Magic angle effect on diffusion tensor imaging in ligament and brain

Applications of Diffusion-Weighted MRI to the Musculoskeletal System

Diffusion-weighted imaging (DWI) is an established MRI technique that can investigate tissue microstructure at the scale of a few micrometers. Musculoskeletal tissues typically have a highly ordered structure to fulfill their functions and therefore represent an optimal application of DWI. Even more since disruption of tissue organization affects its biomechanical properties and may indicate irreversible damage. The application of DWI to the musculoskeletal system faces application-specific challenges on data acquisition including susceptibility effects, the low T2 relaxation time of most musculoskeletal tissues (2-70 msec) and the need for sub-millimetric resolution. Thus, musculoskeletal applications have been an area of development of new DWI methods. In this review, we provide an overview of the technical aspects of DWI acquisition including diffusion-weighting, MRI pulse sequences and different diffusion regimes to study tissue microstructure. For each tissue type (growth plate, articular cartilage, muscle, bone marrow, intervertebral discs, ligaments, tendons, menisci, and synovium), the rationale for the use of DWI and clinical studies in support of its use as a biomarker are presented. The review describes studies showing that DTI of the growth plate has predictive value for child growth and that DTI of articular cartilage has potential to predict the radiographic progression of joint damage in early stages of osteoarthritis. DTI has been used extensively in skeletal muscle where it has shown potential to detect microstructural and functional changes in a wide range of muscle pathologies. DWI of bone marrow showed to be a valuable tool for the diagnosis of benign and malignant acute vertebral fractures and bone metastases. DTI and diffusion kurtosis have been investigated as markers of early intervertebral disc degeneration and lower back pain. Finally, promising new applications of DTI to anterior cruciate ligament grafts and synovium are presented. The review ends with an overview of the use of DWI in clinical routine. EVIDENCE LEVEL: 5 TECHNICAL EFFICACY: Stage 3.

The impact of head orientation with respect to B0 on diffusion tensor MRI measures

Diffusion tensor MRI (DT-MRI) remains the most commonly used approach to characterise white matter (WM) anisotropy. However, DT estimates may be affected by tissue orientation w.r.t. B → 0 due to local gradients and intrinsic T 2 orientation dependence induced by the microstructure. This work aimed to investigate whether and how diffusion tensor MRI-derived measures depend on the orientation of the head with respect to the static magnetic field, B → 0 . By simulating WM as two compartments, we demonstrated that compartmental T 2 anisotropy can induce the dependence of diffusion tensor measures on the angle between WM fibres and the magnetic field. In in vivo experiments, reduced radial diffusivity and increased axial diffusivity were observed in white matter fibres perpendicular to B → 0 compared to those parallel to B → 0 . Fractional anisotropy varied by up to 20 % as a function of the angle between WM fibres and the orientation of the main magnetic field. To conclude, fibre orientation w.r.t. B → 0 is responsible for up to 7 % variance in diffusion tensor measures across the whole brain white matter from all subjects and head orientations. Fibre orientation w.r.t. B → 0 may introduce additional variance in clinical research studies using diffusion tensor imaging, particularly when it is difficult to control for (e.g., fetal or neonatal imaging, or when the trajectories of fibres change due to, e.g., space occupying lesions).