Evaluation of normal cadaveric Achilles tendon and enthesis with ultrashort echo time (UTE) magnetic resonance imaging and indentation testing

Chen, Bimin; Cheng, Xin; Dorthé, Erik W.; Zhao, Yinghua; D’Lima, Darryl D.; Bydder, Graeme M.; Liu, Sirun; Du, Jiang; Ma, Yajun

doi:10.1002/nbm.4034

Cited by 29 publications

(33 citation statements)

References 27 publications

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“…The authors stressed the utility of this sequence in morphological and quantitative evaluation of enthesitis in PsA patients (79). The same group recently explored the MRI morphology of Achilles tendons and entheses using high resolution MRI UTE sequences, and described its utility as biomarkers of biomechanical degradation of entheses in SpA (80).…”

Section: Recent Advances In the Field Of Mri Enthesitis In Spamentioning

confidence: 99%

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Magnetic Resonance Imaging of Enthesitis in Spondyloarthritis, Including Psoriatic Arthritis—Status and Recent Advances

Mathew

Østergaard

2020

Front. Med.

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Enthesitis, inflammation at the attachment sites of tendons, ligaments, fascia, and joint capsules to bones plays a critical role in the pathogenesis of spondyloarthritis (SpA), including psoriatic arthritis (PsA). Magnetic resonance imaging (MRI) has aided in a better understanding of pathophysiology, early diagnosis, prognostication, therapeutic outcomes, and follow up of enthesitis. The concept of enthesitis as a focal insertional pathology has transformed over the past decade, with the help of MRI, to a more widespread entity involving both bone and surrounding soft tissues. The utility of MRI in the differential diagnosis of suspected enthesitis has recently been explored. With the emergence of the treat-to-target concept, and a domain-based approach in the management of SpA, objective and sensitive monitoring of response to targeted therapy becomes prudent. Properties like high sensitivity, ability to image intra-osseous pathology along with surrounding structures exemplify the utility of MRI technology. Considering the lack of a comprehensive, validated MRI score the Outcome Measures in Rheumatology (OMERACT) MRI in Arthritis Working Group, informed by a systematic literature review, developed the first international, consensus-based MRI-scoring system, combined with MRI definitions of pathologies for enthesitis in patients with spondyloarthritis (SpA) and PsA. An atlas with representative images of each grade of the scoring system was subsequently developed by the group to aid readers interested in using the heel enthesitis MRI scoring system (HEMRIS). The HEMRIS can find utility in clinical trials targeting enthesitis as the primary outcome. MRI also finds value for global assessment of the total burden of enthesitis. The concept of whole-body MRI (WBMRI), enabling visualization of entheses throughout the body using a single image is relatively new. The MRI whole-body score for inflammation in peripheral joints and entheses (MRI-WIPE) is a promising scoring system, which is undergoing further testing in clinical trials and longitudinal cohorts evaluating global measures of inflammation at entheses. This review discusses the role of MRI in diagnosis and monitoring of enthesitis in SpA and PsA, along with recent advances in the field, based on published literature.

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Section: Recent Advances In the Field Of Mri Enthesitis In Spamentioning

confidence: 99%

“…(a,b) Courtesy of Professor Iris Eshed, Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel. (c,d) have been taken from the OMERACT MRI heel enthesitis exercises(27,80).…”

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confidence: 99%

Magnetic Resonance Imaging of Enthesitis in Spondyloarthritis, Including Psoriatic Arthritis—Status and Recent Advances

Mathew

Østergaard

2020

Front. Med.

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“…Ultrashort echo time (UTE) sequences with echo times <100 µs can detect fast decaying signals and provide a much higher signal to noise ratio for short T 2 tissues than conventional clinical gradient recalled echo–type sequences with much longer echo times . In the past decade, these UTE sequences have been widely investigated for both morphological and quantitative imaging of short T 2 tissues, including calcified cartilage, menisci, tendons, ligaments, bone, and myelin …”

Section: Introductionmentioning

confidence: 99%

“…1 In the past decade, these UTE sequences have been widely investigated for both morphological and quantitative imaging of short T 2 tissues, including calcified cartilage, menisci, tendons, ligaments, bone, and myelin. [2][3][4][5][6][7] Fat suppression is very important for UTE imaging of musculoskeletal tissues. [8][9][10] This is because UTE imaging tends to show a high fat signal, attributed to fat's high proton density and short T 1 value, which lead to low contrast for short T 2 tissues.…”

Section: Introductionmentioning

confidence: 99%

Fat suppression for ultrashort echo time imaging using a novel soft‐hard composite radiofrequency pulse

Jerban

Jang

et al. 2019

Magnetic Resonance in Med

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Purpose To design a soft‐hard composite pulse for fat suppression and water excitation in ultrashort echo time (UTE) imaging with minimal short T2 signal attenuation. Methods The composite pulse contains a narrow bandwidth soft pulse centered on the fat peak with a small negative flip angle (–α) and a short rectangular pulse with a small positive flip angle (α). The fat magnetization experiences both tipping‐down and ‐back with an identical flip angle and thus returns to the equilibrium state, leaving only the excited water magnetization. Bloch simulations, as well as knee, tibia, and ankle UTE imaging studies, were performed to investigate the effectiveness of fat suppression and corresponding water signal attenuation. A conventional fat saturation (FatSat) module was used for comparison. Signal suppression ratio (SSR), defined as the ratio of signal difference between non‐fat‐suppression and fat‐suppression images over the non‐fat‐suppression signal, was introduced to evaluate the efficiency of the composite pulse. Results Numerical simulations demonstrate that the soft‐hard pulse has little saturation effect on short T2 water signals. Knee, tibia, and ankle UTE imaging results suggest that comparable fat suppression can be achieved with the soft‐hard pulse and the FatSat module. However, much less water saturation is induced by the soft‐hard pulse, especially for short T2 tissues, with SSRs reduced from 71.8 ± 6.9% to 5.8 ± 4.4% for meniscus, from 68.7 ± 5.5% to 7.7 ± 7.6% for bone, and from 62.9 ± 12.0% to 4.8 ± 3.2% for the Achilles tendon. Conclusion The soft‐hard composite pulse can suppress fat signals in UTE imaging with little signal attenuation on short T2 tissues.

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“…42 UTE-T2* values have been shown to be sensitive to these biochemical collagen matrix changes. [6][7][8]38 Moreover, this technique has been used by several scholars to assess the biochemical healing process of short T2 tissue. 3,10,30 For instance, Biercevicz et al 3 reported that UTE-T2* values were significantly associated with structural properties as determined by tensile testing regarding the healing of the anterior cruciate ligament.…”

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confidence: 99%

Quantitative Magnetic Resonance Imaging UTE-T2* Mapping of Tendon Healing After Arthroscopic Rotator Cuff Repair: A Longitudinal Study

Xie

Liu

et al. 2020

Am J Sports Med

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Background: Quantitative ultrashort echo time–T2* (UTE-T2*) mapping shows promise for the detection of potential tendon biochemical conditions, while validation against established clinical studies in the shoulder is needed. Purpose: To evaluate and characterize the healing process of the repaired rotator cuff based on longitudinal changes in UTE-T2* values, clinical outcomes, and repair status in patients after arthroscopic rotator cuff repair (ARCR). Study Design: Cohort study; Level of evidence, 2. Methods: Patients with ARCR (n = 25) underwent quantitative MRI and clinical examinations at serial follow-up time points: 3, 6, 12, and 24 months postoperatively. Age-matched healthy controls (n = 15) were evaluated at 3 and 12 months after enrollment. Clinical scores included the Constant, American Shoulder and Elbow Surgeons, and Fudan University Shoulder score, and visual analog scale for pain. The MRI examination included UTE-T2*mapping. UTE-T2* maps were generated for T2* values at the healing site. Sugaya classification was adopted to evaluate the repair status. Longitudinal analyses of clinical outcomes, UTE-T2* changes, and Sugaya classification were conducted. Results: The overall retear rate was 8% (2/25, all Sugaya type IV). All patients (including the ones with retear) achieved satisfactory outcomes at 12 months that lasted to 24 months on the basis of clinical scores. The mean UTE-T2* values at the healing site showed an increase from 3 to 6 months ( P = .03) and then decreased to a level similar to that observed in age-matched healthy tendons at 12 months ( P = .1). No significant differences were found between UTE-T2* values at 12 and 24 months ( P = .6). UTE-T2* values at the healing site significantly varied with the repair status according to Sugaya classification ( P < .05). Moreover, significant correlations were noted between clinical scores and UTE-T2* values at 6 months ( r = −0.6 to −0.3; all P < .05) and 12 months ( r = −0.6 to −0.2; all P < .05). Conclusion: This study indicated a healing-related relationship between clinical outcomes and quantitative UTE-T2* values, which highlights the potential of using UTE-T2* mapping to track the tendon-healing process noninvasively. Moreover, the repaired tendon was comparable to age-matched healthy controls at 12-month follow-up based on UTE-T2* values.

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Evaluation of normal cadaveric Achilles tendon and enthesis with ultrashort echo time (UTE) magnetic resonance imaging and indentation testing

Cited by 29 publications

References 27 publications

Magnetic Resonance Imaging of Enthesitis in Spondyloarthritis, Including Psoriatic Arthritis—Status and Recent Advances

Magnetic Resonance Imaging of Enthesitis in Spondyloarthritis, Including Psoriatic Arthritis—Status and Recent Advances

Fat suppression for ultrashort echo time imaging using a novel soft‐hard composite radiofrequency pulse

Quantitative Magnetic Resonance Imaging UTE-T2* Mapping of Tendon Healing After Arthroscopic Rotator Cuff Repair: A Longitudinal Study

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