Characterizing the Myoarchitecture of the Supraspinatus and Infraspinatus Muscles With MRI Using Diffusion Tensor Imaging.

BACKGROUND: The societal cost of shoulder disabilities in our aging society keeps rising. Providing biomarkers of early changes in the microstructure of rotator cuff (RC) muscles might improve surgical planning. Elevation angle (E1A) and pennation angle (PA) assessed by ultrasound change with RC tears. Furthermore, ultrasounds lack repeatability. PURPOSE: To propose a repeatable framework to quantify the myocyte angulation in RC muscles. STUDY TYPE: Prospective. SUBJECTS: Six asymptomatic healthy volunteers (1 female aged 30 years; 5 males, mean age 35 years, range 25-49 years), who underwent three repositioned scanning sessions (10 minutes apart) of the right infraspinatus muscle (ISPM) and supraspinatus muscle (SSPM). FIELD STRENGTH/SEQUENCE: 3-T, T1-weighted and diffusion tensor imaging (DTI; 12 gradient encoding directions, b-values of 500 and 800 s/mm2 ). ASSESSMENT: Each voxel was binned in percentage of depth defined by the shortest distance in the antero-posterior direction (manual delineation), i.e. the radial axis. A second order polynomial fit for PA across the muscle depth was used, while E1A described a sigmoid across depth: E 1 A sig = E 1 A range × sigmf 1 : 100 % depth , - EA 1 grad   ,   E 1 A asym + E 1 A shift . STATISTICAL TESTS: Repeatability was assessed with the nonparametric Wilcoxon's rank-sum test for paired comparisons across repeated scans in each volunteer for each anatomical muscle region and across repeated measures of the radial axis. A P-value <0.05 was considered statistically significant. RESULTS: In the ISPM, E1A was constantly negative, became helicoidal, then mainly positive across the antero-posterior depth, respective at the caudal, central and cranial regions. In the SSPM, posterior myocytes ran more parallel to the intramuscular tendon ( PA ≈ 0 ° ), while anterior myocytes inserted with a pennation angle ( PA ≈ - 20 ° ). E1A and PA were repeatable in each volunteer (error < 10%). Intra-repeatability of the radial axis was achieved (error < 5%). DATA CONCLUSION: ElA and PA in the proposed framework of the ISPM and SSPM are repeatable with DTI. Variations of myocyte angulation in the ISPM and SSPM can be quantified across volunteers. EVIDENCE LEVEL: 2 TECHNICAL EFFICACY: Stage 2.

Intersession Repeatability of Diffusion-Tensor Imaging in the Supraspinatus and the Infraspinatus Muscles of Volunteers.

BACKGROUND: Quantifying the rotator cuff (RC) muscles' viscoelasticity could provide outcome relevant information in patients with RC tears. MR-elastography requires robust diffusion-tensor imaging (DTI) to account for tissue anisotropy in muscles stiffness computation. PURPOSE: To assess the repeatability of DTI parameters in the supraspinatus and infraspinatus muscles and to explore DTI tractography conformity with the muscles' anatomy. STUDY TYPE: Prospective. SUBJECTS: Six healthy volunteers underwent three consecutive shoulder MRI sessions about 10 minutes apart. FIELD STRENGTH/SEQUENCE: 3T/T1-vibe Dixon and Spin echo EPI DTI (12 gradient encoding directions, b-values 500 and 800 sec/mm2 ). ASSESSMENT: Supraspinatus and infraspinatus muscles were segmented on the T1-vibe Dixon sequence. DTI image quality was assessed using a quantitative threshold based on the signal-to-noise ratio (SNR). The eigenvalues ( λ 1 , λ 2 , λ 3 ), fractional anisotropy (FA) and mean diffusivity were calculated. DTI tractography was visually assessed. STATISTICAL TESTS: DTI parameters within-subject intersession repeatability was assessed with Bland-Altman analysis and the coefficient of variation (CV). Repeatability was considered good for CV < 10%. RESULTS: The SNR between diffusion-weighted and non-diffusion-weighted images was greater than 3, which aligns with standards for estimating DTI parameters. The FA showed the lowest mean bias (-0.007; 95% confidence interval [CI] -0.031 to 0.018) whereas the λ1 had the highest mean bias (0.146 × 10-3  mm2 /sec; CI -0.034 to 0.326 × 10-3  mm2 /sec). CVs of the DTI parameters varied between 3.5% (FA) and 8.4% (λ3 ) for the supraspinatus and between 3.2% (λ1 ) and 6.8% (λ3 ) for the infraspinatus. Tractography provided muscle fiber representations in three-dimensional space concordant with RC anatomy. DATA CONCLUSION: DTI of the supraspinatus and infraspinatus muscles achieved an adequate SNR, allowing the measurement of the DTI metrics with good repeatability, and thus can be used for optimizing stiffness estimation in these anisotropic tissues. EVIDENCE LEVEL: 2 TECHNICAL EFFICACY: Stage 2.