RPS 710 - Sports imaging

Author Block: K. L. Radke, B. Valentin, A. Müller-Lutz, M. Frenken; Düsseldorf/DE
Purpose: The purpose of this study was to examine the potential of differently composed MR sequences, including T1, T2, T2* and T1ρ, in assessing cartilage regeneration. These MR techniques were compared to dGEMRIC, providing valuable insight into non-invasive methods for monitoring and assessing cartilage repair after surgery.
Methods or Background: In orthopaedics, assessing articular cartilage regeneration safely and effectively remains a challenge, despite advancements in compositional MRI. We aimed to investigate the efficacy of various compositional MR sequences in quantitatively assessing cartilage and compare them to the gold standard, delayed gadolinium-enhanced MR imaging of cartilage (dGEMRIC).
In a preclinical minipig model, we induced standardised osteochondral defects in the proximal femur of 14 animals, divided into four groups: porcine collagen scaffolds with autologous adipose stromal cells (ASC), autologous bone marrow stromal cells (BMSC), unpopulated scaffolds (US), and an untreated defect group. After six months, we employed different MR composition methods, including dGEMRIC, T1, T2, T2*, and T1ρ, using a clinical 3T MR scanner.
Results or Findings: Results showed significant differences in the untreated defect group, with lower dGEMRIC values (404.86±64.2 ms, P=0.018) and higher T2 times (44.24±2.75 ms, P<0.001) in the defect region. Conversely, there were no significant differences in dGEMRIC values among the three treatment groups (ASC, BMSC, US), indicating successful cartilage reconstruction.
Conclusion: Notably, dGEMRIC proved effective for monitoring cartilage regeneration. Interestingly, T2 imaging emerged as a reliable alternative, offering non-contrast cartilage imaging for future in vivo studies exploring different treatment modalities' cartilage regeneration potential.
Limitations: These results have not yet been translated from animal to human.
Funding for this study: Funding was received from the University of Düsseldorf, Deutsche Arthrose-Hilfe.
Has your study been approved by an ethics committee? Yes
Ethics committee - additional information: The study was approved by the Ethics Committee of the University of Düsseldorf.

Author Block: A. Gökduman; Frankfurt a. Main/DE
Purpose: The purpose of this study was to investigate the diagnostic accuracy of limited magnetic resonance imaging for acute ankle injuries in patients with negative plain radiographs.
Methods or Background: Patients that had undergone a routinely performed 3-T MRI scan after acute trauma of the upper ankle with unremarkable plain radiographs (within a two-week interval) were eligible for study inclusion in this retrospective study. For reference, standard definition five radiologists blinded to clinical information evaluated the full MRI study (PD-weighted fat-saturated axial, coronal, and sagittal sequences, and T1-weighted coronal/sagittal sequences) in consensus reading sessions. After six weeks, the studies were independently reevaluated by utilising only PD-weighted fat-saturated coronal sequences. Sensitivity, specificity, and accuracy for injuries of the most relevant bone structures (tibia, fibula, and talus), ligaments (syndesmotic, medial, and lateral ligaments), and tendons (tibialis and peroneal tendons) assessed by application of a binary classification (0=no injury, 1=injury) were the primary metrics of diagnostic performance. Diagnostic confidence was rated by the usage of a 5-point Likert scale (1=low; 5=high).
Results or Findings: 137 patients were enrolled in this study. A total of 108 bone injuries, 126 ligament injuries, and 5 tendon injuries were defined by the consensus. Limited MRI showed overall high diagnostic accuracy for assessing bone (sensitivity: 97%, specificity: 93%, accuracy: 95%), ligament (sensitivity: 92%, specificity: 94%, accuracy: 93%), and tendon (sensitivity: 80%, specificity: 100%, accuracy: 90%) injuries in comparison to full MRI (p<0.01). Diagnostic confidence was comparable (scores: 4.37/5 vs 4.41/5; p=0.12) and interreader agreement for limited MRI was high (K=0.83).
Conclusion: Limited MRI provides high diagnostic accuracy and confidence for assessing acute trauma injuries of the upper ankle.
Limitations: No limitations were identified.
Funding for this study: No funding was received for this study.
Has your study been approved by an ethics committee? Yes
Ethics committee - additional information: This study was approved by vote through the relevant Ethics Board.

Author Block: M. R. Akram, N. Rajamohan, A. Chhabra, G. Liu, M. VanPelt, Y. Xi, F. Duarte Silva; Dallas, TX/US
Purpose: Peroneal compartment pathology (PCP) is a common yet underdiagnosed source of lateral ankle pain, often requiring clinical examination and imaging for diagnosis. Current literature lacks research on 3D MRI accuracy for PCP. We investigated interreader reliability (IRR) for PCP using parallel 2D and 3D ankle MRIs, hypothesising higher IRR and accuracy with this combined analysis than with 2D alone.
Methods or Background: We retrospectively screened 634 patients with 3-Tesla ankle MRIs, including multiplanar proton density DIXON and isotropic 3D fast-spin echo acquisitions (3DFSE), and excluded patients with unretrievable operative reports or prior peroneal compartment surgery. Our final sample comprised 27 scans from 26 patients who underwent peroneal surgery at least six months post-MRI. Two radiologists (14- and 1-year post-musculoskeletal fellowship) analysed scans for peroneus brevis (PB) and peroneus longus (PL) tenosynovitis, tendinopathy, and tears. We evaluated IRR using intraclass correlation coefficient (ICC) and assessed sensitivity (Se) and specificity (Sp) against surgical results.
Results or Findings: IRR was good for PB/PL tendons (ICC=0.735-0.724, respectively) and common peroneal tenosynovitis (ICC=0.630), and was fair for PL/PB tenosynovitis (ICC=0.573-0.541, respectively). Surgical reports identified PB partial/split tears in 51.9% (MRI Se=63.6-83.3% and Sp=66.7-83.3%) and complete tears in 7.4% (MRI Se=25-100% and Sp=88.5-100%) of cases. Regarding the PL tendon, surgical reports identified 7.4% partial/split tears (MRI Se=0-28.6% and Sp=80-92%) and 3.7% complete tears (MRI Se=33.3-100% and Sp=93.2-100%). The readers identified an average of 31.5% PL tenosynovitis, 27.8% PB tenosynovitis, and 46.3% common peroneal tenosynovitis cases.
Conclusion: MR identification of PCP had moderate IRR with higher specificity than sensitivity. Additional 3D sequencing did not improve accuracy compared to prior literature.
Limitations: Surgical reports prioritised tears over tendinopathy details, which led to the merger of normal and tendinopathy subgroups and prevented us from analysing accuracy for tendinopathy.
Funding for this study: No funding was received for this study.
Has your study been approved by an ethics committee? Not applicable
Ethics committee - additional information: The study was retrospective.

Author Block: M. Basile¹, S. Gitto¹, C. Messina¹, Ž. Snoj², S. GIanola¹, S. Bargeri¹, G. Castellini¹, L. M. Sconfienza¹, D. Albano¹; ¹Milan/IT, ²Ljubljana/SI
Purpose: The purpose of this study was to compare pathologic and healthy tendons using shear-wave elastography (SWE).
Methods or Background: A systematic review with meta-analysis was conducted by searching Pubmed and EMBASE up to September 2022. Prospective, retrospective, and cross-sectional studies that used SWE in the assessment of pathologic tendons versus control were included. Our primary outcomes were SWE velocity (m/s) and stiffness (kPa). Methodological quality was assessed by the methodological index for non-randomized studies (MINORS). We used the mean difference (MD) with corresponding 95% confidence intervals (CIs) to quantify effects between groups. We performed sensitivity analysis in case of high heterogeneity, after excluding poor quality studies according to MINORS assessment. We used Grades of Recommendation, Assessment, Development and Evaluation to evaluate the certainty of evidence (CoE).
Results or Findings: Overall, 16 studies with 676 pathologic tendons (188 Achilles, 142 patellar, 96 supraspinatus, 250 mixed) and 723 control tendons (484 healthy; 239 contralateral tendon) were included. Five studies (31.3%) were judged as having poor methodological quality. Shear-wave velocity and stiffness meta-analyses showed high heterogeneity. According to a sensitivity analysis, pathologic tendons had a lower shear wave velocity (MD −1.69m/s; 95% CI -1.85; -1.52; n=274; I2 50%) compared to healthy tendons with very low CoE. Sensitivity analysis on stiffness still showed high heterogeneity.
Conclusion: Pathological tendons may have reduced SWE velocity compared to controls. Future robust high-quality longitudinal studies and clear technical indications on the use of this tool are needed.
Limitations: We included different a study design in order to obtain more literature, however this choice has incorporated some methodological heterogeneity.
Funding for this study: No funding was received for this study.
Has your study been approved by an ethics committee? Not applicable
Ethics committee - additional information: Institutional Review Board approval was not required because no patient data was used for this study.

Author Block: A. Lupi, D. Creazzo, M. Tordin, S. Zinato, E. Quaia, A. Pepe; Padua/IT
Purpose: In the context of magnetic resonance imaging (MRI), modern-day mapping techniques allow for precise and quantitative tissue characterisation and are increasingly widespread. In the musculoskeletal field, MRI finds extensive application thanks to its high soft tissue contrast. In specific clinical scenarios, T1/T2 mapping can be used as a valuable tool to provide skeletal muscle tissue characterisation. To the best of our knowledge, correlation between myocardial and skeletal muscle involvement has never been explored. The aim of our study is to evaluate muscle mapping in athletes with myocardial inflammation.
Methods or Background: We included competitive athletes consecutively referred to our center for a Cardiovascular Magnetic Resonance (CMR) (1.5T Siemens), that showed myocardial inflammation. T1 and T2 mapping values were extracted from single Regions of Interest (ROIs) manually traced always in the same back muscles included in the Field of View (latissimus dorsi or serratus anterior), both on MOLLI and T2p-SSFP images, and compared with reference values obtained in our Institute from fifty healthy volunteers stratified by age and sex. Image analysis was performed using cvi42.
Results or Findings: Fifteen patients; twelve males, mean age 50.1±14.7 years, with myocardial inflammation assessed with parametric and/ or nonparametric techniques, were included. Normal T1 and T2 mapping muscle values were found in four (26.6%) patients (mean T1 852.3±10.1ms and T2 38.8±1.5ms). In one female patient (6.7%) with peri-myocarditis by CMR, T2 mapping values turned out to be pathological (44.2ms, n.v. 30-42ms) and in ten male patients (66.6%) T1 mapping values turned out to be pathological (n.v. 762-853ms).
Conclusion: These preliminary results show that muscle oedema could be found in subjects with myocardial inflammation. Further studies on larger population and prognostic data are needed to better understand increased T1 mapping values significance.
Limitations: No limitations were identified.
Funding for this study: No funding was received for this study.
Has your study been approved by an ethics committee? Yes
Ethics committee - additional information: This study was approved by the Azienda Ospedale Università Padova.

Author Block: O. D. Rodriguez Martinez, P. S. Perez, M. E. Scherer, J. E. Prieto Terán, N. E. Alanis, I. Bidart, S. Centofante, E. Piedra, O. Montaña; Buenos Aires/AR
Purpose: The study purpose was to assess the anatomical variants prevalence of peroneal tendon tract in patients with external retromalleolar pain and define their association with the development of tendinopathies.
Methods or Background: A retrospective review of 1929 ankle MRI scans (Philips 1.5T) was performed between January and December 2022. We found 117 patients with peroneal tendon pathology in the context of external ankle pain. In these, the prevalence of convex/ flat retromalleolar sulcus (CFRS), hypertrophic peroneal tubercle of the calcaneus greater than 5mm (HPTC), peroneus quartus muscle (PQM), and os peroneum presence were evaluated as anatomical variants that could be predisposed to the development of pathology tendinous. Cases with fractures in the area of interest, people under 15 years old and over 80 years old, and studies with suboptimal imagen quality and/ or with acquisition artifacts such as magic angle were excluded from the study.
Results or Findings: In the 117 patients studied, it was found that 69% (n=81) had at least one anatomical variant in the peroneus tendons tract up to their distal insertions, with the loss of the concavity of the retromalleolar sulcus being the most frequent (65 cases). HPTC was the second most common variant, with eleven cases, and finally four cases of PQM were found. Only one case of os peroneum was found in analysed patients, probably due to the method used (MRI).
Conclusion: We found a high prevalence of SRCP and TPCH in association with peroneal tendinopathies. This demonstrates the importance of a systematic evaluation of these anatomical variants as possible causes of external retromalleolar pain, and its search and mention in routine ankle study is recommended.
Limitations: No limitations were identified.
Funding for this study: This study was funded by DIM.
Has your study been approved by an ethics committee? Not applicable
Ethics committee - additional information: The study is retrospective, so approval is not needed.

Author Block: L. D. Grünewald, V. Koch, C. Booz, S. Martin, S. Mahmoudi, T. Vogl; Frankfurt a. Main/DE
Purpose: Distal radius fractures (DRF) are among the most diagnosed fractures in emergency departments, and bone non-union can lead to persistent pain and functional limitations. Despite the clinical implications, there is currently no established approach to identify patients at risk of bone non-union. The purpose of this study was to evaluate various metrics derived from routine CT scans of the distal radius to identify patients at risk of bone non-union.
Methods or Background: The distal radius of patients who underwent dual-energy CT (DECT) between 01/2016 and 08/2021 was retrospectively analysed. Cortical HU, trabecular HU, cortical thickness, and DECT-based bone mineral density (BMD) were obtained from all examinations. Patient files and follow-up images of patients were examined for the occurrence of bone non-union. Receiver-operating characteristic (ROC) analysis identified AUC values for BMD, HU values, and cortical thickness, and logistic regression models were used to evaluate their associations with the occurrence of bone non-union.
Results or Findings: 263 patients (median age 52 years; interquartile range 36–64) were included in this study. ROC curve analysis demonstrated a significantly higher AUC value for DECT-derived BMD compared to cortical HU, trabecular HU and cortical thickness (0.83 vs. 0.63, 0.60 and 0.56, respectively; p<0.01). Logistic regression models confirmed a significant association of lower DECT-derived BMD with the occurrence of bone non-union (Odds Ratio, 0.93; p<0.001), but not of cortical HU, trabecular HU or cortical thickness (p>0.05 for all values, respectively).
Conclusion: CT examinations of the distal radius obtained in clinical routine may serve as a useful tool in identifying patients at risk of developing bone non-union. Dual-energy CT-derived bone mineral density is a better predictor of bone non-union compared to cortical HU, trabecular HU, and cortical thickness.
Limitations: The study is limited by the possibility of preselection bias, as well as the limiting of research to dual-energy CT scans.
Funding for this study: No funding was received for this study.
Has your study been approved by an ethics committee? Not applicable
Ethics committee - additional information: Written consent was waived due to the retrospective nature of the study.

Author Block: F. Lombardo, C. Longo, E. Oliboni, S. Crosara, G. Sala, T. Mignolli, G. Foti; Negrar/IT
Purpose: The purpose of this study was to evaluate the diagnostic accuracy of a deep learning- (DL) based protocol in identifying meniscal and ligament tears of the knee in comparison to standard magnetic resonance imaging (MRI) protocol.
Methods or Background: We included 88 consecutive patients (46 males and 42 females, mean age of 55.2) between April and May 2023. All patients underwent standard MRI protocol, including multiplanar 3 mm T1W, STIR and DP fat-saturated sequences (acquisition time 18 minutes) and a fast protocol acquired with DL sequences (acquisition time 5 minutes) the same day. Four radiologists (21, 16, 13 and 5 years of experience, respectively), blinded to standard MRI protocol, evaluated the presence of meniscal and ligament tears on DL protocol images. Standard MRI images served as standard of reference (consensus reading of two additional experienced MSK radiologists). Diagnostic accuracy values of DL protocol (qualitative assessment) and inter-observer agreement were calculated.
Results or Findings: Standard MRI revealed the presence of meniscal tear in 45/88 patients (51.1%) and ligament tears in 37/88 cases (42.0%). Sensitivity, specificity and overall accuracy of DL protocol for meniscal and ligaments tear were 97.7% (44/45), 100% (43/43) and 98.9% (87/88), and 100% (37/37), 98.0% (50/51) and 98.9% (87/88), respectively. The diagnostic accuracy values of DL protocol were similar to those of standard protocol (p=0.43). Conversely, the acquisition time for DL protocol was significantly lower if compared to that of standard protocol (p=0.001).
The inter-observer agreement was near perfect (k=0.96).
Conclusion: Despite a significant reduction of acquisition time, the DL MRI protocol of the knee showed similar diagnostic accuracy value compared to standard MRI protocol.
Limitations: The study is limited by its small sample size.
Funding for this study: No funding was received for this study.
Has your study been approved by an ethics committee? Yes
Ethics committee - additional information: This study was approved by the relevant Institutional Research Board.