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Ultrahigh-field MRI at 7T to enable direct visualization of pulley lesions- feasibility study on anatomical specimens

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  • Title:
    Ultrahigh-field MRI at 7T to enable direct visualization of pulley lesions- feasibility study on anatomical specimens
  • Author: Librimir, Alexander
  • Description: Objective In recent years, climbing has gained considerable popularity. With more than 500,000 active athletes in Germany, it has become a popular sport. This develop- ment is associated with an increase in injuries of the musculoskeletal system, es- pecially pulley lesions of the fingers. The therapeutic approach depends on the spe- cific structural injury pattern. A surgical procedure is favored for multiple pulley rup- tures. Various imaging procedures have dealt with the visualization of the pulley system. Due to its small anatomical size, indirect visualization methods using US are considered as the standard clinical approach to visualize pulley lesions. US is considered to be operator dependent and inaccurate in depicting micro-injuries such as A3- pulley lesions. The main objective of this thesis is therefore to assess the direct visualization of all pulleys and pulley ruptures, including the A3, using 7.0 Tesla MRI in order to improve the diagnostic and therapeutic procedure for patients with pulley lesions. Materials and methods 30 fingers from 10 human cadavers were examined before and after iatrogenic pul- ley disruption using 7 Tesla MRI. Therefore, a motor-driven device was used to ap- ply a tensile force to the flexor tendons until a pulley rupture occurred. The prepa- rations were examined before and after this rupture with different sequences, espe- cially designed for a possible application on patients. Images were evaluated by two independent radiologists for the presence and anatomic location of finger pulley le- sions. For this purpose, a 4-point Likert scale from “not evaluable” to “excellent” was applied. The localization and morphology of the ruptures were documented. As ref- erence standard, a macroscopic follow-up examination was performed, respec- tively. Results The Identification of the pulleys was successful in 100% (n= 90/90) before and after mechanically induced pulley lesions. The consensus Likert-value for the qualitative MR-visualization of the pulleys was 2.71 before disruption and 2.87 after disruption. 3 Pulley lesions were detected in 24% (n= 22/90). A macroscopic diagnostic confir- mation was achieved in 100% (n= 22/22). In 82% (n= 18/22) intercalation of the pulley stump in between the flexor tendon and finger phalanges was observed. Mac- roscopically, this could be confirmed in 100% (n= 18/18). Pulley lesions were de- tected in 36% (n= 8/22) at the radial, in 41% (n= 9/22) at the ulnar as well as in in 23% (n= 5/22) in the central parts of the finger pulley. Rupture localization was rated 2.14 on the Likert Scale. Conclusion Ultrahigh-field MRI at 7T enables direct visualization of intact and also ruptured A2, A3 and A4 finger flexor pulleys. Furthermore, it enables the characterization of rup- ture morphology and localization. These results have the potential to improve clini- cal outcomes, especially for patients with combined pulley ruptures as well as for patients with intercalation of pulley stumps.
  • Creation Date: 2020
  • Language: German
  • Source: OPUS FAU Online publication system of Friedrich Alexander Universität Erlangen Nürnberg
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