Advanced MR imaging of bone marrow: quantification of signal alterations on T1-weighted Dixon and T2-weighted Dixon sequences in red marrow, yellow marrow, and pathologic marrow lesions

Objectives: To quantify and compare signal intensity (SI) changes on T1-weighted (W) and T2W Dixon imaging in yellow marrow, red marrow, and bone marrow lesions. Materials and methods: A total of 141 patients (77 controls, 64 lesions—33 benign, 31 malignant) between January 2016 and December 2017 were retrospectively identified. For the control group, fixed 2-cm² region of interests (ROI) were drawn at L5, bilateral ilium and femurs on in-phase and opposed-phase T1W and T2W Dixon images. For the lesion group, ROIs of best fit were drawn around each lesion on in-phase and opposed-phase T2W Dixon images. SI changes between in-phase and opposed phase maps for each group were compared. Inter-reader analysis was performed. Results: Yellow marrow exhibited smaller SI changes as compared to red marrow on both T1W and T2W Dixon imaging at all locations (p < 0.0001) except at L5 on T2W Dixon imaging (p = 0.206). Both benign and malignant lesions showed significantly smaller SI changes as compared to both yellow (p = 0.0087, p < 0.0001) and red marrow (p = 0.0004, p < 0.0001) on T2W Dixon imaging. Malignant lesions exhibited smaller SI change as compared to benign lesions on T2W Dixon imaging (p = 0.0005). Signal intensity loss on both red and yellow marrow were smaller on T1W Dixon as compared to T2W Dixon (0.49–0.64, 0.27–0.31 vs. 0.70–0.74, 0.48–0.71). Inter-reader agreements were excellent (0.91–0.97). Conclusions: SI change calculated from T2-weighted Dixon imaging can adequately differentiate between yellow marrow, red marrow, and osseous lesions, both benign and malignant.