Methods and applications of diffusion imaging of vertebral bone marrow

Abstract

Diffusion-weighted imaging (DWI) is an MRI technique that is sensitive to random water movements at spatial scales far below typical MRI voxel dimensions. DWI is a valuable tool for the diagnoses of diseases that involve alterations in water mobility. In the spine, DWI has proven to be a highly useful method for the differential diagnosis of benign and malignant compression fractures. In these pathologies, the microscopic structure of bone marrow is altered in a very different ways, leading to different water mobility, which can be depicted by DWI. Most of the pulse sequences developed for MRI can be adapted for DWI. However, these DWI-adapted sequences are frequently affected by artifacts, mostly caused by physiological motion. Therefore, the introduction of additional correction techniques, or even the development of new sequences is necessary. The first part of this article describes the principles of DWI and the sequences used for DWI of the spine: spin echo (SE), turbo spin echo (TSE), single-shot echo planar imaging (EPI), and steady-state free precession (SSFP) sequences. In the second part, clinical applications of DWI of the spinal bone marrow are extensively discussed.

The value of apparent diffusion coefficient measurements in the differential diagnosis of vertebral bone marrow lesions

“…Therefore, their ADC values are high. Our results support studies made by using quantitative ADC values in the literature (3,4,(14)(15)(16)18,25). Furthermore, we found the mean ADC values of acute benign compression fractures to be statistically higher than those of malign compression fractures (P < 0.0001).…”

“…In a comparatively small number of surveys, ADC values have been studied in discriminating the infectious lesions from the malign lesions (4,5,17). Atypical hemangioma may have different appearances; it has a striated pattern in most cases and contains prominent vascular channels and an enlarged, prominent basivertebral venous plexus (18). However, it is important to differentiate atypical hemangiomas, which appear as hypointensity in T1A sequences and hyperintensity in T2A sequences, and which do not possess a striated pattern, from malign lesions with conventional MR sequences, especially in those with a primary malignancy from metastasis.…”

MRI in acute and subacute post-traumatic spinal cord injury: pictorial review

“…7 It may be particularly useful in the clinical context of abnormal neurology and normal standard MR sequences when it may demonstrate diffusion restriction as a marker of previously occult cord injury. [8][9][10] In the subacute period, many patients will have spinal fixation and the clinical question is more commonly related to post-operative infection, post-operative bleeding and cause for ascending neurology or pain. Artefact from spinal fixation constructs has traditionally limited the information available from MRI in this situation.…”

Application of Diffusion-Weighted Imaging in the Detection of Active Sacroiliitis and the Comparison of Apparent Diffusion Coefficient and Relative Apparent Diffusion Coefficient Values

“…2 Various pathological conditions cause alteration of the mobility of water molecules in biological Diffusion Weighted Imaging in Sacroiliitis tissues and can be detectable with DWI. 3 DWI is most commonly used in the assessment of acute stroke. 3 Other clinical applications include demyelinating diseases (e.g.…”

“…3 DWI is most commonly used in the assessment of acute stroke. 3 Other clinical applications include demyelinating diseases (e.g. multiple sclerosis), brain tumors and abscess, and musculoskeletal abnormalities.…”