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Evaluation of MR-derived CT-like images and simulated radiographs compared to conventional radiography in patients with benign and malignant bone tumors

  • Musculoskeletal
  • Published:
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Abstract

Objectives

To evaluate the diagnostic value of MR-derived CT-like images and simulated radiographs compared with conventional radiographs in patients with benign and malignant bone tumors.

Methods

In 32 patients with a benign or malignant bone lesion (mean age 33.9 ± 18.5 years, 17 females), 3-T MR imaging was performed including a 3D T1-weighted gradient echo sequence as the basis for the CT-like images. From these, intensity-inverted MR image volumes were converted into 2D images via a forward projection to obtain simulated radiographs. Two radiologists assessed these images as well as conventional radiographs for the type of periosteal reaction, matrix mineralization and destruction pattern. Agreement between the modalities was calculated using Cohen’s κ.

Results

The agreement between conventional radiographs and MR-derived CT-like images in combination with simulated radiographs was substantial (periosteal reaction, κ = 0.67; destruction pattern, κ = 0.75), and the sensitivity of both modalities for the final diagnosis of the lesion (aggressive vs. nonaggressive) was high (MR-derived CT-like images, 86.2% vs. conventional radiographs, 90.0%). Additional information on soft tissue extension (MR-derived CT-like images, 21.9% vs. conventional radiographs, 12.5%; p = 0.009) and lobulation (9.4% vs. 0%; p < 0.001) was significantly more often found on MR-derived CT-like images compared with conventional radiographs.

Conclusions

The assessment of the destruction patterns, periosteal reaction and distinction between aggressive and nonaggressive tumors was feasible using MR-derived CT-like images and simulated radiographs and is comparable to that of conventional radiographs. Moreover, MR-derived CT-like images provided additional information on soft tissue extension and tumor architecture.

Key Points

• CT-like images and simulated radiographs can be generated from 3D MRI.

• Evaluation of bone tumors is feasible with MR-derived images.

• CT-like images and simulated radiographs provide additional information on bone tumors

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Abbreviations

AP:

Anterior-posterior

FOV:

Field of view

GPU:

Graphic processing unit

TE:

Echo time

TR:

Repetition time

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Acknowledgements

This work was presented as a scientific presentation at the 4th Annual Meeting of the German Society of Musculoskeletal Radiology in Berlin (April 2018).

Funding

The authors state that this work has not received any funding.

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Author notes

  1. Alexandra S. Gersing and Daniela Pfeiffer contributed equally to this work.

Authors and Affiliations

  1. Department of Radiology, Klinikum rechts der Isar, Technical University of Munich, Klinikum rechts der Isar, Ismaninger Straße 22, 81675, Munich, Germany

    Alexandra S. Gersing, Daniela Pfeiffer, Felix K. Kopp, Benedikt J. Schwaiger, Peter B. Noël, Marcus Settles, Ernst J. Rummeny & Klaus Woertler

  2. Chair for Biomedical Physics, Department of Physics & Munich School of BioEngineering, Technical University of Munich, Garching, Germany

    Daniela Pfeiffer & Peter B. Noël

  3. Department of Orthopaedic Surgery, Klinikum rechts der Isar, Technical University of Munich, Munich, Germany

    Carolin Knebel

  4. Institute of Medical Informatics, Statistics and Epidemiology, Technical University of Munich, Munich, Germany

    Bernhard Haller

Authors
  1. Alexandra S. Gersing
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  2. Daniela Pfeiffer
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  3. Felix K. Kopp
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  4. Benedikt J. Schwaiger
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  5. Carolin Knebel
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  6. Bernhard Haller
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  7. Peter B. Noël
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  8. Marcus Settles
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  9. Ernst J. Rummeny
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  10. Klaus Woertler
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Corresponding author

Correspondence to Alexandra S. Gersing.

Ethics declarations

Guarantor

The scientific guarantor of this publication is Dr. Klaus Woertler, M.D.

Conflict of interest

The authors of this manuscript declare no relationships with any companies, whose products or services may be related to the subject matter of the article.

Statistics and biometry

One of the authors, Dr. Bernhard Haller, Ph.D., has significant statistical expertise.

Informed consent

Written informed consent was obtained from all patients in this study.

Ethical approval

Institutional Review Board approval was obtained.

Methodology

• prospective

• diagnostic or prognostic study

• performed at one institution

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Gersing, A.S., Pfeiffer, D., Kopp, F.K. et al. Evaluation of MR-derived CT-like images and simulated radiographs compared to conventional radiography in patients with benign and malignant bone tumors. Eur Radiol 29, 13–21 (2019). https://doi.org/10.1007/s00330-018-5450-y

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  • DOI: https://doi.org/10.1007/s00330-018-5450-y

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