Recommendations for Improvement of Protocol for Curing the ACL Ligament - Essay Example

This technology has also enabled the assessment of other conditions that affect the ACL ligament together with any associated injuries. To obtain meaningful diagnostic performance, any direct or indirect tears that affect the ACL should be identified through MRI. The major challenge affecting prognosis, however, has been the imaging of partial tears.

Therefore, I provide the following recommendations for the improvement of this protocol:

Oblique imaging planes, including oblique axial, oblique coronal, and oblique sagittal, would improve the accuracy of diagnosis and detection of any partial tears in the ACL. It would also aid in assessing individual bundle tears. This approach has been noted to be more useful than the standard MRI in cases where an ACL tear is anticipated.

The protocol could also benefit from 3D sequences such as the 3D-DESS, known to be isotropic acquisition having the potential of reducing partial volume averaging through the acquisition of thin and continuous slices from the joints. Additionally, this could be used to come up with multiplanar reformat images, MPR, which would make the evaluation of ACL possible from any orientation or oblique planes through a single acquisition. This creation of the MPR could be sourced as part of the PACS system or through dependent workstations. The MPR images in this context would be useful for the acquisition of the oblique planes, including the oblique axial, coronal, and sagittal, to better assess the ACL tears.

Finally, the 3D-DEES sequences play a crucial role in enhancing the image’s T2* weighting and also increase synovial fluid and cartilage signal intensities. This 3D-DEES technique is beneficial in the sense that it provides moderate accuracy with regard to early cartilage delineation and high accuracy when detecting advanced cartilage lesions. As such, this sequence can only be employed when dealing with cartilage structures. Replacing this ACL imaging sequence with the subtraction-DESS technique would result in its optimization.

Part 2:

MRI technology has been beneficial in supporting chronic and acute ligament injury diagnosis and, even more importantly, in assessing problems that arise after the reconstruction of the ligament. Even so, the short T2-relaxation time associated with tendon tissue (4), the standard MRI having echo times, TE, greater than a few milliseconds senses a low signal from the tendon graft. This makes the visualization of the graft occur through negative contrast with reference to the surrounding tissues. Moreover, those elements employed during graft fixing often have susceptibility effects that cause the local signal to be lost at the usually achievable echo times.

To visualize short-T2 components when dealing with highly ordered tissues like ligaments, menisci, tendons, or periosteum (5 – 7), ultrashort echo-time, UTE techniques would be employed. As such, after cruciate ligament repairs, such techniques could offer a direct and positive contrast graft visualization in addition to promising perfect contrast between fixation elements and graft. Moreover, it has been noted that 3D UTE techniques produce isotropic spatial resolution (8.9) which makes it possible for easy data reformatting to stick to the grafting course through the anatomy of the knee. This makes it possible for UTE imaging to provide additional information on the tendon graft’s condition and its fixation.

The arrows show the metal implants at the low artifact level acquired in UTE images. The arrow shows the section of the femoral cross pin that is broken as visualized from UTE images.