Department of Radiology and Radiation Oncology, University Hospital Bonn, Rheinische-Friedrich-Wilhelms-Universität Bonn, Sigmund-Freud-Straße 25, 53127, Bonn, Germany.
Eur Radiol. 2018 Dec;28(12):5001-5009. doi: 10.1007/s00330-018-5513-0. Epub 2018 Jun 1.
To evaluate the diagnostic performance of proton density fat fraction (PDFF) magnetic resonance imaging (MRI) to differentiate between acute benign and neoplastic vertebral compression fractures (VCFs).
Fifty-seven consecutive patients with 46 acute benign and 41 malignant VCFs were prospectively enrolled in this institutional review board approved study and underwent routine clinical MRI with an additional six-echo modified Dixon sequence of the spine at a clinical 3.0-T scanner. All fractures were categorised as benign or malignant according to either direct bone biopsy or 6-month follow-up MRI. Intravertebral PDFF and PDFF (fracture PDFF/normal vertebrae PDFF) for benign and malignant VCFs were calculated using region-of-interest analysis and compared between both groups. Additional receiver operating characteristic and binary logistic regression analyses were performed.
Both PDFF and PDFF of malignant VCFs were significantly lower compared to acute benign VCFs [PDFF, 3.48 ± 3.30% vs 23.99 ± 11.86% (p < 0.001); PDFF, 0.09 ± 0.09 vs 0.49 ± 0.24 (p < 0.001)]. The areas under the curve were 0.98 for PDFF and 0.97 for PDFF, yielding an accuracy of 96% and 95% for differentiating between acute benign and malignant VCFs. PDFF remained as the only imaging-based variable to independently differentiate between acute benign and malignant VCFs on multivariate analysis (odds ratio, 0.454; p = 0.005).
Quantitative assessment of PDFF derived from modified Dixon water-fat MRI has high diagnostic accuracy for the differentiation of acute benign and malignant vertebral compression fractures.
• Chemical-shift-encoding based water-fat MRI can reliably assess vertebral bone marrow PDFF • PDFF is significantly higher in acute benign than in malignant VCFs • PDFF provides high accuracy for differentiating acute benign from malignant VCFs.
评估质子密度脂肪分数（PDFF）磁共振成像（MRI）在鉴别急性良性和恶性椎体压缩性骨折（VCF）中的诊断性能。
本研究为机构审查委员会批准的前瞻性研究，共纳入 57 例连续患者，其中 46 例为急性良性 VCF，41 例为恶性 VCF，均在临床 3.0T 扫描仪上接受常规临床 MRI 检查，外加 6 回波改良 Dixon 脊柱序列。所有骨折均根据直接骨活检或 6 个月的 MRI 随访进行良性或恶性分类。使用感兴趣区分析计算良性和恶性 VCF 的椎体内 PDFF 和 PDFF（骨折 PDFF/正常椎体 PDFF），并比较两组之间的差异。另外还进行了接收者操作特征和二元逻辑回归分析。
与急性良性 VCF 相比，恶性 VCF 的 PDFF 和 PDFF 均显著降低[PDFF，3.48 ± 3.30%比 23.99 ± 11.86%（p < 0.001）；PDFF，0.09 ± 0.09 比 0.49 ± 0.24（p < 0.001）]。PDFF 和 PDFF 的曲线下面积分别为 0.98 和 0.97，区分急性良性和恶性 VCF 的准确率分别为 96%和 95%。多变量分析显示，PDFF 仍然是唯一可独立区分急性良性和恶性 VCF 的影像学变量（优势比，0.454；p = 0.005）。
基于改良 Dixon 水脂 MRI 的 PDFF 定量评估对急性良性和恶性椎体压缩性骨折的鉴别具有很高的诊断准确性。
化学位移编码水脂 MRI 可可靠评估椎体骨髓 PDFF
急性良性 VCF 的 PDFF 明显高于恶性 VCF
PDFF 对区分急性良性和恶性 VCF 具有很高的准确性
