{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,29]],"date-time":"2026-07-29T11:03:16Z","timestamp":1785322996972,"version":"3.55.0"},"reference-count":34,"publisher":"MDPI AG","issue":"15","license":[{"start":{"date-parts":[[2026,7,27]],"date-time":"2026-07-27T00:00:00Z","timestamp":1785110400000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Diagnostics"],"abstract":"<jats:p>Background\/Objectives: This study assesses the outcomes of integrating deep learning-augmented zero echo time (ZTE DL) MRI sequences into standard MRI protocols for assessment of the hands and feet. Methods: In this single-center, retrospective study, a standard MRI protocol of hands and feet at 1.5 T was compared with the same protocol with an added ZTE DL sequence. Pathological changes in the bone, including subcortical sclerosis, osteophytes, joint space narrowing and fractures, were rated as present or absent. Indeterminate intraosseous lesions (erosions\/ganglia) and indeterminate extraosseous lesions (ossicles\/soft tissue calcifications) were additionally assessed on a semi-quantitative 4-point Likert scale. Diagnostic confidence was rated as low, moderate, or high. Standard MRI vs. ZTE-DL-augmented MRI comparisons were evaluated using a mixed-effects model with reader as a random effect, and X-ray vs. ZTE-DL-augmented MRI comparisons using a paired Wilcoxon signed-rank test. Interreader agreement (two readers) was assessed using Kappa statistics. Results: The cohort encompassed 59 datasets (feet = 22, hands = 37) of 40 patients with an average age of 51.79 (SD \u00b1 11.84) years (58% women (n = 34), 42% men (n = 25)). Additional ZTE DL sequences resulted in similar findings, but with higher diagnostic confidence for assessment of bone changes when compared to conventional MR sequences (p-values &lt; 0.05) and, overall, when compared to radiographs in a subgroup (p &lt; 0.05 for five of six pathologic bone changes). Interreader agreement of diagnostic confidence was moderate to substantial (kappa 0.59\u20130.71). Conclusions: Addition of ZTE DL sequences to standard MRI protocols of hands and feet at 1.5 T demonstrated similar findings in the assessment of pathological bone changes, but with higher diagnostic confidence compared to conventional MR sequences and radiographs. However, further validation against a reference standard is required to determine diagnostic accuracy.<\/jats:p>","DOI":"10.3390\/diagnostics16152363","type":"journal-article","created":{"date-parts":[[2026,7,27]],"date-time":"2026-07-27T16:11:56Z","timestamp":1785168716000},"page":"2363","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Deep Learning-Augmented Zero Echo Time MRI Increases Diagnostic Confidence for Osseous Assessment in Hand and Foot MRI Protocols"],"prefix":"10.3390","volume":"16","author":[{"ORCID":"https:\/\/orcid.org\/0009-0001-5605-3668","authenticated-orcid":false,"given":"Carina","family":"Oberm\u00fcller","sequence":"first","affiliation":[{"name":"Department of Diagnostic and Interventional Radiology, University Hospital Zurich, 8091 Zurich, Switzerland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Karolina","family":"Pawlus","sequence":"additional","affiliation":[{"name":"Department of Diagnostic and Interventional Radiology, University Hospital Zurich, 8091 Zurich, Switzerland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0007-4326-4005","authenticated-orcid":false,"given":"Maelene","family":"Lohezic","sequence":"additional","affiliation":[{"name":"GE HealthCare, 8152 Glattbrugg, Switzerland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jose de Arcos","family":"Rodriguez","sequence":"additional","affiliation":[{"name":"GE HealthCare, 28023 Madrid, Spain"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-5903-2248","authenticated-orcid":false,"given":"Roman","family":"Guggenberger","sequence":"additional","affiliation":[{"name":"Klinik f\u00fcr Radiologie und Nuklearmedizin, Kantonsspital Winterthur, 8400 Winterthur, Switzerland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-7840-8415","authenticated-orcid":false,"given":"Malwina","family":"Kaniewska","sequence":"additional","affiliation":[{"name":"Department of Diagnostic and Interventional Radiology, University Hospital Zurich, 8091 Zurich, Switzerland"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2026,7,27]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","unstructured":"Expert Panel on Musculoskeletal Imaging, Stensby, J.D., Fox, M.G., Nacey, N., Blankenbaker, D.G., Frick, M.A., Jawetz, S.T., Raizman, N.M., Said, N., and Stephens, L.A. 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