An advanced magnetic resonance imaging perspective on the etiology of deep tissue injury

Jules L. Nelissen, Willeke A. Traa, Hans H. de Boer, Larry de Graaf, Valentina Mazzoli, C. Dilara Savci-Heijink, Klaas Nicolay, Martijn Froeling, Dan L. Bader, Aart J. Nederveen, Cees W.J. Oomens, Gustav J. Strijkers

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Early diagnosis of deep tissue injury remains problematic due to the complicated and multifactorial nature of damage induction and the many processes involved in damage development and recovery. In this paper, we present a comprehensive assessment of deep tissue injury development and remodeling in a rat model by multiparametric magnetic resonance imaging (MRI) and histopathology. The tibialis anterior muscle of rats was subjected to mechanical deformation for 2 h. Multiparametric in vivo MRI, consisting of T 2, T 2*, mean diffusivity (MD), and angiography measurements, was applied before, during, and directly after indentation as well as at several time points during a 14-day follow-up. MRI readouts were linked to histological analyses of the damaged tissue. The results showed dynamic change in various MRI parameters, reflecting the histopathological status of the tissue during damage induction and repair. Increased T 2 corresponded with edema, muscle cell damage, and inflammation. T 2* was related to tissue perfusion, hemorrhage, and inflammation. MD increase and decrease was reported on the tissue's microstructural integrity and reflected muscle degeneration and edema as well as fibrosis. Angiography provided information on blockage of blood flow during deformation. Our results indicate that the effects of a single damage-causing event of only 2 h of deformation were present up to 14 days. The initial tissue response to deformation, as observed by MRI, starts at the edge of the indentation. The quantitative MRI readouts provided distinct and complementary information on the extent, temporal evolution, and microstructural basis of deep tissue injury-related muscle damage. NEW & NOTEWORTHY We have applied a multiparametric MRI approach linked to histopathology to characterize damage development and remodeling in a rat model of deep tissue injury. Our approach provided several relevant insights in deep tissue injury. Response to damage, as observed by MRI, started at some distance from the deformation. Damage after a single indentation period persisted up to 14 days. The MRI parameters provided distinct and complementary information on the microstructural basis of the damage.

Original languageEnglish
Pages (from-to)1580-1596
Number of pages17
JournalJournal of Applied Physiology
Issue number6
Publication statusPublished - 1 Jun 2018


  • Animals
  • Female
  • Magnetic Resonance Imaging/methods
  • Muscle, Skeletal/diagnostic imaging
  • Rats, Sprague-Dawley
  • Regeneration
  • Soft Tissue Injuries/diagnostic imaging


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