MRI-only Comprehensive Musculoskeletal Imaging
Multi-echo UTE, CG-SENSE, and deep learning-based reconstruction enabled comprehensive imaging of all musculoskeletal tissues in under 10 minutes, making what was previously impossible achievable.
This work addresses three interrelated challenges in musculoskeletal (MSK) imaging.
First, Medicare and Medicaid reimbursement for MRI has steadily declined. Huang et al. (Clinical Imaging, 2025) reported that reimbursement for extremity MRI in 2025 has decreased by up to 77% compared with its peak in 2004. These economic pressures motivate the development of faster MSK MRI examinations.
Second, short-T2 tissues including tendons, ligaments, and menisci are poorly visualized by CT and by standard-of-care routine MSK MRI until relatively late stages of injury or disease, when they appear hyperintense or morphologically deformed on conventional MRI. Earlier visualization and quantitative assessment of short-T2 tissues would enable not only earlier detection but also more objective evaluation of disease progression and treatment response.
Third, when comprehensive assessment of both bone and soft tissue is required, patients typically undergo both CT and MRI examinations. Although MRI may not fully replace CT, MRI-derived CT-like bone-weighted images can, when appropriate, obviate the need for a CT scan, thereby streamlining clinical workflow, reducing costs, and eliminating ionizing radiation exposure, particularly important for pediatric and pregnant patients and for individuals requiring repeated CT imaging.
Zero-echo-time (ZTE) and single-echo ultrashort-echo-time (UTE) techniques have demonstrated the ability to provide CT-like bone-weighted contrast; however, they do not provide assessment of short-T2 tissues. Multi-echo UTE allows simultaneous generation of CT-like contrast and quantitative T2* mapping of short-T2 tissues, but its clinical adoption has been limited because of long scan times and insufficient spatial resolution.
In this work, we demonstrate the feasibility of a fast, 2-minute multi-echo UTE acquisition that provides CT-like bone-weighted contrast and quantitative T2* mapping of short-T2 tissues. With the integration of deep learning-based reconstruction (MRI-DLR), routine MSK MRI can be completed in under 8 minutes. Together, this enables a comprehensive MRI-only MSK examination in under 10 minutes.
Total scan time can be further reduced by combining a 2-minute multi-echo UTE acquisition with an abbreviated musculoskeletal (MSK) MRI protocol, in which sequences are selected to maximize diagnostic yield per unit scan time. The abbreviated MSK-MRI protocol is indication-specific and can be completed in well under 3 minutes.
Together, this approach enables a comprehensive, MRI-only MSK examination in under 5 minutes. As a result, a single MRI-only exam can provide information traditionally obtained from both MRI and CT, while achieving CT-like throughput. This capability has the potential to position MRI as a first-line imaging modality, particularly by reducing or eliminating the need for subsequent MRI and/or CT examinations.
Whitepaper:
Peer-reviewed publications accepted as oral presentations:
- HP Do, et al. "Accelerated 1.2-minute 4-echo UTE-based CT-like Imaging using CG-SENSE and Deep Learning-based Denoising Reconstruction (DLR).” International Society for Magnetic Resonance in Medicine Scientific Meeting, Hawaii, May 2025. SLIDES-PDF VIDEO-YouTube
- HP Do, et al. "Accelerated 2-3-Minute Multi-echo Ultra-short Echo Time (mecho UTE) using Conjugate Gradient SENSE (CG-SENSE) Reconstruction.” The Radiological Society of North America (RSNA) Scientific Session, Chicago, Nov 2023. SLIDES-PDF VIDEO-YouTube
- HP Do, et al. "Eleven-minute Comprehensive MSK Imaging Using Deep Learning Reconstruction (DLR) and Multi-echo Ultrashort Echo-Time (UTE)." The Radiological Society of North America (RSNA) Scientific Session, Chicago, Nov 2022. SLIDES-PDF
High-level overview