Patient-Specific Biases in Fat Fraction Estimates of Malignant Bone Marrow due to Relaxation Times Measured With...

Semiquantitative fat fraction estimation using 2-point Dixon sequences is widely used in whole-body (WB) MR imaging for malignant bone disease but is biased by relaxation times. Understanding this bias requires water- and fat-specific relaxometry data in normal-appearing marrow and lesions. This study measured bone marrow relaxation times in healthy volunteers and WB-MRI patients using MRS at 3T. Five healthy female volunteers (mean age 38.0 ± 2.5 years) and 24 patients with malignant bone disease undergoing clinical WB-MRI (13 male; mean age 67.7 ± 9.7 years; primary cancers: breast = 5, melanoma = 1, multiple myeloma = 8, prostate = 10) underwent variable inversion/echo time STEAM and 3D gradient echo fat-water imaging. MRS water and fat peaks were fitted to determine T1, T2, R2* (from linewidths) and proton density fat fraction (PDFF). Scan-rescan repeatability of MRS parameters was assessed in volunteers. Lesions were classified by disease state according to clinical reports and segmented in Dixon imaging data for comparison of fat fraction estimates with MRS. Repeatability was evaluated using coefficients of variation. Summary statistics (mean, standard deviation and range) were reported; exploratory inferential statistics were also determined with normality (Shapiro-Wilk) and variance (Levene's) tests before one-way ANOVA and Tukey's comparisons (p < 0.05). Monte-Carlo simulations assessed relaxation bias on PDFF. All quantitative MRS parameters were repeatable (coefficient of variation < 10%). Water T1 and T2 were most sensitive to disease state in patients, ranging from 1121 to 2206 and from 15 to 71 ms respectively, and were demonstrated to substantially affect 2-point Dixon fat fraction estimates with Monte-Carlo simulation. Imaging PDFF achieves closer agreement with MRS PDFF than 2-point Dixon methods. These findings remain preliminary due to the small sample size, but they suggest value in future studies with larger cohorts evaluating water relaxation times or PDFF in malignant bone disease.