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Morphometric and clinical comparison of MRI-based synthetic CT to conventional CT of the hip in children

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Abstract

Background

MRI-based synthetic CT (sCT) generates CT-like images from MRI data.

Objective

To evaluate equivalence, inter- and intraobserver reliability, and image quality of sCT compared to conventional (cCT) for assessing hip morphology and maturity in pediatric patients.

Materials and methods

We prospectively enrolled patients <21 years old with cCT and 3T MRI of the hips/pelvis. A dual-echo gradient-echo sequence was used to generate sCT via a commercially available post-processing software (BoneMRI v1.5 research version, MRIguidance BV, Utrecht, NL). Two pediatric musculoskeletal radiologists measured seven morphologic hip parameters. 3D surface distances between cCT and sCT were computed. Physeal status was established at seven locations with cCT as reference standard. Images were qualitatively scored on a 5-point Likert scale regarding diagnostic quality, signal-to-noise ratio, clarity of bony margin, corticomedullary differentiation, and presence and severity of artifacts. Quantitative evaluation of Hounsfield units (HU) was performed in bone, muscle, and fat tissue. Inter- and intraobserver reliability were measured by intraclass correlation coefficients. The cCT-to-sCT intermodal agreement was assessed via Bland-Altman analysis. The equivalence between modalities was tested using paired two one-sided tests. The quality parameter scores of each imaging modality were compared via Wilcoxon signed-rank test. For tissue-specific HU measurements, mean absolute error and mean percentage error values were calculated using the cCT as the reference standard.

Results

Thirty-eight hips in 19 patients were included (16.6 ± 3 years, range 9.9–20.9; male = 5). cCT- and sCT‐based morphologic measurements demonstrated good to excellent inter- and intraobserver correlation (0.77<ICC<0.98). Measurements were statistically equivalent (P < 0.05), with average intermodal differences <2°. Mean surface distance between cCT and sCT was 0.23 ± 0.18 mm. Accuracy to determine physeal maturity status by sCT was 98.4% (242/246, 95% CI 96.0–99.6). No significant differences were found on overall diagnostic quality, bony margin clarity, corticomedullary differentiation, and artifacts between sCT and cCT; signal-to-noise ratio was higher on sCT (P < 0.001). HU were within reference values on both sCT and cCT.

Conclusion

sCT is equivalent to cCT for the assessment of hip morphology, physeal status, and radiodensity assessment in pediatric patients.

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Data availability

The datasets generated during and/or analyzed during the current study are available from the corresponding author on reasonable request.

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Funding

No funding was received to assist with the preparation of this manuscript.

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Author notes

  1. Jade Iwasaka-Neder and M. Alejandra Bedoya contributed equally.

Authors and Affiliations

  1. Department of Radiology, Boston Children’s Hospital, 300 Longwood Ave, Boston, MA, 02115, USA

    Jade Iwasaka-Neder, M. Alejandra Bedoya, James Connors & Sarah D. Bixby

  2. Computational Radiology Laboratory, Boston Children’s Hospital, 401 Park Drive, Boston, MA, 02215, USA

    Simon Warfield

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  1. Jade Iwasaka-Neder
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  5. Sarah D. Bixby
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Contributions

S.D.B. conceived, supervised, and supported the study. M.A.B. advised study design, analysis, and manuscript structure. J.I.N. collated the data, performed statistical analysis, coordinated study design, drafted the initial manuscript and illustrations, and oversaw all aspects of study design. S.D.B. and M.A.B. interpreted the images. J.C. supported experimental sequence implementation and technical quality of images. S.W. advised study design and analysis. All authors reviewed and approved the final manuscript.

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Correspondence to Jade Iwasaka-Neder.

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Iwasaka-Neder, J., Bedoya, M.A., Connors, J. et al. Morphometric and clinical comparison of MRI-based synthetic CT to conventional CT of the hip in children. Pediatr Radiol 54, 743–757 (2024). https://doi.org/10.1007/s00247-024-05888-7

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  • DOI: https://doi.org/10.1007/s00247-024-05888-7

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