Dataset Information

Association Between T₂ ^* Relaxation Times Derived From Ultrashort Echo Time MRI and Symptoms During Exercise Therapy for Patellar Tendinopathy: A Large Prospective Study.

ABSTRACT:

Background

Exercise therapy is considered preferential treatment for patellar tendinopathy (PT). However, there is conflicting evidence for structural patellar tendon adaptation in response to exercise therapy and its association with symptoms is weak.

Purpose

To assess the association between 1) T₂ ^* relaxation times and symptom severity; 2) baseline T₂ ^* and clinical outcome; and 3) longitudinal T₂ ^* changes and clinical outcome in athletes with PT performing exercise therapy.

Study type

Randomized controlled clinical trial.

Subjects

Seventy-six athletes (18-35 years) with clinically diagnosed and ultrasound-confirmed PT.

Field strength/sequence

3D gradient echo sequence (3.0 T).

Assessment

Patients were enrolled in a randomized trial of progressive tendon-loading exercises (PTLE) versus eccentric exercise therapy (EET). Symptoms were assessed using the Victorian Institute of Sports Assessment (VISA-P) questionnaire. 3D-Ultrashort echo time (UTE)-MRI was acquired at baseline, 12 and 24 weeks. Voxel-wise T₂ ^* relaxation times were quantified using mono-exponential and bi-exponential models. T₂ ^* analysis was performed in three patellar tendon tissue compartments representing: aligned collagen, degenerative tissue, and interface.

Statistical tests

Adjusted general linear, mixed-linear models, and generalized estimating equations.

Results

We included 76 patients with PT (58 men, mean age 24 ± 4 years); 38 in the PTLE-group and 38 in the EET-group, of which 57 subjects remained eligible for analysis. T₂ ^* relaxation times were significantly associated with VISA-P in degenerative and interface tissues of the patellar tendon. No association was found between baseline T₂ ^* and VISA-P after 24 weeks (P > 0.29). The estimated mean T₂ ^* in degenerative tissue decreased from 14 msec (95%CI: 12-16) at baseline to 13 msec (95%CI: 11-15) at 12 weeks and to 13 msec (95%CI: 10-15) at 24 weeks. The significant decrease in T₂ ^* from baseline to 24 weeks was associated with improved clinical outcome.

Data conclusion

Tissue-specific T₂ ^* relaxation times, identified with 3D-UTE-MRI, decreased significantly in athletes with patellar tendinopathy performing exercise therapy and this decrease was associated with improved clinical outcome.

Evidence level

1 TECHNICAL EFFICACY: Stage 4.

SUBMITTER: Breda SJ

PROVIDER: S-EPMC8596625 | biostudies-literature |

REPOSITORIES: biostudies-literature

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Project description:BACKGROUND:Quantitative MRI of patellar tendinopathy (PT) can be challenging due to spatial variation of T2 * relaxation times. PURPOSE:1) To compare T2 * quantification using a standard approach with analysis in specific tissue compartments of the patellar tendon. 2) To evaluate test-retest reliability of different methods for fitting ultrashort echo time (UTE)-relaxometry data. STUDY TYPE:Prospective. SUBJECTS:Sixty-five athletes with PT. FIELD STRENGTH/SEQUENCE:3D UTE scans covering the patellar tendon were acquired using a 3.0T scanner and a 16-channel surface coil. ASSESSMENT:Voxelwise median T2 * was quantified with monoexponential, fractional-order, and biexponential fitting. We applied two methods for T2 * analysis: first, a standard approach by analyzing all voxels covering the proximal patellar tendon. Second, within subregions of the patellar tendon, by using thresholds on biexponential fitting parameter percentage short T2 * (0-30% for mostly long T2 *, 30-60% for mixed T2 *, and 60-100% for mostly short T2 *). STATISTICAL TESTS:Average test-retest reliability was assessed in three athletes using coefficients-of-variation (CV) and coefficients-of-repeatability (CR). RESULTS:With standard image analysis, we found a median [interquartile range, IQR] monoexponential T2 * of 6.43 msec [4.32-8.55] and fractional order T2 * 4.39 msec [3.06-5.78]. The percentage of short T2 * components was 52.9% [35.5-69.6]. Subregional monoexponential T2 * was 13.78 msec [12.11-16.46], 7.65 msec [6.49-8.61], and 3.05 msec [2.52-3.60] and fractional order T2 * 11.82 msec [10.09-14.44], 5.14 msec [4.25-5.96], and 2.19 msec [1.82-2.64] for 0-30%, 30-60%, and 60-100% short T2 *, respectively. Biexponential component short T2 * was 1.693 msec [1.417-2.003] for tissue with mostly short T2 * and long T2 * of 15.79 msec [13.47-18.61] for mostly long T2 *. The average CR (CV) was 2 msec (15%), 2 msec (19%) and 10% (22%) for monoexponential, fractional order and percentage short T2 *, respectively. DATA CONCLUSION:Patellar tendinopathy is characterized by regional variability in binding states of water. Quantitative multicompartment T2 * analysis in PT can be facilitated using a voxel selection method based on using biexponential fitting parameters. LEVEL OF EVIDENCE:1 TECHNICAL EFFICACY STAGE: 1 J. Magn. Reson. Imaging 2020;52:420-430.

Project description:Background Signal contamination from long T2 water is a major challenge in direct imaging of myelin with MRI. Nulling of the unwanted long T2 signals can be achieved with an inversion recovery (IR) preparation pulse to null long T2 white matter within the brain. The remaining ultrashort T2 signal from myelin can be detected with an ultrashort echo time (UTE) sequence. Purpose To develop patient-specific whole-brain myelin imaging with a three-dimensional double-echo sliding inversion recovery (DESIRE) UTE sequence. Materials and Methods The DESIRE UTE sequence generates a series of IR images with different inversion times during a single scan. The optimal inversion time for nulling long T2 signal is determined by finding minimal signal on the second echo. Myelin images are generated by subtracting the second echo image from the first UTE image. To validate this method, a prospective study was performed in phantoms, cadaveric brain specimens, healthy volunteers, and patients with multiple sclerosis (MS). A total of 20 healthy volunteers (mean age, 40 years ± 13 [standard deviation], 10 women) and 20 patients with MS (mean age, 58 years ± 8; 15 women) who underwent MRI between November 2017 and February 2019 were prospectively included. Analysis of variance was performed to evaluate the signal difference between MS lesions and normal-appearing white matter in patients with MS. Results High signal intensity and corresponding T2* and T1 of the extracted myelin vesicles provided evidence for direct imaging of ultrashort-T2 myelin protons using the UTE sequence. Gadobenate dimeglumine phantoms with a wide range of T1 values were selectively suppressed with DESIRE UTE. In the ex vivo brain study of MS lesions, signal loss was observed in MS lesions and was conformed with histologic analysis. In the human study, there was a significant reduction in normalized signal intensity in MS lesions compared with that in normal-appearing white matter (0.19 ± 0.10 vs 0.76 ± 0.11, respectively; P < .001). Conclusion The double-echo sliding inversion recovery ultrashort echo time sequence can generate whole-brain myelin images specifically with a clinical 3-T scanner. © RSNA, 2019 Online supplemental material is available for this article. See also the editorial by Port in this issue.

Project description:PurposeTo evaluate three-dimensional (3D) ultrashort echo time (UTE) MRI regarding image quality and suitability for functional image analysis using gradient-echo sequences in breath-hold and with self-navigation.Materials and methodsIn this prospective exploratory study, 10 patients (mean age, 21 years; age range, 5-58 years; five men) and 10 healthy control participants (mean age, 25 years; age range, 10-39 years; five men) underwent 3D UTE MRI at 3.0 T. Imaging was performed with a prototypical stack-of-spirals 3D UTE sequence during single breath holds (echo time [TE], 0.05 msec) and with a self-navigated "Koosh ball" 3D UTE sequence at free breathing (TE, 0.03 msec). Image quality was rated on a four-point Likert scale. Edge sharpness was calculated. After semiautomated segmentation, fractional ventilation was calculated from MRI signal intensity (FVSI) and volume change (FVVol). The air volume fraction (AVF) was estimated from relative signal intensity (aortic blood signal intensity was used as a reference). Means were compared between techniques and participants. The Wilcoxon signed rank test and Spearman rank correlation were used for statistical analyses.ResultsImage quality ratings were equal for both techniques. However, stack-of-spirals breath-hold UTE was more susceptible to motion and aliasing artifacts. Mean FVSI was higher during breath hold than at free breathing (mean ± standard deviation in milliliters of gas per milliliters of parenchyma, 0.17 mL/mL ± 0.06 [minimum, 0.07; maximum, 0.34] vs 0.11 mL/mL ± 0.03 [minimum, 0.06; maximum, 0.17], P = .016). Mean FVSI and FVVol were in good agreement (mean difference: at breath hold, -0.008 [95% confidence interval {CI}: 0.007, -0.024]; ρ = 0.97 vs free breathing, -0.004 [95% CI: 0.007, -0.016]; ρ = 0.91). AVF correlated between both techniques (ρ = 0.94).ConclusionBreath-hold and self-navigated 3D UTE sequences yield proton density-weighted images of the lungs that are similar in quality, and both techniques are suitable for functional image analysis.Supplemental material is available for this article.© RSNA, 2020.

Dataset Information

Association Between T₂ ^* Relaxation Times Derived From Ultrashort Echo Time MRI and Symptoms During Exercise Therapy for Patellar Tendinopathy: A Large Prospective Study.

Background

Purpose

Study type

Subjects

Field strength/sequence

Assessment

Statistical tests

Results

Data conclusion

Evidence level

Similar Datasets

OmicsDI is part of the ELIXIR infrastructure

Tweets

Dataset Information

Association Between T2 * Relaxation Times Derived From Ultrashort Echo Time MRI and Symptoms During Exercise Therapy for Patellar Tendinopathy: A Large Prospective Study.

Background

Purpose

Study type

Subjects

Field strength/sequence

Assessment

Statistical tests

Results

Data conclusion

Evidence level

Similar Datasets

OmicsDI is part of the ELIXIR infrastructure

Tweets

Association Between T₂ ^* Relaxation Times Derived From Ultrashort Echo Time MRI and Symptoms During Exercise Therapy for Patellar Tendinopathy: A Large Prospective Study.