Clinical Application of Ultrahigh-Field-Strength Wrist MRI: A Multireader 3-T and 7-T Comparison Study

Rafael Heiss; Marc André Weber; Eva Balbach; Rainer Schmitt; Christoph Rehnitz; Azien Laqmani; Andreas Sternberg; Jutta J. Ellermann; Armin M. Nagel; Mark E. Ladd; Matthias Englbrecht; Andreas Arkudas; Raymund Horch; Ali Guermazi; Michael Uder; Frank W. Roemer

doi:10.1148/radiol.220753

Clinical Application of Ultrahigh-Field-Strength Wrist MRI: A Multireader 3-T and 7-T Comparison Study

Rafael Heiss, Marc André Weber, Eva Balbach, Rainer Schmitt, Christoph Rehnitz, Azien Laqmani, Andreas Sternberg, Jutta J. Ellermann, Armin M. Nagel, Mark E. Ladd, Matthias Englbrecht, Andreas Arkudas, Raymund Horch, Ali Guermazi, Michael Uder, Frank W. Roemer

Radiology

Research output: Contribution to journal › Article › peer-review

9 Scopus citations

Abstract

Background: Ultrahigh-field-strength MRI at 7 T may permit superior visualization of noninflammatory wrist pathologic conditions, particularly due to its high signal-to-noise ratio compared with the clinical standard of 3 T, but direct comparison studies are lacking. Purpose: To compare the subjective image quality of 3-T and 7-T ultrahigh-field-strength wrist MRI through semiquantitative scoring of multiple joint tissues in a multireader study. Materials and Methods: In this prospective study, healthy controls and participants with chronic wrist pain underwent 3-T and 7-T MRI (coronal T1-weighted turbo spin-echo [TSE], coronal fat-suppressed proton-density [PD]–weighted TSE, transversal T2-weighted TSE) on the same day, from July 2018 to June 2019. Images were scored by seven musculoskeletal radiologists. The overall image quality, presence of artifacts, homogeneity of fat suppression, and visualization of cartilage, the triangular fibrocartilage complex (TFCC), and scapholunate and lunotriquetral ligaments were semiquantitatively assessed. Pairwise differences between 3 T and 7 T were assessed using the Wilcoxon signed-rank test. Interreader reliability was determined using the Fleiss kappa. Results: In total, 25 healthy controls (mean age, 25 years ± 4 [SD]; 13 women) and 25 participants with chronic wrist pain (mean age, 39 years ± 16; 14 men) were included. Overall image quality (P = .002) and less presence of artifacts at PD-weighted fat-suppressed MRI were superior at 7 T. T1- and T2-weighted MRI were superior at 3 T (both P < .001), as was fat suppression (P < .001). Visualization of cartilage was superior at 7 T (P < .001), while visualization of the TFCC (P < .001) and scapholunate (P = .048) and lunotriquetral (P = .04) ligaments was superior at 3 T. Interreader reliability showed slight to substantial agreement for the detected pathologic conditions (κ = 0.20–0.64). Conclusion: A 7-T MRI of the wrist had potential advantages over 3-T MRI, particularly in cartilage assessment. However, superiority was not shown for all parameters; for example, visualization of the triangular fibrocartilage complex and wrist ligaments was superior at 3 T.

Original language	English (US)
Article number	e220753
Journal	Radiology
Volume	307
Issue number	2
DOIs	https://doi.org/10.1148/radiol.220753
State	Published - Apr 2023

Bibliographical note

Funding Information:
Department of Radiology (R. Heiss, E.B., A.M.N., M.U., F.W.R.) and Department of Plastic and Hand Surgery and Laboratory for Tissue Engineering and Regenerative Medicine (A.A., R. Horch), University Hospital Erlangen, Friedrich-Alexander-Universität Erlangen-Nürnberg (FAU), Maximiliansplatz 3, 91054 Erlangen, Germany; Institute of Diagnostic and Interventional Radiology, Pediatric Radiology and Neuroradiology, University Medical Center Rostock, Rostock, Germany (M.A.W.); Department of Radiology, Ludwig Maximilian University of Munich, Munich, Germany (R.S.); Diagnostic and Interventional Radiology, University Hospital Heidelberg, Heidelberg, Germany (C.R.); Department of Diagnostic and Interventional Radiology and Nuclear Medicine, University Medical Center Hamburg-Eppendorf, Hamburg, Germany (A.L.); Medizinisches Versorgungszentrum am Rotes Kreuz Krankenhaus, Bremen, Germany (A.S.); University of Minnesota Medical School, Minneapolis, Minnesota (J.J.E.); Medical Physics in Radiology, German Cancer Research Center (DKFZ), Heidelberg, Germany (A.M.N., M.E.L.); Statscoach, Eckental, Germany (M.E.); VA Boston Healthcare System, West Roxbury, Mass (A.G.); and Boston University School of Medicine, Boston, Mass (M.U., F.W.R.). Received March 31, 2022; revision requested May 23; revision received October 13; accepted November 11. Address correspondence to R. Heiss (email: [email protected]). The work presented herein was funded in part by a research grant (2018_01: 7T MRI of the wrist) from the German Roentgen Society (Deutsche Röntgengesellschaft). * R.H. and M.A.W. contributed equally to this work. Conflicts of interest are listed at the end of this article.

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© RSNA, 2023.

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10.1148/radiol.220753

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Heiss, R., Weber, M. A., Balbach, E., Schmitt, R., Rehnitz, C., Laqmani, A., Sternberg, A., Ellermann, J. J., Nagel, A. M., Ladd, M. E., Englbrecht, M., Arkudas, A., Horch, R., Guermazi, A., Uder, M., & Roemer, F. W. (2023). Clinical Application of Ultrahigh-Field-Strength Wrist MRI: A Multireader 3-T and 7-T Comparison Study. Radiology, 307(2), Article e220753. https://doi.org/10.1148/radiol.220753

Heiss, R, Weber, MA, Balbach, E, Schmitt, R, Rehnitz, C, Laqmani, A, Sternberg, A, Ellermann, JJ, Nagel, AM, Ladd, ME, Englbrecht, M, Arkudas, A, Horch, R, Guermazi, A, Uder, M & Roemer, FW 2023, 'Clinical Application of Ultrahigh-Field-Strength Wrist MRI: A Multireader 3-T and 7-T Comparison Study', Radiology, vol. 307, no. 2, e220753. https://doi.org/10.1148/radiol.220753

@article{ab4dfc511b124aafb8c711c28cf2ff9c,

title = "Clinical Application of Ultrahigh-Field-Strength Wrist MRI: A Multireader 3-T and 7-T Comparison Study",

abstract = "Background: Ultrahigh-field-strength MRI at 7 T may permit superior visualization of noninflammatory wrist pathologic conditions, particularly due to its high signal-to-noise ratio compared with the clinical standard of 3 T, but direct comparison studies are lacking. Purpose: To compare the subjective image quality of 3-T and 7-T ultrahigh-field-strength wrist MRI through semiquantitative scoring of multiple joint tissues in a multireader study. Materials and Methods: In this prospective study, healthy controls and participants with chronic wrist pain underwent 3-T and 7-T MRI (coronal T1-weighted turbo spin-echo [TSE], coronal fat-suppressed proton-density [PD]–weighted TSE, transversal T2-weighted TSE) on the same day, from July 2018 to June 2019. Images were scored by seven musculoskeletal radiologists. The overall image quality, presence of artifacts, homogeneity of fat suppression, and visualization of cartilage, the triangular fibrocartilage complex (TFCC), and scapholunate and lunotriquetral ligaments were semiquantitatively assessed. Pairwise differences between 3 T and 7 T were assessed using the Wilcoxon signed-rank test. Interreader reliability was determined using the Fleiss kappa. Results: In total, 25 healthy controls (mean age, 25 years ± 4 [SD]; 13 women) and 25 participants with chronic wrist pain (mean age, 39 years ± 16; 14 men) were included. Overall image quality (P = .002) and less presence of artifacts at PD-weighted fat-suppressed MRI were superior at 7 T. T1- and T2-weighted MRI were superior at 3 T (both P < .001), as was fat suppression (P < .001). Visualization of cartilage was superior at 7 T (P < .001), while visualization of the TFCC (P < .001) and scapholunate (P = .048) and lunotriquetral (P = .04) ligaments was superior at 3 T. Interreader reliability showed slight to substantial agreement for the detected pathologic conditions (κ = 0.20–0.64). Conclusion: A 7-T MRI of the wrist had potential advantages over 3-T MRI, particularly in cartilage assessment. However, superiority was not shown for all parameters; for example, visualization of the triangular fibrocartilage complex and wrist ligaments was superior at 3 T.",

author = "Rafael Heiss and Weber, {Marc Andr{\'e}} and Eva Balbach and Rainer Schmitt and Christoph Rehnitz and Azien Laqmani and Andreas Sternberg and Ellermann, {Jutta J.} and Nagel, {Armin M.} and Ladd, {Mark E.} and Matthias Englbrecht and Andreas Arkudas and Raymund Horch and Ali Guermazi and Michael Uder and Roemer, {Frank W.}",

note = "Funding Information: Department of Radiology (R. Heiss, E.B., A.M.N., M.U., F.W.R.) and Department of Plastic and Hand Surgery and Laboratory for Tissue Engineering and Regenerative Medicine (A.A., R. Horch), University Hospital Erlangen, Friedrich-Alexander-Universit{\"a}t Erlangen-N{\"u}rnberg (FAU), Maximiliansplatz 3, 91054 Erlangen, Germany; Institute of Diagnostic and Interventional Radiology, Pediatric Radiology and Neuroradiology, University Medical Center Rostock, Rostock, Germany (M.A.W.); Department of Radiology, Ludwig Maximilian University of Munich, Munich, Germany (R.S.); Diagnostic and Interventional Radiology, University Hospital Heidelberg, Heidelberg, Germany (C.R.); Department of Diagnostic and Interventional Radiology and Nuclear Medicine, University Medical Center Hamburg-Eppendorf, Hamburg, Germany (A.L.); Medizinisches Versorgungszentrum am Rotes Kreuz Krankenhaus, Bremen, Germany (A.S.); University of Minnesota Medical School, Minneapolis, Minnesota (J.J.E.); Medical Physics in Radiology, German Cancer Research Center (DKFZ), Heidelberg, Germany (A.M.N., M.E.L.); Statscoach, Eckental, Germany (M.E.); VA Boston Healthcare System, West Roxbury, Mass (A.G.); and Boston University School of Medicine, Boston, Mass (M.U., F.W.R.). Received March 31, 2022; revision requested May 23; revision received October 13; accepted November 11. Address correspondence to R. Heiss (email: [email protected]). The work presented herein was funded in part by a research grant (2018_01: 7T MRI of the wrist) from the German Roentgen Society (Deutsche R{\"o}ntgengesellschaft). * R.H. and M.A.W. contributed equally to this work. Conflicts of interest are listed at the end of this article. Publisher Copyright: {\textcopyright} RSNA, 2023.",

year = "2023",

month = apr,

doi = "10.1148/radiol.220753",

language = "English (US)",

volume = "307",

journal = "Radiology",

issn = "0033-8419",

publisher = "Radiological Society of North America Inc.",

number = "2",

}

TY - JOUR

T1 - Clinical Application of Ultrahigh-Field-Strength Wrist MRI

T2 - A Multireader 3-T and 7-T Comparison Study

AU - Heiss, Rafael

AU - Weber, Marc André

AU - Balbach, Eva

AU - Schmitt, Rainer

AU - Rehnitz, Christoph

AU - Laqmani, Azien

AU - Sternberg, Andreas

AU - Ellermann, Jutta J.

AU - Nagel, Armin M.

AU - Ladd, Mark E.

AU - Englbrecht, Matthias

AU - Arkudas, Andreas

AU - Horch, Raymund

AU - Guermazi, Ali

AU - Uder, Michael

AU - Roemer, Frank W.

N1 - Funding Information: Department of Radiology (R. Heiss, E.B., A.M.N., M.U., F.W.R.) and Department of Plastic and Hand Surgery and Laboratory for Tissue Engineering and Regenerative Medicine (A.A., R. Horch), University Hospital Erlangen, Friedrich-Alexander-Universität Erlangen-Nürnberg (FAU), Maximiliansplatz 3, 91054 Erlangen, Germany; Institute of Diagnostic and Interventional Radiology, Pediatric Radiology and Neuroradiology, University Medical Center Rostock, Rostock, Germany (M.A.W.); Department of Radiology, Ludwig Maximilian University of Munich, Munich, Germany (R.S.); Diagnostic and Interventional Radiology, University Hospital Heidelberg, Heidelberg, Germany (C.R.); Department of Diagnostic and Interventional Radiology and Nuclear Medicine, University Medical Center Hamburg-Eppendorf, Hamburg, Germany (A.L.); Medizinisches Versorgungszentrum am Rotes Kreuz Krankenhaus, Bremen, Germany (A.S.); University of Minnesota Medical School, Minneapolis, Minnesota (J.J.E.); Medical Physics in Radiology, German Cancer Research Center (DKFZ), Heidelberg, Germany (A.M.N., M.E.L.); Statscoach, Eckental, Germany (M.E.); VA Boston Healthcare System, West Roxbury, Mass (A.G.); and Boston University School of Medicine, Boston, Mass (M.U., F.W.R.). Received March 31, 2022; revision requested May 23; revision received October 13; accepted November 11. Address correspondence to R. Heiss (email: [email protected]). The work presented herein was funded in part by a research grant (2018_01: 7T MRI of the wrist) from the German Roentgen Society (Deutsche Röntgengesellschaft). * R.H. and M.A.W. contributed equally to this work. Conflicts of interest are listed at the end of this article. Publisher Copyright: © RSNA, 2023.

PY - 2023/4

Y1 - 2023/4

N2 - Background: Ultrahigh-field-strength MRI at 7 T may permit superior visualization of noninflammatory wrist pathologic conditions, particularly due to its high signal-to-noise ratio compared with the clinical standard of 3 T, but direct comparison studies are lacking. Purpose: To compare the subjective image quality of 3-T and 7-T ultrahigh-field-strength wrist MRI through semiquantitative scoring of multiple joint tissues in a multireader study. Materials and Methods: In this prospective study, healthy controls and participants with chronic wrist pain underwent 3-T and 7-T MRI (coronal T1-weighted turbo spin-echo [TSE], coronal fat-suppressed proton-density [PD]–weighted TSE, transversal T2-weighted TSE) on the same day, from July 2018 to June 2019. Images were scored by seven musculoskeletal radiologists. The overall image quality, presence of artifacts, homogeneity of fat suppression, and visualization of cartilage, the triangular fibrocartilage complex (TFCC), and scapholunate and lunotriquetral ligaments were semiquantitatively assessed. Pairwise differences between 3 T and 7 T were assessed using the Wilcoxon signed-rank test. Interreader reliability was determined using the Fleiss kappa. Results: In total, 25 healthy controls (mean age, 25 years ± 4 [SD]; 13 women) and 25 participants with chronic wrist pain (mean age, 39 years ± 16; 14 men) were included. Overall image quality (P = .002) and less presence of artifacts at PD-weighted fat-suppressed MRI were superior at 7 T. T1- and T2-weighted MRI were superior at 3 T (both P < .001), as was fat suppression (P < .001). Visualization of cartilage was superior at 7 T (P < .001), while visualization of the TFCC (P < .001) and scapholunate (P = .048) and lunotriquetral (P = .04) ligaments was superior at 3 T. Interreader reliability showed slight to substantial agreement for the detected pathologic conditions (κ = 0.20–0.64). Conclusion: A 7-T MRI of the wrist had potential advantages over 3-T MRI, particularly in cartilage assessment. However, superiority was not shown for all parameters; for example, visualization of the triangular fibrocartilage complex and wrist ligaments was superior at 3 T.

AB - Background: Ultrahigh-field-strength MRI at 7 T may permit superior visualization of noninflammatory wrist pathologic conditions, particularly due to its high signal-to-noise ratio compared with the clinical standard of 3 T, but direct comparison studies are lacking. Purpose: To compare the subjective image quality of 3-T and 7-T ultrahigh-field-strength wrist MRI through semiquantitative scoring of multiple joint tissues in a multireader study. Materials and Methods: In this prospective study, healthy controls and participants with chronic wrist pain underwent 3-T and 7-T MRI (coronal T1-weighted turbo spin-echo [TSE], coronal fat-suppressed proton-density [PD]–weighted TSE, transversal T2-weighted TSE) on the same day, from July 2018 to June 2019. Images were scored by seven musculoskeletal radiologists. The overall image quality, presence of artifacts, homogeneity of fat suppression, and visualization of cartilage, the triangular fibrocartilage complex (TFCC), and scapholunate and lunotriquetral ligaments were semiquantitatively assessed. Pairwise differences between 3 T and 7 T were assessed using the Wilcoxon signed-rank test. Interreader reliability was determined using the Fleiss kappa. Results: In total, 25 healthy controls (mean age, 25 years ± 4 [SD]; 13 women) and 25 participants with chronic wrist pain (mean age, 39 years ± 16; 14 men) were included. Overall image quality (P = .002) and less presence of artifacts at PD-weighted fat-suppressed MRI were superior at 7 T. T1- and T2-weighted MRI were superior at 3 T (both P < .001), as was fat suppression (P < .001). Visualization of cartilage was superior at 7 T (P < .001), while visualization of the TFCC (P < .001) and scapholunate (P = .048) and lunotriquetral (P = .04) ligaments was superior at 3 T. Interreader reliability showed slight to substantial agreement for the detected pathologic conditions (κ = 0.20–0.64). Conclusion: A 7-T MRI of the wrist had potential advantages over 3-T MRI, particularly in cartilage assessment. However, superiority was not shown for all parameters; for example, visualization of the triangular fibrocartilage complex and wrist ligaments was superior at 3 T.

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DO - 10.1148/radiol.220753

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JO - Radiology

JF - Radiology

IS - 2

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ER -

Clinical Application of Ultrahigh-Field-Strength Wrist MRI: A Multireader 3-T and 7-T Comparison Study

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