Abstract
Objective
MRI signal intensity of pediatric bone marrow can be difficult to interpret using conventional methods. Chemical shift imaging (CSI), which can quantitatively assess relative fat content, may improve the ability to accurately diagnose bone marrow abnormalities in children.
Methods
Consecutive pelvis and extremity MRI at a children’s hospital over three months were retrospectively reviewed for inclusion of CSI. Medical records were reviewed for final pathological and/or clinical diagnosis. Cases were classified as normal or abnormal, and if abnormal, subclassified as marrow-replacing or non-marrow-replacing entities. Regions of interest (ROI) were then drawn on corresponding in and out-of-phase sequences over the marrow abnormality or over a metaphysis and epiphysis in normal studies. Relative signal intensity ratio for each case was then calculated to determine the degree of fat content in the ROI.
Results
In all, 241 MRI were reviewed and 105 met inclusion criteria. Of these, 61 had normal marrow, 37 had non-marrow-replacing entities (osteomyelitis without abscess n = 17, trauma n = 9, bone infarction n = 8, inflammatory arthropathy n = 3), and 7 had marrow-replacing entities (malignant neoplasm n = 4, bone cyst n = 1, fibrous dysplasia n = 1, and Langerhans cell histiocytosis n = 1). RSIR averages were: normal metaphyseal marrow 0.442 (0.352–0.533), normal epiphyseal marrow 0.632 (0.566–698), non-marrow-replacing diagnoses 0.715 (0.630–0.799), and marrow-replacing diagnoses 1.06 (0.867–1.26). RSIR for marrow-replacing entities proved significantly different from all other groups (p < 0.05). ROC analysis demonstrated an AUC of 0.89 for RSIR in distinguishing marrow-replacing entities.
Conclusion
CSI techniques can help to differentiate pathologic processes that replace marrow in children from those that do not.
Similar content being viewed by others
References
Foster K, Chapman S, Johnson K. MRI of the marrow in the paediatric skeleton. Clin Radiol. 2004;59(8):651–73.
Dreizin D, Ahlawat S, Del Grande F, Fayad LM. Gradient-echo in-phase and opposed-phase chemical shift imaging: role in evaluating bone marrow. Clin Radiol. 2014;69(6):648–57.
Vogler 3rd JB, Murphy WA. Bone marrow imaging. Radiology. 1988;168(3):679–93.
Laor T, Jaramillo D. MR imaging insights into skeletal maturation: what is normal? Radiology. 2009;250(1):28–38.
Guillerman RP. Marrow: red, yellow and bad. Pediatr Radiol. 2013;43 Suppl 1:S181–92.
Outwater EK, Mitchell DG. Differentiation of adrenal masses with chemical shift MR imaging. Radiology. 1994;193(3):877–8.
Pokharel SS, Macura KJ, Kamel IR, Zaheer A. Current MR imaging lipid detection techniques for diagnosis of lesions in the abdomen and pelvis. Radiographics. 2013;33(3):681–702.
Ream JM, Gaing B, Mussi TC, Rosenkrantz AB. Characterization of adrenal lesions at chemical-shift MRI: a direct intraindividual comparison of in- and opposed-phase imaging at 1.5 T and 3 T. AJR Am J Roentgenol. 2015;204(3):536–41.
Hood MN, Ho VB, Smirniotopoulos JG, Szumowski J. Radiographics. 1999;19(2):357–71.
Ma J. Dixon techniques for water and fat imaging. J Magn Reson Imaging. 2008;28:543–58.
Costa DN, Pedrosa I, McKenzie C, Reeder SB, Rofsky NM. Body MRI using IDEAL. AJR Am J Roentgenol. 2008;190(4):1076–84.
Gerdes CM, Kijowski R, Reeder SB. IDEAL Imaging of the musculoskeletal system: robust water-fat separation for uniform fat suppression, marrow evaluation, and cartilage imaging. AJR Am J Roentgenol. 2007;189:W284–91.
Wismer GL, Rosen BR, Buxton R, et al. Chemical shift imaging of bone marrow: preliminary experience. AJR Am J Roentgenol. 1985;145:1031–7.
Sepponen RESJ, Tanttu JI. A method for chemical shift imaging: demonstration of bone marrow involvement with proton chemical shift imaging. J Comput Assist Tomogr. 1984;8:585–7.
Fayad LM, Jacobs MA, Wang X, et al. Musculoskeletal tumors: how to use anatomic, functional, and metabolic MR techniques. Radiology. 2012;265:340–56.
Disler DG, McCauley TR, Ratner LM, et al. In-phase and out-of-phase MR imaging of bone marrow: prediction of neoplasia based on the detection of coexistent fat and water. AJR Am J Roentgenol. 1997;169:1439–47.
Zajick DC, Morrison WB, Schweitzer ME, et al. Benign and malignant processes: normal values and differentiation with chemical shift MR imaging in vertebral marrow. Radiology. 2005;237:590–6.
Erly WK, Oh ES, Outwater EK. The utility of in-phase/opposed-phase imaging in differentiating malignancy from acute benign compression fractures of the spine. AJNR Am J Neuroradiol. 2006;27:1183–8.
Zampa V, Cosottini M, Michelassi M, et al. Value of opposed-phase gradient-echo technique in distinguishing between benign and malignant vertebral lesions. Eur Radiol. 2002;12:1811–8.
Thawait SK, Marcus MA, Morrison WB, et al. Research synthesis: what is the diagnostic performance of magnetic resonance imaging to discriminate benign from malignant vertebral compression fractures? Systematic review and meta-analysis. Spine. 2012;37:E736–44.
Author information
Authors and Affiliations
Corresponding author
Ethics declarations
Conflict of Interest
The authors declare that they have no conflict of interest.
Ethical approval
All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.
Informed consent
Informed consent was waived due to the retrospective nature of the study.
Rights and permissions
About this article
Cite this article
Winfeld, M., Ahlawat, S. & Safdar, N. Utilization of chemical shift MRI in the diagnosis of disorders affecting pediatric bone marrow. Skeletal Radiol 45, 1205–1212 (2016). https://doi.org/10.1007/s00256-016-2403-x
Received:
Revised:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s00256-016-2403-x