T2 relaxation times of the glenohumeral joint at 3.0 T MRI in patients with and without primary and secondary osteoarthritis

Detection and Quantitative Assessment of Arthroscopically Proven Long Biceps Tendon Pathologies Using T2 Mapping

This study evaluates how far T2 mapping can identify arthroscopically confirmed pathologies in the long biceps tendon (LBT) and quantify the T2 values in healthy and pathological tendon substance. This study comprised eighteen patients experiencing serious shoulder discomfort, all of whom underwent magnetic resonance imaging, including T2 mapping sequences, followed by shoulder joint arthroscopy. Regions of interest were meticulously positioned on their respective T2 maps, capturing the sulcal portion of the LBT and allowing for the quantification of the average T2 values. Subsequent analyses included the calculation of diagnostic cut-off values, sensitivities, and specificities for the detection of tendon pathologies, and the calculation of inter-reader correlation coefficients (ICCs) involving two independent radiologists. The average T2 value for healthy subjects was measured at 23.3 ± 4.6 ms, while patients with tendinopathy displayed a markedly higher value, at 47.9 ± 7.8 ms. Of note, the maximum T2 value identified in healthy tendons (29.6 ms) proved to be lower than the minimal value measured in pathological tendons (33.8 ms), resulting in a sensitivity and specificity of 100% (95% confidence interval 63.1-100) across all cut-off values ranging from 29.6 to 33.8 ms. The ICCs were found to range from 0.93 to 0.99. In conclusion, T2 mapping is able to assess and quantify healthy LBTs and can distinguish them from tendon pathology. T2 mapping may provide information on the (ultra-)structural integrity of tendinous tissue, facilitating early diagnosis, prompt therapeutic intervention, and quantitative monitoring after conservative or surgical treatments of LBT.

Quantitative Analysis of Supraspinatus Tendon Pathologies via T2/T2* Mapping Techniques with 1.5 T MRI

The aim of this study was to quantitatively assess supraspinatus tendon pathologies with T2/T2* mapping techniques, which are sensitive to biochemical changes. Conventional magnetic resonance imaging (MRI) and T2/T2* mapping techniques were applied to 41 patients with shoulder pathology, and there were also 20 asymptomatic cases included. The patients were divided into two groups: tendinosis and rupture. The supraspinatus tendon was divided into medial, middle, and lateral sub-regions, and the T2/T2* values were measured in both the coronal and sagittal planes for intergroup comparison. Intra-class and inter-class correlation coefficients (ICCs) were calculated to assess test reproducibility. Receiver operating characteristic (ROC) analysis was used to determine the cut-off value in each group. A total of 61 patients (27 males and 34 females)-including 20 asymptomatic individuals, 20 with tendinosis, and 21 with rupture-were evaluated using T2/T2* mapping techniques. In the rupture group, there were significant differences in the values of the lateral region (p < 0.001), as well as in the middle and medial regions (p < 0.05) of the supraspinatus tendon compared to the tendinosis and asymptomatic groups. These were determined using both T2* and T2 mapping in both the coronal and sagittal plane measurements. In the tendinosis group, there were significant differences in the values of the lateral region with T2* mapping (p < 0.001) in both the coronal and sagittal planes, and also with the T2 mapping in the coronal plane (p < 0.05) compared to the asymptomatic groups. The cut-off values for identifying supraspinatus pathology ranged from 85% to 90% for T2 measurements and above 90% for T2* measurements in both planes of the lateral section. The ICC values showed excellent reliability (ICC > 0.75) for all groups. In conclusion, T2 and T2* mapping techniques with 1.5 T MRI can be used to assess tendon rupture and tendinosis pathologies in the supraspinatus tendon. For an accurate evaluation, measurements from the lateral region in both the coronal and sagittal planes are more decisive.

3-Tesla T2 Mapping Magnetic Resonance Imaging for Evaluation of SLAP Lesions in Patients with Shoulder Pain: An Arthroscopy-Controlled Study

This study investigated the ability of T2 mapping to assess the glenoid labrum and to differentiate between healthy labral substances and superior labral anterior posterior (SLAP) lesions using arthroscopy as the gold standard. Eighteen patients (mean age: 52.4 ± 14.72 years, 12 men) with shoulder pain were examined using 3-Tesla T2 mapping. All the patients underwent shoulder arthroscopy. Using morphological sequences for correlation, regions of interest covering the entire labral substance were placed in the corresponding T2 maps. The diagnostic cutoff values, sensitivities, and specificities, as well as the inter-reader correlation coefficients (ICCs) determined by two independent radiologists, were calculated. The mean T2 value was 20.8 ± 2.4 ms for the healthy labral substances and 37.7 ± 10.63 ms in the patients with SLAP lesions. The maximum T2 value in normal labrum (21.2 ms) was lower than the minimum T2 value in the patients with SLAP lesions (27.8 ms), leading to sensitivities, specificities, and positive and negative predictive values of 100% (95% CI 54.1-100.0) for all the cutoff values between 21.2 and 27.8 ms. The ICCs ranged from 0.91 to 0.99. In summary, the data suggest that evaluation and quantification of the labral (ultra)structural integrity using T2 mapping may allow discrimination between arthroscopically confirmed SLAP lesions and a healthy glenoid labrum. T2 mapping may therefore be helpful in diagnosing patients with suspected labral damage.

Quantitative analysis of triangular fibrocartilage complex injury by 3.0T MR 3D VIBE and T2 mapping techniques

To evaluate triangular fibrocartilage complex (TFCC) injury based on quantitative analysis of fibrocartilage by 3.0T MR 3D VIBE and T2 mapping techniques. In this study, 25 patients with TFCC (15 patients with unilateral injury and 10 patients with bilateral injury) and 30 healthy subjects were enrolled. All 55 participants underwent bilateral wrist joint routine plain scan + enhanced scan, 3D VIBE and T2 mapping sequence scan. The 2 hands were divided into the dominant group and the non-dominant hand group. Pseudo-color images of T2 mapping were obtained through the post-processing workstation. Except for the meniscus homologue, there were statistical differences in the overall mean T2 value of all other regions between the injured group and the healthy group (P < .001). The T2 value of each region in the injury group was statistically different in the pairwise comparison (all P < .02). There was no statistical difference in the overall mean T2 value between the dominant hand group and the non-dominant hand group. 3.0T MR 3D VIBE and T2 mapping techniques are helpful for the evaluation of TFCC injury and the quantitative analysis of fibrocartilage. The parameters can reflect molecular changes of fibrocartilage injury, and T2 values are not affected by dominant hand, age and gender.

The value of the glenohumeral joint cross-sectional area as a morphological parameter of glenohumeral osteoarthritis

Glenohumeral joint (GHJ) space narrowing has been demonstrated to be an important morphologic parameter of glenohumeral osteoarthritis (GHO). However, the morphology of GHJ space is irregular because of degeneration of subchondral bone and articular cartilage. Thus, we devised GHJ cartilage cross-sectional area (GHJCCSA) as a new diagnostic morphological parameter to assess the irregular morphologic change of GHJ. GHJ samples were acquired from 33 patients with GHO and from 33 normal controls without evidence of GHO based on shoulder magnetic resonance imaging. T2-weighted coronal MRIs were collected at the GHJ level for all individuals. GHJCCSA and GHJ cartilage thickness (GHJCT) at the GHJ were measured on MRIs using a graphic measuring system. The GHJCCSA was measured as the whole cartilage cross-sectional area of the GHJ. The average GHJCCSA was 115.28 ± 17.36 mm2 in normal individuals and 61.77 ± 13.74 mm2 in the GHO group. The mean GHJCT was 2.06 ± 0.35 mm in normal individuals and 1.50 ± 0.28 mm in the GHO group. GHO patients had significantly lower GHJCCSA (P < .001) and GHJCT (P < .001) than normal individuals. Receiver operator characteristics curve analysis revealed that the optimal cutoff score of the GHJCCSA was 82.21 mm2, with a sensitivity of 97.0%, a specificity of 97.0%, and an area under the curve of 0.99 (95% CI: 0.97-1.00). Although GHJCCSA and GHJCT were both significantly associated with GHO, the GHJCCSA was a more sensitive measurement parameter.

Quantitative T2 mapping of the glenohumeral joint cartilage in asymptomatic shoulders and shoulders with increasing severity of rotator cuff pathology

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Glenohumeral cartilage T2 values were correlated to increasing rotator cuff pathology severity.

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Massive tear versus lesser injury differences were most evident in superior humeral cartilage.

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Sagittal T2 mapping best captures superior humeral head cartilage change in massive tear patients.

Purpose

To examine the relationship between glenohumeral cartilage T2 mapping values and rotator cuff pathology.

Method

Fifty-nine subjects (age 48.2 ± 13.5 years, 15 asymptomatic volunteers and 10 tendinosis, 13 partial-thickness tear, 8 full-thickness tear, and 13 massive tear patients) underwent glenohumeral cartilage T2 mapping. The humeral head cartilage was segmented in the sagittal and coronal planes. The glenoid cartilage was segmented in the coronal plane. Group means for each region were calculated and compared between the groups.

Results

Massive tear group T2 values were significantly higher than the asymptomatic group values for the humeral head cartilage included in the sagittal (45 ± 7 versus 32 ± 4 ms, p <  .001) and coronal (44 ± 6 versus 38 ± 1 ms, p =  0.01) plane images. Mean T2 was also significantly higher for massive than full-thickness tears (45 ± 7 versus 38 ± 5 ms, p =  0.02), massive than partial-thickness tears (45 ± 7 versus 34 ± 4 ms, p <  0.001), and massive tears than tendinosis (45 ± 7 versus 35 ± 4 ms, p =  0.001) in the sagittal-images humeral head region and significantly higher for massive tears than asymptomatic shoulders (44 ± 6 versus 38 ± 1 ms, p =  0.01) in the coronal-images humeral head region.

Conclusion

Humeral head cartilage T2 values were significantly positively correlated with rotator cuff pathology severity. Massive rotator cuff tear patients demonstrated significantly higher superior humeral head cartilage T2 mapping values relative to subjects with no/lesser degrees of rotator cuff pathology.

Quantitative T2 mapping of glenohumeral joint osteoarthritis: a case-control study

Background

T2 relaxometry is a highly sensitive technique used to assess morphological changes in the cartilage prior to anatomical changes; it provides the quantification of the disparate components of cartilage such as water, proteoglycans, and collagen. This study aims to assess T2 values of glenohumeral joint cartilage using 1.5 T magnetic resonance imaging (MRI) and comparing T2 relaxation time values between two groups—the control group and the group of patients with osteoarthritis (OA). The study was conducted among 35 OA patients (27 females and eight males; median age, 60 years; age range, 43–69 years). This group was divided into primary OA (n = 15) and secondary OA (n = 20). The control group had 30 patients (25 females and five males; median age, 46 years; age range, 30–56 years). All patients were assessed using plain radiography to determine the grade of osteoarthritis followed by a multi-echo spin pulse sequence (T2 mapping) of the coronal plane. Three areas were considered to evaluate the cartilage-humeral zone, glenoid zone, and central zones by manually drawing the region of interest (ROI). The values were compared statistically by using Mann-Whitney U tests.

Results

Median T2 values differed significantly between the control group (43.4 ms [interquartile ranges, 41.54-45.33 ms]) and the OA patients for grades I (59.2 ms [interquartile ranges, 57.54-63.33 ms]), II (64.7 ms [interquartile ranges, 62.54-67.39 ms]), and III (61.9 ms, [interquartile ranges, 57.54-64.53 ms]). Mean T2 values were significantly higher in the different zones when comparing the OA patients whatever the cause primary or secondary (p value < 0.05) with the control group; no significant difference was noticed between the primary and secondary OA (p value > 0.05).

Conclusion

T2 relaxometry is a reliable, quantitative method for the assessment of the glenohumeral cartilage for significant differences in T2 values between the control group and the OA patients.

3-T T2 mapping magnetic resonance imaging for biochemical assessment of normal and damaged glenoid cartilage: a prospective arthroscopy-controlled study

This study evaluated the ability of T2 mapping to assess the glenoid cartilage using arthroscopy as the gold standard. Eighteen consecutive patients (mean age: 52.4 ± 14.72 years, including 12 men) with shoulder pain underwent T2 mapping at 3-T with subsequent shoulder arthroscopy. With correlation to cartilage-sensitive morphologic sequences regions-of-interest were placed in the corresponding T2 maps both in normal-appearing cartilage and focal cartilage lesions using a quadrant-wise approach. Inter-reader and intra-reader correlation coefficients (ICCs) between two independent radiologists as well as cut-off values with their sensitivities/specificities for the detection of cartilage damage were calculated. The mean T2 value for healthy cartilage was 23.0 ± 3 ms with significantly higher values in the superior quadrants compared to the inferior quadrants (p < 0.0001). In 5 patients with focal cartilage damage significantly higher T2 values of 44.7 ± 3.7 ms (P < 0.01) were observed. The maximum T2 value in normal cartilage (27.3 ms) was lower than the minimum value in damaged cartilage (40.8 ms) resulting in perfect sensitivities/specificities of 100% (95% confidence-interval 47.8-100.0) for all cut-off values between 27.3-40.8 ms. ICCs ranged between 0.63 and 0.99. In conclusion, T2 mapping can evaluate biochemical cartilage integrity and discriminates arthroscopy-proven healthy and damaged glenoid cartilage with high diagnostic performance.

Quantitative mapping of glenohumeral cartilage in asymptomatic subjects using 3 T magnetic resonance imaging

OBJECTIVE

The purpose of this study was to develop quantitative T2 mapping methodology in asymptomatic shoulders for the entire mappable region of the glenohumeral cartilage in the coronal and sagittal planes, to assess the feasibility and limitations of the development of a diagnostic tool for future application in symptomatic patients.

MATERIALS AND METHODS

Twenty-one asymptomatic volunteers underwent sagittal and coronal glenohumeral T2 mapping, as the spherical geometry of the humeral head obviates the need to evaluate the entire glenohumeral cartilage in a single plane. The humeral head cartilage orthogonal to the mapping plane was manually segmented in the sagittal and coronal planes, whereas the glenoid cartilage was segmented in the coronal plane. Cartilage T2 summary statistics were calculated and coverage in each mapping plane was qualitatively assessed.

RESULTS

The mean ± standard deviation of the glenoid cartilage T2 was 38 ± 2 ms. The coronal and sagittal mapping planes captured different regions of the humeral head with some overlap: inferior-medial to superior-lateral versus superior/superior-lateral to anterior-lateral and posterior-lateral respectively. The mean humeral head cartilage T2 in the coronal plane was 41 ± 3 ms, which was significantly different (p < 0.05) from the sagittal plane mean of 34 ± 2 ms.

CONCLUSION

This study measured characteristic glenoid and humeral head cartilage T2 values over the area mappable with two planes. Importantly, this study demonstrated that two-dimensional mapping in a single plane or two combined planes cannot capture the entirety of the semi-spherical humeral head cartilage. This highlights the need for three-dimensional T2 mapping techniques in the shoulder.

Proton Density Fat-Fraction of Rotator Cuff Muscles Is Associated With Isometric Strength 10 Years After Rotator Cuff Repair: A Quantitative Magnetic Resonance Imaging Study of the Shoulder

BACKGROUND

Quantitative muscle fat-fraction magnetic resonance (MR) imaging techniques correlate with semiquantitative Goutallier scores with failure after rotator cuff (RC) repair.

PURPOSE

To investigate the relationship of proton density fat fraction (PDFF) of the RC muscles with semiquantitative MR scores, cartilage T2 relaxation times, and clinical isometric strength measurements in patients 10 years after unilateral RC repair.

STUDY DESIGN

Cross-sectional study; Level of evidence, 3.

METHODS

Bilateral shoulder MR imaging was performed in 13 patients (11 male, 2 female; age, 72 ± 8 years) 10.9 ± 0.4 years after unilateral autologous periosteal flap augmented RC repair (total shoulders assessed, N = 26). Goutallier classification, muscle atrophy, RC tendon integrity, and cartilage defects were determined based on morphological MR sequences. A paracoronal 2D multi-slice multi-echo sequence was used for quantitative cartilage T2 mapping. A chemical shift-encoding-based water-fat separation technique (based on a 6-echo 3D spoiled gradient echo sequence) was used for quantification of the PDFF of RC muscles. Isometric shoulder abduction strength was measured clinically. Mean and SD, Pearson correlation, and partial Spearman correlation were calculated.

RESULTS

There were 6 RC full-thickness retears in ipsilateral shoulders and 6 RC full-thickness tears in contralateral shoulders. Isometric shoulder abduction strength was not significantly different between ipsilateral and contralateral shoulders (50 ± 24 N vs 54 ± 24 N; P = .159). The mean PDFF of RC muscles was 11.7% ± 10.4% (ipsilateral, 14.2% ± 8.5%; contralateral, 9.2% ± 7.8%; P = .002). High supraspinatus PDFF correlated significantly with higher Goutallier scores ( R = 0.75, P < .001) and with lower isometric muscle strength ( R = -0.49, P = .011). This correlation remained significant after adjustment for muscle area measurements and tendon rupture ( R = -0.41, P = .048). More severe cartilage defects at the humerus were significantly associated with higher supraspinatus PDFF ( R = 0.44; P = .023). Cartilage T2 values did not correlate with muscle PDFF ( P > .05).

CONCLUSION

MR imaging-derived RC muscle PDFF is associated with isometric strength independent of muscle atrophy and tendon rupture in shoulders with early and advanced degenerative changes. It therefore provides complementary, clinically relevant information in tracking RC muscle composition on a quantitative level.

Layer-specific femorotibial cartilage T2 relaxation time in knees with and without early knee osteoarthritis: Data from the Osteoarthritis Initiative (OAI)

Magnetic resonance imaging (MRI)-based spin-spin relaxation time (T2) mapping has been shown to be associated with cartilage matrix composition (hydration, collagen content &orientation). To determine the impact of early radiographic knee osteoarthritis (ROA) and ROA risk factors on femorotibial cartilage composition, we studied baseline values and one-year change in superficial and deep cartilage T2 layers in 60 subjects (age 60.6 ± 9.6 y; BMI 27.8 ± 4.8) with definite osteophytes in one knee (earlyROA, n = 32) and with ROA risk factors in the contralateral knee (riskROA, n = 28), and 89 healthy subjects (age 55.0 ± 7.5 y; BMI 24.4 ± 3.1) without signs or risk factors of ROA. Baseline T2 did not differ significantly between earlyROA and riskROA knees in the superficial (48.0 ± 3.5 ms vs. 48.1 ± 3.1 ms) or the deep layer (37.3 ± 2.5 ms vs. 37.3 ± 1.8 ms). However, healthy knees showed significantly lower superficial layer T2 (45.4 ± 2.3 ms) than earlyROA or riskROA knees (p ≤ 0.001) and significantly lower deep layer T2 (35.8 ± 1.8 ms) than riskROA knees (p = 0.006). Significant longitudinal change in T2 (superficial: 0.5 ± 1.4 ms; deep: 0.8 ± 1.3 ms) was only detected in healthy knees. These results do not suggest an association of early ROA (osteophytes) with cartilage composition, as assessed by T2 mapping, whereas cartilage composition was observed to differ between knees with and without ROA risk factors.

T2 mapping of articular cartilage of the glenohumeral joint at 3.0 T in healthy volunteers: a feasibility study

OBJECTIVE

The purpose of this study was to assess the T2 values of the glenohumeral joint cartilage in healthy asymptomatic individuals at 3.0 T and to analyze the T2 profile of the humeral cartilage.

MATERIALS AND METHODS

This prospective study was approved by our institutional review board and written informed consent was obtained. Thirteen subjects (mean age, 28.6 years; age range, 24-33 years) were included and underwent multiecho spin-echo T2-weighted MR imaging and T2 mapping was acquired. Regions of interest were placed on the humeral cartilage and glenoid cartilage on oblique coronal images. T2 profiles of humeral cartilage were measured from the bone-cartilage interface to the articular surface. Intra-observer agreement was analyzed using intraclass correlation coefficient (ICC).

RESULTS

All 13 joints showed normal appearance on conventional T2-weighted images. The mean T2 values of humeral and glenoid cartilage were 50.5 ± 12.1 and 49.0 ± 9.9 ms, respectively. Intra-observer agreement was good, as determined by ICC (0.736). Longer T2 values were observed at the articular surface with a tendency to decrease toward the bone-cartilage interface. The mean cartilage T2 value was 69.03 ± 21.2 ms at the articular surface and 46.99 ± 19.6 ms at the bone-cartilage interface.

CONCLUSION

T2 values of the glenohumeral joint cartilage were similar to reported values of cartilage in the knee. The T2 profile of normal humeral cartilage showed a spatial variation with an increase in T2 values from the subchondral bone to the articular surface.