MR imaging of bone metastases and choice of sequence: spin echo, in-phase gradient echo, diffusion, and contrast medium.

Magnetic resonance imaging (MRI) is the only imaging technique allowing the direct visualization of the bone marrow and is the most sensitive to detect bone metastases. Sensitivity is high, but a good understanding and an informed choice of acquisition sequences can easily improve specificity. Fat and water distribution (spin echo), indirect visualization of bone trabeculae (in-phase gradient echo), evaluation of bone edema and cell density (diffusion), and the study of vascularization (contrast medium) should be cleverly combined to enable good detection and lesion characterization.