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Guo T, Song Y, Tong J, Jiao S, Shen C, Wang H, Cui J, Dai D, Ma J, Chen M. Collagen degradation assessment with an in vitro rotator cuff tendinopathy model using multiparametric ultrashort-TE magnetization transfer (UTE-MT) imaging. Magn Reson Med 2024; 92:1658-1669. [PMID: 38725197 DOI: 10.1002/mrm.30144] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2024] [Revised: 04/17/2024] [Accepted: 04/18/2024] [Indexed: 07/23/2024]
Abstract
PURPOSE This study aims to assess ultrashort-TE magnetization transfer (UTE-MT) imaging of collagen degradation using an in vitro model of rotator cuff tendinopathy. METHODS Thirty-six supraspinatus tendon specimens were divided into three groups and treated with 600 U collagenase (Group 1), 150 U collagenase (Group 2), and phosphate buffer saline (Group 3). UTE-MT imaging was performed to assess changes in macromolecular fraction (MMF), macromolecule transverse relaxation time (T2m), water longitudinal relaxation rate constant (R1m), the magnetization exchange rate from the macromolecular to water pool (Rm0 w) and from water to the macromolecular pool (Rm0 m), and magnetization transfer ratio (MTR) at baseline and following digestion and their differences between groups. Biochemical and histological studies were conducted to determine the extent of collagen degradation. Correlation analyses were performed with MMF, T2m, R1m, Rm0 w, Rm0 m, and MTR, respectively. Univariate and multivariate linear regression analyses were performed to evaluate combinations of UTE-MT parameters to predict collagen degradation. RESULTS MMF, T2m, R1m, Rm0 m, and MTR decreased after digestion. MMF (r = -0.842, p < 0.001), MTR (r = -0.78, p < 0.001), and Rm0 m (r = -0.662, p < 0.001) were strongly negatively correlated with collagen degradation. The linear regression model of differences in MMF and Rm0 m before and after digestion explained 68.9% of collagen degradation variation in the tendon. The model of postdigestion in MMF and T2m and the model of MTR explained 54.2% and 52.3% of collagen degradation variation, respectively. CONCLUSION This study highlighted the potential of UTE-MT parameters for evaluation of supraspinatus tendinopathy.
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Affiliation(s)
- Tan Guo
- Peking University Fifth School of Clinical Medicine, Beijing, China
- Department of Radiology, Beijing Hospital, National Center of Gerontology; Institute of Geriatric Medicine, Chinese Academy of Medical Sciences, Beijing, China
| | - Yan Song
- Department of Radiology, Beijing Hospital, National Center of Gerontology; Institute of Geriatric Medicine, Chinese Academy of Medical Sciences, Beijing, China
| | - Jinlian Tong
- Biotherapy Center, Beijing Hospital, National Center of Gerontology; Institute of Geriatric Medicine, Chinese Academy of Medical Sciences, Beijing, China
| | - Sheng Jiao
- Department of Radiology, Beijing Hospital, National Center of Gerontology; Institute of Geriatric Medicine, Chinese Academy of Medical Sciences, Beijing, China
| | - Cheng Shen
- Department of Radiology, Beijing Hospital, National Center of Gerontology; Institute of Geriatric Medicine, Chinese Academy of Medical Sciences, Beijing, China
| | - Hong Wang
- Department of Radiology, Beijing Hospital, National Center of Gerontology; Institute of Geriatric Medicine, Chinese Academy of Medical Sciences, Beijing, China
| | - Ju Cui
- The Key Laboratory of Geriatrics, Beijing Institute of Geriatrics, Institute of Geriatric Medicine, Chinese Academy of Medical Science, Beijing Hospital/National Center of Gerontology of National Health Commission, Beijing, China
| | - Dapeng Dai
- The Key Laboratory of Geriatrics, Beijing Institute of Geriatrics, Institute of Geriatric Medicine, Chinese Academy of Medical Science, Beijing Hospital/National Center of Gerontology of National Health Commission, Beijing, China
| | - Jie Ma
- Biotherapy Center, Beijing Hospital, National Center of Gerontology; Institute of Geriatric Medicine, Chinese Academy of Medical Sciences, Beijing, China
| | - Min Chen
- Peking University Fifth School of Clinical Medicine, Beijing, China
- Department of Radiology, Beijing Hospital, National Center of Gerontology; Institute of Geriatric Medicine, Chinese Academy of Medical Sciences, Beijing, China
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Jerban S, Shaterian Mohammadi H, Athertya JS, Afsahi AM, Shojaeiadib N, Moazamian D, Ward SR, Woods G, Chung CB, Du J, Chang EY. Significant age-related differences between lower leg muscles of older and younger female subjects detected by ultrashort echo time magnetization transfer modeling. NMR IN BIOMEDICINE 2024:e5237. [PMID: 39155273 DOI: 10.1002/nbm.5237] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/16/2023] [Revised: 07/23/2024] [Accepted: 07/25/2024] [Indexed: 08/20/2024]
Abstract
Magnetization transfer (MT) magnetic resonance imaging (MRI) can be used to estimate the fraction of water and macromolecular proton pools in tissues. MT modeling paired with ultrashort echo time acquisition (UTE-MT modeling) has been proposed to improve the evaluation of the myotendinous junction and fibrosis in muscle tissues, which the latter increases with aging. This study aimed to determine if the UTE-MT modeling technique is sensitive to age-related changes in the skeletal muscles of the lower leg. Institutional review board approval was obtained, and all recruited subjects provided written informed consent. The legs of 31 healthy younger (28.1 ± 6.1 years old, BMI = 22.3 ± 3.5) and 20 older (74.7 ± 5.5 years old, BMI = 26.7 ± 5.9) female subjects were imaged using UTE sequences on a 3 T MRI scanner. MT ratio (MTR), macromolecular fraction (MMF), macromolecular T2 (T2-MM), and water T2 (T2-W) were calculated using UTE-MT modeling for the anterior tibialis (ATM), posterior tibialis (PTM), soleus (SM), and combined lateral muscles. Results were compared between groups using the Wilcoxon rank sum test. Three independent observers selected regions of interest (ROIs) and processed UTE-MRI images separately, and the intraclass correlation coefficient (ICC) was calculated for a reproducibility study. Significantly lower mean MTR and MMF values were present in the older compared with the younger group in all studied lower leg muscles. T2-MM showed significantly lower values in the older group only for PTM and SM muscles. In contrast, T2-W showed significantly higher values in the older group. The age-related differences were more pronounced for MMF (-17 to -19%) and T2-W (+20 to 47%) measurements in all muscle groups compared with other investigated MR measures. ICCs were higher than 0.93, indicating excellent consistency between the ROI selection and MRI measurements of independent readers. As demonstrated by significant differences between younger and older groups, this research emphasizes the potential of UTE-MT MRI techniques in evaluating age-related skeletal muscle changes.
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Affiliation(s)
- Saeed Jerban
- Department of Radiology, University of California, San Diego, CA, USA
| | | | - Jiyo S Athertya
- Department of Radiology, University of California, San Diego, CA, USA
| | | | | | - Dina Moazamian
- Department of Radiology, University of California, San Diego, CA, USA
| | - Samuel R Ward
- Department of Orthopaedic Surgery, University of California San Diego, San Diego, CA, USA
| | - Gina Woods
- Department of Medicine, University of California, San Diego, CA, USA
| | - Christine B Chung
- Department of Radiology, University of California, San Diego, CA, USA
- Research Service, Veterans Affairs San Diego Healthcare System, San Diego, CA, USA
| | - Jiang Du
- Department of Radiology, University of California, San Diego, CA, USA
- Research Service, Veterans Affairs San Diego Healthcare System, San Diego, CA, USA
| | - Eric Y Chang
- Department of Radiology, University of California, San Diego, CA, USA
- Research Service, Veterans Affairs San Diego Healthcare System, San Diego, CA, USA
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McNish R, Lohse K, Pruthi S, Hastings MK, Zheng J, Zellers JA. Achilles tendon assessment on quantitative MRI: Sources of variability and relationships to tendinopathy. Scand J Med Sci Sports 2024; 34:e14650. [PMID: 38712745 PMCID: PMC11081531 DOI: 10.1111/sms.14650] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2024] [Revised: 04/24/2024] [Accepted: 04/25/2024] [Indexed: 05/08/2024]
Abstract
Quantitative MRI (qMRI) measures are useful in assessing musculoskeletal tissues, but application to tendon has been limited. The purposes of this study were to optimize, identify sources of variability, and establish reproducibility of qMRI to assess Achilles tendon. Additionally, preliminarily estimates of effect of tendon pathology on qMRI metrics and structure-function relationships between qMRI measures and ankle performance were examined. T1, T1ρ, T2, and T2* maps of the Achilles tendon were obtained using a 3T MRI scanner. In participants with asymptomatic tendons (n = 21), MRI procedures were repeated twice, and region of interest selection was performed by three raters. Variance decomposition and reproducibility statistics were completed. To estimate the effect of pathology, qMRI measures from individuals with asymptomatic tendons were compared to qMRI measures from a pilot group of individuals with Achilles tendinopathy (n = 7). Relationships between qMRI and ankle performance measures were assessed. Between-participant variation accounted for the majority of variability (46.7%-64.0%) in all qMRI measures except T2*. ICCs met or exceeded 0.7 for all qMRI measures when averaged across raters or scans. Relaxation times were significantly longer in tendinopathic tendons (mean (SD) T1: 977.8 (208.6) ms, T1ρ: 35.4 (7.1) ms, T2: 42.8 (7.9) ms, T2*: 14.1 (7.6) ms, n = 7) compared to asymptomatic control tendons (T1: 691.7 (32.4) ms, T1ρ: 24.0 (3.6) ms, T2: 24.4 (7.5) ms, T2*: 9.5 (3.4) ms, n = 21) (p < 0.011 for all comparisons). T1 related to functional performance measures in symptomatic and asymptomatic groups. Study findings suggest that qMRI is reliable to assess the Achilles tendon. qMRI quantitatively assesses the presence of tendon pathology and relates to functional performance outcomes, supporting the utility of incorporating qMRI in research and clinic.
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Affiliation(s)
- Reika McNish
- Program in Physical Therapy, Washington University School of Medicine, St. Louis, Missouri, USA
| | - Keith Lohse
- Program in Physical Therapy, Washington University School of Medicine, St. Louis, Missouri, USA
- Department of Neurology, Washington University in St. Louis, St. Louis, Missouri, USA
| | - Saksham Pruthi
- School of Medicine, Saint Louis University, St. Louis, Missouri, USA
| | - Mary K Hastings
- Program in Physical Therapy, Washington University School of Medicine, St. Louis, Missouri, USA
- Department of Orthopaedic Surgery, Washington University in St. Louis, St. Louis, Missouri, USA
| | - Jie Zheng
- Mallinckrodt Institute of Radiology, Washington University School of Medicine, St. Louis, Missouri, USA
| | - Jennifer A Zellers
- Program in Physical Therapy, Washington University School of Medicine, St. Louis, Missouri, USA
- Department of Orthopaedic Surgery, Washington University in St. Louis, St. Louis, Missouri, USA
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Jerban S, Moazamian D, Ma Y, Afsahi AM, Dwek S, Athertya J, Malhi B, Jang H, Woods G, Chung CB, Du J, Chang EY. Fast dual-echo estimation of apparent long T2 fraction using ultrashort echo time magnetic resonance imaging in tibialis tendons and its osteoporosis-related differences in women. Quant Imaging Med Surg 2024; 14:3146-3156. [PMID: 38617168 PMCID: PMC11007502 DOI: 10.21037/qims-23-1341] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2023] [Accepted: 01/09/2024] [Indexed: 04/16/2024]
Abstract
Background Tendon and bone comprise a critical interrelating unit. Bone loss, including that seen with osteopenia (OPe) or osteoporosis (OPo), may be associated with a reduction in tendon quality, though this remains incompletely investigated. Clinical magnetic resonance imaging (MRI) sequences cannot directly detect signals from tendons because of the very short T2. Clinical MRI may detect high-graded abnormalities by changes in the adjacent structures like bone. However, ultrashort echo time MRI (UTE-MRI) can capture high signals from all tendons. To determine if the long T2 fraction, as measured by a dual-echo UTE-MRI sequence, is a sensitive quantitative technique to the age- and bone-loss-related changes of the lower leg tendons. Methods This is a cross-sectional study conducted between January 2018 to February 2020 in the lower legs of 14 female patients with OPe [72±6 years old, body mass index (BMI) =25.8±6.2 kg/m2] and 31 female patients with OPo (73±6 years old, BMI=22.0±3.8 kg/m2), as well as 30 female subjects with normal bone (Normal, 35±18 years old, BMI =23.2±4.3 kg/m2), were imaged on a 3T clinical scanner using a dual-echo 3D Cones UTE sequence. We defined the apparent long T2 signal fraction (aFrac-LongT2) of tendons as the ratio between the signal at the second echo time (TE =2.2 ms) to the UTE signal. The average aFrac-LongT2 and the cross-sectional area were calculated for the anterior tibialis tendons (ATTs) and the posterior tibialis tendons (PTTs). The Kruskal-Wallis rank test was used to compare the differences in aFrac-LongT2 and the cross-sectional area of the tendons between the groups. Results The aFrac-LongT2 of the ATTs and PTTs were significantly higher in the OPo group compared with the Normal group (22.2% and 34.8% in the ATT and PTT, respectively, P<0.01). The cross-sectional area in the ATTs was significantly higher for the OPo group than in the Normal group (Normal/OPo difference was 28.7, P<0.01). Such a difference for PTTs did not reach the significance level. Mean aFrac-LongT2 and cross-sectional area in the OPe group were higher than the Normal group and lower than the OPo group. However, the differences did not show statistical significance, likely due to the higher BMI in the OPe group. Conclusions Dual-echo UTE-MRI is a rapid quantification technique, and aFrac-LongT2 values showed significant differences in tendons between Normal and OPo patients.
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Affiliation(s)
- Saeed Jerban
- Department of Radiology, University of California, San Diego, La Jolla, CA, USA
- Research Service, Veterans Affairs San Diego Healthcare System, San Diego, La Jolla, CA, USA
- Department of Orthopaedic Surgery, University of California, San Diego, La Jolla, CA, USA
| | - Dina Moazamian
- Department of Radiology, University of California, San Diego, La Jolla, CA, USA
| | - Yajun Ma
- Department of Radiology, University of California, San Diego, La Jolla, CA, USA
- Research Service, Veterans Affairs San Diego Healthcare System, San Diego, La Jolla, CA, USA
| | - Amir Masoud Afsahi
- Department of Radiology, University of California, San Diego, La Jolla, CA, USA
| | - Sophia Dwek
- Department of Radiology, University of California, San Diego, La Jolla, CA, USA
| | - Jiyo Athertya
- Department of Radiology, University of California, San Diego, La Jolla, CA, USA
| | - Bhavsimran Malhi
- Department of Radiology, University of California, San Diego, La Jolla, CA, USA
| | - Hyungseok Jang
- Department of Radiology, University of California, San Diego, La Jolla, CA, USA
- Research Service, Veterans Affairs San Diego Healthcare System, San Diego, La Jolla, CA, USA
| | - Gina Woods
- Department of Medicine, University of California, San Diego, La Jolla, CA, USA
| | - Christine B. Chung
- Department of Radiology, University of California, San Diego, La Jolla, CA, USA
- Research Service, Veterans Affairs San Diego Healthcare System, San Diego, La Jolla, CA, USA
| | - Jiang Du
- Department of Radiology, University of California, San Diego, La Jolla, CA, USA
- Research Service, Veterans Affairs San Diego Healthcare System, San Diego, La Jolla, CA, USA
| | - Eric Y. Chang
- Department of Radiology, University of California, San Diego, La Jolla, CA, USA
- Research Service, Veterans Affairs San Diego Healthcare System, San Diego, La Jolla, CA, USA
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Moazamian D, Athertya JS, Dwek S, Lombardi AF, Mohammadi HS, Sedaghat S, Jang H, Ma Y, Chung CB, Du J, Jerban S, Chang EY. Achilles tendon and enthesis assessment using ultrashort echo time magnetic resonance imaging (UTE-MRI) T1 and magnetization transfer (MT) modeling in psoriatic arthritis. NMR IN BIOMEDICINE 2024; 37:e5040. [PMID: 37740595 PMCID: PMC10754405 DOI: 10.1002/nbm.5040] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/08/2023] [Revised: 08/14/2023] [Accepted: 08/29/2023] [Indexed: 09/24/2023]
Abstract
The purpose of this study is to investigate the use of ultrashort echo time (UTE) magnetic resonance imaging (MRI) techniques (T1 and magnetization transfer [MT] modeling) for imaging of the Achilles tendons and entheses in patients with psoriatic arthritis (PsA) compared with asymptomatic volunteers. The heels of twenty-six PsA patients (age 59 ± 15 years, 41% female) and twenty-seven asymptomatic volunteers (age 33 ± 11 years, 47% female) were scanned in the sagittal plane with UTE-T1 and UTE-MT modeling sequences on a 3-T clinical scanner. UTE-T1 and macromolecular proton fraction (MMF; the main outcome of MT modeling) were calculated in the tensile portions of the Achilles tendon and at the enthesis (close to the calcaneus bone). Mann-Whitney-U tests were used to examine statistically significant differences between the two cohorts. UTE-T1 in the entheses was significantly higher for the PsA group compared with the asymptomatic group (967 ± 145 vs. 872 ± 133 ms, p < 0.01). UTE-T1 in the tendons was also significantly higher for the PsA group (950 ± 145 vs. 850 ± 138 ms, p < 0.01). MMF in the entheses was significantly lower in the PsA group compared with the asymptomatic group (15% ± 3% vs. 18% ± 3%, p < 0.01). MMF in the tendons was also significantly lower in the PsA group compared with the asymptomatic group (17% ± 4% vs. 20% ± 5%, p < 0.01). Percentage differences in MMF between the asymptomatic and PsA groups (-16.6% and -15.0% for the enthesis and tendon, respectively) were higher than the T1 differences (10.8% and 11.7% for the enthesis and tendon, respectively). The results suggest higher T1 and lower MMF in the Achilles tendons and entheses in PsA patients compared with the asymptomatic group. This study highlights the potential of UTE-T1 and UTE-MT modeling for quantitative evaluation of entheses and tendons in PsA patients.
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Affiliation(s)
- Dina Moazamian
- Department of Radiology, University of California, San Diego, CA
| | - Jiyo S Athertya
- Department of Radiology, University of California, San Diego, CA
| | - Sophia Dwek
- Department of Radiology, University of California, San Diego, CA
| | | | | | - Sam Sedaghat
- Department of Radiology, University of California, San Diego, CA
- Department of Diagnostic and Interventional Radiology, University Hospital Heidelberg, Heidelberg, Germany
| | - Hyungseok Jang
- Department of Radiology, University of California, San Diego, CA
| | - Yajun Ma
- Department of Radiology, University of California, San Diego, CA
| | - Christine B. Chung
- Department of Radiology, University of California, San Diego, CA
- Radiology Service, VA San Diego Healthcare System, San Diego, CA, USA
| | - Jiang Du
- Department of Radiology, University of California, San Diego, CA
- Radiology Service, VA San Diego Healthcare System, San Diego, CA, USA
| | - Saeed Jerban
- Department of Radiology, University of California, San Diego, CA
- Radiology Service, VA San Diego Healthcare System, San Diego, CA, USA
- Department of Orthopedic Surgery, University of California, San Diego, La Jolla, CA, USA
| | - Eric Y. Chang
- Department of Radiology, University of California, San Diego, CA
- Radiology Service, VA San Diego Healthcare System, San Diego, CA, USA
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Zellers JA, Edalati M, Eekhoff JD, McNish R, Tang SY, Lake SP, Mueller MJ, Hastings MK, Zheng J. Quantative MRI predicts tendon mechanical behavior, collagen composition, and organization. J Orthop Res 2023; 41:2329-2338. [PMID: 36324161 PMCID: PMC10151441 DOI: 10.1002/jor.25471] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/13/2022] [Revised: 09/06/2022] [Accepted: 10/08/2022] [Indexed: 11/05/2022]
Abstract
Quantitative magnetic resonance imaging (qMRI) measures have provided insights into the composition, quality, and structure-function of musculoskeletal tissues. Low signal-to-noise ratio has limited application to tendon. Advances in scanning sequences and sample positioning have improved signal from tendon allowing for evaluation of structure and function. The purpose of this study was to elucidate relationships between tendon qMRI metrics (T1, T2, T1ρ and diffusion tensor imaging [DTI] metrics) with tendon tissue mechanics, collagen concentration and organization. Sixteen human Achilles tendon specimens were collected, imaged with qMRI, and subjected to mechanical testing with quantitative polarized light imaging. T2 values were related to tendon mechanics [peak stress (rsp = 0.51, p = 0.044), equilibrium stress (rsp = 0.54, p = 0.033), percent relaxation (rsp = -0.55, p = 0.027), hysteresis (rsp = -0.64, p = 0.007), linear modulus (rsp = 0.67, p = 0.009)]. T1ρ had a statistically significant relationship with percent relaxation (r = 0.50, p = 0.048). Collagen content was significantly related to DTI measures (range of r = 0.56-0.62). T2 values from a single slice of the midportion of human Achilles tendons were strongest predictors of tendon tensile mechanical metrics. DTI diffusivity indices (mean diffusivity, axial diffusivity, radial diffusivity) were strongly correlated with collagen content. These findings build on a growing body of literature supporting the feasibility of qMRI to characterize tendon tissue and noninvasively measure tendon structure and function. Statement of Clinical Significance: Quantitative MRI can be applied to characterize tendon tissue and is a noninvasive measure that relates to tendon composition and mechanical behavior.
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Affiliation(s)
- Jennifer A. Zellers
- Program in Physical Therapy; Washington University School of Medicine in St. Louis
- Department of Orthopaedic Surgery; Washington University School of Medicine in St. Louis
| | - Masoud Edalati
- Mallinckrodt Institute of Radiology; Washington University School of Medicine in St. Louis
| | - Jeremy D. Eekhoff
- Department of Biomedical Engineering; Washington University in St. Louis
| | - Reika McNish
- Program in Physical Therapy; Washington University School of Medicine in St. Louis
| | - Simon Y. Tang
- Department of Orthopaedic Surgery; Washington University School of Medicine in St. Louis
| | - Spencer P. Lake
- Department of Orthopaedic Surgery; Washington University School of Medicine in St. Louis
- Department of Mechanical Engineering & Materials Science; Washington University in St. Louis
| | - Michael J. Mueller
- Program in Physical Therapy; Washington University School of Medicine in St. Louis
- Mallinckrodt Institute of Radiology; Washington University School of Medicine in St. Louis
| | - Mary K. Hastings
- Program in Physical Therapy; Washington University School of Medicine in St. Louis
- Department of Orthopaedic Surgery; Washington University School of Medicine in St. Louis
| | - Jie Zheng
- Mallinckrodt Institute of Radiology; Washington University School of Medicine in St. Louis
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Jerban S, Ma Y, Tang Q, Fu E, Szeverenyi N, Jang H, Chung CB, Du J, Chang EY. Robust Assessment of Macromolecular Fraction (MMF) in Muscle with Differing Fat Fraction Using Ultrashort Echo Time (UTE) Magnetization Transfer Modeling with Measured T1. Diagnostics (Basel) 2023; 13:876. [PMID: 36900019 PMCID: PMC10001337 DOI: 10.3390/diagnostics13050876] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2023] [Revised: 02/17/2023] [Accepted: 02/21/2023] [Indexed: 03/03/2023] Open
Abstract
Magnetic resonance imaging (MRI) is widely regarded as the most comprehensive imaging modality to assess skeletal muscle quality and quantity. Magnetization transfer (MT) imaging can be used to estimate the fraction of water and macromolecular proton pools, with the latter including the myofibrillar proteins and collagen, which are related to the muscle quality and its ability to generate force. MT modeling combined with ultrashort echo time (UTE-MT modeling) may improve the evaluation of the myotendinous junction and regions with fibrotic tissues in the skeletal muscles, which possess short T2 values and higher bound-water concentration. The fat present in muscle has always been a source of concern in macromolecular fraction (MMF) calculation. This study aimed to investigate the impact of fat fraction (FF) on the estimated MMF in bovine skeletal muscle phantoms embedded in pure fat. MMF was calculated for several regions of interest (ROIs) with differing FFs using UTE-MT modeling with and without T1 measurement and B1 correction. Calculated MMF using measured T1 showed a robust trend, particularly with a negligible error (<3%) for FF < 20%. Around 5% MMF reduction occurred for FF > 30%. However, MMF estimation using a constant T1 was robust only for regions with FF < 10%. The MTR and T1 values were also robust for only FF < 10%. This study highlights the potential of the UTE-MT modeling with accurate T1 measurement for robust muscle assessment while remaining insensitive to fat infiltration up to moderate levels.
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Affiliation(s)
- Saeed Jerban
- Department of Radiology, University of California, La Jolla, San Diego, CA 92093, USA
- Radiology Service, Veterans Affairs San Diego Healthcare System, La Jolla, San Diego, CA 92161, USA
- Department of Orthopedic Surgery, University of California, La Jolla, San Diego, CA 92093, USA
| | - Yajun Ma
- Department of Radiology, University of California, La Jolla, San Diego, CA 92093, USA
- Radiology Service, Veterans Affairs San Diego Healthcare System, La Jolla, San Diego, CA 92161, USA
| | - Qingbo Tang
- Department of Radiology, University of California, La Jolla, San Diego, CA 92093, USA
- Radiology Service, Veterans Affairs San Diego Healthcare System, La Jolla, San Diego, CA 92161, USA
| | - Eddie Fu
- Radiology Service, Veterans Affairs San Diego Healthcare System, La Jolla, San Diego, CA 92161, USA
| | - Nikolaus Szeverenyi
- Department of Radiology, University of California, La Jolla, San Diego, CA 92093, USA
| | - Hyungseok Jang
- Department of Radiology, University of California, La Jolla, San Diego, CA 92093, USA
- Radiology Service, Veterans Affairs San Diego Healthcare System, La Jolla, San Diego, CA 92161, USA
| | - Christine B. Chung
- Department of Radiology, University of California, La Jolla, San Diego, CA 92093, USA
- Radiology Service, Veterans Affairs San Diego Healthcare System, La Jolla, San Diego, CA 92161, USA
| | - Jiang Du
- Department of Radiology, University of California, La Jolla, San Diego, CA 92093, USA
- Radiology Service, Veterans Affairs San Diego Healthcare System, La Jolla, San Diego, CA 92161, USA
| | - Eric Y. Chang
- Department of Radiology, University of California, La Jolla, San Diego, CA 92093, USA
- Radiology Service, Veterans Affairs San Diego Healthcare System, La Jolla, San Diego, CA 92161, USA
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Xie Y, Li X, Liu S, Hu Y, Chen Y, Liu S, Wu P, Tao H, Chen S. Quantitative Magnetic Resonance Imaging-Based Tendon Healing of Different Regions of the Shoulder: Comparison Between the Suture-Bridge and Single-Row Techniques. Orthop J Sports Med 2023; 11:23259671221137835. [PMID: 36655017 PMCID: PMC9841867 DOI: 10.1177/23259671221137835] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/19/2022] [Accepted: 08/30/2022] [Indexed: 01/12/2023] Open
Abstract
Background Rotator cuff retears occur more often at the proximal region with the suture-bridge (SB) technique than at the typical footprint region with the single-row (SR) technique. Few longitudinal clinical trials have focused on the postoperative tendon quality of the repaired rotator cuff at different regions between the 2 techniques. Purpose To compare tendon healing of the proximal and distal regions between the SB and SR techniques. Study Design Cohort study; Level of evidence, 3. Methods Included were consecutive patients who underwent arthroscopic rotator cuff repair and undertook clinical and magnetic resonance imaging (MRI) examinations at 3, 6, and 12 months postoperatively between 2016 and 2017. These patients were divided into the SB and SR groups according to the technique used. The repaired tendon was segmented into distal and proximal regions on ultrashort echo time-T2* mapping images. Clinical outcomes (Constant score, American Shoulder and Elbow Surgeons score, Fudan University Shoulder Score, and visual analog scale for pain) and MRI-based tendon healing (T2* values) of different regions were compared between the 2 groups. The differences in T2* values and clinical scores were determined by 1-way analysis of variance for repeated measurements. Results A total of 31 patients (17 in SB group and 14 in SR group) were included. At 12-month follow-up, significant improvements from preoperatively were achieved for all patients in all clinical scores (P < .001 for all). No significant between-group differences were found in T2* values of the distal region at any time point; however, the mean T2* value of the proximal region at 3 months was significantly higher in the SB group compared with the SR group (P = .03). This difference became nonsignificant at subsequent follow-up time points. Conclusion Significant clinical improvements over time can be expected in the first year after arthroscopic rotator cuff repair. In the early postoperative period, higher T2* values in the proximal region of the repaired tendon (representing inferior tendon quality) were seen with the SB technique compared with the SR technique; however, this phenomenon was resolved over time.
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Affiliation(s)
- Yuxue Xie
- Department of Radiology and Institute of Medical Functional and Molecular Imaging, Huashan Hospital, Fudan University, Shanghai, China
| | - Xiangwen Li
- Department of Radiology and Institute of Medical Functional and Molecular Imaging, Huashan Hospital, Fudan University, Shanghai, China
| | - Shaohua Liu
- Department of Sports Medicine, Huashan Hospital, Fudan University, Shanghai, China
| | - Yiwen Hu
- Department of Radiology and Institute of Medical Functional and Molecular Imaging, Huashan Hospital, Fudan University, Shanghai, China
| | - Ye Chen
- Department of Radiology and Institute of Medical Functional and Molecular Imaging, Huashan Hospital, Fudan University, Shanghai, China
| | - Shiyin Liu
- Department of Radiology and Institute of Medical Functional and Molecular Imaging, Huashan Hospital, Fudan University, Shanghai, China
| | - Puye Wu
- GE Healthcare, Shanghai, China
| | - Hongyue Tao
- Department of Radiology and Institute of Medical Functional and Molecular Imaging, Huashan Hospital, Fudan University, Shanghai, China.,Hongyue Tao, MD, Department of Radiology, Huashan Hospital, Fudan University, 12 Wulumuqizhong Road, Shanghai, China (); and Shuang Chen, PhD, Department of Radiology, Huashan Hospital, Fudan University, 12 Wulumuqizhong Road, Shanghai, China ()
| | - Shuang Chen
- Department of Radiology and Institute of Medical Functional and Molecular Imaging, Huashan Hospital, Fudan University, Shanghai, China.,Hongyue Tao, MD, Department of Radiology, Huashan Hospital, Fudan University, 12 Wulumuqizhong Road, Shanghai, China (); and Shuang Chen, PhD, Department of Radiology, Huashan Hospital, Fudan University, 12 Wulumuqizhong Road, Shanghai, China ()
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Quantitative MRI in patients with gluteal tendinopathy and asymptomatic volunteers: initial results on T1- and T2*-mapping diagnostic accuracy and correlation with clinical assessment. Skeletal Radiol 2021; 50:2221-2231. [PMID: 33914122 DOI: 10.1007/s00256-021-03781-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/02/2021] [Revised: 04/04/2021] [Accepted: 04/04/2021] [Indexed: 02/02/2023]
Abstract
OBJECTIVE To determine if T1- and T2*-mapping of the gluteal tendons can discriminate between participants with and without clinical findings of gluteal tendinopathy (GT) and if they correlate with clinical assessment. MATERIALS AND METHODS This prospective study was conducted between January and December 2016. MRI of the hip included spin echo, short-T1 inversion recovery, variable-flip angle, and variable echo-time gradient echo sequences. MRI studies were reviewed independently by two radiologists. Two other readers segmented the gluteal tendons and T1, mono- (T2*m) and bi-exponential T2* (short (T2*s) and long (T2*l) components) were computed. RESULTS Ten participants with GT (median age; interquartile range: 63 (57-67) years, all women) and 9 participants without GT (57 (55-59) years, 8 women) (P = 0.06) were enrolled. The sensitivity and specificity of reader 1 for disease classification were 40% (95% confidence interval (CI): 17-61%) and 70% (CI: 47-91%), and those of reader 2 were 70% (CI: 43-86%) and 80% (CI: 53-96%), with fair inter-reader agreement (Kappa = .38). T1 values could not discriminate between the two groups. The gluteal tendons T2*m and T2*s showed diagnostic accuracy ranging from .80 to .89. The posterior gluteus medius tendon T2*m and T2*s respectively showed sensitivity and specificity of 90%, and strong correlation (Spearman's rho = -.71; P = 0.02) with the Lower Extremity Functional Scale score. CONCLUSION Quantitative MRI could help gain new insight into healthy and diseased gluteal tendons to allow better diagnosis and treatment stratification for patients.
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Jang H, Ma Y, Carl M, Jerban S, Chang EY, Du J. Ultrashort echo time Cones double echo steady state (UTE-Cones-DESS) for rapid morphological imaging of short T 2 tissues. Magn Reson Med 2021; 86:881-892. [PMID: 33755258 DOI: 10.1002/mrm.28769] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2020] [Revised: 02/17/2021] [Accepted: 02/18/2021] [Indexed: 12/12/2022]
Abstract
PURPOSE In this study, we aimed to develop a new technique, ultrashort echo time Cones double echo steady state (UTE-Cones-DESS), for highly efficient morphological imaging of musculoskeletal tissues with short T2 s. We also proposed a novel, single-point Dixon (spDixon)-based approach for fat suppression. METHODS The UTE-Cones-DESS sequence was implemented on a 3T MR system. It uses a short radiofrequency (RF) pulse followed by a pair of balanced spiral-out and spiral-in readout gradients separated by an unbalanced spoiling gradient in-between. The readout gradients are applied immediately before or after the RF pulses to achieve a UTE image (S+ ) and a spin/stimulated echo image (S- ). Weighted echo subtraction between S+ and S- was performed to achieve high contrast specific to short T2 tissues, and spDixon was applied to suppress fat by using the intrinsic complex signal of S+ and S- . Six healthy volunteers and five patients with osteoarthritis were recruited for whole-knee imaging. Additionally, two healthy volunteers were recruited for lower leg imaging. RESULTS The UTE-Cones-DESS sequence allows fast volumetric imaging of musculoskeletal tissues with excellent image contrast for the osteochondral junction, tendons, menisci, and ligaments in the knee joint as well as cortical bone and aponeurosis in the lower leg within 5 min. spDixon yields efficient fat suppression in both S+ and S- images without requiring any additional acquisitions or preparation pulses. CONCLUSION The rapid UTE-Cones-DESS sequence can be used for high contrast morphological imaging of short T2 tissues, providing a new tool to assess their association with musculoskeletal disorders.
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Affiliation(s)
- Hyungseok Jang
- Department of Radiology, University of California, San Diego, San Diego, CA, USA
| | - Yajun Ma
- Department of Radiology, University of California, San Diego, San Diego, CA, USA
| | | | - Saeed Jerban
- Department of Radiology, University of California, San Diego, San Diego, CA, USA
| | - Eric Y Chang
- Department of Radiology, University of California, San Diego, San Diego, CA, USA.,Radiology Service, Veterans Affairs San Diego Healthcare System, San Diego, CA, USA
| | - Jiang Du
- Department of Radiology, University of California, San Diego, San Diego, CA, USA
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Abstract
The aim of this article is to review the use of magnetic resonance imaging (MRI) for the evaluation of shoulder pain, which is a common clinical complaint of the musculoskeletal system. MRI is an essential auxiliary tool to evaluate these patients because of its high resolution and high sensitivity in depicting the soft tissues. This article will review the imaging technique, normal imaging anatomy, and most common imaging findings of disorders of tendons, labrum, and ligaments of the shoulder. It will also discuss common systemic diseases that manifest in the shoulder as well as disorders of the acromioclavicular joint and bursae. New advances and research in MRI have provided additional potential uses for evaluating shoulder derangements.
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Xie Y, Liu S, Qu J, Wu P, Tao H, Chen S. Quantitative Magnetic Resonance Imaging UTE-T2* Mapping of Tendon Healing After Arthroscopic Rotator Cuff Repair: A Longitudinal Study. Am J Sports Med 2020; 48:2677-2685. [PMID: 32813550 DOI: 10.1177/0363546520946772] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
BACKGROUND Quantitative ultrashort echo time-T2* (UTE-T2*) mapping shows promise for the detection of potential tendon biochemical conditions, while validation against established clinical studies in the shoulder is needed. PURPOSE To evaluate and characterize the healing process of the repaired rotator cuff based on longitudinal changes in UTE-T2* values, clinical outcomes, and repair status in patients after arthroscopic rotator cuff repair (ARCR). STUDY DESIGN Cohort study; Level of evidence, 2. METHODS Patients with ARCR (n = 25) underwent quantitative MRI and clinical examinations at serial follow-up time points: 3, 6, 12, and 24 months postoperatively. Age-matched healthy controls (n = 15) were evaluated at 3 and 12 months after enrollment. Clinical scores included the Constant, American Shoulder and Elbow Surgeons, and Fudan University Shoulder score, and visual analog scale for pain. The MRI examination included UTE-T2*mapping. UTE-T2* maps were generated for T2* values at the healing site. Sugaya classification was adopted to evaluate the repair status. Longitudinal analyses of clinical outcomes, UTE-T2* changes, and Sugaya classification were conducted. RESULTS The overall retear rate was 8% (2/25, all Sugaya type IV). All patients (including the ones with retear) achieved satisfactory outcomes at 12 months that lasted to 24 months on the basis of clinical scores. The mean UTE-T2* values at the healing site showed an increase from 3 to 6 months (P = .03) and then decreased to a level similar to that observed in age-matched healthy tendons at 12 months (P = .1). No significant differences were found between UTE-T2* values at 12 and 24 months (P = .6). UTE-T2* values at the healing site significantly varied with the repair status according to Sugaya classification (P < .05). Moreover, significant correlations were noted between clinical scores and UTE-T2* values at 6 months (r = -0.6 to -0.3; all P < .05) and 12 months (r = -0.6 to -0.2; all P < .05). CONCLUSION This study indicated a healing-related relationship between clinical outcomes and quantitative UTE-T2* values, which highlights the potential of using UTE-T2* mapping to track the tendon-healing process noninvasively. Moreover, the repaired tendon was comparable to age-matched healthy controls at 12-month follow-up based on UTE-T2* values.
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Affiliation(s)
- Yuxue Xie
- Department of Radiology and Institute of Medical Functional and Molecular Imaging, Huashan Hospital, Fudan University, Shanghai, China
| | - Shaohua Liu
- Department of Sports Medicine, Huashan Hospital, Fudan University, Shanghai, China
| | | | - Puye Wu
- GE Healthcare, MR Research, Beijing, China
| | - Hongyue Tao
- Department of Radiology and Institute of Medical Functional and Molecular Imaging, Huashan Hospital, Fudan University, Shanghai, China
| | - Shuang Chen
- Department of Radiology and Institute of Medical Functional and Molecular Imaging, Huashan Hospital, Fudan University, Shanghai, China
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