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Erkal Tonkaz D, Ozpar R, Tonkaz M, Yazici Z. Efficacy of fat quantification methods used in MRI to distinguish between normal, benign, and malignant bone marrow pathologies in children. Acta Radiol 2024; 65:841-850. [PMID: 38659300 DOI: 10.1177/02841851241247110] [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] [Indexed: 04/26/2024]
Abstract
BACKGROUND Fat quantification methods in magnetic resonance imaging (MRI) have been studied to differentiate bone marrow pathologies in adult patients; however, scarce literature is available in pediatric patients. PURPOSE To evaluate the efficacy of the T1 signal intensity value (T1-SIV), out-of-phase/in-phase signal ratio (OP/IP SR), and fat fraction (FF) to differentiate between normal, benign, and malignant pathological processes. MATERIAL AND METHODS A total of 48 pediatric patients with lumbar and pelvic MRI were classified into three groups according to bone marrow pathology (group 1, normal; group 2, benign pathology/reconversion; group 3, malignant). The efficacy of T1-SIV, OP/IP SR, and FF values in differentiating these pathologies was evaluated using Kruskal-Wallis or analysis of variance and followed by Bonferroni or Dunn-Bonferroni tests. Cutoff values for malignant infiltration were defined using ROC analysis. RESULTS Although these values were significantly different in all three groups (P = 0.001-0.008), this difference was not sufficient to discriminate between all groups. Subgroup analyses showed significant differences in T1-SIV between groups 1-3, in OP/IP SR between groups 1-3, 2-3, and 1-2, in FF between groups 1-2 and 1-3 in various regions (P = 0.001-0.049). Cutoff values had a sensitivity and specificity of 90%-100% for OP/IP SR and FF. CONCLUSION T1-SIV, OP/IP SR, and FF may potentially distinguish normal from pathological bone marrow. OP/IP SR and FF values detected malignant infiltration with high sensitivity and specificity in this study. However, only OP/IP SR may significantly differentiate benign and malignant bone marrow pathologies which needs to be confirmed in the future study with a larger patient population.
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Affiliation(s)
| | - Rifat Ozpar
- Department of Radiology, Bursa Uludag University Faculty of Medicine, Bursa, Turkey
| | - Mehmet Tonkaz
- Department of Radiology, Gumushane State Hospital, Gumushane, Turkey
| | - Zeynep Yazici
- Department of Radiology, Bursa Uludag University Faculty of Medicine, Bursa, Turkey
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Park S, Huh JD. Differentiation of bone metastases from benign red marrow depositions: utilizing qualitative and quantitative analysis of conventional T1-weighted imaging and fat-suppressed T2-weighted imaging. Br J Radiol 2024; 97:422-429. [PMID: 38308029 DOI: 10.1093/bjr/tqad033] [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: 05/18/2023] [Revised: 10/04/2023] [Accepted: 11/20/2023] [Indexed: 02/04/2024] Open
Abstract
OBJECTIVES To distinguish bone metastases (BMs) from benign red marrow depositions (BRMs) by qualitative and quantitative analyses of T1-weighted imaging and fat-suppressed T2-weighted imaging (T2 FS). METHODS For 75 lesions including 38 BMs and 37 BRMs, two radiologists independently evaluated magnetic resonance images by qualitative (signal intensity [SI] of lesions compared to that of normal muscle [NM] or normal bone marrow [NBM]) and quantitative (parameters of the region of interests in the lesions, including T1 ratio [T1 SI ratio of lesion and NM], T2FMu ratio [T2 FS SI ratio of lesion and NM], and T2FMa ratio [T2 FS SI ratio of lesion and NBM]) analyses. RESULTS Hyperintensity relative to NM or NBM on T2 FS was more frequent in BMs than in BRMs (100% vs 59.5%-78.4%, respectively; P ≤ 0.001) but also was present in more than half of BRMs. All quantitative parameters showed a significant difference between BMs and BRMs (T1 ratio, 1.075 vs 1.227 [P = 0.002]; T2FMu ratio, 2.094 vs 1.282 [P < 0.001]; T2FMa ratio, 3.232 vs 1.810 [P < 0.001]). The receiver operating characteristics areas under the curves of T2FMu and T2FMa ratios were clinically useful (0.781 and 0.841, respectively) and did not demonstrate statistically significant differences. CONCLUSIONS The quantitative analysis of T2 FS facilitates distinguishing between BMs and BRMs, regardless of whether the reference was NM or NBM. ADVANCES IN KNOWLEDGE Quantitative parameters derived from T2 FS facilitate differentiation of BMs BRMs without additional scans. The role of NBM as an internal standard for T2 FS to differentiate between BMs and BRMs is similar to that of NM.
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Affiliation(s)
- Sekyoung Park
- Department of Radiology, Kosin University Gospel Hospital, Kosin University College of Medicine, Busan 49267, Korea
| | - Jin Do Huh
- Department of Radiology, Kosin University Gospel Hospital, Kosin University College of Medicine, Busan 49267, Korea
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Park SY, Yoon MA, Lee MH, Lee SH, Chung HW. [Imaging Findings of Spinal Metastases with Differential Diagnosis: Focusing on Solitary Spinal Lesion in Older Patients]. JOURNAL OF THE KOREAN SOCIETY OF RADIOLOGY 2024; 85:77-94. [PMID: 38362381 PMCID: PMC10864150 DOI: 10.3348/jksr.2023.0156] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/15/2023] [Revised: 01/06/2024] [Accepted: 01/18/2024] [Indexed: 02/17/2024]
Abstract
If a solitary spinal lesion is found in an older patient, bone metastasis can be primarily considered as the diagnosis. Bone metastasis can occur anywhere, but it mostly occurs in the vertebral body and may sometimes show typical imaging findings, presenting as a single lesion. Therefore, differentiating it from other lesions that mimic bone metastases can be challenging, potentially leading to delayed diagnosis and initiation of primary cancer treatment. This review provides an overview of imaging findings and clinical guidelines for bone metastases and discusses its differences from other diseases that can occur as solitary spinal lesions in older patients.
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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: 3] [Impact Index Per Article: 3.0] [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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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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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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