A number of clinical studies have applied emerging MRI methods to study tendon, ligament and meniscus pathology in-vivo. MRI methods which have been used include UTE, sodium, CEST and diffusion. UTE imaging, including quantitative techniques, have been used to study tendinopathy, psoriatic arthritis, and meniscal injury. Sodium MRI has been used to show changes in tendon pathology including chronic tendinopathy. Diffusion imaging has been investigated for studying damage to tendons and ligaments.
UTE MRI: UTE imaging has been used to study tendons and menisci of patients. The normal tendon appears with low signal intensity on conventional MRI due to its short T2. UTE imaging has shown structure within the tendon and enthesis. Quantification has been performed with UTE and variable echo time (vTE) measurements including T2* and off resonance saturation ratio (OSR). These have shown differences from normal in Achilles tendinopathy. Mild and asymptomatic tendinopathy have also been studied. Results have been correlated with clinical findings and different techniques have been compared. T2* measurements have also been published from patients with patellar tendinopathy. In patients with psoriatic arthritis, changes at the tendon and enthesis have been investigated. T2* has been used to compare tendon autograft and tendon allograft after lateral ankle ligament reconstruction. The meniscus has been studied with UTE in patients with anterior cruciate ligament injury and differences in T2* have been demonstrated compared to uninjured controls, whether or not a meniscal tear was found; longitudinal changes in intact meniscus T2* were seen after anterior cruciate ligament repair.
Sodium MRI: Sodium MRI is attractive for assessing tendons as it is expected to be correlated with glycosaminoglycan content in connective tissues. Several small studies have looked at tendons with sodium imaging. Differences from healthy controls have been reported in the Achilles tendons of patients with clinical chronic tendinopathy and the patellar tendons of patients with type I diabetes mellitus. Longitudinal changes have been seen in the Achilles tendon following ciprofloxacin administration.
CEST: The previous study also looked at changes in the Achilles tendon following ciprofloxacin administration with glycosaminoglycan chemical exchange saturation transfer (GAG CEST) imaging at 7T.
Diffusion: It has been postulated that diffusion weighted imaging may be useful for assessing tendon and ligament damage. Diffusion weighted imaging (DWI) has been used to look at differences between torn and intact anterior cruciate ligaments and also between complete and partial tears. Apparent diffusion coefficients have been used to investigate longitudinal changes in the tibial tunnel following anterior cruciate ligament reconstruction and the effects of local administration of platelet rich plasma gel. Diffusion tensor imaging has been used to study the Achilles tendon after repair following rupture.
Juras V, Zbyn S, Pressl C, Valkovic L, Szomolanyi P, Frollo I, Trattnig S. Regional variations of T₂* in healthy and pathologic achilles tendon in vivo at 7 Tesla: preliminary results. Magn Reson Med. 2012 Nov;68(5):1607-13.
Juras V, Apprich S, Szomolanyi P, Bieri O, Deligianni X, Trattnig S. Bi-exponential T2* analysis of healthy and diseased Achilles tendons: an in vivo preliminary magnetic resonance study and correlation with clinical score. Eur Radiol. 2013 Oct;23(10):2814-22.
Grosse U, Syha R, Martirosian P, Wuerslin C, Horger M, Grözinger G, Schick F, Springer F. Ultrashort echo time MR imaging with off-resonance saturation for characterization of pathologically altered Achilles tendons at 3 T. Magn Reson Med. 2013 Jul;70(1):184-92.
Grosse U, Syha R, Hein T, Gatidis S, Grözinger G, Schabel C, Martirosian P, Schick F, Springer F. Diagnostic value of T1 and T2 * relaxation times and off-resonance saturation effects in the evaluation of Achilles tendinopathy by MRI at 3T. J Magn Reson Imaging. 2015 Apr;41(4):964-73.
Kijowski R, Wilson JJ, Liu F. Bicomponent ultrashort echo time T2* analysis for assessment of patients with patellar tendinopathy. J Magn Reson Imaging. 2017 Nov;46(5):1441-1447.
Chen B, Zhao Y, Cheng X, Ma Y, Chang EY, Kavanaugh A, Liu S, Du J. Three-dimensional ultrashort echo time cones (3D UTE-Cones) magnetic resonance imaging of entheses and tendons. Magn Reson Imaging. 2018 Jan 5;49:4-9.
Williams A, Qian Y, Golla S, Chu CR. UTE-T2* mapping detects sub-clinical meniscus injury after anterior cruciate ligament tear. Osteoarthritis Cartilage. 2012 Jun;20(6):486-94.
Chu CR, Williams AA, West RV, Qian Y, Fu FH, Do BH, Bruno S. Quantitative Magnetic Resonance Imaging UTE-T2* Mapping of Cartilage and Meniscus Healing After Anatomic Anterior Cruciate Ligament Reconstruction. Am J Sports Med. 2014 Aug;42(8):1847-56.
Juras V, Zbýn S, Pressl C, Domayer SE, Hofstaetter JG, Mayerhoefer ME, Windhager R, Trattnig S. Sodium MR imaging of Achilles tendinopathy at 7 T: preliminary results. Radiology. 2012 Jan;262(1):199-205.
Marik W, Nemec SF, Zbýň Š, Zalaudek M, Ludvik B, Riegler G, Karner M, Trattnig S. Changes in Cartilage and Tendon Composition of Patients With Type I Diabetes Mellitus: Identification by Quantitative Sodium Magnetic Resonance Imaging at 7 T. Invest Radiol. 2016 Apr;51(4):266-72.
Juras V, Winhofer Y, Szomolanyi P, Vosshenrich J, Hager B, Wolf P, Weber M, Luger A, Trattnig S. Multiparametric MR Imaging Depicts Glycosaminoglycan Change in the Achilles Tendon during Ciprofloxacin Administration in Healthy Men: Initial Observation. Radiology. 2015 Jun;275(3):763-71.
Park HJ, Lee SY, Rho MH, Kim MS, Kwon HJ, Chung EC. Usefulness of the quantitative evaluation of diffusion-weighted MRI in the diagnosis of anterior cruciate ligament tears. J Magn Reson Imaging. 2016 Nov;44(5):1116-1122.
Delin C, Silvera S, Coste J, Thelen P, Lefevre N, Ehkirch FP, Le Couls V, Oudjit A, Radier C, Legmann P. Reliability and diagnostic accuracy of qualitative evaluation of diffusion-weighted MRI combined with conventional MRI in differentiating between complete and partial anterior cruciate ligament tears. Eur Radiol. 2013 Mar;23(3):845-54.
Rupreht M, Jevtič V, Serša I, Vogrin M, Seruga T, Jevšek M. Quantitative evaluation of the tibial tunnel after anterior cruciate ligament reconstruction using diffusion weighted and dynamic contrast enhanced MRI: a follow-up feasibility study. Skeletal Radiol. 2012 May;41(5):569-74.
Rupreht M, Jevtič V, Serša I, Vogrin M, Jevšek M. Evaluation of the tibial tunnel after intraoperatively administered platelet-rich plasma gel during anterior cruciate ligament reconstruction using diffusion weighted and dynamic contrast-enhanced MRI. J Magn Reson Imaging. 2013 Apr;37(4):928-35.
Sarman H, Atmaca H, Cakir O, Muezzinoglu US, Anik Y, Memisoglu K, Baran T, Isik C. Assessment of Postoperative Tendon Quality in Patients With Achilles Tendon Rupture Using Diffusion Tensor Imaging and Tendon Fiber Tracking. J Foot Ankle Surg. 2015 Sep-Oct;54(5):782-6.
Bhojwani N, Szpakowski P, Partovi S, Maurer MH, Grosse U, von Tengg-Kobligk H, Zipp-Partovi L, Fergus N, Kosmas C, Nikolaou K, Robbin MR. Diffusion-weighted imaging in musculoskeletal radiology-clinical applications and future directions. Quant Imaging Med Surg. 2015 Oct;5(5):740-53.
Fouré A. New Imaging Methods for Non-invasive Assessment of Mechanical, Structural, and Biochemical Properties of Human Achilles Tendon: A Mini Review. Front Physiol. 2016 Jul 27;7:324.
Bae WC, Ruangchaijatuporn T, Chung CB. New Techniques in MR Imaging of the Ankle and Foot. Magn Reson Imaging Clin N Am. 2017 Feb;25(1):211-225.
Chang EY, Du J, Chung CB. UTE imaging in the musculoskeletal system. J Magn Reson Imaging. 2015 Apr;41(4):870-83.