Skip to main content
SpringerLink
Log in

Dixon-based MRI for assessment of muscle-fat content in phantoms, healthy volunteers and patients with achillodynia: comparison to visual assessment of calf muscle quality

  • Musculoskeletal
  • Published:
European Radiology Aims and scope Submit manuscript

Abstract

Objectives

To quantify the muscle fat-content (MFC) in phantoms, volunteers and patients with achillodynia using two-point Dixon-based magnetic resonance imaging (2pt-MRIDIXON) in comparison to MR spectroscopy (MRS) and visual assessment of MFC.

Methods

Two-point Dixon-based MRI was used to measure the MFC of 15 phantoms containing 0-100 % fat-content and calf muscles in 30 patients (13 women; 57 ± 15 years) with achillodynia and in 20 volunteers (10 women; 30 ± 14 years) at 1.5 T. The accuracy of 2pt-MRIDIXON in quantification of MFC was assessed in vitro using phantoms and in vivo using MRS as the standard of reference. Fat-fractions derived from 2pt-MRIDIXON (FFDIXON) and MRS (FFMRS) were related to visual assessment of MFC (Goutallier grades 0–4) and Achilles-tendon quality (grade 0-4).

Results

Excellent linear correlation was demonstrated for FFDIXON with phantoms and with FFMRS in patients (p c = 0.997/0.995; p < 0.001). FFDIXON of the gastrocnemius muscle was significantly higher (p = 0.002) in patients (7.0 % ± 4.7 %) compared with volunteers (3.6 % ± 0.7 %), whereas visual-grading showed no difference between both groups (p > 0.05). FFMRS and FFDIXON were significantly higher in subjects with (>grade 1) structural damage of the Achilles-tendon (p = 0.01).

Conclusions

Two-point Dixon-based MRI allows for accurate quantification of MFC, outperforming visual assessment of calf muscle fat. Structural damage of the Achilles tendon is associated with a significantly higher MFC.

Key points

• Two-point Dixon-based MRI allows accurate quantification of muscular fat content (MFC).

• Quantitative analysis outperforms visual analysis in the detection of elevated MFC.

• Achillodynia results in an increased MFC of the gastrocnemius muscles.

• Structural damage of the Achilles tendon further increases the MFC.

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
Fig. 6

Similar content being viewed by others

Abbreviations

MFC:

Muscle fat content

2pt-MRIDIXON :

Two-point Dixon-based MRI

FF:

Fat fraction

References

  1. Theodorou DJ, Theodorou SJ, Kakitsubata Y (2012) Skeletal muscle disease: patterns of MRI appearances. Br J Radiol 85:e1298–e1308

    Article  CAS  PubMed Central  PubMed  Google Scholar 

  2. Fischer MA, Nanz D, Shimakawa A et al (2013) Quantification of muscle fat in patients with low back pain: comparison of multi-echo MR imaging with single-voxel MR spectroscopy. Radiology 266:555–563

    Article  PubMed  Google Scholar 

  3. Ma J (2008) Dixon techniques for water and fat imaging. J Magn Reson Imaging 28:543–558

    Article  PubMed  Google Scholar 

  4. Fischer MA, Nanz D, Reiner CS et al (2010) Diagnostic performance and accuracy of 3-D spoiled gradient-dual-echo MRI with water- and fat-signal separation in liver-fat quantification: comparison to liver biopsy. Investig Radiol 45:465–470

    Article  Google Scholar 

  5. Schweitzer ME, Karasick D (2000) MR imaging of disorders of the Achilles tendon. AJR Am J Roentgenol 175:613–625

    Article  CAS  PubMed  Google Scholar 

  6. Sharma P, Maffulli N (2005) Tendon injury and tendinopathy: healing and repair. J Bone Joint Surg Am 87:187–202

    Article  PubMed  Google Scholar 

  7. Hoffmann A, Mamisch N, Buck FM et al (2011) Oedema and fatty degeneration of the soleus and gastrocnemius muscles on MR images in patients with Achilles tendon abnormalities. Eur Radiol 21:1996–2003

    Article  PubMed  Google Scholar 

  8. Munteanu SE, Barton CJ (2011) Lower limb biomechanics during running in individuals with achilles tendinopathy: a systematic review. J Foot Ankle Res 4:15

    Article  PubMed Central  PubMed  Google Scholar 

  9. Bartolozzi A, Andreychik D, Ahmad S (1994) Determinants of outcome in the treatment of rotator cuff disease. Clin Orthop Relat Res 308:90–97

    PubMed  Google Scholar 

  10. Gerber C, Schneeberger AG, Hoppeler H et al (2007) Correlation of atrophy and fatty infiltration on strength and integrity of rotator cuff repairs: a study in thirteen patients. J Shoulder Elbow Surg 16:691–696

    Article  PubMed  Google Scholar 

  11. Raptis DA, Fischer MA, Graf R et al (2012) MRI: the new reference standard in quantifying hepatic steatosis? Gut 61:117–127

    Article  PubMed  Google Scholar 

  12. Dickson LC, Costain R, McKenzie D et al (2009) Quantitative screening of stilbenes and zeranol and its related residues and natural precursors in veal liver by gas chromatography-mass spectrometry. J Agric Food Chem 57:6536–6542

    Article  CAS  PubMed  Google Scholar 

  13. Dixon WT (1984) Simple proton spectroscopic imaging. Radiology 153:189–194

    CAS  PubMed  Google Scholar 

  14. Fischmann A, Kaspar S, Reinhardt J et al (2012) Exercise might bias skeletal-muscle fat fraction calculation from Dixon images. Neuromuscul Disord 22:S107–S110

    Article  PubMed  Google Scholar 

  15. Pineda N, Sharma P, Xu Q et al (2009) Measurement of hepatic lipid: high-speed T2-corrected multiecho acquisition at 1H MR spectroscopy—a rapid and accurate technique. Radiology 252:568–576

    Article  PubMed  Google Scholar 

  16. Goutallier D, Postel JM, Bernageau J et al (1994) Fatty muscle degeneration in cuff ruptures. Pre- and postoperative evaluation by CT scan. Clin Orthop Relat Res 304:78–83

    PubMed  Google Scholar 

  17. Lin L, Torbeck LD (1998) Coefficient of accuracy and concordance correlation coefficient: new statistics for methods comparison. PDA J Pharm Sci Technol 52:55–59

    CAS  PubMed  Google Scholar 

  18. Gladstone JN, Bishop JY, Lo IK et al (2007) Fatty infiltration and atrophy of the rotator cuff do not improve after rotator cuff repair and correlate with poor functional outcome. Am J Sports Med 35:719–728

    Article  PubMed  Google Scholar 

  19. Alizai H, Nardo L, Karampinos DC et al (2012) Comparison of clinical semi-quantitative assessment of muscle fat infiltration with quantitative assessment using chemical shift-based water/fat separation in MR studies of the calf of post-menopausal women. Eur Radiol 22:1592–1600

    Article  PubMed Central  PubMed  Google Scholar 

  20. Fischmann A, Hafner P, Gloor M et al (2012) Quantitative MRI and loss of free ambulation in Duchenne muscular dystrophy. J Neurol 260:969–974

    Article  PubMed  Google Scholar 

  21. Karampinos DC, Baum T, Nardo L et al (2012) Characterization of the regional distribution of skeletal muscle adipose tissue in type 2 diabetes using chemical shift-based water/fat separation. J Magn Reson Imaging 35:899–907

    Article  PubMed Central  PubMed  Google Scholar 

  22. Rofsky NM, Lee VS, Laub G et al (1999) Abdominal MR imaging with a volumetric interpolated breath-hold examination. Radiology 212:876–884

    Article  CAS  PubMed  Google Scholar 

  23. Cassidy FH, Yokoo T, Aganovic L et al (2009) Fatty liver disease: MR imaging techniques for the detection and quantification of liver steatosis. Radiographics 29:231–260

    Article  PubMed  Google Scholar 

  24. Reeder SB, Robson PM, Yu H et al (2009) Quantification of hepatic steatosis with MRI: the effects of accurate fat spectral modeling. J Magn Reson Imaging 29:1332–1339

    Article  PubMed Central  PubMed  Google Scholar 

  25. Kovanlikaya A, Guclu C, Desai C et al (2005) Fat quantification using three-point dixon technique: in vitro validation. Acad Radiol 12:636–639

    Article  PubMed  Google Scholar 

  26. Bernard CP, Liney GP, Manton DJ et al (2008) Comparison of fat quantification methods: a phantom study at 3.0T. J Magn Reson Imaging 27:192–197

    Article  PubMed  Google Scholar 

  27. Karampinos DC, Yu H, Shimakawa A et al (2011) T-corrected fat quantification using chemical shift-based water/fat separation: application to skeletal muscle. Magn Reson Med 66:1312–1326

    Article  CAS  PubMed Central  PubMed  Google Scholar 

  28. Yu H, Shimakawa A, McKenzie CA et al (2008) Multiecho water-fat separation and simultaneous R2* estimation with multifrequency fat spectrum modeling. Magn Reson Med 60:1122–1134

    Article  PubMed Central  PubMed  Google Scholar 

  29. Bydder M, Yokoo T, Hamilton G et al (2008) Relaxation effects in the quantification of fat using gradient echo imaging. Magn Reson Imaging 26:347–359

    Article  PubMed Central  PubMed  Google Scholar 

  30. Gloor M, Fasler S, Fischmann A et al (2011) Quantification of fat infiltration in oculopharyngeal muscular dystrophy: comparison of three MR imaging methods. J Magn Reson Imaging 33:203–210

    Article  PubMed  Google Scholar 

  31. Mengiardi B, Schmid MR, Boos N et al (2006) Fat content of lumbar paraspinal muscles in patients with chronic low back pain and in asymptomatic volunteers: quantification with MR spectroscopy. Radiology 240:786–792

    Article  PubMed  Google Scholar 

Download references

Acknowledgements

The scientific guarantor of this publication is Professor Christian W. A. Pfirrmann. 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. The authors state that this work has not received any funding. One of the authors has significant statistical expertise. No complex statistical methods were necessary for this paper. Institutional Review Board approval was obtained. Written informed consent was obtained from all subjects (patients) in this study. None of the study subjects or cohorts have been previously reported. Methodology: prospective, case-control study, performed at one institution.

Author information

Authors and Affiliations

  1. Radiology, University Hospital Balgrist, Forchstrasse 340, 8008, Zurich, Switzerland

    Michael. A. Fischer, Christian W. A. Pfirrmann & Florian M. Buck

  2. Department of Orthopedic Surgery, University Hospital Balgrist, Forchstrasse 340, 8008, Zurich, Switzerland

    Norman Espinosa

  3. Clinic of Visceral and Transplant Surgery, University Hospital Zurich, Raemistrasse 100, 8091, Zurich, Switzerland

    Dimitri A. Raptis

Authors
  1. Michael. A. Fischer
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Christian W. A. Pfirrmann
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Norman Espinosa
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Dimitri A. Raptis
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Florian M. Buck
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Michael. A. Fischer.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Fischer, M.A., Pfirrmann, C.W.A., Espinosa, N. et al. Dixon-based MRI for assessment of muscle-fat content in phantoms, healthy volunteers and patients with achillodynia: comparison to visual assessment of calf muscle quality. Eur Radiol 24, 1366–1375 (2014). https://doi.org/10.1007/s00330-014-3121-1

Download citation

  • Received:

  • Revised:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00330-014-3121-1

Keywords

Search

Navigation