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Feuerriegel GC, Marth AA, Germann C, Wanivenhaus F, Nanz D, Sutter R. 7 T MRI of the Cervical Neuroforamen: Assessment of Nerve Root Compression and Dorsal Root Ganglia in Patients With Radiculopathy. Invest Radiol 2024; 59:450-457. [PMID: 37855725 DOI: 10.1097/rli.0000000000001039] [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: 10/20/2023]
Abstract
OBJECTIVES The aim of this study was to assess the diagnostic value of 3-dimensional dual-echo steady-state (DESS) magnetic resonance imaging (MRI) of the cervical spine at 7 T compared with 3 T in patients with cervical radiculopathy. MATERIALS AND METHODS Patients diagnosed with cervical radiculopathy were prospectively recruited between March 2020 and January 2023 before undergoing surgical decompression and received 3-dimensional DESS imaging at 3 T and 7 T MRI. Cervical nerve root compression and the dimensions of the dorsal root ganglia were assessed by 2 radiologists independently. Signal intensity, visibility of nerve anatomy, diagnostic confidence, and image artifacts were evaluated with Likert scales. The degree of neuroforaminal stenosis was assessed on standard clinical 3 T scans. Statistics included the analysis of the diagnostic accuracy and interreader reliability. The Wilcoxon signed rank test was used to assess differences between the groups. RESULTS Forty-eight patients (mean age, 57 ± 12 years; 22 women) were included in the study with the highest prevalence of severe neuroforaminal stenosis observed at C6 (n = 68) followed by C7 (n = 43). Direct evaluation of nerve root compression showed significantly higher diagnostic confidence and visibility of cervical nerve rootlets, roots, and dorsal root ganglia on 7 T DESS than on 3 T DESS (diagnostic confidence: P = 0.01, visibility: P < 0.01). Assessment of nerve root compression using 7 T DESS allowed more sensitive grading than standard clinical MRI ( P < 0.01) and improved the performance in predicting sensory or motor dysfunction (area under the curve combined: 0.87). CONCLUSIONS 7 T DESS imaging allows direct assessment of cervical nerve root compression in patients with radiculopathy, with a better prediction of sensory or motor dysfunction than standard clinical MRI. Diagnostic confidence and image quality of 7 T DESS were superior to 3 T DESS.
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Affiliation(s)
- Georg C Feuerriegel
- From the Department of Radiology, Balgrist University Hospital, Faculty of Medicine, University of Zurich, Zurich, Switzerland (G.C.F., A.A.M., C.G., D.N., and R.S.); Swiss Center for Musculoskeletal Imaging, Balgrist Campus AG, Zurich, Switzerland (A.A.M. and D.N.); and Department of Orthopedic Surgery, Balgrist University Hospital, Faculty of Medicine, University of Zurich, Zurich, Switzerland (F.W.)
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McKenna MJ, Renaud JM, Ørtenblad N, Overgaard K. A century of exercise physiology: effects of muscle contraction and exercise on skeletal muscle Na +,K +-ATPase, Na + and K + ions, and on plasma K + concentration-historical developments. Eur J Appl Physiol 2024; 124:681-751. [PMID: 38206444 PMCID: PMC10879387 DOI: 10.1007/s00421-023-05335-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2023] [Accepted: 09/27/2023] [Indexed: 01/12/2024]
Abstract
This historical review traces key discoveries regarding K+ and Na+ ions in skeletal muscle at rest and with exercise, including contents and concentrations, Na+,K+-ATPase (NKA) and exercise effects on plasma [K+] in humans. Following initial measures in 1896 of muscle contents in various species, including humans, electrical stimulation of animal muscle showed K+ loss and gains in Na+, Cl- and H20, then subsequently bidirectional muscle K+ and Na+ fluxes. After NKA discovery in 1957, methods were developed to quantify muscle NKA activity via rates of ATP hydrolysis, Na+/K+ radioisotope fluxes, [3H]-ouabain binding and phosphatase activity. Since then, it became clear that NKA plays a central role in Na+/K+ homeostasis and that NKA content and activity are regulated by muscle contractions and numerous hormones. During intense exercise in humans, muscle intracellular [K+] falls by 21 mM (range - 13 to - 39 mM), interstitial [K+] increases to 12-13 mM, and plasma [K+] rises to 6-8 mM, whilst post-exercise plasma [K+] falls rapidly, reflecting increased muscle NKA activity. Contractions were shown to increase NKA activity in proportion to activation frequency in animal intact muscle preparations. In human muscle, [3H]-ouabain-binding content fully quantifies NKA content, whilst the method mainly detects α2 isoforms in rats. Acute or chronic exercise affects human muscle K+, NKA content, activity, isoforms and phospholemman (FXYD1). Numerous hormones, pharmacological and dietary interventions, altered acid-base or redox states, exercise training and physical inactivity modulate plasma [K+] during exercise. Finally, historical research approaches largely excluded female participants and typically used very small sample sizes.
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Affiliation(s)
- Michael J McKenna
- Institute for Health and Sport, Victoria University, Melbourne, VIC, 8001, Australia.
- College of Physical Education, Southwest University, Chongqing, China.
- College of Sport Science, Zhuhai College of Science and Technology, Zhuhai, China.
| | - Jean-Marc Renaud
- Department of Cellular and Molecular Medicine, Neuromuscular Research Center, University of Ottawa, Ottawa, ON, Canada
| | - Niels Ørtenblad
- Department of Sports Science and Clinical Biomechanics, University of Southern Denmark, Odense, Denmark
| | - Kristian Overgaard
- Exercise Biology, Department of Public Health, Aarhus University, Aarhus, Denmark
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Torresan F, Rossi FB, Zanin S, Caputo I, Caroccia B, Iacobone M, Rossi GP. Water and Electrolyte Content in Salt-Dependent HYpertension in the SKIn (WHYSKI): Effect of Surgical Cure of Primary Aldosteronism. High Blood Press Cardiovasc Prev 2024; 31:15-21. [PMID: 38123759 PMCID: PMC10925570 DOI: 10.1007/s40292-023-00614-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2023] [Accepted: 11/21/2023] [Indexed: 12/23/2023] Open
Abstract
INTRODUCTION: This study will test the hypothesis that primary aldosteronism (PA) involves alterations in Na+, K+, and water content in the skin that are corrected by adrenalectomy. AIM AND METHODS In skin biopsies, we will measure the content of Na+, K+, water, by physical-chemical methods and the osmotic-stress-responsive transcription factor Tonicity-responsive Enhancer Binding Protein (TonEBP, NFAT5) mRNA copy number by droplet digital PCR, in sex-balanced cohorts of 18 -75-year-old consecutive consenting patients with unilateral and bilateral PA, primary (essential) hypertension, and normotension. Before surgery, the patients with unilateral PA will receive the mineralocorticoid receptor antagonist (MRA) canrenone at doses that correct hypokalemia and high blood pressure values. They will be reassessed in an identical way one month after surgical cure, while off MRA. PA patients not selected for adrenalectomy will similarly be assessed at diagnosis and follow-up while on stable MRA treatment. Since a pilot study showed a direct correlation of dry weight (DW) with skin electrolytes and water content and significant differences of biopsy DW between surgery and follow-up, meaningful comparison of the skin cations and water content and TonEBP mRNA copy number, between specimen obtained at different time points, will require DW- and total mRNA-adjustment, respectively. CONCLUSION This study will provide novel information on the skin Na+, K+ and water content in PA, the paradigm of salt-dependent hypertension, and novel knowledge on the effect of surgical cure of hyperaldosteronism. The TonEBP-mediated regulation of Na+, K+ and water content in the skin will also be unveiled. TRAIL REGISTRY Trial Registration number: NCT06090617. Date of Registration: 2023-10-19.
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Affiliation(s)
- Francesca Torresan
- Endocrine Surgery Unit, Department of Surgery, Oncology, and Gastroenterology, University Hospital, University of Padua, Via Giustiniani, 2, 35128, Padua, Italy
| | - Federico Bernardo Rossi
- Internal and Emergency Unit and Specialized Hypertension Centre, Department of Medicine-DIMED, University Hospital, University of Padua, Via Giustiniani, 2, 35128, Padua, Italy
| | - Sofia Zanin
- Laboratory for Genetics of Mithocondrial Disorders, Imagine Institute, Université Paris Cité, Bd du Montparnasse, 24, 75015, Paris, France
| | - Ilaria Caputo
- Internal and Emergency Unit and Specialized Hypertension Centre, Department of Medicine-DIMED, University Hospital, University of Padua, Via Giustiniani, 2, 35128, Padua, Italy
| | - Brasilina Caroccia
- Internal and Emergency Unit and Specialized Hypertension Centre, Department of Medicine-DIMED, University Hospital, University of Padua, Via Giustiniani, 2, 35128, Padua, Italy
| | - Maurizio Iacobone
- Endocrine Surgery Unit, Department of Surgery, Oncology, and Gastroenterology, University Hospital, University of Padua, Via Giustiniani, 2, 35128, Padua, Italy
| | - Gian Paolo Rossi
- Internal and Emergency Unit and Specialized Hypertension Centre, Department of Medicine-DIMED, University Hospital, University of Padua, Via Giustiniani, 2, 35128, Padua, Italy.
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Heiss R, Höger SA, Uder M, Hotfiel T, Hanspach J, Laun FB, Nagel AM, Roemer FW. Early functional and morphological changes of calf muscles in delayed onset muscle soreness (DOMS) assessed with 7T MRI. Ann Anat 2024; 251:152181. [PMID: 37871829 DOI: 10.1016/j.aanat.2023.152181] [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: 07/16/2023] [Revised: 09/24/2023] [Accepted: 10/19/2023] [Indexed: 10/25/2023]
Abstract
BACKGROUND To assess morphological and functional alterations of the skeletal muscle in exercise-induced delayed onset muscle soreness (DOMS) using 7 Tesla (T) magnetic resonance imaging (MRI). METHODS DOMS was induced in 16 volunteers performing an eccentric exercise protocol of the calf muscles of one randomized leg. 7 T MRI including T1w- (0.18×0.18×1mm3), T2w-images (0.2×0.2×2mm3), T2-maps (0.5×0.5×5mm3), and susceptibility weighted imaging (SWI, 0.7×0.7×0.7 mm3) were acquired at baseline, directly (t1) and 60 hours (t2) after the exercise. T2 signal intensity (SI), T2 values [ms], T1 SI and SWI were assessed in the medial (MG) and lateral gastrocnemius muscle (LG) and in the soleus muscle (SM). In addition, the serum creatine kinase (CK) activity, range of motion (ROM) of the ankle, calf circumference, and muscle soreness were assessed at each time point. RESULTS Directly after exercise (t1), T2 SI (p=0.04) and T2 values (p=0.03) increased significantly in the LG. No changes of SI and T2 values for MG and SM were present at t1. At t2, T2 SI and T2 values of LG (p=0.001, p=0.02) and MG (p=0.04, p=0.03) increased significantly compared to baseline. T1 SI did not change in any muscle at any time point. In SWI, no signs of intramuscular signal drop could be detected. Clinical parameters confirmed the induction of DOMS, with a significant increase of CK (p=0.03), muscle soreness (p<0.001), calf circumference (p=0.001), and respective a decrease of ROM (p=0.04). CONCLUSIONS 7 T MRI has the potential to visualize microstructural muscle damage immediately after an exercise that induces DOMS. No changes in susceptibility which could, for example, reflect micro-hemorrhage, could be detected with SWI immediately after exercise or in DOMS. Ultra-high field MRI may potentially be used in sports medicine to monitor intramuscular structural changes, allowing for modification of training intensity or to implement appropriate therapeutic strategies.
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Affiliation(s)
- Rafael Heiss
- Institute of Radiology, University Hospital Erlangen, Friedrich-Alexander-Universität (FAU), Erlangen-Nürnberg, Maximiliansplatz 3, Erlangen 91054, Germany.
| | - Svenja A Höger
- Institute of Radiology, University Hospital Erlangen, Friedrich-Alexander-Universität (FAU), Erlangen-Nürnberg, Maximiliansplatz 3, Erlangen 91054, Germany; Department of Sports Orthopaedics, Technical University of Munich, Ismaninger Str. 22, Munich 81675, Germany
| | - Michael Uder
- Institute of Radiology, University Hospital Erlangen, Friedrich-Alexander-Universität (FAU), Erlangen-Nürnberg, Maximiliansplatz 3, Erlangen 91054, Germany
| | - Thilo Hotfiel
- Department of Orthopedic Surgery, University Hospital Erlangen, Friedrich-Alexander-Universität (FAU), Erlangen-Nürnberg, Krankenhausstr. 12, Erlangen 91054, Germany; Center for Muskuloskeletal Surgery Osnabrück (OZMC), Klinikum Osnabrück GmbH, Klinikum Osnabrück, Am Finkenhügel 1, Osnabrück 49076, Germany
| | - Jannis Hanspach
- Institute of Radiology, University Hospital Erlangen, Friedrich-Alexander-Universität (FAU), Erlangen-Nürnberg, Maximiliansplatz 3, Erlangen 91054, Germany
| | - Frederik B Laun
- Institute of Radiology, University Hospital Erlangen, Friedrich-Alexander-Universität (FAU), Erlangen-Nürnberg, Maximiliansplatz 3, Erlangen 91054, Germany
| | - Armin M Nagel
- Institute of Radiology, University Hospital Erlangen, Friedrich-Alexander-Universität (FAU), Erlangen-Nürnberg, Maximiliansplatz 3, Erlangen 91054, Germany
| | - Frank W Roemer
- Institute of Radiology, University Hospital Erlangen, Friedrich-Alexander-Universität (FAU), Erlangen-Nürnberg, Maximiliansplatz 3, Erlangen 91054, Germany; Boston University Chobanian & Avedisian School of Medicine, 820 Harrison Ave, Boston, MA 02118, USA
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Heiss R, Tol JL, Pogarell T, Roemer FW, Reurink G, Renoux J, Crema MD, Guermazi A. Imaging of muscle injuries in soccer. Skeletal Radiol 2023:10.1007/s00256-023-04514-1. [PMID: 37991553 DOI: 10.1007/s00256-023-04514-1] [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: 08/18/2023] [Revised: 09/24/2023] [Accepted: 11/07/2023] [Indexed: 11/23/2023]
Abstract
Accurate diagnosis of muscle injuries is a challenge in everyday clinical practice and may have profound impact on the recovery and return-to-play decisions of professional athletes particularly in soccer. Imaging techniques such as ultrasound and magnetic resonance imaging (MRI), in addition to the medical history and clinical examination, make a significant contribution to the timely structural assessment of muscle injuries. The severity of a muscle injury determined by imaging findings has a decisive influence on therapy planning and affects prognosis. Imaging is of high importance when the diagnosis or grade of injury is unclear, when recovery is taking longer than expected, and when interventional or surgical management may be needed. This narrative review will discuss ultrasound and MRI for the assessment of sports-related muscle injuries in the context of soccer, including advanced imaging techniques, with the focus on the clinical relevance of imaging findings for the prediction of return to play.
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Affiliation(s)
- Rafael Heiss
- Department of Radiology, University Hospital Erlangen, Friedrich-Alexander-Universität Erlangen-Nürnberg (FAU), Erlangen, Germany
| | - Johannes L Tol
- Aspetar Orthopaedic and Sports Medicine Hospital, Doha, Qatar
- Department of Orthopedic Surgery and Sports Medicine, Amsterdam UMC Location University of Amsterdam, Amsterdam, The Netherlands
- Musculoskeletal Health and Sports, Amsterdam Movement Sciences, Amsterdam, The Netherlands
| | - Tobias Pogarell
- Department of Radiology, University Hospital Erlangen, Friedrich-Alexander-Universität Erlangen-Nürnberg (FAU), Erlangen, Germany
| | - Frank W Roemer
- Department of Radiology, University Hospital Erlangen, Friedrich-Alexander-Universität Erlangen-Nürnberg (FAU), Erlangen, Germany
- Quantitative Imaging Center, Boston University School of Medicine, Boston, MA, USA
| | - Guus Reurink
- Musculoskeletal Health and Sports, Amsterdam Movement Sciences, Amsterdam, The Netherlands
| | - Jerome Renoux
- Institute of Sports Imaging, Sports Medicine Department, French National Institute of Sports (INSEP), Paris, France
| | - Michel D Crema
- Quantitative Imaging Center, Boston University School of Medicine, Boston, MA, USA
- Institute of Sports Imaging, Sports Medicine Department, French National Institute of Sports (INSEP), Paris, France
| | - Ali Guermazi
- Quantitative Imaging Center, Boston University School of Medicine, Boston, MA, USA.
- VA Boston Healthcare System, West Roxbury, MA, USA.
- Department of Radiology, VA Boston Healthcare System, 1400 VFW Parkway, Suite 1B106, West Roxbury, MA, 02132, USA.
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Gast LV, Platt T, Nagel AM, Gerhalter T. Recent technical developments and clinical research applications of sodium ( 23Na) MRI. PROGRESS IN NUCLEAR MAGNETIC RESONANCE SPECTROSCOPY 2023; 138-139:1-51. [PMID: 38065665 DOI: 10.1016/j.pnmrs.2023.04.002] [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: 01/27/2023] [Revised: 04/11/2023] [Accepted: 04/13/2023] [Indexed: 12/18/2023]
Abstract
Sodium is an essential ion that plays a central role in many physiological processes including the transmembrane electrochemical gradient and the maintenance of the body's homeostasis. Due to the crucial role of sodium in the human body, the sodium nucleus is a promising candidate for non-invasively assessing (patho-)physiological changes. Almost 10 years ago, Madelin et al. provided a comprehensive review of methods and applications of sodium (23Na) MRI (Madelin et al., 2014) [1]. More recent review articles have focused mainly on specific applications of 23Na MRI. For example, several articles covered 23Na MRI applications for diseases such as osteoarthritis (Zbyn et al., 2016, Zaric et al., 2020) [2,3], multiple sclerosis (Petracca et al., 2016, Huhn et al., 2019) [4,5] and brain tumors (Schepkin, 2016) [6], or for imaging certain organs such as the kidneys (Zollner et al., 2016) [7], the brain (Shah et al., 2016, Thulborn et al., 2018) [8,9], and the heart (Bottomley, 2016) [10]. Other articles have reviewed technical developments such as radiofrequency (RF) coils for 23Na MRI (Wiggins et al., 2016, Bangerter et al., 2016) [11,12], pulse sequences (Konstandin et al., 2014) [13], image reconstruction methods (Chen et al., 2021) [14], and interleaved/simultaneous imaging techniques (Lopez Kolkovsky et al., 2022) [15]. In addition, 23Na MRI topics have been covered in review articles with broader topics such as multinuclear MRI or ultra-high-field MRI (Niesporek et al., 2019, Hu et al., 2019, Ladd et al., 2018) [16-18]. During the past decade, various research groups have continued working on technical improvements to sodium MRI and have investigated its potential to serve as a diagnostic and prognostic tool. Clinical research applications of 23Na MRI have covered a broad spectrum of diseases, mainly focusing on the brain, cartilage, and skeletal muscle (see Fig. 1). In this article, we aim to provide a comprehensive summary of methodological and hardware developments, as well as a review of various clinical research applications of sodium (23Na) MRI in the last decade (i.e., published from the beginning of 2013 to the end of 2022).
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Affiliation(s)
- Lena V Gast
- Institute of Radiology, University Hospital Erlangen, Friedrich-Alexander-Universität Erlangen-Nürnberg (FAU), Erlangen, Germany.
| | - Tanja Platt
- Medical Physics in Radiology, German Cancer Research Center (DKFZ), Heidelberg, Germany.
| | - Armin M Nagel
- Institute of Radiology, University Hospital Erlangen, Friedrich-Alexander-Universität Erlangen-Nürnberg (FAU), Erlangen, Germany; Medical Physics in Radiology, German Cancer Research Center (DKFZ), Heidelberg, Germany.
| | - Teresa Gerhalter
- Institute of Radiology, University Hospital Erlangen, Friedrich-Alexander-Universität Erlangen-Nürnberg (FAU), Erlangen, Germany.
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