Balanced Turbo Field Echo MRI as a radiation-free adjunct for spinal bone imaging: A prospective study of 526...

Single-centre, prospective, within-subject observational imaging-quality study with a single experienced reader.

To evaluate whether adding a 3D Balanced Turbo Field Echo (BTFE) sequence to routine 3T spine MRI improves visualization of osseous spinal pathology compared with conventional T1/T2-weighted MRI and plain radiographs.

Between March and November 2024, 526 consecutive adults underwent spine imaging including T1/T2-weighted and BTFE MRI on a 3T scanner plus plain radiographs; thin-section CT served as confirmatory reference in a small ligamentum flavum ossification (LFO) subgroup. Six osseous pathologies were scored: disc osteophyte complex, OPLL, LFO, spondylolisthesis, spondylolysis and vertebral fracture. A single senior consultant radiologist ( $>$ 10 years' experience), blinded to other modalities and clinical details, graded visualization on a 3-point ordinal scale in separate, randomized, washed-out sessions. Modalities were compared per pathology with Friedman's test and Holm-corrected Wilcoxon post-hoc tests.

Mean age was $60.2\pm 11.8$ years; 297 (56.5%) were female; thoraco-lumbar scans accounted for 454 (86.3%). Disc osteophyte was most common (n = 229, 43.5%). BTFE scored significantly higher than routine MRI and plain radiographs for every pathology (all $p<0.001$ ). OPLL was invisible on radiographs but well delineated on BTFE. For LFO, BTFE meaningfully outperformed routine MRI, representing a radiation-free improvement over standard MRI practice.

Adding a widely available BTFE sequence to routine 3T spine MRI improved visualization of spinal osseous pathology without ionizing radiation. BTFE should be regarded as a candidate bone-imaging adjunct; head-to-head comparison with CT and with established CT-like MRI sequences (ZTE, FRACTURE, 3D FLASH, T1-spoiled gradient-echo, synthetic CT) is needed.