Current Landscape of Short-T2 Imaging Techniques in the Musculoskeletal System: The Past, Present and Future

Conventional MRI is limited in imaging tissues with short T2 relaxation times, such as bone, ligaments, and cartilage, due to their rapid signal decay. This limitation has spurred the development of specialized MRI techniques designed specifically for short-T2 tissue imaging. Traditional pulse sequences, including three-dimensional gradient echo (3D-GRE), susceptibility-weighted imaging (SWI), and Fast Field Echo Resembling a CT using Restricted Echo-Spacing (FRACTURE), initially addressed some of these challenges but often lacked sufficient resolution or contrast differentiation. Recent advancements, such as ultrashort echo time (UTE), zero echo time (ZTE), 3D-Bone, and synthetic computed tomography (sCT), have significantly enhanced the diagnostic capabilities of MRI by providing high-quality, CT-like visualization without exposure to ionizing radiation. These innovations have substantially improved MRI's ability to depict bone morphology, assess joint pathology, identify subtle fractures, and characterize bone tumors with higher accuracy. Beyond musculoskeletal applications, these techniques have demonstrated emerging clinical utility in additional domains, including pulmonary and dental imaging. This review article evaluates conventional pulse sequences alongside emerging MRI innovations, highlighting their clinical applications, current limitations, and technical considerations. Continued optimization of these techniques promises broader clinical adoption, potentially reducing dependence on invasive and radiation-intensive imaging modalities. Evidence Level: N/A Technical Efficacy: Stage 3.