• Jan Fritz, Esther Raithel, Gaurav K Thawait, Wesley Gilson, and Derek F Papp.
• From the *Russell H. Morgan Department of Radiology and Radiological Science, Johns Hopkins University School of Medicine, Baltimore, MD; †Siemens Healthcare GmbH, Erlangen, Germany; ‡Siemens Healthcare USA, Inc, Malvern, PA; and §Department of Orthopedic Surgery, Johns Hopkins University School of Medicine, Baltimore, MD.
• Invest Radiol. 2016 Jun 1; 51 (6): 400-9.

PurposeThe aim of this study was to prospectively test the hypothesis that 6-fold acceleration of a 3-dimensional (3D) turbo spin echo (TSE) magnetic resonance imaging (MRI) pulse sequence with k-space undersampling and iterative reconstruction is feasible for fast high spatial resolution MRI of the knee, while yielding similar image quality and diagnostic performance when compared with a conventional 2-dimensional (2D) TSE MRI standard.Materials And MethodsThe study was approved by the institutional review board. A 10-minute isotropic 3D TSE knee protocol consisting of accelerated intermediate-weighted (repetition time, 900 milliseconds; echo time, 29 milliseconds; voxel size, 0.5 × 0.5 × 0.5 mm; acquisition time, 4:45 minutes) and fat-saturated T2-weighted (repetition time, 900 milliseconds; echo time, 92 milliseconds; voxel size, 0.5 × 0.5 × 0.5 mm; acquisition time, 5:10 minutes) SPACE (sampling perfection with application optimized contrast using different flip angle evolutions) sequence prototypes was compared against a 20-minute 2D TSE standard protocol. The accelerated SPACE sequences were equipped with an optional variable-density poisson-disc pattern as an undersampling mask. An undersampling factor of 0.17 was chosen (6-fold acceleration compared with an acquisition with full sampling). An iterative, sensitivity encoding-type reconstruction with L1 norm-based regularization term was used. The study was performed on a 3 T MRI system using a 15-channel transmit/receive knee coil. The study groups included 15 asymptomatic volunteers and 15 patient volunteers. Quantitative and qualitative assessments were performed by 2 observers. Outcome variables included signal and contrast-to-noise ratio, image quality, and diagnostic accuracy. Qualitative and quantitative measurements were statistically analyzed using nonparametric tests. P values of less than 0.01 were considered significant.ResultsThe signal-to-noise ratios of 2D and 3D MRI were similar with the exception of fluid, which was brighter on 2D MRI. Relevant contrast-to-noise ratios of 2D MRI were higher than 3D MRI; however, observer ratings for satisfaction, image quality, and visibility of anatomic structures were similar for 2D and 3D MRI. There was moderate to excellent interobserver (κ = 0.54-1.00) and intermethod (κ = 0.54-1.00) agreement for assessing menisci, cartilage, ligaments, cartilage, and bone. Two-dimensional and 3D MRI had similar sensitivity (100%/100%, respectively) and specificity (87%/75%, respectively) for detecting 9 meniscal tears (P = 1.00).ConclusionsWe demonstrate the successful clinical implementation of 3D TSE MRI with incoherent k-space undersampling and iterative reconstruction for 6-fold accelerated high spatial resolution isotropic 3D MRI data acquisition. Our preliminary assessments suggest similar image quality and diagnostic performance of a comprehensive 10-minute 3D TSE MRI prototype protocol and 20-minute TSE MRI standard protocol.

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