Evaluation of diagnostic value and T2-weighted three-dimensional isotropic turbo spin-echo (3D-SPACE) image quality in comparison with T2-weighted two-dimensional turbo spin-echo (2D-TSE) sequences in lumbar spine MR imaging

Purpose: to evaluate diagnostic value and image quality of T2-weighted Three-dimensional isotropic turbo spin-echo (SPACE) in comparison with T2-weighted two-dimensional turbo spin-echo (TSE) sequences for comprehensive evaluation of lumbar spine pathologies. Materials and methods: Thirty-five participants with lumbar discopathy were examined on a 1.5-T MRI system with both 2D TSE and 3D SPACE sequences. Obtained images were analyzed with synedra view personal (V 17.0.0.2) software in terms of calculating image quality factors such as signal to noise ratio (SNR) and contrast to noise ratio (CNR) for selected regions of interest. In addition, images were referred to radiologists to report their pathologic indexes. The visibility of anatomical structures in the 3D and 2D sequences was qualitatively assessed by two radiologists independently. Cohen's kappa (k) and Wilcoxon signed rank test was used for the statistical analysis. Results: In this study, the 3D SPACE T2-weighted sequence showed significant higher SNR and CNR as well as visibility in all of the regions of interest except vertebrae and intervertebral discs (p-value < 0.05). Inter-observer agreement for visibility of regions of interest was substantial and perfect (k > 0.6). Also, inter-observer and inter-method agreements for pathologic indexes were substantial and perfect for all of the pathologic indexes (k > 0.6). Inter-observer agreement for 3D SPACE sequence was higher (k = 0.793) in comparison with 2D-TSE sequence (k = 0.603). 3D SPACE sequence and its multi-planar reconstructions (MPR) scan time were less (192 s) than 2D TSE in the sagittal, axial and coronal planes (209 s). Conclusion: 3D SPACE sequence for lumbar spine MRI proved to have higher SNR, CNR, and visibility for all regions of lumbar spine except vertebrae and disc. Inter-observer and inter-method agreements for pathologic indexes between 3D SPACE and 2D TSE sequences were substantial and 3D SPACE had a higher inter-observer agreement and less scan time. Therefore, T2 weighted 3D SPACE sequence, and its MPR might be an excellent alternative for 2D TSE in sagittal, axial, and coronal planes, especially for patients with abnormal curvature of the lumbar spine.