Accuracy of chemical shift MR imaging in diagnosing indeterminate bone marrow lesions in the pelvis: review of a single institution’s experience

Abstract

Chemical shift imaging is a useful adjunct MR technique to characterize focal and diffuse marrow abnormalities on routine non-contrast pelvic imaging. It is highly sensitive in identifying malignant disease. Despite its lower specificity, the need for biopsy could be eliminated in more than 60 % of patients with benign disease.

Chemical shift MRI can aid in the diagnosis of indeterminate skeletal lesions of the spine

“…Our findings are largely in agreement with the observations by Kohl and co-workers who evaluated the role of CSI in indeterminate skeletal lesions of the pelvis [12]. In our study, CSI was false positive in 12 lesions (false positive rate of 26.7 %) (Fig.…”

“…We agree with Kohl and co-workers that chemical shift MRI is the most accurate non-invasive test in distinguishing benign from malignant skeletal lesions on non-contrast MRI studies [12] and we therefore propose to (1) include CSI in routine clinical practice when attempting to characterise skeletal lesions of the spine and to (2) implement CSI in the routine bone tumour protocol of the spine and pelvis.…”

“…The reason for this difference in cut-off values when compared to the literature is uncertain; however, it could relate to the fact that all of our patients underwent 3-T MRI. In contrast, the experience of CSI of bone marrow in the literature is based on low-field MRI scanners with a field strength ranging from 0.5 to 1.5 T [10][11][12][13][14][15][16][17]. However, magnetic field strength may potentially influence this cut-off value.…”

“…Most recently, Kohl and co-workers evaluated the accuracy of CSI in the diagnosis of indeterminate skeletal lesions of the pelvis. The authors found that CSI demonstrated a sensitivity of 100 %, a specificity of 61 % and a diagnostic accuracy of 82 % [12]. The utility of CSI in the spine has been evaluated previously [10,11,[13][14][15][16][17].…”

“…In chemical shift MRI, the presence of microscopic fat will result in signal loss on the opposedphase images when compared to the in-phase images within a voxel [8,9]. Hence, CSI has been utilized to identify microscopic fat within skeletal lesions with the aim to distinguish benign from malignant marrow replacement processes [10][11][12][13][14][15][16]. Most recently, Kohl and co-workers evaluated the accuracy of CSI in the diagnosis of indeterminate skeletal lesions of the pelvis.…”