BLADE Sequences in Transverse T2-weighted MR Imaging of the Cervical Spine. Cut-off for Artefacts?

Abstract

Purpose: The BLADE (PROPELLER) technique reduces artefacts in imaging of the cervical spine in sagittal orientation, but till now failed to do so in axial orientation, because here it increased through plane CSF-flow artefacts, which spoiled the benefit of BLADE artefact reduction “in plane”. The aim of this study was to compare a BLADE sequence with optimised measurement parameters in axial orientation to T2-TSE.

Materials and Methods: Both sequences were compared in 58 patients with 31 discal, 16 bony and 11 spinal cord lesions. Image sharpness, reliability of spinal cord depiction, CSF flow artefacts and lesion detection were evaluated by 3 independent observers. Additionally the observers were asked which sequence they would prefer for diagnostic workup. Statistical evaluations were performed using sign and χ2 test.

Results: BLADE was significantly superior concerning image sharpness, spinal cord depiction and overall lesion detection. BLADE was rated better for most pathologies, for bony lesions the differences compared with TSE were statistically significant. Regarding CSF-flow artefacts both sequences showed no difference. All readers preferred BLADE in side by side reading.

Conclusion: An optimised axial T2 BLADE sequence decreases the problems of increased through plane CSF-flow artefacts in this orientation. By reducing various other artefacts it yields better image quality and has the potential to reduce the number of non-diagnostic examinations especially in uncooperative patients.

Key points:

• T2 BLADE/PROPELLER sequences proofed to reduce artefacts in sagittal spine imaging

• BLADE/PROPELLER improve image quality, but can aggravate CSF flow artefacts in axial orientation

• optimised parameter setting for axial T2 BLADE reduces “through-plane” CSF artefacts aggravation

• optimised axial T2 BLADE reduces non-diagnostic examinations especially in uncooperative patients

Citation Format:

• Finkenzeller T, Wendl CM, Lenhart S et al. BLADE Sequences in Transverse T2-weighted MR Imaging of the Cervical Spine. Cut-off for Artefacts?. Fortschr Röntgenstr 2015; 187: 102 – 108

Zusammenfassung

Ziel: BLADE (PROPELLER) Sequenzen reduzieren Artefakte in der sagittalen Bildgebung der Halswirbelsäule. Diese konnten aber nur eingeschränkt in die axiale Schichtrichtung übertragen werden, da hier bisher vermehrte through plane Artefakte des Liquors den BLADE-Benefit wieder aufgehoben haben. Ziel dieser Studie war es, eine axiale T2-BLADE-Sequenz mit optimierten Untersuchungsparametern mit einer T2-TSE zu vergleichen.

Material und Methoden: Beide Sequenzen wurden bei 58 Patienten mit 31 Bandscheibenschäden, 16 knöchernen und 11 Myelon-Läsionen verglichen. Bildschärfe, Myelonbeurteilbarkeit, Liquorflussartefakte und Läsionserkennbarkeit wurden von 3 unabhängigen Auswertern beurteilt. Zusätzlich wurden die Untersucher gefragt, welche der Sequenzen sie für eine klinisch diagnostische Auswertung bevorzugen würden. Die statistische Auswertung erfolgte mittels Vorzeichen- und χ2- Test.

Ergebnisse: BLADE zeigte signifikant bessere Bildschärfe, Myelonbeurteilbarkeit und allgemeine Läsionserkennbarkeit. BLADE wurde für fast alle Läsionen als besser gewertet, für knöcherne Läsionen war der Unterschied im Vergleich zur T2-TSE signifikant. Im Bezug auf Liquorpulsationsartefakte zeigte sich kein statistischer Unterschied der Sequenzen. Im direkten Vergleich bevorzugten alle Auswerter die BLADE-Sequenz.

Schlussfolgerung: Eine axiale T2-BLADE-Sequenz mit optimierten Untersuchungsparametern vermindert das Problem der through-plane Artefakte des Liquors in dieser Orientierung. Sie bietet durch die Reduktion der übrigen Artefakte eine bessere Bildqualität und hat somit das Potential, besonders bei unkooperativen Patienten, die Anzahl nicht auswertbarer Untersuchungen zu minimieren.

Kernaussagen:

• T2-BLADE/PROPELLER-Sequenzen reduzieren Artefakte in sagittaler Orientierung an der Wirbelsäule

• BLADE/PROPELLER verbessern die Bildqualität, können aber Liquorflussartefakte in axialer Orientierung verstärken

• Optimierte Sequenzparameter für axiale T2-BLADE reduzieren erhöhte “through-plane” Artefakte des Liquors

• Optimierte axiale T2-BLADE vermindern nicht-diagnostische Untersuchungen vor allem bei unkooperativen Patienten

Key words

spine - spinal cord - MR-imaging - spinal canal - technical aspects

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