Hotfiel, T, Swoboda, B, Krinner, S, Grim, C, Engelhardt, M, Uder, M, and Heiss, R. Acute effects of lateral thigh foam rolling on arterial tissue perfusion determined by spectral Doppler and power ...Doppler ultrasound. J Strength Cond Res 31(4): 893-900, 2017-Foam rolling has been developed as a popular intervention in training and rehabilitation. However, evidence on its effects on the cellular and physiological level is lacking. The aim of this study was to assess the effect of foam rolling on arterial blood flow of the lateral thigh. Twenty-one healthy participants (age, 25 ± 2 years; height, 177 ± 9 cm; body weight, 74 ± 9 kg) were recruited from the medical and sports faculty. Arterial tissue perfusion was determined by spectral Doppler and power Doppler ultrasound, represented as peak flow (Vmax), time average velocity maximum (TAMx), time average velocity mean (TAMn), and resistive index (RI), and with semiquantitative grading that was assessed by 4 blindfolded investigators. Measurement values were assessed under resting conditions and twice after foam rolling exercises of the lateral thigh (0 and 30 minutes after intervention). The trochanteric region, mid portion, and distal tibial insertion of the lateral thigh were representative for data analysis. Arterial blood flow of the lateral thigh increased significantly after foam rolling exercises compared with baseline (p ≤ 0.05). We detected a relative increase in Vmax of 73.6% (0 minutes) and 52.7% (30 minutes) (p < 0.001), in TAMx of 53.2% (p < 0.001) and 38.3% (p = 0.002), and in TAMn of 84.4% (p < 0.001) and 68.2% (p < 0.001). Semiquantitative power Doppler scores at all portions revealed increased average grading of 1.96 after intervention and 2.04 after 30 minutes compared with 0.75 at baseline. Our results may contribute to the understanding of local physiological reactions to self-myofascial release.
•Low-field technology promises to substantially decrease the procedural costs of breast MRI.•Low-field technology supports operating MRI units directly at the breast clinic.•Low-field scanners may ...facilitate integrating MRI into the diagnostic at the breast clinic.•Low-field breast MRI was feasible at diagnostic image quality at acceptable examination time.
Broader clinical adoption of breast magnetic resonance imaging (MRI) faces challenges such as limited availability and high procedural costs. Low-field technology has shown promise in addressing these challenges. We report our initial experience using a next-generation scanner for low-field breast MRI at 0.55T.
This initial cases series was part of an institutional review board-approved prospective study using a 0.55T scanner (MAGNETOM Free.Max, Siemens Healthcare, Erlangen/Germany: height < 2 m, weight < 3.2 tons, no quench pipe) equipped with a seven-channel breast coil (Noras, Höchberg/Germany). A multiparametric breast MRI protocol consisting of dynamic T1-weighted, T2-weighted, and diffusion-weighted sequences was optimized for 0.55T. Two radiologists with 12 and 20 years of experience in breast MRI evaluated the examinations.
Twelve participants (mean age: 55.3 years, range: 36–78 years) were examined. The image quality was diagnostic in all examinations and not impaired by relevant artifacts. Typical imaging phenotypes were visualized. The scan time for a complete, non-abbreviated breast MRI protocol ranged from 10:30 to 18:40 min.
This initial case series suggests that low-field breast MRI is feasible at diagnostic image quality within an acceptable examination time.
Interpretation of T2 values remains difficult due to limited comparability across hardware and software systems and the lack of validated measurement recommendations for the number and orientation of ...mandatory slices. Our aims were to provide a standardized comparison of intra- and inter-individual T2 values in the short and long axes and to investigate inter-scanner reproducibility.
Ninety cardiovascular magnetic resonance (CMR) studies in 30 healthy subjects were performed with three identical 1.5 T CMR scanners (same hardware and software) using a balanced steady-state free precession (bSSFP) gradient echo sequence in three short axis (SAx) and three long axis (LAx) views. A commercially available T2 mapping software package of the latest generation with automatic in-line motion correction was used for acquisition. Regions of interest were manually drawn in each of the 16 myocardial segments according to the American Heart Association (AHA) model in three SAx and three LAx acquisitions. Analysis of inter-scanner, inter-segmental, intra-segmental, inter-regional and inter-level differences was performed.
Inter-scanner reproducibility was high and the mean myocardial T2 value for all evaluated segments was 45.7 ± 3.4 ms. Significant inter-segmental variations of mean T2 values were found. Mean intra-segmental T2 values were comparable between LAx and SAx acquisitions in 72%. Significantly higher T2 values were found in apical segments and a significant disparity among different regions was found for SAx and LAx orientations.
Standardized cardiac T2 mapping is highly reproducible on identical CMR systems. T2 values vary significantly between single heart segments, regions, levels, and axes in young, healthy subjects.
Whole-body electromyostimulation (WB-EMS) is an innovative training method that stimulates large areas simultaneously. In order to determine the spatial distribution of WB-EMS with respect to volume ...involvement and stimulation depth, we determined the extent of intramuscular edema using magnetic resonance imaging (MRI) as a marker of structural effects. Intense WB-EMS first application (20 min, bipolar, 85 Hz, 350 µs) was conducted with eight physically less trained students without previous WB-EMS experience. Transversal T2-weighted MRI was performed at baseline and 72 h post WB-EMS to identify edema at the mid-thigh and lower leg. The depth of the edema ranged from superficial to maximum depth with superficial and deeper muscle groups of the mid-thigh or lower leg area approximately affected in a similar fashion. However, the grade of edema differed between the muscle groups, which suggests that the intensity of EMS-induced muscular contraction was not identical for all muscles. WB-EMS of the muscles via surface cuff electrodes has an effect on deeper parts of the stimulated anatomy. Reviewing the spatial and volume distribution, we observed a heterogeneous pattern of edema. We attribute this finding predominately to different stimulus thresholds of the muscles and differences in the stress resistance of the muscles.
Objective
To describe the occurrence of imaging-depicted sports-related injuries (bone, muscle, tendon, and ligament injuries) during the Rio 2016 Summer Paralympic Games.
Methods
Descriptive data on ...all imaging examinations by using radiography, ultrasonography (US), and MRI were collected and retrospectively analyzed centrally by five musculoskeletal radiologists according to imaging modality, country of origin of the athletes, type of sport, type of disability, and type and location of injury.
Results
We report 109 injuries in 4378 athletes. A total of 382 radiologic examinations were performed in 261 athletes, including 118 (31%) radiographic, 22 (6%) US, and 242 (63%) MRI examinations. Para athletes from Africa had the highest utilization rate (20.1%, 67 out of 333). Athletes from Europe underwent the most examinations with 29 radiographic, 12 US, and 66 MRI examinations. The highest utilization rate of imaging modalities by sport was among Judo para athletes (16.7%, 22 out of 132). Most injuries were reported in athletics discipline (37.6%, 41 out of 109). Most injuries were also reported among para athletes with visual impairment (40 injuries, 36.7% of all injuries). Bone stress injuries were most common among para athletes with visual impairment (6 out of 7). Para athletes with visual impairment were also more prone to bone stress injuries than traumatic fractures, unlike para athletes with neurologic and musculoskeletal impairments.
Conclusions
Imaging was used in 6.0% of para athletes. MRI comprised 63% of imaging utilization. Identification of patterns of injuries may help building future prevention programs in elite para athletes.
Key Points
• The highest imaging utilization rates were found among para athletes competing in Judo, sitting volleyball, powerlifting, and football.
• Utilization of diagnostic imaging at the Rio 2016 Paralympic Games demonstrated similar trends to what was observed at the Rio 2016 Olympic Games.
• Comparison of the rate of imaging-depicted injuries between Olympic and Paralympic athletes is limited due to inherent differences between the two athlete populations and the manner in which injury risk in the Paralympic athlete varies dependent on impairment type, which is not the case for the Olympic athlete.
The aim of this study was to develop an algorithm for automated estimation of patient height and weight during computed tomography (CT) and to evaluate its accuracy in everyday clinical practice.
...Depth images of 200 patients were recorded with a 3D camera mounted above the patient table of a CT scanner. Reference values were obtained using a calibrated scale and a measuring tape to train a machine learning algorithm that fits a patient avatar into the recorded patient surface data. The resulting algorithm was prospectively used on 101 patients in clinical practice and the results were compared to the reference values and to estimates by the patient himself, the radiographer and the radiologist. The body mass index was calculated from the collected values for each patient using the WHO formula. A tolerance level of 5 kg was defined in order to evaluate the impact on weight-dependent contrast agent dosage in abdominal CT.
Differences between values for height, weight and BMI were non-significant over all assessments (p > 0.83). The most accurate values for weight were obtained from the patient information (R² = 0.99) followed by the automated estimation via 3D camera (R² = 0.89). Estimates by medical staff were considerably less precise (radiologist: R² = 0.78, radiographer: R² = 0.77). A body-weight dependent dosage of contrast agent using the automated estimations matched the dosage using the reference measurements in 65 % of the cases. The dosage based on the medical staff estimates would have matched in 49 % of the cases.
Automated estimation of height and weight using a digital twin model from 3D camera acquisitions provide a high precision for protocol design in computer tomography.
· Machine learning can calculate patient-avatars from 3D camera acquisitions.. · Height and weight of the digital twins are comparable to real measurements of the patients.. · Estimations by medical staff are less precise.. · The values can be used for calculation of contrast agent dosage..
· Geissler F, Heiß R, Kopp M et al. Personalized computed tomography - Automated estimation of height and weight of a simulated digital twin using a 3D camera and artificial intelligence. Fortschr Röntgenstr 2021; 193: 437 - 445.
The use of stereotactic body radiation therapy (SBRT) for tumor and pain control in patients with bone metastases is increasing. We report response assessment after bone SBRT using radiological ...changes through time and clinical examination of patients.
We analyzed retrospectively oligo-metastatic/progressive patients with bony lesions treated with SBRT between 12/2008 and 10/2018, without in-field re-irradiation, in our institution. Radiological data were obtained from imaging modalities used for SBRT planning and follow-up purposes in picture archiving and communication system and assessed by two independent radiologists blind to the time of treatment. Several radiological changes were described. Radiographic response assessment was classified according to University of Texas MD Anderson Cancer Center criteria. Pain response and the neurological deficit were captured before and at least 6 months after SBRT.
A total of 35 of the 74 reviewed patients were eligible, presenting 43 bone metastases, with 51.2% (n = 22) located in the vertebral column. Median age at the time of SBRT was 66 years (range 38-84) and 77.1% (n = 27) were male. Histology was mainly prostate (51.4%, n = 18) and breast cancer (14.3%, n = 5). Median total radiation dose delivered was 24 Gy (range 24-42), in three fractions (range 2-7), prescribed to 70-90% isodose-line. After a median follow-up of 1.8 years (range < 1-8.2) for survivors, complete or partial response, stable, and progressive disease occurred in 0%, 11.4% (n = 4), 68.6% (n = 24), and 20.0% (n = 7) of the patients, respectively. Twenty patients (57.1%) died during the follow-up time, all from disease progression, yet 70% (n = 14) from this population with local stable disease after SBRT. From patients who were symptomatic and available for follow-up, almost half (44.4%) reported pain reduction after SBRT.
Eighty percent of the patients showed local control after SBRT for bone metastases. Pain response was favorable. For more accurate response assessment, comparing current imaging modalities with advanced imaging techniques such as functional MRI and PET/CT, in a prospective and standardized way is warranted. Trial registration Retrospectively registered.
ZusammenfassungHintergrundEine frühzeitige Diagnose von Muskelverletzungen ist von wesentlicher klinischer Bedeutung, um eine stadiengerechte Therapie einzuleiten und einen optimalen Heilungsverlauf ...zu ermöglichen.ZielZiel dieser Übersichtsarbeit ist es, ein Update zur bildgebenden Diagnostik von Muskelverletzungen in der Sportmedizin mit dem Schwerpunkt Sonographie und Magnetresonanztomographie (MRT) zu geben und neben den Verfahren in der Routinediagnostik auch experimentelle Ansätze vorzustellen.Material und MethodenEs wurde eine PubMed-Literaturrecherche durchgeführt zu den Stichworten: muscle, muscle injury, muscle imaging, muscle injury classification, delayed onset muscle soreness, ultrasound, MRI, sodium MRI, potassium MRI, ultra-high-field MRI, injuries of athletes. Fokus der Literaturrecherche war der Zeitraum 2012 bis 2022.ErgebnisseBildgebende Verfahren spielen in der Diagnostik von Muskelverletzungen eine entscheidende Rolle, um eine klinische Verdachtsdiagnose zu bestätigen und das Verletzungsausmaß zu bestimmen. Das Ergebnis der Bildgebung hat unmittelbaren Einfluss auf Therapieentscheidungen und beeinflusst die Prognose. Der Bildgebung kommt besonders bei unklaren Beschwerden oder unklarem Verletzungsausmaß, rezidivierenden Verletzungen, und auch bei unerwartet prolongierten Heilungsverläufen oder in Fällen, die einer interventionellen oder chirurgischen Intervention bedürfen, eine große Bedeutung zu. Neben etablierten Verfahren wie der B‑Bild-Sonographie und der 1H‑MRT zeigen einzelne Studien vielversprechende Ansätze, um die Bildgebung von Muskelverletzungen zukünftig zu verbessern. Hinsichtlich einer konkreten Anwendung von neuen Verfahren wie der kontrastmittelverstärkten Sonographie oder der X‑Kern-MRT sind weiterführende Studien mit größeren Patientenkollektiven notwendig, um die bisherigen Erkenntnisse zu bestätigen und ggf. klinisch anwendbar zu machen.SchlussfolgerungDie B‑Bild-Sonographie bietet sich als leicht verfügbare, kostengünstige Modalität zur initialen Diagnostik von Muskelverletzungen an. Die MRT gilt weiterhin als Referenzstandard und ermöglicht eine genaue morphologische Erfassung des Verletzungsausmaßes. Insbesondere zur objektiven Bestimmung von „Return-to-Sports“-Kriterien und der individuellen Beurteilung von Belastungs- und Trainingsfähigkeiten stehen nach wie vor keine bildgebenden Verfahren zur Verfügung.
Abstract
Background
The IMI-APPROACH cohort is an exploratory, 5-centre, 2-year prospective follow-up study of knee osteoarthritis (OA). Aim was to describe baseline multi-tissue semiquantitative MRI ...evaluation of index knees and to describe change for different MRI features based on number of subregion-approaches and change in maximum grades over a 24-month period.
Methods
MRIs were acquired using 1.5 T or 3 T MRI systems and assessed using the semi-quantitative MRI OA Knee Scoring (MOAKS) system. MRIs were read at baseline and 24-months for cartilage damage, bone marrow lesions (BML), osteophytes, meniscal damage and extrusion, and Hoffa- and effusion-synovitis. In descriptive fashion, the frequencies of MRI features at baseline and change in these imaging biomarkers over time are presented for the entire sample in a subregional and maximum score approach for most features. Differences between knees without and with structural radiographic (R) OA are analyzed in addition.
Results
Two hundred eighty-nine participants had readable baseline MRI examinations. Mean age was 66.6 ± 7.1 years and participants had a mean BMI of 28.1 ± 5.3 kg/m
2
. The majority (55.3%) of included knees had radiographic OA. Any change in total cartilage MOAKS score was observed in 53.1% considering full-grade changes only, and in 73.9% including full-grade and within-grade changes. Any medial cartilage progression was seen in 23.9% and any lateral progression on 22.1%. While for the medial and lateral compartments numbers of subregions with improvement and worsening of BMLs were very similar, for the PFJ more improvement was observed compared to worsening (15.5% vs. 9.0%). Including within grade changes, the number of knees showing BML worsening increased from 42.2% to 55.6%. While for some features 24-months change was rare, frequency of change was much more common in knees with vs. without ROA (e.g. worsening of total MOAKS score cartilage in 68.4% of ROA knees vs. 36.7% of no-ROA knees, and 60.7% vs. 21.8% for an increase in maximum BML score per knee).
Conclusions
A wide range of MRI-detected structural pathologies was present in the IMI-APPROACH cohort. Baseline prevalence and change of features was substantially more common in the ROA subgroup compared to the knees without ROA.
Trial Registration
Clinicaltrials.gov identification: NCT03883568.
Foam rolling (FR) has been developed into a popular intervention and has been established in various sports disciplines. However, its effects on target tissue, including changes in stiffness ...properties, are still poorly understood.
To investigate muscle-specific and connective tissue-specific responses after FR in recreational athletes with different FR experience.
Case series.
Laboratory environment.
The study was conducted with 40 participants, consisting of 20 experienced (EA) and 20 nonexperienced athletes (NEA).
The FR intervention included 5 trials per 45 seconds of FR of the lateral thigh in the sagittal plane with 20 seconds of rest between each trial.
Acoustic radiation force impulse elastosonography values, represented as shear wave velocity, were obtained under resting conditions (t0) and several times after FR exercise (0 min t1, 30 min t2, 6 h t3, and 24 h t4). Data were assessed in superficial and deep muscle (vastus lateralis muscle; vastus intermedius muscle) and in connective tissue (iliotibial band).
In EA, tissue stiffness of the iliotibial band revealed a significant decrease of 13.2% at t1 (P ≤ .01) and 12.1% at t3 (P = .02). In NEA, a 6.2% increase of stiffness was found at t1, which was not significantly different to baseline (P = .16). For both groups, no significant iliotibial band stiffness changes were found at further time points. Also, regarding muscle stiffness, no significant changes were detected at any time for EA and NEA (P > .05).
This study demonstrates a significant short-term decrease of connective tissue stiffness in EA, which may have an impact on the biomechanical output of the connective tissue. Thus, FR effects on tissue stiffness depend on the athletes' experience in FR, and existing studies have to be interpreted cautiously in the context of the enrolled participants.
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