Investig Magn Reson Imaging.  2024 Dec;28(4):184-192. 10.13104/imri.2024.0017.

Diagnostic Value of Zero Echo Time Magnetic Resonance Imaging for Pediatric Osseous Pathologies

• Kim S
• Choi YH
• Choi JW
• Cho YJ
• Lee S
• Hwang JY
• Cheon JE

• KMID: 2563827
• DOI: http://doi.org/10.13104/imri.2024.0017

Abstract

Purpose
This study aimed to determine whether zero echo time magnetic resonance imaging (ZTE-MRI), as an alternative imaging modality, and conventional computed tomography (CT) have similar diagnostic qualities for assessing pediatric osseous pathologies.
Materials and Methods
Twenty-six sets of pediatric musculoskeletal CT and MRI scans (15 boys and 11 girls; mean age, 12 ± 4 years; range, 5–23 years) acquired at Seoul National University Children’s Hospital (January 2021 to November 2023) were retrospectively evaluated. CT-like images from ZTE-MRI were generated using grayscale inversion. Two radiologists independently assessed ZTE-MRI image quality (S anat) on a 5-point scale (1 = nondiagnostic, 5 = excellent) and a comparative scale (–2 = CT greater, 0 = same, 2 = ZTE-MRI greater) for lesion delineation (S_comp). The confidence interval of proportions and intraclass correlation coefficient were calculated to assess inter-rater agreement, and Wilcoxon rank-sum test, Mann–Whitney U test, or paired t-test was used to compare image quality or cortical thickness between the modalities.
Results
ZTE-MRI demonstrated diagnostic quality (S anat ≥ 3) in 85%–96% of the cases, 89%–96% for cortical delineation, 92%–100% for intramedullary cavity (IMC) delineation, and 92% for lesion delineation. Compared with conventional CT, ZTE-MRI showed comparable diagnostic power (S_comp ≥ –1) in 92%–96% of the cases, with S_comp scores indicating no significant difference in lesion delineation (p = 0.53 in reader 1 and p = 0.25 in reader 2). There was a preference for CT over ZTE-MRI in terms of overall image quality and delineation of the cortex and IMC (p < 0.001). Cortical thickness was not significantly different (p = 0.11) between ZTE-MRI and CT.
Conclusion
ZTE-MRI demonstrated diagnostic quality comparable to that of CT, particularly in lesion delineation. In addition to the unique information that conventional MRI can provide, ZTE-MRI can provide additional information about osseous structures similar to that provided by CT, which we believe will be valuable in the future.

Keyword

Zero echo time; MRI bone imaging; Children; Musculoskeletal disease