Can unenhanced multiparametric MRI substitute gadolinium-enhanced MRI in the characterization of vertebral marrow infiltrative lesions?

Abstract

PurposeTo assess the diagnostic effectiveness of unenhanced-multiparametric magnetic resonance imaging (mp MRI) as an alternative to gadolinium (Gad)-enhanced MRI in the characterization of vertebral marrow infiltrative lesions. Patients and methodsA prospective evaluation of fifty-six patients with suspected or untreated vertebral metastases undergoing MRI of the spine at 1.5T was carried out. Two groups of sequences were assigned and compared for the characterization of marrow infiltrative lesions: group [A] unenhanced-mp MRI (including T1-weighted, T2-weighted, short time inversion recovery (STIR), diffusion weighted imaging (DWI) and in/opposed phase sequences) and group [B] gadolinium-enhanced MRI (including T1-weighted, T2-weighted, STIR and T1-weighted fat-suppressed gadolinium-enhanced sequence). Qualitative and quantitative image analysis was performed and compared. The sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV) and accuracy for both imaging techniques were calculated. ResultsThere was no statistical significant difference between unenhanced-multiparametric MRI and gadolinium-enhanced MRI as regards their diagnostic performance in differentiating benign from malignant vertebral marrow infiltrative lesions (p>0.05) with calculated sensitivity (94% vs. 97%), specificity (92% vs. 88%), positive predictive value (94% vs. 91%), negative predictive value (92% vs. 95%) and (93% vs. 93%) accuracy. ConclusionUnenhanced-multiparametric MRI is compatible with gadolinium-enhanced MRI in reliable characterization of marrow infiltrative lesions. The routine MRI protocol of cancer patients should be altered to accommodate the evolving MRI technology and cost effectively substitute the need for a gadolinium enhanced scan.