| Objective To investigate the feasibility of iterative decomposition of water and fat with echo asymmetry and the least squares estimation quantification sequence (IDEAL-IQ) in the quantitative detection of the bone marrow fat content in vertebral compression fractures caused by osteoporosis and tumor metastasis. Methods On the acquired IDEAL-IQ sequence，the FF and R2* values in the lesions of vertebral compression fractures were independently measured in all patients. In addition, FF ratio, defined as FF value of the lesion / FF value in the normal vertebral bone marrow, was calculated in each patient. Mann-Whitney U test was used to determine the differences of FF, FF ratio, and R2* between the parameters of osteoporosis and metastasis. In addition, the receiver operating characteristic curve (ROC) analysis was applied to estimate the diagnostic efficacy of FF, FF ratio, and R2* in vertebral compression fractures. Results Significant lower FF values, R2* values, and FF ratios of bone marrow fat content were found (P<0.05) in the metastasis caused vertebral lesions than the osteoporosis caused acute compression fractures. All FF cut-off values of acute compression fractures for diagnostic performance on ROC analysis revealed that a cut-off value of 10.58% was optimal to differentiate between metastasis and osteoporosis. High AUC values of FF, R2*, and FF ratio were shown, indicating a robust differentiation of metastatic tumor compression fractures from osteoporosis acute compression fractures (0.967, 0.715, and 0.921). Conclusion IDEAL-IQ has revealed its feasibility and clinical values in distinguishing the vertebral compression fractures caused by osteoporosis or by tumor metastasis. |