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Nizinski J, Kaczmarek A, Antonik B, Rauhut S, Tuczynski P, Jakubowski F, Slawski J, Stefaniak J, Lubiatowski P. Reliability of glenoid measurements performed using Multiplanar Reconstruction (MPR) of Magnetic Resonance (MRI) in patients with shoulder instability. INTERNATIONAL ORTHOPAEDICS 2024; 48:2129-2136. [PMID: 38833167 PMCID: PMC11246251 DOI: 10.1007/s00264-024-06226-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/01/2024] [Accepted: 05/19/2024] [Indexed: 06/06/2024]
Abstract
PURPOSE Measurement of glenoid bone loss in the shoulder instability can be assessed by CT or MRI multiplanar imaging and is crucial for pre-operative planning. The aim of this study is to determine the intra and interobserver reliability of glenoid deficiency measurement using MRI multiplanar reconstruction with 2D assessment in the sagittal plane (MPR MRI). METHODS We reviewed MRI images of 80 patients with anterior shoulder instability with Osirix software using MPR. Six observers with basic experience measured the glenoid, erosion edge length, and bone loss twice, with at least one-week interval between measurements. We calculated reliability and repeatability using the intra-class correlation coefficient (ICC) and minimal detectable change with 95% confidence (MDC95%). RESULTS Intra and Inter-observer ICC and MDC95% for glenoid width and height were excellent (ICC 0,89-0,96). For erosion edge length and area of the glenoid were acceptable/good (ICC 0,61-0,89). Bone loss and Pico Index were associated with acceptable/good ICC (0,63 -0,86)) but poor MDC95% (45 - 84 %). Intra-observer reliability improved with time, while inter-observer remained unchanged. CONCLUSION The MPR MRI measurement of the anterior glenoid lesion is very good tool for linear parameters. This method is not valid for Pico index measurement, as the area of bone loss is variable. The pace of learning is individual, therefore complex calculations based on MPR MRI are not resistant to low experience as opposed to true 3D CT.
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Affiliation(s)
| | | | | | | | | | | | | | | | - Przemyslaw Lubiatowski
- Rehasport Clinic, Poznan, Poland.
- Department of Traumatology, Orthopaedics and Hand Surgery, University of Medical Sciences in Poznan, Poznan, Poland.
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Oishi T, Tasaki A, Mashimo S, Moriya M, Yamashita D, Nozaki T, Kitamura N, Inaba Y. Evaluation of glenoid morphology and bony Bankart lesion in shoulders with traumatic anterior instability using zero echo time magnetic resonance imaging. JSES Int 2024; 8:714-718. [PMID: 39035642 PMCID: PMC11258840 DOI: 10.1016/j.jseint.2024.03.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/23/2024] Open
Abstract
Background Preoperative computed tomography (CT) evaluation of bone morphometry aids in determining treatment strategies for shoulder instability. The use of zero echo time (ZTE) sequence in magnetic resonance imaging (MRI), a new bone cortex imaging technique, may help reduce radiation exposure and medical costs. Therefore, this study aimed to evaluate the glenoid morphology and detect the presence of bony Bankart lesion using ZTE MRI in shoulders with anterior instability and compare its diagnostic accuracy with that of CT. Methods Thirty-six patients (36 shoulders) with anterior instability who underwent preoperative CT and MRI examinations between April 2019 and October 2021 were retrospectively analyzed. The percentages of glenoid bone defects on 3-dimensional (3D) CT and ZTE images were determined, and the correlation between these percentages was evaluated. The number of cases with bony Bankart lesion on CT and 2 types of ZTE (3D and CT-like) images was determined, and the diagnostic accuracy of ZTE for detecting bony Bankart lesion was assessed, with CT as the gold standard. Patients with bony Bankart lesion on CT images were divided into 2 groups based on whether the lesion was detectable on 3D ZTE or CT-like images. The longer diameters of bony Bankart lesion were compared between the groups. Results The median percentage of glenoid bone loss was 12.1% (range, 1.3%-45.9%) and 12.3% (range, 0%-46.6%) on 3D CT and 3D ZTE images, respectively. The Spearman's rank correlation coefficient was 0.89. Bony Bankart lesion was detected in 18, 13, and 8 shoulders of the 36 patients on CT, 3D ZTE, and CT-like images, respectively. The overall diagnostic accuracy of the CT-like and 3D ZTE images for detecting bony Bankart lesion was 86.1% and 72.2%, respectively. A significant difference was observed between the groups with and without bony Bankart lesion on CT-like images in terms of the long diameter of the bone fragments on CT (P < .01). Conclusion ZTE MRI demonstrated high reproducibility for the evaluation of glenoid bone defect in shoulders with anterior instability. Although no significant difference in the measurement was observed compared with that on CT, the ability of ZTE MRI to delineate bone Bankart lesion remains limited.
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Affiliation(s)
- Takayuki Oishi
- Department of Orthopedic Surgery, St. Luke’s International Hospital, Tokyo, Japan
| | - Atsushi Tasaki
- Department of Orthopedic Surgery, St. Luke’s International Hospital, Tokyo, Japan
| | - Shota Mashimo
- Department of Rehabilitation, St. Luke’s International Hospital, Tokyo, Japan
| | - Michiru Moriya
- Department of Orthopedic Surgery, St. Luke’s International Hospital, Tokyo, Japan
| | - Daisuke Yamashita
- Department of Orthopedic Surgery, St. Luke’s International Hospital, Tokyo, Japan
| | - Taiki Nozaki
- Department of Radiology, Keio University School of Medicine, Tokyo, Japan
| | - Nobuto Kitamura
- Department of Orthopedic Surgery, St. Luke’s International Hospital, Tokyo, Japan
| | - Yutaka Inaba
- Department of Orthopedic Surgery, Yokohama City University, Yokohama, Japan
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Thacher RR, Pascual-Leone N, Rodeo SA. Treatment of Knee Chondral Defects in Athletes. Sports Med Arthrosc Rev 2024; 32:75-86. [PMID: 38978201 DOI: 10.1097/jsa.0000000000000405] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/10/2024]
Abstract
Cartilage lesions of the knee are a challenging problem, especially for active individuals and athletes who desire a return to high-load activities. They occur both through chronic repetitive loading of the knee joint or through acute traumatic injury and represent a major cause of pain and time lost from sport. They can arise as isolated lesions or in association with concomitant knee pathology. Management of these defects ultimately requires a sound understanding of their pathophysiologic underpinnings to help guide treatment. Team physicians should maintain a high index of suspicion for underlying cartilage lesions in any patient presenting with a knee effusion, whether painful or not. A thorough workup should include a complete history and physical examination. MRI is the most sensitive and specific imaging modality to assess these lesions and can provide intricate detail not only of the structure and composition of cartilage, but also of the surrounding physiological environment in the joint. Treatment of these lesions consists of both conservative or supportive measures, as well as surgical interventions designed to restore or regenerate healthy cartilage. Because of the poor inherent capacity for healing associated with hyaline cartilage, the vast majority of symptomatic lesions will ultimately require surgery. Surgical treatment options range from simple arthroscopic debridement to large osteochondral reconstructions. Operative decision-making is based on numerous patient- and defect-related factors and requires open lines of communication between the athlete, the surgeon, and the rest of the treatment team. Ultimately, a positive outcome is based on the creation of a durable, resistant repair that allows the athlete to return to pain-free sporting activities.
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Affiliation(s)
- Ryan R Thacher
- Department of Orthopaedic Surgery, Sports Medicine Institute, Hospital for Special Surgery, New York, NY
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Cui DD, Long Y, Yan Y, Li C, Yang YT, Zhong JL, Yang R. Three-Dimensional Magnetic Resonance Imaging Fast Field Echo Resembling a Computed Tomography Using Restricted Echo-Spacing Sequence Is Equivalent to 3-Dimensional Computed Tomography in Quantifying Bone Loss and Measuring Shoulder Morphology in Patients With Shoulder Dislocation. Arthroscopy 2024; 40:1777-1788. [PMID: 38154531 DOI: 10.1016/j.arthro.2023.12.016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/09/2023] [Revised: 12/11/2023] [Accepted: 12/13/2023] [Indexed: 12/30/2023]
Abstract
PURPOSE To evaluate the equivalence of 3-dimensional (3D) magnetic resonance imaging (MRI) (FRACTURE [Fast field echo Resembling A CT Using Restricted Echo-spacing]) and 3D computed tomography (CT) in quantifying bone loss in patients with shoulder dislocation and measuring morphologic parameters of the shoulder. METHODS From July 2022 to June 2023, patients with anterior shoulder dislocation who were aged 18 years or older and underwent both MRI and CT within 1 week were included in the study. The MRI protocol included an additional FRACTURE sequence. Three-dimensional reconstructions of MRI (FRACTURE) and CT were completed by 2 independent observers using Mimics software (version 21.0) through simple threshold-based segmentation. For bone defect cases, 2 independent observers evaluated glenoid defect, percentage of glenoid defect, glenoid track, Hill-Sachs interval, and on-track/off-track. For all cases, glenoid width, glenoid height, humeral head-fitting sphere radius, critical shoulder angle, glenoid version, vault depth, and post-processing time were assessed. The paired t test was used to assess the differences between 3D CT and 3D MRI (FRACTURE). Bland-Altman plots were constructed to evaluate the consistency between 3D CT and 3D MRI (FRACTURE). Interobserver and intraobserver agreement was evaluated with the interclass correlation coefficient. The paired χ2 test and Cohen κ statistic were used for binary variables (on-track/off-track). RESULTS A total of 56 patients (16 with bipolar bone defect, 5 with only Hill-Sachs lesion, and 35 without bone defect) were ultimately enrolled in the study. The measurements of 21 bone defect cases showed no statistically significant differences between 3D CT and 3D MRI: glenoid defect, 4.05 ± 1.44 mm with 3D CT versus 4.16 ± 1.39 mm with 3D MRI (P = .208); percentage of glenoid defect, 16.21% ± 5.95% versus 16.61% ± 5.66% (P = .199); glenoid track, 18.02 ± 2.97 mm versus 18.08 ± 2.98 mm (P = .659); and Hill-Sachs interval, 14.29 ± 1.93 mm versus 14.35 ± 2.07 mm (P = .668). No significant difference was found between 3D CT and 3D MRI in the diagnosis of on-track/off-track (P > .999), and diagnostic agreement was perfect (κ = 1.00, P < .001). There were no statistically significant differences between the 2 examination methods in the measurements of all 56 cases, except that the post-processing time of 3D MRI was significantly longer than that of 3D CT: glenoid height, 34.56 ± 1.98 mm with 3D CT versus 34.67 ± 2.01 mm with 3D MRI (P = .139); glenoid width, 25.32 ± 1.48 mm versus 25.45 ± 1.47 mm (P = .113); humeral head-fitting sphere radius, 22.91 ± 1.70 mm versus 23.00 ± 1.76 mm (P = .211); critical shoulder angle, 33.49° ± 2.55° versus 33.57° ± 2.51° (P = .328); glenoid version, -3.25° ± 2.57° versus -3.18° ± 2.57° (P = .322); vault depth, 37.43 ± 1.68 mm versus 37.58 ± 1.75 mm (P = .164); and post-processing time, 89.66 ± 10.20 seconds versus 360.93 ± 26.76 seconds (P < .001). For all assessments, the Bland-Altman plots showed excellent consistency between the 2 examination methods, and the interclass correlation coefficients revealed excellent interobserver and intraobserver agreement. CONCLUSIONS Three-dimensional MRI (FRACTURE) is equivalent to 3D CT in quantifying bone loss in patients with shoulder dislocation and measuring shoulder morphologic parameters. LEVEL OF EVIDENCE Level II, development of diagnostic criteria (consecutive patients with consistently applied reference standard and blinding).
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Affiliation(s)
- De-Dong Cui
- Department of Orthopaedics, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou, China
| | - Yi Long
- Department of Orthopaedics, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou, China
| | - Yan Yan
- Department of Orthopaedics, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou, China
| | - Cheng Li
- Department of Orthopaedics, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou, China
| | - Yi-Tao Yang
- Department of Orthopaedics, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou, China
| | - Jing-Lian Zhong
- Department of Radiology, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou, China
| | - Rui Yang
- Department of Orthopaedics, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou, China.
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Knight JA, Powell GM, Johnson AC. Radiographic and Advanced Imaging Evaluation of Posterior Shoulder Instability. Curr Rev Musculoskelet Med 2024; 17:144-156. [PMID: 38605219 PMCID: PMC11068713 DOI: 10.1007/s12178-024-09892-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 03/13/2024] [Indexed: 04/13/2024]
Abstract
PURPOSE OF REVIEW Posterior shoulder instability is an uncommon but important cause of shoulder dysfunction and pain which may occur as the result of seizure, high energy trauma, or repetitive stress related to occupational or sport-specific activities. This current review details the imaging approach to the patient with posterior shoulder instability and describes commonly associated soft tissue and bony pathologies identified by radiographs, CT, and MR imaging. RECENT FINDINGS Advances in MR imaging technology and techniques allow for more accurate evaluation of bone and soft tissue pathology associated with posterior shoulder instability while sparing patients exposure to radiation. Imaging can contribute significantly to the clinical management of patients with posterior shoulder instability by demonstrating the extent of associated injuries and identifying predisposing anatomic conditions. Radiologic evaluation should be guided by clinical history and physical examination, beginning with radiographs followed by CT and/or MRI for assessment of osseous and soft tissue pathology. Synthesis of a patient's clinical history, physical exam findings, and radiologic examinations should guide clinical management.
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Affiliation(s)
- Jennifer A Knight
- Department of Radiology, Mayo Clinic, Charlton Building North, 1st Floor, 200 First Street SW, Rochester, MN, 55905, USA.
| | - Garret M Powell
- Department of Radiology, Mayo Clinic, Charlton Building North, 1st Floor, 200 First Street SW, Rochester, MN, 55905, USA
| | - Adam C Johnson
- Department of Radiology, Mayo Clinic, Charlton Building North, 1st Floor, 200 First Street SW, Rochester, MN, 55905, USA
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Tran CV, Yang HR, Ahmad ZY, Utukuri PS, Quarterman P, Fung M, Lignelli A, Wong TT. Utility of Zero-Echo time sequence as an adjunct for MR evaluation of degenerative disease in the cervical spine. Skeletal Radiol 2024; 53:899-908. [PMID: 37945769 DOI: 10.1007/s00256-023-04507-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/02/2023] [Revised: 10/31/2023] [Accepted: 10/31/2023] [Indexed: 11/12/2023]
Abstract
OBJECTIVE Determine the utility of ZTE as an adjunct to routine MR for assessing degenerative disease in the cervical spine. METHODS Retrospective study on 42 patients with cervical MR performed with ZTE from 1/1/2022 to 4/30/22. Fellowship trained radiologists evaluated each cervical disc level for neural foraminal (NF) narrowing, canal stenosis (CS), facet arthritis (FA), and presence of ossification of the posterior longitudinal ligament (OPLL). When NF narrowing and CS were present, the relative contributions of bone and soft disc were determined and a confidence level for doing so was assigned. Comparisons were made between assessments on routine MR without and with ZTE. RESULTS With ZTE added, bone contribution as a cause of NF narrowing increased in 47% (n = 110) of neural foramina and decreased in 12% (n = 29) (p = < 0.001). Bone contribution as a cause of CS increased in 25% (n = 33) of disc levels and decreased in 10% (n = 13) (p = 0.013). Confidence increased in identifying the cause of NF narrowing (p = < 0.001)) and CS (p = 0.009) with ZTE. The cause of NF narrowing (p = 0.007) and CS (p = 0.041) changed more frequently after ZTE was added when initial confidence in making the determination was low. There was no change in detection of FA or presence of OPLL with ZTE. CONCLUSION Addition of ZTE to a routine cervical spine MR changes the assessment of the degree of bone involvement in degenerative cervical spine pathology.
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Affiliation(s)
- Clement Vinh Tran
- Department of Radiology, Division of Musculoskeletal Radiology, NewYork-Presbyterian Hospital - Columbia University Medical Center, New York, NY, USA
| | - Hye Ryung Yang
- Department of Radiology, Division of Musculoskeletal Radiology, NewYork-Presbyterian Hospital - Columbia University Medical Center, New York, NY, USA
| | - Zohaib Y Ahmad
- Department of Radiology, Division of Musculoskeletal Radiology, NewYork-Presbyterian Hospital - Columbia University Medical Center, New York, NY, USA
| | - Pallavi S Utukuri
- Department of Radiology, Division of Neuroradiology, NewYork-Presbyterian Hospital - Columbia University Medical Center, New York, NY, USA
| | | | - Maggie Fung
- New York, NY General Electric (GE) Healthcare, New York, NY, USA
| | - Angela Lignelli
- Department of Radiology, Division of Neuroradiology, NewYork-Presbyterian Hospital - Columbia University Medical Center, New York, NY, USA
| | - Tony T Wong
- Department of Radiology, Division of Musculoskeletal Radiology, NewYork-Presbyterian Hospital - Columbia University Medical Center, New York, NY, USA.
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Ensle F, Kaniewska M, Lohezic M, Guggenberger R. Enhanced bone assessment of the shoulder using zero-echo time MRI with deep-learning image reconstruction. Skeletal Radiol 2024:10.1007/s00256-024-04690-8. [PMID: 38658419 DOI: 10.1007/s00256-024-04690-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/22/2024] [Revised: 04/07/2024] [Accepted: 04/18/2024] [Indexed: 04/26/2024]
Abstract
OBJECTIVES To assess a deep learning-based reconstruction algorithm (DLRecon) in zero echo-time (ZTE) MRI of the shoulder at 1.5 Tesla for improved delineation of osseous findings. METHODS In this retrospective study, 63 consecutive exams of 52 patients (28 female) undergoing shoulder MRI at 1.5 Tesla in clinical routine were included. Coronal 3D isotropic radial ZTE pulse sequences were acquired in the standard MR shoulder protocol. In addition to standard-of-care (SOC) image reconstruction, the same raw data was reconstructed with a vendor-supplied prototype DLRecon algorithm. Exams were classified into three subgroups: no pathological findings, degenerative changes, and posttraumatic changes, respectively. Two blinded readers performed bone assessment on a 4-point scale (0-poor, 3-perfect) by qualitatively grading image quality features and delineation of osseous pathologies including diagnostic confidence in the respective subgroups. Quantitatively, signal-to-noise ratio (SNR) and contrast-to-noise ratio (CNR) of bone were measured. Qualitative variables were compared using the Wilcoxon signed-rank test for ordinal data and the McNemar test for dichotomous variables; quantitative measures were compared with Student's t-testing. RESULTS DLRecon scored significantly higher than SOC in all visual metrics of image quality (all, p < 0.03), except in the artifact category (p = 0.37). DLRecon also received superior qualitative scores for delineation of osseous pathologies and diagnostic confidence (p ≤ 0.03). Quantitatively, DLRecon achieved superior CNR (95 CI [1.4-3.1]) and SNR (95 CI [15.3-21.5]) of bone than SOC (p < 0.001). CONCLUSION DLRecon enhanced image quality in ZTE MRI and improved delineation of osseous pathologies, allowing for increased diagnostic confidence in bone assessment.
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Affiliation(s)
- Falko Ensle
- Diagnostic and Interventional Radiology, University Hospital Zurich, University Zurich, Zurich, Switzerland.
- University of Zurich (UZH), Raemistrasse 100, CH-8091, Zurich, Switzerland.
| | - Malwina Kaniewska
- Diagnostic and Interventional Radiology, University Hospital Zurich, University Zurich, Zurich, Switzerland
- University of Zurich (UZH), Raemistrasse 100, CH-8091, Zurich, Switzerland
| | | | - Roman Guggenberger
- Diagnostic and Interventional Radiology, University Hospital Zurich, University Zurich, Zurich, Switzerland
- University of Zurich (UZH), Raemistrasse 100, CH-8091, Zurich, Switzerland
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Liu G, Huang C, Li Y, Jiang S, Lu W, Yacoub Hassan MH, Essien AE, Pavel V, Xiao W. Accuracy and Consistency of 3-Dimensional Magnetic Resonance Imaging Is Comparable With 3-Dimensional Computed Tomography in Assessing Glenohumeral Instability: A Systematic Review. Arthroscopy 2024:S0749-8063(24)00266-4. [PMID: 38599537 DOI: 10.1016/j.arthro.2024.03.043] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/20/2023] [Revised: 03/23/2024] [Accepted: 03/24/2024] [Indexed: 04/12/2024]
Abstract
PURPOSE To compare the accuracy of 3-dimensional (3D) magnetic resonance imaging (MRI) with that of 3D computed tomography (CT) in evaluating glenoid bone loss (GBL). METHODS This review aligned with Preferred Reporting Items for Systematic Reviews and Meta-analyses guidelines. PubMed, the Cochrane Library, Embase, and Web of Science were obtained from data inception to August 28, 2023. The search term "glenoid bone loss" was extracted and analyzed via stringent inclusion and exclusion criteria. The Quality Assessment of Diagnostic Accuracy Studies (QUADAS)-2 combined with the QUADAS-Comparative to assess the heterogeneity of included studies. RESULTS A total of 1,589 related studies were retrieved, and 10 studies were finally included, of which a total of 143 shoulders were evaluated. The index test in QUADAS-Comparative was low risk in 9 studies. 3D MRI measurements of GBL were primarily best-fit circles (n = 9). In both clinical and cadaveric studies, the mean percentages of GBL measured by 3D MRI were 0.38% to 2.19% and 0.25% to 6.1% when compared with 3D CT and standard reference values, respectively. Intraclass correlation coefficient agreement greater than 0.9 between GBL percentages measured by 3D CT and 3D MRI. 3D MRI also could accurately measure glenoid width, glenoid height, humeral head width, and height. 3D MRI reconstruction time was similar to that of 3D CT, which was mainly 10 to 15 minutes. CONCLUSIONS In both clinical and cadaveric studies, compared with 3D CT, 3D MRI is accurate and consistent in assessing glenohumeral bone, especially in measuring GBL, and the reconstruction time of 3D MRI is similar to 3D CT. LEVEL OF EVIDENCE Level Ⅲ, systematic review of Level Ⅱ-Ⅲ studies.
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Affiliation(s)
- Gaoming Liu
- Department of Orthopedics, Xiangya Hospital, Central South University, Changsha, China
| | - Cheng Huang
- Department of Orthopaedics, China-Japan Friendship Hospital, Beijing, China
| | - Yusheng Li
- Department of Orthopedics, Xiangya Hospital, Central South University, Changsha, China; National Clinical Research Center for Geriatric Disorders, Xiangya Hospital, Central South University, Changsha, China
| | - Shide Jiang
- Department of Orthopedics, The Central Hospital of Yongzhou, Yongzhou, China
| | - Wenhao Lu
- Department of Orthopedics, Xiangya Hospital, Central South University, Changsha, China
| | | | - Anko Elijah Essien
- Department of Orthopedics, Xiangya Hospital, Central South University, Changsha, China
| | - Volotovski Pavel
- Republican Scientific and Practical Center of Traumatology and Orthopedics, Minsk, Belarus
| | - Wenfeng Xiao
- Department of Orthopedics, Xiangya Hospital, Central South University, Changsha, China; National Clinical Research Center for Geriatric Disorders, Xiangya Hospital, Central South University, Changsha, China.
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Lee D, Kim E, Woo H, Jeon CY, Yoon J, Choi J. Fast field echo resembling CT using restricted echo-spacing (FRACTURE) MR sequence can provide craniocervical region images comparable to a CT in dogs. Front Bioeng Biotechnol 2024; 12:1297675. [PMID: 38476967 PMCID: PMC10927716 DOI: 10.3389/fbioe.2024.1297675] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2023] [Accepted: 02/09/2024] [Indexed: 03/14/2024] Open
Abstract
Magnetic resonance imaging (MRI) is essential for evaluating cerebellar compression in patients with craniocervical junction abnormalities (CJA). However, it is limited in depicting cortical bone because of its short T2 relaxation times, low proton density, and organized structure. Fast field echo resembling a computed tomography (CT) scan using restricted echo-spacing (FRACTURE) MRI, is a new technique that offers CT-like bone contrast without radiation. This study aimed to assess the feasibility of using FRACTURE MRI for craniocervical junction (CCJ) assessment compared with CT and conventional MRI, potentially reducing the need for multiple scans and radiation exposure, and simplifying procedures in veterinary medicine. CT and MRI of the CCJ were obtained from five healthy beagles. MRI was performed using three-dimensional (3D) T1-weighted, T2-weighted, proton density-weighted (PDW), single echo-FRACTURE (sFRACTURE), and multiple echo-FRACTURE (mFRACTURE) sequences. For qualitative assessment, cortical delineation, trabecular bone visibility, joint space visibility, vertebral canal definition, overall quality, and artifacts were evaluated for each sequence. The geometrical accuracy, signal-to-noise ratio (SNR), and contrast-to-noise ratio (CNR) were quantified. Both sFRACTURE and CT images provided significantly higher scores for cortical delineation and trabecular bone visibility than conventional MRI. Joint space visibility and vertebral canal definition were similar to those observed on CT images, regardless of the MR sequence. In the quantitative assessment, the distances measured on T2-weighted images differed significantly from those measured on CT. There were no significant differences between the distances taken using T1-weighted, PD-weighted, sFRACTURE, mFRACTURE and those taken using CT. T1-weighted and sFRACTURE had a higher SNR for trabecular bone than CT. The CNR between the cortical bone and muscle was high on CT and FRACTURE images. However, the CNR between the cortical and trabecular bones was low in mFRACTURE. Similar to CT, FRACTURE sequences showed higher cortical delineation and trabecular bone visibility than T2-weighted, T1-weighted, and PDW CCJ sequences. In particular, sFRACTURE provided a high signal-to-noise ratio (SNR) of the trabecular bone and a high CNR between the cortical bone and muscle and between the cortical and trabecular bones. FRACTURE sequences can complement conventional MR sequences for bone assessment of the CCJ in dogs.
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Affiliation(s)
- Dongjae Lee
- Department of Veterinary Medical Imaging, College of Veterinary Medicine, Seoul National University, Seoul, Republic of Korea
| | - Eunjee Kim
- Department of Veterinary Medical Imaging, College of Veterinary Medicine, Seoul National University, Seoul, Republic of Korea
| | - Hyeonjae Woo
- Department of Veterinary Medical Imaging, College of Veterinary Medicine, Seoul National University, Seoul, Republic of Korea
| | - Chang-Yeop Jeon
- National Primate Research Center, Korea Research Institute of Bioscience and Biotechnology, Cheongju, Republic of Korea
| | - Junghee Yoon
- Department of Veterinary Medical Imaging, College of Veterinary Medicine, Seoul National University, Seoul, Republic of Korea
| | - Jihye Choi
- Department of Veterinary Medical Imaging, College of Veterinary Medicine, Seoul National University, Seoul, Republic of Korea
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Silva FD, Ramachandran S, Chhabra A. Glenohumeral osteoarthritis: what the surgeon needs from the radiologist. Skeletal Radiol 2023; 52:2283-2296. [PMID: 36287234 DOI: 10.1007/s00256-022-04206-2] [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: 07/06/2022] [Revised: 10/06/2022] [Accepted: 10/09/2022] [Indexed: 02/02/2023]
Abstract
Glenohumeral osteoarthritis (GHOA) is a widely prevalent disease with increasing frequency due to population aging. Both clinical manifestations and radiography play key roles in the initial diagnosis, staging, and management decisions. Radiographic disease progression evaluation is performed using validated staging systems, such as Kellgren and Lawrence, Samilson, and Hamada. For young patients with mild to moderate GHOA and failed conservative treatment, arthroscopic preservation surgery (APS) is usually considered. Older patients and those with severe GHOA benefit from different types of arthroplasties. Preoperative magnetic resonance imaging (MRI) is essential for APS surgical planning, as it maps repairable labral, cartilage, and rotator cuff lesions. For arthroplasty planning, the status of glenoid cartilage and intactness of rotator cuff as well as glenoid morphology represent key factors guiding the decision regarding the most suitable hardware design, whether resurfacing, partial, total, or reverse joint replacement. Pre-surgical MRI or alternatively computed tomography arthrogram is employed to evaluate the cartilage and rotator cuff. Finally, three-dimensional computed tomography (3D CT) is indicated to optimally assess the glenoid morphology (to determine Walch classification, version, inclination, and bone loss) and analyze the necessity for glenoid osteotomy or graft augmentation to correct the glenoid structural abnormalities for future success and longevity of the shoulder implants or chosen constructs. Understanding the purpose of each imaging and treatment modality allows more efficient image interpretation. This article reviews the above concepts and details what a surgeon needs from a radiologist and could benefit from accurate reporting of preoperative imaging studies.
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Affiliation(s)
| | | | - Avneesh Chhabra
- Musculoskeletal Radiology, UT Southwestern, Dallas, TX, 75390-9178, USA.
- Orthopedic Surgery, UT Southwestern, Dallas, TX, 75390-9178, USA.
- Johns Hopkins University, Baltimore, MD, USA.
- University of Dallas, Irving, TX, USA.
- Walton Centre for Neuroscience, Liverpool, UK.
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11
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Cheng KY, Moazamian D, Ma Y, Jang H, Jerban S, Du J, Chung CB. Clinical application of ultrashort echo time (UTE) and zero echo time (ZTE) magnetic resonance (MR) imaging in the evaluation of osteoarthritis. Skeletal Radiol 2023; 52:2149-2157. [PMID: 36607355 PMCID: PMC10323038 DOI: 10.1007/s00256-022-04269-1] [Citation(s) in RCA: 9] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/03/2022] [Revised: 12/13/2022] [Accepted: 12/13/2022] [Indexed: 01/07/2023]
Abstract
Novel compositional magnetic resonance (MR) imaging techniques have allowed for both the qualitative and quantitative assessments of tissue changes in osteoarthritis, many of which are difficult to characterize on conventional MR imaging. Ultrashort echo time (UTE) and zero echo time (ZTE) MR imaging have not been broadly implemented clinically but have several applications that leverage contrast mechanisms for morphologic evaluation of bone and soft tissue, as well as biochemical assessment in various stages of osteoarthritis progression. Many of the musculoskeletal tissues implicated in the initiation and progression of osteoarthritis are short T2 in nature, appearing dark as signal has already decayed to its minimum when image sampling starts. UTE and ZTE MR imaging allow for the qualitative and quantitative assessments of these short T2 tissues (bone, tendon, calcified cartilage, meniscus, and ligament) with both structural and functional reference standards described in the literature [1-3]. This review will describe applications of UTE and ZTE MR imaging in musculoskeletal tissues focusing on its role in knee osteoarthritis. While the review will address tissue-specific applications of these sequences, it is understood that osteoarthritis is a whole joint process with involvement and interdependence of all tissues. KEY POINTS: • UTE MR imaging allows for the qualitative and quantitative evaluation of short T2 tissues (bone, calcified cartilage, and meniscus), enabling identification of both early degenerative changes and subclinical injuries that may predispose to osteoarthritis. • ZTE MR imaging allows for the detection of signal from bone, which has some of the shortest T2 values, and generates tissue contrast similar to CT, potentially obviating the need for CT in the assessment of osseous features of osteoarthritis.
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Affiliation(s)
- Karen Y Cheng
- Department of Radiology, University of California, San Diego, CA, USA
| | - Dina Moazamian
- Department of Radiology, University of California, San Diego, CA, USA
| | - Yajun Ma
- Department of Radiology, University of California, San Diego, CA, USA
| | - Hyungseok Jang
- Department of Radiology, University of California, San Diego, CA, USA
| | - Saeed Jerban
- Department of Radiology, University of California, San Diego, CA, USA
- Research Service, Veterans Affairs San Diego Healthcare System, San Diego, CA, USA
- Department of Orthopedic Surgery, University of California, San Diego, San Diego, CA, USA
| | - Jiang Du
- Department of Radiology, University of California, San Diego, CA, USA
- Research Service, Veterans Affairs San Diego Healthcare System, San Diego, CA, USA
- Department of Bioengineering, University of California, San Diego, CA, USA
| | - Christine B Chung
- Department of Radiology, University of California, San Diego, CA, USA.
- Department of Radiology, Veterans Affairs San Diego Healthcare System, San Diego, CA, USA.
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12
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Wong V, Calivá F, Su F, Pedoia V, Lansdown D. Comparing bone shape models from deep learning processing of magnetic resonance imaging to computed tomography-based models. JSES Int 2023; 7:861-867. [PMID: 37719825 PMCID: PMC10499848 DOI: 10.1016/j.jseint.2023.05.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/19/2023] Open
Abstract
Background The purpose of this study was to develop a deep learning approach to automatically segment the scapular bone on magnetic resonance imaging (MRI) images and to compare the accuracy of these three-dimensional (3D) models with that of 3D computed tomography (CT). Methods Fifty-five patients with high-resolution 3D fat-saturated T2 MRI were retrospectively identified. The underlying pathology included rotator cuff tendinopathy and tears, shoulder instability, and impingement. Two experienced musculoskeletal researchers manually segmented the scapular bone. Five cross-validation training and validation splits were generated to independently train two-dimensional (2D) and 3D models using a convolutional neural network approach. Model performance was evaluated using the Dice similarity coefficient (DSC). All models with DSC > 0.70 were ensembled and used for the test set, which consisted of four patients with matching high-resolution MRI and CT scans. Clinically relevant glenoid measurements, including glenoid height, width, and retroversion, were calculated for two of the patients. Paired t-tests and Wilcoxon signed-rank tests were used to compare the DSC of the models. Results The 2D and 3D models achieved a best DSC of 0.86 and 0.82, respectively, with no significant difference observed. Augmentation of imaging data significantly improved 3D but not 2D model performance. In comparing clinical measurements of 3D MRI and CT, there was a mean difference ranging from 1.29 mm to 3.46 mm and 0.05° to 7.47°. Conclusion We have presented a fully automatic, deep learning-based strategy for extracting scapular shape from a high-resolution MRI scan. Further developments of this technology have the potential to allow for surgeons to obtain all clinically relevant information from MRI scans and reduce the need for multiple imaging studies for patients with shoulder pathology.
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Affiliation(s)
- Victoria Wong
- Center for Intelligent Imaging, Radiology and Biomedical Imaging, University of California San Francisco, San Francisco, CA, USA
| | - Francesco Calivá
- Center for Intelligent Imaging, Radiology and Biomedical Imaging, University of California San Francisco, San Francisco, CA, USA
| | - Favian Su
- Department of Orthopaedic Surgery, University of California San Francisco, San Francisco, CA, USA
| | - Valentina Pedoia
- Center for Intelligent Imaging, Radiology and Biomedical Imaging, University of California San Francisco, San Francisco, CA, USA
| | - Drew Lansdown
- Department of Orthopaedic Surgery, University of California San Francisco, San Francisco, CA, USA
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13
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Puel U, Lombard C, Hossu G, Louis M, Blum A, Teixeira PAG, Gillet R. Zero echo time MRI in shoulder MRI protocols for the diagnosis of rotator cuff calcific tendinopathy improves identification of calcific deposits compared to conventional MR sequences but remains sub-optimal compared to radiographs. Eur Radiol 2023; 33:6381-6391. [PMID: 37014406 DOI: 10.1007/s00330-023-09602-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2022] [Revised: 02/02/2023] [Accepted: 02/22/2023] [Indexed: 04/05/2023]
Abstract
OBJECTIVE To compare the diagnostic performance of standard MRI and standard MRI + ZTE images for the detection of rotator cuff calcific tendinopathy (RCCT) and to describe the artifacts encountered with ZTE images, using computed radiography (CR) as a reference. METHODS In a retrospective study, patients with suspicion of rotator cuff tendinopathy who underwent standard MRI + ZTE images after radiography were enrolled between June 2021 and June 2022. Images were independently analyzed for calcific deposit presence and ZTE images artifacts, by two radiologists. Diagnostic performance was calculated individually with MRI + CR as the reference standard. RESULTS A total of 46 RCCT subjects (27 women; mean age, 55.3 years ± 12.4) and 51 control subjects (27 men; mean age, 45.5 ± 12.9) were evaluated. For both readers, there was an increase in the sensitivity for the identification of calcific deposits of MRI + ZTE compared to MRI (77% (95% CI: 64.5-86.8) and 75.4% (95% CI: 62.7-85.5) versus 57.4% (95% IC: 44.1-70) and 47.5% (95% IC: 34.6-60.7), for R1 and R2, respectively). Specificity was quite similar for both readers and both imaging techniques and ranged from 96.6% (95% IC: 93.3-98.5) to 98.7% (95% IC: 96.3-99.7). Hyperintense joint fluid (62.8% of patients), long head of the biceps tendon (in 60.8%), and subacromial bursa (in 27.8%) on ZTE were considered artifactual. CONCLUSION The addition of ZTE images to a standard MRI protocol improved MRI diagnostic performance of RCCT, but with a suboptimal detection rate and a relatively high frequency of artifactual soft tissue signal hyperintensity. KEY POINTS • Adding ZTE images to standard shoulder MRI improves the MR-based detection of rotator cuff calcific tendinopathy, but half of the calcification unseen with standard MRI remained unseen with ZTE MRI. On ZTE images, joint fluid and long head biceps tendon were hyperintense in about 60% of the shoulders, as well as the subacromial bursa in about 30%, without calcific deposit on conventional radiographs. • The detection rate of calcific deposits using ZTE images was dependent on the disease phase. In the calcific stage, it reached 100% in this study but remained at a maximum of 80.7% in the resorptive phase.
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Affiliation(s)
- Ulysse Puel
- Guilloz Imaging Department, Central Hospital, University Hospital Center of Nancy, 29 Avenue du Marechal de Lattre de Tassigny, 54000, Nancy, France
- Guilloz Imaging Department, Saint-Charles Hospital, University Hospital Center of Nancy, Toul, France
| | - Charles Lombard
- Guilloz Imaging Department, Central Hospital, University Hospital Center of Nancy, 29 Avenue du Marechal de Lattre de Tassigny, 54000, Nancy, France
- Guilloz Imaging Department, Saint-Charles Hospital, University Hospital Center of Nancy, Toul, France
| | - Gabriela Hossu
- Université de Lorraine, INSERM, IADI, Nancy, France
- CIC, Innovation Technologique, Université de Lorraine, University Hospital Center of Nancy, Nancy, France
| | - Mathias Louis
- Guilloz Imaging Department, Central Hospital, University Hospital Center of Nancy, 29 Avenue du Marechal de Lattre de Tassigny, 54000, Nancy, France
- Guilloz Imaging Department, Saint-Charles Hospital, University Hospital Center of Nancy, Toul, France
| | - Alain Blum
- Guilloz Imaging Department, Central Hospital, University Hospital Center of Nancy, 29 Avenue du Marechal de Lattre de Tassigny, 54000, Nancy, France
- Guilloz Imaging Department, Saint-Charles Hospital, University Hospital Center of Nancy, Toul, France
- Université de Lorraine, INSERM, IADI, Nancy, France
| | - Pedro Augusto Gondim Teixeira
- Guilloz Imaging Department, Central Hospital, University Hospital Center of Nancy, 29 Avenue du Marechal de Lattre de Tassigny, 54000, Nancy, France
- Guilloz Imaging Department, Saint-Charles Hospital, University Hospital Center of Nancy, Toul, France
- Université de Lorraine, INSERM, IADI, Nancy, France
| | - Romain Gillet
- Guilloz Imaging Department, Central Hospital, University Hospital Center of Nancy, 29 Avenue du Marechal de Lattre de Tassigny, 54000, Nancy, France.
- Guilloz Imaging Department, Saint-Charles Hospital, University Hospital Center of Nancy, Toul, France.
- Université de Lorraine, INSERM, IADI, Nancy, France.
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14
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Thacher RR, Retzky JS, Dekhne MS, Oquendo YA, Greditzer HG. Current Concepts in the Measurement of Glenohumeral Bone Loss. Curr Rev Musculoskelet Med 2023; 16:419-431. [PMID: 37341857 PMCID: PMC10427601 DOI: 10.1007/s12178-023-09852-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 06/09/2023] [Indexed: 06/22/2023]
Abstract
PURPOSE The extent of glenohumeral bone loss seen in anterior shoulder dislocations plays a major role in guiding surgical management of these patients. The need for accurate and reliable preoperative assessment of bone loss on imaging studies is therefore of paramount importance to orthopedic surgeons. This article will focus on the tools that are available to clinicians for quantifying glenoid bone loss with a focus on emerging trends and research in order to describe current practices. RECENT FINDINGS Recent evidence supports the use of 3D CT as the most optimal method for quantifying bone loss on the glenoid and humerus. New trends in the use of 3D and ZTE MRI represent exciting alternatives to CT imaging, although they are not widely used and require further investigation. Contemporary thinking surrounding the glenoid track concept and the symbiotic relationship between glenoid and humeral bone loss on shoulder stability has transformed our understanding of these lesions and has inspired a new focus of study for radiologists and orthopedist alike. Although a number of different advanced imaging modalities are utilized to detect and quantify glenohumeral bone loss in practice, the current literature supports 3D CT imaging to provide the most reliable and accurate assessments. The emergence of the glenoid track concept for glenoid and humeral head bone loss has inspired a new area of study for researchers that presents exciting opportunities for the development of a deeper understanding of glenohumeral instability in the future. Ultimately, however, the heterogeneity of literature, which speaks to the diverse practices that exist across the world, limits any firm conclusions from being drawn.
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Affiliation(s)
- Ryan R Thacher
- Department of Orthopaedic Surgery, Hospital for Special Surgery, 535 East 70Th Street, New York, NY, 10021, USA.
| | - Julia S Retzky
- Department of Orthopaedic Surgery, Hospital for Special Surgery, 535 East 70Th Street, New York, NY, 10021, USA
| | - Mihir S Dekhne
- Department of Orthopaedic Surgery, Hospital for Special Surgery, 535 East 70Th Street, New York, NY, 10021, USA
| | - Yousi A Oquendo
- Department of Orthopaedic Surgery, Hospital for Special Surgery, 535 East 70Th Street, New York, NY, 10021, USA
| | - Harry G Greditzer
- Department of Radiology, Hospital for Special Surgery, 535 East 70Th Street, New York, NY, 10021, USA
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15
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Vuillemin V, Guerini H, Thévenin F, Sibileau E, Corcos G, Khaled W, Zeitoun F, Morvan G. Bone Tissue in Magnetic Resonance Imaging: Contribution of New Zero Echo Time Sequences. Semin Musculoskelet Radiol 2023; 27:411-420. [PMID: 37748464 DOI: 10.1055/s-0043-1770771] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/27/2023]
Abstract
The introduction of new ultrashort and zero echo time (ZTE) sequences is revolutionizing magnetic resonance imaging (MRI) and optimizing patient management. These sequences acquire signals in tissues with very short T2: mineralized bone, cortical bone, and calcium deposits. They can be added to a classic MRI protocol. ZTE MRI provides computed tomography-like contrast for bone.
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16
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Aydıngöz Ü, Yıldız AE, Huri G. Glenoid Track Assessment at Imaging in Anterior Shoulder Instability: Rationale and Step-by-Step Guide. Radiographics 2023; 43:e230030. [PMID: 37410625 DOI: 10.1148/rg.230030] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/08/2023]
Abstract
Anterior shoulder dislocation is the most common form of joint instability in humans, usually resulting in soft-tissue injury to the glenohumeral capsuloligamentous and labral structures. Bipolar bone lesions in the form of fractures of the anterior glenoid rim and posterolateral humeral head are often associated with anterior shoulder dislocation and can be a cause or result of recurrent dislocations. Glenoid track assessment is an evolving concept that incorporates the pathomechanics of anterior shoulder instability into its management. Currently widely endorsed by orthopedic surgeons, this concept has ramifications for prognostication, treatment planning, and outcome assessment of anterior shoulder dislocation. The glenoid track is the contact zone between the humeral head and glenoid during shoulder motion from the neutral position to abduction and external rotation. Two key determinants of on-track or off-track status of a Hill-Sachs lesion (HSL) are the glenoid track width (GTW) and Hill-Sachs interval (HSI). If the GTW is less than the HSI, an HSL is off track. If the GTW is greater than the HSI, an HSL is on track. The authors focus on the rationale behind the glenoid track concept and explain stepwise assessment of the glenoid track at CT or MRI. Off-track to on-track conversion is a primary goal in stabilizing the shoulder with anterior instability. The key role that imaging plays in glenoid track assessment warrants radiologists' recognition of this concept along with its challenges and pitfalls and the production of relevant and actionable radiology reports for orthopedic surgeons-to the ultimate benefit of patients. ©RSNA, 2023 Online supplemental material is available for this article. Quiz questions for this article are available through the Online Learning Center.
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Affiliation(s)
- Üstün Aydıngöz
- From the Department of Radiology (Ü.A., A.E.Y.) and Department of Orthopedics and Traumatology (G.H.), Hacettepe University School of Medicine, 06230 Ankara, Turkey
| | - Adalet Elçin Yıldız
- From the Department of Radiology (Ü.A., A.E.Y.) and Department of Orthopedics and Traumatology (G.H.), Hacettepe University School of Medicine, 06230 Ankara, Turkey
| | - Gazi Huri
- From the Department of Radiology (Ü.A., A.E.Y.) and Department of Orthopedics and Traumatology (G.H.), Hacettepe University School of Medicine, 06230 Ankara, Turkey
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17
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Jungmann PM, Lange T, Wenning M, Baumann FA, Bamberg F, Jung M. Ankle Sprains in Athletes: Current Epidemiological, Clinical and Imaging Trends. Open Access J Sports Med 2023; 14:29-46. [PMID: 37252646 PMCID: PMC10216848 DOI: 10.2147/oajsm.s397634] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2022] [Accepted: 05/06/2023] [Indexed: 05/31/2023] Open
Abstract
Purpose Ankle injuries are frequent sports injuries. Despite optimizing treatment strategies during recent years, the percentage of chronification following an ankle sprain remains high. The purpose of this review article is, to highlight current epidemiological, clinical and novel advanced cross-sectional imaging trends that may help to evaluate ankle sprain injuries. Methods Systematic PubMed literature research. Identification and review of studies (i) analyzing and describing ankle sprain and (ii) focusing on advanced cross-sectional imaging techniques at the ankle. Results The ankle is one of the most frequently injured body parts in sports. During the COVID-19 pandemic, there was a change in sporting behavior and sports injuries. Ankle sprains account for about 16-40% of the sports-related injuries. Novel cross-sectional imaging techniques, including Compressed Sensing MRI, 3D MRI, ankle MRI with traction or plantarflexion-supination, quantitative MRI, CT-like MRI, CT arthrography, weight-bearing cone beam CT, dual-energy CT, photon-counting CT, and projection-based metal artifact reduction CT may be introduced for detection and evaluation of specific pathologies after ankle injury. While simple ankle sprains are generally treated conservatively, unstable syndesmotic injuries may undergo stabilization using suture-button-fixation. Minced cartilage implantation is a novel cartilage repair technique for osteochondral defects at the ankle. Conclusion Applications and advantages of different cross-sectional imaging techniques at the ankle are highlighted. In a personalized approach, optimal imaging techniques may be chosen that best detect and delineate structural ankle injuries in athletes.
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Affiliation(s)
- Pia M Jungmann
- Department of Diagnostic and Interventional Radiology, Medical Center–University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany
- Department of Radiology, Kantonsspital Graubünden, Chur, Switzerland
| | - Thomas Lange
- Department of Radiology, Medical Physics, Medical Center – University of Freiburg, Faculty of Medicine, Freiburg, Germany
| | - Markus Wenning
- Department of Orthopedic and Trauma Surgery, Medical Center – University of Freiburg, Faculty of Medicine, Freiburg, Germany
| | - Frédéric A Baumann
- Department of Vascular Medicine, Hospital of Schiers, Schiers, Switzerland
| | - Fabian Bamberg
- Department of Diagnostic and Interventional Radiology, Medical Center–University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Matthias Jung
- Department of Diagnostic and Interventional Radiology, Medical Center–University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany
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18
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Nicholas Nacey, Fox MG, Blankenbaker DG, Chen D, Frick MA, Jawetz ST, Mathiasen RE, Raizman NM, Rajkotia KH, Said N, Stensby JD, Subhas N, Surasi DS, Walker EA, Chang EY. ACR Appropriateness Criteria® Chronic Shoulder Pain: 2022 Update. J Am Coll Radiol 2023; 20:S49-S69. [PMID: 37236752 DOI: 10.1016/j.jacr.2023.02.017] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2023] [Accepted: 02/27/2023] [Indexed: 05/28/2023]
Abstract
Chronic shoulder pain is an extremely common presenting complaint. Potential pain generators include the rotator cuff tendons, biceps tendon, labrum, glenohumeral articular cartilage, acromioclavicular joint, bones, suprascapular and axillary nerves, and the joint capsule/synovium. Radiographs are typically the initial imaging study obtained in patients with chronic shoulder pain. Further imaging may often be required, with modality chosen based on patient symptoms and physical examination findings, which may lead the clinician to suspect a specific pain generator. The American College of Radiology Appropriateness Criteria are evidence-based guidelines for specific clinical conditions that are reviewed annually by a multidisciplinary expert panel. The guideline development and revision process support the systematic analysis of the medical literature from peer reviewed journals. Established methodology principles such as Grading of Recommendations Assessment, Development, and Evaluation or GRADE are adapted to evaluate the evidence. The RAND/UCLA Appropriateness Method User Manual provides the methodology to determine the appropriateness of imaging and treatment procedures for specific clinical scenarios. In those instances where peer reviewed literature is lacking or equivocal, experts may be the primary evidentiary source available to formulate a recommendation.
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Affiliation(s)
- Nicholas Nacey
- Panel Vice-Chair, University of Virginia Health System, Charlottesville, Virginia.
| | | | - Donna G Blankenbaker
- University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin
| | - Doris Chen
- Stanford University, Stanford, California, Primary care physician
| | | | | | - Ross E Mathiasen
- University of Nebraska Medical Center, Omaha, Nebraska; American College of Emergency Physicians
| | - Noah M Raizman
- The Centers for Advanced Orthopaedics, George Washington University, Washington, District of Columbia; American Academy of Orthopaedic Surgeons
| | - Kavita H Rajkotia
- University of Michigan Health System, Ann Arbor, Michigan; Committee on Emergency Radiology-GSER
| | - Nicholas Said
- Duke University Medical Center, Durham, North Carolina
| | | | | | - Devaki Shilpa Surasi
- The University of Texas MD Anderson Cancer Center, Houston, Texas; Commission on Nuclear Medicine and Molecular Imaging
| | - Eric A Walker
- Penn State Milton S. Hershey Medical Center, Hershey, Pennsylvania, and Uniformed Services University of the Health Sciences, Bethesda, Maryland
| | - Eric Y Chang
- Specialty Chair, VA San Diego Healthcare System, San Diego, California
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19
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Oeding JF, Williams RJ, Nwachukwu BU, Martin RK, Kelly BT, Karlsson J, Camp CL, Pearle AD, Ranawat AS, Pareek A. A practical guide to the development and deployment of deep learning models for the Orthopedic surgeon: part I. Knee Surg Sports Traumatol Arthrosc 2023; 31:382-389. [PMID: 36427077 DOI: 10.1007/s00167-022-07239-1] [Citation(s) in RCA: 8] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/08/2022] [Accepted: 11/15/2022] [Indexed: 11/26/2022]
Abstract
Deep learning has a profound impact on daily life. As Orthopedics makes use of this rapid escalation in technology, Orthopedic surgeons will need to take leadership roles on deep learning projects. Moreover, surgeons must possess an understanding of what is necessary to design and implement deep learning-based project pipelines. This review provides a practical guide for the Orthopedic surgeon to understand the steps needed to design, develop, and deploy a deep learning pipeline for clinical applications. A detailed description of the processes involved in defining the problem, building the team, acquiring and curating the data, labeling the data, establishing the ground truth, pre-processing and augmenting the data, and selecting the required hardware is provided. In addition, an overview of unique considerations involved in the training and evaluation of deep learning models is provided. This review strives to provide surgeons with the groundwork needed to identify gaps in the clinical landscape that deep learning models may be able to fill and equips them with the knowledge needed to lead an interdisciplinary team through the process of creating novel deep-learning-based solutions to fill those gaps.
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Affiliation(s)
- Jacob F Oeding
- School of Medicine, Mayo Clinic Alix School of Medicine, Rochester, MN, USA
| | - Riley J Williams
- Sports Medicine and Shoulder Service, Hospital for Special Surgery, 535 East 70th Street, New York, NY, 10021, USA
| | - Benedict U Nwachukwu
- Sports Medicine and Shoulder Service, Hospital for Special Surgery, 535 East 70th Street, New York, NY, 10021, USA
| | - R Kyle Martin
- Department of Orthopedic Surgery, University of Minnesota, Minneapolis, MN, USA
| | - Bryan T Kelly
- Sports Medicine and Shoulder Service, Hospital for Special Surgery, 535 East 70th Street, New York, NY, 10021, USA
| | - Jón Karlsson
- Department of Orthopaedics, Sahlgrenska University Hospital, Sahlgrenska Academy, Gothenburg University, Gothenburg, Sweden
| | - Christopher L Camp
- Department of Orthopedic Surgery and Sports Medicine, Rochester, MN, USA
| | - Andrew D Pearle
- Sports Medicine and Shoulder Service, Hospital for Special Surgery, 535 East 70th Street, New York, NY, 10021, USA
| | - Anil S Ranawat
- Sports Medicine and Shoulder Service, Hospital for Special Surgery, 535 East 70th Street, New York, NY, 10021, USA
| | - Ayoosh Pareek
- Sports Medicine and Shoulder Service, Hospital for Special Surgery, 535 East 70th Street, New York, NY, 10021, USA.
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20
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Borreguero J, Galve F, Algarín JM, Benlloch JM, Alonso J. Low field slice-selective ZTE imaging of ultra-short [Formula: see text] tissues based on spin-locking. Sci Rep 2023; 13:1662. [PMID: 36717649 PMCID: PMC9886919 DOI: 10.1038/s41598-023-28640-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2022] [Accepted: 01/23/2023] [Indexed: 01/31/2023] Open
Abstract
Magnetic Resonance Imaging of hard biological tissues is very challenging due to small proton abundance and ultra-short [Formula: see text] decay times, especially at low magnetic fields, where sample magnetization is weak. While several pulse sequences, such as Ultra-short Echo Time (UTE), Zero Echo Time (ZTE) and SWeep Imaging with Fourier Transformation (SWIFT), have been developed to cope with ultra-short lived MR signals, only the latter two hold promise of imaging tissues with sub-millisecond [Formula: see text] times at low fields. All these sequences are intrinsically volumetric, thus 3D, because standard slice selection using a long soft radio-frequency pulse is incompatible with ultra-short lived signals. The exception is UTE, where double half pulses can perform slice selection, although at the cost of doubling the acquisition time. Here we demonstrate that spin-locking is a versatile and robust method for slice selection for ultra-short lived signals, and present three ways of combining this pulse sequence with ZTE imaging of the selected slice. With these tools, we demonstrate slice-selected 2D ex vivo imaging of the hardest tissues in the body at low field (260 mT) within clinically acceptable times.
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Affiliation(s)
| | - Fernando Galve
- Institute for Molecular Imaging and Instrumentation, Spanish National Research Council, 46022 Valencia, Spain
- Institute for Molecular Imaging and Instrumentation, Universitat Politècnica de València, 46022 Valencia, Spain
| | - José M. Algarín
- Institute for Molecular Imaging and Instrumentation, Spanish National Research Council, 46022 Valencia, Spain
- Institute for Molecular Imaging and Instrumentation, Universitat Politècnica de València, 46022 Valencia, Spain
| | - José M. Benlloch
- Institute for Molecular Imaging and Instrumentation, Spanish National Research Council, 46022 Valencia, Spain
- Institute for Molecular Imaging and Instrumentation, Universitat Politècnica de València, 46022 Valencia, Spain
| | - Joseba Alonso
- Institute for Molecular Imaging and Instrumentation, Spanish National Research Council, 46022 Valencia, Spain
- Institute for Molecular Imaging and Instrumentation, Universitat Politècnica de València, 46022 Valencia, Spain
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21
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Lombardi AF, Ma YJ, Jang H, Jerban S, Du J, Chang EY, Chung CB. Synthetic CT in Musculoskeletal Disorders: A Systematic Review. Invest Radiol 2023; 58:43-59. [PMID: 36070535 PMCID: PMC9742139 DOI: 10.1097/rli.0000000000000916] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
ABSTRACT Repeated computed tomography (CT) examinations increase patients' ionizing radiation exposure and health costs, making an alternative method desirable. Cortical and trabecular bone, however, have short T2 relaxation times, causing low signal intensity on conventional magnetic resonance (MR) sequences. Different techniques are available to create a "CT-like" contrast of bone, such as ultrashort echo time, zero echo time, gradient-echo, and susceptibility-weighted image MR sequences, and artificial intelligence. This systematic review summarizes the essential technical background and developments of ultrashort echo time, zero echo time, gradient-echo, susceptibility-weighted image MR imaging sequences and artificial intelligence; presents studies on research and clinical applications of "CT-like" MR imaging; and describes their main advantages and limitations. We also discuss future opportunities in research, which patients would benefit the most, the most appropriate situations for using the technique, and the potential to replace CT in the clinical workflow.
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Affiliation(s)
- Alecio F Lombardi
- From the Department of Radiology, University of California San Diego, La Jolla, and the Research Service, Veterans Affairs San Diego Healthcare System, California
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3D-MRI versus 3D-CT in the evaluation of glenoid deformity in glenohumeral arthritis using Dixon 3D FLASH sequence. Skeletal Radiol 2022; 51:2281-2289. [PMID: 35737085 DOI: 10.1007/s00256-022-04086-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/17/2022] [Revised: 05/25/2022] [Accepted: 05/27/2022] [Indexed: 02/02/2023]
Abstract
OBJECTIVE To compare MRI with 3D reconstructions and 3D-CT with respect to assessment of glenoid wear in osteoarthritic shoulders. METHODS 3D reconstructions were generated for CT and MR (utilizing the Dixon technique) imaging performed on 29 osteoarthritic shoulders. Two reviewers independently performed glenoid morphometric measurements and evaluated glenoid erosion. Mean differences between the two modalities were calculated. Inter-observer agreement was calculated using kappa coefficient. RESULTS The combined mean absolute difference (bias) in glenoid version between 3D-CT and 3D-MRI was 2.7° ± 1.6° (range 0.15-7.85, P value = 0.7). The combined mean absolute difference in glenoid inclination between 3D-CT and 3D-MRI was 6.8° ± 4.1° (range 0.8°-15.75°, P value = 0.17). No significant inter-reader variation in glenoid version and inclination measurements on 3D-CT and 3D-MRI was found (P > 0.05). The inter-reader reliability for both CT and MRI was high for Walch grading of glenoid bone loss (κ = 1, κ = 0.81, respectively). CONCLUSIONS 3D-MRI is comparable to 3D-CT with respect to axial glenoid bone loss, as measured by glenoid version. However, for coronal bone loss estimation, measured by glenoid inclination, 3D-CT remains the gold standard. Thus, 3D-MR can be used as an alternative for preoperative assessment of glenoid version in arthritic shoulders.
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Ma Y, Jang H, Jerban S, Chang EY, Chung CB, Bydder GM, Du J. Making the invisible visible-ultrashort echo time magnetic resonance imaging: Technical developments and applications. APPLIED PHYSICS REVIEWS 2022; 9:041303. [PMID: 36467869 PMCID: PMC9677812 DOI: 10.1063/5.0086459] [Citation(s) in RCA: 14] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/25/2022] [Accepted: 09/12/2022] [Indexed: 05/25/2023]
Abstract
Magnetic resonance imaging (MRI) uses a large magnetic field and radio waves to generate images of tissues in the body. Conventional MRI techniques have been developed to image and quantify tissues and fluids with long transverse relaxation times (T2s), such as muscle, cartilage, liver, white matter, gray matter, spinal cord, and cerebrospinal fluid. However, the body also contains many tissues and tissue components such as the osteochondral junction, menisci, ligaments, tendons, bone, lung parenchyma, and myelin, which have short or ultrashort T2s. After radio frequency excitation, their transverse magnetizations typically decay to zero or near zero before the receiving mode is enabled for spatial encoding with conventional MR imaging. As a result, these tissues appear dark, and their MR properties are inaccessible. However, when ultrashort echo times (UTEs) are used, signals can be detected from these tissues before they decay to zero. This review summarizes recent technical developments in UTE MRI of tissues with short and ultrashort T2 relaxation times. A series of UTE MRI techniques for high-resolution morphological and quantitative imaging of these short-T2 tissues are discussed. Applications of UTE imaging in the musculoskeletal, nervous, respiratory, gastrointestinal, and cardiovascular systems of the body are included.
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Affiliation(s)
- Yajun Ma
- Department of Radiology, University of California, San Diego, California 92037, USA
| | - Hyungseok Jang
- Department of Radiology, University of California, San Diego, California 92037, USA
| | - Saeed Jerban
- Department of Radiology, University of California, San Diego, California 92037, USA
| | | | | | - Graeme M Bydder
- Department of Radiology, University of California, San Diego, California 92037, USA
| | - Jiang Du
- Author to whom correspondence should be addressed:. Tel.: (858) 246-2248, Fax: (858) 246-2221
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24
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Christopher HW, Grainger AJ. Anterior Shoulder Instability. Semin Musculoskelet Radiol 2022; 26:546-557. [DOI: 10.1055/s-0042-1756168] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
AbstractThe anatomy of the glenohumeral joint prioritizes mobility at the expense of stability and thus predisposes it to injury through dislocation. This article discusses the anatomical basis for instability and how it translates into patterns of injury, focusing on anterior instability. We suggest an approach to imaging the unstable shoulder and examine the imaging features seen in the context of anterior instability, along with consideration of postoperative appearances.
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Affiliation(s)
- Holly W. Christopher
- Department of Radiology, Cambridge University Hospitals NHS Foundation Trust, Cambridge, United Kingdom
| | - Andrew J. Grainger
- Department of Radiology, Cambridge University Hospitals NHS Foundation Trust, Cambridge, United Kingdom
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25
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Bharadwaj UU, Coy A, Motamedi D, Sun D, Joseph GB, Krug R, Link TM. CT-like MRI: a qualitative assessment of ZTE sequences for knee osseous abnormalities. Skeletal Radiol 2022; 51:1585-1594. [PMID: 35088162 PMCID: PMC9198000 DOI: 10.1007/s00256-021-03987-2] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/14/2021] [Revised: 12/15/2021] [Accepted: 12/29/2021] [Indexed: 02/02/2023]
Abstract
OBJECTIVE To qualitatively evaluate the utility of zero echo-time (ZTE) MRI sequences in identifying osseous findings and to compare ZTE with optimized spoiled gradient echo (SPGR) sequences in detecting knee osseous abnormalities. MATERIALS AND METHODS ZTE and standard knee MRI sequences were acquired at 3T in 100 consecutive patients. Three radiologists rated confidence in evaluating osseous abnormalities and image quality on a 5-grade Likert scale in ZTE compared to standard sequences. In a subset of knees (n = 57) SPGR sequences were also obtained, and diagnostic confidence in identifying osseous structures was assessed, comparing ZTE and SPGR sequences. Statistical significance of using ZTE over SPGR was characterized with a paired t-test. RESULTS Image quality of the ZTE sequences was rated high by all reviewers with 278 out of 299 (100 studies, 3 radiologists) scores ≥ 4 on the Likert scale. Diagnostic confidence in using ZTE sequences was rated "very high confidence" in 97%, 85%, 71%, and 73% of the cases for osteophytosis, subchondral cysts, fractures, and soft tissue calcifications/ossifications, respectively. In 74% of cases with osseous findings, reviewer scores indicated confidence levels (score ≥ 3) that ZTE sequences improved diagnostic certainty over standard sequences. The diagnostic confidence in using ZTE over SPGR sequences for osseous structures as well as abnormalities was favorable and statistically significant (p < 0.01). CONCLUSION Incorporating ZTE sequences in the standard knee MRI protocol was technically feasible and improved diagnostic confidence for osseous findings in relation to standard MR sequences. In comparison to SPGR sequences, ZTE improved assessment of osseous abnormalities.
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Affiliation(s)
- Upasana Upadhyay Bharadwaj
- Musculoskeletal Imaging, Department of Radiology and Biomedical Imaging, University of California San Francisco, 185 Berry Street, Suite 350, San Francisco, CA, 94107, USA.
| | - Adam Coy
- Musculoskeletal Imaging, Department of Radiology and Biomedical Imaging, University of California San Francisco, 185 Berry Street, Suite 350, San Francisco, CA, 94107, USA
- Musculoskeletal Radiology, Vision Radiology, Dallas, TX, USA
| | - Daria Motamedi
- Musculoskeletal Imaging, Department of Radiology and Biomedical Imaging, University of California San Francisco, 185 Berry Street, Suite 350, San Francisco, CA, 94107, USA
| | - Dong Sun
- Musculoskeletal Imaging, Department of Radiology and Biomedical Imaging, University of California San Francisco, 185 Berry Street, Suite 350, San Francisco, CA, 94107, USA
- Department of Radiology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Gabby B Joseph
- Musculoskeletal Imaging, Department of Radiology and Biomedical Imaging, University of California San Francisco, 185 Berry Street, Suite 350, San Francisco, CA, 94107, USA
| | - Roland Krug
- Musculoskeletal Imaging, Department of Radiology and Biomedical Imaging, University of California San Francisco, 185 Berry Street, Suite 350, San Francisco, CA, 94107, USA
| | - Thomas M Link
- Musculoskeletal Imaging, Department of Radiology and Biomedical Imaging, University of California San Francisco, 185 Berry Street, Suite 350, San Francisco, CA, 94107, USA
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Borreguero Morata J, González JM, Pallás E, Rigla JP, Algarín JM, Bosch R, Galve F, Grau‐Ruiz D, Pellicer R, Ríos A, Benlloch JM, Alonso J. Prepolarized MRI of hard tissues and solid-state matter. NMR IN BIOMEDICINE 2022; 35:e4737. [PMID: 35384092 PMCID: PMC9540585 DOI: 10.1002/nbm.4737] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/16/2021] [Revised: 03/25/2022] [Accepted: 03/31/2022] [Indexed: 05/25/2023]
Abstract
Prepolarized MRI (PMRI) is a long-established technique conceived to counteract the loss in signal-to-noise ratio (SNR) inherent to low-field MRI systems. When it comes to hard biological tissues and solid-state matter, PMRI is severely restricted by their ultra-short characteristic relaxation times. Here we demonstrate that efficient hard-tissue prepolarization is within reach with a special-purpose 0.26 T scanner designed for ex vivo dental MRI and equipped with suitable high-power electronics. We have characterized the performance of a 0.5 T prepolarizer module, which can be switched on and off in 200 μs. To this end, we have used resin, dental and bone samples, all with T1 times of the order of 20 ms at our field strength. The measured SNR enhancement is in good agreement with a simple theoretical model, and deviations in extreme regimes can be attributed to mechanical vibrations due to the magnetic interaction between the prepolarization and main magnets.
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Affiliation(s)
| | | | - Eduardo Pallás
- MRILab, Institute for Molecular Imaging and Instrumentation (i3M)Spanish National Research Council (CSIC) and Universitat Politècnica de València (UPV)ValenciaSpain
- Instituto de Instrumentación para Imagen MolecularCentro Mixto CSIC–Universitat Politècnica de ValènciaValenciaSpain
| | | | - José M. Algarín
- MRILab, Institute for Molecular Imaging and Instrumentation (i3M)Spanish National Research Council (CSIC) and Universitat Politècnica de València (UPV)ValenciaSpain
- Instituto de Instrumentación para Imagen MolecularCentro Mixto CSIC–Universitat Politècnica de ValènciaValenciaSpain
| | | | - Fernando Galve
- MRILab, Institute for Molecular Imaging and Instrumentation (i3M)Spanish National Research Council (CSIC) and Universitat Politècnica de València (UPV)ValenciaSpain
- Instituto de Instrumentación para Imagen MolecularCentro Mixto CSIC–Universitat Politècnica de ValènciaValenciaSpain
| | | | - Rubén Pellicer
- MRILab, Institute for Molecular Imaging and Instrumentation (i3M)Spanish National Research Council (CSIC) and Universitat Politècnica de València (UPV)ValenciaSpain
- Asociación de investigación MPCSan SebastiánSpain
| | | | - José M. Benlloch
- MRILab, Institute for Molecular Imaging and Instrumentation (i3M)Spanish National Research Council (CSIC) and Universitat Politècnica de València (UPV)ValenciaSpain
- Instituto de Instrumentación para Imagen MolecularCentro Mixto CSIC–Universitat Politècnica de ValènciaValenciaSpain
| | - Joseba Alonso
- MRILab, Institute for Molecular Imaging and Instrumentation (i3M)Spanish National Research Council (CSIC) and Universitat Politècnica de València (UPV)ValenciaSpain
- Instituto de Instrumentación para Imagen MolecularCentro Mixto CSIC–Universitat Politècnica de ValènciaValenciaSpain
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Nguyen JC, Guariento A, Williams BA, Lawrence JTR, Ganley TJ, Venkatesh TP, Sze RW. MRI evaluation of pediatric tibial eminence fractures: comparison between conventional and "CT-like" ultrashort echo time (UTE) images. Skeletal Radiol 2022; 51:1603-1610. [PMID: 35112140 DOI: 10.1007/s00256-022-04000-0] [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: 12/14/2021] [Revised: 01/20/2022] [Accepted: 01/20/2022] [Indexed: 02/02/2023]
Abstract
OBJECTIVE UTE MRI offers a radiation-free alternative to CT for bone depiction, but data on children is lacking. The purpose of this study was to determine whether UTE images improve detection and characterization of pediatric tibial eminence fractures. METHODS Fifteen MRIs with UTE from 12 children (10 boys, 2 girls; mean age: 12.6 ± 3.3 years) with tibial eminence fractures (2018-2020) and 15 age-matched MRIs without fractures were included. After randomization, 5 readers reviewed images without and with UTE, at least 1 month apart, and recorded the presence of fracture and preferred images. If fracture is present, radiologists also recorded fragment size, number, and displacement; surgeons assigned Meyers-McKeever grade and management. Disagreements on management were resolved through consensus review. Kappa and intra-class correlation (ICC), sensitivity, and specificity were used to compare agreement between readers and fracture detection between images without and with UTE. RESULTS For fracture detection, inter-reader agreement was almost perfect (κ-range: 0.91-0.93); sensitivity and specificity were equivalent between images without and with UTE (range: 95-100%). For fracture characterization, UTE improved agreement on size (ICC = 0.88 to 0.93), number (ICC = 0.52 to 0.94), displacement (ICC = 0.74 to 0.86), and grade (ICC = 0.92 to 0.93) but reduced agreement on management (κ = 0.68 to 0.61), leading to a change in consensus management in 20% (3/15). Radiologists were more likely to prefer UTE for fracture and conventional images for non-fracture cases (77% and 77%, respectively, p < 0.001). CONCLUSION While UTE did not improve diagnosis, it improved agreement on characterization of pediatric tibial eminence fractures, ultimately changing the preferred treatment in 20%.
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Affiliation(s)
- Jie C Nguyen
- Department of Radiology, Children's Hospital of Philadelphia, 3401 Civic Center Blvd, Philadelphia, PA, 19104, USA.
- University of Pennsylvania Perelman School of Medicine, Philadelphia, PA, USA.
| | - Andressa Guariento
- Department of Radiology, Children's Hospital of Philadelphia, 3401 Civic Center Blvd, Philadelphia, PA, 19104, USA
| | - Brendan A Williams
- University of Pennsylvania Perelman School of Medicine, Philadelphia, PA, USA
- Division of Orthopedic Surgery, Children's Hospital of Philadelphia, Philadelphia, PA, USA
| | - J Todd R Lawrence
- University of Pennsylvania Perelman School of Medicine, Philadelphia, PA, USA
- Division of Orthopedic Surgery, Children's Hospital of Philadelphia, Philadelphia, PA, USA
| | - Theodore J Ganley
- University of Pennsylvania Perelman School of Medicine, Philadelphia, PA, USA
- Division of Orthopedic Surgery, Children's Hospital of Philadelphia, Philadelphia, PA, USA
| | - Tanvi P Venkatesh
- Department of Radiology, Children's Hospital of Philadelphia, 3401 Civic Center Blvd, Philadelphia, PA, 19104, USA
- University of Pennsylvania Undergraduate Program, Philadelphia, PA, USA
| | - Raymond W Sze
- Department of Radiology, Children's Hospital of Philadelphia, 3401 Civic Center Blvd, Philadelphia, PA, 19104, USA
- University of Pennsylvania Perelman School of Medicine, Philadelphia, PA, USA
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28
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Aydıngöz Ü, Yıldız AE, Ergen FB. Zero Echo Time Musculoskeletal MRI: Technique, Optimization, Applications, and Pitfalls. Radiographics 2022; 42:1398-1414. [PMID: 35904982 DOI: 10.1148/rg.220029] [Citation(s) in RCA: 18] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
Zero echo time (ZTE) imaging is an MRI technique that produces images similar to those obtained with radiography or CT. In ZTE MRI, the very short T2 signal from the mineralized trabecular bone matrix and especially cortical bone-both of which have a low proton density (PD)-is sampled in a unique sequence setup. Additionally, the PD weighting of the ZTE sequence results in less contrast between soft tissues. Therefore, along with gray-scale inversion from black to white and vice versa, ZTE imaging provides excellent contrast between cortical bone and soft tissues similar to that of radiography and CT. However, despite isotropic or near-isotropic three-dimensional (3D) imaging capabilities of the ZTE sequence, spatial resolution in this technique is still inferior to that of radiography and CT, and 3D volume renderings are currently time-consuming and require postprocessing software that features segmentation and manual contouring. Optimization of ZTE MRI mostly entails adjustments of bandwidth, flip angle, field of view, and image matrix. A wide range of structural abnormalities and disease or healing processes in the musculoskeletal system are well delineated with ZTE MRI, including conditions that involve bone-based morphometric analyses (which aid diagnosis, help prognostication, and guide surgery), impaction, avulsion and stress fractures, loose bodies or erosions in and around joints, soft-tissue calcifications and ossifications, and bone tumors (including treatment response). The pitfalls of ZTE imaging include mimics of foci of calcification or ossification such as intra-articular gas and susceptibility artifacts from surgical materials and hemosiderin deposition, which can be avoided in many instances by cross-referencing images obtained with other MRI sequences. Online supplemental material is available for this article. ©RSNA, 2022.
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Affiliation(s)
- Üstün Aydıngöz
- From the Department of Radiology, Hacettepe University School of Medicine, 06230 Ankara, Turkey
| | - Adalet Elçin Yıldız
- From the Department of Radiology, Hacettepe University School of Medicine, 06230 Ankara, Turkey
| | - F Bilge Ergen
- From the Department of Radiology, Hacettepe University School of Medicine, 06230 Ankara, Turkey
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Abstract
Three-dimensional imaging has changed the understanding and management of tibial plateau fractures. In the 1970s, Schatzker proposed a classification for tibial plateau fractures, which highlighted the morphology of the six principal types. More recently, this original classification was complimented by an extended one underscoring the importance of understanding where the split wedge fragment(s) is/are located in three dimensions. The extended classification introduced the split wedge fragment and the continuity of the rim as the determinants of joint stability and the critical role that this plays in the management of tibial plateau fractures. The current manuscript re-emphasizes contemporary concepts of tibial plateau stability and depicts key issues which must be considered when planning the definitive surgical fixation of tibial plateau fractures.
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Design and validation of a semi-automatic bone segmentation algorithm from MRI to improve research efficiency. Sci Rep 2022; 12:7825. [PMID: 35551485 PMCID: PMC9098419 DOI: 10.1038/s41598-022-11785-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2021] [Accepted: 04/22/2022] [Indexed: 11/24/2022] Open
Abstract
Segmentation of medical images into different tissue types is essential for many advancements in orthopaedic research; however, manual segmentation techniques can be time- and cost-prohibitive. The purpose of this work was to develop a semi-automatic segmentation algorithm that leverages gradients in spatial intensity to isolate the patella bone from magnetic resonance (MR) images of the knee that does not require a training set. The developed algorithm was validated in a sample of four human participants (in vivo) and three porcine stifle joints (ex vivo) using both magnetic resonance imaging (MRI) and computed tomography (CT). We assessed the repeatability (expressed as mean ± standard deviation) of the semi-automatic segmentation technique on: (1) the same MRI scan twice (Dice similarity coefficient = 0.988 ± 0.002; surface distance = − 0.01 ± 0.001 mm), (2) the scan/re-scan repeatability of the segmentation technique (surface distance = − 0.02 ± 0.03 mm), (3) how the semi-automatic segmentation technique compared to manual MRI segmentation (surface distance = − 0.02 ± 0.08 mm), and (4) how the semi-automatic segmentation technique compared when applied to both MRI and CT images of the same specimens (surface distance = − 0.02 ± 0.06 mm). Mean surface distances perpendicular to the cartilage surface were computed between pairs of patellar bone models. Critically, the semi-automatic segmentation algorithm developed in this work reduced segmentation time by approximately 75%. This method is promising for improving research throughput and potentially for use in generating training data for deep learning algorithms.
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Florkow MC, Willemsen K, Zijlstra F, Foppen W, van der Wal BCH, van der Voort van Zyp JRN, Viergever MA, Castelein RM, Weinans H, van Stralen M, Sakkers RJB, Seevinck PR. MRI-based synthetic CT shows equivalence to conventional CT for the morphological assessment of the hip joint. J Orthop Res 2022; 40:954-964. [PMID: 34191351 PMCID: PMC9291600 DOI: 10.1002/jor.25127] [Citation(s) in RCA: 27] [Impact Index Per Article: 13.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/18/2021] [Revised: 05/05/2021] [Accepted: 06/09/2021] [Indexed: 02/04/2023]
Abstract
This study evaluated the accuracy of synthetic computed tomography (sCT), as compared to CT, for the 3D assessment of the hip morphology. Thirty male patients with asymptomatic hips, referred for magnetic resonance (MR) imaging and CT, were included in this retrospective study. sCT images were generated from three-dimensional radiofrequency-spoiled T1-weighted multi-echo gradient-echo MR images using a commercially available deep learning-enabled software and were compared with CT images through mean error and surface distance computation and by means of eight clinical morphometric parameters relevant for hip care. Parameters included center-edge angle (CEA), sharp angle, acetabular index, extrusion index, femoral head center-to-midline distance, acetabular version (AV), and anterior and posterior acetabular sector angles. They were measured by two senior orthopedic surgeons and a radiologist in-training on CT and sCT images. The reliability and agreement of CT- and sCT-based measurements were assessed using intraclass correlation coefficients (ICCs) for absolute agreement, Bland-Altman plots, and two one-sided tests for equivalence. The surface distance between CT- and sCT-based bone models were on average submillimeter. CT- and sCT-based measurements showed moderate to excellent interobserver and intraobserver correlation (0.56 < ICC < 0.99). In particular, the inter/intraobserver agreements were good for AV (ICC > 0.75). For CEA, the intraobserver agreement was good (ICC > 0.75) and the interobserver agreement was moderate (ICC > 0.69). Limits of agreements were similar between intraobserver CT and intermodal measurements. All measurements were found statistically equivalent, with average intermodal differences within the intraobserver limits of agreement. In conclusion, sCT and CT were equivalent for the assessment of the hip joint bone morphology.
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Affiliation(s)
- Mateusz C. Florkow
- Image Sciences InstituteUniversity Medical Center UtrechtUtrechtThe Netherlands
| | - Koen Willemsen
- Department of OrthopedicsUniversity Medical Center UtrechtUtrechtThe Netherlands
| | - Frank Zijlstra
- Image Sciences InstituteUniversity Medical Center UtrechtUtrechtThe Netherlands
| | - Wouter Foppen
- Department of RadiologyUniversity Medical Center UtrechtUtrechtThe Netherlands
| | | | | | - Max A. Viergever
- Image Sciences InstituteUniversity Medical Center UtrechtUtrechtThe Netherlands
| | - René M. Castelein
- Department of OrthopedicsUniversity Medical Center UtrechtUtrechtThe Netherlands
| | - Harrie Weinans
- Department of OrthopedicsUniversity Medical Center UtrechtUtrechtThe Netherlands
| | - Marijn van Stralen
- Image Sciences InstituteUniversity Medical Center UtrechtUtrechtThe Netherlands,MRIguidance B.V.UtrechtThe Netherlands
| | - Ralph J. B. Sakkers
- Department of OrthopedicsUniversity Medical Center UtrechtUtrechtThe Netherlands
| | - Peter R. Seevinck
- Image Sciences InstituteUniversity Medical Center UtrechtUtrechtThe Netherlands,MRIguidance B.V.UtrechtThe Netherlands
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Evaluation of the degenerative lumbar osseous morphology using zero echo time magnetic resonance imaging (ZTE-MRI). EUROPEAN SPINE JOURNAL : OFFICIAL PUBLICATION OF THE EUROPEAN SPINE SOCIETY, THE EUROPEAN SPINAL DEFORMITY SOCIETY, AND THE EUROPEAN SECTION OF THE CERVICAL SPINE RESEARCH SOCIETY 2022; 31:792-800. [PMID: 35015138 DOI: 10.1007/s00586-021-07099-2] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/09/2021] [Revised: 11/16/2021] [Accepted: 12/18/2021] [Indexed: 10/19/2022]
Abstract
PURPOSE To determine and compare the performance of zero echo imaging (ZTE) with conventional MRI sequences on lumbar osseous morphology in patients suspected with lumbar degeneration with multi-slice computed tomography (MSCT) as standard reference. METHODS 22 subjects with concerned lumbar degeneration were recruited. All subjects were scanned with ZTE sequence after routine conventional MR sequences on a 3.0 T system and also received MSCT examination. Image quality was assessed. The quantitative and qualitative parameters of lumbar osseous morphology on MSCT, ZTE and MRI images were evaluated by three musculoskeletal radiologists independently. Inter-reader and inter-modality reliability and the difference between the modalities were calculated. RESULTS There was no difference for the osseous parameters between modalities, including axial orientation (p = 0.444), IAD (p = 0.381), lateral recess (p = 0.370), pedicle width (p = 0.067), pedicle height (p = 0.056), and osteophyte grade (p = 0.052). The measurement of the foramina diameter was statistically different between conventional MRI and MSCT (p < 0.05) but not between the MSCT and ZTE (p = 0.660). Conventional MRI was more likely to miss cortical bone abnormalities. ZTE appeared blurrier in cortical bone than MSCT, especially in cases with severe lumbar degeneration. The inter-reader agreement between MSCT and ZTE-MRI was higher than between MSCT and conventional MRI. CONCLUSIONS ZTE-MRI could offer more cortical bone details than conventional MRI images and might be a valid alternative to CT for lumbar osseous morphology assessment to some extent.
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Feuerriegel GC, Kopp FK, Pfeiffer D, Pogorzelski J, Wurm M, Leonhardt Y, Boehm C, Kronthaler S, Karampinos DC, Neumann J, Schwaiger BJ, Makowski MR, Woertler K, Gersing AS. Evaluation of MR-derived simulated CT-like images and simulated radiographs compared to conventional radiography in patients with shoulder pain: a proof-of-concept study. BMC Musculoskelet Disord 2022; 23:122. [PMID: 35123466 PMCID: PMC8818249 DOI: 10.1186/s12891-022-05076-4] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/06/2021] [Accepted: 01/28/2022] [Indexed: 11/24/2022] Open
Abstract
Background To evaluate the diagnostic value of MR-derived CT-like images and simulated radiographs compared with conventional radiographs in patients with suspected shoulder pathology. Methods 3 T MRI of the shoulder including a 3D T1-weighted gradient echo sequence was performed in 25 patients (mean age 52.4 ± 18 years, 13 women) with suspected shoulder pathology. Subsequently a cone-beam forward projection algorithm was used to obtain intensity-inverted CT-like images and simulated radiographs. Two radiologists evaluated the simulated images separately and independently using the conventional radiographs as the standard of reference, including measurements of the image quality, acromiohumeral distance, critical shoulder angle, degenerative joint changes and the acromial type. Additionally, the CT-like MR images were evaluated for glenoid defects, subcortical cysts and calcifications. Agreement between the MR-derived simulated radiographs and conventional radiographs was calculated using Cohen’s Kappa. Results Measurements on simulated radiographs and conventional radiographs overall showed a substantial to almost perfect inter- and intra-rater agreement (κ = 0.69–1.00 and κ = 0.65–0.85, respectively). Image quality of the simulated radiographs was rated good to excellent (1.6 ± 0.7 and 1.8 ± 0.6, respectively) by the radiologists. A substantial agreement was found regarding diagnostically relevant features, assessed on Y- and anteroposterior projections (κ = 0.84 and κ = 0.69 for the measurement of the CSA; κ = 0.95 and κ = 0.60 for the measurement of the AHD; κ = 0.77 and κ = 0.77 for grading of the Samilson-Prieto classification; κ = 0.83 and κ = 0.67 for the grading of the Bigliani classification, respectively). Conclusion In this proof-of-concept study, clinically relevant features of the shoulder joint were assessed reliably using MR-derived CT-like images and simulated radiographs with an image quality equivalent to conventional radiographs. MR-derived CT-like images and simulated radiographs may provide useful diagnostic information while reducing the amount of radiation exposure.
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Green GL, Arnander M, Pearse E, Tennent D. CT estimation of glenoid bone loss in anterior glenohumeral instability. Bone Jt Open 2022; 3:114-122. [PMID: 35109662 PMCID: PMC8886323 DOI: 10.1302/2633-1462.32.bjo-2021-0163.r1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
Aims Recurrent dislocation is both a cause and consequence of glenoid bone loss, and the extent of the bony defect is an indicator guiding operative intervention. Literature suggests that loss greater than 25% requires glenoid reconstruction. Measuring bone loss is controversial; studies use different methods to determine this, with no clear evidence of reproducibility. A systematic review was performed to identify existing CT-based methods of quantifying glenoid bone loss and establish their reliability and reproducibility Methods A Preferred Reporting Items for Systematic reviews and Meta-Analyses-compliant systematic review of conventional and grey literature was performed. Results A total of 25 studies were initially eligible. Following screening, nine papers were included for review. Main themes identified compared 2D and 3D imaging, as well as linear- compared with area-based techniques. Heterogenous data were acquired, and therefore no meta-analysis was performed. Conclusion No ideal CT-based method is demonstrated in the current literature, however evidence suggests that surface area methods are more reproducible and lead to fewer over-estimations of bone loss, provided the views used are standardized. A prospective imaging trial is required to provide a more definitive answer to this research question. Cite this article: Bone Jt Open 2022;3(2):114–122.
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Affiliation(s)
- Gemma L. Green
- Trauma and Orthopaedics, St George's Hospital, London, UK
| | | | - Eyiyemi Pearse
- Shoulder and Elbow Unit, St George's Hospital, London, UK
| | - Duncan Tennent
- Shoulder and Elbow Unit, St George's Hospital, London, UK
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Hurley ET, Matache BA, Wong I, Itoi E, Strauss EJ, Delaney RA, Neyton L, Athwal GS, Pauzenberger L, Mullett H, Jazrawi LM. Anterior Shoulder Instability Part I-Diagnosis, Nonoperative Management, and Bankart Repair-An International Consensus Statement. Arthroscopy 2022; 38:214-223.e7. [PMID: 34332055 DOI: 10.1016/j.arthro.2021.07.022] [Citation(s) in RCA: 53] [Impact Index Per Article: 26.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/16/2021] [Revised: 07/06/2021] [Accepted: 07/13/2021] [Indexed: 02/02/2023]
Abstract
PURPOSE The purpose of this study was to establish consensus statements via a modified Delphi process on the diagnosis, nonoperative management, and Bankart repair for anterior shoulder instability. METHODS A consensus process on the treatment using a modified Delphi technique was conducted, with 65 shoulder surgeons from 14 countries across 5 continents participating. Experts were assigned to one of 9 working groups defined by specific subtopics of interest within anterior shoulder instability. RESULTS The independent factors identified in the 2 statements that reached unanimous agreement in diagnosis and nonoperative management were age, gender, mechanism of injury, number of instability events, whether reduction was required, occupation, sport/position/level played, collision sport, glenoid or humeral bone-loss, and hyperlaxity. Of the 3 total statements reaching unanimous agreement in Bankart repair, additional factors included overhead sport participation, prior shoulder surgery, patient expectations, and ability to comply with postoperative rehabilitation. Additionally, there was unanimous agreement that complications are rare following Bankart repair and that recurrence rates can be diminished by a well-defined rehabilitation protocol, inferior anchor placement (5-8 mm apart), multiple small-anchor fixation points, treatment of concomitant pathologies, careful capsulolabral debridement/reattachment, and appropriate indications/assessment of risk factors. CONCLUSION Overall, 77% of statements reached unanimous or strong consensus. The statements that reached unanimous consensus were the aspects of patient history that should be evaluated in those with acute instability, the prognostic factors for nonoperative management, and Bankart repair. Furthermore, there was unanimous consensus on the steps to minimize complications for Bankart repair, and the placement of anchors 5-8 mm apart. Finally, there was no consensus on the optimal position for shoulder immobilization. LEVEL OF EVIDENCE Level V, expert opinion.
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Affiliation(s)
- Eoghan T Hurley
- NYU Langone Health, New York, New york, USA; Sports Surgery Clinic, Dublin, Ireland.
| | | | - Ivan Wong
- Dalhousie University, Halifax, Nova Scotia, Canada
| | - Eiji Itoi
- Tohoku University School of Medicine, Sendai, Japan
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36
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Florkow MC, Willemsen K, Mascarenhas VV, Oei EHG, van Stralen M, Seevinck PR. Magnetic Resonance Imaging Versus Computed Tomography for Three-Dimensional Bone Imaging of Musculoskeletal Pathologies: A Review. J Magn Reson Imaging 2022; 56:11-34. [PMID: 35044717 PMCID: PMC9305220 DOI: 10.1002/jmri.28067] [Citation(s) in RCA: 23] [Impact Index Per Article: 11.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2021] [Revised: 12/31/2021] [Accepted: 01/05/2022] [Indexed: 12/18/2022] Open
Abstract
Magnetic resonance imaging (MRI) is increasingly utilized as a radiation‐free alternative to computed tomography (CT) for the diagnosis and treatment planning of musculoskeletal pathologies. MR imaging of hard tissues such as cortical bone remains challenging due to their low proton density and short transverse relaxation times, rendering bone tissues as nonspecific low signal structures on MR images obtained from most sequences. Developments in MR image acquisition and post‐processing have opened the path for enhanced MR‐based bone visualization aiming to provide a CT‐like contrast and, as such, ease clinical interpretation. The purpose of this review is to provide an overview of studies comparing MR and CT imaging for diagnostic and treatment planning purposes in orthopedic care, with a special focus on selective bone visualization, bone segmentation, and three‐dimensional (3D) modeling. This review discusses conventional gradient‐echo derived techniques as well as dedicated short echo time acquisition techniques and post‐processing techniques, including the generation of synthetic CT, in the context of 3D and specific bone visualization. Based on the reviewed literature, it may be concluded that the recent developments in MRI‐based bone visualization are promising. MRI alone provides valuable information on both bone and soft tissues for a broad range of applications including diagnostics, 3D modeling, and treatment planning in multiple anatomical regions, including the skull, spine, shoulder, pelvis, and long bones.
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Affiliation(s)
- Mateusz C Florkow
- Image Sciences Institute, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Koen Willemsen
- Department of Orthopedics, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Vasco V Mascarenhas
- Musculoskeletal Imaging Unit, Imaging Center, Hospital da Luz, Lisbon, Portugal
| | - Edwin H G Oei
- Department of Radiology and Nuclear Medicine, Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands
| | - Marijn van Stralen
- Image Sciences Institute, University Medical Center Utrecht, Utrecht, The Netherlands.,MRIguidance BV, Utrecht, The Netherlands
| | - Peter R Seevinck
- Image Sciences Institute, University Medical Center Utrecht, Utrecht, The Netherlands.,MRIguidance BV, Utrecht, The Netherlands
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Chong LR, Lee K, Sim FY. 3D MRI with CT-like bone contrast - An overview of current approaches and practical clinical implementation. Eur J Radiol 2021; 143:109915. [PMID: 34461599 DOI: 10.1016/j.ejrad.2021.109915] [Citation(s) in RCA: 24] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2021] [Revised: 08/13/2021] [Accepted: 08/15/2021] [Indexed: 12/24/2022]
Abstract
CT is the imaging modality of choice for assessment of 3D bony morphology but incurs the penalty of ionizing radiation. Improving the ability of 3D MRI to provide high-resolution images of cortical bone with CT-like bone contrast has been a focus of recent research. The ability of 3D MRI to deliver cortical bone information with similar diagnostic performance to CT would complement assessment of soft tissues and medullary bone from a single MRI examination, simplifying evaluation and obviating radiation exposure from additional CT. This article presents an overview of current 3D MRI approaches for imaging cortical bone with CT-like bone contrast including ultrashort echo time, zero echo time, T1-weighted gradient recalled echo, susceptibility-weighted imaging and deep learning techniques. We also discuss clinical implementation of an optimized stack-of-stars 3D gradient recalled echo pulse sequence (3D-Bone) on commercially available MRI scanners for rendering 3D MRI with CT-like bone contrast in our institutional practice.
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Affiliation(s)
- Le Roy Chong
- Department of Radiology, Changi General Hospital, 2 Simei Street 3, Singapore 529889, Republic of Singapore.
| | - Kathy Lee
- Department of Radiology, Changi General Hospital, 2 Simei Street 3, Singapore 529889, Republic of Singapore.
| | - Fang Yang Sim
- Department of Radiology, Changi General Hospital, 2 Simei Street 3, Singapore 529889, Republic of Singapore.
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38
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Vopat ML, Hermanns CA, Midtgaard KS, Baker J, Coda RG, Cheema SG, Tarakemeh A, Peebles L, Vopat BG, Provencher MT. Imaging Modalities for the Glenoid Track in Recurrent Shoulder Instability: A Systematic Review. Orthop J Sports Med 2021; 9:23259671211006750. [PMID: 34159209 PMCID: PMC8182199 DOI: 10.1177/23259671211006750] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/17/2021] [Accepted: 02/28/2021] [Indexed: 11/16/2022] Open
Abstract
Background: The glenoid track (GT) concept illustrates how the degree of glenoid bone
loss and humeral bone loss in the glenohumeral joint can guide further
treatment in a patient with anterior instability. The importance of
determining which lesions are at risk for recurrent instability involves
imaging of the glenohumeral joint, but no studies have determined which type
of imaging is the most appropriate. Purpose/Hypothesis: The purpose of this study was to determine the validity and accuracy of
different imaging modalities for measuring the GT in shoulders with
recurrent anterior instability. We hypothesized that 3-dimensional computed
tomography (3D-CT) would be the most accurate imaging technique. Study Design: Systematic review; Level of evidence, 4. Methods: A systematic review was performed according to the PRISMA (Preferred
Reporting Items for Systematic Reviews and Meta-Analyses) guidelines using
PubMed, Scopus, Medline, and Cochrane libraries between database inception
and July 2019. We included all clinical trials or cadaveric studies that
evaluated imaging modalities for assessing the GT. Results: A total of 13 studies were included in this review: 1 study using
2-dimensional CT, 6 studies using 3D-CT, 4 studies using magnetic resonance
imaging (MRI), 1 study using magnetic resonance arthrography (MRA)/MRI, and
1 study combining CT and MRI. The mean sensitivity, specificity, and
accuracy for 2D-CT was 92%, 100%, and 96%, respectively. For MRI, the means
were 72.2%, 87.9%, and 84.2%, respectively. No papers included 3D-CT
metrics. The mean intraclass correlation coefficients (ICCs) for
intraobserver reliability were 0.9046 for 3D-CT and 0.867 for MRI. ICCs for
interobserver reliability were 0.8164, 0.8845, and 0.43 for 3D-CT, MRI, and
MRA/MRI, respectively. Conclusion: There is evidence to support the use of both CT and MRI imaging modalities in
assessing the GT. In addition, few studies have compared radiographic
measurements with a gold standard, and even fewer have looked at the GT
concept as a predictor of outcomes. Thus, future studies are needed to
further evaluate which imaging modality is the most accurate to assess the
GT.
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Affiliation(s)
- Matthew L Vopat
- University of Kansas School of Medicine--Wichita, Wichita, Kansas, USA
| | | | - Kaare S Midtgaard
- Steadman Philippon Research Institute, Vail, Colorado, USA.,The Steadman Clinic, Vail, Colorado, USA.,Division of Orthopaedic Surgery, Oslo University Hospital, Oslo, Norway
| | - Jordan Baker
- University of Kansas School of Medicine--Kansas City, Kansas City, Kansas, USA
| | - Reed G Coda
- University of Kansas School of Medicine--Kansas City, Kansas City, Kansas, USA
| | - Sana G Cheema
- University of Kansas School of Medicine--Kansas City, Kansas City, Kansas, USA
| | - Armin Tarakemeh
- University of Kansas School of Medicine--Kansas City, Kansas City, Kansas, USA
| | - Liam Peebles
- Steadman Philippon Research Institute, Vail, Colorado, USA
| | - Bryan G Vopat
- University of Kansas School of Medicine--Kansas City, Kansas City, Kansas, USA
| | - Matthew T Provencher
- Steadman Philippon Research Institute, Vail, Colorado, USA.,The Steadman Clinic, Vail, Colorado, USA
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Abstract
With sincere thanks to the Arthroscopy Association of North America Education Foundation for their support, we are pleased to announce the Annual Awards for our best Clinical Research, Basic Science Research, Resident/Fellow Research, and Systematic Reviews published in 2020, as well as the Most Downloaded and Most Cited papers published 5 years ago. We proudly introduce new members of our editorial team, and your editors update their disclosures of potential conflicts of interest.
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Afsahi AM, Lombardi AF, Wei Z, Carl M, Athertya J, Masuda K, Wallace M, Lee RR, Ma YJ. High-Contrast Lumbar Spinal Bone Imaging Using a 3D Slab-Selective UTE Sequence. Front Endocrinol (Lausanne) 2021; 12:800398. [PMID: 35069448 PMCID: PMC8777294 DOI: 10.3389/fendo.2021.800398] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/23/2021] [Accepted: 12/13/2021] [Indexed: 01/11/2023] Open
Abstract
Ultra-short echo time (UTE) MRI with post-processing is a promising technique in bone imaging that produces a similar contrast to computed tomography (CT). Here, we propose a 3D slab-selective ultrashort echo time (UTE) sequence together with image post-processing to image bone structures in the lumbar spine. We also explore the intermodality agreement between the UTE and CT images. The lumbar spines of two healthy volunteers were imaged with 3D UTE using five different resolutions to determine the best imaging protocol. Then, four patients with low back pain were imaged with both the 3D UTE sequence and CT to investigate agreement between the imaging methods. Two other patients with low back pain were then imaged with the 3D UTE sequence and clinical conventional T1-weighted and T2-weighted fast spin-echo (FSE) MRI sequences for qualitative comparison. The 3D UTE sequence together with post-processing showed high contrast images of bone and high intermodality agreement with CT images. In conclusion, post-processed slab-selective UTE imaging is a feasible approach for highlighting bone structures in the lumbar spine and demonstrates significant anatomical correlation with CT images.
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Affiliation(s)
- Amir Masoud Afsahi
- Department of Radiology, University of California San Diego, San Diego, CA, United States
| | - Alecio F. Lombardi
- Department of Radiology, University of California San Diego, San Diego, CA, United States
- Research Service, Veterans Affairs San Diego Healthcare System, San Diego, CA, United States
| | - Zhao Wei
- Department of Radiology, University of California San Diego, San Diego, CA, United States
| | | | - Jiyo Athertya
- Department of Radiology, University of California San Diego, San Diego, CA, United States
| | - Koichi Masuda
- Department of Orthopedic Surgery, University of California San Diego, San Diego, CA, United States
| | - Mark Wallace
- Department of Anesthesiology, University of California San Diego, San Diego, CA, United States
| | - Roland R. Lee
- Department of Radiology, University of California San Diego, San Diego, CA, United States
- Research Service, Veterans Affairs San Diego Healthcare System, San Diego, CA, United States
| | - Ya-Jun Ma
- Department of Radiology, University of California San Diego, San Diego, CA, United States
- *Correspondence: Ya-Jun Ma,
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Stefaniak J, Lubiatowski P, Kubicka AM, Wawrzyniak A, Wałecka J, Romanowski L. Clinical and radiological examination of bony-mediated shoulder instability. EFORT Open Rev 2020; 5:815-827. [PMID: 33312708 PMCID: PMC7722946 DOI: 10.1302/2058-5241.5.200049] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/19/2022] Open
Abstract
The coexistence of glenoid and humeral head bone defects may increase the risk of recurrence of instability after soft tissue repair. Revealed factors in medical history such as male gender, younger age of dislocation, an increasing number of dislocations, contact sports, and manual work or epilepsy may increase the recurrence rate of instability. In physical examination, positive bony apprehension test, catching and crepitations in shoulder movement may suggest osseous deficiency. Anteroposterior and axial views allow for the detection of particular bony lesions in patients with recurrent anterior shoulder instability. Computed Tomography (CT) with multiplanar reconstruction (MPR) and various types of 3D rendering in 2D (quasi-3D-CT) and 3D (true-3D-CT) space allows not only detection of glenoid and humeral bone defects but most of all their quantification and relations (engaging/not-engaging and on-track/off-track) in the context of bipolar lesion. Magnetic resonance imaging (MRI) is increasingly developing and can provide an equally accurate measurement tool for bone assessment, avoiding radiation exposure for the patient.
Cite this article: EFORT Open Rev 2020;5:815-827. DOI: 10.1302/2058-5241.5.200049
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Affiliation(s)
- Jakub Stefaniak
- Department of Traumatology, Orthopaedics and Hand Surgery, Poznan University of Medical Sciences, Poznan, Poland.,Sport Traumatology and Biomechanics Unit, Rehasport Clinic, Poznan University of Medical Sciences, Poznan, Poland
| | - Przemyslaw Lubiatowski
- Sport Traumatology and Biomechanics Unit, Rehasport Clinic, Poznan University of Medical Sciences, Poznan, Poland
| | - Anna Maria Kubicka
- Institute of Zoology, Poznan University of Life Sciences, Poznan, Poland
| | - Anna Wawrzyniak
- Sport Traumatology and Biomechanics Unit, Rehasport Clinic, Poznan University of Medical Sciences, Poznan, Poland
| | - Joanna Wałecka
- Sport Traumatology and Biomechanics Unit, Rehasport Clinic, Poznan University of Medical Sciences, Poznan, Poland
| | - Leszek Romanowski
- Department of Traumatology, Orthopaedics and Hand Surgery, Poznan University of Medical Sciences, Poznan, Poland
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Lansdown DA, Pedoia V. Editorial Commentary: Can We Evaluate Glenoid Bone With Magnetic Resonance Imaging? Yes, If You Have the Right Sequence. Arthroscopy 2020; 36:2401-2402. [PMID: 32891242 DOI: 10.1016/j.arthro.2020.07.029] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/13/2020] [Accepted: 07/20/2020] [Indexed: 02/02/2023]
Abstract
Glenoid bone loss must be recognized when treating patients with shoulder instability to appropriately determine surgical treatment with either a soft-tissue stabilization or bony augmentation procedure. Three-dimensional reconstructions from computed tomography scans currently are the clinical gold standard for accurately evaluating glenoid bone loss. Novel advances in magnetic resonance imaging sequences and processing may allow for obtaining complete bony information from a single preoperative imaging study.
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