Faculty Bibliography

OBJECTIVE: To assess the relationship between knee alignment and subregional T1rho values of the femorotibial cartilage and menisci in patients with mild (Kellgren-Lawrence grade 1) to moderate (KL3) osteoarthritis (OA) at 3T. MATERIALS AND METHODS: 26 subjects with a clinical diagnosis of KL1-3 OA were included and subdivided into three subgroups: varus, valgus, and neutral. All subjects were evaluated on a 3T MR scanner. Mann-Whitney and Wilcoxon signed rank tests were performed to determine any statistically significant differences in subregional T1rho values of femorotibial cartilage and menisci among the three subgroups of KL1-3 OA patients. RESULTS: Medial femoral anterior cartilage subregion in varus group had significantly higher (p<0.05) T1rho values than all cartilage subregions in valgus group. Medial tibial central cartilage subregion had significantly higher T1rho values (p<0.05) than lateral tibial central cartilage subregion in varus group. The posterior horn of the medial meniscus in neutral group had significantly higher T1rho values (p<0.0029) than all meniscus subregions in valgus group. CONCLUSION: There exists some degree of association between knee alignment and subregional T1rho values of femorotibial cartilage and menisci in patients with clinical OA.

Phosphorus ((31) P) magnetization transfer (MT) techniques enable the non-invasive measurement of metabolic turnover rates of important enzyme-catalyzed reactions, such as the creatine kinase reaction (CK), a major transducing reaction involving adenosine triphosphate and phosphocreatine. Alteration in the kinetics of the CK reaction rate appears to play a central role in many disease states. In this study, we developed and implemented at ultra-high field (7T) a novel three-dimensional (31) P-MT imaging sequence that maps the kinetics of CK in the entire volume of the lower leg at relatively high resolution (0.52 mL voxel size), and within acquisition times that can be tolerated by patients (below 60 min). We tested the sequence on five healthy and two clinically diagnosed type 2 diabetic subjects. Overall, we obtained measurements that are in close agreement with measurements reported previously using spectroscopic methods. Importantly, our spatially resolved method allowed us to measure local CK reaction rate constants and metabolic fluxes in individual muscles in a non-invasive manner. Furthermore, it allowed us to detect variations of the CK rates of different muscles, which would not have been possible using unlocalized MRS methods. The results of this work suggest that 3D mapping of the CK reaction rates and metabolic fluxes can be achieved in the skeletal muscle in vivo at relatively high spatial resolution and with acquisition times well tolerated by patients. The ability to measure bioenergetics simultaneously in large areas of muscles will bring new insights into possible heterogeneous patterns of muscle metabolism associated with several diseases and serve as a valuable tool for monitoring the efficacy of interventions

Purpose:To assess the potential use of sodium magnetic resonance (MR) imaging of cartilage, with and without fluid suppression by using an adiabatic pulse, for classifying subjects with versus subjects without osteoarthritis at 7.0 T.Materials and Methods:The study was approved by the institutional review board and was compliant with HIPAA. The knee cartilage of 19 asymptomatic (control subjects) and 28 symptomatic (osteoarthritis patients) subjects underwent 7.0-T sodium MR imaging with use of two different sequences: one without fluid suppression (radial three-dimensional sequence) and one with fluid suppression (inversion recovery [IR] wideband uniform rate and smooth truncation [WURST]). Fluid suppression was obtained by using IR with an adiabatic inversion pulse (WURST pulse). Mean sodium concentrations and their standard deviations were measured in the patellar, femorotibial medial, and lateral cartilage regions over four consecutive sections for each subject. The minimum, maximum, median, and average means and standard deviations were calculated over all measurements for each subject. The utility of these measures in the detection of osteoarthritis was evaluated by using logistic regression and the area under the receiver operating characteristic curve (AUC). Bonferroni correction was applied to the P values obtained with logistic regression.Results:Measurements from IR WURST were found to be significant predicators of all osteoarthritis (Kellgren-Lawrence score of 1-4) and early osteoarthritis (Kellgren-Lawrence score of 1 or 2). The minimum standard deviation provided the highest AUC (0.83) with the highest accuracy (>78%), sensitivity (>82%), and specificity (>74%) for both all osteoarthritis and early osteoarthritis groups.Conclusion:Quantitative sodium MR imaging at 7.0 T with fluid suppression by using adiabatic IR is a potential biomarker for osteoarthritis.(c) RSNA, 2013.

The critical design aim for a sodium/proton coil is to maximize sodium sensitivity and transmit field homogeneity while simultaneously providing adequate proton sensitivity and homogeneity. While most dual-frequency coils use lossy high-impedance trap circuits or PIN diodes to allow dual-resonance, we explored a nested-coil design for sodium/proton knee imaging at 7 T. A stand-alone eight-channel sodium receive array was implemented without standard dual-resonance circuitry to provide improved sodium signal-to-noise ratio. A detunable sodium birdcage was added for homogeneous sodium excitation and a four-channel proton transmit-receive array was added to provide anatomical reference imaging and B(0) shimming capabilities. Both additional modules were implemented with minimal disturbance to the eight-channel sodium array by managing their respective resonances and geometrical arrangement. In vivo sodium signal-to-noise ratio was 1.2-1.7 times greater in the developed eight-channel array than in a mononuclear sodium birdcage coil, whereas the developed four-channel proton array provided signal-to-noise ratio similar to that of a commercial mononuclear proton birdcage coil. Magn Reson Med, 2012. (c) 2012 Wiley Periodicals, Inc.

Micro-finite element analysis applied to high-resolution (0.234-mm length scale) MRI reveals greater whole and cancellous bone stiffness, but not greater cortical bone stiffness, in the distal femur of female dancers compared to controls. Greater whole bone stiffness appears to be mediated by cancellous, rather than cortical bone adaptation. INTRODUCTION: The purpose of this study was to compare bone mechanical competence (stiffness) in the distal femur of female dancers compared to healthy, relatively inactive female controls. METHODS: This study had institutional review board approval. We recruited nine female modern dancers (25.7 +/- 5.8 years, 1.63 +/- 0.06 m, 57.1 +/- 4.6 kg) and ten relatively inactive, healthy female controls matched for age, height, and weight (32.1 +/- 4.8 years, 1.6 +/- 0.04 m, 55.8 +/- 5.9 kg). We scanned the distal femur using a 7-T MRI scanner and a three-dimensional fast low-angle shot sequence (TR/TE = 31 ms/5.1 ms, 0.234 mm x 0.234 mm x 1 mm, 80 slices). We applied micro-finite element analysis to 10-mm-thick volumes of interest at the distal femoral diaphysis, metaphysis, and epiphysis to compute stiffness and cross-sectional area of whole, cortical, and cancellous bone, as well as cortical thickness. We applied two-tailed t-tests and ANCOVA to compare groups. RESULTS: Dancers demonstrated greater whole and cancellous bone stiffness and cross-sectional area at all locations (p < 0.05). Cortical bone stiffness, cross-sectional area, and thickness did not differ between groups (>0.08). At all locations, the percent of intact whole bone stiffness for cortical bone alone was lower in dancers (p < 0.05). Adjustment for cancellous bone cross-sectional area eliminated significant differences in whole bone stiffness between groups (p > 0.07), but adjustment for cortical bone cross-sectional area did not (p < 0.03). CONCLUSIONS: Modern dancers have greater whole and cancellous bone stiffness in the distal femur compared to controls. Elevated whole bone stiffness in dancers may be mediated via cancellous, rather than cortical bone adaptation.

The rate of phosphocreatine (PCr) resynthesis after physical exercise has been extensively studied with phosphorus ((31) P)-MRS. Previous studies have used small surface coils that were limited to measuring one superficial muscle per experiment. This study focuses on the development and implementation of a spectrally selective three-dimensional turbo spin echo (3D-TSE) sequence at 3T and 7T with temporal resolution of 24 s, using two geometrically identical volume coils. We acquired imaging data of PCr recovery from four healthy volunteers and one diabetic patient, who performed plantar flexions using resistance bands. We segmented the anatomical regions of six different muscles from the lower leg, namely the gastrocnemius [lateral (GL) and medial (GM)], the tibialis [anterior (TA) and posterior (TP)], the soleus (S) and the peroneus (P) and measured the local PCr resynthesis rate constants. During the same examination, we also acquired unlocalized (31) P-MRS data at a temporal resolution of 6 s. At 3T, the PCr resynthesis rate constants were measured at 25.4 +/- 3.7 s [n = 4, mean +/- standard deviation (SD)] using the MRS method and 25.6 +/- 4.4 s using the MRI method. At 7T, the measured rates were 26.4 +/- 3.2 s and 26.2 +/- 4.7 s for MRS and MRI. Using our imaging method, we measured the local PCr resynthesis rate constants in six individual muscles of the lower leg (min/max 20.2/31.7 s). The recovery rate constants measured for the diabetic patient were 55.5 s (MRS) and 52.7 s (MRI). The successful implementation of our 3D-method suggests that imaging is possible at both fields with a relatively high spatial resolution (voxel size: 4.2 mL at 3T and 1.6 mL at 7T) using volume coils and that local PCr resynthesis rates can be obtained in a single measurement. The advantage of the imaging method is that it can highlight differences in PCr resynthesis rates between different muscles in a single measurement in order to study spatial gradients of metabolic properties of diseased states for which very little is currently known

The clinical diagnosis of osteoporosis has evolved over the past 20 years to emphasize the relationship between compromised bone strength and fracture susceptibility. The goal of treatment of osteoporosis is fracture prevention. The aging of the American population will place additional burdens on our healthcare system among which will be the need to treat and prevent the estimated increase in fracture rates projected over the next 10 years. There is a significant number of currently available bone strengthening medications used in the treatment of osteoporosis, and this report highlights the effects of these drugs on bone mineral density values and on the relative rates of fragility fractures when these drugs are compared to placebo in clinical trials of subjects with osteoporosis. Identifying those individuals most in need of immediate treatment to prevent fractures remains a challenge despite the use of fracture risk assessment tools, which assess bone mineral density and clinical parameters in order to define an individual's risk of fracture over a finite period of time. Newer tools that may help better define bone strength (resistance to fracture) include high resolution MRI and finite element analysis of the MRI generated images, and this technology and our experience with it is briefly reviewed in this report. There are a number of new classes of drugs in development for the treatment of osteoporosis, and the clinician is likely to have additional antiresorptive and anabolic agents as treatment options for this condition over the next few years.

OBJECTIVE: To assess and compare subregional and whole T1rho values (median+/-interquartile range) of femorotibial cartilage and menisci in patients with doubtful (Kellgren-Lawrence (KL) grade 1) to severe (KL4) osteoarthritis (OA) at 3T. MATERIALS AND METHODS: 30 subjects with varying degrees of OA (KL1-4, 13 females, 17 males, mean age+/-SD=63.9+/-13.1 years) were evaluated on a 3T MR scanner using a spin-lock-based 3D GRE sequence for T1rho mapping. Clinical proton density (PD)-weighted fast spin echo (FSE) images in sagittal (without fat saturation), axial, and coronal (fat-saturated) planes were acquired for cartilage and meniscus Whole-organ MR imaging score (WORMS) grading. Wilcoxon rank sum test was performed to determine whether there were any statistically significant differences between subregional and whole T1rho values of femorotibial cartilage and menisci in subjects with doubtful to severe OA. RESULTS: Lateral (72+/-10ms, median+/-interquartile range) and medial (65+/-10ms) femoral anterior cartilage subregions in moderate-severe OA subjects had significantly higher T1rho values (P<0.05) than cartilage subregions and whole femorotibial cartilage in doubtful-minimal OA subjects. There were statistically significant differences in meniscus T1rho values of the medial posterior subregion of subjects with moderate-severe OA and T1rho values of all subregions and the whole meniscus in subjects with doubtful-minimal OA. When evaluated based on WORMS, statistically significant differences were identified in T1rho values between the lateral femoral anterior cartilage subregion in patients with WORMS5-6 (advanced degeneration) and whole femorotibial cartilage and all cartilage subregions in patients with WORMS0-1 (normal). CONCLUSION: T1rho values are higher in specific meniscus and femorotibial cartilage subregions. These findings suggest that regional damage of both femorotibial hyaline cartilage and menisci may be associated with osteoarthritis

Osteoarthritis is a degenerative disease of articular cartilage that may be associated with a loss of glycosaminoglycans. Quantitative sodium magnetic resonance imaging is highly specific to glycosaminoglycan content and could be used to assess the biochemical degradation of cartilage in early osteoarthritis. However, the reproducibility and repeatability of this technique are not well documented. The aim of this study is to test the reproducibility and repeatability of sodium quantification in cartilage in vivo using intraday and interday acquisitions at 3 T and 7 T, with a radial 3D sequence, with and without fluid suppression. Fluid suppression was obtained by adiabatic inversion recovery (IR WURST) and is expected to improve the sensitivity of the method to glycosaminoglycan content. The root mean square of coefficients of variation are all in the range of 7.5-13.6%. No significant intermagnet, intersequence, intraday, and interday differences in the coefficients of variation were observed. Sodium quantification using IR WURST gave values closer to those reported in the literature for healthy cartilage (220-310 mM) than radial 3D. In conclusion, IR WURST was more accurate in context of sodium measurement, with a reproducibility and repeatability comparable to other compositional magnetic resonance imaging techniques of cartilage. Magn Reson Med, 2011. (c) 2011 Wiley Periodicals, Inc.

OBJECTIVES: To evaluate cartilage repair and native tissue using a three-dimensional (3D), radial, ultra-short echo time (UTE) (23)Na MR sequence without and with an inversion recovery (IR) preparation pulse for fluid suppression at 7 Tesla (T). METHODS: This study had institutional review board approval. We recruited 11 consecutive patients (41.5 +/- 11.8 years) from an orthopaedic surgery practice who had undergone a knee cartilage restoration procedure. The subjects were examined postoperatively (median = 26 weeks) with 7-T MRI using: proton-T2 (TR/TE = 3,000 ms/60 ms); sodium UTE (TR/TE = 100 ms/0.4 ms); fluid-suppressed, sodium UTE adiabatic IR. Cartilage sodium concentrations in repair tissue ([Na(+)](R)), adjacent native cartilage ([Na(+)](N)), and native cartilage within the opposite, non-surgical compartment ([Na(+)](N2)) were calculated using external NaCl phantoms. RESULTS: For conventional sodium imaging, mean [Na(+)](R), [Na(+)](N), [Na(+)](N2) were 177.8 +/- 54.1 mM, 170.1 +/- 40.7 mM, 172.2 +/- 30 mM respectively. Differences in [Na(+)](R) versus [Na(+)](N) (P = 0.59) and [Na(+)](N) versus [Na(+)](N2) (P = 0.89) were not significant. For sodium IR imaging, mean [Na(+)](R), [Na(+)](N), [Na(+)](N2) were 108.9 +/- 29.8 mM, 204.6 +/- 34.7 mM, 249.9 +/- 44.6 mM respectively. Decreases in [Na(+)](R) versus [Na(+)](N) (P = 0.0.0000035) and [Na(+)](N) versus [Na(+)](N2) (P = 0.015) were significant. CONCLUSIONS: Sodium IR imaging at 7 T can suppress the signal from free sodium within synovial fluid. This may allow improved assessment of [Na(+)] within cartilage repair and native tissue. KEY POINTS : * NaIR magnetic resonance imaging can suppress signal from sodium within synovial fluid. * NaIR MRI thus allows assessment of sodium concentration within cartilage tissue alone. * This may facilitate more accurate assessment of repair tissue composition and quality.