High-Resolution 2D versus 3D Lumbar Spine MRI Optimized with a Deep Learning Reconstruction Algorithm and Prototype Conformal Coil

Clinical Snapshot

Key Findings

• P Value: Not reported for primary comparisons

• Effect Size: 14% overall scan time reduction with 3D sequences, 38% reduction for T2 sequences

• Primary Outcome: Image quality comparison between 2D and 3D MRI sequences

• Nnt Or Sensitivity: Excellent interrater agreement for spinal canal area (ICC >0.94 for both techniques)

• Confidence Interval: ICC 0.941 (95% CI: 0.866-0.973) for 3D spinal canal assessment

Clinical Application

Limited by requirement for prototype conformal coil and specialized DLR software not widely available Potential for PBS consideration if technology becomes commercially available and demonstrates cost-effectiveness. Would require TGA approval for new coil technology. Adults requiring lumbar spine MRI, particularly those with spinal curvature

Abstract

BACKGROUND AND PURPOSE: Lumbar spine MRI is predominantly performed using 2D FSE sequences. 3D FSE sequences offer potential advantages over 2D, especially with recent advances in deep-learning reconstruction (DLR) and the use of conformal high-density coil arrays to improve the SNR. This study aimed to compare image quality and diagnostically relevant differences between 2D and 3D lumbar spine protocols, both using a prototype conformal coil and DLR. MATERIALS AND METHODS: Subjects with lumbar curvature referred for routine lumbar spine MRI were prospectively recruited (n=31). A prototype, conformal spine coil array with 70 total posterior receiver elements was used at 3T. DLR was applied to both the 2D- and 3D-protocols to improve sharpness and reduce noise. For 3D, a prototype DLR ("Sonic DL") technique was applied to provide higher acceleration factors. Three attending musculoskeletal radiologists assessed 2D and 3D T1-weighted (T1), T2-weighted (T2), and STIR sequences for image quality and diagnostic performance. The Gwet agreement coefficient (AC1, AC2) or intraclass correlation (ICC) was used to assess interrater agreement, while the Wilcoxon signed rank test or a sign test with Bonferroni correction assessed differences between 2D and 3D sequences. RESULTS: There was an overall 14% scan time reduction of 3D compared with 2D sequences, and a 38% time reduction for T2 sequences. All 3D sequences exhibited similar image quality to 2D. 3D T2 sequences had less CSF flow artifact than 2D T2 sequences. Interrater agreement was mostly comparable between all 2D and 3D assessments, including excellent agreement for the spinal canal area (ICC = 0.952 [95% CI: 0.907-0.976] for 2D, 0.941 [0.866-0.973] for 3D), good agreement for foraminal stenosis assessments on T2 sequences (AC2 = 0.713 to 0.795 for 2D, 0.706-0.832 for 3D), and good agreement for fracture detection on T1 sequences (AC1 = 0.869 for 2D, 0.815 for 3D). CONCLUSIONS: DLR-enabled 3D lumbar spine MRI offers comparable image quality to 2D with reduced overall scan time.

References

1. 1.Sahr, M., Lowe, A., Sneag, D. B., Stickle, Y.-J., Wen, Y., Follante, C., Giancola, M., Wang, S.-H., Alschuler, D. M., Chazen, J. L., Kijowski, R., Robb, F., & Tan, E. T. (2026). High-Resolution 2D versus 3D Lumbar Spine MRI Optimized with a Deep Learning Reconstruction Algorithm and Prototype Conformal Coil. *AJNR American Journal of Neuroradiology*. https://doi.org/10.3174/ajnr.A9141