Application of monoexponential, biexponential, and stretched-exponential models of diffusion-weighted magnetic resonance imaging in the differential diagnosis of metastases and myeloma in the spine-Univariate and multivariate analysis of related parameters

Abstract

Objective: To explore the value of related parameters in monoexponential, biexponential, and stretched-exponential models of diffusion-weighted imaging (DWI) in differentiating metastases and myeloma in the spine. Methods: 53 metastases and 16 myeloma patients underwent MRI with 10 b-values (0–1500 s/mm2). Parameters of apparent diffusion coefficient (ADC), true diffusion coefficient (D), pseudo-diffusion coefficient (D*), perfusion fraction (f), the distribution diffusion coefficient (DDC), and intravoxel water diffusion heterogeneity (α) from DWI were calculated. The independent sample t test and the Mann–Whiney U test were used to compare the statistical difference of the parameter values between the two. Receiver operating characteristics (ROC) curve analysis was used to identify the diagnostic efficacy. Then substituted each parameter into the decision tree model and logistic regression model, identified meaningful parameters, and evaluated their joint diagnostic performance. Results: The ADC, D, and α values of metastases were higher than those of myeloma, whereas the D* value was lower than that of myeloma, and the difference was significant (p < 0.05); the area under the ROC curve for the above parameters was 0.661, 0.710, 0.781, and 0.743, respectively. There was no significant difference in the f and DDC values (p > 0.05). D and α were found to conform to the decision tree model, and the accuracy of model diagnosis was 84.1%. ADC and α were found to conform to the logistic regression model, and the accuracy was 87.0%. Conclusion: The 3 models of DWI have certain values indifferentiating metastases and myeloma in spine, and the diagnostic performance of ADC, D, α and D*was better. Combining ADC with α may markedly aid in the differential diagnosis of the two. Advances in knowledge: Monoexponential, biexponential, and stretched-exponential models can offer additional information in the differential diagnosis of metastases and myeloma in the spine. Decision tree model and logistic regression model are effective methods to help further distinguish the two.

T1-weighted Dynamic Contrast-enhanced MRI to Differentiate Nonneoplastic and Malignant Vertebral Body Lesions in the Spine

“…In our study, we observed that V p changes occurred in spinal metastases from a wide variety of primary cancers. The Diffusion-weighted imaging is another widely used MRI sequence that can help differentiate between nonneoplastic and malignant lesions (19,20). For example, Xing et al (19) used math models of DWI to differentiate metastases and myeloma with receiver operating characteristic curves in the range of 0.7.…”

“…The Diffusion-weighted imaging is another widely used MRI sequence that can help differentiate between nonneoplastic and malignant lesions (19,20). For example, Xing et al (19) used math models of DWI to differentiate metastases and myeloma with receiver operating characteristic curves in the range of 0.7. Lee et al (20) differentiated Schmorl nodes from metastases with a receiver operating characteristic of 0.94.…”

Intravoxel incoherent motion to differentiate spinal metastasis: A pilot study

“…The region of interest (ROI) was set in the lesion center where the cross-section showed the largest level of the tumor with an area of 30–100 mm 2 ( 11 , 19 ) and the solid components of the tumor were included avoiding the lesion edge, necrosis, bone cortex of vertebral bodies or attachments, and blood vessels. The analysis was performed independently by two radiologists (initials: ELZ, XYX) with more than 5 years of experience on the GE AW4.5 workstation, and the average of the ROI measurements for each parameter was taken as the final measurement result.…”

“…The results showed that the ADC slow and ADC fast values of malignant spinal tumors were significantly different from those of tuberculous spondylitis (all P < 0.05) ( 4 ). In addition, IVIM has certain clinical value in differentiating spinal metastasis from myeloma and atypical vertebral hemangiomas ( 11 , 12 ). IVIM-diffusion-weighted imaging (DWI) could allow the early diagnosis of ductal carcinoma in situ of the breast, and reduce the misdiagnosis and over-treatment of benign lesions ( 13 ).…”

Differentiation between spinal multiple myeloma and metastases originated from lung using multi-view attention-guided network

“…However, many studies have revealed that it is often difficult to distinguish spinal MM from metastases by standard MRI alone, especially for patients with multiple vertebral focal osteolytic lesions and other atypical manifestation ( 11 , 12 ). Many studies pointed out that advanced MRI including contrast-enhanced (DCE) MRI and diffusion-weighted imaging (DWI) MRI could help differential diagnosis in the two diseases ( 5 , 11 – 13 ). But relevant studies are still limited and their findings require further investigation.…”