Comparison of FRACTURE MRI, Conventional Radiography, and CT in the Evaluation of Bone Tumors

Purpose To evaluate the intermodality and interobserver agreement of fast field echo resembling a CT using restricted echo-spacing (FRACTURE) MRI with conventional radiography and CT in assessing bone tumors. Materials and Methods This retrospective study included patients with histopathologically confirmed bone tumors who underwent FRACTURE MRI and radiography over a 10-month period; a subset also underwent CT. Two independent readers assessed lesion features across modalities, with agreement calculated using Cohen κ. Results Among 161 patients (median age, 18 years [IQR, 13.5-31]; 95 male), FRACTURE showed near-perfect/perfect agreement with conventional radiography for lesion type (κ = 0.96 and 0.86, for reader 1 and reader 2, respectively) and treatment response (κ = 1.00, 1.00), near-perfect/substantial agreement for both fractures (κ = 0.95, 0.76) and lesion location (κ = 0.95, 0.79), and near-perfect/moderate agreement for matrix content (κ = 0.89, 0.56). Agreement was substantial for extraosseous soft tissue (κ = 0.74, 0.65) and osteochondral defects (κ = 0.75, 0.75) and moderate for lesion margins (κ = 0.42, 0.59). Cortical integrity showed moderate to near-perfect agreement (range, κ = 0.46-0.85) and periosteal reactions fair to near-perfect agreement (range, κ = 0.34-0.91), depending on subtype and reader. In the CT subset (n = 69), FRACTURE maintained near-perfect/perfect agreement for lesion type (κ = 0.90, 0.84), location (κ = 1.00, 0.94), extraosseous soft tissue (κ = 0.96, 0.85), fractures (κ = 0.95, 0.96), treatment response (κ = 1.00, 1.00), and osteochondral defects (κ = 1.00, 1.00). Near-perfect/substantial agreement was present for matrix content (κ = 0.81, 0.61). Cortical integrity and periosteal reaction showed fair to near-perfect agreement (range, κ = 0.25-0.81, 0.33-0.91). Conclusion FRACTURE MRI demonstrated high agreement with radiography and CT in evaluating most bone tumor features. Keywords: Conventional Radiography, MR Imaging, Skeletal-Appendicular, FRACTURE Sequence, 3D T1 GRE, Bone Tumors, MRI, Osteosarcoma Supplemental material is available for this article. © RSNA, 2026.