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Abstract Background: Pelvimetry is essential in obstetrics for delivery planning. While computed tomography (CT) is the standard, magnetic resonance imaging (MRI) offers a radiation-free alternative with zero echo time (ZTE) and black bone (BB) sequences providing high bone-to-soft tissue contrast within short scan times. This proof-of-concept study evaluates the reliability of these sequences and the agreement with CT for pelvimetry in a predominantly elderly population. Methods: This retrospective study included 21 female patients who underwent 3-T whole-body MRI including ZTE and BB sequences and 18fluorodeoxyglucose (18F-FDG) positron emission tomography (PET)/CT with optimized low-dose whole-body CT. Obstetric conjugate diameter (OCD), interspinous diameter (ISD), and median transverse diameter (MTD) were measured by five radiologists. Intra-reader, inter-reader, and inter-technique agreement were assessed using intraclass correlation coefficient (ICC) and repeatability/reproducibility coefficients. Results: Intra-reader agreement was good regardless of diameter or reader: all ICC ≥ 0.90, repeatability ranging from ± 0.26 to ± 0.48 cm (CT), ± 0.30 to ± 0.52 cm (BB), and ± 0.29 to ± 0.67 cm (ZTE). The inter-reader agreement was good regardless of sequence: all ICC ≥ 0.88, reproducibility ranging from ± 0.39 to ± 0.42 (OCD), ± 0.26 to ± 0.51 cm (ISD), and ± 0.53 to ± 0.58 cm (MTD). ZTE and BB showed similar agreement with CT: ± 0.57 to ± 0.81 cm when including inter-reader variability; ± 0.34 to ± 0.47 cm for only intra-reader variability. Conclusion: ZTE and BB sequences provided reliable measurements with good agreement with CT, for obstetric pelvimetry. Further validation in the context of pregnancy is needed. Relevance statement: MRI-based pseudo-CT sequences are a promising radiation-free alternative to CT for obstetric pelvimetry, offering the prospect of accurate, reliable measurements of pelvic diameters in pregnant women. Trial registration: The population included female patients with suspected multiple myeloma from a previous prospective oncology trial (ClinicalTrials.gov: NCT05381077). Key points: This study explores pseudo-CT MRI sequences for radiation-free non-invasive obstetric pelvimetry. Pseudo-CT zero echo time and black bone sequences provide repeatable and reproducible measurements of pelvic diameters. Pseudo-CT MRI sequences show good inter-technique agreement with the reference CT.
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Chabot, C., Haegeman, M., Chaouch, E., Dumitriu, D. I., Menten, R., Steenhaut, P., Bernard, P., Triqueneaux, P., Michoux, N., & Lecouvet, F. (2025). MRI-based pseudo-CT sequences as a radiation-free alternative to CT for obstetric pelvimetry: a proof-of-concept study. European Radiology Experimental, 9(1). https://doi.org/10.1186/s41747-025-00585-y (Original work published 2025)