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Advanced MRI Techniques for Musculoskeletal Imaging 2.0

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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 (30 July 2023) | Viewed by 20043

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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 they are 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 in Diagnostics (13 articles)

Published Papers (9 papers)

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Research

11 pages, 4757 KiB

Open AccessArticle

Image Quality and Diagnostic Performance of Accelerated 2D Hip MRI with Deep Learning Reconstruction Based on a Deep Iterative Hierarchical Network

by Judith Herrmann, Saif Afat, Sebastian Gassenmaier, Gregor Koerzdoerfer, Andreas Lingg, Haidara Almansour, Dominik Nickel and Sebastian Werner

Diagnostics 2023, 13(20), 3241; https://0-doi-org.brum.beds.ac.uk/10.3390/diagnostics13203241 - 18 Oct 2023

Viewed by 724

Abstract

Objectives: Hip MRI using standard multiplanar sequences requires long scan times. Accelerating MRI is accompanied by reduced image quality. This study aimed to compare standard two-dimensional (2D) turbo spin echo (TSE) sequences with accelerated 2D TSE sequences with deep learning (DL) reconstruction (TSE_DL) for routine clinical hip MRI at 1.5 and 3 T in terms of feasibility, image quality, and diagnostic performance. Material and Methods: In this prospective, monocentric study, TSE_DL was implemented clinically and evaluated in 14 prospectively enrolled patients undergoing a clinically indicated hip MRI at 1.5 and 3T between October 2020 and May 2021. Each patient underwent two examinations: For the first exam, we used standard sequences with generalized autocalibrating partial parallel acquisition reconstruction (TSE_S). For the second exam, we implemented prospectively undersampled TSE sequences with DL reconstruction (TSE_DL). Two radiologists assessed the TSE_DL and TSE_S regarding image quality, artifacts, noise, edge sharpness, diagnostic confidence, and delineation of anatomical structures using an ordinal five-point Likert scale (1 = non-diagnostic; 2 = poor; 3 = moderate; 4 = good; 5 = excellent). Both sequences were compared regarding the detection of common pathologies of the hip. Comparative analyses were conducted to assess the differences between TSE_DL and TSE_S. Results: Compared with TSE_S, TSE_DL was rated to be significantly superior in terms of image quality (p ≤ 0.020) with significantly reduced noise (p ≤ 0.001) and significantly improved edge sharpness (p = 0.003). No difference was found between TSE_S and TSE_DL concerning the extent of artifacts, diagnostic confidence, or the delineation of anatomical structures (p > 0.05). Example acquisition time reductions for the TSE sequences of 52% at 3 Tesla and 70% at 1.5 Tesla were achieved. Conclusion: TSE_DL of the hip is clinically feasible, showing excellent image quality and equivalent diagnostic performance compared with TSE_S, reducing the acquisition time significantly. Full article

(This article belongs to the Special Issue Advanced MRI Techniques for Musculoskeletal Imaging 2.0)

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18 pages, 17972 KiB

Open AccessArticle

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

by Bunyamin Ece, Hasan Yigit, Elif Ergun, Enver Necip Koseoglu, Erdal Karavas, Sonay Aydin and Pinar Nercis Kosar

Diagnostics 2023, 13(15), 2534; https://0-doi-org.brum.beds.ac.uk/10.3390/diagnostics13152534 - 30 Jul 2023

Viewed by 981

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. Full article

(This article belongs to the Special Issue Advanced MRI Techniques for Musculoskeletal Imaging 2.0)

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14 pages, 2454 KiB

Open AccessArticle

Fluid-Attenuated Inversion Recovery Sequence with Fat Suppression for Assessment of Ankle Synovitis without Contrast Enhancement: Comparison with Contrast-Enhanced MRI

by Ji Hee Kang, Sung Gyu Moon, Hong-Geun Jung and Eun Young Kwon

Diagnostics 2023, 13(11), 1960; https://0-doi-org.brum.beds.ac.uk/10.3390/diagnostics13111960 - 04 Jun 2023

Viewed by 1051

Abstract

The purpose of this study was to investigate the feasibility of the fluid-attenuated inversion recovery sequence with fat suppression (FLAIR-FS) for the assessment of ankle synovitis without contrast enhancement. FLAIR-FS and contrast-enhanced, T1-weighted sequences (CE-T1) of 94 ankles were retrospectively reviewed by two radiologists. Grading of synovial visibility (four-point scale) and semi-quantitative scoring of synovial thickness (three-point scale) were performed in four compartments of the ankle in both sequences. Synovial visibility and thickness in FLAIR-FS and CE-T1 images were compared, and agreement between both sequences was assessed. Synovial visibility grades and synovial thickness scores for FLAIR-FS images were lower than those for CE-T1 images (reader 1, p = 0.016, p < 0.001; reader 2, p = 0.009, p < 0.001). Dichotomized synovial visibility grades (partial vs. full visibility) were not significantly different between both sequences. The agreement in synovial thickness scores between the FLAIR-FS and CE-T1 images was moderate to substantial (κ = 0.41–0.65). The interobserver agreement between the two readers was fair for synovial visibility (κ = 0.27–0.32) and moderate to substantial for synovial thickness (κ = 0.54–0.74). In conclusion, FLAIR-FS is a feasible MRI sequence for the evaluation of ankle synovitis without contrast enhancement. Full article

(This article belongs to the Special Issue Advanced MRI Techniques for Musculoskeletal Imaging 2.0)

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10 pages, 9531 KiB

Open AccessArticle

The Tomographic Study and the Phenotype of Wormian Bones

by Ali Al Kaissi, Sergey Ryabykh, Farid Ben Chehida, Hamza Al Kaissi, Susanne Gerit Kircher, Martin J. Stransky and Franz Grill

Diagnostics 2023, 13(5), 874; https://0-doi-org.brum.beds.ac.uk/10.3390/diagnostics13050874 - 24 Feb 2023

Cited by 2 | Viewed by 2509

Abstract

Background: We describe patients who were recognized via conventional radiographs of the skull as manifesting wormian bones. Wormian bones are not a specific diagnostic entity and can be seen in variable forms of syndromic disorders. Materials and Methods: Seven children and three adults (of 10–28 years) were seen and diagnosed in our departments. The principal complaints for the pediatric and adult group were: ligamentous hyperlaxity, a history of delayed walking and occasional fractures, which later in life started to manifest a constellation of neurological symptoms such as nystagmus, persistent headache, and apnea. Conventional radiographs were the first traditional tools used to recognize wormian bones. We performed 3D reconstruction CT scans to further understand the precise etiology and the nature of these wormian bones and attempted to connect them with a broad spectrum of unpleasant clinical presentations. Our group of patients was consistent with the phenotypic and genotypic diagnoses of osteogenesis imperfecta type I and type IV as well as patients with multicentric carpotarsal osteolysis syndrome. Results: Three-dimensional reconstruction CT scan of the skulls confirmed that these worm-like phenotypes are in fact stemmed from the progressive softening of the sutures. The overall phenotype of the melted sutures is akin to overly stretched pastry. The most concerning sutures in this pathological process are the lambdoid. The overstretching of the lambdoid sutures was responsible for the development of sub-clinical basilar impression/invagination. Patients with certain forms of skeletal dysplasia such as osteogenesis imperfecta type I and IV manifested the heterozygous mutation of COL1A1/COLA2, shown as typical overstretching of the sutures. Similarly, patients with multicentric carpotarsal osteolysis syndrome with a heterozygous missense mutation of MAFB also manifested the phenotype of overly stretched pastry along the skull sutures. Conclusion: What we encountered via 3D reconstruction CT scan in our group of patients was entirely different than the traditional description that can be found in all relevant literature of the last decades. The worm-like phenomenon is in fact a pathological sequel occurring as a result of a progressive softening of the sutures, which results in the overstretching of the lambdoid sutures, a pathological process roughly similar to an overly stretched soft pastry. This softening is totally connected to the weight of the cerebrum (the occipital lobe of the cerebrum). The lambdoid sutures represent the weight-bearing zone of the skull. When these joints are loose and soft, they adversely alter the anatomical structures of the skull and lead to a highly hazardous derangement of the craniocervical junction. The latter causes the pathological upward invasion of the dens into the brain stem, leading to the development of morbid/mortal basilar impression/invagination. Full article

(This article belongs to the Special Issue Advanced MRI Techniques for Musculoskeletal Imaging 2.0)

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10 pages, 2970 KiB

Open AccessArticle

Reliability of Gradient-Echo Magnetic Resonance Elastography of Lumbar Muscles: Phantom and Clinical Studies

by Tsyh-Jyi Hsieh, Ming-Chung Chou, Yi-Chu Chen, Yi-Chen Chou, Chien-Hung Lin and Clement Kuen-Huang Chen

Diagnostics 2022, 12(6), 1385; https://0-doi-org.brum.beds.ac.uk/10.3390/diagnostics12061385 - 03 Jun 2022

Cited by 3 | Viewed by 1343

Abstract

Magnetic resonance elastography (MRE) has been used to successfully characterize the mechanical behavior of healthy and diseased muscles, but no study has been performed to investigate the reliability of MRE on lumbar muscles. The objective of this work was to determine the reliability of MRE techniques on lumbar muscles in both ex vivo phantom and in vivo human studies. In this study, fresh porcine leg muscles were used in the phantom study, and 80 healthy adults (38.6 ± 11.2 years, 40 women) were recruited in the human study. Five repeated stiffness maps were obtained from both the phantom and human muscles by using a gradient-echo MRE sequence with a pneumatic vibration on a 1.5 T MR scanner. The technical failure rate, coefficient of variation (CV), and quality score were assessed to evaluate the reliability of MRE, respectively. Analysis of variance was performed to compare the stiffness between different lumbar muscles, and the difference was significant if p < 0.05 after Bonferroni correction. The results showed that the MRE achieved a zero technical failure rate and a low CV of stiffness (6.24 ± 1.41%) in the phantom muscles. However, in the human study, the MRE exhibited high CVs of stiffness (21.57%–25.24%) in the lumbar muscles, and the technical failure rate was higher in psoas muscles (60.0–66.3% in) than in paraspinal muscles (0.0–2.5%). Further, higher quality scores were noticed in paraspinal muscles (7.31–7.71) than those in psoas muscles (1.83–2.06). In conclusion, the MRE was a reliable technique to investigate the mechanical property of lumbar muscles, but it was less reliable to assess stiffness in psoas muscles than paraspinal muscles. Full article

(This article belongs to the Special Issue Advanced MRI Techniques for Musculoskeletal Imaging 2.0)

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11 pages, 1800 KiB

Open AccessArticle

Lower Macromolecular Content in Tendons of Female Patients with Osteoporosis versus Patients with Osteopenia Detected by Ultrashort Echo Time (UTE) MRI

by Saeed Jerban, Yajun Ma, Amir Masoud Afsahi, Alecio Lombardi, Zhao Wei, Meghan Shen, Mei Wu, Nicole Le, Douglas G. Chang, Christine B. Chung, Jiang Du and Eric Y. Chang

Diagnostics 2022, 12(5), 1061; https://0-doi-org.brum.beds.ac.uk/10.3390/diagnostics12051061 - 24 Apr 2022

Cited by 5 | Viewed by 2017

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. Full article

(This article belongs to the Special Issue Advanced MRI Techniques for Musculoskeletal Imaging 2.0)

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16 pages, 4070 KiB

Open AccessArticle

Fast, Accurate, and Robust T2 Mapping of Articular Cartilage by Neural Networks

by Gustav Müller-Franzes, Teresa Nolte, Malin Ciba, Justus Schock, Firas Khader, Andreas Prescher, Lena Marie Wilms, Christiane Kuhl, Sven Nebelung and Daniel Truhn

Diagnostics 2022, 12(3), 688; https://0-doi-org.brum.beds.ac.uk/10.3390/diagnostics12030688 - 11 Mar 2022

Cited by 5 | Viewed by 2327

Abstract

For T2 mapping, the underlying mono-exponential signal decay is traditionally quantified by non-linear Least-Squares Estimation (LSE) curve fitting, which is prone to outliers and computationally expensive. This study aimed to validate a fully connected neural network (NN) to estimate T2 relaxation times and to assess its performance versus LSE fitting methods. To this end, the NN was trained and tested in silico on a synthetic dataset of 75 million signal decays. Its quantification error was comparatively evaluated against three LSE methods, i.e., traditional methods without any modification, with an offset, and one with noise correction. Following in-situ acquisition of T2 maps in seven human cadaveric knee joint specimens at high and low signal-to-noise ratios, the NN and LSE methods were used to estimate the T2 relaxation times of the manually segmented patellofemoral cartilage. In-silico modeling at low signal-to-noise ratio indicated significantly lower quantification error for the NN (by medians of 6–33%) than for the LSE methods (p < 0.001). These results were confirmed by the in-situ measurements (medians of 10–35%). T2 quantification by the NN took only 4 s, which was faster than the LSE methods (28–43 s). In conclusion, NNs provide fast, accurate, and robust quantification of T2 relaxation times. Full article

(This article belongs to the Special Issue Advanced MRI Techniques for Musculoskeletal Imaging 2.0)

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13 pages, 1924 KiB

Open AccessArticle

Reliability as a Precondition for Trust—Segmentation Reliability Analysis of Radiomic Features Improves Survival Prediction

by Gustav Müller-Franzes, Sven Nebelung, Justus Schock, Christoph Haarburger, Firas Khader, Federico Pedersoli, Maximilian Schulze-Hagen, Christiane Kuhl and Daniel Truhn

Diagnostics 2022, 12(2), 247; https://0-doi-org.brum.beds.ac.uk/10.3390/diagnostics12020247 - 19 Jan 2022

Cited by 3 | Viewed by 1505

Abstract

Machine learning results based on radiomic analysis are often not transferrable. A potential reason for this is the variability of radiomic features due to varying human made segmentations. Therefore, the aim of this study was to provide comprehensive inter-reader reliability analysis of radiomic features in five clinical image datasets and to assess the association of inter-reader reliability and survival prediction. In this study, we analyzed 4598 tumor segmentations in both computed tomography and magnetic resonance imaging data. We used a neural network to generate 100 additional segmentation outlines for each tumor and performed a reliability analysis of radiomic features. To prove clinical utility, we predicted patient survival based on all features and on the most reliable features. Survival prediction models for both computed tomography and magnetic resonance imaging datasets demonstrated less statistical spread and superior survival prediction when based on the most reliable features. Mean concordance indices were C_mean = 0.58 [most reliable] vs. C_mean = 0.56 [all] (p < 0.001, CT) and C_mean = 0.58 vs. C_mean = 0.57 (p = 0.23, MRI). Thus, preceding reliability analyses and selection of the most reliable radiomic features improves the underlying model’s ability to predict patient survival across clinical imaging modalities and tumor entities. Full article

(This article belongs to the Special Issue Advanced MRI Techniques for Musculoskeletal Imaging 2.0)

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15 pages, 1912 KiB

Open AccessArticle

Quantification of Sodium Relaxation Times and Concentrations as Surrogates of Proteoglycan Content of Patellar CARTILAGE at 3T MRI

by Benedikt Kamp, Miriam Frenken, Jan M. Henke, Daniel B. Abrar, Armin M. Nagel, Lena V. Gast, Georg Oeltzschner, Lena M. Wilms, Sven Nebelung, Gerald Antoch, Hans-Jörg Wittsack and Anja Müller-Lutz

Diagnostics 2021, 11(12), 2301; https://0-doi-org.brum.beds.ac.uk/10.3390/diagnostics11122301 - 08 Dec 2021

Cited by 7 | Viewed by 6602

Abstract

Sodium MRI has the potential to depict cartilage health accurately, but synovial fluid can influence the estimation of sodium parameters of cartilage. Therefore, this study aimed to reduce the impact of synovial fluid to render the quantitative compositional analyses of cartilage tissue technically [...] Read more.

T_{1}

and

T_{2}^{*}

relaxation times. For each protocol, data were acquired from 10 healthy volunteers and one patient with patellar cartilage damage. Data recorded with multiple repetition times for

T_{1}

measurement and multi-echo data acquired with an additional inversion recovery pulse for

T_{2}^{*}

measurement were analysed using biexponential models to differentiate longitudinal relaxation components of cartilage (

T_{1, car}

) and synovial fluid (

T_{1, syn}

), and short (

T_{2 s}^{*}

) from long (

T_{2 l}^{*}

) transversal relaxation components. Sodium relaxation times and concentration estimates in patellar cartilage were successfully determined:

T_{1, car}

= 14.5 ± 0.7 ms;

T_{1, syn}

= 37.9 ± 2.9 ms; c(

T_{1}

-protocol) = 200 ± 48 mmol/L;

T_{2 s}^{*}

= 0.4 ± 0.1 ms;

T_{2 l}^{*}

= 12.6 ± 0.7 ms; c(

T_{2}^{*}

-protocol) = 215 ± 44 mmol/L for healthy volunteers. In conclusion, a robust determination of sodium relaxation times is possible at a clinical field strength of 3T to quantify sodium concentrations, which might be a valuable tool to determine cartilage health. Full article

(This article belongs to the Special Issue Advanced MRI Techniques for Musculoskeletal Imaging 2.0)

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