Comparison of echo planar imaging, gradient echo and fast spin echo MR scans of knee menisci

In order to reduce the acquisition time, we compared a three-dimensional multi-shot echo-planar imaging (EPI) sequence with fat-suppression with two widely used sequences, the fat-suppressed gradient echo (GRE) and the proton-density weighted turbo spin-echo (FSE) in imaging the menisci of the knee. Sixty patients with various indications were studied prospectively with MRI. The menisci were imaged in the sagittal plane with all three sequences using a 1T MR scanner with 15mT/m gradients. The signal-to-noise ratio (SNR) of bone (b), cartilage (c), and meniscus (m) as well as contrast-to-noise ratio (CNR) and relative contrast (ReCon) between menisci and cartilage and between bone and cartilage were measured. A qualitative analysis was performed on grading of meniscal pathology (0-IV). The imaging accuracy of meniscal pathology was assessed compared to arthroscopy in 13 patients. The EPI provided the highest SNR in cartilage and meniscus (p<0.001), the highest CNR and the highest ReCon between bone and cartilage (p< or =0.001). MR grading of meniscal abnormalities showed overestimation compared to GRE and FSE. The EPI sequence could not be included in the routine protocol in imaging the menisci since the overestimation of meniscal abnormalities could lead to unnecessary arthroscopy.