Synthetic and conventional magnetic resonance imaging for knee assessment in children with leukemia: a comparative study

Wenfeng Jin; Hongding Zhang; Yi Liao; Shiyu Xiong; Xiangao Lei; Xia Guo; Zhigang Yang; Ruzhi Zhang; Huilou Liang; Yingkun Guo; Qing Wu; Lu Ye; Jieqian Zheng; Rong Xu

doi:10.21037/qims-2025-1-2580

Synthetic and conventional magnetic resonance imaging for knee assessment in children with leukemia: a comparative study

Quant Imaging Med Surg. 2026 Jun 1;16(6):442. doi: 10.21037/qims-2025-1-2580. Epub 2026 May 11.

Authors

Wenfeng Jin^#^{1

2

3

4}, Hongding Zhang^#¹, Yi Liao^{1

2

3

4}, Shiyu Xiong^{1

2

3

4}, Xiangao Lei¹, Xia Guo⁵, Zhigang Yang⁶, Ruzhi Zhang⁷, Huilou Liang⁷, Yingkun Guo^{1

2

3

4}, Qing Wu⁸, Lu Ye^{1

2

3

4}, Jieqian Zheng^#¹, Rong Xu^#^{1

2

3

4}

Affiliations

¹ Department of Radiology, Medical Imaging Center, West China Second University Hospital, Sichuan University, Chengdu, China.
² Key Laboratory of Birth Defects and Related Diseases of Women and Children (Sichuan University), Ministry of Education, Chengdu, China.
³ Development and Related Diseases of Women and Children Key Laboratory of Sichuan Province, Chengdu, China.
⁴ Children's Medicine Key Laboratory of Sichuan Province, West China Second University Hospital, Sichuan University, Chengdu, China.
⁵ Department of hematology, West China Second University Hospital, Sichuan University, Chengdu, China.
⁶ Department of Radiology, State Key Laboratory of Biotherapy, West China Hospital, Sichuan University, Chengdu, China.
⁷ GE Healthcare China, Beijing, China.
⁸ Affiliated Children's Hospital of Jiangnan University (Wuxi Children's Hospital), Wuxi, China.

^# Contributed equally.

Abstract

Background: Magnetic resonance imaging (MRI) is an ideal method for the detection of osteonecrosis in children with acute lymphoblastic leukemia (ALL), but some children struggle to adhere to the procedure due to its lengthy examination time. This study evaluated the feasibility of synthetic MRI for knee examinations in children with ALL.

Methods: This prospective study included 33 children with ALL who underwent conventional and synthetic MRI. Participants were categorized into Group A (>8 years, n=23) and Group B (≤8 years, n=10). Scan time, signal-to-noise ratio (SNR), contrast-to-noise ratio (CNR), motion artifacts, image quality score, lesion detection, and T2 values were compared using paired t-tests, Wilcoxon signed-rank tests, Cohen's kappa, and Bland-Altman analysis, with Bonferroni correction (α=0.003).

Results: Synthetic MRI significantly reduced scan time (Group A: 286±74 vs. 504±64 s, P<0.001; Group B: 254±8 vs. 461±17 s, P=0.002). No significant SNR or CNR differences were found between synthetic and conventional T1-weighted imaging (T1WI) (P>0.003). Synthetic proton density-weighted imaging (PDWI) showed lower SNR (P<0.003) but similar CNR (P>0.003). In T1WI, motion artifacts were comparable between synthetic and conventional MRI in Group A (P=0.166) but were more pronounced with synthetic MRI in Group B (P=0.038). In PDWI, synthetic images exhibited significantly greater motion artifacts in both Group A and Group B (P=0.011 and P=0.023, respectively). Image noise was higher in synthetic T1WI and PDWI (P<0.050). Lesion detection showed excellent agreement (κ=0.86-0.96), though two Group B cases were nondiagnostic. T2 values showed no significant inter-method differences in either group (P>0.003).

Conclusions: For pediatric leukemia patients capable of maintaining stillness, synthetic MRI shortens acquisition time while preserving diagnostic accuracy and quantitative precision. However, due to motion susceptibility, its clinical use should be limited to cooperative children.

Keywords: Acute lymphoblastic leukemia (ALL); T2 mapping; knee; magnetic resonance imaging (MRI); synthetic imaging.