Zero Echo Time vs. T1‐Weighted MRI for Assessment of Cortical and Medullary Bone Morphology Abnormalities Using CT as the Reference Standard

Background Conventional MR pulse sequences result in poor signal from low T2 cortical bone because the minimum achievable echo time is limited. A sequence resulting in improved bone contrast is desirable. Purpose To evaluate the image quality and diagnostic performance of grayscale inversion zero echo time imaging (GI‐ZTE) and grayscale inversion T1‐weighted imaging (GI‐T1WI) compared with computed tomography (CT). Study Type Prospective. Subjects A total of 50 patients with musculoskeletal tumors or tumor‐like diseases of the lower extremities having MRI and CT studies. Field Strength/Sequence GI‐T1WI and GI‐ZTE sequences at 1.5 T. Assessment Assessed cortical and medullary bone morphology abnormalities using CT as the reference standard. Three radiologists scored the images quality and recorded nine metrics to assess the diagnostic performance. Statistical Tests Differences in image quality were calculated using the Wilcoxon signed‐rank test. The intraclass correlation coefficient (ICC) was used to analyze the agreement of quantitative lesion parameters between CT and MR sequences, as well as the interobserver reliability. A P value <0.05 was considered statistically significant. Results Image quality score was significantly higher for CT images than GI‐TIWI images. Except for radiologist 3 [4(0) vs 4 (1)], there was no significant difference in scores between CT and GI‐ZTE [radiologist 1: 4 (0) vs 4 (0), P = 0.133; radiologist 2: 4 (0) vs 4 (0), P = 0.085]. There was good–excellent agreement between both MR sequences and CT for size, lesion number, location, sclerotic rim, expanded shell, destruction pattern, and matrix mineralization for all radiologists (ICC: 0.636–1.000). The consistency of periosteal reaction and penetration of the cortex was fair to good (0.481–0.729) between GI‐T1WI and CT and good to excellent between GI‐ZTE and CT (0.682–0.852). Data Conclusions GI‐ZTE images had superior intermodality agreement with CT images and allowed visualization of more cortical bone detail than GI‐T1WI images. Evidence Level 1. Technical Efficacy Stage 2.