Optimization of a double inversion recovery sequence for noninvasive synovium imaging of joint effusion in the knee

Purpose: We wanted to optimize a double inversion recovery (DIR) sequence to image joint effusion regions of the knee, especially intracapsular or intrasynovial imaging in the suprapatellar bursa and patellofemoral joint space. Methods: Computer simulations were performed to determine the optimum inversion times (TI) for suppressing both fat and water signals, and a DIR sequence was optimized based on the simulations for distinguishing synovitis from fluid. In vivo studies were also performed on individuals who showed joint effusion on routine knee MR images to demonstrate the feasibility of using the DIR sequence with a 3T whole-body MR scanner. To compare intracapsular or intrasynovial signals on the DIR images, intermediate density-weighted images and/or post-enhanced T₁-weighted images were acquired. Results: The timings to enhance the synovial contrast from the fluid components were TI₁ 2830 ms and TI₂ 254 ms for suppressing the water and fat signals, respectively. Improved contrast for the intrasynovial area in the knees was observed with the DIR turbo spin-echo pulse sequence compared to the intermediate density-weighted sequence. Conclusions: Imaging contrast obtained noninvasively with the DIR sequence was similar to that of the post-enhanced T₁-weighted sequence. The DIR sequence may be useful for delineating synovium without using contrast materials.