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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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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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Bécam J, Ropars G, Dwiri FA, Brunaud C, Toutain J, Chazalviel L, Naveau M, Valable S, Bernaudin M, Touzani O, Pérès EA. Physical Activity Attenuates Brain Irradiation-Associated Skeletal Muscle Damage in the Rat. Int J Radiat Oncol Biol Phys 2024; 118:1081-1093. [PMID: 37866760 DOI: 10.1016/j.ijrobp.2023.10.007] [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: 06/23/2023] [Revised: 09/09/2023] [Accepted: 10/08/2023] [Indexed: 10/24/2023]
Abstract
PURPOSE Radiation therapy for brain tumors increases patient survival. Nonetheless, side effects are increasingly reported such as cognitive deficits and fatigue. The etiology of fatigue remains poorly described. Our hypothesis is that the abscopal effects of radiation therapy on skeletal muscle may be involved in fatigue. The present study aims to assess the effect of brain irradiation on skeletal muscles and its relationship with fatigue and to analyze whether physical activity could counteract brain radiation-induced side effects. METHODS AND MATERIALS Adult Wistar rats were randomly distributed between 4 groups: control (CTL), irradiated (IR), nonirradiated with physical activity (PA), and irradiated with physical activity (IR+PA). IR rats were exposed to a whole-brain irradiation (WBI) of 30 Gy (3 × 10 Gy). Rats subjected to PA underwent sessions of running on a treadmill, 3 times/week for 6 months. The effects of WBI on muscles were evaluated by complementary approaches: behavioral tests (fatigue, locomotion activity), magnetic resonance imaging, and histologic analyses. RESULTS IR rats displayed a significant fatigue and a reduced locomotor activity at short term compared with the CTL group, which were attenuated with PA at 6 months after WBI. The IR rat's gastrocnemius mass decreased compared with CTL rats, which was reversed by physical activity at 14 days after WBI. Multiparametric magnetic resonance imaging of the skeletal muscle highlighted an alteration of the fiber organization in IR rats as demonstrated by a significant decrease of the mean diffusivity in the gastrocnemius at short term. Alteration of fibers was confirmed by histologic analyses: the number of type I fibers was decreased, whereas that of type IIa fibers was increased in IR animals but not in the IR+PA group. CONCLUSIONS The data show that WBI induces skeletal muscle damage, which is attenuated by PA. This muscle damage may explain, at least in part, the fatigue of patients treated with radiation therapy.
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Affiliation(s)
- Julie Bécam
- Université de Caen Normandie, CNRS, Normandie Université, ISTCT, UMR6030, GIP Cyceron, F-14000 Caen, France
| | - Gwenn Ropars
- Université de Caen Normandie, CNRS, Normandie Université, ISTCT, UMR6030, GIP Cyceron, F-14000 Caen, France
| | - Fatima-Azzahra Dwiri
- Université de Caen Normandie, CNRS, Normandie Université, ISTCT, UMR6030, GIP Cyceron, F-14000 Caen, France
| | - Carole Brunaud
- Université de Caen Normandie, CNRS, Normandie Université, ISTCT, UMR6030, GIP Cyceron, F-14000 Caen, France
| | - Jérôme Toutain
- Université de Caen Normandie, CNRS, Normandie Université, ISTCT, UMR6030, GIP Cyceron, F-14000 Caen, France
| | - Laurent Chazalviel
- Université de Caen Normandie, CNRS, Normandie Université, ISTCT, UMR6030, GIP Cyceron, F-14000 Caen, France
| | - Mikaël Naveau
- Université de Caen Normandie, CNRS, INSERM, CEA, Normandie Université, UAR3408/US50, Cyceron, GIP Cyceron, F-14000 Caen, France
| | - Samuel Valable
- Université de Caen Normandie, CNRS, Normandie Université, ISTCT, UMR6030, GIP Cyceron, F-14000 Caen, France
| | - Myriam Bernaudin
- Université de Caen Normandie, CNRS, Normandie Université, ISTCT, UMR6030, GIP Cyceron, F-14000 Caen, France
| | - Omar Touzani
- Université de Caen Normandie, CNRS, Normandie Université, ISTCT, UMR6030, GIP Cyceron, F-14000 Caen, France
| | - Elodie Anne Pérès
- Université de Caen Normandie, CNRS, Normandie Université, ISTCT, UMR6030, GIP Cyceron, F-14000 Caen, France.
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Wille CM, Hurley SA, Joachim MR, Lee K, Kijowski R, Heiderscheit BC. Association of quantitative diffusion tensor imaging measures with time to return to sport and reinjury incidence following acute hamstring strain injury. J Biomech 2024; 163:111960. [PMID: 38290304 PMCID: PMC10923138 DOI: 10.1016/j.jbiomech.2024.111960] [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: 05/17/2023] [Revised: 01/03/2024] [Accepted: 01/19/2024] [Indexed: 02/01/2024]
Abstract
Hamstring strain injuries (HSI) are a common occurrence in athletics and complicated by limited prognostic indicators and high rates of reinjury. Assessment of injury characteristics at the time of injury (TOI) may be used to manage athlete expectations for time to return to sport (RTS) and mitigate reinjury risk. Magnetic resonance imaging (MRI) is routinely used in soft tissue injury management, but its prognostic value for HSI is widely debated. Recent advancements in musculoskeletal MRI, such as diffusion tensor imaging (DTI), have allowed for quantitative measures of muscle microstructure assessment. The purpose of this study was to determine the association of TOI MRI-based measures, including the British Athletic Muscle Injury Classification (BAMIC) system, edema volume, and DTI metrics, with time to RTS and reinjury incidence. Negative binomial regressions and generalized estimating equations were used to determine relationships between imaging measures and time to RTS and reinjury, respectively. Twenty-six index injuries were observed, with five recorded reinjuries. A significant association was not detected between BAMIC score and edema volume at TOI with days to RTS (p-values ≥ 0.15) or reinjury (p-values ≥ 0.13). Similarly, a significant association between DTI metrics and days to RTS was not detected (p-values ≥ 0.11). Although diffusivity metrics are expected to increase following injury, decreased values were observed in those who reinjured (mean diffusivity, p = 0.016; radial diffusivity, p = 0.02; principal effective diffusivity eigenvalues, p-values = 0.007-0.057). Additional work to further understand the directional relationship observed between DTI metrics and reinjury status and the influence of external factors is warranted.
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Affiliation(s)
- Christa M Wille
- Department of Orthopedics and Rehabilitation, University of Wisconsin-Madison, Madison, WI, the United States of America; Department of Biomedical Engineering, University of Wisconsin-Madison, Madison, WI, the United States of America; Badger Athletic Performance Program, University of Wisconsin-Madison, Madison, WI, the United States of America
| | - Samuel A Hurley
- Department of Radiology, University of Wisconsin-Madison, Madison, WI, the United States of America
| | - Mikel R Joachim
- Department of Orthopedics and Rehabilitation, University of Wisconsin-Madison, Madison, WI, the United States of America; Badger Athletic Performance Program, University of Wisconsin-Madison, Madison, WI, the United States of America
| | - Kenneth Lee
- Department of Radiology, University of Wisconsin-Madison, Madison, WI, the United States of America
| | - Richard Kijowski
- Department of Radiology, NYU Grossman School of Medicine, New York, NY, the United States of America
| | - Bryan C Heiderscheit
- Department of Orthopedics and Rehabilitation, University of Wisconsin-Madison, Madison, WI, the United States of America; Department of Biomedical Engineering, University of Wisconsin-Madison, Madison, WI, the United States of America; Badger Athletic Performance Program, University of Wisconsin-Madison, Madison, WI, the United States of America.
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Engelke K, Chaudry O, Gast L, Eldib MAB, Wang L, Laredo JD, Schett G, Nagel AM. Magnetic resonance imaging techniques for the quantitative analysis of skeletal muscle: State of the art. J Orthop Translat 2023; 42:57-72. [PMID: 37654433 PMCID: PMC10465967 DOI: 10.1016/j.jot.2023.07.005] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/17/2023] [Revised: 07/04/2023] [Accepted: 07/19/2023] [Indexed: 09/02/2023] Open
Abstract
Background Magnetic resonance imaging (MRI) is the dominant 3D imaging modality to quantify muscle properties in skeletal muscle disorders, in inherited and acquired muscle diseases, and in sarcopenia, in cachexia and frailty. Methods This review covers T1 weighted and Dixon sequences, introduces T2 mapping, diffusion tensor imaging (DTI) and non-proton MRI. Technical concepts, strengths, limitations and translational aspects of these techniques are discussed in detail. Examples of clinical applications are outlined. For comparison 31P-and 13C-MR Spectroscopy are also addressed. Results MRI technology provides a rich toolset to assess muscle deterioration. In addition to classical measures such as muscle atrophy using T1 weighted imaging and fat infiltration using Dixon sequences, parameters characterizing inflammation from T2 maps, tissue sodium using non-proton MRI techniques or concentration or fiber architecture using diffusion tensor imaging may be useful for an even earlier diagnosis of the impairment of muscle quality. Conclusion Quantitative MRI provides new options for muscle research and clinical applications. Current limitations that also impair its more widespread use in clinical trials are lack of standardization, ambiguity of image segmentation and analysis approaches, a multitude of outcome parameters without a clear strategy which ones to use and the lack of normal data.
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Affiliation(s)
- Klaus Engelke
- Department of Medicine III, Friedrich-Alexander University of Erlangen-Nürnberg, University Hospital Erlangen, Ulmenweg 18, 91054, Erlangen, Germany
- Institute of Medical Physics (IMP), Friedrich-Alexander-Universität Erlangen-Nürnberg (FAU), Henkestr. 91, 91052, Erlangen, Germany
- Clario Inc, Germany
| | - Oliver Chaudry
- Department of Medicine III, Friedrich-Alexander University of Erlangen-Nürnberg, University Hospital Erlangen, Ulmenweg 18, 91054, Erlangen, Germany
| | - Lena Gast
- Institute of Radiology, Friedrich-Alexander-Universität Erlangen-Nürnberg (FAU), University Hospital Erlangen, Maximiliansplatz 3, 91054, Erlangen, Germany
| | | | - Ling Wang
- Department of Radiology, Beijing Jishuitan Hospital, Beijing, China
| | - Jean-Denis Laredo
- Service d’Imagerie Médicale, Institut Mutualiste Montsouris & B3OA, UMR CNRS 7052, Inserm U1271 Université de Paris-Cité, Paris, France
| | - Georg Schett
- Department of Medicine III, Friedrich-Alexander University of Erlangen-Nürnberg, University Hospital Erlangen, Ulmenweg 18, 91054, Erlangen, Germany
| | - Armin M. Nagel
- Institute of Radiology, Friedrich-Alexander-Universität Erlangen-Nürnberg (FAU), University Hospital Erlangen, Maximiliansplatz 3, 91054, Erlangen, Germany
- Division of Medical Physics in Radiology, German Cancer Research Center (DKFZ), Im Neuenheimer Feld 280, 69120, Heidelberg, Germany
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Martín-Noguerol T, Barousse R, Wessell DE, Rossi I, Luna A. Clinical applications of skeletal muscle diffusion tensor imaging. Skeletal Radiol 2023; 52:1639-1649. [PMID: 37083977 DOI: 10.1007/s00256-023-04350-3] [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: 02/06/2023] [Revised: 04/16/2023] [Accepted: 04/17/2023] [Indexed: 04/22/2023]
Abstract
Diffusion tensor imaging (DTI) may allow the determination of new threshold values, based on water anisotropy, to differentiate between healthy muscle and various pathological processes. Additionally, it may quantify treatment monitoring or training effects. Most current studies have evaluated the potential of DTI of skeletal muscle to assess sports-related injuries or therapy, and training monitoring. Another critical area of application of this technique is the characterization and monitoring of primary and secondary myopathies. In this manuscript, we review the application of DTI in the evaluation of skeletal muscle in these and other novel clinical scenarios, with emphasis on the use of quantitative imaging-derived biomarkers. Finally, the main limitations of the introduction of DTI in the clinical setting and potential areas of future use are discussed.
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Affiliation(s)
| | | | | | | | - Antonio Luna
- MRI Unit, Radiology Department, HT Médica, Jaén, Spain
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Giraudo C, Modugno A, Negro G, Dell'Amore A, Cecchin D, Motta R, Balestro E, Boscolo A, Calabrese F, Faccioli E, Navalesi P, Vianello A, Rea F, Stramare R. Radiomics of spinal muscles: toward a radiological biomarker for allograft rejection in lung transplant. LA RADIOLOGIA MEDICA 2023; 128:1070-1078. [PMID: 37458906 PMCID: PMC10474186 DOI: 10.1007/s11547-023-01674-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/09/2022] [Accepted: 06/29/2023] [Indexed: 09/02/2023]
Abstract
PURPOSE To assess the role of muscle composition and radiomics in predicting allograft rejection in lung transplant. MATERIAL AND METHODS The last available HRCT before surgery of lung transplant candidates referring to our tertiary center from January 2010 to February 2020 was retrospectively examined. Only scans with B30 kernel reconstructions and 1 mm slice thickness were included. One radiologist segmented the spinal muscles of each patient at the level of the 11th dorsal vertebra by an open-source software. The same software was used to extract Hu values and 72 radiomic features of first and second order. Factor analysis was applied to select highly correlating features and then their prognostic value for allograft rejection was investigated by logistic regression analysis (level of significance p < 0.05). In case of significant results, the diagnostic value of the model was computed by ROC curves. RESULTS Overall 200 patients had a HRCT prior to the transplant but only 97 matched the inclusion criteria (29 women; mean age 50.4 ± 13 years old). Twenty-one patients showed allograft rejection. The following features were selected by the factor analysis: cluster prominence, Imc2, gray level non-uniformity normalized, median, kurtosis, gray level non-uniformity, and inverse variance. The radiomic-based model including also Hu demonstrated that only the feature Imc2 acts as a predictor of allograft rejection (p = 0.021). The model showed 76.6% accuracy and the Imc2 value of 0.19 demonstrated 81% sensitivity and 64.5% specificity in predicting lung transplant rejection. CONCLUSION The radiomic feature Imc2 demonstrated to be a predictor of allograft rejection in lung transplant.
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Affiliation(s)
- Chiara Giraudo
- Unit of Advanced Clinical and Translational Imaging, Department of Medicine - DIMED, University of Padova, Padua, Italy.
| | - Antonella Modugno
- Unit of Advanced Clinical and Translational Imaging, Department of Medicine - DIMED, University of Padova, Padua, Italy
| | - Giacomo Negro
- Unit of Advanced Clinical and Translational Imaging, Department of Medicine - DIMED, University of Padova, Padua, Italy
| | - Andrea Dell'Amore
- Thoracic Surgery Unit, Department of Cardiac, Thoracic, Vascular Sciences and Public Health, University of Padova, Padua, Italy
| | - Diego Cecchin
- Nuclear Medicine Unit, Department of Medicine - DIMED, University of Padova, Padua, Italy
| | - Raffaella Motta
- Unit of Advanced Clinical and Translational Imaging, Department of Medicine - DIMED, University of Padova, Padua, Italy
| | - Elisabetta Balestro
- Respiratory Disease Unit, Department of Cardiac, Thoracic, Vascular Sciences and Public Health, University of Padova, Padua, Italy
| | - Annalisa Boscolo
- Anesthesiology and Intensive Care Unit, Department of Medicine-DIMED, University of Padova, Padua, Italy
| | - Fiorella Calabrese
- Pathological Anatomy Section, Department of Cardiac, Thoracic, Vascular Sciences and Public Health, University of Padova, Padua, Italy
| | - Eleonora Faccioli
- Thoracic Surgery Unit, Department of Cardiac, Thoracic, Vascular Sciences and Public Health, University of Padova, Padua, Italy
| | - Paolo Navalesi
- Anesthesiology and Intensive Care Unit, Department of Medicine-DIMED, University of Padova, Padua, Italy
| | - Andrea Vianello
- Respiratory Pathophysiology Division, Department of Cardiac, Thoracic, Vascular Sciences and Public Health, University of Padova, Padua, Italy
| | - Federico Rea
- Thoracic Surgery Unit, Department of Cardiac, Thoracic, Vascular Sciences and Public Health, University of Padova, Padua, Italy
| | - Roberto Stramare
- Unit of Advanced Clinical and Translational Imaging, Department of Medicine - DIMED, University of Padova, Padua, Italy
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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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9
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Kvist O, Dorniok T, Sanmartin Berglund J, Nilsson O, Flodmark CE, Diaz S. DTI assessment of the maturing growth plate of the knee in adolescents and young adults. Eur J Radiol 2023; 162:110759. [PMID: 36931119 DOI: 10.1016/j.ejrad.2023.110759] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2022] [Revised: 02/13/2023] [Accepted: 02/23/2023] [Indexed: 03/09/2023]
Abstract
PURPOSE To assess the growth plates of the knee in a healthy population of young adults and adolescents using DTI, and to correlate the findings with chronological age and skeletal maturation. METHODS A prospective, cross-sectional study to assess the tibial and femoral growth plates with DTI in 155 healthy volunteers aged between 14.0 and 21 years old. Echo-planar DTI with 15 directions and b value of 0 and 600 s/mm2 was performed on a 3 T whole-body scanner. RESULTS A relationship was observed between chronological age and most DTI metrics (fractional anisotropy, mean diffusivity, and radial diffusivity), tract length and volume. (No significant relationship could be seen for axonal diffusivity and tract length.) Subdivision according to skeletal maturation showed the greatest tract lengths and volumes seen in stage 4b and not 4a. The intra-observer agreement was significant (P = 0.01) for all the measured variables, but agreement varied (femur 0.53 - 0.98; tibia 0.58 - 0.98). Spearman's correlation showed a significant correlation for age (P = 0.05; P = 0.01) as well as for the fractional anisotropy value within all variables in both femur and tibia. Tract number and volume had a similar correlation with most variables, especially the DTI metrics, and would seem to be interchangeable. CONCLUSION The current study indicates that DTI metrics could be a tool to assess the skeletal maturation process of the growth plate and its activity. Tractography seems promising to assess the activity of the growth plate in a younger population but must be used with caution in the more mature growth plate.
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Affiliation(s)
- Ola Kvist
- Department of Paediatric Radiology, Karolinska University Hospital, Stockholm, Sweden; Department of Women's and Children's Health, Karolinska Institute, Stockholm, Sweden.
| | - Torsten Dorniok
- Department of Medical Radiation Physics and Nuclear Medicine, Karolinska University Hospital, Stockholm, Sweden.
| | | | - Ola Nilsson
- Department of Women's and Children's Health, Karolinska Institute, Stockholm, Sweden; School of Medical Sciences and Department of Paediatrics, Örebro University and University Hospital, Örebro, Sweden.
| | - Carl-Erik Flodmark
- Department of Clinical Sciences in Malmö, Lunds University, Lund, Sweden.
| | - Sandra Diaz
- Department of Paediatric Radiology, Karolinska University Hospital, Stockholm, Sweden; Department of Women's and Children's Health, Karolinska Institute, Stockholm, Sweden; Department of Radiology, Lunds University, Lund, Sweden.
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10
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Carpenter RS, Samaan MA, Clasey JL, Butterfield TA, Gao F, Hardy PA, Bollinger LM. Association of vastus lateralis diffusion properties with in vivo quadriceps contractile function in premenopausal women. Scand J Med Sci Sports 2023; 33:213-223. [PMID: 36337008 PMCID: PMC9928607 DOI: 10.1111/sms.14266] [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: 03/24/2022] [Revised: 09/10/2022] [Accepted: 10/23/2022] [Indexed: 11/09/2022]
Abstract
BACKGROUND Diffusion tensor imaging (DTI) parameters correlate with muscle fiber composition, but it is unclear how these relate to in vivo contractile function. PURPOSE To determine the relationship between DTI parameters of the vastus lateralis (VL) and in vivo knee extensor contractile. METHODS Thirteen healthy, premenopausal women underwent magnetic resonance imaging of the mid-thigh to determine patellar tendon moment arm length and quadriceps cross-sectional area. Fractional anisotropy (FA), mean diffusivity (MD), axial diffusivity (AD), and radial diffusivity (RD) of the VL were determined using diffusion tensor imaging (DTI). Participants underwent an interpolated twitch (ITT) experiment before and after a fatiguing concentric-eccentric isokinetic knee extension (60°·s-1 ). During the ITT, supramaximal electrical stimuli were delivered to elicit twitch responses from the knee extensors before, during, and after a maximal voluntary isometric contraction (MVIC). Knee extensor-specific tension during twitch and MVIC were calculated from isometric torque data. Pearson's correlations were used to determine the relationship between muscle contractile properties and DTI parameters. RESULTS MD and RD were moderately correlated with peak twitch force and rate of force development. FA and AD were moderately inversely related to percent change in MVIC following exercise. CONCLUSION MD and RD are associated with in vivo quadriceps twitch properties but not voluntary strength, which may reflect the mechanical properties of constituent fiber types. FA and AD appear to relate to MVIC strength following fatiguing exercise.
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Affiliation(s)
- Rebekah S Carpenter
- Department of Kinesiology and Health Promotion, University of Kentucky, Lexington, Kentucky, USA
| | - Michael A Samaan
- Department of Kinesiology and Health Promotion, University of Kentucky, Lexington, Kentucky, USA
| | - Jody L Clasey
- Department of Kinesiology and Health Promotion, University of Kentucky, Lexington, Kentucky, USA
- Center for Muscle Biology, University of Kentucky, Lexington, Kentucky, USA
- Body Composition Core Laboratory, University of Kentucky, Lexington, Kentucky, USA
| | - Tim A Butterfield
- Center for Muscle Biology, University of Kentucky, Lexington, Kentucky, USA
- Department of Athletic Training, University of Kentucky, Lexington, Kentucky, USA
| | - Fan Gao
- Department of Kinesiology and Health Promotion, University of Kentucky, Lexington, Kentucky, USA
| | - Peter A Hardy
- Department of Radiology, University of Kentucky, Lexington, Kentucky, USA
- Magnetic Resonance Imaging and Spectroscopy Center, University of Kentucky, Lexington, Kentucky, USA
| | - Lance M Bollinger
- Department of Kinesiology and Health Promotion, University of Kentucky, Lexington, Kentucky, USA
- Center for Muscle Biology, University of Kentucky, Lexington, Kentucky, USA
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11
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Rau A, Jungmann PM, Diallo TD, Reisert M, Kellner E, Eisenblaetter M, Bamberg F, Jung M. Application of diffusion microstructure imaging in musculoskeletal radiology - translation from head to shoulders. Eur Radiol 2023; 33:1565-1574. [PMID: 36307552 PMCID: PMC9935724 DOI: 10.1007/s00330-022-09202-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2022] [Revised: 09/14/2022] [Accepted: 09/25/2022] [Indexed: 11/25/2022]
Abstract
OBJECTIVES Quantitative MRI techniques, such as diffusion microstructure imaging (DMI), are increasingly applied for advanced tissue characterization. We determined its value in rotator cuff (RC) muscle imaging by studying the association of DMI parameters to isometric strength and fat fraction (FF). METHODS Healthy individuals prospectively underwent 3T-MRI of the shoulder using DMI and chemical shift encoding-based water-fat imaging. RC muscles were segmented and quantitative MRI metrics (V-ISO, free fluid; V-intra, compartment inside of muscle fibers; V-extra, compartment outside of muscle fibers, and FF) were extracted. Isometric shoulder strength was quantified using specific clinical tests. Sex-related differences were assessed with Student's t. Association of DMI-metrics, FF, and strength was tested. A factorial two-way ANOVA was performed to compare the main effects of sex and external/internal strength-ratio and their interaction effects on quantitative imaging parameters ratios of infraspinatus/subscapularis. RESULTS Among 22 participants (mean age: 26.7 ± 3.1 years, 50% female, mean BMI: 22.6 ± 1.9 kg/m2), FF of the individual RC muscles did not correlate with strength or DMI parameters (all p > 0.05). Subjects with higher V-intra (r = 0.57 to 0.87, p < 0.01) and lower V-ISO (r = -0.6 to -0.88, p < 0.01) had higher internal and external rotation strength. Moreover, V-intra was higher and V-ISO was lower in all RC muscles in males compared to female subjects (all p < 0.01). There was a sex-independent association of external/internal strength-ratio with the ratio of V-extra of infraspinatus/subscapularis (p = 0.02). CONCLUSIONS Quantitative DMI parameters may provide incremental information about muscular function and microstructure in young athletes and may serve as a potential biomarker. KEY POINTS • Diffusion microstructure imaging was successfully applied to non-invasively assess the microstructure of rotator cuff muscles in healthy volunteers. • Sex-related differences in the microstructural composition of the rotator cuff were observed. • Muscular microstructural metrics correlated with rotator cuff strength and may serve as an imaging biomarker of muscular integrity and function.
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Affiliation(s)
- Alexander Rau
- Department of Diagnostic and Interventional Radiology, Medical Center, University of Freiburg, Faculty of Medicine, University of Freiburg, Breisacher Str. 64, 79106, Freiburg, Germany.
- Department of Neuroradiology, Medical Center, University of Freiburg, Faculty of Medicine, University of Freiburg, 79106, Freiburg, Germany.
| | - Pia M Jungmann
- Department of Diagnostic and Interventional Radiology, Medical Center, University of Freiburg, Faculty of Medicine, University of Freiburg, Breisacher Str. 64, 79106, Freiburg, Germany
| | - Thierno D Diallo
- Department of Diagnostic and Interventional Radiology, Medical Center, University of Freiburg, Faculty of Medicine, University of Freiburg, Breisacher Str. 64, 79106, Freiburg, Germany
| | - Marco Reisert
- Medical Physics, Department of Diagnostic and Interventional Radiology, Medical Center, University of Freiburg, Faculty of Medicine, University of Freiburg, 79106, Freiburg, Germany
- Department of Stereotactic and Functional Neurosurgery, Medical Center, University of Freiburg, Faculty of Medicine, University of Freiburg, 79106, Freiburg, Germany
| | - Elias Kellner
- Medical Physics, Department of Diagnostic and Interventional Radiology, Medical Center, University of Freiburg, Faculty of Medicine, University of Freiburg, 79106, Freiburg, Germany
| | - Michel Eisenblaetter
- Department of Diagnostic and Interventional Radiology, Medical Center, University of Freiburg, Faculty of Medicine, University of Freiburg, Breisacher Str. 64, 79106, Freiburg, Germany
| | - Fabian Bamberg
- Department of Diagnostic and Interventional Radiology, Medical Center, University of Freiburg, Faculty of Medicine, University of Freiburg, Breisacher Str. 64, 79106, Freiburg, Germany
| | - Matthias Jung
- Department of Diagnostic and Interventional Radiology, Medical Center, University of Freiburg, Faculty of Medicine, University of Freiburg, Breisacher Str. 64, 79106, Freiburg, Germany
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12
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Martín-Noguerol T, Barousse R, Wessell DE, Rossi I, Luna A. A handbook for beginners in skeletal muscle diffusion tensor imaging: physical basis and technical adjustments. Eur Radiol 2022; 32:7623-7631. [PMID: 35554647 DOI: 10.1007/s00330-022-08837-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2021] [Revised: 04/09/2022] [Accepted: 04/14/2022] [Indexed: 01/03/2023]
Abstract
Magnetic resonance imaging (MRI) of skeletal muscle is routinely performed using morphological sequences to acquire anatomical information. Recently, there is an increasing interest in applying advanced MRI techniques that provide pathophysiologic information for skeletal muscle evaluation to complement standard morphologic information. Among these advanced techniques, diffusion tensor imaging (DTI) has emerged as a potential tool to explore muscle microstructure. DTI can noninvasively assess the movement of water molecules in well-organized tissues with anisotropic diffusion, such as skeletal muscle. The acquisition of DTI studies for skeletal muscle assessment requires specific technical adjustments. Besides, knowledge of DTI physical basis and skeletal muscle physiopathology facilitates the evaluation of this advanced sequence and both image and parameter interpretation. Parameters derived from DTI provide a quantitative assessment of muscle microstructure with potential to become imaging biomarkers of normal and pathological skeletal muscle. KEY POINTS: • Diffusion tensor imaging (DTI) allows to evaluate the three-dimensional movement of water molecules inside biological tissues. • The skeletal muscle structure makes it suitable for being evaluated with DTI. • Several technical adjustments have to be considered for obtaining robust and reproducible DTI studies for skeletal muscle assessment, minimizing potential artifacts.
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Affiliation(s)
- Teodoro Martín-Noguerol
- MRI Section, Radiology Department, SERCOSA, HT Médica, Carmelo Torres 2, 23007, Jaén, Spain.
| | | | | | | | - Antonio Luna
- MRI Section, Radiology Department, SERCOSA, HT Médica, Carmelo Torres 2, 23007, Jaén, Spain
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13
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Evans V, Behr M, Gangwar A, Noseworthy MD, Kumbhare D. Potential Role of MRI Imaging for Myofascial Pain: A Scoping Review for the Clinicians and Theoretical Considerations. J Pain Res 2021; 14:1505-1514. [PMID: 34079365 PMCID: PMC8166277 DOI: 10.2147/jpr.s302683] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2021] [Accepted: 04/28/2021] [Indexed: 12/24/2022] Open
Abstract
The most common cause of chronic musculoskeletal pain is chronic myofascial pain syndrome (MPS). MPS often presents with increased muscle stiffness, and the myofascial trigger point (MTrP). Imaging modalities have been used to identify the MTrP, but their role in the detection and diagnosis of MPS remains unclear. The purpose of this review was to identify evidence in literature for the use of imaging in the role of classifying and explaining the physiology of MTrPs. Since few imaging techniques have been performed on MTrPs, we explored the imaging techniques that can effectively image complex skeletal muscle microstructure, and how they could be used. As part of a scoping review, we conducted a systematic search from three medical databases (CINAHL, EMBASE and MEDLINE) from year to year to analyze past MTrP imaging, as well as analyzing imaging techniques performed on the microstructure of muscle. Previously, ultrasound has been used to differentiate active, latent MTrPs, but these studies do not adequately address their underlying anatomical structure. MRI remains the standard method of imaging skeletal muscle. The existing MRI literature suggests that the DTI technique can quantify muscle injury, strain, and structure. However, theoretically, HARDI and DKI techniques seem to provide more information for complex structural areas, although these modalities have a disadvantage of longer scan times and have not been widely used on skeletal muscle. Our review suggests that DTI is the most effective imaging modality that has been used to define the microstructure of muscle and hence, could be optimal to image the MTrP. HARDI and DKI are techniques with theoretical potential for analysis of muscle, which may provide more detailed information representative of finer muscle structural features. Future research utilizing MRI techniques to image muscle are necessary to provide a more robust means of imaging skeletal muscle and the MTrP.
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Affiliation(s)
- Valerie Evans
- Institute of Biomaterials and Biomedical Engineering (IBBME), University of Toronto, Toronto, Ontario, Canada.,University Health Network - Toronto Rehabilitation Institute, Toronto, Ontario, Canada
| | - Michael Behr
- University Health Network - Toronto Rehabilitation Institute, Toronto, Ontario, Canada.,Department of Medicine, Division of Physical Medicine and Rehabilitation, University of Toronto, Toronto, Ontario, Canada
| | - Anshika Gangwar
- University Health Network - Toronto Rehabilitation Institute, Toronto, Ontario, Canada
| | - Michael D Noseworthy
- Department of Electrical and Computer Engineering, McMaster University, Hamilton, Ontario, Canada
| | - Dinesh Kumbhare
- Institute of Biomaterials and Biomedical Engineering (IBBME), University of Toronto, Toronto, Ontario, Canada.,University Health Network - Toronto Rehabilitation Institute, Toronto, Ontario, Canada.,Department of Medicine, Division of Physical Medicine and Rehabilitation, University of Toronto, Toronto, Ontario, Canada
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14
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Gao Y, Lu Z, Lyu X, Liu Q, Pan S. A Longitudinal Study of T2 Mapping Combined With Diffusion Tensor Imaging to Quantitatively Evaluate Tissue Repair of Rat Skeletal Muscle After Frostbite. Front Physiol 2021; 11:597638. [PMID: 33569011 PMCID: PMC7868413 DOI: 10.3389/fphys.2020.597638] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2020] [Accepted: 12/30/2020] [Indexed: 11/30/2022] Open
Abstract
Purpose: T2 mapping and diffusion tensor imaging (DTI) enable the detection of changes in the skeletal muscle microenvironment. We assessed T2 relaxation times, DTI metrics, performed histological characterization of frostbite-induced skeletal muscle injury and repair, and provided diagnostic imaging biomarkers. Design and Methods: Thirty-six Sprague Dawley rats (200 ± 10 g) were obtained. Thirty rats were used for establishing a skeletal muscle frostbite model, and six were untreated controls. Functional MR sequences were performed on rats on days 0, 3, 5, 10, and 14 (n = 6 per time point). Rats were then sacrificed to obtain the quadriceps muscles. Tensor eigenvalues (λ1, λ2, and λ3), mean diffusivity (MD), fractional anisotropy (FA), and T2 values were compared between the frostbite model and control rats. ImageJ was used to measure the extracellular area fraction (EAF), muscle fiber cross-sectional area (fCSA), and skeletal muscle tumor necrosis factor α (TNF-α), and Myod1 expression. The correlation between the histological and imaging parameters of the frostbitten skeletal muscle was evaluated. Kolmogorov–Smirnoff test, Leven’s test, one-way ANOVA, and Spearman coefficient were used for analysis. Results: T2 relaxation time of frostbitten skeletal muscle was higher at all time points (p < 0.01). T2 relaxation time correlated with EAF, and TNF-α and Myod1 expression (r = 0.42, p < 0.05; r = 0.86, p < 0.01; r = 0.84, p < 0.01). The average tensor metrics (MD, λ1, λ2, and λ3) of skeletal muscle at 3 and 5 days of frostbite increased (p < 0.05), and fCSA correlated with λ1, λ2, and λ3, and MD (r = 0.65, p < 0.01; r = 0.48, p < 0.01; r = 0.52, p < 0.01; r = 0.62, p < 0.01). Conclusion: T2 mapping and DTI imaging detect frostbite-induced skeletal muscle injury early. This combined approach can quantitatively assess skeletal muscle repair and regeneration within 2 weeks of frostbite. Imaging biomarkers for the diagnosis of frostbite were suggested.
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Affiliation(s)
- Yue Gao
- Department of Radiology, Shengjing Hospital of China Medical University, Shenyang, China
| | - Zhao Lu
- Department of Radiology, Shengjing Hospital of China Medical University, Shenyang, China
| | - Xiaohong Lyu
- Department of Radiology, The First Affiliated Hospital of Jinzhou Medical University, Jinzhou, China
| | - Qiang Liu
- Department of Radiology, Shengjing Hospital of China Medical University, Shenyang, China
| | - Shinong Pan
- Department of Radiology, Shengjing Hospital of China Medical University, Shenyang, China
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15
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Biglands JD, Grainger AJ, Robinson P, Tanner SF, Tan AL, Feiweier T, Evans R, Emery P, O'Connor P. MRI in acute muscle tears in athletes: can quantitative T2 and DTI predict return to play better than visual assessment? Eur Radiol 2020; 30:6603-6613. [PMID: 32666321 PMCID: PMC7599135 DOI: 10.1007/s00330-020-06999-z] [Citation(s) in RCA: 21] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2020] [Revised: 04/14/2020] [Accepted: 06/03/2020] [Indexed: 11/05/2022]
Abstract
OBJECTIVES To assess the ability of quantitative T2, diffusion tensor imaging (DTI) and radiologist's scores to detect muscle changes following acute muscle tear in soccer and rugby players. To assess the ability of these parameters to predict return to play times. METHODS In this prospective, longitudinal study, 13 male athletes (age 19 to 34 years; mean 25 years) underwent MRI within 1 week of suffering acute muscle tear. Imaging included measurements of T2 and DTI parameters. Images were also assessed using modified Peetrons and British athletics muscle injury classification (BAMIC) scores. Participants returned for a second scan within 1 week of being determined fit to return to play. MRI measurements were compared between visits. Pearson's correlation between visit 1 measurements and return to play times was assessed. RESULTS There were significant differences between visits in BAMIC scores (Z = - 2.088; p = 0.037), modified Peetrons (Z = - 2.530; p = 0.011) and quantitative MRI measurements; T2, 13.12 ms (95% CI, 4.82 ms, 21.42 ms; p = 0.01); mean diffusivity (0.22 (0.04, 0.39); p = 0.02) and fractional anisotropy (0.07 (0.01, 0.14); p = 0.03). BAMIC scores showed a significant correlation with return to play time (Rs = 0.64; p = 0.02), but modified Peetrons scores and quantitative parameters did not. CONCLUSIONS T2 and DTI measurements in muscle can detect changes due to healing following muscle tear. Although BAMIC scores correlated well with return to play times, in this small study, quantitative MRI values did not, suggesting that T2 and DTI measurements are inferior predictors of return to play time compared with visual scoring. KEY POINTS • Muscle changes following acute muscle tear can be measured using T2 and diffusion measurements on MRI. • Measurements of T2 and diffusion using MRI are not as good as a radiologist's visual report at predicting return to play time after acute muscle tear.
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Affiliation(s)
- J D Biglands
- NIHR Leeds Biomedical Research Centre, Leeds Teaching Hospitals NHS Trust, Leeds, UK.
- Medical Physics and Engineering, Leeds Teaching Hospitals NHS Trust, Leeds, UK.
| | - A J Grainger
- NIHR Leeds Biomedical Research Centre, Leeds Teaching Hospitals NHS Trust, Leeds, UK
- Leeds Institute of Rheumatic and Musculoskeletal Medicine, Chapel Allerton Hospital, University of Leeds, Leeds, UK
| | - P Robinson
- NIHR Leeds Biomedical Research Centre, Leeds Teaching Hospitals NHS Trust, Leeds, UK
- Leeds Institute of Rheumatic and Musculoskeletal Medicine, Chapel Allerton Hospital, University of Leeds, Leeds, UK
| | - S F Tanner
- NIHR Leeds Biomedical Research Centre, Leeds Teaching Hospitals NHS Trust, Leeds, UK
- Medical Physics and Engineering, Leeds Teaching Hospitals NHS Trust, Leeds, UK
| | - A L Tan
- NIHR Leeds Biomedical Research Centre, Leeds Teaching Hospitals NHS Trust, Leeds, UK
- Leeds Institute of Rheumatic and Musculoskeletal Medicine, Chapel Allerton Hospital, University of Leeds, Leeds, UK
| | - T Feiweier
- Siemens Healthcare GmbH, Erlangen, Germany
| | - R Evans
- NIHR Leeds Biomedical Research Centre, Leeds Teaching Hospitals NHS Trust, Leeds, UK
| | - P Emery
- NIHR Leeds Biomedical Research Centre, Leeds Teaching Hospitals NHS Trust, Leeds, UK
- Leeds Institute of Rheumatic and Musculoskeletal Medicine, Chapel Allerton Hospital, University of Leeds, Leeds, UK
| | - P O'Connor
- NIHR Leeds Biomedical Research Centre, Leeds Teaching Hospitals NHS Trust, Leeds, UK
- Leeds Institute of Rheumatic and Musculoskeletal Medicine, Chapel Allerton Hospital, University of Leeds, Leeds, UK
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Giraudo C, Cavaliere A, Lupi A, Guglielmi G, Quaia E. Established paths and new avenues: a review of the main radiological techniques for investigating sarcopenia. Quant Imaging Med Surg 2020; 10:1602-1613. [PMID: 32742955 PMCID: PMC7378089 DOI: 10.21037/qims.2019.12.15] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2019] [Accepted: 12/19/2019] [Indexed: 12/18/2022]
Abstract
Sarcopenia is a clinical condition mainly affecting the elderly that can be associated in a long run with severe consequences like malnutrition and frailty. Considering the progressive ageing of the world population and the socio-economic impact of this disease, much effort is devoted and has to be further focused on an early and accurate diagnostic assessment of muscle loss. Currently, several radiological techniques can be applied for evaluating sarcopenia. If dual-energy X-ray absorptiometry (DXA) is still considered the main tool and it is even recommended as reference by the most current guidelines of the European working group on sarcopenia in older people (EWGSOP), the role of ultrasound (US), computed tomography (CT), peripheral quantitative CT (pQCT), and magnetic resonance imaging (MRI) should not be overlooked. Indeed, such techniques can provide robust qualitative and quantitative information. In particular, regarding MRI, the use of sequences like diffusion-weighted imaging (DWI), diffusion tensor imaging (DTI), magnetic resonance spectroscopy (MRS) and mapping that could provide further insights into the physiopathological features of sarcopenia, should be fostered. In an era pointing to the quantification and automatic evaluation of diseases, we call for future research extending the application of organ tailored protocols, taking advantage of the most recent technical developments.
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Affiliation(s)
- Chiara Giraudo
- Radiology Institute, Department of Medicine—DIMED, University of Padova, Padova, Italy
| | - Annachiara Cavaliere
- Radiology Institute, Department of Medicine—DIMED, University of Padova, Padova, Italy
| | - Amalia Lupi
- Radiology Institute, Department of Medicine—DIMED, University of Padova, Padova, Italy
| | - Giuseppe Guglielmi
- Department of Radiology, Scientific Institute “Casa Sollievo della Sofferenza” Hospital, University of Foggia, Foggia, Italy
| | - Emilio Quaia
- Radiology Institute, Department of Medicine—DIMED, University of Padova, Padova, Italy
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Peripheral arterial disease: the role of extracellular volume measurements in lower limb muscles with MRI. Eur Radiol 2020; 30:3943-3950. [PMID: 32166488 DOI: 10.1007/s00330-020-06730-y] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2019] [Revised: 02/01/2020] [Accepted: 02/06/2020] [Indexed: 12/25/2022]
Abstract
OBJECTIVES Peripheral arterial disease (PAD) is characterised by arterial occlusion and fibrosis in the lower extremities. Extracellular volume matrix fraction (ECV) is a biomarker of skeletal muscle fibrosis, but has not been applied to the lower extremities with PAD. This study investigated the clinical feasibility of using ECV for calf muscle fibrosis quantification by comparing normal controls (NC) and PAD patients. METHODS From October 2016 to December 2017, we recruited patients with PAD, and patients with head and neck cancer receiving fibular flap as NC group. All participants underwent magnetic resonance imaging (MRI) to determine the ECV of the calves and the differences between the NC and PAD groups. ECV was calculated from T1 values at steady-state equilibrium, defined as the point in time after contrast agent injection when the variance of T1 relaxation time in blood and muscle becomes less than 5%. RESULTS A total of 46 patients (18 in the NC group and 28 in the PAD group) were recruited. Steady-state equilibrium was reached at 11-12 min after contrast agent injection. The NC group had significantly lower mean ECV than the PAD group (12.71% vs. 31.92%, respectively, p < 0.001). In the PAD group, the mean ECV was slightly lower in patients with collateral vessels than in those without (26.58% vs. 34.88%, respectively, p = 0.047). CONCLUSION Evaluation of skeletal fibrosis in PAD using ECV is feasible. ECV can help identify PAD patients with collateral vessel formation and lay the foundation for future research in PAD management. KEY POINTS • Steady-state equilibrium for ECV measurement of the lower limbs can be reached at around 11-12 min. • Quantification of lower limb muscle fibrosis by measuring ECV is clinically feasible and can be used to differentiate between patients with PAD and histologically proven normal controls. • ECV can differentiate PAD patients with or without visible collateral vessels, further expanding its role in identifying the presence of collateral supply in clinical decision-making.
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Flores Quispe SKJ, Cavaliere A, Weber M, Stramare R, Zuliani M, Quaia E, Zulian F, Giraudo C. Sarcopenia in juvenile localized scleroderma: new insights on deep involvement. Eur Radiol 2020; 30:4091-4097. [PMID: 32144460 DOI: 10.1007/s00330-020-06764-2] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2019] [Revised: 02/13/2020] [Accepted: 02/19/2020] [Indexed: 11/26/2022]
Abstract
OBJECTIVES Juvenile localized scleroderma (JLS) is a rare chronic autoimmune disease which can also affect bones and muscles. Nevertheless, muscle loss was not previously investigated in patients with JLS. Thus, the aim of this study was to retrospectively evaluate deep involvement and assess and quantify sarcopenia in JLS patients using magnetic resonance imaging (MRI). METHODS Fourteen children with JLS (nine females, mean age ± SD, 7.1 ± 3.6 years) referring to our tertiary center from January 2012 to January 2018 who underwent at least one MRI examination including axial T1-weighted and short tau inversion recovery images were included. Two readers assessed in consensus superficial and deep involvement. Muscle edema, muscle fatty infiltration, and sarcopenia were independently scored (absent, moderate, or severe) and the Cohen's kappa coefficient computed. Skin perimeter, subcutaneous area, muscle area, and muscle volume were independently measured using the contralateral unaffected extremity as reference (paired Student's t test, p < 0.05). The intraclass correlation coefficient (ICC) was used to investigate the reliability of the measurements. RESULTS All patients showed superficial involvement with subcutaneous fat atrophy being the most common finding (13 patients). Bone marrow edema occurred in five patients. Muscle edema affected ten children (moderate in seven, severe in three; k = 0.89), muscle fatty replacement occurred in one case (severe; k = 1.00), and sarcopenia was detected in eight patients (severe in two; k = 0.78). All quantitative parameters were lower on the affected side than on the unaffected contralateral limb (p < 0.05, each) and all measurements showed a high reliability (ICC > 0.750, each). CONCLUSION Patients with JLS can be affected by sarcopenia and quantitative analyses allow a robust characterization of such finding. KEY POINTS • Deep involvement in juvenile localized scleroderma is frequently characterized by sarcopenia. • In juvenile localized scleroderma, muscle edema and sarcopenia are mostly moderate while fatty infiltration, even if rare, can be severe. • Sarcopenia can be reliably quantified in children with juvenile localized scleroderma using MRI.
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Affiliation(s)
| | - Annachiara Cavaliere
- Department of Medicine - DIMED, Radiology Institute, University of Padova, Via Giustiniani 2, 35100, Padua, Italy
| | - Michael Weber
- Department of Biomedical Imaging and Image-guided Therapy, Medical University of Vienna, Vienna, Austria
| | - Roberto Stramare
- Department of Medicine - DIMED, Radiology Institute, University of Padova, Via Giustiniani 2, 35100, Padua, Italy
| | - Monica Zuliani
- Department of Medicine - DIMED, Radiology Institute, University of Padova, Via Giustiniani 2, 35100, Padua, Italy
| | - Emilio Quaia
- Department of Medicine - DIMED, Radiology Institute, University of Padova, Via Giustiniani 2, 35100, Padua, Italy
| | | | - Chiara Giraudo
- Department of Medicine - DIMED, Radiology Institute, University of Padova, Via Giustiniani 2, 35100, Padua, Italy.
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Diffusion tensor imaging combined with T2 mapping to quantify changes in the skeletal muscle associated with training and endurance exercise in competitive triathletes. Eur Radiol 2020; 30:2830-2842. [PMID: 31953666 DOI: 10.1007/s00330-019-06576-z] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2019] [Revised: 11/01/2019] [Accepted: 11/06/2019] [Indexed: 10/25/2022]
Abstract
OBJECTIVES Diffusion tensor magnetic resonance imaging (DTI) and T2 mapping enable the detection of exercise-induced changes in the skeletal muscle microenvironment. This study prospectively quantified DTI metrics and T2 relaxation times of thigh muscles in competitive triathletes at rest and following a triathlon race in comparison with sedentary controls. METHODS Twenty-two triathletes (males N = 16, females N = 6) and twenty-three controls (males N = 16, females N = 7) underwent magnetic resonance imaging (MRI) on a 3 T system at baseline (time point 1; 72 h at rest). Twelve triathletes (males N = 8, females N = 4) underwent a second scan (time point 2; 3 h of completing a triathlon race). The tensor eigenvalues (λ1, λ2, λ3), mean diffusivity (MD), fractional anisotropy (FA), and T2 times were compared between controls and triathletes at time point 1 and triathletes at time points 1 and 2 using independent and paired t tests. RESULTS In comparison with the controls at time point 1, the T2 times of rectus femoris (RF, p < 0.02), adductor magnus (AM, p = 0.02), biceps femoris (BF, p < 0.001), semitendinosus (ST, p = 0.005), and semimembranosus (SM, p = 0.003) muscles were significantly increased in triathletes. At time point 2 in triathletes, the average tensor metrics (MD, λ3/ λ1) of BF, ST, and SM muscles increased (p < 0.05) and FA values in ST and SM muscles decreased (p < 0.03). T2 times were not significantly changed between both time points in triathletes. CONCLUSION Our results indicate that this multiparametric MRI protocol allows detection and quantification of changes in the skeletal muscle microenvironment caused by endurance training and acute strenuous exercise. KEY POINTS • Endurance training results in changes to the skeletal microstructure, which can be quantified using MRI-based diffusion tensor imaging. • The combined application of MRI diffusion tensor imaging and T2 mapping allows the differentiation of microstructural changes caused by active exercise or endurance training. • Environmental adaptations of the skeletal muscle caused by physical training are influenced by gender.
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Diffusion tensor imaging of the human thigh: consideration of DTI-based fiber tracking stop criteria. MAGNETIC RESONANCE MATERIALS IN PHYSICS BIOLOGY AND MEDICINE 2019; 33:343-355. [DOI: 10.1007/s10334-019-00791-x] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/18/2019] [Revised: 10/04/2019] [Accepted: 10/22/2019] [Indexed: 01/06/2023]
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The repeatability of bilateral diffusion tensor imaging (DTI) in the upper leg muscles of healthy adults. Eur Radiol 2019; 30:1709-1718. [PMID: 31705253 PMCID: PMC7033061 DOI: 10.1007/s00330-019-06403-5] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2019] [Revised: 07/10/2019] [Accepted: 07/29/2019] [Indexed: 12/26/2022]
Abstract
Objectives Assessment of the repeatability of diffusion parameter estimations in the upper leg muscles of healthy adults over the time course of 2 weeks, from a simultaneous bilateral upper leg DTI measurement. Methods SE-EPI DTI datasets were acquired at 3 T in the upper legs of 15 active adults at a time interval of 2 weeks. ROIs were manually drawn for four quadriceps and three hamstring muscles of both legs. The following DTI parameters were analyzed: 1st, 2nd, and 3rd eigenvalue (λ1, λ2, and λ3), mean diffusivity (MD), and fractional anisotropy (FA). DTI parameters per muscle were calculated with and without intravoxel incoherent motion (IVIM) correction together with SNR levels per muscle. Bland-Altman plots and within-subject coefficient of variation (wsCV) were calculated. Left-right differences between muscles were assessed. Results The Bland-Altman analysis showed good repeatability of all DTI parameters except FA for both the IVIM-corrected and standard data. wsCV values show that MD has the highest repeatability (4.5% IVIM; 5.6% standard), followed by λ2 (4.9% IVIM; 5.5% standard), λ1 (5.3% IVIM; 7.5% standard), and λ3 (5.7% IVIM; 5.7% standard). wsCV values of FA were 15.2% for the IVIM-corrected data and 13.9% for the standard analysis. The SNR (41.8 ± 16.0 right leg, 41.7 ± 17.1 left leg) and wsCV values were similar for the left and right leg and no left-right bias was detected. Conclusions Repeatability was good for standard DTI data and slightly better for IVIM-corrected DTI data. Our protocol is suitable for DTI of the upper legs with overall good SNR. Key Points • The presented DTI protocol is repeatable and therefore suitable for bilateral DT imaging of the upper legs. • Additional B1+calibrations improve SNR and repeatability. • Correcting for perfusion effects improves repeatability. Electronic supplementary material The online version of this article (10.1007/s00330-019-06403-5) contains supplementary material, which is available to authorized users.
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Juras V, Mlynarik V, Szomolanyi P, Valkovič L, Trattnig S. Magnetic Resonance Imaging of the Musculoskeletal System at 7T: Morphological Imaging and Beyond. Top Magn Reson Imaging 2019; 28:125-135. [PMID: 30951006 PMCID: PMC6565434 DOI: 10.1097/rmr.0000000000000205] [Citation(s) in RCA: 23] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
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∗, T1ρ 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.
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Affiliation(s)
- Vladimir Juras
- High-field MR Center, Department of Biomedical Imaging and Image-guided Therapy, Medical University of Vienna, Vienna, Austria.,Department of Imaging Methods, Institute of Measurements Science, Slovak Academy of Sciences, Bratislava, Slovakia
| | - Vladimir Mlynarik
- High-field MR Center, Department of Biomedical Imaging and Image-guided Therapy, Medical University of Vienna, Vienna, Austria.,Karl Landsteiner Society, St. Pölten, Austria
| | - Pavol Szomolanyi
- High-field MR Center, Department of Biomedical Imaging and Image-guided Therapy, Medical University of Vienna, Vienna, Austria.,Department of Imaging Methods, Institute of Measurements Science, Slovak Academy of Sciences, Bratislava, Slovakia
| | - Ladislav Valkovič
- High-field MR Center, Department of Biomedical Imaging and Image-guided Therapy, Medical University of Vienna, Vienna, Austria.,Oxford Centre for Clinical Magnetic Resonance Research, BHF Centre of Research Excellence, University of Oxford, Oxford, UK.,Department of Imaging Methods, Institute of Measurements Science, Slovak Academy of Sciences, Bratislava, Slovakia
| | - Siegfried Trattnig
- High-field MR Center, Department of Biomedical Imaging and Image-guided Therapy, Medical University of Vienna, Vienna, Austria.,Austrian Cluster for Tissue Regeneration, Vienna, Austria.,Christian Doppler Laboratory for Clinical Molecular MR Imaging, Vienna, Austria
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Farrow M, Grainger AJ, Tan AL, Buch MH, Emery P, Ridgway JP, Feiweier T, Tanner SF, Biglands J. Normal values and test-retest variability of stimulated-echo diffusion tensor imaging and fat fraction measurements in the muscle. Br J Radiol 2019; 92:20190143. [PMID: 31298948 DOI: 10.1259/bjr.20190143] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
OBJECTIVES To assess the test-retest variability of both diffusion parameters and fat fraction (FF) estimates in normal muscle, and to assess differences in normal values between muscles in the thigh. METHODS 29 healthy volunteers (mean age 37 years, range 20-60 years, 17/29 males) completed the study. Magnetic resonance images of the mid-thigh were acquired using a stimulated echo acquisition mode-echoplanar imaging (STEAM-EPI) imaging sequence, to assess diffusion, and 2-point Dixon imaging, to assess FF. Imaging was repeated in 19 participants after a 30 min interval in order to assess test-retest variability of the measurements. RESULTS Intraclass correlation coefficients (ICCs) for test-retest variability were 0.99 [95% confidence interval, (CI): 0.98, 1] for FF, 0.94 (95% CI: 0.84, 0.97) for mean diffusivity and 0.89 (95% CI: 0.74, 0.96) for fractional anisotropy (FA). FF was higher in the hamstrings than the quadriceps by a mean difference of 1.81% (95% CI:1.63, 2.00)%, p < 0.001. Mean diffusivity was significantly lower in the hamstrings than the quadriceps (0.26 (0.13, 0.39) x10-3 mm2s-1, p < 0.001) whereas fractional anisotropy was significantly higher in the hamstrings relative to the quadriceps with a mean difference of 0.063 (0.05, 0.07), p < 0.001. CONCLUSIONS This study has shown excellent test-retest, variability in MR-based FF and diffusion measurements and demonstrated significant differences in these measures between hamstrings and quadriceps in the healthy thigh. ADVANCES IN KNOWLEDGE Test-retest variability is excellent for STEAM-EPI diffusion and 2-point Dixon-based FF measurements in the healthy muscle. Inter- and intraobserver variability were excellent for region of interest placement for STEAM-EPI diffusion and 2-point Dixon-based FF measurements in the healthy muscle. There are significant differences in FF and diffusion measurements between the hamstrings and quadriceps in the normal muscle.
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Affiliation(s)
- Matthew Farrow
- 1Leeds institute of Rheumatic and Musculoskeletal Medicine, Chapel Allerton Hospital, University of Leeds, United Kingdom.,2NIHR Leeds Biomedical Research Centre, Leeds Teaching Hospitals NHS Trust, Leeds, United Kingdom
| | - Andrew J Grainger
- 1Leeds institute of Rheumatic and Musculoskeletal Medicine, Chapel Allerton Hospital, University of Leeds, United Kingdom.,2NIHR Leeds Biomedical Research Centre, Leeds Teaching Hospitals NHS Trust, Leeds, United Kingdom
| | - Ai Lyn Tan
- 1Leeds institute of Rheumatic and Musculoskeletal Medicine, Chapel Allerton Hospital, University of Leeds, United Kingdom.,2NIHR Leeds Biomedical Research Centre, Leeds Teaching Hospitals NHS Trust, Leeds, United Kingdom
| | - Maya H Buch
- 1Leeds institute of Rheumatic and Musculoskeletal Medicine, Chapel Allerton Hospital, University of Leeds, United Kingdom.,2NIHR Leeds Biomedical Research Centre, Leeds Teaching Hospitals NHS Trust, Leeds, United Kingdom
| | - Paul Emery
- 1Leeds institute of Rheumatic and Musculoskeletal Medicine, Chapel Allerton Hospital, University of Leeds, United Kingdom.,2NIHR Leeds Biomedical Research Centre, Leeds Teaching Hospitals NHS Trust, Leeds, United Kingdom
| | - John P Ridgway
- 2NIHR Leeds Biomedical Research Centre, Leeds Teaching Hospitals NHS Trust, Leeds, United Kingdom.,3Medical Physics and Engineering, Leeds Teaching Hospitals NHS Trust, Leeds, United Kingdom
| | | | - Steven F Tanner
- 2NIHR Leeds Biomedical Research Centre, Leeds Teaching Hospitals NHS Trust, Leeds, United Kingdom.,3Medical Physics and Engineering, Leeds Teaching Hospitals NHS Trust, Leeds, United Kingdom
| | - John Biglands
- 2NIHR Leeds Biomedical Research Centre, Leeds Teaching Hospitals NHS Trust, Leeds, United Kingdom.,3Medical Physics and Engineering, Leeds Teaching Hospitals NHS Trust, Leeds, United Kingdom
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25
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Malis V, Sinha U, Csapo R, Narici M, Smitaman E, Sinha S. Diffusion tensor imaging and diffusion modeling: Application to monitoring changes in the medial gastrocnemius in disuse atrophy induced by unilateral limb suspension. J Magn Reson Imaging 2018; 49:1655-1664. [PMID: 30569482 DOI: 10.1002/jmri.26295] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2018] [Revised: 07/24/2018] [Accepted: 07/26/2018] [Indexed: 12/20/2022] Open
Abstract
BACKGROUND Diffusion tensor imaging (DTI) assesses underlying tissue microstructure, and has been applied to studying skeletal muscle. Unloading of the lower leg causes decreases in muscle force, mass, and muscle protein synthesis as well as changes in muscle architecture. PURPOSE To monitor the change in DTI indices in the medial gastrocnemius (MG) after 4-week unilateral limb suspension (ULLS) and to explore the feasibility of extracting tissue microstructural parameters based on a two-compartment diffusion model. STUDY TYPE Prospective cohort study. SUBJECTS Seven moderately active subjects (29.1 ± 5.7 years). FIELD STRENGTH/SEQUENCE 3T, single-shot fat-suppressed echo planar spin echo sequence. ASSESSMENT Suspension-related changes in the DTI indices (eigenvalues: λ1 , λ2 , λ3 , fractional anisotropy; coefficient of planarity) were statistically analyzed. Changes in model-derived tissue parameters (muscle fiber circularity and diameter, intracellular volume fraction, and residence time) after suspension are qualitatively discussed. STATISTICAL TESTS Changes in the DTI indices of the MG between pre- and postsuspension were assessed using repeated-measures two-way analysis of variance (ANOVA). RESULTS All the eigenvalues (λ1 : P = 0.025, λ2 : P = 0.035, λ3 : P = 0.049) as well as anisotropic diffusion coefficient (P = 0.029) were significantly smaller post-ULLS. Diffusion modeling revealed that fibers were more circular (circularity index increased from 0.55 to 0.95) with a smaller diameter (diameter decreased from 82-60 μm) postsuspension. DATA CONCLUSION We have shown that DTI indices change with disuse and modeling can relate these voxel level changes to changes in the tissue microarchitecture. LEVEL OF EVIDENCE 2 Technical Efficacy: Stage 1 J. Magn. Reson. Imaging 2018.
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Affiliation(s)
- Vadim Malis
- Muscle Imaging and Modeling Lab, Department of Radiology, UC San Diego, San Diego, California, USA.,Physics, UC San Diego, San Diego, California, USA
| | - Usha Sinha
- Physics, San Diego State University, California, USA
| | - Robert Csapo
- Muscle Imaging and Modeling Lab, Department of Radiology, UC San Diego, San Diego, California, USA.,Institute for Sports Medicine, Alpine Medicine and Health Tourism, University for Health Sciences, Medical Informatics and Technology, Hall, Austria
| | - Marco Narici
- School of Graduate Entry Medicine and Health University of Nottingham, Derby, UK
| | - Edward Smitaman
- Department of Radiology, UC San Diego, San Diego, California, USA
| | - Shantanu Sinha
- Muscle Imaging and Modeling Lab, Department of Radiology, UC San Diego, San Diego, California, USA
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Kumaravel M, Bawa P, Murai N. Magnetic resonance imaging of muscle injury in elite American football players: Predictors for return to play and performance. Eur J Radiol 2018; 108:155-164. [PMID: 30396649 DOI: 10.1016/j.ejrad.2018.09.028] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2018] [Revised: 09/17/2018] [Accepted: 09/24/2018] [Indexed: 11/18/2022]
Abstract
Muscle injury accounts for about one-third of total sports-related injuries. The lower limb muscles have one of the highest predisposition for injury in high-level professional athletic sports, such as the National Football League. The commonest group of muscles injured among football players include the hamstrings, followed by the quadriceps. Muscle injuries lead to significant time, off the field and affect return to play. Sports physicians and teams have been keen on assessing such injuries and also relying on multiple tools to safely return the player back to the field. MRI plays a key role in evaluation, follow-up, and assessment for return to play (RTP). In this review, we will discuss details of muscle anatomy, incidence of muscle injuries, injury mechanisms, and use of MRI in assessment, grading, follow-up and in predicting the natural course of muscle injuries in the high-end athletic players. While the use of MRI is clear in diagnosis, and for follow up of muscle injuries, there is some limitation in its ability to predict RTP, based on current MRI classification systems. Footballers who have clinical injuries without MRI evidence of significant muscle injury (grade 0 and 1) have a shorter period of RTP. Injuries classified as high grade (3 and 4) on MRI do not correlate well with time to RTP. Further trials are required to improve the capability of MRI in its prediction of RTP.
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Affiliation(s)
- Manickam Kumaravel
- Department of Diagnostic and Interventional Imaging, University of Texas Health Science Center at Houston, 6431 Fannin street MSB 2.130B, Houston, TX 77030 USA.
| | - Pritish Bawa
- Department of Diagnostic and Interventional Imaging, University of Texas Health Science Center at Houston, 6431 Fannin street MSB 2.130B, Houston, TX 77030 USA
| | - Naoki Murai
- Department of Diagnostic and Interventional Imaging, University of Texas Health Science Center at Houston, 6431 Fannin street MSB 2.130B, Houston, TX 77030 USA
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