Differentiation of acute osteoporotic from malignant vertebral compression fractures with conventional MRI and diffusion MR imaging (original) (raw)
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European Spine Journal, 2012
Purpose To assess the usefulness of magnetic resonance imaging (MRI) with spin-echo echo-planar diffusionweighted imaging (SE-EPI-DWI) in differentiation between vertebral osteoporotic fractures and pathological neoplastic fractures. Materials and methods Thirty-three patients with both osteoporotic or neoplastic vertebral fractures diagnosed with X-ray or TC were studied with MRI exam, (1.5 T unit) with DWI sequences. DWI sequences were qualitatively analyzed. Apparent diffusion coefficient (ADC) values were also determined and compared to the definitive histologic diagnosis. Results DWI of neoplastic lesions showed hyperintensity signal in 22 out of 23 cases. Mean ADC value of neoplastic fractures was 1.241 ± 0.4 9 10-3 mm 2 /s; mean ADC value of osteoporotic fractures was 0.646 ± 0.368 9 10-3 mm 2 /s. Neoplastic fractures showed ADC values significantly higher than osteoporotic ones (p \ 0.001). DWI imaging and histology showed a significant correlation. Conclusion DWI provides reliable information to support MRI diagnosis of neoplastic versus osteoporotic fractures. ADC value appears as a useful adjunctive parameter.
Journal of the Medical Association of Thailand = Chotmaihet thangphaet, 2012
To evaluate the diagnostic performance of apparent diffusion coefficient (ADC) value in discriminating benign from malignant vertebral compression fracture. 22 symptomatic patients with compression fracture of vertebra referred for conventional MRI spines during January 2009-March 2010 underwent additional diffusion weighted MR techniques. Evaluation of diffusion weighted MR imaging and quantified ADC value from reconstructed ADC map were performed. The accuracy, sensitivity, specificity, positive predictive value and negative predictive value of apparent diffusion coefficient (ADC) value were calculated. A total of 39 vertebral fractures; 7 malignant compression fractures and 32 benign compression fractures were evaluated. The difference between ADC values of malignant, benign compression fracture and normal vertebrae were statistically significant (p < 0.0001). The accuracy, sensitivity and specificity were 89.7%, 85.7% and 90.6% respectively with the ADC threshold of 0.89 to d...
Journal of orthopaedic surgery (Hong Kong), 2011
To evaluate the sensitivity, specificity and accuracy of various magnetic resonance imaging (MRI) features in differentiating vertebral compression fractures caused by malignancy, osteoporosis, and infections. 35 men and 45 women aged 40 to 78 (mean, 59) years underwent MRI to assess the underlying pathology of already diagnosed vertebral compression fractures (n=152). The interval from presentation to imaging ranged from 7 to 95 (mean, 62) days. MRI features of each vertebral compression fracture were assessed. The sensitivity, specificity, and accuracy for each of the MRI features were calculated. Association between each MRI feature and various underlying pathologies (malignancy, osteoporosis, and infections) of vertebral compression fractures was evaluated. Regarding these 80 patients, the MRI diagnosis was correct in 78 and inconclusive in 2 with malignancy. MRI features suggestive of malignant fractures were a convex posterior border of the vertebral body, pedicle involvement,...
2002
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 0.23610 23 mm 2 s 21 in normal vertebrae, 0.82610 23 mm 2 s 21 in malignant acute vertebral fractures and 1.94610 23 mm 2 s 21 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.
Magnetic Resonance Imaging Characteristics of Benign and Malignant Vertebral Fractures
2000
Background: Attempts to differentiate benign and malignant vertebral fractures may be difficult, particularly when there is no obvious evidence of malignancy. Since early diagnosis and appropriate management of malignant vertebral fractures are important, a reliable imaging modality is required. Methods: From January 1996 to December 2002, 48 patients with malignant vertebral fractures and 50 patients with benign processes were studied.
Phase Shift MRI in Assessement of Vertebral Compression Fracture: Trial for a New Scoring System
2020
PurposeTo assess the value of in /opposed-phase quantitative chemical shift MRI in differentiating malignant from benign vertebral compression fractures (VCF).Patients and methodsTwenty patients (8 men), mean age 56 years, with low back and radiological proof of VCF were included in the study. MRI of spine with standard conventional sequences and special chemical shift sequence (in/opposed phase) as well as diffusion weighted imaging were performed (at 1.5 Tesla). Quantitative image analysis of regions of interest (ROI) on the abnormal marrow in the compressed (study group) and related normal vertebra in same patient (control group) was done in each patient. The signal intensity ratio (SIR) of the marrow was determined by dividing the mean signal intensity on the opposed-phase and in-phase images was performed.ResultsMean SIR of benign VCF [0.6 ± 0.27 (range 0.23–1.1)] was significantly lower than malignant VCF values [1.115 ± 0.14 (range 0.87–1.45)] (p < 0.0001, ROC 0.97). The o...
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Evaluation of Vertebral Bone Marrow with Diffusion Weighted MRI and ADC Measurements
Istanbul Medical Journal, 2014
The purpose was to determine the usefulness of diffusionweighted imaging (DWI) and apparent diffusion coefficient (ADC) in the evaluation of vertebral bone marrow. Methods: Patients were divided into; osteoporotic, traumatic, infectious spondylitis, hemangioma, malignancy and non-osteoporotic groups. Seventy-four patients (45 women and 29 men; mean age, 58 years; range 17-89) were investigated in this study. Conventional magnetic resonance imagining (MRI) sequences and SE-EPI sequence with b-value of 600 s/mm 2 were used. Qualitative and quantitative evaluation with DWI and ADC was carried out for each fractured vertebra and randomly chosen normal vertebrae. A p-value of <0.05 was considered significant. Results: The mean DWI and ADC values of normal vertebrae was found to be 142.5±100 and 0.48±0.1x10-3 mm 2 /s, respectively. A total of 103 fractures were encountered in 74 patients and L1 was the most commonly fractured vertebra (20 fractures, 19.4%). DWI and ADC qualitative assessment of fractures showed no significant difference between groups. The mean DWI and ADC values of fractured vertebrae was found to be 284.3±255.8 and 1.35±0.39x10-3 mm 2 /s, respectively, which were significantly higher than that of normal vertebrae (p<0.05). The mean DWI value of normal vertebrae (76.2±37.3) and fractured vertebrae (124.5±87.6) in osteoporotic patients were significantly lower than that of non-osteoporotic patients (172.4±105.6 and 359.6±274.3) (p<0.05). Conclusion: DWI and ADC quantitative evaluation can differentiate fractured vertebrae from normal vertebrae, but qualitative assessment of fractures cannot distinguish between groups. DWI with quantitative assessment is helpful in the differential diagnosis of osteoporotic fractures from malignant fractures and also osteoporotic normal vertebrae from non-osteoporotic normal vertebrae, but ADC values are unhelpful.
Polish Journal of Radiology, 2021
To evaluate the usefulness of chemical shift imaging (CSI) in differentiating benign osteoporotic and malignant vertebral marrow lesions. Patients undergoing spinal magnetic resonance imaging (MRI) for back pain, which showed altered marrow signal intensity on conventional MRI sequences, were included in the study. Patients with acute traumatic vertebral fractures, infective spondylodiscitis, paravertebral collections, etc. were excluded. The patients underwent CSI. In-phase and opposed-phase images were taken to calculate the signal intensity ratio (SIR) of the abnormal vertebra. The SIR of the mean signal intensity measured on opposed-phase to mean signal intensity measured on in-phase images was measured and recorded. The studied population included 30 patients, in whom 58 vertebrae were accessed, which included 38 dorsal, 18 lumbar, 1 sacral, and 1 cervical. Out of 58 vertebrae, 46 (79%) were malignant and 12 (20%) were benign. The mean CSI/SIR of malignant lesions was 0.96 and the mean SIR of benign lesions was 0.76. Conventional MRI sequences cannot always differentiate between benign and malignant lesions. So newer sequences like CSI have been developed. CSI SIR can be used as a new tool in differentiating benign osteoporotic and malignant vertebral marrow lesions.