MUSCULOSKELETAL RADIOLOGY / ORIGINAL PAPER
Role of diffusion-weighted magnetic resonance imaging in the evaluation of vertebral bone marrow lesions
1
Department of Radiology, Guru Gobind Singh (GGS) Medical College and Hospital, Baba Farid University of Health Sciences, India
2
Department of Radiodiagnosis and Imaging, Sri Guru Ram Das Institute of Medical Sciences, India
3
Department of Orthopaedics, Sri Guru Ram Das Institute of Medical Sciences
Submission date: 2020-01-03
Final revision date: 2020-03-09
Acceptance date: 2020-03-10
Publication date: 2020-05-04
Pol J Radiol, 2020; 85: 215-223
KEYWORDS
TOPICS
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 mm2/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.
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 mm2/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.
REFERENCES (24)
1.
Leake RL, Mills MK, Hanrahan CJ. Spinal marrow imaging: clues to disease. Radiol Clin North Am 2019; 57: 359-375.
2.
Lin S, Ouyang T, Kanekar S. Imaging of bone marrow. Hematol Oncol Clin North Am 2016; 30: 945-971.
3.
Schieda N, Blaichman JI, Costa AF, et al. Gadolinium-based contrast agents in kidney disease: a comprehensive review and clinical practice guideline issued by the Canadian Association of Radiologists. Can J Kidney Health Dis 2018; 5: 20543581 18778573.
4.
Dietrich O, Geith T, Reiser MF, Baur-Melnyk A. Diffusion imaging of the vertebral bone marrow. NMR Biomed 2017; 30: e3333.
5.
Karampinos DC, Ruschke S, Dieckmeyer M, et al. Quantitative MRI and spectroscopy of bone marrow. J Magn Reson Imaging 2018; 47: 332-353.
6.
Suh CH, Yun SJ, Jin W, et al. ADC as a useful diagnostic tool for differentiating benign and malignant vertebral bone marrow lesions and compression fractures: a systematic review and meta-analysis. Eur Radiol 2018; 28: 2890-2992.
7.
Sheu A, Diamond T. Bone mineral density: testing for osteoporosis. Aust Prescr 2016; 39: 35-39.
8.
Mahajan PS, Jayaram AP, Negi VC. Rare case of multiple aggressive vertebral hemangiomas. J Nat Sci Biol Med 2015; 6: 439-442.
9.
Drake-Pérez M, Boto J, Fitsiori A, et al. Clinical applications of diffusion weighted imaging in neuroradiology. Insights Imaging 2018; 9: 535-547.
10.
Turna O, Aybar MD, Tuzcu G, et al. Evaluation of vertebral bone marrow with diffusion weighted MRI and ADC measurements. Istanbul Med J 2014; 15: 116-121.
11.
Abo Dewan KAW, Salama AA, El Habashy HMS, et al. Evaluation of benign and malignant vertebral lesions with diffusion weighted magnetic resonance imaging and apparent diffusion coefficient measurements. Egypt J Radiol Nucl Med 2015; 46: 423-433.
12.
Mauch JT, Carr CM, Cloft H, et al. Review of the Imaging Features of Benign Osteoporotic and Malignant Vertebral Compression Fractures. AJNR Am J Neuroradiol 2018; 39: 1584-1592.
13.
Moritani T, Kim J, Capizzano AA, et al. Pyogenic and non-pyogenic spinal infections: emphasis on diffusion-weighted imaging for the detection of abscesses and pus collections. Br J Radiol 2014; 87: 20140011.
14.
Castillo M, Arbelaez A, Smith JK, et al. Diffusion-weighted MR imaging offers no advantage over routine noncontrast MR imaging in the detection of vertebral metastases. AJNR Am J Neuroradiol 2000; 21: 948-953.
15.
Luo Z, Litao L, Gu S, et al. Standard-b-value vs low-b-value DWI for differentiation of benign and malignant vertebral fractures: a meta- analysis. Br J Radiol 2016; 89: 20150384.
16.
Zhang SW, Xu L, Zhong TK, et al. Comments on “Standard-b-value vs low-b-value DWI for differentiation of benign and malignant vertebral fractures: a meta-analysis”. Br J Radiol 2016; 89: 20160224.
17.
Baur A, Huber A, Ertl-Wagner B, et al. Diagnostic value of increased diffusion weighting of a steady-state free precession sequence for differentiating acute benign osteoporotic fractures from pathologic vertebral compression fractures. AJNR Am J Neuroradiol 2001; 22: 366-372.
18.
Padhani AR, Koh DM, Collins DJ. Whole-body diffusion-weighted MR imaging in cancer: current status and research directions. Radiology 2011; 261: 700-718.
19.
Wonglaksanapimon S, Chawalparit O, Khumpunnip S, et al. Vertebral body compression fracture: discriminating benign from malignant causes by diffusion-weighted MR imaging and apparent diffusion coefficient value. J Med Assoc Thai 2012; 95: 81-87.
20.
Balliu E, Vilanova JC, Peláez I, et al. Diagnostic value of apparent diffusion coefficients to differentiate benign from malignant vertebral bone marrow lesions. Eur J Radiol 2009; 69: 560-566.
21.
Baur A, Stäbler A, Brüning R, et al. Diffusion-weighted MR imaging of bone marrow: differentiation of benign versus pathologic compression fractures. Radiology 1998; 207: 349-356.
22.
Bhugaloo A, Abdullah B, Siow Y, et al. Diffusion weighted MR imaging in acute vertebral compression fractures: differentiation between malignant and benign causes. Biomed Imaging Interv J 2006; 2: e12.
23.
Pui MH, Mitha A, Rae WI, Corr P. Diffusion-weighted magnetic resonance imaging of spinal infection and malignancy. J Neuroimaging 2005; 15: 164-170.
24.
Palle L, Reddy MB, Reddy KJ. Role of magnetic resonance diffusion imaging and apparent diffusion coefficient values in the evaluation of spinal tuberculosis in Indian patients. Indian J Radiol Imaging 2010; 20: 279-283.
Share
RELATED ARTICLE
We process personal data collected when visiting the website. The function of obtaining information about users and their behavior is carried out by voluntarily entered information in forms and saving cookies in end devices. Data, including cookies, are used to provide services, improve the user experience and to analyze the traffic in accordance with the Privacy policy. Data are also collected and processed by Google Analytics tool (more).
You can change cookies settings in your browser. Restricted use of cookies in the browser configuration may affect some functionalities of the website.
You can change cookies settings in your browser. Restricted use of cookies in the browser configuration may affect some functionalities of the website.
