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Fully Automated 10-Minute 3D CAIPIRINHA SPACE TSE MRI of the Knee in Adults: A Multicenter, Multireader, Multifield-Strength Validation Study

Del Grande, Filippo, MD*,†; Delcogliano, Marco, MD; Guglielmi, Riccardo, MD*; Raithel, Esther, PhD§; Stern, Steven E., PhD; Papp, Derek F., MD¶,#; Candrian, Christian, MD; Fritz, Jan, MD, PD, DABR

doi: 10.1097/RLI.0000000000000493
Original Articles

Objectives The aim of this study was to test the hypothesis that magnetic resonance imaging (MRI) of the knee with 10-minute 3-dimensional (3D) controlled aliasing in parallel imaging results in higher acceleration (CAIPIRINHA) sampling perfection with application optimized contrast using different flip angle evolutions (SPACE) turbo spin echo (TSE) protocols can replace 20-minute 2-dimensional (2D) TSE standard-of-reference protocols for the diagnosis of internal derangement.

Materials and Methods After internal review board approval and prospective informed consent, 100 symptomatic subjects underwent MRI of the knee at 3 T and 50 symptomatic subjects at 1.5 T, consisting of 10-minute 3D CAIPIRINHA SPACE TSE and 20-minute standard-of-reference 2D TSE protocols. Two fellowship-trained musculoskeletal radiologists assessed the studies in an anonymized and randomized fashion for structural abnormalities. Descriptive statistics, interreader reliability, intermethod concordance, diagnostic definitiveness, and interchangeability tests were applied. P values equal to or smaller than 0.01 were considered significant.

Results The interchangeability analysis showed that the 3D MRI can replace the 2D MRI protocols, whereas a superiority of 3D MRI was suggested statistically for the detection of medial and lateral meniscal tears, cartilage defects, and bone marrow edema by significantly higher common pair exact match proportions of readers (P < 0.01, respectively).The overall interreader reliabilities were 89% of exact matches for 2D TSE (κ, 0.842) and 96% of exact matches for 3D TSE (κ, 0.941) (P < 0.01). There was good intermethod concordance (κ, 0.736; range, 0.579–1.000). The interreader reliability (2D TSE: κ, 0.748 [0.603–1.000]; 3D TSE: κ, 0.901 [0.797–1.000]) and diagnostic definitiveness were significantly higher for the 3D than 2D MRI (P < 0.01).

Conclusions 10-minute 3D CAIPIRINHA SPACE TSE MRI protocols can replace 20-minute 2D TSE standard-of-reference MRI protocols for the evaluation of internal derangement of the knee by producing similar results in individual patient diagnoses, whereas interpretations of 3D CAIPIRINHA SPACE TSE MRI examinations resulted in an overall higher interreader reliability, intermethod concordance, and reader definitiveness.

From the *Department of Radiology, Ospedale Regionale di Lugano, Lugano, Ticino, Switzerland;

Russell H. Morgan Department of Radiology and Radiological Science, Johns Hopkins University School of Medicine, Baltimore, MD;

Department of Orthopedic Surgery, Ospedale Regionale di Lugano, Lugano, Ticino, Switzerland;

§Siemens Healthcare GmbH, Erlangen, Germany;

Bond Business School, Bond University, Gold Coast, Australia;

Department of Orthopedic Surgery, Johns Hopkins University School of Medicine, Baltimore, MD; and

#Miami Orthopedics and Sports Medicine Institute, Coral Gables, FL.

Received for publication March 10, 2018; and accepted for publication, after revision, May 6, 2018.

F.D.G. received institutional research support from Siemens AG and received speaker's honorarium from Siemens AG and Bayer AG. E.R. is an employee of Siemens Healthcare GmbH. J.F. received institutional research support from Siemens AG, DePuy, Zimmer, Microsoft, and BTG International; is an unpaid scientific advisor of Siemens AG and BTG International; received speaker's honorarium from Siemens AG; and has shared patents with Siemens AG and Johns Hopkins University. The other authors have no conflicts of interest to declare.

Conflicts of interest and sources of funding: Support by an institutional research grant by Siemens AG.

Correspondence to: Jan Fritz, MD, PD, DABR, Russell H. Morgan Department of Radiology and Radiological Science, Johns Hopkins University School of Medicine, 601 N Caroline St, JHOC 3140A, Baltimore, MD 21287. E-mail: jfritz9@jhmi.edu.

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