Original investigations|Articles in Press

Deep Learning MRI Reconstruction for Accelerating Turbo Spin Echo Hand and Wrist Imaging: A Comparison of Image Quality, Visualization of Anatomy, and Detection of Common Pathologies with Standard Imaging

Published:February 14, 2023DOI:

      Rationale and Objectives

      Magnetic resonance imaging (MRI) of the hand and wrist is a routine MRI examination and takes about 15-20 minutes, which can lead to problems resulting from the relatively long scan time, such as decreased image quality due to motion artifacts and lower patient throughput.
      The objective of this study was to evaluate a deep learning (DL) reconstruction for turbo spin echo (TSE) sequences of the hand and wrist regarding image quality, visualization of anatomy, and diagnostic performance concerning common pathologies.

      Materials and Methods

      Twenty-one patients (mean age: 43 ± 19 [19-85] years, 10 men, 11 female) were prospectively enrolled in this study between October 2020 and June 2021. Each participant underwent two MRI protocols: first, standard fully sampled TSE sequences reconstructed with a standard GRAPPA reconstruction (TSES) and second, prospectively undersampled TSE sequences using a conventional parallel imaging undersampling pattern reconstructed with a DL reconstruction (TSEDL). Both protocols were acquired consecutively in one examination. Two experienced MSK-imaging radiologists qualitatively evaluated the images concerning image quality, noise, edge sharpness, artifacts, and diagnostic confidence, as well as the delineation of anatomical structures (triangular fibrocartilage complex, tendon of the extensor carpi ulnaris muscle, extrinsic and intrinsic ligaments, median nerve, cartilage) using a five-point Likert scale and assessed common pathologies. Wilcoxon signed-rank test and kappa statistics were performed to compare the sequences.


      Overall image quality, artifacts, delineation of anatomical structures, and diagnostic confidence of TSEDL were rated to be comparable to TSES (p > 0.05). Additionally, TSEDL showed decreased image noise (4.90, median 5, IQR 5-5) compared to TSES (4.52, median 5, IQR 4-5, p < 0.05) and improved edge sharpness (TSEDL: 4.10, median 4, IQR 3.5-5; TSES: 3.57, median 4, IQR 3-4; p < 0.05). Inter- and intrareader agreement was substantial to almost perfect (κ = 0.632-1.000) for the detection of common pathologies. Time of acquisition could be reduced by more than 60% with the protocol using TSEDL.


      Compared to TSES, TSEDL provided decreased noise and increased edge sharpness, equal image quality, delineation of anatomical structures, detection of pathologies, and diagnostic confidence. Therefore, TSEDL may be clinically relevant for hand and wrist imaging, as it reduces examination time by more than 60%, thus increasing patient comfort and patient throughput.

      Key Words

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        • Schnaiter JW
        • Roemer F
        • McKenna-Kuettner A
        • et al.
        Diagnostic accuracy of an MRI protocol of the knee accelerated through parallel imaging in correlation to arthroscopy.
        Rofo. 2018; 190: 265-272
        • Alaia EF
        • Benedick A
        • Obuchowski NA
        • et al.
        Comparison of a fast 5-min knee MRI protocol with a standard knee MRI protocol: a multi-institutional multi-reader study.
        Skeletal Radiol. 2018; 47: 107-116
        • Subhas N
        • Benedick A
        • Obuchowski NA
        • et al.
        Comparison of a fast 5-minute shoulder MRI protocol with a standard shoulder MRI protocol: a multiinstitutional multireader study.
        AJR Am J Roentgenol. 2017; 208: W146-WW54
        • Van Dyck P
        • Kenis C
        • Vanhoenacker FM
        • et al.
        Comparison of 1.5- and 3-T MR imaging for evaluating the articular cartilage of the knee.
        Knee Surg Sports Traumatol Arthrosc. 2014; 22: 1376-1384
        • Van Dyck P
        • Vanhoenacker FM
        • Lambrecht V
        • et al.
        Prospective comparison of 1.5 and 3.0-T MRI for evaluating the knee menisci and ACL.
        J Bone Joint Surg Am. 2013; 95: 916-924
        • Magee T
        • Shapiro M
        • Williams D.
        Usefulness of simultaneous acquisition of spatial harmonics technique for MRI of the knee.
        AJR Am J Roentgenol. 2004; 182: 1411-1415
        • Magee T
        • Shapiro M
        • Williams D
        • et al.
        Usefulness of the simultaneous acquisition of spatial harmonics technique during MRI of the shoulder.
        AJR Am J Roentgenol. 2003; 181: 961-964
        • Gao F
        • Wen Z
        • Dou S
        • et al.
        High-resolution simultaneous multi-slice accelerated turbo spin-echo musculoskeletal imaging: a head-to-head comparison with routine turbo spin-echo imaging.
        Front Physiol. 2021; 12759888
        • Li X
        • Peng Z
        • Sun Y
        • et al.
        Is simultaneous multisection turbo spin echo ready for clinical MRI? A feasibility study on fast imaging of knee lesions.
        Clin Radiol. 2020; 75 (e21- e30): 238
        • Haraikawa M
        • Suzuki M
        • Inoue K
        • et al.
        Simultaneous multi-slice MR imaging of the hip at 3 T to reduce acquisition times and maintain image quality.
        BMC Musculoskelet Disord. 2018; 19: 440
        • Longo MG
        • Fagundes J
        • Huang S
        • et al.
        Simultaneous multislice-based 5-minute lumbar spine MRI protocol: initial experience in a clinical setting.
        J Neuroimaging. 2017; 27: 442-446
        • Matcuk GR
        • Gross JS
        • Fields BKK
        • et al.
        Compressed sensing MR imaging (CS-MRI) of the knee: assessment of quality, inter-reader agreement, and acquisition time.
        Magn Reson Med Sci. 2020; 19: 254-258
        • Gersing AS
        • Bodden J
        • Neumann J
        • et al.
        Accelerating anatomical 2D turbo spin echo imaging of the ankle using compressed sensing.
        Eur J Radiol. 2019; 118: 277-284
        • Lee SH
        • Lee YH
        • Song HT
        • et al.
        Rapid acquisition of magnetic resonance imaging of the shoulder using three-dimensional fast spin echo sequence with compressed sensing.
        Magn Reson Imaging. 2017; 42: 152-157
        • Kijowski R
        • Rosas H
        • Samsonov A
        • et al.
        Knee imaging: rapid three-dimensional fast spin-echo using compressed sensing.
        J Magn Reson Imaging. 2017; 45: 1712-1722
        • Altahawi FF
        • Blount KJ
        • Morley NP
        • et al.
        Comparing an accelerated 3D fast spin-echo sequence (CS-SPACE) for knee 3-T magnetic resonance imaging with traditional 3D fast spin-echo (SPACE) and routine 2D sequences.
        Skeletal Radiol. 2017; 46: 7-15
        • Fritz J
        • Raithel E
        • Thawait GK
        • et al.
        Six-fold acceleration of high-spatial resolution 3d space mri of the knee through incoherent k-space undersampling and iterative reconstruction-first experience.
        Invest Radiol. 2016; 51: 400-409
        • Koch KM
        • Sherafati M
        • Arpinar VE
        • et al.
        Analysis and evaluation of a deep learning reconstruction approach with denoising for orthopedic MRI.
        Radiol Artif Intell. 2021; 3e200278
        • Foreman SC
        • Neumann J
        • Han J
        • et al.
        Deep learning-based acceleration of Compressed Sense MR imaging of the ankle.
        Eur Radiol. 2022; 32: 8376-8385
        • Kim M
        • Lee SM
        • Park C
        • et al.
        Deep learning-enhanced parallel imaging and simultaneous multislice acceleration reconstruction in knee MRI.
        Invest Radiol. 2022;
        • Knoll F
        • Hammernik K
        • Kobler E
        • et al.
        Assessment of the generalization of learned image reconstruction and the potential for transfer learning.
        Magn Reson Med. 2019; 81: 116-128
        • Hammernik K
        • Klatzer T
        • Kobler E
        • et al.
        Learning a variational network for reconstruction of accelerated MRI data.
        Magn Reson Med. 2018; 79: 3055-3071
        • Schlemper J
        • Caballero J
        • Hajnal JV
        • et al.
        A deep cascade of convolutional neural networks for dynamic MR image reconstruction.
        IEEE Trans Med Imaging. 2018; 37: 491-503
        • Deshmane A
        • Gulani V
        • Griswold MA
        • et al.
        Parallel MR imaging.
        J Magn Reson Imaging. 2012; 36: 55-72
        • Benali S
        • Johnston PR
        • Gholipour A
        • et al.
        Simultaneous multi-slice accelerated turbo spin echo of the knee in pediatric patients.
        Skeletal Radiol. 2018; 47: 821-831