Zero echo-time magnetic resonance imaging (ZTE-MRI) for pediatric spine pathology: a novel radiation free approach

Sunday, May 5, 2024

4:27 PM – 4:29 PM CT

Location: S405b

Presenting Author(s)

Kevin K. Kumar, MD, PhD

Clinical Instructor
Division of Pediatric Neurosurgery, Lucile Packard Children’s Hospital at Stanford
Los Altos, CA, US

Co-Author(s)

Arokoruba O. Cheetham-West, BS

Medical Student
Stanford University School of Medicine
MG

Mark Golchehreh, n/a

MRI Technologist
Division of Pediatric Radiology, Lucile Packard Children’s Hospital at Stanford, United States
KM

Kelly Mahaney, MD

Assistant Professor
Division of Pediatric Neurosurgery, Lucile Packard Children’s Hospital at Stanford
Palo Alto, California, United States
Cormac O. Maher, MD

Professor
Division of Pediatric Neurosurgery, Lucile Packard Children’s Hospital at Stanford
Palo Alto, California, United States
Laura M. Prolo, MD, PhD

Assistant Professor
Division of Pediatric Neurosurgery, Lucile Packard Children’s Hospital at Stanford
Stanford, California, United States
ET

Elizabeth Tong, MD

Clinical Assistant Professor
Stanford University, United States
KY

Kristen Yeom, MD

Attending Physician
Department of Radiology, Phoenix Children’s Hospital, United States

Disclosure(s):

Kevin K. Kumar, MD, PhD: No financial relationships to disclose

Arokoruba O. Cheetham-West, BS: No financial relationships to disclose

Introduction: Zero echo-time magnetic resonance imaging (ZTE-MRI) is a rapid, high-resolution technique that permits imaging of cortical bone without ionizing radiation. Recently ZTE-MRI has been used to assess craniosynostosis and other calvarial pathologies in children, however its use in pediatric spine is unexplored. We hypothesized that ZTE-MRI is comparable to computed tomography (CT) in evaluating spine pathology in children.

Methods: We identified patients who obtained ZTE-MRI on cervical, thoracic, and/or lumbar spine from January 2021- October 2023 at Lucile Packard Children’s Hospital at Stanford. ZTE-MRI were acquired using body and air coils and software (ZTE and Silenz;GE Healthcare). The coronal ZTE-MRI 3d Radial sequence were acquired with the following parameters: TE 0;FOV 24; readout matrix 256x256, slice thickness 1.2; NEX 8, receiver bandwidth 83, flip angle 2. In-plane and through plane resolution 100%. Scans were reviewed by two blinded pediatric neuroradiologists to examine performance of ZTE MRI compared to conventional CT, including signal to noise, contrast, image blurring, and overall diagnostic quality.

Results: 179 patients obtained spine ZTE-MRI of which 20 patients underwent both ZTE-MRI and CT. Indications for spine imaging in these patients were tumor (n=10), craniocervical junction concern (n=5), trauma (n=2), scoliosis/tethered cord (n=3). 9/20 scans showed normal bone anatomy on both CT and ZTE-MRI, where ZTE-MRI was considered to perform on par with CT with regards to bony anatomy, including cortical outline. 10/20 cases presented with abnormal bony findings, where ZTE-MRI correctly identified an underlying bony abnormality detectable by CT; one ZTE-MRI scan was degraded by hardware artifact rendering the study non-diagnostic, similar to CT.

Conclusion : ZTE-MRI is a quickly acquired, promising imaging sequence that may be considered an adjunct to conventional MRI or CT for bony evaluation and may be useful in children presenting with trauma or other forms of spinal pathology, e.g., scoliosis, formation-segmentation anomalies while reducing radiation exposure.