MRI-Based Synthetic CT Shows Promise as a Radiation-Free Alternative to Conventional CT in Orthopaedics

➢ Computed tomography (CT) remains the gold standard for bone imaging, but radiation risks, especially in children, are driving interest in alternatives.➢ Magnetic resonance imaging (MRI)-based techniques are emerging as a radiation-free alternative to CT, using sequences such as zero echo time, ultrashort echo time, and 3-dimensional (3D) gradient recalled echo, along with deep learning-based synthetic CT.➢ Zero echo time MRI stands out for its high-resolution and silent imaging, whereas 3D gradient recalled echo offers widespread availability and minimal requirements for implementation.➢ Early studies have shown high agreement of all modalities with CT across multiple anatomical sites, supporting broader clinical use, especially in pediatrics, surgical planning, and cost-reduction efforts.➢ Deep learning-based synthetic CT demonstrates strong potential given its ability to improve over time and to generate highly accurate CT-like images, although current applications are limited by existing training data.