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The DW-PSIF sequence (delta = 3 ms) had the highest accuracy in differentiating benign from malignant vertebral fractures. Quantitative chemical-shift imaging and quantitative DW single-shot TSE imaging had a lower accuracy than DW-PSIF imaging because of a large overlap. Qualitative assessment of opposed-phase, DW-EPI, and DW single-shot TSE sequences and quantitative assessment of the DW-EPI sequence were not suitable for distinguishing between benign and malignant vertebral fractures.

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In diffusion-weighted magnetic resonance ima ging (DWI), the observed MRI signal intensity is attenuated by the self-diffusion of water mo lecules. DWI can provide information about the microscopic structure and organization of biolo gical tissue and, thus, can depict various patholo gical changes of organs or tissues. DWI has been successfully used for the characterization of bone marrow alterations or lesions, and in particular for the differentiation of benign and malignant vertebral compression fractures. In this review article, the basics of diffusion-weighted magnetic resonance imaging are introduced and several pulse sequences, which have been used for DWI of the bone marrow, are described. Sub sequently, an extensive overview about diffusion studies of the bone marrow and in particular of DWI of vertebral compression fractures is given.