Combined t2 mapping and diffusion tensor imaging: A sensitive tool to assess myofascial trigger points in a rat model

Abstract

Background: Myofascial trigger points (MTrPs) are defined as very small and hypersensi-tive points in skeletal muscle that are palpable, and produce localized pain on compression. The aim of this study was to explore the feasibility of combining T2 mapping with diffusion tensor imaging (DTI) for assessing MTrPs in a rat model and to investigate properties of the pathophysiological mechanisms. Methods: Twenty-four Sprague-Dawley rats (model group, n = 14; control group, n = 10) underwent a magnetic resonance imaging (MRI) examination on a 3 T-MRI-scanner with a protocol consisting of T2 mapping and DTI. The MTrPs were established by blunt strike in combination with eccentric exercise. Enzyme-linked immunosorbent assays (ELISAs) were used to detect the levels of interleukin-1ß (IL-1ß) and interleukin-2 (IL-2) and their results were correlated with T2 values. Parameters from MRI including T2 values, fractional anisotropy (FA), axial diffusivity (AD), mean diffusivity (MD), and radial diffusivity (RD) were compared between the two groups. Histological analysis was applied to provide an additional supply for MRI findings. Results: The MTrPs of rats displayed significantly increased T2 values and FA (= 0.000) compared with normal controls, whereas MD and RD values were significantly lower (P= 0.031, = 0.000, respectively). There was no statistically significant difference in AD between the two groups (P= 0.400). These differences were accompanied by elevated levels of IL-1ß and interleukin-2 IL-2 in the MTrP group compared with controls. T2 values were positively correlated with elevated IL-1ß levels (r = 0.543, P < 0.05) but were not correlated with IL-2 levels (P > 0.05). Conclusion: Combining T2 and DTI sequences creates a sensitive tool to assess MTrPs in a rat model. These data clarify a hypothesis that a trigger point is a chronic and mild muscle injury with inflammation.