T2-weighted Fast Spin-echo Research Articles

Usefulness of the oblique view of three-dimensional isotropic T2-weighted fast spin-echo (VISTA) in the evaluation of anterior cruciate ligament reconstruction

BackgroundTo compare the diagnostic performance of the oblique sagittal and oblique coronal views of the anterior cruciate ligament (ACL) on three-dimensional (3D) volume isotropic turbo spin-echo acquisition (VISTA) images with two-dimensional (2D) fast spin-echo (FSE) T2-weighted images in the diagnosis of complications in ACL reconstruction. Materials and methodsThis retrospective study included 74 patients. Both sequences were independently interpreted by two radiologists. ResultThere were no statistically significant differences in the sensitivity, specificity, or accuracy between the two images. ConclusionThe diagnostic performance of the two oblique views on 3D VISTA imaging was comparable to that of 2D FSE.

Contrast-enhanced synthetic MRI for the detection of brain metastases.

BackgroundSynthetic magnetic resonance imaging (MRI), a technique that enables creation of various contrast-weighted images from a single MRI quantification scan, is a useful clinical tool. However, there are currently no reports examining the use of contrast-enhanced synthetic MRI for detecting brain metastases.PurposeTo assess whether contrast-enhanced synthetic MRI is suitable for detecting brain metastases.Material and MethodsTen patients with a combined total of 167 brain metastases who underwent quantitative MRI and conventional T1-weighted inversion recovery fast spin-echo (conventional T1IR) MRI before and after administration of a contrast agent were included in the study. Synthetic T1IR and T1-weighted (synthetic T1W) images were produced after parameter quantification. Lesion-to-white matter contrast and contrast-to-noise ratio were calculated for each image. The number of visible lesions in each image was determined by two neuroradiologists.ResultsThe mean lesion-to-white matter contrast and mean contrast-to-noise ratio of the synthetic T1IR images were significantly higher than those of the synthetic T1W (P < 0.001 and P < 0.001, respectively) and conventional T1IR (P = 0.04 and P = 0.002, respectively) images. Totals of 130 and 124 metastases were detected in the synthetic T1IR images by the first and second radiologists, respectively. The corresponding numbers were 91 and 85 in the synthetic T1W images and 119 and 119 in the conventional T1IR images. Statistical significance was not found among detected numbers of lesions.ConclusionSynthetic T1IR imaging created better contrast compared with synthetic T1W or conventional T1IR imaging. The ability to detect brain metastases was comparable among these imaging.

Renal ablation using magnetic resonance-guided high intensity focused ultrasound: Magnetic resonance imaging and histopathology assessment.

To use magnetic resonance-guided high intensity focused ultrasound (MRg-HIFU), magnetic resonance imaging (MRI) and histopathology for noninvasively ablating, quantifying and characterizing ablated renal tissue. Six anesthetized/mechanically-ventilated pigs underwent single/double renal sonication (n = 24) using a 3T-MRg-HIFU (1.1 MHz frequency and 3000J-4400J energies). T2-weighted fast spin echo (T2-W), perfusion saturation recovery gradient echo and contrast enhanced (CE) T1-weighted (T1-W) sequences were used for treatment planning, temperature monitoring, lesion visualization, characterization and quantification, respectively. Histopathology was conducted in excised kidneys to quantify and characterize cellular and vascular changes. Paired Student's t-test was used and a P-value < 0.05 was considered statistically significant. Ablated renal parenchyma could not be differentiated from normal parenchyma on T2-W or non-CE T1-W sequences. Ablated renal lesions were visible as hypoenhanced regions on perfusion and CE T1-W MRI sequences, suggesting perfusion deficits and necrosis. Volumes of ablated parenchyma on CE T1-W images in vivo (0.12-0.36 cm(3) for single sonication 3000J, 0.50-0.84 cm(3), for double 3000J, 0.75-0.78 cm(3) for single 4400J and 0.12-2.65 cm(3) for double 4400J) and at postmortem (0.23-0.52 cm(3), 0.25-0.82 cm(3), 0.45-0.68 cm(3) and 0.29-1.80 cm(3), respectively) were comparable. The ablated volumes on 3000J and 4400J double sonication were significantly larger than single (P < 0.01), thus, the volume and depth of ablated tissue depends on the applied energy and number of sonication. Macroscopic and microscopic examinations confirmed the locations and presence of coagulation necrosis, vascular damage and interstitial hemorrhage, respectively. Contrast enhanced MRI provides assessment of MRg-HIFU renal ablation. Histopathology demonstrated coagulation necrosis, vascular damage and confirmed the volume of damage seen on MRI.

Low-field magnetic resonance imaging of penetrating hoof injuries in 10horses

The aim of the present study was to verify the diagnostic validity of low-field magnetic-resonance-imaging (MRI) findings in septic diseases of the foot region following penetrating sole injuries caused by nails. MRI examinations were performed in 10 horses with injuries in the foot region. The diagnostic findings were validated by conventional methods (clinical, surgical, radiological, sonographic, and computed tomographic findings and/or post-mortem histological examination). Navicular bone involvement was revealed most accurately, with a high degree of predictability, and was best detected by fat-suppressed T2 or short-TI inversion recovery (STIR) sequences. MRI examinations of defects in the deep digital flexor tendon showed a high level of sensitivity, but these findings were less specific than changes to the navicular bone. They could be best reproduced in transverse T2-weighted fast spin echo sequences (T2w FSE). The penetration tract was recognisable in all cases and in all planes, and the T2w FSE proved to be very suitable for diagnosis. Septic bursitis was revealed least accurately by MRI. Bursal disease was best recognised in the sagittal plane. MRI is a reliable method for confirming the diagnosis of diseases in the foot region after injuries caused by foreign bodies, particularly nails. A transverse T2w FSE is best suited for demonstrating a penetration tract and tendon damage. Visualisation of the penetration tract and secondary reactions of the navicular bone are crucial for diagnosing bursitis. Fat-suppressed sequences can clearly show bone involvement when the penetration tract has not reached the bone. The cases described illustrate that MRI is an appropriate method for evaluating puncture wounds in the foot region. Only MRI allows for intravital assessment of various structures within the hoof capsule. This information is essential for deciding upon targeted therapy while avoiding unnecessary therapies.

The Role of Magnetic Resonance Cholangiopancreatography in Diagnosis of Hepatobiliary Lesions

IntroductionMagnetic resonance cholangiopancreatography (MRCP) has achieved widespread success as a diagnostic tool for hepatobiliary lesions. MRCP offers an effective method of hepatobiliary diagnosis that is safer than the use of invasive procedures, namely endoscopic retrograde cholangiopancreatography, and is more accurate than ultrasound. AimThe aim of the study was to assess the diagnostic quality and overall accuracy of MRCP for the evaluation of hepatobiliary lesions. Patients and MethodsEighty patients (42 male, 38 female; mean age, 38.3 years) suspected for hepatobiliary lesions were enrolled in this study. MRCP protocols applied for imaging of the hepatobiliary system were T2-weighted fast spin echo sequence on axial and coronal planes; three-dimensional, fat suppressed, heavily T2-weighted fast spin echo sequence with multislab acquisition mode; two-dimensional thick single slab projectional images, and three-dimensional reconstruction algorithms. ResultsAmong the patients, jaundice and biliary colic were the commonest clinical complaints. MRCP has detected different pathologic entities among congenital anomalies, inflammatory conditions, neoplastic disorders, and postoperative and post-traumatic complications. The MRCP diagnosis was compared with the final diagnosis reached by endoscopic retrograde cholangiopancreatography, surgical, or histopathologic data. MRCP has a high overall diagnostic accuracy of 97%, sensitivity of 98%, and specificity of 93%. ConclusionsMRCP provides a safe, noninvasive, accurate diagnostic tool in detection of the presence and level of biliary obstruction and also denotes its cause with high accuracy.

Comparison of high-resolution T1W 3D GRE (LAVA) with 2-point Dixon fat/water separation (FLEX) to T1W fast spin echo (FSE) in prostate cancer (PCa)

PurposeTo compare T1-weighted (T1W) fast spin echo (FSE) to T1W 3-dimensional gradient recalled echo (LAVA) with fat water separation (FLEX) in prostate cancer (PCa). MethodologyWith institutional review board waiver, 39 patients underwent 3-T magnetic resonance imaging including T1W LAVA FLEX (157s)/T1W FSE (316s). Two radiologists assessed (a) image quality/sharpness, (b) presence/severity of artifacts, and (c) skeletal (N=22)/nodal (N=9) metastases. Results were compared using Wilcoxon signed-rank test/receiver operator characteristic analysis. ResultsWith T1W LAVA FLEX, image quality/sharpness improved (P<.001) with less motion (P=.002–.03) and no difference in phase-encoding artifact (P>.05). One patient had moderate fat/water swap.Detection of skeletal metastases was unchanged (P>.05) and nodal metastases either improved (P=.002) or were comparable (P=.16) using T1W LAVA FLEX. ConclusionT1W LAVA FLEX improves image quality, lessens motion artifact, and is comparable or improves detection of metastases in PCa with reduction in acquisition time.

Three-dimensional isotropic fast spin-echo MR lymphangiography of T1-weighted and intermediate-weighted pulse sequences in patients with lymphoedema

To evaluate the feasibility of magnetic resonance (MR) lymphangiography acquired using three-dimensional (3D) isotropic T1-weighted fast spin-echo (FSE) and 3D isotropic intermediate-weighted FSE sequences, as the new method of MR lymphangiography, and to compare the results of these two methods in patients with lymphoedema. Thirty-three extremities of 27 patients with primary or secondary lymphoedema and who had undergone radionuclide lymphoscintigraphy and MR lymphangiography with 3D isotropic T1-weighted FSE and 3D isotropic intermediate-weighted FSE were included in the study. The results of both imaging techniques were independently reviewed by two readers in consensus who rated the lymphatic drainage pattern, the quality of the depiction of lymphatic vessels and lymph nodes, and the level of lymph vessel enhancement. The assessment scores of each imaging sequence were compared using the Wilcoxon signed-rank test. The results were expressed as means with standard deviations. More lymphatic vessels were visualised on T1-weighted FSE than on intermediate-weighted FSE (p<0.001). As more lymphatic vessels were detected on T1-weighted FSE, the per-extremity grade of the lymphatic drainage pattern was higher (p=0.046) and the visible levels of lymph-vessel enhancement were also significantly higher (p=0.004) on the T1-weighted FSE sequence, whereas the conspicuity of lymph nodes was superior on intermediate-weighted FSE (p=0.004). MR lymphangiography using the 3D FSE pulse sequence is a feasible and noticeable new technique of MR lymphangiography. Between the two applicable protocols used, T1-weighted FSE provided better information regarding lymphatic vessels and their drainage, whereas intermediate-weighted FSE has the advantage of depicting lymph nodes in lymphoedematous extremities.

Correlation between conductivity and prognostic factors in invasive breast cancer using magnetic resonance electric properties tomography (MREPT).

To investigate the correlation between conductivity and prognostic factors of invasive breast cancer using magnetic resonance electric properties tomography (MREPT). This retrospective study was approved by the Institutional Review Board, and verbal informed consent was obtained prior to breast MRI. This study included 65 women with surgically confirmed invasive breast cancers measuring 1cm or larger on T2-weighted fast spin echo (FSE). Phase-based MREPT and the coil combination technique were used to reconstruct conductivity. Simple and multiple linear regression analysis were used to find an independent factor associated with conductivity. In total tumours, tumours with HER-2 overexpression showed lower conductivity than those without, and HER-2 overexpression was independently associated with conductivity. In 37 tumours 2cm or larger, tumours with high mitosis or PR positivity showed higher conductivity than those without, and high mitosis and PR positivity were independently associated with conductivity. In 28 tumours 1-2cm in size, there were no differences in conductivity according to the prognostic factors. Conductivity values measured using MREPT are associated with the HER-2 overexpression status, and may provide information about mitosis and the PR status of invasive breast cancers 2cm or larger. • In all tumours, HER-2 overexpression was independently associated with conductivity. • In tumours ≥ 2cm, high mitosis and PR positivity were associated with conductivity. • Conductivity is associated with the HER-2 overexpression status of invasive breast cancers.

High-Resolution 3-T Endorectal Prostate MRI: A Multireader Study of Radiologist Preference and Perceived Interpretive Quality of 2D and 3D T2-Weighted Fast Spin-Echo MR Images.

The goal of this study was to compare the perceived quality of 3-T axial T2-weighted high-resolution 2D and high-resolution 3D fast spin-echo (FSE) endorectal MR images of the prostate. Six radiologists independently reviewed paired 3-T axial T2-weighted high-resolution 2D and 3D FSE endorectal MR images of the prostates of 85 men in two sessions. In the first session (n = 85), each reader selected his or her preferred images; in the second session (n = 28), they determined their confidence in tumor identification and compared the depiction of the prostatic anatomy, tumor conspicuity, and subjective intrinsic image quality of images. A meta-analysis using a random-effects model, logistic regression, and the paired Wilcoxon rank-sum test were used for statistical analyses. Three readers preferred the 2D acquisition (67-89%), and the other three preferred the 3D images (70-80%). The option for one of the techniques was not associated with any of the predictor variables. The 2D FSE images were significantly sharper than 3D FSE (p < 0.001) and significantly more likely to exhibit other (nonmotion) artifacts (p = 0.002). No other statistically significant differences were found. Our results suggest that there are strong individual preferences for the 2D or 3D FSE MR images, but there was a wide variability among radiologists. There were differences in image quality (image sharpness and presence of artifacts not related to motion) but not in the sequences' ability to delineate the glandular anatomy and depict a cancerous tumor.

Proton Density MRI Increases Detection of Cervical Spinal Cord Multiple Sclerosis Lesions Compared with T2-Weighted Fast Spin-Echo.

There is a paucity of literature that supports the Consortium of Multiple Sclerosis Centers guideline that proton density MR imaging is a core spinal cord sequence. We hypothesized that proton density fast spin-echo imaging is superior to T2 fast spin-echo MR imaging for the detection of cervical cord MS lesions. This study compared the detection rate and conspicuity of cervical cord MS lesions on sagittal 1.5T proton density fast spin-echo and T2 fast spin-echo MR imaging. One hundred consecutive patients with MS imaged with 1.5T sagittal proton density fast spin-echo and T2 fast spin-echo cervical cord MR imaging between September 2012 and October 2013 were retrospectively included. The number of MS lesions detected on each sequence was recorded; conspicuity was assessed quantitatively with the lesion-to-cord contrast ratio and lesion-contrast-to-noise ratio. Statistical analysis was performed by using the Wilcoxon signed rank test. Seventy-eight patients had MS cord lesions detected. Proton density fast spin-echo imaging detected a greater number of lesions (n = 181) compared with T2 fast spin-echo imaging (n = 137, P < .001). Fifteen patients (19%) with abnormal findings on proton density fast spin-echo imaging had normal findings on T2 fast spin-echo imaging; no patient with abnormal T2 fast spin-echo imaging findings had normal proton density fast spin-echo imaging findings. Although proton density fast spin-echo and T2 fast spin-echo imaging had similar lesion-to-cord contrast ratios (proton density fast spin-echo, 0.32 ± 0.01, versus T2 fast spin-echo, 0.33 ± 0.01; P = .43), proton density fast spin-echo had greater lesion-contrast-to-noise ratio (proton density fast spin-echo, 82 ± 3.0, versus T2 fast spin-echo, 64 ± 2.6; P < .001). Proton density fast spin-echo imaging is superior to T2 fast spin-echo MR imaging for the detection of cervical cord MS lesions. Proton density fast spin-echo detects cord lesions in patients in whom T2 fast spin-echo findings appear normal. This study forms the evidentiary base for the current Consortium of Multiple Sclerosis Centers guideline that proton density imaging is a core spinal cord sequence.

T2 black lesions on routine knee MRI: differential considerations.

The majority of abnormal findings or lesions on T2-weighted fast spin-echo (FSE) magnetic resonance imaging (MRI) are hyperintense due to increased perfusion or fluid content, such as infections, tumours or synovitis. Hypointense lesions on T2-weighted images (both fat-suppressed and non-fat-suppressed) are less common and can sometimes be overlooked. Such lesions have limited differential diagnostic possibilities, and include vacuum phenomenon, loose body, tenosynovial giant cell tumour, rheumatoid arthritis, haemochromatosis, gout, amyloid, chondrocalcinosis, hydroxyapetite deposition disease, lipoma arborescens, arthrofibrosis and iatrogenic lesions. These lesions often show characteristic appearances and predilections in the knee. In this article, the authors describe the MRI features of hypointense T2 lesions on routine knee MRI and outline a systematic diagnostic approach towards their evaluation. Key Points • Hypointense lesions on T2 images (T2 Dark Lesions) encompass limited diagnostic possibilities. • T2 Dark lesions often show characteristic appearances and predilections in the knee. • A systematic diagnostic approach will help radiologists make the correct diagnosis.

Association Between Infrapatellar Fat Pad Volume and Knee Structural Changes in Patients with Knee Osteoarthritis.

The function of the infrapatellar fat pad (IPFP) in knee osteoarthritis (OA) remains uncertain. This study aimed to examine cross-sectional associations between IPFP volume and knee structures in patients with knee OA. The study included 174 patients with clinical knee OA (mean age, 55.5 yrs). Fat-suppressed 3-D T1-weighted spoiled gradient recall magnetic resonance imaging (MRI) was used to measure the IPFP and cartilage volume. T2-weighted fast spin echo MRI was used to assess cartilage defects and bone marrow lesions (BML). Radiographic knee osteophytes and joint space narrowing (JSN) were assessed using the Osteoarthritis Research Society International atlas. After adjustment for potential confounders, greater IPFP volume was associated with greater tibial and patellar cartilage volume (all p < 0.05), and fewer cartilage defects at all sites (OR 0.88-0.91, all p < 0.05). IPFP volume was associated with presence of BML at lateral tibial and medial femoral sites (OR 0.88-0.91, all p < 0.05) and osteophytes at lateral tibiofemoral compartment (OR 0.88, p < 0.05). IPFP volume was not significantly associated with JSN. Greater IPFP volume was associated with greater knee cartilage volume and fewer structural abnormalities, suggesting a protective role of IPFP size in knee OA.

Relaxation enhanced compressed sensing three-dimensional black-blood vessel wall MR imaging: Preliminary studies

ObjectiveIn this study, we sought to investigate the feasibility of a new technique termed relaxation enhanced compressed sensing three-dimensional motion-sensitizing driven equilibrium prepared 3D rapid gradient echo sequence (RECS-3D MERGE). Materials and methodsThe RECS-3D MERGE sequence consisted of a 3D MERGE sequence for imaging, a period of delay time (TD) for relaxation enhancement, and a pseudo-centric phase encoding order used for under-sampling acquisition to maintain scan efficiency. Seven healthy volunteers and six patients with 40% to 75% carotid artery stenosis were recruited in this study. Healthy subjects underwent 3D MERGE, RECS-3D MERGE and two-dimensional (2D) T1-weighted double inversion recovery fast spin echo (T1W DIR-FSE) scans. The signal ratio (SR) values of 21 RECS-3D MERGE scans were compared in order to determine the optimal scan parameter set of acceleration factor (AF) and delay time (TD) for RECS-3D MERGE sequence. Patients then underwent 3D MERGE, RECS-3D MERGE using the aforementioned optimal scan parameter set and 2D T1W DIR-FSE scans. Two radiologists, blinded to the imaging technique, qualitatively graded each image on a six-point ordinal scale. ResultsThe highest value of SR occurred with the scan parameter set of 3-fold AF and 800ms TD. Compared to 3D MERGE, RECS-3D MERGE with the parameter set significantly improved the image quality for both healthy subjects and patients experiments, while the scan efficiency was not sacrificed. And no significant differences were observed in the subjective scores of RECS-3D MERGE and 2D T1W DIR-FSE image qualities. ConclusionRECS-3D MERGE technique achieved significant improvement in black-blood image quality compared with 3D MERGE. And the image quality of this 3D rapid carotid black-blood imaging technique is comparable to 2D T1W DIR-FSE while it has much higher scan efficiency.

3D anatomy and deformation of the seated buttocks

AimTo describe the 3D anatomy and deformation of the buttocks during sitting. Materials and methodsThe buttocks of 4 able-bodied individuals and 3 individuals with spinal cord injury were scanned sitting in a FONAR Upright MRI. T1-weighted Fast Spin Echo scans were collected with the individuals seated on a custom wheelchair cushion to unload the ischial tuberosities (ITs) and seated on a 3 inch foam cushion. Multi-planar scans were analyzed, and the muscle, bone and adipose tissue was manually segmented for 3D rendering and analysis of the quantity, geometry, and location of tissues. ResultsThe gluteus maximus was positioned lateral and posterior to the IT, covering the inferior portion of the IT for only 2 able-bodied participants. Adipose thickness directly under the IT did not differ by diagnosis, nor did it have a consistent response to loading. However, the envelopment of the IT by the surrounding adipose tissue was much greater in two of the participants with spinal cord injuries. These two subjects also had the most curved skin surface as the tissue wrapped around the IT. Tissue strains around the ischium were most visible in the adipose and connective tissue. The gluteus maximus displaced and distorted upwards, posterior and lateral, away from the inferior IT. ConclusionsMulti-planar imaging is necessary to investigate anatomy and deformation of the buttocks. 5 out of 7 participants did not sit directly on muscle. The tissue beneath their ITs was predominantly composed of fat and connective tissue, suggesting that these tissues might be most vulnerable to injury.

MR T1ρ and T2 of meniscus six months and one year after acute anterior cruciate ligament injury

s / Osteoarthritis and Cartilage 23 (2015) A82eA416 A223 354 MR T1r AND T2 OF MENISCUS SIX MONTHS AND ONE YEAR AFTER ACUTE ANTERIOR CRUCIATE LIGAMENT INJURY A. Wang, F. Su, V. Pedoia, M. Kretzschmar, L. Nardo, T.M. Link, C.B. Ma, X. Li. Univ. of California, San Francisco, San Francisco, CA, USA Purpose: Acute anterior cruciate ligament (ACL) injury, a high-risk factor for post-traumatic osteoarthritis, is often concomitant with meniscal lesions and tears. In our previous cross-sectional study, we found that acute ACL injuries were associated with significantly elevated meniscal T1r and T2 values compared to healthy knees, even in menisci without morphological signs of damage. The goal of this longitudinal study was to evaluate intermediate-term changes in meniscal T1r and T2 quantification in ACL-injured patients six months and one year after ACL reconstruction and to compare these changes to baseline results. Methods: Using a 3T MR scanner, a closed cohort of 39 patients (age 1⁄4 29.4 ± 7.5 years; 16 females) with acute ACL injuries was scanned at an average of 8.4 ± 6.4 weeks post-injury and prior to ACL reconstruction. After ACL reconstruction, follow-up scans of ACL-injured knees were completed at six months and one year after baseline scan. Subjects were categorized by no lateral meniscectomy (n 1⁄4 32) and partial lateral meniscectomy (n 1⁄4 7). Effects of medial meniscectomy were not evaluated due to small sample size (n 1⁄4 2). Imaging protocol included sagittal T2-weighted 3D fast spin-echo (CUBE) images [repetition time (TR)/echo time (TE) 1⁄4 1500/25 ms, field of view (FOV)1⁄4 16 cm, matrix1⁄4 384 x 384, slice thickness1⁄4 1mm, echo train length 1⁄4 50, bandwidth 1⁄4 50 kHz, number of excitations 1⁄4 0.5] and sagittal 3D T1r and T2 quantification sequences [TR/TE 1⁄4 9 ms/min full, FOV1⁄4 14 cm, matrix1⁄4 256 x 128, slice thickness1⁄4 4mm, Views Per Segment 1⁄4 64, time of recovery 1⁄4 1.2 s, spin-lock frequency 1⁄4 500 Hz, ARC phase AF1⁄4 2. TSL1⁄4 0/10/40/80 ms for T1r, and preparation TE1⁄4 0/ 13.7/27.3/54.7 ms for T2]. Menisci were segmented using CUBE images into four sub-compartments: anterior horn of the lateral/medial meniscus (AHLAT/AHMED) and the posterior horn of the lateral/medial meniscus (PHLAT/PHMED). These regions of interest (ROI) were overlaid onto T1r and T2 maps, andmean T1r and T2 values were calculated for each ROI. Paired t-tests were performed when comparing the same cohort at different time points, and unpaired t-tests were performed when comparing patients who had a partial meniscectomy and patients who did not have a meniscectomy. An alpha of less than 0.05 was considered significant. Results: In ACL-injured knees without meniscectomy, T1r values increased significantly from baseline to six months in the AHLAT, AHMED, and PHMED (all p r > -0.46; p r > -0.30; p<0.005). Intraclass correlation coefficients ranged between 0.95-1.00 for the DCE-MRI variables and 0.80-1.00 for the static MRI variables. Conclusions: The results confirm an association between pain and synovitis assessed on both DCEand CE-MRI in obese patients with knee OA. The whole-knee synovitis score on CE-MRI and most of the DCE-MRI variables were also significantly associated with the remaining KOOS items. DCE-MRI analyses were robust and highly reproducible and have the potential to be used to further investigate the role of inflammation and perfusion in knee OA, in a similar way it has been used in inflammatory joint diseases.

Noncontrast Magnetic Resonance Lymphography.

Different imaging techniques have been used for the investigation of the lymphatic channels and lymph glands. Noncontrast magnetic resonance (MR) lymphography has significant advantages in comparison with other imaging modalities. Noncontrast MR lymphography uses very heavily T2-weighted fast spin echo sequences which obtain a nearly complete signal loss in tissue background and specific display of lymphatic vessels with a long T2 relaxation time. The raw data can be processed with different algorithms such as maximum intensity projection algorithm to obtain an anatomic representation. Standard T2-weighted MR images easily demonstrate the location of edema. It appears as subcutaneous infiltration of soft tissue with a classical honeycomb pattern. True collection around the muscular area may be demonstrated in case of severe lymphedema. Lymph nodes may be normal in size, number, and signal intensity; in other cases, lymph nodes may be smaller in size or number of lymph nodes may be restricted. MR lymphography allows a classification of lymphedema in aplasia (no collecting vessels demonstrated); hypoplasia (a small number of lymphatic vessels), and numerical hyperplasia or hyperplasia (with an increased number of lymphatic vessels of greater and abnormal diameter). Noncontrast MR lymphography is a unique noninvasive imaging modality for the diagnosis of lymphedema. It can be used for positive diagnosis, differential diagnosis, and specific evaluation of lymphedema severity. It may also be used for follow-up evaluation after treatment.

Diagnostic Per-Patient Accuracy of an Abbreviated Hepatobiliary Phase Gadoxetic Acid–Enhanced MRI for Hepatocellular Carcinoma Surveillance

OBJECTIVE. The purpose of this study is to evaluate the per-patient diagnostic performance of an abbreviated gadoxetic acid-enhanced MRI protocol for hepatocellular carcinoma (HCC) surveillance. MATERIALS AND METHODS. A retrospective review identified 298 consecutive patients at risk for HCC enrolled in a gadoxetic acid-enhanced MRI-based HCC surveillance program. For each patient, the first gadoxetic acid-enhanced MRI was analyzed. To simulate an abbreviated protocol, two readers independently read two image sets per patient: set 1 consisted of T1-weighted 20-minute hepatobiliary phase and T2-weighted single-shot fast spin-echo (SSFSE) images; set 2 included diffusion-weighted imaging (DWI) and images from set 1. Image sets were scored as positive or negative according to the presence of at least one nodule 10 mm or larger that met the predetermined criteria. Agreement was assessed using Cohen kappa statistics. A composite reference standard was used to determine the diagnostic performance of each image set for each reader. RESULTS. Interreader agreement was substantial for both image sets (κ = 0.72 for both) and intrareader agreement was excellent (κ = 0.97-0.99). Reader performance for image set 1 was sensitivity of 85.7% for reader A and 79.6% for reader B, specificity of 91.2% for reader A and 95.2% for reader B, and negative predictive value of 97.0% for reader A and 96.0% for reader B. Reader performance for image set 2 was nearly identical, with only one of 298 examinations scored differently on image set 2 compared with set 1. CONCLUSION. An abbreviated MRI protocol consisting of T2-weighted SSFSE and gadoxetic acid-enhanced hepatobiliary phase has high negative predictive value and may be an acceptable method for HCC surveillance. The inclusion of a DWI sequence did not significantly alter the diagnostic performance of the abbreviated protocol.

Association of patellar bone marrow lesions with knee pain, patellar cartilage defect and patellar cartilage volume loss in older adults: a cohort study

To examine the cross-sectional and longitudinal associations of patellar bone marrow lesion (BMLs) with knee pain, cartilage defects and cartilage volume in older adults. A total of 904 randomly selected subjects (mean 62.4 years, 49.9% female) were studied. Fat suppressed T1-weighted spoiled gradient recall and T2-weighted fast spin echo magnetic resonance imaging (MRI) sequences were used to assess cartilage volume, cartilage defects and/or BMLs at baseline (n = 904) and 2.6 (range: 1.4-4.8) years' follow-up (n = 414). Knee pain was assessed by self-administered Western Ontario McMaster Osteoarthritis Index (WOMAC) questionnaire at baseline (n = 904) and follow-up (n = 790). The prevalence of any patellar BMLs was 19% and was higher in those with tibiofemoral BMLs. In multivariable analyses, patellar BMLs were positively associated with any knee pain at baseline and an increase in knee pain when going up/down stairs (odds ratio (OR): 1.67, 95% confidence interval (CI): 1.08, 2.59) but not with other knee pain subscales. Patella BMLs were also associated with patellar cartilage defects both at baseline and change over time (OR: 1.76, 95% CI: 1.00, 3.70) but not tibiofemoral defects. Patellar BMLs were negatively associated with baseline and change in patella cartilage volume (β: -2.10%, 95% CI: -3.39%, -0.80%). These associations remained significant after further adjustment for tibiofemoral BMLs. Patellar BMLs were consistently associated with increased knee pain especially going up/down stairs, increased patellar cartilage defects, and decreased patellar cartilage volume cross-sectionally and longitudinally, suggesting a predominantly compartment specific role for patellar BMLs.

Bone bruises in anterior cruciate ligament injured knee and long-term outcomes. A review of the evidence.

BackgroundBone bruises are frequently associated with anterior cruciate ligament (ACL) tears as a result of trauma or direct shear stress of the bone.PurposeTo review the evidence regarding the characteristics of the bone bruise associated with ACL tears, its relevance on clinical outcomes, and its progression over time. In particular, the long-term effects of the bone bruise on the knee osteochondral architecture and joint function were evaluated.Study designReview; level of evidence: 4.MethodsAn electronic search was performed on PubMed. Combinations of keywords included: “bone bruise AND knee”; “bone bruise AND anterior cruciate ligament”; “bone bruise AND osteo-chondral defects”. Any level of evidence studies concerning bone bruises in patients with partial or complete ACL tears were retrieved.ResultsA total of 25 studies were included; three of them investigated biomechanical parameters, seven were concerned with clinical outcomes, and 15 were radiological studies. Evaluation of the bone bruise is best performed using a fat-saturated T2-weighted fast spin echo exam or a short tau inversion recovery sequence where fat saturation is challenging. The location of the injury has been demonstrated to be more frequent in the lateral compartment of the joint (lateral femoral condyle and lateral tibial plateau). It is associated with ACL tears in approximately 70% of cases, often with collateral ligament or meniscal tears. Mid- and long-term outcomes demonstrated a complete healing of the marrow lesions at magnetic resonance imaging, but chondral defects detected with T1ρ sequences are still present 1 year after the ACL injury. Functional examination of the knee, through clinical International Knee Documentation Committee scores, did not show any correlation with the bone bruise.ConclusionAlthough bone bruise presence yields to higher pain levels, no correlation with functional outcomes was reported. Most studies have a short-term follow-up (<2 years) compared to the length of time it takes to develop post-traumatic osteoarthritis, so it still remains unclear whether the initial joint injury and bone bruise have a direct relationship to long-term function.

Four dimensional magnetic resonance imaging with retrospective k-space reordering: a feasibility study.

Current four dimensional magnetic resonance imaging (4D-MRI) techniques lack sufficient temporal/spatial resolution and consistent tumor contrast. To overcome these limitations, this study presents the development and initial evaluation of a new strategy for 4D-MRI which is based on retrospective k-space reordering. We simulated a k-space reordered 4D-MRI on a 4D digital extended cardiac-torso (XCAT) human phantom. A 2D echo planar imaging MRI sequence [frame rate (F) = 0.448 Hz; image resolution (R) = 256 × 256; number of k-space segments (NKS) = 4] with sequential image acquisition mode was assumed for the simulation. Image quality of the simulated "4D-MRI" acquired from the XCAT phantom was qualitatively evaluated, and tumor motion trajectories were compared to input signals. In particular, mean absolute amplitude differences (D) and cross correlation coefficients (CC) were calculated. Furthermore, to evaluate the data sufficient condition for the new 4D-MRI technique, a comprehensive simulation study was performed using 30 cancer patients' respiratory profiles to study the relationships between data completeness (Cp) and a number of impacting factors: the number of repeated scans (NR), number of slices (NS), number of respiratory phase bins (NP), NKS, F, R, and initial respiratory phase at image acquisition (P0). As a proof-of-concept, we implemented the proposed k-space reordering 4D-MRI technique on a T2-weighted fast spin echo MR sequence and tested it on a healthy volunteer. The simulated 4D-MRI acquired from the XCAT phantom matched closely to the original XCAT images. Tumor motion trajectories measured from the simulated 4D-MRI matched well with input signals (D = 0.83 and 0.83 mm, and CC = 0.998 and 0.992 in superior-inferior and anterior-posterior directions, respectively). The relationship between Cp and NR was found best represented by an exponential function (CP=1001-e(-0.18NR) , when NS = 30, NP = 6). At a CP value of 95%, the relative error in tumor volume was 0.66%, indicating that NR at a CP value of 95% (NR,95%) is sufficient. It was found that NR,95% is approximately linearly proportional to NP (r = 0.99), and nearly independent of all other factors. The 4D-MRI images of the healthy volunteer clearly demonstrated respiratory motion in the diaphragm region with minimal motion induced noise or aliasing. It is feasible to generate respiratory correlated 4D-MRI by retrospectively reordering k-space based on respiratory phase. This new technology may lead to the next generation 4D-MRI with high spatiotemporal resolution and optimal tumor contrast, holding great promises to improve the motion management in radiotherapy of mobile cancers.