Comparing CT-Like Bone Images Based on Fast Field Echo Resembling a CT Using Restricted Echo Spacing (FRACTURE) MR...

Congenital vertebral anomalies are commonly associated with underlying spinal cord anomaly that necessitates imaging both the spinal cord and the bony vertebral column to understand the extent of the deformity better. While MRI is the standard for spinal cord imaging, it does not provide CT-like bone details. Many MR bone imaging techniques have been tested in various adult spine conditions in the past decade but not much has been described on their reliability in pediatric spine. We elaborate on our experience with fast field echo resembling a CT by using restricted echo spacing (FRACTURE) MR bone imaging in congenital vertebral anomalies in children.

Eleven pediatric patients referred to the imaging department for CT and MR study of congenital vertebral anomaly were prospectively included. After receiving informed consent from these patients' guardians, both studies were performed in a single setting and under a single sedation. FRACTURE MR was accelerated by using the compressed sensitivity encoding (CS) technique to reduce the imaging time. We then compared FRACTURE MR and CT images for image quality and studied parameters such as formation or segmentation anomalies, anomalous shape of vertebrae, and alignment deformities.

FRACTURE MR showed acceptable image quality with diagnostically limiting artifacts in only 1 patient. The interreader agreement was perfect in the assessment of vertebral body segmentation or formation anomaly and alignment abnormalities, and it was substantial for posterior element anomalies. The bone signal was lower in children under the age of 3 years due to a more immature and cartilaginous skeleton.

FRACTURE MR provides images of acceptable quality in pediatric spinal anomalies. The addition of this novel sequence can be complementary to conventional MR in providing osseous details and CT can be reserved for certain specific indications like postoperative cases. This can help in reducing the radiation dose to this group of pediatric patients who will be serially followed up with imaging during their management.