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Sakai T, Yoneyama M, Zhang S, Kitsukawa K, Yokota H, Ichikawa R, Aoki Y, Watanabe A, Sato Y, Yanagawa N, Murayama D, Ito H, Ochi S, Miyati T. Clinical evaluation of 3D high-resolution isotropic knee MRI using Multi-Interleaved X-prepared TSE with inTUitive RElaxometry (MIXTURE) for simultaneous morphology and T2 mapping. Eur J Radiol 2024; 177:111579. [PMID: 38897053 DOI: 10.1016/j.ejrad.2024.111579] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2024] [Revised: 05/25/2024] [Accepted: 06/16/2024] [Indexed: 06/21/2024]
Abstract
PURPOSE Quantitative MRI techniques such as T2 mapping are useful in comprehensive evaluation of various pathologies of the knee joint yet require separate scans to conventional morphological measurements and long acquisition times. The recently introduced 3D MIXTURE (Multi-Interleaved X-prepared Turbo-Spin Echo with Intuitive Relaxometry) technique can obtain simultaneous morphologic and quantitative information of the knee joint. To compare MIXTURE with conventional methods and to identify differences in morphological and quantitative information. METHODS Phantom studies were conducted, and in vivo human scans were performed (20 patients) presented with knee arthralgia. MIXTURE is based on 3D TSE without and with T2 preparation modules in an interleaved manner for both morphology with PDW and fat suppressed T2W imaging as well as quantitative T2 mapping within one single scan. Image quality and lesion depiction were visually assessed and compared between MIXTURE and conventional 2D TSE by two experienced radiologists. Contrast-to-noise ratio was used to assess the adjacent tissue contrast in a quantitative way for both obtained PDW and fat suppressed T2W images. Quantitative T2 values were measured in phantom and from in vivo knee cartilage. RESULTS The overall diagnostic confidence and contrast-to-noise ratio were deemed comparable between MIXTURE and 2D TSE. While the chosen T2 preparation modules for MIXTURE rendered consistent T2 values comparing to the current standard, measured cartilage T2 values ranged from 26.1 to 50.7 ms, with significant difference between the lesion and normal areas (p < 0.05). CONCLUSIONS MIXTURE can help to provide high-resolution information for both anatomical and pathological assessment.
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Affiliation(s)
- Takayuki Sakai
- Department of Radiology, Eastern Chiba Medical Center, Chiba, Japan; Faculty of Health Sciences, Institute of Medical, Pharmaceutical and Health Sciences, Kanazawa University, Ishikawa, Japan; Faculty of Health Sciences, Tsukuba International University, Ibaraki, Japan.
| | | | | | - Kaoru Kitsukawa
- Department of Radiology, Chiba University Hospital Comprehensive Radiology Center, Chiba, Japan
| | - Hajime Yokota
- Diagnostic Radiology and Radiation Oncology, Graduate School of Medicine, Chiba University, Chiba, Japan
| | - Rina Ichikawa
- Department of Radiology, Chiba University Hospital Comprehensive Radiology Center, Chiba, Japan
| | - Yasuchika Aoki
- Department of General Medical Science, Graduate School of Medicine, Chiba University, Chiba, Japan; Department of Orthopaedic Surgery, Eastern Chiba Medical Center, Chiba, Japan
| | - Atsuya Watanabe
- Department of General Medical Science, Graduate School of Medicine, Chiba University, Chiba, Japan; Department of Orthopaedic Surgery, Eastern Chiba Medical Center, Chiba, Japan
| | - Yusuke Sato
- Department of General Medical Science, Graduate School of Medicine, Chiba University, Chiba, Japan; Department of Orthopaedic Surgery, Eastern Chiba Medical Center, Chiba, Japan
| | - Noriyuki Yanagawa
- Faculty of Health Sciences, Tsukuba International University, Ibaraki, Japan
| | - Daichi Murayama
- Department of Radiology, Eastern Chiba Medical Center, Chiba, Japan
| | - Hajime Ito
- Department of Radiology, Eastern Chiba Medical Center, Chiba, Japan
| | - Shigehiro Ochi
- Department of Radiology, Eastern Chiba Medical Center, Chiba, Japan
| | - Tosiaki Miyati
- Faculty of Health Sciences, Institute of Medical, Pharmaceutical and Health Sciences, Kanazawa University, Ishikawa, Japan
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Loozen LD, Younger AS, Veljkovic AN. Preoperative and Postoperative Imaging and Outcome Scores for Osteochondral Lesion Repair of the Ankle. Foot Ankle Clin 2024; 29:235-252. [PMID: 38679436 DOI: 10.1016/j.fcl.2023.11.003] [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] [Indexed: 05/01/2024]
Abstract
Cartilage lesions to the ankle joint are common and can result in pain and functional limitations. Surgical treatment aims to restore the damaged cartilage's integrity and quality. However, the current evidence for establishing best practices in ankle cartilage repair is characterized by limited quality and a low level of evidence. One of the contributing factors is the lack of standardized preoperative and postoperative assessment methods to evaluate treatment effectiveness and visualize repaired cartilage. This review article seeks to examine the importance of preoperative imaging, classification systems, patient-reported outcome measures, and radiological evaluation techniques for cartilage repair surgeries.
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Affiliation(s)
- Loek D Loozen
- Division of Distal Extremities, Department of Orthopaedics, University of British Columbia, Vancouver, British Columbia, Canada; Footbridge Clinic for Integrated Orthopaedic Care, 221 Keefer Place, Vancouver, British Columbia, V6B 6C1, Canada.
| | - Alastair S Younger
- Division of Distal Extremities, Department of Orthopaedics, University of British Columbia, Vancouver, British Columbia, Canada; Footbridge Clinic for Integrated Orthopaedic Care, 221 Keefer Place, Vancouver, British Columbia, V6B 6C1, Canada
| | - Andrea N Veljkovic
- Division of Distal Extremities, Department of Orthopaedics, University of British Columbia, Vancouver, British Columbia, Canada; Footbridge Clinic for Integrated Orthopaedic Care, 221 Keefer Place, Vancouver, British Columbia, V6B 6C1, Canada; University of British Columbia, Adult Foot and Ankle Reconstructive Surgery, Department of Orthopaedics, Vancouver, British Columbia, Canada
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Bajaj S, Chhabra A, Taneja AK. 3D isotropic MRI of ankle: review of literature with comparison to 2D MRI. Skeletal Radiol 2024; 53:825-846. [PMID: 37978990 DOI: 10.1007/s00256-023-04513-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/26/2023] [Revised: 11/01/2023] [Accepted: 11/06/2023] [Indexed: 11/19/2023]
Abstract
The ankle joint has complex anatomy with different tissue structures and is commonly involved in traumatic injuries. Magnetic resonance imaging (MRI) is the primary imaging modality used to assess the soft tissue structures around the ankle joint including the ligaments, tendons, and articular cartilage. Two-dimensional (2D) fast spin echo/turbo spin echo (FSE/TSE) sequences are routinely used for ankle joint imaging. While the 2D sequences provide a good signal-to-noise ratio (SNR) and contrast-to-noise ratio (CNR) with high spatial resolution, there are some limitations to their use owing to the thick slices, interslice gaps leading to partial volume effects, limited fluid contrast, and the need to acquire separate images in different orthogonal planes. The 3D MR imaging can overcome these limitations and recent advances have led to technical improvements that enable its widespread clinical use in acceptable time periods. The volume imaging renders the advantage of reconstructing into thin continuous slices with isotropic voxels enabling multiplanar reconstructions that helps in visualizing complex anatomy of the structure of interest throughout their course with improved sharpness, definition of anatomic variants, and fluid conspicuity of lesions and injuries. Recent advances have also reduced the acquisition time of the 3D datasets making it more efficient than 2D sequences. This article reviews the recent technical developments in the domain 3D MRI, compares imaging with 3D versus 2D sequences, and demonstrates the use-case scenarios with interesting cases, and benefits of 3D MRI in evaluating various ankle joint components and their lesions.
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Affiliation(s)
- Suryansh Bajaj
- Department of Radiology, University of Arkansas for Medical Sciences, Little Rock, AR, USA
| | - Avneesh Chhabra
- Musculoskeletal Radiology Division, Department of Radiology, UT Southwestern Medical Center, 5323 Harry Hines Blvd, Dallas, TX, 75390, USA
- Department of Orthopaedic Surgery, UT Southwestern Medical Center, Dallas, TX, USA
- Johns Hopkins University, Baltimore, MD, USA
- Walton Center of Neurosciences, Liverpool, UK
- University of Dallas, Richardson, TX, USA
| | - Atul Kumar Taneja
- Musculoskeletal Radiology Division, Department of Radiology, UT Southwestern Medical Center, 5323 Harry Hines Blvd, Dallas, TX, 75390, USA.
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4
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Fritz B, de Cesar Netto C, Fritz J. Multiaxial 3D MRI of the Ankle: Advanced High-Resolution Visualization of Ligaments, Tendons, and Articular Cartilage. Foot Ankle Clin 2023; 28:529-550. [PMID: 37536817 DOI: 10.1016/j.fcl.2023.05.008] [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] [Indexed: 08/05/2023]
Abstract
MRI is a valuable tool for diagnosing a broad spectrum of acute and chronic ankle disorders, including ligament tears, tendinopathy, and osteochondral lesions. Traditional two-dimensional (2D) MRI provides a high image signal and contrast of anatomic structures for accurately characterizing articular cartilage, bone marrow, synovium, ligaments, tendons, and nerves. However, 2D MRI limitations are thick slices and fixed slice orientations. In clinical practice, 2D MRI is limited to 2 to 3 mm slice thickness, which can cause blurred contours of oblique structures due to volume averaging effects within the image slice. In addition, image plane orientations are fixated and cannot be changed after the scan, resulting in 2D MRI lacking multiplanar and multiaxial reformation abilities for individualized image plane orientations along oblique and curved anatomic structures, such as ankle ligaments and tendons. In contrast, three-dimensional (3D) MRI is a newer, clinically available MRI technique capable of acquiring high-resolution ankle MRI data sets with isotropic voxel size. The inherently high spatial resolution of 3D MRI permits up to five times thinner (0.5 mm) image slices. In addition, 3D MRI can be acquired image voxel with the same edge length in all three space dimensions (isotropism), permitting unrestricted multiplanar and multiaxial image reformation and postprocessing after the MRI scan. Clinical 3D MRI of the ankle with 0.5 to 0.7 mm isotropic voxel size resolves the smallest anatomic ankle structures and abnormalities of ligament and tendon fibers, osteochondral lesions, and nerves. After acquiring the images, operators can align image planes individually along any anatomic structure of interest, such as ligaments and tendons segments. In addition, curved multiplanar image reformations can unfold the entire course of multiaxially curved structures, such as perimalleolar tendons, into one image plane. We recommend adding 3D MRI pulse sequences to traditional 2D MRI protocols to visualize small and curved ankle structures to better advantage. This article provides an overview of the clinical application of 3D MRI of the ankle, compares diagnostic performances of 2D and 3D MRI for diagnosing ankle abnormalities, and illustrates clinical 3D ankle MRI applications.
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Affiliation(s)
- Benjamin Fritz
- Department of Radiology, Balgrist University Hospital, Forchstrasse 340, Zurich 8008, Switzerland; Faculty of Medicine, University of Zurich, Zurich, Switzerland
| | - Cesar de Cesar Netto
- Department of Orthopaedics and Rehabilitation, University of Iowa, 200 Hawkins Drive, Iowa City, IA 52242, USA
| | - Jan Fritz
- Department of Radiology, Division of Musculoskeletal Radiology, NYU Grossman School of Medicine, 660 1st Avenue, New York, NY 10016, USA.
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Gowda P, Kohli A, Chhabra A. Two-Dimensional and 3-Dimensional MRI Assessment of Progressive Collapsing Foot Deformity-Adult Acquired Flat Foot Deformity. Foot Ankle Clin 2023; 28:551-566. [PMID: 37536818 DOI: 10.1016/j.fcl.2023.04.009] [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] [Indexed: 08/05/2023]
Abstract
This article is meant to serve as a reference for radiologists, orthopedic surgeons, and other physicians to enhance their understanding of progressive collapsing foot deformity, also known as adult acquired flat foot deformity. Pathophysiology, imaging findings, especially on MRI and 3-dimensional MRI are discussed with relevant illustrations so that the readers can apply these principles in their practice for better patient managements.
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Affiliation(s)
- Prajwal Gowda
- Radiology, UT Southwestern Medical Center, Dallas, TX, USA; Orthopedic Surgery, UT Southwestern Medical Center, Dallas, TX, USA
| | - Ajit Kohli
- Radiology, UT Southwestern Medical Center, Dallas, TX, USA; Orthopedic Surgery, UT Southwestern Medical Center, Dallas, TX, USA
| | - Avneesh Chhabra
- Radiology, UT Southwestern Medical Center, Dallas, TX, USA; Orthopedic Surgery, UT Southwestern Medical Center, Dallas, TX, USA.
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Ahmad ZY, Rasiej MJ. Imaging of the Ankle Ligaments and Cartilage Injuries as an Aid to Ankle Preservation Surgery. Semin Ultrasound CT MR 2023; 44:319-331. [PMID: 37437970 DOI: 10.1053/j.sult.2023.04.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/14/2023]
Abstract
Ankle sprains are among the most common musculoskeletal injuries and can lead to ankle ligament and cartilage injuries. Imaging plays an important role in differentiating ligament injuries from other causes of ankle pain such as fractures, osteochondral lesions or tendon injuries that helps guide further management. Chronic untreated ankle ligamentous and cartilage injuries can further progress to ankle osteoarthritis, hence the need for timely diagnosis and treatment. Surgical treatment is often required in patients not responding to conservative treatment and ranges from repair and reconstruction procedures for ligament injuries to arthroscopic debridement and repair procedures for cartilage injuries. Cartilage defects and deficiency may be augmented depending on the extent of cartilage loss and associated subchondral changes on MRI. Awareness of operative techniques utilized is essential to interpret imaging findings in postoperative settings.
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Affiliation(s)
- Zohaib Y Ahmad
- Department of Radiology, Division of Musculoskeletal Radiology, New York-Presbyterian Hospital-Columbia University Irving Medical Center, New York, NY.
| | - Michael J Rasiej
- Department of Radiology, Division of Musculoskeletal Radiology, New York-Presbyterian Hospital-Columbia University Irving Medical Center, New York, NY
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do Amaral E Castro A, Godoy-Santos AL, Taneja AK. Advanced Imaging in the Chronic Lateral Ankle Instability: An Algorithmic Approach. Foot Ankle Clin 2023; 28:265-282. [PMID: 37137622 DOI: 10.1016/j.fcl.2022.12.005] [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] [Indexed: 05/05/2023]
Abstract
Imaging examinations are a fundamental part of assessing chronic lateral ankle instability (CLAI). Plain radiographs are used in the initial examination, whereas stress radiographs can be requested to actively search for instability. Ultrasonography (US) and Magnetic Resonance Imaging (MRI) allow direct visualization of ligamentous structures, with the advantage of dynamic evaluation for US, and assessment of associated lesions and intra-articular abnormalities for MRI, which plays an essential role in surgical planning. This article reviews imaging methods to diagnose and follow up on CLAI, along with illustrative cases and an algorithmic approach.
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Affiliation(s)
- Adham do Amaral E Castro
- Hospital Israelita Albert Einstein, Av. Albert Einstein, 627 - Jardim Leonor, São Paulo - SP, 05652-900, Brasil; Universidade Federal de São Paulo, Rua Napoleão de Barros, 800 - Vila Clementino - CEP 04024-002 - São Paulo, SP, Brasil
| | - Alexandre Leme Godoy-Santos
- Hospital Israelita Albert Einstein, Av. Albert Einstein, 627 - Jardim Leonor, São Paulo - SP, 05652-900, Brasil; Faculdade de Medicina, USP, R. Dr. Ovídio Pires de Campos, 333 - Cerqueira César, São Paulo - SP, 05403-010, Brasil
| | - Atul K Taneja
- Hospital Israelita Albert Einstein, Av. Albert Einstein, 627 - Jardim Leonor, São Paulo - SP, 05652-900, Brasil; Department of Radiology, UT Southwestern Medical Center, 5323 Harry Hines Boulevard, Dallas, Texas 75390-9316, USA.
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Park EH, Fritz J. The role of imaging in osteoarthritis. Best Pract Res Clin Rheumatol 2023; 37:101866. [PMID: 37659890 DOI: 10.1016/j.berh.2023.101866] [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: 04/24/2023] [Revised: 08/08/2023] [Accepted: 08/13/2023] [Indexed: 09/04/2023]
Abstract
Osteoarthritis is a complex whole-organ disorder that involves molecular, anatomic, and physiologic derangement. Advances in imaging techniques have expanded the role of imaging in evaluating osteoarthritis and functional changes. Radiography, magnetic resonance imaging, computed tomography (CT), and ultrasonography are commonly used imaging modalities, each with advantages and limitations in evaluating osteoarthritis. Radiography comprehensively analyses alignment and osseous features, while MRI provides detailed information about cartilage damage, bone marrow edema, synovitis, and soft tissue abnormalities. Compositional imaging derives quantitative data for detecting cartilage and tendon degeneration before structural damage occurs. Ultrasonography permits real-time scanning and dynamic joint evaluation, whereas CT is useful for assessing final osseous detail. Imaging plays an essential role in the diagnosis, management, and research of osteoarthritis. The use of imaging can help differentiate osteoarthritis from other diseases with similar symptoms, and recent advances in deep learning have made the acquisition, management, and interpretation of imaging data more efficient and accurate. Imaging is useful in monitoring and predicting the prognosis of osteoarthritis, expanding our understanding of its pathophysiology. Ultimately, this enables early detection and personalized medicine for patients with osteoarthritis. This article reviews the current state of imaging in osteoarthritis, focusing on the strengths and limitations of various imaging modalities, and introduces advanced techniques, including deep learning, applied in clinical practice.
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Affiliation(s)
- Eun Hae Park
- Division of Musculoskeletal Radiology, Department of Radiology, NYU Grossman School of Medicine, New York, USA; Department of Radiology, Research Institute of Clinical Medicine of Jeonbuk National University-Biomedical Research Institute of Jeonbuk National University Hospital, Jeonju, Republic of Korea
| | - Jan Fritz
- Division of Musculoskeletal Radiology, Department of Radiology, NYU Grossman School of Medicine, New York, USA.
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Park EH, de Cesar Netto C, Fritz J. MRI in Acute Ankle Sprains: Should We Be More Aggressive with Indications? Foot Ankle Clin 2023; 28:231-264. [PMID: 37137621 DOI: 10.1016/j.fcl.2023.01.011] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 05/05/2023]
Abstract
Acute ankle sprains are common sports injuries. MRI is the most accurate test for assessing the integrity and severity of ligament injuries in acute ankle sprains. However, MRI may not detect syndesmotic and hindfoot instability, and many ankle sprains are treated conservatively, questioning the value of MRI. In our practice, MRI adds value in confirming the absence or presence of ankle sprain-associated hindfoot and midfoot injuries, especially when clinical examinations are challenging, radiographs are inconclusive, and subtle instability is suspected. This article reviews and illustrates the MRI appearances of the spectrum of ankle sprains and associated hindfoot and midfoot injuries.
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Affiliation(s)
- Eun Hae Park
- Division of Musculoskeletal Radiology, Department of Radiology, NYU Grossman School of Medicine, 660 1St Ave, 3rd Floor, New York, NY 10016, USA; Department of Radiology, Jeonbuk National University Medical School, Jeonju, Republic of Korea
| | - Cesar de Cesar Netto
- Department of Orthopaedics and Rehabilitation, University of Iowa, 200 Hawkins Dr, Iowa City, IA 52242, USA
| | - Jan Fritz
- Division of Musculoskeletal Radiology, Department of Radiology, NYU Grossman School of Medicine, 660 1St Ave, 3rd Floor, New York, NY 10016, USA.
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Fritz B, Fritz J. MR Imaging–Ultrasonography Correlation of Acute and Chronic Foot and Ankle Conditions. Magn Reson Imaging Clin N Am 2023; 31:321-335. [PMID: 37019553 DOI: 10.1016/j.mric.2023.01.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/22/2023]
Abstract
Foot and ankle injuries are common musculoskeletal disorders. In the acute setting, ligamentous injuries are most common, whereas fractures, osseous avulsion injuries, tendon and retinaculum tears, and osteochondral injuries are less common. The most common chronic and overuse injuries include osteochondral and articular cartilage defects, tendinopathies, stress fractures, impingement syndromes, and neuropathies. Common forefoot conditions include traumatic and stress fractures, metatarsophalangeal and plantar plate injuries and degenerations, intermittent bursitis, and perineural fibrosis. Ultrasonography is well-suited for evaluating superficial tendons, ligaments, and muscles. MR imaging is best for deeper-located soft tissue structures, articular cartilage, and cancellous bone.
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Postoperative MRI of the Ankle and Foot. Magn Reson Imaging Clin N Am 2022; 30:733-755. [DOI: 10.1016/j.mric.2022.05.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
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Effect of Ligament Mapping from Different Magnetic Resonance Image Quality on Joint Stability in a Personalized Dynamic Model of the Human Ankle Complex. APPLIED SCIENCES-BASEL 2022. [DOI: 10.3390/app12105087] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/27/2023]
Abstract
Background. Mechanical models of the human ankle complex are used to study the stabilizing role of ligaments. Identification of ligament function may be improved via image-based personalized approach. The aim of this study is to compare the effect of the ligament origin and insertion site definitions obtained with different magnetic resonance imaging (MRI) modalities on the mechanical behaviour of a dynamic model of the ankle complex. Methods. MRI scans, both via 1.5 T and 3.0 T, were performed on a lower-limb specimen, free from anatomical defects, to obtain morphological information on ligament-to-bone attachment sites. This specimen was used previously to develop the dynamic model. A third ligament attachment site mapping scheme was based on anatomical dissection of the scanned specimen. Following morphological comparison of the ligament attachment sites, their effect on the mechanical behaviour of the ankle complex, expressed by three-dimensional load–displacement properties, was assessed through the model. Results. Large differences were observed in the subtalar ligament attachment sites between those obtained through the two MRI scanning modalities. The 3.0 T MRI mapping was more consistent with dissection than the 1.5 T MRI. Load–displacement curves showed similar mechanical behaviours between the three mappings in the frontal plane, but those obtained from the 3.0 T MRI mapping were closer to those obtained from dissection. Conclusions. The state-of-the-art 3.0 T MRI image analysis resulted in more realistic mapping of ligament fibre origin and insertion site definitions; corresponding load–displacement predictions from a subject-specific model of the ankle complex showed a mechanical behaviour more similar to that using direct ligament attachment observations.
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