Diffusion-weighted MR imaging in differentiation between osteoporotic and neoplastic vertebral fractures

• Published in: European spine journal Vol. 21; no. Suppl 1; pp. 123 - 127
• Main Authors: Pozzi, G., Garcia Parra, C., Stradiotti, P., Tien, T. V., Luzzati, A., Zerbi, A.
• Format: Journal Article
• Language: English
• Published: Berlin/Heidelberg Springer-Verlag 01-05-2012; Springer Nature B.V
• Subjects: Aged; Diagnosis, Differential; Diffusion Magnetic Resonance Imaging - methods; Female; Humans; Male; Medicine; Medicine & Public Health; Middle Aged; Neurosurgery; Original; Original Article; Osteoporotic Fractures - diagnosis; Osteoporotic Fractures - pathology; Retrospective Studies; Sensitivity and Specificity; Spinal Fractures - diagnosis; Spinal Fractures - etiology; Spinal Fractures - pathology; Spinal Neoplasms - complications; Surgical Orthopedics; Thoracic Vertebrae - injuries; Thoracic Vertebrae - pathology; Vertebral fractures; MRI imaging; ADC values; DWI
• ISSN: 0940-6719; 1432-0932
• DOI: 10.1007/s00586-012-2227-x

Purpose
To assess the usefulness of magnetic resonance imaging (MRI) with spin-echo echo-planar diffusion-weighted 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 × 10
−3
 mm
2
/s; mean ADC value of osteoporotic fractures was 0.646 ± 0.368 × 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.