Comparison of Modern 3D and 2D MR Imaging Sequences of the Wrist at 3 Tesla

Abstract

Purpose: To compare the image quality of modern 3 D and 2 D sequences for dedicated wrist imaging at 3 Tesla (T) MRI.

Materials and Methods: At 3 T MRI, 18 patients (mean age: 36.2 years) with wrist pain and 16 healthy volunteers (mean age: 26.4 years) were examined using 2 D proton density-weighted fat-saturated (PDfs), isotropic 3 D TrueFISP, 3 D MEDIC, and 3 D PDfs SPACE sequences. Image quality was rated on a five-point scale (0 – 4) including overall image quality (OIQ), visibility of important structures (cartilage, ligaments, TFCC) and degree of artifacts. Signal-to-noise ratios (SNR) and contrast-to-noise ratios (CNR) of cartilage/bone/muscle/fluid as well as the mean overall SNR/CNR were calculated using region-of-interest analysis. ANOVA, paired t-, and Wilcoxon-signed-rank tests were applied.

Results: The image quality of all tested sequences was superior to 3 D PDfs SPACE (p < 0.01). 3 D TrueFISP had the highest combined cartilage score (mean: 3.4) and performed better in cartilage comparisons against 3 D PDfs SPACE in both groups and 2 D PDfs in volunteers (p < 0.05). 3 D MEDIC performed better in 7 of 8 comparisons (p < 0.05) regarding ligaments and TFCC. 2 D PDfs provided constantly high scores. The mean overall SNR/CNR for 2 D PDfs, 3 D PDfs SPACE, 3 D TrueFISP, and 3 D MEDIC were 68/65, 32/27, 45/47, and 57/45, respectively. 2 D PDfs performed best in most SNR/CNR comparisons (p < 0.05) and 3 D MEDIC performed best within the 3 D sequences (p < 0.05).

Conclusion: Except 3 D PDfs SPACE, all tested 3 D and 2 D sequences provided high image quality. 3 D TrueFISP was best for cartilage imaging, 3 D MEDIC for ligaments and TFCC and 2 D PDfs for general wrist imaging.

Key points:

• 3 D TrueFISP is recommended for cartilage imaging of the wrist at 3 T.

• 3 D MEDIC is recommended for ligaments and TFCC.

• Robust 2 D PDfs should be used in routine protocols. 3 D sequences may be added depending on the clinical question.

• 3 D PDfs SPACE is currently inferior.

Citation Format:

• Rehnitz C, Klaan B, von Stillfried F et al. Comparison of Modern 3D and 2D MR Imaging Sequences of the Wrist at 3 Tesla. Fortschr Röntgenstr 2016; 188: 753 – 762

Zusammenfassung

Ziel: Vergleich der Bildqualität moderner 3D- und 2D-Sequenzen zur dedizierten MRT des Handgelenkes bei 3 Tesla (T).

Material und Methoden: Bei 18 Patienten mit Handgelenksschmerzen (mittleres Alter: 36,2 Jahre) und 16 gesunden Probanden (mittleres Alter: 26,4 Jahre) wurde eine 3 T MRT-Bildgebung des Handgelenkes unter Einschluss einer 2D-Protonen-gewichteten fettgesättigten (PDfs) Sequenz und drei isotropen 3D-Sequenzen (TrueFISP, MEDIC und PDfs SPACE) durchgeführt. Die subjektive Bildqualität wurde auf einer 5-Punkte-Skala (0 – 4) bewertet und umfasste die Gesamtbildqualität (OIQ), die Beurteilbarkeit von Knorpel/Ligamenten/TFCC sowie das Ausmaß von Artefakten. Das Signal-zu-Rausch- (SNR) und Kontrast-zu-Rausch-Verhältnis (CNR) von Knorpel/Knochen/Muskel/Flüssigkeit sowie das gemittelte Gesamt-SNR/CNR wurden mittels Region-of-Interest-Analyse berechnet. Die statistische Auswertung erfolgte unter Verwendung von Varianzanalysen sowie gepaarten t- und Wilcoxon-Rangsummen-Tests.

Ergebnisse: Die Bildqualität aller getesteten Sequenzen war der 3D-PDfs-SPACE überlegen (p < 0,01). Bezüglich des Knorpels erreichte die 3D-TrueFISP die höchste kombinierte Bewertung (Mittelwert: 3,4), wobei die Unterschiede zur 2D-PDfs in beiden Gruppen und der 3D-PDfs-SPACE in der Probanden-Gruppe signifikant waren (p < 0,05). Die 3D-MEDIC war in 7 von 8 Paarvergleichen bezüglich der Ligamente und des TFCC (p < 0,05) überlegen. Die 2D-PDfs lieferte konstant hohe Bewertungen. Die gemittelten SNR/CNR-Werte für 2D-PDfs, 3D-PDfs-SPACE, 3D-TrueFISP, und 3D-MEDIC waren 68/65, 32/27, 45/47 und 57/45. Bezüglich der anatomischen Einzelstrukturen war die 2D-PDfs in den meisten Einzelvergleichen überlegen (p < 0,05), unter den 3D-Sequenzen die 3D-MEDIC (p < 0,05).

Schlussfolgerung: Mit Ausnahme der 3D-PDfs-SPACE zeigten alle untersuchten 3D- und 2D-Sequenzen eine sehr gute Bildqualität. Die 3D-TrueFISP war die beste 3D-Sequenz zur Knorpelbildgebung, die 3D-MEDIC zur Darstellung der Ligamente und des TFCC und die 2D-PDfs zur allgemeinen Bildgebung aller Strukturen.

Kernaussagen:

• Die 3D-TrueFISP wird zur Knorpelbildgebung der Hand bei 3 T empfohlen.

• Die 3D-MEDIC empfiehlt sich zur Beurteilung der Ligamente und des TFCC.

• Die robuste 2D-PDfs sollte Bestandteil von Routine-Protokollen sein und je nach klinischer Fragstellung durch 3D-Sequenzen ergänzt werden.

• Die 3D-PDfs-SPACE ist den übrigen getesteten Sequenzen unterlegen.

Key words

wrist - hand - 3 Tesla - 3 D imaging - cartilage imaging - MR imaging

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