Black bone MRI morphometry for mandibular cortical bone measurement in head and neck cancer patients: Prospective method comparison with CT

Abstract

Objectives To determine the utility of low-flip angle black bone magnetic resonance imaging (MRI) for cortical mandibular bone assessment by comparing interdentium cortical measurements and inter-observer morphometric variability in relation to computed tomography (CT). Methods Quantification of cortical mandible bone width was performed as per Hamada et al. at 15 cross-sectional interdentium locations on pre-treatment black bone MRI and CT for 15 oropharyngeal cancer patients, with inter-observer analyses on a subset of 3 patients by 11 observers. Bland-Altman limits of agreement and bias estimation, Lin s concordance correlation (LCC), and Deming orthogonal regression were used to compare CT and MRI measurements. The absolute variance and intraclass correlation coefficient (ICC) were implemented for the inter-observer error quantification. Results Both the Bland Altman and Deming regression analyses showed CT and black bone MRI measurements were comparable within ±0.85 mm limits of agreement, and systematically smaller for MRI. LCC (0.60[0.52;0.67]) showed moderate equivalence between modalities. The average absolute variance between the observers was similar on CT (1.13±0.06 mm) and MRI (1.15 ±0.06 mm). The ICC analyses showed that measurement consistency was significantly higher (p<0.001) for the black bone MRI (0.43[0.32;0.56]) than CT (0.22[0.13;0.35]); nonetheless, the ICC was poor for both modalities. Conclusions Black bone MR sequence is usable as an alternative to CT for cortical mandible bone measurements, allowing use for early detection of cortical alteration (e.g. osteonecrosis). The cortical bone measurements showed substantive but equivalent inter-observer variation on both CT and black bone MRI. (Semi)automated measurement may mitigate this in future work.