Abstract
ObjectiveTo determine which of four Dixon image types [in-phase (IP), out-of-phase (OP), fat only (FO) and water-only (WO)] is most sensitive for detecting multiple myeloma (MM) focal lesions on whole body MRI (WB-MRI) images.MethodsThirty patients with clinically-suspected MM underwent WB-MRI at 3 Tesla. Unenhanced IP, OP, FO and WO Dixon images were generated and read by four radiologists. On each image type, each radiologist identified and labelled all visible myeloma lesions in the bony pelvis. Each identified lesion was compared with a reference standard consisting of pre- and post-contrast Dixon and diffusion weighted imaging (read by a further consultant radiologist) to determine whether the lesion was truly positive. Lesion count, true positives, sensitivity, and positive predictive value were compared across the four Dixon image types.ResultsLesion count, true positives, sensitivity and confidence scores were all significantly higher on FO images than on IP images (p>0.05).DiscussionFO images are more sensitive than other Dixon image types for MM focal lesions, and should be preferentially read by radiologists to improve diagnostic accuracy and reporting efficiency.
Highlights
In recent years, whole body-MRI (WB-MRI) has emerged as a valuable tool for assessing disease activity in multiple myeloma (MM).[1,2,3,4,5] MRI is a key component of the Durie-Salmon PLUS staging system[6], and the number of lesions identified on MRI correlates closely with mortality.[7]
fat only (FO) images are more sensitive than other Dixon image types for MM focal lesions, and should be preferentially read by radiologists to improve diagnostic accuracy and reporting efficiency
The IP images can be viewed in a similar fashion to conventional T1-weighted images, whilst water and fat can be separately evaluated on WO and FO images
Summary
Thirty patients with clinically-suspected MM underwent WB-MRI at 3 Tesla. Unenhanced IP, OP, FO and WO Dixon images were generated and read by four radiologists. Each radiologist identified and labelled all visible myeloma lesions in the bony pelvis. Each identified lesion was compared with a reference standard consisting of pre- and post-contrast Dixon and diffusion weighted imaging (read by a further consultant radiologist) to determine whether the lesion was truly positive. True positives, sensitivity, and positive predictive value were compared across the four Dixon image types
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