Yonsei Med J.  2017 Nov;58(6):1186-1194. 10.3349/ymj.2017.58.6.1186.

Three-Dimensional Fast Spin-Echo Imaging without Fat Suppression of the Knee: Diagnostic Accuracy Comparison to Fat-Suppressed Imaging on 1.5T MRI

• Cho HW
• Suh JS
• Park JO
• Kim HS
• Chung SY
• Lee YH
• Hahn S

• KMID: 2418901
• DOI: http://doi.org/10.3349/ymj.2017.58.6.1186

Abstract

PURPOSE
To evaluate the diagnostic performance of three-dimensional fast spin-echo (3D FSE-Cube) without fat suppression (NFS) for detecting knee lesions, using comparison to 3D FSE-Cube with fat suppression (FS).
MATERIALS AND METHODS
One hundred twenty-four patients who underwent 1.5T knee magnetic resonance imaging (MRI) scans and 25 subsequent arthroscopic surgeries were retrospectively reviewed. Using arthroscopic results and two-dimensional images as reference standards, diagnostic performances of 3D FSE-Cube-NFS and FS imaging about lesions of ligament, meniscus, subchondral bone marrow edema (BME), and cartilage were compared. Scan parameters of 3D FSE-Cube imaging were previously optimized by a porcine knee phantom.
RESULTS
No significant differences were observed between detection rates of NFS and FS imaging for detecting lesions of meniscus and cartilage (p>0.05). However, NFS imaging had lower sensitivity for detection of medial collateral ligament (MCL) tears, and lower sensitivity and specificity for detection of BME lesions, compared to FS imaging (p<0.05).
CONCLUSION
3D FSE-Cube-NFS imaging showed similar diagnostic performance for detecting lesions of meniscus or cartilage compared to FS imaging, unlike MCL or BME lesions.

Keyword

Knee; magnetic resonance imaging; three-dimensional image; Cube; fat suppression

MeSH Terms

Adult
Aged
Animals
Arthroscopy/*methods
Female
Humans
Imaging, Three-Dimensional/*methods
Knee Joint/*diagnostic imaging/pathology
Magnetic Resonance Imaging/*methods
Male
Middle Aged
Phantoms, Imaging
Predictive Value of Tests
Reproducibility of Results
Retrospective Studies
Sensitivity and Specificity
Swine

Figure

• 

  Fig. 1 Subjective scores of phantom imaging (A) with fat suppression and (B) without fat suppression. Images with a score of -1 or above were regarded as acceptable. Highest SNRs per unit time were acquired with scan parameters of TR=1300 ms and ETL=45 in both FS and NFS images with parameter settings of acceptable image quality, measured in the (C) patellar cartilage and (D) femoral epiphyseal bone marrow. (E) 3D FSE-Cube-NFS phantom image with optimized parameters. 3D FSE-Cube-FS, three-dimensional fast spin-echo with fat suppression; 3D FSE-Cube-NFS, three-dimensional fast spin-echo without fat suppression; SNR, signal-to-noise ratio; TR, repetition time; ETL, echo train length.

• 

  Fig. 2 (A) Blurring of MCL fibers in addition to an increase in signal intensity of surrounding soft tissue are seen on the coronal reformatted 3D FSE-Cube-FS image (arrow). (B) Blurring of ligament fiber is not definite, and no signal abnormality in surrounding soft tissue is detected on the coronal reformatted 3D FSE-Cube-NFS image. (C) Conventional 2D coronal T2-weighted image reveals MCL tear. MCL, medial collateral ligament; 3D FSE-Cube-FS, three-dimensional fast spin-echo with fat suppression; 3D FSE-Cube-NFS, three-dimensional fast spin-echo without fat suppression.

• 

  Fig. 3 (A) 3D FSE-Cube-NFS image shows a suspicious subchondral BME lesion on the posterolateral tibial plateau (arrow), while (B) 3D FSE-Cube-FS image shows a subchondral sclerotic change. After correlation with 2D imaging, it turned out to be a false-positive lesion. 3D FSE-Cube-FS, three-dimensional fast spin-echo with fat suppression; 3D FSE-Cube-NFS, three-dimensional fast spin-echo without fat suppression; 2D, two-dimensional.

• 

  Fig. 4 (A) Metal artifact posterior to the proximal tibial cortex in 3D FSE-Cube-FS image. (B) Greatly reduced artifact is noted in 3D FSE-Cube-NFS image (arrow). Posterior tibial cortex margin is well-demarcated in this sequence. 3D FSE-Cube-FS, three-dimensional fast spin-echo with fat suppression; 3D FSE-Cube-NFS, three-dimensional fast spin-echo without fat suppression.

• 

  Fig. 5 (A) Artifact during 3D FSE-Cube-FS imaging. It is impossible to know whether there is a tear in the LM (arrow). (B) Subsequent 3D FSE-Cube-NFS image shows a normal meniscus. 3D FSE-Cube-FS, three-dimensional fast spin-echo with fat suppression; 3D FSE-Cube-NFS, three-dimensional fast spin-echo without fat suppression; LM, lateral meniscus.

• 

  Fig. 6 (A) No definite subchondral bone marrow signal change is seen in the medial femoral condyle in 3D FSE-Cube-FS image. (B) A small suspicious low signal intensity lesion is seen in the subsequent 3D FSE-Cube-NFS image (arrow). (C) Conventional 2D coronal T2-weighted image reveals a tiny subchondral BME lesion in the medial femoral condyle (arrow). 3D FSE-Cube-FS, three-dimensional fast spin-echo with fat suppression; 3D FSE-Cube-NFS, three-dimensional fast spin-echo without fat suppression; 2D, two-dimensional.

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