Differentiation of acute osteoporotic from malignant vertebral compression fractures with conventional MRI and diffusion MR imaging

Abowarda, Mohamad H.; Abdel-Rahman, Hossam M.; Taha, Mahmoud M.

doi:10.1016/j.ejrnm.2016.11.001

“…CE imaging has become a key component of conventional MRI to discriminate underlying normal bone marrow from tumor involvement for assessing malignant pathologic fracture. However, moderate specificity of the CE set was observed in our study, and this was consistent with results of the previous studies, which reported limited specificity (71% and 70%) of CE images in diagnosing vertebral compression fractures (1213). In our study, when comparisons were made between the CE and DW sets and between the DW and combined sets, the diagnostic performance did not differ significantly.…”

Section: Discussionsupporting

confidence: 93%

“…Various studies have been published on the utility of DWI in the detection, characterization, and longitudinal evaluation of bone and soft tissue tumors (567). In previous studies, although fractures have been evaluated with DWI, the focus has mostly been on differentiating malignant from osteoporotic vertebral compression fractures through measurement of apparent diffusion coefficient (ADC) values (8910111213). The usefulness of DWI in evaluating suspected pathologic fractures at extremities has not yet been elucidated.…”

Section: Introductionmentioning

confidence: 99%

MRI Evaluation of Suspected Pathologic Fracture at the Extremities from Metastasis: Diagnostic Value of Added Diffusion-Weighted Imaging

Park

¹

,

Lee

²

,

Jeon

³

et al. 2019

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Objective To assess the diagnostic value of combining diffusion-weighted imaging (DWI) with conventional magnetic resonance imaging (MRI) for differentiating between pathologic and traumatic fractures at extremities from metastasis. Materials and Methods Institutional Review Board approved this retrospective study and informed consent was waived. This study included 49 patients each with pathologic and traumatic fractures at extremities. The patients underwent conventional MRI combined with DWI. For qualitative analysis, two radiologists (R1 and R2) independently reviewed three imaging sets with a crossover design using a 5-point scale and a 3-scale confidence level: DWI plus non-enhanced MRI (NEMR; DW set), NEMR plus contrast-enhanced fat-saturated T1-weighted imaging (CEFST1; CE set), and DWI plus NEMR plus CEFST1 (combined set). McNemar's test was used to compare the diagnostic performances among three sets and perform subgroup analyses (single vs. multiple bone abnormality, absence/presence of extra-osseous mass, and bone enhancement at fracture margin). Results Compared to the CE set, the combined set showed improved diagnostic accuracy (R1, 84.7 vs. 95.9%; R2, 91.8 vs. 95.9%, p < 0.05) and specificity (R1, 71.4% vs. 93.9%, p < 0.005; R2, 85.7% vs. 98%, p = 0.07), with no difference in sensitivities ( p > 0.05). In cases of absent extra-osseous soft tissue mass and present fracture site enhancement, the combined set showed improved accuracy (R1, 82.9–84.4% vs. 95.6–96.3%, p < 0.05; R2, 90.2–91.1% vs. 95.1–95.6%, p < 0.05) and specificity (R1, 68.3–72.9% vs. 92.7–95.8%, p < 0.005; R2, 83.0–85.4% vs. 97.6–98.0%, p = 0.07). Conclusion Combining DWI with conventional MRI improved the diagnostic accuracy and specificity while retaining sensitivity for differentiating between pathologic and traumatic fractures from metastasis at extremities.

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“…Castillo et al [14] indicated that qualitative findings of DWI at b= 165 s/mm2 had no advantage in the detection of vertebral metastases compared to T1-weighted sequences in 15 patients. In contrast, qualitative findings of DWI were found valuable in some previous studies [15][16][17]. The results of these previous studies and ours were summarized in Table 3.…”

Section: Discussionmentioning

confidence: 51%

“…Wonglaksanapimon et al [23] found the accuracy of 89.7%, sensitivity of 85.7% and specificity of 90.6% with a cut off ADC value of 0.89 for differentiation malignant (n=7) from benign (n=32) fractures (p< 0.05) [23]. Geith et al [24] found that the best diagnostic performance of DWI and ADC measurements is achieved by a combination of b-values of 100, 250, and 400 s/mm2 with a cut off ADC value of < 1.7x10-3 mm2/s for differential diagnosis of acute benign (n=26) and malignant vertebral fractures (n=20) (sensitivity, 85%; specificity, 84.6%; PPV, 81.0%; NPV, 88.0%) [17]. In our study, a cut off value couldn't be estimated because there was a gap between maximum mean ADC value of malignant fractures and minimum mean ADC value of benign fractures.…”

Section: Mean Adc and Normalized Adc Values Of Benign And Malignant Thoracolumbar Vertebral Fractures According To Different B-valuesmentioning

confidence: 99%

Quantitative evaluation of diffusion-weighted imaging with multiple b-values in vertebral fractures

Kulalı

¹

2018

J Clin Med Kaz

0

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Differentiating benign from malignant vertebral fracture is sometimes difficult in geriatric oncology patients. Accurate diagnosis is necessary for treatment planning. Therefore, we aimed to investigate the role of quantitative evaluation of diffusion-weighted imaging (DWI) at multiple b-values of 200, 400 and 600 s/mm2 in differentiating benign from malignant thoracolumbar vertebral fractures and to determine an optimal b-value. Methods: Forty-four patients with 72 vertebral fractures were enrolled. Magnetic resonance imaging (MRI) findings combined with DWI at b-values of 200, 400 and 600 s/mm2 were evaluated. Apparent diffusion coefficient (ADC) and normalized ADC values were obtained. Radiological and histopathological/ follow-up results were compared. Results: Of 72 vertebral fractures, 22 were benign and 50 were malignant. Mean ADC and normalized ADC values of malignant group were lower than benign group's in all b-values (p<0.05). Despite of no significant difference between ADC values at b-values of 200, 400 and 600 s/mm2 within each group, normalized ADC values were lower at b-value of 200 s/mm2 than those of at 600 s/mm2 in malignant group (p<0.05). Conclusion: MRI combined with DWI is a problem solving modality especially in geriatric oncology patients. Performing DWI at b-value of 200 s/mm2 and estimation of normalized ADC value for optimization of data are recommended.

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“…Castillo et al [14] indicated that qualitative findings of DWI at b= 165 s/mm2 had no advantage in the detection of vertebral metastases compared to T1-weighted sequences in 15 patients. In contrast, qualitative findings of DWI were found valuable in some previous studies [15][16][17]. The results of these previous studies and ours were summarized in Table 3.…”

Section: Discussionmentioning

confidence: 51%

Quantitative evaluation of diffusion-weighted imaging with multiple b-values in vertebral fractures

Kulalı¹

2018

J Clin Med Kaz

0

View full text Add to dashboard Cite

Differentiating benign from malignant vertebral fracture is sometimes difficult in geriatric oncology patients. Accurate diagnosis is necessary for treatment planning. Therefore, we aimed to investigate the role of quantitative evaluation of diffusion-weighted imaging (DWI) at multiple b-values of 200, 400 and 600 s/mm2 in differentiating benign from malignant thoracolumbar vertebral fractures and to determine an optimal b-value. Methods: Forty-four patients with 72 vertebral fractures were enrolled. Magnetic resonance imaging (MRI) findings combined with DWI at b-values of 200, 400 and 600 s/mm2 were evaluated. Apparent diffusion coefficient (ADC) and normalized ADC values were obtained. Radiological and histopathological/ follow-up results were compared. Results: Of 72 vertebral fractures, 22 were benign and 50 were malignant. Mean ADC and normalized ADC values of malignant group were lower than benign group's in all b-values (p<0.05). Despite of no significant difference between ADC values at b-values of 200, 400 and 600 s/mm2 within each group, normalized ADC values were lower at b-value of 200 s/mm2 than those of at 600 s/mm2 in malignant group (p<0.05). Conclusion: MRI combined with DWI is a problem solving modality especially in geriatric oncology patients. Performing DWI at b-value of 200 s/mm2 and estimation of normalized ADC value for optimization of data are recommended.

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Differentiation of acute osteoporotic from malignant vertebral compression fractures with conventional MRI and diffusion MR imaging

Cited by 6 publications

References 27 publications

MRI Evaluation of Suspected Pathologic Fracture at the Extremities from Metastasis: Diagnostic Value of Added Diffusion-Weighted Imaging

MRI Evaluation of Suspected Pathologic Fracture at the Extremities from Metastasis: Diagnostic Value of Added Diffusion-Weighted Imaging

Quantitative evaluation of diffusion-weighted imaging with multiple b-values in vertebral fractures

Quantitative evaluation of diffusion-weighted imaging with multiple b-values in vertebral fractures

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