Computerised tomography (CT)-like images based on T1-weighted gradient echo magnetic resonance imaging (MRI) sequences for the assessment of osteochondral lesions of the ankle

초록

AIM: To compare the diagnostic performance of computerised tomography (CT)-like magnetic resonance imaging (MRI) using the fast field echo resembling a CT using restricted echo-spacing (FRACTURE) with conventional CT for assessing osteochondral lesions (OCLs) of the ankle. MATERIALS AND METHODS: This prospective single-centre study included 29 patients (30 ankles) with suspected OCLs who underwent both 3T MRI with the 3D FRACTURE sequence and conventional CT. OCL detection, classification, and measurement accuracy were compared, using CT as the comparative group. Agreement between modalities and readers were analysed using Cohen's kappa, Fleiss' kappa, and intraclass correlation coefficients (ICCs). RESULTS: CT identified 22 OCLs, predominantly in the talus (59.1 % in the medioequator zone). CT-like MRI detected all OCLs, demonstrating excellent agreement with CT for lesion location (kappa = 0.968-1.00 0), Ferkel classification (kappa = 0.878-.970), and containment type (kappa = 0.913-1.00 0). OCL size measurements showed strong correlation (ICC = 0.909-0.968 intraobserver; 0.797-0.999 interobserver). Evaluation of surrounding bone quality and additional osseous change yield substantial to almost perfect agreement (kappa = 0.734-1.00 0). Image quality and diagnostic confidence were comparable between modalities. CONCLUSION: CT-like MRI using the FRACTURE sequence provides high diagnostic accuracy and excellent agreement with CT in the assessment of ankle OCLs and associated bony abnormalities. It offers a reliable, radiation-free alternative to CT that may support preoperative planning while reducing radiation exposure and overall imaging burden. (c) 2025 The Author(s). Published by Elsevier Ltd on behalf of The Royal College of Radiologists. This is an open access article under the CC BY-NC-ND license (http://creativecommons.org/ licenses/by-nc-nd/4.0/).

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