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Vertebral Compression Fractures in Elderly: How to Recognize and Report. CURRENT RADIOLOGY REPORTS 2018. [DOI: 10.1007/s40134-018-0289-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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52
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Accuracy of Opposed-phase Magnetic Resonance Imaging for the Evaluation of Treated and Untreated Spinal Metastases. Acad Radiol 2018; 25:877-882. [PMID: 29398437 DOI: 10.1016/j.acra.2017.11.022] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2017] [Revised: 11/18/2017] [Accepted: 11/29/2017] [Indexed: 12/30/2022]
Abstract
RATIONALE AND OBJECTIVES To assess whether the accuracy of opposed-phase magnetic resonance (MR) imaging to differentiate spinal metastases from benign lesions is influenced by treatment. MATERIALS AND METHODS We retrospectively evaluated 25 benign lesions, 25 untreated spinal metastases, and 89 treated spinal metastases in 101 patients who underwent opposed-phase MR spine imaging at our institution. The largest possible region of interest was placed over the lesion in question on out-of-phase and in-phase MR sequences, and the signal intensity ratio (SIR) of the lesions was calculated. The SIRs were compared between benign, untreated, and treated lesions. Receiver operator characteristic (ROC) curves were used to identify the optimal threshold to differentiate benign lesions from untreated spinal metastases, and the accuracy of this threshold was assessed for treated spinal metastases, chemotherapy-treated spinal metastases, and radiated spinal metastases. RESULTS Benign lesions had lower mean SIR than untreated (P = 2.4 × 10-8, 95% confidence interval [0.29, 0.51]) and treated spinal metastases (P = .51; 95% confidence interval [-0.13, 0.06]). A cutoff SIR of 0.856 had an accuracy of 88.00% for untreated lesions, 77.48% for previously treated lesions, and 70.45% for previously radiated lesions. The ROC curve to differentiate benign lesions from radiated spinal metastases was significantly different from the ROC curve to differentiate benign lesions from untreated spinal metastases (P = .0180). The ROC curve to differentiate benign lesions from lesions treated with chemotherapy only was significantly different from the ROC curve to differentiate between benign lesions and radiated spinal metastases (P = .041). CONCLUSIONS Opposed-phase imaging is less accurate for treated spinal metastases, in particular after radiation.
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Schweitzer ME. Now is the time to start routinely using chemical shift imaging in the spine. Eur Radiol 2018; 28:2779-2780. [DOI: 10.1007/s00330-018-5399-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2018] [Accepted: 02/21/2018] [Indexed: 11/30/2022]
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Costa FM, Canella C, Vieira FG, Vianna EM, Meohas W, Marchiori E. The usefulness of chemical-shift magnetic resonance imaging for the evaluation of osteoid osteoma. Radiol Bras 2018; 51:156-161. [PMID: 29991836 PMCID: PMC6034728 DOI: 10.1590/0100-3984.2017.0037] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/03/2022] Open
Abstract
Objective The purpose of this study was to determine whether chemical-shift magnetic
resonance imaging (MRI) could be useful in the diagnosis of osteoid osteoma
when clinical and radiological tumor features are inconclusive. Materials and Methods This retrospective study included 17 patients who underwent chemical-shift
MRI for the evaluation of osteoid osteoma. For all patients, two
musculoskeletal radiologists independently recorded signal intensities on
in-phase and out-of-phase images in the nidus of the tumor, in
abnormal-intensity bone marrow surrounding the lesion, and in
normal-appearing bone marrow. For each region, relative signal intensity
ratios were calculated by dividing out-of-phase by in-phase values. Relative
ratios > 1 were considered indicative of neoplastic lesions. Statistical
analysis was carried out to analyze the sample. Inter-observer and
intra-observer agreement for each imaging method were assessed using
intraclass correlation coefficients according to the Fleiss method and a
value > 0.65 was considered to indicate substantial agreement. Results The mean relative signal intensity ratios were 1.2 (range, 0.9-1.4) for the
nidus and 0.35 (range, 0.11-0.66) for the surrounding tissue; these values
differed significantly from the relative signal-intensity ratios for
normal-appearing bone marrow (p < 0.05). Conclusion Chemical-shift MRI is useful for the diagnosis and evaluation of osteoid
osteoma.
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Affiliation(s)
| | - Clarissa Canella
- MD, PhD, Clínica de Diagnóstico Por Imagem (CDPI), Rio de Janeiro, RJ, and Universidade Federal Fluminense (UFF), Niterói, RJ, Brazil
| | | | | | - Walter Meohas
- MD, Instituto Nacional de Traumatologia e Ortopedia (INTO), Rio de Janeiro, RJ, Brazil
| | - Edson Marchiori
- MD, PhD, Universidade Federal do Rio de Janeiro (UFRJ), Rio de Janeiro, RJ, Brazil
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Schmeel FC, Luetkens JA, Enkirch SJ, Feißt A, Endler CHJ, Schmeel LC, Wagenhäuser PJ, Träber F, Schild HH, Kukuk GM. Proton density fat fraction (PDFF) MR imaging for differentiation of acute benign and neoplastic compression fractures of the spine. Eur Radiol 2018; 28:5001-5009. [PMID: 29858641 DOI: 10.1007/s00330-018-5513-0] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2018] [Revised: 04/18/2018] [Accepted: 04/26/2018] [Indexed: 12/23/2022]
Abstract
OBJECTIVES To evaluate the diagnostic performance of proton density fat fraction (PDFF) magnetic resonance imaging (MRI) to differentiate between acute benign and neoplastic vertebral compression fractures (VCFs). METHODS Fifty-seven consecutive patients with 46 acute benign and 41 malignant VCFs were prospectively enrolled in this institutional review board approved study and underwent routine clinical MRI with an additional six-echo modified Dixon sequence of the spine at a clinical 3.0-T scanner. All fractures were categorised as benign or malignant according to either direct bone biopsy or 6-month follow-up MRI. Intravertebral PDFF and PDFFratio (fracture PDFF/normal vertebrae PDFF) for benign and malignant VCFs were calculated using region-of-interest analysis and compared between both groups. Additional receiver operating characteristic and binary logistic regression analyses were performed. RESULTS Both PDFF and PDFFratio of malignant VCFs were significantly lower compared to acute benign VCFs [PDFF, 3.48 ± 3.30% vs 23.99 ± 11.86% (p < 0.001); PDFFratio, 0.09 ± 0.09 vs 0.49 ± 0.24 (p < 0.001)]. The areas under the curve were 0.98 for PDFF and 0.97 for PDFFratio, yielding an accuracy of 96% and 95% for differentiating between acute benign and malignant VCFs. PDFF remained as the only imaging-based variable to independently differentiate between acute benign and malignant VCFs on multivariate analysis (odds ratio, 0.454; p = 0.005). CONCLUSIONS Quantitative assessment of PDFF derived from modified Dixon water-fat MRI has high diagnostic accuracy for the differentiation of acute benign and malignant vertebral compression fractures. KEY POINTS • Chemical-shift-encoding based water-fat MRI can reliably assess vertebral bone marrow PDFF • PDFF is significantly higher in acute benign than in malignant VCFs • PDFF provides high accuracy for differentiating acute benign from malignant VCFs.
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Affiliation(s)
- Frederic Carsten Schmeel
- Department of Radiology and Radiation Oncology, University Hospital Bonn, Rheinische-Friedrich-Wilhelms-Universität Bonn, Sigmund-Freud-Straße 25, 53127, Bonn, Germany.
| | - Julian Alexander Luetkens
- Department of Radiology and Radiation Oncology, University Hospital Bonn, Rheinische-Friedrich-Wilhelms-Universität Bonn, Sigmund-Freud-Straße 25, 53127, Bonn, Germany
| | - Simon Jonas Enkirch
- Department of Radiology and Radiation Oncology, University Hospital Bonn, Rheinische-Friedrich-Wilhelms-Universität Bonn, Sigmund-Freud-Straße 25, 53127, Bonn, Germany
| | - Andreas Feißt
- Department of Radiology and Radiation Oncology, University Hospital Bonn, Rheinische-Friedrich-Wilhelms-Universität Bonn, Sigmund-Freud-Straße 25, 53127, Bonn, Germany
| | - Christoph Hans-Jürgen Endler
- Department of Radiology and Radiation Oncology, University Hospital Bonn, Rheinische-Friedrich-Wilhelms-Universität Bonn, Sigmund-Freud-Straße 25, 53127, Bonn, Germany
| | - Leonard Christopher Schmeel
- Department of Radiology and Radiation Oncology, University Hospital Bonn, Rheinische-Friedrich-Wilhelms-Universität Bonn, Sigmund-Freud-Straße 25, 53127, Bonn, Germany
| | - Peter Johannes Wagenhäuser
- Department of Radiology and Radiation Oncology, University Hospital Bonn, Rheinische-Friedrich-Wilhelms-Universität Bonn, Sigmund-Freud-Straße 25, 53127, Bonn, Germany
| | - Frank Träber
- Department of Radiology and Radiation Oncology, University Hospital Bonn, Rheinische-Friedrich-Wilhelms-Universität Bonn, Sigmund-Freud-Straße 25, 53127, Bonn, Germany
| | - Hans Heinz Schild
- Department of Radiology and Radiation Oncology, University Hospital Bonn, Rheinische-Friedrich-Wilhelms-Universität Bonn, Sigmund-Freud-Straße 25, 53127, Bonn, Germany
| | - Guido Matthias Kukuk
- Department of Radiology and Radiation Oncology, University Hospital Bonn, Rheinische-Friedrich-Wilhelms-Universität Bonn, Sigmund-Freud-Straße 25, 53127, Bonn, Germany
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Morales KA, Arevalo-Perez J, Peck KK, Holodny AI, Lis E, Karimi S. Differentiating Atypical Hemangiomas and Metastatic Vertebral Lesions: The Role of T1-Weighted Dynamic Contrast-Enhanced MRI. AJNR Am J Neuroradiol 2018; 39:968-973. [PMID: 29650780 DOI: 10.3174/ajnr.a5630] [Citation(s) in RCA: 36] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2017] [Accepted: 01/18/2018] [Indexed: 12/16/2022]
Abstract
BACKGROUND AND PURPOSE Vertebral hemangiomas are benign vascular lesions that are almost always incidentally found in the spine. Their classic typical hyperintense appearance on T1- and T2-weighted MR images is diagnostic. Unfortunately, not all hemangiomas have the typical appearance, and they can mimic metastases on routine MR imaging. These are generally referred to as atypical hemangiomas and can result in misdiagnosis and ultimately additional imaging, biopsy, and unnecessary costs. Our objective was to assess the utility of dynamic contrast-enhanced MR imaging perfusion in distinguishing vertebral atypical hemangiomas and malignant vertebral metastases. We hypothesized that permeability and vascular density will be increased in metastases compared with atypical hemangiomas. MATERIALS AND METHODS Consecutive patients from 2011 to 2015 with confirmed diagnoses of atypical hemangiomas and spinal metastases from breast and lung carcinomas with available dynamic contrast-enhanced MR imaging were analyzed. Time-intensity curves were qualitatively compared among the groups. Perfusion parameters, plasma volume, and permeability constant were quantified using an extended Tofts 2-compartment pharmacokinetic model. Statistical significance was tested using the Mann-Whitney U test. RESULTS Qualitative inspection of dynamic contrast-enhanced MR imaging time-intensity curves demonstrated differences in signal intensity and morphology between metastases and atypical hemangiomas. Quantitative analysis of plasma volume and permeability constant perfusion parameters showed significantly higher values in metastatic lesions compared with atypical hemangiomas (P < .001). CONCLUSIONS Our data demonstrate that plasma volume and permeability constant perfusion parameters and qualitative inspection of contrast-enhancement curves can be used to differentiate atypical hemangiomas from vertebral metastatic lesions. This work highlights the benefits of adding perfusion maps to conventional sequences to improve diagnostic accuracy.
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Affiliation(s)
- K A Morales
- From the Departments of Radiology (K.A.M., J.A.-P., K.K.P., A.I.H., E.L., S.K.).,University of Puerto Rico Medical Sciences Campus (K.A.M.), San Juan, Puerto Rico
| | - J Arevalo-Perez
- From the Departments of Radiology (K.A.M., J.A.-P., K.K.P., A.I.H., E.L., S.K.)
| | - K K Peck
- From the Departments of Radiology (K.A.M., J.A.-P., K.K.P., A.I.H., E.L., S.K.).,Medical Physics (K.K.P.), Memorial Sloan Kettering Cancer Center, New York, New York
| | - A I Holodny
- From the Departments of Radiology (K.A.M., J.A.-P., K.K.P., A.I.H., E.L., S.K.)
| | - E Lis
- From the Departments of Radiology (K.A.M., J.A.-P., K.K.P., A.I.H., E.L., S.K.)
| | - S Karimi
- From the Departments of Radiology (K.A.M., J.A.-P., K.K.P., A.I.H., E.L., S.K.)
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Raghavan M. Conventional Modalities and Novel, Emerging Imaging Techniques for Musculoskeletal Tumors. Cancer Control 2018; 24:161-171. [DOI: 10.1177/107327481702400208] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/13/2023] Open
Affiliation(s)
- Meera Raghavan
- Department of Radiology, Northwell Health, New Hyde Park,
New York
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58
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Hahn S, Lee YH, Suh JS. Detection of vertebral metastases: a comparison between the modified Dixon turbo spin echo T 2 weighted MRI and conventional T 1 weighted MRI: a preliminary study in a tertiary centre. Br J Radiol 2018; 91:20170782. [PMID: 29393668 DOI: 10.1259/bjr.20170782] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022] Open
Abstract
OBJECTIVE To compare the diagnostic performance of modified Dixon (mDixon) turbo spin echo (TSE) T2 weighted MRI and conventional T1 weighted MRI in vertebral metastasis detection. METHODS Between September 2014 and October 2016, 33 patients with 68 metastases who had undergone whole-spine MRI were enrolled. The following sagittal image sets were evaluated: T1WI, and mDixon TSE T2 weighted water and fat images. Two radiologists independently evaluated each image-set for metastasis. The MR findings were compared with positron emission tomography-CT (PET-CT) scans. Sensitivity, specificity, positive predictive value (PPV) and negative predictive value (NPV) were calculated for each sequence. The diagnostic performance of each sequence was evaluated using receiver operating characteristic (ROC) curves. RESULTS Sensitivity, specificity, PPV and NPV for reviewer 1 were 83.8, 99.1, 89.1 and 98.6%, respectively, with T1WI; 79.4, 98.8, 85.7 and 98.2%, respectively, with mDixon TSE T2 weighted water imaging; and 86.8, 99.1, 89.4 and 98.8%, respectively, with mDixon TSE T2 weighted fat imaging. For reviewer 2, the respective scores were 91.2, 99.2, 91.2 and 99.2%; 85.3, 99.5, 93.4 and 98.7%; and 89.7, 99.3, 92.4 and 99.1%. With PET-CT as the gold standard, the ROC curves of the three sequences showed no significant difference (all p > 0.05). CONCLUSION The diagnostic performance of mDixon TSE T2 weighted water and fat imaging was comparable to that of conventional T1WI in the detection of vertebral metastases. Advances in knowledge: mDixon TSE T2WI can be a good alternative to conventional T1WI for detecting vertebral metastases.
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Affiliation(s)
- Seok Hahn
- 1 Department of Radiology, Research Institute of Radiological Science, YUHS-KRIBB Medical Convergence Research Institute, and Severance Biomedical Science Institute, Yonsei University College of Medicine , Seoul , Republic of Korea.,2 Department of Radiology, Inje University College of Medicine, Haeundae Paik Hospital , Busan , Republic of Korea
| | - Young Han Lee
- 1 Department of Radiology, Research Institute of Radiological Science, YUHS-KRIBB Medical Convergence Research Institute, and Severance Biomedical Science Institute, Yonsei University College of Medicine , Seoul , Republic of Korea
| | - Jin-Suck Suh
- 1 Department of Radiology, Research Institute of Radiological Science, YUHS-KRIBB Medical Convergence Research Institute, and Severance Biomedical Science Institute, Yonsei University College of Medicine , Seoul , Republic of Korea
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Mauch JT, Carr CM, Cloft H, Diehn FE. Review of the Imaging Features of Benign Osteoporotic and Malignant Vertebral Compression Fractures. AJNR Am J Neuroradiol 2018; 39:1584-1592. [PMID: 29348133 DOI: 10.3174/ajnr.a5528] [Citation(s) in RCA: 66] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
Vertebral compression fractures are very common, especially in the elderly. Benign osteoporotic and malignant vertebral compression fractures have extremely different management and prognostic implications. Although there is an overlap in appearances, characteristic imaging features can aid in the distinction between these 2 types of compression fractures. The aim of this review is to characterize the imaging features of benign and malignant vertebral compression fractures seen with CT, PET, SPECT, and MR imaging.
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Affiliation(s)
- J T Mauch
- From the Department of Radiology, Mayo Clinic, Rochester, Minnesota.
| | - C M Carr
- From the Department of Radiology, Mayo Clinic, Rochester, Minnesota
| | - H Cloft
- From the Department of Radiology, Mayo Clinic, Rochester, Minnesota
| | - F E Diehn
- From the Department of Radiology, Mayo Clinic, Rochester, Minnesota
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Proton density fat fraction (PDFF) MRI for differentiation of benign and malignant vertebral lesions. Eur Radiol 2018; 28:2397-2405. [PMID: 29313118 DOI: 10.1007/s00330-017-5241-x] [Citation(s) in RCA: 33] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2017] [Revised: 11/25/2017] [Accepted: 12/05/2017] [Indexed: 12/17/2022]
Abstract
OBJECTIVES To investigate whether proton density fat fraction (PDFF) measurements using a six-echo modified Dixon sequence can help to differentiate between benign and malignant vertebral bone marrow lesions. METHODS Sixty-six patients were prospectively enrolled in our study. In addition to conventional MRI at 3.0-Tesla including at least sagittal T2-weighted/spectral attenuated inversion recovery and T1-weighted sequences, all patients underwent a sagittal six-echo modified Dixon sequence of the spine. The mean PDFF was calculated using regions of interest and compared between vertebral lesions. A cut-off value of 6.40% in PDFF was determined by receiver operating characteristic curves and used to differentiate between malignant (< 6.40%) and benign (≥ 6.40%) vertebral lesions. RESULTS There were 77 benign and 44 malignant lesions. The PDFF of malignant lesions was statistically significant lower in comparison with benign lesions (p < 0.001) and normal vertebral bone marrow (p < 0.001). The areas under the curves (AUC) were 0.97 for differentiating benign from malignant lesions (p < 0.001) and 0.95 for differentiating acute vertebral fractures from malignant lesions (p < 0.001). This yielded a diagnostic accuracy of 96% in the differentiation of both benign lesions and acute vertebral fractures from malignancy. CONCLUSION PDFF derived from six-echo modified Dixon allows for differentiation between benign and malignant vertebral lesions with a high diagnostic accuracy. KEY POINTS • Establishing a diagnosis of indeterminate vertebral lesions is a common clinical problem • Benign bone marrow processes may mimic the signal alterations observed in malignancy • PDFF differentiates between benign and malignant lesions with a high diagnostic accuracy • PDFF of non-neoplastic vertebral lesions is significantly higher than that of malignancy • PDFF from six-echo modified Dixon may help avoid potentially harmful bone biopsy.
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61
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Differentiation of Acute Osteoporotic and Malignant Vertebral Fractures by Quantification of Fat Fraction With a Dixon MRI Sequence. AJR Am J Roentgenol 2017; 209:1331-1339. [DOI: 10.2214/ajr.17.18168] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
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62
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Okuda S, Nishibori H, Hoshi H. Utility of 111In-Cl 3 scintigraphy for differentiating bone marrow reconversion. J Nucl Med Technol 2017; 46:jnmt.117.197913. [PMID: 29127248 DOI: 10.2967/jnmt.117.197913] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2017] [Accepted: 10/12/2017] [Indexed: 12/13/2022] Open
Abstract
Indium chloride (111In-Cl3) scintigraphy has been used to evaluate various hematological diseases for many years. However, there have been few reports on patients with bone marrow reconversion showing high uptake in 111In-Cl3 scintigraphy. Herein, we report a case of a 68-year-old man with esophageal cancer who underwent 18F-FDG PET/CT for staging of the disease. 18F-FDG PET/CT demonstrated high uptake in the first lumbar vertebral body, which was difficult to distinguish bone metastasis and bone marrow reconversion. 111In-Cl3 scintigraphy demonstrated specific findings with high uptake in the lesion, indicating bone marrow hyperplasia or reconversion.
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63
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Maeder Y, Dunet V, Richard R, Becce F, Omoumi P. Bone Marrow Metastases: T2-weighted Dixon Spin-Echo Fat Images Can Replace T1-weighted Spin-Echo Images. Radiology 2017; 286:948-959. [PMID: 29095674 DOI: 10.1148/radiol.2017170325] [Citation(s) in RCA: 67] [Impact Index Per Article: 9.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
Purpose To test the potential of Dixon T2-weighted fat-only sequences to replace T1-weighted sequences for the detection of bone metastases, with the hypothesis that diagnostic performance with an alternative magnetic resonance (MR) imaging protocol (sagittal spin-echo Dixon T2-weighted fat-only and water-only imaging) would not be inferior to that with the standard protocol (sagittal spin-echo T1-weighted and spin-echo Dixon T2-weighted water-only imaging). Materials and Methods A total of 121 consecutive whole-spine MR imaging examinations (63 men; mean age ± standard deviation, 61.4 years ± 11.8) performed for suspected vertebral bone metastases were included in this retrospective, institutional review board-approved study. Quantitative image analysis was performed for 30 randomly selected spine levels. Qualitative analysis was performed separately by two musculoskeletal radiologists, who registered the number of metastases for each spine level. Areas under the curve with the protocols were compared on the basis of nonparametric receiver operating characteristic curve estimations by using a noninferiority test on paired data, with a best valuable comparator as a reference. Interobserver and interprotocol agreement was assessed by using κ statistics. Results Contrast-to-noise ratio was significantly higher on the alternative protocol images than on the standard protocol images (181.1 [95% confidence interval: 140.4, 221.7] vs 84.7 [95% confidence interval: 66.3, 103.1] respectively; P < .001). Diagnostic performance was not significantly inferior with the alternative protocol than with the standard protocol for both readers in a per-patient analysis (sensitivity, 97.9%-98.9% vs 93.6%-97.9%; specificity, 85.2%-92.6% vs 92.6%-96.3%; area under the curve, 0.92-0.96 vs 0.95, respectively; all P ≤ .02) and a per-spine level analysis (all P < .01). Interobserver and interprotocol agreement was good to very good (κ = 0.70-0.81). Conclusion Dixon T2-weighted fat-only and water-only imaging provide, in one sequence, diagnostic performance similar to that of the standard combination of morphologic sequences for the detection of probable spinal bone metastases, thereby providing an opportunity to reduce imaging time by eliminating the need to perform T1 sequences. © RSNA, 2017 An earlier incorrect version of this article appeared online. This article was corrected on November 6, 2017.
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Affiliation(s)
- Yaël Maeder
- From the Department of Diagnostic and Interventional Radiology, Lausanne University Hospital, Rue du Bugnon 46, 1011 Lausanne, Switzerland
| | - Vincent Dunet
- From the Department of Diagnostic and Interventional Radiology, Lausanne University Hospital, Rue du Bugnon 46, 1011 Lausanne, Switzerland
| | - Raphael Richard
- From the Department of Diagnostic and Interventional Radiology, Lausanne University Hospital, Rue du Bugnon 46, 1011 Lausanne, Switzerland
| | - Fabio Becce
- From the Department of Diagnostic and Interventional Radiology, Lausanne University Hospital, Rue du Bugnon 46, 1011 Lausanne, Switzerland
| | - Patrick Omoumi
- From the Department of Diagnostic and Interventional Radiology, Lausanne University Hospital, Rue du Bugnon 46, 1011 Lausanne, Switzerland
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Jones BC, Fayad LM. Musculoskeletal Tumor Imaging: Focus on Emerging Techniques. Semin Roentgenol 2017; 52:269-281. [PMID: 28965546 DOI: 10.1053/j.ro.2017.04.004] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Affiliation(s)
- Blake C Jones
- The Russell H. Morgan Department of Radiology and Radiological Science, The Johns Hopkins University School of Medicine, Baltimore, MD.
| | - Laura M Fayad
- The Russell H. Morgan Department of Radiology and Radiological Science, The Johns Hopkins University School of Medicine, Baltimore, MD; The Department of Orthopaedic Surgery, The Johns Hopkins University School of Medicine, Baltimore, MD; The Department of Oncology, The Johns Hopkins University School of Medicine, Baltimore, MD
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65
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Pezeshk P, Alian A, Chhabra A. Role of chemical shift and Dixon based techniques in musculoskeletal MR imaging. Eur J Radiol 2017; 94:93-100. [DOI: 10.1016/j.ejrad.2017.06.011] [Citation(s) in RCA: 36] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2017] [Revised: 06/13/2017] [Accepted: 06/14/2017] [Indexed: 12/25/2022]
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Differential diagnosis of hemangiomas from spinal osteolytic metastases using 3.0 T MRI: comparison of T1-weighted imaging, chemical-shift imaging, diffusion-weighted and contrast-enhanced imaging. Oncotarget 2017; 8:71095-71104. [PMID: 29050345 PMCID: PMC5642620 DOI: 10.18632/oncotarget.20533] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2017] [Accepted: 07/29/2017] [Indexed: 11/25/2022] Open
Abstract
The retrospective study investigated accuracy of quantitative evaluation of T1-weighted imaging (T1WI) with and without fat suppression (FS), chemical-shift, diffusion-weighted imaging (DWI) and enhanced imaging at 3.0 T MRI for distinguishing spinal hemangiomas from metastases. 27 patients with 33 spinal hemangiomas (15 atypical hemangiomas) and 26 patients with 71 metastases were recruited. T1WI, FS T1WI, in- and out-phase, DWI and enhanced T1WI were acquired. Signal intensities (SIs) of lesions were obtained. Signal intensity ratios (SIRs) and enhancement ratios of lesions in enhanced imaging were assessed. Ratio of SI loss of hemangiomas or atypical hemangiomas between T1WI and FS T1WI was higher than those of metastases (p < 0.001). The accuracies of ratio of SI loss between T1WI and FS T1WI for differentiating hemangiomas and atypical hemangiomas from metastases were 96.15% and 91.86%. Ratio of SI loss between in- and out- phase could differentiate hemangiomas and atypical hemangiomas from metastases with accuracies of 74.04% and 84.88%. Cutoff values for hemangiomas in SIRs of ≤ 1.52 (early phase) and ≤ 1.38 (middle phase) yielded accuracies of 92.31% and 82.69%. Enhancement ratios of atypical hemangiomas in middle and delayed phases were higher than that of metastases. Accuracies of apparent diffusion coefficient for differentiating hemangiomas and atypical hemangiomas from metastases were 70.19% and 89.53%. T1WI with and without fat suppression could distinguish spinal hemangiomas from metastases. Quantitative assessment of chemical-shift, DWI and enhanced imaging were helpful to identification of spinal hemangiomas and metastases.
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67
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Comparison of Chemical Shift MR Imaging Findings between Vertebral Benign and Metastatic Lesions. INTERNATIONAL JOURNAL OF CANCER MANAGEMENT 2017. [DOI: 10.5812/ijcm.8661] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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68
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Pozzi G, Albano D, Messina C, Angileri SA, Al-Mnayyis A, Galbusera F, Luzzati A, Perrucchini G, Scotto G, Parafioriti A, Zerbi A, Sconfienza LM. Solid bone tumors of the spine: Diagnostic performance of apparent diffusion coefficient measured using diffusion-weighted MRI using histology as a reference standard. J Magn Reson Imaging 2017; 47:1034-1042. [PMID: 28755383 DOI: 10.1002/jmri.25826] [Citation(s) in RCA: 35] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2017] [Accepted: 07/13/2017] [Indexed: 11/11/2022] Open
Abstract
PURPOSE To assess the diagnostic performance of mean apparent diffusion coefficient (mADC) in differentiating benign from malignant bone spine tumors, using histology as a reference standard. Conventional magnetic resonance imaging (MRI) sequences have good reliability in evaluating spinal bone tumors, although some features of benign and malignant cancers may overlap, making the differential diagnosis challenging. MATERIALS AND METHODS In all, 116 patients (62 males, 54 females; mean age 59.5 ± 14.1) with biopsy-proven spinal bone tumors were studied. Field strength/sequences: 1.5T MR system; T1 -weighted turbo spin-echo (repetition time / echo time [TR/TE], 500/13 msec; number of excitations [NEX], 2; slice thickness, 4 mm), T2 -weighted turbo spin-echo (TR/TE, 4100/102 msec; NEX, 2; slice thickness, 4 mm), short tau inversion recovery (TR/TE, 4800/89 msec; NEX, 2; slice thickness, 4 mm, IT, 140 msec), axial spin-echo echo-planar diffusion-weighted imaging (DWI) (TR/TE 5200/72 msec; slice thickness 5 mm; field of view, 300; interslice gap, 1.5 mm; NEX, 6; echo-planar imaging factor, 96; no parallel imaging) with b-values of 0 and 1000 s/mm², and 3D fat-suppressed T1 -weighted gradient-recalled-echo (TR/TE, 500/13 msec; slice thickness, 4 mm) after administration of 0.2 ml/kg body weight gadolinum-diethylenetriamine pentaacetic acid. Two readers manually drew regions of interest on the solid portion of the lesion (hyperintense on T2 -weighted images, hypointense on T1 -weighted images, and enhanced after gadolinium administration on fat-suppressed T1 -weighted images) to calculate mADC. Histology was used as the reference standard. Tumors were classified into malignant primary tumors (MPT), bone metastases (BM), or benign primary tumors (BPT). Statistical tests: Nonnormality of distribution was tested with the Shapiro-Wilk test. The Kruskal-Wallis and Mann-Whitney U-test with Bonferroni correction were used. Sensitivity and specificity of the mADC values for BM, MPT, and BPT were calculated. Approximate receiver operating characteristic curves were created. Interobserver reproducibility was evaluated using the intraclass correlation coefficient (ICC). RESULTS The mADC values of MPT (n = 35), BM (n = 65), and BPT (n = 16) were 1.00 ± 0.32 (0.59-2.10) × 10-3 mm2 /s, 1.02 ± 0.25 (0.73-1.96) × 10-3 mm2 /s, 1.31 ± 0.36 (0.83-2.14) × 10-3 mm2 /s, respectively. The mADC was significantly different between BPT and all malignant lesions (BM+MPT) (P < 0.001), BM and BPT (P = 0.008), and MPT and BPT (P = 0.008). No difference was found between BM and MPT (P = 0.999). An mADC threshold of 0.952 × 10-3 mm2 /s yielded 81.3% sensitivity, 55.0% specificity. Accuracy was 76% (95% confidence interval [CI] = 63.9%-88.1%). Interobserver reproducibility was almost perfect (ICC = 0.916; 95% CI = 0.879-0.942). CONCLUSION DWI with mADC quantification is a reproducible tool to differentiate benign from malignant solid tumors with 76% accuracy. The mADC values of BPT were statistically higher than that of malignant tumors. However, the large overlap between cases may make mADC not helpful in a specific patient. LEVEL OF EVIDENCE 3 Technical Efficacy: Stage 2 J. Magn. Reson. Imaging 2018;47:1034-1042.
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Affiliation(s)
- Grazia Pozzi
- Unità Operativa di Radiologia Diagnostica ed Interventistica, IRCCS Istituto Ortopedico Galeazzi, Milano, Italy
| | - Domenico Albano
- Sezione di scienze Radiologiche, Di.Bi.Med., Università degli Studi di Palermo, Palermo, Italy
| | - Carmelo Messina
- Scuola di Specializzazione in Radiodiagnostica, Università degli Studi di Milano, Milano, Italy
| | | | - Asma'a Al-Mnayyis
- Department of Radiology, College of Medicine, Yarmouk University, Irbid, Jordan
| | - Fabio Galbusera
- Laboratorio di Meccanica delle Strutture Biologiche, IRCCS Istituto Ortopedico Galeazzi, Milano, Italy
| | - Alessandro Luzzati
- Centro di Chirurgia Ortopedica Oncologica e Ricostruttiva del Rachide, IRCCS Istituto Ortopedico Galeazzi, Milano, Italy
| | - Giuseppe Perrucchini
- Centro di Chirurgia Ortopedica Oncologica e Ricostruttiva del Rachide, IRCCS Istituto Ortopedico Galeazzi, Milano, Italy
| | - Gennaro Scotto
- Centro di Chirurgia Ortopedica Oncologica e Ricostruttiva del Rachide, IRCCS Istituto Ortopedico Galeazzi, Milano, Italy
| | - Antonina Parafioriti
- Anatomia Patologica, Azienda Sociosanitaria Territoriale PINI-CTO, Milano, Italy
| | - Alberto Zerbi
- Unità Operativa di Radiologia Diagnostica ed Interventistica, IRCCS Istituto Ortopedico Galeazzi, Milano, Italy
| | - Luca Maria Sconfienza
- Unità Operativa di Radiologia Diagnostica ed Interventistica, IRCCS Istituto Ortopedico Galeazzi, Milano, Italy.,Dipartimento di Scienze Biomediche per la Salute, Università degli Studi di Milano, Milano, Italy
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Nacey NC, Geeslin MG, Miller GW, Pierce JL. Magnetic resonance imaging of the knee: An overview and update of conventional and state of the art imaging. J Magn Reson Imaging 2017; 45:1257-1275. [PMID: 28211591 DOI: 10.1002/jmri.25620] [Citation(s) in RCA: 31] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2016] [Accepted: 11/04/2016] [Indexed: 12/28/2022] Open
Abstract
Magnetic resonance imaging (MRI) has become the preferred modality for imaging the knee to show pathology and guide patient management and treatment. The knee is one of the most frequently injured joints, and knee pain is a pervasive difficulty that can affect all age groups. Due to the diverse pathology, complex anatomy, and a myriad of injury mechanisms of the knee, the MRI knee protocol and sequences should ensure detection of both soft tissue and osseous structures in detail and with accuracy. The knowledge of knee anatomy and the normal or injured MRI appearance of these key structures are critical for precise diagnosis. Advances in MRI technology provide the imaging necessary to obtain high-resolution images to evaluate menisci, ligaments, and tendons. Furthermore, recent advances in MRI techniques allow for improved imaging in the postoperative knee and metal artifact reduction, tumor imaging, cartilage evaluation, and visualization of nerves. As treatment and operative management techniques evolve, understanding the correct application of these advancements in MRI of the knee will prove to be valuable to clinical practice. LEVEL OF EVIDENCE 5 J. MAGN. RESON. IMAGING 2017;45:1257-1275.
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Affiliation(s)
- Nicholas C Nacey
- Department of Radiology and Medical Imaging, University of Virginia, Charlottesville, Virginia, USA
| | - Matthew G Geeslin
- Department of Radiology and Medical Imaging, University of Virginia, Charlottesville, Virginia, USA
| | - Grady Wilson Miller
- Department of Radiology and Medical Imaging, University of Virginia, Charlottesville, Virginia, USA
| | - Jennifer L Pierce
- Department of Radiology and Medical Imaging, University of Virginia, Charlottesville, Virginia, USA
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Xiao Z, Li J, Li C, Zhang Y, She D, Cao D. Chemical shift MR imaging in the lumbar vertebra: the effect of field strength, scanner vendors and flip angles in repeatability of signal intensity index measurement. BMC Med Imaging 2016; 16:64. [PMID: 27884115 PMCID: PMC5123365 DOI: 10.1186/s12880-016-0167-3] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2016] [Accepted: 11/14/2016] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND To evaluate the reproducibility of signal intensity index (SII) measurements with MRI systems from different vendors and with different field strengths, and to test the effectiveness of flip angle. METHODS Thirty-two healthy volunteers (mean age 35.3 ± 9.3 years) were enrolled in this ethics committee-approved study. Chemical shift MR imaging was performed on 1.5- and 3.0-T MR systems from three vendors. Two independent observers measured SII values in five lumbar segments. Inter- and intraobserver agreement was assessed using the interclass correlation coefficients (ICCs). Differences of mean SII values between different field strengths and MR vendors as well as flip angles were compared by using repeated-measures analysis of variance. Differences of mean SII values between different flip angles were also compared by using paired-sample t test. RESULTS Inter- and intra-observer correlation coefficients showed good agreement (all ICC > 0.75) when measuring SII values at different MR systems (ICCs ranging from 0.896 to 0.983) and flip angles (ICCs ranging from 0.824 to 0.983). There were no significant differences in mean SII values measured by different MR vendors with different field strengths (all p > 0.05 ranging from 0.337 to 0.824). The differences in the mean SII between the four different flip angles were statistically significant (all p < 0.05 ranging from < 0.001 to 0.004) except the group of flip angle 50° versus 70° (p = 0.116). CONCLUSION The SII measurement using chemical shift MR imaging may be comparable between different MR systems. Also high flip angles showed better stability to quantitate lumbar fat content.
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Affiliation(s)
- Zebin Xiao
- Department of Radiology, First Affiliated Hospital of Fujian Medical University, 20 Cha-Zhong Road, Fuzhou, Fujian, 350005, China
| | - Jian Li
- Department of Radiology, First Affiliated Hospital of Fujian Medical University, 20 Cha-Zhong Road, Fuzhou, Fujian, 350005, China
| | - Chengqi Li
- Department of Radiology, Sanming Hospital of Integrated Traditional and Western, Sanming, Fujian, 365000, China
| | - Yuyang Zhang
- Department of Radiology, First Affiliated Hospital of Fujian Medical University, 20 Cha-Zhong Road, Fuzhou, Fujian, 350005, China
| | - Dejun She
- Department of Radiology, First Affiliated Hospital of Fujian Medical University, 20 Cha-Zhong Road, Fuzhou, Fujian, 350005, China
| | - Dairong Cao
- Department of Radiology, First Affiliated Hospital of Fujian Medical University, 20 Cha-Zhong Road, Fuzhou, Fujian, 350005, China.
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Baik JS, Jung JY, Jee WH, Chun CW, Kim SK, Shin SH, Chung YG, Jung CK, Kannengiesser S, Sohn Y. Differentiation of focal indeterminate marrow abnormalities with multiparametric MRI. J Magn Reson Imaging 2016; 46:49-60. [PMID: 27859835 DOI: 10.1002/jmri.25536] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2016] [Accepted: 10/14/2016] [Indexed: 01/15/2023] Open
Abstract
PURPOSE To explore magnetic resonance imaging (MRI) parameters from intravoxel incoherent motion diffusion-weighted imaging (IVIM-DWI), multiecho Dixon imaging (ME-Dixon), and dynamic contrast-enhanced imaging (DCE) for differentiating focal indeterminate marrow abnormalities MATERIALS AND METHODS: Forty-two patients with 14 benign and 28 malignant focal marrow abnormalities were included. The following were independently analyzed by two readers: signal intensity (SI), contour, and margin on conventional MR images; SI on b-800 images (SIb-800 ), apparent diffusion coefficient (ADC), IVIM parameters (Dslow, Dfast , and f), fat fraction (Ff), and DCE parameters (time-to-signal intensity curve pattern, iAUC, Ktrans , kep , and ve ). The MR characteristics and parameters from benign and malignant lesions were compared with a chi-squared test and the Mann-Whitney U-test, respectively. The area under receiver operating characteristic (ROC) curves (AUC) of each sequence were also compared. Interobserver agreements were assessed with Cohen's κ, and intraclass correlation coefficient (ICC). RESULTS ADC, Dslow , and Ff demonstrated a significant difference between benign and malignant marrow abnormalities for both readers (P < 0.001). SIb-800 and perfusion-related parameters from IVIM-DWI and DCE were not significantly different between the two groups (P = 0.145, 0.439, and 0.337 for reader 1, P = 0.378, 0.368, and 0.343 for reader 2, respectively). The AUCs of ADC, Dslow , and Ff were significantly higher for differentiating indeterminate marrow abnormalities in both readers (P < 0.001). Interobserver agreements were substantial in SIb-800 , and ICCs were almost perfect for ADC, Dslow , f, and Ff, and substantial for iAUC, kep , Ktrans , ve , and Dfast . CONCLUSION ADC, Dslow , and Ff may provide information for differentiating focal indeterminate abnormalities. LEVEL OF EVIDENCE 3 Technical Efficacy: Stage 2 J. MAGN. RESON. IMAGING 2017;46:49-60.
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Affiliation(s)
- Jun Seung Baik
- Department of Radiology, Seoul St. Mary's Hospital, College of Medicine, Catholic University of Korea, Seoul, South Korea
| | - Joon-Yong Jung
- Department of Radiology, Seoul St. Mary's Hospital, College of Medicine, Catholic University of Korea, Seoul, South Korea
| | - Won-Hee Jee
- Department of Radiology, Seoul St. Mary's Hospital, College of Medicine, Catholic University of Korea, Seoul, South Korea
| | | | - Sun Ki Kim
- Incheon St. Mary's Hospital, College of Medicine, Catholic University of Korea, Seoul, South Korea
| | - Seung Han Shin
- Department of Orthopedic Surgery, Seoul St. Mary's Hospital, College of Medicine, Catholic University of Korea, Seoul, South Korea
| | - Yang Guk Chung
- Department of Orthopedic Surgery, Seoul St. Mary's Hospital, College of Medicine, Catholic University of Korea, Seoul, South Korea
| | - Chan-Kwon Jung
- Department of Pathology, Seoul St. Mary's Hospital, College of Medicine, Catholic University of Korea, Seoul, South Korea
| | | | - YoHan Sohn
- Siemens Healthcare, Seoul, Republic of Korea
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Yoo HJ, Hong SH, Kim DH, Choi J, Chae HD, Jeong BM, Ahn JM, Kang HS. Measurement of fat content in vertebral marrow using a modified dixon sequence to differentiate benign from malignant processes. J Magn Reson Imaging 2016; 45:1534-1544. [DOI: 10.1002/jmri.25496] [Citation(s) in RCA: 51] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2016] [Revised: 09/12/2016] [Accepted: 09/12/2016] [Indexed: 11/10/2022] Open
Affiliation(s)
- Hye Jin Yoo
- Department of RadiologySeoul National University HospitalSeoul Korea
- Department of RadiologySeoul National University College of MedicineSeoul Korea
| | - Sung Hwan Hong
- Department of RadiologySeoul National University HospitalSeoul Korea
- Department of RadiologySeoul National University College of MedicineSeoul Korea
- Institute of Radiation MedicineSeoul National University Medical Research CenterSeoul Korea
| | - Dong Hyun Kim
- Department of RadiologySeoul National University HospitalSeoul Korea
| | - Ja‐Young Choi
- Department of RadiologySeoul National University HospitalSeoul Korea
- Department of RadiologySeoul National University College of MedicineSeoul Korea
| | - Hee Dong Chae
- Department of RadiologySeoul National University HospitalSeoul Korea
- Department of RadiologySeoul National University College of MedicineSeoul Korea
| | - Bo Mi Jeong
- Department of RadiologySeoul National University HospitalSeoul Korea
| | - Joong Mo Ahn
- Department of RadiologySeoul National University College of MedicineSeoul Korea
- Department of RadiologySeoul National University Bundang HospitalGyeongi‐Do Korea
| | - Heung Sik Kang
- Department of RadiologySeoul National University College of MedicineSeoul Korea
- Institute of Radiation MedicineSeoul National University Medical Research CenterSeoul Korea
- Department of RadiologySeoul National University Bundang HospitalGyeongi‐Do Korea
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Koutoulidis V, Fontara S, Terpos E, Zagouri F, Matsaridis D, Christoulas D, Panourgias E, Kastritis E, Dimopoulos MA, Moulopoulos LA. Quantitative Diffusion-weighted Imaging of the Bone Marrow: An Adjunct Tool for the Diagnosis of a Diffuse MR Imaging Pattern in Patients with Multiple Myeloma. Radiology 2016; 282:484-493. [PMID: 27610934 DOI: 10.1148/radiol.2016160363] [Citation(s) in RCA: 66] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
Purpose To evaluate the apparent diffusion coefficients (ADCs) of magnetic resonance (MR) imaging patterns in the bone marrow of patients with multiple myeloma (MM) and to determine a threshold ADC that may help distinguish a diffuse from a normal pattern with high accuracy. Materials and Methods This prospective study was approved by the ethics review board, and informed consent was obtained. Ninety-nine patients with newly diagnosed, untreated MM and 16 healthy control subjects underwent spinal MR imaging including diffusion-weighted imaging, and bone marrow ADCs were calculated. Pattern assignment was based on visual assessment of conventional MR images. The Kruskal-Wallis H test, the Mann-Whitney test, and the one-way analysis of variance were used to compare ADCs between patient subsets and control subjects, and a receiver operating characteristic analysis was performed. Results Mean ADCs ± standard deviation in patients with MM for the normal, focal, and diffuse MR imaging patterns were 0.360 × 10-3 mm2/sec ± 0.110, 1.046 × 10-3 mm2/sec ± 0.232, and 0.770 × 10-3 mm2/sec ± 0.135, respectively. There were significant differences in ADCs between diffuse and normal (P < .001), diffuse and focal (P < .001), and focal and normal (P < .001) patterns. Patients with a diffuse pattern had more features of advanced disease, higher international staging system score, increased incidence of high-risk cytogenetics, and higher revised international staging system score. ADCs greater than 0.548 × 10-3 mm2/sec showed 100% sensitivity (26 of 26) and 98% specificity (48 of 49) for the diagnosis of a diffuse (vs normal) MR imaging pattern, whereas an ADC greater than 0.597 × 10-3 mm2/sec showed 96% sensitivity (25 of 26) and 100% specificity (49 of 49). Conclusion ADCs of MR imaging patterns in patients with MM differ significantly. A diffuse MR imaging pattern can be distinguished more objectively from a normal MR imaging pattern by adding quantitative diffusion-weighted imaging to standard MR imaging protocols. © RSNA, 2016 Online supplemental material is available for this article.
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Affiliation(s)
- Vassilis Koutoulidis
- From the First Department of Radiology (V.K., S.F., D.M., E.P., L.A.M.) and Department of Clinical Therapeutics (E.T., F.Z., D.C., E.K., M.A.D.), School of Medicine, National and Kapodistrian University of Athens, Areteion Hospital, 76, Vas. Sophias Avenue, 11528 Athens, Greece
| | - Sophia Fontara
- From the First Department of Radiology (V.K., S.F., D.M., E.P., L.A.M.) and Department of Clinical Therapeutics (E.T., F.Z., D.C., E.K., M.A.D.), School of Medicine, National and Kapodistrian University of Athens, Areteion Hospital, 76, Vas. Sophias Avenue, 11528 Athens, Greece
| | - Evangelos Terpos
- From the First Department of Radiology (V.K., S.F., D.M., E.P., L.A.M.) and Department of Clinical Therapeutics (E.T., F.Z., D.C., E.K., M.A.D.), School of Medicine, National and Kapodistrian University of Athens, Areteion Hospital, 76, Vas. Sophias Avenue, 11528 Athens, Greece
| | - Flora Zagouri
- From the First Department of Radiology (V.K., S.F., D.M., E.P., L.A.M.) and Department of Clinical Therapeutics (E.T., F.Z., D.C., E.K., M.A.D.), School of Medicine, National and Kapodistrian University of Athens, Areteion Hospital, 76, Vas. Sophias Avenue, 11528 Athens, Greece
| | - Dimitris Matsaridis
- From the First Department of Radiology (V.K., S.F., D.M., E.P., L.A.M.) and Department of Clinical Therapeutics (E.T., F.Z., D.C., E.K., M.A.D.), School of Medicine, National and Kapodistrian University of Athens, Areteion Hospital, 76, Vas. Sophias Avenue, 11528 Athens, Greece
| | - Dimitrios Christoulas
- From the First Department of Radiology (V.K., S.F., D.M., E.P., L.A.M.) and Department of Clinical Therapeutics (E.T., F.Z., D.C., E.K., M.A.D.), School of Medicine, National and Kapodistrian University of Athens, Areteion Hospital, 76, Vas. Sophias Avenue, 11528 Athens, Greece
| | - Evangelia Panourgias
- From the First Department of Radiology (V.K., S.F., D.M., E.P., L.A.M.) and Department of Clinical Therapeutics (E.T., F.Z., D.C., E.K., M.A.D.), School of Medicine, National and Kapodistrian University of Athens, Areteion Hospital, 76, Vas. Sophias Avenue, 11528 Athens, Greece
| | - Efstathios Kastritis
- From the First Department of Radiology (V.K., S.F., D.M., E.P., L.A.M.) and Department of Clinical Therapeutics (E.T., F.Z., D.C., E.K., M.A.D.), School of Medicine, National and Kapodistrian University of Athens, Areteion Hospital, 76, Vas. Sophias Avenue, 11528 Athens, Greece
| | - Meletios A Dimopoulos
- From the First Department of Radiology (V.K., S.F., D.M., E.P., L.A.M.) and Department of Clinical Therapeutics (E.T., F.Z., D.C., E.K., M.A.D.), School of Medicine, National and Kapodistrian University of Athens, Areteion Hospital, 76, Vas. Sophias Avenue, 11528 Athens, Greece
| | - Lia A Moulopoulos
- From the First Department of Radiology (V.K., S.F., D.M., E.P., L.A.M.) and Department of Clinical Therapeutics (E.T., F.Z., D.C., E.K., M.A.D.), School of Medicine, National and Kapodistrian University of Athens, Areteion Hospital, 76, Vas. Sophias Avenue, 11528 Athens, Greece
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Winfeld M, Ahlawat S, Safdar N. Utilization of chemical shift MRI in the diagnosis of disorders affecting pediatric bone marrow. Skeletal Radiol 2016; 45:1205-12. [PMID: 27179650 DOI: 10.1007/s00256-016-2403-x] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/24/2016] [Revised: 04/20/2016] [Accepted: 04/28/2016] [Indexed: 02/02/2023]
Abstract
OBJECTIVE MRI signal intensity of pediatric bone marrow can be difficult to interpret using conventional methods. Chemical shift imaging (CSI), which can quantitatively assess relative fat content, may improve the ability to accurately diagnose bone marrow abnormalities in children. METHODS Consecutive pelvis and extremity MRI at a children's hospital over three months were retrospectively reviewed for inclusion of CSI. Medical records were reviewed for final pathological and/or clinical diagnosis. Cases were classified as normal or abnormal, and if abnormal, subclassified as marrow-replacing or non-marrow-replacing entities. Regions of interest (ROI) were then drawn on corresponding in and out-of-phase sequences over the marrow abnormality or over a metaphysis and epiphysis in normal studies. Relative signal intensity ratio for each case was then calculated to determine the degree of fat content in the ROI. RESULTS In all, 241 MRI were reviewed and 105 met inclusion criteria. Of these, 61 had normal marrow, 37 had non-marrow-replacing entities (osteomyelitis without abscess n = 17, trauma n = 9, bone infarction n = 8, inflammatory arthropathy n = 3), and 7 had marrow-replacing entities (malignant neoplasm n = 4, bone cyst n = 1, fibrous dysplasia n = 1, and Langerhans cell histiocytosis n = 1). RSIR averages were: normal metaphyseal marrow 0.442 (0.352-0.533), normal epiphyseal marrow 0.632 (0.566-698), non-marrow-replacing diagnoses 0.715 (0.630-0.799), and marrow-replacing diagnoses 1.06 (0.867-1.26). RSIR for marrow-replacing entities proved significantly different from all other groups (p < 0.05). ROC analysis demonstrated an AUC of 0.89 for RSIR in distinguishing marrow-replacing entities. CONCLUSION CSI techniques can help to differentiate pathologic processes that replace marrow in children from those that do not.
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Affiliation(s)
- Matthew Winfeld
- University of Pennsylvania Perelman School of Medicine, 3737 Market St, 6th floor, Philadelphia, PA, 19102, USA.
| | - Shivani Ahlawat
- The Russell H. Morgan Department of Radiology and Radiological Science, The Johns Hopkins Medical Institutions, 601 N Caroline St, Baltimore, MD, 21287, USA
| | - Nabile Safdar
- Department of Radiology and Imaging Sciences, Emory University School of Medicine, 201 Dowman Drive, Atlanta, GA, 30322, USA
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Discrimination between benign and malignant in vertebral marrow lesions with diffusion weighted MRI and chemical shift. THE EGYPTIAN JOURNAL OF RADIOLOGY AND NUCLEAR MEDICINE 2016. [DOI: 10.1016/j.ejrnm.2016.02.007] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/12/2023] Open
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Lee SH, Lee YH, Hahn S, Suh JS. Fat fraction estimation of morphologically normal lumbar vertebrae using the two-point mDixon turbo spin-echo MRI with flexible echo times and multipeak spectral model of fat: Comparison between cancer and non-cancer patients. Magn Reson Imaging 2016; 34:1114-20. [PMID: 27211257 DOI: 10.1016/j.mri.2016.05.007] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2016] [Accepted: 05/11/2016] [Indexed: 01/17/2023]
Abstract
PURPOSE This study aims to compare fat fraction of lumbar vertebrae between cancer and non-cancer patients, using the two-point modified Dixon (mDixon) turbo spin-echo (TSE) MRI with flexible echo times and multipeak fat spectral model. MATERIALS AND METHODS Fat fraction was calculated from fat and water images reconstructed by the mDixon TSE technique. Fat fraction of fat-water phantoms measured with the mDixon TSE method was compared with actual fat percentages. Patients who had undergone mDixon spine MRI and dual-energy X-ray absorptiometry within one year and had no bone metastasis were divided into cancer (n=7) and non-cancer (n=23) groups. Fat fraction and bone mineral density (BMD) were compared between the two groups. RESULTS Fat fraction of phantoms measured with mDixon MRI was highly correlated with their actual fat percentages (P<0.01, R(2)=0.93). Fat fraction of lumbar vertebrae was significantly lower in cancer patients (58.27±3.16%) than in non-cancer patients (70.48±1.83%) (P<0.01). BMD was not different between cancer (0.912±0.057g/cm(2)) and non-cancer patients (0.876±0.032g/cm(2)) (P=0.58). Fat fraction and BMD showed no significant correlation (P=0.95, R=0.006). CONCLUSIONS A two-point mDixon TSE method for assessing fat fraction was reliable. Fat fraction of morphologically normal lumbar vertebrae was significantly lower in cancer patients compared to non-cancer patients, using the two-point mDixon TSE technique.
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Affiliation(s)
- Seung Hyun Lee
- Department of Radiology, Research Institute of Radiological Science, Medical Convergence Research Institute, and Severance Biomedical Science Institute, Yonsei University College of Medicine, 50-1 Yonsei-ro, Seodaemun-gu, Seoul, 03722, Republic of Korea.
| | - Young Han Lee
- Department of Radiology, Research Institute of Radiological Science, Medical Convergence Research Institute, and Severance Biomedical Science Institute, Yonsei University College of Medicine, 50-1 Yonsei-ro, Seodaemun-gu, Seoul, 03722, Republic of Korea.
| | - Seok Hahn
- Department of Radiology, Research Institute of Radiological Science, Medical Convergence Research Institute, and Severance Biomedical Science Institute, Yonsei University College of Medicine, 50-1 Yonsei-ro, Seodaemun-gu, Seoul, 03722, Republic of Korea.
| | - Jin-Suck Suh
- Department of Radiology, Research Institute of Radiological Science, Medical Convergence Research Institute, and Severance Biomedical Science Institute, Yonsei University College of Medicine, 50-1 Yonsei-ro, Seodaemun-gu, Seoul, 03722, Republic of Korea.
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Magnetic Resonance Imaging of Nontraumatic Musculoskeletal Emergencies. Magn Reson Imaging Clin N Am 2016; 24:369-89. [DOI: 10.1016/j.mric.2015.11.005] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/26/2023]
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Amin WM, Kotb HT, Abdel-Kerim AA, Barakat MS, El-Malky AA, Fadel SH. Diffusion-weighted MRI and in-phase/opposed-phase sequences in the assessment of bone tumors. J Magn Reson Imaging 2016; 44:565-72. [PMID: 26934685 DOI: 10.1002/jmri.25212] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2015] [Revised: 02/10/2016] [Accepted: 02/10/2016] [Indexed: 11/06/2022] Open
Abstract
PURPOSE To evaluate the role of diffusion-weighted apparent diffusion coefficient (ADC) and in-phase/opposed-phase sequences in the differentiation of benign and malignant osseous tumors. MATERIALS AND METHODS At 1.5T, routine sequences were compared to diffusion-weighted and in-phase/opposed-phase in 63 patients. Routine sequence magnetic resonance imaging (MRI) scoring, mean ADC value, and in-phase/opposed-phase signal intensity ratio (SIR) was obtained. Statistical analysis included significance, receiver operating characteristic (ROC), and linear correlation between the three parameters. RESULTS In all, 38 patients had malignant tumors and 25 patients had benign tumors. Benign and malignant tumors showed different routine sequence scores (P < 0.001). Mean ADC of the benign lesions ranged 0.9-3.2 × 10(-3) mm(2) /sec of mean ± SD (1.9 ± 0.6). In malignant tumors, the mean ADC ranged 0.6-1.9 × 10(-3) mm(2) /sec of mean ± SD (1.1 ± 0.4) (P < 0.0001). There was a possible differentiation between malignant and benign tumors at a threshold of 1.1 × 10(-3) mm(2) /sec of sensitivity and specificity of 94.1% and 70.3%, respectively. SIR for benign tumors ranged 0.2-1.0 of mean ± SD (0.6 ± 0.3). For malignant lesions SIR ranged 0.4-1.2 of mean ± SD (0.8 ± 0.3). Benign and malignant tumors show statistically significant SIR at P < 0.022 with possible differentiation at a threshold of 0.75 of sensitivity and specificity of 70.3% and 76.5%, respectively. Simple linear correlation between both ADC and SIR was significant at P < 0.01 with correlation coefficient (r) = 0.45. CONCLUSION Diffusion-weighted and in-phase/opposed-phase imaging might be used in addition to conventional MRI as a routine tool for differentiation of benign and malignant tumors. J. Magn. Reson. Imaging 2016;44:565-572.
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Affiliation(s)
- Wessam M Amin
- Radiology Department, Alexandria University, Alexandria, Egypt
| | - Hesham T Kotb
- Radiology Department, Alexandria University, Alexandria, Egypt
| | | | | | - Awad A El-Malky
- Orthopedic surgery Department, Alexandria University, Alexandria, Egypt
| | - Shady H Fadel
- Oncology Department, Alexandria University, Alexandria, Egypt
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79
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Roberts CC, Kransdorf MJ, Beaman FD, Adler RS, Amini B, Appel M, Bernard SA, Fries IB, Germano IM, Greenspan BS, Holly LT, Kubicky CD, Lo SSM, Mosher TJ, Sloan AE, Tuite MJ, Walker EA, Ward RJ, Wessell DE, Weissman BN. ACR Appropriateness Criteria Follow-Up of Malignant or Aggressive Musculoskeletal Tumors. J Am Coll Radiol 2016; 13:389-400. [PMID: 26922595 DOI: 10.1016/j.jacr.2015.12.019] [Citation(s) in RCA: 40] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2015] [Accepted: 12/16/2015] [Indexed: 02/07/2023]
Abstract
Appropriate imaging modalities for the follow-up of malignant or aggressive musculoskeletal tumors include radiography, MRI, CT, (18)F-2-fluoro-2-deoxy-D-glucose PET/CT, (99m)Tc bone scan, and ultrasound. Clinical scenarios reviewed include evaluation for metastatic disease to the lung in low- and high-risk patients, for osseous metastatic disease in asymptomatic and symptomatic patients, for local recurrence of osseous tumors with and without significant hardware present, and for local recurrence of soft tissue tumors. The timing for follow-up of pulmonary metastasis surveillance is also reviewed. The ACR Appropriateness Criteria are evidence-based guidelines for specific clinical conditions that are reviewed every three years by a multidisciplinary expert panel. The guideline development and review include an extensive analysis of current medical literature from peer-reviewed journals and the application of a well-established consensus methodology (modified Delphi) to rate the appropriateness of imaging and treatment procedures by the panel. In those instances in which evidence is lacking or not definitive, expert opinion may be used to recommend imaging or treatment.
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Affiliation(s)
| | | | | | - Ronald S Adler
- New York University Center for Musculoskeletal Care, New York, New York
| | - Behrang Amini
- University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Marc Appel
- Warwick Valley Orthopedic Surgery, Warwick, New York, American Academy of Orthopaedic Surgeons
| | - Stephanie A Bernard
- Penn State University Milton S. Hershey Medical Center, Hershey, Pennsylvania
| | - Ian Blair Fries
- Bone, Spine and Hand Surgery, Chartered, Brick, New Jersey, American Academy of Orthopaedic Surgeons
| | | | | | - Langston T Holly
- University of California Los Angeles Medical Center, Los Angeles, California
| | | | - Simon Shek-Man Lo
- University Hospitals Seidman Cancer Center, Case Western Reserve University, Cleveland, Ohio
| | - Timothy J Mosher
- Penn State University Milton S. Hershey Medical Center, Hershey, Pennsylvania
| | - Andrew E Sloan
- University Hospital Case Medical Center, Cleveland, Ohio
| | | | - Eric A Walker
- Penn State University Milton S. Hershey Medical Center, Hershey, Pennsylvania
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80
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Torres C, Hammond I. Computed Tomography and Magnetic Resonance Imaging in the Differentiation of Osteoporotic Fractures From Neoplastic Metastatic Fractures. J Clin Densitom 2016; 19:63-9. [PMID: 26376170 DOI: 10.1016/j.jocd.2015.08.008] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/19/2014] [Accepted: 08/12/2015] [Indexed: 11/21/2022]
Abstract
Determining whether a low-intensity vertebral fracture in an older person, particularly one with a history of cancer, is due to osteoporosis (OP) or is the result of a metastasis, is a not infrequent clinical problem that has important prognostic and therapeutic implications. The 2 types of fracture are usually indistinguishable on plain radiographs and require higher order imaging for diagnosis. Magnetic resonance imaging is the modality of choice because of its unique ability to depict the bone marrow, which becomes transiently edematous in an acute OP fracture. Preservation of at least part of the normal marrow signal, the visualization of a fracture line parallel to the end plates, the presence of an intravertebral cleft, lack of pedicle involvement, and no extra-osseous mass all favor a benign OP fracture. Absence of the preceding signs, particularly if there is complete replacement of the normal bone marrow and a convex posterior contour of the vertebral body, favors a fracture of malignant origin. Non-routine magnetic resonance sequences using diffusion-weighted imaging and/or chemical shift imaging may be helpful in difficult cases.
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Affiliation(s)
- Carlos Torres
- Department of Radiology, The Ottawa Hospital, University of Ottawa, Ottawa, ON, Canada.
| | - Ian Hammond
- Department of Radiology, The Ottawa Hospital, University of Ottawa, Ottawa, ON, Canada
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81
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Nouh MR, Eid AF. Magnetic resonance imaging of the spinal marrow: Basic understanding of the normal marrow pattern and its variant. World J Radiol 2015; 7:448-458. [PMID: 26753060 PMCID: PMC4697119 DOI: 10.4329/wjr.v7.i12.448] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/02/2015] [Revised: 09/29/2015] [Accepted: 10/27/2015] [Indexed: 02/06/2023] Open
Abstract
For now, magnetic resonance (MR) is the best noninvasive imaging modality to evaluate vertebral bone marrow thanks to its inherent soft-tissue contrast and non-ionizing nature. A daily challenging scenario for every radiologist interpreting MR of the vertebral column is discerning the diseased from normal marrow. This requires the radiologist to be acquainted with the used MR techniques to judge the spinal marrow as well as its normal MR variants. Conventional sequences used basically to image marrow include T1W, fat-suppressed T2W and short tau inversion recovery (STIR) imaging provides gross morphological data. Interestingly, using non-routine MR sequences; such as opposed phase, diffusion weighted, MR spectroscopy and contrasted-enhanced imaging; may elucidate the nature of bone marrow heterogeneities; by inferring cellular and chemical composition; and adding new functional prospects. Recalling the normal composition of bone marrow elements and the physiologic processes of spinal marrow conversion and reconversion eases basic understanding of spinal marrow imaging. Additionally, orientation with some common variants seen during spinal marrow MR imaging as hemangiomas and bone islands is a must. Moreover, awareness of the age-associated bone marrow changes as well as changes accompanying different variations of the subject’s health state is essential for radiologists to avoid overrating normal MR marrow patterns as pathologic states and metigate unnecessary further work-up.
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82
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Nievelstein RAJ, Littooij AS. Whole-body MRI in paediatric oncology. Radiol Med 2015; 121:442-53. [PMID: 26631075 PMCID: PMC4837204 DOI: 10.1007/s11547-015-0600-7] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2015] [Accepted: 10/27/2015] [Indexed: 12/12/2022]
Abstract
Imaging plays a crucial role in the diagnosis and follow-up of paediatric malignancies. Until recently, computed tomography (CT) has been the imaging technique of choice in children with cancer, but nowadays there is an increasing interest in the use of functional imaging techniques like positron emission tomography and single-photon emission tomography. These later techniques are often combined with CT allowing for simultaneous acquisition of image data on the biological behaviour of tumour, as well as the anatomical localisation and extent of tumour spread. Because of the small but not negligible risk of radiation induced secondary cancers and the significantly improved overall survival rates of children with cancer, there is an increasing interest in the use of alternative imaging techniques that do not use ionising radiation. Magnetic resonance imaging (MRI) is a radiation-free imaging tool that allows for acquiring images with a high spatial resolution and excellent soft tissue contrast throughout the body. Moreover, recent technological advances have resulted in fast diagnostic sequences for whole-body MR imaging (WB-MRI), including functional techniques such as diffusion weighted imaging. In this review, the current status of the technique and major clinical applications of WB-MRI in children with cancer will be discussed.
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Affiliation(s)
- Rutger A J Nievelstein
- Department of Paediatric Radiology, Wilhelmina Children's Hospital, University Medical Center Utrecht, Utrecht, The Netherlands. .,Imaging Division, Department of Radiology and Nuclear Medicine, University Medical Center Utrecht, P.O. Box 85500, 3508 GA, Utrecht, The Netherlands.
| | - Annemieke S Littooij
- Department of Paediatric Radiology, Wilhelmina Children's Hospital, University Medical Center Utrecht, Utrecht, The Netherlands
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83
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The Radiologic Diagnosis and Treatment of Typical and Atypical Bone Hemangiomas: Current Status. Can Assoc Radiol J 2015; 67:2-11. [PMID: 26514943 DOI: 10.1016/j.carj.2014.07.002] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2014] [Revised: 07/15/2014] [Accepted: 07/23/2014] [Indexed: 12/26/2022] Open
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84
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Affiliation(s)
- Clarissa Canella
- MD, Radiologist, Clínica de Diagnóstico por Imagem (CDPI), Rio de Janeiro, RJ, Brazil. E-mail:
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85
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The value of added opposed/in phase MRI sequences in characterization of the focal vertebral bone marrow lesions in oncology patients. THE EGYPTIAN JOURNAL OF RADIOLOGY AND NUCLEAR MEDICINE 2015. [DOI: 10.1016/j.ejrnm.2015.05.004] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
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86
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Douis H, Davies AM, Jeys L, Sian P. Chemical shift MRI can aid in the diagnosis of indeterminate skeletal lesions of the spine. Eur Radiol 2015; 26:932-40. [PMID: 26162578 DOI: 10.1007/s00330-015-3898-6] [Citation(s) in RCA: 36] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2015] [Revised: 06/16/2015] [Accepted: 06/22/2015] [Indexed: 12/12/2022]
Abstract
OBJECTIVES To evaluate the role of chemical shift MRI in the characterisation of indeterminate skeletal lesions of the spine as benign or malignant. METHODS Fifty-five patients (mean age 54.7 years) with 57 indeterminate skeletal lesions of the spine were included in this retrospective study. In addition to conventional MRI at 3 T which included at least sagittal T1WI and T2WI/STIR sequences, patients underwent chemical shift MRI. A cut-off value with a signal drop-out of 20 % was used to differentiate benign lesions from malignant lesions (signal drop-out <20 % being malignant). RESULTS There were 45 benign lesions and 12 malignant lesions. Chemical shift imaging correctly diagnosed 33 of 45 lesions as benign and 11 of 12 lesions as malignant. In contrast, there were 12 false positive cases and 1 false negative case based on chemical shift MRI. This yielded a sensitivity of 91.7 %, a specificity of 73.3 %, a negative predictive value of 97.1 %, a positive predictive value of 47.8 % and a diagnostic accuracy of 82.5 %. CONCLUSIONS Chemical shift MRI can aid in the characterisation of indeterminate skeletal lesions of the spine in view of its high sensitivity in diagnosing malignant lesions. Chemical shift MRI can potentially avoid biopsy in a considerable percentage of patients with benign skeletal lesions of the spine. KEY POINTS • Differentiating benign from malignant skeletal lesions of the spine can be challenging. • Utility of chemical shift MRI in characterising indeterminate spinal lesion is unreported. • This study demonstrates sensitivity 91.7 %, specificity 73.3 %, diagnostic accuracy 82.5 % for CSI. • CSI is useful in differentiating benign from malignant skeletal spine lesions. • Biopsy can potentially be avoided in some patients with benign skeletal lesions.
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Affiliation(s)
- H Douis
- Department of Radiology, University Hospital Birmingham, Birmingham, B15 2TH, UK. .,Department of Radiology, Royal Orthopaedic Hospital, Birmingham, UK.
| | - A M Davies
- Department of Radiology, Royal Orthopaedic Hospital, Birmingham, UK
| | - L Jeys
- Department of Orthopaedic Oncology, Royal Orthopaedic Hospital, Birmingham, UK
| | - P Sian
- Department of Spinal Surgery and Spinal Oncology, Royal Orthopaedic Hospital, Birmingham, UK
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87
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Dong Y, Zheng S, Machida H, Wang B, Liu A, Liu Y, Zhang X. Differential diagnosis of osteoblastic metastases from bone islands in patients with lung cancer by single-source dual-energy CT: Advantages of spectral CT imaging. Eur J Radiol 2015; 84:901-7. [DOI: 10.1016/j.ejrad.2015.01.007] [Citation(s) in RCA: 35] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2014] [Revised: 12/23/2014] [Accepted: 01/05/2015] [Indexed: 10/24/2022]
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88
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Osteoporotic or malignant vertebral fracture? This is the question. What can we do about it? THE EGYPTIAN JOURNAL OF RADIOLOGY AND NUCLEAR MEDICINE 2015. [DOI: 10.1016/j.ejrnm.2014.11.010] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023] Open
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89
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Martel Villagrán J, Bueno Horcajadas Á, Pérez Fernández E, Martín Martín S. Accuracy of magnetic resonance imaging in differentiating between benign and malignant vertebral lesions: Role of Diffusion-weighted imaging, in-phase/opposed-phase imaging and apparent diffusion coefficient. RADIOLOGIA 2015. [DOI: 10.1016/j.rxeng.2013.11.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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90
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Precisión de la resonancia magnética en la diferenciación entre lesión vertebral maligna y benigna: papel de las secuencias de difusión, del cociente fuera de fase/en fase y de los valores del coeficiente de difusión aparente. RADIOLOGIA 2015; 57:142-9. [DOI: 10.1016/j.rx.2013.11.003] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2013] [Revised: 11/05/2013] [Accepted: 11/07/2013] [Indexed: 11/20/2022]
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91
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Kim YP, Kannengiesser S, Paek MY, Kim S, Chung TS, Yoo YH, Yoon CS, Song HT, Lee YH, Suh JS. Differentiation between focal malignant marrow-replacing lesions and benign red marrow deposition of the spine with T2*-corrected fat-signal fraction map using a three-echo volume interpolated breath-hold gradient echo Dixon sequence. Korean J Radiol 2014; 15:781-91. [PMID: 25469090 PMCID: PMC4248634 DOI: 10.3348/kjr.2014.15.6.781] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2014] [Accepted: 08/27/2014] [Indexed: 01/21/2023] Open
Abstract
Objective To assess the feasibility of T2*-corrected fat-signal fraction (FF) map by using the three-echo volume interpolated breath-hold gradient echo (VIBE) Dixon sequence to differentiate between malignant marrow-replacing lesions and benign red marrow deposition of vertebrae. Materials and Methods We assessed 32 lesions from 32 patients who underwent magnetic resonance imaging after being referred for assessment of a known or possible vertebral marrow abnormality. The lesions were divided into 21 malignant marrow-replacing lesions and 11 benign red marrow depositions. Three sequences for the parameter measurements were obtained by using a 1.5-T MR imaging scanner as follows: three-echo VIBE Dixon sequence for FF; conventional T1-weighted imaging for the lesion-disc ratio (LDR); pre- and post-gadolinium enhanced fat-suppressed T1-weighted images for the contrast-enhancement ratio (CER). A region of interest was drawn for each lesion for parameter measurements. The areas under the curve (AUC) of the parameters and their sensitivities and specificities at the most ideal cutoff values from receiver operating characteristic curve analysis were obtained. AUC, sensitivity, and specificity were respectively compared between FF and CER. Results The AUCs of FF, LDR, and CER were 0.96, 0.80, and 0.72, respectively. In the comparison of diagnostic performance between the FF and CER, the FF showed a significantly larger AUC as compared to the CER (p = 0.030), although the difference of sensitivity (p = 0.157) and specificity (p = 0.157) were not significant. Conclusion Fat-signal fraction measurement using T2*-corrected three-echo VIBE Dixon sequence is feasible and has a more accurate diagnostic performance, than the CER, in distinguishing benign red marrow deposition from malignant bone marrow-replacing lesions.
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Affiliation(s)
- Yong Pyo Kim
- Department of Radiology, Gangnam Severance Hospital, Yonsei University College of Medicine, Seoul 135-720, Korea
| | - Stephan Kannengiesser
- MR Applications Development, Siemens AG, Healthcare Sector, Erlangen D-91052, Germany, Korea
| | | | - Sungjun Kim
- Department of Radiology, Gangnam Severance Hospital, Yonsei University College of Medicine, Seoul 135-720, Korea
| | - Tae-Sub Chung
- Department of Radiology, Gangnam Severance Hospital, Yonsei University College of Medicine, Seoul 135-720, Korea
| | - Yeon Hwa Yoo
- Department of Radiology, Gangnam Severance Hospital, Yonsei University College of Medicine, Seoul 135-720, Korea
| | - Choon-Sik Yoon
- Department of Radiology, Gangnam Severance Hospital, Yonsei University College of Medicine, Seoul 135-720, Korea
| | - Ho-Taek Song
- Department of Radiology, Severance Hospital, Yonsei University College of Medicine, Seoul 120-752, Korea
| | - Young Han Lee
- Department of Radiology, Severance Hospital, Yonsei University College of Medicine, Seoul 120-752, Korea
| | - Jin-Suck Suh
- Department of Radiology, Severance Hospital, Yonsei University College of Medicine, Seoul 120-752, Korea
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92
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Silva FD, Pinheiro L, Cristofano C, de Oliveira Schiavon JL, Lederman HM. Magnetic Resonance Imaging in Pediatric Bone Tumors. CURRENT RADIOLOGY REPORTS 2014. [DOI: 10.1007/s40134-014-0077-5] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
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93
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Quantitative chemical-shift MR imaging cutoff value: Benign versus malignant vertebral compression – Initial experience. THE EGYPTIAN JOURNAL OF RADIOLOGY AND NUCLEAR MEDICINE 2014. [DOI: 10.1016/j.ejrnm.2014.05.016] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
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94
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Abstract
Focal lesions in bone are very common and many of these lesions are not bone tumors. These bone tumor mimickers can include numerous normal anatomic variants and non-neoplastic processes. Many of these tumor mimickers can be left alone, while others can be due to a significant disease process. It is important for the radiologist and clinician to be aware of these bone tumor mimickers and understand the characteristic features which allow discrimination between them and true neoplasms in order to avoid unnecessary additional workup. Knowing which lesions to leave alone or which ones require workup can prevent misdiagnosis and reduce patient anxiety.
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Affiliation(s)
- Jennifer Ni Mhuircheartaigh
- Department of Radiology, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts, United States
| | - Yu-Ching Lin
- Department of Radiology, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts, United States ; Department of Medical Imaging and Intervention, Chang Gung Memorial Hospital, Keelung Chang Gung University, Taoyuan, Taiwan
| | - Jim S Wu
- Department of Radiology, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts, United States
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95
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Del Grande F, Farahani SJ, Carrino JA, Chhabra A. Bone marrow lesions: A systematic diagnostic approach. Indian J Radiol Imaging 2014; 24:279-87. [PMID: 25114392 PMCID: PMC4126144 DOI: 10.4103/0971-3026.137049] [Citation(s) in RCA: 32] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022] Open
Abstract
Bone marrow lesions on magnetic resonance (MR) imaging are common and may be seen with various pathologies. The authors outline a systematic diagnostic approach with proposed categorization of various etiologies of bone marrow lesions. Utilization of typical imaging features on conventional MR imaging techniques and other problem-solving techniques, such as chemical shift imaging and diffusion-weighted imaging (DWI), to achieve accurate final diagnosis has been highlighted.
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Affiliation(s)
- Filippo Del Grande
- The Russell H. Morgan Departments of Radiology and Radiology Science, Johns Hopkins Hospital, Baltimore, MD 21287, USA
| | - Sahar J Farahani
- The Russell H. Morgan Departments of Radiology and Radiology Science, Johns Hopkins Hospital, Baltimore, MD 21287, USA
| | - John A Carrino
- The Russell H. Morgan Departments of Radiology and Radiology Science, Johns Hopkins Hospital, Baltimore, MD 21287, USA
| | - Avneesh Chhabra
- The Russell H. Morgan Departments of Radiology and Radiology Science, Johns Hopkins Hospital, Baltimore, MD 21287, USA
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96
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Kohl CA, Chivers FS, Lorans R, Roberts CC, Kransdorf MJ. Accuracy of chemical shift MR imaging in diagnosing indeterminate bone marrow lesions in the pelvis: review of a single institution's experience. Skeletal Radiol 2014; 43:1079-84. [PMID: 24781818 DOI: 10.1007/s00256-014-1886-6] [Citation(s) in RCA: 35] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/07/2014] [Revised: 03/28/2014] [Accepted: 03/30/2014] [Indexed: 02/02/2023]
Abstract
OBJECTIVE To re-assess the accuracy of chemical shift imaging in diagnosing indeterminate bone marrow lesions as benign or malignant. MATERIALS AND METHODS We retrospectively reviewed our experience with MR imaging of the pelvis to assess the accuracy of chemical shift imaging in distinguishing benign from malignant bone lesions. Two musculoskeletal radiologists retrospectively reviewed all osseous lesions biopsied since 2006, when chemical shift imaging was added to our routine pelvic imaging protocol. Study inclusion criteria required (1) MR imaging of an indeterminate bone marrow lesion about the pelvis and (2) subsequent histologic confirmation. The study group included 50 patients (29 male, 21 female) with an average age of 67 years (range, 41-89 years). MR imaging results were evaluated using biopsy results as the "gold standard." RESULTS There were 27 malignant and 23 benign lesions. Chemical shift imaging using an opposed-phase signal loss criteria of less than 20 % to indicate a malignant lesion, correctly diagnosed 27/27 malignant lesions and 14/23 benign lesions, yielding a 100 % sensitivity, 61 % specificity, 75 % PPV, 100 % NPV, and 82 % accuracy. The area under the receiver operator characteristic (ROC) curve was 0.88. The inter-rater and intra-rater agreement K values were both 1.0. CONCLUSIONS Chemical shift imaging is a useful adjunct MR technique to characterize focal and diffuse marrow abnormalities on routine non-contrast pelvic imaging. It is highly sensitive in identifying malignant disease. Despite its lower specificity, the need for biopsy could be eliminated in more than 60 % of patients with benign disease.
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Affiliation(s)
- Chad A Kohl
- Department of Radiology, Mayo Clinic, 5777 E Mayo Boulevard, Phoenix, AZ, 85054, USA
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97
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Chemical shift imaging at 3 Tesla: effect of echo time on assessing bone marrow abnormalities. Skeletal Radiol 2014; 43:1139-47. [PMID: 24744013 DOI: 10.1007/s00256-014-1883-9] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/29/2013] [Revised: 03/05/2014] [Accepted: 03/23/2014] [Indexed: 02/02/2023]
Abstract
OBJECTIVE Our purpose is to test the effect of varied in-phase (IP) and opposed-phase (OP) sequence order on characterizing marrow signal changes at 3T. MATERIALS AND METHODS The study was HIPAA compliant and IRB approved. Informed consent was waived. At 3T, IP and OP sequences were acquired in three patients with biopsy-proven osteosarcomas, using two methods: approach 1 (OP acquisition before IP acquisition) and approach 2 (OP after IP). Signal intensity (SI) measurements in 12 locations of biopsy-proven osteosarcoma and in six locations with normal bone marrow were performed independently by two experienced musculoskeletal radiologists. The signal intensity ratio (SIR) was measured within the marrow where there was T1 signal lower than skeletal muscle. A SIR < 20 % on the OP compared with IP imaging was considered positive for marrow replacement, while SIR > = 20 % was considered negative. Interobserver agreement was measured by the Lin concordance correlation coefficient (CCC). RESULTS In 75 % (18/24) of locations within the biopsy-proven tumors, the SIR was >20 % (SI drop more than 20 % in OP compared to IP) using approach 2 and in 100 % (24/24) of the locations the SIR was <20 % (SI drop less than 20 % in OP compared to IP) using approach 1, indicating a high percentage of false-negative results by approach 2, and no false-negative results with approach 1. There was good agreement between observer measurement (CCC = 0.96). CONCLUSIONS At 3T, the OP sequence should be acquired prior to the IP sequence, because susceptibility artifacts on a later-acquired OP sequence may lead to an erroneous interpretation of marrow signal abnormalities.
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98
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Differentiation of osteolytic metastases and Schmorl's nodes in cancer patients using dual-energy CT: Advantage of spectral CT imaging. Eur J Radiol 2014; 83:1216-1221. [DOI: 10.1016/j.ejrad.2014.02.003] [Citation(s) in RCA: 32] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2013] [Revised: 11/14/2013] [Accepted: 02/03/2014] [Indexed: 11/21/2022]
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99
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Del Grande F, Tatizawa-Shiga N, Jalali Farahani S, Chalian M, Fayad LM. Chemical shift imaging: preliminary experience as an alternative sequence for defining the extent of a bone tumor. Quant Imaging Med Surg 2014; 4:173-80. [PMID: 24914418 DOI: 10.3978/j.issn.2223-4292.2014.05.01] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2014] [Accepted: 04/28/2014] [Indexed: 11/14/2022]
Abstract
OBJECTIVE To investigate chemical shift imaging (CSI) with in-phase and opposed-phase (OP) gradient-echo sequences as an alternative sequence to spin-echo T1 imaging for defining intra-medullary skeletal tumor extent. METHODS AND MATERIALS This retrospective HIPAA-compliant study was approved by our institutional institutional review board (IRB). Twenty-three subjects with histologically-proven tumors (17 appendicular, 6 axial) underwent magnetic resonance imaging (MRI) with T1-weighted spin echo (T1SE), fluid-sensitive, CSI, and contrast-enhanced T1 sequences. One observer recorded intra-medullary tumor extent (millimeters), with 153 total measurements on each sequence. Red marrow grade [0 (none), 1 (<50%), 2 (50-75%) and 3 (>75%)] in each bone was recorded. Tumor extent on different sequences was compared (Student's t-test); the impact of red marrow grade on measurements was assessed (Spearman's correlation coefficient). RESULTS There was good agreement between measurements of tumor extent on T1SE and CSI sequences in all cases (T1SE-CSI measurement difference range 0-13.2 mm, P>0.05). Measurements from other sequences were significantly different from those of T1SE (P<0.05). As red marrow grade in the bone increased, a significant increase in measurement difference obtained on T1SE and CSI sequences was observed (P<0.001). CONCLUSIONS CSI is a potential alternative technique to T1SE imaging for defining the intra-medullary extent of a bone tumor, possibly especially useful in regions with abundant red marrow. ADVANCE IN KNOWLEDGE CSI could be an alternative technique to T1SE imaging for defining the intra-medullary extent of bone tumor by abundant red marrow in the surrounding bone.
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Affiliation(s)
- Filippo Del Grande
- 1 The Russell H. Morgan Department of Radiology and Radiological Science, The Johns Hopkins Medical Institutions, 601 North Wolfe Street, Baltimore, MD 21287, USA ; 2 Ospedale Regionale di Lugano, Via Tesserete, 6900 Lugano, Ti Switzerland
| | - Ney Tatizawa-Shiga
- 1 The Russell H. Morgan Department of Radiology and Radiological Science, The Johns Hopkins Medical Institutions, 601 North Wolfe Street, Baltimore, MD 21287, USA ; 2 Ospedale Regionale di Lugano, Via Tesserete, 6900 Lugano, Ti Switzerland
| | - Sahar Jalali Farahani
- 1 The Russell H. Morgan Department of Radiology and Radiological Science, The Johns Hopkins Medical Institutions, 601 North Wolfe Street, Baltimore, MD 21287, USA ; 2 Ospedale Regionale di Lugano, Via Tesserete, 6900 Lugano, Ti Switzerland
| | - Majid Chalian
- 1 The Russell H. Morgan Department of Radiology and Radiological Science, The Johns Hopkins Medical Institutions, 601 North Wolfe Street, Baltimore, MD 21287, USA ; 2 Ospedale Regionale di Lugano, Via Tesserete, 6900 Lugano, Ti Switzerland
| | - Laura Marie Fayad
- 1 The Russell H. Morgan Department of Radiology and Radiological Science, The Johns Hopkins Medical Institutions, 601 North Wolfe Street, Baltimore, MD 21287, USA ; 2 Ospedale Regionale di Lugano, Via Tesserete, 6900 Lugano, Ti Switzerland
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Zidan DZ, Elghazaly HA. Can unenhanced multiparametric MRI substitute gadolinium-enhanced MRI in the characterization of vertebral marrow infiltrative lesions? THE EGYPTIAN JOURNAL OF RADIOLOGY AND NUCLEAR MEDICINE 2014. [DOI: 10.1016/j.ejrnm.2014.02.014] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/17/2023] Open
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