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Athertya JS, Lo J, Chen X, Shin SH, Malhi BS, Jerban S, Ji Y, Sedaghat S, Yoshioka H, Du J, Guma M, Chang EY, Ma Y. High contrast cartilaginous endplate imaging in spine using three dimensional dual-inversion recovery prepared ultrashort echo time (3D DIR-UTE) sequence. Skeletal Radiol 2024; 53:881-890. [PMID: 37935923 PMCID: PMC10973042 DOI: 10.1007/s00256-023-04503-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/17/2023] [Revised: 10/14/2023] [Accepted: 10/29/2023] [Indexed: 11/09/2023]
Abstract
PURPOSE To investigate the feasibility and application of a novel imaging technique, a three-dimensional dual adiabatic inversion recovery prepared ultrashort echo time (3D DIR-UTE) sequence, for high contrast assessment of cartilaginous endplate (CEP) imaging with head-to-head comparisons between other UTE imaging techniques. METHOD The DIR-UTE sequence employs two narrow-band adiabatic full passage (AFP) pulses to suppress signals from long T2 water (e.g., nucleus pulposus (NP)) and bone marrow fat (BMF) independently, followed by multispoke UTE acquisition to detect signals from the CEP with short T2 relaxation times. The DIR-UTE sequence, in addition to three other UTE sequences namely, an IR-prepared and fat-saturated UTE (IR-FS-UTE), a T1-weighted and fat-saturated UTE sequence (T1w-FS-UTE), and a fat-saturated UTE (FS-UTE) was used for MR imaging on a 3 T scanner to image six asymptomatic volunteers, six patients with low back pain, as well as a human cadaveric specimen. The contrast-to-noise ratio of the CEP relative to the adjacent structures-specifically the NP and BMF-was then compared from the acquired images across the different UTE sequences. RESULTS For asymptomatic volunteers, the DIR-UTE sequence showed significantly higher contrast-to-noise ratio values between the CEP and BMF (CNRCEP-BMF) (19.9 ± 3.0) and between the CEP and NP (CNRCEP-NP) (23.1 ± 1.7) compared to IR-FS-UTE (CNRCEP-BMF: 17.3 ± 1.2 and CNRCEP-NP: 19.1 ± 1.8), T1w-FS-UTE (CNRCEP-BMF: 9.0 ± 2.7 and CNRCEP-NP: 10.4 ± 3.5), and FS-UTE (CNRCEP-BMF: 7.7 ± 2.2 and CNRCEP-NP: 5.8 ± 2.4) for asymptomatic volunteers (all P-values < 0.001). For the spine sample and patients with low back pain, the DIR-UTE technique detected abnormalities such as irregularities and focal defects in the CEP regions. CONCLUSION The 3D DIR-UTE sequence is able to provide high-contrast volumetric CEP imaging for human spines on a clinical 3 T scanner.
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Affiliation(s)
- Jiyo S Athertya
- Department of Radiology, University of California San Diego, San Diego, CA, USA
| | - James Lo
- Department of Radiology, University of California San Diego, San Diego, CA, USA
- Department of Bioengineering, University of California San Diego, San Diego, CA, USA
| | - Xiaojun Chen
- Department of Radiology, University of California San Diego, San Diego, CA, USA
| | - Soo Hyun Shin
- Department of Radiology, University of California San Diego, San Diego, CA, USA
| | | | - Saeed Jerban
- Department of Radiology, University of California San Diego, San Diego, CA, USA
| | - Yang Ji
- Department of Radiology, University of California San Diego, San Diego, CA, USA
| | - Sam Sedaghat
- Department of Radiology, University of California San Diego, San Diego, CA, USA
| | - Hiroshi Yoshioka
- Department of Radiological Sciences, University of California Irvine, Irvine, CA, USA
| | - Jiang Du
- Department of Radiology, University of California San Diego, San Diego, CA, USA
- Department of Bioengineering, University of California San Diego, San Diego, CA, USA
- Radiology Service, Veterans Affairs San Diego Healthcare System, San Diego, CA, USA
| | - Monica Guma
- Department of Medicine, University of California San Diego, San Diego, CA, USA
- Medicine Service, Veterans Affairs San Diego Healthcare System, San Diego, CA, USA
| | - Eric Y Chang
- Department of Radiology, University of California San Diego, San Diego, CA, USA
- Radiology Service, Veterans Affairs San Diego Healthcare System, San Diego, CA, USA
| | - Yajun Ma
- Department of Radiology, University of California San Diego, San Diego, CA, USA.
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Abel F, Lebl DR, Gorgy G, Dalton D, Chazen JL, Lim E, Li Q, Sneag DB, Tan ET. Deep-learning reconstructed lumbar spine 3D MRI for surgical planning: pedicle screw placement and geometric measurements compared to CT. EUROPEAN SPINE JOURNAL : OFFICIAL PUBLICATION OF THE EUROPEAN SPINE SOCIETY, THE EUROPEAN SPINAL DEFORMITY SOCIETY, AND THE EUROPEAN SECTION OF THE CERVICAL SPINE RESEARCH SOCIETY 2024:10.1007/s00586-023-08123-3. [PMID: 38472429 DOI: 10.1007/s00586-023-08123-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Subscribe] [Scholar Register] [Received: 09/20/2023] [Revised: 12/06/2023] [Accepted: 12/26/2023] [Indexed: 03/14/2024]
Abstract
PURPOSE To test equivalency of deep-learning 3D lumbar spine MRI with "CT-like" contrast to CT for virtual pedicle screw planning and geometric measurements in robotic-navigated spinal surgery. METHODS Between December 2021 and June 2022, 16 patients referred for spinal fusion and decompression surgery with pre-operative CT and 3D MRI were retrospectively assessed. Pedicle screws were virtually placed on lumbar (L1-L5) and sacral (S1) vertebrae by three spine surgeons, and metrics (lateral deviation, axial/sagittal angles) were collected. Vertebral body length/width (VL/VW) and pedicle height/width (PH/PW) were measured at L1-L5 by three radiologists. Analysis included equivalency testing using the 95% confidence interval (CI), a margin of ± 1 mm (± 2.08° for angles), and intra-class correlation coefficients (ICCs). RESULTS Across all vertebral levels, both combined and separately, equivalency between CT and MRI was proven for all pedicle screw metrics and geometric measurements, except for VL at L1 (mean difference: - 0.64 mm; [95%CI - 1.05, - 0.24]), L2 (- 0.65 mm; [95%CI - 1.11, - 0.20]), and L4 (- 0.78 mm; [95%CI - 1.11, - 0.46]). Inter- and intra-rater ICC for screw metrics across all vertebral levels combined ranged from 0.68 to 0.91 and 0.89-0.98 for CT, and from 0.62 to 0.92 and 0.81-0.97 for MRI, respectively. Inter- and intra-rater ICC for geometric measurements ranged from 0.60 to 0.95 and 0.84-0.97 for CT, and 0.61-0.95 and 0.93-0.98 for MRI, respectively. CONCLUSION Deep-learning 3D MRI facilitates equivalent virtual pedicle screw placements and geometric assessments for most lumbar vertebrae, with the exception of vertebral body length at L1, L2, and L4, compared to CT for pre-operative planning in patients considered for robotic-navigated spine surgery.
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Affiliation(s)
- Frederik Abel
- Department of Radiology and Imaging, Hospital for Special Surgery, 535 E 70th Street, New York, NY, 10021, USA.
- Department of Spine Surgery, Hospital for Special Surgery, 535 E 70th Street, New York, NY, 10021, USA.
| | - Darren R Lebl
- Department of Spine Surgery, Hospital for Special Surgery, 535 E 70th Street, New York, NY, 10021, USA
| | - George Gorgy
- Department of Spine Surgery, Hospital for Special Surgery, 535 E 70th Street, New York, NY, 10021, USA
| | - David Dalton
- Department of Spine Surgery, Hospital for Special Surgery, 535 E 70th Street, New York, NY, 10021, USA
| | - J Levi Chazen
- Department of Radiology and Imaging, Hospital for Special Surgery, 535 E 70th Street, New York, NY, 10021, USA
| | - Elisha Lim
- Department of Radiology and Imaging, Hospital for Special Surgery, 535 E 70th Street, New York, NY, 10021, USA
| | - Qian Li
- Biostatistics Core, Hospital for Special Surgery, 535 E 70th Street, New York, NY, 10021, USA
| | - Darryl B Sneag
- Department of Radiology and Imaging, Hospital for Special Surgery, 535 E 70th Street, New York, NY, 10021, USA
| | - Ek T Tan
- Department of Radiology and Imaging, Hospital for Special Surgery, 535 E 70th Street, New York, NY, 10021, USA
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Tsuchiya K, Gomyo M, Katase S, Hiraoka S, Tateishi H. Magnetic resonance bone imaging: applications to vertebral lesions. Jpn J Radiol 2023; 41:1173-1185. [PMID: 37209299 PMCID: PMC10613598 DOI: 10.1007/s11604-023-01449-4] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2023] [Accepted: 05/12/2023] [Indexed: 05/22/2023]
Abstract
MR bone imaging is a recently introduced technique, that allows visualization of bony structures in good contrast against adjacent structures, like CT. Although CT has long been considered the modality of choice for bone imaging, MR bone imaging allows visualization of the bone without radiation exposure while simultaneously allowing conventional MR images to be obtained. Accordingly, MR bone imaging is expected as a new imaging technique for the diagnosis of miscellaneous spinal diseases. This review presents several sequences used in MR bone imaging including black bone imaging, ultrashort/zero echo time (UTE/ZTE) sequences, and T1-weighted 3D gradient-echo sequence. We also illustrate clinical cases in which spinal lesions could be effectively demonstrated on MR bone imaging, performed in most cases using a 3D gradient-echo sequence at our institution. The lesions presented herein include degenerative diseases, tumors and similar diseases, fractures, infectious diseases, and hemangioma. Finally, we discuss the differences between MR bone imaging and previously reported techniques, and the limitations and future perspectives of MR bone imaging.
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Affiliation(s)
- Kazuhiro Tsuchiya
- Department of Radiology, JR Tokyo General Hospital, 2-1-3 Yoyogi, Shibuya-ku, Tokyo, 151-8528, Japan.
- Department of Radiology, Faculty of Medicine, Kyorin University, 6-20-2 Shinkawa, Mitaka City, Tokyo, 181-8611, Japan.
| | - Miho Gomyo
- Department of Radiology, Faculty of Medicine, Kyorin University, 6-20-2 Shinkawa, Mitaka City, Tokyo, 181-8611, Japan
| | - Shichiro Katase
- Department of Radiology, Faculty of Medicine, Kyorin University, 6-20-2 Shinkawa, Mitaka City, Tokyo, 181-8611, Japan
| | - Sayuki Hiraoka
- Department of Radiology, JR Tokyo General Hospital, 2-1-3 Yoyogi, Shibuya-ku, Tokyo, 151-8528, Japan
| | - Hidekatsu Tateishi
- Department of Radiology, JR Tokyo General Hospital, 2-1-3 Yoyogi, Shibuya-ku, Tokyo, 151-8528, Japan
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Gibbs WN, Basha MM, Chazen JL. Management Algorithm for Osseous Metastatic Disease: What the Treatment Teams Want to Know. Neuroimaging Clin N Am 2023; 33:487-497. [PMID: 37356864 DOI: 10.1016/j.nic.2023.04.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/27/2023]
Abstract
Radiologists play a primary role in identifying, characterizing, and classifying spinal metastases and can play a lifesaving role in the care of these patients by triaging those with instability to urgent spine surgery consultation. For this reason, an understanding of current treatment algorithms and principles of spinal stability in patients with cancer is vital for all who interpret spine studies. In addition, advances in imaging allow radiologists to provide more accurate diagnoses and characterize pathology, thereby improving patient safety.
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Affiliation(s)
- Wende N Gibbs
- Barrow Neurological Institute, Department of Neuroradiology, St. Joseph's Hospital and Medical Center, 350 West Thomas Road, Phoenix, AZ 85013, USA.
| | - Mahmud Mossa Basha
- University of Washington School of Medicine, 1959 Northeast Pacific Street, Seattle, WA 98195, USA
| | - J Levi Chazen
- Hospital for Special Surgery, 535 East 70th Street, New York, NY 10021, USA
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Vuillemin V, Guerini H, Thévenin F, Sibileau E, Corcos G, Khaled W, Zeitoun F, Morvan G. Bone Tissue in Magnetic Resonance Imaging: Contribution of New Zero Echo Time Sequences. Semin Musculoskelet Radiol 2023; 27:411-420. [PMID: 37748464 DOI: 10.1055/s-0043-1770771] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/27/2023]
Abstract
The introduction of new ultrashort and zero echo time (ZTE) sequences is revolutionizing magnetic resonance imaging (MRI) and optimizing patient management. These sequences acquire signals in tissues with very short T2: mineralized bone, cortical bone, and calcium deposits. They can be added to a classic MRI protocol. ZTE MRI provides computed tomography-like contrast for bone.
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Koo JH, Lee J, Han K, Song HT, Ryu L, Lee YH. Preliminary study for prediction of benign vertebral compression fracture age by quantitative water fraction using modified Dixon sequences: an imaging biomarker of fracture age. LA RADIOLOGIA MEDICA 2023:10.1007/s11547-023-01662-1. [PMID: 37336859 DOI: 10.1007/s11547-023-01662-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/23/2022] [Accepted: 06/05/2023] [Indexed: 06/21/2023]
Abstract
PURPOSE This study aimed to evaluate whether quantitative water fraction parameters could predict fracture age in patients with benign vertebral compression fractures (VCFs). METHODS A total of 38 thoracolumbar VCFs in 27 patients imaged using modified Dixon sequences for water fraction quantification on 3-T MRI were retrospectively reviewed. To calculate quantitative parameters, a radiologist independently measured the regions of interest in the bone marrow edema (BME) of the fractures. Furthermore, five features (BME, trabecular fracture line, condensation band, cortical or end plate fracture line, and paravertebral soft-tissue change) were analyzed. The fracture age was evaluated based on clear-onset symptoms and previously available images. A correlation analysis between the fracture age and water fraction was evaluated using a linear regression model, and a multivariable analysis of the dichotomized fracture age model was performed. RESULTS The water fraction ratio was the only significant factor and was negatively correlated with the fracture age of VCFs in multiple linear regression (p = 0.047), whereas the water fraction was not significantly correlated (p = 0.052). Water fraction and water fraction ratio were significant factors in differentiating the fracture age of 1 year in multiple logistic regression (odds ratio 0.894, p = 0.003 and odds ratio 0.986, p = 0.019, respectively). Using a cutoff of 0.524 for the water fraction, the area under the curve, sensitivity, and specificity were 0.857, 85.7%, and 87.1%, respectively. CONCLUSIONS Water fraction is a good imaging biomarker for the fracture healing process. The water fraction ratio of the compression fractures can be used to predict the fracture age of benign VCFs.
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Affiliation(s)
- Ja Ho Koo
- Department of Radiology, Research Institute of Radiological Science, and Center for Clinical Imaging Data Science (CCIDS), Yonsei University College of Medicine, 50-1 Yonsei-Ro, Seodaemun-Gu, Seoul, 03722, South Korea
| | - Joohee Lee
- Department of Radiology, Research Institute of Radiological Science, and Center for Clinical Imaging Data Science (CCIDS), Yonsei University College of Medicine, 50-1 Yonsei-Ro, Seodaemun-Gu, Seoul, 03722, South Korea
| | - Kyunghwa Han
- Department of Radiology, Research Institute of Radiological Science, and Center for Clinical Imaging Data Science (CCIDS), Yonsei University College of Medicine, 50-1 Yonsei-Ro, Seodaemun-Gu, Seoul, 03722, South Korea
| | - Ho-Taek Song
- Department of Radiology, Research Institute of Radiological Science, and Center for Clinical Imaging Data Science (CCIDS), Yonsei University College of Medicine, 50-1 Yonsei-Ro, Seodaemun-Gu, Seoul, 03722, South Korea
| | - Leeha Ryu
- Department of Biostatistics and Computing, Yonsei University Graduate School, Seoul, South Korea
| | - Young Han Lee
- Department of Radiology, Research Institute of Radiological Science, and Center for Clinical Imaging Data Science (CCIDS), Yonsei University College of Medicine, 50-1 Yonsei-Ro, Seodaemun-Gu, Seoul, 03722, South Korea.
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Deininger-Czermak E, Gascho D, Franckenberg S, Kälin P, Blüthgen C, Villefort C, Thali MJ, Guggenberger R. Added value of ultra-short echo time and fast field echo using restricted echo-spacing MR imaging in the assessment of the osseous cervical spine. LA RADIOLOGIA MEDICA 2023; 128:234-241. [PMID: 36637741 PMCID: PMC9938813 DOI: 10.1007/s11547-023-01589-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 06/16/2022] [Accepted: 01/04/2023] [Indexed: 01/14/2023]
Abstract
PURPOSE To evaluate the added value of ultra-short echo time (UTE) and fast field echo resembling a CT using restricted echo-spacing (FRACTURE) MR sequences in the assessment of the osseous cervical spine using CT as reference. MATERIALS AND METHODS Twenty-seven subjects underwent postmortem CT and MRI within 48 h. Datasets were anonymized and analyzed retrospectively by two radiologists. Morphological cervical spine alterations were rated on CT, UTE and FRACTURE images. Afterward, neural foraminal stenosis was graded on standard MR and again after viewing additional UTE/FRACTURE sequences. To evaluate interreader and intermodality reliability, intra-class correlation coefficients (ICC) and for stenosis grading Wilcoxon-matched-pairs testing with multiple comparison correction were calculated. RESULTS Moderate interreader reliability (ICC = 0.48-0.71) was observed concerning morphological findings on all modalities. Intermodality reliability was good between modalities regarding degenerative vertebral and joint alterations (ICC = 0.69-0.91). Compared to CT neural stenosis grades were more often considered as nonsignificant on all analyzed MR sequences. Neural stenosis grading scores differed also significantly between specific bone imaging sequences, UTE and FRACTURE, to standard MR sequences. However, no significant difference was observed between UTE and FRACTURE sequences. CONCLUSION Compared to CT as reference, UTE or FRACTURE sequence added to standard MR sequences can deliver comparable information on osseous cervical spine status. Both led to changes in clinically significant stenosis gradings when added to standard MR, mainly reducing the severity of neural foramina stenosis.
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Affiliation(s)
- Eva Deininger-Czermak
- Department of Forensic Medicine and Imaging, Institute of Forensic Medicine, University of Zurich, Zurich, Switzerland. .,Institute of Diagnostic and Interventional Radiology, University Hospital Zurich, Raemistrasse 100, 8091, Zurich, Switzerland.
| | - Dominic Gascho
- grid.7400.30000 0004 1937 0650Department of Forensic Medicine and Imaging, Institute of Forensic Medicine, University of Zurich, Zurich, Switzerland
| | - Sabine Franckenberg
- grid.7400.30000 0004 1937 0650Department of Forensic Medicine and Imaging, Institute of Forensic Medicine, University of Zurich, Zurich, Switzerland ,grid.412004.30000 0004 0478 9977Institute of Diagnostic and Interventional Radiology, University Hospital Zurich, Raemistrasse 100, 8091 Zurich, Switzerland
| | - Pascal Kälin
- grid.412004.30000 0004 0478 9977Institute of Diagnostic and Interventional Radiology, University Hospital Zurich, Raemistrasse 100, 8091 Zurich, Switzerland
| | - Christian Blüthgen
- grid.412004.30000 0004 0478 9977Institute of Diagnostic and Interventional Radiology, University Hospital Zurich, Raemistrasse 100, 8091 Zurich, Switzerland
| | - Christina Villefort
- grid.412373.00000 0004 0518 9682Orthopedic Surgery, Balgrist University Hospital, Zurich, Switzerland
| | - Michael J. Thali
- grid.7400.30000 0004 1937 0650Department of Forensic Medicine and Imaging, Institute of Forensic Medicine, University of Zurich, Zurich, Switzerland
| | - Roman Guggenberger
- grid.412004.30000 0004 0478 9977Institute of Diagnostic and Interventional Radiology, University Hospital Zurich, Raemistrasse 100, 8091 Zurich, Switzerland
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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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