Musculoskeletal Magnetic Resonance Research Articles

State-of-the-art Musculoskeletal Magnetic Resonance Imaging: Technical Review

State-of-the-art Musculoskeletal Magnetic Resonance Imaging: Technical Review

Functional Improvements and Musculoskeletal Magnetic Resonance Imaging with Spectroscopy Changes following Cell Therapy in a Case of Limb Girdle Muscular Dystrophy

Functional Improvements and Musculoskeletal Magnetic Resonance Imaging with Spectroscopy Changes following Cell Therapy in a Case of Limb Girdle Muscular Dystrophy

Deep convolutional neural network and 3D deformable approach for tissue segmentation in musculoskeletal magnetic resonance imaging.

To describe and evaluate a new fully automated musculoskeletal tissue segmentation method using deep convolutional neural network (CNN) and three-dimensional (3D) simplex deformable modeling to improve the accuracy and efficiency of cartilage and bone segmentation within the knee joint. A fully automated segmentation pipeline was built by combining a semantic segmentation CNN and 3D simplex deformable modeling. A CNN technique called SegNet was applied as the core of the segmentation method to perform high resolution pixel-wise multi-class tissue classification. The 3D simplex deformable modeling refined the output from SegNet to preserve the overall shape and maintain a desirable smooth surface for musculoskeletal structure. The fully automated segmentation method was tested using a publicly available knee image data set to compare with currently used state-of-the-art segmentation methods. The fully automated method was also evaluated on two different data sets, which include morphological and quantitative MR images with different tissue contrasts. The proposed fully automated segmentation method provided good segmentation performance with segmentation accuracy superior to most of state-of-the-art methods in the publicly available knee image data set. The method also demonstrated versatile segmentation performance on both morphological and quantitative musculoskeletal MR images with different tissue contrasts and spatial resolutions. The study demonstrates that the combined CNN and 3D deformable modeling approach is useful for performing rapid and accurate cartilage and bone segmentation within the knee joint. The CNN has promising potential applications in musculoskeletal imaging. Magn Reson Med 79:2379-2391, 2018. © 2017 International Society for Magnetic Resonance in Medicine.

Clinical History Provided by Referring Clinicians and Patients for Musculoskeletal MRI

Access to clinical history is essential for the daily workflow of radiologists. Typically, referring clinicians provide patient-specific information for imaging studies because most radiologists have no contact with patients for routine imaging examinations [ 1 Davis D.L. Mulligan M.E. Moszkowicz A. Resnik C.S. Patient-centered care in diagnostic radiology: lessons learned from patient interviews prior to musculoskeletal magnetic resonance imaging. Qual Manag Health Care. 2015; 24: 38-44 Crossref PubMed Scopus (4) Google Scholar , 2 Glazer G.M. Ruiz-Wibbelsmann J.A. The invisible radiologist. Radiology. 2011; 258: 18-22 Crossref PubMed Scopus (99) Google Scholar , 3 Ruiz J.A. Glazer G.M. The state of radiology in 2006: very high spatial resolution but no visibility. Radiology. 2006; 241: 11-16 Crossref PubMed Scopus (25) Google Scholar , 4 Smith W.L. Altmaier E.M. Ross R.R. Johnson B.D. Berberoglu L.S. Patient expectations of radiology in noninteractive encounters. Radiology. 1989; 172: 275-276 Crossref PubMed Scopus (25) Google Scholar ]. Referring clinicians are a heterogeneous group of health care providers, including physicians, physician assistants, and nurse practitioners. However, the interpretation of imaging examinations by radiologists with inadequate patient history is not uncommon [ 5 Berquist T.H. Communication: the needs of the patient come first. AJR Am J Roentgenol. 2009; 192: 557-559 Crossref PubMed Scopus (14) Google Scholar ]. The fast-paced tempo of current clinical practice and the impersonal nature of referral patterns compound this problem by limiting routine direct communication between radiologists and referring clinicians. Furthermore, imaging referrals that lack clearly defined clinical questions or contain insufficient patient history may on occasion negatively affect the findings and recommendations of a radiologist’s report [ 1 Davis D.L. Mulligan M.E. Moszkowicz A. Resnik C.S. Patient-centered care in diagnostic radiology: lessons learned from patient interviews prior to musculoskeletal magnetic resonance imaging. Qual Manag Health Care. 2015; 24: 38-44 Crossref PubMed Scopus (4) Google Scholar , 6 Loy C.T. Irwig L. Accuracy of diagnostic tests read with and without clinical information: a systematic review. JAMA. 2004; 292: 1602-1609 Crossref PubMed Scopus (165) Google Scholar ]. Inconclusive reports that do not address sufficiently the clinical question often lead clinicians to request additional tests, adding potentially unnecessary costs to the health care system [ 5 Berquist T.H. Communication: the needs of the patient come first. AJR Am J Roentgenol. 2009; 192: 557-559 Crossref PubMed Scopus (14) Google Scholar , 7 Bazzocchi M. Doctor-patient communication in radiology: a great opportunity for future radiology. Radiol Med. 2012; 117: 339-353 Crossref PubMed Scopus (12) Google Scholar ]. Soliciting additional information directly from patients has been advocated as one possible solution for radiologists to avoid these pitfalls [ 1 Davis D.L. Mulligan M.E. Moszkowicz A. Resnik C.S. Patient-centered care in diagnostic radiology: lessons learned from patient interviews prior to musculoskeletal magnetic resonance imaging. Qual Manag Health Care. 2015; 24: 38-44 Crossref PubMed Scopus (4) Google Scholar , 8 Moreno C.C. Fleming M. McKinnie L. Duszak Jr., R. Expanded payer coverage for ultrasound evaluation of deep vein thrombosis with sonographer-obtained clinical history. J Am Coll Radiol. 2016; 13: 59-63 Abstract Full Text Full Text PDF PubMed Scopus (4) Google Scholar , 9 Hawkins C.M. Anton C.G. Bankes W.M. et al. Improving the availability of clinical history accompanying radiographic examinations in a large pediatric radiology department. AJR Am J Roentgenol. 2014; 202: 790-796 Crossref PubMed Scopus (25) Google Scholar ].

State-of-the-art Musculoskeletal Magnetic Resonance Imaging: Technical Review

State-of-the-art Musculoskeletal Magnetic Resonance Imaging: Technical Review

Musculoskeletal MRI findings of juvenile localized scleroderma.

Juvenile localized scleroderma comprises a group of autoimmune conditions often characterized clinically by an area of skin hardening. In addition to superficial changes in the skin and subcutaneous tissues, juvenile localized scleroderma may involve the deep soft tissues, bones and joints, possibly resulting in functional impairment and pain in addition to cosmetic changes. There is literature documenting the spectrum of findings for deep involvement of localized scleroderma (fascia, muscles, tendons, bones and joints) in adults, but there is limited literature for the condition in children. We aimed to document the spectrum of musculoskeletal magnetic resonance imaging (MRI) findings of both superficial and deep juvenile localized scleroderma involvement in children and to evaluate the utility of various MRI sequences for detecting those findings. Two radiologists retrospectively evaluated 20 MRI studies of the extremities in 14 children with juvenile localized scleroderma. Each imaging sequence was also given a subjective score of 0 (not useful), 1 (somewhat useful) or 2 (most useful for detecting the findings). Deep tissue involvement was detected in 65% of the imaged extremities. Fascial thickening and enhancement were seen in 50% of imaged extremities. Axial T1, axial T1 fat-suppressed (FS) contrast-enhanced and axial fluid-sensitive sequences were rated most useful. Fascial thickening and enhancement were the most commonly encountered deep tissue findings in extremity MRIs of children with juvenile localized scleroderma. Because abnormalities of the skin, subcutaneous tissues and fascia tend to run longitudinally in an affected limb, axial T1, axial fluid-sensitive and axial T1-FS contrast-enhanced sequences should be included in the imaging protocol.

MR imaging of scaphoid fractures. Fat-saturated T2-weighted and Short tau inversion recovery images.

Objective: Traumatic injuries of os scaphoideum are serious, and might lead to two main grades of consequences (i.e. osteoarthrosis or avascular necrosis), if a fracture remains undiagnosed. Bone bruise may be the only pathological sign of pain which can last for week or month. Articles describe the importance of early MRI and hereby predict bone bruise with the help of fat suppression sequence; however, only a limited selection articles compares various fat suppression techniques. The purpose of this prospective study was to compare the short tau inversion recovery (STIR) and T2 fat saturation (FAT SAT) sequences, sectional directed along the scaphoid bone axis. In relation to background fat intensity suppression, this study sought the sequence that best evaluated posttraumatic bone marrow edema (bone bruise) on scaphoid injury musculoskeletal magnetic resonance imaging (MRI, 1.5 T extremity scanner).Materials and methods: Two hundred and fifty-one patients with relevant trauma and positive clinical test for scaphoid bone fractures, exceeding no more than 14 days, underwent MRI examinations. A fast STIR and T2 FAT SAT fast spin echo sequence (FSE) were obtained using a comparable parameter setting (scan time ca. 3 minutes). Three experienced readers (one radiographer and two radiologists) carried out the evaluation blinded to each other’s, based on a quantitative assessment of size (area) and image quality (image contrast, IC and contrast-to-noise ratio, CNR). The study period lasted March 2014-April 2015. Sixty patients met the inclusion criteria and were enrolled. This prospective study was ethically approved by the institutional review board.Results: There were no significant difference between the bone bruise areas (P=0.45, P=0.44 and P=0.83) or CNR (P=0.31, P=0.38 and P=0.17). However, image contrast showed significant difference in favour of T2 FAT SAT in all three readers’ reports (P<0.05, P<0.05 and P<0.05).Conclusions: The two sequences appear almost identical. An interchangeable usage of the two sequences was found being acceptable for the diagnosis if the protocol is composed appropriately (1.5T). However, the T2 FAT SAT provided a higher image contrast by specific settings (e.g. short TI = 125 ms) compared to STIR.

Imaging of Athletic Injuries of Knee Ligaments and Menisci: Sports Imaging Series.

Acute knee injuries are a common source of morbidity in athletes and if overlooked may result in chronic functional impairment. Magnetic resonance (MR) imaging of the knee has become the most commonly performed musculoskeletal MR examination and is an indispensable tool in the appropriate management of the injured athlete. Meniscal and ligamentous tearing are the most frequent indications for surgical intervention in sports injuries and an understanding of the anatomy, biomechanics, mechanisms of injury, and patterns of injury are all critical to accurate diagnosis and appropriate management. These will be discussed in reference to meniscal tears and injuries of the cruciate ligaments as well as injuries of the posterolateral and posteromedial corners of the knee. (©) RSNA, 2016.

Imaging of regional pain syndromes; from syndromes to conditions using imaging?

Musculoskeletal regional pain syndromes often lead to patient referrals in general and rheumatological practice. Detailed history taking and clinical examination can in most cases reveal the cause for pain and direct the subsequent management of the conditions. Yet, when in doubt, imaging methods have to support the clinical assessment. This paper presents the underlying pathologies of the most frequently encountered regional pain syndromes and the role of musculoskeletal ultrasonography and magnetic resonance imaging in their visualization. It presents data, where available, on diagnostic accuracy and comparisons with gold standards. The article stresses the advantages and disadvantages of the analyzed imaging modalities and suggests the future research agenda.

Imaging in paediatric rheumatology: Is it time for imaging?

Juvenile idiopathic arthritis (JIA) is a heterogeneous group of arthritides characterized by chronic synovial inflammation that can lead to structural damage. The main objective of JIA therapies is to induce disease control to avoid disability in childhood. The advances in therapeutic effectiveness have created a need to search for imaging tools that describe more precisely disease activity in children with JIA. Musculoskeletal ultrasound and magnetic resonance imaging have demonstrated to be more sensitive than clinical examination in early detection of synovitis. These modalities can detect both inflammatory and destructive changes. The unique characteristics of the growing skeleton and a scarce validation of imaging in children result in important challenges in evaluating paediatric population. This review describes indications and limitations of these imaging techniques and suggests some advices for a rational use in the management of JIA in clinical practice.

Artifacts Affecting Musculoskeletal Magnetic Resonance Imaging: Their Origins and Solutions

Among articles within the radiology literature, few present the manifestations of magnetic resonance imaging artifacts in a clinically oriented manner. Recognizing such artifacts is imperative given the increasing clinical use of magnetic resonance imaging and the emphasis by the American Board of Radiology on practical physics applications. The purpose of this article is to present magnetic resonance physics principles visually and conceptually in the context of common musculoskeletal radiology artifacts and their solutions, described using nonmathematical explanations.

Web Alert

Lids on Kids http://www.lidsonkids.org/ Description: Lids on Kids is a web site dedicated to promoting the use of helmets in adolescent skiers and snowboarders and is a good resource to direct parents who are resistant to the idea of putting a helmet on their child while on the ski slopes. Content includes FAQs, articles supporting the use of ski helmets, helmet-fitting instructions, and general information on ski and snowboard safety. Lids on Kids is a campaign of the National Ski Areas Association. Cost: Free Let’s Move http://www.letsmove.gov/ Description: Let’s Move is a nationwide initiative to combat childhood obesity driven by First Lady Michelle Obama. The web site offers a wealth of information for parents and the general community on the scope of the problem of childhood obesity, nutrition and exercise guidance, and tools to facilitate and implement change. Providers will find value in the patient education resources such as a childhood obesity fact sheet that can be placed in waiting rooms, located in the “Resources” section of the “Learn the Facts Tab,” and the healthier living prescription form they can complete with patients, located in the “Health Care Providers” section of the “Take Action” tab. Cost: Free Musculoskeletal Magnetic Resonance Imaging http://www.freitasrad.net/ Description: Musculoskeletal magnetic resonance imaging (MRI) is a free educational resource for providers both in training and in practice. MRI (including sagittal, axial, and coronal cuts) of most of the major regions of the body is labeled for easy identification of anatomical structures. Images of a shoulder MR arthrogram also are included. Discussion of the strengths and weaknesses of different MR protocols also is provided. Furthermore, the web site is accessible on an iPad®, making this a convenient office reference. Cost: Free American Institute of Ultrasound in Medicine http://www.aium.org Description: This is the home web site of the American Institute of Ultrasound in Medicine (AIUM). This site provides free access to all of the AIUM guidelines including that for musculoskeletal ultrasound. Physician training guidelines, official statements, and special communications also are provided for free. Case-based self-assessments, video tutorials, and access to a musculoskeletal ultrasound online community can be obtained with membership and/or a fee. AIUM accreditation applications also can be submitted on the site. Cost: Free and paid resources Athletes and the Arts http://athletesandthearts.com Description: This is the home web site of Athletes and the Arts, an organization raising awareness of the unique medical needs of performing artists. The site provides free patient handouts and information on topics such as auditory and oral health, nutrition and hydration, and wellness. Topics also are organized into discipline-specific sections. Information on upcoming conferences and events also is provided. The American College of Sports Medicine is a founding sponsor of Athletes and the Arts. Cost: Free

Evaluating Maternal Recovery From Labor and Delivery

Objective We sought to describe occurrence, recovery, and consequences of musculoskeletal (MSK) injuries in women at risk for childbirth-related pelvic floor injury at first vaginal birth. Study Design Evaluating Maternal Recovery from Labor and Delivery is a longitudinal cohort design study of women recruited early postbirth and followed over time. We report here on 68 women who had birth-related risk factors for levator ani (LA) muscle injury, including long second stage, anal tears, and/or older maternal age, and who were evaluated by MSK magnetic resonance imaging at both 7 weeks and 8 months' postpartum. We categorized magnitude of injury by extent of bone marrow edema, pubic bone fracture, LA muscle edema, and LA muscle tear. We also measured the force of LA muscle contraction, urethral pressure, pelvic organ prolapse, and incontinence. Results In this higher-risk sample, 66% (39/59) had pubic bone marrow edema, 29% (17/59) had subcortical fracture, 90% (53/59) had LA muscle edema, and 41% (28/68) had low-grade or greater LA tear 7 weeks' postpartum. The magnitude of LA muscle tear did not substantially change by 8 months' postpartum ( P = .86), but LA muscle edema and bone injuries showed total or near total resolution ( P P P > .05). Conclusion Pubic bone edema and subcortical fracture and LA muscle injury are common when studied in women with certain risk factors. The bony abnormalities resolve, but levator tear does not, and is associated with levator weakness and posterior-vaginal wall descent.

Fat Suppression with Dixon Techniques in Musculoskeletal Magnetic Resonance Imaging: A Pictorial Review.

Dixon techniques are part of the methods used to suppress the signal of fat in MRI. They present many advantages compared with other fat suppression techniques including (1) the robustness of fat signal suppression, (2) the possibility to combine these techniques with all types of sequences (gradient echo, spin echo) and different weightings (T1-, T2-, proton density-, intermediate-weighted sequences), and (3) the availability of images both with and without fat suppression from one single acquisition. These advantages have opened many applications in musculoskeletal imaging. We first review the technical aspects of Dixon techniques including their advantages and disadvantages. We then illustrate their applications for the imaging of different body parts, as well as for tumors, neuromuscular disorders, and the imaging of metallic hardware.

Update on Advances in Musculoskeletal Magnetic Resonance Imaging.

Update on Advances in Musculoskeletal Magnetic Resonance Imaging.

Localized Scleroderma of Lower Extremities:Clinical and Magnetic Resonance Imaging Features

To evaluate the clinical and musculoskeletal characteristics of localized scleroderma with lower extremities affected. All the localized scleroderma patients,who received magnetic resonance (MR ) examinations of affected lower extremities at Peking Union Medical College Hospital from April 2013 to June 2014,were retrospectively reviewed. Their clinical data and laboratory results of antinuclear antibody,anti-double stranded-DNA antibody, and anti-extractable nuclear antigen antibody were collected and analyzed. All the MR examinations were non-contrast imaging using Siemens Skyra 3.0T MR scanner. There were 16 localized scleroderma patients with lower extremities affected, 11 of whom were linear scleroderma, 4 generalized morphea, and 1 deep morphea. Female to male ratio was 1:2.2. The mean age was 22.5 years. The mean time span was 7.4 years. Four of the 14 patients (28.6%) who received antinuclear antibody test were positive. All the 10 patients who received anti-double stranded-DNA antibody test and the 7 patients who received anti-extractable nuclear antigen antibody test were negative. The most common musculoskeletal MR features were subcutaneous septal thickening (16/16) and fascial thickening (11/16). The thickened speta and fascia could either be hypointenstiy or hyperintensity on turbo inversion recovery magnitude/proton density weighted imaging. Other MR manifestations were intramuscular speta thickening (3/16), muscular abnormal signals (1/16), and bone marrow abnormal signals (2/16). Musculoskeletal manifestations of the lower extremities with localized scleroderma can be well revealed using MR imaging.

PP09.14 – 2843: Congenital absence of gluteal muscles without spina bifida occulta: The first case report

Objective To present a case of congenital gluteal muscles absence associated with renal ectopia, without spina bifida occulta. Methods A 3-years-old child was referred to our child Neurology Unit for motor delay and walking difficulties. Familial and pregnancy history were unremarkable except for right renal ectopia diagnosed with antenatal ultrasound. At birth, he presented flexed hips and lower limbs rigidity. He started walking at 19 months. Neurological examination (28 months) showed waddling gait, gluteal muscles hypoplasia and lumbar hyperlordosis. Laboratory findings, imaging and electrophysiological exams were performed. Results At 28 months of age the child underwent electromyography (with needle of 50 mm) that showed absence of voluntary activity in the territory of gluteal muscles, with normal response in the regions of vastus medialis and sural triceps and normal nerve conduction studies. Laboratory findings (creatine phosphokinase and transaminases) were normal. Musculoskeletal and pelvis magnetic resonance imaging (MRI) revealed a complete, symmetrical fibroadipose replacement of gluteus, gracilis, semitendinosus, semimembranosus and biceps femoris muscles, anterior legs muscles were normal. Spinal magnetic resonance excluded spina bifida occulta. Right kidney was ectopic. Conclusion Bilateral symmetrical congenital absence of muscles is rare, other than Eagle-Barrett syndrome. So far, only three cases of congenital absence of gluteal muscles have been reported and they all had spina bifida occulta. To the best of our knowledge, our case is the first report of congenital absence of gluteal muscles without spinal dysraphism. The only remarkable finding was the kidney ectopia, never described in association with gluteus' agenesis by previous Literature. This association could be explained by a disruption of normal embryologic migration of mesodermal cells during gestational age. Muscular MRI and extensive electromyography should be considered in the diagnostic work-up of children with motor delay and walking difficulties and with clinical suspicion of neuromuscular disorders.

Artifacts and pitfalls in shoulder magnetic resonance imaging.

Magnetic resonance imaging has revolutionized the diagnosis of shoulder lesions, in many cases becoming the method of choice. However, anatomical variations, artifacts and the particularity of the method may be a source of pitfalls, especially for less experienced radiologists. In order to avoid false-positive and false-negative results, the authors carried out a compilation of imaging findings that may simulate injury. It is the authors’ intention to provide a useful, consistent and comprehensive reference for both beginner residents and skilled radiologists who work with musculoskeletal magnetic resonance imaging, allowing for them to develop more precise reports and helping them to avoid making mistakes.

Patient-centered care in diagnostic radiology: lessons learned from patient interviews prior to musculoskeletal magnetic resonance imaging.

Since most radiologists do not meet with patients, questionnaires often substitute for face-to-face interviews to collect patients' history. We report the effect of direct radiologist-patient interviews on the quality of patient history recorded for musculoskeletal magnetic resonance imaging. Magnetic resonance imaging questionnaires completed by outpatients were separated into 2 cohorts: (1) imaging center (IC) forms with no radiologist interviews; (2) hospital (H) forms with radiologist-patient interviews. Three blinded radiologists independently scored each questionnaire for quality on a 5-point scale. A separate quantitative analysis was also performed. The unpaired t test, Fischer exact test, and χ² test were used to compare the cohorts. The mean score of the H cohort among reviewers was superior to the IC cohort: 3.79 (±0.98) versus 3.04 (±1.00), P < .0001. Each reviewer also independently found the H cohort to be of higher quality for patient history, P < .0001. For the IC cohort, 7.8% of questionnaires did not report a single symptom versus 0.0% in the H cohort, P = .0331. Also, the IC cohort recorded symptoms in 2 or less words more often than the H cohort, P < .0001. Brief radiologist-patient interviews are superior for obtaining a higher quality of patient history for musculoskeletal MRI than patient questionnaires alone.

The Role of Magnetic Resonance Imaging in a Division I University Sports Medicine Program

To prospectively document musculoskeletal magnetic resonance imaging (MRI) use and how it affects diagnosis, playing status, and treatment of Division I university athletes. We hypothesized that MRI often has little or no effect on the diagnosis or treatment plan. Cross-sectional study. Division I university sports medicine program. Division I university varsity athletes. Data were collected of musculoskeletal MRI use in varsity student athletes for 2 full academic years from 2010 to 2012 at a National Collegiate Athletic Association Division I institution. Timing of the injury, first physician visit, and MRI and pre- and post-MRI diagnosis, playing status, and treatment (surgical vs nonsurgical). Eighty-six MRIs were obtained during the 2 years studied. Average age was 19.9 (18-23) years. Forty-five percent of injuries occurred during competition season, 34% occurred preseason, and 21% occurred postseason. There was a change in diagnosis in 13 athletes (15.1%, 1 led to surgery performed after completion of the season), and there was a change in participation status in 8 athletes (9.3%, 5 increased and 3 decreased). Treatment plan changed in 1 athlete (1.2%). No athlete required surgery immediately after an MRI that was not already being planned. Every athlete treated nonsurgically pre-MRI was able to finish their season. Magnetic resonance imaging was obtained in 14% of athletes and did not demonstrate a clear benefit over history, examination, and radiographs. Magnetic resonance imaging did change diagnosis in 15% of cases, though it did not appreciably change the playing status or treatment plan.