Assessment of Reliability and Diagnostic Performance of Anterior Cruciate Ligament on Proton Density Weighted (PDW) Images using 2D TSE and 3D SPACE in MRI 3T.

Abstract

Knee derangements are becoming more common due to sudden biomechanical twisting of the limbs. MRI stands out as an effective non-invasive diagnostic tool compared to other methods offering high spatial resolution for visualizing complex knee anatomy. 3D SPACE offers advantages over the two-dimensional (2D) turbo spin-echo acquisition with multi-planar reformat using isotropic voxel acquisition, thus providing improved imaging quality for ACL injury detection. Limited studies have compared the diagnostic accuracy of 3D SPACE with the 2D turbo spin-echo sequence in detecting anterior cruciate ligament injuries. This study assesses the image quality and diagnostic performance of 3D SPACE and 2D TSE in ACL evaluation using a 3T MRI. A case-control study involved 60 individuals, divided into an injured-knee group and healthy patients between 2019 – and 2020 at King Fahad Hospital. All MRI acquisitions were performed on a 3T MRI scanner using a standard knee protocol. The study included 35 patients and 25 healthy participants. A significant difference (p = 0.001) in image sharpness between 2D PD and 3D PD in patients with knee injuries was observed with higher diagnostic accuracy of ACL among patients (AUC 0.973), which is statistically significant (P < 0.001) when compared between 3D PD SPACE to 2D PD sequence, with weighted kappa values of 0.740 and 0.784, respectively. Kappa agreement values indicated substantial agreement in 3D PD SPACE compared to 2D PD in cases of ACL knee injury. The results reveal that both sequences proved valuable diagnostic accuracy in detecting ACL injuries, with 3D SPACE offering enhanced isotropic resolution and multiplanar reformation capabilities, leading to improved visualization of the ACL, thus underscoring the importance of appropriate imaging technique selection for scan efficiency and clinical feasibility. This research contributes to the growing evidence that 3D PD SPACE sequences are beneficial, provide sufficient image quality in a short scan time, and are a reliable component of knee MRI.