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Feasibility study of the FRACTURE sequence in evaluating pediatric skull base bone lesions
Guangheng Yin1, Chunlei Du1, Yanqiu Lv1
1Department of Radiology, Beijing Children's Hospital, Capital Medical University, National Center for Children's Health, No. 56, Nanlishi Road, Xicheng District, Beijing, 100045, China.
Insights
The 3D FRACTURE MRI sequence offers a radiation-free alternative for pediatric skull base lesions, providing CT-comparable bone detail and superior soft-tissue visualization. This imaging technique is a feasible option for diagnosis and surgical planning.
Area of Science:
- Medical Imaging
- Pediatric Radiology
- Neuroimaging
Background:
- Computed tomography (CT) is commonly used for evaluating pediatric skull base lesions.
- CT involves ionizing radiation, posing risks, especially in children.
- There is a need for radiation-free imaging alternatives with comparable diagnostic capabilities.
Purpose of the Study:
- To assess the feasibility of a 3D fast field echo resembling a CT using a restricted echo-spacing (FRACTURE) sequence.
- To evaluate FRACTURE as a radiation-free alternative to CT for pediatric skull base lesions.
- To compare image quality, diagnostic accuracy, and treatment planning consistency between FRACTURE and CT.
Main Methods:
- Prospective study of 40 pediatric patients with suspected skull base lesions.
- Patients underwent both 256-slice CT and 3.0T MRI, including a 3D FRACTURE sequence.
- Image quality, bone edge sharpness (ERS), diagnostic accuracy, and treatment planning consistency were assessed and compared.
Main Results:
- FRACTURE demonstrated CT-comparable bone visualization (4.83 vs. 5.00) and significantly superior soft-tissue visualization (5.00 vs. 1.85).
- FRACTURE achieved superior bone edge sharpness (ERS: 474.20) compared to CT (413.45) and conventional MRI (226.50).
- High inter-rater agreement for diagnosis (ICC=1.0) and treatment planning consistency (Kappa=0.892) were observed.
Conclusions:
- The FRACTURE sequence provides excellent CT-like bony delineation with enhanced soft-tissue visualization and sharper bone edges.
- FRACTURE eliminates ionizing radiation exposure, making it a safer alternative for pediatric patients.
- FRACTURE is a feasible and reliable MRI sequence for diagnosing pediatric skull base lesions and aiding in preoperative treatment planning.
Objectives:
This study investigated the feasibility of a fast field echo resembling a CT using a restricted echo-spacing (FRACTURE) sequence as a radiation-free alternative to CT for evaluating pediatric skull base lesions.
Materials And Methods:
In this prospective study (October 2023-December 2024), 40 pediatric patients (mean age, 7.7 ± 4.0 years) with suspected skull base lesions underwent both 256-slice CT and 3.0 T MRI, including a 3D FRACTURE sequence. Two pediatric radiologists independently assessed image quality for bone and soft-tissue visualization. Bone edge sharpness was objectively quantified using the edge rise slope (ERS). Diagnostic accuracy and treatment-planning consistency were evaluated by two radiologists and two surgeons by comparing "FRACTURE combined with conventional MRI" with CT.
Results:
CT showed slightly higher scores for bone visualization than FRACTURE (5.00 ± 0.00 vs. 4.83 ± 0.47; p = 0.001), while both were diagnostically sufficient. FRACTURE provided significantly superior soft-tissue visualization compared with CT (5.00 ± 0.00 vs. 1.85 ± 0.36; p < 0.001). FRACTURE achieved the highest edge sharpness (ERS: 474.20 ± 69.76), exceeding CT (413.45 ± 188.73) and conventional 3D T1-weighted imaging (226.50 ± 47.04) (p < 0.05). Inter-rater agreement was perfect for diagnosis (ICC = 1.0), and treatment-planning consistency was high (Kappa = 0.892) between FRACTURE-based and CT-based protocols.
Conclusion:
The FRACTURE sequence provides CT-like bony delineation with superior soft-tissue visualization and sharper bony edges, while completely eliminating ionizing radiation exposure. FRACTURE represents a feasible and reliable alternative to CT for the diagnosis and preoperative treatment planning of pediatric skull base lesions.
Key Points:
Question Can the 3D FRACTURE MRI sequence replace CT for the evaluation and preoperative planning of pediatric skull base lesions while avoiding ionizing radiation? Findings FRACTURE provides CT‑comparable bone depiction and superior soft‑tissue visualization for evaluating pediatric skull base lesions. Clinical relevance The FRACTURE-based MRI protocol enables comprehensive evaluation of both bony and soft tissue structures and may serve as a radiation-free alternative to CT for preoperative assessment and surgical planning of pediatric skull base lesions.
