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Akatsuka Y, Teramoto A, Murahashi Y, Takahashi K, Imamura R, Takashima H, Watanabe K, Yamashita T. Quantitative assessment of anterior talofibular ligament quality in chronic lateral ankle instability using magnetic resonance imaging T2* value. Skeletal Radiol 2024; 53:733-739. [PMID: 37857750 DOI: 10.1007/s00256-023-04480-8] [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] [Received: 08/13/2023] [Revised: 10/07/2023] [Accepted: 10/09/2023] [Indexed: 10/21/2023]
Abstract
OBJECTIVE To determine T2* normal reference values for anterior talofibular ligament (ATFL) and to investigate the feasibility of the quantitative ATFL quality evaluation in chronic lateral ankle instability (CLAI) using T2* values. MATERIALS AND METHODS This study enrolled 15 patients with CLAI and 30 healthy volunteers. The entire ATFL T2* values from the MRI T2* mapping were measured. The prediction equation (variables: age, height, and weight) in a multiple linear regression model was used to calculate the T2* normal reference value in the healthy group. T2* ratio was defined as the ratio of the actual T2* value of the patient's ATFL to the normal reference value for each patient. A Telos device was used to measure the talar tilt angle (TTA) from the stress radiograph. RESULTS T2* values of ATFL in the healthy and CLAI groups were 10.82 ± 1.84 ms and 14.36 ± 4.30 ms, respectively, which are significantly higher in the CLAI group (P < 0.05). The prediction equation of the normal reference T2* value was [14.9 + 0.14 × age (years) - 4.7 × height (m) - 0.03 × weight (kg)] (R2 = 0.65, P < 0.0001). A significant positive correlation was found between the T2* ratio and TTA (r = 0.66, P = 0.007). CONCLUSION MRI T2* values in patients with CLAI were higher than those in healthy participants, and the T2* ratio correlated with TTA, suggesting that T2* values are promising for quantitative assessment of ATFL quality preoperatively.
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Affiliation(s)
- Yoshihiro Akatsuka
- Division of Radiology and Nuclear Medicine, Sapporo Medical University Hospital, South-1, West-16, Chuo-ku, Sapporo, 060-8543, Japan
- Department of Orthopaedic Surgery, Sapporo Medical University School of Medicine, South-1, West-16, Chuo-ku, Sapporo, 060-8543, Japan
| | - Atsushi Teramoto
- Department of Orthopaedic Surgery, Sapporo Medical University School of Medicine, South-1, West-16, Chuo-ku, Sapporo, 060-8543, Japan.
| | - Yasutaka Murahashi
- Department of Orthopaedic Surgery, Sapporo Medical University School of Medicine, South-1, West-16, Chuo-ku, Sapporo, 060-8543, Japan
| | - Katsunori Takahashi
- Department of Orthopaedic Surgery, Sapporo Medical University School of Medicine, South-1, West-16, Chuo-ku, Sapporo, 060-8543, Japan
| | - Rui Imamura
- Division of Radiology and Nuclear Medicine, Sapporo Medical University Hospital, South-1, West-16, Chuo-ku, Sapporo, 060-8543, Japan
- Department of Orthopaedic Surgery, Sapporo Medical University School of Medicine, South-1, West-16, Chuo-ku, Sapporo, 060-8543, Japan
| | - Hiroyuki Takashima
- Faculty of Health Sciences, Hokkaido University, North-12, West-15, Kita-ku, Sapporo, 060-0812, Japan
| | - Kota Watanabe
- Second Division of Physical Therapy, Sapporo Medical University School of Health Sciences, South-1, West-16, Chuo-ku, Sapporo, 060-8543, Japan
| | - Toshihiko Yamashita
- Department of Orthopaedic Surgery, Sapporo Medical University School of Medicine, South-1, West-16, Chuo-ku, Sapporo, 060-8543, Japan
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Asai K, Nakase J, Yoshimizu R, Kimura M, Kanayama T, Yanatori Y, Tsuchiya H. High initial graft tension is a post-operative risk factor for high UTE T2* value of the graft 6 months after anterior cruciate ligament reconstruction. Knee 2023; 40:143-151. [PMID: 36434971 DOI: 10.1016/j.knee.2022.11.015] [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: 04/16/2022] [Revised: 09/09/2022] [Accepted: 11/03/2022] [Indexed: 11/25/2022]
Abstract
BACKGROUND To evaluate the risk factor of "ligamentization" using the ultrashort echo time (UTE)-T2* imaging. METHODS Fifty-nine patients (23 males and 36 females, age of 21.9 ± 10.6 years old) who underwent anterior cruciate ligament (ACL) reconstruction with hamstring tendon were evaluated. The UTE T2* values of the reconstructed ACL at 6 months postoperatively were calculated. Circular regions of interest (5-10 mm2) were set at the proximal, mid-substance, and distal regions of the reconstructed ACL. The UTE T2* values of the entire reconstructed ACL were calculated as the average of these three points. Patients were divided into high (27 knees) and low (32 knees) UTE T2* groups by calculating whether their UTE T2* values were greater than the median of the UTE T2* values of all patients. Risk factors for high UTE T2* values were evaluated. Clinical outcomes were compared between the two groups. RESULTS There were no significant differences in any measured parameters and clinical outcomes between the two UTE T2* groups. Logistic regression analysis revealed that graft tension was a significant risk factor for patients with high UTE-T2* values (P = 0.047, odds ratio [OR] = 2.285). The UTE-T2* values of the 20 N graft tension using the Tension loc system were significantly lower than those of the 40 N using double-spike plate (DSP) with screws at each site and the 30 N using the Tension loc system at the distal site. CONCLUSIONS Higher graft tension was an independent risk factor for high UTE T2* values of the reconstructed ACL.
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Affiliation(s)
- Kazuki Asai
- Department of Orthopedic Surgery, Graduate School of Medical Science Kanazawa University, 13-1 Takara-machi, Kanazawa-city 920-8641, Japan; Department of Orthopedic Surgery, KKR Hokuriku Hospital, 13-43 izumigaoka nicyoume, Kanazawa-city 921-8035, Japan
| | - Junsuke Nakase
- Department of Orthopedic Surgery, Graduate School of Medical Science Kanazawa University, 13-1 Takara-machi, Kanazawa-city 920-8641, Japan.
| | - Rikuto Yoshimizu
- Department of Orthopedic Surgery, Graduate School of Medical Science Kanazawa University, 13-1 Takara-machi, Kanazawa-city 920-8641, Japan
| | - Mitsuhiro Kimura
- Department of Orthopedic Surgery, Graduate School of Medical Science Kanazawa University, 13-1 Takara-machi, Kanazawa-city 920-8641, Japan
| | - Tomoyuki Kanayama
- Department of Orthopedic Surgery, Graduate School of Medical Science Kanazawa University, 13-1 Takara-machi, Kanazawa-city 920-8641, Japan
| | - Yusuke Yanatori
- Department of Orthopedic Surgery, Graduate School of Medical Science Kanazawa University, 13-1 Takara-machi, Kanazawa-city 920-8641, Japan
| | - Hiroyuki Tsuchiya
- Department of Orthopedic Surgery, Graduate School of Medical Science Kanazawa University, 13-1 Takara-machi, Kanazawa-city 920-8641, Japan
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Wilms LM, Radke KL, Latz D, Thiel TA, Frenken M, Kamp B, Filler TJ, Nagel AM, Müller-Lutz A, Abrar DB, Nebelung S. UTE-T2* versus conventional T2* mapping to assess posterior cruciate ligament ultrastructure and integrity-an in-situ study. Quant Imaging Med Surg 2022; 12:4190-4201. [PMID: 35919061 PMCID: PMC9338370 DOI: 10.21037/qims-22-251] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2022] [Accepted: 05/23/2022] [Indexed: 01/01/2023]
Abstract
Background Clinical-standard morphologic magnetic resonance imaging (MRI) is limited in the refined diagnosis of posterior cruciate ligament (PCL) injuries. Quantitative MRI sequences such as ultrashort echo-time (UTE)-T2* mapping or conventional T2* mapping have been theorized to quantify ligament (ultra-) structure and integrity beyond morphology. This study evaluates their diagnostic potential in identifying and differentiating partial and complete PCL injuries in a standardized graded injury model. Methods Ten human cadaveric knee joint specimens were imaged on a clinical 3.0 T MRI scanner using morphologic, conventional T2* mapping, and UTE-T2* mapping sequences before and after standardized arthroscopic partial and complete PCL transection. Following manual segmentation, quantitative T2* and underlying texture features (i.e., energy, homogeneity, and variance) were analyzed for each specimen and PCL condition, both for the entire PCL and its subregions. For statistical analysis, Friedman’s test followed by Dunn’s multiple comparison test was used against the level of significance of P≤0.01. Results For the entire PCL, T2* was significantly increased as a function of injury when acquired with the UTE-T2* sequence [entire PCL: 11.1±3.1 ms (intact); 10.9±4.6 ms (partial); 14.3±4.9 ms (complete); P<0.001], but not when acquired with the conventional T2* sequence [entire PCL: 10.0±3.2 ms (intact); 11.4±6.2 ms (partial); 15.5±7.8 ms (complete); P=0.046]. The PCL subregions and texture variables showed variable changes indicative of injury-associated disorganization. Conclusions In contrast to the conventional T2* mapping, UTE-T2* mapping is more receptive in the detection of structural damage of the PCL and allows quantitative assessment of ligament (ultra-)structure and integrity that may help to improve diagnostic differentiation of distinct injury states. Once further substantiated beyond the in-situ setting, UTE-T2* mapping may refine diagnostic evaluation of PCL injuries and -possibly- monitor ligament healing, ageing, degeneration, and inflammation.
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Affiliation(s)
- Lena Marie Wilms
- Department of Diagnostic and Interventional Radiology, Medical Faculty, University Dusseldorf, Dusseldorf, Germany.,Department of Orthopaedics and Trauma Surgery, Medical Faculty, University Dusseldorf, Dusseldorf, Germany
| | - Karl Ludger Radke
- Department of Diagnostic and Interventional Radiology, Medical Faculty, University Dusseldorf, Dusseldorf, Germany
| | - David Latz
- Department of Orthopaedics and Trauma Surgery, Medical Faculty, University Dusseldorf, Dusseldorf, Germany
| | - Thomas Andreas Thiel
- Department of Diagnostic and Interventional Radiology, Medical Faculty, University Dusseldorf, Dusseldorf, Germany
| | - Miriam Frenken
- Department of Diagnostic and Interventional Radiology, Medical Faculty, University Dusseldorf, Dusseldorf, Germany
| | - Benedikt Kamp
- Department of Diagnostic and Interventional Radiology, Medical Faculty, University Dusseldorf, Dusseldorf, Germany
| | | | - Armin Michael Nagel
- Institute of Radiology, University Hospital Erlangen, Friedrich-Alexander-Universität Erlangen-Nürnberg (FAU), Erlangen, Germany.,Division of Medical Physics in Radiology, German Cancer Research Center (DKFZ), Heidelberg, Germany
| | - Anja Müller-Lutz
- Department of Diagnostic and Interventional Radiology, Medical Faculty, University Dusseldorf, Dusseldorf, Germany
| | - Daniel Benjamin Abrar
- Department of Diagnostic and Interventional Radiology, Medical Faculty, University Dusseldorf, Dusseldorf, Germany
| | - Sven Nebelung
- Department of Diagnostic and Interventional Radiology, Medical Faculty, University Dusseldorf, Dusseldorf, Germany.,Department of Diagnostic and Interventional Radiology, University Hospital Aachen, Aachen, Germany
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