Fat Suppression in Distal Extremity 3-T MRI Using Spectral Heterogeneity Adaptive Radiofrequency Pulses

Background Conventional chemical shift selective (CHESS) fat suppression may fail in distal extremity MRI due to sensitivity to field inhomogeneities. Purpose To develop a patient-specific fat-suppression method for distal extremity 3-T MRI by exploiting the spectral heterogeneity adaptive radiofrequency pulse (SHARP) technique and to compare it to fat suppression with CHESS. Materials and Methods SHARP uses the routinely acquired frequency spectrum at MRI calibration to adapt the frequency range and time-bandwidth product of the fat-suppression pulse. In this prospective study, fat suppression by SHARP was assessed by numerical simulations, phantom experiments, and imaging in 15 asymptomatic participants who underwent ankle, foot, and hand (in superman and hand-by-the-side positions) MRI using SHARP, CHESS, and reference standard (short-tau inversion recovery or Dixon) techniques. Three readers ranked the MRI scans from 1 (best) to 3 (worst) regarding fat-suppression homogeneity. The added value of SHARP was defined as the difference between the proportions of images where SHARP outranked CHESS and where CHESS outranked SHARP. Friedman, Wilcoxon signed rank, and χ² tests were used to compare in vivo data. Results At numerical simulations, SHARP showed 0% water and 62%-70% fat suppression, whereas CHESS showed 2% water and 57% fat suppression. Phantom data demonstrated lower fat-suppression inhomogeneity indexes with Dixon (1.0%) and SHARP (2.4%) compared with CHESS (10.7%). In 15 participants (mean age, 38.5 years ± 12.8 [SD]; six female participants), mean ranking by readers of fat homogeneity in the reference technique (ankle, foot, hand in superman position, and hand-by-the-side position: 1.02, 1.02, 1.03, and 1.06, respectively) was higher than those with SHARP (1.39, 1.46, 1.50, and 1.66, respectively), which were higher than those with CHESS (1.64, 1.80, 1.61, and 1.80, respectively) (all <i>P</i> < .001). The added value of SHARP was highest for images in the foot (389 of 1158; 33.6%; <i>P</i> < .001 vs other joints), followed by the ankle (247 of 971 [25%]; <i>P</i> < .001 vs both hand positions), and lowest for hand-by-the-side and hand in superman positions (158 of 1223; [13%] and 133 of 1193 [11%], respectively; <i>P</i> = .18). Conclusion SHARP provided more homogeneous fat suppression than CHESS. © RSNA, 2024 <i>Supplemental material is available for this article.</i>