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After routine MRI, the 3D-FRACTURE sequences were performed. Three radiologists independently evaluated the data during three sessions: (1) CT with consensus, (2) routine MRI, and (3) FRACTURE, with a 4-week interval between sessions. Assessments included osteophytes, bony foraminal stenosis, posterior longitudinal ligament ossification (OPLL), their anatomical location, and diagnostic confidence, using CT as the reference standard. Inter- and intra-reader reproducibility was assessed using multi-rater Fleiss \u03ba and the intraclass correlation coefficient (ICC), respectively. The non-inferiority assessment compared routine MRI\/FRACTURE and CT diagnoses using a relative reduction margin of 0.5.<\/jats:p>\n          <\/jats:sec>\n          <jats:sec>\n            <jats:title>Results<\/jats:title>\n            <jats:p>The study sample comprised 82 males and 55 females (age 56.9\u2009\u00b1\u20099.8 years). ICC indicated good to excellent inter-rater reliability for FRACTURE (osteophytes: ICC, 0.83\u20131.00; OPLL: ICC, 0.73\u20130.92; bony foraminal stenosis: ICC, 0.76\u20130.98), which was superior to conventional MRI (most ICC values\u2009&lt;\u20090.7). The diagnostic confidence by FRACTURE sequences was significantly higher than by routine MRI (<jats:italic>p<\/jats:italic>\u2009&lt;\u20090.001). Non-inferiority analysis demonstrated that FRACTURE and CT detection were similar for osteophyte, bony foraminal stenosis, and OPLL within a margin of 0.5.<\/jats:p>\n          <\/jats:sec>\n          <jats:sec>\n            <jats:title>Conclusion<\/jats:title>\n            <jats:p>The FRACTURE sequence demonstrated comparable performance to CT in bone abnormalities detection in cervical spondylosis, superior to the routine MRI protocol.<\/jats:p>\n          <\/jats:sec>\n          <jats:sec>\n            <jats:title>Critical relevance statement<\/jats:title>\n            <jats:p>The FRACTURE sequence addresses the limitations of conventional MRI in evaluating bone abnormalities, potentially minimizing radiation exposure and streamlining the diagnostic process for patients.<\/jats:p>\n          <\/jats:sec>\n          <jats:sec>\n            <jats:title>Key Points<\/jats:title>\n            <jats:p>\n              <jats:list list-type=\"bullet\">\n                <jats:list-item>\n                  <jats:p>MRI has advantages in the evaluation of cervical spondylosis, but is still insufficient in bone abnormalities evaluation.<\/jats:p>\n                <\/jats:list-item>\n                <jats:list-item>\n                  <jats:p>The FRACTURE sequence performed comparably to CT in bone abnormalities detection in cervical spondylosis.<\/jats:p>\n                <\/jats:list-item>\n                <jats:list-item>\n                  <jats:p>MRI with FRACTURE sequences may provide a non-ionizing method for assessing cervical spondylosis in some clinical settings.<\/jats:p>\n                <\/jats:list-item>\n              <\/jats:list>\n            <\/jats:p>\n          <\/jats:sec>\n          <jats:sec>\n            <jats:title>Graphical Abstract<\/jats:title>\n          <\/jats:sec>","DOI":"10.1186\/s13244-025-01997-5","type":"journal-article","created":{"date-parts":[[2025,6,3]],"date-time":"2025-06-03T14:42:58Z","timestamp":1748961778000},"update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":7,"title":["Added value of 3D fast-field-echo (FRACTURE) sequences for cervical spondylosis diagnosis: a prospective multi-reader non-inferiority study"],"prefix":"10.1186","volume":"16","author":[{"given":"Qizheng","family":"Wang","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Xiaoying","family":"Xing","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Zixian","family":"Zhang","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Xiaoxi","family":"Ji","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Shipei","family":"He","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yuxin","family":"Yang","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jiajia","family":"Xu","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Qiang","family":"Zhao","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-1860-2918","authenticated-orcid":false,"given":"Ning","family":"Lang","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"297","published-online":{"date-parts":[[2025,6,3]]},"reference":[{"key":"1997_CR1","doi-asserted-by":"publisher","first-page":"190S","DOI":"10.1016\/j.spinee.2006.04.024","volume":"6","author":"DC Baptiste","year":"2006","unstructured":"Baptiste DC, Fehlings MG (2006) Pathophysiology of cervical myelopathy. 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The remaining authors declare that they have no competing interests.","order":4,"name":"Ethics","group":{"name":"EthicsHeading","label":"Competing interests"}}],"article-number":"114"}}