# FRACTURE MRI: evaluation of imaging capability in hand tendon visualization using healthy volunteer MRI

## TL;DR

This study shows that a new MRI technique called FRACTURE provides clearer images of hand tendons than traditional methods, which could help improve surgical planning.

## Contribution

The study introduces FRACTURE MRI as a novel imaging method with superior tendon visualization and volume rendering capabilities.

## Key findings

- FRACTURE MRI outperformed PD-VISTA and T2WI in tendon conspicuity with statistically significant results.
- FRACTURE-derived VR images provided detailed 3D tendon visualization with high agreement among readers.
- FRACTURE showed higher contrast-to-noise ratios and smaller tendon cross-sectional area measurements compared to other sequences.

## Abstract

To evaluate the conspicuity of fast field echo resembling a CT using restricted echo-spacing (FRACTURE) in visualizing hand tendons and assess the utility of FRACTURE-derived volume rendering (VR) images using MRI in healthy individuals.

This prospective observational study enrolled ten healthy volunteers who underwent MRI, including FRACTURE, three-dimensional proton density-weighted volume isotropic turbo spin-echo acquisition (PD-VISTA), and two-dimensional T2-weighted image (T2WI) in neutral and ulnar deviation positions. VR images depicting bones and tendons were created from FRACTURE data. Twenty-four flexor and extensor tendons were qualitatively evaluated by four experienced readers using a 5-point scale for cross-sectional images (including FRACTURE inversion) and a 3-point scale for VR images. Quantitative analysis included tendon cross-sectional area measurements and contrast-to-noise ratio (CNR) calculations. Inter- and intra-reader reliability and FRACTURE-inversion agreement were assessed using weighted kappa coefficients. Statistical analysis included an ordinal mixed-effects model, Bland–Altman analysis, correlation coefficients, and paired t-tests.

Ten healthy volunteers (5 men, 5 women, mean age 37.4 ± 9.1 years) were evaluated. FRACTURE achieved the highest qualitative scores (3.30 ± 0.364) compared to PD-VISTA (3.09 ± 0.265) and T2WI (2.60 ± 0.509), showing statistically significant superiority by ordinal mixed-effects modeling (p < 0.001). FRACTURE inversion showed high agreement with FRACTURE (weighted kappa = 0.975). Tendon cross-sectional area measurements showed strong correlations between sequences (r = 0.680–0.740) but significant systematic bias (p < 0.017), with FRACTURE measuring consistently smaller areas. FRACTURE demonstrated significantly higher CNR for muscle-tendon comparisons (12.63 ± 1.088 vs 7.911 ± 1.746, p < 0.017).

FRACTURE provides superior hand tendon visualization compared to conventional MRI sequences, with potential value for clinical practice.

FRACTURE showed superior hand tendon visualization compared to T2WI and PD-VISTA, potentially helping assess anatomical variations. VR images provide a three-dimensional understanding of the hand tendon structure. These capabilities could enhance surgical planning and procedure selection in hand surgery.

FRACTURE performs better than T2WI and PD-VISTA for evaluating hand tendons.FRACTURE provides excellent contrast, enabling the creation of VR images.FRACTURE could serve as an aid in surgical planning and procedure selection, with the potential to improve hand surgery practice.

FRACTURE performs better than T2WI and PD-VISTA for evaluating hand tendons.

FRACTURE provides excellent contrast, enabling the creation of VR images.

FRACTURE could serve as an aid in surgical planning and procedure selection, with the potential to improve hand surgery practice.