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Gassert FT, Kufner A, Renz M, Gassert FG, Bollwein C, Kronthaler S, Feuerriegel GC, Kirschke JS, Ganter C, Makowski MR, Braun C, Schwaiger BJ, Woertler K, Karampinos DC, Gersing AS. Comparing CT-Like Images Based on Ultra-Short Echo Time and Gradient Echo T1-Weighted MRI Sequences for the Assessment of Vertebral Disorders Using Histology and True CT as the Reference Standard. J Magn Reson Imaging 2024; 59:1542-1552. [PMID: 37501387 DOI: 10.1002/jmri.28927] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2023] [Revised: 07/14/2023] [Accepted: 07/14/2023] [Indexed: 07/29/2023] Open
Abstract
BACKGROUND Several magnetic resonance (MR) techniques have been suggested for radiation-free imaging of osseous structures. PURPOSE To compare the diagnostic value of ultra-short echo time and gradient echo T1-weighted MRI for the assessment of vertebral pathologies using histology and computed tomography (CT) as the reference standard. STUDY TYPE Prospective. SUBJECTS Fifty-nine lumbar vertebral bodies harvested from 20 human cadavers (donor age 73 ± 13 years; 9 male). FIELD STRENGTH/SEQUENCE Ultra-short echo time sequence optimized for both bone (UTEb) and cartilage (UTEc) imaging and 3D T1-weighted gradient-echo sequence (T1GRE) at 3 T; susceptibility-weighted imaging (SWI) gradient echo sequence at 1.5 T. CT was performed on a dual-layer dual-energy CT scanner using a routine clinical protocol. ASSESSMENT Histopathology and conventional CT were acquired as standard of reference. Semi-quantitative and quantitative morphological features of degenerative changes of the spines were evaluated by four radiologists independently on CT and MR images independently and blinded to all other information. Features assessed were osteophytes, endplate sclerosis, visualization of cartilaginous endplate, facet joint degeneration, presence of Schmorl's nodes, and vertebral dimensions. Vertebral disorders were assessed by a pathologist on histology. STATISTICAL TESTS Agreement between T1GRE, SWI, UTEc, and UTEb sequences and CT imaging and histology as standard of reference were assessed using Fleiss' κ and intra-class correlation coefficients, respectively. RESULTS For the morphological assessment of osteophytes and endplate sclerosis, the overall agreement between SWI, T1GRE, UTEb, and UTEc with the reference standard (histology combined with CT) was moderate to almost perfect for all readers (osteophytes: SWI, κ range: 0.68-0.76; T1GRE: 0.92-1.00; UTEb: 0.92-1.00; UTEc: 0.77-0.85; sclerosis: SWI, κ range: 0.60-0.70; T1GRE: 0.77-0.82; UTEb: 0.81-0.92; UTEc: 0.61-0.71). For the visualization of the cartilaginous endplate, UTEc showed the overall best agreement with the reference standard (histology) for all readers (κ range: 0.85-0.93). DATA CONCLUSIONS Morphological assessment of vertebral pathologies was feasible and accurate using the MR-based bone imaging sequences compared to CT and histopathology. T1GRE showed the overall best performance for osseous changes and UTEc for the visualization of the cartilaginous endplate. LEVEL OF EVIDENCE 1 TECHNICAL EFFICACY: Stage 2.
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Affiliation(s)
- Florian T Gassert
- Department of Radiology, Klinikum Rechts der Isar, School of Medicine, Technical University of Munich, Munich, Germany
| | - Alexander Kufner
- Department of Radiology, Klinikum Rechts der Isar, School of Medicine, Technical University of Munich, Munich, Germany
| | - Martin Renz
- Department of Neuroradiology, Klinikum Rechts der Isar, School of Medicine, Technical University of Munich, Munich, Germany
| | - Felix G Gassert
- Department of Radiology, Klinikum Rechts der Isar, School of Medicine, Technical University of Munich, Munich, Germany
| | - Christine Bollwein
- Department of Pathology, Klinikum Rechts der Isar, School of Medicine, Technical University of Munich, Munich, Germany
| | - Sophia Kronthaler
- Department of Radiology, Klinikum Rechts der Isar, School of Medicine, Technical University of Munich, Munich, Germany
| | - Georg C Feuerriegel
- Department of Radiology, Klinikum Rechts der Isar, School of Medicine, Technical University of Munich, Munich, Germany
| | - Jan S Kirschke
- Department of Neuroradiology, Klinikum Rechts der Isar, School of Medicine, Technical University of Munich, Munich, Germany
| | - Carl Ganter
- Department of Radiology, Klinikum Rechts der Isar, School of Medicine, Technical University of Munich, Munich, Germany
| | - Marcus R Makowski
- Department of Radiology, Klinikum Rechts der Isar, School of Medicine, Technical University of Munich, Munich, Germany
| | - Christian Braun
- Institute of Forensic Medicine, University Hospital of Munich, LMU Munich, Munich, Germany
| | - Benedikt J Schwaiger
- Department of Neuroradiology, Klinikum Rechts der Isar, School of Medicine, Technical University of Munich, Munich, Germany
| | - Klaus Woertler
- Department of Radiology, Klinikum Rechts der Isar, School of Medicine, Technical University of Munich, Munich, Germany
- Musculoskeletal Radiology Section, Klinikum Rechts der Isar, School of Medicine, Technical University of Munich, Munich, Germany
| | - Dimitrios C Karampinos
- Department of Radiology, Klinikum Rechts der Isar, School of Medicine, Technical University of Munich, Munich, Germany
| | - Alexandra S Gersing
- Department of Neuroradiology, University Hospital of Munich, LMU Munich, Munich, Germany
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Ud Din R, Yang H. Editorial for "Comparing CT-Like Images Based on Ultra-Short Echo Time and Gradient Echo T1-Weighted MRI Sequences for the Assessment of Vertebral Disorders Using Histology and True CT as the Reference Standard". J Magn Reson Imaging 2024; 59:1553-1554. [PMID: 37530548 DOI: 10.1002/jmri.28928] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2023] [Accepted: 06/27/2023] [Indexed: 08/03/2023] Open
Affiliation(s)
- Rahman Ud Din
- Department of Biomedical Engineering, Faculty of Environment and Life, Beijing University of Technology, Beijing, China
| | - Haisheng Yang
- Department of Biomedical Engineering, Faculty of Environment and Life, Beijing University of Technology, Beijing, China
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Hesse N, Feuerriegel GC, Erber B, Reidler P, Gottfried V, Stohldreier Y, Schmitt R, Dietrich O, Gersing AS, Spiro JE. CT-like images based on T1-weighted gradient echo MRI sequences for the assessment of fractures of the hand and wrist compared to CT. Skeletal Radiol 2024:10.1007/s00256-024-04683-7. [PMID: 38662095 DOI: 10.1007/s00256-024-04683-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/12/2024] [Revised: 04/11/2024] [Accepted: 04/12/2024] [Indexed: 04/26/2024]
Abstract
OBJECTIVE To evaluate the performance of a 3D T1-weighted gradient-echo (3D T1GRE) computed tomography (CT)-like magnetic resonance imaging (MRI) sequence for detecting and assessing wrist and hand fractures compared to conventional CT. METHODS Subjects with acute wrist or hand fracture in CT underwent additional 3 T MRI including a CT-like 3D T1GRE sequence and were compared to patients without fractures. Two radiologists assessed fracture morphology on both modalities according to the Arbeitsgemeinschaft Osteosynthese (AO) and graded image quality and diagnostic confidence on a 5-point Likert scale. Besides diagnostic test evaluation, differences in image quality and diagnostic confidence between CT-like MRI and CT were calculated using the Wilcoxon test. Agreement of AO classification between modalities and readers was assessed using Cohen's Kappa. RESULTS Twenty-eight patients with 43 fractures and 43 controls were included. Image quality (3D T1GRE 1.19 ± 0.37 vs. CT 1.22 ± 0.42; p = 0.65) and diagnostic confidence (3D T1GRE 1.28 ± 0.53 vs. CT 1.28 ± 0.55; p = 1.00) were rated excellent for both modalities. Regarding the AO classification, intra- (rater 1 and rater 2, κ = 0.89; 95% CI 0.80-0.97) and interrater agreement were excellent (3D T1GRE, κ = 0.82; 95% CI, 0.70-0.93; CT, κ = 0.85; 95% CI, 0.75-0.94). CT-like MRI showed excellent sensitivity, specificity and accuracy for fracture detection (reader 1: 1.00, 0.92, 0.96; reader 2: 0.98, 0.94, 0.96). CONCLUSION CT-like MRI is a comparable alternative to CT for assessing hand and wrist fractures, offering the advantage of avoiding radiation exposure.
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Affiliation(s)
- N Hesse
- Department of Radiology, LMU University Hospital, LMU Munich, Munich, Germany.
| | - G C Feuerriegel
- Department of Diagnostic and Interventional Radiology, Klinikum Rechts der Isar, School of Medicine, Technical University of Munich, Munich, Germany
| | - B Erber
- Department of Radiology, LMU University Hospital, LMU Munich, Munich, Germany
| | - P Reidler
- Department of Radiology, LMU University Hospital, LMU Munich, Munich, Germany
| | - V Gottfried
- Department of Radiology, LMU University Hospital, LMU Munich, Munich, Germany
| | - Y Stohldreier
- Department of Neuroradiology, LMU University Hospital, LMU Munich, Munich, Germany
| | - R Schmitt
- Department of Radiology, LMU University Hospital, LMU Munich, Munich, Germany
| | - O Dietrich
- Department of Radiology, LMU University Hospital, LMU Munich, Munich, Germany
| | - A S Gersing
- Department of Neuroradiology, LMU University Hospital, LMU Munich, Munich, Germany
| | - J E Spiro
- Department of Radiology, LMU University Hospital, LMU Munich, Munich, Germany
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Feuerriegel GC, Weiss K, Tu Van A, Leonhardt Y, Neumann J, Gassert FT, Haas Y, Schwarz M, Makowski MR, Woertler K, Karampinos DC, Gersing AS. Deep-learning-based image quality enhancement of CT-like MR imaging in patients with suspected traumatic shoulder injury. Eur J Radiol 2024; 170:111246. [PMID: 38056345 DOI: 10.1016/j.ejrad.2023.111246] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2023] [Revised: 11/21/2023] [Accepted: 11/29/2023] [Indexed: 12/08/2023]
Abstract
PURPOSE To evaluate the diagnostic performance of CT-like MR images reconstructed with an algorithm combining compressed sense (CS) with deep learning (DL) in patients with suspected osseous shoulder injury compared to conventional CS-reconstructed images. METHODS Thirty-two patients (12 women, mean age 46 ± 14.9 years) with suspected traumatic shoulder injury were prospectively enrolled into the study. All patients received MR imaging of the shoulder, including a CT-like 3D T1-weighted gradient-echo (T1 GRE) sequence and in case of suspected fracture a conventional CT. An automated DL-based algorithm, combining CS and DL (CS DL) was used to reconstruct images of the same k-space data as used for CS reconstructions. Two musculoskeletal radiologists assessed the images for osseous pathologies, image quality and visibility of anatomical landmarks using a 5-point Likert scale. Moreover, signal-to-noise ratio (SNR) and contrast-to-noise ratio (CNR) were calculated. RESULTS Compared to CT, all acute fractures (n = 23) and osseous pathologies were detected accurately on the CS only and CS DL images with almost perfect agreement between the CS DL and CS only images (κ 0.95 (95 %confidence interval 0.82-1.00). Image quality as well as the visibility of the fracture lines, bone fragments and glenoid borders were overall rated significantly higher for the CS DL reconstructions than the CS only images (CS DL range 3.7-4.9 and CS only range 3.2-3.8, P = 0.01-0.04). Significantly higher SNR and CNR values were observed for the CS DL reconstructions (P = 0.02-0.03). CONCLUSION Evaluation of traumatic shoulder pathologies is feasible using a DL-based algorithm for reconstruction of high-resolution CT-like MR imaging.
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Affiliation(s)
- Georg C Feuerriegel
- Department of Radiology, Klinikum Rechts der Isar, School of Medicine, Technical University of Munich, Munich, Germany.
| | | | - Anh Tu Van
- Department of Radiology, Klinikum Rechts der Isar, School of Medicine, Technical University of Munich, Munich, Germany.
| | - Yannik Leonhardt
- Department of Radiology, Klinikum Rechts der Isar, School of Medicine, Technical University of Munich, Munich, Germany.
| | - Jan Neumann
- Department of Radiology, Klinikum Rechts der Isar, School of Medicine, Technical University of Munich, Munich, Germany; Musculoskeletal Radiology Section, Klinikum Rechts der Isar, School of Medicine, Technical University of Munich, Munich, Germany.
| | - Florian T Gassert
- Department of Radiology, Klinikum Rechts der Isar, School of Medicine, Technical University of Munich, Munich, Germany.
| | - Yannick Haas
- Department of Trauma Surgery, Klinikum Rechts der Isar, School of Medicine, Technical University of Munich, Munich, Germany.
| | - Markus Schwarz
- Department of Trauma Surgery, Klinikum Rechts der Isar, School of Medicine, Technical University of Munich, Munich, Germany.
| | - Marcus R Makowski
- Department of Radiology, Klinikum Rechts der Isar, School of Medicine, Technical University of Munich, Munich, Germany.
| | - Klaus Woertler
- Department of Radiology, Klinikum Rechts der Isar, School of Medicine, Technical University of Munich, Munich, Germany; Musculoskeletal Radiology Section, Klinikum Rechts der Isar, School of Medicine, Technical University of Munich, Munich, Germany.
| | - Dimitrios C Karampinos
- Department of Radiology, Klinikum Rechts der Isar, School of Medicine, Technical University of Munich, Munich, Germany.
| | - Alexandra S Gersing
- Department of Radiology, Klinikum Rechts der Isar, School of Medicine, Technical University of Munich, Munich, Germany; Department of Neuroradiology, University Hospital of Munich, LMU Munich, Munich, Germany.
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Lombardi AF, Ma YJ, Jang H, Jerban S, Du J, Chang EY, Chung CB. Synthetic CT in Musculoskeletal Disorders: A Systematic Review. Invest Radiol 2023; 58:43-59. [PMID: 36070535 PMCID: PMC9742139 DOI: 10.1097/rli.0000000000000916] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
ABSTRACT Repeated computed tomography (CT) examinations increase patients' ionizing radiation exposure and health costs, making an alternative method desirable. Cortical and trabecular bone, however, have short T2 relaxation times, causing low signal intensity on conventional magnetic resonance (MR) sequences. Different techniques are available to create a "CT-like" contrast of bone, such as ultrashort echo time, zero echo time, gradient-echo, and susceptibility-weighted image MR sequences, and artificial intelligence. This systematic review summarizes the essential technical background and developments of ultrashort echo time, zero echo time, gradient-echo, susceptibility-weighted image MR imaging sequences and artificial intelligence; presents studies on research and clinical applications of "CT-like" MR imaging; and describes their main advantages and limitations. We also discuss future opportunities in research, which patients would benefit the most, the most appropriate situations for using the technique, and the potential to replace CT in the clinical workflow.
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Affiliation(s)
- Alecio F Lombardi
- From the Department of Radiology, University of California San Diego, La Jolla, and the Research Service, Veterans Affairs San Diego Healthcare System, California
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Boeren AMP, Oei EHG, van der Helm-van Mil AHM. The value of MRI for detecting subclinical joint inflammation in clinically suspect arthralgia. RMD Open 2022; 8:e002128. [PMID: 35820736 PMCID: PMC9277386 DOI: 10.1136/rmdopen-2021-002128] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2022] [Accepted: 05/26/2022] [Indexed: 11/04/2022] Open
Abstract
In the last decade, much research has focused on the development of rheumatoid arthritis (RA) and the symptomatic phase preceding the onset of clinical arthritis. Observational studies on imaging have revealed that subclinical joint inflammation in patients with arthralgia at risk for RA precedes and predicts the onset of clinically apparent arthritis. Moreover, the results of two placebo-controlled randomised proof-of-concept trials in patients with arthralgia and MRI-detected subclinical inflammation studies will soon be available. The initial results are encouraging and suggest a beneficial effect of DMARD treatment on subclinical inflammation. Since this may increase the necessity to detect subclinical joint inflammation in persons with arthralgia that are at risk for RA, we will here review what has been learnt about subclinical inflammation in at-risk individuals by means of imaging. We will focus on MRI as this method has the best sensitivity and reproducibility. We evaluate the prognostic value of MRI-detected subclinical inflammation and assess the lessons learnt from MRIs about the tissues that are inflamed early on and are associated with the clinical phenotype in arthralgia at risk for RA, for example, subclinical tenosynovitis underlying pain and impaired hand function. Finally, because long scan times and the need for intravenous-contrast agent contribute to high costs and limited feasibility of current MRI protocols, we discuss progress that is being made in the field of MRI and that can result in a future-proof way of imaging that is useful for assessment of joint inflammation on a large scale, also in a society with social distancing due to COVID-19 restrictions.
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Affiliation(s)
- Anna M P Boeren
- Department of Rheumatology, Leiden University Medical Center, Leiden, The Netherlands
- Department of Rheumatology, Erasmus Medical Center, Rotterdam, The Netherlands
| | - Edwin H G Oei
- Department of Radiology and Nuclear Medicine, Erasmus Medical Center, Rotterdam, The Netherlands
| | - Annette H M van der Helm-van Mil
- Department of Rheumatology, Leiden University Medical Center, Leiden, The Netherlands
- Department of Rheumatology, Erasmus Medical Center, Rotterdam, The Netherlands
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