Three-Dimensional Isotropic Fat-Suppressed Proton Density-Weighted MRI at 3 Tesla Using a T/R-Coil Can Replace Multiple Plane Two-Dimensional Sequences in Knee Imaging

Abstract

Purpose: To evaluate whether a 3 D proton density-weighted fat-suppressed sequence (PDwFS) of the knee is able to replace multiplanar 2D-PDwFS.

Materials and Methods: 52 patients (26 men, mean age: 41.9 ± 14.5years) underwent magnetic resonance imaging (MRI) of the knee at 3.0 Tesla using a T/R-coil. The imaging protocol included 3 planes of 2D-PDwFS (acquisition time (AT): 6:40 min; voxel sizes: 0.40 – 0.63 × 0.44 – 0.89 × 3mm³) and a 3D-PDwFS (AT: 6:31 min; voxel size: 0.63 × 0.68 × 0.63mm³). Homogeneity of fat suppression (HFS), artifacts, and image sharpness (IS) were evaluated on a 5-point scale (5[excellent] – 1[non-diagnostic]). The sum served as a measure for the overall image quality (OIQ). Contrast ratios (CR) compared to popliteal muscle were calculated for the meniscus (MEN), anterior (ACL) and posterior cruciate ligaments (PCL). In 13 patients who underwent arthroscopic knee surgery, two radiologists evaluated the presence of meniscal, ligamental and cartilage lesions to estimate the sensitivity and specificity of lesion detection.

Results: The CR was higher in the ACL, PCL and MEN in 3D- PDwFS compared to 2D-PDwFS (p < 0.01 for ACL and PCL; p = 0.07 for MEN). Compared to 2 D images, the OIQ was rated higher in 3D-PDwFS images (p < 0.01) due to fewer artifacts and HFS despite the lower IS (p < 0.01). The sensitivity and specificity of lesion detection in 3D- and 2D-PDwFS were similar.

Conclusion: Compared to standard multiplanar 2D-PDwFS knee imaging, isotropic high spatial resolution 3D-PDwFS of the knee at 3.0 T can be acquired with high image quality in a reasonable scan time. Multiplanar reformations in arbitrary planes may serve as an additional benefit of 3D-PDwFS.

Key Points:

• 3D-PDwFS of the knee is acquired with high image quality

• 3D-PDwFS can be achieved in only one measurement with a reasonable scan time

• 3D-PDwFS with the advantage of multiplanar reformation may replace 2D-PD-weighted knee MRI

Citation Format:

• Homsi R, Gieseke J, Luetkens JA et al. Three-Dimensional Isotropic Fat-Suppressed Proton Density-Weighted MRI at 3 Tesla Using a T/R-Coil Can Replace Multiple Plane Two-Dimensional Sequences in Knee Imaging. Fortschr Röntgenstr 2016; 188: 949 – 956

Zusammenfassung

Ziel: Klärung der Frage, ob eine dreidimensionale (3 D) isotrope Protonen-gewichteten fettunterdrückte (PDwFS) Sequenz vom Knie mehrere zweidimensionale (2 D) Sequenzen ersetzen kann.

Material und Methoden: 52 Patienten (26 Männer, 26 Frauen, mittleres Alter 41,9 ± 14,5Jahre) erhielten eine magnetresonanztomografische Bildgebung (MRT) vom Knie unter Nutzung einer T/R Spule an einem 3-Tesla-(T)-Magneten. Das Protokoll enthielt 3 Ebenen 2D-PDwFS (Gesamtaufnahmedauer (AD), 6:40 min; Voxelgröße [V], 0,40 – 0,63 × 0,44 – 0,89 × 3mm³) und eine 3D-PDwFS (AD, 6:31 min; V, 0,63 × 0,68 × 0,63mm³). Beurteilt wurden die Homogenität der Fettunterdrückung, Artefakte, und die Bildschärfe anhand einer 5-Punkteskala (5[Exzellent] – 1[nicht-diagnostisch]). Die Summe der Parameter diente als ein Maß für die Gesamtbildqualität (GBQ). Zusätzlich wurden Kontrastverhältnisse (KR) für den Meniskus (MEN), das vordere (ACL) und das hintere Kreuzband (PCL) im Vergleich zum Musculus popliteus berechnet. Von den 52 Patienten erfolgte bei 13 Patienten aus klinischer Indikation eine Knie-Athroskopie. Bei diesen Patienten untersuchten zwei unabhängige Radiologen die 3D- und 2D-Aufnahmen auf das Vorhandensein von Läsionen des Meniskus, der Bänder und des Knorpels. Hierauf basierend wurden die Sensitivität und Spezifizität berechnet.

Ergebnisse: Die KR waren für ACL, PCL und MEN in der 3D-PDwFS höher als bei der 2D-PDwFS (p < 0,01 für ACL und PCL; p = 0.07 für MEN). Verglichen mit den 2D-Bildern, wurde die GBQ aufgrund von weniger Artefakten und einer homogeneren Fettunterdrückung (p < 0,01) in den 3D-PDwFS Bilder höher bewertet, trotz einer geringeren Bildschärfe (p < 0,01). Sensitivität und Spezifizität für die Diagnose einer Knieläsion waren für 3D- und 2D-PDwFS ähnlich.

Schlussfolgerung: Verglichen mit dem Standard der multiplanaren 2D-PDwFS Knie-Bildgebung, können isotrope hochaufgelöste 3D-PDwFS-Aufnahmen bei 3.0 T mit hoher Bildqualität und ähnlicher Aufnahmedauer akquiriert werden. Ein Vorteil der 3D-PDwFS besteht in der Möglichkeit multiplanarer Reformationen in beliebigen Ebenen.

Kernaussagen:

• 3D-PDwFS Knie Aufnahmen sind bei hoher Bildqualität möglich

• 3D-PDwFS Knieaufnahmen können in nur einer Messung in akzeptabler Zeit erzielt werden

• Im Gegensatz zur Standardbildgebung ermöglicht die 3D-PDwFS zusätzlich die Rekonstruktion multiplanarer Reformationen

Key words

knee - 3 D - MRI - multiplanar reformation - proton density-weighted

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