What are the current challenges with qualitative musculoskeletal magnetic resonance imaging?

Marcelo V. W. Zibetti¹
¹Radiology, NYU Grossman School of Medicine, New York, NY, United States

Synopsis

Keywords: Musculoskeletal: Cartilage, Musculoskeletal: Skeletal, Musculoskeletal: Tendons

Qualitative MRI is still the predominant MRI approach in musculoskeletal (MSK) applications. It has many advantages. such as excellent soft-tissue contrast, submillimeter resolution, and the ability to be quickly assessed by our visual system. However, qualitative MRI depends on well-trained radiologists, and the reading of MRI can be subjective, and differ from one reader to another due to several factors. In this talk, we will briefly discuss some of the limitations of qualitative MRI in MSK applications, including cartilage, bone, muscles, tendons, and ligaments.

Qualitative MRI is still the predominant MRI approach used by trained musculoskeletal (MSK) radiologists for the diagnosis of a variety of conditions, particularly in MSK applications [1]. Qualitative MRI provides excellent soft-tissue contrast and submillimeter resolution. More importantly, qualitative MRI can be quickly assessed by a powerful human sense, our visual system, which recognizes different organs and tissue structures, putting overall things in context while rapidly switching focus on the details.
While these advantages make qualitative MRI the current favorite modality, it depends on a well-trained skeletal radiologist. The reading of MRI can also be subjective: procedures and observations may change from one reader to another based on his/her experience and expertise. To reduce this subjectivity, 3D images, systematic approaches, and different MRI contrasts (i.e., T1w, T2w, proton density and with/without fat suppression, etc) may be necessary for a more accurate diagnosis [2]. This subjectivity and need for multiple contrasts favor research on less subjective MRI modalities, such as quantitative MRI [3].
In this talk, we will briefly discuss some of the limitations of qualitative MRI in MSK applications (cartilage, bone, and muscle), we will see examples where qualitative MRI is perhaps inconclusive, and other approaches, such as quantitative MRI, are possibly a good alternative solution. Currently, research in quantitative MRI shows this approach is promising in many applications, in this talk we will show their potential to overcome limitations in current qualitative MRI for cartilage [4], [5], bone [6], [7], muscles [8], [9], tendons and ligaments [10], [11].

Acknowledgements

The author’s research was supported by NIH grants, R21-AR075259-01A1, R01-AR068966, R01-AR076328-01A1, R01-AR076985-01A1, and R01-AR078308-01A1 and was performed under the rubric of the Center of Advanced Imaging Innovation and Research (CAI2R), an NIBIB Biomedical Technology Resource Center (NIH P41-EB017183). The author thanks the support of the Division of Musculoskeletal Imaging of the Radiology Department of the New York University Grossman School of Medicine, particularly Drs. Jan Fritz, Iman Khodarahmi, Gregory Chang, Richard Kijowski, and Michael Recht.

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Proc. Intl. Soc. Mag. Reson. Med. 31 (2023)