Foot and ankle disorders are common in everyday clinical practice. MR imaging is frequently required for diagnosis given the variety and complexity of foot and ankle anatomy. Although conventional MR imaging plays a significant role in diagnosis, contemporary management increasingly relies on advanced imaging for monitoring therapeutic response. There is an expanding need for identification of biomarkers for musculoskeletal tissues. Advanced imaging techniques capable of imaging these tissue substrates will be increasingly used in routine clinical practice. Radiologists should therefore become familiar with these innovative MR techniques. Many such techniques are already widely used in other organ systems.

Abstract Background Osteoarthritis (OA) is a progressive degenerative condition of synovial joints in response to both internal and external factors. The relationship of OA in one joint of an extremity to another joint within the same extremity, or between extremities, has been a topic of interest in reference to the etiology and/or progression of the disease. Methods The prevalence of articular cartilage lesions and osteophytes, characteristic of OA, was evaluated through visual inspection and grading in 1060 adult knee/tali pairs from 545 cadaveric joint donors. Results Joint degeneration increased more rapidly with age for the knee joint, and significantly more knee joints displayed more severe degeneration than ankle joints from as early as the third decade. Women displayed more severe knee degeneration than did men. Severe ankle degeneration did not exist in the absence of severe knee degeneration. The effect of weight on joint degeneration was joint-specific whereby weight had a significantly greater effect on the knee. Ankle grades increasingly did not match within a donor as the grade of degeneration in either the left or the right knee increased. Conclusions Gender and body type have a greater effect on knee joint integrity as compared to the ankle, suggesting that knees are more prone to internal causative effects of degeneration. We hypothesize that the greater variability in joint health between joints within an individual as disease progresses from normal to early signs of degeneration may be a result of mismatched limb kinetics, which in turn might lead to joint disease progression.

Objective

The purposes of this article are to present a state-of-the-art routine protocol for MRI of the ankle, to provide problem-solving tools based on specific clinical indications, and to introduce principles for the implementation of ultrashort echo time MRI of the ankle, including morphologic and quantitative assessment.

Conclusion

Ankle injury is common among both athletes and the general population, and MRI is the established noninvasive means of evaluation. The design of an ankle protocol depends on various factors. Higher magnetic field improves signal-to-noise ratio but increases metal artifact. Specialized imaging planes are useful but prolong acquisition times. MR neurography is useful, but metal reduction techniques are needed whenever a metal prosthesis is present. An ultrashort echo time sequence is a valuable tool for both structural and quantitative evaluation.

Objective

Cartilage degeneration involves structural, compositional, and biomechanical alterations that may be detected non-invasively using quantitative MRI. The goal of this study was to determine if topographical variation in T1rho values correlates with indentation stiffness and biochemical contents of human patellar cartilage.

Design

Cadaveric patellae from unilateral knees of 5 donors with moderate degeneration were imaged at 3-Telsa with spiral chopped magnetization preparation T1rho sequence. Indentation testing was performed, followed by biochemical analyses to determine water and sulfated glycosaminoglycan contents. T1rho values were compared to indentation stiffness, using semi-circular regions of interest (ROIs) of varying sizes at each indentation site. ROIs matching the resected tissues were analyzed, and univariate and multivariate regression analyses were performed to compare T1rho values to biochemical contents.

Results

Grossly, superficial degenerative change of the cartilage (i.e., roughened texture and erosion) corresponded with regions of high T1rho values. High T1rho values correlated with low indentation stiffness, and the strength of correlation varied slightly with the ROI size. Spatial variations in T1rho values correlated positively with that of the water content (R² = 0.10, p < 0.05) and negatively with the variations in the GAG content (R² = 0.13, p < 0.01). Multivariate correlation (R² = 0.23, p < 0.01) was stronger than either of the univariate correlations.

Conclusion

These results demonstrate the sensitivity of T1rho values to spatially varying function and composition of cartilage and that the strength of correlation depends on the method of data analysis and consideration of multiple variables.

Purpose

For biochemical evaluation of soft tissues of the knee, T1rho magnetic resonance imaging (MRI) has been proposed. Purpose of this study was to compare three T1rho sequences based on fast advanced spin echo (FASE), ultrashort echo time (UTE), and magnetization-prepared angle-modulated partitioned k-space spoiled gradient echo snapshots (MAPSS) acquisitions for the knee evaluation.

Materials and methods

We developed two T1rho sequences using 3D FASE or 3D radial UTE acquisitions. 3D MAPSS T1rho was provided by the manufacturer. Agarose phantoms with varying concentrations were imaged. Additionally, bilateral knees of asymptomatic subjects were imaged sagittally. T1rho values of the phantoms and 4 regions of interest (ROI) of the knees (i.e., anterior and posterior meniscus, femoral and tibial cartilage) were determined.

Results

In phantoms, all T1rho values monotonically decreased with increasing agarose concentration. 3D MAPSS T1rho values of 51, 34, and 38 ms were found for 2, 3, and 4% agarose, respectively, similar to published values on another platform. In the knee, the raw images were detailed with good contrast. Cartilage and meniscus T1rho values varied with the pulse sequence, being the lowest in the 3D UTE T1rho sequence. Comparing different ROIs, menisci generally had lower T1rho values compared to cartilage, as expected in healthy knees.

Conclusion

We have successfully developed and implemented the new T1rho sequences and validated them using agarose phantoms and volunteer knees. All sequences were optimized to be clinically feasible (~ 5 min or less) and yielded satisfactory image quality and T1rho values consistent with the literature.

Purpose

Cerebrospinal fluid (CSF) clearance is essential for maintaining a healthy brain and cognition by removal of metabolic waste from the central nervous system. Physical exercise has been shown to improve human health; however, the effect of physical exercise on intrinsic CSF outflow in humans remains unexplored. The purpose of this study was to investigate intrinsic CSF outflow pathways and quantitative metrics of healthy individuals with active and sedentary lifestyles. In addition, the effect of exercise was investigated among the sedentary subjects before and after 3 weeks of physical activity.

Methods

This study was performed on 18 healthy adults with informed consent, using a clinical 3-Tesla MRI scanner. We classified participants into two groups based on reported time spent sitting per day (active group: < 7 hours sitting per day and sedentary group: ≥ 7 hours sitting per day). To elucidate the effect of exercise, sedentary individuals increased their activity to 3.5 hours for 3 weeks.

Results

We show that there are two intrinsic CSF egress pathways of the dura mater and lower parasagittal dura (PSD). The adults with an active lifestyle had greater intrinsic CSF outflow metrics than adults with a more sedentary lifestyle. However, after increased physical activity, the sedentary group showed improved CSF outflow metrics. This improvement was particularly notable at the lower PSD, where outflow metrics were highest among the active group.

Conclusion

Our findings describe the relationship between physical activity and intrinsic CSF outflow and show a potential selective outflow pathway with increasing physical activity in the lower PSD pathway, potentially from the perivascular space or cortical venous subpial space.

Obtaining multiple series of magnetic resonance (MR) images with different contrasts is useful for accurate diagnosis of human spinal conditions. However, this can be time consuming and a burden on both the patient and the hospital. We propose a Bloch equation-based autoencoder regularization generative adversarial network (BlochGAN) to generate a fat saturation T2-weighted (T2 FS) image from T1-weighted (T1-w) and T2-weighted (T2-w) images of human spine. To achieve this, our approach was to utilize the relationship between the contrasts using Bloch equation since it is a fundamental principle of MR physics and serves as a physical basis of each contrasts. BlochGAN properly generated the target-contrast images using the autoencoder regularization based on the Bloch equation to identify the physical basis of the contrasts. BlochGAN consists of four sub-networks: an encoder, a decoder, a generator, and a discriminator. The encoder extracts features from the multi-contrast input images, and the generator creates target T2 FS images using the features extracted from the encoder. The discriminator assists network learning by providing adversarial loss, and the decoder reconstructs the input multi-contrast images and regularizes the learning process by providing reconstruction loss. The discriminator and the decoder are only used in the training process. Our results demonstrate that BlochGAN achieved quantitatively and qualitatively superior performance compared to conventional medical image synthesis methods in generating spine T2 FS images from T1-w, and T2-w images.

We propose a semi-automatic algorithm for the segmentation of vertebral bodies in magnetic resonance (MR) images of the human lumbar spine. Quantitative analysis of spine MR images often necessitate segmentation of the image into specific regions representing anatomic structures of interest. Existing algorithms for vertebral body segmentation require heavy inputs from the user, which is a disadvantage. For example, the user needs to define individual regions of interest (ROIs) for each vertebral body, and specify parameters for the segmentation algorithm. To overcome these drawbacks, we developed a semi-automatic algorithm that considerably reduces the need for user inputs. First, we simplified the ROI placement procedure by reducing the requirement to only one ROI, which includes a vertebral body; subsequently, a correlation algorithm is used to identify the remaining vertebral bodies and to automatically detect the ROIs. Second, the detected ROIs are adjusted to facilitate the subsequent segmentation process. Third, the segmentation is performed via graph-based and line-based segmentation algorithms. We tested our algorithm on sagittal MR images of the lumbar spine and achieved a 90% dice similarity coefficient, when compared with manual segmentation. Our new semi-automatic method significantly reduces the user's role while achieving good segmentation accuracy.