CC BY-NC-ND 4.0 · Indian J Radiol Imaging 2023; 33(04): 450-455
DOI: 10.1055/s-0043-57255
Original Article

The T1 Ratio of Marrow (TROM) as a Novel Tool to Identify Metastatic from Nonmalignant Marrow Lesions of the Spine: A Pilot Study

1   Department of Musculoskeletal Radiology, Royal Orthopedic Hospital, Birmingham, United Kingdom
Mahtab Afzali
2   Aston Medical School, Aston University, Birmingham, United Kingdom
2   Aston Medical School, Aston University, Birmingham, United Kingdom
Christine Azzopardi
1   Department of Musculoskeletal Radiology, Royal Orthopedic Hospital, Birmingham, United Kingdom
3   Department of Orthopedics, Southport and Ormskirk Hospital, Southport, United Kingdom
4   Department of Spine Surgery, Royal Orthopedic Hospital, Birmingham, United Kingdom
5   Department of Orthopedic Oncology, Royal Orthopedic Hospital, Birmingham, United Kingdom
Rajesh Botchu
1   Department of Musculoskeletal Radiology, Royal Orthopedic Hospital, Birmingham, United Kingdom
› Author Affiliations
Funding None.


Objective The purpose of this study was to analyze quantitative values of normal and abnormal marrow on T1-weighted images of spine, to propose a ratio for T1 values of abnormal to normal vertebrae, and to assess whether this ratio could be helpful in predicting presence of neoplastic lesions in the spine.

Materials and Methods One-hundred randomly selected magnetic resonance imagings of lumbar spine without infection, fracture, and tumor were selected to form normal cohort. A second cohort of 100 metastasis of lumbar spine was identified. Ratio of T1 value of vertebral body to the T1 value of the inferior vertebral body was performed for normal cohort from D11 to L5. Ratio of T1 value of metastasis to adjacent normal vertebral body was done for metastatic cohort. Data was analyzed using standard t-test and kappa was performed for intra- and inter-observer reliability.

Results A decline in T1 value of abnormal to normal marrow was seen in patients with metastasis that was statistically significant. We call this the T1 ratio of marrow (TROM). The sensitivity and accuracy with the cutoff value of TROM at 0.7 (92% sensitivity, 97.1% accuracy) are better than at 0.6 (75% sensitivity, 96.2% accuracy) or 0.5 (47% sensitivity, 93.2% accuracy). A subset analysis of the other T1 hypointense benign lesions including atypical hemangiomas and focal marrow hyperplasia, however, revealed overlapping TROM values with the metastatic cohort.

Conclusion Using the TROM on T1-weighted images could not confidently differentiate malignant from benign T1 hypointense lesions of the spine.

Publication History

Article published online:
02 May 2023

© 2023. Indian Radiological Association. This is an open access article published by Thieme under the terms of the Creative Commons Attribution-NonDerivative-NonCommercial License, permitting copying and reproduction so long as the original work is given appropriate credit. Contents may not be used for commercial purposes, or adapted, remixed, transformed or built upon. (

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  • References

  • 1 Vanel D. MRI of bone metastases: the choice of the sequence. Cancer Imaging 2004; 4 (01) 30-35
  • 2 Patel A, James SL, Davies AM, Botchu R. Spinal imaging update: an introduction to techniques for advanced MRI. Bone Joint J 2015; 97-B (12) 1683-1692
  • 3 Shigematsu Y, Hirai T, Kawanaka K. et al. Distinguishing imaging features between spinal hyperplastic hematopoietic bone marrow and bone metastasis. Am J Neuroradiol 2014; 35 (10) 2013-2020
  • 4 Meyer JS, Siegel MJ, Farooqui SO, Jaramillo D, Fletcher BD, Hoffer FA. Which MRI sequence of the spine best reveals bone-marrow metastases of neuroblastoma?. Pediatr Radiol 2005; 35 (08) 778-785
  • 5 Małkiewicz A, Dziedzic M. . Bone marrow reconversion-imaging of physiological changes in bone marrow [Internet]. Accessed April 5, 2023 at:
  • 6 Hwang S, Panicek DM. Magnetic resonance imaging of bone marrow in oncology, Part 1. Skeletal Radiol 2007; 36 (10) 913-920
  • 7 Vanel D, Dromain C, Tardivon A. MRI of bone marrow disorders. Eur Radiol 2000; 10 (02) 224-229
  • 8 Zhao J, Krug R, Xu D, Lu Y, Link TM. MRI of the spine: image quality and normal-neoplastic bone marrow contrast at 3 T versus 1.5 T. AJR Am J Roentgenol 2009; 192 (04) 873-880
  • 9 Castillo M, Arbelaez A, Smith JK, Fisher LL. Diffusion-weighted MR imaging offers no advantage over routine noncontrast MR imaging in the detection of vertebral metastases. Am J Neuroradiol 2000; 21 (05) 948-953
  • 10 Hanrahan CJ, Shah LM. MRI of spinal bone marrow: part 2, T1-weighted imaging-based differential diagnosis. Am J Roentgenol 2011; 197 (06) 1309-1321
  • 11 Heusner T, Gölitz P, Hamami M. et al. “One-stop-shop” staging: should we prefer FDG-PET/CT or MRI for the detection of bone metastases?. Eur J Radiol 2011; 78 (03) 430-435
  • 12 Grankvist J, Fisker R, Iyer V. et al. MRI and PET/CT of patients with bone metastases from breast carcinoma. Eur J Radiol 2012; 81 (01) e13-e18
  • 13 Liu T, Wang S, Liu H. et al. Detection of vertebral metastases: a meta-analysis comparing MRI, CT, PET, BS and BS with SPECT. J Cancer Res Clin Oncol 2017; 143 (03) 457-465
  • 14 Hanna SL, Fletcher BD, Fairclough DL, Jenkins III JH, Le AH. Magnetic resonance imaging of disseminated bone marrow disease in patients treated for malignancy. Skeletal Radiol 1991; 20 (02) 79-84
  • 15 Herneth AM, Philipp MO, Naude J. et al. Vertebral metastases: assessment with apparent diffusion coefficient. Radiology 2002; 225 (03) 889-894
  • 16 Disler DG, McCauley TR, Ratner LM, Kesack CD, Cooper JA. In-phase and out-of-phase MR imaging of bone marrow: prediction of neoplasia based on the detection of coexistent fat and water. Am J Roentgenol 1997; 169 (05) 1439-1447
  • 17 Zajick Jr DC, Morrison WB, Schweitzer ME, Parellada JA, Carrino JA. Benign and malignant processes: normal values and differentiation with chemical shift MR imaging in vertebral marrow. Radiology 2005; 237 (02) 590-596
  • 18 Eito K, Waka S, Naoko N, Makoto A, Atsuko H. Vertebral neoplastic compression fractures: assessment by dual-phase chemical shift imaging. J Magn Reson Imaging 2004; 20 (06) 1020-1024
  • 19 Erly WK, Oh ES, Outwater EK. The utility of in-phase/opposed-phase imaging in differentiating malignancy from acute benign compression fractures of the spine. Am J Neuroradiol 2006; 27 (06) 1183-1188
  • 20 Vande Berg BC, Lecouvet FE, Galant C, Maldague BE, Malghem J. Normal variants and frequent marrow alterations that simulate bone marrow lesions at MR imaging. Radiol Clin North Am 2005; 43 (04) 761-770, ix