Affiliation:
1. Department of Radiology Kindai University Nara Hospital Ikoma Nara Japan
2. Department of Medical Physics and Engineering, Graduate School of Medicine Osaka University Suita Osaka Japan
3. Department of Surgery Tsuji Hospital Miyakojima‐ku Osaka Japan
Abstract
BackgroundOsteoporosis with low trabecular bone quality (OLB) in patients with breast cancer receiving aromatase inhibitor (AI) therapy is associated with an increased risk of vertebral fractures. The capability of chemical shift‐encoded MRI (CSE‐MRI) in detecting OLB needs to be investigated.PurposeTo assess the diagnostic performance of proton density fat fraction (PDFF) and R2* measurements from CSE‐MRI for detecting OLB in postmenopausal women with breast cancer undergoing AI therapy.Study TypeProspective.Population126 postmenopausal females (mean age: 69.5 ± 8.8 years) receiving AIs (average period: 41.6 ± 26.5 months) after breast cancer surgery.Field Strength/Sequence1.5‐T, three‐dimensional CSE‐MRI (six echoes), T1‐weighted Dixon, short tau inversion recovery, and diffusion‐weighted images.AssessmentBoth CSE‐MRI and dual‐energy x‐ray absorptiometry were performed on the same day. Measurements included averaged PDFF, R2*, bone mineral density (BMD), and trabecular bone score (TBS) from L1 to L4 vertebrae. A T‐score ≤ −2.5 from BMD measurements indicated osteoporosis, whereas T‐scores of ≤ − 2.5 plus TBS ≤‐3.7 indicated OLB. The diagnostic performance of PDFF, R2*, and the combination of PDFF and R2* for identifying osteoporosis or OLB was assessed.Statistical TestsStudent's t‐test; Mann–Whitney U test; χ2 or Fisher exact tests; Pearson correlation; multivariate analysis; Receiver operating characteristic (ROC) analysis with the area under the curve (AUC); logistic regression model; intraclass correlation coefficient. A P‐value <0.05 was considered statistically significant.ResultsFor detecting osteoporosis, AUC values were 0.59 (PDFF), 0.66 (R2*), and 0.65 (combined PDFF and R2*). Significant mean differences were noted between patients with and without OLB for PDFF (66.11 ± 5.36 vs. 57.49 ± 6.43) and R2* (46.62 ± 9.24 vs. 63.36 ± 12.44). AUC values for detecting OLB were 0.75 (PDFF), 0.82 (R2*), and 0.84 (combined PDFF and R2*).Data ConclusionR2* may perform better than PDFF for identifying OLB in patients with breast cancer receiving AIs.Level of Evidence2Technical EfficacyStage 4
Subject
Radiology, Nuclear Medicine and imaging