Clinical Imaging of Tendons, Ligaments, Meniscus with Emerging MR Methods
Richard Hodgson1

1University of Manchester, United Kingdom

Synopsis

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.

Target Audience

Radiologists and physicists interested in the potential clinical musculoskeletal applications of emerging MRI techniques.

Objectives

The aim of this presentation is to review published clinical studies of emerging MRI techniques. This will include studies which have used UTE, CEST, diffusion and sodium MRI to assess tendon, ligament and meniscus pathology in-vivo.

Results

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.

Conclusion

UTE, Sodium, CEST and diffusion techniques have been applied to clinical studies of the tendons, ligaments and meniscus. The different image contrast and quantitative capabilities of the methods offer the potential to provide new insights into pathology of these tissues.

Acknowledgements

No acknowledgement found.

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Proc. Intl. Soc. Mag. Reson. Med. 26 (2018)