Evaluation of exercised or cooled skeletal muscle on the basis of diffusion-weighted magnetic resonance imaging

Quantitative analysis of masticatory muscle changes by Eichner index using diffusion-weighted imaging

OBJECTIVES

Diffusion-weighted imaging (DWI) provides quantitative functional information about the microscopic movement of water at the cellular level. However, few reports have quantitatively evaluated histological changes in masticatory muscles due to changes in occlusal relationships using DWI. This study aimed to assess the changes in masticatory muscles by Eichner index using DWI.

METHODS

We analyzed magnetic resonance imaging (MRI) studies of 201 patients from November 2017 to April 2018. Each Eichner index group, age, and sex were used as criterion variables, and the average apparent diffusion coefficient (ADC) values of the masticatory muscles were the explanatory variable. The mean ADC value differences were analyzed in each Eichner index group. We analyzed the data using the Kruskal-Wallis test and post hoc Mann-Whitney test with Bonferroni adjustment multiple regression analysis with Shapiro-Wilk test and Spearman's correlation coefficients. P < 0.05 was considered statistically significant.

RESULTS

The mean ADC values of each Eichner classification group were significantly different, with the lowest value in group C (P < 0.001). There was a negative correlation between the ADC value of the masseter, lateral pterygoid muscle, and age (P < 0.001). There were significant differences between the sex groups (P < 0.001).

CONCLUSIONS

ADC values of masticatory muscles were significantly different in the Eichner index groups. The ADC values of masticatory muscles may be useful for the quantitative evaluation of the masticatory muscles affected by the occlusal state.

Blood oxygenation level-dependent cardiovascular magnetic resonance of the skeletal muscle in healthy adults: Different paradigms for provoking signal alterations

PURPOSE

Stress blood oxygenation level-dependent (BOLD) cardiovascular magnetic resonance allows for quantitative evaluation of blood flow reserve in skeletal muscles. This study aimed to prospectively compare three commonly used skeletal BOLD cardiovascular magnetic resonance paradigms in healthy adults: gas inhalation, cuff compression-induced ischemia and postocclusive reactive hyperemia, and exercise.

METHODS

Twelve young (22 ± 0.9 years) and 10 elderly (58 ± 5.0 years) healthy subjects underwent BOLD cardiovascular magnetic resonance under the three paradigms. T 2 ∗ signal intensity time curves were generated and quantitative parameters were calculated. Meanwhile, stress transcutaneous oxygen pressure measurements were obtained as comparison. Measurement reproducibility was assessed with intraclass correlation coefficients. Differences in the T 2 ∗ BOLD variation, the correlation with transcutaneous oxygen pressure, and the age-related change between paradigms were statistically analyzed.

RESULTS

Minimum ischemic value and maximum hyperemic peak value showed the highest interobserver and interscan reproducibilities (intraclass correlation coefficient >0.90). The plantar dorsiflexion exercise paradigm elicited the largest T 2 ∗ BOLD variation (15.48% ± 10.56%), followed by ischemia (8.30% ± 6.33%). Negligible to weak changes were observed during gas inhalation. Correlations with transcutaneous oxygen pressure measurements were found in the ischemic phase (r = 0.966; P < .001) and in the postexercise phase (r = -0.936; P < .001). Minimum ischemic value, maximum hyperemic peak value, maximum postexercise value, and slope of postexercise signal decay showed significant differences between young and elderly subjects (P < .01).

CONCLUSION

Ischemia and reactive hyperemia have superior reproducibility, and exercise could induce the largest T 2 ∗ variation. Key parameters from the two paradigms show age-related differences.

Short- and long-term reproducibility of diffusion-weighted magnetic resonance imaging of lower extremity musculature in asymptomatic individuals and a comparison to individuals with spinal cord injury

Background

Diffusion-weighted magnetic resonance imaging (DW-MRI) of skeletal muscle has the potential to be a sensitive diagnostic and/or prognostic tool in complex, enigmatic neuromusculoskeletal conditions such as spinal cord injury and whiplash associated disorder. However, the reliability and reproducibility of clinically accessible DW-MRI parameters in skeletal muscle remains incompletely characterized – even in individuals without neuromusculoskeletal injury – and these parameters have yet to be characterized for many clinical populations. Here, we provide normative measures of the apparent diffusion coefficient (ADC) in healthy muscles of the lower limb; assess the rater-based reliability and short- and long-term reproducibility of the ADC in the same muscles; and quantify ADC of these muscles in individuals with motor incomplete spinal cord injury.

Methods

Twenty individuals without neuromusculoskeletal injury and 14 individuals with motor incomplete spinal cord injury (SCI) participated in this investigation. We acquired bilateral diffusion-weighted MRI of the lower limb musculature in all participants at 3 T using a multi-shot echo-planar imaging sequence with b-values of 0, 100, 300 and 500 s/mm² and diffusion-probing gradients applied in 3 orthogonal directions. Outcome measures included: (1) average ADC in the lateral and medial gastrocnemius, tibialis anterior, and soleus of individuals without neurological or musculoskeletal injury; (2) intra- and inter-rater reliability, as well as short and long-term reproducibility of the ADC; and (3) estimation of average muscle ADC in individuals with SCI.

Results

Intra- and inter-rater reliability of the ADC averaged 0.89 and 0.79, respectively, across muscles. Least significant change, a measure of temporal reproducibility, was 4.50 and 11.98% for short (same day) and long (9-month) inter-scan intervals, respectively. Average ADC was significantly elevated across muscles in individuals with SCI compared to individuals without neurological or musculoskeletal injury (1.655 vs. 1.615 mm²/s, respectively).

Conclusions

These findings provide a foundation for future studies that track longitudinal changes in skeletal muscle ADC of the lower extremity and/or investigate the mechanisms underlying ADC changes in cases of known or suspected pathology.

Apparent Diffusion Coefficient Is a Novel Imaging Biomarker of Myopathic Changes in Liver Cirrhosis

Diffusion weighted imaging can provide information regarding tissue composition and can quantitatively characterize different pathological changes by means of apparent diffusion coefficient (ADC). The study comprised of 114 patients with liver cirrhosis-22 women and 92 men with a mean age of 56.5 ± 9.0 years. In all patients, the Model for End Stage-Liver Disease (MELD) score was calculated. Furthermore, 12 healthy persons (5 women, 7 men), mean age, 42.1 ± 16.2 years, were investigated as a control group. In all cases, magnetic resonance imaging of the liver/trunk was performed using different 3T scanners and diffusion weighted images were obtained with a multi-shot SE-EPI sequence. In all cases, polygonal regions of interest were manually drawn on the ADC maps along the contours of the iliopsoas and paravertebral muscles. The comparison of ADC values in groups was performed by Mann-Whitney-U tests. The association between ADC and MELD score was calculated by Spearman's rank correlation coefficient. ADC values of the skeletal musculature were statistically much higher in comparison to those in the control group: 1.85 ± 0.46 × 10^-3 mm² s^-1 vs. 1.23 ± 0.12 × 10^-3 mm² s^-1, p = 0.001. ADC values showed statistically significant correlation with the MELD score (r = 0.473, p = 0.0001). Furthermore, ADC values differed between the subgroups with different values of the MELD score. ADC values correlated slightly with lactate dehydrogenase (LDH) (r = 0.381, p = 0.0001) and tended to correlate with C-reactive protein (CRP) (r = 0.171, p = 0.07) and alanine aminotransferase (ALAT) (r = -0.167, p = 0.076). ADC can reflect muscle changes in liver cirrhosis and shows statistically significant correlation with the MELD score. Therefore, ADC can be used as an imaging biomarker of myopathic changes in liver cirrhosis.

Evaluation of Psoas Major and Quadratus Lumborum Recruitment Using Diffusion-Weighted Imaging Before and After 5 Trunk Exercises

Study Design Controlled laboratory study, with a pretest-posttest design. Background Diffusion-weighted imaging is a noninvasive magnetic resonance imaging technique that can be used to assess the recruitment of the psoas major (PM) and quadratus lumborum (QL). The recruitment of these muscles during trunk exercises has not been evaluated. Objective To evaluate the diffusion of water movement in several trunk muscles using diffusion-weighted imaging before and after specific trunk exercises and thereby to understand the level of recruitment of each muscle during each exercise. Methods Nine healthy male participants performed the right side bridge, knee raise, and 3 front bridges, including the hand-knee, elbow-knee, and elbow-toe bridges. Diffusion-weighted imaging was performed before and after each exercise. After scanning, the apparent diffusion coefficient (ADC) map was constructed, and ADC values of the rectus abdominis, lateral abdominal muscles, QL, PM, and back muscles were calculated. Results The right PM following the elbow-toe bridge demonstrated the largest increase in ADC values, a change significantly greater than that demonstrated by the hand-knee bridge (P<.001) and side bridge (P = .002) exercises. The ADC change in the right QL following the side bridge exercise was significantly larger than that of other exercises (P<.008). Conclusion Of the 5 exercises investigated, the elbow-toe bridge and side bridge exercises elicit the greatest recruitment of the PM and QL, respectively. J Orthop Sports Phys Ther 2017;47(2):108-114. Epub 5 Nov 2016. doi:10.2519/jospt.2017.6730.

Advancements in Imaging Technology: Do They (or Will They) Equate to Advancements in Our Knowledge of Recovery in Whiplash?

Synopsis It is generally accepted that up to 50% of those with a whiplash injury following a motor vehicle collision will fail to fully recover. Twenty-five percent of these patients will demonstrate a markedly complex clinical picture that includes severe pain-related disability, sensory and motor disturbances, and psychological distress. A number of psychosocial factors have shown prognostic value for recovery following whiplash from a motor vehicle collision. To date, no management approach (eg, physical therapies, education, psychological interventions, or interdisciplinary strategies) for acute whiplash has positively influenced recovery rates. For many of the probable pathoanatomical lesions (eg, fracture, ligamentous rupture, disc injury), there remains a lack of available clinical tests for identifying their presence. Fractures, particularly at the craniovertebral and cervicothoracic junctions, may be radiographically occult. While high-resolution computed tomography scans can detect fractures, there remains a lack of prevalence data for fractures in this population. Conventional magnetic resonance imaging has not consistently revealed lesions in patients with acute or chronic whiplash, a "failure" that may be due to limitations in the resolution of available devices and the use of standard sequences. The technological evolution of imaging techniques and sequences eventually might provide greater resolution to reveal currently elusive anatomical lesions (or, perhaps more importantly, temporal changes in physiological responses to assumed lesions) in those patients at risk of poor recovery. Preliminary findings from 2 prospective cohort studies in 2 different countries suggest that this is so, as evidenced by changes to the structure of skeletal muscles in those who do not fully recover. In this clinical commentary, we will briefly introduce the available imaging decision rules and the current knowledge underlying the pathomechanics and pathophysiology of whiplash. We will then acknowledge known prognostic factors underlying functional recovery. Last, we will highlight emerging evidence regarding the pathobiology of muscle degeneration/regeneration, as well as advancements in neuroimaging and musculoskeletal imaging techniques (eg, functional magnetic resonance imaging, magnetization transfer imaging, spectroscopy, diffusion-weighted imaging) that may be used as noninvasive and objective complements to known prognostic factors associated with whiplash recovery, in particular, poor functional recovery. J Orthop Sports Phys Ther 2016;46(10):861-872. doi:10.2519/jospt.2016.6735.

Proton diffusion tensor spectroscopy of metabolites in human muscle in vivo

PURPOSE

To study the apparent diffusivity and its directionality for metabolites of skeletal muscle in humans in vivo by (1) H magnetic resonance spectroscopy.

METHODS

The diffusion tensors were determined on a 3 Tesla MR system using optimized acquisition and processing methods including an adapted STEAM sequence with orientation-dependent diffusion weighting, pulse-triggering with individually adapted delays, eddy-current correction schemes, median filtering, and simultaneous prior-knowledge fitting of all related spectra.

RESULTS

The average apparent diffusivities, as well as the fractional anisotropies of taurine (ADCav=0.74 × 10(-3) s/mm(2) , FA=0.46), creatine (ADCav =0.41 × 10(-3) s/mm(2) , FA=0.33), trimethylammonium compounds (ADCav =0.48 × 10(-3) s/mm(2) , FA=0.34), carnosine (ADCav =0.46 × 10(-3) s/mm(2) , FA=0.47), and water (ADCav=1.5 × 10(-3) s/mm(2) , FA=0.36) were estimated. The diffusivities of most metabolites and water were significantly different from each other. Diffusion was found to be anisotropic and the diffusion tensors showed tensor correlation coefficients close to 1 and were hence found to be essentially coaligned. The magnitudes of apparent metabolite diffusivities were largely ordered according to molecular weight, with taurine as the smallest molecule diffusing fastest, both along and across the fiber direction.

CONCLUSION

Diffusivities, directional dependence of diffusion and fractional anisotropies of (1) H MRS-visible muscle metabolites were presented. It was shown that metabolites share diffusion directionality with water and have similar fractional anisotropies, hinting at similar diffusion barriers.

Influence of postexercise cooling on muscle oxygenation and blood volume changes

PURPOSE

The aim of this study was to investigate the effects of postexercise cold water immersion (CWI) on tissue oxygenation and blood volume changes after intense exercise.

METHODS

Nine physically active men performed 30 min of continuous running (CR) at 70% of their maximal treadmill velocity (Vmax), followed by 10 bouts of intermittent running at Vmax. After exercise, one of the participants' legs was immersed in a cold water bath (10°C, CWI) to the level of their gluteal fold for 15 min. The contralateral leg remained outside the water bath and served as a control (CON). Vastus lateralis (VL) skin temperature (TskVL), VL oxygenation (tissue oxygenation index [TOI]), and blood volume changes (total hemoglobin [tHb] volume) were monitored continuously throughout exercise and CWI using near-infrared spectroscopy.

RESULTS

TskVL, TOI, and tHb were not significantly different between CON and CWI during continuous running and intermittent running, respectively (P > 0.05). In contrast, TskVL was significantly lower in CWI compared with CON throughout immersion, with peak differences occurring at the end of immersion (CON = 35.1 ± 0.6 vs CWI = 16.9°C ± 1.7°C, P < 0.001). tHb was significantly lower during CWI compared with CON at most time points, with peak differences of 20% ± 4% evident at the end of the 15-min immersion (P < 0.01). Likewise, TOI was significantly higher in CWI compared with CON, with peak differences of 2.5% ± 1% evident at the 12th min of immersion (P < 0.05).

CONCLUSIONS

Postexercise cooling decreased microvascular perfusion and muscle metabolic activity. These findings are consistent with the suggested mechanisms by which CWI is hypothesized to improve local muscle recovery.

Multiple echo multi-shot diffusion sequence

PURPOSE

To measure both transversal relaxation time (T2 ) and diffusion coefficients within a single scan using a multi-shot approach. Both measurements have drawn interest in many applications, especially in skeletal muscle studies, which have short T2 values. Multiple echo single-shot schemes have been proposed to obtain those variables simultaneously within a single scan, resulting in a reduction of the scanning time. However, one problem with those approaches is the associated long echo read-out. Consequently, the minimum achievable echo time tends to be long, limiting the application of these sequences to tissues with relatively long T2 .

MATERIALS AND METHODS

To address this problem, we propose to extend the multi-echo sequences using a multi-shot approach, so that to allow shorter echo times. A multi-shot dual-echo EPI sequence with diffusion gradients and echo navigators was modified to include independent diffusion gradients in any of the two echoes.

RESULTS

The multi-shot approach allows us to drastically reduce echo times. Results showed a good agreement for the T2 and mean diffusivity measurements with gold standard sequences in phantoms and in vivo data of calf muscles from healthy volunteers.

CONCLUSION

A fast and accurate method is proposed to measure T2 and diffusion coefficients simultaneously, tested in vitro and in healthy volunteers.

The pearls and pitfalls of magnetic resonance imaging for the spine

Musculoskeletal imaging of the spine can be an invaluable tool to inform clinical decision making in patients with spinal pain. An understanding of the technology involved in producing and interpreting high-resolution images produced from magnetic resonance imaging (MRI) of the human spine is necessary to better appreciate which sequences can be used for, or tailored to, individual patients and their conditions. However, there is substantial variability in the clinical meaningfulness of some MRI findings of spinal tissues. For example, normal variants can often mimic significant musculoskeletal pathology, which could increase the risk of misinformed clinical decisions and, even worse, poor or adverse outcomes. This clinical commentary will highlight some of the pearls and pitfalls of MRI for the cervical, thoracic, and lumbar regions, and include cases to illustrate some of the common imaging artifacts and normal variants for MRI of the spine.

Diffusion-weighted Magnetic Resonance Imaging: What Makes Water Run Fast or Slow?

Diffusion-Weighted Magnetic Resonance Imaging (DWI) obtains information useful in diagnosing several diseases through the measurement of random, Brownian diffusion of water molecules in tissues. This pictorial essay illustrates the main factors, i.e., ratio between the volume occupied by cells and the extracellular space, composition of the extracellular space, and temperature, that determine the rate of the water diffusion. The mechanism through which these influencing factors affect water diffusion is explained. Clinical and experimental examples, derived both from physiology and from non-human models, are described.

Diffusion-weighted magnetic resonance imaging for the healthy cervical multifidus: a potential method for studying neck muscle physiology following spinal trauma

STUDY DESIGN

Cross-sectional.

OBJECTIVE

To develop a new magnetic resonance imaging (MRI) measure for the diffusive properties of the healthy cervical multifidus and to determine the interrater and intrarater reliability of the measurement.

BACKGROUND

Diffusion-weighted MRI, via calculation of the apparent diffusion coefficient (ADC), provides a representation of microscopic movements of water molecules in human tissues and may be useful to assess structural changes in neck muscle, as has been observed following whiplash. The optimal imaging parameters, however, have not been established.

METHODS

A diffusion-weighted MRI measure was developed, and, for the basic examination, the right cervical multifidus muscle at the C5 level was studied. A total of 6 asymptomatic volunteer individuals (3 females and 3 males) underwent a single diffusion-weighted MRI scan. Interrater and intrarater agreement was evaluated using Bland-Altman plots and intraclass correlation coefficients.

RESULTS

Mean ADCb0-b50 and ADCb50-250 were significantly different from one another (P=.03). The plots confirmed the agreement of raters for ADC of the right cervical multifidus at C5.

CONCLUSIONS

A quantitative and reliable diffusion-weighted MRI measure of cervical multifidus ADC has been described. There appears to be a fast and slow component ADC for the healthy multifidus, suggesting changes in extracellular and intracellular volume. Further comparative study is needed to quantify ADCs in the neck muscles in patients with traumatic whiplash.