Initial clinical experience of synthetic MRI as a routine neuroimaging protocol in daily practice: A single-center study

We investigated the clinical feasibility of synthetic MRI with a 4-min single scan using a 48-channel head coil as a routine neuroimaging protocol in daily practice by assessing its diagnostic image quality. We retrospectively reviewed the imaging data of 89 patients who underwent routine brain MRI using synthetic MRI acquisition between February 2017 and April 2017. Image quality assessments were performed by two independent readers on synthetic T1 fluid-attenuated inversion recovery (FLAIR), T2-weighted, T2 FLAIR, and phase-sensitive inversion recovery sequences acquired using multiple-dynamic multiple-echo imaging. Interobserver reliability between the two readers was assessed using kappa (κ) statistics. On a 4-point assessment scale, the overall image quality and anatomical delineation provided by synthetic brain MRI were found to be good with scores of more than 3 points for all sequences except for the T2 FLAIR sequence. The synthetic T2 FLAIR sequence provided sufficient image quality but showed more pronounced artifacts, especially the CSF pulsation artifact and linear hyperintensity along the brain surface. Interobserver agreement for evaluating image quality of all synthetic sequences was good to excellent (κ, 0.61–0.99; P < 0.001). Synthetic MRI can be acceptable as a routine clinical neuroimaging protocol with a short scan time. It can be helpful to design customized and flexible neuroimaging protocols for each institution.