Fat-saturated Proton Density Research Articles

Quantitative Comparison of 2D and 3D MRI Techniques for the Evaluation of Chondromalacia Patellae in 3.0T MR Imaging of the Knee

Methods: Seventy-five knee MRI exams of 69 adult consecutive patients were included in the study. Fat-saturated T2-weighted (FST2), fat-saturated proton density (FSPD), water-only T2-weighted DIXON (T2mD), T2-weighted 3 dimensional steady state (3DT2FFE), merged multi-echo steady state (3DmFFE), and water selective T1-weighted fatsuppressed (WATSc) images were acquired. Quantitative comparison of grade 1 and grade 5 lesions were made using contrast-to-noise (CNR) ratios. Grade 2-4 lesions were scored qualitatively and scorings of the lesions were compared statistically. Analysis of variance and Tukey’s tests were used to compare CNR data. Two sample z-test was used to compare the ratio of MR exams positive for grade 1 lesions noted on T2-mapping and other conventional sequences. Paired samples t-test was used to compare two different pulse sequences. Results: In detecting grade 1 lesions, FSPD, FST2 and T2mD images were superior in comparison to other sequences. FSPD and FST2 images were statistically superior in detecting grade 2-4 lesions. Although all grade 5 lesions were noted in every single sequence, FST2 images have the highest mean CNR followed by 3DT2FFE images. Conclusion: FST2 sequence is equal or superior in detecting every grade of patellar chondromalacia in 3.0T MR imaging of the knee in comparison to FSPD, T2mD, WATSc, 3DT2FFE, and 3DmFFE images.

Biochemical cartilage alteration and unexpected signal recovery in T2* mapping observed in ankle joints with mobile MRI during a transcontinental multistage footrace over 4486 km

The effect of ultra-long distance running on the ankle cartilage with regard to biochemical changes, thickness and lesions is examined in the progress of a transcontinental ultramarathon over 4486km. In an observational field study, repeated follow-up scanning of 22 participants of the TransEurope FootRace (TEFR) with a 1.5T MRI mounted on a mobile unit was performed. For quantitative biochemical and structural evaluation of cartilage a fast low angle shot (FLASH) T2* weighted gradient-echo (GRE)-, a turbo-inversion-recovery-magnitude (TIRM)- and a fat-saturated proton density (PD)-weighted sequence were utilized. Statistical analysis of cartilage T2* and thickness changes was obtained on the 13 finishers (12 male, mean age 45.4 years, BMI 23.5kg/m²). None of the nine non-finisher (eight male, mean age 53.8 years, BMI 23.4kg/m²) stopped the race due to ankle problems. From a mean of 17.0ms for tibial plafond and 18.0ms for talar dome articular cartilage at baseline, nearly all observed regions of interest (ROIs) of the ankle joint cartilage showed a significant T2*-signal increase (25.6% in mean), with standard error ranging from 19% to 33% within the first 2500km of the ultra-marathon. This initial signal behavior was followed by a signal decrease. This signal recovery (30.6% of initial increase) showed a large effect size. No significant morphological or cartilage thickness changes (at baseline 2.9mm) were observed. After initial T2*-increase during the first 2000-2500km, a subsequent T2*-decrease indicates the ability of the normal cartilage matrix to partially regenerate under ongoing multistage ultramarathon burden in the ankle joints.

Comparison of PD BLADE with fat saturation (FS), PD FS and T2 3D DESS with water excitation (WE) in detecting articular knee cartilage defects

The purpose of this study, is to compare the sequences: 1) proton density (PD) BLADE (BLADE is a PROPELLER-equivalent implementation of the Siemens Medical System) with fat saturation (FS) coronal (COR), 2) PD FS COR, 3) multi-planar reconstruction (MPR) with 3mm slice thickness and 4) multi-planar reconstruction (MPR) with 1.5mm slice thickness, both from the T2 3D-double-echo steady state (DESS) with water excitation (WE) sagittal (SAG), regarding their abilities to identify changes in the femorotibial condyle cartilage in knee MRI examinations. Thirty three consecutive patients with osteoarthritis (18 females, 15 males; mean age 56years, range 37–71years), who had been routinely scanned for knee examination using the previously mentioned image acquisition techniques, participated in the study. A quantitative analysis was performed based on the relative contrast (ReCON) measurements, which were taken both on normal tissues as well as on pathologies. Additionally, a qualitative analysis was performed by two radiologists. Motion and pulsatile flow artifacts were evaluated. The PD BLADE FS COR sequence produced images of higher contrast between Menisci and Cartilage, Fluid and Cartilage, Pathologies and Cartilage as well as of the Conspicuousness Superficial Cartilage and it was found to be superior to the other sequences (p<0.001). The sequences T2 3D DESS 1.5mm and T2 3D DESS 3mm were significantly superior to the PD BLADE FS COR and the PD FS COR sequences in the visualization of Bone and Cartilage and the Conspicuousness Deep Surface Cartilage. This pattern of results is also confirmed by the quantitative analysis. PD FS BLADE sequences are ideal for the depiction of the cartilage pathologies compared to the conventional PD FS and T2 3D DESS sequences.

Post-Operative Cyst Formation after Autologous Osteochondral Transplanation in the Talus: An MRI Evaluation (SS-45)

Post-Operative Cyst Formation after Autologous Osteochondral Transplanation in the Talus: An MRI Evaluation (SS-45)

SU‐E‐I‐71: Detection of Articular Knee Cartilage Defects Using PD BLADE with Fat Saturation (FS), PD FS and T2 3D DESS with Water Excitation (WE)

Purpose: The purpose of this study, is to compare the sequences: 1) proton density (PD) BLADE with fat saturation (FS) coronal (COR), 2) PD FS COR, 3) multi‐planar reconstruction (MPR) with 3mm slice thickness and 4) multi‐planar reconstruction (MPR) with 1.5mm slice thickness, both derived from the T2 3D‐double‐echo steady state (DESS) with water excitation (WE) sagittal (SAG) sequence, regarding their abilities to identify changes in the femorotibial condyle cartilage in knee MRI examinations. Methods: Thirty three consecutive patients with osteoarthritis (18 females, 15 males; mean age 56 years, range 37‐71 years), who had been routinely scanned for knee examination using the previously mentioned image acquisition techniques, participated in the study. A quantitative analysis was performed based on the relative contrast (ReCON) measurements, which were taken both on normal tissues as well as on pathologies. Additionally, a qualitative analysis was performed by two radiologists. Motion and pulsatile flow artifacts were evaluated. Results: The PD BLADE FS COR sequence produced images of higher contrast between Menisci and Cartilage, Fluid and Cartilage, Pathologies and Cartilage as well as of the Conspicuousness Superficial Cartilage and it was found to be superior to the other sequences (p&lt;0.001). The sequences T2 3D DESS 1.5mm and T2 3D DESS 3mm were significantly superior to the PD BLADE FS COR and the PD FS COR sequences in the visualization of Bone, Cartilage and the Conspicuousness Deep Surface Cartilage. This pattern of results is also confirmed by the quantitative analysis. Also, in the PD BLADE FS COR sequence, the results of the Truncation Artifact, Pulsation Artifact, Edge Sharpness and Blurring Artifacts, were superior to the other sequences (p&lt;0.001). Conclusion: PD FS BLADE sequences are ideal for the depiction of the cartilage pathologies compared to the conventional PD FS and T2 3D DESS sequences.

SU‐E‐I‐70: Use of Blade Sequences to Eliminate Motion and Pulsation Artifacts in Knee MR Imaging

Purpose: The purpose of this study is to evaluate the ability of Proton Density (PD)‐BLADE sequences in reducing or even eliminating motion and pulsatile flow artifacts in knee MRI examinations. Methods: Eighty consecutive patients, who had been routinely scanned for knee examination, participated in the study. The following pairs of sequences with and without BLADE were compared: a) PD Turbo Spin Echo (TSE) Sagittal (SAG) Fat Saturation (FS) in thirty five patients, b) PD TSE Coronal (COR) FS in nineteen patients, c) T2 TSE AXIAL in thirteen patients and d) PD TSE SAG in thirteen patients. Both qualitative and quantitative analyses were performed based on the signal‐to‐noise ratio (SNR), contrast‐to‐noise ratio (CNR), and relative contrast (ReCon) measures of normal anatomic structures. The qualitative analysis was performed by experienced radiologists. Also, the presence of image motion and pulsation artifacts was evaluated. Results: Based on the results of the SNR, CRN and ReCon for the different sequences and anatomical structures, the BLADE sequences were significantly superior in nineteen cases, whereas the corresponding conventional sequences were significantly superior in six only cases. The BLADE sequences eliminated motion artifacts in all the cases. However, motion artifacts were shown in: a) six PD TSE SAG FS, b) three PD TSE COR FS, c) three PD TSE SAG, and d) two T2 TSE AXIAL conventional sequences. In our results, it was found that in PD FS sequences (Sagittal and Coronal) the differences between the BLADE and conventional sequences regarding the elimination of motion and pulsatile flow artifacts were statistically significant. In all the comparisons, the PD FS BLADE sequences (coronal and sagittal) were significantly superior to the corresponding conventional sequences regarding the classification of their image quality. Conclusion: This technique appears to be capable to potentially eliminate motion and pulsatile flow artifacts in knee MR images.

Sub‐acute and chronic MRI findings in bilateral canine fibrotic contracture of the infraspinatus muscle

A six-year-old, 30-kg female German pointer dog was presented for examination with a history of pre-existing right-forelimb lameness and more recent (3 months) persistent lameness in the left-forelimb. Physical examination revealed mild left-forelimb lameness and a mild circumduction movement. There were no signs of pain or crepitation detected during manipulation of the shoulders, but the animal was unable to fully flex both glenohumeral joints. Magnetic resonance imaging, using fast recovery fast spin echo T2-weighted and fat saturated proton density sequences, revealed abnormal heterogeneous hypointensity in the right infraspinatus muscle and a heterogeneous hyperintense area in the left infraspinatus muscle. Surgical treatment consisting of a bilateral infraspinatus tenectomy resulted in improved limb function. Histopathological examination demonstrated tissue changes in the right infraspinatus, characterised by myofibre degeneration and fibrosis, compatible with a chronic degenerative process, while changes in the left infraspinatus muscle were characterised by variable degrees of fibre degeneration, haemorrhage and interstitial oedema.

Elimination of motion and pulsation artifacts using BLADE sequences in knee MR imaging

The purpose of this study is to evaluate the ability of proton density (PD)-BLADE sequences in reducing or even eliminating motion and pulsatile flow artifacts in knee magnetic resonance imaging examinations. Eighty consecutive patients, who had been routinely scanned for knee examination, participated in the study. The following pairs of sequences with and without BLADE were compared: (a) PD turbo spin echo (TSE) sagittal (SAG) fat saturation (FS) in 35 patients, (b) PD TSE coronal (COR) FS in 19 patients, (c) T2 TSE axial in 13 patients and (d) PD TSE SAG in 13 patients. Both qualitative and quantitative analyses were performed based on the signal-to-noise ratio (SNR), contrast-to-noise ratio (CNR) and relative contrast (ReCon) measures of normal anatomic structures. The qualitative analysis was performed by experienced radiologists. Also, the presence of image motion and pulsation artifacts was evaluated. Based on the results of the SNR, CRN and ReCon for the different sequences and anatomical structures, the BLADE sequences were significantly superior in 19 cases, whereas the corresponding conventional sequences were significantly superior in only 6 cases. BLADE sequences eliminated motion artifacts in all the cases. However, motion artifacts were shown in (a) six PD TSE SAG FS, (b) three PD TSE COR FS, (c) three PD TSE SAG and (d) two T2 TSE axial conventional sequences. In our results, it was found that, in PD FS sequences (sagittal and coronal), the differences between the BLADE and conventional sequences regarding the elimination of motion and pulsatile flow artifacts were statistically significant. In all the comparisons, the PD FS BLADE sequences (coronal and sagittal) were significantly superior to the corresponding conventional sequences regarding the classification of their image quality. In conclusion, this technique appears to be capable to potentially eliminate motion and pulsatile flow artifacts in MR images.

DIRECT MAGNETIC RESONANCE ARTHROGRAPHY OF THE CANINE SHOULDER

Our goal was to evaluate the ability of three magnetic resonance arthrography (MRA) techniques to improve visualization of soft tissue stabilizing components of the canine shoulder. The optimum concentration of gadolinium (gadodiamide) for MRA was determined by imaging seven individual shoulders with one of seven dilutions of 0.5 mol/l gadodiamide in saline; (1:100, 1:400, 1:800, 1:1000, 1:1200, 1:1400, and 1:1600). For this, sagittal and dorsal T1-weighted fat saturation (T1WFS) images were used. The 1:1200 dilution of gadolinium was determined to be the optimum concentration as it provided adequate contrast to distinguish supporting joint structures without obscuring the edges of those structures. Sagittal, dorsal, and transverse MRA images were then acquired in nine cadaver shoulders using T1WFS with gadolinium, proton density fat saturation (PDFS) with gadolinium, and PDFS with saline. Descriptive comparisons were made among techniques. When gadolinium was compared with saline as a contrast medium, gadolinium provided greater contrast against underlying soft tissues, thereby enhancing tendon and ligament conspicuity. When T1WFS and PDFS gadolinium sequences were compared, minor differences were noted. The interface between tissue and fluid was sharper and more distinct in PDFS images. MRI arthrography has promise as a tool for the diagnosis of canine soft tissue shoulder injury. MRA may be most useful when trauma to the biceps tendon, lateral glenohumeral ligament, or medial glenohumeral ligament is suspected.

Magnetic Resonance Imaging of the Canine Shoulder: An Anatomic Study

To describe the normal anatomy of the soft tissue stabilizing components of the canine shoulder identified by magnetic resonance imaging (MRI) and to evaluate specific acquisition sequences and planes for observing structures of diagnostic interest. Descriptive study. Canine cadavers (n=3). T1-weighted, proton density fat saturation (PD), and T2(*)-weighted gradient echo (GE) MRI sequences were obtained in the sagittal, transverse, and dorsal planes of the left shoulder of 3 canine cadavers. After imaging, each shoulder was embedded and thin sectioned. The corresponding right shoulder was frozen and thick sectioned. The anatomic structures on the histologic and frozen thick sections were visually correlated with the MR images. The sagittal plane provided a longitudinal view of the bicep, infraspinatus, and supraspinatus tendons. The biceps, supraspinatus, infraspinatus, and subscapularis tendons, and the medial and lateral glenohumeral ligaments were identified in the transverse and dorsal planes. The dorsal plane allowed for the bicep tendon to be evaluated transversely as it passed over the humeral head. The GE sequence was more useful in identifying tendons and ligaments. The PD sequence was more helpful in identifying fluid accumulations in the joint and around tendons. The tendinous and ligamentous structures that stabilize the canine shoulder joint can be readily identified with MRI. MRI has the potential to be a useful tool in the diagnosis of canine soft tissue shoulder injuries.

3.0 vs 1.5 T MRI in the detection of focal cartilage pathology – ROC analysis in an experimental model

To use receiver operator characteristics (ROC) analysis for assessing the diagnostic performance of three cartilage-specific MR sequences at 1.5 and 3 T in detecting cartilage lesions created in porcine knees. Eighty-four cartilage lesions were created in 27 porcine knee specimens at the patella, the medial and lateral femoral and the medial and lateral tibial cartilage. MR imaging was performed using a fat saturated spoiled gradient echo (SPGR) sequence (in plane spatial resolution/slice thickness: 0.20 x 0.39 mm2/1.5 mm) and two fat saturated proton density weighted (PDw) sequences (low spatial resolution: 0.31 x 0.47 mm2/3 mm and high spatial resolution: 0.20 x 0.26 mm2/2 mm). The images were independently analyzed by three radiologists concerning the absence or presence of lesions using a five-level confidence scale. Significances of the differences for the individual sequences were calculated based on comparisons of areas under ROC curves (A(Z)). The highest A(Z)-values for all three radiologists were consistently obtained for the SPGR (A(Z) = 0.84) and the high-resolution (hr) PDw (A(Z) = 0.79) sequences at 3T. The corresponding A(Z)-values at 1.5 T were 0.77 and 0.69; the differences between 1.5 and 3 T were statistically significant (P < 0.05). A(Z)-values for the low-resolution PDw sequence were lower: 0.59 at 3 T and 0.55 at 1.5 T and the differences between 1.5 and 3T were not significant. With optimized hr MR sequences diagnostic performance in detecting cartilage lesions was improved at 3 T. For a standard, lower spatial resolution PDw sequence no significant differences, however, were found.

Parsonage–Turner syndrome

Magnetic resonance imaging is a useful tool in the diagnosis of Parsonage–Turner syndrome. The acute–subacute findings of increased signal intensity primarily within the supraspinatus muscle on fat-saturated proton density and T2-weighted images are characteristic of the syndrome. Chronic findings include focal increased T1 signal within the involved musculature consistent with atrophy. The exclusion of other possible diagnoses such as a ganglion cyst at the level of the suprascapular notch causing compression of the suprascapular nerve or rotator cuff tears is also important in evaluating patients referred for assessment of shoulder weakness.

MR accuracy and arthroscopic incidence of meniscal radial tears.

A meniscal radial tear is a vertical tear that involves the inner meniscal margin. The tear is most frequent in the middle third of the lateral meniscus and may extend outward in any direction. We report (1) the arthroscopic incidence of radial tears, (2) MR signs that aid in the detection of radial tears and (3) our prospective accuracy in detection of radial tears. Three musculoskeletal radiologists prospectively read 200 consecutive MR examinations of the knee that went on to arthroscopy by one orthopedic surgeon. MR images were assessed for location and MR characteristics of radial tears. MR criteria used for diagnosis of a radial tear were those outlined by Tuckman et al.: truncation, abnormal morphology and/or lack of continuity or absence of the meniscus on one or more MR images. An additional criterion used was abnormal increased signal in that area on fat-saturated proton density or T2-weighted coronal and sagittal images. Prospective MR readings were correlated with the arthroscopic findings. Of the 200 consecutive knee arthroscopies, 28 patients had radial tears reported arthroscopically (14% incidence). MR readings prospectively demonstrated 19 of the 28 radial tears (68% sensitivity) when the criteria for diagnosis of a radial tear were truncation or abnormal morphology of the meniscus. With the use of the additional criterion of increased signal in the area of abnormal morphology on fat-saturated T2-weighted or proton density weighted sequences, the prospective sensitivity was 25 of 28 radial tears (89% sensitivity). There were no radial tears described in MR reports that were not demonstrated on arthroscopy (i.e., there were no false positive MR readings of radial tears in these 200 patients). Radial tears are commonly seen at arthroscopy. There was a 14% incidence in this series of 200 patients who underwent arthroscopy. Prospective detection of radial tears was 68% as compared with arthroscopy when the criteria as outlined by Tuckman et al. were used alone. With the use of the additional criterion of increased signal in the area of abnormal morphology on fat-saturated T2-weighted and proton density weighted sequences, the prospective sensitivity for radial tear detection as compared with arthroscopy was 89% in our series. Fat-saturated proton density and T2-weighted images greatly improve the detection of radial tears as signal intensity changes in radial tears as well as morphologic changes can be utilized for the detection of subtle tears.

MR imaging of biodegradable polylevolactide osteosynthesis devices in the ankle.

To assess the feasibility of magnetic resonance (MR) imaging in the postoperative follow-up after internal fracture fixation using biodegradable polylevolactide (PLLA) plugs and to investigate the MR characteristics of these devices. MR findings in ten patients with displaced malleolar fractures treated by internal fixation using absorbable PLLA plugs were evaluated after three different postoperative periods. The average postoperative follow-up time was thirty months for four patients, forty-two months for another four patients, and fifty-one months for the remaining two patients. On T1-weighted coronal images, the geometry of the PLLA plug was clearly visible in all cases, without signs of fatigue failure or absorption. The host-to-tissue area between the deployed two fins of the plug showed higher signal intensity than the surrounding cancellous bone on fat-saturated proton density (PD) and turbo inversion recovery (tIR) images. This area had signal intensity similar to articular cartilage on T1-weighted coronal images. In none of the cases could any fluid accumulation be seen around the plug. In all ten cases, a thin rim with signal intensity similar to the area between the deployed fins was detected around the PLLA plug on fat-saturated axial PD images. On fat-saturated T2 and tIR sequences, this rim was less clearly detectable in all cases. No differences in the signal intensity or geometry of the PLLA plug on the MR images emerged between the three patient groups with mean follow-ups of thirty, forty-two, and fifty-one months. No artifacts produced by the implants were seen on any of the MR images. A biopsy specimen obtained at a reoperation necessary seventeen months postoperatively showed no signs of degradation of the PLLA plug. MR imaging can visualize PLLA implants within bone. It also shows, without artifacts, the tissue interaction between the artificial biodegradable material and bone tissue in humans.