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Hooijmans MT, Schlaffke L, Bolsterlee B, Schlaeger S, Marty B, Mazzoli V. Compositional and Functional MRI of Skeletal Muscle: A Review. J Magn Reson Imaging 2024; 60:860-877. [PMID: 37929681 PMCID: PMC11070452 DOI: 10.1002/jmri.29091] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2023] [Revised: 10/09/2023] [Accepted: 10/09/2023] [Indexed: 11/07/2023] Open
Abstract
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.
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Affiliation(s)
- Melissa T Hooijmans
- Department of Radiology and Nuclear Medicine, Amsterdam UMC, University of Amsterdam, Amsterdam Movement Sciences, Amsterdam, The Netherlands
| | - Lara Schlaffke
- Department of Neurology BG-University Hospital Bergmannsheil, Ruhr-University Bochum, Bochum, Germany
| | - Bart Bolsterlee
- Neuroscience Research Australia (NeuRA), Sydney, New South Wales, Australia
- Graduate School of Biomedical Engineering, University of New South Wales, Sydney, New South Wales, Australia
- School of Mechanical, Medical and Process Engineering, Queensland University of Technology, Brisbane, Queensland, Australia
| | - Sarah Schlaeger
- Department of Diagnostic and Interventional Neuroradiology, School of Medicine, Klinikum rechts der Isar, Technical University of Munich, Munich, Germany
- Department of Radiology, LMU University Hospital, LMU Munich, Munich, Germany
| | - Benjamin Marty
- Institute of Myology, Neuromuscular Investigation Center, NMR Laboratory, Paris, France
| | - Valentina Mazzoli
- Department of Radiology, Stanford University, Stanford, California, USA
- Bernard and Irene Schwartz Center for Biomedical Imaging, Department of Radiology, NYU Langone Medical Center, New York, New York, USA
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Flores DV. Invited Commentary: MRI of Muscle Healing and Return to Play: Current Status. Radiographics 2024; 44:e240096. [PMID: 39052500 DOI: 10.1148/rg.240096] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/27/2024]
Affiliation(s)
- Dyan V Flores
- Department of Radiology, Radiation Oncology and Medical Physics, Faculty of Medicine, University of Ottawa, Ottawa, ON, Canada; Department of Medical Imaging, The Ottawa Hospital, 501 Smyth Rd, Ottawa, ON, Canada K1H 8L6; and the Ottawa Hospital Research Institute, Ottawa, ON, Canada
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Forsting J, Rehmann R, Rohm M, Kocabas A, De Lorenzo A, Güttsches AK, Vorgerd M, Froeling M, Schlaffke L. Prospective longitudinal cohort study of quantitative muscle magnetic resonance imaging in a healthy control population. NMR IN BIOMEDICINE 2024:e5214. [PMID: 38982853 DOI: 10.1002/nbm.5214] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/23/2024] [Revised: 06/03/2024] [Accepted: 06/18/2024] [Indexed: 07/11/2024]
Abstract
Quantitative muscle magnetic resonance imaging (qMRI) is a valuable methodology for assessing muscular injuries and neuromuscular disorders. Notably, muscle diffusion tensor imaging (DTI) gives insights into muscle microstructural and macrostructural characteristics. However, the long-term reproducibility and robustness of these measurements remain relatively unexplored. The purpose of this prospective longitudinal cohort study was to assess the long-term robustness and range of variation of qMRI parameters, especially DTI metrics, in the lower extremity muscles of healthy controls under real-life conditions. Twelve volunteers (seven females, age 44.1 ± 12.1 years, body mass index 23.3 ± 2.0 kg/m2) underwent five leg muscle MRI sessions every 20 ± 4 weeks over a total period of 1.5 years. A multiecho gradient-echo Dixon-based sequence, a multiecho spin-echo T2-mapping sequence, and a spin-echo echo planar imaging diffusion-weighted sequence were acquired bilaterally with a Philips 3-T Achieva MR System using a 16-channel torso coil. Fifteen leg muscles were segmented in both lower extremities. qMRI parameters, including fat fraction (FF), water T2 relaxation time, and the diffusion metrics fractional anisotropy (FA) and mean diffusivity (MD), were evaluated. Coefficients of variance (wsCV) and intraclass correlation coefficients (ICCs) were calculated to assess the reproducibility of qMRI parameters. The standard error of measurement (SEM) and the minimal detectable change (MDC) were calculated to determine the range of variation. All tests were applied to all muscles and, subsequently, to each muscle separately. wsCV showed good reproducibility (≤ 10%) for all qMRI parameters in all muscles. The ICCs revealed excellent agreement between time points (FF = 0.980, water T2 = 0.941, FA = 0.952, MD = 0.948). Random measurement errors assessed by SEM and the MDC were low (< 12%). In conclusion, in this study, we showed that qMRI parameters in healthy volunteers living normal lives are stable over 18 months, thereby defining a benchmark for the expected range of variation over time.
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Affiliation(s)
- Johannes Forsting
- Department of Neurology, BG-University Hospital Bergmannsheil, Ruhr-University Bochum, Bochum, Germany
| | - Robert Rehmann
- Department of Neurology, BG-University Hospital Bergmannsheil, Ruhr-University Bochum, Bochum, Germany
- Department of Neurology, Klinikum Dortmund, University Witten-Herdecke, Dortmund, Germany
| | - Marlena Rohm
- Department of Neurology, BG-University Hospital Bergmannsheil, Ruhr-University Bochum, Bochum, Germany
- Heimer Institute for Muscle Research, BG-University Hospital Bergmannsheil, Bochum, Germany
| | - Abdulhadi Kocabas
- Department of Neurology, BG-University Hospital Bergmannsheil, Ruhr-University Bochum, Bochum, Germany
| | - Alice De Lorenzo
- Department of Neurology, BG-University Hospital Bergmannsheil, Ruhr-University Bochum, Bochum, Germany
| | - Anne-Katrin Güttsches
- Department of Neurology, BG-University Hospital Bergmannsheil, Ruhr-University Bochum, Bochum, Germany
| | - Matthias Vorgerd
- Department of Neurology, BG-University Hospital Bergmannsheil, Ruhr-University Bochum, Bochum, Germany
- Heimer Institute for Muscle Research, BG-University Hospital Bergmannsheil, Bochum, Germany
| | - Martijn Froeling
- Department of Radiology, University Medical Centre Utrecht, Utrecht, Netherlands
| | - Lara Schlaffke
- Department of Neurology, BG-University Hospital Bergmannsheil, Ruhr-University Bochum, Bochum, Germany
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Wille CM, Hurley SA, Schmida E, Lee K, Kijowski R, Heiderscheit BC. Diffusion tensor imaging of hamstring muscles after acute strain injury and throughout recovery in collegiate athletes. Skeletal Radiol 2024; 53:1369-1379. [PMID: 38267763 DOI: 10.1007/s00256-024-04587-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/05/2023] [Revised: 01/09/2024] [Accepted: 01/09/2024] [Indexed: 01/26/2024]
Abstract
OBJECTIVE To identify the region of interest (ROI) to represent injury and observe between-limb diffusion tensor imaging (DTI) microstructural differences in muscle following hamstring strain injury. MATERIALS AND METHODS Participants who sustained a hamstring strain injury prospectively underwent 3T-MRI of bilateral thighs using T1, T2, and diffusion-weighted imaging at time of injury (TOI), return to sport (RTS), and 12 weeks after RTS (12wks). ROIs were using the hyperintense region on a T2-weighted sequence: edema, focused edema, and primary muscle injured excluding edema (no edema). Linear mixed-effects models were used to compare diffusion parameters between ROIs and timepoints and limbs and timepoints. RESULTS Twenty-four participants (29 injuries) were included. A significant ROI-by-timepoint interaction was detected for all diffusivity measures. The edema and focused edema ROIs demonstrated increased diffusion at TOI compared to RTS for all diffusivity measures (p-values < 0.006), except λ1 (p-values = 0.058-0.12), and compared to 12wks (p-values < 0.02). In the no edema ROI, differences in diffusivity measures were not observed (p-values > 0.82). At TOI, no edema ROI diffusivity measures were lower than the edema ROI (p-values < 0.001) but not at RTS or 12wks (p-values > 0.69). A significant limb-by-timepoint interaction was detected for all diffusivity measures with increased diffusion in the involved limb at TOI (p-values < 0.001) but not at RTS or 12wks (p-values > 0.42). Significant differences in fractional anisotropy over time or between limbs were not detected. CONCLUSION Hyperintensity on T2-weighted imaging used to define the injured region holds promise in describing muscle microstructure following hamstring strain injury by demonstrating between-limb differences at TOI but not at follow-up timepoints.
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Affiliation(s)
- Christa M Wille
- Department of Biomedical Engineering, University of Wisconsin-Madison, Madison, WI, USA
- Department of Orthopedics and Rehabilitation, University of Wisconsin-Madison, 6136 UW Medical Foundation Centennial Bldg, 1685 Highland Ave, Madison, WI, 53705, USA
- Badger Athletic Performance Program, University of Wisconsin-Madison, Madison, WI, USA
| | - Samuel A Hurley
- Department of Radiology, University of Wisconsin-Madison, Madison, WI, USA
| | - Elizabeth Schmida
- Department of Orthopedics and Rehabilitation, University of Wisconsin-Madison, 6136 UW Medical Foundation Centennial Bldg, 1685 Highland Ave, Madison, WI, 53705, USA
- Badger Athletic Performance Program, University of Wisconsin-Madison, Madison, WI, USA
- Department of Mechanical Engineering, University of Wisconsin-Madison, Madison, WI, USA
| | - Kenneth Lee
- Department of Radiology, University of Wisconsin-Madison, Madison, WI, USA
| | - Richard Kijowski
- Department of Radiology, NYU Grossman School of Medicine, New York, NY, USA
| | - Bryan C Heiderscheit
- Department of Biomedical Engineering, University of Wisconsin-Madison, Madison, WI, USA.
- Department of Orthopedics and Rehabilitation, University of Wisconsin-Madison, 6136 UW Medical Foundation Centennial Bldg, 1685 Highland Ave, Madison, WI, 53705, USA.
- Badger Athletic Performance Program, University of Wisconsin-Madison, Madison, WI, USA.
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Berry DB, Gordon JA, Adair V, Frank LR, Ward SR. From Voxels to Physiology: A Review of Diffusion Magnetic Resonance Imaging Applications in Skeletal Muscle. J Magn Reson Imaging 2024. [PMID: 39031753 DOI: 10.1002/jmri.29489] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2024] [Revised: 06/03/2024] [Accepted: 06/03/2024] [Indexed: 07/22/2024] Open
Abstract
Skeletal muscle has a classic structure function relationship; both skeletal muscle microstructure and architecture are directly related to force generating capacity. Biopsy, the gold standard for evaluating muscle microstructure, is highly invasive, destructive to muscle, and provides only a small amount of information about the entire volume of a muscle. Similarly, muscle fiber lengths and pennation angles, key features of muscle architecture predictive of muscle function, are traditionally studied via cadaveric dissection. Noninvasive techniques such as diffusion magnetic resonance imaging (dMRI) offer quantitative approaches to study skeletal muscle microstructure and architecture. Despite its prevalence in applications for musculoskeletal research, clinical adoption is hindered by a lack of understanding regarding its sensitivity to clinically important biomarkers such as muscle fiber cross-sectional area. This review aims to elucidate how dMRI has been utilized to study skeletal muscle, covering fundamentals of muscle physiology, dMRI acquisition techniques, dMRI modeling, and applications where dMRI has been leveraged to noninvasively study skeletal muscle changes in response to disease, aging, injury, and human performance. LEVEL OF EVIDENCE: 5 TECHNICAL EFFICACY: Stage 2.
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Affiliation(s)
- David B Berry
- Department of Orthopaedic Surgery, University of California, San Diego, California, USA
| | - Joseph A Gordon
- Department of Orthopaedic Surgery, University of California, San Diego, California, USA
| | - Vincent Adair
- Department of Medicine, University of California, San Diego, California, USA
| | - Lawrence R Frank
- Center for Scientific Computation in Imaging, University of California, San Diego, California, USA
| | - Samuel R Ward
- Department of Orthopaedic Surgery, University of California, San Diego, California, USA
- Department of Radiology, University of California, San Diego, California, USA
- Department of Bioengineering, University of California, San Diego, California, USA
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Rubin EB, Schmidt AM, Koff MF, Kogan F, Gao K, Majumdar S, Potter H, Gold GE. Advanced MRI Approaches for Evaluating Common Lower Extremity Injuries in Basketball Players: Current and Emerging Techniques. J Magn Reson Imaging 2024; 59:1902-1913. [PMID: 37854004 DOI: 10.1002/jmri.29019] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2023] [Revised: 08/31/2023] [Accepted: 09/01/2023] [Indexed: 10/20/2023] Open
Abstract
Magnetic resonance imaging (MRI) can provide accurate and non-invasive diagnoses of lower extremity injuries in athletes. Sport-related injuries commonly occur in and around the knee and can affect the articular cartilage, patellar tendon, hamstring muscles, and bone. Sports medicine physicians utilize MRI to evaluate and diagnose injury, track recovery, estimate return to sport timelines, and assess the risk of recurrent injury. This article reviews the current literature and describes novel developments of quantitative MRI tools that can further advance our understanding of sports injury diagnosis, prevention, and treatment while minimizing injury risk and rehabilitation time. Innovative approaches for enhancing the early diagnosis and treatment of musculoskeletal injuries in basketball players span a spectrum of techniques. These encompass the utilization of T2, T1ρ, and T2* quantitative MRI, along with dGEMRIC and Na-MRI to assess articular cartilage injuries, 3D-Ultrashort echo time MRI for patellar tendon injuries, diffusion tensor imaging for acute myotendinous injuries, and sagittal short tau inversion recovery and axial long-axis T1-weighted, and 3D Cube sequences for bone stress imaging. Future studies should further refine and validate these MR-based quantitative techniques while exploring the lifelong cumulative impact of basketball on players' knees. LEVEL OF EVIDENCE: 5 TECHNICAL EFFICACY: Stage 2.
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Affiliation(s)
- Elka B Rubin
- Department of Radiology, Stanford University, Stanford, California, USA
| | - Andrew M Schmidt
- Department of Radiology, Stanford University, Stanford, California, USA
| | - Matthew F Koff
- Department of Radiology and Imaging, Hospital for Special Surgery, New York City, New York, USA
| | - Feliks Kogan
- Department of Radiology, Stanford University, Stanford, California, USA
| | - Kenneth Gao
- Department of Radiology and Biomedical Imaging, University of California, San Francisco, California, USA
| | - Sharmila Majumdar
- Department of Radiology and Biomedical Imaging, University of California, San Francisco, California, USA
| | - Hollis Potter
- Department of Radiology and Imaging, Hospital for Special Surgery, New York City, New York, USA
| | - Garry E Gold
- Department of Radiology, Stanford University, Stanford, California, USA
- Department of Orthopaedic Surgery, Stanford University, Stanford, California, USA
- Department of Bioengineering, Stanford University, Stanford, California, USA
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7
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Forsting J, Wächter M, Froeling M, Rohm M, Güttsches AK, De Lorenzo A, Südkamp N, Kocabas A, Vorgerd M, Enax-Krumova E, Rehmann R, Schlaffke L. Quantitative muscle magnetic resonance imaging in limb-girdle muscular dystrophy type R1 (LGMDR1): A prospective longitudinal cohort study. NMR IN BIOMEDICINE 2024:e5172. [PMID: 38794994 DOI: 10.1002/nbm.5172] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/03/2023] [Revised: 04/16/2024] [Accepted: 04/20/2024] [Indexed: 05/27/2024]
Abstract
Limb-girdle muscular dystrophy (LGMD) type R1 (LGMDR1) is the most common subtype of LGMD in Europe. Prospective longitudinal data, including clinical assessments and new biomarkers such as quantitative magnetic resonance imaging (qMRI), are needed to evaluate the natural course of the disease and therapeutic options. We evaluated eight thigh and seven leg muscles of 13 LGMDR1 patients (seven females, mean age 36.7 years, body mass index 23.9 kg/m2) and 13 healthy age- and gender-matched controls in a prospective longitudinal design over 1 year. Clinical assessment included testing for muscle strength with quick motor function measure (QMFM), gait analysis and patient questionnaires (neuromuscular symptom score, activity limitation [ACTIVLIM]). MRI scans were performed on a 3-T MRI scanner, including a Dixon-based sequence, T2 mapping and diffusion tensor imaging. The qMRI values of fat fraction (FF), water T2 relaxation time (T2), fractional anisotropy, mean diffusivity, axial diffusivity and radial diffusivity were analysed. Within the clinical outcome measures, significant deterioration between baseline and follow-up was found for ACTIVLIM (p = 0.029), QMFM (p = 0.012). Analysis of qMRI parameters of the patient group revealed differences between time points for both FF and T2 when analysing all muscles (FF: p < 0.001; T2: p = 0.016). The highest increase of fat replacement was found in muscles with an FF of between 10% and 50% at baseline. T2 in muscles with low-fat replacement increased significantly. No significant differences were found for the diffusion metrics. Significant correlations between qMRI metrics and clinical assessments were found at baseline and follow-up, while only T2 changes in thigh muscles correlated with changes in ACTIVLIM over time (ρ = -0.621, p < 0.05). Clinical assessments can show deterioration of the general condition of LGMDR1 patients. qMRI measures can give additional information about underlying pathophysiology. Further research is needed to establish qMRI outcome measures for clinical trials.
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Affiliation(s)
- Johannes Forsting
- Department of Neurology, BG-University Hospital Bergmannsheil, Ruhr-University Bochum, Bochum, Germany
| | - Marian Wächter
- Department of Neurology, BG-University Hospital Bergmannsheil, Ruhr-University Bochum, Bochum, Germany
| | - Martijn Froeling
- Department of Radiology, University Medical Centre Utrecht, Utrecht, The Netherlands
| | - Marlena Rohm
- Department of Neurology, BG-University Hospital Bergmannsheil, Ruhr-University Bochum, Bochum, Germany
- Heimer Institute for Muscle Research, BG-University Hospital Bergmannsheil, Bochum, Germany
| | - Anne-Katrin Güttsches
- Department of Neurology, BG-University Hospital Bergmannsheil, Ruhr-University Bochum, Bochum, Germany
- Heimer Institute for Muscle Research, BG-University Hospital Bergmannsheil, Bochum, Germany
| | - Alice De Lorenzo
- Department of Neurology, BG-University Hospital Bergmannsheil, Ruhr-University Bochum, Bochum, Germany
| | - Nicolina Südkamp
- Department of Neurology, BG-University Hospital Bergmannsheil, Ruhr-University Bochum, Bochum, Germany
| | - Abdulhadi Kocabas
- Department of Neurology, BG-University Hospital Bergmannsheil, Ruhr-University Bochum, Bochum, Germany
| | - Matthias Vorgerd
- Department of Neurology, BG-University Hospital Bergmannsheil, Ruhr-University Bochum, Bochum, Germany
- Heimer Institute for Muscle Research, BG-University Hospital Bergmannsheil, Bochum, Germany
| | - Elena Enax-Krumova
- Department of Neurology, BG-University Hospital Bergmannsheil, Ruhr-University Bochum, Bochum, Germany
| | - Robert Rehmann
- Department of Neurology, BG-University Hospital Bergmannsheil, Ruhr-University Bochum, Bochum, Germany
- Department of Neurology, Klinikum Dortmund, University Witten-Herdecke, Dortmund, Germany
| | - Lara Schlaffke
- Department of Neurology, BG-University Hospital Bergmannsheil, Ruhr-University Bochum, Bochum, Germany
- Heimer Institute for Muscle Research, BG-University Hospital Bergmannsheil, Bochum, Germany
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8
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Rauh SS, Suskens JJM, Monte JR, Smithuis F, Gurney-Champion OJ, Tol JL, Maas M, Nederveen AJ, Strijkers GJ, Hooijmans MT. Accelerated IVIM-corrected DTI in acute hamstring injury: towards a clinically feasible acquisition time. Eur Radiol Exp 2024; 8:38. [PMID: 38499843 PMCID: PMC10948680 DOI: 10.1186/s41747-024-00437-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2023] [Accepted: 01/15/2024] [Indexed: 03/20/2024] Open
Abstract
BACKGROUND Intravoxel incoherent motion (IVIM)-corrected diffusion tensor imaging (DTI) potentially enhances return-to-play (RTP) prediction after hamstring injuries. However, the long scan times hamper clinical implementation. We assessed accelerated IVIM-corrected DTI approaches in acute hamstring injuries and explore the sensitivity of the perfusion fraction (f) to acute muscle damage. METHODS Athletes with acute hamstring injury received DTI scans of both thighs < 7 days after injury and at RTP. For a subset, DTI scans were repeated with multiband (MB) acceleration. Data from standard and MB-accelerated scans were fitted with standard and accelerated IVIM-corrected DTI approach using high b-values only. Segmentations of the injury and contralateral healthy muscles were contoured. The fitting methods as well as the standard and MB-accelerated scan were compared using linear regression analysis. For sensitivity to injury, Δ(injured minus healthy) DTI parameters between the methods and the differences between injured and healthy muscles were compared (Wilcoxon signed-rank test). RESULTS The baseline dataset consisted of 109 athletes (16 with MB acceleration); 64 of them received an RTP scan (8 with MB acceleration). Linear regression of the standard and high-b DTI fitting showed excellent agreement. With both fitting methods, standard and MB-accelerated scans were comparable. Δ(injured minus healthy) was similar between standard and accelerated methods. For all methods, all IVIM-DTI parameters except f were significantly different between injured and healthy muscles. CONCLUSIONS High-b DTI fitting with MB acceleration reduced the scan time from 11:08 to 3:40 min:s while maintaining sensitivity to hamstring injuries; f was not different between healthy and injured muscles. RELEVANCE STATEMENT The accelerated IVIM-corrected DTI protocol, using fewer b-values and MB acceleration, reduced the scan time to under 4 min without affecting the sensitivity of the quantitative outcome parameters to hamstring injuries. This allows for routine clinical monitoring of hamstring injuries, which could directly benefit injury treatment and monitoring. KEY POINTS • Combining high-b DTI-fitting and multiband-acceleration dramatically reduced by two thirds the scan time. • The accelerated IVIM-corrected DTI approaches maintained the sensitivity to hamstring injuries. • The IVIM-derived perfusion fraction was not sensitive to hamstring injuries.
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Affiliation(s)
- Susanne S Rauh
- Department of Biomedical Engineering and Physics, Amsterdam University Medical Centers, University of Amsterdam, Amsterdam, The Netherlands.
- Amsterdam Movement Sciences, Sports, Amsterdam, The Netherlands.
| | - Jozef J M Suskens
- Amsterdam Movement Sciences, Sports, Amsterdam, The Netherlands
- Department of Orthopedic Surgery and Sports Medicine, Amsterdam University Medical Centers, University of Amsterdam, Amsterdam, The Netherlands
| | - Jithsa R Monte
- Department of Radiology and Nuclear Medicine, Amsterdam University Medical Centers, University of Amsterdam, Amsterdam, The Netherlands
| | - Frank Smithuis
- Department of Radiology and Nuclear Medicine, Amsterdam University Medical Centers, University of Amsterdam, Amsterdam, The Netherlands
| | - Oliver J Gurney-Champion
- Department of Radiology and Nuclear Medicine, Amsterdam University Medical Centers, University of Amsterdam, Amsterdam, The Netherlands
| | - Johannes L Tol
- Department of Orthopedic Surgery and Sports Medicine, Amsterdam University Medical Centers, University of Amsterdam, Amsterdam, The Netherlands
- Academic Center for Evidence Based Sports Medicine (ACES), Amsterdam, The Netherlands
- Amsterdam Collaboration for Health and Safety in Sports (ACHSS), AMC/VUmc IOC Research Center Amsterdam, Amsterdam, The Netherlands
| | - Mario Maas
- Amsterdam Movement Sciences, Sports, Amsterdam, The Netherlands
- Department of Radiology and Nuclear Medicine, Amsterdam University Medical Centers, University of Amsterdam, Amsterdam, The Netherlands
| | - Aart J Nederveen
- Department of Radiology and Nuclear Medicine, Amsterdam University Medical Centers, University of Amsterdam, Amsterdam, The Netherlands
| | - Gustav J Strijkers
- Department of Biomedical Engineering and Physics, Amsterdam University Medical Centers, University of Amsterdam, Amsterdam, The Netherlands
- Amsterdam Movement Sciences, Sports, Amsterdam, The Netherlands
| | - Melissa T Hooijmans
- Amsterdam Movement Sciences, Sports, Amsterdam, The Netherlands
- Department of Radiology and Nuclear Medicine, Amsterdam University Medical Centers, University of Amsterdam, Amsterdam, The Netherlands
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9
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Schlaffke L, Rehmann R, Froeling M, Güttsches AK, Vorgerd M, Enax-Krumova E, Forsting J. Quantitative muscle MRI in sporadic inclusion body myositis (sIBM): A prospective cohort study. J Neuromuscul Dis 2024; 11:997-1009. [PMID: 39031378 PMCID: PMC11380292 DOI: 10.3233/jnd-240053] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/22/2024]
Abstract
Background Sporadic inclusion body myositis (sIBM) is the predominant idiopathic inflammatory myopathy (IIM) in older people. Limitations of classical clinical assessments have been discussed as possible explanations for failed clinical trials, underlining the need for more sensitive outcome measures. Quantitative muscle MRI (qMRI) is a promising candidate for evaluating and monitoring sIBM. Objective Longitudinal assessment of qMRI in sIBM patients. Methods We evaluated fifteen lower extremity muscles of 12 sIBM patients (5 females, mean age 69.6, BMI 27.8) and 12 healthy age- and gender-matched controls. Seven patients and matched controls underwent a follow-up evaluation after one year. Clinical assessment included testing for muscle strength with Quick Motor Function Measure (QMFM), IBM functional rating scale (IBM-FRS), and gait analysis (6-minute walking distance). 3T-MRI scans of the lower extremities were performed, including a Dixon-based sequence, T2 mapping and Diffusion Tensor Imaging. The qMRI-values fat-fraction (FF), water T2 relaxation time (wT2), fractional anisotropy (FA), mean diffusivity (MD), axial diffusivity (λ1), and radial diffusivity (RD) were analysed. Results Compared to healthy controls, significant differences for all qMRI parameters averaged over all muscles were found in sIBM using a MANOVA (p < 0.001). In low-fat muscles (FF < 10%), a significant increase of wT2 and FA with an accompanying decrease of MD, λ1, and RD was observed (p≤0.020). The highest correlation with clinical assessments was found for wT2 values in thigh muscles (r≤-0.634). Significant changes of FF (+3.0%), wT2 (+0.6 ms), MD (-0.04 10-3mm2/s), λ1 (-0.05 10-3mm2/s), and RD (-0.03 10-3mm2/s) were observed in the longitudinal evaluation of sIBM patients (p≤0.001). FA showed no significant change (p = 0.242). Conclusion qMRI metrics correlate with clinical findings and can reflect different ongoing pathophysiological mechanisms. While wT2 is an emerging marker of disease activity, the role of diffusion metrics, possibly reflecting changes in fibre size and intracellular deposits, remains subject to further investigations.
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Affiliation(s)
- Lara Schlaffke
- Department of Neurology, BG-University Hospital Bergmannsheil, Ruhr-University Bochum, Bochum, Germany
| | - Robert Rehmann
- Department of Neurology, BG-University Hospital Bergmannsheil, Ruhr-University Bochum, Bochum, Germany
- Department of Neurology, Klinikum Dortmund, University Witten-Herdecke, Dortmund, Germany
| | - Martijn Froeling
- Department of Radiology, University Medical Centre Utrecht, Utrecht, The Netherlands
| | - Anne-Katrin Güttsches
- Department of Neurology, BG-University Hospital Bergmannsheil, Ruhr-University Bochum, Bochum, Germany
| | - Matthias Vorgerd
- Department of Neurology, BG-University Hospital Bergmannsheil, Ruhr-University Bochum, Bochum, Germany
- Heimer Institute for Muscle Research, BG-University Hospital Bergmannsheil, Bochum, Germany
| | - Elena Enax-Krumova
- Department of Neurology, BG-University Hospital Bergmannsheil, Ruhr-University Bochum, Bochum, Germany
| | - Johannes Forsting
- Department of Neurology, BG-University Hospital Bergmannsheil, Ruhr-University Bochum, Bochum, Germany
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Marth AA, Auer TA, Bertalan G, Gebert P, Kirchenberger T, Geisel D, Hamm B, Keller S. Advanced muscle imaging in adolescent elite rowers utilizing diffusion tensor imaging: Association of imaging findings with stroke typology. PLoS One 2023; 18:e0294693. [PMID: 38019893 PMCID: PMC10686450 DOI: 10.1371/journal.pone.0294693] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2023] [Accepted: 11/07/2023] [Indexed: 12/01/2023] Open
Abstract
PURPOSE Muscular overuse injuries are a common health issue in elite athletes. Changes in the muscular microenvironment can be depicted by Diffusion Tensor Imaging (DTI). We hypothesize that the biomechanics of different stroke typologies plays a role in muscle injury and tested our hypothesis by magnetic resonance imaging (MRI) examination of the lumbar spine muscles of adolescent rowers utilizing DTI. METHODS AND MATERIALS Twenty-two male elite rowers (12 sweep, 10 scull rowers) with a mean age of 15.8 ± 1.2 years underwent 3-Tesla MRI of the lumbar spine 6 hours after cessation of training. Apparent diffusion coefficient (ADC) and fractional anisotropy (FA) were calculated for the erector spinae and multifidus muscle. Student's t-test was used to test differences of DTI parameters between sweep and scull rowers and a Pearson correlation was utilized to correlate the parameters to training volume. RESULTS ADC values in the erector spinae and multifidus muscle were significantly higher (p = 0.039) and FA values significantly lower (p < 0.001) in sweep rowers compared to scull rowers. There was no significant association between DTI parameters and training volume (r ≤ -0.459, p ≥ 0.074). CONCLUSIONS Our DTI results show that lumbar spine muscle diffusivity is higher in sweep rowers than in scull rowers. Altered muscle diffusivity is suggestive of microscopic tissue disruption and might be attributable to biomechanical differences between stroke typologies.
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Affiliation(s)
- Adrian Alexander Marth
- Department of Radiology, Charité—Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin, Germany
| | - Timo Alexander Auer
- Department of Radiology, Charité—Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin, Germany
- Clinician Scientist Program, Berlin Institute of Health at Charité—Universitätsmedizin Berlin, Berlin, Germany
| | - Gergely Bertalan
- Department of Radiology, Charité—Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin, Germany
| | - Pimrapat Gebert
- Institute for Biometry, Charité—Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin, Germany
| | - Timo Kirchenberger
- Charité—Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin, Germany
| | - Dominik Geisel
- Department of Radiology, Charité—Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin, Germany
| | - Bernd Hamm
- Department of Radiology, Charité—Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin, Germany
| | - Sarah Keller
- Department of Radiology, Charité—Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin, Germany
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Hayashi D, Roemer FW, Tol JL, Heiss R, Crema MD, Jarraya M, Rossi I, Luna A, Guermazi A. Emerging Quantitative Imaging Techniques in Sports Medicine. Radiology 2023; 308:e221531. [PMID: 37552087 DOI: 10.1148/radiol.221531] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/09/2023]
Abstract
This article describes recent advances in quantitative imaging of musculoskeletal extremity sports injuries, citing the existing literature evidence and what additional evidence is needed to make such techniques applicable to clinical practice. Compositional and functional MRI techniques including T2 mapping, diffusion tensor imaging, and sodium imaging as well as contrast-enhanced US have been applied to quantify pathophysiologic processes and biochemical compositions of muscles, tendons, ligaments, and cartilage. Dual-energy and/or spectral CT has shown potential, particularly for the evaluation of osseous and ligamentous injury (eg, creation of quantitative bone marrow edema maps), which is not possible with standard single-energy CT. Recent advances in US technology such as shear-wave elastography or US tissue characterization as well as MR elastography enable the quantification of mechanical, elastic, and physical properties of tissues in muscle and tendon injuries. The future role of novel imaging techniques such as photon-counting CT remains to be established. Eventual prediction of return to play (ie, the time needed for the injury to heal sufficiently so that the athlete can get back to playing their sport) and estimation of risk of repeat injury is desirable to help guide sports physicians in the treatment of their patients. Additional values of quantitative analyses, as opposed to routine qualitative analyses, still must be established using prospective longitudinal studies with larger sample sizes.
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Affiliation(s)
- Daichi Hayashi
- From the Department of Radiology, Tufts Medical Center, Tufts University School of Medicine, Boston, Mass (D.H.); Quantitative Imaging Center, Department of Radiology, Boston University School of Medicine, Boston, Mass (D.H., F.W.R., M.D.C., A.G.); Department of Radiology, University Hospital Erlangen, Friedrich-Alexander-Universität Erlangen-Nürnberg, Erlangen, Germany (F.W.R., R.H.); University of Amsterdam Academic Center for Evidence-based Sports Medicine, Amsterdam, the Netherlands (J.L.T.); Institute of Sports Imaging, French National Institute of Sports, Paris, France (M.D.C.); Department of Radiology, Massachusetts General Hospital, Harvard Medical School, Boston, Mass (M.J.); Centro Rossi, Buenos Aires, Argentina (I.R.); Department of Radiology, HT Medica, Jaén, Spain (A.L.); and Department of Radiology, VA Boston Healthcare System, Boston University School of Medicine, 1400 VFW Parkway, Suite 1B105, West Roxbury, MA 02132 (A.G.)
| | - Frank W Roemer
- From the Department of Radiology, Tufts Medical Center, Tufts University School of Medicine, Boston, Mass (D.H.); Quantitative Imaging Center, Department of Radiology, Boston University School of Medicine, Boston, Mass (D.H., F.W.R., M.D.C., A.G.); Department of Radiology, University Hospital Erlangen, Friedrich-Alexander-Universität Erlangen-Nürnberg, Erlangen, Germany (F.W.R., R.H.); University of Amsterdam Academic Center for Evidence-based Sports Medicine, Amsterdam, the Netherlands (J.L.T.); Institute of Sports Imaging, French National Institute of Sports, Paris, France (M.D.C.); Department of Radiology, Massachusetts General Hospital, Harvard Medical School, Boston, Mass (M.J.); Centro Rossi, Buenos Aires, Argentina (I.R.); Department of Radiology, HT Medica, Jaén, Spain (A.L.); and Department of Radiology, VA Boston Healthcare System, Boston University School of Medicine, 1400 VFW Parkway, Suite 1B105, West Roxbury, MA 02132 (A.G.)
| | - Johannes L Tol
- From the Department of Radiology, Tufts Medical Center, Tufts University School of Medicine, Boston, Mass (D.H.); Quantitative Imaging Center, Department of Radiology, Boston University School of Medicine, Boston, Mass (D.H., F.W.R., M.D.C., A.G.); Department of Radiology, University Hospital Erlangen, Friedrich-Alexander-Universität Erlangen-Nürnberg, Erlangen, Germany (F.W.R., R.H.); University of Amsterdam Academic Center for Evidence-based Sports Medicine, Amsterdam, the Netherlands (J.L.T.); Institute of Sports Imaging, French National Institute of Sports, Paris, France (M.D.C.); Department of Radiology, Massachusetts General Hospital, Harvard Medical School, Boston, Mass (M.J.); Centro Rossi, Buenos Aires, Argentina (I.R.); Department of Radiology, HT Medica, Jaén, Spain (A.L.); and Department of Radiology, VA Boston Healthcare System, Boston University School of Medicine, 1400 VFW Parkway, Suite 1B105, West Roxbury, MA 02132 (A.G.)
| | - Rafael Heiss
- From the Department of Radiology, Tufts Medical Center, Tufts University School of Medicine, Boston, Mass (D.H.); Quantitative Imaging Center, Department of Radiology, Boston University School of Medicine, Boston, Mass (D.H., F.W.R., M.D.C., A.G.); Department of Radiology, University Hospital Erlangen, Friedrich-Alexander-Universität Erlangen-Nürnberg, Erlangen, Germany (F.W.R., R.H.); University of Amsterdam Academic Center for Evidence-based Sports Medicine, Amsterdam, the Netherlands (J.L.T.); Institute of Sports Imaging, French National Institute of Sports, Paris, France (M.D.C.); Department of Radiology, Massachusetts General Hospital, Harvard Medical School, Boston, Mass (M.J.); Centro Rossi, Buenos Aires, Argentina (I.R.); Department of Radiology, HT Medica, Jaén, Spain (A.L.); and Department of Radiology, VA Boston Healthcare System, Boston University School of Medicine, 1400 VFW Parkway, Suite 1B105, West Roxbury, MA 02132 (A.G.)
| | - Michel D Crema
- From the Department of Radiology, Tufts Medical Center, Tufts University School of Medicine, Boston, Mass (D.H.); Quantitative Imaging Center, Department of Radiology, Boston University School of Medicine, Boston, Mass (D.H., F.W.R., M.D.C., A.G.); Department of Radiology, University Hospital Erlangen, Friedrich-Alexander-Universität Erlangen-Nürnberg, Erlangen, Germany (F.W.R., R.H.); University of Amsterdam Academic Center for Evidence-based Sports Medicine, Amsterdam, the Netherlands (J.L.T.); Institute of Sports Imaging, French National Institute of Sports, Paris, France (M.D.C.); Department of Radiology, Massachusetts General Hospital, Harvard Medical School, Boston, Mass (M.J.); Centro Rossi, Buenos Aires, Argentina (I.R.); Department of Radiology, HT Medica, Jaén, Spain (A.L.); and Department of Radiology, VA Boston Healthcare System, Boston University School of Medicine, 1400 VFW Parkway, Suite 1B105, West Roxbury, MA 02132 (A.G.)
| | - Mohamed Jarraya
- From the Department of Radiology, Tufts Medical Center, Tufts University School of Medicine, Boston, Mass (D.H.); Quantitative Imaging Center, Department of Radiology, Boston University School of Medicine, Boston, Mass (D.H., F.W.R., M.D.C., A.G.); Department of Radiology, University Hospital Erlangen, Friedrich-Alexander-Universität Erlangen-Nürnberg, Erlangen, Germany (F.W.R., R.H.); University of Amsterdam Academic Center for Evidence-based Sports Medicine, Amsterdam, the Netherlands (J.L.T.); Institute of Sports Imaging, French National Institute of Sports, Paris, France (M.D.C.); Department of Radiology, Massachusetts General Hospital, Harvard Medical School, Boston, Mass (M.J.); Centro Rossi, Buenos Aires, Argentina (I.R.); Department of Radiology, HT Medica, Jaén, Spain (A.L.); and Department of Radiology, VA Boston Healthcare System, Boston University School of Medicine, 1400 VFW Parkway, Suite 1B105, West Roxbury, MA 02132 (A.G.)
| | - Ignacio Rossi
- From the Department of Radiology, Tufts Medical Center, Tufts University School of Medicine, Boston, Mass (D.H.); Quantitative Imaging Center, Department of Radiology, Boston University School of Medicine, Boston, Mass (D.H., F.W.R., M.D.C., A.G.); Department of Radiology, University Hospital Erlangen, Friedrich-Alexander-Universität Erlangen-Nürnberg, Erlangen, Germany (F.W.R., R.H.); University of Amsterdam Academic Center for Evidence-based Sports Medicine, Amsterdam, the Netherlands (J.L.T.); Institute of Sports Imaging, French National Institute of Sports, Paris, France (M.D.C.); Department of Radiology, Massachusetts General Hospital, Harvard Medical School, Boston, Mass (M.J.); Centro Rossi, Buenos Aires, Argentina (I.R.); Department of Radiology, HT Medica, Jaén, Spain (A.L.); and Department of Radiology, VA Boston Healthcare System, Boston University School of Medicine, 1400 VFW Parkway, Suite 1B105, West Roxbury, MA 02132 (A.G.)
| | - Antonio Luna
- From the Department of Radiology, Tufts Medical Center, Tufts University School of Medicine, Boston, Mass (D.H.); Quantitative Imaging Center, Department of Radiology, Boston University School of Medicine, Boston, Mass (D.H., F.W.R., M.D.C., A.G.); Department of Radiology, University Hospital Erlangen, Friedrich-Alexander-Universität Erlangen-Nürnberg, Erlangen, Germany (F.W.R., R.H.); University of Amsterdam Academic Center for Evidence-based Sports Medicine, Amsterdam, the Netherlands (J.L.T.); Institute of Sports Imaging, French National Institute of Sports, Paris, France (M.D.C.); Department of Radiology, Massachusetts General Hospital, Harvard Medical School, Boston, Mass (M.J.); Centro Rossi, Buenos Aires, Argentina (I.R.); Department of Radiology, HT Medica, Jaén, Spain (A.L.); and Department of Radiology, VA Boston Healthcare System, Boston University School of Medicine, 1400 VFW Parkway, Suite 1B105, West Roxbury, MA 02132 (A.G.)
| | - Ali Guermazi
- From the Department of Radiology, Tufts Medical Center, Tufts University School of Medicine, Boston, Mass (D.H.); Quantitative Imaging Center, Department of Radiology, Boston University School of Medicine, Boston, Mass (D.H., F.W.R., M.D.C., A.G.); Department of Radiology, University Hospital Erlangen, Friedrich-Alexander-Universität Erlangen-Nürnberg, Erlangen, Germany (F.W.R., R.H.); University of Amsterdam Academic Center for Evidence-based Sports Medicine, Amsterdam, the Netherlands (J.L.T.); Institute of Sports Imaging, French National Institute of Sports, Paris, France (M.D.C.); Department of Radiology, Massachusetts General Hospital, Harvard Medical School, Boston, Mass (M.J.); Centro Rossi, Buenos Aires, Argentina (I.R.); Department of Radiology, HT Medica, Jaén, Spain (A.L.); and Department of Radiology, VA Boston Healthcare System, Boston University School of Medicine, 1400 VFW Parkway, Suite 1B105, West Roxbury, MA 02132 (A.G.)
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