Exponential subtraction in 3D ultrashort echo time imaging to visualize short T2 tissues in tibia

Background Short T2 tissues can be directly visualized by dual-echo ultrashort echo time imaging with weighted subtraction. As a type of post-processing method, exponential subtraction of ultrashort echo time images with an optimal exponential factor is expected to provide improved positive short T2 contrast. Purpose To test the feasibility and effectiveness of exponential subtraction in three-dimensional ultrashort echo time imaging and to determine the optimal exponential factor. Material and Methods A dual-echo three-dimensional ultrashort echo time sequence was implemented on a 3-T MRI system. Exponential subtraction was performed on dual three-dimensional ultrashort echo time images of the tibia of seven healthy volunteers with exponential factors in the range of 1.00–3.00 in increments of 0.01. The regions of interest, including cortical bone, marrow, and muscle, were depicted on subtracted images of different exponential factors. Contrast-to-noise ratio values were calculated from these regions of interest and then used to assess the optimal exponential factor. To determine intra-observer agreement regarding region of interest selection, paired intra-observer measurements of regions of interest in all direct subtraction images were conducted with a one-week interval and the paired measurements were assessed using Bland–Altman analysis and paired-samples t-test. Results Cortical bone can be better visualized by using exponential subtraction in three-dimensional ultrashort echo time imaging; the suggested optimal exponential factor is 1.99–2.03 in the tibia. Paired measurements showed excellent intra-observer agreement. Conclusion It is feasible to visualize cortical bone of the tibia using exponential subtraction in three-dimensional ultrashort echo time imaging. Compared with weighted subtraction images, exponential subtraction images with an optimal exponential factor provide enhanced visualization of short T2 tissues.