Abstract
ObjectivesTo evaluate whether multiparametric bone MRI (mpBMRI) utilising a combination of DWI signal, ADC and relative fat-fraction (rFF) can identify bone metastases, which provide high diagnostic biopsy yield and next-generation genomic sequencing (NGS) feasibility.MethodsA total of 150 CT-guided bone biopsies performed by interventional radiologists (3/2013 to 2/2021) at our centre were reviewed. In 43 patients, contemporaneous DWI and rFF images, calculated from 2-point T1w Dixon MRI, were available. For each biopsied lesion, a region of interest (ROI) was delineated on ADC and rFF images and the following MRI parameters were recorded: visual classification of DWI signal intensity (SI), mean, median, 10th and 90th centile ADC and rFF values. Non-parametric tests were used to compare values between tumour positive/negative biopsies and feasible/non-feasible NGS, with p-values < 0.05 deemed significant.ResultsThe mpBMRI combination high DWI signal, mean ADC < 1100 µm2/s and mean rFF < 20% identified tumour-positive biopsies with 82% sensitivity, 80% specificity, a positive predictive value (PPV) of 93% (p = 0.001) and NGS feasibility with 91% sensitivity, 78% specificity and 91% PPV (p < 0.001). The single MRI parameters DWI signal, ADC and rFF failed to distinguish between tumour-positive and tumour-negative biopsies (each p > 0.082). In NGS feasible biopsies, mean and 90th centile rFF were significantly smaller (each p < 0.041). Single ADC parameters did not show significant difference regarding NGS feasibility (each p > 0.292).ConclusionsMpBMRI utilising the combination of DWI signal, ADC and rFF can identify active bone metastases, which provide biopsy tissue with high diagnostic yield and NGS feasibility.Key Points• Multiparametric bone MRI with diffusion-weighted and relative fat-fraction images helps to identify active bone metastases suitable for CT-guided biopsy.• Target lesions for CT-guided bone biopsies in cancer patients can be chosen with greater confidence.• CT-guided bone biopsy success rates, especially yielding sufficient viable tissue for advanced molecular tissue analyses, can be improved.
Highlights
The role and frequency of CT-guided metastatic bone biopsies is increasing to determine prognosis, predict response and detect treatment resistance in cancer patients [1, 2]
Published data on using prostate-specific membrane antigen (PSMA)PET/CT for bone biopsy targeting in prostate cancer patients improved next-generation genomic sequencing (NGS) feasibility rates up to 70–90% [12, 17, 18]
Study inclusion criteria were as follows: CT-guided bone biopsy performed in our department between 01/03/2013 and 28/02/2021, availability of the biopsy CT (Bx-CT) allowing for unequivocal identification of the biopsied lesion, availability of the conclusive histopathology result and contemporaneous MRI including DWI, apparent diffusion coefficient (ADC) and relative fat fraction (rFF) images performed within 3 months prior to the biopsy
Summary
The role and frequency of CT-guided metastatic bone biopsies is increasing to determine prognosis, predict response and detect treatment resistance in cancer patients [1, 2]. Published success rates of CT-guided bone biopsies for tumour diagnosis range between 58 and 90% [1, 3,4,5,6,7,8,9,10,11,12]. Reported CT features favouring a successful bone biopsy include targeting CTlucent lesions, the periphery of high CT attenuation lesions and progressive lesions [6, 14]. Published data on using prostate-specific membrane antigen (PSMA)PET/CT for bone biopsy targeting in prostate cancer patients improved NGS feasibility rates up to 70–90% [12, 17, 18]. Being recognised as the gold standard imaging method for detecting malignant bone diseases, MRI features that are associated with a positive bone biopsy or NGS outcome have not been described [19, 20]
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