Quantitative ultrashort TE imaging of the short-T2 components in skeletal muscle using an extended echo-subtraction method

Magnetic Resonance Imaging Biomarkers of Muscle

This review is focused on the current status of quantitative MRI (qMRI) of skeletal muscle. The first section covers the techniques of qMRI in muscle with the focus on each quantitative parameter, the corresponding imaging sequence, discussion of the relation of the measured parameter to underlying physiology/pathophysiology, the image processing and analysis approaches, and studies on normal subjects. We cover the more established parametric mapping from T1-weighted imaging for morphometrics including image segmentation, proton density fat fraction, T2 mapping, and diffusion tensor imaging to emerging qMRI features such as magnetization transfer including ultralow TE imaging for macromolecular fraction, and strain mapping. The second section is a summary of current clinical applications of qMRI of muscle; the intent is to demonstrate the utility of qMRI in different disease states of the muscle rather than a complete comprehensive survey.

Compositional and Functional MRI of Skeletal Muscle: A Review

Due to its exceptional sensitivity to soft tissues, MRI has been extensively utilized to assess anatomical muscle parameters such as muscle volume and cross-sectional area. Quantitative Magnetic Resonance Imaging (qMRI) adds to the capabilities of MRI, by providing information on muscle composition such as fat content, water content, microstructure, hypertrophy, atrophy, as well as muscle architecture. In addition to compositional changes, qMRI can also be used to assess function for example by measuring muscle quality or through characterization of muscle deformation during passive lengthening/shortening and active contractions. The overall aim of this review is to provide an updated overview of qMRI techniques that can quantitatively evaluate muscle structure and composition, provide insights into the underlying biological basis of the qMRI signal, and illustrate how qMRI biomarkers of muscle health relate to function in healthy and diseased/injured muscles. While some applications still require systematic clinical validation, qMRI is now established as a comprehensive technique, that can be used to characterize a wide variety of structural and compositional changes in healthy and diseased skeletal muscle. Taken together, multiparametric muscle MRI holds great potential in the diagnosis and monitoring of muscle conditions in research and clinical applications. EVIDENCE LEVEL: 5 TECHNICAL EFFICACY: Stage 2.

New Insights into the Spread of MRS-Based Water T2 Values Observed in Highly Fatty Replaced Muscles

BACKGROUND

The reference standard for assessing water T2 (T2,H2O ) at high fat fraction (FF) is 1 H MRS. T2,H2O (T2,H2O,MRS ) dependence on FF (FFMRS ) has recently been demonstrated in muscle at high FF (i.e. ≥60%).

PURPOSE

To investigate the relationship between T2,H2O,MRS and FFMRS in the thigh/leg muscles of patients with neuromuscular diseases and to compare with quantitative MRI.

STUDY TYPE

Retrospective case-control study.

POPULATION

A total of 151 patients with neuromuscular disorders (mean age ± standard deviation = 52.5 ± 22.6 years, 54% male), 44 healthy volunteers (26.5 ± 13.0 years, 57% male).

FIELD STRENGTH/SEQUENCE

A 3-T; single-voxel stimulated echo acquisition mode (STEAM) MRS, multispin echo (MSE) imaging (for T2 mapping, T2,H2O,MRI ), three-point Dixon imaging (for FFMRI andR 2 * mapping).

ASSESSMENT

Mono-exponential and bi-exponential models were fitted to water T2 decay curves to extract T2,H2O,MRS and FFMRS . Water resonance full-width-at-half-maximum (FWHM) and B0 spread (∆B0 ) values were calculated. T2,H2O,MRI (mean), FFMRI (mean, kurtosis, and skewness), andR 2 * (mean) values were estimated in the MRS voxel.

STATISTICAL TESTS

Mann-Whitney U tests, Kruskal-Wallis tests. A P-value <0.05 was considered statistically significant.

RESULTS

Normal T2,H2O,MRS threshold was defined as the 90th percentile in healthy controls: 30.3 msec. T2,H2O,MRS was significantly higher in all patients with FFMRS  < 60% compared to healthy controls. We discovered two subgroups in patients with FFMRS  ≥ 60%: one with T2,H2O,MRS  ≥ 30.3 msec and one with T2,H2O,MRS  < 30.3 msec including abnormally low T2,H2O,MRS . The latter subgroup had significantly higher water resonance FWHM, ∆B0 , FFMRI kurtosis, and skewness values but nonsignificantly differentR 2 * (P = 1.00) and long T2,H2O,MRS component and its fraction (P > 0.11) based on the bi-exponential analysis.

DATA CONCLUSION

The findings suggest that the cause for (abnormally) T2,H2O,MRS at high FFMRS is biophysical, due to differences in susceptibility between muscle and fat (increased FWHM and ∆B0 ), rather than pathophysiological such as compartmentation changes, which would be reflected by the bi-exponential analysis.

EVIDENCE LEVEL

3 TECHNICAL EFFICACY: Stage 3.

Spatially resolved free-induction decay spectroscopy using a 3D ultra-short echo time multi-echo imaging sequence with systematic echo shifting and compensation of B0 field drifts

PURPOSE

Biologically interesting signals can exhibit fast transverse relaxation and frequency shifts compared to free water. For spectral assignment, a ultra-short echo time (UTE) imaging sequence was modified to provide pixel-wise free-induction decay (FID) acquisition.

METHODS

The UTE-FID approach presented relies on a multi-echo 3D spiral UTE sequence with six echoes per radiofrequency (RF) excitation (TE_min 0.05 ms, echo spacing 3 ms). A complex pixel-wise raw data set for FID spectroscopy is obtained by several multi-echo UTE measurements with systematic shifting of the readout by 0.25 or 0.5 ms, until the time domain is filled for 18 or 45 ms. B₀ drifts are compensated by mapping and according phase correction. Autoregressive extrapolation of the signal is performed before Gaussian filtering. This method was applied to a phantom containing collagen-water solutions of different concentrations. To calculate the collagen content, a 19-peak collagen model was extracted from a non-selective FID spectrum (50% collagen solution). Proton-density-collagen-fraction (PDCF) was calculated for 10 collagen solutions (2%-50%). Furthermore, an in vivo UTE-FID spectrum of adipose tissue was recorded.

RESULTS

UTE-FID signal patterns agreed well with the non-spatially selective pulse-acquire FID spectrum from a sphere filled with 50% collagen. Differentiation of collagen solution from distilled water in the PDCF map was possible from 4% collagen concentration for a UTE-FID sequence with 128 × 128 × 64 matrix (voxel size 1 × 1 × 2.85 mm³ ). The mean values of the PDCF correlate linearly with collagen concentration.

CONCLUSION

The presented UTE-FID approach allows pixel-wise raw data acquisition similar to non-spatially selective pulse-acquire spectroscopy. Spatially resolved applications for assessment of spectra of rapidly decaying signals seem feasible.

Medical imaging of tissue engineering and regenerative medicine constructs

Advancement of tissue engineering and regenerative medicine (TERM) strategies to replicate tissue structure and function has led to the need for noninvasive assessment of key outcome measures of a construct's state, biocompatibility, and function. Histology based approaches are traditionally used in pre-clinical animal experiments, but are not always feasible or practical if a TERM construct is going to be tested for human use. In order to transition these therapies from benchtop to bedside, rigorously validated imaging techniques must be utilized that are sensitive to key outcome measures that fulfill the FDA standards for TERM construct evaluation. This review discusses key outcome measures for TERM constructs and various clinical- and research-based imaging techniques that can be used to assess them. Potential applications and limitations of these techniques are discussed, as well as resources for the processing, analysis, and interpretation of biomedical images.

Non-invasive assessment of skeletal muscle fibrosis in mice using nuclear magnetic resonance imaging and ultrasound shear wave elastography

Fibrosis is a key pathological feature in muscle disorders, but its quantification mainly relies on histological and biochemical assays. Muscle fibrosis most frequently is entangled with other pathological processes, as cell membrane lesions, inflammation, necrosis, regeneration, or fatty infiltration, making in vivo assessment difficult. Here, we (1) describe a novel mouse model with variable levels of induced skeletal muscle fibrosis displaying minimal inflammation and no fat infiltration, and (2) report how fibrosis affects non-invasive metrics derived from nuclear magnetic resonance (NMR) and ultrasound shear-wave elastography (SWE) associated with a passive biomechanical assay. Our findings show that collagen fraction correlates with multiple non-invasive metrics. Among them, muscle stiffness as measured by SWE, T₂, and extracellular volume (ECV) as measured by NMR have the strongest correlations with histology. We also report that combining metrics in a multi-modality index allowed better discrimination between fibrotic and normal skeletal muscles. This study demonstrates that skeletal muscle fibrosis leads to alterations that can be assessed in vivo with multiple imaging parameters. Furthermore, combining NMR and SWE passive biomechanical assay improves the non-invasive evaluation of skeletal muscle fibrosis and may allow disentangling it from co-occurring pathological alterations in more complex scenarios, such as muscular dystrophies.

MRI-Based Quantitative Osteoporosis Imaging at the Spine and Femur

Osteoporosis is a systemic skeletal disease with a high prevalence worldwide, characterized by low bone mass and microarchitectural deterioration, predisposing an individual to fragility fractures. Dual-energy X-ray absorptiometry (DXA) has been the clinical reference standard for diagnosing osteoporosis and for assessing fracture risk for decades. However, other imaging modalities are of increasing importance to investigate the etiology, treatment, and fracture risk. The purpose of this work is to review the available literature on quantitative magnetic resonance imaging (MRI) methods and related findings in osteoporosis at the spine and proximal femur as the clinically most important fracture sites. Trabecular bone microstructure analysis at the proximal femur based on high-resolution MRI allows for a better prediction of osteoporotic fracture risk than DXA-based bone mineral density (BMD) alone. In the 1990s, T₂ * mapping was shown to correlate with the density and orientation of the trabecular bone. Recently, quantitative susceptibility mapping (QSM), which overcomes some of the limitations of T₂ * mapping, has been applied for trabecular bone quantifications at the spine, whereas ultrashort echo time (UTE) imaging provides valuable surrogate markers of cortical bone quantity and quality. Magnetic resonance spectroscopy (MRS) and chemical shift encoding-based water-fat MRI (CSE-MRI) enable the quantitative assessment of the nonmineralized bone compartment through extraction of the bone marrow fat fraction (BMFF). Furthermore, CSE-MRI allows for the differentiation of osteoporotic vs. pathologic fractures, which is of high clinical relevance. Lastly, advanced postprocessing and image analysis tools, particularly considering statistical parametric mapping and region-specific BMFF distributions, have high potential to further improve MRI-based fracture risk assessments at the spine and hip. LEVEL OF EVIDENCE: 5 TECHNICAL EFFICACY STAGE: 2.

Role of the Extracellular Matrix in Loss of Muscle Force With Age and Unloading Using Magnetic Resonance Imaging, Biochemical Analysis, and Computational Models

The focus of this review is the application of advanced MRI to study the effect of aging and disuse related remodeling of the extracellular matrix (ECM) on force transmission in the human musculoskeletal system. Structural MRI includes (i) ultra-low echo times (UTE) maps to visualize and quantify the connective tissue, (ii) diffusion tensor imaging (DTI) modeling to estimate changes in muscle and ECM microstructure, and (iii) magnetization transfer contrast imaging to quantify the macromolecular fraction in muscle. Functional MRI includes dynamic acquisitions during contraction cycles enabling computation of the strain tensor to monitor muscle deformation. Further, shear strain extracted from the strain tensor may be a potential surrogate marker of lateral transmission of force. Biochemical and histological analysis of muscle biopsy samples can provide "gold-standard" validation of some of the MR findings. The review summarizes biochemical studies of ECM adaptations with age and with disuse. A brief summary of animal models is included as they provide experimental confirmation of longitudinal and lateral force transmission pathways. Computational muscle models enable exploration of force generation and force pathways and elucidate the link between structural adaptations and functional consequences. MR image findings integrated in a computational model can explain and predict subject specific functional changes to structural adaptations. Future work includes development and validation of MRI biomarkers using biochemical analysis of muscle tissue as a reference standard and potential translation of the imaging markers to the clinic to noninvasively monitor musculoskeletal disease conditions and changes consequent to rehabilitative interventions.

Decreased water T2 in fatty infiltrated skeletal muscles of patients with neuromuscular diseases

Quantitative imaging techniques are emerging in the field of magnetic resonance imaging of neuromuscular diseases (NMD). T₂ of water (T_2w ) is considered an important imaging marker to assess acute and chronic alterations of the muscle fibers, being generally interpreted as an indicator for "disease activity" in the muscle tissue. To validate the accuracy and robustness of quantitative imaging methods, ¹ H magnetic resonance spectroscopy (MRS) can be used as a gold standard. The purpose of the present work was to investigate T_2w of remaining muscle tissue in regions of higher proton density fat fraction (PDFF) in 40 patients with defined NMD using multi-TE single-voxel ¹ H MRS. Patients underwent MR measurements on a 3 T system to perform a multi-TE single-voxel stimulated echo acquisition method (STEAM) MRS (TE = 11/15/20/25(/35) ms) in regions of healthy, edematous and fatty thigh muscle tissue. Muscle regions for MRS were selected based on T₂ -weighted water and fat images of a two-echo 2D Dixon TSE. MRS results were confined to regions with qualitatively defined remaining muscle tissue without edema and high fat content, based on visual grading of the imaging data. The results showed decreased T_2w values with increasing PDFF with R²  = 0.45 (p < 10^-3 ) (linear fit) and with R²  = 0.51 (exponential fit). The observed dependence of T_2w on PDFF should be considered when using T_2w as a marker in NMD imaging and when performing single-voxel MRS for T_2w in regions enclosing edematous, nonedematous and fatty infiltrated muscle tissue.

Characterizing a short T2 * signal component in the liver using ultrashort TE chemical shift-encoded MRI at 1.5T and 3.0T

PURPOSE

Recent studies have suggested the presence of short-T₂ * signals in the liver, which may confound chemical shift-encoded (CSE) fat quantification when using short echo times (TEs). The purpose of this study was to characterize the liver signal at short echo times and to determine its impact on liver fat quantification.

METHODS

An ultrashort echo time (UTE) chemical shift-encoded MRI (CSE-MRI) technique and a multicomponent reconstruction were developed to characterize short-T₂ * liver signals. Subsequently, liver fat fraction was quantified using a short-TE (first TE = 0.7 ms) and UTE CSE-MRI acquisitions and compared with a standard CSE-MRI (first TE = 1.2 ms).

RESULTS

Short-T₂ * signals were consistently observed in the liver of all healthy volunteers imaged at both 1.5T and 3.0T. At 3.0T, short-T₂ * signal fractions of 9.6 ± 1.5%, 7.0 ± 1.7%, and 7.4 ± 1.7% with T₂ * of 0.23 ± 0.05 ms, 0.20 ± 0.05 ms, and 0.10 ± 0.02 ms were measured in healthy volunteers, patients with liver cirrhotic disease, and patients with hepatic steatosis (but no cirrhosis), respectively. For proton density fat fraction (PDFF) estimation, 1.7% (P < .01) and 3.4% (P < .01) biases were observed in subjects imaged using short-TE CSE-MRI and using UTE CSE-MRI at 1.5T, respectively. The biases were reduced to 0.4% and -0.7%, respectively, by excluding short echoes less than 1 ms. A 3.2% bias (P < .01) was observed in subjects imaged using UTE CSE-MRI at 3.0T, which was reduced to 0.1% by excluding short echoes <1 ms.

CONCLUSIONS

A liver short-T₂ * signal component was consistently observed and was shown to confound liver fat quantification when short echo times were used with CSE-MRI.

Recent Advances in Pediatric Brain, Spine, and Neuromuscular Magnetic Resonance Imaging Techniques

Magnetic resonance imaging (MRI) is a powerful radiologic tool with the ability to generate a variety of proton-based signal contrast from tissues. Owing to this immense flexibility in signal generation, new MRI techniques are constantly being developed, tested, and optimized for clinical utility. In addition, the safe and nonionizing nature of MRI makes it a suitable modality for imaging in children. In this review article, we summarize a few of the most popular advances in MRI techniques in recent years. In particular, we highlight how these new developments have affected brain, spine, and neuromuscular imaging and focus on their applications in pediatric patients. In the first part of the review, we discuss new approaches such as multiphase and multidelay arterial spin labeling for quantitative perfusion and angiography of the brain, amide proton transfer MRI of the brain, MRI of brachial plexus and lumbar plexus nerves (i.e., neurography), and T2 mapping and fat characterization in neuromuscular diseases. In the second part of the review, we focus on describing new data acquisition strategies in accelerated MRI aimed collectively at reducing the scan time, including simultaneous multislice imaging, compressed sensing, synthetic MRI, and magnetic resonance fingerprinting. In discussing the aforementioned, the review also summarizes the advantages and disadvantages of each method and their current state of commercial availability from MRI vendors.

Advancements in magnetic resonance imaging-based biomarkers for muscular dystrophy

Recent years have seen steady progress in the identification of genetic muscle diseases as well as efforts to develop treatment for these diseases. Consequently, sensitive and objective new methods are required to identify and monitor muscle pathology. Magnetic resonance imaging offers multiple potential biomarkers of disease severity in the muscular dystrophies. This Review uses a pathology-based approach to examine the ways in which MRI and spectroscopy have been used to study muscular dystrophies. Methods that have been used to quantitate intramuscular fat, edema, fiber orientation, metabolism, fibrosis, and vascular perfusion are examined, and this Review describes how MRI can help diagnose these conditions and improve upon existing muscle biomarkers by detecting small increments of disease-related change. Important challenges in the implementation of imaging biomarkers, such as standardization of protocols and validating imaging measurements with respect to clinical outcomes, are also described.

The application value of ultra-short echo time MRI in the quantification of liver iron overload in a rat model

Background

The quantitative evaluation of liver iron concentration (LIC) is important in guiding the treatment of blood transfusion-dependent patients. Conventionally, LIC is assessed through R2*or R2 values using magnetic resonance imaging (MRI). However, most of the studies using MRI to determine iron overload were restricted by the minimum echo time, so that severe iron overload could hardly be quantified. In our study, we demonstrate a new approach to overcome the limitation of the shortest echo time using ultra-short echo time (UTE) MRI to quantify liver iron overload of varying degrees in a rat model.

Methods

Sixty female Sprague-Dawley rats were included and randomly assigned into 10 equal groups. Group 1 was not injected with iron dextran. Groups 2 to 10 were intraperitoneally injected with iron dextran at a dose of 15 mg/kg every 3 days. On every 6th day, one group was randomly selected from groups 2 to 10 for MRI scanning and liver iron concentration (LIC) detection. For groups 1 to 10, images were acquired by UTE sequence using a 3.0T MR scanner, and the T2* value and R2* value were obtained (R2* =1/T2*). In addition, LIC was measured using an atomic absorption photometer. The correlation analysis between R2* value and LIC was performed and the regression equation of R2* and LIC was established and its reliability verified.

Results

For groups 1 to 10, R2* values and LIC ranged from 60.16±4.76 to 1,306.90±42.26 Hz and from 0.84±0.11 to 5.89±2.64 mg/g dry, respectively. The R2* value was linearly correlated to the LIC (r=0.897, P<0.001), and the linear regression equation was LIC = 0.005 × R2* + 1.783. The validation analysis results showed that the intragroup correlation coefficient (ICC) between the predicted and measured LIC was 89.5%.

Conclusions

The UTE sequence could be used for quantification of varying degrees of hepatic iron overload in the rat model, and the LIC could be predicted by using the R2* value on an MR 3.0T scanner.

Bi-component T1ρ and T2 Relaxation Mapping of Skeletal Muscle In-Vivo

The goal of this paper was to evaluate the possibility of bi-component T1ρ and T2 relaxation mapping of human skeletal muscle at 3 T in clinically feasible scan times. T1ρ- and T2-weighted images of calf muscle were acquired using a modified 3D-SPGR sequence on a standard 3 T clinical MRI scanner. The mono- and biexponential models were fitted pixel-wise to the series of T1ρ and T2 weighted images. The biexponential decay of T1ρ and T2 relaxations was detected in ~30% and ~40% of the pixels across all volunteers, respectively. Monoexponential and bi-exponential short and long T1ρ relaxation times were estimated to be 26.9 ms, 4.6 ms (fraction 22%) and 33.2 ms (fraction: 78%), respectively. Similarly, the mono- and bi-exponential short and long T2 relaxation times were 24.7 ms, 4.2 ms (fraction 15%) and 30.4 ms (fraction 85%) respectively. The experiments had good repeatability with RMSCV < 15% and ICC > 60%. This approach could potentially be used in exercise intervention studies or in studies of inflammatory myopathies or muscle fibrosis, permitting greater sensitivity and specificity via measurement of different water compartments and their fractions.