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MRI Evaluation of Suspected Pathologic Fracture at the Extremities from Metastasis: Diagnostic Value of Added Diffusion-Weighted Imaging
OBJECTIVE: To assess the diagnostic value of combining diffusion-weighted imaging (DWI) with conventional magnetic resonance imaging (MRI) for differentiating between pathologic and traumatic fractures at extremities from metastasis. MATERIALS AND METHODS: Institutional Review Board approved this re...
Autores principales: | , , , , , |
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Formato: | Online Artículo Texto |
Lenguaje: | English |
Publicado: |
The Korean Society of Radiology
2019
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Materias: | |
Acceso en línea: | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6470093/ https://www.ncbi.nlm.nih.gov/pubmed/30993932 http://dx.doi.org/10.3348/kjr.2018.0545 |
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author | Park, Sun-Young Lee, Min Hee Jeon, Ji Young Chung, Hye Won Lee, Sang Hoon Shin, Myung Jin |
author_facet | Park, Sun-Young Lee, Min Hee Jeon, Ji Young Chung, Hye Won Lee, Sang Hoon Shin, Myung Jin |
author_sort | Park, Sun-Young |
collection | PubMed |
description | OBJECTIVE: To assess the diagnostic value of combining diffusion-weighted imaging (DWI) with conventional magnetic resonance imaging (MRI) for differentiating between pathologic and traumatic fractures at extremities from metastasis. MATERIALS AND METHODS: Institutional Review Board approved this retrospective study and informed consent was waived. This study included 49 patients each with pathologic and traumatic fractures at extremities. The patients underwent conventional MRI combined with DWI. For qualitative analysis, two radiologists (R1 and R2) independently reviewed three imaging sets with a crossover design using a 5-point scale and a 3-scale confidence level: DWI plus non-enhanced MRI (NEMR; DW set), NEMR plus contrast-enhanced fat-saturated T1-weighted imaging (CEFST1; CE set), and DWI plus NEMR plus CEFST1 (combined set). McNemar's test was used to compare the diagnostic performances among three sets and perform subgroup analyses (single vs. multiple bone abnormality, absence/presence of extra-osseous mass, and bone enhancement at fracture margin). RESULTS: Compared to the CE set, the combined set showed improved diagnostic accuracy (R1, 84.7 vs. 95.9%; R2, 91.8 vs. 95.9%, p < 0.05) and specificity (R1, 71.4% vs. 93.9%, p < 0.005; R2, 85.7% vs. 98%, p = 0.07), with no difference in sensitivities (p > 0.05). In cases of absent extra-osseous soft tissue mass and present fracture site enhancement, the combined set showed improved accuracy (R1, 82.9–84.4% vs. 95.6–96.3%, p < 0.05; R2, 90.2–91.1% vs. 95.1–95.6%, p < 0.05) and specificity (R1, 68.3–72.9% vs. 92.7–95.8%, p < 0.005; R2, 83.0–85.4% vs. 97.6–98.0%, p = 0.07). CONCLUSION: Combining DWI with conventional MRI improved the diagnostic accuracy and specificity while retaining sensitivity for differentiating between pathologic and traumatic fractures from metastasis at extremities. |
format | Online Article Text |
id | pubmed-6470093 |
institution | National Center for Biotechnology Information |
language | English |
publishDate | 2019 |
publisher | The Korean Society of Radiology |
record_format | MEDLINE/PubMed |
spelling | pubmed-64700932019-05-01 MRI Evaluation of Suspected Pathologic Fracture at the Extremities from Metastasis: Diagnostic Value of Added Diffusion-Weighted Imaging Park, Sun-Young Lee, Min Hee Jeon, Ji Young Chung, Hye Won Lee, Sang Hoon Shin, Myung Jin Korean J Radiol Musculoskeletal Imaging OBJECTIVE: To assess the diagnostic value of combining diffusion-weighted imaging (DWI) with conventional magnetic resonance imaging (MRI) for differentiating between pathologic and traumatic fractures at extremities from metastasis. MATERIALS AND METHODS: Institutional Review Board approved this retrospective study and informed consent was waived. This study included 49 patients each with pathologic and traumatic fractures at extremities. The patients underwent conventional MRI combined with DWI. For qualitative analysis, two radiologists (R1 and R2) independently reviewed three imaging sets with a crossover design using a 5-point scale and a 3-scale confidence level: DWI plus non-enhanced MRI (NEMR; DW set), NEMR plus contrast-enhanced fat-saturated T1-weighted imaging (CEFST1; CE set), and DWI plus NEMR plus CEFST1 (combined set). McNemar's test was used to compare the diagnostic performances among three sets and perform subgroup analyses (single vs. multiple bone abnormality, absence/presence of extra-osseous mass, and bone enhancement at fracture margin). RESULTS: Compared to the CE set, the combined set showed improved diagnostic accuracy (R1, 84.7 vs. 95.9%; R2, 91.8 vs. 95.9%, p < 0.05) and specificity (R1, 71.4% vs. 93.9%, p < 0.005; R2, 85.7% vs. 98%, p = 0.07), with no difference in sensitivities (p > 0.05). In cases of absent extra-osseous soft tissue mass and present fracture site enhancement, the combined set showed improved accuracy (R1, 82.9–84.4% vs. 95.6–96.3%, p < 0.05; R2, 90.2–91.1% vs. 95.1–95.6%, p < 0.05) and specificity (R1, 68.3–72.9% vs. 92.7–95.8%, p < 0.005; R2, 83.0–85.4% vs. 97.6–98.0%, p = 0.07). CONCLUSION: Combining DWI with conventional MRI improved the diagnostic accuracy and specificity while retaining sensitivity for differentiating between pathologic and traumatic fractures from metastasis at extremities. The Korean Society of Radiology 2019-05 2019-03-20 /pmc/articles/PMC6470093/ /pubmed/30993932 http://dx.doi.org/10.3348/kjr.2018.0545 Text en Copyright © 2019 The Korean Society of Radiology http://creativecommons.org/licenses/by-nc/4.0/ This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/4.0/) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited. |
spellingShingle | Musculoskeletal Imaging Park, Sun-Young Lee, Min Hee Jeon, Ji Young Chung, Hye Won Lee, Sang Hoon Shin, Myung Jin MRI Evaluation of Suspected Pathologic Fracture at the Extremities from Metastasis: Diagnostic Value of Added Diffusion-Weighted Imaging |
title | MRI Evaluation of Suspected Pathologic Fracture at the Extremities from Metastasis: Diagnostic Value of Added Diffusion-Weighted Imaging |
title_full | MRI Evaluation of Suspected Pathologic Fracture at the Extremities from Metastasis: Diagnostic Value of Added Diffusion-Weighted Imaging |
title_fullStr | MRI Evaluation of Suspected Pathologic Fracture at the Extremities from Metastasis: Diagnostic Value of Added Diffusion-Weighted Imaging |
title_full_unstemmed | MRI Evaluation of Suspected Pathologic Fracture at the Extremities from Metastasis: Diagnostic Value of Added Diffusion-Weighted Imaging |
title_short | MRI Evaluation of Suspected Pathologic Fracture at the Extremities from Metastasis: Diagnostic Value of Added Diffusion-Weighted Imaging |
title_sort | mri evaluation of suspected pathologic fracture at the extremities from metastasis: diagnostic value of added diffusion-weighted imaging |
topic | Musculoskeletal Imaging |
url | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6470093/ https://www.ncbi.nlm.nih.gov/pubmed/30993932 http://dx.doi.org/10.3348/kjr.2018.0545 |
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