Faculty Bibliography

Background Conventional chemical shift selective (CHESS) fat suppression may fail in distal extremity MRI due to sensitivity to field inhomogeneities. Purpose To develop a patient-specific fat-suppression method for distal extremity 3-T MRI by exploiting the spectral heterogeneity adaptive radiofrequency pulse (SHARP) technique and to compare it to fat suppression with CHESS. Materials and Methods SHARP uses the routinely acquired frequency spectrum at MRI calibration to adapt the frequency range and time-bandwidth product of the fat-suppression pulse. In this prospective study, fat suppression by SHARP was assessed by numerical simulations, phantom experiments, and imaging in 15 asymptomatic participants who underwent ankle, foot, and hand (in superman and hand-by-the-side positions) MRI using SHARP, CHESS, and reference standard (short-tau inversion recovery or Dixon) techniques. Three readers ranked the MRI scans from 1 (best) to 3 (worst) regarding fat-suppression homogeneity. The added value of SHARP was defined as the difference between the proportions of images where SHARP outranked CHESS and where CHESS outranked SHARP. Friedman, Wilcoxon signed rank, and χ² tests were used to compare in vivo data. Results At numerical simulations, SHARP showed 0% water and 62%-70% fat suppression, whereas CHESS showed 2% water and 57% fat suppression. Phantom data demonstrated lower fat-suppression inhomogeneity indexes with Dixon (1.0%) and SHARP (2.4%) compared with CHESS (10.7%). In 15 participants (mean age, 38.5 years ± 12.8 [SD]; six female participants), mean ranking by readers of fat homogeneity in the reference technique (ankle, foot, hand in superman position, and hand-by-the-side position: 1.02, 1.02, 1.03, and 1.06, respectively) was higher than those with SHARP (1.39, 1.46, 1.50, and 1.66, respectively), which were higher than those with CHESS (1.64, 1.80, 1.61, and 1.80, respectively) (all P < .001). The added value of SHARP was highest for images in the foot (389 of 1158; 33.6%; P < .001 vs other joints), followed by the ankle (247 of 971 [25%]; P < .001 vs both hand positions), and lowest for hand-by-the-side and hand in superman positions (158 of 1223; [13%] and 133 of 1193 [11%], respectively; P = .18). Conclusion SHARP provided more homogeneous fat suppression than CHESS. © RSNA, 2024 Supplemental material is available for this article.

ABSTRACT/UNASSIGNED:Magnetic resonance imaging (MRI) provides essential information for diagnosing and treating musculoskeletal disorders. Although most musculoskeletal MRI examinations are performed at 1.5 and 3.0 T, modern low-field MRI systems offer new opportunities for affordable MRI worldwide. In 2021, a 0.55 T modern low-field, whole-body MRI system with an 80-cm-wide bore was introduced for clinical use in the United States and Europe. Compared with current higher-field-strength MRI systems, the 0.55 T MRI system has a lower total ownership cost, including purchase price, installation, and maintenance. Although signal-to-noise ratios scale with field strength, modern signal transmission and receiver chains improve signal yield compared with older low-field magnetic resonance scanner generations. Advanced radiofrequency coils permit short echo spacing and overall compacter echo trains than previously possible. Deep learning-based advanced image reconstruction algorithms provide substantial improvements in perceived signal-to-noise ratios, contrast, and spatial resolution. Musculoskeletal tissue contrast evolutions behave differently at 0.55 T, which requires careful consideration when designing pulse sequences. Similar to other field strengths, parallel imaging and simultaneous multislice acquisition techniques are vital for efficient musculoskeletal MRI acquisitions. Pliable receiver coils with a more cost-effective design offer a path to more affordable surface coils and improve image quality. Whereas fat suppression is inherently more challenging at lower field strengths, chemical shift selective fat suppression is reliable and homogeneous with modern low-field MRI technology. Dixon-based gradient echo pulse sequences provide efficient and reliable multicontrast options, including postcontrast MRI. Metal artifact reduction MRI benefits substantially from the lower field strength, including slice encoding for metal artifact correction for effective metal artifact reduction of high-susceptibility metallic implants. Wide-bore scanner designs offer exciting opportunities for interventional MRI. This review provides an overview of the economical aspects, signal and image quality considerations, technological components and coils, musculoskeletal tissue relaxation times, and image contrast of modern low-field MRI and discusses the mainstream and new applications, challenges, and opportunities of musculoskeletal MRI.

Postoperative MR imaging of joints is now commonly requested, yet artifacts caused by metallic orthopedic implants remain a significant challenge during image interpretation. Effective artifact reduction is essential to identify postsurgical complications, such as prosthesis loosening, infection, adverse local tissue reaction, and periarticular soft tissue injuries. This article reviews basic and advanced metal artifact reduction MR imaging techniques applied to various clinical protocols for successful postoperative MR imaging of small and large joints.

Flexible radiofrequency coils for magnetic resonance imaging (MRI) have garnered attention in research and industrial communities because they provide improved accessibility and performance and can accommodate a range of anatomic postures. Most recent flexible coil developments involve customized conductors or substrate materials and/or target applications at 3 T or above. In contrast, we set out to design a flexible coil based on an off-the-shelf conductor that is suitable for operation at 0.55 T (23.55 MHz). Signal-to-noise ratio (SNR) degradation can occur in such an environment because the resistance of the coil conductor can be significant with respect to the sample. We found that resonating a commercially available RG-223 coaxial cable shield with a lumped capacitor while the inner conductor remained electrically floating gave rise to a highly effective "cable coil." A 10-cm diameter cable coil was flexible enough to wrap around the knee, an application that can benefit from flexible coils, and had similar conductor loss and SNR as a standard-of-reference rigid copper coil. A two-channel cable coil array also provided good SNR robustness against geometric variability, outperforming a two-channel coaxial coil array by 26 and 16% when the elements were overlapped by 20-40% or gapped by 30-50%, respectively. A 6-channel cable coil array was constructed for 0.55 T knee imaging. Incidental cartilage and bone pathologies were clearly delineated in T1- and T2-weighted turbo spin echo images acquired in 3-4 min with the proposed coil, suggesting that clinical quality knee imaging is feasible in an acceptable examination timeframe. Correcting for T1, the SNR measured with the cable coil was approximately threefold lower than that measured with a 1.5 T state-of-the-art 18-channel coil, which is expected given the threefold difference in main magnetic field strength. This result suggests that the 0.55 T cable coil conductor loss does not deleteriously impact SNR, which might be anticipated at low field.

The purpose of this article is to present algorithms for the diagnostic management of solitary bone lesions incidentally encountered on computed tomography (CT) and magnetic resonance (MRI) in adults. Based on review of the current literature and expert opinion, the Practice Guidelines and Technical Standards Committee of the Society of Skeletal Radiology (SSR) proposes a bone reporting and data system (Bone-RADS) for incidentally encountered solitary bone lesions on CT and MRI with four possible diagnostic management recommendations (Bone-RADS1, leave alone; Bone-RADS2, perform different imaging modality; Bone-RADS3, perform follow-up imaging; Bone-RADS4, biopsy and/or oncologic referral). Two algorithms for CT based on lesion density (lucent or sclerotic/mixed) and two for MRI allow the user to arrive at a specific Bone-RADS management recommendation. Representative cases are provided to illustrate the usability of the algorithms.

OBJECTIVES/OBJECTIVE:Despite significant progress, artifact-free visualization of the bone and soft tissues around hip arthroplasty implants remains an unmet clinical need. New-generation low-field magnetic resonance imaging (MRI) systems now include slice encoding for metal artifact correction (SEMAC), which may result in smaller metallic artifacts and better image quality than standard-of-care 1.5 T MRI. This study aims to assess the feasibility of SEMAC on a new-generation 0.55 T system, optimize the pulse protocol parameters, and compare the results with those of a standard-of-care 1.5 T MRI. MATERIALS AND METHODS/METHODS:Titanium (Ti) and cobalt-chromium total hip arthroplasty implants embedded in a tissue-mimicking American Society for Testing and Materials gel phantom were evaluated using turbo spin echo, view angle tilting (VAT), and combined VAT and SEMAC (VAT + SEMAC) pulse sequences. To refine an MRI protocol at 0.55 T, the type of metal artifact reduction techniques and the effect of various pulse sequence parameters on metal artifacts were assessed through qualitative ranking of the images by 3 expert readers while taking measured spatial resolution, signal-to-noise ratios, and acquisition times into consideration. Signal-to-noise ratio efficiency and artifact size of the optimized 0.55 T protocols were compared with the 1.5 T standard and compressed-sensing SEMAC sequences. RESULTS:Overall, the VAT + SEMAC sequence with at least 6 SEMAC encoding steps for Ti and 9 for cobalt-chromium implants was ranked higher than other sequences for metal reduction (P < 0.05). Additional SEMAC encoding partitions did not result in further metal artifact reductions. Permitting minimal residual artifacts, low magnetic susceptibility Ti constructs may be sufficiently imaged with optimized turbo spin echo sequences obviating the need for SEMAC. In cross-platform comparison, 0.55 T acquisitions using the optimized protocols are associated with 45% to 64% smaller artifacts than 1.5 T VAT + SEMAC and VAT + compressed-sensing/SEMAC protocols at the expense of a 17% to 28% reduction in signal-to-noise ratio efficiency. B1-related artifacts are invariably smaller at 0.55 T than 1.5 T; however, artifacts related to B0 distortion, although frequently smaller, may appear as signal pileups at 0.55 T. CONCLUSIONS:Our results suggest that new-generation low-field SEMAC MRI reduces metal artifacts around hip arthroplasty implants to better advantage than current 1.5 T MRI standard of care. While the appearance of B0-related artifacts changes, reduction in B1-related artifacts plays a major role in the overall benefit of 0.55 T.

Total hip arthroplasty and hip preservation surgeries have substantially increased over the past few decades. Musculoskeletal imaging and interventions are cornerstones of comprehensive postoperative care and surveillance in patients undergoing established and more recently introduced hip surgeries. Hence the radiologist's role continues to evolve and expand. A strong understanding of hip joint anatomy and biomechanics, surgical procedures, expected normal postoperative imaging appearances, and postoperative complications ensures accurate imaging interpretation, intervention, and optimal patient care. This article presents surgical principles and procedural details pertinent to postoperative imaging evaluation strategies after common hip surgeries, such as radiography, ultrasonography, computed tomography, and magnetic resonance imaging. We review and illustrate the expected postoperative imaging appearances and complications following chondrolabral repair, acetabuloplasty, osteochondroplasty, periacetabular osteotomy, realigning and derotational femoral osteotomies, and hip arthroplasty.

The posteromedial and posterolateral corners of the knee are important areas to consider when assessing the patient with a possible knee injury. An understanding of the anatomy, associated biomechanics, and typical injury patterns in these regions will improve the value that the radiologist interpreting the MRIs brings to this patient population.