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1
Cardiovascular Division/Cardiac MRI, Beth Israel Deaconess Medical Center, 330
Brookline Ave., Boston, MA 02215.
2
Present address: Department of Diagnostic Radiology, Technical University of
Aachen, Pauwelsstr. 30, 52057 Aachen, Germany.
3
Philips Medical Systems, P.O. 10000, 5680 Best, DA, The Netherlands.
OBJECTIVE. The aim of this study was to investigate diffusion-weighted MR imaging for differentiation of benign fracture edema and tumor infiltration with and without accompanying fracture.
SUBJECTS AND METHODS. In 10 volunteers, diffusion-weighted
spin-echo, fat-suppressed spin-echo, and stimulated-echo sequences were
optimized on a clinical 1.5-T scanner. In 34 patients, MR imaging with and
without diffusion-sensitizing gradients (b = 598 sec/mm2 in
spin-echo and fat-suppressed spin-echo, b = 360 sec/mm2 in
stimulated-echo) was performed. Thirty-five lesions were analyzed, with 18
caused by acute (
10 days old) osteoporotic or traumatic fractures and 17
caused by untreated malignant vertebral infiltration including nine fractures.
Signal attenuation in diffusion-weighted images and contrast-to-noise ratio
were calculated. The diffusion-weighted images were analyzed by two
radiologists.
RESULTS. Images from three of 34 patients were excluded because of motion artifact. In osteoporotic and traumatic fractures, a strong signal attenuation of bone marrow edema was seen. In contrast to this, malignant-tumor infiltration caused only minor signal attenuation (p < 0.05), independent of accompanying pathologic fracture. All sequences showed identical changes of signal intensities. In four patients, initial diagnosis was changed by the findings in the diffusion-weighted images.
CONCLUSION. Diffusion-weighted spin-echo, fat-suppressed spin-echo, and stimulated-echo sequences are equally suitable for imaging of the spine. Calculation of signal attenuation and observation of signal characteristics allowed differentiation of benign fracture edema and tumor infiltration and provided excellent distinction between benign and malignant vertebral fractures in our series.
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