Comparison of in-phase and opposed-phase T1W gradient echo and T2W fast spin echo dixon chemical shift imaging for the a
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SCIENTIFIC ARTICLE
Comparison of in-phase and opposed-phase T1W gradient echo and T2W fast spin echo dixon chemical shift imaging for the assessment of non-neoplastic, benign neoplastic and malignant marrow lesions Asif Saifuddin 1 & Hassan Shafiq 2 & Karan Malhotra 3 & Rodney Santiago 1 & Ian Pressney 1 Received: 20 August 2020 / Revised: 26 October 2020 / Accepted: 27 October 2020 # ISS 2020
Abstract Objective The objective of this study is to compare T1-weighted gradient echo (T1W GrE: control technique) chemical shift imaging (CSI) with T2-weighted fast spin echo (T2W FSE: experimental technique) CSI for differentiating non-neoplastic and neoplastic marrow lesions. Materials and methods Patients undergoing MRI for various marrow lesions were investigated with T1W GrE and T2W FSE Dixon CSI. Signal intensity (SI) change between in-phase (IP) and opposed-phase (OP) sequences was calculated, and SI drop > 20% considered to represent non-neoplastic lesions while SI drop < 20% considered to represent neoplastic lesions. Final diagnosis was based on imaging features (n = 42) or histology (n = 43) and classified as non-neoplastic, benign neoplastic, and malignant neoplastic. Inter-observer and inter-technique agreement between 2 readers was calculated. Results The study included 85 patients (44 males and 41 females; mean age 41.1 years, range 2–83 years). Final diagnosis included 19 (22.4%) non-neoplastic lesions, 27 (31.8%) benign neoplasms, and 39 (45.9%) malignant neoplasms. On T1W GrE CSI, 19–21 lesions were classed as non-neoplastic and 64–66 as neoplastic, while on T2W FSE Dixon CSI, 22–24 lesions were classed as non-neoplastic and 61–64 as neoplastic. Lesion classification matched between the 2 techniques in 91.8–96.5% of cases. Sensitivity, specificity, positive predictive value, negative predictive value, and accuracy of T1W GrE CSI for differentiating non-neoplastic and neoplastic marrow lesions were 66.7–72.2%, 88.1–89.6%, 61.9–63.2%, 90.9–92.2%, and 84.7%, and of T2W FSE Dixon CSI were 72.2–77.8%, 85.1–86.6%, 58.3–59.1%, 92.1–93.4%, and 83.5%. Conclusions T1W GrE CSI and T2W FSE Dixon CSI produce similar results in the assessment of non-neoplastic and neoplastic marrow lesions. Keywords Bone tumour . MRI . Chemical shift imaging . Dixon sequence
Introduction The applications of the Dixon sequence in the assessment of bone marrow lesions has recently been reviewed [1–3]. A particular value of in-phase (IP) and opposed-phase (OP)
* Ian Pressney [email protected] 1
Department of Radiology, Royal National Orthopaedic Hospital, Brockley Hill, Stanmore, Middlesex HA7 4LP, UK
2
Department of Orthopaedics, Bart’s Health NHS Trust, London, UK
3
Department of Orthopaedics, Royal National Orthopaedic Hospital, Stanmore, UK
chemical shift imaging (CSI) using a T1-weighted gradient echo (T1W GrE) Dixon sequence is the differentiation of fat-containing marrow lesions such as focal nodular marrow hyperplasia (FNMH), atypical haemangioma, and reactive marrow oedema of any cause, from marrow replacing lesions su
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