Balanced Turbo Field Echo MRI as a radiation-free adjunct for spinal bone imaging: A prospective study of 526 patients

Study Design: Single-centre, prospective, within-subject observational imaging-quality study with a single experienced reader. Aims & Objectives: To evaluate whether adding a 3D Balanced Turbo Field Echo (BTFE) sequence to routine 3T spine MRI improves visualization of osseous spinal pathology compared with conventional T1/T2-weighted MRI and plain radiographs. Materials & Methods: Between March and November 2024, 526 consecutive adults underwent spine imaging including T1/T2-weighted and BTFE MRI on a 3T scanner plus plain radiographs; thin-section CT served as confirmatory reference in a small ligamentum flavum ossification (LFO) subgroup. Six osseous pathologies were scored: disc osteophyte complex, OPLL, LFO, spondylolisthesis, spondylolysis and vertebral fracture. A single senior consultant radiologist (>[jls-end-space/]10 years’ experience), blinded to other modalities and clinical details, graded visualization on a 3-point ordinal scale in separate, randomized, washed-out sessions. Modalities were compared per pathology with Friedman’s test and Holm-corrected Wilcoxon post-hoc tests. Results: Mean age was (Formula presented) years; 297 (56.5%) were female; thoraco-lumbar scans accounted for 454 (86.3%). Disc osteophyte was most common (n = 229, 43.5%). BTFE scored significantly higher than routine MRI and plain radiographs for every pathology (all (Formula presented) ). OPLL was invisible on radiographs but well delineated on BTFE. For LFO, BTFE meaningfully outperformed routine MRI, representing a radiation-free improvement over standard MRI practice. Conclusion: Adding a widely available BTFE sequence to routine 3T spine MRI improved visualization of spinal osseous pathology without ionizing radiation. BTFE should be regarded as a candidate bone-imaging adjunct; head-to-head comparison with CT and with established CT-like MRI sequences (ZTE, FRACTURE, 3D FLASH, T1-spoiled gradient-echo, synthetic CT) is needed.