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01-06-2018 | Magnetic Resonance

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

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

Published in: European Radiology | Issue 6/2018

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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Title: Proton density fat fraction (PDFF) MRI for differentiation of benign and malignant vertebral lesions
Authors: Frederic Carsten Schmeel
Julian Alexander Luetkens
Peter Johannes Wagenhäuser
Michael Meier-Schroers
Daniel Lloyd Kuetting
Andreas Feißt
Jürgen Gieseke
Leonard Christopher Schmeel
Frank Träber
Hans Heinz Schild
Guido Matthias Kukuk
Publication date: 01-06-2018
Publisher: Springer Berlin Heidelberg
Published in: European Radiology / Issue 6/2018
Print ISSN: 0938-7994
Electronic ISSN: 1432-1084
DOI: https://doi.org/10.1007/s00330-017-5241-x

Keynote webinar | Spotlight on medication adherence

Springer Medicine

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

Abstract

Objectives

Methods

Results

Conclusion

Key Points

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Abstract

Objectives

Methods

Results

Conclusion

Key Points

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