Technical Developments: Zero Echo Time Imaging of the Shoulder: Enhanced Osseous Detail by Using MR Imaging

As evidenced by comparison of clinical measurements and grades and direct comparison with standard-of-care MR imaging, zero echo time MR imaging provides additional morphologic information comparable to that provided by CT and may obviate CT imaging in some cases of shoulder assessment.


To determine the intermodality agreement of morphologic grading and clinically relevant quantitative measurements between computed tomography (CT) and zero echo time (ZTE) magnetic resonance (MR) imaging of the shoulder. The primary objective was to demonstrate the clinical applicability of ZTE in osseous shoulder imaging.

Materials and Methods

Thirty-four patients undergoing standard-of-care (SOC) MR imaging with concomitant CT were enrolled in this institutional review board–approved study. ZTE images were acquired after SOC MR imaging. Glenoid morphology (version, vault depth, erosion), injury or disease (osteoarthritis, Bankart and Hill-Sachs lesions, subchondral cysts), and evidence of prior surgery were graded or measured. κ Values, intraclass correlation coefficients (ICCs), and Bland-Altman limits of agreement were used to establish agreement. Qualitative comparison of osseous findings was performed between ZTE and SOC MR imaging.


Binary classification and nominal/ordinal grades showed substantial or better agreement between raters and modalities (κ or ICC > 0.6). Continuous measurements exhibited strong correlation between raters and modalities, although not universally. Bankart ICCs were not significant, owing to low prevalence. ZTE exhibited greater conspicuity of enthesopathic cysts and marrow edema. In 21 of 34 cases, ZTE imaging of osseous features exceeded SOC MR imaging.


ZTE MR imaging provides “CT-like” contrast for bone. The results of this study demonstrate strong intermodality agreement between measurements and grades from CT and ZTE images in a cohort of patients undergoing imaging with both modalities. A majority of ZTE image sets provided superior visualization of osseous features when compared with SOC MR image sets. This superiority coupled with strong quantitative agreement with CT suggests that ZTE may be used clinically in lieu of CT in some cases.

© RSNA, 2017

Online supplemental material is available for this article.


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Article History

Received April 20, 2017; revision requested June 8; revision received July 31; accepted August 12; final version accepted September 7.
Published online: Nov 08 2017
Published in print: Mar 2018