Abstract
ObjectiveTo establish and optimize a stable 3 Tesla (T) glycosaminoglycan chemical exchange saturation transfer (gagCEST) imaging protocol for assessing the articular cartilage of the tibiotalar joint in healthy volunteers and patients after a sustained injury to the ankle.MethodsUsing Bloch–McConnell simulations, we optimized the sequence protocol for a 3 T MRI scanner for maximum gagCEST effect size within a clinically feasible time frame of less than 07:30 min. This protocol was then used to analyze the gagCEST effect of the articular cartilage of the tibiotalar joint of 17 healthy volunteers and five patients with osteochondral lesions of the talus following ankle trauma. Reproducibility was tested with the intraclass correlation coefficient.ResultsThe mean magnetization transfer ratio asymmetry (MTRasym), i.e., the gagCEST effect size, was significantly lower in patients than in healthy volunteers (0.34 ± 1.9% vs. 1.49 ± 0.11%; p < 0.001 [linear mixed model]). Intra- and inter-rater reproducibility was excellent with an average measure intraclass correlation coefficient (ICC) of 0.97 and a single measure ICC of 0.91 (p < 0.01).DiscussionIn this feasibility study, pre-morphological tibiotalar joint cartilage damage was quantitatively assessable on the basis of the optimized 3 T gagCEST imaging protocol that allowed stable quantification gagCEST effect sizes across a wide range of health and disease in clinically feasible acquisition times.
Highlights
To this day and age, several magnetic resonance imaging (MRI) techniques have emerged that go beyond mere morphological depiction of joint cartilage
Due to recent restrictions imposed on gadolinium-based contrast agents, alternative compositional MRI techniques that do not rely on the administration of contrast agents have received ever-increasing scientific and clinical attention [4]
The most important finding of this study is that -following comprehensive and systematic sequence optimizationgagCEST imaging of the tibiotalar joint is feasible using a clinical standard 3 T MRI scanner, fits into clinical workflows with an acquisition time of less than 07:30 min, and yields stable and reproducible results that allow compositional cartilage assessment
Summary
To this day and age, several magnetic resonance imaging (MRI) techniques have emerged that go beyond mere morphological depiction of joint cartilage. Such compositional MRI techniques allow the detection of early degenerative changes of the articular cartilage, e.g., loss of proteoglycans, that precede morphological damage and are considered an early, and more importantly, reversible, stage of osteoarthritis (OA) [1]. Due to recent restrictions imposed on gadolinium-based contrast agents, alternative compositional MRI techniques that do not rely on the administration of contrast agents have received ever-increasing scientific and clinical attention [4]. To achieve a more widespread scientific and clinical adaptation of the technique, the clinical utility has to be demonstrated on a broader scale, which -given the limited availability of 7 T MRI scanners- necessitates the technique’s implementation on more widely available 3 T MRI scanners
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