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Chemical shift imaging with in-phase and opposed-phase sequences at 3 T: what is the optimal threshold, measurement method, and diagnostic accuracy for characterizing marrow signal abnormalities?

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Skeletal Radiology Aims and scope Submit manuscript

Abstract

Objective

To determine the threshold signal drop on 3-T chemical shift imaging (CSI), with in-phase (IP) and opposed-phase (OP) sequences, for accurately identifying bone marrow replacement with 100% sensitivity, and determine a clinically useful measurement method for deriving such a threshold.

Materials and methods

From a convenience series of 157 MRIs, 36 cases with histologically proven marrow-replacing lesions and 22 sites of red marrow (histologically proven (2) or with minimum 6-month stability) with 3-Tesla CSI were included. Two musculoskeletal radiologists performed two measurement methods (first: multiple algorithmic ROIs at the top, middle, and bottom of lesions (M-ROI); second: an ROI was drawn where there appeared to be the least opposed-phase signal reduction qualitatively/visually (Q-ROI)). Lesional and red marrow signal change (%,[(IP-OP)signal/IP signal]*100) was determined. Statistical analyses included Student’s t test, Cohen’s kappa, and receiver operator characteristic curve generation.

Results

By M-ROI, lesion signal change was − 0.508% (confidence interval (CI) = − 5.537:4.521) and 1.348% (CI = − 3.541:6.311) for readers 1 and 2. By Q-ROI, lesion signal change was − 11.03% (CI = − 17.01:- 5.046) and − 5.657% (CI = − 12.36:1.048) for readers 1 and 2. For all M-ROI and Q-ROI measurement strategies, signal change between lesional tissue and red marrow was significantly different (p < 0.0001). QROI produced the best composite sensitivities and specificities with a maximized Youden index of 0.955–1. A threshold signal drop of 25% with Q-ROI produced at least 100%/86% sensitivity/specificity for both readers for identifying marrow replacement.

Conclusions

For 3-T CSI, a single visually targeted measurement using a 25% threshold is accurate for identifying marrow-replacing lesions.

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Authors and Affiliations

  1. Dakota Radiology, 2929 5th St #100, Rapid City, SD, 57701, USA

    Neil M. Kumar

  2. The Russell H. Morgan Department of Radiology & Radiological Science, The Johns Hopkins Medical Institutions, 600 North Wolfe Street, Baltimore, MD, 21287, USA

    Neil M. Kumar, Shivani Ahlawat & Laura M. Fayad

  3. Department of Orthopedic Surgery, The Johns Hopkins Medical Institutions, 601 North Caroline Street, Baltimore, MD, 21287, USA

    Laura M. Fayad

  4. Department of Oncology, The Johns Hopkins Medical Institutions, 601 North Caroline Street, Baltimore, MD, 21287, USA

    Laura M. Fayad

Authors
  1. Neil M. Kumar
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  2. Shivani Ahlawat
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  3. Laura M. Fayad
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Correspondence to Neil M. Kumar.

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Kumar, N.M., Ahlawat, S. & Fayad, L.M. Chemical shift imaging with in-phase and opposed-phase sequences at 3 T: what is the optimal threshold, measurement method, and diagnostic accuracy for characterizing marrow signal abnormalities?. Skeletal Radiol 47, 1661–1671 (2018). https://doi.org/10.1007/s00256-018-2999-0

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  • DOI: https://doi.org/10.1007/s00256-018-2999-0

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