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Is It Necessary Of Short Tau Inversion Recovery Image For The Evaluation Of Vertebral Metastasis In Hepatocellular Carcinoma Patients? 2013

Category General Spine Changkeun Sung
Sanghoon Lee
Kyunghee Choi
Minhee Lee
Myungjin Shin
Purpose To determine the accuracy of whole spine MRI with STIR sequence as compare with conventional T1 and T2WI for the evaluation of vertebral metastasis in hepatocellular carcinoma (HCC) patients. Materials & Methods Over the past 4 years, thirty-one HCC with vertebral metastasis patients undergone enhanced whole spine MRI with sagittal T1 and T2-weighted sequence and subsequent coronal STIR sequence. Each MR imaging sequence was retrospectively and independently reviewed by two radiologists for the presence of vertebral metastasis. Seven cervical spine, twelve thoracic spine, five lumbar spine, and sacrum were evaluated separately and a total of 775 vertebral segments were included in this study. Follow up whole spine MRI in 25 patients and follow up CT in 6 patients were evaluated and change of size or signal intensity was regarded as metastasis. We calculated sensitivity, specificity, accuracy, and interobserver agreement. Results Sensitivity, specificity, and accuracy of observer 1 in T1- and T2WI were 94%/97%/97%, combined coronal STIR image were 93%/100%/98%, observer 2 in T1- and T2WI were 87%/99%/96%, combined STIR were 93%/100%/98%. Coronal STIR image combined T1- and T2WI was diagnosed more accurately than T1- and T2WI for the evaluation of vertebral metastasis. Interobserver agreement was high (0.882). Conclusion STIR image is necessary for the evaluation of vertebral metastasis in HCC patients. References 1. Steinborn MM, Heuck AF, Tiling R, Bruegel M, Gauger L, Reiser MF. Whole-body bone marrow MRI in patients with metastatic disease to the skeletal system. J Comput Assist Tomogr 1999; 23:123-129. 2. Eustace S, Tello R, DeCarvalho V, et al. A comparison of whole-body turbo STIR MR imaging and planar 99mTc-methylene diphosphonate scintigraphy in the examination of patients with suspected skeletal metastases. AJR Am J Roentgenol 1997; 169:1655-1661. 3. Hargaden G, O'Connell M, Kavangh E, Powell T, Ward R, Eustace S. Current comcepts in whole-body imaging using turbo short tau inversion recovery MR imaging. AJR Am J Roentgenol 2003: 180:247-252. 4. Lauenstein TC, Freudenberg LS, Goehde Sc, et al. Whole-body MRI using a rolling table platform for the detection of bone metastases. Eur Radiol 2002; 12:2091-2099. 5. Walker R, Kessar P, Blanchard R, et al. Turbo STIR magnetic resonance imaging as a whole-body screening tool for metastases in patients with breast carcinoma: preliminary clinical experience. J Magn Reson Imaging 2000; 11:343-350. 6. Chan Y, Chan K, Lam W, Metreweli C. Comparison of whole body MRI and radioisotope bone scintigram for skeletal metastases detection. Chin Med J (Engl) 1997; 110:485-489. 7. Layer G, Rieker O, Dorr D, Schnakenberg D, Steudel A, Reiser M. MR tomography and bone marrow scintigraphy in the screening of skeletal metastases in patients with breast carcinoma. Rofo Fortschr Geb Rontgenstr Neuen Bildgeb Verfahr 1994; 160:448-452. 8. Altehoefer C, Ghanem N, Hogerle S, Moser E, Langer M. Comparative detectability of bone metastases and impact on therapy of magnetic resonance imaging and bone scintigraphy in patients with breast cancer. Eur J Radiol 2001; 40:16-23. 9. Haubold-Reuter BG, Duewell S, Schilcher BR, Marincek B, von Schulthess GK. The value of bone scintigraphy, bone marrow scintigraphy and fast spin-echo magnetic resonance imaging in staging of patients with malignant solid tumours: a prospective study. Eur J Nucl Med 1993; 20: 1063-1069. 10. Lauenstein TC, Goehde SC, Herborn CU, et al. Breath-hold MR imaging for whole-body tumor staging in less than 15 minutes: a feasibility study. AJR Am J Roentgenol 2002; 179:445-449. 11. Tamada T, Nagai K, Iizuka M, et al. Comparison of whole-body MR imaging and bone scintigraphy in the detection of bone metastases from breast cancer. Nippon Igaku Hoshasen Gakkai Zasshi 2000; 60:249-254. Japanese. 12. Iizuka M, Nagai K, Tamada T, Kajihara Y, Fukunaga M. Fundamental study of the detection of metastatic bone tumors with whole-body MR imaging. Nippon Igaku Hoshasen Gakkai Zasshi 1999; 59:470-472. Japanese. 13. Lauenstein TC, Goehde SC, Herborn CU, et al. Whole-body MR imaging: evaluation of patients for metastases. Radiology 2004; 233:139-148.