Differentiation of tuberculosis and metastatic cancer in the spine using dynamic contrast-enhanced MRI

Abstract

Purpose To investigate the differences between imaging features of spinal tuberculosis (TB) and metastatic cancer measured by dynamic contrast-enhanced magnetic resonance imaging (DCE-MRI). The presentation of TB on convention MRI may not show the typical TB signs, and they may be mis-diagnosed as malignant diseases. DCE-MRI may provide additional information to help making differential diagnosis. Materials and methods DCE-MRI was performed in 24 TB and 22 metastatic cancer patients. The DCE kinetic pattern was determined as “wash-out”, “plateau” or “persistent enhancement”. The characteristic DCE parameters were calculated from the signal intensity time course. The two-compartmental pharmacokinetic model was used to obtain Ktrans, which is the parameter associated with the delivery of MR contrast agents into the lesion, and kep, which is the parameter associated with the distribution and clearance of contrast agents from the lesion. Results Of the 24 TB, one case showed the wash-out kinetic pattern, 12 cases showed the plateau pattern, and 11 cases showed the persistent enhancement pattern. Of the 22 metastatic cancers, 12 cases showed wash-out, 7 cases showed plateau, and 3 cases showed persistent enhancement patterns. Compared to the metastatic cancer group, the TB group had a lower kep (0.27±0.15 vs. 0.49±0.23 min−1, P<0.001). The ROC analysis showed that the area under the curve was 0.780 for kep. Conclusions DCE-MRI may provide additional information for differentiation between spinal TB and metastasis, when their manifestations on conventional imaging were similar.

Diagnosis of Spinal Lesions Using Heuristic and Pharmacokinetic Parameters Measured by Dynamic Contrast-Enhanced MRI

“…DCEMRI using heuristic analysis and model fitting has been applied to characterize vascular properties of different hematologic malignancies (eg, myeloma and lymphoma) with different grades of bone marrow involvement (8,9,15). We have shown that DCE parameters of metastatic cancers were significantly different from those of myeloma (10) and inflammatory TB (11). Unfortunately, there were few studies in the literature that reported the diagnosis of spinal masses using DCE-MRI for comparison with our findings.…”

“…DCE-MRI has been applied to diagnose different spinal lesions (8–11) and distinguish between hypervascular (eg, renal cell carcinoma) and hypovascular (eg, prostate cancer) metastases (12,13). It has also been used to characterize vascular properties of hematologic malignancies (eg, myeloma and lymphoma) with different grades of bone marrow involvement, as well as to evaluate changes after various therapies for predicting treatment outcome and prognosis (8,9,14–20).…”

Morphological and dynamic contrast enhanced MR imaging features for the differentiation of chordoma and giant cell tumors in the Axial Skeleton

“…or the pharmacokinetic parameters K trans and k ep ; as well as for classification of the DCE kinetics into "wash-out," "plateau," or "persistent enhancement" pattern. 6,7 The DCE kinetic pattern was significantly different between GCT and chordoma. Consistent with a much higher proportion of GCT cases showed the early peak enhancement with the wash-out DCE pattern, the obtained pharmacokinetic parameters K trans and k ep were also much higher in GCT than in chordoma.…”

“…or the pharmacokinetic parameters K trans and k ep ; as well as for classification of the DCE kinetics into “wash-out,” “plateau,” or “persistent enhancement” pattern. 6,7 …”

“…The semiquantitative and quantitative DCE-MRI analysis methods were applied to characterize spinal tumors. 6,7 Based on the signal intensity time course the DCE kinetic pattern was separated into three categories: (1) the wash-out pattern: reaching the peak near 1-min and showing wash-out with >10% slope from the peak; (2) the plateau pattern: the signal intensity remaining at a constant level after 1-min with less than 10% change; (3) the persistent enhancement pattern: the signal intensity continuing to increase in the DCE period with > 10% change from the intensity at 1-min.…”