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

Quadrupole-Central-Transition 23Na, 39K, 87Rb NMR Studies of Alkali Metal Ions under Different Molecular Tumbling Conditions: A Simple Model to Treat Chemical Exchange Involving Quadrupolar Nuclei

We report a new NMR method for treating two-site chemical exchange involving half-integer quadrupolar nuclei in a solution. The new method was experimentally verified with extensive 23Na (I = 3/2), 39K (I = 3/2), and 87Rb (I = 3/2) NMR results from alkali metal ions (Na+, K+, and Rb+) in a solution over a wide range of molecular tumbling conditions. In the fast-motion limit, all allowed single-quantum NMR transitions for a particular quadrupolar nucleus are degenerate giving rise to one Lorentzian signal. In the slow-motion regime, although the NMR signal from quadrupolar nuclei should in principle exhibit a multi-Lorentzian line shape, only the quadrupole central transition (QCT) is often detectable in practice. In all the cases studied in this work, we found that alkali metal ions undergo fast exchange between free and bound states. Using the new theoretical method, we were able to interpret the experimental transverse relaxation data (i.e., line widths) obtained for 23Na, 39K, and 87Rb NMR signals including QCT signals over a large temperature range and extract information about ion-binding dynamics in different chemical environments. This work fills a gap in the literature where a unified approach for treating NMR transverse relaxation data for quadrupolar nuclei over the entire range of motion has been lacking. Our results suggest that the new approach is applicable in the study of alkali metal ion binding to biological macromolecules.

Machine Learning Mapping Approach for Computing Spin Relaxation Dynamics

In this work, a machine learning mapping approach for predicting the properties of atomistic systems is reported. Within this approach, the atomic orbital overlap, density, or Kohn-Sham (KS) Fock matrix elements obtained at a low level of theory such as extended tight-binding have been used as input features to predict the electric field gradient (EFG) tensors at a higher level of theory such as those obtained with hybrid functionals. It is shown that the machine-learning-predicted EFG tensors can be used to compute spin relaxation rates of several ions in aqueous solutions. From only a fraction of data used in direct calculation, one can predict the quadrupolar isotropic spin relaxation rates with good accuracy, achieving relative errors between about 2-8% for different ions.

Measurement of T1ρ dispersion with compressed sensing and magnetization prepared radial balanced steady-state free precession in spontaneous human osteoarthritis

PURPOSE

To assess the potential for accelerating continuous-wave (CW) T1ρ dispersion measurement with compressed sensing approach via studying the effect that the data reduction has on the ability to detect differences between intact and degenerated articular cartilage with different spin-lock amplitudes and to assess quantitative bias due to acceleration.

METHODS

Osteochondral plugs (n = 27, 4 mm diameter) from femur (n = 14) and tibia (n = 13) regions from human cadaver knee joints were obtained from commercial biobank (Science Care, USA) under Ethical permission 134/2015. MRI of specimens was performed at 9.4T with magnetization prepared radial balanced SSFP (bSSFP) readout sequence, and the CWT1ρ relaxation time maps were computed from the measured data. The relaxation time maps were evaluated in the cartilage zones for different acceleration factors. For reference, Osteoarthritis Research Society International (OARSI) grading and biomechanical measurements were performed and correlated with the MRI findings.

RESULTS

Four-fold acceleration of CWT1ρ dispersion measurement by compressed sensing approach was feasible without meaningful loss in the sensitivity to osteoarthritic (OA) changes within the articular cartilage. Differences were significant between intact and OA groups in the superficial and transitional zones, and CWT1ρ correlated moderately with the reference measurements (0.3 < r < 0.7).

CONCLUSION

CWT1ρ was able to differentiate between intact and OA cartilage even with four-fold acceleration. This indicates that acceleration of CWT1ρ dispersion measurement by compressed sensing approach is feasible with negligible loss in the sensitivity to osteoarthritic changes in articular cartilage.

What is New in Osteoarthritis Imaging?

Osteoarthritis (OA) is the leading joint disorder globally, affecting a significant proportion of the population. Recent studies have changed our understanding of OA, viewing it as a complex pathology of the whole joint with a multifaceted etiology, encompassing genetic, biological, and biomechanical elements. This review highlights the role of imaging in diagnosing and monitoring OA. Today's role of radiography is discussed, while also elaborating on the advances in computed tomography and magnetic resonance imaging, discussing semiquantitative methods, quantitative morphologic and compositional techniques, and giving an outlook on the potential role of artificial intelligence in OA research.

Cartilage extracellular matrix polymers: hierarchical structure, osmotic properties, and function

Proteoglycans are hierarchically organized structures that play an important role in the hydration and the compression resistance of cartilage matrix. In this study, the static and dynamic properties relevant to the biomechanical function of cartilage are determined at different levels of the hierarchical structure, using complementary osmotic pressure, neutron scattering (SANS) and light scattering (DLS) measurements. In cartilage proteoglycans (PGs), two levels of bottlebrush structures can be distinguished: the aggrecan monomer, which consists of a core protein to which are tethered charged glycosaminoglycan (GAG) chains, and complexes formed of the aggrecan monomers attached around a linear hyaluronic acid backbone. The principal component of GAG, chondroitin sulfate (CS), is used as a baseline in this comparison. The osmotic modulus, measured as a function of the proteoglycan concentration, follows the order CS < aggrecan < aggrecan-HA complex. This order underlines the benefit of the increasing complexity at each level of the molecular architecture. The hierarchical bottlebrush configuration, which prevents interpenetration among the bristles of the aggrecan monomers, enhances both the mechanical properties and the osmotic resistance. The osmotic pressure of the collagen solution is notably smaller than in the proteoglycan systems. This is consistent with its known primary role to provide tensile strength to the cartilage and to confine the aggrecan-HA complexes, as opposed to load bearing. The collective diffusion coefficient D governs the rate of recovery of biological tissue after compressive load. In CS solutions the diffusion process is fast, D ≈ 3 × 10-6 cm2 s-1 at concentrations comparable with that of the GAG chains inside the aggrecan molecule. In CS solutions D is a weakly decreasing function of calcium ion concentration, while in aggrecan and its complexes with HA, the relaxation rate is insensitive to the presence of calcium.

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

PURPOSE

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

METHODS

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

RESULTS

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

CONCLUSION

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

In situ observation of cartilage matrix based on two-photon fluorescence microscopy

Articular cartilage lesions remain a major challenge for clinicians and researchers. Several techniques, such as histological scoring, magnetic resonance imaging, and tissue section staining, are available for detecting cartilage degeneration and lesions and evaluating cartilage repairs. Nevertheless, these methods are complex and have numerous influencing factors, which may present obstacles to efficient communication between studies. In this study, we developed a fluorescence observation system that integrated a two-photon laser scanning confocal microscope (TPLSCM) with the second-harmonic generation (SHG) of a cartilage matrix. The observation system enabled the detection of autofluorescence emitted by the cartilage matrix without species specificity, facilitating both qualitative and quantitative analyses of the cartilage matrix. Notably, this observation could be applied three-dimensionally to a fresh specimen in situ up to a depth of 300 μm, obviating the need for traditional histological fixation, slicing, or staining. Furthermore, using this observation system, we reconstructed a three-dimensional (3D) image and a 3D model of the cartilage matrix. The utilization of the 3D fluorescence model may serve as a dependable option for the fabrication of cartilage matrix biomimetic scaffolds in future studies.

Imaging of joint response to exercise with MRI and PET

Imaging of the joint in response to loading stress may provide additional measures of joint structure and function beyond conventional, static imaging studies. Exercise such as running, stair climbing, and squatting allows evaluation of the joint response to larger loading forces than during weight bearing. Quantitative MRI (qMRI) may assess properties of cartilage and meniscus hydration and organization in vivo that have been investigated to assess the functional response of these tissues to physiological stress. [18F]sodium fluoride ([18F]NaF) interrogates areas of newly mineralizing bone and provides an opportunity to study bone physiology, including perfusion and mineralization rate, as a measure of joint loading stress. In this review article, methods utilizing quantitative MRI, PET, and hybrid PET-MRI systems for assessment of the joint response to loading from exercise in vivo are examined. Both methodology and results of various studies performed are outlined and discussed. Lastly, the technical considerations, challenges, and future opportunities for these approaches are addressed.

Rapid Whole-Knee Quantification of Cartilage Using T1, T2*, and TRAFF2 Mapping With Magnetic Resonance Fingerprinting

OBJECTIVE

Quantitative Magnetic Resonance Imaging (MRI) holds great promise for the early detection of cartilage deterioration. Here, a Magnetic Resonance Fingerprinting (MRF) framework is proposed for comprehensive and rapid quantification of T1, T2*, and TRAFF2 with whole-knee coverage.

METHODS

A MRF framework was developed to achieve quantification of Relaxation Along a Fictitious Field in the 2nd rotating frame of reference ( TRAFF2) along with T1 and T2*. The proposed sequence acquires 65 measurements of 25 high-resolution slices, interleaved with 7 inversion pulses and 40 RAFF2 trains, for whole-knee quantification in a total acquisition time of 3:25 min. Comparison with reference T1, T2*, and TRAFF2 methods was performed in phantom and in seven healthy subjects at 3 T. Repeatability (test-retest) with and without repositioning was also assessed.

RESULTS

Phantom measurements resulted in good agreement between MRF and the reference with mean biases of -54, 2, and 5 ms for T1, T2*, and TRAFF2, respectively. Complete characterization of the whole-knee cartilage was achieved for all subjects, and, for the femoral and tibial compartments, a good agreement between MRF and reference measurements was obtained. Across all subjects, the proposed MRF method yielded acceptable repeatability without repositioning ( R2 ≥ 0.94) and with repositioning ( R2 ≥ 0.57) for T1, T2*, and TRAFF2.

SIGNIFICANCE

The short scan time combined with the whole-knee coverage makes the proposed MRF framework a promising candidate for the early assessment of cartilage degeneration with quantitative MRI, but further research may be warranted to improve repeatability after repositioning and assess clinical value in patients.

Insights into the Age Dependency of Compositional MR Biomarkers Quantifying the Health Status of Cartilage in Metacarpophalangeal Joints

(1) Background: We aim to investigate age-related changes in cartilage structure and composition in the metacarpophalangeal (MCP) joints using magnetic resonance (MR) biomarkers. (2) Methods: The cartilage tissue of 90 MCP joints from 30 volunteers without any signs of destruction or inflammation was examined using T1, T2, and T1ρ compositional MR imaging techniques on a 3 Tesla clinical scanner and correlated with age. (3) Results: The T1ρ and T2 relaxation times showed a significant correlation with age (T1ρ: Kendall-τ-b = 0.3, p < 0.001; T2: Kendall-τ-b = 0.2, p = 0.01). No significant correlation was observed for T1 as a function of age (T1: Kendall-τ-b = 0.12, p = 0.13). (4) Conclusions: Our data show an increase in T1ρ and T2 relaxation times with age. We hypothesize that this increase is due to age-related changes in cartilage structure and composition. In future examinations of cartilage using compositional MRI, especially T1ρ and T2 techniques, e.g., in patients with osteoarthritis or rheumatoid arthritis, the age of the patients should be taken into account.

Adiabatically prepared spin-lock could reduce the R1ρ dispersion

Background

R_1ρ (or spin-lock) imaging is prone to artifacts arising from field inhomogeneities that may impact the R_1ρ quantification. Previous research has proposed two types of method to manage the artifacts in continuous-wave constant amplitude spin-lock, one is based on the composite block pulses to compensate for the field imperfections, another category uses adiabatic pulses in the R_1ρ pre-pulse to excite and reverse the magnetization (named adiabatic prepared approach). Although both methods have proved their efficiency in alleviating artifacts, we observed that the adiabatic pulse approach could produce much lower R_1ρ dispersion in human knee cartilage than the block pulse method (characterized by the R_1ρ difference ∆R_1ρ =11.4 Hz (from spin-lock field 50 to 500 Hz) for the block pulse method vs. ∆R_1ρ =4.5 Hz for the adiabatic pulse approach). Prompted by this observation, the purpose of this study was to investigate the underlying factors that may affect the R_1ρ dispersion through numerical simulations based on the two-pool exchanging Bloch-McConnell equations.

Methods

The effects of free water pool size P_a (from 0.80 to 0.95), chemical exchange rate k_b (from the bound to free water pool, ranged from 500 to 3,000 Hz), adiabatic pulse duration T_p (from 5.0 to 25 ms), and the chemical shift of the bound pool ppm_b (from 1.0 to 5.0 ppm) were examined on the degree of the R_1ρ dispersion for the two R_1ρ imaging methods.

Results

In general, the greater the ppm_b, k_b, T_p, and the smaller P_a, the more significant difference in R_1ρ dispersion between the block and adiabatic approaches, with the dispersion curve of the adiabatic method becoming flatter.

Conclusions

The adiabatic prepared approach may compromise the R_1ρ dispersion, the effect is determined by the combination of the tissue and radiofrequency (RF) pulse properties. It is suggested that care should be taken when using the adiabatically prepared approach to study R_1ρ dispersion.

New methods for robust continuous wave T1ρ relaxation preparation

Measurement of the longitudinal relaxation time in the rotating frame of reference (T_1ρ ) is sensitive to the fidelity of the main imaging magnetic field (B₀ ) and that of the RF pulse (B₁ ). The purpose of this study was to introduce methods for producing continuous wave (CW) T_1ρ contrast with improved robustness against field inhomogeneities and to compare the sensitivities of several existing and the novel T_1ρ contrast generation methods with the B₀ and B₁ field inhomogeneities. Four hard-pulse and four adiabatic CW-T_1ρ magnetization preparations were investigated. Bloch simulations and experimental measurements at different spin-lock amplitudes under ideal and non-ideal conditions, as well as theoretical analysis of the hard-pulse preparations, were conducted to assess the sensitivity of the methods to field inhomogeneities, at low (ω₁  << ΔB₀ ) and high (ω₁ >> ΔB₀ ) spin-locking field strengths. In simulations, previously reported single-refocus and new triple-refocus hard-pulse and double-refocus adiabatic preparation schemes were found to be the most robust. The mean normalized absolute deviation between the experimentally measured relaxation times under ideal and non-ideal conditions was found to be smallest for the refocused preparation schemes and broadly in agreement with the sensitivities observed in simulations. Experimentally, all refocused preparations performed better than those that were non-refocused. The findings promote the use of the previously reported hard-pulse single-refocus ΔB₀ and B₁ insensitive T_1ρ as a robust method with minimal RF energy deposition. The double-refocus adiabatic B₁ insensitive rotation-4 CW-T_1ρ preparation offers further improved insensitivity to field variations, but because of the extra RF deposition, may be preferred for ex vivo applications.

A self-compensated spin-locking scheme for quantitative R1ρ dispersion MR imaging in ordered tissues

PURPOSE

To propose a self-compensated spin-locking (SL) method for quantitative R_1ρ dispersion imaging in ordered tissues.

METHODS

Two pairs of antiphase rotary-echo SL pulses were proposed in a new scheme with each pairs sandwiching one refocusing RF pulse. This proposed SL method was evaluated by Bloch simulations and experimental studies relative to three prior schemes. Quantitative R_1ρR dispersion imaging studies with constant SL duration (TSL = 40 ms) were carried out on an agarose (1-4% w/v) phantom and one in vivo human knee at 3 T, using six SL RF strengths ranging from 50 to 1000 Hz. The performances of these SL schemes were characterized with an average coefficient of variation (CV) of the signal intensities in agarose gels and the sum of squared errors (SSE) for quantifying in vivo R_1ρ dispersion of the femoral and tibial cartilage.

RESULTS

The simulations demonstrate that the proposed SL scheme was less prone to B₀ and B₁ field inhomogeneities. This theoretical prediction was supported by fewer image banding artifacts and less signal fluctuation signified by a reduced CV (%) on the phantom without R_1ρ dispersion (i.e., 4.04 ± 1.36 vs. 18.87 ± 4.46 or 6.66 ± 2.92 or 5.71 ± 2.05 for others), and further by mostly decreased SSE (*10^-3) for characterizing R_1ρ dispersion of the femoral (i.e., 0.3 vs. 1.2 or 0.4 or 0.1) and tibial (i.e., 0.4 vs. 7.2 or 3.2 or 2.8) cartilage.

CONCLUSION

The proposed SL scheme is less sensitive to B₀ and B₁ field artifacts for a wide range of SL RF strengths and thus more suitable for quantitative R_1ρ dispersion imaging in ordered tissues.

Quantitative 23 Na-MRI of the intervertebral disk at 3 T

Monitoring the tissue sodium content (TSC) in the intervertebral disk geometry noninvasively by MRI is a sensitive measure to estimate changes in the proteoglycan content of the intervertebral disk, which is a biomarker of degenerative disk disease (DDD) and of lumbar back pain (LBP). However, application of quantitative sodium concentration measurements in ²³ Na-MRI is highly challenging due to the lower in vivo concentrations and smaller gyromagnetic ratio, ultimately yielding much smaller signal relative to ¹ H-MRI. Moreover, imaging the intervertebral disk geometry imposes higher demands, mainly because the necessary RF volume coils produce highly inhomogeneous transmit field patterns. For an accurate absolute quantification of TSC in the intervertebral disks, the B1 field variations have to be mitigated. In this study, we report for the first time quantitative sodium concentration in the intervertebral disks at clinical field strengths (3 T) by deploying ²³ Na-MRI in healthy human subjects. The sodium B1 maps were calculated by using the double-angle method and a double-tuned (¹ H/²³ Na) transceive chest coil, and the individual effects of the variation in the B1 field patterns in tissue sodium quantification were calculated. Phantom measurements were conducted to evaluate the quality of the Na-weighted images and B1 mapping. Depending on the disk position, the sodium concentration was calculated as 161.6 mmol/L-347 mmol/L, and the mean sodium concentration of the intervertebral disks varies between 254.6 ± 54 mmol/L and 290.1 ± 39 mmol/L. A smoothing effect of the B1 correction on the sodium concentration maps was observed, such that the standard deviation of the mean sodium concentration was significantly reduced with B1 mitigation. The results of this work provide an improved integration of quantitative ²³ Na-MRI into clinical studies in intervertebral disks such as degenerative disk disease and establish alternative scoring schemes to existing morphological scoring such as the Pfirrmann score.

Therapeutic effects of statins on osteoarthritis: A review

Osteoarthritis (OA) is a progressive joint disease. The etiology of OA is considered to be multifactorial. Currently, there is no definitive treatment for OA, and the existing treatments are not very effective. Hypercholesterolemia is considered a novel risk factor for the development of OA. Statins act as a competitive inhibitor of the β-hydroxy β-methylglutaryl-CoA (HMG-CoA) reductase and are widely used to manage hypercholesterolemia. Inhibition of HMG-CoA reductase results in reduced synthesis of a metabolite named mevalonate, thereby reducing cholesterol biosynthesis in subsequent steps. By this mechanism, statins such as atorvastatin and simvastatin could potentially have a preventive impact on joint cartilage experiencing osteoarthritic deterioration by reducing serum cholesterol levels. Atorvastatin can protect cartilage degradation following interleukin-1β-stimulation. Atorvastatin stimulates the STAT1-caspase-3 signaling pathway that was shown to be responsible for its anti-inflammatory effects on the knee joint. Simvastatin had chondroprotective effects on OA in vitro by reducing matrix metalloproteinases expression patterns. In this study, we tried to review the therapeutic effects of statins on OA.

Embedded Quantitative MRI T1ρ Mapping Using Non-Linear Primal-Dual Proximal Splitting

Quantitative MRI (qMRI) methods allow reducing the subjectivity of clinical MRI by providing numerical values on which diagnostic assessment or predictions of tissue properties can be based. However, qMRI measurements typically take more time than anatomical imaging due to requiring multiple measurements with varying contrasts for, e.g., relaxation time mapping. To reduce the scanning time, undersampled data may be combined with compressed sensing (CS) reconstruction techniques. Typical CS reconstructions first reconstruct a complex-valued set of images corresponding to the varying contrasts, followed by a non-linear signal model fit to obtain the parameter maps. We propose a direct, embedded reconstruction method for T1ρ mapping. The proposed method capitalizes on a known signal model to directly reconstruct the desired parameter map using a non-linear optimization model. The proposed reconstruction method also allows directly regularizing the parameter map of interest and greatly reduces the number of unknowns in the reconstruction, which are key factors in the performance of the reconstruction method. We test the proposed model using simulated radially sampled data from a 2D phantom and 2D cartesian ex vivo measurements of a mouse kidney specimen. We compare the embedded reconstruction model to two CS reconstruction models and in the cartesian test case also the direct inverse fast Fourier transform. The T1ρ RMSE of the embedded reconstructions was reduced by 37–76% compared to the CS reconstructions when using undersampled simulated data with the reduction growing with larger acceleration factors. The proposed, embedded model outperformed the reference methods on the experimental test case as well, especially providing robustness with higher acceleration factors.

Quantification of Sodium Relaxation Times and Concentrations as Surrogates of Proteoglycan Content of Patellar CARTILAGE at 3T MRI

Sodium MRI has the potential to depict cartilage health accurately, but synovial fluid can influence the estimation of sodium parameters of cartilage. Therefore, this study aimed to reduce the impact of synovial fluid to render the quantitative compositional analyses of cartilage tissue technically more robust. Two dedicated protocols were applied for determining sodium T1 and T2* relaxation times. For each protocol, data were acquired from 10 healthy volunteers and one patient with patellar cartilage damage. Data recorded with multiple repetition times for T1 measurement and multi-echo data acquired with an additional inversion recovery pulse for T2* measurement were analysed using biexponential models to differentiate longitudinal relaxation components of cartilage (T1,car) and synovial fluid (T1,syn), and short (T2s*) from long (T2l*) transversal relaxation components. Sodium relaxation times and concentration estimates in patellar cartilage were successfully determined: T1,car = 14.5 ± 0.7 ms; T1,syn = 37.9 ± 2.9 ms; c(T1-protocol) = 200 ± 48 mmol/L; T2s* = 0.4 ± 0.1 ms; T2l* = 12.6 ± 0.7 ms; c(T2*-protocol) = 215 ± 44 mmol/L for healthy volunteers. In conclusion, a robust determination of sodium relaxation times is possible at a clinical field strength of 3T to quantify sodium concentrations, which might be a valuable tool to determine cartilage health.

Magnetization-prepared spoiled gradient-echo snapshot imaging for efficient measurement of R2 -R1ρ in knee cartilage

PURPOSE

To validate the potential of quantifying R₂ -R_1ρ using one pair of signals with T_1ρ preparation and T₂ preparation incorporated to magnetization-prepared angle-modulated partitioned k-space spoiled gradient-echo snapshots (MAPSS) acquisition and to find an optimal preparation time (T_prep ) for in vivo knee MRI.

METHODS

Bloch equation simulations were first performed to assess the accuracy of quantifying R₂ -R_1ρ using T_1ρ - and T₂ -prepared signals with an equivalent T_prep . For validation of this technique in comparison to the conventional approach that calculates R₂ -R_1ρ after estimating both T₂ and T_1ρ , phantom experiments and in vivo validation with five healthy subjects and five osteoarthritis patients were performed at a clinical 3T scanner.

RESULTS

Bloch equation simulations demonstrated that the accuracy of this efficient R₂ -R_1ρ quantification method and the optimal T_prep can be affected by image signal-to-noise ratio (SNR) and tissue relaxation times, but quantification can be closest to the reference with an around 25 ms T_prep for knee cartilage. Phantom experiments demonstrated that the proposed method can depict R₂ -R_1ρ changes with agarose gel concentration. With in vivo data, significant correlation was observed between cartilage R₂ -R_1ρ measured from the conventional and the proposed methods, and a T_prep of 25.6 ms provided the most agreement by Bland-Altman analysis. R₂ -R_1ρ was significantly lower in patients than in healthy subjects for most cartilage compartments.

CONCLUSION

As a potential biomarker to indicate cartilage degeneration, R₂ -R_1ρ can be efficiently measured using one pair of T_1ρ -prepared and T₂ -prepared signals with an optimal T_prep considering cartilage relaxation times and image SNR.

Knee Cartilage Imaging

Articular cartilage injury and degeneration represent common causes of knee pain, which can be evaluated accurately and noninvasively using MRI. This review describes the structure of cartilage focusing on its histologic appearance to emphasize that structure will dictate patterns of tissue failure as well as MR appearance. In addition to identifying cartilage loss, MRI can demonstrate signal changes that correspond to intrinsic structural abnormalities which place the cartilage at risk for subsequent more serious injury or premature degeneration, allowing for earlier intervention and treatment of important causes of pain and morbidity.

Low-field and variable-field NMR relaxation studies of H2O and D2O molecular dynamics in articular cartilage

Osteoarthritis (OA) as the main degenerative disease of articular cartilage in joints is accompanied by structural and compositional changes in the tissue. Degeneration is a consequence of a reduction of the amount of macromolecules, the so-called proteoglycans, and of a corresponding increase in water content, both leading to structural weakening of cartilage. NMR investigations of cartilage generally address only the relaxation properties of water. In this study, two-dimensional (T1-T2) measurements of bovine articular cartilage samples were carried out for different stages of hydration, complemented by molecular exchange with D2O and treatment by trypsin which simulates degeneration by OA. Two signal components were identified in all measurements, characterized by very different T2 which suggests liquid-like and solid-like dynamics. These measurements allow the quantification of separate hydrogen components and their assignment to defined physical pools which had been discussed repeatedly in the literature, i.e. bulk-like water and a combination of protein hydrogens and strongly bound water. The first determination of 2H relaxation dispersion in comparison to 1H dispersion suggests intramolecular interactions as the dominating source for the pronounced magnetic field dependence of the longitudinal relaxation time T1.

An efficient R1ρ dispersion imaging method for human knee cartilage using constant magnetization prepared turbo-FLASH

This work aimed to develop an efficient R_1ρ dispersion imaging method for clinical studies of human knee cartilage at 3 T. Eight constant magnetizations (M_prep ) were prepared by tailoring both the duration and amplitude (ω₁ ) of a fully refocused spin-lock preparation pulse. The limited M_prep dynamic range was expanded by the measure, equivalent to that with ω₁  = ∞, from the magic angle location in the deep femoral cartilage. The developed protocol with M_prep  = 60% was demonstrated on one subject's bilateral and two subjects' unilateral asymptomatic knees. The repeatability of the proposed protocol was estimated by two repeated scans with a three-month gap for the last two subjects. The synthetic R_1ρ and R₂ derived from R_1ρ dispersions were compared with the published references using state-of-the-art R_1ρ and R₂ mapping (MAPSS). The proposed protocol demonstrated good (<5%) repeatability quantified by the intra- and intersubject coefficients of variation in the femoral and tibial cartilage. The synthetic R_1ρ (1/s) and the references were comparable in the femoral (23.0 ± 5.3 versus 24.1 ± 3.8, P = 0.67) and the tibial (29.1 ± 8.8 versus 27.1 ± 5.1, P = 0.62), but not the patellar (16.5 ± 4.9 versus 22.7 ± 1.6, P < 0.01) cartilage. The same trends were also observed for the current and the previous R₂ . In conclusion, the developed R_1ρ dispersion imaging scheme has been revealed to be not only efficient but also robust for clinical studies of human knee cartilage at 3 T.

Effects of repeated intra-articular hyaluronic acid on cartilage degeneration evaluated by T1ρ mapping in knee osteoarthritis

OBJECTIVES

Intra-articular injection of hyaluronic acid (IAHA) has been used for the treatment of knee osteoarthritis (OA), but its effectiveness remains controversial. This study analyzed knee OA over time by magnetic resonance imaging (MRI) T1ρ mapping to objectively evaluate whether long-term repeated administration of IAHA influences cartilage degeneration.

METHODS

Sixty knees of 60 patients [58.3 ± 12.5 years (mean ± standard deviation)] who had multiple T1ρ mapping images were retrospectively analyzed. We calculated the T1ρ values of the medial femorotibial cartilage and classified changes in degenerative areas over time into 3 groups: Improvement, No Change, and Deterioration.

RESULTS

Average time between 2 MRI scans was 7.6 ± 1.2 months. The number of IAHA administrations was 15.5 ± 21.3, 8.39 ± 7.19, and 5.80 ± 7.49 in the Improvement, No Change, and Deterioration groups, respectively. Body mass index and number of IAHA administrations were significant factors causing change in the area of degeneration (p < .05) independent of age, sex, Kellgren-Lawrence grade, and posterior horn meniscus tears.

CONCLUSION

Cartilage degeneration may be improved with a higher number of administrations of IAHA, based on T1ρ mapping results. This highlights the possibility of increased treatment effectiveness of IAHA for knee OA with repeated administrations.

Numerical and Workbench Design of 2.35 T Double-Tuned (¹H/²³Na) Nested RF Birdcage Coils Suitable for Animal Size MRI

The birdcage Radio Frequency (RF) coil is one of the most used configurations in Magnetic Resonance Imaging (MRI) scanners for the detection of the proton (¹H) signal over a large homogeneous volume. More recently, birdcage RF coils have been successfully used also in the field of X-nuclei MRI, where the signal of a second nucleus (e.g. ¹³C, ²³Na, ³¹P, and many others) needs to be detected with high sensitivity and spatial homogeneity. To this purpose several technical solutions have been adopted to design Double Tuned (DT) volume RF coils, including the recent configuration of the nested birdcage RF coils. One of the main problems in the design of DT RF coils is the decoupling between the ¹H and X channels, and a number of solutions have been adopted over the years. In this work, based on numerical and workbench methods, we report the decoupling optimization of DT (¹H/²³Na) nested RF birdcage coils suitable for 2.35 T MRI scanners encompassing an inner Low-Pass (LP) birdcage used for X-nuclei, an outer High-Pass (HP) birdcage for ¹H and an external cylindrical RF shield. We show that a suitable geometrical selection of the two coaxial RF birdcage coils (relative angular orientation, diameters and lengths) and RF shield (diameter, length) allows a significant decoupling optimization. We also provide valuable information about the RF B₁⁺ field homogeneity and efficiency. Our approach was validated both with numerical simulations and workbench testing using DT nested RF coil prototypes.

Zone- and layer-specific differences in proteoglycan content in patellofemoral pain syndrome are detectable on T1ρ MRI

OBJECTIVE

Determine if differences in T1ρ would be detected in specific regions or layers of patellofemoral cartilage between patients with symptomatic patellofemoral pain syndrome and asymptomatic control subjects.

MATERIALS AND METHODS

Ten subjects diagnosed with patellofemoral pain syndrome were compared with ten age-, gender-, and BMI-matched control subjects with no knee pain or prior trauma. Conventional turbo (fast) spin echo sequences and T1ρ-weighted imaging were performed on the symptomatic knee in each of the ten subjects. At the patella and distal femur, cartilage regions of interest were divided into medial and lateral sub-regions, each then further sub-divided by layer (superficial, middle, or deep). Two-tailed t test and chi-squared tests were used to analyze demographic data. A mixed effect model was run for each sub-region of T1ρ imaging. Statistical significance was determined using the likelihood ratio test against reduced models without patellofemoral pain syndrome symptomatic status as a fixed effect.

RESULTS

There was no difference in age, sex, or BMI between symptomatic and control patients. T1ρ values were significantly higher among patellofemoral pain syndrome patients when compared with controls in the superficial zone of the lateral patella (58.43 vs. 50.83, p = 0.03) and the middle zone of the lateral patella (52.67 vs. 43.60, p = 0.03). T1ρ was also higher in the superficial zone of the medial femur (50.94 vs. 46.70, p = 0.09) with a value approaching statistical significance.

CONCLUSION

We report statistically significant differences in the T1ρ value in the superficial and middle zones of the lateral patella in patients with patellofemoral pain syndrome who had no abnormalities seen on conventional MRI sequences, suggesting an alteration the macromolecular structure of the cartilage in this population.

Higher Body Mass Index Is Associated With Biochemical Changes in Knee Articular Cartilage After Marathon Running: A Quantitative T2-Relaxation MRI Study

Background:

More than 30 million individuals participate in marathon running every year worldwide. As the popularity of marathon running continues to increase, it is essential for the purposes of injury prevention to understand the effects of marathon running on the knee cartilage.

Purpose:

To investigate the immediate effects of marathon running on knee articular cartilage and to determine the relationship between body mass index and cartilage biochemical composition.

Study Design:

Descriptive laboratory study.

Methods:

T2-relaxation magnetic resonance imaging (MRI) of knees in 18 nonprofessional marathoners (mean age, 35.6 ± 6.4 years) was performed before and after a full-length marathon. Three-dimensional models of the knee articular cartilage were reconstructed and divided into different regions of interest. The 3-dimensional models were then applied to corresponding T2-relaxation MRI maps to calculate T2 values in each region of interest. The mean values of the T2-relaxation times in each region of interest before and after the marathon were compared by use of the paired Student t test. The Pearson correlation coefficient between T2 change and runner body mass index (BMI) was calculated.

Results:

Postmarathon T2-relaxation times were significantly higher than premarathon values for patellofemoral cartilage (32.6 ± 12.1 vs 34.1 ± 10.9 ms; P < .01) and medial tibial cartilage (35.6 ± 11.7 vs 34.6 ± 12.0 ms; P = .01). The greatest increase was observed in the anterior part of the medial tibial cartilage. No statistically significant changes were seen in the T2-relaxation times of the lateral tibial and femoral cartilage. Postmarathon T2-relaxation elevation in the anteromedial knee tibiofemoral joint cartilage strongly correlated with body weight (R = 0.6746; P = .03) and BMI (R = 0.6989; P = .001). Changes in T2-relaxation times did not correlate with marathon time, height, age, or sex in any regions of interest.

Conclusion:

Marathon running leads to immediate postmarathon elevated T2-relaxation values within knee articular cartilage, suggesting biochemical content alteration. Additionally, runners with higher BMI may have greater changes in cartilage biochemical composition after a marathon. Further studies should investigate whether these changes are sustained over time to determine the relationship between immediate biochemical changes in cartilage composition and cartilage degeneration.

Clinical Relevance:

Runners with a higher BMI may carry a higher risk of anteromedial tibiofemoral cartilage degeneration compared with runners with lower BMI.

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

OBJECTIVE

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

MATERIALS AND METHODS

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

RESULTS

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

CONCLUSION

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

Upper and Lower Extremity Measurement of Tissue Sodium and Fat Content in Patients with Lipedema

OBJECTIVE

The aim of this study is to compare tissue sodium and fat content in the upper and lower extremities of participants with lipedema versus controls using magnetic resonance imaging (MRI).

METHODS

MRI was performed at 3.0 T in females with lipedema (n = 15, age = 43.2 ± 10.0 years, BMI = 30.3 ± 4.4 kg/m² ) and controls without lipedema (n = 14, age = 42.8 ± 13.2 years, BMI = 28.8 ± 4.4 kg/m² ). Participants were assessed for pain and disease stage. Sodium MRI was performed in the forearm and calf to quantify regional tissue sodium content (TSC, mmol/L). Chemical-shift-encoded water-fat MRI was performed in identical regions for measurement of fat/water (ratio).

RESULTS

In the calf, skin TSC (16.3 ± 2.6 vs. 14.4 ± 2.2 mmol/L, P = 0.04), muscle TSC (20.3 ± 3.0 vs. 18.3 ± 1.7 mmol/L, P = 0.03), and fat/water (1.03 ± 0.37 vs. 0.56 ± 0.21 ratio, P < 0.001) were significantly higher in participants with lipedema versus control participants. In the forearm, skin TSC (13.4 ± 3.3 vs. 12.0 ± 2.3 mmol/L, P = 0.2, Cohen's d = 0.50) and fat/water (0.65 ± 0.24 vs. 0.48 ± 0.24 ratio, P = 0.07, Cohen's d = 0.68) demonstrated moderate effect sizes in participants with lipedema versus control participants. Calf skin TSC was significantly correlated with pain (Spearman's rho = 0.55, P = 0.03) and disease stage (Spearman's rho = 0.82, P < 0.001) among participants with lipedema.

CONCLUSIONS

MRI-measured tissue sodium and fat content are significantly higher in the lower extremities, but not upper extremities, of patients with lipedema compared with BMI-matched controls.

Thermo-Mechanical Behaviour of Human Nasal Cartilage

The aim of this study was to undergo a comprehensive analysis of the thermo-mechanical properties of nasal cartilages for the future design of a composite polymeric material to be used in human nose reconstruction surgery. A thermal and dynamic mechanical analysis (DMA) in tension and compression modes within the ranges 1 to 20 Hz and 30 °C to 250 °C was performed on human nasal cartilage. Differential scanning calorimetry (DSC), as well as characterization of the nasal septum (NS), upper lateral cartilages (ULC), and lower lateral cartilages (LLC) reveals the different nature of the binding water inside the studied specimens. Three peaks at 60–80 °C, 100–130 °C, and 200 °C were attributed to melting of the crystalline region of collagen matrix, water evaporation, and the strongly bound non-interstitial water in the cartilage and composite specimens, respectively. Thermogravimetric analysis (TGA) showed that the degradation of cartilage, composite, and subcutaneous tissue of the NS, ULC, and LLC take place in three thermal events (~37 °C, ~189 °C, and ~290 °C) showing that cartilage releases more water and more rapidly than the subcutaneous tissue. The water content of nasal cartilage was estimated to be 42 wt %. The results of the DMA analyses demonstrated that tensile mode is ruled by flow-independent behaviour produced by the time-dependent deformability of the solid cartilage matrix that is strongly frequency-dependent, showing an unstable crystalline region between 80–180 °C, an amorphous region at around 120 °C, and a clear glass transition point at 200 °C (780 kJ/mol). Instead, the unconfined compressive mode is clearly ruled by a flow-dependent process caused by the frictional force of the interstitial fluid that flows within the cartilage matrix resulting in higher stiffness (from 12 MPa at 1 Hz to 16 MPa at 20 Hz in storage modulus). The outcomes of this study will support the development of an artificial material to mimic the thermo-mechanical behaviour of the natural cartilage of the human nose.

Proton Exchange Magnetic Resonance Imaging: Current and Future Applications in Psychiatric Research

Proton exchange provides a powerful contrast mechanism for magnetic resonance imaging (MRI). MRI techniques sensitive to proton exchange provide new opportunities to map, with high spatial and temporal resolution, compounds important for brain metabolism and function. Two such techniques, chemical exchange saturation transfer (CEST) and T1 relaxation in the rotating frame (T1ρ), are emerging as promising tools in the study of neurological and psychiatric illnesses to study brain metabolism. This review describes proton exchange for non-experts, highlights the current status of proton-exchange MRI, and presents advantages and drawbacks of these techniques compared to more traditional methods of imaging brain metabolism, including positron emission tomography (PET) and MR spectroscopy (MRS). Finally, this review highlights new frontiers for the use of CEST and T1ρ in brain research.

Bio-SCOPE: fast biexponential T1ρ mapping of the brain using signal-compensated low-rank plus sparse matrix decomposition

PURPOSE

To develop and evaluate a fast imaging method based on signal-compensated low-rank plus sparse matrix decomposition to accelerate data acquisition for biexponential brain T_1ρ mapping (Bio-SCOPE).

METHODS

Two novel strategies were proposed to improve reconstruction performance. A variable-rate undersampling scheme was used with a varied acceleration factor for each k-space along the spin-lock time direction, and a modified nonlinear thresholding scheme combined with a feature descriptor was used for Bio-SCOPE reconstruction. In vivo brain T_1ρ mappings were acquired from 4 volunteers. The fully sampled k-space data acquired from 3 volunteers were retrospectively undersampled by net acceleration rates (R) of 4.6 and 6.1. Reference values were obtained from the fully sampled data. The agreement between the accelerated T_1ρ measurements and reference values was assessed with Bland-Altman analyses. Prospectively undersampled data with R = 4.6 and R = 6.1 were acquired from 1 volunteer.

RESULTS

T_1ρ -weighted images were successfully reconstructed using Bio-SCOPE for R = 4.6 and 6.1 with signal-to-noise ratio variations <1 dB and normalized root mean square errors <4%. Accelerated and reference T_1ρ measurements were in good agreement for R = 4.6 (T_{1ρ s} : 18.6651 ± 1.7786 ms; T_{1ρ l} : 88.9603 ± 1.7331 ms) and R = 6.1 (T_{1ρ s} : 17.8403 ± 3.3302 ms; T_{1ρ l} : 88.0275 ± 4.9606 ms) in the Bland-Altman analyses. T_1ρ parameter maps from prospectively undersampled data also show reasonable image quality using the Bio-SCOPE method.

CONCLUSION

Bio-SCOPE achieves a high net acceleration rate for biexponential T_1ρ mapping and improves reconstruction quality by using a variable-rate undersampling data acquisition scheme and a modified soft-thresholding algorithm in image reconstruction.

An order parameter without magic angle effect (OPTIMA) derived from R 1 ρ dispersion in ordered tissue

PURPOSE

MR R₂ imaging of ordered tissue exhibits the magic angle effect, potentially masking subtle pathological changes in cartilage. This work aimed to develop an orientation-independent order parameter (S) exclusively sensitive to collagen degeneration.

METHODS

A theory was developed based on R 1 ρ dispersion coupled with a simplified molecular motion model in which anisotropic R 2 a ( θ ) became directly proportional to correlation time τ b θ and S could be derived. This new parameter was validated with ex vivo R 1 ρ dispersion reported on orientated (n = 4), enzymatically depleted bovine cartilage (n = 6), and osteoarthritic human knee specimens (n = 14) at 9.4 Tesla, which was further demonstrated on 1 healthy human knee in vivo at 3 Tesla.

RESULTS

τ b θ from orientation-dependent R 1 ρ dispersion revealed a significantly high average correlation (r = 0.89 ± 0.05, P < 0.05) with R 2 a (θ) on cartilage samples and a moderate correlation (r = 0.48, P < 0.001) for the human knee in vivo. The derived S (10^-3 ) significantly decreased in advanced osteoarthritis (1.64 ± 0.03 vs. 2.30 ± 0.11, P < 0.001) and collagen-depleted samples (1.30 ± 0.11 vs. 2.12 ± 0.12, P < 0.001) when compared with early osteoarthritis and the control, respectively.

CONCLUSION

The proposed order parameter could be a potentially useful orientation-independent MR biomarker for collagen alterations in cartilage and other highly structured tissues.

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

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

Triple Contrast CT Method Enables Simultaneous Evaluation of Articular Cartilage Composition and Segmentation

Early degenerative changes of articular cartilage are detected using contrast-enhanced computed tomography (CT) with a cationic contrast agent (CA). However, cationic CA diffusion into degenerated cartilage decreases with proteoglycan depletion and increases with elevated water content, thus hampering tissue evaluation at early diffusion time points. Furthermore, the contrast at synovial fluid-cartilage interface diminishes as a function of diffusion time hindering accurate cartilage segmentation. For the first time, we employ quantitative dual-energy CT (QDECT) imaging utilizing a mixture of three CAs (cationic CA4+ and non-ionic gadoteridol which are sensitive to proteoglycan and water contents, respectively, and bismuth nanoparticles which highlight the cartilage surface) to simultaneously segment the articulating surfaces and determine of the cartilage condition. Intact healthy, proteoglycan-depleted, and mechanically injured bovine cartilage samples (n = 27) were halved and imaged with synchrotron microCT 2-h post immersion in triple CA or in dual CA (CA4+ and gadoteridol). CA4+ and gadoteridol partitions were determined using QDECT, and pairwise evaluation of these partitions was conducted for samples immersed in dual and triple CAs. In conclusion, the triple CA method is sensitive to proteoglycan depletion while maintaining sufficient contrast at the articular surface to enable detection of cartilage lesions caused by mechanical impact.

Functional MRI for evaluation of hyaline cartilage extracelullar matrix, a physiopathological-based approach

MRI of articular cartilage (AC) integrity has potential to become a biomarker for osteoarthritis progression. Traditional MRI sequences evaluate AC morphology, allowing for the measurement of thickness and its change over time. In the last two decades, more advanced, dedicated MRI cartilage sequences have been developed aiming to assess AC matrix composition non-invasively and detect early changes in cartilage not captured on morphological sequences. T2-mapping and T1ρ sequences can be used to estimate the relaxation times of water inside the AC. These sequences have been introduced into clinical protocols and show promising results for cartilage assessment. Extracelullar matrix can also be assessed using diffusion-weighted imaging and diffusion tensor imaging as the movement of water is limited by the presence of extracellular matrix in AC. Specific techniques for glycosaminoglycans (GAG) evaluation, such as delayed gadolinium enhanced MRI of cartilage or Chemical Exchange Saturation Transfer imaging of GAG, as well as sodium imaging have also shown utility in the detection of AC damage. This manuscript provides an educational update on the physical principles behind advanced AC MRI techniques as well as a comprehensive review of the strengths and weaknesses of each approach. Current clinical applications and potential future applications of these techniques are also discussed.

[Advanced cartilage imaging for detection of cartilage injuries and osteochondral lesions]

BACKGROUND

Osteochondral defects represent a main risk factor for osteoarthritis of the ankle.

OBJECTIVES

The aim of this article is to provide an overview of current optimal clinical cartilage imaging techniques of the foot and ankle and to show typical osteochondral injuries on imaging.

MATERIALS AND METHODS

A thorough literature search was performed and was supported by personal experience.

RESULTS

Cartilage imaging of the foot and ankle remains challenging. However, advanced morphological and quantitative magnetic resonance (MR) imaging techniques may provide useful clinical information, for example, concerning cartilage repair surgery. Compared to MRI, MR arthrography (MR-A) and CT arthrography (CT-A) have higher sensitivity with respect to detection of osteochondral defects. Regarding smaller joints of the foot, mainly advanced osteoarthritic changes are detected on conventional radiography; only in rare cases, MR and CT imaging of these smaller joints is of relevance.

CONCLUSIONS

While at the smaller joints of the foot cartilage imaging only plays a minor role, at the ankle joint cross-sectional cartilage imaging using CT and MRI becomes more and more important for clinicians due to emerging therapeutic options, such as different osteochondral repair techniques.

3D grating-based X-ray phase-contrast computed tomography for high-resolution quantitative assessment of cartilage: An experimental feasibility study with 3T MRI, 7T MRI and biomechanical correlation

Objective

Aim of this study was, to demonstrate the feasibility of high-resolution grating-based X-ray phase-contrast computed tomography (PCCT) for quantitative assessment of cartilage.

Materials and methods

In an experimental setup, 12 osteochondral samples were harvested from n = 6 bovine knees (n = 2 each). From each knee, one cartilage sample was degraded using 2.5% Trypsin. In addition to PCCT and biomechanical cartilage stiffness measurements, 3T and 7T MRI was performed including MSME SE T2 and ME GE T2* mapping sequences for relaxationtime measurements. Paired t-tests and receiver operating characteristics (ROC) curves were used for statistical analyses.

Results

PCCT provided high-resolution images for improved morphological cartilage evaluation as compared to 3T and 7T MRI. Quantitative analyses revealed significant differences between the superficial and the deep cartilage layer for T2 mapping as well as for PCCT (P<0.05). No significant difference was detected for PCCT between healthy and degraded samples (P>0.05). MRI and stiffness measurements showed significant differences between healthy and degraded osteochondral samples. Accuracy in the prediction of cartilage degradation was excellent for MRI and biomechanical analyses.

Conclusion

In conclusion, high-resolution grating-based X-ray PCCT cartilage imaging is feasible. In addition to MRI and biomechanical analyses it provides complementary, water content independent, information for improved morphological and quantitative characterization of articular cartilage ultrastructure.

Compressed sensing acceleration of biexponential 3D-T1ρ relaxation mapping of knee cartilage

PURPOSE

Use compressed sensing (CS) for 3D biexponential spin-lattice relaxation time in the rotating frame (T_1ρ ) mapping of knee cartilage, reducing the total scan time and maintaining the quality of estimated biexponential T_1ρ parameters (short and long relaxation times and corresponding fractions) comparable to fully sampled scans.

METHODS

Fully sampled 3D-T_1ρ -weighted data sets were retrospectively undersampled by factors 2-10. CS reconstruction using 12 different sparsifying transforms were compared for biexponential T_1ρ -mapping of knee cartilage, including temporal and spatial wavelets and finite differences, dictionary from principal component analysis (PCA), k-means singular value decomposition (K-SVD), exponential decay models, and also low rank and low rank plus sparse models. Synthetic phantom (N = 6) and in vivo human knee cartilage data sets (N = 7) were included in the experiments. Spatial filtering before biexponential T_1ρ parameter estimation was also tested.

RESULTS

Most CS methods performed satisfactorily for an acceleration factor (AF) of 2, with relative median normalized absolute deviation (MNAD) around 10%. Some sparsifying transforms, such as low rank with spatial finite difference (L + S SFD), spatiotemporal finite difference (STFD), and exponential dictionaries (EXP) significantly improved this performance, reaching MNAD below 15% with AF up to 10, when spatial filtering was used.

CONCLUSION

Accelerating biexponential 3D-T_1ρ mapping of knee cartilage with CS is feasible. The best results were obtained by STFD, EXP, and L + S SFD regularizers combined with spatial prefiltering. These 3 CS methods performed satisfactorily on synthetic phantom as well as in vivo knee cartilage for AFs up to 10, with median error below 15%.

Lessons to be learned and future directions for intervertebral disc biomaterials

Biomaterials science has achieved significant advancements for the replacement, repair and regeneration of intervertebral disc tissues. However, the translation of this research to the clinic presents hurdles. The goal of this paper is to identify strategies to recapitulate the intrinsic complexities of the intervertebral disc, to highlight the unresolved issues in basic knowledge hindering the clinical translation, and finally to report on the emerging technologies in the biomaterials field. On this basis, we identify promising research directions, with the hope of stimulating further debate and advances for resolving clinical problems such as cervical and low back pain using biomaterial-based approaches.

STATEMENT OF SIGNIFICANCE

Although not life-threatening, intervertebral disc disorders have enormous impact on life quality and disability. Disc function within the human body is mainly mechanical, and therefore the use of biomaterials to rescue disc function and alleviate pain is logical. Despite intensive research, the clinical translation of biomaterial-based therapies is hampered by the intrinsic complexity of this organ. After decades of development, artificial discs or tissue replacements are still niche applications given their issues of integration and displacement with detrimental consequences. The struggles of biological therapies and tissue engineering are therefore understandable. However, recent advances in biomaterial science give new hope. In this paper we identify the most promising new directions for intervertebral disc biomaterials.

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.

RAFFn relaxation rate functions

In the present study we derive expressions for relaxation rate functions due to dipolar interactions between identical spins in the rotating frames of rank greater than or equal to 3. The rotating frames are produced due to fictitious magnetic field as generated by amplitude and frequency modulated radiofrequency (RF) pulses operating in non-adiabatic regime. This solution provides a means for description of the relaxations during method entitled Relaxation Along a Fictitious Field (RAFF) in the rotating frame of rank n (RAFFn), in which a fictitious field is created in a coordinate frame undergoing multi-fold rotation about n axes (i.e., rank n). We validate the proposed model by comparison with the accepted trigonometric relations for relaxation rates between tilted frames. The agreement between the proposed model for RAFF3 and the trigonometric model is excellent.

Imaging of nuclear magnetic resonance spin-lattice relaxation activation energy in cartilage

Samples of human and bovine cartilage have been examined using magnetic resonance imaging to determine the proton nuclear magnetic resonance spin-lattice relaxation time, T₁, as a function of depth within through the cartilage tissue. T₁ was measured at five to seven temperatures between 8 and 38°C. From this, it is shown that the T₁ relaxation time is well described by Arrhenius-type behaviour and the activation energy of the relaxation process is quantified. The activation energy within the cartilage is approximately 11 ± 2 kJ mol^-1 with this notably being less than that for both pure water (16.6 ± 0.4 kJ mol^-1) and the phosphate-buffered solution in which the cartilage was immersed (14.7 ± 1.0 kJ mol^-1). It is shown that this activation energy increases as a function of depth in the cartilage. It is known that cartilage composition varies with depth, and hence, these results have been interpreted in terms of the structure within the cartilage tissue and the association of the water with the macromolecular constituents of the cartilage.

Multiparametric MRI and Computational Modelling in the Assessment of Human Articular Cartilage Properties: A Comprehensive Approach

Quantitative magnetic resonance imaging (qMRI) is a promising approach to detect early cartilage degeneration. However, there is no consensus on which cartilage component contributes to the tissue's qMRI signal properties. T1, T1ρ, and T2^⁎ maps of cartilage samples (n = 8) were generated on a clinical 3.0-T MRI system. All samples underwent histological assessment to ensure structural integrity. For cross-referencing, a discretized numerical model capturing distinct compositional and structural tissue properties, that is, fluid fraction (FF), proteoglycan (PG) and collagen (CO) content and collagen fiber orientation (CFO), was implemented. In a pixel-wise and region-specific manner (central versus peripheral region), qMRI parameter values and modelled tissue parameters were correlated and quantified in terms of Spearman's correlation coefficient ρs. Significant correlations were found between modelled compositional parameters and T1 and T2^⁎, in particular in the central region (T1: ρs ≥ 0.7 [FF, CFO], ρs ≤ −0.8 [CO, PG]; T2^⁎: ρs ≥ 0.67 [FF, CFO], ρs ≤ −0.71 [CO, PG]). For T1ρ, correlations were considerably weaker and fewer (0.16 ≤ ρs ≤ −0.15). QMRI parameters are characterized in their biophysical properties and their sensitivity and specificity profiles in a basic scientific context. Although none of these is specific towards any particular cartilage constituent, T1 and T2^⁎ reflect actual tissue compositional features more closely than T1ρ.

T2*-Mapping of Acetabular Cartilage in Patients With Femoroacetabular Impingement at 3 Tesla: Comparative Analysis with Arthroscopic Findings

Objective To evaluate the diagnostic accuracy of T2*-mapping for detecting acetabular cartilage damage in patients with symptomatic femoroacetabular impingement (FAI). Design A total of 29 patients (17 females, 12 males, mean age 35.6 ± 12.8 years, mean body mass index 25.1 ± 4.1 kg/m², 16 right hips) with symptomatic FAI underwent T2* MRI and subsequent hip arthroscopy. T2* values were obtained by region of interest analysis in seven radially reformatted planes around the femoral neck (anterior, anterior-superior, superior-anterior, superior, superior-posterior, posterior-superior, posterior). Intraoperatively, a modified Outerbridge classification was used for assessment of the cartilage status in each region. T2* values and intraoperative data were compared, and sensitivity, specificity, negative predictive values (NPV) and positive predictive values (PPV) as well as the correlation between T2*-mapping and intraoperative findings, were determined. The mean time interval between MRI and arthroscopy was 65.7 ± 48.0 days. Results Significantly higher T2* values were noted in arthroscopically normal evaluated cartilage than in regions with cartilage degeneration (mean T2* 25.6 ± 4.7 ms vs. 19.9 ± 4.5 ms; P < 0.001). With the intraoperative findings as a reference, sensitivity, specificity, NPV and PPV were 83.5%, 67.7%, 78.4% and 74.4%, respectively. The correlation between T2*-mapping and intraoperative cartilage status was moderate (ρ = -0.557; P < 0.001). Conclusions T2*-mapping enabled analysis of acetabular cartilage with appropriate correlation with intraoperative findings and promising results for sensitivity, specificity, PPV, and NPV in this cohort. Our results emphasize the value of T2*-mapping for the diagnosis of hip joint cartilage pathologies in symptomatic FAI.

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

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

Accelerating 3D-T1ρ mapping of cartilage using compressed sensing with different sparse and low rank models

PURPOSE

To evaluate the feasibility of using compressed sensing (CS) to accelerate 3D-T_1ρ mapping of cartilage and to reduce total scan times without degrading the estimation of T_1ρ relaxation times.

METHODS

Fully sampled 3D-T_1ρ datasets were retrospectively undersampled by factors 2-10. CS reconstruction using 12 different sparsifying transforms were compared, including finite differences, temporal and spatial wavelets, learned transforms using principal component analysis (PCA) and K-means singular value decomposition (K-SVD), explicit exponential models, low rank and low rank plus sparse models. Spatial filtering prior to T_1ρ parameter estimation was also tested. Synthetic phantom (n = 6) and in vivo human knee cartilage datasets (n = 7) were included.

RESULTS

Most CS methods performed satisfactorily for an acceleration factor (AF) of 2, with relative T_1ρ error lower than 4.5%. Some sparsifying transforms, such as spatiotemporal finite difference (STFD), exponential dictionaries (EXP) and low rank combined with spatial finite difference (L+S SFD) significantly improved this performance, reaching average relative T_1ρ error below 6.5% on T_1ρ relaxation times with AF up to 10, when spatial filtering was used before T_1ρ fitting, at the expense of smoothing the T_1ρ maps. The STFD achieved 5.1% error at AF = 10 with spatial filtering prior to T_1ρ fitting.

CONCLUSION

Accelerating 3D-T_1ρ mapping of cartilage with CS is feasible up to AF of 10 when using STFD, EXP or L+S SFD regularizers. These three best CS methods performed satisfactorily on synthetic phantom and in vivo knee cartilage for AFs up to 10, with T_1ρ error of 6.5%.

T1ρ mapping of articular cartilage grafts after autologous osteochondral transplantation for osteochondral lesions of the talus: A longitudinal evaluation

BACKGROUND

Clinical results of autologous osteochondral transplantation (AOT) for treatment of osteochondral lesions of the talus have been mixed. T1ρ imaging can be used to noninvasively detect early cartilage degeneration.

PURPOSE OR HYPOTHESIS

To quantitatively assess, by means of T1ρ imaging, changes over time in the biochemical health of grafted cartilage after AOT for osteochondral lesions of the talus.

STUDY TYPE

Retrosepctive case series.

POPULATION

The study group comprised nine patients who underwent AOT for an osteochondral lesion of the talus and in whom T1ρ mapping was performed 1 and 2 years postoperatively.

FIELD STRENGTH/SEQUENCE

3 Tesla. T1ρ-weighted turbo field echo.

ASSESSMENT

The mean T1ρ value of full-thickness cartilage at the repair site and that of full-thickness cartilage elsewhere in the same image (far-field cartilage) were determined. Clinical assessment was based on the American Orthopaedic Foot & Ankle Society (AOFAS) scale. Correlation between the T1ρ ratios (grafted-to-far-field cartilage T1ρ values) and clinical outcomes was examined.

STATISTICAL TESTS

Mixed effects model. Pearson correlation analysis.

RESULTS

At 1 year, a significant difference existed between the mean T1ρ value of the grafted cartilage (57.0 ± 7.7 ms) and that of the far-field cartilage (41.8 ± 4.6 ms) (P < 0.001). At 2 years, the mean T1ρ value of the grafted cartilage (49.1 ± 6.4 ms) was significantly lower than that at 1 year (P = 0.011). Moderate negative correlation was found between the 1-year T1ρ ratio and 1-year AOFAS score (r = -0.60) and between the 2-year T1ρ ratio and 2-year AOFAS score (r = -0.50).

DATA CONCLUSION

Our observation of substantial restoration of the proteoglycan content of the grafted cartilage approximately 2 years after AOT for osteochondral lesions of the talus indicates that the content changes gradually and that the cartilage reparation process is slower than previously believed.

LEVEL OF EVIDENCE

3 Technical Efficacy: Stage 3 J. MAGN. RESON. IMAGING 2018;48:398-403.

Non-invasive T1ρ mapping of the human cartilage response to loading and unloading

OBJECTIVE

To define the physiological response to sequential loading and unloading in histologically intact human articular cartilage using serial T1ρ mapping, as T1ρ is considered to indicate the tissue's macromolecular content.

METHOD

18 macroscopically intact cartilage-bone samples were obtained from the central lateral femoral condyles of 18 patients undergoing total knee replacement. Serial T1ρ mapping was performed on a clinical 3.0-T MRI system using a modified prostate coil. Spin-lock multiple gradient-echo sequences prior to, during and after standardized indentation loading (displacement controlled, strain 20%) were used to obtain seven serial T1ρ maps: unloaded (δ₀), quasi-statically loaded (indentation₁-indentation₃) and under subsequent relaxation (relaxation₁-relaxation₃). After manual segmentation, zonal and regional regions-of-interest were defined. ROI-specific relative changes were calculated and statistically assessed using paired t-tests. Histological (Mankin classification) and biomechanical (unconfined compression) evaluations served as references.

RESULTS

All samples were histologically and biomechanically grossly intact (Mankin sum: 1.8 ± 1.2; Young's Modulus: 0.7 ± 0.4 MPa). Upon loading, T1ρ consistently increased throughout the entire sample thickness, primarily subpistonally (indentation₁ [M ± SD]: 9.5 ± 7.8% [sub-pistonal area, SPA] vs 4.2 ± 5.8% [peri-pistonal area, PPA]; P < 0.001). T1ρ further increased with ongoing loading (indentation₃: 14.1 ± 8.1 [SPA] vs 7.7 ± 5.9% [PPA]; P < 0.001). Even upon unloading (i.e., relaxation), T1ρ persistently increased in time.

CONCLUSION

Serial T1ρ-mapping reveals distinct and complex zonal and regional changes in articular cartilage as a function of loading and unloading. Thereby, longitudinal adaptive processes in hyaline cartilage become evident, which may be used for the tissue's non-invasive functional characterization by T1ρ.

T2* Mapping of the Hip in Asymptomatic Volunteers with Normal Cartilage Morphology: An Analysis of Regional and Age-Dependent Distribution

Objective To assess age-dependent and regional differences in T2* relaxation measurements in hip joint cartilage of asymptomatic volunteers at 3 T. Design Three age cohorts (cohort 1: age 20-30 years, 15 individuals; cohort 2: age 30-40 years, 17 individuals; cohort 3: age 40-50 years, 15 individuals) were enrolled. T2* values were obtained in the central and peripheral cartilage of the acetabulum and the femoral head in 7 regions (anterior to superior and posterior). Results T2* did not differ among age cohorts in acetabular cartilage (cohort 1: 24.65 ± 6.56 ms, cohort 2: 24.70 ± 4.83 ms, cohort 3: 25.81 ± 5.10 ms, P = 0.10) and femoral head cartilage (cohort 1: 27.08 ± 8.24 ms, cohort 2: 25.90 ± 7.82 ms, cohort 3: 26.50 ± 5.61 ms, P = 0.34). Analysis of the regional T2* distribution pattern indicates increased T2* values in the anterior, anterior-superior, superior-anterior, and the posterior-superior aspects of acetabular and femoral head cartilage. For acetabular cartilage, higher values were observed in the central region (25.90 ± 4.80 ms vs. 24.21 ± 4.05 ms, P < 0.0001) whereas femoral head cartilage did not reveal such differences (26.62 ± 5.74 ms vs. 26.37 ± 5.89 ms, P = 0.44). Conclusions The T2* analysis of presumably healthy hip joint cartilage does not seem to be stratified according to age in this population. Regional T2* variation throughout hip joint cartilage is apparent in this modality.

Quadrupolar jump-and-return pulse sequence for fluid-suppressed sodium MRI of the knee joint at 7T

PURPOSE

To demonstrate the feasibility of the so-called quadrupolar jump-and-return (QJR) pulse sequence by assessing its performance on the contrast modification to knee cartilage and quality of fluid suppression in the knee joint in vivo at 7T.

METHODS

The right knee joints of five healthy volunteers (3 males: mean age = 32.4 ± 1.3 years; 2 females: mean age = 27.9 ± 1.0 years; mean age = 30.6 ± 2.7 years) were scanned on a 7T scanner with variation of the delay in the QJR sequence from 1 ms to 5 ms. For one healthy volunteer, the QJR scan with the delay of 3 ms and the inversion-recovery (IR) scan were performed. Numerical simulations were conducted to evaluate the effects of B₀ - and B₁ -field inhomogeneities and residual quadrupolar couplings on fluid suppression and tissue contrast, respectively.

RESULTS

The QJR sequence suppressed the fluid signal from the artery and produced the contrast of knee cartilage in vivo. Its performance was comparable to that of the conventional IR sequence. Numerical simulations suggested that the fluid suppression may not be affected much by field inhomogeneities but that a distribution of residual quadrupolar couplings and weak RF pulses may interfere with the clear interpretation of cartilage contrast.

CONCLUSION

This preliminary work demonstrated that the QJR pulse sequence produces contrast for knee cartilage while suppressing the fluid signal from the artery. The knee cartilage contrast and quality of fluid suppression obtained from the QJR sequence were comparable to those of the IR sequence. Magn Reson Med 80:641-647, 2018. © 2017 International Society for Magnetic Resonance in Medicine.