Increased signal intensity on fat-suppressed three-dimensional T1-weighted pulse sequences in patellar tendon: magic angle effect?

Abstract 

Objective. To assess the frequency of increased signal intensity in the patellar tendon using three-dimensional T1-weighted MRI pulse sequences. Design and patients. Sixty patients were examined with a 1.0 T scanner (15mT/m gradient strength) using a quadrature coil. Three pulse sequences were applied in the sagittal plane: PD turbo spin echo (PD-TSE), 3D T1-weighted gradient echo with fat suppression (3D-T1-FFE-FS) and 3D T1-weighted echo planar imaging with fat suppression (3D-T1-EPI-FS). The high signal intensity areas were measured in their maximum length. The angle of the patellar tendon relative to the main field position was measured in the same slice. In eight patients with anterior knee pain, and in 11 with no anterior knee pain, a fourth T2-weighted TSE pulse sequence (T2-TSE) was obtained to rule out patellar tendinitis. Results. The correlation of the high signal intensity areas with the relative position of the tendon was found to be significant with the 3D sequences (P=0.03 for 3D-T1-FFE-FS and P=0.003 for 3D-T1-EPI-FS). The length of the high signal intensity area in the tendon was 5.4 mm with 3D-T1-FFE-FS, 4.9 mm with 3D-T1-EPI-FS and 3.1 mm with PD-TSE images. No patellar tendinitis was demonstrated on the T2-TSE images. Conclusion. The magic angle effect is commonly observed in the 3D based T1-weighted pulse sequences with fat suppression. The presence of the above sign must be recognized by radiologists, so that misdiagnosis of patellar tendinitis is avoided.