title: Differentiation between focal malignant marrow-replacing lesions and benign red marrow deposition of the spine with T2*-corrected fat-signal fraction map using a three-echo volume interpolated breath-hold gradient echo Dixon sequence.
abstract: OBJECTIVE
  To assess the feasibility of T2*-corrected fat-signal fraction (FF) map by using the three-echo volume interpolated breath-hold gradient echo (VIBE) Dixon sequence to differentiate between malignant marrow-replacing lesions and benign red marrow deposition of vertebrae.
  
  
  METHODS
  We assessed 32 lesions from 32 patients who underwent magnetic resonance imaging after being referred for assessment of a known or possible vertebral marrow abnormality. The lesions were divided into 21 malignant marrow-replacing lesions and 11 benign red marrow depositions. Three sequences for the parameter measurements were obtained by using a 1.5-T MR imaging scanner as follows: three-echo VIBE Dixon sequence for FF; conventional T1-weighted imaging for the lesion-disc ratio (LDR); pre- and post-gadolinium enhanced fat-suppressed T1-weighted images for the contrast-enhancement ratio (CER). A region of interest was drawn for each lesion for parameter measurements. The areas under the curve (AUC) of the parameters and their sensitivities and specificities at the most ideal cutoff values from receiver operating characteristic curve analysis were obtained. AUC, sensitivity, and specificity were respectively compared between FF and CER.
  
  
  RESULTS
  The AUCs of FF, LDR, and CER were 0.96, 0.80, and 0.72, respectively. In the comparison of diagnostic performance between the FF and CER, the FF showed a significantly larger AUC as compared to the CER (p = 0.030), although the difference of sensitivity (p = 0.157) and specificity (p = 0.157) were not significant.
  
  
  CONCLUSIONS
  Fat-signal fraction measurement using T2*-corrected three-echo VIBE Dixon sequence is feasible and has a more accurate diagnostic performance, than the CER, in distinguishing benign red marrow deposition from malignant bone marrow-replacing lesions.
authors.affiliation: Department of Radiology, Gangnam Severance Hospital, Yonsei University College of Medicine, Seoul 135-720, Korea.
authors.forename: Yong Pyo
authors.initials: YP
authors.lastname: Kim
authors.affiliation: MR Applications Development, Siemens AG, Healthcare Sector, Erlangen D-91052, Germany, Korea.
authors.forename: Stephan
authors.initials: S
authors.lastname: Kannengiesser
authors.affiliation: Siemens Ltd., Seoul 120-837, Korea.
authors.forename: Mun-Young
authors.initials: MY
authors.lastname: Paek
authors.affiliation: Department of Radiology, Gangnam Severance Hospital, Yonsei University College of Medicine, Seoul 135-720, Korea.
authors.forename: Sungjun
authors.initials: S
authors.lastname: Kim
authors.affiliation: Department of Radiology, Gangnam Severance Hospital, Yonsei University College of Medicine, Seoul 135-720, Korea.
authors.forename: Tae-Sub
authors.initials: TS
authors.lastname: Chung
authors.affiliation: Department of Radiology, Gangnam Severance Hospital, Yonsei University College of Medicine, Seoul 135-720, Korea.
authors.forename: Yeon Hwa
authors.initials: YH
authors.lastname: Yoo
authors.affiliation: Department of Radiology, Gangnam Severance Hospital, Yonsei University College of Medicine, Seoul 135-720, Korea.
authors.forename: Choon-Sik
authors.initials: CS
authors.lastname: Yoon
authors.affiliation: Department of Radiology, Severance Hospital, Yonsei University College of Medicine, Seoul 120-752, Korea.
authors.forename: Ho-Taek
authors.initials: HT
authors.lastname: Song
authors.affiliation: Department of Radiology, Severance Hospital, Yonsei University College of Medicine, Seoul 120-752, Korea.
authors.forename: Young Han
authors.initials: YH
authors.lastname: Lee
authors.affiliation: Department of Radiology, Severance Hospital, Yonsei University College of Medicine, Seoul 120-752, Korea.
authors.forename: Jin-Suck
authors.initials: JS
authors.lastname: Suh
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D019540:Area Under Curve; D001854:Bone Marrow Cells / Q000166:cytology; D016026:Bone Marrow Transplantation; D003287:Contrast Media; D003937:Diagnosis, Differential; D005260:Female; D006801:Humans; D008279:Magnetic Resonance Imaging; D008297:Male; D008875:Middle Aged; D012372:ROC Curve; D011859:Radiography; D012680:Sensitivity and Specificity; D059629:Signal-To-Noise Ratio; D013122:Spinal Diseases / Q000175:diagnosis / Q000000981:diagnostic imaging*
chemical_list: D003287:Contrast Media
keywords: Bone marrow; Fat signal fraction; Magnetic resonance imaging; Spine