Postmortem imaging exposed: an aid in MR imaging of musculoskeletal structures

Relationship between CT-Derived Bone Mineral Density and UTE-MR-Derived Porosity Index in Equine Third Metacarpal and Metatarsal Bones

Fatigue-related subchondral bone injuries of the third metacarpal/metatarsal (McIII/MtIII) bones are common causes of wastage, and they are welfare concerns in racehorses. A better understanding of bone health and strength would improve animal welfare and be of benefit for the racing industry. The porosity index (PI) is an indirect measure of osseous pore size and number in bones, and it is therefore an interesting indicator of bone strength. MRI of compact bone using traditional methods, even with short echo times, fail to generate enough signal to assess bone architecture as water protons are tightly bound. Ultra-short echo time (UTE) sequences aim to increase the amount of signal detected in equine McIII/MtIII condyles. Cadaver specimens were imaged using a novel dual-echo UTE MRI technique, and PI was calculated and validated against quantitative CT-derived bone mineral density (BMD) measures. BMD and PI are inversely correlated in equine distal Mc/MtIII bone, with a weak mean r value of -0.29. There is a statistically significant difference in r values between the forelimbs and hindlimbs. Further work is needed to assess how correlation patterns behave in different areas of bone and to evaluate PI in horses with and without clinically relevant stress injuries.

Bone marrow lesions: plugging the holes in our knowledge using animal models

Bone marrow lesions (BMLs), which are early signs of osteoarthritis (OA) that are associated with the presence, onset and severity of pain, represent an emerging imaging biomarker and clinical target. Little is known, however, regarding their early spatial and temporal development, structural relationships or aetiopathogenesis, because of the sparsity of human early OA imaging and paucity of relevant tissue samples. The use of animal models is a logical approach to fill the gaps in our knowledge, and it can be informed by appraising models in which BMLs and closely related subchondral cysts have already been reported, including in spontaneous OA and pain models. The utility of these models in OA research, their relevance to clinical BMLs and practical considerations for their optimal deployment can also inform medical and veterinary clinicians and researchers alike.

Magnetic Resonance Imaging Investigation of Cervical-Spine Meniscoid Composition: A Validation Study

OBJECTIVE

The composition of cervical-spine meniscoids may have clinical significance in neck-pain conditions, but the accuracy of assessment of meniscoid composition in vivo using magnetic resonance imaging has not been established. The aim of this study was to compare cervical-spine meniscoid composition by magnetic resonance imaging with histologic composition.

METHODS

Four embalmed cadaveric cervical spines (mean [standard deviation] age, 79.5 [3.7] years; 1 female, 3 male) underwent magnetic resonance imaging, allowing radiologic classification of lateral atlantoaxial- and zygapophyseal-joint (C2-3 to C6-7) meniscoids as either mostly fatty, mixed tissue, or mostly connective tissue. Subsequently, each joint was dissected and disarticulated to allow excision of meniscoids for histologic processing. Each meniscoid was sectioned sagittally, stained with hematoxylin and eosin, examined using light microscopy, and classified as adipose, fibroadipose, or fibrous in composition. Data were analyzed using the kappa statistic with linear weighting.

RESULTS

From dissection, 62 meniscoids were identified, excised, and processed; 46 of these 62 were visualized with magnetic resonance imaging. For single-rater identifying structures, agreement between assessment of meniscoid composition by magnetic resonance imaging and by microscopy was fair (κ = 0.24; 95% confidence interval, 0.02-0.46; P = .02).

CONCLUSION

Findings suggest that the accuracy of this method of magnetic resonance imaging assessment of cervical-spine meniscoid composition may be limited. This should be considered when planning or interpreting research investigating meniscoid composition using magnetic resonance imaging.

Magnetic resonance imaging and histopathological evaluation of equine oblique sesamoidean ligaments

BACKGROUND

Pathology involving the oblique sesamoidean ligaments (OSLs) is commonly diagnosed during magnetic resonance imaging (MRI) of the equine distal limb. Presence of striations within the ligament and magic angle artefact can result in an incorrect diagnosis of pathological change. No studies have been performed using histopathology, the gold standard, to corroborate their imaging diagnosis.

OBJECTIVES

(a) To determine which MRI characteristics are associated with normal vs abnormal OSLs and (b) to evaluate the ability of MRI to correctly identify abnormal vs normal oblique sesamoidean ligaments using histopathology as the gold standard.

STUDY DESIGN

Observational, cross-sectional study.

METHODS

Cadaver limbs (n = 77) were obtained from horses (n = 21) subjected to euthanasia at the hospital. MRI and histopathology was performed on each of the limbs. MRI scoring was performed for multiple MRI characteristics, and each limb was deemed normal or abnormal. Histopathology scoring was performed to give an overall score of normal or abnormal. Mixed model logistic regression was performed to evaluate which MRI characteristics were associated with normal vs abnormal OSLs using backwards elimination and a significance level of <0.1. Sensitivity and specificity were also calculated.

RESULTS

The sensitivity and specificity of MRI to correctly identify abnormal OSLs was 81% (95% CI 54%-96%) and 90% (95% CI 79%-96%) respectively. Based on logistic regression, increased cross-sectional area at the origin (OR: 26.77, 95% CI 1.1-4640, P = .07), increased ligament hyperintensity (OR: 9.59, 95% CI 1.23-155; P = .04) and reduction in striations (increased hypointensity score) (OR: 7.8, 95% CI 0.72-218, P = .07) were associated with abnormal OSL.

MAIN LIMITATIONS

Lameness exam was not performed on any of the horses prior to euthanasia. Findings can only be applied to chronic, degenerative changes, rather than an acute injury.

CONCLUSIONS

Increased cross-sectional area and changes in the signal intensity are associated with pathology within the OSLs. Medial to lateral size asymmetry and striation pattern variation can occur in histologically normal OSLs and should be interpreted with caution if other signs of pathology are absent.

Influence of storage on the quality of conventional CT and µCT-imaging for the middle and inner cat ear

The aim of this study was to analyze whether different fixation methods such as freezing or formaldehyde storage for different periods of time have an influence on the recognition of anatomical relevant structures in the middle and inner ear of the cat with conventional computed tomography (cCT) and micro-computed tomography (µCT). Besides, effects of freeze-thaw cycles on determined structures of the ear were investigated by means of histological slices. Three veterinarians with different radiologic expertise evaluated the scans of 30 dissected cat ears anonymously and scored predefined structures in a five-point scale with reference to visually sharp reproducibility and perfect image quality. The total scores of the different fixation groups as well as the ears within a group were compared with each other. Furthermore, an intra-reader examination including an evaluation of the identifiability of specified structures was performed for both imaging methods. cCT as well as µCT-scans have a very low variation coefficient of 1.6% and 2.3%, respectively. The results for the alterations between the different fixation methods show that the changes for cCT-scans are negligible, as the percentage alteration compared to fresh samples ranges in a very small interval with values from 1.0% better to 1.2% worse. µCT-scans are more influenced by the fixation method with a range from 1.3% better to 6.9% worse values. The scans mostly deteriorated after two freeze-thaw cycles (1.8% worse) and after storing the samples for 1 (2.4% worse), respectively, and 3 weeks in formaldehyde (6.9% worse).

Quantitative magnetic resonance imaging assessment of lateral atlantoaxial joint meniscoid composition: a validation study

PURPOSE

Lateral atlantoaxial (LAA) joint meniscoid composition may have clinical significance in patients following neck trauma. However, the existing method of radiologically assessing meniscoid composition has an inherent element of subjectivity, which could contribute to measurement variability. The present study sought to investigate the accuracy of two-point Dixon fat/water separation MRI as a quantitative assessment of LAA joint meniscoid composition.

METHODS

Sixteen LAA joint meniscoids were excised from four cadavers (mean [SD] age 79.5 [3.7] years; one female) following cervical spine MRI (two-point Dixon, T1-weighted VIBE and T2-weighted SPACE sequences). Composition of LAA joint meniscoids was undertaken by (1) histological examination by light microscopy, (2) calculation of fat fraction by Dixon MRI (both in-phase/opposed-phase and fat/water methods), and (3) the existing method of considering VIBE and SPACE signal intensities. Analysis was performed using the kappa statistic with linear weighting.

RESULTS

Microscopy revealed three, five, and eight meniscoids to be composed of adipose, fibroadipose, and fibrous tissues, respectively. Dixon sequence MRI classified 11 of these meniscoids correctly, with 'substantial' level of agreement (In-phase/Opp-phase kappa statistic = 0.78 [95% CI 0.38, 1.17]; fat/water kappa statistic = 0.72 [95% CI 0.32, 1.11]). Level of agreement between microscopy and the VIBE and SPACE method was 'slight' (kappa statistic = 0.02 [95% CI - 0.34, 0.38]).

CONCLUSIONS

Findings suggest that Dixon fat/water separation MRI may have superior utility in the assessment of LAA joint meniscoid composition than the existing method of considering VIBE and SPACE signal intensities. These slides can be retrieved under Electronic Supplementary Material.

Whole-body magnetic resonance imaging in children: technique and clinical applications

Whole-body MR imaging is being increasingly used in children to evaluate the extent of various oncologic and non-oncologic entities. The lack of exposure to ionizing radiation, excellent soft-tissue contrast (even without the use of contrast agents), and functional imaging capabilities make it especially suitable for screening and surveillance in the pediatric population. Technical developments such as moving table platforms, multi-channel/multi-element surface coils, and parallel imaging allow imaging of the entire body with multiple sequences in a reasonable 30- to 40-min time frame, which has facilitated its acceptance in routine clinical practice. The initial investigations in whole-body MR imaging were primarily focused on oncologic applications such as tumor screening and staging. The exquisite sensitivity of fluid-sensitive MR sequences to many different types of pathology has led to new applications of whole-body MR imaging in evaluation of multifocal rheumatologic conditions. Availability of blood pool contrast agents has allowed whole-body MR angiographic imaging of vascular malformations, vasculitides and vasculopathies. Whole-body MRI is being applied for delineating the extent and distribution of systemic and multifocal diseases, establishing diagnoses, assessing treatment response, and surveillance imaging. This article reviews the technique and clinical applications of whole-body MR imaging in children.

The effect of freeze-thawing on magnetic resonance imaging T2* of freshly harvested bovine patellar tendon

BACKGROUND

Analysis of fresh specimens in research studies is ideal; however, it is often necessary to freeze samples for evaluation at a later time. Limited evaluation of the effect of freeze-thawing of tendon tissue samples on inherent magnetic resonance imaging (MRI) parameters, such as ultrashort echo time (UTE) T2* values, have been performed to date.

METHODS

This study performed UTE MRI on 14 bovine patellar tendons at harvest and after four consecutive freeze-thaw cycles.

RESULTS

Results demonstrated a small but significant reduction (12%) in tendon T2* values after the first freeze thaw cycle, but not after successive cycles. Tendons from juvenile animals with open physis had a significant reduction of T2* following a single freeze thaw cycle, P<0.0001.

CONCLUSIONS

The results of this study emphasize the importance of using uniform tendon storage protocols when using UTE MRI in preclinical models.

Validation of cone-beam computed tomography and magnetic resonance imaging of the porcine spine: a comparative study with multidetector computed tomography and anatomical specimens

BACKGROUND CONTEXT

New spinal interventions or implants have been tested on ex vivo or in vivo porcine spines, as they are readily available and have been accepted as a comparable model to human cadaver spines. Imaging-guided interventional procedures of the spine are mostly based on fluoroscopy or, still, on multidetector computed tomography (MDCT). Cone-beam computed tomography (CBCT) and magnetic resonance imaging (MRI) are also available methods to guide interventional procedures. Although some MDCT data from porcine spines are available in the literature, validation of the measurements on CBCT and MRI is lacking.

PURPOSE

To describe and compare the anatomical measurements accomplished with MDCT, CBCT, and MRI of lumbar porcine spines to determine if CBCT and MRI are also useful methods for experimental studies.

STUDY DESIGN

An experimental descriptive-comparative study.

METHODS

Sixteen anatomical measurements of an individual vertebra from six lumbar porcine spines (n=36 vertebrae) were compared with their MDCT, CBCT, and MRI equivalents. Comparisons were made for the absolute values of the parameters.

RESULTS

Similarities were found in all imaging methods. Significant correlation (p<.05) was observed with all variables except those that included cartilaginous tissue from the end plates when the anatomical study was compared with the imaging methods.

CONCLUSIONS

The CBCT and MRI provided imaging measurements of the lumbar porcine spines that were similar to the anatomical and MDCT data, and they can be useful for specific experimental research studies.

High resolution MRI imaging at 9.4 Tesla of the osteochondral unit in a translational model of articular cartilage repair

Background

Non-destructive structural evaluation of the osteochondral unit is challenging. Here, the capability of high-field magnetic resonance imaging (μMRI) at 9.4 Tesla (T) was explored to examine osteochondral repair ex vivo in a preclinical large animal model. A specific aim of this study was to detect recently described alterations of the subchondral bone associated with cartilage repair.

Methods

Osteochondral samples of medial femoral condyles from adult ewes containing full-thickness articular cartilage defects treated with marrow stimulation were obtained after 6 month in vivo and scanned in a 9.4 T μMRI. Ex vivo imaging of small osteochondral samples (typical volume: 1–2 cm³) at μMRI was optimised by variation of repetition time (TR), time echo (TE), flip angle (FA), spatial resolution and number of excitations (NEX) from standard MultiSliceMultiEcho (MSME) and three-dimensional (3D) spoiled GradientEcho (SGE) sequences.

Results

A 3D SGE sequence with the parameters: TR = 10 ms, TE = 3 ms, FA = 10 °, voxel size = 120 × 120 × 120 μm³ and NEX = 10 resulted in the best fitting for sample size, image quality, scanning time and artifacts. An isovolumetric voxel shape allowed for multiplanar reconstructions. Within the osteochondral unit articular cartilage, cartilaginous repair tissue and bone marrow could clearly be distinguished from the subchondral bone plate and subarticular spongiosa. Specific alterations of the osteochondral unit associated with cartilage repair such as persistent drill holes, subchondral bone cysts, sclerosis of the subchondral bone plate and of the subarticular spongiosa and intralesional osteophytes were precisely detected.

Conclusions

High resolution, non-destructive ex vivo analysis of the entire osteochondral unit in a preclinical large animal model that is sufficient for further analyses is possible using μMRI at 9.4 T. In particular, 9.4 T is capable of accurately depicting alterations of the subchondral bone that are associated with osteochondral repair.

The Gini coefficient: a methodological pilot study to assess fetal brain development employing postmortem diffusion MRI

BACKGROUND

Diffusion-weighted imaging (DWI) is important in the assessment of fetal brain development. However, it is clinically challenging and time-consuming to prepare neuromorphological examinations to assess real brain age and to detect abnormalities.

OBJECTIVE

To demonstrate that the Gini coefficient can be a simple, intuitive parameter for modelling fetal brain development.

MATERIALS AND METHODS

Postmortem fetal specimens(n = 28) were evaluated by diffusion-weighted imaging (DWI) on a 3-T MRI scanner using 60 directions, 0.7-mm isotropic voxels and b-values of 0, 150, 1,600 s/mm(2). Constrained spherical deconvolution (CSD) was used as the local diffusion model. Fractional anisotropy (FA), apparent diffusion coefficient (ADC) and complexity (CX) maps were generated. CX was defined as a novel diffusion metric. On the basis of those three parameters, the Gini coefficient was calculated.

RESULTS

Study of fetal brain development in postmortem specimens was feasible using DWI. The Gini coefficient could be calculated for the combination of the three diffusion parameters. This multidimensional Gini coefficient correlated well with age (Adjusted R(2) = 0.59) between the ages of 17 and 26 gestational weeks.

CONCLUSIONS

We propose a new method that uses an economics concept, the Gini coefficient, to describe the whole brain with one simple and intuitive measure, which can be used to assess the brain's developmental state.

"Modeling ancient Egyptian embalming": radiological assessment of experimentally mummified human tissue by CT and MRI

OBJECTIVE

To assess changes in different tissues during the process of artificial mummification by natron using computed tomography (CT) and magnetic resonance imaging (MRI), and to translate the results to image interpretation in paleoradiological studies of ancient mummies.

MATERIALS AND METHODS

A human lower limb (LL) was amputated from a female donor 24 h post-mortem and mummified by artificial natron (54 % NaCl, 16 % Na2SO4, 18 % Na2CO3 12 % NaHCO3) in ancient Egyptian style. The LL was kept in a fume hood at 16-25 °C and 30-75 % relative humidity. CT and MRI were performed at specific intervals with quantitative evaluation of Hounsfield units (HU) and signal intensities (SI).

RESULTS

Evaluated tissues showed different HU and SI changes during the experimental mummification. All tissues revealed an overall but varying increase of HU in CT examinations. All tissues except for the compact bone revealed an overall but varying decrease of SI in the IR and T2-weighted sequences of the MRI. Typical findings included a distinct increase of HU in the cutis at the end of the study and a temporary increase of SI in the IR and T2-weighted sequences in all muscle groups.

CONCLUSIONS

Radiological findings showed a regular, controlled and effective dehydration by the applied natron without detectable putrefaction. Evaluated tissues revealed different radiological changes during the experiment, which altogether led to preservation of the tissues without radiologically identifiable destruction. The cutis revealed radiological signs of direct interaction with the natron in the form of covering and possibly permeation.

Imaging in anatomy: a comparison of imaging techniques in embalmed human cadavers

BACKGROUND

A large variety of imaging techniques is an integral part of modern medicine. Introducing radiological imaging techniques into the dissection course serves as a basis for improved learning of anatomy and multidisciplinary learning in pre-clinical medical education.

METHODS

Four different imaging techniques (ultrasound, radiography, computed tomography, and magnetic resonance imaging) were performed in embalmed human body donors to analyse possibilities and limitations of the respective techniques in this peculiar setting.

RESULTS

The quality of ultrasound and radiography images was poor, images of computed tomography and magnetic resonance imaging were of good quality.

CONCLUSION

Computed tomography and magnetic resonance imaging have a superior image quality in comparison to ultrasound and radiography and offer suitable methods for imaging embalmed human cadavers as a valuable addition to the dissection course.