ORIGINAL RESEARCH n TECHNICAL DEVELOPMENTS 538 radiology.rsna.org n Radiology: Volume 283: Number 2—May 2017 1 From the Department of Radiology (X.W., C.E.H., A.C., R.E.L., A.J.M.) and Advanced Imaging Research Center (A.C., R.E.L., A.J.M.), UT Southwestern Medical Center, 5323 Harry Hines Blvd, Dallas, TX 75019-9061; and Philips Healthcare, Philips Innovation Campus, Bangalore, India (Y.K.M., K.G.). Received January 6, 2016; revision requested February 24; revision received August 23; accepted September 19; final version accepted October 4. Address correspondence to A.J.M. (e-mail: Ananth. Madhuranthakam@UTSouthwestern.edu). q RSNA, 2016 Purpose: To develop and evaluate magnetic resonance (MR) neu- rography of the brachial plexus with robust fat and blood suppression for increased conspicuity of nerves at 3.0 T in clinically feasible acquisition times. Materials and Methods: This prospective study was HIPAA compliant, with in- stitutional review board approval and written informed consent. A low-refocusing-flip-angle three-dimensional (3D) turbo spin-echo (TSE) sequence was modified to ac- quire both in-phase and out-of-phase echoes, required for chemical shift (Dixon) reconstruction, in the same rep- etition by using partial echoes combined with modified homodyne reconstruction with phase preservation. This multiecho TSE modified Dixon (mDixon) sequence was optimized by using simulations and phantom studies and in three healthy volunteers. The sequence was tested in five healthy volunteers and was evaluated in 10 patients who had been referred for brachial plexopathy at 3.0 T. The images were evaluated against the current standard of care, images acquired with a 3D TSE short inversion time inversion recovery (STIR) sequence, qualitatively by using the Wilcoxon signed-rank test and quantitatively by using the Friedman two-way analysis of variance, with P , .05 considered to indicate a statistically significant difference. Results: Multiecho TSE-mDixon involving partial-echo and ho- modyne reconstruction with phase preservation achieved uniform fat suppression in half the imaging time com- pared with multiacquisition TSE-mDixon. Compared with 3D TSE STIR, fat suppression, venous suppression, and nerve visualization were significantly improved (P , .05), while arterial suppression was better but not significantly so (P = .06), with increased apparent signal-to-noise ratio in the dorsal nerve root ganglion and C6 nerve (P , .001) with the multiecho TSE-mDixon sequence. Conclusion: The multiecho 3D TSE-mDixon sequence provides robust fat and blood suppression, resulting in increased conspi- cuity of the nerves, in clinically feasible imaging times and can be used for MR neurography of the brachial plexus at 3.0 T. q RSNA, 2016 Online supplemental material is available for this article. Xinzeng Wang, MS Crystal Harrison, PhD Yogesh K. Mariappan, PhD Karthik Gopalakrishnan, PhD Avneesh Chhabra, MD Robert E. Lenkinski, PhD Ananth J. Madhuranthakam, PhD MR Neurography of Brachial Plexus at 3.0 T with Robust Fat and Blood Suppression 1 This copy is for personal use only. To order printed copies, contact reprints@rsna.org