Rapid estimation of cartilage T 2 with reduced T 1 sensitivity using double echo steady state imaging

Whole-brain T2 mapping with radial sampling and retrospective motion correction at 3T

PURPOSE

Several barriers prevent the use of whole-brain T2 mapping in routine use despite increasing interest in this parameter. One of the main barriers is the long scan time resulting in patient discomfort and motion corrupted data. To address this challenge, a method for accurate whole-brain T2 mapping with a limited acquisition time and motion correction capabilities is investigated.

METHODS

A 3D radial multi-echo spin-echo sequence was implemented with optimized sampling trajectory enabling the estimation of intra-scan motion, subsequently used to correct the raw data. Motion corrected echo images are then reconstructed with linear subspace constrained reconstruction. Experiments were carried out on phantom and volunteers at 3T to evaluate the accuracy of the T2 estimation, the sensitivity to lesions and the efficiency of the correction on motion corrupted data.

RESULTS

Whole-brain T2 mapping acquired in less than 7 min enabled the depiction of lesions in the white matter with longer T2. Data retrospectively corrupted with typical motion traces of pediatric patients highly benefited from the motion correction by reducing the error in T2 estimates within the lesions. All datasets acquired on seven volunteers, with deliberate motion, also showed that motion corrupted T2 maps could be improved with the retrospective motion correction both at the voxel level and the structure level.

CONCLUSION

A whole-brain T2 mapping sequence with retrospective intra-scan motion correction and reasonable acquisition time is proposed. The method necessitates advanced iterative reconstruction strategies but no additional navigator, external device, or increased scan time is required.

The design of a sample rapid magnetic resonance imaging (MRI) acquisition protocol supporting assessment of multiple articular tissues and pathologies in knee osteoarthritis

Objective

This expert opinion paper proposes a design for a state-of-the-art magnetic resonance image (MRI) acquisition protocol for knee osteoarthritis clinical trials in early and advanced disease. Semi-quantitative and quantitative imaging endpoints are supported, partly amendable to automated analysis. Several (peri-) articular tissues and pathologies are covered, including synovitis.

Method

A PubMed literature search was conducted, with focus on the past 5 years. Further, osteoarthritis imaging experts provided input. Specific MRI sequences, orientations, spatial resolutions and parameter settings were identified to align with study goals. We strived for implementation on standard clinical scanner hardware, with a net acquisition time ≤30 ​min.

Results

Short- and long-term longitudinal MRIs should be obtained at ≥1.5T, if possible without hardware changes during the study. We suggest a series of gradient- and spin-echo-sequences, supporting MOAKS, quantitative analysis of cartilage morphology and T2, and non-contrast-enhanced depiction of synovitis. These sequences should be properly aligned and positioned using localizer images. One of the sequences may be repeated in each participant (re-test), optimally at baseline and follow-up, to estimate within-study precision. All images should be checked for quality and protocol-adherence as soon as possible after acquisition. Alternative approaches are suggested that expand on the structural endpoints presented.

Conclusions

We aim to bridge the gap between technical MRI acquisition guides and the wealth of imaging literature, proposing a balance between image acquisition efficiency (time), safety, and technical/methodological diversity. This approach may entertain scientific innovation on tissue structure and composition assessment in clinical trials on disease modification of knee osteoarthritis.

Anterior cruciate ligament injury and age affect knee cartilage T2 but not thickness

OBJECTIVE

To investigate the effect of unilateral anterior cruciate ligament (ACL) injury on cartilage thickness and composition, specifically laminar transverse relaxation time (T2) by magnetic resonance imaging (MRI), in younger and older participants and to compare within-person side differences in these parameters between ACL-injured and healthy controls.

DESIGN

Quantitative double-echo steady-state 3 Tesla MRI-sequences were acquired in both knees of 85 participants in four groups: 20-30 years: healthy, HEA20-30, n = 24; ACL-injured, ACL20-30, n = 23; 40-60 years: healthy, HEA40-60, n = 24; ACL-injured, ACL40-60, n = 14 (ACL injury 2-10 years prior to study inclusion). Weight-bearing femorotibial cartilages were manually segmented; cartilage T2 and thickness were computed using custom software. Mean and side differences in subregional cartilage thickness, superficial and deep cartilage T2 were compared within and between groups using non-parametric statistics.

RESULTS

Cartilage thickness did not differ within or between groups. Only the side difference in medial femorotibial cartilage thickness was greater in ACL20-30 than in HEA20-30. Deep zone T2 was longer in the ACL-injured than in the contralateral uninjured knees and than in healthy controls, especially in the lateral compartment. Most ACL-injured participants had side differences in femorotibial deep zone T2 above the threshold derived from controls.

CONCLUSION

In the ACL-injured knee, early compositional differences in femorotibial cartilage (T2) appear to occur in the deep zone and precede cartilage thickness loss. These results suggest that monitoring laminar T2 after ACL injury may be useful in diagnosing and monitoring early articular cartilage changes.

Robust T2 estimation with balanced steady state free precession

PURPOSE

To develop a novel signal representation for balanced steady state free precession (bSSFP) displaying its T2 independence on B1 and on magnetization transfer (MT) effects.

METHODS

A signal model for bSSFP is developed that shows only an explicit dependence (up to a scaling factor) on E2 (and, therefore, T2) and a novel parameter c (with implicit dependence on the flip angle and E1). Moreover, it is shown that MT effects, entering the bSSFP signal via a binary spin bath model, can be captured by a redefinition of T1 and, therefore, leading to modification of E1, resulting in the same signal model. Various sets of phase-cycled bSSFP brain scans (different flip angles, different TR, different RF pulse durations, and different number of phase cycles) were recorded at 3 T. The parameters T2 (E2) and c were estimated using a variable projection (VARPRO) method and Monte-Carlo simulations were performed to assess T2 estimation precision.

RESULTS

Initial experiments confirmed the expected independence of T2 on various protocol settings, such as TR, the flip angle, B1 field inhomogeneity, and the RF pulse duration. Any variation (within the explored range) appears to directly affect the estimation of the parameter c only-in agreement with theory.

CONCLUSION

BSSFP theory predicts an extraordinary feature that all MT and B1-related variational aspects do not enter T2 estimation, making it a potentially robust methodology for T2 quantification, pending validation against existing standards.

Water diffusion and T2 quantification in transient-state MRI: the effect of RF pulse sequence

In quantitative measurement of the T 2 value of tissues, the diffusion of water molecules has been recognized as a confounder. This is most notably so for transient-state quantitative mapping techniques, which allow simultaneous estimation of T 1 and T 2 . In prior work, apparently conflicting conclusions are presented on the level of diffusion-induced bias on the T2 estimate. So far there is a lack of studies on the effect of the RF pulse angle sequence on the level of diffusion-induced bias. In this work, we show that the specific transient-state RF pulse sequence has a large effect on this level of bias. In particular, the bias level is strongly influenced by the mean value of the RF pulse angles. Also, for realistic values of the spoiling gradient area, we infer that the diffusion-induced bias is negligible for non-liquid human tissues; yet, for phantoms, the effect can be substantial (15% of the true T 2 value) for some RF pulse sequences. This should be taken into account in validation procedures.

Muscle activity with 0.5 T upright MRI-DESS to measure T2 in biceps and triceps

The purpose of this study was to determine if muscle activity of the biceps followed by isometric flexion changes T₂ measured in the biceps. It is hypothesized that an increase in T₂ will be observed in the biceps but not in the triceps after flexion exercise. Ten healthy volunteers were imaged with a one-channel neck coil while seated in a 0.5 T upright open magnetic resonance imaging (MRI) scanner using a three-dimensional double echo steady-state (DESS) sequence. Volunteers were imaged while relaxing their arm for 10, 20, and 30  min during an isometric biceps flexion immediately following performance of biceps curls to exhaustion, and again after relaxing for 10 and 20 min. Voxel-wise T₂ was calculated by fitting to a DESS signal equation in regions segmented at muscle centers to determine mean T₂ . During isometric biceps flexion immediately following biceps curls, mean T₂ increased (average 33%, p < 0.05) in the biceps but not in the triceps. By 20 min after curls, mean T₂ decreased (p < 0.05), and was near preactivity values. In contrast, there was no change in triceps T₂ across any activity or postactivity time points. Intra-rater repeatability was excellent (ICC: 0.90-0.97). This study demonstrated that measuring T₂ in an active muscle is feasible using a DESS sequence in an upright open MRI scanner. This could enable the study of muscle function while the muscle is working and weight-bearing, rather than of the "fatigue" of the muscles after activity. In comparison to electromyography, MRI also enables the study of deep muscles and allows simultaneous assessment of activity and function.

Dose-response relationship of in vivo ambulatory load and mechanosensitive cartilage biomarkers-The role of age, tissue health and inflammation: A study protocol

OBJECTIVE

To describe a study protocol for investigating the in vivo dose-response relationship between ambulatory load magnitude and mechanosensitive blood markers of articular cartilage, the influence of age, cartilage tissue health and presence of inflammation on this relationship, and its ability to predict changes in articular cartilage quality and morphology within 2 years.

DESIGN

Prospective experimental multimodal (clinical, biomechanical, biological) data collection under walking stress and three different load conditions varied in a randomized crossover design.

EXPERIMENTAL PROTOCOL

At baseline, equal numbers of healthy and anterior cruciate ligament injured participants aged 20-30 or 40-60 years will be assessed clinically and complete questionnaires regarding their knee health. Biomechanical parameters (joint kinetics, joint kinematics, and surface electromyography) will be recorded while performing different tasks including overground and treadmill walking, single leg balance and hopping tasks. Magnetic resonance images (MRI) of both of knees will be obtained. On separate stress test days, participants will perform a 30-minute walking stress with either reduced (80% body weight (BW)), normal (100%BW) or increased (120%BW) load. Serum blood samples will be taken immediately before, immediately after, 30, 120 and 210 minutes after the walking stress. Concentration of articular cartilage blood biomarkers will be assessed using enzyme linked immunosorbent assays. At 24-month follow-up, participants will be again assessed clinically, undergo an MRI, complete questionnaires, and have a blood sample taken.

CONCLUSION

The study design provides a standardized set up that allows to better understand the influence of ambulatory load on articular cartilage biomarkers and thereby extend current knowledge on in vivo cartilage metabolism and mechanosensitivity. Further, this study will help to elucidate the prognostic value of the load-induced cartilage biomarker response for early articular cartilage degeneration.

TRIAL REGISTRATION

The protocol was approved by the regional ethics committee and has been registered at clinicaltrials.gov (NCT04128566).

Comparison of T2 Quantification Strategies in the Abdominal-Pelvic Region for Clinical Use

OBJECTIVES

The aim of the study was to compare different magnetic resonance imaging (MRI) acquisition strategies appropriate for T2 quantification in the abdominal-pelvic area. The different techniques targeted in the study were chosen according to 2 main considerations: performing T2 measurement in an acceptable time for clinical use and preventing/correcting respiratory motion.

MATERIALS AND METHODS

Acquisitions were performed at 3 T. To select sequences for in vivo measurements, a phantom experiment was conducted, for which the T2 values obtained with the different techniques of interest were compared with the criterion standard (single-echo SE sequence, multiple acquisitions with varying echo time). Repeatability and temporal reproducibility studies for the different techniques were also conducted on the phantom. Finally, an in vivo study was conducted on 12 volunteers to compare the techniques that offer acceptable acquisition time for clinical use and either address or correct respiratory motion.

RESULTS

For the phantom study, the DESS and T2-preparation techniques presented the lowest precision (ρ2 = 0.9504 and ρ2 = 0.9849 respectively), and showed a poor repeatability/reproducibility compared with the other techniques. The strategy relying on SE-EPI showed the best precision and accuracy (ρ2 = 0.9994 and Cb = 0.9995). GRAPPATINI exhibited a very good precision (ρ2 = 0.9984). For the technique relying on radial TSE, the precision was not as good as GRAPPATINI (ρ2 = 0.9872). The in vivo study demonstrated good respiratory motion management for all of the selected techniques. It also showed that T2 estimate ranges were different from one method to another. For GRAPPATINI and radial TSE techniques, there were significant differences between all the different types of organs of interest.

CONCLUSIONS

To perform T2 measurement in the abdominal-pelvic region, one should favor a technique with acceptable acquisition time for clinical use, with proper respiratory motion management, with good repeatability, reproducibility, and precision. In this study, the techniques relying respectively on SE-EPI, radial TSE, and GRAPPATINI appeared as good candidates.

Multiple-echo steady-state (MESS): Extending DESS for joint T2 mapping and chemical-shift corrected water-fat separation

Purpose

To extend the double echo steady‐state (DESS) sequence to enable chemical‐shift corrected water‐fat separation.

Methods

This study proposes multiple‐echo steady‐state (MESS), a sequence that modifies the readouts of the DESS sequence to acquire two echoes each with bipolar readout gradients with higher readout bandwidth. This enables water‐fat separation and eliminates the need for water‐selective excitation that is often used in combination with DESS, without increasing scan time. An iterative fitting approach was used to perform joint chemical‐shift corrected water‐fat separation and T₂ estimation on all four MESS echoes simultaneously. MESS and water‐selective DESS images were acquired for five volunteers, and were compared qualitatively as well as quantitatively on cartilage T₂ and thickness measurements. Signal‐to‐noise ratio (SNR) and T₂ quantification were evaluated numerically using pseudo‐replications of the acquisition.

Results

The water‐fat separation provided by MESS was robust and with quality comparable to water‐selective DESS. MESS T₂ estimation was similar to DESS, albeit with slightly higher variability. Noise analysis showed that SNR in MESS was comparable to DESS on average, but did exhibit local variations caused by uncertainty in the water‐fat separation.

Conclusion

In the same acquisition time as DESS, MESS provides water‐fat separation with comparable SNR in the reconstructed water and fat images. By providing additional image contrasts in addition to the water‐selective DESS images, MESS provides a promising alternative to DESS.

Utilizing shared information between gradient-spoiled and RF-spoiled steady-state MRI signals

This work presents an analytical relationship between gradient-spoiled and RF-spoiled steady-state signals. The two echoes acquired in double-echo in steady-state scans are shown to lie on a line in the signal plane, where the two axes represent the amplitudes of each echo. The location along the line depends on the amount of spoiling and the diffusivity. The line terminates in a point corresponding to an RF-spoiled signal. In addition to the main contribution of demonstrating this signal relationship, we also include the secondary contribution of preliminary results from an example application of the relationship, in the form of a heuristic denoising method when both types of scans are performed. This is investigated in simulations, phantom scans, and in vivo scans. For the signal model, the main topic of this study, simulations confirmed its accuracy and explored its dependency on signal parameters and image noise. For the secondary topic of its preliminary application to reduce noise, simulations demonstrated the denoising method giving a reduction in noise-induced standard deviation of about 30%. The relative effect of the method on the signals is shown to depend on the slope of the described line, which is demonstrated to be zero at the Ernst angle. The phantom scans show a similar effect as the simulations. In vivo scans showed a slightly lower average improvement of about 28%.

Quantitative magnetic resonance imaging of meniscal pathology ex vivo

OBJECTIVE

To determine the ability of conventional spin echo (SE) T2 and ultrashort echo time (UTE) T2* relaxation times to characterize pathology in cadaveric meniscus samples.

MATERIALS AND METHODS

From 10 human donors, 54 triangular (radially cut) meniscus samples were harvested. Meniscal pathology was classified as normal (n = 17), intrasubstance degenerated (n = 33), or torn (n = 4) using a modified arthroscopic grading system. Using a 3-T MR system, SE T2 and UTE T2* values of the menisci were determined, followed by histopathology. Effect of meniscal pathology on relaxation times and histology scores were determined, along with correlation between relaxation times and histology scores.

RESULTS

Mean ± standard deviation UTE T2* values for normal, degenerated, and torn menisci were 3.6 ± 1.3 ms, 7.4 ± 2.5 ms, and 9.8 ± 5.7 ms, respectively, being significantly higher in degenerated (p < 0.0001) and torn (p = 0.0002) menisci compared to that in normal. In contrast, the respective mean SE T2 values were 27.7 ± 9.5 ms, 25.9 ± 7.0 ms, and 35.7 ± 10.4 ms, without significant differences between groups (all p > 0.14). In terms of histology, we found significant group-wise differences (each p < 0.05) in fiber organization and inner-tip surface integrity sub-scores, as well as the total score. Finally, we found a significant weak correlation between UTE T2* and histology total score (p = 0.007, R_s² = 0.19), unlike the correlation between SE T2 and histology (p = 0.09, R_s² = 0.05).

CONCLUSION

UTE T2* values were found to distinguish normal from both degenerated and torn menisci and correlated significantly with histopathology.

Reliability of tibiofemoral contact area and centroid location in upright, open MRI

BACKGROUND

Imaging cannot be performed during natural weightbearing in biomechanical studies using conventional closed-bore MRI, which has necessitated simulating weightbearing load on the joint. Upright, open MRI (UO-MRI) allows for joint imaging during natural weightbearing and may have the potential to better characterize the biomechanical effect of tibiofemoral pathology involving soft tissues. However open MRI scanners have lower field strengths than closed-bore scanners, which limits the image quality that can be obtained. Thus, there is a need to establish the reliability of measurements in upright weightbearing postures obtained using UO-MRI.

METHODS

Knees of five participants with prior anterior cruciate ligament (ACL) rupture were scanned standing in a 0.5 T upright open MRI scanner using a 3D DESS sequence. Manual segmentation of cartilage regions in contact was performed and centroids of these contact areas were automatically determined for the medial and lateral tibiofemoral compartments. Inter-rater, test-retest, and intra-rater reliability were determined and quantified using intra-class correlation (ICC_3,1), standard error of measurement (SEM), and smallest detectable change with 95% confidence (SDC₉₅). Accuracy was assessed by using a high-resolution 7 T MRI as a reference.

RESULTS

Contact area and centroid location reliability (inter-rater, test-retest, and intra-rater) for sagittal scans in the medial compartment had ICC_3,1 values from 0.95-0.99 and 0.98-0.99 respectively. In the lateral compartment, contact area and centroid location reliability ICC_3,1 values ranged from 0.83-0.91 and 0.95-1.00 respectively. The smallest detectable change in contact area was 1.28% in the medial compartment and 0.95% in the lateral compartment. Contact area and centroid location reliability for coronal scans in the medial compartment had ICC_3,1 values from 0.90-0.98 and 0.98-1.00 respectively, and in the lateral compartment ICC_3,1 ranged from 0.76-0.94 and 0.93-1.00 respectively. The smallest detectable change in contact area was 0.65% in the medial compartment and 1.41% in the lateral compartment. Contact area was accurate to within a mean absolute error of 11.0 mm².

CONCLUSIONS

Knee contact area and contact centroid location can be assessed in upright weightbearing MRI with good to excellent reliability. The lower field strength used in upright, weightbearing MRI does not compromise the reliability of tibiofemoral contact area and centroid location measures.

Depth-dependent changes in cartilage T2 under compressive strain: a 7T MRI study on human knee cartilage

OBJECTIVE

To assess the potential of using ΔT2 as an indirect index of cartilage strain by quantifying the relationship between local in situ compressive strain and ΔT2 through the full depth of human tibial and femoral articular cartilage.

DESIGN

Osteochondral samples (n = 4) of human tibial and femoral cartilage were harvested from cadavers and imaged in a Bruker 7T research MRI scanner under increasing displacement-controlled compressive strains. T2 was calculated for 3D double echo steady state (DESS) image volumes at each strain level. A decaying exponential model estimated local, depth-dependent strains. Strained image volumes were non-linearly warped back to their unloaded configurations and ΔT2 was calculated by image subtraction. Linear modeling assessed local relationships between strain and ΔT2.

RESULTS

Bulk average tibial T2 was 13.2 ms for unstrained cartilage and ranged from 13.0 to 13.1 ms under strain; femoral T2 was 14.0 ms for unstrained cartilage and ranged from 13.5 to 14.8 ms under strain. Local ΔT2 in strained cartilage varied with depth. Linear modeling revealed significant correlations between in situ strain and ΔT2 for both tibial and femoral cartilage; correlation coefficients were higher for tibial cartilage.

CONCLUSIONS

Changes in bulk average T2 are unsuitable as a quantitative surrogate measure of cartilage strain because bulk averaging masks important local variations. High-resolution measures of local ΔT2 have potential value as a surrogate for strain; however, their value is limited until we fully understand the influence of factors like age, joint surface and degeneration on the strain vs T2 relationship.

Phase-based T2 mapping with gradient echo imaging

PURPOSE

Transverse relaxation time (T₂ ) mapping with MRI has a plethora of clinical and research applications. Current T₂ mapping techniques are based primarily on spin-echo (SE) relaxometry strategies that rely on the signal magnitude, and often suffer from lengthy acquisition times. In this work, we propose a phase-based T₂ mapping technique where T₂ information is encoded into the signal phase of rapid gradient echo (GRE) acquisitions.

THEORY

Bloch equation simulations demonstrate that the phase of GRE acquisitions obtained with a very small inter-repetition RF phase increment has a strong monotonic dependence on T₂ , resulting from coherent transverse magnetization. This T₂ -dependent phase behavior forms the basis of the proposed T₂ mapping technique. To isolate T₂ -dependent phase from background phase, at least 2 data sets with different RF phase increments are acquired. The proposed method can also be combined with chemical shift encoded MRI to separate water and fat signals.

METHODS

The feasibility of the proposed technique was validated in a phantom experiment. In vivo feasibility was demonstrated in the brain, knee, abdomen, and pelvis. Comparisons were made with SE-based T₂ mapping, spectroscopy, and T₂ values from the literature.

RESULTS

The proposed method produced accurate T₂ maps compared with SE-based T₂ mapping in the phantom. Good qualitative agreement was observed in vivo between the proposed method and the reference. T₂ measured in various anatomies agreed well with values reported in the literature.

CONCLUSION

A phase-based T₂ mapping technique was developed and its feasibility demonstrated in phantoms and in vivo.

A unique anisotropic R2 of collagen degeneration (ARCADE) mapping as an efficient alternative to composite relaxation metric (R2 -R1 ρ ) in human knee cartilage study

PURPOSE

Anisotropic transverse R₂ (1/T₂ ) relaxation of water proton is sensitive to cartilage degenerative changes. The purpose is to develop an efficient method to extract this relaxation metric in clinical studies.

METHODS

Anisotropic R₂ can be measured inefficiently by standard R₂ mapping after removing an isotropic contribution obtained from R_{1 ρ} mapping. In the proposed method, named as a unique anisotropic R₂ of collagen degeneration (ARCADE) mapping, an assumed uniform isotropic R₂ was estimated at magic angle locations in the deep cartilage, and an anisotropic R₂ was thus isolated in a single T2W sagittal image. Five human knees from 4 volunteers were studied with standard R₂ and R_{1 ρ} mappings at 3T, and anisotropic R₂ derived from ARCADE on the T2W (TE = 48.8 ms) image from R₂ mapping was compared with the composite relaxation (R₂ - R_{1 ρ} ) using statistical analysis including Student's t-test and Pearson's correlation coefficient.

RESULTS

Anisotropic R₂ (1/s) from ARCADE was highly positively correlated with but not significantly different from standard R₂ - R_{1 ρ} (1/s) in the segmented deep (r = 0.83 ± 0.06; 8.3 ± 2.9 vs. 7.3 ± 1.9, P = .50) and the superficial (r = 0.82 ± 0.05; 3.5 ± 2.4 vs. 4.5 ± 1.6, P = .39) zones. However, after eliminating systematic errors by the normalization in terms of zonal contrast, anisotropic R₂ was significantly higher (60.2 ± 18.5% vs. 38.4 ± 16.6%, P < .01) than R₂ - R_{1 ρ} as predicted.

CONCLUSION

The proposed anisotropic R₂ mapping could be an efficient alternative to the conventional approach, holding great promise in providing both high-resolution morphological and more sensitive transverse relaxation imaging from a single T2W scan in a clinical setting.

Diffusion tensor imaging of articular cartilage using a navigated radial imaging spin-echo diffusion (RAISED) sequence

OBJECTIVE

To validate a radial imaging spin-echo diffusion tensor (RAISED) sequence for high-resolution diffusion tensor imaging (DTI) of articular cartilage at 3 T.

METHODS

The RAISED sequence implementation is described, including the used non-linear motion correction algorithm. The robustness to eddy currents was tested on phantoms, and accuracy of measurement was assessed with measurements of temperature-dependent diffusion of free water. Motion correction was validated by comparing RAISED with single-shot diffusion-weighted echo-planar imaging (EPI) measures. DTI was acquired in asymptomatic subjects (n = 6) and subjects with doubtful (Kellgren-Lawrence [KL] grade 1, n = 9) and mild (KL = 2, n = 9) symptomatic knee osteoarthritis (OA). MD and FA values without correction, and after all corrections, were calculated. A test-retest evaluation of the DTI acquisition on three asymptomatic and three OA subjects was also performed.

RESULTS

The root mean squared coefficient of variation of the global test-restest reproducibility was 3.54% for MD and 5.34% for FA. MD was significantly increased in both femoral condyles (7-9%) of KL 1 and in the medial (11-17%) and lateral (10-12%) compartments of KL 2 subjects. Averaged FA presented a trend of lower values with increasing KL grade, which was significant for the medial femoral condyle (-11%) of KL 1 and all three compartments in KL 2 subjects (-18 to -11%). Group differences in MD and FA were only significant after motion correction.

CONCLUSION

The RAISED sequence with the proposed reconstruction framework provides reproducible assessment of DTI parameters in vivo at 3 T and potentially the early stages of the disease in large regions of interest.

KEY POINTS

• DTI of articular cartilage is feasible at 3T with a multi-shot RAISED sequence with non-linear motion correction. • RAISED sequence allows estimation of the diffusion indices MD and FA with test-retest errors below 4% (MD) and 6% (FA). • RAISED-based measurement of DTI of articular cartilage with non-linear motion correction holds potential to differentiate healthy from OA subjects.

SNR-weighted regularization of ADC estimates from double-echo in steady-state (DESS)

PURPOSE

To improve the homogeneity and consistency of apparent diffusion coefficient (ADC) estimates in cartilage from the double-echo in steady-state (DESS) sequence by applying SNR-weighted regularization during post-processing.

METHODS

An estimation method that linearizes ADC estimates from DESS is used in conjunction with a smoothness constraint to suppress noise-induced variation in ADC estimates. Simulations, phantom scans, and in vivo scans are used to demonstrate how the method reduces ADC variability. Conventional diffusion-weighted echo-planar imaging (DW EPI) maps are acquired for comparison of mean and standard deviation (SD) of the ADC estimate.

RESULTS

Simulations and phantom scans demonstrated that the SNR-weighted regularization can produce homogenous ADC maps at varying levels of SNR, whereas non-regularized maps only estimate ADC accurately at high SNR levels. The in vivo maps showed that the SNR-weighted regularization produced ADC maps with similar heterogeneity to maps produced with standard DW EPI, but without the distortion of such reference scans.

CONCLUSION

A linear approximation of a simplified model of the relationship between DESS signals allows for fast SNR-weighted regularization of ADC maps that reduces estimation error in relatively short T₂ tissue such as cartilage.

Morphologic and quantitative magnetic resonance imaging of knee articular cartilage for the assessment of post-traumatic osteoarthritis

Orthopedic trauma, such as anterior cruciate ligament (ACL) disruption, is a common source of osteoarthritis in the knee. Magnetic resonance imaging (MRI) is a non-invasive multi-planar imaging modality commonly used to evaluate hard and soft tissues of diarthrodial joints following traumatic injury. The contrast provided by generated images enables the evaluation of bone marrow lesions as well as delamination and degeneration of articular cartilage. We will provide background information about MRI signal generation and decay (T₁ and T₂ values), the utility of morphologic MRI, and the quantitative MRI techniques of T_1ρ , T₂ , and T₂ * mapping, to evaluate subjects with traumatic knee injuries, such as ACL rupture. Additionally, we will provide information regarding the dGEMRIC, sodium, and gagCEST imaging techniques. Finally, the description and utility of newer post hoc analysis techniques, such as texture analysis, will be given. Continued development and refinement of these advanced MRI techniques will facilitate their clinical translation. © 2016 Orthopaedic Research Society. Published by Wiley Periodicals, Inc. J Orthop Res 35:412-423, 2017.

Optimizing MR Scan Design for Model-Based ${T}_{1}$ , ${T}_{2}$ Estimation From Steady-State Sequences

Rapid, reliable quantification of MR relaxation parameters T1 and T2 is desirable for many clinical applications. Steady-state sequences such as Spoiled Gradient-Recalled Echo (SPGR) and Dual-Echo Steady-State (DESS) are fast and well-suited for relaxometry because the signals they produce are quite sensitive to T1 and T2 variation. However, T1, T2 estimation with these sequences typically requires multiple scans with varied sets of acquisition parameters. This paper describes a systematic framework for selecting scan types (e.g., combinations of SPGR and DESS scans) and optimizing their respective parameters (e.g., flip angles and repetition times). The method is based on a Cramér-Rao Bound (CRB)-inspired min-max optimization that finds scan parameter combinations that robustly enable precise object parameter estimation. We apply this technique to optimize combinations of SPGR and DESS scans for T1, T2 relaxometry in white matter (WM) and grey matter (GM) regions of the human brain at 3T field strength. Phantom accuracy experiments show that SPGR/DESS scan combinations are in excellent agreement with reference measurements. Phantom precision experiments show that trends in T1,T2 pooled sample standard deviations reflect CRB-based predictions. In vivo experiments show that in WM and GM, T1 and T2 estimates from a pair of optimized DESS scans exhibit precision (but not necessarily accuracy) comparable to that of optimized combinations of SPGR and DESS scans. To our knowledge, T1 maps from DESS acquisitions alone are new. This example application illustrates that scan optimization may help reveal new parameter mapping techniques from combinations of established pulse sequences.

Imaging and T2 relaxometry of short-T2 connective tissues in the knee using ultrashort echo-time double-echo steady-state (UTEDESS)

PURPOSE

To develop a radial, double-echo steady-state (DESS) sequence with ultra-short echo-time (UTE) capabilities for T₂ measurement of short-T₂ tissues along with simultaneous rapid, signal-to-noise ratio (SNR)-efficient, and high-isotropic-resolution morphological knee imaging.

METHODS

THe 3D radial UTE readouts were incorporated into DESS, termed UTEDESS. Multiple-echo-time UTEDESS was used for performing T₂ relaxometry for short-T₂ tendons, ligaments, and menisci; and for Dixon water-fat imaging. In vivo T₂ estimate repeatability and SNR efficiency for UTEDESS and Cartesian DESS were compared. The impact of coil combination methods on short-T₂ measurements was evaluated by means of simulations. UTEDESS T₂ measurements were compared with T₂ measurements from Cartesian DESS, multi-echo spin-echo (MESE), and fast spin-echo (FSE).

RESULTS

UTEDESS produced isotropic resolution images with high SNR efficiency in all short-T₂ tissues. Simulations and experiments demonstrated that sum-of-squares coil combinations overestimated short-T₂ measurements. UTEDESS measurements of meniscal T₂ were comparable to DESS, MESE, and FSE measurements while the tendon and ligament measurements were less biased than those from Cartesian DESS. Average UTEDESS T₂ repeatability variation was under 10% in all tissues.

CONCLUSION

The T₂ measurements of short-T₂ tissues and high-resolution morphological imaging provided by UTEDESS makes it promising for studying the whole knee, both in routine clinical examinations and longitudinal studies. Magn Reson Med 78:2136-2148, 2017. © 2017 International Society for Magnetic Resonance in Medicine.

A simple analytic method for estimating T2 in the knee from DESS

PURPOSE

To introduce a simple analytical formula for estimating T₂ from a single Double-Echo in Steady-State (DESS) scan.

METHODS

Extended Phase Graph (EPG) modeling was used to develop a straightforward linear approximation of the relationship between the two DESS signals, enabling accurate T₂ estimation from one DESS scan. Simulations were performed to demonstrate cancellation of different echo pathways to validate this simple model. The resulting analytic formula was compared to previous methods for T₂ estimation using DESS and fast spin-echo scans in agar phantoms and knee cartilage in three volunteers and three patients. The DESS approach allows 3D (256×256×44) T₂-mapping with fat suppression in scan times of 3-4min.

RESULTS

The simulations demonstrated that the model approximates the true signal very well. If the T₁ is within 20% of the assumed T₁, the T₂ estimation error was shown to be less than 5% for typical scans. The inherent residual error in the model was demonstrated to be small both due to signal decay and opposing signal contributions. The estimated T₂ from the linear relationship agrees well with reference scans, both for the phantoms and in vivo. The method resulted in less underestimation of T₂ than previous single-scan approaches, with processing times 60 times faster than using a numerical fit.

CONCLUSION

A simplified relationship between the two DESS signals allows for rapid 3D T₂ quantification with DESS that is accurate, yet also simple. The simplicity of the method allows for immediate T₂ estimation in cartilage during the MRI examination.

Nasal chondrocyte-based engineered autologous cartilage tissue for repair of articular cartilage defects: an observational first-in-human trial

BACKGROUND

Articular cartilage injuries have poor repair capacity, leading to progressive joint damage, and cannot be restored predictably by either conventional treatments or advanced therapies based on implantation of articular chondrocytes. Compared with articular chondrocytes, chondrocytes derived from the nasal septum have superior and more reproducible capacity to generate hyaline-like cartilage tissues, with the plasticity to adapt to a joint environment. We aimed to assess whether engineered autologous nasal chondrocyte-based cartilage grafts allow safe and functional restoration of knee cartilage defects.

METHODS

In a first-in-human trial, ten patients with symptomatic, post-traumatic, full-thickness cartilage lesions (2-6 cm²) on the femoral condyle or trochlea were treated at University Hospital Basel in Switzerland. Chondrocytes isolated from a 6 mm nasal septum biopsy specimen were expanded and cultured onto collagen membranes to engineer cartilage grafts (30 × 40 × 2 mm). The engineered tissues were implanted into the femoral defects via mini-arthrotomy and assessed up to 24 months after surgery. Primary outcomes were feasibility and safety of the procedure. Secondary outcomes included self-assessed clinical scores and MRI-based estimation of morphological and compositional quality of the repair tissue. This study is registered with ClinicalTrials.gov, number NCT01605201. The study is ongoing, with an approved extension to 25 patients.

FINDINGS

For every patient, it was feasible to manufacture cartilaginous grafts with nasal chondrocytes embedded in an extracellular matrix rich in glycosaminoglycan and type II collagen. Engineered tissues were stable through handling with forceps and could be secured in the injured joints. No adverse reactions were recorded and self-assessed clinical scores for pain, knee function, and quality of life were improved significantly from before surgery to 24 months after surgery. Radiological assessments indicated variable degrees of defect filling and development of repair tissue approaching the composition of native cartilage.

INTERPRETATION

Hyaline-like cartilage tissues, engineered from autologous nasal chondrocytes, can be used clinically for repair of articular cartilage defects in the knee. Future studies are warranted to assess efficacy in large controlled trials and to investigate an extension of indications to early degenerative states or to other joints.

FUNDING

Deutsche Arthrose-Hilfe.

MR fingerprinting using the quick echo splitting NMR imaging technique

PURPOSE

The purpose of the study is to develop a quantitative method for the relaxation properties with a reduced radio frequency (RF) power deposition by combining magnetic resonance fingerprinting (MRF) technique with quick echo splitting NMR imaging technique (QUEST).

METHODS

A QUEST-based MRF sequence was implemented to acquire high-order echoes by increasing the gaps between RF pulses. Bloch simulations were used to calculate a dictionary containing the range of physically plausible signal evolutions using a range of T₁ and T₂ values based on the pulse sequence. MRF-QUEST was evaluated by comparing to the results of spin-echo methods. The specific absorption rate (SAR) of MRF-QUEST was compared with the clinically available methods.

RESULTS

MRF-QUEST quantifies the relaxation properties with good accuracy at the estimated head SAR of 0.03 W/kg. T₁ and T₂ values estimated by MRF-QUEST are in good agreement with the traditional methods.

CONCLUSIONS

The combination of the MRF and the QUEST provides an accurate quantification of T₁ and T₂ simultaneously with reduced RF power deposition. The resulting lower SAR may provide a new acquisition strategy for MRF when RF energy deposition is problematic. Magn Reson Med 77:979-988, 2017. © 2016 International Society for Magnetic Resonance in Medicine.

MR fingerprinting using fast imaging with steady state precession (FISP) with spiral readout

PURPOSE

This study explores the possibility of using gradient echo-based sequences other than balanced steady-state free precession (bSSFP) in the magnetic resonance fingerprinting (MRF) framework to quantify the relaxation parameters .

METHODS

An MRF method based on a fast imaging with steady-state precession (FISP) sequence structure is presented. A dictionary containing possible signal evolutions with physiological range of T1 and T2 was created using the extended phase graph formalism according to the acquisition parameters. The proposed method was evaluated in a phantom and a human brain. T1 , T2 , and proton density were quantified directly from the undersampled data by the pattern recognition algorithm.

RESULTS

T1 and T2 values from the phantom demonstrate that the results of MRF FISP are in good agreement with the traditional gold-standard methods. T1 and T2 values in brain are within the range of previously reported values.

CONCLUSION

MRF-FISP enables a fast and accurate quantification of the relaxation parameters. It is immune to the banding artifact of bSSFP due to B0 inhomogeneities, which could improve the ability to use MRF for applications beyond brain imaging.

Imaging of cartilage and bone: promises and pitfalls in clinical trials of osteoarthritis

Imaging in clinical trials is used to evaluate subject eligibility, and/or efficacy of intervention, supporting decision making in drug development by ascertaining treatment effects on joint structure. This review focusses on imaging of bone and cartilage in clinical trials of (knee) osteoarthritis. We narratively review the full-text literature on imaging of bone and cartilage, adding primary experience in the implementation of imaging methods in clinical trials. Aims and constraints of applying imaging in clinical trials are outlined. The specific uses of semi-quantitative and quantitative imaging biomarkers of bone and cartilage in osteoarthritis trials are summarized, focusing on radiography and magnetic resonance imaging (MRI). Studies having compared both imaging methodologies directly and those having established a relationship between imaging biomarkers and clinical outcomes are highlighted. To make this review of practical use, recommendations are provided as to which imaging protocols are ideal for capturing specific aspects of bone and cartilage tissue, and pitfalls in their usage are highlighted. Further, the longitudinal sensitivity to change, of different imaging methods is reported for various patient strata. From these power calculations can be accomplished, provided the strength of the treatment effect is known. In conclusion, current imaging methodologies provide powerful tools for scoring and measuring morphological and compositional aspects of most articular tissues, capturing longitudinal change with reasonable to excellent sensitivity. When employed properly, imaging has tremendous potential for ascertaining treatment effects on various joint structures, potentially over shorter time scales than required for demonstrating effects on clinical outcomes.

Triple-echo steady-state T2 relaxometry of the human brain at high to ultra-high fields

Quantitative MRI techniques, such as T2 relaxometry, have demonstrated the potential to detect changes in the tissue microstructure of the human brain with higher specificity to the underlying pathology than in conventional morphological imaging. At high to ultra-high field strengths, quantitative MR-based tissue characterization benefits from the higher signal-to-noise ratio traded for either improved resolution or reduced scan time, but is impaired by severe static (B0 ) and transmit (B1 ) field heterogeneities. The objective of this study was to derive a robust relaxometry technique for fast T2 mapping of the human brain at high to ultra-high fields, which is highly insensitive to B0 and B1 field variations. The proposed method relies on a recently presented three-dimensional (3D) triple-echo steady-state (TESS) imaging approach that has proven to be suitable for fast intrinsically B1 -insensitive T2 relaxometry of rigid targets. In this work, 3D TESS imaging is adapted for rapid high- to ultra-high-field two-dimensional (2D) acquisitions. The achieved short scan times of 2D TESS measurements reduce motion sensitivity and make TESS-based T2 quantification feasible in the brain. After validation in vitro and in vivo at 3 T, T2 maps of the human brain were obtained at 7 and 9.4 T. Excellent agreement between TESS-based T2 measurements and reference single-echo spin-echo data was found in vitro and in vivo at 3 T, and T2 relaxometry based on TESS imaging was proven to be feasible and reliable in the human brain at 7 and 9.4 T. Although prominent B0 and B1 field variations occur at ultra-high fields, the T2 maps obtained show no B0 - or B1 -related degradations. In conclusion, as a result of the observed robustness, TESS T2 may emerge as a valuable measure for the early diagnosis and progression monitoring of brain diseases in high-resolution 2D acquisitions at high to ultra-high fields.