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Comparison of zero echo time MRI with T1-weighted fast spin echo for the recognition of sacroiliac joint structural lesions using CT as the reference standard

  • Musculoskeletal
  • Published:
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Abstract

Objectives

To evaluate the diagnostic performance of zero echo time (ZTE) MRI in the depiction of structural lesions of sacroiliac joints (SIJs) in patients with the suspicion of sacroiliitis compared with T1-weighted fast spin echo (T1 FSE), using CT as the reference standard.

Methods

Forty patients with suspicion of sacroiliitis underwent both CT and MR scans of SIJs with 80 SIJs (160 bone articular surfaces) included for analysis. Two readers independently scored SIJs for structural lesions on CT and MR images. The diagnostic capability of ZTE MRI and T1 FSE were compared by the McNemar test, using CT as the reference standard. Agreements of diagnosis and sum scores of lesions between MR sequences and CT as well as between readers were also investigated using Cohen’s κappa tests and intraclass correlation coefficients.

Results

Diagnostic accuracy of ZTE MRI was higher than that of T1 FSE for erosions, sclerosis, and joint space changes (e.g., joint space changes: 91.3% vs 75.0%). ZTE MRI also improved sensitivity for detection of erosions and sclerosis (e.g., erosions at the joint level: 98.2% vs 80.0%) as well as specificity for detection of joint space changes (93.0% vs 67.4%). ZTE MRI had more consistency with CT than T1 FSE for both diagnosis and sum scores. Inter-reader agreements were higher for CT and ZTE MRI than those for T1 FSE.

Conclusions

ZTE MRI showed superior diagnostic performance in the depiction of SIJ structural lesions compared with routine T1-weighted MRI and had reliability comparable to CT.

Key Points

• ZTE MRI can provide CT-like bone contrast for the depiction of osseous structural lesions of the sacroiliac joints.

• ZTE MRI showed superior diagnostic performance than conventional T1 FSE in the detection of osseous structural lesions of sacroiliitis, using CT as the reference standard.

• In terms of inter-reader reliability, ZTE MRI performed comparably to CT and better than conventional T1 FSE.

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Abbreviations

3D:

Three-dimensional

ASAS:

Assessment of SpondyloArthritis international Society

AxSpA:

Axial spondyloarthritis

DICOM:

Digital Imaging and Communications in Medicine

FSE:

Fast spin echo

GRE:

Gradient echo

ICC:

Intraclass correlation coefficient

IRB:

Institutional review board

NPV:

Negative predictive value

PPV:

Positive predictive value

sCT:

Synthetic CT

SIJ:

Sacroiliac joint

TE:

Echo time

TR:

Repetition time

UTE:

Ultrashort echo time

VIBE:

Volumetric interpolated breath-hold examination

WS-bSSFP:

Water selective balanced steady-state free precession

ZTE:

Zero echo time

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Acknowledgements

We acknowledge Weiyin Vivian Liu from GE Healthcare for the technical support and manuscript revision. We also thank professor John N. Morelli for proofreading and editing the language of this paper.

Funding

This research was supported by the National Natural Science Foundation of China (NSFC) (No. 31630025 and 81930045) and Tongji Hospital Clinical Research Flagship Program (No. 2019CR102).

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Author notes

  1. Weiyin Vivian Liu and Xiaoming Li contributed equally to this work.

Authors and Affiliations

  1. Department of Radiology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei Province, China

    Yitong Li, Yan Xiong, Bowen Hou, Chanyuan Liu, Jingyi Wang & Xiaoming Li

  2. MR Research, GE Healthcare, Beijing, China

    Weiyin Vivian Liu

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  1. Yitong Li
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Correspondence to Weiyin Vivian Liu or Xiaoming Li.

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The scientific guarantor of this publication is Xiaoming Li.

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One of the authors of this manuscript (Weiyin Vivian Liu) is an employee of GE Healthcare. The remaining authors declare no relationships with any companies whose products or services may be related to the subject matter of the article.

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Written informed consent was obtained from all patients in this study.

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Institutional Review Board approval was obtained.

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Li, Y., Xiong, Y., Hou, B. et al. Comparison of zero echo time MRI with T1-weighted fast spin echo for the recognition of sacroiliac joint structural lesions using CT as the reference standard. Eur Radiol 32, 3963–3973 (2022). https://doi.org/10.1007/s00330-021-08513-5

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