Acute vertebral body compression fractures: discrimination between benign and malignant causes using apparent diffusion coefficients

Abstract

Diffusion weighted MRI was performed on patients with acute vertebral body compression. The usefulness of the apparent diffusion coefficient (ADC) in differentiating between benign and malignant fractures was evaluated. A total of 49 acute vertebral body compression fractures were found in 32 patients. 25 fractures in 18 patients were due to osteoporosis, 18 fractures in 12 patients were histologically proven to be due to malignancy, and 6 fractures in 2 patients were due to tuberculosis. Signal intensities on T(1) weighted, short tau inversion recovery (STIR) and diffusion weighted images were compared. ADC values of normal and abnormal vertebral bodies were calculated. Except for two patients with sclerotic metastases, benign acute vertebral fractures were hypointense and malignant acute vertebral fractures were hyperintense with respect to normal bone marrow on diffusion weighted images. Mean combined ADCs (ADC(cmb); average of the combined ADCs in the x, y and z diffusion directions) were 0.23 x 10(-3) mm(2) s(-1) in normal vertebrae, 0.82 x 10(-3) mm(2) s(-1) in malignant acute vertebral fractures and 1.94 x 10(-3) mm(2) s(-1) in benign acute vertebral fractures. The differences between ADC(cmb) values were statistically significant (p<0.001). The ADC is useful in differentiating benign from malignant acute vertebral body compression fractures, but there may be overlapping ADC values between malignant fractures and tuberculous spondylitis.

Role of Diffusion – Weighted Magnetic Resonance Imaging in Characterization of Vertebral Bone Marrow Pathological Lesions

“…Also the convex bulge of the posterior cortex of the vertebra have 70% sensitivity and 80% specificity (17) this is going with our result, where 72.7% of malignant cases show involvement of pedicle and posterior neural element, however we found one cases of pathologically proved atypical hemangiomas (case 4) and a one case of ABC showed involvement of posterior neural element (case 3 ). 63.6% of malignant cases show convex bulge of the posterior cortex of the vertebra, which not found in osteoporotic cases.…”

“…63.6% of malignant cases show convex bulge of the posterior cortex of the vertebra, which not found in osteoporotic cases. Presence of an epidural mass have 80% sensitivity and 100% specificity (17). In our results the presence of epidural and/or paraspinal mass was found only in 45 % malignant cases, this is because 7 of malignant cases were under therapy and 2 of them were operated for decompression of the epidural component.…”

The value of apparent diffusion coefficient measurements in the differential diagnosis of vertebral bone marrow lesions

“…Some studies have been able to differentiate benign acute compression fractures from malign induced compression fractures according to ADC values (3,4,(13)(14)(15)(16). In a comparatively small number of surveys, ADC values have been studied in discriminating the infectious lesions from the malign lesions (4,5,17).…”

Clinical Evaluation of Reduced Field-of-View Diffusion-Weighted Imaging of the Cervical and Thoracic Spine and Spinal Cord

“…[18][19][20][21][22][23] In this study, we performed an rFOV EPI-based diffusionweighted sequence on an unselected group of clinical patients undergoing clinically indicated imaging of the spine. We assessed whether it improved visualization of specific pathologies, narrowed the differential diagnosis for any findings, and/or increased diagnostic confidence.…”