Quantitative imaging of bone-cartilage interactions in ACL-injured patients with PET-MRI.

OBJECTIVE: To investigate changes in bone metabolism by positron emission tomography (PET), as well as spatial relationships between bone metabolism and magnetic resonance imaging (MRI) quantitative markers of early cartilage degradation, in anterior cruciate ligament (ACL)-reconstructed knees. DESIGN: Both knees of 15 participants with unilateral reconstructed ACL tears and unaffected contralateral knees were scanned using a simultaneous 3.0T PET-MRI system following injection of 18F-sodium fluoride (18F-NaF). The maximum pixel standardized uptake value (SUVmax) in the subchondral bone and the average T2 relaxation time in cartilage were measured in each knee in eight knee compartments. We tested differences in SUVmax and cartilage T2 relaxation times between the ACL-injured knee and the contralateral control knee as well as spatial relationships between these bone and cartilage changes. RESULTS: Significantly increased subchondral bone 18F-NaF SUVmax and cartilage T2 times were observed in the ACL-reconstructed knees (median [inter-quartile-range (IQR)]: 5.0 [5.8], 36.8 [3.6] ms) compared to the contralateral knees (median [IQR]: 1.9 [1.4], 34.4 [3.8] ms). A spatial relationship between the two markers was also seen. Using the contralateral knee as a control, we observed a significant correlation of r = 0.59 between the difference in subchondral bone SUVmax (between injured and contralateral knees) and the adjacent cartilage T2 (between the two knees) [P < 0.001], with a slope of 0.49 ms/a.u. This correlation and slope were higher in deep layers (r = 0.73, slope = 0.60 ms/a.u.) of cartilage compared to superficial layers (r = 0.40, slope = 0.43 ms/a.u.). CONCLUSIONS: 18F-NaF PET-MR imaging enables detection of increased subchondral bone metabolism in ACL-reconstructed knees and may serve as an important marker of early osteoarthritis (OA) progression. Spatial relationships observed between early OA changes across bone and cartilage support the need to study whole-joint disease mechanisms in OA.

Cluster analysis of quantitative MRI T2 and T1ρ relaxation times of cartilage identifies differences between healthy and ACL-injured individuals at 3T.

PURPOSE: To identify focal lesions of elevated MRI T2 and T1ρ relaxation times in articular cartilage of an ACL-injured group using a novel cluster analysis technique. MATERIALS AND METHODS: Eighteen ACL-injured patients underwent 3T MRI T2 and T1ρ relaxometry at baseline, 6 months and 1 year and six healthy volunteers at baseline, 1 day and 1 year. Clusters of contiguous pixels above or below T2 and T1ρ intensity and area thresholds were identified on a projection map of the 3D femoral cartilage surface. The total area of femoral cartilage plate covered by clusters (%CA) was split into areas above (%CA+) and below (%CA-) the thresholds and the differences in %CA(+ or -) over time in the ACL-injured group were determined using the Wilcoxon signed rank test. RESULTS: %CA+ was greater in the ACL-injured patients than the healthy volunteers at 6 months and 1 year with average %CA+ of 5.2 ± 4.0% (p = 0.0054) and 6.6 ± 3.7% (p = 0.0041) for T2 and 6.2 ± 7.1% (p = 0.063) and 8.2 ± 6.9% (p = 0.042) for T1ρ, respectively. %CA- at 6 months and 1 year was 3.0 ± 1.8% (p > 0.1) and 5.9 ± 5.0% (p > 0.1) for T2 and 4.4 ± 4.9% (p > 0.1) and 4.5 ± 4.6% (p > 0.1) for T1ρ, respectively. CONCLUSION: With the proposed cluster analysis technique, we have quantified cartilage lesion coverage and demonstrated that the ACL-injured group had greater areas of elevated T2 and T1ρ relaxation times as compared to healthy volunteers.

A simple analytic method for estimating T2 in the knee from DESS.

PURPOSE: To introduce a simple analytical formula for estimating T2 from a single Double-Echo in Steady-State (DESS) scan. METHODS: Extended Phase Graph (EPG) modeling was used to develop a straightforward linear approximation of the relationship between the two DESS signals, enabling accurate T2 estimation from one DESS scan. Simulations were performed to demonstrate cancellation of different echo pathways to validate this simple model. The resulting analytic formula was compared to previous methods for T2 estimation using DESS and fast spin-echo scans in agar phantoms and knee cartilage in three volunteers and three patients. The DESS approach allows 3D (256×256×44) T2-mapping with fat suppression in scan times of 3-4min. RESULTS: The simulations demonstrated that the model approximates the true signal very well. If the T1 is within 20% of the assumed T1, the T2 estimation error was shown to be less than 5% for typical scans. The inherent residual error in the model was demonstrated to be small both due to signal decay and opposing signal contributions. The estimated T2 from the linear relationship agrees well with reference scans, both for the phantoms and in vivo. The method resulted in less underestimation of T2 than previous single-scan approaches, with processing times 60 times faster than using a numerical fit. CONCLUSION: A simplified relationship between the two DESS signals allows for rapid 3D T2 quantification with DESS that is accurate, yet also simple. The simplicity of the method allows for immediate T2 estimation in cartilage during the MRI examination.

Variability of CubeQuant T1ρ, quantitative DESS T2, and cones sodium MRI in knee cartilage.

OBJECTIVE: To measure the variability of T1ρ relaxation times using CubeQuant, T2 relaxation times using quantitative double echo in steady state (DESS), and normalized sodium signals using 3D cones sodium magnetic resonance imaging (MRI) of knee cartilage in vivo at 3 T. DESIGN: Eight healthy subjects were scanned at 3 T at baseline, 1 day, 5 months, and 1 year. Ten regions of interest (ROIs) of knee cartilage were segmented in the medial and lateral compartments of each subject's knee. T1ρ and T2 relaxation times and normalized sodium signals were measured and the root-mean-square coefficient of variation (CVRMS) was calculated. Intra-subject variability was measured over short, moderate and long-term, as well as intra-observer and inter-observer variability. RESULTS: The average intra-subject CVRMS measurements over short, moderate, and long-term time periods were 4.6%, 6.1%, and 6.0% for the T1ρ measurements, 6.4%, 9.3%, and 10.7% for the T2 measurements and 11.3%, 11.6%, and 12.9% for the sodium measurements, respectively. The average CVRMS measurements for intra-observer and inter-observer segmentation were 3.8% and 5.7% for the T1ρ measurements, 4.7% and 6.7% for the T2 measurements, and 8.1% and 11.4% for the sodium measurements, respectively. CONCLUSIONS: These CVRMS measurements are substantially lower than previously measured changes expected in patients with advanced osteoarthritis compared to healthy volunteers, suggesting that CubeQuant T1ρ, quantitative DESS T2 and 3D cones sodium measurements are sufficiently sensitive for in vivo cartilage studies.

Regional variation in T1ρ and T2 times in osteoarthritic human menisci: correlation with mechanical properties and matrix composition.

OBJECTIVE: Changes in T1ρ and T2 magnetic resonance relaxation times have been associated with articular cartilage degeneration, but similar relationships for meniscal tissue have not been extensively investigated. This work examined relationships between T1ρ and T2 measurements and biochemical and mechanical properties across regions of degenerate human menisci. DESIGN: Average T1ρ and T2 relaxation times were determined for nine regions each of seven medial and 13 lateral menisci from 14 total knee replacement patients. Sulfated glycosaminoglycan (sGAG), collagen and water contents were measured for each region. Biomechanical measurements of equilibrium compressive, dynamic compressive and dynamic shear moduli were made for anterior, central and posterior regions. RESULTS: T1ρ and T2 times showed similar regional patterns, with longer relaxation times in the (radially) middle region compared to the inner and outer regions. Pooled over all regions, T1ρ and T2 times showed strong correlations both with one another and with water content. Correlations with biochemical content varied depending on normalization to wet or dry mass, and both imaging parameters showed stronger correlations with collagen compared to sGAG content. Mechanical properties displayed moderate inverse correlations with increasing T1ρ and T2 times and water content. CONCLUSION: Both T1ρ and T2 relaxation times correlated strongly with water content and moderately with mechanical properties in osteoarthritic menisci, but not as strongly with sGAG or collagen contents alone. While the ability of magnetic resonance imaging (MRI) to detect early osteoarthritic changes remains the subject of investigation, these results suggest that T1ρ and T2 relaxation times have limited ability to detect compositional variations in degenerate menisci.

Imaging near metal with a MAVRIC-SEMAC hybrid.

The recently developed multi-acquisition with variable resonance image combination (MAVRIC) and slice-encoding metal artifact correction (SEMAC) techniques can significantly reduce image artifacts commonly encountered near embedded metal hardware. These artifact reductions are enabled by applying alternative spectral and spatial-encoding schemes to conventional spin-echo imaging techniques. Here, the MAVRIC and SEMAC concepts are connected and discussed. The development of a hybrid technique that utilizes strengths of both methods is then introduced. The presented technique is shown capable of producing minimal artifact, high-resolution images near total joint replacements in a clinical setting.

Magnetic resonance imaging near metal implants.

The desire to apply magnetic resonance imaging (MRI) techniques in the vicinity of embedded metallic hardware is increasing. The soft-tissue contrast available with MR techniques is advantageous in diagnosing complications near an increasing variety of MR-safe metallic hardware. Near such hardware, the spatial encoding mechanisms utilized in conventional MRI methods are often severely compromised. Mitigating these encoding difficulties has been the focus of numerous research investigations over the past two decades. Such approaches include view-angle tilting, short echo-time projection reconstruction acquisitions, single-point imaging, prepolarized MRI, and postprocessing image correction. Various technical advances have also enabled the recent development of two alternative approaches that have shown promising clinical potential. Here, the physical principals and proposed solutions to the problem of MRI near embedded metal are discussed.

Characterization and reduction of the transient response in steady-state MR imaging.

Refocused steady-state free precession (SSFP) imaging sequences have recently regained popularity as faster gradient hardware has allowed shorter repetition times, thereby reducing SSFP's sensitivity to off-resonance effects. Although these sequences offer fast scanning with good signal-to-noise efficiency, the "transient response," or time taken to reach a steady-state, can be long compared with the total imaging time, particularly when using 2D sequences. This results in lost imaging time and has made SSFP difficult to use for real-time and cardiac-gated applications. A linear-systems analysis of the steady-state and transient response for general periodic sequences is shown. The analysis is applied to refocused-SSFP sequences to generate a two-stage method of "catalyzing," or speeding up the progression to steady-state by first scaling, then directing the magnetization. This catalyzing method is compared with previous methods in simulations and experimentally. Although the second stage of the method exhibits some sensitivity to B(1) variations, our results show that the transient time can be significantly reduced, allowing imaging in a shorter total scan time. Magn Reson Med 46:149-158, 2001.

MR imaging of articular cartilage using driven equilibrium.

The high incidence of osteoarthritis and the recent advent of several new surgical and non-surgical treatment approaches have motivated the development of quantitative techniques to assess cartilage loss. Although magnetic resonance (MR) imaging is the most accurate non-invasive diagnostic modality for evaluating articular cartilage, improvements in spatial resolution, signal-to-noise ratio (SNR), and contrast-to-noise ratio (CNR) would be valuable. Cartilage presents an imaging challenge due to its short T(2) relaxation time and its low water content compared with surrounding materials. Current methods sacrifice cartilage signal brightness for contrast between cartilage and surrounding tissue such as bone, bone marrow, and joint fluid. A new technique for imaging articular cartilage uses driven equilibrium Fourier transform (DEFT), a method of enhancing signal strength without waiting for full T(1) recovery. Compared with other methods, DEFT imaging provides a good combination of bright cartilage and high contrast between cartilage and surrounding tissue. Both theoretical predictions and images show that DEFT is a valuable method for imaging articular cartilage when compared with spoiled gradient-recalled acquisition in the steady state (SPGR) or fast spin echo (FSE). The cartilage SNR for DEFT is as high as that of either FSE or SPGR, while the cartilage-synovial fluid CNR of DEFT is as much as four times greater than that of FSE or SPGR. Implemented as a three-dimensional sequence, DEFT can achieve coverage comparable to that of other sequences in a similar scan time. Magn Reson Med 42:695-703, 1999.