Department of Radiology and Radiation Oncology, University Hospital Bonn, Rheinische-Friedrich-Wilhelms-Universität Bonn, Sigmund-Freud-Straße 25, 53127, Bonn, Germany.
Philips Healthcare, Best, The Netherlands.
Eur Radiol. 2018 Jun;28(6):2397-2405. doi: 10.1007/s00330-017-5241-x. Epub 2018 Jan 8.
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.
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.
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.
PDFF derived from six-echo modified Dixon allows for differentiation between benign and malignant vertebral lesions with a high diagnostic accuracy.
• 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.
探究使用六回波改良 Dixon 序列测量质子密度脂肪分数（PDFF）是否有助于鉴别良性和恶性椎体骨髓病变。
本研究前瞻性纳入 66 例患者。除了在 3.0T 磁共振成像上进行常规检查，包括矢状位 T2 加权/频谱衰减反转恢复和 T1 加权序列外，所有患者均接受了脊柱矢状位六回波改良 Dixon 序列检查。使用感兴趣区域计算平均 PDFF，并对椎体病变进行比较。通过受试者工作特征曲线确定 PDFF 的截断值为 6.40%，并用于区分恶性（<6.40%）和良性（≥6.40%）椎体病变。
良性病变 77 个，恶性病变 44 个。与良性病变（p<0.001）和正常椎体骨髓（p<0.001）相比，恶性病变的 PDFF 有统计学意义上的降低。良性与恶性病变鉴别、急性椎体骨折与恶性病变鉴别的曲线下面积（AUC）分别为 0.97（p<0.001）和 0.95（p<0.001）。因此，良性病变和急性椎体骨折与恶性病变的鉴别准确率为 96%。
六回波改良 Dixon 衍生的 PDFF 可用于鉴别良性和恶性椎体病变，具有较高的诊断准确性。
明确诊断不确定的椎体病变是临床常见问题。
良性骨髓病变可能与恶性病变的信号改变相似。
PDFF 可准确区分良性和恶性病变。
非肿瘤性椎体病变的 PDFF 显著高于恶性病变。
六回波改良 Dixon 的 PDFF 有助于避免潜在的有害骨活检。
