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A special issue of Diagnostics (ISSN 2075-4418). This special issue belongs to the section "Medical Imaging and Theranostics".

Deadline for manuscript submissions: closed (31 July 2021) | Viewed by 34981

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Special Issue Editor

Dr. Sven Nebelung

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Guest Editor

Department of Diagnostic and Interventional Radiology, University Hospital Aachen, Pauwelsstreet 30, 52074 Aachen, Germany
Interests: musculoskeletal imaging; quantitative MRI; soft tissue; functionality; artificial intelligence
Special Issues, Collections and Topics in MDPI journals

Special Issue Information

Dear colleagues,

This Special Issue on “Advanced MRI Techniques for Musculoskeletal Imaging” aims to attract high-quality research studies from imaging scientists, radiologists, and specialists from related fields that advance the application of state-of-the-art MR imaging techniques in scientific and clinical contexts. Potential areas of interest may be new and substantive developments in image acquisition techniques such as recent innovations in morphologic joint imaging, e.g., abbreviated MRI protocols, multi-contrast sequences, functional joint imaging under loading or traction, and quantitative joint imaging using compositional techniques such as sodium, DTI/DWI, T2, (UTE-)T2*, T1ρ, and Magnetization Transfer. Even though submitted research projects ought to be focused on joints and the intra- and periarticular soft tissues such as cartilage, ligaments/tendons, meniscus, and synovium, highly relevant submissions on bone will be considered too. Alongside image acquisition techniques, further areas of interest are sophisticated image analysis and pre- and post-processing methodologies. Submissions dealing with innovative machine learning or other artificial intelligence applications with scientific and/or clinical benefit will be considered for publication, too, if of relevance to the field of musculoskeletal imaging.

Overall, basic research, proof-of-concept and feasibility, and clinical studies with in-vitro, in-situ, or in-vivo designs dealing with trauma, degeneration, inflammation, or other conditions of clinical relevance on the tissue or joint level will be considered.

Dr. Sven Nebelung
Guest Editor

Manuscript Submission Information

Manuscripts should be submitted online at www.mdpi.com by registering and logging in to this website. Once you are registered, click here to go to the submission form. Manuscripts can be submitted until the deadline. All submissions that pass pre-check are peer-reviewed. Accepted papers will be published continuously in the journal (as soon as accepted) and will be listed together on the special issue website. Research articles, review articles as well as short communications are invited. For planned papers, a title and short abstract (about 100 words) can be sent to the Editorial Office for announcement on this website.

Submitted manuscripts should not have been published previously, nor be under consideration for publication elsewhere (except conference proceedings papers). All manuscripts are thoroughly refereed through a single-blind peer-review process. A guide for authors and other relevant information for submission of manuscripts is available on the Instructions for Authors page. Diagnostics is an international peer-reviewed open access semimonthly journal published by MDPI.

Please visit the Instructions for Authors page before submitting a manuscript. The Article Processing Charge (APC) for publication in this open access journal is 2600 CHF (Swiss Francs). Submitted papers should be well formatted and use good English. Authors may use MDPI's English editing service prior to publication or during author revisions.

Keywords

advanced MRI techniques
functional imaging
soft tissues
joints
artificial intelligence
clinical relevance
functionality

Related Special Issue

Advanced MRI Techniques for Musculoskeletal Imaging 2.0 in Diagnostics (9 articles)

Published Papers (13 papers)

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Research

14 pages, 3883 KiB

Open AccessArticle

Micro- and Macroscale Assessment of Posterior Cruciate Ligament Functionality Based on Advanced MRI Techniques

by Lena Marie Wilms, Karl Ludger Radke, Daniel Benjamin Abrar, David Latz, Justus Schock, Miriam Frenken, Joachim Windolf, Gerald Antoch, Timm Joachim Filler and Sven Nebelung

Diagnostics 2021, 11(10), 1790; https://0-doi-org.brum.beds.ac.uk/10.3390/diagnostics11101790 - 28 Sep 2021

Cited by 5 | Viewed by 1594

Abstract

T2 mapping assesses tissue ultrastructure and composition, yet the association of imaging features and tissue functionality is oftentimes unclear. This study aimed to elucidate this association for the posterior cruciate ligament (PCL) across the micro- and macroscale and as a function of loading. Ten human cadaveric knee joints were imaged using a clinical 3.0T scanner and high-resolution morphologic and T2 mapping sequences. Emulating the posterior drawer test, the joints were imaged in the unloaded (δ₀) and loaded (δ₁) configurations. For the entire PCL, its subregions, and its osseous insertion sites, loading-induced changes were parameterized as summary statistics and texture variables, i.e., entropy, homogeneity, contrast, and variance. Histology confirmed structural integrity. Statistical analysis was based on parametric and non-parametric tests. Mean PCL length (37.8 ± 1.8 mm [δ₀]; 44.0 ± 1.6 mm [δ₁] [p < 0.01]), mean T2 (35.5 ± 2.0 ms [δ₀]; 37.9 ± 1.3 ms [δ₁] [p = 0.01]), and mean contrast values (4.0 ± 0.6 [δ₀]; 4.9 ± 0.9 [δ₁] [p = 0.01]) increased significantly under loading. Other texture features or ligamentous, osseous, and meniscal structures remained unaltered. Beyond providing normative T2 values across various scales and configurations, this study suggests that ligaments can be imaged morphologically and functionally based on joint loading and advanced MRI acquisition and post-processing techniques to assess ligament integrity and functionality in variable diagnostic contexts. Full article

(This article belongs to the Special Issue Advanced MRI Techniques for Musculoskeletal Imaging)

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13 pages, 2720 KiB

Open AccessArticle

Radiomics and Machine Learning Can Differentiate Transient Osteoporosis from Avascular Necrosis of the Hip

by Michail E. Klontzas, Georgios C. Manikis, Katerina Nikiforaki, Evangelia E. Vassalou, Konstantinos Spanakis, Ioannis Stathis, George A. Kakkos, Nikolas Matthaiou, Aristeidis H. Zibis, Kostas Marias and Apostolos H. Karantanas

Diagnostics 2021, 11(9), 1686; https://0-doi-org.brum.beds.ac.uk/10.3390/diagnostics11091686 - 15 Sep 2021

Cited by 17 | Viewed by 2867

Abstract

Differentiation between transient osteoporosis (TOH) and avascular necrosis (AVN) of the hip is a longstanding challenge in musculoskeletal radiology. The purpose of this study was to utilize MRI-based radiomics and machine learning (ML) for accurate differentiation between the two entities. A total of 109 hips with TOH and 104 hips with AVN were retrospectively included. Femoral heads and necks with segmented radiomics features were extracted. Three ML classifiers (XGboost, CatBoost and SVM) using 38 relevant radiomics features were trained on 70% and validated on 30% of the dataset. ML performance was compared to two musculoskeletal radiologists, a general radiologist and two radiology residents. XGboost achieved the best performance with an area under the curve (AUC) of 93.7% (95% CI from 87.7 to 99.8%) among ML models. MSK radiologists achieved an AUC of 90.6% (95% CI from 86.7% to 94.5%) and 88.3% (95% CI from 84% to 92.7%), respectively, similar to residents. The general radiologist achieved an AUC of 84.5% (95% CI from 80% to 89%), significantly lower than of XGboost (p = 0.017). In conclusion, radiomics-based ML achieved a performance similar to MSK radiologists and significantly higher compared to general radiologists in differentiating between TOH and AVN. Full article

(This article belongs to the Special Issue Advanced MRI Techniques for Musculoskeletal Imaging)

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13 pages, 6060 KiB

Open AccessArticle

High Inter-Rater Reliability of Manual Segmentation and Volume-Based Tractography in Healthy and Dystrophic Human Calf Muscle

by Johannes Forsting, Marlena Rohm, Martijn Froeling, Anne-Katrin Güttsches, Matthias Vorgerd, Lara Schlaffke and Robert Rehmann

Diagnostics 2021, 11(9), 1521; https://0-doi-org.brum.beds.ac.uk/10.3390/diagnostics11091521 - 24 Aug 2021

Cited by 3 | Viewed by 2352

Abstract

Background: Muscle diffusion tensor imaging (mDTI) is a promising surrogate biomarker in the evaluation of muscular injuries and neuromuscular diseases. Since mDTI metrics are known to vary between different muscles, separation of different muscles is essential to achieve muscle-specific diffusion parameters. The commonly used technique to assess DTI metrics is parameter maps based on manual segmentation (MSB). Other techniques comprise tract-based approaches, which can be performed in a previously defined volume. This so-called volume-based tractography (VBT) may offer a more robust assessment of diffusion metrics and additional information about muscle architecture through tract properties. The purpose of this study was to assess DTI metrics of human calf muscles calculated with two segmentation techniques—MSB and VBT—regarding their inter-rater reliability in healthy and dystrophic calf muscles. Methods: 20 healthy controls and 18 individuals with different neuromuscular diseases underwent an MRI examination in a 3T scanner using a 16-channel Torso XL coil. DTI metrics were assessed in seven calf muscles using MSB and VBT. Coefficients of variation (CV) were calculated for both techniques. MSB and VBT were performed by two independent raters to assess inter-rater reliability by ICC analysis and Bland-Altman plots. Next to analysis of DTI metrics, the same assessments were also performed for tract properties extracted with VBT. Results: For both techniques, low CV were found for healthy controls (≤13%) and neuromuscular diseases (≤17%). Significant differences between methods were found for all diffusion metrics except for λ₁. High inter-rater reliability was found for both MSB and VBT (ICC ≥ 0.972). Assessment of tract properties revealed high inter-rater reliability (ICC ≥ 0.974). Conclusions: Both segmentation techniques can be used in the evaluation of DTI metrics in healthy controls and different NMD with low rater dependency and high precision but differ significantly from each other. Our findings underline that the same segmentation protocol must be used to ensure comparability of mDTI data. Full article

(This article belongs to the Special Issue Advanced MRI Techniques for Musculoskeletal Imaging)

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10 pages, 1698 KiB

Open AccessArticle

MRI of Finger Pulleys at 7T—Direct Characterization of Pulley Ruptures in an Ex Vivo Model

by Rafael Heiss, Alexander Librimir, Christoph Lutter, Rolf Janka, Stefanie Kuerten, Frank W. Roemer, Armin M. Nagel, Michael Uder and Thomas Bayer

Diagnostics 2021, 11(7), 1206; https://0-doi-org.brum.beds.ac.uk/10.3390/diagnostics11071206 - 03 Jul 2021

Cited by 6 | Viewed by 2715

Abstract

The aim of this study was to evaluate 7 Tesla (7T) magnetic resonance imaging (MRI) for direct visualization and specific characterization of the finger flexor pulleys A2, A3, and A4 before and after ex vivo pulley rupture. Thirty fingers of human cadavers were examined before and after pulley disruption with a 26 min clinical 7T pulse sequence protocol. Images were assessed by two experienced radiologists for the presence of pulley rupture. Injury characterization included definition of rupture location, morphology, and complications. Image quality was evaluated according to a 4-point Likert-type scale from “not evaluable” to “excellent”. Macroscopic preparations were used as the reference standard. Direct characterization of intact A2, A3, and A4 pulleys and the corresponding pulley lesions was possible in all cases. The rupture location was distributed equally at the radial, ulnar, and central parts of the pulleys. A dislocation and intercalation of the pulley stump between the flexor tendon and finger phalanges was observed as a complication in 62.5% of cases. The average Likert score for direct visualization of pulleys was 2.67 before rupture and 2.79 after rupture creation, demonstrating adequate image quality for routine application. 7T MRI enables a direct characterization of A2, A3, and A4 pulleys before and after artificial disruption, including the definition of rupture morphology and location as well as the detection of rupture complications. This promises a precise presurgical evaluation of pulley injuries and complicated pulley stump dislocations. Full article

(This article belongs to the Special Issue Advanced MRI Techniques for Musculoskeletal Imaging)

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17 pages, 5352 KiB

Open AccessArticle

Deep Learning-Based Post-Processing of Real-Time MRI to Assess and Quantify Dynamic Wrist Movement in Health and Disease

by Karl Ludger Radke, Lena Marie Wollschläger, Sven Nebelung, Daniel Benjamin Abrar, Christoph Schleich, Matthias Boschheidgen, Miriam Frenken, Justus Schock, Dirk Klee, Jens Frahm, Gerald Antoch, Simon Thelen, Hans-Jörg Wittsack and Anja Müller-Lutz

Diagnostics 2021, 11(6), 1077; https://0-doi-org.brum.beds.ac.uk/10.3390/diagnostics11061077 - 11 Jun 2021

Cited by 10 | Viewed by 2400

Abstract

While morphologic magnetic resonance imaging (MRI) is the imaging modality of choice for the evaluation of ligamentous wrist injuries, it is merely static and incapable of diagnosing dynamic wrist instability. Based on real-time MRI and algorithm-based image post-processing in terms of convolutional neural networks (CNNs), this study aims to develop and validate an automatic technique to quantify wrist movement. A total of 56 bilateral wrists (28 healthy volunteers) were imaged during continuous and alternating maximum ulnar and radial abduction. Following CNN-based automatic segmentations of carpal bone contours, scapholunate and lunotriquetral gap widths were quantified based on dedicated algorithms and as a function of wrist position. Automatic segmentations were in excellent agreement with manual reference segmentations performed by two radiologists as indicated by Dice similarity coefficients of 0.96 ± 0.02 and consistent and unskewed Bland–Altman plots. Clinical applicability of the framework was assessed in a patient with diagnosed scapholunate ligament injury. Considerable increases in scapholunate gap widths across the range-of-motion were found. In conclusion, the combination of real-time wrist MRI and the present framework provides a powerful diagnostic tool for dynamic assessment of wrist function and, if confirmed in clinical trials, dynamic carpal instability that may elude static assessment using clinical-standard imaging modalities. Full article

(This article belongs to the Special Issue Advanced MRI Techniques for Musculoskeletal Imaging)

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14 pages, 1325 KiB

Open AccessArticle

Quantitative Muscle MRI in Patients with Neuromuscular Diseases—Association of Muscle Proton Density Fat Fraction with Semi-Quantitative Grading of Fatty Infiltration and Muscle Strength at the Thigh Region

by Sarah Schlaeger, Nico Sollmann, Agnes Zoffl, Edoardo Aitala Becherucci, Dominik Weidlich, Elisabeth Kottmaier, Isabelle Riederer, Tobias Greve, Federica Montagnese, Marcus Deschauer, Benedikt Schoser, Claus Zimmer, Dimitrios C. Karampinos, Jan S. Kirschke and Thomas Baum

Diagnostics 2021, 11(6), 1056; https://0-doi-org.brum.beds.ac.uk/10.3390/diagnostics11061056 - 08 Jun 2021

Cited by 10 | Viewed by 3146

Abstract

(1) Background and Purpose: The skeletal muscles of patients suffering from neuromuscular diseases (NMD) are affected by atrophy, hypertrophy, fatty infiltration, and edematous changes. Magnetic resonance imaging (MRI) is an important tool for diagnosis and monitoring. Concerning fatty infiltration, T₁-weighted or T₂-weighted DIXON turbo spin echo (TSE) sequences enable a qualitative assessment of muscle involvement. To achieve higher comparability, semi-quantitative grading scales, such as the four-point Mercuri scale, are commonly applied. However, the evaluation remains investigator-dependent. Therefore, effort is being invested to develop quantitative MRI techniques for determination of imaging markers such as the proton density fat fraction (PDFF). The present work aims to assess the diagnostic value of PDFF in correlation to Mercuri grading and clinically determined muscle strength in patients with myotonic dystrophy type 2 (DM2), limb girdle muscular dystrophy type 2A (LGMD2A), and adult Pompe disease. (2) Methods: T₂-weighted two-dimensional (2D) DIXON TSE and chemical shift encoding-based water-fat MRI were acquired in 13 patients (DM2: n = 5; LGMD2A: n = 5; Pompe disease: n = 3). Nine different thigh muscles were rated in all patients according to the Mercuri grading and segmented to extract PDFF values. Muscle strength was assessed according to the British Medical Research Council (BMRC) scale. For correlation analyses between Mercuri grading, muscle strength, and PDFF, the Spearman correlation coefficient (r_s) was computed. (3) Results: Mean PDFF values ranged from 7% to 37% in adults with Pompe disease and DM2 and up to 79% in LGMD2A patients. In all three groups, a strong correlation of the Mercuri grading and PDFF values was observed for almost all muscles (r_s > 0.70, p < 0.05). PDFF values correlated significantly to muscle strength for muscle groups responsible for knee flexion (r_s = −0.80, p < 0.01). (4) Conclusion: In the small, investigated patient cohort, PDFF offers similar diagnostic precision as the clinically established Mercuri grading. Based on these preliminary data, PDFF could be further considered as an MRI-based biomarker in the assessment of fatty infiltration of muscle tissue in NMD. Further studies with larger patient cohorts are needed to advance PDFF as an MRI-based biomarker in NMD, with advantages such as its greater dynamic range, enabling the assessment of subtler changes, the amplified objectivity, and the potential of direct correlation to muscle function for selected muscles. Full article

(This article belongs to the Special Issue Advanced MRI Techniques for Musculoskeletal Imaging)

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11 pages, 885 KiB

Open AccessArticle

Evaluating Lumbar Intervertebral Disc Degeneration on a Compositional Level Using Chemical Exchange Saturation Transfer: Preliminary Results in Patients with Adolescent Idiopathic Scoliosis

by Lena M. Wollschläger, Sven Nebelung, Christoph Schleich, Anja Müller-Lutz, Karl L. Radke, Miriam Frenken, Matthias Boschheidgen, Max Prost, Gerald Antoch, Markus R. Konieczny and Daniel B. Abrar

Diagnostics 2021, 11(6), 934; https://0-doi-org.brum.beds.ac.uk/10.3390/diagnostics11060934 - 22 May 2021

Cited by 5 | Viewed by 2333

Abstract

Lumbar intervertebral disc (IVD) degeneration is characterized by structural and compositional changes. This study aimed to assess the glycosaminoglycan (GAG) content of IVDs of patients with adolescent idiopathic scoliosis (AIS) and healthy controls using GAG chemical exchange saturation transfer (gagCEST) imaging. Ten AIS patients (mean age 18.3 ± 8.2 years) and 16 healthy controls (mean age 25.5 ± 1.7 years) were included. Clinical standard morphologic MR images (T1w-, T2w-, and STIR-sequences), to rule out further spinal disorders and assess IVD degeneration using the Pfirrmann score, and compositional gagCEST sequences were acquired on a 3T MRI. In AIS patients, the most distal scoliotic curve was determined on whole-spine conventional radiographs and morphological MRI and IVDs were divided as to whether they were affected by scoliotic deformity, i.e., proximal (affected, aIVDs) or distal (unaffected, uaIVDs) to the stable vertebra of the most distal scoliotic curve. Linear mixed models were used to compare mean gagCEST-values. Over all segments, AIS-patients’ IVDs exhibited significantly lower gagCEST-values than the controls: 2.76 [2.32, 3.20]% (AIS), 3.51 [3.16, 3.86]% (Control); p = 0.005. Meanwhile, no significant differences were found for gagCEST values comparing aIVDs with uaIVDs. In conclusion, as a powerful diagnostic adjunct, gagCEST imaging may be prospectively applied to detect early compositional degenerative changes in patients suffering from AIS. Full article

(This article belongs to the Special Issue Advanced MRI Techniques for Musculoskeletal Imaging)

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15 pages, 3588 KiB

Open AccessArticle

Utilizing Dynamic Phosphorous-31 Magnetic Resonance Spectroscopy for the Early Detection of Acute Compartment Syndrome: A Pilot Study on Rats

by Hiroki Ohta, Nhat-Minh Van Vo, Junichi Hata, Koshiro Terawaki, Takako Shirakawa and Hirotaka James Okano

Diagnostics 2021, 11(4), 586; https://doi.org/10.3390/diagnostics11040586 - 24 Mar 2021

Cited by 2 | Viewed by 3674

Abstract

Introduction: Disasters, including terrorism and earthquakes, are significant threats to people and may lead to many people requiring rescue. The longer the rescue takes, the higher the chances of an individual contracting acute compartment syndrome (ACS). ACS is fatal if diagnosed too late, and early diagnosis and treatment are essential. Objective: To assess the ability of dynamic phosphorus magnetic resonance spectroscopy (³¹P-MRS) in the early detection of muscular damage in ACS. Materials and Methods: Six ACS model rats were used for serial ³¹P-MRS scanning (9.4 Tesla). Skeletal muscle metabolism, represented by the levels of phosphocreatine (PCr), inorganic phosphate (Pi), and adenosine triphosphate (ATP), was assessed. The PCr/(Pi + PCr) ratio, which decreases with ischemia, was compared with simultaneously sampled plasma creatine phosphokinase (CPK), a muscle damage marker. Results: The PCr/(Pi + PCr) ratio significantly decreased after inducing ischemia (from 0.86 ± 0.10 to 0.18 ± 0.06; p < 0.05), while CPK did not change significantly (from 89 ± 29.46 to 241.50 ± 113.28; p > 0.05). The intracellular and arterial pH index decreased over time, revealing significant differences at 120 min post-ischemia (from 7.09 ± 0.01 to 6.43 ± 0.13, and from 7.47 ± 0.03 to 7.39 ± 0.04, respectively). In the reperfusion state, the spectra and pH did not return to the original values. Conclusions: The dynamic ³¹P-MRS technique can rapidly detect changes in muscle bioenergetics. This technique is a promising non-invasive method for determining early muscular damage in ACS. Full article

(This article belongs to the Special Issue Advanced MRI Techniques for Musculoskeletal Imaging)

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11 pages, 1858 KiB

Open AccessArticle

Non-Specific Low Back Pain and Lumbar Radiculopathy: Comparison of Morphologic and Compositional MRI as Assessed by gagCEST Imaging at 3T

by Miriam Frenken, Sven Nebelung, Christoph Schleich, Anja Müller-Lutz, Karl Ludger Radke, Benedikt Kamp, Matthias Boschheidgen, Lena Wollschläger, Bernd Bittersohl, Gerald Antoch, Markus R. Konieczny and Daniel B. Abrar

Diagnostics 2021, 11(3), 402; https://0-doi-org.brum.beds.ac.uk/10.3390/diagnostics11030402 - 26 Feb 2021

Cited by 4 | Viewed by 3595

Abstract

Using glycosaminoglycan Chemical Exchange Saturation Transfer (gagCEST) magnetic resonance imaging (MRI), this study comparatively evaluated the GAG contents of lumbar intervertebral disks (IVDs) of patients with non-specific low back pain (nsLBP), radiculopathy, and asymptomatic volunteers to elucidate the association of clinical manifestation and compositional correlate. A total of 18 patients (mean age 57.5 ± 22.5 years) with radiculopathy, 16 age-matched patients with chronic nsLBP and 20 age-matched volunteers underwent standard morphologic and compositional gagCEST MRI on a 3T scanner. In all cohorts, GAG contents of lumbar IVDs were determined using gagCEST MRI. An assessment of morphologic IVD degeneration based on the Pfirrmann classification and T2-weighted sequences served as a reference. A linear mixed model adjusted for multiple confounders was used for statistical evaluation. IVDs of patients with nsLBP showed lower gagCEST values than those of volunteers (nsLBP: 1.3% [99% confidence intervals (CI): 1.0; 1.6] vs. volunteers: 1.9% [99% CI: 1.6; 2.2]). Yet, IVDs of patients with radiculopathy (1.8% [99% CI: 1.4; 2.1]) were not different from patients with nsLBP or volunteers. In patients with radiculopathy, IVDs directly adjacent to IVD extrusions demonstrated lower gagCEST values than distant IVDs (adjacent: 0.9% [99% CI: 0.3; 1.5], distant: 2.1% [99% CI: 1.7; 2.5]). Advanced GAG depletion in nsLBP and directly adjacent to IVD extrusions in radiculopathy indicates close interrelatedness of clinical pathology and compositional degeneration. Full article

(This article belongs to the Special Issue Advanced MRI Techniques for Musculoskeletal Imaging)

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13 pages, 1295 KiB

Open AccessArticle

Association of Thigh Muscle Strength with Texture Features Based on Proton Density Fat Fraction Maps Derived from Chemical Shift Encoding-Based Water–Fat MRI

by Michael Dieckmeyer, Stephanie Inhuber, Sarah Schläger, Dominik Weidlich, Muthu R. K. Mookiah, Karupppasamy Subburaj, Egon Burian, Nico Sollmann, Jan S. Kirschke, Dimitrios C. Karampinos and Thomas Baum

Diagnostics 2021, 11(2), 302; https://0-doi-org.brum.beds.ac.uk/10.3390/diagnostics11020302 - 13 Feb 2021

Cited by 3 | Viewed by 2183

Abstract

Purpose: Based on conventional and quantitative magnetic resonance imaging (MRI), texture analysis (TA) has shown encouraging results as a biomarker for tissue structure. Chemical shift encoding-based water–fat MRI (CSE-MRI)-derived proton density fat fraction (PDFF) of thigh muscles has been associated with musculoskeletal, metabolic, and neuromuscular disorders and was demonstrated to predict muscle strength. The purpose of this study was to investigate PDFF-based TA of thigh muscles as a predictor of thigh muscle strength in comparison to mean PDFF. Methods: 30 healthy subjects (age = 30 ± 6 years; 15 females) underwent CSE-MRI of the lumbar spine at 3T, using a six-echo 3D spoiled gradient echo sequence. Quadriceps (EXT) and ischiocrural (FLEX) muscles were segmented to extract mean PDFF and texture features. Muscle flexion and extension strength were measured with an isokinetic dynamometer. Results: Of the eleven extracted texture features, Variance(global) showed the highest significant correlation with extension strength (p < 0.001, R²_adj = 0.712), and Correlation showed the highest significant correlation with flexion strength (p = 0.016, R²_adj = 0.658). Multivariate linear regression models identified Variance(global) and sex, but not PDFF, as significant predictors of extension strength (R²_adj = 0.709; p < 0.001), while mean PDFF, sex, and BMI, but none of the texture features, were identified as significant predictors of flexion strength (R²_adj = 0.674; p < 0.001). Conclusions: Prediction of quadriceps muscle strength can be improved beyond mean PDFF by means of TA, indicating the capability to quantify muscular fat infiltration patterns. Full article

(This article belongs to the Special Issue Advanced MRI Techniques for Musculoskeletal Imaging)

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9 pages, 1538 KiB

Open AccessCommunication

Scanned versus Fused-Reconstructed Oblique MR-Images for Assessment of the Tibiofibular Syndesmosis—Diagnostic PerFormance and Reader Agreement

by Hannes Seuss, Matthias Hammon, Frank Roemer, Rafael Heiss, Rolf Janka, Michael Uder and Peter Dankerl

Diagnostics 2021, 11(2), 197; https://0-doi-org.brum.beds.ac.uk/10.3390/diagnostics11020197 - 29 Jan 2021

Cited by 1 | Viewed by 1698

Abstract

To evaluate the diagnostic performance and reader agreement of a novel MRI image fusion method enabling the reconstruction of oblique images for the assessment of the tibiofibular syndesmosis. We evaluated 40 magnetic resonance imaging examinations of patients with ankle sprains (16 with ruptures and 24 without) for the presence of anteroinferior tibiofibular ligament rupture. For all patients, we performed a fusion of standard two-dimensional transversal and coronal 3 mm PDw TSE images into an oblique-fusion reconstruction (OFR) and compared these against conventionally scanned oblique sequence for the evaluation of the tibiofibular syndesmosis. To evaluate diagnostic performance, two expert readers independently read the OFR images twice. We analyzed sensitivity, specificity, negative and positive predictive values, accuracy, and agreement. Reader 1 misinterpreted one OFR as a false negative, demonstrating a sensitivity of 0.94 and specificity of 1.00, reader 2 demonstrated perfect accuracy. Intrareader agreement was almost perfect for reader 1 (α = 0.95) and was perfect for reader 2 (α = 1.00). Additionally, interreader agreement between all fusion sequence reads was almost perfect (α = 0.97). The proposed OFR enables reliable detection of anteroinferior tibiofibular ligament rupture with excellent inter- and intrareader agreement, making conventional scanning of oblique images redundant and supplies a method to retroactively create oblique images, e.g., from external examinations. Full article

(This article belongs to the Special Issue Advanced MRI Techniques for Musculoskeletal Imaging)

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10 pages, 626 KiB

Open AccessArticle

DGEMRIC in the Assessment of Pre-Morphological Cartilage Degeneration in Rheumatic Disease: Rheumatoid Arthritis vs. Psoriatic Arthritis

by Daniel B. Abrar, Christoph Schleich, Miriam Frenken, Stefan Vordenbäumen, Jutta Richter, Matthias Schneider, Benedikt Ostendorf, Sven Nebelung and Philipp Sewerin

Diagnostics 2021, 11(2), 147; https://0-doi-org.brum.beds.ac.uk/10.3390/diagnostics11020147 - 20 Jan 2021

Cited by 8 | Viewed by 1945

Abstract

Background: Even though cartilage loss is a known feature of psoriatic (PsA) and rheumatoid arthritis (RA), research is sparse on its role in the pathogenesis of PsA, its potential use for disease monitoring and for differentiation from RA. We therefore assessed the use of delayed gadolinium-enhanced magnetic resonance imaging of cartilage (dGEMRIC) to evaluate biochemical cartilage changes in metacarpophalangeal (MCP) and proximal interphalangeal (PIP) joints in PsA patients and compared these to RA patients. Materials and Methods: A total of 17 patients with active PsA and 20 patients with active RA were evaluated by high-resolution 3 Tesla dGEMRIC using a dedicated 16-channel hand coil. Images were analyzed by two independent raters for dGEMRIC indices and joint space width (JSW) at MCP and PIP joint levels. Results: No significant differences of dGEMRIC values could be found between both study populations (PsA 472.25 ms, RA 461.11 ms; p = 0.763). In all RA and most PsA patients, PIP joints showed significantly lower dGEMRIC indices than MCP joints (RA: D2: p = 0.009, D3: p = 0.008, D4: p = 0.002, D5: p = 0.002; PsA: D3: p = 0.001, D4: p = 0.004). Most joint spaces had similar widths in both disease entities and no significant differences were found. Conclusions: As evaluated by dGEMRIC, the molecular composition of the MCP and PIP joint cartilage of PsA patients is similar to that of RA patients, demonstrating the scientific and clinical feasibility of compositional magnetic resonance (MR) imaging in these disease entities. Patterns and severity of compositional cartilage degradation of the finger joints may therefore be assessed beyond mere morphology in PsA and RA patients. Full article

(This article belongs to the Special Issue Advanced MRI Techniques for Musculoskeletal Imaging)

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11 pages, 1141 KiB

Open AccessArticle

Bone Structure Analysis of the Radius Using Ultrahigh Field (7T) MRI: Relevance of Technical Parameters and Comparison with 3T MRI and Radiography

by Mohamed Jarraya, Rafael Heiss, Jeffrey Duryea, Armin M. Nagel, John A. Lynch, Ali Guermazi, Marc-André Weber, Andreas Arkudas, Raymund E. Horch, Michael Uder and Frank W. Roemer

Diagnostics 2021, 11(1), 110; https://0-doi-org.brum.beds.ac.uk/10.3390/diagnostics11010110 - 12 Jan 2021

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Abstract

Bone fractal signature analysis (FSA—also termed bone texture analysis) is a tool that assesses structural changes that may relate to clinical outcomes and functions. Our aim was to compare bone texture analysis of the distal radius in patients and volunteers using radiography and 3T and 7T magnetic resonance imaging (MRI)—a patient group (n = 25) and a volunteer group (n = 25) were included. Participants in the patient group had a history of chronic wrist pain with suspected or confirmed osteoarthritis and/or ligament instability. All participants had 3T and 7T MRI including T1-weighted turbo spin echo (TSE) sequences. The 7T MRI examination included an additional high-resolution (HR) T1 TSE sequence. Radiographs of the wrist were acquired for the patient group. When comparing patients and volunteers (unadjusted for gender and age), we found a statistically significant difference of horizontal and vertical fractal dimensions (FDs) using 7T T1 TSE-HR images in low-resolution mode (horizontal: p = 0.04, vertical: p = 0.01). When comparing radiography to the different MRI sequences, we found a statistically significant difference for low- and high-resolution horizontal FDs between radiography and 3T T1 TSE and 7T T1 TSE-HR. Vertical FDs were significantly different only between radiographs and 3T T1 TSE in the high-resolution mode; FSA measures obtained from 3T and 7T MRI are highly dependent on the sequence and reconstruction resolution used, and thus are not easily comparable between MRI systems and applied sequences. Full article

(This article belongs to the Special Issue Advanced MRI Techniques for Musculoskeletal Imaging)

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