Measurement of fat content in vertebral marrow using a modified dixon sequence to differentiate benign from malignant processes.
To determine whether fat-signal-fraction (FF) map using a modified Dixon sequence could help differentiate benign from malignant bone lesions.



Spine magnetic resonance images (MRIs) of 120 consecutive patients were studied by using a 3T MRI with standard T1-weighted image (T1WI) and modified-Dixon sequence for FF measurement. There were three groups: a control group (n = 51) with normal vertebrae; a benign group (n = 40) with focal red marrow deposition, Schmorl's nodes, benign compression fracture, or Modic type 1 endplate degeneration; a malignant group (n = 29) with spinal malignancies. The following three parameters were measured on T1WI and FF map by two radiologists independently: T1signal intensity (SI), FF and T1 SI of normal disc (SI). Then, Lesion-to-disc ratio (LDR = SI of the lesion/SId) and FF ratio of lesion and normal marrow were calculated. The mean values of the parameters were compared among the groups and Receiver Operating Characteristic (ROC) curves were analyzed. Then a logistic regression was performed.



The FF (2.8%) and FF ratio (0.082) of malignancy were lower than benign lesions (P < 0.001). There was no difference in the LDR between malignancy and Schmorl's nodes (P = 0.795) or a benign compression fracture (P = 0.866). The areas under the ROC curves of FF and FF ratio were 93% and 87%, respectively, which were higher than those of the other parameters used for differentiation (P < 0.001). In logistic regression analyses, FF remained a significant variable that could be used to independently differentiate benign from malignant lesions, with an odds ratio of 1.9 (P < 0.001).



The FF and FF ratio obtained from FF maps using modified-Dixon sequence could be used to distinguish between benign and malignant causes of focal bone marrow abnormalities when difficulty in the qualitative interpretation of conventional MR images arises.



3 J. MAGN. RESON. IMAGING 2017;45:1534-1544.
Department of Radiology, Seoul National University Hospital, Seoul, Korea.|Department of Radiology, Seoul National University College of Medicine, Seoul, Korea.
Hye Jin
HJ
Yoo
Department of Radiology, Seoul National University Hospital, Seoul, Korea.|Department of Radiology, Seoul National University College of Medicine, Seoul, Korea.|Institute of Radiation Medicine, Seoul National University Medical Research Center, Seoul, Korea.
Sung Hwan
SH
Hong
Department of Radiology, Seoul National University Hospital, Seoul, Korea.
Dong Hyun
DH
Kim
Department of Radiology, Seoul National University Hospital, Seoul, Korea.|Department of Radiology, Seoul National University College of Medicine, Seoul, Korea.
Ja-Young
JY
Choi
Department of Radiology, Seoul National University Hospital, Seoul, Korea.|Department of Radiology, Seoul National University College of Medicine, Seoul, Korea.
Hee Dong
HD
Chae
Department of Radiology, Seoul National University Hospital, Seoul, Korea.
Bo Mi
BM
Jeong
Department of Radiology, Seoul National University College of Medicine, Seoul, Korea.|Department of Radiology, Seoul National University Bundang Hospital, Gyeongi-Do, Korea.
Joong Mo
JM
Ahn
Department of Radiology, Seoul National University College of Medicine, Seoul, Korea.|Institute of Radiation Medicine, Seoul National University Medical Research Center, Seoul, Korea.|Department of Radiology, Seoul National University Bundang Hospital, Gyeongi-Do, Korea.
Heung Sik
HS
Kang
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D019540:Area Under Curve; D001853:Bone Marrow / Q000000981:diagnostic imaging* / Q000473:pathology; D005260:Female; D050815:Fractures, Compression / Q000000981:diagnostic imaging* / Q000473:pathology; D006801:Humans; D008159:Lumbar Vertebrae / Q000000981:diagnostic imaging* / Q000473:pathology; D008279:Magnetic Resonance Imaging / Q000379:methods*; D008297:Male; D008875:Middle Aged; D012372:ROC Curve; D012044:Regression Analysis; D012189:Retrospective Studies; D016103:Spinal Fractures / Q000000981:diagnostic imaging* / Q000473:pathology; D013131:Spine / Q000000981:diagnostic imaging* / Q000473:pathology; D055815:Young Adult
bone marrow malignancy; chemical shift encoded imaging; fat quantification; fat-signal fraction; modified Dixon method