Vladimir Juras1,2, Lenka Hornakova3, Petr Kubovy3, Daniel Hadraba3,4, Pavel Stursa5, David Gerych3, Pavol Szomolanyi1, Karel Jelen3, and Siegfried Trattnig1,6
1Department of Biomedical Imaging and Image-Guided Therapy, High Field MR Centre, Medical University of Vienna, Vienna, Austria, 2Department of Imaging Methods, Institute for Measurement Science, Bratislava, Slovakia, 3Department of Anatomy and Biomechanics, Faculty Of Physical Education and Sport, Prague, Czech Republic, 4Department of Radiology, Hospital na Homolce, Prague, Czech Republic, 5Academy of Sciences of the Czech Republic, Prague, Czech Republic, 6Christian Doppler Laboratory for Clinical Molecular MR Imaging, Vienna, Austria
Synopsis
Meniscus behavior under loading in vivo has been
studied using parametric MR imaging. T2* has been acquired with vTE using very
short first TE = 0.8 ms to secure the precise estimation. The knees of the
subjects were loaded in situ with custom made compression device and T2*
mapping was performed in 5 time points (without loading, and 4 consequent scans
under the loading 7 min apart). The increase in T2* was observed in all
compartments, significance was found in medial meniscus only. vTE T2* mapping
might be a prospective marker for detecting the dynamic response of the meniscal
tissue. Introduction
(Knee) meniscus is a
crescent-shaped fibrocartilaginous structure that serves to disperse friction
in the knee joint between tibia and femur. Although the biomechanical function
of the menisci has been investigated by numerous researchers, only few have
studied the actual response in vivo [1]. Quantitative MRI provides a useful link
between biomechanical parameters and collagen fibers organization in connective
tissues [2]. Here, we studied the dynamic response of meniscus tissue to the
loading using T2* acquired by variable echo time sequence (vTE) capable of very
low TE (~0.8ms)[3]. Low TE allows for acquiring a lot of signal from meniscus
resulting in much more precise T2* estimation.
Methods
All MRI examinations were
performed on a 3T MR system (Tim Trio, Siemens Healthcare, Erlangen, Germany)
with an eight-channel knee coil (In vivo, Gainesville, FL).To obtain T2* values
in meniscus, vTE sequence has been used with 10 echoes: TE = [0.8, 2.2, 3.1,
4.1, 5.1, 6.1, 7.1, 8.1, 9.1, 10.1] ms, flip angle 13 degrees; repetition time =
29 ms; and one signal average. The bandwidth was 320 Hz/pixel; 144 sections;
with a total acquisition time of 6:10 min. The field of view was 120x180
mm, with a consecutive in-plane resolution of 0.47x 1.02. The two-parametric
least square fitting procedure written in C++ has been used. Four subject with no
history of knee pain or any meniscal problems were included in the study (4
females, mean age 28.3±1 years).
A custom made diamagnetic
apparatus has been created to simulate stress conditions on the lower limb in a
conventional MR scanner. It consists of a board with 4 holes. Through these
holes pass 4 bars with air rubber bands attached to their ends. These rubbers
are attached to the harness. Simulation of the load is induced by tightening
each rubber band to pre-determined value of the extension. Prior to load
induction using this apparatus, the resultant force vectors in the chosen
segment of the feet after long-term static load has to be quantified.
Dynamometric insoles (Pedar-X) have been used for quantification of force
vectores on the sole. Insoles record
pressure distribution map in the interaction between foot segments and the pad.
(Fig. 1)
vTE T2* was performed in five
consecutive scans (baseline. comp1[+6:10min], comp2[+12:20min], comp3[+18:30],
comp4[+24:30]). In each subject, four meniscal parts were selected: anterior
and posterior horns in both lateral and medial meniscus, in each red and white
zone was selected according to [4]. Care was given to avoid partial volume
effect - pixels at the edge of the meniscus were excluded from evaluation. The
differences in different time-points were calculated using a Wilcoxon signed
ranks test. P-value <0.05 was considered statistically significant.
Results
The mean T2* in meniscus (red and white zone
pooled) was before loading 7.06±2.53ms (LAT,ANT) 6.53±3.20ms (LAT, POS), 6.62±2.76ms
(MED,ANT) and 4.79±1.07ms (MED,POS) and after loading 7.88±4.38ms (LAT,ANT) 8.16±5.21ms
(LAT, POS), 8.02±3.45ms (MED,ANT) and 8.87±2.97ms (MED,POS). The example T2*
maps are depicted on the Figure 2. The pattern of gradient T2* increase was
observed clearly in medial meniscus (both horns) - see Figure 3.
Discussion/Conclusion
In this study, the feasibility of the
meniscus dynamic response has been validated using vTE T2* mapping. Submilisecond
first echo time is a great advantage of vTE sequence allowing for precise
mapping of relatively short T2* in menisci. This is, in our mind, the advantage
over T2 mapping which has technological limits for decreasing the first echo
time [1]. This study showed vTE-T2* is capable of detecting the biochemical
processes in meniscus during loading and, moreover, the trend in different time
points was acquired. Unlike in cartilage, the T2* in menisci elevates under loading
due to interaction of negatively charged proteoglycans with fluid cations which
helps to take in the fluid and thus resist the compression [5]. The evaluation
of meniscal response to loading might help in diagnostic of knee lesions such
as meniscal tears and degenerations, osteoarthritis or meniscal lesion related
to ligament tears. In the future, we plan to increase the number of subject to
validate the results and also to evaluate the meniscal body.
Acknowledgements
Funding support provided by Austrian Science Fund (FWF)
P 25246 B24References
[1]. Calixto N. et al, Zonal Differences in Meniscus MR
Relaxation Times in Response to in Vivo Static Loading in Knee Osteoarthritis,
Journal of Orthopaedic Research, DOI: 10.1002/jor.23004, In Press, 2015
[2] Lu XL and Mow WC, Biomechanics of articular
cartilage and determination of material properties; Med Sci Sports Exerc.
40(2):193-9 2008
[3] Deligianni X et al.. High-resolution Fourier-encoded
sub-millisecond echo time musculoskeletal imaging at 3 Tesla and 7 Tesla. Magn
Reson Med 70:1434–1439, 2013
[4] Juras et al. Quantitative MRI analysis of menisci
using biexponential T2* fitting with a variable echo time sequence, Magnetic
Resonance in Medicine 71(3) 1015–1023, 2014
[5] Fithian DC et al. Material properties and
structure-function relationships in the menisci, Clin Orthop Relat Res. 252, 19-31,
1990