Diffusion-Weighted MR Imaging for Differentiation of Benign Fracture Edema and Tumor Infiltration of the Vertebral Body
Elmar Spuentrup1,2,
Arno Buecker1,
Gerhard Adam1,
Joop J. van Vaals3 and
Rolf W. Guenther1
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.
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Fig. 1. —Bar chart shows normalized signal attenuation in
benign-fracture edema, tumor lesion with and without accompanying fracture,
and normal bone marrow for three investigated sequences. Signal attenuation of
benign fracture edema was statistically significant (p < 0.05),
whereas tumor lesions independent of accompanying fracture lacked statistical
significance. Normal fatty bone marrow showed no signal attenuation. White
bars = benign fracture, striped bars = tumor with fracture, black bars =
tumor, Ibars with dots = fatty bone marrow.
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Fig. 2. —Bar chart shows contrast-to-noise ratio (CNR) with (b = i)
without (b = 0) and diffusion-sensitizing gradients in benign fracture edema
and malignant lesions with and without accompanying fracture. In benign
fracture edema, statistically significant difference between sequences without
(b = 0) and with (b = i) diffusion-sensitizing gradients was found (p
< 0.05), whereas malignant lesions independent of accompanying fractures
lacked statistical significance. Only in diffusion-weighted images was CNR
between two entities of vertebral fracture (benign and malignant)
significantly different (p < 0.05). (b(i) = 598 sec/mm2
in spin-echo sequences (white bars) and fat-suppressed spin-echo
sequences (black bars) and 360 sec/mm2 in stimulated-echo
(gray bars) sequences.
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Fig. 3A. —78-year-old woman with osteoporotic fracture (T12). Sagittal
spin-echo MR image without diffusion-sensitizing gradients shows moderate
hyperintense signal intensity of fractured vertebral body.
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Fig. 3B. —78-year-old woman with osteoporotic fracture (T12).
Diffusion-weighted spin-echo MR image (b = 598 sec/mm2)
corresponding to (A) reveals strong signal attenuation with hypointense
signal of fractured area.
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Fig. 3C. —78-year-old woman with osteoporotic fracture (T12). Sagittal
stimulated-echo MR image without diffusion-sensitizing gradients shows
minimally hypointense signal intensity of fractured vertebral body.
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Fig. 3D. —78-year-old woman with osteoporotic fracture (T12).
Diffusion-weighted stimulated-echo MR image (b = 360 sec/mm2)
corresponding to (C) reveals markedly hypointense signal intensity.
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Fig. 3E. —78-year-old woman with osteoporotic fracture (T12). Sagittal
fat-suppressed spin-echo MR image without diffusion-sensitizing gradients
shows hyperintense signal intensity of fractured vertebral body.
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Fig. 3F. —78-year-old woman with osteoporotic fracture (T12).
Diffusion-weighted fat-suppressed spin-echo MR image (b = 598
sec/mm2) corresponding to (E) shows marked signal
attenuation. Only minimally increased signal in fractured vertebral body
remains.
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Fig. 4A. —49-year-old woman with tumor mass and pathologic fracture of
first lumbar vertebral body after minor trauma. Biopsy during surgery revealed
diagnosis of metastasis of formerly occult breast carcinoma. Sagittal
spin-echo MR image without diffusion-sensitizing gradients shows moderate
hyperintense signal of tumor mass.
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Fig. 4B. —49-year-old woman with tumor mass and pathologic fracture of
first lumbar vertebral body after minor trauma. Biopsy during surgery revealed
diagnosis of metastasis of formerly occult breast carcinoma.
Diffusion-weighted spin-echo MR image (b = 598 sec/mm2)
corresponding to (A) reveals no signal attenuation with remaining
hyperintense signal intensity in tumor mass.
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Fig. 4C. —49-year-old woman with tumor mass and pathologic fracture of
first lumbar vertebral body after minor trauma. Biopsy during surgery revealed
diagnosis of metastasis of formerly occult breast carcinoma. Sagittal
stimulated-echo MR image without diffusion-sensitizing gradients shows
isointense signal intensity of tumor mass.
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Fig. 4D. —49-year-old woman with tumor mass and pathologic fracture of
first lumbar vertebral body after minor trauma. Biopsy during surgery revealed
diagnosis of metastasis of formerly occult breast carcinoma.
Diffusion-weighted stimulated-echo MR image (b = 360 sec/mm2)
corresponding to (C) shows no signal attenuation.
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Fig. 4E. —49-year-old woman with tumor mass and pathologic fracture of
first lumbar vertebral body after minor trauma. Biopsy during surgery revealed
diagnosis of metastasis of formerly occult breast carcinoma. Sagittal
fat-suppressed spin-echo MR image without diffusion-sensitizing gradients
shows hyperintense signal intensity of tumor mass in fractured vertebral
body.
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Fig. 4F. —49-year-old woman with tumor mass and pathologic fracture of
first lumbar vertebral body after minor trauma. Biopsy during surgery revealed
diagnosis of metastasis of formerly occult breast carcinoma.
Diffusion-weighted fat-suppressed spin-echo MR image (b = 598
sec/mm2) corresponding to (E) reveals no signal attenuation
with remaining markedly hyperintense signal intensity.
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Fig. 5A. —75-year-old man with known osteporosis due to long-term
steroid medication with pathologic fracture of T12. Additional examination
revealed further osseous metastases of formerly occult lung cancer. Sagittal
spin-echo MR image without diffusion-sensitizing gradients shows fractured
vertebral body with mixed hyper- and hypointense signal intensities.
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Fig. 5B. —75-year-old man with known osteoporosis due to long-term
steroid medication with pathologic fracture of T12. Additional examination
revealed further osseous metastases of formerly occult lung cancer.
Diffusion-weighted spin-echo MR image (b = 598 sec/mm2) shows
clearly hyperintense lesion in dorsal aspect of vertebral body. Ventral part
shows marked signal attenuation compared with non-diffusion-weighted image
(A).
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Fig. 6A. —62-year-old woman with three fractured vertebral bodies
(T10-T12). She reported history of lung cancer and cerebral metastasis. In
routine MR imaging, osseous metastases had been suspected. Sagittal
fat-suppressed spin-echo MR image without diffusion-sensitizing gradients
shows hyperintense signal intensity of all fractured vertebral bodies.
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Fig. 6B. —62-year-old woman with three fractured vertebral bodies
(T10-T12). She reported history of lung cancer and cerebral metastasis. In
routine MR imaging, osseous metastases had been suspected. Diffusion-weighted
fat-suppressed spin-echo MR image (b = 598 sec/mm2) corresponding
to (A) reveals marked signal attenuation of all lesions, and diagnosis
was changed to osteoporotic fracture.
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Copyright © 2001 by the American Roentgen Ray Society.
