Skip to main content
Key Specialties
Cardiology Diabetology Endocrinology Gastroenterology Geriatrics and Gerontology Gynecology and Obstetrics Hematology Infectious Disease Internal Medicine Nephrology Neurology Oncology Pediatrics Respiratory Medicine Rheumatology Surgery
Congress Coverage
2024 ACC Congress 2023 ESMO Congress 2023 EASD Congress 2023 ERS Congress 2023 ESC Congress
Clinical Collections
Advances in Alzheimer’s

At a glance: The STEP trials

A round-up of the STEP phase 3 clinical trials evaluating semaglutide for weight loss in people with overweight or obesity.
ADVANCED SEARCH
Log in
Top
European Radiology
Published in: European Radiology 12/2018

01-12-2018 | Magnetic Resonance

Proton density fat fraction (PDFF) MR imaging for differentiation of acute benign and neoplastic compression fractures of the spine

Authors: Frederic Carsten Schmeel, Julian Alexander Luetkens, Simon Jonas Enkirch, Andreas Feißt, Christoph Hans-Jürgen Endler, Leonard Christopher Schmeel, Peter Johannes Wagenhäuser, Frank Träber, Hans Heinz Schild, Guido Matthias Kukuk

Published in: European Radiology | Issue 12/2018

Login to get access

Abstract

Objectives

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).

Methods

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 PDFFratio (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.

Results

Both PDFF and PDFFratio of malignant VCFs were significantly lower compared to acute benign VCFs [PDFF, 3.48 ± 3.30% vs 23.99 ± 11.86% (p < 0.001); PDFFratio, 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 PDFFratio, 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).

Conclusions

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.

Key Points

• 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
Literature
1.
Chapman J, Smith JS, Kopjar B et al (2013) The AOSpine North America Geriatric Odontoid Fracture Mortality Study: a retrospective review of mortality outcomes for operative versus nonoperative treatment of 322 patients with long-term follow-up. Spine (Phila Pa 1976) 38:1098–1104CrossRef
2.
Hansen EJ, Simony A, Carreon L, Andersen MO (2016) Rate of unsuspected malignancy in patients with vertebral compression fracture undergoing percutaneous vertebroplasty. Spine (Phila Pa 1976) 41:549–552CrossRef
3.
Jung HS, Jee WH, McCauley TR, Ha KY, Choi KH (2003) Discrimination of metastatic from acute osteoporotic compression spinal fractures with MR imaging. Radiographics 23:179–187CrossRef
4.
Link TM, Guglielmi G, van Kuijk C, Adams JE (2005) Radiologic assessment of osteoporotic vertebral fractures: diagnostic and prognostic implications. Eur Radiol 15:1521–1532CrossRef
5.
Geith T, Schmidt G, Biffar A et al (2012) Comparison of qualitative and quantitative evaluation of diffusion-weighted MRI and chemical-shift imaging in the differentiation of benign and malignant vertebral body fractures. AJR Am J Roentgenol 199:1083–1092CrossRef
6.
Disler DG, McCauley TR, Ratner LM, Kesack CD, Cooper JA (1997) In-phase and out-of-phase MR imaging of bone marrow: prediction of neoplasia based on the detection of coexistent fat and water. AJR Am J Roentgenol 169:1439–1447CrossRef
7.
Zajick DC Jr, Morrison WB, Schweitzer ME, Parellada JA, Carrino JA (2005) Benign and malignant processes: normal values and differentiation with chemical shift MR imaging in vertebral marrow. Radiology 237:590–596CrossRef
8.
Erly WK, Oh ES, Outwater EK (2006) The utility of in-phase/opposed-phase imaging in differentiating malignancy from acute benign compression fractures of the spine. AJNR Am J Neuroradiol 27:1183–1188PubMed
9.
Eito K, Waka S, Naoko N, Makoto A, Atsuko H (2004) Vertebral neoplastic compression fractures: assessment by dual-phase chemical shift imaging. J Magn Reson Imaging 20:1020–1024CrossRef
10.
Douis H, Davies AM, Jeys L, Sian P (2016) Chemical shift MRI can aid in the diagnosis of indeterminate skeletal lesions of the spine. Eur Radiol 26:932–940CrossRef
11.
Fischer MA, Nanz D, Shimakawa A et al (2013) Quantification of muscle fat in patients with low back pain: comparison of multi-echo MR imaging with single-voxel MR spectroscopy. Radiology 266:555–563CrossRef
12.
Ruschke S, Pokorney A, Baum T et al (2017) Measurement of vertebral bone marrow proton density fat fraction in children using quantitative water-fat MRI. MAGMA 30:449–460CrossRef
13.
Gee CS, Nguyen JT, Marquez CJ et al (2015) Validation of bone marrow fat quantification in the presence of trabecular bone using MRI. J Magn Reson Imaging 42:539–544CrossRef
14.
Karampinos DC, Melkus G, Baum T, Bauer JS, Rummeny EJ, Krug R (2014) Bone marrow fat quantification in the presence of trabecular bone: initial comparison between water-fat imaging and single-voxel MRS. Magn Reson Med 71:1158–1165CrossRef
15.
Latifoltojar A, Hall-Craggs M, Bainbridge A et al (2017) Whole-body MRI quantitative biomarkers are associated significantly with treatment response in patients with newly diagnosed symptomatic multiple myeloma following bortezomib induction. Eur Radiol 27:5325–5336CrossRef
16.
Baker LL, Goodman SB, Perkash I, Lane B, Enzmann DR (1990) Benign versus pathologic compression fractures of vertebral bodies: assessment with conventional spin-echo, chemical-shift, and STIR MR imaging. Radiology 174:495–502CrossRef
17.
Minne HW, Leidig G, Wuster C et al (1988) A newly developed spine deformity index (SDI) to quantitate vertebral crush fractures in patients with osteoporosis. Bone Miner 3:335–349PubMed
18.
19.
Faul F, Erdfelder E, Buchner A, Lang AG (2009) Statistical power analyses using G*Power 3.1: tests for correlation and regression analyses. Behav Res Methods 41:1149–1160CrossRef
20.
Yoo HJ, Hong SH, Kim DH et al (2017) Measurement of fat content in vertebral marrow using a modified dixon sequence to differentiate benign from malignant processes. J Magn Reson Imaging 45:1534–1544CrossRef
21.
22.
Kim DH, Yoo HJ, Hong SH, Choi JY, Chae HD, Chung BM (2017) Differentiation of acute osteoporotic and malignant vertebral fractures by quantification of fat fraction with a Dixon MRI sequence. AJR Am J Roentgenol 209:1331–1339CrossRef
23.
Kugel H, Jung C, Schulte O, Heindel W (2001) Age- and sex-specific differences in the 1H-spectrum of vertebral bone marrow. J Magn Reson Imaging 13:263–268CrossRef
24.
Ragab Y, Emad Y, Gheita T et al (2009) Differentiation of osteoporotic and neoplastic vertebral fractures by chemical shift {in-phase and out-of phase} MR imaging. Eur J Radiol 72:125–133CrossRef
25.
Baum T, Yap SP, Dieckmeyer M et al (2015) Assessment of whole spine vertebral bone marrow fat using chemical shift-encoding based water-fat MRI. J Magn Reson Imaging 42:1018–1023CrossRef
26.
Karampinos DC, Ruschke S, Dieckmeyer M et al (2015) Modeling of T2* decay in vertebral bone marrow fat quantification. NMR Biomed 28:1535–1542CrossRef
27.
Reeder SB, Robson PM, Yu H et al (2009) Quantification of hepatic steatosis with MRI: the effects of accurate fat spectral modeling. J Magn Reson Imaging 29:1332–1339CrossRef
28.
Karampinos DC, Yu H, Shimakawa A, Link TM, Majumdar S (2011) T(1)-corrected fat quantification using chemical shift-based water/fat separation: application to skeletal muscle. Magn Reson Med 66:1312–1326CrossRef
29.
Hines CD, Yu H, Shimakawa A, McKenzie CA, Brittain JH, Reeder SB (2009) T1 independent, T2* corrected MRI with accurate spectral modeling for quantification of fat: validation in a fat-water-SPIO phantom. J Magn Reson Imaging 30:1215–1222CrossRef
30.
Bray TJP, Bainbridge A, Punwani S, Ioannou Y, Hall-Craggs MA (2017) Simultaneous quantification of bone edema/adiposity and structure in inflamed bone using chemical shift-encoded mri in spondyloarthritis. Magn Reson Med 79:1031–1042CrossRef
31.
Kukuk GM, Hittatiya K, Sprinkart AM et al (2015) Comparison between modified Dixon MRI techniques, MR spectroscopic relaxometry, and different histologic quantification methods in the assessment of hepatic steatosis. Eur Radiol 25:2869–2879CrossRef
32.
Yokoo T, Serai SD, Pirasteh A et al (2017) Linearity, bias, and precision of hepatic proton density fat fraction measurements by using MR imaging: a meta-analysis. Radiology 286:486–498CrossRef
33.
Zampa V, Cosottini M, Michelassi C, Ortori S, Bruschini L, Bartolozzi C (2002) Value of opposed-phase gradient-echo technique in distinguishing between benign and malignant vertebral lesions. Eur Radiol 12:1811–1818CrossRef
34.
Stabler A, Baur A, Bartl R, Munker R, Lamerz R, Reiser MF (1996) Contrast enhancement and quantitative signal analysis in MR imaging of multiple myeloma: assessment of focal and diffuse growth patterns in marrow correlated with biopsies and survival rates. AJR Am J Roentgenol 167:1029–1036CrossRef
Metadata
Title
Proton density fat fraction (PDFF) MR imaging for differentiation of acute benign and neoplastic compression fractures of the spine
Authors
Frederic Carsten Schmeel
Julian Alexander Luetkens
Simon Jonas Enkirch
Andreas Feißt
Christoph Hans-Jürgen Endler
Leonard Christopher Schmeel
Peter Johannes Wagenhäuser
Frank Träber
Hans Heinz Schild
Guido Matthias Kukuk
Publication date
01-12-2018
Publisher
Springer Berlin Heidelberg
Published in
European Radiology / Issue 12/2018
Print ISSN: 0938-7994
Electronic ISSN: 1432-1084
DOI
https://doi.org/10.1007/s00330-018-5513-0

Other articles of this Issue 12/2018

European Radiology 12/2018 Go to the issue

Chest

Comparative clinical and predictive value of lung perfusion blood volume CT, lung perfusion SPECT and catheter pulmonary angiography images in patients with chronic thromboembolic pulmonary hypertension before and after balloon pulmonary angioplasty

Neuro

Radial diffusivity as an imaging biomarker for early diagnosis of non-demented amyotrophic lateral sclerosis

Contrast Media

Preventing contrast medium-induced acute kidney injury

Neuro

Shear-wave elastography: a new potential method to diagnose ulnar neuropathy at the elbow

Oncology

Quantitative characterisation of clinically significant intra-prostatic cancer by prostate-specific membrane antigen (PSMA) expression and cell density on PSMA-11

Cardiac

Biatrial performance in children with hypertrophic cardiomyopathy: CMR study