Optimization of cervical cord synthetic T1-weighted MRI for enhancing clinical application

Motivation: MRI acquisition time is a critical factor for patient comfort and motion artifacts. To reduce total acquisition time, synthetic MRI is a flexible solution. Goal(s): To optimize synthetic T1-w (synT1-w) MRI for increasing the accuracy (i.e. difference between synT1-w and MPRAGE) of spinal cord cross-sectional area measurements. Approach: We optimized and validated synT1-w for tracking neurodegeneration in the cervical cord after spinal cord injury and assessed the required sample size for detecting hypothetical treatment effects. Results: Accuracy of synT1-w improved considerably with a minor remaining bias of -0.5% compared to MPRAGE. 13.5% less participants are required when using synT1-w instead of MPRAGE. Impact: Synthetic MRI can help to optimize imaging protocols in clinical trials by reducing acquisition time and the number of required participants. By improving the accuracy of synthetic T1-weighted images, better comparability with different studies using acquired MRI can be achieved.