Korean J Radiol.  2019 Jun;20(6):916-930. 10.3348/kjr.2018.0032.

Simultaneous Estimation of the Fat Fraction and Râ‚‚* Via Tâ‚‚*-Corrected 6-Echo Dixon Volumetric Interpolated Breath-hold Examination Imaging for Osteopenia and Osteoporosis Detection: Correlations with Sex, Age, and Menopause

• Kim D
• Kim SK
• Lee SJ
• Choo HJ
• Park JW
• Kim KY

• KMID: 2447070
• DOI: http://doi.org/10.3348/kjr.2018.0032

Abstract

OBJECTIVE
To investigate the relationships of T2 *-corrected 6-echo Dixon volumetric interpolated breath-hold examination (VIBE) imaging-based fat fraction (FF) and R2 * values with bone mineral density (BMD); determine their associations with sex, age, and menopause; and evaluate the diagnostic performance of the FF and R2 * for predicting osteopenia and osteoporosis.
MATERIALS AND METHODS
This study included 153 subjects who had undergone magnetic resonance (MR) imaging, including MR spectroscopy (MRS) and T2 *-corrected 6-echo Dixon VIBE imaging. The FF and R2 * were measured at the L4 vertebra. The male and female groups were divided into two subgroups according to age or menopause. Lin's concordance and Pearson's correlation coefficients, Bland-Altman 95% limits of agreement, and the area under the curve (AUC) were calculated.
RESULTS
The correlation between the spectroscopic and 6-echo Dixon VIBE imaging-based FF values was statistically significant for both readers (pc = 0.940 [reader 1], 0.908 [reader 2]; both p < 0.001). A small measurement bias was observed for the MRS-based FF for both readers (mean difference = −0.3% [reader 1], 0.1% [reader 2]). We found a moderate negative correlation between BMD and the FF (r = −0.411 [reader 1], −0.436 [reader 2]; both p <0.001) with younger men and premenopausal women showing higher correlations. R2 * and BMD were more significantly correlated in women than in men, and the highest correlation was observed in postmenopausal women (r = 0.626 [reader 1], 0.644 [reader 2]; both p < 0.001). For predicting osteopenia and osteoporosis, the FF had a higher AUC in men and R2 * had a higher AUC in women. The AUC for predicting osteoporosis was highest with a combination of the FF and R2 * in postmenopausal women (AUC = 0.872 [reader 1], 0.867 [reader 2]; both p < 0.001).
CONCLUSION
The FF and R2 * measured using T2 *-corrected 6-echo Dixon VIBE imaging can serve as predictors of osteopenia and osteoporosis. R2 * might be useful for predicting osteoporosis, especially in postmenopausal women.

Keyword

Osteoporosis; Magnetic resonance imaging; Fat fraction; Râ‚‚*; Bone marrow

MeSH Terms

Area Under Curve
Bias (Epidemiology)
Bone Density
Bone Diseases, Metabolic*
Bone Marrow
Female
Humans
Magnetic Resonance Imaging
Magnetic Resonance Spectroscopy
Male
Menopause*
Osteoporosis*
Spine

Figure

• 

  Fig. 1 71-year-old female subject with lower back pain.Screen-captured images of single-voxel T2-corrected multi-echo MRS (A) and T2*-corrected 6-echo Dixon VIBE imaging (B).A. FF of single-voxel HISTO MRS scan. Each water and fat integral at five echoes (TE = 12, 24, 36, 48, and 72 ms; top left) with estimated FF of 48.8% (bottom left). Water and fat spectral peaks at TE of 12 ms are shown. Red curve represents 1.3-ppm fat spectrum, and blue curve represents 4.7-ppm water spectrum (top right). Image on right shows T2 exponential decay curve. Chem. = chemical, CI = confidence interval, FF = fat fraction, HISTO = high-speed T2-corrected multi-echo, MRS = magnetic resonance spectroscopy, rsq = r-squared, S.I. (a.u.) = signal intensity (arbitrary units), TE = echo time, VIBE = volumetric interpolated breath-hold examination B. Measurement of FF and R2* at MR imaging workstation (Syngo software; Siemens Healthineers). Free-drawn polygonal ROIs was located at least 2 mm from endplate and excluded basivertebral plexus. ROIs were drawn on fat-only images (top left) and directly copied onto R2* map (bottom right). FF and R2* are displayed as histograms (right). FF = fat fraction, MR = magnetic resonance, MRS = magnetic resonance spectroscopy, ROI = region of interest, SD = standard deviation, VIBE = volumetric interpolated breath-hold examination

• 

  Fig. 2 Comparison between FF values measured with T2*-corrected 6-echo Dixon VIBE imaging and MRS at L4 vertebra.pc for assessment of agreement between FF values measured via MRS and T2*-corrected 6-echo Dixon VIBE imaging (reader 1, A; reader 2, B). Correlation between spectroscopic and T2*-corrected 6-echo Dixon VIBE-based FF values was statistically significant for readers 1 and 2 (both p < 0.001). pc values for readers 1 and 2 were 0.940 and 0.908, respectively. CCC = concordance correlation coefficient, GRE = gradient echo, 3D = three-dimensional

• 

  Fig. 3 Correlations between BMD and FF or R2*.A. Scatterplot displaying correlation between FF obtained via T2*-corrected 6-echo Dixon VIBE imaging and areal BMD (g/cm2; reader 1, A-left; reader 2, A-right). Moderate negative correlation between FF and areal BMD was found (r = −0.411 [reader 1], −0.436 [reader 2]; both p < 0.001). B. Scatterplot displaying correlation between R2* and areal BMD (g/cm2; reader 1, B-left; reader 2, B-right). Weak positive correlation between R2* and areal BMD was found (r = 0.358 [reader 1], 0.353 [reader 2]; both p <0.001). BMD = bone mineral density

• 

  Fig. 4 Bland-Altman plots showing mean measurement bias with limits of agreement for FF derived from T2*-corrected 6-echo Dixon VIBE imaging relative to that measured with MRS.Mean measurement bias for reader 1 (A) was −0.3% (range, −6.4–5.8%), and mean measurement bias for reader 2 (B) was 0.1% (range, −4.8–5.0%). Mean bias is shown as solid line, and limits of agreement are shown as dashed lines.

• 

  Fig. 5 Graphs showing ROC curves of readers 1 and 2 for predicting osteopenia (reader 1, A-left; reader 2, A-right) and osteoporosis (reader 1, B-left; reader 2, B-right) using FF, R2*, or combination of FF and R2*.ROC analysis demonstrated that combination of FF and R2* improved diagnostic performance for predicting osteopenia and osteoporosis for both readers. AUC = area under curve, ROC = receiver operating characteristic

• 

  Fig. 6 ROC analysis of FF, R2*, and combination of FF and R2* for predicting osteopenia (reader 1, A-left; reader 2, A-right) and osteoporosis (reader 1, B-left; reader 2, B-right) in older men.ROC analysis demonstrated that AUCs for FF were higher than those for R2* for both readers. However, ROC curve showed only minor improvements in diagnostic performance for predicting osteopenia and osteoporosis.

• 

  Fig. 7 ROC analysis of FF, R2*, and combination of FF and R2* for predicting osteopenia (reader 1, A-left; reader 2, A-right) and osteoporosis (reader 1, B-left; reader 2, B-right) in postmenopausal women.ROC analysis demonstrated that AUCs for R2* were excellent for both readers. However, there was no significant difference in AUCs between FF, R2*, and combination of FF and R2*.

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