T2-weighted MRI of the uterus: Fast spin echo vs. breath-hold fast spin echo

This study compared one routine Ta-weighted fast spin echo (T2FSE) sequence with a breath-hold T2FSE (BH T2FSE) sequence of the female pelvis for imag e quality, uterine anatomy, lesion detection, and signal intensity measurem ents. Thirty-two consecutive women (mean age 41.7 years) were imaged at 1.5 T with one high-resolution routine T2FSE sequence and one BH T2FSE sequenc e in the sagittal plane as part of comprehensive pelvic magnetic resonance imaging. The different image sets were rated separately for imaging charact eristics (overall image quality, uterine anatomy definition, lesion detecti on, and free fluid conspicuity) and then compared side by side. The image s ets were also compared for artifacts (ghosting, blurring, pulsatility, and chemical shift misregistration). Signal-to-noise (S/N) and signal differenc e-to-noise (SD/N) ratios were calculated for the different uterine zones, u terine abnormalities, free fluid, rectus abdominis muscle, and bladder. Con trast-to-noise ratios (CNRs) were calculated for uterine abnormalities. Twe nty-eight uterine abnormalities were detected in 20 patients and included l eiomyomata (13 patients), adenomyosis (7 patients), benign endometrial poly ps (6 patients), endometrial carcinoma (1 patient), and pregnancy(1 patient ). BH T2FSE was superior or equivalent to T2FSE for overall image quality i n 23/32 patients (71.8%), uterine anatomy definition in 19/32 patients (59. 3%), and lesion detection in 13/20 patients (65%), BH T2FSE performed less well than T2FSE for free fluid conspicuity in 5/5 (100%) patients. BH T2FSE was equivalent to or less affected than T2FSE for ghosting artifact in 24/ 32 patients (75%) and blurring artifact in 29/32 patients (90.6%). Pulsatil ity and chemical shift artifacts were not problematic for either image set. S/N and SD/N were higher for all BH T2FSE determinations compared with T2F SE, For the endometrium, junctional zone, myometrium, and bladder, these di fferences were statistically significant. There were no statistically signi ficant differences for CNR between the two image sets, although BH T2FSE va lues for leiomyomata, adenomyosis, and abnormal endometria were higher than those calculated for T2FSE, All pathology detected with T2FSE was detected an BH T2FSE despite the breath-hold sequence's inherently poorer spatial r esolution compared with the non-breath-hold sequence. BH T2FSE may be able to replace T2FSE for some uterine applications with a substantial time savi ngs, (C) 1999 Wiley-Liss. Inc.