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Jerban S, Ma Y, Afsahi AM, Lombardi A, Wei Z, Shen M, Wu M, Le N, Chang DG, Chung CB, Du J, Chang EY. Lower Macromolecular Content in Tendons of Female Patients with Osteoporosis versus Patients with Osteopenia Detected by Ultrashort Echo Time (UTE) MRI. Diagnostics (Basel) 2022; 12:1061. [PMID: 35626217 PMCID: PMC9140093 DOI: 10.3390/diagnostics12051061] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2022] [Revised: 04/20/2022] [Accepted: 04/21/2022] [Indexed: 01/30/2023] Open
Abstract
Tendons and bones comprise a special interacting unit where mechanical, biochemical, and metabolic interplays are continuously in effect. Bone loss in osteoporosis (OPo) and its earlier stage disease, osteopenia (OPe), may be coupled with a reduction in tendon quality. Noninvasive means for quantitatively evaluating tendon quality during disease progression may be critically important for the improvement of characterization and treatment optimization in patients with bone mineral density disorders. Though clinical magnetic resonance imaging (MRI) sequences are not typically capable of directly visualizing tendons, ultrashort echo time MRI (UTE-MRI) is able to acquire a high signal from tendons. Magnetization transfer (MT) modeling combined with UTE-MRI (i.e., UTE-MT-modeling) can indirectly assess macromolecular proton content in tendons. This study aimed to determine whether UTE-MT-modeling could detect differences in tendon quality across a spectrum of bone health. The lower legs of 14 OPe (72 ± 6 years) and 31 OPo (73 ± 6 years) female patients, as well as 30 female participants with normal bone (Normal-Bone, 36 ± 19 years), are imaged using UTE sequences on a 3T MRI scanner. Institutional review board approval is obtained for the study, and all recruited subjects provided written informed consent. A T1 measurement and UTE-MT-modeling are performed on the anterior tibialis tendon (ATT), posterior tibialis tendon (PTT), and the proximal Achilles tendon (PAT) of all subjects. The macromolecular fraction (MMF) is estimated as the main measure from UTE-MT-modeling. The mean MMF in all the investigated tendons was significantly lower in OPo patients compared with the Normal-Bone cohort (mean difference of 24.2%, p < 0.01), with the largest Normal-Bone vs. OPo difference observed in the ATT (mean difference of 32.1%, p < 0.01). Average MMF values of all the studied tendons are significantly lower in the OPo cohort compared with the OPe cohort (mean difference 16.8%, p = 0.02). Only the PPT shows significantly higher T1 values in OPo patients compared with the Normal-Bone cohort (mean difference 17.6%, p < 0.01). Considering the differences between OPo and OPe groups with similar age ranges, tendon deterioration associated with declining bone health was found to be larger than a priori detected differences caused purely by aging, highlighting UTE-MT MRI techniques as useful methods in assessing tendon quality over the course of progressive bone weakening.
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Affiliation(s)
- Saeed Jerban
- Department of Radiology, University of California, San Diego, CA 92093, USA; (Y.M.); (A.M.A.); (A.L.); (Z.W.); (M.S.); (M.W.); (N.L.); (C.B.C.); (J.D.)
| | - Yajun Ma
- Department of Radiology, University of California, San Diego, CA 92093, USA; (Y.M.); (A.M.A.); (A.L.); (Z.W.); (M.S.); (M.W.); (N.L.); (C.B.C.); (J.D.)
| | - Amir Masoud Afsahi
- Department of Radiology, University of California, San Diego, CA 92093, USA; (Y.M.); (A.M.A.); (A.L.); (Z.W.); (M.S.); (M.W.); (N.L.); (C.B.C.); (J.D.)
| | - Alecio Lombardi
- Department of Radiology, University of California, San Diego, CA 92093, USA; (Y.M.); (A.M.A.); (A.L.); (Z.W.); (M.S.); (M.W.); (N.L.); (C.B.C.); (J.D.)
- Research Service, Veterans Affairs San Diego Healthcare System, San Diego, CA 92161, USA
| | - Zhao Wei
- Department of Radiology, University of California, San Diego, CA 92093, USA; (Y.M.); (A.M.A.); (A.L.); (Z.W.); (M.S.); (M.W.); (N.L.); (C.B.C.); (J.D.)
| | - Meghan Shen
- Department of Radiology, University of California, San Diego, CA 92093, USA; (Y.M.); (A.M.A.); (A.L.); (Z.W.); (M.S.); (M.W.); (N.L.); (C.B.C.); (J.D.)
| | - Mei Wu
- Department of Radiology, University of California, San Diego, CA 92093, USA; (Y.M.); (A.M.A.); (A.L.); (Z.W.); (M.S.); (M.W.); (N.L.); (C.B.C.); (J.D.)
| | - Nicole Le
- Department of Radiology, University of California, San Diego, CA 92093, USA; (Y.M.); (A.M.A.); (A.L.); (Z.W.); (M.S.); (M.W.); (N.L.); (C.B.C.); (J.D.)
- Research Service, Veterans Affairs San Diego Healthcare System, San Diego, CA 92161, USA
| | - Douglas G. Chang
- Department of Orthopaedic Surgery, University of California, San Diego, CA 92093, USA;
| | - Christine B. Chung
- Department of Radiology, University of California, San Diego, CA 92093, USA; (Y.M.); (A.M.A.); (A.L.); (Z.W.); (M.S.); (M.W.); (N.L.); (C.B.C.); (J.D.)
- Research Service, Veterans Affairs San Diego Healthcare System, San Diego, CA 92161, USA
| | - Jiang Du
- Department of Radiology, University of California, San Diego, CA 92093, USA; (Y.M.); (A.M.A.); (A.L.); (Z.W.); (M.S.); (M.W.); (N.L.); (C.B.C.); (J.D.)
- Research Service, Veterans Affairs San Diego Healthcare System, San Diego, CA 92161, USA
| | - Eric Y. Chang
- Department of Radiology, University of California, San Diego, CA 92093, USA; (Y.M.); (A.M.A.); (A.L.); (Z.W.); (M.S.); (M.W.); (N.L.); (C.B.C.); (J.D.)
- Research Service, Veterans Affairs San Diego Healthcare System, San Diego, CA 92161, USA
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Wang JE, Bai RJ, Zhan HL, Li WT, Qian ZH, Wang NL, Yin Y. High-resolution 3T magnetic resonance imaging and histological analysis of capsuloligamentous complex of the first metatarsophalangeal joint. J Orthop Surg Res 2021; 16:638. [PMID: 34689814 PMCID: PMC8543817 DOI: 10.1186/s13018-021-02795-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/19/2021] [Accepted: 10/12/2021] [Indexed: 11/10/2022] Open
Abstract
Background There are discrepancies in the understanding of the structure of the capsuloligamentous complex of the first metatarsophalangeal joint (MTPJ); this study aims to investigate the differences with previous anatomical reports of high-resolution 3T magnetic resonance imaging (MRI) and histological analysis in illustrating the structure of the capsuloligamentous complex of the first MTPJ. Methods Nine fresh frozen cadaveric feet specimens (from two women and three men; aged 32 to 58 years) were used in this study. All specimens underwent MR examination with T1-weighted imaging and T2-weighted spectral attenuated inversion recovery in three planes. Subsequently, all cadaveric feet specimens were sliced into 2-mm-thick sections. The MRI features of the capsuloligamentous complex of the first MTPJ were analyzed in these specimens. Hematoxylin–eosin and Masson’s trichrome staining methods were used to explore the histologic features of the capsuloligamentous complex of the first MTPJ. Results Different from most previous studies, our results showed that the plantar plate could be divided into four portions including the central portion of the plantar plate, the intersesamoid, the sesamoid phalangeal and the metatarsosesamoid ligaments. The normal central portion of the plantar plate could be clearly visualized in the sagittal and coronal plane MR images. The intersesamoid ligament is a continuation of the central portion of the plantar plate on the sagittal plane on the gross specimen, the MR imaging, and the histological examination. On the coronal plane of the gross specimen and MR imaging, the sesamoid phalangeal ligaments and the central portion of the plantar plate can be seen as separate ligaments, but they appeared interwoven with the same continuous collagenous fibers on the histological analysis. Conclusion High-resolution 3T MRI allows accurate demonstration of the different anatomical details of the capsuloligamentous complex of the first MTPJ from previous anatomical reports. The histological analysis provides further understanding of the structures of the capsuloligamentous complex of the first MTPJ from previous studies. Supplementary Information The online version contains supplementary material available at 10.1186/s13018-021-02795-7.
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Affiliation(s)
- Jin-E Wang
- Department of Radiology, Peking University Fourth School of Clinical Medicine, Beijing, 100035, China
| | - Rong-Jie Bai
- Department of Radiology, Peking University Fourth School of Clinical Medicine, Beijing, 100035, China. .,Department of Radiology, Beijing Jishuitan Hospital, Beijing, 100035, China.
| | - Hui-Li Zhan
- Department of Radiology, Beijing Jishuitan Hospital, Beijing, 100035, China
| | - Wen-Ting Li
- Institute of Basic Medical Sciences, Chinese Academy of Medical Sciences, School of Basic Medicine, Peking Union Medical College, Beijing, 100005, China
| | - Zhan-Hua Qian
- Department of Radiology, Beijing Jishuitan Hospital, Beijing, 100035, China
| | - Nai-Li Wang
- Institute of Basic Medical Sciences, Chinese Academy of Medical Sciences, School of Basic Medicine, Peking Union Medical College, Beijing, 100005, China
| | - Yuming Yin
- Direct Radiology, 3501 Ocean Drive, Corpus Christi, TX, 78411, USA
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Abstract
The aim of this article is to review the use of magnetic resonance imaging (MRI) for the evaluation of shoulder pain, which is a common clinical complaint of the musculoskeletal system. MRI is an essential auxiliary tool to evaluate these patients because of its high resolution and high sensitivity in depicting the soft tissues. This article will review the imaging technique, normal imaging anatomy, and most common imaging findings of disorders of tendons, labrum, and ligaments of the shoulder. It will also discuss common systemic diseases that manifest in the shoulder as well as disorders of the acromioclavicular joint and bursae. New advances and research in MRI have provided additional potential uses for evaluating shoulder derangements.
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Jerban S, Ma Y, Namiranian B, Ashir A, Shirazian H, Wei Z, Le N, Wu M, Cai Z, Du J, Chang EY. Age-related decrease in collagen proton fraction in tibial tendons estimated by magnetization transfer modeling of ultrashort echo time magnetic resonance imaging (UTE-MRI). Sci Rep 2019; 9:17974. [PMID: 31784631 PMCID: PMC6884538 DOI: 10.1038/s41598-019-54559-3] [Citation(s) in RCA: 22] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2019] [Accepted: 11/11/2019] [Indexed: 12/12/2022] Open
Abstract
Clinical magnetic resonance imaging (MRI) sequences are not often capable of directly visualizing tendons. Ultrashort echo time (UTE) MRI can acquire high signal from tendons thus enabling quantitative assessments. Magnetization transfer (MT) modeling combined with UTE-MRI—UTE-MT-modeling—can indirectly assess macromolecular protons in the tendon. This study aimed to determine if UTE-MT-modeling is a quantitative technique sensitive to the age-related changes of tendons. The legs of 26 young healthy (29 ± 6 years old) and 22 elderly (75 ± 8 years old) female subjects were imaged using UTE sequences on a 3T MRI scanner. Institutional review board approval was obtained, and all recruited subjects provided written informed consent. T1 and UTE-MT-modeling were performed on anterior tibialis tendons (ATT) and posterior tibialis tendons (PTT) as two representative human leg tendons. A series of MT pulse saturation powers (500–1500°) and frequency offsets (2–50 kHz) were used to measure the macromolecular fraction (MMF) and macromolecular T2 (T2MM). All measurements were repeated by three independent readers for a reproducibility study. MMF demonstrated significantly lower values on average in the elderly cohort compared with the younger cohort for both ATT (decreased by 16.8%, p = 0.03) and PTT (decreased by 23.0%, p < 0.01). T2MM and T1 did not show a significant nor a consistent difference between the young and elderly cohorts. For all MRI parameters, intraclass correlation coefficient (ICC) was higher than 0.98, indicating excellent consistency between measurements performed by independent readers. MMF serving as a surrogate measure for collagen content, showed a significant decrease in elderly leg tendons. This study highlighted UTE-MRI-MT techniques as a useful quantitative method to assess the impact of aging on human tendons.
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Affiliation(s)
- Saeed Jerban
- Department of Radiology, University of California, San Diego, CA, USA.
| | - Yajun Ma
- Department of Radiology, University of California, San Diego, CA, USA
| | - Behnam Namiranian
- Department of Radiology, University of California, San Diego, CA, USA
| | - Aria Ashir
- Department of Radiology, University of California, San Diego, CA, USA
| | - Hoda Shirazian
- Department of Radiology, University of California, San Diego, CA, USA
| | - Zhao Wei
- Department of Radiology, University of California, San Diego, CA, USA
| | - Nicole Le
- Radiology Service, VA San Diego Healthcare System, San Diego, CA, USA
| | - Mei Wu
- Department of Radiology, University of California, San Diego, CA, USA
| | - Zhenyu Cai
- Department of Radiology, University of California, San Diego, CA, USA
| | - Jiang Du
- Department of Radiology, University of California, San Diego, CA, USA
| | - Eric Y Chang
- Department of Radiology, University of California, San Diego, CA, USA. .,Radiology Service, VA San Diego Healthcare System, San Diego, CA, USA.
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Guo T, Ma YJ, High RA, Tang Q, Wong JH, Byra M, Searleman AC, To SC, Wan L, Le N, Du J, Chang EY. Assessment of an in vitro model of rotator cuff degeneration using quantitative magnetic resonance and ultrasound imaging with biochemical and histological correlation. Eur J Radiol 2019; 121:108706. [PMID: 31655315 DOI: 10.1016/j.ejrad.2019.108706] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2019] [Revised: 09/10/2019] [Accepted: 10/09/2019] [Indexed: 02/06/2023]
Abstract
PURPOSE Quantitative imaging methods could improve diagnosis of rotator cuff degeneration, but the capability of quantitative MR and US imaging parameters to detect alterations in collagen is unknown. The goal of this study was to assess quantitative MR and US imaging measures for detecting abnormalities in collagen using an in vitro model of tendinosis with biochemical and histological correlation. METHOD 36 pieces of supraspinatus tendons from 6 cadaveric donors were equally distributed into 3 groups (2 subjected to different concentrations of collagenase and a control group). Ultrashort echo time MR and US imaging measures were performed to assess changes at baseline and after 24 h of enzymatic digestion. Biochemical and histological measures, including brightfield, fluorescence, and polarized microscopy, were used to verify the validity of the model and were compared with quantitative imaging parameters. Correlations between the imaging parameters and biochemically measured digestion were analyzed. RESULTS Among the imaging parameters, macromolecular fraction (MMF), adiabatic T1ρ, T2*, and backscatter coefficient (BSC) were useful in differentiating between the extent of degeneration among the 3 groups. MMF strongly correlated with collagen loss (r=-0.81; 95% confidence interval [CI]: -0.90,-0.66), while the adiabatic T1ρ (r = 0.66; CI: 0.42,0.81), T2* (r = 0.58; CI: 0.31,0.76), and BSC (r = 0.51; CI: 0.22,0.72) moderately correlated with collagen loss. CONCLUSIONS MMF, adiabatic T1ρ, and T2* measured and US BSC can detect alterations in collagen. Of the quantitative MR and US imaging measures evaluated, MMF showed the highest correlation with collagen loss and can be used to assess rotator cuff degeneration.
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Affiliation(s)
- Tan Guo
- Department of Radiology, Beijing Hospital, Beijing, China; Department of Radiology, University of California, San Diego, CA, United States.
| | - Ya-Jun Ma
- Department of Radiology, University of California, San Diego, CA, United States.
| | - Rachel A High
- Department of Radiology, University of California, San Diego, CA, United States; Research Service, VA San Diego Healthcare System, San Diego, CA, United States.
| | - Qingbo Tang
- Department of Radiology, University of California, San Diego, CA, United States; Research Service, VA San Diego Healthcare System, San Diego, CA, United States.
| | - Jonathan H Wong
- Department of Radiology, University of California, San Diego, CA, United States; Research Service, VA San Diego Healthcare System, San Diego, CA, United States.
| | - Michal Byra
- Department of Radiology, University of California, San Diego, CA, United States; Department of Ultrasound, Institute of Fundamental Technological Research, Polish Academy of Sciences, Warsaw, Poland.
| | - Adam C Searleman
- Department of Radiology, University of California, San Diego, CA, United States.
| | - Sarah C To
- Department of Radiology, University of California, San Diego, CA, United States; Research Service, VA San Diego Healthcare System, San Diego, CA, United States.
| | - Lidi Wan
- Department of Radiology, University of California, San Diego, CA, United States.
| | - Nicole Le
- Department of Radiology, University of California, San Diego, CA, United States; Research Service, VA San Diego Healthcare System, San Diego, CA, United States.
| | - Jiang Du
- Department of Radiology, University of California, San Diego, CA, United States; Research Service, VA San Diego Healthcare System, San Diego, CA, United States.
| | - Eric Y Chang
- Department of Radiology, University of California, San Diego, CA, United States; Research Service, VA San Diego Healthcare System, San Diego, CA, United States.
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Zhu Y, Cheng X, Ma Y, Wong JH, Xie Y, Du J, Chang EY. Rotator cuff tendon assessment using magic-angle insensitive 3D ultrashort echo time cones magnetization transfer (UTE-Cones-MT) imaging and modeling with histological correlation. J Magn Reson Imaging 2017; 48:160-168. [PMID: 29219218 DOI: 10.1002/jmri.25914] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2017] [Accepted: 11/16/2017] [Indexed: 11/07/2022] Open
Abstract
BACKGROUND Rotator cuff tendons (RCTs) are challenging to image due to the "magic angle effect" and their short T2 . PURPOSE To assess the degree of magic angle sensitivity of human RCTs and to utilize a 3D ultrashort echo time Cones sequence with magnetization transfer preparation (UTE-Cones-MT) and two-pool quantitative MT modeling with histological correlation. We hypothesized that MT parameters would be less sensitive to the magic angle compared with conventional T2 measurements. STUDY TYPE Prospective imaging pathologic correlation. SPECIMEN Twenty cadaveric rotator cuff tendons were imaged at five sample orientations ranging from 0-90° relative to the B0 field. FIELD STRENGTH/SEQUENCE 3T/3D UTE-Cones-MT and Carr-Purcell-Meiboom-Gill (CPMG). ASSESSMENT Two-pool quantitative MT modeling parameters and T2 values were calculated in regions of interest drawn by a medical physicist. Histopathological analysis was performed and mild and severe tendinopathy groups were assigned by a histopathologist and histotechnician. STATISTICAL TESTS Coefficients of variations (CVs) were calculated for measures between the different orientations and group means were compared for each measure. RESULTS CVs of T2 and macromolecular fractions between orientations were 26.14 ± 16.82% and 6.18 ± 2.77% (mean ± SD), respectively. T2 measurements at 0°, 27°, 70°, and 90° showed significant differences between the two histological groups (P = 0.004, 0.008, 0.003, and 0.015, respectively), but not at 55° (P = 0.611). Mean T2 value ranges between orientations for the mild and severe tendinopathy groups were 15.27-30.32 msec and 20.81-35.85 msec, respectively, showing overlap despite statistically significant differences (P = 0.003). Macromolecular fractions at all angles showed significant differences between the two groups (P < 0.0001). Mean fraction ranges between orientations for the mild and severe tendinopathy groups were 14.32-17.17% and 10.00-13.75% respectively (P < 0.0001) with no overlap. DATA CONCLUSION Compared with T2 , macromolecular fraction obtained with the 3D UTE-Cones-MT technique is resistant to the magic angle effect and is more sensitive to RCT degeneration. LEVEL OF EVIDENCE 1 Technical Efficacy: Stage 2 J. Magn. Reson. Imaging 2017.
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Affiliation(s)
- Yanchun Zhu
- Department of Radiology, University of California, San Diego Medical Center, San Diego, California, USA.,Shenzhen Institute of Advanced Technology, Chinese Academic of Science, Shenzhen, China
| | - Xin Cheng
- Department of Radiology, University of California, San Diego Medical Center, San Diego, California, USA.,Department of Histology and Embryology, Jinan University School of Medicine, Guangzhou, China
| | - Yajun Ma
- Department of Radiology, University of California, San Diego Medical Center, San Diego, California, USA.,Radiology Service, VA San Diego Healthcare System, San Diego, California, USA
| | - Jonathan H Wong
- Department of Radiology, University of California, San Diego Medical Center, San Diego, California, USA.,Radiology Service, VA San Diego Healthcare System, San Diego, California, USA
| | - Yaoqin Xie
- Shenzhen Institute of Advanced Technology, Chinese Academic of Science, Shenzhen, China
| | - Jiang Du
- Department of Radiology, University of California, San Diego Medical Center, San Diego, California, USA
| | - Eric Y Chang
- Radiology Service, VA San Diego Healthcare System, San Diego, California, USA
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Ultrasound and anatomical assessment of the infraspinatus tendon through anterosuperolateral approach. Eur Radiol 2015; 25:2240-5. [DOI: 10.1007/s00330-015-3614-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2014] [Revised: 12/09/2014] [Accepted: 01/19/2015] [Indexed: 10/24/2022]
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Lavagnino M, Wall ME, Little D, Banes AJ, Guilak F, Arnoczky SP. Tendon mechanobiology: Current knowledge and future research opportunities. J Orthop Res 2015; 33:813-22. [PMID: 25763779 PMCID: PMC4524513 DOI: 10.1002/jor.22871] [Citation(s) in RCA: 90] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/08/2015] [Accepted: 02/13/2015] [Indexed: 02/04/2023]
Abstract
Tendons mainly function as load-bearing tissues in the muscloskeletal system; transmitting loads from muscle to bone. Tendons are dynamic structures that respond to the magnitude, direction, frequency, and duration of physiologic as well as pathologic mechanical loads via complex interactions between cellular pathways and the highly specialized extracellular matrix. This paper reviews the evolution and current knowledge of mechanobiology in tendon development, homeostasis, disease, and repair. In addition, we review several novel mechanotransduction pathways that have been identified recently in other tissues and cell types, providing potential research opportunities in the field of tendon mechanobiology. We also highlight current methods, models, and technologies being used in a wide variety of mechanobiology research that could be investigated in the context of their potential applicability for answering some of the fundamental unanswered questions in this field. The article concludes with a review of the major questions and future goals discussed during the recent ORS/ISMMS New Frontiers in Tendon Research Conference held on September 10 and 11, 2014 in New York City.
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Affiliation(s)
- Michael Lavagnino
- Laboratory for Comparative Orthopaedic Research, College of Veterinary Medicine Michigan State University, East Lansing, Michigan
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