Fat saturation in dynamic breast MRI at 3 Tesla: is the Dixon technique superior to spectral fat saturation? A visual grading characteristics study

AbstractPurposeTo intra-individually compare the diagnostic image quality of Dixon and spectral fat suppression at 3 T.MethodsFifty consecutive patients (mean age 55.1 years) undergoing 3 T breast MRI were recruited for this prospective study. The image protocol included pre-contrast and delayed post-contrast spectral and Dixon fat-suppressed T1w series. Two independent blinded readers compared spectral and Dixon fat-suppressed series by evaluating six ordinal (1 worst to 5 best) image quality criteria (image quality, delineation of anatomical structures, fat suppression in the breast and axilla, lesion delineation and internal enhancement). Breast density and size were assessed. Data analysis included Spearman’s rank correlation coefficient and visual grading characteristics (VGC) analysis.ResultsFour examinations were excluded; 48 examinations in 46 patients were evaluated. In VGC analysis, the Dixon technique was superior regarding image quality criteria analysed (P < 0.01). Smaller breast size and lower breast density were significantly (P < 0.01) correlated with impaired spectral fat suppression quality. No such correlation was identified for the Dixon technique, which showed reconstruction-based water-fat mixups leading to insufficient image quality in 20.8 %.ConclusionsThe Dixon technique outperformed spectral fat suppression in all evaluated criteria (P < 0.01). Non-diagnostic examinations can be avoided by fat and water image reconstruction. The superior image quality of the Dixon technique can improve breast MRI interpretation.Key Points• Optimal fat suppression quality is necessary for optimal image interpretation • Superior fat suppression quality is achieved using the Dixon technique • Lesion margin and internal enhancement evaluation improves using the Dixon technique • Superior image quality of the Dixon technique improves breast MRI interpretation