Quantitative MRI for Evaluation of Musculoskeletal Disease

Abstract

Magnetic resonance imaging (MRI) is a valuable tool for evaluating musculoskeletal disease as it offers a range of image contrasts that are sensitive to underlying tissue biochemical composition and microstructure. Although MRI has the ability to provide high-resolution, information-rich images suitable for musculoskeletal applications, most MRI utilization remains in qualitative evaluation. Quantitative MRI (qMRI) provides additional value beyond qualitative assessment via objective metrics that can support disease characterization, disease progression monitoring, or therapy response. In this review, musculoskeletal qMRI techniques are summarized with a focus on techniques developed for osteoarthritis evaluation. Cartilage compositional MRI methods are described with a detailed discussion on relaxometric mapping (T2, T2*, T1ρ) without contrast agents. Methods to assess inflammation are described, including perfusion imaging, volume and signal changes, contrast-enhanced T1 mapping, and semiquantitative scoring systems. Quantitative characterization of structure and function by bone shape modeling and joint kinematics are described. Muscle evaluation by qMRI is discussed, including size (area, volume), relaxometric mapping (T1, T2, T1ρ), fat fraction quantification, diffusion imaging, and metabolic assessment by 31P-MR and creatine chemical exchange saturation transfer. Other notable technologies to support qMRI in musculoskeletal evaluation are described, including magnetic resonance fingerprinting, ultrashort echo time imaging, ultrahigh-field MRI, and hybrid MRI-positron emission tomography. Challenges for adopting and using qMRI in musculoskeletal evaluation are discussed, including the need for metal artifact suppression and qMRI standardization.

Hip Muscle Atrophy and Hip Osteoarthritis-Evidence and Continuing Challenges

“…The discussions here do not focus on the nature of the research design to any degree, but rather focus on either what appears to be the impact of hip osteoarthritis on one or more surrounding muscles as manifest by changes in muscle size and composition, or the less well accepted idea of muscle mass and its properties as a causative or hip osteoarthritis mediating factor [15,18]. Although increasing numbers of articles have discussed other aspects of muscle rather than muscle mass or size, it was assumed muscle atrophy and/or its association with joint instability, muscle fibrosis and fat infiltration may be an understudied albeit clinically important contributing factors to hip osteoarthritis pathology that may also be expected to produce disturbances of cartilage metabolism and consequent manifestations of joint degeneration [19][20][21][22][23][24][25][26].…”

Osteoarthritis, part of life or a curable disease? A bird's‐eye view

“…For research purposes, a number of new MRI sequences and processing techniques have been developed to determine the changes of joint structures, including cartilage morphometry [61] and changes to bone shape [62]. In addition, compositional in vivo imaging techniques with MRI-such as T2 and T1rho relaxation time mapping-will provide new insights, in particular into the early development of OA, whereas joint structures are relatively macroscopically intact [63,64]. These techniques may also serve as potential tools in clinical trials to increase sensitivity to change with respect to early structural changes.…”

Radiomics and Deep Learning for Disease Detection in Musculoskeletal Radiology

“…Next to ligament and meniscus tear detection and characterization, the assessment of articular cartilage integrity is a major indication for knee MRI, particularly in patients with disproportionate symptoms and findings on radiographs 73 . Owing to the high contrast resolution, MRI has the highest diagnostic imaging performance for detecting cartilage lesions, in particular when applying high spatial resolution and cartilage-accentuating contrast pulse sequences.…”

“…Next to ligament and meniscus tear detection and characterization, the assessment of articular cartilage integrity is a major indication for knee MRI, particularly in patients with disproportionate symptoms and findings on radiographs. 73 Owing to the high contrast resolution, MRI has the highest diagnostic imaging performance for detecting cartilage lesions, in particular when applying high spatial resolution and cartilage-accentuating contrast pulse sequences. Although the published diagnostic performance of MRI for detecting cartilage defects varies substantially, some studies report sensitivities and specificities of up to 100% when using optimized pulse sequence parameters, particularly in regions with high cartilage thickness, such as the patellar articular cartilage.…”