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Vertebral fracture characterization with mDIXON TSE

Case Study
Lefebvre, Guillaume, M.D. CHRU Lille • France

Patient history

A 63-year-old patient with breast cancer in remission and a recent lumbar back pain was referred to MRI to characterize vertebral fractures and to visualize the bone metastases in the spine. The exam took place in University Hospital Lille (CHRU, Lille, France)

MR examination

The patient was examined on Ingenia 3.0T (Release 5) with the integrated Posterior coil. The MRI examination included pre- and post-contrast T1W mDIXON TSE.

 

Homogeneous fat suppression is seen, also of the subcutaneous fat. Both post-contrast images, with or without fat suppression, are obtained from the same acquisition. Sagittal T1W mDIXON TSE with TR 596 ms, TE 8.3 ms, NSA 1, 4 /1.3 mm slice thickness, acquired voxel size 0.80 x 1.01 mm, reconstructed voxel size 0.63 x 0.63 mm.

Images

Click on image to enlarge.
 Pre contrast T1W in phase Post contrast T1W in phase Post-contrast T1W water
Pre contrast T1W in phase
Post contrast T1W in phase
Post-contrast T1W water

Diagnosis

Thanks to the water images the edematous changes into vertebral bodies related to recent fractures and inter spinous edema related to new biomechanical constraints are also seen. No focal lesion is seen on T1W pre-contrast in-phase or post-contrast water images.

 

The addition of post-contrast in-phase images allows to visualize homogenization of the bone marrow, suggestive of no malignancy. Diagnosis is recent osteoporotic vertebral fractures are seen at L2 and L4 levels.

Clinical impact of mDIXON TSE:

mDIXON TSE sequences provide images with and without fat suppression simultaneously and without time penalty. In addition to in-phase, out-of-phase, and T2W imaging, pre- and post-contrast T1W mDIXON sequences are particularly useful for exploring vertebral fractures. The limited number of mDIXON acquisitions helps answering both questions in the characterization (benign vs malignant) and the visualization of associated lesions. Thus, it is possible to view other lesions and the fracture line on T1W pre-contrast in phase, to assess the homogenization of the bone marrow (T1W post contrast in-phase) and confirm the absence of suspicious contrast uptake (T1W post-contrast water).

 

These mDIXON TSE sequences appear reliable thanks to the homogeneity of the fat suppression even obtained with extended fields of view at 3.0T. They reduce the total scan duration which has limits and is a source of motion artifacts especially in elderly or painful patients. Lesion visualization is improved in the peripheral areas of the field of view. Finally, the decomposition of one acquisition in different contrasts enables reliable matches without displacement, sometimes encountered when two successive acquisitions are performed.

Related reading

 

Results from case studies are not predictive of results in other cases. Results in other cases may vary.



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Dec 15, 2015

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Case Study
Ingenia 3.0T
dStream, Lumbar spine, mDIXON, mDIXON TSE, Musculoskeletal, Oncology, Vertebral fracture
 

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