Volumetric fat-water separated T2-weighted MRI

Background: Pediatric body MRI exams often cover multiple body parts, making the development of broadly applicable protocols and obtaining uniform fat suppression a challenge. Volumetric T2 imaging with Dixon-type fat-water separation might address this challenge, but it is a lengthy process. Objective: We develop and evaluate a faster two-echo approach to volumetric T2 imaging with fat-water separation. Materials and methods: A volumetric spin-echo sequence was modified to include a second shifted echo so two image sets are acquired. A region-growing reconstruction approach was developed to decompose separate water and fat images. Twenty-six children were recruited with IRB approval and informed consent. Fat-suppression quality was graded by two pediatric radiologists and compared against conventional fat-suppressed fast spin-echo T2-W images. Additionally, the value of in- and opposed-phase images was evaluated. Results: Fat suppression on volumetric images had high quality in 96% of cases (95% confidence interval of 80-100%) and were preferred over or considered equivalent to conventional two-dimensional fat-suppressed FSE T2 imaging in 96% of cases (95% confidence interval of 78-100%). In- and opposed-phase images had definite value in 12% of cases. Conclusion: Volumetric fat-water separated T2-weighted MRI is feasible and is likely to yield improved fat suppression over conventional fat-suppressed T2-weighted imaging.