Dynamic MRI of Joints: Technical Factors and Clinical Applications
Valentina Mazzoli1

1Radiology, Stanford University, CA, United States

Synopsis

while static MRI is widely used clinically for the assessment of several joints, it often fails to provide information on their biomechanical and functional status. On the other hand, dynamic MRI allows to gather information on the normal and impaired musculoskeletal function during motion but is technically more challenging. This presentation will cover some of the technical factors needed to perform and analyze a dynamic MRI experiment of the joints, and will highlight some clinical and research applications where dynamic MRI can add useful information to conventional static imaging.

Target audience

Clinicians and researchers who are interested in using dynamic MRI to assess the functional status of human joints.

Introduction

MR sequences typically used in the clinics enable to acquire images of the human joints with excellent contrast, but they are just “static picture” and provide very limited information on the function of the joint. This is an important shortcoming, since many musculoskeletal disorders are strongly linked to abnormal loading and abnormal motion patterns. On the other hand, dynamic MRI allows to assess the joints under load and/or clinically relevant loading conditions, therefore potentially increasing the diagnostic information of the MR examination. This educational talk will discuss emerging application of dynamic MRI of joints. Technical considerations and challenges will also be discussed.

Objective

The main objectives of this talk are to highlight technical factors needed in dynamic MRI of the joints, and to illustrate some clinical and research applications of these methods. In particular, the presentation will cover:

1) Understanding the different approaches for dynamic MRI data of joints

2) Technical considerations in designing and performing a dynamic MRI exam

3) Utilizing dynamic MRI to generate relevant clinical information on the status of the joints

Image acquisition

From a technical point of view, dynamic imaging can be performed following two main approaches: in real time or in a segmented/trigged fashion (CINE MRI). Real time MRI does not require repetition of the motion task1–3, and is therefore more suitabke for the study of non-repetitive motion of for patients who experience pain during a motion task. On the other hand, CINE MRI approaches require the motion task to be repeated several times, and the motion to be synchronized with the scanner acquisition4,5. Non-cartesian k-space sampling approaches also allow to continuously acquire k-space lines and assign them to the individual time frames retrospectively, without the need for perfect synchronization of the motion task with the scanner acquisition6,7. Phase Contrast can be coupled to dynamic acquisition to determine velocities of bony segments 8–10 and muscles 4,5,11,12 during a specific motion task.

3D dynamic MRI methods offer the potential to simultaneously assess bone kinetics and soft tissue deformation, but are currently hampered by acquisition speed. Recent developments in image acquisition allowed 3D dynamic imaging of the knee joint, by making use of undersampled acquisition and compressed sensing reconstruction 6,7. Besides enabling a volumetric visualization of bones and soft tissue structures during motion, acceleration techniques in the context of dynamic MRI, have also been shown to increase the repeatability of the dynamic MRI experiment 13.

Technical considerations

In order to increase the physiological and biomechanical value of a dynamic MRI experiment, the joint should be imaged in physiologically relevant loading conditions14. To this aim, appropriate MR compatible loading devices have been designed15–17. Furthermore, dedicated coils are needed for the data collection 7,15.

Additional technical considerations can be found in review papers on the topic14,18.

Applications

Dynamic MRI methods have been used to assess skeletal kinematics in a range of joints including knee19, shoulder20, wrist3,21, ankle22, and hip23. Besides providing a non-invasive, highly repeatable way to assess healthy joint kinematics9, dynamic MRI techniques have been employed to evaluate joint mechanics in musculoskeletal disorders24,25. Altered knee kinematics was measured using dynamic MRI in patients following ACL reconstruction26. Furthermore, dynamic MRI has been shown to be sensitive enough to detect changes in kinematics following surgical27 and non-surgical interventions24.

One of the most promising application of dynamic MRI is to provide a better understanding of pain mechanisms28. Additionally, functional parameters measured using dynamic MRI also play a crucial role in the field of biomechanics and musculoskeletal modeling18. Dynamic MRI has been used, inter alia, to measure tendon29, and muscle22,30 moment arms under different loading conditions. Dynamic MRI also allows to quantify cartilage contact patterns19,31, which are clinically relevant to better understand the development of osteoarthritis.

Additional applications of Dynamic musculoskeletal MRI are highlighted in a recent review32.

Conclusions

The development of dynamic MRI methods has enabled imaging and quantification of functional aspects of the musculoskeletal system and shown its value as a complementary tool in addition to convention static MRI. With careful design of the MR experiment and loading devices, information that is complementary to anatomy can be obtained. It is therefore important to focus on the validation and application of these methods in the clinic, to evaluate their true utility as a diagnostic tool.

Acknowledgements

No acknowledgement found.

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Proc. Intl. Soc. Mag. Reson. Med. 27 (2019)