Generating synthetic high-resolution spinal STIR and T1w images from T2w FSE and low-resolution axial Dixon

To generate sagittal T1-weighted fast spin echo (T1w FSE) and short tau inversion recovery (STIR) images from sagittal T2-weighted (T2w) FSE and axial T1w gradient echo Dixon technique (T1w-Dixon) sequences.

This retrospective study used three existing datasets: "Study of Health in Pomerania" (SHIP, 3142 subjects, 1.5 Tesla), "German National Cohort" (NAKO, 2000 subjects, 3 Tesla), and an internal dataset (157 patients 1.5/3 Tesla). We generated synthetic sagittal T1w FSE and STIR images from sagittal T2w FSE and low-resolution axial T1w-Dixon sequences based on two successively applied 3D Pix2Pix deep learning models. "Peak signal-to-noise ratio" (PSNR) and "structural similarity index metric" (SSIM) were used to evaluate the generated image quality on an ablations test. A Turing test, where seven radiologists rated 240 images as either natively acquired or generated, was evaluated using misclassification rate and Fleiss kappa interrater agreement.

Including axial T1w-Dixon or T1w FSE images resulted in higher image quality in generated T1w FSE (PSNR = 26.942, SSIM = 0.965) and STIR (PSNR = 28.86, SSIM = 0.948) images compared to using only single T2w images as input (PSNR = 23.076/24.677 SSIM = 0.952/0.928). Radiologists had difficulty identifying generated images (misclassification rate: 0.39 ± 0.09 for T1w FSE, 0.42 ± 0.18 for STIR) and showed low interrater agreement on suspicious images (Fleiss kappa: 0.09 for T1w/STIR).

Axial T1w-Dixon and sagittal T2w FSE images contain sufficient information to generate sagittal T1w FSE and STIR images.

T1w fast spin echo and short tau inversion recovery can be retroactively added to existing datasets, saving MRI time and enabling retrospective analysis, such as evaluating bone marrow pathologies.

Sagittal T2-weighted images alone were insufficient for differentiating fat and water and to generate T1-weighted images. Axial T1w Dixon technique, together with a T2-weighted sequence, produced realistic sagittal T1-weighted images. Our approach can be used to retrospectively generate STIR and T1-weighted fast spin echo sequences.