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AJR Am J Roentgenol. 2017 Dec;209(6):1331-1339. doi: 10.2214/AJR.17.18168. Epub 2017 Aug 31.

Differentiation of Acute Osteoporotic and Malignant Vertebral Fractures by Quantification of Fat Fraction With a Dixon MRI Sequence.

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1 Department of Radiology, Seoul Metropolitan Government Seoul National University, Boramae Medical Center, Seoul, Korea.
2 Department of Radiology, Seoul National University College of Medicine, 103 Daehak-ro, Jongno-gu, Seoul, 03080, Korea.
3 Department of Radiology, Seoul National University College of Medicine, Seoul, Korea.
4 Institute of Radiation Medicine, Seoul National University Medical Research Center, Seoul, Korea.
5 Department of Radiology, Veterans Health Service Medical Center, Seoul, Korea.



The purpose of this study was to differentiate malignant compression fractures from acute osteoporotic compression fractures of the spine by use of a Dixon MRI sequence to quantify fat fraction (FF).


Forty-four vertebral compression fractures were assessed with turbo spin-echo T1-weighted and six-echo Dixon sequences for FF quantification at 3-T MRI. The fractures were divided into malignant compression fractures (n = 24) and acute osteoporotic compression fractures (n = 20). Two radiologists independently measured quantitative parameters from ROIs in the fractures, including the T1 signal intensity of the fracture, the FF of the fracture, and the FF ratio (fracture FF divided by normal marrow FF). The mean values of the parameters were compared between the two groups, interobserver reliability between two radiologists was assessed, ROC curves were analyzed, and logistic regression analysis was performed.


The fracture FF and FF ratio of malignant compression fractures were significantly lower than those of acute osteoporotic compression fractures (fracture FF, 2.73% vs 14.36% [p < 0.001]; FF ratio, 0.05 vs 0.22 [p < 0.001]). There was no difference in T1 signal intensity of the fracture. The ROC AUC of fracture FF was 0.98 and of FF ratio was 0.95. In logistic regression analysis, fracture FF remained a significant variable that could be used to independently differentiate malignant from acute osteoporotic compression fractures (odds ratio, 0.33; p < 0.005).


FF and FF ratio obtained from FF maps obtained with a six-echo Dixon MRI sequence may be useful for differentiating acute osteoporotic compression fractures from malignant compression fractures.


Dixon sequence; fat fraction; malignant compression fracture; osteoporotic compression fracture

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