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DOI

  • M.I. Metwally
  • Y.E. Almalki
  • M.F. Khalil
  • A.M. Alsowey
  • H.I.A. Tantawy
  • M.G. Hamed
  • S. Abdelmoneem
  • S.K. Alduraibi
  • Z.A. Almushayti
  • S.H.S. Alshehri
  • A.M.A. Basha
  • M.A.A. Basha
Background: Bone marrow (BM) lesion differentiation remains challenging, and quantitative magnetic resonance imaging (MRI) may enhance accuracy over conventional methods. We evaluated the diagnostic value and inter-reader reliability of Dixon-based signal drop (%drop) and fat fraction percentage (%fat) as adjuncts to existing protocols. Materials and methods: In this prospective two-center study, 172 patients with BM signal abnormalities underwent standardized 1.5-T MRI protocols, including Dixon sequences. Two musculoskeletal radiologists independently evaluated images and performed quantitative measurements of %drop and %fat. Final diagnoses were established through histopathology (n = 96) or imaging follow-up (n = 76). Diagnostic value was assessed using area under the receiver operating characteristic curve (AUROC), inter-reader reliability using Cohen’s κ coefficient. Results: The consensus optimal cutoff was for %drop ≤ 19.8%, yielding 87.2% accuracy, 95.3% sensitivity, and 73.8% specificity, and that for %fat was ≤ 18.3%, achieving 86.6% accuracy, 96.3% sensitivity, and 70.8% specificity. Both metrics showed high diagnostic performance (AUROC 0.824–0.863) and excellent inter-reader reliability (κ > 0.93, p < 0.001). Multivariate analysis identified %drop ≤ 19.8% and %fat ≤ 18.3% as the strongest independent predictors of malignancy, with odds ratio (OR) being 9.38 and 8.85, respectively (p < 0.001). Signal characteristics on Dixon sequences provided additional diagnostic value, with signal voids on fat-only images (OR 7.14) and high signals on water-only images (OR 5.46). Conclusion: Quantitative MRI Dixon imaging parameters demonstrated high diagnostic accuracy and excellent inter-reader reliability in differentiating benign and malignant BM lesions, supporting their implementation in clinical practice protocols as a reproducible adjunct to conventional MRI. Relevance statement: Quantitative Dixon MRI provides reproducible, noninvasive differentiation of bone marrow lesions with high diagnostic accuracy across anatomical sites, enhancing clinical decision-making with standardized thresholds while demonstrating excellent inter-center consistency. Key Points: Quantitative Dixon MRI thresholds of %drop ≤ 19.8% and %fat ≤ 18.3% were established as reliable predictors of malignancy in bone marrow lesions. Dixon metrics demonstrated superior diagnostic accuracy (86.6–87.2%), compared to conventional T1-weighted sequences (79.2%). Excellent inter-reader reliability (κ = 0.895–0.943) supports the reproducibility of quantitative Dixon MRI in clinical practice. © 2025 Elsevier B.V., All rights reserved.
Original languageEnglish
JournalEuropean Radiology Experimental
Volume9
Issue number1
DOIs
StatePublished - 10 Sep 2025

    Research areas

  • Biomarkers, Bone marrow, Bone neoplasms, Magnetic resonance imaging, Sensitivity and specificity, CD163 antigen, CD34 antigen, CD68 antigen, fluorodeoxyglucose f 18, gadolinium pentetate meglumine, platelet endothelial cell adhesion molecule 1, protein p53, syndecan 1, aortic calcification, Article, backache, bleeding, bone marrow edema, breast cancer, cell infiltration, clinical decision making, clinical practice, cohort analysis, colon cancer, controlled study, diagnostic accuracy, diagnostic test accuracy study, diffusion weighted imaging, diskitis, female, fluid-attenuated inversion recovery imaging, fluorescence in situ hybridization, follow up, gated single photon emission computed tomography, histopathology, human, image analysis, image quality, immunohistochemistry, liver cell carcinoma, male, multiple myeloma, myelofibrosis, needle biopsy, nuclear magnetic resonance imaging, oncogene c myc, pelvic pain, prospective study, prostate cancer, quality control, quantitative analysis, receiver operating characteristic, rectum cancer, sensitivity and specificity, T1 weighted imaging, T2 weighted imaging, adipose tissue, adolescent, adult, aged, bone marrow, bone marrow cancer, clinical trial, diagnostic imaging, differential diagnosis, middle aged, multicenter study, pathology, procedures, reproducibility, very elderly, young adult, Adipose Tissue, Adolescent, Adult, Aged, Aged, 80 and over, Bone Marrow, Bone Marrow Neoplasms, Diagnosis, Differential, Female, Humans, Magnetic Resonance Imaging, Male, Middle Aged, Prospective Studies, Reproducibility of Results, Sensitivity and Specificity, Young Adult, Magnetic Resonance Imaging/methods, Bone Marrow/diagnostic imaging, Adipose Tissue/diagnostic imaging, Bone Marrow Neoplasms/diagnostic imaging

ID: 143469043