Skip to main content
SpringerLink
Log in

Magnetic resonance imaging of ankle tendon pathology: benefits of additional axial short-tau inversion recovery imaging to reduce magic angle effects

  • Scientific Article
  • Published:
Skeletal Radiology Aims and scope Submit manuscript

Abstract

Objectives

Our goals were to quantify the reduction of the magic angle effect using short-tau inversion recovery (STIR) imaging and to determine the value of adding an axial STIR sequence to the magnetic resonance imaging ankle protocol.

Materials and methods

Axial STIR sequences were used to measure normal tendon T1 and to estimate signal loss due to the inversion recovery preparation of our clinical protocol. In addition, 102 ankles were imaged with axial fat-suppressed intermediate-weighted fast spin echo and STIR sequences. Two radiologists analyzed the tendons for signal intensity, size, abnormalities, and magic angle effect. The diagnostic value and image quality of the two sequences were compared.

Results

We calculated a 50 % reduction of signal intensity in healthy tendons on the STIR sequence at TI = 170 ms compared with TI = 0 ms, explaining the decrease in the magic angle effect. Using the STIR sequence, our study demonstrated significantly lower signal intensity within the tendons, more precise tendon size, and a lower magic angle effect compared with the standard intermediate-weighted FSE sequence (p < 0.001). Diagnostic classification of tendon abnormalities using the STIR sequences showed higher sensitivity (82.35 % vs 75.27 %) and better agreement with a reference standard than the intermediate-weighted sequences, and superior image quality (p < 0.01).

Conclusions

Axial STIR sequences reduce magic angle effects and improve visualization of ankle tendon pathology.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2
Fig. 3
Fig. 4
Fig. 5

Similar content being viewed by others

References

  1. Schweitzer ME, Karasick D. MRI of the ankle and hindfoot. Semin Ultrasound CT MR. 1994;15(5):410–22.

    Article  PubMed  CAS  Google Scholar 

  2. Cheung Y, Rosenberg ZS, Magee T, Chinitz L. Normal anatomy and pathologic conditions of ankle tendons: current imaging techniques. Radiographics. 1992;12(3):429–44.

    PubMed  CAS  Google Scholar 

  3. Aerts P, Disler DG. Abnormalities of the foot and ankle: MR imaging findings. AJR Am J Roentgenol. 1995;165(1):119–24.

    PubMed  CAS  Google Scholar 

  4. Kingston S. Magnetic-resonance imaging of the ankle and foot. Clin Sport Med. 1988;7(1):15–28.

    CAS  Google Scholar 

  5. Khoury NJ, el-Khoury GY, Saltzman CL, Brandser EA. MR imaging of posterior tibial tendon dysfunction. AJR Am J Roentgenol. 1996;167(3):675–82.

    PubMed  CAS  Google Scholar 

  6. Rosenberg ZS, Beltran J, Bencardino JT. From the RSNA Refresher Courses. Radiological Society of North America. MR imaging of the ankle and foot. Radiographics. 2000;20:S153–79.

    PubMed  Google Scholar 

  7. Wang XT. Normal variants and diseases of the peroneal tendons and superior peroneal retinaculum: MR imaging features. Radiographics. 2005;25:587–602.

    Article  PubMed  Google Scholar 

  8. Campbell RS, Grainger AJ. Current concepts in imaging of tendinopathy. Clin Radiol. 2001;56(4):253–67.

    Article  PubMed  CAS  Google Scholar 

  9. Mengiardi B, Pfirrmann CWA, Schöttle PB, Bode B, Hodler J, Vienne P, et al. Magic angle effect in MR imaging of ankle tendons: influence of foot positioning on prevalence and site in asymptomatic subjects and cadaveric tendons. Eur Radiol. 2006;16(10):2197–206.

    Article  PubMed  Google Scholar 

  10. Schweitzer ME, Caccese R, Karasick D, Wapner KL, Mitchell DG. Posterior tibial tendon tears - utility of secondary signs for Mr-imaging diagnosis. Radiology. 1993;188(3):655–9.

    PubMed  CAS  Google Scholar 

  11. Zanetti M. Founder’s lecture of the ISS 2006: borderlands of normal and early pathological findings in MRI of the foot and ankle. Skelet Radiol. 2008;37(10):875–84.

    Article  Google Scholar 

  12. Erickson SJ, Prost RW, Timins ME. The magic-angle effect—background physics and clinical relevance. Radiology. 1993;188(1):23–5.

    PubMed  CAS  Google Scholar 

  13. Fullerton GD, Rahal A. Collagen structure: the molecular source of the tendon magic angle effect. J Magn Reson Imaging. 2007;25(2):345–61.

    Article  PubMed  Google Scholar 

  14. Erickson SJ, Cox IH, Hyde JS, Carrera GF, Strandt JA, Estkowski LD. Effect of tendon orientation on Mr imaging signal intensity—a manifestation of the magic angle phenomenon. Radiology. 1991;181(2):389–92.

    PubMed  CAS  Google Scholar 

  15. Peh WCG, Chan JHM. The magic angle phenomenon in tendons: effect of varying the MR echo time. Br J Radiol. 1998;71(841):31–6.

    PubMed  CAS  Google Scholar 

  16. Fullerton GD, Cameron IL, Ord VA. Orientation of tendons in the magnetic field and its effect on T2 relaxation times. Radiology. 1985;155(2):433–5.

    PubMed  CAS  Google Scholar 

  17. Li T. Manifestation of magic angle phenomenon: comparative study on effects of varying echo time and tendon orientation among various MR sequences. Magn Reson Imaging. 2003;21(7):741–4.

    Article  PubMed  CAS  Google Scholar 

  18. Bydder M, Rahal A, Fullerton GD, Bydder GM. The magic angle effect: a source of artifact, determinant of image contrast, and technique for imaging. J Magn Reson Imaging. 2007;25(2):290–300.

    Article  PubMed  Google Scholar 

  19. Bydder GM, Young IR. MR imaging—clinical use of the inversion recovery sequence. J Comput Assist Tomogr. 1985;9(4):659–75.

    Article  PubMed  CAS  Google Scholar 

  20. Bydder GM, Steiner RE, Blumgart LH, Khenia S, Young IR. MR imaging of the liver using short TI inversion recovery sequences. J Comput Assist Tomogr. 1985;9(6):1084–9.

    Article  PubMed  CAS  Google Scholar 

  21. Wright P, Jellus V, McGonagle D, Robson M, Ridgeway J, Hodgson R. Comparison of two ultrashort echo time sequences for the quantification of T(1) within phantom and human Achilles tendon at 3T. Magn Reson Med. 2012;68(4):1279–84.

    Article  PubMed  Google Scholar 

  22. Du J, Pak BC, Znamirowski R, Statum S, Takahashi A, Chung CB, et al. Magic angle effect in magnetic resonance imaging of the Achilles tendon and enthesis. Magn Reson Imaging. 2009;27(4):557–64.

    Article  PubMed  Google Scholar 

  23. Gold GE, Han E, Stainsby J, Wright G, Brittain J, Beaulieu C. Musculoskeletal MRI at 3.0T: relaxation times and image contrast. AJR Am J Roentgenol. 2004;183(2):343–51.

    PubMed  Google Scholar 

  24. Kingsley PB. Signal intensities and T-1 calculations in multiple-echo sequences with imperfect pulses. Concepts Magn Reson. 1999;11(1):29–49.

    Article  CAS  Google Scholar 

  25. Kijowski R, Farber JM, Medina J, Morrison W, Ying J, Buckwalter K. Comparison of fat-suppressed T2-weighted fast spin-echo sequence and modified STIR sequence in the evaluation of the rotator cuff tendon. AJR Am J Roentgenol. 2005;185(2):371–8.

    PubMed  Google Scholar 

  26. Rosenberg ZS, Cheung Y, Jahss MH, Noto AM, Norman A, Leeds NE. Rupture of posterior tibial tendon: CT and MR imaging with surgical correlation. Radiology. 1988;169(1):229–35.

    PubMed  CAS  Google Scholar 

  27. Delfaut EM, Demondion X, Bieganski A, Cotten H, Mestdagh H, Cotten A. The fibrocartilaginous sesamoid: a cause of size and signal variation in the normal distal posterior tibial tendon. Eur Radiol. 2003;13(12):2642–9.

    Article  PubMed  CAS  Google Scholar 

  28. Delfaut EM, Beltran J, Johnson G, Rousseau J, Marchandise X, Cotten A. Fat suppression in MR imaging: techniques and pitfalls. Radiographics. 1999;19(2):373–82.

    PubMed  CAS  Google Scholar 

Download references

Acknowledgments

We would like to thank Ms Piyawan Srikhum, doctoral student at CEREG-University Paris-Dauphine for her assistance with the statistical analyses. I would also like to express a special thanks to Mr Napat Boonsaeng for his help with data processing, and for all of his suggestions during difficult times.

Author information

Authors and Affiliations

  1. Musculoskeletal Quantitative Imaging Research Group, Department of Radiology and Biomedical Imaging, University of California San Francisco, San Francisco, CA, USA

    Waraporn Srikhum, Lorenzo Nardo, Dimitrios C. Karampinos, Gerd Melkus, Theresa Poulos, Lynne S. Steinbach & Thomas M. Link

  2. Department of Radiology, Thammasat University, Pathum Thani, Thailand

    Waraporn Srikhum

  3. Department of Diagnostic and Interventional Radiology, Technische Universitat Munchen, Munich, Germany

    Dimitrios C. Karampinos

  4. Department of Radiology and Biomedical Imaging, UCSF, 400 Parnassus Ave, A-367, Box 0628, San Francisco, CA, 94143, USA

    Thomas M. Link

Authors
  1. Waraporn Srikhum
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Lorenzo Nardo
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Dimitrios C. Karampinos
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Gerd Melkus
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Theresa Poulos
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Lynne S. Steinbach
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. Thomas M. Link
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Thomas M. Link.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Srikhum, W., Nardo, L., Karampinos, D.C. et al. Magnetic resonance imaging of ankle tendon pathology: benefits of additional axial short-tau inversion recovery imaging to reduce magic angle effects. Skeletal Radiol 42, 499–510 (2013). https://doi.org/10.1007/s00256-012-1550-y

Download citation

  • Received:

  • Revised:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00256-012-1550-y

Keywords

Search

Navigation