PERBEDAAN INFORMASI CITRA ANATOMI MRI GENU PADA APLIKASI

SHORT TE DAN ULTRASHORT TE (UTE) (STUDI KOMPARASI CITRA MRI

GENU PEMBOBOTAN T1WI TURBO SPIN ECHO (TSE)).

THE ANATOMICAL INFORMATION DIFFERENCES BETWEEN THE APPLICATION OF SHORT TE

AND ULTRASHOT TE (UTE) ON KNEE MRI
(A COMPARATIVE STUDY ON KNEE MRI IMAGES WITH T1WI TURBO SPIN ECHO (TSE))

I Made Lana Prasetya1, Gatot Murti Wibowo2, I Bagus Gede Dharmawan 3

1
Poltekkes Kemenkes Semarang
2
Poltekkes Kemenkes Semarang
3
Rumah Sakit Umum Prima Medika Denpasar
E-mail: lanaprasetya182@gmail.com

ABSTRACT

Penelitian ini ingin mengetahui perbedaan informasi anatomi dengan menggunakan pembobotan antara T1WI TSE
Short TE dengan T1WI TSE UTE pada pemeriksaan MRI Genu. Penelitian ini adalah kuantitatif dengan pendekatan
eksperimen berupa citra T1WI TSE MRI Genu sequences sagital dari 30 pasien dengan 2 Aplikasi Short TE dan
Ultrashort TE (UTE). Penilaian data informasi anatomis dilakukan oleh 2 orang responden. Analisis data dilakukan
dengan uji beda. Hasil penelitian menunjukan ada perbedaan informasi anatomis MRI Genu sequences sagital T1WI
TSE Short TE dengan T1WI TSE UTE (0,000). Aplikasi UTE merupakan aplikasi yang lebih jelas dalam menampilkan
informasi anatomis genu. MRI Genu sequences sagital pembobotan T1WI TSE UTE memperoleh nilai mean rank 83,00
sedangkan T1WI TSE Short TE 0 sehingga dapat diartikan T1WI TSE UTE adalah citra yang optimal.

Kata Kunci : Ultrashort TE, Short TE, MRI Genu.

PENDAHULUAN
Rumah Sakit Umum Daerah Badung telah banyak kasus musculoskeletal yang diperiksa menggunakan
MRI, diantaranya adalah MRI Genu. Pemeriksaan ini menggunakan beberapa sequens standar salah
satunya pembobotan T1WI TSE dengan potongan axial dan sagittal dengan nilai TE pada potongan sagittal
18 ms. Menurut Bryan (2001) informasi diagnostic yang dapat dilihat dari MRI genu adalah meniscus,
ligament pada lutut (soft tissue), join effusion (cairan) dan bony surfaces (tulang). Menurut Westbrook dan
Kaut (2011) T1WI adalah waktu yang diperlukan untuk kembalinya 63% magnetisasi longitudinal setelah
pulse 90o sedangkan TSE (turbo spin echo) merupakan spin echo tapi dengan waktu scanning yang
dipersingkat. Waktu scanning dipersingkat dengan cara melakukan lebih dari satu phase encode per TR
yang dikenal dengan echo train yakni aplikasi beberapa RF (Radio Frequency) pulse per TR (Time
Repetition) dan pada masing-masing rephrasing atau refocusing dihasilkan satu echo sehingga dapat
melakukan phase encod yang lain. Parameter TSE pada T1 memiliki rentang nilai TR yang pendek berkisar
antara 400 ms sampai dengan 800 ms dengan nilai TE yang pendek / Short TE pula berkisar antara 10 ms
sampai dengan 25 ms. Ultrashort time echo (UTE) merupakan suatu pulse sequence yang bertujuan untuk
mendeteksi sinyal dari jaringan yang memiliki nilai T2 yang pendek dengan menggunakan nilai TE yang lebih
kecil dari nilai TE T1WI konvensional, dimana nilai TE pada UTE berkisar antara 0, 07 ms sampai dengan
10 ms (Reichert, 2005). Menurut penelitian Robson 2003, UTE dapat di gunakan pada beberapa pulse
sequence yaitu conventional MRI (T1W, T2W, Proton Density), Fat-Suppressed, Long T2-suppressed, Fat
and long T2-suppressed ultrashort TE, Short TI Inversion time ultrashort TE, Medium TI inversion time
ultrashort TE. Sehingga penelitian ini bertujuan untuk mengetahui perbedaan informasi citra antara
pembobotan T1WI TSE Short TE dengan pembobotan T1WI TSE UTE pada pemeriksaan MRI Genu dan
untuk mengetahui manakah yang paling optimal antara pembobotan T1WI TSE Short TE dengan pembobotan
T1WI TSE UTE pada pemeriksaan MRI Genu.

METODE
Jenis penelitian kuantitatif dengan pendekatan eksperimental. Waktu pengambilan data pada penelitian
ini dimulai pada bulan Maret sampai dengan bulan Mei 2017 di bagian MRI Instalasi Radiologi Rumah Sakit
Umum Daerah Badung.
Prosedur dalam penelitian ini adalah mengambil sampel penelitian sebanyak 30 sampel. Pemeriksaan
fisik yang dilakukan oleh dokter spesialis orthopedic kepada seluruh calon sampel. Sukarelawan diberikan
informed consent tentang maksud dan tujuan penelitian, serta diberi penjelasan tentang prosedur
pemeriksaan, serta diyakinkan bahwa penelitian ini tidak berbahaya bagi mereka. Sukarelawan diukur tinggi
dan berat badannya untuk perhitungan IMT (Indeks Massa Tubuh). Pembuatan citra MRI Genu diawali
dengan membuat 3 plane localizer. Selanjutnya dilakukan pembuatan citra MRI Genu T1 Weighted TSE
Sagital dan T1 Weighted TSE UTE Sagital. Setiap sukarelawan dilakukan scanning dengan dua variasi
metode T1 Weighted yaitu metode TSE dan TSE UTE. Citra hasil penelitian tersebut disimpan dalam CD
dengan format DICOM tanpa ada keterangan identitas apapun, hanya diberikan kode serial citra. Dua orang
dokter spesialis radiologi yang berpengalaman di bidang MRI 1.5 Tesla dimohon untuk mencermati citra dari
masing-masing gambar. Penilaian kualitatif berupa menilai kontras citra secara umum, anterior cruciate
ligament, posterior cruciate ligament, medial dan collateral ligament, medial dan lateral patella retinaculae,
capsule joint, dan menisci knee, serta memilih citra terbaik dari dua variasi metode T1 Weighted TSE
tersebut. Penilaian dokter spesialis radiologi dilakukan dengan memberikan tanda check (√) pada kuisioner
yang telah disediakan. Analisis data dilakukan dengan cara menggunakan komputerisasi program SPSS.

HASIL
Penelitian telah dilakukan terhadap 30 (tiga puluh) data pasien berjenis kelamin laki-laki sebanya 19 orang
dan perempuan sebanyak 11 orang dapat dilihat pada tabel 1, rentang usia antara 19 tahun sampai 25 tahun
dengan jumlah yang dapat dilihat dari tabel 2. Adapun pengelompokan voluntir tersebut di bagi atas tiga
kelompok indeks massa tubuh yaitu under weight, normal, dan over weight yang dapat dilihat pada tabel 3.

Tabel 1. Karakteristik Data Pasien berdasarkan Jenis Kelamin

Jenis Kelamin Jumlah Persentase
Laki-Laki 19 63,3%
Perempuan 11 36,7%
Total 30 100%
Sumber : data penelitian hasil SPSS 16

Tabel 2. Karakterikstik Data Pasien berdasarkan Umur

Umur Jumlah Persentase
19 3 10%
20 5 16,7%
21 5 16,7%
22 2 6,7%
23 3 10%
24 4 13,3%
25 8 26,7%
Total 30 100%
Sumber : data penelitian hasil SPSS 16

Tabel 3. Karakteristik Data Pasien berdasarkan Indeks Massa Tubuh

Indeks Massa Tubuh Jumlah Persentase
Under Weight 2 6.7%
Normal 22 73.3%
Over Weight 6 20.0%
Total 30 100%
Sumber : data penelitian hasil SPSS 16

Dari keseluruhan data pasien tersebut diperoleh informasi anatomi MRI Genu dengan dua perbedaan
pembobotan T1WI TSE Short TE dan T1WI TSE UTE. Masing-masing pembobotan tersebut menghasilkan
citra yang dapat menampakkan anatomi Anterior Cruciate Ligament, Posterior Cruciate Ligament, Medial
Collateral Ligament, Lateral Collateral Ligament, Medial Dan Lateral Patella Retinaculae, Medial Menisci
Knee, dan Lateral Menisci Knee. Setiap pasien dilakukan 2 (dua) pembobotan T1WI TSE Short TE dengan
nilai TE 18 ms dan pembobotan T1WI TSE UTE dengan nilai TE 9ms.
Dari hasil penelitian tersebut dilakukan penilaian oleh 2 responden yaitu dokter spesialis Radiologi yang
sudah berpengalaman dalam menilai pemeriksaan MRI Genu. Sebelum dilakukan uji statistik untuk
mengetahui Perbedaan Informasi Citra Anatomi MRI Genu Antara Pembobotan T1WI TSE Short TE dan T1WI
TSE Ultrashort TE (UTE), dilakukan pengujian kappa test untuk mengetahui kesesuaian atau kesamaan
persepsi responden dalam penilaian kuisioner. Adapun hasil pengujian kappa test terhadap 2 responden
memiliki kesamaan presepsi dalam menilai informasi Citra Anatomi MRI Genu pada kedua pembobotan (P1
= 0,852; P2 = 0,813)
Uji beda dilakukan pada Informasi citra secara general atau menyeluruh dengan membandingkan nilai
total dari keseluruhan kriteria anatomi yang dapat dinilai pada sebuah citra MRI Genu pada pembobotan
T1WI TSE Short TE dan pembobotan T1WI TSE Ultrashort TE (UTE) pada kedua responden. Berdasarkan
uji beda yang telah dilakukan, maka didapatkan hasil sebagai berikut.:

Tabel 4. Hasil Uji Beda antara T1WI TSE Short TE dan T1WI TSE UTE
Perbedaan Aplikasi p value
Pembobotan T1WI TSE Short TE 0.000
dan T1WI TSE UTE
Sumber : data penelitian hasil SPSS 16

Dengan p value <0,001 (p <0,05), dapat dinyatakan bahwa terdapat perbedaan informasi citra MRI Genu
antara pembobotan T1WI TSE Short TE dan pembobotan T1WI TSE Ultra Short TE (UTE). Selain itu
dilakukan juga uji beda pada setiap kriteria anatomis. Berdasarkan uji beda yang telah dilakukan tersebut
didapatkan hasil sebagai berikut :

Tabel 5. Hasil Uji Beda per-kriteria antara pembobotan T1WI TSE Short TE dan pembobotan T1WI TSE
UTE
Informasi anatomis p value
Anterior Cruciate Ligament Short TE – 0,000
Anterior Cruciate Ligament UTE
Posterior Cruciate Ligament Short TE – 0,000
Posterior Cruciate Ligament UTE
Medial Collateral Ligament Short TE – 0,000
Medial Collateral Ligament UTE
Lateral Collateral Ligament Short TE – 0,000
Lateral Collateral Ligament UTE
Medial Dan Lateral Patella Retinaculae 0,000
Short TE – Medial Dan Lateral Patella
Retinaculae UTE
Medial Menisci Knee Short TE – Medial 0,000
Menisci Knee UTE
Lateral Menisci Knee Short TE – Lateral 0,000
Menisci Knee UTE
Sumber : data penelitian hasil SPSS 16

Seluruh kriteria anatomi memiliki p value = <0,001 atau (p value < 0,05). Hal ini menunjukkan terdapat
perbedaan informasi anatomis pada kriteria anatomis Anterior Cruciate Ligament, Posterior Cruciate
Ligament, Medial Collateral Ligament, Lateral Collateral Ligament, Medial Dan Lateral Patella Retinaculae,
Medial Menisci Knee, dan Lateral Menisci Knee antara pembobotan T1WI TSE Short TE dan T1WI TSE UTE.
Uji beda mean rank antara pembobotan T1WI TSE Short TE dan T1WI TSE UTE dilakukan untuk
mengetahui pembobotan yang paling optimal dalam menggambarkan informasi citra Genu pada
pemeriksaan MRI Genu dilakukan dengan melihat mean rank pada wilcoxon test seperti pada tabel 7 :

Tabel 6. Hasil Mean Rank Uji Beda antara pembobotan T1WI TSE Short TE dan pembobotan T1WI TSE
UTE
Perbedaan Aplikasi Mean Rank
T1WI TSE Short TE 0
T1WI TSE UTE 83.00
Sumber : data penelitian hasil SPSS 16

Berdasarkan mean rank yang dihasilkan, pembobotan T1WI TSE UTE memperoleh nilai mean rank
sebesar 83,00 sedangkan pembobotan T1WI TSE Short TE memperoleh nilai mean rank 0, maka dapat
dinyatakan pembobotan T1WI TSE UTE lebih jelas dalam menggambarkan informasi citra Genu pada MRI
Genu.
Uji beda mean rank untuk setiap kriteria anatomis antara pembobotan T1WI TSE Short TE dan T1WI TSE
UTE juga dilakukan untuk mengetahui pembobotan yang lebih jelas menggambarkan setiap kriteria anatomis
yang terdapat pada MRI Genu. Hasil uji mean rank pada wilcoxon test seperti pada tabel 8 :
 Tabel 7. Hasil Mean Rank pada Setiap kriteria anatomis
Mean
Informasi Anatomis
Rank
Anterior Cruciate Ligament Short TE 0
Anterior Cruciate Ligament UTE 13,5
Posterior Cruciate Ligament Short TE 0
Posterior Cruciate Ligament UTE 13,5
Medial Collateral Ligament Short TE 0
Medial Collateral Ligament UTE 12
Lateral Collateral Ligament Short TE 0
Lateral Collateral Ligament UTE 15
Medial Dan Lateral Patella Retinaculae
0
Short TE
Medial Dan Lateral Patella Retinaculae UTE 10
Medial Menisci Knee Short TE 0
Medial Menisci Knee UTE 10,5
Lateral Menisci Knee Short TE 0
Lateral Menisci Knee UTE 11,5
Sumber : data penelitian hasil SPSS 16

Berdasarkan mean rank yang dihasilkan, anatomi Anterior Cruciate Ligament UTE memperoleh nilai 13,5,
Posterior Cruciate Ligament UTE 13,5, Medial Collateral Ligament UTE 12, Lateral Collateral Ligament UTE
15, Medial Dan Lateral Patella Retinaculae UTE 10, Medial Menisci Knee UTE 10,5, dan Lateral Menisci
Knee UTE 11,5 sedangkan seluruh kriteria anatomis pada aplikasi Short TE memperoleh mean rank 0, maka
dapat dinyatakan pembobotan T1WI TSE UTE lebih jelas dalam menggambarkan informasi anatomis MRI
Genu pada setiap kriteria dibandingkan pembobotan T1WI TSE Short TE.

PEMBAHASAN
Pada penelitian ini dilakukan uji beda untuk keseluruhan organ didapatkan hasil yang menunjukkan nilai
p value <0,001 atau (p value < 0,05) bahwa terdapat perbedaan informasi citra untuk keseluruhan organ
antara pembobotan T1WI TSE Short TE dengan T1WI TSE UTE pada pemeriksaan MRI Genu. Setelah
dilakukan uji beda untuk keseluruhan organ selanjutnya dilakukan uji beda untuk tiap kriteria anatomi dan
didapatkan hasil sebagai berikut : Seluruh kriteria anatomi memiliki p value = <0,001 atau (p value < 0,05).
Hal ini menunjukkan terdapat perbedaan informasi anatomis pada kriteria anatomis Anterior Cruciate
Ligament, Posterior Cruciate Ligament, Medial Collateral Ligament, Lateral Collateral Ligament, Medial Dan
Lateral Patella Retinaculae, Medial Menisci Knee, dan Lateral Menisci Knee antara pembobotan T1WI TSE
Short TE dan T1WI TSE UTE.

a. b.
Gambar 1. a) Hasil Citra MRI Genu Potongan Sagital Dengan Pembobotan T1WI TSE UTE.
b) Hasil Citra MRI Genu Potongan Sagital Dengan Pembobotan T1WI TSE Short TE
Ultrashort Time Echo menggunakan nilai Time Echo yang lebih kecil dari nilai Time Echo T1WI
Konvensional, dimana nilai Time Echo pada Ultrashort Time Echo berkisar antara 0,07 ms sampai dengan
10ms. Nilai Time Echo pada UTE tersebut bertujuan untuk mendeteksi sinyal MR sebelum sinyal decay
mencapai nilai nol sehingga sinyal jaringan yang memiliki nilai T2 yang pendek dapat terdeteksi dengan baik
dibandingkan dengan menggunakan nilai Time Echo dari T1WI Konvensional dengan pemilihan Time Echo
yang tepat dapat membantu radiolog menginterpretasi citra secara tepat dan akurat. Jaringan yang memiliki
nilai T2 pendek antara lain: Ligaments, Tendon Achilles, Knee Menisci, Periosteum, Cortical Bones, Dentine,
dan Dental enamel (Riechert, 2005).
Pada organ anterior cruciate ligament, posterior cruciate ligament, medial collateral ligament, lateral
collateral ligament, medial dan lateral patella retinaculae, medial menisci knee, dan lateral menisci knee
terdapat perbedaan informasi citra anatomi karena organ – organ tersebut merupakan jaringan yang memiliki
nilai T2 yang pendek sehingga dapat mudah untuk di evaluasi pada saat menggunakan aplikasi Ultrashort
Time Echo dibandingkan pada saat menggunakan aplikasi Short Time Echo.
Peran indeks massa tubuh dalam pencitraan MRI berpengaruh pada jumlah sinyal yang dihasilkan karena
menyebabkan perbedaan daya serap jaringan yang berdampak pada meningkatknya inhomogenitas RF.
Setiap modalitas MRI mengharuskan identifikasi berat badan dan tinggi badan untuk dapat dilakukan
penyesuaian spesific absorbtion rate (SAR) serta sinyal RF yang diterima oleh receiver. Dengan diketahuinya
berat badan yang berkolerasi dengan indeks massa tubuh tentu modalitas dapat melakukan perhitungan
akuisisi data yang diperlukan untuk menjaga sinyal RF yang dihasilkan tetap 100%. Pada aplikasi UTE, tidak
adanya perbedaan informasi anatomis pada setiap kategori IMT. Sinyal yang dihasilkan akan tetap sama
meskipun pada kriteria anatomis tersebut memiliki daya serap sinyal yang berbeda akibat perbedaan tingkat
kerapatan (densitas) anatomi.
Berdasarkan hasil uji beda mean rank untuk keseluruhan organ yang dilakukan pada penelitian ini
didapatkan hasil yaitu pembobotan T1WI TSE UTE memperoleh nilai mean rank sebesar 38,00 sedangkan
pembobotan T1WI TSE Short TE memperoleh nilai mean rank 0 (nol), sehingga dapat dinyatakan
pembobotan T1WI TSE UTE dalam menggambarkan informasi citra anatomi pada MRI Genu paling optimal
dibandingan dengan pembobotan T1WI TSE Short TE.
Setelah dilakukan uji beda mean rank untuk keseluruhan organ selanjutnya dilakukan uji mean rank untuk
tiap kriteria anatomi dan didapatkan hasil sebagai berikut : Anterior Cruciate Ligament UTE memperoleh nilai
13,5, Posterior Cruciate Ligament UTE 13,5, Medial Collateral Ligament UTE 12, Lateral Collateral Ligament
UTE 15, Medial Dan Lateral Patella Retinaculae UTE 10, Medial Menisci Knee UTE 10,5, dan Lateral Menisci
Knee UTE 11,5 sedangkan seluruh kriteria anatomis pada aplikasi Short TE memperoleh mean rank 0,
sehingga dapat dinyatakan pembobotan T1WI TSE UTE paling optimal dalam menggambarkan setiap
kriteria anatomi yang terdapat pada MRI Genu dibandingkan dengan pembobotan T1WI TSE Short TE.
Menurut Reichert (2005) Ultrashort TE merupakan suatu cara dari indirect methods yang menggunakan
waktu TE yang lebih kecil dari nilai TE T1W Konvensional yang bertujuan untuk menangkap sinyal jaringan
yang memiliki nilai T2 jaringan yang pendek. Dimana sinyal jaringan yang terdeteksi pada penggunaan Time
Echo Ultra Short tersebut nantinya akan menjadi batas – batas untuk menentukan jaringan yang tidak dapat
dideteksi oleh conventional sequence, sehingga citra yang dihasilkan dengan menggunakan Time Echo Ultra
Short dapat lebih jelas dalam menampilkan citra anatomi dibandingkan dengan citra yang dihasilkan oleh
conventional sequence. Ultrashort Time Echo telah digunakan untuk mempelajari cartilage, cortical bone,
tendon, knee meisci dan jaringan lainnya (Fabich, 2014).
Penggunaan TE yang semakin pendek mempengaruhi beberapa faktor salah satunya yaitu scan time.
Scan time pada MRI memiliki peranan penting karena, seorang pasien yang dilakukan pemeriksaan MRI
berada didalam ruang yang sempit dan tidak diperbolehkan bergerak dalam jangka waktu yang cukup lama,
untuk memaksimalkan pemeriksaan penggunaan TE yang semakin pendek dapat mempersingkat waktu
pemeriksaan sehingga dapat meminimalisir pergerakan pasien dikarenakan scan time yang lama sehingga
menghasilkan citra yang optimal. Di Instalasi Radiologi Rumah Sakit Umum Daerah Badung untuk
pemeriksaan MRI Genu menggunakan nilai Time Echo sebesar 18ms tetapi pada penelitian ini hasil uji mean
rank yang paling tertinggi yaitu pembobotan T1WI TSE UTE dengan nilai Time Echo sebesar 9ms.

SIMPULAN
Dari hasil uji beda untuk keseluruhan organ didapatkan hasil yaitu nilai p value sebesar <0.001 (p < 0.05)
yang berarti ada perbedaan informasi citra untuk keseluruhan organ antara pembobotan T1WI TSE Short TE
dan T1WI TSE UTE pada pemeriksaan MRI Genu. Informasi citra anatomi yang paling optimal antara
pembobotan T1WI TSE Short TE dan T1WI TSE UTE yang dilakukan uji beda mendapatkan hasil uji yaitu
pembobotan T1WI TSE UTE mendapatkan nilai mean rank yang tertinggi yaitu 83.00 sehingga pembobotan
T1WI TSE UTE menghasilkan informasi citra yang paling optimal dibandingkan dengan T1WI TSE Short TE
Sebaiknya untuk mendapatkan informasi citra anatomi yang optimal pada jaringan dengan nilai T2 pendek
dianjurkan menggunakan aplikasi UTE (Ultra Short Time Echo) dengan rentang nilai TE antara 0.07 ms
sampai 10 ms dan pada pemeriksaan MRI Genu dianjurkan menggunakan pembobotan dengan T1WI TSE
UTE (nilai TE 0,07 ms sampai 10 ms).
DAFTAR PUSTAKA
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Vol 2, Department of Medical Imaging, University of Toronto. Canada (hal 513-537)
Bryan S. Weatherburn G, Bungay H, Hatrick C, Salas C, Parry D, et al, 2001. The Costeffectiveness Of
Magnetic Resonance Imaging For Investigation Of The Knee Joint. Health Technology Assessment.
Health Technology Assessment 2001; Vol. 5: No. 27 Medline. United Kingdome. (hal 1-95)
Bushberg. J. T. 2002. The Essential Physics of Medical Imaging (hal 9-12), Second Edition, New York, USA
(hal 9-12)
Fabich, Hilary. 2014, Ultrashort Echo Time (UTE) Imaging Using Gradient Pre-Equalization And Compressed
Sensing (hal 116-124), Department of Chemical Engineering and Biotechnology, Pembroke Street,
Cambridge CB2 3RA, United Kingdom
Fong. Alan. 2006. MRI Procedure Manual for Examinations Of The Knee and Thigh (hal 18-27), Version 1,
San Fransisco
Gold Gerry E, et al. 1998. MR Imaging Of Articular Cartilage Of The Knee: New Methods Using Ultrashort
TEs. American Journal Radiology (hal 1223-1226)
Hasemi, H. R and Bradley G. 1997. The Basic MRI (hal 39), Second Edition. The Williams & Wilkins: New
York.
Reicherta, Ines. 2005, Magnetic Resonance Imaging Of Cortical Bone With Ultrashort TE Pulse Sequences
(611– 618) Department of Orthopedic Surgery, Imperial College Faculty of Medicine, Charing Cross
Hospital, London W6 8RF, UK
Robbie, Mc. 2006. MRI From Picture To Proton (hal 1), Second Edition. Cambridge University Press. New
York
Seeley, Stephen. 2016, Tate, Anatomy and Physiologi, international edition, nine edition , Mc Graw Hill , New
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Setiadi, K. B., 2012, Pengaruh Variasi Nilai Time Infersion (TI) Sekuen T2 Turbo Inversion Recovery
Magnitude (TIRM) terhadap Kualitas Citra dan Informasi Anatomi MRI Knee Joint Coronal, Poltekkes
Kemenkes, Semarang
 PERBEDAAN INFORMASI CITRA ANATOMI MRI GENU PADA APLIKASI
SHORT TE DAN ULTRASHORT TE (UTE) (STUDI KOMPARASI CITRA MRI
GENU PEMBOBOTAN T1WI TURBO SPIN ECHO (TSE)).

THE ANATOMICAL INFORMATION DIFFERENCES BETWEEN THE APPLICATION OF SHORT TE

AND ULTRASHOT TE (UTE) ON KNEE MRI
(A COMPARATIVE STUDY ON KNEE MRI IMAGES WITH T1WI TURBO SPIN ECHO (TSE))

I Made Lana Prasetya1, Gatot Murti Wibowo2, I Bagus Gede Dharmawan 3

1
Poltekkes Kemenkes Semarang
2
Poltekkes Kemenkes Semarang
3
Rumah Sakit Umum Prima Medika Denpasar
E-mail: lanaprasetya182@gmail.com

ABSTRACT

This study aimed to determine the differences of anatomical information by using T1WI TSE Short TE and T1WI TSE
UTE on knee MRI examination. This study is quantitative study with experimental approach in the form of data are T1WI
TSE images of knee MRI in sagittal slices from 30 patients each from the application of Short TE and Ultrashort TE
(UTE). The data assessment was done by two respondents and the analysis was done. The result showed that there
was a difference on anatomical information of knee MRI in sagital slices between the application of T1WI TSE Short TE
and T1WI TSE UTE (p = 0,000). The application of UTE was the better on demonstrating the anatomy of knee. knee
MRI in sagital slices between the application of T1WI TSE UTE Obtain a mean rank of 83.00 while T1WI TSE Short TE
is 0 so it can mean T1WI TSE UTE is the optimal image.

Keywords : Ultrashort TE, Short TE, knee MRI.

BACKGROUND
In Rumah Sakit Umum Daerah (RSUD) Badung (Badung Regional General Hospital) there are many
musculo-skeletal cases that have been examined by MRI and one of them is knee MRI. It uses some standard
sequences such as T1WI using axial and sagittal slices with the TE value of 18 ms. According to Bryan (2001)
the diagnostic information that can be assessed from knee MRI are meniscus, knee, ligaments (soft tissue),
joint effusion (liquid), and bony surface (bone)
According to Bryan (2001), diagnostic information that can be seen on knee MRI are meniscus, knee
ligaments (soft tissue), joint effusion (fluid) and bony surfaces (bone). According to Westbrook and Kaut
(2011) T1 is the time needed by longitudinal magnetization to recover 63% after 90o pulse while TSE (turbo
spin echo) is a spin echo with shortened scanning time. The scanning time is shortened by adding more than
one phase encode per TR which is widely known as echo train, it is an application of numbers of RF pulse
per TR and each of rephasing or refocusing resulted on an echo so there can be done another phase encode.
TSE parameter on T1 is has TR value of 400 – 800 ms with short TE value of 10 – 25 ms. Ultrashort time
echo (UTE) is a pulse sequence that aims to detect signals fro tissues with short T2 using TE shorter than it
is in the conventional T1WI, whereas TE on UTE ranged from 0,07 – 10 ms (Reichert, 2005).
According to Robson (2003), UTE could be used on some pulse sequences, such as conventional MRI
(T1W, T2W, Proton Density), fat-suppressed, long T2 fat-suppressed, short TI inversion time ultrashort TE,
and medium TI time inversion ultrashort TE. So this study aims to determine differences in image information
between T1WI TSE Short TE weighting and UTE T1WI weighting at Genu MRI examination and to find out
which is the most optimal between T1WI TSE Short TE weighting and UTE T1WI TSE weighting at Genu
MRI examination.

METHOD
This study was a quantitative study with experimental approach. Data were obtained on March to May
2017 at MRI division of Radiology Department Badung General Hospital.
The samples were 30 and were physically examined by orthopedist. The volunteers were given informed
consent and given explanation about the examination and also assure them that the procedure was harmless.
After that the patients’ body weight and height were measured for BMI calculation. Next was the production
of knee MRI images that was begun with the T1W TSE and T1W TSE UTE both in sagittal slices. Each
patient was scanned with two variations of T1W, i.e. the TSE and TSE UTE. The final images were then
saved in CD in DICOM format without any patients’ identification, but only the image serial number. Two
radiologists who were expert in 1,5T MRI were asked to evaluate the images. Qualitative assessment
including the overall image contrast, assessment of anterior cruciate ligament, posterior cruciate ligament,
medial and collateral ligament, medial and lateral patella retinacula, capsule joint, and knee menisci, and also
choosing the best image from the two variations of T1W. The assessment were done by giving check list on
available questionnaire. Analyzing data using SPSS application.

RESULTS
The study was done on 30 patients; it consisted of 19 males and 11 females, which can be seen on the
table 1. The age ranged from 19 to 25, that can be seen in the table 2. The volunteers were grouped into
three according to their BMI, which were underweight, normal, and overweight, that is shown in table 3.
Table 1. Patients’ data characteristics based on their gender
Gender Total Percentage
Male 19 63,3%
Female 11 36,7%
Total 30 100%
Source: study data from SPSS 16

Table 2. Patients’ data characteristics based on their age

Age Total Percentage
19 3 10%
20 5 16,7%
21 5 16,7%
22 2 6,7%
23 3 10%
24 4 13,3%
25 8 26,7%
Total 30 100%
Source: study data from SPSS 16

Table 3. Patients’ data characteristics based on their BMI

BMI Total Percentage
Under Weight 2 6.7%
Normal 22 73.3%
Over Weight 6 20.0%
Total 30 100%
Source: study data from SPSS 16

From all of the patients it can be obtained anatomical information of knee MRI with two different T1WI,
that is TSE Short TE and TSE UTE. Each of these weighting produced images that demonstrated Anterior
Cruciate Ligament, Posterior Cruciate Ligament, Medial Collateral Ligament, Lateral Collateral Ligament,
Medial and Lateral Patella Retinacula, Medial Menisci Knee, and Lateral Menisci Knee. Each patient was
treated with two T1WI variations, TSE Short TE with TE value of 18 ms and TSE UTE with TE value of 9 ms.
From the results of the study, two respondents, Radiology specialists who have experience in assessing
Genu MRI examinations, were assessed. Before statistical tests were conducted to determine the Differences
in Information on Genu MRI Anatomy Images Between Weighting T1WI TSE Short TE and T1WI TSE
Ultrashort TE (UTE), kappa test was conducted to determine the suitability or similarity of respondents'
perceptions in the questionnaire assessment. The results of the kappa test on 2 respondents have the same
perception in assessing the information of the Anatomical Image of Genri MRI on both weighting (P1 = 0.852;
P2 = 0.813)
The next test was done to see the differences on the image information in general by comparing the total
value of all anatomies that had been assessed in knee MRI images on T1WI TSE Short TE and T1WI TSE
UTE from the respondents. The result of the statistical test is shown below:
Table 4. The statistical test result of comparing T1WI TSE STE and T1WI TSE UTE
Variables p value
Application of T1WI TSE Short TE 0.000
and T1WI TSE UTE
Source: study data from SPSS 16
 By p value<0.001 (p<0.001), it can be stated that there were differences on knee MRI the application of
T1WI TSE Short TE and T1WI TSE UTE.
Furthermore, there was also a comparison test done for each of the anatomy criteria. The result is shown
below:

Table 5. The result of comparison test of the application of T1WI TSE Short TE and T1WI TSE UTE.
Anatomical Information p value
Anterior Cruciate Ligament Short TE – Anterior 0.000
Cruciate Ligament UTE
Posterior Cruciate Ligament Short TE – Posterior 0.000
Cruciate Ligament UTE
Medial Collateral Ligament Short TE – Medial 0.000
Collateral Ligament UTE
Lateral Collateral Ligament Short TE – Lateral 0.000
Collateral Ligament UTE
Medial And Lateral Patella Retinaculae Short TE 0.000
– Medial And Lateral Patella Retinaculae UTE
Medial Menisci Knee Short TE – Medial Menisci 0.000
Knee UTE
Lateral Menisci Knee Short TE – Lateral Menisci 0.000
Knee UTE
Source: study data from SPSS 16

All of the anatomical criteria had p value < 0.000 (p value < 0.05). It showed that there was significant
difference of anatomical information of Anterior Cruciate Ligament, Posterior Cruciate Ligament, Medial
Collateral Ligament, Lateral Collateral Ligament, Medial And Lateral Patella Retinacula, Medial Menisci
Knee, and Lateral Menisci Knee between the application of T1WI TSE Short TE and T1WI TSE UTE.
Mean rank of comparison test was done to see the most optimum sequence to visualize knee MRI image
between the application of T1WI TSE Short TE and T1WI TSE UTE, the result are as follow:

Table 6. The result of Mean Rank comparison test of the application of T1WI TSE Short TE and T1WI
TSE UTE
Aplication Mean Rank
T1WI TSE Short TE 0
T1WI TSE UTE 83.00
Source: study data from SPSS 16
The mean rank of T1WI TSE UTE was 83,00 while T1WI TSE Short TE got 0 as its mean rank, so it can
be stated that T1WI TSE UTE demonstrated knee anatomy on knee MRI better than T1WI TSE Short TE.
Comparison test on each anatomy criteria between T1WI TSE Short TE and T1WI TSE UTE was also
done to find the mean rank to see which one of these weighting demonstrate anatomy of the knee MRI better.
The mean rank result is shown below:
Table 7. Mean rank on each anatomy
Anatomical Information Mean Rank
Anterior Cruciate Ligament Short TE 0
Anterior Cruciate Ligament UTE 13.5
Posterior Cruciate Ligament Short TE 0
Posterior Cruciate Ligament UTE 13.5
Medial Collateral Ligament Short TE 0
Medial Collateral Ligament UTE 12
Lateral Collateral Ligament Short TE 0
Lateral Collateral Ligament UTE 15
Medial And Lateral Patella Retinaculae Short TE 0
Medial And Lateral Patella Retinaculae UTE 10
Medial Menisci Knee Short TE 0
Medial Menisci Knee UTE 10.5
Lateral Menisci Knee Short TE 0
Lateral Menisci Knee UTE 11.5
Source: study data from SPSS 16
 According to the mean rank, the Anterior Cruciate Ligament UTE got 13.5, Posterior Cruciate Ligament
UTE 13.5, Medial Collateral Ligament UTE 12, Lateral Collateral Ligament UTE 15, Medial And Lateral
Patella Retinacula UTE 10, Medial Menisci Knee UTE 10.5, and Lateral Menisci Knee UTE 11.5 while all of
the anatomy criteria of Short TE had mean rank of 0, so it can be concluded that T1WI Short TE, UTE was
the better weighting to demonstrate each anatomical criteria of knee MRI than the T1WI TSE Short TE.

DISCUSSION
This study used comparison test, for overall anatomy the test resulted in p value < 0.001 (or p value <
0.05) which meant that Ho was rejected and Ha was accepted and it can be stated that there was differences
of anatomical information for overall anatomy between the application of T1WI TSE Short TE and T1WI TSE
UTE on knee MRI examination.
After the test for overall organ, the next one was comparison test for each anatomy criteria and the result
was all part of the anatomy criteria had p value < 0.001 (or p value <0.05). This result showed that there were
differences on each anatomical criteria of knee MRI, which are Anterior Cruciate Ligament, Posterior Cruciate
Ligament, Medial Collateral Ligament, Lateral Collateral Ligament, Medial And Lateral Patella Retinacula,
Medial Menisci Knee, and Lateral Menisci Knee between the application between T1WI TSE Short TE and
T1WI TSE UTE.

a. b.
Image 1. a) knee MRI image in sagittal slices using T1WI TSE UTE weighting b) knee MRI image in sagittal
slices using T1WI TSE Short TE weighting

Ultrashort time echo uses shorter echo time than that in the conventional T1WI, whereas the TE value of
the UTE ranged from 0.07 ms to 10 ms. The short TE of UTE is set to detect MR signal before the decay
signal reaches zero so that the signal from tissues with very short T 2 can be well detected compared to that
with TE of conventional T1WI, so with the right selection of TE could help radiologists to evaluate MRI images
more precise and accurate. Examples of tissues with short T2 are Ligaments, Tendons, Achilles, Knee
Menisci, Periosteal, Cortical Bones, Dentine, and Dental enamel. The appearance of anterior cruciate
ligament, posterior cruciate ligament, medial collateral ligament, lateral collateral ligament, medial and lateral
patella retinacula, medial menisci knee, and lateral menisci is inhomogeneous because they have very short
T2 value and it is easier to evaluate them using UTE than using Short TE.
The BMI in MRI imaging affects the amount of signal produced because of the tissue absorption and could
increase the RF inhomogeneity. Every MRI modality require to input the patients’ body weight to match the
specific absorption rate (SAR) and also the RF pulse obtained by the receiver. By inputting the body weight
that correlates with BMI, the modality could calculate data acquisition precisely to keep the output RF signal
at 100%. On the utilization of UTE, there was no anatomical information difference on every BMI category.
The produced signal will be homogeneous despite the different anatomical density.
Based on the comparison test for overall organs, the mean rank for T1WI TSE UTE was 38.00 while the
T1WI TSE Short TE got 0, so it can be concluded that the T1WI TSE UTE is the most optimal sequence to
demonstrate the anatomies of knee MRI compared to T1WI TSE Short TE.
The next test was to see the mean rank for every anatomical criteria of knee MRI and the results were:
Anterior Cruciate Ligament UTE got 13,5, Posterior Cruciate Ligament UTE got 13,5, Medial Collateral
Ligament UTE got 12, Lateral Collateral Ligament UTE got 15, Medial and Lateral Patella Retinaculae UTE
got 10, Medial Menisci Knee UTE got 10.5, and Lateral Menisci Knee UTE got 11,5 while all of the anatomical
criteria on Short TE got 0. Finally, it can be stated that the T1WI TSE UTE is the best sequence to visualize
every anatomical criteria of knee MRI compared to T1WI TSE Short TE.
According to Reichert (2005) UTE is one way of indirect methods that uses shorter TE than the
conventional TE of T1W in order to obtain signal from tissues that have short T2. Whereas the detected
tissue signals on UTE application are going to be demarcations from the tissues that can’t be detected by
conventional sequence, so the images from UTE is better to demonstrate anatomical information than the
conventional sequence. The UTE has been used to study the cartilages, cortical bones, tendons, knee
menisci, and other tissues (Fabich, 2014).
The use of shortened TE affects some factors and one of them is scan time. In MRI, scan time has a big
role mostly because the patient is examined in a narrow space and isn’t allowed to make any move in a
certain time. Using shorter TE will reduce the time scan which can minimize the motion artifact caused by
patient’s movements because of the inconvenience on the long scan time.
The TE that is used at the Radiology Department of Badung General Hospital on knee MRI is 18 ms, but
in this study, the highest mean rank was on the T1WI TSE UTE with TE value of 9 ms.

CONCLUSION
The result of comparison test for all of the organs had p value < 0.001 (p < 0.05) which meant there were
anatomical information differences for all organs between the utilization of T1WI TSE and T1WI TSE UTE on
knee MRI.
Compared to T1W TSE Short TE, the T1W TSE UTE was the most optimum sequence to demonstrate
anatomical information of knee with mean rank of 83.00.
To get optimum image information of tissue with short T2 it was better to apply UTE with TE ranged from
0,07 – 10 ms and on MRI examination of knee it was suggested to use T1WI TSE with UTE (with TE value
of 0,07 – 10 ms).

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