Tissue-Specific T2 * Biomarkers in Patellar Tendinopathy by Subregional Quantification Using 3D Ultrashort Echo Time MRI

J Magn Reson Imaging. 2020 Aug;52(2):420-430. doi: 10.1002/jmri.27108. Epub 2020 Feb 28.


Background: Quantitative MRI of patellar tendinopathy (PT) can be challenging due to spatial variation of T2 * relaxation times.

Purpose: 1) To compare T2 * quantification using a standard approach with analysis in specific tissue compartments of the patellar tendon. 2) To evaluate test-retest reliability of different methods for fitting ultrashort echo time (UTE)-relaxometry data.

Study type: Prospective.

Subjects: Sixty-five athletes with PT.

Field strength/sequence: 3D UTE scans covering the patellar tendon were acquired using a 3.0T scanner and a 16-channel surface coil.

Assessment: Voxelwise median T2 * was quantified with monoexponential, fractional-order, and biexponential fitting. We applied two methods for T2 * analysis: first, a standard approach by analyzing all voxels covering the proximal patellar tendon. Second, within subregions of the patellar tendon, by using thresholds on biexponential fitting parameter percentage short T2 * (0-30% for mostly long T2 *, 30-60% for mixed T2 *, and 60-100% for mostly short T2 *).

Statistical tests: Average test-retest reliability was assessed in three athletes using coefficients-of-variation (CV) and coefficients-of-repeatability (CR).

Results: With standard image analysis, we found a median [interquartile range, IQR] monoexponential T2 * of 6.43 msec [4.32-8.55] and fractional order T2 * 4.39 msec [3.06-5.78]. The percentage of short T2 * components was 52.9% [35.5-69.6]. Subregional monoexponential T2 * was 13.78 msec [12.11-16.46], 7.65 msec [6.49-8.61], and 3.05 msec [2.52-3.60] and fractional order T2 * 11.82 msec [10.09-14.44], 5.14 msec [4.25-5.96], and 2.19 msec [1.82-2.64] for 0-30%, 30-60%, and 60-100% short T2 *, respectively. Biexponential component short T2 * was 1.693 msec [1.417-2.003] for tissue with mostly short T2 * and long T2 * of 15.79 msec [13.47-18.61] for mostly long T2 *. The average CR (CV) was 2 msec (15%), 2 msec (19%) and 10% (22%) for monoexponential, fractional order and percentage short T2 *, respectively.

Data conclusion: Patellar tendinopathy is characterized by regional variability in binding states of water. Quantitative multicompartment T2 * analysis in PT can be facilitated using a voxel selection method based on using biexponential fitting parameters.

Level of evidence: 1 TECHNICAL EFFICACY STAGE: 1 J. Magn. Reson. Imaging 2020;52:420-430.

Keywords: biomarkers; image processing; magnetic resonance imaging; patellar ligament; reproducibility of results; tendinopathy.

Publication types

  • Research Support, Non-U.S. Gov't

MeSH terms

  • Biomarkers
  • Humans
  • Magnetic Resonance Imaging*
  • Prospective Studies
  • Reproducibility of Results
  • Tendinopathy* / diagnostic imaging


  • Biomarkers