Musculoskeletal Applications of Diffusion MRI
Gustav Strijkers1

1Biomedical Engineering and Physcis, Academic Medical Center (AMC), Amsterdam, Netherlands

Synopsis

In this educational contribution the use of diffusion-tensor (DT-) MRI muscle fiber tracking for studying muscle architectural properties will be discussed. Topics include the importance of muscle structure to muscle function, how muscle architecture is typically assessed, and DT-MRI and its application to muscle. Examples will be given of how DT-MRI data have been used to provide new insights into muscle function, and lastly, important future research directions will be highlighted.

Purpose

Skeletal muscles serve critical mechanical and physiological roles in the body. The mechanical functions include generating force and actuating movement by shortening or lengthening under load. It transpires that a muscle’s abilities to generate force or undergo large and/or rapid length excursions are influenced by the internal arrangement of muscle fibers with respect to the muscle’s mechanical line of action. This property is commonly known as muscle architecture. The purpose of this contribution is to describe the use of diffusion-tensor (DT-) MRI muscle fiber tracking for studying these structural properties. I will discuss the importance of muscle structure to muscle function, how muscle architecture is typically assessed, and describe DT-MRI and its application to muscle. I will provide examples of how DT-MRI data have been used to provide new insights into how muscle function, and lastly, highlight important future research directions.

Diffusion in skeletal muscle

Two important properties of water diffusion in skeletal muscle allow DT-MRI tractography to be performed. First, D for water in skeletal muscle fibers is lower than D in free water (1). Also, water diffuses about 40% more rapidly along skeletal muscle fiber’s long axis than perpendicular to this axis (2). The reduction in D may result from the finite permeability of the cell membrane to water, an action of intracellular solid phase proteins as physical barriers to water displacement, and/or the transient binding of water to macromolecules and ions with smaller diffusion coefficients than that for free water (1,3-5). Because sarcomeres are ~2-3 mm long but have an inter-filament spacing of ~30 nm, and because muscle fibers have a highly elongated overall geometry, there is a greater spatial frequency of diffusion-hindering structures in the transverse direction than in the longitudinal direction. This property contributes to diffusion anisotropy in muscle (3,4). Indeed, recent work by Scheel et al. suggests that the higher FA and lower 2nd and 3rd tensor eigenvalues correspond to smaller fiber diameters (6). Studies in both skeletal (7,8) and cardiac (9,10) muscle have reported the correspondence of the 1st tensor eigenvector to the histology-determined muscle fiber direction. It is this correspondence that allows DT-MRI fiber tracking to be used to represent skeletal muscle architecture (Figure 1).

Applications of skeletal muscle DT-MRI

Muscle fiber tracking has been used to assess the structure of a variety of small animal muscles and human muscles. In vivo small animal studies have been performed in the rat gastrocnemius (11) and the mouse hindlimb (12). The studies in the rat gastrocnemius provided validation of the pennation angle measurements; Heemskerk et al. calculated the PCSA as the dot product of a measured anatomical cross-sectional area and the fiber direction (12). DT-MRI-based fiber tracking also has been performed in a variety of human muscles, including the plantarflexor (13,14,15,16) and tibialis anterior (17,18,19) muscles of the leg, the quadriceps muscles of the thigh (20,21,22,23), the forearm muscles (24), and the muscles of the female pelvic floor (25).

Clinically relevant applications of fiber tracking have included examining structural changes in the genioglossus muscle due to oral appliance use (26), studying the effects of chronic lateral patella dislocation (22), and examining age-associated changes in muscle architecture (27). DT-MRI fiber tracking can provide new insights into muscle structure. For example, in the tibialis anterior muscle, Lansdown et al. observed larger values of the pennation angle theta in the superior portion of the muscle than in the inferior portion (17). Although a 3-D US study had observed such heterogeneity (28), this finding had not been previously reported in the 2-D US literature (33,29). This heterogeneity was shown to be related to changes in the aponeurosis’s orientation within the axial plane (17). Heterogeneity in fiber track length (L) has also been reported using DT-MTI tracking methods (19,30), and preliminary reports exist to indicate that theta and curvature decrease and L increase upon muscle elongation (30,31). Schwenzer et al. (32) and Sinha et al. (15) have reported changes in the orientation of the principal eigenvector due to muscle lengthening and that presumably changes in theta. These data indicate that DT-MRI and DT-MRI-based fiber tracking can provide new insights into muscle architecture not obtainable via 2-D imaging methods that do not use a fixed frame of reference. Also, when proper positioning procedures are used, DT-MRI is not subject to experimental errors such as the muscle deformation caused by US probe placement (33).

There have been a few studies in which DT-MRI fiber tracking, in conjunction with other methods, has been used to predict and investigate the active mechanics of muscle. Muscle deformation during contraction can be characterized by a strain tensor. Felton et al. used DT-MRI to assess the tongue’s architecture and combined this with phase contrast MRI to measure strain rates in the tongue during swallowing. This enabled them to relate the architecture of the intrinsic and extrinsic muscles of the tongue with the manner in which the tongue deformed during swallowing (34). Englund et al. used spatial tagging MRI to estimate the 3-D strain tensor associated with isometric contraction of the tibialis anterior (35). Finally, Levin et al. have used DT-MRI data to generate musculoskeletal models (36). These initial efforts illustrate the potential for combining functional MRI or other computational methods and DT-MRI-based muscle architectural information to obtain new insights into muscle structure-function relationships.

Future directions

It has been shown that DT-MRI has provided new insights into muscle structure not available through other methods; and that the wide range of other measurement capabilities that is available through physiological MRI methods affords considerable possibilities for using DT-MRI to understand the integration of structure and function of skeletal muscle. Several important future research directions that are needed to realize fully the potential for DT-MRI skeletal muscle fiber tracking: (a) Widespread dissemination of muscle-specific DT-MRI software tools; (b) Determination and validation of the best approaches for acquiring, generating, and analyzing DT-MRI fiber tracking data under conditions of fat infiltration; (c) Determination and validation of the best approaches for using DT-MRI fiber tracking to quantify muscle architecture in the active state; and (d) Development of approaches for synthesizing DT-MRI fiber tracking and other types of functional imaging data. This existing strengths of DT-MRI fiber tracking, coupled with continued advancements of this kind, will favor the continued use of DT-MRI to generate new knowledge concerning the relationships among muscle structure and function, in health and disease.

Acknowledgements

I would like to thank Martijn Froeling and Bruce Damon for valuable input and discussion.

References

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Figures

Images show posterior view of segmented upper leg muscles and fiber tractography. A, Textbook illustration of upper leg muscles. B, Whole-muscle volume fiber tractography. C, Region-of-interest–based muscle segmentation. D, Tractography of individual muscles. (Figure courtesy of Martijn Froeling, Radiology. 2015 Feb;274(2):548–62.)



Proc. Intl. Soc. Mag. Reson. Med. 24 (2016)