Orthopaedic Applications

Joints in motion inside an MR bore!

MRI is the gold standard for the investigation of pathological processes in the joints and the spine. However, a high-quality MRI examination can only be carried out in supine or prone position, which does not correspond to the physiological conditions in everyday life.

Patients with degenerative disorders in the musculo-skeletal system commonly suffer from pain during walking, working or other activities, which are caused by a load on the joints. In the supine position the joints and the spine are uncompressed so that the causative pathology can be underdiagnosed. Therefore, an investigation of joints and spine under stress is preferable to identify the causative alteration, e.g. a disk herniation pressing on a nerve or a meniscus luxating in an upright position. The Orthospect module generates a compression of the musculoskeletal system, permitting MRI examinations in a simulated standing position. The advantage of our system is the automatic pressure adjustment, which provides a constant load during the examination and achieves pressure changes for real-time imaging.

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Application fields for Ergospect Modules

Orthospect:

Functional Specification:

  • joints of the lower extremities, spine for loaded MRI

Indications:

  • degenerative disorders of the musculoskeletal system (spine, joints of the lower extremities),
  • cartilage injuries/damage,
  • disc herniation/recurrent disc herniation

Parameters:

  • phase-contrast MRI: assessment of changes in tissue elasticity (ligaments, cartilage, menisci, discs, muscles of the lower extremities)
  • relaxometry: determination of oedema or water content under stress (ligaments, cartilage, menisci, discs, muscles of the lower extremities)
  • elastography: elasticity testing and evaluation of re-ruptures after surgical fixation
  • conventional loaded MRI: investigation of anatomical structures under isometric strain

Target:

  • gerontologists, neurologists, neurosurgeons, orthopaedists, physiologists, traumatologists, sports physicians, radiologists

Trispect:

Functional Specification:

  • calf muscles, muscles of the planta pedis, tendons of the extensor muscles, Achilles tendon, ankle for loaded MRI

Indications:

  • disorders of muscle metabolism (myopathies, lipid metabolism),
  • changes in lactate metabolism (e.g. tumours),
  • determination of the intramuscular recruitment pattern for the evaluation of the risk of calf muscle injuries in athletes and amateur sportsmen (e.g.: soccer players),
  • tumour perfusion before, during and after chemotherapy,
  • tissue perfusion after transplantations, replantation, frostbite or drug application,
  • Achilles tendon re-ruptures after surgical fixation,
  • integrity evaluation of extensor muscle tendons,
  • osteoarthritis, osteochondritis dissecans

Parameters:

  • 31P MRS, 13C MRS: determination of mitochondrial function, anaerobic and aerobic capacity and glycogen metabolism
  • 1H-MRS: lipid metabolism and deoxymyoglobin: tracking of intra- and extra-myocellular lipids and myoglobin
  • LATEST: lactate chemical exchange saturation transfer (CEST) to image lactate in vivo
  • perfusion MRI: microcirculation within the exercising muscle
  • phase-contrast MRI: assessment of bllod flow or changes in tissue elasticity (Achilles tendon, calf muscles)
  • CINE MRI: real-time imaging of calf muscles, tendons and ankle during exercise testing
  • relaxometry: determination of oedema or water content in different tissues during exercise testing (tendons, calf muscles)
  • elastography: elasticity testing and evaluation of re-ruptures after surgical fixation
  • mfMRI: T2-imaging of the flexor muscles to determine intramuscular water content changes under strain
  • conventional loaded MRI: investigation of anatomical structures under isometric strain

Target:

  • angiologists, gerontologists, interventional radiologists, neurologists, orthopaedists, paediatricians, physiologists, plastic surgeons, radiologists, sports physicians, training facilities for astronauts and athletes, traumatologists, vascular physicians/surgeons

Tibiospect:

Functional Specification:

  • extensor muscles of the lower leg, tendons of the flexor muscles, Achilles tendon, ankle for loaded MRI

Indications:

  • disorders of muscle metabolism (myopathies, lipid metabolism),
  • changes in lactate metabolism (e.g. cancer, diabetes mellitus (DM)),
  • assessment of muscle fiber type composition (MFTC) of athletes (non-invasive discrimination between endurance and strength athletes),
  • tumour perfusion before, during and after chemotherapy,
  • tissue perfusion after transplantations, replantation, frostbite or drug application,
  • Achilles tendon re-ruptures after surgical fixation,
  • integrity evaluation of flexor muscle tendons,
  • osteoarthritis, osteochondritis dissecans

Parameters:

  • 31P MRS, 13C MRS: determination of mitochondrial function, anaerobic and aerobic capacity and glycogen metabolism
  • 1H-MRS: lipid metabolism and deoxymyoglobin: tracking of intra- and extra-myocellular lipids and myoglobin
  • LATEST: lactate chemical exchange saturation transfer (CEST) to image lactate in vivo
  • perfusion MRI: microcirculation within the exercising muscle
  • phase-contrast MRI: assessment of blood flow or changes in tissue elasticity
  • CINE MRI: real-time imaging of the extensor muscles of the lower leg, the tendons of the flexor muscles, the Achilles tendon and the ankle during exercise testing
  • relaxometry: determination of oedema or water content within the extensor muscles under stress
  • elastography: elasticity testing and evaluation of re-ruptures after surgical fixation
  • conventional loaded MRI: investigation of anatomical structures under isometric strain

Target:

  • neurologists, gerontologists, orthopaedists, paediatricians, physiologists, plastic surgeons, radiologists, sports physicians, training facilities for astronauts and athletes, traumatologists

Quadspect:

Functional Specification:

  • extensor muscles of the thigh, quadriceps and patellar tendon, internal knee structures for loaded MRI

Indications:

  • disorders of muscle metabolism (myopathies, lipid metabolism),
  • changes in lactate metabolism (cancer, diabetes mellitus (DM)),
  • tumour perfusion before, during and after chemotherapy,
  • tissue perfusion after transplantations, replantation or drug application,
  • ligament, tendon and meniscal tears and re-ruptures after surgical fixation,
  • Osteoarthritis, Osteochondritis dissecans

Parameters:

  • 31P MRS, 13C MRS: determination of mitochondrial function, anaerobic and aerobic capacity and glycogen metabolism
  • 1H-MRS: lipid metabolism and deoxymyoglobin: tracking of intra- and extra-myocellular lipids and myoglobin
  • LATEST: lactate chemical exchange saturation transfer (CEST) to image lactate in vivo
  • Perfusion MRI: microcirculation within the exercising muscle
  • Phase-contrast MRI: assessment of blood flow or changes in tissue elasticity (ligaments, tendons, menisci, cartilage, thigh muscles)
  • CINE MRI: real-time imaging of the extensor muscles of the thigh, the tendons and the internal structures of the knee during exercise testing
  • relaxometry: determination of oedema or water content under stress (ligaments, tendons, menisci, cartilage, thigh muscles)
  • elastography: quadriceps and patellar tendon elasticity testing and evaluation of re-ruptures after surgical fixation
  • mfMRI: T2-imaging of the flexor muscles to determine intramuscular water content changes under strain
  • Conventional loaded MRI: investigation of anatomical structures under isometric strain

Target:

  • gerontologists, neurologists, orthopaedists, paediatricians, physiologists, plastic surgeons, radiologists, sports physicians, training facilities for astronauts and athletes, traumatologists


Ischiospect:

Functional Specification:

  • flexor muscles of the thigh, internal structures of hip and knee for loaded MRI

Indications:

  • disorders of muscle metabolism (myopathies, lipid metabolism),
  • changes in lactate metabolism (cancer, diabetes mellitus (DM)),
  • tumour perfusion before, during and after chemotherapy,
  • tissue perfusion after transplantations, replantation and drug application, ligament tears,
  • impingement,
  • osteoarthritis, osteonecrosis

Parameters:

  • 31P MRS, 13C MRS: determination of mitochondrial function, anaerobic and aerobic capacity and glycogen metabolism
  • 1H-MRS: lipid metabolism and deoxymyoglobin: tracking of intra- and extra-myocellular lipids and myoglobin
  • LATEST: lactate chemical exchange saturation transfer (CEST) to image lactate in vivo
  • perfusion MRI: microcirculation within the exercising muscle
  • phase-contrast MRI: assessment of blood flow or changes in tissue elasticity (ligaments, cartilage, flexor muscles)
  • CINE MRI: real-time imaging of the flexor muscles of the thigh, the tendons and the internal structures of hip and knee during exercise testing
  • relaxometry: determination of oedema or water content under stress (ligaments, cartilage, flexor muscles)
  • elastography: elasticity testing and evaluation of re-ruptures after surgical fixation
  • mfMRI: T2-imaging of the flexor muscles to determine intramuscular water content changes under strain
  • Conventional loaded MRI: investigation of anatomical structures under isometric strain

Target:

  • gerontologists, neurologists, orthopaedists, paediatricians, physiologists, plastic surgeons, radiologists, sports physicians, training facilities for astronauts and athletes, traumatologists

In Development

Genuspect:

Functional Specification:

  • internal structures of the knee for loaded MRI

Indications:

  • evaluation of anterior cruciate ligament (ACL) integrity and tears, ACL changes and re-ruptures after surgical repair, osteochondral injuries, peripheral meniscal tears and patellar dislocation during the Lachman-test,
  • assessment of lateral collateral ligament (LCL), anterior and posterior cruciate ligament (ACL and PCL) integrity and tears during varus stress testing in full extension and at 30° of flexion of the knee,
  • investigation of medial collateral ligament (MCL) and anterior cruciate ligament (ACL) integrity and tears, meniscal tears, chondral injuries, patellar subluxation, distal femoral physeal fracture and pes tendinitis during valgus stress testing in full extension and at 30° of flexion of the knee,
  • evaluation of medial meniscus integrity and tears during abduction and external rotation of lower leg and foot,
  • assessment of lateral meniscus integrity and tears during abduction and internal rotation of lower leg and foot,
  • evaluation of articular cartilage degeneration (e.g. osteoarthritis, osteochondritis dissecans) and injuries,
  • follow-up after reparative and reconstructive surgery of traumatic and degenerative cartilaginous damage,
  • monitoring of the effects of potentially chondroprotective agents

Parameters:

  • conventional loaded MRI of the knee:
  1. coronal, sagittal and axial fat suppressed 2D fast SE proton-density (PD)-weighted images for the assessment of ligaments, articular cartilage and menisci before and during load
  2. coronal, sagittal and axial fat suppressed 2D fast SE T2-weighted images for the examination of ligaments, articular cartilage, menisci and associated bone bruise lesions or fracture lines before and during load
  3. coronal and sagittal fat suppressed 2D fast SE Intermediate-weighted sequences (TE 33-60msec) for the assessment of articular cartilage and differentiation between cartilage and subchondral bone
  • relaxometry: determination of oedema or water content under stress (ligaments, cartilage, menisci)
  • T2 mapping for the assessment of articular cartilage composition (e.g. osteoarthritis, after anterior cruciate ligament repair, monitoring of cartilage repair)
  • dGEMRIC: T1 mapping after intravenous administration of Gd-DTPA allows quantitative assessment of articular cartilage composition

Target:

  • gerontologists, orthopaedists, paediatricians, physiologists, radiologists, sports physicians, traumatologists