Differentiation of Acute Osteoporotic and Malignant Vertebral Fractures by Quantification of Fat Fraction With a Dixon MRI Sequence

Kim, Dong Hyun; Yoo, Hye Jin; Hong, Sung Hwan; Choi, Ja Young; Chae, Hee Dong; Chung, Bo Mi

doi:10.2214/ajr.17.18168

Cited by 37 publications

(28 citation statements)

References 26 publications

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“…Additional MR sequences such as fat-suppressed T2-weighted imaging, DWI, or Dixon MRI sequence may be helpful for clear delineation. 8 , 19 …”

Section: Discussionmentioning

confidence: 99%

Differential diagnostic value of <sup>18</sup>F-FDG PET/CT for benign and malignant vertebral compression fractures: comparison with magnetic resonance imaging

He¹,

Zhao²,

Guo³

et al. 2018

CMAR

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PurposeThe purpose of this study was to evaluate the differential diagnostic value of 2-[fluorine-18]-fluoro-2-deoxy-d-glucose (18F-FDG) positron emission tomography (PET)/computed tomography (CT) for benign and malignant vertebral compression fractures (VCFs), where the diagnostic accuracy of 18F-FDG PET/CT was compared with magnetic resonance imaging (MRI).Patients and methodsBetween 2015 and 2017, we retrospectively evaluated 87 patients with 116 VCFs. MRI was performed in all the 87 patients, whereas 18F-FDG PET/CT was executed in 51 patients. Three malignant features (convex posterior cortex, epidural mass formation, and pedicle enhancement) from MRI and the maximum standardized uptake value (SUVmax) from 18F-FDG PET/CT were evaluated in benign and malignant VCFs, respectively. Sensitivity, specificity, positive predictive value, and negative predictive value of MRI and 18F-FDG PET/CT were compared in the differentiation of malignant from benign VCFs.ResultsThe results of our investigation showed that the sensitivity and specificity for predicting malignant VCFs were 75.6% and 77.3% for convex posterior cortex, 82.9% and 813% for epidural mass formation, and 85.7% and 70.8% for pedicle enhancement. 18F-FDG PET/CT demonstrated higher sensitivity (100%) but lower specificity (38.9%) as compared to MRI with regard to differentiation between benign and malignant VCFs. A significant difference in the SUVmax values was observed between the benign and malignant fractures (2.9 ± 1.0 vs 5.0 ± 1.8, P < 0.01). Besides the value of SUVmax, it has been noticed that the FDG uptake pattern differed in malignant and benign fractures.ConclusionSignificant MRI findings such as convex posterior cortex, epidural mass formation, and pedicle enhancement are highly suggestive of malignancy. 18F-FDG PET/CT reliably differentiated the fractures of malignant from benign based on both SUVmax and 18F-FDG uptake pattern. In a situation where MRI findings are not diagnostic, 18F-FDG PET/CT provides additional information as it has high sensitivity and is semiquantitative.

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“…Additional MR sequences such as fat-suppressed T2-weighted imaging, DWI, or Dixon MRI sequence may be helpful for clear delineation. 8 , 19 …”

Section: Discussionmentioning

confidence: 99%

Differential diagnostic value of <sup>18</sup>F-FDG PET/CT for benign and malignant vertebral compression fractures: comparison with magnetic resonance imaging

He¹,

Zhao²,

Guo³

et al. 2018

CMAR

View full text Add to dashboard Cite

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“…Because trabecular bone can shorten the T2* relaxation time of water and fat compartments in bone marrow, inducing rapid gradient echo signal decay with echo time (TE), T2*correction should be used to remove T2* bias for vertebral bone marrow fat quantification . Modified Dixon (mDixon) Quant technique with six echoes, seven fat peaks and T2* correction was found to enable robust water‐fat separation and to have high quality fat quantification . Recent studies using similar modified Dixon sequences to differentiate benign from malignant lesions and acute osteoporotic fractures from pathologic fractures in vertebrae show strong potential toward clinical applications …”

mentioning

confidence: 99%

“…Modified Dixon (mDixon) Quant technique with six echoes, seven fat peaks and T2* correction was found to enable robust water‐fat separation and to have high quality fat quantification . Recent studies using similar modified Dixon sequences to differentiate benign from malignant lesions and acute osteoporotic fractures from pathologic fractures in vertebrae show strong potential toward clinical applications …”

mentioning

confidence: 99%

Prediction of Abnormal Bone Density and Osteoporosis From Lumbar Spine MR Using Modified Dixon Quant in 257 Subjects With Quantitative Computed Tomography as Reference

Zhao

Huang

Ding

et al. 2018

Magnetic Resonance Imaging

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Background: Bone marrow fat increases when bone mass decreases, which could be attributed to the fact that adipogenesis competes with osteogenesis. Bone marrow fat has the potential to predict abnormal bone density and osteoporosis. Purpose: To investigate the predictive value of using vertebral bone marrow fat fraction(BMFF) obtained from modified Dixon(mDixon) Quant in the determination of abnormal bone density and osteoporosis. Study type: Prospective. Population: 257 subjects (age: 20-79 years old; BMI: 16.6-32.9 kg/m 2 ;181 females,76 males) without known spinal tumor, history of trauma, dysplasia, spinal surgery or hormone therapy. Field strength/sequence: 3.0T/mDixon. Assessment: BMFF was measured at the L1, L2 and L3 vertebral body on fat fraction maps of the lumbar spine. Bone mineral density (BMD) was obtained using quantitative computed tomography, which served as the reference standard. Statistical tests: The BMFF between the three groups (normal bone density, osteopenia and osteoporosis) was tested using one-way analysis of variance in SPSS. The correlation and partial correlation of BMFF and BMD were analyzed before and after controlling for age, sex and BMI. Logistic regression analysis using independent training and validation data was conducted to evaluate the performance of predicting abnormal BMD or osteoporosis using BMFF. Results: There was a significant difference in vertebral BMFF between the three groups (P < 0.001). Moderate inverse correlation was found between vertebral BMFF and BMD after controlling age, sex and BMI (r = -0.529; P < 0.001). The mean area under the curve, sensitivity, specificity and negative predictive value (NPV) for predicting abnormal bone density were 0.940, 0.877, 0.896, and 0.890, respectively. The corresponding results for predicting subjects with osteoporosis were 0.896, 0.848, 0.853, and 0.969, respectively. Data conclusion: mDixon Quant is a fast, simple, noninvasive and nonionizing method to access vertebral BMFF and has a high predictive power for identifying abnormal bone density and osteoporosis. Level of Evidence: 1 Technical Efficacy: Stage 2

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“…MRI adds significant specificity in the diagnosis of these patients. It may even be possible to differentiate osteoporotic and malignant compression fractures with modern MRI applications [21,22]. Computerized tomography is also a valuable imaging tool to detect musculoskeletal diagnoses of abdominal pain, but it is seldom available in outpatient clinics in our country.…”

Section: Discussionmentioning

confidence: 99%

Diagnostic Potential of Magnetic Resonance Imaging in Chronic Abdominal Pain

et al. 2019

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Introduction: About half of the adult patients suffering from chronic abdominal pain may have no organ-related cause. Our purpose was to evaluate the additional information of magnetic resonance imaging (MRI) in diagnosing the underlying organic causes of such pain. Methods: We performed retrospective audit of 636 consecutive abdominal MRI in patients suffering from nonspecific abdominal pain (NSAP) during years 2014-2017. Medical history, clinical examination, endoscopy reports, and the results of MRI were compared in all patients. The hypothesis was that MRI increases markedly the diagnostic specificity of patients' symptoms. Results: The mean age of patients was 66 ± 14 years and 60 percent were females. Duration of abdominal pain ranged from 1 month to 30 years (median 1.1 ± 4.0 years). Concurrently with abdominal MRI (n = 636), also ultrasound (n = 106, 17%), colonoscopy (n = 222, 35%), and gastroscopy (n = 217, 34%) were performed. Abdominal MRI revealed additional information in 161/636 (25%) of NSAP patients. Spinal and pelvic bone abnormalities (n = 107) and malignant tumors (n = 31) were the most significant organ-specific findings changing the treatment algorithm. Conclusions: When computerized tomography is not available in outpatient clinics, abdominal MRI increases markedly diagnostic specificity and alters the treatment in 1 of 4 patients suffering from NSAP. Abdominal MRI is therefore suggested for patients suffering from severe symptoms of NSAP.

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Differentiation of Acute Osteoporotic and Malignant Vertebral Fractures by Quantification of Fat Fraction With a Dixon MRI Sequence

Abstract: FF and FF ratio obtained from FF maps obtained with a six-echo Dixon MRI sequence may be useful for differentiating acute osteoporotic compression fractures from malignant compression fractures.

Cited by 37 publications

References 26 publications

Differential diagnostic value of <sup>18</sup>F-FDG PET/CT for benign and malignant vertebral compression fractures: comparison with magnetic resonance imaging

Differential diagnostic value of <sup>18</sup>F-FDG PET/CT for benign and malignant vertebral compression fractures: comparison with magnetic resonance imaging

Prediction of Abnormal Bone Density and Osteoporosis From Lumbar Spine MR Using Modified Dixon Quant in 257 Subjects With Quantitative Computed Tomography as Reference

Diagnostic Potential of Magnetic Resonance Imaging in Chronic Abdominal Pain

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