Multicentre Evaluation of Spinal Bone Pathologies Using Zero Echo Time (ZTE) Pseudo-CT MRI Sequences: a Clinical Implementation Study

Magnetic resonance imaging (MRI) is the gold-standard modality for examining the bone marrow and soft tissues of the spine, thanks to its excellent contrast resolution. It enables precise visualization of the intervertebral discs, nerve roots, and spinal cord. However, its ability to visualize bone mineral remains limited due to the rapid decay of the T2 signal and the inability of conventional sequences to capture signals from tissues with very short relaxation times. Consequently, assessing bone structures-such as cortical or trabecular bone, osteophytes, or fractures-remains challenging, particularly in cases of complex pathologies.

Innovative sequences known as "pseudo-CT" sequences-such as Ultrashort Echo Time (UTE) and Zero Echo Time (ZTE)-enable the capture of signals from tissues with very short T2 relaxation times and provide good visualization of mineralized bone. These new sequences appear to enhance MRI performance in the detection of fractures, spondylolysis, and other bone abnormalities.

Despite the promising potential of "pseudo-CT" sequences, studies comparing them to conventional CT and MRI sequences remain limited, as do data regarding their overall clinical benefit. Further research is therefore needed to evaluate their diagnostic value, their ability to improve patient management, and their potential to reduce the need for other imaging examinations.