Annual Scientific Meeting Abstracts of the International Skeletal Society
(ISS) 2018, Berlin, Germany
Special Scientific Session Program
Monday, September 24, 2018
Ad Hoc Scientific Session Committee:
Julie Fanburg-Smith, MD
Alice S. Ha, MD
Kenneth S. Lee, MD
Thomas M. Link, MD, PhD
Luca M. Sconfienza, MD, PhD
Reto Sutter, MD
Chair: Miriam A. Bredella, MD
Moderators: Miriam A. Bredella, USA; Luca M. Sconfienza, Italy
13:30. Bone Metastases in Non-Small Cell Lung Cancer: Assessment
of Early Treatment Response to Target Therapy with 3T
Multiparametric MR Imaging
Jaejung Lim, Won-Hee Jee, Seul Ki Lee, Joon-Yong Jung, Ie-Ryung Yoo,
Jun-Pyo Myong, Jin Hyoung Kang, Yohan Son, Mun Young Paek,
Soojung Kim. Seoul, Republic of Korea.
Purpose: To prospectively investigate the early response of bone metas-
tases to target therapy with 3T multiparametric MR imaging in non-small
cell lung cancer (NSCLC) patients with positive epidermal growth factor
Materials and Methods: The institutional review board approved this
prospective study and written informed consent was obtained. Thirteen
EGFR positive NSCLC patients underwent 3T MR imaging including
standard MR imaging, intravoxel incoherent motion (IVIM) diffusion-
weighted MR imaging, multiecho Dixon imaging, and dynamic
contrast-enhanced (DCE) MR imaging. MR imaging and
PET/CT were performed at baseline and 20 weeks after target therapy.
MR imaging alone was obtained at 3 weeks after target therapy. There
were 24 bone metastases: osteolytic (n = 12) and sclerotic (n = 12) le-
sions. MR parameters were measured on a single-slice (2D) and volumet-
ric (3D) analysis of whole tumor volume. Interval changes of MR param-
eters were calculated. In addition, MR parameters were compared be-
tween osteolytic and sclerotic metastases. Statistical analysis was per-
formed with repeated measures analysis of variance (ANOVA),
Wilcoxon signed-rank test, and Mann-Whitney test.
Results: All bone metastases were classified as goodresponders based on
final PET/CT. Between baseline and 3-week, significant time effects were
found in interval increase of 2D and 3D apparent diffusion coefficient
(ADC), 2D and 3D Ktrans, 2D Ve, 2D and 3D iAUC, and fat fraction,
whereasintervaldecreaseof3Dkurtosisand3DKep(P < .05). At 3-
week, percent changes were as follows: 33 and 14% for 2D and 3D
ADC; 49 and 69% for 2D and 3D Ktrans; 141% for 2D Ve; 125 and
83% for 2D and 3D iAUC; −10% for 3D kurtosis; −14% for 3D Kep; and
69% for fat fraction. There was no significant difference in baseline MR
parameters between osteolytic and sclerotic metastases (P >.05).
However, percent change between baseline and 3-week MR imaging of
2D Ktrans significantly greater in sclerotic than osteolytic metastases (83
vs 22%, P < .05), while those of 2D and 3D Kep were significantly lower
in sclerotic than osteolytic metastases (−0.17 vs −0.29%; −7.48 vs −11%,
respectively, P <.05).
Conclusion: Multiparametric MR imaging may help predict the early
response of bone metastases to target therapy in EGFR positive NSCLC
patients at 3 T.
13:40. Do Contrast-Enhanced Sequences and Functional MRI
Sequences Improve Diagnostic Accuracy in the Spectrum of
Brett A Shannon, Shivani Ahlawat, Carol D Morris, Adam S Levin,
Laura M Fayad. Baltimore, MD, USA.
Purpose: Distinguishing amongst lipomas, atypical lipomatous tumors
(ALT), and dedifferentiated liposarcomas (DDLPS) can be challenging.
We hypothesized that addition of dynamic contrast enhancement (DCE),
diffusion weighted imaging (DWI), and chemical shift imaging (CSI) to
the magnetic resonance imaging (MRI) protocol improves diagnostic
accuracy for indeterminate lipomatous tumors.
Materials and Methods: This is a retrospective study of 32 patients
referred for biopsy or excision of a lipomatous tumor and pre-procedure
MRI including fluid-sensitive, CSI, DWI (b values 50, 400, 800 s/mm
pre- and post-contrast T1-weighted and DCE (7-second time resolution)
sequences. MRI studies were reviewed for tumor septations, nodules,
early arterial enhancement by DCE, apparent diffusion coefficient
(ADC) values of the tumor and largest nodule, and CSI signal loss on
opposed-phase compared with in-phase sequences. Radiologist diagnosis
was recorded after review of imaging in 3 sessions: 1) T1/fluid-sensitive
sequences, 2) with addition of post-contrast T1, and 3) with addition of
DCE, DWI and CSI sequences. Histology was the diagnostic gold stan-
dard. Descriptive statistics were reported.
Results: All tumors without thick septations were lipomas, and 12/13
tumors with nodules >1 cm were ALT or DDLPS. For lipomas, variants,
ALT, and DDLPS, respectively: early arterial enhancement was present in
0/14 (0%), 1/4 (25%), 1/5 (20%), and 5/6 (83%); average tumor ADC
values were 0.3, 0.9, 1.2, and 0.9; CSI signal loss >20% was present in 4/
13 (31%), 3/4 (75%), 6/7 (86%), and 6/6 (100%). The radiologist’s inter-
pretation accuracy using pre-contrast, post-contrast, and functional/CSI
sequences, respectively, was 6/6 (100%), 6/6 (100%) and 6/6 (100%) for
lipomas; 0/2 (0%), 0/1 (0%), and 0/2 (0%) for lipoma variants; 5/15
(33%), 5/16 (32%), and 5/15 (33%) for ALT; and 5/9 (56%), 5/9 (56%),
and 5/9 (56%) for DDLPS.
Conclusion: Diagnostic interpretation for indeterminate lipomatous tu-
mors is not changed by the addition of contrast or functional imaging with
DCE or DWI, as thick septations and large nodules are important to