Effectively Measuring Exercise-Related Variations in T1ρ and T2 Relaxation Times of Healthy Articular Cartilage

Abstract

Background: Determining the compositional response of articular cartilage to dynamic joint-loading using MRI may be a more sensitive assessment of cartilage status than conventional static imaging. However, distinguishing the effects of joint-loading vs. inherent measurement variability remains difficult, as the repeatability of these quantitative methods is often not assessed or reported.

Purpose: To assess exercise-induced changes in femoral, tibial, and patellar articular cartilage composition and compare these against measurement repeatability.

Study type: Prospective observational study.

Population: Phantom and 19 healthy participants.

Field strength/sequence: 3T; 3D fat-saturated spoiled gradient recalled-echo; T_1ρ - and T₂ -prepared pseudosteady-state 3D fast spin echo.

Assessment: The intrasessional repeatability of T_1ρ and T₂ relaxation mapping, with and without knee repositioning between two successive measurements, was determined in 10 knees. T_1ρ and T₂ relaxation mapping of nine knees was performed before and at multiple timepoints after a 5-minute repeated, joint-loading stepping activity. 3D surface models were created from patellar, femoral, and tibial articular cartilage.

Statistical tests: Repeatability was assessed using root-mean-squared-CV (RMS-CV). Using Bland-Altman analysis, thresholds defined as the smallest detectable difference (SDD) were determined from the repeatability data with knee repositioning.

Results: Without knee repositioning, both surface-averaged T_1ρ and T₂ were very repeatable on all cartilage surfaces, with RMS-CV <1.1%. Repositioning of the knee had the greatest effect on T_1ρ of patellar cartilage with the surface-averaged RMS-CV = 4.8%. While T_1ρ showed the greatest response to exercise at the patellofemoral cartilage region, the largest changes in T₂ were determined in the lateral femorotibial region. Following thresholding, significant (>SDD) average exercise-induced in T_1ρ and T₂ of femoral (-8.0% and -5.3%), lateral tibial (-6.9% and -5.9%), medial tibial (+5.8% and +2.9%), and patellar (-7.9% and +2.8%) cartilage were observed.

Data conclusion: Joint-loading with a stepping activity resulted in T_1ρ and T₂ changes above background measurement error.

Evidence level: 2 TECHNICAL EFFICACY STAGE: 1 J. MAGN. RESON. IMAGING 2020;52:1753-1764.

Keywords: MRI; articular cartilage; exercise; quantitative imaging; relaxation time; repeatability.