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Can MRI differentiate surrounding vertebral invasion from reactive inflammatory changes in superior sulcus tumor?

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Abstract

Objectives

Vertebral invasion is a key prognostic factor and a critical aspect of surgical planning for superior sulcus tumors. This study aims to further evaluate MRI features of vertebral invasion in order to distinguish it from reactive inflammatory changes.

Methods

Between 2000 and 2016, a retrospective study was performed at a single institution. All patients with superior sulcus tumors undergoing surgery, including at least two partial vertebrectomies, were included. An expert radiologist evaluated qualitative and quantitative MRI signal intensity characteristics (contrast-to-noise ratio [CNR]) of suspected involved and non-involved vertebrae. A comparison of CNR of invaded and sane vertebrae was performed using non-parametric tests. Imaging data were correlated with pathological findings.

Results

A total of 92 surgical samples of vertebrectomy were analyzed. The most specific sequences for invasion were T1 and T2 weighted (92% and 97%, respectively). The most sensitive sequences were contrast enhanced T1 weighted fat suppressed and T2 weighted fat suppressed (100% and 80%). Loss of extrapleural paravertebral fat on the T1-weighted sequence was highly sensitive (100%) but not specific (63%). Using quantitative analysis, the optimum cut-off (p < 0.05) to distinguish invasion from reactive inflammatory changes was CNR > 11 for the T2-weighted fat-sat sequence (sensitivity 100%), CNR > 9 for contrast-enhanced T1-weighted fat-suppressed sequence (sensitivity 100%), and CNR < − 30 for the T1-weighted sequence (specificity 97%). Combining these criteria, 23 partial vertebrectomies could have been avoided in our cohort.

Conclusion

Qualitative and quantitative MRI analyses are useful to discriminate vertebral invasion from reactive inflammatory changes.

Key Points

• Abnormal signal intensity in a vertebral body adjacent to a superior sulcus tumor may be secondary to direct invasion or reactive inflammatory changes.

• Accurate differentiation between invasion and reactive inflammatory changes significantly impacts surgical planning. T1w and T2w are the best sequences to differentiate malignant versus benign bone marrow changes. The use of quantitative analysis improves MRI specificity.

• Using contrast media improves the sensitivity for the detection of tumor invasion.

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Abbreviations

ACCP:

American College of Chest Physicians

CNR:

Contrast-to-noise ratio

CT:

Computed tomography

MRI:

Magnetic resonance imaging

NCNN:

National Comprehensive Cancer Network

NICE:

National Institute for Clinical Excellence

NPV:

Negative predictive value

PACS:

Picture Archived Centralized System

PPV:

Positive predictive value

ROC curve:

Receiver operating characteristic curve

ROI:

Region of interest

SD:

Standard deviation

STIR:

Short tau inversion recovery

T1w:

T1-weighted images

T2w:

T1-weighted images

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Acknowledgements

We thank Dr. Celine Denoiseux for editing the manuscript.

Funding

The authors state that this work has not received any funding.

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Authors and Affiliations

  1. Department of Radiology, Gustave Roussy Cancer Campus, 114 Rue Edouard Vaillant, Villejuif, 94800, Paris, France

    Fadila Mihoubi Bouvier, Corinne Balleyguier & Caroline Caramella

  2. Pathology Department, Marie Lannelongue Hospital, University of Paris Sud, Le Plessis Robinson, Paris, France

    Vincent Thomas De Montpréville

  3. Department of Medical Oncology, Gustave Roussy Cancer Campus, University of Paris Sud, Villejuif, Paris, France

    Benjamin Besse

  4. Orthopaedic Department, Tumor and Spine Unit, Bicêtre University Hospital, AP-HP Paris, University of Paris Sud, Le Kremlin-Bicêtre, Paris, France

    Gilles Missenard & Charles Court

  5. Department of Osteoarticular Radiology, Cochin Hospital, AP-HP Paris, Paris, France

    Mickael Tordjman

  6. Department of Radiation Oncology, Gustave Roussy Cancer Campus, University of Paris Sud, Villejuif, Paris, France

    Cécile Le Pechoux

  7. Department of Pneumology, Marie Lannelongue Hospital University of Paris Sud Le Plessis Robinson, Paris, France

    François Leroy Ladurie

  8. Department of Thoracic and Vascular Surgery and Heart-Lung Transplantation, Marie Lannelongue Hospital, University of Paris Sud, Le Plessis Robinson, Paris, France

    Elie Fadel

Authors
  1. Fadila Mihoubi Bouvier
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  2. Vincent Thomas De Montpréville
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  3. Benjamin Besse
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  4. Gilles Missenard
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  5. Charles Court
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  6. Mickael Tordjman
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  7. Cécile Le Pechoux
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  8. François Leroy Ladurie
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  9. Corinne Balleyguier
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  10. Elie Fadel
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  11. Caroline Caramella
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Corresponding author

Correspondence to Fadila Mihoubi Bouvier.

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Guarantor

The scientific guarantor of this publication is Dr. Caramella Caroline.

Conflict of interest

The authors of this manuscript declare no relationships with any companies whose products or services may be related to the subject matter of the article.

Statistics and biometry

No complex statistical methods were necessary for this paper.

Informed consent

Written informed consent was waived by the Institutional Review Board.

Ethical approval

Institutional Review Board approval was obtained.

Methodology

• Retrospective

• Observational

• Performed at one institution

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Mihoubi Bouvier, F., Thomas De Montpréville, V., Besse, B. et al. Can MRI differentiate surrounding vertebral invasion from reactive inflammatory changes in superior sulcus tumor?. Eur Radiol 31, 8991–8999 (2021). https://doi.org/10.1007/s00330-021-08001-w

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  • DOI: https://doi.org/10.1007/s00330-021-08001-w

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