Preliminary clinical results with low flip angle spin-echo MR imaging of the head and neck

A new approach for producing primarily T2- and proton-density-weighted MR images in less time than the conventional long TR, long TE imaging is to reduce the TR of a double spin-echo pulse sequence and to also reduce the RF excitation flip angle to minimize the resulting T1 sensitivity. In preliminary studies with a human volunteer and five patients with various diseases of the head and neck, conventional long TR, long TE and short TR, short TE images were compared with short TR, long TE images with reduced flip angles (45 degrees, 30 degrees), which required only 40% of the imaging time of the long TR images. The latter images showed a similar contrast pattern to the conventional T2-weighted image, and contrast-to-noise measurements indicated an increase in contrast between the lesion and nearby tissue when the flip angle was reduced. Furthermore, the maximum contrast/noise per unit imaging time on the short TR, long TE image was comparable to that on the long TR, long TE image. Optimization of the flip angle with short TR allows a substantial reduction in imaging time but with a reduction in multislice capability. This technique will be most useful in areas of complex anatomy where two or more orthogonal imaging planes are required, such as the head and neck.     

Fast MR imaging of liver metastasis using FLASH and FISP--optimal sequences for T1- and T2*-weighted images

This paper deals with a study to obtain the optimal sequence of gradient echo (GE) for T1- and T2*-weighted images similar to T1- and T2-weighted images of spin echo (SE). Two GE sequences, fast low angle shot (FLASH) and fast imaging with steady-state precession (FISP), were performed in 15 cases of liver metastasis in various combination of flip angle (FA), repetition time (TR), and echo time (TE). The optimal combinations were summarized as follows: 1) T1-weighted FLASH image with FA of 40 degrees, TR of 22 msec and TE of 10 msec, 2) T1-weighted FISP image with FA of 70 degrees, TR of 100 msec, TE of 10 msec, 3) both T2*-weighted FLASH and FISP images with FA of 10 degrees, TR of 100 msec and TE of 30 msec. Not only to provide the adequate T1- and T2*-weighted images but also to enable breath-holding MR imaging, GE sequences can optionally take place SE in cases of deteriorated images caused by moving artifacts. Other applications support the re-examination and further detailing when required, conveniently rather in short time.     

Cervical spine: MR imaging with a partial flip angle, gradient- refocused pulse sequence. Part II. Spinal cord disease

A magnetic resonance imaging pulse sequence (GRASS) with a short repetition time (TR), short echo time (TE), partial flip angle, and gradient refocused echo was prospectively evaluated for the detection of cervical cord disease that caused minimal or no cord enlargement in eight patients. Sagittal T2-weighted, cerebrospinal fluid (CSF)-gated images and sagittal and axial GRASS images were obtained in all patients. The following GRASS parameters were manipulated to determine their effect on signal-to-noise ratio (S/N) and contrast: flip angle (4 degrees-18 degrees), TR (22-50 msec), and TE (12.5-25 msec). Flip angle had the greatest effect on S/N and contrast. There were no differences between axial and sagittal imaging for the spinal cord or lesion. However, because the signal intensity of CSF did differ on sagittal and axial images and because this influenced the conspicuity of lesions, there was a difference in the useful flip angle range for axial and sagittal imaging. No one set of imaging parameters was clearly superior, and in all patients, the gated image was superior to the sagittal GRASS image in lesion detection. GRASS images should be used in the axial plane primarily to confirm spinal cord disease detected on sagittal CSF-gated images. For this, a balanced approach is suggested (TR = 40 msec, TE = 20 msec, with flip angles of 4 degrees-6 degrees for sagittal and 6 degrees-8 degrees for axial imaging).     

Low flip angle spin-echo MR imaging to obtain better Gd-DTPA enhanced imaging with ECG gating]

ECG-gated spin-echo imaging (ECG-SE) can reduce physiological motion artifacts. However, ECG-SE does not provide strong T1-weighted images because repetition time (TR) depends on heart rate (HR). We investigated the usefulness of low flip angle spin-echo imaging (LFSE) in obtaining more T1-dependent contrast with ECG gating. in computer simulation, the predicted image contrast and signal-to-noise ratio (SNR) obtained for each flip angle (0-180 degrees) and each TR (300 msec-1200 msec) were compared with those obtained by conventional T1-weighted spin-echo imaging (CSE: TR = 500 msec, TE = 20 msec). In clinical evaluation, tissue contrast [contrast index (CI): (SI of lesion-SI of muscle)2*100/SI of muscle] obtained by CSE and LFSE were compared in 17 patients. At a TR of 1,000 msec, T1-dependent contrast increased with decreasing flip angle and that at 38 degrees was identical to that with T1-weighted spin-echo. SNR increased with the flip angle until 100 degrees, and that at 53 degrees was identical to that with T1-weighted spin-echo. CI on LFSE (74.0 +/- 52.0) was significantly higher than CI on CSE (40.9 +/- 35.9). ECG-gated LFSE imaging provides better T1-dependent contrast than conventional ECG-SE. This method was especially useful for Gd-DTPA enhanced MR imaging.     

Lymph nodes of the neck. Diagnosis using magnetic resonance with gradient-echo technique

As for the pathologic conditions of neck lymph nodes, the clinician needs to know if the involved node is reactive, phlogistic, or neoplastic in nature. If accurate tumor staging is required, imaging techniques play a fundamental role. Our study was aimed at assessing the actual role of MR imaging in the evaluation of neck lymph node involvement. The study was performed using an MR Max Plus by General Electrics operating with an 0.5 T superconductive magnet. We employed gradient-echo (GE) pulse sequences with TR 500, TE 15 ms and 90 degrees flip angle for T1-weighted images, and with TR 500, TE 30 ms and 25-30 degrees flip angles for T2-weighted images; for Pd-T2-weighted images, TR was 520, TE 30 ms, and flip angles were 40-45 degrees. The results were correlated with histopathologic findings obtained at biopsy. The advantages of GE sequences were: 1) whole neck imaging--thus saving time, and reducing radiation dose and contrast media; 2) optimal anatomical and topographic evaluation of the lesion; 3) imaging of the longitudinal diameter of the node; 4) higher sensitivity for lymph node tissue modifications; 5) imaging of necrosis, hemorrhage, and/or fibrosis. GE sequences were especially useful for accurate tumor staging, in the follow-up, and to verify response to therapy. However, even though MR imaging has proven to have high sensitivity, its specificity was similar to that of contrast-enhanced CT. Further studies with the use of paramagnetic contrast media are needed to solve these problems.     

Evaluation of three-dimensional fast spoiled gradient recalled acquisition in the steady state (FSPGR) using ultra magnetic field 3-Tesla MRI for optimal pulse sequences of T1-weighted imaging

The advantage of the higher signal-to-noise ratio (SNR) of 3-Tesla magnetic resonance imaging (3TMRI) contributes to the improvement of spatial and temporal resolution. However, T1-weighted images of the brain obtained by the spin-echo (SE) method at 3T MR are not satisfactory for clinical use because of radiofrequency (RF) field inhomogeneity and prolongation of the longitudinal relaxation time (T1) of most tissues. We evaluated optimal pulse sequences to obtain adequate T1 contrast, high gray matter/white matter contrast, and suitable postcontrast T1-weighted images using the three-dimentional (3D) fast spoiled gradient recalled acquisition in the steady state (FSPGR) method instead of the SE method. For the optimization of T1 contrast, the Ernst angle of the optimal flip angle (FA) was obtained from the T1 value of cerebral white matter with the shortest TR and TE. Then the most appropriate FA, showing the maximum contrast-to-noise ratio (CNR) and SNR, was obtained by changing the FA every 5 degrees at about the level of the Ernst angle. Image uniformity was evaluated by a phantom showing similar T1 and T2 values of cerebral white matter. In order to evaluate the effect of the contrast enhancement, signal intensity was compared by the same method using a phantom filled with various dilutions of contrast media. Moreover, clinical studies using full (0.1 mmol/kg) and half (0.05 mmol/kg) doses of Gd-DTPA were carried out with the most appropriate parameters of the 3D-FSPGR method. These studies indicated that the optimal pulse sequences for obtaining an adequate T1-weighted image of the brain using 3D-FSPGR are 9/2 msec (TR/TE) and 13 degrees (FA).     

Conventional and rapid MR imaging of the liver with Gd-DTPA

Twenty-three patients with malignant hepatic tumors underwent magnetic resonance (MR) imaging before and after intravenous administration of gadolinium-diethylene-triaminepentaacetic acid (DTPA). Two different doses were used, 0.1 mmol/kg and 0.2 mmol/kg. The larger dose proved to be more effective than the smaller dose. The signal-enhancement-to-noise ratio was significantly larger in the tumor than in the liver (2 alpha less than or equal to .05). In a moderately T1-weighted spin echo (SE) sequence (SE 400/30) (repetition time [TR] msec/echo time [TE] msec), the tumor was better defined 6 minutes after administration of Gd-DTPA. More strongly T1-weighted sequences--that is, SE 200/20 and inversion recovery 1,500/35/400 (TR msec/TE msec/inversion time, msec)--showed significantly worse contrast between tumor and liver (signal-difference-to-noise ratio [SD/N]) 10 and 15 minutes after administration (2 alpha less than or equal to .05). On the other hand, the low SD/N in the rapid MR imaging sequence was significantly improved (2 alpha less than or equal to .05). The most important indications for administration of Gd-DTPA in diagnosing hepatic tumors are the presentation of perfusion conditions and contrast optimization in rapid MR images.     

Novel T*2-weighted contrast preparation scheme for segmented k-space myocardial imaging.

A novel T*(2)-weighted contrast-preparation scheme is described for use with segmented k-space cardiac sequences. This approach frees the imaging phase from the requirement of a long TE and, hence, a relatively long TR. A [90 degrees (x)-tau-90 degrees (rho)] preparation scheme is used to acquire four image data sets with the phase rho of the second pulse set to x, y, -x, and -y. The rho = x raw data is subtracted from the rho = -x data to form the "x" image, with a similar subtraction to generate the "y" image. These images are added in quadrature to obtain the T*(2)-weighted image. The method results in reduced artifact compared to a simple two-image scheme with rho = x, and y. T*(2) was measured in the myocardial septum in six normal volunteers by comparing tau = 7 and 28 ms images, and it was found to be 44 +/- 5 ms at 0.95 T.     

Detection of hepatic metastases with MR imaging: spin-echo vs phase-contrast pulse sequences at 0.6 T

The purpose of this study was to compare the sensitivity of T1-weighted and T2-weighted spin-echo (SE) pulse sequences with T2-weighted phase-contrast (PC) imaging techniques for the detection of hepatic metastases. Pulse-sequences performance was evaluated in 52 consecutive patients with 88 hepatic metastases who underwent MR imaging at 0.6 T. Lesion-liver contrast-to-noise ratios (CNR) on SE 260/14 (-12.4 +/- 6.7) and PC 2350/60 (+10.8 +/- 4.2) images were significantly (p less than .05) greater than on SE 2350/60 (+ 7.8 +/- 3.9), SE 2350/120 (+8.1 +/- 4.8), SE 2350/180 (+7.9 +/- 4.5), and PC 2350/30 (+4.6 +/- 2.9) images. Sensitivity for detection of 88 individual metastases was comparable on SE 260/14 (78 of 88 patients) and PC 2350/60 (81 of 88 patients) images and was significantly (p less than .05) greater than on in-phase T2-weighted SE images (TE = 60, 70 of 88 patients; TE = 120, 69 of 88 patients; TE = 180, 65 of 88 patients). Histologic analysis of tumor-free liver showed fatty change in 11 of 13 specimens available for pathologic evaluation. In all 11 of those patients, PC images increased tumor-liver contrast in comparison with the in-phase SE images. This analysis suggests that for detection of hepatic metastases at midfield strengths, the T1-weighted, short TR/short TE (SE 260/14) and the T2-weighted, phase-contrast (PC 2350/60) pulse sequences offer comparable performance.     

Fast spin-echo imaging of the knee: Factors influencing contrast

Conventional T2-weighted spin-echo magnetic resonance imaging of the knee requires a long TR. Fast spin-echo (FSE) imaging can improve acquisition efficiency severalfold by collecting multiple lines of k space for each TR. Compromises in resolution, section coverage, and contrast inevitably result. The authors examined the compromises encountered in FSE imaging of the knee and discuss the variations in image contrast and resolution due to choices of sequence parameters. For short TR/TE knee imaging, FSE does not appear to offer any advantages, since the increased collection efficiency for one section reduces the available number of sections, so that the total imaging time for a given number of sections remains constant relative to conventional spin-echo imaging. For T2-weighted images, considerable time can be saved and comparable quality images can be obtained. This saved time can be usefully spent on increasing both the resolution of the image and its signal-to-noise ratio, while still reducing total acquisition time by a factor of two. The preferred FSE T2-weighted images were acquired with a TR of 4,500 msec, TE of 120 msec, and eight echoes. The available number of sections is compromised, and the sequence remains sensitive to flow artifacts; however, the FSE sequence appears to be promising for knee imaging.     

Short TI inversion-recovery imaging of the liver: pulse-sequence optimization and comparison with spin-echo imaging

Magnitude-reconstructed short inversion-time (TI) inversion-recovery (IR) sequences have the advantage of reducing the signal of fat while providing additive T1 and T2 contrast. A double-echo short TI IR sequence was implemented to offer different degrees of T1- and T2-dependent image contrast. In 50 consecutive patients with proved liver tumors (30 metastases, 13 hemangiomas, seven other primary liver tumors), images obtained with a double-echo IR sequence at a repetition time (TR) of 1,500 msec, echo time (TE) of 30 and 60 msec, and TI of 80 msec (TR/TE/TI = 1,500/30, 60/80) were compared with those obtained with spin-echo (SE) sequences at a TR of 275 msec and a TE of 14 msec (TR/TE = 275/14) and 2,350/60, 120, 180. Metastases-liver contrast-to-noise ratios were highest at SE 275/14, followed by IR 1,500/30/80 and SE 2,350/180. IR 1,500/30/80 and SE 275/14 sequences consistently showed higher sensitivity for the detection of metastases than T2-weighted SE sequences. Differential diagnosis of benign and malignant lesions was more reliable with T2-weighted SE sequences than T2-weighted short TI IR sequences.     

Contrast optimization for the detection of focal hepatic lesions by MR imaging at 1.5 T

The relative efficacies of different spin-echo pulse sequences at 1.5 T were evaluated in the detection of focal hepatic disease. Pulse sequences compared were spin-echo with a repetition time (TR) of 200 msec and echo time (TE) of 20 msec, with six excitations; TR = 300 msec, TE = 20 msec, with 16 excitations (T1-weighted sequences); and a double spin-echo with TR = 2500 and TE = 25 and 70, with two excitations (proton-density-weighted and T2-weighted pulse sequences, respectively). Respiratory-motion compensation, which involved a recording of the phase-encoding gradients (Exorcist), was used for the last two sequences. Spin-echo with TR = 2500 msec and TE = 70 msec was superior in lesion detection and contrast-to-noise ratio. The proton-density-weighted and T2-weighted sequences with respiratory compensation produced better artifact suppression than did the short TR, short TE T1-weighted sequence with temporal averaging. In contradistinction to prior results at 0.6 T, T2-weighted pulse sequences appear superior to T1-weighted pulse sequences with multiple excitations for both lesion detection and artifact suppression at 1.5 T.     

Detection of hepatic VX2 carcinomas with ferucarbotran-enhanced magnetic resonance imaging in rabbits: Comparison of nine pulse sequences

OBJECTIVE: To compare the diagnostic performance of a variety of magnetic resonance imaging (MRI) sequences, in order to identify the most effective ferucarbotran-enhanced sequence for the detection of multiple small hepatic VX2 carcinomas in rabbits. METHODS: Fifteen rabbits with experimentally induced 135 VX2 carcinomas in the liver underwent ferucarbotran-enhanced MRI using the following nine pulse sequences: a fat-suppressed fast spin-echo (FSE) sequence with two echo times (TE) (proton density- and T2-weighted images), four different T2*-weighted fast multiplanar GRASS (gradient-recalled acquisition in the steady state) (FMPGR) with the combination of three TEs (9, 12, 15 ms, respectively) and two flip angles (20 degrees , 80 degrees, respectively), T2*-weighted fast multiplanar spoiled GRASS (FMPSPGR), T1-weighted FMPSPGR, and dynamic T1-weighted FMPSPGR. All images were reviewed by three radiologists with quantitative and qualitative analysis. RESULTS: Tumor-to-liver contrast-to-noise ratio of the proton density-weighted FSE sequence was significantly higher than those of the others (p<0.05). The lesion conspicuities of proton density- and T2-weighted FSE and T2*-weighted FMPGR (TE/flip angle, 9/20 degrees and 12/20 degrees ) images were better and the image artifacts of T2*-weighted FMPGR (TE/flip angle, 15/20 degrees and 12/80 degrees ) and T2*-weighted FMPSPGR images were more prominent than those of the others (p<0.05). The lesion detection in T2- and proton density-weighted FSE and T2*-weighted FMPGR (TE/flip angle, 12/20 degrees ) images were superior to those of the others and for the detection of very small hepatic tumors of less than 5 mm, the sensitivities of these sequences were less than 30%. CONCLUSION: Ferucarbotran-enhanced T2- and proton density-weighted FSE and T2*-weighed FMPGR (TE/flip angle, 12/20 degrees ) images were found to be the most effective pulse sequences for the detection of multiple small hepatic VX2 carcinomas but these sequences were limited in the detection of very small hepatic tumors of less than 5 mm in size.     

Hybrid RARE: Implementations for abdominal MR imaging

Hybrid RARE (rapid acquisition with relaxation enhancement) is a family of magnetic resonance (MR) imaging techniques whereby a set of images is phase encoded with more than one spin echo per excitation pulse. This increases the efficiency of obtaining T2-weighted images, allowing greater flexibility regarding acquisition time, resolution, signal-to-noise ratio, and tissue contrast. Hybrid RARE techniques involve several important new user-selectable parameters such as effective TE, echo train length, and echo spacing. Choices of other parameters, such as TR, sampling bandwidth, and acquisition matrix, may be different from those of comparable conventional T2-weighted spin-echo images. Different hybrid RARE implementations can be used for abdominal screening, with T2-weighted or T2-weighted and inversion-recovery contrast, or for characterizing liver lesions or imaging the biliary system with an extremely long TE. High-resolution images may be obtained by averaging multiple signals during quiet breathing, or images may be acquired more rapidly during suspended respiration. In this review, the authors discuss the basic principles of hybrid RARE techniques and how various imaging parameters can be manipulated to increase the quality and flexibility of abdominal T2-weighted MR imaging.     

Acute hypertensive intracranial hemorrhage: MR imaging at 1.5T

Twelve patients with acute hypertensive intracranial hemorrhage underwent magnetic resonance (MR) imaging within 7 days after the ictus. T1-weighted (TR = 400 msec; TE = 20 msec) and T2-weighted (TR = 2000 msec; TE = 80 msec) images were obtained on a 1.5 Tesla MR system. Signal intensities of hematomas were carefully evaluated and were compared with white matter intensity. A 9-hour-old hematoma was mildly hypointense on T1-weighted images, and was mildly hyperintense on T2-weighted images, suggesting a reflection of the high water content. On T2-weighted images, thin peripheral hypointense rim, probably due to deoxyhemoglobin, was also observed. Both of 15-hour-old hematoma and 21-hour-old hematoma had peripheral hypointensity on T2-weighted images. Both of 39-hour-old hematoma and 43-hour-old hematoma had central hyper-intensity on T1-weighted images and iso-to-mild central hypointensity on T2-weighted images, suggesting a reflection of decreased water content. A 3-day-old hematoma had thin peripheral iso-to-mild hyperintense rim on T1-weighted images, presumably due to intracellular methomoglobin. A 5-day-old hematoma had thin peripheral hyperintense rim on T2-weighted images, probably due to free methemoglobin. A 7-day-old hematoma was hyperintense on T1-weighted images and was mildly hypointense to hyperintense on T2-weighted images, presumably due to mixed intracellular methemoglobin and free methemoglobin.     

Magnetization transfer contrast MRI of musculoskeletal neoplasms

Magnetic resonance imaging (MRI) examinations were performed in 15 patients with musculoskeletal neoplasms to assess the value of magnetization transfer contrast in tumor characterization. Multiplanar gradient-recalled echo sequences (TR 500-600/TE 15-20/flip angle 20–30°) were performed first without and then with magnetization transfer contrast generated by a zero degree binomial pulse (MPGR and MTMPGR). Standard T1-weighted spin echo images (SE; TR 300-400/TE 12-20) and either T2-weighted SE (TR 2000-2900/TE 70-80) or T2-weighted fast spin echo (FSE; TR 4000-5000/TE 100-119 effective) images were also obtained. Signal intensities on MTMPGR scans were compared to those on MPGR scans for both tumors and normal tissues. Signal intensity ratios (SIR) and contrast-to-noise ratios (CNR) were also compared for all sequences. MTMPGR images provided better contrast between pathologic tissues and muscle than did standard MPGR images, increasing both conspicuity of lesions and definition of tumor/muscle interfaces. Benign and malignant tumors, with the exception of lipoma, underwent similar degrees of magnetization transfer and could not be distinguished by this technique.     

Spin-echo and STIR MR imaging of sports-related muscle injuries at 1.5 T

Seventy patients with clinically diagnosed athletic muscle injuries of varying severity were studied with MR imaging at 1.5 T. Twenty underwent follow-up MR studies. In all cases, SE T1-weighted and double-echo T2-weighted pulse sequences were used. These were supplemented by short T1 inversion recovery (STIR) sequence in 36 cases. Muscle injuries were more readily seen with STIR images than with SE T2-weighted images. In both initial assessment and follow-up of tears, the use of the STIR technique allowed the greatest lesion/muscle contrast. Short TR, short TE SE images provided anatomic detail and were an adjunct to T2-dependent SE images in the evaluation of organized hematomas (11 cases). Follow-up MR studies in 20 patients at variable time intervals allowed demonstration of regression of the tear in 11 cases, fibrous scar formation in 5 cases, and recurrence of the tear in 4 cases. Evolution of hematomas into scar and into cyst was demonstrated in three and two cases, respectively. Owing to the additive effect of T1 and T2 mechanisms, the STIR sequence is well suited for initial evaluation and can replace T2-weighted images in the follow-up of muscle trauma.     

Gadolinium-DOTA enhanced fast imaging of liver tumors at 1.5 T

Twenty patients [15 men, 5 women, 19-71 years old (mean 52 years)] highly suspected of having tumoral liver pathology were prospectively studied with motion compensated T2-weighted spin echo (SE) [repetition time (TR) 2,200 ms, echo time (TE) 90 ms] and Gd-DOTA enhanced gradient echo fast low angle shot [TR 60 ms, TE 10 ms, angle 30 degrees) sequences. The final diagnoses were hemangioma (five), hepatocellular carcinoma (four), focal nodular hyperplasia (one), adenoma (one), metastasis (two), abscess (two), echinococcal cyst (one), tumor of unknown origin (three), cirrhosis (one). Contrast enhanced images were obtained during the early vascular phases after intravenous bolus injection of Gd-DOTA at a dose of 0.1 mmol/kg (0.2 ml/kg). After Gd-DOTA, positive contrast enhancement was seen in 11 cases, negative enhancement in 4, and nonenhancement in 6. Contrast patterns were similar to contrast enhanced CT. In terms of visibility of lesions, the unenhanced motion-compensated T2 SE sequences were superior to the nonenhanced gradient echo sequences in 12 patients and equal in 8. After gadolinium enhancement, T2-weighted SE images were superior to the postcontrast gradient echo images in eight cases, equal in eight and inferior in four cases.     

T2-weighted contrasts in rapid low flip-angle imaging

Expressions for the contrast-to-noise (C/N) behavior in images obtained from rapid low flip-angle excitation pulses are derived, taking into account both T1- and T2-dependent contrasts. It is shown, and demonstrated experimentally, that images with T2-weighted contrasts can be efficiently acquired with such sequences, by a suitable choice of TR, TE, and tip angle.     

Musculoskeletal MR imaging: turbo (fast) spin-echo versus conventional spin-echo and gradient-echo imaging at 0.5 tesla

The value of T2-weighted fast spin-echo imaging of the musculoskeletal system was assessed in 22 patients with various neoplastic, inflammatory, and traumatic disorders. Images were acquired with high echo number (i.e., echo train length) fast spin-echo (FSE; TR 2000 ms, effective TE 100 ms, echo number 13, lineark-space ordering), conventional spin-echo (SE; TR 2000 ms, TE 100 ms) and gradient-echo (GRE) sequences (TR 600 ms, TE 34 ms, flip angle 25°). Signal intensities, signal-to-noise ratios, contrast, contrast-to-noise ratios, lesion conspicuousness, detail perceptibility, and sensitivity towards image artifacts were compared. The high signal intensity of fat on FSE images resulted in a slightly inferior lesion-to-fat contrast on FSE images. However, on the basis of lesion conspicuity, FSE is able to replace time-consuming conventional T2-weighted SE imaging in musculoskeletal MRI. In contrast, GRE images frequently showed superior lesion conspicuity. One minor disadvantage of FSE in our study was the frequent deterioration of image quality by blurring, black band, and rippling artifacts. Some of these artifacts, however, can be prevented using short echo trains and/or short echo spacings.