Differentiation of focal indeterminate marrow abnormalities with multiparametric MRI

Jun Seung Baik; Joon-Yong Jung; Won-Hee Jee; Chang-Woo Chun; Sun Ki Kim; Seung Han Shin; Yang Guk Chung; Chan-Kwon Jung; Stephan Kannengiesser; YoHan Sohn

doi:10.1002/jmri.25536

Differentiation of focal indeterminate marrow abnormalities with multiparametric MRI

J Magn Reson Imaging. 2017 Jul;46(1):49-60. doi: 10.1002/jmri.25536. Epub 2016 Nov 9.

Authors

Affiliations

¹ Department of Radiology, Seoul St. Mary's Hospital, College of Medicine, Catholic University of Korea, Seoul, South Korea.
² Department of Radiology, Uijeongbu St. Mary's Hospital.
³ Incheon St. Mary's Hospital, College of Medicine, Catholic University of Korea, Seoul, South Korea.
⁴ Department of Orthopedic Surgery, Seoul St. Mary's Hospital, College of Medicine, Catholic University of Korea, Seoul, South Korea.
⁵ Department of Pathology, Seoul St. Mary's Hospital, College of Medicine, Catholic University of Korea, Seoul, South Korea.
⁶ Siemens Healthcare, Erlangen, Germany.
⁷ Siemens Healthcare, Seoul, Republic of Korea.

PMID: 27859835
DOI: 10.1002/jmri.25536

Abstract

Purpose: To explore magnetic resonance imaging (MRI) parameters from intravoxel incoherent motion diffusion-weighted imaging (IVIM-DWI), multiecho Dixon imaging (ME-Dixon), and dynamic contrast-enhanced imaging (DCE) for differentiating focal indeterminate marrow abnormalities MATERIALS AND METHODS: Forty-two patients with 14 benign and 28 malignant focal marrow abnormalities were included. The following were independently analyzed by two readers: signal intensity (SI), contour, and margin on conventional MR images; SI on b-800 images (SI_b-800 ), apparent diffusion coefficient (ADC), IVIM parameters (D_slow, D_fast , and f), fat fraction (Ff), and DCE parameters (time-to-signal intensity curve pattern, iAUC, K^trans , k_ep , and v_e ). The MR characteristics and parameters from benign and malignant lesions were compared with a chi-squared test and the Mann-Whitney U-test, respectively. The area under receiver operating characteristic (ROC) curves (AUC) of each sequence were also compared. Interobserver agreements were assessed with Cohen's κ, and intraclass correlation coefficient (ICC).

Results: ADC, D_slow , and Ff demonstrated a significant difference between benign and malignant marrow abnormalities for both readers (P < 0.001). SI_b-800 and perfusion-related parameters from IVIM-DWI and DCE were not significantly different between the two groups (P = 0.145, 0.439, and 0.337 for reader 1, P = 0.378, 0.368, and 0.343 for reader 2, respectively). The AUCs of ADC, D_slow , and Ff were significantly higher for differentiating indeterminate marrow abnormalities in both readers (P < 0.001). Interobserver agreements were substantial in SI_b-800 , and ICCs were almost perfect for ADC, D_slow , f, and Ff, and substantial for iAUC, k_ep , K^trans , v_e , and D_fast .

Conclusion: ADC, D_slow , and Ff may provide information for differentiating focal indeterminate abnormalities.

Level of evidence: 3 Technical Efficacy: Stage 2 J. MAGN. RESON. IMAGING 2017;46:49-60.

Keywords: bone marrow; chemical shift; dynamic contrast-enhanced imaging; intravoxel incoherent motion.

Publication types

Research Support, Non-U.S. Gov't

MeSH terms

Aged
Aged, 80 and over
Bone Marrow Neoplasms / diagnosis*
Bone Marrow Neoplasms / pathology*
Diagnosis, Differential
Female
Humans
Image Enhancement / methods
Image Interpretation, Computer-Assisted / methods*
Magnetic Resonance Imaging / methods*
Male
Middle Aged
Multimodal Imaging / methods*
Observer Variation
Reproducibility of Results
Sensitivity and Specificity