Added Value of 3D Fast-field-echo (FRACTURE) Sequences for Cervical Spondylosis Diagnosis: A Prospective Multi-Reader Non-Inferiority Study

Motivation: MRI is still insufficient in the evaluation of bone abnormalities. Goal(s): To assess the diagnostic performance of fast field echo resembling a CT using restricted echo-spacing (FRACTURE) in detecting cervical bone abnormalities. Approach: 137 consecutive patients with cervical spondylosis were continuously enrolled. CT, routine MRI and 3D-FRACTURE sequences were performed. Three radiologists independently evaluated osteophytes, bony foraminal stenosis, posterior longitudinal ligament ossification (OPLL). Results: Good to excellent inter-rater reliability for FRACTURE with CT (osteophytes: ICC, 0.83-1.00; OPLL: ICC, 0.73-0.92; bony foraminal stenosis: ICC, 0.76-0.98), which was superior to conventional MRI.FRACTURE passed the non-inferiority test within a margin of 0.5 with higher diagnostic confidence. Impact: The FRACTURE protocol demonstrated comparable performance to CT in assessing bone abnormalities in cervical spondylosis, offering the potential to reduce radiation exposure and streamline the diagnostic process for patients.