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Schlaeger, Sarah; Weidlich, Dominik; Klupp, Elisabeth; Montagnese, Federica; Deschauer, Marcus; Schoser, Benedikt; Bublitz, Sarah; Ruschke, Stefan; Zimmer, Claus; Rummeny, Ernst J.; Kirschke, Jan S. and Karampinos, Dimitrios C. (2019): Water T-2 Mapping in Fatty Infiltrated Thigh Muscles of Patients With Neuromuscular Diseases Using a T-2-Prepared 3D Turbo Spin Echo With SPAIR. In: Journal of Magnetic Resonance Imaging, Vol. 51, No. 6: pp. 1727-1736

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Background Muscle water T-2 (T-2w) has been proposed as a biomarker to monitor disease activity and therapy effectiveness in patients with neuromuscular diseases (NMD). Multi-echo spin-echo (MESE) is known to be affected by fatty infiltration. A T-2-prepared 3D turbo spin echo (TSE) is an alternative method for T-2 mapping, but has been only applied in healthy muscles. Purpose To examine the performance of T-2-prepared 3D TSE in combination with spectral adiabatic inversion recovery (SPAIR) in measuring T-2w in fatty infiltrated muscles based on simulations and in vivo measurements in thigh muscles of patients with NMD. Study Type Prospective. Subjects One healthy volunteer, 34 NMD patients. Field Strength/Sequence T-2-prepared stimulated echo acquisition mode (STEAM) magnetic resonance spectroscopy (MRS), SPAIR STEAM MRS, and SPAIR T-2-prepared STEAM MRS were performed in the subcutaneous fat of a healthy volunteer's thigh. T-2 mapping based on SPAIR 2D MESE and SPAIR T-2-prepared 3D TSE was performed in the NMD patients' thigh region. Multi-TE STEAM MRS was performed for measuring a reference T-2w at different thigh locations. Assessment The behavior of the fat spectrum in the SPAIR T-2-prepared 3D TSE was simulated using Bloch simulations. The in vivo T-2 results of the imaging methods were compared to the in vivo T-2w MRS results. Statistical Tests Pearson correlation coefficient with slope and intercept, relative error. Results The simulated T-2 for the SPAIR T-2-prepared 3D TSE sequence remained constant within a relative error of not more than 4% up to a fat fraction of 80%. In vivo T-2 values of SPAIR T-2-prepared 3D TSE were in good agreement with the T-2w values of STEAM MRS (R = 0.86;slope = 1.12;intercept = -1.41 ms). In vivo T-2 values of SPAIR 2D MESE showed large deviations from the T-2w values of STEAM MRS (R = 0.14;slope = 0.32;intercept = 38.83 ms). Data Conclusion The proposed SPAIR T-2-prepared 3D TSE shows reduced sensitivity to fatty infiltration for T-2w mapping in the thigh muscles of NMD patients. Level of Evidence 1 Technical Efficacy Stage 1

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