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Keywords: Musculoskeletal: Muscular

The present educational lecture will provide an overview of the technical aspects of the most important quantitative skeletal muscle imaging techniques and will discuss recent applications and current trends. Special focus will be given to techniques to measure the proton density fat fraction and relaxation parameters of skeletal muscle and to the application of the techniques in the context of neuromuscular diseases and orthopedic imaging.

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Keywords: MSK, Spectroscopy, Down-field 1H MRS

We have detected new resonances that were not reported previously with chemical shifts of ~10.1, 10.3, and 10.9 ppm occurring in the down-field ¹H MRS (DFMRS) from the human calf muscle in vivo. Based on the phantom and literature data, we speculate that the contribution to the 10.1 ppm peak might be from L-Tryptophan whereas the peaks at 10.3 and 10.9 ppm are yet to be assigned. This is for the first time that these peaks are observed and reported from the down-field ¹H MRS of the human calf muscle.

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Ziying Yin¹, Yi Sui¹, Keni Zheng¹, Xiang Shan¹, Philips Rossman¹, Armando Manduca², Brent A. Bauer³, and Richard L. Ehman^1
1Radiology, Mayo Clinic, Rochester, MN, United States, ²Physiology and Biomedical Engineering, Mayo Clinic, Rochester, MN, United States, ³General Internal Medicine, Mayo Clinic, Rochester, MN, United States

Keywords: Muscle, Elastography, slip interface imaging, myofascial interface, myofascial pain syndrome

Myofascial pain syndrome (MPS) is a common chronic pain disorder that can cause disability. Efforts to understand the MPS pathology have focused on myofascial connective tissue and the function of fascial plane mobility. Slip interface imaging (SII) offers a unique opportunity to assess fascial plane mobility noninvasively. Here, we investigated the feasibility of SII to visualize the mobility of the intermuscular myofascial interface in the upper leg and the functional intramuscular interface in the forearm flexor muscles in healthy volunteers. This creates a foundation for using MRE/SII to distinguish between a healthy and a dysfunctional fascial plane in MPS patients.

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Lara Schlaffke¹, Johannes Forsting¹, Marlena Rohm^1,2, Peter Schwenkreis¹, Martin Tegenthoff¹, Christine Meyer-Frießem³, and Elena Enax-Krumova^1
1Neurology, University Clinic Bergmannsheil Bochum gGmbH, Bochum, Germany, ²Heimer Institute for Muscle Research, University Clinic Bergmannsheil Bochum gGmbH, Bochum, Germany, ³Anaesthesiology, Intensive Care and Pain Management, University Clinic Bergmannsheil Bochum gGmbH, Bochum, Germany

Keywords: Muscle, COVID-19

Patients with post COVID-19 condition (PCC) often suffer from musculoskeletal pain with unknown pathophysiology. qMRI of the lower limbs was used to unravel the underlying mechanisms. 20 PCC were compared to 20 age and gender matched controls with regard to muscle fatfraction (revealed by Dixon imaging) water T2 time (using T2-mapping) and structural alterations (using DTI). Quantitative MRI did not depict any signs of ongoing inflammation or dystrophic process of the skeletal muscles in PCC patients. However, differences observed in muscle DTI depicts microstructural abnormalities, which may reflect potentially reversible fiber hypotrophy due to deconditioning.

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Donnie Cameron¹, Melissa T. Hooijmans², Erik H. Niks³, and Hermien E. Kan^1
1C.J. Gorter MRI Center, Department of Radiology, Leiden University Medical Center, Leiden, Netherlands, ²Department of Radiology and Nuclear Medicine, Amsterdam UMC, Location AMC, Amsterdam, Netherlands, ³Department of Neurology, Leiden University Medical Center, Leiden, Netherlands

Keywords: Muscle, Permeability, Neuromuscular diseases

Becker muscular dystrophy (BMD) is an X-linked disorder characterised by variable, progressive muscle damage and loss of function. MR-derived fat fraction is used as a disease-progression marker, but early markers are lacking. Here we compared membrane permeability measures between BMD patients and controls to test whether these are altered in BMD. Phosphorus-(³¹P)-MRS showed reduced ionised magnesium [Mg²⁺], and increased phosphodiester/adenosine-triphosphate ratios and pH in the tibialis anterior muscle in patients, while diffusion-tensor-(DT)-MRI-derived permeability showed no inter-group differences. Future studies should determine the predictive value of ³¹P-MRS-measured [Mg²⁺], pH, and membrane breakdown for disease progression, to establish their potential as biomarkers.

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Alfredo Liubomir Lopez Kolkovsky¹, Béatrice Matot¹, Harmen Reyngoudt¹, Benjamin Marty¹, Ericky Caldas de Almeida Araujo¹, and Yves Fromes^1
1NMR Laboratory , Neuromuscular Investigation Center, Institute of Myology, Paris Cedex 13, France

Keywords: Muscle, Aging, Multi-contrast, Relaxometry, MR Fingerprinting

Aging is a multi-factorial process and studies in the lower leg are scarce. We performed a multi-contrast protocol in 51 volunteers from 20 to 81 y.o. We found an age-related increase of muscle water T₁(water-fat separation,MR fingerprinting), fat fraction, water T₂ and T₂ heterogeneity in the anterior and posterior compartments. Phosphodiesters and mitochondrial stress biomarkers also increased with age. Through bi-compartment water T₂ CPMG measures, age-related increases of the long water T₂ relative fraction were observed relative to the short water T₂ (T_{2-H2O-CPMG-short}) fraction, but T_{2-H2O-CPMG-short} values were unaltered with age, suggesting inflammation with preservation of the intracellular water compartment.

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Keywords: Muscle, Diffusion/other diffusion imaging techniques

Single pulsed field gradient (sPFG) diffusion MRI (dMRI) is a commonly researched tool to monitor changes in muscle microstructure associated with injury. Double pulsed field gradient (dPFG) dMRI has been used to characterize microstructure of neural tissues, but is not commonly applied to skeletal muscle. This study demonstrates both in silico and in vivo applications of dPFG dMRI to assess changes in muscle microstructure that are related to muscle function (e.g. fiber diameter). Additionally, a novel method for analyzing dPFG data called Diffusion Tensor Subspace Imaging (DiTSI) demonstrates high sensitivity to quantifiable biomarkers of muscle microstructure. 

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Eric Baetscher¹, William Triplett², Glenn Walter², Sean Forbes², Rebecca Willcocks², Robert Mueller², Alison Barnard², Krista Vandenborne², and William Rooney^3
1Biomedical Engineering, Oregon Health & Science University, Portland, OR, United States, ²University of Florida, Gainesville, FL, United States, ³Oregon Health & Science University, Portland, OR, United States

Keywords: Muscle, Relaxometry

Fatty tissue replacement of muscle is characteristic of disease progression in Duchenne muscular dystrophy (DMD), and correlates with a decrease in muscle ¹H₂O T₂. We report longitudinal analysis of MRS data from 86 subjects with DMD. We detect a significant effect of μ (age at 50% fat-fraction) on the slope of T₂ by FF. The effect of μ on slope is a consequence of lower T₂ at high FF in early progressing subjects, not an effect of T₂  differences at low FF. The slope of muscle water T₂ decline with FF may contain additional information related to pathology in DMD.

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Keywords: Muscle, Metabolism, capillary function

Phosphorous (³¹P) MRS is frequently used to study alterations in muscle mitochondrial function but works under the assumption that exercise triggers sufficient changes in perfusion to allow for delivery oxygen and energy substrates to the tissue. Here, we used interleaved scanning of 31PMRS and BOLD imaging to obtain an in-debt evaluation of muscle oxidative capacity in the upper arm muscles during arm-cycling exercise. We demonstrated that similar levels of PCr depletion and PCr recovery times resulted in variable Time-To-Peaks (TTPs) and max %BOLD response while a tendency was observed between a lower end-exercise pH and longer TTP. 

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Qin Zhou¹, Pei Chen¹, Xiaoxiao Zhao¹, Jing Zhao¹, Mengzhu Wang², and Zhiyun Yang^1
1The first affiliated hospital of sun yat-sen university, Guangzhou, China, ²MR Scientific Marketing, Siemens Healthineers Ltd, Guangzhou, China

Keywords: Muscle, CEST & MT, Myasthenia Gravis,MTR

This study looked into the feasibility of using MTI to assess the EOM morphological and pathological changes in MG. The MTR can effectively quantify fibrosis and atrophy of EOM in MG patients, which is significantly related to the poor response to medication and the long duration of the disease, implying that it can be used as a non-invasive auxiliary diagnostic tool for MG patients' prognosis evaluation.

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Junrong Chen¹, Jiujun Lan¹, Ze Li², Min Fu², Xiaochun Yuan², and Huilou Liang^3
1Sichuan Province Orthopedic Hospital, Chengdu, China, ²Chengdu Sport University, Chengdu, China, ³GE Healthcare China, Beijing, China

Keywords: Muscle, Fat, Quantitative imaging, Lumbar disc herniation

The development, progression, treatment and rehabilitation of lumbar disc herniation (LDH) are strongly associated with morphology and structural characteristics of lumbar paraspinal muscle. The IDEAL-IQ MR sequence allows the direct quantification of lumbar paraspinal muscle properties including fat fraction (FF) and cross-sectional area (CSA). The side-to-side differences between quantitative properties of bilateral paraspinal muscles in patients with unilateral LDH remain unclear. Therefore, this study aimed to investigate the possible unilateral changes of the paraspinal muscles in patients with unilateral LDH. Our results found no difference in FF and CSA values of paraspinal muscles between the affected and unaffected sides.