Increase in cartilage degeneration in all knee compartments after failed ACL reconstruction at 4 years of follow-up.

PURPOSE: Degeneration of the cartilage after anterior cruciate ligament reconstruction (ACL-R) is known, and further deterioration can be expected in patients with tunnel malplacement or partial meniscal resection. It was hypothesized that there is a significant increase in cartilage degeneration after failed ACL-R. MATERIAL AND METHODS: Isolated ACL revision surgery was performed in 154 patients at an interval of 46 ± 33 months (5-175 months) between primary and revision surgery. Cartilage status at the medial, lateral femorotibial, and patellofemoral compartments were assessed arthroscopically during primary and revision ACL-R in accordance with the Outerbridge classification. Tunnel placement, roof angle, and tibial slope was measured using anteroposterior and lateral radiographic views. RESULTS: Cartilage degeneration increased significantly in the medial femorotibial compartment, followed by the lateral and patellofemoral compartments. There was a correlation between both cartilage degeneration in the patellofemoral compartment (PFC) (rs = 0.28, p = 0.0012) and medial tibial plateau (Rs = 0.24, p = 0.003) in relation to the position of tibial tunnel in the frontal plane. Worsening of the cartilage status in the medial femorotibial compartment, either femoral or tibial, was correlated with the tibial aperture site in the lateral view (Rs = 0.28, p < 0.001). Cartilage degeneration in the lateral compartment of the knee, on both femoral or tibial side, was inversely correlated with the femoral roof angle (Rs = -0.1985, p = 0.02). Meniscal tears, either at the medial or lateral site or at both, were found in 93 patients (60%) during primary ACL-R and increased to 132 patients (86%) during revision ACL-R. DISCUSSION: Accelerated cartilage degeneration and high prevalence of meniscal lesions are seen in failed ACL-R. Tunnel placement showed significant impact on cartilage degeneration and may partially explain the increased risk of an inferior outcome when revision surgery is required after failed primary ACL-R. LEVEL OF EVIDENCE: Level IV-retrospective cohort study.

Joint effusion, anteroposterior stability, muscle strength and degree of patellofemoral osteoarthritis significantly impact outcome following revision ACL reconstruction.

PURPOSE: Effusion, impaired muscle function and knee instability are considered as some of the most important factors effecting outcome following anterior cruciate ligament reconstruction (ACL-R) but the impact on revision ACL-R remains unclear. It was hypothesized that these factors will significantly worsen clinical outcome following revision ACL-R. METHODS: Seventy knees (13 female and 57 male) were followed retrospectively after revision ACL-R at a mean follow-up of 47.8 ± 20.7 months. Clinical examination was based on the International Knee Documentation Evaluation Form-2000 (IKDC), Tegner activity scale. Instrumented measurement of anterior tibial translation was performed using the Rolimeter® (DJO Global, Freiburg, Germany). Bilateral circumference of the thigh was measured 10 and 20 cm proximal to the medial joint space. Cartilage was assessed according to Outerbridge classification during both primary and revision ACL-R. RESULTS: Tegner activity scale decreased significantly from 7.8 ± 1.4 points at primary ACL-R to 7 ± 1.8 points at revision ACL-R, and 5.8 ± 1.7 points at the time of follow up (p < 0.001). Joint effusion (r = - 0.47, p < 0.01) and side to side differences in single leg hop test (r = - 0.48, p < 0.1) significantly correlated with inferior outcome. Cartilage lesions were found in 67% of the patients at the time of revision ACL-R compared to 38% at the time of primary ACL-R. According to the IKDC classification A was graded in three patients (4.3%), B in 35 (50%), C in 29 (41.4%) and D in three (4.3%). Joint effusion was measured in 35% of patients at the time of follow-up. Degeneration at the patellofemoral compartment of > grad 2 was responsible for IKDC grade C and D (p = 0.035). Instrumented anteroposterior site-to-site difference of ≥3 mm showed significant impact on clinical outcome (p < 0.019). CONCLUSION: The study has shown that chronic effusion, quadriceps dysfunction, cartilage lesions especially at the patellofemoral compartment and side to side difference in anteroposterior stability significantly influences patient outcome after revision ACL-R. These factors require special attention when predicting patient's outcome. LEVEL OF EVIDENCE: Level-IV, case-controlled study.

Radial magnetic resonance imaging (MRI) using a rotating radiofrequency (RF) coil at 9.4 T.

The rotating radiofrequency coil (RRFC) has been developed recently as an alternative approach to multi-channel phased-array coils. The single-element RRFC avoids inter-channel coupling and allows a larger coil element with better B1 field penetration when compared with an array counterpart. However, dedicated image reconstruction algorithms require accurate estimation of temporally varying coil sensitivities to remove artefacts caused by coil rotation. Various methods have been developed to estimate unknown sensitivity profiles from a few experimentally measured sensitivity maps, but these methods become problematic when the RRFC is used as a transceiver coil. In this work, a novel and practical radial encoding method is introduced for the RRFC to facilitate image reconstruction without the measurement or estimation of rotation-dependent sensitivity profiles. Theoretical analyses suggest that the rotation-dependent sensitivities of the RRFC can be used to create a uniform profile with careful choice of sampling positions and imaging parameters. To test this new imaging method, dedicated electronics were designed and built to control the RRFC speed and hence positions in synchrony with imaging parameters. High-quality phantom and animal images acquired on a 9.4 T pre-clinical scanner demonstrate the feasibility and potential of this new RRFC method.

Image Reconstruction for a Rotating Radiofrequency Coil (RRFC) Using Self-Calibrated Sensitivity From Radial Sampling.

The purpose of this study was to develop a practical magnetic resonance imaging (MRI) scheme for the latest rotating radiofrequency coil (RRFC) design at 9.4 T. The new prototype RRFC was integrated with an optical sensor to facilitate recording of its angular positions relative to the sequence timing. In imaging, the RRFC was used together with radial k-space trajectories. To recover the image, the radial spokes were grouped according to the coil locations. Using an Eigen-decomposition approach, an array of location-dependent sensitivity maps was extracted from the central regions of the segmented k-space, enabling parallel-imaging techniques for image recovery in a straightforward manner. When the RRFC angular velocity is carefully designed and accurately controlled according to the sequence timing, the encoding by means of varying RRFC sensitivity maps can be accurately calibrated for a faithful image recovery. Approximations were made to counteract the variations of the RRFC angular velocity, providing successful image reconstruction at 9.4 T. The current study demonstrated a new and practical imaging scheme for RRFC-MRI. It is able to extract the temporally varying sensitivity maps retrospectively from the k-space acquisition itself, without resorting to electromagnetic simulation or numerical interpolation. The proposed imaging scheme and the supporting engineering solutions of the RRFC prototype enable accurate image reconstructions. These new developments pave the way for routine applications of the RRFC, and bode well for its further development in providing simultaneous multinuclear imaging by incorporating, for example, independent X-nuclear coil elements into the rotating structure.

Inner-volume imaging in vivo using three-dimensional parallel spatially selective excitation.

This work describes the first experimental realization of three-dimensional spatially selective excitation using parallel transmission in vivo. For the design of three-dimensional parallel excitation pulses with short durations and high excitation accuracy, the choice of a suitable transmit k-space trajectory is crucial. For this reason, the characteristics of a stack-of-spirals trajectory and of a concentric-shells trajectory were examined in an initial simulation study. It showed that, especially when undersampling the trajectories in combination with parallel transmission, experimental parameters such as transmit-coil geometry and off-resonance conditions have an essential impact on the suitability of the selected trajectory and undersampling scheme. Both trajectories were applied in MR inner-volume imaging experiments which demonstrate that acceptably short and robust three-dimensional selective pulses can be achieved if the trajectory is temporally optimized and its actual path is measured and considered during pulse calculation. Pulse durations as short as 3.2 ms were realized and such pulses were appropriate to accurately excite arbitrarily shaped volumes in a corn cob and in a rat in vivo. Reduced field-of-view imaging of these selectively excited targets allowed high spatial resolution and significantly reduced measurement times and furthermore demonstrates the feasibility of three-dimensional parallel excitation in realistic MRI applications in vivo.

Robust spatially selective excitation using radiofrequency pulses adapted to the effective spatially encoding magnetic fields.

Multidimensional spatially selective excitation (SSE) has stimulated a variety of useful applications in magnetic resonance imaging and magnetic resonance spectroscopy, which have regained considerable interest after the recent introduction of parallel excitation. For SSE, radiofrequency pulses are designed specifically for certain time-courses of spatially encoding magnetic fields (SEM) which are applied simultaneously with the radiofrequency pulses. However, experimental imperfections of gradient-systems and undesired SEM field contributions often prevent the correct co-action of radiofrequency pulses and gradient-waveforms and therefore degrade the fidelity of excitation patterns, especially for parallel excitation. To cope with such imperfections, a classical measurement of k-space-trajectories can be performed followed by an adaptation of the SSE-pulses. However, this method is limited to linear SEM field distributions, which are describable in the k-space-formalism. Hence, this work presents a more sophisticated method consisting in a spatially resolved measurement of the temporal phase evolution of the transverse magnetization. This exhaustive phase information can be incorporated into pulse-design algorithms to compensate even for undesired spatially nonlinear, dynamic SEM field contributions. Both approaches are assessed in various experimental scenarios and individual benefits and limitations are discussed. The adaptation of SSE-pulses to experimentally achieved calibration data turned out to be very beneficial, and especially the novel spatially resolved method exhibited high potential for robust SSE even in adverse experimental setups.

Reconstruction of MRI data encoded with arbitrarily shaped, curvilinear, nonbijective magnetic fields.

A basic framework for image reconstruction from spatial encoding by curvilinear, nonbijective magnetic encoding fields in combination with multiple receivers is presented. The theory was developed in the context of the recently introduced parallel imaging technique using localized gradients (PatLoc) approach. In this new imaging modality, the linear gradient fields are generalized to arbitrarily shaped, nonbijective spatial encoding magnetic fields, which lead to ambiguous encoding. Ambiguities are resolved by adaptation of concepts developed for parallel imaging. Based on theoretical considerations, a practical algorithm for Cartesian trajectories is derived in the case that the conventional gradient coils are replaced by coils for PatLoc. The reconstruction method extends Cartesian sensitivity encoding (SENSE) reconstruction with an additional voxelwise intensity-correction step. Spatially varying resolution, signal-to-noise ratio, and truncation artifacts are described and analyzed. Theoretical considerations are validated by two-dimensional simulations based on multipolar encoding fields and they are confirmed by applying the reconstruction algorithm to initial experimental data.

Parallel MRI with extended and averaged GRAPPA kernels (PEAK-GRAPPA): optimized spatiotemporal dynamic imaging.

PURPOSE: To evaluate an optimized k-t-space related reconstruction method for dynamic magnetic resonance imaging (MRI), a method called PEAK-GRAPPA (Parallel MRI with Extended and Averaged GRAPPA Kernels) is presented which is based on an extended spatiotemporal GRAPPA kernel in combination with temporal averaging of coil weights. MATERIALS AND METHODS: The PEAK-GRAPPA kernel consists of a uniform geometry with several spatial and temporal source points from acquired k-space lines and several target points from missing k-space lines. In order to improve the quality of coil weight estimation sets of coil weights are averaged over the temporal dimension. RESULTS: The kernel geometry leads to strongly decreased reconstruction times compared to the recently introduced k-t-GRAPPA using different kernel geometries with only one target point per kernel to fit. Improved results were obtained in terms of the root mean square error and the signal-to-noise ratio as demonstrated by in vivo cardiac imaging. CONCLUSION: Using a uniform kernel geometry for weight estimation with the properties of uncorrelated noise of different acquired timeframes, optimized results were achieved in terms of error level, signal-to-noise ratio, and reconstruction time.

Highly k-t-space-accelerated phase-contrast MRI.

The purpose of this study was to combine a recently introduced spatiotemporal parallel imaging technique, PEAK-GRAPPA (parallel MRI with extended and averaged generalized autocalibrating partially parallel acquisition), with two-dimensional (2D) cine phase-contrast velocity mapping. Phase-contrast MRI was applied to measure the blood flow in the thoracic aorta and the myocardial motion of the left ventricle. To evaluate the performance of different reconstruction methods, fully acquired k-space data sets were used to compare conventional parallel imaging using GRAPPA with reduction factors of R = 2-6 and PEAK-GRAPPA as well as sliding window reconstruction with reduction factors R = 2-12 (net acceleration factors up to 5.2). PEAK-GRAPPA reconstruction resulted in improved image quality with considerably reduced artifacts, which was also supported by error analysis. To analyze potential blurring or low-pass filtering effects of spatiotemporal PEAK-GRAPPA, the velocity time courses of aortic flow and myocardial tissue motion were evaluated and compared with conventional image reconstructions. Quantitative comparisons of blood flow velocities and pixel-wise correlation analysis of velocities highlight the potential of PEAK-GRAPPA for highly accelerated dynamic phase-contrast velocity mapping.

Experimental analysis of parallel excitation using dedicated coil setups and simultaneous RF transmission on multiple channels.

An experimental implementation and first performance analysis of parallel spatially selective excitation with an array of transmit coils and simultaneous transmission of individual waveforms on multiple channels is presented. This technique, also known as Transmit SENSE, uses the basic idea of parallel imaging to shorten the k-space trajectories that accompany multidimensional excitation pulses, and hence shorten the duration of such pulses. So far, this concept has only been presented in simulations and semi-experimental studies since no hardware setup had been available for a full experimental realization. In this study, a hardware solution, in combination with a dedicated coil setup, is presented to overcome this limitation, and in several experiments of localized excitation and transmit field inhomogeneity compensation the practical feasibility of Transmit SENSE is demonstrated and a first performance analysis is given.

The oldest fossil myxogastroid slime mould.

A piece of Baltic amber (Tertiary, Eocene) contains a sporocarp of a slime mould which is assigned to the recent genus Arcyria and described as A. sulcata sp. nov. Apart from a fossil stemonitoid myxomycete, there are no further unambiguous fossil records of slime moulds and therefore the fossil gives new insights into the evolutionary history of the Myxomycetes.

Suspension (S)-FISH, a new technique for interphase nuclei.

We describe a versatile method for performing fluorescence in situ hybridization (FISH) in suspension instead of on a slide as usually done. This so-called suspension-FISH (S-FISH) opens new possibilities for the analysis of shape and functions of the human interphase nucleus. The procedure is described and the first results using this approach are presented.

The DNA-based structure of human chromosome 5 in interphase.

In contrast to those of metaphase chromosomes, the shape, length, and architecture of human interphase chromosomes are not well understood. This is mainly due to technical problems in the visualization of interphase chromosomes in total and of their substructures. We analyzed the structure of chromosomes in interphase nuclei through use of high-resolution multicolor banding (MCB), which paints the total shape of chromosomes and creates a DNA-mediated, chromosome-region-specific, pseudocolored banding pattern at high resolution. A microdissection-derived human chromosome 5-specific MCB probe mixture was hybridized to human lymphocyte interphase nuclei harvested for routine chromosome analysis, as well as to interphase nuclei from HeLa cells arrested at different phases of the cell cycle. The length of the axis of interphase chromosome 5 was determined, and the shape and MCB pattern were compared with those of metaphase chromosomes. We show that, in lymphocytes, the length of the axis of interphase chromosome 5 is comparable to that of a metaphase chromosome at 600-band resolution. Consequently, the concept of chromosome condensation during mitosis has to be reassessed. In addition, chromosome 5 in interphase is not as straight as metaphase chromosomes, being bent and/or folded. The shape and banding pattern of interphase chromosome 5 of lymphocytes and HeLa cells are similar to those of the corresponding metaphase chromosomes at all stages of the cell cycle. The MCB pattern also allows the detection and characterization of chromosome aberrations. This may be of fundamental importance in establishing chromosome analyses in nondividing cells.