Tim Finkenstaedt

Metallic artifacts from internal scaphoid fracture fixation screws: Comparison between C-Arm flat-panel, cone-beam, and multidetector computed tomography

ObjectivesThe aim of this study was to compare image quality and extent of artifacts from scaphoid fracture fixation screws using different computed tomography (CT) modalities and radiation dose protocols. Materials and MethodsImaging of 6 cadaveric wrists with artificial scaphoid fractures and different fixation screws was performed in 2 screw positions (45° and 90° orientation in relation to the x/y-axis) using multidetector CT (MDCT) and 2 flat-panel CT modalities, C-arm flat-panel CT (FPCT) and cone-beam CT (CBCT), the latter 2 with low and standard radiation dose protocols. Mean cartilage attenuation and metal artifact–induced absolute Hounsfield unit changes (= artifact extent) were measured. Two independent radiologists evaluated different image quality criteria using a 5-point Likert-scale. Interreader agreements (Cohen &kgr;) were calculated. Mean absolute Hounsfield unit changes and quality ratings were compared using Friedman and Wilcoxon signed-rank tests. ResultsArtifact extent was significantly smaller for MDCT and standard-dose FPCT compared with CBCT low- and standard-dose acquisitions (all P < 0.05). No significant differences in artifact extent among different screw types and scanning positions were noted (P > 0.05). Both MDCT and FPCT standard-dose protocols showed equal ratings for screw bone interface, fracture line, and trabecular bone evaluation (P = 0.06, 0.2, and 0.2, respectively) and performed significantly better than FPCT low- and CBCT low- and standard-dose acquisitions (all P < 0.05). Good interreader agreement was found for image quality comparisons (Cohen &kgr; = 0.76–0.78). ConclusionsBoth MDCT and FPCT standard-dose acquisition showed comparatively less metal-induced artifacts and better overall image quality compared with FPCT low-dose and both CBCT acquisitions. Flat-panel CT may provide sufficient image quality to serve as a versatile CT alternative for postoperative imaging of internally fixated wrist fractures.

The IVIM signal in the healthy cerebral gray matter: A play of spherical and non-spherical components

ABSTRACT The intra‐voxel incoherent motion (IVIM) model assumes that blood flowing in isotropically distributed capillary segments induces a phase dispersion of the MR signal, which increases the signal attenuation in diffusion‐weighted images. However, in most tissue types the capillary network has an anisotropic micro‐architecture. In this study, we investigated the possibility to indirectly infer the anisotropy of the capillary network in the healthy cerebral gray matter by evaluating the dependence of the IVIM signal from the direction of the diffusion‐encoding. Perfusion‐related indices and self‐diffusion were modelled as symmetric rank 2 tensors. The geometry of the tensors was quantified pixel‐wise by decomposing the tensor in sphere‐like, plane‐like, and line‐like components. Additionally, trace and fractional anisotropy of the tensors were computed. While the self‐diffusion tensor is dominated by a spherical geometry with a residual contribution of the non‐spherical components, both, fraction of perfusion and pseudo‐diffusion, present a substantial (in the order of 30%) contribution of planar and linear components to the tensor metrics. This study shows that the IVIM perfusion estimates in the cerebral gray matter present a detectable deviation from the spherical model. These non‐spherical components may reflect the direction‐dependent morphology of the microcirculation. Therefore, the tensor generalization of the IVIM model may provide a tool for the non‐invasive monitoring of cerebral capillary micro‐architecture during development, aging or in pathologies. Graphical abstract Figure. No Caption available. HighlightsTensor analysis reveals anisotropy of the IVIM signal in cerebral gray matter.Planar and linear components contribute to approx. 30% of the metric of the tensors.Fraction of perfusion anisotropy may reflect the morphometry of the microcirculation.The anisotropy of the pseudo‐diffusion may provide functional information.IVIM tensor imaging allows for quantitative characterization of microcirculation.

Cross-Sectional Area of the Rotator Cuff Muscles in MRI - Is there Evidence for a Biomechanical Balanced Shoulder?

Objective To provide in-vivo evidence for the common biomechanical concept of transverse and craniocaudal force couples in the shoulder that are yielded by both the rotator cuff muscles (RCM) and the deltoid and to quantitatively evaluate and correlate the cross-sectional areas (CSA) of the corresponding RCM as a surrogate marker for muscle strength using MRI. Materials and Methods Fifty patients (mean age, 36 years; age range, 18–57 years; 41 male, 9 female) without rotator cuff tears were included in this retrospective study. Data were assessed by two readers. The CSA (mm2) of all rotator cuff muscles was measured on parasagittal T1-weighted FSE sequence at two different positions (at the established “y-position” and at a more medial slice in the presumably maximal CSA for each muscle, i.e., the “set position”). The CSA of the deltoid was measured on axial intermediate-weighted FSE sequences at three positions. CSA measurements were obtained using 1.5 Tesla MR-arthrographic shoulder. Pearson’s correlation for the corresponding CSA of the force couple as well as was the intraclass correlation coefficient for the inter- and intra-reader agreement was calculated. Results The mean CSA was 770 mm2 (±167) and 841 mm2 (±191) for the supraspinatus (in the y- and set-positions, respectively) and 984 mm2 (±241) and 1568 mm2 (±338) for the infraspinatus. The mean CSA was 446 mm2 (±129) and 438 mm2 (±128) for the teres minor (in the y- and set-positions, respectively) and 1953 mm2 (±553) and 2343 mm2 (±587) for the subscapularis. The three measurements of the deltoid revealed a CSA of 3063 mm2 (±839) for the upper edge, 3829 mm2 (±836) for the lower edge and 4069 mm2 (±937) for the middle of the glenoid. At the set position Pearson’s correlation of the transverse force couple (subscapularis/infraspinatus) showed a moderate positive correlation of r = 0.583 (p<0.0001) and a strong correlation when the CSA of the teres minor was added to the infraspinatus CSA (r = 0.665, p = 0.0008) and a strong positive correlation of the craniocaudal force couple (supraspinatus/deltoid) that ranged from r = 0.565–0.698 (p<0.0001). Inter-reader agreement (ranged from 0.841 to 0.997, p = 0.0007) and intra-reader agreement were excellent (ranged from 0.863 to 0.999, p = 0.0006). Conclusion The significant correlation of the CSA of the RCM that form the transverse (subscapularis/infraspinatus-teres minor) and craniocaudal (supraspinatus/deltoid) force couple measured by MR-arthrography supports the biomechanical concept of a dynamically balanced shoulder in patients with an intact rotator cuff.

Investigation of the pulsatility of cerebrospinal fluid using cardiac-gated Intravoxel Incoherent Motion imaging

ABSTRACT The quantitative and non‐invasive monitoring of cerebrospinal fluid (CSF) dynamics and composition may have high clinical relevance in the management of CSF disorders. In this study, we propose the use of the Intravoxel Incoherent Motion (IVIM) MRI for obtaining simultaneous measurements of CSF self‐diffusion and fluid circulation. The rationale for this study was that turbulent fluid and mesoscopic fluid fluctuations can be modeled in a first approximation as a fast diffusion process. In this case, we expect that the fast fluid circulation and slower molecular diffusion dynamics can be quantified, assuming a bi‐exponential attenuation pattern of the diffusion‐weighted signal in MRI. IVIM indexes of fast and slow diffusion measured at different sites of the CSF system were systematically evaluated depending on both the phase of the heart cycle and the direction of the diffusion‐encoding. The IVIM measurements were compared to dynamic measurements of fluid circulation performed by phase‐contrast MRI. Concerning the dependence on the diffusion/flow‐encoding direction, similar patterns were found both in the fraction of fast diffusion, f, and in the fluid velocity. Generally, we observed a moderate to high correlation between the fraction of fast diffusion and the maximum fluid velocity along the high‐flow directions. Exploratory data analysis detected similarities in the dependency of the fraction of fast diffusion and of the velocity from the phase of the cardiac cycle. However, no significant differences were found between parameters measured during different phases of the cardiac cycle. Our results suggest that the fraction of fast diffusion may reflect CSF circulation. The bi‐exponential IVIM model potentially allows us to disentangle the two diffusion components of the CSF dynamics by providing measurements of fluid cellularity (via the slow‐diffusion coefficient) and circulation (via the fraction of fast‐diffusion index). Graphical abstract Figure. No Caption available. HighlightsThe fraction of fast diffusion in the IVIM model reflects CSF circulation.Cardiac‐gated IVIM measures fluid diffusion and circulation.IVIM complements phase‐contrast MRI in the assessment of CSF dynamics.

Patterns of cartilage degeneration in knees with medial tibiofemoral offset

ObjectiveTo determine if radiographic medial tibiofemoral offset (MTFO) is associated with: (1) magnetic resonance imaging (MRI) pathology of cartilage, meniscus, and ligament; and (2) a distinct pattern of lateral cartilage degeneration on MRI.Materials and methodsThree hundred consecutive adult knee MRIs with anteroposterior (AP) radiographs were retrospectively reviewed, and 145 studies were included. MTFO was defined as a medial extension of the medial femoral condyle beyond the articular surface of the medial tibial plateau on weight-bearing AP radiographs. The patients were then divided into the MTFO (n = 61) or no-offset (n = 84) groups. On MRI data obtained on a 1.5-Tesla system, articular cartilage of the femoral condyle and tibial plateau were graded using a modified Outerbridge classification (36 sub-regions similar to whole-organ MRI Score (WORMS) system). In addition, MR pathology of the ACL, MCL, LCL, medial and lateral menisci, were determined.ResultsSignificantly increased (ANOVA p < 0.007) MR grade of the ligaments, menisci, and cartilage in the MTFO group (ranging from 0.3 to 2.5) compared to the control group (0.2 to 1.1). Color maps of the cartilage grades suggested a marked difference in both severity of degeneration and regional variations between the groups. MTFO group exhibited focally increased cartilage grades in the central, non-weight regions of lateral compartment (region p = 0.07 to 0.12, interaction p = 0.05 to 0.1).ConclusionsMTFO is associated with overall degeneration of the knee and features a distinct lateral cartilage degeneration pattern, which may reflect non-physiologic contact of the cartilage between the lateral tibial eminence and lateral central femoral condyle.

Gouty arthritis: Can we avoid unnecessary dual-energy CT examinations using prior radiographs?

Objective The dual-energy CT (DECT) algorithm for urate detection is feasible only if hyperdense deposits are present. Based on our experience, around half of the performed DECT examinations show no such deposits and thus were useless for this indication. Our diagnostic accuracy study investigates whether conventional radiographs can serve as gatekeeper test prior to DECT for reliable exclusion of such radiopaque deposits. Materials and methods In this retrospective study, 77 clinically indicated DECT examinations of the hand (n = 29), foot (n = 36) and ankle (n = 12) of 55 patients (13 female, mean age 62±15 years) with suspected gouty arthritis were included. Two blinded readers independently evaluated DECT, gray-scale CT images (reference standard) and corresponding standardized radiographs for the presence/location of dense soft tissue deposits. Results Interreader agreement for detection of soft tissue deposits with DECT and radiographs was excellent (DECT: both readers, κ = 1; radiographs: both readers, κ = 0.94). DECT showed soft tissue deposits in 54/77 DECT (70%) scans. 30/54 scans (56%) showed deposits on the corresponding radiographs, while in 24 scans (44%) no deposits were seen on radiographs. Test performance of radiographs for soft tissue deposit detection: sensitivity 56%, specificity 100%, PPV 100%, NPV 48.9%, and accuracy 69%. Low density of the deposits was the main reasons for false-negative radiographs (19 cases, 79%), followed by superimposition of deposits by osseous structures (5 cases, 21%). Conclusion Conventional radiographs of the hand, foot and ankle cannot serve as a gatekeeper test for reliable exclusion of radiopaque soft tissue deposits prior to DECT.

Modic Type 1 Changes: Detection Performance of Fat-Suppressed Fluid-Sensitive MRI Sequences

PURPOSE To assess the performance of fat-suppressed fluid-sensitive MRI sequences compared to T1-weighted (T1w) / T2w sequences for the detection of Modic 1 end-plate changes on lumbar spine MRI. MATERIALS AND METHODS Sagittal T1w, T2w, and fat-suppressed fluid-sensitive MRI images of 100 consecutive patients (consequently 500 vertebral segments; 52 female, mean age 74 ± 7.4 years; 48 male, mean age 71 ± 6.3 years) were retrospectively evaluated. We recorded the presence (yes/no) and extension (i. e., Likert-scale of height, volume, and end-plate extension) of Modic I changes in T1w/T2w sequences and compared the results to fat-suppressed fluid-sensitive sequences (McNemar/Wilcoxon-signed-rank test). RESULTS Fat-suppressed fluid-sensitive sequences revealed significantly more Modic I changes compared to T1w/T2w sequences (156 vs. 93 segments, respectively; p < 0.001). The extension of Modic I changes in fat-suppressed fluid-sensitive sequences was significantly larger compared to T1w/T2w sequences (height: 2.53 ± 0.82 vs. 2.27 ± 0.79, volume: 2.35 ± 0.76 vs. 2.1 ± 0.65, end-plate: 2.46 ± 0.76 vs. 2.19 ± 0.81), (p < 0.05). Modic I changes that were only visible in fat-suppressed fluid-sensitive sequences but not in T1w/T2w sequences were significantly smaller compared to Modic I changes that were also visible in T1w/T2w sequences (p < 0.05). CONCLUSION In conclusion, fat-suppressed fluid-sensitive MRI sequences revealed significantly more Modic I end-plate changes and demonstrated a greater extent compared to standard T1w/T2w imaging. KEY POINTS · When the Modic classification was defined in 1988, T2w sequences were heavily T2-weighted and thus virtually fat-suppressed.. · Nowadays, the bright fat signal in T2w images masks edema-like changes.. · The conventional definition of Modic I changes is not fully applicable anymore.. · Fat-suppressed fluid-sensitive MRI sequences revealed more/greater extent of Modic I changes.. CITATION FORMAT · Finkenstaedt T, Del Grande F, Bolog N et al. Modic Type 1 Changes: Detection Performance of Fat-Suppressed Fluid-Sensitive MRI Sequences. Fortschr Röntgenstr 2018; 190: 152 - 160.

Non-parametric intravoxel incoherent motion analysis of the thyroid gland

Purpose To implement a protocol for intravoxel incoherent motion (IVIM) of the thyroid, to determine base parameters in healthy volunteers, and to provide preliminary experience on clinical applicability in one patient. Materials and methods Eight healthy volunteers underwent 3T MRI using a diffusion weighted echo-planar imaging sequence with 12 different b-values between 0–800 s/mm2. The IVIM parameters diffusion coefficient D, pseudo-diffusion coefficient D*, perfusion fraction Fp, and the optimal b-values thresholds were calculated for each thyroid lobe, muscle tissue and the cerebrospinal fluid (CSF) using a non-parametric multi-step algorithm and compared with a Students t-test. A p-value <0.05 was considered significant. Results Mean values for healthy thyroid tissue were: D 1.01 ± 0.13 × 10−3 mm2/s, D* 71.0 ± 52.5 × 10−3 mm2/s and Fp 17.1 ± 4.2%; for muscle: D 0.50 ± 0.21 × 10−3 mm2/s, D* 58.3 ± 99.2 × 10−3 mm2/s and Fp 26.5 ± 9.3%; and for CSF D 2.18 ± 0.93 × 10−3 mm2/s, D* 99.2 ± 41.2 × 10−3 mm2/s and Fp 74.6 ± 12.7%. The optimal b-value threshold separating diffusion and perfusion effects in thyroid ranged between 0–70 s/mm2. Healthy thyroid tissue showed similar Fp compared to muscle, both lower than CSF. Conclusions The proposed IVIM protocol provides surrogate markers on cellular diffusion restriction and perfusion; thereby providing a more comprehensive description of tissue properties compared to conventional DWI.