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Proton density fat fraction (PDFF) MRI for differentiation of benign and malignant vertebral lesions

European Radiology volume 28, pages 2397–2405 (2018)Cite this article

A Magnetic Resonance to this article was published on 13 April 2018

Abstract

Objectives

To investigate whether proton density fat fraction (PDFF) measurements using a six-echo modified Dixon sequence can help to differentiate between benign and malignant vertebral bone marrow lesions.

Methods

Sixty-six patients were prospectively enrolled in our study. In addition to conventional MRI at 3.0-Tesla including at least sagittal T2-weighted/spectral attenuated inversion recovery and T1-weighted sequences, all patients underwent a sagittal six-echo modified Dixon sequence of the spine. The mean PDFF was calculated using regions of interest and compared between vertebral lesions. A cut-off value of 6.40% in PDFF was determined by receiver operating characteristic curves and used to differentiate between malignant (< 6.40%) and benign (≥ 6.40%) vertebral lesions.

Results

There were 77 benign and 44 malignant lesions. The PDFF of malignant lesions was statistically significant lower in comparison with benign lesions (p < 0.001) and normal vertebral bone marrow (p < 0.001). The areas under the curves (AUC) were 0.97 for differentiating benign from malignant lesions (p < 0.001) and 0.95 for differentiating acute vertebral fractures from malignant lesions (p < 0.001). This yielded a diagnostic accuracy of 96% in the differentiation of both benign lesions and acute vertebral fractures from malignancy.

Conclusion

PDFF derived from six-echo modified Dixon allows for differentiation between benign and malignant vertebral lesions with a high diagnostic accuracy.

Key Points

• Establishing a diagnosis of indeterminate vertebral lesions is a common clinical problem

• Benign bone marrow processes may mimic the signal alterations observed in malignancy

• PDFF differentiates between benign and malignant lesions with a high diagnostic accuracy

• PDFF of non-neoplastic vertebral lesions is significantly higher than that of malignancy

• PDFF from six-echo modified Dixon may help avoid potentially harmful bone biopsy

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Abbreviations

AUC:

Area Under the Curve

DWI:

Diffusion-Weighted Imaging

mDixon:

Modified Dixon

6E-mDixon:

Six-Echo Modified Dixon

NPV:

Negative Predictive Value

PDFF:

Proton Density Fat Fraction

PET/CT:

Positron Emission Tomography/Computed Tomography

PPV:

Positive Predictive Value

ROC:

Receiver Operating Characteristic

ROI:

Region Of Interest

SE:

Spin Echo

SENSE:

Sensitivity Encoding

SPAIR:

Spectral Attenuated Inversion Recovery

STIR:

Short-Tau Inversion Recovery

TE:

Echo Time

TR:

Repetition Time

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Funding

The authors state that this work has not received any funding.

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Authors and Affiliations

  1. Department of Radiology and Radiation Oncology, University Hospital Bonn, Rheinische-Friedrich-Wilhelms-Universität Bonn, Sigmund-Freud-Straße 25, 53127, Bonn, Germany

    Frederic Carsten Schmeel, Julian Alexander Luetkens, Peter Johannes Wagenhäuser, Michael Meier-Schroers, Daniel Lloyd Kuetting, Andreas Feißt, Leonard Christopher Schmeel, Frank Träber, Hans Heinz Schild & Guido Matthias Kukuk

  2. Philips Healthcare, Best, The Netherlands

    Jürgen Gieseke

Authors
  1. Frederic Carsten Schmeel
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  2. Julian Alexander Luetkens
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  11. Guido Matthias Kukuk
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Corresponding author

Correspondence to Guido Matthias Kukuk.

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Guarantor

The scientific guarantor of this publication is Priv.-Doz. Dr. med. Guido Matthias Kukuk at Bonn University Hospital.

Conflict of interest

The authors of this manuscript declare relationships with the following companies: Dr. Jürgen Gieseke is an employee of Philips Healthcare (Best, The Netherlands) but had no control of inclusion of any data or data analysis. The other authors of this manuscript declare no relationships with any companies whose products or services may be related to the subject matter of the article.

Statistics and biometry

No complex statistical methods were necessary for this paper.

Informed consent

Written informed consent was obtained from all patients in this study.

Ethical approval

Institutional review board approval was obtained.

Methodology

• prospective

• diagnostic or prognostic study

• performed at one institution

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Schmeel, F.C., Luetkens, J.A., Wagenhäuser, P.J. et al. Proton density fat fraction (PDFF) MRI for differentiation of benign and malignant vertebral lesions. Eur Radiol 28, 2397–2405 (2018). https://doi.org/10.1007/s00330-017-5241-x

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