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Acute vertebral body compression fractures: discrimination between benign and malignant causes using apparent
J H M Chan1, W C G Peh, E Y K Tsui
1Department of Diagnostic Radiology, Tuen Mun Hospital, Hong Kong.
The British Journal of Radiology
|April 5, 2002
Summary
Apparent diffusion coefficient (ADC) from diffusion weighted MRI helps distinguish benign from malignant acute vertebral fractures. While effective, overlapping ADC values can occur with tuberculous spondylitis.
Area of Science:
- Radiology
- Oncology
- Orthopedics
Background:
- Acute vertebral body compression fractures require differentiation between benign and malignant causes.
- Diffusion weighted MRI (DW-MRI) offers potential for non-invasive fracture characterization.
Purpose of the Study:
- To evaluate the utility of apparent diffusion coefficient (ADC) values in distinguishing benign from malignant acute vertebral compression fractures.
Main Methods:
- DW-MRI was performed on 32 patients with 49 acute vertebral compression fractures.
- ADC values were calculated and compared between normal vertebrae, benign fractures (osteoporosis), malignant fractures, and tuberculous spondylitis.
- Signal intensities on T1-weighted, STIR, and DW images were also analyzed.
Main Results:
- Benign fractures were typically hypointense and malignant fractures hyperintense on DW images compared to normal marrow (except sclerotic metastases).
- Mean ADC values differed significantly: 0.23 x 10(-3) mm(2)/s (normal), 0.82 x 10(-3) mm(2)/s (malignant), and 1.94 x 10(-3) mm(2)/s (benign).
- Statistically significant differences (p<0.001) were observed in ADC values.
Conclusions:
- ADC measurements are valuable for differentiating benign from malignant acute vertebral compression fractures.
- Potential overlap in ADC values exists between malignant fractures and tuberculous spondylitis, necessitating careful interpretation.