DIFFERENCE OF SIGNAL TO NOISE RATIO (SNR) BETWEEN

PDW_SPAIR (SPECTRAL ADIABATIC INVERSION RECOVERY) SEQUNECE WITH

PDW_FATSAT (FAT SATURATION) SEQUENCE
IN EXAMINATION OF MRI KNEE JOINT SAGITAL PIECES.

Annisa 1), Bambang Satoto 2), Siti Masrochah 3)

Student of Health Politechnic of Semarang1, Departement of Radiology and Radioteraphy2)3)

Author Mail : Annisaicha2215@gmail.com

ABSTRACT
Background : In some cases, an MRI exam have difficulty distinguishing fat and soft tissue around. Fat is often a source of problems in MRI,
because fat around many anatomical structures, but not well constrained. Spair and Fatsat is a technique used to suppress the fat signal. Signal
To Noise Ratio (SNR) is an influential factor in a lot of quality MRI image. This study aims to determine the difference in value SNR anatara
sequences PDW_SPAIR and PDW_Fatsat MRI Knee Joint Pieces Sagittal.
Method : This research is a quantitative study with an experimental approach. Data were collected from November to December 2016 at the
Radiology Siloam Hospital Lippo Village. Data taken from the examination using MRI Knee Joint PDW_SPAIR sequences and PDW_Fatsat
on 10 probandus. Data was analyzed using software measurement ROI (Region Of Interest) in the organs of articular cartilage, anterior
cruciate ligament, posterior cruciate ligament and Meniscus. then calculated the value of SNR, SNR values are tested with Shapiro Wilk
normality test and showed normal distribution of data is then performed statistical tests using paired T test to determine whether or not there is
a difference of the two sequences.
Result : Research show that there are differences between the sequences PDW_SPAIR SNR with PDW_Fatsat MRI Knee joint with a p value
of 0.000 (p <0.05). When viewed from the mean value of the sequence PDW_SPAIR MRI Knee joint sagittal slice generate value SNR better
than PDW_Fatsat sequences with a mean of 42.10 PDW_SPAIR and a mean value of 35.14 PDW_Fatsat.
Conclusion: There is a difference Signal to Noise Ratio (SNR) between PDW_SPAIR (Spectral Adiabatic Inversion Recovery) sequence with
PDW_Fatsat (Fat Saturation) sequence in examination of MRI Knee Joint Sagital Pieces with a significance level of p-value 0,000 (p<0,05).
PDW_SPAIR sequence is an optimal value for Signal to Noise Ratio (SNR)in examination of MRI Knee Joint sagital pieces.
Keyword : PDW_SPAIR, PDW_Fatsat, SNR, MRI Knee Joint

INTRODUCTION networks, fat is a molecular component with the liquid

Knee joint is the most major joints in the human hydrogen atom. To overcome these obstacles then
body. This joint is located at the foot of which is between developed a fat suppression technique called fat
the upper limbs and lower limbs. Knee joint basically suppression (Wu Jing, 2012).
consists of two articulatio condylaris condylus between the According Grande (2014), Fat suppression is a
medial and lateral femoral and tibial related condylus and a technique The advantages of this spair technique is a very
saddle joint between the patella and femoral Patellar effective technique for fat suppression that provide distinct
fascies. Knee joints in including the type of synovial joints advantages of fat suppression techniques are conventional
(synovial joint), which has the synovial fluid of joints that and SAPIR well used for inspection Muskuloskletal. In the
serve to help the movement between the two bones that are knee joint This technique can reveal the soft tissue on the
jointed to more freely move (Pearce, 2009).
articular cartilage, ligaments, articular capsule and can be
According Mc.Robbie (2006), conventional xray
used to diagnose abnormalities of the knee joint prior to
inspection at the knee joint can only show a fracture or
surgery (Wuu Jing, 2012).
effusion in large numbers, and this is sometimes not very
Fat Saturation (Fatsat) is one of the fat suppression
helpful in clinical diagnosis. The ability of MRI to show
technique is recommended to suppress the signals in a large
soft tissue, tendons, ligaments and the meniscus is very
amount of fat and can be demonstrated in the aquisition
helpful in assessing the knee joint pathology.
picture Enhance contrast media. Fat Saturation is also
Magnetic Resonance Imaging (MRI) is a diagnostic
beneficial to avoid misregistration artifacts, so it can be
imaging modality that can result in multiplanar slices of
used in various imaging sequences. One of the advantages
anatomy with excellent contrast resolution. MRI can detect
of fat saturation is time that used more quickly because of
differences in contrast in the network is better than CT
the time needed to apply the saturation pulse is 10 msec
scan. MRI is very good to use detect a lesion in soft tissue
(Westbrook, 2011).
(Blink, 2004).
MRI imaging qualities greatly affect the ability to
In some cases, an MRI exam have difficulty
provide an overview contrast to the soft tissues of the body.
distinguishing fat and soft tissue around. Fat is often a
In selecting the parameters necessary that the image
source of problems in MRI, because fat around many
produced in in short optimal scanning. The quality of the
anatomical structures, but not well constrained. On some
MRI picture is influenced by four factors, namely the The data is tested by statistical test data generated through
Signal to Noise Ratio (SNR), Contras to Noise Ratio the data berupada ratio and average data from two sample
(CNR), Spatial Resolusition, Scan Time (Westbrook, pairs. Data were tested through the statistical test data
2011). normality test to determine the data is normally distributed
According to Mc Robbie (2006), Signal to Noise or not. Normality test data using Shapiro Wilk test.
Ratio (SNR) is the ratio between the magnitude of the Furthermore, if the normal data, the data is processed with
amplitude of the signal with amplitude noise. MRI knee statistical methods menggunaakn paired T-test and when
joint using a Proton Density Weighted (PDW) to get the the abnormal data is processed using the Wilcoxon test. As
PD-weighted image, the effect of T1 and T2 should be for determining the value of SNR better views than the
reduced so that the PD is more dominant. Using Proton mean value between the paired t test test sequences and
Density Weighted (PDW) SNR will increase and small PDW_Fatsat PDW_SPAIR.
organs such as, cortical bone, ligament and meniscus seen
more clearly. RESULTS
According to Moeller (2003), knee joint MRI Research conducted on 10 probandus sex male and
examination using fat suppression technique PDW Fatsat female, of every probandus examination Sagittal MRI Knee
sagittal sequences. Radiology at Hospital dr.Saiful Anwar Joint pieces with sequences PDW_SPAIR and PDW_Fatsat
poor fat suppression technique used Proton density with menggunakanpesawat Brands Philips Achieva MRI 3
weighted Fat saturation (PDW_Fatsat) and the author Tesla.
conducted observations in Radiology Siloam Hospital
Lippo Village for Knee Joint MRI examination using the Table 1. Characteristics probandus by gender and age
technique of fat suppression sequences PDW_SPAIR. Kategori Klasifikasi Jumlah Presentase (%)
The purpose of this study was to determine the difference Laki-Laki 5 50%
between the value of SNR PDW_SPAIR sequences with Jenis Perempuan 5 50%
sequences PDW_Fatsat MRI Knee Joint sagittal slice. In Kelamin Total 10 100%
addition it aims to determine the optimal SNR values of the 20-25 4 40%
two sequences. 25-30 6 60%
Umur
Total 10 100%
METHOD
This type of research is quantitative research with an
experimental approach. Variables that digunakam in the
study were free variable that sequences PDW_SPAIR
sequences PDW_Fatsat, the dependent variable is the value
of SNR generated from sequences PDW_SPAIR and
PDW_Fatsat, variable control that time repetition, time
echo, field of view, slice thickness, matrix, NEX and coil.
This study was conducted from November to December
2016 on the installation of radiological Siloam Hospital
Lippo Village. The population in this study were all
patients MRI Knee Joint sagittal pieces and samples in this
study 10 volunteers. With MRI examination Knee Joint
sagittal slice.
The Proccedure of this expremintal are :
1. Do imaging MRI sagital knee joint piece 20 samples Figure 1. (A) The results of image sequences PDW_SPAIR.
2. Each volunteer perfomed canning sequence (B) Results PDW_Fatsat image sequences.
PDW_SPAIR and PDW_Fatsat.
3. The result of each imaging scannning measureent Table 2 Results of data normality test SNR values are
Region Of Interest (ROI) of 0,001 cm 2 in area Articular kesluruhan organ MRI Knee Joint between sequences
cartilage,anterior cruciate ligament, posterior cruciate PDW_SPAIR and PDW_Fatsat
ligament, posterior cruciate ligament and meniscus an Nilai SNR secara Nilai
Keteranga
baground 0,005 cm2 keseluruhan organ MRI Kemaknaan
n
4. Having obtained the value of the signal on the organs in Knee Joint (P Value)
the ROI, then put the formula for calculating PDW_SPAIR 0,521 Data
5. The result of SNR values of 10 samples with PDW_Fatsat 0,890 Normal
PDW_SPAIR and PDW_Fatsat sequence are analyzed Normality test results overall SNR value with
using SPSS. Shapiro Wilk test found the level of confidence (confident
Data from the calculation of SNR ratio is a form of level) 95% (α = 5%) value of significance (p-value) of the
data and data from the average of two samples are paired. two data sets each organ is greater than (p> 0.05 ), namely
for the group amounted to 0.521 PDW_SPAIR sequence
data and the sequence data for the group amounted to 0.890
PDW_Fatsat. This indicates that the two groups normally
distributed data, so analysis of statistical tests can proceed
with paired T test.
Table 3. Test Results Pairwise SNR T MRI Knee
Joint sequences PDW_SPAIR and PDW_Fatsat
Nilai SNR secara Nilai Keterangan
keseluruhan organ MRI Kemaknaan
Knee Joint (P Value)
PDW_SPAIR Data
0.000
PDW_Fatsat Ada Beda
Based on Test Results T berpasngan overall SNR
value be obtained level of confidence (confident level) 95%
(α = 5 5) the value of significance (p-value) is smaller than
α (p, 0.05) Ayani 0,000. Thus Ho is rejected, it means that
there are significant differences between the sequences
SNR PDW_SPAIR with PWD_Fatsat on pemerikssaan
Pieces Sagittal MRI Knee Joint. Mean results of SNR
values between sequences PDW_SPAIR and PDW_Fatsat
MRI Knee joint sagittal slice.
Table 4. Mean Value PDW_SPAIR and PDW_Fatsat
Sekuens Mean
PDW_SPAIR 42,10
PDW_Fatsat 35,14
Based on the data in Table 4. The mean values of
SNR MRI Knee Joint sequences PDW_SPAIR at 41.37 and
at 35.79 PDW_Fatsat sequences. The mean value of SNR
sequences PDW_SPAIR rank higher than the mean value
of SNR at PDW_Fatsat sequences.
DISCUSSION
Based on statistical test, the SNR of data normality
test sequence performed by the Shapiro-Wilk test and the
test results obtained by indigo p value> 0.05, ie to
sequences PDW_SPAIR amounted to 0.521 and 0.890 for
PDW_Fatsat sequences. This shows normally distributed
data, and then the data is processed by Paired T test to
determine differences in SNR MRI Knee Joint. After the
test results obtained test results p value <0.05, ie p value =
0.000, meaning that Ho refused and Ha is received, it
shows that there are significant differences in values
between the sequences PDW_SPAIR SNR with
PDW_Fatsat MRI Knee Joint sagittal slice.
PDW_SPAIR sequences and PDW_Fatsat are two
techniques to suppress fat. Fat tissue appears bright in most
of the sequences in MRI imaging. The ability selectively
suppress fat signal will help determine abnormalities in
other tissues or lesions.
SNR value differences in sequences with
PDW_Fatsat PDW_SPAIR is because the parameters of the
proton density-weighted (PDW) using a long TR, short TE
and characteristics of each method in terms of the ability to
conduct suppression of fat signal. By using a long TR and
short TE will increase the value Signal to Noise Ratio
(SNR).
Sequences PDW_SPAIR generate SNR values are
high and this is because the use of TR length is 3600 ms
and TE short is 30 ms, in addition to the nature of
techniques suppression spair insensitive to inhomogenitas
RF signals make the method spair can suppress the signal
of fat is more homogeneous on each criterion anatomy such
as Articular Cartilage, anterior cruciate ligament, posterior
cruciate ligament and Meniscus
According to U. jing (2012), Methods spair using
selective adiabatic inversion pulse. The use of adiabatic
pulse provides a major influence in the selective fat
suppression. Spair method is not sensitive to magnetic
fields makes inhomogenitas of spair can suppress fat
signals are more homogeneous in each anatomical criteria.
Supressi homogeneous can be useful to distinguish the type
of organ or tissue from one another and determine whether
or not a normal organ or the network.
As for the sequences PDW_Fatsat This technique
uses pulse frequency selektive sensitive inhomogenitas
magnetic field so that is not optimal in fat mensupress one
factor caused the tissues around there is fluid that can not
be saturated. According Default (1999), Fat Saturation
would cause Signal to Noise Ratio (SNR) decreases when
the fat supressed altogether in adipose tissue (tissue
composed of fat). This causes low SNR values
PDW_Fatsat compared with PDW_SPAIR sequences.
The use of sequences PDW_Fatsat has the
advantage of a fast scanning time, these sequences can be
used for non-cooperative patients who require fast scan
times. This is because the scanning time of rapid sequences
can PDW_Fatsat minimize artifacts due to patient
movement. Signal to Noise Ratio (SNR) is the most
attention to the quality of the MRI image. If the actual
signal is relatively stronger than the noise, the SNR will
increase, and poor quality of the picture will be better
(Westbrook, 2011).
Based on the resulting mean value of SNR MRI
Knee Joint, the result of the mean SNR MRI Knee Joint
sequences PDW_SPAIR at 42.10. While on PDW_Fatsat
sequences obtained mean value of 35.14. This shows that
the sequences PDW_SPAIR SNR values higher than the
value of SNR at PDW_Fatsat.dan sequences generated
imagery in some organs such as the ACL, PCL looked
intermediate, Articular Cartilage and meniscus visualized
clearly and bounded firmer.
In this study, the selection of appropriate suppressi
techniques can help radiologists interpret the image
precisely and accurately. Spair technique is best used in a
system check muskuloskletal like MRI Knee Joint area of
articular cartilage, ligament and meniscus can be displayed
clearly when no abnormalities such as meniscus tears and
ligament injuries and can be used to mendiagnossa
abnormalities in the knee joint prior to surgery. Fatsat good
and techniques used in non-cooperative patients who need
short inspection time.
CONCLUSION MRI team, 2011, Aplication for MRI Parameter: SPIR vs SPAIR, Philips
Healthcare
There is a difference in the value of the Signal to
Noise Ratio (SNR) between sequences with sequences NessAiver, 1996, All you really need to know About MRI Physics,
PDW_SPAIR PDW_Fatsat with p-value of 0.000 (p University of MarylandMedical Center, USA.
<0.05). Based on the mean value paired T test can be Pearce, Evelyn C. 2009. Anatomi dan fisiologi untuk Paramedis. PT.
concluded that the sequence PDW_SPAIR better than Gramedia Pustaka Utama: Jakarta
PDW_Fatsat sequences in generating value SNR MRI
Riberio, Margarida et al. 2013. STIR, SPIR and SPAIR Techniques in
Knee Joint. Magnetic Resonance of the Breast : A Comparative Study,
www.scirp.org/journal/jbise/. Diakses tanggal 1 September
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