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Review
. 2021 Jan-Feb;54(1):33-42.
doi: 10.1590/0100-3984.2019.0086.

Applications of the Dixon technique in the evaluation of the musculoskeletal system

Carolina Freitas Lins  1   2 , Carlos Ernesto Garrido Salmon  3 , Marcello Henrique Nogueira-Barbosa  4
Affiliations
Review

Applications of the Dixon technique in the evaluation of the musculoskeletal system

Carolina Freitas Lins et al. Radiol Bras. 2021 Jan-Feb.

Abstract
in English, Portuguese

The acquisition of images with suppression of the fat signal is very useful in clinical practice and can be achieved in a variety of sequences. The Dixon technique, unlike other fat suppression techniques, allows the signal of fat to be suppressed in the postprocessing rather than during acquisition, as well as allowing the visualization of maps showing the distribution of water and fat. This review of the Dixon technique aims to illustrate the basic physical principles, to compare the technique with other magnetic resonance imaging sequences for fat suppression or fat quantification, and to describe its applications in the study of diseases of the musculoskeletal system. Many variants of the Dixon technique have been developed, providing more consistent separation of the fat and water signals, as well as allowing correction for many confounding factors. It allows homogeneous fat suppression, being able to be acquired in combination with several other sequences, as well as with different weightings. The technique also makes it possible to obtain images with and without fat suppression from a single acquisition. In addition, the Dixon technique can be used as a quantitative method, allowing the proportion of tissue fat to be determined, and, in more updated versions, can quantify tissue iron.

A aquisição de imagens com supressão do sinal da gordura é um recurso de grande utilidade diagnóstica, existindo várias sequências capazes de realizá-la. A técnica Dixon, ao contrário de outras técnicas de supressão de gordura, permite suprimir a contribuição do sinal de gordura no pós-processamento e não durante a aquisição, além de permitir a visualização de mapas com a distribuição da água e da gordura. Esta revisão sobre a técnica Dixon almeja ilustrar os princípios físicos básicos, comparar a técnica com outras sequências de ressonância magnética para supressão ou quantificação de gordura, e descrever suas aplicações no estudo de doenças do sistema musculoesquelético. Muitas variantes da técnica Dixon foram desenvolvidas, proporcionando separação mais consistente dos sinais de gordura e água e permitindo correção de muitos fatores de confusão. Permite obter supressão homogênea de gordura, podendo ser adquirida de forma combinada com várias outras sequências, bem como com diferentes ponderações. Esta técnica possibilita também a obtenção de imagens com e sem supressão de gordura a partir de uma única aquisição. Adicionalmente, a técnica Dixon pode ser utilizada como recurso quantitativo, pois permite a mensuração do porcentual de gordura e, em versões mais atualizadas, consegue quantificar ferro tecidual.

Keywords: Dixon technique; Fat quantification; Fat suppression; Magnetic resonance imaging; Musculoskeletal system.

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Figures

Figure 1
Figure 1
Representation of transverse magnetization vectors of water and fat in acquisitions with different TEs (indicated in ms), based on the resonant frequency of water, in a 1.5 T scanner.
Figure 2
Figure 2
Contrast-enhanced coronal images of the thighs of a 59-year-old female patient with various pulse sequences: T1-weighted FSE sequence with fat suppression (A) and T1-weighted IDEAL sequence (B). Clear presence of artifacts at the edges of image A due to heterogeneity of the B0 or B1 magnetic field when using a wide field of view, impairing fat suppression.
Figure 3
Figure 3
Sagittal images of the cervical spine of a 52-year-old female patient with various pulse sequences: contrast-enhanced T1-weighted FSE with fat suppression (A), contrast-enhanced T1-weighted IDEAL (B) and STIR (C). The IDEAL sequence (B) shows a clear reduction of the magnetic susceptibility artifact, especially for visualization of the second cervical vertebra.
Figure 4
Figure 4
Axial plane images of cervicothoracic transition of a 58-year-old male patient demonstrating insufficient fat suppression in a T2-weighted FSE sequence with fat suppression (A), compared with a T2-weighted IDEAL wateronly sequence (B).
Figure 5
Figure 5
Axial images, from a T1-weighted FSE sequence (A) and a T2-weighted IDEAL fat-only sequence (B), of a 15-year-old female patient, showing periarticular areas of fatty replacement in the iliac components of both sacroiliac joints, detectable in both sequences.
Figure 6
Figure 6
Images obtained in a single acquisition by the modified Dixon technique in a 33-year-old female patient to allow direct quantification of the FF and estimation of iron content. In A, the FF map; in B, the water-only image; in C, the fat-only image; in D, the R2* map; in E, the in-phase image; in F, the out-of-phase image. Quantitative evaluation with demarcated regions of interest can be illustrated by demonstrating the FF (A) and estimating the iron content (D).
Figure 7
Figure 7
Short- and long-axis images of the hands and wrists of a 30-year-old female patient with psoriatic arthritis followed by a protocol for rheumatologic disease with simultaneous contrast-enhanced imaging of both hands. Contrast-enhanced T1-weighted FSE sequence with fat suppression (A,C) and contrastenhanced T1-weighted IDEAL sequence (B,D), demonstrating that the latter (the Dixon technique) provided more effective fat suppression in the hand and wrist.
Figure 8
Figure 8
T2-weighted FSE sequence with fat suppression (A) and IDEAL water-only sequence (B) images of a 24-year-old female patient showing na osteochondral lesion in the navicular bone. The Dixon technique provides better delineation of chondral involvement, whereas bone marrow edema is more evident in the T2-weighted FSE sequence with fat suppression.
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