Pabi, Ronard

ABSTRACT Background Clinical T 2 ‐weighted (T2W) MRI of prostate cancer (PCa) usually implements a 2D fast‐spin‐echo (FSE) sequence, but understanding the echo‐time‐dependent contrast behavior is not straightforward due to the complicated FSE signal evolution. Consequently, consensus‐based recommendations on the optimal effective echo time (TE eff ) to maximize contrast are lacking. Purpose To investigate the effect of TE eff on PCa lesion contrast in prostate T2W MRI. Study Type Phantom and in vivo prospective study. Subjects A standard MRI phantom and 53 prostate cancer patients (29 for image evaluation and 24 for quantitative lesion analysis). Field Strength and Sequence Multi‐slice T2W FSE sequence at 3 T acquired at multiple TE eff values. Assessment Three readers (13, 25, and 27 years' experience) evaluated TE eff = 100 ms versus 150 ms on diagnostic quality and reader preference. The effective T 2 relaxation rates ( T 2,eff ) were measured using FSE sequences in the phantom and used to predict the optimal TE eff maximizing T2W contrasts. From multi‐TE eff scans of subjects with suspected PCa, T 2,eff values of PCa lesions and healthy tissue were measured and used to calculate the optimal TE eff maximizing the lesion contrast. In vivo contrast metrics were measured as a function of TE eff . Statistical Tests Wilcoxon test of reader scores, with p < 0.05 defining statistical significance. Results No statistically significant difference was found in diagnostic quality between TE eff = 150 ms and 100 ms images, but all three readers significantly favored TE eff = 150 ms. Phantom experiments demonstrated that TE eff ‐dependent FSE signal progression can be characterized by T 2,eff values typically 40% longer than actual T 2 values, allowing accurate prediction of optimal TE eff within 2%–5%. Applied to PCa imaging, in vivo measurements indicated that effective T 2 relaxation times of the prostate are on average 1.5× longer than published T 2 values. Data Conclusion The benefits of TE eff = 150 ms versus 100 ms in prostate T2W FSE were supported by reader preference, phantom experiments, in vivo measurements, and analytic optimizations. Evidence Level 2. Technical Efficacy 2.