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Updated: Jul 4, 2026
Assessment of Bone Fracture Healing Using Micro-Computed Tomography
Published on: December 9, 2022
Can diffusion-weighted imaging be used to differentiate benign from pathologic fractures? A meta-analysis
Michael Karchevsky1, James S Babb, Mark E Schweitzer
1Department of Radiology, Hahnemann University Hospital, 230 North Broad Street, Philadelphia, PA 19102, USA. misha413@hotmail.com
Objective:
Conventional MR sequences are sometimes nonspecific in differentiating benign from pathologic fractures. To address this difficulty, diffusion-weighted images were conjectured to aid in this discrimination with variable results. As each of these studies contained somewhat small numbers of patients, we performed a meta-analysis to determine if this sequence may be used for this important diagnostic problem.
Materials And Methods:
We reviewed and statistically analyzed the results of eight studies, performed between 1998 and 2003, comparing diffusion-weighted magnetic resonance signal intensity characteristics of benign and pathologic vertebral body fractures. Diffusion-weighted imaging (DWI) signal characteristics and apparent diffusion coefficient (ADC) values of 104 benign fractures and 161 combined malignant vertebral body lesions and pathologic fractures were statistically evaluated in terms of mean ADC, as well as percentage classified as either hypointense or isointense. The meta-analysis to compare benign fractures with the combined pathologic fractures and metastatic lesions in terms of mean ADC used Hedge's g statistic with a small sample bias adjustment; the comparison of the percentage hypo- or isointense used the Mantel-Haenszel method to calculate a weighted summary odds ratio. All summary effect sizes were computed under a random effects model to account for study heterogeneity.
Results:
The mean ADC was significantly higher (p < 0.01) among benign fractures, with a standardized mean difference (SMD) of 2.8 and a 95% confidence interval (CI) for the SMD of 2.1 to 3.5. Lesions classified as hypointense were significantly more likely to be benign (p < 0.01), based on a summary odds ratio (OR) of 24.5 and 95% confidence that the OR exceeds 1.7. Lesions classified as isointense were not significantly more likely to be benign or malignant (p > 0.1), based on a summary OR of 3.6 and a 95% CI for the OR of 0.35 to 36.6.
Conclusion:
Even though the literature has been inconsistent, ADC maps appear to be a reliable method to differentiate benign from malignant fractures.
Insights
Diffusion-weighted imaging (DWI) and apparent diffusion coefficient (ADC) maps can reliably differentiate benign from malignant fractures. This meta-analysis confirms ADC maps are a valuable tool for diagnosing vertebral body fractures.
Area of Science:
- Radiology
- Medical Imaging
- Oncology
Background:
- Conventional MRI sequences often lack specificity in distinguishing benign from pathologic fractures.
- Diffusion-weighted imaging (DWI) has shown potential in aiding this differentiation, but previous studies had limited sample sizes.
Purpose of the Study:
- To conduct a meta-analysis to determine if DWI can reliably differentiate benign from pathologic vertebral body fractures.
- To evaluate the diagnostic performance of apparent diffusion coefficient (ADC) values and signal intensity characteristics in distinguishing fracture types.
Main Methods:
- A meta-analysis of eight studies (1998-2003) comparing DWI characteristics of benign and pathologic vertebral fractures.
- Statistical analysis included mean ADC values and signal intensity classifications (hypointense, isointense) using Hedge's g and Mantel-Haenszel methods.
- A random effects model was employed to account for study heterogeneity.
Main Results:
- Mean ADC values were significantly higher in benign fractures compared to malignant ones (SMD = 2.8, p < 0.01).
- Hypointense lesions on DWI were significantly more likely to be benign (OR = 24.5, p < 0.01).
- Isointense lesions did not show a significant association with either benign or malignant fractures (p > 0.1).
Conclusions:
- Despite inconsistent literature, ADC maps demonstrate reliability in differentiating benign from malignant fractures.
- DWI, particularly ADC values and hypointense signal characteristics, offers a valuable tool for fracture diagnosis.
