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Objectives As in-vivo knowledge of training-induced remodeling of intervertebral discs (IVD) is scarce, this study assessed how lumbar IVDs change as a function of long-term training in elite athletes and age-matched controls using compositional Magnetic Resonance Imaging (MRI). Design Prospective case-control study. Methods Prospectively, lumbar spines of 17 elite rowers (ERs) of the German national rowing team (mean age: 23.9 ± 3.3 years) were imaged on a clinical 3.0 T MRI scanner. ERs were imaged twice during the annual training cycle, i.e., at training intensive preseason preparations (t0) and 6 months later during post-competition recovery (t1). Controls (n = 22, mean age: 26.3 ± 1.9 years) were imaged once at corresponding time points (t0: n = 11; t1: n = 11). Segment-wise, the glycosaminoglycan (GAG) content of lumbar IVDs (n = 195) was determined using glycosaminoglycan chemical exchange saturation transfer (gagCEST). Linear mixed models were set up to assess the influence of cohort and other variables on GAG content. Results During preseason, IVD GAG values of ERs were significantly higher than those of controls (ERs(t0): 2.58 ± 0.27% (mean ± standard deviations); controls(t0): 1.43 ± 0.36%; p ≤ 0.001), while during post-competition recovery, such differences were not present anymore (ERs(t1): 2.11 ± 0.18%; controls(t1): 1.89 ± 0.24%; p = 0.362). Conclusions Professional elite-level rowing is transiently associated with significantly higher gagCEST values, which indicate increased lumbar IVD-GAG content and strong remodeling effects in response to training. Beyond professional rowing, core-strengthening full-body exercise may help to enhance the resilience of the lumbar spine as a potential therapeutic target in treating back pain.

Purpose To compare CT, MRI, and [18F]-fluorodeoxyglucose positron emission tomography ([18F]-FDG PET/MRI) for nodal status, regarding quantity and location of metastatic locoregional lymph nodes in patients with newly diagnosed breast cancer. Materials and methods One hundred eighty-two patients (mean age 52.7 ± 11.9 years) were included in this prospective double-center study. Patients underwent dedicated contrast-enhanced chest/abdomen/pelvis computed tomography (CT) and whole-body ([18F]-FDG PET/) magnet resonance imaging (MRI). Thoracal datasets were evaluated separately regarding quantity, lymph node station (axillary levels I–III, supraclavicular, internal mammary chain), and lesion character (benign vs. malign). Histopathology served as reference standard for patient-based analysis. Patient-based and lesion-based analyses were compared by a McNemar test. Sensitivity, specificity, positive and negative predictive values, and accuracy were assessed for all three imaging modalities. Results On a patient-based analysis, PET/MRI correctly detected significantly more nodal positive patients than MRI (p p p p p = 0.015). Subgroup analysis for different lymph node stations showed that PET/MRI detected significantly more lymph node metastases than MRI and CT in each location (axillary levels I–III, supraclavicular, mammary internal chain). MRI was superior to CT only in axillary level I (p = 0.0291). Conclusion [18F]-FDG PET/MRI outperforms CT or MRI in detecting nodal involvement on a patient-based analysis and on a lesion-based analysis. Furthermore, PET/MRI was superior to CT or MRI in detecting lymph node metastases in all lymph node stations. Of all the tested imaging modalities, PET/MRI showed the highest sensitivity, whereas CT showed the lowest sensitivity, but was most specific.

Background Because of overlapping phenotypical presentations, the diagnostic differentiation of rheumatoid arthritis (RA) and psoriatic arthritis (PsA) remains challenging. Thus, this study aimed to examine the diagnostic value of distinct imaging features obtained by high-resolution 3-T MRI for the diagnostic differentiation. Materials and methods Seventeen patients with PsA and 28 patients with RA were imaged at high resolution using 3-T MRI scanners and a dedicated 16-channel hand coil. All images were analyzed according to the outcome measures in rheumatology clinical trials’ (OMERACT) RAMRIS (Rheumatoid Arthritis Magnetic Resonance Imaging Score) and PsAMRIS (Psoriatic Arthritis Magnetic Resonance Imaging Score) for the presence and intensity of synovitis, flexor tenosynovitis, bone edema, bone erosion, periarticular inflammation, bone proliferation, and joint space narrowing. Next, odds ratios (OR) were calculated to determine the strength of the associations between these imaging features, demographic characteristics, and the outcome RA vs. PsA. Results PsA could be differentiated from RA by extracapsular inflammatory changes (PsAMRIS sub-score “periarticular inflammation”), with low odds for the presence of RA (OR of 0.06, p Conclusion High-resolution imaging is beneficial for the identification of relevant imaging features that may assist the clinical differentiation of inflammatory conditions of the hand. At the MCP level, extracapsular inflammatory changes were strongly associated with PsA and may consequently allow the imaging differentiation of PsA and RA.

Purpose To assess radiocarpal articular cartilage after distal radius fracture, with and without intra-articular extension, compared with healthy controls using multiparametric, nonenhanced magnetic resonance imaging (MRI). Methods In this prospective study, multiparametric MRI of the radiocarpal articular cartilage was performed in 26 participants (16 males and 10 females; mean age, 39.5 ± 14.7 years; range, 20–70 years) using 3T MRI. The cohort consisted of 14 patients with a distal radius fracture and 12 healthy volunteers. The radiocarpal articular cartilage was assessed using morphological (Double Echo Steady-State [DESS] and True Fast Imaging With Steady-State Precession [TrueFISP]) and biochemical (T2∗) MRI sequences without an intravenous contrast agent. The modified Outerbridge classification system for morphological analyses and region-of-interest biochemical analysis were applied to assess the degree of articular cartilage damage in each patient. Results Morphological articular cartilage assessment showed no difference between the DESS sequence and the reference standard, TrueFISP. In the morphological (DESS and TrueFISP) and biochemical (T2∗) assessments, patients with intra-articular fractures did not show articular cartilage damage different from those with extra-articular fractures. Greater articular cartilage degradation was observed after distal radius fracture compared with controls. Conclusions Posttraumatic radiocarpal articular cartilage damage did not differ between fractures with intra-articular and extra-articular extension, but patients with fractures had notably higher articular cartilage degradation compared with healthy controls. Magnetic resonance imaging using advanced multiparametric sequences may facilitate accurate, noninvasive assessment of articular cartilage changes after distal radius fracture without the need for a contrast agent. Type of study/level of evidence Diagnostic IV.

To measure sodium relaxation times and concentrations in human wrists on a clinical magnetic resonance imaging (MRI) scanner with a density-adapted radial sequence. Sodium MRI of human wrists was conducted on a 3T MR system using a dual-tuned 1H/23Na surface coil. We performed two studies with 10 volunteers each investigating either sodium T1 (study 1) or sodium T2* (study 2) relaxation times in the radiocarpal joint (RCJ) and midcarpal joint (MCJ). Sodium concentrations of both regions were determined. No differences for transversal of longitudinal relaxation times were found between RCJ and MCJ (T2,s*(RCJ) = (0.9 ± 0.4) ms; T2,s*(MCJ) = (0.9 ± 0.3) ms; T2,l*(RCJ) = (14.9 ± 0.9) ms; T2,l*(MCJ) = (13.9 ± 1.1) ms; T1(RCJ) = (19.0 ± 2.4) ms; T1(MCJ) = (18.5 ± 2.1) ms). Sodium concentrations were (157.7 ± 28.4) mmol/l for study 1 and (159.8 ± 29.1) mmol/l for study 2 in the RCJ, and (172.7 ± 35.6) mmol/l for study 1 and (163.4 ± 26.3) mmol/l for study 2 in the MCJ. We successfully determined sodium relaxation times and concentrations of the human wrist on a 3T MRI scanner.

Objective Beyond static assessment, functional techniques are increasingly applied in magnetic resonance imaging (MRI) studies. Stress MRI techniques bring together MRI and mechanical loading to study knee joint and tissue functionality, yet prototypical axial compressive loading devices are bulky and complex to operate. This study aimed to design and validate an MRI-compatible pressure-controlled varus–valgus loading device that applies loading along the joint line. Methods Following the device’s thorough validation, we demonstrated proof of concept by subjecting a structurally intact human cadaveric knee joint to serial imaging in unloaded and loaded configurations, i.e. to varus and valgus loading at 7.5 kPa (= 73.5 N), 15 kPa (= 147.1 N), and 22.5 kPa (= 220.6 N). Following clinical standard (PDw fs) and high-resolution 3D water-selective cartilage (WATSc) sequences, we performed manual segmentations and computations of morphometric cartilage measures. We used CT and radiography (to quantify joint space widths) and histology and biomechanics (to assess tissue quality) as references. Results We found (sub)regional decreases in cartilage volume, thickness, and mean joint space widths reflective of areal pressurization of the medial and lateral femorotibial compartments. Discussion Once substantiated by larger sample sizes, varus–valgus loading may provide a powerful alternative stress MRI technique.

Biomechanical Magnetic Resonance Imaging (MRI) of articular cartilage, i.e. its imaging under loading, is a promising diagnostic tool to assess the tissue's functionality in health and disease. This study aimed to assess the response to static and dynamic loading of histologically intact cartilage samples by functional MRI and pressure-controlled in-situ loading. To this end, 47 cartilage samples were obtained from the medial femoral condyles of total knee arthroplasties (from 24 patients), prepared to standard thickness, and placed in a standard knee joint in a pressure-controlled whole knee-joint compressive loading device. Cartilage samples' responses to static (i.e. constant), dynamic (i.e. alternating), and no loading, i.e. free-swelling conditions, were assessed before (δ0), and after 30 min (δ1) and 60 min (δ2) of loading using serial T1ρ maps acquired on a 3.0T clinical MRI scanner (Achieva, Philips). Alongside texture features, relative changes in T1ρ (Δ1, Δ2) were determined for the upper and lower sample halves and the entire sample, analyzed using appropriate statistical tests, and referenced to histological (Mankin scoring) and biomechanical reference measures (tangent stiffness). Histological, biomechanical, and T1ρ sample characteristics at δ0 were relatively homogenous in all samples. In response to loading, relative increases in T1ρ were strong and significant after dynamic loading (Δ1 = 10.3 ± 17.0%, Δ2 = 21.6 ± 21.8%, p = 0.002), while relative increases in T1ρ after static loading and in controls were moderate and not significant. Generally, texture features did not demonstrate clear loading-related associations underlying the spatial relationships of T1ρ. When realizing the clinical translation, this in-situ study suggests that serial T1ρ mapping is best combined with dynamic loading to assess cartilage functionality in humans based on advanced MRI techniques.

To assess the impact of dynamic contrast-enhanced imaging (DCE) in mp-MRI on prostate cancer (PCa) detection in a large patient cohort assigned to PI-RADS category 4. This retrospective, single center cohort study includes 193 consecutive patients with PI-RADS assessment category 4 in mp-MRI (T2WI, DWI, DCE) at 3 T with targeted plus systematic biopsy combined as the reference standard. The detection of prostate cancer with and without the use of DCE was compared. Overall, the PCa detection rate in PI-RADS-4 patients was 62 % (119/193) with DCE and 52 % (101/193) without the inclusion of lesions upgraded on the basis of DCE. 48 % (92/193) had clinically significant PCa (csPCa; Gleason score ≥ 3 + 4 = 7) and 40 % (78/193) without use of DCE. 38 of the 193 patients (20 %) had peripheral lesions upgraded from PI-RADS category 3 to an overall PI-RADS category 4 due to focal positive DCE findings. Of these 38 patients, 18 had PCa including 14 with csPCa. Thus, 15 % (18/119) of the patients with PCa and 15 % (14/92) of the patients with csPCa were detected only based on additional DCE information. DCE prevents underestimation and misclassification of a significant number of cases of peripheral csPCa and might improve detection rates in PI-RADS-4 patients. The current PI-RADS decision rules regarding upgrading PI-RADS-3 lesions to category 4 due to positive DCE imaging are useful for PCa detection. · Positive peripheral DCE upgraded 20 % of patients in PI-RADS category 4 from category 3.. · Clinically significant PCa was found in almost 40 % of upgraded, peripheral PIRADS-3-lesions.. · 15 % of all csPCa in PI-RADS-4-patients was detected in DCE-upgraded lesions.. · In 7 % of all PI-RADS-4-cases csPCa would had been underestimated without DCE upgrade..· Ullrich T, Quentin M, Arsov C et al. Value of Dynamic Contrast-Enhanced (DCE) MR Imaging in Peripheral Lesions in PI-RADS-4 Patients. Fortschr Röntgenstr 2020; 192: 441 - 447.ZIEL: Ziel der Studie war die Evaluation des Mehrwerts der dynamischen kontrastmittelgestützten Sequenzen (DCE) in der multiparametrischen MRT (mp-MRT) bezüglich der Prostatakarzinomdetektion in einer großen Kohorte von Patienten mit PI-RADS-4-Befund. 193 Patienten mit einer MR-Gesamtklassifikation von PI-RADS 4 nach mp-MRT der Prostata bei 3 T (T2WI, DWI, DCE) und anschließend kombiniert gezielter plus systematischer Biopsie als Referenzstandard wurden retrospektiv in diese unizentrische Kohortenstudie eingeschlossen. Es wurde die Prostatakarzinomdetektion mit und ohne die Hilfe kontrastmittelgestützter Sequenzen verglichen. Die Gesamtkarzinomdetektionsrate in den PI-RADS-4-Patienten war 62 % (119/193). Ohne Einschluss von Läsionen, die mithilfe der DCE von Kategorie PI-RADS 3 auf PI-RADS 4 aufgewertet wurden, lag die Detektionsrate bei 52 % (101/193). Mit DCE wurden 48 % (92/193) klinisch signifikante Prostatakarzinome (Gleason-Score ≥ 3 + 4 = 7) detektiert und 40 % (78/193) ohne DCE-Verwendung. 38 der 193 Patienten (20 %) hatten periphere Läsionen, die durch auffällige Kontrastmittelanreicherung von PI-RADS Kategorie 3 auf 4 aufgewertet wurden. Von diesen 38 Patienten hatten 18 ein Prostatakarzinom, einschließlich 14 mit einem klinisch signifikanten Karzinom. Somit wurden 15 % (18/119) mit jeglichem Prostatakarzinom und 15 % (14/92) mit einem klinisch relevanten Karzinom nur durch zusätzliche Informationen aus kontrastmittelgestützten Sequenzen detektiert. Kontrastmittelgestützte, dynamische Sequenzen können eine zu niedrige PI-RADS-Fehlklassifizierung einer relevanten Anzahl von Prostatakarzinomen verhindern und die Detektionsraten bei PI-RADS-4-Patienten verbessern. Die aktuellen PI-RADS-Kriterien zur Aufwertung von PI-RADS-3-Läsionen in die Gesamtkategorie 4 durch auffällige Kontrastmittelanreicherung scheinen sinnvoll. · 20 % der PI-RADS-4-Patienten wurden durch auffällige, periphere Kontrastmittelanreicherung aus Kategorie 3 aufgewertet.. · Klinisch signifikante Prostatakarzinome wurden in fast 40 % der aufgewerteten, peripheren PI-RADS-3-Läsionen gefunden.. · 15 % aller signifikanten Karzinome bei PI-RADS-4-Patienten wurden in durch DCE aufgewerteten Läsionen detektiert.. · In 7 % aller PI-RADS-4-Befunde wären klinisch signifikante Prostatakarzinome ohne DCE unterschätzt worden..

Background: Using high-field MRI to differ morphologically between OA and RA. Objectives: To evaluate the value of morphological and biochemical, contrast-agent free high-field (3 Tesla) MRI of the radiocarpal cartilage to differ between osteoarthritis (OA) and rheumatoid arthritis (RA). Methods: The group consisted of 47 subjects, who were examined during the period from October 2016 to December 2017. The clinical dominant hand of 11 patients suffering from early rheumatoid arthritis (RA) (German ArthroMark cohort, O 52.8years; min: 32; max 74), seropositive (ACPA and/or RF), disease duration Results: Morphological sequences demonstrated significantly higher cartilage damage in RA and OA compared to healthy controls (DESS: p = 0.01, p = 0.0004; TrueFISP: p = 0.02, p = 0.0001), while there was no significant difference between RA and OA patients. With biochemical MRI using T2* imaging, patients with OA showed higher cartilage integrity compared to patients with RA (p = 0.01). Conclusion: Morphological and biochemical MRI of radiocarpal cartilage could be helpful to differentiate between RA and OA patients. Both, RA and OA, are associated with cartilage damage measured by morphological MRI of the hand. Hence, OA was associated with more loss of cartilage integrity compared to RA using biochemical MRI, whereby only early RA patients were analyzed in this first evaluation. Non-contrast-agent morphological and biochemical MRI could be a non-invasive tool to investigate cartilage integrity in RA and OA patients and could help to differ disease pattern in the future. Acknowledgement: We would like to thank Erika Radisch for the assistance in receiving the MRI scans. Disclosure of Interests: Philipp Sewerin: None declared, Lino Sawicki: None declared, Christoph Schleich: None declared, Daniel Abrar: None declared, Matthias Schneider Grant/research support from: GlaxoSmithKline and UCB Pharma for performing the LuLa-study., Speakers bureau: Chugai, Stefan Vordenbaumen: None declared, Benedikt Ostendorf: None declared

Background:Even though cartilage loss is a known feature of psoriatic arthritis (PsA), research is sparse on its role in the pathogenesis of PsA and its potential use for disease detection and monitoring. Using delayed gadolinium-enhanced magnetic resonance imaging of cartilage (dGEMRIC) and dynamic contrast-enhanced MRI (DCE MRI), research has shown that early cartilage loss is strongly associated with synovial inflammation in rheumatoid arthritis (RA). The aim of this study was to determine if acute inflammation is associated with early cartilage loss in small finger joints of patients with PsA.Objectives:Is local perfusion in PsA patients measured by dynamic MRI associated to local cartilage loss?Methods:Metacarpophalangeal (MCP), proximal interphalangeal (PIP), and distal interphalangeal (DIP) joints of 17 patients with active PsA were evaluated by high-resolution 3 Tesla dGEMRIC and DCE MRI using a dedicated 16-channel hand coil. Semi-quantitative and quantitative perfusion parameters were calculated. Images were analyzed by two independent raters for dGEMRIC indices, PsA MRI scores (PsAMRIS), total cartilage thickness (TCT), and joint space width (JSW).Results:We found significant negative correlations between perfusion parameters (except Kep) and dGEMRIC indices, with the highest value at the MCP joints (KTrans: τ = -0.54, p = 0.01; Kep: τ= -0.02, p = 0.90; IAUC: τ = -0.51, p = 0.015; Initial Slope: τ = -0.54, p = 0.01; Peak: τ = -0.67, p = 0.002). Heterogeneous correlations were detected between perfusion parameters and both, total PsAMRIS and PsAMRIS synovitis sub-scores. No significant correlation was seen between any perfusion parameter and JSW and/or TCT.Conclusion:As examined by DCE MRI and dGEMRIC, there is a significant association between early cartilage loss and acute synovial inflammation in small finger joints of PsA patients.Figure 1.dGEMRIC maps (third digit) and perfusion maps (peak parameter) of MCP, PIP, and DIP joints in 26-year-old male (A and B) and a 59-year-old female (C and D) with PsA. Lower dGEMRIC values are illustrated in D, indicating more proteoglycan loss than in A. Higher peak values are depicted in C, indicating a higher severity of synovitis than in B. Peak parameter is illustrated in mM/l per second, dGEMRIC indices in ms.Disclosure of Interests:Philipp Sewerin Grant/research support from: AbbVie Deutschland GmbH & Co. KGBristol-Myers Squibb Celgene GmbHLilly Deutschland GmbHNovartis Pharma GmbH Pfizer Deutschland GmbHRheumazentrum Rhein-Ruhr, Consultant of: AMGEN GmbH AbbVie Deutschland GmbH & Co. KG Biogen GmbHBristol-Myers Squibb Celgene GmbH Chugai Pharma arketing Ltd. / Chugai Europe GmbHHexal Pharma Janssen-CilagGmbH Johnson & Johnson Deutschland GmbHLilly Deutschland GmbH / Lilly Europe / Lilly Global Novartis Pharma GmbH Pfizer Deutschland GmbH Roche Pharma Rheumazentrum Rhein-Ruhr Sanofi-Genzyme Deutschland GmbH Swedish Orphan Biovitrum GmbH UCB Pharma GmbH, Speakers bureau: AMGEN GmbH AbbVie Deutschland GmbH & Co. KG Biogen GmbHBristol-Myers Squibb Celgene GmbH Chugai Pharma arketing Ltd. / Chugai Europe GmbHHexal Pharma Janssen-CilagGmbH Johnson & Johnson Deutschland GmbHLilly Deutschland GmbH / Lilly Europe / Lilly Global Novartis Pharma GmbH Pfizer Deutschland GmbH Roche Pharma Rheumazentrum Rhein-Ruhr Sanofi-Genzyme Deutschland GmbH Swedish Orphan Biovitrum GmbH UCB Pharma GmbH, Daniel Abrar: None declared, Anja Müller-Lutz: None declared, Miriam Frenken: None declared, Karl Ludger Radke: None declared, Stefan Vordenbäumen: None declared, Matthias Schneider Grant/research support from: GSK, UCB, Abbvie, Consultant of: Abbvie, Alexion, Astra Zeneca, BMS, Boehringer Ingelheim, Gilead, Lilly, Sanofi, UCB, Speakers bureau: Abbvie, Astra Zeneca, BMS, Chugai, GSK, Lilly, Pfizer, Sanofi, Benedikt Ostendorf: None declared, Christoph Schleich: None declared

Background The aim of the study was to evaluate a simplified version of the Rheumatoid Arthritis Magnetic Resonance Imaging Score (RAMRIS) for five joints of the hand (RAMRIS-5) in patients with early rheumatoid arthritis (RA) before and after the initiation of methotrexate (MTX) therapy using high-resolution, 3-T magnetic resonance imaging (MRI). Methods Twenty-eight patients with a seropositive, early RA (disease duration of less than 6 months (range 2–23 weeks)) according to 2010 American College of Rheumatology/European League Against Rheumatism (ACR/EULAR) criteria (mean age 56.8 years, range 39–74) were prospectively assessed with a baseline investigation including clinical assessment (disease activity score of 28 joints (DAS-28) and C-reactive protein (CRP)) and 3-T MRI of the clinically dominant hand. Follow-up visits were performed 3 and 6 months after initiation of a MTX therapy at baseline. MRI scans were analyzed in accordance with RAMRIS and the simplified RAMRIS-5. Results DAS-28 and CRP decreased significantly after initiation of MTX therapy. Even though erosion scores increased over time, RAMRIS and RAMRIS-5 also decreased significantly after the start of therapy. There was a strong correlation between the total RAMRIS-5 and RAMRIS at baseline (r = 0.838; P