PURPOSEFat suppression magnetic resonance imaging (MRI) technique has been used to improve the diagnostic confidence in lumbar spine diseases. We aimed to compare T2-weighted water-fat separation technique (T2 Dixon) with spectral attenuated inversion recovery (SPAIR) image for fat suppression.
METHODSLumbar spine MRI examinations were performed in 79 patients by using a 3.0 T machine. We compared T2 Dixon water-only image and SPAIR image for the evaluation of fat suppression quality and lesion conspicuity. For qualitative evaluation, two radiologists scored the images from Dixon and SPAIR for fat suppression uniformity and lesion conspicuity. Quantitative assessment was also performed for 39 lesions in 26 patients who had lesions in their spine bodies. Contrast ratio (CR) and contrast-to-noise ratio (CNR) were calculated by signal intensity measurement of the lesions, adjacent bodies, and background noise. The Wilcoxon's signed-rank test and paired sample t-test were used to assess the statistical significance of qualitative and quantitative data, respectively.
RESULTSFor qualitative assessment, T2 Dixon water-only image showed higher mean scores for fat suppression quality and lesion conspicuity than SPAIR (2.99±0.11 vs. 2.18±0.38 and 2.84±0.37 vs. 2.28±0.51, respectively). For quantitative measurement, the CR and CNR values of the lesions were higher on T2 Dixon than on SPAIR. Both qualitative and quantitative results showed statistically significant differences between T2 Dixon and SPAIR (P < 0.01 in all). (1-3). However, the train of 180° rephasing pulses in FSE and short T1 relaxation time of fat affect J-coupling modulation, which produces bright signal of the fat on T2-weighted image (4). Increased signal of the fat on T2-weighted image can obscure underlying pathology with elongated T2 signal such as edema, bone marrow infiltration, and metastasis (5). Thus, additional T2-weighted image with fat suppression is necessary to improve visualization of abnormalities in an anatomical region with abundant fat component such as the lumbar spine.
CONCLUSIONSeveral fat suppression techniques have been developed and widely used: chemical shift-selective saturation (CHESS), short-tau inversion recovery (STIR) and spectral attenuated inversion recovery (SPAIR) (6-8). The CHESS and STIR have advantages and disadvantages. Although CHESS has advantages of selectivity for fat and high signal-to-noise ratio (SNR), it is vulnerable to magnetic field inhomogeneity. STIR is insensitive to magnetic field inhomogeneity; however, it is not specific for fat. SPAIR is a hybrid technique combining the fat selectivity of CHESS and the inversion radiofrequency pulse of STIR. Thus, it has advantages of high fat selectivity and low vulnerability to the magnetic field inhomogeneity (7, 9).