Abstract

ObjectivesAssessment of the repeatability of diffusion parameter estimations in the upper leg muscles of healthy adults over the time course of 2 weeks, from a simultaneous bilateral upper leg DTI measurement.MethodsSE-EPI DTI datasets were acquired at 3 T in the upper legs of 15 active adults at a time interval of 2 weeks. ROIs were manually drawn for four quadriceps and three hamstring muscles of both legs. The following DTI parameters were analyzed: 1st, 2nd, and 3rd eigenvalue (λ1, λ2, and λ3), mean diffusivity (MD), and fractional anisotropy (FA). DTI parameters per muscle were calculated with and without intravoxel incoherent motion (IVIM) correction together with SNR levels per muscle. Bland-Altman plots and within-subject coefficient of variation (wsCV) were calculated. Left-right differences between muscles were assessed.ResultsThe Bland-Altman analysis showed good repeatability of all DTI parameters except FA for both the IVIM-corrected and standard data. wsCV values show that MD has the highest repeatability (4.5% IVIM; 5.6% standard), followed by λ2 (4.9% IVIM; 5.5% standard), λ1 (5.3% IVIM; 7.5% standard), and λ3 (5.7% IVIM; 5.7% standard). wsCV values of FA were 15.2% for the IVIM-corrected data and 13.9% for the standard analysis. The SNR (41.8 ± 16.0 right leg, 41.7 ± 17.1 left leg) and wsCV values were similar for the left and right leg and no left-right bias was detected.ConclusionsRepeatability was good for standard DTI data and slightly better for IVIM-corrected DTI data. Our protocol is suitable for DTI of the upper legs with overall good SNR.Key Points• The presented DTI protocol is repeatable and therefore suitable for bilateral DT imaging of the upper legs.• Additional B1+calibrations improve SNR and repeatability.• Correcting for perfusion effects improves repeatability.

Highlights

  • Muscle injuries are the most prevalent injuries in elite and recreational sports [1]

  • The artifacts were mostly present in the rectus femoris (RF) muscle, causing an overall Signal-to-noise ratio (SNR) drop in the quadriceps muscles compared with that in the hamstring muscles

  • The shading artifacts were primarily present in the upper quadrant of the left leg and in the lower quadrant of the right leg and were most apparent in the left quadriceps

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Summary

Introduction

Muscle injuries are the most prevalent injuries in elite and recreational sports [1]. Conventional T2-weighted fat-suppressed MRI is commonly used [4]. A major drawback is that hyperintensity—a characteristic of the injury—remains visible in these images long after all clinical symptoms have cleared and the athlete has resumed sports activity [5]. This implies that T2-weighted imaging with fat suppression is insufficient for evaluating muscle recovery during rehabilitation and for assessing return to play (RTP) [6,7,8].

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