Ingenia 3.0T (Release 5) with the integrated Posterior coil. The MRI examination includes pre- and post-contrast T1W mDIXON TSE. Homogeneous fat suppression is seen, also of the subcutaneous fat. Both post-contrast images, with or without fat suppression, are obtained from the same acquisition. Sagittal T1W mDIXON TSE with TR 596 ms, TE 8.3 ms, NSA 1, 4 /1.3 mm slice thickness, acquired voxel size 0.80 x 1.01 mm, reconstructed voxel size 0.63 x 0.63 mm.
Thanks to the water images the edematous changes into vertebral bodies related to recent fractures and inter spinous edema related to new biomechanical constraints are also seen. No focal lesion is seen on T1W pre-contrast in-phase or post-contrast water images. The addition of post-contrast in-phase images allows to visualize homogenization of the bone marrow, suggestive of no malignancy. Diagnosis is recent osteoporotic vertebral fractures are seen at L2 and L4 levels.
Clinical impact of mDIXON TSE:
mDIXON TSE sequences provide images with and without fat suppression simultaneously and without time penalty. In addition to in phase, out of phase, and T2W imaging, pre and post-contrast T1W mDIXON sequences are particularly useful for exploring vertebral fractures. The limited number of mDIXON acquisitions helps answering both questions in the characterization (benign vs malignant) and the visualization of associated lesions. Thus, it is possible to view other lesions and the fracture line on T1W pre-contrast in phase, to assess the homogenization of the bone marrow (T1W post contrast in-phase) and confirm the absence of suspicious contrast uptake (T1W post-contrast water). These mDIXON TSE sequences appear reliable thanks to the homogeneity of the fat suppression even obtained with extended fields of view at 3.0T. They reduce the total scan duration which has limits and is a source of motion artifacts especially in elderly or painful patients. Lesion visualization is improved in the peripheral areas of the field of view. Finally, the decomposition of one acquisition in different contrasts enables reliable matches without displacement, sometimes encountered when two successive acquisitions are performed.