Bone lesions in the oncohematological patient: Pearls and pitfalls In-Phase and Out- of - Phase Magenitc Resonance Imaging sequences.

Congress:

ECR 2018

Poster Number:

C-1954

Type:

Educational Exhibit

Keywords:

Metastases, Cancer, Diagnostic procedure, MR, Oncology, Musculoskeletal spine, Musculoskeletal bone, Haematologic diseases

Authors:

M. Martínez Fernández¹, C. Botía González¹, A. García Gerónimo², A. García Chiclano¹, M. J. GAYÁN BELMONTE¹, A. P. Solano Romero¹, J. Trejo Falcón¹, I. M. González Moreno¹; ¹Murcia/ES, ²Murcia, SP/ES

DOI:

10.1594/ecr2018/C-1954

DOI-Link:

https://dx.doi.org/10.1594/ecr2018/C-1954

Fig. 1: Fig. 1: (A) Sagittal T1, (B) T2 and (C) T2 Fat Sat: multiple focal lesions in...

Fig. 2: Fig. 2: (A) Sagittal IP and (B) OP: hypointense lesions in the IP sequence do...

Fig. 3: Fig. 3 (A) Sagittal IP and (B) OP: quantitative assessment in the lesion of L2,...

Fig. 4: Fig. 4. Blastic metastasis. (A) Sagittal T1, (B) T2 and (C) T2 Fatsat:...

Learning objectives

- Describe the utility of opposed phase – in phase quantitative chemical shift (OP/IP) magnetic resonance imaging (MRI) to differentiate malignant and benign osseous lesions in patients with oncohematological disease. - Highlight possibles causes of false positives or negatives of this sequence.

Background

Focal benign lesions of the spine and pelvis may sometimes mimic metastasis or lesions secondary to hematologic diseases. Although MRI using conventional T1-weighted images (T1WI) , T2-weighted images (T2WI) and fat saturation technique (STIR or T2 FSE FAT SAT) is a sensitive method for the assessment of bone marrow, it sometimes lacks specificity. In order to solve this problem, IP/OP sequence or chemical shift imaging (CSI) due to its capacity to detect the presence of microscopic fat in an osseus lesion, has been proposed as...

Findings and procedure details

We show our experience in oncohematologic patients who underwent MRI from January 2015 to date and showed focal lesions in the spine or pelvis. MRI was performed on a 1.5 T unit with our standard protocol, including : - In the spine, T1WI and T2WI spin-echo (SE) sequences in sagittal, and axial plane, STIR or T2 FSE FAT SAT and IF-OF in sagittal. - In the pelvis, T1WI and T2FSE FAT SAT in coronal, and STIR and IP/OP in axial plane. In some patients, an...

Conclusion

The specificity of malignant bone lesions in the oncohematologic patient increases with the use of conventional MRI sequences together with IP/OP chemical shift MRI and reduces the number of required biopsies.

Personal information

Contact details: Dra. Margarita Martínez Fernández Muskuloskeletal Radiology Section. Department of Radiology, Hospital J.M. Morales Meseguer, 30008, Murcia, Spain. Email: [email protected]

References

1.- Disler, D. G., McCauley, T. R., Ratner, L. M., Kesack, C. D., Cooper, J. A. In-phase and out-of-phase MR imaging of bone marrow: prediction of neoplasia based on the detection of coexistent fat and water. American Journal of Roentgenology, 1997; 169(5), 1439-1447. 2.- Kohl, C. A., Chivers, F. S., Lorans, R., Roberts, C. C., Kransdorf, M. J. Accuracy of chemical shift MR imaging in diagnosing indeterminate bone marrow lesions in the pelvis: review of a single institution’s experience. Skeletal Radiology, 2014; 43(8), 1079-1084. 3.-...