Burcu AKMAN, Hatice Ayça ATA KORKMAZ, Ahmet SARI

Efficacy of chemical shift MRI for differentiating diffuse red bone marrow reconversion and hematological malignancies

Background/aim: The main purpose of our study was to determine the efficacy of chemical shift imaging (CSI) for differentiatingdiffuse red bone marrow reconversion (RBMR) and hematological malignancies. We also aimed to calculate the cut-off value for theseentities with similar imaging features in routine magnetic resonance (MR) sequences.Materials and methods: A total of 54 patients were included: 17 patients (31.4%) with hematological malignancies (group 1), 16 patients(29.6%) with RBMR (group 2), and 21 patients (38.0%) with no clinical and hematological malignancies (control group). Patients withno pathological data or completed two-year follow-up and children were excluded from the study. An experienced radiologist on MRIevaluated the images blindly for final diagnosis. Pathologic results were determined as gold standard. Regions of interests (ROI) wereplaced on the vertebrae in CSI and signal intensity ratios (SIR) were calculated. The cut-off value was calculated using receiver operatingcharacteristic (ROC) analysis.Results: SIR values were 0.97 ± 0.16, 0.69 ± 0.31 and 0.28 ± 0.35 (P < 0.001) for GI, G2, and G3, respectively. The cut-off value was 0.82(P < 0.001). The sensitivity rate was 83.3% (AUC: 58%–96%), specificity was 87% (AUC: 58–98).Conclusion: CSI may be a valuable diagnostic tool for differentiating diffuse RBMR and hematological malignancies.

PDF

___

1. Vogler JB 3rd, Murphy WA. Bone marrow imaging. Radiology 1988; 168: 679-693.
2. Stoller DW. Magnetic Resonance Imaging in Orthopaedics and Sports Medicine. Vol 1. Philadelphia, PA, USA: Lippincott Williams & Wilkins, 2007.
3. Del Grande F, Farahani SJ, Carrino JA, Chhabra A. Bone marrow lesions: a systematic diagnostic approach. Indian J Radiol Imaging 2014; 24: 279.
4. Zhao F, Shen J, Yu X, Zhou H, Lu Z et al. Bone marrow reconversion mimicking pelvis metastases in a patient with rectal cancer: a pitfall on magnetic resonance images. Quant Imaging Med Surg 2018; 8: 621.
5. Swartz PG, Roberts CC. Radiological reasoning: bone marrow changes on MRI. AJR Am J Roentgenol 2009; 193: S1-S4.
6. Alyas F, Saifuddin A, Connell D. MR imaging evaluation of the bone marrow and marrow infiltrative disorders of the lumbar spine. Magn Reson Imaging Clin N Am 2007; 15: 199-219.
7. Małkiewicz A, Dziedzic M. Bone marrow reconversion– imaging of physiological changes in bone marrow. Pol J Radiol 2012; 77: 45.
8. Yazıcı Z, Doğan Ö, Yalçın R, Savcı G. Adrenal adenomların tanısında kimyasal şift mr görüntüleme: kalitatif değerlendirme. Uludağ Üniversitesi Tıp Fakültesi Dergisi 2002; 28: 17-21.
9. Xiao Z, Li J, Li C, Zhang Y, She D et al. Chemical shift MR imaging in the lumbar vertebra: the effect of field strength, scanner vendors and flip angles in repeatability of signal intensity index measurement. BMC Med Imaging 2016; 16: 64.
10. Ragab Y, Emad Y, Gheita T, Mansour M, Abou-Zeid A et al. Differentiation of osteoporotic and neoplastic vertebral fractures by chemical shift {in-phase and out-of phase} MR imaging. Eur J Radiol 2009; 72: 125-133.
11. Del Grande F, Subhawong T, Flammang A, Fayad L. Chemical shift imaging at 3 Tesla: effect of echo time on assessing bone marrow abnormalities. Skeletal Radiol 2014; 43: 1139-1147.
12. Costa FM, Canella C, Vieira FG, Vianna EM, Meohas W et al. The usefulness of chemical-shift magnetic resonance imaging for the evaluation of osteoid osteoma. Radiol Bras 2018; 51: 156-161.
13. Disler DG, McCauley TR, Ratner LM, Kesack CD, Cooper JA. 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 1997; 169: 1439-1447.
14. Eito K, Waka S, Naoko N, Makoto A, Atsuko H. Vertebral neoplastic compression fractures: Assessment by dual-phase chemical shift imaging. J Magn Reson Imaging 2004; 20: 1020- 1024.
15. IBM Corp. Released IBM SPSS Statistics for Windows, Version 22.0. Armonk, NY: IBM Corp. Vol Version 22.0. NY: IBM Corp.: Armonk; 2013.
16. Delfaut EM, Beltran J, Johnson G, Rousseau J, Marchandise X et al. Fat suppression in MR imaging: techniques and pitfalls. Radiograph. 1999; 19: 373-382.
17. Wismer GL, Rosen BR, Buxton R, Stark DD, Brady TJ. Chemical shift imaging of bone marrow: preliminary experience. Am J Roentgenol 1985;145:1031-7.
18. Erly WK, Oh ES, Outwater EK. The utility of in-phase/ opposed-phase imaging in differentiating malignancy from acute benign compression fractures of the spine. AJNR Am J Neuroradiol 2006; 27: 1183-1188.
19. Zajick Jr DC, Morrison WB, Schweitzer ME, Parellada JA, Carrino JA. Benign and malignant processes: normal values and differentiation with chemical shift MR imaging in vertebral marrow. Radiology 2005; 237: 590-596.
20. Kohl CA, Chivers FS, Lorans R, Roberts CC, Kransdorf MJ. Accuracy of chemical shift MR imaging in diagnosing indeterminate bone marrow lesions in the pelvis: review of a single institution’s experience. Skeletal Radiol 2014; 43: 1079- 1084.