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Saifuddin A, Ali M, Santiago R, Pressney I. In-phase and opposed-phase Dixon chemical shift imaging for the assessment of skeletal marrow lesions: comparison of measurements from longitudinal sequences to those from axial sequences. Br J Radiol 2024; 97:828-833. [PMID: 38321150 PMCID: PMC11027321 DOI: 10.1093/bjr/tqae031] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2023] [Revised: 12/21/2023] [Accepted: 01/10/2024] [Indexed: 02/08/2024] Open
Abstract
OBJECTIVE In-phase and opposed-phase chemical shift imaging (CSI) is a useful technique for assessing skeletal lesions. This study determined the frequency of significant differences in measurements obtained from longitudinal (coronal or sagittal) sequences to those obtained from axial sequences. METHODS Chemical shift imaging was undertaken in 96 consecutive patients referred from the Musculoskeletal Sarcoma and Spinal Oncology services for assessment of possible bone tumours as part of a standard tumour protocol, which included turbo spin echo and inversion recovery sequences. For spinal lesions, CSI was obtained in the sagittal and axial planes, while for all other sites, it was obtained in the coronal and axial planes. RESULTS The study included 49 (51.0%) males and 47 (49.0%) females with mean age 42.4 years (range 2-91 years). In 4 cases, 2 individual lesions were assessed, making a total of 100 lesions. Based on typical imaging features (n = 57) or histology (n = 43), 22 lesions (22%) were classified as non-neoplastic, 44 (44%) as benign neoplasms, 6 (6%) as intermediate-grade neoplasms, and 28 (28%) as malignant neoplasms. A significant discrepancy, wherein a lesion was classified as fat-containing (% SI drop >20%-25%) in the longitudinal plane, while in the axial plane it was classified as fat-replacing (% SI drop <20%-25%), or vice versa, occurred in 9%-14% of cases. However, this discrepancy had no appreciable effect on overall diagnostic accuracy, which was calculated at 79% for the longitudinal plane and 75%-80% for the axial plane. CONCLUSIONS Significant differences in CSI measurements occur in 9%-14% of cases based on imaging plane, but with no significant effect on diagnostic accuracy. ADVANCES IN KNOWLEDGE Radiologists should be aware that CSI measurements in different planes appear to have significant differences in up to 14% of lesions. However, diagnostic accuracy does not seem to be significantly affected.
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Affiliation(s)
- Asif Saifuddin
- Department of Radiology, Royal National Orthopaedic Hospital, Stanmore, Middlesex HA7 4LP, United Kingdom
| | - Mohamed Ali
- Department of Psychiatry, Leicestershire NHS Trust, Leicester LE3 9PQ, United Kingdom
| | - Rodney Santiago
- Department of Radiology, Royal National Orthopaedic Hospital, Stanmore, Middlesex HA7 4LP, United Kingdom
| | - Ian Pressney
- Department of Radiology, Royal National Orthopaedic Hospital, Stanmore, Middlesex HA7 4LP, United Kingdom
- Institute of Orthopaedics and Musculoskeletal Science, University College London, Middlesex, HA7 4LP, United Kingdom
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Zadig P, von Brandis E, Ording Müller LS, Tanturri de Horatio L, Rosendahl K, Avenarius DFM. Pediatric whole-body magnetic resonance imaging: comparison of STIR and T2 Dixon sequences in the detection and grading of high signal bone marrow changes. Eur Radiol 2023; 33:5045-5053. [PMID: 36700955 PMCID: PMC10290001 DOI: 10.1007/s00330-023-09413-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2022] [Revised: 10/31/2022] [Accepted: 01/01/2023] [Indexed: 01/27/2023]
Abstract
OBJECTIVES To compare short time inversion recovery (STIR) and T2 Dixon in the detection and grading of high signal intensity areas in bone marrow on whole-body MRI in healthy children. METHODS Prospective study, including whole-body 1.5-T MRIs from 77 healthy children. Two experienced radiologists in consensus identified and graded areas of high bone marrow signal on STIR and T2-weighted (T2W) turbo spin echo (TSE) Dixon images (presence, extension) in two different sessions at an interval of at least 3 weeks. In a third session, a third observer joined the two readers for an additional consensus reading with all sequences available (substitute gold standard). RESULTS Four hundred ninety of 545 (89.9%) high signal areas were visible on both sequences, while 27 (5.0%) were visible on STIR only and 28 (5.1%) on T2W Dixon only. Twenty-four of 27 (89%) lesions seen on STIR only, and 25/28 (89%) seen on T2W Dixon only, were graded as mildly increased signal intensity. The proportion of true positive high signal lesions was higher for the T2W Dixon images as compared to STIR (74.2% vs. 68.2%) (p = 0.029), while the proportion of false negatives was lower (25.9% vs. 31.7% (p = 0.035) for T2W Dixon and STIR, respectively). There was a moderate agreement between the T2W Dixon and STIR-based extension scores on a 0-4 scale, with a kappa of 0.45 (95% CI = 0.34-0.56). CONCLUSIONS Most high signal bone marrow changes identified on a 1.5-T whole-body MRI were seen on both STIR and water-only T2W Dixon, underscoring the importance of using identical protocols when following bone-marrow signal changes over time. KEY POINTS • Whole-body MRI is increasingly being used to diagnose and monitor diseases in children, such as chronic non-bacterial osteomyelitis, malignant/metastatic disease, and histiocytosis. • Standardized and validated imaging protocols, as well as reference standards by age for the growing skeleton are lacking. • Prospective single-center study showed that 90% of high signal bone marrow areas identified on a 1.5-T whole-body MRI in healthy children is seen on both STIR and water-only T2W Dixon, while 5% is seen on STIR only and 5% on T2W Dixon only.
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Affiliation(s)
- P Zadig
- Department of Radiology, University Hospital of North-Norway, Tromsø, Norway
- Department of Clinical Medicine, UiT, The Arctic University of Norway, Tromsø, Norway
| | - E von Brandis
- Division of Radiology and Nuclear Medicine, Oslo University Hospital, Oslo, Norway
| | - L S Ording Müller
- Division of Radiology and Nuclear Medicine, Oslo University Hospital, Oslo, Norway
| | - L Tanturri de Horatio
- Department of Radiology, University Hospital of North-Norway, Tromsø, Norway
- Department of Clinical Medicine, UiT, The Arctic University of Norway, Tromsø, Norway
- Department of Pediatric Radiology, Ospedale Pediatrico Bambino Gesù, Rome, Italy
| | - K Rosendahl
- Department of Radiology, University Hospital of North-Norway, Tromsø, Norway.
- Department of Clinical Medicine, UiT, The Arctic University of Norway, Tromsø, Norway.
| | - D F M Avenarius
- Department of Radiology, University Hospital of North-Norway, Tromsø, Norway
- Department of Clinical Medicine, UiT, The Arctic University of Norway, Tromsø, Norway
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Saifuddin A, Tyler P, Rajakulasingam R. Imaging of bone marrow pitfalls with emphasis on MRI. Br J Radiol 2023; 96:20220063. [PMID: 35522786 PMCID: PMC9975530 DOI: 10.1259/bjr.20220063] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2022] [Revised: 04/17/2022] [Accepted: 04/19/2022] [Indexed: 01/27/2023] Open
Abstract
Normal marrow contains both hematopoietic/red and fatty/yellow marrow with a predictable pattern of conversion and skeletal distribution on MRI. Many variations in normal bone marrow signal and appearances are apparent and the reporting radiologist must differentiate these from other non-neoplastic, benign or neoplastic processes. The advent of chemical shift imaging has helped in characterising and differentiating more focal heterogeneous areas of red marrow from marrow infiltration. This review aims to cover the MRI appearances of normal marrow, its evolution with age, marrow reconversion, variations of normal marrow signal, causes of oedema-like marrow signal, and some common non-neoplastic entities, which may mimic marrow neoplasms.
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Affiliation(s)
- Asif Saifuddin
- Department of Radiology, Royal National Orthopaedic Hospital, Stanmore, United Kingdom
| | - Philippa Tyler
- Department of Radiology, Royal National Orthopaedic Hospital, Stanmore, United Kingdom
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Tyler PA, Rajakulasingam R, Saifuddin A. Normal Bone Marrow and Non-neoplastic Systemic Hematopoietic Disorders in the Adult. Semin Musculoskelet Radiol 2023; 27:30-44. [PMID: 36868243 DOI: 10.1055/s-0043-1761495] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/05/2023]
Abstract
This article provides an overview of the imaging appearances of normal adult bone marrow with an emphasis on magnetic resonance imaging. We also review the cellular processes and imaging features of normal developmental yellow-to-red marrow conversion and compensatory physiologic or pathologic red marrow reconversion. Key imaging features that differentiate between normal adult marrow, normal variants, non-neoplastic hematopoietic disorders, and malignant marrow disease are discussed, as well as posttreatment changes.
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Affiliation(s)
- Philippa Anne Tyler
- Royal National Orthopaedic Hospital, Brockley Hill, Stanmore, United Kingdom
| | | | - Asif Saifuddin
- Royal National Orthopaedic Hospital, Brockley Hill, Stanmore, United Kingdom
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Fat-only Dixon: how to use it in body MRI. Abdom Radiol (NY) 2022; 47:2527-2544. [PMID: 35583822 DOI: 10.1007/s00261-022-03546-w] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2022] [Revised: 04/26/2022] [Accepted: 04/27/2022] [Indexed: 12/14/2022]
Abstract
The Dixon method for fat/water separation is widely used to obtain uniform fat suppression using the water-only reconstruction. However, the fat-only reconstruction is potentially neglected in clinical practice, either not sent to the PACS or ignored upon imaging review. Fat-only Dixon provides a valuable tool for rapid screening for microscopic fat and problem-solving of lesions of interest. This work will review the physics of Dixon fat/water separation, some clinical applications, artifacts, and protocol design considerations of Dixon imaging, and how to integrate the Dixon method into the clinical practice of body MRI.
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Chang CY, Garner HW, Ahlawat S, Amini B, Bucknor MD, Flug JA, Khodarahmi I, Mulligan ME, Peterson JJ, Riley GM, Samim M, Lozano-Calderon SA, Wu JS. Society of Skeletal Radiology- white paper. Guidelines for the diagnostic management of incidental solitary bone lesions on CT and MRI in adults: bone reporting and data system (Bone-RADS). Skeletal Radiol 2022; 51:1743-1764. [PMID: 35344076 PMCID: PMC9283187 DOI: 10.1007/s00256-022-04022-8] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/27/2021] [Revised: 02/21/2022] [Accepted: 02/21/2022] [Indexed: 02/02/2023]
Abstract
The purpose of this article is to present algorithms for the diagnostic management of solitary bone lesions incidentally encountered on computed tomography (CT) and magnetic resonance (MRI) in adults. Based on review of the current literature and expert opinion, the Practice Guidelines and Technical Standards Committee of the Society of Skeletal Radiology (SSR) proposes a bone reporting and data system (Bone-RADS) for incidentally encountered solitary bone lesions on CT and MRI with four possible diagnostic management recommendations (Bone-RADS1, leave alone; Bone-RADS2, perform different imaging modality; Bone-RADS3, perform follow-up imaging; Bone-RADS4, biopsy and/or oncologic referral). Two algorithms for CT based on lesion density (lucent or sclerotic/mixed) and two for MRI allow the user to arrive at a specific Bone-RADS management recommendation. Representative cases are provided to illustrate the usability of the algorithms.
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Affiliation(s)
| | | | | | | | | | | | | | | | | | | | | | | | - Jim S. Wu
- Beth Israel Deaconess Medical Center, Boston, USA
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India ink artifact on Dixon out-of-phase images can be used as a landmark to measure joint space width at MRI. Diagn Interv Imaging 2021; 103:87-96. [PMID: 34666946 DOI: 10.1016/j.diii.2021.09.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2021] [Revised: 09/26/2021] [Accepted: 09/27/2021] [Indexed: 11/23/2022]
Abstract
PURPOSE The purpose of this study was to test the feasibility of joint space width (JSW) measurement on Dixon MR images with the "India ink" artifact between cartilage and bone marrow as a landmark for the subchondral plate and to correlate it with radiographic JSW. MATERIALS AND METHODS Both hands of six volunteers (three women, three men; mean age, 36.7 ± 10.4 [SD] years) and 24 patients with early rheumatoid arthritis (16 women, 8 men; mean age, 45.7 ± 14.5 [SD] years) were imaged with MRI Dixon sequences and radiographs. Two radiologists (R1, R2) separately measured JSW in 11 joints per hand on all Dixon images in volunteers, on contrast-enhanced T1-weighted out-of-phase images in patients and on radiographs in both groups. Inter-technique, intra-observer and inter-observer agreements were assessed using intraclass correlation coefficient (ICC) and Bland Altman analysis. RESULTS In volunteers, agreement between JSW measurements on MRI and radiographs was the highest with T1-weighted Dixon out-of-phase images (mean ICC ranging from 0.69 to 0.76 for R1 and 0.65 to 0.74 for R2). In patients, median bias between JSW measurements at first and second readings was not statistically significantly different from 0 on T1-weighted Dixon out-of-phase images (mean bias of 0.00 and + 0.01 mm) and radiographs (mean bias of 0.00 and +0.01 mm). Median bias of the difference between measurements of R1 and R2 was statistically significantly different from 0 on T1-weighted Dixon out-of-phase images (mean bias of -0.11 and -0.09 mm; P < 0.039) and radiographs (mean bias of -0.24 and -0.20 mm; P < 0.035). CONCLUSION Measurement of hand JSW on T1-weighted Dixon out-of-phase images using India ink artifact as a landmark for the subchondral plate is repeatable and reproducible.
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Bacher S, Hajdu SD, Maeder Y, Dunet V, Hilbert T, Omoumi P. Differentiation between benign and malignant vertebral compression fractures using qualitative and quantitative analysis of a single fast spin echo T2-weighted Dixon sequence. Eur Radiol 2021; 31:9418-9427. [PMID: 34041569 PMCID: PMC8589814 DOI: 10.1007/s00330-021-07947-1] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2021] [Accepted: 03/25/2021] [Indexed: 01/15/2023]
Abstract
Objectives To determine and compare the qualitative and quantitative diagnostic performance of a single sagittal fast spin echo (FSE) T2-weighted Dixon sequence in differentiating benign and malignant vertebral compression fractures (VCF), using multiple readers and different quantitative methods. Methods From July 2014 to June 2020, 95 consecutive patients with spine MRI performed prior to cementoplasty for acute VCFs were retrospectively included. VCFs were categorized as benign (n = 63, mean age = 76 ± 12 years) or malignant (n = 32, mean age = 63 ± 12 years) with a best valuable comparator as a reference. Qualitative analysis was independently performed by four radiologists by categorizing each VCF as either benign or malignant using only the image sets provided by FSE T2-weighted Dixon sequences. Quantitative analysis was performed using two different regions of interest (ROI1-2) and three methods (signal drop, fat fraction (FF) from ROIs, FF maps). Diagnostic performance was compared using ROC curves analyses. Interobserver agreement was assessed using kappa statistics and intraclass correlation coefficients (ICC). Results The qualitative diagnostic performance ranged from area under the curve (AUC) = 0.97 (95% CI: 0.91–1.00) to AUC = 0.99 (95% CI: 0.95–1.0). The quantitative diagnostic performance ranged from AUC = 0.82 (95% CI: 0.73–0.89) to AUC = 0.97 (95% CI: 0.91–0.99). Pairwise comparisons showed no statistical difference in diagnostic performance (all p > 0.0013, Bonferroni-corrected p < 0.0011). All five cases with disagreement among the readers were correctly diagnosed at quantitative analysis using ROI2. Interobserver agreement was excellent for both qualitative and quantitative analyses. Conclusions A single FSE T2-weighted Dixon sequence can be used to differentiate benign and malignant VCF with high diagnostic performance using both qualitative and quantitative analyses, which can provide complementary information. Key Points • Qualitative analysis of a single FSE T2-weighted Dixon sequence yields high diagnostic performance and excellent observer agreement for differentiating benign and malignant compression fractures. • The same FSE T2-weighted Dixon sequence allows quantitative assessment with high diagnostic performance. • Quantitative data can readily be extracted from the FSE T2-weighted Dixon sequence and may provide complementary information to the qualitative analysis, which may be useful in doubtful cases.
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Affiliation(s)
- Sebastien Bacher
- Department of Radiology, Lausanne University Hospital and University of Lausanne, Rue du Bugnon 46, 1011, Lausanne, Switzerland
| | - Steven David Hajdu
- Department of Radiology, Lausanne University Hospital and University of Lausanne, Rue du Bugnon 46, 1011, Lausanne, Switzerland
| | - Yael Maeder
- Department of Radiology, Lausanne University Hospital and University of Lausanne, Rue du Bugnon 46, 1011, Lausanne, Switzerland
| | - Vincent Dunet
- Department of Radiology, Lausanne University Hospital and University of Lausanne, Rue du Bugnon 46, 1011, Lausanne, Switzerland
| | - Tom Hilbert
- Department of Radiology, Lausanne University Hospital and University of Lausanne, Rue du Bugnon 46, 1011, Lausanne, Switzerland
- Advanced Clinical Imaging Technology, Siemens Healthcare AG, Lausanne, Switzerland
- LTS5 , École Polytechnique Fédérale de Lausanne (EPFL) , Lausanne, Switzerland
| | - Patrick Omoumi
- Department of Radiology, Lausanne University Hospital and University of Lausanne, Rue du Bugnon 46, 1011, Lausanne, Switzerland.
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Saifuddin A, Rajakulasingam R, Santiago R, Siddiqui M, Khoo M, Pressney I. Comparison of lumbar degenerative disc disease using conventional fast spin echo T2W MRI and T2 fast spin echo dixon sequences. Br J Radiol 2021; 94:20201438. [PMID: 33684306 DOI: 10.1259/bjr.20201438] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/23/2023] Open
Abstract
OBJECTIVES To compare the grading of lumbar degenerative disc disease (DDD), Modic end-plate changes (MEPC) and identification of high intensity zones (HIZ) on a combination of sagittal T1weighted turbo spin echo (T1W TSE), T2weighted fast spin echo (T2W FSE) and short tau inversion recovery (STIR) sequences (routine protocol) with a single sagittal T2W FSE Dixon MRI sequence which provides in-phase, opposed-phase, water only and fat only images in a single acquisition (Dixon protocol). METHODS 50 patients underwent lumbar spine MRI using the routine protocol with the addition of a T2W FSE Dixon sequence. DDD grade, MEPC and HIZ for each disc level were assessed on the routine and Dixon protocols. Each protocol was reviewed independently by three readers (consultant musculoskeletal radiologists with 26-, 8- and 4 years' experience), allowing assessment of inter-reader agreement and inter protocol agreement for each assessed variable. RESULTS The study included 17 males and 33 females (mean age 51 years; range 8-82 years). Inter-reader agreement for DDD grade on the routine protocol was 0.57 and for the Dixon protocol was 0.63 (p = 0.08). Inter-reader agreement for MEPC on the routine protocol was 0.45 and for the Dixon protocol was 0.53 (p = 0.02), and inter-reader agreement for identification of the HIZ on the routine protocol was 0.52 and for the Dixon protocol was 0.46 (p = 0.27). Intersequence agreement for DDD grade ranged from 0.61 to 0.97, for MEPC 0.46-0.62 and for HIZ 0.39-0.5. CONCLUSION A single sagittal T2W FSE Dixon MRI sequence could potentially replace the routine three sagittal sequence protocol for assessment of lumbar DDD, MEPC and HIZ resulting in ~60% time saving. ADVANCES IN KNOWLEDGE Grading of lumbar DDD, presence of Modic changes and high intensity zones were compared on sagittal T1W TSE, T2W FSE and STIR sequences with a T2W FSE Dixon sequence, with fair-to-good correlation suggesting that three conventional sequences could be replaced by a single Dixon sequence.
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Affiliation(s)
- Asif Saifuddin
- Department of Radiology, Royal National Orthopaedic Hospital, Stanmore, UK
| | | | - Rodney Santiago
- Department of Radiology, Royal National Orthopaedic Hospital, Stanmore, UK
| | - Mateen Siddiqui
- Department of Radiology, North West Anglia Foundation Trust, Hinchingbrooke Hospital, Huntingdon, UK
| | - Michael Khoo
- Department of Radiology, Royal National Orthopaedic Hospital, Stanmore, UK
| | - Ian Pressney
- Department of Radiology, Royal National Orthopaedic Hospital, Stanmore, UK
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