Differentiation of Benign and Malignant Vertebral Compression Fractures Using Qualitative and Quantitative Analysis of a Single Fast Spin-Echo T2-weighted Dixon Sequence

Presentation Format: Oral presentation.

Purpose or Learning Objective: The differentiation of benign and malignant vertebral compression fractures (VCFs) is a common clinical problem and relies on qualitative and quantitative assessment of multiple magnetic resonance imaging (MRI) sequences. Our purpose was the determination and comparison of the qualitative and quantitative diagnostic performance of a single sagittal fast spin-echo (FSE) T2-weighted Dixon sequence in differentiating benign and malignant VCFs, using multiple readers and different quantitative methods.

Methods or Background: From July 2014 to October 2019, 90 consecutive patients with spine MRI performed before cementoplasty for acute VCFs were included retrospectively. VCFs were categorized as benign (n = 61; mean age: 76 ± 13 years) or malignant (n = 29; mean age: 63 ± 13 years), based on the reference standard, biopsy, and/or ≥ 9 months of clinical and imaging follow-up. Qualitative analysis was performed independently 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 (ROIs 1 and 2) and three methods (signal drop, fat fraction [FF] from ROIs, and FF from maps). Diagnostic performance was compared using receiver operating characteristic curve analyses. Interobserver agreement was assessed using κ statistics and intraclass correlation coefficients.

Results or Findings: The qualitative diagnostic performance ranged from area under the curve (AUC) = 0.97 (95% confidence interval [CI], 0.92–1.00) to AUC = 0.99 (95% CI, 0.98–1.0). The quantitative diagnostic performance ranged from AUC = 0.82 (95% CI, 0.72–0.92) to AUC = 0.96 (95% CI, 0.92–0.99). Pairwise comparisons showed no statistical difference in diagnostic performance (all p ≥ 0.002; Bonferroni corrected p < 0.0011). All five cases with discordance among the readers were correctly diagnosed at quantitative analysis using ROI 2. Interobserver agreement was excellent for both qualitative and quantitative analysis.

Conclusion: A single FSE T2-weighted Dixon sequence can be used to differentiate benign and malignant VCFs with high diagnostic performance using both qualitative and quantitative analysis that can provide complementary information.

Publication History

Article published online:
03 June 2021