Accuracy of diffusion-weighted imaging in discriminating atypical vertebral haemangiomas from malignant masses in patients with vertebral lesions: a cross-sectional study

Abstract

Purpose: Vertebral haemangiomas are incidental findings in imaging modalities. Atypical haemangiomas are haeman giomas rich in vascular tissue, and they are found to be hypointense in T1 sequences and hyperintense in T2 se quences, mimicking the findings of metastatic lesions. In the present study we aim to evaluate the ability of diffusion weighted imaging to differentiate these two groups of vertebral lesions. Material and methods: In the present crosssectional study, a total of 23 lesions were included, including 10 haeman giomas and 13 malignant lesions. Diffusionweighted imaging was used to compare atypical haemangiomas and metastatic lesions. The apparent diffusion coefficient was determined for each lesion, and then the mean of each group was calculated. The means were then compared. Receiver operating characteristic analysis was used to deter mine a cutoff ADC value to differentiate these lesions. Results: The difference between the mean age of the two groups was not significant. The mean ADC value for atypical haemangiomas was 1884 ± 74 × 10 6 mm 2 /s and 1008 ± 81 × 10 6 mm 2 /s for the malignant lesions. The difference between the two groups was statistically significant (p < 10 3). ROC curve analysis determined an ADC value of 958 × 10 6 mm 2 /s to be able to differentiate between atypical haemangiomas and malignant lesions. Conclusions: Diffusionweighted MRI could be used to differentiate between atypical haemangiomas and malignant metastatic lesions.

Management of Aggressive Vertebral Haemangioma and Assessment of Differentiating Pointers Between Aggressive Vertebral Haemangioma and Metastases – A Systematic Review

“… 13 The apparent diffusion co-efficient (ADC) determined in diffusion weighted imaging sequence differentiate between atypical haemangiomas and metastases. 14 The mean ADC value for atypical haemangiomas was 1884 + 74 × 10 -6 mm 2 /s and 1008 + 81 × 10 -6 mm 2 /s for the malignant lesions. An ADC value of 958 × 10 -6 mm 2 /s reliably differentiate between atypical haemangiomas and metastases (p < .01).…”

“…A sum of 79 AVH and 126 metastatic vertebral lesions had been studied in the included study cohort. These studies highlight the benefits of adding dynamic contrast imaging, 12 ratio of signal intensity in T1weighted imaging (T1w) with and without fat suppression (FS), 13 and diffusion weighted imaging 14 to conventional MRI sequences in differentiating AVH from metastases.…”

“…An ADC value of 958 × 10 -6 mm 2 /s reliably differentiate between atypical haemangiomas and metastases (p < .01). 14 …”

“…Yan-jie shi et al 13 suggests the ratio of signal intensity between T1w and fat suppressed T1w is more with AVH when compared to metastases and he proposes it as the highest accuracy in differentiating between AVH and metastases. Diffusion weighted MRI 14 can also be used to differentiate AVH and metastases with cut-off for an ADC value above 958 × 10-6 mm2/s for AVH and below the cut-off value as metastases.…”

The Role of DWI in Differentiating Metastatic from Non-Metastatic Bone Lesions

“…Hajalioghli et al [11] used the mean ADC value of 10 atypical vertebral hemangiomas and 13 vertebral metastatic lesions to reach a cut-off ADC value of 0.95 x 10 -3 mm 2 /s (p-value 0.01) between the two study groups with mean ADC of (1.8 x 10 -3 mm 2 /s) for benign lesions and mean ADC (1 x 10 -3 mm 2 /s) for metastatic lesions.…”