Role of diffusion-weighted magnetic resonance imaging in the evaluation of vertebral bone marrow lesions

Abstract

Purpose: To evaluate the role of diffusion-weighted magnetic resonance imaging (DW-MRI) in differentiating vertebral marrow pathologies. To determine the sensitivity, specificity, and threshold apparent diffusion coefficient (ADC) values that can aid in the differentiation of malignant from benign bone marrow lesions. Material and methods: This observational study included 100 patients, who underwent MRI examination with a 1.5 Tesla scanner. The ADC values of normal and pathological vertebrae were estimated, and the threshold ADC values were computed by receiver operating characteristic (ROC) analysis. The results were correlated with histopathological diagnosis, clinical follow-up, and other investigations. Statistical analysis was done by employing unpaired two-tailed Student's t-test and the p-value of < 0.05 was deemed as statistically significant. Results: Vertebral bone marrow lesions had a male predominance and there was a predilection towards thoracic and lumbar vertebrae, with L4 being the commonest. Metastasis was the commonest lesion, followed by spondylodiscitis. The mean ADC value of benign pathologies was significantly greater than malignant pathologies (p < 0.05). The threshold value for the demarcation between benign and malignant pathologies was computed to be 1.21 × 10-3 mm 2 /s. DW imaging had sensitivity of 100%, specificity of 92.31%, positive predictive value of 87.5%, and negative predictive value of 100%. Conclusions: Vertebral marrow lesions can be differentiated as benign or malignant with good sensitivity and specificity with the help of DW-ADC maps.

Magnetic Resonance Imaging with Diffusion in Differentiation between Spinal Canal Lesions

“…The sensitivity was found to be 96.5%, specificity was 95.2%, positive predictive value was 96.5%, and negative predictive value was 95.2%. Kaur et al [24] successfully differentiated between benign and malignant diseases utilizing quantitative DW-ADC maps. They achieved high levels of sensitivity, specificity, positive predictive value, and negative predictive value by using a threshold value of 1.21 × 10 −3 mm 2 /s.…”

Magnetic Resonance Diffusion Tensor Imaging in Differentiating Benign and Malignant Compressed Vertebrae

“…The most prevalent region of VCFs was the lumbar region (48.57%) while the cervical and sacral regions was the least injured (5.71%) for each. Kaur, et al [19] found that the lumbar region had the maximum vertebral lesions in 45.69% of the studied patients.…”

The Role of DWI in Differentiating Metastatic from Non-Metastatic Bone Lesions

“…On the other hand, the quantitative assessment of the DWI was done by measuring the ADC values as done by many authors. Kaur et al [10] proposed ROC analysis of mean ADC for 65 benign and 35 malignant lesions most of which were metastatic lesions (n=24), this yielded threshold cut off value of 1.21 x 10 -3 mm 2 /s (p value <0.05) where malignant lesions were defined to be more than 1.21 x 10 -3 mm 2 /s and benign lesions were defined to be less than 1.21 x 10 -3 mm 2 /s with sensitivity and specificity of 100% and 92.3% for differentiating benign and malignant nature of the lesions. The standard of reference was histopathological assessment, characteristic CT appearance or lesions' behavior upon 6 months follow-up.…”