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AG MSK

AG Muskuloskelettal

Contact Details

Group leaders:
Dr. med. Thierno Diallo
Dr. med. Matthias Jung
Associate:
Prof. Dr. med. Pia M. Jungmann

 

Department of Diagnostic and Interventional Radiology

Medical Center – University of Freiburg
Faculty of Medicine
University of Freiburg
Hugstetter Strasse 55
79106 Freiburg
Germany

phone: +49 (0) 7621 270-38052
thierno.diallo@uniklinik-freiburg.de
matthias.jung@uniklinik-freiburg.de

 

Research Background

Musculoskeletal (MSK) diseases represent a main cause for disability with major individual and social costs. Traumatic defects of different joint structures such as cartilage, meniscus or ligaments may lead to early osteoarthritis. Osteoarthritis is the most common musculoskeletal disorder with a continuously increasing prevalence in our aging society.

Qualitative and quantitative MR imaging is an important diagnostic tool that allows early detection of structural joint defects and osteoarthritis. Preoperative and postoperative MR imaging after surgical procedures may be able to predict and monitor disease progression and postoperative outcomes.

The “AG MSK” mainly works on developing, optimizing and clinically implementing different qualitative and quantitative MR sequences in order to assess individual joint structures non-invasively on a biochemical and biomechanical level.

Morphological evaluation

Standardized morphological evaluation of individual joint structures on high resolution MR imaging is essential for assessment, monitoring and outcome evaluation in the context of clinical studies and also for proper clinical treatment. Continuous optimization of MR image quality and development of standardized image interpretation is a focus of current ongoing investigations.

Articular Cartilage

Non-invasive cartilage MR biomarkers such as T2 or T1rho relaxation time measurements are able to detect early biochemical cartilage matrix changes, mainly increases in water content, collagen disruption and loss of proteoglycans (Figure 1, 2 and 3). T2 relaxation time measurements have been shown to predict progression to morphological cartilage loss. These measurements may have important impact on describing epidemiology of early OA and for outcome evaluation after cartilage repair procedures.

Figure 1. Cartilage T2 relaxation time measurements at the knee at 0, 2, 4, 6 and 8 year follow-up. Blue indicates low T2 values. Red indicates high T2 values. High T2 values are predictive for cartilage loss and osteoarthritis.
Figure 2. T2 relaxation time measurements of cartilage repair tissue after matrix-associated autologous chondrocyte implantation for treatment of a focal cartilage defect at the knee. Blue indicates low T2 values, red indicates high T2 values of the repair tissue.
Figure 3. Cartilage T2 relaxation time measurements at the shoulder. Blue indicates low T2 values, red indicates high T2 values.

Muscle

Skeletal muscle volume, fatty degeneration and perfusion are essential for proper musculoskeletal function. It has been shown, that qualitative and quantitative muscle MR parameters correlate with clinical strength, with progression of joint degeneration and with outcomes after surgical procedures (Figures 4 and 5). Potentially, MR parameters may be defined that help individual clinical decision making with respect to conservative versus operative treatment strategies.

Figure 4. Quantitative measurements of the fat fraction of skeletal muscle at the shoulder (sagittal images). Red indicates high fat fraction. Blue indicates low fat fraction. A: Young patient with low fat fraction of the supraspinatus muscle. B: Older patient with transmural supraspinatus tendon rupture, fatty infiltration and atrophy of the supraspinatus muscle.
Figure 5. Sagittal color coded map of the IVIM-Perfusion parameter fD* of the rotator cuff in a young healthy volunteer. Young patient before (A) and after (B) activation of the supraspinatus muscle.

Metal

After total joint arthroplasty MR imaging of the periprosthetic soft tissue is challenging due to major susceptibility artifacts caused by the implant. Metal artifact reducing sequences (Slice Encoding for Metal Artifact Correction, SEMAC) have been developed in order to decrease those artifacts while keeping the MR acquisition time in a reasonable time frame. These sequences are being evaluated and optimized for improved periprosthetic evaluation after final joint replacement (Figure 6). In patients with persistent or new complaints after total joint arthroplasty the underlying causes may be identified. Also, these sequences allow for ideal postoperative follow-up evaluation after tumor resection.

Figure 6. Metal artifact reduced MR imaging in a patient with a shoulder prosthesis.

Osteoporosis

New CT and MR imaging techniques and post-processing algorithms allow for automated quantitative image analysis (Figure 7). This enables osteodensitometry at the spine in non-dedicated routine CT scans (opportunistic osteoporosis screening) and can help diagnose osteoporosis in order to initiate adequate therapy and prevent osteoporotic fractures. We develop and apply deep-learning based methods for automated image analysis in collaboration with the Department of Neuroradiology at the Technical University Munich ([deep-spine.de]deep-spine.de).

Figure 7. Segmentation masks in 3D rendering and segmentation mask overlaid on a sagittal CT scan. Reference: Löffler MT et al. 2021 Jan 11;11:552719. doi: 10.3389/fendo.2020.552719.

Body composition

Body composition CT and MR imaging parameters such as muscle density, muscle fat-fraction (Figure 8), muscle area or body fat distribution are reported to be associated with skeletal muscle depletion (e.g. sarcopenia), frailty, cancer, osteoarthritis and metabolic diseases, including diabetes and metabolic syndrome. In this context, longitudinal studies may help to better understand the impact of body composition on pathogenesis and disease progression. Further, analyses of the different abdominal body compartments (subcutaneous fat, visceral fat, abdominal muscles; Figure 9) may contribute to risk stratification, initiation of preventive measures and follow-up evaluation during and after therapeutic intervention.

Figure 8. MR imaging assessment of body composition. A Severe fatty infiltration of paravertebral muscles. B No fatty infiltration of muscles.
Figure 9. CT imaging assessment of different abdominal body compartments. Orange: muscle; green: visceral fat; blue: subcutaneous fat.

Tumor

Primary bone and soft tissue tumors are rare, but potentially fatal pathologies that are diagnosed via MR imaging. Outcomes after radiotherapy, chemotherapy and/ or surgery of musculoskeletal tumors differ by tumor entity, pathological grading, tumor location and other parameters. Besides providing exact information on tumor location, on tumor size and on involved and infiltrated structures, MR imaging is able to narrow differential diagnoses, monitor therapeutic effects (Figure 10) and detect local recurrence during follow-up.

Figure 10. MR imaging of a Ewing sarcoma at the right shoulder at baseline, at 2 months follow-up, at 4 months follow-up (neoadjuvant chemotherapy) and postoperatively.

Group Members

Dr. med. Thierno D. Diallo
Dr. med. Matthias Jung
Dr. med. Annika Catherine Bach
Dr. med. Balasz Bogner
Dr. med. Paula Giesler
Prof. Dr. med. Pia M. Jungmann
Dr. med. Dipl.-Ing. Maximilian T. Löffler

Open Positions

You can contact us directly, if you would like to work with us.

 

Research Grants

We acknowledge funding support by:

  • Berta-Ottenstein “Clinician Scientist” Programme 
  • Berta-Ottenstein “Advanced Clinician Scientist” Programme
  • Deutsche Arthrose-Hilfe e.V.
  • DGMSR (Deutsche Gesellschaft für Muskuloskelettale Radiologie)

Pubmed Link

Pubmed Link