Objectives This study investigated the feasibility of a fast field echo resembling a CT using a restricted echo-spacing (FRACTURE) sequence as a radiation-free alternative to CT for evaluating pediatric skull base lesions. Materials and methods In this prospective study (October 2023–December 2024), 40 pediatric patients (mean age, 7.7 ± 4.0 years) with suspected skull base lesions underwent both 256-slice CT and 3.0 T MRI, including a 3D FRACTURE sequence. Two pediatric radiologists independently assessed image quality for bone and soft-tissue visualization. Bone edge sharpness was objectively quantified using the edge rise slope (ERS). Diagnostic accuracy and treatment-planning consistency were evaluated by two radiologists and two surgeons by comparing “FRACTURE combined with conventional MRI” with CT. Results CT showed slightly higher scores for bone visualization than FRACTURE (5.00 ± 0.00 vs. 4.83 ± 0.47; p = 0.001), while both were diagnostically sufficient. FRACTURE provided significantly superior soft-tissue visualization compared with CT (5.00 ± 0.00 vs. 1.85 ± 0.36; p < 0.001). FRACTURE achieved the highest edge sharpness (ERS: 474.20 ± 69.76), exceeding CT (413.45 ± 188.73) and conventional 3D T1-weighted imaging (226.50 ± 47.04) (p < 0.05). Inter-rater agreement was perfect for diagnosis (ICC = 1.0), and treatment-planning consistency was high (Kappa = 0.892) between FRACTURE-based and CT-based protocols. Conclusion The FRACTURE sequence provides CT-like bony delineation with superior soft-tissue visualization and sharper bony edges, while completely eliminating ionizing radiation exposure. FRACTURE represents a feasible and reliable alternative to CT for the diagnosis and preoperative treatment planning of pediatric skull base lesions. Key Points <Emphasis Type="BoldItalic">Question</Emphasis> Can the 3D FRACTURE MRI sequence replace CT for the evaluation and preoperative planning of pediatric skull base lesions while avoiding ionizing radiation? <Emphasis Type="BoldItalic">Findings</Emphasis> FRACTURE provides CT‑comparable bone depiction and superior soft‑tissue visualization for evaluating pediatric skull base lesions. <Emphasis Type="BoldItalic">Clinical relevance</Emphasis> The FRACTURE-based MRI protocol enables comprehensive evaluation of both bony and soft tissue structures and may serve as a radiation-free alternative to CT for preoperative assessment and surgical planning of pediatric skull base lesions. Graphical Abstract

Feasibility study of the FRACTURE sequence in evaluating pediatric skull base bone lesions

期刊论文
发表日期：

2026年7月17日

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Guangheng Yin,
Chunlei Du,
Yanqiu Lv,
Xiaojian Yang,
Haoyan Li,
Yun Peng,
Jihang Sun

摘要

Objectives

This study investigated the feasibility of a fast field echo resembling a CT using a restricted echo-spacing (FRACTURE) sequence as a radiation-free alternative to CT for evaluating pediatric skull base lesions.

Materials and methods

In this prospective study (October 2023–December 2024), 40 pediatric patients (mean age, 7.7 ± 4.0 years) with suspected skull base lesions underwent both 256-slice CT and 3.0 T MRI, including a 3D FRACTURE sequence. Two pediatric radiologists independently assessed image quality for bone and soft-tissue visualization. Bone edge sharpness was objectively quantified using the edge rise slope (ERS). Diagnostic accuracy and treatment-planning consistency were evaluated by two radiologists and two surgeons by comparing “FRACTURE combined with conventional MRI” with CT.

Results

CT showed slightly higher scores for bone visualization than FRACTURE (5.00 ± 0.00 vs. 4.83 ± 0.47; p = 0.001), while both were diagnostically sufficient. FRACTURE provided significantly superior soft-tissue visualization compared with CT (5.00 ± 0.00 vs. 1.85 ± 0.36; p < 0.001). FRACTURE achieved the highest edge sharpness (ERS: 474.20 ± 69.76), exceeding CT (413.45 ± 188.73) and conventional 3D T1-weighted imaging (226.50 ± 47.04) (p < 0.05). Inter-rater agreement was perfect for diagnosis (ICC = 1.0), and treatment-planning consistency was high (Kappa = 0.892) between FRACTURE-based and CT-based protocols.

Conclusion

The FRACTURE sequence provides CT-like bony delineation with superior soft-tissue visualization and sharper bony edges, while completely eliminating ionizing radiation exposure. FRACTURE represents a feasible and reliable alternative to CT for the diagnosis and preoperative treatment planning of pediatric skull base lesions.

Key Points

Question Can the 3D FRACTURE MRI sequence replace CT for the evaluation and preoperative planning of pediatric skull base lesions while avoiding ionizing radiation?

Findings FRACTURE provides CT‑comparable bone depiction and superior soft‑tissue visualization for evaluating pediatric skull base lesions.

Clinical relevance The FRACTURE-based MRI protocol enables comprehensive evaluation of both bony and soft tissue structures and may serve as a radiation-free alternative to CT for preoperative assessment and surgical planning of pediatric skull base lesions.

Graphical Abstract