Optimal Fat Suppression in Head and Neck MRI: Comparison of Multipoint Dixon with 2 Different Fat-Suppression Techniques, Spectral Presaturation and Inversion Recovery, and STIR

S. Gaddikeri; M. Mossa-Basha; J.B. Andre; D.S. Hippe; Y. Anzai

doi:10.3174/ajnr.A5483

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Fig 1.
Lateral (A) and frontal (B) projections of CT topogram images with measurements of anteroposterior diameter at the level of C2–3 and C4–5 and transverse diameters at the shoulder.
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Fig 2.
Gadolinium-enhanced T1-weighted MR images with SPIR (A) and mDixon (B) techniques for fat suppression. ROIs are placed on the spinal cord and fat to obtain a signal intensity ratio.
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Fig 3.
Axial STIR (A and B) and mDixon T2-weighted (C and D) MR images. Note incomplete fat suppression (asterisks) in the maxillary and supraclavicular regions on the STIR technique and complete uniform fat suppression (arrowheads) in the submandibular and supraclavicular regions on the mDixon technique.
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Fig 4.
Gadolinium-enhanced axial T1-weighted MR images with SPIR (A and B) and mDixon (C and D) techniques for fat suppression. Note incomplete fat suppression (asterisks) in the submandibular and supraclavicular regions on the SPIR technique and complete uniform fat suppression (arrowheads) in similar regions on the mDixon technique.
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Fig 5.
Gadolinium-enhanced coronal T1-weighted MR images with SPIR (A) and mDixon (B) techniques for fat suppression. Note incomplete fat suppression (dark asterisk) in the supraclavicular regions on the SPIR technique and complete uniform fat suppression (white asterisk) in similar regions on the mDixon technique.

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Table 1:

Parameters used for different fat-suppression sequences on a 3T scanner^{^a}

	Axial STIR	Axial T2WI	Axial Gad-T1WI	Axial Gad-T1WI
	TSE	mDixon TSE	SPIR TSE	mDixon TSE
Coil	16 Channel	16 Channel	16 Channel	16 Channel
Coil	SENSE NV	SENSE NV	SENSE NV	SENSE NV
TR/TE	3000/15 ms	3000/80 ms	600/9.2 ms	500/10 ms
Section thickness/intersection gap	3/1 mm	3/1 mm	3/1 mm	3/1 mm
No. of axial images	40	40	40	40
FS technique	Inversion recovery (TI = 200 ms)	mDixon	SPIR	mDixon
Acquisition matrix	200 × 141	232 × 232	288 × 196	204 × 199
NEX	2	1	1	1
Acquisition time	4 min, 56 sec	2 min, 2 sec	3 min, 2 sec	2 min, 8 sec
Parallel imaging	Yes	Yes	Yes	Yes
Gadolinium contrast	N/A	N/A	0.1 mmol/kg gadodiamide (Gd-DTPA) (ProHance)	0.1 mmol/kg gadodiamide (Gd-DTPA) (ProHance)

Note:—SENSE indicates sensitivity encoding; N/A, not applicable; NV, NeuroVascular.
↵a Achieva; Philips Healthcare.

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Table 2:

Demographics and body habitus^{^a}

Variable	Sequence Group		P Value^{^b}
Variable	Group B (n = 31)	Group A (n = 33)	P Value^{^b}
Sex
Male	20 (64.5)	23 (69.7)	.79
Female	11 (35.5)	10 (30.3)
Age (yr)	61 ± 15	55 ± 17	.15
Body habitus
AP neck diameter at the level of mandible (C2–3) (mm)	185 ± 21	188 ± 21	.28
AP diameter of midneck (C4–5) (mm)	127 ± 22	124 ± 19	.90
Shoulder width (mm)	394 ± 35	394 ± 45	.84
AP neck diameter at the level of mandible-to-shoulder width ratio	1.48 ± 0.15	1.53 ± 0.16	.35
Shoulder width-to midneck AP diameter ratio	3.16 ± 0.40	3.21 ± 0.36	.88

↵a Values are No. (%) or mean ± SD unless otherwise specified.
↵b Mann-Whitney U test.

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Table 3:

Objective signal intensity ratios^{^a}

Variable	Sequence Group		P Value^{^b}
Variable	Group B (n = 31)	Group A (n = 33)	P Value^{^b}
T2WI spinal cord–to-fat ratio
Submandibular level	5.7 ± 1.6	3.5 ± 3.4	<.001
Supraclavicular level	7.4 ± 2.4	3.3 ± 3.4	<.001
Post-Gad-T1WI spinal cord–to-fat ratio
Submandibular level	3.7 ± 1.4	0.9 ± 0.7	<.001
Supraclavicular level	4.3 ± 2.0	0.5 ± 0.3	<.001

↵a Values are mean ± SD unless otherwise specified.
↵b Mann-Whitney U test.

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Table 4:

Subjective assessment of image quality, fat suppression, and susceptibility artifacts^{^a}

Variable	Sequence Group		P Value^{^b}
Variable	Group B (n = 31)	Group A (n = 33)	P Value^{^b}
T2WI/STIR images
Overall image-quality grade	3.9 ± 0.5	3.6 ± 0.7	.022
Fat-saturation grade
Maxillary region	4.6 ± 0.4	4.3 ± 0.5	.013
Mandibular region	4.4 ± 0.5	4.0 ± 0.6	.007
Lower neck region	4.7 ± 0.4	4.3 ± 0.4	.001
Dental amalgam susceptibility artifacts (%)	38.7%	22.7%	.056
Post-Gad-T1WIs
Overall image-quality grade	4.0 ± 0.4	2.6 ± 0.6	<.001
Fat-saturation grade
Maxillary region	4.8 ± 0.3	3.8 ± 0.7	<.001
Mandibular region	4.7 ± 0.3	2.8 ± 0.5	<.001
Lower neck region	4.8 ± 0.3	1.4 ± 0.7	<.001
Dental amalgam susceptibility artifacts (%)	37.1%	31.8%	.50

↵a Two readers averaged. Values are mean ± SD unless otherwise specified.
↵b Mann-Whitney U test comparing average ratings or permutation test (clustered by patient) for susceptibility artifacts.