title: Chemical shift MRI can aid in the diagnosis of indeterminate skeletal lesions of the spine.
abstract: OBJECTIVE
  To evaluate the role of chemical shift MRI in the characterisation of indeterminate skeletal lesions of the spine as benign or malignant.
  
  
  METHODS
  Fifty-five patients (mean age 54.7 years) with 57 indeterminate skeletal lesions of the spine were included in this retrospective study. In addition to conventional MRI at 3 T which included at least sagittal T1WI and T2WI/STIR sequences, patients underwent chemical shift MRI. A cut-off value with a signal drop-out of 20 % was used to differentiate benign lesions from malignant lesions (signal drop-out <20 % being malignant).
  
  
  RESULTS
  There were 45 benign lesions and 12 malignant lesions. Chemical shift imaging correctly diagnosed 33 of 45 lesions as benign and 11 of 12 lesions as malignant. In contrast, there were 12 false positive cases and 1 false negative case based on chemical shift MRI. This yielded a sensitivity of 91.7 %, a specificity of 73.3 %, a negative predictive value of 97.1 %, a positive predictive value of 47.8 % and a diagnostic accuracy of 82.5 %.
  
  
  CONCLUSIONS
  Chemical shift MRI can aid in the characterisation of indeterminate skeletal lesions of the spine in view of its high sensitivity in diagnosing malignant lesions. Chemical shift MRI can potentially avoid biopsy in a considerable percentage of patients with benign skeletal lesions of the spine.
  
  
  CONCLUSIONS
  • Differentiating benign from malignant skeletal lesions of the spine can be challenging. • Utility of chemical shift MRI in characterising indeterminate spinal lesion is unreported. • This study demonstrates sensitivity 91.7 %, specificity 73.3 %, diagnostic accuracy 82.5 % for CSI. • CSI is useful in differentiating benign from malignant skeletal spine lesions. • Biopsy can potentially be avoided in some patients with benign skeletal lesions.
authors.affiliation: Department of Radiology, University Hospital Birmingham, Birmingham, B15 2TH, UK. h.douis@nhs.net.|Department of Radiology, Royal Orthopaedic Hospital, Birmingham, UK. h.douis@nhs.net.
authors.forename: H
authors.initials: H
authors.lastname: Douis
authors.affiliation: Department of Radiology, Royal Orthopaedic Hospital, Birmingham, UK.
authors.forename: A M
authors.initials: AM
authors.lastname: Davies
authors.affiliation: Department of Orthopaedic Oncology, Royal Orthopaedic Hospital, Birmingham, UK.
authors.forename: L
authors.initials: L
authors.lastname: Jeys
authors.affiliation: Department of Spinal Surgery and Spinal Oncology, Royal Orthopaedic Hospital, Birmingham, UK.
authors.forename: P
authors.initials: P
authors.lastname: Sian
mesh_terms: D001707:Biopsy, Needle; D003937:Diagnosis, Differential; D005260:Female; D006801:Humans; D008279:Magnetic Resonance Imaging / Q000379:methods*; D008297:Male; D008875:Middle Aged; D012372:ROC Curve; D012189:Retrospective Studies; D012680:Sensitivity and Specificity; D013125:Spinal Neoplasms / Q000175:diagnosis*
keywords: Benign; Chemical shift MRI; Malignant; Skeletal lesion; Spine