Deep learning reconstruction for optimized bone assessment in zero echo time MR imaging of the knee

PurposeTo evaluate the impact of deep learning-based reconstruction (DLRecon) on bone assessment in zero echo-time (ZTE) MRI of the knee at 1.5 Tesla.MethodsThis retrospective study included 48 consecutive exams of 46 patients (23 females) who underwent clinically indicated knee MRI at 1.5 Tesla. Standard imaging protocol comprised a sagittal prescribed, isotropic ZTE sequence. ZTE image reconstruction was performed with a standard-of-care (non-DL) and prototype DLRecon method. Exams were divided into subsets with and without osseous pathology based on the radiology report. Using a 4-point scale, two blinded readers qualitatively graded features of bone depiction including artifacts and conspicuity of pathology including diagnostic certainty in the respective subsets. Quantitatively, one reader measured signal-to-noise ratio (SNR) and contrast-to-noise ratio (CNR) of bone. Comparative analyses were conducted to assess the differences between the reconstruction methods. In addition, interreader agreement was calculated for the qualitative gradings.ResultsDLRecon significantly improved gradings for bone depiction relative to non-DL reconstruction (all, p < 0.05), while there was no significant difference with regards to artifacts (both, median score of 0; p = 0.058). In the subset with pathologies, conspicuity of pathology and diagnostic confidence were also scored significantly higher in DLRecon compared to non-DL (median 3 vs 2; p ≤ 0.03). Interreader agreement ranged from moderate to almost-perfect (κ = 0.54–0.88). Quantitatively, DLRecon demonstrated significantly enhanced CNR and SNR of bone compared to non-DL (p < 0.001).ConclusionZTE MRI with DLRecon improved bone depiction in the knee, compared to non-DL. Additionally, DLRecon increased conspicuity of osseous findings together with diagnostic certainty.