Imaging of skeletal muscle function using (18)FDG PET: force production, activation, and metabolism.

The purpose of this study was to determine whether [(18)F]fluorodeoxyglucose (FDG) positron emission tomography (PET) can be used to evaluate muscle force production, create anatomic images of muscle activity, and resolve the distribution of metabolic activity within exercising skeletal muscle. Seventeen subjects performed either elbow flexion, elbow extension, or ankle plantar flexion after intravenous injection of FDG. PET imaging was performed subsequently, and FDG uptake was measured in skeletal muscle for each task. A fivefold increase in resistance during elbow flexion increased FDG uptake in the biceps brachii by a factor of 4. 9. Differences in relative FDG uptake were demonstrated as exercise tasks and loads were varied, permitting differentiation of active muscles. The intramuscular distribution of FDG within exercising biceps brachii varied along the transverse and longitudinal axes of the muscle; coefficients of variation along these axes were 0.39 and 0.23, respectively. These findings suggest FDG PET is capable of characterizing task-specific muscle activity and measuring intramuscular variations of glucose metabolism within exercising skeletal muscle.

Human patellar tendon strain. A noninvasive, in vivo study.

This study showed the assumption of patellar tendon inextensibility was not valid, and the strain in the patellar tendon was higher than previously reported for other human tendons. The in vivo three-dimensional velocity profiles for the patella, femur, and tibia were measured noninvasively in 18 healthy knees during a low load extensor task using cine phase contrast magnetic resonance imaging. These data were used to calculate patellar tendon elongation and strain. Average maximum strains of 6.6% were found for a low load extension task at relatively small knee angles.

Quantitative MR measures of three-dimensional patellar kinematics as a research and diagnostic tool.

PURPOSE: A three-dimensional (3D) study of normal patellar-femoral-tibial (knee) joint kinematics was performed using Cine Phase Contrast Magnetic resonance imaging (Cine-PC MRI) to determine the utility of this technique as a diagnostic tool in defining alterations in patellar tracking. METHODS: Cine-PC MRI was originally developed to measure heart motion and blood flow and has now been adapted to the study of the musculoskeletal system. Thus, for the first time knee joint kinematics can be studied three-dimensionally, noninvasively, and in vivo during dynamic volitional leg extensions under load. Cine-PC MRI provides one anatomic and three orthogonal velocity images (vx, vy, and vz) for each time frame within the motion cycle. Bone displacements are calculated using integration and are then converted into both 3D orientation angles and 2D clinical angles. RESULTS: The 3D patellar tilt and 2D clinical patellar tilt angle were nearly identical, even though these two angles have distinct mathematical definitions. The precision of the 2D clinical patellar tilt angle (N = 3) was approximately 2.4 degrees. CONCLUSIONS: Since the overall subject (N = 18) variability for clinical patellar tilt angle and medial/lateral patellar displacement was low (SD = 2.9 degrees and 3.3 mm, respectively), Cine-PC MRI could prove to be a valuable tool in studying subtle changes in patellar tracking.

In vivo tracking of the human patella using cine phase contrast magnetic resonance imaging.

Improper patellar tracking is often considered to be the cause of patellar-femoral pain. Unfortunately, our knowledge of patellar-femoral-tibial (knee) joint kinematics is severely limited due to a lack of three-dimensional, noninvasive, in vivo measurement techniques. This study presents the first large-scale, dynamic, three-dimensional, noninvasive, in vivo study of nonimpaired knee joint kinematics during volitional leg extensions. Cine-phase contrast magnetic resonance imaging was used to measure the velocity profiles of the patella, femur, and tibia in 18 unimpaired knees during leg extensions, resisted by a 34 N weight. Bone displacements were calculated through integration and then converted into three-dimensional orientation angles. We found that the patella displaced laterally, superiorly, and anteriorly as the knee extended. Further, patellar flexion lagged knee flexion, patellar tilt was variable, and patellar rotation was fairly constant throughout extension.

Using cine phase contrast magnetic resonance imaging to non-invasively study in vivo knee dynamics.

We tested the accuracy and feasibility of using cine phase contrast magnetic resonance imaging (cine-PC MRI) to non-invasively measure three-dimensional, in vivo, skeletal velocity. Bone displacement was estimated by integrating the velocity measurements. Cine-PC MRI was originally developed to directly and non-invasively measure in vivo blood and heart velocity. Since no standard of reference exists for in vivo measurement of trabecular bone motion, a motion phantom (consisting of a series of paired gears that moved a sample box containing a human femoral bone sample) was built to assess the accuracy of tracking trabecular bone with cine-PC MRI. The in-plane, average absolute displacement errors were 0.55 +/- 0.38 and 0.36 +/- 0.27 mm in the x- and y-direction, respectively. Thus, estimates of bone position based on the integration of bone velocity measurements are affected little by the magnetic properties of bone [Majumdar and Genant (1995) Osteoporos International 5, 79-92]. The velocity profiles of the patella, femur and tibia were measured in five healthy subjects during leg extensions. Extension was resisted by a 34 N weight. Subjects maintained a consistent motion rate (35 +/- 0.5 cycles min(-1)) and motion artifacts were minimal. Our results indicate that patellar flexion lags knee flexion and the patella tilts laterally and then medially as the knee extends. We conclude cine-PC MRI is a promising technique for the non-invasive measurement of in vivo skeletal dynamics and, based on our previous work, muscular dynamics as well.

Skeletal muscle contraction: analysis with use of velocity distributions from phase-contrast MR imaging.

PURPOSE: Velocity gradient data from phase-contrast magnetic resonance (MR) imaging were tested for the ability to calculate tensile strain and shear strain (deformation) during cyclical motion of skeletal muscle. MATERIALS AND METHODS: Strain data were derived from in vitro and in vivo phase-contrast MR velocity maps. A motion phantom designed to cyclically compress and expand a specimen of skeletal muscle provided a standard of reference to validate deformation, translation, and rotation measurements. The authors studied anterior and posterior muscle compartments of the lower extremity in three healthy volunteers during ankle dorsiflexion and plantar flexion against various resistances and the forearms of five healthy volunteers during flexion and extension of the fingers. RESULTS: The mean in vitro tracking error was 0.5 mm. The gastrocnemius muscle area in vivo changed 20% for both the minimum and maximum force conditions and therefore did not appear to be a good predictor of force. CONCLUSION: Phase-contrast MR imaging provides quantitative data on muscle contraction and demonstrates that shear and tensile strain can be measured and separated from translation and rotation of muscle.

Tracking the motion of skeletal muscle with velocity-encoded MR imaging.

Phase-contrast magnetic resonance velocity-encoding techniques were used to track two-dimensional movement of skeletal muscle tissue. Axial and longitudinal planes in the forearms of five healthy volunteers were imaged during cyclic flexion and extension of the fingers, and the resulting data were used to plot the trajectories of the motion of pieces of muscle tissue. A phantom that produced complex two-dimensional trajectories validated the accuracy of the imaging and analysis techniques; after adjustments for phase errors, two-dimensional trajectories were tracked with an root-mean-square error of 0.1 cm. Preliminary results indicate that velocity-encoded image data can characterize motion trajectories and that refinements in data acquisition and analysis techniques may make it possible to correlate the movements of different regions within a muscle, characterize muscle contraction, and quantify longitudinal strain. This ability to track velocity vectors may provide a foundation for quantitative analysis of muscle motion.

Elastic deformation in tendons and myotendinous tissue: measurement by phase-contrast MR imaging.

PURPOSE: To determine whether phase-contrast magnetic resonance (MR) imaging can be used to measure stretch in the myotendinous junction and tendon. MATERIALS AND METHODS: Velocity-encoded cine MR images obtained during cyclic motion were used to measure strain in myotendinous tissue and indirectly in tendons in gastrocnemius muscle-tendon sutured to a motion phantom. Videotapes of the experiments were digitized and used as a standard of reference for validation of MR measurements. Strain, rotation, and translation of the myotendinous junction were calculated from the phase-contrast MR data and indirectly in the tendon. RESULTS: Strain as determined from the MR imaging experiments agreed with the measurements from the video reference, with linear correlation coefficients of .987 for tendon strain and .992 for strain in the myotendinous junction. CONCLUSION: Measurement of tendon and myotendinous stretch during movement may provide insight into tendon ability to store energy and a means of noninvasive measurement of muscle force.

Measurement of skeletal muscle motion in vivo with phase-contrast MR imaging.

The ability to measure skeletal muscle motion with phase-contrast magnetic resonance (MR) imaging was tested with a motion phantom that simulated muscle activity. Quantitative analytic data on unidimensional, bidirectional skeletal muscle motion measured in vivo was obtained in four healthy volunteers. MR images of the subjects' forearms were obtained during flexion and extension of the fingers and of the anterior and posterior muscle compartments of the lower leg with various resistances to ankle dorsiflexion and plantar flexion. It was necessary to correct the data for the effects of eddy currents. In vitro evaluation of the technique was done by studying through-plane sinusoidal motion of solid objects. The largest error was underestimation of the peak excursion of 11.5 mm by 0.09 mm (the root mean square error for the cycle was 0.04 mm) In vivo experiments demonstrated the contraction of muscles in relation to each other. Data acquisition and analysis techniques must be refined, but measuring skeletal muscle motion with phase-contrast MR imaging should enhance the understanding of bioengineering fundamentals and muscular changes in disease and adaptation.

TMJ meniscus and bilaminar zone: MR imaging of the substructure--diagnostic landmarks and pitfalls of interpretation.

Identification of the junction of the posterior band with the bilaminar zone is important to detect anterior displacements of the temporomandibular joint (TMJ) meniscus on magnetic resonance (MR) images. However, significant differences in tissue characteristics within the meniscus itself may cause a confusing appearance that is not easily reconciled with available anatomic references. Six cadaveric TMJ specimens were imaged sagittally at 1.5 T with various combinations of repetition time and echo time and with use of both standard surface coils and a specially developed solenoidal specimen coil. Corresponding histologic sections were correlated with the in vitro MR images to identify the anatomic structure and tissue characteristics. Comparison of these in vitro images with in vivo images of 100 joints identified a vertical, linear, low-signal-intensity band as an important landmark of the junction of the posterior band and bilaminar zone. Recognition of the signal-intensity characteristics of the center and the surfaces of the posterior band as well as the appearance of the insertion of the bilaminar zone also increased confidence of visualization and helped avoid possible false-positive diagnoses.

Defining the normal temporomandibular joint: closed-, partially open-, and open-mouth MR imaging of asymptomatic subjects.

Fifty temporomandibular joints (TMJs) in 30 asymptomatic volunteers were imaged with a 1.5-T magnetic resonance (MR) imaging system to determine (a) the normal range of meniscus position, (b) the best definition of a normal TMJ and criteria to distinguish it from a TMJ with significant internal derangements, (c) the significance of certain findings such as joint effusion and disk distortion, and (d) the optimum mouth position(s) to be used for imaging. A method was devised to quantify meniscus displacement in terms of the number of degrees from a 12 o'clock or vertical position (relative to the condyle). The distribution of meniscus positions defined two groups in this asymptomatic study group. A strong correlation between abnormal joints and a history of orthodontics led to the exclusion of subjects with a history of orthodontics, and those with mouth trauma were also excluded, leaving a better "normal control" group. The junction of the posterior band of the meniscus and the bilaminar zone should fall within 10 degrees of vertical to be within the 95th percentile of normal.