{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,5,27]],"date-time":"2026-05-27T10:58:06Z","timestamp":1779879486014,"version":"3.53.1"},"reference-count":42,"publisher":"Springer Science and Business Media LLC","issue":"1","license":[{"start":{"date-parts":[[2025,9,10]],"date-time":"2025-09-10T00:00:00Z","timestamp":1757462400000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"},{"start":{"date-parts":[[2025,9,10]],"date-time":"2025-09-10T00:00:00Z","timestamp":1757462400000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"}],"content-domain":{"domain":["link.springer.com"],"crossmark-restriction":false},"short-container-title":["Eur Radiol Exp"],"abstract":"<jats:title>Abstract<\/jats:title>\n          <jats:sec>\n            <jats:title>Background<\/jats:title>\n            <jats:p>Bone marrow (BM) lesion differentiation remains challenging, and quantitative magnetic resonance imaging (MRI) may enhance accuracy over conventional methods. We evaluated the diagnostic value and inter-reader reliability of Dixon-based signal drop (%drop) and fat fraction percentage (%fat) as adjuncts to existing protocols.<\/jats:p>\n          <\/jats:sec>\n          <jats:sec>\n            <jats:title>Materials and methods<\/jats:title>\n            <jats:p>In this prospective two-center study, 172 patients with BM signal abnormalities underwent standardized 1.5-T MRI protocols, including Dixon sequences. Two musculoskeletal radiologists independently evaluated images and performed quantitative measurements of %drop and %fat. Final diagnoses were established through histopathology (<jats:italic>n<\/jats:italic>\u2009=\u200996) or imaging follow-up (<jats:italic>n<\/jats:italic>\u2009=\u200976). Diagnostic value was assessed using area under the receiver operating characteristic curve (AUROC), inter-reader reliability using Cohen\u2019s \u03ba coefficient.<\/jats:p>\n          <\/jats:sec>\n          <jats:sec>\n            <jats:title>Results<\/jats:title>\n            <jats:p>The consensus optimal cutoff was for %drop \u2264 19.8%, yielding 87.2% accuracy, 95.3% sensitivity, and 73.8% specificity, and that for %fat was \u2264 18.3%, achieving 86.6% accuracy, 96.3% sensitivity, and 70.8% specificity. Both metrics showed high diagnostic performance (AUROC 0.824\u20130.863) and excellent inter-reader reliability (\u03ba\u2009&gt;\u20090.93, <jats:italic>p<\/jats:italic>\u2009&lt;\u20090.001). Multivariate analysis identified %drop \u2264 19.8% and %fat \u2264 18.3% as the strongest independent predictors of malignancy, with odds ratio (OR) being 9.38 and 8.85, respectively (<jats:italic>p<\/jats:italic>\u2009&lt;\u20090.001). Signal characteristics on Dixon sequences provided additional diagnostic value, with signal voids on fat-only images (OR 7.14) and high signals on water-only images (OR 5.46).<\/jats:p>\n          <\/jats:sec>\n          <jats:sec>\n            <jats:title>Conclusion<\/jats:title>\n            <jats:p>Quantitative MRI Dixon imaging parameters demonstrated high diagnostic accuracy and excellent inter-reader reliability in differentiating benign and malignant BM lesions, supporting their implementation in clinical practice protocols as a reproducible adjunct to conventional MRI.<\/jats:p>\n          <\/jats:sec>\n          <jats:sec>\n            <jats:title>Relevance statement<\/jats:title>\n            <jats:p>Quantitative Dixon MRI provides reproducible, noninvasive differentiation of bone marrow lesions with high diagnostic accuracy across anatomical sites, enhancing clinical decision-making with standardized thresholds while demonstrating excellent inter-center consistency.<\/jats:p>\n          <\/jats:sec>\n          <jats:sec>\n            <jats:title>Key Points<\/jats:title>\n            <jats:p>\n              <jats:list list-type=\"bullet\">\n                <jats:list-item>\n                  <jats:p>Quantitative Dixon MRI thresholds of %drop \u2264 19.8% and %fat \u2264 18.3% were established as reliable predictors of malignancy in bone marrow lesions.<\/jats:p>\n                <\/jats:list-item>\n                <jats:list-item>\n                  <jats:p>Dixon metrics demonstrated superior diagnostic accuracy (86.6\u201387.2%), compared to conventional T1-weighted sequences (79.2%).<\/jats:p>\n                <\/jats:list-item>\n                <jats:list-item>\n                  <jats:p>Excellent inter-reader reliability (\u03ba\u2009=\u20090.895\u20130.943) supports the reproducibility of quantitative Dixon MRI in clinical practice.<\/jats:p>\n                <\/jats:list-item>\n              <\/jats:list>\n            <\/jats:p>\n          <\/jats:sec>\n          <jats:sec>\n            <jats:title>Graphical Abstract<\/jats:title>\n          <\/jats:sec>","DOI":"10.1186\/s41747-025-00615-9","type":"journal-article","created":{"date-parts":[[2025,9,10]],"date-time":"2025-09-10T14:04:48Z","timestamp":1757513088000},"update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":2,"title":["Quantitative MRI Dixon signal drop and fat fraction for differentiating bone marrow lesions: a two-center prospective analysis"],"prefix":"10.1186","volume":"9","author":[{"given":"Maha Ibrahim","family":"Metwally","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-7046-5311","authenticated-orcid":false,"given":"Yassir Edrees","family":"Almalki","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Marwa Fathy","family":"Khalil","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ahmed Mohamed","family":"Alsowey","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Hazem Ibrahim Aly","family":"Tantawy","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mohamed Gaber","family":"Hamed","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Shimaa","family":"Abdelmoneem","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sharifa Khalid","family":"Alduraibi","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ziyad A.","family":"Almushayti","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Shaker Hassan S.","family":"Alshehri","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ahmed M. 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