Quantitative chemical-shift MR imaging cutoff value: Benign versus malignant vertebral compression – Initial experience

Zidan, Dalia Z.; Habib, Lobna Abdelmonem; Chalabi, Nevine A.

doi:10.1016/j.ejrnm.2014.05.016

Cited by 13 publications

(14 citation statements)

References 12 publications

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“…Statistically, we defined the optimal SI ratio cut off value for separating benign and malignant vertebral compression as 0.96 with a calculated sensitivity of 100%, and specificity of 86%. Our results were in concordance with a study conducted by Zidan et al that defined cut off value as 0.91 and very close to studies carried out by Erly et al and Ogura et al (11,12).…”

Section: Discussionsupporting

confidence: 94%

“…Whereas, no overlap was found in malignant ones. False positive results were defined as fatty infiltration due to previous radiotherapy or marrow fibrosis in other studies, but our patients did not have both conditions (11). False negative results were defined as sclerotic metastasis with evident susceptibility and possible fat containing metastasis are also rare (11,13).…”

Section: Discussionmentioning

confidence: 80%

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Benign Versus Malignant Vertebral Compression, Chemical Shift MR Imaging, Is It Useful?

Ovalı

Düzgün

Farasat³

et al. 2016

Iran J Radiol

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Objectives: The aim of this study was to evaluate the diagnostic accuracy of chemical shift imaging in vertebral compression. Patients and Methods: Forty-nine patients with vertebral compression with suspected malignancy or history of trauma were included in this study. MR imaging of the spine with standard conventional MR sequences and additional chemical shift imaging was done with 1.5 Tesla MR Unit. Regions of interest (ROI) were placed on the abnormal marrow of compressed vertebrae both on the opposed phase and on the matching in phase images and signal intensity (SI) ratio values (SI out-phase/SI-in phase) were calculated. Results: Forty-nine patients had 68 spine lesions, consisting of 49 benign and 19 malignant fractures. Student t test, receiver operating characteristic (ROC) analysis and interclass correlation test were used statistically. Mean SI ratio of benign vertebral compression (0. 68 ± 0.29, range 0.13-1.53) was significantly lower than malignant SI ratio values (1.06 ± 0.10, range 0.96-1.35). With student t-test, there was significant difference between benign compressions compared to malignant compressions (P < 0.001). Receiver operating characteristic (ROC) curve analysis was used to determine the optimal cut off value in malignant and benign lesion definition. The optimal SI ratio cut off value was found to be 0.96 for separating benign and malignant vertebral compression. The area under the curve (AUC) value was observed as 0.92 (95% confidence interval [CI] = 0.86-0.99). According to that cutoff value, sensitivity was 100% (95% CI = 82.35%-100%) and the specificity was 86% (95% CI = 72.76%-94.06%). Interobserver reliability was studied with intraclass correlation and results were statistically significant with intraclass correlation coefficient (ICC) as 0.85 (P < 0.05). Conclusions: There is significant difference in signal values between benign and malignant compression fractures in chemical shift MR imaging. Chemical shift MR imaging has much additive data to conventional MRI in vertebral compression.

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Section: Discussionsupporting

confidence: 94%

Section: Discussionmentioning

confidence: 80%

Benign Versus Malignant Vertebral Compression, Chemical Shift MR Imaging, Is It Useful?

Ovalı

Düzgün

Farasat³

et al. 2016

Iran J Radiol

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“…A previous study [33] showed that there was a significant difference (p < 0.001, Student's t-test) in the mean SIR for benign lesions (mean, 0.58; SD, 0.02) as compared to malignant lesions (mean, 0.98; SD, 0.095); if the SIR of 0.80 was chosen as a cut-off, with > 0.8 defined as malignant and < 0.8 defined as a benign result, in-phase/opposed-phase imaging correctly identified 19 of 20 malignant lesions and 26 of 29 benign lesions (sensitivity, 0.95; specificity, 0.89). Our results were in concordance with previous studies [32,34]. There were few limitations in our study.…”

Section: Discussionsupporting

confidence: 93%

“…In our study, an ADC cut-off value of 0.93 resulted in 88.9 % sensitivity, 95.5% specificity and 92.5% accuracy in the discrimination between benign and malignant vertebral marrow lesions. Though our cut-off was higher than that in previous studies, our results were in concordance with previous studies [29,31,32]. We also tried to find out the relationship between ADC of normal vertebral bodies and age.…”

Section: Discussionsupporting

confidence: 90%

Role of Diffusion-Weighted and Chemical Shift Magnetic Resonance Imaging in Differentiation of Benign and Malignant Spinal Fractures

et al. 2020

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Atraumatic spinal compression fractures are common clinical problem. Differentiating benign osteoporotic fractures from pathological fractures due to malignant/metastatic lesions affects the management and prognoses in patients with known extraspinal malignancy. The objective of the research was to assess the role of conventional magnetic resonance imaging sequences with diffusion-weighted imaging and chemical-shift imaging in differentiating benign and malignant acute spinal compression fractures. Materials and Methods. The study included 40 patients with acute spinal compression fractures. Patients were evaluated using magnetic resonance imaging with diffusion-weighted imaging and chemical-shift imaging to differentiate benign etiology from malignant one. The results obtained were compared with histopathological follow-up for 6 months for definite clinical diagnoses. Results. No significant difference was noted in signal characteristics of benign and malignant fractures on T1, T2 and short-tau inversion recovery. However, posterior element involvement, soft tissue component and post-contrast enhancement were seen more frequently in malignant fractures (p<0.05). On diffusion-weighted images, 77.8% of malignant fractures were hyperintense and 59.1% of benign fractures were hypointense (p<0.05). The mean apparent diffusion coefficient value was 0.81 ± 0.19 for malignant and 1.24 ± 0.24 for benign fractures (p<0.5). The mean signal intensity ratio for malignant fractures was 0.91 ± 0.125, whereas the signal intensity ratio for benign fractures was 0.64 ± 0.096 (p<0.001). Conclusions. Signal characteristics on T1, T2 and short-tau inversion recovery sequences do not differentiate benign from malignant fractures; however, posterior element involvement, soft tissue and post contrast enhancement help in differentiating the etiology. Diffusion-weighted imaging and apparent diffusion coefficient values, as well as using chemical shift imaging further improve the diagnostic accuracy of magnetic resonance imaging.

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“…Post contrast enhancement of compression fracture is highly suggestive of underlying malignant in ltrative process. However, Zhou et al and Dalia et al reported enhancement in 9 out 17 of benign fractures, which all showed a signal drop on the out of phase image compared to the in phase image, a benign SIR, and were proved benign on follow up of patients, and thus the authors concluded contrast enhancement is not speci c for differentiation between benign and malignant lesions (7,12 ) .…”

Section: Discussionmentioning

confidence: 96%

Phase Shift MRI in Assessement of Vertebral Compression Fracture: Trial for a New Scoring System

Matrawy

Fattah

ElNekidy

et al. 2020

Preprint

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PurposeTo assess the value of in /opposed-phase quantitative chemical shift MRI in differentiating malignant from benign vertebral compression fractures (VCF).Patients and methodsTwenty patients (8 men), mean age 56 years, with low back and radiological proof of VCF were included in the study. MRI of spine with standard conventional sequences and special chemical shift sequence (in/opposed phase) as well as diffusion weighted imaging were performed (at 1.5 Tesla). Quantitative image analysis of regions of interest (ROI) on the abnormal marrow in the compressed (study group) and related normal vertebra in same patient (control group) was done in each patient. The signal intensity ratio (SIR) of the marrow was determined by dividing the mean signal intensity on the opposed-phase and in-phase images was performed.ResultsMean SIR of benign VCF [0.6 ± 0.27 (range 0.23–1.1)] was significantly lower than malignant VCF values [1.115 ± 0.14 (range 0.87–1.45)] (p < 0.0001, ROC 0.97). The optimal SIR cutoff value for separating benign and malignant VCF was found to be 0.9 with a calculated sensitivity of 91.5%, specificity of 87.5% and accuracy of 90%. We also found a cut-off value of 0.9, to be a statistically significant in differentiating benign from malignant causes of VCF. If SIR of 0.91 as a cutoff is applied, with >0.91 indicating malignant result and <0.91 defined as a benign result.ConclusionQuantitative chemical shift MR imaging could be a valuable addition to standard MR imaging techniques in differentiating benign from malignant vertebral compression fracture. We designed a new scoring system based on conventional MRI, in/opposed phase chemical shift and diffusion weighted imaging. The new scoring system may be a useful tool and add value in the diagnosis of compression vertebral fractures.

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Quantitative chemical-shift MR imaging cutoff value: Benign versus malignant vertebral compression – Initial experience

Cited by 13 publications

References 12 publications

Benign Versus Malignant Vertebral Compression, Chemical Shift MR Imaging, Is It Useful?

Benign Versus Malignant Vertebral Compression, Chemical Shift MR Imaging, Is It Useful?

Role of Diffusion-Weighted and Chemical Shift Magnetic Resonance Imaging in Differentiation of Benign and Malignant Spinal Fractures

Phase Shift MRI in Assessement of Vertebral Compression Fracture: Trial for a New Scoring System

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Quantitative chemical-shift MR imaging cutoff value: Benign versus malignant vertebral compression – Initial experience

Cited by 13 publications

References 12 publications

Benign Versus Malignant Vertebral Compression, Chemical Shift MR Imaging, Is It Useful?

Benign Versus Malignant Vertebral Compression, Chemical Shift MR Imaging, Is It Useful?

Role of Diffusion-Weighted and Chemical Shift Magnetic Resonance Imaging in Differentiation of Benign and Malignant Spinal Fractures

Phase Shift MRI&nbsp;in Assessement of Vertebral Compression Fracture: Trial for a New Scoring System

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Phase Shift MRI in Assessement of Vertebral Compression Fracture: Trial for a New Scoring System