VIBE-MRI is a promising tool for the diagnosis of MSK injuries in radiation-sensitive athletes

Keywords: VIBE-MRI, musculoskeletal injuries, radiation exposure

Volumetric interpolated breath-hold examination (VIBE) is an MRI sequence that is increasingly being used by Sports and Exercise Medicine (SEM) clinicians, to evaluate sports injuries in radiation-sensitive populations (1). It offers the promise of evaluating osseous lesions and soft tissue injuries where time, patient comfort and early diagnoses are key to rehabilitation. This blog discusses how VIBE-MRI can be considered to help diagnose sports injuries in adult and adolescent athletes. 

What makes VIBE-MRI different?

VIBE sequence MRI is a relatively new technique that was first developed in 1999. It has the benefit of being fast – producing high resolution images in under 30 seconds, when traditional sequences can take up to 30 minutes. Recently, it has been adapted for the diagnosis of MSK injuries, where reducing ionising radiation exposure and early diagnosis, can help to inform rehabilitation in young athletes. 

Modality	Typical effective doses (MsV)	Equivalent period of natural background radiation
CT Head	2	1 year
CT Abdomen / Pelvis	10	4.5 years
Lumbar X-Ray	1.3	7 months
Limbs & Joints X-Ray (except hip)	<0.01	<1.5 days
Hip X-Ray	0.3	7 weeks
VIBE MRI	0	0

Table 1: Radiation exposure of common MSK imaging modalities (2)

*2.2 MsV per year = Average natural background radiation in the United Kingdom

VIBE-MRI has the following additional benefits over standard MRI:

• High cortical resolution enables the identification of intracortical bone pathologies/fractures. 
• Avoids the need of duplicate/additional scans, such as CT.
• Obtain high quality, multiplanar and 3D reconstruction images.
• Rapid scanning time – minimises discomfort in athletes with significant pain following an injury or those that have claustrophobia.

VIBE-MRI – Avoid the need for duplicate imaging.

• MRI scans have traditionally been more expensive than CT, however, the costs are decreasing.

• VIBE-MRI can also negate the need for duplicate imaging (MRI followed by CT). This is by providing soft tissue definition and images to detect fractures or osseous lesions in a single scan, where appropriate.

Figure 1: Infographic summarising VIBE-MRI

The following images show typical findings on Standard MRI Sequences:

Figure 2: Pars Fracture. 

Sagittal T2 weighted image of the lumbar spine. Red arrow indicates a pars defect at L5/S1. There is also some grade 1 anterolisthesis.

Figure 3: Osteitis Pubis

Axial STIR image of the pelvis. Red arrow shows the bone marrow oedema present at the pubic symphysis. Green arrow shows the adductor muscle oedema.

Figure 4: Osteitis Pubis 

Coronal STIR image of the pelvis. Red arrow shows the bone marrow oedema present at the pubic symphysis. Green arrow shows the adductor muscle oedema.

Figure 5: Medial Tibial Stress Syndrome. 

Axial STIR sequences of the tibia and fibula. There’s an increased fluid signal adjacent to the tibia, as shown by the red arrow.  This scan shows a slightly atypical appearance, as the oedema is advancing to the posterior aspect of the tibia.

Injury Type	Findings
Pars Fracture	Assessed with sagittal views at the level of the pedicles. Look for a low signal intensity (fracture line) transversing the pedicle. (Craniocaudal orientation) Anterolisthesis, secondary to a pars defect, may also be seen by assessing alignment of the end plates.
Osteitis Pubis	Assessed best with axial/coronal views (T2 fat saturation sequence/STIR sequences)  An increased signal at the pubic symphysis (medial aspect of the inferior and superior pubic rami) indicates fluid/oedema. Cystic change and sclerosis may also be seen here.
Medial Tibial Stress Syndrome	Can be assessed using the Fredericson criteria for low grade stress responses (periosteal/bone marrow oedema). Grade 4a/4b lesions should be visible when assessing for stress fractures on VIBE sequence images.
Bankart Lesion	Sagittal views, at the level of the glenoid, are optimal to visualise a Bankart fracture (seen as a linear low signal fracture line). Bony Bankart lesions are also well visualised with VIBE sequence MRI.

 

Table 2: Typical findings on VIBE-MRI Sequences.

How does VIBE-MRI measure up to other imaging modalities?

In the world of elite sport and adolescent injuries, SEM clinicians are increasingly using VIBE-MRI to diagnose injuries. These sequences show good diagnostic accuracy for certain MSK injuries and can help provide key information to plan further interventions and rehabilitation.

Injury	Standard MRI3		VIBE-MRI4
	Sensitivity	Specificity	Sensitivity	Specificity
Pars Fracture	81	99	97.7	92.3

 

Injury	CT Arthrography5		VIBE-MR Arthrography6
	Sensitivity	Specificity	Sensitivity	Specificity
Bankart Lesion	89.4	96.4	95.7–100	93.9–97.0
Glenoid Bone Loss	100	100	95	93.8

 

Injury	Ultrasound7		VIBE-MR Arthrography8
	Sensitivity	Specificity	Sensitivity	Specificity
Rotator Cuff Tears Full Thickness Partial Thickness	91 68	93 94	92 55->92	>92 92-94

 

Injury	CT arthrography9		VIBE-MRI9
	Sensitivity	Specificity	Sensitivity	Specificity
Elbow Loose Bodies Anterior Posterior Either/Both	64-91 92-100 88-100	33-67 54-69 20-70	46-91 92-100 88-100	13-73 15-77 20-60

Table 3: VIBE-MRI compared to other imaging modalities.

Figure 5: Infographic summarising when a VIBE MRI scan may be appropriate for sport-related injuries.

In conclusion, how can SEM clinicians utilise VIBE-MRI?

• VIBE-MRI produces fast sequence images, with good sensitivity for the detection of common sports-related, bone and soft tissue injuries.

• VIBE-MRI scans can help inform early diagnosis and management, reducing time lost to injury and enabling appropriate return to sport timelines.10 This is key for radiation-sensitive populations (adolescent and young adults).

• VIBE-MRI can prevent the need for dual scanning, using both CT and MRI, in complex soft tissue pathologies.

• Further studies are needed to evaluate the sensitivities and specificities of VIBE-MRI in a wider range of sports-related injuries. This could help to inform how and when VIBE-MRI scans can be used as the first line in injury management pathways. 

 

Authors and Affiliations:

Mr Rifat Hassan, Dr Irfan Ahmed, Dr Haseeb Rehman, Dr Imran Lasker 

No competing interest

No relevant disclosures

 

Rifat Hassan 

Final Year Medical Student 

University of Southampton

Twitter @RifatHassan_

 

Dr Irfan Ahmed 

Sports and Exercise Medicine Consultant 

Connect Health, United Kingdom

Twitter @Exerciseirfan

 

Dr Haseeb Rehman 

Junior Doctor

York Hospital

Twitter @Haseeb2502

 

Dr Imran Lasker

Consultant Radiologist with Specialist interest in MSK

Employer: Mid and South Essex Foundation Trust

Twitter @DocLasker

Link to MSK/MRI courses: imranlasker.com, radiologyseminars.com. emergencyimaging.co.uk

References

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