ISMRM 24th Annual Meeting & Exhibition 07-13 May 2016 Singapore

Combined Educational & Scientific Session: Advanced Cartilage Imaging

Skill Level: Intermediate to Advanced

Organizers: Jenny T. Bencardino, M.D., Eric Y. Chang, M.D., Christine Chung, M.D., Ravinder R. Regatte, Ph.D., Philip Robinson, M.D. & Siegfried Trattnig, M.D.

Tuesday 10 May 2016

Review the state of the art technical aspects of cartilage imaging and describe emerging quantitative MRI techniques for evaluating cartilage composition and structure.

Target Audience
Radiologists, graduate students, post docs, MR technologists and clinical support scientists who wish to incorporate the use of MRI into their practice and to know how evolving MRI techniques can aid in clinical problem-solving in the musculoskeletal system and impact individualized patient care.

Educational Objectives
Upon completion of this course, participants should be able to:

  • Describe how relaxation time measurements (pulse sequences, image post processing and visualization) are made in MSK MRI, and sources of error; and
  • Describe advanced quantitative methods of cartilage MR relaxation mapping and clinical applications.

Moderators: Miika Nieminen, Ravinder Regatte
Compositional Mapping Techniques
Xiaojuan Li
Advanced Cartilage Imaging: Clinical Applications
Michel Crema
Advanced MRI techniques enable evaluation of the biochemical composition of articular cartilage. Compositional MRI techniques have the potential to supplement clinical MRI sequences in identifying cartilage degeneration at an earlier stage than is possible today using morphologic sequences only. Although there is some evidence regarding the relationship with some compositional MRI techniques (mainly T2 mapping, T1rho, and dGEMRIC) with symptoms and progression of disease, additional work is needed to isolate the role of the different compositional MRI techniques in predicting structural and clinical outcomes taking into account feasibility of application, reliability and responsiveness of the different techniques available today.

Comparison of DESS T2 Relaxation Times and Apparent Diffusion Coefficient in Articular Cartilage at 3T and 7T
Garry E Gold1, Bragi Sveinsson2, Kevin Eppersson2, Akshay Chaudhari3, Marcus Alley2, Daehyun Yoon2, Brian A Hargreaves3, and Feliks Kogan2
1Radiology, Bioengineering, and Orthopedic Surgery, Stanford University, Stanford, CA, United States, 2Radiology, Stanford University, Stanford, CA, United States, 3Radiology and Bioengineering, Stanford University, Stanford, CA, United States
Double-echo Steady-Sate (DESS) is an efficient 3D approach to measure cartilage thickness, T2, and apparent diffusion coefficient (ADC).  We tested the DESS sequence at 3T and 7T in healthy volunteers. DESS can acquire accurate cartilage T2 and ADC values at both 3T and 7T, with more consistent ADC measurements at 7T, likely due to less image noise in the fit. 

DESS T2 mapping in Knee Cartilage at Supine and Standing Positions in an Upright MR Scanner
Andrew C Yung1, Reza Nickmanesh2, Piotr Kozlowski1,3, and David R Wilson2,4
1UBC MRI Research Centre, University of British Columbia, Vancouver, BC, Canada, 2Centre for Hip Health and Mobility, University of British Columbia, Vancouver, BC, Canada, 3Radiology, University of British Columbia, Vancouver, BC, Canada, 4Department of Orthopaedics, University of British Columbia, Vancouver, BC, Canada
With the use of an upright open MR scanner, we demonstrate knee cartilage T2 mapping using DESS in a true standing position for the first time, and have shown preliminary evidence that there may be differences between loading the joint in the standing position versus the supine loaded and unloaded case.  The volumetric DESS T2 maps were acquired with short acquisition time which is critical for imaging weightbearing postures, while maintaining a range of T2 values that were similar to gold-standard T2 maps generated by a multi-spin-echo sequence. 

Texture analysis of T2 relaxation time maps reveals degenerative changes in articular cartilage: Oulu Knee Osteoarthritis study
Arttu Peuna1,2,3, Joonas Hekkala1,3, Marianne Haapea1,2, Jana Podlipska1,3, Ali Guermazi4, Miika T Nieminen1,2,3, Simo Saarakkala1,2,3, and Eveliina Lammentausta1,2
1Medical Research Center, University of Oulu and Oulu University Hospital, Oulu, Finland, 2Department of Diagnostic Radiology, Oulu University Hospital, Oulu, Finland, 3Research group of Medical Imaging, Physics and Technology, University of Oulu, Oulu, Finland, 4Department of Radiology, Boston University School of Medicine, Boston, MA, United States
Gray level co-occurrence matrix based texture analysis is a sensitive image processing method that probes the spatial information from knee MR T2 maps and of the changes caused by osteoarthritis (OA). Texture analysis can distinguish symptomatic patients from healthy control subjects more sensitively than regional mean T2 analysis, and provides additional information also when compared to clinical evaluations such as MOAKS. Advanced learning algorithms can be further utilized to classify asymptomatic and OA subjects.

Use of comprehensive MRI to assess cartilage composition in patients with acute cartilage injury
Didier Laurent1, Stefan Zbyn2, Vladimir Mlynarik2, Markus Schreiner2, Pavol Szomolanyi2, Nicole Getzmann1, Harry Haber1, Joerg Goldhahn1, Stefan Marlovits3, and Siegfried Trattnig2
1Novartis Institutes fo Biomedical Research, Basel, Switzerland, 2Department of Biomedical Imaging and Image-Guided Therapy, Medical University of Vienna, Vienna, Austria, 3Department of Traumatology, Medical University of Vienna, Vienna, Austria
A comprehensive MRI approach was implemented to assess cartilage macromolecular composition in patients with acute cartilage injury. Differences in T2 relaxation and gagCEST asymmetry values were observed between the defective and adjacent regions in the tibio-femoral cartilage. Preliminary results indicate that the combination of T2 mapping with gagCEST scans at 7T may be reproducible and sensitive enough to monitor early cartilage degeneration, and thus may be considered as a good alternative to cartilage biopsies in future clinical trials on new therapies aimed at cartilage regeneration.

A New High-resolution 3D gagCEST Imaging method for In Vivo Human Knee Cartilage at 7T
Guruprasad Krishnamoorthy1, Ravi Prakash Reddy Nanga1, Puneet Bagga1, Hari Hariharan1, and Ravinder Reddy1
1Center for Magnetic Resonance and Optical Imaging, Department of Radiology, University of Pennsylvania, Philadelphia, PA, United States
Osteoarthritis (OA), one of the most prevalent musculoskeletal conditions, affects a large number of people around the world with an increased risk on an even larger number of people getting affected by it in the future [1]. GAG chemical exchange saturation transfer (gagCEST) is a promising MRI technique to non-invasively quantify GAG content present in the cartilages [2].  In this study, a new burst mode magnetization preparation 3D gagCEST technique was developed which provided high-resolution gagCEST maps of knee cartilages in practically achievable scan times at 7T with more than twice the sensitivity of the previously reported steady-state saturation 3D gagCEST study [5].

Adjournment & Meet the Teachers

The International Society for Magnetic Resonance in Medicine is accredited by the Accreditation Council for
Continuing Medical Education to provide continuing medical education for physicians.