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10.
Figure 13

Figure 13. From: The Transeurope Footrace Project: longitudinal data acquisition in a cluster randomized mobile MRI observational cohort study on 44 endurance runners at a 64-stage 4,486km transcontinental ultramarathon.

Supplementary mobile MRI examinations during the TEFR09. A: male, 61-years-old, stage 38, 2,601 km (PDw TSE fs, A1: coronal, A2: sagittal): Stress fracture of the proximal tibia (1) with perifocal bone edema (2) and focal subcutaneous edema (3). B: male, 49-years old, stage 52, 3,609 km (PDw TSE fs, B1: sagittal, B2: transversal): Retropatellar chondral ulcer (1) leading to bleeding/hematoma of the patellar bone (2). C: male, 41-years-old, stage 13, 857 km (PDw TSE fs transversal): Massive subcutaneous edema (panniculitis: 1) with focal myositis of deep flectors (2) and tenosynovitis of Achilles tendon (3).

Uwe HW Schütz, et al. BMC Med. 2012;10:78-78.
11.
Figure 11

Figure 11. From: The Transeurope Footrace Project: longitudinal data acquisition in a cluster randomized mobile MRI observational cohort study on 44 endurance runners at a 64-stage 4,486km transcontinental ultramarathon.

Semiautomatic tissue separation with mobile whole body MRI of a 32-year-old male finisher of the TEFR09. A: Right row (before start): green: total lean tissue, red: somatic adipose soft tissue, yellow: visceral adipose tissue, blue: adipose bone marrow. Left row (after 4,120 km): green: total lean tissue, red: somatic adipose tissue (= somatic adipose soft tissue + adipose bone marrow), yellow: visceral adipose tissue. (selected slices: I: ankles, II: middle of lower legs, III: knees, IV: middle of upper legs, V: hip/pelvis, VI: umbilical level, VII: upper abdomen, VIII: heart/mediastinum, IX: shoulder girth, X: elbows). B: Right row (before start): green: somatic lean tissue, red: somatic adipose tissue, grey: total visceral volume. Left row (after 4,120 km): green: total lean tissue, red: somatic adipose tissue (= somatic adipose soft tissue + adipose bone marrow), yellow: visceral adipose tissue, blue: intraluminal nutrition fat in intestinal tract. (selected slices: V: hip/pelvis, VI: umbilical level, VII: upper abdomen, VIII: heart/mediastinum). C: Loss of total lean and total adipose tissue during the TEFR09.

Uwe HW Schütz, et al. BMC Med. 2012;10:78-78.
12.
Figure 6

Figure 6. From: The Transeurope Footrace Project: longitudinal data acquisition in a cluster randomized mobile MRI observational cohort study on 44 endurance runners at a 64-stage 4,486km transcontinental ultramarathon.

Mobile MRI of pelvis region and hip joints. A: male, 45-years-old, stage 8, 511 km (PDw TSE fs coronal): Massive edema and (peri-)myositis of right proximal quadriceps muscle (1). B: female, 46-years-old, stage 48, 3,290 km (PDw TSE fs, B1: coronal, B2,3: transversal): Stress fracture of left ventral pelvic ring (1: Ramus superior ossis pubis; 2: Ramus inferior ossis pubis) with perifocal soft tissue edema/inflammation (3). C: male, 41-years old, stage 11, 739 km (T1 TSE coronal): Arthrosis of the left hip (1: acetabular sclerosis, 2: deformation and osteophyte of the femoral head). D: male, 61-years-old, stage 38, 2601 km (PDw TSE fs transversal): Intraosseus edema in the right Ala ossis ileum (1) with massive peri-osseal inflammation of the gluteal muscle origin (2).

Uwe HW Schütz, et al. BMC Med. 2012;10:78-78.
13.
Figure 10

Figure 10. From: The Transeurope Footrace Project: longitudinal data acquisition in a cluster randomized mobile MRI observational cohort study on 44 endurance runners at a 64-stage 4,486km transcontinental ultramarathon.

Mobile vascular cine-MRI: male, 52-years-old, stage 27, 1,838 km. A1: MR localizer sagittal, A2,3: FLASH transversal: Automatic functional measurement of common right carotid artery diameter just below carotid bifurcation (1). Left carotid artery (2), right deep jugular vein (3). B1: MR localizer, B2: phase contrast transversal: Ascending aortic (1) diameter and flow is measured by specific velocity-encoded (venc) MR imaging. Descending aorta (2), pulmonary artery (3), lung (4). B3: graphic depiction of aortic pulsatile flow (ml/second). C1: MR localizer coronal, C2: phase contrast transversal: Distal descending aortic (1) diameter and flow is measured by specific velocity-encoded (venc) MR imaging just above the aortic bifurcation. Inferior vena cava (2), liver (3), intestines (4). D1: FLASH transversal: Functional measurement of superficial right femoral artery diameter just below bifurcation (1), left femoral artery (2). D2: Manual diameter measurement (1), D3: Automatic diameter measurement (1). Femoral veins (2).

Uwe HW Schütz, et al. BMC Med. 2012;10:78-78.
14.
Figure 8

Figure 8. From: The Transeurope Footrace Project: longitudinal data acquisition in a cluster randomized mobile MRI observational cohort study on 44 endurance runners at a 64-stage 4,486km transcontinental ultramarathon.

MRI of the brain. Male, 52-years-old. A1: stage 57, 3,971 km (T1w turbo FLASH 3D sagittal): High resolution isometric three-dimensional sequence (1 mm) allows isovoxel based volumetry (VBM) of the whole brain. A2: Three-dimensional view shows dominant areas of volume loss (colored) of grey brain matter occurring during the TEFR09. B: stage 36, 2,448 km (T2w FLAIR): Sensitive sequence for detection of brain lesions. In this case, no lesions visible. C: 20 days before the start. Functional MRI (fMRI) using blood oxygenation level dependent (BOLD) contrast for evaluation of pain perception in ultra runners (C1: without pain stimulus, C2: with pain stimulus). C3: Post-processing analysis using statistical parametric mapping (SPM) shows areas of activation.

Uwe HW Schütz, et al. BMC Med. 2012;10:78-78.
15.
Figure 5

Figure 5. From: The Transeurope Footrace Project: longitudinal data acquisition in a cluster randomized mobile MRI observational cohort study on 44 endurance runners at a 64-stage 4,486km transcontinental ultramarathon.

Mobile MRI of the knees. Femoral condyle (1), tibial head (2), patella (3), retropetallar cartilage layer (4), ventral femoral cartilage layer (5), dorsal femoral cartilage layer (6), tibial cartilage layer (7), medial meniscus (8), lateral meniscus (9), patellar tendon (10). A: female, 45-years-old, stage 44, 3,021 km (fused colored T2* GRE map: syngo™ MapIt fusion technique, A1: medial femorotibial joint sagittal, A2: lateral femorotibila joint sagittal, A3: femoropatellar joint transversal). B: male, 25-years-old, before start of TEFR09 Cartilage layer segmentation (T2* GRE map: syngo™ MapIt). C: male, 43-years-old, stage 40, 2,738 km (PDw TSE fs, C1: sagittal, C2: coronal, C3: transversal): Severe arthrosis of the patellofemoral joint with retropatellar cartilage defects (4, 5) and wide subchondral bone edema of the patella (3), intrachondral signal alterations of the femoral (6) and tibial (7) cartilage layers. D: male, 26-years-old, stage 40, 2,738 km (PDw TSE fs coronal): Nondescript cartilage layers of femorotibial joint.

Uwe HW Schütz, et al. BMC Med. 2012;10:78-78.
16.
Figure 7

Figure 7. From: The Transeurope Footrace Project: longitudinal data acquisition in a cluster randomized mobile MRI observational cohort study on 44 endurance runners at a 64-stage 4,486km transcontinental ultramarathon.

Mobile MRI of upper and lower legs. A: male, 49-years-old (coronal slices): A1: stage 12, 789 km, upper legs (PDw TSE fs): Subfascial intermuscular fluid, superficial (1), deep peri-neural (2). Partial quadriceps tear (M. vastus intermedius: 3). A2: stage 19, 1,260 km, upper legs (PDw TSE fs): Subfascial intermuscular fluid, superficial (1), deep peri-neural (2) and peri-vascular (3). Partial muscle edema of M. vastus intermedius (4). Specific diffusion weight imaging (A3, same slice as A2) is a sensitive method for free water detection. A4: stage 19, 1,260 km, lower legs (T2 TIRM): Subfascial intermuscular (1) and epifascial subcutaneous edema (2) indicating soft tissue inflammation such as perimyositis and panniculitis (shin splints), respectively. B: male, 31-years-old, B1: start, B2: stage 62, 6,358 km (PDw TSE fs transversal): Segmentation of muscle compartments of upper leg for functional muscle volumetry. C: male, 53-years-old: C1: start, C2: stage 46, 3,161 km (T2 TIRM transversal): Segmentation of muscle compartments of lower leg for functional muscle volumetry. Muscle edema in calf muscle (1).

Uwe HW Schütz, et al. BMC Med. 2012;10:78-78.
17.
Figure 9

Figure 9. From: The Transeurope Footrace Project: longitudinal data acquisition in a cluster randomized mobile MRI observational cohort study on 44 endurance runners at a 64-stage 4,486km transcontinental ultramarathon.

Mobile cardiac cine-MRI. A: male, 52-years-old, stage 23, 1,569 km (cine SSFP GRE, 2-chamber view): Focus is the left ventricle (1), myocardium (2). papillary muscles (3), right ventricle (4), lung (5), liver (6), left kidney (7), spleen (8), stomach (9). A2, A3: Specific post-processing makes functional volumetry of left ventricle and myocardium possible (green line: epicardium, red line: endocardium). B: male, 52-years-old, stage 25, 1,706 km (cine SSFP GRE, 3-chamber view): left ventricle (1), myocardium (2), papillary muscles (3), left atrium (4), lung (5), mitral valve (6), aortic valve (7), pulmonary vein (8), aorta (9), thoracic spine (10). C: male, 49-years-old, stage 26, 1,770 km (cine tagging SSFP GRE, four-chamber view): MR tagging of the left ventricle (1) makes quantification of the myocardial (2) motion with its spatial orientation possible. D: female, 45-years-old, stage 38, 2,601 km (phase contrast transversal): Ascending aortic (1) flow is measured by specific velocity-encoded (venc) MR imaging. Descending aorta (2), pulmonary artery (3), liver (4), lung (5). E: Selection of possible cardiac parameters measurable by cardiac cine-MRI.

Uwe HW Schütz, et al. BMC Med. 2012;10:78-78.
18.
Figure 4

Figure 4. From: The Transeurope Footrace Project: longitudinal data acquisition in a cluster randomized mobile MRI observational cohort study on 44 endurance runners at a 64-stage 4,486km transcontinental ultramarathon.

Mobile MRI of the feet. A: male, 39-years-old, stage 53, 3,669 km (fused colored T2* GRE map sagittal: syngo™ MapIt fusion technique, Siemens Medical solutions, Erlangen, Germany): Colored visualization of focal water concentration in cartilage layers of the ankle joint (1), subtalar joint (2), talonavicular joint (3) and calcneocuboid joint (4). B: male, 61-years-old, stage 23, 2,176 km (T2 TIRM sagittal): Multiple running related signs of tissue alteration: Peritendinous fluid accumulation in tendon sheaths (1). Focal bone edema at insertion of plantar fascia (2) with corresponding subcutaneous edema (3), but without plantar fasciitis. Edema in the Achilles tendon (4). Articular effusion in the ankle joint (5). C: male, 59-years-old, stage 45, 3,082 km (T2 TIRM sagittal): Peritendinous fluid accumulation in tendon sheaths of foot dorsiflexors (1), focal arthrosis of the ankle joint with subchondral bone edema (2), plantar subcutaneous edema (3), articular effusion in subtalar and metatarsophalangeal joint (4). D: male, 54-years-old, stage 32, 2,176 km (T2 TIRM sagittal): Subcutaneous edema (1), arthrosis of midfoot joints (2). E: male, 30-years-old, stage 12, 789 km (PDw TSE fs transversal): Peritendinous fluid accumulation in Achilles tendon sheath (1) with wide local subcutaneous edema (2). F: female, 68-years old, stage 15, 1,003 km (PDw TSE fs transversal): Extensive plantar subcutaneous edema (1). G: male, 47-years-old, stage 52, 3,609 km (PDw TSE fs transversal): Severe arthrosis of midfoot joints (1) with perifocal bone edema (2), hallux valgus (3).

Uwe HW Schütz, et al. BMC Med. 2012;10:78-78.

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