Applications of T

1
in Clinical Studies
of Post-Operative Tibial Fracture
Patients
Sujay Rajkumar
8/06/14
Purpose
Determine T
1
values over time in patients who
have undergone intramedullary nailing to
improve post operation imaging.
Focus:
Patella, Femur and Tibia
T
1
Imaging
T
1
or T
1rho
utilizes components of T
1
and T
2

RF pulses prevent spin from relaxing (T
1
) yet T
2
decay is still occurring
Mock T
2
Results in a crisp and cleaner image than T
2
Images fluidity similar to T
2
yet retains clarity.
Post-Operative Patients
Loss occurs due to the loss of proteoglycan molecules which hold water molecules.
Retains fluidity of joint
Due to age, strain, etc.
T
1
imaging creates values which show intensity of proteoglycan
Healthy cartilage has lower T
1
values in seconds
Unhealthy cartilage has higher T
1
values in seconds
More Information: The effects of acute loading on T1rho and T2
relaxation times of tibiofemoral articular cartilage; UCSF Dept. Radiology
Processing
Data collected from various clinical scans in
2012 processed via MATLAB.
Images created and overlay of cartilage area.
Image points are taken at various stages of post
op recovery
12 mos. is the final data point.
Utilizing this data, we can create averages.
Data and Analysis
6 months Post-Op
3 months Post-Op 6 months Post-Op
Patient 3 Patient 6 Patient 4
P
a
t
e
l
l
a
r

F
e
m
o
r
a
l

Analysis and Observations
Average T
1
values were compiled in excel to create an understanding of how this
surgery affects T
1
values.

Patient 3
(6 Months)
Patient 4 (2
weeks)
Patient 4
(3 Months)
Patient 6
(6 Months)
46.13738571 68.0464642 63.38019462 37.13534848
T
1
values are not exact as possible based off of objective vs. subjective
data.
Hindrance from titanium and stainless steel implants in tibia is the
main source of discrepancy.
Unfortunately there are gaps within data
Patient mishaps or still required time for more Post-Op scans
Conclusion
Current post- op identification is primarily limited to
Blood Tests
X-Rays and Radiographs.
The use of T
1
can be used in the definitive mapping of cartilage can assist in understanding anatomy of
cartilage and fluidity of joints after operation has occurred.
Development of these imaging techniques with magnetic resonance can allow physicians to
Provide early diagnosis of cartilage complications
Provide effective preventative measures and treatment for patients who have undergone
intramedullary nailing.
Conclusion of My Experiences
Basics of Magnetic Resonance
Science and Mathematics
Procedures
7T and 9.4T
Preservation (Wax slicing)
Animal Handling
Professional Research Procedures

Acknowledgements
Mentors: Guided the process of projects, presentations, etc.
Kevin
Sid
Damodar
Teachers: Provided complex knowledge of the basics of MR
Organizers: Assigned projects and created classes
Shelly
Susan
Special Thanks to Dr. Reddy for allowing me to
learn under his directorship at the CMROI.
Using a Mathematical Model to Determine T
2

Relaxivity with Glucose as a Contrast Agent
Garimall S., Rajkumar S., DAquilla K.,
Reddy R. Ph.D
Relaxivity: Concept
Relaxivity (r
1
and r
2
) in MRI refers to the
ability of any compound or element to
increase the relaxation rates (T
1
& T
2
) of
surrounding bulk protons.
Units are mM
-1
* sec
-1

The relaxivity effect of a particular compound is
determined by its molecular structure and kinetic
behavior.

Relaxivity: Applications
Compounds with free electrons can impact
the relaxivity of bulk water protons quite
dramatically.
This allows the use of MRI contrast agents, like
Gadolinium (Gd) which allow for higher image
contrast.
Useful for tumor detection.

Gadolinium enhanced axial MRI image (on right) shows a 2 cm mass (with
surrounding edema) in the right parietal lobe (arrow added for emphasis).
Image Credit: South Med J. 2003;96(4) copyright 2003 Lippincott Williams & Wilkins
Accessed from: Saccente, Michael et al.; Cerebral Histoplasmosis in the Azole Era: Report of Four Cases and Review; South Med J. 2003;96(4)

Glucose as a contrast agent
Warburg Effect: Otto Heinrich Warburg
observed that tumor cells use glycolysis as
the predominant mode of energy production.
It follows that if differences in in vivo glucose
uptake and metabolism could be observed, tumor
detection would be possible.
Therefore glucose could be used as a contrast
agent.
Glucose vs. Gadolinium
Gadolinium is a superior contrast agent, but
Glucose offers some advantages, if an
acceptable image contrast can be achieved.
Glucose is endogenous to the human body, and
can be introduced in large physiological quantities
orally, intravenously, etc.
Cost effective, readily available.
Better tolerated by certain patients.
E.g. renal failure

Evaluating Relaxivity (r
2
)
It is possible to evaluate the r
2
of a given
compound using this formula:

r
2
= 1/T
2
* 1000

(for a given concentration and temperature)
where T
2
(ms) is the spin-spin relaxation constant
This formula requires the lengthy process of
generating a curve from multiple echo time
points.
SI = S
0
e
-TE/T2


Evaluating Relaxivity (r
2
)
To save time and create a more efficient
process to determine r
2
, it may be possible to
use a formula:
[-ln(S
exp
/S
baseline
)/TE] = r
2
Where:
S
exp
/S
baseline
represents the signal intensity (SI) of
a given glucose sample at some echo time (TE)
divided by the SI of a control sample without
glucose.

Relaxivity Measurements
Five samples of glucose (0, 1, 2, 5, 10 mM) in
PBS (pH = 7), where 0 mM acted as the
baseline.
A standard T
2
FLASH

mapping sequence was
performed using the small in-house RF coil:
TE taken from 0-200 ms at 20 ms intervals.
SHOT TR = 8000 ms
T
2
map created of each sample.

T
2
Maps with 2% Agarose Samples
0mM 1mM
2mM 5mM
10mM
Images showed good
fitting at R
2
= 0.95
-0.500
0.000
0.500
1.000
1.500
2.000
2.500
3.000
3.500
4.000
0 50 100 150 200 250
Relaxivity (1/mM*s)
TE (ms)
Relaxivity vs. TE by concentration
10mm
5mm
2mm
1mm
Sample
(mM)
r
2

1 0.265
2 0.110
5 0.894
10 1.26
0
200
400
600
800
1000
1200
1400
1600
1800
0 50 100 150 200 250
Signal Intensity
TE (ms)
Signal Intensity vs. TE by concentration
10mm
5mm
2mm
1mm
0mm
Expon. (10mm)
Expon. (5mm)
Expon. (2mm)
Expon. (1mm)
Expon. (0mm)
Concentration
Glucose Sample
(mM)
T
2
(ms) by curve
fitting
r
2


0 1754 0
1 1351 0.17
2 1515 0.09
5 990 0.44
10 794 0.69
T
2
decreases substantially as the glucose
concentration is increased.
The advantage of using an agarose phantom is
that in theory, the change in T
2
could only be
caused by glucose.
Relaxivity of the first two time points (TE) is
unusually high, but levels out at later points
for all samples.
Repeat measurements are needed.
Observations & Key Points