Korean J Radiol.  2015 Oct;16(5):1086-1095. 10.3348/kjr.2015.16.5.1086.

Comparison of Multi-Echo Dixon Methods with Volume Interpolated Breath-Hold Gradient Echo Magnetic Resonance Imaging in Fat-Signal Fraction Quantification of Paravertebral Muscle

• Yoo YH
• Kim HS
• Lee YH
• Yoon CS
• Paek MY
• Yoo H
• Kannengiesser S
• Chung TS
• Song HT
• Suh JS
• Kim S

• KMID: 2160776
• DOI: http://doi.org/10.3348/kjr.2015.16.5.1086

Abstract

OBJECTIVE
To assess whether multi-echo Dixon magnetic resonance (MR) imaging with simultaneous T2* estimation and correction yields more accurate fat-signal fraction (FF) measurement of the lumbar paravertebral muscles, in comparison with non-T2*-corrected two-echo Dixon or T2*-corrected three-echo Dixon, using the FF measurements from single-voxel MR spectroscopy as the reference standard.
MATERIALS AND METHODS
Sixty patients with low back pain underwent MR imaging with a 1.5T scanner. FF mapping images automatically obtained using T2*-corrected Dixon technique with two (non-T2*-corrected), three, and six echoes, were compared with images from single-voxel MR spectroscopy at the paravertebral muscles on levels L4 through L5. FFs were measured directly by two radiologists, who independently drew the region of interest on the mapping images from the three sequences.
RESULTS
A total of 117 spectroscopic measurements were performed either bilaterally (57 of 60 subjects) or unilaterally (3 of 60 subjects). The mean spectroscopic FF was 14.3 +/- 11.7% (range, 1.9-63.7%). Interobserver agreement was excellent between the two radiologists. Lin's concordance correlation between the spectroscopic findings and all the imaging-based FFs were statistically significant (p < 0.001). FFs obtained from the T2*-corrected six-echo Dixon sequences showed a significantly better concordance with the spectroscopic data, with its concordance correlation coefficient being 0.99 and 0.98 (p < 0.001), as compared with two- or three-echo methods.
CONCLUSION
T2*-corrected six-echo Dixon sequence would be a better option than two- or three-echo methods for noninvasive quantification of lumbar muscle fat quantification.

Keyword

Magnetic resonance imaging; Fat-signal fraction; Dixon; Muscle; Spine

MeSH Terms

Adult
Aged
Aged, 80 and over
Female
Humans
Image Processing, Computer-Assisted
Low Back Pain/*radiography
Magnetic Resonance Imaging/instrumentation/*methods
Male
Middle Aged
Muscles/radiography
Spinal Cord

Figure

• 

  Fig. 1 T2-corrected single-voxel multi-echo 1H MR spectroscopy (MRS). Screen-captured image of T2-corrected single-voxel multi-echo 1H MRS result from 62-year-old female subject. Data on left includes five water and fat integrals at each measured echo (TE = 12, 24, 36, 48, and 72 ms) and estimated fat-signal fraction was 27.4%. Image on top right shows representative water and fat spectral peaks, which were measured at TE of 12 ms. Image on bottom left shows T2 exponential decay. CI = confidence interval, TE = echo time

• 

  Fig. 2 Region of interest (ROI) placement from mapping images. Example of screen-captured image of ROI placement from mapping images, obtained from 68-year-old male subject. ROI was drawn on mapping image from non-T2*-corrected two-echo volume interpolated breath-hold gradient-echo Dixon (VIBE-Dixon) sequence (top left) at same location of spectroscopic voxel referring to captured image (bottom right) obtained while placing voxel in each MR imaging. This was then copied and pasted to other mapping images from T2*-corrected three-echo VIBE-Dixon sequence (top right) and T2*-corrected six-echo VIBE-Dixon sequence (bottom right). Diameter of circular ROI was fixed at 15 mm, based on voxel size of MR spectroscopy. For precise representative data acquisition embracing entire voxel area, ROIs were drawn at three consecutive slices of mapping images in same manner as stated above. As result, three ROI measurements from three fat-signal fraction pulse sequences were obtained for every voxel location.

• 

  Fig. 3 Concordance correlation coefficient (CCC) of fat-signal fraction (FF) between MR spectroscopy (MRS) and mapping image measurements. Concordance correlation coefficient for assessment of agreement between MRS and mapping image measurements obtained from FF maps using non-T2*-corrected two-echo VIBE-Dixon sequence (Observer A, A-1; Observer B, B-1), T2*-corrected three-echo Dixon sequence (Observer A, A-2; Observer B, B-2), T2*-corrected six-echo VIBE-Dixon sequence (Observer A, A-3; Observer B, B-3) in each observer. Correlation of FFs between all mapping images and spectroscopic data was statistically significant in each observer (p < 0.001). CCC was 0.93 for two-echo VIBE-Dixon, 0.94 for three-echo VIBE-Dixon, 0.99 for six-echo VIBE-Dixon pulse sequence in observer A, and was 0.94 for two-echo VIBE-Dixon, 0.93 for three-echo VIBE-Dixon, and 0.98 for six-echo VIBE-Dixon pulse sequence in observer B. FF of two-echo = FF obtained from non-T2*-corrected two-echo VIBE-Dixon sequence, FF of three-echo = FF obtained from T2*-corrected three-echo VIBE-Dixon sequence, FF of six-echo = FF obtained from T2*-corrected six-echo VIBE-Dixon sequence, FF of MRS = FF obtained from MR spectroscopy, VIBE-Dixon = volume interpolated breath-hold gradient-echo Dixon

• 

  Fig. 4 Bland-Altman plots for assessment of agreement of fat-signal fraction (FF) between MR spectroscopy (MRS) and mapping image measurements. Bland-Altman plot shows mean measurement bias with limits of agreement of FFs, obtained from FF maps using non-T2*-corrected two-echo volume interpolated breath-hold gradient-echo (VIBE-Dixon) sequence (Observer A, A-1; Observer B, B-1), T2*-corrected three-echo VIBE-Dixon sequence (Observer A, A-2; Observer B, B-2), and T2*-corrected six-echo VIBE-Dixon sequence (Observer A, A-3; Observer B, B-3) in relation to FFs measured with MRS. Narrow range of limits of agreement was seen in T2*-corrected six-echo VIBE-Dixon as compared with other sequences in each observer. FF % two-echo = FF obtained from non-T2*-corrected two-echo VIBE-Dixon sequence, FF % three-echo = FF obtained from T2*-corrected three-echo VIBE-Dixon sequence, FF % six-echo = FF obtained from T2*-corrected six-echo VIBE-Dixon sequence, FF % MRS = FF obtained from MR spectroscopy, SD = standard deviation

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