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Ece B, Yigit H, Ergun E, Koseoglu EN, Karavas E, Aydin S, Kosar PN. Quantitative Analysis of Supraspinatus Tendon Pathologies via T2/T2* Mapping Techniques with 1.5 T MRI. Diagnostics (Basel) 2023; 13:2534. [PMID: 37568898 PMCID: PMC10417426 DOI: 10.3390/diagnostics13152534] [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: 06/02/2023] [Revised: 07/21/2023] [Accepted: 07/27/2023] [Indexed: 08/13/2023] Open
Abstract
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.
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Affiliation(s)
- Bunyamin Ece
- Department of Radiology, Kastamonu University, 37150 Kastamonu, Turkey
| | - Hasan Yigit
- Department of Radiology, Health Sciences University, Ankara Education and Research Hospital, 06100 Ankara, Turkey; (H.Y.); (E.E.); (E.N.K.); (P.N.K.)
| | - Elif Ergun
- Department of Radiology, Health Sciences University, Ankara Education and Research Hospital, 06100 Ankara, Turkey; (H.Y.); (E.E.); (E.N.K.); (P.N.K.)
| | - Enver Necip Koseoglu
- Department of Radiology, Health Sciences University, Ankara Education and Research Hospital, 06100 Ankara, Turkey; (H.Y.); (E.E.); (E.N.K.); (P.N.K.)
| | - Erdal Karavas
- Department of Radiology, Bandırma Onyedi Eylül University, 10200 Bandırma, Turkey;
| | - Sonay Aydin
- Department of Radiology, Erzincan University, 24100 Erzincan, Turkey;
| | - Pinar Nercis Kosar
- Department of Radiology, Health Sciences University, Ankara Education and Research Hospital, 06100 Ankara, Turkey; (H.Y.); (E.E.); (E.N.K.); (P.N.K.)
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Wong TT, Quarterman P, Lynch TS, Rasiej MJ, Jaramillo D, Jambawalikar SR. Feasibility of ultrashort echo time (UTE) T2* cartilage mapping in the hip: a pilot study. Acta Radiol 2022; 63:760-766. [PMID: 33926266 DOI: 10.1177/02841851211011563] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND Ultrashort echo time (UTE) T2* is sensitive to molecular changes within the deep calcified layer of cartilage. Feasibility of its use in the hip needs to be established to determine suitability for clinical use. PURPOSE To establish feasibility of UTE T2* cartilage mapping in the hip and determine if differences in regional values exist. MATERIAL AND METHODS MRI scans with UTE T2* cartilage maps were prospectively acquired on eight hips. Hip cartilage was segmented into whole and deep layers in anterosuperior, superior, and posterosuperior regions. Quantitative UTE T2* maps were analyzed (independent one-way ANOVA) and reliability was calculated (ICC). RESULTS UTE T2* mean values (anterosuperior, superior, posterosuperior): full femoral layer (19.55, 18.43, 16.84 ms) (P=0.004), full acetabular layer (19.37, 17.50, 16.73 ms) (P=0.013), deep femoral layer (18.68, 17.90, 15.74 ms) (P=0.010), and deep acetabular layer (17.81, 16.18, 15.31 ms) (P=0.007). Values were higher in anterosuperior compared to posterosuperior regions (mean difference; 95% confidence interval [CI]): full femur layer (2.71 ms; 95% CI 0.91-4.51: P=0.003), deep femur layer (2.94 ms; 95% CI 0.69-5.19; P=0.009), full acetabular layer (2.63 ms 95% CI 0.55-4.72; P=0.012), and deep acetabular layer (2.50 ms; 95% CI 0.69-4.30; P=0.006). Intra-reader (ICC 0.89-0.99) and inter-reader reliability (ICC 0.63-0.96) were good to excellent for the majority of cartilage layers. CONCLUSION UTE T2* cartilage mapping was feasible in the hip with mean values in the range of 16.84-19.55 ms in the femur and 16.73-19.37 ms in the acetabulum. Significantly higher values were present in the anterosuperior region compared to the posterosuperior region.
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Affiliation(s)
- Tony T Wong
- Department of Radiology, Division of Musculoskeletal Radiology, New York Presbyterian Hospital – Columbia University Medical Center, New York, NY, USA
| | | | - Thomas S Lynch
- Department of Orthopedics, The Center for Shoulder, Elbow, and Sports Medicine, New York Presbyterian Hospital – Columbia University Medical Center, New York, NY, USA
| | - Michael J Rasiej
- Department of Radiology, Division of Musculoskeletal Radiology, New York Presbyterian Hospital – Columbia University Medical Center, New York, NY, USA
| | - Diego Jaramillo
- Department of Radiology, Division of Pediatric Radiology, New York Presbyterian Hospital – Columbia University Medical Center, New York, NY, USA
| | - Sachin R Jambawalikar
- Department of Radiology, Division of Physics, New York Presbyterian Hospital – Columbia University Medical Center, New York, NY, USA
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Bugeja JM, Chandra SS, Neubert A, Fripp J, Lockard CA, Ho CP, Crozier S, Engstrom C. Automated analysis of immediate reliability of T2 and T2* relaxation times of hip joint cartilage from 3 T MR examinations. Magn Reson Imaging 2021; 82:42-54. [PMID: 34147595 DOI: 10.1016/j.mri.2021.06.008] [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: 10/18/2020] [Revised: 03/31/2021] [Accepted: 06/15/2021] [Indexed: 10/21/2022]
Abstract
BACKGROUND Magnetic resonance (MR) T2 and T2* mapping sequences allow in vivo quantification of biochemical characteristics within joint cartilage of relevance to clinical assessment of conditions such as hip osteoarthritis (OA). PURPOSE To evaluate an automated immediate reliability analysis of T2 and T2* mapping from MR examinations of hip joint cartilage using a bone and cartilage segmentation pipeline based around focused shape modelling. STUDY TYPE Technical validation. SUBJECTS 17 asymptomatic volunteers (M: F 7:10, aged 22-47 years, mass 50-90 kg, height 163-189 cm) underwent unilateral hip joint MR examinations. Automated analysis of cartilage T2 and T2* data immediate reliability was evaluated in 9 subjects (M: F 4: 5) for each sequence. FIELD STRENGTH/SEQUENCE A 3 T MR system with a body matrix flex-coil was used to acquire images with the following sequences: T2 weighted 3D-trueFast Imaging with Steady-State Precession (water excitation; 10.18 ms repetition time (TR); 4.3 ms echo time (TE); Voxel Size (VS): 0.625 × 0.625 × 0.65 mm; 160 mm field of view (FOV); Flip Angle (FA): 30 degrees; Pixel Bandwidth (PB): 140 Hz/pixel); a multi-echo spin echo (MESE) T2 mapping sequence (TR/TE: 2080/18-90 ms (5 echoes); VS: 4 × 0.78 × 0.78 mm; FOV: 200 mm; FA: 180 degrees; PB: 230 Hz/pixel) and a MESE T2* mapping sequence (TR/TE: 873/3.82-19.1 ms (5 echoes); VS: 3 × 0.625 × 0.625 mm; FOV: 160 mm; FA: 25 degrees; PB: 250 Hz/pixel). ASSESSMENT Automated cartilage segmentation and quantitative analysis provided T2 and T2* data from test-retest MR examinations to assess immediate reliability. STATISTICAL TESTS Coefficient of variation (CV) and intraclass correlations (ICC2, 1) to analyse automated T2 and T2* mapping reliability focusing on the clinically important superior cartilage regions of the hip joint. RESULTS Comparisons between test-retest T2 and (T2*) data revealed mean CV's of 3.385% (1.25%), mean ICC2, 1's of 0.871 (0.984) and median mean differences of -1.139ms (+0.195ms). CONCLUSION The T2 and T2* times from automated analyses of hip cartilage from test-retest MR examinations had high (T2) and excellent (T2*) immediate reliability.
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Affiliation(s)
- Jessica M Bugeja
- School of Information Technology and Electrical Engineering, The University of Queensland, Australia; Australian e-Health Research Centre, CSIRO, Australia.
| | - Shekhar S Chandra
- School of Information Technology and Electrical Engineering, The University of Queensland, Australia.
| | - Aleš Neubert
- School of Information Technology and Electrical Engineering, The University of Queensland, Australia; Australian e-Health Research Centre, CSIRO, Australia.
| | - Jurgen Fripp
- Australian e-Health Research Centre, CSIRO, Australia.
| | - Carly A Lockard
- Imaging Research Department, Steadman Philippon Research Institute, USA.
| | - Charles P Ho
- Imaging Research Department, Steadman Philippon Research Institute, USA.
| | - Stuart Crozier
- School of Information Technology and Electrical Engineering, The University of Queensland, Australia.
| | - Craig Engstrom
- School of Human Movement Studies, The University of Queensland, Australia.
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Melkus G, Beaulé PE, Wilkin G, Rakhra KS. What Is the Correlation Among dGEMRIC, T1p, and T2* Quantitative MRI Cartilage Mapping Techniques in Developmental Hip Dysplasia? Clin Orthop Relat Res 2021; 479:1016-1024. [PMID: 33355837 PMCID: PMC8083801 DOI: 10.1097/corr.0000000000001600] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/17/2020] [Accepted: 11/10/2020] [Indexed: 01/31/2023]
Abstract
BACKGROUND Delayed gadolinium-enhanced MRI of cartilage (dGEMRIC) is a validated technique for evaluating cartilage health in developmental dysplasia of the hip (DDH), which can be a helpful prognosticator for the response to surgical treatments. dGEMRIC requires intravenous injection of gadolinium contrast, however, which adds time, expense, and possible adverse reactions to the imaging procedure. Newer MRI cartilage mapping techniques such as T1 rho (ρ) and T2* have been performed in the hip without the need for any contrast, although it is unknown whether they are equivalent to dGEMRIC. QUESTION/PURPOSE In this study, our purpose was to determine the correlation between the relaxation values of three cartilage mapping techniques, dGEMRIC, T1ρ, and T2*, in patients with DDH. METHODS Fifteen patients with DDH (three male, 12 female; mean age 29 ± 9 years) scheduled for periacetabular osteotomy underwent preoperative dGEMRIC, T1ρ, and T2* MRI at 3T with quantitative cartilage mapping. The outcomes of dGEMRIC, T1ρ, and T2* mapping were calculated for three regions of interest (ROI) to analyze the weightbearing cartilage of the hip: global ROI, anterior and posterior ROI, and further subdivided into medial, intermediate, and lateral to generate six smaller ROIs. The correlation between the respective relaxation time values was evaluated using the Spearman correlation coefficient (rS) for each ROI, categorized as negligible, weak, moderate, strong, or very strong. The relaxation values within the subdivided ROIs were compared for each of the three cartilage mapping techniques using the Kruskal-Wallis test. RESULTS There was a moderate correlation of T1ρ and T2* relaxation values with dGEMRIC relaxation values. For the global ROI, there was a moderate correlation between dGEMRIC and T2* (moderate; rS = 0.63; p = 0.01). For the anterior ROI, a moderate or strong correlation was found between dGEMRIC and both T1ρ and T2*: dGEMRIC and T1ρ (strong; rS = -0.71; p = 0.003) and dGEMRIC and T2* (moderate; rS = 0.69; p = 0.004). There were no correlations for the posterior ROI. The mean dGEMRIC, T1ρ, and T2* relaxation values were not different between the anterior and posterior ROIs nor between the subdivided six ROIs. CONCLUSION Quantitative T1ρ and T2* cartilage mapping demonstrated a moderate correlation with dGEMRIC, anteriorly and globally, respectively. However, the clinical relevance of such a correlation remains unclear. Further research investigating the correlation of these two noncontrast techniques with clinical function and outcome scores is needed before broad implementation in the preoperative investigation of DDH. LEVEL OF EVIDENCE Level II, diagnostic study.
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Affiliation(s)
- Gerd Melkus
- G. Melkus, K. S. Rakhra, Department of Medical Imaging, The Ottawa Hospital, Ottawa, ON, Canada
- G. Melkus, K. S. Rakhra, Department of Radiology, University of Ottawa, Ottawa, ON, Canada
- P. E. Beaulé, G. Wilkin, Division of Orthopaedic Surgery, The Ottawa Hospital, Ottawa, ON, Canada
- P. E. Beaulé, G. Wilkin, Department of Medicine, University of Ottawa, Ottawa, Canada
| | - Paul E Beaulé
- G. Melkus, K. S. Rakhra, Department of Medical Imaging, The Ottawa Hospital, Ottawa, ON, Canada
- G. Melkus, K. S. Rakhra, Department of Radiology, University of Ottawa, Ottawa, ON, Canada
- P. E. Beaulé, G. Wilkin, Division of Orthopaedic Surgery, The Ottawa Hospital, Ottawa, ON, Canada
- P. E. Beaulé, G. Wilkin, Department of Medicine, University of Ottawa, Ottawa, Canada
| | - Geoffrey Wilkin
- G. Melkus, K. S. Rakhra, Department of Medical Imaging, The Ottawa Hospital, Ottawa, ON, Canada
- G. Melkus, K. S. Rakhra, Department of Radiology, University of Ottawa, Ottawa, ON, Canada
- P. E. Beaulé, G. Wilkin, Division of Orthopaedic Surgery, The Ottawa Hospital, Ottawa, ON, Canada
- P. E. Beaulé, G. Wilkin, Department of Medicine, University of Ottawa, Ottawa, Canada
| | - Kawan S Rakhra
- G. Melkus, K. S. Rakhra, Department of Medical Imaging, The Ottawa Hospital, Ottawa, ON, Canada
- G. Melkus, K. S. Rakhra, Department of Radiology, University of Ottawa, Ottawa, ON, Canada
- P. E. Beaulé, G. Wilkin, Division of Orthopaedic Surgery, The Ottawa Hospital, Ottawa, ON, Canada
- P. E. Beaulé, G. Wilkin, Department of Medicine, University of Ottawa, Ottawa, Canada
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Elite Rowers Demonstrate Consistent Patterns of Hip Cartilage Damage Compared With Matched Controls: A T2* Mapping Study. Clin Orthop Relat Res 2019; 477:1007-1018. [PMID: 30516651 PMCID: PMC6494313 DOI: 10.1097/corr.0000000000000576] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
BACKGROUND Rowing exposes the femoral head and acetabulum to high levels of repetitive abutment motion and axial loading that may put elite athletes at an increased risk for developing early hip osteoarthritis. QUESTIONS/PURPOSES Do elite rowers demonstrate characteristic hip cartilage lesions on T2 MRI sequences compared with asymptomatic individuals who do not row? METHODS This study included 20 asymptomatic rowers (mean age, 23 ± 3 years; nine females, 11 males) who had a minimum of 5 years of intensive (≥ 12 hours/week) training. The recruiting of the rowers took place from the central German federal rowing base, which has inherent intense training and selection requirements to declare these athletes as "elite rowers." We investigated one hip per study participant. MRI was performed on a 3-T scanner. The protocol included standard sequences, a double-echo steady-state sequence, and a multiecho data image combination sequence with inline T2 calculation (= the decay of transverse magnetization arising from molecular interactions [T2] and inhomogeneities in the magnetic field resulting from tissue susceptibility-induced field distortions and variations in the magnet itself), which detects changes in water content and the disruption of collagen structure. Although extrinsic and intrinsic influences on the T2 values including diurnal effects, MR technic-derived variations, and anatomic-related regional disparities need to be taken into account, low T2 values well below 20 ms indicate cartilage degeneration. Cartilage was morphologically analyzed in the anterior, anterosuperior, superoanterior, superior, superoposterior, posterosuperior, and posterior regions of the hip and graded as follows: Grade 0 = normal; Grade 1 = signal changes; Grade 2 = cartilage abrasion; Grade 3 = cartilage loss. Labrum was classified as follows: Grade 0 = normal; Grade 1 = partial tear; Grade 2 = full-thickness tear; Grade 3 = labrum degeneration. The T2 measurement was done through a region of interest analysis. For reliability assessment, morphologic evaluation and T2 measurement were performed by two observers while one observer repeated his analysis with a time interval > 2 weeks. Intra- and interobserver reliability was determined using κ analysis and intraclass correlation coefficients. Control T2 data were derived from a previous study on 15 hips in 15 asymptomatic volunteers of similar ages (seven males and eight females) who were not competitive rowers with similar MR hardware and imaging sequences. RESULTS Compared with the control group of asymptomatic volunteers who were not competitive rowers, we noted a high level of labrum and cartilage degeneration in the cohort of elite rowers. In the group of elite rowers, cartilage degeneration was noted in all hips. Regarding the acetabular cartilage, 271 zones could be evaluated. Of those, 44% (120 of 271) were graded normal, 6% (15 of 271) revealed signal alteration, 45% (122 of 271) demonstrated cartilage abrasion, and 5% (14 of 271) were noted to have full-thickness cartilage loss. Morphologic cartilage degeneration in the femoral head was less frequent. T2 values were lower than the control hips in all zones except for the posterior central acetabular zone (global T2 acetabular: 20 ± 6 ms, range, 9-36 ms, 95% confidence interval [CI], 19-21 ms versus 25 ± 5 ms, range, 14-44 ms, 95% CI, 24-25 ms, p < 0.001; global T2 femoral: 23 ± 7 ms, range, 9-38 ms, 95% CI, 22-24 ms versus 27 ± 5 ms, range, 17-45 ms, 95% CI, 26-28 ms, p < 0.001). The difference in T2 between the two study groups was superior in the peripheral zone of the anterosuperior region (16 ± 3 ms; range, 10-22 ms, 95% CI, 15-18 ms versus 26 ms ± 5 ms, range, 18-38 ms, 95% CI, 24-29 ms, p < 0.001). CONCLUSIONS We found signs of hip cartilage degeneration to a much greater degree in elite rowers than in asymptomatic controls. Although causation cannot be inferred, this is concerning, and future investigations including controlled longitudinal studies both on elite and nonelite athletes with sufficient cohort size are warranted to clarify our findings. LEVEL OF EVIDENCE Level III, therapeutic study.
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Hesper T, Neugroda C, Schleich C, Antoch G, Hosalkar H, Krauspe R, Zilkens C, Bittersohl B. T2*-Mapping of Acetabular Cartilage in Patients With Femoroacetabular Impingement at 3 Tesla: Comparative Analysis with Arthroscopic Findings. Cartilage 2018; 9:118-126. [PMID: 29126367 PMCID: PMC5871124 DOI: 10.1177/1947603517741168] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Objective To evaluate the diagnostic accuracy of T2*-mapping for detecting acetabular cartilage damage in patients with symptomatic femoroacetabular impingement (FAI). Design A total of 29 patients (17 females, 12 males, mean age 35.6 ± 12.8 years, mean body mass index 25.1 ± 4.1 kg/m2, 16 right hips) with symptomatic FAI underwent T2* MRI and subsequent hip arthroscopy. T2* values were obtained by region of interest analysis in seven radially reformatted planes around the femoral neck (anterior, anterior-superior, superior-anterior, superior, superior-posterior, posterior-superior, posterior). Intraoperatively, a modified Outerbridge classification was used for assessment of the cartilage status in each region. T2* values and intraoperative data were compared, and sensitivity, specificity, negative predictive values (NPV) and positive predictive values (PPV) as well as the correlation between T2*-mapping and intraoperative findings, were determined. The mean time interval between MRI and arthroscopy was 65.7 ± 48.0 days. Results Significantly higher T2* values were noted in arthroscopically normal evaluated cartilage than in regions with cartilage degeneration (mean T2* 25.6 ± 4.7 ms vs. 19.9 ± 4.5 ms; P < 0.001). With the intraoperative findings as a reference, sensitivity, specificity, NPV and PPV were 83.5%, 67.7%, 78.4% and 74.4%, respectively. The correlation between T2*-mapping and intraoperative cartilage status was moderate (ρ = -0.557; P < 0.001). Conclusions T2*-mapping enabled analysis of acetabular cartilage with appropriate correlation with intraoperative findings and promising results for sensitivity, specificity, PPV, and NPV in this cohort. Our results emphasize the value of T2*-mapping for the diagnosis of hip joint cartilage pathologies in symptomatic FAI.
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Affiliation(s)
- Tobias Hesper
- Department of Orthopedics, Medical Faculty, University of Düsseldorf, Düsseldorf, Germany,Tobias Hesper, Department of Orthopedics, Heinrich-Heine University, Düsseldorf, Moorenstraße 5, 40225 Düsseldorf, Germany.
| | - Christina Neugroda
- Department of Orthopedics, Medical Faculty, University of Düsseldorf, Düsseldorf, Germany
| | - Christoph Schleich
- Department of Diagnostic and Interventional Radiology, Medical Faculty, University of Düsseldorf, Düsseldorf, Germany
| | - Gerald Antoch
- Department of Diagnostic and Interventional Radiology, Medical Faculty, University of Düsseldorf, Düsseldorf, Germany
| | - Harish Hosalkar
- Joint Preservation and Deformity Correction, Paradise Valley Hospital, San Diego, CA, USA,Hip Preservation, Tri-city Medical Center, San Diego, CA, USA
| | - Rüdiger Krauspe
- Department of Orthopedics, Medical Faculty, University of Düsseldorf, Düsseldorf, Germany
| | - Christoph Zilkens
- Department of Orthopedics, Medical Faculty, University of Düsseldorf, Düsseldorf, Germany
| | - Bernd Bittersohl
- Department of Orthopedics, Medical Faculty, University of Düsseldorf, Düsseldorf, Germany
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