TY - JOUR

T1 - Quantitative MRI Dixon signal drop and fat fraction for differentiating bone marrow lesions: a two-center prospective analysis

AU - Metwally, M.I.

AU - Almalki, Y.E.

AU - Khalil, M.F.

AU - Alsowey, A.M.

AU - Tantawy, H.I.A.

AU - Hamed, M.G.

AU - Abdelmoneem, S.

AU - Alduraibi, S.K.

AU - Almushayti, Z.A.

AU - Alshehri, S.H.S.

AU - Basha, A.M.A.

AU - Basha, M.A.A.

N1 - Export Date: 01 November 2025; Cited By: 0; Correspondence Address: Y.E. Almalki; Division of Radiology, Department of Internal Medicine, Medical College, Najran University, Najran, Saudi Arabia; email: yealmalki@nu.edu.sa

PY - 2025/9/10

Y1 - 2025/9/10

N2 - 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.

AB - 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.

KW - Biomarkers

KW - Bone marrow

KW - Bone neoplasms

KW - Magnetic resonance imaging

KW - Sensitivity and specificity

KW - CD163 antigen

KW - CD34 antigen

KW - CD68 antigen

KW - fluorodeoxyglucose f 18

KW - gadolinium pentetate meglumine

KW - platelet endothelial cell adhesion molecule 1

KW - protein p53

KW - syndecan 1

KW - aortic calcification

KW - Article

KW - backache

KW - bleeding

KW - bone marrow edema

KW - breast cancer

KW - cell infiltration

KW - clinical decision making

KW - clinical practice

KW - cohort analysis

KW - colon cancer

KW - controlled study

KW - diagnostic accuracy

KW - diagnostic test accuracy study

KW - diffusion weighted imaging

KW - diskitis

KW - female

KW - fluid-attenuated inversion recovery imaging

KW - fluorescence in situ hybridization

KW - follow up

KW - gated single photon emission computed tomography

KW - histopathology

KW - human

KW - image analysis

KW - image quality

KW - immunohistochemistry

KW - liver cell carcinoma

KW - male

KW - multiple myeloma

KW - myelofibrosis

KW - needle biopsy

KW - nuclear magnetic resonance imaging

KW - oncogene c myc

KW - pelvic pain

KW - prospective study

KW - prostate cancer

KW - quality control

KW - quantitative analysis

KW - receiver operating characteristic

KW - rectum cancer

KW - sensitivity and specificity

KW - T1 weighted imaging

KW - T2 weighted imaging

KW - adipose tissue

KW - adolescent

KW - adult

KW - aged

KW - bone marrow

KW - bone marrow cancer

KW - clinical trial

KW - diagnostic imaging

KW - differential diagnosis

KW - middle aged

KW - multicenter study

KW - pathology

KW - procedures

KW - reproducibility

KW - very elderly

KW - young adult

KW - Adipose Tissue

KW - Adolescent

KW - Adult

KW - Aged

KW - Aged, 80 and over

KW - Bone Marrow

KW - Bone Marrow Neoplasms

KW - Diagnosis, Differential

KW - Female

KW - Humans

KW - Magnetic Resonance Imaging

KW - Male

KW - Middle Aged

KW - Prospective Studies

KW - Reproducibility of Results

KW - Sensitivity and Specificity

KW - Young Adult

KW - Magnetic Resonance Imaging/methods

KW - Bone Marrow/diagnostic imaging

KW - Adipose Tissue/diagnostic imaging

KW - Bone Marrow Neoplasms/diagnostic imaging

UR - https://www.mendeley.com/catalogue/7856b9c0-e052-33c5-920e-3f8857563788/

U2 - 10.1186/s41747-025-00615-9

DO - 10.1186/s41747-025-00615-9

M3 - статья

C2 - 40928596

VL - 9

JO - European Radiology Experimental

JF - European Radiology Experimental

SN - 2509-9280

IS - 1

ER -