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Iterative Decomposition of Water and Fat with Echo Asymmetry and Least-Squares Estimation (IDEAL) Fast Spin-Echo Imaging of the Ankle: Initial Clinical Experience

Samuel Fuller1, Scott Reeder1, Ann Shimakawa2, Huanzhou Yu1, Jane Johnson2, Christopher Beaulieu1 and Garry E. Gold1

1 Department of Radiology, Grant Building S0-68B, Stanford University, 300 Pasteur Drive, Stanford, CA 94305-5105.
2 GE Global Applied Science Laboratory, Menlo Park, CA.


Figure 1
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  		Fig. 1A —24-year-old woman with ankle pain. Recombined fat-water iterative decomposition of water and fat with echo asymmetry and least-squares estimation (IDEAL) fast spin-echo image.

 

Figure 2
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  		Fig. 1B —24-year-old woman with ankle pain. IDEAL fast spin-echo water-only image.

 

Figure 3
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  		Fig. 1C —24-year-old woman with ankle pain. IDEAL fast spin-echo fat-only image.

 

Figure 4
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  		Fig. 1D —24-year-old woman with ankle pain. Fat-suppressed fast spin-echo image. Note homogeneous, excellent fat-water separation in IDEAL fast spin-echo image (B) as compared with fat-suppressed fast spin-echo image (D). Multiple areas of failed fat saturation (arrows) are seen in both bone and soft tissues.

 

Figure 5
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  		Fig. 2A —20-year-old man with foot pain. Axial T1-weighted (TR/TE, 800/14) image shows cyst in calcaneus (solid arrow).

 

Figure 6
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  		Fig. 2B —20-year-old man with foot pain. Coronal iterative decomposition of water and fat with echo asymmetry and least-squares estimation (IDEAL) fast spin-echo water-only image shows cyst (arrow).

 

Figure 7
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  		Fig. 2C —20-year-old man with foot pain. Coronal IDEAL fast spin-echo combined image.

 

Figure 8
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  		Fig. 2D —20-year-old man with foot pain. Coronal fat-suppressed fast spin-echo image shows cyst (solid arrow). Note superior fat-water separation in region of lateral malleolus in IDEAL fast spin-echo image (B) as compared with failure of fat saturation that might be mistaken for bone contusion in fat-suppressed fast spin-echo image (dashed arrow).

 

Figure 9
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  		Fig. 3A —Images of ankle in 40-year-old woman with metallic plate in fibula after fracture. Recombined fat-water iterative decomposition of water and fat with echo asymmetry and least-squares estimation (IDEAL) fast spin-echo image.

 

Figure 10
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  		Fig. 3B —Images of ankle in 40-year-old woman with metallic plate in fibula after fracture. IDEAL fast spin-echo water-only image.

 

Figure 11
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  		Fig. 3C —Images of ankle in 40-year-old woman with metallic plate in fibula after fracture. IDEAL fast spin-echo fat-only image.

 

Figure 12
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  		Fig. 3D —Images of ankle in 40-year-old woman with metallic plate in fibula after fracture. Fat-suppressed fast spin-echo image. Note superior fat-water separation of IDEAL fast spin-echo image (B) in region of metal plate compared with failure of fat saturation in fat-suppressed fast spin-echo image (D, arrows).

 

Figure 13
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  		Fig. 4A —44-year-old woman with ankle pain. Recombined fat-water iterative decomposition of water and fat with echo asymmetry and least-squares estimation (IDEAL) fast spin-echo image.

 

Figure 14
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  		Fig. 4B —44-year-old woman with ankle pain. IDEAL fast spin-echo water-only image. Osteochondral lesion is present in medial talar dome (arrow).

 

Figure 15
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  		Fig. 4C —44-year-old woman with ankle pain. IDEAL fast spin-echo fat-only image.

 

Figure 16
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  		Fig. 4D —44-year-old woman with ankle pain. Fat-suppressed fast spin-echo image. Osteochondral lesion is present in medial talar dome (large arrow). The IDEAL fast spin-echo image (B) displays superior fat-water separation in soft tissues on lateral aspect of ankle and medial aspect of foot, and reduced artifact and superior fat saturation associated with metallic hardware in distal fibula (small arrows).

 

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