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Technical Article
Application value of T2WI-Dixon water fat separation sequence in the evaluation of muscle fat infiltration and edema in patient with Duchenne muscular dystrophy
SHI Cailing  FU Hang  GUO Yingkun  CAI Xiaotang  XU Huayan  YUE Wenjun 

Cite this article as: Shi CL, Fu H, Guo YK, et al. Application value of T2WI-Dixon water fat separation sequence in the evaluation of muscle fat infiltration and edema in patient with Duchenne muscular dystrophy[J]. Chin J Magn Reson Imaging, 2022, 13(7): 96-102. DOI:10.12015/issn.1674-8034.2022.07.017.

[Abstract] Objective This study aimed to compare image quality of T2-weighted imaging water-fat separation (T2WI-Dixon) sequence with conventional sequence [T1WI and T2WI-SPAIR (spectral attenuated inversion recovery) sequence] and the consistency in evaluating the degree of fatty infiltration and edema in the gluteal and leg muscles of patient with Duchenne muscular dystrophy (DMD), and to investigate the value of T2WI-Dixon as a single sequence in assessing the gluteal and leg muscles of patient with DMD.Materials and Methods A total of 71 patient with DMD were prospectively enrolled for 3.0 T magnetic resonance imaging scanning of the hip and thigh. The scanning sequences included T2WI-Dixon fast spin echo sequence, T1WI sequence and T2WI-SPAIR sequence. The image quality of each sequence was comprehensively evaluated by combining subjective (Likert 4-point scale, including image artifacts, fat suppression ability, and overall quality) with objective [quantitative measurement of image SNR (signal-noise ratio) and CNR (contrast-to-noise ratio)] methods. The degree of muscle fatty infiltration and edema were scored using the Mercuri grading scale and the Kim grading scale to assess consistency between methods. Inter-observer and intra-observer subjective score consistency were also assessed.Results In terms of subjective evaluation of image quality, the artifact and overall image quality score of T2WI-Dixon-fat were higher than those of T1WI (P<0.001). The fat suppression uniformity, artifact and overall image quality scores of T2WI-Dixon-water images were also higher than those of T2WI-SPAIR images (P<0.001). In objective evaluation, CNR of T2WI-Dixon-fat images were significantly higher than that of T1WI, while SNR were significantly lower than that of T1WI (P<0.001). SNR and CNR of T2WI-Dixon-water images were higher than those of T2WI-SPAIR (P<0.001). T2WI-Dixon-fat showed excellent consistency with T1WI in evaluating the degree of muscle fat infiltration (Kappa=0.95, P<0.001). T2WI-Dixon-water and T2WI-SPAIR also had excellent consistency in evaluating the degree of muscle edema (Kappa=0.84, P<0.001). The intra-observer and inter-observer subjective scores were moderate-excellent consistent, with Kappa values of 0.42-0.86, all P<0.001.Conclusions T2WI-Dixon sequence has good consistency with conventional sequence in the evaluation of muscle fat infiltration and edema, and can significantly shorten the scanning time and improve image quality, which has good application value in the evaluation of gluteal and leg muscle injury in patient with DMD.
[Keywords] magnetic resonance imaging;water fat separation imaging;Duchenne muscular dystrophy;fat infiltration;edema;image quality

SHI Cailing1   FU Hang2   GUO Yingkun2   CAI Xiaotang3   XU Huayan2   YUE Wenjun1*  

1 Department of Radiology, Affiliated Hospital of North Sichuan Medical College, Nanchong 637000, China

2 Key Laboratory of Birth Defects and Related Diseases of Women and Children of Ministry of Education, Department of Radiology, West China Second Hospital, Sichuan University, Chengdu 610041, China

3 Key Laboratory of Urban Defects and Related Women and Children's Diseases of Ministry of Education, Department of Pediatric Neurology, West China Second Hospital, Sichuan University, Chengdu 610041, China

Yue WJ, E-mail:

Conflicts of interest   None.

Received  2022-03-01
Accepted  2022-06-24
DOI: 10.12015/issn.1674-8034.2022.07.017
Cite this article as: Shi CL, Fu H, Guo YK, et al. Application value of T2WI-Dixon water fat separation sequence in the evaluation of muscle fat infiltration and edema in patient with Duchenne muscular dystrophy[J]. Chin J Magn Reson Imaging, 2022, 13(7): 96-102.DOI:10.12015/issn.1674-8034.2022.07.017

Crisafulli S, Sultana J, Fontana A, et al. Global epidemiology of Duchenne muscular dystrophy: an updated systematic review and meta-analysis[J]. Orphanet J Rare Dis, 2020, 15(1): 141. DOI: 10.1186/s13023-020-01430-8.
Kim HK, Merrow AC, Shiraj S, et al. Analysis of fatty infiltration and inflammation of the pelvic and thigh muscles in boys with Duchenne muscular dystrophy (DMD): grading of disease involvement on MR imaging and correlation with clinical assessments[J]. Pediatr Radiol, 2013, 43(10): 1327-1335. DOI: 10.1007/s00247-013-2696-z.
Rooney WD, Berlow YA, Triplett WT, et al. Modeling disease trajectory in Duchenne muscular dystrophy[J/OL]. Neurology, 2020, 94(15) [2022-03-01]. DOI: 10.1212/WNL.0000000000009244.
Nuñez-Peralta C, Alonso-Pérez J, Díaz-Manera J. The increasing role of muscle MRI to monitor changes over time in untreated and treated muscle diseases[J]. Curr Opin Neurol, 2020, 33(5): 611-620. DOI: 10.1097/WCO.0000000000000851.
Mercuri E, Pichiecchio A, Allsop J, et al. Muscle MRI in inherited neuromuscular disorders: past, present, and future[J]. J Magn Reson Imaging, 2007, 25(2): 433-440. DOI: 10.1002/jmri.20804.
Brogna C, Cristiano L, Verdolotti T, et al. Longitudinal motor functional outcomes and magnetic resonance imaging patterns of muscle involvement in upper limbs in Duchenne muscular dystrophy[J]. Medicina (Kaunas), 2021, 57(11): 1267. DOI: 10.3390/medicina57111267.
Bu SS, Xiao JX, Zhu Y, et al. Comparative study of conventional MRI between Duchenne muscular dystrophy and Becker muscular dystrophy[J]. Chin J Med Imaging Technol, 2019, 35(11): 1717-1721. DOI: 10.13929/j.1003-3289.201903166.
Dixon WT. Simple proton spectroscopic imaging[J]. Radiology, 1984, 153(1): 189-194. DOI: 10.1148/radiology.153.1.6089263.
Chen L, Hu H, Chen HH, et al. Usefulness of two-point Dixon T2-weighted imaging in thyroid-associated ophthalmopathy: comparison with conventional fat saturation imaging in fat suppression quality and staging performance[J/OL]. Br J Radiol, 2021, 94(1118)[2022-03-01]. DOI: 10.1259/bjr.20200884.
Wendl CM, Eiglsperger J, Dendl LM, et al. Fat suppression in magnetic resonance imaging of the head and neck region: is the two-point DIXON technique superior to spectral fat suppression?[J/OL]. Br J Radiol, 2018, 91(1085) [2022-03-01]. DOI: 10.1259/bjr.20170078.
Guerini H, Omoumi P, Guichoux F, et al. Fat suppression with Dixon techniques in musculoskeletal magnetic resonance imaging: a pictorial review[J]. Semin Musculoskelet Radiol, 2015, 19(4): 335-347. DOI: 10.1055/s-0035-1565913.
Omoumi P. The Dixon method in musculoskeletal MRI: from fat-sensitive to fat-specific imaging[J]. Skeletal Radiol, 2022, 51(7): 1365-1369. DOI: 10.1007/s00256-021-03950-1.
Schlaeger S, Klupp E, Weidlich D, et al. T2-weighted Dixon Turbo spin echo for accelerated simultaneous grading of whole-body skeletal muscle fat infiltration and edema in patients with neuromuscular diseases[J]. J Comput Assist Tomogr, 2018, 42(4): 574-579. DOI: 10.1097/RCT.0000000000000723.
Grimm A, Meyer H, Nickel MD, et al. Evaluation of 2-point, 3-point, and 6-point Dixon magnetic resonance imaging with flexible echo timing for muscle fat quantification[J]. Eur J Radiol, 2018, 103: 57-64. DOI: 10.1016/j.ejrad.2018.04.011.
Xiang QS. Two-point water-fat imaging with partially-opposed-phase (POP) acquisition: an asymmetric Dixon method[J]. Magn Reson Med, 2006, 56(3): 572-584. DOI: 10.1002/mrm.20984.
Lins CF, Salmon CEG, Nogueira-Barbosa MH. Applications of the Dixon technique in the evaluation of the musculoskeletal system[J]. Radiol Bras, 2021, 54(1): 33-42. DOI: 10.1590/0100-3984.2019.0086.
Noble JJ, Keevil SF, Totman J, et al. In vitroandin vivocomparison of two-, three- and four-point Dixon techniques for clinical intramuscular fat quantification at 3 T[J/OL]. Br J Radiol, 2014, 87(1036) [2022-03-01]. DOI: 10.1259/bjr.20130761.
Özgen A. The value of the T2-weighted multipoint Dixon sequence in MRI of sacroiliac joints for the diagnosis of active and chronic sacroiliitis[J]. AJR Am J Roentgenol, 2017, 208(3): 603-608. DOI: 10.2214/AJR.16.16774.
Maeder Y, Dunet V, Richard R, et al. Bone marrow metastases: T2-weighted Dixon spin-echo fat images can replace T1-weighted spin-echo images[J]. Radiology, 2018, 286(3): 948-959. DOI: 10.1148/radiol.2017170325.
Salari R, Ballard DH, Hoegger MJ, et al. Fat-only Dixon: how to use it in body MRI[J]. Abdom Radiol, 2022, 47(7): 2527-2544. DOI: 10.1007/s00261-022-03546-w.
del Grande F, Santini F, Herzka DA, et al. Fat-suppression techniques for 3-T MR imaging of the musculoskeletal system[J]. Radiographics, 2014, 34(1): 217-233. DOI: 10.1148/rg.341135130.
Bley TA, Wieben O, François CJ, et al. Fat and water magnetic resonance imaging[J]. J Magn Reson Imaging, 2010, 31(1): 4-18. DOI: 10.1002/jmri.21895.
Reid AL, Alexander MS. The interplay of mitophagy and inflammation in Duchenne muscular dystrophy[J]. Life (Basel), 2021, 11(7): 648. DOI: 10.3390/life11070648.

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