Should less motion sensitive T2-weighted BLADE TSE replace Cartesian TSE for female pelvic MRI?

Johannes M Froehlich,Rahel A Kubik-Huch,Thierry Metens,Bianka Chilla,Markus Klarhoefer,Nik Hauser

doi:10.1007/s13244-012-0193-9

Johannes M Froehlich, Rahel A Kubik-Huch + Show 4 more

Open Access

https://doi.org/10.1007/s13244-012-0193-9

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Abstract

ObjectivesTo prospectively compare the diagnostic performance of a non-Cartesian k-space sampling T2-weighted TSE BLADE sequence with a conventional T2-weighted TSE sequence in female pelvic organs.MethodsForty-seven patients with sonographically indeterminate adnexal masses or uterine lesions underwent sagittal BLADE and conventional TSE at 1.5 T after glucagon administration. Two radiologists independently determined their preferred sequence by rating: overall image diagnostic quality, conspicuity of the zonal anatomy and delineation of pathologies of the uterus and cervix, presence of artefacts, and of fluid in the pouch of Douglas (Wilcoxon signed rank test). Signal-to noise ratios (SNRs) and contrast-to-noise ratios (CNRs) were measured for the myometrium versus the rectus abdominis muscle (Student’s t-test).ResultsBLADE significantly (p < 0.0001) reduced motion and ghosting artefacts and showed improved conspicuity (p = 0.3/0.24), but overall image quality did not differ significantly (inter-observer agreement BLADE κ = 0.89; TSE κ = 0.84). In the majority of cases (53.2 % vs 59.6 %, respectively, κ = 0.82) radiologists preferred conventional TSE due to better image contrast (p < 0.0001) and visibility of free pelvic fluid (p ≤ 0.0001). SNR (TSE 57.5 ± 37.7; BLADE 16.6 ± 12.2) and CNR (TSE 40.4 ± 33.5; BLADE 7.2 ± 8.8) were significantly higher on conventional TSE (p < 0.0001).ConclusionsAlthough BLADE reduces motion artefacts and provides a clearer delineation of uterine zonal anatomy compared with conventional TSE, this comes at the expense of overall contrast.Main Messages• Use of BLADE may reduce T2 contrast and thus visibility of free pelvic fluid or cystic structures• Non-Cartesian sampling of k-space such as BLADE is beneficial due to less motion sensitivity• BLADE provides clearer delineation and conspicuity of uterine zonal anatomy on pelvic MRIs

Highlights

T2-weighted contrast plays an important role in magnetic resonance imaging (MRI) of the female pelvis
The multiple over-sampling of central k-space using periodically rotated overlapping parallel lines with enhanced reconstruction (PROPELLER) offers significant advantages over other methods for patient motion correction, as it corrects for two types of motion: in-plane rotation and translation
Our results indicate that BLADE improves anatomic depiction and image quality thanks to less movement artefact, but at the expense of contrast-to-noise ratios (CNRs) of cystic structures or visibility of free pelvic fluid

Summary

Introduction

T2-weighted contrast plays an important role in magnetic resonance imaging (MRI) of the female pelvis. Recent work by Lane et al [6], Koyama et al [7], Fujimoto et al [8] and Haneder et al [9] demonstrated the potential of this technique to improve image quality in the small pelvis by reducing motion artefacts resulting from bowel peristalsis, breathing and abdominal wall motion. These authors focused primarily on visual and qualitative assessment of images. The aim of the present study was to prospectively compare overall image quality, contrast, and diagnostic information of the recently

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