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Schmeel FC, Enkirch SJ, Luetkens JA, Faron A, Lehnen N, Sprinkart AM, Schmeel LC, Radbruch A, Attenberger U, Kukuk GM, Mürtz P. Diagnostic Accuracy of Quantitative Imaging Biomarkers in the Differentiation of Benign and Malignant Vertebral Lesions : Combination of Diffusion-Weighted and Proton Density Fat Fraction Spine MRI. Clin Neuroradiol 2021; 31:1059-1070. [PMID: 33787957 PMCID: PMC8648653 DOI: 10.1007/s00062-021-01009-1] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2020] [Accepted: 02/26/2021] [Indexed: 11/30/2022]
Abstract
Purpose To compare and combine the diagnostic performance of the apparent diffusion coefficient (ADC) derived from diffusion-weighted imaging (DWI) and proton density fat fraction (PDFF) derived from chemical-shift encoding (CSE)-based water-fat magnetic resonance imaging (MRI) for distinguishing benign and malignant vertebral bone marrow lesions (VBML). Methods A total of 55 consecutive patients with 53 benign (traumatic, inflammatory and primary) and 36 malignant (metastatic and hematologic) previously untreated VBMLs were prospectively enrolled in this IRB-approved study and underwent sagittal DWI (single-shot spin-echo echo-planar with multi-slice short TI inversion recovery fat suppression) and CSE-based MRI (gradient-echo 6‑point modified Dixon) in addition to routine clinical spine MRI at 1.5 T or 3.0 T. Diagnostic reference standard was established according to histopathology or imaging follow-up. The ADC = ADC (0, 800) and PDFF = fat / (water + fat) were calculated voxel-wise and examined for differences between benign and malignant lesions. Results The ADC and PDFF values of malignant lesions were significantly lower compared to benign lesions (mean ADC 861 × 10−6 mm2/s vs. 1323 × 10−6 mm2/s, p < 0.001; mean PDFF 3.1% vs. 28.2%, p < 0.001). The areas under the curve (AUC) and diagnostic accuracies were 0.847 (p < 0.001) and 85.4% (cut-off at 1084.4 × 10−6 mm2/s) for ADC and 0.940 (p < 0.001) and 89.9% for PDFF (cut-off at 7.8%), respectively. The combined use of ADC and PDFF improved the diagnostic accuracy to 96.6% (malignancy if ADC ≤ 1118.2 × 10−6 mm2/s and PDFF ≤ 20.0%, otherwise benign). Conclusion Quantitative evaluation of both ADC and PDFF was useful in differentiating benign VBMLs from malignancy. The combination of ADC and PDFF improved the diagnostic performance and yielded high diagnostic accuracy for the differentiation of benign and malignant VBMLs.
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Affiliation(s)
- Frederic Carsten Schmeel
- Department of Neuroradiology, University Hospital Bonn, Rheinische-Friedrich-Wilhelms-Universität Bonn, Venusberg-Campus 1, 53127, Bonn, Germany. .,Research Group Clinical Neuroimaging, German Centre for Neurodegenerative Diseases (DZNE), Bonn, Germany.
| | - Simon Jonas Enkirch
- Department of Neuroradiology, University Hospital Bonn, Rheinische-Friedrich-Wilhelms-Universität Bonn, Venusberg-Campus 1, 53127, Bonn, Germany
| | - Julian Alexander Luetkens
- Department of Radiology, University Hospital Bonn, Rheinische-Friedrich-Wilhelms-Universität Bonn, Bonn, Germany
| | - Anton Faron
- Department of Radiology, University Hospital Bonn, Rheinische-Friedrich-Wilhelms-Universität Bonn, Bonn, Germany
| | - Nils Lehnen
- Department of Neuroradiology, University Hospital Bonn, Rheinische-Friedrich-Wilhelms-Universität Bonn, Venusberg-Campus 1, 53127, Bonn, Germany.,Research Group Clinical Neuroimaging, German Centre for Neurodegenerative Diseases (DZNE), Bonn, Germany
| | - Alois Martin Sprinkart
- Department of Radiology, University Hospital Bonn, Rheinische-Friedrich-Wilhelms-Universität Bonn, Bonn, Germany
| | - Leonard Christopher Schmeel
- Department of Radiotherapy and Radiation Oncology, University Hospital Bonn, Rheinische-Friedrich-Wilhelms-Universität Bonn, Bonn, Germany
| | - Alexander Radbruch
- Department of Neuroradiology, University Hospital Bonn, Rheinische-Friedrich-Wilhelms-Universität Bonn, Venusberg-Campus 1, 53127, Bonn, Germany.,Research Group Clinical Neuroimaging, German Centre for Neurodegenerative Diseases (DZNE), Bonn, Germany
| | - Ulrike Attenberger
- Department of Radiology, University Hospital Bonn, Rheinische-Friedrich-Wilhelms-Universität Bonn, Bonn, Germany
| | - Guido Matthias Kukuk
- Department of Radiology, University Hospital Bonn, Rheinische-Friedrich-Wilhelms-Universität Bonn, Bonn, Germany.,Department of Radiology, Cantonal Hospital Graubuenden, Chur, Switzerland
| | - Petra Mürtz
- Department of Radiology, University Hospital Bonn, Rheinische-Friedrich-Wilhelms-Universität Bonn, Bonn, Germany
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Sato K, Urakawa H, Sakamoto K, Ito E, Hamada Y, Yoshimitsu K. Undifferentiated carcinoma of the pancreas with osteoclast-like giant cells showing intraductal growth and intratumoral hemorrhage: MRI features. Radiol Case Rep 2019; 14:1283-1287. [PMID: 31452826 PMCID: PMC6704396 DOI: 10.1016/j.radcr.2019.07.020] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2019] [Revised: 07/29/2019] [Accepted: 07/30/2019] [Indexed: 01/27/2023] Open
Abstract
We report a case of undifferentiated carcinoma of the pancreas with osteoclast-like giant cells ocalized within the main pancreatic duct (MPD). A 61-year-old woman was referred to our hospital for evaluation of dilatation of the MPD that was detected on screening sonogram. Preoperative MR imaging revealed a small hypervascular tumor within the dilated MPD, showing high signal on R2* map and signal reduction on in-phase as compared to out-of-phase. R2* hyperintensity and in-phase signal reduction may be a characteristic feature of undifferentiated carcinoma of the pancreas with osteoclast-like giant cells, which indicates intratumoral hemorrhage even if they are small.
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Affiliation(s)
- Keisuke Sato
- Department of Radiology, Fukuoka University Faculty of Medicine, Fukuoka University, 7-45-1 Nanakuma, Jonan-ku, Fukuoka-shi, Fukuoka 814-0180, Japan
| | - Hiroshi Urakawa
- Department of Radiology, Fukuoka University Faculty of Medicine, Fukuoka University, 7-45-1 Nanakuma, Jonan-ku, Fukuoka-shi, Fukuoka 814-0180, Japan
| | - Keiko Sakamoto
- Department of Radiology, Fukuoka University Faculty of Medicine, Fukuoka University, 7-45-1 Nanakuma, Jonan-ku, Fukuoka-shi, Fukuoka 814-0180, Japan
| | - Emi Ito
- Department of Radiology, Fukuoka University Faculty of Medicine, Fukuoka University, 7-45-1 Nanakuma, Jonan-ku, Fukuoka-shi, Fukuoka 814-0180, Japan
| | - Yoshihiro Hamada
- Department of Pathology, Fukuoka University Faculty of Medicine, Fukuoka University, 7-45-1 Nanakuma, Jonan-ku, Fukuoka-shi, Fukuoka 814-0180, Japan
| | - Kengo Yoshimitsu
- Department of Radiology, Fukuoka University Faculty of Medicine, Fukuoka University, 7-45-1 Nanakuma, Jonan-ku, Fukuoka-shi, Fukuoka 814-0180, Japan
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