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Comparison of Three-Dimensional Fast Spin Echo with Driven Equilibrium Pulse Sequence with Conventional Two-Dimensional Fast Spin Echno in Evaluation of Intramedullary Lesions of the Cervical Spine 2003

Mehfoud, David P., Vossough, Arastoo, and Melhem, Elias R.
Department of Radiology, Hospital of the University of Pennsylvania
Philadelphia, PA

Purpose:
Three-dimensional fast spin echo with driven equilibrium (3D-FSE-DE) pulse sequence has been recently introduced as a possible means for evaluating the cervical spine. High spatial resolution, hyperintense CSF (myelographic effect), and spin echo based contrast at relatively short acquisiton time are all desirable features of 3D-FSE-DE, possibly enabling it to provide a comprehensive evaluation of the cervical spine and to replace more conventional sequences (T2-weighted 2D FSE and 3D T2*-weighted GRE). We tested the ability of 3D-FSE-DE to demonstrate T2-hyperintense cord lesions by comparing it to the current imaging "gold standard", T2-weighted (long TR) 2D FSE.

Materials & Methods:
Seventy consecutive patients referred for cervical spine MR imaging at our institution were evaluated. Axial 2D-FSE (TR/TE=6870/129) and 3D-FSE-DE (TR/TE=500/124) imaging of the entire cervical spine was performed. The two sequences were matched for coverage, field of view (200mm), and slice thickness (3mm). The images were independently evaluated for the presence of T2-hyperintense lesions in the cervical cord by two readers. A confidence level of high or low was assigned to each lesion found. The 2D-FSE sequence was hypothesized to be the gold standard and tests characteristics were accordingly calculated.

Results: A total of 63 intramedullary lesions of the cervical spine were detected in 27 patients. The agreement rate of the two readers on the 3D-FSE-DE sequence was 100% and 87% for high and low confidence lesions, respectively. On the 2D-FSE sequence, reader agreement was 98.5% and 71% for high and low confidence lesions, respectively. When compared to 2D-FSE, the 3D-FSE-DE pulse sequence demonstrated an overall sensitivity of 35% and a specificity of 95% in the detection of intramedullary cervical cord lesions. Calculated sensitivity and specificity were almost identical for the two readers.

Conclusion: The 3D-FSE-DE pulse sequence has a low sensitivity for detection of T2-hyperintense intramedullary lesions of the cervical spine and thus should not be used in lieu of the 2D-FSE sequence for the evaluation of these lesions.