title: Chemical shift imaging: preliminary experience as an alternative sequence for defining the extent of a bone tumor.
abstract: OBJECTIVE
  To investigate chemical shift imaging (CSI) with in-phase and opposed-phase (OP) gradient-echo sequences as an alternative sequence to spin-echo T1 imaging for defining intra-medullary skeletal tumor extent.
  
  
  METHODS
  This retrospective HIPAA-compliant study was approved by our institutional institutional review board (IRB). Twenty-three subjects with histologically-proven tumors (17 appendicular, 6 axial) underwent magnetic resonance imaging (MRI) with T1-weighted spin echo (T1SE), fluid-sensitive, CSI, and contrast-enhanced T1 sequences. One observer recorded intra-medullary tumor extent (millimeters), with 153 total measurements on each sequence. Red marrow grade [0 (none), 1 (<50%), 2 (50-75%) and 3 (>75%)] in each bone was recorded. Tumor extent on different sequences was compared (Student's t-test); the impact of red marrow grade on measurements was assessed (Spearman's correlation coefficient).
  
  
  RESULTS
  There was good agreement between measurements of tumor extent on T1SE and CSI sequences in all cases (T1SE-CSI measurement difference range 0-13.2 mm, P>0.05). Measurements from other sequences were significantly different from those of T1SE (P<0.05). As red marrow grade in the bone increased, a significant increase in measurement difference obtained on T1SE and CSI sequences was observed (P<0.001).
  
  
  CONCLUSIONS
  CSI is a potential alternative technique to T1SE imaging for defining the intra-medullary extent of a bone tumor, possibly especially useful in regions with abundant red marrow.
  
  
  CONCLUSIONS
  CSI could be an alternative technique to T1SE imaging for defining the intra-medullary extent of bone tumor by abundant red marrow in the surrounding bone.
authors.affiliation: 1 The Russell H. Morgan Department of Radiology and Radiological Science, The Johns Hopkins Medical Institutions, 601 North Wolfe Street, Baltimore, MD 21287, USA ; 2 Ospedale Regionale di Lugano, Via Tesserete, 6900 Lugano, Ti Switzerland.
authors.forename: Filippo
authors.initials: F
authors.lastname: Del Grande
authors.affiliation: 1 The Russell H. Morgan Department of Radiology and Radiological Science, The Johns Hopkins Medical Institutions, 601 North Wolfe Street, Baltimore, MD 21287, USA ; 2 Ospedale Regionale di Lugano, Via Tesserete, 6900 Lugano, Ti Switzerland.
authors.forename: Ney
authors.initials: N
authors.lastname: Tatizawa-Shiga
authors.affiliation: 1 The Russell H. Morgan Department of Radiology and Radiological Science, The Johns Hopkins Medical Institutions, 601 North Wolfe Street, Baltimore, MD 21287, USA ; 2 Ospedale Regionale di Lugano, Via Tesserete, 6900 Lugano, Ti Switzerland.
authors.forename: Sahar
authors.initials: S
authors.lastname: Jalali Farahani
authors.affiliation: 1 The Russell H. Morgan Department of Radiology and Radiological Science, The Johns Hopkins Medical Institutions, 601 North Wolfe Street, Baltimore, MD 21287, USA ; 2 Ospedale Regionale di Lugano, Via Tesserete, 6900 Lugano, Ti Switzerland.
authors.forename: Majid
authors.initials: M
authors.lastname: Chalian
authors.affiliation: 1 The Russell H. Morgan Department of Radiology and Radiological Science, The Johns Hopkins Medical Institutions, 601 North Wolfe Street, Baltimore, MD 21287, USA ; 2 Ospedale Regionale di Lugano, Via Tesserete, 6900 Lugano, Ti Switzerland.
authors.forename: Laura Marie
authors.initials: LM
authors.lastname: Fayad
keywords: Bone marrow lesion; chemical shift imaging (CSI); magnetic resonance imaging (MRI); red bone marrow