In-phase and out-of-phase MR imaging of bone marrow: Prediction of neoplasia based on the detection of coexistent fat and water

OBJECTIVE. The purpose of this study was to determine if gradient-echo MR imaging with TEs selected with fat and water in phase and out of phase can help predict the likelihood of neoplastic or nonneoplastic lesions in bone marrow. SUBJECTS AND METHODS. Thirty consecutive patients with 31 suspected bone marrow lesions underwent MR imaging, including two spoiled gradient-echo sequences identical in all parameters except TE, which was chosen such that fat and water were either in phase or out of phase. Relative ratios of the abnormal bone marrow signal intensity and a control site on the in-phase and out-of-phase images were expressed. The images were also assessed independently by mio reviewers who were unaware of the patients' identities and clinical histories. Reviewers assessed decreased marrow signal intensity relative to control sites on the out-of-phase and in-phase images. Pathologic confirmation was obtained in 16 patients (17 lesions); the remainder of patients had either established diagnoses or determination of benignity based on stability of findings at 1 year. Relative ratios were compared with the Student's t test and receiver operating characteristic (ROC) curve analysis, and the reviewers' scores were evaluated with ROC curve analysis. RESULTS. The relative signal-intensity ratios were 1.03 +/- 0.13 for the neoplastic group and 0.62 +/- 0.13 for the nonneoplastic group (p < .0001). ROC curve analysis of the signal-intensity ratios showed a z-score of .99. A ratio cutoff value of 0.81 resulted in a 95% sensitivity and a 95% specificity for detection of neoplasm. Both reviewers achieved 100% sensitivity and 94-100% specificity for detection of neoplasms. CONCLUSION. In-phase and out-of-phase gradient-echo MR imaging of bone marrow signal-intensity abnormalities can help predict the likelihood of neoplastic or nonneoplastic lesions.