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A handbook for beginners in skeletal muscle diffusion tensor imaging: physical basis and technical adjustments

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Abstract

Magnetic resonance imaging (MRI) of skeletal muscle is routinely performed using morphological sequences to acquire anatomical information. Recently, there is an increasing interest in applying advanced MRI techniques that provide pathophysiologic information for skeletal muscle evaluation to complement standard morphologic information. Among these advanced techniques, diffusion tensor imaging (DTI) has emerged as a potential tool to explore muscle microstructure. DTI can noninvasively assess the movement of water molecules in well-organized tissues with anisotropic diffusion, such as skeletal muscle. The acquisition of DTI studies for skeletal muscle assessment requires specific technical adjustments. Besides, knowledge of DTI physical basis and skeletal muscle physiopathology facilitates the evaluation of this advanced sequence and both image and parameter interpretation. Parameters derived from DTI provide a quantitative assessment of muscle microstructure with potential to become imaging biomarkers of normal and pathological skeletal muscle.

Key Points

• Diffusion tensor imaging (DTI) allows to evaluate the three-dimensional movement of water molecules inside biological tissues.

• The skeletal muscle structure makes it suitable for being evaluated with DTI.

• Several technical adjustments have to be considered for obtaining robust and reproducible DTI studies for skeletal muscle assessment, minimizing potential artifacts.

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Abbreviations

AD :

Axial diffusivity

DTI :

Diffusion tensor imaging

EPI :

Echo-planar imaging

FA :

Fractional anisotropy

MD :

Mean diffusivity

PCSA :

Physiological cross-sectional area

RD :

Radial diffusivity

SNR :

Signal to noise ratio

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Acknowledgements

Jose G Raya PhD (Department of Radiology, NYU School of Medicine, NY, USA) for his support and valuable guidance.

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The authors state that this work has not received any funding.

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Authors and Affiliations

  1. MRI Section, Radiology Department, SERCOSA, HT Médica, Carmelo Torres 2, 23007, Jaén, Spain

    Teodoro Martín-Noguerol & Antonio Luna

  2. Centro Rossi, Buenos Aires, Argentina

    Rafael Barousse & Ignacio Rossi

  3. Mayo Clinic Department of Radiology, Jacksonville, FL, USA

    Daniel E. Wessell

Authors
  1. Teodoro Martín-Noguerol
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Correspondence to Teodoro Martín-Noguerol.

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The scientific guarantor of this publication is Antonio Luna, MD, PhD.

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Antonio Luna, MD, PhD is occasional lecturer of Philips, Siemens Healthineers, Bracco and Canon and receives royalties as book editor from Springer-Verlag. The rest of the authors of this manuscript declare no relationships with any companies whose products or services may be related to the subject matter of the article.

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Supplementary Information

Movie 1.

At each level of tissue organization of skeletal muscle (actin-myosin complex, muscle cell, sarcomere, muscle fiber or muscle fascicle), a structural configuration is mediated by physiological barriers that create a dominant direction of water diffusion. These histological features make skeletal muscle suitable for being evaluated by DTI. (MP4 1299 kb)

Movie 2.

DTI, by applying diffusion gradients in multiple directions, can assess the main direction of water diffusion along skeletal muscle fibers and represent them by using fiber tracking algorithms, in this case of a quadriceps reconstruction in a healthy volunteer. (MP4 3740 kb)

Movie 3.

32-year-old male healthy volunteer that undergone MRI for the study of thigh muscles using DTI. The existence of multiple interfaces between air, fat, soft tissue and bone, all with different susceptibilities, can result in EPI readout related artifacts caused by off-resonance effects (white arrows). (MP4 2231 kb)

Movie 4.

It is not unusual to identify chemical shift artifact in the direction of frequency encoding caused by fat/water interfaces. The different resonance frequency of fat protons causes a displacement of fat signal on images in the frequency encoding direction. The severity of this artifact varies with the amount of fat in the tissue and acquisition parameters (e.g., bandwidth) and can degrade image quality dramatically in the periphery of the image. In this case, a 25-year-old male with acute thigh pain after playing a soccer match, shows a subtle muscle strain at anterior rectus femoris (black arrow on STIR and DTI acquisitions). Note how chemical shift artifact (white arrows) obscure it on the DTI acquisition. (MP4 1655 kb)

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Martín-Noguerol, T., Barousse, R., Wessell, D.E. et al. A handbook for beginners in skeletal muscle diffusion tensor imaging: physical basis and technical adjustments. Eur Radiol 32, 7623–7631 (2022). https://doi.org/10.1007/s00330-022-08837-w

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