Differentiation of normal and neoplastic bone tissue in dynamic gadolinium-enhanced magnetic resonance imaging: validation of a semiautomated technique

Differenziazione di tessuto osseo normale e neoplastico in RM dinamica con software di analisi semiautomatico

Abstract

Purpose

This study was undertaken to clinically validate the accuracy of a semiautomated software tool for analysing the enhancement curve in focal malignant bone lesions.

Materials and methods

Twenty-three patients affected by cancer with malignant focal bone lesions underwent dynamic gadolinium-enhanced magnetic resonance (MR) imaging using the following protocol: T1-weighted turbo spin-echo sequences (time to repeat [TR] 600 ms, time to echo [TE] 8.6 ms, field of view [FOV] 40×40 cm) before and after intravenous injection of gadolinium-containing contrast agent. Image postprocessing was performed using the software DyCoH. Each region of interest (5×5 pixels), drawn to include the area of the lesion with the highest values of the area under the curve map, was analysed to obtain time-intensity curves and relative perfusion parameters: time to peak (TTP), peak intensity (PI), slope (60-s slope), intensity at 60 s after contrast agent injection (60-s I) and final intensity (FI).

Results

Data were obtained by analysing 86 malignant lesions and 86 apparently normal bone regions. PI, 60-s slope, 60-s I and FI were significantly different between neoplastic and apparently normal (p<0.001) samples. Sensitivity, specificity and accuracy were, respectively, 94%, 93% and 94% at a PI threshold of 100 (signal-to-noise ratio), with positive and negative predictive values of 93% and 94%. At a threshold value of 0.85 for 60-s slope, sensitivity and specificity values were both 91%.

Conclusions

The semiautomated technique we report appears to be accurate for identifying neoplastic tissue and for mapping perfusion parameters, with the added value of a consistent measurement of perfusion parameters on colour-coded maps.

Riassunto

Obiettivo

Scopo del presente lavoro è stato valutare l’accuratezza di un software di analisi semiautomatica nell’analisi delle curve di potenziamento post-contrastografico delle lesioni ossee focali maligne.

Materiali e metodi

Ventitre pazienti oncologici con lesioni ossee focali maligne sono stati sottoposti ad esame di risonanza magnetica dinamica utilizzando sequenze turbo spin echo T1-pesate (tempo di ripetizione [TR] 600 ms, tempo di eco [TE] 8,6 ms, campo di vista [FOV] 40×40 cm) prima e dopo somministrazione endovenosa di mezzo di contrasto paramagnetico. L’analisi delle immagini è stata poi effettuata utilizzando il software DyCoH. Ciascuna regione di interesse (ROI, 5×5 pixel), posizionata nella zona della lesione che presentava i più alti valori di area sotto la curva (AUC) sulla mappa, è stata analizzata per ottenere le curve intensità/tempo ed i relativi parametri perfusionali: tempo di picco (TTP), intensità di picco (PI), pendenza (60”Slope) ed intensità (60”I) al primo minuto dopo la somministrazione di mezzo di contrasto, intensità finale (FI).

Risultati

I risultati sono stati ottenuti dall’analisi di 86 lesioni maligne ed 86 regioni di tessuto osseo apparentemente normale. I parametri PI, 60”Slope, 60”I e FI hanno mostrato valori con differenza statisticamente significativa tra lesioni neoplastiche e tessuto osseo apparentemente normale (p<0,001). La sensibilità, la specificità e l’accuratezza calcolate si sono mostrate rispettivamente del 94%, 93% e 94% ad un valore soglia di PI di 100 (signal to noise ratio, SNR), con valori predittivi positivi e negativi rispettivamente del 93% e 94%. Ad un valore soglia di 0,85 per il parametro 60”Slope, la sensibilità, la specificità, l’accuratezza ed i valori predittivi positivi e negativi erano del 91%.

Conclusioni

La tecnica di analisi semiautomatica utilizzata appare accurata nell’identificazione di tessuto neoplastico e nell’elaborazione di mappe parametriche perfusionali, con il valore aggiunto di una valida misura dei parametri perfusionali sulle mappe colorimetriche stesse.

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Correspondence to F. D’Agostino.

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D’Agostino, F., Dell’Aia, P., Quattrocchi, C. et al. Differentiation of normal and neoplastic bone tissue in dynamic gadolinium-enhanced magnetic resonance imaging: validation of a semiautomated technique. Radiol med 115, 804–814 (2010). https://doi.org/10.1007/s11547-010-0572-6

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Keywords

  • Contrast-enhanced magnetic resonance
  • Bone neoplastic lesion
  • Tumour perfusion

Parole chiave

  • Risonanza magnetica dinamica
  • Lesione ossea neoplastica
  • Perfusione del tessuto neoplastico