Department of Radiology, Ajou University School of Medicine, Suwon, South Korea; Musculoskeletal Imaging Laboratory, Ajou University Medical Center, Suwon, South Korea.
Department of Orthopaedic Surgery, Ajou University School of Medicine, Suwon, South Korea.
Clin Radiol. 2020 Feb;75(2):123-130. doi: 10.1016/j.crad.2019.09.141. Epub 2019 Oct 31.
To investigate the diagnostic performance of proton density fat fraction (PDFF) and simultaneous R2* for focal vertebral bone marrow lesion (VBML) assessment, compared with the apparent diffusion coefficient (ADC).
One hundred and ninety-two spinal magnetic resonance imaging (MRI) examinations performed in 126 patients with focal VBMLs from March 2016 to November 2018 were reviewed retrospectively. The lesions were divided into metastases and benign VBMLs. The protocol consisted of routine morphological MRI sequences, followed by complex-based chemical shift imaging (CSE)-MRI and diffusion-weighted (DW)-MRI with a 1.5 T system. PDFF, R2*, and the ADC values were compared using the Mann-Whitney U-test. Receiver operating characteristic curve analysis was carried out to assess the diagnostic performance for differentiating metastases from focal benign VBMLs.
PDFF, R2*, and mean ADC values in metastases were significantly lower than those in benign VBMLs (p<0.05). The PDFF (area under the curve [AUC]= 0.968; 95% confidence interval [CI]=0.932-0.988) showed a significantly larger AUC compared with R2* (AUC=0.670; 95% CI=0.599-0.736) and ADC (AUC=0.801; 95% CI=0.738-0.855). The optimal cut-off value of the PDFF for predicting metastases was 9%; this threshold corresponded to a sensitivity of 96.67%, specificity of 90.28%, and accuracy of 94.27%.
PDFF is significantly more accurate than ADC and R2* for differentiating focal benign VMBLs from metastases.
探讨质子密度脂肪分数（PDFF）和同时 R2* 对局灶性椎体骨髓病变（VBML）的诊断性能，与表观扩散系数（ADC）相比。
回顾性分析 2016 年 3 月至 2018 年 11 月期间 126 例局灶性 VBML 患者的 192 次脊柱磁共振成像（MRI）检查。病变分为转移瘤和良性 VBML。方案包括常规形态学 MRI 序列，然后是基于相控阵的化学位移成像（CSE）-MRI 和扩散加权（DW）-MRI，使用 1.5T 系统。采用 Mann-Whitney U 检验比较 PDFF、R2*和 ADC 值。进行受试者工作特征曲线分析，以评估区分转移瘤和局灶性良性 VBML 的诊断性能。
转移瘤的 PDFF、R2和平均 ADC 值明显低于良性 VBML（p<0.05）。PDFF（曲线下面积[AUC]=0.968；95%置信区间[CI]=0.932-0.988）的 AUC 明显大于 R2（AUC=0.670；95%CI=0.599-0.736）和 ADC（AUC=0.801；95%CI=0.738-0.855）。PDFF 预测转移瘤的最佳截断值为 9%；该阈值的敏感性为 96.67%，特异性为 90.28%，准确性为 94.27%。
PDFF 对区分局灶性良性 VMBL 和转移瘤明显优于 ADC 和 R2*。
