Bone Marrow Abnormalities of Foot and Ankle: STIR versus T1-weighted Contrast-enhanced Fat-suppressed Spin-Echo MR Imaging

PURPOSE: To compare short inversion time inversion-recovery (STIR) and T1-weighted contrast material–enhanced fat-suppressed spin-echo magnetic resonance (MR) sequences for depiction of bone marrow abnormalities of the foot and ankle.

MATERIALS AND METHODS: Fifty-one consecutive patients with bone marrow abnormalities depicted on turbo STIR images were examined with additional T1-weighted contrast-enhanced (0.1 mmol/kg gadopentetate dimeglumine) MR imaging with fat suppression. Volume and signal difference–to-noise ratio (SDNR) were measured. An additional qualitative analysis was performed by two experienced musculoskeletal radiologists to correlate the presence or absence of ill-defined edema-like zones, well-defined zones, and cystlike zones. Diagnoses determined with MR findings with each sequence were compared with the results of a review panel. Correlation coefficients (r2) and paired t tests were calculated for all measurements. Agreement percentages and κ values were calculated for inter- and intraobserver reproducibility.

RESULTS: Regarding volume of bone marrow abnormalities, a high correlation (r2 = 0.98) of both sequences was found. SDNR was substantially higher on T1-weighted contrast-enhanced images than on STIR images (mean, 125.9 vs 95.4; P < .001). The qualitative analysis demonstrated identical imaging patterns with both sequences in 96% (79 of 82, κ = 0.38) of ill-defined zones, in 88% (72 of 82, κ = 0.76) of well-defined zones, and in 98% (80 of 82, κ = 0.84) of cystlike zones. Interobserver reproducibility of the three imaging patterns was similar for both sequences. The κ values for these three zones with STIR sequence were 0.55, 0.68, and 0.69, and those for the T1-weighted contrast-enhanced MR sequence were 0.49, 0.73, and 0.58, respectively. Diagnoses determined with MR findings were equal with both sequences in 94% (80 of 85) of involved bones.

CONCLUSION: STIR images and T1-weighted contrast-enhanced fat-suppressed MR images demonstrate almost identical imaging patterns, and diagnoses determined with these findings show little difference.

© RSNA, 2002

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Article History

Published in print: Aug 2002