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de Moura HL, Kijowski R, Zhang X, Sharafi A, Zibetti MVW, Regatte R. Age and Gender-Dependence of Single-and Bi-Exponential T 1ρ MR Parameters in Knee Ligaments. J Magn Reson Imaging 2024; 60:702-712. [PMID: 37877751 PMCID: PMC11043208 DOI: 10.1002/jmri.29084] [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: 04/18/2023] [Revised: 10/07/2023] [Accepted: 10/09/2023] [Indexed: 10/26/2023] Open
Abstract
BACKGROUND There is limited understanding of differences in the composition and structure of ligaments between healthy males and females, and individuals of different ages. Females present higher risk for ligament injuries than males and there are conflicting reports on its cause. This study looks into T1ρ parameters for an explanation as it relates to proteoglycan, collagen, and water content in these tissues. PURPOSE To investigate gender-related and age-related differences in T1ρ parameters in knee joint ligaments in healthy volunteers using a T1ρ-prepared zero echo-time (ZTE)-based pointwise-encoding time-reduction with radial acquisition (T1ρ-PETRA) sequence. STUDY TYPE Prospective. POPULATION The study group consisted of 22 healthy subjects (11 females, ages: 41 ± 18 years, and 11 males, ages: 41 ± 14 years) with no known inflammation, trauma, or pain in the knee joint. FIELD STRENGTH/SEQUENCE A T1ρ-prepared 3D-PETRA sequence was used to acquire fat-suppressed images with varying spin-lock lengths (TSLs) of the knee joint at 3T. ASSESSMENT Monoexponential, biexponential, and stretched-exponential 3D-PETRA-T1ρ parameters were measured in the anterior cruciate ligament (ACL), posterior cruciate ligament (PCL), and patellar tendon (PT) by manually drawing ROIs over the entirety of the tissues. STATISTICAL TESTS Mann-Whitney U-tests were used to compare 3D-PETRA-T1ρ parameters in the ACL, PCL, and PT between males and females. Spearman correlation coefficients were used to determine the association between age and T1ρ parameters. Statistical significance was defined as P < 0.05. RESULTS Significant correlations with age were found the three ligaments with most of the measured T1ρ parameters (rs = 0.28-0.74) with the exception of the short fraction in the PCL (P = 0.18), and the short relaxation time in the ACL (P = 0.58) and in the PCL (P = 0.14). DATA CONCLUSION 3D-PETRA-T1ρ can detect age-related differences in monoexponential, biexponential, and stretched-exponential T1ρ parameters in three ligaments of healthy volunteers, which are thought to be related to changes in tissue composition and structure during the aging process. LEVEL OF EVIDENCE 2 TECHNICAL EFFICACY: Stage 1.
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Affiliation(s)
- Hector Lise de Moura
- Department of Radiology, New York University Grossman School of Medicine, New York, NY, United States
| | - Richard Kijowski
- Department of Radiology, New York University Grossman School of Medicine, New York, NY, United States
| | - Xiaoxia Zhang
- Department of Radiology, New York University Grossman School of Medicine, New York, NY, United States
| | - Azadeh Sharafi
- Medical College of Wisconsin, Wauwatosa, WI, United States
| | - Marcelo V. W. Zibetti
- Department of Radiology, New York University Grossman School of Medicine, New York, NY, United States
| | - Ravinder Regatte
- Department of Radiology, New York University Grossman School of Medicine, New York, NY, United States
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Jerban S, Moazamian D, Ma Y, Afsahi AM, Dwek S, Athertya J, Malhi B, Jang H, Woods G, Chung CB, Du J, Chang EY. Fast dual-echo estimation of apparent long T2 fraction using ultrashort echo time magnetic resonance imaging in tibialis tendons and its osteoporosis-related differences in women. Quant Imaging Med Surg 2024; 14:3146-3156. [PMID: 38617168 PMCID: PMC11007502 DOI: 10.21037/qims-23-1341] [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] [Received: 09/19/2023] [Accepted: 01/09/2024] [Indexed: 04/16/2024]
Abstract
Background Tendon and bone comprise a critical interrelating unit. Bone loss, including that seen with osteopenia (OPe) or osteoporosis (OPo), may be associated with a reduction in tendon quality, though this remains incompletely investigated. Clinical magnetic resonance imaging (MRI) sequences cannot directly detect signals from tendons because of the very short T2. Clinical MRI may detect high-graded abnormalities by changes in the adjacent structures like bone. However, ultrashort echo time MRI (UTE-MRI) can capture high signals from all tendons. To determine if the long T2 fraction, as measured by a dual-echo UTE-MRI sequence, is a sensitive quantitative technique to the age- and bone-loss-related changes of the lower leg tendons. Methods This is a cross-sectional study conducted between January 2018 to February 2020 in the lower legs of 14 female patients with OPe [72±6 years old, body mass index (BMI) =25.8±6.2 kg/m2] and 31 female patients with OPo (73±6 years old, BMI=22.0±3.8 kg/m2), as well as 30 female subjects with normal bone (Normal, 35±18 years old, BMI =23.2±4.3 kg/m2), were imaged on a 3T clinical scanner using a dual-echo 3D Cones UTE sequence. We defined the apparent long T2 signal fraction (aFrac-LongT2) of tendons as the ratio between the signal at the second echo time (TE =2.2 ms) to the UTE signal. The average aFrac-LongT2 and the cross-sectional area were calculated for the anterior tibialis tendons (ATTs) and the posterior tibialis tendons (PTTs). The Kruskal-Wallis rank test was used to compare the differences in aFrac-LongT2 and the cross-sectional area of the tendons between the groups. Results The aFrac-LongT2 of the ATTs and PTTs were significantly higher in the OPo group compared with the Normal group (22.2% and 34.8% in the ATT and PTT, respectively, P<0.01). The cross-sectional area in the ATTs was significantly higher for the OPo group than in the Normal group (Normal/OPo difference was 28.7, P<0.01). Such a difference for PTTs did not reach the significance level. Mean aFrac-LongT2 and cross-sectional area in the OPe group were higher than the Normal group and lower than the OPo group. However, the differences did not show statistical significance, likely due to the higher BMI in the OPe group. Conclusions Dual-echo UTE-MRI is a rapid quantification technique, and aFrac-LongT2 values showed significant differences in tendons between Normal and OPo patients.
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Affiliation(s)
- Saeed Jerban
- Department of Radiology, University of California, San Diego, La Jolla, CA, USA
- Research Service, Veterans Affairs San Diego Healthcare System, San Diego, La Jolla, CA, USA
- Department of Orthopaedic Surgery, University of California, San Diego, La Jolla, CA, USA
| | - Dina Moazamian
- Department of Radiology, University of California, San Diego, La Jolla, CA, USA
| | - Yajun Ma
- Department of Radiology, University of California, San Diego, La Jolla, CA, USA
- Research Service, Veterans Affairs San Diego Healthcare System, San Diego, La Jolla, CA, USA
| | - Amir Masoud Afsahi
- Department of Radiology, University of California, San Diego, La Jolla, CA, USA
| | - Sophia Dwek
- Department of Radiology, University of California, San Diego, La Jolla, CA, USA
| | - Jiyo Athertya
- Department of Radiology, University of California, San Diego, La Jolla, CA, USA
| | - Bhavsimran Malhi
- Department of Radiology, University of California, San Diego, La Jolla, CA, USA
| | - Hyungseok Jang
- Department of Radiology, University of California, San Diego, La Jolla, CA, USA
- Research Service, Veterans Affairs San Diego Healthcare System, San Diego, La Jolla, CA, USA
| | - Gina Woods
- Department of Medicine, University of California, San Diego, La Jolla, CA, USA
| | - Christine B. Chung
- Department of Radiology, University of California, San Diego, La Jolla, CA, USA
- Research Service, Veterans Affairs San Diego Healthcare System, San Diego, La Jolla, CA, USA
| | - Jiang Du
- Department of Radiology, University of California, San Diego, La Jolla, CA, USA
- Research Service, Veterans Affairs San Diego Healthcare System, San Diego, La Jolla, CA, USA
| | - Eric Y. Chang
- Department of Radiology, University of California, San Diego, La Jolla, CA, USA
- Research Service, Veterans Affairs San Diego Healthcare System, San Diego, La Jolla, CA, USA
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Malhi BS, Moazamian D, Shin SH, Athertya JS, Silva L, Jerban S, Jang H, Chang E, Ma Y, Carl M, Du J. Bi-Exponential 3D UTE-T1ρ Relaxation Mapping of Ex Vivo Human Knee Patellar Tendon at 3T. Bioengineering (Basel) 2024; 11:66. [PMID: 38247943 PMCID: PMC10813751 DOI: 10.3390/bioengineering11010066] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2023] [Revised: 12/30/2023] [Accepted: 01/03/2024] [Indexed: 01/23/2024] Open
Abstract
Introduction: The objective of this study was to assess the bi-exponential relaxation times and fractions of the short and long components of the human patellar tendon ex vivo using three-dimensional ultrashort echo time T1ρ (3D UTE-T1ρ) imaging. Materials and Methods: Five cadaveric human knee specimens were scanned using a 3D UTE-T1ρ imaging sequence on a 3T MR scanner. A series of 3D UTE-T1ρ images were acquired and fitted using single-component and bi-component models. Single-component exponential fitting was performed to measure the UTE-T1ρ value of the patellar tendon. Bi-component analysis was performed to measure the short and long UTE-T1ρ values and fractions. Results: The single-component analysis showed a mean single-component UTE-T1ρ value of 8.4 ± 1.7 ms for the five knee patellar tendon samples. Improved fitting was achieved with bi-component analysis, which showed a mean short UTE-T1ρ value of 5.5 ± 0.8 ms with a fraction of 77.6 ± 4.8%, and a mean long UTE-T1ρ value of 27.4 ± 3.8 ms with a fraction of 22.4 ± 4.8%. Conclusion: The 3D UTE-T1ρ sequence can detect the single- and bi-exponential decay in the patellar tendon. Bi-component fitting was superior to single-component fitting.
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Affiliation(s)
- Bhavsimran Singh Malhi
- Department of Radiology, University of California, La Jolla, San Diego, CA 92037, USA; (B.S.M.); (D.M.); (S.H.S.); (J.S.A.); (L.S.); (S.J.); (H.J.); (E.C.); (Y.M.); (M.C.)
| | - Dina Moazamian
- Department of Radiology, University of California, La Jolla, San Diego, CA 92037, USA; (B.S.M.); (D.M.); (S.H.S.); (J.S.A.); (L.S.); (S.J.); (H.J.); (E.C.); (Y.M.); (M.C.)
| | - Soo Hyun Shin
- Department of Radiology, University of California, La Jolla, San Diego, CA 92037, USA; (B.S.M.); (D.M.); (S.H.S.); (J.S.A.); (L.S.); (S.J.); (H.J.); (E.C.); (Y.M.); (M.C.)
| | - Jiyo S. Athertya
- Department of Radiology, University of California, La Jolla, San Diego, CA 92037, USA; (B.S.M.); (D.M.); (S.H.S.); (J.S.A.); (L.S.); (S.J.); (H.J.); (E.C.); (Y.M.); (M.C.)
| | - Livia Silva
- Department of Radiology, University of California, La Jolla, San Diego, CA 92037, USA; (B.S.M.); (D.M.); (S.H.S.); (J.S.A.); (L.S.); (S.J.); (H.J.); (E.C.); (Y.M.); (M.C.)
| | - Saeed Jerban
- Department of Radiology, University of California, La Jolla, San Diego, CA 92037, USA; (B.S.M.); (D.M.); (S.H.S.); (J.S.A.); (L.S.); (S.J.); (H.J.); (E.C.); (Y.M.); (M.C.)
| | - Hyungseok Jang
- Department of Radiology, University of California, La Jolla, San Diego, CA 92037, USA; (B.S.M.); (D.M.); (S.H.S.); (J.S.A.); (L.S.); (S.J.); (H.J.); (E.C.); (Y.M.); (M.C.)
| | - Eric Chang
- Department of Radiology, University of California, La Jolla, San Diego, CA 92037, USA; (B.S.M.); (D.M.); (S.H.S.); (J.S.A.); (L.S.); (S.J.); (H.J.); (E.C.); (Y.M.); (M.C.)
- Radiology Service, Veterans Affairs San Diego Healthcare System, La Jolla, San Diego, CA 92161, USA
| | - Yajun Ma
- Department of Radiology, University of California, La Jolla, San Diego, CA 92037, USA; (B.S.M.); (D.M.); (S.H.S.); (J.S.A.); (L.S.); (S.J.); (H.J.); (E.C.); (Y.M.); (M.C.)
| | - Michael Carl
- Department of Radiology, University of California, La Jolla, San Diego, CA 92037, USA; (B.S.M.); (D.M.); (S.H.S.); (J.S.A.); (L.S.); (S.J.); (H.J.); (E.C.); (Y.M.); (M.C.)
- General Electric Health Care, San Diego, CA 92037, USA
| | - Jiang Du
- Department of Radiology, University of California, La Jolla, San Diego, CA 92037, USA; (B.S.M.); (D.M.); (S.H.S.); (J.S.A.); (L.S.); (S.J.); (H.J.); (E.C.); (Y.M.); (M.C.)
- Radiology Service, Veterans Affairs San Diego Healthcare System, La Jolla, San Diego, CA 92161, USA
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Wu Z, Zaylor W, Sommer S, Xie D, Zhong X, Liu K, Kim J, Beveridge JE, Zhang X, Li X. Assessment of ultrashort echo time (UTE) T 2* mapping at 3T for the whole knee: repeatability, the effects of fat suppression, and knee position. Quant Imaging Med Surg 2023; 13:7893-7909. [PMID: 38106304 PMCID: PMC10722028 DOI: 10.21037/qims-23-459] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2023] [Accepted: 10/07/2023] [Indexed: 12/19/2023]
Abstract
Background Knee tissues such as tendon, ligament and meniscus have short T2* relaxation times and tend to show little to no signal in conventional magnetic resonance acquisitions. An ultrashort echo time (UTE) technique offers a unique tool to probe fast-decaying signals in these tissues. Clinically relevant factors should be evaluated to quantify the sensitivity needed to distinguish diseased from control tissues. Therefore, the objectives of this study were to (I) quantify the repeatability of UTE-T2* relaxation time values, and (II) evaluate the effects of fat suppression and (III) knee positioning on UTE-T2* relaxation time quantification. Methods A dual-echo, three-dimensional center-out radially sampling UTE and conventional gradient echo sequences were utilized to image gadolinium phantoms, one ex-vivo specimen, and five in-vivo subjects on a clinical 3T scanner. Scan-rescan images from the phantom and in-vivo experiments were used to evaluate the repeatability of T2* relaxation time values. Fat suppressed and non-suppressed images were acquired for phantoms and the ex-vivo specimen to evaluate the effect of fat suppression on T2* relaxation time quantifications. The effect of knee positioning was evaluated by imaging in-vivo subjects in extended and flexed positions within the knee coil and comparing T2* relaxation times quantified from tissues in each position. Results Phantom and in-vivo measurements demonstrated repeatable T2* mapping, where the percent difference between T2* relaxation time quantified from scan-rescan images was less than 8% for the phantom and knee tissues. The coefficient of variation across fat suppressed and non-suppressed images was less than 5% for the phantoms and ex-vivo knee tissues, showing that fat suppression had a minimal effect on T2* relaxation time quantification. Knee position introduced variability to T2* quantification of the anterior cruciate ligament, posterior cruciate ligament, and patellar tendon, with percent differences exceeding 20%, but the meniscus showed a percent difference less than 10%. Conclusions The 3D radial UTE sequence presented in this study could potentially be used to detect clinically relevant changes in mean T2* relaxation time, however, reproducibility of these values is impacted by knee position consistency between scans.
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Affiliation(s)
- Zhenzhou Wu
- Program of Advanced Musculoskeletal Imaging (PAMI), Cleveland Clinic, Cleveland, OH, USA
- Department of Biomedical Engineering, Cleveland Clinic, Cleveland, OH, USA
| | - William Zaylor
- Program of Advanced Musculoskeletal Imaging (PAMI), Cleveland Clinic, Cleveland, OH, USA
- Department of Biomedical Engineering, Cleveland Clinic, Cleveland, OH, USA
| | - Stefan Sommer
- Advanced Clinical Imaging Technology (ACIT), Siemens Healthineers International AG, Zurich and Lausanne, Switzerland
- Swiss Center for Musculoskeletal Imaging (SCMI), Balgrist Campus, Zurich, Switzerland
| | - Dongxing Xie
- Program of Advanced Musculoskeletal Imaging (PAMI), Cleveland Clinic, Cleveland, OH, USA
- Department of Biomedical Engineering, Cleveland Clinic, Cleveland, OH, USA
| | - Xiaodong Zhong
- Siemens Medical Solutions USA, Inc., Los Angeles, CA, USA
| | - Kecheng Liu
- Siemens Medical Solutions USA, Inc., Malvern, PA, USA
| | - Jeehun Kim
- Program of Advanced Musculoskeletal Imaging (PAMI), Cleveland Clinic, Cleveland, OH, USA
- Department of Biomedical Engineering, Cleveland Clinic, Cleveland, OH, USA
| | - Jillian E. Beveridge
- Program of Advanced Musculoskeletal Imaging (PAMI), Cleveland Clinic, Cleveland, OH, USA
| | - Xiaoliang Zhang
- Department of Biomedical Engineering, University at Buffalo, State University of New York, Buffalo, NY, USA
| | - Xiaojuan Li
- Program of Advanced Musculoskeletal Imaging (PAMI), Cleveland Clinic, Cleveland, OH, USA
- Department of Biomedical Engineering, Cleveland Clinic, Cleveland, OH, USA
- Department of Diagnostic Radiology, Cleveland Clinic, Cleveland, OH, USA
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Jang H, Ma Y, Carl M, Jerban S, Chang EY, Du J. Ultrashort echo time Cones double echo steady state (UTE-Cones-DESS) for rapid morphological imaging of short T 2 tissues. Magn Reson Med 2021; 86:881-892. [PMID: 33755258 DOI: 10.1002/mrm.28769] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2020] [Revised: 02/17/2021] [Accepted: 02/18/2021] [Indexed: 12/12/2022]
Abstract
PURPOSE In this study, we aimed to develop a new technique, ultrashort echo time Cones double echo steady state (UTE-Cones-DESS), for highly efficient morphological imaging of musculoskeletal tissues with short T2 s. We also proposed a novel, single-point Dixon (spDixon)-based approach for fat suppression. METHODS The UTE-Cones-DESS sequence was implemented on a 3T MR system. It uses a short radiofrequency (RF) pulse followed by a pair of balanced spiral-out and spiral-in readout gradients separated by an unbalanced spoiling gradient in-between. The readout gradients are applied immediately before or after the RF pulses to achieve a UTE image (S+ ) and a spin/stimulated echo image (S- ). Weighted echo subtraction between S+ and S- was performed to achieve high contrast specific to short T2 tissues, and spDixon was applied to suppress fat by using the intrinsic complex signal of S+ and S- . Six healthy volunteers and five patients with osteoarthritis were recruited for whole-knee imaging. Additionally, two healthy volunteers were recruited for lower leg imaging. RESULTS The UTE-Cones-DESS sequence allows fast volumetric imaging of musculoskeletal tissues with excellent image contrast for the osteochondral junction, tendons, menisci, and ligaments in the knee joint as well as cortical bone and aponeurosis in the lower leg within 5 min. spDixon yields efficient fat suppression in both S+ and S- images without requiring any additional acquisitions or preparation pulses. CONCLUSION The rapid UTE-Cones-DESS sequence can be used for high contrast morphological imaging of short T2 tissues, providing a new tool to assess their association with musculoskeletal disorders.
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Affiliation(s)
- Hyungseok Jang
- Department of Radiology, University of California, San Diego, San Diego, CA, USA
| | - Yajun Ma
- Department of Radiology, University of California, San Diego, San Diego, CA, USA
| | | | - Saeed Jerban
- Department of Radiology, University of California, San Diego, San Diego, CA, USA
| | - Eric Y Chang
- Department of Radiology, University of California, San Diego, San Diego, CA, USA.,Radiology Service, Veterans Affairs San Diego Healthcare System, San Diego, CA, USA
| | - Jiang Du
- Department of Radiology, University of California, San Diego, San Diego, CA, USA
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Jang H, McMillan AB, Ma Y, Jerban S, Chang EY, Du J, Kijowski R. Rapid single scan ramped hybrid-encoding for bicomponent T2* mapping in a human knee joint: A feasibility study. NMR IN BIOMEDICINE 2020; 33:e4391. [PMID: 32761692 PMCID: PMC7584401 DOI: 10.1002/nbm.4391] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/27/2019] [Revised: 06/20/2020] [Accepted: 07/21/2020] [Indexed: 05/03/2023]
Abstract
The purpose of this study is to determine the feasibility of using a single scan ramped hybrid-encoding (RHE) method for rapid bicomponent T2* analysis of the human knee joint. The proposed method utilizes RHE to acquire ultrashort echo time (UTE) and subsequent gradient echo images at 16 different echo times ranging between 40 μs and 30 ms in a single scan. In the proposed RHE technique, UTE imaging was followed by acquisition of 14 gradient recalled echo images, where an additional UTE image was obtained within the first readout by oversampling single point imaging (SPI) encoding. The single scan RHE method with a 9-minute scan time was performed on human cadaveric knee joints from six donors and in vivo knee joints from four healthy volunteers at 3 T. A bicomponent signal model was used to characterize the short T2* and long T2* water components. Mean bicomponent T2* parameters for patellar tendon, anterior cruciate ligament (ACL), posterior cruciate ligament (PCL) and meniscus were calculated. In the experimental results, the RHE technique provided bicomponent T2* parameter estimations of tendon, ACL, PCL and meniscus, which were similar to previously reported values in the literature. In conclusion, the proposed single scan RHE technique provides rapid bicomponent T2* analysis of the human knee joint with a total scan time of less than 9 minutes.
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Affiliation(s)
- Hyungseok Jang
- Department of Radiology, University of California San Diego, San Diego, CA 92103, USA
- Corresponding Author: Hyungseok Jang, Ph.D., University of California, San Diego, Department of Radiology, 200 West Arbor Drive, San Diego, CA 92103-8226, Phone (858) 246-2225,
| | - Alan B McMillan
- Department of Radiology, University of Wisconsin Madison, Madison, WI 53705, USA
| | - Yajun Ma
- Department of Radiology, University of California San Diego, San Diego, CA 92103, USA
| | - Saeed Jerban
- Department of Radiology, University of California San Diego, San Diego, CA 92103, USA
| | - Eric Y Chang
- Department of Radiology, University of California San Diego, San Diego, CA 92103, USA
- Radiology Service, VA San Diego Healthcare System, San Diego, CA 92037, USA
| | - Jiang Du
- Department of Radiology, University of California San Diego, San Diego, CA 92103, USA
| | - Richard Kijowski
- Department of Radiology, University of Wisconsin Madison, Madison, WI 53705, USA
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van Groningen B, van der Steen M, Janssen DM, van Rhijn LW, van der Linden AN, Janssen RP. Assessment of Graft Maturity After Anterior Cruciate Ligament Reconstruction Using Autografts: A Systematic Review of Biopsy and Magnetic Resonance Imaging studies. Arthrosc Sports Med Rehabil 2020; 2:e377-e388. [PMID: 32875303 PMCID: PMC7451875 DOI: 10.1016/j.asmr.2020.02.008] [Citation(s) in RCA: 24] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2019] [Accepted: 02/18/2020] [Indexed: 12/16/2022] Open
Abstract
Purpose The purpose of this investigation was to evaluate systematically the literature concerning biopsy, MRI signal to noise quotient (SNQ) and clinical outcomes in graft-maturity assessment after autograft anterior cruciate ligament reconstruction (ACLR) and their possible relationships. Methods The systematic review was reported and conducted according to the PRISMA (Preferred Reporting Items for Systematic reviews and Meta-Analyses) guidelines. Studies through May 2019 evaluating methods of intra-articular ACL autograft maturity assessment were considered for inclusion. Eligible methods were histologic studies of biopsy specimens and conventional MRI studies reporting serial SNQ and/or correlation with clinical parameters. Results Ten biopsy studies and 13 imaging studies, with a total of 706 patients, met the inclusion criteria. Biopsy studies show that graft remodeling undergoes an early healing phase, a phase of remodeling or proliferation and a ligamentization phase as an ongoing process even 1 year after surgery. Imaging studies showed an initial increase in SNQ, peaking at approximately 6 months, followed by a gradual decrease over time. There is no evident correlation between graft SNQ and knee stability outcome scores at the short- and long-term follow-up after ACLR. Conclusions The remodeling of the graft is an ongoing process even 1 year after ACLR, based on human biopsy studies. MRI SNQ peaked at approximately 6 months, followed by a gradual decrease over time. Heterogeneity of the MRI methods and technical restrictions used in the current literature limit prediction of graft maturity and clinical and functional outcome measures by means of MRI graft SNQ after ACLR. Level of evidence Level IV, systematic review, including level III and IV studies.
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Affiliation(s)
- Bart van Groningen
- Orthopaedic Center Máxima, Máxima Medical Center, Eindhoven, the Netherlands
- Address correspondence to Bart van Groningen, M.D., Orthopaedic Center Máxima, Máxima Medical Center, PO Box 90052, 5600 PD Eindhoven, the Netherlands.
| | - M.C. van der Steen
- Orthopaedic Center Máxima, Máxima Medical Center, Eindhoven, the Netherlands
- Department of Orthopaedic Surgery, Catharina Hospital Eindhoven, Eindhoven, the Netherlands
| | - Daan M. Janssen
- Orthopaedic Center Máxima, Máxima Medical Center, Eindhoven, the Netherlands
| | - Lodewijk W. van Rhijn
- Department of Orthopaedic Surgery, Maastricht University Medical Center, Maastricht, the Netherlands
| | | | - Rob P.A. Janssen
- Orthopaedic Center Máxima, Máxima Medical Center, Eindhoven, the Netherlands
- Fontys University of Applied Sciences, Eindhoven, the Netherlands
- Orthopaedic Biomechanics, Department of Biomedical Engineering, Eindhoven University of Technology, Eindhoven, the Netherlands
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Abbreviated quantitative UTE imaging in anterior cruciate ligament reconstruction. BMC Musculoskelet Disord 2019; 20:426. [PMID: 31521135 PMCID: PMC6745079 DOI: 10.1186/s12891-019-2811-x] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/04/2019] [Accepted: 08/30/2019] [Indexed: 01/26/2023] Open
Abstract
BACKGROUND Existing ultrashort echo time magnetic resonance imaging (UTE MRI) methods require prohibitively long acquisition times (~ 20-40 min) to quantitatively assess the clinically relevant fast decay T2* component in ligaments and tendons. The purpose of this study was to evaluate the feasibility and clinical translatability of a novel abbreviated quantitative UTE MRI paradigm for monitoring graft remodeling after anterior cruciate ligament (ACL) reconstruction. METHODS Eight patients who had Graftlink™ hamstring autograft reconstruction were recruited for this prospective study. A 3D double-echo UTE sequence at 3.0 Tesla was performed at 3- and 6-months post-surgery. An abbreviated UTE MRI paradigm was established based on numerical simulations and in vivo validation from healthy knees. This proposed approach was used to assess the T2* for fast decay component ([Formula: see text]) and bound water signal fraction (fbw) of ACL graft in regions of interest drawn by a radiologist. RESULTS Compared to the conventional bi-exponential model, the abbreviated UTE MRI paradigm achieved low relative estimation bias for [Formula: see text] and fbw over a range of clinically relevant values for ACL grafts. A decrease in [Formula: see text] of the intra-articular graft was observed in 7 of the 8 ACL reconstruction patients from 3- to 6-months (- 0.11 ± 0.16 ms, P = 0.10). Increases in [Formula: see text] and fbw from 3- to 6-months were observed in the tibial intra-bone graft ([Formula: see text]: 0.19 ± 0.18 ms, P < 0.05; Δfbw: 4% ± 4%, P < 0.05). Lower [Formula: see text] (- 0.09 ± 0.11 ms, P < 0.05) was observed at 3-months when comparing the intra-bone graft to the graft/bone interface in the femoral tunnel. The same comparisons at the 6-months also yielded relatively lower [Formula: see text] (- 0.09 ± 0.12 ms, P < 0.05). CONCLUSION The proposed abbreviated 3D UTE MRI paradigm is capable of assessing the ACL graft remodeling process in a clinically translatable acquisition time. Longitudinal changes in [Formula: see text] and fbw of the ACL graft were observed.
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