BLADE Sequences in Sagittal T2-Weighted MR Imaging of the Cervical Spine and Spinal Cord – Lesion Detection and Clinical Value

Abstract

Purpose: Using the BLADE (PROPELLER) technique for T2-weighted MR imaging of the cervical spine has proven to be a reliable tool for reducing artifacts typically for this region. The aim of this study was to evaluate whether the application of BLADE sequences has an impact on the detection of small or low contrast spinal cord and epidural lesions.

Materials and Methods: A standard TSE and a BLADE sequence were compared in 33 patients with 46 spinal cord and epidural lesions for T2-weighted sagittal imaging of the cervical spine. Image sharpness, visualization of the dura, reliability of spinal cord depiction as well as lesion contrast were evaluated by two independent readers. Additionally two experienced neuroradiologists selected in consensus the sequence they would prefer for diagnostic purposes. Statistical evaluations were performed using the sign and the χ2 test.

Results: BLADE was significantly superior to TSE regarding image sharpness, visualization of the dura and reliability of spinal cord depiction. Regarding lesion contrast there was a positive trend towards the BLADE sequence. In 17 of 46 lesions, BLADE was judged superior to TSE, while TSE was favored in 10 lesions. In consensus reading both neuroradiologists preferred BLADE for overall image quality in 27 of 33 patients and for lesion contrast in 10 and TSE in 14 of the 33 patients, but 3 TSE sequences were rated as non-diagnostic regarding this criterion.

Conclusion: For the detection of even small and low-contrast spinal cord lesions, BLADE is at least equivalent to TSE, yielding better overall image quality and fewer non-diagnostic images.

Citation Format:

• Finkenzeller T, Menzel C, Fellner FA et al. BLADE-Sequenzen zur sagittalen T2-gewichteten Bildgebung der Halswirbelsäule und des zervikalen Myelons. Läsionsdetektion und klinische Wertigkeit. Fortschr Röntgenstr 2014; 186: 47 – 53

Zusammenfassung

Ziel: BLADE (PROPELLER) Sequenzen zur T2-gewichteten Bildgebung der HWS sind geeignet Artefakte zu reduzieren, wie sie für diese Region typisch sind. Ziel war es, zu prüfen, ob BLADE-Sequenzen eine Auswirkung auf die Detektierbarkeit von kleinen und wenig kontrastreichen Myelonläsionen und epiduralen Läsionen haben.

Material und Methoden: T2-gewichtete sagittale Bildgebung der Halswirbelsäule mittels Standard TSE und BLADE-Sequenz bei 33 Patienten mit 46 spinalen und epiduralen Läsionen. Bildschärfe, Abgrenzbarkeit der Dura, Verlässlichkeit der Myelonbeurteilbarkeit und Läsionskontrast wurden von zwei unabhängigen Untersuchern ausgewertet. Zusätzlich wählten zwei weitere erfahrene Neuroradiologen in Konsensusverfahren die Sequenz, die sie für die diagnostische Beurteilung bevorzugen würden. Die Statistik erfolgte mittels Vorzeichentest und χ2 Test.

Ergebnisse: BLADE wurde für die Kriterien Bildschärfe, Abgrenzbarkeit der Dura und Verlässlichkeit der Myelonbeurteilung gegenüber der TSE-Sequenz als signifikant besser bewertet. Für den Läsionskontrast zeigte sich ein positiver Trend für die BLADE-Sequenz. Sie wurde in 17 von 46 Läsionen besser bewertet als die TSE-Sequenz, während TSE nur bei 10 Läsionen bevorzugt wurde. In der Konsensus-Auswertung wählten die beiden Neuroradiologen in 27 von 33 Patienten BLADE als die bevorzugte Sequenz hinsichtlich der allgemeinen Bildqualität. Für den Läsionskontrast bevorzugten sie bei 10 die BLADE und bei 14 Patienten die TSE-Sequenz, jedoch wurde bei 3 Patienten die TSE-Sequenz für dieses Kriterium als nicht diagnostisch gewertet.

Schlussfolgerungen: Für die Beurteilung von kleinen und wenig kontrastreichen Myelonläsionen sind BLADE-Sequenzen der TSE zumindest gleichwertig. Gleichzeitig liefern sie eine bessere Bildqualität und reduzieren die Zahl diagnostisch nicht verwertbare Bilder.

Key words

spinal cord - MR imaging < METHODS & TECHNIQUES - imaging sequences - lesions - artifacts

• References

• 1 Melhem ER. Technical challenges in MR imaging of the cervical spine and cord. Magn Reson Imaging Clin N Am 2000; 8: 435-452
• 2 Taber KH, Herrick KH, Weathers SW et al. Pitfalls and artifacts encountered in clinical MR imaging of the spine. Radiographics 1998; 18: 1499-1521
• 3 Fenchel M, Roser F, Nagele T et al. Syringomyelia – Syringomyelie. Fortschr Röntgenstr 2012; 184: 191-195
• 4 Forbes KP, Pipe JG, Bird CR et al. PROPELLER MRI. Clinical testing of a novel technique for quantification and compensation of head movement. J Magn Reson Imaging 2001; 14: 215-222
• 5 Forbes KP, Pipe JG, Karis JP et al. Brain imaging in the unsedated pediatric patient: Comparison of periodically rotated overlapping parallel lines with enhanced reconstruction with single shot fast spin-echo sequences. AJNR Am J Neuroradiol 2003; 24: 794-798
• 6 Panigrahy A, Blüml S. Advances in magnetic resonance neuroimaging techniques in the evaluation of neonatal encephalopathy. Top Magn Reson Imaging 2007; 18: 3-29
• 7 Heyer CM, Lemburg SP, Sterl S et al. Dispensing with Sedation in Pediatric MR Imaging of the Brain: What is Feasible?. Fortschr Röntgenstr 2012; 184: 1034-1042
• 8 Hirokawa Y, Isoda H, Maetani YS et al. MRI artifact reduction and quality improvement in the upper abdomen with PROPELLER and prospective acquisition correction (PACE) technique. Am J Roentgenol 2008; 191: 1154-1158
• 9 Hirokawa Y, Isoda H, Maetani YS et al. Evaluation of motion correction effect and image quality with the periodically rotated overlapping parallel lines with enhanced reconstruction (PROPELLER) (BLADE) and parallel imaging acquisition technique in the upper abdomen. J Magn Reson Imaging 2008; 28: 957-962
• 10 Hirokawa Y, Isoda H, Maetani YS et al. Hepatic lesions: Improved image quality and detection with the Periodically Rotated Overlapping Parallel Lines with Enhanced Reconstruction technique – evaluation of SPIO-enhanced T2-weighted MR images. Radiology 2009; 251: 388-397
• 11 Michaeli HJ, Kramer H, Weckbach S et al. Renal T2-weighted turbo-spin-echo imaging with BLADE at 3.0 T: initial experience. J Magn Reson Imaging 2008; 27: 148-153
• 12 Forbes KP, Pipe JG, Karis JP et al. Improved image quality and detection of acute cerebral infarction with PROPELLER diffusion-weighted MR imaging. Radiology 2002; 225: 551-555
• 13 Wang FN, Huang TY, Lin FH et al. PROPELLER EPI: an MRI technique suitable for diffusion tensor imaging at high field strength with reduced geometric distortions. Magn Reson Med 2005; 54: 1232-1240
• 14 Adachi M, Kabasawa H, Kawaguchi E. Depiction of the cranial nerves within the brain stem with use of PROPELLER multishot diffusion-weighted imaging. AJNR Am J Neuroradiol 2008; 29: 911-912
• 15 Chuang TC, Huang TY, Lin FH et al. PROPELLER-EPI with parallel imaging using a circularly symmetric phased-array RF coil at 3 T: application to high-resolution diffusion tensor imaging. Magn Reson Med 2006; 56: 1352-1358
• 16 Lehmann P, Saliou G, Brochart C et al. 3T MR imaging of postoperative recurrent middle ear cholesteatomas: Value of periodically rotated overlapping parallel lines with enhanced reconstruction diffusion-weighted MR imaging. AJNR Am J Neuroradiol 2009; 30: 423-427
• 17 Kiryu S, Watanabe M, Kabasawa H et al. Evaluation of super paramagnetic iron oxide-enhanced diffusion-weighted PROPELLER T2-fast spin echo magnetic resonance imaging: Preliminary experience. J Comput Assist Tomogr 2006; 30: 197-200
• 18 Deng J, Miller FH, Salem R et al. Multishot diffusion-weighted PROPELLER magnnetic resonance imaging of the abdomen. InvestRadiol 2006; 41: 769-775
• 19 Fellner C, Menzel C, Fellner FA et al. BLADE in sagittal T2-weighted MR imaging of the cervical spine. Am J Neuroradiol 2010; 31 (04) 674-681
• 20 Ragoschke-Schumm A, Schmidt P, Schumm J et al. Decreased CSF-flow artifacts in T2 imaging of the cervical spine with periodically rotated overlapping parallel lines with enhanced reconstruction (PROPELLER/BLADE). Neuroradiology 2011; 53: 13-18
• 21 Wintersperger BJ, Runge VM, Biswas J et al. Brain magnetic resonance imaging at 3 tesla using BLADE compared with standard rectilinear data sampling. Invest Radiol 2006; 41: 586-592
• 22 Naganawa S, Satake H, Iwano S et al. Contrast-enhanced MR imaging of the brain using T1-weighted FLAIR with BLADE compared with a conventional spin-echo sequence. Eur Radiol 2008; 18: 337-342
• 23 Pipe JG. Motion correction with PROPELLER MRI: Application to head motion and free-breathing cardiac imaging. Magn Reson Med 1999; 42: 963-969