Correlation between apparent diffusion coefficient and viscoelasticity of articular cartilage in a porcine model.

OBJECTIVE: Quantitative MR imaging techniques of degenerative cartilage have been reported as useful indicators of degenerative changes in cartilage extracellular matrix, which consists of proteoglycans, collagen, non-collagenous proteins, and water. Apparent diffusion coefficient (ADC) mapping of cartilage has been shown to correlate mainly with the water content of the cartilage. As the water content of the cartilage in turn correlates with its viscoelasticity, which directly affects the mechanical strength of articular cartilage, ADC can serve as a potentially useful indicator of the mechanical strength of cartilage. The aim of this study was to investigate the correlation between ADC and viscoelasticity as measured by indentation testing. MATERIALS AND METHODS: Fresh porcine knee joints (n = 20, age 6 months) were obtained from a local abattoir. ADC of porcine knee cartilage was measured using a 3-Tesla MRI. Indentation testing was performed on an electromechanical precision-controlled system, and viscosity coefficient and relaxation time were measured as additional indicators of the viscoelasticity of cartilage. The relationship between ADC and viscosity coefficient as well as that between ADC and relaxation time were assessed. RESULTS: ADC was correlated with relaxation time and viscosity coefficient (R(2) = 0.75 and 0.69, respectively, p < 0.01). The mean relaxation time values in the weight-bearing and non-weight-bearing regions were 0.61 ± 0.17 ms and 0.14 ± 0.08 ms, respectively. CONCLUSIONS: This study found a moderate correlation between ADC and viscoelasticity in the superficial articular cartilage. Both molecular diffusion and viscoelasticity were higher in weight bearing than non-weight-bearing articular cartilage areas.

Evaluation of human muscle hardness after dynamic exercise with ultrasound real-time tissue elastography: a feasibility study.

AIM: To assess the feasibility of ultrasound real-time tissue elastography (RTE) for measuring exercise-induced changes in muscle hardness and to compare the findings of RTE with those of a tissue hardness meter for semi-quantitative assessment of the hardness of exercised muscles. MATERIALS AND METHODS: Nine male participants performed an arm-curl exercise. RTE measurements were performed by manually applying repetitive compression with the transducer on the scan position before exercise, immediately after exercise, and at 30 min after exercise; strain ratios between muscle and a reference material (hydrogel) were calculated (muscle strain/material strain). A tissue hardness meter was also used to evaluate muscle hardness. The intraclass correlation coefficients (ICCs) for the three repeated measurements at each measurement time were calculated to evaluate the intra-observer reproducibility of each technique. RESULTS: Immediately after exercise, the strain ratio and the value obtained using the tissue hardness meter significantly decreased (from 1.65 to 1.35) and increased (from 51.8 to 54.3), respectively. Both parameters returned to their pre-exercise value 30 min after exercise. The ICCs of the RTE (and the ICCs of the muscle hardness meter) were 0.971 (0.816) before exercise, 0.939 (0.776) immediately after exercise, and 0.959 (0.882) at 30 min after exercise. CONCLUSION: Similar to the muscle hardness meter, RTE revealed the exercise-induced changes of muscle hardness semi-quantitatively. The intra-observer reproducibility of RTE was very high at each measurement time. These findings suggest that RTE is a clinically useful technique for assessing hardness of specific exercised muscles.

Polyamine distributions in thermophilic eubacteria belonging to Thermus and Acidothermus.

Triamines such as norspermidine, spermidine, and homospermidine and tetraamines such as norspermine, spermine, thermospermine, and aminopropylhomospermidine were found to be distributed ubiquitously in the eight extremely thermophilic (growing at 70 degrees C) Thermus species tested. Three linear pentaamine (caldopentamine, homocaldopentamine, and thermopentamine), two linear hexaamines (caldohexamine and homocaldohexamine), two tertiary branched tetraamines (N4-aminopropylnorspermidine and N4-aminopropyl-spermidine), and quaternary branched pentaamines such as N4-bis(aminopropyl)norspermidine and N4-bis(aminopropyl)spermidine were detected in T. thermophilus HB8, T. filiformis Wai33 A1, T. flavus AT-62, and T. caldophilus GK24. The linear hexaamines and branched polyamines were absent in T. aquaticus YT-1, T. sp. X-1, T. sp. T2, and T. sp. T351, in which linear pentaamines were minor components. Moderately thermophilic Thermus ruber and Thermus sp. K-2 contained putrescine, spermidine, norspermidine, homospermidine, spermine, norspermine, thermospermine, and aminopropylhomospermidine. No pentaamines, hexaamines, or branched polyamines were found in these two moderately thermophilic Thermus species. On the other hand, moderately thermophilic, acidophilic Acidothermus cellulolyticus was devoid of all the polyamines.

High temporal resolution dynamic contrast MRI in a high risk group for placenta accreta.

Antenatal diagnosis of placenta accreta with MR is not easy even now because T2-weighted images (T2WI) cannot differentiate chorionic villi from decidua basalis. We performed dynamic contrast MRI to study whether trophoblastic villi could be separately demonstrated from the decidua basalis, and whether the contrast resolution between the placenta and myometrium could improve compared to T2WI. Six pregnant women with prior cesarean section were examined at 34-38 gestational weeks. Sagittal T2-weighted images with fast spin echo sequences and dynamic contrast studies with fast field echo sequence every 10-14 s after contrast injection were performed. We analyzed the enhancing pattern of the placenta and compared the contrast between placenta and myometrium. We reviewed medical records to identify complications during the placental delivery and the complications of their newborns. In the early phase after contrast enhancement, multiple foci of the strong lobular enhancement were observed in all cases. Other parts of placenta were slowly but strongly enhanced following them. We speculated that the former corresponded to intervillous space and the latter decidua basalis. The contrast between placenta and myometrium tended to be distinct near the inner cervical os on both T2WI and dynamic contrast study. On the other hand, it was indistinct in the upper part of the uterine body on T2WI despite it was clearly demonstrated on dynamic contrast study. The placentae were delivered without any complication in all cases. Although two neonates showed fetal distress, none of the infant remained any sequelae at the time of the discharge. The other four were well although one of them complicated with meconium staining. As dynamic contrast MRI can differentiate chorionic villi and decidua basalis, and can provide excellent contrast between placenta and myometrium at anywhere within the uterus, it may be a promising technique for antepartum diagnosis of the placenta accreta.

Acute change of exercised muscle using magnetization transfer contrast MR imaging.

We evaluated the acute changes in exercised muscle using magnetization transfer contrast (MTC) MR imaging with a short repetition time sequence. Ten volunteers performed supine ankle dorsiflexion exercise. MTC gradient-recalled echo (GRE) images were obtained before and after exercise at 1.5 T. The effect of MTC was assessed by dividing the signal intensity on MTC GRE images by that on conventional GRE images (M(s)/M0). The signal intensity, M(s)/M0 and cross-sectional area of exercised muscle were all greater at 1-2 min after exercise than immediately after exercise. We propose that this additional increase in these parameters after exercise was due to physiological reflow or hyperemia. Since the M(s)/M0 showed a good correlation with free water content in exercised muscle, this ratio may provide a quantitative variable for evaluating dynamic change of water-macromolecule interaction in skeletal muscle.

Changes in the liver parenchyma after proton beam radiotherapy: evaluation with MR imaging.

The objective of this study was to describe magnetic resonance (MR) findings with a 1.5T imager for hepatic parenchymal changes after proton beam radiotherapy. Thirty-two patients who received proton radiotherapy with doses of 50-87 Gy underwent MR imaging 1-75 months (mean 22 months) after the start of irradiation. Axial T(2), T(1)-weighted imaging, and a dynamic study after a gadolinium injection were performed. The irradiated areas showed hypointense in T(1)-weighted images, hyperintense in T(2)-weighted images, and intense and prolonged enhancement on the dynamic study (maximum relative enhancement 441.8%+/-263.3 vs. surrounding liver 145.6%+/-67.7, p<0.0001). T(2) values of the irradiated areas were 50.6 to 65.8 msec greater than in the surrounding liver (p<0.005). The values increased with time, being significantly greater 13 months or longer after the beginning of the therapy than after a period of less than 3 months (p<0.05). Pathologic examinations (n = 3) indicated that the irradiated areas were composed of collapsed lobules with hepatic small vein occlusions, and rich extracellular matrices which retained extracellular fluid. MR imaging can demonstrate hepatic parenchymal changes after proton beam radiotherapy, and show the changes are irreversible.

Signal intensity changes in anterior cruciate ligament autografts: relation to magnetic field orientation.

RATIONALE AND OBJECTIVES: The purpose of this study was to use magnetic resonance (MR) imaging to investigate the contribution of graft alignment to changes in signal intensity in anterior cruciate ligament (ACL) autografts. MATERIALS AND METHODS: Forty patients who had undergone reconstruction of the ACL with an autograft underwent MR examinations of the knee in extension and flexion. The signal intensity of the intratibial bone tunnel and intraarticular portions of ACL graft were measured, and signal intensity ratios were defined by dividing the mean signal intensity of the graft by the mean signal intensity of the fatty marrow. The angles from the intraarticular and intratibial bone tunnel portions of the graft to the static magnetic field were measured for each signal intensity ratio. The Hotteling T2 test was used to evaluate the differences in signal intensity ratios to the differences in angles from flexion to extension for the intratibial bone tunnel and intraarticular portions of the graft. RESULTS: Significant increases occurred in the signal intensity of the graft and the angle with the change in position from flexion to extension for both the intratibial bone tunnel (P < .01) and intraarticular (P < .01) portions of the graft. Changes in signal intensity ratios were greater than zero, and these values differed significantly for the intraarticular and the intratibial bone tunnel (P < .01) portions of the graft. CONCLUSION: The signal intensity changes of the ACL graft related to changes in its alignment are likely a result of the magic-angle effect.

Flexure deformation of the temporomandibular joint disk in pseudodynamic magnetic resonance images.

OBJECTIVE: The purpose of this study was to determine correlation of flexure disk deformation during jaw movement with other findings on magnetic resonance images and with clinical signs and symptoms in patients with anterior displacement of the temporomandibular joint disk. STUDY DESIGN: T(1)-weighted magnetic resonance images and gradient recalled acquisition in steady state magnetic resonance images were obtained in 62 subjects with flexure deformed disk in the jaw opening phase. Each disk deformation observed on a pseudodynamic image during jaw opening was classified as an upward or downward flexure deformation. The relationships between type of disk deformation, clinical signs and symptoms, and other findings on the magnetic resonance images were statistically analyzed by chi(2) test.Results. Of 80 delineated joints, 30 showed upward deformation and 50 showed downward deformation. There were significant differences between the upward and downward deformations in TMJ sound, TMJ pain, restricted jaw opening, extent of anterior displacement, and presence of disk reduction. CONCLUSIONS: The type of disk deformation appeared to correlate with the clinical signs and symptoms and with the progress of internal derangement.

Fibrous scar in the infrapatellar fat pad after arthroscopy: MR imaging.

PURPOSE: We describe the MR appearance of fibrous scars in the infrapatellar fat pad after arthroscopy. MATERIALS AND METHODS: The subjects were 96 patients who underwent arthroscope-assisted anterior cruciate ligament (ACL) reconstruction and were examined by oblique sagittal MR imaging at different follow-up intervals. Two observers evaluated the characteristics of the fibrous scars in the infrapatellar fat pad. RESULTS: All fibrous scars with low signal intensity were accentuated at the portal and coursed horizontally through the infrapatellar fat pad. The fibrous scar within the fat pad occurred and peaked within 6 months after arthroscopy. It then subsided gradually and had disappeared by one year later in nearly half of the patients. CONCLUSION: Identifying MR imaging characteristics of fibrous scars in the fat pad after arthroscopy may be clinically helpful to differentiate these scars from other abnormalities that involve the infrapatellar fat pad.

MR imaging of Pellegrini-Stieda disease.

OBJECTIVE: To describe the MR imaging of Pellegrini-Stieda disease, a post-traumatic ossification of the medial collateral ligament with typical radiographic findings. METHODS: Coronal and/or axial T2*-weighted field echo and T1-weighted conventional spin echo MR images were obtained with 1.5-Tesla or 0.5-Tesla units. Four patients with radiographic and clinical diagnoses of Pellegrini-Stieda disease were examined. Surgery was performed on one patient, and histopathologic correlation was obtained. RESULTS AND CONCLUSION: Delineating it as a signal void, T2*-weighted MR imaging indicated the precise extent of the osseous fragment in relation to the medial collateral ligament. T1-weighted imaging showed the presence of fatty marrow as a high signal region within the fragment, indicating maturity of the fragment. These findings may help to determine preoperative planning for resection of massive fragments around the ligament. Pellegrini-Stieda disease cannot be considered rare, since it is often encountered in daily MRI examinations.

Magnetic resonance imaging of the rotator cuff muscles after baseball pitching.

AIM: The purposes of present study were to investigate quantitatively using functional MR imaging the effect of a series of throwing activities on rotator cuff muscles and to compare the effect of pitching with that of all-out shoulder external rotator exercise as the targeted external rotator muscle group (the infraspinatus and the teres minor). EXPERIMENTAL DESIGN: MRI measurements after 135 baseball pitches or all-out shoulder external rotator exercise (concentric mode) in each subject's nondominant shoulder. PARTICIPANTS: 6 amateur baseball pitchers. MEASURES: serial T2-weighted images of rotator cuff muscles were obtained before pitching (or shoulder exercise) and immediately, 30, 60 min, 24, 48, 96 hrs after pitching (or shoulder exercise). T2 relaxation times (T2) at each measurement time were calculated for the rotator cuff muscles. RESULTS: Both the supraspinatus and the external rotator muscle group showed significant T2 elevations until 96 hrs after pitching. The subscapularis also showed significantly increased T2 until postpitching 48 hrs. On the other hand, a significant T2 elevation continued until 60 min after shoulder exercise, but thereafter returned towards the value at rest over the next 24 hrs. CONCLUSION: Long lasting T2 elevations in rotator cuff muscles would be associated with an increase in each intramuscular water content, and may be attributed to the muscle damage that resulted from eccentric contraction during pitching. This information should serve as a useful complement to shoulder injury prevention for baseball pitchers.

The effects of various therapeutic measures on shoulder range of motion and cross-sectional areas of rotator cuff muscles after baseball pitching.

AIM: The purpose of this study was to investigate the effects of various therapeutic measures on the shoulder range of motion (ROM) and muscle cross-sectional area (mCSA) of rotator cuff muscles after baseball pitching. EXPERIMENTAL DESIGN: a mode of therapeutic measures was classified in 4 groups; the control (CON), ice treatment (IT), light shoulder exercise (LSE) and ice treatment with LSE (ILSE) groups. Each therapeutic measure was performed after pitching. PARTICIPANTS: 7 healthy, skilled baseball pitchers. MEASURES: ROM and mCSA were measured before pitching, immediately after pitching, at the time of the therapeutic measure, and 24 hours after pitching. Shoulder ROM at 90 inverted exclamation mark of abduction included internal rotation (IROM), maximum internal rotation (IMROM), external rotation (EROM) and maximum external rotation (EMROM). RESULTS: In all groups, both IROM and IMROM were significantly decreased after pitching compared with the pre-exercise values and conversely both EROM and EMROM were significantly increased. The mCSA of all rotator cuff muscles were increased significantly after pitching. For IMROM, ILSE showed a significant recovery at the post-therapeutic measure compared with the others and at 24 hours after pitching compared with IT, respectively. For IROM, both LSE and ILSE showed significant recovery compared with CON at the post-therapeutic measure. For the mCSA of external muscles, ILSE showed a greater decrease at the post-therapeutic measure than the others, and at 24 hours after pitching than CON. CONCLUSION: This study suggested the possibility that ILSE was more effective to recover ROM and decrease mCSA than the other methods.

The effects of various therapeutic measures on shoulder strength and muscle soreness after baseball pitching.

AIM: This study was intended as an investigation of the effects of various therapeutic measures on the shoulder strength and muscle soreness after baseball pitching. EXPERIMENTAL DESIGN: participants threw 98 pitches in a simulated single game. The mode of the therapeutic measures after pitching were classified into 4 groups; the control group (CON), the ice treatment group (IT), the light shoulder exercise group (LSE) and the ice treatment with LSE group (ILSE). Each therapeutic measure was applied to the dominant shoulder immediately after pitching. PARTICIPANTS: 7 healthy, skilled baseball pitchers. MEASURES: both shoulder strength and muscle soreness were measured before pitching, immediately after pitching (Post-P), at the time of the therapeutic measure (Post-TM), and 24 hours after pitching (Post-24 h). RESULTS: All 4 groups showed shoulder strength losses in shoulder abduction, internal/external rotation with no shoulder abduction or with the shoulder abducted to 90 degrees immediately after pitching. ILSE had greater recovery from Post-P values at Post-TM or Post-24 h than the other methods in all 5 shoulder strengths. On the other hand, the soreness in shoulder internal rotation was increased significantly from Post-P and continued by Post-24 h. Both IT and ILSE had beneficial effects on reducing the shoulder muscle soreness at Post-TM or Post-24 h. CONCLUSION: The findings of this study suggested that ILSE was the optimal therapeutic measure against decreased shoulder strength or increased shoulder muscle soreness resulting from the repetitive baseball pitching.

[MR imaging of the arm].

Thirty arms of healthy adults were studied with MR imaging using surface coil. Fine structures of the arm, such as muscular bundles, small vessels and nerves were clearly demonstrated. Deep fascia dividing muscular bundles appeared as high intensity on T1-weighed image due to fat deposition beneath the fascia. Aponeurosis is also flat sheet of densely arranged collagen fibers. With rather thicker layer of collagen fibers than fascia, aponeurosis appeared as low intensity sheet that was frequently demonstrated on MR images of the extremities.

[MRI and ultrasonography of cavernous hemangioma of the liver].

The frequency of detection of hemangioma has increased with the improvements of ultrasonography. Sonography detected 24 lesions out of 30 (80%), and 28 lesions out of 30 (93%) by MRI. MRI is superior to ultrasonography in detection rate. In T2 weighted spin echo image, most of the hepatic hemangiomas show moderately or markedly higher intensity than the liver and mildly higher or the same intensity as that of the spleen. MRI will play an important role in determination of necessity of further invasive diagnostic methods such as angiography or biopsy.

[Three-dimensional MR imaging of the knee joint--diagnostic value for meniscal tears].

The value of a three-dimensional (3D) imaging system was evaluated using a newly developed workstation. Fifteen knee joints with meniscal tears confirmed by arthroscopic examinations underwent 3D magnetic resonance (MR) imaging. These 3D data sets were processed into 3D display by multiplanar reformation (MPR) and the volume rendering technique, and the features of the meniscal tears were compared with those on conventional two-dimensional (2D) MR images. The 3D images with MPR provided higher detectability and more descriptive delineation of the meniscal tears than the 2D images. With its powerful image processing capacity, the workstation facilitated high-speed, high-quality 3D display and provided precise views of meniscal cleavages for the planning of surgical treatment. The independent processing system permitted efficient throughput of the MR data and eliminated wasteful filming processes.

Kinematic MR imaging of the knee.

This is an overview of the "cine magnetic resonance (MR) imaging" system and rapid (ultra-fast) MR imaging of the knee for evaluation of injury of the cruciate ligament including its function during flexion and extension. Cine MR imaging using a gating system and a cine acquisition delineates alterations of the signal and shape of the cruciate ligaments and menisci. Rapid (ultra-fast) MR images with a single acquisition time of half second or less using a mobile knee brace and a flexible surface coil has enabled rapid acquisition of moving knee motion in multi-image frames. Visualization of the moving normal and torn anterior cruciate ligaments indicates that kinematic MR imaging of the moving knee is advantageous in evaluating the continuity and tension in the cruciate ligaments.

Current practice of knee MR imaging in Japan (radiologist's view).

The knee is probably the most frequent site for MR imaging of the extremities in most institutions, and it has significantly changed the practice of knee surgery, including arthroscopy. The following commentary by a radiologist discusses the growing number of MR units, which facilitates increases in the number of MR examinations of the knee in Japan. This easy access to MRI includes elderly patients with degenerative knee disorders, as well as younger patients with traumatic injuries. With prolonged life expectancy, indication for MRI of the knee will be expanded, despite its high cost. Precise evaluation of articular cartilage in the early stages of regeneration is still a challenge; proper use of MR imaging for this disorder must be considered.