonance compositional imaging of articular cartilage: What can we expect in veterinary medicine?

Since cartilage has limited ability to repair itself, it is useful to determine its biochemical composition early in clinical cases. It is also important to assess cartilage content in research animals in longitudinal studies in vivo. In recent years, compositional imaging techniques using magnetic resonance imaging (MRI) have been developed to assess the biochemical composition of cartilage. This article describes MR compositional imaging techniques, and discusses their use and interpretation. Technical concerns still limit the use of some techniques for research and clinical use, especially in veterinary medicine. Glycosaminoglycan chemical-exchange saturation transfer and sodium imaging are better used with high field magnets, which have limited availability. Long acquisition times are sometimes required, for instance in T1rho (ρ) and diffusion-weighted imaging, and necessitate general anaesthesia. Even in human medicine, some techniques such as ultra-short echo T2 are not fully validated, and nearly all techniques require validation for veterinary research and clinical practice. Delayed gadolinium-enhanced MRI of cartilage and T2 mapping appear to be the most applicable methods for compositional imaging of animal cartilage. Combining T2 mapping and T1ρ allows for the assessment of proteoglycans and the collagen network, respectively.

Ultra-High-Field MR Neuroimaging

At ultra-high magnetic fields, such as 7T, MR imaging can noninvasively visualize the brain in unprecedented detail and through enhanced contrast mechanisms. The increased SNR and enhanced contrast available at 7T enable higher resolution anatomic and vascular imaging. Greater spectral separation improves detection and characterization of metabolites in spectroscopic imaging. Enhanced blood oxygen level-dependent contrast affords higher resolution functional MR imaging. Ultra-high-field MR imaging also facilitates imaging of nonproton nuclei such as sodium and phosphorus. These improved imaging methods may be applied to detect subtle anatomic, functional, and metabolic abnormalities associated with a wide range of neurologic disorders, including epilepsy, brain tumors, multiple sclerosis, Alzheimer disease, and psychiatric conditions. At 7T, however, physical and hardware limitations cause conventional MR imaging pulse sequences to generate artifacts, requiring specialized pulse sequences and new hardware solutions to maximize the high-field gain in signal and contrast. Practical considerations for ultra-high-field MR imaging include cost, siting, and patient experience.

Quantitative magnetic resonance imaging of the articular cartilage of the knee joint

Osteoarthritis is characterized by a decrease in the proteoglycan content and disruption of the highly organized collagen fiber network of articular cartilage. Various quantitative magnetic resonance imaging techniques have been developed for noninvasive assessment of the proteoglycan and collagen components of cartilage. These techniques have been extensively used in clinical practice to detect early cartilage degeneration and in osteoarthritis research studies to monitor disease-related and treatment-related changes in cartilage over time. This article reviews the role of quantitative magnetic resonance imaging in evaluating the composition and ultrastructure of the articular cartilage of the knee joint.

MRI of the hip for the evaluation of femoroacetabular impingement; past, present, and future

The concept of femoroacetabular impingement (FAI) has, in a relatively short time, come to the forefront of orthopedic imaging. In just a few short years MRI findings that were in the past ascribed to degenerative change, normal variation, or other pathologies must now be described and included in radiology reports, as they have been shown, or are suspected to be related to, FAI. Crucial questions have come up in this time, including: what is the relationship of bony morphology to subsequent cartilage and labral damage, and most importantly, how is this morphology related to the development of osteoarthritis? In this review, we attempt to place a historical perspective on the controversy, provide guidelines for interpretation of MRI examinations of patients with suspected FAI, and offer a glimpse into the future of MRI of this complex condition.

High-resolution measurements of the multilayer ultra-structure of articular cartilage and their translational potential

Current musculoskeletal imaging techniques usually target the macro-morphology of articular cartilage or use histological analysis. These techniques are able to reveal advanced osteoarthritic changes in articular cartilage but fail to give detailed information to distinguish early osteoarthritis from healthy cartilage, and this necessitates high-resolution imaging techniques measuring cells and the extracellular matrix within the multilayer structure of articular cartilage. This review provides a comprehensive exploration of the cellular components and extracellular matrix of articular cartilage as well as high-resolution imaging techniques, including magnetic resonance image, electron microscopy, confocal laser scanning microscopy, second harmonic generation microscopy, and laser scanning confocal arthroscopy, in the measurement of multilayer ultra-structures of articular cartilage. This review also provides an overview for micro-structural analysis of the main components of normal or osteoarthritic cartilage and discusses the potential and challenges associated with developing non-invasive high-resolution imaging techniques for both research and clinical diagnosis of early to late osteoarthritis.

Sodium MR Imaging of Articular Cartilage Pathologies

Many studies have proved that noninvasive sodium MR imaging can directly determine the cartilage GAG content, which plays a central role in cartilage homeostasis. New technical developments in the recent decade have helped to transfer this method from in vitro to pre-clinical in vivo studies. Sodium imaging has already been applied for the evaluation of cartilage and repair tissue in patients after various cartilage repair surgery techniques and in patients with osteoarthritis. These studies showed that this technique could be helpful not only for assessment of the cartilage status, but also predictive for osteoarthritis. However, due to the low detectable sodium MR signal in cartilage, sodium imaging is still challenging, and further hardware and software improvements are necessary for translating sodium MR imaging into clinical practice, preferably to 3T MR systems.

Mechanisms of osteoarthritis in the knee: MR imaging appearance

Osteoarthritis has grown to become a widely prevalent disease that has major implications in both individual and public health. Although originally considered to be a degenerative disease driven by "wear and tear" of the articular cartilage, recent evidence has led to a consensus that osteoarthritis pathophysiology should be perceived in the context of the entire joint and multiple tissues. MRI is becoming an increasingly more important modality for imaging osteoarthritis, due to its excellent soft tissue contrast and ability to acquire morphological and biochemical data. This review will describe the pathophysiology of osteoarthritis as it is associated with various tissue types, highlight several promising MR imaging techniques for osteoarthritis and illustrate the expected appearance of osteoarthritis with each technique.

Quantitative MRI of articular cartilage and its clinical applications

Cartilage is one of the most essential tissues for healthy joint function and is compromised in degenerative and traumatic joint diseases. There have been tremendous advances during the past decade using quantitative MRI techniques as a noninvasive tool for evaluating cartilage, with a focus on assessing cartilage degeneration during osteoarthritis (OA). In this review, after a brief overview of cartilage composition and degeneration, we discuss techniques that grade and quantify morphologic changes as well as the techniques that quantify changes in the extracellular matrix. The basic principles, in vivo applications, advantages, and challenges for each technique are discussed. Recent studies using the OA Initiative (OAI) data are also summarized. Quantitative MRI provides noninvasive measures of cartilage degeneration at the earliest stages of joint degeneration, which is essential for efforts toward prevention and early intervention in OA.

MRI of the hip at 7T: feasibility of bone microarchitecture, high-resolution cartilage, and clinical imaging

PURPOSE

To demonstrate the feasibility of performing bone microarchitecture, high-resolution cartilage, and clinical imaging of the hip at 7T.

MATERIALS AND METHODS

This study had Institutional Review Board approval. Using an 8-channel coil constructed in-house, we imaged the hips of 15 subjects on a 7T magnetic resonance imaging (MRI) scanner. We applied: 1) a T1-weighted 3D fast low angle shot (3D FLASH) sequence (0.23 × 0.23 × 1-1.5 mm(3) ) for bone microarchitecture imaging; 2) T1-weighted 3D FLASH (water excitation) and volumetric interpolated breath-hold examination (VIBE) sequences (0.23 × 0.23 × 1.5 mm(3) ) with saturation or inversion recovery-based fat suppression for cartilage imaging; 3) 2D intermediate-weighted fast spin-echo (FSE) sequences without and with fat saturation (0.27 × 0.27 × 2 mm) for clinical imaging.

RESULTS

Bone microarchitecture images allowed visualization of individual trabeculae within the proximal femur. Cartilage was well visualized and fat was well suppressed on FLASH and VIBE sequences. FSE sequences allowed visualization of cartilage, the labrum (including cartilage and labral pathology), joint capsule, and tendons.

CONCLUSION

This is the first study to demonstrate the feasibility of performing a clinically comprehensive hip MRI protocol at 7T, including high-resolution imaging of bone microarchitecture and cartilage, as well as clinical imaging.

Sodium imaging of the human knee using soft inversion recovery fluid attenuation

Sodium signal strength in MRI is low when compared with (1)H. Thus, image voxel volumes must be relatively large in order to produce a sufficient signal-to-noise ratio (SNR). The measurement of sodium in cartilage is hindered by conflation with signal from the adjacent fluid spaces. Inversion recovery can be used to null signal from fluid, but reduces SNR. The purpose of this work was to optimize inversion recovery sodium MRI to enhance cartilage SNR while nulling fluid. Sodium relaxation was first measured for knee cartilage (T1=21±1 ms, T(2 fast)(∗)=0.8±0.2 ms, T(2 slow)(∗)=19.7±0.5 ms) and fluid (T1=48±3 ms, T2(∗)=47±4 ms) in nine healthy subjects at 4.7 T. The rapid relaxation of cartilage in relation to fluid permits the use of a lengthened inversion pulse to preferentially invert the fluid components. Simulations of inversion pulse length were performed to yield a cartilage SNR enhancing combination of parameters that nulled fluid. The simulations were validated in a phantom and then in vivo. B0 inhomogeneity was measured and the effect of off-resonance during the soft inversion pulse was assessed with simulation. Soft inversion recovery yielded twice the SNR and much improved sodium images of cartilage in human knee with little confounding signal from fluid.

T1-weighted sodium MRI of the articulator cartilage in osteoarthritis: a cross sectional and longitudinal study

Structural magnetic resonance imaging (MRI) has shown great utility in diagnosing soft tissue burden in osteoarthritis (OA), though MRI measures of cartilage integrity have proven more elusive. Sodium MRI can reflect the proteoglycan content of cartilage; however, it requires specialized hardware, acquisition sequences, and long imaging times. This study was designed to assess the potential of a clinically feasible sodium MRI acquisition to detect differences in the knee cartilage of subjects with OA versus healthy controls (HC), and to determine whether longitudinal changes in sodium content are observed at 3 and 6 months. 28 subjects with primary knee OA and 19 HC subjects age and gender matched were enrolled in this ethically-approved study. At baseline, 3 and 6 months subjects underwent structural MRI and a 0.4ms echo time 3D T1-weighted sodium scan as well as the knee injury and osteoarthritis outcome score (KOOS) and knee pain by visual analogue score (VAS). A standing radiograph of the knee was taken for Kellgren-Lawrence (K-L) scoring. A blinded reader outlined the cartilage on the structural images which was used to determine median T1-weighted sodium concentrations in each region of interest on the co-registered sodium scans. VAS, K-L, and KOOS all significantly separated the OA and HC groups. OA subjects had higher T1-weighted sodium concentrations, most strongly observed in the lateral tibial, lateral femoral and medial patella ROIs. There were no significant changes in cartilage volume or sodium concentration over 6 months. This study has shown that a clinically-feasible sodium MRI at a moderate 3T field strength and imaging time with fluid attenuation by T1 weighting significantly separated HCs from OA subjects.

Non-invasive imaging of cartilage in early osteoarthritis

Treatment for osteoarthritis (OA) has traditionally focused on joint replacement for end-stage disease. An increasing number of surgical and pharmaceutical strategies for disease prevention have now been proposed. However, these require the ability to identify OA at a stage when it is potentially reversible, and detect small changes in cartilage structure and function to enable treatment efficacy to be evaluated within an acceptable timeframe. This has not been possible using conventional imaging techniques but recent advances in musculoskeletal imaging have been significant. In this review we discuss the role of different imaging modalities in the diagnosis of the earliest changes of OA. The increasing number of MRI sequences that are able to non-invasively detect biochemical changes in cartilage that precede structural damage may offer a great advance in the diagnosis and treatment of this debilitating condition.

Application of advanced magnetic resonance imaging techniques in evaluation of the lower extremity

This article reviews current magnetic resonance imaging (MR imaging) techniques for imaging the lower extremity, focusing on imaging of the knee, ankle, and hip joints. Recent advancements in MR imaging include imaging at 7 T, using multiple receiver channels, T2* imaging, and metal suppression techniques, allowing more detailed visualization of complex anatomy, evaluation of morphologic changes within articular cartilage, and imaging around orthopedic hardware.

Quantitative parametric MRI of articular cartilage: a review of progress and open challenges

With increasing life expectancies and the desire to maintain active lifestyles well into old age, the impact of the debilitating disease osteoarthritis (OA) and its burden on healthcare services is mounting. Emerging regenerative therapies could deliver significant advances in the effective treatment of OA but rely upon the ability to identify the initial signs of tissue damage and will also benefit from quantitative assessment of tissue repair in vivo. Continued development in the field of quantitative MRI in recent years has seen the emergence of techniques able to probe the earliest biochemical changes linked with the onset of OA. Quantitative MRI measurements including T(1), T(2) and T(1ρ) relaxometry, diffusion weighted imaging and magnetisation transfer have been studied and linked to the macromolecular structure of cartilage. Delayed gadolinium-enhanced MRI of cartilage, sodium MRI and glycosaminoglycan chemical exchange saturation transfer techniques are sensitive to depletion of cartilage glycosaminoglycans and may allow detection of the earliest stages of OA. We review these current and emerging techniques for the diagnosis of early OA, evaluate the progress that has been made towards their implementation in the clinic and identify future challenges in the field.

Design of a nested eight-channel sodium and four-channel proton coil for 7T knee imaging

The critical design aim for a sodium/proton coil is to maximize sodium sensitivity and transmit field homogeneity while simultaneously providing adequate proton sensitivity and homogeneity. While most dual-frequency coils use lossy high-impedance trap circuits or PIN diodes to allow dual-resonance, we explored a nested-coil design for sodium/proton knee imaging at 7 T. A stand-alone eight-channel sodium receive array was implemented without standard dual-resonance circuitry to provide improved sodium signal-to-noise ratio. A detunable sodium birdcage was added for homogeneous sodium excitation and a four-channel proton transmit-receive array was added to provide anatomical reference imaging and B0 shimming capabilities. Both additional modules were implemented with minimal disturbance to the eight-channel sodium array by managing their respective resonances and geometrical arrangement. In vivo sodium signal-to-noise ratio was 1.2-1.7 times greater in the developed eight-channel array than in a mononuclear sodium birdcage coil, whereas the developed four-channel proton array provided signal-to-noise ratio similar to that of a commercial mononuclear proton birdcage coil.

Diagnosis of osteoarthritis: imaging

Osteoarthritis (OA) is a chronic, debilitating joint disease characterized by degenerative changes to the bones, cartilage, menisci, ligaments, and synovial tissue. Imaging modalities such as radiography, magnetic resonance imaging (MRI), optical coherence tomography (OCT), and ultrasound (US) permit visualization of these structures and can evaluate disease onset and progression. Radiography is primarily useful for the assessment of bony structures, while OCT is used for evaluation of articular cartilage and US for ligaments and the synovium. MRI permits visualization of all intraarticular structures and pathologies, though US or OCT may be preferential in some circumstances. As OA is a disease of the whole joint, a combination of imaging techniques may be necessary in order to gain the most comprehensive picture of the disease state. This article is part of a Special Issue entitled "Osteoarthritis".

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).

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.

Preserving the accuracy and resolution of the sodium bioscale from quantitative sodium MRI during intrasubject alignment across longitudinal studies

Emerging applications of sodium bioscales derived from quantitative sodium magnetic resonance imaging assess temporal changes in regional sodium concentration over intervals that vary from hours (monitoring tissue viability in stroke) to weeks (monitoring brain tumor treatment during radiation therapy) or even years (monitoring progression of neurodegenerative disease). Accurate interpretation of such quantitative data requires precise registration between magnetic resonance imaging sessions to avoid session-to-session changes in partial volume effects between normal tissue (∼38 mM sodium concentration), lesions (variable sodium concentration), and cerebrospinal fluid (∼144 mM sodium concentration). The existing Automated Image Registration algorithm is shown to be suitable for rapid, accurate, and precise determination of the transform that aligns sodium magnetic resonance images. Implementation of this transform during image reconstruction from the k-space data is shown to produce smaller errors than conventional image-domain interpolation. Experimental results at 9.4 T and 3.0 T demonstrating this registration approach to sodium data illustrate preservation of quantification accuracy during alignment of sodium magnetic resonance images acquired from the same subject during different imaging sessions.

Review. The Agfa Mayneord lecture: MRI of short and ultrashort T₂ and T₂* components of tissues, fluids and materials using clinical systems

A variety of techniques are now available to directly or indirectly detect signal from tissues, fluids and materials that have short, ultrashort or supershort T₂ or T₂* components. There are also methods of developing image contrast between tissues and fluids in the short T₂ or T₂* range that can provide visualisation of anatomy, which has not been previously seen with MRI. Magnetisation transfer methods can now be applied to previously invisible tissues, providing indirect access to supershort T₂ components. Particular methods have been developed to target susceptibility effects and quantify them after correcting for anatomical distortion. Specific methods have also been developed to image the effects of magnetic iron oxide particles with positive contrast. Major advances have been made in techniques designed to correct for loss of signal and gross image distortion near metal. These methods are likely to substantially increase the range of application for MRI.