EXPERT OPINION PAPER ON MRI ACQUISITION PROTOCOLS

We are proud to announce our design and MRI acquisition protocol paper in Osteoarthritis Cartilage Open 2024 Jul 23;6(3):100505. PMID: 39183946  

Design of a sample rapid MRI acquisition protocol, supporting the assessment of multiple articular tissues & pathologies in knee osteoarthritis. by Felix Eckstein et al.

In this expert opinion paper, we describe and discuss a <30 min MRI acquisition protocol for use in interventional clinical trials. This will be applied in the PROTO Horizon EU-consortium project (one for a rehabilitation, and one for an i.a. therapy study), as a basis for (automated) image segmentation and analysis of multiple (quantitative) endpoints.

 The intent was to be both visionary and realistic, in that all sequences can be installed and used on a clinical (3T) scanner, but are not yet routinely applied for the given purpose. The spearhead is a qDESS (double echo steady stated) water excitation (we) sequence originally proposed by Akshay Chaudhari and others https://pubmed.ncbi.nlm.nih.gov/29090500/ (Fig. top row). The sequence is unique in that it permits analysis of quantitative endpoints of all below measures:

• cartilage morphometry (e.g. cartilage thickness, subchondral bone & denuded area)
• cartilage T2 (transverse relaxation time, related to collagen & hydration)
• bone shape, including complex measures such as the B-score
• meniscus morphology and position (coverage, overlap, extrusion)
• potentially also Hoffa synovitis

Although qDESS is not routinely available on clinical scanners, it can be installed with the help of dedicated application specialists under a research agreement with the manufacturer, once fitted to the specific soft- and hardware environment.

We further suggest “clinical” IW TSE FS acquisitions in 3 planes to support radiological scoring of structural pathologies (cartilage, meniscus, and bone marrow lesions, Hoffa- and Effusion synovitis, bone pathology, Fig.).

Finally, we propose a FLAIR sequence (Fig. bottom right), because of its superiority in separating synovitis from effusion compared with IW TSE FS (Fig.). As indiated above, qDESS may have some potential in detecting Hoffa synovitis. These two sequences hence represent interesting options, if contrast enhanced (CE) MRI is not available or not recommended for a trial (see PROTO), albeit clearly representing the gold standard in the assessment of synovitis. Synovitis represents a core topic in the PROTO Horizon project, with quantitative non-CE MRI endpoints of synovitis being developed and tested.

This work is funded by the European Union / Grant Agreement Nr. 101095635 (PROTO-Horizon Europe). Views and opinions expressed are those of the authors and not of the EU, with neither the EU nor the granting authority to be held responsible. The design of the image acquisition protocol and the content of this article has not been contingent upon approval from the sponsor.