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Cattabriga A, Renzetti B, Galuppi F, Bartalena L, Gaudiano C, Brocchi S, Rossi A, Schiavina R, Bianchi L, Brunocilla E, Spinozzi L, Catanzaro C, Castellucci P, Farolfi A, Fanti S, Tunariu N, Mosconi C. Multiparametric Whole-Body MRI: A Game Changer in Metastatic Prostate Cancer. Cancers (Basel) 2024; 16:2531. [PMID: 39061171 PMCID: PMC11274871 DOI: 10.3390/cancers16142531] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2024] [Revised: 06/24/2024] [Accepted: 07/07/2024] [Indexed: 07/28/2024] Open
Abstract
Prostate cancer ranks among the most prevalent tumours globally. While early detection reduces the likelihood of metastasis, managing advanced cases poses challenges in diagnosis and treatment. Current international guidelines support the concurrent use of 99Tc-Bone Scintigraphy and Contrast-Enhanced Chest and Abdomen CT for the staging of metastatic disease and response assessment. However, emerging evidence underscores the superiority of next-generation imaging techniques including PSMA-PET/CT and whole-body MRI (WB-MRI). This review explores the relevant scientific literature on the role of WB-MRI in metastatic prostate cancer. This multiparametric imaging technique, combining the high anatomical resolution of standard MRI sequences with functional sequences such as diffusion-weighted imaging (DWI) and bone marrow relative fat fraction (rFF%) has proved effective in comprehensive patient assessment, evaluating local disease, most of the nodal involvement, bone metastases and their complications, and detecting the increasing visceral metastases in prostate cancer. It does have the advantage of avoiding the injection of contrast medium/radionuclide administration, spares the patient the exposure to ionizing radiation, and lacks the confounder of FLARE described with nuclear medicine techniques. Up-to-date literature regarding the diagnostic capabilities of WB-MRI, though still limited compared to PSMA-PET/CT, strongly supports its widespread incorporation into standard clinical practice, alongside the latest nuclear medicine techniques.
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Affiliation(s)
- Arrigo Cattabriga
- Department of Radiology, IRCCS Azienda Ospedaliero Universitaria di Bologna, 40138 Bologna, Italy; (B.R.); (F.G.); (L.B.); (C.G.); (S.B.); (C.M.)
- Department of Medical and Surgical Sciences (DIMEC), University of Bologna, 40136 Bologna, Italy; (R.S.); (L.B.); (E.B.); (L.S.); (C.C.); (S.F.)
| | - Benedetta Renzetti
- Department of Radiology, IRCCS Azienda Ospedaliero Universitaria di Bologna, 40138 Bologna, Italy; (B.R.); (F.G.); (L.B.); (C.G.); (S.B.); (C.M.)
- Department of Medical and Surgical Sciences (DIMEC), University of Bologna, 40136 Bologna, Italy; (R.S.); (L.B.); (E.B.); (L.S.); (C.C.); (S.F.)
| | - Francesco Galuppi
- Department of Radiology, IRCCS Azienda Ospedaliero Universitaria di Bologna, 40138 Bologna, Italy; (B.R.); (F.G.); (L.B.); (C.G.); (S.B.); (C.M.)
- Department of Medical and Surgical Sciences (DIMEC), University of Bologna, 40136 Bologna, Italy; (R.S.); (L.B.); (E.B.); (L.S.); (C.C.); (S.F.)
| | - Laura Bartalena
- Department of Radiology, IRCCS Azienda Ospedaliero Universitaria di Bologna, 40138 Bologna, Italy; (B.R.); (F.G.); (L.B.); (C.G.); (S.B.); (C.M.)
| | - Caterina Gaudiano
- Department of Radiology, IRCCS Azienda Ospedaliero Universitaria di Bologna, 40138 Bologna, Italy; (B.R.); (F.G.); (L.B.); (C.G.); (S.B.); (C.M.)
| | - Stefano Brocchi
- Department of Radiology, IRCCS Azienda Ospedaliero Universitaria di Bologna, 40138 Bologna, Italy; (B.R.); (F.G.); (L.B.); (C.G.); (S.B.); (C.M.)
| | - Alice Rossi
- Radiology Unit, IRCCS Istituto Romagnolo per lo Studio dei Tumori (IRST) “Dino Amadori”, 47014 Meldola, Italy;
| | - Riccardo Schiavina
- Department of Medical and Surgical Sciences (DIMEC), University of Bologna, 40136 Bologna, Italy; (R.S.); (L.B.); (E.B.); (L.S.); (C.C.); (S.F.)
- Division of Urology, IRCCS Azienda Ospedaliero Universitaria di Bologna, 40138 Bologna, Italy
| | - Lorenzo Bianchi
- Department of Medical and Surgical Sciences (DIMEC), University of Bologna, 40136 Bologna, Italy; (R.S.); (L.B.); (E.B.); (L.S.); (C.C.); (S.F.)
- Division of Urology, IRCCS Azienda Ospedaliero Universitaria di Bologna, 40138 Bologna, Italy
| | - Eugenio Brunocilla
- Department of Medical and Surgical Sciences (DIMEC), University of Bologna, 40136 Bologna, Italy; (R.S.); (L.B.); (E.B.); (L.S.); (C.C.); (S.F.)
- Division of Urology, IRCCS Azienda Ospedaliero Universitaria di Bologna, 40138 Bologna, Italy
| | - Luca Spinozzi
- Department of Medical and Surgical Sciences (DIMEC), University of Bologna, 40136 Bologna, Italy; (R.S.); (L.B.); (E.B.); (L.S.); (C.C.); (S.F.)
- Division of Urology, IRCCS Azienda Ospedaliero Universitaria di Bologna, 40138 Bologna, Italy
| | - Calogero Catanzaro
- Department of Medical and Surgical Sciences (DIMEC), University of Bologna, 40136 Bologna, Italy; (R.S.); (L.B.); (E.B.); (L.S.); (C.C.); (S.F.)
- Division of Urology, IRCCS Azienda Ospedaliero Universitaria di Bologna, 40138 Bologna, Italy
| | - Paolo Castellucci
- Nuclear Medicine, IRCCS Azienda Ospedaliero-Universitaria di Bologna, 40138 Bologna, Italy; (P.C.); (A.F.)
| | - Andrea Farolfi
- Nuclear Medicine, IRCCS Azienda Ospedaliero-Universitaria di Bologna, 40138 Bologna, Italy; (P.C.); (A.F.)
| | - Stefano Fanti
- Department of Medical and Surgical Sciences (DIMEC), University of Bologna, 40136 Bologna, Italy; (R.S.); (L.B.); (E.B.); (L.S.); (C.C.); (S.F.)
- Nuclear Medicine, IRCCS Azienda Ospedaliero-Universitaria di Bologna, 40138 Bologna, Italy; (P.C.); (A.F.)
| | - Nina Tunariu
- Clinical Radiology, Royal Marsden Hospital & Institute of Cancer Research, London SW3 6JJ, UK;
| | - Cristina Mosconi
- Department of Radiology, IRCCS Azienda Ospedaliero Universitaria di Bologna, 40138 Bologna, Italy; (B.R.); (F.G.); (L.B.); (C.G.); (S.B.); (C.M.)
- Department of Medical and Surgical Sciences (DIMEC), University of Bologna, 40136 Bologna, Italy; (R.S.); (L.B.); (E.B.); (L.S.); (C.C.); (S.F.)
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Saifuddin A, Ali M, Santiago R, Pressney I. In-phase and opposed-phase Dixon chemical shift imaging for the assessment of skeletal marrow lesions: comparison of measurements from longitudinal sequences to those from axial sequences. Br J Radiol 2024; 97:828-833. [PMID: 38321150 PMCID: PMC11027321 DOI: 10.1093/bjr/tqae031] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2023] [Revised: 12/21/2023] [Accepted: 01/10/2024] [Indexed: 02/08/2024] Open
Abstract
OBJECTIVE In-phase and opposed-phase chemical shift imaging (CSI) is a useful technique for assessing skeletal lesions. This study determined the frequency of significant differences in measurements obtained from longitudinal (coronal or sagittal) sequences to those obtained from axial sequences. METHODS Chemical shift imaging was undertaken in 96 consecutive patients referred from the Musculoskeletal Sarcoma and Spinal Oncology services for assessment of possible bone tumours as part of a standard tumour protocol, which included turbo spin echo and inversion recovery sequences. For spinal lesions, CSI was obtained in the sagittal and axial planes, while for all other sites, it was obtained in the coronal and axial planes. RESULTS The study included 49 (51.0%) males and 47 (49.0%) females with mean age 42.4 years (range 2-91 years). In 4 cases, 2 individual lesions were assessed, making a total of 100 lesions. Based on typical imaging features (n = 57) or histology (n = 43), 22 lesions (22%) were classified as non-neoplastic, 44 (44%) as benign neoplasms, 6 (6%) as intermediate-grade neoplasms, and 28 (28%) as malignant neoplasms. A significant discrepancy, wherein a lesion was classified as fat-containing (% SI drop >20%-25%) in the longitudinal plane, while in the axial plane it was classified as fat-replacing (% SI drop <20%-25%), or vice versa, occurred in 9%-14% of cases. However, this discrepancy had no appreciable effect on overall diagnostic accuracy, which was calculated at 79% for the longitudinal plane and 75%-80% for the axial plane. CONCLUSIONS Significant differences in CSI measurements occur in 9%-14% of cases based on imaging plane, but with no significant effect on diagnostic accuracy. ADVANCES IN KNOWLEDGE Radiologists should be aware that CSI measurements in different planes appear to have significant differences in up to 14% of lesions. However, diagnostic accuracy does not seem to be significantly affected.
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Affiliation(s)
- Asif Saifuddin
- Department of Radiology, Royal National Orthopaedic Hospital, Stanmore, Middlesex HA7 4LP, United Kingdom
| | - Mohamed Ali
- Department of Psychiatry, Leicestershire NHS Trust, Leicester LE3 9PQ, United Kingdom
| | - Rodney Santiago
- Department of Radiology, Royal National Orthopaedic Hospital, Stanmore, Middlesex HA7 4LP, United Kingdom
| | - Ian Pressney
- Department of Radiology, Royal National Orthopaedic Hospital, Stanmore, Middlesex HA7 4LP, United Kingdom
- Institute of Orthopaedics and Musculoskeletal Science, University College London, Middlesex, HA7 4LP, United Kingdom
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Zandee van Rilland ED, Yoon SY, Garner HW, Ni Mhuircheartaigh J, Wu JS. Does the presence of macroscopic intralesional fat exclude malignancy? An analysis of 613 histologically proven malignant bone lesions. Eur Radiol 2024:10.1007/s00330-024-10687-7. [PMID: 38488967 DOI: 10.1007/s00330-024-10687-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2023] [Revised: 01/15/2024] [Accepted: 02/15/2024] [Indexed: 03/17/2024]
Abstract
OBJECTIVE To determine if macroscopic intralesional fat detected in bone lesions on CT by Hounsfield unit (HU) measurement and on MRI by macroscopic assessment excludes malignancy. MATERIALS AND METHODS All consecutive CT-guided core needle biopsies (CNB) of non-spinal bone lesions performed at a tertiary center between December 2005 and September 2021 were reviewed. Demographic and histopathology data were recorded. All cases with malignant histopathology were selected, and imaging studies were reviewed. Two independent readers performed CT HU measurements on all bone lesions using a circular region of interest (ROI) to quantitate intralesional fat density (mean HU < -30). MRI images were reviewed to qualitatively assess for macroscopic intralesional fat signal in a subset of patients. Inter-reader agreement was assessed with Cronbach's alpha and intraclass correlation coefficient. RESULTS In 613 patients (mean age 62.9 years (range 19-95 years), 47.6% female), CT scans from the CNB of 613 malignant bone lesions were reviewed, and 212 cases had additional MRI images. Only 3 cases (0.5%) demonstrated macroscopic intralesional fat on either CT or MRI. One case demonstrated macroscopic intralesional fat density on CT in a case of metastatic prostate cancer. Two cases demonstrated macroscopic intralesional fat signal on MRI in cases of chondrosarcoma and osteosarcoma. Inter-reader agreement was excellent (Cronbach's alpha, 0.95-0.98; intraclass correlation coefficient, 0.90-0.97). CONCLUSION Malignant lesions rarely contain macroscopic intralesional fat on CT or MRI. While CT is effective in detecting macroscopic intralesional fat in primarily lytic lesions, MRI may be better for the assessment of heterogenous and infiltrative lesions with mixed lytic and sclerotic components. CLINICAL RELEVANCE STATEMENT Macroscopic intralesional fat is rarely seen in malignant bone tumors and its presence can help to guide the diagnostic workup of bone lesions. KEY POINTS • Presence of macroscopic intralesional fat in bone lesions has been widely theorized as a sign of benignity, but there is limited supporting evidence in the literature. • CT and MRI are effective in evaluating for macroscopic intralesional fat in malignant bone lesions with excellent inter-reader agreement. • Macroscopic intralesional fat is rarely seen in malignant bone lesions.
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Affiliation(s)
- Eddy D Zandee van Rilland
- Department of Radiology, Beth Israel Deaconess Medical Center, Harvard Medical School, 330 Brookline Avenue, Sherman 231, Boston, MA, 02215, USA.
| | - Se-Young Yoon
- Department of Radiology, Beth Israel Deaconess Medical Center, Harvard Medical School, 330 Brookline Avenue, Sherman 231, Boston, MA, 02215, USA
| | - Hillary W Garner
- Department of Radiology, Mayo Clinic Florida, 4500 San Pablo Road, Jacksonville, FL, 32224, USA
| | | | - Jim S Wu
- Department of Radiology, Beth Israel Deaconess Medical Center, Harvard Medical School, 330 Brookline Avenue, Sherman 231, Boston, MA, 02215, USA
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Montoya-Bordón J, Elvira-Ruiz P, Carriazo-Jiménez B, Robles-Blanco C, Pereiro-Montbrun F, Rodríguez-Fernández C. Imaging diagnosis of vertebral metastasis. Rev Esp Cir Ortop Traumatol (Engl Ed) 2023; 67:511-522. [PMID: 37209915 DOI: 10.1016/j.recot.2023.05.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2023] [Revised: 05/02/2023] [Accepted: 05/12/2023] [Indexed: 05/22/2023] Open
Abstract
The spine is the third most frequent location for metastatic disease, after the lung and liver. On the other hand, the most frequent bone tumors are metastases and the spine is the main location. A review of the different imaging techniques available, both radiological and nuclear medicine, and the morphological appearance of spinal metastases in each of them is performed. Magnetic resonance imaging is the best imaging modality for detection of spinal metastases. It is important to make the differential diagnosis between vertebral fracture of osteoporotic and pathological cause. Spinal cord compression is a serious complication of metastatic disease and its assessment by imaging through objective scales is decisive for estimating spinal stability and therefore establishing treatment. Lastly, percutaneous intervention techniques are briefly discussed.
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Affiliation(s)
- J Montoya-Bordón
- Servicio de Radiología, Hospital Universitario Fundación Jiménez Díaz, Madrid, España.
| | - P Elvira-Ruiz
- Servicio de Radiología, Hospital Universitario Fundación Jiménez Díaz, Madrid, España
| | - B Carriazo-Jiménez
- Servicio de Radiología, Hospital Universitario Fundación Jiménez Díaz, Madrid, España
| | - C Robles-Blanco
- Servicio de Radiología, Hospital Universitario Fundación Jiménez Díaz, Madrid, España
| | - F Pereiro-Montbrun
- Servicio de Radiología, Hospital Universitario Fundación Jiménez Díaz, Madrid, España
| | - C Rodríguez-Fernández
- Servicio de Radiología, Hospital Universitario Fundación Jiménez Díaz, Madrid, España
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Montoya-Bordón J, Elvira-Ruiz P, Carriazo-Jiménez B, Robles-Blanco C, Pereiro-Montbrun F, Rodríguez-Fernández C. [Translated article] Imaging diagnosis of vertebral metastasis. Rev Esp Cir Ortop Traumatol (Engl Ed) 2023; 67:S511-S522. [PMID: 37541345 DOI: 10.1016/j.recot.2023.08.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2023] [Accepted: 05/12/2023] [Indexed: 08/06/2023] Open
Abstract
The spine is the third most frequent location for metastatic disease, after the lung and liver. On the other hand, the most frequent bone tumours are metastases and the spine is the main location. A review of the different imaging techniques available, both radiological and nuclear medicine, and the morphological appearance of spinal metastases in each of them is performed. Magnetic resonance imaging is the best imaging modality for detection of spinal metastases. It is important to make the differential diagnosis between vertebral fracture of osteoporotic and pathological cause. Spinal cord compression is a serious complication of metastatic disease and its assessment by imaging through objective scales is decisive for estimating spinal stability and therefore establishing treatment. Lastly, percutaneous intervention techniques are briefly discussed.
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Affiliation(s)
- J Montoya-Bordón
- Servicio de Radiología, Hospital Universitario Fundación Jiménez Díaz, Madrid, Spain.
| | - P Elvira-Ruiz
- Servicio de Radiología, Hospital Universitario Fundación Jiménez Díaz, Madrid, Spain
| | - B Carriazo-Jiménez
- Servicio de Radiología, Hospital Universitario Fundación Jiménez Díaz, Madrid, Spain
| | - C Robles-Blanco
- Servicio de Radiología, Hospital Universitario Fundación Jiménez Díaz, Madrid, Spain
| | - F Pereiro-Montbrun
- Servicio de Radiología, Hospital Universitario Fundación Jiménez Díaz, Madrid, Spain
| | - C Rodríguez-Fernández
- Servicio de Radiología, Hospital Universitario Fundación Jiménez Díaz, Madrid, Spain
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Shah AJ, BT P. Neoplastic and Non-Neoplastic Vertebral Marrow Pathologies: Can the Conventional and Advanced MRI Sequences Provide a Definitive Answer? Indian J Radiol Imaging 2023; 33:438-439. [PMID: 37811169 PMCID: PMC10556313 DOI: 10.1055/s-0043-1775571] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/10/2023] Open
Affiliation(s)
- Ankur J. Shah
- Department of Radiology, Sadbhav Imaging Centre, Ahmedabad, Gujarat, India
| | - Pushpa BT
- Department of Radiology, Ganga Hospital, Coimbatore, India
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Yan SY, Yang YW, Jiang XY, Hu S, Su YY, Yao H, Hu CH. Fat quantification: Imaging methods and clinical applications in cancer. Eur J Radiol 2023; 164:110851. [PMID: 37148843 DOI: 10.1016/j.ejrad.2023.110851] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2023] [Revised: 04/19/2023] [Accepted: 04/24/2023] [Indexed: 05/08/2023]
Abstract
Recently, the study of the relationship between lipid metabolism and cancer has evolved. The characteristics of intratumoral and peritumoral fat are distinct and changeable during cancer development. Subcutaneous and visceral adipose tissue are also associated with cancer prognosis. In non-invasive imaging, fat quantification parameters such as controlled attenuation parameter, fat volume fraction, and proton density fat fraction from different imaging methods complement conventional images by providing concrete fat information. Therefore, measuring the changes of fat content for further understanding of cancer characteristics has been applied in both research and clinical settings. In this review, the authors summarize imaging advances in fat quantification and highlight their clinical applications in cancer precaution, auxiliary diagnosis and classification, therapy response monitoring, and prognosis.
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Affiliation(s)
- Suo Yu Yan
- Department of Radiology, The First Affiliated Hospital to Soochow University, Suzhou 215006, PR China
| | - Yi Wen Yang
- Department of Radiology, The First Affiliated Hospital to Soochow University, Suzhou 215006, PR China
| | - Xin Yu Jiang
- Department of Radiology, The First Affiliated Hospital to Soochow University, Suzhou 215006, PR China
| | - Su Hu
- Department of Radiology, The First Affiliated Hospital to Soochow University, Suzhou 215006, PR China
| | - Yun Yan Su
- Department of Radiology, The First Affiliated Hospital to Soochow University, Suzhou 215006, PR China.
| | - Hui Yao
- Department of Radiology, The First Affiliated Hospital to Soochow University, Suzhou 215006, PR China; Department of General Surgery, The First Affiliated Hospital to Soochow University, Suzhou 215006, PR China.
| | - Chun Hong Hu
- Department of Radiology, The First Affiliated Hospital to Soochow University, Suzhou 215006, PR China.
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Heidemeier A, Schloetelburg W, Thurner A, Metz C, Heidemeier H, Rasche L, Martin Kortuem K, Boeckle D, Weiland E, Benkert T, Nickel D, Werner R, Buck AK, Bley TA. Multi-parametric whole-body MRI evaluation discerns vital from non-vital multiple myeloma lesions as validated by 18F-FDG and 11C-methionine PET/CT. Eur J Radiol 2022; 155:110493. [PMID: 36027759 DOI: 10.1016/j.ejrad.2022.110493] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2021] [Revised: 08/04/2022] [Accepted: 08/15/2022] [Indexed: 11/03/2022]
Abstract
PURPOSE We tested a novel multi-parametric (mp) whole body (WB)-MRI evaluation algorithm for medullary lesions in comparison to positron emission tomography (PET) radiotracers 18F-fluorodeoxyglucose (18F-FDG) and 11C-methionine (11C-MET). METHODS AND MATERIALS This retrospective single-center study included 44 MM patients, who received both 18F-FDG-PET and WB-MRI within ten days. MRI classified focal lesions as vital when showing 1) significant diffusion-restriction, 2) a fat fraction (FF) less than 20 % and 3) homogenous hypointensity on T2-weighted images. On a lesion-by-lesion level the findings were compared to 18F-FDG PET by using a 5-point scoring system (analogous to the Deauville score [DS]). In 24/44 (55 %) patients additional comparison to 11C-MET PET was available. RESULTS Among two radiologists, an excellent inter-observer reliability for mpWB-MRI in a total of 84 medullary lesions was observed (ICC = 1, k = 1, p <.01). 16/17 (94.1 %) MRI-classified vital lesions had a DS of 4 or 5 on either 18F-FDG-PET or 11C-MET-PET. MRI-rated non-vital lesions correlated with PET-based DS ≤ 3. When results of mpWB-MRI were compared to 18F-FDG, a fair inter-observer agreement was recorded (ICC = 0.52, k = 0.53, p <.01), while for 11C-MET, an excellent concordance rate was achieved (ICC = 0.81, k = 0.79, p <.01). CONCLUSION The proposed mpWB-MRI interpretation algorithm allowed to assess tumor activity of myeloma lesions with high inter-observer reproducibility. We observed a substantial concordance between the mpWB-MRI classification of lesions and PET assessment based on a semi-automatically calculated 5-point scoring system analogous to the Deauville scores.
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Affiliation(s)
- Anke Heidemeier
- Department of Diagnostic and Interventional Radiology, University Hospital Würzburg, Oberdürrbacherstr 6, 97080 Würzburg, Germany.
| | - Wiebke Schloetelburg
- Department of Nuclear Medicine, University Hospital Würzburg, Oberdürrbacherstr 6, 97080 Würzburg, Germany
| | - Annette Thurner
- Department of Diagnostic and Interventional Radiology, University Hospital Würzburg, Oberdürrbacherstr 6, 97080 Würzburg, Germany
| | - Corona Metz
- Department of Diagnostic and Interventional Radiology, University Hospital Würzburg, Oberdürrbacherstr 6, 97080 Würzburg, Germany
| | - Heike Heidemeier
- Department of Psychology, Private University Göttingen, Weender Landstrasse 3-7, 37073 Göttingen, Germany
| | - Leo Rasche
- Department of Internal Medicine II, University Hospital Würzburg, Oberdürrbacherstr 6, 97080 Würzburg, Germany
| | - K Martin Kortuem
- Department of Internal Medicine II, University Hospital Würzburg, Oberdürrbacherstr 6, 97080 Würzburg, Germany
| | - David Boeckle
- Department of Internal Medicine II, University Hospital Würzburg, Oberdürrbacherstr 6, 97080 Würzburg, Germany
| | - Elisabeth Weiland
- Department of MR Application Predevelopment, Siemens Healthcare, 91301 Erlangen, Germany
| | - Thomas Benkert
- Department of MR Application Predevelopment, Siemens Healthcare, 91301 Erlangen, Germany
| | - Dominik Nickel
- Department of MR Application Predevelopment, Siemens Healthcare, 91301 Erlangen, Germany
| | - Rudolf Werner
- Department of Nuclear Medicine, University Hospital Würzburg, Oberdürrbacherstr 6, 97080 Würzburg, Germany
| | - Andreas Konrad Buck
- Department of Nuclear Medicine, University Hospital Würzburg, Oberdürrbacherstr 6, 97080 Würzburg, Germany
| | - Thorsten Alexander Bley
- Department of Diagnostic and Interventional Radiology, University Hospital Würzburg, Oberdürrbacherstr 6, 97080 Würzburg, Germany
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Zarad CA, Elmaaty AAA, Shanab WSA. Dixon chemical shift MR sequences for demonstrating of bone marrow vertebral metastasis. THE EGYPTIAN JOURNAL OF RADIOLOGY AND NUCLEAR MEDICINE 2022. [DOI: 10.1186/s43055-022-00861-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
Abstract
Background
This study aimed to investigate the diagnostic performance and clinical utility of different MR Dixon sequences in the characterization of vertebral metastasis in a patient with a history of malignant neoplasm and compare the results with 18-F FDG PET CT. Patients were subjected to MR imaging of the dorsal and lumbosacral spine (1.5 T MR machine) using conventional MR, T2 Dixon and T1 post-contrast Dixon.
Results
This study involved 40 patients (45% female and 55% male) with 161 metastatic lesions and median age 61.5 years. The sensitivities of T1 post-contrast water-only (WO), fat-only (FO) and opposed-phase (OP) Dixon for diagnosis of vertebral metastasis were 92.6%, 89.4% and 83.1%, respectively, while the sensitivity of T2 (WO, OP) Dixon was 78.3% with 100% specificity for both T1 and T2 Dixon. There were excellent positive clinical utilities of T1 post-contrast WO (0.925), FO (0.894) and OP (0.826) Dixon with the good positive clinical utility of T2 Dixon (0.783) for lesion finding. There were fair negative clinical utilities of T1 WO (0.636) and FO (0.553) Dixon with poor negative clinical utilities of T1 OP (0.429), T2 WO and OP (0.375) Dixon for lesion screening. 15% was the best in-phase/opposed-phase ratio for differentiation between metastatic and benign vertebral lesions.
Conclusions
MR Dixon techniques are sensitive and specific for the diagnosis of vertebral metastasis. T1 post-contrast and T2 Dixons have excellent and good positive clinical utilities for lesion finding with fair and poor negative clinical utilities for lesion screening, respectively.
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Whole-body MRI in oncology: can a single anatomic T2 Dixon sequence replace the combination of T1 and STIR sequences to detect skeletal metastasis and myeloma? Eur Radiol 2022; 33:244-257. [PMID: 35925384 DOI: 10.1007/s00330-022-09007-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2022] [Revised: 06/21/2022] [Accepted: 06/30/2022] [Indexed: 11/04/2022]
Abstract
OBJECTIVES To compare the diagnostic accuracy of a single T2 Dixon sequence to the combination T1+STIR as anatomical sequences used for detecting tumoral bone marrow lesions in whole-body MRI (WB-MRI) examinations. METHODS Between January 2019 and January 2020, seventy-two consecutive patients (55 men, 17 women, median age = 66 years) with solid (prostate, breast, neuroendocrine) cancers at high risk of metastasis or proven multiple myeloma (MM) prospectively underwent a WB-MRI examination including coronal T1, STIR, T2 Dixon and axial diffusion-weighted imaging sequences. Two radiologists independently assessed the combination of T1+STIR sequences and the fat+water reconstructions from the T2 Dixon sequence. The reference standard was established by consensus reading of WB-MRI and concurrent imaging available at baseline and at 6 months. Repeatability and reproducibility of MRI scores (presence and semi-quantitative count of lesions), image quality (SNR: signal-to-noise, CNR: contrast-to-noise, CRR: contrast-to-reference ratios), and diagnostic characteristics (Se: sensitivity, Sp: specificity, Acc: accuracy) were assessed per-skeletal region and per-patient. RESULTS Repeatability and reproducibility were at least good regardless of the score, region, and protocol (0.67 ≤ AC1 ≤ 0.98). CRR was higher on T2 Dixon fat compared to T1 (p < 0.0001) and on T2 Dixon water compared to STIR (p = 0.0128). In the per-patient analysis, Acc of the T2 Dixon fat+water was higher than that of T1+STIR for the senior reader (Acc = +0.027 [+0.025; +0.029], p < 0.0001) and lower for the junior reader (Acc = -0.029 [-0.031; -0.027], p < 0.0001). CONCLUSIONS A single T2 Dixon sequence with fat+water reconstructions offers similar reproducibility and diagnostic accuracy as the recommended combination of T1+STIR sequences and can be used for skeletal screening in oncology, allowing significant time-saving. KEY POINTS • Replacement of the standard anatomic T1 + STIR WB-MRI protocol by a single T2 Dixon sequence drastically shortens the examination time without loss of diagnostic accuracy. • A protocol based on fat + water reconstructions from a single T2 Dixon sequence offers similar inter-reader agreement and a higher contrast-to-reference ratio for detecting lesions compared to the standard T1 + STIR protocol. • Differences in the accuracy between the two protocols are marginal (+ 3% in favor of the T2 Dixon with the senior reader; -3% against the T2 Dixon with the junior reader).
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Differentiation of bone metastases from benign red marrow depositions of the spine: the role of fat-suppressed T2-weighted imaging compared to fat fraction map. Eur Radiol 2022; 32:6730-6738. [PMID: 35798881 DOI: 10.1007/s00330-022-08965-3] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2022] [Revised: 05/09/2022] [Accepted: 06/12/2022] [Indexed: 11/04/2022]
Abstract
OBJECTIVE To differentiate bone metastases (BMs) from benign red marrow depositions (BRMs) of the spine using quantitative parameters derived from fat-suppressed T2-weighted imaging (T2 FS) and fat fraction (FF) map METHODS: One hundred eleven lesions, divided into 62 BMs and 49 BRMs according to MR images and either bone scan or PET-CT, were assessed with T2 FS and FF map. Two radiologists independently measured quantitative parameters from the ROIs in the lesions, including fat-suppressed (FS) T2 ratio (ratio of lesion FS T2 signal intensity [SI] to normal marrow FS T2 SI), FF, and FF ratio (ratio of lesion FF to normal marrow FF). The mean values of these parameters were compared between the two groups. To evaluate the diagnostic utilities of individual (FS T2 ratio, FF, and FF ratio) and combined parameters, ROC curves were analyzed. For the ROC curves among the individual parameters and their combinations, AUCs were compared. RESULTS The FS T2 ratio of BMs was significantly higher than that of BRMs (2.638 vs. 1.155 [p < 0.001]). The FF and FF ratio of BMs were significantly lower than those of BRMs (FF, 3.554% vs. 20.038% [p < 0.001]; FF ratio, 0.072 vs. 0.364 [p < 0.001]). The ROC AUCs of individual and combined parameters ranged from 0.941 to 0.980. The AUCs of all individual parameters and their combinations did not demonstrate statistically significant differences. CONCLUSION The FS T2 ratio, FF, and FF ratio can be useful in differentiating BMs from BRMs with or without any combination of the parameters. KEY POINTS • Quantitative parameters derived from fat-suppressed T2-weighted imaging and fat fraction map could be used to differentiate bone metastases from benign red marrow depositions with or without any combination of the parameters. • Quantitative parameters of fat-suppressed T2-weighted imaging provide diagnostic performance similar to those of fat fraction map in differentiating bone metastases from benign red marrow depositions.
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Greve T, Rayudu NM, Dieckmeyer M, Boehm C, Ruschke S, Burian E, Kloth C, Kirschke JS, Karampinos DC, Baum T, Subburaj K, Sollmann N. Finite Element Analysis of Osteoporotic and Osteoblastic Vertebrae and Its Association With the Proton Density Fat Fraction From Chemical Shift Encoding-Based Water-Fat MRI - A Preliminary Study. Front Endocrinol (Lausanne) 2022; 13:900356. [PMID: 35898459 PMCID: PMC9313539 DOI: 10.3389/fendo.2022.900356] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/20/2022] [Accepted: 05/11/2022] [Indexed: 11/16/2022] Open
Abstract
PURPOSE Osteoporosis is prevalent and entails alterations of vertebral bone and marrow. Yet, the spine is also a common site of metastatic spread. Parameters that can be non-invasively measured and could capture these alterations are the volumetric bone mineral density (vBMD), proton density fat fraction (PDFF) as an estimate of relative fat content, and failure displacement and load from finite element analysis (FEA) for assessment of bone strength. This study's purpose was to investigate if osteoporotic and osteoblastic metastatic changes in lumbar vertebrae can be differentiated based on the abovementioned parameters (vBMD, PDFF, and measures from FEA), and how these parameters correlate with each other. MATERIALS AND METHODS Seven patients (3 females, median age: 77.5 years) who received 3-Tesla magnetic resonance imaging (MRI) and multi-detector computed tomography (CT) of the lumbar spine and were diagnosed with either osteoporosis (4 patients) or diffuse osteoblastic metastases (3 patients) were included. Chemical shift encoding-based water-fat MRI (CSE-MRI) was used to extract the PDFF, while vBMD was extracted after automated vertebral body segmentation using CT. Segmentation masks were used for FEA-based failure displacement and failure load calculations. Failure displacement, failure load, and PDFF were compared between patients with osteoporotic vertebrae versus patients with osteoblastic metastases, considering non-fractured vertebrae (L1-L4). Associations between those parameters were assessed using Spearman correlation. RESULTS Median vBMD was 59.3 mg/cm3 in osteoporotic patients. Median PDFF was lower in the metastatic compared to the osteoporotic patients (11.9% vs. 43.8%, p=0.032). Median failure displacement and failure load were significantly higher in metastatic compared to osteoporotic patients (0.874 mm vs. 0.348 mm, 29,589 N vs. 3,095 N, p=0.034 each). A strong correlation was noted between PDFF and failure displacement (rho -0.679, p=0.094). A very strong correlation was noted between PDFF and failure load (rho -0.893, p=0.007). CONCLUSION PDFF as well as failure displacement and load allowed to distinguish osteoporotic from diffuse osteoblastic vertebrae. Our findings further show strong associations between PDFF and failure displacement and load, thus may indicate complimentary pathophysiological associations derived from two non-invasive techniques (CSE-MRI and CT) that inherently measure different properties of vertebral bone and marrow.
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Affiliation(s)
- Tobias Greve
- Department of Neurosurgery, University Hospital, Ludwig-Maximilians-University (LMU) Munich, Munich, Germany
- Department of Diagnostic and Interventional Neuroradiology, School of Medicine, Klinikum rechts der Isar, Technical University of Munich, Munich, Germany
- *Correspondence: Tobias Greve,
| | - Nithin Manohar Rayudu
- Engineering Product Development (EPD) Pillar, Singapore University of Technology and Design (SUTD), Singapore, Singapore
| | - Michael Dieckmeyer
- Department of Diagnostic and Interventional Neuroradiology, School of Medicine, Klinikum rechts der Isar, Technical University of Munich, Munich, Germany
| | - Christof Boehm
- Department of Diagnostic and Interventional Radiology, School of Medicine, Klinikum rechts der Isar, Technical University of Munich, Munich, Germany
| | - Stefan Ruschke
- Department of Diagnostic and Interventional Radiology, School of Medicine, Klinikum rechts der Isar, Technical University of Munich, Munich, Germany
| | - Egon Burian
- Department of Diagnostic and Interventional Neuroradiology, School of Medicine, Klinikum rechts der Isar, Technical University of Munich, Munich, Germany
- Department of Diagnostic and Interventional Radiology, School of Medicine, Klinikum rechts der Isar, Technical University of Munich, Munich, Germany
| | - Christopher Kloth
- Department of Diagnostic and Interventional Radiology, University Hospital Ulm, Ulm, Germany
| | - Jan S. Kirschke
- Department of Diagnostic and Interventional Neuroradiology, School of Medicine, Klinikum rechts der Isar, Technical University of Munich, Munich, Germany
- TUM-Neuroimaging Center, Klinikum rechts der Isar, Technical University of Munich, Munich, Germany
| | - Dimitrios C. Karampinos
- Department of Diagnostic and Interventional Radiology, School of Medicine, Klinikum rechts der Isar, Technical University of Munich, Munich, Germany
| | - Thomas Baum
- Department of Diagnostic and Interventional Neuroradiology, School of Medicine, Klinikum rechts der Isar, Technical University of Munich, Munich, Germany
| | - Karupppasamy Subburaj
- Engineering Product Development (EPD) Pillar, Singapore University of Technology and Design (SUTD), Singapore, Singapore
- Sobey School of Business, Saint Mary’s University, Halifax, NS, Canada
| | - Nico Sollmann
- Department of Diagnostic and Interventional Neuroradiology, School of Medicine, Klinikum rechts der Isar, Technical University of Munich, Munich, Germany
- Department of Diagnostic and Interventional Radiology, University Hospital Ulm, Ulm, Germany
- TUM-Neuroimaging Center, Klinikum rechts der Isar, Technical University of Munich, Munich, Germany
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India ink artifact on Dixon out-of-phase images can be used as a landmark to measure joint space width at MRI. Diagn Interv Imaging 2021; 103:87-96. [PMID: 34666946 DOI: 10.1016/j.diii.2021.09.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2021] [Revised: 09/26/2021] [Accepted: 09/27/2021] [Indexed: 11/23/2022]
Abstract
PURPOSE The purpose of this study was to test the feasibility of joint space width (JSW) measurement on Dixon MR images with the "India ink" artifact between cartilage and bone marrow as a landmark for the subchondral plate and to correlate it with radiographic JSW. MATERIALS AND METHODS Both hands of six volunteers (three women, three men; mean age, 36.7 ± 10.4 [SD] years) and 24 patients with early rheumatoid arthritis (16 women, 8 men; mean age, 45.7 ± 14.5 [SD] years) were imaged with MRI Dixon sequences and radiographs. Two radiologists (R1, R2) separately measured JSW in 11 joints per hand on all Dixon images in volunteers, on contrast-enhanced T1-weighted out-of-phase images in patients and on radiographs in both groups. Inter-technique, intra-observer and inter-observer agreements were assessed using intraclass correlation coefficient (ICC) and Bland Altman analysis. RESULTS In volunteers, agreement between JSW measurements on MRI and radiographs was the highest with T1-weighted Dixon out-of-phase images (mean ICC ranging from 0.69 to 0.76 for R1 and 0.65 to 0.74 for R2). In patients, median bias between JSW measurements at first and second readings was not statistically significantly different from 0 on T1-weighted Dixon out-of-phase images (mean bias of 0.00 and + 0.01 mm) and radiographs (mean bias of 0.00 and +0.01 mm). Median bias of the difference between measurements of R1 and R2 was statistically significantly different from 0 on T1-weighted Dixon out-of-phase images (mean bias of -0.11 and -0.09 mm; P < 0.039) and radiographs (mean bias of -0.24 and -0.20 mm; P < 0.035). CONCLUSION Measurement of hand JSW on T1-weighted Dixon out-of-phase images using India ink artifact as a landmark for the subchondral plate is repeatable and reproducible.
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Rajakulasingam R, Botchu R. Current progress and future trends in imaging of musculoskeletal bone tumours. J Clin Orthop Trauma 2021; 23:101622. [PMID: 34707971 PMCID: PMC8522479 DOI: 10.1016/j.jcot.2021.101622] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/29/2021] [Revised: 10/01/2021] [Accepted: 10/04/2021] [Indexed: 10/20/2022] Open
Abstract
Plain radiographs and MRI remains the gold standard imaging modality for bone tumour and tumour like lesions. Several imaging techniques have been developed to be used in conjunction, but doubt remains over how much additional diagnostic information they provide over and above routine MRI bone tumour sequences. Given the plethora of new modalities, this review aims to highlight some of them and how they may help in the diagnostic assessment of musculoskeletal bone tumours.
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Affiliation(s)
- R. Rajakulasingam
- Departments of Musculoskeletal Radiology, Royal National Orthopaedic Hospital, Stanmore, UK
| | - R. Botchu
- Departments of Musculoskeletal Radiology, Royal Orthopaedic Hospital, Birmingham, UK,Corresponding author. Department of Radiology, Royal Orthopaedic Hospital, Bristol Road South, Birmingham, B21 3AP, UK.
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Petralia G, Zugni F, Summers PE, Colombo A, Pricolo P, Grazioli L, Colagrande S, Giovagnoni A, Padhani AR. Whole-body magnetic resonance imaging (WB-MRI) for cancer screening: recommendations for use. Radiol Med 2021; 126:1434-1450. [PMID: 34338948 PMCID: PMC8558201 DOI: 10.1007/s11547-021-01392-2] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2021] [Accepted: 06/25/2021] [Indexed: 02/06/2023]
Abstract
Whole-body magnetic resonance imaging (WB-MRI) is currently recommended for cancer screening in adult and paediatric subjects with cancer predisposition syndromes, representing a substantial aid for prolonging health and survival of these subjects with a high oncological risk. Additionally, the number of studies exploring the use of WB-MRI for cancer screening in asymptomatic subjects from the general population is growing. The primary aim of this review was to analyse the acquisition protocols found in the literature, in order to identify common sequences across published studies and to discuss the need of additional ones for specific populations. The secondary aim of this review was to provide a synthesis of current recommendations regarding the use of WB-MRI for cancer screening.
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Affiliation(s)
- Giuseppe Petralia
- Precision Imaging and Research Unit, Department of Radiology, IEO European Institute of Oncology IRCCS, Milan, Italy.
- Department of Oncology and Hematology, University of Milan, Milan, Italy.
| | - Fabio Zugni
- Division of Radiology, IEO European Institute of Oncology IRCCS, Milan, Italy
| | - Paul E Summers
- Division of Radiology, IEO European Institute of Oncology IRCCS, Milan, Italy
| | - Alberto Colombo
- Division of Radiology, IEO European Institute of Oncology IRCCS, Milan, Italy
| | - Paola Pricolo
- Division of Radiology, IEO European Institute of Oncology IRCCS, Milan, Italy
| | - Luigi Grazioli
- First Department of Radiology, Civic and University Hospital of Brescia, Brescia, Italy
| | - Stefano Colagrande
- Department of Experimental and Clinical Biomedical Sciences, Radiodiagnostic Unit N. 2, University of Florence, Azienda Ospedaliero-Universitaria Careggi, Florence, Italy
| | - Andrea Giovagnoni
- Department of Radiology, Ospedali Riuniti, Università Politecnica Delle Marche, Ancona, Italy
| | - Anwar R Padhani
- Paul Strickland Scanner Centre, Mount Vernon Hospital, Northwood, UK
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Oki N, Ikebe Y, Koike H, Ideguchi R, Niino D, Uetani M. FDG-PET vs. chemical shift MR imaging in differentiating intertrabecular metastasis from hematopoietic bone marrow hyperplasia. Jpn J Radiol 2021; 39:1077-1085. [PMID: 34101119 PMCID: PMC8568862 DOI: 10.1007/s11604-021-01149-x] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2021] [Accepted: 05/31/2021] [Indexed: 12/28/2022]
Abstract
Purpose To evaluate the utility of SUVmax on FDG-PET and chemical shift imaging (CSI) on MRI in the differentiation of intertrabecular metastasis (ITM) from hematopoietic bone marrow hyperplasia (HBMH). Patients and methods We retrospectively evaluated 54 indeterminate focal bone marrow lesions in 44 patients detected on FDG-PET. The lesions were assigned to the metastasis group (M group, 29 lesions of 24 patients) and the non-metastasis group (non-M group, 25 lesions of 20 patients) based on the follow-up or the histopathological studies. The lesions were assessed with the maximum standardized uptake value (SUVmax) on FDG-PET CT images and signal change ratio (SCR) on CSI. Results The median SUVmax were 5.62 and 2.91; the median SCR were − 0.08 and − 34.8 in M and non-M groups respectively, with significant difference (p < 0.001). With ROC curve analysis, the optimal cutoff value of SUVmax was 4.48 with a sensitivity of 72.4%, a specificity of 100%, and AUC of 0.905. The cutoff value of SCR was − 6.15 with a sensitivity of 82.8%, a specificity of 80%, and AUC of 0.818. Conclusion FDG-PET and CSI on MRI are useful in distinguishing ITM from HBMH. Though their sensitivities are similar, the specificity of FDG-PET was higher than that of MRI.
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Affiliation(s)
- Nozomi Oki
- Department of Radiological Sciences, Nagasaki University Graduate School of Biomedical Sciences, 1-7-1 Sakamoto, Nagasaki, 852-8501 Japan
| | - Yohei Ikebe
- Department of Diagnostic and Interventional Radiology, Hokkaido University Hospital, N14, W5, Kita-ku, Sapporo, 060-8648 Japan
| | - Hirofumi Koike
- Department of Radiological Sciences, Nagasaki University Graduate School of Biomedical Sciences, 1-7-1 Sakamoto, Nagasaki, 852-8501 Japan
| | - Reiko Ideguchi
- Department of Radioisotope Medicine, Atomic Bomb Disease Institute, Nagasaki University, 1-12-4 Sakamoto, Nagasaki, 852-8523 Japan
| | - Daisuke Niino
- Pathology, University of Occupational and Environmental Health, 1-1 Iseigaoka, Yahatanishi-ku, Kitakyushu, 807-8555 Japan
| | - Masataka Uetani
- Department of Radiological Sciences, Nagasaki University Graduate School of Biomedical Sciences, 1-7-1 Sakamoto, Nagasaki, 852-8501 Japan
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Saifuddin A, Shafiq H, Malhotra K, Santiago R, Pressney I. Comparison of in-phase and opposed-phase T1W gradient echo and T2W fast spin echo dixon chemical shift imaging for the assessment of non-neoplastic, benign neoplastic and malignant marrow lesions. Skeletal Radiol 2021; 50:1209-1218. [PMID: 33196854 DOI: 10.1007/s00256-020-03663-x] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/20/2020] [Revised: 10/26/2020] [Accepted: 10/27/2020] [Indexed: 02/02/2023]
Abstract
OBJECTIVE The objective of this study is to compare T1-weighted gradient echo (T1W GrE: control technique) chemical shift imaging (CSI) with T2-weighted fast spin echo (T2W FSE: experimental technique) CSI for differentiating non-neoplastic and neoplastic marrow lesions. MATERIALS AND METHODS Patients undergoing MRI for various marrow lesions were investigated with T1W GrE and T2W FSE Dixon CSI. Signal intensity (SI) change between in-phase (IP) and opposed-phase (OP) sequences was calculated, and SI drop > 20% considered to represent non-neoplastic lesions while SI drop < 20% considered to represent neoplastic lesions. Final diagnosis was based on imaging features (n = 42) or histology (n = 43) and classified as non-neoplastic, benign neoplastic, and malignant neoplastic. Inter-observer and inter-technique agreement between 2 readers was calculated. RESULTS The study included 85 patients (44 males and 41 females; mean age 41.1 years, range 2-83 years). Final diagnosis included 19 (22.4%) non-neoplastic lesions, 27 (31.8%) benign neoplasms, and 39 (45.9%) malignant neoplasms. On T1W GrE CSI, 19-21 lesions were classed as non-neoplastic and 64-66 as neoplastic, while on T2W FSE Dixon CSI, 22-24 lesions were classed as non-neoplastic and 61-64 as neoplastic. Lesion classification matched between the 2 techniques in 91.8-96.5% of cases. Sensitivity, specificity, positive predictive value, negative predictive value, and accuracy of T1W GrE CSI for differentiating non-neoplastic and neoplastic marrow lesions were 66.7-72.2%, 88.1-89.6%, 61.9-63.2%, 90.9-92.2%, and 84.7%, and of T2W FSE Dixon CSI were 72.2-77.8%, 85.1-86.6%, 58.3-59.1%, 92.1-93.4%, and 83.5%. CONCLUSIONS T1W GrE CSI and T2W FSE Dixon CSI produce similar results in the assessment of non-neoplastic and neoplastic marrow lesions.
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Affiliation(s)
- Asif Saifuddin
- Department of Radiology, Royal National Orthopaedic Hospital, Brockley Hill, Stanmore, Middlesex, HA7 4LP, UK
| | - Hassan Shafiq
- Department of Orthopaedics, Bart's Health NHS Trust, London, UK
| | - Karan Malhotra
- Department of Orthopaedics, Royal National Orthopaedic Hospital, Stanmore, UK
| | - Rodney Santiago
- Department of Radiology, Royal National Orthopaedic Hospital, Brockley Hill, Stanmore, Middlesex, HA7 4LP, UK
| | - Ian Pressney
- Department of Radiology, Royal National Orthopaedic Hospital, Brockley Hill, Stanmore, Middlesex, HA7 4LP, UK.
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Imaging findings of granulocyte colony-stimulating factor-producing tumors: a case series and review of the literature. Jpn J Radiol 2021; 39:857-867. [PMID: 34021462 PMCID: PMC8413199 DOI: 10.1007/s11604-021-01130-8] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2021] [Accepted: 04/28/2021] [Indexed: 11/21/2022]
Abstract
Granulocyte colony-stimulating factor (G-CSF)-producing tumors have an aggressive clinical course. Here, we report five cases of G-CSF-producing tumors and review the literature, focusing on imaging findings related to tumor-produced G-CSF. In addition to our cases, we identified 30 previous reports of G-CSF-producing tumors on which 18F-fluorodeoxyglucose positron emission tomography (FDG-PET)/CT, bone scintigraphy, or evaluation of bone marrow MR findings was performed. White blood cell count, serum C-reactive protein, and serum interleukin-6 were elevated in all cases for which these parameters were measured. G-CSF-producing tumors presented large necrotic masses (mean diameter 83.2 mm, range 17–195 mm) with marked FDG uptake (mean maximum standardized uptake value: 20.09). Diffuse FDG uptake into the bone marrow was shown in 28 of the 31 cases in which FDG-PET/CT was performed. The signal intensity of bone marrow suggested marrow reconversion in all seven MRI-assessable cases. Bone scintigraphy demonstrated no significant uptake, except in two cases with bone metastases. Splenic FDG uptake was increased in 8 of 10 cases in which it was evaluated. These imaging findings may reflect the effects of tumor-produced G-CSF. The presence of G-CSF-producing tumors should be considered in patients with cancer who show these imaging findings and marked inflammatory features of unknown origin.
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Schmeel FC, Enkirch SJ, Luetkens JA, Faron A, Lehnen N, Sprinkart AM, Schmeel LC, Radbruch A, Attenberger U, Kukuk GM, Mürtz P. Diagnostic Accuracy of Quantitative Imaging Biomarkers in the Differentiation of Benign and Malignant Vertebral Lesions : Combination of Diffusion-Weighted and Proton Density Fat Fraction Spine MRI. Clin Neuroradiol 2021; 31:1059-1070. [PMID: 33787957 PMCID: PMC8648653 DOI: 10.1007/s00062-021-01009-1] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2020] [Accepted: 02/26/2021] [Indexed: 11/30/2022]
Abstract
Purpose To compare and combine the diagnostic performance of the apparent diffusion coefficient (ADC) derived from diffusion-weighted imaging (DWI) and proton density fat fraction (PDFF) derived from chemical-shift encoding (CSE)-based water-fat magnetic resonance imaging (MRI) for distinguishing benign and malignant vertebral bone marrow lesions (VBML). Methods A total of 55 consecutive patients with 53 benign (traumatic, inflammatory and primary) and 36 malignant (metastatic and hematologic) previously untreated VBMLs were prospectively enrolled in this IRB-approved study and underwent sagittal DWI (single-shot spin-echo echo-planar with multi-slice short TI inversion recovery fat suppression) and CSE-based MRI (gradient-echo 6‑point modified Dixon) in addition to routine clinical spine MRI at 1.5 T or 3.0 T. Diagnostic reference standard was established according to histopathology or imaging follow-up. The ADC = ADC (0, 800) and PDFF = fat / (water + fat) were calculated voxel-wise and examined for differences between benign and malignant lesions. Results The ADC and PDFF values of malignant lesions were significantly lower compared to benign lesions (mean ADC 861 × 10−6 mm2/s vs. 1323 × 10−6 mm2/s, p < 0.001; mean PDFF 3.1% vs. 28.2%, p < 0.001). The areas under the curve (AUC) and diagnostic accuracies were 0.847 (p < 0.001) and 85.4% (cut-off at 1084.4 × 10−6 mm2/s) for ADC and 0.940 (p < 0.001) and 89.9% for PDFF (cut-off at 7.8%), respectively. The combined use of ADC and PDFF improved the diagnostic accuracy to 96.6% (malignancy if ADC ≤ 1118.2 × 10−6 mm2/s and PDFF ≤ 20.0%, otherwise benign). Conclusion Quantitative evaluation of both ADC and PDFF was useful in differentiating benign VBMLs from malignancy. The combination of ADC and PDFF improved the diagnostic performance and yielded high diagnostic accuracy for the differentiation of benign and malignant VBMLs.
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Affiliation(s)
- Frederic Carsten Schmeel
- Department of Neuroradiology, University Hospital Bonn, Rheinische-Friedrich-Wilhelms-Universität Bonn, Venusberg-Campus 1, 53127, Bonn, Germany. .,Research Group Clinical Neuroimaging, German Centre for Neurodegenerative Diseases (DZNE), Bonn, Germany.
| | - Simon Jonas Enkirch
- Department of Neuroradiology, University Hospital Bonn, Rheinische-Friedrich-Wilhelms-Universität Bonn, Venusberg-Campus 1, 53127, Bonn, Germany
| | - Julian Alexander Luetkens
- Department of Radiology, University Hospital Bonn, Rheinische-Friedrich-Wilhelms-Universität Bonn, Bonn, Germany
| | - Anton Faron
- Department of Radiology, University Hospital Bonn, Rheinische-Friedrich-Wilhelms-Universität Bonn, Bonn, Germany
| | - Nils Lehnen
- Department of Neuroradiology, University Hospital Bonn, Rheinische-Friedrich-Wilhelms-Universität Bonn, Venusberg-Campus 1, 53127, Bonn, Germany.,Research Group Clinical Neuroimaging, German Centre for Neurodegenerative Diseases (DZNE), Bonn, Germany
| | - Alois Martin Sprinkart
- Department of Radiology, University Hospital Bonn, Rheinische-Friedrich-Wilhelms-Universität Bonn, Bonn, Germany
| | - Leonard Christopher Schmeel
- Department of Radiotherapy and Radiation Oncology, University Hospital Bonn, Rheinische-Friedrich-Wilhelms-Universität Bonn, Bonn, Germany
| | - Alexander Radbruch
- Department of Neuroradiology, University Hospital Bonn, Rheinische-Friedrich-Wilhelms-Universität Bonn, Venusberg-Campus 1, 53127, Bonn, Germany.,Research Group Clinical Neuroimaging, German Centre for Neurodegenerative Diseases (DZNE), Bonn, Germany
| | - Ulrike Attenberger
- Department of Radiology, University Hospital Bonn, Rheinische-Friedrich-Wilhelms-Universität Bonn, Bonn, Germany
| | - Guido Matthias Kukuk
- Department of Radiology, University Hospital Bonn, Rheinische-Friedrich-Wilhelms-Universität Bonn, Bonn, Germany.,Department of Radiology, Cantonal Hospital Graubuenden, Chur, Switzerland
| | - Petra Mürtz
- Department of Radiology, University Hospital Bonn, Rheinische-Friedrich-Wilhelms-Universität Bonn, Bonn, Germany
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van Vucht N, Santiago R, Pressney I, Saifuddin A. Role of in-phase and out-of-phase chemical shift MRI in differentiation of non-neoplastic versus neoplastic benign and malignant marrow lesions. Br J Radiol 2021; 94:20200710. [PMID: 33571012 DOI: 10.1259/bjr.20200710] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
OBJECTIVE To determine its ability of in-phase (IP) and out-of-phase (OOP) chemical shift imaging (CSI) to distinguish non-neoplastic marrow lesions, benign bone tumours and malignant bone tumours. METHODS CSI was introduced into our musculoskeletal tumour protocol in May 2018 to aid in characterisation of suspected bone tumours. The % signal intensity (SI) drop between IP and OOP sequences was calculated and compared to the final lesion diagnosis, which was classified as non-neoplastic (NN), benign neoplastic (BN) or malignant neoplastic (MN). RESULTS The study included 174 patients (84 males; 90 females: mean age 44.2 years, range 2-87 years). Based on either imaging features (n = 105) or histology (n = 69), 44 lesions (25.3%) were classified as NN, 66 (37.9%) as BN and 64 (36.8%) as MN. Mean % SI drop on OOP for NN lesions was 36.6%, for BN 3.19% and for MN 3.24% (p < 0.001). The sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV) and diagnostic accuracy of CSI for differentiating NN from neoplastic lesions were 65.9%, 94.6%, 80.6%, 89.1%% and 87.4% respectively, and for differentiating BN from MN were 9.1%, 98.4%, 85.7%, 51.2 and 53.1% respectively. CONCLUSION CSI is accurate for differentiating non-neoplastic and neoplastic marrow lesions, but is of no value in differentiating malignant bone tumours from non-fat containing benign bone tumours. ADVANCES IN KNOWLEDGE CSI is of value for differentiating non-neoplastic marrow lesions from neoplastic lesions, but not for differentiating benign bone tumours from malignant bone tumours as has been previously reported.
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Affiliation(s)
- Niels van Vucht
- Centre for Medical Imaging, University College London Hospitals, London, UK
| | - Rodney Santiago
- Department of Medical Imaging, Royal National Orthopaedic Hospital, Stanmore, UK
| | - Ian Pressney
- Department of Medical Imaging, Royal National Orthopaedic Hospital, Stanmore, UK
| | - Asif Saifuddin
- Department of Medical Imaging, Royal National Orthopaedic Hospital, Stanmore, UK
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21
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Differentiation of Vertebral Metastases From Focal Hematopoietic Marrow Depositions on MRI: Added Value of Proton Density Fat Fraction. AJR Am J Roentgenol 2021; 216:734-741. [PMID: 33405947 DOI: 10.2214/ajr.19.22698] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
OBJECTIVE. The purpose of this study was to evaluate the added value of proton density fat fraction (PDFF) in differentiating vertebral metastases from focal hematopoietic marrow depositions. MATERIALS AND METHODS. The study included 44 patients with 30 vertebral metastases and 14 focal hematopoietic marrow depositions who underwent spinal MRI. The final diagnoses were based on histologic confirmation, follow-up MRI, or PET/CT. Two musculoskeletal radiologists with 1 and 15 years of experience independently interpreted both image sets (i.e., images from conventional MRI alone versus images from conventional MRI and PDFF combined). Using a 5-point scale, the readers scored their confidence in the malignancy of the vertebral lesions. The diagnostic performance (AUC) of the two image sets was assessed via ROC curve analyses. Sensitivities, specificities, and accuracies (for both image sets) were compared using the McNemar test. Kappa coefficients were calculated to assess interobserver agreement. RESULTS. Both readers showed improved diagnostic performance after PDFF was added (AUC, 0.840-0.912 and 0.805-0.895 for readers 1 and 2, respectively). However, adding PDFF did not significantly improve the sensitivity and specificity of either reader (p > .05). Interobserver agreement significantly improved from moderate (κ = 0.563) to excellent (κ = 0.947) after PDFF was added. CONCLUSION. The addition of PDFF to a conventional MRI protocol improved the diagnostic performance for differentiating vertebral metastases from focal hematopoietic marrow depositions but without resulting in significant improvement in sensitivity and specificity.
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22
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Anomalous signal intensity increase on out-of-phase chemical shift imaging: a manifestation of marrow mineralisation? Skeletal Radiol 2020; 49:1269-1275. [PMID: 32198527 DOI: 10.1007/s00256-020-03420-0] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/14/2020] [Revised: 03/11/2020] [Accepted: 03/11/2020] [Indexed: 02/02/2023]
Abstract
OBJECTIVE In-phase (IP) and out-of-phase (OOP) chemical shift imaging (CSI) is an established technique for clarifying the nature of indeterminate bone marrow lesions, a signal intensity (SI) drop of > 20% at 1.5 tesla (T) or > 25% on 3 T on the OOP sequence being consistent with a non-neoplastic process. Occasionally, SI increase is seen on OOP sequences. The aim of this study is to determine if this is related to marrow sclerosis or matrix mineralisation. MATERIALS AND METHODS In 184 cases, the SI change on OOP was calculated. For patients in whom the SI on OOP increased compared with the IP sequence, available CT studies and radiographs were reviewed to look for marrow sclerosis and/or matrix mineralisation. RESULTS Forty out of 184 patients (34.25%) showed an anomalous increase in SI on the OOP sequence. CT studies were available in 27 cases (67.5%), of which medullary sclerosis was seen in 20 (74.1%) while matrix mineralisation was seen in a further 2 cases. Review of radiographs demonstrated matrix mineralisation in 6 cases, while punctate signal void consistent with chondral calcification was seen on MRI in 2 more cases. Based on either typical imaging features (n = 22) or histology (n = 18), 7 lesions (17.5%) were classed as non-neoplastic, 18 (45%) as benign neoplasms and 15 (37.5%) as malignant neoplasms. CONCLUSION When assessing focal marrow lesions with CSI, anomalous SI increase may be seen on the OOP sequence in approximately one-third of cases. In over 75% of such cases, CT or radiographs demonstrate either diffuse marrow sclerosis or matrix mineralisation.
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Rajakulasingam R, Saifuddin A. Focal nodular marrow hyperplasia: Imaging features of 53 cases. Br J Radiol 2020; 93:20200206. [PMID: 32463293 DOI: 10.1259/bjr.20200206] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022] Open
Abstract
OBJECTIVE To describe the characteristic imaging features of focal nodular marrow hyperplasia (FNMH). METHODS AND MATERIALS Retrospective review of all patients with a diagnosis of FNMH between January 2007 and September 2019. RESULTS The study included 53 patients, 7 males and 46 females with a mean age of 58 years (range 12-95 years). All had MRI with conventional spin echo sequences showing a poorly defined round/oval lesion with mild T1W iso/hyperintensity compared to skeletal muscle, low T2W turbo spin echo (TSE) signal intensity (SI) compared to marrow fat and variable SI on STIR, but never associated with reactive marrow oedema. All 53 patients had follow-up MRI, with all lesions remaining stable or partially resolving. In-phase (IP) and out-of-phase (OP) chemical shift imaging (CSI) was obtained in 31 of these, with 28 (90.3%) showing >20% SI drop on the OP sequence, while 3 (9.7%) demonstrated <20% SI drop. CT was available in 26 cases, 17 (65.4%) showing mild medullary sclerosis. Single-photon emission computed tomography CT (SPECT-CT) was available in four cases and Flourodeoxyglucose positron emission tomography CT (FDG PET-CT) in 2, all showing increased uptake. Focal uptake was also seen in three of eight patients who had undergone whole body bone scintigraphy. Only one lesion was biopsied, confirming FNMH. CONCLUSION The imaging appearances of FNMH have been described on various modalities, particularly MRI with emphasis on the role of IP and OP CSI typically demonstrating >20% SI reduction. FNMH should be recognised and treated as a 'do not touch' lesion which does not require biopsy or prolonged follow-up. ADVANCES IN KNOWLEDGE We describe and clarify the imaging characteristics of FNMH on MRI, including CSI, CT and various nuclear medicine modalities. An imaging algorithm is suggested for allowing a non-invasive diagnosis.
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Affiliation(s)
- Ramanan Rajakulasingam
- Department of Medical Imaging, Royal National Orthopaedic Hospital, Brockley Hill Stanmore, UK
| | - Asif Saifuddin
- Department of Medical Imaging, Royal National Orthopaedic Hospital, Brockley Hill Stanmore, UK
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24
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Bestic JM, Wessell DE, Beaman FD, Cassidy RC, Czuczman GJ, Demertzis JL, Lenchik L, Motamedi K, Pierce JL, Sharma A, Sloan AE, Than K, Walker EA, Ying-Kou Yung E, Kransdorf MJ. ACR Appropriateness Criteria® Primary Bone Tumors. J Am Coll Radiol 2020; 17:S226-S238. [PMID: 32370967 DOI: 10.1016/j.jacr.2020.01.038] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2020] [Accepted: 01/25/2020] [Indexed: 12/28/2022]
Abstract
Although primary bone tumors are relatively uncommon, appropriate imaging evaluation is essential when they are suspected or incidentally detected. In almost all cases, radiographs are the most appropriate initial imaging study for screening and characterization of primary bone tumors. Radiographs often provide sufficient information for diagnosis and to guide the treating clinician. However, when conventional radiographs alone are inadequate, they still often guide the selection of the most appropriate next step for advanced imaging. MRI and CT are typically the most appropriate next step. MRI provides excellent soft-tissue contrast allowing for evaluation of the tissue composition (such as fat, hemorrhage, fluid levels) and anatomic extent of bone tumors. CT provides complementary information, with its ability to detect subtle matrix mineralization or periosteal reaction that may not be seen on radiographs or MRI. This publication focuses on six common variants to guide diagnosis and management of primary bone tumors. In addition to conventional radiographs, appropriate use of MRI, CT, PET/CT, bone scan, and ultrasound are discussed. The American College of Radiology Appropriateness Criteria are evidence-based guidelines for specific clinical conditions that are reviewed annually by a multidisciplinary expert panel. The guideline development and revision include an extensive analysis of current medical literature from peer reviewed journals and the application of well-established methodologies (RAND/UCLA Appropriateness Method and Grading of Recommendations Assessment, Development, and Evaluation or GRADE) to rate the appropriateness of imaging and treatment procedures for specific clinical scenarios. In those instances where evidence is lacking or equivocal, expert opinion may supplement the available evidence to recommend imaging or treatment.
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Affiliation(s)
| | | | | | - R Carter Cassidy
- UK Healthcare Spine and Total Joint Service, Lexington, Kentucky; American Academy of Orthopaedic Surgeons
| | | | | | - Leon Lenchik
- Wake Forest University School of Medicine, Winston Salem, North Carolina
| | - Kambiz Motamedi
- David Geffen School of Medicine at UCLA, Los Angeles, California
| | | | | | - Andrew E Sloan
- University Hospitals Cleveland Medical Center and Case Western Reserve University School of Medicine, Cleveland, Ohio; Neurosurgery expert
| | - Khoi Than
- Oregon Health & Science University, Portland, Oregon; Neurosurgery expert
| | - Eric A Walker
- Penn State Milton S. Hershey Medical Center, Hershey, Pennsylvania and Uniformed Services University of the Health Sciences, Bethesda, Maryland
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25
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Sasiponganan C, Yan K, Pezeshk P, Xi Y, Chhabra A. Advanced MR imaging of bone marrow: quantification of signal alterations on T1-weighted Dixon and T2-weighted Dixon sequences in red marrow, yellow marrow, and pathologic marrow lesions. Skeletal Radiol 2020; 49:541-548. [PMID: 31606776 DOI: 10.1007/s00256-019-03303-z] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/06/2019] [Revised: 08/19/2019] [Accepted: 08/20/2019] [Indexed: 02/02/2023]
Abstract
OBJECTIVES To quantify and compare signal intensity (SI) changes on T1-weighted (W) and T2W Dixon imaging in yellow marrow, red marrow, and bone marrow lesions. MATERIALS AND METHODS A total of 141 patients (77 controls, 64 lesions-33 benign, 31 malignant) between January 2016 and December 2017 were retrospectively identified. For the control group, fixed 2-cm2 region of interests (ROI) were drawn at L5, bilateral ilium and femurs on in-phase and opposed-phase T1W and T2W Dixon images. For the lesion group, ROIs of best fit were drawn around each lesion on in-phase and opposed-phase T2W Dixon images. SI changes between in-phase and opposed phase maps for each group were compared. Inter-reader analysis was performed. RESULTS Yellow marrow exhibited smaller SI changes as compared to red marrow on both T1W and T2W Dixon imaging at all locations (p < 0.0001) except at L5 on T2W Dixon imaging (p = 0.206). Both benign and malignant lesions showed significantly smaller SI changes as compared to both yellow (p = 0.0087, p < 0.0001) and red marrow (p = 0.0004, p < 0.0001) on T2W Dixon imaging. Malignant lesions exhibited smaller SI change as compared to benign lesions on T2W Dixon imaging (p = 0.0005). Signal intensity loss on both red and yellow marrow were smaller on T1W Dixon as compared to T2W Dixon (0.49-0.64, 0.27-0.31 vs. 0.70-0.74, 0.48-0.71). Inter-reader agreements were excellent (0.91-0.97). CONCLUSIONS SI change calculated from T2-weighted Dixon imaging can adequately differentiate between yellow marrow, red marrow, and osseous lesions, both benign and malignant.
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Affiliation(s)
- Chayanit Sasiponganan
- Radiology Department, UT Southwestern Medical Center, 5323 Harry Hines Blvd, Dallas, TX, 75390, USA.
| | - Kevin Yan
- Radiology Department, UT Southwestern Medical Center, 5323 Harry Hines Blvd, Dallas, TX, 75390, USA
| | - Parham Pezeshk
- Radiology Department, UT Southwestern Medical Center, 5323 Harry Hines Blvd, Dallas, TX, 75390, USA
| | - Yin Xi
- Radiology Department, UT Southwestern Medical Center, 5323 Harry Hines Blvd, Dallas, TX, 75390, USA
| | - Avneesh Chhabra
- Radiology Department, UT Southwestern Medical Center, 5323 Harry Hines Blvd, Dallas, TX, 75390, USA.,Orthopedics Department, UT Southwestern Medical Center, Dallas, TX, USA
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26
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van Vucht N, Santiago R, Lottmann B, Pressney I, Harder D, Sheikh A, Saifuddin A. The Dixon technique for MRI of the bone marrow. Skeletal Radiol 2019; 48:1861-1874. [PMID: 31309243 DOI: 10.1007/s00256-019-03271-4] [Citation(s) in RCA: 40] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/07/2019] [Revised: 06/25/2019] [Accepted: 06/27/2019] [Indexed: 02/02/2023]
Abstract
Dixon sequences are established as a reliable MRI technique that can be used for problem-solving in the assessment of bone marrow lesions. Unlike other fat suppression methods, Dixon techniques rely on the difference in resonance frequency between fat and water and in a single acquisition, fat only, water only, in-phase and out-of-phase images are acquired. This gives Dixon techniques the unique ability to quantify the amount of fat within a bone lesion, allowing discrimination between marrow-infiltrating and non-marrow-infiltrating lesions such as focal nodular marrow hyperplasia. Dixon can be used with gradient echo and spin echo techniques, both two-dimensional and three-dimensional imaging. Another advantage is its rapid acquisition time, especially when using traditional two-point Dixon gradient echo sequences. Overall, Dixon is a robust fat suppression method that can also be used with intravenous contrast agents. After reviewing the available literature, we would like to advocate the implementation of additional Dixon sequences as a problem-solving tool during the assessment of bone marrow pathology.
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Affiliation(s)
- Niels van Vucht
- Department of Medical Imaging, Royal National Orthopaedic Hospital, Brockley Hill, Stanmore, HA7 4LP, UK.
| | - Rodney Santiago
- Department of Medical Imaging, Royal National Orthopaedic Hospital, Brockley Hill, Stanmore, HA7 4LP, UK
| | - Bianca Lottmann
- Department of Medical Imaging, Royal National Orthopaedic Hospital, Brockley Hill, Stanmore, HA7 4LP, UK
| | - Ian Pressney
- Department of Medical Imaging, Royal National Orthopaedic Hospital, Brockley Hill, Stanmore, HA7 4LP, UK
| | - Dorothee Harder
- Clinic of Radiology and Nuclear Medicine, University Hospital Basel, University of Basel, Petersgraben 4, 4031, Basel, Switzerland
| | - Adnan Sheikh
- Department of Medical Imaging, The Ottawa Hospital, Civic Campus, 1053 Carling Avenue, Ottawa, Ontario, K1Y 4E9, Canada
| | - Asif Saifuddin
- Department of Medical Imaging, Royal National Orthopaedic Hospital, Brockley Hill, Stanmore, HA7 4LP, UK
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27
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Kwack KS, Lee HD, Jeon SW, Lee HY, Park S. Comparison of proton density fat fraction, simultaneous R2*, and apparent diffusion coefficient for assessment of focal vertebral bone marrow lesions. Clin Radiol 2019; 75:123-130. [PMID: 31676038 DOI: 10.1016/j.crad.2019.09.141] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2019] [Accepted: 09/24/2019] [Indexed: 12/11/2022]
Abstract
AIM To investigate the diagnostic performance of proton density fat fraction (PDFF) and simultaneous R2* for focal vertebral bone marrow lesion (VBML) assessment, compared with the apparent diffusion coefficient (ADC). MATERIALS AND METHODS One hundred and ninety-two spinal magnetic resonance imaging (MRI) examinations performed in 126 patients with focal VBMLs from March 2016 to November 2018 were reviewed retrospectively. The lesions were divided into metastases and benign VBMLs. The protocol consisted of routine morphological MRI sequences, followed by complex-based chemical shift imaging (CSE)-MRI and diffusion-weighted (DW)-MRI with a 1.5 T system. PDFF, R2*, and the ADC values were compared using the Mann-Whitney U-test. Receiver operating characteristic curve analysis was carried out to assess the diagnostic performance for differentiating metastases from focal benign VBMLs. RESULTS PDFF, R2*, and mean ADC values in metastases were significantly lower than those in benign VBMLs (p<0.05). The PDFF (area under the curve [AUC]= 0.968; 95% confidence interval [CI]=0.932-0.988) showed a significantly larger AUC compared with R2* (AUC=0.670; 95% CI=0.599-0.736) and ADC (AUC=0.801; 95% CI=0.738-0.855). The optimal cut-off value of the PDFF for predicting metastases was 9%; this threshold corresponded to a sensitivity of 96.67%, specificity of 90.28%, and accuracy of 94.27%. CONCLUSION PDFF is significantly more accurate than ADC and R2* for differentiating focal benign VMBLs from metastases.
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Affiliation(s)
- K-S Kwack
- Department of Radiology, Ajou University School of Medicine, Suwon, South Korea; Musculoskeletal Imaging Laboratory, Ajou University Medical Center, Suwon, South Korea
| | - H-D Lee
- Department of Orthopaedic Surgery, Ajou University School of Medicine, Suwon, South Korea
| | - S W Jeon
- Department of Radiology, Ajou University School of Medicine, Suwon, South Korea; Musculoskeletal Imaging Laboratory, Ajou University Medical Center, Suwon, South Korea
| | - H Y Lee
- Regional Clinical Trial Center, Ajou University Medical Center, Suwon, South Korea; Department of Biostatistics, Yonsei University College of Medicine, Seoul, South Korea
| | - S Park
- Department of Radiology, Ajou University School of Medicine, Suwon, South Korea; Musculoskeletal Imaging Laboratory, Ajou University Medical Center, Suwon, South Korea.
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28
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Chen Y, Yu Q, La Tegola L, Mei Y, Chen J, Huang W, Zhang X, Guglielmi G. Intravoxel incoherent motion MR imaging for differentiating malignant lesions in spine: A pilot study. Eur J Radiol 2019; 120:108672. [PMID: 31550637 DOI: 10.1016/j.ejrad.2019.108672] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2019] [Revised: 08/22/2019] [Accepted: 09/14/2019] [Indexed: 10/26/2022]
Abstract
PURPOSE To determine the diagnostic potential of Intravoxel Incoherent Motion (IVIM) MRI for differentiating malignant spinal tumours from acute vertebral compression fractures and tuberculous spondylitis, and to compare IVIM with diffusion-weighted imaging (DWI) and chemical shift imaging (CSI). METHODS The Institutional Review Board approved this prospective study, and informed consent was obtained. IVIM MRI, DWI, and CSI at 1.5 T were performed in 25 patients with 12 acute compression fractures, 14 tuberculous spondylitis, and 18 malignant spinal tumours. The parameters of these techniques were assessed using the Kruskal-Wallis test. The diagnostic performance of the parameters was evaluated using receiver operating characteristic (ROC) analysis. RESULTS ADC, SIR, Dslow, Dfast, and f values of malignant tumours were significantly different from those of acute compression fracture (for all, p < 0.05). The mean Dslow and Dfast values of malignant spinal tumours had significant differences compared with those of tuberculous spondylitis (for all, p < 0.05). However, no significant differences were observed in any quantitative parameters between the acute compression fracture and the tuberculous spondylitis (p > 0.05). Dslow•f showed the highest AUC value of 0.980 (95%CI: 0.942-1.000) in differentiating acute compression fracture and malignant spinal tumours. Dslow showed the highest AUC value of 0.877 (95%CI: 0.713-0.966) in differentiating tuberculous spondylitis and malignant spinal tumours. CONCLUSIONS IVIM MR imaging may be helpful for differentiating malignant spinal tumours from acute vertebral compression fractures and tuberculous spondylitis.
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Affiliation(s)
- Yanjun Chen
- Department of Medical Imaging, The Third Affiliated Hospital of Southern Medical University (Academy of Orthopedics. Guangdong Province), Guangzhou, China; Institute of Clinical Anatomy, School of Basic Medical Sciences, Southern Medical University, Guangzhou, China
| | - Qinqin Yu
- Institute of Clinical Anatomy, School of Basic Medical Sciences, Southern Medical University, Guangzhou, China
| | - Luciana La Tegola
- Università degli Studi di Foggia, Scuola di Specializzazione di Area Medica, Department of Radiology, Foggia, Italy
| | | | - Jialing Chen
- Department of Medical Imaging, The Third Affiliated Hospital of Southern Medical University (Academy of Orthopedics. Guangdong Province), Guangzhou, China
| | - Wenhua Huang
- Institute of Clinical Anatomy, School of Basic Medical Sciences, Southern Medical University, Guangzhou, China
| | - Xiaodong Zhang
- Department of Medical Imaging, The Third Affiliated Hospital of Southern Medical University (Academy of Orthopedics. Guangdong Province), Guangzhou, China.
| | - Giuseppe Guglielmi
- Università degli Studi di Foggia, Scuola di Specializzazione di Area Medica, Department of Radiology, Foggia, Italy
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29
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Gimber LH, Chadaz TS, Flake W, Taljanovic MS. Advanced MR Imaging of Musculoskeletal Tumors: An Overview. Semin Roentgenol 2019; 54:149-161. [PMID: 31128738 DOI: 10.1053/j.ro.2018.10.001] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Affiliation(s)
- Lana Hirai Gimber
- Department of Medical Imaging, Banner University Medical Center, The University of Arizona, College of Medicine, Tucson, AZ.
| | - Tyson S Chadaz
- Department of Medical Imaging, Banner University Medical Center, The University of Arizona, College of Medicine, Tucson, AZ.
| | - William Flake
- Department of Medical Imaging, Banner University Medical Center, The University of Arizona, College of Medicine, Tucson, AZ.
| | - Mihra S Taljanovic
- Department of Medical Imaging, Banner University Medical Center, The University of Arizona, College of Medicine, Tucson, AZ
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30
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The effects of granulocyte colony-stimulating factor on MR images of bone marrow. Skeletal Radiol 2019; 48:209-218. [PMID: 30091008 DOI: 10.1007/s00256-018-3035-0] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/06/2018] [Revised: 07/15/2018] [Accepted: 07/24/2018] [Indexed: 02/02/2023]
Abstract
Granulocyte colony-stimulating factor (G-CSF) analogs such as filgrastim/pegfilgrastim are increasingly used to enhance neutrophilic recovery after chemotherapy. It is widely known that, physiologically, pegfilgrastim stimulates marrow mitotic activity and induces marrow reconversion from fatty to cellular. However, there is limited literature discussing the effects of pegfilgrastim on musculoskeletal magnetic resonance imaging, with the consensus that marrow reconversion secondary to pegfilgrastim therapy is easily confounded with a malignant process, especially in patients with a history of cancer. We attempt to discuss the expected changes and MRI findings after pegfilgrastim therapy through a summary of current literature. Additionally, we provide images from our own practice to support the previously established findings. G-CSF-stimulated reconversion can appear as patchy expansions of baseline hematopoietic marrow, but can also appear to be diffusely homogeneous, adding to its ambiguity. We conclude that using a baseline MRI, clinical information, and assessing sequential MRI changes in conjunction with pegfilgrastim therapy may aid the differentiation between benign and pathological change. We expand our discussion to include the effects of novel technologies, such as whole-body MRI, chemical shift imaging, and contrast agents in helping the distinction.
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31
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Fukuda T, Wengler K, de Carvalho R, Boonsri P, Schweitzer ME. MRI biomarkers in osseous tumors. J Magn Reson Imaging 2019; 50:702-718. [PMID: 30701624 DOI: 10.1002/jmri.26672] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2018] [Revised: 01/15/2019] [Accepted: 01/15/2019] [Indexed: 12/12/2022] Open
Abstract
Although radiography continues to play a critical role in osseous tumor assessment, there have been remarkable advances in cross-sectional imaging. MRI has taken a lead in this assessment due to high tissue contrast and spatial resolution, which are well suited for bone lesion assessment. More recently, although somewhat lagging other organ systems, quantitative parameters have shown promising potential as biomarkers for osseous tumors. Among these sequences are chemical shift imaging (CSI), apparent diffusion coefficient (ADC), and intravoxel incoherent motion (IVIM) from diffusion-weighted imaging (DWI), quantitative dynamic contrast enhanced (DCE)-MRI, and magnetic resonance spectroscopy (MRS). In this article, we review the background and recent roles of these quantitative MRI biomarkers for osseous tumors. Level of Evidence: 3 Technical Efficacy Stage: 3 J. MAGN. RESON. IMAGING 2019. J. Magn. Reson. Imaging 2019;50:702-718.
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Affiliation(s)
- Takeshi Fukuda
- Department of Radiology, Stony Brook University, Stony Brook, New York, USA
| | - Kenneth Wengler
- Department of Biomedical Engineering, Stony Brook University, Stony Brook, New York, USA
| | - Ruben de Carvalho
- Department of Radiology, Stony Brook University, Stony Brook, New York, USA
| | - Pattira Boonsri
- Department of Radiology, Stony Brook University, Stony Brook, New York, USA
| | - Mark E Schweitzer
- Department of Radiology, Stony Brook University, Stony Brook, New York, USA
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32
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Shetty AS, Sipe AL, Zulfiqar M, Tsai R, Raptis DA, Raptis CA, Bhalla S. In-Phase and Opposed-Phase Imaging: Applications of Chemical Shift and Magnetic Susceptibility in the Chest and Abdomen. Radiographics 2019; 39:115-135. [DOI: 10.1148/rg.2019180043] [Citation(s) in RCA: 22] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Affiliation(s)
- Anup S. Shetty
- From the Mallinckrodt Institute of Radiology, Washington University School of Medicine, 510 S Kingshighway Blvd, Campus Box 8131, St Louis, MO 63110
| | - Adam L. Sipe
- From the Mallinckrodt Institute of Radiology, Washington University School of Medicine, 510 S Kingshighway Blvd, Campus Box 8131, St Louis, MO 63110
| | - Maria Zulfiqar
- From the Mallinckrodt Institute of Radiology, Washington University School of Medicine, 510 S Kingshighway Blvd, Campus Box 8131, St Louis, MO 63110
| | - Richard Tsai
- From the Mallinckrodt Institute of Radiology, Washington University School of Medicine, 510 S Kingshighway Blvd, Campus Box 8131, St Louis, MO 63110
| | - Demetrios A. Raptis
- From the Mallinckrodt Institute of Radiology, Washington University School of Medicine, 510 S Kingshighway Blvd, Campus Box 8131, St Louis, MO 63110
| | - Constantine A. Raptis
- From the Mallinckrodt Institute of Radiology, Washington University School of Medicine, 510 S Kingshighway Blvd, Campus Box 8131, St Louis, MO 63110
| | - Sanjeev Bhalla
- From the Mallinckrodt Institute of Radiology, Washington University School of Medicine, 510 S Kingshighway Blvd, Campus Box 8131, St Louis, MO 63110
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Diagnostic Performance of In-Phase and Opposed-Phase Chemical-Shift Imaging for Differentiating Benign and Malignant Vertebral Marrow Lesions: A Meta-Analysis. AJR Am J Roentgenol 2018; 211:W188-W197. [DOI: 10.2214/ajr.17.19306] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
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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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You JH, Kim IH, Hwang J, Lee HS, Park EH. Fracture of ankle: MRI using opposed-phase imaging obtained from turbo spin echo modified Dixon image shows improved sensitivity. Br J Radiol 2018; 91:20170779. [PMID: 29762056 DOI: 10.1259/bjr.20170779] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022] Open
Abstract
OBJECTIVE To evaluate if opposed-phase (OP) imaging obtained from the turbo spin echo (TSE) modified Dixon (mDixon) technique can increase the sensitivity of MRI for diagnosing ankle fractures. METHODS This study included 95 CT-confirmed ankle fractures with additional MRI of the ankle using a TSE modified Dixon (mDixon) technique. Two groups of images were analyzed independently: Group 1-imaging group without OP imaging; Group 2-imaging group with OP imaging. Readers assessed the images using a 4-point confidence score to detect fractures. During the first review session, the fracture site was blinded. For the second review session, the fracture site was provided. Sensitivity and positive-predictive value were calculated. RESULTS In both sessions, the sensitivity for Group 2 was significantly greater than that for Group 1 (Session 1: 76.3% vs 62.6%, p < 0.0001; Session 2: 80.5% vs 65.3%, p < 0.0001). The positive-predictive value of Group 2 was significantly lower in both sessions 1 and 2 (Session 1: 85.8% vs 97.5%, p < 0.0001; Session 2: 90.5% vs 96.9%, p = 0.0068). Among the 28 false-negative fractures missed in Group 1 (Session 1), 12 (9 minimal displaced and 4 small diameter fractures) were identified in Group 2 (Session 1). While 8.9% showed lower movement, 33.6% showed upper movement in Group 2 compared with Group 1. Possible causes of false-positive lesions were subcutaneous fat, bone marrow edema, and intraosseous vessel mimic fractures. CONCLUSION OP imaging obtained using the modified Dixon technique provided better sensitivity and improved descriptions of fractures, especially for minimal displaced fractures and small diameter fractures. However, caution is required when diagnosing fractures with OP imaging because pseudofractures can appear as a result of adjacent bone marrow edema, vascular structures, or subcutaneous fat lobules. Advances in knowledge: In MRI, minimal displaced or small chip bone fracture maybe missed, OP imaging obtained using the mDixon technique provided better sensitivity and improved descriptions of fractures using the black boundary artifact.
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Affiliation(s)
- Jin Hee You
- 1 Department of Radiology, Research Institute of Clinical Medicine of Chonbuk National University - Biomedical Research Institute of Chonbuk National University Hospital, Chonbuk National University Medical School , Jeonju , South Korea
| | - In Hwan Kim
- 1 Department of Radiology, Research Institute of Clinical Medicine of Chonbuk National University - Biomedical Research Institute of Chonbuk National University Hospital, Chonbuk National University Medical School , Jeonju , South Korea.,2 Department of Radiology, Jeonju Wooridul Spine Hospital , Jeonju , Republic of Korea
| | - Jinwoo Hwang
- 3 Clinical Science, Philips Healthcare , Seoul , Republic of Korea
| | - Hye Sun Lee
- 4 Biostatistics Collaboration Unit, Yonsei University College of Medicine , Seoul , South Korea
| | - Eun Hae Park
- 1 Department of Radiology, Research Institute of Clinical Medicine of Chonbuk National University - Biomedical Research Institute of Chonbuk National University Hospital, Chonbuk National University Medical School , Jeonju , South Korea
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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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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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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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Martín Noguerol T, Luna A, Gómez Cabrera M, Riofrio AD. Clinical applications of advanced magnetic resonance imaging techniques for arthritis evaluation. World J Orthop 2017; 8:660-673. [PMID: 28979849 PMCID: PMC5605351 DOI: 10.5312/wjo.v8.i9.660] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/11/2017] [Revised: 04/18/2017] [Accepted: 05/05/2017] [Indexed: 02/06/2023] Open
Abstract
Magnetic resonance imaging (MRI) has allowed a comprehensive evaluation of articular disease, increasing the detection of early cartilage involvement, bone erosions, and edema in soft tissue and bone marrow compared to other imaging techniques. In the era of functional imaging, new advanced MRI sequences are being successfully applied for articular evaluation in cases of inflammatory, infectious, and degenerative arthropathies. Diffusion weighted imaging, new fat suppression techniques such as DIXON, dynamic contrast enhanced-MRI, and specific T2 mapping cartilage sequences allow a better understanding of the physiopathological processes that underlie these different arthropathies. They provide valuable quantitative information that aids in their differentiation and can be used as potential biomarkers of articular disease course and treatment response.
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Affiliation(s)
| | - Antonio Luna
- MRI Unit, Clínica Las Nieves, SERCOSA, Health Time, 23007 Jaén, Spain
- Department of Radiology, University Hospitals of Cleveland, Case Western Reserve University, Cleveland, OH 44106, United States
| | | | - Alexie D Riofrio
- Department of Radiology, Duke Regional Hospital, Durham, NC 27710, United States
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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: 21] [Impact Index Per Article: 2.6] [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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